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D H Stone

Publications and source records attributed to D H Stone.

At least 19 recordsLinked to original sources
PubMed1992

The Chief Scientist reports.... Pattern of decline in prevalence of anencephaly and spina bifida in a high risk area.

The results of three studies spanning the period 1964 to 1989 were aggregated in an attempt to identify secular trends which might contribute to aetiological understanding of anencephaly and spina bifida (ASB). All data related to the prevalence of ASB in a geographically defined population in Glasgow, a known high risk area of neural tube defects. Multiple sources of ascertainment were employed to identify affected cases, whether live births, still births or induced abortions following prenatal diagnosis. The birth prevalence of ASB dropped by 82%, from 5.63 per 1,000 births in 1964-1968 to 1.04 per 1,000 births in 1979-1989, while the pregnancy prevalence (adjusted by including induced abortions) declined by 46%, from 5.63 per 1,000 births in 1964-1968 to 3.02 per 1,000 births in 1979-1989. Thus, prenatal screening contributed just under half of the observed decline in ASB birth prevalence. The pregnancy prevalence appeared to decline throughout the 1970's and early 1980's, and to increase again, temporarily, in the mid-1980s. These data could be interpreted as being broadly consistent with socio-economic hypotheses of ASB aetiology.

Anencephaly↗
PubMed1990

Anatomical distribution of soft tissue sepsis sites in intravenous drug misusers attending an accident and emergency department.

Of 77,686 case records of attendance at an accident and emergency department during 1986, 488 (0.6%) contained documented evidence of intravenous drug misuse (IDM). Clinical examination had revealed signs of soft tissue sepsis in 150 (31%) of these, the commonest sites being the wrist and forearm (31% of lesions), the antecubital fossa (19%), fingers and hand (14%) and thigh and groin (11%). These data highlight the anatomical areas to which medical and nursing staff should pay particular attention when examining patients with a background of IDM. Conversely, the presentation of soft tissue sepsis in these sites should alert clinicians to the possibility of underlying IDM.

Abscess↗
PubMed1990

Proposed taxonomy of audit and related activities.

The quality of the current debate on medical audit has been compromised by semantic confusion. A simple taxonomy is suggested for six frequently cited terms: review, audit, evaluation, surveillance, appraisal and monitoring. Review is usually a clinically based professional scrutiny of a particular service. Continuous peer review is audit, which may be internal or external. Evaluation involves measuring health indices in relation to a reference point, such as an objective or a control group, and has a strong statistical or epidemiological flavour, as has surveillance which may be regarded as continuous evaluation. Appraisal is the managerial form of evaluation, while monitoring is its routine counterpart. Thus, review and audit are primarily clinically oriented activities, evaluation and surveillance tend to be more epidemiological, and appraisal and monitoring are largely managerial. Review, evaluation and appraisal may be described as one-off quality assessment methods, and audit, surveillance and monitoring as routine ones. This classification attributes a distinct theoretical identity to each of the six categories though they are not mutually exclusive. It also delineates boundaries between the necessarily separate professional worlds inhabited by clinicians, public health staff and managers, and places various quality assessment methods within appropriate time-frames. The scheme preserves the fundamental integrity of the six activities which collectively comprise the intelligence gathering arm of quality assurance.

Health Services↗
PubMed1989

Declining prevalence of hydrocephalus.

Data from the Glasgow Register of Congenital Anomalies were used to compare the recent prevalence of primary hydrocephalus with that of anencephalus and spina bifida. Between 1974 and 1985, the prevalence rates of all three conditions declined significantly and virtually in parallel, a phenomenon suggestive of a common aetiology.

Anencephaly↗
PubMed1989

The Glasgow Register of Congenital Anomalies 1972-88: a critical review.

Since 1972, the Glasgow Register of Congenital Anomalies has collected population-based data on all anatomical, metabolic and genetic congenital anomalies. Multiple sources of ascertainment, with no time limit for registration, are used. Its objectives are the detection of epidemics, the calculation of prevalence rates, the epidemiological investigation of malformations and the study of cohorts of survivors. A review of the achievements of the Register to date suggests that these objectives have only partly been fulfilled, though a number of recent measures, including the association of the Register with the multi-centre European Registry (EUROCAT), have improved its future prospects. Previously unpublished data on cystic fibrosis and phenylketonuria are presented indicating that the prevalence rates of these disorders are stable and comparable to those of other centres, while the prevalence of hypothyroidism appears to have risen slightly since 1982.

Congenital Abnormalities↗
PubMed1989

Responses to Chernobyl.

Explore the source record for details and available documents.

Abnormalities, Radiation-Induced↗
PubMed1989

Recent trends in the prevalence and secondary prevention of Down's syndrome.

Examination of data from the Glasgow Registry of Congenital Anomalies indicated that 184 infants with Down's syndrome were born (live or still) to mothers residing in the Greater Glasgow Health Board area between 1974 and 1986 inclusive. This represents a period prevalence of 1.1 per 1000 total births. Despite a strongly positive correlation between prevalence and maternal age, most of the Down's syndrome infants were born to mothers aged under 35 years. There was no evidence either of a recent decline in the annual prevalence rate or of a changing pattern of risk in relation to maternal age. Antenatal diagnosis resulted in the termination of less than a tenth of all Down's syndrome pregnancies. These findings point to a need for further aetiological research, for continued epidemiological monitoring, for an improvement in the relatively low uptake of amniocentesis by older mothers, and for the development of a screening test which can be offered to the entire pregnant population.

Adult↗
PubMed1989

Intravenous drug misusers presenting to the accident and emergency department of a large teaching hospital. A failure of clinical management?

The records of all 77,686 attendances at or via the accident and emergency department of the Glasgow Royal Infirmary in 1986 were examined. Of these, 488 (0.6%) contained evidence of intravenous drug misuse (IDM). Most (68%) of the 354 attenders were male. The mean age of attenders in both sexes was 22 years. Over half of the presenting conditions were 'surgical' (mainly abscesses), while 'psychiatric' (including explicitly drug-related) conditions comprised about 30%. In almost two-thirds of cases, patients were discharged without specialist follow-up or care. Only 5% were referred for specialist assessment of their drug misuse. About a fifth were admitted. It is argued that these findings appear to represent a serious a serious failure of clinical management requiring an urgent remedy, particularly in the light of the growing problem of HIV transmission in this group.

Adolescent↗
PubMed1988

Screening for congenital neural tube defects in a high-risk area: an epidemiological perspective.

Data from the Glasgow Register of Congenital Malformations were used to investigate the extent of the recent decline in the prevalence of anencephaly and spina bifida, and the contribution of antenatal screening to it. Over the period 1974-85 inclusive, 303 pregnancies with an anencephalic foetus were diagnosed, representing an "adjusted" prevalence of 1.9 per 1000 total births, of which 179 (59%) were terminated following antenatal screening. There were 364 pregnancies with a spina bifida foetus representing an "adjusted" prevalence of 2.3 per 1000 total births, of which 84 (23%) were terminated. Over the study period, the "adjusted" prevalence of anencephaly fell by 50% while the birth prevalence fell by 89%; the "adjusted" prevalence of spina bifida fell by 38% while the birth prevalence fell by 76%. It was concluded that although the birth prevalence of both defects (particularly anencephaly) would have declined substantially in the absence of screening, the West of Scotland programme should continue.

Anencephaly↗
PubMed1987

Epidemiology of facial clefts.

Data from the Glasgow Register of Congenital Malformations were used to investigate the epidemiology of congenital facial clefts over the period 1974-85. Facial clefts were registered in 247 infants representing a prevalence of 1.56 per 1000 total births. Cleft palate was more common than cleft lip, with cleft lip and palate occupying an intermediate position. More than half of the infants with facial clefts had associated defects. Males predominated for cleft lip; females for cleft palate. Cleft lip (alone) was more common in babies born to women aged 35 years and over. Sudden declines in registered prevalence were observed in 1978 and 1985. Clefts were more common in socioeconomically deprived areas of the city. In comparison with data from elsewhere, Glasgow seems to have a low rate of cleft lip, a high rate of cleft palate, and a high rate of associated defects. Many of the findings of cleft palate in Glasgow could be explained by the interaction of an unidentified environmental teratogen with a susceptible population.

Abnormalities, Multiple↗
PubMed1987

Primary care, community medicine and prevention: a convergence of needs.

Both general practitioners and community physicians practise a range of activities along a spectrum from health care to prevention, but increasingly they have come to regard preventive medicine as the key to their respective future roles. This convergence of goals is deceptive because the primary care model of prevention is individual-oriented while that of community medicine is population-oriented. Since an effective preventive strategy is likely to require the use of both these approaches, community physicians and general practitioners should acknowledge the complementary nature of their skills and work towards the integration of their preventive efforts.

Community Medicine↗