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PubMed1991

Physicians' recognition of and response to child abuse: Northern Ireland and the U.S.A.

There is a long history of professional and public concern with the problems of recognizing and reporting child abuse. The research reported here compares recognition of and response to potential abuse by physicians in Northern Ireland and the United States. An experimental study using vignettes in the USA and hospital data, showed that physicians' judgments were moderately affected by ethnic status (black-white) and socioeconomic status of the family, in addition to level of injury to the child. We conducted a comparative study to test whether the social cleavage based on religion (Protestant-Catholic in North Ireland), would affect the recognition of and response to child abuse by medical practitioners in North Ireland. While there was a slight tendency for responses to be affected by socioeconomic status and religion, the results were not statistically significant, as was true for the level of injury to the child. We also compared "diagnostic behavior," signs used to diagnose abuse and causal notions concerning abuse. Medical practitioners in the two countries differ with respect to (1) the amount and type of information desired about a case, and (2) the factors believed to "cause" abuse, but are in general agreement about the "signs" of abuse.

Child↗
PubMed1989

Coping with political violence in Northern Ireland.

Recent community based research, employing a self-assessed measure of psychological distress, has suggested that people in Northern Ireland may be coping relatively well with the stress of continuing political violence. This paper reports a first direct investigation of coping in Northern Ireland. Using two scales from the Folkman and Lazarus Ways of Coping Questionnaire--Distancing and seeking Social Support--an attempt was made to investigate the role of coping in relation to local levels of violence, the appraisal of violence, gender and trait neutoticism. The results indicated that trait neuroticism was not related to the appraisal of levels of violence, but that appraisal was related to both types of coping. In particular, those who perceived the violence to be more serious reported using less distancing, while they also reported seeking the most social support. In addition more women reported seeking social support compared to men. Finally those who lived in a high violence area were more likely to report using distancing than were those from a less violence prone area. These results were taken to support the contention that some form of denial may be the main form of coping in Northern Ireland, and that coping is related more to the appraisal of violence than to actual violence levels, while the appraisal of violence is in turn not related to trait neuroticism.

Adaptation, Psychological↗
PubMed1993

Oral cancer in Ireland, 1984-1988.

Age standardised oral cancer incidence rates were calculated for the Republic of Ireland from data collected by the Southern Tumour Registry for the years 1984-1988. The annual incidence rates (per 100,000) for men were lip 3.8, tongue 1.2 and mouth 1.8 while the corresponding rates for women were lip 0.2, tongue 0.7 and mouth 0.5. The incidence of lip cancer is shown to be much lower than indicated by previously published Irish rates. In general, oral cancer incidence rates in Ireland are comparable to those reported for Denmark. The vast majority (94%) of cases were histologically verified. The results, along with recent findings on mortality, contradict the view that Ireland has a very high rate of oral cancer by west European standards.

Adenocarcinoma↗
PubMed2004

Streptococcus pneumoniae and Streptococcus pyogenes isolated from a paediatric population in Great Britain and Ireland: the in vitro activity of telithromcycin versus comparators.

OBJECTIVES: To investigate the antimicrobial susceptibility profiles of clinical isolates of Streptococcus pneumoniae and Streptococcus pyogenes, isolated from children within Great Britain and Ireland (Northern Ireland and Eire), with particular reference to the new oral ketolide telithromycin. To determine the distribution of macrolide resistance genes within the erythromycin resistant population. METHODS: MICs were determined using NCCLS microbroth dilution methodology and macrolide resistance mechanisms were investigated using PCR. RESULTS: Penicillin susceptibility was found to be 92.6% in S. pneumoniae isolates ( n=831; 3.7% intermediate, MIC 0.12-1 mg/l, 3.7% resistant, MIC >2.0 mg/l) and 100% in S. pyogenes isolates (n=1333) 8.8% of S. pneumoniae and 2.5% of S. pyogenes isolates demonstrated erythromycin-A resistance (EryA(R)). One hundred percent of S. pneumoniae and 99.8% of S. pyogenes isolates were susceptible to telithromycin (MIC<or=1.0 mg/l). Of the 73 EryA(R) S. pneumoniae isolates tested, 55 (75.3%) were mef (A) positive, 17 (23.3%) erm (B) positive and one isolate (1.4%) was positive for both mechanisms. Of the 34 isolates of EryA(R) S. pyogenes tested, 23 (67.6%) were erm (A) subclass erm (TR) positive, 4 (11.8%) erm (B) and 7 (20.6%) mef (A) positive. CONCLUSIONS: This paper presents baseline data on penicillin and macrolide resistance in S. pneumoniae and S. pyogenes isolates in the paediatric population of Great Britain and Ireland. Telithromycin, recently approved for the treatment of community acquired respiratory tract infections (CARTI) in patients over 12 years of age throughout the European community, demonstrated high in vitro activity against these pathogens, including EryA(R) strains.

Child↗
PubMed2005

The epidemiology of peritonsillar abscess disease in Northern Ireland.

OBJECTIVES: 1. To describe the epidemiology of peritonsillar abscess disease in Northern Ireland. 2. To describe the impact of the nature of microbiological sampling on culture results. METHOD: Retrospective review of cases of peritonsillar abscess identified by diagnostic coding in three centres in Northern Ireland between August 2001 and July 2002. RESULTS: One hundred and twenty eight cases of confirmed peritonsillar abscess were treated as inpatients accounting for 1 in 10,000/year of the population in the hospitals' catchment area. The mean age was 26.4 (range 9-78) years. Sixty-nine patients were male; the mean length of hospital stay was 3 days. Culture yield was greatest from needle aspirates; throat swabs and blood cultures were typically unhelpful. Beta haemolytic streptococci were the most common isolates. Resistance among Group A haemolytic streptococci to macrolide antibiotics was present in 26% of isolates. Heterophile antibody testing was routine and revealed that Epstein-Barr virus infectious mononucleosis had a prevalence of 1.8% in this group of patients. CONCLUSION: In this population, although there were many similarities with the clinical features reported by other investigators, there were also several differences. Notably, we found a comparatively low proportion of anaerobic infections. Although cultures results did not influence individual patient treatment, reviewing data derived from populations is valuable for guiding empirical antibiotic therapy. SUMMARY: The epidemiology of peritonsillar abscess disease is not well described. Other investigators describing the bacteriology give differing results, presumably reflecting different countries and techniques. The need for routine microbiological testing has been questioned in several reports, but the benefit of routine culture and sensitivity data for planning empirical antibiotic treatment has not been explored. We present a retrospective review of 128 cases of confirmed peritonsillar abscess in Northern Ireland from August 2001 to July 2002. The annual population incidence in this region is 1 in 10,000/year. In this group concurrent Epstein-Barr virus infection was found to have a prevalence of 1.8%. The yield of positive cultures from routine microbiological sampling was low in comparison to that reported in detailed prospective studies, from various countries. Needle aspiration was the best technique for obtaining pus for culture; throat swabs and blood cultures were unhelpful. Culture results did not affect individual patient treatment, but may have a potentially useful role for selecting empirical therapy.

Adolescent↗
PubMed2005

The impact of badger removal on the control of tuberculosis in cattle herds in Ireland.

In Ireland, the herd prevalence of bovine tuberculosis has remained stable for several decades, and in common with several other countries, progress towards eradication has stalled. There is evidence in support of the potential role of infected badgers (Meles meles, a protected species) in bovine tuberculosis in Ireland and Britain. However, this evidence on its own has not been sufficient to prove disease causation. Field trials are likely to offer the best opportunity to define this role. Building on the earlier East Offaly project, our objectives were to assess the impact of badger removal on the control of tuberculosis in cattle herds in Ireland. The study was conducted from September 1997 to August 2002 in matched removal and reference areas (average area of 245.1km(2)) in four counties: Cork, Donegal, Kilkenny and Monaghan. Badger removal was intensive and proactive throughout the study period in the removal areas, but reactive (in response to severe tuberculosis outbreaks in cattle) in the reference areas. Removal intensity in the removal and reference areas during the first 2 years of the study averaged 0.57 and 0.07 badgers/km(2)/year, respectively. The outcome of interest was restriction of cattle herds due to confirmed tuberculosis, where tuberculous lesions were detected in one or more animals. Data were analysed using logistic regression (modelling the probability of a confirmed herd restriction) and survival analysis (modelling time to a confirmed herd restriction). During the study period, there was a significant difference between the removal and reference areas in all four counties in both the probability of and the time to a confirmed herd restriction due to tuberculosis. In the final year of the study, the odds of a confirmed herd restriction in the removal (as compared to the reference areas) were 0.25 in Cork, 0.04 in Donegal, 0.26 in Kilkenny and 0.43 in Monaghan. Further, the hazard ratios (removal over reference) ranged from 0.4 to 0.04 (a 60-96% decrease in the rate at which herds were becoming the subject of a confirmed restriction).

Animals↗
PubMed2005

Methicillin-resistant Staphylococcus aureus (MRSA) isolated from animals and veterinary personnel in Ireland.

Reports of methicillin-resistant Staphylococcus aureus (MRSA) in animals have become more frequent in recent years. This paper documents the recovery of MRSA from animals with respiratory, urinary tract or wound infection and from animals subjected to surgical procedures following treatment in one veterinary hospital and 16 private veterinary clinics in different geographical locations throughout Ireland. MRSA was recovered from 25 animals comprising 14 dogs, eight horses, one cat, one rabbit and a seal, and also from 10 attendant veterinary personnel. Clinical susceptibility testing suggested that the 35 isolates fell into two different groups. One group of isolates (Group 1) was resistant to one or more of the following classes of antimicrobials: macrolides, lincosamines, tetracyclines and/or fluoroquinolones. The second group (Group 2) was resistant to macrolides, aminoglycosides, tetracyclines and trimethoprim/sulphamethoxazole and variably resistant to fluoroquinolones, lincosamines and rifampicin. One isolate in Group 2 was susceptible to trimethoprim. Epidemiological typing by antibiogram-resistogram (AR) typing, biotyping and by chromosomal DNA restriction fragment length polymorphism analysis using SmaI digestion followed by pulsed field gel electrophoresis (PFGE), confirmed these two major clusters. PFGE analysis showed that most isolates from non-equine animals were indistinguishable from each other and from the isolates from personnel caring for these animals. MRSA was isolated from eight horses which attended six different veterinary practices before referral to an equine veterinary hospital. Isolates from the eight horses and from their attendant personnel had PFGE patterns that were indistinguishable and were unlike the patterns obtained from the other isolates. Comparison of PFGE patterns of isolates from veterinary sources with patterns from MRSA recovered in human hospitals showed that the most frequently occurring pattern of MRSA from non-equine animals was indistinguishable from the predominant pattern obtained from the most prevalent MRSA strain in the human population in Ireland. However, the patterns of the isolates from horses were unlike any patterns previously reported in Irish studies of human isolates. This study shows that transmission of two strains of MRSA is occurring in veterinary practices in Ireland and that one strain may have arisen from human hospitals. The source of the second strain remains to be determined.

Animal Technicians↗
PubMed2005

The tuberculosis eradication programme in Ireland: a review of scientific and policy advances since 1988.

A national programme to eradicate bovine tuberculosis commenced in Ireland in 1954. During the last 15-20 years, research has been conducted to address gaps in knowledge of disease epidemiology, to objectively evaluate alternative strategy options, and to critically assess the implementation of disease control strategies. This paper provides a review of scientific and policy advances in Ireland since 1988, relevant to the tuberculosis eradication programme in Ireland. There have been substantial advances in knowledge of aspects of disease epidemiology, relating to cattle-to-cattle transmission, the role of wildlife, transmission of infection from wildlife and methods to minimise wildlife-to-cattle transmission. Further, scientific advances have been made both in the detection and management of infected herds. With respect to policy, the paper describes current policy and policy advances in both the detection and management of infected herds, as well as current strategies to prevent herd breakdowns. The Irish programme is a useful example of science-informed policy in a national context.

Animals↗
PubMed2006

Molecular characterisation and analysis of bovine rotavirus strains circulating in Ireland 2002-2004.

One hundred and two faecal samples were collected from calves diagnosed with rotavirus infection, in the southern region of Ireland, from 2002 to 2004. Ninety one percent (n=93) were confirmed positive for rotavirus, using latex agglutination and enzyme linked immunosorbent assay (ELISA) methods. Determination of the G- and P-types was carried out using nested reverse transcriptase polymerase chain reaction (nRT-PCR). G6 was the most prevalent genotype, accounting for 80.6% (75/93), G10 accounted for 6.5% (6/93) and G6G10 mixed types accounted for 9.7% (9/93) of the collection. Rotavirus in three of the samples (3.2%) could not be characterised with any of the five G-specific primers used in this study. A subset of the positive samples (n=54) was examined for their P-type specificities, P[5] and P[11] accounted for 77.8% (42/54), and 9.3% (5/54), respectively. One P[1] genotype (1.9%) was found in the collection. P[5] and P[11] mixed genotypes accounted for 11% (6/54) of the study. The genotypes corresponded to the UK-like strain (G6P[5]) 57.4%, KN4-like strain (G6[P11]) 7.4%, B223-like strain (G10P[11]) and NCDV-like strain (G6P[1]) 1.9% each. The unusual combination of G10P[5] accounted for 7.4%, with mixed infections G6+G10P[5] and G6P[5]+P[11] representing 13% and 11%, respectively. This is the first time that the G- and P-types of bovine rotaviruses (BRVs) have been determined in Ireland, and this study contributes to a better understanding of the epidemiology of such viruses circulating in Ireland.

Animals↗
PubMed2003

Plasma fibrinogen explains much of the difference in risk of coronary heart disease between France and Northern Ireland. The PRIME study.

The incidence of coronary heart disease is higher in Northern Ireland than in France. These differences have not been adequately explained. We have investigated the associations of plasma fibrinogen concentration and factor VII activity with the incidence of coronary heart disease in a prospective cohort study involving 10600 men aged 50-59 living in four regions (Lille, Strasbourg, and Toulouse in France, Belfast in Northern Ireland). Baseline fibrinogen and factor VII were measured in 9489 men free of coronary heart disease at entry (7167 in France and 2322 in Northern Ireland). Over 5 years of follow-up, 161 participants developed myocardial infarction (MI) or coronary death (100 in France and 61 in Belfast) and 151 developed angina pectoris (94 in France and 57 in Belfast). The risk of future coronary events was 1.9 times higher in Belfast than in France (95% confidence interval: 1.5-2.4). Baseline mean levels of fibrinogen were significantly higher in Belfast than in France and they were higher in participants who experienced coronary events compared with those who did not in both countries. The age-adjusted relative risk of coronary heart disease associated with a rise of one standard deviation in fibrinogen level was 1.56 (95% confidence interval: 1.29-1.95, P<0.0001) in the whole cohort. This association remained significant after adjustment for other cardiovascular risk factors (relative risk:1.36; 95% confidence interval: 1.14-1.68; P<0.0001). There was no clear geographical variation in factor VII and no significant association between factor VII levels and the risk of coronary events was observed. Classic risk factors explained 25% of the excess risk of coronary heart disease in Belfast compared with France, while fibrinogen alone accounted for 30%. These findings add to the epidemiological evidence that elevated fibrinogen is a major risk factor for coronary heart disease.

Coronary Disease↗
PubMed1997

National survey of MRSA: Ireland, 1995.

The objective of this survey was to obtain an indication of the size of the methicillin-resistant Staphylococcus aureus (MRSA) problem in Ireland prior to introducing national MRSA control guidelines. A survey of all microbiology laboratories in Ireland was carried out over two weeks in Spring 1995. For patients from whom MRSA was isolated during the study period standard demographic and clinical data were requested and period prevalence/1000 discharges was calculated. All 45 microbiology laboratories surveyed responded. MRSA was isolated from 448 patients during the two-week period. The period prevalence of MRSA was 16.5/1000 discharges. Males aged > or = 65 had the highest rate (50/1000 discharges). Half of all isolates were from patients in surgical or medical wards, but 4% were from community-based sources such as GPs, nursing homes and hospices. Thirty-two percent of MRSA patients were infected rather than colonized. MRSA is clearly a significant problem in Ireland. While it is largely a hospital problem at present, the increasing trend towards day procedures and shorter hospital stay means that infection will increase in the community.

Adolescent↗
PubMed2001

Modelling the spatial distribution of SO2 and NOx emissions in Ireland.

The spatial distributions of sulphur dioxide (SO2) and nitrogen oxides (NOx) emissions are essential inputs to models of atmospheric transport and deposition. Information of this type is required for international negotiations on emission reduction through the critical load approach. High-resolution emission maps for the Republic of Ireland have been created using emission totals and a geographical information system, supported by surrogate statistics and landcover information. Data have been subsequently allocated to the EMEP 50 x 50-km grid, used in long-range transport models for the investigation of transboundary air pollution. Approximately two-thirds of SO2 emissions in Ireland emanate from two grid-squares. Over 50% of total SO2 emissions originate from one grid-square in the west of Ireland, where the largest point sources of SO2 are located. Approximately 15% of the total SO2 emissions originate from the grid-square containing Dublin. SO2 emission densities for the remaining areas are very low, < 1 t km-2 year-1 for most grid-squares. NOx emissions show a very similar distribution pattern. However, NOx emissions are more evenly spread over the country, as about 40% of total NOx emissions originate from road transport.

Air Movements↗
PubMed2001

Gender trends in occupancy rates in mental health beds in Northern Ireland.

Based on census material from 1926 to 1991, this study focuses on gender differences in occupancy rates in mental health beds in Northern Ireland. More specifically, using two sets of research literature--the relationships between war and mental health and gender and mental health respectively--it explores changing patterns in bed occupancy in terms of both gender and age differences within this society. The results suggest that, although men and women no longer vary in terms of their overall occupancy rates within mental health facilities in Northern Ireland, within their respective male and female sub-populations, however, some notable age-specific differences have now emerged. Since 1981, whereas increases in mental health bed occupancy among women have been exclusively confined to the old (65 years or older), among males, it is the very young, specifically men aged 15-24 years, who have demonstrated the most dramatic rise in bed usage. It is important to note, however, that these age-specific gender increases cannot be accounted for by demographic changes in the general population. The authors suggest that, at least as far as men are concerned, the increasing pattern of vulnerability among the young may be attributed to the impact of changing definitions of mental disorder rather than to the effect of political violence on mental health. It is to this group of individuals--the cohort of men born since the outbreak of civil unrest in Northern Ireland in 1969--that future research should be directed.

Adolescent↗
PubMed2003

Current knowledge of risks and benefits of prophylactic oophorectomy at hysterectomy for benign disease in United Kingdom and Republic of Ireland.

OBJECTIVE: To estimate current practice of prophylactic oophorectomy at hysterectomy for benign disease and also define the role of the variables considered prior to making the decision of prophylactic oophorectomy among consultant obstetricians and gynaecologists in UK and Republic of Ireland. DESIGN: A postal questionnaire was sent to all 1536 practising consultant gynaecologists in UK and Republic of Ireland. METHODS AND MAIN OUTCOMES MEASURED: Of the 809 replies received, 21% of the respondents routinely performed prophylactic oophorectomy. There was a wide regional variation; 40% consultants in Wales considered prophylactic oophorectomy compared to 16% in the Northern and Yorkshire regions. Consultants with a special interest with a more surgical bias were more likely to consider performing prophylactic oophorectomy. The majority of respondents estimated that prophylactic oophorectomy would reduce risk of ovarian cancer by up to 5%, and that following hysterectomy and ovarian conservation there was an increased risk of premature menopause. CONCLUSION: There is a large variation and uncertainty in the practice of prophylactic oophorectomy in UK and Ireland.

Adult↗
PubMed1996

Tuberculosis due to Mycobacterium bovis in humans in the south-west region of Ireland: is there a relationship with infection prevalence in cattle?

OBJECTIVE: To compare the incidence of tuberculosis due to Mycobacterium bovis in humans to the prevalence of M. bovis infection in cattle in south-west Ireland and discuss possible links between them. SETTING: In the south-west region of Ireland, a mixed urban and rural community (pop. 536,000), there is a residuum of human tuberculosis caused by M. bovis. METHODS: A retrospective analysis of the incidence of culture-positive M. bovis disease in humans in south-west Ireland from 1983 to 1994 and of the results of tuberculin testing in cattle from 1978 to 1994 for the same region. RESULTS: One to five cases of human tuberculosis due to M. bovis were recorded per year while the overall prevalence of bovine infection fell gradually during the period of study from 467 tuberculin-positive animals per 100,000 cattle tested in 1983 to 158 per 100,000 in 1994. CONCLUSION: The low incidence plateau of human tuberculosis due to M. bovis together with the decline in prevalence of animal infection in the overall period studied suggest a cut-off in the animal to human chain of infection at two points; the animal source and the ingestion of (now pasteurized) milk. This would suggest that disease in humans is now due to reactivation of previous foci of infection which were acquired when milk pasteurization was not compulsory. Based on this, we would anticipate a further reduction and possible elimination of human tuberculosis due to M. bovis in this region in the next 10-15 years.

Animals↗
PubMed1990

Do statistics lie? Suicide in Kildare--and in Ireland.

This study, reporting a ten-year investigation of suicide in Kildare, found that the suicide rate based on clinical assessment of coroner's records was very close to the Central Statistics Office (CSO) figure for Kildare and for Ireland as a whole for the same period. Dublin data for 1977-1981 confirmed these findings. Since in the 1960s similar clinical assessment concluded that CSO rates underestimated suicide by a factor of two or over, we believe that changes in CSO coding procedures whereby more deaths are now coded to suicide than was the case in the past have resulted in current CSO data reflecting accurately the rate of clinical suicide. There has been more than a three-fold increase in CSO suicide rates in Ireland between 1968 and 1987. Even allowing for improved CSO practices there still remains a considerable excess of suicide deaths which indicates a doubling of 'real' suicide in Ireland over these twenty years.

Cause of Death↗
PubMed2000

Prevalence of hepatitis B anti-core antibody in the Republic of Ireland.

The aim of this study was to estimate the prevalence of hepatitis B exposure in the population of the Republic of Ireland, by measuring the prevalence of hepatitis B anti-core antibody in oral fluid collected by postal survey. A random multi-stage stratified sample of Irish households was obtained, using the Irish electoral register as the sampling frame. A total of 962 households were selected, and a household response rate of 60.4% was achieved. Oral fluid specimens totalling 1714 were tested for antibody to hepatitis B core antigen (anti-HBc), using an Immune Capture Enzyme Immuno-Assay. Five specimens (0.29%) were found to contain anti-HBc. Adjusting for study design, the estimated anti-HBc prevalence in the Republic of Ireland is 0.51%. This study demonstrates that self-collection of oral fluid samples is acceptable to the public, and based upon the data generated, that the Republic of Ireland has a low prevalence of hepatitis B infection.

Adolescent↗
PubMed2006

Molecular epidemiology of norovirus strains circulating in Ireland from 2003 to 2004.

Since 2002, the burden of norovirus (NoV) infection in Ireland has increased. Outbreaks in institutional settings are the most common causing widespread disruption to health service delivery. This is the first national study of NoV in the Republic of Ireland and its aim was to identify the major NoV strains circulating in Ireland over a 13-month period between November 2003 and November 2004, inclusive. A prospective study screened faecal samples (n = 478) for NoV RNA. Positive samples (n = 116) were further analysed by a second PCR, targeted to the orf1/orf2 junction of the virus. Phylogenetic analysis was based on sequence alignments of this domain. GII/4 viruses represented 92.2% of sequences, 2.7% were GII/2, GII/3 and GGIIB cluster-like strains. The remaining 5.2% were of GI origin. NoV was detectable throughout the study period, although two peaks of infection were observed. The majority of infections were caused by a range of closely related GII/4 NoV strains.

Caliciviridae Infections↗