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PubMed2002

Re-assessing the flood risk in Scotland.

This paper presents a review of changes in flood risk estimation on Scottish rivers resulting from re-analysis of flood records or from the application of new methods. The review arises at a time when flood damages have received recent prominence through the occurrence of a number of extreme floods in Scotland, and when the possible impacts of climate change on flood risk are receiving considerable attention. An analysis of the nine longest available peaks-over-threshold (POT) flood series for Scottish rivers reveals that, for thresholds yielding two events per year on average, annual POT frequencies on western rivers have increased in the 1980s/1990s to maximum recorded values, while in the east, values were highest in the 1950s/1960s. These results support the results of flood modelling work based on rainfall and temperature records from the 1870s, which indicate that, in western catchments, annual POT frequencies in the 1980s/1990s are unprecedented. No general trends in flood magnitude series were found, but an unexpected cluster of extreme floods is identified as having occurred since 1988, resulting in eight of Scotland's 16 largest gauged rivers producing their maximum recorded flows since then. These shifts are related to recent increases in the dominance of westerly airflows, share similarities with the results of climate change modelling, and collectively point to increases in flood risk in many parts of Scotland. The paper also reviews advances in flood risk estimation arising from the publication of the UK Flood Estimation Handbook, developments in the collection and use of historic flood estimation and the production of maps of 100-year flood areal extent. Finally the challenges in flood risk estimation posed by climate change are examined, particularly in relation to the assumption of stationarity.

Disasters↗
PubMed1998

Environmental risk factors for sporadic Escherichia coli O157 infection in Scotland: results of a descriptive epidemiology study.

The objective of the study was to obtain detailed descriptive epidemiological information on sporadic verocytotoxin-producing Escherichia coli O157 infection in Scotland in relation to transmission routes and host-related risk factors. Using a standardized questionnaire, the study was carried out throughout Scotland over an 18-month period from July 1992 and co-ordinated at the Communicable Diseases and Environmental Health (Scotland) Unit, Glasgow (CDEH(S)U). The subjects were laboratory-confirmed cases of Escherichia coli O157 infection, of whom 138 met the criteria for inclusion in the study. The most important findings were the high proportion of cases who had been exposed to environmental factors such as farm animals and/or their by-products; or who had participated in gardening or garden-play; or who had suspected or confirmed household water supply problems, prior to the onset of illness. The frequency and relative importance of environmental risk factors requires further quantification and study in order to assess where control measures can be directed most effectively. The implications for the NHS in preventing this crippling, life-threatening infection are considerable, not least in relation to hospitalization, dialysis and renal transplantation costs.

Adult↗
PubMed1998

The incidence of other primary tumours in patients with oral cancer in Scotland.

OBJECTIVE: To find out the incidence of second or multiple primary malignant tumours in patients with oral cancer in Scotland and identify the sites at most risk. DESIGN: Retrospective cohort study of data from the Cancer Registry. SUBJECTS: 1891 patients registered with oral cancer in Scotland between 1 January 1980 and 31 December 1986. MAIN OUTCOME MEASURES: Relative risks of subsequent cancers in patients with oral cancer. Identification of the sites at most risk of second cancers. RESULTS: Of the 1891 patients, 228 (12%) developed a second primary cancer. The mean follow-up period was 3.2 years. Fourteen patients had 3, and 2 patients had 4 primary cancers. The overall risk of second primary cancers was 2.03 (95% confidence intervals (CI) 1.77 to 2.39) times greater than expected in the general population. The relative risk for male patients was 1.95 (95% CI 1.65 to 2.24) and for female patients 2.29 (95% CI 1.7 to 2.9). CONCLUSIONS: Men with cancer of the lip in Scotland have an increased risk of developing second cancers of the lip and skin (excluding melanoma), whilst women with cancer of the lip have an increased risk of developing skin cancer only. Both men and women with intra-oral cancers have increased risks of developing second cancers of the oral cavity, pharynx, and trachea, bronchus, and lung, while men alone have an increased risk of developing second cancers in the oesophagus.

Adolescent↗
PubMed2004

Is going to church good or bad for you? Denomination, attendance and mental health of children in West Scotland.

Religiosity is often associated with mental health in adult populations, but not in a consistent direction. Conflicting results reflect the multidimensional nature of both concepts. Few studies have addressed the relationship between religiosity and mental health among children. In this paper, we examine the relation of weekly church attendance to measures of mental health for 11 year olds from the two main Christian denominations in West Scotland. Levels of church-attendance were low among those affiliated with the Church of Scotland and relatively high among Catholics. The only mental health measure to show a similar relationship with church attendance in both denominations was aggression, which was less prevalent among weekly attenders. Self-esteem, anxiety and depression all demonstrated an interaction, such that weekly church attendance was associated either with advantage for Catholics, disadvantage for children with a Church of Scotland affiliation, or both. Teasing/bullying acted in a small way as a mediating factor in these relationships. In an education system with separate Catholic and 'non-denominational' schools, we hypothesise that the relationship between church attendance and mental health may be contingent on whether church attendance is normative within the peer group.

Aggression↗
PubMed1994

Declining incidence of amputation for arterial disease in Scotland.

OBJECTIVES: To determine time trends and geographical variations in the incidence of major amputation for peripheral arterial disease and whether lower rates of amputation were related to higher rates of arterial reconstruction. DESIGN: Analysis of Scottish hospital discharge data. SETTING: Scotland 1981-1990. MATERIALS: Patients undergoing major amputation or arterial reconstruction for peripheral arterial disease. CHIEF OUTCOME MEASURES: Time trends in age-sex standardised rates of major amputation and arterial reconstruction, and correlation between the rates of these operations by health board. MAIN RESULTS: In Scotland, between 1981 and 1990, the incidence of major amputation fell by 22% (p < 0.001). Inconsistencies were observed within different age-sex groups. In the population under 65 years of age the incidence of amputation fell by 45% (p < 0.001), whereas in those over 65 years the incidence increased by 54% (p < 0.001). Amputation rates fell in men but a paradoxical increase was observed in women. Between 1981 and 1990, rates of arterial reconstruction doubled (p < 0.001), with an increase in all age-sex groups. Rates of amputation and reconstruction varied between health boards of residence, with a positive correlation (r = 0.5) between rates of operations within health board. Therefore areas with higher reconstruction rates tended to have higher amputation rates. CONCLUSIONS: In Scotland, the incidence of amputation has fallen during a period when reconstruction rates have risen greatly. However inconsistencies in time trends by age-sex groups, and the lack of an inverse correlation by health board of residence, suggest that fewer amputations are unlikely to be due solely to an increase in reconstructive surgery.

Adult↗
PubMed2003

Do increases in mortality from intrahepatic cholangiocarcinoma reflect a genuine increase in risk? Insights from cancer registry data in Scotland.

The mortality from intrahepatic cholangiocarcinoma has increased recently in England and Wales and elsewhere. This study aims to examine recent trends in the incidence of intrahepatic cholangiocarcinoma in Scotland, to assess the extent to which changes in diagnostic practice may be influencing the observed trends, and to consider whether the results are compatible with a genuine increase in the risk of this cancer. Cancer registration (intrahepatic cholangiocarcinoma and anatomically adjacent cancers) data from Scotland 1968-1997 were analysed, including examination of trends in the percentage of cases recorded as being microscopically-verified. Since the late 1960s, the incidence of intrahepatic cholangiocarcinoma has increased approximately eight-fold in both sexes in Scotland. However, the proportion of cases verified microscopically has decreased substantially since the late 1970s, presumably due to an increasing reliance on radiological imaging for diagnosis. Despite this change in diagnostic practice, the incidence of microscopically-verified intrahepatic cholangiocarcinoma has also increased. While changes in diagnostic practice and misclassification could explain, at least part of, the observed increase in incidence of intrahepatic cholangiocarcinoma, a genuine increase in the risk of this cancer in the Scottish population seems probable. Further work is indicated to examine international trends in incidence, and to assess whether incidence differs within countries according to characteristics such as area of residence, socio-economic status, ethnic origin or occupation.

Adult↗
PubMed1982

Legionella infections in Scotland.

Four thousand two hundred and thirty-five sera from 2794 patients and 740 sera from 735 tourists domiciled in Scotland recently returned from abroad were examined between 1977 and 1981 for antibodies to Legionella pneumophila and related organisms. In addition, specimens were examined from some patients for cultural or serological demonstration of these organisms in lung or sputum. One hundred and ten cases were diagnosed, 104 serologically, five by immunofluorescence demonstration of legionellas in lung biopsy or autopsy specimens and L. pneumophila serogroup 1 was isolated from a further case. Of patients with pneumonia 6.7% showed evidence of legionella infection. Only 0.4% of healthy tourists had antibodies at a level of greater than or equal to 256. The majority of cases occurred in patients aged 50-69 and in 36 patients the infection was acquired outside the United Kingdom. Males predominated, the male: female ratio being 2: 1. Cases were less frequent in the first quarter of the year but those originating in Scotland were equally common in the remaining three quarters. Cases with disease acquired abroad added to indigenous cases resulted in a summer peak occurring in July, August and September. There were no outbreaks of legionellosis in Scotland.

Adult↗
PubMed2004

HIV-1 subtype in Scotland: the establishment of a national surveillance system.

Historically, subtype B viruses in men who have sex with men (MSM) and injecting drug users (IDU) dominated the HIV epidemic in the United Kingdom, whereas non-B heterosexual infections dominate globally. Heterosexual contact is now the most common route of transmission in the United Kingdom. Here we monitor HIV subtype in Scotland, and link it to origin of infection. HIV-1 sequence was generated from new diagnoses and the subtype thus obtained linked with demographic data. Virus was subtyped from 80% (137/171) of all new diagnoses in Scotland. Of 58 individuals infected by heterosexual contact, 74% (43) harboured non-B viruses, contrasting with 7% (5/68) of those infected by IDU or MSM. Eighty-four per cent of non-Bs (46/55) were probably acquired outside the United Kingdom, but nine individuals probably acquired their non-B infection in the United Kingdom. Non-B subtypes of HIV-1 predominate in recently diagnosed, heterosexually acquired infections in Scotland and are present in all risk groups, even those with no exposure outside the United Kingdom.

Adult↗
PubMed1997

Statistical modelling of breast cancer incidence and mortality rates in Scotland.

The interpretation of time trends in disease rates can be facilitated using estimable contrasts from age-period-cohort models. Cohort and period trends in breast cancer incidence and mortality rates in Scotland were investigated using contrasts that measure the changes in the linear trends. These contrasts were compared with estimates obtained from mortality rates in the USA and Japan. A significant moderation of both breast cancer incidence and mortality rates was observed in Scotland, associated with cohorts of women born after the Second World War compared with women born between the two world wars. The moderation of breast cancer mortality among cohorts born after 1925 compared with cohorts born before 1925 that was observed in the USA and Japan was also observed in this study. This moderation is not present in the incidence rates. The relative decline in the risk of breast cancer seen in younger cohorts seems to be contradictory to the temporal pattern present among breast cancer risk factors. It may well be that the alteration of eating patterns as a result of rationing in the wartime and immediate post-war period, and the subsequent influence on certain breast cancer risk factors probably produced by such changes, may have had some influence on the development of healthier girls and women. Such speculation could be addressed in a well-designed epidemiological study. There have been no changes in the mortality rate trends with period in Scotland, although the changes in the incidence rate trends with period are consistent with an increase in registration coverage.

Adult↗
PubMed2000

Career patterns of dental hygienists in Scotland.

OBJECTIVE: To study career patterns of dental hygienists in Scotland. SUBJECTS AND METHODS: Questionnaires were sent to all the dental hygienists enrolled with the General Dental Council in 1998 who had addresses in Scotland and those who were alumni of Scottish School of Dental Hygiene within the past 10 years. RESULTS: There was a 58.7% response (334 out of 569). A net loss of trained hygienists was not found. The results suggested that most would remain in employment for at least 30 years and about a third would retire early. Half were in full-time employment and 60% had been in continuous employment. Most of the remainder had personal reasons for ceasing work. 39% had refused employment because of the poor level of pay. CONCLUSIONS: The introduction of the 2-year course has reduced output from schools of dental hygiene and demand for hygienists is high. Little hard information exists to support manpower planning in this area. This study suggests that there is little wastage of trained dental hygienists in Scotland. More data is required concerning employment opportunities and potential unmet demand for this group of PCDs to establish the number of training places required.

Adult↗
PubMed2004

A survey of the opinions of consultant anaesthetists in Scotland of sedation carried out by dentists.

OBJECTIVES: To elicit the attitudes and opinions of consultant anaesthetists working in Scotland, with regard to conscious sedation carried out by dental practitioners. METHOD: A questionnaire was designed to gauge opinion of consultant anaesthetists in Scotland on the practice of conscious sedation by dentists. The questionnaire was sent to 353 consultant anaesthetists working in 49 hospitals within the 15 health boards in Scotland. RESULTS: Of the 366 questionnaires sent, 249 were returned of which 235 were valid. This gave a response rate of 64%. In general, those questioned felt that the provision of sedation in a hospital setting was more appropriate than in general dental practice. A majority (65%) thought that it was unrealistic for anaesthetists to provide all sedation for dental treatment, although many (58%) felt that anaesthetists should take more responsibility in this area. Again, a majority (60%) agreed that dentists should be trained to use sedation techniques for their patients but a significant number (63%) disagreed with the practice of operator/sedationist. CONCLUSION: It is of concern to the dental profession that a significant number of anaesthetists do not feel that it is appropriate for dentists to be administering even the most simple methods of sedation. At present there are no clear, recognised guidelines as to the level of formal training required for the practice of conscious sedation by dentists. It is in the interests of the dental profession and the public to ensure that those choosing to practice sedation do so safely by following recognised guidelines in the training and practice of sedation.

Anesthesia Department, Hospital↗
PubMed2004

Assessment of children prior to dental extractions under general anaesthesia in Scotland.

OBJECTIVE: To determine the type of dental assessment service offered to children prior to exodontia under chair dental general anaesthesia (CDGA) in the community and hospital dental services (CDS, HDS) in Scotland. DESIGN AND SETTING: Telephone interviews were conducted with CDS and HDS clinical directors in Scotland using a semi-structured questionnaire, with written follow-up confirmation. Copies of CDGA referral forms were also requested. RESULTS: All clinical directors, or their nominated deputies, participated (n = 21). Almost half of interviewees indicated that their area offered a "dedicated" pre-CDGA assessment service (n = 10). A range of grades was identified amongst assessors; a minority were described as "specialist paediatric staff". The availability of CDGA alternatives, including local analgesia and conscious sedation varied. Changes to the referral treatment plan were reported to occur "sometimes" or "often" by 11 interviewees regarding the anaesthetic used, and by 16 respondents regarding the number of teeth extracted. The content of CDGA referral forms was diverse. CONCLUSIONS: The method of referral and assessment of children for CDGA in Scotland is diverse, partly reflecting geographic limitations and local need. Guidance on pre-GA assessment, including use of standardised referral forms, may reduce variation and improve the quality of the pathway of care.

Anesthesia, Dental↗
PubMed2006

Progressing the action plan in Scotland--an educational perspective.

In March 2005 the Scottish Executive Health Department published the 'Action plan for improving oral health and modernising NHS dental services in Scotland'. Six areas required major new educational input: pre-qualification education, workforce supply, career development, dental practice and team development, clinical effectiveness/quality improvement and support for the oral health strategy. Targets from the action plan that have been fully achieved include: 1) undergraduate student numbers have reached the target output of 135 per year; 2) vocational training numbers match graduate numbers; 3) a vocational training scheme for dental therapists has been developed and numbers of VT places will match the number of qualifying therapists; 4) a new strategy to support dental nurse training will allow an additional 200 dental nurse training places by 2007; and 5) a clinical effectiveness programme has developed a rolling programme of guidelines, the first one of which, on conscious sedation, was released in May. The dental action plan has provided Scotland with the best opportunity for modernising dental services since the NHS was established. This paper describes some of the educational developments that will ensure NHS dental services in Scotland are 'fit for the future' and 'delivering for health'.

Capital Expenditures↗
PubMed1999

Epidemiology of Kaposi's sarcoma in Scotland, 1976-1996.

Based on data from the Scottish Cancer Registry, the epidemiology of Kaposi's sarcoma (KS) in Scotland during the period 1976-96 is described. In males, the annual age-standardized incidence rate (World standard population) increased from less than 0.09 per 100,000 before 1986 to 0.44 in 1991 and then decreased to around 0.17. Peak incidence is now at ages 30-39 compared with ages 80+ during the period 1976-82; and by 1986-96 the standardized incidence ratio for the Health Board which includes Edinburgh had risen to almost four times the national level. These changes are largely consistent with the pattern of HIV infection in Scotland. However, in both sexes, relative to other neoplasms, and in international terms, KS remains rare in Scotland. For patients diagnosed during 1976-92, cumulative observed survival at 5 years was 8.7% at ages 0-49 compared with 49.8% at ages 50-84, reflecting the more aggressive course of AIDS-related KS, as well as the co-morbidity and competing causes of death associated with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Who gets what treatment for obesity? A survey of GPs in Scotland.

OBJECTIVE: To describe the types and delivery of obesity treatment currently favoured by General Practitioners (GPs) working in Scotland. DESIGN: Representative cross-sectional survey using a postal questionnaire which included case stories as stimuli for questions about the GPs' nutrition guidance to overweight female patients. SUBJECTS: A systematic sample of 1400 general practitioners (GPs) from a total of 3593 GPs working in Scotland in 1997. RESULTS: From 1363 eligible GPs, 609 returned the full questionnaire and a further 132 took part in a telephone mini-interview. Net response was 54.4% (741/1363). Almost half of the GPs (45.6%) reported that they had read the recent national clinical guideline for integrating obesity prevention with weight management (SIGN 1996). The majority of GPs (89.6%) agreed that nutrition has an important role to play in the management of disease and 82.4% agreed that they can offer healthy eating advice to patients. However, only 34.8% of GPs believed that they had been successful in treating overweight patients. Routinely used treatments involve either a dietitian, practice nurse and/or a commercial slimming group and realistic weight loss was considered one criteria of successful treatment by some GPs. Age, year qualified and location of practice were found to have little influence over variations in GP treatment while weak associations between gender of GP and treatment were found. CONCLUSIONS: The readership of the clinical guidelines in Scotland has been moderate so far although a multidisciplinary approach to obesity treatment is recognised. Further investigations of any relationships between nutrition education-obesity treatment are needed.

Adult↗
PubMed2000

The changing nature of the 206Pb/207Pb isotopic ratio of lead in rainwater, atmospheric particulates, pine needles and leaded petrol in Scotland, 1982-1998.

The inductively coupled plasma-mass spectrometry (ICP-MS)-determined 206Pb/207Pb ratio of 145 samples of rainwater collected at 25 locations around Scotland during December 1997 and January 1998 and at three longterm monitoring stations in the northeast, central belt and southeast of the country from November 1997 to December 1998 averaged 1.144+/-0.017 (1 s). This represents a significant increase from the mean value of 1.120+/-0.016 recorded for the long-term sites in 1989 1991, only partly attributable to a concomitant increase in the 206Pb/207Pb ratio of leaded petrol from 1.075+/-0.013 to 1.088+/-0.007. The rainwater 206Pb/207Pb data for the late 1990s also contrast markedly with the lower 206Pb/207Pb ratios found for pine needle and atmospheric particulate samples from Scotland (e.g. Glasgow: 1.085+/-0.012 in 1985-1986, 1.099+/-0.007 in 1991-1992), England and Western Europe in this study for the period 1982-1992 when emissions of lead to the atmosphere from petrol-engined vehicles in the UK were approximately 2-9 times higher. The observed change in the lead isotopic signature of rainwater predominantly reflects the impact of measures, such as the introduction and growing uptake of unleaded petrol, to reduce car exhaust emissions of lead to the atmosphere in the UK. Based on the rainwater data, source apportionment calculations suggest a general decline in the contribution of leaded petrol to atmospheric lead in Scotland from 53-61% in 1989-1991 to 32-45% in 1997-1998, with a corresponding decline in the urban environment from 84-86% to 48-58%.

Air Pollutants↗
PubMed2002

Personality testing and profiling for anaesthetic job recruitment: attitudes of anaesthetic specialists/consultants in New Zealand and Scotland.

Specialist/consultant anaesthetists based in New Zealand and Scotland were sent a reply paid postal questionnaire asking about their attitudes to personality testing and personality types in the recruitment process for registrars and specialists. The questionnaire consisted of nine Likert-style questions and 14 visual analogue questions. The overall response rate was 65% (523/808). The responses to all the questions were broadly similar in the two countries. Personality testing was deemed of use in recruiting trainees and specialists, with a slightly greater proportion considering personality traits more important than academic achievement. An overwhelming majority believed the presence of an adverse personality trait would influence an appointment process, but few believed that the personality makeup of anaesthetists influenced the way in which they react to stressful situations. A slight majority considered the interview process a poor predictor of personality. New Zealand anaesthetists rated independence, orderliness, compassion, empathy, reflectiveness and patience higher than did anaesthetists in Scotland. In contrast, anaesthetists in Scotland rated pragmatism, as opposed to perfection, as a more important characteristic than did the New Zealand specialists. Personality assessment, although not effective as the sole tool for candidate selection, may have a role in the process of anaesthetic job recruitment and warrants further investigation.

Anesthesiology↗
PubMed2000

Groin hernia repair in Scotland.

BACKGROUND: The use of mesh for groin hernia repair has dramatically changed the way this common operation is performed. The aim of this study was to survey the methods of groin hernia repair in Scotland and to assess patient satisfaction with the operation. METHODS: Between 1 April 1998 and 31 March 1999 all patients who underwent groin hernia repair in the National Health Service in Scotland were identified. As well as looking at the type of hernia repair performed and postoperative morbidity, patients were sent a Short Form-36 about 3 months after the operation to assess satisfaction and return to normal activity. RESULTS: Information was obtained on 5506 (97 per cent) of patients who underwent groin hernia repair during the study period. Eighty-five per cent of patients had an open mesh repair and 4 per cent had a laparoscopic repair. Most operations (85 per cent) were performed using general anaesthesia on an inpatient basis (78 per cent), and 8 per cent were for repair of a recurrent hernia. Potentially serious intraoperative complications were rare (seven patients), although they were significantly (P < 0. 001) more likely to be associated with a laparoscopic approach or repair of a femoral hernia: relative risk compared with open inguinal hernia repair 33 (95 per cent confidence interval (c.i.) 6-197) and 22 (95 per cent c.i. 3-152) respectively. Wound complications were common and 10 per cent of patients required a district nurse to attend the wound. Patients expressed a high degree of satisfaction; 94 per cent would recommend the same operation to someone else if required. CONCLUSION: An open mesh repair using general anaesthesia has become the repair of choice for a groin hernia in Scotland. Despite a high incidence of wound complications, patients are satisfied with this operation.

Aged↗