Equality and Inequalities in Health and Social Care in Northern Ireland

A Statistical Overview: 2002 Following some scene setting, the report draws together wide ranging information to document inequalities in health and social care in Northern Ireland that are relevant to the New Targeting Social Need (New TSN) policy, including the base report of the ‘Inequalities Monitoring System’. The overview also documents comparisons between people living in rural and non-rural areas, and between the statutory equality categories of Section 75 of the Northern Ireland Act. While some of the information has been previously published most of the results are new, and the majority of the new analyses has been undertaken by IAD. åÊ

Best Practice Best Care

A framework for setting standards, delivering services and improving monitoring and regulation in the HPSS åÊ

Gut-derived signaling molecules and vagal afferents in the control of glucose and energy homeostasis.

PURPOSE OF REVIEW: The control of glucose and energy homeostasis, including feeding behaviour, is tightly regulated by gut-derived peptidic and nonpeptidic endocrine mediators, autonomic nervous signals, as well as nutrients such as glucose. We will review recent findings on the role of the gastrointestinal tract innervation and of portal vein glucose sensors; we will review selected data on the action of gastrointestinally released hormones. RECENT FINDINGS: The involvement of mechanosensory vagal afferents in postprandial meal termination has been clarified using mouse models with selective impairments of genes required for development of mechanosensory fibres. These activate central glucogen-like peptide-1/glucogen-like peptide-2 containing ascending pathways linking the visceroceptive brainstem neurons to hypothalamic nuclei. Mucosal terminals comprise the chemosensory vagal afferents responsive to postprandially released gastrointestinal hormones. The mechanism by which the hepatoportal glucose sensor stimulates glucose utilization by muscles was demonstrated, using genetically modified mice, to be insulin-independent but to require GLUT4 and AMP-kinase. This sensor is a key site of glucogen-like peptide-1 action and plays a critical role in triggering first phase insulin secretion. PeptideYY and ghrelin target intracerebral receptors as they are bidirectionally transported across the blood brain barrier. The anorectic functions of peripherally released peptideYY may however be mediated both via vagal afferents and intracerebral Y2 receptors in the brainstem and arcuate nucleus. SUMMARY: These recent findings demonstrate that the use of improved anatomical and physiological techniques and animal models with targeted gene modifications lead to an improved understanding of the complex role of gastrointestinal signals in the control of energy homeostasis.

Epidemiological Aspects of Head Lice in Children Attending Day Care Centres, Urban and Rural Schools in Uberlândia, Central Brazil

From November 1996 to March 2000, a total of 884 children between 0 and 15 years, from 11 institutions including day care centres, public urban and public rural schools in Uberlândia, State of Minas Gerais, central Brazil, were examined for head louse infestation. Children's sex, race, age and some hairs characteristics were shown to be associated to parasite infestation. A prevalence rate of 35% was found and the highest rates were observed in black, female children, with long, dark, wavy hairs. Hairs density and thickness did not seem to influence significantly the distribution of this pediculosis in Uberlândia's schoolchildren. Differences observed between the prevalence rates of head lice in children from the urban institutions suggest there is a greater epidemiological heterogeneity in this group when compared to the rural schoolchildren.

Revue critique d'instruments pour evaluer la douleur chez les personnes cérébrolésées non communicantes aux soins intensifs [Critical review of instruments to assess pain in the non communicative brain injured persons in intensive care].

The purpose of this review is to critically appraise the pain assessment tools for non communicative persons in intensive care available in the literature and to determine their relevance for those with brain injury. Nursing and medical electronic databases were searched to identify pain tools, with a description of psychometric proprieties, in English and French. Seven of the ten tools were considered relevant and systematically evaluated according to the criteria and the indicators in the following five areas: conceptualisation, target population, feasibility and clinical utility, reliability and validity. Results indicate a number of well designed pain tools, but additional work is necessary to establish their accuracy and adequacy for the brain injured non communicative person in intensive care. Recommendations are made to choose the best tool for clinical practice and for research.

Format of medical order sheet improves security of antibiotics prescription: The experience of an intensive care unit.

OBJECTIVE: To assess whether formatting the medical order sheet has an effect on the accuracy and security of antibiotics prescription. DESIGN: Prospective assessment of antibiotics prescription over time, before and after the intervention, in comparison with a control ward. SETTING: The medical and surgical intensive care unit (ICU) of a university hospital. PATIENTS: All patients hospitalized in the medical or surgical ICU between February 1 and April 30, 1997, and July 1 and August 31, 2000, for whom antibiotics were prescribed. INTERVENTION: Formatting of the medical order sheet in the surgical ICU in 1998. MEASUREMENTS AND MAIN RESULTS: Compliance with the American Society of Hospital Pharmacists' criteria for prescription safety was measured. The proportion of safe orders increased in both units, but the increase was 4.6 times greater in the surgical ICU (66% vs. 74% in the medical ICU and 48% vs. 74% in the surgical ICU). For unsafe orders, the proportion of ambiguous orders decreased by half in the medical ICU (9% vs. 17%) and nearly disappeared in the surgical ICU (1% vs. 30%). The only missing criterion remaining in the surgical ICU was the drug dose unit, which could not be preformatted. The aim of antibiotics prescription (either prophylactic or therapeutic) was indicated only in 51% of the order sheets. CONCLUSIONS: Formatting of the order sheet markedly increased security of antibiotics prescription. These findings must be confirmed in other settings and with different drug classes. Formatting the medical order sheet decreases the potential for prescribing errors before full computerized prescription is available.

A Strategy for Health & Social Care Research and Development in Northern Ireland

The Department of Health, Social Services and Public Safety (DHSSPS) is seeking your views on a A Strategy for Health & Social Care Research and Development in Northern Ireland Allowing for public holidays, the draft Strategy has been issued for a 13 week consultation period from 29 September 2014. åÊResponses must be received no later than 5pm on Friday 2 January 2015

Pseudomonas aeruginosa: study of Antibiotic Resistance and Molecular Typing in Hospital Infection Cases in a Neonatal Intensive Care Unit from Rio de Janeiro City, Brazil

This study had the objective of to analyze the demographic and bacteriologic data of 32 hospitalized newborns in an neonatal intensive care unit of a public maternity hospital in Rio de Janeiro city, Brazil, seized by Pseudomonas aeruginosa sepsis during a period ranged from July 1997 to July 1999, and to determine the antimicrobial resistance percentage, serotypes and pulsed field gel electrophoresis (PFGE) patterns of 32 strains isolated during this period. The study group presented mean age of 12.5 days, with higher prevalence of hospital infection in males (59.4%) and vaginal delivery (81.2%), than females (40.6%) and cesarean delivery (18.8%), respectively. In this group, 20 (62.5%) patients received antimicrobials before positive blood cultures presentation. A total of 87.5% of the patients were premature, 62.5% presented very low birth weight and 40.6% had asphyxia. We detected high antimicrobial resistance percentage to b-lactams, chloramphenicol, trimethoprim/sulfamethoxazole and tetracycline among the isolated strains. All isolated strains were classified as multi-drug resistant. Most strains presented serotype O11 while PFGE analysis revealed seven distinct clones with isolation predominance of a single clone (75%) isolated from July 1997 to June 1998.

Health Inequalities: NI Health % Social Care Inequalities Monitoring System - Regional 2014

Key Points: Health outcomes are generally worse in the most deprived areas in Northern Ireland when compared both with those witnessed in the region generally and in the least deprived areas. Large differences (health inequality gaps) continue to exist for a number of different health measures. åá Males in the 20% most deprived areas could expect, on average, to live 4.3 fewer years than the NI average and 7.3 fewer years than those in the 20% least deprived areas.åá Female life expectancy in the most deprived areas was 2.6 years less than the regional average and 4.3 years less than that in the least deprived areas.åá The overall death rate for males as measured by the All Age All Cause Mortality (AAACM) rate was a fifth higher in the most deprived areas (1,567 deaths per 100,000 population) than the NI average (1,304 deaths per 100,000 population), and 44% higher than in the least deprived areas (1,090 deaths per 100,000 population).åá The overall death rate for females (AAACM) in the most deprived areas (1,093 deaths per 100,000 population) was 17% higher than regionally (935 deaths per 100,000 population), and a third higher than in the least deprived areas (829 deaths per 100,000 population).åá The suicide rate in the most deprived areas (30.7 deaths per 100,000 population) was three times that in the least deprived areas (10.1 deaths per 100,000 population). All HSCIMS reports are published on the Departmental website at: http://www.dhsspsni.gov.uk/index/statistics/health-inequalities.htm

A palliative care needs assessment for children

The development of a children’s hospice is not seen as a priority by the respondents in this study, some of whom raised concerns regarding accessibility and cost. There is a degree of ambiguity however, regarding the role of ‘hospice’ in paediatric palliative care with some respondents associating it only with end-of-life care. There is a substantial need for ongoing education, training and development of healthcare professionals caring for children with life-limiting conditions. Palliative care services currently provided to children in Ireland with life-limiting conditions are seen to be inequitable, differing significantly according to diagnosis (malignant versus nonmalignant) and according to geographic location. This poses challenges, particularly for parents of children with non-malignant diseases. Both families and professionals often deem the physical environment for adolescents in hospitals unsuitable. The difficulties encountered in the transition from children’s services to adult services have been identified as an issue for adolescents. The provision of bereavement support varies between services. Professionals have identified the need for a broader range of bereavement services.

Care and Case Management for Older People in Ireland

This study provides, for the first time, a systematic review of how health and social services are currently being delivered to older people with the purpose of identifying models of best practice within a Care Management framework. The research allows the voices of a wide range of health and social service providers to comment individually about how care is currently delivered in Ireland. In addition, the research provides them with an opportunity to express how they feel about Care and Case Management as a model for the planning, co-ordination and delivery of services and its feasibility in an Irish context Download the Report here

Report of the National Advisory Committee on Palliative Care

Over thirty years ago, Prof. John Hinton voiced his criticisms of the standard of medical care offered to patients with advanced and life-threatening conditions. In the decades that followed, we have witnessed a remarkable renaissance in terms of our understanding of the needs of patients in the final stages of life. Developments in therapeutics and in our knowledge of pain and symptom management have spearheaded a quiet but very effective revolution. In parallel with developments in medical science, we have developed a much deeper understanding of the complex psychosocial and spiritual needs of patients and their families, as they seek to cope with the pain and suffering associated with progressive and inevitable loss Download the Report here

Foster Care - A Child Centred Partnership

Many people involved in the foster care service, including professionals working in the area, voluntary agencies and foster carers, have expressed concerns over the last number of years that the infrastructure and policies around foster care need urgent review. As a result of these concerns, the Minister of State at the Department of Health and Children with special responsibility for children established a Working Group in October 1998 to review and make recommendations on all aspects of foster care service Download the Report here Appendices

Report of the National Advisory Committee on Palliative Care

Report of the National Advisory Committee on Palliative Care It is anticipated that the need for palliative care services will increase in coming years. Population projections indicate that between 1996 and 2031 the population aged 65 years and over is expected to more than double. Currently, over 95% of all patients availing of palliative care services suffer from cancer. The number of people dying from cancer is expected to rise in future years, due to the ageing population. Click here to download the document (PDF, 1mb)