Structuring diabetes care in general practices: many improvements, remaining challenges.

BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets

Length of stay and associated costs of obesity related hospital admissions in Ireland.

BACKGROUND: Obesity is the cause of other chronic diseases, psychological problems, obesity shortens the lifespan and puts strain on health systems. The risk associated with childhood obesity in particular, which will accelerate the development of adult morbidity and mortality, has been identified as an emerging public health problem. METHODS: To estimate the length of stay and associated hospital costs for obesity related illnesses a cost of illness study was set up. All discharges from all acute hospitals in the Republic of Ireland from 1997 to 2004 with a principal or secondary diagnostic code for obesity for all children from 6 to 18 years of age and for adults were collected.A discharge frequency was calculated by dividing obesity related discharges by the total number of diagnoses (principal and secondary) for each year. The hospital costs related to obesity was calculated based on the total number of days care. RESULTS: The discharge frequency of obesity related conditions increased from 1.14 in 1997 to 1.49 in 2004 for adults and from 0.81 to 1.37 for children. The relative length of stay (number of days in care for obesity related conditions per 1000 days of hospital care given) increased from 1.47 in 1997 to 4.16 in 2004 for children and from 3.68 in 1997 to 6.74 in 2004 for adults.Based on the 2001 figures for cost per inpatient bed day, the annual hospital cost was calculated to be 4.4 Euromillion in 1997, increasing to 13.3 Euromillion in 2004. At a 20% variable hospital cost the cost ranges from 0.9 Euromillion in 1997 to 2.7 Euromillion in 2004; a 200% increase. CONCLUSION: The annual increase in the proportion of hospital discharges related to obesity is alarming. This increase is related to a significant increase in economic costs. This paper emphasises the need for action at an early stage of life. Health promotion and primary prevention of obesity should be high on the political agenda

Schizophrenia: the impact of parental illness on children

This research sets out to discover what impact parental schizophrenia makes on a child’s life. It focuses on the daily life and experiences of children. Their health, education, family and leisure activities are examined. Contact with helping agencies and their unmet needs are investigated. The sample was drawn from the children of patients attending the mental health services in South West Dublin. They were matched with a control group of children of well parents. The majority of children who have one parent with schizophrenia had similar profiles to the children of well parents in the areas of physical health, positive family feelings, friendships, hobbies and household tasks. In a number of other areas, however, differences were found. Sample children had more psychiatric disturbance, more problems associated with school, less contact with relatives and spent more time at home. The children had little access to services and were upset by hospital visiting. The need for an educational programme and support for these children was demonstrated. It is recommended that a more co-ordinated approach is required by both adult and child mental health services in order to meet their needs

Epidemiology of hepetitis C infection, ERHA/HSE Eastern region.

Hepatitis C became statutorily notifiable in Ireland on 1 January 2004. Prior to 2004, only hepatitis A and hepatitis B were notifiable as distinct types of hepatitis. A third category notifiable under the Infectious Diseases Regulations 1981 was "viral hepatitis unspecified". The majority of cases notified under this heading were thought to be due to infection with hepatitis C Virus (HCV). Between January 1 2004 and December 31 2005, the Department of Public Health HSE Eastern Region, received notification of 2,014 cases of HCV infection (2004, 941 cases, 2005 1,073 cases). This report outlines basic demographic details on cases notified and comments on missing data. Peak age band at notification for males and females is in the 25-29 year old age group where 538 (26.7%) were notified. Thirty cases notified (1.5%) were under 15 years of age. Drug misuse has been confirmed as a risk factor for 1247 (61.9%) of cases notified, and may be a risk factor in a large percentage of the reminder where risk factor data are unknown. Problems with completeness of notification have been identified. Enhanced surveillance of all hepatitis C infections is a prerequisite for future service planning

National Intellectual Disability Database Committee: annual report 2004 / Steve Barron, Fiona Mulvany.

HRB / 200

National physical and sensory disability database: a preliminary analysis June 2004 / Karen Galligan, Fiona Mulvany

HRB / 200

Trends in treated problem opiate use in the seven health board areas outside the Eastern Regional Health Authority: 1998 to 2002 / Jean Long, Tracey Kelleher, Fionnola Kelly, Hamish Sinclair

HRB / 200

Mental illness in Ireland 1750 - 2002: reflections on the rise and fall of institutional care / Dermot Walsh and Antoinette Daly

HRB / 200

Developing a structured approach to furthering integrated care for the population of the Midland Health Board, Republic of Ireland: the ICON project / Susan Tucker, Veronica Larkin and Martina Martin

MHB / 200

Activities of Irish psychiatric services 2003 / by Antoinette Daly...[et al].

HRB / 200