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To assess community mental health in suburban Dublin in 2018, 5 years after Ireland’s economic recession ended.
A cross-sectional, face-to-face, household survey was conducted in a random cluster sample of 351 households in Tallaght, a deprived suburb of Dublin.
A majority of respondents (61.3%) reported stress over the previous 12 months, with a higher rate in areas of high (66.9%) compared to lower deprivation (55.5%). Deprivation was not related to rates of loneliness (20.2%), feeling depressed (20.2%), loss of interest (19.7%) or anxiety (22.5%). Mean score for positive mental health (59.3/100, with a higher score indicating better mental health) was lower than that reported in a national sample in 2007 (68/100); positive mental health was associated with not living with a person with chronic illness, self-identifying as ‘non-Irish’ and greater age. Mean score for psychological distress (76.7/100, with a higher score indicating less distress) was also lower than that in 2007 (82/100); less psychological distress was associated with not living with a person with chronic illness or disability, greater age and identifying as non-Irish. The rate of ‘probable mental illness’ over the previous 4 weeks (13.1%) was higher than in 2007 (7%).
Our findings emphasise the high prevalence of stress, especially in deprived suburban areas; the centrality of carer burden in determining mental wellbeing; and associations between positive mental health on the one hand and greater age and identifying as non-Irish on the other.
To date, Ireland has been a leading light in the provision of youth mental health services. However, cognisant of the efforts of governmental and non-governmental agencies working in youth mental health, there is much to be done. Barriers into care as well as discontinuity of care across the spectrum of services remain key challenges. This editorial provides guidance for the next stage of development in youth mental care and support that will require significant national engagement and resource investment.
Brucellosis is usually acquired by humans through contact with infected animals or the consumption of raw milk from infected ruminants. Brucella suis biovar 2 (BSB2) is mainly encountered in hares and wild boars (Sus scrofa), and is known to have very low pathogenicity to humans with only two case reports published in the literature. Human cases of brucellosis caused by BSB2 were identified through the national mandatory notification of brucellosis. The identification of the bacterium species and biovar were confirmed by the national reference laboratory. Epidemiological data were obtained during medical follow-up visits. Seven human cases were identified between 2004 and 2016, all confirmed by the isolation of BSB2 in clinical specimens. All patients had direct contact with wild boars while hunting or preparing wild boar meat for consumption. Five patients had chronic medical conditions possibly responsible for an increased risk of infection. Our findings suggest that BSB2 might be an emerging pathogen in hunters with massive exposure through the dressing of wild boar carcasses. Hunters, especially those with chronic medical conditions, should be informed about the risk of BSB2 infection and should receive information on protective measures.
Technological innovation has been pervasive and has touched almost every aspect of modern life, including the delivery of behavioural and mental heath care. As telehealth expands, internet interventions are particularly interesting as a medium of delivering effective care. However, standards are required to help inform healthcare policy makers, providers, clinicians and patients.
Move towards outlining a gold standard for internet-delivered behavioural and mental health interventions.
Contribute and build upon existing standards and guidelines for the practice of telehealth, but to now extend these to include internet-delivered interventions.
Drawing from research, experience and practice, the authors propose a matrix for the evaluation of what might be considered a gold standard for internet-delivered behavioural and mental health interventions.
Seven elements are proposed and considered aspects of what would constitute a gold standard and they include, the use of evidence-based and empirically supported content, robust, engaging, secure and responsive technologies, shaped by behavioural health subject matter experts, employ user-centred design and development principles, have a focus on accountable care-achieving clinical outcomes, have research and evaluation that supports its effectiveness, and a well developed implementation science and support.
The paper proposes some characteristics that could compose a gold standard for internet-delivered interventions for behavioural and mental health care. The contribution is neither exhaustive nor conclusive, but offers an invitation to the discussion.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Human milk oligosaccharides (HMO) have been shown to interact directly with immune cells. However, large quantities of HMO are required for intervention or clinical studies, but these are unavailable in most cases. In this respect, bovine milk is potentially an excellent source of commercially viable analogues of these unique molecules. In the present study, we compared the transcriptional response of colonic epithelial cells (HT-29) to the entire pool of HMO and bovine colostrum oligosaccharides (BCO) to determine whether the oligosaccharides from bovine milk had effects on gene expression that were similar to those of their human counterparts. Gene set enrichment analysis of the transcriptional data revealed that there were a number of similar biological processes that may be influenced by both treatments including a response to stimulus, signalling, locomotion, and multicellular, developmental and immune system processes. For a more detailed insight into the effects of milk oligosaccharides, the effect on the expression of immune system-associated glycogenes was chosen as a case study when performing validation studies. Glycogenes in the current context are genes that are directly or indirectly regulated in the presence of glycans and/or glycoconjugates. RT-PCR analysis revealed that HMO and BCO influenced the expression of cytokines (IL-1β, IL-8, colony-stimulating factor 2 (granulocyte–macrophage) (GM-CSF2), IL-17C and platelet factor 4 (PF4)), chemokines (chemokine (C–X–C motif) ligand 1 (CXCL1), chemokine (C–X–C motif) ligand 3 (CXCL3), chemokine (C–C motif) ligand 20 (CCL20), chemokine (C–X–C motif) ligand 2 (CXCL2), chemokine (C–X–C motif) ligand 6 (CXCL6), chemokine (C–C motif) ligand 5 (CCL5), chemokine (C–X3–C motif) ligand 1 (CX3CL1) and CXCL2) and cell surface receptors (interferon γ receptor 1 (IFNGR1), intercellular adhesion molecule-1 (ICAM-1), intercellular adhesion molecule-2 (ICAM-2) and IL-10 receptor α (IL10RA)). The present study suggests that milk oligosaccharides contribute to the development and maturation of the intestinal immune response and that bovine milk may be an attractive commercially viable source of oligosaccharides for such applications.
The boundaries of psychotic illness and the extent to which operational diagnostic categories are distinct in the long term remain poorly understood. Clarification of these issues requires prospective evaluation of diagnostic trajectory, interplay and convergence/divergence across psychotic illness, without a priori diagnostic or other restrictions.
The Cavan-Monaghan First Episode Psychosis Study (CAMFEPS), conducted using methods to attain the closest approximation to epidemiological completeness, incepts all 12 DSM-IV psychotic diagnoses. In this study we applied methodologies to achieve diagnostic reassessments on follow-up, at a mean of 6.4 years after first presentation, for 196 (97%) of the first 202 cases, with quantification of prospective and retrospective consistency.
Over 6 years, the 12 initial psychotic diagnoses were characterized by numerous transitions but only limited convergence towards a smaller number of more stable diagnostic nodes. In particular, for initial brief psychotic disorder (BrP), in 85% of cases this was the harbinger of long-term evolution to serious psychotic illness of diagnostic diversity; for initial major depressive disorder with psychotic features (MDDP), in 18% of cases this was associated with mortality of diverse causality; and for initial psychotic disorder not otherwise specified (PNOS), 31% of cases continued to defy DSM-IV criteria.
CAMFEPS methodology revealed, on an individual case basis, a diversity of stabilities in, and transitions between, all 12 DSM-IV psychotic diagnoses over 6 years; thus, psychotic illness showed longitudinal disrespect to current nosology and may be better accommodated by a dimensional model. In particular, a first episode of BrP or MDDP may benefit from more vigorous, sustained interventions.
Modification of behaviour in response to changes in the environment or ambient
conditions, based on memory, is typical of the human and, possibly, many animal
species.One obvious example of such adaptivity is, for instance, switching to a safer
behaviour when in danger, from either a predator or an infectious disease. In human
society such switching to safe behaviour is particularly apparent during epidemics.
Mathematically, such changes of behaviour in response to changes in the ambient conditions
can be described by models involving switching. In most cases, this switching is assumed
to depend on the system state, and thus it disregards the history and, therefore, memory.
Memory can be introduced into a mathematical model using a phenomenon known as hysteresis.
We illustrate this idea using a simple SIR compartmental model that is applicable in
epidemiology. Our goal is to show why and how hysteresis can arise in such a model, and
how it may be applied to describe a variety of memory effects. Our other objective is to
introduce a unified paradigm for mathematical modelling with memory effects in
epidemiology and ecology. Our approach treats changing behaviour as an irreversible flow
related to large ensembles of elementary exchange operations that recently has been
successfully applied in a number of other areas, such as terrestrial hydrology, and
macroeconomics. For the purposes of illustrating these ideas in an application to biology,
we consider a rather simple case study and develop a model from first principles. We
accompany the model with extensive numerical simulations which exhibit interesting
This paper uses meta-analysis of published data and a deterministic mathematical model of hepatitis B virus (HBV) transmission to describe the patterns of HBV infection in high endemicity areas. We describe the association between the prevalence of carriers and a simple measure of the rate of infection, the age at which half the population have been infected (A50), and assess the contribution of horizontal and perinatal transmission to this association. We found that the two main hyper-endemic areas of sub-Saharan Africa and east Asia have similar prevalences of carriers and values of A50, and that there is a negative nonlinear relationship between A50 and the prevalence of carriers in high endemicity areas (Spearman's Rank, P = 0·0086). We quantified the risk of perinatal transmission and the age-dependent rate of infection to allow a comparison between the main hyper-endemic areas. East Asia was found to have higher prevalences of HBeAg positive mothers and a greater risk of perinatal transmission from HBeAg positive mothers than sub-Saharan Africa, though the differences were not statistically significant. However, the two areas have similar magnitudes and age-dependent rates of horizontal transmission. Results of a simple compartmental model suggest that similar rates of horizontal transmission are sufficient to generate the similar patterns between A50 and the prevalences of carriers. Interrupting horizontal transmission by mass immunization is expected to have a significant, nonlinear impact on the rate of acquisition of new carriers.
Various forms of containerised gas killing systems have been used to slaughter large numbers of poultry on farms during outbreaks of notifiable diseases. However, none of the systems have been fully evaluated to assess bird welfare, operators’ health and safety and biosecurity during operation. In addition, standard operating procedures associated with containerised gas killing systems are lacking in the literature. Therefore, a research and development project was initiated by the Department for Environment, Food and Rural Affairs (DEFRA) in the UK with the primary objective being to develop humane systems for culling poultry on farm and to produce operating procedures based on sound scientific principles. A series of studies have been conducted to achieve the objective and relevant observations and operating procedures are reviewed in this paper.
Fitness of tick-borne pathogens may be determined by the degree to which their infection dynamics in vertebrate hosts permits transmission cycles if infective and uninfected tick stages are active at different times of the year. To investigate this hypothesis we developed a simulation model that integrates the transmission pattern imposed by seasonally asynchronous nymphal and larval Ixodes scapularis ticks in northeastern North America, with a model of infection in white-footed mice (Peromyscus leucopus) reservoir hosts, using the bacteria Borrelia burgdorferi and Anaplasma phagocytophilum as examples. In simulations, survival of microparasites, their sensitivity to reduced rodent and tick abundance, and to ‘dilution’ by a reservoir-incompetent host depended on traits that allowed (i) highly efficient transmission from acutely-infected hosts, (ii) long-lived acute or ‘carrier’ host infections, and/or (iii) transmission amongst co-feeding ticks. Minimum values for transmission efficiency to ticks, and duration of host infectivity, necessary for microparasite persistence, were always higher when nymphal and larval ticks were seasonally asynchronous than when these instars were synchronous. Thus, traits influencing duration of host infectivity, transmission efficiency to ticks and co-feeding transmission are likely to be dominant determinants of fitness in I. scapularis-borne microparasites in northeastern North America due to abiotic forcings influencing I. scapularis seasonality.
Background and objective: Prospective longitudinal studies now indicate that cognitive dysfunction following coronary artery bypass surgery (CABG) is both common and persistent. This dysfunction is due in part to the inflammatory response and cerebral ischaemia–reperfusion, with nitric oxide (NO) as an important mediator of both. We hypothesized that a clinically significant association exists between plasma concentrations of nitrate/nitrite (NO3−/NO2−) and cognitive dysfunction after CABG.
Methods: Cognitive assessment was performed on 36 adult patients the day before CABG, on the fourth postoperative day and 3 months postoperatively. Patient spouses (n = 10) were also studied.
Results: A new cognitive deficit was present in 22/36 (62%) 4 days postoperatively and in 16/35 (49%) of patients, 3 months postoperatively. Patients who had cognitive dysfunction 3 months postoperatively were more likely to have cognitive dysfunction and increased plasma NO3−/NO2− concentrations compared to the non-deficit group preoperatively (22.6 (9.2) vs. 27.6 (8.4)) (P = 0.002). Plasma NOx (NO3− plus NO2−) concentrations were greater in patients with cognitive dysfunction 3 months postoperatively, 2 h (24.2 (6.3) vs. 19.1 (5.2)) (P = 0.002), and 12 h postoperatively (24.8 (7.6) vs. 18.8 (5.6)) (P = 0.001). There was, however, a time course similarity in NOx elevations for both deficit and non-deficit groups.
Conclusions: Perioperative plasma NOx concentrations do not serve as an effective biomarker of cognitive deficit after CABG.
Mycotoxins are secondary metabolites produced by many phytopathogenic and food spoilage fungi including Penicillium, Fusarium and Aspergillus. The toxicity and carcinogenicity of many of these mycotoxins, and their potential to contaminate foods and animal feedstuffs is a cause of serious concern globally, both from a food safety and food trade standpoint. Thus the rapid identification of mycotoxigenic fungi would be desirable, such that early intervention steps could be applied to help limit the amounts of contaminated materials, particularly cereals and cereal-based products, gaining access to the human food chain. With this in mind a number of PCR-based methodologies have been developed for the identification of mycotoxin biosynthetic genes in different fungal genera, together with assays developed using other genes or random amplification of polymorphic DNA (RAPD) methodologies for the identification of specific toxigenic fungi. In addition, reverse transcription (RT)-PCR, competitive PCR and Real Time quantitative PCR methodologies have also been developed for this purpose. The development of each of these techniques, their usefulness, limitations and adaptability will be discussed together with descriptions of specific examples where these techniques have been utilised in different experimental settings.
We describe the case of a 30 year old Chinese woman who presented to an Irish psychiatric service with a five-month history of somatic delusions, auditory hallucinations and denial of lineage. We utilise this case to illustrate the significant cultural influences on psychopathology. We discuss the increasingly frequent diagnostic and therapeutic challenges presented by migrants with mental illness.
The effects of a dietary supplement with calcium salts of fatty acids and methionine hydroxy analogue on reproductive performance, blood metabolites, milk production, milk composition, body weight and body condition score was studied in lactating dairy cows. Autumn-calving, Holstein-Friesian cows (no. = 162) were assigned 1 week post calving to one of two diets: (1) unsupplemented maize-silage-based complete diet while housed before turn-out to perennial ryegrass pasture and (2) the same diet with 400 g per cow per day of a supplement with calcium salts of long-chain fatty acids and methionine hydroxy analogue (Megalac Plus, Volac Ltd). Eleven cows were removed from the study following randomization for reasons not related to the experiment leaving 151 cows on dietary treatments. The diets were offered until the end of the 18-week breeding period. Cows receiving supplement had higher milk yield and milk lactose production and lower milk protein and milk fat proportion (P < 0·05). Body weight and body condition scores were not different between treatments in the first 20 weeks of lactation (P > 0·05). Overall reproductive performance was not different between dietary treatments (P > 0·05). However, first lactation animals (no. = 33) receiving the dietary lipid and methionine supplement tended to have increased conception rates to first and second service (P < 0·09) which resulted in a shorter calving-to-conception interval in those animals (P < 0·06). Services per conception (P < 0·08), services per cow served (P < 0·05) and services per conception for pregnant cows (P < 0·05) in first lactation animals was reduced in the supplemented group. Although plasma cholesterol concentrations were increased following lipid and methionine supplementation (P < 0·01), plasma progesterone concentrations on day 5 and day 8 after artificial insemination were not different between dietary treatments (P > 0·05). In conclusion, a dietary supplement of calcium salts of fatty acids and methionine hydroxy analogue increased milk yield, milk lactose production and blood cholesterol concentration but did not improve reproductive performance, except in first lactation cows.
Based on their pedigree indices for milk production traits, 48 high (HM) and 48 medium (MM) genetic merit cows were studied in each of two years to determine the possible relationships between genetic merit, milk production, body condition, metabolite and hormone concentrations, feed intake and reproductive performance. The high genetic merit cows had higher milk production, greater body condition loss between calving and first service, lower plasma glucose and insulin-like growth factor-1 (IGF-1) and lower first and second service conception rates than the medium genetic merit cows. Furthermore, more high genetic merit cows were not pregnant at the end of the breeding period compared with medium genetic merit cows. Cows that did not conceive to first service were retrospectively compared to those that conceived to first service within each genetic merit category. Within the high and medium genetic merit category there were no significant differences between the cows that did not conceive and those that conceived to first service in terms of milk production, or plasma concentrations of glucose, non-esterified fatty acids (NEFA). Although medium genetic merit cows that did not conceive to first service lost more body condition score between calving and first service than those that conceived to first service, there was no difference in body condition score (BCS) change between calving and first service between high genetic merit cows that did not conceive and those that conceived to first service. In the present study, high genetic merit cows had higher milk production and reduced reproductive performance in comparison with medium genetic merit cows. However, reproductive performance was not associated with milk production, energy balance or plasma concentrations of glucose, NEFA or IGF-1 between calving and insemination
Plasma urea concentrations have been used as a diagnostic tool in the investigation of reproductive performance in cattle. Data were compiled from three recent studies on bovine fertility and a retrospective comparison of plasma urea concentrations was made between those animals that conceived to an insemination or embryo transfer. In studies I and 2 plasma urea concentrations around the time of insemination were determined. Pregnancies were diagnosed using ultrasonography 35 days later. There was no significant difference between the mean plasma urea concentrations around the time of insemination in the cattle subsequently diagnosed pregnant or not pregnant. In study 3, in vitro produced good quality embryos were transferred into three groups of beef heifers. The three groups were allocated to diets of high energy / high urea, high energy / no urea and low energy / high urea. The plasma urea concentrations at the time of embryo transfer were different between the three groups. However, the pregnancy rates 28 days post transfer, were not significantly different between the three groups. This suggests that the previously reported effects of high protein diets on fertility are not solely due to disruptive effects on the uterine environment. The main effect of urea on fertility may be on oocyte development within the follicle. Overall, these results indicate that measurement of plasma urea concentrations in individual animals around the time of insemination or embryo transfer is not a useful predictor of subsequent pregnancy rate.
The reduced fertility that is becoming more evident in high yielding dairy cows may be related to many factors including changes in milk production, food intake and fluctuations in body condition. Metabolic and production markers have been studied as a way of predicting success to a particular artificial insemination. Successful conception to a particular service was not associated with milk production, body condition or plasma concentrations of several indicators of metabolic state around the time if insemination. This highlights the importance of time of information collection in fertility management programmes. Increased food intake may reduce systemic progesterone concentrations. This is more evident in sheep than cattle, but a positive relationship between systemic progesterone early post mating and establishment of pregnancy in cattle has been reported. However, progesterone concentrations in the ovarian vein and endometrium are not strongly correlated with systemic progesterone. Thus, the significance of modest changes in systemic progesterone in affecting oocyte and embryo development must be questioned. Blood urea concentrations can be altered by diet, and reduced pregnancy rates have been reported in cows with high urea concentrations. However, in other recent studies, no difference was reported in serum urea in cows that conceived and those that failed to conceive. Pregnancy rate was equally high in heifers when in-vitro produced embryos were transferred to heifers on high and low urea diets. When embryos were produced in sheep on high and low dietary urea, the effects on embryo development appear to occur early in the developmental process, suggesting a substantial effect on the development of the oocyte. The developmental capacity of oocytes and quality of embryos is reduced in cattle maintained on extremely high dietary intakes. Oocyte developmental capacity is reduced in cows of higher genetic merit and embryo quality can be substantially reduced in the early postpartum period. Collectively, these results suggest that high dietary intake or high metabolic load is deleterious to normal oocyte development and establishment of pregnancy. This highlights the importance of further studies on the effect of dietary intake on metabolic state and follicle, oocyte and embryo development. In a practical context, these results highlight the importance of nutritional management and avoiding changes in the amount or type of diet around the time of mating in high-production dairy cows.
A prospective cohort study was conducted in five purposively-sampled agro-ecological zone
(AEZ)-grazing system strata in Murang’a District, Kenya, between March 1995 and June 1996.
The study strata were selected based on a preliminary characterization study to represent the
widest range of risks to East Coast fever (ECF) in the District and included zero-grazing and
open-grazing farms. In total, 225 calves from 188 smallholder farms were examined from birth
to 6 months of age and visited within the first 2 weeks of life and thereafter at bi-weekly
intervals for up to 14 visits.
The purpose of the study was to characterize the differences in epidemiology (risks of
infection, morbidity and mortality) and potential control of ECF between the selected strata.
Evidence of Theileria parva infection was assessed by increased antibody levels as measured in
an indirect ELISA assay by the percent positivity (PP) of serum samples relative to a strong
positive reference serum.
Sero-conversion risks of T. parva were highest in the open-grazing strata. Antibody
prevalence in adult cattle and ECF morbidity and mortality risks were also highest in open-grazing strata. While different, all five AEZ-grazing strata were considered to be endemically
unstable for ECF. East Coast fever challenge was low in all zero-grazing strata and this
challenge is likely to remain low due to continuing intensification of smallholder farming in the
central highlands. In the open-grazing strata, there was higher challenge and a greater impact