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1.
Ir Med J ; 108(7): 199-202, 2015.
Article in English | MEDLINE | ID: mdl-26349347

ABSTRACT

This study describes the demographics and treatment status of HIV-infected adults accessing ambulatory care in the Republic of Ireland and estimates diagnosed HIV prevalence rates. 3254 HIV-infected adults attended 1 of the 6 specialist HIV centres in the 12- month period 1st July 2009 to 30th June 2010. 2023/3254 (62%) were male, 1761/3133 (56%) Irish and 1048/3133 (34%) African. 1924/3098 (62%) resided in the Dublin area. The mean age was 39.8 years (SD 9.3); probable route of acquisition was available for 2898/3254 (89%); heterosexual acquisition accounted for 1442 (50%), MSM 777 (27%) and IDU 598 (21%). 2574/3202 (80%) were on highly active antiretroviral therapy (HAART). Of these 87% had HIV-RNA levels < 50cpm and 94% < 500cpm. The HIV diagnosed prevalence rate is estimated at 1.09/1000 nationally and at 2.25/1000 in the Dublin area for 15-59 year olds.


Subject(s)
Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , HIV Infections , Adult , Ambulatory Care/methods , Ambulatory Care/statistics & numerical data , Antiretroviral Therapy, Highly Active/methods , Antiretroviral Therapy, Highly Active/statistics & numerical data , Female , HIV Infections/diagnosis , HIV Infections/epidemiology , HIV Infections/therapy , Humans , Ireland/epidemiology , Male , Middle Aged , Prevalence , Risk Factors
2.
Ir Med J ; 107(9): 270-2, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25417383

ABSTRACT

Sex trafficking within Ireland is a hidden phenomenon. In 2010, 78 alleged victims were reported to An Garda Siochina and the recorded levels of human trafficking into Ireland have remained at this level for the last four years. Despite this, no Irish guidelines or referral pathways exist to assist health care professionals. This paper highlights that health care professionals are not aware of this occurrence nor have they been trained to identify victims. Due to a lack of awareness many potential opportunities to detect these victims may be missed. While there is no single set of symptoms or signs that differentiates sex-trafficked victims from other sex workers, an awareness of common physical and psychological health problems associated with sex trafficking by health care professionals may increase victim detection rates. This paper summarises indicators, approach mechanisms, screening questions and a referral guideline relevant to the Irish health care system. This step-by-step guide can be used by health care professionals who encounter such a situation.


Subject(s)
Crime Victims , Health Personnel , Human Trafficking , Patient Care Management , Attitude of Health Personnel , Crime Victims/psychology , Crime Victims/statistics & numerical data , Health Knowledge, Attitudes, Practice , Health Personnel/psychology , Health Personnel/standards , Health Services Needs and Demand , Health Status Indicators , Human Trafficking/prevention & control , Human Trafficking/statistics & numerical data , Humans , Ireland , Mass Screening/methods , Mass Screening/organization & administration , Patient Care Management/methods , Patient Care Management/organization & administration , Practice Guidelines as Topic
3.
Ir Med J ; 104(3): 90-1, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21667616

ABSTRACT

Rapidly progressive acute respiratory failure attributed to 2009 H1N1 influenza A infection has been reported worldwide-3. Refractory hypoxaemia despite conventional mechanical ventilation and lung protective strategies has resulted in the use a combination of rescue therapies, such as conservative fluid management, prone positioning, inhaled nitric oxide, high frequency oscillatory ventilation and extracorporeal membrane oxygenation (ECMO)4. ECMO allows for pulmonary or cardiopulmonary support as an adjunct to respiratory and cardiac failure, minimising ventilator-associated lung injury (VALI). This permits treatment of the underlying disease process, while concurrently allowing for recovery of the acute lung injury. This case documents a previously healthy twenty-two year old Asian male patient with confirmed pandemic (H 1N1) 2009 influenza A who was successfully managed with ECMO in the setting of severe refractory hypoxaemia and progressive hypercapnia.


Subject(s)
Influenza A Virus, H1N1 Subtype , Influenza, Human/therapy , Respiratory Insufficiency/therapy , Disease Progression , Extracorporeal Membrane Oxygenation , Humans , Hypercapnia/etiology , Hypoxia/etiology , Male , Young Adult
4.
Vaccine ; 25(8): 1509-12, 2007 Feb 09.
Article in English | MEDLINE | ID: mdl-17095130

ABSTRACT

WHO currently recommends three vaccinations against hepatitis B to provide optimal protection against infection and carriage. However, immunological theory and mathematical modelling suggest that similar protection could be induced with two doses, and trials among adolescents and adults have shown comparable rates for both primary seroprotection and geometric mean titres following vaccination. We determined vaccine efficacy among 60 children who only received two doses of hepatitis B vaccine as infants and among 463 children who had received three doses after 4-7 years of follow-up. Vaccine efficacy among the two-dose group was 86.3% against anti-HBc positivity (infection) and 92.3% against HBsAg positivity (carriage), which was similar to the vaccine efficacy found among the participants who had received three doses. To confirm this comparable vaccine efficacy a randomised controlled non-inferiority trial with long-term follow-up is needed.


Subject(s)
Hepatitis B Vaccines/administration & dosage , Hepatitis B Vaccines/immunology , Hepatitis B/prevention & control , Vaccination/methods , Child, Preschool , Dose-Response Relationship, Immunologic , Female , Humans , Infant , Infant, Newborn , Male
5.
J Infect Dis ; 193(11): 1528-35, 2006 Jun 01.
Article in English | MEDLINE | ID: mdl-16652281

ABSTRACT

BACKGROUND: Carriage of hepatitis B virus (HBV) is a major risk factor for liver cirrhosis and hepatocellular carcinoma. Infant vaccination has been effective in preventing horizontal transmission during early childhood. It is unknown whether protection is maintained into early adulthood. METHODS: In 1984, early childhood vaccination was introduced in 2 rural Gambian villages. In 2003, serological assessment of 81.5% of 1,350 eligible participants 1-24 years old was done, to determine vaccine efficacy against infection and carriage. RESULTS: Overall vaccine efficacy against infection and carriage was 83.4% (95% confidence interval [CI], 79.8%-86.6%) and 96.5% (85% CI, 93.9%-98.9%), respectively. Vaccine efficacy against infection was similar when restricted to primary responders (85.3%), but a significant effect of peak antibody concentration was found. Both vaccine efficacy and levels of hepatitis B surface antibody (anti-HBs) decreased with age, resulting in a vaccine efficacy against infection and carriage among 20-24-year-old participants of 70.9% (95% CI, 60.4%-80.5%) and 91.1% (95% CI, 75.8%-100%), respectively. Fifteen years after vaccination, fewer than half of the vaccinees had detectable anti-HBs. The prevalence of carriage in the unvaccinated population was similar to the prevalence 20 years earlier. CONCLUSIONS: HBV vaccination early during life can provide long-lasting protection against carriage, despite decreasing antibody levels. The role played by subclinical boosting and the necessity of a booster need to be evaluated.


Subject(s)
Carrier State/prevention & control , Hepatitis B Vaccines/immunology , Hepatitis B/prevention & control , Adolescent , Adult , Age Factors , Child , Child, Preschool , Gambia , Hepatitis B Antibodies/blood , Hepatitis B Surface Antigens/blood , Hepatitis B Vaccines/administration & dosage , Humans , Infant
6.
Int J Tuberc Lung Dis ; 6(3): 246-52, 2002 Mar.
Article in English | MEDLINE | ID: mdl-11934143

ABSTRACT

OBJECTIVE AND SETTING: We evaluated a rapid-format antibody card test and the tuberculin skin test for diagnosis of active tuberculosis (TB) in high (Cairo, Egypt) and low (St. Louis, USA) prevalence areas. DESIGN: Prospective study of hospitalized TB patients and controls with other chest diseases. RESULTS: Test performance varied significantly in the two study sites. The antibody test detected 87% of 71 smear-positive pulmonary TB cases (86% of smear-negative pulmonary cases and 48% of TB meningitis cases) in Egypt; specificity was 82%. The tuberculin test was highly sensitive in Egypt in subjects with pulmonary TB (100%) but not in those with meningitis (23%); specificity was 70%. The sensitivity and specificity of the antibody test in St. Louis were 29% and 79%, respectively; 50% of St. Louis TB cases and 15% of controls had positive tuberculin tests. CONCLUSIONS: This convenient antibody card test may have value for diagnosis of patients suspected of having TB in high prevalence areas like Egypt. However, the specificity of the test is too low for it to be useful as a screening test. Our results suggest that neither the antibody test nor the tuberculin test have much diagnostic utility in low prevalence settings like St. Louis.


Subject(s)
Antibodies, Bacterial/analysis , Mass Screening , Tuberculin Test , Tuberculosis, Pulmonary/diagnosis , Adult , Antigens, Bacterial/immunology , Diagnosis, Differential , Female , Humans , Male , Prospective Studies , Sensitivity and Specificity , Serologic Tests , Tuberculosis, Pulmonary/immunology
8.
Infect Control Hosp Epidemiol ; 20(8): 533-8, 1999 Aug.
Article in English | MEDLINE | ID: mdl-10466552

ABSTRACT

OBJECTIVE: To evaluate the efficacy of a comprehensive infection control program on the reduction of surgical-site infections (SSIs) following coronary artery bypass graft (CABG) surgery. DESIGN: Prospective cohort study. SETTING: 1,000-bed tertiary-care hospital. PATIENTS: Persons undergoing CABG with or without concomitant valve surgery from April 1991 through December 1994. INTERVENTIONS: Prospective surveillance, quarterly reporting of SSI rates, chlorhexidene showers, discontinuation of shaving, administration of antibiotic prophylaxis in the holding area, elimination of ice baths for cooling of cardioplegia solution, limitation of operating room traffic, minimization of flash sterilization, and elimination of postoperative tap-water wound bathing for 96 hours. Logistic regression models were fitted to assess infection rates over time, adjusting for severity of illness, surgeon, patient characteristics, and type of surgery. RESULTS: 2,231 procedures were performed. A reduction in infection rates was noted at all sites. The rate of deep chest infections decreased from 2.6% in 1991 to 1.6% in 1994. Over the same period, the rate of leg infections decreased from 6.8% to 2.7%, and of all SSI from 12.4% to 8.9%. The adjusted odds ratio (OR) for all SSIs for the end of 1994 compared to December 31, 1991, was 0.37 (95% confidence interval [CI95], 0.22-0.63). For deep chest and mediastinal infections, the adjusted OR comparing the same period was 0.69 (CI95, 0.28-1.71). CONCLUSIONS: We observed significant reductions in SSI rates of deep and superficial sites in CABG surgery following implementation of a comprehensive infection control program. These differences remained significant when adjusted for potential confounding covariables.


Subject(s)
Coronary Artery Bypass/adverse effects , Infection Control/methods , Surgical Wound Infection/prevention & control , Adult , Aged , Cohort Studies , Cross Infection/prevention & control , Female , Humans , Incidence , Male , Middle Aged , Prospective Studies , Surgical Wound Infection/epidemiology
10.
Commun Dis Rep CDR Rev ; 7(12): R185-9, 1997 Nov 14.
Article in English | MEDLINE | ID: mdl-9394061

ABSTRACT

Official government statistics and serological laboratory data provide limited information about the incidence of leptospirosis in the Republic of Ireland. The mean annual notified incidence in the Republic of Ireland from 1985 to 1996 was 1.3/million. The incidence according to hospital discharge diagnosis was higher at 4.9/million. One hundred and seventy-five serologically confirmed cases of leptospirosis were reported from 1986 to 1996, giving a mean annual incidence of 4.5/million. The true incidence of leptospirosis in the Republic of Ireland is probably higher, as hospital discharge data are incomplete and full serological testing was not always performed. Our data indicate that leptospirosis is an underestimated public health problem with only 26% of cases being notified. A national communicable disease surveillance centre in the Republic of Ireland would facilitate better monitoring and understanding of this disease.


Subject(s)
Leptospirosis/epidemiology , Adult , Aged , Aged, 80 and over , Bias , Female , Humans , Incidence , Ireland/epidemiology , Leptospirosis/immunology , Leptospirosis/microbiology , Male , Middle Aged , Patient Discharge/statistics & numerical data , Population Surveillance/methods , Seasons , Seroepidemiologic Studies , Serotyping
12.
J Hosp Infect ; 14(4): 277-84, 1989 Nov.
Article in English | MEDLINE | ID: mdl-2575626

ABSTRACT

The observation that Enterobacter cloacae has emerged as a cause of infection in a haematology/oncology ward prompted a prospective study over an eight-month period. Sensitivity to antibiotics, plasmid screening and typing methods were used to describe the epidemiology of the organism which was isolated from 22 patients. There was evidence of a limited amount of cross infection. No common sources were found. A large number of distinct strains were identified. E. cloacae infection was associated with prolonged profound leucopenia and broad-spectrum antibiotic therapy.


Subject(s)
Cross Infection/epidemiology , Enterobacteriaceae Infections/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacterial Typing Techniques , Cross Infection/drug therapy , Drug Resistance, Microbial , Enterobacter/classification , Enterobacter/drug effects , Enterobacter/isolation & purification , Enterobacteriaceae Infections/drug therapy , Female , Hematology , Hospital Units , Humans , Ireland , Male , Medical Oncology , Middle Aged , Neutropenia/complications , Prospective Studies
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