Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.664
Filtrar
1.
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
2.
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
3.
4.
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
5.
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
6.
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
7.
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
8.
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
10.
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
11.
Health Promot Int ; 37(4)2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-36130306

RESUMO

This repeated cross-sectional study investigated physical activity and associated barriers and facilitators during the first two waves of COVID-19 restrictions in Ireland. An online, anonymous questionnaire collated data from adults during May (n = 1274) and November (n = 810) 2020. Statistical analysis used a combination of traditional significance testing and Bayesian lasso logistic regression. The pattern of physical activity changed significantly between waves (χ2 86.8 on 3df; p < 0.001). During wave 1 restrictions, the majority [46.1% (n = 587)] of participants reported being more active than usual, decreasing to 26.3% (n = 213) during wave 2. More participants reported that their activity levels were less than usual [W1 29% (n = 369); W2 35% (n = 283)] during wave 2. Adherence to physical activity guidelines decreased from 56.5% (n = 705) to 43.7% (n = 35). Being unable to access their usual means of exercise [OR, 95% OR intervals; W1 1.611 (1.370-1.904), W2 1.638 (1.3731.968)] and advice not to leave home [OR, 95% OR intervals; W1 1.401 (1.164-1.697), W2 1.367 (1.106-1.696)] predicted less activity than usual during both waves. Increased time [OR, 95% OR intervals; W1 2.326 (1.948-2.794), W2 1.809 (1.478-2.233)], and valuing physical activity as important [OR, 95% OR intervals; W1 1.192 (1.001-1.444), W2 1.253 (1.003-1.637)] predicted increased activity during both waves, whilst finding new ways to be active [OR, 95% OR intervals; 2.515 (1.641-3.887)] predicted more activity in wave 2 only. Increases in physical activity of Irish adults during the first phase of COVID-19 restrictions were not maintained during the second wave and barriers to physical activity persisted.


Our study looked at the physical activity levels of Irish adults during the first two waves of COVID-19 restrictions. We also examined the factors that helped or hindered people to be active at this time. We used an anonymous, online questionnaire to collect responses during May and November 2020. In total, 1274 people responded in May and 810 in November. We found that in May, almost half of the respondents reported they were more active than usual. By November this had reduced to just over a quarter and about one in three people reported they were doing less activity than usual. People who were less active than usual reported that the closure of their usual means of getting activity, and the advice not to outdoors were the main factors preventing them from being active. People who were more active than usual reported that having more time and feeling that physical activity was important helped them to be more active. The things that helped or hindered people from being active generally did not change between May and November.


Assuntos
COVID-19 , Adulto , Teorema de Bayes , COVID-19/prevenção & controle , Estudos Transversais , Exercício Físico , Humanos , Irlanda/epidemiologia
12.
PLoS One ; 17(9): e0273948, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36103469

RESUMO

Metabolic syndrome (MetS) consists of the cluster of central obesity, insulin resistance, hypertension and atherogenic dyslipidaemia. It is a risk factor for cardiovascular disease, diabetes, and mortality. The prevalence of MetS has not been described in older adults from a population-representative sample in a European country before. This study aimed to determine the prevalence of MetS in older adults in Ireland and examine the association between MetS and socio-demographic, health, and lifestyle factors. This study used data from a population aged ≥50 years from waves 1 and 3 of the Irish Longitudinal Study on Ageing. The prevalence of MetS using the National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) and the International Diabetes Foundation (IDF) criteria were determined. Weighted logistic regression examined the association between MetS and age, sex, education, and physical activity. MetS status was determined at both waves with transitions examined. 5340 participants had complete data for MetS criteria at wave 1. 33% had MetS according to the ATPIII criteria (32.5%; 95% CI: 31.1, 34.0), with 39% according to the IDF criteria (39.3%; 95% CI: 37.8, 40.8). MetS was more prevalent with advancing age, among males, those with lower educational attainment and lower physical activity. 3609 participants had complete data for both waves- 25% of those with MetS at wave 1 did not have MetS at wave 3 but the overall number of participants with MetS increased by 19.8% (ATPIII) and 14.7% (IDF). MetS is highly prevalent in older adults in Ireland. 40% of the 1.2 million population aged ≥50 years in Ireland meet either the ATPIII or IDF criteria. Increasing age, male sex, lower educational attainment, and lower physical activity were all associated with an increased likelihood of MetS.


Assuntos
Síndrome Metabólica , Idoso , Envelhecimento , Humanos , Irlanda/epidemiologia , Estudos Longitudinais , Masculino , Prevalência
13.
Demography ; 59(5): 1607-1630, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36149005

RESUMO

We revisit the link between demographic pressure and economic conditions in pre-Famine Ireland and harness highly disaggregated parish-level data from the 1841 census in our analysis. The results indicate that on the eve of the Great Irish Famine of the 1840s, population pressure was positively associated with two measures of poverty-illiteracy and the prevalence of poor-quality housing. Malthus mattered in the sense that our results indicate that a "no population growth" scenario between 1800 and 1841 would have led to a 6% improvement in poor-quality housing and a 4% reduction in illiteracy. However, the strength of this relationship is reduced when additional explanatory factors are considered, and factors relating to location and economic geography offer greater explanatory power. Incorporation of data from the 1821 census reveals that in the two decades before 1841, population growth was fastest in areas under less population pressure, supporting the notion that preventive check forces were at play. These findings are consistent with some elements of Malthusian theory, although ultimately they refute the notion that overpopulation was the principal cause of pre-Famine Irish poverty.


Assuntos
Fome Epidêmica , Inanição , Humanos , Irlanda/epidemiologia , Dinâmica Populacional , Crescimento Demográfico , Pobreza , Inanição/epidemiologia
14.
Arch Osteoporos ; 17(1): 128, 2022 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-36161538

RESUMO

Ireland and Denmark have similar hip fracture surgery rates but differences in care quality indicators and patterns of intracapsular fracture repair. Very high variation in total hip arthroplasty rate within both countries and higher observed early mortality in Denmark require further investigation. PURPOSE: To explore and compare geographic variation of hip fracture surgery rate, care quality and outcomes in Ireland and Denmark. METHODS: Patients aged ≥ 65 years with surgically treated hip fracture were included from the Irish Hip Fracture Database (years = 2017-2020, n = 12,904) and the Danish Multidisciplinary Hip Fracture Registry (years = 2016-2017, n = 12,924). The age and sex standardised rate of hip fracture surgery and the proportion of patients with seven process quality indicators, three surgery types and four outcomes were calculated. Systematic components of variation (SCV) were calculated based on hospital area (6 Irish hospital groups, 5 Danish regions). RESULTS: The age and sex standardised rate of hip fracture surgery per 1000 older population in 2017 was 4.7 (95% CI = 4.4-5.1) in Ireland and 5.3 (95% CI = 5.1-5.5) in Denmark. Ireland had lower rates of surgery within 36 h (59% versus 84%), nutritional assessment (27% versus 84%) and pre-discharge mobility recording (52% versus 92%). Patterns of intracapsular fracture repair also differed between countries (hemiarthroplasty: Ireland = 85%, Denmark = 52%). Both countries had very high variation for total hip arthroplasty (THA) provision (SCV Ireland = 10.6, Denmark = 97.9). Ireland had longer hospital stays (median 12 versus 7 days), but lower 7-day (1.0% versus 3.1%) and 14-day (2.0% versus 5.5%) mortality. CONCLUSION: Ireland and Denmark have similar hip fracture surgery rates, but differences in care quality, surgery patterns and outcomes. High variation in THA provision and observed differences in mortality require further exploration. In Ireland, there is scope for improvement regarding early surgery, mobility, nutrition assessment and improved post-discharge follow-up.


Assuntos
Assistência ao Convalescente , Fraturas do Quadril , Dinamarca/epidemiologia , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Irlanda/epidemiologia , Alta do Paciente , Sistema de Registros , Fatores de Risco
15.
BMJ Paediatr Open ; 6(1)2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-36053599

RESUMO

BACKGROUND: Management of acute pain should commence at the earliest opportunity, as it has many short-term and long-term consequences. A research priority of Paediatric Emergency Research in the UK and Ireland (PERUKI) was to examine paediatric pain practices. OBJECTIVE: To describe the outcomes for paediatric pain management of minor injuries presenting to emergency departments (EDs) across PERUKI. METHODS: A retrospective service evaluation was performed over a 7-day period in late 2016/early 2017 across PERUKI sites, and analysis performed using an adapted Donabedian framework. Patients under 16 years presenting with minor trauma were eligible, and data were collected on prehospital management, pain assessment, analgesia administered and injury diagnosed. RESULTS: Thirty-one sites submitted data on 3888 patients. There were 111 missed cases (missed rate 3.6%). The most common injuries were sprains, lacerations, contusions/abrasions and fractures. Documentation of receiving analgesia before arrival in ED occurred in 21% of patients (n=818). A pain assessment was documented in 57.5% of patients (n=2235) during their ED visit, and 3.5% of patients had their pain reassessed (n=138). Of the patients who presented in severe pain (pain score 7-10 or rated severe), 11% were reassessed. Site variability of initial pain assessment ranged from 1.4% to 100% (median 62%). The characteristics of the top quartile performing centres against the bottom quartile performing centres based on completion rate of initial pain scores were identified. CONCLUSION: Pain assessment was documented in under 60% of children with minor injury, re-assessment of pain was almost completely absent, data and outcomes were missing in a substantial volume of patients, indicating that pain management and the associated outcomes have not been adequately addressed and prioritised within existing network structures and processes.


Assuntos
Serviços Médicos de Emergência , Manejo da Dor , Criança , Serviço Hospitalar de Emergência , Humanos , Irlanda/epidemiologia , Dor/epidemiologia , Pesquisa , Estudos Retrospectivos , Reino Unido , Adulto Jovem
16.
BMJ Paediatr Open ; 6(1)2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-36053629

RESUMO

INTRODUCTION: Despite increasing prevalence, European family homelessness remains under-researched. METHODS: A retrospective review was performed of homeless children attending a paediatric emergency department in Dublin, Ireland, from 1 January 2017 to 31 December 2020. Comparison was made with a random cohort of 1500 non-homeless paediatric attendances in 2019. Homelessness was defined using the European Typology of Homelessness and Housing Exclusion, including those with addresses of no fixed abode, government homeless accommodation and certain residential settings. The objectives were to compare presentations between homeless and non-homeless children. We were interested in determining differences regarding demographics, healthcare utilisation, clinical presentation and outcomes. RESULTS: Of 197 437 attendances 3138 (1.59%) were homeless. Compared with the non homeless, homeless children were less likely to be ethnically Irish (37.4% vs 74.6%, p<0.001) or have been born in Ireland (82.3% vs 96.2%, p<0.001). Irish Travellers (3% vs 0.8%), Roma (22.5% vs 2.4%) and black (21.1% vs 4.2%) ethnicities were over-represented (p<0.001) in the homeless cohort.Homeless children were younger (age <12 months: 26% vs 16%; p<0.001), less likely to be fully vaccinated (73.6% vs 81.9%, p<0.001) and have registered general practitioners (89.7% vs 95.8%, p<0.001). They were more likely to represent within 2 weeks (15.9% vs 10.5%, p<0.001), and use ambulance transportation (13.2% vs 6.7%, p<0.001). Homeless children had lower acuity presentations (triage category 4-5: 47.2% vs 40.7%, p<0.001) and fewer admissions (5.9% vs 8.4%, p<0.001) than non-homeless children. DISCUSSION: Infants, Irish Travellers, Roma and black ethnicities were over-represented in homeless presentations. Homeless children had increased reliance on emergency services for primary healthcare needs.


Assuntos
Pessoas em Situação de Rua , Jovens em Situação de Rua , Criança , Serviço Hospitalar de Emergência , Humanos , Lactente , Irlanda/epidemiologia , Estudos Retrospectivos
17.
Injury ; 53(11): 3680-3691, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36167689

RESUMO

INTRODUCTION: Traumatic brain injury (TBI) is the most significant cause of death and disability resulting from major trauma. The aim of this study is to describe the demographics of TBI patients, the current pathways of care and outcomes in the Republic of Ireland from 2014 to 2019. METHODS: We performed a retrospective review of all TBI patients meeting inclusion criteria in Ireland's Major Trauma Audit (MTA) from 2014 to 2019. Severe TBI was defined as an abbreviated injury scale (AIS) ≥3 and GCS ≤8. RESULTS: During the study period, 30,891 patients sustained major trauma meeting inclusion criteria for MTA, of which 7,393 (23.9%) patients met the inclusion criteria for TBI; 1,025 (13.9%) were classified as severe. The median age was 60.6 years (IQR 36.9-78.0), 54.3 years (32.8-73.4) for males and 71.7 years (50.0-83.0) for females (p<0.001). Of patients with severe TBI, 185 (18.0%) were brought direct to a neurosurgical centre, 389 (37.9%) were transferred to a neurosurgical centre and 321 (31.3%) had a neurosurgical intervention performed. In patients sustaining severe TBI, older patients (Adjusted OR, 0.96,95% CI 0.95-0.97) and patients requiring another surgery (OR 0.31, 95%CI 0.18-0.53) were less likely to be secondarily transferred to a neurosurgical centre. There were 47 (4.6%) patients with severe TBI discharged to rehabilitation. The 30-day mortality in Ireland was 11.6% in all TBI patients and 45.5% in severe TBI patients. Older patients and patients with higher ISS had a higher chance of death. Male patients, patients treated in neurosurgical centre, patients who had neurosurgery or non-neurosurgical surgery had a higher chance of survival. CONCLUSION: This population-based study bench marks the 'as is' for patients with TBI in Ireland. We found that presently in Ireland, the mortality rate from severe TBI appears to be higher than that reported in international literature, and only a minority of severe TBI patients are brought directly from the incident to a neurosurgical centre. The new major trauma system should focus on providing effective and efficient access to neurosurgical, neuro-critical and neuro-rehabilitative care for patients who sustain TBI.


Assuntos
Lesões Encefálicas Traumáticas , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Escala de Coma de Glasgow , Irlanda/epidemiologia , Pemetrexede , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/cirurgia
18.
Int J Public Health ; 67: 1604720, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36016962

RESUMO

Objectives: This study aims to understand mental health issues among Irish employees arising from COVID-19 adaptation from the perspective of Occupational Safety and Health (OSH) and/or Human Resource (HR) professionals. Methods: Fifteen focus groups including 60 OSH/HR professionals from various sectors were conducted covering four predetermined themes. The data were transcribed verbatim, with transcripts entered into Nvivo for thematic analysis incorporating intercoder reliability testing. Results: The mental health impacts among employees are identified from three stages: pre-adaptation, during adaptation, and post-adaptation. Most issues were reported during the second stage when working conditions dramatically changed to follow emerging COVID-19 policies. The identified mental health support from participating organizations included providing timely and reliable information, Employee Assistance Programme (EAP), informal communication channels, hybrid work schedules and reinforcement of control measures. Conclusion: This study explores the challenges facing employees during the different stages of COVID-19 adaptation and the associated mental health impacts. Gender's influence on mental health consultations should be considered when planning for public health emergencies, and further research conducted in male dominated industries.


Assuntos
COVID-19 , Saúde do Trabalhador , COVID-19/epidemiologia , Humanos , Irlanda/epidemiologia , Masculino , Saúde Mental , Reprodutibilidade dos Testes , Recursos Humanos
19.
Vaccine ; 40(39): 5716-5725, 2022 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-36038408

RESUMO

Vaccination of children aged 5 years and older is recommended as part of a multifaceted strategy to protect children against SARS CoV-2 infection and serious disease, and to control the spread of infection. COVID-19 vaccine trials in children aged less than5 years are underway, however, parental acceptance of vaccines for this age group is unknown. Between June and August 2021, a cross-sectional national survey of parental attitudes towards childhood vaccination in Ireland was conducted. Parents of children aged 0-48 months were surveyed to determine their attitudes towards COVID-19 vaccines for their children. A total of 855 parents were surveyed. Overall, 50.6 % reported that they intend to vaccinate their child, 28.7 % reported that they did not intend to vaccinate and 20.2 % were unsure. Among those who stated that they did not intend to vaccinate their child, concern about risks and side effects of vaccination was the primary reason reported (45.6 %). The most frequently reported information needs related to side effects of the vaccine (64.7 %) and vaccine safety (60.3 %). Results of the multivariable analysis showed that believing COVID-19 can be a serious illness in children was a strong predictor of parental intention to vaccinate (aOR 4.88, 95 % CI 2.68, 8.91, p-value < 0.001). In comparison with Irish-born parents, parents born in a Central and Eastern European country were less likely to report intention to vaccinate (aOR 0.21, 95 % CI 0.09, 0.47, p-value, <0.001). Parental belief in vaccine importance and safety and parental trust in official vaccine information sources were associated with increased parental intention to vaccinate. Understanding parental attitudes to vaccination of young children against COVID-19 is important to tailor the provision of information to parents' needs, and to inform the development of vaccination information and communication campaigns for current and future COVID-19 immunisations programmes for children.


Assuntos
COVID-19 , Vacinas , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Criança , Pré-Escolar , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Irlanda/epidemiologia , Pais , Vacinação
20.
Acta Paediatr ; 111(12): 2344-2351, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36030064

RESUMO

AIM: Our aim was to describe the epidemiology of multisystem inflammatory syndrome in children (MIS-C) in the Republic of Ireland, in the context of all cases of COVID-19 in children, during the first year of the SARS-CoV-2 pandemic. METHODS: Cases of MIS-C were identified by prospective surveillance in Irish hospitals from April 2020 to April 2021. Paediatric COVID-19 cases and outbreaks in schools or childcare facilities were notified to and routinely investigated by Public Health. Univariate and bivariate analyses were carried out in Excel, Stata and JMP statistical package. RESULTS: Fifty-four MIS-C cases (median age 7.58 years; males 57%) were identified over the study period. MIS-C incidence was higher in certain ethnicities ('black' 21.3/100,000 [95% CI 4.3-38.4]; and 'Irish Traveller' 14.7/100,000 [95% CI -5.7-35.1]) than those of 'white' ethnicity (3.4 /100,000). MIS-C cases occurred in three temporal clusters, which followed three distinct waves of community COVID-19 infection, irrespective of school closures. Formal contact tracing identified an epidemiological link with a COVID-19-infected family member in the majority of MIS-C cases (77%). In contrast, investigation of COVID-19 school outbreaks demonstrated no epidemiological link with MIS-C cases during the study period. CONCLUSION: Efforts at controlling SARS-CoV-2 transmission in the community may be a more effective means to reduce MIS-C incidence than school closures. Establishing a mandatory reporting structure for MIS-C will help delineate the role of risk factors such as ethnicity and obesity and the effect of vaccination on MIS-C incidence.


Assuntos
COVID-19 , Masculino , Criança , Humanos , COVID-19/epidemiologia , SARS-CoV-2 , Estudos Prospectivos , Irlanda/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...