TY - JOUR T1 - Prevalence and predictors of periconceptional folic acid uptake--prospective cohort study in an Irish urban obstetric population JF - Hum Reprod Y1 - 2010 A1 - McGuire, M A1 - Cleary, B A1 - Sahm, L A1 - Murphy, Deirdre J KW - Adult KW - Cohort Studies KW - Female KW - Folic Acid KW - Humans KW - Ireland KW - Neural Tube Defects KW - Pregnancy KW - Prevalence KW - Socioeconomic Factors KW - Urban Health KW - Urban Population AB - BACKGROUND: Neural tube defects (NTDs) are severe abnormalities of the central nervous system that occur as a result of abnormal development in the third and fourth weeks of gestation. Studies have shown that periconceptional folic acid (FA) can reduce both the incidence and recurrence of NTDs. METHODS: A cohort study was carried out using the electronic hospital booking records of women delivering in a large Dublin maternity hospital between 2000 and 2007. Logistic regression analyses were performed to measure the associations between maternal factors and optimal FA use. RESULTS: Of the 61,252 women in the cohort, 85% reported taking FA at some point during the periconceptional period; however, only 28% took FA as recommended. Factors associated with taking the recommended amount of FA included nulliparity [adjusted OR: 1.35 (95% CI: 1.28-1.43)], early booking (<12 weeks) [OR: 1.24 (95% CI: 1.17-1.31)], increasing maternal age (e.g. 30-34 years) [OR: 1.39 (95% CI: 1.30-1.48)], private health care [OR: 4.32 (95% CI: 4.1-4.6)] and fertility treatment [OR: 2.88 (95% CI: 2.44-3.40)]. Factors associated with taking less than recommended or no FA included unplanned pregnancy [OR: 0.08 (0.07-0.08)], lower socio-economic status (e.g. unemployed) [OR: 0.63 (95% CI: 0.55-0.71)], non-Irish nationality [OR: 0.82 (0.74-0.90)] and smokers [OR: 0.51 (95% CI: 0.47-0.55)]. CONCLUSIONS: Social, demographic and economic factors have an important influence on the FA uptake. Vulnerable groups who report limited uptake of FA need to be specifically targeted in future Public Health campaigns and further consideration needs to be given to the debate on food fortification in countries where this is currently not available. VL - 25 UR - http://www.ncbi.nlm.nih.gov/pubmed/19910320 IS - 2 ER - TY - JOUR T1 - Prevalence and outcomes of use of potentially inappropriate medicines in older people: cohort study stratified by residence in nursing home or in the community JF - BMJ Qual Saf Y1 - 2011 A1 - Barnett, K A1 - McCowan, Colin A1 - Evans, J M M A1 - Gillespie, N D A1 - Davey, P G A1 - Fahey, T KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Drug Utilization KW - Female KW - Humans KW - Independent Living KW - Male KW - Medication Errors KW - Nursing Homes KW - Polypharmacy KW - Prescription Drugs KW - Prevalence KW - Scotland KW - Sex Factors AB - OBJECTIVES: To compare the prevalence of use of potentially inappropriate medicines (PIMs) between older patients living in their own homes versus those living in nursing or residential homes, and to test the association between exposure to PIMs and mortality. DESIGN: Cohort study stratified by place of residence. SETTING: Tayside, Scotland. PARTICIPANTS: All people aged between 66 and 99 years who were resident or died in Tayside from 2005 to 2006. MAIN OUTCOME MEASURES: The exposure variable was PIM use as defined by Beers' Criteria. All cause mortality was the main outcome measure. RESULTS: 70,299 people were enrolled in the cohort of whom 96% were exposed to any medicine and 31% received a PIM. Place of residence was not associated with overall risk of receiving PIMs, adjusted OR 0.94, 95% CI 0.87 to 1.01. Exposure to five of the PIMs (including long-acting benzodiazepines) was significantly higher in nursing homes whereas exposure to five other PIMs (including amitriptyline and NSAIDs) was significantly lower. Exposure to PIMs was similar (20-46%) across all 71 general practices in Tayside and was not associated with increased risk of mortality after adjustment for age, gender and polypharmacy (adjusted OR 0.98, 95% CI 0.92 to 1.05). CONCLUSIONS: The authors question the validity of the full list of PIMs as an indicator of safety of medicines in older people because one-third of the population is exposed with little practice variation and no significant impact on mortality. Future studies should focus on management of a shorter list of genuinely high-risk medicines. VL - 20 UR - http://qualitysafety.bmj.com/content/20/3/275.full IS - 3 ER - TY - JOUR T1 - Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women JF - Pharmacoepidemiol Drug Saf Y1 - 2010 A1 - Cleary, B A1 - Butt, Hajeera A1 - Strawbridge, Judith D A1 - Gallagher, Paul J A1 - Fahey, T A1 - Murphy, Deirdre J KW - Adult KW - Cohort Studies KW - Drug Utilization Review KW - Female KW - Fetal Development KW - Gestational Age KW - Humans KW - Pharmaceutical Preparations KW - Plant Preparations KW - Pregnancy KW - Pregnancy Complications KW - Prescription Drugs KW - Prevalence KW - Prospective Studies KW - Questionnaires KW - Street Drugs KW - United States KW - United States Food and Drug Administration KW - Young Adult AB - PURPOSE: To examine the extent, nature and determinants of medication use in early pregnancy. METHODS: We reviewed early pregnancy medication use, as reported to a midwife at the booking interview, in women delivering between 2000 and 2007 in a large maternity hospital in Dublin, Ireland (n = 61 252). RESULTS: Excluding folic acid, at least one medication was reported in 23 989 (39.2%) pregnancies. Over the counter (OTC) medications were reported in 11 970 (19.5%) pregnancies, illicit drugs or methadone in 545 (0.9%) and herbal medicines/supplements in 352 (0.58%). FDA category D and X medications were reported by 1532 (2.5%) and 1987 (3.2%) women. Asthma, depression and hypertension were among the most commonly reported chronic medical disorders. Medications with potential for foetal harm were reported by 86 (15.7%) women treated for depression and 68 (20%) women treated for hypertension. Factors associated with reporting the use of medications with potential for foetal harm included unplanned pregnancy (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 1.12-1.52), booking at less than 12 weeks gestation (aOR 1.83, 95%CI 1.58-2.13), being above 25 years of age, unemployed (aOR 2.58, 95%CI 2.03-3.29), nulliparous (aOR 1.41; 95%CI 1.22-1.63), single (aOR 1.28; 95%CI 1.06-1.54) or smoking during pregnancy (aOR 1.96, 95%CI 1.67-2.28). CONCLUSIONS: Women frequently report medication use in early pregnancy. Women and prescribers need to be aware of the lack of pregnancy safety data for many medications, and the need for pre-pregnancy planning. Prescribers should ensure that optimal medications are used when treating women of childbearing potential with chronic medical disorders. VL - 19 UR - http://onlinelibrary.wiley.com/doi/10.1002/pds.1906/abstract IS - 4 ER - TY - JOUR T1 - Hypertension prevalence, awareness, treatment and control in the over 50s in Ireland: evidence from The Irish Longitudinal Study on Ageing JF - Journal of Public Health Y1 - 2015 A1 - Murphy, C A1 - P. M. Kearney A1 - E.B. Shelley A1 - Fahey, T A1 - C. Dooley A1 - Kenny, RA KW - Adult KW - Aged KW - Awareness KW - Cross-Sectional Studies KW - Epidemiology KW - Hypertension KW - Ireland KW - Prevalence AB - Background To assess the prevalence, awareness, treatment and control of hypertension among adults in Ireland and to describe the determinants of awareness, treatment and control in order to inform public health policy. Methods A cross-sectional study of a nationally representative sample of community living adults aged 50 years and older using data collected from 2009 to 2011 for the first wave of the Irish Longitudinal Study on Ageing (TILDA) (n = 5857). Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg and/or currently taking antihypertensive medications. Results The prevalence of hypertension was 63.7% [95% confidence interval (CI) 62.3–65.1%]. Among those with hypertension, 54.5% (95% CI 52.6–56.2%) were aware of their hypertensive status and 58.9% (95% CI 57.1–60.4%) were on antihypertensive medication. Among those on treatment, 51.6% (95% CI 49.3–53.9%) had their BP controlled to below 140/90 mmHg. Respondents facing financial barriers to primary care and medication were less likely to be on antihypertensive treatment compared with those without financial barriers. Conclusions A high prevalence of hypertension was identified in this cohort, with low levels of awareness, treatment and control. Population and primary care interventions are required to reduce prevalence and to improve awareness, detection and management of hypertension. UR - http://jpubhealth.oxfordjournals.org/content/early/2015/04/27/pubmed.fdv057.full ER - TY - JOUR T1 - Chronic respiratory disease and multimorbidity: prevalence and impact in a general practice setting JF - Respir Med Y1 - 2011 A1 - O'Kelly, Siobhan A1 - Smith, SM A1 - Lane, S A1 - Teljeur, C A1 - O'Dowd, T KW - Adolescent KW - Adult KW - Aged KW - Chronic Disease KW - Comorbidity KW - Cross-Sectional Studies KW - Female KW - General Practice KW - Humans KW - Ireland KW - Lung Diseases KW - Male KW - Middle Aged KW - Prevalence KW - Socioeconomic Factors KW - Urban Health Services KW - Young Adult AB - BACKGROUND: Multimorbidity is defined as two or more co-existing chronic conditions in an individual and is common in general practice. It is associated with poorer outcomes for patients. This study aimed to establish the prevalence of multimorbidity in patients with chronic respiratory disease in general practice and to describe its impact on health service use. METHODS: Cross-sectional study based in general practice in Dublin. Drug and disease code searches were performed to identify adult patients with a diagnosis of chronic respiratory disease. Medical records were reviewed for chronic respiratory diagnosis, other chronic conditions, demographic characteristics, General Practitioner (GP) and practice nurse utilisation rates, and numbers of medications. RESULTS: In a general practice population of 16,946 patients 3.9% had chronic respiratory disease and 60% of these had one or more co-existing chronic condition(s). GP and practice nurse utilisation rates, and number of medications were significantly higher among those with multimorbidity compared with those with respiratory disease alone. Multivariate analysis showed that increasing age and low socio-economic status were significantly associated with multimorbidity. CONCLUSION: The majority of patients with chronic respiratory disease have multimorbidity. Clinical guidelines based on single disease entities and outcomes are not as easy to implement and may not be as effective in this group. VL - 105 UR - http://www.sciencedirect.com/science/article/pii/S0954611110003409 IS - 2 ER -