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PubMed2005

Who are your public? A survey comparing the views of a population-based sample with those of a community-based public forum in Scotland.

UNLABELLED: This paper describes a questionnaire survey, carried out in the NHS Grampian area of NE Scotland. It compares responses from 84 members of a community-based public forum (39 of whom were sent questionnaires) and a random sample of 10,000 adults registered with general practices in Grampian (2,449 of whom were sent questionnaires). MAIN OUTCOME MEASURES: differences in demographic profiles and opinions about different feedback mechanisms (patient representative, telephone helpline and NHS feedback website) and their likely effectiveness in three different scenarios. 46% of community forum members consented to take part compared to 24% of the population sample. Younger people and residents in more deprived areas were under-represented in both groups. Community forum members were older (only one under 40 years of age), more likely to be retired and not in employment. Internet access was similar in both groups. Opinions about different systems of feeding back views to the NHS varied but community forum members were more likely to be positive in their opinions about the value of different feedback mechanisms and less likely to think they were 'a waste of NHS money'. Responses to three scenarios revealed similar opinions, but on some issues, there were key differences in the responses from the two groups. Community forum members were more likely to consider writing a letter as a means of getting something done about a problem and were more likely to talk to their GP if experiencing a problem than respondents in the main group. In general their responses were more positive towards the NHS. There is a need to ensure a broad basis for membership of public forums and/or proactively seek the views of groups that are under-represented if public forums are to be used to represent the views of the wider population and inform decision making in the NHS.

Adult↗
PubMed2006

Local environmental effects and spatial effects in macroecological studies using mapped abundance classes: the case of the rook Corvus frugilegus in Scotland.

1. The study of the spatial pattern of species abundance is complicated by statistical problems, such as spatial autocorrelation of the abundance data, which lead to the confusion of environmental effects and dispersal. 2. Atlas-derived data for the rook in Scotland are used as a case study to propose an approach for assessing the likely contribution of dispersal and local environmental effects, based on a Bayesian Conditional Autoregressive (CAR) approach. 3. The availability of moist grasslands is a key factor explaining the spatial pattern of abundance. This is influenced by a combination of climatic and soil-related factors. A direct link to soil properties is for the first time reported for the wide-scale distribution of a bird species. In addition, for this species, dispersal seems to contribute significantly to the spatial pattern and produces a smoother than expected decline in abundance at the north-western edge of its distribution range. Areas where dispersal is most likely to be important are highlighted. 4. The approach described can help ecologists make more efficient use of atlas data for the investigation of the structure of species abundance, and can highlight potential sink areas at the landscape and regional scale. 5. Bayesian spatial models can deal with data autocorrelation in atlas-type data, while clearly communicating uncertainty through the estimation of the full posterior probability distribution of all parameters.

Animals↗
PubMed1983

Incidence of antibiotic-resistant Escherichia coli in milk produced in the west of Scotland.

Antibiotic-resistant Esch. coli were found in 10.6% of milk samples collected from 998 farms in the west of Scotland. The incidence of both Esch. coli and antibiotic-resistant Esch. coli in milk was higher when the cattle were housed day and night than when they were outdoors. Of the 1125 Esch. coli isolates tested 22.2% were antibiotic resistant and of these 42.4% were resistant to more than one antibiotic. Escherichia coli carrying up to six resistance determinants were isolated. The possible implications to animal and human health are discussed.

Animal Husbandry↗
PubMed2005

A mathematical model of the growth of sea lice, Lepeophtheirus salmonis, populations on farmed Atlantic salmon, Salmo salar L., in Scotland and its use in the assessment of treatment strategies.

Sea lice are a persistent problem for farmed and wild salmonid populations. Control can be achieved through the use of veterinary medicines. A model was developed to describe the patterns of sea lice infection on salmon farms in Scotland and to predict the likely effect of various treatment strategies. This model takes into account development rates and mortality using compartments representing life history stages and external infection pressure. The national sea lice infection pattern was described using parameters representing stage survival, background infection levels and egg viability rates. The patterns observed across farms varied greatly and the model gave broad agreement to observed trends with different parameters being required in the model for sites using hydrogen peroxide and cypermethrin treatments. The parameter estimates suggest that the background infection pressure on sites where cypermethrin was administered was higher than for those using hydrogen peroxide. Both models had comparable magnitudes of sensitivity with survival from one stage to another being the most sensitive parameter, followed by feedback rates at which gravid females produce eggs, with background infection levels the least sensitive. The effect of different cypermethrin treatment strategies was assessed using the model. Increasing treatments in a production cycle gave more effective control. However, the model showed that timing of treatments is most important if sea lice are to be effectively controlled.

Animals↗
PubMed2006

Infectious pancreatic necrosis virus in Atlantic salmon, Salmo salar L., post-smolts in the Shetland Isles, Scotland: virus identification, histopathology, immunohistochemistry and genetic comparison with Scottish mainland isolates.

During mid-June 1999 peak mortalities of 11% of the total stock per week were seen at a sea cage site of Atlantic salmon, Salmo salar L., post-smolts in the Shetland Isles, Scotland. Virus was isolated on chinook salmon embryo (CHSE) cells in a standard diagnostic test and infectious pancreatic necrosis virus (IPNV) identified by enzyme-linked immunosorbent assay. IPNV was confirmed as serogroup A by a cell immunofluorescent antibody test using the cross-reactive monoclonal antibody AS-1. Four weeks after the main outbreak, virus titres in surviving moribund fish were assayed at >10(10) TCID50 g(-1) kidney. Histopathology of moribund fish was characterized by pancreatic acinar cell necrosis and a marked catarrhal enteritis of the intestinal mucosa. In the liver, necrosis, leucocytic infiltration and a generalized cell vacuolation were noted. IPNV-specific immunostaining was demonstrated in pancreas, liver, heart, gill and kidney tissue. The nucleotide sequence of the coding region of segment A was determined from the Shetland isolate. A 1180 bp fragment of the VP2 gene of this isolate was compared with a 1979 reference isolate from mainland Scottish Atlantic salmon, La/79 and another more recent mainland isolate, 432/00. Both A2 isolates were derived from carrier fish without signs of IPN and serotyped by a plaque neutralization test. The Shetland isolate shows a different nucleotide and amino acid sequence compared with the two isolates from carrier fish. These latter isolates showed identical amino acid sequences in the fragment examined, despite the 21 years separating the isolations. Sequence comparisons with other A2 (Sp) isolates on the database confirm all three Scottish isolates are A2 (Sp).

Animals↗
PubMed1984

Experience of the mothers of Down's syndrome and spina bifida children on going home from hospital in Scotland 1971-1981.

A postal questionnaire completed by the mothers of 123 children with Down's syndrome and 109 children with Spina bifida born over the past 10 years in Scotland has shown that difficulties exist in the transfer of care from hospital to the home. Few Spina bifida children came home at the same time as the mothers and only one-half of both groups were given positive encouragement concerning the homecoming. Two-thirds of the Down's mothers and less than half of the Spina bifida mothers were seen by their general practitioner on their return and a significant minority of those visited found his visit unhelpful. A greater percentage of both groups were visited by the health visitor and about a third found her visit unhelpful. It is suggested that the training of both these health professionals may not be appropriate to the correct management of these handicaps at home.

Adaptation, Psychological↗
PubMed1994

Medical concerns in people with severe learning difficulties: report on a vision week and symposium at the Royal College of Physicians and Surgeons of Glasgow, Scotland, 8-12 March 1993.

Over the course of a week, vision clinics were conducted in the wards of Lennox Castle, one of the largest remaining mental handicap institutions in Scotland. Receptions and a seminar encouraged participation by staff and local services. A day Symposium at the Royal College of Physicians and Surgeons in Glasgow presented recent developments in medical care and facilitated discussion on methods of ensuring effective health surveillance, assessment and advisory services.

Combined Modality Therapy↗
PubMed2004

Hepatitis A virus and injecting drug misuse in Aberdeen, Scotland: a case-control study.

To describe an epidemiological investigation of an outbreak of hepatitis A virus (HAV) infection among injecting drug users in Aberdeen, Scotland. A case-control study to determine whether transmission was facilitated by poor personal hygiene or through sharing injecting equipment. Cases were more likely to report not washing their hands after using the toilet [odds ratio (OR) = 12.9, 95% confidence interval (CI) = 1.58-105.89] or before preparing food (OR = 4.0, 95% CI = 1.01-15.8), and less likely to have washed their hands prior to preparing drugs (OR = 10.67, 95% CI = 2.14-53.07). Cases were also more likely to report recipient sharing of needles/syringes (OR = 8.27, 95% CI = 1.68-40.57), and to have had injecting contact with someone who was jaundiced (OR = 29.4, 95% CI = 3.18-271.44). The results indicate that the lack of hygiene within the context of individuals gathering to prepare and inject drugs provides ample opportunity for the transmission of HAV. Although the promotion of good hygiene and the avoidance of sharing injecting equipment are important measures in preventing HAV transmission, they are unlikely to effect major behavioural change. Such measures should, therefore, be reinforced by routinely offering HAV vaccine to injectors.

Adolescent↗
PubMed2006

New nursing roles: the experience of Scotland's consultant nurse/midwives.

AIM: To describe career pathways of consultant nurses/midwives and identify postholders views on key factors in role initiation, development and progression to inform future development and appointment of nurse/midwife consultants in National Health Service Scotland. BACKGROUND: Nurse/midwife consultants represent the highest levels of clinical practice. Given the Scottish Executive Health Department's aim to treble numbers conditions and circumstances that enable them to flourish must be identified. METHOD: A postal survey was undertaken of all nurse/midwife consultants in post (n = 16). RESULTS: Key themes emerged around factors that consultant nurse/midwives considered important including mentorship, autonomy and clinical credibility. Barriers to role delivery included lack of understanding of roles and the wide scope of some posts. Considerable variation in support, conditions of service and line management arrangements was found. CONCLUSIONS: Development of a recognized career pathway and a consistent approach to employment and support of postholders is recommended.

Consultants↗
PubMed2005

Changing patterns of inequality in birthweight and its determinants: a population-based study, Scotland 1980-2000.

Birthweight is used as an indicator of individual and population health and is known to be strongly correlated with adult cardiovascular disease. This paper uses routinely collected maternity discharge data from Scotland between 1980 and 2000 to look at birthweight trends and the changes in the distribution of maternal risk factors for birthweight. We also examine the contributions of each of the risk factors to birthweight trends and investigate whether there has been a reduction in inequality in birthweight over time. Data from 1,282,172 singleton live births were used in the analysis. Both mean birthweight and low birthweight (LBW:<2500 g) were used as outcomes. The risk factors studied were maternal age, parity, maternal height, marital status and occupational social class of the father. The slope and relative indices of inequality were used to measure the change in inequalities over time. Mean birthweight increased from 3320 g in 1980 to 3410 g in 2000, while the percentage LBW decreased slightly from 5.7% in 1980 to 5.4% in 2000. The prevalence of many risk factors changed; there has been an increase in the proportion of older mothers, single mothers, taller mothers and mothers with undetermined social class. Although most risk factors had a significant change in effect over time, the inequalities in birthweight between groups did not appear to diminish over time. Both the slope and relative index of inequality had a quadratic relationship over time, with the inequalities in birthweight being greatest in the early 1980s and late 1990s.

Adult↗
PubMed1993

Cytomegalovirus studies on blood donors in north-east Scotland and a review of UK data.

The epidemiology of cytomegalovirus (CMV) infection as assessed by CMV antibody testing varies significantly in different parts of the world and also in different regions of a country. A study was therefore carried out to assess the prevalence of CMV antibody in our blood donors, looking in particular at different subgroups of donors as divided by age, sex and social class, to see how we could maximise the yield of CMV-negative blood from our testing. It was shown that patterns of CMV infection in the North East of Scotland followed well-established norms. Data from other Regional Transfusion Centres within the UK were also collected for comparison.

Antibodies, Viral↗
PubMed1999

Health status of bulls used for natural breeding on farms in south west Scotland.

One hundred and nine breeding bulls were examined during the period November 1992 to June 1993 on farms in south west Scotland for evidence of infectious diseases associated with breeding. Preputial washings were collected to screen for Campylobacter fetus venerialis, together with serial blood samples to assess their seroprevalence to Bovine Virus Diarrhoea virus (BVDv), Bovine Herpes Virus-1 (BHV-1), Leptospira hardjo and Bovine Herpes Virus-4 (BHV-4). The possible impact of natural mating on the epidemiology of these diseases is described. Evidence of infections with Campylobacter fetus and BVH-4 were not found in this sample. The overall seroprevalence to BVDv was 78%, for BHV-1 49%, and L. hardjo 27% at titres of > or = 1/400. This study shows that bulls may be responsible for the introduction and dissemination of these diseases when moved from farm to farm as part of normal cattle breeding in this area. Young unproven bulls may be particularly susceptible to endemic diseases associated with lowered reproductive performance.

Agglutination Tests↗
PubMed2001

Patterns of referral, management and survival of patients diagnosed with prostate cancer in Scotland during 1988 and 1993: results of a national, retrospective population-based audit.

OBJECTIVES: To examine patterns of referral, management and survival of men with prostate cancer, and to document changes over time. PATIENTS AND METHODS: All men registered with prostate cancer in 1988 and 1993 were identified from the Scottish Cancer Registry. Data were abstracted according to standard definitions from the available medical records of 930 men in 1988 and 1355 in 1993. RESULTS: There was limited evidence of multidisciplinary care, with only 8% of patients in 1988 being managed by both a urologist and a clinical oncologist within a year of diagnosis, increasing to 13% in 1993. Only a small proportion of patients were managed by clinical oncologists during the first year of care (14% in 1988 and 20% in 1993). Documentation of thorough staging information was poor, with a T stage being recorded in <30% of cases in both years. Documentation of metastatic status increased from 53% to 63% between 1988 and 1993, paralleling an increase in the use of bone scans. The proportion of cases with pathological grading obtained at diagnosis increased from 63% in 1988 to 68% by 1993. The use of PSA testing and core biopsies increased between the years while the use of transurethral prostatectomy decreased. More patients received radical radiotherapy within a year of diagnosis in 1993 than 1988, increasing from 6% to 9%, and more radical prostatectomies were also undertaken (0.2% to 2.3%). Nonetheless, most patients (81% in 1993) with no documented evidence of metastases received no active intervention (radical radiotherapy, radical prostatectomy, or 'watchful waiting'). The survival at 5 years increased nonsignificantly from 34% for the 1988 cohort to 38% for the 1993 cohort. CONCLUSION: This audit reveals considerable inconsistency in the management of men with prostate cancer in Scotland. Against a background of controversy about numerous aspects of the management of this disease, the need for a multidisciplinary approach, comprehensive staging and appropriate documentation is highlighted.

Adult↗
PubMed2003

A national retinal screening programme for diabetes in Scotland.

The Health Technology Board Scotland (HTBS) have issued recommendations for eye screening in patients with diabetes. These are based on evidence-based clinical studies. Evidence-based studies do not answer all the practical issues, and some conclusions have thus been extrapolated from the known evidence base. Other factors such as patient issues, organizational issues and cost effectiveness have also been incorporated into the recommendations. HTBS recommend single-field digital retinal photography. Retinal photography best addresses the issues of adequate sensitivity and accountable quality assurance. Non-mydriatic photography is recommended, followed by immediate use of dilating eye drops if it is unsuccessful, followed by slit-lamp examination if both of these approaches fail. An independent grading scheme has been established, which is similar to the 'Global', and compatible with the National Screening Committee (NSC) grading scheme. The rationale for these recommendations, and debate behind some of the decisions, is laid out in this article.

Diabetic Retinopathy↗
PubMed2005

Predicting vascular risk in Type 1 diabetes: stratification in a hospital based population in Scotland.

AIMS: To estimate the absolute cardiovascular risk of patients with Type 1 diabetes attending hospital diabetes clinics in Scotland and to develop a method for identifying those at highest risk, thus enabling therapy to be targeted. METHODS: Baseline information was collected for 2136 patients with Type 1 diabetes using the Royal College of Physicians of Edinburgh Diabetes Register. These records were then linked to diagnoses of macrovascular disease in databases of the Information Statistics Division of the Common Services Agency. RESULTS: During six to nine years of follow up 110 patients (5%) developed macrovascular disease. There were significant associations between baseline age (P < 0.00001), blood pressure (P < 0.00001), albuminuria (P < 0.0002), HbA1c (P < 0.001), cholesterol (P < 0.00001) and smoking status (P < 0.00001) with the development of macrovascular disease. A scoring system for future macrovascular risk was developed from a multivariate analysis of this data. CONCLUSIONS: The data confirm the high vascular risk of patients with Type 1 diabetes. The relationship with age is such that those patients above 50 years require only one additional risk factor to reach such a high vascular risk that intervention is indicated. Using these data many patients between the age of 40 and 49 years are also likely to be identified to be at high risk.

Adult↗
PubMed1992

Seizures and intellectual disability associated with tuberous sclerosis complex in the west of Scotland.

Of 104 individuals with tuberous sclerosis complex ascertained from the total population of the west of Scotland, 52 were born before and 52 after 1st July 1966. Of those born before. 10 had no seizures, 14 had seizures and no intellectual disability and 28 had seizures and intellectual disability; of those born after, four had no seizures, 18 had seizures and 30 had seizures and a degree of intellectual disability. Infantile spasms or other generalised seizures as the presenting seizure type (N = 29) was strongly associated with intellectual disability; partial seizures as the presenting seizure type (N = 19) was associated with normal development. Although the onset of seizures under one year of age and the presence of multiple seizure types were associated with intellectual disability, the strongest association was with the type of presenting seizure.

Child↗
PubMed1997

Determinants of nocturnal enuresis in England and Scotland in the '90s.

The aim of this study was to assess whether changes have occurred in the determinants of nocturnal enuresis in Scotland and England in comparison with previous studies. The study was based on 22 study areas from a representative English sample, 14 areas from a representative Scottish sample, and 20 areas from an English inner-city sample. A total of 14,674 subjects was included in the analysis from 16,835 eligible children in the age range 5 to 11 years. For the main analysis, an enuretic child was one who wet the bed at least once a week. As expected, the frequency of enuresis was higher in boys and decreased markedly with age in both sexes. Bedwetting was more frequent in: Afro-Caribbean children compared with white children in the representative samples (OR 1.72 95% CI 1.22 to 2.42); those whose mothers smoked at least 10 cigarettes at home compared with non-smokers (OR 1.58 95% CI 1.26 to 1.98); children who had disturbed sleep compared with those who slept well (OR 1.96 95% CI 1.53 to 2.51); those with mothers aged less than 20 years at the child's birth compared with mothers in the age range 25 to 34 (OR 1.63 95% CI 1.20 to 2.22); and in the second- or third-born in the family in comparison with the first-born (OR 1.42 95% CI 1.17 to 1.72). Father's social class was associated with enuresis only in girls. Only 50% of the parents consulted a doctor for enuresis in their child. The percentage was even lower in Afro-Caribbean families (33%). Enuresis continues to be a highly prevalent problem and has not decreased over the last 45 years. We confirm that environmental factors are still important in the aetiology of enuresis. It is surprising that despite the availability of effective treatment only half of parents consult a doctor about the problem.

Black or African American↗
PubMed1989

Survival of younger cervical carcinoma patients treated by radical radiotherapy in the west of Scotland 1964-1984.

Between 1964 and 1984, 2011 patients in the West of Scotland were treated by radical radiotherapy for carcinoma of cervix. In keeping with the rise in incidence amongst younger patients nationally, the number of women aged less than 35 years seen during the 20-year period has doubled. Younger women (aged less than 35 or less than 45) have a better prognosis mainly because more present with earlier disease. Stage for stage there has been no change in survival of women of all ages treated by identical radiotherapy during this period. The rise in mortality of younger patients from carcinoma of cervix may be due to the increased incidence of the condition rather than a more virulent form of the disease.

Adult↗