Evaluation of a national clinical programme for the management of self-harm in hospital emergency departments: impact on patient outcomes and the provision of care.

BACKGROUND: Emergency departments are important points of intervention, to reduce the risk of further self-harm and suicide. A national programme to standardise the management of people presenting to the emergency department with self-harm and suicidal ideation (NCPSHI) was introduced in Ireland in 2014. The aim of this study was to evaluate the impact of the NCPSHI on patient outcomes and provision of care. METHODS: Data on self-harm presentations were obtained from the National Self-Harm Registry Ireland from 2012 to 2017. The impacts of the NCPSHI on study outcomes (3-month self-harm repetition, biopsychosocial assessment provision, admission, post-discharge referral, and self-discharge) were examined at an individual and aggregate (hospital) level, using a before and after study design and interrupted time series analyses, respectively. The 15 hospitals that implemented the programme by January 2015 (of a total of 24 between 2015 and 2017) were included in the analyses. RESULTS: There were 31,970 self-harm presentations during the study period. In hospitals with no service for self-harm (n = 4), risk of patients not being assessed reduced from 31.8 to 24.7% following the introduction of the NCPSHI. Mental health referral in this hospital group increased from 42.2 to 59.0% and medical admission decreased from 27.5 to 24.3%. Signs of a reduction in self-harm repetition were observed for this hospital group, from 35.1 to 30.4% among individuals with a history of self-harm, but statistical evidence was weak. In hospitals with a pre-existing liaison psychiatry service (n = 7), risk of self-discharge was lower post-NCPSHI (17.8% vs. 14.8%). In hospitals with liaison nurse(s) pre-NCPSHI (n = 4), medical admission reduced (27.5% vs. 24.3%) and there was an increase in self-harm repetition (from 5.2 to 7.8%. for those without a self-harm history). CONCLUSION: The NCPSHI was associated with improvements in the provision of care across hospital groups, particularly those with no prior service for self-harm, highlighting the need to consider pre-existing context in implementation planning. Our evaluation emphasises the need for proper resourcing to support the implementation of clinical guidelines on the provision of care for people presenting to hospital with self-harm.

The Influence of Different Physical Activity Behaviours on the Gut Microbiota of Older Irish Adults.

OBJECTIVE: A 24-hour day is made up of time spent in a range of physical activity (PA) behaviours, including sleep, sedentary time, standing, light-intensity PA (LIPA) and moderate-to-vigorous PA (MVPA), all of which may have the potential to alter an individual's health through various different pathways and mechanisms. This study aimed to explore the relationship between PA behaviours and the gut microbiome in older adults. DESIGN: Cross-sectional study. SETTINGS AND PARTICIPANTS: Participants (n=100; age 69.0 [3.0] years; 44% female) from the Mitchelstown Cohort Rescreen (MCR) Study (2015-2017). METHODS: Participants provided measures of gut microbiome composition (profiled by sequencing 16S rRNA gene amplicons), and objective measures of PA behaviours (by a 7-day wear protocol using an activPAL3 Micro). RESULTS: Standing time was positively correlated with the abundance of butyrate-producing and anti-inflammatory bacteria, including Ruminococcaceae, Lachnospiraceae and Bifidobacterium, MVPA was positively associated with the abundance of Lachnospiraceae bacteria, while sedentary time was associated with lower abundance of Ruminococcaceae and higher abundance of Streptococcus spp. CONCLUSION: Physical activity behaviours appear to influence gut microbiota composition in older adults, with different PA behaviours having diverging effects on gut microbiota composition.

Psychosocial, psychiatric and work-related risk factors associated with suicide in Ireland: optimised methodological approach of a case-control psychological autopsy study.

BACKGROUND: Suicide has profound effects on families and communities, but is a statistically rare event. Psychological autopsies using a case-control design allow researchers to examine risk factors for suicide, using a variety of sources to detail the psychological and social characteristics of decedents and to compare them to controls. The Suicide Support and Information System Case Control study (SSIS-ACE) aimed to compare psychosocial, psychiatric and work-related risk factors across three groups of subjects: suicide decedents, patients presenting to hospital with a high-risk self-harm episode, and general practice controls. METHODS: The study design includes two inter-related studies; one main case-control study: comparing suicide cases to general practice (GP) controls, and one comparative study: comparing suicide cases to patients presenting with high-risk self-harm. Consecutive cases of suicide and probable suicide are identified through coroners' registration of deaths in the defined region (Cork City and County, Ireland) and are frequency-matched for age group and gender with GP patient controls recruited from the same GP practice as the deceased. Data sources for suicide cases include coroners' records, interviews with health care professionals and proxy informants; data sources for GP controls and for high-risk self-harm controls include interviews with control, with proxy informants and with health care professionals. Interviews are semi-structured and consist of quantitative and qualitative parts. The quantitative parts include a range of validated questionnaires addressing psychiatric, psychosocial and occupational factors. The study adopts several methodological innovations, including accessing multiple data sources for suicide cases and controls simultaneously, recruiting proxy informants to examine consistency across sources. CONCLUSIONS: The study allows for the investigation of consistency across different data sources and contributes to the methodological advancement of psychological autopsy research. The study will also inform clinical and public health practice. The comparison between suicide cases and controls will allow investigation of risk and protective factors for suicide more generally, while the comparison with high-risk self-harm patients will help to identify the factors associated specifically with a fatal outcome to a self-harm episode. A further enhancement is the particular focus on specific work-related risk factors for suicide.

The lifetime costs of overweight and obesity in childhood and adolescence: a systematic review.

BACKGROUND: Research into lifetime costs of obesity in childhood is growing. This review synthesizes that knowledge. METHODOLOGY: A computerized search of the international literature since 2000 was conducted. Mean total lifetime healthcare and productivity costs were estimated and inflated to 2014 Irish euros. RESULTS: This resulted in 13 published articles. The methodology used in these studies varied widely, and only one study estimated both healthcare and productivity costs. Cognizant of this heterogeneity, the mean total lifetime cost of a child or adolescent with obesity was €149,206 (range, €129,410 to €178,933) for a boy and €148,196 (range, €136,576 to €173,842) for a girl. This was divided into an average of €16,229 (range, €6,580 to €35,810) in healthcare costs and €132,977 (range, €122,830 to €143,123) in productivity losses for boys and €19,636 (range, €8,016 to €45,283) and €128,560, respectively, for girls. Income penalty accounted for the greater part of productivity costs, amounting to €97,118 (range, €86,971 to €107,264) per male adolescent with obesity and €126,108 per female adolescent. CONCLUSIONS: Healthcare costs and income penalty appear greater in girls while costs because of workdays lost seem greater in boys. There is proportionality between body mass index and costs. Productivity costs are greater than healthcare costs.

Job characteristics and mental health for older workers.

BACKGROUND: Adverse job characteristics have been linked with increased incidence of depression and anxiety in working populations. However, the association between job characteristics and mental health, in an older working population while controlling for personality traits, is less well known. AIMS: To examine the association between job characteristics (job demands and job control) and mental health (depression and anxiety) for older workers while controlling for personality traits. METHODS: A sample of workers aged 50-69 years were recruited from a primary health care clinic in Southern Ireland. Job characteristics were measured using the Copenhagen Psychosocial Questionnaire; demands (quantitative and cognitive) and control (influence at work and possibilities for development). Personality traits were measured using the Ten-Item Personality Inventory, depression was measured using the Center for Epidemiological Studies-Depression Scale and anxiety was measured using the Hospital Anxiety and Depression Scale. Descriptive analysis, simple and multiple linear regression analyses were conducted. RESULTS: The final sample size was 1025 with an initial 67% response rate. Multiple linear regression analysis showed job characteristics (in particular, job demands) to be significant positive predictors of symptoms of depression and anxiety. The inverse was true for job control variables and symptoms of depression. Neither possibilities for development nor influence at work were associated with symptoms of anxiety. CONCLUSIONS: Our findings indicate that despite potential confounders, higher demands at work can impact the worker's mental health negatively. Reducing job demands and encouraging role development may benefit the mental health of older workers.

Barriers and facilitators to initial and continued attendance at community-based lifestyle programmes among families of overweight and obese children: a systematic review.

The success of childhood weight management programmes relies on family engagement. While attendance offers many benefits including the support to make positive lifestyle changes, the majority of families referred to treatment decline. Moreover, for those who do attend, benefits are often compromised by high programme attrition. This systematic review investigated factors influencing attendance at community-based lifestyle programmes among families of overweight or obese children. A narrative synthesis approach was used to allow for the inclusion of quantitative, qualitative and mixed-method study designs. Thirteen studies met the inclusion criteria. Results suggest that parents provided the impetus for programme initiation, and this was driven largely by a concern for their child's psychological health and wellbeing. More often than not, children went along without any real reason or interest in attending. Over the course of the programme, however, children's positive social experiences such as having fun and making friends fostered the desire to continue. The stigma surrounding excess weight and the denial of the issue amongst some parents presented barriers to enrolment and warrant further study. This study provides practical recommendations to guide future policy makers, programme delivery teams and researchers in developing strategies to boost recruitment and minimise attrition.

The area level association between suicide, deprivation, social fragmentation and population density in the Republic of Ireland: a national study.

PURPOSE: Numerous studies have examined the ecological relationship between suicide and area level determinants such as deprivation and social fragmentation. In Ireland, there is considerable geographic variation in the rates of suicide. However, there is a dearth of Irish studies investigating the geographic variability of suicide. METHODS: The Irish Central Statistics Office (CSO) provided data relating to all deaths by suicide and deaths of undetermined intent that occurred from 2009 to 2011. Negative binomial regression was used to examine the relationship between area level suicide rates and measures of deprivation, social fragmentation and population density that were taken from the 2011 National Census. RESULTS: Overall deprivation had the strongest independent effect on small-area rates of suicide, with the most deprived areas showing the greatest risk of suicide (risk ratio = 2.1; 95 % CI 1.70-2.52). Low population density (rurality) was associated with an increased risk suicide in males across both age groups and among females in the older 40-64-year age group. Conversely, a weak association between high population density (urbanicity) and increased suicide risk was found among females in the 15-39-year age group. Associations with social fragmentation only became apparent in the sub group analysis. Social fragmentation was associated with an elevated risk of suicide in the older 40-64 age group, with this effect being most pronounced among females. CONCLUSION: The findings of this study demonstrate marked geographical inequalities in the distribution of suicide in Ireland and highlight the importance of targeting suicide prevention resources in the most deprived areas.

Health workforce planning and service expansion during an economic crisis: A case study of the national breast screening programme in Ireland.

This article aims to estimate the workforce and resource implications of the proposed age extension of the national breast screening programme, under the economic constraints of reduced health budgets and staffing levels in the Irish health system. Using a mixed method design, a purposive sample of 20 participants were interviewed and data were analysed thematically (June-September 2012). Quantitative data (programme-level activity data, screening activity, staffing levels and screening plans) were used to model potential workload and resource requirements. The analysis indicates that over 90% operational efficiency was achieved throughout the first six months of 2012. Accounting for maternity leave (10%) and sick leave (3.5%), 16.1 additional radiographers (whole time equivalent) would be required for the workload created by the age extension of the screening programme, at 90% operational efficiency. The results suggest that service expansion is possible with relatively minimal additional radiography resources if the efficiency of the skill mix and the use of equipment are improved. Investing in the appropriate skill mix should not be limited to clinical groups but should also include administrative staff to manage and support the service. Workload modelling may contribute to improved health workforce planning and service efficiency.

Validation of diet and urinary excretion derived estimates of sodium excretion against 24-h urine excretion in a worksite sample.

BACKGROUND AND AIMS: To validate diet and urinary excretion derived estimates of sodium intake against those derived from 24-h urine collections in an Irish manufacturing workplace sample. METHODS AND RESULTS: We have compared daily sodium (Na) excretion from PABA validated 24-h urine collections with estimated daily sodium excretion derived from the following methods: a standard Food Frequency Questionnaire (FFQ), a modified 24-h dietary recall method, arithmetic extrapolations from morning and evening spot urine samples, predicted sodium excretion from morning and evening spot urine samples using Tanaka's, Kawasaki's and the INTERSALT formula. All were assessed using mean differences (SD), Bland-Altman plots, correlation coefficients and ROC Area under the Curve (AUC) for a cut off of ≥100 mmol of Na/day. The Food Choice at Work study recruited 802 participants aged 18-64 years, 50 of whom formed the validation sample. The mean measured 24-h urinary sodium (gold standard) was 138 mmol/day (8.1 g salt). At the group level, mean differences were small for both dietary methods and for the arithmetic extrapolations from morning urine samples. The Tanaka, Kawasaki and INTERSALT methods provided biased estimates of 24-h urinary sodium. R(2) values for all methods ranged from 0.1 to 0.48 and AUC findings from 0.57 to 0.76. CONCLUSION: Neither dietary nor spot urine sample methods provide adequate validity in the estimation of 24-h urinary sodium at the individual level. However, group mean errors from dietary methods are small and random and compare favourably with those from spot urine samples in this population.

Chronic kidney disease and obesity in Ireland: comparison of self-reported coronary artery disease in population study with clinic attendees.

Obesity is a growing issue in Ireland. The link between obesity, CKD and CAD has not previously been described in the Irish population. The prevalence of obesity and CKD was compared across 3 groups: population based estimates with self-reported CAD, population based estimates without self-reported CAD (SLAN-07) and a random selection of cardiology outpatients with CAD. The SLAN-07 is a representative survey of 1207 randomly selected participants ≥ 45 years. Validated methods measured parameters including waist circumference, blood pressure and markers of renal function specifically glomerular filtration rate (eGFR) and albumin: creatinine ratio. The Cardiology clinic surveyed a random selection of 126 participants ≥ 45 years with CAD. Similar parameters were measured using the validated methods utilised in SLAN-07 study. Prevalence of obesity and renal disease was significantly higher in both CAD groups. At population level, risk factors were modelled using logistic regression to compare odds of participants with self-reported CAD with those without. Age, hypertension, obesity, elevated waist circumference, renal disease and diabetes are significantly associated with existing CAD. Obesity and CKD are more frequent in patients with CAD. Routine evaluation is essential to facilitate more intensive management of these risk factors.

Characteristics of small areas with high rates of hospital-treated self-harm: deprived, fragmented and urban or just close to hospital? A national registry study.

BACKGROUND: Previous research has shown an inconsistent relationship between the spatial distribution of hospital treated self-harm and area-level factors such as deprivation and social fragmentation. However, many of these studies have been confined to urban centres, with few focusing on rural settings and even fewer studies carried out at a national level. Furthermore, no previous research has investigated if travel time to hospital services can explain the area-level variation in the incidence of hospital treated self-harm. METHODS: From 2009 to 2011, the Irish National Registry of Deliberate Self Harm collected data on self-harm presentations to all hospital emergency departments in the country. The Registry uses standard methods of case ascertainment and also geocodes patient addresses to small area geographical level. Negative binomial regression was used to explore the ecological relationship between area-level self-harm rates and various area-level factors. RESULTS: Deprivation, social fragmentation and population density had a positive linear association with self-harm, with deprivation having the strongest independent effect. Furthermore, self-harm incidence was found to be elevated in areas that had shorter journey times to hospital. However, while this association became attenuated after controlling for other area-level factors it still remained statistically significant. A subgroup analysis examining the effect of travel time on specific methods of self-harm, found that this effect was most marked for self-harm acts involving minor self-cutting. CONCLUSIONS: Self-harm incidence was influenced by proximity to hospital services, population density and social fragmentation; however, the strongest area-level predictor of self-harm was deprivation.

Nutrition knowledge, diet quality and hypertension in a working population.

OBJECTIVE: To examine if employees with higher nutrition knowledge have better diet quality and lower prevalence of hypertension. METHOD: Cross-sectional baseline data were obtained from the complex workplace dietary intervention trial, the Food Choice at Work Study. Participants included 828 randomly selected employees (18-64 years) recruited from four multinational manufacturing workplaces in Ireland, 2013. A validated questionnaire assessed nutrition knowledge. Food Frequency Questionnaires (FFQ) measured diet quality from which a DASH (Dietary Approaches to Stop Hypertension) score was constructed. Standardised digital blood pressure monitors measured hypertension. RESULTS: Nutrition knowledge was positively associated with diet quality after adjustment for age, gender, health status, lifestyle and socio-demographic characteristics. The odds of having a high DASH score (better diet quality) were 6 times higher in the highest nutrition knowledge group compared to the lowest group (OR = 5.8, 95% CI 3.5 to 9.6). Employees in the highest nutrition knowledge group were 60% less likely to be hypertensive compared to the lowest group (OR = 0.4, 95% CI 0.2 to 0.87). However, multivariate analyses were not consistent with a mediation effect of the DASH score on the association between nutrition knowledge and blood pressure. CONCLUSION: Higher nutrition knowledge is associated with better diet quality and lower blood pressure but the inter-relationships between these variables are complex.

Implementation and evaluation of a clinical data management programme in a primary care centre.

Electronic health records (EHR)support clinical management, administration, quality assurance, research, and service planning. The aim of this study was to evaluate a clinical data management programme to improve consistency, completeness and accuracy of EHR information in a large primary care centre with 10 General Practitioners (GPs). A Clinical Data Manager was appointed to implement a Data Management Strategy which involved coding consultations using ICPC-2 coding, tailored support and ongoing individualised feedback to clinicians. Over an eighteen month period there were improvements in engagement with and level of coding. Prior to implementation (August 2011) 4 of the 10 GPs engaged in regular coding and 69% of their consultation notes were coded. After 12 months, all 10 GPs and 6 nurses were ICPC-2 coding their consultations and monthly coding levels had increased to 98%. This structured Data Management Strategy provides a feasible sustainable way to improve information management in primary care.

The effectiveness of workplace dietary modification interventions: a systematic review.

OBJECTIVE: To evaluate the effectiveness of workplace dietary modification interventions alone or in combination with nutrition education on employees' dietary behaviour, health status, self-efficacy, perceived health, determinants of food choice, nutrition knowledge, co-worker support, job satisfaction, economic cost and food-purchasing patterns. METHOD: Data sources included PubMed, Medline, Embase, Psych Info., Web of Knowledge and Cochrane Library (November 2011). This review was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies were randomised controlled trials and controlled studies. Interventions were implemented for at least three months. Cochrane Collaboration's risk of bias tool measured potential biases. Heterogeneity precluded meta-analysis. Results were presented in a narrative summary. RESULTS: Six studies conducted in Brazil, the USA, Netherlands and Belgium met the inclusion criteria. Four studies reported small increases in fruit and vegetable consumption (≤half serving/day). These studies involved workplace dietary modifications and three incorporated nutrition education. Other outcomes reported included health status, co-worker support, job satisfaction, perceived health, self-efficacy and food-purchasing patterns. All studies had methodological limitations that weakened confidence in the results. CONCLUSION: Limited evidence suggests that workplace dietary modification interventions alone and in combination with nutrition education increase fruit and vegetable intakes. These interventions should be developed with recommended guidelines, workplace characteristics, long-term follow-up and objective outcomes for diet, health and cost.

Does contact with a podiatrist prevent the occurrence of a lower extremity amputation in people with diabetes? A systematic review and meta-analysis.

OBJECTIVE: To determine the effect of contact with a podiatrist on the occurrence of Lower Extremity Amputation (LEA) in people with diabetes. DESIGN AND DATA SOURCES: We conducted a systematic review of available literature on the effect of contact with a podiatrist on the risk of LEA in people with diabetes. Eligible studies, published in English, were identified through searches of PubMed, CINAHL, EMBASE and Cochrane databases. The key terms, 'podiatry', 'amputation' and 'diabetes', were searched as Medical Subject Heading terms. Reference lists of selected papers were hand-searched for additional articles. No date restrictions were imposed. STUDY SELECTION: Published randomised and analytical observational studies of the effect of contact with a podiatrist on the risk of LEA in people with diabetes were included. Cross-sectional studies, review articles, chart reviews and case series were excluded. Two reviewers independently assessed titles, abstracts and full articles to identify eligible studies and extracted data related to the study design, characteristics of participants, interventions, outcomes, control for confounding factors and risk estimates. ANALYSIS: Meta-analysis was performed separately for randomised and non-randomised studies. Relative risks (RRs) with 95% CIs were estimated with fixed and random effects models as appropriate. RESULTS: Six studies met the inclusion criteria and five provided data included in meta-analysis. The identified studies were heterogenous in design and included people with diabetes at both low and high risk of amputation. Contact with a podiatrist did not significantly affect the RR of LEA in a meta-analysis of available data from randomised controlled trials (RCTs); (1.41, 95% CI 0.20 to 9.78, 2 RCTs) or from cohort studies; (0.73, 95% CI 0.39 to 1.33, 3 Cohort studies with four substudies in one cohort). CONCLUSIONS: There are very limited data available on the effect of contact with a podiatrist on the risk of LEA in people with diabetes.

Pre-diabetes in adults 45 years and over in Ireland: the Survey of Lifestyle, Attitudes and Nutrition in Ireland 2007.

OBJECTIVES: Pre-diabetes is an important indicator of future diabetes burden and many countries are reporting prevalence estimates of pre-diabetes. To date in Ireland, estimates of the prevalence of pre-diabetes were unavailable. Our objectives were to estimate the prevalence of pre-diabetes in a nationally representative sample of Irish adults and to explore determinants of pre-diabetes. METHODS: The Survey of Lifestyle Attitudes and Nutrition 2007 was a cross-sectional survey on health and lifestyle in a nationally representative sample of Irish adults. Analysis was performed on a subsample of 1132 participants ≥ 45 years who provided blood samples. Determination of pre-diabetes was based on American Diabetes Association HbA1c cut points of 39-46 mmol/mol (5.7-6.4%). To explore determinants, we modelled pre-diabetes prevalence as a function of a set of health system and socio-demographic variables using logistic regression. RESULTS: The overall weighted prevalence estimate of pre-diabetes in participants ≥ 45 years was 19.8% (95% CI 16.4-23.9). There was no significant difference between age or gender-specific prevalence rates. Obesity was significantly associated with pre-diabetes on univariate and multivariate analysis. Population attributable fraction estimates for excess BMI, physical inactivity and poor diet as causes of pre-diabetes were 31.3% (95% CI -3.9 to 54.5), 10.0% (95% CI -2.7 to 21.3) and 6.1% (95% CI -4.9 to 15.9), respectively. CONCLUSIONS: The high levels of pre-diabetes detected in this study are worrying. Population level interventions to address diet and lifestyle factors are needed urgently to prevent progression to diabetes in high-risk individuals.

Has your work worked you too hard? Physically demanding work and disability in a sample of the older Irish population.

BACKGROUND: There is a heightened need for the practitioner to be alert to the determinants of functional limitations and disabilities owing to the ageing workforce. AIM: This study investigated the association between work type and disability in older age in both the paid and the previously unexplored, unpaid worker (household labour). METHODS: Data on demographic factors, physical measurements, work history and functional status were collected on three hundred and fifty seven 57-80-year-olds. Past or present work was identified as either physically demanding or not. Functional limitations and activities of daily living (ADL) disabilities were assessed using validated scales. Logistic regression was used to examine the relationship between the dependent variables and work type (physically demanding work or not physically demanding work). RESULTS: Over half of the sample reported doing physically demanding work. 20% had complete function (n = 67), 65% (n = 223) functional limitations and 15% (n = 53) ADL disability. Physically demanding work was associated with functional limitations [OR 2.52 (1.41, 4.51), p = 0.01] and ADL disability [OR 2.10 (1.06, 4.17), p = 0.03] after adjustment for a measure of obesity and gender. When gender stratified, looking only at females, physically demanding work was associated with ADL disability [OR 2.79 (1.10, 7.07), p = 0.03] adjusted for a measure of obesity and household labour. CONCLUSIONS: Physically demanding work was related to functional limitations and ADL disability in older age. This is valuable information to inform practitioners in the treatment of older people with functional limitations and disabilities and in guiding interventions in the prevention of work related disability.

Age, job characteristics and coronary health.

BACKGROUND: Workplace demographics are changing in many European countries with a higher proportion of older workers in employment. Research has shown that there is an association between job strain and cardiovascular disease, but this relationship is unclear for the older worker. AIMS: To investigate the association between job strain and a coronary event comparing younger and older male workers. METHODS: Cases with a first-time coronary event were recruited from four coronary/intensive care units (1999-2001). Matched controls were recruited from the case's general practitioner surgery. Physical measurements were taken and self-administered questionnaires completed with questions on job characteristics, job demands and control. Unconditional logistic regression was carried out adjusting for classical cardiovascular risk factors. RESULTS: There were 227 cases and 277 matched controls. Age stratified analyses showed a clear difference between younger (<50 years) and older (≥50 years) workers with regard to the exposure of job strain (job demands and control) and the association between these factors and cardiovascular disease. Older workers who had a coronary event were four times as likely to have high job strain [OR = 4.09 (1.29-13.02)] and more likely to report low job control [OR = 0.83 (0.72-0.95)]. CONCLUSIONS: Job control emerged as a potential protective factor for heart disease and this evidence was stronger in the older male worker. Nevertheless, they were significantly more likely to have job strain. These results suggest that older workers may be more susceptible to job strain.

The incidence of injury presentations to emergency departments: what we don't know can hurt us.

The incidence of injury presentations to emergency departments in the Republic of Ireland has not been established. Data were collected relating to all injuries that presented on every eighth day in July-December 2005 to the three hospitals in Cork City. In total, 2,967 injury presentations were recorded. The total, male and female age-adjusted rate of injury presentations was 11,322, 13,933 and 8,550 per 100,000, respectively. The peak male rate was among 15-29 year-olds (26,735 per 100,000), 2.5 times the female rate in the same age range (10,719 per 100,000). The peak female rate was among over 85 year-olds (18,543 per 100,000). Place of injury, activity at time of injury and underlying substance/object causing injury were unspecified for 44%, 46% and 43% of recorded injuries. Improving the recording of injury data needs to be prioritised in Irish emergency departments ideally in conjunction with the development of a national injury surveillance system.