Homes and health in the Outer Hebrides: A social prescribing framework for addressing fuel poverty and the social determinants of health.

Health services are increasingly being reshaped with reference to addressing social determinants of health (SDoH), with social prescribing a prominent example. We examine a project in the Outer Hebrides that reshaped and widened the local health service, framing fuel poverty as a social determinant of health and mobilising a cross-sector support pathway to make meaningful and substantive improvements to islanders' living conditions. The 'Moving Together' project provided support to almost 200 households, ranging from giving advice on home energy, finances and other services, to improving the energy efficiency of their homes. In so doing, the project represents an expansion of the remit of social prescribing, in comparison with the majority of services currently provided under this banner, and can be seen as a more systemic approach that engages with the underlying conditions of a population's health. We present a framework through which to understand and shape initiatives to address fuel poverty through a social prescribing approach.

A year as a prehospital physician in the Outer Hebrides, Scotland.

Responding in the Scottish Outer Hebrides presents a number of challenges above and beyond standard prehospital work owing to its remoteness in terms of reaching definitive care, and the limited resources available on the island. As a prehospital physician, it is important to have an excellent working relationship with all local emergency services and with the wider community. One's emotional resilience will be tested when responding and living in a rural setting, when you are far less removed from the tragedies you encounter when providing prehospital care.

Adverse effects of routine bovine health treatments containing triclabendazole and synthetic pyrethroids on the abundance of dipteran larvae in bovine faeces.

Macrocyclic lactone treatments for livestock can have detrimental effects on the arthropod populations in livestock faeces. For the last twenty years, avoidance of these products has been a standard recommendation on livestock farms that are managed for wildlife by the Royal Society for Protection of Birds (RSPB). However, the continued decline in the populations of birds (in particular the red-billed chough Pyrrhocorax pyrrhocorax) that are dependent on dung invertebrates on islands in the Inner Hebrides of Scotland prompted us to investigate the effects of livestock treatments that are commonly used on these islands. We conducted a replicated field plot study over two years to quantify the effects of livestock treatments containing copper, deltamethrin and triclabendazole on invertebrate density in pooled, artificial faecal pats on the island of Islay. We found that the density of arthropod larvae was significantly reduced by the triclabendazole and deltamethrin treatments in both years and by as much as 86% when the treatments were combined. Copper-containing boluses did not consistently affect abundance of arthropod larvae. These results suggest that veterinary treatment of livestock might contribute to a reduction in the food supply of chough.

Evaluation of molecular methods for the field study of the natural history of Dicrocoelium dendriticum.

There is a need for improved methods for the study of the impacts of climatic and livestock management change on the epidemiology of production-limiting helminth parasitic diseases. In this study we report the application of molecular methods to describe the natural history of the small lancet fluke, Dicrocoelium dendriticum on Machair pastures on the Inner Hebridean Isle of Coll. Our results build upon those of the only previous historic field study of D. dendriticum in the British Isles that had been undertaken on the same study site. We demonstrate the value of combining conventional parasitological methods with PCR amplification of a mitochondrial DNA fragment for the detection of D. dendriticum in ants and snails, and PCR amplification of ITS2 and 28S ribosomal DNA fragments to support the species identity of the intermediate hosts, to improving understanding of the epidemiology of D. dendriticum. We report the presence of D. dendriticum infection in cattle, sheep and rabbits grazing on Machair pastures. D. dendriticum infection was identified in a high percentage of the snails, identified as Cochlicella acuta and Cernuella virgata, and in a high percentage of Formica fusca and Myrmica ruginoides ants that were collected from, or clinging to, the tops of flowers. We have identified the involvement of different intermediate host species and higher prevalences of snail and ant infection than previously reported, in part reflecting differences between the sensitivity and specificity of morphological and molecular speciation methods. Overall, our results highlight the complex life history of dicrocoeliosis and illustrate the parasite's generalist host strategy that confers potential to exploit new niches created by climatic change or grazing management for habitat conservation.

Exposure to viral and bacterial pathogens among Soay sheep (Ovis aries) of the St Kilda archipelago.

We assessed evidence of exposure to viruses and bacteria in an unmanaged and long-isolated population of Soay sheep (Ovis aries) inhabiting Hirta, in the St Kilda archipelago, 65 km west of Benbecula in the Outer Hebrides of Scotland. The sheep harbour many metazoan and protozoan parasites but their exposure to viral and bacterial pathogens is unknown. We tested for herpes viral DNA in leucocytes and found that 21 of 42 tested sheep were infected with ovine herpesvirus 2 (OHV-2). We also tested 750 plasma samples collected between 1997 and 2010 for evidence of exposure to seven other viral and bacterial agents common in domestic Scottish sheep. We found evidence of exposure to Leptospira spp., with overall seroprevalence of 6·5%. However, serological evidence indicated that the population had not been exposed to border disease, parainfluenza, maedi-visna, or orf viruses, nor to Chlamydia abortus. Some sheep tested positive for antibodies against Mycobacterium avium subsp. paratuberculosis (MAP) but, in the absence of retrospective faecal samples, the presence of this infection could not be confirmed. The roles of importation, the pathogen-host interaction, nematode co-infection and local transmission warrant future investigation, to elucidate the transmission ecology and fitness effects of the few viral and bacterial pathogens on Hirta.

Environmental variability and biodiversity of megabenthos on the Hebrides Terrace Seamount (Northeast Atlantic).

We present the first remotely operated vehicle investigation of megabenthic communities (1004-1695 m water depth) on the Hebrides Terrace Seamount (Northeast Atlantic). Conductivity-temperature-depth casts showed rapid light attenuation below the summit and an oceanographic regime on the flanks consistent with an internal tide, and high short-term variability in water temperature, salinity, light attenuation, aragonite and oxygen down to 1500 m deep. Minor changes in species composition (3-14%) were explained by changes in depth, substratum and oceanographic stability, whereas environmental variability explained substantially more variation in species richness (40-56%). Two peaks in species richness occurred, the first at 1300-1400 m where cooler Wyville Thomson Overflow Water (WTOW) mixes with subtropical gyre waters and the second at 1500-1600 m where WTOW mixes with subpolar mode waters. Our results suggest that internal tides, substrate heterogeneity and oceanographic interfaces may enhance biological diversity on this and adjacent seamounts in the Rockall Trough.

Testes size, testosterone production and reproductive behaviour in a natural mammalian mating system.

1. Testosterone (T) is a key mediator in the expression of numerous morphological and behavioural traits in mammals, but the factors underlying individual variation in circulating T levels are poorly understood. 2. The intimate structural integration of sperm and T production within the testes, alongside the dependency of sperm production on high levels of T, suggests that T requirements for spermatogenesis could be an important driver of individual differences in T. 3. To test this hypothesis, we examine how male capacity for sperm production (as indicated by their testes size) is associated with T levels in a feral population of Soay sheep, resident on St. Kilda, Scotland, during their rutting season. 4. We found a strong positive relationship between an individual's testes size (as measured before their seasonal enlargement) and the levels of circulating T during their rut, suggesting that T requirements for spermatogenesis has a prominent influence on the production of this androgen. 5. In contrast, body condition and competitive ability did not independently predict T levels, findings that are inconsistent with conventional 'condition-dependent' and 'challenge' hypotheses of T production. 6. This influence of male's capacity for sperm production on T appeared to be substantial enough to be biologically relevant, as testes size also predicted male aggression and mate-seeking behaviour. 7. Our results suggest that a male's inherent capacity for sperm and T production is tightly phenotypically integrated, with potential consequences for a wide range of other T-mediated reproductive traits.

Bayesian inference on age-specific survival for censored and truncated data.

1. Traditional estimation of age-specific survival and mortality rates in vertebrates is limited to individuals with known age. Although this subject has been studied extensively using effective capture-recapture and capture-recovery models, inference remains challenging because of large numbers of incomplete records (i.e. unknown age of many individuals) and because of the inadequate duration of the studies. 2. Here, we present a hierarchical model for capture-recapture/recovery (CRR) data sets with large proportions of unknown times of birth and death. The model uses a Bayesian framework to draw inference on population-level age-specific demographic rates using parametric survival functions and applies this information to reconstruct times of birth and death for individuals with unknown age. 3. We simulated a set of CRR data sets with varying study span and proportions of individuals with known age, and varying recapture and recovery probabilities. We used these data sets to compare our method to a traditional CRR model, which requires knowledge of individual ages. Subsequently, we applied our method to a subset of a long-term CRR data set on Soay sheep. 4. Our results show that this method performs better than the common CRR model when sample sizes are low. Still, our model is sensitive to the choice of priors with low recapture probability and short studies. In such cases, priors that overestimate survival perform better than those that underestimate it. Also, the model was able to estimate accurately ages at death for Soay sheep, with an average error of 0.94 years and to identify differences in mortality rate between sexes. 5. Although many of the problems in the estimation of age-specific survival can be reduced through more efficient sampling schemes, most ecological data sets are still sparse and with a large proportion of missing records. Thus, improved sampling needs still to be combined with statistical models capable of overcoming the unavoidable limitations of any fieldwork. We show that our approach provides reliable estimates of parameters and unknown times of birth and death even with the most incomplete data sets while being flexible enough to accommodate multiple recapture probabilities and covariates.

A taste of rural Highlands and Islands general practice: evaluation of remote placements in GP specialty training.

BACKGROUND: Despite being home to the most remote GP practices in the UK, the Highlands and Islands GPST programme offers its trainees limited opportunity to gain experience in remote general practice. In an attempt to remedy this situation, a pilot of short remote placements was carried out in spring/summer 2010. AIMS: The aims of the pilot were to assess the placements' feasibility including level of interest from GPSTs and remote GPs; evaluate the perceived benefits to GPSTs and their hosts; and consider the impact such placements might have on recruitment to remote and rural general practice. METHODS: Following the placements, semi-structured interviews were conducted with participating GPSTs and host GPs. In addition, written statements were collated from interested GPSTs prior to their placement indicating why they wished to take part. Parties who had expressed an interest but for whom a placement did not take place were asked to complete a follow-up questionnaire. FINDINGS: Placements were highly valued by both GPSTs and their host GPs. In particular, the GPSTs valued being able to 'put themselves in the shoes of a remote GP' and being able to discuss potential career pathways with a remote practitioner. The participating GPSTs all had pre-existing interests in a career in remote and rural general practice, but found this was reinforced by their remote placement experience. Sufficient host GPs were identified to accommodate all of the interested GPSTs and placements were successfully organised despite a limited budget. Difficulties obtaining study leave did hinder some GPSTs, and this consideration along with resource limitations are potential barriers to the scheme being continued in the future. CONCLUSIONS: Remote placements are valued by GPSTs considering a career in remote and rural general practice and tend to reinforce their interest in this area. However, it is unknown whether this will impact on recruitment. Inviting GPSTs from outwith the North of Scotland to experience a remote placement might allow them an insight into remote and rural general practice that is not possible from their host deanery. The benefits of a remote placement to GPSTs without a pre-existing interest in remote and rural general practice have not been assessed.

Cryptic differences in dispersal lead to differential sensitivity to habitat fragmentation in two bumblebee species.

Habitat loss has led to fragmentation of populations of many invertebrates, but social hymenopterans may be particularly sensitive to habitat fragmentation due to their low effective population sizes. The impacts of fragmentation depend strongly on dispersal abilities, but these are difficult to quantify. Here, we quantify and compare dispersal abilities of two bumblebee species, Bombus muscorum and Bombus jonellus, in a model island system. We use microsatellites to investigate population genetic structuring, dispersal and spatial patterns in genetic diversity. Populations of both species showed significant structuring, and isolation by distance, but this was markedly greater in B. muscorum (theta = 0.13) than in B. jonellus (theta = 0.034). This difference could reflect a higher effective population size in B. jonellus compared to B. muscorum, but this is not consistent with the observed abundance of the two species. We argue that it is more likely that B. jonellus has a higher propensity to disperse than B. muscorum. This will influence their relative susceptibility to habitat fragmentation and may in part explain differential declines of mainland populations of these and other bumblebee species.

Climate change: is the dark Soay sheep endangered?

It was recently reported that the proportion of dark-coloured Soay sheep (Ovis aries) in the Hebrides has decreased, despite the fact that dark sheep tend to be larger than lighter sheep, and there exists a selective advantage to large body size. It was concluded that an apparent genetic linkage between loci for the coat colour polymorphism and loci with antagonistic effects on body size explained the decrease. Those results explain why the proportion of dark animals is not increasing, but not why it is decreasing. Between 1985 and 2005 there was a significant increase in mean ambient temperature near the islands. We suggest that, while in the past a dark coat has offset the metabolic costs of thermoregulation by absorbing solar radiation, the selective advantage of a dark coat may be waning as the climate warms in the North Atlantic. In parallel, Bergman's rule may be operating, reducing the selective advantage of large body size in the cold. Either or both of these mechanisms can explain the decrease in the proportion of dark-coloured larger sheep in this population in which smaller (and light-coloured) sheep should be favoured by their lower gross energy demand. If environmental effects are the cause of the decline, then we can expect the proportion of dark-coloured Soay sheep to decrease further.

Eco-evolutionary dynamics: disentangling phenotypic, environmental and population fluctuations.

Decomposing variation in population growth into contributions from both ecological and evolutionary processes is of fundamental concern, particularly in a world characterized by rapid responses to anthropogenic threats. Although the impact of ecological change on evolutionary response has long been acknowledged, the converse has predominantly been neglected, especially empirically. By applying a recently published conceptual framework, we assess and contrast the relative importance of phenotypic and environmental variability on annual population growth in five ungulate populations. In four of the five populations, the contribution of phenotypic variability was greater than the contribution of environmental variability, although not significantly so. The similarity in the contributions of environment and phenotype suggests that neither is worthy of neglect. Population growth is a consequence of multiple processes, which strengthens arguments advocating integrated approaches to assess how populations respond to their environments.

Dioxin, diet and disease on St. Kilda.

The inhabitants of St Kilda are well known for their susceptibility to infection. Low herd immunity, limited genetic biodiversity, malnutrition and poor social conditions have been incriminated as the major predisposing factors, but the clinical evidence for the effect of malnutrition and the clinical relevance of the more recent discovery of heavy metal and dioxin pollution on infectious diseases have not been scrutinised from a medical perspective.

Photosynthetic responses of plant communities to sand burial on the machair dune systems of the outer hebrides, Scotland.

BACKGROUND AND AIMS: The effects of both short-term (2 weeks) and long-term (6 weeks) burial on the photosynthetic efficiency of four typical plant sub-communities of the machair sand dunes of the Outer Hebrides are described. Previous studies have examined the photosynthetic responses on individual species rather than the response at the community level. METHODS: Three replicate turves from four different sub-community types (foredune grassland, dune slack, three-year fallow and unploughed grassland) were subjected to short- and long-term burial treatments after acclimatisation in an unheated greenhouse for approximately 10 weeks. Three replicate control turves from each sub-community were left unburied. After treatment, photosynthetic rate was measured at 16-20 h and 40-44 h after re-exposure, using an infra-red gas analyser, with standardization by total leaf area for each turf. Effects of sub-community type, burial duration and time since re-exposure were analysed by 3-factor split-plot analysis of variance (ANOVA) with repeated measures for time since re-exposure in the subplots. KEY RESULTS: Buried turves were characterized by a low dark respiration rate, which may represent a maintenance response to burial. After removal of sand, each machair sub-community showed some capacity for an elastic photosynthetic response. There were no differences between the effects of short- and long-term burial on the photosynthetic efficiency of machair vegetation, although turves buried for 6 weeks generally attained photosynthetic rates approaching those of control rates sooner than turves buried for 2 weeks. Photosynthetic responses to burial varied between sub-communities, with the slack turves exhibiting the poorest capacity for recovery within the investigated 44-h period. CONCLUSIONS: In the machair environment, the ability to maintain photosynthetic equipment whilst buried, and the ability to bring about a relatively rapid reinstatement of photosynthetic mechanisms on emergence or exposure, is an important adaptation for survival. Survival is closely related to the ability of a plant to replenish carbohydrate reserves before the next burial event.

Contamination and compensation: Gruinard as a 'menace to the mainland'.

The decades-long contamination of Gruinard Island by anthrax is now a well-known part of the history of biological weapons (BW) development, as well as that of military encroachments in the Scottish Highlands and Islands (and the authorities' rather less persistent efforts at damage limitation). Some accounts have included the related episode, reportedly well-remembered by local people, of anthrax contamination on the mainland close to Gruinard. This occurred in 1942--43, when BW experiments were conducted on the island as part of the war effort by scientists from Porton Down under the auspices of the British government. After much top-level discussion, payments were made to the owners of animals that had died as a result of the contamination. The episode had a bearing on discussions about the future of the island and on subsequent policy with regard to the siting, conduct and secrecy of BW experiments.

Infectious disease mortality in two Outer Hebridean islands: 1. measles, pertussis and influenza.

OBJECTIVES: The purpose of the study was to examine changes in mortality from measles, pertussis (whooping cough) and influenza (all epidemic diseases) in Harris and Barra, two Outer Hebridean islands, from 1855 to 1990, and to compare the findings with those from Scotland as a whole over the same period. It was also intended to relate changes in mortality to those in social and economic factors. MATERIALS AND METHODS: Ages and causes of death in Harris and Barra were ascertained from copies of death certificates held at the General Register Office, Edinburgh, and for Scotland as a whole from the Annual Reports of the Registrars General for Scotland. Data were standardized by calculating the Proportionate Mortality Ratio (PMR), the proportion of deaths due to a particular cause to all deaths over a given period. Spectral analysis was employed to examine the durations of epidemic cycles. RESULTS: Ages at death increased slightly over the period of the study. For measles and pertussis, other than for the former in Harris, there were significant relationships between numbers of deaths per decade, and numbers of new susceptibles, estimated as the numbers of births. Epidemics of measles and pertussis in the islands occurred at intervals, usually separated by years of no mortality. The highest PMRs were generally during the later decades of the 19th and first decade of the 20th centuries; this may have been related to the economic problems of agriculture and fishing, and to increasing population density. Influenza epidemics were more frequent than those of the other two diseases. For all three diseases in both islands, there were significant negative power relationships between epidemic size and frequency of occurrence; those in Harris were the stronger. The relationships between length and frequency were significant only in Harris. Generally, epidemic lengths seemed less variable than sizes, possibly because of the rather 'coarse' units of length (quarters) employed. Spectral analysis of the 'detrended' data for the period before the introduction of specific immunoprophylaxis revealed that for measles the main epidemic cycle in all three populations was between 7.3 and 7.8 years' duration. Barra and Scotland had additional 2.5- and 2-year cycles, respectively. For pertussis, Harris and Barra had main cycles of 7.4 years. Harris had an additional cycle of 3.2 years. Scotland had cycles of 4 and 2 years. For influenza, Harris had a main cycle length of 7.4 years, and a less-defined one of about 2.6 years. Barra had a main cycle of 6.9 years, and a subsidiary one of 2 years. Scotland has a single cycle of 8 years. Cubic regressions of the spectral densities on cycle frequencies showed large coefficients for Harris and Barra, but small ones for Scotland. Measles coefficients were closely similar in the two islands, but not those for pertussis. CONCLUSIONS: The findings demonstrate the episodic occurrence of epidemics of these three diseases in the two islands, as against their continual presence in the much larger population of Scotland. They reveal also the decreasing importance of these causes of death in all three populations. The data from Harris and Barra suggest that measles is a more epidemiologically 'stable' disease than pertussis. Both islands appear to obey Hamer's law of 'mass action'. The relatively long intervals between epidemics in the islands may be due partly to their isolation, and partly to the slow accumulation of sufficient numbers of susceptibles to enable an epidemic to occur.

Infectious disease mortality in two Outer Hebridean islands: 2. pulmonary tuberculosis.

OBJECTIVE: To examine mortality from pulmonary tuberculosis (PTB) in the Outer Hebridean islands of Harris and Barra, and to compare it with that in Scotland as a whole. DESIGN: Ages and dates of death from PTB in Harris and Barra between 1855 and 1990 were ascertained from copies of death certificates. For Scotland, annual numbers of deaths in 5-year age-groups were extracted from Annual Reports of the Registrars General. Proportionate mortality ratios (PMRs) were calculated for each population in the 1-14 and 15 or over age-groups, and the 'detrended' PMRs were subjected to spectral analysis. For this purpose the data were divided into the pre-antibiotic (1855-1950) and antibiotic/chemo-therapeutic (1951-1990) periods. RESULTS: PTB was predominantly a disease of adolescence and early adulthood, although ages at death increased towards the end of the period of study. While PMRs for Scotland decreased steadily after the mid-1870s, apart from increases during the 1940s, those for the two islands increased during the late 19th century, and did not decrease markedly until the 1930s. In the younger age-groups the pattern of mortality was similar to that of an acute infectious disease, while in the older age-group the pattern was largely endemic. Spectral analysis of pre-1951 data from both islands showed marked periodicities in mortality, mostly among the younger age-group. The introduction of effective therapy in the 1950s appeared to lengthen inter-epidemic intervals. There appeared to be no relationship in either island between mortality and socio-economic deprivation, as indicated by numbers of new poor registrations. In Harris, mortality was higher in colder and wetter years. This was not the case in Barra. CONCLUSIONS: The findings are reasonably consistent with a hypothesis that PTB was relatively uncommon in the Outer Hebrides until the later 19th century, and that it behaved epidemiologically like an acute infectious disease. This was not the case with Scotland as a whole, where the disease appeared to be largely endemic.

Comparative ungulate dynamics: the devil is in the detail.

Attempts to relate species differences in population dynamics to variation in life histories rely on the assumption that the causes of contrasts in demography are sufficiently simple to be derived from first principles. Here, we investigate the causes of contrasts in dynamics between two ungulate populations on Hebridean islands (red deer and Soay sheep) and show that differences in stability, as well as in the effects of variation in density and climate, are related to differences in timing of reproduction relative to seasonal variation in resource abundance. In both populations, attempts to predict changes in population size sufficiently accurately for the results to be useful for management purposes require a knowledge of the responses of different age and sex categories to changes in density and climate, as well as of population structure.