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PubMed2003

Lyme disease--what is the cost for Scotland?

This paper analyses likely Lyme disease costs incurred by patients tested in the authors' laboratory over an 18 month period, based on patient histories and test results relating to 2110 samples submitted from laboratories serving 59% of the Scottish population. Cost analysis takes account of the direct costs of consultation, laboratory tests, antibiotic treatment and management of any sequelae, as well as indirect costs of the loss of healthy time through illness. Standard costs for each element are derived from published information, and the proportions applied to each patient category are estimated from studies described elsewhere in the literature. Of the sample, 295 patients had evidence of early Lyme disease and 31 had late Lyme disease symptoms. Based on these figures, the total annual cost for Lyme disease, when projected to the whole of Scotland, is estimated to be significant at 331,000 Pounds (range 47,000-615,000 Pounds). The range is inevitably wide because it was not possible to document complete clinical and management histories on individual patients. In addition, some late Lyme disease sequelae will require management for more than 1 year, and costs are also identified that could justifiably be included for all the other patients who tested negative for Lyme disease. These data raise the question of whether there is sufficient focus on prevention and the best management of this disease.

Cost of Illness↗

PubMed1995

Needs assessment in Scotland: collaboration in public health.

The National Health Service reforms revitalized the national emphasis on the public's health and health needs assessment. In Scotland, in contrast with England, there was no central investment in the development of methods and programmes for needs assessment in the context of the new NHS. To achieve a concerted effort, therefore, a self-help network--the Scottish Needs Assessment Programme (SNAP)--was created by the Scottish Forum for Public Health Medicine. This paper describes its evolution to the point where it is now supported as part of a national network of information for purchasing.

Health Care Reform↗

PubMed1993

Enteric fever in Scotland 1975-1990.

In the 16-year period 1975-90, there were 267 cases of acute infection with typhoidal salmonellae reported in Scotland, in addition to which 32 chronic carriers were identified. The overall incidence of disease changed little over this period, but there was a fall in indigenously acquired paratyphoid B and typhoid, and a rise in imported paratyphoid A. The majority, 215 (81%), had a history of recent travel and were considered to have acquired infection overseas. Only six of the indigenously acquired infections were traced to acutely infected persons, illustrating the low risk of transmission associated with acute enteric fever in the UK. Only one death was definitely ascribed to enteric fever, and one person with S. paratyphi B became a chronic carrier. Significant illness was observed in five chronically infected individuals, including one with carcinoma of the gallbladder. UK residents of 'Asian' ethnicity returning from the Indian subcontinent accounted for 63 (46%) of the 137 cases of typhoid, and 34 (64%) of the 53 cases of paratyphoid A. People of 'Asian' ethnicity were more likely to have acquired infection overseas than 'non-Asians': 110 (89%) of 123 persons compared with 105 (73%) of 144 (odds ratio 3.1, 95% confidence interval 1.5-6.6, P = 0.001). Although there seems to be limited scope for preventing indigenously acquired infection, immunisation of travellers could contribute significantly to reducing the incidence of typhoid.

Acute Disease↗

PubMed2003

Congruence in the performance of model nitrifying activated sludge plants located in Germany, Scotland and Spain.

A laboratory model nitrifying activated sludge plant treating OECD synthetic sewage was designed and constructed by each of three laboratories in Germany, Scotland and Spain in order to produce a sludge inoculum for 5 rapid toxicity bioassays. The plants were run for 3 years and produced sludge for the microbially based bioassays Vibrio fischeri bioluminescence, ATP luminescence and respiration, and, nitrification and enzyme inhibition. Although the initial sludge inoculum for the plants differed, as did some of the running conditions such as temperature regime, the sludge produced within the different countries had similar characteristics with respect to sludge age, total suspended solids and volatile suspended solids. Nitrification was generally maintained over the 3-year period although there were occasions when the process was inconsistent. Nitrification recovery was afforded by reseeding with a nitrifying sludge from a local wastewater treatment works (WWTW) or imposition of starvation conditions for a period of time. The sludge produced was used to carry out toxicity testing and results compared well with those using sludge from a WWTW. Overall, the use of sludge generated in the laboratory could be used for toxicity testing negating the need to resort to the use of natural WWTW sludge, which may contain a range of toxic substances due to uncontrolled industrial and domestic inputs and an unbalanced microbial consortium.

Adenosine Triphosphate↗

PubMed2001

A model for predicting chloride concentrations in river water in a relatively unpolluted catchment in north-east Scotland.

The River Dee is an oligotrophic soft water system, in the NE of Scotland, with a catchment area of approximately 2100 km2. The river rises in the Cairngorm Mountains and enters the North Sea at Aberdeen, approximately 140 km from its source. Water chemical quality data was collected every 2 weeks over 12 months for 59 sites distributed throughout the catchment. River water chloride concentrations increased significantly from west to east. In depth investigation of the relationship with distance from the coast revealed the significant difference in spatial distribution of river water chloride concentrations between upland and lowland/agricultural areas, suggesting the possible importance of agricultural practices to streamwater chloride concentrations. Thirty of the sample sites are independent and have been used to develop a simple model for prediction of streamwater Cl- concentration throughout the catchment. The model has been validated using data from the remaining sub-catchments. The model shows that mean Cl- concentration may be reliably predicted from distance from the coast and the percentage of improved grassland and arable land cover in each sub-catchment (r2 = 0.98). It is postulated that the land use effects may be partly due to the evolved link between landuse and catchment altitude characteristics, rather than just the direct effect of applied potassium chloride fertiliser on agricultural land. It was noted that there was insufficient forestry within the River Dee Catchment to reliably include % forest cover in the model.

Agriculture↗

PubMed2001

Modelling instream nitrogen variability in the Dee catchment, NE Scotland.

The Integrated Nitrogen in CAtchments model (INCA) was applied to the River Dee, Aberdeenshire, NE Scotland. To a first approximation the model was able to simulate the annual mean streamwater NO3-N concentrations observed along the length of the main channel. This provided the basis for using INCA to subsequently explore the effects of N deposition and land use management on streamwater NO3-N concentrations and loads. On an annual timescale, the model predictions suggest that NO3-N concentrations will decrease by 5% following a 20% reduction in fertiliser application. Furthermore, model results also suggest that a 50% increase in N deposition will cause a 15% increase in the streamwater NO3-N concentrations. The utility of INCA as a tool for catchment management is discussed, current limitations are highlighted and possible improvements are suggested.

Agriculture↗

PubMed2001

Hydrogeochemistry of groundwater in coastal wetlands: implications for coastal conservation in Scotland.

Groundwater in a shallow coastal aquifer in north east Scotland was monitored over the hydrological year October 1996-September 1997. Groundwater flow from inland areas sustained freshwater conditions in a dune-wetland complex of conservation importance. In particular, seasonal flooding of the coastal wetlands due to water table rise provided important roosting and breeding habitats for waterfowl. Hydrogeochemical analysis revealed that groundwater in the shallow sand aquifer was circum-neutral, and non-saline, despite being within 50 m of the sea and only 1 m above the mean high water mark. Calcium and HCO3 were the dominant cation and anion respectively, reflecting weathering processes in the aquifer. Use of the geochemical code NETPATH indicated that calcite weathering in shell fragments within the sand was the primary source of Ca and alkalinity generation. The concentrations of Na and Cl were also important, though these can be explained primarily by atmospheric inputs from precipitation. In detail, the spatial and temporal variation in groundwater chemistry was remarkably complex for what intuitively appeared a simple aquifer system. Temporal variations in groundwater chemistry mainly related to the seasonal event of groundwater recharge. Thus, the main period of rising groundwater levels resulted in a marked dilution of solutes in the aquifer, implying that water storage greatly increased in a relatively short period. A period of several weeks appeared to be required for dissolution processes to proceed to equilibrium. Spatial variation in groundwater chemistry appears to relate to the spatial distribution of geochemical processes in different hydrogeological units. Sulphate reduction, alkalinity generation and Fe precipitation appear to be locally important processes. The chemistry of groundwater maintains the wetland habitat by providing freshwater conditions that allow populations of various plant species to flourish. The potentially large recharge catchments of coastal wetlands, together with increasing pressures in the coastal zone, dictate that pollution can threaten the integrity of hydrochemical processes and requires careful monitoring if freshwater wetlands are to maintain their conservation importance.

Calcium↗

PubMed2001

Environmental change, land use and water quality in Scotland: current issues and future prospects.

An outline of both the scientific and management needs facing the future water quality issues of Scotland is discussed. The scientific needs are considered in terms of monitoring to increase the understanding of hydrochemical processes, issues of scaling, and the need for improved modelling under changing environmental processes. In terms of the management needs, the requirements highlighted relate to improving the ecological quality of Scottish rivers and the implementation of integrated river basin management plans.

Agriculture↗

PubMed2002

Calcite saturation in the River Dee, NE Scotland.

The spatial and temporal variations in calcite (calcium carbonate) solubility within the Dee basin of NE Scotland were assessed using water chemistry data gathered from a network of 59 sites monitored for water quality from June 1996 to May 1997. Calcite solubility, expressed in terms of a saturation index (SIcalcite), was determined from measured streamwater pH, Gran alkalinity and calcium concentrations and water temperature. In general, the waters of the Dee system are undersaturated with respect to calcite, though the saturation index is higher during the summer months indicating a dependency on flow conditions and biological activity. Under low-flow conditions, the streamwaters are dominated by water derived from the lower soil horizons and deeper groundwater stores and therefore, ions such as Gran alkalinity and calcium are at their highest concentrations as they are derived mainly from bedrock weathering. The influence of biological activity on the carbonate system is also evident as the observed pH and estimated EpCO2 values indicate strong seasonal patterns, with the highest pH and lowest EpCO2 values occurring during the summer low-flow periods. Only at three sites in the lowland region of the catchment, during the summer low-flow period, are the waters oversaturated. As such, the Dee system represents an extreme 'end-member' case when compared to many UK rivers that span both under- and oversaturated conditions during the year. Regression analysis highlights a systematic change in the SIcalcite-pH relationship in a broad east-west direction across the Dee system. At sites draining the relatively impermeable upland areas, the regression of SIcalcite against pH gives a straight line with a gradient in the range 1.6-2.4. Correspondingly, under the most extreme alkaline conditions found at sites draining lowland agricultural areas, a straight-line relationship exists but with a gradient of unity. It is concluded that these changes in the SIcalcite-pH relationship are due to variations in the bicarbonate system induced by the flow conditions and biological activity. Given the waters are undersaturated, then calcite precipitation and hence phosphorus co-precipitation cannot occur within the water column.

Agriculture↗

PubMed2002

Stable lead isotopic characterisation of the historical record of environmental lead contamination in dated freshwater lake sediment cores from northern and central Scotland.

Sediment cores from three Scottish freshwater lakes, Loch Ness in the remote north and Loch Lomond and the Lake of Menteith, much closer to the heavily populated and industrialised central belt were analysed for 210Pb, 137Cs, Pb and stable Pb isotopic composition (206Pb/207Pb). The radionuclide data were used to establish chronologies for the Loch Ness and Loch Lomond cores, but a chronology could not be developed for the Lake of Menteith core, in which the surface sediment had been subject to intense mixing. Although Pb concentrations generally started increasing during the mid-17th Century, a small peak occurred for Loch Ness in the early 16th Century, perhaps attributable to the influence of medieval mining and smelting in mainland Europe. Temporal trends in the pattern of Pb accumulation were similar for Loch Ness and both sites in Loch Lomond, with 40-50% of the anthropogenic Pb deposited prior to the 20th Century. Fluxes of anthropogenic Pb to the lake sediments peaked during the 1950s at all locations where chronologies could be established. The 5-fold increase in anthropogenic Pb inventory for the southern basin of Loch Lomond relative to Loch Ness reflected geographical proximity to the main polluting sources. The 206Pb/207Pb data for anthropogenic Pb in the sediments from Loch Ness and Loch Lomond exhibited largely similar trends related to five different time periods. Pre-1820, the 206Pb/207Pb ratio was close to that for coal (1.181). From 1820 to 1900, a fairly constant 206Pb/207Pb ratio of approximately 1.17 probably resulted from a combination of emissions from the smelting of indigenous Pb ore (1.170) and coal burning (1.181) in Scotland, and industrial activity to the south in England, where Australian Pb of characteristically low 206Pb/207Pb ratio (1.04) was already in use. From 1901 to 1930, the 206Pb/207Pb ratio declined by <0.01, due to the increasing influence of Australian Pb. From 1931 to 1975/1985, the 206Pb/207Pb ratio of anthropogenic Pb declined by a further 0.03 to 0.04, to minimum values from approximately 1975 to 1985, primarily a consequence of car-exhaust emissions of Pb arising from the introduction of alkyl Pb petrol additives (206Pb/207Pb approximately 1.06-1.09). From 1975/1985 to the mid-1990s, the 206Pb/207Pb ratio of anthropogenic Pb increased by up to 0.015, a consequence of a reduction in car-exhaust emissions of Pb, resulting from reductions in the maximum permitted concentration of Pb in petrol, and the introduction and increasing uptake of unleaded petrol. Source apportionment calculations, on the basis of 206Pb/207Pb values in surface sediment, suggested that the contribution of Pb emissions from the use of leaded petrol was 27-40% of the atmospheric burden by the mid-1990s, in line with estimates from rainwater 206Pb/207Pb data.

Air Pollutants↗

PubMed2002

Assessing the water resources of Scotland--perspectives, progress and problems.

This paper reviews historical progress in the assessment of rainfall, evaporation, runoff and groundwater resources in Scotland and, within the same water-balance framework, considers recent advances in quantifying the major hydrological fluxes, with particular reference to river flows. The contributions of hydrological models and digital cartography are considered against a background of changing information needs and the likelihood that the long term stability which has characterised water resource variability in the past may not, continue in the future. The complementary roles of modelling and hydrometric monitoring networks are considered and the need for greater integration, and an increased strategic dimension to network design and evolution is discussed.

Conservation of Natural Resources↗

PubMed2002

Abstraction and abstraction control in Scotland.

This paper explores the limited existing forms of control on abstractions in Scotland and considers the benefits and drawbacks of introducing a wider control mechanism. Institutional changes since 1996, which include the creation of the Scottish Environment Protection Agency (SEPA), the establishment of three Water Authorities and the transfer of devolved powers to the Scottish Parliament all impact on the issue of abstraction control. The implementation of various EU Directives in the same period has highlighted increased needs for abstraction control and the draft Water Framework Directive is expected to reinforce these. Against this background, a review of research and development projects to address future needs is followed by a discussion on possible elements of a Scottish system for abstraction control.

Conservation of Natural Resources↗

PubMed1997

Streamwater nitrate concentrations in six agricultural catchments in Scotland.

The concentrations of nitrate-N (NO3-N) in catchment inputs and outputs have been compared and contrasted between 6 farm catchments in Scotland, 3 in the West and 3 in the North-East. Forms of intensive animal farming ranging between beef and dairy cattle, sheep and poultry give different sources for potential NO3-N leakage from the systems. While stream reaches bordered by intensive cereal production give rise to the largest inputs to surface waters, climatic influences result in the more-efficient use of fertilizer- and farm waste-N in the West, and an enhanced potential for N-loss to waters in the cooler North-East, regardless of the N-inputs being considerably lower in the latter region. Although the EC Nitrate Directive limit of 11.3 mg NO3-N 1(-1) was not exceeded, peak values occurring during summer baseflows and autumn soil rewetting were commonly larger than the 'target' maximum concentration of 5.65 mg NO3-N 1-1.

Agriculture↗

PubMed2000

Increased ciprofloxacin resistance in gonococci isolated in Scotland.

A review of the susceptibility of Neisseria gonorrhoeae isolated from 4415 episodes of infection in Scotland between 1991 and 1999 showed that the proportion of isolates with lowered susceptibility (ciprofloxacin minimum inhibitory concentration [MIC] > or = 0.05 mg/L) increased from 0.5% in 1991 to 5% in 1999 (p<0.001), whereas the proportion of isolates with clinical resistance (ciprofloxacin MIC > or = 1 mg/L) was significantly higher in 1999 than the average for the preceding 4 years (2.2% vs 0.9%; p=0.02). Ciprofloxacin is a recommended treatment for gonococcal infection in the UK but if resistance continues to increase at the present rate it might not be suitable as a first-line treatment of gonorrhoea for much longer.

Anti-Infective Agents↗

PubMed2001

Age, sex, and social trends in out-of-hospital cardiac deaths in Scotland 1986-95: a retrospective cohort study.

BACKGROUND: Most deaths from coronary heart disease occur out of hospital. Hospital patients face social, age, and sex inequalities. Our aim was to examine inequalities and trends in out-of-hospital cardiac deaths. METHODS: We used the Scottish record linked database to identify all deaths from acute myocardial infarction that occurred in Scotland (population 5.1 million), in 1986-95. We have compared population-based death rates for men and women across age and social groups. FINDINGS: Between 1986 and 1995, 83365 people died from acute myocardial infarction, out of hospital and without previous hospital admission (44655 men, 38710 women); and 117749 were admitted with a first acute myocardial infarction, of whom 37020 died within 1 year. Thus, out-of-hospital deaths accounted for 69.2% (95% CI 69.0-69.5) of all 120385 deaths. Out-of-hospital deaths, measured as a proportion of all acute myocardial infarction events (deaths plus first hospital admissions), increased with age, from 20.1% (19.2-21.0) in people younger than 55 years, to 62.1% (61.3-62.9) in those older than 85 years. Population-based out-of-hospital mortality rates fell by a third in men and by a quarter in women. Mean yearly falls were larger in people aged 55-64 years (5.6% per year in men, 3.7% in women), than in those older than 85 years (2.5% in men and women). Mortality rates were substantially higher in deprived socioeconomic groups than in affluent groups, especially in people younger than 65 years. INTERPRETATION: These inequalities in age, sex, and socioeconomic class should be actively addressed by prevention strategies for coronary heart disease.

Age Distribution↗

PubMed2002

Incidence of and survival from malignant melanoma in Scotland: an epidemiological study.

BACKGROUND: We aimed to assess the incidence and survival for all patients with invasive primary cutaneous malignant melanoma diagnosed in Scotland, UK, during 1979-98. METHODS: The Scottish Melanoma Group obtained data for 8830 patients (3301 male and 5529 female) first diagnosed with invasive cutaneous malignant melanoma. FINDINGS: Age-standardised incidence rose from 3.5 in 1979 to 10.6 per 10(5) population in 1998 for men, and from 7.0 to 13.1 for women, a rise of 303% and 187%, respectively. After 1995, the rate of increase levelled in women younger than 65 years at diagnosis. Melanoma incidence increased most in men on the trunk, head, and neck and in women on the leg. 5-year survival rose from 58% to 80% for men diagnosed in 1979 and 1993, respectively, and from 74% to 85% for women; improvements of 38% (p<0.001) and 15% (p<0.001), respectively. Most improvement was attributable to a higher proportion of thinner tumours. Male mortality from melanoma was 1.9/10(5) population per year at the start and end of the study, whereas mortality for men younger than 65 years at diagnosis rose from 1.2 to 1.35 (p=0.24). For all women, mortality fell slightly from 1.9 to 1.85/10(5) population per year (p=0.61), whereas for women younger than 65 years at diagnosis, mortality fell from 1.3 to 1.15 (p=0.62). INTERPRETATION: Interventions aimed at both primary and secondary prevention of melanoma are justified. Specialist tumour registers for entire countries can be used to plan and monitor public health interventions.

Adult↗

PubMed1977

Social-services support for multiple sclerosis patients in West of Scotland.

A survey has been carries out of 104 patients with multiple sclerosis (m.s.) in West-Central-Scotland. All patients were living at home, and success of services to assist them in the community was examined. The partients were aged 16-65 years and had permanent disability, many being severely handicapped. Regular hospital follow-up was more common among the least disabled. 24 patients had never seen a social worker. Many patients had experienced problems with employment but 37 per cent of these had never registered with a disablement resettlement officer. After advice 10 additional patients applied successfully for an attendance allowance. Legislation requires local authorities to compile a register of the disabled and give information on services available to them. Only 19 patients were registered, however, and no one had received any information from a local authority. Many of these M.S. patients had failed to establish or maintain contact with available services. These results indicate a need for reorganisation of the support for the chronically disabled, possibly by setting up regular clinics for assessment and management, as recommended by the Tunbridge report (1972).

Adolescent↗

PubMed1985

Malignant melanoma in Scotland 1979-1983.

1318 cases of primary malignant melanoma of the skin first presenting in Scotland in the years 1979-83 and registered with the Scottish Melanoma Group are described. The annual age-adjusted incidence rate is 4.75 per 100 000 for females and 2.77 per 100 000 for males. Incidence rose by an annual average of 2.5% over the five-year period. The female: male ratio was 2:1, and 48.5% of all cases were of the superficial spreading histogenetic variety. Five-year survival rates for the patients registered in 1979 confirm the prognostic value of the tumour-thickness (Breslow) measurement. They were 93% for patients with tumours less than 1.5 mm thick (39% of patients), 67% for those with tumours 1.5-3.49 mm thick (30%), and 37% for those with tumours thicker than 3.5 mm (31%). This study shows that methods for early recognition of thin tumours should be encouraged.

Adolescent↗