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PubMed1992

Knowledge of drug costs: a comparison of general practitioners in Scotland and England.

The implementation of drug budgets will make it essential that general practitioners are aware of prescribing costs. A previous study of general practitioners in Scotland found that their knowledge of drug costs was often inaccurate. At the time of the Scottish study, doctors received very limited information on prescribing costs. By contrast, general practitioners in England have been receiving much more detailed information on their prescribing costs since the introduction of PACT (prescribing analyses and cost) in 1988/89. This study examines whether, as a result, doctors in England are more aware of drug costs. The results suggest that they are not; indeed, doctors in Scotland had marginally better knowledge of drug costs. There is a continuing need to improve the cost information available to general practitioners.

Awareness↗
PubMed2006

Male suicide and occupation in Scotland.

Some occupational groups in England and Wales have higher than expected proportion of deaths from suicide or undetermined intent. This study examined the association of occupation with suicide in men in, Scotland. Information from the General Register Office for Scotland was used to identify deaths from suicide and undetermined intent in 1981-1999 for men aged 16-64 years. Proportional Mortality Ratios (PMRs) and 95 per cent confidence intervals were calculated for all occupational categories. The largest number of male deaths in groups with elevated PMRs occurred in low paying occupations, such as labourers. Counterhands (sales and stores assistants) and assistants and chefs and cooks had increased PMRs in the 16-45 year age group. Some occupations with access to lethal means of suicide had high PMRs, including medical practitioners in the 16-45 and 46-64 year age groups and hospital ward orderlies, in the younger age group. There were increased PMRs in some rural occupations including farmers, forestry workers, fishermen, and some ships' crewmembers. Groups with low

Adolescent↗
PubMed2006

Suicide in farmers in Scotland.

INTRODUCTION: Farmers and farm workers have higher than expected rates of suicide and undetermined deaths in UK studies, and some rural areas of Scotland have higher than average male suicide rates. Firearm access seems to be an influencing factor in England and Wales. Type of farming, and farming social networks may also be important. This article describes suicide and undetermined deaths in male farmers and farm workers in Scotland from 1981-1999 using anonymised, routine data. METHOD: Deaths of men aged 15-74 years from suicide or undetermined cause were identified from anonymised Scottish death records. Farmers and farm workers were identified using occupation codes. Methods of suicide used by farmers were compared with those of the general male population of the same age. A multiple linear regression was used to examine the influence of farm type, and the proportion of farmers in the working population of an area. RESULTS: 307 male farmers or farm workers died by suicide or undetermined cause in the time period. The overall rate was 31.4/100,000 per year (95% CI 28.1-35.1). Deaths using firearms were over-represented (29% of farming deaths compared with 3.6% in the general male population). There was no significant association between the male suicide rate in an area, and the farming suicide rate. Areas with lower proportions of farmers tended to have higher rates of farming suicide and undetermined deaths. This one factor described 85% of the variance among areas. CONCLUSION: Deaths were substantially more likely to involve firearms than suicide and undetermined deaths in the general male population. Less use of other methods did not completely compensate for this, indicating that method availability is likely to contribute to farming suicide rates. Farmers in areas where farming is less common were more likely to die by suicide, and this described most of the differences among areas. Networks and social supports may be important protective factors for farmers.

Accidental Falls↗
PubMed2006

Cost-benefit analysis and the water framework directive in Scotland.

The Water Framework Directive seeks to achieve the enhancement of aquatic ecosystem quality for all waters across Europe. However, it recognizes the need to accommodate social and economic considerations, so Heavily Modified Water Bodies may be designated where achievement of the Directive's objectives may result in disproportionate costs. This necessitates the use of cost and benefit data, which may be hard to acquire. Benefits and costs of implementing the Directive also can be tested at the national level. This paper considers the evaluation of costs and benefits at 2 scales in Scotland: microlevel analysis, for case studies on the rivers Tummel and Dee and the Forth Estuary, and macrolevel analysis. In the microlevel analysis, costs of hydroelectric power generation are compared with the marginal benefits of increased fisheries revenues and are argued to be disproportionate. In the estuary environment, the benefits of returning an area to ecologically productive salt marsh and mudflats are compared with the costs of lost agricultural revenue. In the macrolevel analysis, we compare the costs to impacted industries with the estimated national benefits from implementing the Directive. We find that for Scotland as a whole, implementation is predicted to result in positive net social benefits.

Conservation of Natural Resources↗
PubMed2006

Exploring potential explanations for the increase in antidepressant prescribing in Scotland using secondary analyses of routine data.

BACKGROUND: Antidepressant prescribing in general practice has dramatically increased since the beginning of the last decade. AIM: To determine if the increase in antidepressants prescribed in Scotland between 1995 and 2001 was due to increase in incidence, prevalence, care-seeking behaviour by patients, or identification by GPs of depression. METHOD: Secondary analysis of routine data. Prescribing information was obtained from Information and Statistics Division Scotland, psychosocial morbidity from the Scottish Health Surveys of 1995 and 1998 and GP consultations from the continuous morbidity recording (CMR) dataset. Annual trends in antidepressant prescribing for prescriptions, gross ingredient cost and defined daily doses (DDDs) were examined for all Scottish Practices and 54 stable CMR practices (175 955 patients). Prevalence of psychological morbidity in responders with a General Health Questionnaire score > or = 4, their contact probability and contact frequency was compared in the 1995 and 1998 Scottish Health Surveys. Changes in diagnostic and GP consultation patterns in CMR practices were compared. RESULTS: Total prescriptions for antidepressants increased from 1.5 million in 1995-1996 to 2.8. million in 2000-2001. The gross ingredient cost increased from pounds 20 to pounds 44 million and total DDDs from 44.5 to 93.2 million. Prescription trends in CMR practices were similar. Overall prevalence of psychological morbidity was the same in the 1995 and 1998 Scottish Health Surveys. Percentage of consultations in CMR practices for new diagnoses of depression decreased from 1.7 to 1.3%, the depression-related contact rate decreased and annual prevalence rates for depressive illness were stable between 1998-1999 and 2000-2001. CONCLUSIONS: There is no evidence of an increase in incidence, prevalence, care-seeking behaviour or identification of depression during the period of a sharp increase in antidepressant prescribing. Further work is required to explain the increase.

Adolescent↗
PubMed1991

Continuing hospital care in Scotland: a survey of consultant geriatricians.

We report a survey of Consultant Geriatricians in Scotland with regard to the provision of continuing geriatric care. There are wide variations in the numbers of patients that individual consultants are responsible for, the type and geographical site on which a service is provided, and also in views on the adequacy of staffing levels. Quality of physical surroundings and nursing care are generally thought to be more than adequate. Consultants believed their main contribution was providing expert medical advice, and felt their patients' quality of life could most be improved by increased diversional therapy. There are wide geographical differences in the number of private nursing and residential homes in Scotland but they have had some influence on the criteria for placement of patients in continuing hospital care.

Aged↗
PubMed1989

Coefficients of relationship by isonymy within and between the regions of Scotland.

The distribution of surnames for births, marriages and deaths in 1976 among residents of the 12 Local Government Regions of Scotland was analyzed in terms of the coefficient of relationship by isonymy, Ri. Differences between sexes and events for Ri within Regions were consistent with greater inter-Region mobility among males compared with females and among young adults compared with the elderly. There were near zero correlations of geographical distance with Ri between Regions based on all surnames or common surnames. With Ri based on rare surnames, there was a small though statistically nonsignificant negative correlation. The best-fitting two dimensional relationship derived from Ri values based on rare surnames showed a fair correspondence with the map of Scotland, indicating a degree of genetic isolation between the Regions.

Adult↗
PubMed1989

A survey of the work of medical advisers appointed to panels under the adoption; boarding out and fostering regulations (Scotland 1984 and 1985).

Following the implementation of new Adoption Regulations (Scotland) 1984 and Boarding Out and Fostering (Scotland) 1985, a preliminary survey of Scottish Medical Advisers was carried out in December 1987 to examine current background and practice in this area of work. A very high response rate was achieved and the findings and some implications are considered. The growth, actual and expected in this area of health board/social work collaboration, has cost implications for management.

Adoption↗
PubMed1988

Between-group differences in basal metabolic rates: an analysis of data collected in Scotland, the Gambia and Thailand.

Basal metabolic rate (BMR; using the Douglas bag method), body weight, and fat-free mass (FFM; using the skinfold method) were measured in 46 Scottish and 47 Gambian women in the non-pregnant non-lactating state and in 91 Scottish, 50 Gambian and 52 Thai women early in pregnancy. There were significant between-country differences in BMR (1) in absolute terms (MJ/d), (2) per kg body weight and (3) per kg FFM. However, these differences probably resulted from differences between the groups in average body weight and body composition. Differences per kg body weight were in part explained by differences in body fat content and the relatively low metabolic rate of adipose tissue. Differences in BMR/kg FFM were largely explained by between-group differences in the mass of the FFM, together with the finding that within each group, the BMR/kg FFM tended to decrease as weight increased. There were no significant differences in BMR between Scottish, Gambian and Thai women of similar FFM. There were, therefore, no apparent effects on BMR due to differences in race, climate, diet or nutritional status. Differences in the composition of the FFM could explain the 15 per cent lower BMR/kg FFM in the heaviest compared to the lightest subjects. This brings into question the widespread practice of using FFM as a metabolic reference standard. In contrast, BMR divided by the square root of FFM was similar in all three countries: for non-pregnant women, in MJ/kg0.5/d (mean and s.d.), Scotland 0.87 (0.07) and The Gambia 0.89 (0.07), and for pregnant women, Scotland 0.86 (0.07), The Gambia 0.87 (0.06) and Thailand 0.87 (0.08), and this may be a useful basis for comparing different groups in future. The accuracy of two equations for predicting BMR was assessed. The equation of FAO/WHO/UNU (1985) accurately predicted, from body weight, the average BMR of Scottish women, but under-estimated the average BMR of Gambian and Thai women by 5-10 per cent. The equation of Garby et al. (1988), which predicts BMR from FFM and fat mass, under-estimated the BMR of Scottish, Gambian and Thai women by 5, 10 and 14 per cent respectively, with the largest error within each group being for subjects with the smallest FFM.

Adipose Tissue↗
PubMed1985

Trichostrongyle larval populations on herbage from grazed and ungrazed cattle pastures in south west Scotland.

In the course of studies on the control of bovine parasitic gastroenteritis in south west Scotland using a morantel sustained release bolus the populations of trichostrongyle infective larvae on herbage were monitored over a two-year period. From the results of the herbage analysis and the worm burdens in parasite naive tracer calves introduced at the end of 18 months, it was clear that considerable numbers of infective larvae of Ostertagia ostertagi and Cooperia oncophora survived for at least 18 months on pastures not grazed at all. The results suggest that in south west Scotland after one, or even two, seasons with no further contamination of grazing, permanent cattle pastures cannot be assumed to be helminthologically 'safe' and that this should be taken into consideration when determining prophylactic strategies.

Animals↗
PubMed1974

Survey of general practitioners' views on postgraduate education in North-east Scotland.

A questionnaire was sent to all doctors in North-east Scotland enquiring about postgraduate education. The educational programme devised by the Education Committee of the North-east Scotland Faculty of the Royal College of General Practitioners was considered to be relevant, interesting, and well-planned. Suggestions made by the doctors have been taken account of by the Education Committee in their present programme.Journals considered to have the best educational content were Prescriber's Journal, Update and The Practitioner. Those doctors who read The Journal of the Royal College of General Practitioners thought it expressed up-to-date and helpful views about the development of general practice. However, it was ranked poorly alongside such journals as Update.The doctors rated contact with their partners and hospital colleagues as the most important sources of education. These links must be a growth point for postgraduate education within an integrated health service.One-week courses, covering several subjects with a variety of presentations, were most favoured by the replying doctors.

Education, Medical, Continuing↗
PubMed1983

Susceptibility of itinerants ("travelling people") in Scotland to poliomyelitis.

A total of 109 travelling people (people with a nomadic lifestyle), living on 8 separate sites in central and south Scotland, were examined for neutralizing antibodies to poliovirus types 1, 2, and 3. Of those studied, 10% had no detectable antibody to poliovirus type 3 while 7% had no antibody to type 1, the types most commonly associated with outbreaks of paralytic poliomyelitis. Only one subject, a child aged 9 years, had no detectable poliomyelitis antibody; he had no history of poliomyelitis immunization. The best protected groups of travellers were those located on sites with good facilities.As far as poliomyelitis is concerned, we conclude that travelling people in Scotland who live on well equipped sites do not pose a hazard to nearby settled populations and, indeed, are no more vulnerable to infection than members of those communities.

Adolescent↗
PubMedDate not supplied

Subarachnoid spinal analgesia. A comparative survey of current practice in Scotland and Sweden.

A postal inquiry into the current use of subarachnoid spinal analgesia obtained replies from approximately 70% of consultants in both Scotland and Sweden. Although medico-legal anxiety was still an important feature of Scottish practice, the publication of large series with a low incidence of complications had also exerted some influence, and 40% of consultants employed the technique. In contrast, 70% of Swedish replies indicated current use of spinal analgesia and the individual frequency of administration was considerably higher. The present popularity of epidural analgesia has contributed to some decline in the use of subarachnoid spinal analgesia in Sweden, particularly in the case of longer surgical procedures. Anaesthetists in both countries expressed dissatisfaction with the limited choice of available spinal agents and considered their duration of action to be inadequate. In Scotland, conditional indications, such as diabetes mellitus and respiratory disease, were of major importance, whereas Swedish users more often specified surgical procedures for which subarachnoid spinal analgesia was considered to be the anaesthetic of choice. Few anaesthetists had experience of complications and no major neurological sequelae were reported. More than 80% of replies indicated that subarachnoid spinal anaesthesia had a useful place in anaesthetic practice.

Anesthesia, Spinal↗
PubMed1995

Health promotion and the use of Gpass in Scotland.

OBJECTIVE: To identify how computerised practices using Gpass software (General Practice Administration System for Scotland), currently implement the new health promotion regulations. DESIGN: Postal questionnaire to all Gpass practices in Scotland. Data were gathered on types and methods of recording health promotion data, Read code selection, health education given and intended methods of data analysis. Questionnaire results were compared with data from an Electronic Questionnaire analysing actual data recorded on practice computers. RESULTS: Overall response rate: 64.6%, 94.8% of the responding practices have been approved for health promotion band three. Most practices (94.5%) use their computer for data collection, 63.6% of practices use a manual data capture form and 28.8% use computer data capture methods. Methods of collecting patient data and selection of Read codes for computer data entry are variable. Most practices use one method of data collection; a significant minority use multiple methods or more than one Read code to record the same item. The recording of health promotion on computer has increased greatly since the introduction of the new regulations: the current levels of recording are alcohol history (26.3%), blood pressure reading (57.6%), smoking (35.4%), exercise (7.1%), weight (21.4%) and height (16.4%). Most practices (94.3%) intend using Gpass for data analysis. CONCLUSION: Methods of collecting and recording health promotion data differ greatly between practices, with variable standardisation of health promotion codes and differing use of appropriate elements of the Gpass software.

Adult↗
PubMed1993

Human hydatid disease leading to hospital admission in Scotland 1968-1989.

An attempt to estimate the impact of hydatid disease upon human health in Scotland between 1968-89 was made by examining Scottish hospital discharge statistics, and death statistics. Because hydatid disease may be asymptomatic, and coding errors are more likely to occur with rare diseases, an assessment was made as to the likelihood of hydatid disease having been responsible for hospital admission. Over the 22 year period a total of 110 hospitalised individuals with a diagnosis of hydatid disease were identified; no deaths were recorded. Inspection of the other diagnoses and operations recorded for each case suggested that hydatid disease was responsible for hospital admission in only 65 individuals (59%). One further individual, who had been admitted to a hospital outside Scotland, was identified from a Western Isles register of cases receiving surgery for hydatid disease. This register was used to assess the completeness of the Scottish hospital statistics; 10/11 Western Isles cases were identified using hospital statistics. Local case registers seem essential for accurate estimates of incidence and prevalence, and to evaluate the need for control programmes. The median age of the 66 individuals considered to have been admitted to hospital because of hydatid disease was 49 years (range 4-85); 38 (58%) were male. A total of 36 cases were managed surgically (55%), and there was a tendency for the use of surgery to increase over the 22 year period. The Health Boards with the highest incidence of clinically apparent infection leading to hospital admission were: Western Isles, Shetland and Highland; with 2.53, 1.23, and 0.21 cases per 100,000 population per year respectively.

Adolescent↗
PubMed1996

The educational needs of staff grade doctors and dentists in Scotland.

OBJECTIVE: Since its introduction in 1990, the Staff Grade has expanded to comprise almost 10% of the career grade establishment in Scotland. A study of this new grade was carried out to determine its progress and whether educational needs were being met. DESIGN: A questionnaire was sent to all doctors and dentists in the Staff Grade asking about reasons for applying; working environment; educational needs and perceptions of the grade. SUBJECTS: In Scotland 45% of Staff Grade doctors and dentists are male and 55% are female. The majority of posts are held by UK qualified women and overseas qualified men. RESULTS: Post holders are well qualified. 56% hold at least one full Membership or Fellowship qualification. The main reasons for applying for a Staff Grade post are domestic commitments and the desire for a permanent post. Staff Grade doctors are often used to strengthen 'middle grade' services and cover awkward times. The majority feel the educational content of their job is sufficient. Of those who were dissatisfied, most complained of a lack of formal education. In general the doctors and dentists feel they are viewed with respect by colleagues. Comments showed that senior staff are more positive towards the grade than juniors. 21% of Staff Grade doctors and dentists still hope to achieve Consultant status, although the greater majority do not think it likely they will reach this level. CONCLUSIONS: In the short term the introduction of the grade has been a success. The service needs which otherwise would be difficult to meet have been covered by the appointment of Staff Grade doctors and dentists. For the individual the Staff Grade has often been the answer to personal rather than professional aspirations. Some battle against colleagues' misconceptions that the grade is for 'failed Consultants'. Isolation is a problem for others. There is a desire to keep knowledge up to date, but heavy workload and problems in scheduling prevent many from attending educational activities. If the Staff Grade is to be an attractive option in the long term, there needs to be some form of career progression for the doctors and dentists within it.

Adult↗
PubMed1996

Nuclear medicine in Scotland: a survey of departments. Scottish Nuclear Medicine Audit Group.

A postal survey has been performed of all departments in Scotland providing a Nuclear Medicine service. Twenty out of twenty-one departments replied to a questionnaire, which sought information on staffing, equipment and general operational procedures. The results give an impression of the organisation and structure of Nuclear Medicine in Scotland and provide a foundation for further work on regional audit of various aspects of Nuclear Medicine practice.

Health Services Research↗
PubMed1996

The measles/rubella immunisation campaign in Scotland.

This report describes why the 1994 measles/rubella immunisation campaign was necessary, reviews its implementation, and provides information on its impact in Scotland where 60,504 children were immunised. Data on suspected adverse reactions to the measles/rubella vaccine are also presented. A large UK measles epidemic was predicted by independent researchers, and action in response was planned in accordance with the recommendations of the Joint Committee on Vaccination and Immunisation. As a result, the epidemic predicted for England and Wales was averted and the epidemic which had occurred in the West of Scotland was prevented from spreading to the East. Laboratory-confirmed cases of measles and rubella are now rare in all parts of the UK, especially in the age group targeted by the campaign. Most reported adverse reactions were mild and self-limiting: only one child per 6,700 vaccinated in the UK was reported to have suffered any adverse reaction. Immediate, serious reactions were either allergic or were described as convulsions (most associated with immediate syncope); all of these children recovered fully. Later onset neurological problems were reported at rates no higher than expected from normal population incidence.

Adolescent↗