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PubMed2005

The epidemiology of ciprofloxacin resistant isolates of Neisseria gonorrhoeae in Scotland 2002: a comparison of phenotypic and genotypic analysis.

OBJECTIVES: To characterise all isolates with reduced susceptibility or resistance to ciprofloxacin received by the Scottish Neisseria gonorrhoeae Reference Laboratory (SNGRL) in 2002 using N gonorrhoeae multi-antigen sequence typing (NG-MAST); to compare NG-MAST with conventional typing and to describe the epidemiology of ciprofloxacin resistant gonorrhoea in Scotland in 2002. METHODS: Isolates were characterised on receipt by auxotyping and serotyping (A/S typing), and antibiotic susceptibility testing, and retrospectively by NG-MAST. Epidemiological data were requested for all isolates in the study. RESULTS: The 106 isolates were separated into more sequence types (ST) than A/S classes (44 versus 17). All isolates within a sequence type had the same serotype, were homogeneous with respect to ciprofloxacin resistance category, but were sometimes heterogeneous with respect to auxotype or plasmid borne resistance to penicillin. Combined NG-MAST and epidemiological data revealed sustained transmission of several gonococcal strains predominantly within Greater Glasgow and Lothian. Clusters of isolates were associated with transmission within the United Kingdom, whereas isolates with unique STs were associated with foreign travel (p < 0.0001). CONCLUSIONS: NG-MAST is more discriminatory than A/S typing. Ciprofloxacin resistant gonococcal isolates in Scotland are heterogeneous, with endemic spread of some strains occurring predominantly in Greater Glasgow and Lothian.

Anti-Infective Agents↗
PubMed2001

Partner notification in HIV-1 infection: a population based evaluation of process and outcomes in Scotland.

OBJECTIVES: To evaluate the process and outcomes of HIV partner notification (PN) activity in Scotland. DESIGN: Retrospective population based study. SUBJECTS: 114 adults newly diagnosed with HIV infection (index patients) in Scotland between September 1995 and August 1996. SETTING: Healthcare settings in which all 114 new HIV diagnoses were made: 42 (37%) from genitourinary medicine; 32 (28%) infectious diseases; 18 (16%) general practice; and 22 (19%) from other sites. MAIN OUTCOME MEASURES: Number of partners notified and tested up to 9 months after initial diagnosis. RESULTS: Of 114 index patients (IPs), information on current partners was available for 102 (89%). PN was not appropriate for 47 of the 102 IPs. The remaining 55 IPs identified 63 current partners at risk, of whom 51 were notified: 44 underwent HIV testing, which yielded 11 new HIV positive diagnoses. Information on previous partners was available for only 56 IPs (49%). PN was not appropriate for 30 of the 56 IPs; the remaining 26 IPs identified 46 previous partners at risk, of whom 12 were notified: four were tested, but yielded no new diagnoses. CONCLUSIONS: Notification of current partners was performed well and was an effective strategy for identification of HIV positive individuals at a presymptomatic stage. Notification of previous partners was limited. Partner notification was attempted in a wide range of healthcare settings. Given the clinical effectiveness of antiretroviral therapy, partner notification as a tool towards early diagnosis of HIV disease deserves renewed attention.

Adult↗
PubMed2000

Costs of employee smoking in the workplace in Scotland.

BACKGROUND: Employers have responded to new regulations on the effects of passive smoking by introducing a range of workplace policies. Few policies include provision of smoking cessation intervention. OBJECTIVE: To estimate the cost to employers of smoking in the workplace in Scotland to illustrate the potential gains from smoking cessation provision. Costs vary with type of smoking policy in place; therefore, to estimate these costs results from a survey were combined with evidence drawn from a literature review. STUDY DESIGN: A telephone survey of 200 Scottish workplaces, based on a stratified random sample of workplaces with 50 or more employees, was conducted in 1996. Additional evidence was compiled from a review of the literature of smoking related costs and specific smoking related effects. RESULTS: 167 completed responses were received, of which 156 employers (93%) operated a smoking policy, 57 (34%) operated smoke free buildings, and 89 (53%) restricted smoking to a "smoke room". The research literature shows absenteeism to be higher among smokers when compared to non-smokers. The estimated cost of smoking related absence in Scotland is pound40 million per annum. Total productivity losses are estimated at approximately pound450 million per annum. In addition, the resource cost in terms of losses from fires caused by smoking materials is estimated at approximately pound4 million per annum. In addition, there are costs from smoking related deaths and smoking related damage to premises. CONCLUSION: This study shows how smoking cessation interventions in the workplace can yield positive cost savings for employers, resulting in gains in productivity and workplace attendance which may outweigh the cost of any smoking cessation programme.

Absenteeism↗
PubMed2001

Management and survival of patients with lung cancer in Scotland diagnosed in 1995: results of a national population based study.

BACKGROUND: The prognosis of patients with lung cancer in Scotland is poor and not improving. This study was designed to document factors influencing referral, diagnostic evaluation, treatment, and survival in patients with lung cancer. METHODS: Patients diagnosed during 1995 were identified from the Scottish Cancer Registry and their medical records were reviewed. Adequate records were available in 91.2% of all potentially eligible cases. RESULTS: In 1995, patients in Scotland with lung cancer had a high rate of microscopic verification (74.1%) and 75.3% were assessed by a respiratory physician; however, only 56.8% received active treatment (resection 10.7%, radiotherapy 35.8%, chemotherapy 16.1%) and 2.9% participated in a clinical trial. Survival was poor with a median of 3.6 months; 21.1% (95% CI 19.8% to 22.4%) were alive at 1 year and 7.0% (95% CI 6.2% to 7.8%) at 3 years. Management by respiratory physician, oncologist, or thoracic surgeon was an independent predictor of access to potentially curative treatment and better survival. CONCLUSION: This national population based study demonstrates low use of treatment, poor survival, and the influence of process of care on survival. Implementation of evidence-based guidelines will require substantial changes in practice. Increasing the number of patients who receive treatment may improve survival.

Adult↗
PubMed1987

Mycobacterium malmoense infections in Scotland: an increasing problem.

During 1982-4 20 cases of Mycobacterium malmoense infection were identified in Scotland (13 male, seven female; age 34-82, median 62 years). Features of the disease were obtained from case notes and radiographs of 19 patients and were found to be indistinguishable from those of patients with pulmonary tuberculosis. Chronic chest disease, predominantly chronic airflow obstruction, was the most frequent associated disease. The organisms showed in vitro resistance in eight patients to rifampicin, in 19 patients to isoniazid, and in all patients to pyrazinamide and p-aminosalicylic acid. Nevertheless, all patients showed an early response to standard combination chemotherapy with rifampicin, isoniazid, and ethambutol, with or without pyrazinamide. Five have been cured and none had died of the infection, although four died of unrelated disease. Of nine patients still having treatment, five had relapsed after completing a course of antituberculosis drugs. All had received ethambutol for less than five months. The response to standard drugs was more satisfactory when the course included administration of ethambutol for at least nine months. Currently one new infection with M malmoense occurs in Scotland for every 40 with tuberculosis, and the incidence appears to be rising. In view of this, it is suggested that when tuberculosis is suspected the chemotherapeutic regimen should include ethambutol until the culture results are reported. If these then show M malmoense, ethambutol should be continued in the combination for at least nine months.

Adult↗
PubMed1982

Interprofessional liaison in Scotland.

Communication between the medical, veterinary and environmental health professions has been established in Scotland since the early 1970s and was strengthened by the introduction of the Zoonoses Order 1975. The secondment of a veterinary officer to the Communicable Diseases (Scotland) Unit in Glasgow provides veterinary expertise on matters relating to public health, in addition to improving liaison, surveillance and the other functions of the unit.

Animals↗
PubMed1993

An estimate of the prevalence of enzootic abortion of ewes in Scotland.

The prevalence of enzootic abortion of ewes in Scotland was estimated over a period of five years. Between 1987 and 1991, 30.7 per cent of all flocks with breeding ewes in Scotland submitted ovine abortion material, and of these flocks 28 per cent showed evidence of the infection, giving a prevalence of 8.6 per cent. Regional differences were observed in both the submission rate and the prevalence.

Abortion, Veterinary↗
PubMed1998

Salmonella typhimurium DT104 infection in people and animals in Scotland: a collaborative epidemiological study 1993-96.

This paper describes a comparative analysis of human and farm animal salmonellosis in Scotland between 1993 and 1996, with particular reference to Salmonella typhimurium definitive type 104 (DT104). Cattle were the main reservoir, accounting for 73.1 per cent of incidents involving all salmonellae and 69.5 per cent of those involving S typhimurium DT104. The annual rates of incidence in people and cattle were recorded in each Health Board area. Dumfries and Galloway had the highest rate of incidence in cattle for all salmonellae (19.0 per 100,000) but people were affected uniformly across mainland Scotland. However, the rate of incidence of S typhimurium DT104 was highest in Dumfries and Galloway for both people (10.1 per 100,000) and cattle (13.0 per 100,000). In Dumfries and Galloway, Wigtownshire had the highest rates for all salmonellae and for S typhimurium DT104 in both people and cattle. In Dumfries and Galloway, 37.8 per cent of the adult cases of S typhimurium DT104 in people were among those known to have had regular contact with animals, and children under six years of age accounted for 36.3 per cent of the human infections in this region.

Adult↗
PubMed1996

Infanticide in Scotland.

Details from Scottish Office records of all infants under a year who were the victims of homicide in Scotland during 1978-1993 are presented and compared with results from studies of infant homicide in England and Wales. Although Scottish homicide rates in the total population are much higher than those in England and Wales, the annual Scottish infanticide rate (43/million) is remarkably similar to that of England and Wales (45/million). In addition, characteristics of victims and perpetrators are also similar between the two regions. As with England and Wales, in Scotland the younger the infant the greater the risk of becoming the victim of homicide (83% were killed within 6 months of birth); male babies were more frequently killed than female ones; a parent was the most frequent perpetrator (93% of offences); mothers tended to kill neonates but for infants older than a day more fathers than mothers were recorded as the main accused. Mothers and fathers were convicted of similar offences but fathers were less likely to receive non-custodial sentences. Differences in sentencing appeared to be related to either gender-related differences in attributions as to the motivation for the offence, or to the level of violence used against the victim. Offences of mothers were most frequently recorded as being motivated by mental illness, those by fathers as due to rage. Fathers were more likely to have killed by kicking or hitting, mothers by some form of suffocation.

Adult↗
PubMed2000

Injury prevention in Scotland--the case for a national strategy.

In children and young adults, injury overshadows other causes of death and is a major contributor to acute and long-term disability. Yet injury is more amenable to prevention than most other causes of ill health. The purpose of this paper is to present the case for the development and implementation of a national injury prevention strategy for Scotland. Systematic reviews of the evidence have identified a series of specific interventions that have been shown to reduce injury incidence, mortality or morbidity. Research suggests that over half of all traumatic deaths are avoidable in children. In addition to the responsibilities of individuals, parents, carers, schools and employers to prevent or to reduce the probability of injury, responsibility for injury prevention and the protection of the public from injury hazards lies with a range of national and local agencies in the UK. These vary across the country and are unco-ordinated. To reduce the number of deaths and disorders resulting from injury, and the costs associated with treating and caring for injured people and their families, we contend that the most pressing current need is to develop a national strategy for Scotland.

Adult↗
PubMed2001

Fractures in medieval Scotland.

The prevalence of fractures in medieval Scotland is assessed, particular attention being given to excavations of cemeteries beside three Carmelite cemeteries, at Aberdeen, Perth and Linlithgow, and another one at Whithorn Abbey. In the friaries the prevalence of fractures was 7.6% and in Whithorn it was 5.0%. These figures are comparable with an estimated prevalence of 7.2% for individuals between 0 and 65 years in present day Scotland. Males were more at risk of fractures than females, but a small group from both genders had been struck on the head by weapons. A study from a rural cemetery in England indicates that both male and female peasants had a much higher risk of fractures than their urban counterparts.

Female↗
PubMed2003

No excess risk of adverse birth outcomes in populations living near special waste landfill sites in Scotland.

A recent study showed small excess risks of low birth weight, very low birth weight and certain congenital anomalies in populations living near landfill sites in Great Britain. The objective of the current study was to investigate the risk of adverse birth outcomes associated with residence near special waste landfill sites in Scotland. We studied risks of adverse birth outcomes in populations living within 2 km of 61 Scottish special waste landfill sites operational at some time between 1982 and 1997 compared with those living further away. 324,167 live births, 1,849 stillbirths, and 11,138 congenital anomalies (including terminations) were included in the study. Relative risks were computed for all congenital anomalies combined, some specific anomalies and prevalence of stillbirth and low and very low birth weight (< 2500 g and < 1500 g). For all anomalies combined, relative risk of residence near special waste landfill sites was 0.96 (99% confidence interval 0.89 to 1.02) adjusted for confounders. Adjusted risks were 0.71 (0.36 to 1.42) for neural tube defects, 1.03 (0.85 to 1.26) for cardiovascular defects, 0.84 (0.58 to 1.22) for hypospadias and epispadias (with no excess of surgical corrections), 0.78 (0.27 to 2.23) for abdominal wall defects (1.32 (0.42-4.17) for hospital admissions), 1.22 (0.28 to 5.38) for surgical correction of gastroschisis and exomphalos and 1.01 (0.96 to 1.07) and 1.01 (0.90 to 1.15) for low and very low birth weight respectively. There was no excess risk of stillbirth. In conclusion, we found no statistically significant excess risks of congenital anomalies or low birth weight in populations living near special waste landfill sites in Scotland.

Adolescent↗
PubMed2004

Childhood asthma in the Highlands of Scotland--morbidity and school absence.

BACKGROUND: The prevalence of childhood asthma in Scotland is one of the highest in the world. The morbidity secondary to allergic diseases is significant in terms of costs to the nation and effects on the family including the child. AIMS: The aims of this study were to describe the prevalence of asthma, eczema and hay fever in the Highlands of Scotland and in the Shetland Isles and to examine factors in relation to quality of life and social deprivation. METHOD: A total population survey of 12 year old children using a parent completed questionnaire. RESULTS: 86.3% (2658/3080) returned questionnaires. Of the 2549 questionnaires analysed, 476 (18.7%) reported asthma ever, 362 (14.2%) wheeze in last 12 months, 508 (19.9%) reported hay fever ever and 555 (21.8%) reported eczema ever. Of the children reporting asthma or wheeze, 35.4% (229/647) had missed school because of asthma or wheeze, 38.0% (246/647) had missed physical education. 62.5% (354/566) of subjects with wheeze ever reported sleep disturbance. Deprivation measured by DEPCAT scores was associated with maternal smoking and bronchitis in the child but not with allergic diseases. CONCLUSION: Compared with previous studies, the prevalence of asthma was unchanged but eczema has increased in Highland adolescents. Allergic disease has a significant impact on school attendance and physical activity. Deprivation was associated with maternal smoking and bronchitis in the child but not with allergic diseases. The impact of allergic diseases in rural areas may be different from urban areas.

Absenteeism↗
PubMed1980

Academic departments of general practice in Ontario and Scotland.

The departments of family medicine in Ontario are compared with departments of general practice in Scotland. The former are mainly involved with postgraduate training and are much larger than the Scottish departments which are primarily concerned with undergraduate teaching. Because of the difference in numbers the full time staff in the Department of Family Medicine at McMaster University were compared with those in all four Departments of General Practice in Scotland. A self-completed questionnaire was used to find out where the full-time academic staff had come from; what they were doing at present; and where they saw academic family medicine going in the future. The results are discussed in the context of health care provision and medical education in Canada and the United Kingdom.

Academic Medical Centers↗
PubMed1983

Acute hepatitis a in West Scotland in 1981. A change in pattern.

In 1981, 151 cases of laboratory confirmed Hepatitis A infection were diagnosed in West Scotland, an increase of more than three-fold over both 1979 and 1980. The majority (54%) were in children under 15 years of age, case numbers then declining with age, apart from a rise in numbers in the 21-30 age group. Almost all children infected were Scottish children. Significant numbers were associated with contact with a known case (25%) or travel abroad (16%). Few cases were diagnosed in the first five months of the year. This upsurge in laboratory-diagnosed cases was associated with an increase in notifications of viral hepatitis to the Registrar General for Scotland for the first time in 10 years.

Acute Disease↗
PubMed1988

Hepatitis A in Scotland--is it a continuing problem?

The prevalence of anti-HAV in blood donors in West Scotland and in children admitted to a Glasgow hospital was determined. By the age of five years, 16% of the children had antibody and at 15 years, 30%. In adults, prevalence continued to rise with age, with 78% of those over 40 years showing evidence of past infection. Cases of acute hepatitis A in West Scotland have declined since 1983. At present the peak age group for infection is 25-34 years whereas in the early 80s the peak group was five to 14 years.

Acute Disease↗
PubMed1994

Heart transplantation: initial results in Scotland.

Between 1st Jan 1992 and 1st Sept 1993 164 patients were referred as candidates for heart transplantation in Scotland. 79 were accepted for transplantation and 39 of these received orthotopic heart transplants. 30 day mortality was zero. Mean time on intensive care post operatively was 46.35 hrs and mean time to hospital discharge was 17.03 days. Cumulative actuarial survival (survival at 18 months post operatively) was 87%. There were three deaths, two from infection at six and 19 weeks and one from neoplasia at 37 weeks. Mean time to rejection was 38.54 days. Linear rejection rates at 0-3, 3-6, 6-9, 9-12, 12-15 and 15-18 months were 1.86, 0.94, 0.6, 0.04, 0 and 0 events per 100 pt-days respectively. Linear infection rates at 0-3, 3-6, 6-9, 9-12, 12-15 and 15-18 months were 1.81, 0.17, 0.1, 0, 0.05 and 0.18 events per 100 pt-days respectively. The heart transplant programme in Scotland has been successful in terms of operative mortality and short to medium term survival.

Female↗
PubMed1994

How sick is the West of Scotland? Age specific comparisons with national datasets on a range of health measures.

The Central Clydeside Conurbation (CCC) has relatively high mortality rates. This paper examines whether it also has relatively high rates of ill health, using data from three cohorts (aged 15, 35 and 55 in 1987/88) in the West of Scotland. Comparisons on a range of self-reported physical and mental health indicators, anthropometric measures, blood pressure, and respiratory function were made with comparable age groups in ten British or Scottish national studies. The older two cohorts in the CCC exhibited relatively high rates of longstanding and limiting longstanding illness and the youngest cohort had relatively poor psychosocial health, compared to their age peers elsewhere. Fewer differences were found in blood pressure, anthropometric measures or respiratory function although older CCC residents were slightly shorter than in Britain as a whole and had slightly poorer respiratory function. Central Clydesiders in the late 1980s were generally in poorer health than those of the same sex and similar age elsewhere in the UK, but the extent of the disadvantage varied across different dimensions of health, and was not as marked as some stereotypes of the West of Scotland would suggest.

Adaptation, Psychological↗