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PubMed2005

Improvement in neonatal intensive care in Northern Ireland through sharing of audit data.

PROBLEM: Ten percent of infants born will require admission to a neonatal facility. Coordinated activity to monitor and improve the quality of care for this high risk, high cost group of infants is considered a high priority. At the time of initiation of this project no system for collection and analysis of neonatal data existed in Northern Ireland. DESIGN: In 1994 an ongoing prospective centralised data collection system was implemented to facilitate quality improvement and research in neonatal care. We aim to ascertain if there has been a demonstrable improvement in the quality of care provided since the initiation of this system. SETTING: All nine Northern Ireland neonatal intensive care units returned prospectively collected socioeconomic, obstetric and neonatal episode data. KEY MEASURES FOR IMPROVEMENT: Achievement of the agreed quality indicators relating to transfer patterns, thermoregulation, antenatal steroid administration, and timing of administration of surfactant during the period 1 April 1999 to 31 March 2000 were compared with data for the period 1 April 1994 to 31 March 1996. STRATEGIES FOR CHANGE: Monitoring included audit and annual feedback of timely clear and relevant data where results were provided confidentially as standardised reports, together with anonymised comparisons with other similar sized units. Draft recommendations were made at regional level and units were asked to adopt finalized consensus guidelines at the local level and to implement changes to clinical practice. EFFECTS OF CHANGE: The proportion of transfers taking place in utero increased from 26% to 42% and antenatal steroid administration from 68% to 82%. Normothermia on first admission improved from 66% to 71% for inborn infants. The proportion of infants receiving surfactant where the first dose was given within an hour of birth increased from 13% to 66%. LESSONS LEARNT: A multi-professional regional care network can facilitate the development of agreed standards and a culture of regular evaluation leading to quality improvement.

Body Temperature Regulation↗
PubMed1995

A survey on hepatitis B vaccination policies in genitourinary medicine in UK and Ireland.

OBJECTIVE: To determine the policies applied in genitourinary medicine (GUM) departments in the United Kingdom (UK) and Ireland with regard to hepatitis B vaccination. DESIGN: All genitourinary medicine consultants were sent a questionnaire requesting information concerning their selection criteria and the management of patients offered Hepatitis B vaccine. If no response was obtained a second questionnaire was sent. The survey was carried out in 1993. SETTING: All genitourinary medicine departments in UK and Ireland. PARTICIPANTS: 234 consultants were sent the questionnaire. 153 consultants responded. RESULTS: Overall, there was a 65.4% response rate to the questionnaire. Almost all genitourinary physicians would offer the vaccine to male homosexuals and up to 74% offer it to all male homosexuals, intravenous drug users (IVDU) and prostitutes. Of the genitourinary physicians, 96% agreed that hepatitis B virus (HBV) serological markers should be checked prior to or simultaneously with vaccination, yet there was no agreement as to which marker should be performed. Up to 79% of consultants recalled the patients to check their response to vaccination but only 61% offered long term follow up after vaccination. CONCLUSION: HBV vaccine is offered to all male homosexuals, IVDU and prostitutes in GUM departments. Currently, the vaccine is not generally offered to patients who present with sexually transmitted diseases. Almost all genitourinary physicians (96%) agree that HBV serological markers should be checked prior to or simultaneously with the start of the vaccination course and 80% would request hepatitis B surface antibody levels after vaccination to identify inadequate responders and non-responders. From this survey, there appears to be a need for uniform post-vaccination HBV screening and timing and frequency of booster doses.

Consultants↗
PubMed1994

Asthma mortality and death certification in Northern Ireland.

BACKGROUND: Asthma mortality has been rising in many western countries for largely unknown reasons. One cause could be change in certification practice. This study was designed to investigate the accuracy of death certification in Northern Ireland for the years 1981-4 and, in addition, to assess the reliability of trends observed in asthma death registration from 1957 to 1985. METHODS: The following death certificates were obtained for the years 1981-4: those mentioning asthma (all age groups), chronic obstructive airway disease, emphysema, or chronic bronchitis, but only where the decreased was 55 years or less. Information was collected from medical records, questionnaires to the general practitioner, and interviews with a close relative of the decreased. Death as a result of asthma was confirmed or otherwise by a panel and the confirmed deaths were compared with those registered. The numbers of deaths from asthma for the years 1957-85 were obtained from the offices of the Northern Ireland Registrar General. RESULTS: A total of 174 deaths from asthma was identified; 123 (70.7%) had been registered, while the remainder had been coded under another diagnosis. The annual number of confirmed deaths differed little from the figures of the Registrar General. A sharp increase in the annual number of deaths from asthma was observed, beginning in 1977, following a decline in the mid 1970s. CONCLUSIONS: During the years 1981-4 death certification for asthma was found to be inaccurate. The number of false positive registrations was balanced by the number of false negatives, suggesting that the registered totals reflect actual asthma mortality.

Adolescent↗
PubMed1996

Death from airways obstruction: accuracy of certification in Northern Ireland.

BACKGROUND: Studies of mortality from asthma and chronic obstructive pulmonary disease (COPD) have relied on death certification or registration for case finding. The aim of this study was to determine the accuracy of death certification and registration in asthma and COPD. METHODS: All death certificates in Northern Ireland for 1987 where asthma or COPD (defined as International Classification of Diseases 9th Revision (ICD9) 490, 491, 492, 496) were listed in part I or part II were identified. The following certificates were then selected for further investigation: those mentioning asthma for all ages, those mentioning COPD for ages less than 56 years, and a 50% sample of those mentioning COPD aged 56-75 years. For these selected deaths the general practitioners' case notes, hospital records, and necropsy findings were reviewed. Questionnaires detailing the clinical history and circumstances of death were completed by the general practitioner by post and by a close relative or associate of the deceased (doctor administered) if, after initial investigation, the death was likely to be due to COPD or asthma. A panel of two respiratory physicians reviewed each death and, using clinical diagnostic criteria, assessed the accuracy of the registered cause of death. RESULTS: Of 50 registered asthma deaths 43 were confirmed as being due to asthma. In nine registered deaths from COPD in cases aged less than 56 years one was confirmed as COPD, two as asthma, and six as other respiratory conditions. Of 105 registered deaths from COPD in cases aged 56-75, 42 were confirmed as COPD, 27 as asthma, eight as other respiratory conditions, and 28 as other causes. Although few errors in registration were found, 21% of certificates mentioning asthma and 38% of certificates mentioning COPD but not asthma in part I were subject to variable application of the classification rules by the registering officers. For all deaths under 75 years of age in Northern Ireland in 1987 where either asthma or COPD was mentioned anywhere on the death certificate, the estimated sensitivity and specificity of the registered cause of death in predicting the "true" cause of death were 29% and 98.6% for asthma and 69% and 70% for COPD. CONCLUSIONS: In a population of subjects where asthma or COPD was mentioned anywhere on the death certificate, the registered cause of death is a relatively poor indicator of the "true" cause of death for both asthma and COPD. Variation occurred in the application of death classification rules by registration officers. Many deaths certified and registered as COPD could have been called asthma using current standards of clinical diagnosis. In studies investigating risk factors for deaths from asthma, case finding should consider deaths registered as COPD.

Aged↗
PubMed1986

Serological surveillance for maedi-visna virus and caprine arthritis-encephalitis virus in Northern Ireland.

The results of serological testing for maedi-visna virus infection in indigenous and non-indigenous sheep in Northern Ireland, over a five year period (1980 to 1984) are presented. In tests carried out in 1980 and 1981 on pedigree breeds, 10 reactors were identified on seven farms and maedi-visna virus was isolated on three occasions from leucocyte cultures. None of the animals showed clinical signs of maedi-visna and all the reactors were subsequently destroyed. Nine of the reactors were imports from Scotland or the Republic of Ireland and the other was the progeny of an imported ewe. In subsequent tests (1982 to 1984) of exotic and indigenous flocks no further reactors were identified. A survey of goat herds for evidence of caprine arthritis-encephalitis virus infection was also negative.

Animals↗
PubMed1992

Characterisation of an antigenically unusual virus responsible for two outbreaks of Newcastle disease in the Republic of Ireland in 1990.

Antigenic characterisation of two highly virulent virus isolates from outbreaks of Newcastle disease on two closely connected farms in County Monaghan, Republic of Ireland, in 1990 showed the viruses to be indistinguishable but unlike other Newcastle disease viruses so far tested. However, they appeared to be antigenically closest to avirulent viruses isolated from waterfowl from several countries and from chickens in Northern Ireland in 1986. Despite the antigenic differences, chickens vaccinated with a live commercial Hitchner B1 vaccine were protected against intramuscular challenge with one of the virulent isolates.

Animals↗
PubMed1999

Bovine tuberculosis in Northern Ireland: a case-control study of herd risk factors.

This paper presents the results of the first formal epidemiological study in Northern Ireland of risk factors for bovine tuberculosis (TB) associated with farm boundaries, neighbours and wildlife. The study was designed as a case-control study and 427 dairy herds were investigated between December 1993 and January 1995. The case herds had more than 30 cattle, and herds in which the source of infection had been ascribed to purchased cattle were avoided. Data on the Department of Agriculture Animal Health Computer were used in conjunction with data collected through a questionnaire to examine a range of possible risk factors, including the number and nature of the farm boundaries, the number of neighbours and their TB history, the number of hedgerows, the presence of badger setts, whether badger carcases had been found on the land, and the possible presence of deer. A follow-up telephone survey was conducted to minimise bias. The results highlighted two main associations with TB breakdowns, the presence of badgers, and contiguous neighbours who had had confirmed TB breakdowns. The estimated aetiological fraction for both associations was approximately 40 per cent, suggesting that although infected cattle may have a significant role in the transmission of TB their importance relative to the badger may have been over-estimated in the Northern Ireland TB scheme. The contribution of the badger is possibly one of several main reasons for the lack of significant progress in TB eradication despite strenuous efforts associated with all aspects of the scheme.

Analysis of Variance↗
PubMed2002

Fertility of dairy cows in Northern Ireland.

A comprehensive database was established on the milk production and reproductive performance of dairy cows in 19 selected herds in Northern Ireland, varying in size, management system and genetic merit. Data were obtained for 2471 cows, 1775 of which calved in a second year, and 693 were culled from the herd for specific reasons. The estimated mean rate of heat detection (assessed by the interheat interval during the main breeding season) in all the herds was 71 per cent, with a range from 53 to 92 per cent The average conception rate to first insemination was 37.1 per cent (range 21 to 66 per cent). The average calving interval for the retained cows was 407.2 days (range 359 to 448 days). Twenty-eight per cent of the cows that calved were culled, with infertility being the largest single reason (26.8 per cent of the cows culled). There were major differences in reproductive performance between the herds, but heat detection rate, conception rate and calving interval did not appear to be affeded by a herd's genetic merit. The herds with shorter calving intervals were characterised by better heat detection efficiency (83 v 61 per cent, P<0.01), a shorter interval from calving to first insemination (74 v 97 days; P<0.05), a higher conception rate to first insemination (45 v 34 per cent, P>0.10) and a lower removal rate (23 v 37 per cent, P<0.01). Furthermore, the cows in these herds had lower body condition scores (BCS) in the dry period (3.0 v 3.3; P<0.05) but lost less body condition in early lactation (0.3 v 0.6 BCS units, P<0.05). These results show that dairy herd fertility in Northern Ireland is generally low and similar to that previously reported for England and the USA, but that in some herds changes in herd management practices improved the cows' fertility.

Animal Nutritional Physiological Phenomena↗
PubMed2004

Creutzfeldt-Jakob disease in Ireland: epidemiological aspects 1980-2002.

Surveillance for Creutzfeldt-Jakob disease (CJD) has been carried out in the Republic of Ireland since 1980. Initial surveillance was passive and based on consented autopsy confirmation of CJD in patients in whom there was a high index of clinical suspicion. Since 1999, an active surveillance programme involving formal notification of all suspect CJD cases has been in place. The annual mortality rate has increased from 0.34 cases/million in 1980 to 1.27 cases/million in 2001. In all, 29 cases have been pathologically confirmed: 1 had variant CJD (vCJD), 1 had iatrogenic human growth hormone-induced CJD and 1 had fatal insomnia. Sporadic CJD (sCJD) accounted for the remainder. This paper details the change in incidence over 22 years as the surveillance programme in Ireland got under way; the increased incidence is attributed to better case ascertainment, as has occurred in other countries where active surveillance programmes have been established.

Adult↗
PubMedDate not supplied

A probabilistic estimation of fluoride intake by infants up to the age of 4 months from infant formula reconstituted with tap water in the fluoridated regions of Ireland.

Two probabilistic models were developed to estimate the acute and chronic exposure to fluoride of exclusively formula-fed infants aged 0-4 months as a result of the consumption of infant formula reconstituted with fluoridated tap water in Ireland. The estimates were based on calculated infant formula consumption and accepted body weight standards, together with reported concentrations of fluoride in infant formula powder and measured values for the fluoride content of water in Ireland. The mean acute exposure of infants to fluoride on any single day in areas served by 387 fluoridated water supplies was estimated to be between 0.11 and 0.14 mg/kg body weight depending on age group (95th percentiles 0.2 and 0.26 mg/kg b.w., respectively). These predicted intakes were well below the intake of fluoride associated with acute toxic effects, which is considered to be 5 mg fluoride (F(-))/kg body weight. The mean chronic exposure of infants to fluoride was estimated to be between 0.106 and 0.170 mg/kg b.w./day depending on body weight (95th percentiles 0.108 and 0.172 mg/kg b.w./day, respectively). This estimate described the average daily fluoride intake of infants during the first 4 months of life residing in the areas served by 226 water supplies that achieved an average yearly fluoride concentration below 1.03 mg/l. Dental fluorosis may be considered to be the only risk at these low doses and from our work it is estimated that there is a very low risk of moderate dental fluorosis of the permanent dentition in infants exposed to fluoride at these levels.

Age Factors↗
PubMed2006

Education for practice in the UK and Ireland: implementing problem-based learning.

OBJECTIVE: This paper outlines the education of speech and language therapists in the UK and Ireland, and presents a preliminary study of student therapists' perceptions of problem-based learning (PBL) as a learning strategy in preparation for clinical work. PBL has been used extensively in medical and dental education in Europe, in Canada, and in the Middle East, and has been applied to speech and language therapist education in Sweden and in Australia. Its implementation in the UK and Ireland is relatively new. METHODS: A survey questionnaire was circulated to students in two centres via e-mail. Questions posed included student impressions of the most and least useful elements of PBL in their preparation for clinical practice, as well as how they considered improvements could be made; student reflections regarding PBL were also sought. RESULTS AND CONCLUSIONS: Findings support the implementation of PBL in the education of speech and language therapists, with more experienced students showing more positive support for PBL. Issues raised by the study include emphasis on clinical relevance of problems, particularly in the early years of the course. The majority of students regarded PBL as directly relevant for clinical preparation.

Humans↗
PubMed1992

The changing mortality from motor neurone disease and multiple sclerosis in England and Wales and the Republic of Ireland.

A study has been undertaken to ascertain the changes in mortality from motor neurone disease (MND) and from multiple sclerosis (MS) in England and Wales and in the Republic of Ireland. During the 20 years 1968-1987, 16,077 deaths were reported as being primarily due to MND in England and Wales with a male/female ratio of 1.22. There has been an increase in MND deaths from 3,185 in 1968-1972 to 5,241 in 1983-1987. The increase occurred in the death rates in both sexes and in all age groups, but particularly over the age of 65. In contrast, there was no increase in MS deaths and the MS death rates fell below the age of 55 but increased over this age, evidence that MS patients are living longer. A similar but more marked increase in MND mortality, and a considerable fall in MS mortality, occurred in the Republic of Ireland. The increase in MND mortality is not due to an increase in the number of neurologists, as there has been little increase in their numbers. The highest MND mortality was in Social Class IIIN males - skilled non-manual workers.

Age Factors↗
PubMed2001

Different alcohol drinking and blood pressure relationships in France and Northern Ireland: The PRIME Study.

To assess the effect of alcoholic beverages consumed on blood pressure levels by day of the week, baseline data from the Prospective Epidemiological Study of Myocardial Infarction (PRIME), including 6523 male subjects who drank at least once a week (5156 in France and 1367 in Northern Ireland), were analyzed. In France, alcohol consumption was rather homogeneous throughout the week, with a slight increase during weekends, whereas in Northern Ireland, Fridays and Saturdays accounted for 66% of total alcohol consumption. After adjustment for age, body mass index, heart rate, tobacco smoking, educational level, marital status, and professional activity, blood pressure levels were higher in Northern Irish drinkers on Monday and decreased until Thursday, whereas blood pressure levels were constant throughout the week for French drinkers (day x country interactions, P<0.05). Conversely, no between-day differences were found regarding teetotalers in both countries. In drinkers, between-day differences and day x country interactions were suppressed after adjustment for the average alcohol consumption of the third day before measurement. We conclude that the binge-drinking pattern observed among Northern Irish drinkers leads to physiologically disadvantageous consequences regarding blood pressure levels, whereas no such fluctuations in blood pressure levels are found for regular consumption.

Alcohol Drinking↗
PubMed1984

Endemic psychosis in western Ireland.

For over 200 years parts of Ireland have been thought to have a high prevalence of psychosis, and recent hospital and community studies have confirmed this impression. In an intensive study of a rural area, the authors found that 4% of the population over age 40 was actively psychotic, with diagnoses of schizophrenia, schizoaffective disorder, and bipolar disorder. Psychosis seems to be endemic in some rural, lower socioeconomic areas in Ireland. Possible etiological explanations are discussed.

Adult↗
PubMed1996

Vitamin E and exercise in the Northern Ireland population.

Serum vitamin E, vitamin E/cholesterol and physical activity and fitness were examined in a representative cross section (n = 1600) of the Northern Ireland population as part of the Northern Ireland health and activity survey. Serum vitamin E levels were measured by high-performance liquid chromatography, cholesterol by an enzymatic method, physical activity profile was recorded by computer assisted interview and physical fitness was determined by estimation of VO2 max. The levels of serum vitamin E and vitamin E/cholesterol ratio in the Northern Irish population were similar or higher than in other populations with lower incidences of coronary heart disease. The assessment of activity showed that 75% of the population fell below recommended activity levels likely to confer a cardioprotective effect. A significant relationship (P = 0.01) was found in males between serum vitamin E levels and lifetime participation in physical activity. Otherwise no relationship was found between serum vitamin E or vitamin E/cholesterol ratio and physical activity or fitness in the population.

Adolescent↗
PubMed2004

Temporal acculturation and mental health in modern Ireland.

BACKGROUND: Research on geographic acculturation has demonstrated an association between the sort of acculturation strategy adopted by migrants and their mental health status. However, there have been no studies of the relationship between temporal acculturation--attempts to adapt to change within the same society over time--and mental health. METHOD: We explored the relevance of Berry's bidimensional framework of acculturation, to perceptions of social change within Ireland over the last 10 years, in a sample of 735 members of the general public. RESULTS: There was a significant relationship between temporal acculturation strategy and mental health. An acculturation strategy of assimilating into 'modern' Ireland was associated with significantly better mental health than an ambivalent acculturation strategy. CONCLUSIONS: This is a first exploration of the relationship between temporal acculturation and mental health. While models of geographic acculturation are relevant to temporal acculturation, we have also identified a new category of acculturation strategy, ambivalence, as being associated with the poorest mental health outcomes.

Acculturation↗
PubMed2002

Mood and behaviour problems associated with seasonal changes in Britain and Ireland.

BACKGROUND: Research from across the world has shown that rates of seasonal mood disturbances may vary according to such factors as geographical location, age and gender. Little is known of the nature of these problems within representative community samples in UK and Ireland. AIMS: In two studies we examined the extent to which winter disrupts mood and behaviour among random samples of British and Irish adults. METHODS: In the first study, 533 adults randomly chosen from electoral data from four towns spread across 50-58 degrees N completed the Seasonal Pattern Assessment Questionnaire (SPAQ). In the second study, 498 adults from two towns in Northern Ireland (54 degrees N) completed the SPAQ. RESULTS: Although the combined response rate across the two studies was low (20.5%), the prevalence rates were similar to several other western European sites. The rate of SAD and S-SAD averaged across the six centres as determined from strict SPAQ criteria, was 6.7% and 10.5% respectively. There was some variability in rates from town to town, with one Northern Irish town presenting rates more associated with areas at much lower latitudes, although most differences between towns were not significant. As in most other studies, females of reproductive age tended to supply the higher number of incidences. CONCLUSION: This report from community samples across six sites confirms earlier suggestions that rates of seasonal disturbance in mood and behaviour deserve serious consideration by mental health practitioners throughout the region.

Adolescent↗
PubMed1989

Social class, psychological wellbeing and minority status in Northern Ireland.

The present study sought to evaluate the completing claims of the social stress hypothesis and the social selection hypothesis which both claim to explain the relationship between social class and psychopathology. Scores on a self-report measure of psychological wellbeing, the General Health Questionnaire (GHQ) were obtained from a random sample of 581 respondents in Northern Ireland. An analysis of variance comparing majority (Protestant) and minority (Catholic) group males and females at three socioeconomic levels produced a Religion X Social Status interaction. This was due to a trend of increasing symptoms with decreasing social status among Protestants and the reverse phenomenon among Catholics. It was concluded that the results while similar to those reported earlier by Cochrane and Stopes-Roe, provided no clear support for either the social selection hypothesis or the social stress hypothesis but were possibly related to local factors connected with emigration or the ongoing political violence in Northern Ireland.

Adaptation, Psychological↗