IPH response to the HIQA consultation on the National Demographic Dataset and Guidance for use in health and social care settings in Ireland

The remit of the Institute of Public Health in Ireland (IPH) is to promote cooperation for public health between Northern Ireland and the Republic of Ireland in the areas of research and information, capacity building and policy advice. Our approach is to support Departments of Health and their agencies in both jurisdictions, and maximise the benefits of all-island cooperation to achieve practical benefits for people in Northern Ireland and the Republic of Ireland. IPH have previously responded to consultations to the Department of Health’s Discussion Paper on the Proposed Health Information Bill (June 2008), the Health Information and Quality Authority on their Corporate Plan (Oct 2007), and the Road Safety Authority of Ireland Road Safety Strategy (Jul 2012). IPH supports the development of a national standard demographic dataset for use within the health and social care services. Provided necessary safeguards are put in place (such as ethics and data protection) and the purpose of collecting the information is fully explained to subjects, mandatory provision of a minimum demographic dataset is usually the best way to achieve the necessary coverage and data quality. Demographic information is needed in several forms to support the public health function: Detailed aggregated information for comparison to population counts in order to assess equity of access to healthcare as well as examining population patterns and trends in morbidity and mortality Accurate demographic information for the surveillance of infectious disease outbreaks, monitoring vaccination programmes, setting priorities for public health interventions Linked to other data outside of health and social care such as population data, survey data, and longitudinal studies for research and analysis purposes.   Identify and address public health issues to tackle health inequalities, and to monitor the success of such efforts to tackle them.

A Health Economics Model. The cost benefits of the Physical Activity Strategy for Northern Ireland - a summary of key findings

This summary report follows on from the publication of the Northern Ireland physical activity strategy in 1996 and the subsequent publication of the strategy action plan in 1998. Within this strategy action plan a recommendation was made for the health sector, that research should be carried out to evaluate and compare the cost of investing in physical activity programmes against the cost of treating preventable illness. To help in the development of this key area, the Department of Health, Social Services and Public Safety's Economics Branch agreed to develop a model that would seek to establish the extent of avoidable deaths from physical inactivity and, as a consequence, the avoidable economic and healthcare costs for Northern Ireland.

Acquired epileptic dysgraphia: a longitudinal study.

A male presenting with benign partial epilepsy with rolandic spikes from the age of 7 years was evaluated at age 11 years for worsening of his epilepsy associated with a specific regression of graphomotor skills. A longitudinal study over nearly 2 years showed an improvement in handwriting to an almost normal level under modified antiepileptic therapy. A detailed analysis with a computer-monitored graphics table showed at first a rapid improvement of skills followed by protracted slower progress. We argue that the initial rapid recovery of skills was directly linked to the improvement of his epilepsy. The slower late acquisition of motor programmes that had never been fully established was due to long-standing interference by his epilepsy. The specificity of the deficit within the graphomotor system and its possible neurobiological basis are also discussed. The analytical method and approach used in a single patient might provide an example for other patients in whom epilepsy can interfere in the acquisition, progress, and maintenance of new skills and can be responsible for selective deficits.

Skin Cancer Prevention Strategy and Action Plan (PDF 455KB)

Northern Ireland may not enjoy the sunniest climate in the world, or even in the UK, however, in spite of this we have witnessed a significant rise in the incidence of melanoma skin cancer cases in recent years - from 80 cases in 1984 to 282 in 2009 (the latest year for which published figures are available). In relation to non-melanoma skin cancers, there are approximately 2,850 new cases here each year, making it the most common type of cancer diagnosed in Northern Ireland. åÊ The rise in the number of skin cancer cases is alarming. We know that the increase in this particular type of cancer is global and not just confined to our part of the world. We also know there are many factors involved: the significant rise in people travelling on foreign sun holidays; more leisure time being spent out of doors; and damage caused to the ozone layer to name but a few. åÊ Substantial progress in the area of skin cancer awareness raising and prevention has been made through the previous “Melanoma Strategy” which was developed in 1997. However, the unfortunate reality is that we will continue to see rising rates of skin cancer for some time to come as a result of many years of overexposure to the sun before skin cancer prevention programmes were developed. Until we can reverse this trend through effective campaigning and awareness raising, early detection will be key to bringing down mortality rates. While the 1997 strategy was right for its time, there have been many developments since then, necessitating a new strategy to reflect today’s position. åÊ For example, recent studies about the importance of vitamin D have highlighted the need for balance in sun safety messages. This new strategy is not about stopping people from enjoying the sun and its many benefits. Rather, it is about encouraging people to take proportionate measures to prevent overexposure. åÊ åÊ

Stage of change of cigarette smoking in drug dependent patients

Résumé En Suisse, les programmes de désaccoutumance au tabac se réfèrent généralement au modèle de préparation au changement de Prochaska et DiClemente (1983), Les patients atteints de maladies somatiques liées au tabagisme comme les pathologies cardiovasculaires ou pulmonaires accèdent facilement à ces programmes, contrairement aux patients présentant une dépendance à des drogues illicites. La prévalence de fumeurs dans cette population est pourtant élevée et les problèmes engendrés par le tabac sont importants, non seulement d'un point de vue individuel mais aussi en terme de santé publique. Il est par conséquent intéressant d'évaluer la motivation concernant la désaccoutumance au tabac de patients toxicomanes entreprenant un sevrage de drogues illicites. Dans cette étude, nous avons évalué les stades de préparation au changement concernant la dépendance au tabac chez 100 patients toxicomanes hospitalisés sur un mode volontaire dans le cadre d'un programme de sevrage à des drogues illégales. L'évaluation s'est faite à l'aide d'un auto-questionnaire dont les résultats indiquent qu'une minorité de patients sont décidés à interrompre la consommation de tabac. En effet, seul 15% des patients se trouvaient aux stades de contemplation ou de décision. De plus, 93% des sujets considéraient l'arrêt du tabac comme difficile ou très difficile. Ces données montrent qu'il existe un décalage important entre la motivation relative au sevrage de drogues illégales et la motivation liées à l'arrêt du tabac. En effet, malgré leur motivation élevée pour se sevrer de drogues illicites, la proportion de patients restant au stade de précontemplation concernant la désaccoutumance au tabac reste élevée. Diverses hypothèses permettent d'expliquer ces résultats, notamment la perception que la désaccoutumance au tabac est plus difficile à réaliser que le sevrage de substances illicites. Abstract Nicotine cessation programmes in Switzerland, which are commonly based on the stage of change model of Prochaska and DiClemente (1983), are rarely offered to patients with illicit drug dependence. This stands in contrast to the high smoking rates and the heavy burden of tobacco-related problems in these patients. The stage of change was therefore assessed by self-administered questionnaire in 100 inpatients attending an illegal drug withdrawal programme. Only 15% of the patients were in the contemplation or decision stage. 93% considered smoking cessation to be difficult or very difficult. These data show a discrepancy between the motivation to change illegal drug consumption habits and the motivation for smoking cessation. The high pro-portion of patients remaining in the precontemplation stage for smoking cessation, in spite of their motivation for illicit drug detoxification, may be due to the perception that cessation of smoking is more difficult than illicit drug abuse cessation.

Maintien des capacités des myopathes ou l'art de prescrire l'exercice physique [How to maintain the motor capacities in neuromuscular disorders or the art to prescribe physical exercises].

Optimum management of non-acquired neuromuscular disorders requires a multidisciplinary approach in order to prevent secondary complications related to the progression of the disease and to maintain the patient's independency in daily activities. For treatments, the physiotherapists and occupational therapists must have precise and measurable goals to quantify muscle strength and functions in conjunction with a specialist in neurorehabilitation. Examples of simple motor scores or scales are given in order to transmit precise information to the GP and the multidisciplinary team, and type of orthosis and physiotherapy programmes are given as pieces of advice to assume the follow-up of patients.

Some methodological reflections about the study of religions on video sharing websites

This article offers an overview of methodological difficulties that arise in the study of religions on video sharing websites (VSW). We suggest how to put these difficulties in perspective and how to overcome them. A typology lists the various forms of religions represented on this type of website. We will also try to understand why some religious groups have created their own video sharing websites. Finally we will give possible interpretations of this phenomenon and suggest some ways to use this type of material in academic research and teaching about religions. Cet article propose une vue d'ensemble des difficultés méthodologiques rencontrées dans l'étude des religions sur les sites web de partage de vidéos. Il propose des pistes pour relativiser et surmonter ces difficultés. Une typologie présente les différentes formes sous lesquelles on trouve des religions dans ce type de sites web. Nous tentons aussi de comprendre pourquoi certains groupes religieux ont créé leurs propres sites de partages de vidéos. Enfin, nous donnerons des possibles interprétations du phénomène et suggérerons comment on pourrait utiliser de ce type de matériel dans la recherche et l'enseignement académiques sur les religions.

Home Accident Prevention Strategy

The overall aim of the strategy is “To reduce the number of accidental deaths and injuries in the home.” OBJECTIVES OF THE STRATEGY The key objectives are: • to reduce home accidents, particularly in those most at risk; • to raise awareness of the causes of home accidents and promote effective preventative measures to reduce such accidents; • to promote and facilitate effective training, skills and knowledge in home accident prevention across all relevant organisations, groups and individuals. These objectives will be met through integrated and effective approaches including: • education and information programmes to promote home safety, and promote a change in public behaviour towards home accident prevention; and • the use of evidence based practice, models of good practice, and by evaluating home accident prevention initiatives. OUTCOMES If successful, implementation of this strategy will lead to a reduction in the number of home accidents and contribute to the outcome “reduction in preventable deaths and diseases and improvement in wellbeing” set out in the Northern Ireland Priorities and Budget 2004-2006.

L'intégration de l'adaptation au changement climatique dans la conduite des politiques publiques: déficit de mise en oeuvre ou déficit de légitimité?

L'échec des tentatives de juguler les émissions globales de gaz à effet de serre a mené au renforcement d'un discours sur la nécessité de l'adaptation au changement climatique. Il est de plus souvent considéré qu'une transformation de l'action publique serait nécessaire afin de réduire les impacts de grande magnitude qui découlent du changement climatique. Depuis les années 2000, on constate ainsi un développement des activités étatiques dans le domaine de l'adaptation. Cette évolution suscite une question centrale: quels sont les effets réels que provoque l'intégration de l'adaptation au changement climatique dans la conduite des politiques publiques et comment expliquer les éventuelles limites à ces processus? La littérature spécialisée sur l'adaptation fait preuve d'un certain réductionnisme à l'égard de la complexité de l'action publique en considérant que lorsque la capacité d'agir contre le problème de la vulnérabilité au changement climatique existe, toute forme d'inaction publique serait un déficit de mise en oeuvre provoqué par des barrières à l'action qu'il faudrait lever. A contrario, cette thèse considère l'adaptation comme une norme de politique publique dont l'intégration est susceptible de provoquer des changements institutionnels dans la forme et le contenu des politiques publiques, et des effets concrets sur les acteurs vulnérables au changement climatique. Afin de mesurer les effets de l'intégration politique de l'adaptation, un concept est formulé sur la base d'un idéal-type du régime institutionnel adaptatif, soit une construction théorique des régulations qu'impliquerait une gestion cohérente du système socioécologique complexe dans lequel s'insère le système climatique. L'auteur propose un cadre d'analyse empirique des processus publics d'adaptation qu'il applique ensuite à deux États: l'Inde (politique agricole) et la Suisse (politique du tourisme hivernal), avec pour objectif de repérer des mécanismes explicatifs communs aux effets de l'intégration dans ces deux contextes extrêmement dissemblables. L'étude débouche sur six résultats qui constituent une contribution appréciable à la littérature. L'auteur montre: premièrement, que l'intégration politique de l'adaptation conduit à une production d'actes symboliques, qui s'explique notamment par le manque de pression publique à agir sur le problème de la vulnérabilité au changement climatique; deuxièmement, que le processus d'intégration agit sur la réalité sociale par le biais d'un mécanisme d'attribution de ressources publiques à certains acteurs du champ politique; troisièmement, que les groupes sociaux qui bénéficient de ces ressources publiques ne sont pas nécessairement les plus vulnérables, mais ceux détenant les ressources d'action nécessaires à l'activation de l'intervention publique; quatrièmement, que l'absence de clefs de répartition des coûts de l'adaptation, de procédures de monitoring et d'instruments d'action contraignants limitent les effets des programmes publics d'adaptation; cinquièmement, que la faible articulation institutionnelle entre objectif d'adaptation et objectifs de protection de l'environnement accentue le risque de processus d'adaptation produisant des externalités environnementales; sixièmement, que les transformations dont la littérature souligne la nécessité ne sont pas nécessairement faisables ni désirables. Sur la base de cette analyse, cette thèse s'écarte de la littérature dominante en concluant que les processus publics d'adaptation ne souffrent pas d'un déficit de mise en oeuvre, mais d'un déficit de légitimité lié à leurs effets pernicieux. L'auteur formule alors trois recommandations pour améliorer la légitimité de ces politiques et trois questions ouvertes sur le futur politique de l'adaptation.

Percepció dels docents del curs bàsic de l'ISPC en relació a les seves competències digitals

Presentem els resultats d’un estudi relatiu a les competències digitals dels docents de l’ Institut de Seguretat Pública de Catalunya, centrant-nos en una mostra de 500 docents que imparteixen el curs bàsic policial, i fent servir una enquesta online. Tenint en compte els coneixements anteriors envers les TIC i la seva aplicació a la seva vida quotidiana es vol donar una visió de la preparació dels docents per tal de poder detectar virtuts i mancances en els seus coneixements per a una futura aplicació de les TIC a les seves pràctiques docents. Paraules clau: Competències digitals, Institut de Seguretat Pública de Catalunya, docents

Annual Report to the Equality Commission 04-05 (PDF 187 KB)

The Department’s Evaluation and Equality Unit provides advice and guidance to colleagues throughout the Department who are planning and undertaking reviews and evaluations of programmes, services and policies, and provides guidance and information to support the policy-making processes. In carrying out this function the Unit has continued to help colleagues to mainstream equality considerations into decision-making, reviews and evaluations from the earliest stages of these processes. åÊ

Test methods: anabolics.

In the International Olympic Committee (IOC) accredited laboratories, specific methods have been developed to detect anabolic steroids in athletes' urine. The technique of choice to achieve this is gas-chromatography coupled with mass spectrometry (GC-MS). In order to improve the efficiency of anti-doping programmes, the laboratories have defined new analytical strategies. The final sensitivity of the analytical procedure can be improved by choosing new technologies for use in detection, such as tandem mass spectrometry (MS-MS) or high resolution mass spectrometry (HRMS). A better sample preparation using immuno-affinity chromatography (IAC) is also a good tool for improving sensitivity. These techniques are suitable for the detection of synthetic anabolic steroids whose structure is not found naturally in the human body. The more and more evident use, on a large scale, of substances chemically similar to the endogenous steroids obliges both the laboratory and the sports authorities to use the steroid profile of the athlete in comparison with reference ranges from a population or with intraindividual reference values.

La incidència de l’aprovació de la LO 1/2004, de mesures de protecció integral contra la violència de gènere, a nivell institucional

L’obligació a partir de la LO 1/2004 de realitzar programes formatius en cas de suspensió o substitució d’una pena imposada per un delicte de violència de gènere ha suposat que els operadors jurídics, malgrat el recolzament majoritari a aquesta mesura, es mostrin en desacord amb l’obligatorietat i demanin més discrecionalitat.

Equality Programme for Health, Social Services and Public Safety (PDF 181KB)

The Department of Health, Social Services and Public Safety (HSSPS), like all public authorities, is required under Section 75 of the Northern Ireland Act 1998 (‘the Act’) in carrying out its functions, powers and duties, to have due regard to the need to promote equality of opportunity and good relations among 9 specific categories of people. In fulfilling these obligations, the Department is required to submit its policies and programmes to formal assessment of the equality implications arising from them through Equality Impact Assessments (EQIAs). åÊ

Schistosomiasis epidemiology and control: how did we get here and where should we go?

Although a disease of great antiquity, scientific studies of schistosomiasis began only 150 years ago. The complete life-cycle was not described until just before the First World War, making it possible at last to plan proper community control programmes. Inadequate tools prevented their effective implementation until well after the Second World War when new tools became available, thanks to the newly formed World Health Organization. Molluscicides spearheaded control programmes until the late 1970s but were then replaced by the newly developed, safe drugs still used today. Whatever the method used, the initial goal of eradication was, in the light of experience and cost, gradually replaced by less ambitious targets; first to stop transmission and then to reduce morbidity. The most successful programmes combined several methods to minimise reinfection after chemotherapy. Comparisons between different programmes are difficult without using appropriate, standardised diagnostic techniques and the correct epidemiological measurements. Some examples will be presented, mainly from our studies on Schistosoma mansoni in Kenya. Drug resistance on a scale comparable with malaria has not occurred in schistosomiasis but the likely withdrawal of all drugs except praziquantel leaves its control extremely vulnerable to this potential problem. An effective, affordable vaccine for use in endemic countries is unlikely to be ready for at least 5 years, and developing strategies for its use could take a further decade or more, judging from experience with drugs and molluscicides. In the interim, by analogy with malaria, the most cost-effective approach would the use of drugs combined with other methods to stop transmission, including molluscicides. The cost of molluscicides needs to be reduced and fears allayed about their supposedly adverse ecological effects.