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PubMed2004

Early experience with chronic hepatitis C in Northern Ireland: epidemiology and response to monotherapy.

UNLABELLED: Chronic hepatitis C virus (HCV) infection has become a major health problem affecting an estimated 170 million people worldwide. The epidemiology of HCV and its response to treatment in Northern Ireland has not been described before. Our aims were to determine the epidemiology, histological stage, suitability for treatment and response to treatment in patients with hepatitis C presenting to one clinic in Northern Ireland. All patients were prospectively recruited with hepatitis C attending the Liver Clinic, Royal Victoria Hospital during the period December 1992 to June 1997. Sixty patients (33 male, mean age 44 years, range 19-84 years) who tested anti-HCV antibody positive were identified. The predominant genotypes were 1b (33%), 3a (28%) and 1a (26%). Most patients (78%) were asymptomatic at the time of detection and only four (7%) gave a history of jaundice. The most common modes of transmission were i.v. drug use in 30 (50%) and blood products in 20 (33%) patients. Forty-eight (86%) of the 56 patients tested were PCR positive for HCV RNA. Fifty-one patients (85%) underwent liver biopsy of whom 13 had cirrhosis (22% of original group). Twenty-nine patients were suitable for treatment, but three declined treatment and only 26 (43%) started interferon-alpha. During treatment 17 (65%) patients became PCR negative and eight (31%) remained PCR negative 12 months after completion of therapy. Liver histology was assessed before and after interferon treatment in 17 patients and showed no change in total necroinflammatory scores (p = 0.1) or staging of architectural change (p = 0.55). CONCLUSIONS: The epidemiology and response to therapy of HCV in Northern Ireland appear comparable to elsewhere in the UK. Only a minority of anti-HCV positive non-haemophiliac patients progress to have interferon therapy suggesting that the cost of treating chronic HCV may not be as great as initially thought.

Adult↗
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↗
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↗
PubMed2005

Surveillance for Barrett's oesophagus: results from a programme in Northern Ireland.

BACKGROUND: The reported incidence of adenocarcinoma in patients with Barrett's oesophagus in surveillance programmes varies widely. Great Britain has one of the highest incidence rates of this cancer in the world, but there are no data from Ireland reporting its incidence in patients with Barrett's oesophagus undergoing surveillance. We carried out a study of all such patients at a large District General Hospital in Northern Ireland. METHODS: A retrospective review of all patients with Barrett's oesophagus from January 1986 to March 2004 at Altnagelvin Area Hospital, Derry, Northern Ireland was performed. Barrett's oesophagus was defined as specialized intestinal metaplasia present in the tubular oesophagus. RESULTS: A total of 277 patients had Barrett's oesophagus. Twenty-one patients had adenocarcinoma and two patients had high-grade dysplasia at initial endoscopy and were excluded. Of the remaining 254 patients, 178 were entered into the surveillance programme (127 men, 51 women). The average follow-up period was 3.4 years, resulting in 613 patient-years of follow-up. Three patients developed adenocarcinoma, an incidence of 1/204 patient-years of follow-up. Two of the three patients had early-stage (T1 or T2) cancers detected and are alive and well. A total of 429 surveillance endoscopies were performed, and a marked year-on-year increase in the workload generated as a result of the surveillance programme was observed. CONCLUSIONS: The incidence of adenocarcinoma in patients in Northern Ireland was similar to the incidence reported by other large institutions. Clinical benefit is suggested but is not certain from these data, because of biases that affect surveillance programmes. Large multicentre studies are required to determine whether surveillance is beneficial.

Adenocarcinoma↗
PubMed1995

Medical treatment of myocardial infarction in France and Northern Ireland. Results from the ECTIM study. Enquête cas-Témoins de l'Infarctus du Myocarde.

As part of the ECTIM Study, the medical treatment given to male patients (25-64 years) 3 to 9 months after myocardial infarction (MI) were analysed in France and Northern Ireland. On univariate analysis, hypolipidaemic drugs, angiotensin-converting enzyme inhibitors and antiarrhythmic drugs were found to be prescribed more frequently in France, while beta-blockers were more common in Northern Ireland. No differences were found for diuretics, calcium channel blockers, antithrombotic and anti-anginal drugs, although the Northern Irish patients were mainly on antiplatelet drugs and nitrates, while the French patients received nitrates and non-nitrates, as well as oral anticoagulants and antiplatelet drugs in similar amounts. These differences remained after adjustment for personal history of diabetes, hyperlipidaemia, hypertension, and previous myocardial infarction, but the beta-blocker prescription was no longer significant. When the French centres were analysed, patients from Strasbourg were more frequently on oral anticoagulants and diuretics and less frequently on antiplatelet drugs, while patients from Toulouse had fewer anti-anginal drugs. Hence, although the current guidelines for secondary prevention of myocardial infarction are generally well applied in France and Northern Ireland, significant differences exist regarding the choice of the active drug.

Adult↗
PubMed2002

Physical activity and coronary event incidence in Northern Ireland and France: the Prospective Epidemiological Study of Myocardial Infarction (PRIME).

BACKGROUND: The influence of physical activity on the incidence of angina pectoris and hard coronary events (myocardial infarction and coronary deaths) was examined in Northern Ireland and France at contrasting risk for coronary heart disease (CHD) and with different physical activity patterns. METHODS AND RESULTS: Participants of the Prospective Epidemiological Study of Myocardial Infarction (PRIME) (n=9758; age, 50 to 59 years), free of CHD at baseline, were followed up for 5 years: 167 hard CHD and 154 angina events were recorded. Net energy expenditure (EE) as the result of physical activity was assessed by means of the MONICA Optional Study of Physical Activity Questionnaire (MOSPA-Q). Leisure-time physical activity EE was calculated; subjects were also categorized as to whether they performed high-intensity leisure-time activities or walked or cycled to work. After multivariate adjustment, leisure-time physical activity EE was associated with a lower risk of hard CHD events (P<0.04), whereas walking or cycling to work was not independently related to hard CHD events. No interaction by country was found. The beneficial effect of leisure-time physical activity was also present among subjects who did not report high-intensity activities (P<0.04), with similar results in France and Northern Ireland. In contrast, an increasing level of leisure-time physical activity was associated with a higher risk of angina in both countries. CONCLUSIONS: These data indicate a beneficial effect of leisure-time physical activity EE on hard CHD incidence in middle-aged men, which could partly explain the unfavorable rate of CHD in Northern Ireland. The higher level of leisure-time activities in France could, in part, explain its lower rate of CHD.

Angina Pectoris↗
PubMed2004

Prevalent diagnosed HIV in England, Wales and Northern Ireland: adjusted totals 1996 to 2001 and extrapolations to 2004.

OBJECTIVE: To predict trends in diagnosed HIV prevalence by extrapolation to 2004 using data from the annual surveys of individuals receiving HIV-related care in England, Wales and Northern Ireland from 1996 to 2001. METHODS: Data from the annual surveys of prevalent HIV infections diagnosed (SOPHID) were adjusted for under-reporting and non-attendance and separately extrapolated for infections acquired homosexually, heterosexually and by other routes. The data were extrapolated using negative binomial and linear regression models based on the 1996 to 2001 annual surveys. RESULTS: The negative binomial model predicted an increase of 56% in diagnosed HIV prevalence in England, Wales and Northern Ireland between 2001 and 2004. The linear model predicted an increase of 25% for the same time period. The predicted increases are mostly driven by the large rise in the number of new diagnoses, in particular in individuals infected heterosexually. CONCLUSION: Increases in HIV prevalence in England, Wales and Northern Ireland have diverged from a linear trend. Negative binomial modelling of the data predicts that large rises in prevalence will continue during the early 2000s.

Binomial Distribution↗
PubMed1978

Mental subnormality in Northern Ireland.

A prevalence survey of mental subnormality in Northern Ireland was carried out on lines similar to an earlier investigation by MacKay (1971). In a general population of one and a half million there were 6,854 ascertained subnormal individuals. The male : female ratio was 1. 14 :1. Approximately one in three subnormal people was under residential care. The prevalence of severe subnormality (IQ less than 50) in the 15-19 year old group was 4.81. The findings do not support the "steady rate" theory of severe subnormality.

Adolescent↗
PubMed1989

Acute pancreatitis as a cause of sudden or unexpected death in Northern Ireland.

Utilising incomplete data supplied by the Hospital Inpatient Analysis, the annual incidence of acute pancreatitis in Northern Ireland was estimated to be about 170 cases per million population. The annual mortality rate for the years 1974-1983, using figures obtained from the Registrar-General for Northern Ireland, was 12.3 cases per million. An increase in both incidence and mortality from acute pancreatitis was demonstrated during the study. There was 191 deaths from pancreatitis during the study period and in 27 of these the diagnosis was made only at postmortem examination. Of the undiagnosed fatalities, 10 occurred in individuals with a history of alcohol abuse. Eight of the 27 undiagnosed cases had not sought medical attention, five had presented with a systemic complication of acute pancreatitis, and a further five had only minor gastrointestinal tract symptoms prior to death. The diagnosis of acute pancreatitis requires a high index of suspicion and should be considered in acutely ill patients, particularly those with a history of alcohol abuse, who fail to respond to appropriate therapy.

Acute Disease↗
PubMed1992

Epidermolysis bullosa in Northern Ireland.

Cases of epidermolysis bullosa (EB) diagnosed in Northern Ireland during a 23-year period (1962-84) were identified from dermatology clinic files, paediatric hospital notes and cases known by general practitioners. A total of 48 confirmed new cases of EB were diagnosed during the screening period. This involved 31 families, with identification of 36 further cases. The distribution of incident EB subtypes was: simplex 31 (65%), junctional 1 (2%), dystrophic 12 (25%) and acquisita 4 (8%). The incidence rate of new cases of EB diagnosed per year is 1.4/million and prevalence of all forms estimated at 32/million. The prevalence of simplex, junctional and dystrophic forms is 28, 0.7 and 3/million, respectively.

Epidermolysis Bullosa↗
PubMed1985

Echovirus type 7 outbreak in Northern Ireland during 1984.

During 1984, 118 patients with echovirus type 7 infection were diagnosed. The incidence in Northern Ireland was more than three times higher than the rest of the United Kingdom. The outbreak peaked in June and July, with the highest incidence in Belfast and the eastern part of Northern Ireland. All patients were sufficiently unwell to require hospital admission. Aseptic meningitis was the commonest illness (54.2%) followed by gastroenteritis (22.0%), respiratory tract infections (11.9%) and influenza-like illnesses (8.5%). Males (62%) were affected more than females and 50 patients (42%) were less than one year old. The present epidemic had features in common with four previous enterovirus epidemics, except that the under one year age group was predominantly affected and no family or street outbreaks were detected.

Adolescent↗
PubMed1998

Factors affecting levels of untreated caries in a sample of 14-15-year-old adolescents in Northern Ireland.

UNLABELLED: Dental caries experience in children in Northern Ireland is the highest in the United Kingdom. OBJECTIVE: The aims were to examine the levels of untreated decay in a sample of 14-15-year-old children from an area known to have high dental needs and to relate them to factors which affect dental attendance. METHOD: A sample of 470 pupils aged 14-15 years who attended the 4th form of second level schools in North and West Belfast was obtained and closed questionnaires were distributed 2 weeks prior to the dental examination. RESULTS: 417 pupils were included in the analysis (inclusion rate 88.7%). The mean D value was 1.52 and the D/DMFT mean was 0.31. Individual factors which had significant associations with untreated decay were social class, time since the last dental visit, dental anxiety ratings and the type of dentist attended (mean D of 2.78 for those attending community service dentists and 1.24 for those attending general dental practitioners). Stepwise multiple regression models were constructed with dependent variables of D and the D/DMFT ratio, and the above independent variables remained significantly related to the outcome variables, with the exception of the type of dentist attended. Those attending the community service had higher social needs and longer intervals since dental treatment. CONCLUSION: Factors related to dental attendance are important in relation to the level of untreated decay but exclusive analysis of the type of dental service attended can be misleading. An active approach is required in order to improve the status of pupils with the highest needs.

Adolescent↗
PubMed1999

Developing programmes to achieve a healthy society: creating healthy workplaces in Northern Ireland.

Healthy workplaces help to prevent occupational disease and injury as well as promoting positive healthy lifestyle behaviours. The concept of creating healthy workplaces through workplace health promotion has been identified as a legitimate area of activity for public health policy in Northern Ireland, supporting as it does, the settings approach as a means of improving the health and well-being of the population at large. Benefits accrue to businesses, organizations and individuals from the enhancement of positive healthy lifestyle messages in addition to reinforcing the principles of good occupational health practices. Developing a framework for the creation of healthy workplaces is part of a joint initiative between the Northern Ireland Health Promotion and Health and Safety Agencies. Commitment to delivering the concept is required from all the key players who include: employers, employees, trade union groups and health and safety professionals. A healthy workplace model needs to be created which is flexible and adaptable to suit all types of business and in particular the needs of small businesses which predominate in Northern Ireland. The principles underpinning the Business Excellence Model may be a useful vehicle for delivering workplace health promotion onto an organization's agenda.

Government↗
PubMed2003

A cross-national perspective on school bullying in Northern Ireland: a supplement to Smith, et al. (1999).

There is great value in exploring the prevalence of school bullying from a cross-national perspective. Smith, Morita, Junger-Tas, Olweus, Catalano, and Slee in 1999 presented a cross-national perspective on the nature, prevalence, and correlates of school bullying that encompassed a wide range of countries. However, Northern Ireland was not included, despite potentially being an important country to include, given its volatile social, ethnic, and religious history--leading to the concern that the population has become somewhat habituated to low level aggression. Thus, the present paper provides a review of the current literature on school bullying in the Northern Ireland school system. Evidence presented suggests that the incidence of school bullying in Northern Ireland may be higher than that in the rest of Ireland and the United Kingdom.

Aggression↗
PubMed1998

BSE in Northern Ireland: epidemiological patterns past, present and future.

By 30 January 1998, there had been 170,259 confirmed cases of BSE in Great Britain (GB), 1766 confirmed cases in Northern Ireland (NI) (2 January 1998), and 276 confirmed cases in the Republic of Ireland (31 January 1998). Analysis of the epidemiological patterns in the NI epidemic reveals significant clustering of cases in herds and counties. The observed clustering of cases within herds results in lower per capita incidence of BSE in previously unaffected herds, providing support for the introduction of a certified herd scheme in NI. By fitting a backcalculation model to the case data, we can estimate the number of animals infected with the aetiological agent of BSE and project the number of future cases. We predict that the epidemic will decline rapidly, with approximately 99 cases (95% confidence interval 30,504) occurring in the five year period 1997-2001.

Animals↗
PubMed1984

Periconceptional vitamin supplementation and the prevention of neural tube defects in south-east England and Northern Ireland.

A comparison has been made of the effectiveness of periconceptional vitamin supplementation for the prevention of recurrence of neural tube defects (NTD) in south-east England and Northern Ireland. These areas represent the extremes of birth prevalence of NTD (low and high respectively) within the United Kingdom. Vitamin therapy resulted in a slightly less than two-fold reduction in the recurrence risk in south-east England and a greater than three-fold reduction in Northern Ireland, when compared with unsupplemented women at the same risk from the two areas. It is probable that one of the recurrences in each area did not involve the multifactorial form of NTD and, if these are excluded, then the reduction in recurrence risk with vitamin supplementation is 2.4 times in south-east England and 5.4 times in Northern Ireland. Either way, beneficial effects of supplementation are apparent in both areas but are more marked in the high prevalence area. The implications of this for the future are discussed. Two other important findings were that all but one of the recurrences of NTD with full supplementation occurred in male fetuses, and there was a higher than expected occurrence of isolated hydrocephalus in infants or fetuses following full supplementation.

Female↗
PubMed1998

Salmonella in raw shell eggs in Northern Ireland: 1996-7.

The shells and contents of 2090 packs of six raw eggs from shops in Northern Ireland were examined for the presence of salmonella between April 1996 and October 1997. Nine isolates of salmonella were detected from separate packs of eggs (0.43%). One of the isolates was from egg contents (0.05%), where salmonella can proliferate to levels likely to cause human infection if the egg is inadequately cooked. Visible dirt and organic contamination were poor predictors of salmonella contamination since most contaminated eggs had apparently clean and uncracked shells. Contaminated eggs were more likely to have been sold from small shops than supermarkets. Sampling for uncommon pathogens is expensive, labour intensive, and yields many negative results. The small numbers of positive results make it particularly susceptible to variations between methods. It continues to be important to cook eggs thoroughly to eliminate the risk of salmonellosis since this survey suggests that over 10,000 boxes containing one or more contaminated eggs may be sold in Northern Ireland each year. Caterers should use pasteurised liquid egg. A system of branding to enable eggs to be traced to individual flocks would assist in the investigation of outbreaks.

Eggs↗
PubMed2001

Occurrence and molecular genotyping of Cryptosporidium spp. in surface waters in Northern Ireland.

AIMS: To investigate the incidence and genotype of Cryptosporidium parvum oocysts in drinking water sources in Northern Ireland for the period 1996-1999, and to compare conventional and molecular methods of detection. METHODS AND RESULTS: Four hundred and seventy-four waters were investigated by conventional methods, namely immuno-fluorescent antibody detection (IFA; 380) and immuno-magnetic separation-IFA (IMS-IFA; 94), of which 14/474 (3%) were positive. Two hundred and fourteen samples (214/474) were also investigated by PCR techniques, targeting both the 18S rRNA and TRAP-C2 genes, of which 11/214 (5.1%) were positive. These 11 samples were classified as genotype II following sequence analysis of the TRAP-C2 amplicon. CONCLUSIONS: This study demonstrated the low incidence of oocysts of C. parvum in water sources in Northern Ireland. SIGNIFICANCE AND IMPACT OF THE STUDY: Such molecular-based techniques offer a number of advantages over conventional detection methodologies, namely greater sensitivity and specificity as well as the ability to provide accurate genotyping data rapidly, which may be valuable in directing operational management in potential outbreak situations.

Animals↗