RESUMO
BACKGROUND: Expenditure on residential placements for people with intellectual disability (ID) in Ireland is considerable and expected to increase. Despite this, there is limited evidence on the factors driving variation in privately provided 'out-of-area' residential placement costs, including across Community Health Organisations (CHOs)/regions. This is important to help inform the delivery of services at best value. METHODS: We analyse unit cost data from 2019 for a sample of 278 high-cost publicly funded privately provided out-of-area residential placements for people with ID in Ireland. We undertake univariate analysis of the relationship between costs and a wide range of variables using t-tests and one-way analysis of variance. We employ multivariable regression analysis to examine how raw differentials in unit costs across regions can be accounted for by individual-level characteristics. RESULTS: We estimate average unit costs of 264 170 per annum in our sample. The univariate analysis shows considerable variation in costs across a range of personal, disability, psychiatry/psychological, forensic issues, behaviour and supports and plans related variables. We also find wide variation in average unit costs across CHOs/regions (F = 4.58, P < 0.001), ranging from 213 380 to 331 880. The multivariable analysis shows that regional differences remain even after accounting for a wide range of individual characteristics that influence costs. CONCLUSIONS: Our analysis shows that while the majority of differences in costs across regions can be explained, there is potential for cost savings in the provision of high-cost publicly funded out-of-area residential placements in Ireland. Overall this can help to develop and implement a more sustainable disability residential funding model in a context of rising demand for services. It also has potential implications for the approach to procurement of services.
Assuntos
Pessoas com Deficiência , Deficiência Intelectual , Humanos , IrlandaRESUMO
OBJECTIVES: To examine levels of psychological distress among higher education students in Ireland overall and across a range of personal, higher education, and socioeconomic characteristics, prior to the COVID-19 pandemic. METHODS: A cross-sectional online survey of college students in Ireland was undertaken in 2018. Data on 5201 students from 13 higher education institutions (HEIs) were analyzed. Stress, anxiety, and depression symptom scores based on the Depression, Anxiety and Stress Scale (DASS-21) were calculated and reported, with statistical testing used to compare across groups. RESULTS: Overall, 29.6% and 19.1% of respondents were classified in the mild to moderate and severe to extremely severe range for depression respectively. The corresponding proportions were 25.9% and 20.7% for anxiety, and 24.5% and 14.8% for stress. Differences across groups included higher levels of psychological distress for transgender and female students compared to males (p < 0.01), for gay/lesbian/bisexual students compared to heterosexuals (p < 0.01), for undergraduates compared to postgraduates (p < 0.01), for students from intermediate/technical/service/unskilled social classes compared to professional/self-employed social classes (p < 0.01), and for those with financial difficulties compared to those without financial difficulties (p < 0.01). CONCLUSIONS: Rates of psychological distress were high amongst college students in Ireland prior to the COVID-19 pandemic, with substantial differences across groups. Due to study limitations, such as possible selection bias, the findings need replication. Further research is needed to determine the impact of the pandemic on the prevalence of mental illness in this population.
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BACKGROUND: Workplace bullying is a pervasive problem with significant personal, social and economic costs. Estimates of the resulting lost productivity provide an important societal perspective on the impact of the problem. Understanding where these economic costs fall is relevant for policy. AIMS: We estimated the value of lost productivity to the economy from workplace bullying in the public and private sectors in Ireland. METHODS: We used nationally representative survey data and multivariable negative binomial regression to estimate the independent effect of workplace bullying on days absent from work. We applied the human capital approach to derive an estimate of the annual value of lost productivity due to bullying by sector and overall, in 2017. RESULTS: Bullying was independently associated with an extra 1.00 (95% CI: 0.38-1.62) days absent from work over a 4-week period. This differed for public and private sector employees: 0.69 (95% CI: -0.12 to 1.50) versus 1.45 (95% CI: 0.50-2.40) days respectively. Applying official data, we estimated the associated annual value of lost productivity to be 51.8 million in the public sector, 187.6 million in the private sector and 239.3 million overall. CONCLUSIONS: The economic value of lost productivity from workplace bullying in Ireland is significant. Although bullying is more prevalent in the public sector, it has a larger effect on absence in the private sector. Given this, along with the greater overall share of employees, productivity losses from bullying are considerably larger in the private sector in Ireland.
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Bullying/estatística & dados numéricos , Eficiência Organizacional/economia , Setor Privado/economia , Setor Público/economia , Local de Trabalho/economia , Adulto , Feminino , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Local de Trabalho/psicologiaRESUMO
Shiga toxigenic Escherichia coli (STEC) are pathogenic E. coli that cause infectious diarrhoea. In some cases infection may be complicated by renal failure and death. The incidence of human infection with STEC in Ireland is the highest in Europe. The objective of the study was to examine the spatial incidence of human STEC infection in a region of Ireland with significantly higher rates of STEC incidence than the national average and to identify possible risk factors of STEC incidence at area level. Anonymised laboratory records (nâ¯=â¯379) from 2009 to 2015 were obtained from laboratories serving three counties in the West of Ireland. Data included location and sample date. Population and electoral division (ED) data were obtained from the Irish 2011 Census of Population. STEC incidence was calculated for each ED (nâ¯=â¯498) and used to map hotspots/coldspots using the Getis-Ord Gi* spatial statistic and significant spatial clustering using the Anselin's Local Moran's I statistic. Multivariable regression analysis was used to consider the importance of a number of potential predictors of STEC incidence. Incidence rates for the seven-year period ranged from 0 to 10.9 cases per 1000. A number of areas with significant local clustering of STEC incidence as well as variation in the spatial distribution of the two main serogroups associated with disease in the region i.e. O26 and O157 were identified. Cattle density was found to be a statistically significant predictor of STEC in the region. GIS analysis of routine data indicates that cattle density is associated STEC infection in this high incidence region. This finding points to the importance of agricultural practices for human health and the importance of a "one-health" approach to public policy in relation to agriculture, health and environment.
Assuntos
Monitoramento Ambiental , Escherichia coli Shiga Toxigênica/crescimento & desenvolvimento , Animais , Bovinos , Humanos , Incidência , Irlanda , Escherichia coli Shiga Toxigênica/isolamento & purificação , Análise de Pequenas ÁreasRESUMO
BACKGROUND: Lyme borreliosis is caused by Borrelia burgdorferi and is the most common tick-transmitted infection in temperate regions. Infection often presents with erythema migrans and/or other clinical features in early infection. METHODS: Blood samples are submitted for testing for antibodies to Borrelia burgdorferi by enzyme immunoassay and positive samples are confirmed by a reference laboratory by IgG and IgM line immune assay. A retrospective extraction of all laboratory requests and results for Lyme borreliosis from 2011 to 2014 was performed. Patient addresses were mapped to local electoral area (LEA). RESULTS: The total number of requests was 5049 and 242 (5%) were positive over 5 years. The number of positive and tested samples were 40/748, 45/905, 41/947, 73/1126 and 43/1323 from 2011 to 2014. Even though the number of requests increased over the years, there was no significant increase in the number of positives. Incidences per 100,000 population for requests and positives were calculated at LEA level and showed considerable variation. The highest incidence was shown in one LEA (Connemara) with nearly 500 requests and 43 positives per 100,000 population per year. CONCLUSIONS: Increased awareness may explain the increase in requests. There is no indication of an increase in incidence. As many GPs treat suspected Lyme borreliosis empirically without testing and as antibody may be undetectable early in the course of illness, the true incidence of infection is likely to exceed the number of laboratory-confirmed cases.
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Doença de Lyme/epidemiologia , Adulto , Geografia , Humanos , Incidência , Irlanda , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
We studied the association between amputation and distance of patients' residences to a diabetes care centre. We performed a case-control study matching each case (amputation) with 5 controls (no amputation) by age and sex. We compared the distance of residence to the diabetes centre, duration and type of diabetes, haemoglobin-A1c levels and foot examination findings for cases and controls. We analysed the association between distance and the strongest predictors of amputation. Sixty-six cases of amputation and 313 controls were identified. Distance of residence was 12.1km greater for cases (p = 0.028). In multivariate analysis, only diabetes duration (OR/year 1.07, 1.03 to 1.11) and neuropathy (OR 10.73, 4.55 to 25.74) were significantly associated with amputation. Patients with neuropathy resided 97 km further than those without neuropathy (p = 0.01). Patients requiring amputation reside at greater distances from the diabetes centre, possibly due to higher rates of neuropathy.
Assuntos
Amputação Cirúrgica/estatística & dados numéricos , Pé Diabético/epidemiologia , Pé Diabético/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Análise EspacialRESUMO
OBJECTIVE: To explore the incremental effects of patient dependence and function on costs of care for patients with Alzheimer's disease (AD) and amnestic mild cognitive impairment (MCI) in Ireland. METHODS: Cost analysis based on reported resource use for a cross-section of 100 community-based people with AD and MCI. Formal care included general practice visits, hospitalizations, outpatient clinic consultations, accident and emergency visits, respite care, meals on wheels services and other health and social care professional consultations. Informal care included time input provided by caregivers. Resource unit costs were applied to value formal care and the opportunity cost method was used to value informal care. Patient dependence on others was measured using the Dependence Scale and patient functional capacity using the Disability Assessment for Dementia scale. Multivariate regression analysis was used to model the cost of care. RESULTS: Both dependence and function were independently and significantly associated with total formal and informal care cost: a one point increase in dependence was associated with a 796 increase in total cost and a one point improvement in function with a 417 reduction in total cost over 6 months. Patient function was significantly associated with formal care costs, whereas patient function and dependence were both significantly associated with informal care costs. CONCLUSION: The costs of care for patients with AD and MCI in Ireland are substantial. Interventions that reduce patient dependence on others and functional decline may be associated with important economic benefits.
Assuntos
Doença de Alzheimer/economia , Disfunção Cognitiva/economia , Custos de Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/terapia , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/terapia , Custos e Análise de Custo , Avaliação da Deficiência , Feminino , Serviços de Saúde para Idosos/economia , Humanos , Irlanda , Masculino , Análise Multivariada , Escalas de Graduação Psiquiátrica , Apoio SocialRESUMO
This paper estimates the impact of travel distance on the decision to attend for screening for gestational diabetes mellitus (GDM), controlling for a range of personal, clinical and lifestyle characteristics. The results suggest that women who live further away from a screening site are less likely to attend for screening. In particular, the probability of attending for screening is reduced by 1.8% [95% CI: 1.2% to 2.4%] for every additional 10 kms of travel. This is consistent wth previous research that shows geographic inequalities in access to GDM screening in Ireland. We also find that older women, those with a family history of diabetes, and those who are obese are more likely to accept the screening offer, suggesting that certain higher-risk groups may be either self-selecting into the screening programme or are being targeted by health care professionals through specific initiatives.
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Tomada de Decisões , Diabetes Gestacional/diagnóstico , Programas de Rastreamento , Viagem , Adolescente , Adulto , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Irlanda/epidemiologia , Pessoa de Meia-Idade , GravidezRESUMO
Previous studies have shown an association between Type 2 diabetes and lower socioeconomic status. This link is less clear in those with gestational diabetes mellitus (GDM). We test for a socioeconomic gradient in the prevalence of GDM by analysing data on 9,842 pregnant women who were offered testing for GDM in the Atlantic Diabetes in Pregnancy universal screening programme. A bivariate probit model relating GDM prevalence to socioeconomic status was estimated, controlling for variation in screening uptake rates across socioeconomic groups. The estimated increased prevalence of GDM is 8.6% [95% CI 2.7%-12.0%] for women in the lowest socioeconomic group when compared to the highest, suggesting a strong socioeconomic gradient in the prevalence of GDM. This gradient is found to be driven by differences in personal, clinical and lifestyle factors across socioeconomic groups.
Assuntos
Diabetes Gestacional/epidemiologia , Programas de Rastreamento , Classe Social , Adolescente , Adulto , Feminino , Humanos , Irlanda/epidemiologia , Pessoa de Meia-Idade , Modelos Estatísticos , Gravidez , PrevalênciaRESUMO
Addressing the extra economic costs of disability is a logical step towards alleviating elements of social exclusion for people with disabilities. This study estimates the long-run economic cost of disability in Ireland in terms of the additional spending needs that arise due to disability. It defines and estimates models of the private costs borne by families with individuals who have a disability in Ireland when compared with the wider population, both in general and by severity of disability. Our modelling framework is based on the standard of living approach to estimating the cost of disability. We extend on previous research by applying panel ordered probit models to living in Ireland survey data 1995-2001 in order to control for the effects of previous disability and income and correlated unobserved heterogeneity. The approach allows us to quantify, for the first time, the additional long-run economic costs of living associated with disability. Our findings suggest that the extra economic cost of disability in Ireland is large and varies by severity of disability, with important implications for measures of poverty.
Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Economia/estatística & dados numéricos , Fatores Etários , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Humanos , Renda/estatística & dados numéricos , Irlanda , Modelos Econômicos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores de TempoAssuntos
Bactérias/isolamento & purificação , Infecção Hospitalar , Eletrocardiografia/instrumentação , Eletrodos/microbiologia , Contaminação de Equipamentos , Reutilização de Equipamento , 2-Propanol , Contagem de Colônia Microbiana , Desinfetantes , Desinfecção/métodos , Enterococcus/isolamento & purificação , Humanos , Pseudomonas aeruginosa/isolamento & purificação , Staphylococcus aureus/isolamento & purificaçãoRESUMO
The diagnostic accuracy of sonohysterography combined with sonosalpingography or sonohysterosalpingography was evaluated in 100 infertility patients who also underwent endoscopic (hysteroscopy with or without laparoscopy) procedures. In patients with normal endometrial biopsy results, single endometrial layer thickness ranged from 3 to 5 mm and varied up to 2 mm in some areas. Diagnostic accuracy was 98% for submucosal fibroids, 96% for polyps, and 81% for synechiae. Missed lesions, were less than 2 mm in diameter. Tubal patency was successfully assessed in 79% of women with saline solution and in 92% of those who received contrast agent. This study demonstrates the efficacy of the combined use of SHG and SSG in infertility patients with uterine or tubal factor disorders.
Assuntos
Histerossalpingografia/métodos , Infertilidade Feminina/diagnóstico por imagem , Doenças das Tubas Uterinas/diagnóstico por imagem , Testes de Obstrução das Tubas Uterinas , Feminino , Humanos , Infertilidade Feminina/etiologia , Leiomioma/complicações , Leiomioma/diagnóstico por imagem , Ultrassonografia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico por imagemRESUMO
OBJECTIVE: To evaluate the reproducibility of radiographic quantification of pulmonary edema on the supine plain chest radiograph and to correlate the radiographic appearance of edema with the clinical assessment and treatment of pulmonary edema. STUDY DESIGN: Retrospective, blind, descriptive study of 24 women with singleton pregnancies in the last trimester selected because of a clinical question of pulmonary edema. RESULTS: Interobserver variability between radiologists resulted in an average weighted kappa of .71 in grading edema on a 0-3 scale where 0 = no edema and 3 = alveolar flooding. The vascular pedicle (a measure of central circulating volume) was larger among patients who received furosemide (63.4 mm) than those who did not (57.0 mm) (P = .01). The vascular pedicle was also larger among patients receiving tocolytics or steroids (62.8 mm) than those who did not (56.0 mm) (P = .01). The radiographic edema score tended to be lower in patients who received tocolytics and steroids (P = .05). The other correlations were not significant. CONCLUSION: Radiographic assessment of pulmonary edema shows fair to good reproducibility, but the clinical correlations are modest. A wider understanding of the wealth of physiologic information available on the plain chest radiograph may prove invaluable in understanding the clinical course and treatment of these patients.
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Complicações na Gravidez/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Variações Dependentes do Observador , Gravidez , Complicações na Gravidez/terapia , Terceiro Trimestre da Gravidez , Edema Pulmonar/terapia , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Método Simples-Cego , Resultado do TratamentoRESUMO
These case reports illustrate the clinical and color Doppler sonographic findings in two cases of isolated tubal torsion. This condition may be associated with prior tubal ligation. The presence of high impedance or absent flow in a tubular structure in a patient with a history of tubal ligation should make one suspect this condition.
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Doenças das Tubas Uterinas/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Adulto , Velocidade do Fluxo Sanguíneo , Doenças das Tubas Uterinas/fisiopatologia , Doenças das Tubas Uterinas/cirurgia , Tubas Uterinas/irrigação sanguínea , Tubas Uterinas/diagnóstico por imagem , Tubas Uterinas/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Anormalidade Torcional/diagnóstico por imagemRESUMO
This study correlates the color Doppler sonography (CDS) findings in ovarian masses according to histomorphologic groups. Sixty-two surgically excised ovarian masses (31 benign and 31 malignant) in patients who underwent CDS were retrospectively reviewed. Lowest pulsatility index (PI) was used in benign and malignant unilocular cysts, septated cysts, predominantly cystic masses with solid components, predominantly solid masses with cystic areas and solid masses. The mean of the lowest PIs of benign lesions (1.7 +/- 0.7) were statistically significantly different (p < 0.05) from malignancies (0.7 +/- 0.3). The group of septated cysts (1.8 +/- 0.5 vs. 0.61 +/- 0.3) and predominantly cystic masses with solid areas (1.1 +/- 0.1 vs. 0.6 +/- 0.2) achieved statistical significance for benign vs. malignant masses. Predominantly solid masses with cystic areas (1.8 +/- 0.5 vs. 0.8 +/- 0.2) and solid masses (1.4 +/- 1.0 vs. 0.7 +/- 0.3) were not statistically significantly different. Because of a limited number of cases, statistically significant differences in the mean of the lowest PIs of benign vs. malignant unilocular cysts (2.1 +/- 0.5 vs. 1.9) could not be determined. When analyzed according to histomorphology, CDS findings were of predictive value in certain morphologies and not as much in others. This fact should be taken into account when evaluating an ovarian mass for malignancy with CDS.
Assuntos
Cistos Ovarianos/diagnóstico por imagem , Cistos Ovarianos/patologia , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/patologia , Ultrassonografia Doppler em Cores , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Cistos Ovarianos/fisiopatologia , Neoplasias Ovarianas/fisiopatologia , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: Our purpose was to assess the potentials and limitations of the early detection of ovarian cancer in protocols that involve transvaginal color Doppler ultrasonography. STUDY DESIGN: Retrospective analysis was performed on the data from 206 referred patients who either had surgical or clinical follow-up of ovarian masses evaluated by transvaginal color Doppler ultrasonography. Most of the patients were referrals or had risk factors. RESULTS: In this series of 206 patients, 26 ovarian cancers were detected, > 70% of which were stage I or II. CONCLUSION: Transvaginal color Doppler ultrasonography is capable of early detection of ovarian carcinoma. An improved detection rate may be realized with better identification of high-risk patients who should be studied with transvaginal color Doppler ultrasonography.
Assuntos
Neoplasias Ovarianas/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Vagina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
The purpose of this study was to describe the color Doppler sonographic findings in adnexal torsion that distinguish viable from nonviable ovaries. We present the color Doppler sonographic features in 13 patients with surgically proved adnexal torsion that help determine whether or not the ovaries were viable or nonviable at the time of surgery. Eleven combined ovarian and tubal torsions and two isolated tubal torsions were studied. In 10 cases the ovaries were considered nonviable at the time of surgery and in three cases they were considered viable. Of the nonviable group, six showed absent arterial and venous flow centrally, but two had low velocity (< 5 cm/s) arterial flow peripherally in the region of the adnexal branch of the uterine artery or in the main ovarian artery, and two demonstrated absent or reversed diastolic arterial flow. None of the nonviable ovaries showed venous flow centrally. In contrast, all of the viable ovaries demonstrated venous flow centrally, and two had peripheral and central arterial flow. Although the CDS findings in adnexal torsion are variable, ovarian viability may be predicted if central venous flow is present.
Assuntos
Doenças das Tubas Uterinas/diagnóstico por imagem , Doenças Ovarianas/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Adolescente , Adulto , Artérias/fisiologia , Velocidade do Fluxo Sanguíneo , Criança , Pré-Escolar , Doenças das Tubas Uterinas/patologia , Feminino , Humanos , Hipertrofia , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Doenças Ovarianas/patologia , Ovário/irrigação sanguínea , Ovário/patologia , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/patologia , Estudos Retrospectivos , Anormalidade Torcional/diagnóstico por imagem , Útero/irrigação sanguínea , Veias/fisiologiaAssuntos
Radiografia/história , História do Século XX , Humanos , Mamografia/história , Mamografia/instrumentação , Radiografia/instrumentação , Radiografia Abdominal , Radiografia Torácica/história , Radiografia Torácica/instrumentação , Tecnologia Radiológica/história , Tecnologia Radiológica/instrumentação , Tomografia por Raios X/história , Tomografia por Raios X/instrumentaçãoRESUMO
Sonohysterography involves the instillation of sterile saline under continuous sonographic visualization to assess the endometrial cavity. The technique is most useful for evaluating women with fertility problems, postmenopausal bleeding, or an abnormal endometrial interface as seen at baseline sonography. The procedure is performed with saline instilled into the endometrial cavity through a 5-F pediatric feeding tube or a hysterosalpingography or insemination catheter. In the normal uterus, the endometrium appears symmetric, surrounding the anechoic, saline-distended endometrial cavity. Adhesions appear as bridging bands of tissue that distort the uterine cavity or as very thin, undulating membranes, best seen at real-time examination. An intracavitary polyp is seen surrounded by anechoic fluid, with the point of attachment and thickness of the stalk clearly demonstrated. The location of leiomyomas can be determined: Intramural lesions do not distort the endometrial cavity, whereas submucosal lesions often do, with the overlying normal layer of endometrium clearly seen. In women with abnormal bleeding, focal areas of asymmetric endometrial thickening can be identified. Sonohysterography allows differentiation of intracavitary, endometrial, and submucosal abnormalities without the use of ionizing radiation or contrast agents.