Consultant psychiatrists's experience of the impact of the COVID19 pandemic on mental health services in Ireland

Objectives: The novel coronavirus 2019 (COVID-19) has spread worldwide threatening human health. To reduce transmission, a ‘lockdown’ was introduced in Ireland between March-May 2020. The aim of this study is to capture the experiences of Consultant Psychiatrists during lockdown and their perception of its impact on Mental Health Services. Methods: A questionnaire designed by the Royal College of Psychiatrists was adapted and circulated to Consultant members of the College of Psychiatrists following the easing of restrictions. The questionnaire assessed the perceived impact on referral rates, mental health act provision, availability of Information Technology (IT), consultant well-being and availability of Personal Protective Equipment (PPE). Thematic analysis was employed to analyse free-text sections. Results: Response rate was 32% (N=197/623). Consultants reported an initial decrease/significant decrease in referrals in the first month of lockdown (68%, N=95/140) followed by an increase/significant increase in the second month for both new (83%, N=100/137) and previously attending patients (65%, N=88/136). Social isolation and reduced face-to-face mental health supports were among the main reasons identified. The needs of children and older adults were highlighted. Most consultants (76%, N=98/129) felt their working day was affected and their well-being reduced (52%, N=61/119). The majority felt IT equipment availability was inadequate (67%, N=88/132). Main themes identified from free-text sections were service management, relationship between patients and healthcare service and effects on consultants’ lives. Conclusions: The COVID19 pandemic has placed increased pressure on service provision and consultant wellness. This further supports the longstanding need to increase mental health service investment in Ireland

Assessment of Air Pollution in Different World Regions

Climate Change (CC) and Air pollution (AP) are intimately linked through emissions from common sources, primarily those related to the use of fossil fuels. The Climate Change Unit (Institute for Environment and Sustainability), which is part of the Joint Research Centre based in Ispra, Northern Italy, performs scientific research on the linkages between air pollution and climate change to make policy makers aware of potential synergies and trade-offs that are imposed by the way the atmosphere and the climate system work. CCU focuses on a number of world regions such as the Mediterranean, China, Russia, India where AP and CC are different priorities for policy makers. It will provide the European Commission and EU negotiators with comparative assessments of (present day) air pollution and its impact on climate in these regions. The CCU uses models, ground- and space-based monitoring systems to produce its assessments. For instance the JRC global chemistry transport model TM5 is used to assess the impact of air pollution emissions on ozone and particulate matter concentrations worldwide. Likewise the ECHAM-HAM climate model is used to provide assessments of the climate impacts of sector and region based emission reduction strategies on climate. The CCU operates the EMEP superstation in Ispra, measuring long term records of air pollutants and climate gases. A new high-tech instrument employed at JRC linking pollution by aerosol and the climate effect of the same aerosol is a so-called aerosol lidar, that can measure vertical profiles of aerosol upto 10 km altitude. Ispra is the only station in Southern Europe with such a complete set of measurements to characterize changes in the atmosphere. Recently, CCU has installed measurement equipment on the cruise ship ¿Costa Magica¿, with frequently cruises around the Mediterranean Ocean. Preliminary results indicate that concentrations of air pollution (ozone and aerosols) are high over the Mediterranean, and thus provide high ¿background¿ concentrations on top of which countries and regions in the Mediterranean add their local pollution, which leads to frequent exceedances of air pollution regulations. The CCU also plays a leading role in bringing the worlds¿ scientific community to perform common model studies (e.g. AEROCOM, PhotoComp, and recently the work for the Task Force on Hemispheric Transport of Airpollution) and collecting and harmonizing measurements (e.g. the JRC WMO-GAW database), in order to improve the common scientific understanding that is input to policy making. To support the fourth assessment report of IPCC the JRC, together with scientists of the ACCENT Network of Excellence, organized an international comparison of global atmospheric models to calculate the effects of air pollution emission reduction strategies for a range of environmental issues. Fig. 1a shows the average results of about 25 models in predicting current ozone, Fig 1b ozone in the year 2030 evaluating the effects of currently decided world-wide emission reductions, and Fig 1c the emission reductions achieved when all currently available technologies would be used to achieve a better air quality. The uncertainties of these predictions are large at the regional level. This uncertainty range, and the sparcity of existing measurements of ozone over the Mediterranean region motivated JRC to start measurements over the Mediterranean sea, by installing a set of measurement devices for ozone and particles on the cruise ship Costa Fortuna. The policies that these activities support are the the EU post-Kyoto Climate Change Policy, the EU transboundary air pollution policy, the UN convention on long range transport of transboundary air pollution and the UN Framework Convention on Climate Change / IPCC.JRC.H.2-Climate chang

Trends and prevalence of overweight and obesity in primary school aged children in the Republic of Ireland from 2002-2012: a systematic review

BACKGROUND: The prevalence of childhood overweight and obesity in developed countries appears to be levelling off. As trends in childhood obesity prevalence have not been examined over the past decade in the Republic of Ireland, this systematic review aims to compile and synthesise all available information on the prevalence of overweight and obesity in primary school aged children between 2002 and 2012. METHODS: Systematic review of published and grey literature containing data on objectively measured height and weight. Inclusion criteria included studies where data was collected between 2002 and 2012 from at least 200 primary school aged children in the Republic of Ireland. Database searching, Google searching, reference searching and contact with obesity experts was undertaken. Overweight, obesity and morbid obesity were defined using standard International Obesity Taskforce definitions. Study quality was assessed. RESULTS: Fourteen studies (16 prevalence estimates) met the inclusion criteria. The combined prevalence of overweight and obesity within the studies ranged from 20-34%. No significant trend in overweight prevalence over time was observed (p=0.6). However, there was evidence of a slight decrease in obesity prevalence over the period (p=0.01), with a similar though non-significant decline in the prevalence of morbid obesity (p=0.2). CONCLUSION: The findings of this systematic review require cautious interpretation though the prevalence of childhood overweight and obesity in the Republic of Ireland has reached a plateau and may be falling. These findings provide some ground for optimism though the current plateau is at an unacceptably high level. Thus current population based preventive strategies need to be sustained and intensified

Evaluation of 6 candidate genes on chromosome 11q23 for coeliac disease susceptibility: a case control study

Background: Recent whole genome analysis and follow-up studies have identified many new risk variants for coeliac disease (CD, gluten intolerance). The majority of newly associated regions encode candidate genes with a clear functional role in T-cell regulation. Furthermore, the newly discovered risk loci, together with the well established HLA locus, account for less than 50% of the heritability of CD, suggesting that numerous additional loci remain undiscovered. Linkage studies have identified some well-replicated risk regions, most notably chromosome 5q31 and 11q23. Methods: We have evaluated six candidate genes in one of these regions (11q23), namely CD3E, CD3D, CD3G, IL10RA, THY1 and IL18, as risk factors for CD using a 2-phase candidate gene approach directed at chromosome 11q. 377 CD cases and 349 ethnically matched controls were used in the initial screening, followed by an extended sample of 171 additional coeliac cases and 536 additional controls. Results: Promotor SNPs (-607, -137) in the IL18 gene, which has shown association with several autoimmune diseases, initially suggested association with CD (P < 0.05). Follow-up analyses of an extended sample supported the same, moderate effect (P < 0.05) for one of these. Haplotype analysis of IL18-137/-607 also supported this effect, primarily due to one relatively rare haplotype IL18-607C/-137C (P < 0.0001), which was independently associated in two case-control comparisons. This same haplotype has been noted in rheumatoid arthritis. Conclusion: Haplotypes of the IL18 promotor region may contribute to CD risk, consistent with this cytokine\u27s role in maintaining inflammation in active CD

Development of national consensus statements on food labelling interpretation and protein allocation in a low phenylalanine diet for PKU.

BACKGROUND In the treatment of phenylketonuria (PKU), there was disparity between UK dietitians regarding interpretation of how different foods should be allocated in a low phenylalanine diet (allowed without measurement, not allowed, or allowed as part of phenylalanine exchanges). This led to variable advice being given to patients. METHODOLOGY In 2015, British Inherited Metabolic Disease Group (BIMDG) dietitians (n = 70) were sent a multiple-choice questionnaire on the interpretation of protein from food-labels and the allocation of different foods. Based on majority responses, 16 statements were developed. Over 18-months, using Delphi methodology, these statements were systematically reviewed and refined with a facilitator recording discussion until a clear majority was attained for each statement. In Phase 2 and 3 a further 7 statements were added. RESULTS The statements incorporated controversial dietary topics including: a practical 'scale' for guiding calculation of protein from food-labels; a general definition for exchange-free foods; and guidance for specific foods. Responses were divided into paediatric and adult groups. Initially, there was majority consensus (≥86%) by paediatric dietitians (n = 29) for 14 of 16 statements; a further 2 structured discussions were required for 2 statements, with a final majority consensus of 72% (n = 26/36) and 64% (n = 16/25). In adult practice, 75% of dietitians agreed with all initial statements for adult patients and 40% advocated separate maternal-PKU guidelines. In Phase 2, 5 of 6 statements were agreed by ≥76% of respondents with one statement requiring a further round of discussion resulting in 2 agreed statements with a consensus of ≥71% by dietitians in both paediatric and adult practice. In Phase 3 one statement was added to elaborate further on an initial statement, and this received 94% acceptance by respondents. Statements were endorsed by the UK National Society for PKU. CONCLUSIONS The BIMDG dietitians group have developed consensus dietetic statements that aim to harmonise dietary advice given to patients with PKU across the UK, but monitoring of statement adherence by health professionals and patients is required

Evaluation of 6 candidate genes on chromosome 11q23 for coeliac disease susceptibility: a case control study

<p>Abstract</p> <p>Background</p> <p>Recent whole genome analysis and follow-up studies have identified many new risk variants for coeliac disease (CD, gluten intolerance). The majority of newly associated regions encode candidate genes with a clear functional role in T-cell regulation. Furthermore, the newly discovered risk loci, together with the well established HLA locus, account for less than 50% of the heritability of CD, suggesting that numerous additional loci remain undiscovered. Linkage studies have identified some well-replicated risk regions, most notably chromosome 5q31 and 11q23.</p> <p>Methods</p> <p>We have evaluated six candidate genes in one of these regions (11q23), namely <it>CD3E</it>, <it>CD3D</it>, <it>CD3G</it>, <it>IL10RA</it>, <it>THY1 </it>and <it>IL18</it>, as risk factors for CD using a 2-phase candidate gene approach directed at chromosome 11q. 377 CD cases and 349 ethnically matched controls were used in the initial screening, followed by an extended sample of 171 additional coeliac cases and 536 additional controls.</p> <p>Results</p> <p>Promotor SNPs (<it>-607, -137</it>) in the <it>IL18 </it>gene, which has shown association with several autoimmune diseases, initially suggested association with CD (P < 0.05). Follow-up analyses of an extended sample supported the same, moderate effect (P < 0.05) for one of these. Haplotype analysis of <it>IL18-137/-607 </it>also supported this effect, primarily due to one relatively rare haplotype <it>IL18-607C/-137C </it>(P < 0.0001), which was independently associated in two case-control comparisons. This same haplotype has been noted in rheumatoid arthritis.</p> <p>Conclusion</p> <p>Haplotypes of the <it>IL18 </it>promotor region may contribute to CD risk, consistent with this cytokine's role in maintaining inflammation in active CD.</p