Established cardiovascular disease and CVD risk factors in a primary care population of middle-aged Irish men and women

Contemporary Irish data on the prevalence of major cardiovascular disease (CVD) risk factors are sparse. The primary aims of this study were (1) to estimate the prevalence of major cardiovascular disease risk factors, including Type 2 Diabetes Mellitus, in the general population of men and women between the ages of 50 and 69 years; and (2) to estimate the proportion of individuals in this age group at high absolute risk of cardiovascular disease events on the basis of pre-existing cardiovascular disease or as defined by the Framingham equation. Participants were drawn from the practice lists of 17 general practices in Cork and Kerry using stratified random sampling. A total of 1018 people attended for screening (490 men, 48%) from 1473 who were invited, a response rate of 69.1%. Cardiovascular disease risk factors and glucose intolerance are common in the population of men and women aged between 50 and 69 years. Almost half the participants were overweight and a further quarter met current international criteria for obesity, one of the highest recorded prevalence rates for obesity in a European population sample. Forty per cent of the population reported minimal levels of physical activity and 19% were current cigarette smokers. Approximately half the sample had blood pressure readings consistent with international criteria for the diagnosis of hypertension, but only 38% of these individuals were known to be hypertensive. Eighty per cent of the population sample had a cholesterol concentration in excess of 5 mmol/l. Almost 4% of the population had Type 2 Diabetes Mellitus, of whom 30% were previously undiagnosed. A total of 137 participants (13.5%) had a history or ECG findings consistent with established cardiovascular disease. Of the remaining 881 individuals in the primary prevention population, a total of 20 high-risk individuals (19 male) had a risk of a coronary heart disease event 30% over ten years according to the Framingham risk equation, giving an overall population prevalence of 2.0% (95% CI 1.3 - 3.0). At a risk level 20% over ten years, an additional 91 individuals (8.9%) were identified. Thus a total of 24.4% of the population were at risk either through pre-existing CVD (13.5%) or an estimated 10-year risk exceeding 20% according to the Framingham risk equation (10.9%). Thus a substantial proportion of middle-aged men are at high risk of CVD. The findings emphasise the scale of the CVD epidemic in Ireland and the need for ongoing monitoring of risk factors at the population level and the need to develop preventive strategies at both the clinical and societal level.

An analysis of political efficacy socialisation among threshold voters in the Republic of Ireland

The spread of democracy in the latter part of the twenty first century has been accompanied by an increasing focus on its perceived performance in established western democracies. Recent literature has expressed concern about a critical outlook among younger cohorts which threatens their political support and engagement. Political efficacy, referring to the feeling of political effectiveness, is considered to be a key indicator of the performance of democratic politics; as it refers to the empowerment of citizens, and relates to their willingness to engage in political matters. The aim of this thesis is to analyse the socialisation of political efficacy among those on the threshold of political adulthood; i.e., 'threshold voters'. The long-term significance of attitudes developed by time of entry to adulthood for political engagement during adulthood has been emphasised in recent literature. By capturing the effect of non-political and political learning among threshold voters, the study advances existing research frames which focus on childhood and early adolescent socialisation. The theoretical and methodological framework applied herein recognises the distinction between internal and external political efficacy, which has not been consistently operationalized in existing research on efficacy socialisation. This research involves a case study of 'threshold voters' in the Republic of Ireland, and employs a quantitative methodology. A study on Irish threshold voters is timely as the parliament and government have recently proposed a lowering of the voting age and an expansion of formal political education to this age group. A project-specific survey instrument was developed and administered to a systematic stratified sample of 1,042 post-primary students in the Cork area. Interpretation of the results of statistical analysis leads to findings on the divergent influence of family, school, associational, and political agents/environments on threshold voter internal and external political efficacy.

‘Doing’ separation in contemporary Ireland: the experiences of women who separate in midlife

This study explores the experiences of fourteen Irish women who separated in midlife. The rationale for choosing to study this age group of women is because they are the first generation of Irish women to publically separate in midlife in such large numbers. All of them entered marriage at a time when divorce was not possible in Ireland and as such they are broadly without a cultural ‘script’ for how to ‘do’ separation. An exploratory study was conducted to try to capture the processes and events that are part of the lived experiences of separation for women in midlife. In-depth interviews were conducted with fourteen women who were recruited following their attendance at post-separation courses. The participants came from predominantly middle class backgrounds. Narrative interviews were conducted which covered topics such as the attitudes to separation internalised during childhood, the genesis of the marital problems, the events that triggered the separations, the women’s emotional reactions at the time of separating and their social, housing and financial outcomes of having separated. A theoretical framework using concepts related to connectedness and fragmentation was used to analyse the data. Significant diversity was found in the experiences of the interviewees. Most of the women retained connectedness to their children, to their families of origin and to friends who were not joint friends. Significant fragmentation was found in relationships with ex-husbands, with in-laws and with joint friends. All of the women were worse off financially than if they had remained married. They felt socially isolated in the aftermath of separation. Many of the women were struggling to establish positive identities as separated women. While a few of them were very relieved that their marriages had ended, for most, separation was experienced as a painful episode in their lives.

Development of a general internet attitude scale and internet self-efficacy scale

The measurement of users’ attitudes towards and confidence with using the Internet is an important yet poorly researched topic. Previous research has encountered issues that serve to obfuscate rather than clarify. Such issues include a lack of distinction between the terms ‘attitude’ and ‘self-efficacy’, the absence of a theoretical framework to measure each concept, and failure to follow well-established techniques for the measurement of both attitude and self-efficacy. Thus, the primary aim of this research was to develop two statistically reliable scales which independently measure attitudes towards the Internet and Internet self-efficacy. This research addressed the outlined issues by applying appropriate theoretical frameworks to each of the constructs under investigation. First, the well-known three component (affect, behaviour, cognition) model of attitudes was applied to previous Internet attitude statements. The scale was distributed to four large samples of participants. Exploratory factor analyses revealed four underlying factors in the scale: Internet Affect, Internet Exhilaration, Social Benefit of the Internet and Internet Detriment. The final scale contains 21 items, demonstrates excellent reliability and achieved excellent model fit in the confirmatory factor analysis. Second, Bandura’s (1997) model of self-efficacy was followed to develop a reliable measure of Internet self-efficacy. Data collected as part of this research suggests that there are ten main activities which individuals can carry out on the Internet. Preliminary analyses suggested that self-efficacy is confounded with previous experience; thus, individuals were invited to indicate how frequently they performed the listed Internet tasks in addition to rating their feelings of self-efficacy for each task. The scale was distributed to a sample of 841 participants. Results from the analyses suggest that the more frequently an individual performs an activity on the Internet, the higher their self-efficacy score for that activity. This suggests that frequency of use ought to be taken into account in individual’s self-efficacy scores to obtain a ‘true’ self-efficacy score for the individual. Thus, a formula was devised to incorporate participants’ previous experience of Internet tasks in their Internet self-efficacy scores. This formula was then used to obtain an overall Internet self-efficacy score for participants. Following the development of both scales, gender and age differences were explored in Internet attitudes and Internet self-efficacy scores. The analyses indicated that there were no gender differences between groups for Internet attitude or Internet self-efficacy scores. However, age group differences were identified for both attitudes and self-efficacy. Individuals aged 25-34 years achieved the highest scores on both the Internet attitude and Internet self-efficacy measures. Internet attitude and self-efficacy scores tended to decrease with age with older participants achieving lower scores on both measures than younger participants. It was also found that the more exposure individuals had to the Internet, the higher their Internet attitude and Internet self-efficacy scores. Examination of the relationship between attitude and self-efficacy found a significantly positive relationship between the two measures suggesting that the two constructs are related. Implication of such findings and directions for future research are outlined in detail in the Discussion section of this thesis.

Survival analysis of adult tuberculosis disease

Background: We conducted a survival analysis of all the confirmed cases of Adult Tuberculosis (TB) patients treated in Cork-City, Ireland. The aim of this study was to estimate Survival time (ST), including median time of survival and to assess the association and impact of covariates (TB risk factors) to event status and ST. The outcome of the survival analysis is reported in this paper. Methods: We used a retrospective cohort study research design to review data of 647 bacteriologically confirmed TB patients from the medical record of two teaching hospitals. Mean age 49 years (Range 18–112). We collected information on potential risk factors of all confirmed cases of TB treated between 2008–2012. For the survival analysis, the outcome of interest was ‘treatment failure’ or ‘death’ (whichever came first). A univariate descriptive statistics analysis was conducted using a non- parametric procedure, Kaplan -Meier (KM) method to estimate overall survival (OS), while the Cox proportional hazard model was used for the multivariate analysis to determine possible association of predictor variables and to obtain adjusted hazard ratio. P value was set at <0.05, log likelihood ratio test at >0.10. Data were analysed using SPSS version 15.0. Results: There was no significant difference in the survival curves of male and female patients. (Log rank statistic = 0.194, df = 1, p = 0.66) and among different age group (Log rank statistic = 1.337, df = 3, p = 0.72). The mean overall survival (OS) was 209 days (95%CI: 92–346) while the median was 51 days (95% CI: 35.7–66). The mean ST for women was 385 days (95%CI: 76.6–694) and for men was 69 days (95%CI: 48.8–88.5). Multivariate Cox regression showed that patient who had history of drug misuse had 2.2 times hazard than those who do not have drug misuse. Smokers and alcohol drinkers had hazard of 1.8 while patients born in country of high endemicity (BICHE) had hazard of 6.3 and HIV co-infection hazard was 1.2. Conclusion: There was no significant difference in survival curves of male and female and among age group. Women had a higher ST compared to men. But men had a higher hazard rate compared to women. Anti-TNF, immunosuppressive medication and diabetes were found to be associated with longer ST, while alcohol, smoking, RICHE, BICHE was associated with shorter ST.