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O'Farrell A.,Health Intelligence Unit
Irish medical journal | Year: 2013

The aim of this study was to describe the epidemiology and impact of serious assault warranting in-patient care over six years and its impact on ED attendances in a large teaching hospital in Dublin over 2 years. There were 16,079 emergency assault-related inpatient hospital discharges reducing from 60.1 per 100,000 population in 2005 to 50.6 per 100,000 population in 2010. The median length of stay was 1 day (1-466) representing 49,870 bed days. The majority were young males (13,921, 86.6%; median age 26 years). Overall crime figures showed a similar reduction. However, knife crimes did not reduce over this period. Data on ED attendances confirmed the age and gender profile and also showed an increase at weekends. Alcohol misuse was recorded in 2,292/16079 (14%) of in-patient cases and 242/2484 (10%) in ED attendances. An inter-sectoral preventative approach specifically targeting knife crime is required to reduce this burden on health services.

O'Flanagan D.,Health Protection Surveillance Center | Barret A.S.,Health Protection Surveillance Center | Foley M.,Health Protection Surveillance Center | Cotter S.,Health Protection Surveillance Center | And 6 more authors.
Eurosurveillance | Year: 2014

In 2011, the Irish Medicines Board received reports of onset of narcolepsy following vaccination against influenza A(H1N1)pdm09 with Pandemrix. A national steering committee was convened to examine the association between narcolepsy and pandemic vaccination. We conducted a retrospective population-based cohort study. Narcolepsy cases with onset from 1 April 2009 to 31 December 2010 were identified through active case finding. Narcolepsy history was gathered from medical records. Pandemic vaccination status was obtained from vaccination databases. Two independent experts classified cases using the Brighton case definition. Date of onset was defined as date of first healthcare contact for narcolepsy symptoms. Incidence of narcolepsy in vaccinated and non-vaccinated individuals was compared. Of 32 narcolepsy cases identified, 28 occurred in children/adolescents and for 24 first healthcare contact was between April 2009 and December 2010. Narcolepsy incidence was 5.7 (95% confidence interval (CI): 3.4-8.9) per 100,000 children/adolescents vaccinated with Pandemrix and 0.4 (95% CI: 0.1-1.0) per 100,000 unvaccinated children/adolescents (relative risk: 13.9; absolute attributable risk: 5.3 cases per 100,000 vaccinated children/adolescents). This study confirms the crude association between Pandemrix vaccination and narcolepsy as observed in Finland and Sweden. The vaccine is no longer in use in Ireland. Further studies are needed to explore the immunogenetic mechanism of narcolepsy.

Ansari Z.,Health Intelligence Unit | Ansari Z.,Monash University | Haider S.I.,Health Intelligence Unit | Ansari H.,University of Melbourne | And 2 more authors.
BMC Health Services Research | Year: 2012

Background: Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable with the application of preventive care and early disease management, usually delivered in a primary care setting. ACSCs are used extensively as indicators of accessibility and effectiveness of primary health care. We examined the association between patient characteristics and hospitalisation for ACSCs in the adult and paediatric population in Victoria, Australia, 2003/04. Methods. Hospital admissions data were merged with two area-level socioeconomic indexes: Index of Socio-Economic Disadvantage (IRSED) and Accessibility/Remoteness Index of Australia (ARIA). Univariate and multiple logistic regressions were performed for both adult (age 18+ years) and paediatric (age <18 years) groups, reporting odds ratios (OR) and 95% confidence intervals (CI) for a number of predictors of ACSCs admissions compared to non-ACSCs admissions. Results: Predictors were much more strongly associated with ACSCs admissions compared to non-ACSCs admissions in the adult group than for the paediatric group with the exception of rurality. Significant adjusted ORs in the adult group were 1.06, 1.15, 1.13, 1.06 and 1.11 for sex, rurality, age, IRSED and ARIA variables, and 1.34, 1.04 and 1.09 in the paediatric group for rurality, IRSED and ARIA, respectively. Conclusions: Disadvantaged paediatric and adult population experience more need of hospital care for ACSCs. Access barriers to primary care are plausible causes for the observed disparities. Understanding the characteristics of individuals experiencing access barriers to primary care will be useful for developing targeted interventions meeting the unique ambulatory needs of the population. © 2012 Ansari et al.; licensee BioMed Central Ltd.

Ansari Z.,Health Intelligence Unit | Ansari Z.,Monash University | Rowe S.,Communicable Disease Prevention and Control | Ansari H.,University of Melbourne | Sindall C.,Health Intelligence Unit
Population Health Management | Year: 2013

Ambulatory care sensitive conditions (ACSCs) are used as a measure of access to primary health care. The purpose of this study was to identify factors associated with variation in ACSC admissions at a small area level in Victoria, Australia. The study was ecologic, using Victorian Primary Care Partnerships (PCPs) as the unit of analysis. Data sources were the Victorian Admitted Episodes Dataset, census data from the Australian Bureau of Statistics, and the Victorian Population Health Survey. Age- and sex-adjusted total ACSC admission rates were calculated, and weighted least squares multiple linear regression was used to examine the associations of total ACSC admission rates by various predictor variables. Key variables were categorized into 1 of 4 framework components for analyzing access and use of health care services: predisposing, enabling, need, or structural. Enabling characteristics explained 61.70% of the variation in ACSC admission rates across PCPs. Socioeconomic characteristics (income, education) and percentage with poor self-rated health were important factors in explaining variations in ACSC admissions at a small area-level [R2=0.77]. Community-level variables differentially affect access to primary health care, with significant variation by socioeconomic status. This analytical approach will assist researchers to identify community-level predicators of access across populations at locations, including factors that may be affected by policy change. © Copyright 2013, Mary Ann Liebert, Inc. 2013.

Markwick A.,Health Intelligence Unit | Vaughan L.,Health Intelligence Unit | Ansari Z.,Monash University
Australian and New Zealand Journal of Public Health | Year: 2013

Objective: Investigate the relationship between socioeconomic status (SES) and prevalence of overweight and/or obesity, by sex, using total annual household income as the indicator of SES and the World Health Organization (WHO) recommended ranges of self-reported Body Mass Index (BMI) as the indicator of overweight and/or obesity. Methods: Total annual household income and BMI data were obtained from the Victorian Population Health Survey (VPHS), an annual computer-Assisted telephone survey of the health and well-being of Victorian adults aged 18 years and older. Statistical analysis was conducted using ordinary least squares linear regression on the logarithms of age-standardised prevalence estimates of overweight (25.0-29.9 kg/m2), obesity (≥30.0 kg/m2), and overweight and obesity combined (≥25.0 kg/m2), by income category and sex. Results: Typical SES gradients were observed in obese males and females, where the prevalence of obesity decreased with increasing income. No SES gradient was observed in overweight females, however, a reverse SES gradient was observed in overweight males, where the prevalence of overweight increased with increasing income. Combining the overweight and obesity categories into a single group eliminated the typical SES gradients observed in males and females for obesity, and resulted in a statistically significant reverse SES gradient in males. Conclusions: Combining the BMI categories of overweight and obesity into a single category masks important SES differences, while combining the data for males and females masks important sex differences. BMI categories of overweight and obesity should be analysed and reported independently, as should BMI data by sex. © 2013 The Authors.

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