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PubMed2000

Seasonal variation in mortality in Scotland.

BACKGROUND: Seasonal patterns in mortality have been recognized for many years. This study assesses seasonal variation in mortality in Scotland between 1981 and 1993 and considers its association with socioeconomic status and outdoor temperature. METHODS: Lagged Poisson regression analysis of numbers of deaths and average weekly temperature with adjustment for serial autocorrelation and influenza epidemics. RESULTS: There was significant seasonal variation in weekly death rates with a difference of about 30% between a summer trough and a winter peak. This variation was principally attributable to respiratory disease, cerebrovascular disease and coronary artery disease. Seasonal variation in mortality fell from around 38% in 1981-1983 to around 26% in 1991-1993. There was no clear evidence of a relationship between socioeconomic status and seasonal mortality, however the extent of the fall in seasonal variation was greater in deprived areas than in affluent areas. Overall, a 1 degree C decrease in mean temperature was associated with a 1% increase in deaths one week later. The lag in this relationship varied by cause of death and underlying temperature. CONCLUSIONS: Seasonal variations in mortality and the relationship between temperature and mortality are a significant public health problem in Scotland. It is likely that the strength of this relationship is a result of the population being unable to protect themselves adequately from the effects of temperature rather than the effects of temperature itself.

Adolescent↗
PubMed2005

The involvement of occupational health services prior to ill-health retirement in NHS staff in Scotland and predictors of re-employment.

OBJECTIVE: To assess the process, causes and outcomes of retirement because of ill-health in NHS staff in Scotland. Particular areas to be investigated include the involvement of occupational health services, access to rehabilitation and redeployment, current health, whether working again and to identify predictors of re-employment. METHOD: An ill-health retirement (IHR) questionnaire was mailed to 863 NHS staff awarded IHR benefits by the Scottish Public Pensions Agency between April 1998 and March 2000. RESULTS: In all, 49% of the 863 postal questionnaires were returned. The most common reasons for retiring were diseases of the musculoskeletal system (38%) and mental disorders (21%). Seventy-one percent of the participants reported their ill-health was partly or completely work related and 29% not work related. Ninety-two percent of NHS staff had attended an occupational health department prior to IHR. Twenty-three percent of participants had no contact with their line manager during their illness prior to retiral. Eighteen percent of individuals were offered the opportunity of working part-time and 15% offered alternative work. Seventeen percent of participants have obtained other work. Predictors of re-employment after IHR were: medical condition, managerial responsibility, improvement of health, wanting to work again, occupation and age at retirement. CONCLUSION: This is the first comprehensive study investigating NHS staff experiences of IHR in Scotland. This study illustrates the need for improved support and rehabilitation for ill-health care workers and that there is the potential to reduce levels of ill-health retirement.

Adult↗
PubMed2000

Sex, birth weight, and the risk of stillbirth in Scotland, 1980-1996.

The aim of this study was to determine whether the risk of stillbirth associated with male fetal sex was modified by fetal growth. The study group consisted of all singleton first births weighing greater than 500 g delivered between 28 and 43 weeks gestation in Scotland in 1980-1996 (n = 469,152). Overall, male fetuses were at an increased risk of stillbirth (relative risk = 1.19, 95 percent confidence interval: 1.10, 1.29). There was a significant negative interaction between male sex and increasing birth weight quintile in term, but not preterm, births. The interaction was virtually identical when calculated independently for births in the periods 1980-1987 and 1988-1996. There were linear decreases in the proportion of stillbirths and the proportion of birth weights in the lowest quintile over the period 1980-1996. Adjustment for year of birth did not affect the relation between male sex and stillbirth. However, adjustment for birth weight resulted in a loss of the association between year of birth and risk of stillbirth. The authors concluded that 1) the association between male sex and stillbirth diminishes with increasing birth weight quintile, and 2) there was a fall in the proportion of stillbirths in Scotland between 1980 and 1996, which may have been due to a fall in the proportion of small babies over the same period.

Birth Weight↗
PubMed1987

Statistical modelling of lung cancer and laryngeal cancer incidence in Scotland, 1960-1979.

The ratio of cancer occurrence among smokers compared to nonsmokers has been generally reported to be greatest for carcinomas arising in the lung and larynx. This report presents the results of an investigation into mechanisms underlying the temporal trends in the incidence of these two forms of cancer in Scotland over the 20-year period, 1960-1979. The purpose of the study was to establish the independent effects of age, calendar time, and birth cohort on the observed pattern of incidence by adopting an alternative approach to this classical problem which can be employed when data are available as individual records. The most economic model found to explain the data involved the independent effects of site, sex, and age and different cohort effects in each sex. The cohort effect was more pronounced in men than women in older cohorts but, conversely, stronger in women than in men in younger cohorts, i.e., among those born most recently. This observation accords with the observed increase in the use of cigarettes in young women relative to young men. There appeared to be a small effect of calendar time which was the same in both sexes and both sites, although this main effect, it must be emphasized, could be eliminated from the model on statistical grounds. The effect can be interpreted to indicate the increase in the coverage of cancer registration in Scotland which has taken place since 1960. These results indicate that lung cancer risk in Scottish males will continue to fall, with the risk in women lagging 20 years behind, although the levels in women will probably not reach those attained by men.

Adult↗
PubMed1996

Promoting breastfeeding: a view of the current position and a proposed agenda for action in Scotland.

The prevalence of breastfeeding in Scotland is the second lowest in Europe. There is good evidence that breastfeeding results in decreased gastrointestinal, and to a lesser extent respiratory infections, in the first year of life, and reduced serious infections in low-birthweight babies. Published evidence for the effectiveness of interventions which seek to promote successful breastfeeding within populations is scanty and of poor quality, although numerous studies have highlighted hospital practices which discourage and undermine breastfeeding. Changing these poor practices has been shown to be achievable and can lead to improved breastfeeding rates. Experience in other industrialized countries such as Canada, Australia and Norway has shown that substantial increases in breastfeeding are achievable through combined government and health service action over a period of one or two decades. We recommend a combination of government and health service action to promote breastfeeding in Scotland including: implementation of the International Code on Marketing of Breastmilk Substitutes; reviews of health professional basic and in-service training in breastfeeding management, maternity leave and allowances, and workplace facilities for breastfeeding mothers; promotion of the Baby Friendly Initiative; development of community support for breastfeeding mothers; routine collection of breastfeeding data to support annual monitoring of breastfeeding rates; and support for research on the effectiveness of strategies which seek to promote breastfeeding.

Adult↗
PubMed2003

Urban-rural differences in self-reported limiting long-term illness in Scotland.

BACKGROUND: Previous research suggests that there are significant differences in health between urban and rural areas. The aim of this study is to describe the pattern and magnitude of urban-rural variation in health in Scotland and to examine the factors associated with health inequalities in urban and rural areas. METHODS: The data used in this study were limiting long-term illness (LLTI) and socio-economic data collected by the 1991 Census. A rurality indicator was created using Scottish Household Survey rurality classifications. Multilevel Poisson regression modelling was carried out with LLTI as a health indicator for each type of rurality within Scotland. A variety of socio-economic factors were investigated for each rurality. RESULTS: Areas with the highest Standardized Illness Ratios (SIRs) (>125) are predominantly urban whereas the lowest SIRs (<75) are found in both urban and rural areas. Rural communities are more heterogeneous than urban areas in terms of their social make-up with relation to health; however, when these areas are split according to minor road length and different socio-economic factors are added, the model fit for each new model is improved and the reduction in total variation is comparable with that of the urban models. CONCLUSION: These findings suggest that rural areas should not be treated as a homogeneous group but should be subdivided into rural types.

Chronic Disease↗
PubMed2006

Homicides involving knives and other sharp objects in Scotland, 1981-2003.

BACKGROUND: Homicide rates have been increasing in Scotland, and homicides involving knives are of particular concern. METHODS: and results We use mortality and population data from 1981 to 2003 to calculate smoothed, standardized mortality rates for all homicides and homicides involving knives and other sharp objects, for all of Scotland and separately for Glasgow. Over half of homicides where the victim was male involved the use of a knife. Over 20 years, the homicide rate rose 83%, whilst that involving knives increased by 164%. CONCLUSION: The rapid increase in homicide involving knives is becoming a public health problem. Proposed changes to legislation are unlikely to halt this rise.

Adolescent↗
PubMed1995

Anonymous HIV surveillance with risk factor elicitation at Scotland's largest prison, Barlinnie.

OBJECTIVE: To determine prevalence of HIV infection and risk behaviours among male inmates of Her Majesty's Prison (HMP) Barlinnie, Glasgow, Scotland on 8-9 September 1994. DESIGN: Cross-sectional study: voluntary, anonymous HIV surveillance (using saliva samples) of all inmates and linked self-completion risk-factor questionnaire. SUBJECTS: Of 1073 prisoners available to participate, 985 (92%) completed a risk-factor questionnaire and 982 salivettes were received for testing, of which 978 were tested for HIV antibodies (four were dry samples); 928 questionnaires passed logical checks for consistency. MAIN OUTCOME MEASURES: HIV prevalence on saliva testing, related risk behaviours and ratio of overall-to-disclosed HIV prevalence. Proportion of all inmates who have ever injected drugs, ever injected inside prison, started injecting inside, ever had acute hepatitis, had a recent personal HIV test (since January 1993). RESULTS: Nine saliva samples [eight injecting drug users (IDU), one recognized other risk] out of 978 were HIV-antibody-positive (three presumptively from known HIV-infected inmates). Overall HIV prevalence was estimated at 1% compared with a known prevalence of 0.4%, giving an overall-to-disclosed HIV prevalence ratio of 2.6 in HMP Barlinnie in September 1994. A higher proportion of prisoners from Glasgow (48%) than elsewhere (19%) were IDU. Year of first injection was also different by residence with 23% of Glasgow IDU having first injected after 1988 compared with 45% of IDU from elsewhere, mainly West and South Scotland. Half the IDU inmates reported having injected while incarcerated and 6% had started to inject while incarcerated. Ten per cent of all prisoners and 20% of IDU inmates had had a personal HIV test since January 1993. Logistic regression showed that there was a significant deficit of recent HIV test uptake by Glasgow residents (odds ratio, 0.5; 95% confidence interval, 0.27-0.89), that IDU were more likely to have had treatment for a sexually transmitted disease, and that IDU who had injected inside and those whose injecting career began prior to 1989 were more likely to have had acute hepatitis. CONCLUSION: A consistent harm-reduction policy is needed across prisons in the United Kingdom to avoid transmission of blood-borne viral infections. Drug injecting inside prison is common, a proportion of IDU inmates having first injected drugs while in prison, and much higher rates of hepatitis have been reported in association with injecting while incarcerated compared with that for IDU who only injected outside prison.

Adult↗
PubMed2005

Non-paracetamol drug-induced fulminant hepatic failure among adults in Scotland.

BACKGROUND AND METHODS: This study details 30 cases of non-paracetamol drug-induced fulminant hepatic failure (NPDI-FHF) that have presented to the Scottish Liver Transplant Unit since 1992. Using the patients' case notes and a previously constructed database, the demographics of NPDI-FHF in Scotland were studied. The clinical and biochemical features, and the outcome of each individual case were also investigated. RESULTS: Of the 30 patients, 10 died. Our study revealed that antibiotics are the most commonly associated drugs with NPDI-FHF while ecstasy and anti-tuberculous drugs are also commonly implicated. The geographical distribution of referrals mirrors that of the population distribution and NPDI-FHF is not confined to any particular social class. It is, more than twice as common among females than males, however. The incidence is evenly spread across the different age categories, but NPDI-FHF as a consequence of ecstasy ingestion is confined to younger age groups. Ecstasy associated NPDI-FHF was also associated with short latency periods. CONCLUSION: NPDI-FHF is not a common problem in Scotland, but it is a serious problem for those affected and consumes considerable health care resources. Doctors need to be made aware that commonly prescribed drugs may cause fulminant hepatic failure. When a young adult presents with fulminant hepatic failure of sudden onset, ecstasy consumption must be considered.

Adolescent↗
PubMed2004

Lipid levels and the use of lipid-lowering agents in England and Scotland.

OBJECTIVE: Preventing cardiovascular events with lipid-lowering drugs has been established in several trials reported since 1994. Consequently national guidelines recommend statins for those with established cardiovascular disease (CVD) and those at high risk of developing CVD. We evaluated blood lipid levels, and compare treatment and control of dyslipidaemia in English and Scottish adults with national recommendations for lipid lowering. DESIGN AND METHODS: In 1998 the nationally-representative Health Survey for England and the Scottish Health Survey included valid cholesterol results for 9631 (England) and 6065 (Scotland) adults aged 16-74. Mean blood levels of total, high-density lipoproteins (HDL-), and total:HDL-cholesterol ratio; prevalence of elevated total cholesterol levels, and total:HDL-cholesterol ratios; prevalence of use of lipid-lowering agents in high risk subgroups; and lipid levels of those on treatment were calculated. RESULTS: Levels of dyslipidaemia, treatment and control were not significantly different between Scotland and England. Combining these data, mean total cholesterol levels were 5.43 and 5.48 mmol/l in men and women respectively; and mean HDL-cholesterol levels were 1.29 and 1.56 mmol/l. Overall 64.6% of adults had a total cholesterol > or =5 mmol/l, 24.6% had a total:HDL ratio > or =5 and 2.3% reported taking lipid-lowering drugs. Treatment rates among those with a total cholesterol >5 mmol/l and a history of coronary heart disease or stroke, hypertension, or diabetes, were 27.3%, 15.4% and 17.8% respectively, and control rates (total cholesterol <5 mmol/l) among those treated were 45.3%, 38.5% and 32.7%. CONCLUSIONS: Low treatment rates with lipid-lowering drugs existed overall, among high-risk patients suitable for primary prevention, and among those with established cardiovascular disease.

Adolescent↗
PubMed2007

Long-term outcomes of major trauma without head injury in the West of Scotland: pilot case-control study.

The aim of this study was to identify the outcomes of survivors of blunt major trauma (without head injury) 2 years or more following injury. The study uses a case-control design, is set in the West of Scotland and includes trauma patients treated in Greater Glasgow NHS Board hospitals. Participants consisted of patients who had sustained major trauma (injury severity score >15) with little or no head injury at least 2 years before assessment, identified from the Scottish Trauma Audit Group database, and age and sex-matched controls nominated by the index case's general practitioner. Nineteen cases and seven controls completed the study from 223 potential cases and 39 potential controls. Participants and non-participants had comparable injury severity score, probability of survival (Ps) and length of stay. American Medical Association impairment scores show survivors were more impaired than controls (25.9 vs 7.4%, P=0.043). No differences were observed in Functional Independence Measure (FIM) or Community Integration Questionnaire (CIQ) scores, although a type II error is possible. Short-form 36 (SF36) Physical Component Summary (PCS) scores of survivors showed no difference compared with controls although survivors' PCS scores were below UK and US means (P=0.008). SF36 Mental Component Summary (MCS) scores of survivors were below those of controls (45.07 vs 56.65, P=0.004) and normal values of the UK population (P=0.036). No differences in work status were noted, but small sample sizes were used. Non-head-injured survivors of major trauma in the West of Scotland have poorer health status (SF36), physically and mentally, than the UK population. They have greater impairment, but have an employment status comparable to that of the controls. The lack of differences in FIM and CIQ scores between survivors and controls may be due to small sample sizes.

Adolescent↗
PubMed1979

Biotyping and colicine typing of Salmonella typhimurium strains of phage type 141 isolated in Scotland.

Cultures of Salmonella typhimurium (551 strains) of phage type 141 isolated in Scotland from 1965 to 1977 were examined for biotype and colicine type. Three main biotype clones were recognised: If (30 strains), 9f (507 strains) and 31bd (11 strains) with subtype variants 9bf (1 strain), 9cf (1 strain) and 31b (1 strain). The contribution made by each biotype clone to outbreaks in Scotland was analysed. The findings confirmed the distinctness of the three biotype clones within the single phage type and indicated possible origins of strains of biotypes of 9f and 31bd.

Animals↗
PubMed2005

Serotype incidence and antibiotic susceptibility of Streptococcus pneumoniae causing invasive disease in Scotland, 1999-2002.

Pneumococcal disease remains an important cause of invasive and non-invasive disease in Scotland and elsewhere. The Scottish Meningococcus and Pneumococcus Reference Laboratory receives isolates of Streptococcus pneumoniae from diagnostic laboratories around Scotland. Here, the serogroups/types and antibiotic-susceptibility patterns of invasive isolates received between 1999 and 2002 are described. There were a total of 1741 invasive isolates received, the most common serogroups/types being 14 (19.8 %), 9 (10.2 %), 6 (8.3 %), 19 (7.9 %), 23 (7.9 %), 4 (6.5 %), 8 (6.4 %), 3 (5.7 %), 1 (3.8 %), 7 (3.8 %) and 18 (3.4 %). Importantly, serotypes 7 and 8 are not represented in the 7-, 9- and 11-valent pneumococcal conjugate polysaccharide vaccines. There were 67 (3.8 %) isolates considered penicillin non-susceptible, although no penicillin resistance (MIC > or = 0.002 mg ml(-1)) was recorded. One hundred and ninety-four (11.1 %) isolates, predominantly of serotype 14, were resistant to erythromycin, and 12 (0.7 %) were resistant to ciprofloxacin. This information provides an important dataset that will prove essential prior to and during the implementation of pneumococcal conjugate vaccines in the UK.

Anti-Bacterial Agents↗
PubMed2005

Audit of the laboratory diagnosis of Lyme disease in Scotland.

An audit was performed on the laboratory diagnosis of lyme disease in Scotland. The problem of a significant number of patients with clinical symptoms of lyme disease being reported as seronegative or equivocal by the confirmatory Western blot test was identified. Comparisons of current practice were made with American and European standards, and the Western blot scoring system revised. When applied retrospectively (April 2003 to March 2004), 39 (33 %) of 116 serum samples previously negative or equivocal became weak positive or stronger. Thirty-one (80 %) of these 39 samples were from patients with clinical details suggestive of early lyme disease. The changes were implemented and assessed prospectively for 6 months. There was a significant increase in the proportion of equivocal results, with fewer negatives compared to the same time period 1 year previously. This audit has helped clinicians in the diagnosis of lyme disease and the management of these patients in Scotland.

Blotting, Western↗
PubMed2006

Pneumococci causing invasive disease in children prior to the introduction of pneumococcal conjugate vaccine in Scotland.

This study aimed to determine the serotypes and sequence types (STs) of pneumococci causing paediatric invasive disease in Scotland prior to the introduction of pneumococcal conjugate vaccines (PCVs). All invasive pneumococci isolated between 2000 and 2004 from children aged less than 5 years in Scotland were used. The isolates were characterized by serotyping and multi-locus sequence typing. Two hundred and seventeen pneumococci were characterized into 22 different serogroups/types, the most common, in rank order, being 14, 19F, 6B, 18C, 23F, 9V, 4, 1, 19A and 6A. They were further genotyped into 77 different STs, the three most common being 9, 162 and 176. Common serotypes possessed multiple STs, but pneumococci of a particular clone were mostly associated with a particular serotype. The seven most common serotypes are included in the 7-valent polysaccharide conjugate vaccine (PCV7). Serotype coverage for PCV7 was 76.5% in those aged less than 5 years but increased to 88.9% for those aged 1 year. The introduction of PCV7 into the childhood immunization schedule would reduce the burden of pneumococcal disease in children, although continued surveillance of invasive pneumococcal disease will be required before, during and after the introduction of PCVs.

Child, Preschool↗
PubMed1995

Managing temporary nursing staff: nurse banks in Scotland.

Nurse banks are locally organized in-house sources of temporary nursing staff. Reports on a study of policy and practice in the management of nurse banks in the National Health Service in Scotland. The study was based on a census survey of all 55 NHS units in Scotland (100 per cent response rate). Examines management rationales in establishing a nurse bank, explores costs and benefits of managing a bank, and provides recommendations on good practice in maintaining continuity of care.

Costs and Cost Analysis↗
PubMed1990

The changing face of dermatology out-patient referrals in the south-east of Scotland.

A study of out-patient dermatological services (NHS and private) in the south-east of Scotland was carried out by medical staff in the Department of Dermatology in Edinburgh during the month of November 1988. The aim was to assess changes in referral patterns and workload compared with the findings of an identical investigation undertaken in November 1981. Of particular interest were the possible effects of recent publicity campaigns aimed at increasing public awareness about skin cancer. The medical complement of the dermatology department had changed minimally since 1981 and the population increase in the south-east of Scotland over the same period was 1.5%. During November 1988 1592 new patients and 2037 review patients were seen. This represented an increase of 29.2% and 28.3%, respectively, since 1981. The most striking changes in diagnostic groups were a 173% rise in new cases presenting with benign tumours (excluding viral warts) and a 106% increase in new patients with malignant tumours. Viral warts and eczema were, as in 1981, the second and third most common diagnostic categories amongst new patients. There was a 98% increase in the number of surgical procedures performed on new patients compared with 1981. We conclude that the substantial increase in numbers of both benign and malignant tumours and the consequent doubling in surgical treatments was due to increased public awareness and concern about skin cancer.

Dermatology↗
PubMed1994

Naevi in schoolchildren in Scotland and Australia.

To test the hypothesis that children living in subtropical and tropical environments have more naevi than those of similar ethnicity living in temperature countries, a comparative study of melanocytic naevi in 111 schoolchildren from Brisbane, Australia, and 222 from Glasgow, Scotland, was carried out. All children were aged 13-15 years, of European ancestry, and had spent most of their lives at latitudes of less than 30 degrees S (Australia) or greater than 30 degrees N (Scotland). Using an identical protocol, all naevi of 2 mm or more in diameter occurring on the right arm were counted by either a highly experienced research nurse in Brisbane, or a dermatologist in Glasgow. Hair and eye colour, and facial freckling, were assessed by the examiner, and axillary skin colour of children in both cities was measured using the same reflectance spectrophotometer. Children in Brisbane had significantly more naevi than those in Glasgow (P < 0.05), after adjusting for complexion variables. The difference in the geometric mean number of naevi on the arm was much greater among boys (7.7 vs. 4.4, in Brisbane and Glasgow, respectively) than among girls (7.3 vs. 6.7). This has parallels with the sex differences in melanoma at later ages in the two countries. Besides country of residence, freckles and innate skin colour were the most significant predictors of large numbers of naevi, whereas red hair had a significant protective effect. Overall, these data on prevalence of naevi in children from contrasting environments provide some evidence in support of the theory that naevus development is related to the level of sun exposure in childhood and adolescence.

Adolescent↗