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PubMed2005

Sustainable maternity services in remote and rural Scotland? A qualitative survey of staff views on required skills, competencies and training.

OBJECTIVES: To explore staff views on their roles, skills and training to deliver high quality and local intrapartum services in remote and rural settings against national recommendations. DESIGN: Interview and postal survey. SETTING: A stratified representative sample of remote and rural maternity units in Scotland (December 2002 to May 2003). PARTICIPANTS: Staff proportionally representative of professional groups involved in maternity care. RESULTS: Staff interviews took place at 11 units (response rate 93%). A subsequent postal survey included the interview sample and staff in a further 11 units (response rate 78%). Medical specialisation, workforce issues, and proposed regulatory evaluation of competencies linked to throughput raised concerns about the sustainability and safety of services, particularly for "generalists" in rural maternity care teams and for medical cover in small district general hospitals with large rural catchments. Risk assessment and decision making to transfer were seen as central for effective rural practice and these were influenced by rural context. Staff self-reported competence and confidence varied according to procedure, but noted service change appeared to be underway ahead of their preparedness. Self-reported competence in managing obstetric emergencies was surprisingly high, with the caveat that they were not independently assessed in this study. Staff with access to video conference technology reported low actual use although there was enthusiasm about its potential use. CONCLUSIONS: Considerable uncertainties remain around staffing models and training to maintain maternity care team skills and competencies. Further research is required to test how this will impact on safety, appropriateness, and access and acceptability to rural communities.

Female↗
PubMed1979

Seasonsal variations in the reported incidence of sexually transmitted diseases in Scotland (1972-76).

The seasonal variation in the quarterly incidence of some sexually transmitted diseases and other conditions in Scotland is compared with that of gonorrhoea and of conceptions leading to live births or abortions. The seasonal incidence for non-specific genital infections and for other conditions not requiring treatment in both men and women was similar to that of gonorrhoea, thus indicating an association with promiscuity, whereas the seasonal variation for candidosis in men and women-an infection not usually associated with promiscuity-was similar to that of conceptions. Differences between the sexes occurred, however, in the seasonal incidences of scabies, pubic lice, genital herpes, trichomoniasis, and other conditions requiring treatment; thus men with these conditions appeared to be more promiscuous than women. The seasonal variations in incidence of genital scabies and pubic lice indicate that these infestations are more easily transmitted by close bodily contact indoors during cold weather than in the open air.

Female↗
PubMed1998

HIV infection among homosexual/bisexual males attending genitourinary clinics in Scotland.

BACKGROUND: Since 1991, unlinked anonymous HIV testing of homosexual/bisexual males attending genitourinary clinics in Edinburgh and Glasgow has been conducted and resulting prevalence data have been published annually. More detailed information which provides an understanding of what proportion of HIV infected men attending genitourinary clinics in central Scotland (i) remain undetected, (ii) acquire sexually transmitted infections following HIV diagnosis, and (iii) possibly become HIV infected either abroad or following sex with someone from abroad, is reported by the authors. METHODS: Unlinked anonymous HIV testing of syphilis serology specimens from homosexual/bisexual males attending genitourinary clinics during 1991-5. RESULTS: Of 3468 specimens tested, 165 (4.8%) were HIV positive. Thirty five per cent (57) of all HIV positive specimens were from men whose infection remained undetected following clinic attendance. Of the 80 attenders who knew themselves to be HIV positive before their clinic visit, 13 had clinical and/or laboratory evidence of a sexually transmitted infection. Men who had a sexual risk associated with America or who were American, had a 2.4-fold greater risk of being HIV infected than those with United Kingdom only connections. CONCLUSION: Increased efforts should be made to ensure that HIV infected men are diagnosed early after infection and do not engage in high risk sexual behaviour, and that all homosexual men are educated about the particular risks of acquiring HIV infection abroad. More effective interventions to prevent indigenous HIV transmissions need to be developed.

Bisexuality↗
PubMed1997

Cost effectiveness of a mass media-led anti-smoking campaign in Scotland.

OBJECTIVE: To evaluate the costs and outcomes associated with the Health Education Board for Scotland's general public anti-smoking campaign during the developmental stage and its first year of operation. DESIGN: Cost information collected retrospectively was combined with prospectively collected effectiveness data. SUBJECTS: A panel of 970 adults were recruited from a 1-in-10 random sample of adult callers to the telephone helpline (Smokeline). Those who smoked were subsequently interviewed at three weeks, six months, and one year follow up. Information on smoking status at one year and time spent as a non-smoker was available for 587 members of the panel. MAIN OUTCOME MEASURES: Intermediate outcomes in the follow-up sample included a point prevalence and period prevalence measure of smoking cessation. Long-term outcomes were measured in terms of predicted reductions in mortality as a consequence of smoking cessation. RESULTS: At the 12-month point, 9.88% of individuals in the follow-up sample reported themselves as non-smokers and as having given up for at least six months in the previous year. Estimates of the cost per life-year saved as a result of the campaign range from 304 pounds sterling to 656 pounds sterling. CONCLUSIONS: Provided that the benefits of smoking cessation are broadly accurate, and the assumed level of quitting can be directly attributed to Smokeline, then this mass media-led anti-smoking campaign appears to have been cost effective.

Adult↗
PubMed1998

Training pharmacists and pharmacy assistants in the stage-of-change model of smoking cessation: a randomised controlled trial in Scotland.

OBJECTIVE: To evaluate a training workshop for community pharmacy personnel to improve their counselling in smoking cessation based on the stage-of-change model. DESIGN: A randomised controlled trial of community pharmacies and pharmacy customers. SETTING: All 76 non-city community pharmacies registered in Grampian, Scotland, were invited to participate. Sixty-two pharmacies (82%) were recruited. SUBJECTS: All the intervention pharmacy personnel were invited to attend the training; 40 pharmacists and 54 assistants attended. A total of 492 customers who smoked (224 intervention, 268 controls) were recruited during the 12-month recruitment period (overall recruitment rate 63%). MAIN OUTCOME MEASURES: The perceptions of customers and pharmacy personnel of the pharmacy support and self-reported smoking cessation rates for the two groups of customers at one, four, and nine months. RESULTS: The intervention customer respondents were significantly more likely to have discussed stopping smoking with pharmacy personnel, 85% (113) compared with 62% (99) of the controls (p < 0.001). The former also rated their discussion more highly; 34% (45) of the intervention customers compared with 16% (25) of the controls rated it as "very useful" (p = 0.048). Assuming non-responders had lapsed, one-month point prevalence of abstinence was claimed by 30% of intervention customers and 24% of controls (p = 0.12); four months' continuous abstinence was claimed by 16% of intervention customers and 11% of controls (p = 0.094); and nine months' continuous abstinence was claimed by 12% of intervention customers and 7% of controls (p = 0.089). These trends in outcome were not affected by potential confounders (sex, age, socioeconomic status, nicotine dependence, and type of nicotine replacement product used) or adjustment for clustering. CONCLUSIONS: The intervention was associated with increased and more highly rated counselling, and a trend toward higher smoking cessation rates, indicating that community pharmacy personnel have the potential to make a significant contribution to national smoking cessation targets.

Adolescent↗
PubMed1996

Management of lung cancer in South East Scotland.

BACKGROUND: There are few reports which describe the management of unselected groups of patients with lung cancer. This study was undertaken to audit prospectively the presentation, diagnosis, management, and outcome of patients presenting with lung cancer in South East Scotland. METHODS: Data were recorded on all patients with newly diagnosed lung cancer who presented to a multidisciplinary group of clinicians over a 12 month period. Subsequent follow up data on treatment and survival were collected. RESULTS: Six hundred and twenty two patients were registered, 80% of whom were referred from primary care. There was a considerable variation in the length of history, but the diagnosis was rapidly made after referral (87% within two weeks). In 82% of patients the pathological examination was positive; 70% were treated with palliative intent. Only 36% of patients who underwent surgery had computed tomographic scanning and 55% had sampling of mediastinal nodes. A wide variety of regimens was used for treatment with radiotherapy and chemotherapy, and follow up data were difficult to obtain in these patients. Survival was poor in all patients treated with palliative intent. CONCLUSIONS: This audit confirms the importance of previously noted prognostic factors. Significant variation in referral practice, diagnostic and management evaluation has been shown. The data serve as a useful background for the formation of local management guidelines.

Adult↗
PubMed1979

Observations on the selenium status of cattle in the north-east of Scotland.

Cattle on 18 of 21 farms in north-east Scotland were found to have low whole blood activities of the selenium-containing enzyme, glutathione peroxidase (less than 5 units per ml whole blood), and a low blood concentration of selenium (less than 0.05 mg per litre). These cattle had all been fed on locally produced feedstuffs without any mineral supplementation. The low selenium status in cattle occurred on farms with soils derived from a range of parent material, no one particular type predominating.

Animals↗
PubMed1979

Field studies on enzootic abortion of ewes in south east Scotland.

Statistical data were collected from 20 sheep flocks in which enzootic abortion of ewes (EAE) was diagnosed by examination of fetal material and maternal blood samples. The abortion rate in the 10,645 ewes in these flocks was 7.6 per cent. Thirteen of the flocks were fully vaccinated against EAE but the abortion rate in these was still in the order of 6.5 per cent. EAE was the major cause of the problem as ascertained from the laboratory examination of samples from a wide range of cases of abortion. There is therefore evidence that, in some flocks in south east Scotland, the efficacy of the vaccine against EAE is unsatisfactory. The reasons for this are discussed.

Abortion, Veterinary↗
PubMed1980

A survey of sheep losses and their causes on commercial farms in the north of Scotland.

A three year survey on sheep deaths and their causes was conducted on 10 commercial farms in the north of Scotland. Diseases and other trauma associated with the perinatal period accounted for 56.81% of all ewe deaths, while pneumonia, parasitic gastroenteritis, torsion of the bowel and haemorrhagic enteritis (redgut) accounted for a further 21.7%. No one disease condition predominated in the rams and hoggs. In lambs, most deaths occurred between birth and four days old (77.86%). Causes came in the form of starvation and exposure (34.2%), stillbirths (18.2%), lambing injuries (11.06%), infectious conditions (8.0%), dystocia (7.6%) and abortion (5.2%). The overall death rate among the lambs was 14.2%.

Animal Husbandry↗
PubMed1981

Human and animal salmonellosis in Scotland associated with environmental contamination, 1973-79.

Twenty-six incidents of salmonellosis occurring in Scotland between 1973 and 1979 and attributed to environmental pollution are reviewed. The apparent sources of pollution were sewage effluent (10 incidents), septic tank effluent (eight), sewage sludge (three), seagulls (three) and abattoir effluents (two). Cattle were the species predominantly affected. Human infection was primary in three incidents and was secondary to bovine infection in another four. Thirteen salmonella serotypes were recovered from infected humans or animals and 17 during related environmental investigations. The factors causing pollutions and possible control measures are discussed.

Animals↗
PubMed1981

A survey of abomasal parasitism in dairy and beef cows in south-west Scotland.

Abomasa were collected from 183 dairy and 186 beef cows in south-west Scotland and examined for the presence of nematodes. One hundred and fifty-two of the dairy cows (83 per cent) and 154 of the beef cows (83 per cent) had Ostertagia species worm burdens of less than 1000; 4 per cent of both dairy and beef animals had more than 10,000 ostertagia present. The only other nematode detected was Trichostrongylus axei and this was present in low numbers in 23 cows (13 dairy and 10 beef). A marked seasonal fluctuation was observed in the proportion of adult and fourth larval stages of ostertagia present. Over 70 per cent of the burdens from October through to April were fourth larval stages. In contrast less than 20 per cent of the burdens from May to September were fourth stage larvae.

Abomasum↗
PubMed1983

Prevalence of enterotoxigenic Escherichia coli in calves in Scotland and northern England.

Eighty-eight of 1529 (5.7 per cent) Escherichia coli isolates from diarrhoeic and clinically normal calves in Scotland and northern England were found to possess the K99 pilus antigen (K99+). There was complete correlation between possession of K99 antigen, heat stable enterotoxin production and ability to dilate intestinal loops. The diagnosis of calf enterotoxigenic E coli infections may therefore be based on the detection of K99 antigen alone. Enterotoxigenic E coli was isolated from 23 of 306 (7.5 per cent) diarrhoeic calves from eight of 70 (11.4 per cent) farms and was not isolated from clinically normal calves. Infected calves were between one and three days old. A survey by an enzyme-linked immunosorbent assay found 3.0 per cent and 3.9 per cent of sera from calves and cows respectively to contain antibodies to K99 antigen. The prevalence of other enteropathogenic organisms in calf faeces is also discussed.

Animals↗
PubMed1985

Larvae of Elaphostrongylus cervi in the deer of Scotland.

Protostrongylid larvae were recovered from the faeces or lungs of red deer (Cervus elaphus), roe deer (Capreolus capreolus) and reindeer (Rangifer tarandus) in Scotland during 1981. Typical protostrongylid first-stage larvae were also recovered from possible intermediate hosts, the grey field slug (Agriolimax reticulata) and the white-soled slug (Arion fasciatus). All these protostrongylid larvae were microscopically identical to those of the nematode Elaphostrongylus cervi. Despite careful search, adult E cervi were not found, but it is concluded that infection with E cervi is widespread in Scottish deer.

Animals↗
PubMed1985

Prolonged gestation in sheep in western Scotland associated with diffuse neuronal necrosis of the fetal central nervous system.

A specific disorder of sheep resulting in gestation periods extending up to eight months is reported for the first time. The condition, which is of low prevalence, occurs on hill farms in coastal regions of western Scotland and affected ewes usually die unless relieved of their fetuses by surgery. The fetuses may weigh up to 12 kg and have long hairy coats, skeletal deformities, precocious gonadal development and extensive liquefaction of central nervous system tissue. The aetiology has not been determined but some mechanisms which may be involved in the pathogenesis are discussed.

Animals↗
PubMed1986

Acute myopathy in horses at grass in east and south east Scotland.

A myopathy of horses at grass in east and south east Scotland was recognised in the autumn and winter of 1984 and the spring of 1985. The clinical signs resembled those of paralytic myoglobinuria. Grossly increased creatine kinase activities and the passage of dark brown urine were consistent features. However, the horses were not in training, most of them died and the muscles affected were those of posture and respiration rather than movement. The condition may be unrelated to nutritional myopathy because all the cases had adequate levels of alpha-tocopherol although their selenium status varied from normal to deficient. The clinical and pathological findings in 12 cases are presented and the differential diagnosis and possible aetiologies discussed.

Acute Disease↗
PubMed1986

Salmonella in sewage effluent and the relationship to animal and human disease in the north of Scotland.

During the period July 1982 to December 1984, the presence of salmonella organisms was investigated at weekly intervals in the sewage system and abattoir effluent of a town in the north of Scotland. Three hundred and fifteen isolations, representing 37 different serotypes, were made which included 20 different Salmonella typhimurium phage types and four different S enteritidis phage types. Ten of the serotypes were isolated from livestock in the district during the survey as well as in the periods immediately before and after the survey. There were seven recorded incidents of human infection, involving four salmonella serotypes, only three of which were isolated concurrently from sewage.

Abattoirs↗
PubMed1987

A census of the prevalence of vaginal prolapse in sheep flocks in the Borders region of Scotland.

A postal census of vaginal prolapse in sheep flocks in the Borders region of Scotland yielded 540 replies from 963 owners (56 per cent). There were 262,250 ewes in 976 flocks and 2573 vaginal prolapses were reported. Analysis of the data revealed that 390 (40 per cent) of the flocks had no vaginal prolapses and in 237 (24.3 per cent) the reported prevalence was between 0.1 per cent and 1.0 per cent. Only 63 (6.5 per cent) of flocks had a greater than 5 per cent prevalence of vaginal prolapses. The greatest number of prolapses occurred in an upland flock of greyface ewes mated with Suffolk tups with 50 cases among 700 ewes (7.1 per cent) and the highest prevalence was in an upland Scottish blackface flock of ewes bred with Suffolk tups with 15.2 per cent (35 cases among 230 ewes). There were marked breed differences; very few hill breeds were affected and most cases occurred in greyface ewes mated with Suffolk tups.

Animals↗
PubMed1992

Morbillivirus infection in two common porpoises (Phocoena phocoena) from the coasts of England and Scotland.

Two common porpoises (Phocoena phocoena), one found stranded on the Isle of Sheppey, Kent, and the other in the Moray Firth, Scotland, in late 1990, were examined post mortem. Lesions of diffuse bronchointerstitial pneumonia were present in both animals; they were characterised by the infiltration of alveoli with leucocytes, macrophages and multinucleate syncytia, the necrosis of bronchial and bronchiolar epithelium, focal proliferation of type II pneumocytes and occasional acidophilic cytoplasmic inclusions in alveolar macrophages and syncytia. Lymphoid depletion was apparent in the spleen, thymus and lymph nodes of both porpoises. Other changes in the Isle of Sheppey porpoise included severe dacryoadenitis. Marked pharyngitis, oesophagitis and balanoposthitis were present in the Moray Firth porpoise. Immunoperoxidase staining revealed the presence of morbillivirus antigen in a range of epithelia from both porpoises. This is the first report of morbillivirus infection in cetaceans from the coast of Great Britain.

Animals↗