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Birnie, Esmond. "Trading Places: Continuity and Change in Northern Ireland's Trading Relationships." Irish Studies in International Affairs 35, no. 2 (2024): 129–63. http://dx.doi.org/10.1353/isia.2024.a928747.
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ABSTRACT: Northern Ireland's external trading relations for 2011–22 were analysed using the NISRA 'Northern Ireland economic trade statistics'. The major geographical markets were considered: Northern Ireland itself, Ireland, Great Britain (GB), rest of EU and rest of the world. In volume terms exports and external sales of goods declined during 2011–22. There was considerable growth of services. Trade integration between Northern Ireland and Ireland was considered as one indicator of the all-island economy. For both goods and services, especially the former, Northern Ireland sales to Ireland outgrew those going to GB during 2011–22. Potential explanations were considered: development of cross-border supply chains, impact on aggregate figures of the closure/contraction of a small number of larger firms and InterTradeIreland interventions. Data for 2021 and 2022 were used to consider the impact of the Protocol: more rapid growth in Northern Ireland purchases of goods from Ireland than from GB may indicate trade diversion.
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Hatton, Chris. "Specialist inpatient services for people with learning disabilities across the four countries of the UK." Tizard Learning Disability Review 21, no. 4 (October 3, 2016): 220–25. http://dx.doi.org/10.1108/tldr-08-2016-0023.
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Purpose The purpose of this paper is to compare data from national censuses on specialist inpatient service use by people with learning disabilities across England, Scotland, Wales and Northern Ireland. Design/methodology/approach National statistics (England, Scotland, Wales, Northern Ireland) reporting inpatient service censuses including people with learning disabilities were accessed, with data extracted on trends over time, rate of service use, young people and length of stay. Findings The number and rate of people with learning disabilities in specialist inpatient services varied across the UK: 230 people in Scotland (rate 4.88 per 100,000 population); 3,250 people in England (5.48); 183 people in Wales (5.90); 144 people in Northern Ireland (7.82). The number of people in inpatient services in Northern Ireland halved over four years, in other areas reductions were modest. Between 5 and 8 per cent of people in inpatient services were children/young people. Median length of stay in the person’s current inpatient service varied: 19 months in England; 33 months in Scotland; three to five years in Northern Ireland. Social implications Different parts of the UK vary in the scale of their specialist inpatient services for people with learning disabilities. With the exception of Northern Ireland, which may still be in the last stages of completing a “regular” deinstitutionalisation programme, strong policy prescriptions for substantial reductions in specialist inpatient services are currently only resulting in modest reductions. Originality/value This paper is a first attempt to compare national inpatient service statistics across the UK. With increasing divergence of health and social service systems, further comparative analyses of services for people with learning disabilities are needed.
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Hatton, Chris. "Day services and home care for adults with learning disabilities across the UK." Tizard Learning Disability Review 22, no. 2 (April 3, 2017): 109–15. http://dx.doi.org/10.1108/tldr-01-2017-0004.
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Purpose The purpose of this paper is to compare data from national social care statistics on day services and home care for people with learning disabilities across England, Scotland, Wales and Northern Ireland. Design/methodology/approach National social care statistics (England, Scotland, Wales and Northern Ireland) reporting the number of adults with learning disabilities accessing day services and home care were reviewed, with data extracted on trends over time and rate of service use. Findings Regarding day services, despite some variations in definitions, the number of adults with learning disabilities in England, Scotland and Wales (but not Northern Ireland) using building-based day services decreased over time. Data from Scotland also indicate that adults with learning disabilities are spending less time in building-based day services, with alternative day opportunities not wholly compensating for the reduction in building-based day services. Regarding home care, there are broadly similar rates of usage across the four parts of the UK, with the number of adults with learning disabilities using home care now staying static or decreasing. Social implications Similar policy ambitions across the four parts of the UK have resulted (with the exception of Northern Ireland) in similar trends in access to day services and home care. Originality/value This paper is a first attempt to compare national social care statistics concerning day services and home care for adults with learning disabilities across the UK. With increasing divergence of health and social service systems, further comparative analyses of services for people with learning disabilities are needed.
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Hatton, Chris. "Living arrangements of adults with learning disabilities across the UK." Tizard Learning Disability Review 22, no. 1 (January 3, 2017): 43–50. http://dx.doi.org/10.1108/tldr-11-2016-0040.
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Purpose The purpose of this paper is to compare data from national social care statistics on the living situations of people with learning disabilities across England, Scotland, Wales and Northern Ireland. Design/methodology/approach National social care statistics (England, Scotland, Wales, Northern Ireland) reporting the living situations of adults with learning disabilities (residential and nursing care, living with family, other forms of accommodation) were accessed, with data extracted on trends over time and rate of service use. Findings There were substantial differences in the statistics collected across the UK. Overall, there were higher reported rates of adults with learning disabilities in residential/nursing accommodation in England than Scotland or Wales, but much lower reported rates of adults living in other forms of unsupported and supported accommodation and much lower reported rates of adults living with their families. In all three countries, trends over time suggest that reductions in residential care towards more independent living options may be stalling. In Northern Ireland reductions in currently extensive residential and nursing care services are continuing, unlike other parts of the UK. Social implications Despite similar policy ambitions across the four parts of the UK, statistics on the living situations of adults with learning disabilities report substantial differences. Originality/value This paper is a first attempt to compare national social care statistics concerning the living situations of adults with learning disabilities across the UK. With increasing divergence of health and social service systems, further comparative analyses of services for people with learning disabilities are needed.
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Goodyear, P. M., and D. A. Eastwood. "Spatial variations in level of living in Northern Ireland." Irish Geography 11, no. 1 (December 26, 2016): 54–67. http://dx.doi.org/10.55650/igj.1978.826.
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Geographers in recent years have displayed an increasing interest in the spatial distributions characterising a number of aspects of social well‐being. In this paper an attempt is made to provide a holistic perspective on the mapping of social well‐being in Northern Ireland through the adoption of a level of living approach. A method of level of living index construction developed by Knox for data in England and Wales is applied to statistics for Northern Ireland in 1971, and the pattern of internal geographical variation is analysed at two scale levels. Conclusions would suggest the need for a critical re‐assessment of the dichotomous east‐west model of well‐being.
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MORISON, JOHN, and RAY GEARY. "Crime, Conflict and Counting: Another Commentary on Northern Ireland Crime Statistics." Howard Journal of Criminal Justice 28, no. 1 (January 26, 2009): 9–26. http://dx.doi.org/10.1111/j.1468-2311.1989.tb00632.x.
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Walter, Bronwen. "From ‘flood’ to ‘trickle’: Irish migration to Britain 1987." Irish Geography 41, no. 2 (April 16, 2014): 181–94. http://dx.doi.org/10.55650/igj.2008.116.
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A dramatic change in the size and direction of emigration from Ireland has taken place over the past 20 years. The most striking feature is the sharp decline in movement to Britain from the Republic of Ireland, a traditional supplier of labour for well over 200 years. By contrast there has been a small increase in emigration from Northern Ireland, an important element of which is higher education students from Protestant backgrounds, who may be permanent migrants. Detailed statistics available from the Central Statistics Office of the Republic of Ireland show that proportionately more women have left as gross numbers have declined. This reflects the persistence of social, rather than predominantly economic, causes of emigration, also evident in the range of socially excluded people for whom Britain represents a ‘safety valve’. Two groups now characterise the Irish population in Britain; the ageing 1950s cohort and their children and grandchildren, the large second and third generations.
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BRAMS, STEVEN J., and JEFFREY M. TOGMAN. "AGREEMENT THROUGH THREATS: THE NORTHERN IRELAND CASE." International Game Theory Review 01, no. 03n04 (September 1999): 251–65. http://dx.doi.org/10.1142/s0219198999000189.
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Privilege, John. "The Northern Ireland government and the welfare state, 1942–8: the case of health provision." Irish Historical Studies 39, no. 155 (May 2015): 439–59. http://dx.doi.org/10.1017/ihs.2014.2.
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Abstract Northern Ireland, the United Kingdom’s only self-governing region, recorded year-on- year the worst statistics on health and poverty. However, it was far from certain that the Unionist government in Belfast would enact the kind of sweeping post-war reform that occurred in England and Wales. The raft of legislation governing health and social care introduced in 1948 was, therefore, the product of conditions and circumstances peculiar to Northern Ireland. The government in Belfast needed to overcome the conservative instincts of Ulster Unionism as well as suspicions regarding Clement Attlee’s Labour administration. Although the process was somewhat blighted by sectarianism, the government of Sir Basil Brooke enacted what amounted to a revolution in health and social care provision.
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McParland, Patricia, Paula Devine, Anthea Innes, and Vernon Gayle. "Dementia knowledge and attitudes of the general public in Northern Ireland: an analysis of national survey data." International Psychogeriatrics 24, no. 10 (May 17, 2012): 1600–1613. http://dx.doi.org/10.1017/s1041610212000658.
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ABSTRACTBackground: This paper provides an overview of the findings from the dementia module of the 2010 Northern Ireland Life and Times (NILT) Survey: an annual survey recording public attitudes to major social policy issues. Northern Ireland, in line with many other developed countries, recently released a Dementia Strategy. The opportunity to explore the knowledge and attitudes of the general public to dementia at a national level in Northern Ireland is timely and valuable. This paper reports on an initial exploration of these attitudes, based on bivariate analysis across demographic groups.Methods: Data were analyzed using SPSS (Version 19). Descriptive and summary statistics were produced. A series of categorical bivariate relationships were tested (chi-square) and tests of association (Cramer's V) were reported. We discuss both knowledge-related findings and attitudinal findings.Results: We found that the general public in Northern Ireland have a reasonably good level of knowledge about dementia. However, attitudinal measures indicate the stereotyping and infantilization of people with dementia.Conclusions: This NILT module provides a unique source of data on attitudes to, and knowledge of, dementia. A key strength is that it provides statistically representative data with national level coverage. This information can be used to target public health education policies more effectively and to inform delivery of health and social services. The success of the module leads us to believe that it stands as a blue-print for collecting information on dementia in other social surveys.
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Hayes, Davy, and John Pinkerton. "What’s in the Numbers? Child Welfare Statistics and the Children (Northern Ireland) Order." Child Care in Practice 22, no. 4 (August 17, 2016): 408–21. http://dx.doi.org/10.1080/13575279.2016.1209904.
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Congdon, P., and C. D. Lloyd. "A spatial random-effects model for interzone flows: commuting in Northern Ireland." Journal of Applied Statistics 39, no. 1 (January 2012): 199–213. http://dx.doi.org/10.1080/02664763.2011.580336.
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McKeaveney, Clare, Tracey McConnell, Craig Harrison, Victoria Stone, and Joanne Reid. "Population-Based Projections of Place of Death for Northern Ireland by 2040." Palliative Medicine and Hospice Care – Open Journal 6, no. 2 (December 31, 2020): 22–33. http://dx.doi.org/10.17140/pmhcoj-6-140.
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Background There are global challenges in relation to an increasingly older population, rising numbers of deaths and the resulting need for end-of-life care. It is imperative for Health and Social Care to examine where people die and forward plan. Aim To establish the place where people have died 2004-2018 and project future place of death care setting by 2040. Materials and Methods Population-based trend analysis of place of death for people that died in Northern Ireland (2004-2018 from Northern Ireland Statistics and Research Agency) and projections using linear modelling (2019-2040 projections by Office of National Statistics). Results Deaths are projected to increase by 45.9%, from 15,922 in 2018 (of which 36.3% will be aged 85+ years) to 23,231 deaths in 2040 (39.8% aged 85+ years). Between 2004 and 2018, proportions of home and care home (defined as nursing and residential beds) deaths increased (24.5-27% and 16.3-19.4% respectively), while the proportion of hospital deaths declined (51.9-47.6%). If current trends continue, by 2040, deaths within the community (home and care home) will account for between 46.7-55.2% of all deaths. However, if care home capacity is limited at current levels (as of 2018), hospital deaths are projected to account for the largest proportion of deaths by 2040 (51.7%). Discussion Death at an increasing age has implications for end-of-life care provision. This study demonstrates an increasing need for end-oflife care over the next 20-years, particularly within community settings. Projections highlight the need for comprehensive planning to ensure service provision within the community meets the needs of the population.
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O’Reilly, D., and M. Rosato. "Unexpected variations in official UK statistics related to rates of suicide and those of undetermined intent: An exploration of causes." European Psychiatry 41, S1 (April 2017): S401. http://dx.doi.org/10.1016/j.eurpsy.2017.02.469.
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BackgroundOfficial rates of suicide are perhaps the most important and enduring measures of population mental health. They are however prone to variations in reporting usually relating to deaths where the intention was uncertain, though most official statistics circumvent this by including ‘events of undetermined intent’ (ICD10 Y10-34 and Y87.2) along with ‘intentional self-harm’ in their official statistics. It is however unclear how successful this strategy has been and whether significant sources of bias still persist.AimTo systematically examine the dramatic change in rates of death from suicide (and undetermined intent) in Northern Ireland, that coincided with a major overhaul and reorganisation of the Coroners Service in 2005/6, to understand the extent to which the initial investigation by the coroners’ office, legal processing, registration and coding practices can influence official suicide statistics.MethodsIn the space of one year, Northern Ireland went from having a standardised rate of suicide (incl undetermined intent) of 12.6/100,000 in 2004 to 26.6/100,000 in 2006 (a 111% increase) and in doing so went from having consistently the lowest to consistently the highest registered rate of suicide in the UK.ResultsInitial analyses rules out changes in the police service, pathology service or registration coding practices as causative and suggest that the introduction of a coroner's liaison officer (with a formal data gathering role) was the most likely factor. The centralisation of the coroners’ service also reduced variations according to age, sex, geography and coding.ConclusionsThe process underpinning official statistics need to be routinely scrutinised.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Roulston, Audrey, Anne Campbell, Victoria Cairnduff, Deirdre Fitzpatrick, Conan Donnelly, and Anna Gavin. "Bereavement outcomes: A quantitative survey identifying risk factors in informal carers bereaved through cancer." Palliative Medicine 31, no. 2 (July 10, 2016): 162–70. http://dx.doi.org/10.1177/0269216316649127.
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Background: Enabling patients to die in their preferred place is important but achieving preferred place of death may increase the informal carer’s risk into bereavement. Aim: To determine risk factors of family carers bereaved through cancer in Northern Ireland. Design: These results form part of a larger QUALYCARE-NI study which used postal questionnaires to capture quantitative data on carer’s bereavement scores using the Texas Revised Inventory of Grief. Setting/participants: Participants were individuals who registered the death of a person between 1 December 2011 and 31 May 2012; where cancer (defined by ICD10 codes C00-D48) was the primary cause; where the deceased was over 18 years of age and death occurred at home, hospice, nursing home or hospital in Northern Ireland. Participants were approached in confidence by the Demography and Methodology Branch of the Northern Ireland Statistics and Research Agency. Those wishing to decline participation were invited to return the reply slip. Non-responders received a second questionnaire 6 weeks after initial invitation. Results indicated that risk factors positively influencing bereavement outcomes included patients having no preference for place of death and carers remaining in employment pre- or post-bereavement. In contrast, patients dying in hospital, carers stopping work, being of lower socio-economic status and close kinship to the deceased negatively affected bereavement scores. Family carers should be adequately supported to continue in employment; priority should be given to assessing the financial needs of families from lower socio-economic areas; and bereavement support should focus on close relatives of the deceased.
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Kent, Lisa, Christopher Cardwell, Ian Young, and Kelly-Ann Eastwood. "Trends in maternal body mass index in Northern Ireland: a cross-sectional and longitudinal study." Family Medicine and Community Health 9, no. 4 (December 2021): e001310. http://dx.doi.org/10.1136/fmch-2021-001310.
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ObjectivesExplore (1) associations between maternal body mass index (BMI), demographic and clinical characteristics, (2) longitudinal trends in BMI, (3) geographical distributions in prevalence of maternal overweight and obesity.DesignRetrospective population-based study.SettingLinked, anonymised, routinely collected healthcare data and official statistics from Northern Ireland.ParticipantsAll pregnancies in Northern Ireland (2011–2017) with BMI measured at ≤16 weeks gestation.MethodsAnalysis of variance and χ2 tests were used to explore associations. Multiple linear regression was used to explore longitudinal trends and spatial visualisation illustrated geographical distribution. Main outcomes are prevalence of overweight (BMI ≥25 kg/m2) and obesity (BMI ≥30 kg/m2).Results152 961 singleton and 2362 multiple pregnancies were included. A high prevalence of maternal overweight and obesity in Northern Ireland is apparent (singleton: 52.4%; multiple: 48.3%) and is increasing. Obesity was positively associated with older age, larger numbers of previous pregnancies and unplanned pregnancy (p<0.001). BMI category was also positively associated with unemployment (35% in obese class III vs 22% in normal BMI category) (p<0.001). Higher BMI categories were associated with increased rate of comorbidities, including hypertension (normal BMI: 1.8% vs obese III: 12.4%), diabetes mellitus (normal BMI: 0.04% vs obese III: 1.29%) and mental ill-health (normal BMI: 5.0% vs obese III: 11.8%) (p<0.001). Prevalence of maternal obesity varied with deprivation (most deprived: 22.8% vs least deprived: 15.7%) (p<0.001). Low BMI was associated with age <20 years, nulliparity, unemployment and mental ill-health (p<0.001).ConclusionsThe prevalence of maternal BMI >25 kg/m2 is increasing over time in Northern Ireland. Women are entering pregnancy with additional comorbidities likely to impact their life course beyond pregnancy. This highlights the need for prioritisation of preconception and inter-pregnancy support for management of weight and chronic conditions.
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Poon, Michael T. C., Paul M. Brennan, Kai Jin, Jonine D. Figueroa, and Cathie L. M. Sudlow. "Tracking Excess Deaths (TRACKED) – an interactive online tool to monitor excess deaths associated with the COVID-19 pandemic in the United Kingdom." Wellcome Open Research 5 (July 16, 2020): 168. http://dx.doi.org/10.12688/wellcomeopenres.16058.1.
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Background: We aimed to describe trends of excess mortality in the United Kingdom (UK) stratified by nation and cause of death, and to develop an online tool for reporting the most up to date data on excess mortality Methods: Population statistics agencies in the UK including the Office for National Statistics (ONS), National Records of Scotland (NRS), and Northern Ireland Statistics and Research Agency (NISRA) publish weekly mortality data. We used mortality data up to 22nd May in the ONS and the NISRA and 24th May in the NRS. The main outcome measures were crude mortality for non-COVID deaths (where there is no mention of COVID-19 on the death certificate) calculated, and excess mortality defined as difference between observed mortality and expected average of mortality from previous 5 years. Results: There were 56,961 excess deaths, of which 8,986 were non-COVID excess deaths. England had the highest number of excess deaths per 100,000 population (85) and Northern Ireland the lowest (34). Non-COVID mortality increased from 23rd March and returned to the 5-year average on 10th May. In Scotland, where underlying cause mortality data besides COVID-related deaths was available, the percentage excess over the 8-week period when COVID-related mortality peaked was: dementia 49%, other causes 21%, circulatory diseases 10%, and cancer 5%. We developed an online tool (TRACKing Excess Deaths - TRACKED) to allow dynamic exploration and visualisation of the latest mortality trends. Conclusions: Continuous monitoring of excess mortality trends and further integration of age- and gender-stratified and underlying cause of death data beyond COVID-19 will allow dynamic assessment of the impacts of indirect and direct mortality of the COVID-19 pandemic.
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Poon, Michael T. C., Paul M. Brennan, Kai Jin, Jonine D. Figueroa, and Cathie L. M. Sudlow. "Tracking Excess Deaths (TRACKED) – an interactive online tool to monitor excess deaths associated with the COVID-19 pandemic in the United Kingdom." Wellcome Open Research 5 (November 20, 2020): 168. http://dx.doi.org/10.12688/wellcomeopenres.16058.2.
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Background: We aimed to describe trends of excess mortality in the United Kingdom (UK) stratified by nation and cause of death, and to develop an online tool for reporting the most up to date data on excess mortality Methods: Population statistics agencies in the UK including the Office for National Statistics (ONS), National Records of Scotland (NRS), and Northern Ireland Statistics and Research Agency (NISRA) publish weekly mortality data. We used mortality data up to 22nd May in the ONS and the NISRA and 24th May in the NRS. The main outcome measures were crude mortality for non-COVID deaths (where there is no mention of COVID-19 on the death certificate) calculated, and excess mortality defined as difference between observed mortality and expected average of mortality from previous 5 years. Results: There were 56,961 excess deaths, of which 8,986 were non-COVID excess deaths. England had the highest number of excess deaths per 100,000 population (85) and Northern Ireland the lowest (34). Non-COVID mortality increased from 23rd March and returned to the 5-year average on 10th May. In Scotland, where underlying cause mortality data besides COVID-related deaths was available, the percentage excess over the 8-week period when COVID-related mortality peaked was: dementia 49%, other causes 21%, circulatory diseases 10%, and cancer 5%. We developed an online tool (TRACKing Excess Deaths - TRACKED) to allow dynamic exploration and visualisation of the latest mortality trends. Conclusions: Continuous monitoring of excess mortality trends and further integration of age- and gender-stratified and underlying cause of death data beyond COVID-19 will allow dynamic assessment of the impacts of indirect and direct mortality of the COVID-19 pandemic.
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McCallion, T. "Optimum Allocation in Stratified Random Sampling with Ratio Estimation as Applied to the Northern Ireland December Agricultural Sample." Applied Statistics 41, no. 1 (1992): 39. http://dx.doi.org/10.2307/2347615.
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Manikyam, Y., G. G. Hanna, R. J. Harte, P. G. Henry, R. F. Houston, and M. M. Eatock. "Impact of socioeconomic status on treatment outcome in patients with advanced esophagogastric cancer in Northern Ireland." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e20531-e20531. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e20531.
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e20531 Background: The survival advantage for combination chemotherapy in advanced gastroesophageal adenocarcinoma is well documented. Epirubicin and cisplatin in combination with either 5FU (ECF) or capecitabine (ECX) result in response rates of 35–46% and a median survival of around 9 months in RCT. We report the impact of socioeconomic status on the outcome of ECF and ECX treatment in advanced gastroesophageal cancer patients in Northern Ireland between 2000 and 2007. Methods: All patients with advanced esophageal (O), gastric (G), or esophagogastric junction (OGJ) adenocarcinoma, receiving palliative chemotherapy from January 2000 to August 2007, were identified from our institutional database. Baseline demographics, clinical characteristics, treatment details, and clinical outcomes were recorded. Patients receiving chemotherapy in a clinical trial were excluded. Survival was estimated using the Kaplan-Meier method. Deprivation was assessed using the patient's home address deprivation index (DPI) (Northern Ireland Multiple Deprivation Measure 2005; May 2005. Northern Ireland Statistics and Research Agency. www.nisra.gov.uk ). Results: 274 eligible patients (m=200, f=74, O=114, OGJ=19, G=141) were identified. Median age was 62 years (range 22–83). 172 (62.8%) had ECOG performance status 0 or 1. 231 patients (84.3%) had metastatic disease, 43 (15.7%) had locally advanced disease. 216 (78.8%) patients received ECF and 58 (21.2%) patients received ECX. Overall median survival was 7.3 months. Treatment response and performance status were strong predictors of survival, however disease extent did not influence survival. Median survival was significantly longer in those with DPIs in the upper two quintiles than the lower 3 quintiles (9.5 months vs. 6.8 months, p=0.032). Conclusions: Outcomes achieved with palliative ECF/ECX treatment are similar to the reference clinical trials. Socioeconomic deprivation is significantly associated with reduced survival in this group of patients and is unrelated to disease extent at presentation; however it may be related to nutritional status and comorbidity and requires further investigation. No significant financial relationships to disclose.
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Foley, Brian, Ian Shuttleworth, and David Martin. "Administrative Data Quality: Investigating Record-Level Address Accuracy in the Northern Ireland Health Register." Journal of Official Statistics 34, no. 1 (March 1, 2018): 55–81. http://dx.doi.org/10.1515/jos-2018-0004.
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Abstract Many national statistical institutes (NSIs) are seeking to supplement or replace their traditional population census with a methodology underpinned by administrative sources. Health service register data are key in this regard owing to their high population coverage; it is therefore important to improve understanding of data quality in this administrative source. This study investigated the factors associated with record-level address data mismatch between the Northern Ireland (NI) Health Card Registration System (HCRS) and the 2011 Census, using the NI Longitudinal Study (NILS). Address information in the form of anonymised Unique Property Reference Number (XUPRN) was available for circa 334,000 NILS members with census returns in 2001 and 2011, which provided a benchmark to assess XUPRN accuracy in their linked HCRS record for comparable time points. Multinomial logistic regression revealed a significantly greater likelihood of address mismatch in the HCRS for: males; young adults; individuals with no limiting long-term illness; migrants in the year prior to each census; and residents of communal establishments. Identification of population groups affected by poor quality address information in administrative sources can assist NSIs with the development and implementation of methodological improvements to ensure that official population statistics generated from these sources are fit for purpose.
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F., T. W., J. P. H., T. J. H., A. R. O., T. J. H., T. J. H., R. A. B., et al. "Reviews of Books." Irish Geography 5, no. 1 (January 3, 2017): 97–103. http://dx.doi.org/10.55650/igj.1964.997.
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DAS WERDEN DER AGRARLANDSCHAFT IN DER GRAFSCHAFT TIPPERARY (IRLAND). Ingeborg Leister. Marburger Geographische Schriften, Heft 18, 1963. 434 pp. 21 DM.LAND USE IN NORTHERN IRELAND. General Report of the Land Utilisation Survey of Northern Ireland. Editor, Leslie Symons. University of London Press Ltd. 1963. pp. 288. £2–2‐0.WEST CORK RESOURCE SURVEY. Prepared and published by an Foras Talúntais (Agricultural Institute). Dublin 1963. £1.GEOLOGY AND IRELAND. W. E. Nevill. Dublin: Figgis, 1963. 8#fr1/2> × 5#fr1/2> in., xv + 263 pp., 65 text figures. 25s.RECENT RESEARCH ON IRISH RURAL SETTLEMENT. The report of a symposium held at Belfast, January 1963. By Ronald H. Buchanan. Belfast: Geography Department, The Queen's University. 1/‐.COUNTY LONDONDERRY HANDBOOK. Belfast: Nicholson & Bass. (no date) 2s. 6d.L'EUROPE DU NORD ET DU NORD‐OUEST. Tome III. LES ILES BRITANNIQUES. J. Beaujeu‐Garnier and A. Guilcher. ‘Orbis’ Introduction aux Etudes de Geographie. Paris: Presses Universitaires de France, 1963. 560pp. F.32.THE ECONOMIC PATTERN OF MODERN GERMANY, by Norman G. Pounds. London: John Murray, 1963. Pp. 133. 80#fr1/2> × 5#fr1/4> in. 18s.NORTH AMERICA. N. J. G. Pounds. London: John Murray, 2nd. ed., 1964. 238 pp. 18s. 6d.THE EARTH AND YOU. Norman J. G. Pounds. London: John Murry, 1963. 591 pp. 60s.INDUSTRIALISATION AND UNDER‐DEVELOPED COUNTRIES, by Alan B. Mountjoy. London: Hutchinson University Library, 1963. 223 pp. 15s.ATLAS OF CENTRAL EUROPE. London: J. Murray, 1963. 13 ins. × 9#fr1/2> ins. 42s.STATISTICAL MAPPING AND THE PRESENTATION OF STATISTICS. G C. Dickenson. London: Edward Arnold Ltd., 1963. 160pp. 21s.INTERNATIONAL YEARBOOK OF CARTOGRAPHY, III, 1963. Edited by Eduard Imhof. London: George Philip and Son Ltd., 1963. Pp. 232. 9#fr1/2> × 6#fr1/2> in. 40s.
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Garland, C., and S. Jacklin. "Patient satisfaction with community pharmacy COVID-19 vaccination in Northern Ireland." International Journal of Pharmacy Practice 31, Supplement_2 (November 30, 2023): ii20—ii21. http://dx.doi.org/10.1093/ijpp/riad074.025.
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Abstract Introduction Northern Ireland’s community pharmacies have contributed substantially to the COVID-19 response, with over 436,000 COVID-19 vaccines administered since March 2021. Community pharmacy has an established role across the UK in delivering influenza vaccination programmes. Research has found that community pharmacy vaccination can increase vaccine availability and uptake and is highly valued by patients1, and although European studies have demonstrated high satisfaction with community pharmacy COVID-19 vaccination services2, further studies are required that are applicable to a UK context. Aim This evaluation aimed to measure user satisfaction with the HSC community pharmacy COVID-19 vaccination service, reasons why users chose community pharmacy for vaccination, and user attitudes towards service quality in three key quality domains of patient-centredness, professionalism, and privacy. The findings aimed to inform recommendations for service improvement for future vaccination campaigns. Methods Following ethical approval from Keele University School of Pharmacy & Bioengineering Research Ethics Committee, a cross-sectoral survey of individuals accessing COVID-19 vaccination from 61 participating community pharmacies was carried out between 20th September 2022 and 3rd December 2022. Voluntary participation was offered to all individuals accessing COVID-19 vaccination from pharmacies purposively chosen as representative of the community pharmacy network. Respondent views on service quality and overall satisfaction were collected anonymously via a Microsoft Forms questionnaire. The results were analysed for overall satisfaction and across three quality domains of patient-centredness, professionalism and privacy identified from the literature as mattering most to users of pharmacy services3. The results were reported using descriptive statistics including frequencies, percentages, skewness and measurements of central tendency. The findings informed the development of five key recommendations for future service improvement. Results 135 patients completed the online questionnaire. Overall patient satisfaction was extremely high, with 100% of respondents indicating they would recommend the service to friends and family and that they would return to a community pharmacy for COVID-19 vaccination. 96% of participants cited convenience, trust, ease of access and time spent at the pharmacy as reasons they chose community pharmacy for vaccination. Respondents were very satisfied with the quality of the service provided across the domains of patient-centredness, professionalism and privacy. Over 95% of participants were very satisfied with the quality of the service, professionalism of the vaccinator and caring of the pharmacy team, however only 73.2% of respondents were very satisfied with the standard of the consultation room. Discussion/Conclusion Overall satisfaction with community pharmacy COVID-19 vaccination in Northern Ireland is very high. Participants largely chose to access vaccination from community pharmacies for reasons of convenience, trust, ease of appointment and time spent at the pharmacy. Users are very satisfied with service quality in terms of patient-centredness, professionalism and privacy. Although generalisation is limited due to relatively small sample size, underrepresentation of some geographical areas and the potential for selection bias arising from voluntary participation and use of online questionnaires, this evaluation still provides a framework for continued quality improvement and a detailed perspective on user attitudes towards community pharmacy COVID-19 vaccination that has informed the development of recommendations for service improvement. References 1. Maidment, I; Young, E; MacPhee, M; Booth, A; Zaman, H; Breen, J; Hilton, A; Kelly, T; Wong, G. Rapid realist review of the role of community pharmacy in the public health response to COVID-19. BMJ Open [Internet] 2021 [cited 2023 Apr 17];11:e050043. Available at: https://doi.org/10.1136/bmjopen-2021-050043 2. Piraux, A; Cavillon, M; Ramond-Roquin, A; Faure, S. Assessment of Satisfaction with Pharmacist-Administered COVID-19 Vaccinations in France: PharmaCoVax. Vaccines [Internet] 2022 [cited 2023 Apr 17];10, 440. Available at: https://doi.org/10.3390/vaccines10030440 3. Watson, M; Silver, K; Watkins, R. How does the public conceptualise the quality of care and its measurement in community pharmacies in the UK: a qualitative interview study. BMJ Open [Internet] 2019 [cited 2023 Apr 17];9:e027198. Available at https://doi.org/10.1136/bmjopen-2018-027198
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Davies, Katie, Emma Louise Johnson, Linda Hollén, Hywel M. Jones, Mark D. Lyttle, Sabine Maguire, and Alison Mary Kemp. "Incidence of medically attended paediatric burns across the UK." Injury Prevention 26, no. 1 (February 21, 2019): 24–30. http://dx.doi.org/10.1136/injuryprev-2018-042881.
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ObjectiveChildhood burns represent a burden on health services, yet the full extent of the problem is difficult to quantify. We estimated the annual UK incidence from primary care (PC), emergency attendances (EA), hospital admissions (HA) and deaths.MethodsThe population was children (0–15 years), across England, Wales, Scotland and Northern Ireland (NI), with medically attended burns 2013–2015. Routinely collected data sources included PC attendances from Clinical Practice Research Datalink 2013–2015), EAs from Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI, 2014) and National Health Services Wales Informatics Services, HAs from Hospital Episode Statistics, National Services Scotland and Social Services and Public Safety (2014), and mortality from the Office for National Statistics, National Records of Scotland and NI Statistics and Research Agency 2013–2015. The population denominators were based on Office for National Statistics mid-year population estimates.ResultsThe annual PC burns attendance was 16.1/10 000 persons at risk (95% CI 15.6 to 16.6); EAs were 35.1/10 000 persons at risk (95% CI 34.7 to 35.5) in England and 28.9 (95% CI 27.5 to 30.3) in Wales. HAs ranged from 6.0/10 000 person at risk (95% CI 5.9 to 6.2) in England to 3.1 in Wales and Scotland (95% CI 2.7 to 3.8 and 2.7 to 3.5, respectively) and 2.8 (95% CI 2.4 to 3.4) in NI. In England, Wales and Scotland, 75% of HAs were aged <5 years. Mortality was low with 0.1/1 000 000 persons at risk (95% CI 0.06 to 0.2).ConclusionsWith an estimated 19 574 PC attendances, 37 703 EAs (England and Wales only), 6639 HAs and 1–6 childhood deaths annually, there is an urgent need to improve UK childhood burns prevention.
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Beacom, Emma, Sinéad Furey, Lynsey Elizabeth Hollywood, and Paul Humphreys. "Food poverty contributors: individual, structural or political? Examining stakeholder perspectives using interviews and nominal group technique." British Food Journal 123, no. 6 (February 12, 2021): 2199–215. http://dx.doi.org/10.1108/bfj-09-2020-0817.
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PurposeData were collected from a range of stakeholders in Northern Ireland including consumer representatives, policy makers and public health representatives. Data collection occurred in two phases: firstly via in-depth interviews (n = 19), and secondly via roundtables (n = 4) with stakeholders (n = 36) using nominal group technique.Design/methodology/approachFood poverty has been identified as a significant societal and public health problem in the UK, evidenced in part by published statistics on the prevalence of food poverty, and the well-documented increase in the uptake of food bank provision. This paper presents various theoretical perspectives regarding the aetiology of (food) poverty, followed by stakeholders' opinions on the contributors to food poverty and consideration of how these align with various theoretical perspectives.FindingsVarious individual, structural and political factors were identified by stakeholders as contributors to food poverty, with income largely agreed to be the most significant contributor. Two themes of contributors were identified during analysis: micro-level and individual-level contributors and macro-level and economic-level contributors. Structural factors were most commonly cited as contributors to food poverty during both stakeholder interviews and stakeholder roundtables, followed by individual factors and political factors.Practical implicationsUnderstanding the contributors to food poverty can inform targeted policy action.Originality/valueThere is a lack of theoretical and conceptual literature regarding the causes of food poverty, and there has to date been limited research on the contributors to food poverty in Northern Ireland/the United Kingdom.
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Ahmed, Rakesh, and Peter May. "Does high COVID-19 spread impact neighbouring countries? Evidence from Ireland." HRB Open Research 4 (May 20, 2021): 56. http://dx.doi.org/10.12688/hrbopenres.13263.1.
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Background: Coronavirus disease 2019 (COVID-19) has necessitated public health responses on an unprecedented scale. Controlling infectious diseases requires understanding of the conditions that increase spread. Prior studies have identified sociodemographic, epidemiological and geographic associations. Ireland offers an unusual opportunity to quantify how high infection rates in one country impacted cases in a neighbouring country. Methods: We analysed official statistics on confirmed COVID-19 cases on the island of Ireland for 52 weeks from March 2020. Our main research question was: Did higher cases in Northern Ireland (NI) impact the number of cases in the Republic of Ireland (ROI)? We used least squares regression to compare confirmed cases in ROI counties that border NI with the rest of the state. We included in our model sociodemographic, epidemiological and geographic factors. We employed the latitude of each county town as an instrumental variable to isolate a quasi-experimental estimate of the cross-border spread. Results: In the quasi-experimental framework, and controlling for population density, age distribution and circulatory disease prevalence, border counties had an extra 21.0 (95%CI: 8.4-33.6) confirmed COVID-19 cases per 1000 people. This equates to an estimated 9,611 additional cases in ROI, or 4% of the national total in the first year of the pandemic. Our results were substantively similar in non-experimental frameworks, with alternative additional predictors, and in sensitivity analyses. Additionally, population density in ROI counties was positively associated with confirmed cases and higher proportions of residents in the professional classes was negatively associated. Conclusion: On the island of Ireland during the first year of the COVID-19 pandemic, high infection rates in NI increased cases in the neighbouring ROI. Maximising co-ordination of pandemic responses among neighbouring countries is essential to minimising disease spread, and its associated disruptions to society and the economy. Socioeconomic disadvantage appeared to confer significant additional risk of spread.
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Ahmed, Rakesh, and Peter May. "Does high COVID-19 spread impact neighbouring countries? Quasi-experimental evidence from the first year of the pandemic in Ireland." HRB Open Research 4 (September 6, 2021): 56. http://dx.doi.org/10.12688/hrbopenres.13263.2.
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Background: Coronavirus disease 2019 (COVID-19) has necessitated public health responses on an unprecedented scale. Controlling infectious diseases requires understanding of the conditions that increase spread. Prior studies have identified sociodemographic, epidemiological and geographic associations. Ireland offers an unusual opportunity to quantify how high infection rates in one country impacted cases in a neighbouring country. Methods: We analysed official statistics on confirmed COVID-19 cases on the island of Ireland for 52 weeks from March 2020. Our main research question was: Did higher cases in Northern Ireland (NI) impact the number of cases in the Republic of Ireland (ROI)? We used least squares regression to compare confirmed cases in ROI counties that border NI with the rest of the state. We included in our model sociodemographic, epidemiological and geographic factors. We employed the latitude of each county town as an instrumental variable to isolate a quasi-experimental estimate of the cross-border spread. Results: In the quasi-experimental framework, and controlling for population density, age distribution and circulatory disease prevalence, border counties had an extra 21.0 (95%CI: 8.4-33.6) confirmed COVID-19 cases per 1000 people. This equates to an estimated 9,611 additional cases in ROI, or 4% of the national total in the first year of the pandemic. Our results were substantively similar in non-experimental frameworks, with alternative additional predictors, and in sensitivity analyses. Additionally, population density in ROI counties was positively associated with confirmed cases and higher proportions of residents in the professional classes was negatively associated. Conclusion: On the island of Ireland during the first year of the COVID-19 pandemic, high infection rates in NI increased cases in the neighbouring ROI. Maximising co-ordination of pandemic responses among neighbouring countries is essential to minimising disease spread, and its associated disruptions to society and the economy. Socioeconomic disadvantage appeared to confer significant additional risk of spread.
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Jordan, Crawford, Chaosheng Zhang, and Alex Higgins. "Using GIS and statistics to study influences of geology on probability features of surface soil geochemistry in Northern Ireland." Journal of Geochemical Exploration 93, no. 3 (June 2007): 135–52. http://dx.doi.org/10.1016/j.gexplo.2007.03.001.
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Connolly, Hayley, Natalie Delimata, Karen Galway, Bridget Kiely, Margaret Lawler, Jill Mulholland, Megan O’Grady, and Deirdre Connolly. "Exploration of Evaluation Practices in Social Prescribing Services in Ireland: A Cross-Sectional Observational Study." Healthcare 12, no. 2 (January 16, 2024): 219. http://dx.doi.org/10.3390/healthcare12020219.
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National health services in Ireland and the UK fund the majority of social prescribing services and have issued recommendations for evaluation. However, it is not known what outcomes are prioritised for evaluation within individual services and what evaluation methods are used to capture recommended outcomes. A survey was carried out to examine evaluation practices of social prescribing services on the island of Ireland. This study used a cross-sectional observational design. The sample was all the staff involved in delivering and/or managing SP services on the island of Ireland. Questionnaires were distributed at a national SP conference and online. Closed-response questions were analysed using descriptive statistics. Content analysis was used for open-ended questions. Eighty-four usable surveys were returned (50% from the Republic of Ireland and 50% from Northern Ireland). All respondents (100%) agreed on the importance of measuring SP outcomes. The most frequently measured outcomes were health and well-being (89.2%) and loneliness (84%). The least frequently measured outcome was the satisfaction of healthcare professionals referring to SP: 78.4% of respondents never measured this outcome. The most frequently used measurement tool was the Short Warwick Edinburgh Mental Well-Being Scale, with 38/76 (50%) respondents using this measure. There was a lack of standardised measures identified for some outcomes. For example, 70% of respondents reported always measuring physical activity (PA), but only four respondents identified a specific PA measure. In open-ended questions, respondents recommended flexibility in evaluation methods to reflect the complexity and individualised focus of SP. They also identified the need for protected time to complete evaluations and recommended a national strategy to inform priorities in evaluations. This study demonstrates a wide variation on the island of Ireland on how SP services are measuring outcomes, with many outcomes rarely or never measured using standardised measures. Agreement is needed on a core outcome set for social prescribing in order to guide service delivery and evaluations.
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Robson, P. J., A. M. Gallagher, M. B. E. Livingstone, G. W. Cran, J. J. Strain, J. M. Savage, and C. A. G. Boreham. "Tracking of nutrient intakes in adolescence: the experiences of the Young Hearts Project, Northern Ireland." British Journal of Nutrition 84, no. 4 (October 2000): 541–48. http://dx.doi.org/10.1017/s0007114500001859.
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This study evaluated the tracking of energy and nutrient intakes, assessed by diet history, in a random sample of adolescents (boys n 225, girls n 230) at baseline (age 12 years), and subsequently at age 15 years. Median energy (MJ/d) and macronutrient (g/d) intakes increased significantly (all P<0·001) with increasing age in the boys. The girls' reported energy intake (MJ/d) remained stable over time, despite significant increases in BMI, weight and % body fat. Age-related changes in the girls' macronutrient intakes were inconsistent. When expressed in terms of nutrient density, the diets of both sexes became significantly richer, over time, in total folate (both sexes, P<0·01), but poorer in Ca (boys P<0·01, girls P<0·001) and riboflavin (both sexes P<0·001). Vitamin B6 (P<0·001) and Fe (P<0·05) densities increased in the boys, while the thiamin density of the girls' diets decreased (P<0·001). Tracking, defined as maintenance of rank over time, was summarised using weighted kappa statistics (κ). There were some significant changes in intakes at the group level; however, tracking of energy and nutrients in both sexes was only poor to fair (κ<0·40), indicating substantial drift of individuals between classes of intake over time. Particularly poor tracking was evident for % energy from sugars (κ 0·09) and total fat (κ 0·09) in the girls' diets. In conclusion, the poor to fair tracking observed in this cohort suggests that individual dietary patterns exhibited at 12 years of age are unlikely to be predictive of energy and nutrient intake at age 15 years.
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Lloyd, C. D. "Exploring population spatial concentrations in Northern Ireland by community background and other characteristics: an application of geographically weighted spatial statistics." International Journal of Geographical Information Science 24, no. 8 (June 21, 2010): 1193–221. http://dx.doi.org/10.1080/13658810903321321.
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Gallagher, AM, PJ Robson, MBE Livingstone, GW Cran, JJ Strain, L. J. Murray, JM Savage, and CAG Boreham. "Tracking of energy and nutrient intakes from adolescence to young adulthood: the experiences of the Young Hearts Project, Northern Ireland." Public Health Nutrition 9, no. 8 (December 2006): 1027–34. http://dx.doi.org/10.1017/phn2006969.
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AbstractObjectiveTo assess tracking of energy and nutrient intakes between adolescence and young adulthood.DesignLongitudinal study of a random sample of adolescents (aged 15 years at baseline). The extent of tracking of dietary intakes (assessed by diet history) was investigated using weighted kappa statistics (κ).SettingNorthern Ireland population survey.SubjectsAdolescents who participated in the Young Hearts Project, Northern Ireland at age 15 years, and subsequently at young adulthood aged between 20 and 25 years (n = 245 males,n = 231 females).ResultsDespite overall increases in height and weight (bothP < 0.001), increases in body mass index in males (P < 0.001) and body fatness in females (P < 0.001), median reported intakes of energy (kJ kg− 1 day− 1), carbohydrate (g day− 1) and fat (g day− 1) decreased (allP < 0.001) over time. Expressed as nutrient densities (per MJ), diets at young adulthood were overall richer in thiamin, vitamin B6, total folate (allP < 0.001), vitamin C (P < 0.01) and vitamin D (P < 0.05). Whereas the nutrient density of the males' diets decreased over time for calcium (P < 0.05) and vitamin A (P < 0.001), iron and riboflavin densities increased in the females' diet (P < 0.001). Tracking of energy (MJ day− 1) and nutrient intakes (expressed per MJ day− 1) at the individual level was only poor to fair (all κ < 0.25), indicating substantial drift of subjects between the low, medium and high classes of intake with increasing age.ConclusionsThese data suggest that individual dietary patterns exhibited at 15 years of age are unlikely to be predictive of dietary intakes at young adulthood.
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Fox, Siobhan, Niamh O'Connor, Johnathan Drennan, Suzanne Guerin, W. George Kernohan, Aileen Murphy, and Suzanne Timmons. "Components of a community model of dementia palliative care." Journal of Integrated Care 28, no. 4 (June 30, 2020): 349–64. http://dx.doi.org/10.1108/jica-02-2020-0013.
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PurposeThe Model for Dementia Palliative Care Project will develop a service-delivery model for community-based dementia palliative care. Many countries provide dementia palliative care services, albeit with considerable variability within these. However, little is known about what service providers consider to be the most important components of a dementia palliative care model. This study aimed to address this knowledge gap.Design/methodology/approachAn exploratory design using a survey method was used as an initial phase of the wider project. A web-based survey was developed, piloted (n = 5), revised, and distributed within five healthcare jurisdictions: the Republic of Ireland, Northern Ireland, England, Scotland, and Wales. The target population was health and social care professionals, policymakers, and academics interested in dementia and palliative care. Content analysis of open-ended questions identified common themes; descriptive statistics were applied to the closed-ended questions.FindingsOverall, N = 112 complete surveys were received. Key care principles incorporated the philosophies of palliative care and dementia care; many described “holistic” and “person-centred care” as the core. Important individual service components were the support for carers, advanced care planning, information, education and training, activities for “meaningful living”, comprehensive disease management, coordinated case management, and linking with community health services and social activities. Barriers included poor availability and organisation of healthcare services, stigma, misconceptions around dementia prognosis, insufficiently advanced care planning, and dementia-related challenges to care. Facilitators included education, carer support, and therapeutic relationships.Originality/valueThis study, as part of the larger project, will directly inform the development of a novel service delivery Model of Dementia Palliative Care for Ireland. The results can also inform service planning and design in other countries.
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O'Kelly, Michael, John Doyle, and Philip J. Boland. "How many ways can you look at a proportion?: cross-community vote transfers in Northern Ireland after the Belfast Agreement." Journal of the Royal Statistical Society: Series A (Statistics in Society) 173, no. 1 (January 2010): 215–35. http://dx.doi.org/10.1111/j.1467-985x.2009.00608.x.
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Koop, Gary, Stuart McIntyre, James Mitchell, and Aubrey Poon. "RECONCILED ESTIMATES AND NOWCASTS OF REGIONAL OUTPUT IN THE UK." National Institute Economic Review 253 (July 28, 2020): R44—R59. http://dx.doi.org/10.1017/nie.2020.29.
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There is renewed interest in levelling up the regions of the UK. The combination of social and political discontent, and the sluggishness of key UK macroeconomic indicators like productivity growth, has led to increased interest in understanding the regional economies of the UK. In turn, this has led to more investment in economic statistics. Specifically, the Office for National Statistics (ONS) recently started to produce quarterly regional GDP data for the nine English regions and Wales that date back to 2012Q1. This complements existing real GVA data for the regions available from the ONS on an annual basis back to 1998; with the devolved administrations of Scotland and Northern Ireland producing their own quarterly output measures. In this paper we reconcile these two data sources along with UK quarterly output data that date back to 1970. This enables us to produce both more timely real terms estimates of quarterly economic growth in the regions of the UK and a new reconciled historical time-series of quarterly regional real output data from 1970. We explore a number of features of interest of these new data. This includes producing a new quarterly regional productivity series and commenting on the evolution of regional productivity growth in the UK.
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Shuttleworth, I. G., C. D. Lloyd, and D. J. Martin. "Exploring the implications of changing census output geographies for the measurement of residential segregation: the example of Northern Ireland 1991-2001." Journal of the Royal Statistical Society: Series A (Statistics in Society) 174, no. 1 (July 28, 2010): 1–16. http://dx.doi.org/10.1111/j.1467-985x.2010.00647.x.
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Essery, C. L., and D. N. Wilcock. "An appraisal of SPOT imagery to investigate landuse in the River Main drainage basin, N. Ireland." Irish Geography 19, no. 1 (December 20, 2016): 15–22. http://dx.doi.org/10.55650/igj.1986.705.
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The study described here was designed to test the use of SPOT imagery for the mapping and assessment of landuse. Unlike England & Wales, no landuse maps are available in N. Ireland and as such all testing is achieved by Field ground truth.Numerous techniques, ranging from the use of single band (3) through ratios and vegetation indices to maximum-likelihood, were used to enable a successful classification. The major problem was the similarity of bare soil (arable landuse) and heather. The solution to this problem involved the use of a 3/2 ratio to give landuse classes augmented by an “edited” box classification which gives an estimate of the bare soil/arable component. This problem may not be significant in future studies, provided the fly-over occurs during the period of growth for arable crops.Testing of the classification developed from SPOT data was undertaken using field ground truth and agricultural statistics for the year 1984. Landuse derived from the classification was shown to agree with ground truth on 97% of all cases, while the areal estimates of landuse types produced an r2 value of 0.9607 when plotted against estimates derived from official 1984 Agricultural Statistics.Production of this classification would have been virtually impossible with other available imagery for several reasons, the prime reason being the relatively small field size in Northern Ireland. Standard Landsat-3 imagery was found to be of little use in comparison with that from SPOT imagery.
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Elia, M., C. A. Russell, and R. J. Stratton. "Malnutrition in the UK: policies to address the problem." Proceedings of the Nutrition Society 69, no. 4 (June 16, 2010): 470–76. http://dx.doi.org/10.1017/s0029665110001746.
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In 2007, the estimated cost of disease-related malnutrition in the UK was in excess of £13×109. At any point in time, only about 2% of over 3 million individuals at risk of malnutrition were in hospital, 5% in care homes and the remainder in the community (2–3% in sheltered housing). Some government statistics (England) grossly underestimated the prevalence of malnutrition on admission and discharge from hospital (1000–3000 annually between 1998 and 2008), which is less than 1% of the prevalence (about 3 million in 2007–2008) established by national surveys using criteria based on the ‘Malnutrition Universal Screening Tool’ (‘MUST’). The incidence of malnutrition-related deaths in hospitals, according to government statistics (242 deaths in England in 2007), was also <1% of an independent estimate, which was as high as 100 000/year. Recent healthcare policies have reduced the number of hospital and care home beds and encouraged care closer to home. Such policies have raised issues about education and training of the homecare workforce, including 6 million insufficiently supported informal carers (10% of the population), the commissioning process, and difficulties in implementing nutritional policies in a widely distributed population. The four devolved nations in the UK (England, Scotland, Northern Ireland and Wales) have developed their own healthcare polices to deal with malnutrition. These generally aim to span across all care settings and various government departments in a co-ordinated manner, but their effectiveness remains to be properly evaluated.
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Knipe, Damian, and Geraldine Magennis. "Arts-Based Approaches to Studying Traveller Children’s Educational Experiences." Art/Research International: A Transdisciplinary Journal 3, no. 2 (September 15, 2018): 20–47. http://dx.doi.org/10.18432/ari29377.
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In this article, we present ideas on how arts-based methods can be applied to conducting research with a minority ethnic group (i.e., Traveller children) and offer ways to analyse data. We refer to the culture of Traveller children, report statistics on their educational performance and refer to recent research in Northern Ireland on their disengagement from compulsory post-primary (11-16 years old) education. We look through the lens of Bronfenbrenner’s ecological systems theory and consider a re-think of the approach typically used in research to tap into Traveller children’s educational experiences. We offer a brief summary of the principles of arts-based research, outlining the theoretical underpinnings of supporters who argue for its use in educational research settings. We elaborate on three arts-based research methods as options in the design of conducting research with Traveller children and offer advice on associated ethical issues. In exploring methods of analysis, we refer to the types of data and suggest a content and thematic analytical approach to interpret the data. In conclusion, we reiterate the importance of offering these culturally responsive means to engage with this minority ethnic group.
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Zhang, Chaosheng, Crawford Jordan, and Alex Higgins. "Using neighbourhood statistics and GIS to quantify and visualize spatial variation in geochemical variables: An example using Ni concentrations in the topsoils of Northern Ireland." Geoderma 137, no. 3-4 (January 2007): 466–76. http://dx.doi.org/10.1016/j.geoderma.2006.10.018.
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Rickard, Emily, Emma Carmel, and Piotr Ozieranski. "Comparing pharmaceutical company payments in the four UK countries: a cross-sectional and social network analysis." BMJ Open 13, no. 3 (March 2023): e061591. http://dx.doi.org/10.1136/bmjopen-2022-061591.
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ObjectivesTo examine the characteristics of pharmaceutical payments to healthcare and patient organisations in the four UK countries. Compare companies spending the most; types of organisations receiving payments and types of payments in the four countries. Measure the extent to which companies target payments at the same recipients in each country and whether it differs depending on the type of recipient.DesignCross-sectional comparative and social network analysis.SettingEngland, Scotland, Wales, Northern Ireland.Participants100 donors (pharmaceutical companies) reporting payments to 4229 recipients (healthcare organisations and patient organisations) in 2015.Main outcome measuresFor each country: payment totals and distribution; average number of common recipients between companies; share of payments to organisations fulfilling different roles in the health ecosystem and payments for different activities.ResultsCompanies prioritised different types of recipient and different types of activity in each country. There were significant differences in the distribution of payments across the four countries, even for similar types of recipients. Recipients in England and Wales received smaller individual payments than in Scotland and Northern Ireland. Overall, targeting shared recipients occurred most frequently in England, but was also common in certain pockets of each country’s health ecosystem. We found evidence of reporting errors in Disclosure UK.ConclusionsOur findings suggest a strategic approach to payments tailored to countries’ policy and decision-making context, indicating there may be specific vulnerabilities to financial conflicts of interest at subnational level. Payment differences between countries may be occurring in other countries, particularly those with decentralised health systems and/or high levels of independence across its decision-making authorities. We call for a single database containing all recipient types, full location details and published with associated descriptive and network statistics.
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Marchment, Zoe, Paul Gill, and John Morrison. "Risk Factors for Violent Dissident Republican Incidents in Belfast: A Comparison of Bombings and Bomb Hoaxes." Journal of Quantitative Criminology 36, no. 3 (April 17, 2019): 647–66. http://dx.doi.org/10.1007/s10940-019-09413-0.
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Abstract Objectives To identify risk factors for bombings and bomb hoaxes committed by dissident Republicans in Belfast, Northern Ireland. Methods Risk terrain modelling (RTM) was applied to each type of incident to identify significant risk layers. Results Previous protests and riots [relative risk value (RRV) of 14.07; spatial influence (SI) of 100 m], punishment attacks (RRV 6.56; SI 300 m) and areas dense with pubs and bars (RRV 4.98; SI 200 m) were identified as risk factors for bombings. Punishment attacks (RRV 10.77; SI 100 m), police stations (RRV 8.76; SI of 200 m) and places dense with shops (RRV 6.94; SI 400 m) were identified as risk factors for bomb hoaxes. Descriptive statistics regarding predictive accuracy concluded that half of incidents for both types occurred in high or very high risk cells in a 3-year post-study period. Conclusions RTM could be a useful tool in guiding targeted responses to the dissident Republican threat in Belfast. The results suggest that there is some assessment of risk by the offenders, and that they are selecting targets rationally. Due to the differences in risk factors for the two types of events it can be proposed that there may be differences between targets relevant to ideology and realistic targets with increased chance of success.
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Gittins, Matthew, David Lugo-Palacios, Andy Vail, Audrey Bowen, Lizz Paley, Benjamin Bray, Brenda Gannon, and Sarah F. Tyson. "Delivery, dose, outcomes and resource use of stroke therapy: the SSNAPIEST observational study." Health Services and Delivery Research 8, no. 17 (March 2020): 1–114. http://dx.doi.org/10.3310/hsdr08170.
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Background Therapy is key to effective stroke care, but many patients receive little. Objectives To understand how stroke therapy is delivered in England, Wales and Northern Ireland, and which factors are associated with dose, outcome and resource use. Design Secondary analysis of the Sentinel Stroke National Audit Programme, using standard descriptive statistics and multilevel mixed-effects regression models, while adjusting for all known and measured confounders. Setting Stroke services in England, Wales and Northern Ireland. Participants A total of 94,905 adults admitted with stroke, who remained an inpatient for > 72 hours. Results Routes through stroke services were highly varied (> 800), but four common stroke pathways emerged. Seven distinct impairment-based patient subgroups were characterised. The average amount of therapy was very low. Modifiable factors associated with the average amount of inpatient therapy were type of stroke team, timely therapy assessments, staffing levels and model of therapy provision. More (of any type of) therapy was associated with shorter length of stay, less resource use and lower mortality. More occupational therapy, speech therapy and psychology were also associated with less disability and institutionalisation. Large amounts of physiotherapy were associated with greater disability and institutionalisation. Limitations Use of observational data does not infer causation. All efforts were made to adjust for all known and measured confounding factors but some may remain. We categorised participants using the National Institutes of Health Stroke Scale, which measures a limited number of impairments relatively crudely, so mild or rare impairments may have been missed. Conclusions Stroke patients receive very little therapy. Modifiable organisational factors associated with greater amounts of therapy were identified, and positive associations between amount of therapy and outcome were confirmed. The reason for the unexpected associations between large amounts of physiotherapy, disability and institutionalisation is unknown. Prospective work is urgently needed to investigate further. Future work needs to investigate (1) prospectively, the association between physiotherapy and outcome; (2) the optimal amount of therapy to provide for different patient groups; (3) the most effective way of organising stroke therapy/rehabilitation services, including service configuration, staffing levels and working hours; and (4) how to reduce unexplained variation in resource use. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 17. See the NIHR Journals Library website for further project information.
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Gibbs, John L., James L. Monro, David Cunningham, and Anthony Rickards. "Survival after surgery or therapeutic catheterisation for congenital heart disease in children in the United Kingdom: analysis of the central cardiac audit database for 2000-1." BMJ 328, no. 7440 (February 24, 2004): 611. http://dx.doi.org/10.1136/bmj.38027.613403.f6.
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AbstractObjectives To analyse simple national statistics and survival data collected in the central cardiac audit database after treatment for congenital heart disease and to provide long term comparative statistics for each contributing centre.Design Prospective, longitudinal, observational, national cohort survival study.Setting UK central cardiac audit database.Main outcome measures Survival at 30 days and one year after treatment in the year April 2000-March 2001, assessed by using both volunteered life status and independently validated life status through the Office for National Statistics, using the patient's unique NHS number, or the general register offices of Scotland and Northern Ireland. Institutional results following a group of six benchmark operations and three benchmark catheterisation procedures.Results Since April 2000 data have been received from all 13 UK tertiary centres performing cardiac surgery or therapeutic cardiac catheterisation in children with congenital heart disease. Altogether 3666 surgical procedures and 1828 therapeutic catheterisations were performed. Central tracking of mortality identified 469 deaths, 194 occurring within 30 days and 275 later. Forty two of the 194 deaths within 30 days were detected by central tracking but not by volunteered data. For surgery overall, survival at 30 days was 94.9%, falling to 91.2% at one year; this effect was most marked for infants. For therapeutic catheterisation survival at 30 days was 99.1%, falling to 98.1% at one year. Survival of individual centres or individual operators did not differ from the national average after benchmark procedures.Conclusions Independent data validation is essential for accurate survival analysis. One year survival gives a more realistic view of outcome than traditional perioperative mortality. Currently no detectable difference exists in survival between any of the 13 UK tertiary congenital heart disease centres, but confidence intervals for small centres are wide, limiting our power to detect underperformance from analysis of a single year's data. Appropriately resourced, focused national audit is capable of accurate data collection on which nationwide, long term quality control can be based.
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Kesten, Joanna May, Carrie Flannagan, Eimear Ruane-McAteer, Samuel William David Merriel, Tom Nadarzynski, Gilla Shapiro, Zeev Rosberger, and Gillian Prue. "Mixed-methods study in England and Northern Ireland to understand young men who have sex with men’s knowledge and attitudes towards human papillomavirus vaccination." BMJ Open 9, no. 5 (May 2019): e025070. http://dx.doi.org/10.1136/bmjopen-2018-025070.
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ObjectivesMen who have sex with men (MSM) are at greater risk for human papillomavirus (HPV)-associated cancers. Since 2016, MSM have been offered the HPV vaccination, which is most effective when received prior to sexual debut, at genitourinary medicine clinics in the UK. In September 2019, the national HPV vaccination programme will be extended to boys. This study aimed to understand young MSM’s (YMSM) knowledge and attitudes towards HPV vaccination.DesignQuestionnaires assessed YMSM demographics, sexual behaviour, culture, knowledge and attitudes towards HPV vaccination and stage of vaccine decision-making using the precaution adoption process model. Focus groups explored sexual health information sources, attitudes, barriers and facilitators to vaccination and strategies to support vaccination uptake. Questionnaire data were analysed using descriptive statistics and focus group data were analysed thematically.SettingQuestionnaires were completed online or on paper. Focus groups were conducted within Lesbian Gay Bisexual Transgender Queer organisational settings and a university student’s union in England and Northern Ireland.ParticipantsSeventeen YMSM (M=20.5 years) participated in four focus groups and 51 (M=21.1 years) completed questionnaires.ResultsOver half of YMSM were aware of HPV (54.9%), yet few (21.6%) had previously discussed vaccination with a healthcare professional (HCP). Thematic analyses found YMSM were willing to receive the HPV vaccine. Vaccination programmes requiring YMSM to request the vaccine, particularly prior to sexual orientation disclosure to family and friends, were viewed as unfeasible. Educational campaigns explaining vaccine benefits were indicated as a way to encourage uptake.ConclusionsThis study suggests that to effectively implement HPV vaccination for YMSM, this population requires clearer information and greater discussion with their HCP. In support of the decision made by the Joint Committee on Vaccination and Immunisation, universal vaccination is the most feasible and equitable option. However, the absence of a catch-up programme will leave a significant number of YMSM at risk of HPV infection.
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Henderson, P., and L. Dobson. "DOP50 PINPOINT: The epidemiology of paediatric-onset Inflammatory Bowel Disease in the United Kingdom – a prospective, national, cohort study." Journal of Crohn's and Colitis 18, Supplement_1 (January 1, 2024): i163. http://dx.doi.org/10.1093/ecco-jcc/jjad212.0090.
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Abstract Background Paediatric inflammatory bowel disease (PIBD) incidence and prevalence is increasing worldwide. Robust epidemiology can inform new aetiological hypothesis, inform healthcare provision and improve patient outcomes. The last prospective United Kingdom (UK) PIBD incidence study was performed in 1999 (5.2/100,000/yr); we aimed to update this incidence data and to provide a robust prevalence figure for PIBD prospectively across the UK. Methods Robust site selection identified all units in the UK providing endoscopy services for paediatric patients. Patients were included if they were diagnosed with Crohn’s disease (CD), ulcerative colitis (UC) or IBD-unclassified (IBD-U) less than 16yrs of age while a permanent UK resident. A custom-built spreadsheet was used to record basic demographics prospectively from June 2021 – December 2022 (18 months). A point prevalence study on 28th February 2023 was also performed capturing all patients under 16yrs of age living in the UK. A subset of patients was approached to provide consent for future clinical note review, data linkage and future contact (the PINPOINT cohort). Multiple data points were triangulated to avoid duplicate records. Data was securely collated electronically by the IBD Registry (www.ibdregistry.org.uk) and basic descriptive statistics performed in R v4.1.3. Publicly available population data was used to calculate rates. Results All 34 selected sites prospectively recorded cases; all were diagnosed by ileocolonoscopy. During the study 2,243 new diagnoses were recorded (1,050 patients [47%] also consented to join the PINPOINT cohort). UK PIBD incidence was 12.1/100,000/yr (England/Wales 11.7/100,000/yr, Northern Ireland 12.7/100,000/yr, Scotland 17.2/1000,000/yr). CD (56%) was more prevalent than UC (33%) and IBDU (11%). Median age at diagnosis was 12.9yrs (IQR 10.6-14.5). There was a male preponderance (62%) with CD, IBDU and UC having male to female ratios of 1.8, 1.7 and 1.4 respectively. With regard to ethnicity 72% of patients identified as white; those of other ethnicities were diagnosed younger (12.1yrs vs 13.0yrs; p<0.001) and had a higher incidence of UC (38.5% vs 30.3%; p=0.003). Regarding prevalence, 6,116 patients aged less than 16 years were identified as living with IBD on 28th February 2023 giving a UK prevalence of 49.6/100,000 (England/Wales 48.7/100,000, Northern Ireland 53.3/100,000, Scotland 58.6/1000,000). Conclusion There has been over a two-fold rise in PIBD incidence across all regions of the UK since 1999 with the first accurate prevalence figure mirroring this rise. Further detailed analysis of epidemiological trends using these data and the PINPOINT cohort are merited to drive improved care for this growing group of patients with high healthcare needs.
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Kingston, Mark, Rhiannon Griffiths, Hayley Hutchings, Alison Porter, Ian Russell, and Helen Snooks. "Emergency admission risk stratification tools in UK primary care: a cross-sectional survey of availability and use." British Journal of General Practice 70, no. 699 (September 21, 2020): e740-e748. http://dx.doi.org/10.3399/bjgp20x712793.
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BackgroundStratifying patient populations by risk of adverse events was believed to support preventive care for those identified, but recent evidence does not support this. Emergency admission risk stratification (EARS) tools have been widely promoted in UK policy and GP contracts.AimTo describe availability and use of EARS tools across the UK, and identify factors perceived to influence implementation.Design and settingCross-sectional survey in UK.MethodOnline survey of 235 organisations responsible for UK primary care: 209 clinical commissioning groups (CCGs) in England; 14 health boards in Scotland; seven health boards in Wales; and five local commissioning groups (LCGs) in Northern Ireland. Analysis results are presented using descriptive statistics for closed questions and by theme for open questions.ResultsResponses were analysed from 171 (72.8%) organisations, of which 148 (86.5%) reported that risk tools were available in their areas. Organisations identified 39 different EARS tools in use. Promotion by NHS commissioners, involvement of clinical leaders, and engagement of practice managers were identified as the most important factors in encouraging use of tools by general practices. High staff workloads and information governance were identified as important barriers. Tools were most frequently used to identify individual patients, but also for service planning. Nearly 40% of areas using EARS tools reported introducing or realigning services as a result, but relatively few reported use for service evaluation.ConclusionEARS tools are widely available across the UK, although there is variation by region. There remains a need to align policy and practice with research evidence.
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McCormack, Brendan George, Paul F. Slater, Fiona Gilmour, Denise Edgar, Stefan Gschwenter, Sonyia McFadden, Ciara Hughes, Val Wilson, and Tanya McCance. "The development and structural validity testing of the Person-centred Practice Inventory–Care (PCPI-C)." PLOS ONE 19, no. 5 (May 10, 2024): e0303158. http://dx.doi.org/10.1371/journal.pone.0303158.
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Background Person-centred healthcare focuses on placing the beliefs and values of service users at the centre of decision-making and creating the context for practitioners to do this effectively. Measuring the outcomes arising from person-centred practices is complex and challenging and often adopts multiple perspectives and approaches. Few measurement frameworks are grounded in an explicit person-centred theoretical framework. Aims In the study reported in this paper, the aim was to develop a valid and reliable instrument to measure the experience of person-centred care by service users (patients)–The Person-centred Practice Inventory-Care (PCPI-C). Methods Based on the ‘person-centred processes’ construct of an established Person-centred Practice Framework (PCPF), a service user instrument was developed to complement existing instruments informed by the same theoretical framework–the PCPF. An exploratory sequential mixed methods design was used to construct and test the instrument, working with international partners and service users in Scotland, Northern Ireland, Australia and Austria. A three-phase approach was adopted to the development and testing of the PCPI-C: Phase 1 –Item Selection: following an iterative process a list of 20 items were agreed upon by the research team for use in phase 2 of the project; Phase 2 –Instrument Development and Refinement: Development of the PCPI-C was undertaken through two stages. Stage 1 involved three sequential rounds of data collection using focus groups in Scotland, Australia and Northern Ireland; Stage 2 involved distributing the instrument to members of a global community of practice for person-centred practice for review and feedback, as well as refinement and translation through one: one interviews in Austria. Phase 3: Testing Structural Validity of the PCPI-C: A sample of 452 participants participated in this phase of the study. Service users participating in existing cancer research in the UK, Malta, Poland and Portugal, as well as care homes research in Austria completed the draft PCPI-C. Data were collected over a 14month period (January 2021-March 2022). Descriptive and measures of dispersion statistics were generated for all items to help inform subsequent analysis. Confirmatory factor analysis was conducted using maximum likelihood robust extraction testing of the 5-factor model of the PCPI-C. Results The testing of the PCPI-C resulted in a final 18 item instrument. The results demonstrate that the PCPI-C is a psychometrically sound instrument, supporting a five-factor model that examines the service user’s perspective of what constitutes person-centred care. Conclusion and implications This new instrument is generic in nature and so can be used to evaluate how person-centredness is perceived by service users in different healthcare contexts and at different levels of an organisation. Thus, it brings a service user perspective to an organisation-wide evaluation framework.
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Mohammad, Hasan R., Andrew Judge, and David W. Murray. "A matched comparison of cementless unicompartmental and total knee replacement outcomes based on the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man." Acta Orthopaedica 93 (May 24, 2022): 478–87. http://dx.doi.org/10.2340/17453674.2022.2743.
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Background and purpose: The main treatments for severe medial compartment knee arthritis are unicompartmental (UKR) and total knee replacement (TKR). UKRs have higher revision rates, particularly for aseptic loosening, therefore the cementless version was introduced. We compared the outcomes of matched cementless UKRs and TKRs.Patients and methods: The National Joint Registry was linked to the English Hospital Episode Statistics and Patient Reported Outcome Measures (PROMs) databases. 10,552 cementless UKRs and 10,552 TKRs were propensity matched and regression analysis used to compare revision/reoperation risks. 6-month PROMs were compared. UKR results were stratified by surgeon caseload into low- (< 10 UKRs/year), medium- (10 to < 30 UKRs/year), and high-volume (≥ 30 UKRs/year).Results: 8-year cementless UKR revision survival for the 3 respective caseloads were 90% (95% CI 87–93), 93% (CI 91–95), and 96% (CI 94–97). 8-year reoperation survivals were 76% (CI 71–80), 81% (CI 78–85), and 84% (CI 82–86) respectively. For TKR the 8-year implant survivals for revision and reoperation were 96% (CI 95–97) and 81% (CI 80–83). The HRs for the 3 caseload groups compared with TKR for revision were 2.0 (CI 1.3–2.9), 2.0 (CI 1.6–2.7), and 1.0 (CI 0.8–1.3) and for reoperation were 1.2 (CI 1.0–1.4), 0.9 (CI 0.8–1.0), and 0.6 (CI 0.5–0.7). 6-month Oxford Knee Score (OKS) (39 vs. 37) and EQ-5D (0.80 vs. 0.77) were higher (p < 0.001) for the cementless UKR.Interpretation: Cementless UKRs have higher revision and reoperation rates than TKR for low-volume UKR surgeons, similar reoperation but higher revision rates for mid-volume surgeons, and lower reoperation and similar revision rates for high-volume surgeons. Cementless UKR also had better PROMs.
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Westerlund, Caroline, Carol Tishelman, Inger Benkel, Carl Johan Fürst, Ulla Molander, Birgit H. Rasmussen, Sylvia Sauter, and Olav Lindqvist. "Public awareness of palliative care in Sweden." Scandinavian Journal of Public Health 46, no. 4 (January 4, 2018): 478–87. http://dx.doi.org/10.1177/1403494817751329.
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Objective: The aim of this study was to investigate the awareness of palliative care (PC) in a general Swedish population. Design: We developed an e-survey based on a similar study conducted in Northern Ireland, consisting of 10 questions. Closed questions were primarily analyzed using descriptive statistics. Open questions were subject to inductive qualitative analysis. Subjects: The study utilized a population sample of 7684 persons aged 18–66, of which 2020 responded, stratified by gender, age and region. Results: Most participants reported ‘no’ ( n = 827, 41%) or ‘some’ ( n = 863, 43%) awareness of PC. Being female or older were associated with higher levels of awareness, as was a university-level education, working in a healthcare setting and having a friend or family member receiving PC. Most common sources of knowledge were the media, close friends and relatives receiving PC, as well as working in a healthcare setting. Aims of PC were most frequently identified as ‘care before death’, ‘pain relief’, ‘dignity’ and a ‘peaceful death’. The preferred place of care and death was one’s own home. The main barriers to raising awareness about PC were fear, shame and taboo, along with perceived lack of information and/or personal relevance. The term ‘palliative care’ was said to be unfamiliar by many. A number of strategies to enhance awareness and access to PC were suggested, largely reflecting the previously identified barriers. Conclusions: This survey found limited awareness of palliative care in an adult sample of the Swedish general public ≤ 66 years, and points to a more widespread disempowerment surrounding end-of-life issues.