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Objective: To compare baseline cardiovascular risk management between people from two different health- care systems recruited to a research trial of an intervention to optimise secondary prevention. Design: Cross-sectional study. Setting: 16 randomly selected general practices in Northern Ireland (NI) (UK NHS, strong infrastructure, pay- for-performance) and 32 in the Republic of Ireland (Aol) (mixed healthcare economy, less infrastructure, no pay- for-performance). Patients: 903 (mean age 67.5 years; 69.9% male) randomly selected patients with known coronary heart disease. Main outcome measures: Blood pressure (BP), cholesterol, medications; validated questionnaires for diet (DINE), exercise )Godin) and quality of life )SF-12); healthcare usage. Results: More Aol than NI participants had systolic BP >140 mm Hg (37% vs 28%, p = 0.01) and cholesterol >5 mmol/l (24% vs 17%, p = 0.02). Aol mean systolic BP was higher (139 vs 132 mm Hg). More Aol participants reported a high fibre intake (35% vs 23%), higher levels of physical activity (62% vs 44%) and better physical and mental health )SF-12); they also had more GP (5.6 vs 4.4) and fewer nurse visits (1.6 vs 2.1) in the previous year. Fewer participants in the Aol (55% vs 70%) were prescribed )3 blockers. ACE inhibitor prescribing was similar for both groups (41%; 48%); high proportions were prescribed statins (84%; 85%) and aspirin (83%; 77%). Conclusions: BP and cholesterol are better controlled among patients in a primary healthcare system with a strong infrastructure supporting computerisation and rewarding measured performance, but this is not associated with healthier lifestyle or better quality of life. Further exploration of differences in professionals' and patients' engagement in secondary prevention in different healthcare systems is needed. [ABSTRACT FROM AUTHOR]

The article deals with a research which investigated the effect of tailored practice and patient care plans on outcomes for patients with coronary heart disease in Ireland. It was observed that after an 18 month investigation, hospital admissions were reduced among 92.8% of the patient population. Other noted differences between intervention and control groups include systolic blood pressure, diastolic blood pressure and total cholesterol concentration, among others. Also discussed are bias, confounding and other reasons for caution.

Objective: To investigate whether the Irish smoking ban has had an impact on secondhand smoke (SHS) exposures for hospitality workers. Design, setting, and participants: Before and after the smoking ban a cohort of workers (n = 35) from a sample of city hotels (n = 15) were tested for saliva cotinine concentrations and completed questionnaires. Additionally, a random sample (n = 20) of city centre bars stratified by size (range 400–5000 square feet), were tested for air nicotine concentrations using passive samplers before and after the ban. Main outcome measures: Salivary cotinine concentrations (ng/ml), duration of self reported exposures to secondhand smoke, air nicotine (μg/cubic metre). Results: Cotinine concentrations reduced by 69%, from 1.6 ng/ml to 0.5 ng/ml median (SD 1.29; p « 0.005). Overall 74% of subjects experienced decreases (range 16–99%), with 60% showing a halving of exposure levels at follow up. Self reported exposure to SHS at work showed a significant reduction from a median 30 hours a week to zero (p «0.001). There was an 83% reduction in air nicotine concentrations from median 35.5 μg/m3 to 5.95 μg/m3 (p « 0.001). At baseline, three bars (16%) were below the 6.8 μg/m3 air nicotine significant risk level for lung cancer alone; at follow up this increased to 10 (53%). Conclusions: Passive smoking and associated risks were significantly reduced but not totally eliminated. Exposure to SHS is still possible for those working where smokin9 is still allowed and those working where smoke may migrate from outdoor areas. Further research is required to assess the true extent and magnitude of these exposures. [ABSTRACT FROM AUTHOR]