Search

Background Patients with enteral feeding tubes are increasingly managed in their home environment and these patients require support from a range of healthcare professionals. Methods A cluster randomised trial of an educational intervention was undertaken among General Practitioners and nurses both in the community and in nursing home caring for patients recently discharged to primary care. This was a short, duration (<1 h), nutrition education programme delivered in the work place soon after the patient was discharged from hospital. The primary outcome was an improvement in knowledge immediately after the intervention and the secondary outcome was knowledge at 6 months. Results Those in the intervention group had improved knowledge, which was significantly greater than those in the control group ( P < 0.001), although this knowledge was not sustained at 6 months. Conclusions A short, work-based targeted nutrition education programme is effective for improving knowledge among general practitioners and nurses both in the community and in nursing homes. [ABSTRACT FROM AUTHOR]

Background: The aim of this pilot retrospective study was to investigate the immunohistochemical expression of Cathepsin S (CatS) in three cohorts of colorectal cancer (CRC) patients (n=560).Methods: Prevalence and association with histopathological variables were assessed across all cohorts. Association with clinical outcomes was investigated in the Northern Ireland Adjuvant Chemotherapy Trial cohort (n=211), where stage II/III CRC patients were randomised between surgery-alone or surgery with adjuvant fluorouracil/folinic acid (FU/FA) treatment.Results: Greater than 95% of tumours had detectable CatS expression with significantly increased staining in tumours compared with matched normal colon (P>0.001). Increasing CatS was associated with reduced recurrence-free survival (RFS; P=0.03) among patients treated with surgery alone. Adjuvant FU/FA significantly improved RFS (hazard ratio (HR), 0.33; 95% CI, 0.12-0.89) and overall survival (OS; HR, 0.25; 95% CI, 0.08-0.81) among 36 patients with high CatS. Treatment did not benefit the 66 patients with low CatS, with a RFS HR of 1.34 (95% CI, 0.60-3.19) and OS HR of 1.33 (95% CI, 0.56-3.15). Interaction between CatS and treatment status was significant for RFS (P=0.02) and OS (P=0.04) in a multivariate model adjusted for known prognostic markers.Conclusion: These results signify that CatS may be an important prognostic biomarker and predictive of response to adjuvant FU/FA in CRC. [ABSTRACT FROM AUTHOR]

Objectives: To measure the effects of the civil unrest (the Troubles) on the mental health of the general population of Northern Ireland. Design: A secondary analysis of a nationally representative population survey conducted in 1997. Setting: Northern Ireland. Methods: This is an analysis of the 1694 respondents (aged 16-64) who had their mental health assessed using the 12 question version of the General Health Questionnaire (GHQ). The effects of the Troubles was based on the responses to two survey questions; one asking about the impact on respondent's area; the second about the impact on the life of the respondent or their family. To model simultaneous effects, multiple logistic regression models were constructed with GHQ case as the dependent variable, the impact of the Troubles questions as independent variables, and the demographic, socioeconomic, and health related factors as covariates. Results: 21.3% (361) of respondents said that the Troubles had either "quite a bit" or "a lot" of impact on their lives or the lives of their families and 25.1% (418) reported a similar impact on their area of residence. The likelihood of psychological morbidity increased the greater the extent to which the Troubles affected the respondent's area or life, the association being stronger for the second factor. Neither demographic nor socioeconomic factors significantly diminished this relation although adjusting for health related factors did attenuate the magnitude of the odd ratios especially for the effects of the Troubles on area of residence. Conclusion: It is probable that mental health of the population of Northern Ireland has been significantly affected by the Troubles. Whether this is attributable to the violence in itself or to other aspects of the Troubles is unclear and whether any additional inputs from psychiatric services are needed requires further study. [ABSTRACT FROM AUTHOR]

The impetus for evidence-based practice arose from the science of maternity and childcare. Yet this has to coexist with patient preferences which are often based on a belief system far removed from science. This paper shows how a superstition, which suggests that moving on a Saturday is unlucky, affects a large proportion of discharges from maternity units in Northern Ireland. This is a descriptive study of the 77 018 patients admitted to maternity units in Northern Ireland between 1994/95 and 1996/97. Overall 3819 (35.7%) fewer patients than expected were discharged on Saturday and 2445 (23.2%) and 1834 (17.4%) more than expected were discharged on Friday and Sunday respectively. This means that at least 8097 patients were probably affected by the superstition. In an evidence-based world patient preferences are still evident. [ABSTRACT FROM AUTHOR]

Purpose: In this paper we highlight the impact which the disruption of secondary care ophthalmic services, resulting from COVID-19, has had on Sight Impairment (SI) and Severe Sight Impairment (SSI) certification in Northern Ireland., Methods: Regional data on SI and SSI certification in the period after the onset of the lockdown (19 March 2020-18 June 2020) were compared to the period immediately before lockdown (1 January 2020-18 March 2020) and to the same periods in 2019. Change documented was compared to post-lockdown reductions in primary and secondary ophthalmic care activity., Results: In 2019, during the 3-month period (19 March 2019-18 June 2019), 115 individuals were certified as sight impaired (SI 36, SSI 75, unspecified 4). Of those certified, 65 were female, 49 male. Principal causes of certification were: Age-related macular degeneration (AMD) (N = 45), glaucoma (N = 20) and diabetic eye disease (DED) (N = 10). Mean VA, recorded from the better eye of those certified, was 0.96 LogMAR. In the 3 months following the onset of lockdown (19 March 2020-18 June 2020), only 37 individuals were certified (SI 6, SSI 31), 12 female and 25 male. AMD was the most frequent cause of sight impairment (N = 20). There were only two DED certifications and one due to glaucoma. Mean VA in the better eye of those certified was 1.15LogMAR. The numbers of CVI certifications completed following the introduction of COVID-19 lockdown fell by 68%, compared to the 2019 data. There was a significant reduction in the proportion of female certifications (p = 0.01), and in certifications due to glaucoma (p = 0.02). The proportion of those certified as SSI as opposed to SI in the period after the onset of lockdown rose from 68% in 2019 to 84% in 2020. The mean VA of those certified in the period after the onset of lockdown, when compared to those certified in the other three periods, was worse by between 0.21 and 0.19 LogMAR (p = 0.06). Reductions reflected change in overall primary and secondary ophthalmic care activity., Conclusions: It is inconceivable that COVID-19 has reduced the incidence of sight-threatening eye disease. We must therefore assume that a flood of newly presenting sight loss will present once the pandemic has passed. New presentations will include those who would normally have attended during the lockdown period, and patients who, had they accessed ophthalmic care at the appropriate time, would have been saved from severe levels of blindness. The implications of the predicted increase in demand for medical, social and low vision related services are huge., (2020 The Authors Ophthalmic and Physiological Optics © 2020 The College of Optometrists.)

Involving people with dementia in decision-making is widely accepted as a means of empowering them to lead more independent lives and have more meaningful roles in shaping their care. However, there is a need to conduct rigorous evaluations of empowerment-driven services and policies in order to develop a deeper understanding about how to optimise successful implementation. This paper presents the results of an evaluation of Dementia Northern Ireland, an organisation initiated and led by people with dementia. We used a realist evaluation approach that comprised interviews with 15 people with dementia, three staff and two board members, ethnographic observations, along with documentary analysis to identify 'what works, for whom, under what circumstances'. The analysis used realist logic to build up context-mechanism-outcome configurations. The Dementia Northern Ireland service model of empowerment revolved around the formation and maintenance of social groups of people with dementia. Facilitators, recruited and selected by people with dementia, supported six groups, consisting of one to four members with mild to moderate cognitive impairment. Facilitators helped expand empowerment groups, facilitate decision-making, awareness raising and consultation opportunities with group members. The 'Empowerment Groups' appeared to lead to the development of a shared social identity and a sense of collective strength as indicated by interview and observational data demonstrating an activist mentality among group members to challenge the stigma surrounding dementia. Group members also reported improved quality of life. Widespread implementation of the empowerment model has the potential to lead to reduced stigma and greater social inclusion, increased involvement of people with dementia as active co-producers of policy and service development, better services and support. This case study of Dementia Northern Ireland illustrates that there are boundaries and challenges to empowerment in terms of requiring additional support from staff without dementia. However, despite these challenges, empowerment-driven organisations can and should be committed to involving members in lead roles and key decision-making.

Communication of risks must involve people with dementia meaningfully to ensure informed and inclusive decision-making processes. This qualitative study explored concepts of risk from the perspective of persons with dementia and their experiences of communicating risk with family members and professionals. Data was analysed using grounded theory. Seventeen people in Northern Ireland with mild-moderate dementia who had recently made a decision about their daily life or care involving consideration of risks were interviewed between November 2015 and November 2016. A wide range of actual or feared risks were identified relating to: daily activities; hobbies and socialising; mental health and medicines; and risks to and from others. 'Risk' often held emotional rather than probability connotations. Constructive communications to address issues were presented. Problem-solving models of both active and passive decision-making about risks were evident. Effective risk communication in informed decision-making processes about health and social care is discussed.

Objectives: A retrospective study was performed to investigate if the generation of X-ray system used was an independent factor for radiation dose in chronic total occlusion (CTO) percutaneous coronary intervention (PCI)., Background: PCI procedures for CTOs are known to be associated with higher doses of radiation. The authors suspected progressive reductions in radiation doses for CTO PCI as newer X-ray systems were introduced into clinical practice., Methods: Procedures performed over a five-year period by three interventional cardiologists were retrospectively reviewed. Five different X-ray systems were used across three hospital sites. These included: Axiom Artis and Coroskop HIP (both Siemens), Innova (GE), Allura Xper FD 10, and Allura Clarity FD 10 (both Philips). Procedural and demographic data including body mass index (BMI; kg/m 2 ), fluoroscopy time (min), and dose area product (DAP; cGycm 2 ) were collated for each procedure. Statistical analysis was performed to compare the influence each X-ray system would have on DAP values after BMI and fluoroscopy time were controlled for., Results: In total, 860 procedures were analyzed. Mean fluoroscopy time was 40.00 ± 19.99 min, mean BMI was 29.90 ± 5.13 kg/m 2 , mean DAP 11,980 ± 7,947 cGycm 2 . Log values of DAP were used to normalize results in a general linear model. A significant statistical difference in DAP between X-ray systems was demonstrated after fluoroscopy time and BMI were controlled for (P ≤ 0.001)., Conclusion: There is a significant impact on DAP values resulting from the generation of X-ray system used, measured during PCI for CTOs, with the most modern systems producing the lowest radiation doses., (© 2018 Wiley Periodicals, Inc.)

Supporting people to live at home in line with community care policies requires increasing attention to assessing, communicating and managing risks. There is a challenge in supporting client choices that include risk-taking while demonstrating professional accountability. Risk communication becomes increasingly important with the need to engage clients and families in meaningful shared decision-making. This presents particular challenges in dementia services. This survey of risk communication in dementia care was administered to all health and social care professionals in community dementia services in Northern Ireland: June-September 2016. Of 270 professionals, 70 questionnaires were fully completed, with 55 partial completions. Scores on the Berlin Numeracy Test plus Schwartz items was low-moderate (mean 2.79 out of 7). This study did not find a significant association between numeracy and accurate perceptions of risk likelihoods in practice-based scenarios. Although 86% reported using numeric information in practice (mostly from assessment tools), respondents rarely communicated themselves using numbers. As in other domains, participants' responses were widely variable on numeric estimates of verbal terms for likelihood. In relation to medication side effects, few participants provided responses that were concordant with those in the guidance of the European Union. The risks most commonly encountered in practice were (in rank order): falls, depression, poor personal hygiene, medicines mismanagement, leaving home unsupervised, financial mismanagement, malnutrition, swallowing difficulties, abuse from others, risks to others, home appliance accidents and refusing equipment. Respondents generally overestimated the likelihood of serious harmful events by approximately 10-fold (having a missing person's report filed with the police; having a fall resulting in hospitalisation) and by approximately double (being involved in a car accident; causing a home fire), and with wide variation between respondents. There is potential in icon arrays for communicating risks. Risk literacy among dementia care practitioners needs to be developed., (© 2017 John Wiley & Sons Ltd.)

Introduction: As general practice (GP) is the main source of referrals to neurologists, neurology education for GP trainees is important. We investigated the existence of neurophobia, contributing factors and potential prevention strategies among GP trainees., Methods: In a questionnaire survey interest, knowledge, confidence and perceived difficulty in neurology were compared with different medical specialties. Reasons for difficulty with neurology, postgraduate neurology education experience, learning methods and suggested teaching improvements were examined., Results: Of 205 GP trainees, 118 (58%) completed the questionnaire. Threshold analyses justified categorical intervals for the Likert responses. Trainees recorded poorer knowledge (p<0.001), less confidence (p<0.001) and more perceived difficulty (p<0.001) with neurology than with any other medical specialty. GP trainees had less interest in neurology than any other medical specialty (Duncan test, p<0.001). There was a similar gradation in difficulty and confidence perception across medical specialties. Hospital and community-based neurology teaching was graded as "poor" or "very poor" by over 60% of GP trainees. There were multiple perceived causes of neurophobia, including neuroanatomy and poor quality teaching. More organised clinical teaching and referral guidance were suggested to address GP neurophobia., Conclusions: Neurophobia is common among GP trainees in Northern Ireland. GP trainees have clear and largely uniform ideas on improving their neurology education. GP training posts should reflect the importance of neurology within the GP curriculum., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Financial incentives have been advocated by the UK and U.S. governments to encourage adoption of healthy lifestyles. However, evidence to support the use of incentives for changing physical activity (PA) behavior is sparse., Purpose: To investigate the effectiveness of financial incentives to increase PA in adults in the workplace., Design: Two-arm quasi-experimental design., Setting/participants: Employees (n=406) in a workplace setting in Belfast, Northern Ireland, UK., Intervention: Using a loyalty card to collect points and earn rewards, participants (n=199) in the Incentive Group monitored their PA levels and received financial incentives (retail vouchers) for minutes of PA completed over the course of a 12-week intervention period. Participants (n=207) in the comparison group used their loyalty card to self-monitor their PA levels but were not able to earn points or obtain incentives (No Incentive Group)., Main Outcome Measures: The primary outcome was minutes of PA objectively measured using a novel PA tracking system at baseline (April 2011); Week 6 (June 2011); and Week 12 (July 2011). Other outcomes, including a self-report measure of PA, were collected at baseline, Week 12, and 6 months (October 2011). Data were analyzed in June 2012., Results: No significant differences between groups were found for primary or secondary outcomes at the 12-week and 6-month assessments. Participants in the Incentive Group recorded 17.52 minutes of PA/week (95% CI=12.49, 22.56) compared to 16.63 minutes/week (95% CI=11.76, 21.51) in the No Incentive Group at Week 12 (p=0.59). At 6 months, participants in the Incentive Group recorded 26.18 minutes of PA/week (95% CI=20.06, 32.29) compared to 24.00 minutes/week (95% CI=17.45, 30.54) in the No Incentive Group (p=0.45)., Conclusions: Financial incentives did not encourage participants to undertake more PA than self-monitoring PA. This study contributes to the evidence base and has important implications for increasing participation in physical activity and fostering links with the business sector., (Copyright © 2013 American Journal of Preventive Medicine.)

Objective: To report trends in underweight, overweight and obesity in 12-15-year-old adolescents and examine changes in dieting behaviour, which have been less well documented., Design: Comparison of two independent representative cross-sectional surveys., Setting: Northern Ireland., Subjects: Weight and height were objectively measured in 1324 boys and 1160 girls in 1996 and 1274 boys and 1374 girls in 2007. Participants reported whether they were following any particular diet including a self-proposed or prescribed weight-reduction diet., Results: Overweight and obesity increased in girls from 15 % to 23 % and 2 % to 6 %, respectively. Increases were more modest in boys with overweight increasing from 13 % to 18 % and obesity from 3 % to 6 %. The proportion of underweight adolescents decreased from 9 % to 6 % in girls and 8 % to 5 % in boys. Evidence of social disparity was observed in girls from a manual socio-economic background, with overweight/obesity prevalence rates increasing from 21 % to 36 % compared with 15 % to 26 % in girls from a non-manual background. Despite these trends fewer adolescents, in particular girls, reported following weight-reduction diets (14 % of overweight/obese girls in 2007 v. 21 % in 1996; 8 % of boys in 2007 v. 13 % in 1996). Of these girls, the proportion from a manual background following weight-reduction diets decreased from 25 % to 11 %., Conclusions: Overweight and obesity are continuing to increase in adolescents despite government and media awareness strategies. There also appears to be reduced dieting behaviour, despite increasing body weight, particularly in girls from manual socio-economic backgrounds.

Objectives: To determine whether the daily use of 5% tea tree oil (TTO) body wash (Novabac 5% Skin Wash) compared with standard care [Johnson's Baby Softwash (JBS)] had a lower incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonization., Patients: The study setting was two intensive care units (ICUs; mixed medical, surgical and trauma) in Northern Ireland between October 2007 and July 2009. The study population comprised 391 patients who were randomized to JBS or TTO body wash., Methods: This was a Phase 2/3, prospective, open-label, randomized, controlled trial., Trial Registration: ISRCTN65190967. The primary outcome was new MRSA colonization during ICU stay. Secondary outcomes included the incidence of MRSA bacteraemia and maximum increase in sequential organ failure assessment score., Results: A total of 445 patients were randomized to the study. After randomization, 54 patients were withdrawn; 30 because of a positive MRSA screen at study entry, 11 due to lack of consent, 11 were inappropriately randomized and 2 had adverse reactions. Thirty-nine (10%) patients developed new MRSA colonization (JBS n = 22, 11.2%; TTO body wash n = 17, 8.7%). The difference in percentage colonized (2.5%, 95% CI - 8.95 to 3.94; P = 0.50) was not significant. The mean maximum increase in sequential organ failure assessment score was not significant (JBS 1.44, SD 1.92; TTO body wash 1.28, SD 1.79; P = 0.85) and no study patients developed MRSA bacteraemia., Conclusions: Compared with JBS, TTO body wash cannot be recommended as an effective means of reducing MRSA colonization.

Annual figures collected by the Samaritans from the Registrar Generals' figures for suicides for the years 1984-2002 inclusive were analysed. Trends by gender, age group, marital status and method were examined. Suicide rates were standardised where appropriate. The mean annual rate was calculated for the 10 year period 1984-1993 and compared with the nine year period 1994-2002. The mean annual rate of suicide increased by 4.7%. Female suicide rates decreased by 17%, male suicides increased by 13.2%. The highest percentage increase was seen in males aged 25-34, (34%) followed by the 15-24 age group, (26.5%). There was a significant upward trend in suicide rates at p<0.01 in young males aged 10-34 and a significant fall in total suicide rates in those aged 35+. The greatest increase in the mean annual rate was seen in those of single status in sexes, males 24.2% and females 28.6%. There was a decrease in the mean annual rate for all methods of suicide except hanging with an increase of 99.37% in males and 87.80% in females.The overall rate of suicide in Northern Ireland appears to be rising. This trend is largely a result of the increase in suicides amongst young males aged 10-34. Violent methods of suicide, namely hanging have increased, suggesting that this more lethal method is contributing to the higher suicide rate.

Objectives: To describe the patterns of computer use during patient visits to family doctors and to determine whether doctors alter their pattern of computer use in consultations which have significant psychological content., Design: Observational, non-randomised cluster trial with data being collected from videotaped consultations., Setting: Three inner-city Family Practice offices involved in physician training in Belfast, Northern Ireland., Participants: Ten family doctors, who declared using computers during their consultations and consecutive consenting adult patients attending these doctors., Results: One hundred consultations were videotaped (59% patient participation rate). The average consultation time was 9min 48s, and number of problems per consultation was 1.9. Three broad styles of computer use were defined: (1) "end users" who only used the computer at the end of a consultation to summarise the consultation, (2) "continuous users", who interacted with the computer throughout the consultation, and (3) "minimal users", who only ever used the computer at the end of the consultation mostly to issue prescriptions. Of the 100 consultations videoed 37% were of a psychological nature. Consultations with psychological content were on average longer (11min 47s vs. 8min 39s) and the average percentage time doctors spent on the computer was about half that of non-psychological consultations (11% vs. 23% and p<0.001)., Conclusion: The doctors were found to adopt one of three broad styles of computer use during their consultations. In consultations with observable significant psychological content doctors significantly reduce the proportion of time at the computer suggesting an ability to appropriately tailor their use of the computer during consultations.

Objective: To benchmark the psychological state and physical rehabilitation of patients who have sustained limb loss as a result of terrorist activity in Northern Ireland and to determine their satisfaction with the period of primary prosthetic rehabilitation and the artificial limb., Method: All patients who sustained limb loss as a result of the Troubles and were referred to our rehabilitation centre were sent a questionnaire. The main outcome measures were the SIGAM mobility grades, the General Health Questionnaire (GHQ12) and three screening questions for Post Traumatic Stress Disorder (PTSD)., Results: Out of a 66% response rate, 52 (69%) patients felt that the period of primary prosthetic rehabilitation was adequate; 32 (54%) lower limb amputees graded themselves SIGAM C or D; 45 (60%) patients stated that they were still having significant stump pain. Significant stump pain was associated with poorer mobility. Nine (56%) upper limb amputees used their prosthetic limb in a functional way; 33 (44%) patients showed "psychiatric caseness" on the GHQ 12 and 50 (67%) had symptoms of PTSD., Conclusions: Most patients felt that the period of physical rehabilitation had been adequate; those who did not were more likely to be having ongoing psychological problems. A high percentage of patients continue to have psychological problems and stump pain.

Objective: To determine if administrative data relating to the uptake of disability benefits held by government departments in Northern Ireland are fair and unbiased indicators of relative need for health care and therefore a useful addition to census data., Method: This is an ecological study of the 566 electoral wards in Northern Ireland. The variation in uptake of a health-related benefit (Disability Living Allowance) was regressed against three other indicators of health (limiting long-term illness, mortality and the numbers of patients admitted to hospital). All the indicators had been indirectly standardised by age and sex. The unstandardised residuals from this model were regressed against the social and geographical factors, namely area deprivation score, religious denominational composition and urban/rural dwelling to see if they influenced benefit uptake above and beyond any association with ill health., Results: The health factors alone explained 77.2% of the variation in benefit uptake, with limiting long-term illness being the major determinant; however, even after controlling for differences in health status, benefit uptake was shown to be higher in more urban areas and in areas that had a greater proportion of Catholics. Area deprivation was not associated with benefit uptake once health differences had been controlled for., Conclusion: Administrative data on disability benefits can undoubtedly provide useful additional information for describing the levels of relative disadvantage or ill health of areas. However, because they also reflect variations in uptake, which appears to be confounded by social and geographical factors, we would urge caution when they are used to identify priority areas or to allocate resources.

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.

Purpose: Although antidepressants are the most commonly used treatment for depressive illness, there is uncertainty if their use is associated with a reduction in suicide rate. Antidepressant prescribing in Northern Ireland has increased over fivefold in the decade 1989-1999. The authors sought to explore whether this increase was associated with a reduction in suicide rate taking into account social and political factors thought also to have an influence on suicide., Materials and Methods: Factors that have been suggested to influence suicide were entered into a linear regression with frequency of suicide and undetermined deaths (referred to as suicide rate) as the dependent variable. The above factors were antidepressant prescribing, unemployment rate, household alcohol expenditure and persons charged with terrorist offences. The rise in younger suicides, in recent decades, suggests this analysis should be carried out separately for younger (less than 30 years) and older (30 years and above) suicides separately. The predictors in the two models are based on aggregate data for the total group., Result: In the younger group there was no association between antidepressant prescribing and suicide. For the older group increased antidepressant prescribing was associated with a reduction in suicide rate over the 10 years of the study., Conclusion: Increasing antidepressant prescribing appears to be an effective strategy for reducing suicide. This has been demonstrated in older individuals.

Background: In recent years, following the publication of Tomorrow's Doctors, the undergraduate medical curriculum in most UK medical schools has undergone major revision. This has resulted in a significant reduction in the time allocated to the teaching of the basic medical sciences, including anatomy. However, it is not clear what impact these changes have had on medical students' knowledge of surface anatomy., Aim: This study aimed to assess the impact of these curricular changes on medical students' knowledge of surface anatomy., Setting: Medical student intakes for 1995-98 at the Queen's University of Belfast, UK., Methods: The students were invited to complete a simple examination paper testing their knowledge of surface anatomy. Results from the student intake of 1995, which undertook a traditional, 'old' curriculum, were compared with those from the student intakes of 1996-98, which undertook a new, 'systems-based' curriculum. To enhance linear response and enable the use of linear models for analysis, all data were adjusted using probit transformations of the proportion (percentage) of correct answers for each item and each year group., Results: The student intake of 1995 (old curriculum) were more likely to score higher than the students who undertook the new, systems-based curriculum., Conclusion: The introduction of the new, systems-based course has had a negative impact on medical students' knowledge of surface anatomy.

Objectives: We examined clinical parameters of patients from Northern Ireland with potentially malignant lesions (PML) to determine association with development of intraoral squamous cell carcinoma (SCC)., Design: retrospective, cross-sectional, population-based, clinically validated, laboratory-verified., Subjects and Methods: All patients who had more than one incisional oral mucosal biopsy diagnosed from 1975-1991 were abstracted from a database of all PML and SCC and their clinical records and biopsies reviewed. Patients were excluded if there was priorlsynchronous SCC or radiotherapy, frictional keratosis or lichen planus, missing clinical records/biopsy material or follow-up of <24 months. From the 50 suitable patients, gender, age, smoking status, site, clinical appearance and extent of lesion(s), treatment and year of diagnosis were recorded. Patients who developed SCC from PML were compared with those who did not., Results: Squamous cell carcinoma occurred significantly more often in patients with single rather than multiple PML, those with 'non-homogenous' PML and in patients diagnosed prior to 1980. In Cox's survival analysis, only the clinical extent was predictive of SCC., Conclusions: Of all the features considered in our series, size (extent) was the most important clinical factor in determining the risk of future SCC in PML, particularly when several adjacent anatomical sites were affected.

Background: Environmental, cultural and health care differences may account for variation among countries in the prevalence of asthma and respiratory symptoms in teenagers., Objective: To examine the prevalence of respiratory symptoms and the level of diagnosis, and to compare determinants of asthma and severe wheeze in two countries., Methods: Self-completion questionnaires based on the International Study of Asthma and Allergies in Childhood (ISAAC) protocol were provided to school children in Ireland (Republic and Northern Ireland). In the Republic of Ireland, all children in classes largely aged 13-14 years from 30 post-primary schools were selected by random sampling stratified by school size, composition and Health Board in Spring 1995. In Northern Ireland, all children largely aged 13-14 years of age from 26 post-primary schools were selected by random sampling stratified by school type, composition and Education and Library Board in Spring 1996., Results: Questionnaires were completed by 2,364 children from Northern Ireland and 2,671 from the Republic, about 90% of those eligible to participate. The prevalences of wheeze at various levels of severity, of diagnosed asthma and of treated wheeze were very similar in Northern Ireland and the Republic of Ireland. A significant proportion of those reporting more severe symptomatology (four or more attacks of wheeze in the past 12 months and/or one or more nights disturbed and/or moderate or greater disruption of daily activities and/or speech restriction due to wheeze) had been neither diagnosed nor treated for asthma (20-37%). To investigate the determinants of the more severe symptomatology of asthma or treated wheeze a series of stepwise multiple regression analyses was performed. A history of atopy, cigarette smoking, the possession of a furry pet other than a dog or cat and age were each independently associated with severe wheeze, whilst atopy, a furry pet (as above) and gender were each independently associated with asthma or treated wheeze., Conclusions: Cigarette smoking is closely associated with the reporting of significant respiratory symptoms together with atopy and exposure to furry pets. Some 20-37% of severe symptoms were neither diagnosed nor treated as asthma.

The last 30 years have seen a gradual change in the management of otosclerosis. The aim of this study is to evaluate the current practice amongst Irish otolaryngology consultants by a questionnaire and to compare it with the practice currently followed in Great Britain. Thirty-eight responses (67.9%) were available for analysis. The overall trend is towards centralisation with a reduction in the number of surgeons undertaking stapes surgery (39%). The majority of consultants (67%) who undertake stapes surgery would operate for a unilateral conductive loss and 67% would undertake bilateral stapes surgery. Stapedotomy is the only operation performed (100%) with none of the consultants performing partial or total stapedectomies.

Background: Influenza is a common respiratory disease that may affect a large proportion of the population annually. Vaccination is recommended for those most at risk of complications; namely everyone aged 65 and over and those under 65 who are immunosuppressed or who have chronic disease., Objective: To explore the variations in influenza vaccination rates for the winter of 2000, with special reference to uptake amongst older patients., Design: An audit of vaccination rates amongst 12 practices that participate in the Northern Ireland Data Retrieval in Primary Care Project., Methods: Data were extracted from the practice computers; Read codes were used to determine if the patient was immunosuppressed or suffered from chronic heart, lung or renal disease or had diabetes mellitus. The postcode of residence was used as a proxy for residence in a nursing or residential home as this could not be determined directly from the data. Multiple regression analysis was used to determine which factors were significantly related to vaccination uptake., Results: We vaccinated 10,427 patients in these practices against influenza with a vaccination rate of 65.2% for the over-65 population. Uptake rates peaked at age 85 and declined thereafter so that only half of those aged over 90 had been vaccinated. This age related decline in vaccination rates was evident in ten of the twelve practices. The presence of chronic disease increased the likelihood of vaccination even amongst older patients. Logistic regression confirmed the decline in uptake rates at older ages and suggested that patients who shared the address of a nursing or residential home were less likely to have been vaccinated., Conclusions: We feel that the current monitoring of influenza vaccination rates needs to be extended so that uptake amongst those most at risk, namely the very oldest and those in nursing and residential homes, can be adequately assessed.

Background: There is increasing dissatisfaction among general practitioners (GPs) with their 24 hour commitment despite the demand for GP services outside ordinary working hours. The creation of out-of-hours co-operatives has been welcomed by participating GPs and their families and patient satisfaction is generally high. However, there have been concerns about the lack of patient consultation in their development and on the quality of care provided., Objectives: To examine geographical variation in the rates of out-of-hours calls and to see if there is any systematic variation in how the co-operative that covers the area responds to calls., Design of Study: A secondary data analysis of 110,357 calls received by the co-operative during the second year of its operation., Setting: A co-operative with four centres providing out-of-hours care for one mostly rural Health Board in Northern Ireland., Method: Deprivation score and mortality and long-term illness ratios provided indicators of need at an area level. Proximity to the four co-operative centres was measured as the distance in kilometres and estimated travel time (in minutes) along the road network., Results: Out-of-hours call ratios were proportional to the area deprivation score and proximity to the co-operative centres, though not to area indicators of ill health. Older patients were more likely to be seen by the GP and females over the age of 15 years were more likely to receive telephone advice only (adjusted odds ratio [OR] = 0.785, 95% confidence intervals [CI] 0.756-0.816, P < 0.001). Each kilometre from the centres reduced the likelihood of seeing the GP (OR = 0.978, 95% CI = 0.976-0.979, P < 0.001). Even after controlling for potential confounders a large difference remained in how centres responded to calls., Conclusions: It is not certain whether these inequalities in services delivery represent inequity as the apposite level or type of response cannot be determined until more is known about the appropriateness of the demand for out-of-hours medical care.

The aim of this study was to assess general dental practitioners' and orthodontists' perceptions of the benefits of orthodontic treatment. A specially designed questionnaire was sent to a random sample of 150 general dental practitioners (GDPs) and all orthodontists in Northern Ireland (excluding hospital practitioners) with a postgraduate qualification (n = 29). There was a 93 per cent response rate by the general dental practitioners and all but one specialist practitioner returned the questionnaire. The questionnaire comprised 14 visual analogue scales (VAS) whereby participants were asked to rate the importance of various possible dental health and psychosocial benefits of orthodontic treatment. In addition to the VAS, the influence of dentist variables such as number of years since qualification, orthodontic cases completed, referral rates and attendance at postgraduate lectures were examined. When ratings on the 14 dental health and psychosocial scales were examined overall, GDPs rated an improvement in self-esteem while orthodontists considered an improvement in physical attractiveness as the most important benefit of orthodontic treatment. Even though psychosocial variables received the highest ratings, examination of the mean ratings (and 95 per cent confidence intervals) revealed that some dental health factors were also rated highly by both groups. While the results do indicate an encouraging awareness of the psychosocial benefits of orthodontic treatment, they also suggest that both GDPs and orthodontists have an unrealistic expectation of the dental health gain likely to result from orthodontic treatment.

Background: Most patients with cancer prefer to die at home but the majority die in institutions., Aim: To determine place of death for patients with cancer in Belfast, to examine changes over time and identify factors associated with place of death., Methods: A survey of deaths registered in Belfast over a six-month period for 1977, 1987 and 1997 identified patients dying from cancer. Epidemiological data included age, gender, malignancy, social class, marital status, area of residence and place of death., Results: Home deaths fell from 35% in 1977 to 28% in 1997. Hospital deaths fell from 50% in 1977 to 40% in 1987 rising to 42% in 1997. Hospice deaths rose from 13% in 1977 to 25% in 1987 falling to 23% in 1997. There was an association between place of death and age, marital status, type of cancer and area of residence, but not with social class or gender., Conclusion: The majority of people fail to achieve a home death. Resources need to be targeted to those most at risk of an institutional death; females, the elderly, the unmarried, those with haematological malignancies and residents of South Belfast.

This study investigated the periodontal referral patterns of general dental practitioners (GDPs) in Northern Ireland (NI) and North West England (NWE). A questionnaire dealing with periodontal referral was sent to all 520 GDPs registered in NI and to 274 GDPs in NWE. A usable return was made by 355 (68%) in NI and 189 (70%) in NWE. The NI dentists made significantly more periodontal referrals (median 5, range 0-80) in the year preceding the survey than those in NWE (median 2, range 0-50), p<0.001. Distance was the only factor significantly related to the referral rate in both regions with those who practised more than 25 miles from a specialist referring significantly fewer patients in both regions. In NI, there was a trend towards increased periodontal referral by GDPs who had attended more postgraduate courses; however, in NWE, this was not the case. The GDPs in NWE were significantly less likely than those in NI to refer patients with medical conditions. It is concluded that there is considerable variation in periodontal referral both within and between the 2 regions studied. It is further concluded that in many cases, non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in these regions (NI and NWE) in relation to periodontal referral. Much of the variance in referral in North West England, as in Northern Ireland, remains unexplained.

Background: The aim of this study was to examine differences in socio-economic standing and ill health between the two communities in Northern Ireland., Methods: This was a descriptive epidemiological study. Deaths from 1991 to 1995 inclusive were used to calculate standardized mortality rates (SMR, under 75 years) at small level using the 1991 Census population estimates. The standardized limiting long-term illness ratios (SIR) were based on the appropriate Census question. Regression models were tested with SMR and SIR as dependent variables and a wide range of socio-economic indicators, including income support and family credit uptake, as independent predictors., Results: Northern Ireland is a very polarized society. More than 60 per cent of the population live in areas which have more than 80 per cent of one religion. Areas with a preponderance of Catholics tend to be more deprived. Unemployment rates, percentage renting, car availability, and education attainment are all worse in Catholic areas. However, there is considerable heterogeneity between areas with similar levels of religious affiliation and the overall pattern varies with the indicator chosen. SMRs rise stepwise with increasing percentage of Catholics. SIRs increase with increasing polarization of areas, but this is much more marked in those with a predominantly Catholic affiliation. Altogether 46.8 per cent of the variance in SMR and 77.9 per cent of that of SIRs could be explained by socio-economic variables alone. Denomination did not have any residual predictive value., Conclusions: Policy-makers should continue to periodically monitor for differences between the two communities including any differences in service accessibility and uptake. Efforts should be directed towards reducing the inequalities in health for all sections of the community.