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PubMed1985

National Post-Perinatal Infant Mortality and Cot Death Study, Scotland 1981-82.

Throughout 1981 and 1982 all deaths of infants aged 8-365 days (post-perinatal infant mortality, PPIM) in Scotland were studied. During this period there were 135 250 live births and 1533 infant deaths (infant mortality rate 11.3), including 763 PPIM deaths (5.6 per 1000 live births). These 763 deaths fell into three main categories: birth-determined (329), accident or acquired disease (65), and cot deaths (369). Birth-determined deaths included 109 preterm, 199 congenital disorders, and 21 miscellaneous deaths. 61 of the cot deaths were fully explained on necropsy, in 141 an associated finding which might or might not be relevant was found, and in the remaining 167 no explanation was found. The cot death rate was 2.7 per 1000 live births overall (3.3 for boys, 2.1 for girls), and more second-born than first-born children died (approximately 3:2). Excluding "explained" cot deaths the rate was 2.3 per 1000 live births.

Accidents↗
PubMed1987

What follows diagnosis by computed tomography of solitary brain tumour? Audit of one year's experience in South East Scotland.

The referral rate to neurosurgeons after diagnosis by computed tomography (CT) of solitary brain tumour (SBT) was audited for South East Scotland in 1985. 142 patients had SBT diagnosed by CT, but histological confirmation by biopsy or open operation was sought in only 67. Among these the CT diagnosis of glioma proved to be incorrect in 3 of 44 cases and that of solitary metastasis in 4 of 8 cases. Since CT diagnosis of SBT is not fully reliable, biopsy should be considered in all cases.

Adult↗
PubMed1997

Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit.

BACKGROUND: Intensive insulin treatment effectively delays the onset and slows the progression of microvascular complications in insulin-dependent diabetes mellitus (IDDM). Variable adherence to insulin treatment is thought to contribute to poor glycaemic control, diabetic ketoacidosis, and brittle diabetes in adolescents and young adults with IDDM. We assessed the association between the prescribed insulin dose and the amount dispensed from all community pharmacies with the Diabetes Audit and Research in Tayside Scotland (DARTS) database. METHODS: We studied 89 patients, mean age 16 (SD 7) years, diabetes duration 8 (4) years, and glycosylated haemoglobin (HbA1c) 8.4 (1.9)%, who attended a teaching hospital paediatric or young-adult diabetes clinic in 1993 and 1994. The medically recommended insulin dose and cumulative volume of insulin prescriptions supplied were used to calculate the days of maximum possible insulin coverage per annum, expressed as the adherence index. Associations between glycaemic control (HbA1c), episodes of diabetic ketoacidosis, and all hospital admissions for acute complications and the adherence index were modelled. FINDINGS: Insulin was prescribed at 48 (19) IU/day and mean insulin collected from pharmacies was 58 (25) IU/day, 25 (28%) of the 89 patients obtained less insulin than their prescribed dose (mean deficit 115 (68; range 9-246] insulin days/annum). There was a significant inverse association between HbA1c and the adherence index (R2 = 0.39; p < 0.001). In the top quartile (HbA1c > 10%), 14 (64%) of individuals had an adherence index suggestive of a missed dose of insulin (mean deficit 55 insulin days/annum). There were 36 admissions for complications related to diabetes. The adherence index was inversely related to hospital admissions for diabetic ketoacidosis (p < 0.001) and all hospital admissions related to acute diabetes complications (p = 0.008). The deterioration in glycaemic control observed in patients aged 10-20 years was associated with a significant reduction (p = 0.01) in the adherence index. INTERPRETATION: We found direct evidence of poor compliance with insulin therapy in young patients with IDDM. We suggest that poor adherence to insulin treatment is the major factor that contributes to long-term poor glycaemic control and diabetic ketoacidosis in this age group.

Adolescent↗
PubMed2003

Provision of hepatitis B vaccination for primary care dental staff in Scotland.

OBJECTIVES: All dental surgeons should be protected from hepatitis B virus (HBV) infection by immunisation, ideally administered and monitored via occupational health services (OHS). This study examined relevant OHS systems in place for dental primary care healthcare workers (DHCW) across all Health Board Areas (HBAs) in Scotland. It also explored the DHCWs' knowledge of, and access to, these systems in three HBAs. METHODS: Data from senior staff in all Scottish Health Boards and Primary Care Trusts were collected by self-completing questionnaires. Information from DHCWs was collected via telephone interviews with General Dental Practitioners (GDPs) and Community Dental Officers (CDOs) in each of Ayrshire and Arran, Highland and Lothian Health Boards. RESULTS: Thirteen of the 15 HBAs had robust HBV vaccination and monitoring systems. However, only 7/15 (47%) of these covered all DHCWs. Seven HBAs provided vaccination and monitoring for CDOs only, leaving GDPs to undertake these responsibilities for themselves. Of the 105 DHCWs approached, 82 gave an interview. These interviews highlighted major differences between HBAs in relation to access of DHCWs to OHS and indicated that CDOs had greater access than GDPs to OHS. Overall, 31% of DHCWs were not satisfied with the OHS available. CONCLUSION: In order to safeguard both staff and patients, significant further work is required to ensure that all DHCWs have access to appropriate OHS support for provision and monitoring of immunisation procedures and related functions such as management of sharps injuries.

Chi-Square Distribution↗
PubMed1989

Diagnosis of congenital toxoplasmosis in Scotland.

During a period of 10 years (1976-1986) 853 cases of toxoplasmosis were identified serologically in the Toxoplasma Reference Laboratory in Scotland. Suspected cases of infection in pregnancy (29 cases) and of congenital infection (27 cases) were rare but ophthalmic disease was common (224 cases). In two of the congenital cases, maternal infection was identified during pregnancy. The other 25 babies were investigated because of suspected congenital infection. Toxoplasmosis was confirmed retrospectively in 11/25 babies and excluded in two of them. The other 12 cases remain unclassified. Diagnosis of infection in babies was difficult although the introduction of an IgM capture ELISA was of some help. IgM was detected by ELISA in 3/13 congenitally infected babies but by immunofluorescence tests in only one of these. In two antenatal studies, involving 16,000 women, an additional 32 women were identified whose babies might have benefited from treatment or the availability of fetoscopy for early detection of congenital infection.

Animals↗
PubMed1994

Occupational risk and precautions related to HIV infection among dentists in the Lothian region of Scotland.

This retrospective study used a postal questionnaire to measure occupational risks and to assess infection control procedures among 310 dental practitioners. The study comprised general dental practices in the Lothian region of Scotland, Lothian Health Board Community Dental Service and Edinburgh Dental Hospital. Altogether, 217 dental practitioners responded by the due date giving recall of inoculation injuries within the previous 5 years and infection control measures employed. The study revealed that 191 practitioners (88%) had completed a course of hepatitis B vaccination but one-third of them had not been tested for post-vaccination antibody. In 1991, two thirds of dentists (66%: 137 of 207 respondents) wore the same pair of gloves, and 80% of dentists (142 of 177 respondents) wore the same mask, for dealing with more than one patient. The usual practice was to change gloves during sessions (44%: out of 71 dentists) and to change masks for each session or less often (75%: 73 out of 97 dentists). The proportion of dentists who never used gloves fell from 56% in 1981 to 1% in 1991. An autoclave was used for sterilisation by 85% of practitioners in 1991. Reported non-sterile inoculation injuries averaged 1.7 (S.D. = 3.2) injuries per dentist in the previous year with 56% of practitioners having had an injury. The average was 6.8 (S.D. = 15.9) injuries per dentist in the previous 5 years with 76% of practitioners having had an injury. Of recent non-sterile inoculation injuries described by dental practitioners, 30% constituted a moderate or high risk of transmission of infection to the practitioner (43 of 141 described injuries). Combined with HIV seroprevalance rates, probabilities of transmission and numbers of practising dentists, the mean reported number of non-sterile inoculation injuries in the previous 5 years may be used to provide estimates of expected numbers of dental practitioners occupationally infected with HIV in the previous 5 years. U.K. estimates were 0.004 dentists in Lothian region and 0.05 dentists in the Thames region occupationally infected with HIV in the previous five years. Non-sterile inoculation injuries appear to be a common hazard of dental practice. In any year, most dentists are exposed to the risk of blood-borne viral infection. Despite a high reported incidence of such injuries, dental practice within the U.K. appears to carry a low risk of acquiring HIV infection from occupational exposure.

Dentists↗
PubMed2001

The outcome of idiopathic dilated cardiomyopathy and myocarditis in children from the west of Scotland.

We analysed retrospectively all infants and children with idiopathic dilated cardiomyopathy (IDC) and myocarditis at the Regional Cardiac Centre of the Royal Hospital for Sick Children, Glasgow, during 1980-1997. Among the 39 patients with IDC, 25 (64%) were infants aged < 1 year, eight (20.5%) had wheezing as the presenting symptom, and only six (15%) had a significant cardiac murmur. Thirty-eight of thirty-nine patients diagnosed in life were followed-up for 1 day to 15 years (median 3 years). Twelve of the thirty-nine (31%) died, six deaths were within a week of presentation and the rest within a year. The survival at 1 year and at 12 years was 0.69 (95% CI 0.54 to 0.84). Fourteen patients had histologically proven myocarditis, and all 9/14 (64%) detected at post-mortem and one of the five diagnosed in life died. Patients with myocarditis exhibited an actuarial survival of 0.29 (95% CI 0.04 to 0.53) at 1 year and at 9 years, significantly lower than IDC patients (log rank 9.8, P < 0.01). There was no difference in the outcome for patients with positive or negative Coxsackie titres or who presented in the 1980s and in the 1990s. No risk factor that independently influenced the outcome or survival could be identified in either group. Thus our study from a relatively well-defined population of the west of Scotland showed that a significant proportion of children with IDC and myocarditis died in the first week of illness and that patients with myocarditis had shorter survival.

Adolescent↗
PubMed2002

Trends in case-fatality in 22968 patients admitted for the first time with atrial fibrillation in Scotland, 1986-1995.

BACKGROUND: Although atrial fibrillation (AF) is an important cause of cardiovascular morbidity and mortality there is a paucity of data describing hospitalisation rates and case-fatality associated with this common arrhythmia. This study examines recent trends in first-ever hospitalisations for AF in Scotland. METHODS: Using the linked Scottish Morbidity Record Scheme, we identified all 22968 patients admitted to Scottish hospitals for the first time with a principal diagnosis of AF between 1986 and 1995. For each calendar year we calculated short (30-day) and medium (31 day to 2 years) case-fatality rates. Adjusting for each patient's age, sex, deprivation status, concurrent diagnoses and prior hospitalisation status, we examined whether case-fatality rates had significantly improved during this 10-year period. RESULTS: Between 1986 and 1995 the number of men hospitalised for the first time with AF increased by 926 (125%) to 1730 per annum and the number of women and by 875 (105%) to 1712 (both P<0.001). Hospitalisation rates increased from 0.31 to 0.70/1000 men and from 0.32 to 0.65/1000 women (both P<0.001). By the end of this period the proportion of men had increased from 48 to 50%. In both sexes, the median age of patients rose--in men from 66 to 68 years and in women from 74 to 75 years (both P<0.01). Despite the increasing age of patients and greater comorbidity, short-term (30-day) case-fatality declined from 4.0 to 3.1% in men (P<0.001) and 4.1 to 3.8% (P<0.01) in women. Similarly, medium-term (31-day to 2-year) case-fatality fell from 25 to 22% in men and 27 to 25% (both P<0.001) in women. Adjusting for the age, sex, extent of deprivation, secondary diagnoses and prior hospitalisation of hospitalised patients, we found that the risk of short-term case-fatality in the 1995 male and female cohort significantly declined by 21% (P<0.05) and 24% (P<0.05), respectively, in comparison to the 1986 cohort. The adjusted risk of case-fatality in the medium term also declined significantly in men by 30% (P<0.05) over this period and by 20% (P<0.05) in women relative to 1986. CONCLUSION: The number of first-ever hospitalisations for AF has increased twofold during the 10-year period 1986-1995. Although the age of patients has progressively increased during this period, short and medium case-fatality rates have declined, especially in men. This may partly reflect better treatment of AF. However, changing admission thresholds and other factors could also have led to an apparent improvement in prognosis. Nevertheless, medium-term case fatality remains substantial after a first ever admission to hospital with AF.

Aged↗
PubMed1998

Effect of gap length and position on results of treatment of cancer of the larynx in Scotland by radiotherapy: a linear quadratic analysis.

PURPOSE: This paper reports on the analysis of the effect of the length and position of unplanned gaps in radiotherapy treatment schedules. MATERIALS AND METHODS: Data from an audit of the treatment of carcinoma of the larynx are used. They represent all newly diagnosed cases of glottic node-negative carcinoma of the larynx between 1986 and 1990, inclusive, in Scotland that were referred to one of the five Scottish Oncology Centres for primary radical radiotherapy treatment. The end-points are local control of cancer of the larynx in 5 years and the length of the disease-free period. The local control rates at > or =5 years, Pc were analyzed by log linear models and Cox proportional hazard models were used to model the disease-free period. RESULTS: Unplanned gaps in treatment are associated with poorer local control rates and an increased hazard of a local recurrence through their effect on extending the treatment time. A gap of 1 day is potentially damaging but the greatest effect is at treatment extensions of 3 or more days, where the hazard of a failure of local control is increased by a factor of 1.75 (95% confidence interval 1.20-2.55) compared to no gap. The time factor for the actual time was imprecisely estimated at 2.7 Gy/day with a standard error of 13.2 Gy/day. Among those cases who had exactly one gap resulting in a treatment extension of 1 day, there is no evidence that gap position influences local control (P = 0.17). The treatment extension as a result of the gap is more important than the position of the gap in the schedule. CONCLUSIONS: Gaps in the treatment schedule have a detrimental effect on the disease-free period. A gap has a slightly greater effect than an increase in the prescribed treatment time. Any gap in treatment is potentially damaging. The position of the gap in the schedule was shown to be not important.

Appointments and Schedules↗
PubMed2003

Hepatitis C infection among dental personnel in the West of Scotland, UK.

Hepatitis C virus (HCV) is considered a serious occupational hazard for healthcare workers, particularly those performing exposure-prone procedures. In the UK, the majority of dental procedures are classified as exposure prone. In order to gauge the prevalence and determinants of infection among dental healthcare workers, a voluntary anonymous survey of HCV infection among primary care dental workers employed in the West of Scotland was undertaken, in which occupational and personal risk data were collected in parallel with a blood specimen. The overall prevalence of HCV antibodies was 0.1% (1/880, 95% CI 0-0.6); this is no greater than the estimated prevalence of HCV infection in the local population. Personal risk data collected suggested that the single infection identified was acquired through a non-occupational route. These results suggest that HCV infection is not a major occupational risk for dental healthcare workers.

Dental Auxiliaries↗
PubMed1998

Continuing education for registered nurses in the Highlands and Western Isles of Scotland.

This paper focuses on an educational approach used in the Highlands and Western Isles of Scotland in the continuing education of registered nurses. It includes a rationale for the educational approach used by this author and her colleagues, and a discussion of the approach itself. The discussion includes reference to concepts borrowed from learning theorists that underpin the approach, and case study material to illustrate how it works in practice. It is argued that the educational approach in this paper can potentially lead to meaningful learning. Meaningful learning is defined in this context. Finally, the outcomes of the educational approach are highlighted, with a discussion of its value to educators elsewhere.

Cost-Benefit Analysis↗
PubMed1998

Working to learn and learning to work: placement experience of Project 2000 nursing students in Scotland.

It is evident that the Scottish colleges have designed and provided very different curricular arrangements to support students' learning to practise in placements. Evaluation has demonstrated that some of these arrangements are of fundamental importance in facilitating or constraining the educational experience of students, including opportunities for reflection on experience, students' preparation for placements, the role of tutors in students' placement learning, the preparation of mentors and the utility of instruments for the assessment of students' practice-based learning. In addition to the formal provision in support of students' learning to work, students have developed their own informal strategies in order to meet their (sometimes conflicting) needs to maximize practical learning opportunities, ease entry into the nursing team and achieve favourable assessment of learning. Some of these involve working in order to learn. This paper is based on the work of the National Board-funded Evaluation of Project 2000 in Scotland (1992-96). The remit of the evaluation was to examine the teaching/learning processes of the Project 2000 nursing programmes and the new midwifery programmes, and their relationship to the educational outcomes for individual students, giving particular emphasis to the experience of students.

Clinical Competence↗
PubMed2001

Storage and distribution of trace metals and spheroidal carbonaceous particles (SCPs) from atmospheric deposition in the catchment peats of Lochnagar, Scotland.

Lochnagar is a remote mountain lake to the south-east of the Cairngorm region in Scotland. Its catchment receives anthropogenic trace metals solely from atmospheric deposition. Ten peat cores were taken from the catchment and analysis confirmed that they have been contaminated by trace metals. The peats have an high affinity for trace metals and this results in metal accumulation in the surface peat layers. The formation of trace metal sulphides may also reduce remobilisation. In this way, trace metals derived from atmospheric deposition have been scavenged and accumulated. In contaminated peat layers, 77.4% Hg, 89.6% Pb, 93.4% Cu, 72.4% Zn and 86.5% Cd of the total stored are from anthropogenic sources. The accumulated trace metals in the peats can potentially influence the lake system through erosion. Spheroidal carbonaceous particle (SCP) profiles were used to date the peat cores. By referring to the SCP profiles in the peats and comparing these with the trace metal profiles in the lake sediments, the mobility of trace metals in the catchment peats is confirmed.

Air Pollutants↗
PubMed2002

The historical record of PAH, PCB, trace metal and fly-ash particle deposition at a remote lake in north-west Scotland.

Sediment cores taken from the deep basin of Loch Coire nan Arr in north-west Scotland were dated using 210Pb calibrated spheroidal carbonaceous particle (SCP) profiles and analysed for trace metals, polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs). These data show that the site is one of the least contaminated by atmospheric pollution in the UK. Peak concentrations of PAHs were found to be equivalent to background values at sites in the English Lake District. The date of concentration maxima for SCP, PCB and some metals were in agreement with previously published polychlorinated dibenzo-p-dioxin/polychlorinated dibenzofuran (PCDD/F) data suggesting long-range industrial sources. The date of individual PAH concentration maxima were earlier, but concomitant with each other, possibly suggesting the influence of a local source. Comparison with remote European mountain lakes shows Loch Coire nan Arr to be one of the least contaminated sites in Europe with respect to PCBs, but more contaminated with respect to PAHs.

Carbon↗
PubMed2002

Worlds apart: a comparison between physical activities among youth in Glasgow, Scotland and Dunedin, New Zealand.

Against the background of increasing concern about levels of physical activity among young people, this paper reports the results of a cross-national comparison between two longitudinal studies of young people in Glasgow, Scotland and Dunedin, New Zealand, which used similar methods of assessment at 15 and 18 years of age. The comparison revealed that, on average, young people in Dunedin participated in a greater range of activities, encompassing both organised sports and informal activities such as cycling, and with greater frequency than those in Glasgow at both ages, but particularly so at age 18. The difference was especially marked for females, among whom one in three in Glasgow reported no physical activity at all at age 18. By contrast, in both sexes among those who did participate, much less difference in levels of involvement was observed between the two locations. Of 35 activities, only in respect of soccer, and only for males, did participation and involvement in Glasgow exceed that of Dunedin. Neither climatic factors, natural features of the environment, socio-economic composition, nor different proportions in single-sex/co-educational schooling explain the difference in levels of participation between the two locations. Participation rates in selected physical activities do, however, reflect different opportunity structures in Dunedin and Glasgow, with an advantage accruing to the former in respect of both school and post-school provision. Cultural factors, which underpin such differences, also appear to have an additional influence on participation, most notably in relation to the gender gap in physical activities, much bigger in Glasgow than Dunedin. To redress these differences requires an increase in levels of participation generally, particularly among females, which depends as much on a shift in values about physical activity as on the provision of better resources.

Adolescent↗
PubMed1997

Interpreting silence, documenting experience: an anthropological approach to the study of health service users' experience with HIV/AIDS care in Lothian, Scotland.

This paper presents a critique of "health service user satisfaction studies" as a forum for users' voice and influence in health services evaluation and development. The study of service user experience is discussed from a social anthropological perspective, which explicitly theorises the relationship between the theoretical/epistemological foundation of health services evaluation and its political effects. It is argued that "experience" and its articulation are products of a social and political process in which research is implicated. "Experience" is thus not a static and absolute entity which can be measured or described out of the context in which data on experience are elicited and recorded-a context of which the researcher is a part. Validating findings on service user experience proceeds from a consideration of the way power and authority structure the situations where statements of experience are elicited and includes a critical appraisal of the researcher's role and ways in which this influenced interaction with study participants. The challenge and responsibility of the researcher is to capture the expression of experience without removing it from the flow of time and the situation and context where people have some control over its articulation. Attention to silence is suggested as a part of this strategy. An action research project concerned with coordination of services for people with HIV in Lothian, Scotland, is introduced. Material on users' experience of services is presented and discussed. In conclusion, the effects of research on the organisation and content of communication in the service settings studied are considered.

Acquired Immunodeficiency Syndrome↗
PubMed2001

The reasons for the extraction of various tooth types in Scotland: a 15-year follow up.

OBJECTIVES: The aim of this survey was to investigate the reasons for extraction of the various tooth types in Scotland. This study replicated one which was undertaken 15 years earlier. A further aim, therefore, was to identify any changes in the frequency of extraction of each tooth type in the 15 years between the two studies. METHODS: The names of every fourth dentist on the list of the Scottish Dental Practice Board were obtained. Four hundred and twenty-five general dental practitioners were asked to record permanent tooth extractions for 1 week. Data requested for each extraction were: the patient's age, gender and dental attendance pattern, the type of tooth removed and the reason for the extraction. RESULTS: Three hundred and fifty-two dentists participated (a response rate of 82.8%). There were 25% fewer teeth extracted per patient and 30% fewer per dentist than in the 1984 study. In 1999, more teeth of most types were extracted from regular attenders whereas, in 1984, more teeth of all types were extracted from irregular attenders. Premolars and first and second molars were the tooth types most frequently extracted in both surveys. In 1999 premolars were the teeth most commonly removed below 21 years of age, accounting for 57.5% of extractions in this age range. Molars accounted for 33.8% of extractions in this age range compared with 52% in 1984. Overall, caries was found to be the principal reason for loss of all tooth types apart from lower incisors which were extracted mainly for periodontal reasons. However, below 21 years, 84.5% of premolar extractions were performed for orthodontic purposes. CONCLUSIONS: Over the last 15 years, the overall number of extractions has reduced and the proportion of extractions from regular attenders has increased. Proportionately more premolars and fewer molars were extracted from under-21-year-olds. This observation can be explained by an increase in orthodontic extractions or a decline in extractions for caries in this age group. However, when extractions from the population as a whole are considered, caries and its sequelae remains the principal reason for loss of all tooth types other than lower incisors which are extracted mainly for periodontal reasons.

Adolescent↗
PubMed1999

Resuscitation of drowning victims in south-east Scotland.

INTRODUCTION: Immersion in cold water is compatible with long-term survival, even when the period of immersion is relatively long. Guidelines for resuscitation after immersion stress the importance of prolonged resuscitation using advanced life support techniques. METHODS: Deaths due to drowning in south-east Scotland between 1991 and 1997 were reviewed, using a variety of data sources. RESULTS: 95 deaths (69 males, 26 females) from drowning occurred in the following sites: sea, 35; bath, 15; flowing freshwater, 26; still freshwater, 19; 22 (23%) of the drowning incidents were witnessed, 73 (77%) were unwitnessed. 28 individuals were recovered within 1 h of being seen alive, 13 having had witnessed accidents, 15 having had unwitnessed accidents. Six individuals were not resuscitated at the scene by the emergency services, despite being last seen alive within the previous hour. A further five individuals were initially resuscitated, but declared dead at the scene within 1 h of being known to be alive. CONCLUSIONS: Members of the emergency services, are failing to both initiate prehospital resuscitation and to continue this to hospital for victims of near drowning. There appears to be potential to reduce the drowning death rate by improving resuscitation. The emergency services and the public should be educated about the need to resuscitate those found in water.

Adolescent↗