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1.
Chemosphere ; 311(Pt 1): 137076, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36332738

RESUMO

It is well established that persistent organic pollutants are transported long distances in the atmosphere and deposited into aquatic and terrestrial ecosystems in remote areas, including high altitude lakes. The objective of this research was to evaluate whether compounds of wastewater origin were present in four remote upland headwater lakes in Ireland that primarily receive loadings from atmospheric deposition. Using Polar Organic Chemical Integrative Samplers (POCIS) deployed in the lakes for 60 to 68 days, seven compounds were detected at levels that could be quantified but 25 of the target compounds were not detected. The detected compounds included the cannabinoid metabolite, tetrahydrocannabinol carboxylate (THC-COOH), codeine, acetaminophen (paracetamol), ibuprofen, and the artificial sweeteners, sucralose, and saccharin, which were all present at concentrations estimated to be < 125 ng/L. Caffeine was also present in the lakes at estimated concentrations between 213 and 1320 ng/L. Cocaine and tramadol were detected in POCIS deployed in some of the lakes, but at levels below the limits of quantitation. The highest concentrations of the target analytes were detected in two lakes located in the eastern part of Ireland. These data are consistent with regional atmospheric transport of these compounds originating from wastewater treatment plants in Ireland. However, contaminants from wastewater treatment plants in the United Kingdom may also be a source in these upland lakes that are located far from emissions of urban pollution.


Assuntos
Lagos , Poluentes Químicos da Água , Lagos/química , Águas Residuárias/análise , Ecossistema , Poluentes Químicos da Água/análise , Irlanda , Compostos Orgânicos , Monitoramento Ambiental
2.
BMC Health Serv Res ; 22(1): 1311, 2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36329423

RESUMO

BACKGROUND: Health services research often relies on quasi-experimental study designs in the estimation of treatment effects of a policy change or an intervention. The aim of this study is to compare some of the commonly used non-experimental methods in estimating intervention effects, and to highlight their relative strengths and weaknesses. We estimate the effects of Activity-Based Funding, a hospital financing reform of Irish public hospitals, introduced in 2016. METHODS: We estimate and compare four analytical methods: Interrupted time series analysis, Difference-in-Differences, Propensity Score Matching Difference-in-Differences and the Synthetic Control method. Specifically, we focus on the comparison between the control-treatment methods and the non-control-treatment approach, interrupted time series analysis. Our empirical example evaluated the length of stay impact post hip replacement surgery, following the introduction of Activity-Based Funding in Ireland. We also contribute to the very limited research reporting the impacts of Activity-Based-Funding within the Irish context. RESULTS: Interrupted time-series analysis produced statistically significant results different in interpretation, while the Difference-in-Differences, Propensity Score Matching Difference-in-Differences and Synthetic Control methods incorporating control groups, suggested no statistically significant intervention effect, on patient length of stay. CONCLUSION: Our analysis confirms that different analytical methods for estimating intervention effects provide different assessments of the intervention effects. It is crucial that researchers employ appropriate designs which incorporate a counterfactual framework. Such methods tend to be more robust and provide a stronger basis for evidence-based policy-making.


Assuntos
Pesquisa sobre Serviços de Saúde , Projetos de Pesquisa , Humanos , Irlanda , Análise de Séries Temporais Interrompida/métodos , Pontuação de Propensão
3.
Int J Clin Pract ; 2022: 3232076, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36340964

RESUMO

Background: A recent survey of 109 healthcare professionals explored how UK healthcare professionals typically assess and treat multiple sclerosis (MS)-related cognitive impairment. Little is currently known about what constitutes usual care for cognitive impairment and psychosocial care for people with MS in Ireland. Aim: The aim of the current research was to survey healthcare professionals (HCPs) who work with people with MS, to understand current assessment and management of cognition and psychosocial care in people with MS in the Republic of Ireland. Methods: A cross-sectional survey design was used. Data were collected online through Microsoft forms and through postal responses. The original UK questionnaire was adapted, piloted, and distributed to Irish HCPs. Participants were qualified HCPs who work clinically with people with MS in the Republic of Ireland. Results: Ninety-eight HCPs completed the survey. Only 34% of those surveyed reported routine screening of cognition for people with MS within their services; approximately, 36% HCPs reported that they did not provide information or services in relation to cognition to people with MS and 39% reported not referring elsewhere when cognitive difficulties were suspected. Out of the 98 HCPs, 47% reported assessing mood difficulties as part of their services, with 14% unsure. In total, 70% of participants reported onward referral took place if mood difficulties were identified. The Montreal Cognitive Assessment was the most commonly administrated cognitive assessment. Cognitive intervention choices were found to be guided by clinical judgement in 75.5% of cases. Discussion. Despite the high importance placed on cognitive and psychosocial care, there is very little consistency in treatment and assessment across services for people with MS in Ireland.


Assuntos
Esclerose Múltipla , Humanos , Esclerose Múltipla/complicações , Esclerose Múltipla/terapia , Estudos Transversais , Irlanda/epidemiologia , Inquéritos e Questionários , Cognição
4.
Orphanet J Rare Dis ; 17(1): 403, 2022 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-36329444

RESUMO

Metachromatic Leukodystrophy (MLD) is a rare, autosomal recessive lysosomal storage disorder caused by a deficiency of the enzyme arylsulfatase A (ARSA). MLD causes progressive loss of motor function and severe decline in cognitive function, leading to premature death. Early diagnosis of MLD provides the opportunity to begin treatment before the disease progresses and causes severe disability. MLD is not currently included in newborn screening (NBS) in the UK.This study consisted of an online survey, and follow-up semi-structured interviews open to MLD patients or caregivers, aged 18 years and over. The aims of the study were to understand the importance of early diagnosis and to establish the views of families and caregivers of patients with MLD on NBS.A total of 24 patients took part in the survey, representing 20 families (two families had two children with MLD, one family had three children with MLD). Following on from the survey, six parents participated in the interviews. Our data showed diagnostic delay from first symptoms was between 0 and 3 years, with a median of 1 year (n = 18); during this time deterioration was rapid, especially in earlier onset MLD. In patients with late infantile MLD (n = 10), 50% were wheelchair dependent, 30% were unable to speak, and 50% were tube fed when a diagnosis of MLD was confirmed. In patients with early juvenile MLD (n = 5), over half used a wheelchair some of the time, had uncontrollable crying, and difficulty speaking (all 60%) before or at the time of diagnosis. A high degree of support was expressed for NBS among caregivers, 95% described it as very or extremely important and 86% believed detection of MLD at birth would have changed their child's future. One parent expressed their gratitude for an early diagnosis as a result of familial MLD screening offered at birth and how it had changed their child's future: "It did and it absolutely has I will be forever grateful for his early diagnosis thanks to his older sister."The rapid rate of deterioration in MLD makes it an essential candidate for NBS, particularly now the first gene therapy (Libmeldy™) has been approved by the European Medicines Agency. Libmeldy™ has also been recommended as a treatment option in England and Wales by the National Institute for Health and Care Excellence (NICE) and is being made available to patients in Scotland via the Scottish Medicines Consortium's ultra-orphan pathway.


Assuntos
Leucodistrofia Metacromática , Criança , Recém-Nascido , Humanos , Adolescente , Adulto , Leucodistrofia Metacromática/diagnóstico , Leucodistrofia Metacromática/genética , Cuidadores , Triagem Neonatal , Irlanda , Diagnóstico Tardio , Diagnóstico Precoce , Reino Unido
5.
Eur J Obstet Gynecol Reprod Biol ; 279: 183-190, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36368299

RESUMO

INTRODUCTION: Admission to an Intensive Care Unit (ICU) in obstetrics is often used as a proxy for maternal near miss/severe maternal morbidity (MNM/SMM) events. Understanding incidence and management of pregnant or postpartum patients requiring critical care (CC) is thus important for continued improvement of maternity care. This study aims to describe provision of critical care in obstetrics in the Republic of Ireland. MATERIAL AND METHODS: The national clinical audit on critical care included 15 of 19 maternity units in Ireland (2014-2016). 960 pregnant or postpartum (within 42 days) individuals who required CC were included. Data were reported on all cases requiring level 2 or level 3 CC. We calculated basic descriptive statistics for diagnosis and process of care variables, and compared characteristics of women requiring level 2 care to those requiring level 3. Outcomes included diagnoses necessitating critical care; additional complications; level of care required; care process outcomes such as length of stay, consultation with non-obstetric specialties, location of maternal critical care, and neonatal care provision. RESULTS: Overall, the rate of critical care in obstetrics for these hospitals was 1 in 131 live births; 900 of the 960 cases required level 2 care only. Hypertensive disorders contributed to the need for critical care for 1 in 242; hemorrhage, 1 in 422; and infections, 1 in 926. A substantial minority (15.7%) had more than one diagnosis, accounting for 40% of level 3 care. Serious complications were rare (eg, hysterectomy, 1 in 3846). Parity, hospital size, and identification as high-risk antenatally (<50% cases) were associated with requiring level 3 care. Critical care was provided in multiple locations, including ICUs, HDUs, and operating theatres. Only 23.8% of patients received CC in an ICU, suggesting ICU admission is not an ideal method for identifying severe maternal morbidity. CONCLUSIONS: We reported rates of critical care admission and primary diagnoses within the range of other published estimates, but huge variability exists in the literature, and within our data. ICU admission in and of itself iss not a reliable proxy for having received level 2 or 3 obstetric critical care in Ireland.


Assuntos
Serviços de Saúde Materna , Complicações na Gravidez , Recém-Nascido , Feminino , Gravidez , Humanos , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/terapia , Irlanda/epidemiologia , Cuidados Críticos , Auditoria Clínica , Mortalidade Materna
6.
Health Res Policy Syst ; 21(1): 1, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36397053

RESUMO

BACKGROUND: Between 2019 and 2021, the first Irish health system performance assessment (HSPA) framework was developed. As routinely collected health data are necessary to continuously populate indicators of an HSPA framework, a purpose-driven assessment of the health information system (HIS) in Ireland and its fitness to support the implementation of an HSPA framework was conducted. This study reports on the status of the Irish HIS through a multimethod assessment based on continuous broad stakeholder involvement. METHODS: Between May and November 2020, over 50 informants were engaged in individual and group interviews and stakeholder consultation workshops as part of the HIS assessment process. Descriptive themes and high-level data availability heatmaps were derived from interview and workshop data using thematic analysis. Indicator "passports" for the HSPA framework were populated during stakeholder consultation workshops and analysed using univariate descriptive statistics. RESULTS: The HIS in Ireland was able to provide administrative, survey and registry-based data for public sector acute care services, focusing on structure, process and output metrics. Significant data availability gaps, most notably from primary care, private hospitals and community care, were reported, with little availability of electronic health record and people-reported data. Data on outcome metrics were mostly missing, as were linkage possibilities across datasets for care pathway monitoring. The COVID-19 pandemic highlighted the national HIS's shortcomings but also the capacity for rapid development and improvement. CONCLUSIONS: A tailor-made assessment of the HIS in Ireland, involving a broad set of relevant stakeholders, revealed strengths, weaknesses and areas for improvement in the Irish health data landscape. It also contributed to the development of a national HSPA framework and momentum to further strengthen data infrastructure and governance, while working towards a more data-driven and person-centred healthcare system. This work demonstrates the utility of an inclusive HIS assessment process and is applicable beyond Ireland, where this case study was conducted.


Assuntos
COVID-19 , Sistemas de Informação em Saúde , Humanos , Irlanda , Pandemias , Programas Governamentais
7.
8.
Front Public Health ; 10: 1038409, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36438293

RESUMO

What can we learn from the history of Public and Patient Involvement (PPI) in healthcare and research across global jurisdictions? Depending on region and context, the terminology and heritage of involvement in research vary. In this paper, we draw on global traditions to explore dominant themes and key considerations and critiques pertaining to PPI in order to inform a PPI culture shift in Ireland. We then describe the heritage of PPI in Ireland and present the case for combining methodological imperatives with policy drivers to support and encourage meaningful involvement. Specifically, we propose that PPI can be enriched by the theory and processes of participatory health research (PHR); and that implementation requires concurrent capacity building. We conclude with a call for Irish researchers (authors of this paper included) to consider the conceptual complexities and nuances of a participatory approach to build on the policy imperatives driving PPI and to contribute to the international evidence base and research culture. Specifically, we call for Irish health researchers and funders to consider and reflect on: (1) the rich literature of PHR as a resource for enacting meaningful PPI; (2) the roots and origins of varying participatory health research methods; (3) how community/patient groups can lead health research; and (4) co-learning and partnership synergy to create space for both academic and community expertise; and (5) the importance of using standardized reporting tools.


Assuntos
Participação do Paciente , Políticas , Humanos , Irlanda , Pesquisadores
9.
Lancet ; 400 Suppl 1: S53, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36426471

RESUMO

BACKGROUND: Universal Bacillus Calmette-Guérin vaccine (BCG) vaccination was discontinued in Ireland in April 2015 due to a lack of vaccine supply. We analysed notifications from the Irish National Tuberculosis Surveillance System from 2011 to 2021 to examine the direct impact of vaccination cessation on active tuberculosis cases among young children. METHODS: We did a cross-sectional study to compare tuberculosis age-specific incidence rates (ASIRs) among children aged 0-4 years born during a period of BCG vaccination (January 2007 to March 2015) with those born after BCG vaccination cessation (April 2015 to December 2021). We calculated ASIRs using census population denominators and did a temporal trend analysis of ASIRs using negative binomial regression. Data were anonymised before use in this study so no ethical approval or patient consent was required. FINDINGS: No significant temporal trend was detected in ASIR by notification year during 2011-21 (incidence rate ratio [IRR] 0·98; 95% CI 0·85-1·1). However, the temporal trend for cases born during universal vaccination was significantly declining (IRR 0·72 [95% CI 0·56-0·93]) whereas cases born after vaccination ceased had a non-significant increase (1·4 [0·99-1·96]). No meningitis cases were reported during universal vaccination compared with one (5%) of 19 cases reported after vaccination ceased. The proportion of cases reported as vaccinated decreased from 58% (11 of 19) during universal vaccination to 21% (four of 19) after vaccination ceased. Six (32%) of 19 cases born after vaccination ceased would have been eligible to receive BCG under a selective programme. No significant difference in the proportion of cases associated with outbreaks was detected across the two periods. Regional ASIRs increased in two eastern regions after vaccination ceased, whereas they declined in the remaining six regions. INTERPRETATION: Universal BCG cessation has not directly impacted on new tuberculosis cases among children aged 0-4 years. However, timely surveillance is needed to monitor the impact of vaccination cessation. A selective BCG programme might have prevented cases diagnosed in certain risk groups. FUNDING: Health Service Executive, Ireland.


Assuntos
Vacina BCG , Tuberculose , Criança , Humanos , Pré-Escolar , Irlanda/epidemiologia , Estudos Transversais , Vacinação , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
10.
Lancet ; 400 Suppl 1: S52, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36426470

RESUMO

BACKGROUND: Despite declining tuberculosis crude incidence rates (CIRs) in Ireland, the CIR among migrants remains five times higher than among non-migrants. We analysed notifications from the Irish tuberculosis surveillance system to compare the epidemiology of active tuberculosis among migrants with non-migrants in Ireland from 2011 to 2020 to inform future prevention and control strategies. METHODS: We analysed cases by individuals, place, and time, defining migrants as being diagnosed in Ireland and born outside Ireland. We calculated CIRs per 100 000 population using population denominators stratified by country of birth, defining high tuberculosis incidence as more than 40 per 100 000 population. We did temporal trend analysis using negative-binomial regression. FINDINGS: A total of 3158 cases were notified, of which 1461 (46·3%) were migrants. Annual CIRs declined from 25·2 to 13·6 per 100 000 population among migrants (incidence rate ratio [IRR] 0·95 [95% CI 0·94-0·97]) and from 5·6 to 1·8 per 100 000 population among non-migrants (0·91 [0·89-0·93]). Median age was 34 years among migrants and 53 years among non-migrants. Male-to-female ratio was 1·3 among migrants and 1·7 among non-migrants. Migrants had significantly higher odds of any drug resistance (odds ratio [OR] 1·7 [95% CI 1·2-2·6]), multidrug resistance (19·4 [5·0-166]), and HIV co-infection (4·0 [2·5-6·9]), but lower odds of being linked to an outbreak (OR 0·28 [95% CI 0·21-0·37]) or sputum positive (0·76 [0·61-0·93]). Migrants originated from 96 countries, 82% originated from high tuberculosis incidence countries compared with 23% of the Irish population. The top ten migrant source countries differed when ranked by case numbers versus CIR. Four countries had a higher CIR in Ireland than in those reported by WHO for their country of origin. INTERPRETATION: The pace of tuberculosis decline in migrants is slower than in non-migrants, with elevated CIRs among migrant subpopulations that might indicate underserved communities. A renewed focus on migrant health strategy is required to achieve the global tuberculosis elimination goal. FUNDING: Health Service Executive, Ireland.


Assuntos
Coinfecção , Tuberculose , Humanos , Feminino , Masculino , Adulto , Irlanda/epidemiologia , Tuberculose/epidemiologia , Escarro , Surtos de Doenças
11.
Epidemiol Infect ; 150: e186, 2022 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-36372066

RESUMO

Healthcare workers (HCWs) have increased exposure and subsequent risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This case-control study was conducted to investigate the contemporaneous risks associated with confirmed SARS-CoV-2 infection amongst HCWs following in-work exposure to a confirmed coronavirus disease-2019 (COVID-19) case. We assessed the influence of demographic (age, sex, nationality, high risk co-morbidities and vaccination status) and work-related factors (job role, exposure location, contact type, personal protective equipment (PPE) use) on infection risk following nosocomial SARS-CoV-2 exposure. All contact tracing records within the hospital site during waves 1-3 of the COVID-19 pandemic in Ireland were screened to identify exposure events, cases and controls. In total, 285 cases and 1526 controls were enrolled, as a result of 1811 in-work exposure events with 745 index cases. We demonstrate that male sex, Eastern European nationality, exposure location, PPE use and vaccination status all impact the likelihood of SARS-CoV-2 infection following nosocomial SARS-CoV-2 exposure. The findings draw attention to the need for continuing emphasis on PPE use and its persisting benefit in the era of COVID-19 vaccinations. We suggest that non-work-related factors may influence infection risk seen in certain ethnic groups and that infection risk in high-risk HCW roles (e.g. nursing) may be the result of repeated exposures rather than risks inherent to a single event.


Assuntos
COVID-19 , Infecção Hospitalar , Masculino , Humanos , Pandemias , COVID-19/epidemiologia , SARS-CoV-2 , Estudos de Casos e Controles , Irlanda/epidemiologia , Infecção Hospitalar/epidemiologia , Pessoal de Saúde , Fatores de Risco , Hospitais
13.
Br J Community Nurs ; 27(Sup10): S22-S26, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36205409

RESUMO

The last decade has produced a plethora of lymphoedema-based research. As such, a new All-Ireland Guideline for lymphoedema diagnosis, assessment and management was required to replace the 2008 CREST Guideline. A research team was commissioned to work with healthcare staff and service users following international research standards practice. An evidence-based clinical practice guideline was developed to aid clinicians in the diagnosis, assessment, and management of lymphoedema. Recommendations were formulated based on the evidence available to answer each clinical question and were assigned a grade based on the strength of the evidence. In the absence of sufficient evidence and in an effort to maximise clinical applicability, recommendations were also based on expert opinion, which was gathered via guideline member consensus. The recommendations from the guideline, which aim to provide healthcare professionals with clear, evidence-based guidance on the diagnosis, assessment and management of patients with all types of lymphoedema, should be communicated at all levels regarding responsibility for implementation in clinical care and service development. Audit should be a core component of the implementation. A budget impact analysis should be completed to determine additional costs required to fully implement the guideline.


Assuntos
Prática Clínica Baseada em Evidências , Linfedema , Pessoal de Saúde , Humanos , Irlanda , Linfedema/diagnóstico , Linfedema/terapia
14.
BMC Palliat Care ; 21(1): 170, 2022 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-36195870

RESUMO

INTRODUCTION: Social support is described by patients and other stakeholders to be a valuable component of palliative day care. Less is known about the range of hospice services that have been used in practice that facilitate social support. An online survey aimed to gain an overview of all hospice day services that facilitated social support for adults outside of their own homes. METHODS: An online survey was distributed via email to people involved in managing hospice day services. Questions were asked on hospice characteristics, including staff and volunteer roles. Respondents were asked to identify services they felt offered social support to patients. Data collection took place between August 2017 and May 2018. RESULTS: Responses were received from 103 hospices in the UK and ROI (response rate 49.5%). Results provide an overview of hospice day and outpatient services that offer social support to patients. These are: multi-component interventions, activity groups, formal support groups, befriending, and informal social activities. Multi-component interventions, such as palliative day care, were the most commonly reported. Their stated aims tend to focus on clinical aspects, but many survey respondents considered these multicomponent interventions to be the 'most social' service at their hospice. The survey also identified a huge variety of activity groups, as well as formal therapeutic support groups. Informal 'social-only' activities were present, but less common. Over a third of all the services were described as 'drop in'. Most responding hospices did not routinely use patient reported outcome measures in their 'most social' services. CONCLUSIONS: The survey documents hospice activity in facilitating social support to be diverse and evolving. At the time of data collection, many hospices offered multiple different services by which a patient might obtain social support outside of their own home and in the presence of other patients.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Adulto , Humanos , Irlanda , Cuidados Paliativos/métodos , Pandemias , Apoio Social , Inquéritos e Questionários , Reino Unido
15.
PLoS One ; 17(10): e0275259, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36206240

RESUMO

Slaughterhouse or meat factory surveillance to detect factory lesions (FL) at slaughter is an important part of the bovine tuberculosis (bTB) eradication program in Ireland. The objective of this study was to quantify the effectiveness of Irish slaughterhouses or factories in submitting FL and the proportion of those submitted FL confirmed as being due to bTB in slaughtered cattle, and to identify and quantify the association of risk factors at animal, herd, and factory level with FL submission and confirmation. The data consisted of 6,611,854 animals slaughtered in Irish factories from 2014 to 2018 obtained from the Department of Agriculture, Food and Marine (DAFM), Ireland. Selected risk factors for this study included factory, year and month of slaughter, age, sex, breed, animal movement, ever inconclusive in the standard or severe skin test, herd type, herd size, and bTB history. The association of each risk factor on the FL submission and confirmation risk were analysed with univariable followed by a multivariable logistic regression with herd as random effect. Factories were ranked and compared based on the odds ratio (OR) obtained from the univariable (crude OR) and multivariable (adjusted OR) analysis. The average submission risk of all factories was 20 per 10,000 animals slaughtered, ranging from 1 to 42 per 10,000 animals slaughtered, and the average confirmation risk over all factories was 40.72%, ranging from 0.00 to 61.84%. The odds of submitting and confirming FL as bTB positive were higher in animals over eight years old compared to animals 1-2 years old (OR = 1.91, 95 CI 95% 1.77-2.06 and OR = 4.05, 95% CI 3.17-5.18, respectively), and were higher in animals that ever had inconclusive skin result based on severe interpretation (OR = 2.83, 95% CI 2.44-3.27 and OR = 4.48, 95% CI 2.66-7.54, respectively), animals originating from sucklers herds (OR = 1.08, 95% CI 1.02-1.14 and OR = 1.31, 95% CI 1.11-1.55, respectively), or herds with bTB history in the past three years (OR = 4.46, 95% CI 4.28-4.66 and OR = 319.90, 95% CI 237.98-430.04, respectively). The odds of FL submission and confirmation decreased as the herd size increased (OR = 0.95, 95% CI 0.93-0.96 and OR = 0.82, 95% CI 0.78-0.86, respectively). An inverse relationship of FL submission and confirmation was present for variable sex and inconclusive skin result with standard interpretation, where submission odds were higher in males (OR = 1.05, 95% CI 1.00-1.10) and ever inconclusive animals (OR = 74.24, 95% CI 69.39-79.43), although the confirmation odds were lower (males OR = 0.66, 95% CI 0.56-0.76; ever inconclusive OR = 0.44, 95% CI 0.36-0.54). The crude and adjusted ranking of factories did not differ greatly for FL submission, indicating that factory-related factors may contribute significantly to the submission variation between factories. However, a substantial difference between crude and adjusted confirmation ranking was present which may indicate that animal and herd-related factors were associated to variation in confirmation risk between factories.


Assuntos
Matadouros , Tuberculose Bovina , Animais , Bovinos , Irlanda/epidemiologia , Modelos Logísticos , Masculino , Fatores de Risco , Tuberculose Bovina/diagnóstico , Tuberculose Bovina/epidemiologia , Tuberculose Bovina/patologia
16.
Public Health ; 212: 28-32, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36182748

RESUMO

OBJECTIVES: Human infections from highly pathogenic avian influenza (HPAI) H5N1 are associated with significant morbidity and mortality internationally. This study aimed to use routinely available data to examine key strategies to prevent H5N1 transmission to humans during outbreaks in poultry in residents in Cavan, Louth, Meath and Monaghan. STUDY DESIGN: This was a cross-sectional based study. METHODS: Data were obtained from Health Protection Team in the Department of Public Health, HSE North East and Department of Agriculture, Food, and the Marine (DAFM). Data entry and analyses were conducted using Microsoft Excel 2016. RESULTS: The public health response focussed on contact tracing, monitoring and follow-up for household, farm workers and DAFM staff exposed on the affected farms. A total of 157 contact episodes were identified. Contacts received advice about active monitoring from their last exposure. A total of 111 (80%) were recommended chemoprophylaxis for exposure to HPAI H5N1. During the active monitoring period, two contacts developed acute respiratory symptoms, and parainfluenza 3 and rhino/enterovirus were identified in these individuals, respectively. CONCLUSIONS: The findings of this study, using routinely gathered data, highlighted that collaboration between public health and DAFM at regional and national levels was key to rapid response to these outbreaks of HPAI in domesticated poultry. In addition, the public health response appears to have been successful in preventing H5N1 transmission from domesticated birds to humans.


Assuntos
Virus da Influenza A Subtipo H5N1 , Influenza Aviária , Animais , Humanos , Influenza Aviária/epidemiologia , Aves Domésticas , Saúde Pública , Estudos Transversais , Irlanda/epidemiologia , Surtos de Doenças/veterinária
17.
Obes Facts ; 15(6): 736-752, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36279848

RESUMO

BACKGROUND: This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. SUMMARY: It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients' lived experiences; move beyond simplistic approaches of "eat less, move more" and address the root drivers of obesity. KEY MESSAGES: People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health-need rather than ability to pay.


Assuntos
Obesidade , Sobrepeso , Adulto , Humanos , Irlanda , Canadá , Obesidade/terapia , Obesidade/psicologia , Sobrepeso/terapia , Redução de Peso , Doença Crônica
19.
Bone ; 165: 116574, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36183981

RESUMO

A pre-meeting workshop on spinal complications in children and adults with achondroplasia was held in Dublin, Ireland at the 10th International Conference on Children's Bone Health (ICCBH) 2-5 July 2022. The pathophysiology, natural history and medical/surgical management of thoraco-lumbar kyphosis and spinal stenosis remains poorly described in the literature. The structure of the workshop consisted of lectures, a debate and an interactive round table discussion. In total over 100 delegates affiliated to over 70 institutions from 20 countries were in attendance.


Assuntos
Acondroplasia , Cifose , Estenose Espinal , Adulto , Criança , Humanos , Acondroplasia/complicações , Irlanda , Cifose/complicações , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Coluna Vertebral
20.
BMC Geriatr ; 22(1): 802, 2022 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-36243703

RESUMO

BACKGROUND: Use of restrictive practices (RP) in care settings may sometimes be warranted but can also conflict with human rights. Research to date has focused primarily on physical and chemical RP, however other forms are also used. Better understanding of practice can inform RP reduction. This study describes the incidence of all types of RP use reported from nursing homes in Ireland. METHODS: RP notifications from nursing homes reported in 2020 were extracted from the Database of Statutory Notifications from Social Care in Ireland. The primary outcome measurement was the national incidence of use (frequency of RP/occupancy per 1000 residents) of categories and types of RP. Secondary outcome measurements such as percentage of facilities reporting use and quarterly median incidence of use in these facilities were calculated. RESULTS: Seventy thousand six hundred sixty-three RP uses were notified from 608 facilities (33,219 beds). National incidence of RP use per 1000 residents was, all categories: 2465.1, environmental: 1324.5, physical: 922.5, chemical: 141.1; 'other': 77.0. The most frequently used RPs per category were, environmental: door locks; physical: bedrails; chemical (where drug specified): antipsychotics; 'other': privacy. 90.5% of nursing homes reported using at least one type of RP in the 12-month period. Quarterly incidence of any RP use in these facilities was median 1.642 (IQR: 0.018 to 18.608) per bed. CONCLUSIONS: Nursing homes in Ireland regularly use RP; only 9.5% reported no RP use in the 12-month period. A wide variety of types of RP were reported. Environmental and 'other' (largely psychosocial) RP contributed notably to total RP use and warrant attention alongside the traditional focus on physical and chemical RP. Policy implications include the need for more comprehensive RP definitions.


Assuntos
Antipsicóticos , Casas de Saúde , Humanos , Incidência , Irlanda/epidemiologia , Restrição Física
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