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1.
Bull World Health Organ ; 99(9): 674-679, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34475604

RESUMO

Problem: Mental ill health in the United Kingdom of Great Britain and Northern Ireland has been a major driver of labour market exclusion through sickness absence, reduced productivity and job loss. Approach: A government-supported programme for improving access to psychological therapies was launched in 2008 and expanded across England in 2010. The aim was to provide evidence-based treatments for people with common mental disorders through three principal strategies: (i) routine session-by-session outcome monitoring; (ii) integration with the wider care system; and (iii) delivery of psychological therapies as part of a stepped-care approach. Local setting: Access to effective psychological therapies was previously low in the United Kingdom. In 2010, only about 35% of people with moderately severe mental disorders were in specialist or non-specialist treatment. Relevant changes: The accessibility of quality mental health services has increased, as has the efficiency of the country's mental health system. The numbers of people entering treatment have increased steadily from 0.43 million in 2012-2013 to 1.09 million in 2018-2019. The recovery rate of patients in treatment increased from 42.8% to 52.1% during 2012-2018. The number of people moved off sick pay and benefits rose from 3683 to 18 039 over the same period. Lessons learnt: A clinical guideline on psychological therapies is a prerequisite for increasing the accessibility and efficiency of mental health services. An integrated approach allows mental health services to have better reach. Routine collection of patient-level outcome data plays an important role in the value and function of the mental health care system.


Assuntos
Acesso aos Serviços de Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Qualidade da Assistência à Saúde , Eficiência Organizacional , Humanos , Transtornos Mentais/epidemiologia , Saúde Mental , Irlanda do Norte , Avaliação de Processos e Resultados em Cuidados de Saúde , Reino Unido
2.
Artigo em Inglês | MEDLINE | ID: mdl-34493494

RESUMO

INTRODUCTION: This study investigated Northern Ireland Diabetic Eye Screening Programme (NIDESP) attendance and diabetic retinopathy (DR) prevalence/severity in patients with diabetes mellitus secondary to chronic pancreatitis (PwDMsCP). RESEARCH DESIGN AND METHODS: Medical/NIDESP records for all PwDMsCP attending the pancreatic diabetes clinic were analyzed in 2017 (n=78) and 2019 (n=94). RESULTS: Between 2017 and 2019, those without DR decreased (76% to 63%); mild non-proliferative DR (NPDR), severe NPDR and PDR were found in 30%, 2% and 5%, respectively (previously 18%, 4%, 2%); diabetic maculopathy (DMac) was present in 12% (previously 10%). There was no significant difference between worst-eye DR/DMac grade and HbA1c, gender, body mass index, pancreatitis etiology and screening attendance (p>0.05). Patients with proliferative DR had longer diabetes and pancreatitis duration than DR-free patients (both p=0.001). CONCLUSIONS: DR prevalence was similar in PwDMsCP and patients with type 2 diabetes of similar disease duration. This work demonstrates the importance of reaching all patients for establishing DR severity reliably and to provide accessible, equitable care to PwDMsCP.


Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Pancreatite Crônica , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/etiologia , Humanos , Irlanda do Norte/epidemiologia , Pancreatite Crônica/complicações , Pancreatite Crônica/epidemiologia , Prevalência , Fatores de Risco
3.
Trials ; 22(1): 449, 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34261527

RESUMO

BACKGROUND: The PolyPrime intervention is a theory-based intervention aimed at improving appropriate polypharmacy in older people (aged ≥65 years) in primary care. The intervention consists of an online video which demonstrates how general practitioners (GPs) can prescribe appropriate polypharmacy during a consultation with an older patient and a patient recall process, whereby patients are invited to scheduled medication review consultations with GPs. The aim of the process evaluation is to further examine the implementation of the PolyPrime intervention in primary care. This will involve investigating whether the PolyPrime intervention can be delivered as intended across two healthcare systems, how acceptable the intervention is to GPs, practice staff and patients, and to identify the intervention's likely mechanisms of action. METHODS: The PolyPrime study is an external pilot cluster randomised controlled trial (cRCT) which aims to recruit 12 GP practices across Northern Ireland [NI] (n=6) and the six counties in the Republic of Ireland (ROI) that border NI (n=6). Practices have been randomised to intervention or usual care. An embedded process evaluation will assess intervention fidelity (i.e. was the intervention delivered as intended), acceptability of the intervention to GPs, practice staff and patients and potential mechanisms of action (i.e. what components of the intervention were perceived to be effective). Quantitative data will be collected from data collection forms completed by GPs and practice staff and a feedback questionnaire completed by patients from intervention arm practices, which will be analysed using descriptive statistics. Qualitative data will be collected through semi-structured interviews with GPs and practice staff and audio-recordings of medication review appointments from the intervention arm practices which will be transcribed and analysed using the framework method. Quantitative and qualitative data will be triangulated to provide an overall assessment of intervention fidelity, intervention acceptability, and mechanisms of action. DISCUSSION: This process evaluation will add to feasibility data from the pilot cRCT by providing evidence on the fidelity of implementing the intervention package across two healthcare systems, the acceptability of the intervention and potential mechanisms of action. TRIAL REGISTRATION: ClinicalTrials.gov ISRCTN41009897 . Registered on 19 November 2019. ClinicalTrials.gov NCT04181879 . Registered 02 December 2019.


Assuntos
Clínicos Gerais , Polimedicação , Idoso , Humanos , Irlanda do Norte , Atenção Primária à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e Consulta
4.
Bone Joint J ; 103-B(7): 1197-1205, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192922

RESUMO

AIMS: A typical pattern of blood loss associated with total hip arthroplasty (THA) is 200 ml intraoperatively and 1.3 l in the first 48 postoperative hours. Tranexamic acid (TXA) is most commonly given as a single preoperative dose only and is often withheld from patients with a history of thromboembolic disease as they are perceived to be "high-risk" with respect to postoperative venous thromboembolism (VTE). The TRanexamic ACid for 24 hours trial (TRAC-24) aimed to identify if an additional 24-hour postoperative TXA regime could further reduce blood loss beyond a once-only dose at the time of surgery, without excluding these high-risk patients. METHODS: TRAC-24 was a prospective, phase IV, single centre, open label, parallel group, randomized controlled trial (RCT) involving patients undergoing primary unilateral elective THA. The primary outcome measure was the indirect calculated blood loss (IBL) at 48 hours. The patients were randomized into three groups. Group 1 received 1 g intravenous (IV) TXA at the time of surgery and an additional oral regime for 24 hours postoperatively, group 2 only received the intraoperative dose, and group 3 did not receive any TXA. RESULTS: A total of 534 patients were randomized, with 233 in group 1, 235 in group 2, and 66 in group 3; 92 patients (17.2%) were considered high-risk. The mean IBL did not differ significantly between the two intervention groups (848.4 ml (SD 463.8) for group 1, and 843.7 ml (SD 478.7) for group 2; mean difference -4.7 ml (95% confidence interval -82.9 to 92.3); p = 0.916). No differences in mortality or incidence of VTE were observed between any group. CONCLUSION: The addition of oral TXA for 24 hours postoperatively does not reduce blood loss beyond that achieved with a single 1 g IV perioperative dose alone. There may be a clinically relevant difference in patients with a normal BMI, which warrants further investigation. Critically, there were no safety issues in patients with a history of thromboembolic, cardiovascular, or cerebrovascular disease. Cite this article: Bone Joint J 2021;103-B(7):1197-1205.


Assuntos
Antifibrinolíticos/administração & dosagem , Artroplastia de Quadril , Perda Sanguínea Cirúrgica/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Irlanda do Norte , Estudos Prospectivos , Fatores de Tempo , Tromboembolia Venosa/prevenção & controle
5.
Br Dent J ; 231(1): 20-25, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34244639

RESUMO

National recruitment has radically transformed the selection and allocation of dental graduates to dental foundation training (DFT) schemes across England, Wales and Northern Ireland, with recruitment in Scotland via a separate, independent process. It has been reported as a mostly positive change to the previous deanery-led model, in which nepotism allegedly featured too widely. A candidate's ranking is typically based on performance across two face-to-face assessments and a situational judgement test (SJT). The COVID-19 pandemic, however, has created a recruitment 'lottery' of sorts, in which ranking for 2021 is now solely based on the SJT. Subject matter experts assert that neither preparation nor revision for the SJT is required; yet, following the announcement of the adaptation to DFT recruitment for September 2021, a rapid rise of exorbitantly priced SJT question banks, mock papers, workshops and courses has ensued - a shameless monetisation of the collective angst and increased pressure faced by dental students. Preparation courses present a conceivable risk of SJT 'coaching' and 'faking'. Where medicine leads, dentistry usually follows and future selection to DFT needs to strongly consider the introduction of academic performance measures. SJTs remain one of the most well-accepted, reliable and cost-effective means of selection into healthcare roles, however, only when part of a wider selection process.


Assuntos
COVID-19 , Critérios de Admissão Escolar , Inglaterra , Humanos , Julgamento , Irlanda do Norte , Pandemias , Reprodutibilidade dos Testes , SARS-CoV-2 , Escócia , País de Gales
6.
Br J Cancer ; 125(6): 798-805, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34211120

RESUMO

BACKGROUND: The restructuring of healthcare systems to cope with the demands of the COVID-19 pandemic has led to a reduction in clinical services such as cancer screening and diagnostics. METHODS: Data from the four Northern Ireland pathology laboratories were used to assess trends in pathological cancer diagnoses from 1st March to 12th September 2020 overall and by cancer site, sex and age. These trends were compared to the same timeframe from 2017 to 2019. RESULTS: Between 1st March and 12th September 2020, there was a 23% reduction in cancer diagnoses compared to the same time period in the preceding 3 years. Although some recovery occurred in August and September 2020, this revealed inequalities across certain patient groups. Pathological diagnoses of lung, prostate and gynaecological malignancies remained well below pre-pandemic levels. Males and younger/middle-aged adults, particularly the 50-59-year-old patient group, also lagged behind other population demographic groups in terms of returning to expected numbers of pathological cancer diagnoses. CONCLUSIONS: There is a critical need to protect cancer diagnostic services in the ongoing pandemic to facilitate timely investigation of potential cancer cases. Targeted public health campaigns may be needed to reduce emerging inequalities in cancer diagnoses as the COVID-19 pandemic continues.


Assuntos
COVID-19/epidemiologia , Detecção Precoce de Câncer/estatística & dados numéricos , Disparidades em Assistência à Saúde , Neoplasias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer/tendências , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/tendências , História do Século XXI , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Irlanda do Norte/epidemiologia , Pandemias , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-34199893

RESUMO

Healthcare professionals have a key role in promoting physical activity, particularly among populations at greatest risk of poor health due to physical inactivity. This research aimed to develop our understanding of healthcare professionals knowledge, decision making and routine practice of physical activity promotion with older adults. A cross-sectional survey was conducted with practicing healthcare professionals in general practice, physiotherapy, occupational therapy and nursing in Ireland and Northern Ireland. We received 347 eligible responses, with 70.3% of all respondents agreeing that discussing physical activity is their job and 30.0% agreeing that they have received suitable training to initiate conversations with patients about physical activity. Awareness of the content and objectives of national guidelines for physical activity varied considerably across the health professions surveyed. Less than a third of respondents had a clear plan on how to initiate discussions about physical activity in routine practice with older adults. Assessment of physical activity was not routine, neither was signposting to physical activity supports. Considering the COVID-19 pandemic and its implications, 81.6% of all respondents agreed that healthcare professionals can play an increased role in promoting physical activity to older adults as part of routine practice. Appropriate education, training and access to resources are essential for supporting healthcare professionals promotion of physical activity in routine practice. Effective physical activity promotion in healthcare settings has the potential for health benefits at a population level, particularly in older adult populations.


Assuntos
COVID-19 , Pandemias , Idoso , Atitude do Pessoal de Saúde , Estudos Transversais , Exercício Físico , Humanos , Irlanda do Norte , SARS-CoV-2 , Inquéritos e Questionários
9.
Ulster Med J ; 90(2): 77-80, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34276084

RESUMO

Introduction: During the COVID-19 pandemic, there have been suggestions that there will be a reduction in cancer diagnoses, causing a detrimental effect on patients1. We therefore conducted an analysis to assess if there has been a reduction in new haematological malignancy diagnoses within the Belfast Health and Social Care Trust (BHSCT). Methods: We observed a significant decline in diagnostic tests used in the diagnosis of haematological malignancies. We therefore decided to analyse the impact of COVID-19 on the volume of tests performed to see if this impacted the number of new cases of haematological malignancies diagnosed. To ascertain the number of new diagnoses referred to Clinical Haematology we decided to analyse the number of new diagnoses discussed at the local Multidisciplinary Team Meetings (MDM) between March and June 2020 and compare this with the same period in 2019. In line with NICE guidelines2 there has been no change to the referral pathway for patients with new haematological malignancy. Results: Results show that there is no significant difference between the number of new malignant haematological diagnoses discussed during March to June 2020 and the same period in 2019. This confirms that the number of new diagnoses remains the same within the two time periods. Conclusion: This analysis highlights that despite a reduction in primary and secondary care diagnostic blood tests, there is no difference in the number of new cases of haematological malignancies discussed at Haematology MDM throughout the first surge of the COVID-19 pandemic locally.


Assuntos
COVID-19/epidemiologia , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/epidemiologia , Testes Hematológicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Irlanda do Norte/epidemiologia , Pandemias , SARS-CoV-2
10.
Ulster Med J ; 90(2): 86-89, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34276086

RESUMO

Background: Traditional surgical dogma is that paediatric appendicitis necessitates an appendicectomy; however there is an increasing cohort of evidence suggesting that non-operative management (NOM) using antibiotic therapy is safe and effective. During the COVID-19 surge (April - June 2020) with centralization of paediatric surgical care and risks from anaesthetics to both patients and staff a NOM pathway was used to manage clinically diagnosed appendicitis in the Royal Belfast Hospital for Sick Children (RBHSC). Methods: Prospective data collection was undertaken of all children (<16 years) diagnosed with appendicitis who entered the NOM pathway in RBHSC from 01/04/2020 to 30/06/2020. This was compared to a cohort from the same timeframe in 2019. Primary end-points were inpatient success rate of NOM and 30-day success rate of NOM (success defined as no appendectomy performed). Results: 47 patients completed the NOM pathway, with 43% (20/47) suspected to have complicated appendicitis. The cohort was similar to that of 2019 in terms of age (p=0.1) and sex (p=0.8), but was 155% larger (42 v. 20).For those with simple appendicitis, there was a 96% (26/27) success rate of NOM on discharge, with a 93% (25/27) 30-day success rate. For complicated appendicitis, there was a 40% (8/20) success rate on discharge, with a 30% (6/20) 30-day success rate. Conclusion: The use of a NOM pathway for paediatric appendicitis during the COVID-19 surge in Northern Ireland was safe and effective for staff and patients. With a small sample size and restricted follow up more evidence is required to prove if this is an effective treatment modality with a return to normal theatre availability. In the interests of antibiotic stewardship we would not advocate NOM pathways utilisation by non-surgical clinicians.


Assuntos
Antibacterianos/uso terapêutico , Apendicite/tratamento farmacológico , Apendicite/epidemiologia , COVID-19/epidemiologia , Pneumonia Viral/epidemiologia , Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Criança , Feminino , Hospitais Pediátricos , Humanos , Masculino , Irlanda do Norte/epidemiologia , Pneumonia Viral/virologia , Estudos Prospectivos , SARS-CoV-2
13.
Artigo em Inglês | MEDLINE | ID: mdl-34204779

RESUMO

BACKGROUND: The ongoing novel coronavirus (COVID-19) global pandemic has resulted in significant levels of morbidity and mortality worldwide, particularly among the elderly and immuno-suppressed groups. Although adequate hand hygiene (HH) behaviour and compliance is widely accepted as being the most effective self-protective measure in preventing the spread of diseases like COVID-19, previous research suggests that normal hand hygiene compliance is poor, but generally improves during a disease pandemic. This research aimed to evaluate the hand hygiene behaviour and compliance of the general public in the initial weeks of the COVID-19 pandemic in Northern Ireland (NI). METHODS: This cross-sectional study involved the use of infrared-imaging cameras to observe the hand hygiene behaviour and compliance of the general public when using one set of male and female public restrooms. RESULTS: The findings of this study indicated that the level of hand hygiene compliance of the general public was poor in the initial weeks, with 82.93% overall not washing their hands adequately. CONCLUSIONS: Inadequate HH behaviour and compliance may have added significantly to the rapid rate of spread of COVID-19 in the initial weeks of the pandemic in NI. Current public health campaigns do not appear, based on this study, to have the desired impact and may need to be reviewed or re-enforced in order to achieve the levels of hand hygiene compliance required to slow the spread of COVID-19 and other communicable diseases in the future.


Assuntos
COVID-19 , Infecção Hospitalar , Higiene das Mãos , Idoso , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Desinfecção das Mãos , Humanos , Masculino , Irlanda do Norte/epidemiologia , Pandemias , SARS-CoV-2 , Toaletes
14.
BMJ Open ; 11(6): e048333, 2021 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-34158305

RESUMO

OBJECTIVES: The aim of the study was to investigate the spatial and temporal relationships between the prevalence of COVID-19 symptoms in the community-level and area-level social deprivation. DESIGN: Spatial mapping, generalised linear models, using time as a factor and spatial-lag models were used to explore the relationship between self-reported COVID-19 symptom prevalence as recorded through two smartphone symptom tracker apps and a range of socioeconomic factors using a repeated cross-sectional study design. SETTING: In the community in Northern Ireland, UK. The analysis period included the earliest stages of non-pharmaceutical interventions and societal restrictions or 'lockdown' in 2020. PARTICIPANTS: Users of two smartphone symptom tracker apps recording self-reported health information who recorded their location as Northern Ireland, UK. PRIMARY OUTCOME MEASURES: Population standardised self-reported COVID-19 symptoms and correlation between population standardised self-reported COVID-19 symptoms and area-level characteristics from measures of multiple deprivation including employment levels and population housing density, derived as the mean number of residents per household for each census super output area. RESULTS: Higher self-reported prevalence of COVID-19 symptoms was associated with the most deprived areas (p<0.001) and with those areas with the lowest employment levels (p<0.001). Higher rates of self-reported COVID-19 symptoms within the age groups, 18-24 and 25-34 years were found within the most deprived areas during the earliest stages of non-pharmaceutical interventions and societal restrictions ('lockdown'). CONCLUSIONS: Through spatial regression of self-reporting COVID-19 smartphone data in the community, this research shows how a lens of social deprivation can deepen our understanding of COVID-19 transmission and prevention. Our findings indicate that social inequality, as measured by area-level deprivation, is associated with disparities in potential COVID-19 infection, with higher prevalence of self-reported COVID-19 symptoms in urban areas associated with area-level social deprivation, housing density and age.


Assuntos
COVID-19 , Isolamento Social , Adolescente , Adulto , COVID-19/diagnóstico , COVID-19/psicologia , Controle de Doenças Transmissíveis , Estudos Transversais , Humanos , Aplicativos Móveis , Irlanda do Norte/epidemiologia , Autorrelato , Adulto Jovem
15.
BMC Health Serv Res ; 21(1): 564, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098944

RESUMO

BACKGROUND: Cancer diagnosis, treatment and survivorship is multifaceted, and the cancer patient experience can serve as a key indicator of healthcare performance and quality. The purpose of this paper was to analyse free-text responses from the second Northern Ireland Cancer Patient Experience Survey (NICPES) in 2018, to understand experiences of care, emerging themes and identify areas for improvement. METHODS: A 72-item questionnaire (relating to clinical care experience, socio-demographics and 3 free-text questions) was distributed to all Health & Social Care Northern Ireland patients that met the inclusion criteria (≥ 16 years old; confirmed primary diagnosis of cancer and discharged between 1st May and 31st October 2017) in June 2018. Participants could complete the questionnaire online or access a free telephone support line if required. Open-ended free text responses were analysed thematically to identify common themes. Free text responses were divided into positive or negative comments. RESULTS: In total, 3,748 people responded to the survey, with 2,416 leaving at least one free text comment (69 %). Women aged 55-74 years were most likely to comment. Overall, 3,644 comments were left across the three comments boxes, which were categorised as either positive (2,462 comments; 68 %) or negative / area for improvement (1,182 comments; 32 %). Analysis of free text responses identified six common themes (staff; speed [diagnosis and treatment]; safety; system; support services and specific concerns), which were all related to the overarching theme of survival. Staff was the largest single theme (1,458 responses) with overwhelmingly positive comments (1,322 responses; 91 %), whilst safety (296 negative comments; 70 %) and system (340 negative comments; 81 %) were predominantly negative. Negative comments relating to primary care, aftercare and the cancer system were reported. CONCLUSIONS: The high response rate to the free text comments indicates patients were motivated to engage. Analysis indicates most comments provided were positive in nature. Most survey respondents reported a positive experience in relation to staff. However, there were a number of areas for improvement including the aftercare experience, and a perceived disconnect between primary care and cancer services. These results can help inform the effective delivery of cancer services in Northern Ireland.


Assuntos
Neoplasias , Envio de Mensagens de Texto , Adolescente , Feminino , Humanos , Neoplasias/terapia , Irlanda do Norte/epidemiologia , Avaliação de Resultados da Assistência ao Paciente , Satisfação do Paciente , Inquéritos e Questionários
16.
BMC Public Health ; 21(1): 1041, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078338

RESUMO

BACKGROUND: Antibiotic overuse is the main modifiable driver of antibiotic resistance. Factors associated with overuse have been inconsistently reported and vary across populations. Given the burgeoning occurrence of infectious diseases around the world, there remains a great need to identify barriers and solutions to the control of infections. We examined whether knowledge about infections and antibiotic resistance is associated with antibiotic use in a northern European population sample. METHODS: The Health Survey Northern Ireland 2014/15 was completed by a cross-sectional sample of 4135 participants aged > 16 years. Participants were asked whether they had taken an antibiotic in the past 12 months; and six questions were asked concerning knowledge about infections and antibiotic resistance. Correct answers to the six knowledge questions defined a knowledge score (score range 0-6 correct answers). We used multivariable logistic regression to estimate odds of self-reported antibiotic use during the last 12 months in association with knowledge score (lowest score, 0/6, as referent), and response to each knowledge question. Covariates included sex, age group, smoking, alcohol drinking, deprivation index, self-rated health, and satisfaction with life. Results were outputted as Odds Ratios (OR) and 95% Confidence Intervals (CI). RESULTS: Antibiotic use in the past 12 months was reported by 39.0% (1614/4135); and 84.2% (3482/4135) scored < 6/6 correct on knowledge statements. Compared to the lowest knowledge score (0/6 correct), the highest knowledge score (6/6 correct) was associated with higher odds of antibiotic use (adjusted OR 2.03, 95% CI [1.46, 2.81], p < 0.001), with a P-value < 0.001 for trend with increasing knowledge score. Female sex, age, high deprivation, and poor general health, were independently associated with higher odds of antibiotic use. Stratified analyses showed sex and age group differences. CONCLUSION: Knowledge, and other modifiable and non-modifiable risk factors, were positively associated with antibiotic use in the past 12 months. While the causal direction of these associations could not be determined, given the high prevalence of lesser knowledge, as well as independent contributions of other factors including socioeconomic characteristics, health literacy campaigns to raise awareness of antibiotic resistance should take a multi-pronged approach.


Assuntos
Antibacterianos , Conhecimentos, Atitudes e Prática em Saúde , Antibacterianos/uso terapêutico , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Irlanda do Norte/epidemiologia , Inquéritos e Questionários
18.
Knee ; 31: 144-157, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34175672

RESUMO

BACKGROUND: Total knee replacement (TKR) is clinically and cost-effective. The surgical approach employed influences the outcome, however there is little generalisable and robust evidence to guide practice. We compared outcomes between the common primary TKR surgical approaches. METHODS: 875,166 primary TKRs captured in the National Joint Registry, linked to hospital inpatient, mortality and patient reported outcome measures (PROMs) data, with up to 15.75 years follow-up were analysed. There were 10 surgical approach groups: medial parapatellar, midvastus, subvastus, lateral parapatellar, 'other' and their minimally invasive versions. Survival methods were used to compare revision rates and 45-day mortality. Groups were compared using Cox proportional hazards regression and Flexible Parametric Survival Modelling (FPM). Confounders included age at surgery, sex, risk group (indications additional to osteoarthritis), American Society of Anesthesiologists grade, TKR fixation, year of primary, body mass index, and for mortality, deprivation and Charlson comorbidity subgroups. PROMs were analysed with regression modelling or non-parametric methods. RESULTS: The conventional midvastus approach was associated with lower revision rates (Hazard Rate Ratio (HRR) 0.80 (95% CI 0.71-0.91) P = 0.001) and the lateral parapatellar with higher revision rates (HRR 1.35 (95% CI 1.12-1.63) P = 0.002) compared to the conventional medial parapatellar approach. Mortality rates were similar between approaches. PROMs showed statistically significant, but not clinically important, differences. CONCLUSIONS: There is little difference in PROMs between the various surgical approaches in TKR with all resulting in good outcomes. However, the conventional midvastus approach (used in 3% of cases) was associated with a 20% reduced risk of revision surgery compared to the most commonly used knee approach (the conventional medial parapatellar: used in 91.9% of cases). This data supports the use of the midvastus approach and thus surgeons should consider utilising this approach more frequently. Minimally invasive approaches did not appear to convey any clinical advantage in this study over conventional approaches for primary TKR.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Inglaterra , Humanos , Irlanda do Norte , Osteoartrite do Joelho/cirurgia , Sistema de Registros , Resultado do Tratamento , País de Gales/epidemiologia
19.
Soc Sci Med ; 282: 114111, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34147919

RESUMO

RATIONALE: International border controls were among the earliest and most effective of measures to constrain transmission of COVID-19. However, such measures are complex when established borders are open yet politically contested, as for the border that divides the Republic of Ireland (ROI) from Northern Ireland (NI). Understanding how this border affected the everyday lives of both populations during the pandemic is important for informing the continued development of effective responses to COVID-19 and future health crises. OBJECTIVE: This multi-methods study aimed to explore public perspectives on how the ROI-NI border affected experiences of and responses to the 'first wave' of the pandemic. METHOD: The study collated data from focus groups (n = 8), news articles (n = 967), and Twitter posts (n = 356) on the island of Ireland, which mentioned the ROI-NI border in relation to COVID-19. Thematic analysis was used to explore the range of perspectives on the role played by the border during the early months of the pandemic. RESULTS: Analysis identified three themes: Cross-Border Interdependencies illustrated the complexity and challenges of living near the border; Interpretations of Cross-Border Policy Disparities showed that lay publics perceived NI and ROI policy approaches as discordant and politicised; and Responses to Cross-Border Policy Disparities revealed alternating calls to either strengthen border controls, or pursue a unified all-island approach. CONCLUSIONS: Results reveal clear public appetite for greater synchronisation of cross-border pandemic responses, emphasise the specific vulnerability of communities living near the border, and highlight the risk of long-term socio-political repercussions of border management decisions taken during the pandemic. Findings will inform implementation of pandemic responses and public health policies in jurisdictions that share a porous land border.


Assuntos
COVID-19 , Mídias Sociais , Grupos Focais , Humanos , Irlanda do Norte/epidemiologia , Pandemias , SARS-CoV-2
20.
J Fish Biol ; 99(4): 1201-1221, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34085709

RESUMO

This study quantifies the processes involved in regulating the European eel population of Lough Neagh, a lake in Northern Ireland. The relationship between glass eel input and silver eel output for the 1923-1997 cohorts was best described by a Beverton-Holt stock recruitment model. Glass eel input time series was not complete and was thus derived from the relationship between catches elsewhere in Europe and Lough Neagh, together with the addition of stocked glass eel. Silver eel output was the sum of silver eel escapement, catch and yellow eel catch converted to silver eel equivalents. Natural mortality increased with glass eel density, ranging from 0.017 to 0.142 year-1 . The mean carrying capacity increased from ≈3.25 M silver eels (≈26 kg ha-1 ) for the 1923-1943 cohorts to ≈5.0 M (≈40 kg ha-1 ) for the 1948-1971 cohorts before regressing back to ≈3.25 M. The total silver eel output was highest during the late 1970s/early 1980s at 35-45 kg ha-1  year-1 and lowest during the early years of the 20th century and is currently at 10-15 kg ha-1  year-1 . The findings are discussed in relation to (a) the ecological changes that have occurred within the lough, associated with eutrophication and the introduction of roach (Rutilus rutilus L.), and (b) the decline of the wider European eel stock across its distribution range. The findings from this study have relevance for the wider management of the European eel stock.


Assuntos
Anguilla , Animais , Conservação dos Recursos Naturais , Europa (Continente) , Lagos , Irlanda do Norte
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