Abstract Background Environmental hazards are established health threats. Environmental Incidents (EI) of Public Health concern are reported to Regional Departments of Public Health from a variety of sources in Ireland. A 2023 review of regional data showed that inclusion criteria for incidents differed between departments and were not standardised. Only regional data was collected. Objectives Our aim was to develop and pilot a national EI surveillance system to support the collection, monitoring, and reporting of EI in Ireland. It will inform recommendations for Outbreaks, Case and Incident Management System (OCIMS), the new system which will manage the surveillance of infectious diseases and public health threats in Ireland. Methods Between September 2024 and January 2025, consultations with regional public health colleagues informed incident types and key variables. Further meetings after one quarter of data collection gathered feedback on EI recording. Pilot data collected between the 1st April to 30th September 2025 were analysed in RStudio. Results The national EI surveillance system was created using an excel database with nine EI types, a core suite of variables and issued to Regional Departments of Public Health for data entry. In a pilot between 1st April to 30th September, 234 incidents were recorded. Drinking water (DW) accounted for 69% (n=162) of EI. 60% of DW incidents were linked to public water supplies. Bathing water (BW) accounted for 25% of EI, 79% of which were associated with sea/salt water. Advice was required for the public for 93% of EI, including 43 boil water notices, and 40 bathing prohibition notices. Conclusions This pilot constitutes Ireland’s first national EI surveillance system of public health responses to EI, allowing description of incident patterns, assessment of recommendations, and identification of gaps. It also led to new variables for sub-categorising DW incidents and public health advice, and informed recommendations for OCIMS.

Background Despite increases in heat-related deaths in England, there has been limited progress in developing interventions in primary care that identify and target individuals at risk. Lack of understanding of individual-level socioenvironmental risk factors limits development of an evidence-based approach to targeted prevention.Objective To identify individual-level non-clinical risk factors for heat-related mortality in England using primary care records and to assess the potential of these socio-environmental factors as effect modifiers for the association between ambient temperature and death.Methods A time-stratified case-crossover analysis was undertaken of nine potential risk factors at the individual level and categorised into risk factor subgroups. 430 682 patients with valid records were included in the study population, obtained from the Clinical Practice Research Datalink. Conditional logistic regression was used to characterise associations between temperature and the risk of death on hot days and to investigate the modifying effect of each risk factor.Results Older ages, females, ethnic minorities and those living in the most deprived areas all had increased risk of death during periods of heat. An increasing trend in ORs was observed with increasing amounts of alcohol intake and increasing body mass index, excluding the obese-3 group. No differences in risks were observed by marital status or frailty category.Conclusions This is the first study in England to assess the role of socioenvironmental factors in modifying heat risk at an individual level. The results provide important evidence on the role of disadvantage in driving the inequitable distribution of climate change impacts, and the need for better socioeconomic data linked to health records. For clinical practice, the findings highlight the importance of incorporating an assessment of individual socioenvironmental circumstances when prioritising patients at highest risk during heat events.

Risks to older adults (OA) (aged 65+ years) associated with hot and cold weather in the UK are well-documented. The study aim is to explore OA perception of health risks from high and low temperatures, health-protective measures undertaken, and implications for public health messaging. In 2019/20, Ipsos MORI conducted face-to-face surveys with OA in England (n = 461 cold weather survey, n = 452 hot weather survey). Participants reported temperature-related symptoms, risk perceptions for different groups, and behaviours during hot and cold weather. Analysis involved binomial logistic regression models to assess potential factors (demographics, vulnerability, behaviours) associated with older adults' health risk perception in hot and cold weather. Less than half of OA in both surveys agreed that hot or cold weather posed a risk to their health. OA with higher education, annual income >£25 000 or home ownership were less likely to perceive their health at risk during cold weather and regional differences in hot weather were identified. OA who recognized those the same age or living alone as at an increased risk were more likely to perceive their own health as at risk. OA were more likely to self-identify health risks when reporting those aged 65 yrs+ to be at an increased risk in cold weather. Various temperature-related protective behaviours were associated with older adults' risk perception in hot and cold weather. These findings provide evidence for public health agencies to target high risk individuals, and modify temperature-related public health messaging to protect OA.

Background Despite an increase in heat-related deaths occurring in England in recent years, one of the key recommended actions of identifying individuals at risk and deploying targeted interventions is not routinely undertaken. A major contributing factor to this is a lack of understanding of the individual-level risk factors that would support an evidence-based approach to targeted prevention.Objective To identify individual-level clinical risk factors for heat-related mortality in England by using primary care records and to estimate potential effect modification of a range of pre-existing conditions, clinical measurements and prescribed medications.Methods A time-stratified case-crossover analysis was undertaken of 37 individual-level clinical risk factors. Patient’s data were obtained from the Clinical Practice Research Datalink. Conditional logistic regression was used to characterise associations between temperature and the risk of death on hot days.Results Heat mortality risk was modified by a large range of pre-existing conditions, with cardiorespiratory, mental health and cognitive function conditions, diabetes and Parkinson’s, all increasing risk. The most striking increase was observed for depression with an OR of 1.25 (95% CI 1.09 to 1.44), the highest observed for pre-existing conditions. Individuals prescribed medications to treat heart failure and high blood pressure also have increased odds of death during heatwaves. There appears to be evidence of an increasing trend in ORs for diastolic blood pressure (DBP) categories, with ORs increasing from low DBP up to prehypertensive DBP group.Conclusions This is the first study to explore a comprehensive set of individual-level clinical risk factors and heat using primary care records in England. Results presented have important implications for patient medication management during heat events, incorporating heat-risk considerations into other health policies such as suicide prevention plans and highlighted potential differences between clinical vulnerability and patients at risk.

Introduction Health risks to vulnerable groups associated with hot and cold weather are well-documented. Older adults, aged 65 and above, are particularly vulnerable to higher and lower temperatures. Aim To explore older adult perception of health risks from high and low temperatures, what health-protective measures they have undertaken, and the factors associated with risks and responses. Methods Ipsos MORI conducted face-to-face surveys for the UK Health Security Agency with 461 participants in the cold weather survey and 452 in the hot weather survey. Participants reported temperature-related symptoms, risk perceptions for different groups, and behaviours during hot and cold weather. Data analysis involved using binomial logistic regression models to assess potential factors (demographics, vulnerability, behaviours, and responses) associated with older adults’ health risk perception in hot and cold weather. Results Less than half of older adults in both surveys agreed that hot or cold weather posed a risk to their health. Older adults with higher education, household income >£25,000 annually or home ownership were less likely to perceive their health at risk during cold weather. In both surveys, older adults who perceived people of the same age or people living alone as at an increased risk were more likely to perceive their own health as at risk. Furthermore, during cold weather, older adults were more likely to self-identify their health at risk when reporting other adults aged 65yrs+ to be at an increased risk, but not during hot weather. Various temperature-related protective behaviours were associated with older adults’ risk perception in hot and cold weather. Conclusion These findings highlight the need for effective risk communication strategies and targeted health messaging for older adults to support self-identification of risk. Future research should focus on barriers to risk perception and promoting health-protective behaviours in this population. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The data collection process was carried out by Ipsos MORI, a market research company, who provided the following statement: “This project was reviewed by the internal IPSOS MORI Ethics Group, but it was not submitted externally for ethics approval which is standard practice in market research where the research topic is not considered sensitive and the participants are not considered vulnerable or unable to give informed consent. It was also judged that there would be no potential disclosure of harm through the survey. The data received by the authors in this study was anonymised and individuals are not identifiable.” I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data underlying the results presented in the study are available from (<https://www.ipsos.com/en>).

Objective To critically assess the impacts of very hot weather on (i) frontline staff in hospitals in England and (ii) on healthcare delivery and patient safety.Study design A qualitative study design using key informant semi-structured interviews, preinterview survey and thematic analysis.Setting England.Participants 14 health professionals in the National Health Service (clinicians and non-clinicians, including facilities managers and emergency preparedness, resilience and response professionals).Results Hot weather in 2019 caused significant disruption to health services, facilities and equipment, staff and patient discomfort, and an acute increase in hospital admissions. Levels of awareness varied between clinical and non-clinical staff of the Heatwave Plan for England, Heat-Health Alerts and associated guidance. Response to heatwaves was affected by competing priorities and tensions including infection control, electric fan usage and patient safety.Conclusions Healthcare delivery staff experience difficulty in managing heat risks in hospitals. Priority should be given to workforce development and strategic, long-term planning, prevention and investment to enable staff to prepare and respond, as well as to improve health system resilience to current and future heat-health risks. Further research with a wider, larger cohort is required to develop the evidence base on the impacts, including the costs of those impacts, and to assess the effectiveness and feasibility of interventions. Forming a national picture of health system resilience to heatwaves will support national adaptation planning for health, in addition to informing strategic prevention and effective emergency response.

High ambient temperatures pose a significant risk to health. This study investigates the heatwave mortality in the summer of 2020 during the SARS-CoV-2 coronavirus (COVID-19) pandemic and related countermeasures. The heatwaves in 2020 caused more deaths than have been reported since the Heatwave Plan for England was introduced in 2004. The total and cause-specific mortality in 2020 was compared to previous heatwave events in England. The findings will help inform summer preparedness and planning in future years as society learns to live with COVID-19. Heatwave excess mortality in 2020 was similar to deaths occurring at home, in hospitals, and in care homes in the 65+ years group, and was comparable to the increases in previous years (2016–2018). The third heatwave in 2020 caused significant mortality in the younger age group (0–64) which has not been observed in previous years. Significant excess mortality was observed for cardiovascular disease, respiratory disease, and Alzheimer’s and Dementia across all three heatwaves in persons aged 65+ years. There was no evidence that the heatwaves affected the proportional increase of people dying at home and not seeking heat-related health care. The most significant spike in daily mortality in August 2020 was associated with a period of high night-time temperatures. The results provide additional evidence that contextual factors are important for managing heatwave risks, particularly the importance of overheating in dwellings. The findings also suggest more action is also needed to address the vulnerability in the community and in health care settings during the acute response phase of a heatwave.

OBJECTIVES:To evaluate the potential for long distance airborne transmission of SARS-CoV-2 in indoor community settings and to investigate factors that might influence transmission. DESIGN:Rapid systematic review and narrative synthesis. DATA SOURCES:Medline, Embase, medRxiv, Arxiv, and WHO COVID-19 Research Database for studies published from 27 July 2020 to 19 January 2022; existing relevant rapid systematic review for studies published from 1 January 2020 to 27 July 2020; and citation analysis in Web of Science and Cocites. ELIGIBILITY CRITERIA FOR STUDY SELECTION:Observational studies reporting on transmission events in indoor community (non-healthcare) settings in which long distance airborne transmission of SARS-CoV-2 was the most likely route. Studies such as those of household transmission where the main transmission route was likely to be close contact or fomite transmission were excluded. DATA EXTRACTION AND SYNTHESIS:Data extraction was done by one reviewer and independently checked by a second reviewer. Primary outcomes were SARS-CoV-2 infections through long distance airborne transmission (>2 m) and any modifying factors. Methodological quality of included studies was rated using the quality criteria checklist, and certainty of primary outcomes was determined using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Narrative synthesis was themed by setting. RESULTS:22 reports relating to 18 studies were identified (methodological quality was high in three, medium in five, and low in 10); all the studies were outbreak investigations. Long distance airborne transmission was likely to have occurred for some or all transmission events in 16 studies and was unclear in two studies (GRADE: very low certainty). In the 16 studies, one or more factors plausibly increased the likelihood of long distance airborne transmission, particularly insufficient air replacement (very low certainty), directional air flow (very low certainty), and activities associated with increased emission of aerosols, such as singing or speaking loudly (very low certainty). In 13 studies, the primary cases were reported as being asymptomatic, presymptomatic, or around symptom onset at the time of transmission. Although some of the included studies were well conducted outbreak investigations, they remain at risk of bias owing to study design and do not always provide the level of detail needed to fully assess transmission routes. CONCLUSION:This rapid systematic review found evidence suggesting that long distance airborne transmission of SARS-CoV-2 might occur in indoor settings such as restaurants, workplaces, and venues for choirs, and identified factors such as insufficient air replacement that probably contributed to transmission. These results strengthen the need for mitigation measures in indoor settings, particularly the use of adequate ventilation. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42021236762.

Extreme weather alerting systems are one of the central tools utilised in adapting to changing weather patterns resulting from climate change. This paper evaluates the effectiveness of the current alerting systems for hot and cold weather used in England to notify the health and social care sector of upcoming extreme weather events. We consider the views of stakeholders on the current system and explore their perspectives on the proposal to move towards an impact-based system. The paper concludes that while the current system is an effective tool, stakeholders feel they need to draw on additional material to assist with the development of an appropriate response. We also highlight that many stakeholders are concerned about the potential for creating alert fatigue due to a lack of clarity of the geographical area impact of some of the alerts. Consequently, there was a high level of support from stakeholders for the move towards an impact-focused system.

Heatwaves are a serious threat to human life. Public health agencies that are responsible for delivering heat-health action plans need to assess and reduce the mortality impacts of heat. Statistical models developed in epidemiology have previously been used to attribute past observed deaths to high temperatures and project future heat-related deaths. Here, we investigate the novel use of summer temperature-mortality associations established by these models for monitoring heat-related deaths in regions in England in near real time. For four summers in the period 2011-2020, we find that coupling these associations with observed daily mean temperatures results in England-wide heatwave mortality estimates that are consistent with the excess deaths estimated by UK Health Security Agency. However, our results for 2013, 2018 and 2020 highlight that the lagged effects of heat and characteristics of individual summers contribute to disagreement between the two methods. We suggest that our method can be used for heatwave mortality monitoring in England because it has the advantages of including lagged effects and controlling for other risk factors. It could also be employed by health agencies elsewhere for reliably estimating the health burden of heat in near real time and near-term forecasts.

Introduction The health effects of drought are significant and widespread, but primarily indirect. As climate change projections indicate future increases in drought events globally, it is essential that we continue to develop the evidence base on the health consequences of drought to inform future public health policy and practice (i.e. the quantification of impacts now and in the future). Methods A systematic review was preformed using: MEDLINE, EMBASE, PsycINFO, Maternity and Infant Care, Global Health, CINAHL and Cochrane. Articles were included in the analysis if they met the following criteria: exposure was specified as drought; outcome was a defined and measured human health outcome; a distinct link had to be made between exposure and outcome; drought was defined as a shortage or deficiency that was climate related; population studied was member countries of the Organisation for Economic Co-operation and Development (OECD) to represent HICs; reported original data; published in English from May 2012 to June 2017. Results 10,383 citations were initially identified; 24 papers met the eligibility criteria. Additionally, seven papers not meeting the criteria were incorporated as supporting text. The majority of studies were from Australia and the USA. Five main categories of health effects were found: (i) water borne disease (ii) vector borne disease (iii) airborne, dust and respiratory related diseases (iv) mental health and wellbeing and (v) other health effects. Conclusion The limited evidence suggests that the mental health impacts of drought in rural and farming populations and outbreaks of West Nile Fever in places that harbour the transmitting vector represent the greatest public health concern for drought prone High-Income Countries (HICs). A range of initiatives were identified, including health services preparedness alongside targeted public health policies. Further studies are needed to address gaps in the evidence including the absence of a standardised definition and/or measure of drought exposure, and methods to measure and assess health impacts related to drought.

Thunderstorm asthma is often characterised by a sudden surge in patients presenting with exacerbated symptoms of asthma linked to thunderstorm activity. Here, we describe a large spike in asthma and difficulty breathing symptoms observed across parts of England on 17 June 2021. The number of healthcare presentations during the asthma event was compared to expected levels for the overall population and across specific regions. Across affected geographical areas, emergency department attendances for asthma increased by 560% on 17 June compared to the average number of weekday daily attendances during the previous 4 weeks. General practitioner out of hours contacts increased by 349%, National Health Service (NHS) 111 calls 193%, NHS 111 online assessments 581% and ambulance call outs 54%. Increases were particularly noted in patient age groups 5–14 and 15–44 years. In non-affected regions, increases were small (<10%) or decreased, except for NHS 111 online assessments where there was an increase of 39%. A review of the meteorological conditions showed several localised, weak, or moderate thunderstorms specifically across parts of Southeast England on the night of June 16. In this unprecedented episode of asthma, the links to meteorologically defined thunderstorm activity were not as clear as previous episodes, with less evidence of ‘severe’ thunderstorm activity in those areas affected, prompting further discussion about the causes of these events and implications for public health management of the risk.

Objective To evaluate the potential for long-distance (over two metres) airborne transmission of SARS-CoV-2 in indoor community settings and investigate factors which may impact this transmission. Design Systematic review and narrative synthesis. Data source MEDLINE, Embase, medRxiv, Arxiv and WHO COVID-19 Research Database for studies published from 27 July 2020 to 21 April 2021; existing relevant rapid systematic reviews for studies published between 1 January to 27 July 2020. Eligibility criteria for study selection Observational studies that included a thorough epidemiological assessment of routes of transmission and which reported on the likelihood of airborne transmission of SARS-CoV-2 at a distance greater than two metres in indoor community settings. Data extraction and synthesis Data extraction was completed by one reviewer and independently checked by a second reviewer. Primary outcomes were COVID-19 infections via airborne transmission over distances greater than two metres and any factors that may have modified transmission risk. Included studies were rated using a quality criteria checklist (QCC) for primary research and certainty of key outcomes was determined using GRADE. Narrative synthesis was themed by setting. Results Of the 3,780 articles screened for inclusion, 15 publications reporting on 13 epidemiological investigations were included (three high, six medium and four low quality). Airborne transmission at distances greater than two metres was likely to have occurred for some or all transmission events in 12 studies and was unclear in one study (GRADE: very low certainty). In all studies, one or more factors plausibly increased the likelihood of long-distance airborne transmission occurring, particularly insufficient air replacement (GRADE: very low certainty), recirculating air flow (GRADE: very low certainty) and singing (GRADE: very low certainty). In nine studies, the primary cases were reported as being asymptomatic, presymptomatic or around symptom onset at the time of transmission. Conclusion This rapid systematic review found evidence of long-distance airborne transmission of SARS-CoV-2 in indoor community settings and identified factors that likely contributed to this transmission in all included studies. These results strengthen the need for adequate mitigation measures in indoor community settings, particularly adequate ventilation with fresh air, and caution required with the use of recirculating air flow systems. Systematic review registration PROSPERO CRD42021236762

The first documented British outbreak of Shiga toxin-producing Escherichia coli (STEC) O55:H7 began in the county of Dorset, England, in July 2014. Since then, there have been a total of 31 cases of which 13 presented with haemolytic uraemic syndrome (HUS). The outbreak strain had Shiga toxin (Stx) subtype 2a associated with an elevated risk of HUS. This strain had not previously been isolated from humans or animals in England. The only epidemiological link was living in or having close links to two areas in Dorset. Extensive investigations included testing of animals and household pets. Control measures included extended screening, iterative interviewing and exclusion of cases and high risk contacts. Whole genome sequencing (WGS) confirmed that all the cases were infected with similar strains. A specific source could not be identified. The combination of epidemiological investigation and WGS indicated, however, that this outbreak was possibly caused by recurrent introductions from a local endemic zoonotic source, that a highly similar endemic reservoir appears to exist in the Republic of Ireland but has not been identified elsewhere, and that a subset of cases was associated with human-to-human transmission in a nursery.

Genital Chlamydia trachomatis (CT) infection is the most common curable, bacterial sexually transmitted infection (STI) worldwide [1, 2]. The number of cases notified in Ireland increased from 3,353 in 2005 to 5,781 in 2009 [3]. Notifications have increased since 2004 when legislation requiring laboratory notification came into effect. Chlamydia is usually a ‘silent’ asymptomatic infection, spread without the knowledge of those transmitting and contracting it: most cases remain undetected and thus untreated. It is a major public health problem because it causes pelvic inflammatory disease (PID) in up to 30% of infected women who are not treated, which can lead to ectopic pregnancy and tubal factor infertility, and it also facilitates the transmission of HIV in both women and men [1, 4]. Prevalence studies in Ireland have detected chlamydia in 4–11% of young people [5, 6, 7], with positivity rates of over 10% in some settings [8]. Similar rates have been found in large studies in the United Kingdom (UK) [9], elsewhere in Europe [10] and North America [11]. A 2004 review estimated UK rates of 4–5% for women under 20 years in the general population, and 8–17% in women under 20 years attending sexual health services [9]. The authors of the review assumed, in the absence of data, that males had similar rates. Age under 25 years is considered a risk factor for infection in England [12]. In the English National Chlamydia Screening Programme (NCSP) overall chlamydia positivity rates have averaged 7.6% in men and 9.3% in women, based on a total of 370,012 screening tests reported [13]. Chlamydia screening has become more feasible due to the development of urinebased laboratory tests, which can be used in clinical and non-clinical settings, instead of more invasive and uncomfortable methods such as endocervical and urethral swabs. Urine testing is now the norm for screening men for chlamydia. For these reasons and because most cases are asymptomatic and undetected, especially in women, several countries have introduced chlamydia screening interventions [1]. A 2005 report prepared by the Health Protection Surveillance Centre (HPSC) [14] concluded that an investigation of the feasibility, acceptability and likely uptake of chlamydia screening in various settings in Ireland should be prioritised. It also concluded that agreement on best practice for the management of identified infections and partner notification was urgently needed. Following a competitive tendering process in late 2006, the HPSC, supported by the Health Research Board (HRB), contracted a team of population health and other specialists from the Royal College of Surgeons in Ireland (RCSI), the National University of Ireland Galway (NUIG) and the Health Service Executive (HSE) to conduct a pilot study of chlamydia screening.The study ran from 2007 to 2009. Since 2009, several articles and reports have been published internationally, including reviews and the results of screening studies, which question the case for chlamydia screening in the general population. A systematic review of screening programmes concluded that the available evidence did not justify the establishment of opportunistic chlamydia screening programmes in under-25 year olds in the general population, given methodological weaknesses in the trials cited as justification for screening [4]. A review of the three phases of the English National Chlamydia Screening Programme (NCSP) reported screening coverage levels in the target population of only 4.8% in 2007–2008 [13]; although by 2009–2010, 47% of sexually active young women and 25% of men had been tested [15]. A review by the English National Audit Office [16] concluded that the NCSP had not demonstrated value for money, citing lack of efficiencies in purchasing and logistics. Also, models had shown that annual testing rates of young people of between 26% and 43% would be needed in order to significantly reduce the prevalence of chlamydia [17]. The recent higher coverage levels achieved by the NCSP in reaching these recommended levels is a cause for optimism, and valuable lessons will be learned from the English national programme. However, the potential of opportunistic chlamydia screening to prevent serious morbidity (chiefly pelvic inflammatory disease in women) has been challenged by the results of an important randomised control trial of screening among young female students in London [18]. The trial found that most episodes of PID (30 of 38) would not have been prevented by annual screening as they occurred in women who had tested negative for chlamydia at the start of the 12 months.

Background The World Health Organization estimates that lead is responsible for 143,000 deaths per year and 0.6% of the global burden of disease. However, prevalence rates for lead poisoning and the severity of outcomes vary greatly from country to country. In the UK, public health interventions have succeeded in removing most sources of lead from the human environment, however a small proportion of children continue to be exposed to harmful levels of lead, usually in the home. There are no reliable data on the incidence of lead toxicity in children in the UK or Republic of Ireland (ROI). Aim Surveillance of raised Blood Lead levels In Children (SLIC) is a Health Protection Agency (HPA) study aiming to provide an estimate of the incidence of blood lead concentrations ?10µg/dl in the UK and ROI. Methods Cases were recruited over 24 months, using the methodology developed and managed by the British Paediatric Surveillance Unit for reporting of selected paediatric conditions by clinicians. To increase data capture, toxicologists and Supra-Regional Assay Service Trace Elements laboratories are also involved in case reporting. We will estimate incidence and use this information to identify the location of likely hotspots for exposure to lead in the UK and ROI. Results A successful system was established for reporting of cases by clinicians and laboratories across the countries involved. Cases were recruited from June 2010 to May 2012, and follow up is ongoing to link clinical and laboratory reports and remove double counting. Conclusions Childhood lead poisoning is preventable. The SLIC project will provide important information on both the clinical and public health management of lead poisoning cases in the UK and ROI. In all cases of lead toxicity globally, prevention should be a primary public health objective. Initiatives seeking greater national and international collaboration will help us to better understand and address the health challenges that lead presents.

Objective The objective of this study was to estimate the cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland. Methods Prospective cost analysis of an opportunistic screening programme delivered jointly in three types of healthcare facility in Ireland. Incremental cost-effectiveness analysis was performed using an existing dynamic modelling framework to compare screening to a control of no organised screening. A healthcare provider perspective was adopted with respect to costs and included the costs of screening and the costs of complications arising from untreated infection. Two outcome measures were examined: major outcomes averted, comprising cases of pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in women, neonatal conjunctivitis and pneumonia, and epididymitis in men; and quality-adjusted life-years (QALY) gained. Uncertainty was explored using sensitivity analyses and cost-effectiveness acceptability curves. Results The average cost per component of screening was estimated at €26 per offer, €66 per negative case, €152 per positive case and €74 per partner notified and treated. The modelled screening scenario was projected to be more effective and more costly than the control strategy. The incremental cost per major outcomes averted was €6093, and the incremental cost per QALY gained was €94 717. For cost-effectiveness threshold values of €45 000 per QALY gained and lower, the probability of the screening being cost effective was estimated at <1%. Conclusions An opportunistic chlamydia screening programme, as modelled in this study, would be expensive to implement nationally and is unlikely to be judged cost effective by policy makers in Ireland.

Objectives Chlamydia trachomatis is a sexually transmissible infection (STI) that affects significant numbers of men. Research on men’s perspectives on chlamydia screening (or testing) has been limited. We conducted a narrative review to examine: (1) what factors encourage or discourage men from attending health services for chlamydia screening, and/or from accepting screening once it has been offered to them, and (2) where men want chlamydia screening services to be located. Methods: A narrative review of the recent peer-reviewed literature (published between 1999 and 2009) on men’s attitudes towards chlamydia screening. To be included, articles had to explore men’s perspectives on screening (which could be ascertained through quantitative or qualitative studies, or from relevant discussion papers or reviews). Results: Forty-eight articles were included in all. Men’s attitudes towards chlamydia screening are influenced by their knowledge about the infection, their perceived vulnerability to the infection, the degree of embarrassment and shame that they associate with screening and the stigma that they associate with screening. Men prefer to be offered urine testing for chlamydia. Men want to be offered screening by non-judgemental professionals. Men’s attitudes towards screening for chlamydia in general practice, genito-urinary medicine clinics, home and outreach settings are also explored in this review. Conclusions: Several factors influence men’s attitudes towards screening. Two central themes underlie and influence many of these factors: men’s needs to make positive impressions on others, and men’s identification with particular ideals of masculinity. The review concludes with suggestions for future research on this topic.