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PubMed1993

Epidemiological aspects of outbreaks of food-borne salmonellosis in Scotland between 1980 and 1989.

Between 1980 and 1989, 2,212 outbreaks of food-borne infection were reported in Scotland. Of 2,073 episodes for which a causative agent was established, 1,732 (84%) were caused by salmonellae. An average of 980 people were affected each year, while the average number of individuals infected per general outbreak was 16.8. The infected foods were consumed outside Scotland in 25% of the outbreaks. In 75% of 1,107 episodes where the location was specified, the implicated foods were consumed in the home; hotels and restaurants accounted for 15%. Specific food items were identified in 603 (35%) of the 1,732 outbreaks; poultry meat was responsible for 332 (55%) and milk 49 (8%), while eggs accounted for 23 (4%) outbreaks.

Animals↗
PubMed2005

Urban-rural inequalities in ischemic heart disease in Scotland, 1981-1999.

OBJECTIVES: We sought to describe the pattern and magnitude of urban-rural variation in ischemic heart disease (IHD) in Scotland and to examine the associations among IHD health indicators, level of rurality, and degree of socioeconomic deprivation. METHODS: We used routine population and health data on the population aged 40-74 years between 1981 and 1999 and living in 826 small areas (average population=5600) in Scotland. Three IHD health indicators-mortality rates (deaths per 100,000 population), rates of continuous hospital stays (discharges per 100,000 population), and rates of mortality in the hospital or within 28 days of discharge (MH+) were analyzed with multilevel Poisson models. A 4-level rurality classification was used: urban areas, remote small towns, accessible rural areas, and remote rural areas. RESULTS: Rates of mortality, continuous hospital stays, and MH+ increased with area socioeconomic deprivation. After adjustment for population age, gender, and deprivation, the relative risk of IHD mortality in remote rural areas was similar to that of urban areas in 1981; the relative risk of a continuous hospital stay was significantly lower (relative risk [RR] = 0.70; 95% confidence interval [CI] = 0.64, 0.76) and the relative risk of MH+ was higher (RR=1.18; 95% CI=1.04, 1.35) in remote rural areas. Mortality and MH+ declined for all ruralities over time. However, MH+ remains highest in remote rural areas and remote towns. CONCLUSIONS: Low standardized ratios of IHD continuous hospital stays and mortality in remote rural areas mask health problems among rural populations. Although absolute and relative differences between urban and rural rates of MH+ have diminished, the relative risk of MH+ remains high in remote rural areas.

Aged↗
PubMed2000

Are the WOSCOPS clinical and economic findings generalizable to other populations? A case study for Belgium. The WOSCOPS Economic Analysis Group. West of Scotland Coronary Prevention Study.

AIMS: As the West of Scotland Coronary Prevention Study (WOSCOPS) was conducted in Scotland, a country well-known for its high cardiovascular risk, the generalizability of its findings on pravastatin's clinical and economic effects has been questioned. This study examines the legitimacy of this concern, using Belgium as a case study. METHODS AND RESULTS: Local information on the prevalence and clustering of risk factors in individual patients was used in a risk equation to estimate the reference risk in Belgium. In contrast to prevailing beliefs, this risk was shown to coincide with the trial population's risk. As the relative risk reduction documented in a trial should apply across populations, the health benefits observed in WOSCOPS can clearly be extrapolated. This information in combination with local costs was then used to assess the economic efficiency of primary prevention with pravastatin in Belgium by means of a previously developed model. In parallel with the original estimates for the United Kingdom, the cost-effectiveness ratios remain well within the range of what is considered strong to moderate evidence for adoption and appropriate utilization, over a wide range of input values. CONCLUSION: This study demonstrates that the clinical and economic findings from WOSCOPS can indeed be generalized to other populations.

Anticholesteremic Agents↗
PubMed2000

Hospitalizations for people with type 1 and type 2 diabetes compared with the nondiabetic population of Tayside, Scotland: a retrospective cohort study of resource use.

OBJECTIVE: To compare the hospitalizations of people with type 1 and type 2 diabetes with those of the nondiabetic population of Tayside, Scotland. RESEARCH DESIGN AND METHODS: This was a retrospective cohort study set in Tayside, Scotland. Study subjects were eligible for inclusion if they lived in Tayside from 1 January 1995 to 31 December 1995. The primary end point was hospitalization. Comparisons between people with and without diabetes were assessed using logistic regression modeling. RESULTS: The fixed population for the year 1995 included 366,849 people registered with a Tayside general practitioner; 7,735 (2.1%) of these had diabetes. Approximately 25% of all study subjects with diabetes had at least one hospital admission, compared with 12% of the nondiabetic population. The length of stay was highest for patients with type 2 diabetes (median of 7 days). People with diabetes accounted for 8.2% of the total bed days and had approximately double the risk of admission. Type 2 diabetic patients had increased risks of myocardial infarction and stroke; both type 1 and type 2 diabetic patients were at increased risk for an endocrine/metabolic admission or renal failure. The risk of ophthalmic admissions, especially for cataract, was much higher in patients with type 1 diabetes compared with the nondiabetic population. CONCLUSIONS: Type 2 diabetes was associated with more frequent and longer admissions compared with the nondiabetic population. This was due to a higher risk of neurological, cardiovascular, renal, and ophthalmic hospitalizations compared with people without diabetes.

Adult↗
PubMed2001

Factors influencing glycemic control in young people with type 1 diabetes in Scotland: a population-based study (DIABAUD2).

OBJECTIVE: To evaluate differences in HbA1c concentrations between centers and to assess the factors associated with glycemic control in young people with type 1 diabetes in Scotland. RESEARCH DESIGN AND METHODS: Data on 1,755 patients (94% of those registered) were collected from 18 centers providing care to children <15 years of age. At every clinic visit, a duplicate HbA1c sample was measured in a reference laboratory, and clinical information was collected prospectively. RESULTS: Average HbA1c concentration was 9.1% (range 5.0-15.0). The following significant associations with HbA1c level were identified: age, insulin regimen, BMI, season, social circumstances, and family history. HbA1c concentrations were significantly worse in older children (age 10-15 years 9.5% vs. other ages 8.8%, P < 0.001), those using two injections per day (2/day 9.1% vs. 3/day 8.8%, P < 0.01), children without both parents at home (9.4 vs. 9.0%, P < 0.001), a sibling with diabetes (9.7% vs. no family history 9.1%, P < 0.001). HbA1c concentration ranged from 8.1 to 10.2% between centers, after adjustment for factors associated with poor HbA1c (P < 0.001). CONCLUSIONS: The overall glycemic control of diabetic young people in Scotland is equivalent to a Diabetes Control and Complications Trial HbA1c concentration of 8.7%, placing the majority at a high risk of the complications of diabetes in adulthood. Although factors were significantly associated with poor HbA1c adjustment for these did not explain the differences between centers. We suggest that factors not analyzed in DIABAUD2 (e.g., deployment of resources, organization of the clinical structure, strategies of care, and clinic philosophy) are the determinants of HbA1c. We speculate that the style of utilization of optimum resources is the key to achieving good glycemic control.

Adolescent↗
PubMed2006

Association of pathological gambling with depression in Scotland.

Is most research concerning gambling and depression has been conducted on clinical populations, the present study examined the relationship between gambling and depression across a large sample in Scotland in higher education and the community. A questionnaire-based cluster design involved the distribution of the South Oaks Gambling Screen and the Centre for Epidemiologic Studies Depression Scale mainly to students and staff of higher educational establishments, with small community and gambling samples also included. Thirty-seven colleges and universities across Scotland participated in the research, with a sample of 2259 people aged sixteen years of age or over (M = 28.9 yr., SD = 13.4) being obtained. It was found that past-year probable pathological gamblers had significantly higher depression than problem gamblers, nonproblem gamblers, and nongamblers. However, when probable pathological gamblers who had sought treatment were omitted from the analysis, the nontreatment-seeking probable pathological gambling group no longer had significantly higher depression than the problem gambling group. Female problem and probable pathological gamblers had particularly high depressive symptomatology, suggesting co-morbid depression may be a prominent feature of problematic female gambling.

Adolescent↗
PubMed1999

Nationwide audit of pill knowledge amongst family planning users in Scotland.

OBJECTIVES: The primary objective of this study was to estimate knowledge about oral contraceptives amongst oral contraceptive users within family planning clinics in Scotland and to ascertain if this was due to clinicians not attempting to convey certain information or to a lack of understanding of teaching. METHOD: This was a criterion-based audit using three separate questionnaires to estimate the agreement of senior staff with criteria set by a multi-disciplinary expert panel, actual routine clinical practice and user knowledge. RESULTS: Senior clinical staff within family planning clinics in Scotland agreed with 12 out of 15 criteria set by a multidisciplinary panel in over 85% of cases. For six out of 15 criteria, there was a discrepancy of more than 30% in what clinicians did in practice compared to what senior staff thought they ought to do. For a further two criteria, there was a deficiency of over 30% between the number of clients who understood the criteria and the number of clients the clinicians thought they had taught. Most importantly, these latter criteria included the rules for safe and effective pill taking. CONCLUSION: An improvement in user knowledge is required to achieve effective and reliable use of oral contraceptives. Methods of doing this, such as staff and client prompts, should be further explored.

Contraceptives, Oral, Combined↗
PubMed1998

Prioritisation in speech and language therapy departments in Scotland and Malaysia.

This study investigates how prioritisation in health services have influenced speech and language therapy (SLT) services in Scotland in prioritising their caseload. Additionally, it evaluates how current prioritisation systems may contribute towards the development of the SLT service in Malaysia. Health, education and social agencies in Malaysia were contacted and a literature review was conducted. Information on prioritisation systems used in Malaysia was unavailable. Prioritisation systems from seven SLT departments within Scotland were investigated, of which three SLT managers took part in semi-structured interviews. The findings show that prioritisation is influenced by a combination of factors and that the principles could only be applied to the Malaysian SLT service if consideration is given to the political, economical, social, geographical and cultural factors.

Health Priorities↗
PubMed2000

Nucleotide sequence variation in isolates of infectious salmon anaemia virus (ISAV) from Atlantic salmon Salmo salar in Scotland and Norway.

The nucleotide sequences of segments 2 and 8 of infectious salmon anaemia virus (ISAV) isolates from Scotland and Norway were determined and compared. Sequence variations were found in both segments, with segment 2 being more variable. These variations were of the same degree as those found in previous comparisons of the first recorded strain of ISAV in Scotland and Norwegian strains for which sequence information was available. The sequences again demonstrate the separation of European and Canadian strains of ISAV but, as is expected for an RNA virus, reveal that the European ISAV is not homogeneous. These results demonstrate the value of nucleotide sequences as a tool for strain identification and epidemiological investigation of ISAV.

Amino Acid Sequence↗
PubMed1999

Feline viruses in wildcats from Scotland.

Few data are available on the prevalence of feline viruses in European wildcats (Felis silvestris). Previous surveys have indicated that wildcats may be infected with the common viruses of domestic cats, apart from feline immunodeficiency virus (FIV). In the present study, 50 wildcats trapped throughout Scotland (UK) between August 1992 and January 1997 were tested for evidence of viral infection. All were negative for FIV by several serological or virological methods. By contrast, 10% of the cats were positive for feline leukemia virus (FeLV) antigen and infectious virus was isolated from 13% of a smaller subset. Of the wildcats tested for respiratory viruses, 25% yielded feline calicivirus (FCV) and although no feline herpesvirus was isolated, 16% of the samples had neutralizing antibodies to this virus. Antibodies to feline coronavirus (FCoV) were found in 6% of samples. Feline foamy virus (FFV) was an incidental finding in 33% of samples tested. This study confirms that wildcats in Scotland are commonly infected with the major viruses of the domestic cat, except for FIV.

Animals↗
PubMedDate not supplied

The Nursing Research Initiative for Scotland.

The Nursing Research Initiative for Scotland (NRIS) was established at the end of 1994, one of seven research units core funded by the Chief Scientist Office (CSO) of the Scottish Office. It is a national unit, so although its central base is in Glasgow, it works with nurses, other direct care staff and academics throughout Scotland.

Academies and Institutes↗
PubMed1999

The effects of pravastatin on hospital admission in hypercholesterolemic middle-aged men: West of Scotland Coronary Prevention Study.

OBJECTIVES: The purpose of the study was to assess the effect of lipid reduction with pravastatin on hospital admissions in middle-aged men with hypercholesterolemia in the West of Scotland Coronary Prevention Study. BACKGROUND: A prospective, randomized controlled trial was undertaken in primary care centers in the West of Scotland. METHODS: A total of 6,595 participants randomized to receive pravastatin 40 mg or placebo daily were followed up for a mean of 4.9 years (range 3.5 to 6.1 years). Analysis of hospital admissions was undertaken according to the "intention to treat" principle both for cardiovascular diseases and noncardiovascular diseases (including malignant neoplasms, psychiatric diagnoses, trauma and other causes). A secondary analysis of hospitalization in patients who were > or = 75% compliant was performed. RESULTS: During the trial, 2,198 (33%) of the 6,595 men were admitted to hospital on 4,333 occasions, of which 1,234 (28%) were for cardiovascular causes. Pravastatin reduced the number of subjects requiring hospital admission for cardiovascular causes by 21% (95% CI [confidence interval] 9 to 31, p = 0.0008) overall, and by 27% (95% CI 15 to 38) in compliant participants. The number of admissions per 1,000 subject-years for cardiovascular disease was reduced by 10.8 (95% CI 4 to 17.4, p = 0.0013) in all subjects, and by 15.6 (95% CI 8.3 to 23, p < 0.0001) in compliant participants. Pravastatin had no significant influence on hospital admission for any noncardiovascular diagnostic category. There were 13.4 fewer admissions per 1,000 subject-years for all causes in the pravastatin-treated group (95% CI -0.4 to 27.3, p = 0.076). No significant difference in duration of hospital stay was found between the pravastatin and placebo patients in any diagnostic group. CONCLUSIONS: Pravastatin therapy reduced the burden of hospital admissions for cardiovascular disease, without any adverse effect on noncardiovascular hospitalization.

Anticholesteremic Agents↗
PubMed1991

General management in the NHS: comparisons and contrasts between Scotland and England.

The NHS takes rather different forms in England and Scotland, and comparisons can be instructive. David Hunter and Peter Williamson look at the way general management was evolved in the two countries. If so far it has not flourished in Scotland that may be because it was the adoption of arrangements designed for England, but it may also reflect differences between the two countries.

Administrative Personnel↗
PubMedDate not supplied

'Tomlinson' in Scotland.

The Management Executive (ME) in Scotland has recently announced that between 3000 and 7000 acute sector beds are to be lost in Scotland by the year 2001, for many of the same reasons that the Tomlinson report recommended beds be cut in London. Health boards are developing plans to restructure hospital services but issues of public and professional support for the plans they produce, and questions of funding, will determine the final outcome.

Efficiency↗
PubMedDate not supplied

Ethical review of a multicentre study in Scotland: a weighty problem.

OBJECTIVE: To assess the current working practices of local research ethics committees (LRECs) in their review of a multicentre study approved by the new multicentre research ethics committee in Scotland. DESIGN: Observational data collected from correspondence with LRECs. SUBJECTS: All LRECs within the geographical area of the study in Scotland. INTERVENTIONS: None. OUTCOME MEASURES: Delay from application to calling an LREC meeting, to an initial LREC decision, to final LREC approval, and the number of A4 pages required. RESULTS: The median delay to review of an application at an LREC meeting was 28 days (range 14-97), the median delay from application to the time of LREC final approval was 39 days (range 21-109) and a total of 5,789 A4 pages (26.9 kg) were required to complete the application process. CONCLUSIONS: Despite recent standardisation of ethical review of multicentre research, elimination of unnecessary delay, cost and variation in LREC operating procedures is still necessary.

Ethics Committees↗
PubMed2000

Drug-related deaths among recently released prisoners in the Strathclyde Region of Scotland.

Drug abuse and its consequences are everyday problems encountered globally, and Scotland is no exception. During a study of drug-related deaths in the Strathclyde region of Scotland it was noted that known drug users who had recently been released from prison were at high risk of dying from a drug overdose. The majority of deaths occurred within one week of the release date and polydrug use was prevalent. Morphine was the most frequently encountered drug and this was found in combination with benzodiazepines in a significant number of cases. This paper highlights the dangers of resuming drug consumption following a period of abstinence.

Adult↗
PubMed2000

Unexplained illness and death among injecting-drug users--Glasgow, Scotland; Dublin, Ireland; and England, April-June 2000.

Since April 19, 2000, 30 injecting-drug users (IDUs) died or were hospitalized with unexplained severe illness in Glasgow, Scotland. Illness was characterized by extensive local inflammation at a subcutaneous or intramuscular injection site often followed by hypotension and circulatory collapse. Since April 24, 2000, 15 IDUs in Dublin, Ireland, and 14 IDUs in England with similar illnesses have been identified. Despite debridement and broad spectrum antibiotics, 30 (51%) of the 59 patients in all three countries have died. This report further describes the clinical syndrome and key epidemiologic features of the illness as characterized by a preliminary investigation by health authorities in Scotland, Ireland, England, and the United States (1).

Adult↗
PubMed2000

Investigation and management of sporadic gastrointestinal infections with potentially Vero cytotoxin producing Escherichia coli in Scotland.

Recognition of the potential of Escherichia coli O157 and other Vero cytotoxin producing E. coli (VTEC) organisms to cause serious disease led to the recommendation that all diarrhoeal stool specimens be examined for E. coli O157. National guidelines exist for the testing and exclusion of cases and contacts of VTEC infection. A survey was conducted to discover the extent to which these recommendations are followed in Scotland by asking about current practices for public health management of identified cases and laboratory investigation of E. coli infection. About two thirds of Scottish health boards followed national guidelines for testing and exclusion of cases and contacts of VTEC O157 infection. Most laboratories tested all diarrhoeal stools for E. coli O157 but detection methods varied and a minority tested selected stools for non-O157 E. coli serogroups. Standardisation of policies for laboratory testing of VTEC infection would improve national surveillance. Adherence to evidence based guidelines would standardise public health management of VTEC infections in Scotland.

Aged↗