Search

Background: Finland, Ireland and the United Kingdom have the highest rates of coronary heart disease (CHD) mortality among EU-15 countries. This study examines the pace of change in CHD mortality in these countries from 1985-2006. Methods: The percentage change in 5-year average all age, under 65 and 65 years and over age standardized mortality rates from 1985-89 to 2002-06 was calculated for each country. Joinpoint regression analysis was used to analyse age standardized mortality rates to identify points (years) where the slope of the linear trend changed significantly. The pace of change in the CHD mortality rate was measured using annual percentage change (APC). Results: The percentage change in 5-year age standardized (under 65) CHD mortality rates was similar in Finland and the UK for both genders whereas in Ireland the rate of change was greater, especially for females. The percentage change in ≥65 year and all age rates was between 8.2% and 12.4% lower for Finnish males, and between 11.6% and 13% lower for Finnish females compared to their Irish and UK counterparts. There were different turning points in the downward trend in CHD mortality across the three countries varying from 1991-2003. The APC in CHD mortality after the turning point was greatest for Irish males (all age =-7.3%, under 65=-8.2% and 65 and over=-7.1%), and Irish females (under 65=-7.2%). Conclusion: We have identified differing pace of decline in three countries with similar burden of disease and successful national strategies to control CHD. [ABSTRACT FROM AUTHOR]

Background: In responding to Covid-19, governments have tried to balance protecting health while minimizing gross domestic product (GDP) losses. We compare health-related net benefit (HRNB) and GDP losses associated with government responses of the UK, Ireland, Germany, Spain and Sweden from UK healthcare payer perspective., Methods: We compared observed cases, hospitalizations and deaths under 'mitigation' to modelled events under 'no mitigation' to 20 July 2020. We thus calculated healthcare costs, quality adjusted life years (QALYs), and HRNB at £20,000/QALY saved by each country. On per population (i.e. per capita) basis, we compared HRNB with forecast reductions in 2020 GDP growth (overall or compared with Sweden as minimal mitigation country) and qualitatively and quantitatively described government responses., Results: The UK saved 3.17 (0.32-3.65) million QALYs, £33 (8-38) billion healthcare costs and £1416 (220-1637) HRNB per capita at £20,000/QALY. Per capita, this is comparable to £1455 GDP loss using Sweden as comparator and offsets 46.1 (7.1-53.2)% of total £3075 GDP loss. Germany, Spain, and Sweden had greater HRNB per capita. These also offset a greater percentage of total GDP losses per capita. Ireland fared worst on both measures. Countries with more mask wearing, testing, and population susceptibility had better outcomes. Highest stringency responses did not appear to have best outcomes., Conclusions: Our exploratory analysis indicates the benefit of government Covid-19 responses may outweigh their economic costs. The extent that HRNB offset economic losses appears to relate to population characteristics, testing levels, and mask wearing, rather than response stringency., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: In March 2004, Ireland implemented comprehensive smoke-free regulations. Some were concerned this would cause pub patrons to move their smoking and drinking from inside pubs to inside homes. This article aims to assess whether nationwide smoke-free policies are associated with more smoking or drinking inside the home. Methods: Participants were 1917 adult smokers (>18-years old) from Ireland (n = 582), Scotland (n = 507) and the rest of the United Kingdom (n = 828), which did not have smoke-free laws at the time of the interview, who completed a random digit-dialed telephone survey in February to March 2006. The percentage of alcoholic drinks consumed in the home versus pubs was compared by country as well as the percentage of daily cigarette consumption occurring in the home after work. Results: Irish respondents reported a significantly lower percentage of alcoholic drinks consumed in the home compared to Scotland and the rest of the United Kingdom, and cigarette consumption in the home was comparable in all three regions. Conclusions: Smoking and drinking in the home was not greater in smoke-free Ireland than in the United Kingdom, where there was not a smoke-free law at the time of the survey. These findings add further support to the enactment of comprehensive smoke-free laws, as called for in the Framework Convention on Tobacco Control. [ABSTRACT FROM AUTHOR]

Background Studies confirm the positive effect of sugar-sweetened beverage (SSB) taxation on public health. However, only a few countries in Europe adopt SSB taxes. From a public policy perspective, we investigate the conditions under which countries do or do not follow this evidence. Methods Crisp-set Qualitative Comparative Analysis (QCA) of 26 European Organization of Economic Cooperation and Development countries with and without an SSB tax. We test which configurations of conditions (problem pressure, governmental composition, strategic planning, health care system, public health policies, inclusion of expert advice in policymaking) emerge as relevant in determining adoption and non-adoption between the years 1981 and 2021. Pathways that lead to the presence and absence of SSB taxes are identified separately. Results At least one of the following configurations of conditions is present in countries that introduced taxation: (i) high financial problem pressure, low regulatory impact assessment activity; (ii) high public health problem pressure, a contribution-financed health care system, no holistic strategy for combatting non-communicable diseases (NCDs); (iii) a tax-financed health care system, a holistic NCD strategy, high strategic and executive planning capacity. In countries that did not adopt SSB taxes, we find (i) high regulatory impact assessment activity, high levels of sugar export; (ii) no holistic NCD strategy, high spending on preventive care; (iii and iv) a lack of strategic planning capacity and either a high share of spending on preventive care or inclusion of expert advice. Discussion Evidence inclusion requires clear policy priorities in terms of strategy and resources to promote public health. [ABSTRACT FROM AUTHOR]

Background: Regular breast self-examination (BSE) is a simple, cost-effective way of early breast cancer detection, particularly for women outside eligible screening age and for interval cancers. Although mammographic screening is the current most effective breast screening tool, the importance of regular BSE and breast awareness may be overlooked. The study aimed to identify socio-demographic, lifestyle and health-related factors associated with BSE practice among women in Ireland. Methods: This study was conducted using Wave 4 data from The Irish Longitudinal Study on Ageing (TILDA), which collects healthrelated information from people aged 50 plus in biennial data collection waves. Those women aged 50-64 (eligible breast screening age in 2016) were selected. Following univariate analysis, logistic regression analysis was performed on selected variables to determine the factors independently associated with BSE practice. Results: The prevalence of BSE was 70.7%. There was no significant association found between socio-demographic, lifestyle or health related factors and BSE. On logistic regression analysis, family history of cancer was not found to be associated with increased practice of BSE (Adjusted Odds Ratio (OR) 1.02, 95% Confidence Interval (CI) 0.79-1.31, p=0.86). Having attended for mammogram showed a non-significant reduction in the likelihood of doing BSE (Adjusted OR 0.77, 95% CI 0.58-1.02, p=0.07). Conclusions: There are few studies on BSE from developed countries and this is the first from Ireland. BSE prevalence was 61%, 22.6% and 46.8% from Canada, United Kingdom and United States respectively, and was considerably lower from Asian and African countries. Women in this study were more educated than the general population counterparts, this might have overestimated BSE prevalence and obscured true associations. While we did not identify significant associations there is a suggestion that attending for mammography reduces women’s interest in BSE. Key messages: ) Being ‘Breast Aware’ and BSE are important alongside mammography for early detection of breast cancer. ) In countries where screening mammography is unavailable, BSE is an important detection tool. [ABSTRACT FROM AUTHOR]

Background In Europe, more than 15 million people live with heart failure (HF). It imposes an enormous social, organizational and economic burden. As a reaction to impending impact on healthcare provision, different country-specific structures for HF-care have been established. The aim of this report is to provide an overview and compare the HF-care approaches of Germany, Ireland, the Netherlands and the UK, and to open the possibility of learning from each other's experience. Methods A mixed methods approach was implemented that included a literature analysis, interviews and questionnaires with HF-patients and caregivers, and expert interviews with representatives from healthcare, health service research and medical informatics. Results The models of HF-care in all countries analyzed are based on the European Society of Cardiology guidelines for diagnosis and treatment of HF. Even though the HF-models differed in design and implementation in practice, key challenges were similar: (i) unequal distribution of care between urban and rural areas, (ii) long waiting times, (iii) unequal access to and provision of healthcare services, (iv) information and communication gaps and (v) inadequate implementation and financing of digital applications. Conclusion Although promising approaches exist to structure and improve HF-care, across the four countries, implementation was reluctant to embrace novel methods. A lack of financial resources and insufficient digitalization making it difficult to adopt new concepts. Integration of HF-nurses seems to be an effective way of improving current models of HF-care. Digital solutions offer further opportunities to overcome communication and coordination gaps and to strengthen self-management skills. [ABSTRACT FROM AUTHOR]

Background To date computer models with multiple assumptions have focussed on predicting the incidence of symptomatic cases of COVID-19. Given emerging vaccines, the aim of this study was to provide simple methods for estimating the hidden prevalence of asymptomatic cases and levels of herd immunity to aid future immunization policy and planning. We applied the method in Ireland. Methods For large scale epidemics, indirect models for estimating prevalence have been developed. One such method is the benchmark multiplier method. A further method is back-calculation, which has been used successfully to produce estimates of the scale of a HIV infected population. The methods were applied from March to October 2020 and are applicable globally. Results Results demonstrated that the number of infected individuals was at least twice and possibly six times the number identified through testing. Our estimates ranged from ∼100 000 to 375 000 cases giving a ratio of 1–6 hidden cases for every known case within the study time frame. While both methods are subject to assumptions and limitations, it was interesting to observe that estimates corroborated government statements noting that 80% of people testing positive were asymptomatic. Conclusions As Europe has now endured several epidemic waves with the emergence globally of new variants, it essential that both policy makers and the public are aware of the scale of the hidden epidemic that may surround them. The need for social distancing is as important as ever as we await global immunization rollout. [ABSTRACT FROM AUTHOR]

Background Concerns about the misuse of codeine led to the introduction of guidance restricting the supply of over-the-counter (OTC) codeine-containing products in Ireland in 2010. The aim of this study was to examine the impact of this guidance on the national rate of hospital-presenting self-harm involving codeine-related intentional drug overdose (IDO). Methods Presentations involving IDO to Irish general hospitals between 1 January 2007 and 31 December 2013, as recorded by the National Self-Harm Registry Ireland, were analyzed. Event-based rates per 100 000 were calculated using national population data. Poisson regression models were used to assess rate changes between pre- and post-guidance periods and to calculate excess presentations. Results Between January 2007 and December 2013, a total of 57 759 IDOs were recorded, with 4789 (8.3%) involving a codeine-containing product. The rate of codeine-related IDOs was 20% lower in the period following implementation of the guidance (incidence rate ratio: 0.80; 95% CI: 0.75 to 0.85), representing a total of 509 (95% CI: −624, −387) fewer codeine-related IDOs in that period. Reductions were observed across all ages and were more pronounced for females (0.76, 0.71 to 0.82) than males (0.87, 0.79 to 0.97). The rate of IDOs involving other drugs decreased by 3% in the same period (0.97, 0.95 to 0.98). Conclusion Our findings indicate that the rate of codeine-related IDOs was significantly lower in the period following the implementation of the guidance. There is a large body of evidence supporting the restriction of potentially harmful medication as an effective strategy in suicide prevention. [ABSTRACT FROM AUTHOR]

Background New psychoactive substance (NPS) use can negatively impact health and may result in drug-related hospital admissions (DRHAs). Irish youth reported very high rates of NPS use by international standards, the most common being synthetic cannabinoids and cathinones. There was a rapid expansion in specialist shops, called head shops, selling NPS in 2010. Government responded to public protests about head shops by enacting legislation in May and August 2010 to end this trade. Many academics argued that such actions would prove futile. We sought to determine if changes in head shop activity coincided with changes in DRHA. Methods The national database on admissions to general hospitals hospital in-patient enquiry was examined focusing on young adults admitted from 2008 to 2012, and all emergency admissions with an International Classification of Diseases-10 diagnosis of mental disorder related to any drug (F11–F19) were identified. Joinpoint regression analysis was utilized to explore for the presence of trend changes in DRHA. Results Joinpoint regression analysis identified a significant downward trend change which occurred in June 2010 (95% CI February 2010 to January 2011). DRHA increased by 0.5% (95% CI 0.1–0.9) per month prior to this and then fell by 2.6% (95% CI −1.4 to −3.8) per month over the next 16 months. Conclusions Cessation of NPS sale by head shops coincided with a reversal in the upward trend of emergency hospital admissions related to drugs. Although correlation does not confirm causation, legislation which successfully curtails the commercial sale of NPS may result in reduced hospitalizations. [ABSTRACT FROM AUTHOR]

Ireland has a high rate of doctor emigration. Challenging working conditions and poor work–life balance, particularly in the hospital sector, are often cited as a driver. The aim of this study was to obtain insight into hospital doctors' experiences of work and of work–life balance. In late 2019, a stratified random sample of hospital doctors participated in an anonymous online survey, distributed via the national Medical Register (overall response rate 20%; n  = 1070). This article presents a qualitative analysis of free-text questions relating to working conditions (n  = 469) and work–life balance (n  = 314). Results show that respondent hospital doctors, at all levels of seniority, were struggling to achieve balance between work and life, with work–life imbalance and work overload being the key issues arising. Work–life imbalance has become normalized within Irish hospital medicine. Drawing on insights from respondent hospital doctors, this study reflects on the sustainability of this way of working for the individual doctors, the medical workforce and the Irish health system. If health workforce planning is about getting the right staff with the right skills in the right place at the right time to deliver care, work–life balance is about maintaining doctor wellbeing and encouraging their retention. [ABSTRACT FROM AUTHOR]

Background Identifying ethnic inequalities in health requires data with sufficiently 'granular' (fine detailed) classifications of ethnicity to capture sub-group variation in healthcare use, risk factors and health behaviors. The Robert Wood Johnson Foundation (RWJF), in the USA, commissioned us to explore granular approaches to ethnicity data collection outside of the USA, commencing with the European Union. Methods We examined official data sources (population censuses/registers) within the EU-28 to determine the granularity of their approach to ethnicity. When ethnic information was not available, related variables were sought (e.g. country of birth). Results Within the EU-28, we found 55% of countries collected data on ethnicity. However, only 26% of these countries (England, Wales, Northern Ireland, Scotland, Republic of Ireland, Hungary, Poland and Slovakia) had a granular approach, with half of these being within the UK. Estonia, Lithuania, Croatia, Bulgaria, Republic of Cyprus and Slovenia collected one to six categories. A 'write-in' option only was found in Latvia, Romania and the Czech Republic. Forty-five percent of countries did not collect ethnicity data but collected other related variables. Conclusions (i) Although there is reasonable attention to the diversity of ethnic groups in data collection, a granular approach does not predominate within EU-28 classifications. (ii) Where ethnicity is collected, it is conceptualized in different ways and diverse terminology is used. (iii) A write-in option provides the most granular approach. (iv) Almost half of the countries did not collect data on ethnicity, but did collect related variables that could be used as a proxy. [ABSTRACT FROM AUTHOR]

Background Intentional drug overdose (IDO) is the most common form of hospital-treated self-harm, yet no national study has systematically classified the range of drugs involved using a validated system. We aimed to determine the profile of patients engaging in overdose, to identify drugs frequently used and to quantify the contributions of multiple drug use and alcohol involvement. Methods Between 2012 and 2014, the National Self-Harm Registry, Ireland recorded 18 329 presentations of non-fatal IDO to Irish emergency departments. Information on demographic and overdose characteristics were obtained. Drugs were categorized using the Anatomical Therapeutic Chemical classification system. Results Analgesics (32.4%), antidepressants (21.9%), anxiolytics (21.2%) and hypnotics and sedatives (21.0%) were the most frequently used drugs types involved in overdose. Presentations involving analgesic and antidepressant medication were more common for females whereas males more often took illegal, anxiolytic and hypnotic and sedative drugs. Overdoses with drugs other than those which affect the nervous system were identified, including musculoskeletal drugs, taken in 12.0% of presentations. Paracetamol was the most frequently used drug, particularly among females (32.0%) and persons under 25 years (36.2%). Alcohol was most often present in overdoses involving anxiolytics and illegal drugs. Multiple drug use was a factor in almost half (47.1%) of presentations. Conclusions People who engage in IDO frequently take prescription only or sales restricted drugs, often involving alcohol and/or multiple drug use. These findings highlight the importance of addressing drug and alcohol misuse, potential inappropriate prescribing and the enforcement of legislation restricting specific drug sales. [ABSTRACT FROM AUTHOR]

Background: Many studies have reported a social class gradient within overweight prevalence (1-4). Additionally, cross-country comparisons report high overweight trends and a change in food consumption patterns in countries affected by an economic crisis (5-11). The aim of this study was to assess the association between social class and recession on obesity levels in 3-year-old Irish children. Methods: The population-based infant cohort of the national Growing Up in Ireland (GUI) study was used. Prevalence rates of overweight and obesity were calculated and logistic regression models, adjusting for confounders, were used to examine the relationship between social class, effects of the recession and childhood obesity. Results: In 2008, 19.5% of 9-month-olds were obese and 19.4% overweight increasing to 22.7% and 20.4%, respectively by 2011 when the infants were 3 years old (World Health Organization (WHO) criteria). The prevalence of obesity increased by 2.3% to 10.1% for various social classes (unadjusted). However, adjusting for confounders, there was no evidence of a difference in obesity of 3-year-old children across social classes. There was evidence that obesity was 22-27% higher for families who perceived a very significant crisis effect on their family, compared with those significantly affected. Conclusion: Increases in obesity were found to be significantly associated with perceived recession effects on the family, but not with social class. Policy makers should be aware that in times of economic downturn, public health efforts to promote healthy weight are needed at a population level rather than for specific social classes. [ABSTRACT FROM AUTHOR]

Background: Within the European Union (EU), substantial efforts are being made to achieve economic and social cohesion, and the reduction of health inequalities between EU regions is integral to this process. This paper is the first to examine how self-reported conditions and non-communicable diseases (NCDs) vary spatially between and within countries. Methods: Using 2014 European Social Survey (ESS) data from 20 countries, this paper examines how regional inequalities in self-reported conditions and NCDs vary for men and women in 174 regions (levels 1 and 2 Nomenclature of Statistical Territorial Units, 'NUTS'). We document absolute and relative inequalities across Europe in the prevalence of eight conditions: general health, overweight/obesity, mental health, heart or circulation problems, high blood pressure, back, neck, muscular or joint pain, diabetes and cancer. Results: There is considerable inequality in self-reported conditions and NCDs between the regions of Europe, with rates highest in the regions of continental Europe, some Scandinavian regions and parts of the UK and lowest around regions bordering the Alps, in Ireland and France. However, for mental health and cancer, rates are highest in regions of Eastern European and lowest in some Nordic regions, Ireland and isolated regions in continental Europe. There are also widespread and consistent absolute and relative regional inequalities in all conditions within countries. These are largest in France, Germany and the UK, and smallest in Denmark, Sweden and Norway. There were higher inequalities amongst women. Conclusion: Using newly available harmonized morbidity data from across Europe, this paper shows that there are considerable regional inequalities within and between European countries in the distribution of self-reported conditions and NCDs. [ABSTRACT FROM AUTHOR]

The article presents abstracts on public health reporting topics which include public health reporting systems, utilization and impact in England and Ireland, some hypothesis for public health reporting, and public health reporting systems in Hungary and Malta.

Background: In developed countries, rates of induction of labour (IOL) have increased and vary between hospitals. We aimed to identify whether national variations could be explained by sociodemographic, clinical and organisational differences. Methods: Two national databases in Ireland that routinely collect clinical and administrative data, the National Perinatal Reporting System and the Hospital Inpatient Enquiry Scheme, were used to analyse data for all women with singleton births weighing ≥500 g in 2009. We used logistic multilevel models to examine variation between hospitals, and to determine how much variation was due to individual level sociodemographic, clinical and organisational variables. Analyses were stratified for nulliparas, multiparas without prior caesarean section (CS) and multiparas with prior CS. Results: Of 69 304 eligible births, the rate of IOL nationally was 25.0% (range 14.5-33.2%).In nulliparas, the mean rate was 30.9% (range 18.6-45.7%). The rate was 24.8% (13.5-33.3%) and 3.8% (0.0-10.2%) for multiparas without and with prior CS, respectively. In nulliparas and multiparas without prior CS IOL was predicted by maternal birth in Ireland, increasing birthweight, antepartum complications, giving birth on a weekday and the model of obstetric care. Even after adjusting for known sociodemographic and clinical variables, variation between hospitals remained. Conclusion: We found that clinical, sociodemographic and organisational factors all contributed to variation. However, unexplained variation persisted possibly due to organisational factors such as hospital-specific policies on IOL. The results indicate that the prevalence of antenatal complications, changing immigration patterns and policies on IOL after previous CS are factors likely to influence future IOL rates. [ABSTRACT FROM AUTHOR]

Background: The benefits of breastfeeding for babies, mothers and society have been demonstrated in a large scientific literature. Irish rates of breastfeeding are amongst the lowest in Europe (in 2010, Ireland had the lowest breastfeeding initiation rate of 14 European countries). One of the most distinctive features of breastfeeding behaviour in Ireland is the large difference in breastfeeding rates between immigrants to Ireland and the Irishborn. Data from the 2010 Irish National Perinatal Reporting System show that just 46.1% of Irish-born mothers were breastfeeding at hospital discharge, in comparison with 84.2% of immigrant mothers. Descriptive patterns suggest that breastfeeding behaviour in Ireland may exhibit a ‘healthy immigrant' effect, whereby the health status and behaviours of immigrants are better than the native-born on arrival, but converge to native levels as length of time since migration increases. Methods: Using nationally representative data from two cohorts of children in Ireland, the purpose of this article is to examine the evidence for a ‘healthy immigrant' effect with respect to breastfeeding behaviour. Results: The results indicate that immigrants are significantly more likely to breastfeed than Irish-born mothers, but that immigrant breastfeeding rates converge towards Irish-born rates of breastfeeding as length of time since migration increases. Conclusion: The decline in breastfeeding behaviour among immigrants to Ireland with length of time since migration highlights the need for appropriate interventions aimed at countering the particular negative attitudes to breastfeeding that are observed in Irish society. [ABSTRACT FROM AUTHOR]

Background: Little is known about the differential impact of comprehensive and partial smoke-free legislation on smoking cessation. This study aimed to examine the impact of comprehensive smoke-free workplace legislation in Ireland and England, and partial hospitality industry legislation in the Netherlands on quit attempts and quit success. Methods: Nationally representative samples of 2,219 adult smokers were interviewed in three countries as part of the International Tobacco Control (ITC) Europe Surveys. Quit attempts and quit success were compared between period 1 (in which smoke-free legislation was implemented in Ireland and the Netherlands) and period 2 (in which smoke-free legislation was implemented in England). Results: In Ireland, significantly more smokers attempted to quit smoking in period 1 (50.5%) than in period 2 (36.4%) (p < 0.001). Percentages of quit attempts and quit success did not change significantly between periods in the Netherlands. English smokers were significantly more often successful in their quit attempt in period 2 (47.3%) than in period 1 (26.4%) (p = 0.011). In the first period there were more quit attempts in Ireland than in England and fewer in the Netherlands than in Ireland. Fewer smokers quitted successfully in the second period in both Ireland and the Netherlands than in England. Conclusion: The comprehensive smoke-free legislation in Ireland and England may have had positive effects on quit attempts and quit success respectively. The partial smoke-free legislation in the Netherlands probably had no effect on quit attempts or quit success. Therefore, it is recommended that countries implement comprehensive smoke-free legislation. [ABSTRACT FROM AUTHOR]

Background: In the context of the Irish economic boom we assessed the health, service utilisation and risk behaviour of homeless people in north Dublin city and compared findings with a 1997 study. Methods: A census of homeless adults in north Dublin city was conducted in 2005 using an adapted interviewer-administered questionnaire from the 1997 study. Results: A total of 363 (70%) of the target population participated. Compared to 1997 the population was younger (81% versus 70% under 45 years, P<0.01) with a higher proportion of women (39% versus 29%, P<0.05) and long-term homeless (66% versus 44%, P<0.001). Drug misuse superseded alcohol as the main addiction with a doubling of the proportion reporting past or current drug use (64% versus 32%, P<0.001). The prevalence of comparable physical chronic conditions was largely unchanged while depression (51% versus 35%, P<0.01) and anxiety (42% versus 32%, P<0.05) had increased. There were high rates of blood-borne infections, such as HIV (6%), hepatitis B (5%) and hepatitis C (36%) in 2005 and dental problems (53%) all of which can be associated with drug use. Access to free healthcare had not increased. Similar proportions reported not having medical cards (40% versus 45% NS). Homeless people continued to have higher usage of secondary care services than the general population. Conclusions: This study shows a changing disease profile among the homeless population consistent with a growing drug using population. It confirms that the homeless population in Dublin in terms of health remain excluded from the benefits of an economic boom despite a government policy aimed at redressing social inclusion. [ABSTRACT FROM AUTHOR]

Background: In accordance with World Health Organization recommendations, many European countries have introduced universal hepatitis B vaccination policies. The UK and Ireland are exceptions. In this study, we conducted an economic evaluation of a universal infant hepatitis B vaccination programme, using a six-component vaccine, compared with the current selective strategy of vaccinating high-risk infants with a monovalent hepatitis B vaccine. Methods: A cost effectiveness analysis was conducted using a Markov model. The perspective of the analysis was the Irish Health Service Executive. Unit cost and resource utilization data were derived from expert clinical opinion, published sources, diagnosis-related group costs for hospital admissions and local cost estimates for medical fees and laboratory investigations. A full probabilistic sensitivity analysis was undertaken. Both costs and outcomes were modelled over a period of 80 years and discounted at 3.5%. Results: Assuming an incidence of acute hepatitis B virus (HBV) infection in Ireland of 8.4 per 100000 population, the incremental cost effectiveness ratio ranged from €10992/life years gained (LYG) to €67 200/LYG, at the lowest and highest price estimates for the six-component vaccine, respectively. The cost effectiveness of universal versus selective hepatitis B vaccination was sensitive to the risk of acute HBV infection, the cost of the universal infant vaccination programme and the discount rate. Conclusion: At a cost of €29.00 per dose of the six-component vaccine, universal infant hepatitis B vaccination is cost effective at €37 018/LYG. This compares favourably with other preventive programmes in Ireland. [ABSTRACT FROM AUTHOR]

Background: Over the past 20 years there has been a steady rise in mortality associated with opioid misuse in several Western countries. We aimed to examine trends in opioid-related mortality over a 20-year period in the Republic of Ireland. Methods: Retrospective analysis of deaths attributed to ICD-9 codes 304.0 (morphine-type dependence) and E850.0 (accidental poisoning by opiates and related narcotics) in the Republic of Ireland between 1980 and 1999. Results: The Republic of Ireland has seen a rapid increase in the number of opioid-related deaths over the 20-year period studied, from 0.01% of total deaths in 1980 to 0.15% in 1999. This is most marked in the younger age groups where, for example, it rose to 23% of 15-19 year old male deaths for 1997. The opioid-related mortality rate in the 15-44 years age range increased by nearly 14 times between 1980-1984 and 1995-1999. Over the whole period, 87% of opioid-related deaths were amongst males. Outside Dublin there has been a considerable increase in opioid-related mortality, nearly doubling the percentage of the total from 6% in the 1980s to 11% in the 1990s. Conclusions: Opioid-related mortality is an increasing problem in the Republic of Ireland, as in other Western countries. Today, young people have a very low mortality rate, and hence this rapid increase may need specific targeted interventions. The spread of opioid-related mortality outside Dublin to rural and other urban areas will have implications for service planning and provision. [ABSTRACT FROM AUTHOR]