Diagnostic accuracy of the ID-Migraine: a systematic review.

Objective: The purpose of this systematic review with meta-analysis is to determine the diagnostic accuracy of the ID Migraine as a decision rule for identifying patients with migraine. Background: The ID Migraine screening tool is designed to identify patients with migraine in primary care settings. Several studies have validated the ID Migraine across various clinical settings, including primary care,neurology departments, headache clinics, dental clinics, ENT and primary care settings. Several studies have validated the ID Migraine across various clinical settings, including primary care, neurology departments, headache clinics, dental clinics, ENT and ophthalmology. Method: A systematic literature search was conducted to identify all studies validating the ID Migraine, with the International Headache Criteria as the reference standard. The methodological quality of selected studies was assessed using the Quality of Diagnostic Accuracy Studies tool. All selected studies were combined using a bivariate random effects model. A sensitivity analysis was also conducted, pooling only those studies using representative patient groups (primary care;neurology departments; and headache clinics) to determine the potential influence of spectrum bias on the results. Results: Thirteen studies incorporating 5,866 patients are included. The weighted prior probability of migraine across the thirteen studies is 59%. The ID Migraine is shown to be useful for ruling out rather than ruling in migraine, with a greater pooled sensitivity estimate (0.84, 95% CI 0.75 – 0.90) than specificity (0.76, 95% CI 0.69 – 0.83). A negative ID Migraine score reduces the probability of migraine from 59% to 23%. The sensitivity analysis reveals similar results. Conclusions: This systematic review quantifes the diagnostic accuracy of the ID Migraine as a brief, practical and easy to use diagnostic tool for Migraine. Application of the ID Migraine as a diagnostic tool is likely to improve appropriate diagnosis and management of Migraine sufferers

The Irish Study of Sexual Health and Relationships Sub-Report 3: Sexual Knowledge, Attitudes and Behaviours - A Further Analysis.

The ISSHR was commissioned by the Department of Health and Children and the Crisis Pregnancy Agency in response to a recommendation by the National AIDS Strategy Committee. It is the largest nationally representative study on sexual knowledge, attitudes and behaviour ever undertaken in Ireland. International evidence indicates that aspects of sexual health, such as contraception, crisis pregnancy and sexually transmitted infections, should be examined jointly. To this end, the Crisis Pregnancy Agency and the Department of Health and Children instigated the ISSHR project. The ISSHR findings have been outlined in a suite of reports – the Main Report, a Summary Report and three sub-reports; the latter provide detailed information in defined areas of interest. This, the third sub-report, focuses on the patterning of sexual knowledge and attitudes of people in Ireland and how these affect behaviour. The Crisis Pregnancy Agency (CPA) and the sexual-health sector in general need robust evidence in order to develop sexual-health policies, to plan strategies and to inform the effective promotion of sexual-health messages. The ISSHR findings will be invaluable not only to the work of the CPA in preventing crisis pregnancy, but also to that of other organisations concerned with promoting sexual health, providing sexual-health services, preventing sexually transmitted infections, and providing sex education for young people

Locking plate fixation with and without inferomedial screws for proximal humeral fractures: a biomechanical study.

PURPOSE. To compare the efficacy of locking plate fixation with and without inferomedial screws in maintaining the reduction of a proximal humeral fracture. METHODS. 22 synthetic humerus models were used. A standardised 3-part proximal humeral fracture with a 4-mm wedge segment was created and fixed with a locking plate and screws with (n=11) and without (n=11) inferomedial screws. The intrafragmentary motion of the construct at 250, 500, 750, and 1000 cycles of 532 N loading, and the load to failure of the 2 groups were compared. RESULTS. Locking plate fixation with inferomedial screws reduced the mean intrafragmentary motion in all cycles (

Outcome of periacetabular osteotomy for the management of acetabular dysplasia: experience in an academic centre.

Periacetabular osteotomy (PAO) is a very effective reconstructive procedure for treatment of acetabular dysplasia. An orthopaedic paediatric surgeon and a reconstructive hip arthroplasty surgeon performed this procedure together in the early phase of their learning curve and then performed it individually. The early clinical and radiographic results of 85 consecutive PAOs performed in this academic orthopaedic unit were reviewed. The mean Merle-d\u27Aubigné score increased from 12.4 preoperatively to 16 at follow-up. Pre-operatively 73 hips were anteverted and 12 were neutral or retroverted. The mean angle of Wiberg improved from 5 degrees to 21 degrees (p \u3c 0.0001) in anteverted hips, and from 9 degrees to 30 degrees in neutral or retroverted hips. The mean angle of Lequesne and de Sèze improved from 6 degrees to 35 degrees (p \u3c 0.0001) in anteverted hips, and in neutral or retroverted hips from 9 degrees to 30 degrees (p \u3c 0.0001). The acetabular index improved from 26 degrees to 8 degrees (p \u3c 0.0001) in anteverted hips, and from 21 degrees to 7 degrees (p \u3c 0.0001) in neutral or retroverted hips. Over the 7 year period the blood loss and operative time improved from 2000 ml to 900 ml and 4 hours to 2 hours respectively. Four hips (four patients) required conversion to total hip replacement. The radiographic correction and improved clinical scores are similar to those in previous studies. This study shows a survival rate of 94% at 58 months following periacetabular osteotomy. The learning curve and the early results of this procedure performed in our academic unit are encouraging

Suppression effects of partner type on the alcohol-risky sex relationship in young Irish adults.

OBJECTIVE: The present study examined the link between alcohol consumption and condom use, testing whether partner type suppresses the effects of alcohol consumption on condom use. This study also sought to determine whether the effects of alcohol on condom use during casual sex remain after adjusting for condom-use intentions and planning or preparatory behaviors, such as having a condom available. METHOD: A retrospective, cross-sectional study design was used. A subset of participants aged 19-30 years from the national Irish Study of Sexual Health and Relationships were recontacted (n = 388). Telephone interviews regarding participants' most recent sexual event in their normal social environment (i.e., not on holidays) were conducted (n = 362). Partnership type was defined as "just met," "casual," or "steady." Men comprised 51% of the sample. The mean age was 23.9 years. RESULTS: Both alcohol consumption and condom use were more common in casual sexual events than steady sexual events. In addition, partnership type was found to suppress the effects of alcohol consumption on condom use, such that the relationship between alcohol consumption and condom use became significant and negative only after controlling for partner type. Furthermore, the negative effects of alcohol consumption on condom use during casual sex remained after adjusting for condom-use intentions and planning. CONCLUSIONS: These findings illustrate the complexity of the relationship between alcohol consumption and condom use, highlighting the importance of contextual factors such as partner type. Furthermore, the effects of alcohol on condom use during casual sex cannot be explained by the fact that such events tend to be more spontaneous and less planned

Mortality in people who use illicit opioids in England

People who use illicit opioids have a high risk of premature mortality, with a mortality rate ten times that of the general population. However, causes of mortality in this group have changed over time in the UK, alongside an ageing and increasingly comorbid population of drug users. The trend in increasing age among people who use illicit opioid has been suggested to be driving the recent increases in drug-related mortality observed in national surveillance data in England.</p

Analgesic use by ageing and elderly patients with chronic non-malignant pain: a qualitative study.

Background: Analgesics are used in the management of chronic non-malignant pain (CNMP), a condition which is highly prevalent among older adults. CNMP may not only be physically distressing but also complicated by psychosocial and economic factors. An individual's perception and use of analgesics may be influenced by a range of factors such as perceptions of risk or benefits, ability to purchase medication or access to non-pharmacological therapies or specialist care. Objective: The aim of this study was to describe the perceptions and experiences of analgesics by ageing and elderly individuals with CNMP and identify factors that influence their use. Setting: Telephone interviews with 28 members of Chronic Pain Ireland aged ≥50. Method In-depth semi-structured interviews; audio-recorded, transcribed verbatim, and thematically analysed. Main outcome measure Experiences and perceptions of ageing and elderly individuals with CNMP taking analgesics. Results: A combination of factors specific to the patient and arising from outside influences informed perceptions and experiences of analgesics. Pain severity, perceived efficacy of analgesics, occurrence of adverse-effects and concerns about addiction/dependence were identified as internal factors influencing medication use. External factors included views of family members, access to specialised care and the individual's interaction with healthcare professionals (HCPs). Conclusion: Individuals with CNMP regard analgesics as an important method for managing pain and are relied upon when other interventions are difficult to access. HCPs in primary care, who are the main point of contact for patients, need to take into account the various factors that may influence analgesic use when consulting with this patient group