Association of early life factors and acute lymphoblastic leukaemia in childhood: historical cohort study. (73/723)

In a historical cohort study of all singleton live births in Northern Ireland from 1971-86 (n=434,933) associations between early life factors and childhood acute lymphoblastic leukaemia were investigated. Multivariable analyses showed a positive association between high paternal age (> or =35 years) and acute lymphoblastic leukaemia (relative risk=1.49; 95% confidence interval (CI)=0.96--2.31) but no association with maternal age. High birth weight (> or =3500 g) was positively associated with acute lymphoblastic leukaemia (relative risk=1.66; 95% CI=1.18--2.33). Children of mothers with a previous miscarriage or increased gestation (> or =40 weeks) had reduced risks of ALL (respective relative risks=0.49; 95% CI=0.29--0.80, and 0.67; 95% CI=0.48--0.94). Children born into more crowded households (> or =1 person per room) had substantially lower risks than children born into less crowded homes with also some evidence of a lower risk for children born into homes with three adults (relative risks=0.56; 95% CI=0.35-0.91 and 0.58; 95% CI=0.21-1.61 respectively). These findings indicate that several early life factors, including living conditions in childhood and maternal miscarriage history, influence risk of acute lymphoblastic leukaemia in childhood.  (+info)

Inpatient costs and paramilitary punishment beatings in northern Ireland. (74/723)

BACKGROUND: Paramilitary punishment beatings are a common occurrence in Northern Ireland. Little is known about the costs such attacks impose on the health service. METHODS: Data was collected retrospectively on victims treated by Northern Ireland's regional specialist orthopaedics unit. Data related to all victims treated in the unit between January 1999 and May 2000. RESULTS: Average inpatient care costs were 2010 Pounds ($2914). There was no significant difference in these between patients who were shot and those who were beaten. CONCLUSION: Punishment beatings present a small but significant cost burden to the health service. A fuller understanding of them from a health care perspective is warranted.  (+info)

Clinical screening for developmental dysplasia of the hip in Northern Ireland. (75/723)

PROBLEM: The incidence of late diagnosed developmental dysplasia of the hip requiring surgery in Northern Ireland is high. The reported incidence was 1.14 per 1000 children born during 1983-7. DESIGN: Comparative retrospective study. BACKGROUND AND SETTING: Clinical screening programme in Northern Ireland. Key measure for improvement: Reduced rate of operative intervention in children with developmental dysplasia of the hip detected after 6 months of age. STRATEGIES FOR CHANGE: Increased emphasis on staff training, introduction of a centralised nurse led clinic to improve access to orthopaedic surgeons, and increased use of ultrasonography. EFFECTS OF CHANGE: The incidence of developmental dysplasia of the hip diagnosed after 6 months in children born between January 1991 and December 1997 fell to 0.59 per 1000, presumably due to improved early detection. Nevertheless, 29 (16%) of the affected hips were not diagnosed when the child was first referred in the first 3 months of life. In addition, for 27 affected hips in children diagnosed after the age of 6 months there was a known risk factor (family history or breech delivery). LESSONS LEARNT: Improvements to screening processes can reduce late incidence of developmental dysplasia of the hip. Further steps to improve detection in children with known risk factors and rate of detection at first referral could reduce late presentation further.  (+info)

Standard indicators of deprivation: do they disadvantage older people? (76/723)

BACKGROUND: ecological studies using standard generic indicators of material deprivation have suggested that there is little social inequality at older ages. This may be because the indicators used were designed for studying younger populations and may be biased against older people. OBJECTIVE: to examine the association, at different ages, between mortality ratios, indicators of deprivation and an indicator of poverty, which can be easily tailored to different age groups. METHODS: an ecological study comparing mortality ratios and indicators of deprivation and poverty. We calculated standardised mortality ratios for those under and over 75 years, using all deaths for Northern Ireland between 1990 and 1998. We calculated levels of income support uptake (a social security benefit) for similar age groups. We derived three commonly used indicators of deprivation (Townsend, Carstairs and Jarman) from census data. We assessed the strength of association between the mortality ratios and the indicators of poverty and deprivation using Pearson correlation coefficients. RESULTS: 11.1% of people under 75 and 24.3% of those over 75 were on income support. Income support uptake for those over 75 was strongly correlated with deprivation indicators. There was a much weaker relationship between disadvantage and mortality at older ages, especially in women. Poverty, as measured by income support ratios, was more highly correlated with mortality than any other deprivation indicator-especially at older ages and in women, where income support uptake produced the highest correlations. CONCLUSIONS: many of the commonly used indicators of deprivation are poorly suited to studying inequalities in health in older people. Uptake of income support offers many advantages over conventional indicators.  (+info)

Physical activity and coronary event incidence in Northern Ireland and France: the Prospective Epidemiological Study of Myocardial Infarction (PRIME). (77/723)

BACKGROUND: The influence of physical activity on the incidence of angina pectoris and hard coronary events (myocardial infarction and coronary deaths) was examined in Northern Ireland and France at contrasting risk for coronary heart disease (CHD) and with different physical activity patterns. METHODS AND RESULTS: Participants of the Prospective Epidemiological Study of Myocardial Infarction (PRIME) (n=9758; age, 50 to 59 years), free of CHD at baseline, were followed up for 5 years: 167 hard CHD and 154 angina events were recorded. Net energy expenditure (EE) as the result of physical activity was assessed by means of the MONICA Optional Study of Physical Activity Questionnaire (MOSPA-Q). Leisure-time physical activity EE was calculated; subjects were also categorized as to whether they performed high-intensity leisure-time activities or walked or cycled to work. After multivariate adjustment, leisure-time physical activity EE was associated with a lower risk of hard CHD events (P<0.04), whereas walking or cycling to work was not independently related to hard CHD events. No interaction by country was found. The beneficial effect of leisure-time physical activity was also present among subjects who did not report high-intensity activities (P<0.04), with similar results in France and Northern Ireland. In contrast, an increasing level of leisure-time physical activity was associated with a higher risk of angina in both countries. CONCLUSIONS: These data indicate a beneficial effect of leisure-time physical activity EE on hard CHD incidence in middle-aged men, which could partly explain the unfavorable rate of CHD in Northern Ireland. The higher level of leisure-time activities in France could, in part, explain its lower rate of CHD.  (+info)

Three drinking-water-associated cryptosporidiosis outbreaks, Northern Ireland. (78/723)

Three recent drinking-water-associated cryptosporidiosis outbreaks in Northern Ireland were investigated by using genotyping and subgenotyping tools. One Cryptosporidium parvum outbreak was caused by the bovine genotype, and two were caused by the human genotype. Subgenotyping analyses indicate that two predominant subgenotypes were associated with these outbreaks and had been circulating in the community.  (+info)

Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic. (79/723)

Unkept outpatient appointments are a drain on resources. In a prospective study we asked non-attenders at a gastroenterology clinic why they had missed their appointment. 103 patients missed their appointment (14% of the total invited); 3 had died. The remaining 100 were asked to complete questionnaires, 68 by mail (43 returned) and 32 by telephone (30 successful); the response rate was thus 73%. 49 of the respondents were new patients, 6 of them with urgent referrals. The explanations for non-attendance by the 73 patients were: forgot to attend or to cancel (30%); no reason (26%); clerical errors (10%); felt better (8%), fearful of being seen by junior doctor (3%); inpatient in another hospital (3%); miscellaneous other (20%). 13 (27%) of the review patients had not kept one or more previous appointments. The non-attendance rates for different clinics ranged from 10% to 25% (average 14%). A substantial number of non-attenders claimed to have forgotten their appointment or to cancel it. If, as we surmise, this reflects apathy, no strategy to improve attendance is likely to have great impact. Since the non-attendance rate is reasonably constant, it can be taken into account when patients are booked.  (+info)

Value of HDL cholesterol, apolipoprotein A-I, lipoprotein A-I, and lipoprotein A-I/A-II in prediction of coronary heart disease: the PRIME Study. Prospective Epidemiological Study of Myocardial Infarction. (80/723)

OBJECTIVE: We have examined the association between the incidence of coronary heart disease (CHD) and plasma high density lipoprotein (HDL) cholesterol, apolipoprotein A-I (apoA-I), and 2 HDL fractions, lipoprotein A-I and lipoprotein A-I:A-II. METHODS AND RESULTS: These parameters were measured in subjects recruited in France and in Northern Ireland in the Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study, a prospective cohort study. Among the subjects free of CHD on entry, 176 in France and 113 in Northern Ireland suffered an ischemic attack (CHD patients) during the 5-year follow-up, whereas 6612 French and 2172 Northern Irish men showed no CHD symptoms (CHD-free subjects). All 4 HDL parameter levels were lower in CHD patients than in CHD-free subjects. After the cohort was divided into quintiles based on the distribution of HDL parameter levels, a significant (P<0.0001) linear increase in relative risk was observed for each HDL parameter level. However, regression logistic analyses showed that apoA-I was the strongest predictor (more powerful than HDL cholesterol) and that lipoprotein A-I and lipoprotein A-I:A-II did not supplement apoA-I in predicting CHD. CONCLUSIONS: Among the parameters related to HDL, apoA-I appears to be the strongest independent risk factor.  (+info)