A critical incident study in child health

The critical incident technique is an objective method of analysing doctors' professional behaviour. It extracts the skills which should be taught and assessed in any training programme. In such a study in child health, 438 incidents were collected from general practitioners, paediatricians and others, and analysed according to the problem, the disease, the setting, the skill and the attitude involved. Most of the problems concerned non-specific symptoms (e.g. 'unwell baby', 'fever') and the main skill categories (each with many subheadings) were clinical management (especially at home), the diagnostic process and interpersonal skills. Training of doctors in child health should emphasize the competencies highlighted in this study.     

Public health medicine and drinking water in Scotland

The prevention of the spread of disease by drinking water relies on a tripartate arrangement among the supplier, the regulator and their medical advisers. This paper describes the role of Public Health Medicine in Scotland in preventing a ‘significant risk to health’ from potable water. The legislative framework is highlighted. The rationale of water monitoring is examined and the role of Consultant in Public Health Medicine. The concept of Significant Medical Risk Values is introduced and their derivation, uses, and levels presented.     

Public health liaison the Scottish model

Inter-professional is a highly desirable activity, arguably an essential one, especially in these days of a fragmented public health service. Mechanisms have evolved in Scotland to promote this activity. In light of organisational changes affecting several public health agencies, a questionnaire survey was performed to determine the views of participants on current and future arrangements. This indicated that most participants wished the current structures to continue, albeit with some clearer aims and powers for the liaison committees. This model, with suitable modifications, is applicable elsewhere.     

Ophthalmic and visual profile of guide dog owners in Scotland

BACKGROUND/AIMS: Out of an estimated 90,000 visually impaired people in Scotland, 509 make use of a guide dog. Initial research in Northern Ireland suggests that the ophthalmic profile of guide dog owners (GDOs) is highly specific. The aim of this study was to compare the ophthalmic and visual characteristics of Scottish GDOs with other groups of visually impaired people. METHODS: A random sample of GDOs from central and northern Scotland (n = 82) underwent a detailed assessment of residual vision (distance and near acuity, visual fields, contrast, and glare sensitivity). Comparative data were obtained from two populations of visually impaired non-GDOs-one group attending hospital ophthalmic and low vision clinics (n = 50) the other social services rehabilitation clients (n = 35). All participants completed a questionnaire to elicit ophthalmic history, age, and registration details. RESULTS: GDOs were found to be significantly younger and more profoundly visually impaired than non-GDOs. The main causes of visual impairment were retinitis pigmentosa (23%), optic atrophy (15%), and retinopathy of prematurity (7%). Ninety nine per cent of GDOs were registered blind and had been visually impaired for an average of 39 years. Only 31% were totally blind. CONCLUSION: GDOs represent a unique minority of the visually impaired population. Epidemiological registration trends would suggest that the numbers of young profoundly visually impaired people are unlikely to increase relative to their elderly counterparts. This has implications on the future demand for guide dog ownership.     

The need for pharmaceutical care in the prevention of coronary heart disease: an exploratory study in acute myocardial infarction patients

AIM: To determine guideline-related pharmaceutical care issues for the prevention of coronary heart disease in hospitalised patients admitted for myocardial infarction (MI). METHODS: Consecutive patients admitted with a diagnosis of Q-wave MI to two large teaching hospitals were studied. Relevant patient medical and drug histories, co-morbidities and total cholesterol concentrations were recorded. Primary or secondary prevention treatment prior to admission was assessed using a data collection tool of 16 criteria developed from the Scottish Intercollegiate Guidelines Network (SIGN) guidelines. MAIN OUTCOME MEASURES: Frequency of adherence to defined clinical guideline criteria. RESULTS: There were 167 patients reviewed (mean age 65 years, 111 males), representing possible candidates for primary prevention (n = 98) or secondary prevention (n = 69) based on absence or presence of past history of coronary heart disease (CHD), respectively. Possible primary prevention candidates: eight guideline-based criteria were developed from the SIGN guideline. There were 85 (87%) patients with a total cholesterol concentration available on admission of whom 56 (66%) had a predicted CHD risk > or = 15% and 10 (12%) had CHD risk > or = 30%. Of those with CHD risk > or = 15% 6 (11%) had been receiving an anti-platelet agent and of those with CHD risk > or = 30% only 1 (10%) was recorded as taking a statin. Of known hypertensives with CHD risk > or = 15%, 21% (5/24) were not recorded as having received treatment. Secondary prevention candidates: a further eight guideline-based criteria were developed from the SIGN guidelines. There were 42/65 (65%) candidates for aspirin documented as receiving it. There were 22/47 (47%) of those who had a total cholesterol > or = 5 mmol/l and/or known history of hypercholesterolaemia receiving a statin (representing 76% of the known hypercholesterolaemic patients identified in the community). Of statin-treated patients with a cholesterol measured on admission, 44% (7/16) had cholesterol remaining > or = 5 mmol/l. Beta-blocker use was 27/62 (44%) and ACE inhibitors use was 11/31 (36%) of those eligible. Sublingual GTN was recorded in 36/69 (52%). CONCLUSION: The study has identified opportunities for improved pharmaceutical care in primary and secondary CHD prevention among those destined to suffer an MI. Candidates for secondary prevention are potentially identifiable from community pharmacy patient medication records from which the contribution of pharmacists in primary care might be targeted. The findings were obtained during a period of evolution of the evidence-base and so they establish a baseline for future work.     

Effects of Drinking-Water Filtration on Cryptosporidium Seroepidemiology,Scotland

Continuous exposure to low levels of Cryptosporidium oocysts is associated with production of protective antibodies. We investigated prevalence of antibodies against the 27-kDa Cryptosporidium oocyst antigen among blood donors in 2 areas of Scotland supplied by drinking water from different sources with different filtration standards: Glasgow (not filtered) and Dundee (filtered). During 2006–2009, seroprevalence and risk factor data were collected; this period includes 2007, when enhanced filtration was introduced to the Glasgow supply. A serologic response to the 27-kDa antigen was found for ≈75% of donors in the 2 cohorts combined. Mixed regression modeling indicated a 32% step-change reduction in seroprevalence of antibodies against Cryptosporidium among persons in the Glasgow area, which was associated with introduction of enhanced filtration treatment. Removal of Cryptosporidium oocysts from water reduces the risk for waterborne exposure, sporadic infections, and outbreaks. Paradoxically, however, oocyst removal might lower immunity and increase the risk for infection from other sources.     

The geographic harmonisation of Scotland's small area census data, 1981 to 2011

Previous research in Scotland used a merging approach to combine census boundary data for geographies specific to 1981, 1991 and 2001 to create Consistent Areas Through Time (CATTs) for the analysis of health and social data for small areas. In this paper, we adopt the same methodology to integrate the 2011 Scottish Output Areas to the CATTs. First, we overlaid the 2001 Output Areas upon the 2011 Output Areas to create SUPER OAs, which were then combined with SUPER EDs, which represented a consistent small area geography for 1981 and 1991. This resulted in 8,548 CATTs providing a consistent geography for the 1981, 1991, 2001 and 2011 Censuses in Scotland. We demonstrate the utility of the CATTs by exploring the correlations between deprivation, the proportion of the population who were permanently sick and those with degree qualifications, across the 4 censuses, a research angle impossible without consistent geographies. We have provided a resource that enables users to deepen their understanding of small area social changes in Scotland between the 1981 and 2011 Censuses.