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PubMed1990

HLA antigens and multiple sclerosis in Northern Ireland.

Multiple sclerosis has been shown to be associated with the presence of certain major histocompatibility (MHC) tissue antigens which are coded on chromosome 6. There are racial differences in the antigens associated with MS. The strength of the associations vary in different communities in Western Europe. We have investigated the association between MS and MCH antigens in Northern Ireland in a group of 104 patients. There is a particularly strong association between MS and HLA-DR2, 65.4% compared with 25.5% in 184 controls. A weaker association has been demonstrated with HLA-A3 (44.2% vs 26.5% in controls). There have been conflicting reports concerning an association of HLA-DW2 and HLA-DR2 with a rapidly progressive form of MS. Our data do not support that hypothesis.

Activities of Daily Living↗
PubMed1991

Obesity: a public health problem in Ireland?

We examined the prevalence of different categories of body weight in a random sample of men and women aged 35 to 64 years studied in 1985 in County Kilkenny, Ireland. The largest group was those classified as overweight-51.1% of men and 44.7% of women. There were 13.7% of men and 19.2% of women in the obese category. The obese were older but the distribution by social class did not differ significantly from the non-obese. Obese women had significantly more children born alive and a higher prevalence of positive angina questionnaire than those who were not obese. Serum total cholesterol was higher in obese men and HDL cholesterol was lower in obese men and obese women. Systolic and diastolic blood pressures were significantly higher in obese men and women but smoking status was similar. In a multiple logistic regression analysis, systolic blood pressure in men and diastolic in women remained significantly associated with obesity; there was an inverse association between obesity and HDL cholesterol in women and between obesity and HDL-cholesterol as a proportion of total cholesterol in men. A cardiovascular disease prevention programme should seek to prevent the increase in the prevalence of obesity with age which occurs in this population. It would also be important to assess other risk factors for coronary heart disease among those who are obese, with a view to reducing their overall level of risk.

Adult↗
PubMed1991

Physical activity and risk of coronary heart disease in a survey of adults in Kilkenny, Ireland.

A questionnaire survey was carried out to estimate activity levels in a sample of 784 men and women aged 35 to 64 years in County Kilkenny, Ireland. Men were more likely to have sedentary, heavy or very heavy work activity while the majority of women had moderate activity during an average day. Only a small minority of respondents walked or cycled to work. 44% of those surveyed had leisure pursuits which were sedentary. At leisure, a higher proportion of men were involved in active sports or other vigorous activities for at least three hours per week. Men also spent longer each day walking, cycling or jogging. 16.5% of those surveyed engaged in vigorous activities for at least 20 minutes on one to three occasions weekly while 5.1% did so on four or more occasions. Younger people were more likely to take such exercise while older people were more likely to take less vigorous exercise. Path analysis using multiple regression techniques found that an increase in activity levels in this population could lead to substantial reductions in blood pressure, some of which would be mediated through changes in body weight.

Adult↗
PubMed1991

Medical management of acute myocardial infarction in Ireland: information from the Second International Study of Infarct Survival (ISIS-2).

We report the management of the 831 patients from 18 hospitals which constituted the Irish component of the 17,183 subjects enrolled in the ISIS-2 trial which studied the effects of streptokinase infusion and aspirin therapy given to patients presenting within 24 hours of the onset of suspected acute myocardial infarction. 34% of Irish patients (IP) presented for treatment within 4 hours of the development of symptoms. This compared to 44% of the overall group (OG) (p less than 0.001). This represented the lowest percentage of patients presenting within 4 hours in any of the participating countries. The mean delay time from onset of symptoms was 7.9 hours in IP compared to 6.9 in OG (p less than 0.001). The mean delay time in Ireland was longer than the mean delay time in any of the participating countries. The mean age and systolic blood pressure at presentation was similar in both groups. It was planned to treat 12% IP with aspirin compared to 10% OG (p-NS), and 71% IP with subcutaneous heparin compared with 47% OG (p less than 0.001). Intravenous heparin was planned treatment in 20% IP and 24% OG (p less than 0.01). Planned oral anticoagulant therapy was similar in both groups (p-NS). Planned use of intravenous betablockers occurred in only 2% IP and 6% OG (p less than 0.001). 9% IP and 22% OG received steroids before streptokinase infusion (p less than 0.001). 65% IP and 47% OG received subcutaneous heparin (p less than 0.001). The use of intravenous heparin and oral anticoagulants was similar in IP and OG (p-NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1995

Secular trends in mortality from asthma in children and young adults: Republic of Ireland, 1970-91.

Trends in mortality attributed to asthma in children (0-14 years) and young adults (15-44 years) and the age group 5-34 years were examined for the Republic of Ireland over the period 1970-91. Childhood mortality rates were low with no clear trend. A recent rise in asthma mortality was observed in the 5-34 year olds but not in the 15-44 year age group. More detailed examination of these rates revealed that the rise in mortality in the 5-34 year olds derived from the age band 25-34 years. This increase is masked in the 15-44 year age group by wide fluctuations in mortality in the age band 35-44 years. A similar discrepancy in asthma mortality trends for the 15-44 and 5-34 year age groups has been reported in Britain. Possible reasons for the recent rise in asthma mortality in the 25-34 year age group are discussed.

Adolescent↗
PubMed1992

Public health nursing in Ireland: the general practitioners' view.

Present health policy in Ireland is directed towards a shift in emphasis from the provision of services on a hospital inpatient basis to a community or outpatient basis. This study set out to elicit views of general practitioners (GPs) in relation to the home visiting activities of the nursing services in the community. Of the thirty-five (76%) GPs whose questionnaires were included in the analysis, 88% were satisfied with the quality of nursing services provided by the public health nurse (PHN) but were dissatisfied with access to service (37%), out of hours service (48%) and communication with PHNs (25%). Eight GPs had contact with public health nurses on a weekly basis, 11 had contact monthly and 14 had contact three monthly or less frequently. For chronic conditions requiring dressings, over 70% of GPs refer to the PHN and when given a choice, 25% of GPs would refer these conditions to a registered general nurse (RGN). Care by an RGN or nurses' aide for conditions such as monitoring of vital signs, continence care and administration of enemas, was found acceptable by 50% of GPs. The findings indicate that there is need for review of the structure of the nursing services in the community.

Attitude of Health Personnel↗
PubMed1993

Kawasaki disease--the Northern Ireland experience.

In the period 1985-1991 inclusive, forty five cases of Kawasaki Disease were identified in Northern Ireland. The number of cases increased each year until 1988 when the incidence was 19 per million population under 16 years, the highest reported for any region in the United Kingdom (data from British Paediatric Surveillance Unit). A high incidence of cardiac involvement was found, with 18(40%) having proximal coronary artery dilatation or aneurysm. and 8(17.7%) with pericardial effusion detected by 2D Echocardiography during or shortly after the acute illness. One year after disease onset, persistent coronary artery changes were detectable by 2D Echocardiography in 53% of those initially affected. There have been no deaths and no patient has so far developed myocardial infarction. One patient has required coronary artery bypass grafting. A protocol for the acute management and long term follow-up of Kawasaki Disease is suggested.

Child↗
PubMedDate not supplied

Environmental risk analysis of ultraviolet phototherapy centres in Ireland.

BACKGROUND: Ultraviolet (UV) radiation is commonly used in the treatment of dermatological conditions such as psoriasis. It is known that high levels of exposure to UV radiation (UVR) will increase the risk of adverse biological effects. Exposure limit values for UVR have been developed by the International Commission on Non-Ionising Radiation Protection (ICNIRP) and occupational exposure to phototherapy staff should be kept within these limits. The use of environmental controls such as warning signs, good ventilation and UV-opaque curtains will significantly reduce the risks to staff, patients and members of the public. AIMS: The aim of the study is to identify hazards in phototherapy centres and present recommendations for reducing risks. METHODS: An environmental risk assessment has been carried out at eleven phototherapy centres in the Republic of Ireland. The study assessed a number of areas such as patient safety, staff safety, room design and UV leakage measurements. RESULTS: The majority of clinics are well designed and there is consistent use of protective equipment. CONCLUSIONS: The results show that on the whole there is a satisfactory level of risk management in phototherapy centres. Recommendations on maintaining good safety standards are presented.

Environmental Exposure↗
PubMedDate not supplied

Outcomes of adult cadaveric renal transplantation in ireland 1986 to 2001.

BACKGROUND: Since the introduction of renal transplantation in the Republic of Ireland in 1964, the number of transplants performed annually has increased from single figures in the 1960s to the current rate of approximately 130 renal transplants per year. Improvements in graft and patient outcomes have been associated with the introduction of the immunosuppressive agent Cyclosporin (CSA) in the mid 1980s. AIMS: The aim of this study was to examine trends in outcomes and factors that influence outcomes for adult kidney transplantation from 1986 to 2001. METHODS: All adult cadaveric kidney transplantations carried out between 1986 and 2001 were included. We separated the transplanted grafts and patients into four time periods; 1986-1989, 1990-1993, 1994-1997, 1998-2001. Graft and patient survival outcomes were compared for the different periods. RESULTS: The one-year kidney graft survival rate increased from 82% during 1986-1989 to 86% during 1998-2001. Patient survival over the four time periods studied has remained stable at approximately 95% at one year. CONCLUSION: We report a significant improvement in kidney graft outcomes over the past 16 years. Patient survival has remained relatively stable during this period.

Adult↗
PubMedDate not supplied

Antimicrobial resistance in E.coli associated with urinary tract infection in the west of Ireland.

BACKGROUND: Knowledge of antimicrobial resistance patterns in E. coli, the predominant pathogen associated with urinary tract infection (UTI) is important as a guide in selecting empirical antimicrobial therapy AIMS: To describe the antimicrobial susceptibility of E. coli associated with UTI in a region in the West of Ireland. METHODS: A collection of 934 E. coli isolates associated with UTI were tested for susceptibility to a panel of antimicrobial agents by the disc diffusion method of the National Committee for Clinical Laboratory Standards. RESULTS: More than 50% of E. coli were resistant to ampicillin, more than 40% resistant to sulphonamide and more than 30% resistant to trimethoprim. From 7.9% (community) to 12.5% (hospital) are resistant to co-amoxiclav with approximately 20% of isolates of intermediate susceptibility. In general practice most E. coli remain susceptible to nitrofurantoin (96.7%), nalidixic acid (93.9%) and ciprofloxacin (94.7%). For all agents rates of resistance were higher in hospital as compared with general practice isolates. Three isolates with the phenotype of Extended Spectrum Beta-lactamase (ESBL) resistance were detected. CONCLUSIONS: Ampicillin/amoxicillin are not suitable for empiric therapy of UTI in general practice or hospital patients in this region. There is doubt as to the role of trimethorpim or co-trimoxazole for empiric therapy of UTI. Nitrofurantoin, nalidixic acid and ciprofloxacin are active against the great majority of UTI associated E. coli.

Anti-Bacterial Agents↗
PubMedDate not supplied

Bloodborne virus infections among drug users in Ireland: a retrospective cross-sectional survey of screening, prevalence, incidence and hepatitis B immunisation uptake.

BACKGROUND: Injecting drug users are at high-risk of bloodborne virus infections including hepatitis C (HCV), hepatitis B (HBV) and HIV. AIMS: To document screening for and immunisation against bloodborne viruses and to determine the known prevalence and incidence of these infections. METHODS: A cross-sectional survey of clients attending 21 specialist addiction treatment clinics in one health board area in greater Dublin. Data collected on demographic characteristics, serology for HCV, HBV and HIV and immunisation against HBV. RESULTS: A total of 316 (88%) had been tested for anti-HCV antibody, 244 (68%) had been tested for anti hepatitis B core antibody (anti-HBc), 299 (84%) had been tested for hepatitis B surface antigen (HBsAg) and 307 (86%) had been tested for anti-HIV antibody. The prevalence of anti-HCV, anti-HBc, HBsAg, and anti-HIV were: 66%, 17%, 2% and 11% respectively. The incidence of HCV, HBV and HIV infections were: 24.5, 9.0 and 3.4 per hundred person years respectively. Eighty-one per cent of those in whom it was indicated, had started a targeted HBV immunisation programme in the clinics. CONCLUSION: The proportion of clients screened for HCV, HBV and HIV infection has increased since the introduction of a screening protocol in 1998. Targeted vaccination for opiate users against hepatitis B is more successful than previously shown in Ireland. The prevalence and incidence of bloodborne viruses remains high among opiate users attending addiction treatment services, despite an increase in availability of harm reduction interventions.

Antibodies, Viral↗
PubMedDate not supplied

Pack-size legislation reduces severity of paracetamol overdoses in Ireland.

BACKGROUND: Legislation was introduced in Ireland in October 2001 to control the sale of paracetamol in non-pharmacy outlets. Preparations are now limited to 12 tablets per pack and only one pack can be sold per transaction. AIM: To assess the impact of this legislation on acute deliberate paracetamol overdoses. METHODS: We reviewed acute deliberate paracetamol overdoses reported during two 24-months periods before and after October 2001. We grouped cases according to the number of tablets taken and compared the periods using chi-square and Mann-Whitney tests. RESULTS: The number of tablets taken in acute deliberate paracetamol overdose fell significantly after October 2001 (chi2 = 11.663, P = 0.0029). Fewer cases involved 12-24 tablets (U = 74, P < 0.001) and fewer cases involved more than 24 tablets (U = 131.5, P = 0.0006). CONCLUSION: Legislation controlling sale and packaging of paracetamol preparations appears to be associated with a significant fall in the number of tablets taken in acute deliberate paracetamol overdoses.

Acetaminophen↗
PubMedDate not supplied

Mortality in epilepsy in the west of Ireland: a 10-year review.

BACKGROUND: Sudden and unexpected death is not an uncommon event in otherwise healthy epileptics. AIMS: To study the autopsied cases of sudden death in known epileptic patients in the West of Ireland. METHODS: A retrospective study was carried out which involved the review of 3,103 autopsy reports over a 10-year period in Galway University Hospital. RESULTS: Twenty-two cases were classified as sudden, unexpected death in epilepsy (SUDEP). Forty-five per cent had been found dead in bed. The mean age was 38 years and 68% were males. Of 16 cases with data about antiepileptic drug (AED) levels, 68% had absent or low levels at postmortem. Eighty-eight per cent of the cases had a past history of a generalised seizure. Pulmonary oedema was present in 86% of cases at postmortem. CONCLUSIONS: Compliance with treatment and frequent nightly observations to those at high risk of sudden death may help to minimise its incidence. The patients and their families should be aware of this potential outcome.

Adult↗
PubMedDate not supplied

A & E services in Ireland: the potential role of general practice in accident and emergency services.

BACKGROUND: In 1996, Irish accident and emergency (A&E) departments had approximately 1.2 million visits. General practitioners (GPs) have been shown to work efficiently in A&E. AIM: This study aimed to describe the current A&E structures in Ireland and the potential contribution of general practice. METHOD: Questionnaires were sent to all 43 Irish A&E departments seeking information on staffing levels, training posts and interest in the role of GPs within the department. RESULTS: Thirty-four (79%) hospitals responded, representing at least 71% of all A&E visits. Eleven (32%) had A&E consultants. In 16 (47%) hospitals the A&E department was supervised by other consultants; in 14 supervision was for five hours per week or less. Seven hospitals had no consultant supervision. Twenty-six (76%) had NCHDs assigned to the department. Only 11% of NCHDs were in training in A&E medicine. Six departments employed GPs but 28 said they would like to do so. Most wished GPs to see non-urgent cases but one-third wished them to see all cases. Current staffing levels had little relationship with departmental workload. CONCLUSIONS: The limited consultant supervision and small numbers of NCHDs in training for A&E medicine raise concerns about staffing. Most hospitals want GPs to work in their A&E departments. This has implications for training and for the interface between general practice and the A & E department.

Emergency Service, Hospital↗
PubMed1990

Identification of the needs of elderly people in Northern Ireland.

This paper presents the results of a survey on persons over the age of 65 in Northern Ireland. One of the aims of this research was to identify and measure the needs of the elderly population in order to develop a Programme of Care. It would seem logical that the problems of the elderly tend to increase with age. Since the population is becoming older and given the commitment to community care, this will have serious implications for the National Health and Social Services. The present survey was carried out using a questionnaire to extract details concerning the individuals' mental state, ability for self-care and household duties, mobility, accommodation, social activities, general health, strain imposed on others and current support from the statutory services. The results for each category were then presented for 5 age-groups: 65-69, 70-74, 75-79, 80-84 and 85+. Specific problems in relation to home help provision and social facilities such as day care are also discussed.

Activities of Daily Living↗
PubMed1999

Psychiatric morbidity in people born in Ireland.

BACKGROUND: Irish immigrants are reported to be over-represented in psychiatric admission statistics for England when compared to native whites. This study examines whether this finding is sustained for users of psychiatric services as a whole and explicates the reasons for any differential uptake of mental health care by comparison with community morbidity rates in the same population. METHODS: Demographic and clinical data were collected from staff concerning all adults living in a multiethnic inner-city health district and using mental health services during a 6-month period. A separate interview-based survey of private household residents in the same area was undertaken to ascertain the prevalence of psychiatric disorder in the community. RESULTS: Psychiatric service use was found to be greater for Irish-born people compared to the remainder of the white population. However, this finding only persisted for alcohol use disorders, the rates for schizophrenic and affective disorders being comparable in the two groups. Access to psychiatric care was also similar both with respect to overall morbidity as well as for affective and alcohol use disorders, levels of service use being attributable to patterns of morbidity in the population rather than nosocomial factors. CONCLUSIONS: The excess morbidity for alcohol use disorders reported in people born in Ireland is affirmed and the need for longitudinal and ethnographic research into this important public health issue emphasised.

Adolescent↗
PubMed2005

The application of prescribing indicators to a primary care prescription database in Ireland.

OBJECTIVE: To develop appropriate prescribing indicators and apply these to Irish prescription data. METHODS: A postal survey of 145 randomly selected general practitioners working within the Eastern Health Board region of the State-supported General Medical Services scheme in Ireland regarding the applicability of selected prescribing indicators was carried out. Such indicators were then applied to aggregate prescription data. RESULTS: Prescribing indicators based on agents of questionable efficacy/poor quality prescribing and those based on good prescribing practice were thought to make suitable indicators. Low rates of prescribing were noted for indicators based on drugs of limited efficacy, e.g. cerebral and peripheral vasodilators (rate 3.1 per 1,000 prescriptions), whilst indicators based on drugs associated with good prescribing practice were associated with higher prescribing rates, e.g. the prescription of aspirin in patients receiving nitrate therapy(rate 7.13 per 1,000 patients). However, a low rate of generic prescribing (4.6%) was found amongst general practitioners in the study. The largest variability in prescribing was seen with the prescribing of peripheral and cerebral vasodilators (75th/25th centile=5.6) and the prescription of long-acting sulphonylureas (75th/25th centile=66.6). CONCLUSIONS: Quality indicators based on aggregate prescribing provide valuable information on prescribing standards and should be developed with the close involvement of prescribers.

Databases, Factual↗
PubMed2004

Human waterborne parasites in zebra mussels ( Dreissena polymorpha) from the Shannon River drainage area, Ireland.

Zebra mussels ( Dreissena polymorpha) from throughout the Shannon River drainage area in Ireland were tested for the anthropozoonotic waterborne parasites Cryptosporidium parvum, Giardia lamblia, Encephalitozoon intestinalis, E. hellem, and Enterocytozoon bieneusi, by the multiplexed combined direct immunofluorescent antibody and fluorescent in situ hybridization method, and PCR. Parasite transmission stages were found at 75% of sites, with the highest mean concentration of 16, nine, and eight C. parvum oocysts, G. lamblia cysts, and Encephalitozoon intestinalis spores/mussel, respectively. On average eight Enterocytozoon bieneusi spores/mussel were recovered at any selected site. Approximately 80% of all parasites were viable and thus capable of initiating human infection. The Shannon River is polluted with serious emerging human waterborne pathogens including C. parvum, against which no therapy exists. Zebra mussels can recover and concentrate environmentally derived pathogens and can be used for the sanitary assessment of water quality.

Animals↗