Scottish Adults Research Articles

The 'Walking for Wellbeing in the West' randomised controlled trial of a pedometer-based walking programme in combination with physical activity consultation with 12 month follow-up: rationale and study design

BackgroundScotland has a policy aimed at increasing physical activity levels in the population, but evidence on how to achieve this is still developing. Studies that focus on encouraging real world participants to start physical activity in their settings are needed. The Walking for Well-being in the West study was designed to assess the effectiveness of a pedometer-based walking programme in combination with physical activity consultation. The study was multi-disciplinary and based in the community. Walking for Well-being in the West investigated whether Scottish men and women, who were not achieving the current physical activity recommendation, increased and maintained walking behaviour over a 12 month period. This paper outlines the rationale and design of this innovative and pragmatic study.MethodsParticipants were randomised into two groups: Group 1: Intervention (pedometer-based walking programme combined with a series of physical activity consultations); Group 2: Waiting list control for 12 weeks (followed by minimal pedometer-based intervention). Physical activity (primary outcome) was measured using pedometer step counts (7 day) and the International Physical Activity Questionnaire (long version). Psychological processes were measured using questionnaires relating to the Transtheoretical Model of Behaviour Change, mood (Positive and Negative Affect Schedule) and quality of life (Euroqol EQ-5D instrument). Physiological measures included anthropometric and metabolic outcomes. Environmental influences were assessed subjectively (Neighbourhood Quality of Life Survey) and objectively (neighbourhood audit tool and GIS mapping). The qualitative evaluation employed observation, semi-structured interviews and focus groups. A supplementary study undertook an economic evaluation.DiscussionData analysis is on-going. Walking for Well-being in the West will demonstrate if a pedometer based walking programme, in combination with physical activity consultation results in a sustainable increase in walking behaviour in this sample of Scottish adults over a 12 month period. The study will examine the complex relationships between behavioural change, health consequences and the role of the environment, in conjunction with the cost effectiveness of this approach and a detailed insight into the participants' experiences of the intervention.Trial registrationCurrent Controlled Trials ISRCTN88907382

Why do people fail to turn good intentions into action? The role of executive control processes in the translation of healthy eating intentions into action in young Scottish adults

BackgroundDespite the significant health benefits associated with eating healthily, diet is extremely difficult to change, with the majority of people who intend to eat more healthily failing to do so. Recent evidence has suggested that the ability to turn intentions into actions may be related to individual differences in one facet of executive control – cognitive inhibition (i.e. the ability to inhibit irrelevant information and suppress prepotent responses). The present study investigates the role of this and other executive processes (inhibition, task switching, planning and cognitive flexibility) in the translation of dietary intentions into action. In addition, as the literature suggests that weak executive control may be associated with hyper-responsivity to cues to action, the role of executive processes in susceptibility to environmental food cues and responses to If-Then plans designed to cue intended behaviour are investigated.MethodsFuture intentions about consumption of fruits and vegetables and snack foods will be measured in a sample of young adults. Actual consumption of the target foods will be recorded with computerised diaries over a subsequent 3-day period. Performance on a battery of established executive control tasks (Go-NoGo, Tower task, Verbal Fluency task and Trail-Making) will be used to predict the discrepancy between intended and actual dietary behaviour. In addition, executive control scores will be used to predict reported susceptibility to environmental food cues and benefit derived from the use of 'If-Then plans' designed to cue intended behaviour.DiscussionOur findings will add to understanding about the role of executive control in translating intentions into actions and may demonstrate potential for future public health interventions. If participants with weak executive control are found to be less likely to eat as they intend than those with strong executive control, then interventions that reduce the load on these executive processes may increase chances of successful intention-behaviour translation. If those with weak executive control are found to be more responsive to cues to action they may also benefit more from the use of If-Then plans designed to cue intended behaviour.

T1284 Anti-TNF Antibodies Do Not Ameliorate Bowel Injury in a Model of Acute Bowel Damage Induced By PAF and in a Neonatal Rat Model of Necrotizing Enterocolitis

lished based on the WGO's Montreal Classification. Seven tag-SNPs (tag-single nucleotide polymorhisms) that described the majority of the haplotypes across the gene were genotyped. Allelic/Genotypic associations with single SNPs and haplotype associations with multipleSNPs were examined. Results A total of 270 CD cases, 336 controls, and 395 parents were studied. The mean age (±SD) of the cases was 12.0 (±3.5) yr. Most cases were male (56%), had ileo-colonic disease (40%) and an inflammatory phenotype (88%) at diagnosis. All the 7 SNPs were in Hardy-Weinberg Equilibrium. Single SNP analysis in case-control or caseparent analysis did not reveal any associations either at the allelic or at the genotypic level (all p-values >0.05). No overall haplotype association (omnibus p-value>0.05) or associations with individual haplotypes was evident in either the case-control or case-parent analysis. None of the SNPs were significantly associated with disease location or behavior at diagnosis. The study had >80% power to detect associations of magnitude 1.6 and above for most of the observed allele frequencies. Conclusions Our gene-wide analysis in a large cohort using both the case-control and case-parent designs does not support associations between the PXR gene and CD among Canadian children and confirm similar recent findings among Scottish adults.

Prognostic impact of pulmonary arterial hypertension: A population-based analysis

Background Although pulmonary arterial hypertension (PAH) is widely accepted as deadly, if not a rare disease, its prognostic impact beyond reports from specialist centres is unknown. Methods Using the unique Scottish Morbidity Record Scheme and linked survival data, we tracked the survival of all Scottish adults aged ≤ 65 years admitted for the first time during the period of 1986 to 2001 with a probable diagnosis of Idiopathic PAH and a PAH related to connective tissue disorders ( Connective PAH) and congenital abnormalities ( Congenital PAH) — the three most common forms of PAH. Results Overall, 374 Scottish men and women were discharged from the hospital with incident PAH during the period 1986 to 2001. On an unadjusted basis, Congenital PAH (40–45%) was associated with the lowest case fatality at 5 years in both men and women. In both sexes, Idiopathic PAH and Connective PAH were associated with high initial one-year case fatality (20–30%) with a steady accumulation of fatal events in the four years thereafter (60–75% case fatality at 5 years). Overall, the adjusted risk of dying within one year in the period 1986 to 1989 was 2.22-fold greater (OR 95% CI, 1.27 to 3.85) than in 1998 to 2001 ( P < 0.001). The greatest falls in one year case fatality were seen in those with Connective PAH (18-fold increased risk of dying in 1986 to 1989 versus 1998 to 2001: P = 0.013). Similarly, women (adjusted OR 1.38, 95% CI 1.16 to 1.63: P < 0.001) and the most deprived individuals (OR 2.38, 95% CI 1.17 to 4.82: P < 0.05) were at greater risk of dying within 5 years. Alternatively, those patients discharged in 1997 were less likely to die during this period compared to their 1986 counterparts, although this difference did not quite reach statistical significance (OR 0.45, 95% CI 0.22 to 1.06: P = 0.056). Conclusion This population-based study has confirmed the deadly impact of the three most common forms of PAH. Overall, there are encouraging trends in relation to one and five year adjusted survival rates; particularly in relation to PAH related to connective tissue disorders.

Area deprivation and oral health in Scottish adults: a multilevel study

To explore the association between area deprivation and adult oral health. Multilevel regression analysis of data taken from the 1998 Adult Dental Health Survey in the UK comprising 632 participants living in 346 households located in 31 postcode sectors in Scotland. Three oral health outcomes were investigated: number of sound (including restored) teeth; has one or more unsound teeth; has periodontal pocketing 4 mm or more in one or more teeth. In the most deprived areas, individuals had a mean of 4.6 fewer sound teeth than those in the least deprived areas. The difference in normalised number of sound teeth between least and most deprived areas was -0.707 (95% CI -1.164, -0.250), P = 0.024. After adjusting for age, sex, qualification status, head of household social class and household income, the estimated difference was -0.238 (-0.591 to 0.115) (P = 0.164). Area deprivation was not associated with having one or more unsound teeth or periodontal pocketing 4 mm or more in one or more teeth. There is a univariate association of area deprivation with the number of sound teeth. This association is largely explained by household and individual level socioeconomic variables. A small area deprivation effect cannot be excluded in these data. The findings challenge current understanding of the relationship between area deprivation and oral health. Further multilevel research exploring the relationship between area deprivation and oral health is required using a larger sample and a prospective longitudinal design.

Challenges in obesity epidemiology

This paper was commissioned by the Foresight programme of the Office of Science and Innovation, Department of Trade and Industry © 2007 Queen’s Printer and Controller of HMSO; published with permission Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 8 (Suppl. 1) , 1–11 1 obesity reviews (2007) 8 (Suppl. 1) , 1–11 OnlineOpen: This article is available free online at www.blackwell-synergy.com Blackwell Publishing LtdOxford, UKOBRObesity Reviews1467-7881© 2007 Queen’s Printer and Controller of HMSO; published with permission; Journal compilation © 2007 The International Association for the Study of Obesity ? 20078 ••111Review Article Challenges in obesity epidemiology D. Canoy & I. Buchan

The relationship between NHS patient charges and the uptake of dental examinations by Scottish adults 1982-1998

The aim of this study was to determine if increasing cost to the patient of an NHS dental examination was associated with a change in the uptake of dental examinations by Scottish adults aged 18 years and over. The null hypothesis was that there was no significant difference (a = 0.05) in the number of NHS dental examinations taken up by Scottish adults with increase in cost to the patient. Data for this retrospective study of cost and dental attendance between 1982-1998 was collected from the British Dental Association and Scottish Dental Practice Division. The number of examinations per month per dentist was calculated for the years 1982-1998 as an indicator of dental attendance. The reported number of NHS dental examinations increased by 34% between 1982 and 1998 from 1,564,330 to 2,099,944. However the reported number of general dental practitioners working in the NHS in Scotland increased by 48% from 1362 to 2012. The number of examinations per month per dentist decreased from 95.71 in 1982 to 86.98 in 1998. There was a significant (p = 0.001) reduction of 7.6% in the number of examinations per month per dentist after the introduction of charges. However within the charged data, while there is still a reduction, it was not significant. Other cost related factors may be influencing dental attendance and should be considered.

Effects of added fruits and vegetables on dietary intakes and body weight in Scottish adults

An increased consumption of fruits and vegetables (F&V) has been suggested as a way to limit, or even lower, energy and fat intakes. The present study examined the effects of incorporating F&V supplements into the diets of adults who reported consuming <240 g (three portions) of F&V per d on energy and fat intakes, and change in body weight, over 8 weeks using a randomised parallel design. Thirty-four males and twenty-eight females (age 42.6 (sd 11.1) years, BMI 23.7 (sd 2.7) kg/m(2)) were each provided with supplements of 0, 300 or 600 g F&V per d. Food, nutrient and energy intakes were measured before, during and at the end of the supplementation period using 7 d weighed records. Mean daily energy intakes were not different among the three groups before (P = 0.151) or during the supplementation periods (P = 0.407), although changes in energy intakes over the study period tended to be more positive with increasing amounts of F&V supplements (P = 0.078). There was no difference in changes of body weights during the study (P = 0.242). Carbohydrate (P < 0.001), sugar (P < 0.001), fibre (P < 0.001) and weight of food consumed (P = 0.022) increased in the treatment groups. There were no significant differences, or changes, in fat intakes among the three groups. Consumption of mandatory F&V supplements for 8 weeks produced beneficial changes in diet composition, but did not result in lower reported energy or fat intakes, and did not result in loss of body weight.

Childhood IQ and social factors on smoking behaviour, lung function and smoking‐related outcomes in adulthood: Linking the Scottish Mental Survey 1932 and the Midspan studies

To investigate the associations of childhood IQ and adult social factors, and smoking behaviour, lung function (forced expiratory volume in one second; FEV(1)), and smoking-related outcomes in adulthood. Retrospective cohort study. Participants were from the Midspan prospective studies conducted on Scottish adults in the 1970s. The sample consisted of 938 Midspan participants born in 1921 who were successfully matched with their cognitive ability test results on the Scottish Mental Survey 1932. Structural equation modelling showed that age 11 IQ was not directly associated with smoking consumption, but that IQ and adult social class had indirect effects on smoking consumption via deprivation category. The influence of IQ on FEV(1) was partly indirect via social class. Gender influenced smoking consumption and also IQ and social class. There was a 21% higher risk of having a smoking-related hospital admission, cancer, or death during 25 years of follow-up for each standard deviation disadvantage in IQ. Adjustment for adult social class, deprivation category, and smoking reduced the association to 10%. Childhood IQ was associated with social factors which influenced lung function in adulthood, but was not associated directly with smoking consumption. In future studies, it is important to consider other pathways which may account for variance in the link between childhood IQ and health in later life.

Distribution of Apolipoprotein E Alleles in a Scottish Healthy Newborn Population

The different alleles of the human apolipoprotein E polymorphism, ApoE Ε2, Ε3, Ε4, have important implications for systemic lipid metabolism, immunological function and for the brain in maintenance and in response to injury. Few studies have focussed on their role in early life. The ApoE alleles and genotypes were ascertained in the cord blood of 371 full-term and normal Scottish newborn infants using PCR methodology. The results were compared to previously published data for Scottish adults in late middle age. There was a marginally significant over-representation of Ε4 and under-representation of Ε3 alleles in healthy infants as compared with adults. Inspection of the individual genotypes confirms the over-representation of ApoE 4/4 and 2/4 with a reduction in ApoE 2/3 and 3/3 when compared with Scottish adults. Although these results may have occurred by chance, the ApoE Ε4 allele may confer an increased risk of premature death.

Prevalence of vitamin D inadequacy in Scottish adults with non-vertebral fragility fractures

ABSTRACTBackground: It is well established that vitamin D levels are sub-optimal in the elderly and that adults with fragility fracture are more likely to have serum vitamin D levels either lower than those of control patients of similar age, or below the normal range.Objectives: To investigate the prevalence of vitamin D inadequacy in an elderly population presenting to the South Glasgow Fracture Liaison Service with non-vertebral fragility fractures in order to assess the extent of the problem.Research design and methods: The retrospective arm of this study used data from an established database to identify patients aged over 50 years admitted to South Glasgow University Hospitals over the previous 4 years with hip fracture. The prospective arm identified the first 50 patients aged over 50 presenting with a clinical non-vertebral fragility fracture with osteoporosis as measured by axial spine and/or hip DEXA (T‐score < –2.5) after November 2004.Results: In the retrospective arm, 626 patients were identified from the database: mean age 80.5 years; 94% were aged over 60 and 74% were aged over 75. Data analysis was limited to 548 patients aged over 60 years with vitamin D recordings and not receiving supplementation with calcium and vitamin D. The mean vitamin D level was 24.7 nmol/L (9.9 ng/ml) SD = 17, however, it is likely that the true mean is lower since in approximately 25% of cases vitamin D levels were reported as < 15 nmol/L (effectively unrecordable). These were transcribed as 15 nmol/L in order to permit a numerical value to be calculated. In the absence of an agreement on what should constitute a diagnostic serum level of vitamin D inadequacy, a number of thresholds were considered – 97.8% had vitamin D levels below 70 nmol/L and 91.6% had vitamin D levels below 50 nmol/L. There were no significant differences by patient sex, age or season of presentation.The mean age of patients in the prospective arm was 65.8 years (range 50.6–83.8), 72% were aged over 60 and 16% were aged over 75. The mean vitamin D level was 44.1 nmol/L (18.4 ng/ml) SD = 25.3; 82% had vitamin D levels below 70 nmol/L and 72% had vitamin D levels below 50 nmol/L. Although numbers were too small to justify extensive subgroup analyses, the mean vitamin D level in the 13 patients with hip fracture (34.5 nmol/L) was lower than in the 37 with non-hip fractures (48.2 nmol/L).Conclusions: This study confirms almost universal vitamin D inadequacy among 548 elderly patients admitted to hospital with hip fracture, regardless of whether a threshold of 50 nmol/L or 70 nmol/L was used. However, among a prospective subset of 50 patients with clinical fragility fractures, especially those with non-hip fractures, the prevalence of inadequacy was substantially lower. It may be that vitamin D represents a correctable risk factor for fragility fracture in the elderly, possibly specifically for the hip.

Lipid levels and the use of lipid-lowering agents in England and Scotland

Preventing cardiovascular events with lipid-lowering drugs has been established in several trials reported since 1994. Consequently national guidelines recommend statins for those with established cardiovascular disease (CVD) and those at high risk of developing CVD. We evaluated blood lipid levels, and compare treatment and control of dyslipidaemia in English and Scottish adults with national recommendations for lipid lowering. In 1998 the nationally-representative Health Survey for England and the Scottish Health Survey included valid cholesterol results for 9631 (England) and 6065 (Scotland) adults aged 16-74. Mean blood levels of total, high-density lipoproteins (HDL-), and total:HDL-cholesterol ratio; prevalence of elevated total cholesterol levels, and total:HDL-cholesterol ratios; prevalence of use of lipid-lowering agents in high risk subgroups; and lipid levels of those on treatment were calculated. Levels of dyslipidaemia, treatment and control were not significantly different between Scotland and England. Combining these data, mean total cholesterol levels were 5.43 and 5.48 mmol/l in men and women respectively; and mean HDL-cholesterol levels were 1.29 and 1.56 mmol/l. Overall 64.6% of adults had a total cholesterol > or =5 mmol/l, 24.6% had a total:HDL ratio > or =5 and 2.3% reported taking lipid-lowering drugs. Treatment rates among those with a total cholesterol >5 mmol/l and a history of coronary heart disease or stroke, hypertension, or diabetes, were 27.3%, 15.4% and 17.8% respectively, and control rates (total cholesterol <5 mmol/l) among those treated were 45.3%, 38.5% and 32.7%. Low treatment rates with lipid-lowering drugs existed overall, among high-risk patients suitable for primary prevention, and among those with established cardiovascular disease.

Positive Emotional Experiences in Scottish and Italian Young Adults: a Diary Study

This research focused on the nature and frequency of positive emotion in a sample of Scottish and Italian young adults and is part of larger scale on-going cross-cultural studies on positive emotion, well-being and happiness. A total of 1043 positive incidents were collected from 157 students who completed diaries in the two countries. Positive incidents were frequent in the course of daily life and were triggered by a wide variety of personal, social and environmental antecedents. Although each culture had a very similar life-satisfaction rating some cultural differences in the phenomenology of positive incidents and their emotions still emerged. As hypothesised Italian and Scottish cultures differed in the domain of independence and interdependence. Italians reported more social interactions involving talking with another and intimacy with a significant other. The Scots, in contrast, reported positive feelings associated with relaxation and being alone as frequently as other social categories, thus exemplifying independence. Recording positive incidents, as they occur moment to moment deconstructs the global and retrospective study of subjective well-being and happiness and fulfills the necessity for ecologically valid research.

Neisseria meningitidis, Neisseria lactamica and Moraxella catarrhalis share cross-reactive carbohydrate antigens

Carriage of commensal bacteria species is associated with the development of natural immunity to meningococcal disease, with lipo-oligosaccharides (LOS) of meningococci being one of the main virulence factors associated with severity of meningococcal disease. Meningococcal reference strains and isolates from the commensal species Neisseria lactamica and Moraxella catarrhalis were assessed for the presence of cross-reactive glycoconjugate antigens. Binding of human blood group antibodies of the P and Ii system to meningococcal immunotype reference strains were in accordance with the presence of known LOS carbohydrate structures. Binding studies with meningococcal immunotyping antibodies and blood group phenotyping antibodies to N. lactamica strains from different European countries showed, that a greater number of isolates obtained from native Greek and Scottish adults and children bound anti-meningococcal L(3, 7, 9) immunotyping ( P<0.001), p K ( P=0.035) and paragloboside ( P<0.001) blood group typing antibodies compared to isolates obtained from children of Russian immigrants in Greece. A greater number of M. catarrhalis strains isolated from children in Scotland bound anti-L(3, 7, 9) antibodies (38.2%) compared to strains isolated from adults (22.2%) ( P=0.017). These findings provide evidence that blood group like glycoconjugate antigens found on the commensal species N. lactamica and M. catarrhalis might be involved in the development of natural immunity to meningococcal endotoxins during childhood, and might be exploited as anti-meningococcal vaccine candidates.

Residents and Residence: Factors Predicting the Health Disadvantage of Social Renters Compared to Owner‐Occupiers

Numerous studies have found that owner‐occupiers live longer and stay healthier than renters. Epidemiologists often view housing tenure as a proxy for economic circumstances rather than as having directly health‐promoting or damaging effects. Housing researchers, on the other hand, have tended to study physical and psychosocial aspects of housing that might directly impact upon health. Linking these two literatures, we analyzed nearly 3,000 postal questionnaires from a stratified random sample of Scottish adults. In particular, we examined differences between owners and social renters that might explain observed tenure differences in health. Personal characteristics explained much of the difference between owners and social renters, but some dwelling and neighborhood characteristics also played a role.

Nutrition and respiratory health in adults: findings from the health survey for Scotland.

There is a growing body of evidence to support the hypothesised links between consumption of antioxidant rich foods and the occurrence of obstructive airway disease. The main research question was to examine the relationships between two types of dietary exposure and two indicators of respiratory morbidity in Scottish adults. The relationships between dietary consumption of fruit, vegetables and fish, and plasma levels of vitamins A, C, E and beta-carotene, and pulmonary function (forced expiratory volume in one second (FEV1)) and symptoms (phlegm production and shortness of breath with wheezing), were examined in a random population sample of adults. A dose/response relationship was found between fruit consumption and pulmonary function. In comparison with eating fruit rarely or never, eating fruit at least once per day, 1-6 times per week, and 1-3 times per month were associated with differences of 132, 100 and 63 mL in FEV1, after adjustment for known confounders and dietary intake of vegetables and fish (n=6186). An SD score change in plasma vitamin C was associated with a 49 mL difference in FEV1 (n=930). Fruit and vitamin E were associated with a reduced prevalence of phlegm production for 3 months or more per year. The most beneficial combination of dietary components may be found in natural foodstuffs, particularly fresh fruit.

Refractive errors and visual impairment in 900 adults with intellectual disabilities in the Netherlands.

To collect data on refractive errors and visual impairment in adults with an intellectual disability (ID) in the Netherlands. A randomized sample of 2100 participants was drawn from a base population of 9000 adults with intellectual disabilities in the Netherlands. This article reports on the first 900 participants. All participants underwent a protocol-based on-site ophthalmological assessment carried out by skilled investigators. Co-operation was classified according to the number of tests that could be carried out reliably and was good or excellent in 80% of subjects, average in 13% and poor in 7%. Refraction could be reliably assessed in 505/900 (56%) subjects. There was an increased risk of visual impairment in all subgroups compared to the general Dutch population. Visual acuity (VA) was related to the level of ID, but refractive errors were not. New spectacles were prescribed in 106 cases (12%). Of 374 people in whom both monocular VA and the refractive error of the right eye could be reliably assessed, 153 (41%) had a pretest prescription, 16 (10%) of which we found to be inadequate. Of the 221 participants without a pretest prescription, 41 (19%) benefited from correction. Only 38/84 (45%) subjects aged 50 years or older, who could benefit from correction for near vision, had near spectacles. New correction increased the mean distant VA significantly from 0.44 to 0.65 (p < 0.0005). With some adaptations, visual screening is feasible in a majority of adults with ID. Visual impairment and refractive errors are much more prevalent in adults with ID than in the normal population. Accurate spectacle correction resulted in significant improvement in distant VA.

Colonic diverticula.

Diverticulosis is a condition that is associated with ageing. The older the individual the more likely they are to have diverticulosis, but this process is not necessarily inevitable. Diverticula are a herniation through the wall of the sigmoid colon and are likely to be a consequence of a weakness in the colonic wall or prolonged exposure to increased intracolonic pressure consequent on a low dietary fibre intake. The tensile strength of the colon declines with age and becomes least in the distal colon. Adult Africans living in Africa eat a high-fibre diet and are free from diverticulosis. Their colons are stronger, wider and thinner than those Scottish adults of the same age. The strength of the colon is in part dependent on collagen fibres and their diameter. The collagen fibrils on the left side of the colon are smaller and more tightly packed than those of the right side of the colon. Ageing and the presence of colonic diverticulosis are associated with smaller more-tightly-packed collagen fibrils. An animal model was established to investigate the effect of a lifelong high- and low-fibre diet on the development of colonic diverticulosis. The findings show that a high-fibre diet from birth, and preferably a maternal high-fibre diet, lessen the risk of diverticulosis with age.

Accuracy of the estimated prevalence of obesity from self reported height and weight in an adult Scottish population

STUDY OBJECTIVETo determine whether self reported heights and weights from Scottish adults can provide an accurate assessment of obesity prevalence in the population.DESIGNStandardised clinic measurements of weight and height were...

A longitudinal study of the dental care of adults in the general dental service in Scotland: the first 6 years, 1988-1994.

To provide an overview of routine dental care for adults attending the general dental service in Scotland, in a more detailed manner than is currently possible from national data sets. Cohort study in the general dental service. The cohort consisted of 992 Scottish dentate adults who participated in the adult dental health survey of 1988, conducted by the Office of Population Censuses and Surveys. Details of subsequent treatment undertaken in the general dental service were provided by Dental Practice Division, Edinburgh. Production of patient-specific and tooth-specific data on dental attendance and treatment. 71% of the cohort attended at least once in the 6 years. Registration levels, following the introduction of the continuing care contract, reached 42-44%. Observed lapses in registration illustrate the changing membership of the relatively static level of registration year-on-year. Vulnerability to treatment of different tooth sites is illustrated graphically. Cohort studies provide valuable information on patterns of attendance and treatment needed for planning of dental health services. Growing computer power and increasing demands for management data may mean that future work of this nature can be more appropriately undertaken at the population level.