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PubMed2000

The domiciliary care market in Scotland: quasi-markets revisited.

By offering people the choice of care at home, the policy of encouraging local authorities to purchase domiciliary care services from voluntary and private providers was intended to achieve a key part of the community care agenda. A study to establish the extent to which there was a mixed economy in the purchase and provision of domiciliary care in Scotland in 1996 revealed reluctance by local authority managers to divest the provision of domiciliary care to voluntary and private agencies. In a telephone survey of purchasers, some social work respondents noted a preference for voluntary over private providers and expressed concern as to whether either could take over the bulk of domiciliary care provision. These attitudes were reflected in the pattern of market development observed. Five hundred and ninety providers were identified, but a postal survey of a random sample of one in two providers (response rate 66%) found that the independent sector's share of the market, measured as the proportion of weekly care hours provided, was small compared with the position in England and Wales at that time (15 : 36%). It is concluded that understanding of the development of the quasi-market in domiciliary care in the UK must now take account of slower development in Scotland. Explanation for the difference may lie in the level of state regulation, for in Scotland there was no compulsion on local authorities to purchase from the independent sector. Paradoxically, the quasi-market in England developed through strong state regulation, whereas in Scotland the strength of policy networks may account for the persistence of a more traditional welfare state model. The paper questions whether the incentives for change were sufficient in Scotland under the quasi-market. If local partnerships do not deliver these results the government may have to take a more active role to modernise domiciliary care services.

Journal Article↗
PubMed2002

Changing trends in incidence of lung cancer by histologic type in Scotland.

Lung cancer is a major public health concern worldwide. Our study aims to examine trends in incidence of lung cancer in Scotland during 1959-97 and by histologic type for 1975-97. In Scotland, lung cancer is the most commonly diagnosed cancer in men and is the second most commonly diagnosed cancer in women. Due to poor survival rates, trends in incidence and mortality display similar patterns. Within the United States and many parts of Europe, falls in the incidence of squamous cell carcinoma have occurred whilst the incidence of adenocarcinoma has increased. Data were extracted from the Scottish Cancer Registry. Trends in incidence were examined by standardising rates to the World Standard Population. Age-specific rates were examined by year of diagnosis and mid year of birth. In Scotland the incidence of lung cancer in men has fallen since the late 1970s, whereas incidence in women has continued to increase. Incidence rates of adenocarcinoma have increased over time but squamous cell carcinoma remains the predominant type of lung cancer in Scotland. The quality of lung cancer registration data has improved over time, although a large proportion of lung cancers (>20%) are not microscopically verified. Changes in histologic types are unlikely to be solely due to diagnostic advances. Rates of adenocarcinoma have increased steadily over time, and this may be due to changes in cigarette design during the 1950s.

Adenocarcinoma↗
PubMed2005

Is the urban excess in lung cancer in Scotland explained by patterns of smoking?

Numerous studies have shown that lung cancer rates are higher in urban than rural areas, controlling for differences in age and sex profiles. One explanation is that smoking rates are higher in urban areas, although it is not clear whether the variations in smoking behaviour fully account for the observed urban/rural gradient in lung cancer incidence. Indeed, some studies have demonstrated an excess of cases in urban areas, even controlling for smoking behaviour. However, previous studies have been hampered by the lack of small-area smoking estimates which are required if urban/rural variations are to be examined reliably. This paper considers whether there is an urban excess in lung cancer incidence in Scotland, a country with particularly high rates of the disease, for the period 1988-1991. First, we examine whether an urban excess exists in Scotland using Poisson probabilities and a cluster detection technique. Second, regression analysis was then used to test whether any urban excess in lung cancer incidence remained once smoking behaviour was controlled for, using smoking estimates calculated for small areas throughout Scotland. The results demonstrate that the rates of lung cancer were higher in urban areas and that all the significant clusters of cases of lung cancer were located in the large urban centres of Scotland. Smoking behaviour did account for much of this urban excess in lung cancer, although it did not explain the entire effect. These results suggest that there are urban effects that influence the incidence of lung cancer that are not explained entirely by smoking behaviour. Possible explanations include the variations in exposure to air pollution, occupational differences and the legacy of selective migration between urban and rural areas.

Adult↗
PubMed1991

Deaths from road traffic accidents in Scotland: 1979-1988. Does it matter where you live?

The purpose of this study was to calculate and compare the geographical distributions of male and female deaths from road traffic accidents in Scotland. A retrospective, nationwide study of deaths from road traffic accidents was undertaken; all road traffic deaths between 1979 and 1988 were included. Deaths were abstracted from the Annual Reports of the Registrar General for Scotland. Standardized mortality ratios (SMRs) for males and for females were calculated for 1979-83 and 1984-88. Maps showing the distributions of high SMRs (SMR greater than 135 or P less than 0.05) and low SMRs (SMR less than 65 or P less than 0.05) were prepared for males and females separately. The geographical distributions of deaths from road traffic accidents in Scotland were dissimilar to those of England and Wales. For both sexes, high mortality was predominantly in the sparsely populated regions of the north and south of Scotland; whereas low mortality was found in the cities and the populous central belt. Possible reasons for this pattern are discussed: speed, response time (both of notification of the accident and of arrival of the ambulance), distance to nearest hospital with suitable emergency facilities, and road conditions.

Accidents, Traffic↗
PubMed2001

Mine water pollution in Scotland: nature, extent and preventative strategies.

Scotland was one of the world's first industrialised countries, and has therefore also been one of the first countries to experience wholesale post-industrial dereliction. Water pollution arising from abandoned mines, particularly abandoned coal mines, is second only to sewage as a source of freshwater pollution nation-wide, and in many coalfield catchments it is the pre-eminent source. Most of the pollution is due to net-alkaline ferruginous waters emerging from deep mines. Scrutiny of records from 80 deep mine discharges reveals that iron concentrations in these waters are only likely to exceed 20 mg/l, and the pH to be below 6.5, where the discharge emerges within 0.5 km of the outcrop of the shallowest mined seam. The bulk of mature near-outcrop mine water discharges in Scotland have < 50 mg/l total Fe, and concentrations > 100 mg/l are only likely where a marine bed lies within 25 m of the worked seam. Where the nearest marine bed is more than 80 m above or below the seam, then the total iron will be less than 4 mg/l, and in most cases less than 1 mg/l. Net-acidic mine waters are far more rare than net-alkaline waters in Scotland, and are most commonly associated with unreclaimed spoil heaps (bings). Both net-alkaline and net-acidic discharges have detrimental effects on the hydrochemistry and biological integrity of receiving waters. Scotland has recently pioneered the use of pre-emptive pump-and-treat solutions to prevent mine water pollution, and has also experienced the successful introduction of passive treatment technology for both abandoned and active workings.

Conservation of Natural Resources↗
PubMed1983

Hepatitis B virus infection: mortality, morbidity and the cost to the health service in Scotland.

This study assessed the size and character of hepatitis B virus infection in Scotland in 1980 by looking at laboratory reports, registration of deaths and hospital discharges. Less than half the laboratory reports of hepatitis B virus infection were associated with hepatic disorder and the overall attack rate in Scotland in 1980 was 2.8 per 100 000. The case fatality for active infection was 2.1 per cent. Most clinical cases were admitted to hospital and their mean duration of stay was 12.9 days. The cost of hospital treatment of hepatitis B virus infection in Scotland was considerably less than the equivalent cost in Europe, probably as a result of the lower cost of treatment and a lower attack rate in Scotland.

Adolescent↗
PubMed2003

Adjusting irrigation abstraction to minimise the impact on stream flow in the East of Scotland.

Abstractions of surface and groundwater for irrigation in Scotland are currently subject to control in only two small catchments. Under the terms of the EU Water Framework Directive, it will be necessary to introduce new legislation to control abstractions elsewhere. To help in the development of appropriate policy for Scotland a study has been carried out to examine the significance of irrigation and the effectiveness of different types of control strategies in terms of the economics of potato cropping and stream hydrology in Scotland. This paper presents the findings of the hydrological study and highlights some of the spatial and temporal issues that need to be considered in the selection of control mechanisms, if they are to be successful in achieving objectives for environmental improvement. The study was focussed on two catchments in the east of Scotland, the Tyne and West Peffer. The effectiveness of several different abstraction control strategies was examined to see how stream flows in the catchment would be modified by their implementation. The results of the study demonstrated that the West Peffer catchment in particular is significantly affected by irrigation abstractions. Control mechanisms based on allowable monthly abstraction volumes and flow-based abstraction bans would be of considerable help in restoring stream flows to their natural levels, but would modify the hydrological regime in slightly different ways. A spatial analysis of stream flows demonstrated that implementation of controls based on a single monitoring point may be ineffective at maintaining acceptable levels of flow throughout the catchment and that this may require a tighter control at the monitoring point.

Agriculture↗
PubMed2003

Epidemiology of gallbladder cancer and trends in cholecystectomy rates in Scotland, 1968-1998.

The aim of this study was to describe the epidemiology of gallbladder cancer in Scotland during the last 30 years. A secondary aim was to describe trends in cholecystectomy rates because it has been suggested that changing rates of cholecystectomy for benign gallbladder disease may be influencing the epidemiology of gallbladder cancer. A retrospective analysis of cancer registration and mortality (gallbladder cancer) and hospital discharge (cholecystectomy) data from Scotland in 1968-1998 was carried out. In Scotland the incidence of, and mortality from, gallbladder cancer have been falling in women since at least 1968, and in men since the late 1980s. Whilst overall survival remains poor, survival in older patients may have improved recently, and survival is better in patients from affluent areas. Cholecystectomy rates increased until 1977 then fell until the introduction of laparoscopic surgery caused them to return to the rates previously observed. The current declining incidence of gallbladder cancer in Scotland is probably, in part, related to the increasing cholecystectomy rates seen prior to 1977. Further studies addressing changes in stage at diagnosis and treatment provided are required to investigate the recent apparent improvement in survival of elderly gallbladder cancer patients.

Adolescent↗
PubMed2003

Oropharyngeal cancer incidence and mortality in Scotland: are rates still increasing?

Oropharyngeal cancer incidence and mortality rates increased in Scotland between the early seventies and late eighties. Although these increases appeared to be cohort based, they were at that time confined to younger age groups. The aim of this study was to examine recent time trends in the incidence and mortality of oropharyngeal cancers in Scotland to determine whether previous increases in incidence and mortality had continued. Oropharyngeal cancer mortality rates in Scotland between 1950 and 1998 were analysed using data from the World Health Organisation Mortality Database. Incidence trends were analysed using cancer registration data for Scotland for the period 1965-1997. Between 1989 and 1996, incidence rates for oropharyngeal cancers have risen dramatically in males (18-23.6 per 100,000) and females (7.3-8.5 per 100,000) aged 35-64 years, while age-standardised mortality rates appear to have stabilised. Although oropharyngeal cancer incidence rates continue to rise alarmingly, these increases are not necessarily translated into higher mortality rates as had been suggested by results from earlier studies.

Adolescent↗
PubMed1983

Salmonella montevideo infection in sheep and cattle in Scotland, 1970-81.

Outbreaks of abortion associated with infection by Salmonella montevideo have affected sheep in the east, especially the south-east, of Scotland each year since 1972. Disease in the north and north-east was usually less severe. Between 1 January 1970 and 31 December 1981, a total of 67 incidents affecting sheep were reported by veterinary laboratories to the Communicable Diseases (Scotland) Unit, 87% of which presented during the main lambing months of February, March and April. Twenty-one episodes of bovine infection were also recorded over the same period, 17 of which involved single animals only, usually an aborted cow or a scouring calf. Despite intensive investigations, neither the origin nor the mode of spread of S. montevideo infection among sheep and cattle in Scotland have been established with any certainty, although there has been considerable evidence indicating the role of scavenging wild birds, particularly seagulls, as vectors transmitting infection to other farms in the same district. Also largely unexplained are the differences in the epidemiology and clinical pattern of disease in the south-east compared to the north and north-east, while sheep in the west of Scotland have remained virtually unaffected throughout.

Abortion, Veterinary↗
PubMed2005

Spatial and temporal epidemiology of sporadic human cases of Escherichia coli O157 in Scotland, 1996-1999.

In Scotland, between 1995 and 2000 there were between 4 and 10 cases of illness per 100000 population per year identified as being caused by Escherichia coli O157, whereas in England and Wales there were between 1 and 2 cases per 100000 population per year. Within Scotland there is significant regional variation. A cluster of high rate areas was identified in the Northeast of Scotland and a cluster of low rate areas in central-west Scotland. Temporal trends follow a seasonal pattern whilst spatial effects appeared to be distant rather than local. The best-fit model identified a significant spatial trend with case rate increasing from West to East, and from South to North. No statistically significant spatial interaction term was found. In the models fitted, the cattle population density, the human population density, and the number of cattle per person were variously significant. The findings suggest that rural/urban exposures are important in sporadic infections.

Animals↗
PubMed2006

Hepatitis C virus infection among injecting drug users in Scotland: a review of prevalence and incidence data and the methods used to generate them.

It is estimated that of 50,000 persons in Scotland (1% of the county's population), infected with the hepatitis C virus (HCV), around 90% injected drugs. This paper reviews data on the prevalence and incidence of HCV, and the methods used to generate such information, among injecting drug users (IDUs), in Scotland. The prevalence estimate for HCV among IDUs in Scotland as a whole (44% in 2000), is comparable with those observed in many European countries. Incidence rates ranged from 11.9 to 28.4/100 person-years. The data have shaped policy to prevent infection among IDUs and have informed predictions of the number of HCV-infected IDUs who will likely progress to, and require treatment and care for, severe HCV-related liver disease. Although harm reduction interventions, in particular needle and syringe exchanges and methadone maintenance therapy, reduced the transmission of HCV among IDUs during the early to mid-1990s, incidence in many parts of the country remains high. The prevention of HCV among IDUs continues to be one of Scotland's major public health challenges.

Epidemiologic Methods↗
PubMed2000

Haemophilia care in central Scotland 1980-94. I. Demographic characteristics, hospital admissions and causes of death.

To estimate the resources required to manage patients with haemophilia in Scotland, we studied the demographic features, hospital admissions and causes of deaths for individuals with haemophilia A and B and von Willebrand disease, treated with blood products, during the period 1980-94 living in central Scotland. Data were obtained from 413 adults and children (93% ascertainment). The age distribution in 1980 revealed a paucity of individuals over 60 years but the number in this age group increased over the study period. Of those with haemophilia A and B, 63 and two respectively, became HIV positive. Hospital admissions rose from 103 to 168 per annum; the number of annual bed days utilized also increased, but there was marked annual fluctuation (790-1832). The rate of admission was greater for those with severe haemophilia A and this increased during the 15-year period mainly due to the clinical consequences of human immunodeficiency virus (HIV) and hepatitis C virus (HCV). The admission rate for haemophilia B was significantly lower than that for haemophilia A, and was similar for all degrees of severity of the disorder. Throughout the 15-year period the incidence of admissions for acute bleeds was constant, as was the average duration in hospital. For those with a factor VIII inhibitor, the rate of admission was about double the rate of those without an inhibitor, although the duration of hospital stay was similar for both groups. There were 61 deaths; the death rate increased during the study period principally due to HIV and HCV, and 12 patients died from haemorrhage. We conclude that: (i) the life expectancy for haemophiliacs in Scotland was generally increasing, although HIV and HCV caused increasing mortality and morbidity (as shown by the increase in hospital admissions); (ii) hospital bed usage for the treatment of acute bleeds continued to be required, but fluctuated greatly; and (iii) the clinical impression that haemophilia B is less clinically severe than haemophilia A is confirmed by objective data. The planning implications for haemophilia care in Scotland and similar countries are discussed.

Adolescent↗
PubMed2003

A comparison of epidemiological patterns of salmon lice, Lepeophtheirus salmonis, infections on farmed Atlantic salmon, Salmo salar L., in Norway and Scotland.

This paper examines two large national data sets collected over several years and contrasts the patterns of sea lice, Lepeophtheirus salmonis (Krøyer, 1837), infections, the use of treatments and the occurrence of chalimus peaks between Norwegian and Scottish farms. Infection levels in Scotland were significantly higher in general over the period under study. For the chalimus stage group in the first quarter of the year, Norwegian mean abundance stayed below 10 lice per m2 while Scottish means reached 45 lice per m2 of fish skin per m3 of water. Both countries had more chalimus in summer than at other times of year, but in the last 3 months of the year Scottish fish had, on average, two to four times as many chalimus as Norwegian fish. Peaks of chalimus abundance were more frequent in Scotland, particularly in winter, but the most prominent peaks occurred in summer in both countries. In Scotland a marked mid-year build-up of mobile pre-adult and adult stages was seen, and both countries showed a tendency for mobile counts on the second year fish to increase towards the end of the year. Scottish fish carried, on average, three times as many mobile lice per m2 of skin as Norwegian fish in the last 3 months of the year. The difference in lice loads was reflected in the greater use of veterinary medicines on Scottish farms. The higher infection levels in Scotland may be due to shallower and more enclosed water bodies used for farming, smaller and shallower pens, differences in sea water temperatures or in access to appropriate medication. The results highlight the importance of ensuring that effective veterinary medicines are available in the UK for the control of infection.

Animals↗
PubMed2001

Trends in provision of distal arterial reconstruction in Scotland 1989-1999.

OBJECTIVES: to establish if access to distal arterial reconstructive surgery is equally distributed within the health boards of Scotland and to establish if any variations in practice are reflected in lower limb amputation. METHODS: a retrospective, descriptive study using hospital discharge data (Scottish Morbidity Record-1) from 1989 to 1999. RESULTS: the rate of distal arterial reconstruction in Scotland increased from 0.9 per 100 000 population in 1989, peaked at 2.6 per 100 000 in 1994 and has since declined steadily to 1.6 per 100 000 in 1999. There was up to 17-fold variation in annual rates of distal reconstruction between the 12 mainland health boards. The variations in distal reconstruction between the health boards were not reflected in variations in amputation rate nor is the decline in distal reconstruction easily explained by increased angioplasty. CONCLUSIONS: rates of distal arterial reconstruction in Scotland fall well below those in other European countries. It is likely that insufficient distal operations are undertaken to sufficiently impact on amputation rates. The study recommends an increased provision of specialist vascular surgical expertise in Scotland.

Amputation, Surgical↗
PubMed2001

Management of alcohol misuse in Scotland: the role of A&E nurses.

Despite national targets to reduce excessive drinking in Scotland, rates have increased dramatically since the mid-eighties. The role of Accident and Emergency (A&E) departments in the management of alcohol misuse is much debated. This postal survey was conducted with senior medical and nursing staff in A&E departments and minor injury units throughout Scotland to examine the prevalence of alcohol-related attendances and staff's attitudes towards identifying and responding to alcohol-related attendances. A 57% response rate was achieved, representing 87% of all A&E institutions in Scotland (n = 84). The results reveal an estimated 1 in 7 attendances in A&E in Scotland are alcohol-related, and 1 in 5 of these result in admission. However, over two-fifths of departments do not routinely screen for, or keep records of, patients who attend with alcohol problems. Intervention is normally limited to a brief dialogue and referral to the patient's GP. Despite considerable barriers, A&E nursing staff express a willingness to assume a preventive role, but acknowledge lack of appropriate training and sources of support. It is concluded that there is scope for developing identification and brief intervention services within A&E. However, such developments are dependent upon alcohol issues assuming a higher priority among senior A&E staff.

Alcoholic Intoxication↗
PubMed2000

Evidence of a founder BRCA1 mutation in Scotland.

BRCA1 mutations have been identified in breast and ovarian cancer families from diverse ethnic backgrounds. We studied 17 different families with the BRCA1 2800delAA mutation; seven were ascertained in Scotland (Dundee, Edinburgh, Glasgow, St Andrews), five in Canada (Toronto, Victoria) and five in the United States (Chicago, Philadelphia, Seattle). Overall there was a clear preponderance of Scottish ancestry. Genotype analysis performed on key members from 17 families was consistent with a common haplotype, strongly suggesting a single ancestral origin. A possible link was established between two families by tracing their genealogies through the records of the Registrar General for Scotland. This is the first example of a BRCA1 mutation likely to be derived from a common founder in Scotland. Further studies will be necessary to estimate more accurately the population frequency of the BRCA1 2800delAA mutation among unselected cases of breast and ovarian cancer in Scotland and the UK.

Breast Neoplasms↗
PubMed2000

A national survey of women's views of their maternity care in Scotland.

OBJECTIVE: A survey of women's views of their care was undertaken as part of a national audit of maternity services in Scotland. The overall aim of the audit was to determine the extent to which recommendations from recent national policy documents had been adopted in practice. DESIGN: A cross-sectional study seeking the views of all women giving birth throughout Scotland during a 10-day period in September 1998. PARTICIPANTS: All women giving birth in Scotland within the survey period were eligible to participate in the study. Women unable to complete the questionnaire in English, women for whom the midwife deemed it inappropriate, and women who delivered but no longer resided in Scotland by their 10th postnatal day were excluded. DATA COLLECTION: A self-complete questionnaire given to the woman by her community midwife for completion on her 10th postnatal day. DATA ANALYSIS: Analysis was carried out using the statistical package SPSS for Windows. Descriptive statistics were produced for all variables. Statistical tests of significance were not used, as this was primarily a descriptive survey. FINDINGS: Of the 1152 questionnaires returned, 1137 were suitable for analysis. This gave a response rate of 69% of the eligible population (1639). Most women (80%) had the majority of their antenatal care in the community but only one third had a choice about this. Sixty-nine per cent of women received care from one or two people. However, only 37% had a choice about who these people were. The majority of women gave birth in hospital (99%). Sixty-one per cent felt that they had a choice about where they could have their baby. However, fewer women had a choice about having a home birth (41%) or a DOMINO delivery (23%). Just over half the women felt that it was important to be cared for by a midwife that they had met during pregnancy but only 12% of women achieved this. Sixty-two per cent of women had talked to a health professional about what happened during labour and delivery but less than half had spoken with a professional who was present during her labour or birth. CONCLUSIONS: Considerable efforts have been made to improve information and choice for women. However, it is clear that further work is needed if women are to be offered informed choice in the provision of their maternity care.

Adolescent↗