Barriers and facilitators to adoption, implementation and sustainment of obesity prevention interventions in schoolchildren- a DEDIPAC case study.

BACKGROUND: The aim of the study was to explore the implementation of school based diet and physical activity interventions with respect to the barriers and facilitators to adoption, implementation and sustainability; supportive actions required for implementation and recommendations to overcome identified barriers. Two interventions rolled out nationally in Ireland were chosen; Food Dudes, a programme to encourage primary school children to consume more fruit and vegetables and Green Schools Travel (GST), an active travel to school programme in primary and secondary schools. Trained school coordinators (teachers) cascade the programmes to other teaching staff. METHODS: Multiple case study design using qualitative semi-structured interviews with key stakeholders: primary and secondary school teachers, school coordinators, project coordinators/managers, funders and intermediaries. Fifteen interviews were conducted. Data were coded using a common categorization matrix. Thematic analysis was undertaken using the Adoption, Implementation and Maintenance elements of the RE-AIM implementation framework. RESULTS: Good working relationships within and across government departments, intermediaries and schools were critical for intervention adoption, successful implementation and sustainability. Organisational and leadership ability of coordinators were essential. Provision of participation incentives acted as motivators to engage children's interest. A deep understanding of the lives of the target children was an important contextual factor. The importance of adaptation without compromising core components in enhancing intervention sustainability emerged. Successful implementation was hindered by: funding insecurity, school timetable constraints, broad rather than specific intervention core components, and lack of agreement on conduct of programme evaluation. Supportive actions for maintenance included ongoing political support, secure funding and pre-existing healthy lifestyle policies. CONCLUSIONS: Successful implementation and scale up of public health anti-obesity interventions in schools is dependent on good contextual fit, engagement and leadership at multiple levels and secure funding. Recommendations to overcome barriers include: capacity to deliver within an already overcrowded curriculum and clear specification of intervention components within a conceptual framework to facilitate evaluation. Our findings are generalisable across different contexts and are highly relevant to those involved in the development or adaptation, organisation or execution of national public health interventions: policy makers, guidelines developers, and staff involved in local organisation and delivery.

Investigation and management of an outbreak of Salmonella Typhimurium DT8 associated with duck eggs, Ireland 2009 to 2011.

Salmonella Typhimurium DT8 was a very rare cause of human illness in Ireland between 2000 and 2008, with only four human isolates from three patients being identified. Over a 19-month period between August 2009 and February 2011, 34 confirmed cases and one probable case of Salmonella Typhimurium DT8 were detected, all of which had an MLVA pattern 2-10-NA-12-212 or a closely related pattern. The epidemiological investigations strongly supported a linkbetween illness and exposure to duck eggs. Moreover, S. Typhimurium with an MLVA pattern indistinguishable (or closely related) to the isolates from human cases, was identified in 22 commercial and backyard duck flocks, twelve of which were linked with known human cases. A range of control measures were taken at farm level, and advice was provided to consumers on the hygienic handling and cooking of duck eggs. Although no definitive link was established with a concurrent duck egg-related outbreak of S. Typhimurium DT8 in the United Kingdom, it seems likely that the two events were related. It may be appropriate for other countries with a tradition of consuming duck eggs to consider the need for measures to reduce the risk of similar outbreaks.

Continued raw milk consumption on farms: why?

The potential dangers associated with drinking unpasteurized milk have been highlighted over recent years. Nevertheless, the vast majority of Irish farming families persist in the practice. This qualitative study was undertaken to ascertain the reasons why. It was found that farmers generally believe their milk to be risk free on the basis of 'routine' test results. They also believe it to be of better quality than pasteurised milk, in addition to being the cheaper option. Adherence to tradition is another factor. The targeting of a more informed, credible public health message which takes account of commonly held, and understandable, views among the farming community is proposed.

United front--veterinary and medical collaboration.

Four cases of concomitant animal and human Salmonellosis were investigated. Liaison took place between veterinary, public health medical and environmental health professionals. An epidemiological association between veterinary and medical disease outbreaks was established following cases in a dairy unit, a poultry unit, a calf rearing unit and one pig and dairy unit (on the same farm). In three cases clinical disease in animals preceded clinical disease in humans while in the fourth case, the poultry unit, salmonella isolations from poultry carcasses coincided with clinical salmonellosis in a human working with the live poultry. Important epidemiological factors are identified. The problems of delay in seeking veterinary advice, compartmentalisation of veterinary and medical practices, and the benefits of direct collaboration between veterinary and medical professionals in the event of a diagnosis of salmonellosis in animals and/or humans are highlighted. A collaborative reporting and liaison model is proposed.

Survey of immunity to measles in schoolchildren in Cork.

Surveillance of measles in the Republic of Ireland has relied until now on notifications of clinically diagnosed infections and a manual system for monitoring coverage. In the light of a measles epidemic predicted in the United Kingdom in 1995, it was considered timely to review the epidemiology of measles and obtain baseline seroepidemiological data on measles immunity in Cork City in the Republic of Ireland. The age specific prevalence of measles IgG in saliva from 2000 schoolchildren aged 5 to 15 years was determined. The study also compared susceptibility rates in children with and without a history of measles vaccination or infection. Histories provided by parents were found to be unreliable in informing vaccination practice, as 79 of the 102 seronegative children would have been classified as immune. The proportion of children immune to measles, as gauged by seropositivity, was 91.9% in children aged 5 to 10 years and 95.8% in 11 to 15 year olds. The implications of the study results are discussed in relation to future prevention and control strategies.

Meningococcus: a menace in Cork?

A review of laboratory isolates and notifications of meningococcal disease in the Cork area was conducted for the period 1989-93. The study aimed to describe the epidemiology of meningococcal disease in the area. The incidence of meningococcal disease is high in the Cork area and has been increasing since 1991 with a peak incidence of laboratory confirmed cases of 6.5 per 100,000 in 1993. In the five year review period 113 notifications of meningococcal disease were identified of which 61 (54%) were laboratory confirmed and 52 (46%) were clinically diagnosed only. All laboratory confirmed cases had been notified to the local Director of Community Care/Medical Officer of Health. Group C organisms comprised two-thirds of isolates in 1992 and 1993. Comparison of regional and national incidence rates must be based on laboratory confirmed cases as the criteria for diagnosis and completeness of notifications may vary. A National Infectious Disease Surveillance Centre is vital for monitoring trends and for the coordinated development of a national policy on control and prevention of meningococcal disease.