Structuring diabetes care in general practices: many improvements, remaining challenges.

Background: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way.

Aim: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care.

Methods: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on.

Influenza A outbreak in a community hospital.

In January 2005, the Department of Public Health, HSE Eastern Region, received notification of an outbreak of influenza-like illness (ILI) in a community hospital for elderly patients. Influenza A (H3N2 subtype) was isolated in 12 of 18 (66%) throat swabs sent to the National Virus Reference Laboratory (NVRL). An outbreak control team was convened.

Contact tracing of tuberculosis in a school setting and the relevance of BCG in this population.

Tuberculosis (TB) remains a worldwide health problem. Treatment, contact tracing and screening of at-risk populations continue to be important issues even in countries with low rates of tuberculosis. In contact tracing, prior BCG vaccination can make interpretation of Mantoux positivity difficult.

Hospitalisations due to falls in older persons.

This paper describes hospitalisations due to falls among people aged 65 years and over resident in the Eastern Region of Ireland. Of the 2,029 hospitalisations recorded for 2002, 78% were female and 68% were aged 75 years and over. Fractures accounted for 1,697 or 84% of cases with nearly half of them (841) sustained to the hip.

The standardized prescribing ratio--a new method for comparing prescribing between GPs, controlling for patient age and sex.

Objectives: To develop a method for comparing the proportion of patients on any drug or group of drugs for individual GP patient panels in Ireland, taking account of the age and sex structure of the panel.

Design: Calculations based on prescribing data for the fourth-quarter of 1995 supplied by the Irish General Medical Services Payments Board for the Eastern Health Board area.Setting-Five hundred and fifty Irish general practices serving 355,000 persons entitled to free medical care under the General Medical Services Scheme in the Eastern Health Board area (28% of the population).

Outbreak of Vero cytotoxin-producing Escherichia coli O157 in a child day care facility.

In December 1998, an outbreak of Vero cytotoxin-producing Escherichia coli (VTEC) O157 in a crèche affected ten out of 45 children and one out of five staff members. Eight cases were symptomatic and three were asymptomatic. There were two asymptomatic adult family contacts of child cases.

Oral fluid collection by post for viral antibody testing.

Background: The objective of this study was to estimate the prevalence of hepatitis B virus exposure (HBV) in the population of the Republic of Ireland, by using oral fluid (saliva) collection by post for hepatitis B anti-core antibody (anti-HBc). This paper discusses the methodological approach used and the strategies that were adopted to improve response rates.

Methods: The sampling frame used was the Register of Electors for Irish parliamentary elections.

Comparison between self-reported hepatitis B, hepatitis C, and HIV antibody status and oral fluid assay results in Irish prisoners.

Self-reported hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infection status was compared with the results of oral fluid assays of antibodies to these viruses in prisoners from nine of the 15 prisons in the Republic of Ireland. A total of 1205 out of 1366 prisoners completed a confidential questionnaire and 1193 provided analysable oral fluid specimens for testing for antibodies to HBV core antigen (anti-HBc), HCV (anti-HCV), and HIV (anti-HIV). The self-reported prevalence of hepatitis infection (hepatitis B: 5%; hepatitis C: 19%) was lower than that derived from oral fluid assays (anti-HBc: 9%; anti-HCV: 37%).

Seasonal patterns of morbidity and mortality in the elderly in Ireland.

Weather conditions have been shown to have a strong association with health Status. (1,2) In this study we examined the relationship between meteorological conditions (average daily temperature, humidity, precipitation, and wind strength) and the seasonal morbidity (emergency hospital admissions and drug prescribing) and mortality patterns in the elderly (over 65 years) over a four year period in Ireland. Temperature (summer/winter variation of 10 degrees C) had the strongest (inverse) association with total mortality (correlation coefficient of 0.

Community Mothers Programme--seven year follow-up of a randomized controlled trial of non-professional intervention in parenting.

Background: The Community Mothers Programme aims at using experienced volunteer mothers in disadvantaged areas to give support to first-time parents in rearing their children up to 1 year of age. The programme was evaluated by randomized controlled trial in 1990.

Methods: Seven years later, trial participants were interviewed about child health, nutrition, cognitive stimulation, parenting skills, and maternal self-esteem.

Hepatitis A outbreak in an institution.

In February 1996, four serologically confirmed cases of hepatitis A virus (HAV) occurred in one household. Investigation showed that the source was a family member with sub-clinical HAV who attended a Unit for Learning Disabilities. Reports of two further cases in the institution followed and control measures were instigated.

Feasibility of population based screening in Ireland.

Population registers have formed the basis for computerised call/recall registers for screening programmes in many countries and have been important in achieving high uptakes in targeted populations. The absence of a population register for the ECCLES (European Campaign against Cancer, Localisation, Evaluation & Screening) Breast Screening Project necessitated the development of a special register of women in the target age group. The data sources used to build the project register were the Eastern Health Board and North Eastern Health Board General Medical Services database, Voluntary Health Insurance data and self-registration with the project.

Ten-year survival of Down syndrome births.

Objective: To determine the survival status of children with Down syndrome (DS), and to document factors influencing survival.

Design: Follow-up study of cases identified from the Dublin European Register of Congenital Anomalies and Twins (EUROCAT) Register. Follow-up was attempted for each case until death or 1992 or until the date last known to be alive.

Use of seat belts in a Dublin area.

This study examines public compliance with seat belt regulations. Two busy suburbs in north Dublin were studied. Of the 2,139 vehicles surveyed 1,160 (54.

A profile of attenders to a south Dublin city accident and emergency department.

All new patients attending a Dublin Hospital's Accident and Emergency (A&E) Department were surveyed to document their reasons for attending and to make comparisons between self-referred and GP referred groups. Of the 557 responders 395 (70.9%) were self-referred.

The epidemiology of Down syndrome in four counties in Ireland 1981-1990.

Background: We conducted a descriptive epidemiological study of Down syndrome (DS) in the four Irish counties (Dublin, Kildare, Wicklow and Galway) covered by EUROCAT registries of congenital malformations for the years 1981-1990.

Methods: EUROCAT registries, which cover defined populations, use multiple sources for case ascertainment. All DS cases born between 1 January 1981 and 31 December 1990 to mothers resident in the four counties were identified.

An outbreak of hepatitis A among Irish haemophiliacs.

Background: An outbreak of hepatitis A (HAV) occurred in 1992 in Irish haemophilia A patients treated with high purity solvent-detergent (SD) treated factor VIII. Similar outbreaks were reported in Italy, Germany and Belgium. The aim of this study was to investigate the outbreak, and to test the hypothesis that it was caused by exposure to SD-treated factor VIII.

The capacity of dogs to serve as reservoirs for gastrointestinal disease in children.

A total of 40 Canine faecal specimens were collected from 10 different halting sites in the Dublin area. Specimens were taken from the site surface. The sites were determined by laboratory confirmed gastroenteritis infections reported in children.

Small area analysis of low birth weight.

Birthweight is a broad indicator of health and socio-economic development in a population. This study was designed to examine small area patterns in the incidence of low birthweight in Dublin for the years 1986-89 and to explore the relationship between low birthweight and socio-economic factors. A number of district electoral divisions with a significantly raised incidence of low birthweight were identified.

Community mothers' programme: randomised controlled trial of non-professional intervention in parenting.

Objective: To see whether non-professional volunteer community mothers could deliver a child development programme to disadvantaged first time mothers for children aged up to 1 year.

Design: Randomised controlled trial.

Setting: A regional health authority in Dublin.

Socioeconomic factors and mortality in small areas.

The aim of this study was to determine the extent to which variation in socioeconomic factors derived from the 1986 census could "explain" variation in standardised mortality ratio (SMR) between the 322 electoral wards and district electoral divisions (DEDs) in Dublin. Factors examined included percentage of population in the various Irish social class groupings, percentage of male unemployment, number of cars per private household and number of persons per car. Regression analysis between SMR and each of these factors individually showed a significant relationship in every case.

Behavioural risk factors among young adults in small areas with high mortality versus those in low-mortality areas.

A community-based cross-sectional survey of behavioural risk factors for premature mortality was carried out on a group of 354 adults aged 25-44 from previously identified high-mortality 'black-spots' in Dublin who were compared with 333 others from low-mortality areas. In the black-spot areas, 50.9% of respondents were current smokers versus 28.

The hand in Irish legend and folklore.

A brief review of the significance of the hand in the mythology, folklore, and religion of Ireland from ancient times is presented. Many of these accounts are also found in the history and legends of other Celtic countries.