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PubMed1976

Blood groups antigens, plasma protein and red cell isoenzyme polymorphisms in south-west Scotland.

Blood donor specimens from South-west Scotland were analysed for the following polymorphisms: ABO, Rhesus (D), Haptoglobin, Transferrin, Immunoglobulin (GM), RBC acid phophatase, RBC phosphoglucomutase and RBC adenylate kinase. Genetic differences exist between the regions in S.W. Scotland and between S.W. Scotland and other Irish and Irish Sea regions. This variability is detailed and discussed. The results are mapped by converting the data into distance values and by using a nonmetrical scaling technique. Overall the present S.W. Scotland data are similar to Cumbrian and Manx results and dissimilar to the Irish data.

ABO Blood-Group System↗
PubMed2003

Foot and mouth epidemic reduces cases of human cryptosporidiosis in Scotland.

In Scotland, rates of cryptosporidiosis infection in humans peak during the spring, a peak that is coincident with the peak in rates of infection in farm animals (during lambing and calving time). Here we show that, during the outbreak of foot and mouth disease (FMD) in 2001, there was a significant reduction in human cases of cryptosporidiosis infection in southern Scotland, where FMD was present, whereas, in the rest of Scotland, there was a reduction in cases that was not significant. We associate the reduction in human cases of cryptosporidiosis infection with the reduction in the number of young farm animals, together with restrictions on movement of both farm animals and humans, during the outbreak of FMD in 2001. We further show that, during 2002, there was recovery in the rate of cryptosporidiosis infection in humans throughout Scotland, particularly in the FMD-infected area, but that rates of infection remained lower, though not significantly, than pre-2001 levels.

Animals↗
PubMed1999

Prescribing and dispensing for drug misusers in primary care: current practice in Scotland.

BACKGROUND: Substitute prescribing has increased in Scotland, as in the rest of the UK. Both GPs and pharmacists are becoming increasingly involved in service provision for drug misusers, but anecdotal evidence has suggested considerable variation in prescribing and dispensing practice. OBJECTIVE: We aimed to gain baseline data on (i) current prescribing practice by medical practitioners and drug agencies, (ii) dispensing practice by community pharmacists across Scotland for the management of drug misuse and (iii) variations in practice between health boards. METHODS: A structured questionnaire was posted to all community pharmacies in Scotland (n = 1142), in order to gather information on prescribing from prescriptions held at the time of the survey and information on current dispensing practice in managing drug misusers. RESULTS: The response rate was 79%. Sixty-one per cent of pharmacists were currently dispensing drugs for the management of drug misuse. The most frequently prescribed drug was methadone, dispensed by 46% of pharmacists, followed by diazepam (37%), dihydrocodeine (26%) and temazepam (25%). Sixty-five per cent of methadone prescriptions were dispensed daily on request from the prescriber. Of the 3387 people receiving a methadone prescription, 32.9% had to consume their daily dose on the pharmacy premises under a pharmacist's supervision. Nineteen per cent of pharmacies currently provided a service to supervise the consumption of methadone by clients and a further 14% were prepared to but had no current demand. The proportion of prescriptions requiring supervision of methadone consumption varied considerably between health board areas. CONCLUSIONS: Methadone is the most widely prescribed drug for drug misuse across Scotland, but there is considerable variation between health board areas in how prescribing is managed. Prescribing practice should be revised locally, in a process involving GPs and pharmacists. Pharmacists have an important role in preventing drug misuse in primary care, but need further support to optimize good practice.

Analgesics, Opioid↗
PubMed2001

Increasing incidence of both juvenile-onset Crohn's disease and ulcerative colitis in Scotland.

OBJECTIVE: A previous study reported a three-fold rise in the incidence of juvenile-onset Crohn's disease in Scottish children and a marginal fall in ulcerative colitis between 1968 and 1983. The present study aimed to document the incidence of juvenile-onset inflammatory bowel disease between 1981 and 1995 and examine temporal trends between 1968 and 1995 in Scotland. SETTING: Scotland (latitude 55-60 degrees N) has a total area of 77 837 km2 (30 405 square miles) and includes four urban centres each with a population of over 100,000. PARTICIPANTS: The Scottish hospital discharges linked database was used to identify 1002 patients less than 19 years old who were coded as having inflammatory bowel disease between 1981 and 1997. All case notes were reviewed and diagnoses verified. Incident cases were defined as those with symptom onset before or at 16 years of age between 1 January 1981 and 31 December 1995. RESULTS: During the 15 year period 1981-1995, 438 incident cases of Crohn's disease and 227 of ulcerative colitis were identified, giving standardized incidences of 2.5 cases and 1.3 cases per 100,000 population per year for Crohn's disease and ulcerative colitis respectively. On 31 December 1995 there were 150 children < or = 16 years of age with Crohn's disease and 101 with ulcerative colitis, giving crude prevalences of 13.7 cases per 100,000 population for Crohn's disease and 9.2 for ulcerative colitis. The continuing rise in Crohn's disease incidence between 1981 and 1995 fits that predicted by linear trend analysis of the 1968-1983 data. The incidence of Crohn's disease in the 12-16 age range almost doubled between 1981 and 1995 and was greater for males than females. Ulcerative colitis incidence was thought to show a slight fall in the 1968-1983 data, but this is reversed in the 1981-1995 data. CONCLUSION: The incidence of juvenile-onset Crohn's disease continues to rise in Scotland and the prevalence has increased by 30% since 1983. Unlike the previous report from Scotland, the incidence of juvenile-onset ulcerative colitis also is apparently rising. Whether this represents a real rise in incidence, or merely the inclusion of milder cases which were not previously hospitalized remains uncertain.

Adolescent↗
PubMed1994

Human infection in Tayside, Scotland due to Salmonella serotype Livingstone.

Livingstone was the third most common salmonella serotype isolated from cases of human salmonellosis in the Tayside region of Scotland in 1989-1991; latterly, it spread to Grampian region. The significant upsurge of Livingstone in these two Scottish regions was not matched by similar increases in its frequency of isolation from human cases of salmonellosis in other regions of Scotland or elsewhere in the UK. Although Salmonella Livingstone is usually associated in the UK with incidents of infection among poultry flocks, our detailed investigations found no clear evidence that poultry, eggs or poultry-related products were responsible for this outbreak. Most cases occurred in the summer months from July to September and many of the patients required hospital treatment. Other than one outbreak among geriatric patients in a long-stay hospital in north Tayside, most of the cases were sporadic. The extent of the outbreak, covering 3 years, was recognised mainly because Livingstone was previously an uncommon serotype in Tayside. There were few Livingstone isolations from non-human sources in Scotland in these same years. Possible sources of infection and predisposing factors among patients are discussed. Livingstone was not isolated in Scotland in 1992.

Adolescent↗
PubMed2006

Effectiveness of a breastfeeding peer coaching intervention in rural Scotland.

BACKGROUND: Breastfeeding initiation in Scotland in 2000 was 63 percent, compared with over 90 percent in Norway and Sweden. Although peer support is effective in improving exclusivity of breastfeeding in countries where over 80 percent of women initiate breastfeeding, the evidence for effectiveness in countries with lower initiation is uncertain. Our primary aim was to assess whether group-based and one-to-one peer breastfeeding coaching improves breastfeeding initiation and duration. METHODS: Action research methodology was used to conduct an intervention study in 4 geographical postcode areas in rural northeast Scotland. Infant feeding outcomes at birth and hospital discharge; at 1, 2, and 6 weeks; and at 4 and 8 months were collected for 598 of 626 women with live births during a 9-month baseline period and for 557 of 592 women with live births during a 9-month intervention period. Groups met in 5 locations, with 266 groups meeting in the period when intervention women were eligible to attend. Data on place of birth and length of postnatal hospital stay were also collected. Control data from 10 other Health Board areas in Scotland were compared. An intention-to participate survey about coaching participation was completed by 206 of 345 women initiating breastfeeding. Group attendance data were collected by means of 266 group diaries. RESULTS: There was a significant increase in any breastfeeding of 6.8 percent from 34.3 to 41.1 percent (95% CI 1.2, 12.4) in the study population at 2 weeks after birth compared with a decline in any breastfeeding in the rest of Scotland of 0.4 percent from 44 to 43.6 percent (95% CI -1.2, 0.4). Breastfeeding rates increased compared with baseline rates at all time points until 8 months. However, the effect was not uniform across the 4 postcode areas and was not related to level of deprivation. Little difference was seen in receipt of information and knowledge about the availability of coaching among areas. All breastfeeding groups were well attended, popular, and considered helpful by participants. A minority of women (n = 14/206) participated in formal one-to-one coaching. Women who received antenatal, birth, and postnatal care from community midwife-led units were more likely to be breastfeeding at 2 weeks (p = 0.007) than women who received some or all care in district maternity units. CONCLUSIONS: Group-based and one-to-one peer coaching for pregnant women and breastfeeding mothers increased breastfeeding initiation and duration in an area with below average breastfeeding rates.

Adult↗
PubMed2006

Legislation restricting paracetamol sales and patterns of self-harm and death from paracetamol-containing preparations in Scotland.

AIMS: To describe how changes in legislation to restrict paracetamol sales have affected overdose discharges and death associated with the drug in Scotland. METHODS: A descriptive analysis of routine death and hospital discharge data for the entire Scottish population between 1995 and 2004. Patients in Scotland participated who were discharged from hospital with a diagnosis of poisoning; deaths in Scotland from diagnosis of poisoning 1995-2003 were also analysed. Outcome measures were changes in mortality and overdose due to poisoning involving paracetamol. A comparison was made of in-hospital and out-of-hospital mortality in fatalities involving paracetamol. RESULTS: The majority of paracetamol-associated deaths were due to co-proxamol. Deaths associated with paracetamol alone or with ethanol occurred principally in hospital and were a minority of deaths overall. The proportion of in-hospital deaths attributed to paracetamol increased (post/pre ratio 1.347; 95% confidence interval 1.076, 1.639; P = 0.013). Overall numbers of cases discharged with poisoning fell. The proportion of these involving paracetamol in any form increased significantly in all groups except young men aged 10 to <20 years. CONCLUSIONS: Legislation has not reduced mortality or proportional use of paracetamol in overdose, both of which appear to have increased in Scotland since pack-size limitations. Other approaches are necessary to reduce the death rate from overdoses involving paracetamol.

Acetaminophen↗
PubMed2005

Cultural capital in an understated nation: the case of Scotland.

The concept of cultural capital is rarely used to explore specifically national cultural formations. This paper explores how Scotland, with its distinctive national identity, yet its constitutionally subordinate position within the UK offers an interesting case to explore the relationship between nationality and cultural capital. It examines how the concept can be used to unpick collective national identities, and how devolution might have changed its relationship to matters of identity and culture. It is especially concerned to show how Scotland's position within the UK leads to a form of cultural formation caught between two contradictory assumptions: that Scotland is 'culture-lite'--insufficiently different from the rest of the UK in terms of cultural markers such as language religion etc to be 'national'; and on the other hand that Scotland is 'culture-heavy' in so far as its cultural iconography is so hegemonic and distorted that it generates deformed narratives and discourses.

Cultural Characteristics↗
PubMed1997

Trends in growth in England and Scotland, 1972 to 1994.

AIM: To monitor the growth of 5 to 11 year old English and Scottish children from 1972 to 1994. No similar data are available from any other study. DESIGN: Mixed longitudinal. SUBJECTS: In England 7000 children were sampled in the first year, falling to 5000. In Scotland the original sample was 2000 but this was enlarged later to 3500. MAIN OUTCOME MEASUREMENTS: Height, weight, weight for height index, and triceps skinfold thickness. RESULTS: Height of English children in most age groups increased by more than 1 cm and by more than 2 cm in Scotland during the period 1972 to 1994. Triceps skinfold measurement increased by almost 8% in 7 year old English boys and by 7% in 7 year old girls. In Scotland triceps skinfold measurement increased by nearly 10% in 7 year old boys and by 11% in 7 year old girls. Weight for height index followed a similar pattern. CONCLUSION: Children in England and Scotland are becoming taller for a given age. The increases in fatness indicate an urgent need for realistic interventions for reductions in obesity in the whole population. As weight for height index is less sensitive than skinfold thickness we recommend triceps and subscapular skinfold thickness measurements for monitoring obesity in children.

Body Height↗
PubMed1992

Melanoma in people aged 65 and over in Scotland, 1979-89.

OBJECTIVE: Detailed analysis of primary cutaneous melanoma first diagnosed in Scotland in patients aged 65 and over. DESIGN: Comparison of changing incidence, sex distribution, site, histogenetic type, tumour thickness, and prognosis of all primary cutaneous melanomas in patients aged 65 and over diagnosed in Scotland in the 11 years 1979-89 with similar data for patients aged under 65. SETTING: Data were obtained from the Scottish Melanoma Group's database, established in 1979, which aims to record detailed clinical, pathological, and surgical follow up details of all primary cutaneous melanomas registered in Scotland. PATIENTS: 1430 patients (954 women, 476 men) aged 65 and over; comprising over a third of the 3903 patients with primary melanoma recorded for all age groups in Scotland during this period. RESULTS: The overall incidence of melanoma in patients aged 65 and over increased from 12.2/100,000 in 1979 to 20.7/100,000 in 1989, with the greatest increase seen in older men, from 7.8/100,000 in 1979 to 18.0/100,000 in 1989. The site most commonly affected was the face in both men and women (33% of all tumours). The most common histogenetic type was superficial spreading melanoma. 526 patients (37%) had melanomas with a tumour thickness of 3.5 mm or greater in the older age group, compared with 453 patients (18%) in those aged under 65. The highest proportion of thick tumours was seen in older men. Five year survival figures for 616 patients diagnosed between 1979 and 1984 were 88%, 66%, and 47% for thin, intermediate, and thick tumours respectively. Overall five year survival for the older age group was 64% compared with 78% for the younger age group. CONCLUSION: The increase in melanoma in the elderly and the high proportion of thick tumours, especially in men, require a specific educational programme for both primary and secondary prevention directed towards the older population.

Age Factors↗
PubMed1997

Cutaneous malignant melanoma in Scotland: incidence, survival, and mortality, 1979-94. The Scottish Melanoma Group.

OBJECTIVE: To determine the changing incidence of and mortality from cutaneous malignant melanoma in Scotland from 1979 to 1994. DESIGN: Detailed registration of clinical and pathological features, surgical and other treatment, and follow up of all cases of cutaneous malignant melanoma diagnosed from 1979 to 1994 and registered with specialist database for Scotland. SETTING: Scotland. SUBJECTS: 6288 patients with invasive primary cutaneous malignant melanoma diagnosed between 1 January 1979 and 31 December 1994. RESULTS: The annual age standardised incidence of cutaneous malignant melanoma rose significantly from 3.5 to 7.8 per 100,000 per year in men and from 6.8 to 12.3 per 100,000 per year in women (P < 0.001 for both). World standardised rates increased from 2.7 to 6.0 per 100,000 per year in men and 4.6 to 8.50 per 100,000 in women. The incidence of melanoma continued to increase significantly in men of all ages during the study, but the rate stabilised in women after 1986. Mortality from cutaneous malignant melanoma was 1.3 per million per annum in men in 1979, rising to 2.3 per million per annum in 1994 (P < 0.01); it was 2.4 per million per annum in women in 1979, falling to 1.9 per million per annum in 1994 (P = 0.09). The underlying mortality trends showed a continuing rise for men but a downward trend for women that was not significant (P = 0.09). In men, melanoma free survival was 69% at 5 years and 61% at 10 years; in women the corresponding rates were 82% and 75%. Younger patients had higher survival rates, which were not entirely explained by thinner tumours. Over the 15 year period, survival rates improved by 12% overall, only partly owing to thinner tumours. CONCLUSIONS: In Scotland the incidence of melanoma in women has stabilised, while mortality associated with melanoma in women shows a downward trend.

Adolescent↗
PubMed2003

Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study.

OBJECTIVES: To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. DESIGN: Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. MAIN OUTCOME MEASURES: Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. RESULTS: By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). CONCLUSION: The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1.

Ambulatory Surgical Procedures↗
PubMed2003

Equity of access to renal transplant waiting list and renal transplantation in Scotland: cohort study.

OBJECTIVE: To examine the access to the renal transplant waiting list and renal transplantation in Scotland. DESIGN: Cohort study. SETTING: Renal and transplant units in Scotland. PARTICIPANTS: 4523 adults starting renal replacement therapy in Scotland between 1 January 1989 and 31 December 1999. MAIN OUTCOME MEASURES: Impact of age, sex, social deprivation, primary renal disease, renal or transplant unit, and geography on access to the waiting list and renal transplantation. RESULTS: 1736 of 4523 (38.4%) patients were placed on the waiting list for renal transplantation and 1095 (24.2%) underwent transplantation up to 31 December 2000, the end of the study period. Patients were less likely to be placed on the list if they were female, older, had diabetes, were in a high deprivation category, and were treated in a renal unit in a hospital with no transplant unit. Patients living furthest away from the transplant centre were listed more quickly. The only factors governing access to transplantation once on the list were age, primary renal disease, and year of listing. A significant centre effect was found in access to the waiting list and renal transplantation. CONCLUSIONS: A major disparity exists in access to the renal transplant waiting list and renal transplantation in Scotland. Comorbidity may be an important factor.

Adolescent↗
PubMed2002

Laboratory confirmation of meningococcal disease in Scotland, 1993-9.

AIMS: To describe the laboratory confirmation of meningococcal disease, using culture and non-culture based techniques, between 1993 and 1999 as part of a national service in Scotland. METHODS: Samples from patients with suspected meningococcal disease in Scotland were analysed by culture and non-culture based techniques to gain a laboratory confirmation of disease. Data were analysed to establish the number of disease cases, the serogroups of the organisms involved, and the importance of the techniques used. RESULTS: Between 1993 and 1999, there was a total of 1749 notified cases of meningococcal disease in Scotland. Culture based methods provided a laboratory confirmation of 788 cases whereas non-culture techniques confirmed 461 cases. CONCLUSIONS: Non-culture techniques were a useful addition to culture based techniques in Scotland and improved the dataset required for public health management, disease surveillance, and vaccine policy.

Agglutination Tests↗
PubMed2005

High rates of ischaemic heart disease in Scotland are not explained by conventional risk factors.

STUDY OBJECTIVES: To (1) compare prevalence of socioeconomic, behavioural, and physiological ischaemic heart disease (IHD) risk factors in Scotland with a comparable nation (England) and (2) find out if their distribution explains Scotland's comparatively higher IHD rate (1.62 (1.30, 2.02)). DESIGN, SETTING, AND PARTICIPANTS: Cross sectional, individual level observational study with data on socioeconomic, behavioural, and physiological characteristics, 6064 respondents from Scotland and England, (2362 and 3702 respectively), aged 45-74 and with data on all required items. MAIN RESULTS: There were significant and meaningful differences between the Scottish and English in the prevalence of several IHD risk factors. However, a substantially and significantly higher risk of IHD persisted among the Scottish respondents (1.50 (1.17, 1.91)) despite control for a wide range of risk factors. CONCLUSIONS: Interpretation must be cautious because these are cross sectional data, however higher levels of conventional IHD risk factors contribute to but do not explain the comparatively high rates of IHD in Scotland. Alternative explanations for, and policy interventions to tackle, Scottish rates of IHD must be considered.

Aged↗
PubMed1996

Epidemiology and implications of ocular trauma admitted to hospital in Scotland.

OBJECTIVES: To describe the current epidemiology of serious ocular trauma which necessitates admission to hospital so that health and safety strategies for the prevention of ocular injuries and their role within the national health strategy, The Health of the Nation, can be better informed. DESIGN: A prospective observational study of all patients with ocular trauma admitted to hospital under the care of a consultant ophthalmologist between 1 November 1991 and 31 October 1992. SETTING: All ophthalmic department in Scotland. SUBJECTS: All patients with ocular trauma admitted to hospital in Scotland. The population of Scotland represented the population at risk of injury. MEASURES AND MAIN RESULTS: Measures included the type and cause of injury, the place where it occurred, and awareness of risk and safety. All ophthalmic departments in Scotland participated and 428 admissions were reported. The home was the most common place for a serious injury to occur (30.2%), followed by the workplace (19.6%) and a sports or leisure facility (15.8%). The home was the single most frequent place of injury for the 0-15 year and 65 year and over age groups. Tools or machinery, either at home (13.9%) or at work (10.3%), were collectively (24.2%) the most frequent cause of injury, followed by assault (21.8%) and sports-related activities (12.5%). The most frequent type of injury was a blunt injury (54.4%). Six per cent (n = 25) of all injuries were bilateral. Only 13.2% of patients were aware of any risk of injury, with 5.6% aware of any risk at home. When applicable, protective eye wear was only available to 48.6% of patients and only 19.4% of these used it. CONCLUSION: Serious ocular trauma frequently occurs at home and the young and the elderly are particularly at risk. This represents a significant change in the epidemiology of serious ocular trauma and has important implications for prevention. Health and safety strategies specifically aimed at preventing eye injury should now include the home as a high risk environment in addition to the work-place and sports/leisure facilities. The target groups for accident prevention in The Health of the Nation strategy include those at risk of serious ocular trauma with potentially sight threatening sequelae. Those involved in implementing the national accident prevention strategy should be aware of this, for in this process it is possible that some serious eye injuries may also be prevented.

Accidents, Home↗
PubMed2002

Trends in head injury mortality among 0-14 year olds in Scotland (1986-95).

STUDY OBJECTIVE: To examine the trends in childhood head injury mortality in Scotland between 1986 and 1995. DESIGN: Analysis of routine mortality data from the registrar general for Scotland. SETTING: Scotland, UK. SUBJECTS: Children aged 0-14 years. MAIN RESULTS: A total of 290 children in Scotland died as a result of a head injury between 1986 and 1995. While there was a significant decline in the head injury mortality rate, head injury as a proportion of all injury fatalities remained relatively stable. Boys, and children residing in relatively less affluent areas had the highest head injury mortality rates. Although both these groups experienced a significant decline over the study period, the mortality differences between children in deprivation categories 1-2 and 6-7 persisted among 0-9 year olds, and increased in the 10-14 years age group. Pedestrian accidents were the leading cause of mortality. CONCLUSIONS: Children residing in less affluent areas seem to be at relatively greater risk of sustaining a fatal head injury than their more affluent counterparts. While the differences between the most and least affluent have decreased overall, they have widened among 10-14 year olds. The decline in head injury mortality as a result of pedestrian accidents may be partly attributable to injury prevention measures.

Accidents, Traffic↗
PubMed1980

A further prevalence study of multiple sclerosis in north-east Scotland.

A second epidemiological study of multiple sclerosis (MS) in north-east Scotland has confirmed that the area has the highest prevalence rate in the world for any population of comparable size. On 1 December 1973 the prevalence was 144 per 100000 population. The age and sex specific prevalence rates are the highest ever recorded, one in every 306 of the population aged 40 to 59 years being affected. All patients have been tabulated in the National Health Service Central Register to facilitate future studies. The MS mortality rate in north-east Scotland is similar to the rate for the whole of Scotland. Throughout most of Scotland, therefore, MS probably is as prevalent as it is in the north-east.

Adolescent↗