Scottish Regions Research Articles

Increased Level of Linkage Disequilibrium in Rural Compared with Urban Communities: A Factor to Consider in Association-Study Design

Few studies have investigated genetic differentiation within nonisolate European populations, despite the initiation of large national sample collections such as U.K. Biobank. Here, we used short tandem repeat markers to explore fine-scale genetic structure and to examine the extent of linkage disequilibrium (LD) within national subpopulations. We studied 955 unrelated individuals of local ancestry from nine Scottish rural regions and the urban center of Edinburgh, as well as 96 unrelated individuals from the general U.K. population. Despite little overall differentiation on the basis of allele frequencies, there were clear differences among subpopulations in the extent of pairwise LD, measured between a subset of X-linked markers, that reflected presumed differences in the depths of the underlying genealogies within these subpopulations. Therefore, there are strategic advantages in studying rural subpopulations, in terms of increased power and reduced cost, that are lost by sampling across regions or within urban populations. Similar rural-urban contrasts are likely to exist in many other populations with stable rural subpopulations, which could influence the design of genetic association studies and national biobank data collections.

The effectiveness of quality improvement tools: joint working in integrated community teams

To explore the effectiveness of integrated care pathways in facilitating integration in community-based teams. Case comparison of models of integrated care pathways in two different settings: community mental health teams in one Scottish region and care of the elderly rapid response teams in three Scottish regions. In both settings, an integrated care pathway was used as a tool for integration, but in different ways. Comparison is made by first identifying key factors structuring team-work in both settings, then analysing how the constellation of these factors results in different dynamics of team-work in each setting. The pathway tool used in each setting is then outlined and an analysis presented of how the tool interacts with the organizational dynamics in and around the teams to produce observed outcomes in each setting. In both settings impact of tool was shaped by the same organizational dynamics which produced the nature of team-work. In neither setting was the tool optimally effective in improving integration. In community mental health teams a prescriptive, management-driven integrated care pathway was introduced. This presumed a degree of task sharing in teams which was absent. It was resisted by the teams. In rapid response teams a flexible, team-driven pathway tool was being introduced to help teams conceptualize and communicate about the service. This approach fitted with autonomy and task sharing in rapid response teams and uptake was good. However, management did not engage. The effectiveness of the tool in both settings requires attention to organizational context.

Socioeconomic status, cardiovascular risk factors and the incidence of microvascular and macrovascular disease in type 1 diabetes

This study was undertaken to explore the associations between socioeconomic deprivation, prevalent cardiovascular risk factors and the development of microvascular and macrovascular complications in a cohort of subjects with type 1 diabetes mellitus in Scotland. We identified 2,314 people with type 1 diabetes from clinic records in six Scottish regions from 1989 to 1996. Postcode sectors were used to determine the Carstairs Index as a proxy for socioeconomic status. Clinic records and linkage to Scottish morbidity records allowed the association of socioeconomic status with the development of microvascular and macrovascular disease and the prevalence of cardiovascular risk factors to be evaluated. There was no overall association between prevalence of disease and socioeconomic status. There was a significant univariate relationship between smoking and deprivation (trend test p<0.0 D 0001; 47% of the most deprived were current smokers compared to 25% of the least deprived). Multivariate analysis showed that raised blood pressure, increasing age, smoking, high glycated haemoglobin and albuminuria were all independently associated with the development of macrovascular disease. Raised blood pressure, increasing duration of diabetes and high glycated haemoglobin were independently associated with microvascular disease. No associations were observed between either medical problem and socioeconomic status either before or after adjustment for other factors. Our study concluded that social deprivation is associated with an increased risk of smoking. Our results did not confirm a tendency to poor glycaemic or blood pressure control in people who are deprived and there was no association between deprivation and incident microvascular or macrovascular disease.

ストックとしての『環境資産』の再評価 スコットランドのストラクチャープランにみる環境を評価する視点と計画化の手法

This study clarified the meanings and the planning method of environment in the latest Structure Plans of major four Scottish city regions: Glasgow and the Clyde Valley, Edinburgh and the Lothian, Dundee and Angus, and Aberdeen and Aberdeenshire, which keep rich natural and built heritages. As a result, it was confirmed that the Scottish Structure Plan is one of statutory frameworks for supporting the rich environmental assets because of the following reasons. 1) Planning philosophy: the importance of the policies related to environment, and the plan as means to lead good developments that contribute toward changing environmental resources into environmental assets. 2) Planning method that is supporting 1): the importance of the plan context (clear SP's rolls and responsibilities), and specifying the basic conditions that enable to change environmental resources into environmental assets by the practical policies and key diagram which prepare concrete reasons and assessment criteria for development control.

Rehabilitation and development after childhood cancer: can the need for physical exercise be met?

Clinical and experimental evidence attests to the neurological and psychological benefits of physical exercise. Prescribing exercise for children after cancer has the potential to facilitate recovery, performance and development, with consequent improvement in quality of life and long-term outcome. However, could a school take up the prescription for a child's individual exercise programme? As a preliminary to an intervention study, all primary and secondary schools in two Scottish regions were surveyed. The aim was to evaluate the utility of prescribing exercise as part of a child's individual rehabilitation plan and to investigate awareness in schools of the potential benefits of exercise for cognition and behaviour. Approximately half the respondents indicated that extra physical exercise sessions could be incorporated into the school day. The main difficulties preventing such inclusion were identified as a lack of staff for supervision and timetabling problems. However, there was also a high level (>70%) of lack of information about what a child could be expected to do after cancer. Further, more respondents (approximately 60%) anticipated benefits of exercise for social development than for academic progress (approximately 35%). These results emphasize the necessity of clear and specific liaison with a school when planning and implementing a child's long-term rehabilitation programme.

Fetomaternal alloimmune thrombocytopenia

Thrombocytopenia is the second commonest haematological abnormality in the neonatal period after anaemia due to iatrogenic blood letting. One to four percent of all newborn babies have a platelet count <150×10 9/l at birth and approximately 20–40% of neonates in intensive care units are affected by neonatal thrombocytopenia. The most common cause of severe neonatal thrombocytopenia is fetomaternal platelet incompatibility and subsequent alloimmunisation. During the last decade recent advances in molecular techniques have led to rapid and efficient methods for diagnosis. Progress in fetal medicine has enabled accurate determination of fetal status, allowing improvements in fetal diagnosis and therapy. Human platelet antigen (HPA)-1a is by far the most frequently involved platelet antigen system in Caucasians accounting for 90% of cases, followed at a much lower frequency by HPA-5b (5–15%) and HPA-3a. The incidence is estimated to be 1 per 2000 to 1 per 5000 live births, but this is low in comparison to the incidence of fetomaternal platelet antigen incompatibility especially for the HPA-1 alloantigen system in the Caucasian population in whom the estimated frequency of HPA-1b1b individuals is 2%. Retrospective and prospective studies have reported that the immunogenetic background is important, and the chance of HPA-1a alloimmunisation is strongly associated with maternal HLA class II DRB3 ∗ 0101 (DR52a) type. A significant association ( p=0.004) between severe thrombocytopenia and a third trimester antiHPA titre >1:32 has been observed. It is now possible to genotype the fetus or neonate and the parents, which provides confirmation as to which HPA systems are incompatible between the mother and father. Simultaneous genotyping of HPA-1, 2, 3 and 5 can be carried out using the polymerase chain reaction–sequence specific primers (PCR–SSP) protocol, which has been widely used for HLA class II determination. The platelet count may continue to fall during the first 48 h after birth and the risk of intracranial bleeding is highest during this period. The best option is transfusion of specially selected antigen negative compatible donor platelets or if unavailable, maternal washed platelets. Antenatal screening for the most common form of fetomaternal alloimmune thrombocytopenia (FMAIT), due to antiHPA-1a is under consideration, but there is no established method at present. The Scottish National Blood Transfusion Service started a study in August 1999 on 25,000 pregnancies to carry out a cost benefit analysis of routine antenatal screening. The aims of the study are to determine the frequency of HPA-1b homozygosity; monitor antibody titres during pregnancy and confirm correlation of antibody emergence with HLA-DRB3 ∗ 0101, and finally to access cost effectiveness of routine screening across Scotland. Of 26,509 women screened in three Scottish regions 501 (1.9%) are HPA-1b homozygous and about 9% of the consented women are antibody positive.

Large-scale HPA-1 epidemiological study in scotland: an up-date

Neonatal alloimmune thrombocytopenia (NAIT) in the Caucasian population is mainly due to a mismatch in the HPA-1 marker between mother and foetus. About 10% of pregnant HPA-1b women develop anti-HPA-1a antibodies (ab) which may lead to NAIT with possible intracranial haemorrhage and death or life long morbidity. The ab development is significantly correlated with HLA-DRB3*0101. Although the frequency of homozygous HPA-1b varies between 1·5 and 4·5%, the frequency of HPA-1 NAIT detection in our laboratories was very low suggesting either that the epidemiology was different in Scotland or that the disease was being under-reported. In August 1999 we began a two year study of HPA-1 NAIT involving 25 000 pregnant women in Scotland. The aim of the study is to determine the frequency of HPA-1b homozygosity, monitor ab levels during pregnancy, and assess the cost effectiveness of routine screening across Scotland. The HPA-1 antigen and antibody assays consist of internationally validated ELISAs (Bessos et al. Transfusion, 38, 73S, 1998). The laboratory and clinical data are being collated using a Microsoft Access database. Of 11,500women screened to date in 3 Scottish regions, 216 are HPA-1b homozygous (1·9%): 136/6841(2%) in Edinburgh; 67/3973 (1·69%) in Aberdeen; and 13/686 (1·9%) in Glasgow. So far, 11/145 (about 8%) consented HPA-1b women are ab positive, with ab titres ranging from 1 : 2 to 1 : 256, but staying low or decreasing during pregnancy. Two have had previously affected babies and are being managed according to current guidelines. One woman with no previously affected children but with an ab titre declining from 1 : 256 to 1 : 32 during pregnancy, delivered recently a severely thrombocytopenic baby whose platelet counts rose to 137 × 109/L 3 days later. The mother's ab titre two weeks postdelivery rose back to 1 : 128. Due to observed interregional differences, our results caution prudence in the interpretation of regional vs. national epidemiological studies. Moreover, the overall HPA-1b frequency in Scotland appears to be considerably higher than earlier indications, suggesting that NAIT may be under-reported.

Neglect of growth and development in the clinical monitoring of children and teenagers with inflammatory bowel disease: review of case records

Failure of growth and retarded sexual development are serious and common problems in children and teenagers with inflammatory bowel disease, particularly Crohn's disease. Thus height, weight, sexual staging, and bone...

Eighteenth-Century Mexican Peonage and the Problem of Credits to Hacienda Labourers

The transition to modern, capitalist agriculture is usually marked by the replacement of traditional forms of farm service by a free labour market based on short-term contracts and cash payments. This process is often described in terms like ‘pauperisation’ and ‘proletarianisation’. But, of course, proletarianisation is not an inevitable consequence of the rise of day-labouring in capitalist agriculture; a point emphasized, for example, with particular reference to eighteenth-century Scotland by Alex Gibson and Alastair Orr. Contrary to much of southern England, where the forces of production developed rather fast, in Scotland traditional forms of farm service survived largely intact well into the nineteenth century despite the development of capitalist agriculture. As late as 1861 over 60 per cent of the total agricultural work-force in some Scottish regions were servants on long hires as opposed to day-labourers.

THE IMPACT OF FUNDHOLDING ON PRIMARY HEALTH CARE: ACCOUNTS FROM SCOTTISH GPS

At the inception of the internal market in health care GP fundholding was seen rather as a ‘sidesho’ to the main reforms. But as the reforms have worked through, GP fundholding has emerged as pivotal to the purchaserlprovider agenda and the changes now associated with GP fundholding will be major issues in directing future health care policy initiatives. Drawing on empirical data from three Scottish regions, this paper argues that fundholding is now significant because GPs perceive benefits for primary health care. The paper uses the data collected from the case studies in the regions to assess these gains on two levels: the ‘micro’ impact of fundholding on primary health care processes and the ‘macro’ issues raised for health care policy by involving GPs more closely in resource management. Some GPs wish to use resource management as a vehicle for enhancing equity within the NHS, others are more concerned to manage resources so as to expand their practices into sites which combine primary, secondary and community health care, still others envisage developing the market to include monetary rewards for ‘efficient’ practices.

Study on medical donor deferrals at sessions.

A 10-month audit of reasons for donor medical deferral at sessions was carried out in two Scottish regions of the SNBTS. Six thousand deferred donors were assessed. Although the deferred donor population mirrored the attending donor population in both regions, significantly more donors, both new and regular, were deferred in the Edinburgh and South East region, compared with the North East. The main differences in deferral were attributable to three clinical conditions (cervical carcinoma in situ, other gynaecological conditions and hypertension) and to donors admitting to high-risk behaviour. Although the staff in the deferral process - doctors, nurses and clerks - were involved in roughly equal proportions in both regions, the spectrum of medical conditions seen by each staff grouping appeared to be different in each region. The staff in the South East appeared to have made more correct decisions. Further analysis and audits are being undertaken in areas highlighted by this study.

Epidemiology of presenile Alzheimer's disease in Scotland (1974-88) I. non-random geographical variation.

Factors that determine geographical differences in incidence rates of 'probable' presenile Alzheimer's disease (AD PSD) may help to clarify the possible role of the environment in its aetiology. We have ascertained the treated incidence of AD PSD in Scotland by scrutiny of hospital cassenotes and searched for cases outside hospital settings. Small area geographical analysis compared the observed distribution of cases (each allocated to one of Scotland's 898 postcode sectors) with the estimated random distribution of cases. There was non-random geographical distribution of AD PSD but not of the comparison conditions (vascular dementia (VaD), motor neurone disease, prostatic or ovarian cancers). Substantial differences between Scottish regions were probably not attributable to methodological artefact, as other techniques of case finding showed the same regional differences. The observed differences in incidence of AD PSD between Scotland's regions are real and some localities have a higher incidence, mostly in central Scotland.

The role of the speech and language therapist in the education of children with special educational needs

ABSTRACT An overall aim of the study is to identify effective forms of collaboration between speech and language therapists, teachers and parents in Scotland. The study seeks to define and clarify the roles and responsibilities of speech and language therapists, teaching staff and parents in facilitating the development of speech, language and communication in children and young people with language and communication difficulties. In particular, the contribution of speech and language therapists to educational programmes is investigated. The focus is on children with significant levels of need but not exclusively those with a Record of Needs. The project employs both quantitative and qualitative methods. Visits have been made to a variety of educational locations and in‐depth interviews were carried out with speech and language therapists and teaching staff. National surveys were conducted through postal questionnaires to speech and language therapists, speech and language therapy managers, teachers, advisers in special educational needs, educational psychologists, and parents. Different questionnaires were designed to elicit information specific to each group. Questionnaire returns were received from: 381 (&gt;80%) of speech and language therapists with children on their caseload; 41 speech and language therapy managers (two outstanding); over 800 teachers from 415 schools (mainstream and special); 17 advisers in special educational needs (11 outstanding; and 11 principal educational psychologists (21 outstanding). However, since the analysis of the data is in process, this paper will focus on data collected from 47 interviews carried out during the Autumn term 1994 in five special schools and five mainstream schools located in six Scottish regions. Intervews have allowed the identification of certain elements that may enable effective speech and language therapist/teacher collaboration, these include: working together with individuals or groups of children; joint planning of classroom activities; speech and language therapist input to educational programmes; curricular influences on speech and language therapy programmes; time spent in sharing information, planning and assessment; speech and language therapists and teachers attending training sessions jointly; share framework for the integration of language and communication into the curriculum; formal remit for speech and language therapists to work within the context of educational programmes. At this stage in our research, we are not able to draw the full implications for policy development. However, we shall discuss those strategies which are being employed successfully to promote collaboration and its effectiveness in these 10 schools. The project is commissioned and funded by the Scottish Office Education Department

Implementation of the Rhesus Prevention Programme

All rhesus-negative women who completed a pregnancy between January and August 1992 in two Scottish regions were studied to assess whether the administration of the rhesus prevention programme was complete: 671 rhesus positive (or rhesus type unknown) pregnancies were completed in 1120 Rh D negative women. For eight pregnancies no record of Rh D administration at birth was available. For recorded antenatal events that should have resulted in its administration anti-D was given in 195/280 (69.6%). Kleihauer testing was carried out in 9 of 98 instances of antepartum haemorrhage occurring after 20 weeks gestation. No cases of antenatal immunisation were identified. The study identified a need to increase awareness of the necessity for anti-D administration after potentially immunising events during pregnancy, and for increasing compliance with administration of postnatal anti-D in one of the study regions. Re-evaluation is also required of the recommendation that Kleihauer testing should be done when antenatal anti-D is given following an obstetric event after 20 weeks.

Implementation of the rhesus prevention programme: a prospective study.

All rhesus-negative women who completed a pregnancy between January and August 1992 in two Scottish regions were studied to assess whether the administration of the rhesus prevention programme was complete: 671 rhesus positive (or rhesus type unknown) pregnancies were completed in 1120 Rh D negative women. For eight pregnancies no record of Rh D administration at birth was available. For recorded antenatal events that should have resulted in its administration anti-D was given in 195/280 (69.6%). Kleihauer testing was carried out in 9 of 98 instances of antepartum haemorrhage occurring after 20 weeks gestation. No cases of antenatal immunisation were identified. The study identified a need to increase awareness of the necessity for anti-D administration after potentially immunising events during pregnancy, and for increasing compliance with administration of postnatal anti-D in one of the study regions. Re-evaluation is also required of the recommendation that Kleihauer testing should be done when antenatal anti-D is given following an obstetric event after 20 weeks.

Human infection in Tayside, Scotland due to Salmonella serotype Livingstone

Livingstone was the third most common salmonella serotype isolated from cases of human salmonellosis in the Tayside region of Scotland in 1989-1991; latterly, it spread to Grampian region. The significant upsurge of Livingstone in these two Scottish regions was not matched by similar increases in its frequency of isolation from human cases of salmonellosis in other regions of Scotland or elsewhere in the UK. Although Salmonella Livingstone is usually associated in the UK with incidents of infection among poultry flocks, our detailed investigations found no clear evidence that poultry, eggs or poultry-related products were responsible for this outbreak. Most cases occurred in the summer months from July to September and many of the patients required hospital treatment. Other than one outbreak among geriatric patients in a long-stay hospital in north Tayside, most of the cases were sporadic. The extent of the outbreak, covering 3 years, was recognised mainly because Livingstone was previously an uncommon serotype in Tayside. There were few Livingstone isolations from non-human sources in Scotland in these same years. Possible sources of infection and predisposing factors among patients are discussed. Livingstone was not isolated in Scotland in 1992.

Parents' evaluations of pre-school services for children with Down syndrome in two Scottish regions.

Parental evaluations of current pre-school provision for children with Down's syndrome were surveyed in two Scottish regions. Two methods were used: postal questionnaires and telephone interviews. Services covered were those provided by general practitioners, hospital specialists, health visitors, speech therapists, occupational therapists, physiotherapists, educational psychologists, home teachers, social workers and voluntary organizations. Regional differences were found in provision and in parental satisfaction with currently available services, with some of these differences being dependent on child age. Overall, parents felt they were being given insufficient professional support, with contradictory advice not uncommon. Findings indicate that if limited resources are to be used to the maximum benefit of family and child, both subjective and objective measures of the relative values of different kinds of support at different ages are urgently needed.

FARM NET VALUE ADDED IN SCOTLAND AND THE DESIGNATION OF AREAS FOR RURAL DEVELOPMENT ASSISTANCE

Recent procedures for selecting disadvantaged areas for European Community rural development assistance have specified criteria including low levels of agricultural income and GDP per capita, and proportionately high levels of agricultural employment. The first of these is measured by Farm Net Value Added per Annual Work Unit (FNVA per AWU). This paper presents a methodology which estimates FNVA and AWU for Scottish parishes using data from the Farm Accounts Scheme and the June agricultural census. The ratio of FNVA to AWU is then estimated for various aggregations of parishes, such as Scottish Districts, Regions, and areas currently designated for various rural development programmes. Although only one among several important criteria for targeting rural development aid, the pattern of FNVA per AWU generally supports the current allocation of funding. The results also give some indication of priority areas for future targeting on a more local scale.

The Rural Areas Database: A Geographical Information and Mapping System for the Management and Integration of Data on Rural Britain

The problems of rural areas have started to receive greater attention in academic research, the media and policy-making in recent years. Rural topics such as agricultural overproduction, farm diversification, rural deprivation and afforestation, have had an increased profile. The Rural Areas Database (RAD) unit has been established in the ESRC Data Archive in order to gather together and integrate data from a multitude of sources so that more informed research, planning and policies can be undertaken about these and other rural issues. The RAD is drawing together data on environmental, economic and social subjects pertaining to the rural parts of Great Britain. A broad definition of 'rural areas' has been adopted encompassing the shire counties and Scottish regions; this strategy enables a narrower definition to be employed according to users' demands. The management and integration of the separate data files, the majority of which have a spatial component, is being undertaken within the developing field of Geographical Information Systems. The paper examines some of the problems involved with the handling of computerised geographical data with reference to datasets held in the RAD.

Births and deaths of manufacturing firms in the Scottish regions

Beesley M. E. and Hamilton R. T. (1986) Births and deaths of manufacturing firms in the Scottish regions, Reg. Studies 20, 281–288. Original data is used to investigate the determinants of regional variation in the births and deaths of independent businesses in Scottish manufacturing industries. Inter-regional differences are shown to stem mainly from intra-industry variation in fertility and mortality across the regions. These differences appear to be marked and should be borne in mind when job creation through the stimulation of indigenous entrepreneurial activity is the objective of any regional or national policy.