Search

Background: Social rehabilitation, including return to work (RTW), is a key indicator of transplant success. However, little is known regarding the RTW rate following heart transplantation or the factors influencing this. The objective of this study was to examine RTW among heart transplant recipients and identify associated predictors., Methods: Attendees of the post-heart transplant clinic based at the Golden Jubilee National Hospital, Scotland, were invited to respond to a mailed survey comprising a demographic form, an employment history questionnaire, and a modified Brief Illness Perception Questionnaire. Frequency distributions, χ test, and stepwise regression were used to examine employment history and associated factors., Results: Sixty percent of transplant recipients reported working 12 mo prior to transplant compared with 50% of recipients at 1-y post-transplant. Forty-four percent of all working-age recipients were currently employed, a relatively median rate compared with those found in previous studies. Univariate analysis revealed "receipt of benefits," "time off work pre-heart transplant," "employment 12 mo pre-heart transplant," "employment at listing," "perceived work ability," "discharge age," "illness consequences," "illness concern," and "emotional representation" as predictors of RTW. Logistic regression modeling revealed "time off work pre-heart transplant" and "perceived work ability" to have the most significant influence on RTW, explaining 62% of the variance in outcome., Conclusions: Psychological and demographic variables influence RTW after heart transplant. Knowledge and understanding of these variables facilitate the design of interventions and services to help promote RTW and social rehabilitation. Study limitations are discussed, and suggestions for similar research and the outpatient clinic are provided.

Background: Scalp psoriasis is a chronic recalcitrant condition. An aging literature for topical treatments used in clinical practice and no treatment guidelines means there is no current gold standard for its management in Scotland. There are no Scottish data on the resources and costs of treatment of the scalp psoriasis patient., Objective: Conduct a survey of Scottish healthcare professionals to understand how patients are typically managed to support the development of a model estimating the cost-effectiveness of a new treatment for moderately severe scalp psoriasis in Scotland., Research Design and Methods: Experts from primary and secondary care were invited to participate in an interview programme to collect information on the management of scalp psoriasis in Scotland. This was further informed by Scottish prescribing statistics. Simple descriptive statistics were performed., Results: Forty-three healthcare professionals (33 from primary care and ten in secondary care) completed the survey which illuminated national prescribing statistics. While an overall 72% response rate was achieved, representation from five of 14 Health Boards was not available. There was significant variation in stated patient pathways but some common themes. Most patients were treated initially with coal tar preparations and shampoos, then often progressing to topical potent corticosteroids. There was no consensus on the order patients might receive topicals thereafter although if referred for specialist review they would typically have been treated with three topicals in primary care first. Treatment in secondary care comprised application of topicals available in primary care or alternative preparations with nurse assistance to improve compliance. Phototherapy and systemic agents were not given to patients with scalp psoriasis alone. Study limitations are not considered to impact on the study observations., Conclusions: There was a large variety in first-, second- and third-line agents in primary care in scalp psoriasis although our interview programme and prescribing data confirmed which treatments were most frequently prescribed. Treatment heterogeneity reflects the limitations in current therapies, paucity of evidence-based effectiveness data and lack of clinical guidelines. Experts agreed 'current standard practice' in Scotland was best described as an average across five plausible treatment pathways.

With an increasing number of available kidney transplant donors comes greater demand for systematic screening of prospective donors to ensure the integrity of the donor's decision and to minimize the risk of a poor postoperative outcome. The present study was intended to explore psychosocial outcomes after kidney donation, aspects of donors' decision making, and donors' experience of the transplantation process. It was hoped that this pilot study would inform the design of a large-scale longitudinal prospective investigation of psychosocial outcomes of kidney donation. In this cross-sectional, retrospective investigation, all patients who had received psychosocial screening before their kidney donation were approached. Seventeen of 43 previous kidney donors responded to a postal questionnaire. Donors' health-related quality of life was higher than population norms on all dimensions. Most participants reported involving someone else in the decision-making process. Donors indicated high levels of satisfaction with virtually all aspects of the donation process. The generalizability of the findings in the context of the limitations of the present pilot study is discussed and specific suggestions for the design of future studies are provided.

Objective: To determine whether multidrug-resistant (MDR) strains of Mycobacterium bovis isolated from patients in Scotland were genotypically related., Design: Genotypes of MDR strains were determined using three molecular fingerprinting techniques: pulsed-field gel electrophoresis (PFGE), spoligotyping and restriction fragment length polymorphism (RFLP). PFGE profiles were also obtained for all medical and veterinary isolates occurring in Scotland in 1997-1998., Results: MDR strains showed individual Dra I PFGE profiles. Case III/98 had a profile represented in both veterinary and medical populations, Case I/94 had a profile observed in medical but not veterinary isolates, and Case II/98 had a profile unique to this study. Afl II PFGE discriminated the resistant strains. Spoligotyping grouped Cases I/94 and II/98 (ST-134). Case III/98 had a spoligotype ST-140, which is commonly observed in veterinary isolates. Similarly, DRr-RFLP analysis grouped cases I/94 and II/98, whereas Case III/98 had a common veterinary profile. DRX(PGRS) RFLP gave three unique profiles., Conclusion: Three resistant strains were discriminated by PFGE and DRX(PGRS) RFLP, indicating that the three strains are not related in an epidemiologically relevant time scale. However, Cases I/94 and II/98 were more closely linked by spoligotyping and DRr-RFLP data. PFGE and DRr-RFLP linked Case III/98 profiles to the most common veterinary isolate.

Mycobacterium avium subspecies paratuberculosis, the organism responsible for paratuberculosis in cattle and sheep has been found in wild rabbits (Oryctolagus cuniculus) in the east of Scotland. Few studies have investigated either the level of faecal contamination by rabbits on farms, or the potential infectivity of rabbit excreta. The rate of rabbit faecal contamination deposited and the numbers encountered were estimated for 21 fields on 4 farms with a paratuberculosis problem. 7357 +/- 2571 S.E.M. rabbit faecal pellets were deposited per hectare per day and up to 81,000 pellets/ha ('standing crop') were encountered in October/November 1998. Where access to rabbits was restricted, the standing crop of faeces encountered fell to 22,000 pellets/ha. The prevalence of infection with M. a. paratuberculosis was assessed for 83 rabbits from the four farms. M. a. paratuberculosis was isolated from rabbits on all farms with an overall prevalence of 17%. Out of 17 rabbits from which urine was available, M. a. paratuberculosis was isolated from two--the first reported isolation from urine in wild rabbits. The mean number of colony-forming units per gram of infected rabbit faeces was 7.6 x 10(5) +/- 5.2 x 10(5). A relative estimate of the input of M. a. paratuberculosis onto pasture, at the stocking levels found on the four farms, showed that sheep and cattle potentially contributed 4 and 125 times more organisms/ha per day respectively than rabbits. However, rabbits could still contribute millions of M. a. paratuberculosis organisms per ha per day. Existing rabbit control measures on farms may be inadequate in reducing the risk of transmission to livestock.

Paratuberculosis (Johne's disease) was long considered only a disease of ruminants. Recently non-ruminant wildlife species have been shown to harbor Mycobacterium avium subsp. paratuberculosis, the causative organism of paratuberculosis. We review the known non-ruminant wildlife host range of M. avium subsp. paratuberculosis and consider their role in the epidemiology of paratuberculosis in domestic ruminant livestock. Mycobacterium avium subsp. paratuberculosis has been isolated from lagomorph, canid, mustelid, corvid, and murid species. In agricultural environments domestic ruminants may contact wildlife and/or their excreta when grazing or feeding on farm-stored feed contaminated with wildlife feces, opening up the possibility of inter-species transmission. Of the wildlife species known to harbor M. avium subsp. paratuberculosis in Scotland, the rabbit is likely to pose the greatest risk to grazing livestock. Paratuberculosis in domestic ruminants is a notoriously difficult disease to control; the participation of non-ruminant wildlife in the epidemiology of the disease may partially account for this difficulty.

Natural paratuberculosis infection of rabbits (Oryctolagus cuniculus) was recently diagnosed in Scotland, and an investigation into the pathology of the disease in wild rabbits is reported in this paper. Evidence of Mycobacterium avium subsp. paratuberculosis (M.a. paratuberculosis) infection was detected in 22% of 110 rabbits; the organism was cultured from 17 of 110 rabbits, and histopathological lesions consistent with M.a. paratuberculosis infection were noted in 18 of 98 rabbits examined. No macroscopical lesions suggestive of M.a. paratuberculosis infection were observed. The histopathological lesions were either severe or mild. Severe lesions consisted of extensive macrophage granulomata and numerous giant cells, with many intracellular acid-fast bacteria in the small intestine. For the examination of formalin-fixed, paraffin wax-embedded tissues, neither immunohistochemistry nor the polymerase chain reaction was as sensitive a method of diagnosis as histopathology.

Recent reports of natural paratuberculosis (or Johne's disease) in rabbits, foxes, and stoats has focused debate on the presence and importance of wildlife reservoirs in the epidemiology of this disease. This paper describes an extensive study investigating 18 nonruminant wildlife species for evidence of paratuberculosis. Using both culture and histopathological analysis, fox, stoat, weasel, crow, rook, jackdaw, rat, wood mouse, hare, and badger were found to harbor Mycobacterium avium subsp. paratuberculosis, the causative organism of paratuberculosis, suggesting that the epidemiology of this disease is more complex than previously realized.

Objectives: To obtain further information the incidence of injuries and playing positions affected in club rugby in Scotland., Methods: Routine reports of injury (permanent) and blood (temporary) replacements occurring in competitive club rugby matches by referees to the Scottish Rugby Union during seasons 1990-1991 to 1996-1997 were analysed., Results: A total of 3,513 injuries (87 per 100 scheduled matches) and 1,000 blood replacements (34 per 100 scheduled matches) were reported. Forwards accounted for 60% of the injury and 72% of the blood replacements. Flankers and the front row were the most commonly replaced forwards while wing and centre three quarters were the most vulnerable playing positions among backs. The incidence of injury replacements increased as the match progressed up until the last 10 minutes when the trend was reversed. Blood replacements showed a different pattern with 60% occurring during the first half of the match., Conclusion: The most important finding of the study was reliability of referees in documenting the vulnerability of certain playing positions, and the timing when injuries took place, thus assisting coaches and team selectors when choosing replacement players for competitive club and representative rugby matches. This study re-emphasises the need for continuing epidemiological research.

A survey of 22 farms confirmed the presence of paratuberculosis in wild rabbits in Scotland. Regional differences were apparent in the prevalence of the disease in rabbits, with a significantly higher incidence occurring in the Tayside region. Statistical analysis showed a significant relationship between a previous history or current problem of paratuberculosis in cattle and the presence of paratuberculosis in rabbits on the farms. Molecular genetic typing techniques could not discriminate between selected rabbit and cattle isolates from the same or different farms, suggesting that the same strain may infect and cause disease in both species and that interspecies transmission may occur. The possibility of interspecies transmission and the involvement of wildlife in the epidemiology of paratuberculosis have important implications for the control of the disease.

The objective of the study was to obtain detailed descriptive epidemiological information on sporadic verocytotoxin-producing Escherichia coli O157 infection in Scotland in relation to transmission routes and host-related risk factors. Using a standardized questionnaire, the study was carried out throughout Scotland over an 18-month period from July 1992 and co-ordinated at the Communicable Diseases and Environmental Health (Scotland) Unit, Glasgow (CDEH(S)U). The subjects were laboratory-confirmed cases of Escherichia coli O157 infection, of whom 138 met the criteria for inclusion in the study. The most important findings were the high proportion of cases who had been exposed to environmental factors such as farm animals and/or their by-products; or who had participated in gardening or garden-play; or who had suspected or confirmed household water supply problems, prior to the onset of illness. The frequency and relative importance of environmental risk factors requires further quantification and study in order to assess where control measures can be directed most effectively. The implications for the NHS in preventing this crippling, life-threatening infection are considerable, not least in relation to hospitalization, dialysis and renal transplantation costs.

A survey of wild rabbits in Tayside, Scotland revealed that 67 per cent were infected with Mycobacterium avium subspecies paratuberculosis. In general, the infected rabbits had histopathological changes within the lymph nodes and intestines which were consistent with the changes due to paratuberculosis in ruminants. The survey raises the possibility that rabbits and other wildlife may be involved in the epidemiology of paratuberculosis, a possibility which has important implications for the control of the disease.

It has been demonstrated that bacteria can produce the very potent carcinogens (N-nitroso compounds), from nitrite and suitable amines. It has been hypothesized that this can happen whenever a body site which is normally sterile becomes colonized by bacteria. If this is so then such chronic infections should result in an increased incidence of local cancers and also of cancers at some distant sites. To test this we studied the risk of cancer at various sites in a cohort of chronic carriers of Salmonella typhi/paratyphi. We have observed a greatly increased risk of cancers of the biliary tract and also of cancers of the colorectum, pancreas, lung and all sites. The results are discussed in terms of the hypothesis being tested.

Infections and life-threatening complications due to verotoxin-producing Escherichia coli (VTEC) have been increasingly recognized as a public health problem in recent years. Through enhanced surveillance in Alberta, Canada, and in Scotland, 1,993 cases of VTEC infection and 115 cases of hemolytic-uremic syndrome (HUS) were detected in 1987-1991 in a combined population of more than 7.5 million; there were 24 deaths. The mean annual rates of VTEC infection were 12.1/100,000 and 2.0/100,000 for Alberta and Scotland, respectively. One case of HUS occurred for every 14 (Scotland) to 19 (Alberta) cases of VTEC infection. Rates of VTEC infection were highest among children < 5 years of age, while rates of resultant hospitalization were highest among the elderly. Male-to-female ratios for patients with VTEC infection varied with the age group. The incidence of this infection was highest in the summer: 64.0%-81.7% of cases occurred between May and September. Hamburger was the most common source reported. Unexplained geographic variation in prevalence was evident in both Alberta and Scotland. Most cases were sporadic, although several community and point-source outbreaks were identified in Scotland. HUS exhibited similar epidemiological patterns. Infections with VTEC impose a substantial preventable clinical and public health burden. Routine monitoring of these infections is considered worthwhile in order to elucidate their epidemiology and modes of transmission and ultimately to control them more effectively.

Verotoxin-producing strains of Escherichia coli (VTEC), in particular serotype O157:H7, are now recognised as the major cause of haemorrhagic colitis and the haemolytic uraemic syndrome (HUS) in the U.K. and in North America, and increasingly so in other countries. Over a 3-year period (1989-1991), 16 cases of E. coli 0157 infection occurred in one town (Peterhead) in north-east Grampian. Four patients required admission to hospital, of whom three developed HUS. The bovine source of VTEC infection has now been clearly established with foodborne, waterborne, person-to-person and zoonotic transmission described. Despite extensive local enquiries, the source(s) of infection of the 16 cases in Peterhead was not established. Much still needs to be learned about the epidemiology, risk factors and long-term clinical sequelae of VTEC infection and HUS. Close collaboration between the medical and veterinary professions is of paramount importance in order to provide better understanding of the prevalence of E. coli O157 infection in cattle and the route(s) of transmission to humans.

In May 1992, a small, circumscribed community outbreak of infection due to verotoxin-producing Escherichia coli O157 phage type 49 occurred in a semi-rural area of south-east Scotland. On the basis of stool cultures, six cases were identified, one of whom was asymptomatic. One child developed the haemolytic uraemic syndrome. Although the source of infection of the index case was not established nor could the extent of person-to-person spread be fully determined, the clinical, microbiological and epidemiological evidence available indicated that a children's paddling pool served as the focal point in the transmission of infection causing the outbreak.

It has been shown in vitro that bacteria are able to form or release carcinogens, mutagens, or promoters from intestinal secretions such as bile, or from excretions such as urine. It is, therefore, of interest to find out whether chronic infection of the gallbladder is associated with carcinogens, as in chronic infection of the urinary bladder. A study of cancer risk in chronic typhoid and paratyphoid carriers showed a large excess (observed/expected cases) for cancer of the gallbladder (167.0; 95% confidence interval 54.1-389) and also excess risks of cancer of the pancreas (8.1), colorectum (3.0), lung (2.5), and all neoplasms (2.6). There was no similar excess risk in a group of 386 people with typhoid from the 1964 Aberdeen outbreak. This indicates that it is long-term typhoid carriage, not acute infection, which is the risk factor. This has important implications for cancer prevention. Eradication of chronic carriage, by use of antibiotics or elective cholecystectomy, should be re-emphasised, and the need for good documentation of carriers is, therefore, of great importance.

Between 1980 and 1989, 2,212 outbreaks of food-borne infection were reported in Scotland. Of 2,073 episodes for which a causative agent was established, 1,732 (84%) were caused by salmonellae. An average of 980 people were affected each year, while the average number of individuals infected per general outbreak was 16.8. The infected foods were consumed outside Scotland in 25% of the outbreaks. In 75% of 1,107 episodes where the location was specified, the implicated foods were consumed in the home; hotels and restaurants accounted for 15%. Specific food items were identified in 603 (35%) of the 1,732 outbreaks; poultry meat was responsible for 332 (55%) and milk 49 (8%), while eggs accounted for 23 (4%) outbreaks.

In the 16-year period 1975-90, there were 267 cases of acute infection with typhoidal salmonellae reported in Scotland, in addition to which 32 chronic carriers were identified. The overall incidence of disease changed little over this period, but there was a fall in indigenously acquired paratyphoid B and typhoid, and a rise in imported paratyphoid A. The majority, 215 (81%), had a history of recent travel and were considered to have acquired infection overseas. Only six of the indigenously acquired infections were traced to acutely infected persons, illustrating the low risk of transmission associated with acute enteric fever in the UK. Only one death was definitely ascribed to enteric fever, and one person with S. paratyphi B became a chronic carrier. Significant illness was observed in five chronically infected individuals, including one with carcinoma of the gallbladder. UK residents of 'Asian' ethnicity returning from the Indian subcontinent accounted for 63 (46%) of the 137 cases of typhoid, and 34 (64%) of the 53 cases of paratyphoid A. People of 'Asian' ethnicity were more likely to have acquired infection overseas than 'non-Asians': 110 (89%) of 123 persons compared with 105 (73%) of 144 (odds ratio 3.1, 95% confidence interval 1.5-6.6, P = 0.001). Although there seems to be limited scope for preventing indigenously acquired infection, immunisation of travellers could contribute significantly to reducing the incidence of typhoid.

Objective: To determine the methods of removing ear wax used by local general practitioners and the incidence of associated complications., Design: Postal survey of 312 general practitioners serving a population of about 650,000; supplementary study of ear, nose, and throat outpatients to quantify the improvement in aural acuity after wax removal., Setting: Catchment area of the Edinburgh otolaryngological unit., Participants: 289 General practitioners who responded to the survey; 21 outpatients in the ear, nose, and throat department with occlusive wax., Results: 274 General practitioners removed wax by syringing, but only 53 (19%) always performed the procedure themselves; the remainder routinely delegated the task to practice nurses, some of whom had received no instruction. Ears were rarely examined again after the procedure. Complications had been experienced by 105 practitioners (38%) and included perforation, canal lacerations, and failure of wax removal. The removal of occlusive wax improved hearing by a mean of 5 dB over the frequencies analysed., Conclusions: About 44,000 ears are syringed each year in the area and complications requiring specialist referral are estimated to occur in 1/1000 ears syringed. The incidence of complications could be reduced by a greater awareness of the potential hazards, increased instruction of personnel, and more careful selection of patients.

A survey into the prevalence of salmonella organisms in sewage in the Borders Region of South-east Scotland is described. A total of 317 isolates representing 34 different serotypes were made, of which only 5 serotypes appeared in animals, supporting the view that the spreading of sewage sludge on to pastureland presents little risk to livestock provided the recommended guidelines are followed. Nevertheless, Salmonella typhimurium phage type 12, identified in sewage, was also recovered from animals in incidents on 11 farms, including 4 which had received sludge from this source. A further 48 isolates (13 serotypes) were obtained from the parallel monitoring of abattoir effluents, indicating that the background level of salmonella infection in the animal population appears to be low in comparison to that in humans.

Communication between the medical, veterinary and environmental health professions has been established in Scotland since the early 1970s and was strengthened by the introduction of the Zoonoses Order 1975. The secondment of a veterinary officer to the Communicable Diseases (Scotland) Unit in Glasgow provides veterinary expertise on matters relating to public health, in addition to improving liaison, surveillance and the other functions of the unit.

Outbreaks of abortion associated with infection by Salmonella montevideo have affected sheep in the east, especially the south-east, of Scotland each year since 1972. Disease in the north and north-east was usually less severe. Between 1 January 1970 and 31 December 1981, a total of 67 incidents affecting sheep were reported by veterinary laboratories to the Communicable Diseases (Scotland) Unit, 87% of which presented during the main lambing months of February, March and April. Twenty-one episodes of bovine infection were also recorded over the same period, 17 of which involved single animals only, usually an aborted cow or a scouring calf. Despite intensive investigations, neither the origin nor the mode of spread of S. montevideo infection among sheep and cattle in Scotland have been established with any certainty, although there has been considerable evidence indicating the role of scavenging wild birds, particularly seagulls, as vectors transmitting infection to other farms in the same district. Also largely unexplained are the differences in the epidemiology and clinical pattern of disease in the south-east compared to the north and north-east, while sheep in the west of Scotland have remained virtually unaffected throughout.

A review of 50 hospital-based outbreaks of food poisoning which were reported in Scotland during 1973--7, is described. At least 1530 persons consuming hospital-prepared food were involved. Thirty-one episodes were associated with Clostridium perfringens (C. welchii), 11 were due to food-borne salmonella infection, three to enterotoxigenic Staphylococcus aureus, and five incidents were of undetermined aetiology. This differs noticeably from the experience in England and Wales where salmonellas appear to predominate as the main cause of hospital outbreaks. Twenty-two incidents occurred in hospitals for psychiatric or mentally subnormal patients, and ten others were located in geriatric units. Only 33 hospitals were involved in the 50 outbreaks as nine hospitals experienced two or more episodes. The role of the hospital in the occurrence of food poisoning may be over-emphasized in comparison with other catering establishments, as outbreaks are more readily recognized and laboratory facilities are usually available for investigation, but it is also believed that many episodes may not be reported. The peculiar problems of the hospital-catering service and particularly those of the older long-stay hospitals, are discussed in relation to preventive measures which would minimize the hazards of food poisoning.

Infections carried in milk, particularly salmonellosis and campylobacter enteritis, have continued to feature in Great Britain in recent years. Less commonly reported infections included an outbreak in 1984 in England due to Streptococcus zooepidemicus, in which 12 people, eight of whom died, were admitted to hospital. The implementation of legislation in 1983 requiring heat treatment of cows' milk for sale to the public reduced the incidence of milkborne infection in Scotland compared with previous years and compared with England and Wales, where, without legislative control, outbreaks continue to occur. Until compulsory pasteurisation is introduced throughout Britain and dairy farming communities can be persuaded to drink only heat treated milk outbreaks of milkborne infection will continue.

An outbreak of waterborne cryptosporidiosis affecting 27 persons, diagnosed stool positive, occurred in Ayrshire in April 1988. Twenty-one in 27 confirmed cases required some form of fluid replacement therapy. Local general practitioners indicated a two- to fivefold increase in diarrhoeal disease during the outbreak, and following enquiries made by Environmental Health Officers it became apparent that many hundreds of people had suffered a diarrhoeal illness at that time. Cryptosporidium spp. oocysts were detected in the treated chlorinated water supply system, in the absence of faecal bacterial indicators. Oocyst contamination of a break-pressure tank containing final water for distribution was the cause of this waterborne outbreak. An irregular seepage of oocyst-containing water, which increased during heavy rains, was the cause of the break-pressure tank contamination, rather than a failure of the water-treatment processes. The waterborne route should be considered when clusters of cryptosporidiosis-associated with potable water occur. Waterborne cryptosporidiosis can occur in the absence of other faecal indicators of contamination.

In 1979 WHO recommended the establishment of a surveillance programme in Europe for foodborne infections and intoxications that incorporated an early warning system for incidents affecting more than one country as well as a routine reporting system to record details of outbreaks of foodborne disease. The Early Warning System was introduced in Scotland in July 1979 and the Routine Reporting System in January 1980. By the end of 1985, 23 European countries were participating in the programme.The introduction of the surveillance programme in Scotland permitted the formation of a standard national reporting system for foodborne infections and intoxications. During the 6 years from 1980 to 1985, the major features of the programme in Scotland have been the introduction of compulsory pasteurization of cows' milk, in 1983, with the consequent eradication of general outbreaks of milkborne salmonellosis; the emergence of poultry meat as the major food vehicle of infections; and the development of techniques for costing foodborne disease outbreaks.

During the 10-year period 1978-87 there were 48 outbreaks of food poisoning in Scottish hospitals affecting a total of 2287 persons of whom 12 died. This compared with 50 outbreaks during the previous 5 years (1973-77) when over 1500 persons and 7 deaths were recorded. Although the incidence of outbreaks has decreased the average number of persons affected in outbreaks has increased. A marked reduction was seen in the incidence of outbreaks due to Clostridium perfringens, in contrast to foodborne salmonellosis which remains a problem. Thirty-four hospitals, of which 10 reported two or more outbreaks, were involved. The type of hospitals most frequently affected were general (14), psychiatric (13), geriatric (9) and hospitals for the mentally subnormal (7). Meat, including poultry meat, was incriminated in over 90% of outbreaks where a food vehicle was identified. In modern or re-equipped kitchens cooking in advance with subsequent reheating is being progressively discontinued as more food is being cooked on the day of consumption, a practice which may readily explain the decreasing incidence of outbreaks due to Cl. perfringens. Bacterial cross-contamination from poultry-meat and other raw foods, compounded by inadequate temperature control, however, continues to be a problem in some hospitals. It is too early as yet to determine whether the removal of Crown immunity will have any effect on the future incidence of hospital 'food poisoning'.

A review of campylobacter infection in Scotland over five years (1978-82), during which 7808 human isolates were recorded (mean annual isolation rate of 30 per 100000), revealed differences in the epidemiology of the disease between rural and urban populations which were not apparent in the national data. The incidence of infection in the two rural areas studied was greatest in the early months of the year, whereas that in the two urban areas showed a third-quarter predominance. In both urban and rural populations, age-specific infection rates were highest in children less than 5 years old, but this trend was more pronounced in rural than urban populations. Conversely, secondary peaks in age-specific infection rates observed in young adults were more pronounced in the urban than rural populations. It is postulated that rural children were being infected by campylobacters at an early age by drinking contaminated raw milk which was not normally available to city residents. The lower incidence in adults in the rural populations is interpreted as indicating more widespread immunity, resulting from greater exposure to infection during childhood. The effect of compulsory heat treatment of milk sold in Scotland, introduced in August 1983, is currently being studied.

An estimate of the benefits which would result from a ban on the sale of non-pasteurized milk in Scotland has been assessed by costing a recent outbreak of milk-borne salmonellosis in the Grampian Region. The cost of such a ban would not exceed the benefits under any but the most severe assumptions about the values attached to intangible benefits.

Poultry-borne salmonellosis is the most common form of foodborne infection in Scotland for which the vehicle can be identified, yet little is known about the costs imposed on society by this disease, or the costs of preventing it. The present study identifies and values the costs of a hospital based outbreak of poultry-borne salmonellosis. Account is taken of costs falling on individuals, the health services and society as a whole. Depending on assumptions made about the value of 'intangibles', the cost of the outbreak is estimated to be between pounds 200,000 and pounds 900,000.

The past decade has seen many changes in the relationships between the medical, veterinary and environmental health professions in Britain. Doctors and veterinarians had traditionally tended to remain in isolation to each other despite mutual interests, while working relationships between public health doctors and environmental health officers were disrupted following re-organization of the NHS in 1974 and of local government in 1975. The situation was, however, generally less acute in Scotland where active encouragement had been given since the early 1970s towards the creation of local liaison groups in different areas of the country, the first of which was formally established in Aberdeen in 1969. The subsequent development of other liaison groups and the role of the Communicable Diseases (Scotland) Unit in coordinating inter- and intra-professional liaison and communications throughout Scotland is described, along with examples of combined activities in surveillance, investigation and control measures.

In August, 1980 a rare serotype S. zanzibar was isolated in the North of Scotland from a man home on leave from Malaysia, whence he returned in November having been bacteriologically negative 2 months previously. In December however, S. zanzibar was isolated from a bulk milk sample taken at a nearby dairy farm. No illness occurred among milking cows which had been brought inside from pasture in mid-October. Since 1972 a variety of different salmonella serotypes had been identified in cattle, milk and other samples at this farm, with seagulls being implicated as the vector transmitting infection from the sewage of a local town on to farmland and an adjacent loch. Although water from this source has not been used in recent years for drinking by cattle, it is utilized for washing floors within the dairy premises. Since 1979, following an outbreak affecting consumers, all milk produced at the farm has been pasteurized.

Between 1980-5, 224 outbreaks of salmonellosis associated with poultry-meat were reported in Scotland. In total 2245 persons were affected, 12 of whom died. Twenty-one salmonella serotypes were identified from those affected, while 33 serotypes were isolated from poultry during routine monitoring and disease investigation. Existing measures to prevent the spread of salmonellae within poultry flocks and processing plants are failing. It is suggested that irradiation of poultry-meat may be the only effective method of reducing the public health problem of poultry-borne salmonellosis.

Twenty-six incidents of salmonellosis occurring in Scotland between 1973 and 1979 and attributed to environmental pollution are reviewed. The apparent sources of pollution were sewage effluent (10 incidents), septic tank effluent (eight), sewage sludge (three), seagulls (three) and abattoir effluents (two). Cattle were the species predominantly affected. Human infection was primary in three incidents and was secondary to bovine infection in another four. Thirteen salmonella serotypes were recovered from infected humans or animals and 17 during related environmental investigations. The factors causing pollutions and possible control measures are discussed.

During the period July 1982 to December 1984, the presence of salmonella organisms was investigated at weekly intervals in the sewage system and abattoir effluent of a town in the north of Scotland. Three hundred and fifteen isolations, representing 37 different serotypes, were made which included 20 different Salmonella typhimurium phage types and four different S enteritidis phage types. Ten of the serotypes were isolated from livestock in the district during the survey as well as in the periods immediately before and after the survey. There were seven recorded incidents of human infection, involving four salmonella serotypes, only three of which were isolated concurrently from sewage.

A review of 194 cases of enteric infection in Scotland during 1967-74, is reported. Diagnosis was confirmed by the laboratory isolation of Salmonella typhi (64 cases), S. paratyphi A (3) and S. paratyphi B (127), from blood or faeces; 174 persons were clinically ill and 20 were symptomless infections. Most patients (81-0%) were under 35 years of age, with the highest incidence occurring among young adults of 15-24 years, many of whom had been travelling overseas. One-third of all cases (65) were imported infections; the remaining 129 patients had not been outside the United Kingdom. A significantly greater proportion of typhoid infection (54-7%) was contracted overseas, in contrast to paratyphoid B with only one-fifth of cases (21-2%) being imported; all three cases of paratyphoid A were imported. The geographic distribution of origin of imported infections is discussed, along with the frequency of organisms belonging to different phage types. Two deaths occurred, one of which was the result of complications of paratyphoid fever. All other patients responded well to treatment, although two persons continued to excrete and became chronic carriers. A few examples are given of episodes of particular epidemiological interest. It is expected that in future years there will be a continued increase in the proportion of imported infections as more persons travel overseas, concurrent with the continuing decline in the number of chronic carriers resident in the British Isles.

An outbreak of infection due to echovirus 4 in Scotland involving 194 cases during 1971-72 is described. Clinical and epidemiological information was obtained and analysed for 181 patients, of whom 149 (82%) developed aseptic meningitis. The majority of cases were older children (39%) and young adults (40%), although the highest attack rate was in infants (10.5 per 100,000 population). An unusual feature of the outbreak was its biphasic nature with cases occurring largely in the same geographic areas in successive years.

Among 622 cultures of Salmonella montevideo, 27 biotypes belonging to two biogroups were recognized. One biogroup (10di) was predominant in all animals in Scotland but only in sheep in England and Wales. The other (biogroup 2d) was responsible for almost all human, cattle and poultry infection in England and Wales, but only 24% of human infection in Scotland.