Anna Clarke

Cultural diversity in the Dublin maternity services: the experiences of maternity service providers when caring for ethnic minority women

Background. Ireland has seen an expansion of new migrant communities over the past decade and the country has struggled to cope with this new multi-culturalism, especially within the health services. The maternity services in particular have seen an increase in deliveries from ethnic minority women. Little research has been done exploring this issue with maternity service providers. Methods. Using a grounded theory approach, this study sought to explore the experiences, understanding and perspectives of maternity service providers when working with ethnic minority women in the Dublin maternity services during 2002 and 2003. Results. Four themes emerged from the study: Communication difficulties, knowledge and use of services, cultural differences and ‘Them and Us’. These encompassed a variety of issues including inadequacy of interpretation services, childcare issues, coping with labour, identification as different and racism. Ethnic minority women are expected to adapt to the system rather than the maternity services being responsive or adapting to the new multi-cultural population. Discussion. These issues were relevant a decade ago internationally and are still pertinent today for not only Irish services but also for other European countries. There is an opportunity to improve the services for all women by learning from the experience of Dublin maternity service providers.

Determinants of partial or no primary immunisations

Objective To determine if different factors affect children having full, partial or no primary immunisations. Methods This was a crossgenerational cohort study with linkage to primary care and hospital records conducted in urban and rural settings in Ireland, recruiting in 2001–2003 with 5-year follow-up. A total of 749 children with immunisation information took part. Results The uptake of reported primary immunisations was 92.8% full, 4.9% partial and 2.3% no primary immunisations. Adjusted relative risk ratios for children receiving no primary immunisations were significant for: having a mother who had ever visited an alternative practitioner 3.69 (1.05 to 12.9), a mother with means tested full general medical services eligibility 8.11 (1.58 to 41.65), a mother who scored <50 for the World Health Organization Quality of Life (WHO-QOL) scale psychological domain 8.82 (1.79 to 43.6) or living in the west of Ireland (rural) 3.64 (1.0 to 13.2). Being born prematurely was associated with partial primary immunisation, adjusted OR 4.63 (1.24 to 17.3). Conclusions Knowledge of these differences will help target campaigns to increase full uptake of primary immunisations.

Implementation of a campus-wide Irish hospital smoking ban in 2009: prevalence and attitudinal trends among staff and patients in lead up

We report the evidence base that supported the decision to implement the first campus-wide hospital smoking ban in the Republic of Ireland with effect from 1 January 2009. Three separate data sources are utilized; surveillance data collected from patients and staff in 8 surveys between 1997 and 2006, a 1-week observational study to assess smoker behaviour in designated smoking shelters and an attitudinal interview with 28 smoker patients and 30 staff on the implications of the 2004 indoors workplace smoking ban, conducted in 2005. The main outcome measures were trends in prevalence of smoking over time according to age, sex and occupational groups and attitudes to the 2004 ban and a projected outright campus ban. Smoking rates among patients remained steady, 24.2% in 1997/98 and 22.7% in 2006. Staff smoking rates declined from 27.4% to 17.8%, with a strong occupational gradient. Observational evidence suggested a majority of those using smoking shelters in 2005 were women and health-care workers rather than patients. Attitudes of patients and staff were positive towards the 2004 ban, but with some ambivalence on the effectiveness of current arrangements. Staff particularly were concerned with patient safety issues associated with smoking outdoors. The 2004 ban was supported by 87.6% of patients and 81.3% of staff in 2006 and a majority of 58.6% of patients and 52.4% of staff agreed with an outright campus ban being implemented. These findings were persuasive in instigating a process in 2007/08 to go totally smoke-free by 2009, the stages for which are discussed.

Socio-demographic and health-related predictors of uptake of first MMR immunisation in the Lifeways Cohort Study

The aim of this study was to investigate the uptake of the first dose of measles, mumps and rubella (MMR) vaccine and factors associated with not receiving this vaccine. A cross-generation cohort study was conducted with prospective linkage to primary care and hospital health records in urban and rural settings in Ireland 2001-2004. Seven hundred and forty-nine singleton children were included, with an MMR uptake of 88.7% by the age of 5 years. These data confirm prospectively for the first time that in addition to factors associated with disadvantage, other health practices and beliefs, particularly mothers complementary and alternative medicine use, are associated with decreased MMR uptake (adjusted OR 2.65 (1.76-3.98)). This information suggests that parental attitudes and beliefs regarding vaccines must be considered when developing programmes to improve immunisation uptake.

Smoking bans for reducing smoking prevalence and tobacco consumption

Tobacco is the second major cause of death in the world, and is currently responsible for the death of about one in ten adults worldwide (WHO 2005). Measures to control the demand for and supply of tobacco products as well as to protect public health have been highlighted further through the Framework Convention on Tobacco Control (WHO 2003). In setting the parameters for this systematic review, the authors took a strict methodological approach in keeping with the Cochrane process but had to consider the nature of health promotion interventions in setting those parameters. The overall objective o this review is to assess the extent to which smoking bans or restrictions reduce tobacco consumption, smoking prevalence, exposure to secondhand smoke and health outcomes in the area affected by the ban or restriction. Primary objectives: Does the imposition of bans or restrictions reduce tobacco consumption and smoking prevalence in the area affected by the ban or policy? Does the imposition of bans or restrictions have an effect on exposure to secondhand smoke, in particular groups of people or in specific settings? Secondary objective: What effect does the imposition of bans or restrictions have on the smoking-related morbidity and mortality of those affected by the ban or restriction?