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The COVID-19 pandemic and associated public health 'stay at home' restrictions have intensified familial risk factors. Children would appear to be at increased risk of harm and abuse, yet administrative data from the early months of the pandemic showed falling cases of child maltreatment. Using weekly administrative data from Scotland, UK that span the first 17 months of the pandemic, this article found that child maltreatment activity levels fluctuated as 'stay at home' restrictions changed. During lockdown periods, the number of children subject to Inter-agency Referral Discussion fell but a higher number of children were placed on the Child Protection Register. When restrictions were eased, the number of Inter-agency Referral Discussions increased but the number of children placed on the Child Protection Register fell. To explain the fluctuations, the article asserts that the pandemic's impact on services' ability to engage directly with children and families has been critical, but the limitations of administrative data in providing an accurate measure of child maltreatment levels also need to be recognised. The article advocates that analysis of administrative data is best done in tandem with wider quantitative and qualitative sources in order to understand the impact of crisis events on children and families. [ABSTRACT FROM AUTHOR]

Background: Sars-CoV-2, the causative agent of COVID-19, has led to more than 226,000 deaths in the UK and multiple risk factors for mortality including age, sex and deprivation have been identified. This study aimed to identify which individual indicators of the Scottish Index of Multiple Deprivation (SIMD), an area-based deprivation index, were predictive of mortality. Methods: This was a prospective cohort study of anonymised electronic health records of 710 consecutive patients hospitalised with Covid-19 disease between March and June 2020 in the Lothian Region of Southeast Scotland. Data sources included automatically extracted data from national electronic platforms and manually extracted data from individual admission records. Exposure variables of interest were SIMD quintiles and 12 indicators of deprivation deemed clinically relevant selected from the SIMD. Our primary outcome was mortality. Age and sex adjusted univariable and multivariable analyses were used to determine measures of association between exposures of interest and the primary outcome. Results: After adjusting for age and sex, we found an increased risk of mortality in the more deprived SIMD quintiles 1 and 3 (OR 1.75, CI 0.99–3.08, p = 0.053 and OR 2.17, CI 1.22–3.86, p = 0.009, respectively), but this association was not upheld in our multivariable model containing age, sex, Performance Status and clinical parameters of severity at admission. Of the 12 pre-selected indicators of deprivation, two were associated with greater mortality in our multivariable analysis: income deprivation rate categorised by quartile (Q4 (most deprived): 2.11 (1.20–3.77) p = 0.011)) and greater than expected hospitalisations due to alcohol per SIMD data zone (1.96 (1.28–3.00) p = 0.002)). Conclusions: SIMD as an aggregate measure of deprivation was not predictive of mortality in our cohort when other exposure measures were accounted for. However, we identified a two-fold increased risk of mortality in patients residing in areas with greater income-deprivation and/or number of hospitalisations due to alcohol. In areas where aggregate measures fail to capture pockets of deprivation, exploring the impact of specific SIMD indicators may be helpful in targeting resources to residents at risk of poorer outcomes from Covid-19. [ABSTRACT FROM AUTHOR]

Experiencing mental fatigue (MF) before an orienteering race can lead to a slower completion time. This study aimed to explore the changes in perceived MF, mood and other psychological responses during an orienteering competition. Sixteen national level orienteering athletes (20.8 ± 4.9 years) provided informed consent and completed the online surveys, before and immediately after each race, and 24- and 48-hours post competition (48POST). This study measured MF, physical fatigue, stress, tiredness and motivation using 0–100 Visual Analogue Scale, and the mood was assessed using The Brunel Mood Scale (BRUMS). A moderate to large increase in MF (ES = 0.93 [0.54 to 1.31]), BRUMS fatigue (ES = 0.61 [0.3 to 0.92]), and PF (ES = 1.21 [0.81 to 1.61]) was reported following orienteering races. A small increase in tiredness and BRUMS confusion, and a small decrease in motivation, stress and BRUMS vigour was also reported. There was a delay in recovering from the MF elicited by competition, with a small increase in MF (ES = 0.54 [0.08 to 1.15]) at 48POST compared to the pre-competition value. This study found that orienteers experience MF during competition and have a delayed recovery that can last up to two days after the competition. [ABSTRACT FROM AUTHOR]

Background: People with Down syndrome often present with balance deficits, which compromise safety during daily activity. While evidence shows that exercise can improve balance in the Down syndrome population, it is unclear if a telehealth method will elicit similar benefits. We aimed to examine the effects of a virtual exercise program on balance in adults with Down syndrome. Methods: Eighteen low‐active participants with Down syndrome completed a 12‐week telehealth exercise program based on the Mann Method. Balance testing took place before and after the intervention, which included: TUG, MCTSIB, FICSIT‐4, and FRT. This study was registered as a clinical trial on ClinicalTrials.gov, identifier: NCT04647851. Results: Significant improvement was seen in the TUG (p =.043), FICSIT‐4 (p =.019) and FRT (p =.019). All participants achieved maximum scores on the MCTSIB in pre‐ and post‐testing. Conclusions: Balance in low‐active adults with Down syndrome significantly improved following the telehealth exercise program, which we attribute to the tailored exercises that address visual/vestibular deficits and hip muscle weakness. [ABSTRACT FROM AUTHOR]

Background Lesbian, gay and bisexual (LGB) young people's increased risk of self-harm, suicidal attempts and suicide compared with heterosexual youth is well established. The current study sought to examine whether these findings also apply to the trans (T) population and which factors act as additional risk or protective factors. Methods In a national cross-sectional survey, 3713 LGBT adolescents, aged 11–19 years, reported on their own history of self-harm, suicidal ideation and suicide attempts, as well as their experiences of school and homophobic, biphobic and transphobic bullying. Logistic regressions tested the association between risk and protective factors on self-harm, suicidal ideation and suicide attempts. Results A high proportion of the sample reported self-harm (65.3%), suicidal ideation (73.8%) and suicide attempts (25.7%). Demographic risk factors included identifying as female, non-binary or trans and being from a low-income background. Bullying and online bullying were associated with an increased risk for each outcome, and positive school experience was associated with a reduced risk for each outcome. Conclusions Consistent with minority stress theory, the study found high rates of mental health problems within LGBT youth. Interventions focused on improving young people's experiences in schools appear useful targets to help improve mental health outcomes. [ABSTRACT FROM AUTHOR]

This study aims to determine whether adding an additional modality (ultrasound tongue imaging) improves the inter-rater reliability of phonetic transcription in childhood speech sound disorders (SSDs) and whether it enables the identification of different or additional errors in children's speech. Twenty-three English speaking children aged 5–13 years with SSDs of unknown origin were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio and ultrasound. Two types of transcriptions were undertaken off-line: (1) ultrasound-aided transcription by two ultrasound-trained speech-language pathologists (SLPs) and (2) traditional phonetic transcription from audio recordings, completed by the same two SLPs and additionally by two different SSD specialist SLPs. We classified transcriptions and errors into ten different subcategories and compared: the number of consonants identified as in error by each transcriber; the inter-rater reliability; and the relative frequencies of error types identified by the different types of transcriber. Results showed that error-detection rates were different across the transcription types, with the ultrasound-aided transcribers identifying more errors than were identified using traditional audio-only transcription. Analysis revealed that these additional errors were identified on the dynamic ultrasound image despite being transcribed as correct, suggestive of subtle motor speech differences. Interrater reliability for classifying the type of error was substantial (κ = 0.72) for the ultrasound-aided transcribers and ranged from fair to moderate for the audio-only transcribers (κ = 0.38 to 0.52). Ultrasound-aided transcribers identified more instances of increased variability and abnormal timing errors than the audio-only transcribers. [ABSTRACT FROM AUTHOR]

Introduction: Tonsillectomy is now only indicated in the UK when specific criteria are met, as outlined by the Scottish Intercollegiate Guidelines Network (SIGN) and The National Institute for Health and Care Excellence (NICE). As a result, fewer numbers of tonsillectomy are being performed. Tonsillectomy is the primary treatment for recurrent tonsillitis; therefore, we hypothesise that acute admissions to hospital with tonsillitis and infective complications will have risen since criteria were introduced. Our aim was to assess the rates of acute hospital admissions with tonsillitis in children and the factors associated with this.Methods: Data were provided by Information Service Division for all under 16s in Scotland between 1996/1997 and 2016/2017. Socioeconomic background was determined from the Scottish Index of Multiple Deprivation (SIMD) score. Poisson regression analysis was used to model predictors of surgery and correlation analysis to study the relationship between tonsillitis and other factors.Results: 60 456 tonsillectomies were performed. The number of tonsillectomies dropped significantly following the introduction of SIGN guidelines, and the rates of tonsillitis increased; however, admissions with tonsillitis were already on an upward trajectory. Children from the most deprived areas were 72.0% (95% CI 60% to 85%, p<0.001) more likely to receive tonsillectomy and were also more likely to be admitted with tonsillitis than the least deprived areas.Conclusion: Tonsillectomy and tonsillitis rates are highest in the most deprived; postulated reasons include antibiotic stewardship and difficulty accessing primary care. Current guidelines on tonsillectomy may be disproportionately harmful in children from deprived households. [ABSTRACT FROM AUTHOR]

The present study examined nonword repetition (NWR) and comprehension/production of single-word vocabulary in the majority language (English) in six- to eight-year-old English-Gaelic emergent bilingual children attending Gaelic-medium primary education (GMPE) (primary years 2 and 3). GMPE is an immersion education model found in Scotland where the minority language, Gaelic, is the language of instruction, whereas English is the majority community language, not supported in school in the first three years of primary schooling. All children spoke English as their first language (L1) and had varying exposure to the second language (L2) Gaelic outside the school setting. We investigated how individual factors, such as age and frequency of exposure, and psycholinguistic factors, such as task modality, word class (for vocabulary), frequency, length, and prosody (for NWR), influenced performance. Later exposure to Gaelic and higher nonverbal IQ were contributing predictors of performance for English vocabulary. For NWR, participants with earlier and longer exposure to Gaelic who also used both languages at home more performed significantly better on this task. These results suggest that minority language immersion education differentially affects majority language abilities; later L2 onset benefited L1 vocabulary learning, whereas earlier L2 onset boosted L1 NWR skills in these bilinguals. [ABSTRACT FROM AUTHOR]

Introduction: Occupational therapists provide services to homeless people internationally, yet relatively little research evidence underpins this practice. This study aimed to describe the process of selecting an outcome measure for use in a homeless occupational therapy service and demonstrate the changes experienced in the occupational performance of individuals participating in this service. Method: The Glasgow homeless occupational therapy service staff reviewed eight outcome measures against six pre-determined criteria. The selected tool was then used to collect data pre and post an occupational therapy intervention with 58 participants. Data were analysed using descriptive statistics and Wilcoxon Signed Ranks Test to determine statistically significant change from admission to discharge in the different domains of the selected outcome measure. Results: The AusTOMs-OT was implemented in daily practice and 70% of participants were discharged following achievement of therapy goals. Clients made clinically and statistically significant improvements over their admission as measured on AusTOMs-OT in areas such as Transfers, Self-Care and Domestic Life-Home, across the health domains of activity, participation and wellbeing. Conclusion: AusTOMs-OT was successfully implemented and demonstrated that participants improved over their time with the service. This evidence can be used to support the effectiveness of occupational therapy services with people experiencing homelessness. [ABSTRACT FROM AUTHOR]

The proposition that teaching is a reflective profession is prominent within educational discourse. Theories that underpin reflection are a critical component of initial teacher education (ITE) programmes. This study aims to assess the reliability of the modified Reflective Practice Questionnaire (RPQ) in a population of ITE students; and to compare the study findings to other studies using the RPQ in other professions. This study reports cross-sectional findings for reflective capacity in ITE students undertaking three different ITE programmes, the Bachelor of Arts (Hons) (BA) Education [n=91], Professional Graduate Diploma in Education (PGDE) Primary [n=209] and Secondary [n=167], in one Scottish university. Findings show that the modified RPQ reliably assesses reflective capacity (Cronbach's alpha 0.82), which differs depending on the programme of study followed. BA students' reflective capacity is higher than that of PGDE (P) but is not different to PGDE (S) students. PGDE (P) students differing from BA students in terms of Reflection-in-Action (RiA), Self-Appraisal (SA), Confidence (general) (CG), and Confidence (communication) (CC), whereas PGDE (S) and BA students differ in terms of SA, CG CC and Stress interacting with Pupils (SiP). This study indicates student teachers' reflective capacity is higher than those found in studies of other professions. [ABSTRACT FROM AUTHOR]

Aims: To develop a questionnaire to identify Intensive Care survivor needs at key transitions during the recovery process, and assess its validity and reliability in a group of ICU survivors. Methods: Development of the Support Needs After ICU (SNAC) questionnaire was based on a systematic scoping review, and analysis of patient interviews (n = 22). Face and content validity were assessed by service users (n = 12) and an expert panel of healthcare professionals (n = 6). A pilot survey among 200 ICU survivors assessed recruitment at one of five different stages after ICU discharge [(1) in hospital, (2) < 6 weeks, (3) 7 weeks to 6 months, (4) 7 to 12 months, or (5) 12 to 24 months post‐hospital discharge]; to assess reliability of the SNAC questionnaire; and to conduct exploratory data analysis. Reliability was determined using Cronbach's alpha for internal consistency; intraclass correlation coefficients for test–retest reliability. We explored correlations with sociodemographic variables using Pearson's correlation coefficient; differences between questionnaire scores and patient demographics using one‐way ANOVA. Results: The SNAC questionnaire consisted of 32 items that assessed five categories of support needs (informational, emotional, instrumental [e.g. practical physical help, provision of equipment or training], appraisal [e.g. clinician feedback on recovery] and spiritual needs). ICU survivors were recruited from Northern Ireland, England and Scotland. From a total of 375 questionnaires distributed, 202 (54%) were returned. The questionnaire had high internal consistency (0.97) and high test–retest reliability (r = 0.8) with subcategories ranging from 0.3 to 0.9. Conclusions: The SNAC questionnaire appears to be a comprehensive, valid, and reliable questionnaire. Further research will enable more robust examination of its properties e.g. factor analysis, and establish its utility in identifying whether patients' support needs evolve over time. Relevance to clinical practice: The SNAC questionnaire has the potential to be used to identify ICU survivors' needs and inform post‐hospital support services. [ABSTRACT FROM AUTHOR]

The Scottish government plans a more preventive and partnership‐oriented approach to child protection. However, it has not recently published statistics on the number of child protection investigations. This paper analyses data from a request for information from government. It shows a rate of 153 investigations per 10 000 children aged 0–17 in 2017/18. There were wide variations in rates of investigations across Scottish local authorities. Almost three‐quarters of investigations in 2017/18 did not lead to the child being placed on the child protection register. A small association between investigation rates and local authority deprivation suggests that factors other than deprivation at the local authority level are at play in decisions to investigate child protection. There has been an increase of investigations by one‐third in the last two years with no change in the numbers starting a child protection plan. These trends raise the possibility that concerns about the preventive approach net‐widening and leading to more rather than less children drawn into the formal child protection system may have some basis. The limited nature of published statistical data in Scotland means that policies and activities, which are carried out with large amounts of public funding, receive limited public scrutiny. Key Practitioner Messages: One investigation was conducted for every 65 children in Scotland in 2017/18.One child in 23 was investigated before the age of four.Rates of investigation vary widely between local authorities.One in four investigations are likely to lead to a child protection registration.There was a 33 per cent increase in investigations in the most recent two years with no change in child protection registrations.Investigations harm families and lessen the chances of engaging them with support. 'The limited nature of published statistical data in Scotland means that policies and activities, which are carried out with large amounts of public funding, receive limited public scrutiny' [ABSTRACT FROM AUTHOR]

Background: Maternal serum free beta human chorionic gonadotrophin (free β-hCG) is used as a biomarker in first trimester screening for fetal Down's syndrome. Production of free β-hCG can occur in vitro in a time- and temperature-dependent manner; thus, the current Scottish screening protocol states samples must be received by the laboratory within 72 h. To assess the validity of the protocol, an audit was conducted to determine the impact of transit time on maternal serum free β-hCG multiple of median (MoM) values in the Scottish screened population. Methods: Corrected MoM values from antenatal screening carried out over one year (April 2017 to March 2018) were stratified according to sample transit time and compared. To investigate possible environmental temperature effects, the data were split according to season and maternal serum free β-hCG concentrations from summer and winter compared. Results: Of the 28,368 samples included in the study, 24,368 were received on the day of phlebotomy or after one day in transit. Only 1.5% of samples were received after 3 days in transit. The difference in maternal serum free β-hCG MoM values due to transit time was not significant. No statistical difference was found between maternal serum free β-hCG concentrations from samples collected in summer and winter months. Conclusion: The current sample receipt protocol in use by the Scottish Down's syndrome screening programme is fit for purpose. [ABSTRACT FROM AUTHOR]

Background understanding care-home outbreaks of COVID-19 is a key public health priority in the ongoing pandemic to help protect vulnerable residents. Objective to describe all outbreaks of COVID-19 infection in Scottish care-homes for older people between 01/03/2020 and 31/03/2020, with follow-up to 30/06/2020. Design and setting National linked data cohort analysis of Scottish care-homes for older people. Methods data linkage was used to identify outbreaks of COVID-19 in care-homes. Care-home characteristics associated with the presence of an outbreak were examined using logistic regression. Size of outbreaks was modelled using negative binomial regression. Results 334 (41%) Scottish care-homes for older people experienced an outbreak, with heterogeneity in outbreak size (1–63 cases; median = 6) and duration (1–94 days, median = 31.5 days). Four distinct patterns of outbreak were identified: 'typical' (38% of outbreaks, mean 11.2 cases and 48 days duration), severe (11%, mean 29.7 cases and 60 days), contained (37%, mean 3.5 cases and 13 days) and late-onset (14%, mean 5.4 cases and 17 days). Risk of a COVID-19 outbreak increased with increasing care-home size (for ≥90 beds vs <20, adjusted OR = 55.4, 95% CI 15.0–251.7) and rising community prevalence (OR = 1.2 [1.0–1.4] per 100 cases/100,000 population increase). No routinely available care-home characteristic was associated with outbreak size. Conclusions reducing community prevalence of COVID-19 infection is essential to protect those living in care-homes. More systematic national data collection to understand care-home residents and the homes in which they live is a priority in ensuring we can respond more effectively in future. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn about the differences between psychiatric intensive care, low secure and locked rehabilitation units • To understand how service provision in psychiatric intensive care, low secure and locked rehabilitation units has changed since 2006 • To gather information on the types of interventions offered by the different psychiatric intensive care facilities Psychiatric intensive care can take place in a variety of settings, including psychiatric intensive care units (PICUs), low secure units (LSUs) and locked rehabilitation units (LRUs). These units have a range of referral, admission and discharge care pathways, staffing profiles and core interventions. The aim of this service evaluation was to compare present provision in PICUs and LSUs with results from the first national survey of PICUs and LSUs in 2006. The service evaluation also aimed to define the role of LRUs. The authors used a cross-sectional, 'census day' questionnaire with six-month follow-up design. Overall, 111 NHS units participated in the evaluation. Results included that PICUs were smaller and usually had a mixed-sex distribution of service users; LSUs mostly comprised single-sex facilities; and LRUs mostly comprised single-sex units with a significantly longer mean length of stay than the other types of unit. PICUs primarily cared for service users exhibiting acute behavioural disturbance, first-episode psychosis or psychotic crisis and, compared with the other types of unit, more often used high-dose medication and electroconvulsive therapy. [ABSTRACT FROM AUTHOR]

While a number of previous studies have compared sexual homicides to nonlethal sexual offenses, there have been few studies comparing sexual and nonsexual homicides. This study examines whether sexual homicide offenders differ from nonsexual homicide offenders in Scotland regarding characteristics of the offender, the victim, and the homicide incident. Unlike previous studies, only homicides committed by males against females were examined. Data from a national police database were used to compare 89 male sexual homicide offenders who killed adult females with 306 male nonsexual homicide offenders who had also killed adult females using bivariate and multivariate (logistic regression) analyses. The findings revealed not only some similarities between the two groups, particularly regarding some victim variables, but also significant bivariate and multivariate differences. Sexual homicides appeared to be associated with indicators of instrumentality and sexual deviance. We conclude that sexual homicide offenders might be considered a distinct group of homicide offenders, more similar to sexual offenders than to other homicide offenders. [ABSTRACT FROM AUTHOR]

The purpose of this in vitro study was to evaluate the accuracy of 2 dental electronic shadematching instruments to recognize all individual tab shades of 3 visual shade guides. Two electronic shade matching devices were selected to be evaluated in this study: Vita Easyshade Compact (Vita Zahnfabrik, Bad Sackingen,Germany) and ShadeStar (Dentsply- Germany). The two devices were calibrated according to manufacturer instructions. Three types of visual shade guides were also selected: Senator (Wright Health Group Ltd - Scotland, based on VITA shade guidelines), Ivoclar Vivadent and Ivoclar Vivadent Tetric N-Ceram (United States and Canada). Each shade tab from all the three visual shade guides was measured 10 times using both electronic devices. The measurements were done under simulated clinical conditions. Any reading was considered to be accurate if the device selected a shade that was identical to the shade tab measured. Accuracy was expressed as a percentage of measurements made with the device that were an exact match. Data was statistically analyzed by calculating the percentage of the accurate readings, mean of accurate readings, standard deviation, one way ANOVA and t-test at 5% level of significance. Statistical analysis of the data with one-way ANOVA revealed that, there was a statistically significant difference between the 6 groups being tested in accuracy readings (p≤ 0.05). VITA Easyshade demonstrated the highest shade selection accuracy in this study. The two electronic spectrophotometers showed a very high variability in accuracy reading percentages (23-88%). Easyshade spectrophotometer in general was more accurate than ShadeStar in our study and showed an accuracy reading percentages (74-88%) with the three different visual shade guide tabs. Clinical significance: The most accurate shade selection devise achieves the highest aesthetic results. The purpose of this in vitro study was to evaluate the accuracy of 2 dental electronic shadematching instruments to recognize all individual tab shades of 3 visual shade guides. Two electronic shade matching devices were selected to be evaluated in this study: Vita Easyshade Compact (Vita Zahnfabrik, Bad Sackingen,Germany) and ShadeStar (Dentsply- Germany). The two devices were calibrated according to manufacturer instructions. Three types of visual shade guides were also selected: Senator (Wright Health Group Ltd - Scotland, based on VITA shade guidelines), Ivoclar Vivadent and Ivoclar Vivadent Tetric N-Ceram (United States and Canada). Each shade tab from all the three visual shade guides was measured 10 times using both electronic devices. The measurements were done under simulated clinical conditions. Any reading was considered to be accurate if the device selected a shade that was identical to the shade tab measured. Accuracy was expressed as a percentage of measurements made with the device that were an exact match. Data was statistically analyzed by calculating the percentage of the accurate readings, mean of accurate readings, standard deviation, one way ANOVA and t-test at 5% level of significance. Statistical analysis of the data with one-way ANOVA revealed that, there was a statistically significant difference between the 6 groups being tested in accuracy readings (p≤ 0.05). VITA Easyshade demonstrated the highest shade selection accuracy in this study. The two electronic spectrophotometers showed a very high variability in accuracy reading percentages (23-88%). Easyshade spectrophotometer in general was more accurate than ShadeStar in our study and showed an accuracy reading percentages (74-88%) with the three different visual shade guide tabs. Clinical significance: The most accurate shade selection devise achieves the highest aesthetic results. [ABSTRACT FROM AUTHOR]

The purpose of this in vitro study was to evaluate the reliability of 2 dental electronic shadematching devices o recognize all individual tab shades of 3 visual shade guides. Two electronic shade matching devices were selected to be evaluated in this study: Vita Easyshade Compact (Vita Zahnfabrik, Bad Sackingen,Germany) and ShadeStar (Dentsply- Germany). The two devices were calibrated according to manufacturer instructions. Three types of visual shade guides were also selected: Senator (Wright Health Group Ltd - Scotland, based on VITA shade guidelines), Ivoclar Vivadent and Ivoclar Vivadent Tetric N-Ceram (United States and Canada). Each shade tab from all the three visual shade guides was measured 10 times (n=10) using both electronic devices. The measurements were done under simulated clinical conditions. To measure reliability, each shade tab from each visual shade guide was measured 10 nonconsecutive times by both electronic spectrophotometers. Repeated measurements were considered to be reliable if they were similar, even if they did not match the shade tab itself. Data was statistically analyzed by calculating the percentage of the reliable readings, mean of reliable readings, standard deviation, one way ANOVA and t-test at 5% level of significance. Statistical analysis of the data with one-way ANOVA revealed that, there was a statistically significant difference between the 6 groups being tested in reliability readings (p≤ 0.05). VITA Easyshade and shadeStar spectrophotometers in general demonstrated variable high reliability percentages in this study. In general, the two electronic spectrophotometers showed a high and comparable reliability reading percentages. Easyshade spectrophotometer showed true high reliability percentage while ShadeStar spectrophotometer showed false high reliability percentage. Clinical significance: The most reliable shade selection devise results in more consistent readings but might not achieve a correct shade matching. [ABSTRACT FROM AUTHOR]

Although similar subtypes of sexual homicide have been described cross-nationally, no study has directly examined whether two samples from different jurisdictions are comparable. This study therefore aimed to examine whether any substantively meaningful subtypes of sexual homicide cases could be identified in each sample, and if so, whether these subtypes were similar across jurisdictions. Two samples of male sexual homicide offenders were compared: a Scottish sample (n = 89) and a Canadian sample (n = 150). Subtypes were identified in each sample using LCA, identifying a 3-class solution in each sample. Despite differences between samples on the bivariate level, two very similar subtypes (Controlled-Organized and Diverse) emerged in both samples. Despite differences at the bivariate level, the similarities at the multivariate level indicate similarities in underlying offence pathways which underpin heterogeneity in sexual homicide offenders. The similarities between the subtypes identified suggests potential universality of types of sexual homicides cross-nationally. [ABSTRACT FROM AUTHOR]

Background: Scale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic and diastolic BP were compared with surgery BP measurements from patients not using telemonitoring (comparator patients). The statistical analysis and interpretation of findings was challenging due to the broad range of biases potentially influencing the results, including differences in the frequency of readings, 'white coat effect', end digit preference, and missing data.Methods: Four different statistical methods were employed in order to minimise the impact of these biases on the comparison between telemonitoring and comparator groups. These methods were "standardisation with stratification", "standardisation with matching", "regression adjustment for propensity score" and "random coefficient modelling". The first three methods standardised the groups so that all participants provided exactly two measurements at baseline and 6-12 months follow-up prior to analysis. The fourth analysis used linear mixed modelling based on all available data.Results: The standardisation with stratification analysis showed a significantly lower systolic BP in telemonitoring patients at 6-12 months follow-up (-4.06, 95% CI -6.30 to -1.82, p < 0.001) for patients with systolic BP below 135 at baseline. For the standardisation with matching and regression adjustment for propensity score analyses, systolic BP was significantly lower overall (- 5.96, 95% CI -8.36 to - 3.55 , p < 0.001) and (- 3.73, 95% CI- 5.34 to - 2.13, p < 0.001) respectively, even after assuming that - 5 of the difference was due to 'white coat effect'. For the random coefficient modelling, the improvement in systolic BP was estimated to be -3.37 (95% CI -5.41 to -1.33 , p < 0.001) after 1 year.Conclusions: The four analyses provide additional evidence for the effectiveness of telemonitoring in controlling BP in routine primary care. The random coefficient analysis is particularly recommended due to its ability to utilise all available data. However, adjusting for the complex array of biases was difficult. Researchers should appreciate the potential for bias in implementation studies and seek to acquire a detailed understanding of the study context in order to design appropriate analytical approaches. [ABSTRACT FROM AUTHOR]

Community health and social care practitioners play an increasingly important role in the health promotion agenda, but lack confidence in having effective health behaviour change (HBC) conversations with members of the public. This study reports the development and evaluation of a training intervention based on health psychology to improve health and social care practitioner self‐rated confidence, competence and intention to use five behaviour change techniques (BCTs) in their HBC conversations. A 2‐day behavioural science interprofessional skills training course plus online learning module was designed for health and social care staff across North East Scotland, teaching five evidence‐based BCTs (e.g. Action Planning), plus person‐centred communication skills. Participants rated confidence, competence and future intention to use the BCTs on likert scales (1–10) pre‐course and post‐course, and provided acceptability data. 177 participants aged 20–64 took part, qualitative and quantitative data suggested that the course had high acceptability. Paired samples t tests (n = 120 with complete data) showed significant improvements in confidence, competence and intention following the course, which remained significant with a conservative analysis (n = 174) assuming no change for missing data. Perceived competence in Action Planning increased most during the course (mean change 3.09). In conclusion, health psychology‐based skills training can improve practitioner confidence, competence and intention to use evidence‐based BCTs; further evaluation is needed to assess practice change. [ABSTRACT FROM AUTHOR]

Clinical trials are the standard approach for evaluating new treatments, but may lack the power to assess rare outcomes. Trial results are also necessarily restricted to the population considered in the study. The availability of routinely collected healthcare data provides a source of information on the performance of treatments beyond that offered by clinical trials, but the analysis of this type of data presents a number of challenges. Hierarchical methods, which take advantage of known relationships between clinical outcomes, while accounting for bias, may be a suitable statistical approach for the analysis of this data. A study of direct oral anticoagulants in Scotland is discussed and used to motivate a modeling approach. A Bayesian hierarchical model, which allows a stratification of the population into clusters with similar characteristics, is proposed and applied to the direct oral anticoagulant study data. A simulation study is used to assess its performance in terms of outcome detection and error rates. [ABSTRACT FROM AUTHOR]

Introduction: Two different versions of the Prosthesis Evaluation Questionnaire (PEQ) are available. This study aimed to assess the measurement properties of the original 13-item Mobility Section of the Finnish version of the PEQ on a visual analogue scale (PEQ-VAS, 0–100 points) and its modified 12-item version with five response categories (PEQ-MS12/5, 0–60 points). Methods: Patients having undergone major lower-limb amputation completed the PEQ, the PEQ-MS12/5, the Locomotor Capabilities Index–5, the Houghton Scale, and the 15D instrument, and answered general health and pain questions on a VAS. Participants who completed the instruments twice in a 2-week interval (n = 117) were included. Results: Mean (SD) scores of the PEQ-VAS and the PEQ-MS12/5 were 58 (25) and 31 (13) with coefficients of variation of 0.42 and 0.43, respectively. Reproducibility was consistent between the measures. Although Spearman's correlation coefficient was high (r = 0.83) and Kendall's coefficient of concordance was excellent (0.91), differences were noted in score distribution and patient rank correlation. There were similarities and differences in correlations with the other patient-reported instruments. Conclusions: The original PEQ-VAS Mobility Section and the modified PEQ-MS12/5 have moderate measurement differences; the results are thus not directly comparable. Both measures provide reliable and valid scores, but the modified version is easier to complete and analyze in clinical work. [ABSTRACT FROM AUTHOR]

This article considers the impact of generational changes on the new cohort of social work students most of whom were born post-1995, and therefore belong to 'iGeneration' (iGen). This article is especially concerned with the finding that the generation before iGen is more right-wing authoritarian than all post-war generations and what this might mean for the future of social work should that trajectory continue. A study was undertaken to examine the attitudes of 122 iGen students in first-year university course in Scotland. Results show that mean attitudinal measures were right-wing authoritarian in relation to crime and punishment and to unemployed people. Social work students aligned more in their attitudes with their primary education colleagues and less with their less authoritarian community education colleagues, and, overall, the iGen cohort was significantly more right-wing authoritarian than their older colleagues. In essence, there was evidence to suggest that an individualistic, self-sufficiency neoliberal narrative had been quite profoundly internalised by the iGen cohort of students. Implications of a new individualistic practice are considered, and suggestions for social work education programmes are made. [ABSTRACT FROM AUTHOR]

This paper presents a study of free-standing Bronze Age megalithic monuments across western Scotland: Argyll, Lochaber, Kintyre, and the isles of Mull, Coll and Tiree. The original project was designed to unearth the locational choices of their builders, the reasons for these choices, and what they reveal about the belief systems of these societies. Using statistical analyses and 2D and 3D GIS, it will be demonstrated that vision is the main force behind locational decisions. The GIS analyses revealed that the builders chose a particular horizon shape, defined by qualities of distance, direction and relative apparent height as viewed from the monument (altitude). Significantly, approximately half the sites have the same locational variables as all the sites considered on the isles of Coll and Tiree (labelled 'classic sites': Higginbottom et al. in J Archaeol Method Theory 22:584–645, 2015. 10.1007/s10816-013-9182-7), while the other half are the topographical reverse ('reverse sites'), where the major 'astronomical show' differs due to the topographical differences between the site types. It is relevant to note that landscapes that block views of particular major astronomical phenomena in the south are significantly more common at reverse sites than at classic sites. Specific results pertaining to individual areas will also be highlighted. It will be seen that the interplay between the astronomy and the topographical choices of the builders at each site highlights possible cosmological ideologies that can be observed and that were shared across western Scotland. [ABSTRACT FROM AUTHOR]

Aim: To determine whether a food frequency questionnaire (FFQ) and a short dietary assessment tool can be used to accurately estimate the Eatwell Guide proportions (a plate‐based food model) of diets of adults living in Scotland. Methods: The cross‐sectional study was conducted as a follow up of the 2010 Scottish Health Survey (participants aged 18–65 years old). Proportions of the Eatwell Guide food groups (starchy carbohydrates, fruits and vegetables (F&V), dairy and alternatives, protein foods and oils and spreads) were calculated from the Scottish Health Survey Eating Habits Module (SHeS EHM), Scottish Collaborative Group FFQ (SCG FFQ) and a seven‐day estimated food diary (reference method), and compared using the Aitchison method and Wilcoxon Signed‐Rank Test. Bland–Altman analyses assessed mean difference and 95% limits of agreement between the methods for each food group. Results: Ninety‐six adults were included (mean (SD) age = 51.4 (11.1) years; body mass index = 27.1 (4.9) kg/m2; 58% female). The SCG FFQ scored a lower median Aitchison distance (1.47) than the SHeS EHM (1.99) (P < 0.001), showing greater agreement with the reference method (P < 0.001). Bland–Altman plots also showed better agreement for the SCG FFQ than the SHeS EHM. Poorest agreement was for starchy carbohydrates (both methods), protein foods (SHeS EHM) and dairy (SCG FFQ). Conclusions: The SCG FFQ could be used to estimate Eatwell Guide proportions and monitor compliance to the Eatwell Guide recommendations and could be improved with small changes. The SHeS EHM is less suitable, but additional questions on dairy foods, and oils and spreads would improve its ability to estimate the Eatwell Guide proportions. [ABSTRACT FROM AUTHOR]

Background: Preschool language and behavioural difficulties impact on multiple domains of the child's early life and can endure into adulthood, predicting poor educational, social, and health outcomes. Highlighting risk factors associated with poor outcomes following language and behavioural difficulties raised in early childhood may facilitate early identification and intervention. Methods: Data from the Growing Up in Scotland national birth cohort study were used. Language and behavioural difficulties were assessed at age 4 years using parent‐reported language concerns and the Strengths and Difficulties Questionnaire. Measures of adjustment were collated into four key outcome domains: attitude to school life, language and general development, behaviour, and general health at age 6 years. Both univariate and multivariate logistic regression models were fitted in order to explore independent associations between language and behavioural difficulties at age 4 years and adjustment to life circumstances at age 6 years, whilst controlling for other risk factors. Results: Language difficulties at age 4 years increased the odds of the child experiencing difficulty with language and general development, poorer health outcomes, and behavioural difficulties at age 6 years. Behavioural difficulties alone at age 4 years were associated with increased odds of the child experiencing all of the aforementioned outcomes and difficulties in early school life. Lone parent family, low income, and male gender were identified as risk factors for poorer outcomes in the domains measured. At age 4 years, there was no additive effect found with the presence of behaviour difficulties on the relationship between language difficulties and language and developmental outcomes at 6 years. Conclusions: This paper demonstrates language and behavioural difficulties are associated with poor social, educational, health, and behavioural outcomes. Taking seriously parent‐reported concerns and identifying risk factors could limit negative outcomes for the child, their family, and society. [ABSTRACT FROM AUTHOR]

Background: For the last 17 years, the UK has employed a routine influenza vaccination programme with the aim of reducing the spread of seasonal influenza. In mid‐2000, the programme moved from a purely risk‐based approach to a risk and age group‐targeted approach with all those aged 65+ years being included. To date, there has been no assessment of the population effectiveness of this age‐targeted policy in Scotland. Objectives: Statistical modelling techniques were used to determine what impact the routine vaccination of those aged 65+ years has had on influenza‐related morbidity and mortality in Scotland. Methods: Two Poisson regression models were developed using weekly counts of all‐cause mortality, cause‐specific mortality and emergency hospitalisations for the period 1981‐2012, one using week‐in‐year and the other using temperature to capture the seasonal variability in mortality/hospitalisations. These models were used to determine the number of excess deaths/hospitalisations associated with the introduction of the local risk and age‐based vaccination programme in 2000. Results: Routinely vaccinating those aged 65+ years is associated with a reduction in excess all‐cause mortality, cardiovascular and COPD‐related mortality and COPD‐related hospitalisations. Our analysis suggests that using the week‐in‐year model, on average, 732 (95% CI 66‐1398) deaths from all causes, 248 (95% CI 10‐486) cardiovascular‐related deaths, 123 (95% CI 28‐218) COPD‐related deaths and 425 (95% CI 258‐592) COPD‐related hospitalisations have been prevented each flu season among the those aged 65+. Similar results were found using the temperature model. There was no evidence to suggest that the change in policy was associated with reductions in influenza/pneumonia‐related mortality or influenza/cardiovascular‐related hospitalisations. Conclusions: Routinely vaccinating those aged 65+ years appears to have reduced influenza‐related morbidity and mortality in Scotland. With the childhood vaccination programme well underway, these data provide an importance benchmark which can be used to accurately assess the impact of this new seasonal influenza vaccination programme. [ABSTRACT FROM AUTHOR]

In contrast with diabetic foot ulceration (DFU) and lower-extremity amputation (LEA), current Scottish patient information leaflets reserve Charcot foot education for individuals 'In Remission' from, or with active, Charcot foot. A small group of Scottish NHS podiatrists recently agreed Charcot foot education should be delivered to all 'At-risk' individuals with diabetic peripheral neuropathy. This study sought to compare discussion about diabetes foot disease and Charcot foot between 'At-risk' and 'In Remission' groups among this cohort. Fourteen participants completed an 'At-risk' component of the Charcot foot patient education questionnaire, while six also completed an 'In Remission' component. Topics investigated for both groups included DFU and LEA risk, footwear and insoles, and signs of infection and Charcot foot. Frequency of discussion data was captured with a five-point Likert scale. Median response and interquartile range (IQR) were described and compared between groups. Median values and IQR for discussion of DFU and LEA risk were 5 (IQR 1) and 3 (IQR 1.25) respectively for 'At-risk' groups, and 5 (IQR 0.25) and 3 (IQR 2), respectively, among the 'In Remission' group. For discussion of footwear and insoles, the median response was 4 (IQR 1) for 'At-risk' and 5 (IQR 1) for 'In Remission' groups, reversed for discussion of signs of infection. The greatest between-group discrepancy was found for discussion of Charcot foot, with median responses and IQR found to be 3 (IQR 2) and 5 (IQR 0.25) for 'At-risk' and 'In Remission' groups, respectively. This discrepancy has potential implications for Charcot foot educational strategies, audit and research. It is proposed that 'always' should be the benchmark for frequency of Charcot foot education, not just for those 'In Remission' but also those 'At risk'. [ABSTRACT FROM AUTHOR]

Introduction: The optimal surgical approach for caesarean section is uncertain in women with very severe obesity (body mass index (BMI) >40kg/m2). We aimed to assess maternal and surgical predictors of surgical site skin infection (SSSI) in very severely obese women and to undertake an exploratory evaluation of clinical outcomes in women with a supra-panniculus transverse compared to an infra-panniculus transverse skin incision. Material and methods: Using a retrospective cohort design, case-records were reviewed of very severely obese women with a singleton pregnancy delivered by caesarean between August 2011 and December 2015 (n = 453) in two maternity hospitals in Scotland. Logistic regression analysis was used to determine predictors for SSSI. Outcomes were compared between women who had a supra-panniculus transverse compared to infra-panniculus transverse skin incision. Results: Lower maternal age was predictive of SSSI, with current smoking status and longer wound open times being marginally significant. Maternal BMI, suture method and material demonstrated univariate associations with SSSI but were not independent predictors. Women with a supra-panniculus transverse skin incision were older (32.9 (4.4), vs. 30.6 (5.7), p = 0.002), had higher BMI (49.2 (7.1), vs. 43.3 (3.3), p<0.001), shorter gestation at delivery (days) (267.7 (14.9), vs. 274.8 (14.5), p<0.001) and higher prevalence of gestational diabetes mellitus (42.6% vs. 21.9%, p = 0.002). SSSI rates did not differ between supra-panniculus transverse (13/47; 27.7%) and infra-panniculus transverse (90/406; 22.2%; p = 0.395) skin incisions. Conclusion: SSSI rates are high in very severely obese women following caesarean section, regardless of location of skin incision. [ABSTRACT FROM AUTHOR]

Vaginal lubricants are commonly used by couples trying-to-conceive. However, most vaginal lubricants are sperm toxic and therefore should not be used by couples trying-to-conceive. Despite this, lubricant sperm toxicity is insufficiently reported and guidance for healthcare professionals (HCPs) is absent. In this study, lubricant-related practices of fertility-based HCPs in Scotland were sampled via an online survey. Lubricants identified as being utilised in the fertility setting were subsequently incubated with prepared sperm samples to establish effects on sperm motility. HCP recommendations (n = 32) on lubricant use were varied although knowledge related to sperm toxicity was generally poor. HCPs infrequently asked about lubricant use and were unaware of guidance in this area. Aquagel, the only prescribed lubricant identified in this study, reduced sperm progressive motility to 49% of control after 10 minutes, even at concentrations as low as 5%. Vitality testing suggested the deterioration in progressive motility with Aquagel was not as a result of cell death. Conversely, Pré Vaginal Lubricant, a ‘sperm-safe’ lubricant, did not significantly affect any markers of sperm function assessed. Development of clinical guidance in this area is recommended to ensure HCPs deliver informed advice as lubricant use in couples trying-to-conceive may inadvertently contribute to delay in conception. [ABSTRACT FROM AUTHOR]

Background This study estimates trends in prevalence, and patterns, of individual and multiple substance use between 2002 and 2013 amongst adolescents in Scotland. Methods The study uses data from 134 387 participants of the biennial national 'Scottish Schools Adolescent Lifestyle and Substance Use Survey' on smoking, alcohol and illicit drug use. Current regular use and current heavy use of smoking, alcohol, illicit drugs and multiple substances was measured. Time trends in the prevalence of each outcome were estimated using univariate and multivariate logistic regression. Results Regular smoking, alcohol, illicit drug and multiple substance use declined significantly amongst adolescents in Scotland. However, multivariate analyses that focussed upon high-risk levels of these behaviours revealed an upward linear trend in heavy alcohol (OR = 1.06; 95% CI: 1.04, 1.07) and heavy illicit drug (OR = 1.04; 95% CI: 1.00, 1.08) use (P < 0.05). Non-white pupils were more likely to be involved in individual and multiple substance use than ethnically white British pupils. In comparison to pupils from the least deprived socioeconomic quintile, pupils from the most deprived quintile had increased odds of 1.41 (95% CI: 1.02, 1.97; P < 0.05) and 1.62 (95% CI: 1.14, 2.29; P < 0.05) of being regular and heavy multiple substance users, respectively. Conclusions Further effort is required to tackle heavy alcohol and heavy illicit drug use amongst adolescents in Scotland. Prevention strategies should be informed by the risk profiles of substance misusers and evidence around the clinical and cost-effectiveness of preventive interventions. [ABSTRACT FROM AUTHOR]

Objective: The individual recovery outcomes counter is a 12-item personal recovery self-assessment tool for adults with mental health problems. Although widely used across Scotland, limited research into its psychometric properties has been conducted. We tested its' measurement properties to ascertain the suitability of the tool for continued use in its' present form. Materials and methods: Anonymised data from the assessments of 1743 adults using mental health services in Scotland were subject to tests based on principles of Rasch measurement theory, principal components analysis and confirmatory factor analysis. Results: Rasch analysis revealed that the six-point response structure of the individual recovery outcomes counter (I.ROC) was problematic. Re-scoring on a four-point scale revealed well-ordered items that measure a single, recovery-related construct, and has acceptable fit statistics. Confirmatory factor analysis supported this. Scale items covered around 75% of the recovery continuum; those individuals least far along the continuum were least well addressed. Conclusions: A modified tool worked well for many, but not all, service users. The study suggests specific developments are required if the I.ROC is to maximise its' utility for service users and provide meaningful data for service providers. Implications for Rehabilitation: Agencies and services working with people with mental health problems aim to help them with their recovery. The individual recovery outcomes counter has been developed and is used widely in Scotland to help service users track their progress to recovery. Using a large sample of routinely collected data we have demonstrated that a number of modifications are needed if the tool is to adequately measure recovery. This will involve consideration of the scoring system, item content and inclusion, and theoretical basis of the tool. [ABSTRACT FROM AUTHOR]

The process of ovarian aging is influenced by a complex and poorly understood interplay of endocrine, metabolic, and environmental factors. The purpose of this study was to explore the feasibility of using latent class analysis to identify subgroups based on cardiometabolic, psychological, and reproductive parameters of health and to describe patterns of anti-Müllerian hormone levels, a biomarker of the ovarian reserve, within these subgroups. Sixty-nine lean (body mass index [BMI] ⩽ 25 kg/m2) and severely obese (BMI ⩾ 40 kg/m2) postpartum women in Edinburgh, Scotland, were included in this exploratory study. The best fitting model included three classes: Class 1, n = 23 (33.5%); Class 2, n = 30 (42.2%); Class 3, n = 16 (24.3%). Postpartum women with lower ovarian reserve had less favorable cardiometabolic and psychological profiles. Examining the ovarian reserve within distinct subgroups based on parameters of health that affect ovarian aging may facilitate risk stratification in the context of ovarian aging. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to review the Mental Health Foundation’s experiences designing, implementing and evaluating peer-focused self-management programmes. Through a discussion of barriers and good practice, it outlines ways to be successful in making such projects work to improve mental health and wellbeing among at-risk populations.Design/methodology/approach A total of 11 Mental Health Foundation programmes implemented over the past ten years were reviewed through reading manuals and publications and interviewing programme managers. Key data were extracted from each programme to analyse trends in aims, outcomes and recommendations.Findings Through a focus on peer-work, programmes taught individuals from a variety of societal sectors self-management skills to effectively deal with life stressors. Through sharing in non-judgmental spaces and taking ownership of programme design and content, individuals realised improvements in wellbeing and goal achievement.Practical implications Good practice, barriers and recommendations can be taken from this review and applied to future peer-focused self-management programmes. By better embedding quantitative and qualitative evaluations into programme development and implementation, programmes can add to the evidence base and effectively target needs.Originality/value This review lays out valuable experience on an innovative community service paradigm and supports the evidence on effectiveness of peer-focused self-management programmes with a variety of group populations. [ABSTRACT FROM AUTHOR]

Background The UK National Health Service aims to provide universal availability of healthcare, and eye-care availability was a primary driver in the development of the Scottish General Ophthalmic Services (GOS) model. Accordingly, a relatively equal distribution of optometry practices across socio-economic areas is required. We examined practice distribution relative to deprivation. Methods 672 practices were sampled from nine Health Boards within Scotland. Practices were assigned a deprivation ranking by referencing their postcode with the Scottish Index of Multiple Deprivation (SIMD) tool (Scottish Executive National Statistics: General Report. 2016). Results Averaged across Health Boards, the share of practices for the five deprivation quintiles was 25, 33, 18, 14 and 11% from most to least deprived area, respectively. Although there was some variation of relative practice distribution in individual Health Boards, 17 of the 45 regions (nine Health Boards, five quintiles) had a close balance between population and share of practices. There was no clear pattern of practice distribution as a function of deprivation rank. Analysis revealed good correlation between practice and population share for each Health Board, and for the combined data (R 2 = 0.898, P < 0.01). Conclusion Distribution of optometry practices is relatively balanced across socio-economic areas, suggesting that differences in eye-examination uptake across social strata are unrelated to service availability. [ABSTRACT FROM AUTHOR]

Background The Scottish Dietary Goals (SDGs) were published to promote healthier diets. The higher cost of healthier diets may be a barrier to their adoption by households in deprived areas. The aim was to estimate dietary intakes relevant to the SGDs, derived from purchase data of food and drinks brought into the home by area of deprivation. Methods A cross-sectional study of estimated intakes of food and nutrients, and on fruit and vegetables (F&V) specifically, from Kantar Worldpanel household food purchase data in Scotland from 2012 (n = 2586). Households were grouped by area based index of multiple deprivation. Results Diets of households were further from achieving the SDGs as deprivation increased. Linear regression showed that estimated intakes of oil rich fish decreased, and red and processed meat increased with increasing deprivation (both P < 0.001), while estimated intakes of F&V decreased (P < 0.001) mainly because of lower amounts of fresh F&V (P < 0.001). Negative linear associations were observed between deprivation and the amount spent per person on F&V (P < 0.001), and the amount spent per 100 g of F&V (P < 0.001). Conclusions This study provides further insights into the relationship between social deprivation and diet quality in Scotland, notably in amounts of fresh F&V purchased. [ABSTRACT FROM AUTHOR]

Background: Little comparative evidence is available on utilisation of cancer medicines in different countries and its determinants. The aim of this study was to develop a statistical model to test the correlation between utilisation and possible determinants in selected European countries.Methods: A sample of 31 medicines for cancer treatment that obtained EU-wide marketing authorisation between 2000 and 2012 was selected. Annual data on medicines' utilisation covering the in- and out-patient public sectors were obtained from national authorities between 2008 and 2013. Possible determinants of utilisation were extracted from HTA reports and complemented by contacts with key informants. A longitudinal mixed effect model was fitted to test possible determinants of medicines utilisation in Belgium, Scotland and Sweden.Results: In the all-country model, the number of indications reimbursed positively correlated with increased consumption of medicines [one indication 2.6, 95% CI (1.8-3.6); two indications 2.4, 95% CI (1.4-4.3); three indications 4.9, 95% CI (2.2-10.9); all P < 0.01], years since EU-wide marketing authorisation [1.2, 95% CI (1.02-1.4); p < 0.05], price per DDD [0.9, 95% CI (0.998-0.999), P < 0.01], and Prescrire rating [0.5, 95% CI (0.3-0.9), P < 0.05] after adjusting for time and other covariates.Conclusions: In this study, the most important correlates of increased utilisation in a sample of cancer medicines introduced in the past 15 years were: medicines coverage and time since marketing authorisation. Prices had a negative effect on consumption in Belgium and Sweden. The positive impact of financial MEAs in Scotland suggests that the latter may remove the regressive effect of list prices on consumption. [ABSTRACT FROM AUTHOR]

Background Socioeconomic inequality in child mortality highlights opportunities for policies to reduce child deaths. Methods We used singleton birth, death and maternity records from Scotland, 1981-2011, to examine mortality rate differences by age across deprivation quintiles over time. We measured the difference between the most and least deprived quintiles (Q5-Q1) and the slope index of inequality (SII) across all quintiles--measures of the absolute deprivation gap, providing an indication of the public health impact. Results Q5--Q1 remained relatively constant from 1990 onwards for early neonates, widened in the mid-2000s for late neonates, increased in the 1990 s then decreased in the 2000 s in the post-neonates and declined over time in early childhood. The trend over time in SII showed no significant change for early neonates (P = 0.440), significant decrease for post-neonates (P = 0.010) and early childhood (P = 0.043), and significant increase for late neonates (P = 0.011). Conclusions Over three decades, the absolute deprivation gap in mortality widened in late neonates but stabilized or declined at other ages. This may reflect improved survival beyond the early neonatal period of babies with conditions related to socioeconomic inequality such as prematurity. Monitoring birth cohort data could enhance understanding of this vulnerable group. [ABSTRACT FROM AUTHOR]

Introduction Over 25% of people with multiple sclerosis experience tremor, which may impact on activities of daily living and quality of life. Yet there is no method to objectively measure tremor and effectiveness of interventions on tremor. This study aimed to test validity and reliability of a new objective measurement for upper limb tremor in people with multiple sclerosis. Method Twelve participants with multiple sclerosis who self-reported tremor were observed performing standardised tasks. Validity and reliability of a new method to detect tremor from wrist movement was established against occupational therapist observation of tremor (FAHN). Concurrent validity of severity (displacement) of tremor was assessed. Responsiveness to change in tremor characteristics was explored in a sub-set of participants using weighted wrist-cuffs. Results The new method correctly predicted 98.2% of tremor cases identified by the occupational therapist, with high sensitivity (0.988) and specificity (0.976). Calculated displacement of tremor correlated with FAHN tremor severity scores moderately (rs = .452, p = .004). The new measure was responsive to changes in tremor characteristics due to change in weight of wrist-cuffs. Conclusion The new method of characterising tremor in those with multiple sclerosis demonstrated excellent validity and reliability in relation to tremor identified by an occupational therapist, and could provide valuable objective insight into the efficacy of interventions. [ABSTRACT FROM AUTHOR]

This study compared the progression of muscular strength (MS) adaptation between age-matched Caucasian (CAUC) and South Asian (SOU) men during 6 weeks (3× week−1) of resistance training. MS was determined pre and post intervention by 3-repetition maximum (3RM) strength tests, and data were analysed using repeated measures ANOVA. Pre-intervention upper and lower body 3RM were similar between groups and both upper and lower body 3RM increased in CAUCs (P < .001) and SOUs (P < .001) following resistance training. However, lower body strength adaptation (3RM) was higher in CAUCs compared with SOUs (P = .002). There was a significant group × time interaction in strength progression of the squat exercise (P = 0.03) from session 7 through to 18 (completion). The present study offers novel but provisional data that lower body strength adaptation is slower in SOU than CAUC men despite comparable adaptation to upper body strength. [ABSTRACT FROM PUBLISHER]

An important statistical task in disease mapping problems is to identify divergent regions with unusually high or low risk of disease. Leave-one-out cross-validatory (LOOCV) model assessment is the gold standard for estimating predictive p-values that can flag such divergent regions. However, actual LOOCV is time-consuming because one needs to rerun a Markov chain Monte Carlo analysis for each posterior distribution in which an observation is held out as a test case. This paper introduces a new method, called integrated importance sampling (iIS), for estimating LOOCV predictive p-values with only Markov chain samples drawn from the posterior based on a full data set. The key step in iIS is that we integrate away the latent variables associated the test observation with respect to their conditional distribution without reference to the actual observation. By following the general theory for importance sampling, the formula used by iIS can be proved to be equivalent to the LOOCV predictive p-value. We compare iIS and other three existing methods in the literature with two disease mapping datasets. Our empirical results show that the predictive p-values estimated with iIS are almost identical to the predictive p-values estimated with actual LOOCV and outperform those given by the existing three methods, namely, the posterior predictive checking, the ordinary importance sampling, and the ghosting method by Marshall and Spiegelhalter (2003). Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Shifts in demographic profiles and in the understanding of how to best deliver health care have seen nurses increasingly caring for non-acute client groups outside traditional clinical settings. Evidence suggests that this does not always sit well with nurses, or with nurses in training. This study sought to investigate the influences on student nurse perceptions of the worth of working with various client groups. Thematic analysis of a focus group discussion led to the identification of several themes suggesting that unhelpful opinions are present in some students on entry to the programme; however, programme-related influences also contribute towards unhelpful attitudes. To create a more positive framing of working within such specialisms will require significant focus across nursing, nurse education and society in general. [ABSTRACT FROM AUTHOR]

Objective To measure agreement between dental therapists and the Scottish gold-standard dentist undertaking National Dental Inspection Programme ( NDIP) examinations. Methods A study of interexaminer agreement between 19 dental therapists and the national gold-standard dentist was carried out. Pre-calibration training used the caries diagnostic criteria and examination techniques agreed by the British Association for the Study of Community Dentistry ( BASCD). Twenty-three 5-year-old children (Primary 1) and 17 11-year-old children (Primary 7) children were examined. Agreement was assessed using kappa statistics on d3mft and D3 MFT for P1 and P7 children, sensitivity and specificity values, and kappa statistics on d3t/D3T and ft/ FT. Calibration data on P1 and P7 children from 2009-2012 involving dentists as examiners were used for comparison. Economic evaluation was undertaken using a cost minimization analysis approach. Results The mean kappa score was 0.84 ( SD 0.07) ranging from 0.69 to 0.94. All dental therapists scored good or very good agreement with the gold-standard dentist. This compares with historic NDIP calibration data with dentists, against the same gold-standard dentist, where the mean kappa value was 0.68 ( SD 0.22) with a range of 0.35-1.00. The mean sensitivity score was 0.98 ( SD 0.04) (range 0.88-1.0) and mean specificity score was 0.90 ( SD 0.06) (range 0.78-0.96). Health economic analysis estimated that salary costs would be 33.6% lower if dental therapists were substituted for dentists in the year 2013, with an estimated saving of approximately £103 646 per annum on the national budget. Conclusion We conclude that dental therapists show a high level of interexaminer agreement, and with the appropriate annual training and calibration, they could undertake dental examinations as part of the NDIP programme. [ABSTRACT FROM AUTHOR]

Background Alcohol-related mortality and morbidity among women has increased over recent decades, especially in areas of higher deprivation. Pre-pregnancy alcohol use is associated with continued consumption in pregnancy. We assessed whether general population alcohol consumption patterns were reflected among pregnant women in two Scottish areas with different deprivation levels. Methods Cross-sectional study in two health boards ( HB1, lower deprivation levels, n = 274; HB2, higher deprivation levels, n = 236), using face-to-face 7-day Retrospective Diary estimation of peri-conceptual and mid-pregnancy alcohol consumption. Results A greater proportion of women in HB2 (higher deprivation area) sometimes drank peri-conceptually, but women in HB1 (lower deprivation area) were more likely to drink every week (49.6 vs 29.7%; p < 0.001) and to exceed daily limits (6 units) at least once each week (32.1 vs 14.8%; p < 0.001). After pregnancy recognition, consumption levels fell sharply, but women in HB2 were more likely to drink above recommended daily limits (2 units) each week (2.5 vs 0.0%; p < 0.05). However, women in HB1 were more likely to drink frequently. Women with the highest deprivation scores in each area drank on average less than women with the lowest deprivation scores. Conclusions Heavy episodic and frequent consumption was more common in the lower deprivation area, in contrast with general population data. Eliciting a detailed alcohol history at the antenatal booking visit, and not simply establishing whether the woman is currently drinking, is essential. Inconsistent messages about the effects of alcohol in pregnancy may have contributed to the mixed picture we found concerning peri-conceptual and mid-pregnancy alcohol consumption. [ABSTRACT FROM AUTHOR]

Aims To investigate whether metformin therapy alters circulating aromatic and branched-chain amino acid concentrations, increased levels amino acid concentrations, increased levels of which have been found to predict Type 2 diabetes. Methods In the Carotid Atherosclerosis: Metformin for Insulin Resistance ( CAMERA) study ( NCT00723307), 173 individuals without Type 2 diabetes, but with coronary disease, were randomized to metformin ( n=86) or placebo ( n=87) for 18 months. Plasma samples, taken every 6 months, were analysed using quantitative nuclear magnetic resonance spectroscopy. Ten metabolites consisting of eight amino acids [three branched-chain (isoleucine, leucine, valine), three aromatic (tyrosine, phenylalanine, histidine) and two other amino acids (alanine, glutamine)], lactate and pyruvate were quantified and analysed using repeated-measures models. On-treatment analyses were conducted to investigate whether amino acid changes were dependent on changes in weight, fat mass or insulin resistance estimated using homeostasis model assessment (HOMA-IR). Results Tyrosine decreased [−6.1 μmol/l (95% CI −8.5, -3.7); P<0.0001], while alanine [42 umol/l (95% CI 25, 59); P<0.0001] increased in the metformin-treated group compared with the placebo-treated group. Decreases in phenylalanine [−2.0 μmol/l (95% CI −3.6, −0.3); P=0.018] and increases in histidine [2.3 μmol/l (95% CI 0.1, 4.6); P=0.045] were also observed in the metformin group, although these changes were less statistically robust. Changes in these four amino acids were not accounted for by changes in weight, fat mass or HOMA-IR values. Levels of branched-chain amino acids, glutamine, pyruvate and lactate were not altered by metformin therapy. Conclusions Metformin therapy results in a sustained and specific pattern of changes in aromatic amino acid and alanine concentrations. These changes are independent of any effects on weight and insulin sensitivity. Any causal link to metformin's unexplained cardiometabolic benefit requires further study. [ABSTRACT FROM AUTHOR]

Background: Scottish Intercollegiate Guidelines Network and National Institute of Health and Care Excellence guidelines stress the importance of assessing patients with psoriasis for psoriatic arthritis, comorbidities associated with severe disease and quality of life (QoL). The purpose of the study was to evaluate the primary care management of psoriasis in relation to disease severity and QoL from a patient's perspective. Methods: A cross-sectional survey of adults (≥18 years) with psoriasis managed in primary care was conducted in Scotland over 1-year (2012-2013). Patients with psoriasis were identified and invited to participate in the online/ telephone survey. The questionnaires included; Dermatology Life Quality Index (DLQI), Self-Administered Psoriasis Area and Severity Index (SAPASI), Psoriasis Epidemiology Screening Tool (PEST). The primary outcome measure was DLQI. Secondary outcomes included; demographics; comorbidities; involvement of different body sites; SAPASI and PEST scores. Relationships between measures were analysed using univariate analysis. Results: The mean age of patients (n = 905) was 54.5 years (SD = 16.1), 436 (48.2 %) were men, and median DLQI and SAPASI scores were 4.0 and 6.0, respectively. Current psoriasis treatments were topical only (587, 64.9 %), oral medications or phototherapy (122, 13.5 %), biologics (26, 3 %) and none (156, 17.2 %). Despite SIGN recommendations, 256 of 391 patients (65.5 %) with a DLQI >5 (at least a moderate effect on QoL) had not seen a specialist during the past year. According to PEST scores, 259 patients (28.6 %) had symptoms suggestive of psoriatic arthritis requiring rheumatology referral. Conclusion: National recommendations are not being fully implemented in primary care in patients with psoriasis or psoriatic arthritis. [ABSTRACT FROM AUTHOR]

One of the most famous sound features of Scottish English is the short/long timing alternation of /i u ai/ vowels, which depends on the morpho-phonemic environment, and is known as the Scottish Vowel Length Rule (SVLR). These alternations make the status of vowel quantity in Scottish English (quasi-)phonemic but are also susceptible to change, particularly in situations of intense sustained dialect contact with Anglo-English. Does the SVLR change in Glasgow where dialect contact at the community level is comparably low? The present study sets out to tackle this question, and tests two hypotheses involving (1) external influences due to dialect-contact and (2) internal, prosodically induced factors of sound change. Durational analyses of /i u a/ were conducted on a corpus of spontaneous Glaswegian speech from the 1970s and 2000s; four speaker groups were compared, two of middle-aged men, and two of adolescent boys. Our hypothesis that the development of the SVLR over time may be internally constrained and interact with prosody was largely confirmed. We observed weakening effects in its implementation which were localised in phrase-medial unaccented positions in all speaker groups, and in phrase-final positions in the speakers born after the Second World War. But unlike some other varieties of Scottish or Northern English which show weakening of the Rule under a prolonged contact with Anglo-English, dialect contact seems to be having less impact on the durational patterns in Glaswegian vernacular, probably because of the overall reduced potential for a regular, everyday contact in the West of Scotland. [ABSTRACT FROM AUTHOR]