High morbidity and mortality associated with an outbreak of influenza A(H3N2) in a psycho-geriatric facility.

In spring 2008, an influenza A subtype H3N2 outbreak occurred in a long stay psycho-geriatric ward and two wards in the intellectual disability services (IDS), part of a large psychiatric hospital. The attack rate in the index ward was 90% (18/20) for patients and 35% (7/20) for staff. It was 14% (1/7) and 17% (2/12) in the affected IDS wards for patients and 0% (0/20) and 4% (1/25) for staff. Many of the laboratory-confirmed cases did not have a fever >38 °C, a typical sign of influenza. Control measures included oseltamivir treatment for cases and prophylaxis for contacts, standard and droplet infection control precautions, active surveillance for early detection and isolation of potential cases. As a result, the outbreak did not spread throughout the hospital. Although the staff vaccination rate (10%) prior to the outbreak was low, we observed a much lower vaccine effectiveness rate in the patients (11%) than in the staff (100%) in the index ward. Vaccination of residents and staff of such facilities remains the key influenza prevention strategy.

Screening for breast cancer in Ireland: the Eccles Breast Screening Programme.

The Eccles Breast Screening Programme is a population-based screening programme for breast cancer, based at the Mater Misericordiae Hospital, Dublin. It began in 1989 simultaneously with similar programmes in Belgium, France, Greece, Portugal and Spain. The objectives of the Eccles Programme are: (i) to evaluate the impact of mammographic screening on morbidity and mortality from breast cancer in Irish women; and (ii) to address the feasibility and potential value of a national breast cancer screening programme. The specific group targeted for screening is women born in 1925 to 1940 inclusive, in a defined geographical area comprising north Dublin City and County, and Counties Cavan and Monaghan. The areas combined comprise 16% of the country's population; just over 29,000 women were invited for screening. An analysis of the demographic and socioeconomic features of the target population reveals that it represents the total population remarkably well. Participants were invited from a population register to attend one of two screening units. Follow-up treatment for those with abnormalities takes place predominantly at the Mater Hospital where the facilities of the Departments of Pathology, Surgery and Oncology have been made available to the programme. Almost 18,000 women had a mammogram in the first round of screening, an overall response rate of 62%. A total of 129 cancers were detected, a prevalence of breast cancer of 7.2 per 1,000. Of those, 15 (11.6%) were entirely intraduct, and an additional 7 (5.4%) had minimal invasion. This is considerably higher than the proportion of intraduct cancers seen in referral practice populations.

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.

A profile of attenders to a south Dublin city accident and emergency department.

All new patients attending a Dublin Hospital's Accident and Emergency (A&E) Department were surveyed to document their reasons for attending and to make comparisons between self-referred and GP referred groups. Of the 557 responders 395 (70.9%) were self-referred. Four-fifths of this group said they had a GP but only 6.6 per cent attempted to contact the GP before attending. Compared with GP referred patients the self-referred group were more likely to be under 45 (74.6 per cent v 59.8 per cent, P < 0.01) and have soft tissue injuries (57 per cent v 32.9 per cent, P < 0.01). They were less likely to require laboratory investigation or to be admitted to hospital (11 per cent v 31.2 per cent, P < 0.01). It is likely many of the self-referred patients could have been managed by a GP. However, A & E departments remain popular sources of treatment for patients with a wide variety of conditions. Current methods of delivering health care to patients with minor conditions require assessment so that patient demands for both a responsive minor injury and emergency service can be met. Almost 70 per cent of all hospital admissions originated from the A&E department. This makes rational planning and management of booked admissions difficult. GPs who refer patients for admission should have an alternative route to hospital beds besides the A&E department.

Patients 21 days or more in an acute hospital bed: appropriateness of care.

Patients occupying beds for 21 days or more in acute hospitals were studied. Using predetermined objective criteria, the appropriateness of the previous day's hospitalisation was assessed. Barriers to appropriate care and the level of care required were identified in those deemed inappropriate. Of the 421 patients identified, 194 were considered to be inappropriately placed in an acute hospital bed. Patients deemed inappropriate were more likely to be older (p less than 0.05), female (p less than 0.05), have lost a spouse (p less than 0.05), have been admitted through the Accident and Emergency Department (p less than 0.05), and have longer lengths of stay (p less than 0.001) than those considered appropriate. The most frequently identified barrier to appropriate care (N = 143) was that the patient was awaiting another level of care. The level of inappropriate use of acute beds in Dublin is unacceptably high. Additional longstay accommodation especially for geriatric patients is needed. Alternatives to acute hospital care for patients requiring rehabilitation or nursing care should be explored.

The impact of reminder letters on attendance for breast cancer screening.

OBJECTIVE: The aims of this investigation was to analyse the response to second and third postal invitations from a group of patients previously invited for mammographic screening and to identify any demographic differences between responders and non-responders. SUBJECTS: The subjects were females aged 50-64 yr resident in 6 adjacent District Electoral Divisions (DEDs) in North Dublin where screening had not been carried out prior to the study. METHOD: Non-responders to an invitation for screening were re-invited by computer-generated letter to attend for screening 6 weeks after issue of the first invitation and a final invitation was issued at 12 weeks. Data sources used for the project register were the Eastern Health Board General Medical Services data base (GMS), Voluntary Health Insurance Board (VHI) data and self-registration. RESULTS: There were 1,310 females in the target age group who were eligible for screening. The response rate to the first invitation was 60.7 per cent. Issue of second invitation increased the response rate by 17.9 per cent. A third invitation increased the response rate by a further 7.6 per cent. Those with private medical insurance were more likely to respond to the first and third invitations. The was no difference in response rate to the second invitation for those with and without private insurance. Women aged 55-64 were more likely to respond to first, second or third invitations than those aged less than 55 yr. CONCLUSIONS: Issue of second mailed invitations to women in the target age for mammography screening is cost-effective and should be incorporated into routine policy. Response to third invitations is not cost-effective.

Feasibility of population based screening in Ireland.

Population registers have formed the basis for computerised call/recall registers for screening programmes in many countries and have been important in achieving high uptakes in targeted populations. The absence of a population register for the ECCLES (European Campaign against Cancer, Localisation, Evaluation & Screening) Breast Screening Project necessitated the development of a special register of women in the target age group. The data sources used to build the project register were the Eastern Health Board and North Eastern Health Board General Medical Services database, Voluntary Health Insurance data and self-registration with the project. The register captured 86.3 per cent of the target population. A debate on the merits and difficulties associated with the setting up of a population register in Ireland is now timely.

Use of seat belts in a Dublin area.

This study examines public compliance with seat belt regulations. Two busy suburbs in north Dublin were studied. Of the 2,139 vehicles surveyed 1,160 (54.2%) drivers wore a seat belt. Young female drivers were most likely to comply with the regulations (70.1%). Only 344 (46.1%) front seat passengers wore their seat belt. 188 children who appeared to be under 10 years of age were observed in the front seat of vehicles and of those just 9 babies were appropriately restrained. Of the back seat passengers 108 (19.2%) wore seat belts; 99 (21.8%) children and 9 (9.8%) adults. Despite on-going publicity and progression in the regulations our use of seat belts is grossly disappointing. Road traffic accidents exert an unacceptably high toll on health in Ireland. Seat belts are known to be effective in preventing serious injury. A much greater emphasis on enforcement of legislation is now urgently needed to encourage responsible behaviour among vehicle users and to reduce the needless suffering due to road traffic accidents.