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PubMed2005

Alterations in the practice of open and laparoscopic live donor nephrectomy at renal transplant centers in the UK and Ireland.

Live kidney donor (LKD) activity has increased over recent years. In response, the British Transplantation Society (BTS) has issued guidelines for best practice. This study involved two questionnaires sent to all renal transplant centers in the UK and Ireland to examine practice for the years 2000 and 2002. Findings were compared to BTS guidelines. There was a 100% response rate from 28 centers for both years. Twenty-seven centers performed LKD in the year 2000, falling to 24 in 2002. Consultants reported 356 procedures in 2000, representing 19% of all kidney transplants, and 403 in 2002, representing 23% of all kidney transplants. Three centers offered laparoscopic donor nephrectomy in 2000, and five did so in 2002. The majority of centers organize donor and recipient operations synchronously, and most have a consultant anaesthetist present for the donor procedure. There were variations in the use of thromboprophylaxis, and in donor follow-up. There is widespread practice of live kidney donation in the UK and Ireland, but BTS guidelines are not closely adhered to. Laparoscopic donor nephrectomy is offered at a small number of centers, but many have plans to introduce it.

Graft Rejection↗
PubMed1991

The health of Travellers' children in Northern Ireland.

A study was carried out to examine aspects of the health status of children from a group of 'travelling people' in Northern Ireland. A total of 350 children, aged under 16 years, were included in the study. Data were gathered by community health doctors and health visitors using a standardised questionnaire. The study revealed that this community has a high degree of consanguinity and points to higher levels of congenital abnormalities than in the settled community. Uptake of immunisation was less than the settled community and hospital admissions in the younger age group were particularly due to infectious diseases. The authors conclude that provision of health services for travelling people in Northern Ireland should be urgently reviewed with consideration of the needs and lifestyle of this group. The provision of suitable sites for travelling people with adequate water and sewage facilities to reduce potential risks to health is also advocated.

Child↗
PubMed2000

Multiple organ damage caused by a new toxin azaspiracid, isolated from mussels produced in Ireland.

A new type of food poisoning resulting from ingestion of mussels produced in Ireland occurred in the Netherlands in 1995 and then reoccurred in Ireland in 1997. As the causative agent, azaspiracid, was isolated in pure form and revealed to have a structure entirely unlike other known algal toxins, in vivo studies with mice were carried out to elucidate the pathological injuries caused by the toxin. By per os administration, the toxin caused necrosis in the lamina propria of the small intestine and in lymphoid tissues such as thymus, spleen and the Peyer's patches. Both T and B lymphocytes were injured. Additionally a fatty change was observed in the liver. These injuries distinctly differed from those caused by the representative diarrhetic shellfish toxin, okadaic acid.

Administration, Oral↗
PubMed2000

Ireland: breakdown of trust between doctor and patient.

By European standards Ireland experiences a very high level of medical litigation. The possible reasons for this are numerous but not yet determined with any certainty. The consequences are quite clear with negative effects on medical practice, on the psychological health of doctors and patients alike, and on finances of the state. There are different patterns of medical litigation throughout Europe. Ireland may be merely anticipating the emerging increase in such actions elsewhere in the region. The present adversarial basis for medical litigation is not wholly without merit and has contributed to professional accountability. Nevertheless, a change in the present system ensuring accountability and fair compensation is required, together with a striving to ensure that trust is rebuilt between doctors and patients.

Ethics, Medical↗
PubMed2002

Profiles of child sexual abuse cases in Ireland: an archival study.

OBJECTIVE: This study aimed to profile subgroups of CSA cases referred for assessment at two national CSA assessment centers in Ireland. METHOD: Historical and clinical data for 150 CSA cases were drawn from records of two Dublin-based national specialist sexual abuse assessment and therapeutic centers. Three main comparisons were made involving: (1) 113 confirmed CSA cases and 37 unconfirmed CSA cases, (2) 55 confirmed CSA cases that displayed clinically significant behavior problems, and the 56 confirmed CSA cases without significant adjustment difficulties, and (3) 19 confirmed CSA cases in which violence was a central feature, and 79 confirmed cases in which violence was not a central feature. RESULTS: There were three main findings. (1) More unconfirmed cases were male; had single or separated parents; and a father with a criminal history. As a group, the confirmed cases were largely youngsters who had been abused by male adults or adolescents outside their nuclear family and who subsequently were well supported by one or two parents. (2) Poorly adjusted CSA victims had a history of coercive violent abuse while better adjusted children were victims of nonviolent abuse. (3) Victims of violent CSA were more likely to have experienced penetrative abuse and to display more externalizing behavior problems. CONCLUSIONS: Confirmed and unconfirmed CSA cases, well and poorly adjusted CSA cases, and victims of violent and nonviolent CSA referred for assessment at two national CSA assessment centers in Ireland had distinctive clinical profiles.

Adolescent↗
PubMedDate not supplied

Decision making of nurses practicing in intensive care in Canada, Finland, Northern Ireland, Switzerland, and the United States.

In this study, our intention was to describe the decision making of nurses practicing in intensive care, and the differences of nurses' decision making in Canada, Finland, Northern Ireland, Switzerland, and the United States. The instrument used in the study was a 56-item Likert-type questionnaire that has been used in previous studies and has proved to be a reliable tool. The target group comprised a nonrandom sample of nurses (N = 314) from five countries. The samples are not representative; therefore, the results in these cases cannot be generalized. The results showed that the decision making of nurses practicing in intensive care was broadly based, and that there were some country differences in data collection, problem definition, and planning. In contrast, decision making related to the implementation and evaluation of nursing is quite similar in the different countries. Canada and the United States on the one hand, and Finland, Northern Ireland, and Switzerland on the other, showed more similarities with each other in data collection, problem definition, and nursing planning related to decision making. Neither experience nor nurse's knowledge structure was associated with different decision-making approaches.

Canada↗
PubMed1998

A dosimetric intercomparison of kilovoltage X-rays, megavoltage photons and electrons in the Republic of Ireland.

BACKGROUND AND PURPOSE: A comprehensive dosimetry intercomparison has been carried out involving all the radiotherapy centres, all external beam modalities and every radiotherapy treatment unit in the Republic of Ireland. MATERIALS AND METHODS: Reference point measurements were made for all megavoltage photon beams. Doses were also investigated in planned three-field distributions. One of these was in a homogeneous epoxy resin solid water phantom, whilst the second included a lung equivalent insert. The intercomparison was also carried out for three electron energies in each centre. The position of the depth of maximum dose for a standard field size was independently determined, as was the beam energy and a subsequent beam calibration was made. In addition, a kilovoltage X-ray intercomparison was carried out on every kilovoltage quality. RESULTS: For 13 megavoltage photon beams a mean ratio of intercomparison measured dose to locally measured dose of 1.002 was obtained (standard deviation 1.2%). For 12 electron beam measurements a mean ratio of intercomparison measured dose to locally measured dose of 1.018 was obtained (standard deviation 0.8%). For four kilovoltage beams a mean ratio of intercomparison measured dose to locally measured dose of 0.997 was obtained (standard deviation 1.9%). CONCLUSIONS: The intercomparison has given confidence in the basis of clinical delivery of radiation dose in radiotherapy treatment and in the consistency (precision) of dosimetry between different centres within the Republic of Ireland. In addition, it has established a methodology for subsequent ongoing routine radiotherapy dosimetry audit and a baseline set of results to act as an initial reference point.

Humans↗
PubMed2002

Attitudes to absenteeism among diploma nursing students in Ireland - an exploratory descriptive survey.

Nurse education within Ireland is currently in a transition period. October 2002 heralds the national implementation of a third-level four-year degree based programme for the preparation of nurses, to replace the current three-year diploma system. Anecdotally, one concern expressed by nurse educators regarding this move, is the regulation and monitoring of student non-attendance. This study explores the views of those involved in nurse education in Ireland to absenteeism among diploma nursing students to ascertain whether or not concern exists. The findings reveal absenteeism as a potential problem among nursing students. Most respondents agree that student attendance at both the practical and theoretical aspect of current education programmes is a problem. There is overwhelming agreement that student attendances while on the clinical area should be monitored, while the majority of respondents agree that attendance monitoring during lectures should take place. Some divergent views emerge among the lecturers and tutors with the lecturers seeming more 'liberal' on average than the tutors, reflecting perhaps the different traditions of their environments. Mostly however, the differences between the two groups are small and statistically insignificant. Overall responses indicate a continued commitment to monitoring and control of absenteeism in this population. Systematic policies need to be developed and enforced and key personnel need to be employed to support attendance monitoring in the third level setting.

Absenteeism↗
PubMed2002

Concepts of illness causation and attitudes to health care among older people in the Republic of Ireland.

Fifty-one older people (26 of them women) in the Republic of Ireland were interviewed using a semi-structured schedule on their health and illness experiences at three different time points in their lives; as children, as young adults and presently. Of particular interest were their views about the causes of heart disease, cancer and tuberculosis and their experiences of the prevailing health care system during their lifetime. Participants were recruited by letter from a database of respondents to a previous national quantitative survey of older people. Of 247 people originally contacted 127 (51%) responded by letter and 51 of these took part in the interview study. Data were analysed according to principles of content analysis using NUDIST software. Reported ideas about causes of illnesses were multicausal. These were categorised as behavioural, biological, psychosocial or other explanations. While respondents placed most emphasis on behavioural explanations, this was accompanied by more complex views and critical questioning of formal health education messages. There was a strong allegiance to current biomedical concepts and practices. This appeared to be explained in part by reported negative experiences of health care treatments during childhood, particularly in hospitals, now perceived to be much improved. Advances in biomedicine were discussed with accounts of benefits received or observed by participants. An analysis of the history of health services in Ireland suggests that some of the attitudes reported reflect the experiences of the respondents as a generation rather than as older people per se and hence highlights the impact of public policy on people's experiences of and attitudes toward health and health care systems.

Aged↗
PubMed2003

Antiabortion positions and young women's life plans in contemporary Ireland.

At a critical time when Ireland's abortion ban faces legal challenges and the number of women obtaining abortions abroad each year continues to climb, some antiabortion advocates have turned their attention toward the social factors that influence women's abortion decision-making. Through an analysis of articles carried in the Irish mainstream and Catholic presses, this article examines how antiabortion advocates since the late 1990s have promoted an "antiabortion, pro-motherhood" message in response to trends that they identify as indicating that Irish reproduction has "gone awry". Antiabortion activists have focused in particular on the life plans of young, middle-class, career-oriented women, many of whom have benefited from increased employment opportunities within Ireland. These women are more likely than young women in past generations to postpone childbearing or opt for abortion in the face of an unwanted pregnancy, and thus, symbolize for antiabortion advocates the devaluation of a "traditional" Irish culture centered on the privileging of motherhood and married family life. This article examines antiabortion ideologies deployed around motherhood, work, and childcare, and argues that antiabortion advocates' "pro-motherhood" campaign fails to adequately respond to the changing realities of young, middle-class Irish women's life opportunities and expectations.

Abortion, Induced↗
PubMed2003

Socio-demographic predictors of self-rated health in the Republic of Ireland: findings from the National Survey on Lifestyle, Attitudes and Nutrition, SLAN.

Though Ireland continues to have a poor health profile compared with other European Union countries, previous research on social variations has been limited. For the first time in the Republic of Ireland, the influence on self-rated health of various socio-demographic indicators was assessed in a multi-variate logistic regression model, separately for men and women. Data were from the first National Survey of Lifestyles, Attitudes and Nutrition, SLAN, conducted by post in a multi-stage, cluster random sample across 26 counties. There were 6539 respondents (45.4% males). Mean self-rated health differed significantly according to age, marital status, tenure, educational status, social class, household size and eligibility for general medical services (GMS), but not according to gender or rurality. There were also differences if residing in a district with low level of affluence, or according to social cluster groupings. There were numerous significant correlations between the nine socio-demographic measures, but the most consistent pattern was between GMS eligibility and the various indicators, for both men and women. In the case of men, whether social class was included in the multi-variate model or not, education status remained predictive in the final model, (OR 2.36 CI 1.35-4.12) as did smoking status (OR 2.11 CI 1.47-3.02). Odds ratio for GMS eligibility was 3.33 (CI 2.61-4.26) attenuated to 1.70 (CI 1.12-2.56) in the final model. For women the pattern was somewhat different. Only GMS status (OR 2.64 CI 1.74-3.99) and level of education (2.25 CI 1.19-4.24) were predictive in the final model. A multi-level analysis showed that area level of affluence was not significantly predictive of self-rated health when individual level factors were taken into account.

Adult↗
PubMed2003

Selective migration from deprived areas in Northern Ireland and the spatial distribution of inequalities: implications for monitoring health and inequalities in health.

Much of the evidence suggesting that inequalities in health have been increasing over the last two decades has come from studies that compared the changes in relative health status of areas over time. Such studies ignore the movement of people between areas. This paper examines the population movement between small areas in Northern Ireland in the year prior to the 1991 census as well as the geographical distribution of migrants to Northern Ireland over the same period. It shows that deprived areas tended to become depopulated and that those who left these areas were the more affluent residents. While immigrants differed a little from the indigenous population, the overall effect of their distribution would be to maintain the geographical socio-economic status quo. The selective movement of people between areas would result in the distribution of health and ill-health becoming more polarized, i.e. produce a picture of widening inequalities between areas even though the distribution between individuals is unchanged. These processes suggest potential significant problems with the area-based approaches to monitoring health and inequalities in health.

Censuses↗
PubMed1998

Hypothesized foetal and early life influences on adult heart disease mortality: an ecological analysis of data for the Republic of Ireland.

Spatial disparities in the prevalence of heart disease are frequently explained in terms of adult lifestyle factors (e.g. diet, smoking, alcohol consumption, stress, exercise, etc.). However, research in recent years suggests an alternative explanation: namely, that the risk of heart disease in adult life may be influenced either by living conditions shortly after birth or by foetal development before birth. This paper outlines the evolution of this line of thought, and tests whether these hypotheses are consistent with ecological data for deaths from ischaemic heart disease between 1981 and 1990 and infant deaths between 1916 and 1935 in the Republic of Ireland. Support for the hypotheses is found to be ambiguous. Possible interpretations of these findings are discussed, paying particular attention to the anomalous nature of infant mortality in Ireland between 1916 and 1935.

Adult↗
PubMed1998

Cultural constraints on the delivery of HIV/AIDS prevention in Ireland.

HIV appeared in Ireland following an opiate epidemic in the early 1980s. Initially, however, the gay community mounted the only response to the spread of the virus while the implementation of early actions by the government was hampered by the constructions of the disease within Irish society. This paper considers the influence of the religious hierarchy in both the development of AIDS policy and in the shaping of public perceptions of the disease and those affected. A qualitative methodology is used to examine the role of such cultural constraints in an evaluation of the social context within which the prevention of HIV infection occurs. Three key issues pertinent to the policy context in Ireland are explored in depth. These are the role of the Catholic Church, the influences on health education programmes, particularly information giving, and the development of services and other interventions. These findings are discussed within the social and political contexts in which health policy is formulated.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Long-term surveillance of bladder tumours: current practice in the United Kingdom and Ireland.

INTRODUCTION: Surveillance of transitional cell carcinoma of the bladder forms a major part of the workload of many urology units. Unfortunately, the policy for long-term surveillance of these cancers is neither clear nor agreed upon in the absence of evidence base. Our study was performed to provide current national practice data, and begin the debate on consensus guidelines. MATERIALS AND METHODS: A questionnaire was sent to Consultant Urologists (CUs) in the UK and Ireland (n=501) asking about their policy on the long-term surveillance of different bladder tumours once patients are free of recurrence. RESULTS: A 73% response rate was observed (365/501). Views varied considerably. They ranged from life long cystoscopic surveillance for low-stage low-grade tumours (pTaG1) to discharge after 5 years (or less) of a recurrence-free period for pT1G3 tumour. Once long-term surveillance with cystoscopy had been discontinued, 55% of CUs felt no role was indicated for urine cytology in further follow up, whereas 17% would use it for all tumour types and 28% are selective. CONCLUSION: Our study has shown the complete lack of consensus regarding the long-term surveillance of bladder cancer in the UK and Ireland. This has major implications for policy making, resources allocation and cancer survival. We highlight the need for national guidelines in this area for optimal surveillance of bladder cancer, as a good prospective evidence-based data will not be available for many years. We believe our study might form the basis for discussion on such guidelines.

Carcinoma, Transitional Cell↗
PubMed1998

The conception of community children's nursing services in Northern Ireland.

This report is an exploration of the implications of establishing a community children's nursing service in Northern Ireland. It provides a description of the backdrop to the development of the service in the United Kingdom, and the experiences of children's nurses in attempting to upgrade the quality of care offered to sick children in this province. The frustrations that have characterized this development are explored in detail within the context of broader changes in health care on the national scene. The article ends with recommendations for implementing an effective service, following our experiences in Northern Ireland.

Adolescent↗
PubMed1991

A Lyme borreliosis human serosurvey of asymptomatic adults in Ireland.

Blood samples were obtained through the Blood Transfusion Service in Ireland in order to obtain information on the prevalence of asymptomatic B. burgdorferi infections and in an attempt to identify the type of habitat that presents the most risk of infection. Areas in the country were rated as low, medium or high risk based on the availability of suitable tick habitat, access to the public and the distribution of deer, the latter parameter being related to both the occurrence of rodent reservoir hosts and woodland recreational areas. Approximately 100 plasma samples from each of four areas were analysed for IgG anti-Borrelia antibodies by indirect immuno-fluorescence with a titre of 1 :80 indicating a positive reaction in asymptomatic individuals. Prevalence figures of 15, 11, 8 and 5% were obtained for high, high/medium, medium/low and low risk areas respectively. No positive samples were detected in blood from an Icelandic population which is not exposed to I. ricinus bites. The overall subclinical prevalence (9.75%) is surprisingly high in view of the apparent rarity of clinical cases in Ireland, though under-diagnosis probably occurs. These results seem to indicate that farmland is less important than woodland as Lyme borreliosis habitat. If this is so, it is probably due to the presence in woodland of Apodemus sylvaticus, a putative reservoir host, and also to the use of such areas for recreation at certain times of the year.

Animals↗
PubMed1997

Tuberculosis in health service employees in Northern Ireland.

Tuberculosis can be transmitted from patients to health care workers. However, where the incidence of tuberculosis is low, and good infection control practices exist, the risk of health care workers acquiring the disease is likely to be small. The objective of this study was to determine the rate of notification of tuberculosis in health care workers in Northern Ireland compared with the general population. Information from the statutory tuberculosis notification forms for the period 1982-1991 was entered on to a computer database. Those patients involved in health care occupations were identified and age and sex standardized incidence rates were calculated. The overall notification rate for tuberculosis was 7.4 cases per 100,000 of general population. There was no significant increase in notification of tuberculosis among health care workers [standardized incidence ratio: 126% (95% CI 91-170)]. No cases were diagnosed as a result of screening methods performed during employment. It was concluded that health care workers in Northern Ireland did not have a significantly increased incidence of tuberculosis compared with the general population over the 10-year period studied. This suggests that the risk of transmission from patients to health care workers is negligible in the setting of a low general incidence of tuberculosis and good infection control practice. Under these circumstances, the present findings support the cessation of routine screening of health care workers.

Contact Tracing↗