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PubMed1991

Poor prognosis for malignant melanoma in Northern Ireland: a multivariate analysis.

All cases of cutaneous malignant melanoma, CMM, diagnosed in Northern Ireland between 1974-1978 were reviewed, classified and followed up until the end of 1984. The overall 5 year survival is 54%, among the worst reported in recent literature. Multivariate analysis of these cases confirms some previous findings from other studies, but also reveals features not apparent in univariate analysis. Prognosis worsens with increasing thickness and the presence of ulceration. Likewise histopathological type has an independent effect on survival, ALM having the worst prognosis. Tumour profile emerges as a significant feature affecting prognosis, flat lesions having the poorest outlook, given their thickness. Survival is worse with increasing age. Anatomical site is less important than suggested by previous univariate analysis. Sex has little influence on prognosis when adjusted for the other variables. Cell type and pigmentation are of no prognostic value. Several features including diagnostic delay contribute to the poor overall survival for CMM in Northern Ireland. Educational intervention is essential if this trend is to be reversed.

Female↗

PubMed2003

Phenotypic and genotypic relationship between Campylobacter spp isolated from humans and chickens in Northern Ireland--a comparison of three phenotyping and two genotyping schemes.

Human campylobacteriosis is currently the most common cause of acute bacterial gastroenteritis on the island of Ireland, accounting for over 3,000 laboratory reports per year, where circa 2,000 reports originate from the Republic of Ireland and circa 1,000 reports from Northern Ireland. Elsewhere, consumption of contaminated poultry has been associated with the zoonotic transmission of disease, therefore it was the aim of this study to examine the phenotypic and genotypic relatedness of campylobacters isolated from chickens and humans locally. Sixty isolates were subtyped using phenotyping techniques (biotyping, phage-typing), as well as genotyping techniques (multilocus enzyme electrophoresis (MEE), ribotyping) and the data compared. The frequency of shared phenotypes and genotypes between poultry and humans varied depending on the typing technique employed ranging from 98.2% of human isolates sharing a similar resistotyping (MAST) disc type with poultry strains to 20% similarity with MEE typing. Overall, this small study is the first report on phenotypic and genotypic relatedness between human and poultry campylobacters in Northern Ireland, isolated under controlled conditions. The study demonstrated an association between chicken and human sub-species types, taken from a relatively contained epidemiological environment. Further work is required with larger numbers of isolates coupled with typing schemes, which are able to reliably cluster strains from chicken and humans, which share high degrees of clonality, before local poultry can be conclusively proven to be a significant source of human campylobacteriosis.

Animals↗

PubMed2004

A partnership approach to health promotion: a case study from Northern Ireland.

In recent years there has been a renewal of interest in community development and partnership approaches in the delivery of health and social services in Northern Ireland. The general thrust of these approaches is that local communities can be organized to address health and social needs and to work with government agencies, voluntary bodies and local authorities in delivering services and local solutions to problems. Since the Ottawa Charter was launched in 1986, government in Northern Ireland has stressed that community development should no longer simply be added on to key aspects of Health and Social Services, but should instead be at the core of their work. There is increasing consensus that traditional approaches to improving health and well-being, which have focused on the individual, are paternalistic and have failed to tackle inequalities effectively. Partnerships within a community development setting have been heralded as a means to facilitate participation and empowerment. This paper outlines the policy background to community development approaches in health promotion and delivery in Northern Ireland. Drawing on evidence from a case study of a community health project it highlights the benefits and difficulties with this approach. The findings suggest that partnerships can positively influence a community's health status, but in order to be effective they require effective planning and long-term commitment from both the state and the local community.

Community Health Planning↗

PubMed2002

Physiotherapy management of low back pain: a survey of current practice in northern Ireland.

STUDY DESIGN: A questionnaire survey of physiotherapists treating low back pain. OBJECTIVE: To investigate current clinical practice in the physiotherapeutic management of low back pain in Northern Ireland. SUMMARY OF BACKGROUND: Physiotherapists play an important role in the management of low back pain. However, there is relatively limited evidence about physiotherapy or about current physiotherapeutic management of low back pain. This survey aimed to establish current practice in this area. METHODS: Two sets of questionnaires were completed by physiotherapists during the period 1996-1997: one in relation to their professional profile, and subsequently a questionnaire for each patient referred by physicians to physiotherapy departments in the (government-funded) National Health Service in Northern Ireland. RESULTS: Physiotherapists (n = 157) recorded data for 1062 patients treated for low back pain in 35 outpatient centers across Northern Ireland. Of the patients treated, 70% had a duration of current episode more than 6 weeks; 26% of patients had previously received physiotherapy for low back pain. Physiotherapy treatment most commonly involved advice (89% of patients), McKenzie treatment (70%), Maitland mobilizations (42%), and interferential therapy (30.3%). CONCLUSION AND DISCUSSION: Physiotherapists typically treated subacute and chronic patients, principally using some types of manual techniques and advice, in keeping with current guidelines. However, high levels of the use of electrotherapy, and only limited use of manipulation, indicates the importance of further research to establish optimum management for this group of patients.

Adult↗

PubMed1995

Acinic cell carcinoma in Northern Ireland: a 10-year review.

12 cases of acinic cell carcinoma diagnosed in Northern Ireland from 1942 to 1982 on which there was at least 10 years' follow-up were reviewed, by pooling cases from all regional pathology laboratories. Clinical findings at presentation were established from case notes, together with details of eventual clinical outcome. Sections were examined to determine tumour size, morphological pattern and cytological constitution, the presence or absence of cytological atypia, mitotic activity, lymphocytic and desmoplastic responses, and to assess for infiltrative margins and adequacy of excision. The tumours arose in 8 females and 4 males, aged 22 to 86 years at presentation. Eleven tumours were in the parotid, one in the soft palate. Two patients suffered local recurrence, both more than 7 years after diagnosis. Five patients had regional lymph node metastasis, four at presentation. No patient suffered haematogenous metastasis or died of tumour. Of the features examined, incomplete excision increased the risk of local recurrence. While numbers are small, the acinic cell carcinoma in Northern Ireland is an unpredictable low-grade malignant tumour which is capable of recurrence and metastasis. Adequate excision at presentation appears to be the most appropriate therapy.

Adult↗

PubMed2005

Bed occupancy and turnover interval as determinant factors in MRSA infections in acute settings in Northern Ireland: 1 April 2001 to 31 March 2003.

The following data were obtained from annual hospital statistics in Northern Ireland and from the Communicable Diseases Surveillance Centre (CDSC) Northern Ireland for 2001-2002 and 2002-2003: bed turnover interval (TI), percentage bed occupancy (PO) and methicillin-resistant Staphylococcus aureus rates per 1000 bed-days of patient episodes [MRSA (PE)]. A significant negative correlation was established (r=-0.854; P<0.01) between TI and MRSA (PE) in 2002-2003. A significant positive correlation for PO and MRSA (PE) (r=0.679; P<0.05) was also found for the same year. The correlation for TI and MRSA (PE) in 2001-2002 was r=0.621 (P<0.05), but no significant correlation was established for PO and MRSA (PE) in the same year. Partial correlation indicated that the influence on MRSA (PE) rates was greater for TI than for PO. These results infer that a rapid turnover of patients is an important factor influencing MRSA rates within acute hospitals.

Bed Occupancy↗

PubMed1995

Using census data: religion as a key variable in studies of Northern Ireland.

"For the first time since a question on religion was first included in the Census of Population (in 1861), the recently published results of the 1991 Census show that less than half of the population of Northern Ireland declared themselves as belonging to a Protestant Christian denomination. Discussions surrounding the future political and constitutional arrangements for Northern Ireland frequently include evidence adduced about the relative size of the two 'tribes' widely identified by the labels 'Protestant' and 'Catholic'. The major source of that evidence comes from the question on religion contained in the Northern Ireland Census, and this paper is concerned with the nature and use of that data. The legitimacy of certain uses of the data is questioned; the reliability of the data is considered; and certain tentative findings are presented based on the data published in the (hard copy) reports."

Censuses↗

PubMed1999

Urinary incontinence in Northern Ireland: a prevalence study.

OBJECTIVE: To determine the prevalence of urinary incontinence in a Northern Ireland community drawn from four neighbouring geographical areas and to assess factors predisposing to the development of urinary incontinence. SUBJECTS AND METHODS: A three-page self-administered postal questionnaire was sent to 1050 women (age range 35-74 years), recruited randomly from a target population of 43 829 women. The main survey was preceded by a pilot survey. Respondents and those not responding were compared. RESULTS: The overall response rate was 65.6% (689/1050); there was no significant difference between respondents and those not responding. Two-hundred and thirty-one women (33.5%) reported incontinence 'sometimes' and 161 (23.4%) 'often'. Of those who had urinary incontinence, sanitary protection was required by 21.7% (85/392). This equates to 12.3% (85) of the total study population. Age (chi2=20.34; P<0.001) and parity (Mann-Whitney U-test, P< 0.001) were associated with urinary incontinence, with a higher proportion of women aged 45-54 years having urinary incontinence. The menopause and postnatal pelvic floor exercises were not associated with urinary incontinence. Overall 19.9% (78/392) of women with urinary incontinence had consulted their general practitioner. Of those who required sanitary protection, 40% (34/85) had consulted their doctor. CONCLUSION: Urinary incontinence is common; it is sufficiently severe to require sanitary protection in 12% of women aged 35-74 years in a Northern Ireland community.

Adult↗

PubMed1988

Anxiety and aspects of health behavior among adolescents in Northern Ireland.

A sample of 238 15- to 16-year-old secondary school students from Northern Ireland answered a questionnaire in their schools about the level of anxiety and some aspects of their health behavior. Analysis of the findings showed that these teenagers had no higher anxiety than a Northern American sample of teenagers. In addition, anxiety was clearly correlated with a variety of health complaints and with use of the health service. The findings are discussed with reference to previous research on adolescent health and on stress in Northern Ireland.

Adolescent↗

PubMed1996

Vitamin E and exercise in the Northern Ireland population.

Serum vitamin E, vitamin E/cholesterol and physical activity and fitness were examined in a representative cross section (n = 1600) of the Northern Ireland population as part of the Northern Ireland health and activity survey. Serum vitamin E levels were measured by high-performance liquid chromatography, cholesterol by an enzymatic method, physical activity profile was recorded by computer assisted interview and physical fitness was determined by estimation of VO2 max. The levels of serum vitamin E and vitamin E/cholesterol ratio in the Northern Irish population were similar or higher than in other populations with lower incidences of coronary heart disease. The assessment of activity showed that 75% of the population fell below recommended activity levels likely to confer a cardioprotective effect. A significant relationship (P = 0.01) was found in males between serum vitamin E levels and lifetime participation in physical activity. Otherwise no relationship was found between serum vitamin E or vitamin E/cholesterol ratio and physical activity or fitness in the population.

Adolescent↗

PubMed2002

Clinical screening for developmental dysplasia of the hip in Northern Ireland.

PROBLEM: The incidence of late diagnosed developmental dysplasia of the hip requiring surgery in Northern Ireland is high. The reported incidence was 1.14 per 1000 children born during 1983-7. DESIGN: Comparative retrospective study. BACKGROUND AND SETTING: Clinical screening programme in Northern Ireland. Key measure for improvement: Reduced rate of operative intervention in children with developmental dysplasia of the hip detected after 6 months of age. STRATEGIES FOR CHANGE: Increased emphasis on staff training, introduction of a centralised nurse led clinic to improve access to orthopaedic surgeons, and increased use of ultrasonography. EFFECTS OF CHANGE: The incidence of developmental dysplasia of the hip diagnosed after 6 months in children born between January 1991 and December 1997 fell to 0.59 per 1000, presumably due to improved early detection. Nevertheless, 29 (16%) of the affected hips were not diagnosed when the child was first referred in the first 3 months of life. In addition, for 27 affected hips in children diagnosed after the age of 6 months there was a known risk factor (family history or breech delivery). LESSONS LEARNT: Improvements to screening processes can reduce late incidence of developmental dysplasia of the hip. Further steps to improve detection in children with known risk factors and rate of detection at first referral could reduce late presentation further.

Age Factors↗

PubMed1975

The measurement of drug consumption. Drugs for diabetes in Northern Ireland, Norway and Sweden.

The consumption of insulin and oral antidiabetic drugs was measured at the gross sales level in Sweden and Norway and at the prescription level in Northern Ireland. ""Agreed daily doses'' were used as units of comparison, which defined as follows: insulin 40 I.U., tolbutamide 1 g, acetohexamide 500 mg etc. Consumption was expressed as the number of ""agreed daily doses'' per 1,000 inhabitants per day. This provided a rough estimate of the number of subjects for whom the drug had been prescribed per 1,000 population. The data were collected during the three months April-June 1971. Marked differences in the consumption of antidiabetic drugs were found between the three countries and also between areas within each country. The consumption of insulin was similar in Norway and Northern Ireland (3.5 and 3.9 agreed daily doses per 1,000 inhabitants per day), but almost twice as high in Sweden. In Norway much lower use was found in certain rural areas. The variation in the consumption of oral antidiabetic drugs was even more marked. Surprisingly, consumption was considerably higher in Sweden (15.8) than in the nearby Norway (7.3), and was even lower in Northern Ireland (4.3). The major use was of sulphonylureas, especially chlorpropamide. Within the countries there was marked regional variation in the choice of individual biguanides and sulphonylureas. The data are discussed in relation to such factors as the incidence of diabetes, the sole use of dietary treatment etc. It is concluded that studies in depth, which link the actual use of drugs by patients to diagnosis, diabetic symptoms and clinical outcome of treatment are necessary in order to explore the reasons behind the marked geographical differences and to define a rational drug policy. However, the methods described in the study may be used for early detection of gross national differences in drug utilization, the further investigation of which may reveal to be of great public health interest.

Diabetes Mellitus↗

PubMed2001

An audit of the provision of environmental control systems in Northern Ireland, 1992-1997.

OBJECTIVE: To evaluate the provision of environmental control systems (ECS) in Northern Ireland with regard to assessment and prescription, installation and review and propose guidelines for future service delivery. DESIGN: Structured interview, physical examination, Barthel ADL Index, demonstration and assessment of suitability of ECS for patient. SUBJECTS: Prescriptions for ECS from April 1992 to 1997 were identified from centrally held records. Current users were assessed in their own homes. RESULTS: Forty-six out of 49 current users identified were assessed. All were severely disabled (Barthel 0-9); 24% were living alone; 7 (15%) were not utilizing the system; 96% were satisfied with their initial assessment. Prior to prescription 52% had information about ECS and 20% had a practical demonstration; 78% felt that this would have been useful; 52% of users were not under routine clinical review; 41% of ECS had been altered since installation. Repairs had taken longer than 7 days in 11% of cases. In 45 cases the ECS was essential and in 43 it was appropriate to the users' needs and abilities. CONCLUSIONS: ECS are a valuable tool for severely disabled persons and are appropriately prescribed in Northern Ireland. A multidisciplinary team should perform assessment and prescription. All patients should have a practical trial of the equipment to assist in prescriptions. Regular review by the team should be performed to identify changes in need and alter systems appropriately. Users who live alone should represent a priority for repairs.

Activities of Daily Living↗

PubMed2001

The clinical outcome of non-RhD antibody affected pregnancies in Northern Ireland.

We assessed the clinical outcome of pregnancies with non-Rh-D antibody in Northern Ireland using retrospective case note review. During the study period (April 1999- March 2000) 186 women with clinically significant antibodies were identified from the records of the antenatal laboratory of the Northern Ireland Blood Transfusion Service. Eighty-five women were included in the study using the criteria mentioned above. None of the fetuses required intrauterine transfusion during this period. One baby required exchange transfusion, three were given top-up transfusions and 17 had phototherapy. Nine babies with a positive direct antiglobulin test (DAT) received no treatment. The incidence of anti-Kell could be reduced by transfusing Kell negative red cells to premenopausal women. It is important that all pregnant women are tested at least twice in their pregnancy to detect the antibodies formed late in the pregnancy. It is useful to formulate a standard protocol for antenatal interventions. Non Rh-D antibodies can cause significant anaemia for up to six weeks in the neonatal period, hence early detection of maternal antibodies is important so that the neonates are followed up for an appropriate length of time.

Blood Group Incompatibility↗

PubMed1991

Migration from Northern Ireland: a survey of new year travellers as a means of identifying emigrants.

"Travellers leaving Northern Ireland's air and sea ports at the end of the New Year holiday period 1988 were contacted as a means of identifying potential out-migrants. The method proved to be highly cost effective and reasonably successful. One thousand individuals who had either lived or had been born in Northern Ireland but who were now residing outside the province were obtained from 1,702 traveller contacts. The paper discusses the problems surrounding the representativeness of this sample of emigrants and outlines possible strategies for their resolution. The more significant results of a brief questionnaire survey about migrant origins, destinations, characteristics, motivations and intentions are also presented." (SUMMARY IN FRE AND GER)

Demography↗

PubMed1997

Prescription of oxygen concentrators and survival in Northern Ireland.

Long-term oxygen therapy (LTOT) has been shown to prolong survival and to improve quality of life in patients with chronic obstructive pulmonary disease (COPD) and in respiratory failure. In Northern Ireland oxygen concentrators have been available on prescription since August 1986, initially on a restricted basis from hospital physicians only. This was followed by open prescribing from April 1989, when concentrators could be prescribed by general practitioners. This study examined prescribing habits of LTOT during both periods, and patient survival. Case notes of all prescriptions of oxygen concentrators in Northern Ireland (to April 1991) were reviewed. Prescription criteria and advice regarding usage during both periods were analysed. A questionnaire survey of subjects during open prescribing documented the advice given at the time of prescription and current usage. 164 charts of 178 total installations were available for review. During both periods many concentrators were installed without adherence to the prescribing criteria at the time (75% restricted, 48% open). The majority of these were on the advice of a consultant respiratory physician and only 14 were prescribed directly by GPs. 89 of 91 subjects receiving current LTOT during the study period completed questionnaires. Of the subjects prescribed LTOT during the restricted period, 2 subjects are still alive (median survival 19 m, range 0-104). From the open period, survival data was available on 107 of 129 subjects with 17 still alive (median survival 22 m, range 0-94). This study documents an inadequate rate of prescribing and a lack of conformity to guidelines in the provision of LTOT in Northern Ireland. We would suggest that familiarisation with the prescribing criteria, formal written advice at the time of prescription, appropriate follow up to ensure adequate supplementation and regular patient education on the use of LTOT would address these problems to a substantial degree.

Aged↗

PubMed1991

The development of a programme of care for elderly people in Northern Ireland.

This paper describes the development of a Programme of Care for elderly people in Northern Ireland. The problems of the elderly were previously identified, and a classification system was designed in key areas which allocated groups of individuals with similar needs to particular services. It was thus possible to quantify the resources required to meet the future needs of elderly people in Northern Ireland. The major implications for the Health and Social Services were then stressed on the basis of certain assumptions. Generally, resources are currently being channelled in the right direction but considerable expansion of resources is necessary in the future especially in community care. In showing one method of planning services for the elderly people and the possible results, this study also offers a methodology to assist the planning process in general.

Aged↗

PubMed1992

Tissue concentrations of organochlorine compounds in common seals from the coast of Northern Ireland.

An epizootic of morbillivirus infection killed several hundred common seals (Phoca vitulina) along the coast of Northern Ireland in 1988. Many dead and moribund seals were submitted to the Department of Agriculture for Northern Ireland, Veterinary Research Laboratories for necropsy. Samples of blubber, liver and kidney were collected from these animals (n = 55) for analysis for a wide range of organochlorine pesticides and also total polychlorinated biphenyls (PCBs). The organochlorines found in highest concentrations in blubber were PCBs which were detected in all samples (mean, 26 micrograms g-1 wet wt). sigma DDT (mean, 2.63 micrograms g-1 wet wt) and chlordane (mean, 0.22 micrograms g-1 wet wt) were also present in all samples. Heptachlor including heptachlor epoxide (mean, 0.13 micrograms g-1 wet wt) was present in over 93% of samples. Seventy-four percent of samples contained alpha HCH (mean, 0.035 micrograms g-1 wet wt), 50% contained beta HCH (mean, 0.026 micrograms g-1 wet wt) while gamma HCH (mean, 0.012 micrograms g-1 wet wt) was detected in 46% of samples. The organochlorine concentrations found in this study are at the lower end of the range previously reported for European common seals.

Adipose Tissue↗