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PubMed1996

The need for renal replacement therapy in Scotland.

Each year 80-100 people per million of the population develop end stage renal failure and are medically suitable for renal replacement therapy. This need has been met in Scotland in each of the last three years. With current knowledge there is no prospect of measures to prevent renal disease affecting this number in the foreseeable future. The number of patients on renal replacement therapy in Scotland will increase over the next 15 years to approximately 160% of the current number. The mean age of patient on replacement therapy will increase progressively over the next 15 years. The increase in numbers will be in patients receiving 'in centre' haemodialysis and in those with functioning renal transplants. To meet this increase an approximately 3-4 increase in the current 'in centre' haemodialysis facilities will be required. Additional haemodialysis centres should be established to reduce the time spent by patients travelling for treatment and to avoid centres becoming 'impersonal' by becoming too large. Moves to increase the transplantation rate should be encouraged as transplantation offers the best quality of life for patients. Research should be directed towards improving long term graft survival.

Adolescent↗
PubMed1996

An audit of BCG immunisation and tuberculin skin testing in Scotland. Scottish BCG Study Group.

BACKGROUND: BCG vaccination of all tuberculin-negative schoolchildren has been undertaken in the United Kingdom since 1954. In light of the ten-fold decline in tuberculosis, mass vaccination may no longer be justified. Since most tuberculosis cases now occur among identifiable high-risk groups, restriction of vaccination to these groups may be more appropriate. Before such changes can be recommended, further information is required on current practice within Scotland. OBJECTIVE: To determine current BCG vaccination practice within Scotland, in order to inform planning of future immunisation services. DESIGN: Postal questionnaire survey. SETTING AND SUBJECTS: The questionnaires were posted to the Consultant in Public Health Medicine responsible for Communicable Disease Control in each of the fifteen Scottish Health Boards. RESULTS: Completed questionnaires were returned by all 15 Health Boards. Marked variations were reported in the vaccination of both schoolchildren and high-risk groups. Six (40%) Health Boards immunised all tuberculin-negative children, whereas the remainder excluded those with evidence of previous BCG vaccination. All Health Boards immunised contacts of tuberculosis cases, 11 offered it to healthcare workers and 11 to immigrants from countries with a high prevalence of tuberculosis. However, only 7 offered it to the offspring of high-risk ethnic groups, 5 to students and 4 to animal workers. CONCLUSION: There are marked variations in current BCG vaccination practice. Greater efforts are required to ensure that high-risk groups receive vaccination.

Adolescent↗
PubMed1997

The prevalence of epidermolysis bullosa in Scotland.

The prevalence of epidermolysis bullosa (EB) in Britain and most other countries is unknown. Patients suffering from the inherited forms of EB and living in Scotland have been traced. Two hundred and fifty-nine affected people from 76 families have been identified, of whom 211 were clinically assessed. One-third of these Scottish EB sufferers had never been seen by a dermatologist. In Lothian, where there appears to be a relatively high prevalence of EB, 75% of patients were unknown to their general practitioners. The point prevalence of all forms of EB at the outset of the study was 49.0 per million, comprising EB simplex 28.6 per million and dystrophic EB 20.4 per million. Extrapolation of accurate data available for the Lothians suggests that the point prevalence of all forms of EB in Scotland is in excess of these figures.

Adolescent↗
PubMedDate not supplied

Evaluation of nurse and midwife education in Scotland.

The authors of an evaluation of the new programmes of nurse and midwife education in Scotland summarise their findings and methods. Students were found to be enjoying rich educational experiences. However, they did identify a number of problems in initial programme development, achievement of student roles and in assessment of learning. The authors offer recommendations for continued curriculum development and for further research. The evaluation was commissioned by the National Board for Scotland.

Curriculum↗
PubMed1997

CD4 surveillance in Scotland: perspectives on severe HIV-related immunodeficiency. CD4 Collaborative Group.

OBJECTIVE: To analyse factors that influence the following: the square root of first CD4 cell count; which individuals are severely immunodeficient at or before the start of monitoring; progression from the date of the earlier of two consecutive CD4 counts < or = 200 x 10(6)/l (termed as CD200) to AIDS. SETTING: Scotland's HIV Immunology Laboratories and the Scottish Centre for Infection and Environmental Health. PATIENTS: A total of 1679 adult HIV patients in Scotland to 31 December 1994 who had ever had a CD4 cell count < or = 500 x 10(6)/l or who had developed AIDS without any immunological monitoring, of whom 912 had developed severe HIV-related immunodeficiency (i.e., were CD200/AIDS cases). RESULTS: Square-root first CD4 count was higher in women (by 2.1; SE, 0.5), in injecting drug users (IDU; by 1.8; SE, 0.5) and in younger patients (by 1.5 per 10 years; SE, 0.2), but reduced by 1.5 (SE, 0.1) per calendar year of recruitment, although it was relatively higher (by 3.8; SE, 0.8) for Edinburgh patients recruited in 1993-1994: at least 30% (nine out of 28) of new Edinburgh City Hospital patients in 1993-1994 with a first CD4 count of > or = 500 x 10(6)/l had seroconverted within the past 5 years. Two-thirds of non-IDU (67%; 348 out of 517) were already severely immunodeficient at or before the start of immunological monitoring, in contrast with only 31% of IDU CD200/AIDS cases. Overall, the odds on the CD200 date also being the date of first CD4 count have increased in recent times [log(e)(odds per calendar year of CD200 diagnosis), 0.14; SE, 0.05]. Analysis excluding patients whose AIDS diagnosis or follow-up time was within 1 month of the CD200/AIDS date supported a modest prolongation of the CD200/AIDS to AIDS interval for patients diagnosed with severe HIV-related immunodeficiency in the period 1989-1991 (log(e)[relative risk (RR)], -0.46; SE, 0.22). Similarly, year effects were evident on progression from CD500 to CD200/AIDS [log(e)(RR), -0.55; SE, 0.17) for CD500 cases diagnosed in 1989, and these year effects doubled in 1990-1992. CONCLUSIONS: Minimal CD4 data were hypothesis-generating about region, risk group and calendar year. Lower bound for recent HIV incidence can be derived from new patients with first CD4 cell count above 500 x 10(6)/l if seroconversion intervals are available for a proportion.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Neosporosis and bovine abortion in Scotland.

Serum samples were collected over a two-year period from aborting cows and their fetuses from throughout Scotland; 465 maternal sera were examined using an immunofluorescent antibody test for IgG antibody to Neospora caninum and 547 fetal sera were examined for IgM and IgG antibody to the parasite; 355 of the maternal sera were paired with their respective fetal samples. The maternal titres ranged from 1/8 to 1/16,384, with 59 per cent (275) having titres of 1/128 or 1/256. Of the 547 fetal sera, 9.9 per cent had IgM titres equal to or greater than 1/64, 11.2 per cent had IgG titres equal to or greater than 1/64 and 15.9 per cent had IgM and/or IgG titres equal to or greater than 1/64. It is concluded that a fetal IgM or IgG titre of 1/64 or more is evidence of fetal exposure to N caninum but that the examination of maternal sera is less reliable on an individual basis, although valuable for indicating the degree of infection in a herd. Although fetal seropositivity does not necessarily provide proof that N caninum was the cause of death in a given case, the observation that 15.9 per cent of aborted fetuses had antibody to the parasite shows that vertical transmission from dam to fetus is relatively common and may be an important cause of fetal loss in cattle in Scotland.

Abortion, Septic↗
PubMed1998

GPs, schoolgirls and sex. A cross cultural background comparison of general practitioner attitudes towards contraceptive service provision for young adolescent females in Scotland.

No previous studies have examined the influences of cultural background on the provision of contraceptive services to females under 16 years of age. A research project was undertaken to investigate any differences between general practitioners trained in the United Kingdom and those trained in the Indian sub-continent in relation to contraceptive service provision to females under 16 years of age. A self-completion postal questionnaire survey was distributed to 230 unrestricted principal general practitioners across Scotland. Subjects were identified from the Medical Register. Half of the sample consisted of all those working in Scotland who had been trained in the Indian sub-continent. The other half were a comparable group that had been trained in the United Kingdom and were selected by quasi-random quota sampling. The response rate was 57 per cent (131/230). General practitioners in the study who had trained in the Indian sub-continent were found to be significantly less likely to provide contraceptive services to a female under 16 years of age than those who had trained in the United Kingdom. Cultural background may be influential in general practitioner provision of contraceptive services to females below the legal age of consent for sexual intercourse. In order to obtain more conclusive evidence a larger study is necessary. Such investigations must be undertaken with appropriate sensitivity and social awareness.

Adolescent↗
PubMed2001

A survey of female patients in high security psychiatric care in Scotland.

BACKGROUND: The State Hospital, Carstairs, is the sole high security psychiatric facility for Scotland and Northern Ireland. METHOD: This study compares the female (n = 28) and male (n = 213) patients resident there between 1992 and 1993 using data derived from case-note reviews and interviews with patients and staff. RESULTS: Nearly three-quarters of both the male and female populations had a primary diagnosis of schizophrenia, and secondary diagnoses of substance abuse and antisocial personality disorder were common. Female patients were more frequently admitted from other psychiatric hospitals, had less serious index offences and more minor previous convictions, and were less likely to be subject to a restriction order. They had more often experienced depressive symptoms and had significantly greater histories of self-harm, physical and sexual abuse. At interview, nearly three-quarters had active delusions and over half had recently behaved in an aggressive manner. Almost 90% were said not to require the security of the State Hospital. CONCLUSIONS: It was concluded that mental illness and adverse social circumstances had combined to create a very disadvantaged group of women in high security psychiatric care in Scotland. As a group these women were inappropriately placed and their requirement was for intensive, rather than high security psychiatric care.

Journal Article↗
PubMed2000

Individual and geographical variation in display behaviour of male harbour seals in Scotland.

Studying variations in behaviour at the individual or population level enables insight into the reproductive strategies within a species. We examined individual and geographical variation in the vocal and dive behaviour of male harbour seals, Phoca vitulina, which is associated with aquatic mating. This display behaviour was recorded in the Moray Firth, Scotland, from July 1994 to 1997, and in Orkney, Scotland, during July 1998. One vocalization type was apparent in the Moray Firth and two in Orkney. Time parameters (total and pulse duration) varied between males in the population in the Moray Firth. We used both frequency and time parameters in a discriminant analysis, which showed that 73.2% of individual male vocalizations could be correctly classified; 94.6% of male vocalizations from the Moray Firth and Orkney could be correctly classified according to their geographical areas. Therefore, vocal variation was greater between geographical areas than between individuals. No individual variation was apparent between dive and surface interval durations. However, individuals varied significantly in the percentage of short surface intervals. Male harbour seals showed substantial variability in the parameters affecting their vocal and dive behaviour during the mating season. We suggest that these variations may be indicative of adaptations to varying environmental challenges influencing the reproductive strategies of discrete populations. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1979

Seasonal and geographic variations in urinary composition in England, Scotland and Wales.

Aliquots of 24 hour urine samples were collected from a series of normal doctors in various areas of England, Scotland and Wales. The total volume was recorded and aliquots sent in for analysis for sodium, potassium, urea, creatinine, calcium, phosphate, urate, magnesium and oxalate. Geographical variations in urinary composition were small except for a raised oxalate content in Scotland. Likewise, seasonal variations were small and not systematic with the notable exception of a summer rise in oxalate content in all areas.

Calcium↗
PubMed1988

Egg mass and shell thickness in dippers Cinclus cinclus in relation to stream acidity in Wales and Scotland.

The shell thickness and mass of eggs of the dipper (Cinclus cinclus) collected on streams of different pH in Wales and Scotland were measured. The aluminium, phosphorus and calcium content of their invertebrate prey were also measured. In a regression analysis, significant at p<0.05, stream pH accounted for up to 7% of the variance in shell thickness, with shells decreasing by 2.5% of the overall mean with each unit of pH decline. In the Welsh sample, differences in shell thickness due to pH were small compared with differences between years across all sites. In data pooled between Scotland and Wales, pH accounted for 17% of the variance in egg mass, but a greater proportion (25%) in Scottish eggs alone. Aluminium concentrations in invertebrates showed no relationship with stream pH, but calcium levels in two insect orders increased significantly with pH. Calcium rich prey, such as Gammarus, were found only in circumneutral streams. The importance of calcium in the diet of dippers before and during egg formation is discussed. No evidence that aluminium in prey adversely affected dipper eggs was found.

Journal Article↗
PubMed1996

Concentrations of some organochlorines in otters (Lutra lutra L.) in Scotland: Implications for populations.

The concentrations of polychlorinated biphenyls (PCBs) and residues of organochlorine pesticides (HEOD and DDE) were measured in livers of otters (Lutra lutra) from different areas in Scotland. Whilst HEOD and DDE occurred at very low concentrations only, PCBs were present in high levels in some areas, the highest in Shetland (geom mean 2.05 ppm wet wt), related probably to high levels in sediments in the north-east Atlantic. PCBs were a mixture of congeners in which higher-chlorinated ones predominated, especially 138, 153, 170 and 180, a pattern comparable to that observed in otters from continental Europe. Individual values of total PCB reached levels of over 14 ppm wet weight, even in otters in good condition in thriving populations. Otter population densities were known in some of the study areas; in Shetland numbers increased over the study period, and the density was relatively high also elsewhere in Scotland. There was a strong negative correlation between PCB and body condition, but no correlation between PCB concentration and age of otters (mean age=4.1 years), which suggests that PCBs do not accumulate substantially in otters in the long term. The observations cast doubt on the significance of published 'critical levels' of PCBs to otter populations, based on data obtained from captive mink.

Journal Article↗
PubMed2005

Isotopic characterisation of the historical lead deposition record at Glensaugh, an organic-rich, upland catchment in rural N.E. Scotland.

As part of a wider investigation of the biogeochemistry and fate of Pb deposited from the atmosphere at Glensaugh, a rural upland catchment in N.E. Scotland, the concentration and isotopic composition of Pb were determined in four thinly sectioned monolith cores (25 cm) of peat collected at altitudes of 426--434 m from different faces of Thorter Hill and in a series of 21 10-cm unsectioned cores of peat and organic-rich soil along a transect from near the top (434 m) to the bottom (224 m) of the catchment. Depth profiles of Pb concentration and (206)Pb/(207)Pb ratio were similar for the longer cores. Subsurface Pb maxima (238--489 mg kg(-1)) typically occurred below (206)Pb/(207)Pb minima (1.123-1.134). One core was (210)Pb-dated and had a fairly constant (206)Pb/(207)Pb value of 1.170 from mid-19th century to ca. 1930, followed by a decline (attributable to the increasing influence of Australian Pb of much lower (206)Pb/(207)Pb ratio) to 1.134 by the early 1990s, and then a rapid increase to 1.160 by 2002, after the phased withdrawal of leaded petrol. The fluxes of Pb increased from 15 mg m(-2) year(-1) in the late 19th century to a peak of 60 mg m(-2) year(-1) ca. 1960, before declining steadily to 3.6 mg m(-2) year(-1) by the beginning of the 21st century. Some 40% of the anthropogenic Pb in the core had been deposited prior to 1900. The mean anthropogenic Pb inventory of the four longer cores was 7.4+/-1.5 g m(-2), of which approximately 70% occurred in the top 10 cm, in good agreement with the inventories of the shorter cores collected above 400 m. These inventories are higher than those of the industrial central belt of Scotland, probably because of enhanced deposition at altitude. This is consistent with the derived average (210)Pb flux of 198+/-11 Bq m(-2) year(-1), which is twice that of typical UK (210)Pb deposition and the rainfall for the site. The past deposition of Pb at Glensaugh, including that from sources (e.g., smelting, coal combustion) other than leaded petrol, has clearly been considerable. Even since the introduction of leaded petrol ca. 1930, car-exhaust emissions may have accounted for no more than 35% of the Pb deposited.

Journal Article↗
PubMed2001

Economics of lipid lowering in primary prevention: lessons from the West of Scotland Coronary Prevention Study.

On the basis of the clinical benefit and virtual absence of adverse effects observed with statin treatment in major primary and secondary prevention trials, a case could be made for considering statin therapy for all patients meeting the eligibility criteria for these trials. Establishing a risk threshold for statin treatment based on cost is an urgent item on the agenda of modern healthcare systems. An economic analysis using West of Scotland Coronary Prevention Study (WOSCOPS) findings indicates that statin treatment would have prevented 318 events per 10,000 patients in a population similar to that in WOSCOPS (average 1.5% annual risk of a cardiovascular event) at a discounted cost per life-year gained of 20,375 pounds($31,818). Application of current European treatment guidelines to consider treatment in patients with risk >2% per year would result in treatment of approximately 40% of the WOSCOPS population; discounted cost per life-year gained in this case would be 13,995 pounds($21,855). In Scotland, an annual risk threshold of > or = 3% for treatment has been adopted, corresponding to only 8% of the WOSCOPS population; the discounted cost per life-year gained is 9,680 pounds ($15,116). Reductions in drug cost, improved compliance, and use of more potent statins could alter cost efficiencies and encourage use of statins in a greater proportion of the primary prevention population that has been shown to benefit from such treatment.

Clinical Trials as Topic↗
PubMed2003

A survey of non-accidental injury imaging in England, Scotland and Wales.

AIM: To identify the potential national variation in non-accidental injury (NAI) imaging in England, Scotland and Wales. MATERIALS AND METHODS: A postal survey was sent to 323 hospitals with both paediatric and radiology departments. These were identified by a search through the Medical Directory. RESULTS: One hundred and thirteen of 323 postal questionnaires were returned within the study period (35%). Sixteen were excluded from the study because either no NAI imaging was performed at that institution or an incorrect address had been used. The total number of completed questionnaires was 97 (30%). Extensive variation was seen in all aspects of NAI imaging including imaging techniques used, total case numbers, follow-up imaging and those who report the NAI imaging. CONCLUSIONS: There is currently no national protocol that incorporates all aspects of NAI imaging in England, Scotland and Wales. Extensive variation in practice has been shown by this survey. Further standardization of NAI imaging practice is required. The draft BSPR skeletal survey guidelines and routine neurological imaging is recommended.

Child↗
PubMed1999

Incidence trends in house fire fatalities in eastern Scotland.

Fatal house fires occur more frequently in Scotland than elsewhere in Great Britain.(1,2) Over the last few years several educational campaigns were initiated to instruct the public in the risk factors associated with such fire fatalities and to promote the installation of functional domestic smoke detectors. An epidemiological survey of house fire deaths in the Lothian and Borders region of Scotland over the first half of the present decade, was carried out to evaluate any changing incidence trends by comparison with a survey of the fatalities from the first half of the previous decade. The impact of such campaigns in reducing house fires appears to be limited.

Journal Article↗
PubMed2003

Trends in oesophago-gastric surgery in Scotland.

BACKGROUND: The last twenty years have seen significant changes in both the incidence and treatment of gastro-oesophageal disorders as well as a process of subspecialisation in general surgery. The aim of this study is to identify the changes in gastro-oesophageal surgery in Scotland during this period. METHODS: A retrospective analysis of three years of data, taken over a 20-year period (1977, 1987 and 1997) obtained from the Information and Statistics Division of the Scottish National Health Service, examining the number of patients with oesophageal cancer, gastric cancer and gastro-oesophageal reflux disease (GORD) treated by general and thoracic surgeons. RESULTS: There was a significant increase (p=0.001, chi2) in the number of patients with oesophageal cancer (2.52-fold) and gastric cancer (1.4-fold) treated by general compared with thoracic surgeons. Since 1977, the overall operability for oesophageal cancer has remained unchanged, while a significant decrease in the overall operability of gastric cancer was noted (p<0.001, chi2). There was a 3-fold increase in the incidence of GORD with a significant increase (p<0.001, chi2) of those treated surgically. Since 1977, there has also been a significant shift of workload from thoracic to general surgical units. CONCLUSIONS: Scotland has seen a consistent increase in the surgical workload generated by gastro-oesophageal malignancies over the last three decades without any improvement in the operability rate. Surgically treated GORD has also increased, probably due to the introduction of minimally invasive techniques. These trends have implications on healthcare planning, resource allocation and surgical training. Appropriate resources and trainees should follow the patients to those units carrying out this activity. Further centralisation of these services is likely to follow.

Adolescent↗
PubMed1999

Allozyme variation and genetic structure of calluna vulgaris (heather) populations in scotland: the effect of postglacial recolonization

Recent fragmentation of populations as well as historical postglacial recolonization may have significantly affected the population genetic diversity of temperate plant species. Regional allozymic variability was measured at seven loci within and among 12 populations of Calluna vulgaris in the previously glaciated region of Scotland. These results were compared with existing data on south-western continental populations. Low genetic differentiation (FST = 0.024) and lack of consistent geographical pattern were found at the regional level among Scottish populations, implying a high rate of gene flow (Nm = 10.2), probably favoured by the nearly continuous range of C. vulgaris across Scotland and characteristics of the Scottish environment. Scottish populations possessed lower mean allozymic diversity (PLP = 40.48, A = 1.95, He = 0.133) than populations from all the continental regions investigated previously. Belgian populations were genetically more closely related to Scottish than to other continental populations. These last two findings are interpreted with regard to the evolutionary history of the species revealed by palynological data.

Journal Article↗