Inequalities in HIV testing uptake and needs among men who have sex with men living in Ireland: findings from an internet survey.

OBJECTIVES: HIV disproportionately affects men who have sex with men (MSM) in Ireland. The aim of this study was to improve understanding of HIV testing among MSM living in Ireland to inform prevention and testing initiatives. METHODS: We used data from the MSM Internet Survey Ireland 2015 (MISI 2015), a cross-sectional survey of MSM living in Ireland. We identified factors associated with never having tested for HIV using univariable and multivariable logistic regression. We identified preferred sites for future tests and examined the relationships between unmet HIV testing needs and socio-demographic groups. RESULTS: More than one-third (n = 1006; 36%) of MSM had never tested for HIV. Multivariable logistic regression showed that untested men were more likely to be aged 18-24 years, live outside Dublin, have a lower level of education, be born in Ireland, identify as bisexual, be out to fewer people, and not have had sex with a man in the previous 12 months. The same groups of men also had the least knowledge about HIV and were least confident in accessing an HIV test. Men who had never tested for HIV were more likely to prefer testing by their general practitioner (GP) or using home sampling HIV kits and less likely to prefer testing in a sexual health clinic. CONCLUSIONS: HIV prevention and testing programmes for MSM should be targeted towards younger men, those living outside Dublin and those with lower levels of education. We recommend increased promotion and availability of free HIV testing services in a range of clinical and nonclinical settings (including self-sampling and home testing).

Integration of a recent infection testing algorithm into HIV surveillance in Ireland: improving HIV knowledge to target prevention.

Recent infection testing algorithms (RITA) for HIV combine serological assays with epidemiological data to determine likely recent infections, indicators of ongoing transmission. In 2016, we integrated RITA into national HIV surveillance in Ireland to better inform HIV prevention interventions. We determined the avidity index (AI) of new HIV diagnoses and linked the results with data captured in the national infectious disease reporting system. RITA classified a diagnosis as recent based on an AI < 1.5, unless epidemiological criteria (CD4 count <200 cells/mm3; viral load <400 copies/ml; the presence of AIDS-defining illness; prior antiretroviral therapy use) indicated a potential false-recent result. Of 508 diagnoses in 2016, we linked 448 (88.1%) to an avidity test result. RITA classified 12.5% of diagnoses as recent, with the highest proportion (26.3%) amongst people who inject drugs. On multivariable logistic regression recent infection was more likely with a concurrent sexually transmitted infection (aOR 2.59; 95% CI 1.04-6.45). Data were incomplete for at least one RITA criterion in 48% of cases. The study demonstrated the feasibility of integrating RITA into routine surveillance and showed some ongoing HIV transmission. To improve the interpretation of RITA, further efforts are required to improve completeness of the required epidemiological data.

Influenza in hospitalized children in Ireland in the pandemic period and the 2010/2011 season: risk factors for paediatric intensive-care-unit admission.

Influenza causes significant morbidity and mortality in children. This study's objectives were to describe influenza A(H1N1)pdm09 during the pandemic, to compare it with circulating influenza in 2010/2011, and to identify risk factors for severe influenza defined as requiring admission to a paediatric intensive care unit (PICU). Children hospitalized with influenza during the pandemic were older, and more likely to have received antiviral therapy than children hospitalized during the 2010/2011 season. In 2010/2011, only one child admitted to a PICU with underlying medical conditions had been vaccinated. The risk of severe illness in the pandemic was higher in females and those with underlying conditions. In 2010/2011, infection with influenza A(H1N1)pdm09 compared to other influenza viruses was a significant risk factor for severe disease. An incremental relationship was found between the number of underlying conditions and PICU admission. These findings highlight the importance of improving low vaccination uptake and increasing the use of antivirals in vulnerable children.

High morbidity and mortality associated with an outbreak of influenza A(H3N2) in a psycho-geriatric facility.

In spring 2008, an influenza A subtype H3N2 outbreak occurred in a long stay psycho-geriatric ward and two wards in the intellectual disability services (IDS), part of a large psychiatric hospital. The attack rate in the index ward was 90% (18/20) for patients and 35% (7/20) for staff. It was 14% (1/7) and 17% (2/12) in the affected IDS wards for patients and 0% (0/20) and 4% (1/25) for staff. Many of the laboratory-confirmed cases did not have a fever >38 °C, a typical sign of influenza. Control measures included oseltamivir treatment for cases and prophylaxis for contacts, standard and droplet infection control precautions, active surveillance for early detection and isolation of potential cases. As a result, the outbreak did not spread throughout the hospital. Although the staff vaccination rate (10%) prior to the outbreak was low, we observed a much lower vaccine effectiveness rate in the patients (11%) than in the staff (100%) in the index ward. Vaccination of residents and staff of such facilities remains the key influenza prevention strategy.

Enhanced surveillance of initial cases of pandemic H1N1 2009 influenza in Ireland, April-July 2009.

From 28 April to 18 July 2009 there were 156 cases of pandemic H1N1 2009 influenza confirmed in Ireland. During this time, Ireland was in containment phase, and detailed case-based epidemiological information was gathered on all cases presenting in the community and acute health care setting. Active case finding was performed among contacts of cases. Eighty percent of cases were in people less than 35 years of age and 86% were imported. The most frequent symptoms were fever, sore throat, myalgia and dry cough. Nine people were hospitalized, no fatalities occurred.

Surveillance of the first 205 confirmed hospitalised cases of pandemic H1N1 influenza in Ireland, 28 April - 3 October 2009.

From 28 April 2009 to 3 October 2009, 205 cases of confirmed pandemic H1N1 influenza were hospitalised in Ireland. Detailed case-based epidemiological information was gathered on all hospitalised cases. Age-specific hospitalisation rates were highest in the age group of 15 to 19 year-olds and lowest in those aged 65 years and over. Nineteen hospitalised cases (9%) were admitted to intensive care units (ICU) where the median length of stay was 24 days. Four hospitalised cases (2%) died. Fifty-one percent of hospitalised cases and 42% of ICU cases were not in a recognised risk group. Asthma was the most common risk factor among cases; however, people with haemoglobinopathies and immunosuppression were the most over-represented groups.

Drug use among men who have sex with men in Ireland: Prevalence and associated factors from a national online survey.

BACKGROUND: Little is known about the prevalence and determinants of drug use among men who have sex with men (MSM) in Ireland. The aims of this study were to measure the prevalence of recreational drug use among MSM in a national sample, and to identify sub-groups of MSM who may benefit from targeted preventive interventions. METHODS: The MSM Internet Survey Ireland (MISI) 2015 was a community-recruited, nationally-promoted, self-completed online survey for MSM. MISI 2015 included standardised questions on recreational drugs, poppers, and drugs associated with chemsex (i.e. crystal methamphetamine, GBL/GHB, mephedrone, ketamine). Multivariable-adjusted logistic regression was used to identify factors associated with use of these substances. RESULTS: In the previous year, 36% of MSM used recreational drugs, 33% used poppers, and 7% used drugs associated with chemsex. Five percent were diagnosed HIV-positive. Recreational drug users were significantly younger than non-users (median = 27 vs. 32 years; p < 0.001); popper users were significantly older than non-users (median = 34 vs. 28 years; p < 0.001). The odds of recreational drug use were higher among MSM diagnosed HIV-positive (vs. never tested; AOR 2.27, 95%CI 1.39-3.70). Use of poppers, and use of drugs associated with chemsex, were also higher among MSM diagnosed HIV-positive (vs. never tested; AOR 3.77, 95%CI 2.41-5.90, and AOR 5.87, 95%CI 3.08-11.18 respectively). CONCLUSIONS: The prevalence of recreational drug use is higher among MSM than in the general population in Ireland, and it is particularly high among MSM diagnosed HIV-positive. Targeted harm reduction messages and preventive interventions are warranted to complement population-based approaches to reducing drug use in this population.

Risk groups and uptake of influenza and pneumococcal vaccine in Ireland.

In Ireland, influenza and pneumococcal vaccines are recommended for adults aged 65 years and over and for those with chronic illness or immunosuppression. Influenza vaccine is recommended for healthcare workers (HCWs) and residents of long stay care facilities. Influenza vaccine uptake is only available for those aged 65 years and over. We conducted a survey to estimate the size of risk groups between 18 and 64 years of age, influenza and pneumococcal vaccine uptake in this group, and to determine possible factors influencing vaccine uptake to improve targeted immunisation programmes. Among respondents aged 18-64 years, 136 of 1,218 (11%) belonged to a health risk group; uptake of influenza and pneumococcal vaccine in these risk groups was 28% (95% CI: 20.9-35.4) and 11% (95% CI: 6.7-17.2) respectively. Uptake among persons aged over 65 years was 69% (95% CI: 62.2-74.4) and 41% (95% CI: 35.0-47.9) for influenza and pneumococcal vaccine, respectively. Influenza vaccine uptake among HCWs was 20% (95% CI: 13.1-28.7). Half (47.6%) of influenza-vaccinated respondents reported that their family doctor had recommended it; 60% of non-vaccinated respondents, for whom influenza vaccine was indicated, saw themselves at low risk of influenza.

Characterisation of a smartphone image sensor response to direct solar 305nm irradiation at high air masses.

This research reports the first time the sensitivity, properties and response of a smartphone image sensor that has been used to characterise the photobiologically important direct UVB solar irradiances at 305nm in clear sky conditions at high air masses. Solar images taken from Autumn to Spring were analysed using a custom Python script, written to develop and apply an adaptive threshold to mitigate the effects of both noise and hot-pixel aberrations in the images. The images were taken in an unobstructed area, observing from a solar zenith angle as high as 84° (air mass=9.6) to local solar maximum (up to a solar zenith angle of 23°) to fully develop the calibration model in temperatures that varied from 2°C to 24°C. The mean ozone thickness throughout all observations was 281±18 DU (to 2 standard deviations). A Langley Plot was used to confirm that there were constant atmospheric conditions throughout the observations. The quadratic calibration model developed has a strong correlation between the red colour channel from the smartphone with the Microtops measurements of the direct sun 305nm UV, with a coefficient of determination of 0.998 and very low standard errors. Validation of the model verified the robustness of the method and the model, with an average discrepancy of only 5% between smartphone derived and Microtops observed direct solar irradiances at 305nm. The results demonstrate the effectiveness of using the smartphone image sensor as a means to measure photobiologically important solar UVB radiation. The use of ubiquitous portable technologies, such as smartphones and laptop computers to perform data collection and analysis of solar UVB observations is an example of how scientific investigations can be performed by citizen science based individuals and groups, communities and schools.

Broadband Direct UVA irradiance measurement for clear skies evaluated using a smartphone.

UVA wavelengths (320-400 nm) have been implicated in recent studies to contribute to melanoma induction and skin photoaging in humans and damage to plants. The use of smartphones in UVA observations is a way to supplement measurements made by traditional radiometric and spectroradiometric technology. Although the smartphone image sensor is not capable of determining broadband UVA irradiances, these can be reconstructed from narrowband irradiances, which the smartphone, with narrowband and neutral density filters, can quantify with discrepancies not exceeding 5 %. Three models that reconstruct direct broadband clear sky UVA were developed from narrowband irradiances derived from smartphone image sensor pixel data with coefficients of determination of between 0.97 and 0.99. Reasonable accuracy and precision in determining the direct broadband UVA was maintained for observations made with solar zenith angles as high as 70°. The developed method has the potential to increase the uptake of the measurement of broadband UVA irradiances.

The overnight dexamethasone test is the procedure of choice in screening for Cushing's syndrome.

This study was undertaken to examine the performance of the overnight dexamethasone test, i.e., plasma cortisol level at 8-9 AM following dexamethasone 1 mg by mouth at midnight, in screening for Cushing's syndrome. The participants included 19 patients with Cushing's syndrome (17 with Cushing's disease, 1 with adrenal carcinoma, and 1 with ectopic ACTH syndrome) and 96 patients in whom the possibility of Cushing's syndrome was raised but who did not have the disorder. Utilizing our original very conservative cutoff point of plasma 100 nmol/L (3.62 micrograms/dL) above which Cushing's syndrome was suspected, the sensitivity of the test was 100% but the false positive rate was an unsatisfactory 12.5%. However, the lowest plasma cortisol level achieved following the overnight dexamethasone test in patients with Cushing's syndrome was 259 nmol/L (9.39 micrograms/dL). A plasma cortisol cutoff point of 250 nmol/L (9.06 micrograms/dL) yielded no false negatives and the false positive rate fell to 6.25%. Using a cutoff point of 200 nmol/L (7.24 micrograms/dL) the false positive rate was 7.3%. These performance characteristics of the overnight dexamethasone test compare very favorably with the reported experience of all other screening procedures for Cushing's syndrome including the urinary free cortisol excretion rate and the 48 h dexamethasone test, while the overnight dexamethasone procedure is the simplest for both patients and medical personnel. Since it is possible that some very unusual patients may suppress to plasma cortisol levels lower than that seen in the present study, we now recommend the overnight dexamethasone test using a plasma cortisol cutoff point of 200 nmol/L as the procedure of choice when screening for patients with Cushing's syndrome.

Cerebral insult-like partial status epilepticus in the early-onset variant of benign childhood epilepsy with occipital paroxysms.

Nine children with the early-onset variant of benign childhood epilepsy with occipital paroxysms had protracted, cerebral insult-like, ictal episodes of impairment of consciousness, vomiting, tonic deviation of the eyes and hemi-convulsions or generalized tonic-clonic seizures. Long term follow-up indicates that this is an entirely benign epileptic condition.

Surveillance of tuberculosis in Ireland.

The first disaggregate data on tuberculosis in Ireland were collected in 1998. A total of 424 cases were notified (rate 11.7/100 000 population), of which 241 cases were culture positive and 122 were smear positive pulmonary cases. Only 35 cases were fore

A survey of Irish palliative care services.

There has been no national policy directing the development of palliative care services in Ireland. Over the last 25 years different palliative care services have been established around the country, due largely to a strong and concerted effort on the part of voluntary groups. A study was carried out to determine the structure and process of all adult palliative care services in Ireland, to determine, where possible, the costs of providing these services and to assess the need for palliative care services in Ireland. All adult palliative care services (24 home care services, three inpatient services and one acute hospital service) in existence at the end of 1993 were circulated and 26 returns received (response rate 93 per cent). Twenty-five counties were covered by palliative care services, serving approximately three-quarters of the national population. Less than 10 per cent of patients had non-cancer diagnoses. Wide variation in staffing levels, workload, travelling, assessment of need and finance arrangements was reported. There is a need for further debate on the breadth and scope of palliative care services that should ideally be provided in Ireland, and how they should be funded in the future.

TSH as an index of L-thyroxine replacement and suppression therapy.

When hypothalamic-pituitary function is normal, serum TSH levels measured by ultrasensitive assay yield bioassays of endogenous thyroid action and thus provide an ideal index of thyroid secretion and its relationship to fluctuating endogenous thyroid levels. It is theoretically possible that patients receiving exogenous L-thyroxine for primary hypothyroidism should have suppressed TSH levels if physiological needs are constantly met. To examine this possibility free thyroxine, FT4 and TSH were measured in 90 clinically euthyroid patients receiving treatment with L-thyroxine for primary hypothyroidism. TSH levels were normal in 44, suppressed in 16 and elevated in 30 patients. FT4 levels were normal in 68, elevated in 13 and suppressed in 9 patients. Normal TSH levels were associated with normal FT4 levels in 79.5% of patients, elevated FT4 levels in 13.6% and low FT4 in 6.8%. Suppressed TSH levels were associated with elevated FT4 levels in 37.5% of patients and normal FT4 levels in 62.5%. When FT4 levels were normal, however, TSH levels were normal in only 51.5% and abnormal in 48.5%. We also examined the possibility that FT4 levels may remain within normal range when TSH is suppressed during L-thyroxine treatment for goitre or cancer. FT4 and TSH were measured in 45 patients on L-thyroxine as TSH suppression treatment. TSH was suppressed in 23 patients (51.1%), normal in 20 (44.4%) and elevated in 2 (4.5%). When TSH was suppressed, FT4 was elevated in 30.4% but normal in 69.6% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Tuberculosis in the Republic of Ireland at the end of the 1990s.

There has been limited detailed epidemiological data available on tuberculosis in the Republic of Ireland. The 1998 and 1999 National TB Reports produced by the National Disease Surveillance Centre presented disaggregate national data describing in detail the epidemiology of TB in the Republic of Ireland. Individual case notifications were collated by health boards, forwarded to NDSC where they were entered onto a national TB database and then analysed using Epi-Info. There were 893 cases of TB notified in 1998-1999. It was more common in older age groups and men. 50% of cases occurred in those less than 45 years, an indication of considerable ongoing transmission of tuberculosis. Regional variation in the rate of TB exists and a relatively small proportion of cases occurred in foreign-born patients. TB in HIV positive patients was not common and MDR-TB has also been observed. TB has not disappeared from the Republic of Ireland. Treatment, contact tracing and surveillance need to be maintained and preferably enhanced.

Measurements of occupational ultraviolet exposure and the implications of timetabled yard duty for school teachers in Queensland, Australia: preliminary results.

Simultaneous personal measurements of the occupational ultraviolet exposure weighted to the International Commission on Non-Ionising Radiation Protection hazard sensitivity spectrum (UVICNIRP) were made over a five week period (44 person-days) in the second half of the summer school term of 2012 in Queensland, Australia for individual high school teachers located at latitudes of 27.5°S and 23.5°S. These teachers were employed for the duration of the study in a predominately indoor classroom teaching role, excluding mandatory periods of lunch time yard duty and school sport supervisions. Data is presented from personal measurements made to the shirt collar using polyphenylene oxide (PPO) film UV dosimeters. UVICNIRP exposure data is presented for each week of the study period for the shirt collar measurement site and are further expressed relative to the measured ambient horizontal plane exposure. Personal exposures were correlated with time outdoors, showing a higher exposure trend on days when teachers were required to supervise outdoor areas for more than 2h per week (mean daily exposure: 168Jm(-2)UVICNIRP±5Jm(-2) (1σ)) compared to the study average (mean daily exposure: 115Jm(-2)UVICNIRP±91Jm(-2) (1σ)). Time spent in an open playground environment was found to be the most critical factor influencing the occupational UVICNIRP exposure. A linear model was developed showing a correlation (R(2)=0.77) between the time teachers spent on yard duty and UVICNIRP exposure, expressed relative to ambient. The research findings indicate a greater reduction in personal exposure can be achieved by timetabling for yard duty periods in playground areas which offer more shade from trees and surrounding buildings. All mean daily personal exposures measured at the shirt collar site were higher than the ICNIRP occupational daily exposure limit of 30Jm(-2) for outdoor workers.