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1.
Bone Joint J ; 102-B(1): 72-81, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888363

RESUMO

AIMS: The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death. METHODS: This was a retrospective cohort study of consecutive patients referred to the orthopaedic department at a UK trauma centre with a proximal femoral metastasis (PFM) over a seven-year period (2010 to 2016). The study group were compared to a matched control group of non-metastatic hip fractures. Minimum follow-up was one year. RESULTS: There was a 90-day mortality of 46% in patients with metastatic hip fractures versus 12% in controls (89/195 and 24/192, respectively; p < 0.001). Mean time to surgery was longer in symptomatic metastases versus complete fractures (9.5 days (SD 19.8) and 3.4 days (SD 11.4), respectively; p < 0.05). Albumin, urea, and corrected calcium were all independent predictors of early mortality and were used to generate a simple tool for predicting 90-day mortality, titled the Metastatic Early Prognostic (MEP) score. An MEP score of 0 was associated with the lowest risk of death at 30 days (14%, 3/21), 90 days (19%, 4/21), and one year (62%, 13/21). MEP scores of 3/4 were associated with the highest risk of death at 30 days (56%, 5/9), 90 days (100%, 9/9), and one year (100%, 9/9). Neither age nor primary cancer diagnosis was an independent predictor of mortality at 30 and 90 days. CONCLUSION: This score could be used to predict early mortality and guide perioperative counselling. The delay to surgery identifies a potential window to intervene and correct these abnormalities with the aim of improving survival. Cite this article: Bone Joint J. 2020;102-B(1):72-81.


Assuntos
Neoplasias Femorais/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Estudos de Casos e Controles , Feminino , Neoplasias Femorais/secundário , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Escócia/epidemiologia , Índice de Gravidade de Doença , Análise de Sobrevida , Tempo para o Tratamento
3.
BMC Infect Dis ; 19(1): 847, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615435

RESUMO

BACKGROUND: Salmonella outbreaks in childcare facilities are relatively rare, most often occurring secondary to contaminated food products or poor infection control practices. We report an outbreak of Salmonella Saintpaul at a pre-school facility in Ayrshire, Scotland with atypical clinical and epidemiological features. METHODS: Following notification of the initial two cases, the multi-disciplinary Incident Management Team initiated enhanced active case finding and two environmental inspections of the site, including food preparation areas. Parent and staff interviews were conducted by the Public Health department covering attendance, symptomatology and risk factors for all probable and confirmed cases. Microbiological testing of stool samples and the facility water tank was conducted. Whole Genome Sequencing (WGS) was performed for positive stool samples at the national reference laboratory. Infection control measures were introduced iteratively due to the atypical progression of the outbreak. RESULTS: There were 15 confirmed cases and 3 children admitted to hospital during the outbreak. However, 35.7% of cases reported extremely mild symptoms. The attack rate was 15.2%, and age of affected children ranged from 18 to 58 months (mean 35 months). All cases were the same Multilocus Sequence Type (MLST50). Epidemiological investigation strongly suggested person-to-person spread within the facility. Existing infection control practices were found to be of a high standard, but introduction of additional evidence-based control measures was inadequate in halting transmission. Facility staff reported concerns about lack of parental disclosure of gastrointestinal symptoms, particularly where these were mild, with 50.0% of cases having attended while symptomatic against public health advice. Voluntary two-week closure of the facility was implemented to halt transmission, following which there were no new cases. WGS results were unavailable until after the decision was taken to close the facility. CONCLUSIONS: This is the first reported instance of a Salmonella Saintpaul outbreak at a childcare facility, or where person-to-person transmission is indicated. Clinicians should consider the influence of parental under-reporting on gastrointestinal outbreaks in childcare settings, particularly where perceived severity is low and financial or social pressures to attend work may reduce compliance. WGS cannot yet replace conventional microbiological techniques during short, localised outbreaks due to delays receiving results.


Assuntos
Infecções por Salmonella/diagnóstico , Salmonella/isolamento & purificação , Creches , Pré-Escolar , DNA Bacteriano/química , DNA Bacteriano/metabolismo , Surtos de Doenças , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Tipagem de Sequências Multilocus , Saúde Pública , Salmonella/genética , Infecções por Salmonella/epidemiologia , Escócia/epidemiologia , Sequenciamento Completo do Genoma
4.
N Engl J Med ; 381(19): 1801-1808, 2019 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-31633894

RESUMO

BACKGROUND: Neurodegenerative disorders have been reported in elite athletes who participated in contact sports. The incidence of neurodegenerative disease among former professional soccer players has not been well characterized. METHODS: We conducted a retrospective cohort study to compare mortality from neurodegenerative disease among 7676 former professional soccer players (identified from databases of Scottish players) with that among 23,028 controls from the general population who were matched to the players on the basis of sex, age, and degree of social deprivation. Causes of death were determined from death certificates. Data on medications dispensed for the treatment of dementia in the two cohorts were also compared. Prescription information was obtained from the national Prescribing Information System. RESULTS: Over a median of 18 years, 1180 former soccer players (15.4%) and 3807 controls (16.5%) died. All-cause mortality was lower among former players than among controls up to the age of 70 years and was higher thereafter. Mortality from ischemic heart disease was lower among former players than among controls (hazard ratio, 0.80; 95% confidence interval [CI], 0.66 to 0.97; P = 0.02), as was mortality from lung cancer (hazard ratio, 0.53; 95% CI, 0.40 to 0.70; P<0.001). Mortality with neurodegenerative disease listed as the primary cause was 1.7% among former soccer players and 0.5% among controls (subhazard ratio [the hazard ratio adjusted for competing risks of death from ischemic heart disease and death from any cancer], 3.45; 95% CI, 2.11 to 5.62; P<0.001). Among former players, mortality with neurodegenerative disease listed as the primary or a contributory cause on the death certificate varied according to disease subtype and was highest among those with Alzheimer's disease (hazard ratio [former players vs. controls], 5.07; 95% CI, 2.92 to 8.82; P<0.001) and lowest among those with Parkinson's disease (hazard ratio, 2.15; 95% CI, 1.17 to 3.96; P = 0.01). Dementia-related medications were prescribed more frequently to former players than to controls (odds ratio, 4.90; 95% CI, 3.81 to 6.31; P<0.001). Mortality with neurodegenerative disease listed as the primary or a contributory cause did not differ significantly between goalkeepers and outfield players (hazard ratio, 0.73; 95% CI, 0.43 to 1.24; P = 0.24), but dementia-related medications were prescribed less frequently to goalkeepers (odds ratio, 0.41; 95% CI, 0.19 to 0.89; P = 0.02). CONCLUSIONS: In this retrospective epidemiologic analysis, mortality from neurodegenerative disease was higher and mortality from other common diseases lower among former Scottish professional soccer players than among matched controls. Dementia-related medications were prescribed more frequently to former players than to controls. These observations need to be confirmed in prospective matched-cohort studies. (Funded by the Football Association and Professional Footballers' Association.).


Assuntos
Atletas , Doenças Neurodegenerativas/mortalidade , Futebol , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas , Estudos de Casos e Controles , Causas de Morte , Feminino , Cardiopatias/mortalidade , Humanos , Incidência , Modelos Logísticos , Longevidade , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Nootrópicos/uso terapêutico , Estudos Retrospectivos , Escócia/epidemiologia
5.
BMC Public Health ; 19(1): 1227, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488096

RESUMO

BACKGROUND: The United Kingdom (UK) fully-implemented standardised packaging for cigarettes and rolling tobacco on 20th May 2017. We explore adolescent's awareness of, and responses to, standardised cigarette packaging in the UK after it became mandatory. METHODS: Eight focus groups were conducted in schools in Scotland with 16-17 year-olds (n = 41), between November 2017 and November 2018, to explore awareness of, and responses to, standardised cigarette packaging. Unlike in Australia, where only straight-edged flip-top cigarette packs are permitted, in the UK standardised cigarette packs can have slim designs, and different edge types (straight, rounded or bevelled) and opening styles (flip-top or shoulder box). We explored how each of these pack formats was perceived. We also explored to what extent brand variant name differentiated cigarettes sold in standardised packaging. RESULTS: Most participants were aware of standardised packaging without being shown pack stimuli. Standardised packs were considered embarrassing and off-putting, and the health warnings salient. Among the standardised packs shown, there was a preference for the slimmer pack, viewed as more discrete and the cigarettes potentially less harmful, and the shoulder box, considered cool and different. Participants were interested in some brand variant names on standardised packs (e.g. Legendary Black), particularly those they considered to imply coolness and sophistication. CONCLUSION: Adolescents consider standardised cigarette packs in the UK unappealing, and the warnings salient, two core aims of this measure. However, positive reactions to some of the standardised packs (slimmer pack, shoulder box), and variant names used, has implications for countries developing standardised packaging regulations.


Assuntos
Percepção , Embalagem de Produtos/normas , Produtos do Tabaco , Adolescente , Feminino , Grupos Focais , Humanos , Masculino , Escócia/epidemiologia , Fumar/epidemiologia
6.
Psychiatr Danub ; 31(Suppl 3): 312-317, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488746

RESUMO

INTRODUCTION: A recent study commissioned by the Scottish Government on the prevalence of mental disorders in Muslims in Scotland revealed that over 50% of the sample met the diagnostic criteria for a mental illness. Stigma is a major barrier to mental health services and despite the availability of effective treatment, many Muslims in Scotland with mental health difficulties continue to suffer in silence. The Federation of Student Islamic Societies (FOSIS) Scotland branch organized a mental health conference in Glasgow to improve Mental Health Literacy and challenge mental health related stigma in the Scottish Muslim community. The conference was comprised of: A counsellor with a background of Islamic psychology, a psychiatrist and an Imam (a Muslim religious leader). DESIGN: We conducted a single-arm, pre- post- comparison study on Muslims who attended the FOSIS mental health conference in Glasgow, Scotland. Validated psychometric stigma scales measuring knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes towards the Mentally Ill (CAMI)) and behaviours (Reported and Intended Behaviour Scale (RIBS)) were administered on participants before and immediately after exposure to the programme. RESULTS: 34 out of the 55 participants who attended the conference responded (response rate 62%). 34/34 (100%) of the respondents were Muslim and the mean age was 22.7 years (Std. Dev. 6.04, min. 18, max. 49). There were no statistically significant changes in stigma across the domains of knowledge, attitude and behaviour in respondents following exposure to the event. CONCLUSION: Previous FOSIS anti-stigma conferences in England and Ireland featuring an Expert by Lived Experience were associated with statistically significant reductions in mental health related stigma. The results of the FOSIS Glasgow study supports the, 'Power of contact' with an Expert by Lived Experience at reducing mental health related stigma in the Muslim community. More robust research in this area is urgently required.


Assuntos
Islamismo/psicologia , Transtornos Mentais , Saúde Mental/estatística & dados numéricos , Estigma Social , Estudantes , Adolescente , Adulto , Humanos , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Escócia/epidemiologia , Estereotipagem , Estudantes/psicologia , Adulto Jovem
8.
Sex Transm Infect ; 95(5): 351-357, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31201278

RESUMO

OBJECTIVES: Despite a recent fall in the incidence of HIV within the UK, men who have sex with men (MSM) continue to be disproportionately affected. As biomedical prevention technologies including pre-exposure prophylaxis are increasingly taken up to reduce transmission, the role of HIV testing has become central to the management of risk. Against a background of lower testing rates among older MSM, this study aimed to identify age-related factors influencing recent (≤12 months) HIV testing. METHODS: Cross-sectional subpopulation data from an online survey of sexually active MSM in the Celtic nations-Scotland, Wales, Northern Ireland and Ireland (n=2436)-were analysed to compare demographic, behavioural and sociocultural factors influencing HIV testing between MSM aged 16-25 (n=447), 26-45 (n=1092) and ≥46 (n=897). RESULTS: Multivariate logistic regression demonstrated that for men aged ≥46, not identifying as gay (OR 0.62, CI 0.41 to 0.95), location (Wales) (OR 0.49, CI 0.32 to 0.76) and scoring higher on the personalised Stigma Scale (OR 0.97, CI 0.94 to 1.00) significantly reduced the odds for HIV testing in the preceding year. Men aged 26-45 who did not identify as gay (OR 0.61, CI 0.41 to 0.92) were also significantly less likely to have recently tested for HIV. For men aged 16-25, not having a degree (OR 0.48, CI 0.29 to 0.79), location (Republic of Ireland) (OR 0.55, CI 0.30 to 1.00) and scoring higher on emotional competence (OR 0.57, CI 0.42 to 0.77) were also significantly associated with not having recently tested for HIV. CONCLUSION: Key differences in age-related factors influencing HIV testing suggest health improvement interventions should accommodate the wide diversities among MSM populations across the life course. Future research should seek to identify barriers and enablers to HIV testing among the oldest and youngest MSM, with specific focus on education and stigma.


Assuntos
Infecções por HIV/diagnóstico , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Estudos Transversais , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Escócia/epidemiologia , Comportamento Sexual , Minorias Sexuais e de Gênero/psicologia , Estigma Social , Inquéritos e Questionários , País de Gales/epidemiologia , Adulto Jovem
9.
PLoS Med ; 16(6): e1002825, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31173597

RESUMO

BACKGROUND: Primary care antimicrobial stewardship interventions can improve antimicrobial prescribing, but there is less evidence that they reduce rates of resistant infection. This study examined changes in broad-spectrum antimicrobial prescribing in the community and resistance in people admitted to hospital with community-associated coliform bacteraemia associated with a primary care stewardship intervention. METHODS AND FINDINGS: Segmented regression analysis of data on all patients registered with a general practitioner in the National Health Service (NHS) Tayside region in the east of Scotland, UK, from 1 January 2005 to 31 December 2015 was performed, examining associations between a primary care antimicrobial stewardship intervention in 2009 and primary care prescribing of fluoroquinolones, cephalosporins, and co-amoxiclav and resistance to the same three antimicrobials/classes among community-associated coliform bacteraemia. Prescribing outcomes were the rate per 1,000 population prescribed each antimicrobial/class per quarter. Resistance outcomes were proportion of community-associated (first 2 days of hospital admission) coliform (Escherichia coli, Proteus spp., or Klebsiella spp.) bacteraemia among adult (18+ years) patients resistant to each antimicrobial/class. 11.4% of 3,442,205 oral antimicrobial prescriptions dispensed in primary care over the study period were for targeted antimicrobials. There were large, statistically significant reductions in prescribing at 1 year postintervention that were larger by 3 years postintervention when the relative reduction was -68.8% (95% CI -76.3 to -62.1) and the absolute reduction -6.3 (-7.6 to -5.2) people exposed per 1,000 population per quarter for fluoroquinolones; relative -74.0% (-80.3 to -67.9) and absolute reduction -6.1 (-7.2 to -5.2) for cephalosporins; and relative -62.3% (-66.9 to -58.1) and absolute reduction -6.8 (-7.7 to -6.0) for co-amoxiclav, all compared to their prior trends. There were 2,143 eligible bacteraemia episodes involving 2,004 patients over the study period (mean age 73.7 [SD 14.8] years; 51.4% women). There was no increase in community-associated coliform bacteraemia admissions associated with reduced community broad-spectrum antimicrobial use. Resistance to targeted antimicrobials reduced by 3.5 years postintervention compared to prior trends, but this was not statistically significant for co-amoxiclav. Relative and absolute changes were -34.7% (95% CI -52.3 to -10.6) and -63.5 (-131.8 to -12.8) resistant bacteraemia per 1,000 bacteraemia per quarter for fluoroquinolones; -48.3% (-62.7 to -32.3) and -153.1 (-255.7 to -77.0) for cephalosporins; and -17.8% (-47.1 to 20.8) and -63.6 (-206.4 to 42.4) for co-amoxiclav, respectively. Overall, there was reversal of a previously rising rate of fluoroquinolone resistance and flattening of previously rising rates of cephalosporin and co-amoxiclav resistance. The limitations of this study include that associations are not definitive evidence of causation and that potential effects of underlying secular trends in the postintervention period and/or of other interventions occurring simultaneously cannot be definitively excluded. CONCLUSIONS: In this population-based study in Scotland, compared to prior trends, there were very large reductions in community broad-spectrum antimicrobial use associated with the stewardship intervention. In contrast, changes in resistance among coliform bacteraemia were more modest. Prevention of resistance through judicious use of new antimicrobials may be more effective than trying to reverse resistance that has become established.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/normas , Farmacorresistência Bacteriana/efeitos dos fármacos , Enterobacteriaceae/efeitos dos fármacos , Análise de Séries Temporais Interrompida/normas , Médicos de Atenção Primária/normas , Antibacterianos/farmacologia , Gestão de Antimicrobianos/métodos , Prescrições de Medicamentos/normas , Farmacorresistência Bacteriana/fisiologia , Enterobacteriaceae/fisiologia , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/epidemiologia , Humanos , Análise de Séries Temporais Interrompida/métodos , Médicos de Atenção Primária/educação , Vigilância da População , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Escócia/epidemiologia
10.
BMC Public Health ; 19(1): 742, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196124

RESUMO

BACKGROUND: Smoking prevention programmes that reach adolescents before they experiment with tobacco may reduce the prevalence of tobacco use. ASSIST is a school-based, peer-led smoking prevention programme that encourages the diffusion of non-smoking norms among secondary school students (aged 12-13), and was shown in a randomised control trial (conducted 2001-2004) to reduce the prevalence of weekly smoking. This paper presents findings from a process evaluation of the implementation of ASSIST in Scotland in 2014-2017. It examines acceptability and fidelity of implementation and explores the context of message diffusion between peers. METHODS: Mixed method implementation study with students (n = 61), school staff (n = 41), trainers (n = 31) and policy and commissioning leads (n = 17), structured observations (n = 42) and student surveys (n = 2130). RESULTS: ASSIST was delivered with a high degree of fidelity to the licensed manual with all elements of the programme implemented. Student survey findings indicated that the frequency of conversations about smoking increased over the ASSIST delivery period (18% at baseline, 26% at follow-up), but student recollection of conversations about smoking with peer supporters was low (9%). The delivery context of ASSIST was important when considering perceptions of message diffusion. In the study schools, survey findings showed that 0.9% (n = 19) of participants were regular smokers (at least once a week), with nine out of ten (89.9%, n = 1880) saying they had never smoked. This very low prevalence may have affected when and with whom conversations took place. Study participants indicated that there were wider benefits of taking part in ASSIST for: peer supporters (i.e. personal and communication skills); schools (an externally delivered health promotion programme that required minimal resource from schools); and communities (via communication about the risks of smoking to wider social networks). CONCLUSIONS: ASSIST in Scotland was delivered with a high degree of fidelity to the licensed programme and was acceptable from the perspective of schools, students and trainers. Targeting ASSIST in deprived areas with higher youth smoking prevalence or in other countries where youth smoking rates are rising or higher than in Scotland may be particularly relevant for the future delivery.


Assuntos
Grupo Associado , Serviços de Saúde Escolar/organização & administração , Prevenção do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/organização & administração , Estudantes/psicologia , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Instituições Acadêmicas , Escócia/epidemiologia , Fumar/epidemiologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários
11.
Int J Public Health ; 64(7): 1059-1068, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31139849

RESUMO

OBJECTIVES: To assess what proportion of the association between household low income and incidence of adverse childhood experiences (ACE) would be eliminated if all households had access to housing, transportation and childcare services, breastfeeding counselling, and parks. METHODS: Using Growing Up in Scotland birth cohort data (N = 2816), an inverse probability-weighted regression-based mediation technique was applied to assess associations between low-income status (< £11,000 in 2004/5), resource access, and cumulative 8-year ACE incidence (≥ 1, ≥ 3 ACEs). Resource access was measured based on households' self-reported difficulties (yes/no) in accessing housing, transportation, childcare, and breastfeeding counselling, and park proximity (within 10 min from the residence). RESULTS: The protective effects of resources were heterogeneous. Only access to transportation was associated with lower ACE incidence in both low- and higher-income households. If all had access to transportation, 21% (95% CI 3%, 41%) of the income-based inequality in incidence of 3 or more ACEs could be eliminated. CONCLUSIONS: While second best to the elimination of child poverty, measures to improve families' access to community resources such as transportation may mitigate the effects of poverty on ACE incidence.


Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Criança , Cuidado da Criança/normas , Saúde da Criança , Pré-Escolar , Feminino , Habitação/normas , Humanos , Incidência , Renda , Lactente , Estudos Longitudinais , Masculino , Parques Recreativos/normas , Escócia/epidemiologia , Fatores Socioeconômicos , Transportes/normas
12.
BMC Public Health ; 19(1): 595, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101093

RESUMO

BACKGROUND: Childhood epilepsy can adversely affect education and employment in addition to health. Previous studies are small or highly selective producing conflicting results. This retrospective cohort study aims to compare educational and health outcomes of children receiving antiepileptic medication versus peers. METHODS: Record linkage of Scotland-wide databases covering dispensed prescriptions, acute and psychiatric hospitalisations, maternity records, deaths, annual pupil census, school absences/exclusions, special educational needs, school examinations, and (un)employment provided data on 766,244 children attending Scottish schools between 2009 and 2013. Outcomes were adjusted for sociodemographic and maternity confounders and comorbid conditions. RESULTS: Compared with peers, children on antiepileptic medication were more likely to experience school absence (Incidence Rate Ratio [IRR] 1.43, 95% CI: 1.38, 1.48), special educational needs (Odds ratio [OR] 9.60, 95% CI: 9.02, 10.23), achieve the lowest level of attainment (OR 3.43, 95% CI: 2.74, 4.29) be unemployed (OR 1.82, 95% CI: 1.60, 2.07), be admitted to hospital (Hazard Ratio [HR] 3.56, 95% CI: 3.42, 3.70), and die (HR 22.02, 95% CI: 17.00, 28.53). Absenteeism partly explained poorer attainment and higher unemployment. Girls and younger children on antiepileptic medication had higher risk of poor outcomes. CONCLUSIONS: Children on antiepileptic medication fare worse than peers across educational and health outcomes. In order to reduce school absenteeism and mitigate its effects, children with epilepsy should receive integrated care from a multidisciplinary team that spans education and healthcare.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/epidemiologia , Hospitalização/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Absenteísmo , Adolescente , Adulto , Criança , Bases de Dados Factuais , Prescrições de Medicamentos/estatística & dados numéricos , Escolaridade , Epilepsia/tratamento farmacológico , Feminino , Humanos , Masculino , Registro Médico Coordenado , Razão de Chances , Gravidez , Estudos Retrospectivos , Escócia/epidemiologia , Adulto Jovem
13.
J Neurol ; 266(8): 2018-2026, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31115678

RESUMO

BACKGROUND: Several studies have shown that when patients with functional neurological disorders are followed up, it is rare to find another neurological condition that better explains the initial symptoms in hindsight. No study has examined the reverse, studying patients with a range of neurological disease diagnoses with the aim of assessing how often a new diagnosis of functional disorder better explains the original symptoms. METHODS: A prospective multi-centre cohort study of 2637 new neurology outpatient referrals from primary care in Scotland. Neurologists provided initial diagnoses and a rating of the extent to which their symptoms were explained by an 'organic' neurological disease. Patients were followed up 19 months later with a questionnaire to their primary care physician asking about diagnostic change, and when indicated also by discussion with the original assessing neurologist and review of secondary care records. RESULTS: Valid responses were obtained for 2378 out of 2637 patients (90%) with symptoms 'largely' or 'completely' explained by organic disease at baseline. At follow-up, we found diagnostic errors in 48 patients. Of those, ten (0.4%) had a functional diagnosis and 38 patients (1.6%) had a different 'organic' diagnosis which better explained the original symptoms. CONCLUSIONS: Patients diagnosed with neurological disease sometimes have a functional diagnosis at follow-up which, with hindsight, better explains the original symptoms. This occurs at a frequency similar to the misdiagnosis of 'organic' neurological disease as functional disorder. Misdiagnosis can harm patients in either direction, especially as we enter an era of evidence-based treatment for functional neurological disorders.


Assuntos
Erros de Diagnóstico , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/epidemiologia , Neurologistas/normas , Adolescente , Adulto , Idoso , Estudos de Coortes , Erros de Diagnóstico/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neurologistas/tendências , Estudos Prospectivos , Escócia/epidemiologia , Adulto Jovem
14.
Mult Scler Relat Disord ; 32: 116-122, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31112929

RESUMO

AIMS: To explore the effect of latitude on incidence of multiple sclerosis (MS) in Scotland. METHODS: MS case data (2010-2015) was ascertained from the Scottish Multiple Sclerosis Register. Patient's postcode at diagnosis was linked to the Scottish Index of Multiple Deprivation (SIMD). Geographical data from SIMD was converted into latitude and longitude and patients were grouped by latitude band. A linear regression analysis was then performed. MS Cumulative Incidence was compared to population density calculated from SIMD. RESULTS: Latitude was associated with MS Incidence rate. Using a linear regression analysis (r2 = 0.22, p = 0.03), the data predicted an increase in the average MS Incidence of 1.31 cases/100,000 person years per increase in degree latitude. MS Cumulative Incidence rates rise with increasing northern latitude up until 59° north. CONCLUSIONS: We found an increasing incidence of MS with latitude without any relationship to population in Scotland. The reasons for this are likely to be multifactorial.


Assuntos
Mapeamento Geográfico , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/epidemiologia , Adulto , Feminino , Humanos , Incidência , Masculino , Fatores de Risco , Escócia/epidemiologia
15.
PLoS One ; 14(4): e0215180, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30973931

RESUMO

This study aimed to investigate the reproductive impact of a third- or fourth-degree tear in primigravid women. A retrospective population-based cohort study was conducted using data from Scottish Morbidity Records (SMR02). Primigravid women with a vaginal birth in Scotland from 1997 until 2010 were included. Exposure was third- or fourth-degree tear in the first pregnancy. The second pregnancy rate, interpregnancy interval and third- or fourth-degree tear in a second pregnancy were the primary outcomes. A nested case-control study was used to determine factors associated with repeat third- or fourth-degree tears in a second vaginal birth. Cox regression analysis and logistic regression were used to look for associations. Initial third- or fourth-degree tear occurred in 2.8% women (5174/182445). The percentage of third- or fourth-degree tears in first vaginal births increased from 1% in 1997 to 4.9% in 2010. There was no difference in having a second pregnancy (adjusted Odds Ratio (aOR) 0.98 (99%CI 0.89-1.09)) or the median interpregnancy interval to second pregnancy (adjusted Hazard Ratio (aHR) 1.01 (99%CI 0.95-1.08)) after an initial third- or fourth-degree tear. Women were over four times more likely to have a repeat injury in a subsequent vaginal birth (n = 149/333, aOR 4.68 (99% 3.52-6.23)) and were significantly more likely to have an elective caesarean section in their second pregnancy (n = 887/3333, 26.6%; 12.75 (11.29-14.40)). Increased maternal age and birthweight ≥4500g were risk factors for repeat injury. Third- and fourth-degree tears are increasing in Scotland. Women do not delay or avoid childbirth after initial third- or fourth-degree tear. However, women are more likely to have a repeat third- or fourth-degree tear or an elective caesarean section in the second pregnancy. Strategies to prevent third- or fourth-degree tears are needed.


Assuntos
Complicações do Trabalho de Parto/etiologia , Períneo/lesões , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Número de Gestações , Humanos , Lacerações/etiologia , Modelos Logísticos , Complicações do Trabalho de Parto/epidemiologia , Parto , Gravidez , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Fatores de Risco , Escócia/epidemiologia , Adulto Jovem
16.
Br J Surg ; 106(8): 1005-1011, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30993676

RESUMO

BACKGROUND: The WHO Surgical Safety Checklist has been implemented widely since its launch in 2008. It was introduced in Scotland as part of the Scottish Patient Safety Programme (SPSP) between 2008 and 2010, and is now integral to surgical practice. Its influence on outcomes, when analysed at a population level, remains unclear. METHODS: This was a population cohort study. All admissions to any acute hospital in Scotland between 2000 and 2014 were included. Standardized differences were used to estimate the balance of demographics over time, after which interrupted time-series (segmented regression) analyses were performed. Data were obtained from the Information Services Division, Scotland. RESULTS: There were 12 667 926 hospital admissions, of which 6 839 736 had a surgical procedure. Amongst the surgical cohort, the inpatient mortality rate in 2000 was 0·76 (95 per cent c.i. 0·68 to 0·84) per cent, and in 2014 it was 0·46 (0·42 to 0·50) per cent. The checklist was associated with a 36·6 (95 per cent c.i. -55·2 to -17·9) per cent relative reduction in mortality (P < 0·001). Mortality rates before implementation were decreasing by 0·003 (95 per cent c.i. -0·017 to +0·012) per cent per year; annual decreases of 0·069 (-0·092 to -0·046) per cent were seen during, and 0·019 (-0·038 to +0·001) per cent after, implementation. No such improvement trends were seen in the non-surgical cohort over this time frame. CONCLUSION: Since the implementation of the checklist, as part of an overall national safety strategy, there has been a reduction in perioperative mortality.


Assuntos
Lista de Checagem , Segurança do Paciente , Procedimentos Cirúrgicos Operatórios/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lista de Checagem/métodos , Criança , Pré-Escolar , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Assistência Perioperatória/normas , Escócia/epidemiologia , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas , Organização Mundial da Saúde , Adulto Jovem
17.
J Appl Res Intellect Disabil ; 32(4): 952-957, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30977260

RESUMO

BACKGROUND: Evidence suggests that people with learning disabilities are less likely to have an up-to-date eye examination as sight loss is characteristically underdiagnosed in people with complex needs. METHOD: A retrospective study of records from 576 Service Users of RNIB UK Vision, learning disability and Complex Needs Services was carried out. RESULTS: The record review found a higher prevalence of spectacle prescription in a learning disability (LD) population in agreement with findings from other LD studies. There was a higher prevalence of severe myopia in people with LD compared with a general adult population. CONCLUSION: This study found a higher prevalence of spectacle prescription in people with learning disabilities compared to a general adult population, which has implications for people with learning disabilities to ensure that they have access to eye care and regularly attended eye tests. It also has implications for healthcare professionals working with people with complex needs to ensure they have access to eye care.


Assuntos
Óculos/estatística & dados numéricos , Transtornos da Visão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , /reabilitação , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Escócia/epidemiologia , Transtornos da Visão/diagnóstico , Transtornos da Visão/epidemiologia , Transtornos da Visão/reabilitação , Adulto Jovem
18.
BMJ ; 365: l1161, 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30944092

RESUMO

OBJECTIVE: To quantify the effect on cervical disease at age 20 years of immunisation with bivalent human papillomavirus (HPV) vaccine at age 12-13 years. DESIGN: Retrospective population study, 1988-96. SETTING: National vaccination and cervical screening programmes in Scotland. PARTICIPANTS: 138 692 women born between 1 January 1988 and 5 June 1996 and who had a smear test result recorded at age 20. MAIN OUTCOME MEASURES: Effect of vaccination on cytology results and associated histological diagnoses from first year of screening (while aged 20), calculated using logistic regression. RESULTS: 138 692 records were retrieved. Compared with unvaccinated women born in 1988, vaccinated women born in 1995 and 1996 showed an 89% reduction (95% confidence interval 81% to 94%) in prevalent cervical intraepithelial neoplasia (CIN) grade 3 or worse (from 0.59% (0.48% to 0.71%) to 0.06% (0.04% to 0.11%)), an 88% reduction (83% to 92%) in CIN grade 2 or worse (from 1.44% (1.28% to 1.63%) to 0.17% (0.12% to 0.24%)), and a 79% reduction (69% to 86%) in CIN grade 1 (from 0.69% (0.58% to 0.63%) to 0.15% (0.10% to 0.21%)). Younger age at immunisation was associated with increasing vaccine effectiveness: 86% (75% to 92%) for CIN grade 3 or worse for women vaccinated at age 12-13 compared with 51% (28% to 66%) for women vaccinated at age 17. Evidence of herd protection against high grade cervical disease was found in unvaccinated girls in the 1995 and 1996 cohorts. CONCLUSIONS: Routine vaccination of girls aged 12-13 years with the bivalent HPV vaccine in Scotland has led to a dramatic reduction in preinvasive cervical disease. Evidence of clinically relevant herd protection is apparent in unvaccinated women. These data are consistent with the reduced prevalence of high risk HPV in Scotland. The bivalent vaccine is confirmed as being highly effective vaccine and should greatly reduce the incidence of cervical cancer. The findings will need to be considered by cervical cancer prevention programmes worldwide.


Assuntos
Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Vacinação , Neoplasia Intraepitelial Cervical/patologia , Diagnóstico Precoce , Feminino , Humanos , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/prevenção & controle , Prevalência , Estudos Retrospectivos , Escócia/epidemiologia , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia , Adulto Jovem
19.
Res Dev Disabil ; 89: 69-75, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30947106

RESUMO

BACKGROUND: International prevalence rates for intellectual disability vary widely with estimates often based on samples. In Ireland people with an intellectual disability are identified in the national census. Moreover, a national register of people receiving or requiring intellectual disability services is maintained and updated annually. AIMS: The prevalence rates from the census were contrasted with those from the register along with variations in prevalence across the 26 counties of Ireland. METHODS: 2011 and 2016 Census of Population prevalence per 1000 for children (aged 5-19 years) and adults (20 years and over) stratified by the 26 countries were contrasted with similar prevalence in the national register. Publically available data from the 2011 census in Northern Ireland and Scotland were obtained. RESULTS: The Irish census identified nearly twice as many children and adults than were on the national register. Prevalence rates also varied across the 26 counties; more so on the register than the census. The Irish census had lower prevalence rates than Northern Ireland but higher than Scotland. CONCLUSIONS: Determining the prevalence of intellectual disability is challenging due to variations in terminology. A national register has advantages over reliance on census data for service planning.


Assuntos
Deficiência Intelectual/epidemiologia , Adolescente , Censos , Criança , Comparação Transcultural , Humanos , Irlanda do Norte/epidemiologia , Prevalência , Sistema de Registros/estatística & dados numéricos , Escócia/epidemiologia
20.
Ann R Coll Surg Engl ; 101(5): 363-372, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30855976

RESUMO

INTRODUCTION: Necrotising fasciitis is a life-threatening rapidly progressing bacterial infection of the skin requiring prompt diagnosis and treatment. Optimum care warrants a combination of surgical debridement, antibiotics and intensive care support. All cases of necrotising fasciitis in 10 years in the North East of Scotland were reviewed to investigate and improve patient care. METHODS: Cases between August 2006 and February 2016 were reviewed using case notes and electronic hospital records. Data including mode of admission, clinical observations, investigations, operative interventions, microbiological and clinical outcomes was collected and reviewed. Analysis required multidisciplinary input including microbiology, infectious disease, trauma and orthopaedics, plastic surgery and intensive care teams. RESULTS: A total of 36 cases were identified. The mean laboratory risk indicator for necrotising fasciitis (LRINEC) score was 7 and 86% of patients fulfilled the criteria for necrotising fasciitis. Patients were commonly haemodynamically stable upon admission but deteriorated rapidly; 36% of patients had a temperature of over 37.5 degrees C on initial observations; 29/36 patients were discharged, 6 patients died acutely (acute mortality rate of 17%); 18/31 of cases were polymicrobial with Streptococcus pyogenes, the common organism. Six amputations or disarticulations were performed from a total of 82 operations in this group, with radical debridement the usual primary operation. The mean time to theatre was 3.54 hours. Highly elevated admission respiratory rate (50 breaths/minute) was associated with increased mortality. CONCLUSIONS: Necrotising fasciitis presents subtly and carries significant morbidity and mortality. A high index of suspicion allows early diagnosis and intervention. We believe that a pan-specialty approach is the cornerstone for good outcomes.


Assuntos
Fasciite Necrosante/epidemiologia , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Adulto , Idoso , Cuidados Críticos/métodos , Procedimentos Clínicos , Técnicas de Apoio para a Decisão , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/microbiologia , Fasciite Necrosante/terapia , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/terapia , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Escócia/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento
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