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PubMed2001

Antibiotic prescribing knowledge of National Health Service general dental practitioners in England and Scotland.

The inappropriate use of antibiotics has contributed to the worldwide problem of antimicrobial resistance. Information on the knowledge, understanding and training of dental practitioners in the use of antibiotics in clinical practice is scarce. This study assessed the level of knowledge of general dental practitioners and the need for educational initiatives. An anonymous postal questionnaire was sent to National Health Service dental practitioners working in 10 Health Authorities in England (1544) and four Health Boards in Scotland (672). Each correct answer to the questionnaire was given a score of one mark; there were 84 questions. The scores for each section of the questionnaire were compared. Responses were received from 1338 (60.4%) of practitioners, of whom 22.1% had attended postgraduate courses in the previous 2 years on antibiotic prescribing. Practitioners who had attended courses had a significantly greater knowledge of antibiotic use (P < 0.05) than those who had not. There was no significant difference in knowledge between all age groups under 60 years of age. There were significant differences in knowledge between dentists practising in English Health Authorities and Scottish Health Boards (P < 0.01). Knowledge was good for clinical signs that are indicators for prescribing antibiotics and for a number of non-clinical factors, e.g. patient expectation. Knowledge of therapeutic prescribing for commonly presenting clinical conditions and prophylactic prescribing for medically compromised patients, however, was generally poor. This study has shown that an urgent review of dental undergraduate and postgraduate education in antibiotic prescribing is required. Provision of prescribing guidelines may improve knowledge and encourage the appropriate use of antibiotics in clinical dental practice.

Anti-Bacterial Agents↗
PubMed2005

The use of NHS accident and emergency services by commercial sea fishermen in the North East of Scotland.

BACKGROUND: Commercial sea fishing is known to be a hazardous occupation, but little quantitative research has been conducted in the UK. OBJECTIVE: To describe the demography of commercial fishermen accessing NHS accident and emergency (A&E) services and profile the reasons for attendance. METHODS: Eight NHS A&E departments in North East Scotland participated in the audit. A structured data collection form was completed by the attending nurse or doctor during a 6 month period (March-August). All commercial sea fishermen attending during this time were included whether or not the reason for attendance was work-related. RESULTS: There were 164 cases of which 133 (81%) presented with injuries and 19 (12%) with illnesses (12 unknown). Twenty-seven (16%) cases had required emergency evacuation from commercial vessels. The most frequent category of injury was 'hand', 'wrist' or 'finger' followed by 'head', 'face' and 'throat'. CONCLUSION: Commercial sea fishing is a dangerous occupation with many injuries requiring NHS A&E treatment. The relatively high level of injuries compared to illness indicates that there are still safety issues to be addressed and current risk assessment requirements need to be reviewed.

Accidents, Occupational↗
PubMed2000

Orthodontic treatment with fixed appliances in the General Dental Service in Scotland.

The records of 128 subjects treated by orthodontic specialists with fixed appliances in the General Dental Service in Scotland were randomly selected from the Scottish Dental Practice Board for analysis. The results of the study revealed that: (1) Mean post-treatment Peer Assessment Rating was 7.8 +/- 4.6 PAR points. (2) Mean reduction in PAR score was 14.9 +/- 10.6 PAR points. (3) Mean percentage reduction in PAR was 59 per cent. (4) Twenty-eight per cent of the cases were 'greatly improved', 15 per cent of the cases were made 'worse or no different'. (5) Median duration of treatment was 15 months, with a range of 2-41 months. (6) Multiple regression analysis showed that 82 per cent of the variability of PAR change could be predicted by the pretreatment PAR scores and the number of arches treated. Post-treatment PAR scores and duration of treatment could not be predicted with adequate reliability. It was concluded that although about 75 per cent of the cases were treated to at least acceptable alignment and occlusion, the modest average percentage reduction in PAR score could be explained by the low average initial PAR score and the borderline need for treatment in many cases.

Episode of Care↗
PubMed1993

Estimating the population prevalence of injection drug use and infection with human immunodeficiency virus among injection drug users in Glasgow, Scotland.

Although data on the prevalence of injection drug use are an essential prerequisite for estimating the number of individuals infected with the human immunodeficiency virus (HIV), there have been few attempts to utilize statistical methods of population estimation based on multiple data sources. Data on 3,670 cases (2,866 individuals) were obtained from the HIV test register, drug treatment agencies, police records, and needle and syringe exchanges in Glasgow, Scotland, in 1990. Log-linear analysis was used to model the number of individuals in each of the sources. The model incorporating dependency among the three health care agencies (HIV test, drug treatment, and needle exchange) and independence of the police sample fitted the data well, with a residual chi 2 value of 2.9 (6 df). The expected value of the missing cell corresponding to absence from all four samples was 5,628, yielding an overall estimate of 8,494 injectors (95% confidence interval (CI) 7,491-9,721), for a prevalence rate of 1.35% for people aged 15-55 years in Glasgow during 1990. The high ratio of known to unknown injectors (1:2) resulted from the extensive coverage of known injectors and the relatively high level of overlap between the combined health care agency sample and the police sample. While further analysis demonstrated that the probability of appearing in the four samples varied by age and sex, heterogeneity in the population did not affect the choice of model or substantially alter the estimates for the total number of unknown injectors. A concurrent study of a community-wide sample of 503 injectors resulted in an HIV prevalence rate of 1.1% (95% CI 0.4-2.5%). The results of these studies were combined to produce a further estimate of 93 HIV-infected current injectors in Glasgow (95% CI 33-214).

Adolescent↗
PubMed1996

Does dietary trans fatty acid intake relate to the prevalence of coronary heart disease in Scotland?

Reports of the effects of trans fatty acids on coronary heart disease are inconsistent. Trans fatty acids may particularly influence coronary risk when linoleic acid levels are low, a situation which occurs in Scotland where prevalence of coronary heart disease is also very high. The link between trans fatty acid intake and prevalent coronary heart disease was therefore investigated in the Scottish Heart Health Study population. Trans fatty acid intakes were calculated from 10/359 sets of food-frequency questionnaire data obtained from the cross-sectional survey of men and women aged 40-59 years. Logistic regression analysis was used to calculate the odds ratios for prevalent coronary heart disease by fifths of dietary intake of total, natural and commercial hydrogenation-derived trans fatty acid. The group who had undiagnosed coronary heart disease at the time of survey was the pertinent group for examining the possible causative effects of trans fatty acid intake. After adjustment for the confounding factors (i.e. age, weight, height, smoking, level of physical activity, blood pressure, total energy intake and intakes of saturated fat, linoleic acid and the antioxidant vitamins) the odds of undiagnosed coronary heart disease for men, relative to the lowest intake fifth, did not differ significantly from unity by total or commercially-derived trans fatty acid intake. Odds were around 35% smaller in the higher intake fifths of naturally-derived trans fatty acids. For women, the odds of undiagnosed coronary heart disease tended to be greater in the higher fifths of total (odds ratio 1.36 (95% confidence interval 0.94, 1.89)) and hydrogenated (1.26 (0.92, 1.72)) trans fatty acid relative to the lowest fifth, but only reached significance in the third fifth of total trans fatty acid (1.36 (1.01, 1.83)). Dietary total and commercially-derived trans fatty acids failed to influence the odds of coronary heart disease for men, even though a significant increase in the ratio of low density plus very low density lipoprotein to high density lipoprotein-cholesterol occurred with trans fatty acid intake. The results, therefore, do not support a major effect of dietary trans fatty acid from commercial hydrogenation on coronary heart disease risk in these Scottish men. The results for women are less clear, and the possibility remains that individuals at the high extreme of trans fatty acid intake, who may be essential fatty acid deficient, are at enhanced risk of coronary heart disease.

Adult↗
PubMed1996

An outbreak of bovine tuberculosis in two herds in south west Scotland--veterinary and human public health response.

BACKGROUND: Although the incidence of bovine tuberculosis in UK cattle has declined markedly, outbreaks still occur. There is often confusion as to how veterinary and human public health agencies should interact in such circumstances. We report an outbreak of bovine tuberculosis which occurred in South West Scotland in 1992. METHODS: The outbreak, which affected two cattle herds, and potentially involved 17 humans, was discovered when visible tuberculous lesions were found at routine post mortem examination of a calf. Investigation of animals and humans, exchange of information between human and veterinary public health agencies, and subsequent control measures followed the guidance of a recently produced protocol. RESULTS: Tuberculin testing of other animals in the index herd revealed 11 reactors. Testing of the herd of origin of these animals revealed 84 reactors out of 261 animals. Movement restrictions were placed on the index herd, and all the animals in the herd of origin were slaughtered. The humans were screened primarily by history and tuberculin skin testing. Eleven of them required chest X-rays (all were normal) and six were given prophylactic chemotherapy with isoniazid. Nobody developed clinical illness. CONCLUSION: The use of an agreed protocol proved to be very helpful to both human and veterinary public health agencies in the investigation and control of an outbreak of bovine tuberculosis. There is a clear need for better human screening tests.

Adult↗
PubMed1990

Trends in infant mortality in Scotland, 1970-1987.

Infant mortality rates in Scotland have fallen by 56.6 per cent from 19.6 per 1000 live births in 1970 to 8.5 per 1000 in 1987. The reduction has been more marked in the early neonatal period than at later ages. The causes of death, based on generally high post-mortem rates, have been examined in functional groups and the changes over time are described. Ninety per cent of neonatal deaths throughout the period reviewed were due to congenital anomalies, asphyxia or immaturity-associated conditions. Eighty per cent of post-neonatal deaths are now due to congenital anomaly or sudden infant death syndrome (SIDS). The principal shifts in cause of death groups from infections and external causes in the 1970s to SIDS in the 1980s are described in detail and are probably related to improved recognition of the syndrome of sudden infant death, rather than to true changes.

Asphyxia↗
PubMed1998

Changes in the risk of schizophrenia in Scotland: is there an environmental factor?

Various studies have suggested that there may be an environmental factor in schizophrenia acting before or at birth but with delayed effects. Evidence that the risk of developing schizophrenia varies randomly with the year of birth would help confirm the existence of such a factor. Data from the Scottish Health Service Information and Statistics Division, comprising all first admissions for ICD-9 schizophrenia in the years 1963-91, were used to estimate the lifetime risk of developing schizophrenia for each year of birth from 1900 to 1969. In the period after 1928 the lifetime risk steadily declined. The rate of decline was greater in females. The random fluctuations in the risks in females did not change systematically, but there was a significant decline in the variability of these fluctuations in males. These random fluctuations suggest a possible role for randomly varying environmental influences around the time of birth. Our findings suggest a possible diminution in the role of such environmental influences in schizophrenia among males in Scotland in the years 1929 to 1969.

Adolescent↗
PubMed1999

Association of medical, physiological, behavioural and socio-economic factors with elevated mortality in men of Irish heritage in West Scotland.

BACKGROUND: Men with patrilineal Irish descent from the immigrations of the nineteenth and twentieth centuries have higher death rates from 'all-causes' and, specifically, cardiovascular disease (CVD) than the general population of the West of Scotland. METHODS: A total of 5766 male employees from 27 workplace settings were examined between 1970 and 1973. Surname analysis identified 15 per cent of these men as of patrilineal Irish heritage. For those who have since died, the date and cause of death was obtained. Cox's proportional hazards model was used to compare the mortality risk of those with Irish and non-Irish surnames, and to investigate established medical, physiological, behavioural and socio-economic risk factors (acting in early and later life) as possible explanations for this excess mortality. RESULTS: The relative risk of death from all causes for the Irish of 1.26 (95 per cent confidence interval (CI) (1.12, 1.43)) was reduced to 1.12 (95 per cent CI (0.99, 1.26)) by including established risk factors in the model. The relative risk of CVD mortality of 1.51 (95 per cent CI (1.29, 1.77)) for the Irish was reduced to 1.35 (95 per cent CI (1.14, 1.58)) by the same adjustments. The elevated all-cause mortality of the Irish was mainly attributable to cardiovascular deaths. CONCLUSIONS: Cigarette smoking was only able to 'explain' a small amount of the excess all-cause and CVD mortality of men with patrilineal Irish descent. Relative deprivation during childhood and adulthood contributed to the high Irish mortality. However, there remains a substantial excess of premature deaths among Irish men which is unaccounted for by established risk factors.

Adult↗
PubMed2003

Development and recovery from winter embolism in silver birch: seasonal patterns and relationships with the phenological cycle in oceanic Scotland.

Silver birch (Betula pendula Roth) is increasingly used in the United Kingdom for reforestation. However, recent evidence indicates that, under some circumstances, planted birch can suffer serious and repeated mortality of the apical leaders and branches, with consequent loss of apical dominance and the formation of a contorted stem. Plants from 37 seed sources of silver birch from Scotland and northern England planted at two sites were compared for several characteristics related to hydraulic architecture, vulnerability to freeze-thaw cycle induced embolism and spring recovery from winter embolism during the period 2000-2002. Phenological rhythms were also monitored in late winter-early spring to document relationships between phenology and water relations parameters. Significant differences were found across seed sources in stage of bud flushing for four dates in spring. Early flushing seed sources differed by about 1 to 2 weeks from late-flushing seed sources across the two sites. Wintertime xylem embolism in stems reached a peak of about 50 to 70% loss of xylem hydraulic conductivity, depending on the size and position of the sample shoots in the canopy. Small apical shoots were significantly more embolized than large basal shoots. Development of winter embolism was coupled to the occurrence of frost events. As percent loss of hydraulic conductivity increased during the winter, wood relative water content declined. Embolism reversal occurred rapidly in spring at the time of development of positive root pressure. No significant differences in the degree of winter embolism in 2001 were found among the three seed sources examined. The investigation was expanded in the winter-spring of 2002 to include 10 seed sources across both sites. Significant differences were found in degree of winter embolism across sites, dates and seed sources. For each date, there was a significant relationship between flushing scores and wood relative water contents across the two sites and all seed sources, suggesting that differences in time of flushing across sites and seed sources were likely caused by differences in the time of occurrence of root pressure, a necessary precondition to flushing.

Betula↗
PubMed1989

Changes in HIV risk behaviour in clients of syringe-exchange schemes in England and Scotland.

The impact of syringe-exchange schemes on the behaviour of injecting drug users was investigated through self-reported behaviour change. Fifteen syringe-exchange schemes in England and Scotland participated in a government-sponsored pilot programme from April 1987. Clients were provided with sterile injecting equipment and condoms, and with knowledge of HIV risks. One hundred and forty-two injecting drug users who first attended between April 1987 and March 1988 participated in a prospective interview-based survey with questions at two points in time. Measurements were self-reported attitudinal, knowledge and behavioural changes relevant to HIV infection and transmission. Many clients maintained or adopted low-risk behaviours: 79% sustained or adopted low or lower levels of syringe sharing. Trends identified include decreases in syringe-sharing, from 34 to 27%; using others' syringes (risk of infection) from 25 to 19%; passing on syringes (risk of transmission) from 30 to 25%. Many clients reported changes in sexual behaviour; those with sexual partners decreased from 77 to 69% and those with two or more sexual partners from 26 to 21%. However, non-use of condoms increased from 62 to 79%. Comparison groups of non-attenders showed higher levels of risk behaviour (59-62% sharing syringes, 86-88% with sexual partners). Overall, changes in HIV risk behaviour show small but encouraging trends and support arguments that injectors can be helped to change their behaviour, which could be of cumulative importance in reducing the spread of HIV.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Summer birth and deficit schizophrenia in Nithsdale, Scotland.

Patients with deficit schizophrenia differ from other people with schizophrenia relative to course of illness, treatment response, and neurobiological correlates. An association between deficit schizophrenia and summer birth, in contrast to the winter birth risk factor associated with schizophrenia as a whole, has also been reported. We attempted to replicate the association between summer birth and deficit schizophrenia by using data from a prevalence survey in Nithsdale in southwest Scotland, in which all patients with schizophrenia in Nithsdale were identified and 87% were interviewed directly. Deficit schizophrenia was associated with summer birth, defined as birth in June/July/August (p < .02), June/July (p < .02), or July/August (p < .03). The association with summer birth is consistent with other evidence that patients with deficit schizophrenia have a pathophysiology that differs in some ways from that of other patients with schizophrenia.

Female↗
PubMed1996

Cutaneous malignant melanoma in children and adolescents in Scotland, 1979-1991.

All cases of cutaneous malignant melanoma in Scotland have been registered by the Scottish Melanoma Group since 1979, and there are currently more than 4700 cases on the registry. Of these, only 50 cases are in patients 18 years of age and younger (1.04 percent of all melanomas); 15 of these were prepubertal, i.e., 14 years or younger (0.3 percent of all melanomas). The nine cases of documented metastases occurred in children with tumor thickness of 1.50 mm or more, with only one of these metastases occurring in a prepubertal child. Eight of these patients with metastatic disease died, with a maximum survival of 4 years. A reliable clinical history was obtained from the families of 23 patients. Eight of them had a history of preexisting congenital nevocellular nevus. In this series, no case arose in a large congenital nevocellular nevus. Histological review showed that the majority of cases (58 percent) exhibited typical cytological and architectural features of malignant melanoma. In the remaining cases, the lesions were difficult to fit into any of the classic patterns of malignant melanoma or of the known benign nevocellular lesions.

Adolescent↗
PubMed2002

Seasonal distribution of idiopathic congenital talipes equinovarus in Scotland.

Idiopathic congenital talipes equinovarus has a reported prevalence of between 0.64 and 2.5 per thousand live births in the Scottish population. A retrospective study of neonates (n=162), who presented with idiopathic congenital talipes equinovarus in Scotland over a 3 year period (1994-1996) revealed a seasonal increased incidence of the condition in neonates born in March and April. The probable aetiological factors for congenital talipes equinovarus are discussed.

Clubfoot↗
PubMed1999

Changing incidence of Achilles tendon rupture in Scotland: a 15-year study.

OBJECTIVE: To determine the incidence of Achilles tendon rupture in Scotland from 1980 to 1995. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Data were obtained from the National Health Service Information and Statistics Division and analyzed in terms of age- and gender-specific incidence rates and time trends by age group. PARTICIPANTS: A total of 4,201 patients with Achilles tendon ruptures occurring during the study period. MAIN OUTCOME MEASURES: Calculation of incidence and of seasonality. RESULTS: The overall incidence of Achilles tendon rupture increased from 4.7/100,000 in 1981 to 6/100,000 in 1994, with a peak in 1986. In men, the incidence rose from 6.3/100,000 to 7.3/100,000. In women, the increase in incidence was more pronounced, from 3/100,000 to 4.7/100,000. In men, peak incidence rate occurred in the 30- to 39-year age group, whereas in women, the peak age-specific incidence occurred in those aged 80 years and older, with a steady increase after age 60. There was no evidence of a seasonality effect in the rate of occurrence of Achilles tendon rupture. A bimodal distribution of age at time of Achilles tendon rupture was noted. CONCLUSION: There was a significant increase in the incidence of Achilles tendon rupture during the period from 1980 to 1995. This reflects the increased incidence of the injury noted in other Northern European countries.

Achilles Tendon↗
PubMed2000

ABO blood groups and achilles tendon rupture in the Grampian Region of Scotland.

OBJECTIVE: To test whether the association between blood groups and Achilles tendon rupture (ATR) reported in some Scandinavian countries and in Hungary was present in our region. METHODS: We studied 78 patients treated at Aberdeen Royal Infirmary from 1990 to 1996, and compared their distribution of ABO blood groups with that found in 24.501 blood donors typed at the Blood Transfusion Centre during the same period. RESULTS: Overall, 47 of 78 (60%) of patients with an Achilles tendon rupture belonged to blood group O, compared with 51% of the population as a whole. Only 22 (28%) of the Achilles tendon rupture patients belonged to blood group A, whereas 35% of the general population were members of this group (NS). The A/O ratio was 0.47 for the tendon rupture patients, compared with 0.68 for the general population (NS). CONCLUSIONS: We could not demonstrate any significant association between the proportions of ABO blood groups and ATR in the Grampian Region of Scotland. The findings in other studies could be due to peculiarities in the distribution of the ABO groups in genetically segregated populations.

ABO Blood-Group System↗
PubMed2007

Scaphoid fractures: variation in radiographic views - a survey of current practice in the West of Scotland region.

BACKGROUND: A variation seems to exist between hospitals with regard to the initial radiographic assessment of suspected scaphoid fractures. MATERIALS AND METHODS: A survey of all acute hospitals in the West of Scotland was carried out to ascertain the current practice in the assessment of acute scaphoid fractures. Consultant radiologists and consultant orthopaedic surgeons from the same hospitals were requested to suggest the minimum number and type of views to be ideally performed for a routine scaphoid series. RESULTS: Fourteen hospitals, 85 consultant orthopaedic surgeons and 60 consultant radiologists were contacted. Among the hospitals, 64.3% performed four views and 28.5% performed three views for a suspected scaphoid fracture. The commonly performed radiographs were lateral with the wrist neutral (85.7%) and postero-anterior oblique in ulnar deviation (78.5%). Of the consultant orthopaedic surgeons, 57.5% suggested four views, while 33.3% suggested three views. A lateral view with the wrist neutral (87.8%) and a postero-anterior view in ulnar deviation (51.5%) were considered most useful. Of the consultant radiologists, 68.4% suggested four views and 15.8% suggested three views. A lateral view with the wrist neutral (84.2%) and a postero-anterior view in ulnar deviation (52.6%) were considered most useful. DISCUSSION: A lack of uniformity is found among orthopaedic consultants who request scaphoid views, radiographers who perform the views and radiology consultants who report on these. We feel a uniform system of radiographic evaluation of scaphoid fractures should be introduced, with a standardized number and type of views, in all hospitals to increase the familiarity of both terminology and visualization.

Data Collection↗
PubMed2006

Towards improved empirical isobase models of Holocene land uplift for mainland Scotland, UK.

A new approach to modelling patterns of glacio-isostatic land uplift during the Holocene in mainland Scotland, UK, is described. The approach is based upon altitude measurements at the inner margin or locally highest point of raised estuarine surfaces dated by radiocarbon assay supported by microfossil analyses. 2,241 altitudes have been analysed by a technique new to studies of former sea-levels, Gaussian Trend Surface Analysis, and isobase models for four Holocene shorelines: the Holocene Storegga Slide tsunami shoreline, abandoned rapidly circa 7,900 sidereal years BP; the Main Postglacial shoreline, abandoned during circa 6,400-7,700 sidereal years BP; the Blairdrummond shoreline, abandoned during circa 4,500-5,800 sidereal years BP, and a speculative fourth shoreline, the Wigtown shoreline, abandoned during circa 1,520-3,700 sidereal years BP, are shown in a series of maps. The implications of the shoreline patterns for glaicio-isostasy in the area are discussed. It is maintained that the statistical technique used enables broad estimates to be made of near shore sea surface change.

Age Factors↗