SciCombinator

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Concept: Republic of Ireland

247

Recent lifestyle approaches to physical activity have included the promotion of domestic physical activities such as do-it-yourself or home maintenance, gardening and housework. Although it is acknowledged that any activity is better than none, there is a danger that those undertaking domestic ‘chores’ may assume that this activity is moderate intensity and therefore counts towards this 150 minute per week target The purpose of this paper was to report the contribution domestic physical activity makes to total weekly physical activity and the relationship between domestic physical activity and leanness in the Northern Ireland population.

Concepts: Republic of Ireland, Personal life, Ireland, Home, Homemaker, Northern Ireland, Home improvement, Housekeeping

159

The correct interpretation of microbial sequencing data applied to surveillance and outbreak investigation depends on accessible genomic databases to provide vital genetic context. Our aim was to construct and describe a UK MRSA database containing over 1,000 methicillin-resistant Staphylococcus aureus (MRSA) genomes drawn from England, Northern Ireland, Wales, Scotland and the Republic of Ireland over a decade. We sequenced 1,013 MRSA submitted to the British Society for Antimicrobial Chemotherapy by 46 laboratories between 2001 and 2010. Each isolate was assigned to a regional healthcare referral network in England, and otherwise grouped based on country of origin. Phylogenetic reconstructions were used to contextualise MRSA outbreak investigations, and to detect the spread of resistance. The majority of isolates (n=783, 77%) belonged to CC22, which contains the dominant UK epidemic clone (EMRSA-15). There was marked geographic structuring of EMRSA-15, consistent with widespread dissemination prior to the sampling decade followed by local diversification. The addition of MRSA genomes from two outbreaks and one pseudo-outbreak demonstrated the certainty with which outbreaks could be confirmed or refuted. We identified local and regional differences in antibiotic resistance profiles, with examples of local expansion, as well as widespread circulation of mobile genetic elements across the bacterial population. We have generated a resource for the future surveillance and outbreak investigation of MRSA in the UK and Ireland, and have shown the value of this during outbreak investigation and tracking of antimicrobial resistance.

Concepts: Bacteria, Staphylococcus aureus, Antibiotic resistance, United Kingdom, Republic of Ireland, Methicillin-resistant Staphylococcus aureus, Vancomycin, Northern Ireland

136

Objectives To assess self reported outcomes and adverse events after self sourced medical abortion through online telemedicine.Design Population based study.Setting Republic of Ireland and Northern Ireland, where abortion is unavailable through the formal healthcare system except in a few restricted circumstances.Population 1000 women who underwent self sourced medical abortion through Women on Web (WoW), an online telemedicine service, between 1 January 2010 and 31 December 2012.Main outcome measures Successful medical abortion: the proportion of women who reported ending their pregnancy without surgical intervention. Rates of adverse events: the proportion who reported treatment for adverse events, including receipt of antibiotics and blood transfusion, and deaths reported by family members, friends, or the authorities. Care seeking for symptoms of potential complications: the frequency with which women reported experiencing symptoms of a potentially serious complication and the proportion who reported seeking medical attention as advised.Results In 2010-12, abortion medications (mifepristone and misoprostol) were sent to 1636 women and follow-up information was obtained for 1158 (71%). Among these, 1023 women confirmed use of the medications, and follow-up information was available for 1000. At the time women requested help from WoW, 781 (78%) were <7 weeks pregnant and 219 (22%) were 7-9 weeks pregnant. Overall, 94.7% (95% confidence interval 93.1% to 96.0%) reported successfully ending their pregnancy without surgical intervention. Seven women (0.7%, 0.3% to 1.5%) reported receiving a blood transfusion, and 26 (2.6%, 1.7% to 3.8%) reported receiving antibiotics (route of administration (IV or oral) could not be determined). No deaths resulting from the intervention were reported by family, friends, the authorities, or the media. Ninety three women (9.3%, 7.6% to 11.3%) reported experiencing any symptom for which they were advised to seek medical advice, and, of these, 87 (95%, 87.8% to 98.2%) sought attention. None of the five women who did not seek medical attention reported experiencing an adverse outcome.Conclusions Self sourced medical abortion using online telemedicine can be highly effective, and outcomes compare favourably with in clinic protocols. Reported rates of adverse events are low. Women are able to self identify the symptoms of potentially serious complications, and most report seeking medical attention when advised. Results have important implications for women worldwide living in areas where access to abortion is restricted.

Concepts: Medicine, Pregnancy, Surgery, United Kingdom, Republic of Ireland, Abortion, Abortifacient, Constitution of Ireland

129

Many stem-cell clinics have capitalized on public confusion by selling treatments that are not approved by the FDA, supported by clinical studies, or covered by insurers. Given ambiguous FDA guidelines, these clinics have in effect been operating without regulation.

Concepts: Clinical trial, European Union, United States, Avicenna, Republic of Ireland, Native Americans in the United States, Russia, International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use

64

Endocrine-disrupting chemicals (EDCs) contribute to disease and dysfunction and incur high associated costs (>1% of the gross domestic product [GDP] in the European Union). Exposure to EDCs varies widely between the USA and Europe because of differences in regulations and, therefore, we aimed to quantify disease burdens and related economic costs to allow comparison.

Concepts: European Union, United States, Republic of Ireland, Gross domestic product

48

 To evaluate safety alerts and recalls, publication of key trial outcomes, and subsequent US approval of high profile medical devices introduced in the European Union.

Concepts: European Union, United States, United Kingdom, Republic of Ireland, Estonia, Council of Europe, European integration, Largest urban areas of the European Union

35

The demographics of doctors working in the UK are changing. The United Kingdom (UK) has voted to leave the European Union (EU) and there is heightened political discourse around the world about the impact of migration on healthcare services. Previous work suggests that foreign trained doctors perform worse than UK graduates in postgraduate medical examinations. We analysed the prevalence by country of primary medical qualification of doctors who were required to take an assessment by the General Medical Council (GMC) because of performance concerns.

Concepts: European Union, United States, United Kingdom, Republic of Ireland, Member State of the European Union, Europe, English language, Council of Europe

35

Previous guidelines on consent for anaesthesia were issued by the Association of Anaesthetists of Great Britain and Ireland in 1999 and revised in 2006. The following guidelines have been produced in response to the changing ethical and legal background against which anaesthetists, and also intensivists and pain specialists, currently work, while retaining the key principles of respect for patients' autonomy and the need to provide adequate information. The main points of difference between the relevant legal frameworks in England and Wales and Scotland, Northern Ireland and the Republic of Ireland are also highlighted.

Concepts: United Kingdom, Republic of Ireland, England, United Kingdom of Great Britain and Ireland, Ireland, Wales, Scotland, Northern Europe

29

The Irish Travellers are a population with a history of nomadism; consanguineous unions are common and they are socially isolated from the surrounding, ‘settled’ Irish people. Low-resolution genetic analysis suggests a common Irish origin between the settled and the Traveller populations. What is not known, however, is the extent of population structure within the Irish Travellers, the time of divergence from the general Irish population, or the extent of autozygosity. Using a sample of 50 Irish Travellers, 143 European Roma, 2232 settled Irish, 2039 British and 6255 European or world-wide individuals, we demonstrate evidence for population substructure within the Irish Traveller population, and estimate a time of divergence before the Great Famine of 1845-1852. We quantify the high levels of autozygosity, which are comparable to levels previously described in Orcadian 1(st)/2(nd) cousin offspring, and finally show the Irish Traveller population has no particular genetic links to the European Roma. The levels of autozygosity and distinct Irish origins have implications for disease mapping within Ireland, while the population structure and divergence inform on social history.

Concepts: Republic of Ireland, Ireland, Irish Traveller, Traveler, Ethnic groups in Europe, Northern Ireland, Great Famine, Irish diaspora

29

The use of the generic term “meat and animal derivatives” in declared ingredient lists of pet foods in the European Union is virtually universal. In the wake of the 2013 “horse meat scandal” in the human food chain, we examined the presence and authenticity of animal sources (cow, chicken, pig and horse) of proteins in a range of popular wet pet foods in the United Kingdom.

Concepts: European Union, United States, Food, United Kingdom, Republic of Ireland, Mammal, Europe, Meat