FAMILY PROBLEMS - SUBSTITUTE CARE: CHILDREN IN CARE AND THEIR FAMILIES. 1993

The rationale for undertaking a study of this nature is based on the increasing awareness of children’s rights and their need for the continuity and security of a stable family. With respect to this area of children’s rights, as a result of tile Report of the Inquiry into tile Kilkenn), Incest Case, the Minister for Health Mr. Brendan Howlin, has announced that consultations are to begin between the Government and the Attorney General in relation to one of the recommendations of the Committee of Inquiry. Consideration will be given to amending Articles 41 and 42 of the Constitution so as to include a statement of the constitutional rights of children. The importance of the family to the child, apart from the Constitutional emphasis on the importance of the family, is clearly stated in the United Nations Convention oil tile Rights of the Child ratified by Ireland in September, 1992. Section 3 of the Child Care Act, 1991 specifically states that, inter alia "a health board shall have regard to the principle that it is generally in tile best. interests of a child to be brought up in his own family". For some children the opportunity to experience a stable family life never exists. Some families never operate as a unit. Others break down temporarily or permanently and some parents are unable or unwilling to care for their children. In these circumstances, where an extended family cannot provide for the children, the State may be obliged to provide temporary or permanent substitute families for such children. This study concentrated on characteristics of children in substitute care and their families in one Health Board region of Ireland during 1989. It was argued that the child cannot be treated in isolation as problems leading to substitute care for children are not intrinsic to the child but are very much part of family problems. It is also argued that, of course, in certain limited circumstances, care may be a positive experience for a child. However, in general, research indicates that taking a child into care is seriously disruptive and possibly damaging

SCHOOLING AND SEX ROLES: Sex Differences in Subject Provision and Student Choice in Irish Post-Primary Schools. ESRI General Research Series Paper No. 113, May 1983

This is ill many respects a highly technical report which has had to he " designedto suit a very variable readership: the specialist researcher, the educationalist, policy-makers, parents and the interested public, and those directly concerned with making the main policy decisions at an individual school level. For those who want to find out what our main findings and conclusions are, these are summarised in Chapters 10 and I I. In addition, each chapter ends with a short summary &the main results and conclusions. For those seeking to assess the evidence and the quality of the analysis underlying our conclusions we indicate in Chapter 10 where in the text the relevant evidence is provided. For those wishing to evaluate our assumptions, the selection of the main variables in our analysis and the reliability of samples and measurements, information provided in Chapters 1 and 2 would be essential reading

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Review of literature and policy on the links between poverty and drug abuse.

This review of literature and policy looks at the area of poverty and drug use and was initiated by the Combat Poverty Agency in 1997. Some of the Agency's aims are to highlight the connection between poverty and drug use, to support responses from within the community to addressing drug use and to ensure that community-based drug work has a strong impact on policy

Treated drug misuse in the greater Dublin area: a review of five years, 1990-1994.

This report is a five-year review, based on data returned to the Drug Misuse Research Division of the Health Research Board by the participating drug treatment centres. The report presents the main findings and observes any trends that have emerged over the five years 1990-1994 in treated drug misuse in the greater Dublin area. Noted trends include a steady increase in the number of cases who were treated for drug misuse, and a decrease in the proportion of those injecting their primary drug in favour of smoking. The report provides socio-demographic information, information on problem drug use and risk taking behaviour

Treated drug misuse in Ireland. First national report - 1995.

This is the first annual report of the Drug Misuse Research Division of the Health Research Board. The primary objective of this report is to provide Department of Heatlh and the drug treatment centres who provide the data with ongoing information. The report takes the form of straightforward analysis of the data received. It presents data collected from attenders at drug treatment centres during 1995. Data from the two main, Total Treatment Contacts and First Treatment Contacts, area analysed on the basis of socio-demographic characteristics, aspects of the client's history of drug use, and facets of the client's injecting and needle-sharing practices. The report is divided into two sections and the data area analysed in terms of the two geographic areas: Greater Dublin - Eastern Health Board; and the seven other health board areas. Regarding the first of these areas, the number of cases, as distinct from persons, in the total treatment group has risen by 615 or 20.7% and in the first contact group, the number has risen from 1,150 in 1994 to 1,396 in 1995 - a rise of 246 or 21% on the 1994 figures. Regarding the second general geographic area, the number of cases, as distinct from persons, in the total treatment group in 1995 was 803 and the number in the first contact group was 491

Treated drug misuse in the greater Dublin area: report for 1992 & 1993.

This report is part of a series of annual, and multi-year reports analysing the characteristics of drug users in Dublin. The object of the report is to provide ongoing information to facilitate the understanding of the epidemiology of treated drug misuse and to provide useful data to policy makers. It is estimated that in 1992 2240 people were treated for drug use and 2573 in 1993. The report gives demographic details of those presenting for treatment. Significant differences were observed between males and females on a number of variables

Treated drug misuse in the greater Dublin area. Report for 1994.

This Report for the year 1994 is the fourth and last in the series of Reports on the Drug Treatment Reporting System in the Greater Dublin area published by the Health Research Board. This Report is concerned with persons resident in the Greater Dublin Area who received treatment during 1994 at any one of the 15 centres participating in the reporting system. Between them they cover a range of services and facilities including both medical and non-medical care. Some of these centres are statutory bodies and some are voluntary

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe