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PubMed1995

Anthropometric variation and the population history of Ireland.

Genetic variation among human populations can reflect a combination of contemporary patterns of gene flow and genetic drift as well as long-term population relationships due to population history. We examine the likely impact of past history and contemporary structure on the patterns of anthropometric variation among 31 counties in Ireland (made up of the two nations of the Republic of Ireland and Northern Ireland). Data for 17 anthropometric measures and parent-offspring migration on 7,214 adult Irish males were taken from the large data set originally collected by Dupertuis and Dawson in the mid-1930s (Hooton et al., 1955). Patterns of genetic similarity among 31 counties were assessed using R matrix methods that allow estimation of minimum genetic distances. These distances were compared to distances reflecting history, geography, and migration using matrix permutation methods. The results indicate that among-group variation in Ireland reflects past population history to a much greater extent than contemporary patterns of migration and population size. The midland counties are distinct from other populations, and their history suggests greater genetic input from early Viking invasions. A second major pattern in biological variation is a longitudinal gradient separating western and eastern counties. This gradient appears related to patterns of early settlement and/or a concentration in the east of later immigrants, particularly from England. Comparison of regional means with published data for several other European nations confirms these hypotheses.

Adult↗
PubMed2003

Does integration really make a difference? A comparison of old age psychiatry services in England and Northern Ireland.

OBJECTIVE: This paper seeks to address whether integrated structures are associated with more integrated forms of service. Northern Ireland has one of the most structurally integrated and comprehensive models of health and personal social services in Europe. Social and health services are jointly administered and this arrangement should, in theory, promote collaborative working and interdisciplinary arrangements. DESIGN: The study employed a cross-sectional survey of consultants in old age psychiatry in England and Northern Ireland. Potential respondents were sourced from the UK Royal College of Psychiatrists membership list and locally collected information. MEASURES: A self-administered postal questionnaire. Along with general service arrangements, the domains measured reflect core policy issues for older people's services. Under particular scrutiny in this study were the degree of integration of health and social service provision, as well as inter-professional team working. RESULTS: The integrated health and social care services in Northern Ireland do appear to provide more integrated patterns of working, primarily in managerial arrangements and in the location of staff. There was no evidence of the impact of integration on practice in areas such as: assessment, referral and medical screening. The factors found to be associated with greater integration of health and social care in the prediction model fell into three categories: provision of specialist services; provision of outreach activities; and shared policies by which the whole team worked. CONCLUSIONS: Health and personal social services in Northern Ireland have a distinct advantage over their counterparts in comparable areas of England. The results indicate that integrated structures in old age psychiatry services are associated more with integrated management systems and less with integrated practice-related activities. Further research is required on the effectiveness and cost effectiveness of integrating services in general. It is important that future intervention studies systematically measure the component parts, nature and extent of integration and their individual and joint contribution to the effectiveness and efficacy of services.

Aged↗
PubMed1985

Restriction endonuclease analysis of Aujeszky's disease (pseudorabies) virus DNA: comparison of Northern Ireland isolates and isolates from other countries.

Aujeszky's disease (AD; pseudorabies) viruses isolated in Northern Ireland over a 20 year period were compared with isolates from other parts of the world using restriction endonuclease analysis of virus DNA. When the numbers of Bam H1, Kpn 1 and Sal 1 restriction sites were considered, pathogenic Northern Ireland isolates resembled viruses isolated in England, Hungary and the U.S.A. and could be differentiated from viruses isolated in Denmark, Belgium and the Netherlands. The avirulent Northern Ireland isolate NIA4 and the Bartha vaccine strain were very similar to each other and could be distinguished from pathogenic isolates. While almost all the pathogenic viruses isolated in Northern Ireland from 1963 to 1983 appeared to possess the same number of restriction sites none of the viruses, even those made at the same farm during one outbreak of infection, were identical. The differences were confined to variation in the sizes of certain fragments which map in "variable" regions of the genome.

Base Sequence↗
PubMedDate not supplied

Farmer's lung in Ireland (1983-1996) remains at a constant level.

A prospective study was undertaken by the Departments of Respiratory Medicine and Medical Microbiology at the Cork University Hospital, a. to investigate the epidemiology of Farmer's Lung (F.L.) in the Republic of Ireland (pop. 3.5 million), with special reference to the South Western Region of this country (pop. 536,000) and b. to assess any relationship between the prevalence/incidence of F.L. with climatic factors in South West Ireland, between 1983 and 1996. F.L. incidence remained constant throughout the 13 yrs studied both on a national and a regional basis. A significant relationship was also found between total rainfall each summer and F.L. incidence and prevalence over the following yr (p < 0.005) in South-West Ireland. The persistence of F.L. in Ireland at a constant level suggests that farmers' working environment and farm practices need to be improved.

Climate↗
PubMed1991

Trends in mortality from cardiovascular diseases in Ireland.

Trends in mortality from cardiovascular diseases in Ireland from 1950 to 1986 are examined and compared with trends in some other developed countries. There was a decline in mortality from all causes which was greater in women than in men. Mortality from coronary heart disease (CHD) increased in males from 1953 to 1974 and has been declining slowly since. Mortality rates in men in Canada and the United States are now lower than those in Ireland and rates in Finnish men are approaching those in Ireland. CHD mortality in Irish males was sixth highest of developed countries in 1985. In women, CHD mortality declined in the 1950s, was stable in the 1960s and early 1970s and has been decreasing slowly since 1974. CHD mortality in Irish women was fifth highest of developed countries in 1985. Mortality rates from cerebrovascular disease have been falling in Irish women since 1958 and in men since 1969. The continuing high mortality from CHD in Ireland warrants the establishment of effective community prevention programmes.

Adult↗
PubMed2005

Telemedicine services in the Republic of Ireland: an evolving policy context.

The Republic of Ireland is characterised by few urban conurbations and a high rural population, including significant numbers of island dwellers. Information communication technologies (ICT), including telemedicine, present opportunities to address rural health-service delivery issues. As in other countries, the recent National Health Information Strategy is regarded as pivotal to the modernisation of the Irish health care system. There is, however, a dearth of research about telemedicine in Ireland. This paper reports, to the best of our knowledge, the first systematic review of telemedicine in the two regional health boards in the Republic of Ireland. Details of 11 telemedicine services, all initiated by local policy, will be presented. Results of an interview study with service providers about their experiences of the practices and processes involved in telemedicine service delivery are also provided. The focus of our analysis is two-fold. We assess the resonance of these Irish data with the international literature with particular reference to a recently developed model for the normalisation of telemedicine. For the first time, this model which was developed in the United Kingdom is applied to a fresh set of empirical data in a different health care context. We then discuss a number of health information policy issues for Ireland and elsewhere arising from our analysis.

Ireland↗
PubMed2006

Trends in penicillin and macrolide resistance among pneumococci in the UK and the Republic of Ireland in relation to antibiotic sales to pharmacies and dispensing doctors.

It is widely believed that reducing antimicrobial usage should reduce resistance, although observational evidence is mixed. Pneumococci make ideal subjects to test this belief as they are widely surveyed and lack an animal reservoir. Accordingly, susceptibility data for pneumococci in the UK and Ireland were retrieved from the Health Protection Agency's LabBase/CoSurv system and from the European Antimicrobial Resistance Surveillance System (EARSS) and British Society for Antimicrobial Chemotherapy (BSAC) databases. The BSAC surveillance examines respiratory pneumococci; the other systems focus upon invasive organisms only, with the LabBase/CoSurv system being the most comprehensive, capturing data on most bacteraemias in England and Wales. National pharmacy sales data were obtained from the IMS Health MIDAS database and were modelled to the resistance data by logistic and linear regression analysis. All systems except for the BSAC respiratory surveillance data indicated that penicillin resistance has fallen significantly since 1999 in the UK, whereas macrolide resistance has been essentially stable, or has risen slightly. The data for Ireland were based on smaller sample sizes but suggested a fall in penicillin non-susceptibility from 1999 to 2004, with conflicting evidence for macrolide resistance. The recent decreasing trend in penicillin resistance is in contrast to a rising trend in England and Wales until (at least) 1997 and strongly rising macrolide resistance from 1989 to 1993. UK pharmacy sales of macrolides and oral beta-lactams fell by ca. 30% in the late 1990s following increased concern about resistance, before stabilising or rising weakly; sales in Ireland were stable or rose slightly in the study period. We conclude that falling penicillin resistance in pneumococci followed reduced sales of oral beta-lactams to pharmacies in the UK, but a similar fall in macrolide sales was not associated with any fall in resistance. Stabilisation or decline in penicillin resistance has occurred in Ireland despite stable or increasing oral beta-lactam sales.

Anti-Bacterial Agents↗
PubMed1982

The flax industry in Northern Ireland twenty years on.

In 1961-62 a survey of respiratory symptoms in 2528 workers in flax mills in Northern Ireland and of dust levels in the mills was conducted. The workers were followed up in 1978, because recent developments suggested that an upturn in the industry was likely. Flax dust has an acute, reversible effect on the respiratory system, and byssinosis is a prescribed disease under the Industrial Injuries Act (1965). However, the follow-up study found no evidence of an effect on survival of either exposure to dust or byssinosis. The number of applications to compensation panels for assessment and certification of byssinosis has increased greatly in Northern Ireland. Although certification is independent of any subsequent common law claim by a worker for compensation on the grounds of disablement consequent on negligence by his employer, it must weight heavily in such a claim. About 50 common law claims have been settled out of court for large sums in Northern Ireland, and 950 claims are waiting to be heard. The future cost to the industry is estimated to be at least 16 million pounds. Since byssinosis appears not to cause excess mortality, it is unlikely to cause serious long-term morbidity. Although workers should be compensated for disablement due to negligence, in the absence of unequivocal evidence of disablement caused by byssinosis the financial settlements being reached in Northern Ireland seem unreasonable.

Byssinosis↗
PubMed2003

Patterns of initial management of lung cancer in the Republic of Ireland: a population-based observational study.

OBJECTIVES: To examine geographic and temporal trends in the patterns of initial management of lung cancer in Ireland, and to describe differences in case management according to health board of residence. DESIGN: Population-based observational study using the database of the National Cancer Registry of Ireland. PATIENTS: 7286 patients with primary malignant lung tumours who were diagnosed in Ireland during the 5-year period from 1994 to 1998. METHODS: We compared health boards in terms of treatment patterns of small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) cases adjusting for differences in age, gender, and deprivation status. RESULT: Only half of the patients received any cancer-specific treatment. Radiotherapy was the most commonly employed single-treatment modality (21.7%) followed by surgery (12.3%) and chemotherapy (8.8%). Relative to the Eastern Health Board, the risk of being untreated was significantly higher for NSCLC patients living in the Western, Mid-Western, North, and South-Eastern Health Boards. For SCLC, only the Mid-Western and South-Eastern Heath Boards had significantly higher relative risks. For both groups, older patients were less likely to receive treatment, but we could not adjust for stage and comorbidity. CONCLUSION: We found wide regional variations in treatment rates of lung cancer in Ireland.

Adolescent↗
PubMed2003

Sampling Broad Habitat change to assess biodiversity conservation action in Northern Ireland.

A habitat monitoring programme, the Northern Ireland Countryside Survey, carried out by the University of Ulster for the Department of the Environment for Northern Ireland, is described. It was based on a random sample of quarter kilometer grid squares, stratified by multivariate land classification. Estimates of change in habitat area between 1987-1992 and 1998 are presented and used to assess policy-related priorities for biodiversity conservation action in widespread habitats in Northern Ireland (NI). The basis of the assessment is Broad Habitats, a classification developed as part of the United Kingdom (UK) Biodiversity Action Plan. Improved Grassland, Neutral Grassland and Bog Broad Habitats occupy the largest area of NI, which holds a large proportion of the UK Neutral Grassland and Fen Marsh and Swamp Broad Habitat resource. The greatest net area increases with time were in Improved Grassland (33%), Coniferous Woodland (12%) and Broadleaved, Mixed and Yew Woodland (9%). The greatest net area decreases were in Neutral Grassland (-32%), Arable and Horticulture (-25%), Fen, Marsh and Swamp (-19%), Bog (-8%) and Calcareous Grassland (-7%). These changes are a function of agriculture, public and private forestry, building construction and peat cutting for fuel. The Key biodiversity issue is seminatural Broad Habitat loss, in particular, Neutral Grassland and Fen, Marsh and Swamp, highlighting the lack of effective action for protecting biodiversity in the countryside as a whole. The extent to which current land use is shown to be driving change, indicates that biodiversity conservation action through implementing landscape-scale agri-environment measures could deliver major biodiversity gains. The reliable information on recent changes, provided by the Northern Ireland Countryside Survey, has been used to guide conservation planning. Future re-survey will allow the effectiveness of the conservation strategy as it applies to the countryside as a whole, to be determined. As decisions on land use increasingly have a strong European dimension, concerted action for protecting biodiversity in the countryside as a whole is needed. This would be promoted by a structured sampling approach, based on standard habitat mapping procedures.

Agriculture↗
PubMed2004

Anaesthetic specialist registrars in Ireland: current teaching practices and perceptions of their role as undergraduate teachers.

BACKGROUND AND OBJECTIVES: Teaching is an important responsibility of non-consultant hospital doctors. In Ireland, specialist registrars (SpRs) in anaesthesia are contractually obliged to teach medical students, other doctors and nurses. Both medical students and fellow non-consultant hospital doctors attribute between 30 and 40% of their knowledge gain to non-consultant hospital doctors. METHODS: We carried out a confidential telephone survey of anaesthetic SpRs in Ireland regarding their current teaching practices and the perceptions of their role as undergraduate teachers. All the SpRs currently working in clinical practice in Ireland were eligible. RESULTS: Fifty-five of the 79 (70%) SpRs responded to the questionnaire. Only 7 (12.7%) of the respondents said they had been well trained as a teacher. The majority of the respondents stated that they would attend a learning-to-teach course/workshop if one was available, and felt that such a course would improve their ability as a teacher. Only 8 (14.5%) agreed that adequate emphasis is placed on commitment to teaching in the assessment of SpRs, both by individual departments and by the College of Anaesthetists. Anaesthetic SpRs in Ireland spend a considerable amount of time each day teaching undergraduate medical students, the majority (68.9%) stated that they had inadequate time to prepare for teaching. CONCLUSION: The majority of the respondents stated that they enjoy teaching, feel that they play an important role in undergraduate teaching but have inadequate time to prepare for teaching. An adequate emphasis is not placed on their commitment to teaching.

Adult↗
PubMed2000

Health technology assessment in Ireland.

Ireland's health system is primarily funded from general taxation and is publicly provided, although private health care retains a considerable role. It is a unique structure, a mixture of universal health service free at the point of consumption and a fee-based private system where individuals subscribe to private health insurance that covers some of their medical expenses. The recent history of the Irish health services saw consolidation of existing services and an expansion into new areas to adapt to changing practices and needs. There has also been a drive to extract maximum efficiency so as to maintain the volume and quality of patient services at a time of very tight financial constraints. Introduction of new health technologies continued to accelerate. New technologies tended to spread rapidly before systematic appraisal of their costs and benefits. When the state is involved in funding the public hospital system, acceptance of new technology is a matter for discussion between agencies and the Department of Health and Children. Decisions about spending annual "development funding" have generally not been based on careful assessment of proposals for new technology. In 1995, a healthcare reform put new Public Health Departments in Health Boards in a prime position in Ireland's health services organization. These departments now emphasize evidence-based medicine. While Ireland does not have a national health technology assessment (HTA) program, there are plans to form an advisory group on HTA in 1998. HTA is seen as a significant element of future health policy in Ireland.

Delivery of Health Care↗
PubMed2000

Characteristics of male vitamin supplement users aged 50-59 years in France and Northern Ireland: the PRIME Study. Prospective Epidemiological Study of Myocardial Infarction.

The prevalence and characteristics of vitamin supplement users were assessed in 7538 male subjects aged 50-59 from France and 2468 from Northern Ireland. In France, 15% of subjects used vitamin supplements; users were significantly younger, had a lower body mass index, a higher educational level, had more frequently a hard physical job, reported more frequently a personal history of disease and were less frequently retired or inactive than non-users. In Northern Ireland, 21% of subjects were vitamin supplement users; users had a lower body mass index, drank less alcohol, had a higher educational level, were more frequently non-smokers and professionally active, and reported a hard physical job and the practice of leisure sports more frequently than non-users. Finally, vitamin supplement users in Northern Ireland had a lower consumption of alcohol, smoked less, had a lower frequency of personal history of disease and were more frequently on dietary therapy for hypertension or dyslipidaemia than their French counterparts. We conclude that vitamin supplement use is associated with a healthier lifestyle and with dietary measures against hypertension and dyslipidaemia in Northern Ireland. The less favorable lifestyle observed for vitamin supplement users in France awaits further investigation.

Cross-Cultural Comparison↗
PubMed2002

Breast reconstruction in the United Kingdom and Ireland.

BACKGROUND: Although it is becoming more common, previous surveys have identified concerns regarding the safety of immediate reconstruction following mastectomy. The aims of this study were to define current practice of breast reconstruction in the UK and Ireland, and to identify the characteristics of surgeons who use immediate breast reconstruction. METHODS: : A postal questionnaire survey of 498 consultant breast surgeons in the UK and Ireland was performed in January 2000. RESULTS: There were 376 responses (response rate 76 per cent). Eighty-eight per cent of surgeons 'always' or 'usually' discuss reconstruction with patients due to undergo mastectomy; clinicians with a heavy caseload were significantly more likely to discuss it (odds ratio (OR) 18.45 (95 per cent confidence interval 1.99 to 171.07)). The majority of respondents (57 per cent) preferred delayed to immediate breast reconstruction; 70 per cent believed that immediate reconstruction has disadvantages, most commonly that it interferes with adjuvant therapy (56 per cent). Older surgeons were significantly less likely to perform immediate reconstruction (OR 5.18 (2.21 to 12.11)), and were significantly more likely to believe that immediate breast reconstruction has disadvantages (OR 2.02 (1.01 to 4.05)). Surgeons from Ireland were less likely to discuss and perform breast reconstruction (OR 0.20 (0.10 to 0.43) and 0.27 (0.12 to 0.60) respectively), or to have access to a plastic surgeon (OR 0.22 (0.11 to 0.44)). CONCLUSION: : Significant variation exists in the delivery of breast reconstruction after mastectomy in the UK and Ireland. The age, workload and personal characteristics of the surgeon are important in determining reconstructive practice.

Adult↗
PubMed2002

Aspects of curriculum policy in preregistration nursing education in the Republic of Ireland: issues and reflections.

AIMS: This paper sets out to examine critically aspects of curriculum policy related to preregistration nursing education in the Republic of Ireland. BACKGROUND: Following a period of industrial unrest concerned with pay, promotional opportunities and conditions of employment amongst nurses and midwives in the Republic of Ireland, a Commission on Nursing was established in March 1997. Along with a series on recommendations pertaining to the role and the professional development of nurses and midwives, the final report of the Commission on Nursing contained recommendations on the educational preparation of nurses. Specifically, the Commission recommended that the future framework for preregistration nursing education in the Republic of Ireland be based on a 4-year degree programme, fully integrated into higher education. As a means of giving effect to this recommendation, the Commission also recommended the establishment of a Nursing Education Forum, whose task it was to develop a strategic framework for the introduction of the proposed preregistration nursing degree programme. The Forum published its final report in October 2000 and this report constituted the most explicit statement of official policy on the nursing curriculum in the Republic of Ireland. DESIGN: The paper constitutes a critical analysis of selected aspects of the report of the Nursing Education Forum, in the light of scholarly literature on curriculum philosophy and curriculum policy. SUMMARY OF CONTENT: The paper considers some of the implications for curriculum development and design arising out of the recommendations of the Nursing Education Forum. Among a list of core principles underpinning curriculum regulation and design, the report included the principle of 'eclecticism'. The paper considers this principle with reference to nursing epistemology, pedagogical practice and curriculum policy, and seeks to challenge some of the assumptions underlying this principle. CONCLUSIONS: The epistemological identity and the structural integrity of primary forms of knowledge in the preregistration curriculum need to be maintained if students are to develop their knowledge and understanding of nursing science.

Curriculum↗
PubMed2001

A survey of community mental health nurses' perceptions of clinical supervision in Northern Ireland.

Since the early 1990s, clinical supervision has been the subject of debate by nurse academics and practitioners. This debate has encouraged the adoption of clinical supervision by the profession throughout the United Kingdom. Search of the literature demonstrates that there has been little published research regarding clinical supervision in Northern Ireland. This study is designed to redress this information deficit. The current position of clinical supervision in relation to community psychiatric nursing in Northern Ireland is explored and evaluated. A survey approach was adopted, collecting data from community psychiatric nurses (CPNs) in Health and Social Services Trusts in Northern Ireland. Data was obtained relating to the practice of clinical supervision and to attitudes of CPNs, their managers and supervisors. Results indicate that there is support for clinical supervision and that it is being implemented within community psychiatric nursing in Northern Ireland, although not in all cases. However, the findings indicate that serious education and training deficits exist, and the importance of the interface between managerial and clinical supervision is emphasized. The issues of providing effective education and training in supervision skills, and the uncertainty that was highlighted regarding fundamental concepts underpinning clinical supervision, have implications for nursing practice, education and management. In addition, based on findings of this study, the difference between management-led supervision and clinical supervision as envisaged by the UKCC, which promotes the personal and professional development of nurses, requires further exploration.

Adult↗
PubMed2003

Nontuberculous mycobacteria: incidence in Southwest Ireland from 1987 to 2000.

SETTING: The Southwest of Ireland (Counties Cork and Kerry) 1987-2000, average population 549,500. OBJECTIVE: Nontuberculous mycobacteria (NTM) cause significant morbidity worldwide and the study of epidemiology and characteristics helps in their prevention and treatment. This study was performed to determine the incidence of NTM disease in comparison to Mycobacterium tuberculosis (M. tuberculosis) and Mycobacterium bovis (M. bovis) in Southwest Ireland, over the above time period. DESIGN: A retrospective study was carried out in all human isolates of NTM, M. tuberculosis and M. bovis between 1987 and 2000, in the Southwest Region of Ireland. RESULTS: The mean incidence of NTM (0.4/100,000 population) has risen since 1995, principally of pulmonary Mycobacterium avium intracellulare complex (MAC). The annual incidence of M. tuberculosis in humans over 14 years in the same region was 971/100,000 population with a significant reduction since 1994 and M. bovis remained constant at 0.5/100,000 population. CONCLUSION: The increasing incidence of disease causing NTM noted in Southwest Ireland reflects global data and is surmised to be due to an ageing population, increased incidence related to chronic fibrotic lung disease, and environmental mycobacterial factors.

Adult↗
PubMed2000

VRE in the Republic of Ireland: clinical significance, characteristics and molecular similarity of isolates.

There have been increasing reports worldwide of vancomycin resistant enterococci (VRE) since they were first noted over ten years ago. This study sought to investigate the clinical significance of VRE in Ireland and to compare the phenotypic, genotypic and molecular characteristics of isolates recovered from patients in different institutions. The relative contribution of inter-hospital transmission of strains to the dissemination of VRE in Ireland was assessed. Hospital surveillance for VRE is not well established in Ireland. The organism has been detected in seven hospitals. Detection has been predominantly in oncology inpatients in large tertiary referral hospitals in the Dublin metropolitan area in whom strains generally represent asymptomatic gastrointestinal tract colonization. The predominant species is E. faecium with the Van A resistance phenotype. Twenty-seven (87) of 31 isolates from one unit were shown to be of the same or closely related strain as were 10 (63%) of 16 from another unit, indicating significant nosocomial transmission within institutions. There was no evidence for inter-hospital transmission of VRE. VRE is established in Ireland and nosocomial transmission readily occurs. Regular surveillance for VRE is indicated in high-risk populations in large institutions, specific risk factors for the acquisition of VRE need to be defined and optimal control and preventative strategies need to he instituted to detect and preempt the spread of this organism.

Adolescent↗