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PubMed2000

Trends in case-fatality in 117 718 patients admitted with acute myocardial infarction in Scotland.

OBJECTIVES: To analyse short- and long-term case-fatality trends following admission to hospital with a first acute myocardial infarction, in men and women between 1986 and 1995, after adjusting for risk factors known to influence survival. DESIGN: A Scottish-wide retrospective cohort study. SETTING: The Linked Scottish Morbidity Record Database was analysed. This contains accurate data on all hospital admissions since 1981, for the Scottish population of 5.1 million. It is linked to the Registrar General's death certificate data. SUBJECTS: All 117 718 patients admitted to Scottish hospitals with a principal diagnosis of first acute myocardial infarction (ICD-9 code 410) between 1986 and 1995. MAIN OUTCOME MEASURES: The outcome was death, both in and out of hospital, from any cause, at 30 days, 1 year, 5 and 10 years. RESULTS: Overall case-fatality following hospital admission with acute myocardial infarction was 22. 2%, 31.4%, 51.1% and 64.0% at 1 month, 1 year, 5 and 10 years, respectively. Multivariate analyses identified statistically significant independent prognostic factors. Thirty day mortality increased twofold for each decade of increasing age, and increased with any prior admission to hospital. When comparing the most deprived category to that of the most affluent, men had a 10% increased mortality (P<0.01), whilst women had an increased mortality of 4% (not significant). After adjustment for age, sex, deprivation and prior admission to hospital, case-fatality rates fell significantly between 1986 and 1995. Short-term case-fatality fell by 46% in men (27% in women) and long-term by 34% in men (30% in women) (both P<0.001). CONCLUSIONS: Population-based case-fatality rates in Scotland have fallen dramatically since 1986, particularly in men. The increasing survival in patients admitted to hospital suggests that the trial-based efficacy of modern therapies is now translating into population-based effectiveness. However, an individual's life expectancy still halves after a diagnosis of acute myocardial infarction. Of the variables that we could examine, age was the most powerful predictor of prognosis.

Age Distribution↗
PubMed2001

Natural paratuberculosis infection in rabbits in Scotland.

Natural paratuberculosis infection of rabbits (Oryctolagus cuniculus) was recently diagnosed in Scotland, and an investigation into the pathology of the disease in wild rabbits is reported in this paper. Evidence of Mycobacterium avium subsp. paratuberculosis (M.a. paratuberculosis) infection was detected in 22% of 110 rabbits; the organism was cultured from 17 of 110 rabbits, and histopathological lesions consistent with M.a. paratuberculosis infection were noted in 18 of 98 rabbits examined. No macroscopical lesions suggestive of M.a. paratuberculosis infection were observed. The histopathological lesions were either severe or mild. Severe lesions consisted of extensive macrophage granulomata and numerous giant cells, with many intracellular acid-fast bacteria in the small intestine. For the examination of formalin-fixed, paraffin wax-embedded tissues, neither immunohistochemistry nor the polymerase chain reaction was as sensitive a method of diagnosis as histopathology.

Animals↗
PubMed2001

A statistical approach to an outbreak of endophthalmitis following cataract surgery at a hospital in the West of Scotland.

The number of cases of endophthalmitis following cataract surgery caused considerable concern in a West of Scotland hospital throughout 1998 and early 1999. A multi-disciplinary team including infection control nurses, doctors, public health officials,epidemiologists and statisticians was set up to investigate the situation. This paper examines the statistical issues surrounding the investigation. A method based on the Poisson distribution showed that the number of cases was significantly higher than expected. Fisher's Exact Test and Logistic Regression were then applied to the data from two related case control studies. These analyses showed that a higher risk of endophthalmitis was associated with being female, having a vitrectomy or having a previous history of respiratory disease. Finally, a method was devised to enable staff to recognize more quickly when the number of cases of endophthalmitis was becoming higher than expected. The method should find application in other clinical situations where the probability of rare events is known.

Case-Control Studies↗
PubMed2002

The presentation and management of juvenile-onset chronic inflammatory bowel disease in Northeastern Scotland.

PURPOSE: This study reviews the presentation and management of juvenile onset chronic inflammatory bowel disease and identifies changes in incidence of the disease over a 20-year period. METHODS: This was a retrospective study of all patients aged 16 and under with chronic inflammatory bowel disease diagnosed in 1 health region between 1980 and 1999. The patients were identified from computer records and the following variables studied: age, sex, mode of presentation, medical and surgical management, and length of follow-up. RESULTS: One hundred seven patients were identified: 77 with Crohn's disease and 30 with ulcerative colitis. The incidence of ulcerative colitis and Crohn's disease has risen from 0.7 in 100,000 and 2.2 in 100,000, respectively, in the years 1980 through 1989 to 1.5 in 100,000 and 4.4 in 100,000 in the period 1990 through 1999. The median age at presentation was 10.1 years for ulcerative colitis and 10.8 years for Crohn's disease. The majority of disease was diagnosed within 1 year of the onset of symptoms, which were principally abdominal pain, diarrhea, and rectal bleeding. The average length of follow-up was 6.9 years. Analysis of the surgical management of Crohn's patients has shown a low rate of surgical intervention. CONCLUSIONS: This study has shown an increasing incidence of chronic inflammatory bowel disease in the Grampian region of Scotland coupled with a low rate of surgical intervention in Crohn's disease. These findings could be the result of early referral and diagnosis, with the disease being documented earlier in its course or more aggressive preemptive medical therapy.

Abdominal Pain↗
PubMed1979

Zinc deficiency in the West of Scotland? A dietary intake study.

1. The intake of zinc in the West of Scotland was determined by atomic absorption spectrometry, in ninety-six items of food which make up the local standard diet for 1 week. 2. The diet contained less Zn than the recommended daily allowance ((US) National Academy of Sciences, 1974). This finding either indicates the need for a revision of the suggested allowances or suggests that a change of diet is necessary. 3. The change could be made simply by the substitution of wholemeal flour for white flour. Other changes in diet were considered but they were unlikely to be acceptable. Even with changes the requirement of pregnant or lactating women would not be met. If the recommended allowances are valid these women must be deficient in Zn.

Adult↗
PubMed1992

Selenium content of wheat for bread making in Scotland and the relationship between glutathione peroxidase (EC 1.11.1.9) levels in whole blood and bread consumption.

The selenium content of the 1989 harvest of wheat used for bread making in Scotland ranged from 0.028 microgram/g dry weight for home-grown wheat to 0.518 microgram/g for Canadian wheat. The tonnage values indicate that 13.8% of the wheat used in bread making came from Canada. This reflects in a calculated dietary intake of 31 micrograms/d which is well below the recommended levels of 70 and 55 micrograms for adult males and females respectively (National Research Council, 1989). The average glutathione peroxidase (EC 1.11.1.9) level in 478 samples of human whole blood was 6.08 (SE 0.065) units/ml. This increased to 6.65 (SE 0.321) in sixty-two subjects consuming brown or wholemeal bread but was unaffected by oily fish consumption. Analysis of a small number of samples of whole milk, eggs and meat indicated slightly higher concentrations than previously published values but this trend was insufficient to compensate for the lower cereal provision of Se.

Bread↗
PubMed1994

Dietary patterns among adolescents in the west of Scotland.

Dietary data from 15-year-old adolescents participating in the West of Scotland Twenty-07 study were examined in order to describe current eating patterns and food habits. Comparison of the data with a 'healthy eating' index showed that less than one-third of the sample were eating a diet similar to that promoted by local health education campaigns. Multivariate analysis showed that adolescents from non-manual and wealthier families, non-smokers, and females were more likely to be classified as 'healthy eaters'. Comparison of the data with that collected from a 35-year-old cohort in the same study showed that significantly fewer 15-year-olds were likely to consume diets associated with long-term health.

Adolescent↗
PubMed2005

The Mediterranean eating in Scotland experience project: evaluation of an Internet-based intervention promoting the Mediterranean diet.

A 6-month intervention study with a quasi-experimental design was conducted to evaluate the effectiveness of an Internet-based, stepwise, tailored-feedback intervention promoting four key components of the Mediterranean diet. Fifty-three (intervention group) and nineteen (control group) healthy females were recruited from the Universities of Glasgow and Glasgow Caledonian, Scotland, respectively. Participants in the intervention group received tailored dietary and psychosocial feedback and Internet nutrition education over a 6-month period, while participants in the control group were provided with minimal dietary feedback and general healthy-eating brochures. Internet education was provided via an innovative Mediterranean Eating Website. Dietary changes were assessed with 7 d estimated food diaries at baseline and 6 months, and data were analysed to calculate the Mediterranean Diet Score, a composite score based on the consumption of eight components of the traditional Mediterranean diet. The 'intention-to-treat' analyses showed that, at 6 months, participants in the intervention group had significantly increased their intake of vegetables, fruits and legumes, as well as the MUFA:saturated fatty acid ratio in their diet, and had significantly increased plasma HDL-cholesterol levels and a reduced ratio of total:HDL-cholesterol. Participants in the control group increased their intake of legumes but showed no other favourable significant changes compared with baseline. This Internet-based, tailored-feedback intervention promoting components of the Mediterranean diet holds promise in encouraging a greater consumption of plant foods, as well as increasing monounsaturated fat and decreasing saturated fat in the Scottish diet; it also shows that the Mediterranean diet can be adopted by healthy individuals in northern European countries.

Adult↗
PubMed1978

A serological survey for Babesia in cattle in Scotland. III. The rates of acquisition and loss of antibody to Babesia and their effects on observed levels of antibody incidence.

Data for age and the incidence of antibody to Babesia divergens in cattle from areas of high and low endemicity have been analysed using three simple epidemiological models to estimate the rates of gain and loss of antibody. The models adequately described the observations but did not allow for an increased recovery rate attributable to acquired immunity in older animals. The rate of loss of babesial antibody in the absence of challenge was estimated directly from data for age and the incidence of antibody in Irish bred cattle located in nonendemic areas of Scotland. These data suggested an antibody loss rate of 0.25 per annum but did not provide firm evidence for the form of the antibody loss curve. Measurements of the titre of babesial antibody supported the conclusions drawn from studies of antibody incidence. In Irish bred cattle from non-endemic areas titres declined gradually over eight to ten years, whereas in cattle from an area of high endemicity, titres did not change appreciably with age. Cattle tested within one to three months of infection exhibited high titres.

Age Factors↗
PubMedDate not supplied

Soil arsenic in Armadale, Scotland.

As part of an investigation into the high mortality from lung cancer and the high sex ratios of births in Armadale, central Scotland, concentrations of arsenic were measured in soil cores from 48 sites in Armadale and 6 sites in a comparison town. Concentrations in Armadale were substantially higher than those in the comparison town, and many of the highest range of values were in that part of the town where the epidemiological abnormalities of lung cancer and of birth sex ratios were most pronounced. The study indicated that clues to the etiology of high rates of disease in small areas could be sought most profitably if close links were maintained between epidemiological and environmental investigations.

Arsenic↗
PubMed2002

The changing epidemiology of bacterial meningitis and invasive non-meningitic bacterial disease in scotland during the period 1983-99.

We reviewed population-based laboratory reports of invasive meningococcal, pneumococcal, Haemophilus influenzae, Group B Streptococcus (GBS) and Listeria monocytogenes isolates in order to examine the changing epidemiology of meningitis and invasive non-meningitic disease (INMD) caused by these 5 pathogens in the 2 periods before (1983-91) and after (1992-99) routine use of H. influenzae type B conjugate vaccine (Hib) in Scotland. Neissieria meningitidis was the most common cause of meningitis, accounting for 39.2% of cases of meningitis in 1983-91 and 47% of cases in 1992-99, followed by H. influenzae (31%), Streptococcus pneumoniae (22.4%), GBS (3.9%) and L. monocytogenes (3.5%) in 1983-91 and S. pneumoniae (36.3%), H. influenzae (7.8%), GBS (6.1%) and L. monocytogenes (2.8%) in 1992-99. The important epidemiological features of meningitis and INMD caused by these 5 pathogens between 1983-91 and 1992-99 include: 1. The incidence of bacterial meningitis due to S. pneumoniae and GBS was stable; 2. S. pneumoniae was the predominant cause of INMD in both periods; 3. The incidences of INMD caused by N. meningitidis, GBS and S. pneumoniae increased, by 27%, 55% and 56%, respectively; 4. Decreases in the incidences of bacterial meningitis (by 50%) and INMD (by 50%) due to L. monocytogenes were detected; and 5. There were dramatic reductions in the proportions of bacterial meningitis (by 92%) and INMD (by 56%) due to H. influenzae in vaccinated and non-vaccinated individuals. Continued surveillance is necessary to monitor the disease trend, population at risk, serotype distribution and antimicrobial susceptibility in order to implement appropriate public health interventions against invasive bacterial disease.

Adolescent↗
PubMed2002

Prevalence of penicillin non-susceptible invasive pneumococcal disease in the elderly in Scotland, 1992-99.

Penicillin resistance of Pneumococci is a problem in several European countries. Therefore, we examined 510 invasive pneumococcal isolates, collected between 1992 and 1999 via a national network of diagnostic laboratories covering the entire population of Scotland, for penicillin susceptibility, in order to determine the prevalence, site of infection and serogroup/type distribution of penicillin-resistant Pneumococci in the elderly (> or = 65 y). Of the 510 isolates, 91.6% (n = 467) were from blood, 4.7% (n = 24) from other sterile sites and 3.7% (n = 19) from cerebrospinal fluid. The prevalence of penicillin non-susceptible isolates during the study period was 9%. An increase in the proportion of Pneumococci non-susceptible to penicillin was detected from 1996 onwards, from 10.8% in 1996 to 14.3% in 1999. There were 2 isolates with high-level penicillin resistance, both of which were of serotype 14, accounting for 4.3% (2/46) of all non-susceptible isolates. Penicillin non-susceptible isolates belonged to the following serogroups: 14 (32.6%); 9 (30.4%); 6 (19.6%); 23 (10.9%); and 19 (6.5%). The leading non-susceptible serotype/group varied according to the specimen type: serotype 14 for blood and serogroup 9 for all other sterile sites. Current polysaccharide and new 7-, 9- and 11-valent conjugate vaccine formulations included the serogroups responsible for all the penicillin non-susceptible isolates detected. Therefore vaccination represents the most effective strategy for decreasing the burden of drug resistance. Constant surveillance of the patterns of antibiotic non-susceptible isolates, the site of infection and the serogroup/type are necessary in order to select antibiotic therapy and establish vaccination policy for the prevention of invasive pneumococcal disease.

Aged↗
PubMed2003

Evaluation of an experimental midwife-led unit in Scotland.

This paper reports on the outcome of pregnancy among 3322 low-risk women managed in an 'experimental midwife-led unit' at Forth Park Hospital, Kirkcaldy, Scotland. All women were allocated to receive midwife-led antenatal and intrapartum care. Of the 3322 women, 1786 were nulliparous and 1536 were parous. Of the 1786 nulliparous women, 532 (30%) were transferred to consultant care antepartum, 488 (27%) were transferred intrapartum and the remaining 766 (43%) were delivered in the midwife-led unit (MLU). Of the 1536 multiparous women, 343 (22%) were transferred to consultant care antepartum, 158 (10%) were transferred intrapartum and the remaining 1035 (68%) were delivered in the MLU. Among the intrapartum transfer group, 14% delivered during the first hour after the decision to transfer and another 14% gave birth during the second hour (28% between 0-2 hours). More than half of the women transferred during the second stage delivered within the first hour. Of the 2447 admitted to the MLU, 32% were seen by obstetric team on more than one occasion. Of the 1801 babies delivered in the MLU, 9% required resuscitation and 2% of all the babies were admitted to the special care baby unit. This study suggests that present antenatal criteria are unable to determine who will remain at low risk throughout pregnancy and labour, especially among nulliparous women. The clinical situation could change adversely during labour, requiring the involvement of medical staff. Commissioners of maternity services may wish to utilise these data to formulate local protocols for stand-alone midwife-led units.

Female↗
PubMedDate not supplied

Illicit use of ketamine in Scotland.

Semistructured interviews were carried out with 20 illicit users of ketamine in Scotland. Participants had used a wide range of illegal drugs. Scottish drug agencies reported limited contact with ketamine users; however, subjects were knowledgeable regarding the licit purpose of ketamine, its effects, and its legal status. Ketamine was usually obtained through diversion from legitimate sources. Three participants reported extensive use, indicating the potential for psychological dependence. A standard dose of ketamine was typically 1/8 g, usually taken intranasally. Participants reported the ketamine experience as being extremely intense and dissociative, usually lasting for approximately one hour. All participants reported using ketamine in a carefully preplanned setting, emphasizing comfort, security, and familiarity. Participants identified potential problems arising from using ketamine in a public place, or in unfamiliar surroundings, and also suggested that novice users may encounter problems through lack of knowledge concerning the intense nature of the experience. Accurate information concerning the effects and nature of ketamine as well as the importance of set and setting should be made available. However, publicizing the drug should be avoided as widespread interest could cause greater problems than currently exist.

Adult↗
PubMedDate not supplied

The secular trend in the height of primary school children in England and Scotland from 1972-1980.

Data from 29 230 children in 22 areas in England and 6 in Scotland were used to estimate the secular trend in height of primary school children over the period 1972-1980. The children were from 15 birth cohorts, born 1961-1975. The method of analysis was selected in order to give estimates from mixed longitudinal data, in which the number of measurements differed from cohort to cohort and children with incomplete data could not be assumed to be comparable to those measured at every age. When the overall goodness-of-fit to height data of polynomials in age was examined, for children measured on 7 or 8 occasions, it was found that cubic polynomials were necessary to describe the growth of boys and girls over the age range 5.0 to 11.0 years, but that cubic and quadratic coefficients could not be interpreted for individual children. No evidence of a mid-growth spurt in height was found. Models fitted to mean heights showed that there was a secular trend of increasing height over the period studied, which was greater when estimated at age eight years than at age five. At age 8 the trend was greatest in Scottish boys, 1.5 cm per decade, and least in English girls, 0.5 cm per decade. The data do not distinguish between a trend due to earlier maturation and a trend resulting in increased adult height; further data will show whether the lack of positive trend at age five estimated from the later cohorts was due to a recent cessation of secular trend.

Body Height↗
PubMedDate not supplied

Secular trends in weight, weight-for-height and triceps skinfold thickness in primary schoolchildren in England and Scotland from 1972 to 1980.

Measurements of height, weight and triceps skinfold thickness were obtained from English and Scottish schoolchildren from 15 birth cohorts over the period 1972-1980. Positive trends in weight were found for boys and girls in both countries, but in England they were less than expected from the increases in height. The increase in weight-for-height in Scotland was paralleled by a greater increase in triceps skinfold in Scottish than in English children. Scottish children remained shorter, lighter and thinner than English children, but similar in weight-for-height. Separate monitoring of trends in obesity for English and Scottish children should continue.

Body Height↗
PubMedDate not supplied

Anthropometric variation between migrants and non-migrants: Orkney Islands, Scotland.

Anthropometric measurements on a non-migrant sample consisting of 174 males and 148 females aged 21 to 75 resident in the Orkney Islands are compared with measurements on 91 males and 96 females who migrated as adults to the Aberdeen area of Scotland. Covariance analysis, adjusting for age effects, reveals differences in a number of anthropometric variables, with migrants showing smaller dimensions in several cases. For most variables the differences are more marked in females. Significantly smaller values are found in upper arm circumference, bicondylar humerus and head breadth in female migrants, and in bicondylar humerus in male migrants. Biacromial and head length dimensions are significantly greater in female migrants. There is no significant effect of duration of residence in the new environment on the anthropometric values of migrants.

Adult↗