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PubMed1981

The use of factor IX concentrates in man: a 9-year experience of Scottish concentrates in the South-East of Scotland.

During the last 9 years, two factor IX concentrates produced in Scotland, PPSB and DEFIX, have been used for the treatment of haemophilia B and acquired coagulation disorders, including those due to liver disease, coumarin therapy, neonatal immaturity and post-operative bleeding. During the period of study 112 batches of DEFIX and 40 batches of PPSB were used in the Edinburgh and South-East Scotland Region. Data were analysed from 575 non-haemophilic patients, receiving 968 treatment episodes, as well as 24 haemophiliacs. Serial coagulation studies and analysis of retrospective data showed that both concentrates corrected the coagulation deficiencies in all the above patient groups; in no case was there any evidence of intravascular coagulation resulting from concentrate infusion.

Blood Coagulation Disorders↗

PubMed2005

Dementia care provision in rural Scotland: service users' and carers' experiences.

There has been global neglect of service users' and carers' experiences of dementia care provision in rural areas. The present paper draws on a qualitative study of service provision for people with dementia and their carers in remote and rural Scotland. It draws on interviews with 15 people with dementia and 16 carers to explore their views about health and social dementia care service provision in rural Scotland. A further 14 carers of people with dementia participated in one of three focus groups. The paper discusses perceived gaps in services as well as positive aspects of dementia service provision which service users attribute to living in a rural area. The important issues this raises for the development of dementia care provision in rural areas are briefly discussed.

Adult↗

PubMed1977

The incidence of Duchenne muscular dystrophy in the South East of Scotland.

In a survey carried out to determine the incidence of Duchenne muscular dystrophy in the South East of Scotland, 47 cases were ascertained among 177,413 live male births for the years 1953 to 1968. The overall incidence is 1 case in 3,775 live male births (26.5 +/- 3.2 X 10(-5)). This incidence figure has been compared with those reported in nine other studies, and any differences appear likely to be due to varying degrees of ascertainment. So far there is no evidence of any decrease in incidence of the disease in S.E. Scotland as a result of genetic counselling and antenatal foetal sexing.

Child↗

PubMed1994

A cytogenetic register of trisomies in Scotland: results of the first 2 years (1989, 1990).

A population-based register of all autosomal trisomies diagnosed in Scotland was established in 1989. Data were provided by all cytogenetic service laboratories, and included karyotype, date and place of outcome, indication for analysis, maternal age and place of residence. The Register includes all foetuses diagnosed prenatally and all cytogenetically-confirmed live- and still-births with autosomal trisomy, including partial, mosaic and familial cases. In the 2 years 1989-90, 76 prenatal and 147 postnatal diagnoses were notified. For Down syndrome karyotypes the estimated rate, assuming no terminations and after adjusting for spontaneous foetal losses following diagnosis, was 1.23 per 1000 livebirths. This was almost identical to that expected by applying published maternal age-specific rates to the maternal age distribution in Scotland, indicating a very high level of ascertainment. The adjusted rates for trisomies 13 and 18 were also close to expected values derived from published data. Prenatal screening was estimated to reduce the newborn incidence of trisomy 21 by about one quarter overall, and about one half in mothers over 35 years. For trisomy 18, the estimated overall reduction was also about one quarter. It is concluded that the Register provides a practical and cost-effective means of monitoring the effects of prenatal screening, with near-complete ascertainment. In the longer term it will provide a database for studies of the aetiology of these conditions.

Birth Rate↗

PubMed2006

Religion, social mobility and education in Scotland.

The relationship among religion, education and social mobility in Scotland is analysed statistically using the Scottish Household Survey of 2001. The large sample size allows much greater statistical power for this purpose than any previous source, and thus allows a more reliable assessment of claims that the stratifying effect of religion in Scotland may have declined. The questions investigated are as follows. What are the religious differences in the distributions of class origins and class destinations, in the movement between these (absolute mobility), and in the association of these (relative mobility, or social fluidity)? Do changes in social fluidity across cohorts vary among people with different religious affiliation? Are there religious differences in the association of origins and education, in the association of education and destinations, or in the role of education in social fluidity, and do any of these vary over cohorts? The conclusions are that, in younger cohorts, there is no religious difference in social status, and that in older cohorts Catholics are generally of lower status than Protestants and the non-religious. Social fluidity does not, however, vary among religious groups, even for older cohorts, and does not change over time. The reason for convergence in social status of religious groups over time is probably the equalizing of educational attainment among the groups: there is no evidence for any of the cohorts that the labour-market rewards to education differ by religion.

Education↗

PubMed1985

A routine system for monitoring perinatal deaths in Scotland.

Since 1983 the monitoring of perinatal deaths in Scotland has been incorporated into the established data collection system which monitors maternal and child health in Scotland. This paper describes the transition from a research project to the routine system and the extension of the data collection to include paediatric and pathological findings. This information is provided by local co-ordinators in active clinical practice. Baseline data are obtained from the routine maternity discharge document (SMR 2). A summary of the findings for the first 4 years of the study, 1977, 1979, 1980 and 1981 is presented, including information about birthweight and gestation-specific perinatal mortality rates; perinatal mortality rates by time of death in relation to labour and singleton and multiple perinatal mortality rates by the obstetric complication preceding the death.

Birth Weight↗

PubMed1994

Induced abortion: an audit of reported current practice among consultant gynaecologists in Scotland.

OBJECTIVE: To obtain an overview of current abortion practice in Scotland for comparison with agreed criteria for good quality care based on literature review. DESIGN: Postal questionnaire survey. SUBJECTS: All 132 consultant gynaecologists practising in the NHS in Scotland. RESULTS: Response rate 92%. The survey revealed regional inequalities in the availability of services, particularly with regard to early medical abortion and second trimester procedures. It also revealed great individual variations in many areas of practice notably in screening for genital tract infection, the use of cervical predilatation, contraceptive provision, and follow up. Several aspects of practice compared poorly with the agreed criteria for good quality care. CONCLUSIONS: The postal questionnaire approach achieved a good response rate and has provided an informative overview of current practice on a national basis. Variations in the provision of services and in clinical practice, both among regions and among individual consultants, have been identified. Elements of abortion care in which great variations exist and in which current practice compares poorly with the agreed criteria have been highlighted as appropriate areas for the development of national guidelines and for educational initiatives. Such a questionnaire approach to assessing current practice can complement, and possibly replace, some aspects of casenote review audit.

Abortion, Induced↗

PubMed1994

The treatment of stage I carcinoma of the cervix in the west of Scotland 1980-1987.

OBJECTIVE: To examine the results of different treatments for Stage IA and IB carcinoma of the cervix in patients treated in the West of Scotland between 1980 and 1987. DESIGN: A retrospective review of case records. SETTING: The Beatson Oncology Centre, Western Infirmary and Belvidere Hospital, Glasgow, and the departments of gynaecology of hospitals in the west of Scotland. SUBJECTS: One hundred and five patients with Stage IA and 420 patients with Stage IB carcinoma of the cervix. RESULTS: A variety of treatments were used for women with Stage IA disease, with an overall actuarial five year survival of 100%. The overall actuarial five year survival for women with Stage IB disease was 79.5%. Patients with Stage IB disease treated by radical hysterectomy (n = 123) or radical radiotherapy (n = 229) had similar five year survival rates (86.3% and 79.5%, respectively), whereas patients treated initially by nonradical surgery (n = 68) had a significantly worse five year survival (68.1%; P = 0.008). CONCLUSIONS: These results emphasize the need for adequate and appropriate surgery and the centralisation of treatment for early cervical cancer.

Adult↗

PubMed1997

Laparoscopic sterilisation: opinion and practice among gynaecologists in Scotland.

OBJECTIVES: 1. To produce a list of evidence-based criteria for good quality care relating to female laparoscopic sterilisation. 2. To assess the level of agreement with each criterion among gynaecologists in Scotland. 3. To obtain an overview of current sterilisation practice for comparison with the agreed criteria. DESIGN: 1. Agreement with criteria assessed by questionnaire survey; 2. Overview of current practice obtained by questionnaire survey and by casenote review. SETTING: Scotland. SAMPLE: 1. Questionnaire survey: all 132 consultant gynaecologists in NHS practice. 2. casenote review: 988 consecutive women sterilised in 12 representative hospitals. RESULTS: The response rate to the questionnaire survey was 94%. A list of 15 evidence-based criteria was produced, covering patient selection, information and counselling, techniques of tubal occlusion and timing of sterilisation. All 15 suggested criteria gained an overall balance of support among responding gynaecologists. Similar impressions of current practice were gained from the questionnaire survey and from the casenote review. Aspects of practice which measured up well to the agreed criteria included: only 6% of women sterilised were younger than 25 years of age; over 85% of casenotes included clear documentation that women had been counselled regarding failure rate and intended permanency; 88% of sterilisations were performed, or directly supervised by, a gynaecologist of consultant or senior registrar status; and only 2% of sterilisations were undertaken in combination with induced abortion. Aspects of practice which compared poorly with the agreed criteria, and for which recommendations for change have been made, included: only 22% of casenotes mentioned that the option of vasectomy had been discussed; only 30% of gynaecologists indicated that they provide locally produced information leaflets as an adjunct to counselling; four methods of tubal occlusion (including unipolar diathermy) were in use; and there were wide variations among hospitals in the use of day-case care, ranging from 19% to 99%. CONCLUSIONS: A list of criteria for good quality care in relation to sterilisation has been validated by agreement among Scottish gynaecologists. Current practice (as assessed by questionnaire survey and casenote review) has been compared with the criteria and some recommendations for change in practice have been made. Following dissemination of these results and recommendations, re-audit will be undertaken in order to identify any changes.

Adult↗

PubMed2005

Information needs of specialist healthcare professionals: a preliminary study based on the West of Scotland Colorectal Cancer Managed Clinical Network.

OBJECTIVES: Funded by Research in the Workplace Award (RIWA) 2001, the study investigated the information needs and use of NHS library services by members of the West of Scotland Colorectal Cancer Managed Clinical Network (MCN), a single subject, cross boundary, multi-professional organization. METHOD: A postal questionnaire sent out in October 2002 was returned by 100 members and follow-up interviews were held in March 2003 with 11 of the respondents. The questions related to access to resources, library services such as literature searches, current awareness and training. They also explored the use of electronic resources and the Internet. RESULTS: Respondents were mainly hospital doctors and a few nurses from across five health boards. Most had access to a library, although not all made use of it, possibly an indication of the need for improved communications between librarians and health-care staff. Generally, research and professional development were reported as reasons for needing cancer information, but on further investigation the motivation to conduct literature searches was more related to patient care. Examples included treatment of unusual cases, locating information for patients and identifying guidelines. There are indications of unmet needs for local contact information and evaluated patient information. CONCLUSION: Development of a cancer portal within the NHS Scotland e-Library available from May 2004 based on the Managed Knowledge Network (MKN) concept is attempting to address many of the issues raised in the survey, including inequities of access to services and signposting to a variety of types of information.

Colorectal Neoplasms↗

PubMed1979

Clinical features of multiple sclerosis in north-east Scotland.

The clinical features of multiple sclerosis (MS) in north-east Scotland have been examined along with an epidemiological study to determine the prevalence of the disease on 1st December, 1970. Patient information was collected from all available diagnostic indices, both retrospectively and prospectively from 1965. Every family doctor in the region contributed. The age and sex specific prevalence rates for MS in north-east Scotland on 1st December, 1970, are the highest ever recorded. Among the 80,000 women aged 40 to 69, one in every 340 had the disease. The mean incidence rate for a 12-year period was 5.0/100,000. A significantly better prognosis with regard to disability was found for onset with sensory symptoms, a relapsing/remitting type of course, men with long disease duration, and an initial remission period of 4 or more years. The occurrence of various abnormal neurological signs and symptoms has rarely been recorded in a large epidemiological study. The findings in this study, however, are similar to previous non-epidemiological studies.

Adolescent↗

PubMedDate not supplied

Diarrhea and respiratory symptoms among travelers to Asia, Africa, and South and Central America from Scotland.

Surveillance using admissions to hospital, while being useful, is a poor indicator of the real incidence of disease encountered by travelers. An alternative is self-reported illness among those who attended at a pretravel clinic prior to their travels. Estimates of incidence and risk factors were determined for attendees at a travel clinic in Scotland using a questionnaire. Analysis for risk factors was carried out for those travelers visiting countries in Africa, Asia, or South and Central America, who had traveled for 1 week or more and had returned between 1997 and 2001 (N= 4,856). Multivariate logistic regression was used to test the hypotheses that time abroad and age-group would be significant for both respiratory and diarrheal symptoms regardless of which of the three geographical areas are visited. From 2006 returned questionnaires (response rate = 41.3%), diarrhea and respiratory symptoms were reported by 44.2 and 16.8% of respondents, respectively; the incidence was significantly greater among travelers to Asia for both diarrheal (55.5%) and respiratory (23.7%) symptoms than among travelers to Africa (36.6 and 12.2%, respectively) or South and Central America (39.5 and 16.2%, respectively). For diarrhea, age was a highly significant risk factor for travelers to Asia, South and Central America, and Africa. Being a self-organized tourist/backpacker, traveling to Asia was associated with increased risk, while for Africa and South and Central America visiting family or friends was associated with a lower risk. For travelers to Asia, traveling to the Indian subcontinent was significantly associated with increased risk. The majority of travelers had an adverse event while traveling abroad, with diarrhea and respiratory conditions being especially common despite attending a travel clinic for advice prior to departure. However, the limitations of this surveillance-based strategy have highlighted the requirement for more research to understand more fully the issues of risk and incidence among travelers to high-risk destinations from Scotland.

Adolescent↗

PubMed2005

A study to compare the oral health impact profile and satisfaction before and after having replacement complete dentures in England and Scotland.

OBJECTIVE: To assess the oral health impact profile (OHIP) on edentulous subjects in Scotland and England who needed to have their dentures replaced, and to determine whether any change in the subjects' assessment of their original and replacement dentures impacted on oral health related quality of life parameters. BACKGROUND: The loss of all teeth may impact on functional activities. The OHIP is an instrument used to measure subjects' perception of the social impact of oral disorders on their well being. METHODS: A total of 58 edentulous subjects were studied. Subjects completed the OHIP-14 questionnaires before and after being provided with a set of replacement complete dentures. They also assessed specific features of the upper and lower dentures. Responses were recorded on a Likert scale. RESULTS: For many subjects, the responses in the before treatment questionnaires were at the lower end of the Likert scale, indicating that there were no major impacts on oral health related quality of life parameters. There were significant improvements in four of the 14 OHIP parameters assessed after treatment. With the new dentures, subjects expressed improved satisfaction, particularly for the lower prosthesis. There were no major differences between the responses of the subjects in Scotland and England. CONCLUSION: For this group of edentulous subjects, although they may need dentures to be replaced after a period of wear, this does not necessarily have significant social impacts. For this reason the provision of new dentures did not result in major changes to the OHIP.

Denture, Complete↗

PubMed1980

Young children's awareness of violence in Northern Ireland: the influence of Northern Irish television in Scotland and Northern Ireland.

Children aged 5 to 6 years living in either a suburb of London or in a small town in Northern Ireland which has been virtually free from violence, were asked to make up stories in response to a series of pictures depicting such things as derelict houses or a train crash. More Northern Irish children mentioned bombs and explosions than did the London children. To investigate the possibility that this knowledge of explosions might be the result of at least incidental exposure to coverage of such events on Northern Irish television news a further study was initiated. Children from another relatively quiet part of Northern Ireland were compared with children from two separate areas of Scotland where television reception is only possible from Northern Ireland and from a third area in Scotland where Northern Ireland television news cannot be received. Children from those areas where Northern Irish television news can be received again outnumbered those from the control area in terms of mentions of the words bomb or explosion.

Awareness↗

PubMed1999

Molecular evidence for heterogeneity of the multiple-drug-resistant Mycobacterium tuberculosis population in Scotland (1990 to 1997).

Multiple-drug-resistant Mycobacterium tuberculosis (MDR-MTB) has been well studied in hospitals or health care institutions and in human immunodeficiency virus-infected populations. However, the characteristics of MDR-MTB in the community have not been well investigated. An understanding of its prevalence and circulation within the community will help to estimate the problem and optimize the strategies for control and prevention of its development and transmission. In this study, MDR-MTB isolates from Scotland collected between 1990 and 1997 were characterized, along with non-drug-resistant isolates. The results showed that they were genetically diverse, suggesting they were unrelated to each other and had probably evolved independently. Several new alleles of rpoB, katG, and ahpC were identified: rpoB codon 525 (ACC-->AAC; Thr525Asn); katG codon 128 (CGG-->CAG; Arg128Gln) and codon 291 (GCT-->CCT; Ala291Pro); and the ahpC synonymous substitution at codon 6 (ATT-->ATC). One of the MDR-MTB isolates from an Asian patient had an IS6110 restriction fragment length polymorphism pattern very similar to that of the MDR-MTB W strain and had the same drug resistance-related alleles but did not have any epidemiological connection with the W strains. Additionally, a cluster of M. tuberculosis isolates was identified in our collection of 715 clinical isolates; the isolates in this cluster had genetic backgrounds very similar to those of the W strains, one of which had already developed multiple drug resistances. The diverse population of MDR-MTB in Scotland, along with a low incidence of drug-resistant M. tuberculosis, has implications for the control of the organism and prevention of its spread.

Alleles↗

PubMed2004

Prevalence of hypospadias and other genital anomalies among singleton births, 1988-1997, in Scotland.

BACKGROUND: Considerable debate exists on the epidemiology of genital anomalies. METHODS: All genital anomalies, excluding undescended testes, were identified from neonatal returns, stillbirth and infant death survey records, and returns relating to hospital admissions and linked to form infant profiles on a cohort of singleton births between 1988 and 1997 with follow up for a minimum of three years. FINDINGS: The mean genital anomaly prevalence rate in Scotland was calculated at 4.6 per 1000 births varying from 4.0 per 1000 births in 1988 to 5.9 per 1000 births in 1996. However, there was no evidence of a clear trend to an increasing prevalence of hypospadias, which constituted 73% of the anomalies studied. Logistic regression analysis of the data also showed this rate to be independently associated with being relatively small for gestational age (odds ratio (OR) 1.43, p < 0.001) and increasing maternal age (OR 1.2, p < 0.05). Infants born in deprived areas, as judged by the Carstairs deprivation score, were least likely to have a genital anomaly (OR 0.73, p < 0.01). INTERPRETATION: A new linked register of congenital genital anomalies in Scotland suggests that over a decade, the birth prevalence of genital anomalies has changed little. The associations between genital anomalies, maternal age, and socioeconomic deprivation require further study.

Cohort Studies↗

PubMed2005

The impact of the Health Technology Board for Scotland's grading model on referrals to ophthalmology services.

AIM: To ascertain the impact of the Health Technology Board for Scotland's grading model on referrals to ophthalmology services. METHODS: An analysis was performed of the screening outcomes of 5575 consecutive patients, who were screened by the Grampian Diabetic Retinopathy Screening Programme between March and September 2003 according to the recommendations of the Health Technology Board and the Scottish Diabetic Retinopathy Grading Scheme 2003. RESULTS: 3066 (55%) were male. The median age was 65 years. 5.4% were passed on to the level 3 grader and 3.4% were finally referred to ophthalmology services. 2.3% required re-screening in 6 months; 85% were screened without mydriasis; 11.9% had ungradeable images despite a staged mydriasis protocol. Time to complete grading was 32 days (22-45). CONCLUSION: The impact of the Health Technology Board for Scotland's recommendations on referrals to ophthalmology services is modest and should be containable within existing resources.

Aged↗

PubMed2006

The prevalence of sight-threatening uveitis in Scotland.

AIM: To identify and quantify the prevalence of patients with uveitis receiving systemic immunosuppression in Scotland. METHODS: Anonymised data were prospectively collected on all patients with uveitis requiring systemic immunosuppression. Seven health boards participated over a 4-month period between 1 August 2005 and 30 November 2005. RESULTS: 373 patients were identified, of whom 205 (55%) were female. The mean age was 46.4 (range 7-97 years). Using the data from the seven participating health boards, an estimated Scottish prevalence of 9 per 100 000 was calculated. Prevalence varied between 2 and 59 per 100 000. In National Health Service Grampian, all patients with uveitis, whether sight-threatening or not, are followed up at a specialist clinic. Extrapolating this figure to Scotland gives a prevalence of 25 per 100 000. DISCUSSION: The data from National Health Service Grampian suggest that there is a significant shortfall in the number of patients identified by survey. If the "missing population" exists, then where are they? Some might be receiving appropriate treatment at non-specialist clinics, although simple under-reporting may play a part. Greater concern is for those patients receiving inappropriate treatment for their uveitis, or for those within the community who are either oblivious to or in self denial of their condition.

Adolescent↗