Prevalence of and risk factors for osteoporosis in adults with acquired brain injury.

BACKGROUND: Low bone mineral density (BMD) is common in older people with stroke, particularly in the paretic limb. Younger people with acquired brain injury (ABI), of all causes, are at increased risk of low BMD. AIMS: To examine prevalence of low BMD, based on World Health Organisation diagnostic criteria, in patients with ABI. METHODS: This is a cross-sectional study of 112 ABI patients. All completed a questionnaire, had laboratory investigations and DXA assessment of lumbar spine and one or both hips. RESULTS: Mean age ± SD of participants was 45.7 ± 13.7 years. Risk of vitamin D deficiency (25-OHD < 30 nmol/L) occurred in 27.7 %, 34.3 % had adequate levels (30-50 nmol/L) and 36.6 % had levels in excess of this. Based on T-scores, 41.1 % had osteopenia and 21.4 % had osteoporosis. A Z score of -1 or less but greater than -2 occurred in 25 %; a further 21.4 % had a Z score of -2 or less. Patients who could walk outdoors had significantly higher BMD at the neck of femur than those who walked indoors only and those who could not walk at all (p < 0.001). On multiple linear regression analysis, ambulatory ability and duration of disability were independent predictors of BMD at sound neck of femur and total proximal femur. CONCLUSIONS: Osteopenia and osteoporosis are common in young adults with ABI compared with the general population. Bone heath monitoring should form part of the long-term follow-up of this patient group.

Tuberculosis incidence in the Irish Traveller population in Ireland from 2002 to 2013.

The health status of the Irish Traveller ethnic minority is low compared to the general population in Ireland in terms of infant mortality rates and life expectancies. Respiratory disease is an area of health disparity manifested as excess mortalities in Traveller males and females. In this study, we examined the available data with regard to tuberculosis (TB) notifications in Ireland from 2002 to 2013. We found an increase in TB notifications in Irish Travellers from 2010 onwards. This resulted in a crude incidence rate for TB in Irish Travellers that was approximately threefold higher than that of the white Irish-born population in 2011 and 2012. An outbreak of TB in Irish Travellers in 2013 increased this differential further, but when outbreak-linked cases were excluded, a higher incidence rate was still observed in Irish Travellers relative to the general population and to white Irish-born. The mean age of a TB patient was 26 years in Irish Travellers compared to 43 years in the general population, and 49 years in white Irish-born. Based on available data, Irish Travellers exhibit a higher incidence rate and younger age distribution of TB compared to white Irish-born and the general population. These observations emphasize the importance of routine use of ethnicity identifiers in the management of TB and other notifiable communicable illnesses in Ireland. They also have implications for the orientation of preventive services to address health disparities in Irish Travellers and other ethnic minority groups.

Bicycle helmet wearing in a sample of urban disadvantaged primary school children.

Bicycle helmet wearing is currently not legally enforced in Ireland and little is known about the self-reported practice amongst young children. The principal aim of this study was to assess self-reported helmet wearing amongst a sample (n = 314) of primary school children (aged 8-13 years) attending disadvantaged schools in Dublin. Approximately 86% of the sample owned a bike and provided a response to the question on helmet use. The findings indicate that helmet wearing is not a widespread practice (50.4%; 136/270 report never wearing helmets). As children get older, reported practice is also less likely with 67% (27/40) of 12/13 year-olds compared to 38% (31/81) of 8/9 year-olds reporting never wearing protective headgear. Regardless of age, more girls (61%; 82/135) than boys (39%; 52/135) indicated always/sometimes using helmets when cycling. Conversely, the findings show that (mandatory) seatbelt wearing is standard practice for the majority (93%; 252/270). The findings relating to helmet wearing add further to the debate around the mandatory introduction of protective headgear for cyclists.

A national cross-sectional survey of diagnosed sufferers of myalgic encephalomyelitis/chronic fatigue syndrome: pathways to diagnosis, changes in quality of life and service priorities.

BACKGROUND: The diagnosis and treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is subject to debate. AIMS: To measure the time to diagnosis and services accessed. METHOD: A national cross-sectional study. A profile and service utilisation questionnaire, information on the pathways to diagnosis, the WHOQoL Brief and a listing of priorities of the needs of participants were used. Individuals were invited to participate if they had a medical diagnosis of ME/CFS. RESULTS: A total of 211 surveys were returned. Prior to diagnosis sufferers accessed on average 4.5 services after their initial consultation. The mean time to diagnosis was 3.7 years but time ranged from 0 to 34 years. Quality of life deteriorated post-onset. The priority for future service provision was increased understanding and diagnosis of ME/CFS by the medical profession. CONCLUSION: In order to alleviate the burden on the sufferer there is a greater need for education on this condition.

Alcohol usage and associated treatment outcomes for opiate users entering treatment in Ireland.

Evidence has shown that frequency and quantity of drug usage are reduced after treatment but the effect of opioid addiction treatment on alcohol consumption remains unclear. As part of the national Research Outcome Study in Ireland Evaluating drug treatment effectiveness (ROSIE, see www.nuim.ie/rosie) comprehensive drug and alcohol data on 404 opiate users were collected. This study recruited and followed up at 1 and 3 years a prospective cohort of 404 users entering a new treatment episode. Descriptive and inferential statistics were computed and logistic modelling was used to identify key factors effecting outcomes. The cohort represented 8.2% of all new treatments. Follow-up interview rate at 3 years was 88%. Analysis revealed that those who abstained from alcohol use at 3 years were less likely to be using heroin at 3 years than non-abstainers. In addition, those who abstained from alcohol use at 3 years were also less likely to be using methadone, benzodiazepines and cocaine at 3 years than alcohol users. Outcomes for medium and heavy drinkers were found not to be as good as alcohol abstainers. Finally males tended to reduce the frequency and level of alcohol usage after entering treatment more than females. Results demonstrate to clinicians that an alcohol strategy is a key component of opiate treatment planning and a comprehensive and regular assessment of the client's alcohol and drug use profile is essential if treatment interventions are to have maximum impact on outcomes.

Prevalence and patterns of back pain and residual limb pain in lower limb amputees at the National Rehabilitation Hospital.

AIMS: To examine the prevalence and impact of back pain (BP) and residual limb pain (RLP) in ambulatory lower limb amputees (LLAs). METHODS: Patients completed questionnaires regarding demographics, their amputation, occurrence of BP and RLP. Visual analogue scales assessed pain severity and effect on activities of daily living (ADLs), recreational, family and social life (RFS), and ability to work. Descriptive statistics were compiled and relationships between pain and details of amputation were examined. RESULTS: A total of 107 patients (88 males, 19 females) participated; mean age 51.1 years. Fifty-one patients (47.7%) suffered BP, mean intensity 5.3, mean interference with ADLs, RFS, ability to work 3.5, 3.8, 3.4, respectively. Sixty (56.1%) suffer from RLP, mean intensity 5.7; mean interference with ADLs, RFS, ability to work 2.9, 2.8, 3.9, respectively. BP intensity increased with age; RLP intensity was greatest among vasculopaths. CONCLUSIONS: Irish LLAs maintain functional capacity despite suffering moderate intensity BP and RLP.

Modelling the transmission dynamics of Ross River virus in Southwestern Australia.

During the 1995-1996 Australian financial year, over 1300 notifications of Ross River (RR) virus disease were notified in humans from Southwestern Australia. Due to the mild symptoms of the disease, it is difficult to diagnose and subclinical infections are common. However, these subclinical infections do give rise to immunity. For planning and control, it is important for public health authorities to estimate the true number of people who have contracted the disease and to assess the impact of key epidemiological parameters. A mathematical model was developed to describe the transmission of RR virus between its hosts (humans and kangaroos) and its vectors (mosquitoes). For this model, the threshold conditions and relative removal rates were calculated and interpreted. Finally, a computer program was written to simulate the model in order to estimate the total number, both clinical and sub clinical human infections given known and hypothetical epidemiological parameter values. Within this simulation sensitivity of the results to changes in the parameters were examined. The analysis of the threshold conditions conformed well to established principles of arboviral transmission and control. It was observed that conditions which can prevent an outbreak occuring include reducing the number of susceptibles in host and vector populations, reducing the infection rates between hosts and vectors and shortening the duration of viraemia. Results on the sensitivity analysis showed that some parameters such as the extrinsic incubation period, mosquito mortality rate in winter and the proportion of Western Grey Kangaroos in the marsupial population have little effect on human incidence. However, the transmission rate between hosts and vectors, vector-mortality rate in summer and the proportion of infectious vectors among infected vectors have pronounced effects. The simulation results on the ratio of clinical to subclinical human infections predicted a minimum ratio of 1:2 and a maximum ratio of 1:65, which is consistent with data obtained during previous sero-epidemiological studies.

A capture-recapture study of the prevalence and implications of opiate use in Dublin.

BACKGROUND: To date there have been no studies estimating the hidden prevalence of opiate use in Dublin. METHODS: A multisource enumeration followed by the application of the capture-recapture method with log-linear modelling including age and gender stratification to remove heterogeneity was implemented to provide an estimate of the unknown size of the opiate-using population. Two medical and one legal data sources were used. RESULTS: It was found that the ratio of known to unknown opiate users was 1:1.15 with a total of 13,460 (95% CI: 12,037-15,306) users estimated in Dublin in 1996. CONCLUSION: The findings of this study have important ramifications for service delivery.

Methods for estimating prevalence of opiate use as an aid to policy and planning.

Public health planning continues to be troubled by the uncertainty of the extent of hidden drug use. Methods for estimating the prevalence of opiate use are discussed. These include multisource enumeration, death multiplier, multiple indicator, and capture-recapture methods. The feasibility and data requirements for each of these methods is illustrated for the first time in an Irish context. Estimates presented are the result of years of intensive collaboration between previously unconnected government, health, and legal agencies. Finally, the implications of the methods and their results for the planning and provision of medical and social policy are highlighted and discussed.

AIDS in Ireland: the reporting delay distribution and the implementation of integral equation models.

This paper deals with two basic aspects concerning the modelling of AIDS incidence in the context of Irish data. We describe initially the adjustment of the number of AIDS cases (Xij) to allow for reporting delays, where a simple form of the likelihood function for the Xij is supported by GLIM. Subsequently, we consider the accessibility of numerical solution (through a NAG routine) of the integral equation models generated by the back-projection method for the adjusted AIDS cases. Results for the Irish data are summarized for various choices of the incidence distribution.

Measles vaccination--what percentage uptake must we aim for?

The estimation and derivation of the average age of infection with measles among Irish children is discussed. We found that this equals 3.14 years, a figure that is considerably lower than that of other European countries particularly Britain. The average age of vaccination of children in Irish communities was 2.6 years. The reproductive rate of the disease was defined as the average number of secondary cases produced by one infectious individual in a community. From this, we extrapolate estimates for the proportion we need to vaccinate in order to eradicate measles in Ireland, which is in the region of 95% to 96%. In practice this level may be very difficult to achieve.