Impact of COVID-19 lockdown restrictions: Ambient NO2 and asthma hospital admissions

Aim: The World Health Organization (WHO) declared the COVID-19 pandemic a global health emergency. Many countries of the world, including Ireland, closed their borders and imposed nationwide lockdown. During this period, all major anthropogenic transport activities, which contribute to atmospheric pollution, were restricted. The current study examines the impact of the transport restrictions on ambient nitrogen dioxide (NO2) concentrations and hospital admissions for asthma across Ireland. Methods: This is a retrospective population-based cohort study. National ambient air quality monitoring network data were analysed to investigation variations in NO2 concentrations. Asthma hospital admissions data were collected from the HSE Hospital In-patient Enquiry (HIPE) for Cork, Dublin, and Meath.Results: During the period of transport restrictions, there were reductions in the annual mean NO2 for Cork, Dublin and Meath (i.e. 12µg/m3 to 11µg/m3 (p = 1); 25µg/m3 to 17µg/m3 (p < 0.001); and 23µg/m3 to 21µg/m3 (p = 1)). Reductions in asthma hospital admissions were also observed. Among the 8,471 patient episodes included in this study, the mean [SD] age at admission was 47.2[22.9] years; 61% were female (n=5,134); mean [SD] length of stay was 4.9[10.9] days. Conclusion: The findings of this study provide an opportunity to explore the impact of NO2 emissions for Cork, Dublin and Meath on asthma hospital admissions, in order to improve air quality modelling and policy development of management of asthma

Reviewing changes in adjuvant treatment algorithm over a decade: effects and impact on outcome in patients with newly diagnosed early-stage breast cancer in Mid-Western Ireland.

Breast cancer is a leading cause of morbidity and mortality amongst adult women in Western Europe and North America. Within the last decade our understanding of this condition has improved. This has led to the emergence of new treatment algorithms and prognostic instruments. Examples of the former include taxane-based therapy and trastuzumab; further examples of the latter are novel prognostic instruments such as Nottingham Prognostic Index (NPI) and Adjuvant! Online (AO). The aim of this thesis is to determine if the application of these is associated with improved cancer-specific outcomes. To this end, we conducted a retrospective population-based determination of cancer-specific outcomes associated with newer treatment algorithms. In addition we determined the correlation between prognosis and actual outcome for NPI and AO. These were compared with outcomes associated with prior treatment approaches. The thesis finishes with a comparison of both to determine the optimal treatment management paradigm. Adjuvant taxane therapy was not associated with improved cancer-specific outcome compared with non-taxane based therapy. However, third-generation (taxane-based) therapy was associated improved cancer-specific outcome compared with first- and second-generation (taxane- and non-taxane based) therapy. Adjuvant trastuzumab treatment was associated with improved cancer-specific outcome. Prognostic accuracy differed for NPI and AO. In conclusion, these practice changes have had a mixed effect on outcomes for patients with early-stage breast cancer (EBC)

Impact of Covid-19 transport restrictions on ambient air pollutant concentrations and asthma-related hospital admissions

Objectives: Exposure to air pollution is a known risk factor for asthma exacerbations and hospitalisations. This study aimed to identify if COVID-19 transport restrictions led to improvements in air quality in Dublin and if this had an impact on asthma-related hospital admissions. Study Design: This was a population-based retrospective cohort study. Methods: Daily concentration levels of particulate matter (PM2.5 and PM10) and nitrogen dioxide (NO2) were obtained from the Environmental Protection Agency (EPA). The Hospital In-Patient Enquiry (HIPE) system provided the daily number of asthma-related hospital admissions in Dublin. The figures for 2018-2019 were compared with the period of transport restrictions (from March 2020). Results: During the period of transport restrictions there was a significant decrease in mean daily concentrations in both PM2.5 (8.9 v 7.8μg/m3 p=0.002) and NO2 (24.0 v 16.7μg/m3 p<0.001). There was also a significant reduction in the mean number of daily asthma admissions (4.5 v 2.8 admissions p<0.001). Only NO2 showed a statistically significant correlation with asthma admissions (r=0.132 p<0.001). Conclusion: Transport restrictions introduced to mitigate against COVID-19 led to lower pollutant levels and improved air quality. Previously described associations between pollutants and asthma would indicate that these improvements in air quality contributed to the reduction in asthma-related admissions. The complex nature of PM is the likely explanation for the lack of correlation between its concentration and asthma admissions, unlike NO2 whose primary source in vehicular emissions. Public Health need to advocate for transport policies which can improve air quality and hence improve human health

Long-term outcome data for patients with HER2-positive early-stage breast cancer treated with adjuvant trastuzumab: benefit outside clinical trial setting

Adjuvant treatment options for HER2 positive Early-Stage Breast Cancer (EBC) have grown in recent years. The addition of adjuvant trastuzumab therapy for one-year to standard chemotherapy has been shown in several Randomized Controlled Trials (RCTs) to improve Disease-Free Survival (DFS) and Overall Survival (OS) in patients with high-risk HER2-positive EBC. This study aimed to review the long-term outcome data for patients with HER2-positive EBC who were treated with adjuvant trastuzumab therapy in a designated cancer centre. Methods: Data included all women diagnosed with HER2-positive EBC between 1st January 2001 and 31st January 2010 (N=147). Retrospective evaluation of healthcare records for clinical, demographic, and pathologic data was undertaken. Most had adjuvant trastuzumab following systemic chemotherapy (80/147; 54.4%). Kaplan-Meier estimates were used to evaluate whether one-year trastuzumab administration was associated with improved DFS and OS. Additionally, cohorts were generated by pathologic tumour size and lymph node involvement to stratify outcome measures (i.e. DFS and OS) by risk features

Investigation of a monophasic Salmonella Typhimurium outbreak linked to chocolate products as part of wider international outbreak: A matched case–control study, Ireland, 2022

Abstract Background In March 2022, an outbreak investigation was initiated in Ireland after identifying a cluster of monophasic Salmonella Typhimurium cases, affecting primarily small children. Microbiological investigations revealed that the cluster was part of a wider international outbreak. Methods A total of 18 Irish outbreak cases were identified. We undertook a matched case–control study using the case–case method to determine if exposure to the implicated products was associated with illness. Results In univariable analysis, the highest odds of disease due to monophasic S. Typhimurium versus other gastrointestinal disease were obtained for a chocolate Product A of Brand A [matched odds ratio (mOR) = 7.77, 95% confidence intervals (CI): 0.89–67.20]. When grouping the implicated products in a composite variable, the odds of disease due to monophasic S. Typhimurium versus other gastrointestinal disease were 10.5 times higher with a consumption of at least one of the implicated products [mOR = 10.50, 95% CI: 1.24–88.60, p = 0.031]. Conclusion This analytical study supported the internationally generated hypothesis which led to the implementation of control measures. Owing to the high levels of chocolate purchasing with Easter approaching, early outbreak identification and involvement in the internationally coordinated investigation was essential to an efficient response and to minimise the risk of further harm to a particularly vulnerable population group