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At least 541 records · Page 30Linked to original sources
PubMed2001

Occurrence of Campylobacter spp. in water in Northern Ireland: implications for public health.

The occurrence of Campylobacter spp was examined in a variety of waters in Northern Ireland. Conventional cultural techniques were employed with 768 water specimens, including drinking waters (tap, spring, bore hole and bottled) and recreational waters (swimming pool, lough, river and sea). Positive waters included 1/11 (9.1%) drinking water from untreated well water, as well as 5/12 (41.7%) untreated surface waters from loughs and 7/8 (87.5%) untreated river waters. Overall, untreated surface waters may represent a source of contamination with Campylobacter spp. in Northern Ireland, where they have a recreational involvement or are used as a drinking source by man or agricultural livestock. Therefore waterborne campylobacteriosis should be considered in patients presenting with acute enteritis and a history of participation in water sports/activities. As faecal coliform organisms have been previously shown to be poor markers of water quality, especially for Campylobacter spp, new criteria should be established to assess the risk of this infection and to evaluate and monitor the quality of water used for recreational purposes.

Bathing Beaches↗
PubMed2001

The clinical outcome of non-RhD antibody affected pregnancies in Northern Ireland.

We assessed the clinical outcome of pregnancies with non-Rh-D antibody in Northern Ireland using retrospective case note review. During the study period (April 1999- March 2000) 186 women with clinically significant antibodies were identified from the records of the antenatal laboratory of the Northern Ireland Blood Transfusion Service. Eighty-five women were included in the study using the criteria mentioned above. None of the fetuses required intrauterine transfusion during this period. One baby required exchange transfusion, three were given top-up transfusions and 17 had phototherapy. Nine babies with a positive direct antiglobulin test (DAT) received no treatment. The incidence of anti-Kell could be reduced by transfusing Kell negative red cells to premenopausal women. It is important that all pregnant women are tested at least twice in their pregnancy to detect the antibodies formed late in the pregnancy. It is useful to formulate a standard protocol for antenatal interventions. Non Rh-D antibodies can cause significant anaemia for up to six weeks in the neonatal period, hence early detection of maternal antibodies is important so that the neonates are followed up for an appropriate length of time.

Blood Group Incompatibility↗
PubMed2002

Comparison of secondary prevention of heart disease in Europe: lifestyle getting worse, therapy getting better in Ireland.

We compared the implementation of secondary prevention some 18 months following acute myocardial infarction or coronary artery bypass surgery in Ireland in 1994 to that in 15 European countries, including Ireland, in 2000. While there were substantial improvements in the use of statins, b-blockers and the availability of rehabilitation programmes since the early 1990s, more patients now smoke, take no exercise and are overweight. The prevalence of non-insulin dependent diabetes has increased by 70%. In comparison with other European countries, we have the highest use of aspirin and the highest prevalence of smoking in women. Despite a considerable improvement in the use of drug therapy we will not achieve the full potential of secondary prevention unless lifestyle factors, including smoking, overweight and exercise receive greater attention by patients with coronary heart disease.

Adrenergic beta-Antagonists↗
PubMed2002

Teleneurology in Northern Ireland: a success.

In March 1998 two neurologists and a professor of telemedicine met to solve a clinical problem--how to get neurological expertise to patients admitted acutely to hospitals which had no resident neurologist. Four years later, two new consultant neurologists were appointed in Northern Ireland with sessions in telemedicine, possibly the first such appointments anywhere in the world. This feat was achieved by combining science with politics. First, we chose the most appropriate telemedicine equipment and bandwidth for our needs. Second, we altered our neurological consultation to use the technology efficiently. Third, we were able to show scientifically that teleneurology was reproducible, feasible in practice, safe, acceptable and cost-effective. This required money to pay for a research fellow and equipment, which was obtained initially from some departmental research funds and a local hospital. Conventional research funding bodies were, on the whole, unhelpful. It was serendipitous that a review of neurology services in Northern Ireland was set up by the Department of Health. This identified our original problem as one that it wanted solved and we were in the fortunate position of being able to offer telemedicine as a tested solution. One final political push was required to get the money released. The result of this juxtaposition of science and politics should bring benefit to our neurological patients and will perhaps help others trying to establish similar projects elsewhere.

Financial Support↗
PubMed2003

Carbon monoxide poisoning in the Republic of Ireland.

Carbon monoxide (CO) poisoning remains a common preventable cause of morbidity and mortality from poisoning worldwide. Common environmental sources include motor vehicle exhaust, faulty kerosene or gas heaters used in unventilated rooms, and fireplaces with blocked flues. This paper describes the epidemiology of CO poisoning in Ireland, using Hospital Inpatient Enquiry (HIPE) data, Mortality data and data from the National Poisons Information Centre (NPIC). CO poisoning is responsible for over 40 deaths per year in Ireland. Many occur at home as a result of house-fires. Incomplete combustion of domestic fuels is responsible for many cases of non-fatal unintentional CO poisoning. In comparison, most intentional poisonings are caused by motor vehicle exhaust, representing approximately 6.4% of successful suicides. The advent of catalytic converters in cars may lead to a decline in the effectiveness of this method of suicide. This study illustrates the hidden impact of CO poisoning. Most deaths occur at home and thus do not come to the attention of the health services. Those admitted to hospital represent the milder end of the spectrum and generally recover after a short stay. It is important that the public be aware of the risks of CO poisoning and that Public Health action be taken.

Adolescent↗
PubMed1992

The epidemiology of pertussis in the Republic of Ireland.

Epidemiological data on pertussis in the Republic of Ireland have been gathered annually since 1941. However, no detailed analysis of these data has, until now, been carried out. Fifteen epidemics occurred between 1941 and 1989, an average of one per 3.1 years, which is similar to epidemic intervals observed elsewhere. After the introduction of a vaccine in the 1950s, annual pertussis notifications declined, from 175 per 100,000 in 1956 to 7.6 per 100,000 in 1972. Following adverse publicity in 1973, uptake of the vaccine fell to 30% in 1976. Although uptake has increased again in recent years, it has levelled out at only 40-45% and large epidemics of pertussis occurred in 1985 and 1989. At the same time, mortality from pertussis has fallen to almost negligible levels. Most cases occur in children more than one year of age. Changes in the vaccination schedule could have a major impact on the incidence of the disease in the Republic of Ireland. However, if a further decline in the incidence of the disease is to be achieved, parents have to be persuaded of the benefits of pertussis vaccination.

Adolescent↗
PubMed1992

The treatment received by children in the general dental service in Northern Ireland, 1977-1988.

The reports of the Central Services Agency were analysed to investigate the treatment received by children in general dental practice in Northern Ireland. In recent years there was an increase in the number of children who attended for dental care which was paralleled by reductions in extractions and the restoration of permanent teeth. It was concluded that there had been marked changes in the pattern of dental treatment in children in Northern Ireland between 1977 and 1988.

Child↗
PubMed1992

Committal procedures in Ireland.

The study aims to describe current committal practice in an Irish public psychiatric service and to establish the role of 'dangerousness' in determining practice. A six month retrospective review was undertaken using casenotes and original temporary forms of all patients committed to St Brendan's Hospital, Dublin within a six month period in 1990. A total of 136 cases were examined. In 65% of cases the application for detention was initiated by a spouse or relative. The recommending physician was identified as a General Practitioner in 80% of cases, although most were locum GP's. The number of male and female patients were almost equal. There was a wide age range with the largest group (42%) in the range 26-40 years. Previous contact with the psychiatric service was found in 89% of cases. There was a wide range of diagnoses with the largest category (56%) suffering from schizophrenia. Of those not admitted with alcohol or drug related illness 66% showed evidence of acute psychotic symptoms. Length of admission was relatively short with 84% of patients being discharged within three months. A total of 43% showed evidence of being a danger to themselves or others. Significant differences were found between these patients and the non-dangerous group, the latter being more likely to be older and to suffer from a major psychotic illness. These findings indicate that a committal law based purely on 'dangerousness' criteria would be likely to significantly affect committal practice in Ireland. These findings are discussed in relation to proposed changes in mental health legislation in Ireland.

Adolescent↗
PubMed2003

Lung cancer survival in Northern Ireland.

Lung cancer causes more deaths than any other cancer in Northern Ireland. Survival, and factors which could influence survival, were examined for the 4,458 patients diagnosed with lung cancer from 1992 to 1996. Overall five-year relative survival was low, but better for females (9%) than males (7%). Survival improved each year although this could not be attributed to treatment changes. Survival was better for men under 65 years, than older men (p<0.01), while survival from non-small cell type lung cancer was better than small cell (p<0.001). The proportion of patients having bronchoscopy and CT scan increased over the study period. Although the proportion of patients receiving surgery or radiotherapy remained unchanged over the period there was an increase in the proportion receiving chemotherapy (8.7% vs. 9.4%, P<0.05). Survival rates, although slightly better than in the rest of the United Kingdom, were poorer than in several other countries, including the Republic of Ireland and the United States of America. High mortality rates from lung cancer and, at best, modest improvements in survival, point to the need for increased efforts to reduce levels of lung cancer by tackling the main cause, smoking.

Age Distribution↗
PubMed2003

The caesarean section rate in the Republic of Ireland in 1998.

The Caesarean section (CS) rate has risen dramatically in the United Kingdom and North America over the past 20 years. There are no recent data in the Republic of Ireland on CS rates. Our aim was to ascertain the national CS rate for the year 1998. In addition, we sought to determine instrumental delivery rates and epidural rates. Twenty-two of 24 units replied to a questionnaire giving a response rate of 92%. The CS rate was 17.8% (12.8-26.7%), 7.5% were elective and 10.3% were emergency. The size or type of the maternity unit did not influence the CS rate. The cause for the rise in the CS rate is multifactorial. Review of the current literature would suggest that a further rise in the CS rate in Ireland is likely.

Analgesia, Epidural↗
PubMed2003

The National Dental Nurse Training Programme of Ireland.

The National Dental Nurse Training Programme of Ireland will commence in January 2004. This is the first Irish national training programme for dental nurses. It has been recognised by the Dental Council of Ireland as being suitable for purposes of registration on the Dental Nurse Register. The purpose of this article is to bring this training programme to the attention of Irish dental practitioners.

Curriculum↗
PubMed1992

'An active body, a healthy body': a new health survey for Northern Ireland.

The Northern Ireland Health and Activity Survey is the first survey of its type to take place in Northern Ireland. Its aim is to provide a detailed profile of the general level of physical activity in the province. The main advance in this survey is that it includes studies of blood components, such as various lipids levels. This exciting and far reaching project commenced in February 1992 and extends over a period of approximately one year.

Exercise↗
PubMed1992

Continuing medical education for general practitioners--a Northern Ireland plan.

Following the introduction of the 1990 contract for general practitioners and the new postgraduate education allowance, the Northern Ireland Continuing Medical Education Group, comprising the clinical tutors from four Belfast hospitals and members of the University department of general practice, was established to provide high quality co-ordinated continuing medical education for general practitioners. A questionnaire was sent to all general practitioners in Northern Ireland to find out their needs and preferences with regard to continuing education. The responses indicate the value of small group discussion as well as the traditional lecture and the important role of local hospital consultants in providing education. Therapeutics, recent advances in medicine and learning new skills are all desirable topics. The group intends to use this information in the provision of courses for general practitioners in the province.

Education, Medical, Continuing↗
PubMedDate not supplied

Customer needs, expectations, and satisfaction with clinical neurophysiology services in Ireland: a case for tele-neurophysiology development.

Although equitable access to services should be based on need, geographical location of patients and their clinicians can give rise to inequalities in healthcare delivery. Development of tele-medicine services can improve equity of access. The specialty of Clinical Neurophysiology (CN), currently under-developed in Ireland provides an example of such potential. This study aimed to determine the needs, expectations, and satisfaction of CN customers, namely patients and referring clinicians. The goal was to examine geographical impediments to access that might be addressed by the introduction of tele-neurophysiology. Two customer surveys were conducted: CN referring clinicians and CN patients. Thirty-one North Western Health Board (NWHB) consultant clinicians responded to a postal survey. Distance and delays caused by long waiting lists were felt to deter or make CN referral irrelevant. Ninety-seven percent believed the lack of a local service negatively impacts on patient management and 93% would welcome the introduction of a tele-neurophysiology service. The geographical location of patient's residence and/or the location of the referring clinician's practice influenced waiting lists for CN. Fifty-eight (105/182) percent of patients living in a region with a CN service compared to 39% (50/128) of those living in a region with no service received an appointment within one month. In addition to the current insufficient CN service capacity in Ireland, these surveys highlighted geographical inequities. Tele-neurophysiology has the potential to speed-up diagnosis, result in more patients being appropriately investigated and be fairer to patients.

Consumer Behavior↗
PubMed2004

The evaluation and treatment of female urinary incontinence--a comparison of clinical practice in the Republic of Ireland with the recommendations of the International Continence Society.

In 1998 the International Continence Society (ICS) developed a set of recommendations for the diagnostic evaluation and treatment of urinary incontinence. The aim of this study was to determine to what extent current clinical practice in the Republic of Ireland correlated with the ICS recommendations. We personally interviewed 100 gynaecologists at units around Ireland. Participants were presented with two clinical scenarios, one described a patient with predominantly genuine stress incontinence, the other described a patient with an overactive bladder. Ninety-five (95%) requested a midstream urine sample for culture and sensitivity, and 74 (74%) considered urodynamics an appropriate initial investigation for a woman with stress incontinence. Physiotherapy was recommended as a first line treatment for stress incontinence by 76 (76%). Burch colposuspension, chosen by 55 (55%), was the most common first line surgical procedure. Other first line surgical procedures were TVT [31(31%)] Marshall-Marchetti-Krants procedure [5(5%)], anterior colporrhaphy [4 (4%)] and a variety of other procedures [5 (5%)]. When considering the initial investigation for a woman with an overactive bladder, 95 (95%) asked for a midstream urine sample for culture and sensitivity and 85 (85%) requested urodynamic investigations. Initial management of this condition included anticholinergic therapy alone [57 (57%)], anticholinergic therapy combined with bladder retraining [36 (36%)], bladder retraining alone [5 (5%)], and cystoscopy and bladder distension 2 (2%). Seventy-six (76%) felt that cystoscopy was an appropriate investigation for a woman with symptoms of an overactive bladder who has failed to respond to initial therapy. The study reveals a significant degree of diversity in the evaluation and management of patients who present with symptoms of urinary incontinence. It also highlights a number of areas where current clinical practice deviates from the recommendations of the ICS. In particular, there is a high and inappropriate use of urodynamics in the initial management of these patients.

Adult↗
PubMed2004

Folic acid supplements to prevent neural tube defects: trends in East of Ireland 1996-2002.

Promotion of folic acid to prevent neural Tube Defects (NTD) has been ongoing for ten years in Ireland, without a concomitant reduction in the total birth prevalence of NTD. The effectiveness of folic acid promotion as the sole means of primary prevention of NTD is therefore questionable. We examined trends in folic acid knowledge and peri-conceptional use from 1996-2002 with the aim of assessing the value of this approach. From 1996-2002, 300 women attending ante-natal clinics in Dublin hospitals annually were surveyed regarding their knowledge and use of folic acid. During the period the proportion who had heard of folic acid rose from 54% to 94% between 1996 and 2002 (c2 test for trend: p<0.001). Knowledge that folic acid can prevent NTD also rose from 21% to 66% (c2 test for trend: p<0.001). Although the proportion who took folic acid during pregnancy increased from 14% to 83% from 1996 to 2002 (c2 test for trend: p<0.001), peri-conceptional intake did not rise above 24% in any year. There is a high awareness of folic acid and its relation to NTD, which is not matched by peri-conceptional uptake. The main barrier to peri-conceptional uptake is the lack of pregnancy planning. To date promotional campaigns appear to have been ineffective in reducing the prevalence of NTD in Ireland. Consequently, fortification of staple foodstuffs is the only practical and reliable means of primary prevention of NTD.

Adult↗
PubMed2004

The epidemiology of infectious syphilis in the Republic of Ireland.

In response to the increasing numbers of syphilis cases reported among men having sex with men (MSM) in Dublin, an Outbreak Control Team (OCT) was set up in late 2000. The outbreak peaked in 2001 and had largely ceased by late 2003. An enhanced syphilis surveillance system was introduced to capture data from January 2000. Between January 2000 and December 2003, 547 cases of infectious syphilis were notified in Ireland (415 were MSM). Four per cent of cases were diagnosed with HIV and 15.4% of cases were diagnosed with at least one other STI (excluding HIV) within the previous 3 months. The mean number of contacts reported by male cases in the 3 months prior to diagnosis was 4 (range 0-8) for bisexual contacts and 6 for homosexual contacts (range 1-90). Thirty one per cent of MSM reported having had recent unprotected oral sex and 15.9% of MSM reported having had recent unprotected anal sex. Sixteen per cent of cases reported having had sex abroad in the three months prior to diagnosis. The results suggest that risky sexual behaviour contributed to the onward transmission of infection in Dublin. The outbreak in Dublin could be seen as part of a European-wide outbreak of syphilis. The rates of co-infection with HIV and syphilis in Ireland are comparable with rates reported from other centres. There is a need to improve surveillance systems in order to allow real time evaluation of interventions and ongoing monitoring of infection trends.

Adolescent↗
PubMed2005

A practical method for monitoring general practice mortality in the UK: findings from a pilot study in a health board of Northern Ireland.

BACKGROUND: The Baker report into Dr Harold Shipman's murders recommended monitoring mortality in general practice, but there is currently no practical method available to implement this. AIM: To monitor mortality rates in response to the Baker report and to use the data to improve quality of care. DESIGN OF STUDY: Prospective mortality monitoring study. SETTING: Eastern Health and Social Services Board, Northern Ireland. METHOD: Linked quarterly mortality data from 1994-2001 were compiled for 114 general practices in Eastern Health and Social Services Board in Northern Ireland. Cross-sectional control charts compared crude and adjusted mortality rates across all the practices. Longitudinal control charts analysed quarterly mortality rates over 28 quarters within each practice. Practices were sent their own control charts and invited to feedback workshops. Special cause variation in mortality was investigated as follows: checks on data, case-mix, practice structures, processes of care and finally individual carers. RESULTS: Age, sex and deprivation adjusted cross-sectional control charts identified 18 practices as showing special cause variation in their mortality (11 high and 7 low). Assignable causes were found for all high special cause practices: large numbers of nursing home patients (six practices), very high levels of deprivation and high morbidity not captured by our case-mix adjustment (five practices). For three of seven low special cause practices, case-mix adjustment underestimated affluence and overestimated morbidity levels. Feedback indicated widespread support for the principle of monitoring, but concerns about the public disclosure of mortality data. CONCLUSIONS: We have successfully developed and piloted a general practice mortality monitoring system with the support and participation of local stakeholders. This used control charts for analysis and followed a scientific strategy for investigating special cause variation.

Epidemiologic Methods↗