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PubMed2004

An audit of tumour marker requests in Northern Ireland.

BACKGROUND: An audit of tumour marker requests was carried out in Northern Ireland. The aims were to establish the extent of inappropriate requesting, to effect change in request practice if required, and to standardize laboratory reports for tumour markers. METHODS: A baseline audit was conducted to investigate the appropriateness of tumour marker requesting patterns in Northern Ireland. Information booklets containing guidelines for tumour markers were then distributed to all clinicians and a post-intervention audit was carried out. RESULTS: At baseline, 80% of requests for tumour markers were appropriate for the source of the tumour; however, 54% of clinicians used tumour markers to screen for malignancy and there was a low index of suspicion in 35% of these. Requests for more than two tumour markers were received for 5% of request forms. The post-intervention survey showed no change in requesting practice. Comments were returned by requestors for 55% of questionnaires. They appeared to be appropriate in 72% of cases. CONCLUSIONS: There is a low level of inappropriate requesting of tumour markers in Northern Ireland. Audit and feedback combined with circulation of guidelines were unsuccessful interventions in improving the appropriateness of request practice for these tests.

Biomarkers, Tumor↗
PubMed1995

Ireland: gender, psychological health, and attitudes toward emigration.

Ireland is experiencing one of the highest periods of emigration in its history. The current study collected demographic and psychological data on 203 Irish men and women in Ireland and in Northern Ireland, including measures of self-esteem, depression, attitudes toward immigration, and expectancies of emigration. Analysis indicated that approximately 81% of this Irish sample are considering emigration; however, the prospect of emigration is psychologically experienced differently by men and women. While there were no significant differences over-all in scores on self-esteem between Irish men and women, men who contemplated emigration reported higher self-esteem scores, and women contemplating emigration reported lower self-esteem scores (relative to those who had no plan to emigrate). In addition, women who contemplated emigration had higher depression scores than women who did not contemplate emigration. This pattern was not evident for men. These results indicate that psychologically women view the prospect of emigration less positively than men.

Adolescent↗
PubMed2005

Emergence of G3 and G9 rotavirus and increased incidence of mixed infections in the southern region of Ireland 2001-2004.

Two hundred and thirty fecal specimens were collected from children (up to 5 years of age) admitted with suspected rotaviral gastroenteritis at four Irish hospitals (Cork University Hospital, Mercy Hospital, Cork, Waterford Regional Hospital, and Kerry General Hospital) in the southern region of Ireland, between 2001 and 2004. Following laboratory confirmation of the aetiological agent, the rotavirus G-type was determined in all positive samples by reverse transcriptase-polymerase chain reaction (RT-PCR). The distribution of the G-types (n=230) over the 3 year period was G1 (31%), G9 (21.8%), G3 (8.7%), G4 (6.5%), and G2 (3.5%). There were many mixed infections which accounted for 28.5% of the collection. G9 emerged as the most prevalent G type (30.1%) in 2001-2002, whilst G3 first emerged in 2002-2003 and accounted for 15.8% of the collection. Notably, G2 strains were present at a very low frequency (3.5%) during 2001-2004, compared to an earlier study (1997-1999), where they accounted for 28.5% of the specimens. A smaller subset of the study collection was similarly P-typed (n=139). P[8]-type was identified as the most prevalent P-type, accounting for 97.4% (n=186), while P[4] accounted for just 2.6% (n=5) of the collection. The low frequency of P[4] coincided with the decrease in G2 strains in circulation. The key finding in this study was the emergence of G3- and G9-serotypes as epidemiologically important rotavirus strains since 1999, and the low prevalence of the previously common G2 strains in Ireland. The profile of rotavirus is changing continuously in Ireland and the implications for a successful vaccination program are discussed.

Antigens, Viral↗
PubMed1986

Therapeutic traditions in Northern Ireland, Norway and Sweden: I. Diabetes. WHO Drug Utilization Research Group (DURG).

A questionnaire survey was carried out to explore differences in the approach to treatment of patients with Type II diabetes between physicians in Northern Ireland, Norway and Sweden, and to discover to what extent it could account for the three-fold difference in drug use between the countries. A representative sample of 400 physicians in each country was asked to give their opinions on the choice of therapy for three model cases designed to cover the spectrum of treatment - from diet alone to insulin. Significantly more Swedish (65%) than Northern Irish (51%) and Norwegian (52%) doctors suggested diet alone for uncomplicated diabetes recently discovered in a middle aged, overweight man. For symptomatic diabetes in a 76 year old over-weight woman with few retinal microaneurysms, the majority of physicians in all three countries suggested treatment with sulphonylureas. Biguanides were here a more common alternative in Northern Ireland than in Scandinavia. For suspected secondary treatment failure in a 63 year old woman with no signs of complications, insulin was suggested by 71% of the Norwegian doctors but only by 44 and 49% of those in Northern Ireland and Sweden, respectively. General practitioners tended to suggest oral treatment earlier and to maintain it longer than hospital physicians. The study has demonstrated significant differences in the approach to treatment of Type II diabetes mellitus between physicians in the three countries. However, the differences were more prominent in the choice of drugs than in the threshold of drug treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus↗
PubMed1985

Validation of observed differences in the utilization of antihypertensive and antidiabetic drugs in Northern Ireland, Norway and Sweden.

The amount of antihypertensive and antidiabetic drugs based of defined daily doses per 1000 inhabitants per day varies two to three fold between Northern Ireland, Norway, and Sweden. We explored whether variations based on the universally applied defined daily doses might be accounted for by national differences in the actual average prescribed daily doses. Use of prescribed daily doses for antihypertensive drugs resulted in Northern Irish and Norwegian consumption figures which were respectively 40 and 21% lower than the Swedish one, compared to 38 and 25% when defined daily doses were used. The effect of population age-sex differences on the gross defined daily doses per 1000 inhabitants per day figures was determined by applying the Northern Irish or Norwegian age-sex group proportions to Swedish age-sex specific sales data. Taking population differences into account would have resulted in antihypertensive drug use being 21 rather than 38% less in Northern Ireland and 18 rather than 25% less in Norway. Also adjustment for prescribed daily doses left an unexplained difference of 23% between Sweden and Northern Ireland and 14% between Sweden and Norway. For oral antidiabetics use of prescribed daily doses resulted in a Northern Irish - Swedish difference of 62% compared to 67% when defined daily doses were used. Simultaneous adjustment for population differences and prescribed to defined daily dose variations left a 52% difference.

Adolescent↗
PubMed1975

The measurement of drug consumption. Drugs for diabetes in Northern Ireland, Norway and Sweden.

The consumption of insulin and oral antidiabetic drugs was measured at the gross sales level in Sweden and Norway and at the prescription level in Northern Ireland. ""Agreed daily doses'' were used as units of comparison, which defined as follows: insulin 40 I.U., tolbutamide 1 g, acetohexamide 500 mg etc. Consumption was expressed as the number of ""agreed daily doses'' per 1,000 inhabitants per day. This provided a rough estimate of the number of subjects for whom the drug had been prescribed per 1,000 population. The data were collected during the three months April-June 1971. Marked differences in the consumption of antidiabetic drugs were found between the three countries and also between areas within each country. The consumption of insulin was similar in Norway and Northern Ireland (3.5 and 3.9 agreed daily doses per 1,000 inhabitants per day), but almost twice as high in Sweden. In Norway much lower use was found in certain rural areas. The variation in the consumption of oral antidiabetic drugs was even more marked. Surprisingly, consumption was considerably higher in Sweden (15.8) than in the nearby Norway (7.3), and was even lower in Northern Ireland (4.3). The major use was of sulphonylureas, especially chlorpropamide. Within the countries there was marked regional variation in the choice of individual biguanides and sulphonylureas. The data are discussed in relation to such factors as the incidence of diabetes, the sole use of dietary treatment etc. It is concluded that studies in depth, which link the actual use of drugs by patients to diagnosis, diabetic symptoms and clinical outcome of treatment are necessary in order to explore the reasons behind the marked geographical differences and to define a rational drug policy. However, the methods described in the study may be used for early detection of gross national differences in drug utilization, the further investigation of which may reveal to be of great public health interest.

Diabetes Mellitus↗
PubMed1997

A 3- to 6-year follow-up of former long-stay psychiatric patients in Northern Ireland.

Little is known about the first patients who left hospital before and during the official implementation of the hospital discharge policy in Northern Ireland. This study describes patterns of residential provision for former long-stay patients (approximately two-thirds of whom had an ICD-9 diagnosis of schizophrenia) discharged from the six major psychiatric hospitals in Northern Ireland between 1987 and 1990 (n = 321). It also employs several instruments within a retrospective survey design to examine outcomes for a 35% sample of people (112/321) discharged between 1997 and 1990 and followed up in 1993. Almost two-thirds (61%) had been discharged to independent living or low-staffed statutory settings. None of the group was homeless, one person was in prison and three people had committed suicide during the first 2 years after discharged. Almost one-third had to be re-admitted at some stage during the 6-year period and 13% had died. 'Moderate' to 'major problems' with most daily living skills were reported for less than 25% of people, while 15% or less had problem behaviour. Approximately 90% or more were satisfied with most aspects of their new homes and most also reported feeling happier (77%), healthier (63%) and more independent (78%) since discharge. However, social, recreational and occupational opportunities were limited. Purchasers, providers and practitioners need to review ways in which former long-stay patients might be empowered to live more meaningful and integrated lives in the community, particularly as the current government strategy for health and social well-being (1997-2002) in Northern Ireland points to the closure of existing psychiatric hospitals.

Activities of Daily Living↗
PubMedDate not supplied

Mortality from breast cancer in Ireland prior to the introduction of population-based mammographic screening.

Mammographic screening has been shown in international randomised controlled trials and case-control studies to be effective in reducing mortality from breast cancer. Ireland has a high mortality rate from breast cancer when compared with rates from other countries. Organised population-based mammographic screening for breast cancer is about to begin in Ireland. The purpose of this study was to examine current mortality from breast cancer, as well as trends in breast cancer mortality in Ireland since 1975, as a baseline against which future evaluations of the impact of screening can be carried out. Over the 23-yr period of review, mortality from breast cancer appears to have remained quite stable. Within the period, however, there is some variation in adjusted rates, most notably an increase to a peak in 1989, followed by a decrease between 1989 and 1997. Continued monitoring of recent trends is required, with in-depth analysis of possible explanations, such as changing breast cancer incidence rates, biological characteristics, therapeutic regimes and coding practices.

Adolescent↗
PubMed1991

Risk factors for coronary heart disease: a population survey in County Kilkenny, Ireland, in 1985.

As part of the evaluation of the Kilkenny Health Project, a survey of factors associated with increased risk of coronary heart disease (CHD) was carried out in Kilkenny, Ireland, in 1985. A random sample of 784 men and women aged 35 to 64 years was surveyed. Mean serum total cholesterol was mmol/l in men and women; 7.0% had levels greater than 7.8 mmol/l. Serum total cholesterol was significantly associated with age. 23.4% of males and 23.6% of females were hypertensive. 60.9% of males and 56.4% of females who were hypertensive were not on treatment. The prevalence of regular cigarette smoking was similar in males (27.7%) and females (27.1%). A further 6.3% of males and 1.6% of females smoked cigarettes occasionally or smoked a pipe or cigars regularly. 4.5% had a positive Rose questionnaire for previous myocardial infarction and 3.4% had a positive angina questionnaire. The high median total cholesterol and the low proportion of hypertensives on medication are consistent with findings in other population surveys in the British Isles and with the high mortality rates from CHD in Ireland. The prevalence of hypercholesterolaemia and of untreated hypertension was higher than in population surveys in the United States and Australia where CHD mortality rates are lower and declining at a faster rate than in Ireland.

Adult↗
PubMedDate not supplied

Molecular genotyping of human cryptosporidiosis in Northern Ireland: epidemiological aspects and review.

BACKGROUND: Cryptosporidium parvum is the most common of the protozoal pathogens associated with gastrointestinal disease in Northern Ireland. Genotyping techniques are valuable in helping to elucidate sources and modes of transmission of this parasite. There have been no reports on the prevalence of genotypes in Northern Ireland, mainly due to a lack of discriminatory genotyping techniques, which recently have become available. AIM: To investigate the genotype of C. parvum oocysts isolated from human faeces in sporadic cases of cryptosporidiosis in Northern Ireland. METHODS: Thirty-nine isolates of C. parvum, representing 79.6% of the total 1998 laboratory reports for the Eastern Health and Social Services Board, were investigated. Following DNA extraction from oocysts the thrombospondin-related adhesive protein 2 (TRAP-C2) locus was amplified by polymerase chain reaction (PCR) and subsequently sequenced. RESULTS: The majority of isolates (87.2%) were classified as bovine genotype II with the remainder (12.8%) being the human genotype I. CONCLUSIONS: There is a high prevalence of the bovine genotype II parasite in sporadic cases around the greater Belfast area. Epidemiologically, this suggests that the most frequent mode of transmission may be from animals to humans, but does not suggest a high proportion of human to human spread.

Adolescent↗
PubMedDate not supplied

The need for a national strategy for chronic pain management in Ireland.

BACKGROUND: Chronic pain is defined as pain on a daily basis for more than six months. It affects 13% of the Irish population. Despite its prevalence and the impact on patient's quality of life there is no national strategy for this problem. AIM: To determine the need for a national strategy for chronic pain in Ireland. METHODS: The cost of low back pain (LBP) (common chronic pain condition), the level of education and research and current chronic pain clinic resources were investigated. RESULTS: The cost of LBP in Ireland is enormous: disability payments from the Department of Social and Family Affairs amounted to euros 348 million and insurance payments cost euros 10.5 million. The number of teaching hours timetabled for pain education in the schools of Medicine, Physiotherapy, Dentistry, Nursing and Psychology in Ireland's six universities varied significantly (e.g. 11.5-72 hrs in nursing). Research grants awarded from state organisations were limited to one over a four-year period. No current chronic pain clinics comply with recommended International Association for the Study of Pain (IASP) guidelines. CONCLUSION: A national strategy is needed to reduce costs, standardise teaching and increase pain clinic resources to maximise patient care.

Chronic Disease↗
PubMedDate not supplied

Molecular characterisation of human campylobacteriosis in Northern Ireland: evidence of clonal stability.

BACKGROUND: No study has compared Campylobacter isolates from a human source in Northern Ireland over an extended period of time. AIM: To investigate the clonal stability of thermophilic campylobacters isolated from acute bacterial enteritis in Northern Ireland from 1992 to 1999. METHODS: Human isolates (n=272), originating from faeces, were characterised at the sub-species level using enterobacterial repetitive intergenic consensus sequence (ERIC2)--random amplification of polymorphic DNA (RAPD) typing. RESULTS: Thirteen genotypes were identified where three types, namely ERIC A, ERIC C and ERIC I, accounted for 28.3%, 14.3% and 13.6%, respectively. There were no significant associations (p>0.05) between sex, age groupings and year of isolation and ERIC2 genotype, with the exception of ERIC D, which showed a significant decline in isolation with time (p=0.019). CONCLUSIONS: ERIC genotypes were stable over this period, except genotype C which was lost during this time. Previous molecular typing methods showed campylobacters to be heterogeneous but this study suggests that the local human Campylobacter population consists of several common and stable genotypes. This study has established a database of local ERIC2 genotypes. This methodology may allow the establishment of an all-island database of clinical campylobacters that would be valuable in reducing human campylobacteriosis in Ireland.

Campylobacter↗
PubMedDate not supplied

Analysis of ultraviolet phototherapy and photochemotherapy resources in Ireland.

BACKGROUND: Ultraviolet (UV) phototherapy is widely used and very successful in the treatment of skin conditions. As such a safe and efficient service is essential. At present, there are no standard Irish guidelines regarding the operation, calibration or inspection of UV equipment nor is there an Irish policy on staff/patient safety or training issues. AIM: To survey all known phototherapy centres in Ireland. METHODS: A postal questionnaire was sent to all known phototherapy centres in Ireland addressed to the consultant dermatologist or the physiotherapist-in-charge. It was divided into six sections: Instrumentation, Quality Assurance, UV meters, equipment maintenance, patient/staff safety and training. Comments on current practice were invited. Non-respondents were contacted by telephone, in some cases the survey was mailed a second time. RESULTS: This study demonstrated a substantial quantity of suboptimal equipment in use and a lack of consensus regarding quality assurance inspection and UV meter calibration frequency. CONCLUSIONS: Guidelines must be established for calibration of UV equipment and standardisation of phototherapy protocols in Ireland.

Calibration↗
PubMedDate not supplied

Cardiac rehabilitation services in Ireland: the impact of a coordinated national development strategy.

BACKGROUND: The national Cardiovascular Health Strategy including specific plans for cardiac rehabilitation was launched in Ireland in 1999. A survey of cardiac rehabilitation services was conducted in 2003 to evaluate progress on service provision. AIM: To establish levels of service provision, service formats and geographic distribution of cardiac rehabilitation services in 2003 and compare them with the status pre-Strategy (1998). METHOD: All hospitals in Ireland (n = 39) admitting cardiac patients to a coronary or intensive care unit were surveyed by postal questionnaire. RESULTS: All hospitals provided information and all reported providing Phase I cardiac rehabilitation. Seventy-seven per cent (30 of 39) provided Phase III rehabilitation in 2003 (i.e. outpatient cardiac rehabilitation services) compared with 29% (12 of 41) in 1998. Of those hospitals currently without programmes, 78% (seven of nine) had plans in place for programme establishment. All programmes had trained cardiac rehabilitation coordinators, multidisciplinary teams and multiple components as recommended in the Strategy. In 82% of hospitals, intervention was provided at Phase II (immediate post-discharge period) while 26% of hospitals provided intervention at Phase IV (long-term maintenance period). CONCLUSIONS: There have been substantial achievements towards the Cardiovascular Health Strategy target of providing cardiac rehabilitation services for all relevant hospitals in Ireland over the past five years. Service provision of cardiac rehabilitation can benefit from collective efforts made across centres to encourage the prioritisation of cardiac rehabilitation in national health policy initiatives.

Ambulatory Care Facilities↗
PubMedDate not supplied

Cardiac rehabilitation service provision in Ireland: the Irish Association of Cardiac Rehabilitation survey.

BACKGROUND: The first national survey of cardiac rehabilitation services was conducted. AIMS: To establish levels of service provision, service formats, and geographic distribution of cardiac rehabilitation services in 1998. METHODS: Public hospitals in the Republic (n=41) and Northern Ireland (n=12) which provide services to cardiac patients were surveyed. RESULTSl Response rate was 81%. Twelve centres (29%) in the Republic and nine (75%) in Northern Ireland provided cardiac rehabilitation. There was wide geographic variability in service provision. Most centres were unable to identify the proportion of eligible patient participation. Most programmes were established for less than five years. All programmes had multidisciplinary teams, multicomponent courses and co-ordinators. Additionally, 44% of hospitals without programmes had plans regarding programme establishment. CONCLUSIONS: The findings highlight the underdeveloped but rapidly expanding nature of cardiac rehabilitation services in Ireland. They provide a baseline from which to address rehabilitation needs and to judge the success of the National Cardiovascular Health Strategy in addressing these needs.

Coronary Disease↗
PubMed1992

A comparison of community care of elderly people in Wales and Northern Ireland.

This study compares the provision of community services for elderly people in Wales and Northern Ireland using data from two independent surveys. Despite sampling and definitional problems, certain interesting comparisons can be obtained. In general, elderly people in the Northern Ireland sample seem more likely to be dependent and more disabled than those in Wales. Northern Ireland people receive less help, but the help given is more likely to be from statutory services than in Wales; in many cases statutory help is the sole source of support. Further, in Wales there is more specialized care for very disabled elderly people living in the community, and the work is more likely to be shared by carers and the statutory services. There is however still considerable unmet need in both countries. A comparative study using common definitions and methods would be of considerable interest in relation to the debate concerning the relative shares of health care resources in the United Kingdom.

Aged↗
PubMed2006

Genotypes and subtypes of Cryptosporidium spp. in neonatal calves in Northern Ireland.

Cryptosporidium spp. in diarrheic calves less than 30 days old from farms across Northern Ireland were examined over a year period by microscopic, genotyping, and subtyping techniques to characterize the transmission dynamics. Cryptosporidium oocysts were detected in 291 of 779 (37.4%) animals. The prevalence rates of rotavirus, coronavirus, and Escherichia coli K99+ were lower as seen in 242 of 806 (30.0%), 46/806 (5.7%), and 16/421 (3.8%) of animals, respectively. Of the 224 Cryptosporidium-positive specimens available for molecular analysis, Cryptosporidium parvum was identified in 213 (95.1%) specimens, Cryptosporidium bovis in eight (3.6%), and Cryptosporidium deer-like genotype in three (1.3%). Sequence analysis of the 60-kDa glycoprotein gene identified 16 IIa subtypes and a new subtype family, with 120 of the 216 (55.6%) positive specimens having the subtype IIaA18G3R1. Eight of the IIa subtypes were previously seen in humans in Northern Ireland. Several subtypes were temporally or geographically unique. The genetic diversity in calves in Northern Ireland was much greater than that reported from other areas. This work demonstrates the utility of genotyping and subtyping tools in characterizing the transmission of Cryptosporidium spp. in calves and humans.

Animals↗
PubMed2005

Primary immunodeficiency disorders in the Republic of Ireland: first report of the national registry in children and adults.

Data collection for the national registry for patients with primary immunodeficiency disorders in the Republic of Ireland commenced in 1996. One hundred and fifteen cases of primary immunodeficiency diseases were registered between December 1996 and February 2003. The most frequent primary immunodeficiency disorders were antibody deficiency (n = 53) and complement deficiency (n = 32). In addition, patients with T cell deficiency (n = 11) and chronic granulomatous disease (n = 11) were identified. A small number of patients with Wiskott-Aldrich syndrome, natural killer cell deficiency, DiGeorge syndrome and chronic mucocutaneous candidiasis were also registered. Comparison of our data with that recently reported in the European registry revealed that complement deficiency was more prevalent in the Republic of Ireland compared to other European countries. Results of our registry point to a significant prevalence of primary immunodeficiency disorders in the Republic of Ireland (2.9 cases per 100,000 population). However, it is likely that these figures underestimate the true prevalence of such cases in the country. We hope, with increased awareness of the national registry among primary care physicians, that more patients will be included and we will be able to identify accurately the frequency and the distribution of these disorders.

Adolescent↗