• Comparing Canadian and United States opioid agonist therapy policies.

    Priest, Kelsey C; Gorfinkel, Lauren; Klimas, Jan; Jones, Andrea A; Fairbairn, Nadia; McCarty, Dennis (2019-02-11)
    Canada and the United States (U.S.) face an opioid use disorder (OUD) and opioid overdose epidemic. The most effective OUD treatment is opioid agonist therapy (OAT)-buprenorphine (with and without naloxone) and methadone. Although federal approval for OAT occurred decades ago, in both countries, access to and use of OAT is low. Restrictive policies and complex regulations contribute to limited OAT access. Through a non-systematic literature scan and a review of publicly available policy documents, we examined and compared OAT policies and practice at the federal (Canada vs. U.S.) and local levels (British Columbia [B.C.] vs. Oregon). Differences and similarities were noted between federal and local OAT policies, and subsequently OAT access. In Canada, OAT policy control has shifted from federal to provincial authorities. Conversely, in the U.S., federal authorities maintain primary control of OAT regulations. Local OAT health insurance coverage policies were substantively different between B.C. and Oregon. In B.C., five OAT options were available, while in Oregon, only two OAT options were available with administrative limitations. The differences in local OAT access and coverage policies between B.C. and Oregon, may be explained, in part, to the differences in Canadian and U.S. federal OAT policies, specifically, the relaxation of special federal OAT regulatory controls in Canada. The analysis also highlights the complicating contributions, and likely policy solutions, that exist within other drug policy sub-domains (e.g., the prescription regime, and drug control regime) and broader policy domains (e.g., constitutional rights). U.S. policymakers and health officials could consider adopting Canada's regulatory policy approach to expand OAT access to mitigate the harms of the ongoing opioid overdose epidemic.
  • Integration of a recent infection testing algorithm into HIV surveillance in Ireland: improving HIV knowledge to target prevention

    Robinson, E; Moran, J; O'Donnell, K; Hassan, J; Tuite, H; Ennis, O; Cooney, F; Nugent, E; Preston, L; O'Dea, S; Doyle, S; Keating, S; Connell, J; De Gascun, C; Igoe, D (Epidemiology and Infection, 2019-02)
  • Irish Maternity Early Warning System (IMEWS) V2 National Clinical Guideline No. 4

    HSE National Clinical Programme for Obstetrics and Gynaecology (HSE National Clinical Programme for Obstetrics and Gynaecology, 2019-02)
  • Identifying the Optimum Role and Function of an Epidermolysis Bullosa (EB) Outreach Nurse

    Donohoe, Ann; Kearney, Sandra; McAuliffe, Eilish; School of Nursing, Midwifery and Health Systems at University College Dublin. (School of Nursing, Midwifery and Health Systems at University College Dublin., 2018-07)
  • Is It Time To Review The Vaccination Strategy To Protect Adults Against Invasive Pneumococcal Disease?

    Corcoran, M; Mereckiene, J; Murchan, S; McElligott, M; O’Flanagan, D; Cotter, S; Cunney, R; Humphreys, H (Irish Medical Journal, 2019-03)
    Pneumococcal conjugate vaccines (PCVs) have reduced the predominant serotypes causing invasive pneumococcal disease (IPD). We assessed the impact of the paediatric 7- and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13) among older adults. We compared serotype-specific incidence rates from 2007/08 to 2016/17, expressed as incidence rate ratios (IRR). Introducing PCV7 and PCV13 into the childhood immunisation programme resulted in a decline in these serotypes in adults ≥65 years of age, with PCV7 serotypes decreasing by 85% (IRR=0.11, 95%CI: 0.05-0.22, p<0.0001) and PCV13 serotypes not included in PCV7 (PCV13-7), decreasing by 9% (IRR=0.68, 95%CI: 0.40-1.16, p=0.134). However, there was a significant increase in serotypes only found in the 23-valent polysaccharide vaccine, PPV23-PCV13: IRR=2.57, 95%CI: 1.68-4.03, p<0.0001, and non-vaccine types (NVTs), IRR=3.33, 95%CI: 1.75-6.84, p=0.0001. The decline of IPD associated with PCV7/13 serotypes and the increase in PPV23-PCV13 serotypes indicates clear serotype replacement. Increasing PPV23 uptake could still reduce the burden of disease for this population.

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