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PubMed2000

Attitudes toward clinical guidelines among obstetricians in Northern Ireland.

OBJECTIVES: To evaluate the attitudes of, and the influences on decisions made by, obstetricians in Northern Ireland in order to understand the feasibility of applying guidelines to obstetric practice. DESIGN: Cross-sectional postal survey. SETTING: Northern Ireland. POPULATION: Consultants, senior registrars, registrars, and senior house officers in obstetrics in Northern Ireland (n = 170). Responses were received from 68 x 8% (n = 117), with complete data available for 67 x 1% (n = 114). MAIN OUTCOME MEASURES: An attitudes score was constructed by consolidating responses to a variety of statements about guidelines. Individual responses to guidelines statements and the standardised attitudes T-score were analysed by demographic and practice characteristics. RESULTS: Attitudes toward guidelines were generally positive, with women practitioners more likely to have positive attitudes toward guidelines than did their male counterparts. Younger obstetricians were more likely to report that practitioners should incorporate guidelines into their practices. Doctors who responded that their decisions were influenced by specific tools related to guidelines, such as computerised databases, during the previous three months had more positive attitudes toward guidelines than doctors who did not use such tools. Furthermore, doctors based in teaching hospitals were more likely than others to have been influenced by the guidelines of professional societies. CONCLUSIONS: Generally guidelines appear to be quite well received, with doctors reporting that their practice often is influenced by them. Doctors who reported that their decisions were influenced by guidelines had an especially positive attitude toward them. However, some tools which target the application of evidence-based methods (e.g. computerised databases) are used infrequently by obstetricians. The challenge remains to encourage the further development of guidelines and tools that are useful and appropriate for practitioners.

Adult↗
PubMed1990

Ascertainment and natural history of treated acromegaly in Northern Ireland.

The prevalence of known cases of acromegaly in Northern Ireland in 1984 was 6.3 per 100,000 population. The incidence of newly-diagnosed cases over the preceding 25 years was 5.5 patients per year, or 0.4 patients per 100,000 population per year. This rate would be equivalent to about 200 new cases per year in the United Kingdom. Four options have been available to most of these patients--surgical hypophysectomy (transfrontal or transsphenoidal), pituitary radiotherapy (usually external cobalt beam), drug treatment with bromocriptine, or no treatment. Choice of treatment has been mainly influenced by tumour size, with the larger pituitary adenomas having surgery initially. No single form of treatment has been successful in achieving a clinical remission or cure in more than a minority of cases. The most successful outcome has been where total pituitary ablation has been achieved. Life-table analysis for the whole group shows life expectancy which is not markedly different for that of an age-matched population from Northern Ireland. Morbidity related to long term osteoarthritis and treatment complications remain a major problem. The incidence of malignant tumours is higher than would be expected.

Acromegaly↗
PubMed2000

Reviewing the mid-year population estimates in Northern Ireland.

This article describes the thorough review of the mid-year population estimates for Northern Ireland. No major problems have been identified with the current estimates but a number of enhancements have been put in place. The new figures are consistent with a number of administrative data sources. The overall effect has been to revise the estimated Northern Ireland population by about 6,000 people, or between 0.3 and 0.4 per cent, for each year between 1991 and 1997. The revised estimates for Northern Ireland have been incorporated into the population figures for the United Kingdom included in the Table section of this issue of Population Trends.

Adolescent↗
PubMed2006

Illicit drug users in Northern Ireland: perceptions and experiences of health and social care professionals.

Over the 30 years of conflict, Northern Ireland escaped the worst excesses of illegal drug trafficking and usage. This was in large part due to the 'policing' of local community crime by paramilitaries. However, since the first 'cease-fire' in 1994 the province has witnessed a dramatic and unprecedented rise in the availability of illicit drugs. This increased availability reflects rising consumption of these drugs in the province. The aim of this study was to explore the perceptions that a sample of health and social care professionals' hold of illicit drug users in Northern Ireland. A survey methodology was used. Community settings across Northern Ireland were accessed. Focus groups and face-to-face interviews were used as data collection methods. Thirty-five health and social care professionals took part in this study. Thirty-two took part in six focus groups; three respondents underwent one-to-one interview. The participating professionals reported to have little or no education or training in the care and treatment of illicit drug users. Some stated that they would reject the offer of education and training in this area to prevent contact with illicit drug users. Many displayed strongly negative views of this client group, often expressing a preference not to care for or treat these people, preferring all their care to be given by specialists in illicit drug treatment. These findings indicate that most of the health and social care professionals who took part in this study appear unprepared and unwilling to meet the challenge of caring for illicit drug users. The findings will be of interest to service providers within and outside the UK.

Attitude of Health Personnel↗
PubMed2002

Psychosocial risk factors for heart disease in France and Northern Ireland: the Prospective Epidemiological Study of Myocardial Infarction (PRIME).

BACKGROUND: France has a substantially lower level of premature mortality from cardiovascular diseases (CVD) relative to its comparators. Compared with Northern Ireland, France has one-half the rate, despite having a similar cardiovascular risk profile to Northern Ireland. In this prospective longitudinal study the psychosocial risk hypothesis for CVD was tested. METHOD: A cohort of 9758 men (7359 in France and 2399 in Northern Ireland) aged 50-59 years who were initially free of any CVD were recruited. At baseline the subjects completed a psychosocial questionnaire, measuring hostility, depression, social support, and the Type A behaviour pattern. At 5-years follow-up their clinical status was determined. RESULTS: Multivariate analysis indicated that, contrary to prediction, France had a substantially more negative psychosocial risk profile than Northern Ireland. The psychosocial risk factors were not successful at predicting at 5-years follow-up the hard clinical endpoint of definite fatal/non-fatal myocardial infarction. In the case of the softer clinical endpoint, angina pectoris/unstable angina, only depression predicted outcome with a small effect size. CONCLUSION: The findings provide little support for the psychosocial risk hypothesis. The psychosocial risk profile was more negative in France, the opposite of that predicted. The finding of a relationship between depression and angina may reflect a tendency for individuals who respond negatively on mood state to report more cardiac symptoms irrespective of physical disease state.

Depressive Disorder↗
PubMed2002

Inpatient costs and paramilitary punishment beatings in northern Ireland.

BACKGROUND: Paramilitary punishment beatings are a common occurrence in Northern Ireland. Little is known about the costs such attacks impose on the health service. METHODS: Data was collected retrospectively on victims treated by Northern Ireland's regional specialist orthopaedics unit. Data related to all victims treated in the unit between January 1999 and May 2000. RESULTS: Average inpatient care costs were 2010 Pounds ($2914). There was no significant difference in these between patients who were shot and those who were beaten. CONCLUSION: Punishment beatings present a small but significant cost burden to the health service. A fuller understanding of them from a health care perspective is warranted.

Adolescent↗
PubMed1991

Group membership, strength of group identification and perceptions of violence for locations in Northern Ireland.

118 undergraduate students, all of Northern Irish origin, were asked to rate 60 locations in Northern Ireland for violence and denominational composition. As expected from Social Identity Theory, subjects perceived ingroup locations as less violent than outgroup ones. Contrary to expectations, however, there was no increased differentiation of violence judgements with increasing strength of identity, for which two possible explanations were considered.

Humans↗
PubMed1988

Psychiatric aspects of terrorist violence: Northern Ireland 1969-1987.

For 18 years, Northern Ireland has suffered a changing pattern of civil disorder. Early years were marked by widespread sectarian rioting, shootings, and bombings, which heightened community tension and caused much social and commercial disruption. However, in recent years, terrorist organisations have been more selective in their acts of violence. There are methodological difficulties in assessing the psychological impact of civil disorder and terrorism. But, as well as can be judged from community surveys, hospital admissions and referral data, psychotropic drug usage, suicide and attempted suicide rates, and from assessment of the actual victims of violence, society has not 'broken down' nor has the impact been judged considerable. Possible explanations are discussed.

Civil Disorders↗
PubMed1991

Surgical training posts in Northern Ireland: assessment by surgeons in training.

Northern Ireland has one of the largest surgical training programmes in the United Kingdom. The surgical trainees' assessment of the quality of training provided has been collated prospectively since 1983, and provides a useful insight into the strengths and weaknesses of the programme, as well as the training value of individual posts. The overall quality of clinical training in surgery was considered to be well above average, but some registrars felt that supervision of operative surgery could be improved. Clinical research was considered to be of average quality in the teaching hospitals but below average in district general hospitals. In the current climate of restriction of the number of training posts in general surgery, the views of the trainees should not be neglected in assessing which posts are best suited for training.

Education, Medical, Continuing↗
PubMed1990

Knowledge of HIV infection and AIDS, and attitudes to testing and counselling among general practitioners in Northern Ireland.

All 922 general practitioners in Northern Ireland were sent a questionnaire on human immunodeficiency virus (HIV) infection and the acquired immune deficiency syndrome (AIDS). Five hundred and ninety four general practitioners (64.4%) returned the questionnaire. Thirty eight respondents (6.4%) knew of an HIV positive patient in their practice and 93.3% felt they should be informed if one of their patients was found to be HIV positive at a genitourinary medicine clinic, even without the patient's consent. Of the respondents, 76.8% were willing to be involved in the management of AIDS patients in their practice in cooperation with hospital colleagues but only 37.5% felt confident to provide AIDS counselling and advice. Of the 368 general practitioners who did not feel confident to provide AIDS counselling and advice, 41.3% felt that they had insufficient knowledge and 79.6% felt uncertain of their counselling skills. The information gathered on the administration of injections, taking blood samples and disposal of needles indicated that further education for general practitioners is required to ensure safety at work.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Bovine spongiform encephalopathy in Northern Ireland: epidemiological observations 1988-1990.

This study describes the epidemiological features of bovine spongiform encephalopathy (BSE) in Northern Ireland where the first case occurred in November 1988. They were very similar to those observed in Great Britain except that the annual incidence of BSE in 1990 in Northern Ireland, 2.3 confirmed cases per 10,000 adult cows, was approximately one 10th of that in Great Britain. The findings were also consistent with the current hypothesis that affected cattle had been exposed to a scrapie-like agent via cattle feedstuffs containing ruminant-derived protein. However, a preliminary investigation of the potential sources of infection for cattle in Northern Ireland did not provide any conclusive evidence.

Age Factors↗
PubMed2000

Resource allocation modelling for home-based health and social care services in areas having differential population density levels: a case study in Northern Ireland.

This project arose from deliberations within the Department of Health and Social Services (DHSS) in Northern Ireland concerning the acceptability of the revenue resource allocation methodology they were using. One problem with the method being used had been the absence of a component that adequately reflected the relative costs associated with the differential population densities of the four health boards into which the Province is divided. This study investigates a particular element of this issue, viz differences in the travelling distances and times of those health and social service professionals who provide visiting services to patients in their own homes. A modelling approach has been developed and used in conjunction with a comprehensive spatial and geographical information system for Northern Ireland. An important outcome of the study has been estimates of the targets that should be set for the annual health and social care travelling distances and times per head of population in the boards, for a range of home-based services. Also, the project has contributed to decisions made by the DHSS in Northern Ireland concerning the annual financial compensations required by boards for costs associated with their relative population densities.

Catchment Area, Health↗
PubMed2004

Equity of use of inpatient services by the two communities in Northern Ireland.

OBJECTIVE: There is concern about whether public services in Northern Ireland are equitably targeted across the religious divide. This study investigates whether use of acute hospital inpatient services differs by religious denomination, after adjusting for supply and for identified demographic, morbidity and socio-economic determinants of need for such services. METHODS: Hospital utilisation at small area level was modelled against a wide range of potential health and socioeconomic factors. Spatial interactive modelling was used to estimate the effect of supply of hospital beds and other facilities on hospital utilisation. Two-stage weighted least-squares regression was used to model utilisation against need and supply. RESULTS: There was a clear positive relationship between the proportion of Roman Catholics in a ward and both need for and utilisation of inpatient services. The higher levels of relative utilisation in wards with a greater proportion of Catholics persisted after controlling for needs but not when supply variables were also entered in the regression equation. The surviving needs drivers were: uptake levels of 'income maintenance' benefits, all-ages standardised mortality ratio, low birth weight and elderly people living alone. Most of these indicators of need are positively correlated with proportion of Catholics. CONCLUSIONS: When both need and supply factors are taken into account, there appears to be no significant effect of religion on inpatient hospital use in Northern Ireland. Efforts to ensure socio-economic equity between the two communities should focus on ensuring that hospital rationalisation does not lead to disadvantage and on reducing socio-economic differentials between the Catholic and Protestant communities.

Catchment Area, Health↗
PubMed1989

Living on their nerves: nervous debility in Northern Ireland.

Divis Flats was a high-rise public housing project on the Falls Road in Belfast, Northern Ireland. It was frequently described as the worst ghetto in Western Europe, and was widely reputed to be a political hotbed, an Irish Republican Army stronghold, and one of the most violent housing estates in the United Kingdom. The complex exhibited some of the worst manifestations of Northern Ireland's considerable political, economic, social, health, and housing problems, and had been the scene of some of the worst violence that had occurred since the outbreak of the political "troubles" (as the war in Northern Ireland is euphemistically called) in 1969. Generalized ghetto conditions in combination with political violence created a powerful environment for the development of nervous complaints, and many people in Divis Flats, but particularly women, suffered from "nervous debility" or "bad nerves." Although this problem derived from multiple causes--political, economic, and social--terror stands out as the single most important causal factor. This article describes and analyzes the causes and experience of "nerves" and explores the relationship between gender and nerves in a Northern Irish ghetto.

Female↗
PubMed2004

Alcohol consumption and cardiovascular disease: differential effects in France and Northern Ireland. The PRIME study.

BACKGROUND: The effects of wine and other alcoholic beverages on coronary heart disease (CHD) have seldom been studied in several countries using a common methodology. DESIGN: Five-year prospective study conducted among 9750 men (7352 in France and 2398 in Northern Ireland) free of CHD at entry. Outcomes were angina pectoris, myocardial infarction or CHD death. RESULTS: In all, 90% of subjects in France reported drinking at least once per week, versus 61% in Northern Ireland. In France, after adjusting for other CHD risk factors, subjects in the highest quartile of alcohol consumption had a significantly lower risk of developing angina pectoris relative to non-drinkers. For myocardial infarction and all CHD events, the risk also decreased from the first to the fourth quartile (P for trend=0.02). Conversely, in Northern Ireland, no significant relationship was found between alcohol consumption and the incidence of angina pectoris or all CHD events, although alcohol consumption appeared to decrease the risk for myocardial infarction. Similar findings were obtained when the 5% higher alcohol consumers were excluded from the analysis. Finally, splitting the alcohol consumption into wine, beer and spirits did not improve the relationships, the three types of beverage exerting comparable effects on CHD events. CONCLUSIONS: Alcohol consumption patterns exert differential effects on CHD risk in middle-aged men from France and Northern Ireland. Further, the amount of alcohol consumption, rather than the type of alcoholic beverage, is related to both angina pectoris and myocardial infarction in France, whereas no relationship was found in Northern Ireland.

Alcohol Drinking↗
PubMed1998

Clinical study of primary progressive multiple sclerosis in Northern Ireland, UK.

OBJECTIVE: To investigate the clinical and demographic characteristics of primary progressive multiple sclerosis (PPMS) in Northern Ireland and to establish a database of such patients for genetic and immunological studies and future therapeutic trials. METHODS: Diagnosis and categorisation were performed by two neurologists, potential cases being identified from the following sources: neurology outpatient clinics; neurology inpatients; a review of hospital discharges; and an ongoing epidemiological study of multiple sclerosis in Northern Ireland. Only those with a progressive course from onset and a clear history of no prior relapses were accepted. Potential cases were invited for interview and assessment, the minimal record of disability (MRD) being established. RESULTS: One hundred and eleven cases of PPMS have been identified, 63 women and 48 men (ratio 1.3:1), with a mean age at onset of 39.5 (SD 11.0) (range 17-66)years, and mean disease duration of 13.6 (SD 9.3)years. The mean interval between onset and diagnosis was 4.7 (SD 4.2) years. Nineteen patients (17.1%) did not satisfy the requirements for any category in the Poser criteria. Motor disturbance was the commonest mode of onset (67.6%) with visual loss occurring only rarely at onset (3.6%). Kurtzke EDSS scores were concentrated at the upper end of the scale with a median of 6.0 and levels of unemployment and financial dependence were high. CONCLUSIONS: PPMS in Northern Ireland has a generally later age at onset, lower female preponderance, and predominantly motor onset compared with other subgroups of multiple sclerosis. The delay to diagnosis reflects the often insidious onset and the nature of the clinical course makes application of the Poser criteria difficult. Levels of neurological impairment, disability, and handicap as measured by the MRD are high.

Activities of Daily Living↗
PubMed1989

Coping with political violence in Northern Ireland.

Recent community based research, employing a self-assessed measure of psychological distress, has suggested that people in Northern Ireland may be coping relatively well with the stress of continuing political violence. This paper reports a first direct investigation of coping in Northern Ireland. Using two scales from the Folkman and Lazarus Ways of Coping Questionnaire--Distancing and seeking Social Support--an attempt was made to investigate the role of coping in relation to local levels of violence, the appraisal of violence, gender and trait neutoticism. The results indicated that trait neuroticism was not related to the appraisal of levels of violence, but that appraisal was related to both types of coping. In particular, those who perceived the violence to be more serious reported using less distancing, while they also reported seeking the most social support. In addition more women reported seeking social support compared to men. Finally those who lived in a high violence area were more likely to report using distancing than were those from a less violence prone area. These results were taken to support the contention that some form of denial may be the main form of coping in Northern Ireland, and that coping is related more to the appraisal of violence than to actual violence levels, while the appraisal of violence is in turn not related to trait neuroticism.

Adaptation, Psychological↗