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1.
BMC Public Health ; 22(1): 906, 2022 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-35524295

RESUMO

OBJECTIVES: Advance care planning is a key preparatory step in ensuring high-quality palliative and end of life care, and should be considered as a process, beginning with community-level conversations among lay persons. There is, however, indication that death talk among community-dwelling adults is not occurring, and there is a dearth of research examining why this is the case. This study aims to provide the first examination of barriers and facilitators to talking about death and dying among the general population in a UK region (Northern Ireland), and to provide a novel application of health behaviour change theory towards developing a theoretical understanding of the sources of this behaviour. METHODS: The study involved qualitative analysis of responses (n = 381 participants) to two open-ended questions within a cross-sectional online survey, with recruitment via social media of adults currently living in Northern Ireland. Reflexive thematic analysis was conducted on open text responses per question, with the barriers and facilitators mapped on to health behaviour change models (the Behaviour Change Wheel COM-B and the Theoretical Domains Framework). RESULTS: The findings evidence a myriad of barriers and facilitators to engaging in death talk, with themes aligning to areas such as lack of acceptance of death in social contexts and fear of upsetting self or others, and a need to improve interpersonal communication skills for facilitating conversations and improve knowledge of the existing services around death and dying. A theoretical understanding of the drivers of death talk is presented with findings mapped across most components of the COM-B Behaviour Change Model and the Theoretical Domains Framework. CONCLUSIONS: This study contributes to a small but emergent research area examining barriers and facilitators to talking about death and dying. Findings from this study can be used to inform new public health programmes towards empowering adults to have these conversations with others in their community towards upstreaming advance care planning.


Assuntos
Planejamento Antecipado de Cuidados , Atitude Frente a Morte , Adulto , Estudos Transversais , Comportamentos Relacionados com a Saúde , Humanos , Irlanda do Norte , Pesquisa Qualitativa
3.
Eur J Psychotraumatol ; 13(1): 2046953, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35386731

RESUMO

Background: Complex posttraumatic stress disorder (CPTSD) describes the results of complex, prolonged, and/or inescapable trauma, and is typified by avoidance, re-experiencing, sense of threat, affect dysregulation, negative self-concept, and interpersonal disturbances. Additionally, CPTSD is highly comorbid with other common psychopathologies. Objectives: A study was conducted in a trauma-exposed UK Armed Forces Veteran population resident in Northern Ireland (N = 638, NI) to determine the prevalence of CPTSD and comorbid associations. Methods: Data from the Northern Ireland Veterans Health and Wellbeing Study (NIVHWS), including self-report data describing traumatic stress, depression, anxiety, and suicidality, were used in a latent class analysis to identify distinct profiles of symptomology in the sample, and in a multinomial logistic regression to identify comorbidities associated with class membership. Results: Three distinct classes emerged: a low endorsement 'baseline' class (36%), a 'Moderate Symptomatic' class (27%), and a high endorsement 'Probable CPTSD' class (37%). Both the Moderate Symptomatic and CPTSD classes were predicted by cumulative trauma exposure. Depression was highly comorbid (OR = 23.06 in CPTSD), as was anxiety (OR = 22.05 in CPTSD) and suicidal ideation (OR = 4.32 in CPTSD), with suicidal attempt associated with the CPTSD class (OR = 2.51). Conclusions: Cases of probable CPTSD were more prevalent than cases of probable posttraumatic stress disorder (PTSD) without Difficulties in Self-Organisation (DSO) symptoms in a UK Armed Forces veteran sample, were associated with repeated/cumulative trauma, and were highly comorbid across a range of psychopathologies. Findings validate previous literature on CPTSD and indicate considerable distress and thus need for support in UK Armed Forces veterans resident in NI.


Antecedentes:El trastorno de estrés postraumático complejo (TEPT-C) describe los resultados de un trauma complejo, prolongado y/o inevitable; y se caracteriza por la presencia de evitación, re-experimentación, sensación de amenaza, desregulación afectiva, un autoconcepto negativo y alteraciones en las relaciones interpersonales. Adicionalmente, el TEPT-C es altamente comórbido con otras psicopatologías frecuentes.Objetivos: Se realizó un estudio en una población de veteranos de las Fuerzas Armadas del Reino Unido expuestos a trauma residentes en Irlanda del Norte (N=638, NI) para determinar la prevalencia del TEPT-C y las asociaciones comórbidas.Métodos: Los datos del Estudio de Salud y Bienestar en Veteranos de Irlanda del Norte (NIVHWS, por sus siglas en inglés), incluidos datos de auto-reportes describiendo la presencia de estrés traumático, depresión, ansiedad y suicidalidad, fueron utilizados en un análisis de clases latentes para identificar distintos perfiles de sintomatología en la muestra y en una regresión logística multinomial para identificar las comorbilidades asociadas con la pertenencia a cada clase.Resultados: Surgieron tres clases distintas: una clase de "línea base" de bajo respaldo (36%), una clase de "sintomático moderado" (27%) y una clase de "TEPT-C probable" de alto respaldo (37%). La exposición acumulativa a trauma predijo tanto las clases de sintomático moderado como la del TEPT-C probable. La depresión fue altamente comórbida (OR=23.06 en TEPT-C), así como la ansiedad (OR=22.05 en TEPT-C) y la ideación suicida (OR=4.32 en TEPT-C), con intento de suicidio asociado a la clase de TEPT-C (OR=2.51).Conclusiones: Los casos de TEPT-C probable fueron más prevalentes que los casos de trastorno de estrés postraumático (TEPT) sin síntomas de alteraciones en la autoorganización (AAO) en una muestra de veteranos de las Fuerzas Armadas del Reino Unido. Asimismo, los casos de TEPT-C probable se asociaron a la exposición a trauma repetido/acumulativo y fueron altamente comórbidos con una variedad de psicopatologías. Los hallazgos validan la literatura previa concerniente al TEPT-C e indican una angustia considerable y, por lo tanto, demuestran la necesidad de soporte en los veteranos de las Fuerzas Armadas del Reino Unido residentes en Irlanda del Norte.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Veteranos , Comorbidade , Humanos , Classificação Internacional de Doenças , Irlanda do Norte/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia
5.
BMC Pregnancy Childbirth ; 22(1): 180, 2022 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-35241007

RESUMO

BACKGROUND: Identifying women with perinatal anxiety is important in order to provide timely support and prevent adverse outcomes. Self-report instruments are commonly used in maternity settings. An alternative is to ask women directly whether they self-identify as having anxiety. We examine the agreement between self-reported and self-identified anxiety at 3 months postpartum and compare the characteristics of women with self-reported and self-identified anxiety. METHODS: A secondary analysis of national maternity surveys conducted in 2014 in England and Northern Ireland was conducted. Self-reported anxiety was assessed using the Edinburgh Postnatal Depression Scale anxiety subscale (EPDS-3A). Agreement between self-reported and self-identified anxiety was measured using Cohen's kappa. Logistic regression was used to identify characteristics of women in each group. RESULTS: In our sample of 6752 women, 14.2% had self-reported anxiety, 5.9% had self-identified anxiety and 3.5% were positive on both measures. Among those with self-identified anxiety, 58.1% also had self-reported anxiety. Of those with self-reported anxiety, 24.4% also had self-identified anxiety. Statistical agreement between the two measures was minimal with Cohen's kappa 0.283 at an EPDS-3A threshold of ≥6. Among both self-identified and self-reported anxiety groups, psychological factors were the strongest associated factors. Women with self-reported anxiety had higher odds of being from Northern Ireland (OR 1.81); having a mixed or unhappy reaction to the pregnancy (OR 1.65); living without a partner (aOR 1.37); and antenatal depression (aOR 1.32). Women with self-identified anxiety had higher odds of physical problems (OR 1.84); and being of Black or minority ethnicity (OR 0.39). CONCLUSIONS: Asking postnatal women directly whether they self-identify as having anxiety identifies a different group of women from those who score highly on self-report measures. Women with self-identified anxiety may benefit from further follow-up and support.


Assuntos
Ansiedade/diagnóstico , Período Pós-Parto/psicologia , Adulto , Ansiedade/epidemiologia , Inglaterra , Feminino , Humanos , Irlanda do Norte , Prevalência , Escalas de Graduação Psiquiátrica , Autorrelato , Autoavaliação (Psicologia)
6.
Vaccine ; 40(18): 2535-2539, 2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35346536

RESUMO

BACKGROUND: This study evaluates spike protein IgG antibody response following Oxford-AstraZeneca COVID-19 vaccination using the AbC-19™ lateral flow device. METHODS: Plasma samples were collected from n = 111 individuals from Northern Ireland. The majority were >50 years old and/or clinically vulnerable. Samples were taken at five timepoints from pre-vaccination until 6-months post-first dose. RESULTS: 20.3% of participants had detectable IgG responses pre-vaccination, indicating prior COVID-19. Antibodies were detected in 86.9% of participants three weeks after the first vaccine dose, falling to 74.7% immediately prior to the second dose, and rising to 99% three weeks post-second vaccine. At 6-months post-first dose, this decreased to 90.5%. At all timepoints, previously infected participants had significantly higher antibody levels than those not previously infected. CONCLUSION: This study demonstrates that strong anti-spike protein antibody responses are evoked in almost all individuals that receive two doses of Oxford-AstraZeneca vaccine, and which largely persist beyond six months after first vaccination.


Assuntos
Formação de Anticorpos , COVID-19 , Anticorpos Antivirais , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Humanos , Imunoglobulina G , Pessoa de Meia-Idade , Irlanda do Norte , SARS-CoV-2 , Vacinação
7.
Child Abuse Negl ; 127: 105568, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35247660

RESUMO

BACKGROUND: Although a wealth of international literature consistently links cumulative experiences of adverse childhood experiences (ACEs) with physical, mental and emotional problems in later life, only a few studies have focused on intergenerational ACE exposure and research using nationally representative populations is lacking. OBJECTIVE: This paper examines intergenerational associations between parent and child ACE scores in a large nationally representative sample of parent-child dyads. PARTICIPANTS AND SETTING: Participant comprise 1042 pairs of parents and young people (11-19 year olds) who both completed questions relating to their exposure to ACEs (N = 1042) as part the Northern Ireland Youth Wellbeing Survey (NIYWS) - a stratified random probability household survey of the prevalence of mental health disorders among 2 to 19 year olds in Northern Ireland (N = 3074). METHODS: Hierarchical regression was used to identify the relationship between parent and young people ACE scores and investigate the extent to which this is influenced by child, parent, family and socio-economic variables. RESULTS: In the final model, young person ACE scores were associated with older child age (ß = 0.082, p = .016), younger parental age (ß = -0.083, p = .022), fewer children in the household (ß = -0.120, p < .001), poor child health (ß = 0.160, p < .001), low family support (ß = 0.118, p = .001) and the household being in receipt of benefits (ß = 0.223, p < .001). CONCLUSIONS: This study found a small association between parent and young person ACE exposure which was attenuated through other variables.


Assuntos
Experiências Adversas da Infância , Adolescente , Criança , Humanos , Irlanda do Norte/epidemiologia , Pais , Prevalência , Inquéritos e Questionários
9.
Res Vet Sci ; 145: 205-212, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35245726

RESUMO

Bovine tuberculosis is a notifiable disease in Northern Ireland with the national eradication programme of compulsory testing and slaughter of reactor animals costing approximately £40 million per year. Backward tracing, known as Backward Check Tests (BCTs), of reactor animals is used to identify previous herds where the bTB positive animal has resided. The aim of this study was to quantify the bovine tuberculosis (bTB) risk posed by inconclusive reactors (ICs) at BCTs at both the individual animal and the herd level. ICs to the Comparative Intradermal Tuberculin Test (CITT) at a BCT, in which no reactors were found, were matched with CITT negative animals, based on age, sex, test ID and follow up period, in Northern Ireland between 1st January 2008 and 31st December 2017 (inclusive). A retrospective matched cohort study design was used with the outcome of interest being the bTB status of each animal and subsequent bTB herd breakdowns. After adjusting for herd size, IC animals at a BCT had 16 times the odds (95% confidence interval: 7.75 to 38.28, p < 0.001) of becoming bTB positive compared to CITT negative animals. The percentage population attributable risk was 0.0001%. The majority 75% (n = 71) of ICs that became bTB positive were identified at the 42 day retest. Of those that were not disclosed at the 42 day retest (n = 24), almost a third (29%) had moved to an unrestricted herd. However, after adjusting for herd size and type, herds that had ICs only identified at a BCT did not have an increased odds of a subsequent bTB herd breakdown compared to herds that had a CITT negative BCT. Given the increased risk posed by ICs at a BCT, it may be justifiable to remove them from the herd immediately or place them under lifetime movement restrictions to the herd where they were detected. However, further action regarding the herd of origin does not appear to be justified.


Assuntos
Doenças dos Bovinos , Tuberculose Bovina , Animais , Bovinos , Estudos de Coortes , Humanos , Irlanda do Norte/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Teste Tuberculínico/veterinária , Tuberculose Bovina/diagnóstico , Tuberculose Bovina/epidemiologia
10.
J R Soc Interface ; 19(188): 20210896, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35259954

RESUMO

An age-structured SEIR model simulates the propagation of COVID-19 in the population of Northern Ireland. It is used to identify optimal timings of short-term lockdowns that enable long-term pandemic exit strategies by clearing the threshold for herd immunity or achieving time for vaccine development with minimal excess deaths.


Assuntos
COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Humanos , Imunidade Coletiva , Irlanda do Norte/epidemiologia , SARS-CoV-2
11.
BMC Pregnancy Childbirth ; 22(1): 235, 2022 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-35317772

RESUMO

BACKGROUND: The AFFIRM intervention aimed to reduce stillbirth and neonatal deaths by increasing awareness of reduced fetal movements (RFM) and implementing a care pathway when women present with RFM. Although there is uncertainty regarding the clinical effectiveness of the intervention, the aim of this analysis was to evaluate the cost-effectiveness. METHODS: A stepped-wedge, cluster-randomised trial was conducted in thirty-three hospitals in the United Kingdom (UK) and Ireland. All women giving birth at the study sites during the analysis period were included in the study. The costs associated with implementing the intervention were estimated from audits of RFM attendances and electronic healthcare records. Trial data were used to estimate a cost per stillbirth prevented was for AFFIRM versus standard care. A decision analytic model was used to estimate the costs and number of perinatal deaths (stillbirths + early neonatal deaths) prevented if AFFIRM were rolled out across Great Britain for one year. Key assumptions were explored in sensitivity analyses. RESULTS: Direct costs to implement AFFIRM were an estimated £95,126 per 1,000 births. Compared to standard care, the cost per stillbirth prevented was estimated to be between £86,478 and being dominated (higher costs, no benefit). The estimated healthcare budget impact of implementing AFFIRM across Great Britain was a cost increase of £61,851,400/year. CONCLUSIONS: Perinatal deaths are relatively rare events in the UK which can increase uncertainty in economic evaluations. This evaluation estimated a plausible range of costs to prevent baby deaths which can inform policy decisions in maternity services. TRIAL REGISTRATION: The trial was registered with www. CLINICALTRIALS: gov , number NCT01777022 .


Assuntos
Conscientização , Movimento Fetal , Morte Perinatal/prevenção & controle , Gestantes/educação , Gestantes/psicologia , Cuidado Pré-Natal/métodos , Análise Custo-Benefício , Procedimentos Clínicos , Técnicas de Apoio para a Decisão , Feminino , Custos de Cuidados de Saúde , Pessoal de Saúde/educação , Humanos , Irlanda , Irlanda do Norte , Educação de Pacientes como Assunto , Gravidez , Cuidado Pré-Natal/economia , Natimorto , Reino Unido
12.
Nutrients ; 14(4)2022 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-35215452

RESUMO

(1) Background: Vitamin D status has never been investigated in children in Northern Ireland (UK). (2) Methods: Children (4-11 years) (n = 47) were recruited from November 2019 to March 2020 onto the cross-sectional study. Anthropometry was assessed. Plasma 25-hydroxyvitamin D (25(OH)D) was analysed. Vitamin D intake, parental knowledge and perceptions, participant habits, physical activity and sedentary behaviour were established via questionnaire. Muscle strength was assessed via isometric grip strength dynamometry and balance via dominant single-leg and tandem stance. Parathyroid hormone, bone turnover markers (OC, CTX and P1NP), glycated haemoglobin and inflammatory markers (CRP, IFN-γ, IL-10, IL-12p70, IL-13, IL-1ß, IL-2, IL-4, IL-6, IL-8 and TNF-α) were analysed. (3) Results: Mean (SD) 25(OH)D was 49.17 (17.04) nmol/L (n = 47); 44.7% of the children were vitamin D sufficient (25(OH)D >50 nmol/L), 48.9% were insufficient (25-50 nmol/L) and 6.4% were deficient (<25 nmol/L). 25(OH)D was positively correlated with vitamin D intake (µg/day) (p = 0.012, r = 0.374), spring/summer outdoor hours (p = 0.006, r = 0.402) and dominant grip strength (kg) (p = 0.044, r = 0.317). Vitamin D sufficient participants had higher dietary vitamin D intake (µg/day) (p = 0.021), supplement intake (µg/day) (p = 0.028) and spring/summer outdoor hours (p = 0.015). (4) Conclusion: Over half of the children were vitamin D deficient or insufficient. Wintertime supplementation, the consumption of vitamin D rich foods and spring/summer outdoor activities should be encouraged to minimise the risk of vitamin D inadequacy.


Assuntos
Deficiência de Vitamina D , Vitamina D , Criança , Estudos Transversais , Suplementos Nutricionais , Humanos , Irlanda do Norte , Avaliação de Resultados em Cuidados de Saúde , Estações do Ano , Deficiência de Vitamina D/epidemiologia
13.
Ulster Med J ; 91(1): 9-18, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35169333

RESUMO

BACKGROUND: Several meningococcal vaccines have been recently introduced into the infant and adolescent vaccination schedules in Northern Ireland to promote immunity to Neisseria meningitidis, protecting against meningococcal septicaemia and meningococcal meningitis. Maintained vaccination uptake is vital in securing individual protection as well as herd immunity. Several social factors have been described in influencing vaccine uptake and therefore it was the aim of this study to examine possible correlations between meningococcal vaccine uptake rates and indicators of social deprivation in Northern Ireland. METHODS: Vaccination data was retrieved from the Cover of Vaccination Evaluated Rapidly (COVER) database, for meningococcal vaccines (MenACWY, HiB/MenC & 4CMenB, as well as for MMR vaccine as a non-meningococcal control). Vaccine coverage data assessed included (i). Two doses of MenB by 12 months, (ii). All 3 doses of MenB by 24 months, (iii). HiB/MenC coverage, (iv). MenACWY (Year 12s, for NI) (v). First dose of MMR. Northern Ireland Multiple Deprivation Measures 2017 (NIMDM2017) were examined against 38 indicators in 7 domains. NI HSCT vaccine uptake dataset for each vaccine was correlated with each indicator in the HSCT NIMDM2017 dataset. Regression analysis was performed to determine the relationship between vaccine uptake and deprivation indicators and coefficient of variation (R2) was calculated for each of the indicators. R2 values >0.7 were considered significant. RESULTS: For 4CMenB (all 3 doses by 24 Months), HiB/MenC, MenACWY and for MMR, correlation of variation (R2) values > 0.7, were obtained for 17, 16, 0 and 17 social deprivation indicators, respectively. Significant deprivation indicators were (i) the proportion of 18-21 year olds, who have not enrolled in higher education courses at higher or further education establishments, (ii) the proportion of domestic dwellings that are unfit, (iii) the proportion of domestic dwellings with Local Area Problem Scores, (iv) rate of burglary, (v) rate of vehicle crime, (vi) rate of antisocial behaviour incidents (per 1,000 population), (vii) absenteeism at primary schools and (viii) the proportion of the population aged 65 and over living in households whose equivalised income is below 60% of the NI median. CONCLUSIONS: Within the last two decades, incidence of meningococcal disease has been on the decline. The introduction of meningococcal vaccines has contributed to this decrease and uptake of such vaccines should remain a public health priority to maintain the decline in meningococcal disease. Identifying contributing factors to low vaccine uptake, such as, the association between local deprivation and uptake of meningococcal vaccines, should be of public health importance and acknowledged by local governments and policy makers in their efforts to enhance vaccine uptake, both infant and teenage vaccination. There is a clear correlation with educational deprivation measures such as absenteeism and poor educational attainment and reduced vaccine uptake, perhaps through lack of understanding and willingness to vaccinate. This is where the importance of a clear and coherent public health message surrounding meningococcal vaccination should be prioritised, particularly to establish innovative modalities in a multidisciplinary team approach, to reach out to and increase vaccine uptake rates in socially deprived communities in Northern Ireland.


Assuntos
Haemophilus influenzae tipo b , Infecções Meningocócicas , Vacinas Meningocócicas , Neisseria meningitidis , Adolescente , Idoso , Humanos , Lactente , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Irlanda do Norte/epidemiologia , Vacinas Conjugadas
14.
Int J Drug Policy ; 102: 103615, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35172254

RESUMO

BACKGROUND: In 2019-2020, record-high numbers of overdoses have been reported across the UK. We estimated perceived availability to and carriage of naloxone and explored factors associated with carriage among people who inject drugs (PWID) engaged with services in England, Wales, and Northern Ireland. METHODS: Participants were PWID enrolled in the Unlinked Anonymous Monitoring Survey in 2019 who reported past-year injection drug use (n = 2,139). Recruitment occurred through specialist and community drug agencies located across the UK, excluding Scotland. Socio-demographic, behavioural and service use characteristics were self-reported. Participants were asked whether they carry naloxone (timeframe unspecified). If they answered "no", they were further asked whether it is available in their area. Perceived naloxone availability and carriage were estimated by requirement region, classified using the Nomenclature of Territorial Units for Statistics 1. We used the Gelberg-Andersen Model of healthcare access to explore predisposing, enabling and need factors associated with regionally-aggregated naloxone carriage. RESULTS: Perceived naloxone availability was ≥95% in all 11 regions; naloxone carriage varied (mean: 61.1; range: 48%-71%; P<0.01). Among predisposing factors, female gender (adjusted odds ratio (AOR): 1.52; 95% confidence interval (CI): 1.21-1.91) was positively associated with naloxone carriage, whilst recruitment in Yorkshire and the Humber-relative to London-was negatively associated (AOR: 0.55; 95%CI: 0.37-0.82). Among enabling factors, past-year contact with needle and syringe programmes (AOR: 1.74; 95%CI: 1.39-2.18) and currently receiving treatment for drug use (AOR: 1.75; 95%CI: 1.24-2.46) were positively associated with naloxone carriage. Among need characteristics, past-month heroin injection, with or without past-month high-risk drinking or benzodiazepine use, was positively associated with carriage relative to no heroin injection (range of AORs: 1.71-2.58). CONCLUSION: Perceived naloxone availability is very high among PWID attending services in England, Wales, and Northern Ireland. Naloxone carriage is moderately high and varying across regions, and appears improved through recent engagement with harm-reduction programs.


Assuntos
Overdose de Drogas , Usuários de Drogas , Abuso de Substâncias por Via Intravenosa , Overdose de Drogas/tratamento farmacológico , Feminino , Humanos , Naloxona , Irlanda do Norte/epidemiologia , Abuso de Substâncias por Via Intravenosa/complicações , País de Gales/epidemiologia
15.
Injury ; 53(4): 1455-1458, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35168760

RESUMO

INTRODUCTION: There is good evidence to support that major trauma networks significantly reduce morbidity and mortality in severely injured patients. However, following the introduction of major trauma centres (MTCs) in England in 2012, early concerns were raised regarding the effect on hip fracture patients. The aim of our study was to review data from the National Hip Fracture Database for fractured neck of femur (FNOF) patients, comparing patient outcomes between MTCs and trauma units (TUs), and the national regions of the UK. METHODS: NHFD data from 2018 for all hospitals in England, Wales and NI was collected using the charts and dashboards available online. We recorded data for the following outcomes: time to surgery, acute hospital length of stay, overall hospital length of stay, discharge to original residence within 120 days, crude 30-day mortality and adjusted 30-day mortality. We conducted a one-way ANOVA test to calculate statistical differences for each outcome measure by MTC vs TU and then separately for the regions of the UK divided into England, Wales and Northern Ireland (NI). RESULTS: Data for 175 hospitals are included in this study; 22 of which were MTCs. The total number of operative cases were 65,848. 9668 of these occurred in MTC compared to 56,180 in TUs. This equates to an annual average of 439 per MTC and 367 per TU. Despite this, there was no statistically significant difference observed in all outcomes for MTC vs TU. Patients in NI waited longer for their surgery (60.3 h, p < 0.001), whilst patients in Wales had the longest overall hospital length of stay (31.6 days, p < 0.001). However, there was no difference in patients' crude 30-day mortality (p = 0.480) or adjusted 30-day mortality (p = 0.191). CONCLUSION: These findings are reassuring for MTCs in England. We found no evidence to suggest that FNOF patients are treated inferiorly, or have worse outcomes, at MTCs vs TUs. FNOF patients in NI waited longer for their surgery but this did not have any significant difference on 30-day mortality rates. The care of FNOF patients in NI may warrant further study.


Assuntos
Fraturas do Quadril , Centros de Traumatologia , Bases de Dados Factuais , Inglaterra , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Humanos , Tempo de Internação , Irlanda do Norte , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , País de Gales
17.
Vet Rec ; 190(2): 59, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35061253
18.
Child Abuse Negl ; 125: 105455, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35078089

RESUMO

BACKGROUND: Trauma and adverse experiences among perpetrators of intimate partner violence (IPV) have been associated with more serious patterns of offending. OBJECTIVE: To examine 1) how traumatic and adverse experiences cluster together and co-occur among IPV perpetrators, and 2) whether different patterns of trauma exposure are associated with specific mental health problems. PARTICIPANTS AND SETTING: The sample consisted of 405 convicted IPV perpetrators from Northern Ireland. METHODS: Data was collected between 2018 and 2019. Latent class analysis identified typologies of exposure to traumatic and adverse experiences. A series of binary logistic regression analyses explored associations between the identified classes and five categories of probable mental health problems. RESULTS: Three adversity classes were identified: a baseline class (59.2%), characterised by relatively low levels of exposure to most types of adversity; a 'childhood adversity' class (32.9%), with high levels of childhood adversity; and a 'community violence and disadvantage' class (7.9%), which had high probabilities of endorsing adversities related to economic hardship and community violence. Regression analyses showed that the childhood adversity class was significantly associated with increased likelihood of all categories of mental health problems, except for neurodevelopmental disorders (ORs = 1.77-3.25). The community violence and disadvantage class was significantly associated with probable mood and anxiety disorder (ORs 3.92 and 8.42, respectively). CONCLUSIONS: Different patterns of exposure to adversities were associated with distinct mental health problems in the present sample. Early intervention to prevent poly-victimisation, the clustering of adversities in childhood and the resulting accumulation of risk may be a useful component of preventive responses for IPV in Northern Ireland.


Assuntos
Experiências Adversas da Infância , Criminosos , Violência por Parceiro Íntimo , Transtornos Mentais , Experiências Adversas da Infância/psicologia , Experiências Adversas da Infância/estatística & dados numéricos , Criminosos/psicologia , Humanos , Violência por Parceiro Íntimo/psicologia , Análise de Classes Latentes , Transtornos Mentais/epidemiologia , Irlanda do Norte/epidemiologia , Fatores de Risco
19.
Vaccine ; 40(7): 1054-1060, 2022 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-34996643

RESUMO

BACKGROUND: Pneumococcal disease outbreaks of vaccine preventable serotype 4 sequence type (ST)801 in shipyards have been reported in several countries. We aimed to use genomics to establish any international links between them. METHODS: Sequence data from ST801-related outbreak isolates from Norway (n = 17), Finland (n = 11) and Northern Ireland (n = 2) were combined with invasive pneumococcal disease surveillance from the respective countries, and ST801-related genomes from an international collection (n = 41 of > 40,000), totalling 106 genomes. Raw data were mapped and recombination excluded before phylogenetic dating. RESULTS: Outbreak isolates were relatively diverse, with up to 100 SNPs (single nucleotide polymorphisms) and a common ancestor estimated around the year 2000. However, 19 Norwegian and Finnish isolates were nearly indistinguishable (0-2 SNPs) with the common ancestor dated around 2017. CONCLUSION: The total diversity of ST801 within the outbreaks could not be explained by recent transmission alone, suggesting that harsh environmental and associated living conditions reported in the shipyards may facilitate invasion of colonising pneumococci. However, near identical strains in the Norwegian and Finnish outbreaks does suggest that transmission between international shipyards also contributed to those outbreaks. This indicates the need for improved preventative measures in this working population including pneumococcal vaccination.


Assuntos
Infecções Pneumocócicas , Streptococcus pneumoniae , Surtos de Doenças , Finlândia , Genoma Bacteriano , Humanos , Irlanda do Norte , Noruega , Exposição Ocupacional , Filogenia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Polimorfismo de Nucleotídeo Único , Sorogrupo , Sorotipagem , Navios
20.
Acta Orthop ; 93: 164-170, 2022 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-34981127

RESUMO

Background and purpose - Total knee replacement (TKR) can be implanted with or without bone cement. It is currently unknown how the functional outcomes compare. Therefore, we compared the patient-reported outcome measures (PROMS) of both fixation methods. Patients and methods - We performed a propensitymatched comparison of 14,404 TKRs (7,202 cemented and 7,202 cementless) enrolled in the National Joint Registry and the English National PROMs collection programme. Subgroup analyses were performed in different age groups (1) < 55 years; (2) 55-64 years; (3) 65-74 years; (4) ≥ 75 years. Results - The 6-month postoperative Oxford Knee Score (OKS) was significantly (p < 0.001) higher for cemented TKR (35, SD 9.7) than cementless TKR (34, SD 9.9). The OKS was also significantly higher for the cemented TKR in all age groups, except the 55-64-year group. A significantly higher proportion of cemented TKRs had an excellent OKS (≥ 41) compared with cementless (32% vs. 28%, p < 0.001) and a lower proportion of poor (< 27) scores (19% vs. 22%, p = 0.001). This was also observed for all age subgroups. There were no significant differences in EQ-5D points gained postoperatively between the groups respectively (0.31 vs. 0.30, p = 0.1). Interpretation - Cemented TKRs had a greater proportion of excellent OKS scores and lower proportion of poor scores both overall and across all age groups. However, the absolute differences are small and below the minimally clinically important difference, making both fixation types acceptable. Currently the vast majority of TKRs are cemented and the results from this study suggest that this is appropriate.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Artroplastia do Joelho/métodos , Inglaterra/epidemiologia , Humanos , Pessoa de Meia-Idade , Irlanda do Norte/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Sistema de Registros , Resultado do Tratamento , País de Gales
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