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ABSTRACT: ABSTRACT Background: People with type 2 diabetes frequently have a variety of related and unrelated chronic conditions. These additional conditions have implications for patient education, treatment burden and disease management. Objectives: The aim of this study was to examine the nature of multimorbidity, and its impact on GP visits, polypharmacy and glycaemic control as measured by HbA1c, in a cohort of patients with type 2 diabetes attending general practice in Ireland. Methods: A cohort of 424 patients with type 2 diabetes enrolled in a cluster randomized controlled trial based in Irish general practice was examined. Patient data included: medical conditions, HbA1c, health service utilization, socio-economic status and number of prescribed medications. Results: 90% of patients had at least one additional chronic condition and a quarter had four or more additional chronic conditions. 66% of patients had hypertension; 25% had heart disease; and 16% had arthritis. General practitioner visits and polypharmacy increased significantly with increasing numbers of chronic conditions. When comparing patient self-report with medical records, patients who reported a higher proportion of their conditions had better glycaemic control with a significantly lower HbA1c score. Conclusion: There was a high prevalence of multimorbidity in these patients with type 2 diabetes and the results suggest that glycaemic control is related to patients' awareness of their chronic conditions. The variety of conditions emphasizes the complexity of illness management in this group and the importance of maintaining a generalist and multidisciplinary approach to their clinical care.
The European journal of general practice 03/2013; 19(1):17-22.
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ABSTRACT: Background Although the Irish farming population is a significant occupational group, analysis of their mortality patterns is limited. This study compared mortality trends with other occupational groups and assessed the impact of socio-economic factors. Methods Population and mortality data (2000-06) were obtained to calculate standardized mortality ratios (SMRs) by cause of death and matched with socio-economic data. The extent to which variation in mortality was explained by variations in the socio-economic data was determined using multiple regression. Results Farmers and agricultural workers experienced the highest levels of mortality for all causes of death (2000-06). Farmers are 5.14 times more likely and agricultural workers are 7.35 times more likely to die from any cause of death than the lowest risk group. Circulatory disease is a significant cause of mortality among farmers [SMR = 215.91, 95% confidence interval (CI) = 201.83-229.98]. Other significant causes include cancers (SMR = 156.60, CI = 146.73-166.48) and injuries and poisonings (SMR = 149.69, CI = 135.44-163.93). Agricultural workers have similar mortality trends: circulatory disease (SMR = 226.27; CI = 192.45-260.08), cancers (SMR = 221.44; CI = 193.88-249.00), and injuries and poisonings (SMR = 353.90; CI = 302.48-405.32). From 2000 to 2006, SMRs increased incrementally. Multiple regression identified farm size and income poverty risk as predictors of mortality. Conclusion Irish farmers and agricultural workers have experienced a reversal of mortality trends compared to the 1980s and 1990s. Policies should target them as a high-risk group.
The European Journal of Public Health 03/2012; · 2.73 Impact Factor
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ABSTRACT: As part of EUROCAT's surveillance of congenital anomalies in Europe, a statistical monitoring system has been developed to detect recent clusters or long-term (10 year) time trends. The purpose of this article is to describe the system for the identification and investigation of 10-year time trends, conceived as a "screening" tool ultimately leading to the identification of trends which may be due to changing teratogenic factors.
The EUROCAT database consists of all cases of congenital anomalies including livebirths, fetal deaths from 20 weeks gestational age, and terminations of pregnancy for fetal anomaly. Monitoring of 10-year trends is performed for each registry for each of 96 non-independent EUROCAT congenital anomaly subgroups, while Pan-Europe analysis combines data from all registries. The monitoring results are reviewed, prioritized according to a prioritization strategy, and communicated to registries for investigation. Twenty-one registries covering over 4 million births, from 1999 to 2008, were included in monitoring in 2010.
Significant increasing trends were detected for abdominal wall anomalies, gastroschisis, hypospadias, Trisomy 18 and renal dysplasia in the Pan-Europe analysis while 68 increasing trends were identified in individual registries. A decreasing trend was detected in over one-third of anomaly subgroups in the Pan-Europe analysis, and 16.9% of individual registry tests. Registry preliminary investigations indicated that many trends are due to changes in data quality, ascertainment, screening, or diagnostic methods. Some trends are inevitably chance phenomena related to multiple testing, while others seem to represent real and continuing change needing further investigation and response by regional/national public health authorities.
Birth Defects Research Part A Clinical and Molecular Teratology 03/2011; 91 Suppl 1:S31-43. · 2.27 Impact Factor
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ABSTRACT: To evaluate the effectiveness of a psychological, family-based intervention to improve diabetes-related outcomes in patients with poorly controlled type 2 diabetes.
This study was a randomized controlled trial of a psychological family-based intervention targeted at individuals with poorly controlled type 2 diabetes. Recruitment and follow-up occurred at specialist diabetes clinics. Patients were randomly allocated to an intervention group (n=60) or a control group (n=61). Poor control was defined as at least 2 of the patient's last 3 glycated hemoglobin (A1C) readings at >8.0%. The intervention consisted of 2 sessions delivered by a health psychologist to the patient and a family member in the patient's home, with a third session involving a 15-minute follow-up telephone call.
At 6-month follow-up, the intervention group reported significantly lower mean A1C levels than the control group (8.4% [SD=0.99%] vs 8.8% [SD=1.36%]; P=.04). The intervention was most effective in those with the poorest control at baseline (A1C>9.5%) (intervention 8.7% [SD=1.16%, n=15] vs control 9.9% [SD=1.31%, n=15]; P=.01). The intervention group also reported statistically significant improvements in beliefs about diabetes, psychological well-being, diet, exercise, and family support.
After participating in a family-based intervention targeting negative and/or inaccurate illness perceptions, patients with poorly controlled type 2 diabetes showed improvements in A1C levels and other outcomes. Our results suggest that adding a psychological, family-based component to usual diabetes care may help improve diabetes management.
The American journal of managed care 02/2011; 17(2):105-13. · 2.46 Impact Factor
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ABSTRACT: The general medical services (GMS) scheme provides care free at the point of use for the 30% most economically deprived section of the population and the elderly. Almost all people of over-70-year olds are eligible for the GMS scheme potentially directing resources away from those most in need. The aim of this study is to analyse the relationship between practice GMS income and deprivation amongst Dublin-based general practitioners (GPs). The practice GMS income in Dublin was analysed in relation to practice characteristics including the number of GPs, catchment area population, proportion of over-70-year olds in the catchment area, catchment deprivation, number of GMS GPs within 2 km, and average GMS practice income within 2 km. Practice GMS income was highest in deprived areas but is also a valuable source of income in the least deprived areas. The capitation rate for over-70-year olds provides an incentive for GPs to locate in affluent areas and potentially directs resources away from those in greater need.
International journal of family medicine. 01/2011; 2011:971231.
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ABSTRACT: The aim of this study was to describe the distribution of GP services in Ireland with respect to deprivation. Seven percent of rural inhabitants live within walking distance of the nearest GP compared to 89% of city dwellers. The longest average travel times occur in the most deprived rural areas. The variation in travel times across deprivation scores was modest, particularly in city, town and village areas. The highest workloads were observed in the most deprived urban areas. The current distribution of GPs in Ireland is relatively equitable although the most deprived practices have high workloads or appear to be overstretched. Incentives may be required to increase service provision in these highly deprived areas.
Health & Place 11/2010; 16(6):1077-83. · 2.67 Impact Factor
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Mark Lawler,
Shaun R. McCann,
Judith C. W. Marsh,
Per Ljungman,
Jill Hows,
Elisabeth Vandenberghe,
Joan O’Riordan,
Anna Locasciulli,
Gérard Socié, Alan Kelly,
Hubert Schrezenmeier,
Pedro Marin,
André Tichelli,
Jakob R. Passweg,
Anne Dickenson,
Jacqueline Ryan,
Andrea Bacigalupo,
from the Severe Aplastic Anaemia Working Party of the European Blood and Marrow Transplant Group
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ABSTRACT: Ninety-one patients were studied serially for chimeric status following allogeneic stem cell transplantation (SCT) for severe aplastic anaemia (SAA) or Fanconi Anaemia (FA). Short tandem repeat polymerase chain reaction (STR-PCR) was used to stratify patients into five groups: (A) complete donor chimeras (n = 39), (B) transient mixed chimeras (n = 15) (C) stable mixed chimeras (n = 18), (D) progressive mixed chimeras (n = 14) (E) recipient chimeras with early graft rejection (n = 5). As serial sampling was not possible in Group E, serial chimerism results for 86 patients were available for analysis. The following factors were analysed for association with chimeric status: age, sex match, donor type, aetiology of aplasia, source of stem cells, number of cells engrafted, conditioning regimen, graft-versus-host disease (GvHD) prophylaxis, occurrence of acute and chronic GvHD and survival. Progressive mixed chimeras (PMCs) were at high risk of late graft rejection (n = 10, P < 0·0001). Seven of these patients lost their graft during withdrawal of immunosuppressive therapy. STR-PCR indicated an inverse correlation between detection of recipient cells post-SCT and occurrence of acute GvHD (P = 0·008). PMC was a bad prognostic indicator of survival (P = 0·003). Monitoring of chimeric status during cyclosporin withdrawal may facilitate therapeutic intervention to prevent late graft rejection in patients transplanted for SAA.
British Journal of Haematology 01/2009; 144(6):933 - 945. · 4.94 Impact Factor
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Mark Lawler,
Shaun R McCann,
Judith C W Marsh,
Per Ljungman,
Jill Hows,
Elisabeth Vandenberghe,
Joan O'Riordan,
Anna Locasciulli,
Gérard Socié, Alan Kelly,
Hubert Schrezenmeier,
Pedro Marin,
André Tichelli,
Jakob R Passweg,
Anne Dickenson,
Jacqueline Ryan,
Andrea Bacigalupo
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ABSTRACT: Ninety-one patients were studied serially for chimeric status following allogeneic stem cell transplantation (SCT) for severe aplastic anaemia (SAA) or Fanconi Anaemia (FA). Short tandem repeat polymerase chain reaction (STR-PCR) was used to stratify patients into five groups: (A) complete donor chimeras (n = 39), (B) transient mixed chimeras (n = 15) (C) stable mixed chimeras (n = 18), (D) progressive mixed chimeras (n = 14) (E) recipient chimeras with early graft rejection (n = 5). As serial sampling was not possible in Group E, serial chimerism results for 86 patients were available for analysis. The following factors were analysed for association with chimeric status: age, sex match, donor type, aetiology of aplasia, source of stem cells, number of cells engrafted, conditioning regimen, graft-versus-host disease (GvHD) prophylaxis, occurrence of acute and chronic GvHD and survival. Progressive mixed chimeras (PMCs) were at high risk of late graft rejection (n = 10, P < 0.0001). Seven of these patients lost their graft during withdrawal of immunosuppressive therapy. STR-PCR indicated an inverse correlation between detection of recipient cells post-SCT and occurrence of acute GvHD (P = 0.008). PMC was a bad prognostic indicator of survival (P = 0.003). Monitoring of chimeric status during cyclosporin withdrawal may facilitate therapeutic intervention to prevent late graft rejection in patients transplanted for SAA.
British Journal of Haematology 01/2009; 144(6):933-45. · 4.94 Impact Factor
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Irish Geography 11/2008; 41(3):295-311.
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ABSTRACT: Most Organisation for Economic Co-operation and Development (OECD) countries have introduced cost-sharing. This study compares the views of patients who are used to a service that is free at the point of delivery with those who are used to a system where 70% of patients pay for consultations.
Secondary analysis of survey data from a random sample of 11,870 patients in Northern Ireland and the Republic of Ireland.
A 52% response rate was achieved, though respondents were representative of the two populations. Attitudes generally reflected the national status quo with little support for co-payments where there was currently no charging, but broad support where charging was established. Charging for missed appointments would be supported where there were delays in getting an appointment.
More research is needed to understand what underlies support for, or opposition to, charges. However, it is apparent that patients' opinions need to be considered when formulating health care policy.
Journal of Health Services Research & Policy 11/2007; 12(4):197-201. · 1.73 Impact Factor
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ABSTRACT: To estimate the effect of a consultation charge on the health-seeking behaviour of patients.
Cross-sectional survey of patients carried out in Northern Ireland, where services are free at the point of delivery, and the Republic of Ireland, where 70% of the population are charged a consultation fee to see the general practitioner (GP).
There were 11 870 respondents to the survey (response rate 52%). In the Republic of Ireland, 18.9% of patients (4.4% of non-paying patients and 26.3% of paying patients) had a medical problem in the previous year but had not consulted the doctor because of cost; this compares with only 1.8% of patients in Northern Ireland. Because those in the Republic of Ireland on low income are entitled to free care, the effects of the consultation charge were most marked in the middle of the income distribution, with such patients being over four times as likely to have been deterred as those in the most affluent group. However, amongst paying patients, it was the poorest and those with the worst health who were most affected. Compared to the most affluent patients and those without depression, the likelihood of not having seen the GP due to cost was 6.75 (95% confidence interval [CI] 3.79, 11.09) for the poorest patients and 2.01 (95% CI 1.53, 2.52) for those with depression.
Even in countries with exemptions for the poor and more vulnerable, a consultation charge can deter a large proportion of poorer and less healthy patients from seeing their GP.
The European Journal of General Practice 02/2007; 13(4):231-6. · 1.13 Impact Factor
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ABSTRACT: Objectives: To compare support for, and perceptions of, the impacts of smoke-free workplace legislation among bar workers in the Republic of Ireland (ROI) pre- and post-implementation, and to identify predictors of support for the legislation.
Setting: Public houses (pubs) in three areas of the ROI. Design: Comparisons pre- and post-implementation of smoke-free workplace legislation. Participants: From a largely non-random selection, 288 bar workers volunteered for the baseline survey; 220 were followed up one year later (76.4%). Outcome measures: Level of support for the legislation, attitude statements concerning potential impacts of the law and modelled predictors of support for the legislation.
Pre-implementation 59.5% of participants supported the legislation, increasing to 76.8% post-implementation. Support increased among smokers by 27.3 percentage points from 39.4% to 66.7% (p < 0.001) and among non-smokers by 12.4% percentage points from 68.8% to 81.2% (p = 0.003).Pre-legislation three-quarters of participants agreed that the legislation would make bars more comfortable and was needed to protect workers' health. Post-legislation these proportions increased to over 90% (p < 0.001). However, negative perceptions also increased, particularly for perceptions that the legislation has a negative impact on business (from 50.9% to 62.7%, p = 0.008) and that fewer people would visit pubs (41.8% to 62.7%, p < 0.001). After adjusting for relevant covariates, including responses to the attitude statements, support for the ban increased two to three-fold post-implementation. Regardless of their views on the economic impact, most participants agreed, both pre- and post-implementation, that the legislation was needed to protect bar workers' health.
Smoke-free legislation had the support of three-quarters of a large sample of bar workers in the ROI. However, this group holds complex sets of both positive and negative perspectives on the legislation. Of particular importance is that negative economic perceptions did not diminish the widely held perception that the ban is needed to protect workers' health.
BMC Public Health 01/2007; 7:131. · 2.00 Impact Factor
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ABSTRACT: General practice co-operatives have led to significant improvements in quality of life for general practitioners. Little is known about general practitioners' own experiences with the working arrangements and governance of co-operatives. This study investigates GP satisfaction, the working environment, governance and future developments in co-operatives.
A questionnaire was sent to GPs in two co-operatives in the Republic of Ireland, covering mixed urban and rural areas.
Of 221 GPs in the co-operatives, 82% responded and confirmed the co-operatives' positive effects on their lives. However, 57% still received requests for out-of-hours care while off duty, most commonly from patients who preferred to see their own doctor. Half felt overburdened by out-of-hours work, especially those over 40 y of age. Twenty-five per cent were dissatisfied with the GP complaints mechanism. The majority (63%) would prefer a GP/health board partnership for the organization of out of hours, while 23% wanted sole responsibility. GPs indicated a strong need for better ancillary services such as nursing, mental health, dentistry, pharmacy and social work. Access to records is an important issue in terminal care and mental illness.
While GP co-operatives are a success story for general practice, they will work better for general practitioners and their patients if nursing, mental health, dentistry, pharmacy and social services are improved. Support and training is needed in mental health, palliative and emergency care to increase competence and reduce stress. GPs are willing to work with health authorities in further co-operative development. More attention needs to be paid to the complaints and suggestions of GPs in the running and governance of their co-operatives.
The European Journal of General Practice 02/2006; 12(1):15-8. · 1.13 Impact Factor
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Shane Allwright,
Gillian Paul,
Birgit Greiner,
Bernie J Mullally,
Lisa Pursell, Alan Kelly,
Brendan Bonner,
Maureen D'Eath,
Bill McConnell,
James P McLaughlin,
Diarmuid O'Donovan,
Eamon O'kane,
Ivan J Perry
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ABSTRACT: To compare exposure to secondhand smoke and respiratory health in bar staff in the Republic of Ireland and Northern Ireland before and after the introduction of legislation for smoke-free workplaces in the Republic.
Comparisons before and after the legislation in intervention and control regions.
Public houses in three areas in the Republic (intervention) and one area in Northern Ireland (control).
329 bar staff enrolled in baseline survey; 249 (76%) followed up one year later. Of these, 158 were non-smokers both at baseline and follow-up.
Salivary cotinine concentration, self reported exposure to secondhand smoke, and respiratory and sensory irritation symptoms.
In bar staff in the Republic who did not themselves smoke, salivary cotinine concentrations dropped by 80% after the smoke-free law (from median 29.0 nmol/l (95% confidence interval 18.2 to 43.2 nmol/l)) to 5.1 nmol/l (2.8 to 13.1 nmol/l) in contrast with a 20% decline in Northern Ireland over the same period (from median 25.3 nmol/l (10.4 to 59.2 nmol/l) to 20.4 nmol/l (13.2 to 33.8 nmol/l)). Changes in self reported exposure to secondhand smoke were consistent with the changes in cotinine concentrations. Reporting any respiratory symptom declined significantly in the Republic (down 16.7%, -26.1% to -7.3%) but not in Northern Ireland (0% difference, -32.7% to 32.7%). After adjustment for confounding, respiratory symptoms declined significantly more in the Republic than in Northern Ireland and the decline in cotinine concentration was twice as great.
The smoke-free law in the Republic of Ireland protects non-smoking bar workers from exposure to secondhand smoke.
BMJ (Clinical research ed.). 12/2005; 331(7525):1117.
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5th International Symposium on Cluster Computing and the Grid (CCGrid 2005), 9-12 May, 2005, Cardiff, UK; 01/2005
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ABSTRACT: The role of cytotoxic T lymphocyte responses, restricted by human leukocyte antigen (HLA) class I alleles, is recognized as highly significant in the successful clearance of hepatitis C virus (HCV). The frequency of class I alleles in females inoculated with HCV genotype 1b from a single source was examined for an association with outcome. Class I typing was performed using polymerase chain reaction sequence-specific primers in 227 female subjects: 141 had chronic infection and 86 had viral clearance. Statistical analysis included chi(2) testing and multiple logistic regression analysis. A*03, B*27, and Cw*01 occurred more frequently in those with viral clearance (39.5%, 14%, and 9.3%, respectively) compared with those with chronic infection (19.1%, 2.1%, and 1.4%, respectively; P < or = .005). B*08 occurred more often in those with chronic infection compared with viral clearance (39.7% vs. 19.8%; P =.002). In combination with previously reported class II allele associations, over 75% that successfully eliminate HCV carry either A*03, DRB1*0101, or *0401, compared with only 37% of those with chronic infection (P <.0001). The haplotypes A*03-B*07-DRB1*15-DQB1*0602 and A*02-B*27-Cw*01-DRB1*0101-DQB1*0501 are associated with viral clearance (P =.004 and.01, respectively). By multiple logistic regression analysis, the alleles A*03, B*27, DRB1*0101, *0401, and *15 are associated with viral clearance, and B*27 has the strongest association (odds ratio [OR] 7.99). The haplotype A*01-B*08-Cw*07-DRB1*03011-DQB1*0201 is associated with chronic infection (P =.002), being independent for DQB1*0201 (OR 0.27). In conclusion, certain class I alleles are associated with outcome in this homogeneous cohort. More significantly, either HLA-A*03, -DRB1*0101, or -*0401 are carried by an overwhelming majority of those subjects who successfully clear HCV.
Hepatology 08/2004; 40(1):108-14. · 11.66 Impact Factor
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ABSTRACT: Resource allocation in the Irish health service, based on historical allocations with incremental increases, is widely believed to be inequitable. Using a three-round policy Delphi survey, which seeks to explore both consensus and disagreement surrounding policy issues, the views of 52 senior health service personnel were sought in order to determine ways to improve equity in resource allocation. Panelists provided several reasons why the current method of resource allocation is inequitable and several suggestions for improving equity. The level of consensus on views was determined by calculating the percentage of ratings in each category based on a series of rating scales. The main suggestion centred around the development and implementation of a needs based resource allocation formula. Panelists reached a high consensus in favour of this but only reached a low consensus as to its feasibility. Potential obstacles identified included methodological difficulties, insufficient resources and resistance from potential losers. These findings highlight concerns about the lack of transparency in the resource allocation process and openness to the development of a more equitable needs based resource allocation model, a move which is becoming more common internationally. Feasibility concerns should not preclude an attempt to begin this process.
Health Policy 04/2004; 67(3):271-80. · 1.51 Impact Factor
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ABSTRACT: The aim of this study was to examine the relationship between mortality and hospital admission data for the leading causes of unintentional injury in Ireland.
Mortality data were obtained from the Central Statistics Office for the years 1980-1996. Information on hospital admissions was obtained from the Hospital In-Patient Enquiry system for the years 1993-1997.
Motor vehicle traffic accidents were the leading cause of unintentional injury death. Falls were the most common cause of unintentional injury hospital admission. Drowning and suffocation had high ratios of deaths to admissions, 2:1 and 1:3, respectively. The ratio of deaths to admissions was 1:39 for all unintentional injuries.
Neither mortality data nor admissions data alone give an adequate guide to the impact of injuries, but together the two provide a reasonable basis on which to establish policy.
Journal of Public Health 04/2004; 26(1):6-7. · 2.06 Impact Factor
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4th IEEE/ACM International Symposium on Cluster Computing and the Grid (CCGrid 2004), April 19-22, 2004, Chicago, Illinois, USA; 01/2004
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ABSTRACT: Bipolar affective disorder (BPAD) has considerable implications for personal and social functioning. However a tendency to be over-represented in high socio-economic classes has been reported in earlier studies, suggesting that social disadvantage accompanying the illness is not severe. In addition, an association between affective disorders in general and increased residential mobility has been suggested, but it is unclear if such an association exists with BPAD.
(1) To investigate the suggestion made in previous studies that patients with bipolar disorder are advantaged socially. (2) To test the hypothesis that patients with bipolar disorder show greater residential mobility compared with other patients with psychiatric disorders.
Ninety patients with DSM IV diagnosis of bipolar disorder admitted to the acute in-patient unit of a public-financed district psychiatric service in Dublin were compared with a control group of 91 randomly selected patients with other psychiatric diagnoses, excluding schizophrenia. Socio-economic, educational and employment ratings were compared, and also duration of illness, frequency of admission and residential mobility. The data were collected retrospectively from case notes and through semistructured interviews with patients or their relatives. The bipolar group was compared with the control group and to the unipolar depression subgroup.
The bipolar and control groups were found to have similar demographic and socio-economic features, although the bipolar group had more years of education compared with the whole control group but not when compared with the unipolar depression group. The bipolar group showed longer duration of psychiatric disorder, more frequent hospital admissions and more frequent residential moves since the onset of the illness.
Bipolar patients requiring in-patient care in this service experience severe disruption to their lives over prolonged periods.
Bipolar Disorders 09/2002; 4(4):243-8. · 5.29 Impact Factor
