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A case is described of Tunga penetrans infection in the feet of a tourist returning from South America to Scotland. The condition had initially mimicked verrucae vulgaris, but microscopic examination of the lesions together with the travel history allowed the diagnosis of tungiasis to be made. This is the first case reported in Scotland.
In Scotland since January 1990, unlinked anonymous testing of Guthrie cards has documented maternal HIV-1 antibody in neonatal blood. District postcode and quarter year of birth determined prevalence and spread of infection. The Fujirebio particle agglutination assay screened for HIV-1 antibody, with confirmation by ELISA and full western blotting. Births to known HIV infected women were reported to the Royal College of Obstetricians and Gynaecologists. 0.3/1000 childbearing women were infected with HIV-1 with no significant increase from 1990 to 1992. Spread of infection from 11 to 26 districts has occurred. In 1990, 74%(14/19) of HIV positive deliveries were known to obstetricians falling to 33%(7/21) in 1992. Spread of HIV-1 infection has occurred to mothers who live outside closely defined areas and who do not belong to recognised high risk groups. In Scotland, two thirds of mothers and their infants will not receive early prophylactic care for their HIV disease.
The concept that care of elderly people required special facilities and training started early this century but was only implemented with the advent of the NHS in 1948. In Scotland the speciality gradually evolved and grew in stature and prominence. The early pioneers in Scotland are described.
The objective was to determine how patients are selected for invasive investigation after myocardial infarction in Scotland. Cardiologists in Scotland were surveyed by postal questionnaire asking them to detail their approach to four sample clinical scenarios. Complete responses were obtained from 82% of those surveyed. Substantial differences in practice were observed in the management of subjects with non-Q wave myocardial infarction. Of the cardiologists surveyed 40% would undertake coronary angiography irrespective of the results of non-invasive testing in a 45 year old patient, but only one would adopt the same policy in an otherwise fit 77 year old. Only 44% would perform any investigations (beyond echocardiography) in the 77 year old. A minority of respondents felt that their practice was influenced by resource limitation. Considerable variation continues to exist in the approach to risk stratification after myocardial infarction for some groups of patients. This variation may occur principally as a consequence of physician preference.
A retrospective analysis of the epidemiological characteristics of non-accidental head injury (NAHI) in children in Scotland over the last fifteen years from 1981 until March 1996 was performed. The information was provided by the Information and Statistics Division of the Scottish Health Service. The average incidence of NAHI calculated over this period was 0.04 cases per year per 1000 children under 5 years. Fifty-five per cent of all cases occurred in those children who were less than a year old. 41% of cases were inflicted by a parent but in 47% the perpetrator could not be identified. The mortality rate was found to be 2%. Non-accidental head injury cases identified using the ICD-9 coding classification system gives a surprisingly low incidence. This number is probably an underestimate and the reasons for this are discussed. A prospective epidemiological analysis of NAHI in children in Scotland is being undertaken to determine the true incidence.
We undertook a retrospective review of the Scottish Clinical Audit Project Register (SCAPR). This generated information on audit activities in Scotland relating to children aged 0-15 years over the period 1992 to 1997. All healthcare specialties (including dentistry) in both acute and community sectors were included. Of the 7,073 registered entries, 613 (9%) relating to children were identified. Greater Glasgow contributed a third of entries despite having only 18% of the child population. Over half the projects were conducted in secondary care settings and only 5% in primary care. Medicine and nursing appeared the most audit active professional groups. Our findings suggest that children (who comprise 19% of the Scottish population) are an under-audited group in Scotland. Secondary care (especially surgery) seemed over-represented and primary care under-represented as audit settings. We were unable to use the SCAPR to identify specific service deficiencies or improvements that may have been stimulated in the course of "closing the audit loop." Future refinements to the way data are collected and recorded on the SCAPR will clearly require to address this shortcoming.
OBJECTIVES: To evaluate the impact of a large scale population screening programme on the birth incidence of Down's syndrome in the west of Scotland over a 12 month period. METHODS: Biochemical screening for Down's syndrome using maternal serum alpha fetoprotein, chorionic gonadotrophin, and maternal age was offered to a pregnant population of 37,226 women in the west of Scotland between 1991 and 1992. The combined risk of Down's syndrome pregnancy was reported for each of the 30,084 women who opted for screening. RESULTS: When a threshold risk of 1:220 was used 1523 women (5.1% of the screened population) were assigned to the high risk group, of whom 1070 (70%) proceeded to diagnostic amniocentesis or midtrimester chorionic villus sampling. When multiple sources of ascertainment were used 37 Down's syndrome pregnancies were identified within the screened population, 26 (70%) of which were within the high risk group and 21 (57%) of which were prenatally diagnosed. In addition, three Down's syndrome pregnancies were diagnosed by first trimester chorionic villus sampling before biochemical screening. A further 10 Down's syndrome pregnancies were identified at birth, eight to women who had not had a screening test and two to women who had moved into the area, making a total of 50 Down's syndrome pregnancies in the whole pregnant population of 37,226. Thus the potential prenatal detection rate in the screened population was 70% (26/37), the actual prenatal detection rate in the screened population was 57% (21/37), and the overall prenatal detection rate in the total (screened and unscreened) population was 48% (24/50). CONCLUSION: Biochemical screening for Down's syndrome is practical and effective in routine clinical practice, enabling women to make an informed choice about prenatal diagnosis and providing better use of scarce resources when a suitable protocol is applied to the whole pregnant population. Its maximum potential for the reduction of the birth incidence of Down's syndrome is limited by incomplete uptake of screening and compliance with diagnostic testing in the high risk group.
This paper reviews the considerable progress which the environmental health profession has achieved, particularly during the course of the past 10-20 years. The future of the profession is considered particularly in relation to the development of higher degree opportunities and progress of research, the expanding use of support and associate specialist staff, and the thorny area of meat inspection. Further re-organisation of local government is inevitable and the paper suggests the development of a broader based environmental health and public safety service within local government, mirrored nationally by a similar department at the Scottish Office. The key roles of the Environmental Health (Scotland) Unit and the Royal Environmental Health Institute of Scotland in the future development of the profession are highlighted.
This paper outlines the asbestos hazard in Scotland and draws upon a systematic oral history project to analyze from the workers' perspective the nature of exposure, the limitations of government regulatory initiatives, and the ramifications of contracting asbestos-related diseases for sufferers and their families. Current issues are investigated, stressing the agency of workers, trade unions, sympathetic local councils, and, especially, the victims' pressure groups. The occupational and environmental health threats of asbestos in Scotland remain significant, although recent E.U.- and U.K.-based decisions to ban further use of asbestos together with active campaigning by local activist groups have helped to reduce them. Mesothelioma mortality rates remain high, due to historic exposures, and much work remains to be done to reduce the number and plight of asbestos-exposed workers.
BACKGROUND: Recent United Kingdom strategies focus on preventable suicide deaths in former psychiatric in-patients, but natural causes of death, accidents and homicide may also be important. This study was intended to find the relative importance of natural and unnatural causes of death in people discharged from long-term psychiatric care in Scotland in 1977-1994. METHODS: People discharged alive from psychiatric hospitals in Scotland in 1977-94 after a stay of one year or longer were identified using routine hospital records. Computer record linkage was used to link hospital discharges to subsequent death records. Mortality was described using a person-years analysis, and compared to the general population rates. RESULTS: 6,776 people were discharged in the time period. 1,994 people (29%) died by the end of follow-up, 732 more deaths than expected. Deaths from suicide, homicide, accident and undetermined cause were increased, but accounted for only 197 of the excess deaths. Deaths from respiratory disease were four times higher than expected, and deaths from other causes, including cardiovascular disease, were also elevated. CONCLUSION: Suicide is an important cause of preventable mortality, but natural causes account for more excess deaths. Prevention activities should not focus only on unnatural causes of death.
Our aim was to investigate if the clinical benefits of combination antiretroviral therapy recently reported from clinical trials are reproduced in a population-based HIV surveillance scheme. This surveillance scheme is estimated to cover 90% of the HIV-positive population currently under immunological monitoring in Scotland. Our results showed a considerable reduction in new AIDS cases among this group from 107 in 1995 to 59 in 1996 and an estimated 58 in 1997 (allowing for reporting delay). There was a similar fall in deaths from 75 in 1995 to 59 in 1996 and an estimated 24 in 1997. These observations are temporally associated with increasing prescription of antiretroviral therapy in Scotland throughout 1996 and 1997. Examination of those individuals monitored in both 1996 and 1997 showed that from their first CD4 count in 1996 to their first count in 1997 there has been a median gain of 6 CD4 cells/mm3 (95%CI 0-12) compared with a median fall of 27 CD4 cells/mm3 (95%CI -35, -17) for those monitored in both 1995 and 1996. Highest median gains in CD4 cell counts from 1996 to 1997 were seen in those receiving triple or quadruple therapy (median gain 32CD4 cells/mm3). These results are further strengthened by the results of a separate longitudinal analysis showing a highly significant (P < 0.001) effect of treatment on CD4 cell loss with the highest mean CD4 gains being seen in those in triple or quadruple therapy. Our results indicate that the benefits of combination antiretroviral therapy previously seen in clinical trials are being reproduced at a population level. It remains to be seen if these benefits can be sustained in the long term.
Until recently many remote communities in Scotland, especially on the northern islands, were unable to access specialist eating disorder services. The Grampian Eating Disorder Service, based in the north-east of Scotland, has developed a video-therapy service that offers specialist psychological and nutritional therapy for sufferers of eating disorders. Twelve patients have been treated via videoconferencing. Patients consistently rated high levels of satisfaction with all aspects of video-therapy, and after their last session 67% preferred video-therapy to face-to-face therapy. A number of patients commented that, compared with face-to-face therapy, they felt more in control and less intimidated in video-therapy. There was also a trend for patients to become more comfortable with video-therapy over the course of treatment. Nutritional knowledge increased for all patients, and the nutritional content of dietary intake also markedly improved over the course of therapy.
New case law on diminished responsibility in Scotland (Galbraith v. HM Advocate 2001) re-defined the defence and clarified the role of expert witnesses. We examined how this judgment affected the use of the defence, provision of expert evidence and the outcome of trials. We studied homicide cases in one area of Scotland in the year before and the year after the new judgment. Results indicated little change in the number of cases where the defence was used, but a difference in how psychiatrists set out their opinions.
UNLABELLED: Obesity is an increasing problem in Scotland and Laparoscopic Adjustable Gastric Bands (LAGB) are an effective method of weight reduction. Most outcome data are reported from high volume units with extensive experience or dedicated bariatric practice. We aimed to assess an experienced laparoscopic surgeon's outcome working outwith a dedicated bariatric practice in the west of Scotland. METHODS: All LAGB procedures performed by a single surgeon were prospectively assessed from 1997 to 2004. LAGB were inserted using pars flaccida approach. Patient selection was based on BMI >35 or significant obesity related co-morbidities. Outcomes included percentage excess weight loss (%EWL) and excess BMI loss (EBL). We assessed total operating time to assess the learning curve for LAGB placement. RESULTS: 125 patients were assessed (107 F:18 M). 123 patients were in regular follow-up (98%). Median age was 44 years (range 25-63). Mean follow-up was 34 months (range 11-91). Median initial BMI was 49 (range 37-73). 31% were BMI 35-45, 36% were BMI 45-50 and 33% were BMI>50. %EWL at 1,3 and 5 years was 45, 58 and 74, respectively. EBL at 1, 3 and 5 years was 11.7, 16.1, and 21.7, respectively. Complications included 4 converted procedures, 1 failed band insertion after conversion and re-operation for removal in five. Eight patients had tubing access port problems requiring intervention. The median overall total operation time was 80 minutes (range 50 - 160). CONCLUSIONS: In this cohort LAGB insertion by an experienced laparoscopic surgeon is safe with few re-operations. Satisfactory weight loss is obtained and patient compliance with follow-up is high.
We have investigated the annual incidence of Perthes' disease in Dumfries and Galloway (Southwest Scotland), in relation to the population density and socio-economic status. The incidence of Perthes' disease in rural Scotland is comparable with that in urban areas (15.4 per 100,000). There was a direct association between the incidence of Perthes' disease and deprivation scores, with the highest incidence in the most deprived areas. A higher incidence of Perthes' disease was noted in areas with a lower population density compared with those with a higher density. We found no correlation between population density and deprivation scores for individual electoral wards within the region.
STUDY OBJECTIVES: We aimed to investigate the epidemiology of self-reported chronic respiratory disease throughout Scotland, and to explore the relationship between quality of life and geographic location in those reporting disease. DESIGN: A cross-sectional study. Self-reported data on age, gender, socioeconomic factors, smoking habits, selected illnesses (major respiratory and atopic diseases, and other major conditions), respiratory symptoms, use of medicines and health services, and quality of life were collected using a postal questionnaire. PARTICIPANTS: A total of 4,560 adults registered with 1 of 57 family practices (22 rural and 35 urban) throughout Scotland. RESULTS: The response rate was 60%. Following adjustment for potential confounders, participants from rural areas reported a significantly lower prevalence of any chest illness (adjusted odds ratio [OR], 0.72; 95% confidence interval [CI], 0.58 to 0.91), asthma (adjusted OR, 0.59; 95% CI, 0.46 to 0.76), and eczema/dermatitis (adjusted OR, 0.67; 95% CI, 0.52 to 0.87). Rural location was less likely than urban location to be associated with the reporting of persistent cough and phlegm and different symptoms (types of breathlessness and wheeze) indicative of asthma. No difference in prevalence was found for other respiratory problems. Participants from rural areas reporting COPD or emphysema, or cough or phlegm symptoms had significantly better quality of life scores than their urban counterparts. CONCLUSIONS: In this study, living in a rural area was associated with a lower prevalence of asthma but not other chronic respiratory disorders, and a lower prevalence of some respiratory symptoms (including wheeze). Although the prevalence of COPD or emphysema did not differ between rural and urban areas, rural residency appeared to be associated with better health status among subjects with these conditions.
BACKGROUND: Communication and transfer of information between healthcare professionals are essential to a seamless healthcare process, and are vital for ensuring that there is smooth transition of care for patients. Throughout the National Health Service (NHS) Scotland, there is a wide variability in the quality and quantity of information provided in the immediate discharge document (IDD). AIMS: To analyse general practitioner (GP) attitudes and responses on the quality and efficacy of an electronic IDD (e-IDD). SETTING: All GPs in Dumfries and Galloway. METHODS: GPs communicating electronically with the hospital were sent a survey questionnaire at the end of an 18-month pilot. An amended questionnaire surveying potential interest was sent to the remaining GPs in the region. RESULTS: The overall response rate was 70%. Eighty-one percent of practices connected received the e-IDD regularly, but the majority still used it in conjunction with its postal equivalent. Seventy percent complained of inadequacies in content relating to medication and follow-up information. Eighty percent agreed that it was faster and 68% felt significant cost savings could be made. Eighty-eight percent wanted a multidisciplinary input. Concerns were raised about funding, need for adequate training and back-up systems. Ninety-six percent were optimistic that in future other forms of clinical communications could be sent electronically. CONCLUSION: Discharge content is more important than delivery method. Emphasis should be placed on ensuring standards are met on the quality and quantity of current e-discharge documents. Further clarification is required on patient confidentiality issues and legal validity of electronic patient records. E-health is to play a larger and ever-increasing role in the NHS in Scotland.
OBJECTIVE: To gain a better understanding of the level of literacy in information technology (IT) across the dental team working within primary care in Scotland, thus allowing appropriate planning of education and training for effective use of IT. DESIGN: A postal questionnaire survey of all dentists and dental care professionals (DCPs) within primary care in Scotland; online reply was also an option. SETTING: General dental practice and the salaried dental service, May 2004. SUBJECTS AND METHODS: 2679 dentists and 2861 DCPs were surveyed. RESULTS: Forty-three percent of respondents considered their IT skills to be 'moderate', with a further one-third reporting 'nil' or 'low' skill level. Only a quarter of respondents had accessed a learning programme by computer. The majority of IT competence was self-acquired. CONCLUSIONS: 'Upskilling' the dental team in IT may be required in order to take advantage of e-learning opportunities available now and in the future.