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PubMed1999

Changes in the presenting features of females with anorexia nervosa in northeast Scotland, 1965-1991.

OBJECTIVE: Rates of anorexia nervosa among females presenting to specialist services in northeast Scotland had increased significantly between 1965 and 1991. We sought to elucidate possible causes of this change. METHOD: Hospital and primary care records were searched. Age, weight, and body mass index (BMI) were determined for 196 patients and duration of symptoms from onset to presentation was established in 190 cases. Changes in these parameters were investigated over the 27-year period of the study. RESULTS: There was no significant change in duration of illness or in age at presentation. BMIs increased significantly, but this arose because patients decreased in height, not because they increased in weight. There was no increase in seriously underweight patients with BMIs of < or =15. DISCUSSION: Anorexic females were not referred at an earlier stage of their illness, but primary care teams may be identifying and referring milder cases. Alternatively, the findings may reflect an increasing incidence of eating disorders coupled with changes in their presenting symptomatology.

Adult↗
PubMed1996

Impact of prenatal diagnosis on revised livebirth prevalence estimates of Down syndrome in the Lothian region of Scotland, 1978-1992.

Ramsay et al. [(1991) Biomed Pharmacother 45:267-272] reported on the livebirth prevalence of Down syndrome in the Lothian region of Scotland during 1978-1989. Their results suggested a temporal association between the events of Chernobyl in April 1986 and a significant-excess of cases in 1987. In the current study the data were extended for 3 years and reanalyzed, a major objective being to correct for the differential loss of fetuses with Down syndrome which occurs between prenatal diagnosis and birth. Other objectives were to estimate the prevalence reduction due to prenatal diagnosis, quinquennial maternal age-specific risk rates, and the level of ascertainment of cases. The reanalysis found a 12-year prevalence rate of 1.29 vs. the previous rate of 1.34, and a shift of the annual prevalence peak to 1988, with a reduced prevalence in 1987 compared to that found in the earlier study. The new results are less consistent in showing an association of Down syndrome clustering with the Chernobyl accident. For the 15-year study period, a 23% overall reduction in prevalence occurred due to prenatal diagnosis and elective abortion of affected fetuses, with a 50% reduction to women > or = 35 years of age. For 1988-1992, these reductions were 33% and 60%, which are among the highest reported in the literature for these time periods. The estimated quinquennial maternal risk rates were very similar to others already reported, and the data are consistent with a high level of case ascertainment. Since these women are approaching the upper limits of fetal detection through advanced maternal age alone, continued reduction in prevalence rates for Down syndrome through prenatal diagnosis and elective abortion will come mostly from increased use of other (chemical) screening techniques now available.

Adult↗
PubMed1999

Trends in prenatal diagnosis of Down syndrome and other autosomal trisomies in Scotland 1990 to 1994, with associated cytogenetic and epidemiological findings.

The present report summarizes findings on 670 cases of autosomal trisomy diagnosed in Scotland, with actual or expected dates of delivery in 1990 to 1994 inclusive. Cases were notified by cytogenetic service laboratories. There were 277 prenatal and 369 postnatal diagnoses and 24 spontaneous losses. Excluding the latter, numbers diagnosed with trisomy 21, trisomy 18, trisomy 13, and other trisomies were, respectively, 470 (72.8%), 108 (16.7%), 36 (5.6%), and 32 (5.0%). Estimated maternal age-specific birth rates for trisomy 21 were close to published values from other jurisdictions. However, comparisons with a clinically based national register of congenital anomalies suggested that 3-4% of Down syndrome births were never karyotyped, most being early neonatal deaths. There was a striking increase over the period in the proportion of cases detected prenatally, associated with increased maternal serum screening in mothers <35 years old. Over the 3 final years (1992-1994), prenatal screening followed by elective termination was estimated to reduce the birth rate in trisomy 21 by 24% in mothers aged <35 years, by 57% in older mothers, and by 35% in all mothers. The crude incidence per 1,000 births fell from 1.08 in 1990-1991 to 0.77 in 1992-1994, in spite of an upward shift in the overall maternal age distribution. For trisomies 18 and 13, the estimated overall reductions in the birth rate over the whole 5-year period were respectively, 26 and 17%. In free trisomy 18, there was a significant reduction in the sex ratio (male/female) to 0.65, in line with earlier studies.

Abnormalities, Multiple↗
PubMed1985

Lethal neonatal chondrodysplasias in the West of Scotland 1970-1983 with a description of a thanatophoric, dysplasialike, autosomal recessive disorder, Glasgow variant.

Complete ascertainment of lethal neonatal short-limb chondrodysplasias was attempted in the West of Scotland for the period 1970-1983. Forty-three cases were identified, representing a minimum incidence of 1 in 8,900. The differential diagnosis included 11 well-delineated skeletal dysplasias, one case of warfarin embryopathy, and one apparently new condition with presumed autosomal recessive inheritance that has radiographic similarities to those of thanatophoric dysplasia (TD). In this series TD had an incidence of 1 in 42,221, which is consistent with new dominant mutation at a rate of 11.8 +/- 4.1 X 10(-6) mutations per gene per generation. Ultrasonic measurement of fetal long bone length was performed in eight subsequent pregnancies at risk. Five unaffected fetuses were predicted correctly and three affected fetuses were detected during the second trimester (one with rhizomelic chondrodysplasia punctata-second trimester prenatal diagnosis not previously reported; one with achondrogenesis type II; and one with the new lethal condition).

Chondrodysplasia Punctata↗
PubMed1986

A comparison of the availability and content of genetic counseling as perceived by hemophilic men and carriers in the U.S.A., Canada, Scotland, and Greece.

A survey study was carried out with 211 hemophilic men and 205 carriers of hemophilia at four hemophilia centers in New York; London, Ontario; the West of Scotland; and Athens, Greece. The participants responded to a questionnaire exploring socio-demographic and medical information, attitudes toward hemophilia, and experience of and attitudes toward genetic counseling. The study shows differences between attitudes of hemophilic men and carriers, differences in perceived problems among patients and carriers in the four centers, and differences in opinions between consumers and professionals. Comprehensive services for hemophilic families available in the New York center facilitate both patient education and satisfaction.

Attitude to Health↗
PubMed1993

Survey of minor surgery in general practice in the west of Scotland.

Since April 1990 certain minor surgical procedures have attracted an item-of-service payment for general practitioners (GPs). A postal survey was undertaken to obtain information about minor surgery in general practice in the West of Scotland and to find out whether further postgraduate education is required in this field. From a random stratified sample of 356 GPs, 311 (87.4 per cent) responded. Practitioners on health board minor surgery lists have increased minor surgery activity since April 1990; they prefer to perform the less technically demanding and time-consuming procedures on the eligible list. It is concluded that there is scope for increasing postgraduate education in minor surgery for GPs.

Adult↗
PubMed1994

Changing pattern of admission and operation for duodenal ulcer in Scotland.

To assess changes in the pattern of admission and operation for duodenal ulcer in Scotland, data recorded on Scottish Medical Records forms for the years 1975-1990 were analysed. The overall admission rate fell by 38 per cent from 157 to 98 per 100,000 population while the number of operations per year dropped by 80 per cent from 2955 to 582. There was a decline in perforation rate between 1975 and 1990 from 27 to 15 per 100,000 population. This general trend conceals a significant 93 per cent increase in the incidence of duodenal ulcer perforation among women aged 65 years and above, from 21 per 100,000 in 1975 to 41 per 100,000 in 1990 (r = 0.76, P < 0.001). There was a general trend towards a decline in haemorrhage rates, although this was significant only for men aged 15-44 years (r = -0.73, P < 0.01) and 45-64 years (r = 0.63, P < 0.04).

Adolescent↗
PubMed1994

Abdominal aortic aneurysm in Scotland.

In the 12-year period to December 1991, 5338 new cases of abdominal aortic aneurysm (AAA) were recorded in the Scottish Morbidity Record (SMR) 1. Data from this source were analysed for accuracy; information from 489 of 500 randomly examined case records matched the SMR 1 data, giving an accuracy of 97.8 per cent. There was a steady yearly increase in the number of reported cases, from 283 in 1980 to 612 in 1991; the male to female ratio was 2.5:1. The mean age was 73.1 years, higher in women (73.4 years for intact and 77.2 years for ruptured aneurysm) than in men (69.8 and 71.8 years respectively). The proportion of patients aged over 75 years increased from 29.0 per cent in 1980 to 38.2 per cent in 1991. Rupture occurred in 36.4 per cent of the aneurysms, and 75.0 per cent of these were in men. The increase in numbers occurred in both intact and ruptured cases, particularly the former. The hospital mortality rate for Scotland was 10.5 per cent for intact AAA (including urgent non-ruptured cases) and 54.7 per cent for ruptured aneurysm (including those not operated on), but these figures varied markedly between health boards.

Adolescent↗
PubMed1996

Incidence and nature of bile duct injuries following laparoscopic cholecystectomy: an audit of 5913 cases. West of Scotland Laparoscopic Cholecystectomy Audit Group.

The rapid introduction of laparoscopic cholecystectomy has been associated with an apparently increased incidence of bile duct injury which has provoked worldwide concern. The true incidence and mechanism of iatrogenic ductal injury during the development of this procedure remain unclear. To assess this, the introduction of laparoscopic cholecystectomy in the West of Scotland has been audited prospectively over a 5-year period. All cases of biliary ductal injury have been independently reviewed. Some 48 surgeons undertaking laparoscopic cholecystectomy in 19 hospitals submitted prospective data between September 1990 and September 1995. A total of 5913 laparoscopic cholecystectomies were attempted with 98.3 per cent completion of data collection. During this period 37 laparoscopic bile duct injuries occurred. The annual incidence peaked at 0.8 per cent and has fallen to 0.4 per cent in the final year of audit. Injuries occurred after a median personal experience of 51 (range 3-247) laparoscopic cholecystectomies in 22 surgeons. Major bile duct injuries occurred in 20 of 37 patients, giving an incidence of 0.3 per cent. Five mechanisms for laparoscopic ductal injury were identified, including tenting, confluence and diathermy injuries as well as the classical and variant classical types. Ductal injuries were discovered at operation in 18 patients with consequent repair giving a good clinical outcome in 17. Contributory factors (severe inflammation, aberrant anatomy and poor visualization) were present in only 13 of 37 cases. This audit suggests that, at least in the introductory period, laparoscopic cholecystectomy is associated with an overall bile duct injury rate higher than that reported previously after open cholecystectomy, although the incidence of major ductal injury is similar. The late downward trend in bile duct injury, however, suggests there may be a prolonged learning curve for this procedure. Improved understanding of the mechanism of injury may lead to yet further reductions in this complication.

Bile Ducts↗
PubMed2001

Season of birth in females with anorexia nervosa in Northeast Scotland.

OBJECTIVE: To determine whether patients with anorexia nervosa exhibit an abnormal pattern in their season of birth. METHOD: Case records of female patients presenting to secondary services in Northeast Scotland from 1965 to 1997 who received a clinical diagnosis of anorexia nervosa were examined. The months of birth of the 446 anorexic patients with a confirmed diagnosis were compared with 5,766 female control subjects born locally in 1951, 1961, 1971, and 1981. RESULTS: Patients with anorexia nervosa had an excess of births in the first 6 months of the year (p =.013). The greatest excess was from March to June. DISCUSSION: This provides further evidence that birth dates of anorexics peak in the late spring and early summer. There are parallels with the epidemiology of schizophrenia. The evidence suggests that a seasonally fluctuating factor, most plausibly an intrauterine effect of common infectious agents during the winter months, is of etiological significance.

Adult↗
PubMed2002

Vertical and horizontal aspects of socio-economic inequity in general practitioner contacts in Scotland.

Health status varies across socio-economic groups and health status is generally assumed to predict health care needs. Therefore the need for health care varies across socio-economic groups, and studies of equity in the distribution of health care between socio-economic groups must compare levels of utilisation with levels of need. Economic studies of equity in health care generally assume that health care needs can be derived from the current health-health care relationship. They therefore do not consider whether the current health-health care relationship is (vertically) equitable and the focus is restricted to horizontal inequity. This paper proposes a framework for incorporating the implications of vertical inequity for the socio-economic distribution of health care. An alternative to the current health-health care relationship is proposed using a restriction on the health-elasticity of health care. The health-elasticity of general practitioner contacts in Scotland is found to be generally negative, but positive at low levels of health status. Pro-rich estimates of horizontal inequity and vertical inequity are obtained but neither is statistically significant. Further analysis demonstrates that the magnitude of vertical inequity in health care may be larger than horizontal inequity.

Adolescent↗
PubMedDate not supplied

High grade non-Hodgkins lymphoma in the elderly--12 year experience in the Grampian Region of Scotland.

A retrospective examination of patients with high grade non-Hodgkin's lymphoma (HG NHL) presenting in the Grampian Region of Scotland from 1980-1992 was undertaken to determine the disease characteristics and outcome in patients over the age of 60 years at diagnosis. This group of patients was found to account for 68 per cent of HG NHL presenting in this region. No difference in clinical stage or histology was noted compared to their younger counterparts. The elderly had a significantly poorer survival with an increase in lymphoma-related and unrelated deaths. On Cox regression analysis the main survival advantage was conferred by completion of 'radical' treatment; elderly patients who were given 'radical' therapy had a median survival of 50 months compared to median survival of 10 months in the 'non-radical' group. Patients who had a good performance status at diagnosis had also a significant survival advantage. Histology, clinical stage at diagnosis and age over 60 had no independent significant effect on survival. Not all the factors that resulted in 'non-radical' therapy being given are explicable but we conclude that 'radical' therapy is achievable in 50 per cent of patients over the age of 60 years with an effective outcome and should be pursued in the elderly when the condition of the patient allows.

Adult↗
PubMedDate not supplied

A mobile breast screening project in Scotland: lessons learned for national screening.

In 1986, a project was undertaken to determine the feasibility and cost of screening for breast cancer, using single oblique view mammography. Screening was offered to women aged between 40 and 65, on an open access basis, to those living in rural areas near Edinburgh. This article reports on: the logistical difficulties encountered; the costs of mobile screening; a comparison of costs when screening from a static centre; and, identifies factors found to influence attendance rates. The lessons learned from the project were incorporated into the planning of the mobile van operating in the South-East of Scotland Screening Programme, part of the National Breast Screening Programme; comparisons, where possible, have been included.

Adult↗
PubMed2001

10th International Hugo mutation database initiative meeting, 19 April 2001, Edinburgh, Scotland.

The 10th International Mutation Database Initiative Meeting was held on April 19, 2001, in conjunction with the annual Human Genome Meeting in Edinburgh, Scotland. Key points of the meeting are described here. The BiSC WayStation was presented as an operational, viable beginning to the solution for the lack of centralized variation collection structures, with a number of possibilities, notably the BiSC Central Database and HGBASE, as candidates for storing the data. Exploration of new avenues of funding for this project, affiliation with Wiley-Liss, and the establishment of the Mutation Database Initiative (MDI) as a society were also discussed.

Databases, Nucleic Acid↗
PubMed2006

Colorectal cancer and genetic polymorphisms of CYP1A1, GSTM1 and GSTT1: a case-control study in the Grampian region of Scotland.

Cytochrome P-450 CYP1A1 is involved in the metabolism of polycyclic aromatic hydrocarbons (PAHs) that are derived from meat intake and tobacco smoking. Expression of the CYP1A1 gene is induced by compounds present in cruciferous vegetables. The glutathione S-transferases play a central role in the detoxification of carcinogens, including PAHs. We investigated the association between colorectal cancer and three variants (CYP1A1*2A, CYP1A1*2C, CYP1A1*4) of the CYP1A1 gene, and homozygosity for the null deletion of the GSTM1 and GSTT1 genes, and the joint effects of these genotypes and smoking, meat intake and intake of green leafy vegetables in a population-based study of 264 cases and 408 controls in Northeast Scotland. There was an inverse association with the CYP1A1*4 (m4) variant (OR 0.3, 95% CI 0.13-0.70). The OR for the CYP1A1*2C (m2) variant was 1.3 (95% CI 0.59-2.91), which is similar to a combined estimate for previous studies (OR 1.2, 95% CI 0.95-1.41). We observed no association with the CYP1A1*2A (m1) variant, or the GSTM1 and GSTT1 polymorphisms. Significant interactions between all 3 CYP1A1 variants and meat intake, and between the m1 and m2 variants and intake of green leafy vegetables, were observed. There was no evidence of interaction between CYP1A1 and smoking, and no evidence of interaction between the GSTM1 or GSTT1 polymorphisms and smoking, meat intake, green leafy vegetable intake, CYP1A1 variants or each other.

Aged↗
PubMed2001

The emotional effects of tooth loss in partially dentate people attending prosthodontic clinics in dental schools in England, Scotland and Hong Kong: a preliminary investigation.

AIM: To compare the emotional effects of tooth loss in three partially dentate populations. DESIGN: A questionnaire survey. MATERIALS AND METHODS: A questionnaire was completed by 150 partially dentate subjects undergoing routine prosthodontic care at Guy's, King's and St Thomas's Dental Institute, London; the Dental School, Dundee, Scotland; and the Faculty of Dentistry, University of Hong Kong. Data were analysed using the Chi-square test. RESULTS: Forty nine per cent of all participants reported difficulties in accepting the loss of some of their teeth. People from Dundee were less likely to have difficulties accepting tooth loss (P = 0.001). People from London took longer to come to terms with their tooth loss and were more likely to feel less confident (P < 0.001). Fifty five per cent of all participants restricted their choice of foods and 54 per cent had not enjoyed their food as much as before. Fewer people in Dundee restricted their choice of food (P < 0.001) and were more likely to enjoy their food (P = 0.009). People in Hong Kong were most likely to restrict their choice of food (P = 0.006). Thirty five percent of all subjects felt unprepared for the effects that tooth loss had upon them. People in Hong Kong were more prepared for tooth loss than those in Dundee and London (P = 0.003). In addition, they were less concerned about leaving their dentures out overnight (P = 0.024). CONCLUSIONS: The emotional effects of tooth loss were significant in all groups. People from London took longer to come to terms with their tooth loss.

Attitude to Health↗
PubMed1989

Hepatitis delta virus infections in intravenous drug abusers with hepatitis B in the west of Scotland.

The prevalence of delta virus infection was studied in 264 intravenous drug abusers (IVDAs) whose sera were found to be HBsAg positive between 1985 and 1987 and in 15 IVDAs from the period 1971-75, seven from 1976, 15 from 1979, and 37 from 1982. Delta markers were present in 41% of IVDAs with acute hepatitis B and in 65% of those who were chronic HBsAg carriers between 1985-87. The first evidence of delta virus infection was found in 1975. In 1976, 1979, and 1982, respectively, 42, 63, and 5% of IVDAs with acute hepatitis B had delta coinfection. In the West of Scotland, delta infection has been established in the IVDA population since 1975. The very high percentage of IVDA carriers superinfected with the delta virus implies that there will be an excess of patients presenting with severe liver disease in the future.

Adult↗
PubMedDate not supplied

The impact of maternal serum alpha fetoprotein screening on open neural tube defect births in north-east Scotland.

Over the three years period 1980-1982, 18 256 pregnancies in the Grampian Region of N-E Scotland including the islands of Orkney and Shetland were screened for raised levels of maternal serum alpha fetoprotein (MSAFP) in the second trimester. Thirty six cases of fetal open neural tube defect in singletons were detected (18 anencephaly and 18 spina bifida). Four additional cases of open spina bifida were associated with normal MSAFP levels although two of these were detected by amniotic fluid AFP measurement when amniocentesis was carried out because of previous NTD history. A further three cases of open spina bifida and two of anencephaly occurred in unscreened pregnancies. The MSAFP screening programme alone was thus instrumental in reducing the birth incidence of open neural tube defects by 36 out of 45 cases (80 per cent) in singletons.

Amniocentesis↗