An overview of the main findings from ICCP-2010, as well as comparisons with ICCP- 2003, are presented in this report. Tests were conducted to explore whether differences between the two surveys were statistically significant, where appropriate, and are highlighted below and in the main report.

Transferring guidelines from paper into practice has proven to be frustrating for the many who endeavour to standardise the management of cardiovascular disease across Europe. The EUROASPIRE I, II and III surveys, which audited the practice of preventive cardiology in patients with coronary heart disease over a decade, illustrated that patients were not being managed to the standards set by the ESC guidelines and that limited attention was given to prevention in patients with established heart disease. Evidence of the need for more effective lifestyle management was compelling: blood pressure management remained stubbornly unchanged, and lipid targets were not achieved in almost half of patients. Other studies report disappointing levels of guideline observance among physicians; they are often unaware of recommendations given in guidelines and, even when they are, many fail to consistently apply them in treating patients.2-3 Commonly cited barriers to guideline adherence among physicians include lack of time during consultations, financial constraints and lack of confidence in patients’ motivation to comply. Physicians also find that guideline documents are difficult to translate into practice.

To address the gap between publication of guidelines and their use in practice, the ESC at a European level organises presentations at conferences for its member national societies and key opinion leaders. It works at a political level to promote the prevention agenda and to directly influence EU health policy, leading, for example, to the EU Commission endorsement of the European Heart Health Charter. However, such efforts must be paralleled by concerted strategies at a national level to realise implementation in the front line. The 4th JTF urged national societies to develop implementation programmes, starting with the translation of guidelines to the local language and their adaptation to the national context. It recommended that the guidelines issued by the 4th JTF be regarded as a framework from which national guidance ‘to suit local political, economic, social, and medical circumstances’ would be developed. The recalibration of the SCORE risk assessment charts to reflect mortality and risk factor distributions in individual countries as part of this adaptation was emphasised.

The 4th JTF saw as vital the establishment a multidisciplinary alliance of experts from national professional organisations to oversee the adaptation and to drive implementation. It was necessary that alliances would have the support of national health authorities and work with other sectors such as the medical education and business communities to advance their aims.

Other recommendations included:

An information and education programme aimed at practising doctors that would include an audit of practices and feedback. The development of supplementary materials to the guidelines, specifically electronic versions for use in hand-held devices, such as PDAs, and of A4 sheet versions of risk algorithms and treatment recommendations.

A population health approach addressing lifestyle risk factors in general.

A public information campaign explaining the concept of multiple risk assessment and treatment and intervention thresholds, as well as describing how risk can be reduced.

Transferring guidelines from paper into practice has proven to be frustrating for the many who endeavour to standardise the management of cardiovascular disease across Europe. The EUROASPIRE I, II and III surveys, which audited the practice of preventive cardiology in patients with coronary heart disease over a decade, illustrated that patients were not being managed to the standards set by the ESC guidelines and that limited attention was given to prevention in patients with established heart disease. Evidence of the need for more effective lifestyle management was compelling: blood pressure management remained stubbornly unchanged, and lipid targets were not achieved in almost half of patients. Other studies report disappointing levels of guideline observance among physicians; they are often unaware of recommendations given in guidelines and, even when they are, many fail to consistently apply them in treating patients.2-3 Commonly cited barriers to guideline adherence among physicians include lack of time during consultations, financial constraints and lack of confidence in patients’ motivation to comply. Physicians also find that guideline documents are difficult to translate into practice.

To address the gap between publication of guidelines and their use in practice, the ESC at a European level organises presentations at conferences for its member national societies and key opinion leaders. It works at a political level to promote the prevention agenda and to directly influence EU health policy, leading, for example, to the EU Commission endorsement of the European Heart Health Charter. However, such efforts must be paralleled by concerted strategies at a national level to realise implementation in the front line. The 4th JTF urged national societies to develop implementation programmes, starting with the translation of guidelines to the local language and their adaptation to the national context. It recommended that the guidelines issued by the 4th JTF be regarded as a framework from which national guidance ‘to suit local political, economic, social, and medical circumstances’ would be developed. The recalibration of the SCORE risk assessment charts to reflect mortality and risk factor distributions in individual countries as part of this adaptation was emphasised.

The 4th JTF saw as vital the establishment a multidisciplinary alliance of experts from national professional organisations to oversee the adaptation and to drive implementation. It was necessary that alliances would have the support of national health authorities and work with other sectors such as the medical education and business communities to advance their aims.

Other recommendations included:

An information and education programme aimed at practising doctors that would include an audit of practices and feedback. The development of supplementary materials to the guidelines, specifically electronic versions for use in hand-held devices, such as PDAs, and of A4 sheet versions of risk algorithms and treatment recommendations.

A population health approach addressing lifestyle risk factors in general.

A public information campaign explaining the concept of multiple risk assessment and treatment and intervention thresholds, as well as describing how risk can be reduced.

The aim of this study was to investigate the associations between physicalactivity levels and core depressive symptoms in Irish adults aged 50 years or more. The study used data from the Survey of Lifestyle, Attitudes and Nutrition (SLÁN) 2007, a national survey of individuals living in the Republic of Ireland (n=4,255 adults aged 50 years or older) and The Northern Ireland Health and Social Wellbeing Survey (NIHSWS), 2005-2006, a survey of individuals living in Northern Ireland (n=1,904 adults aged 50 years or older).

Measures of depressed mood and anhedonia (two core depressive symptoms according to diagnostic criteria (DSM IV)) were derived using items from the surveys. Physical activity patterns were categorised using the International Physical Activity Questionnaire (IPAQ) Short Form (Craig et al. 2003). Demographic factors (age, gender and social class), smoking status and health service use were also considered.

Just over 5% (5.4%) of SLÁN 2007 participants and 11.1% of NIHSWS 2005-2006 participants had experienced both depressed mood and anhedonia in the recent past. In the overall sample this was 7.2% of participants. Overall 45% of participants reported being moderately physically active but 36.6% of participants reported activity at low levels (SLÁN 2007: 35.6%; NIHSWS 2005-2006: 38.8%). For the overall sample, depressive symptoms were negatively associated with being male, being older and high levels of physical activity. Depressive symptoms were significantly and positively associated with being separated/divorced or widowed, and social classes 3-6. Overall, people over 50 years who were engaged in moderate to high levels of physical activity had a 50-56% reduction in the odds of having elevated depressive symptoms.

Consistent with other research findings, this study suggests that physical activity levels are strongly associated with depressive symptoms. Increasing levels of physical activity among adults over 50 years has the potential to improve mental health.

Doctors and mothers were interviewed. For GPs and Casualty. Doctors (the primary providers of the medical management of gastroenteritis), management decisions and the factors influencing them were systematically evaluated. Family and home circumstances of children hospitalized for gastroenteritis were compared with the circumstances of families managing gastroenteritis at home. Combining the two sources of information the major role of the individual doctor in the management of gastroenteritis emerged. The findings of the present study indicate that there is considerable scope for improvement in present. gastroenteritis management. Possible improvements have been suggested at the level of GPs' and mothers' management, and at the level of management intermediate between the GP and hospitalization. These suggestions have been made in the light of the current situation in health care in Ireland.

The report consists of four main sections. The problem of gastro- enteritis as it is relevant to this study is outlined in Section I. The background and the research work concerning doctors and their decision-making is presented in the next section (Section 2 ) . Following this is a detailed comparison of the child and family circumstances of those with gastroenteritis who have been managed at home and in hospital (Section 3). The final section (Section 4) presents information on the most fruitful alternatives to hospitalization as suggested by study findings and the current Irish situation. An executive summary of the main findings of the study is provided at the beginning of the report.

International evidence indicates that aspects of sexual health, such as contraception, crisis pregnancy and sexually transmitted infections, should be examined jointly. To this end, the Crisis Pregnancy Agency and the Department of Health and Children instigated the ISSHR project.

The ISSHR findings have been outlined in a suite of reports – the Main Report, a Summary Report and three sub-reports; the latter provide detailed information in defined areas of interest. This, the third sub-report, focuses on the patterning of sexual knowledge and attitudes of people in Ireland and how these affect behaviour.

The Crisis Pregnancy Agency (CPA) and the sexual-health sector in general need robust evidence in order to develop sexual-health policies, to plan strategies and to inform the effective promotion of sexual-health messages. The ISSHR findings will be invaluable not only to the work of the CPA in preventing crisis pregnancy, but also to that of other organisations concerned with promoting sexual health, providing sexual-health services, preventing sexually transmitted infections, and providing sex education for young people.

International evidence indicates that aspects of sexual health, such as contraception, crisis pregnancy and sexually transmitted infections, should be examined jointly. To this end, the Crisis Pregnancy Agency and the Department of Health and Children instigated the ISSHR.

The ISSHR findings have been outlined in a suite of reports – the Main Report, the Summary Report and three sub-reports; the latter provide detailed information in defined areas of interest. This, the second sub-report, focuses on the area of sexual risk-taking and the use of relevant services.

The Crisis Pregnancy Agency (CPA) and the sexual-health sector in general need robust evidence in order to develop sexual-health policies, to plan strategies and to inform the effective promotion of sexual-health messages. The ISSHR findings will be invaluable not only to the work of the CPA in preventing crisis pregnancy, but also to that of other organisations concerned with promoting sexual health , providing sexual-health services, preventing sexually transmitted infections, and providing sex education for young people.

International evidence indicates that aspects of sexual health, such as contraception, crisis pregnancy and sexually transmitted infections, should be examined jointly. To this end, the Crisis Pregnancy Agency and the Department of Health and Children instigated the ISSHR project.

The ISSHR findings have been outlined in a suite of reports – the Main Report, a Summary Report and three sub-reports; the latter provide detailed information in defined areas of interest. This, the first sub-report, focuses on the area of sexual learning and first sexual experiences.

The Crisis Pregnancy Agency (CPA) and the sexual-health sector in general need robust evidence in order to develop sexual-health policies, to plan strategies and to inform the effective promotion of sexual-health messages. The ISSHR findings will be invaluable not only to the work of the CPA in preventing crisis pregnancy, but also to that of other organisations concerned with promoting sexual health, providing sexual-health services, preventing sexually transmitted infections, and providing sex education for young people.

QoL is a multi-dimensional construct and there are various approaches to its evaluation. The approach varies depending on the aims of the exercise. Health economists, for example, use techniques such as the QALY (Quality Adjusted Life Year), standard gamble and time-trade-off techniques in order to incorporate QoL measures into economic analysis and clinical trials. Clinical research has utilised standardised and disease specific measures, usually in the form of questionnaires, in order to determine the impact of disease and treatment on patients' QoL. One of the problems of conducting research in this area is that there is no single agreed definition of QoL nor is there a single 'gold standard' measurement technique. However, there is broad agreement that studies of health related QoL should include assessments of physical functioning, including somatic sensations such as physical symptoms and pain; psychological function including concentration and mood; social and sexual functioning and occupational status. Many researchers also assess patients' global satisfaction and the economic impact of the condition.

While QoL scales and questionnaires, as well as the methods of rating and analysing them, have been developed by assessing the QoL of individuals, the specific items and the response categories do not represent the free choice of individuals who are subsequently investigated using the scale. Furthermore, the measures will often have been standardised in samples other than those currently being assessed. Results are generally presented as group statistics and provide little or no data on the QoL of individual patients.

Having regard to the audit of the implementation of the cardiovascular health strategy, Building Healthier Hearts, and the audit of stroke services, Irish National Audit of Stroke Care, and consistent with developments in relation to the management of chronic diseases and the Primary Care Strategy, to develop a policy framework for the prevention, detection and treatment of cardiovascular disease, including stroke and peripheral arterial disease, which will ensure an integrated and quality-assured approach in their management.

This new cardiovascular policy, Changing Cardiovascular Health covering the period 2010-2019, comes a decade after the first national cardiovascular health strategy, entitled Building Healthier Hearts, was published by the Department of Health in 1999. The new policy is timely given the pace of scientific discovery and related changes in medical practice, changes in health service structures, and patterns and influences on population health behaviours in Ireland over the decade. Cardiovascular health and its maintenance is a microcosm of health more generally. A policy that can improve cardiovascular health and cardiovascular disease management will have beneficial effects for the whole healthcare system and population.