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PubMed1984

Asthma deaths in Scotland 1965-1980.

From 1965 the fall in asthma mortality in Scotland has parallelled that documented for England and Wales. The high proportion of deaths in young people, and deaths at home, is similar to findings elsewhere. Mortality is higher in the more rural health areas, which are characterised by poorer access to general medical services, fewer medical consultants to the population, and lower hospital admission rates for asthma. There is a slightly higher proportion of home deaths in these rural areas, though on the available data not reaching the level of significance. It is suggested that this difference in mortality between the more urban and the more rural areas provides a basis for a case study in detail.

Adult↗
PubMed1988

The incidence of childhood diabetes in certain parts of Scotland.

The incidence of diabetes in children under 12 years of age has been studied in three regions of Scotland from 1976 to 1986. These areas represent more than half of the Scottish population of that age group. The overall annual incidence is 17.6 per 100,000, ranging from 16.8 in densely populated areas to 23.4 in more rural areas. Earlier studies have concerned the age group 0-18 years so the present results from a younger age group are, as expected, slightly lower but show the same trends. After a rise to 1983 there appears to have been a drop, but not in all areas. The danger of drawing conclusions from areas of low population or from short periods of time is stressed.

Adolescent↗
PubMed1988

Vaccine-induced polioencephalomyelitis in Scotland.

A six-month-old British female, living in Glasgow was admitted in June 1986 with a four-day history of fever and lower limb weakness following immunisation with oral polio and triple (DTP) vaccines. Examination revealed paralysis of all limbs, facial muscles and right diaphragm, scoliosis, opsoclonus and ocular flutter. Poliovirus types 1, 2 and 3, isolated from her stool specimens were all vaccine-like strains. Her serial serum IgA levels were persistently low and salivary IgA was undetectable. This appears to be the first fully authenticated case of poliovaccine damage in Scotland. It is unclear whether the selective IgA deficiency contributed to her vulnerability. It is essential to investigate elaborately and process viral isolates in every suspected case of acute poliomyelitis so as to determine the dimension and ramifications of poliovaccine damage in the UK population which is known to be rather apprehensive about vaccine dangers.

Feces↗
PubMed1988

Can bone marrow transplantation be offered to more patients in south east Scotland?

The number of patients with haematological malignancies and aplastic anaemia treated by allogeneic bone marrow transplantation in South East Scotland between 1983-1986 is apparently greater than that estimated by the Black Report in 1982. The potential for increasing the use of this effective therapy by using bone marrow donors from the extended family or national volunteer panels is discussed.

Adult↗
PubMed1989

Post neonatal mortality rates--Scotland.

Post Neonatal Mortality Rates in Scotland have been equal to those of North and South England since 1975. In this respect there is no longer any inequality in health. However, Social Class V still has a higher rate than Social Class I and the rate for illegitimates is the same as for Social Class V. As a result the illegitimate rate remains much higher than that for legitimates in spite of the enormous increase in illegitimate number since 1960. With 18% of all live births now born illegitimate they represent infant (social) deprivation better than Social Class V--which now constitutes only 5% of live births.

Humans↗
PubMed1989

Coronary risk factor and lifestyle variation across Scotland: results from the Scottish Heart Health Study.

Between 1984 and 1986 the Scottish Heart Health Study recorded coronary risk factors and lifestyle in 10,359 men and women aged 40-59 years across 22 districts of Scotland--districts whose standardised mortality ratio for coronary heart disease in men varied from 61 in Eastwood to 136 in Monklands. This paper presents the results by district. Cigarette smoking levels showed the greatest variation, from 29% to 52% in men and 24% to 51% in women. Blood pressure means varied but were not high (129-138mmHg systolic in men, 126-137mmHg in women, 81-88mmHg diastolic in men and 77-84mmHg in women). Mean serum cholesterol values were high and varied little by district in men, (6.1 to 6.5mmol/l), although there was more variation in women (6.3 to 7.0mmol/l). Body mass index (25.3 to 26.6kg/m2 in men and 24.8 to 26.3kg/m2 in women) also varied little. Distribution of other lipids, fibrinogen, exercise levels and fruit and vegetable consumption is also described. When district mean levels of major coronary risk factors are entered into predictive formulae, cigarette smoking and blood pressure could explain part of the regional variation in mortality, but much remains unaccounted for. Nonetheless, these levels provide data for local preventive initiatives. While the overall pattern and interaction of the factors will repay further study, the high levels of serum cholesterol in all districts, and the level and variation in cigarette smoking, are a challenge for action.

Adult↗
PubMed1990

Use of a radiometric technique for rapid sensitivity testing of mycobacteria in Scotland: the first year's experience.

We report the first year's experience of the use of a radiometric technique for sensitivity testing of mycobacterial isolates in Scotland. The techniques (using the Bactec 460 instrument) was much quicker than conventional methods (for example the mean time to obtain results for 60 strains of M.tuberculosis was 14.4 days, compared with 44.9 days for conventional methods). There was good agreement between results obtained by the two methods. Preliminary results also indicated the value of the radiometric technique for rapid isolation of mycobacteria from clinical samples (mean of 10.6 days with the radiometric technique compared with 26.7 days using egg media) although for optimal recovery, both techniques should be used in parallel.

Carbon Radioisotopes↗
PubMed1991

Teenage pregnancy in Scotland: trends and risks.

Teenage pregnancy, considered to be associated with social and medical risks, is seen as a growing problem. Population based information from the Registrar General (Scotland) and Notification of Abortion permitted an analysis of the trends in the numbers, rates and outcomes of pregnancies among women aged less than 20 years. In addition, clinical information is available on all deliveries in Scottish hospitals from the standard hospital discharge document permitting analysis of the association of defined complications with age. Contrary to current perceptions, pregnancies and births among teenagers are not more frequent in 1988 when compared to 1975. There has been, however, a large increase in births to single women, a group with particular problems. The obstetric risks when compared to older women, are small and probably socially, not age related. These include a slightly higher rate of pre-term delivery and low birthweight and a later presentation for specialist antenatal care. The proportion of pregnancies affected by neural tube defects which are terminated is lower among women under 20. These medical risks are small, however, compared to the well-documented social and economic problems which will have long term and indirect effects on health.

Abortion, Induced↗
PubMed1992

Factors affecting asthma mortality in Scotland.

Asthma mortality in the age group 5-44 years appeared to be stable in Scotland in both males and females at a rate of approximately 1.0 per 100,000 during the period 1970-1988 despite an increase in the hospital discharge rate for asthma of approximately 4% per annum during that period. Two-thirds of these deaths occurred outside hospital. There was evidence of a seasonal variation in asthma deaths with a peak mortality occurring in August, four to six weeks after the peak in total pollen counts. Monthly variation in atmospheric pollution did not appear to account for the variation in asthma mortality. It is suggested that the seasonal variation in asthma mortality provides a basis for further studies to elucidate the factors contributing to these deaths.

Adolescent↗
PubMed1992

A review of caesarean sections at 30 weeks gestation or less in the west of Scotland 1988-1989.

A retrospective study was carried out of caesarean sections at 30 completed weeks of gestation or less between 1/1/88 and 31/12/89 in Glasgow and The West of Scotland. One hundred and thirty-three caesarean sections were carried out resulting in 150 babies. Fifteen (11.3%) of these were classical sections. There were 30 neonatal deaths. The perinatal mortality rate was 170 per 1000. Survival was related to increasing gestation from 27 weeks onwards and also to birthweight from 900 grams onwards. In-utero transfers fared badly with seven out of 21 babies (33%) failing to survive beyond the neonatal period. Although survival continues to improve in newborns, the use of caesarean section should still be viewed with caution as the benefits in the very premature situation with regard to infant survival may be outweighed by the increased maternal morbidity both in the present pregnancy and future pregnancies.

Birth Weight↗
PubMed1992

Creutzfeldt-Jakob disease in Scotland and Northern Ireland 1980-1989.

The epidemiological and clinical features of Creutzfeldt-Jakob disease have never before been studied in Scotland and Northern Ireland. Case records for those dying with this diagnosis were obtained for the period 1980-89. Over the ten year period, 25 definite or probable cases were identified, giving an annual incidence of 0.37 cases/million. There were more cases in the second half of the decade, and this was most likely due to increased ascertainment. One pair of cases occurred in close proximity to each other. Sex distribution showed an excess of males (male:female ratio = 1.8:1). Mean age at onset was 65.2 years, and mean duration of disease was 5.3 months. The presenting symptoms and clinical features were similar to those noted in previous studies of other populations. There was no excess of cases in occupations linked to food, farming, or medical/paramedical work.

Aged↗
PubMed1994

The management of operable breast cancer in Scotland surgeons' opinions. The Scottish Cancer Trials Breast Group.

This report gives the responses of general surgeons in Scotland to two questionnaires. Satisfactory rates were obtained: 82% for the more detailed survey in 1988 and 62% for the second survey (1991), where nonrespondents were not followed up. In 1988 the rationale was the poor participation in the Scottish breast conservation trial while the 1991 survey further investigated the diversity of surgical opinion identified in the first. The limited trial support in 1988 was mainly due to reluctance to accept all treatment options. The majority were prepared to consider trial participation although 47% believed this compromised doctor-patient relationships. Although breast-conserving therapy was widely supported, many different views on management were encountered, both in the degree of influence of specific factors and in the decisions taken in relation to them. We believe these surveys have re-inforced a need for management guidelines, particularly as around half the patients with symptomatic breast cancer were being treated in non-specialist units.

Breast Neoplasms↗
PubMed1994

The changing pattern of mortality in young adults aged 15 to 34 in Scotland between 1972 and 1992.

Between 1972 and 1992 the death rate in Scotland in young adults aged 15 to 34 from heart disease fell by nearly a half (49%), from cancer by a third (32%) and from respiratory diseases by 45%, with substantial falls in deaths from most other "natural causes". All of this impressive improvement was wiped out, however, by a massive increase in deaths from drug abuse, suicides and undetermined causes as well as the emergence of AIDS. In view of the fact that many deaths due to drug misuse may be attributed instead to the immediate cause, there is an urgent need for a national agency to be set up to investigate all deaths in young adults in order to determine the number in which alcohol or drugs are the underlying cause. This agency would also monitor progress towards attaining Health of the Nation targets relating to suicide.

Adolescent↗
PubMed1995

Cardiorespiratory disease in men and women in urban Scotland: baseline characteristics of the Renfrew/Paisley (midspan) study population.

UNLABELLED: STUDY OBJECTIVE. To describe the distribution of risk factors, risk behaviors, symptoms and the prevalence of cardiorespiratory disease in men and women in an urban area with high levels of socioeconomic deprivation. A cross-sectional survey of 15,411 men and women aged 45-64, comprising an 80% response rate from the general population in Paisley and Renfrew, Scotland. MAIN RESULTS: The main characteristics of the male Renfrew/Paisley population, compared to previous British studies, were shorter stature, higher blood pressure, a higher proportion of smokers who continue to smoke, lower FEV1 and higher levels of reported angina, breathlessness on effort and chronic bronchitis. In comparison with men, the main characteristics of the female Renfrew/Paisley population were shorter stature, higher plasma cholesterol, lower FEV1, fewer current and ex-smokers, and a higher prevalence of breathlessness on effort. There were only small differences between men and women in the prevalence of angina, ECG evidence of myocardial ischaemia and chronic bronchitis. CONCLUSIONS: Middle-aged men and women in an urban area with high levels of socio-economic deprivation have different cardio-respiratory risk and disease profiles compared to previous population in the UK, based on occupational groups and random national samples.

Angina Pectoris↗
PubMed1995

Risk factors for cardiorespiratory and all cause mortality in men and women in urban Scotland: 15 year follow up.

STUDY OBJECTIVE: To describe the relationship between risk factors, risk behaviours, symptoms and mortality from cardiorespiratory diseases in an urban area with high levels of socioeconomic deprivation. A cohort study of 15,411 men and women aged 45-64, comprising 80% of the general population of Paisley and Renfrew, Scotland. OUTCOMES: Mortality after 15 years from coronary heart disease(ICD 410-4), stroke(ICD 430-8), respiratory disease(ICD 460-519) and all causes. MAIN RESULTS: Mortality rates from all causes were 19% in men aged 45-49, 31% in men aged 50-54, 42% in men aged 55-59 and 57% in men aged 60-64. The rates are considerably higher than those reported in previous UK prospective studies. For women the rates were 12%, 18%, 25% and 38% respectively. In general men and women showed similar relationships between risk factor levels and mortality rates. People in manual occupations had higher mortality rates. Raised levels of systolic and diastolic blood pressure were associated with increased coronary, stroke and all cause mortality rates. Plasma cholesterol had no such association with all cause mortality rates. High and low levels of body mass index were associated with higher mortality rates than intermediate levels. A relationship between short stature and increased mortality rates was observed in men and women. FEV1 expressed as a percentage of the expected value showed the strongest relationship with mortality rates, particularly for respiratory disease, but also for deaths from coronary heart disease, stroke and all causes. CONCLUSIONS: A similar pattern of relationship between risk factor levels and mortality rates exists in men and women in Renfrew and Paisley. Respiratory impairment as measured by FEV1% predicted appears to be the most likely explanation of the observed high all cause mortality rates in this population.

Blood Pressure↗
PubMed1996

Public perceptions of brain tumours in Scotland: the need for access to appropriate information.

The aim of the study was to evaluate knowledge and perceptions of brain tumours in a heterogeneous, highly educated group of adults living in Edinburgh. Two hundred and forty four respondents answered a questionnaire about the causes, effects and treatments of brain tumours. There were misconceptions about several clinical and biological aspects of intracranial tumours although most respondents were aware of the bleak prognosis associated with many neoplasms. These results, from the intellectual elite of Scotland's capital, suggest that access to information about brain tumours should be readily available. Five leaflets, covering various aspects of brain tumours, that are available through the recently established Scottish charity Brain Tumour Action seem well formulated to address areas of concern and misconception.

Adult↗
PubMed1996

General practice blood pressure recording in Scotland: variations in the classification of hypertension.

A questionnaire concerning blood pressure assessment, as part of health promotion activity, was circulated to all 770 Gpass practices in Scotland producing a 64.6% response rate. The results reveal a wide range in both the systolic and diastolic levels chosen to classify blood pressure as normal, borderline raised or raised. Practices are using a variety of values to indicate hypertension when considering systolic and, to a lesser extent, diastolic pressure. The variations found suggest that both over and under treatment are a significant risk to patients. The introduction of the 1993 health promotion regulations means that practices are required to actively target their practice population for blood pressure assessment and appropriate intervention. We suggest that this process will be enhanced if doctors are encouraged to adopt the established guidelines for the classification of blood pressure or general practice computer software is adopted to offer blood pressure protocol support.

Adolescent↗
PubMed1996

Home enteral feeding of children in the west of Scotland.

Home enteral feeding (HEF) is increasingly used to achieve positive energy and nitrogen balance in children with chronic disease outside hospital. It should be considered when oral feeding cannot or should not be used, and when nutritional support is the sole reason for hospitalisation. In the West of Scotland 156 children (80 male, 76 female) cared for by the Royal Hospital for Sick Children in Glasgow received HEF between 1st September 1994 and 1995. They ranged in age from 0 months to 23 years. Indications for HEF were cystic fibrosis (21), cerebral palsy (17), other neurological disease (29), congenital/metabolic abnormalities (23), chronic renal failure (17), neoplastic disease (17), gastrointestinal/hepatic' disease (12), failure-to-thrive (10), and cardiorespiratory disease (10). Most children received feeds by nasogastric tube (59%) or gastrostomy (41%). One child had a jejunostomy. Feeding regimens were continuous infusion (52%), bolus feeding along (26%), and a combination of bolus and infusion (22%). 73% of patients had infusion pumps. Duration of HEF ranged from one month to 12 years. 78% of children received standard infant or enteral feeds, some receiving energy supplements. The remainder received 'disease-specific' or other special feeds. There was a 23% increase in the number of children receiving HEF during the year of the study. HEF represents an affective way of improving the nutritional status of children with chronic disease at home. It frees hospital beds and nursing resources, is well accepted by children and their families and is growing rapidly as an alternative to hospitalisation.

Adolescent↗