Breast cancer mortality in neighbouring European countries with different level of breast screening but similar access to treatment: An analysis of WHO mortality database

Objective: To compare trends in breast cancer mortality within three pairs of neighbouring European countries in relation to implementation of screening. Design: Retrospective trend analysis.
Setting: Three country pairs (Northern Ireland (United Kingdom) v Republic of Ireland, the Netherlands v Belgium and Flanders (Belgian region south of the Netherlands), and Sweden v Norway).
Data sources: WHO mortality database on cause of death and data sources on mammography screening, cancer treatment, and risk factors for breast cancer mortality.
Main outcome measures: Changes in breast cancer mortality calculated from linear regressions of log transformed, age adjusted death rates. Joinpoint analysis was used to identify the year when trends in mortality for all ages began to change.
Results: From 1989 to 2006, deaths from breast cancer decreased by 29% in Northern Ireland and by 26% in the Republic of Ireland; by 25% in the Netherlands and by 20% in Belgium and 25% in Flanders; and by 16% in Sweden and by 24% in Norway. The time trend and year of downward inflexion were similar between Northern Ireland and the Republic of Ireland and between the Netherlands and Flanders. In Sweden, mortality rates have steadily decreased since 1972, with no downward inflexion until 2006. Countries of each pair had similar healthcare services and prevalence of risk factors for breast cancer mortality but differing implementation of mammography screening, with a gap of about 10-15 years.
Conclusions: The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality.

Experimentalism in the Irish Novel, 1750-1770

While recent studies of the novel have turned their attention to the diverse experimentalism of mid-century fiction, a number of significant Irish novels of the period remain under-represented in such work. William Chaigneau, Thomas Amory, Charles Johnstone and Henry Brooke are discussed as experimental novelists, extending the 'new species of writing' by their incorporation of theology and politics, education and philosophy within a fictional frame.

Cost performance of Irish credit unions

There are 424 credit unions in Ireland with assets under their control of €14.3bn and a membership of 2.5m which equates to about 66% of the economically active population, the highest penetration level of any country. That said, the Irish movement sits at a critical development stage, well behind mature markets such as Canada and the US in terms of product provision, technological sophistication, fragmentation of trade bodies and regulatory environment. This study analyses relative cost efficiency or performance of Irish credit unions using the popular frontier approach which measures an entity’s efficiency relative to a frontier of best practice. Parametric techniques are utilised, with variation in inefficiency being attributed to credit union-specific factors. The stochastic cost frontier parameters and the credit-union specific parameters are simultaneously estimated to produce valid statistical inferences. The study finds that the majority of Irish credit unions are not operating at optimal levels. It further highlights the factors which drive efficiency variation across credit unions and they include technological sophistication, ‘sponsor donated’ resources, interest rate differentials and the levels of bad debt written off

'A new sword on an old anvil': W.B.Yeats, Robert Graves and the Anglo-Irish Tradition

Throughout his writing life, Robert Graves was consistently and often publicly hostile to the work of W.B. Yeats, whilst still also owing a considerable debt to the older poet (who he never met). This essay explores Graves' complex responses to Yeats, arguing that his antagonism may be understood in the light of his own Anglo-Irish background, and is implicated in his relations with his father, Alfred Perceval Graves, as well as his experience of the First World War. Probing the suggestiveness of Graves's claim in 1959 that his poems 'remain true to the Anglo-Irish poetic tradition into which I was born', it traces the relation between Yeats and Graves through correspondence, critical writings, and through a comparative reading of Yeats's A Vision and Graves's The White Goddess, and reveals underlying similarities in their critical and mythological thinking in spite of Graves's public disavowal of the Yeatsian aesthetic.

Fecundity of Nephrops norvegicus from the Irish Sea

Potential fecundity, number of oocytes in the mature ovary, and realized fecundity, number of eggs extruded and attached to the pleopods of female Nephrops, caught at the start of the incubation period were estimated for females from the eastern and western Irish Sea grounds. Potential fecundity was found to differ significantly between eastern and western Irish Sea stocks, while realized fecundity did not differ between areas. Inter-year comparison of realized fecundity, and effective fecundity (the number of mature eggs on the pleopods of females at the end of the incubation period) in the western Irish Sea stocks revealed no significant variation over time. Egg loss during the transition from oocytes in the ovary to mature eggs increased with female size, ranging from 40% at 25 mm carapace length (CL) to 65% at 40 mm CL. No relationship was found between egg diameter or volume and female size.

Potentially inappropriate prescribing in an Irish elderly population in primary care.

AIMS Screening tools have been formulated to identify potentially inappropriate prescribing (IP) in older people. Beers’ criteria are the most widely used but have disadvantages when used in Europe. New
IP screening tools called Screening Tool of Older Person’s Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) have been developed to identify potential IP and potential prescribing omissions (PPOs). The aim was to measure the prevalence rates of potential IP and PPOs in primary care using Beers’ criteria, STOPP and START.

METHODS
Case records of 1329 patients 65 years old from three general practices in one region of southern Ireland were studied. The mean age SD of the patients was 74.9 6.4 years, 60.9% were female. Patients’current diagnoses and prescription medicines were reviewed and the Beers’ criteria, STOPP and START tools applied.

RESULTS
The total number of medicines prescribed was 6684; median number of medicines per patient was ?ve (range 1–19). Overall, Beers’ criteria identi?ed 286 potentially inappropriate prescriptions in 18.3% (243) of patients, whilst the corresponding IP rate identi?ed by STOPP was 21.4% (284), in respect of 346 potentially inappropriate prescriptions. A total of 333 PPOs were identi?ed in 22.7% (302) of patients using the START tool.

CONCLUSION
Potentially inappropriate drug prescribing and errors of drug omission are highly prevalent among older people living in the community. Prevention strategies should involve primary care doctors and community pharmacists.