Hippocampal volume and depression: insights from epilepsy surgery.

BACKGROUND: Major depression is common after epilepsy surgery. It has previously been suggested that surgical removal of limbic system structures such as the hippocampus may contribute to this comorbidity. Recent magnetic resonance imaging studies have found smaller hippocampal volumes in depressed patients in comparison with controls. AIMS: The current study examined whether preoperative hippocampal volumes were associated with depression experienced after epilepsy surgery. Patients undergoing mesial (n = 26) and non-mesial (n = 16) temporal lobe resections were assessed preoperatively, and for 1 year postoperatively. Assessment included a clinical interview and the Beck Depression Inventory. Hippocampal volumes were measured on the preoperative T1-weighted magnetic resonance imaging scans of the patients and 41 neurologically normal controls. RESULTS: A similar proportion of mesial and non-mesial temporal patients had a preoperative history of major depression. Postoperatively, 42% of mesial and 19% of non-mesial temporal patients were depressed. There was no relationship between hippocampal volume and preoperative depression in either group. Depression after surgery was associated with significantly smaller hippocampal volumes contralateral to the resection in the mesial temporal group (p = 0.005). This effect was seen in mesial temporal patients who developed de novo depression (p = 0.006). Hippocampal volume was unrelated to postoperative depression in the non-mesial group. CONCLUSION: This study highlights the role of neurobiological factors in the development of postoperative depression. These initial findings have implications for understanding depression following epilepsy surgery as well as the pathogenesis of depression more generally.

Health governance--its introduction in Lanarkshire Health Board.

OBJECTIVE: To describe an approach to implementing the principles of clinical governance in a Health Board setting. DESIGN: Using guidance from the Scottish Executive and The Faculty of Public Health Medicine to set up a health governance structure at Health Board level. Auditing current work to identify areas that required to be progressed. SETTING: Lanarkshire Health Board. RESULTS: A Health Governance Committee and a Health Governance Advisory Group, to support the work of the main committee, were set up at Board level. The Scottish Executive Governance Monitoring Template has been adapted to cover the main public health functions. Topics considered in the first year include qualifications, registration and CPD activity of Consultants in Public Health Medicine, audit of public health advice on gastro-intestinal illness, audit of DPH Annual Report and audit of items of business on Health Board agenda. CONCLUSION: The model developed in Lanarkshire has a Health Governance Advisory Group which works in support of the main Health Governance Committee. This model works well in practice with much of the routine work being done by the Advisory Group. This has streamlined the work of the Health Governance Committee and facilitated its introduction.

First steps in developing a managed clinical network for vascular services in Lanarkshire.

AIM: To survey key personnel involved in setting up a Managed Clinical Network (MCN) for vascular services in Lanarkshire to assess their views, knowledge and understanding about networking, with a view to facilitating the implementation of the MCN. DESIGN: A questionnaire was designed covering current networking practice, use of protocols, audit and training. It was piloted with the MCN core group and extended to the wider steering group. Semi-structured interviews were completed with core group members focusing on the structure and management of the network. SETTING: Lanarkshire Health Board, Lanarkshire Acute Hospital Trust and Lanarkshire Primary Care Trust. SUBJECTS: The core group and steering group for the development of a Managed Clinical Network for Vascular Surgical Services. RESULTS: Clinicians tend to have more contacts with clinicians and managers with managers. There was close and frequent networking among clinicians of equal status. Respondents shared increased expectations for participation in audit, working to protocols, training and development and improved means of obtaining patients' views and providing information. All respondents recognised the necessity for network leadership although, in this study, it was not possible to define the style of leadership. CONCLUSION: This study identified a degree of existing, informal networking among members of the core group and steering group and it will be important to build on that foundation as the MCN develops. Further research is required to determine the most appropriate form of leadership for the network, and to identify, more clearly, what is understood by a managed network and what accountability there should be.

A lasting public health response to an outbreak of HIV infection in a Scottish prison?

Between April and June 1993, 8 cases of acute clinical hepatitis B infection and 2 seroconversions to HIV infection were detected among drug injecting inmates of HM Prison Glenochil in Scotland. To prevent the further spread of infection, an initiative which involved counselling and voluntary attributable HIV testing was conducted over a 10-day period commencing at the end of June. A team of 18 counsellors and phlebotomists was brought together rapidly as part of a unique organizational exercise in the field of public health. Fourteen cases of HIV infection were identified of which 13 were almost certainly infected in Glenochil. Following the exercise, a range of harm reduction measures for injecting prisoners was introduced; these included the availability of hepatitis B vaccine, provision of bleach tablets which could be used to clean injecting equipment, a methadone detoxification programme, increased training for prison officers and improved access to drug and harm minimization counselling for inmates. By mid-1996 all these measures had been sustained and several could be found in many other prisons throughout Scotland. Follow-up investigations showed no evidence of epidemic spread of HIV during the 12 months after the initiative. While the frequency of injecting and needle/syringe sharing may have decreased over the last 3 years, these activities are still being reported and it is highly likely that transmissions of bloodborne infections, in particular hepatitis C, continue to occur. The surveillance and prevention of infections associated with injecting drug use in the prison setting remain a high public health priority.

Outbreak of HIV infection in a Scottish prison.

OBJECTIVE--To investigate the possible spread of HIV infection and its route of transmission among prison inmates. DESIGN--In response to an outbreak of acute clinical hepatitis B and two seroconversions to HIV infection, counselling and testing for HIV were offered to all inmates over a two week period in July 1993. Information was sought about drug injecting, sexual behaviour, and previous HIV testing. SETTING--HM Prison Glenochil in Scotland. SUBJECTS--Adult male prisoners. MAIN OUTCOME MEASURES--Uptake of HIV counselling and testing; occurrence and mode of HIV transmission within the prison. RESULTS--Of a total 378 inmates, 227 (60%) were counselled and 162 (43%) tested for HIV. Twelve (7%) of those tested were positive for antibody to HIV. One third (76) of those counselled had injected drugs at some time, of whom 33 (43%) had injected in Glenochil; all 12 seropositive men belonged to this latter group. Thirty two of these 33 had shared needles and syringes in the prison. A further two inmates who injected in the prison were diagnosed as positive for HIV two months previously. Evidence based on sequential results and time of entry into prison indicated that eight transmissions definitely occurred within prison in the first half of 1993. CONCLUSION--This is the first report of an outbreak of HIV infection occurring within a prison. Restricted access to injecting equipment resulted in random sharing and placed injectors at high risk of becoming infected with HIV. Measures to prevent further spread of infection among prison injectors are urgently required.

Lochgoilhead fever: outbreak of non-pneumonic legionellosis due to Legionella micdadei.

Analysis of case histories from 187 people who had visited a hotel and leisure complex in Lochgoilhead, a village on the west coast of Scotland, indicated that 170 had had an acute illness characterised by headache, fatigue, arthralgia, myalgia, cough, and breathlessness. These symptoms were consistent with Pontiac fever-like illness. Legionella micdadei was isolated from the leisure complex whirlpool spa at the time that 60 of 72 individuals with symptoms seroconverted to L micdadei antigen. This outbreak is thought to be the first of a Pontiac fever-like illness ascribed to L micdadei and the first large-scale outbreak of its kind to have occurred outside North America. Whirlpool spas can be a major reservoir of legionella organisms; they must therefore be properly maintained and operated to prevent outbreaks of infection.

Coronary heart disease: account of a preventive clinic in general practice.

Men between the ages of 25 and 45 years attending a surgery were screened for risk of heart disease. An ;at-risk' group of 188 men were identified and 118 of them (63 per cent) accepted an invitation to attend a coronary heart disease prevention clinic at the practice. A sample of the attending group showed favourable changes in risk factors one year later.Subsamples of 20 men from the attending and non-attending groups were interviewed at the clinic or at home; they showed significant differences with respect to employment status, family history of myocardial infarction and knowledge about coronary heart disease as a cause of death in the United Kingdom. Implications for preventive programmes of this nature are discussed, and the need to utilize routine doctor-patient contacts for health education and prevention is stressed.