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The Irish sea trout, Salmo trutta L., broodstock programme was instigated in response to the collapse of sea trout stocks in the west coast of Ireland in 1989 and 1990. Wild sea trout kelts and post-smolts were successfully reconditioned and used as broodstock to produce eyed ova for distribution to affected fisheries. From 1991 to 1999, a total of 8.2 million green ova from four separate stocks were produced. The number of females stripped increased from 34 in 1991 to a peak of 1435 in 1997. Green ova survival to the eyed ova stage ranged from 65 to 96%. The eyed ova produced were distributed to 23 affected fisheries along the west coast. The average cost per eyed ova decreased from €2.02 at the start of the programme to €0.04 at the end. The growth rates recorded for broodstock held in captivity were comparable with those recorded for wild sea trout. Relationships between fish size, egg size and number of eggs produced were examined for each stock and for each stock in each year. Significant positive relationships were found between fish size and egg number and fish size and egg size, with the exception of the first year in which fish were stripped, when a negative correlation between fish size and egg size was found. [ABSTRACT FROM AUTHOR]

The success of the sea trout, Salmo trutta L., enhancement programme carried out in the Burrishoole catchment in the west of Ireland from 1993 until 1998 is reviewed in terms of the number of fish stocked, the number of fish which migrated to sea and the number which returned from sea during this period. The success of the programme is also evaluated in terms of the cost of producing parr for stocking and the subsequent value of returning post-smolts (0+ sea age) and rod caught fish. A total of 49 235 tagged fish were released into Lough Feeagh, between 1993 and 1998. Of these fish, 14 788 were microtagged and the remainder, 34 447 had either elastomer or alphanumeric visible implant (VI) tags. Tag loss rates at release varied from 3 to 5.7%. Over the course of the programme a maximum of 7801 fish migrated through the traps towards sea, of which 581, or 7.4%, returned. In any 1 yr a maximum 13.1% of fish returned from sea. The average cost of producing a parr for stocking out was €1.15, which translated into average values of €8.16 per smolt and €169 per returning post-smolt. [ABSTRACT FROM AUTHOR]

Unlabelled: This study was undertaken to investigate the frequency of, indications for and appropriateness of glycopeptide prescription in a paediatric tertiary referral hospital and to assess the usefulness of the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines. A prospective audit of all systemic glycopeptide prescriptions over a 2-month period was undertaken. Clinical and microbiological data were recorded. Of 2810 hospital admissions, systemic IV glycopeptides were prescribed on 57 occasions to 50 patients, 30 (52.6%) for vancomycin and 27 (47.4%) for teicoplanin. Prescriptions were for 34 males and 23 females aged from 2 weeks to 11 years (mean 15 months; median 9 months). Median hospital stay was 50 days. Glycopeptides were given to the following patient groups: cardiology 7 (12%), prophylaxis for cardiac surgery 11 (19%), post-cardiac surgery 1 (1.8%), oncology 14 (24.6%), post-gastrointestinal tract surgical 8 (14%), general surgical 9 (15. 8%) and medical 7 (12.3%). Twenty three children (41.8%) had central lines in situ. Reason for use of glycopeptide was therapeutic in 7 (12.3%), empiric in 38 (66.7%), and as prophylaxis in 12 (21.1%). Eight (14%) prescriptions met strict HICPAC criteria, but a further 22 (39%) prescriptions were considered appropriate in this high-risk population. Glycopeptides were chosen appropriately for cardiac surgery prophylaxis in a further 10 (18%) but timing and duration of use in this group was inappropriate. Of all prescriptions, use was empiric in 38 (76%) and appropriate cultures were obtained at the time of commencement in only 13 (34%) of these. Glycopeptides were not used for routine surgical prophylaxis or for first-line empiric treatment of febrile neutropenia.Conclusions: The strict implementation of HICPAC guidelines may not always be appropriate for children at risk of beta-lactam resistant gram-positive infections. Hospital guidelines need to be tailored to the patient population and microbial susceptibility patterns of each institution. Appropriate cultures should be obtained at the time glycopeptide treatment is begun so that duration of exposure can be limited. [ABSTRACT FROM AUTHOR]

In January 2020, increased mortality was reported in a small broiler breeder flock in County Fermanagh, Northern Ireland. Gross pathological findings included coelomitis, oophoritis, salpingitis, visceral gout, splenomegaly, and renomegaly. Clinical presentation included inappetence, pronounced diarrhoea, and increased egg deformation. These signs, in combination with increased mortality, triggered a notifiable avian disease investigation. High pathogenicity avian influenza virus (HPAIV) was not suspected, as mortality levels and clinical signs were not consistent with HPAIV. Laboratory investigation demonstrated the causative agent to be a low-pathogenicity avian influenza virus (LPAIV), subtype H6N1, resulting in an outbreak that affected 15 premises in Northern Ireland. The H6N1 virus was also associated with infection on 13 premises in the Republic of Ireland and six in Great Britain. The close genetic relationship between the viruses in Ireland and Northern Ireland suggested a direct causal link whereas those in Great Britain were associated with exposure to a common ancestral virus. Overall, this rapidly spreading outbreak required the culling of over 2 million birds across the United Kingdom and the Republic of Ireland to stamp out the incursion. This report demonstrates the importance of investigating LPAIV outbreaks promptly, given their substantial economic impacts.

Introduction: Cancer and its associated side effects can cause changes in dietary intakes of people with cancer due to a variety of nutrition impact symptoms. These symptoms can lead to suboptimal dietary intakes which negatively affect muscle mass and therefore survivorship. The aim of this qualitative study was to assess the nutrition needs and dietary changes made by cancer patients in Ireland., Methods: Online focus groups were completed with cancer patients and caregivers, and demographic information was collected via an online questionnaire. An inductive thematic analysis approach was utilised to derive themes and subthemes from the data., Results: Four online focus groups were held with cancer patients and caregivers (n = 15) which reflected 18 total cancer experiences. Novel themes identified from this research included that symptoms were varied and transient-coming and going rapidly-and that patients were not satisfied with dietetic and broader nutrition services provided by hospitals. Themes that aligned with previous research were the severity and variety of nutrition impact symptoms and the variety of both evidence-based and non-evidence-based nutrition strategies used by patients to overcome nutrition impact symptoms, as general coping strategies, and potentially due to the belief that nutrition can be curative., Conclusion: Treatment of nutrition impact symptoms must be rapid and responsive. The development of responsive self-management resources such as booklets and apps for patients is likely to be valuable to ensure that patients can access support for their nutrition impact symptoms as-and when-they occur. Nutrition support must be integrated across the multi-disciplinary team to optimise trust in nutrition strategies., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: We surveyed evidence published by Ireland's National Centre for Pharmacoeconomics (NCPE) on the cost-effectiveness of cancer drugs approved for funding within the Irish public healthcare system. The purpose is threefold: to assess the completeness and clarity of publicly available cost-effectiveness data of such therapies; to provide summary estimates of that data; to consider the implications of constraints on data availability for accountability regarding healthcare resource allocation., Methods: The National Cancer Control Programme lists 91 drug-indication pairs approved between June 2012 and July 2020. Records were retrieved from the NCPE website for each drug-indication pair, including, where available, health technology assessment (HTA) summary reports. We assessed what cost-effectiveness data regarding approved interventions is available, aggregated it and considered the consequences of reporting constraints., Results: Among the 91 drug-indication pairs 61 were reimbursed following full HTA, 22 after a rapid review process and 8 have no corresponding NCPE record. Of the 61 where an HTA report was available, 41 presented costs and quality-adjusted life-year (QALY) estimates of the interventions compared. Cost estimates and corresponding incremental cost-effectiveness ratios (ICERs) are based on prices on application for reimbursement. Reimbursed prices are not published. Aggregating over the drug-indication pairs for which data is available, we find a mean incremental health gain of 0.85 QALY and an aggregate ICER of €100,295/QALY, which exceeds Ireland's cost-effectiveness threshold of €45,000/QALY., Conclusion: Reimbursement applications by pharmaceutical manufacturers for cancer drugs typically exceed Ireland's cost-effectiveness threshold, often by a considerable margin. On aggregate, the additional total net cost of new drugs relative to current treatments needs to be more than halved for the prices sought on application to be justified for reimbursement. Commercial confidentiality regarding prices and cost-effectiveness upon reimbursement compromises accountability regarding the fair and efficient allocation of scarce healthcare resources., (© 2021. The Author(s).)

Objective: Global pandemic H1N1 was atypical of influenza in that it was associated with high symptom severity among young adults. Higher education institutions were therefore understandably concerned about the potential for high infection rates among students. This study examined intention to uptake H1N1 vaccine between November and December 2009, when the virus was classified by the World Health Organization (WHO) as being in the pandemic phase., Design: A cross-sectional survey design was employed., Method: Two hundred university students completed a questionnaire battery comprised of health, belief/attitudes, and behavioural intention measures., Results: Findings suggested that non-intention to vaccinate is associated with a strong disbelief in its efficacy, in negative attitudes towards vaccinations, and in lack of perceived threat, which is underscored by a disinterest in others' opinions, including authoritative bodies. Findings also suggested that there is resistance to the idea of vaccinations being mandatory., Conclusions: Vaccination intent is in some way linked to a range of attitudes and beliefs. The implication for health practitioners is that behaviour intent may be open to influence where psycho-education can create pro-vaccine attitudes and beliefs., (© 2011 The British Psychological Society.)

The introduction of new models of care in the Irish maternity services has been recommended by both advocacy groups and strategic reports. Yet there is a dearth of information about what models of care pregnant women want. We surveyed women in early pregnancy who were attending a large Dublin maternity hospital. Demographic and clinical details were recorded from the hospital chart. Of the 501 women, 351 (70%) (352 (70.3%) of women wanted shared antenatal care between their family doctor and either a hospital doctor or midwife. 228 (45.5%) preferred to have their baby delivered in a doctor-led unit, while 215 (42.9%) preferred a midwifery-led unit. Of those 215 (42.9%), 118 (55%) met criteria for suitability. There was minimal demand (1.6%) for home births. Choice was influenced by whether the woman was attending for private care or not. Safety is the most important factor for women when choosing the type of maternity care they want. Pregnant women want a wide range of choices when it comes to models of maternity care. Their choice is strongly influenced by safety considerations, and will be determined in part by risk assessment.

Aims: To (i) monitor the presence of Enterobacteriaceae as indicators of faecal contamination on pig carcasses, (ii) examine the potential use of chilling as a critical control point (CCP) and establish its influence on pig carcass categorization by Decision 471/EC and (iii) determine the incidence of E. coli O157:H7 in pigs., Methods and Results: Porcine faecal samples and carcass swabs were collected before and after chilling at four Irish pig abattoirs and examined for Enterobacteriaceae and E. coli O157:H7. Chilling generally reduced Enterobacteriaceae counts on carcasses, but increases were also observed, particularly in one abattoir. E. coli O157:H7 was absent from carcasses before chilling, present on 0.21% after chilling and was recovered from 0.63% of faecal samples. All of the isolates were found to contain virulence genes associated with clinical illness in humans., Conclusions: The data show that overall chilling had the capacity to reduce the numbers of carcasses positive for the presence of Enterobacteriaceae., Significance and Impact of Study: The influence of chilling on the categorization of pig carcasses suggests that it has the potential to improve the numbers of acceptable carcasses and the process could be used as a CCP within a HACCP plan.

Of 864 consecutive culture positive cases of tuberculosis (TB) treated in the period 1991-2001, a total of 19 (2.1%) were M. bovis and 32 (3.7%) were drug resistant - Multi-Drug Resistant Tuberculosis (MDR-TB) (8); poly drug resistant (7); mono drug resistant (17). Iatrogenic factors were important in the cause of resistance in 9 cases (4 cases of MDR-TB): in 6 cases patients factors were important. Comparison with previous report for the period 1982-1985 showed relatively more isolates of M. bovis (p = 0.02); drug resistant TB (p = 0.005); and MDR-TB (p = 0.01) in the current study. Comparison with the background population of TB patients showed that patients with resistant TB were more likely to have a previous history of TB (Relative Risk = 3.58) and more likely to be foreign nationals (Relative Risk = 1.93) We conclude that while overall incidence of TB has declined that in relative terms the caseload of drug resistant TB and MDR-TB has increased. The drug cost of treating MDR-TB may be as high as 44,900 euros per patient.

The population biology of the fish acanthocephalan Acanthocephalus clavula was described from 161 wild brown trout, Salmo trutta sampled over a two-year period in Clogher Lake in the west of Ireland. Overall prevalence of the parasite was 86% and the mean abundance was 53 worms per fish. Despite the presence of large numbers of worms in the trout very few females (2%) attained full reproductive maturity. This suggests that trout is an accidental host. A sample of yellow eels, Anguilla anguilla was examined at a different time from the same lake. The prevalence of A. clavula was 97% and the average abundance was 8 worms per fish. In contrast to the situation in trout, the proportion of female worms attaining full reproductive maturity was 61% fulfilling the expected characteristic of a preferred definitive host. The possible explanations for the very high abundance of A. clavula in trout are discussed and include the influence of fluctuations in host populations, host diet and the absence of a potential competitor.

The aim of this paper was to test the hypothesis that when the 2 species of Acanthocephalan Pomphorhynchus laevis and Acanthocephalus clavula are found concurrently within the intestine of brown trout under field conditions, they have the potential to interact negatively. Evidence has shown that Acanthocephala are more likely to exhibit negative interactions with their own and other species, under both field and experimental conditions. Furthermore, the likelihood of these interactions is increased in Ireland because of the absence of certain definitive hosts and the fact that concurrent infections by two or more species of Acanthocephala are more commonly observed in fish. Data collected from wild and stocked brown trout and from 2 lakes provided an opportunity to compare the 2 potentially interacting helminth species in their fundamental and realized niche and several pieces of convincing evidence are provided here to support the hypothesis. A significant negative association between the numbers of each species found in individual fish was reported and this was consistent for both wild and stocked trout. Furthermore, an analysis of the proportions of low, moderate and high intensity infections in single and concurrent infections revealed a significant reduction in increasing intensities in concurrent infections compared to single infections. Finally, strikingly different patterns of niche inhabitation were observed, particularly for P. laevis in the presence of A. clavula in wild trout. Results from the niche width analysis also support the observations on average position in single and concurrent infections. The niche width of P. laevis when it co-occurred with A. clavula decreased markedly in high intensity infections compared to low intensity infections.

The aim of the present study was to compare the helminth infra and component communities of wild and stocked brown trout in Lough Feeagh, in the west of Ireland, and also to examine the establishment and development of helminth communities in stocked brown trout. Fish were sampled in May, August and November 1997 and 1998 and an additional sample of wild brown trout was examined in April 1997. In total 217 wild trout and 122 stocked trout were examined. The acanthocephalans Acanthocephalus clavula and Pomphorhynchus laevis were the first parasite species to infect stocked trout in May 1997. In May 1998 both acanthocephalan species along with the trout specialists Eubothrium crassum and Crepidostomumfarionis were the first to infect trout. Mean species richness values for stocked trout increased from May to November, in 1997 and 1998. For wild trout, mean species richness values increased from April to November, in 1997 and decreased from May to November in 1998. The parasite communities of wild trout were richer than those of stocked trout in May of both years. In August the parasite communities recorded for wild and stocked trout were similar in terms of the number of species present but differed in terms of structure, and in November the parasite communities of stocked trout were richer than those of wild trout.

Close relatives in families who have a child with a neural tube defect (NTD) are at greatly increased risk of having an affected child. Periconceptional folic acid reduces the risk of both occurrence and recurrence of NTDs substantially. Public health authorities currently recommend that the diets of all women between the ages of 15 and 44 who are capable of becoming pregnant be supplemented with folic acid tablets daily. We wondered if relatives in NTD families were more likely to use folic acid. From data obtained by interview with uncles and aunts in Irish NTD families we evaluated folic acid use in 144 of their pregnancies occurring between 1990 and 2000. There was a significant trend towards increasing use of folic acid both before and during pregnancy over the 10 years covered by the study. During the most recent years, 1998-2000, 57.9% of pregnancies reported by aunts were supplemented beforehand and 89.5% during the pregnancy. Pregnancies to smokers were significantly less likely to be supplemented with folic acid. In this study close relatives of an NTD child were more likely to report periconceptional folic acid use than the general public. While these results are encouraging, more remains to be done to ensure in this high risk group to ensure that the full prevention potential of folic acid is realised.

A total of 140 trout were examined from four lakes in north west Ireland, Loughs Craghy, Waskel, Meela and Owennamarve. Eleven species of metazoan parasite were recorded, ten of which were of freshwater origin and Anisakissp. was the only marine species. No acanthocephalan species were found. Diphyllobothrium ditremum, D. dendriticum and Anisakissp. were the only allogenic species. Lough Owennamarve had the largest component community with nine species recorded. Lough Meela, the only brackish water lake had the smallest component community with six species recorded. Lough Waskel and Craghy had intermediate component community values. Lough Meela showed the lowest levels of similarity to any of the other lakes. Values for the Shannon-Wiener diversity index were highest for Lough Owennamarve and lowest for Lough Meela and intermediate for the other two lakes. Lough Meela had the highest values for the Simpson's dominance index and the Berger-Parker index. Lough Owennamarve had the highest Brillouin's index and Lough Meela had the lowest. The use of multiple regression techniques to control for the potentially confounding effect of geographical distance as a predictor of community similarity was discussed. No parasite species found could be considered as regionally and locally abundant and therefore described as a core species. The helminth community appears to have some degree of predictability, but chance colonization events are also important.

There have been increasing reports worldwide of vancomycin resistant enterococci (VRE) since they were first noted over ten years ago. This study sought to investigate the clinical significance of VRE in Ireland and to compare the phenotypic, genotypic and molecular characteristics of isolates recovered from patients in different institutions. The relative contribution of inter-hospital transmission of strains to the dissemination of VRE in Ireland was assessed. Hospital surveillance for VRE is not well established in Ireland. The organism has been detected in seven hospitals. Detection has been predominantly in oncology inpatients in large tertiary referral hospitals in the Dublin metropolitan area in whom strains generally represent asymptomatic gastrointestinal tract colonization. The predominant species is E. faecium with the Van A resistance phenotype. Twenty-seven (87) of 31 isolates from one unit were shown to be of the same or closely related strain as were 10 (63%) of 16 from another unit, indicating significant nosocomial transmission within institutions. There was no evidence for inter-hospital transmission of VRE. VRE is established in Ireland and nosocomial transmission readily occurs. Regular surveillance for VRE is indicated in high-risk populations in large institutions, specific risk factors for the acquisition of VRE need to be defined and optimal control and preventative strategies need to he instituted to detect and preempt the spread of this organism.

We previously reported an outbreak of vancomycin resistant enterococci (VRE) in a paediatric oncology unit in December 1995 which was associated with widespread environmental contamination of the unit with VRE. We undertook this study to evaluate the effectiveness of the infection control policy instituted subsequent to the outbreak and to investigate the underlying prevalence of VRE colonization in hospitalized, outpatient and community-based children. We sought to establish the molecular similarity of VRE isolates from the study. Stool specimens were obtained from outpatients at risk of VRE, hospital inpatients and from healthy community-based children. VRE colonization was eradicated from the inpatient unit within 11 months, but in outpatients, 16 months after the outbreak, 4 of 137 (2.9 %) attending oncology outpatients, 5 of 65 (7.7%) with cystic fibrosis and 1 of 12 (8.3 %) with liver disease were found to be colonized with VRE. The isolates were all Enterococcus faecium, Van A phenotype except one E. casseliflavus of the Van C phenotype. All were unique in SmaI DNA macrorestriction patterns with the exception of two isolates, which were similar to the original outbreak strain and three further isolates of a single strain but which differed from the outbreak strain. Of 315 hospital inpatients, 2.5 % were colonized with VRE of the Van C resistance phenotype but VRE was not detected in 116 healthy, community-based children. We conclude that effective strategies can successfully control spread of VRE but despite a low prevalence of VRE colonization in hospital patients and in community-based children, outbreaks can occur when infection control practices are not optimal. Continued vigilance to detect VRE and limit spread within hospitals is therefore necessary.