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Objectives: To assess the vitamin D status of Irish postmenopausal women during wintertime, and to examine its relationship with serum parathyroid hormone (PTH) and biochemical markers of bone turnover. In addition, the determinants of wintertime serum 25-hydroxyvitamin D (25OH-D) levels in these women were investigated.Design: A cross-sectional observational study.Setting: Cork City, Ireland (52°N).Subjects: Ninety-five apparently healthy, free-living postmenopausal women (aged 51–75 years), not taking any medication and free from any condition likely to affect vitamin D status or calcium/bone metabolism.Results: Forty-eight per cent and 7% of women had serum 25OH-D levels <50 nmol l−1 and <25 nmol l−1, respectively. 25OH-D levels in these women were positively associated with dietary calcium intake (P=0.0002) and use of vitamin D-containing supplements (P=0.031), and negatively associated with cigarette smoking (P=0.027) and body mass index (BMI) (P=0.030). Low serum 25OH-D levels (<50 nmol l−1) were associated (P<0.01) with elevated serum PTH levels. There were no significant differences in urinary pyridinium crosslinks or serum osteocalcin, biochemical indices of bone turnover, between subjects with serum 25OH-D levels above or below 50 nmol l−1.Conclusion: A high proportion of Irish postmenopausal women had low vitamin D status (<50 nmol l−1) during late wintertime, which appeared to lead to elevated levels of serum PTH but not of bone turnover markers. Use of regular low-dose supplemental vitamin D, meeting daily calcium recommendations, cessation of smoking and maintaining BMI in the normal range are important factors that could help maintain adequate vitamin D levels during wintertime in these women. [ABSTRACT FROM AUTHOR]

Objectives: The public health impact of the Irish Making Every Contact Count (MECC) brief intervention programme is dependent on delivery by health care professionals. We aimed to identify enablers and modifiable barriers to MECC intervention delivery to optimize MECC implementation., Design: Online cross-sectional survey design., Methods: Health care professionals (n = 4050) who completed MECC eLearning were invited to complete an online survey based on the Theoretical Domains Framework (TDF). Multiple regression analysis identified predictors of MECC delivery (logistic regression to predict delivery or not; linear regression to predict frequency of delivery). Data were visualized using Confidence Interval-Based Estimates of Relevance (CIBER)., Results: Seventy-nine per cent of participants (n = 283/357) had delivered a MECC intervention. In the multiple logistic regression (Nagelkerke's R 2  = .34), the significant enablers of intervention delivery were 'professional role' (OR = 1.86 [1.10, 3.15]) and 'intentions/goals' (OR = 4.75 [1.97, 11.45]); significant barriers included 'optimistic beliefs about consequences' (OR = .41 [.18, .94]) and 'negative emotions' (OR = .50 [.32, .77]). In the multiple linear regression (R 2  = .29), the significant enablers of frequency of MECC delivery were 'intentions/goals' (b = 10.16, p = .02) and professional role (b = 6.72, p = .03); the significant barriers were 'negative emotions' (b = -4.74, p = .04) and 'barriers to prioritisation' (b = -5.00, p = .01). CIBER analyses suggested six predictive domains with substantial room for improvement: 'intentions and goals', 'barriers to prioritisation', 'environmental resources', 'beliefs about capabilities', 'negative emotions' and 'skills'., Conclusion: Implementation interventions to enhance MECC delivery should target intentions and goals, beliefs about capabilities, negative emotions, environmental resources, skills and barriers to prioritization., (© 2023 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Purpose: Lung cancer is the most common malignancy and the leading cause of cancer death globally. Lung cancer incidence and mortality are highest among socioeconomically deprived individuals. This study explored awareness and help-seeking for early signs and symptoms of lung cancer among high-risk individuals., Methods: Participation was sought from multiple community centres and organisations in high-incidence and socioeconomically deprived areas in Ireland. Semi-structured focus groups were conducted with individuals at risk for lung cancer. Data were analysed using thematic analysis., Results: Five focus groups were conducted with 46 participants. Two themes were identified: (i) lung cancer awareness, beliefs, and experiences and (ii) help-seeking for early signs and symptoms of lung cancer. Participants had fragmented knowledge of lung cancer and associated this malignancy with death. Symptom change, persistence, seriousness, and family history of lung cancer served as triggers to help-seeking. General practitioners were identified as the first point of contact for symptoms of concern, yet their presumed negative attitudes towards smokers served as barriers to help-seeking. Other barriers included symptom misappraisal, fear, denial, use of self-help measures, being inherently a non-help seeker, and machoism and stoicism among men., Conclusion: Study findings offer guidance regarding lung cancer knowledge gaps and barriers to help-seeking that ought to be considered in public health interventions aimed to promote lung cancer awareness and early detection., Clinical Implications: This study highlights the need for healthcare professionals to adopt a non-judgmental approach during consults for symptoms indicative of lung cancer. This can potentially help detect lung cancer early., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Barrett's esophagus (BE) is the main pathological precursor of esophageal adenocarcinoma (EAC). Progression to high-grade dysplasia (HGD) or EAC from nondysplastic BE (NDBE), low-grade dysplasia (LGD) and indefinite for dysplasia (IND) varies widely between population-based studies and specialized centers for many reasons, principally the rigor of the biopsy protocol and the accuracy of pathologic definition. In the Republic of Ireland, a multicenter prospective registry and bioresource (RIBBON) was established in 2011 involving six academic medical centers, and this paper represents the first report from this network. A detailed clinical, endoscopic and pathologic database registered 3,557 patients. BE was defined strictly by both endoscopic evidence of Barrett's epithelium and the presence of specialized intestinal metaplasia (SIM). A prospective web-based database was used to gather information with initial and follow-up data abstracted by a data manager at each site. A total of 2,244 patients, 1,925 with no dysplasia, were included with complete follow-up. The median age at diagnosis was 60.5 with a 2.1:1 male to female ratio and a median follow-up time of 2.7 years (IQR 1.19-4.04), and 6609.25 person years. In this time period, 125 (5.57%) progressed to HGD/EAC, with 74 (3.3%) after 1 year of follow-up and 38 (1.69%) developed EAC, with 20 (0.89%) beyond 1 year. The overall incidence of HGD/EAC was 1.89% per year; 1.16% if the first year is excluded. The risk of progression to EAC alone overall was 0.57% per year, 0.31% excluding the first year, and 0.21% in the 1,925 patients who had SIM alone at diagnosis. Low-grade dysplasia (LGD) progressed to HGD/EAC in 31% of patients, a progression rate of 12.96% per year, 6.71% with the first year excluded. In a national collaboration of academic centers in Ireland, the progression rate for NDBE was similar to recent population studies. Almost one in two who progressed was evident within 1 year. Crucially, LGD diagnosed and confirmed by specialist gastrointestinal pathologists represents truly high-risk disease, highlighting the importance of expertise in diagnosis and management, and providing indirect support for ablative therapies in this context., (© The Author(s) 2020. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The Covid-19 pandemic has brought unprecedented pressure to healthcare systems worldwide, resulting in significant and precipitous changes in demand, burden and method of delivery. The psychosocial impact of this crisis is likely to increase over the course of the pandemic, peak later than medical cases and endure for longer thereby significantly exceeding medical morbidity. It will have far reaching impact on the individual, their family and their care providers. Frontline healthcare workers and those with pre-existing mental health difficulties are recognised at increased risk. Now that the initial surge has been expertly curtailed, it is essential that urgent consideration is now directed towards the mental health implications of the current outbreak and ensure that we are as ready for the increased MH needs of the community as we were for the intensive medical care.

Background: The combined use of the Manchester Triage System (MTS) with the Early Warning Score (EWS) may be useful in ensuring both appropriate prioritisation and continued monitoring in the Emergency Department (ED) leading to early intervention for deteriorating patients thus improving patient outcomes especially in overcrowded EDs., Purpose: Determine the effect of the EWS and MTS on accuracy of the MTS and ED waiting times., Methods: A retrospective cohort chart review of all adult patients who presented to the ED in one large hospital in Ireland (n = 10,048) at three time points between 1st September 2015-30th September 2016; 3 months prior to EWS introduction, implementation month and 9 months post-implementation., Results: Patients were significantly more likely to be categorised as an MTS category 2 (rather than 3-5) after the EWS was introduced (p < 0.001). Waiting times between triage and clinician review (p < 0.05) increased as did total time in the ED (p > 0.001). A similar finding was observed for patients with an MTS of 3-5., Conclusion: Although positive in terms of patient outcomes, the effective and sustained combined use of the MTS and EWS requires increased bed capacity and experienced clinical staff to ensure that the ED journey time reduced rather than increased., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Community-driven development (CDD) initiatives frequently involve funding schemes which are aimed at channelling financial investment into local need and fostering community participation and engagement. This exploratory study examined, through a program theory approach, the design and implementation of a small-scale, community-based fund in Ireland. Observations, documentary analysis, interviews and group discussions with 19 participants were utilized to develop a detailed understanding of the program mechanisms, activities and processes, as well as the experiences of key stakeholders engaged with the funding scheme and its implementation. The findings showed that there were positive perceptions of the scheme and its function within the community. Overall, the availability of funding was perceived by key stakeholders as being beneficial. However, there were concerns over the accessibility of the scheme for more marginalized members of the community, as well as dissatisfaction with the openness and transparency surrounding funding eligibility. Lessons for the implementation of small-scale CDD funds are elaborated and the utility of program theory approaches for evaluators and planners working with programs that fund community-based initiatives is outlined., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Little is known of how cardiopulmonary resuscitation (CPR) decisions are made in Irish long-term care settings., Aim: To examine how CPR decisions are made in Irish long-stay units and those factors associated with use or non-use of CPR., Methods: We surveyed each public long-stay unit and a random sample of private nursing homes across the country., Results: Of the 84 long-stay units that responded (response rate 58%), basic CPR had been performed in 32% and advanced CPR (including defibrillation) in 10%. Only 13% of the units had a written CPR policy. Units performing CPR (N = 35) were closer to an acute hospital, more likely to have short-term residents and more likely to have a CPR policy (all P < 0.05). There were no significant differences between public and private units., Conclusion: The widely disparate approaches to CPR in different Irish long-stay units suggest the need for national guidelines on this issue.

Food safety is a critical factor in the production of farmhouse cheese. In Ireland the varieties of farmhouse cheese produced reflect a much broader range than those produced commercially and some of these cheese varieties are associated with greater microbiological risk. These include cheese produced from unpasteurised milk and soft ripened cheese such as mould or smear-ripened cheeses which have high pH and relatively short ripening times. The aim of this study was to determine the microbiological quality of farmhouse cheeses in Ireland. Three hundred and fifty one cheese samples, from 15 cheese producers, were analysed for microbiological quality on a monthly basis throughout the year. The analyses included enumeration of Escherichia coli, Staphylococcus aureus and Listeria monocytogenes (using the relevant agars) and enrichment for L. monocytogenes. The cheeses selected were produced from ovine, caprine and bovine milk. Both unpasteurised and pasteurised milk cheeses were sampled and these included hard, semi-hard and soft cheeses, internal/external mould-ripened and smear-ripened cheeses and the cheeses represented different geographic regions. Of the cheeses tested, 94% were free of L. monocytogenes, all were within the EU limits for E. coli and only one cheese variety had S. aureus levels above the recommended numbers for the first 6 months of the year. Due to a modified production process the numbers were within the guidelines for the second six months. The results indicate that Irish farmhouse cheeses are of a high microbiological quality.

Listeria monocytogenes is a potentially lethal foodborne pathogen commonly found in the environment. European Union hygiene legislation places responsibility for safety on primary production facilities, including farms, as part of a policy to introduce traceability throughout the food chain. This study aimed to determine the occurrence of L. monocytogenes in the Irish dairy farm environment and in particular the milking facility. Two hundred ninety-eight environmental samples were collected from 16 farms in the southern region of Ireland. A number of farms within the group supply raw milk to the unpasteurized milk cheese industry. The samples taken included cow feces, milk, silage, soil, water, etc. Samples were enriched in Listeria enrichment broth and incubated for 48 h, followed by plating on chromogenic agar Listeria Ottavani & Agosti and further incubation of the plates for 24 to 48 h. Presumptive L. monocytogenes isolates were purified and confirmed by PCR targeting the hly gene. Overall, 19% of the samples (57 of 298) were positive for L. monocytogenes. These were serotyped using conventional and PCR methods; serotypes 1/2a, 1/2b, and 4b made up 78% of the typeable isolates. A correlation was found between the level of hygiene standards on the farm and the occurrence of L. monocytogenes. There was little difference in the occurrence of L. monocytogenes between farms supplying milk to the unpasteurized milk cheese industry and those supplying milk for processing. This study demonstrates the prevalence of L. monocytogenes in the dairy farm environment and the need for good hygiene practices to prevent its entry into the food chain.

Secondary metabolites produced by Penicillium paneum and Penicillium roqueforti from baled grass silage were analyzed. A total of 157 isolates were investigated, comprising 78 P. paneum and 79 P. roqueforti isolates randomly selected from more than 900 colonies cultured from bales. The findings mostly agreed with the literature, although some metabolites were not consistently produced by either fungus. Roquefortine C, marcfortine A, and andrastin A were consistently produced, whereas PR toxin and patulin were not. Five silage samples were screened for fungal metabolites, with two visually moldy samples containing up to 20 mg/kg of roquefortine C, mycophenolic acid, and andrastin A along with minor quantities (0.1-5 mg/kg) of roquefortines A, B, and D, festuclavine, marcfortine A, and agroclavine. Three visually nonmoldy samples contained low amounts of mycophenolic acid and andrastin A. The ability of both molds to produce a diverse range of secondary metabolites in vitro and in silage should be a concern to livestock producers.

Stereotypes which suggest that cardiovascular disease and depression are related to gender can have consequences for the mental and physical health outcomes of both men and women. This study examines how these stereotypes may be reinforced by medical publications advertising for cardiovascular and antidepressant medication. A random sample of 61 (with no repeats) advertisements which appeared in Irish medical publications between July 2001 and December 2002 were analysed using both content and semiotic analysis. Results indicate that the meanings created by advertisers for cardiovascular drugs and antidepressants did in fact gender these products. Women were depicted as the predominant users of antidepressants and men as the main users of cardiovascular drugs. The images used identified two stereotyped patients: the 'male' heart patient and the depressed 'female' patient. Furthermore, the imagery and language used to promote the two categories of medication tended to strengthen gendered associations.

The incidence of fungal growth on baled grass silage was recorded on 35 farms in the Irish Midlands in 2003. Fungal colonies were visible on 58 of 64 bales examined and the number of colonies per bale ranged from 1 to 12. On average, 5% of bale surface areas were affected. The fungus most prevalent on bales was Penicillium roqueforti, present on 86% of bales and representing 52% of all isolates. Other moulds isolated were Penicillium paneum, Geotrichum, Fusarium and mucoraceous species. Schizophyllum commune was observed protruding through the plastic film on bales on 17 of the 35 farms.

In Europe, adolescent substance misuse increased during the 1990s. Ireland has among the highest rates of substance misuse among schoolchildren in Europe. We sought to describe the socio-demographic and drug misuse profile of children presenting to addiction treatment services in Dublin during the 1990s. Of the 9,874 individuals who sought addiction treatment, 1,953 (20%) were aged less than 18 years. There was a sharp increase in the number of children after 1993. The main drug of abuse was an opiate in 48% of cases. Compared to adults, the children were more likely to be female and less likely to inject. As the decade progressed the proportion of girls increased, injecting was reported more frequently and there was a dramatic rise in heroin misuse. Child heroin users were more likely to be female and to be homeless compared to their adult counterparts. This study highlights the need for a dedicated service for child drug users in Dublin., (Copyright 2004 S. Karger AG, Basel)

An Irish pedigree with a strong thrombotic tendency, due to the novel association of antithrombin La Rochelle (N405K) and factor V Leiden is described. Thromboses occurred at a median age of 16 years in four family members, carrying both mutant alleles. Molecular diagnosis was facilitated by the creation of an additional restriction enzyme site (Mnl1) in exon 6 of the antithrombin gene. Both the genes for antithrombin and factor V are located at chromosome 1q23. The molecular data and phenotypic behaviour in this family are strongly suggestive of allelic co-segregation of the mutant alleles.

Background: Asthma prevalence in athletes is variable, depending on the sport and training conditions., Aims: To investigate the prevalence of obstructive airflow limitation, asthma control and lung volume differences in a control group and five groups of collegiate athletes--outdoor field, indoor court, endurance, combat sports and swimming., Methods: Three hundred and five athletes completed a respiratory questionnaire and performed spirometry during normal training conditions, to determine FEV1, FVC and PEFR pre- and at 5, 10 and 15 minutes post-exercise. Between and within group analysis was carried out using single factor and repeated measures ANOVA., Results: Previous diagnosis of asthma was reported by 24%, outdoor field sports 4.9%, indoor court sports 2.3%, endurance events 2.6%, combat sports 3%, swimming 6.9% and controls 4.3%. Mean FEV1 and FVC data, expressed as percentage of predicted, were greatest in swimming and lowest in controls. Swimming showed a significant rise in FEV1 post-exercise, indoor court and endurance sports demonstrated no change and outdoor field, combat and control groups showed a fall in FEV1 post-exercise., Conclusion: Warm humid training conditions appear protective against exercise-induced asthma. The greatest reductions in lung volumes occurred following high intensity exercise under cool conditions in the poorly aerobically conditioned.

Aims: To examine trends in treated opiate misuse and identify factors associated with route of heroin use., Design: Cross-sectional survey., Setting: Services providing addiction treatment in Dublin., Participants: Individuals making their first ever contact seeking treatment for current opiate misuse, between January 1991 and December 1996., Measurements: Data on socio-demographics and current drug use., Findings: The study population was 3981. Over the 6-year period, there was a 330% increase in the number of new attenders. The proportion of females increased. The mean age of first opiate use declined and users began presenting earlier in their opiate-using careers, causing a decline in the age profile of new attenders. Heroin users were more likely to smoke (chase) rather than inject after 1994 (odds ratio 3.3, 95% confidence interval 2.4-4.5). Apart from year of presentation, the other significant independent predictors of chasing as the preferred route of heroin use were being in employment, shorter history of use, less frequent use, younger age, longer period in education and absence of polydrug use. Gender did not independently predict route of use., Conclusions: Ireland has joined the growing number of European countries witnessing a movement towards heroin chasing. This has coincided with a surge in the number of people entering treatment. We are concerned that the greater acceptability of this route of use may be drawing increased numbers of individuals into heroin use.

1725 Irish females aged 15-70+ were included in this analysis to establish the group bone mineral density (BMD) profiles. Each subject was screened for 27 risk factors by questionnaire. Subjects were segregated into normal (N) and non-normal (NN) subgroups on the basis of the questionnaire. BMD of lumbar spine and hip were measured by dual energy X ray absorptiometry (DEXA). A substantial difference in BMD at all sites was observed between subgroups even following adjustment for body mass index and years of exposure to oestrogen. In the subgroup designated as non-normal 42%, 54%, 72% and 69% of those studied had spinal BMD levels > 2SD below mean peak at 55-59, 60-64, 65-69 and 70+ respectively. In comparison, similar age cohorts in the subgroup designated normal were 26%, 46%, 44% and 68% respectively. A marked difference was also observed in the younger age groups (15-34) where the percentage of individuals with spinal BMD levels > 2SD below mean peak was < 1.9% for N and 18.8% for NN. The results of this study suggest that the use of a questionnaire may be a valuable low cost screening tool in the younger groups.

Objective: To determine the incidence, pattern, and severity of injuries resulting from participation in amateur boxing., Design: A prospective 5-month survey of injuries which occurred during competitive amateur boxing and training., Setting: Amateur boxing competitions held in Dublin between November 1992 and March 1993, and the six largest amateur boxing clubs in Dublin., Participants: All the competitors in the tournaments and the > 16 year old members of the boxing clubs., Interventions: Participation in competitive amateur bouts and/or boxing training., Main Outcome Measures: Incidence, pattern, and severity of injuries sustained in competition and training., Results: The incidence of injuries in competition was 0.92 injuries per man-hour of play (or 0.7 injuries per boxer per year), while the incidence in training was 0.69 injuries per boxer per year. Cerebral injuries were reported only in competition, most of these being mild concussion. Hand, wrist and facial injuries were related to direct impact and occurred more frequently in competition than training, while injuries to other body parts were predominantly chronic and training-associated. Shoulder and knee injuries were the most debilitating injuries seen., Conclusions: The yearly risk of injury resulting from participation in amateur boxing is relatively low when compared with other sports. Cerebral injuries, which occur almost exclusively in competition, are predominantly mild concussions.

A prospective study of the serum levels of unfractionated creatine phosphokinase (CPK) in 69 consecutive elderly patients undergoing surgery for hip fracture is reported. Serum unfractionated CPK levels were measured on admission, on the evening following surgery and daily for the first five days post-operatively. All of the CPK levels measured on admission were within the normal range for this laboratory. A gradual rise in CPK levels followed surgery. On the evening following surgery 75% of values were greater than the upper limit of the normal reference range. The peak values were seen on day 1 post-operatively but 25% of values were still less than the reference maximum. A gradual decline was seen after this and at day 5 post operatively 50% of values were within the normal reference range. A single unfractionated CPK determination is not of diagnostic benefit in the post-operative period in elderly patients with hip fracture. However, patients with intracapsular and intertrochanteric fractures do not show elevation of unfractionated CPK levels prior to surgery.