Ruchill Hospital

The incidence of oral cancer is rising in the UK. Mortality from the disease remains high and survival has not improved significantly in the last 30 years. The primary dental health team has an integral role in the delivery of oral health promotion and prevention advice and in the early detection of oral malignancy and potentially malignant lesions. Both prevention and early detection within the general dental practice setting have a potential impact on overall incidence, morbidity and mortality from oral cancer. This paper details the primary dental healthcare team's roles in delivering smoking cessation and alcohol reduction counselling, in the early detection by oral examination, and in the process of prompt referral.

Heroin is abused around the world and is frequently reported as the cause of death in overdose cases. Analysis of morphine in hair has been used in the past in forensic toxicology to study the addiction history of heroin addicts. The purpose of the present study was to evaluate the usefulness of the nail as an analytical specimen in the identification and quantification of morphine in fingernail clippings of known heroin users. Fingernail clippings were obtained from 26 consenting patients of the Glasgow Drug Problem Service. At the time of sampling, the participants provided answers to a questionnaire regarding their drug use patterns. Samples were decontaminated by sonication in SDS, deionized water and methanol, and the methanolic washes were screened for analyte presence. The washed nail clippings were then hydrolyzed and extracted. RIA was used for the screening and HPLC for the confirmation of morphine. Positive RIA results were obtained with nail clippings from 25 of the 26 heroin users. The levels ranged from 0.06 to 4.69 ng/mg with a mean morphine concentration of 1.67 ng/mg. HPLC results were positive for 22 of the 26 nail samples. The mean morphine level by HPLC was 2.11 ng/mg with a range from 0.14 to 6.90 ng/mg. Based on these results, we suggest that nails have the potential of becoming a powerful alternative to hair for the detection of past heroin use in forensic cases.

OBJECTIVE: During 1991-2, unlinked anonymous testing of dried blood spots from neonatal metabolic screening cards showed the prevalence of HIV among childbearing women from Glasgow to be extremely low at 0.01%. A study was conducted to determine if non-pregnant sexually active women who engaged in unprotected sexual intercourse were more likely to be infected than those who were pregnant. METHODS: Unlinked anonymous HIV testing of urine specimens submitted by attenders of the family planning clinic in Glasgow for pregnancy testing. RESULTS: Of 11,990 urine specimens tested, 7664 were from women with a negative pregnancy test and two of these were HIV positive (0.026%); none of the remainder from those with a positive pregnancy test had HIV antibodies. CONCLUSION: No hidden epidemic was unearthed among a population which had engaged in unprotected sexual intercourse and was not pregnant. Other data from Glasgow strongly suggest that the control of HIV transmission among the city's population of current injectors (HIV prevalence, 1% of 8500) has prevented the spread of infection into its wider heterosexual population. It is essential that preventive measures which have been responsible for this public health success should be maintained.

Influenza viruses are unique among respiratory viruses in exhibiting “drift,” which is change in surface antigens as a result of host immunological pressure. In addition, influenza A viruses exhibit “shift”—which is the genetic intermingling of human strains with animal or bird strains, resulting in completely new viruses of pandemic potential. This makes the production of long lasting comprehensive vaccines impossible and continual monitoring for the appearance of new strains essential. Moreover, unlike infections transmitted through blood, food, or water, those transmitted through the respiratory tract are difficult to control through public health measures apart from vaccination and in controlled situations such as laboratories or under barrier protection conditions. Hence the current interest in so called Chinese …

Hepatitis B infection can be transmitted by organ or tissue transplantation. A 40-year-old man received a bone graft from a donor who tested negative for HbsAg with a static-mode assay. The same donor, on a subsequent donation, was found to be HbsAg-positive with a dynamic mode assay. The archival sample from the initial donation also tested HbsAg-positive with the dynamic-mode assay. The recipient of the bone, who had received HBV vaccine in the past, did not develop clinical or laboratory evidence of HBV infection. This case highlights the importance of sensitive microbiological test protocols in the context of tissue banking.

AIMS/BACKGROUNDThe measurement of visual acuity is the most widely accepted indicator of amblyopia and is thought by some to be the only effective screening test. The aim of this study was to investigate the effectiveness of the traditional single optotype Sheridan-Gardiner test (SGT) in the measurement of visual acuity and the detection of amblyopia, compared with the log based linear format Glasgow acuity cards (GAC).METHODSIn the present study visual acuity was measured monocularly in 702 primary 1 schoolchildren using both acuity tests.RESULTSA significant difference was found in the mean (SD) visual acuity measured with GAC (0.9 (0.08) modified logMAR) and SGT (1.13 (0.09) modified logMAR), df=632, t=−59.08, p=0.0001. The majority of children (89.3%) achieved visual acuities better than 6/6 in either eye when using the single optotype test. If the 95% confidence limits for a significant interocular difference in acuity are used as criteria for the detection of unilateral amblyopia, GAC were found to be the most sensitive, correctly identifying 100%, while SGT identified 55% of the children with unilateral amblyopia.CONCLUSIONThe results of this study highlight several problems with both the test format and testing procedure in the present school screening system.

Objectives: To assess the influence of socioeconomic position over a lifetime on risk factors for cardiovascular disease, on morbidity, and on mortality from various causes.Design: Prospective observational study with 21 years of follow up. Social class was determined as manual or non-manual at three stages of participants' lives: from the social class of their father's job, the social class of their first job, and the social class of their job at the time of screening. A cumulative social class indicator was constructed, ranging from non-manual social class at all three stages of life to manual social class at all three stages.Setting: 27 workplaces in the west of Scotland.Participants: 5766 men aged 35-64 at the time of examination.Main outcome measures: Prevalence and level of risk factors for cardiovascular disease; morbidity; and mortality from broad causes of death.Results: From non-manual social class locations at all three life stages to manual at all stages there were strong positive trends for blood pressure, body mass index, current cigarette smoking, angina, and bronchitis. Inverse trends were seen for height, cholesterol concentration, lung function, and being an ex-smoker. 1580 men died during follow up. Age adjusted relative death rates in comparison with the men of non-manual social class locations at all three stages of life were 1.29 (95% confidence interval 1.08 to 1.56) in men of two non-manual and one manual social class; 1.45 (1.21 to 1.73) in men of two manual and one non-manual social class; and 1.71 (1.46 to 2.01) in men of manual social class at all three stages. Mortality from cardiovascular disease showed a similar graded association with cumulative social class. Mortality from cancer was mainly raised among men of manual social class at all three stages. Adjustment for a wide range of risk factors caused little attenuation in the association of cumulative social class with mortality from all causes and from cardiovascular disease; greater attenuation was seen in the association with mortality from non-cardiovascular, non-cancer disease. Fathers having a non-manual occupation was strongly associated with mortality from cardiovascular disease: relative rate 1.41 (1.15 to 1.72). Participants' social class at the time of screening was more strongly associated than the other social class indicators with mortality from cancer and from non-cardiovascular, non-cancer causes.Conclusions: Socioeconomic factors acting over the lifetime affect health and risk of premature death. The relative importance of influences at different stages varies for the cause of death. Studies with data on socioeconomic circumstances at only one stage of life are inadequate for fully elucidating the contribution of socioeconomic factors to health and mortality risk.Key messagesHealth and risk of premature death are determined by socioeconomic factors acting throughout lifeSocioeconomic influences on particular causes of death may have different critical timesThe risk of premature death from cardiovascular disease is particularly sensitive to socioeconomic influences acting in early lifeStudies with data on socioeconomic circumstances at only one stage of life are inadequate for fully elucidating the contribution of socioeconomic factors to health

Patients on renal replacement therapy are recognized as a group at increased risk of infection with hepatitis C virus (HCV). While the risk has been reduced by the use of erythropoietin for treatment of anaemia and the introduction of HCV screening of blood products and potential renal transplant donors, new cases of HCV are still being documented, with patients on hospital haemodialysis appearing to be particularly at risk. The exact mode of transmission of HCV within dialysis units is unclear, although there is evidence to support nosocomial transmission between patients. Third generation HCV antibody testing was performed on all dialysis patients when a new case of HCV was identified within our unit. Stored monthly serum samples were then examined retrospectively to determine when patients became HCV RNA and HCV antibody positive. Viral typing was carried out to identify the HCV strains responsible for transmission. Four new cases of HCV infection are described within a single dialysis shift. Viral typing identified two distinct strains of HCV as being responsible for these infections, both of which had previously been identified in dialysis patients within the unit known to have HCV infection. This information, taken in conjunction with knowledge of the location of each patient for dialysis, suggests two separate episodes of nosocomial transmission of HCV between haemodialysis patients. While evidence of nosocomial transmission of HCV is accumulating, with modern dialytic procedures evidence of transmission through the dialysis machine or equipment used for dialysis is lacking. This stresses the importance of strict applications of universal precautions as the key to prevention of further transmission of HCV infection. This information is obviously applicable not only to dialysis units but all units that may potentially come in contact with HCV patients.