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There are growing concerns about the impact of pollution on maternal and infant health. Despite an extensive correlational literature, observational studies which adopt methods that seek to address potential biases due to unmeasured confounders draw mixed conclusions. Using a population database of births in Northern Ireland (NI) linked to localized geographic information on pollution in mothers' postcodes (zipcodes) of residence during pregnancy, we examine whether prenatal exposure to PM 2.5 is associated with a comprehensive range of birth outcomes, including placental health. Overall, we find little evidence that particulate matter is related to infant outcomes at the pollution levels experienced in NI, once we implement a mother fixed effects approach that accounts for time-invariant factors. This contrasts with strong associations in models that adjust for observed confounders but without fixed effects. While reducing ambient air pollution remains an urgent public health priority globally, our results imply that further improvements in short-run levels of prenatal PM 2.5 exposure in a relatively low-pollution, higher-income country context, are unlikely to impact on birth outcomes at the population level., (© 2024 The Author(s). Health Economics published by John Wiley & Sons Ltd.)

Background: Bovine viral diarrhoea (BVD) is caused by Pestivirus A and Pestivirus B. Northern Ireland (NI) embarked on a compulsory BVD eradication scheme in 2016, which continues to this day, so an understanding of the composition of the pestivirus genotypes in the cattle population of NI is required., Methods: This molecular epidemiology study employed 5' untranslated region (5'UTR) genetic sequencing to examine the pestivirus genotypes circulating in samples taken from a hotspot of BVD outbreaks in the Enniskillen area in 2019., Results: Bovine viral diarrhoea virus (BVDV)-1e (Pestivirus A) was detected for the first time in Northern Ireland, and at a high frequency, in an infection hotspot in Enniskillen in 2019. There was no evidence of infection with BVDV-2 (Pestivirus B), Border disease virus (pestivirus D) or HoBi-like virus/BVDV-3 (pestivirus H)., Limitations: Only 5'UTR sequencing was used, so supplementary sequencing, along with phylogenetic trees that include all BVDV-1 genotype reference strains, would improve accuracy. Examination of farm locations and animal movement/trade is also required., Conclusions: Genotype BVDV-1e was found for the first time in Northern Ireland, indicating an increase in the genetic diversity of BVDV-1, which could have implications for vaccine design and highlights the need for continued pestivirus genotypic surveillance., (© 2024 Agri‐Food and Biosciences Institute. Veterinary Record published by John Wiley & Sons Ltd. on behalf of British Veterinary Association.)

Introduction: People who inject drugs are at high risk of blood-borne infections. We describe the epidemiology of HIV among people who inject drugs in England, Wales, and Northern Ireland (EW&NI) since 1981., Methods: National HIV surveillance data were used to describe trends in diagnoses (1981-2019), prevalence (1990-2019), and behaviours (1990-2019) among people who inject drugs aged ≥15 years in EW&NI. HIV care and treatment uptake were assessed among those attending in 2019., Results: Over the past four decades, the prevalence of HIV among people who inject drugs in EW&NI remained low (range: 0.64%-1.81%). Overall, 4978 people who inject drugs were diagnosed with HIV (3.2% of cases). Diagnoses peaked at 234 in 1987, decreasing to 78 in 2019; the majority were among white men born in the UK/Europe (90%), though the epidemic diversified over time. Late diagnosis (CD4 <350 cells/µl) was common (2010-2019: 52% [429/832]). Of those who last attended for HIV care in 2019, 97% (1503/1550) were receiving HIV treatment and 90% (1375/1520) had a suppressed viral load (<200 copies/ml). HIV testing uptake has steadily increased among people who inject drugs (32% since 1990). However, in 2019, 18% (246/1404) of those currently injecting reported never testing. The proportion of people currently injecting reporting sharing needles/syringes decreased from 1999 to 2012, before increasing to 20% (288/1426) in 2019, with sharing of any injecting equipment at 37% (523/1429)., Conclusion: The HIV epidemic among people who inject drugs in EW&NI has remained relatively contained compared with in other countries, most likely because of the prompt implementation of an effective national harm reduction programme. However, risk behaviours and varied access to preventive interventions among people who inject drugs indicate the potential for HIV outbreaks., (© 2022 Crown copyright. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association. This article is published with the permission of the Controller of HMSO and the Queen’s Printer for Scotland.)

Background and Purpose: This study evaluates the incidence, prevalence and survival trends of motor neurone disease (MND) in Northern Ireland from 2015 to 2019., Methods: A capture-recapture analysis was performed using five independent data sources. Incidence and prevalence rates were standardized to the European Standard Population. Survival outcomes were analysed using Kaplan-Meier curves and Cox regression analysis., Results: Amongst 254 total cases of MND, capture-recapture analysis estimated three missing cases (case ascertainment 98.8%). Age standardized incidence of captured cases was 3.12 per 100,000 (2.73, 3.50) and standardized prevalence ranged from 9.45 to 6.49 per 100,000 from 2015 to 2019. Standardized incidence and prevalence rates in 2006 were 1.4 and 3.3 per 100,000 respectively. Of identified cases, 133 (52.4%) were male; 94.5% had amyotrophic lateral sclerosis; median age of onset was 67 years; median time to diagnosis was 12 months (95% confidence interval 11.2, 12.8); survival from diagnosis was 12 months (95% confidence interval 10.6, 15.4); 25 (9.8%) reported a family history of MND or frontotemporal dementia; and a known MND-associated genetic mutation was identified in 7.9% of total cases, of which the most common was C9orf72 (5.7% of all patients). Factors associated with improved survival were younger age at onset, longer time to diagnosis, attendance at regional MND clinic, and initial neurology presentation as outpatient (all p < 0.001)., Conclusion: The incidence and prevalence of MND in Northern Ireland has increased over the last 10 years, in line with increasing rates reported from other European countries. Improved survival was associated with younger age at onset, longer time to diagnosis, attendance at a regional MND clinic and outpatient presentation to a Neurology Department., (© 2021 European Academy of Neurology.)

Objectives: We explore trends in linkage to HIV care following diagnosis and investigate the impact of diagnosis setting on linkage in the era of expanded testing., Methods: All adults (aged ≥ 15 years) diagnosed with HIV between 2005 and 2014 in England, Wales and Northern Ireland (EW&NI) were followed up until the end of 2017. People who died within 1 month of diagnosis were excluded (n = 1009). Trends in linkage to outpatient care (time to first CD4 count) were examined by sub-population and diagnosis setting. Logistic regression identified predictors of delayed linkage of > 1 month, > 3 months and > 1 year post-diagnosis (2012-2014)., Results: Overall, 97% (60 250/62 079) of people linked to care; linkage ≤ 1 month was 75% (44 291/59 312), ≤ 3 months was 88% (52 460) and ≤ 1 year was 95% (56 319). Median time to link declined from 15 days [interquartile range (IQR): 4-43] in 2005 to 6 (IQR: 0-20) days in 2014 (similar across sub-populations/diagnosis settings). In multivariable analysis, delayed linkage to care was associated with acquiring HIV through injecting drug use, heterosexual contact or other routes compared with sex between men (> 1 month/3 months/1 year), being diagnosed in earlier years (> 1 month/3 months/1 year) and having a first CD4 ≥ 200 cells/μL (> 3 months/1 year). Diagnosis outside of sexual health clinics, antenatal services and infectious disease units predicted delays of > 1 month. By 3 months, only diagnosis in 'other' settings (prisons, drug services, community and other medical settings) was significant., Conclusions: Linkage to care following HIV diagnosis is relatively timely in EW&NI. However, non-traditional testing venues should have well-defined referral pathways established to facilitate access to care and treatment., (© 2021 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)

Background: Bovine viral diarrhoea virus (BVDV) and border disease virus (BDV) can cause significant health problems in ruminants and economic impacts for farmers. The aim of this study was to evaluate pestivirus exposure in Northern Ireland sheep and goat flocks, and to compare findings with a previous study from the region., Methods: Up to 20 animals were sampled from 188 sheep and 9 goat flocks (n = 3,418 animals; 3,372 sheep and 46 goats) for pestivirus antibodies. Differentiation of the causative agent in positive samples was inferred using serum neutralisation. Abortion samples from 177 ovine cases were tested by BVDV reverse-transcription polymerase chain reaction and antigen ELISA., Results: Apparent animal and flock (one antibody positive animal within a flock) prevalence was 1.7% and 17.3%, respectively, a statistically significant drop in apparent prevalence since a survey in 1999. 52.6% of samples testing positive had higher antibody titres to BVDV than to BDV. Of the ovine abortion samples, only one positive foetal fluid sample was detected by ELISA., Conclusion: The present study found that, since 1999, there has been a decrease in apparent animal and flock prevalence of 3.7 and 12.8 percentage points respectively, suggesting pestivirus prevalence has decreased across Northern Ireland between 1999 and 2018., (© 2021 The Authors. Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

Background: Despite ongoing eradication efforts, bovine tuberculosis (bTB) is endemic in cattle herds in Northern Ireland (NI). This disease has serious implications for the economy, farming and animal welfare. Previous research identified a population of herds which have remained free from bTB infection for 10 years (2004-2014). Understanding the characteristics of these herds may have important implications for eradication efforts, such as spatially targeted interventions., Methods: A cluster analysis and a retrospective case-control analysis was conducted to compare bTB- free herds with herds which experienced prolonged infection (ie, bTB breakdowns lasting more than ≥ 365 days)., Results: Only small, localised clusters of herds which have remained free from bTB were revealed, thus limiting the potential for spatially targeted interventions. The results illustrated the importance of herd size to disease status; over 27 per cent of the bTB-free herds had up to 10 animals. However, the data also showed that there were no inward movements in the year before the bTB skin test in those herds which remained free from bTB., Conclusions: Attention should therefore be given to the cattle movement network in NI to better understand the risk associated with cattle purchasing., Competing Interests: Competing interests: None declared., (© British Veterinary Association 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

We identified patient and disease characteristics associated with (1) "current" physical side-effects of any severity; and (2) "severe" physical side-effects "ever" experienced by 3,348 (54%) prostate cancer (PCa) survivors in Ireland diagnosed 2-18 years previously. Postal questionnaires collected symptoms at diagnosis, post-biopsy complications, comorbidities, primary treatments and physical side-effects post-treatment (urinary incontinence, erectile dysfunction, libido loss, bowel problems, breast changes, hot flushes, and fatigue, "ever" and "current" at time of questionnaire completion). Men were grouped by "early" (localised) and "late" (locally advanced/advanced) disease at diagnosis. Multivariable logistic regression analysis identified patient and disease-related factors associated with post-treatment side-effects. Complications post-biopsy were associated with higher risk of "current" libido loss and impotence. Radical prostatectomy was associated with higher risk of "current" and "severe" incontinence, libido loss and impotence in both early and late disease. In early disease, brachytherapy was associated with lower risk of "current" fatigue and "severe" impotence. Comorbidities were associated with higher risk of "current" experience of four side-effects (incontinence, libido loss, bowel problems, fatigue). Men on active surveillance/watchful-waiting reported lower risk of sexual dysfunction. These findings could inform development of tailored information on side-effects, which, in turn, could inform treatment decision-making and post-treatment monitoring., (© 2016 John Wiley & Sons Ltd.)

Northern Ireland is an appropriate region to examine the impact of traumatic experiences, owing to the many years of civil violence that have characterized its recent history, known colloquially as the "Troubles." Given the prominence of traumatic experiences among the aging population of Northern Ireland (NI), an evidence base is required to inform the planning and provision of effective mental health and other services. We analyzed the follow-up interviews (n = 225) of individuals from the Northern Ireland Study of Health and Stress (NISHS), aged 45 years and older, who experienced one or more conflict-related traumatic events. This study demonstrated that in NI traumatic events, such as being involved in an explosion, seeing someone killed or seriously injured, and living in a region of terror were most likely to be related to the Troubles. However, event types that we had not previously known to be related to conflict (such as the sudden death of a loved one), were also often related to the Troubles. Two-thirds of participants (67.1%) reported exposure to a Troubles-related event, and 57.8% reported being a civilian in a region of terror. The vast majority (85.9%) of participants who experienced a Troubles-related trauma never sought help, despite 59.1% meeting the criteria for a lifetime mental disorder. The reasons for not seeking help and sources of help are outlined. Policy makers must address Troubles-related mental health effects, in terms of how they carry forward into aging, and consider ways of improving engagement with services and treatments., (Copyright © 2017 International Society for Traumatic Stress Studies.)

Northern ireland disease surveillance, july to september 2017 Bibersteinia trehalosi causing septicaemic pasteurellosis in lambsAbortion due to Streptococcus pluranimalium in cattleLymphoma in cattleAcute fasciolosis in sheepErysipelas in pigsMarek's disease in chickens., (British Veterinary Association.)

Parasitic pneumonia in cowsLeptospirosis in a calfNecrotising mastitis in ewes due to Mannheimia haemolytica infectionCongenital goitre in ovine fetuses Actinobacillus pleuropneumoniae pneumonia in growing pigsCircovirus and Salmonella Typhimurium infection in pigeons These are among matters discussed in the Northern Ireland animal disease surveillance quarterly report for April to June 2017., (British Veterinary Association.)

Pneumonia in cattle Malignant catarrhal fever in cattle Tumours in sheep Pneumonia in pigs Histomonosis in chickensThese are among matters discussed in the Northern Ireland animal disease surveillance quarterly report for January to March 2017., (British Veterinary Association.)

Parasitic pneumonia in calvesAbomasitis in calvesActinobacillosis in a bullCopper toxicity in ram lambsFasciolosis in ewes and lambsLarval paramphistomosis in shearlingsAspergillosis in a gentoo penguin These are among matters discussed in the Northern Ireland animal disease surveillance quarterly report for October to December 2016., (British Veterinary Association.)

Parasitic pneumonia in cattleBlackleg in cattleHaemonchosis in lambsAcute paramphistome infection in sheepOedema disease in pigsSalmonellosis in pigsThese are among matters discussed in the Northern Ireland animal disease surveillance quarterly report for July to September 2016., (British Veterinary Association.)

Infectious bovine rhinotracheitis in cows and calvesMycoplasma bovis infections in cows and calvesNematodirosis in lambsPneumonic pasteurellosis in lambsEscherichia coli infections in young pigs These are among matters discussed in the Northern Ireland animal disease surveillance quarterly report for April to June 2016., (British Veterinary Association.)

Abomasitis in calvesAortic aneurysm in a dairy cowAbortion due to Salmonella Brandenberg in ewesStreptococcus dysgalactia polyarthritis in lambs These are among matters discussed in the Northern Ireland animal disease surveillance quarterly report for January to March 2016., (British Veterinary Association.)

·Pneumonia and encephalitis due to Histophilus somni in heifers ·Pneumonia due to Bibersteinia trehalosi in a cow ·Fasciolosis in ewes and lambs ·Dosing gun injuries in lambs ·Histomonosis in chickens These are among matters discussed in the Northern Ireland animal disease surveillance quarterly report for October to December 2015., (British Veterinary Association.)

Endocarditis in a cow. Blackleg in unvaccinated calves. Copper poisoning in pedigree sheep. Malignant oedema in a ram. Salmonellosis in fattening pigs. Fungal pneumonia and airsacculitis in turkeys. Coccidiosis and Marek's disease in gamebirds. These are among matters discussed in the Northern Ireland animal disease surveillance quarterly report for July to September 2015., (British Veterinary Association.)

The objective of this study was to estimate the economic costs of posttraumatic stress disorder (PTSD) among the Northern Ireland (NI) adult population. The authors present a prevalence-based, bottom-up study based primarily on data from 1,986 participants in the Northern Ireland Study of Health and Stress (NISHS). Both direct costs of treatment and indirect costs of productivity losses were included. Units of service and medication resource use were obtained from the NISHS and combined with their relevant unit costs from the Personal Social Services Research Unit and Prescription Costs Analysis data for NI. Indirect costs included the costs of incapacity days due to PTSD and presenteeism costs, with gender-specific wage rates used as the relevant unit costs. The total direct and indirect cost of PTSD in NI (2008) was £172,756,062. This figure is likely to be conservative due to the exclusion of a number of cost categories. Nevertheless, comparison of estimates of the burden of PTSD with the estimated cost of treating all adults with PTSD with the recommended treatments shows the potential for substantial economic gains to be made through extension and investment in effective evidence-based treatments., (Copyright © 2015 Wiley Periodicals, Inc., A Wiley Company.)