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PubMed2005

Spatial distribution of Escherichia coli O157-positive farms in Scotland.

Using a sample of 949 Scottish farms with finishing cattle, the spatial distribution of Escherichia coli O157-positive farms was investigated using disease mapping models. The overall prevalence of E. coli O157-positive farms was estimated as 22%. The regions used in this study were the 16 postcode areas of Scotland. For each region, the posterior relative risk (RR) was estimated as a model-based alternative to the saturated standardized morbidity ratio (SMR), i.e., the ratio between observed and expected cases in a region. Three Bayesian hierarchical models with generalized linear modeling of the area-specific risks were used to estimate the posterior relative risk of E. coli O157-positive farms in the postcode areas: a random-effects model incorporating only spatially uncorrelated heterogeneity; a model incorporating both spatially correlated and uncorrelated heterogeneity; and a pseudo-mixture model with unstructured correlation and a weighted mix of two variance components representing the spatial correlation and a jump structure. None of the models identified any areas with a significant increase or decrease in risk. The deviance information criteria slightly favored the simplest model (RR range: 0.92--1.09). However, this model appeared to smooth out more of the variation in the RR compared to the pseudo-mixture model, which gave a more informative pattern of the posterior relative risks (range: 0.81--1.22).

Animals↗
PubMed2005

An evaluation of the impact of a national health demonstration project on testing and management for Chlamydia trachomatis infections in two regions of Scotland.

OBJECTIVES: To compare clinical practice relating to testing for, and management of, genital Chlamydia trachomatis infection in the Lothian and Grampian regions of Scotland as part of an evaluation of a Government-funded health demonstration project in Lothian, Healthy Respect. STUDY DESIGN: Clinical audit against standards developed from a national clinical guideline. METHODS: Clinical practice relating to testing for, and management of, genital C. trachomatis infection was assessed against standards for good quality care developed from a national clinical guideline (Scottish Intercollegiate Guidelines Network Guideline 42). Audit methods comprised: postal survey of primary care clinicians; review of referral letters from primary to secondary care; and review of primary and secondary care patient case records. Findings from Lothian and Grampian were compared. RESULTS: Questionnaires were returned by 167 primary care clinicians in Lothian and 96 in Grampian. Clinicians in Lothian and Grampian gave similar responses relating to: testing of symptomatic patients (87 vs 88%); offer of testing for asymptomatic young patients (55 vs 55%); choice of antichlamydial agent (47 vs 42% azithromycin as first line); and follow-up strategies (50 vs 51% offer follow-up in primary care). Clinicians in Lothian were significantly more likely to participate in partner notification work (57 vs 44%; P=0.04) and to agree with statements reflecting 'perceived self-efficacy' in chlamydia-related care (57 vs 48%; P=0.006). Referral letters from primary to secondary care were reviewed for 31 women with genital symptoms in Lothian and 28 in Grampian. More women in Lothian were tested for chlamydia prior to referral (65 vs 39%; difference not significant). Review of primary care records for consultations in young people (145 in Lothian; 203 in Grampian) showed a higher level of chlamydia testing in Grampian (Lothian, 14%; Grampian, 34%; P<0.0001). However, review of secondary care records (n=39) showed a much higher level of testing in Lothian (Lothian, 75%; Grampian, 9%; P<0.0001). Review of secondary care records relating to proven chlamydia-positive women (n=159) suggested better care in Lothian in relation to ensuring antibiotic treatment (Lothian, 91%; Grampian, 74%; P=0.004), and use of the preferred antibiotic, azithromycin (Lothian, 78%; Grampian, 37%; P<0.0001). However, documented referral to a health adviser appeared to be better in Grampian (Lothian, 32%; Grampian, 48%; P=0.048). CONCLUSIONS: During the period of activity of the Healthy Respect demonstration project, few differences were detected between clinicians in Lothian and Grampian with regard to chlamydia-related practice. In both regions, clinicians appeared to be very aware of the need to test for chlamydia in patients with relevant symptoms, but were less likely to offer opportunistic testing to young patients without specific symptoms. These findings suggest that Healthy Respect in Lothian has had little impact on clinicians. However, these findings must be considered within the context of a broader evaluation, and it is noteworthy that the few significant differences that were detected tended to suggest better practice in Lothian.

Chlamydia Infections↗
PubMed2004

A dosimetric intercomparison of brachytherapy facilities in Ireland, Scotland and the North of England.

BACKGROUND AND PURPOSE: A dosimetric intercomparison of brachytherapy remote afterloading units in Ireland, Scotland and the North of England has been carried out involving 9 radiotherapy centres, and sampling 5 HDR and 6 LDR units. MATERIALS AND METHODS: Absolute calibrations have been performed in air on both HDR and LDR sources. The results are expressed in terms of a ratio of local to calibrated value. Frequency distributions were obtained for the multi-source LDR units by individually measuring each source. Using these distributions the effect of non-uniform source strength on the dose rate at Manchester point A was assessed for a typical clinical brachytherapy insertion for carcinoma of the cervix. Both frequency and dose rate distribution curves were modeled using normal statistics and characterised in terms of the mean (mu) and standard deviation (sigma). RESULTS: Evaluation of the HDR units indicated a mean ratio of 1.008 (+/-0.01) while for LDR the mean ratio was 0.997 (+/-0.02). The LDR frequency distributions demonstrated a variation of sigma values extending from 1.4 to 3.0% of mu. It was shown that this non-uniformity in source strength introduced an uncertainty in the treatment planning process of between 0.8 and 1.8% when compared to the assumption of uniform source strength. CONCLUSIONS: The results of this intercomparison indicate dosimetric consistency between centres for both LDR and HDR units. The distribution of LDR source strengths were within expected limits and the resultant dose rate distributions were considered clinically acceptable.

Brachytherapy↗
PubMed2005

Peroxyacetyl nitrate in eastern Scotland.

Peroxyacetyl nitrate (PAN) concentrations in air were sampled hourly from 1994 to 1998 at a rural site 15 km south-west of Edinburgh, in eastern Scotland. Annual average concentrations were between 0.1 and 0.15 nl l(-1), with episodes up to 3 nl l(-1) in long-range transported polluted air. PAN concentrations were approximately log-normally distributed. The concentrations measured are the result of a balance between photochemical production rates and removal by thermal decomposition and dry deposition. In general, there was a poor correlation between PAN and ozone concentrations at this rural site except during episodes of photochemical pollution, when the PAN/O(3) volume ratio exceeded 0.01. The PAN/NO(x) volume ratio had a median value of 0.015 but ranged up to 0.25. There was a pronounced seasonal maximum in PAN concentrations in late spring, and a strong diurnal cycle only in April-June, with a maximum at 1700 h. Individual episodes, with concentrations up to 3 nl l(-1), could be traced over distances of ca. 1000 km, with rapid changes in concentration as the prevailing winds advected polluted air masses across the site.

Environmental Monitoring↗
PubMed2004

Evidence on equalisation in health in youth from the West of Scotland.

Many studies report few socioeconomic (SES) differences in health in youth, a pattern contrasting with that of health inequalities in childhood and adulthood. This paper focuses on the child-youth transition to examine the hypothesis of equalisation in health over this period. Specifically, we test two hypotheses: (a) that equalisation is more likely for health state measures (physical and malaise symptoms and accidents) than health status ([limiting] longstanding illness and self-rated health) or health potential (height), and (b) that the patterning of health over this period is similar between occupational (social class) and non-occupational (deprivation, housing tenure and family affluence) SES measures. Data are derived from the West of Scotland 11 to 16 cohort, followed from late childhood (aged 11) through early (13) to mid (15) adolescence. The results showed very little evidence of SES differences in (limiting) longstanding illness at any age for both sexes, while self-rated health exhibited some differentiation, and height (as expected) consistent gradients throughout. By contrast, among males evidence of equalisation was found for both physical and malaise symptoms and pedestrian road traffic accidents (RTAs). Among females, equalisation was confined to specific physical symptoms, pedestrian RTAs, sports injuries and burns/scalds, while for malaise symptoms a reverse gradient at age 11 strengthened with age. These patterns were generally unaffected by the SES measure used. We conclude that while some of the evidence is consistent with the equalisation hypothesis, it needs extending to accommodate patterns of no SES differences, and particularly reverse gradients, in childhood. These patterns may reflect the increasingly pervasive influence of youth culture, suggesting that in the UK the boundary between childhood and youth should be set at an earlier age. This in turn suggests that international comparisons have considerable analytic potential for identifying the conditions under which equalisation does and does not occur.

Adolescent↗
PubMed2005

Lay perceptions of type 2 diabetes in Scotland: bringing health services back in.

The growing prevalence of type 2 diabetes is placing Scottish health services under considerable strain. Consequently, diabetes services are undergoing a major process of reorganisation, including the devolvement of routine diabetes care/diabetic review from secondary to primary healthcare settings. This qualitative study was devised to explore newly diagnosed type 2 diabetes patients' perceptions of their disease and the health services they receive at a time when this restructuring of services is taking place. The sample comprised 40 patients resident in Lothian, Scotland, who had diverse experiences of services, some receiving GP-based care only, others having varying contact with hospital diabetes clinics. In-depth interviews were undertaken with patients, three times at six monthly intervals over 1 year, enabling their experiences to be tracked at critical junctures during the post-diagnostic period. Disease perceptions and health service delivery were found to be mutually informing and effecting. Not only did (different types of) health service delivery influence the ways in which patients thought about and self-managed their disease, over time patients' disease perceptions also informed their expectations of, and preferences for, diabetes services. We thus argue that there is a need for a reconceptualisation within the medical social sciences to take into account the context of healthcare and the economic/policy factors that inform health service delivery when looking at patients' disease perceptions. We also discuss the logistical and ethical challenges of drawing upon patients' perspectives, preferences and views in the design and delivery of future health services.

Adult↗
PubMed2007

Health inequalities in Scotland and England: the contrasting journeys of ideas from research into policy.

Both the UK's Labour Government and Scotland's devolved Labour-Liberal Democrat coalition Executive have committed themselves to reducing health inequalities. Furthermore, both institutions have emphasised the importance of using evidence to inform policy responses. In light of such political commitments, a significant amount of work has been undertaken in the field of health inequalities in order to: (i) review the available research evidence; (ii) assess the extent to which policies have been based on this research evidence; and (iii) evaluate the success (or failure) of policies to tackle health inequalities. Yet so far only limited attention has been given to exploring how key actors involved in research-policy dialogues understand the processes involved. In an attempt to address this gap, this article draws on data from semi-structured interviews with 58 key actors in the field of health inequalities research and policymaking in the UK to argue that it is ideas, rather than research evidence, which have travelled from research into policy. The descriptions of the varying journeys of these ideas fit three types--successful, partial and fractured--each of which is outlined with reference to one example. The paper then employs existing theories about research-policy relations and the movement of ideas in an attempt to illuminate and better understand the contrasting journeys. In the concluding discussion, it is argued that the third approach, which focuses on the entrepreneurial processes involved in the marketing of ideas, is most helpful in understanding the research findings, but that this needs to be discussed in relation to the political context within which negotiations take place.

England↗
PubMed2006

Cases of typhoid fever imported into England, Scotland and Wales (2000-2003).

Although typhoid fever is no longer endemic in most of the developed world, it remains a major infectious disease in less developed regions and imported cases continue to occur in returning travellers, immigrants or migrant workers. We analysed all 692 isolates of Salmonella enterica subspecies enterica serovar Typhi from cases in England, Scotland and Wales that were sent to the Laboratory of Enteric Pathogens at the Health Protection Agency, Centre for Infections, London, UK between 2000 and 2003. The country of acquisition was known for 416 isolates (60%), and the majority of these (70%) came from India or Pakistan. Overall, 24 countries were listed, mainly in Asia and Africa. A total of 48 phage types were detected, 41% of which were Vi-phage type E1. Antimicrobial susceptibility testing revealed that 22% of isolates were multidrug resistant (MDR) (defined as resistance to chloramphenicol, ampicillin and co-trimoxazole) and 39% were quinolone resistant. A significant number of isolates (n=49) were sensitive to nalidixic acid by disk test but exhibited low-level ciprofloxacin resistance, suggesting a novel mechanism of resistance and reinforcing the need for minimum inhibitory concentration determination. Overall, 13% of isolates were both MDR and likely to show a poor response to a fluoroquinolone. A third-generation cephalosporin (e.g. ceftriaxone) should be considered as empirical therapy in regions of the Indian subcontinent where resistance is now at high levels as well as in patients returning from these areas. This study helps to describe the epidemiology of antimicrobial drug resistance in typhoid fever.

Anti-Bacterial Agents↗
PubMed2005

The health of wild red and sika deer in Scotland: an analysis of key endoparasites and recommendations for monitoring disease.

Monitoring the health of wildlife populations is important for understanding and controlling the risk of infections to livestock, humans and/or other wildlife. In this paper, we analyse the results of surveys of parasites and non-specific signs of diseases carried out on organs from 638 red and 107 sika deer culled in four regions of Scotland between 1991 and 1997. Infections of the lung by Elaphostrongylus spp. were significantly greater in red than sika deer. Older animals were more heavily infected with Elaphostrongylus spp. and Sarcocystis spp., and infections with Sarcocystis spp. tended to be heavier in more recent years. The results suggest that a combination of key indicator parasite species and non-specific signs of disease may be useful for monitoring the health of wildlife populations at a national scale. However, they also demonstrate that such monitoring needs to be long-term, carried out according to standard protocols and at an appropriate resolution to enable integration with data on other potentially influential environmental factors.

Animals↗
PubMed2006

Observations on the emergence of multiple anthelmintic resistance in sheep flocks in the south-east of Scotland.

Multiple resistance to benzimidazole, imidazothiazole and macrocyclic lactone anthelmintics is an emerging problem in the south-east of Scotland. The general management and nematode control strategies employed in four affected flocks (flocks 1-4) were investigated in an attempt to identify the risk factors which might have led to the appearance of production limiting disease associated with anthelmintic resistance. The important risk factors for multiple anthelmintic resistance could not be confirmed and it proved easier to criticise nematode control practices on theoretical grounds, than to propose practical solutions. It seems likely that different risk factors were involved in the four flocks. Lambs in flocks 1 and 2 had been treated with an anthelmintic at 3-4 weekly intervals with the aim of achieving suppressive nematode control, while sheep in flock 1 had been treated with an anthelmintic after they were moved onto clean grazing. Recently lambed ewes had been treated with moxidectin in three of the four flocks, with the aim of controlling their periparturient rise in faecal nematode egg output. All of these factors might have contributed to the emergence of multiple anthelmintic resistance, because they could have led to anthelmintic treatments at times when the nematode population in refugia was small, compared to that in the sheep. Annual rotation of the anthelmintic group was compromised by the emergence of benzimidazole resistance and did not prevent the emergence of multiple resistance in any of the flocks described, although the practice may have slowed the development of resistance. Underdosing may have selected for benzimidazole and imidazothiazole resistance in flock 2, associated with inaccurate estimation of the weights of terminal sire lambs. These investigations also highlighted problems associated with the diagnosis of anthelmintic resistance, in particular the confounding effects of the onset of host immunity to nematode parasites, the possible influence of the age of the adult nematode population, and the insensitivity of the undifferentiated faecal egg count reduction test in situations where resistance is emerging.

Animals↗
PubMed2002

Factors affecting low-density lipoprotein and high-density lipoprotein cholesterol response to pravastatin in the West Of Scotland Coronary Prevention Study (WOSCOPS).

Statins are regarded as efficacious in general but there is a wide variation in individual response. We sought demographic and lifestyle factors that influenced the response to pravastatin 40 mg/day in moderately hypercholesterolemic men in the West Of Scotland Coronary Prevention Study (WOSCOPS). Changes in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol after 6 months of treatment were examined in 1,604 highly compliant subjects. LDL cholesterol decreased by a mean of 30.4%. The magnitude of the change was influenced, albeit to a small extent, by baseline plasma triglyceride levels and alcohol intake and age; subjects with low plasma triglyceride levels, older subjects, and subjects with low alcohol intake had the greatest reductions. The mean response in HDL cholesterol in the group was an 8.3% increase (0.09 mmol/L). The percent increase in HDL cholesterol was affected by baseline HDL level, plasma triglyceride levels, decrease in plasma triglyceride levels during the administration of pravastatin, and body mass index. The absolute increase in HDL cholesterol was influenced by the decrease in plasma triglyceride levels, body mass index, and alcohol intake. All of these associations were weak (r <0.2) although highly significant. In conclusion, plasma lipid phenotype, obesity, and alcohol consumption appear to influence the response of LDL and HDL cholesterol to statin treatment. The absolute increment in HDL cholesterol is relatively constant across a range of baseline values, hence the percent change is largely a function of the starting value.

Alcohol Drinking↗
PubMed1998

Preventing coronary artery disease in the West of Scotland: implications for primary prevention.

The effectiveness of plasma cholesterol reduction therapy is no longer in question. Recent studies of cholesterol-lowering drug therapy demonstrate significant reductions in risks of mortality and coronary events in patients with existing coronary artery disease. The West of Scotland Coronary Prevention Study (WOSCOPS) demonstrated the therapy's effectiveness as primary prevention in patients without demonstrated coronary artery disease. Now that the efficacy of lipid reduction has been demonstrated conclusively, we face the difficult question of deciding what the treatment goals should be, whom to treat, and how to make those decisions cost effectively. These questions have complex social and ethical components and will lead to considerable discussion about how lipid-decreasing drugs will be used.

Anticholesteremic Agents↗
PubMed2000

The cardiovascular event reduction tool (CERT)--a simplified cardiac risk prediction model developed from the West of Scotland Coronary Prevention Study (WOSCOPS).

The clinical decision to treat hypercholesterolemia is premised on an awareness of patient risk, and cardiac risk prediction models offer a practical means of determining such risk. However, these models are based on observational cohorts where estimates of the treatment benefit are largely inferred. The West of Scotland Coronary Prevention Study (WOSCOPS) provides an opportunity to develop a risk-benefit prediction model from the actual observed primary event reduction seen in the trial. Five-year Cox model risk estimates were derived from all WOSCOPS subjects (n = 6,595 men, aged 45 to 64 years old at baseline) using factors previously shown to be predictive of definite fatal coronary heart disease or nonfatal myocardial infarction. Model risk factors included age, diastolic blood pressure, total cholesterol/ high-density lipoprotein ratio (TC/HDL), current smoking, diabetes, family history of fatal coronary heart disease, nitrate use or angina, and treatment (placebo/ 40-mg pravastatin). All risk factors were expressed as categorical variables to facilitate risk assessment. Risk estimates were incorporated into a simple, hand-held slide rule or risk tool. Risk estimates were identified for 5-year age bands (45 to 65 years), 4 categories of TC/HDL ratio (<5.5, 5.5 to <6.5, 6.5 to <7.5, > or = 7.5), 2 levels of diastolic blood pressure (<90, > or = 90 mm Hg), from 0 to 3 additional risk factors (current smoking, diabetes, family history of premature fatal coronary heart disease, nitrate use or angina), and pravastatin treatment. Five-year risk estimates ranged from 2% in very low-risk subjects to 61% in the very high-risk subjects. Risk reduction due to pravastatin treatment averaged 31%. Thus, the Cardiovascular Event Reduction Tool (CERT) is a risk prediction model derived from the WOSCOPS trial. Its use will help physicians identify patients who will benefit from cholesterol reduction.

Age Factors↗
PubMed1995

The West of Scotland Coronary Prevention Study: a trial of cholesterol reduction in Scottish men.

The West of Scotland Coronary Prevention Study is a primary prevention trial designed to test the hypothesis that reduction of serum cholesterol with pravastatin (a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor) over an average of 5 years will reduce the incidence of fatal and nonfatal myocardial infarction. At entry, 6,595 men aged 45-64 years were randomized to treatment with either pravastatin (40 mg/day) or placebo. None of the men at entry had evidence of previous myocardial infarction. All were given smoking and dietary advice throughout the study, which will terminate in 1995. The principal endpoints are: (1) death due to coronary artery disease (CAD) plus nonfatal myocardial infarction; (2) death due to CAD; and (3) nonfatal myocardial infarction.

Anticholesteremic Agents↗
PubMed1999

Survey of intussusception reduction in England, Scotland and Wales: how and why we could do better.

AIM: The aim of our study was to assess the variation in technique among hospitals in England, Wales and Scotland. In addition, local in hospital variation among paediatric radiologists at our own institution was assessed. METHOD: Postal questionnaires were distributed to the radiology departments of 301 hospitals. RESULTS: 183 (60.8%) replies were received. 122 institutions reduced intussusceptions and 61 did not. A lack of paediatric surgical and/or anaesthetic cover, and a lack of radiological experience were the major reasons cited by the departments which did not attempt intussusception reduction. Sixty-five hospitals use barium for hydrostatic reduction, 43 employ pneumatic reduction, 10 use water-soluble enemas and four use ultrasound. Of the 65 centres using barium 16 (25%) reported a success rate of less than 50%, 24 (37%) had a 50-70% success rate, seven (11%) reduce greater than 70% of intussusceptions and 18 (27%) did not know. In the 43 institutions employing air reduction, one (2%) had a success rate less than 50%, 20 (47%) had a 50-70% success rate, 17 (40%) a success rate greater than 70% and five (11%) did not know. Overall, of the total number of hospitals which replied to our survey, 28 (23%) reported that they were not aware of their success rates. Within the pneumatic reduction group in particular there was marked variation in the methods and duration of attempted reduction - between different hospitals and within the same institution. In six departments the machine used for pneumatic reduction did not measure intraluminal pressure. CONCLUSIONS: Ultrasound is underutilized despite being a sensitive method in diagnosis. There is almost certainly an over-reliance on plain radiographs and on the use of sedation, antibiotics and anti-spasmodics in general. We believe a 70% or greater success rate should be achievable in most institutions whether by pneumatic or hydrostatic reduction, and all departments should strive to achieve success rates in this range. Less than a quarter of centres who replied currently achieve this standard. Successful reduction rates below 50% are unacceptable in our opinion. Not surprisingly, success rates are generally highest in those centres treating more than 20 cases per annum. Twenty-eight (23%) of hospitals performing intussusception reductions did not know their success rates. Regular audits of intussesception figures should take place in all institutions. Unacceptably wide variations in intussusception reduction techniques currently exist. An accurate pressure release valve at least, and preferably intraluminal pressure monitoring should be an integral component of all pneumatic reduction devices. The British Paediatric Radiology and Imaging Group or the Royal College of Radiology should address these issues and introduce some standardization of practice.

Clinical Medicine↗
PubMed1998

A tale of two trials: The West of Scotland Coronary Prevention Study and the Texas Coronary Atherosclerosis Prevention Study.

Few areas in medicine offer such an impressive portfolio of evidence of clinical benefit as does the implementation of statins in the avoidance of coronary heart disease. The West of Scotland Coronary Prevention Study and the Air Force Coronary Atherosclerosis Prevention Study together have triggered a fundamental reappraisal of the use of these agents in preventing the first heart attack. The scientific evidence in support of cholesterol lowering therapy is incontrovertible. Some questions still remain by they relate more to how treatment should be applied rather than whether it is advisable. There is no longer any controversy about the merits of lipid lowering and no justification for inertia.

Clinical Trials as Topic↗
PubMed1988

Surgical treatment of necrotizing enterocolitis: a population-based study in the Grampian region, Scotland.

Ninety-two cases of necrotizing enterocolitis (NEC) were diagnosed in the Grampian Region of Scotland between 1978 and 1984, for a regional incidence of 2.2/1,000 live births. Twenty-seven cases (29.3%) required surgery, 19 acutely and eight for delayed stricture. Acute operative mortality was 10.5%. Disease-related mortality was 3.3%, and overall mortality was 8.7%. Follow-up ranged from 15 to 77 months for surgical patients, with only three of 23 survivors having increased bowel frequency.

Enterocolitis, Pseudomembranous↗
PubMed2003

Assessment of the aesthetic quality of a selection of beaches in the Firth of Forth, Scotland.

The aesthetic quality of fourteen beaches in the Firth of Forth, Scotland was surveyed between May and July 2002 using a protocol designed by the UK's National Aquatic Litter Group (NALG). Local authority beach cleaning regimes influence the amount of litter found on beaches. Frequent and thorough beach cleaning is necessary to maintain high aesthetic standards. Bathing and amenity beaches achieved higher aesthetic quality than non-bathing and non-amenity beaches. The aesthetic quality of rural and urban beaches was very similar. The NALG protocol appears more complicated to use than other beach litter surveys. However, the classification system generates results that are easily interpreted by the general public. Furthermore, the NALG protocol could be combined with coastal zone management plans as a useful environmental performance indicator.

Cities↗