ObjectiveTo assess the prevalence and determinants of haematinic deficiency (lack of B12 folate or iron) and macrocytosis in blood from a national population-based study of middle-aged and older adults.MethodsA cross-sectional study involving 1,207 adults aged ≥45 years, recruited from a sub-study of the Irish National Survey of Lifestyle Attitudes and Nutrition (SLÁN 2007). Participants completed a health and lifestyle questionnaire and a standard food frequency questionnaire. Non-fasting blood samples were obtained for measurement of full blood count and expert morphological assessment, serum ferritin, soluble transferrin receptor assay (sTfR), B12, folate and coeliac antibodies. Blood samples were also assayed for thyroid function (T4, TSH), liver function, aminotransferase (AST) and gamma-glutamyl transferase (GGT).ResultsThe overall prevalence (95% C.I.) of anaemia (Hb <13.5g/dl men and 11.3 g/dl women) was 4.6% (2.9%–6.4%) in men and 1.0% (0.2%–1.9%) in women. Iron deficiency (ferritin <17ng/ml men and <11ng/ml in women) was detected in 6.3% of participants (3.7% in males and 8.7% in females, p<0.001). Based on both low ferritin and raised sTfR (>21nmol/ml) only 2.3% were iron-deficient. 3.0% and 2.7% were found to have low levels of serum folate (<2.3ng/ml) and serum B12 (<120ng/l) respectively. Clinically significant macrocytosis (MCV>99fl) was detected in 8.4% of subjects. Strong, significant and independent associations with macrocytosis were observed for lower social status, current smoking status, moderate to heavy alcohol intake, elevated GGT levels, deficiency of folate and vitamin B12, hypothyroidism and coeliac disease. The population attributable fraction (PAF) for macrocytosis associated with elevated GGT (25.0%) and smoking (24.6%) was higher than for excess alcohol intake (6.3%), folate deficiency (10.5%) or vitamin B12 (3.4%).ConclusionsHaematinic deficiency and macrocytosis are common in middle-aged/older adults in Ireland. Macrocytosis is more likely to be attributable to an elevated GGT and smoking than vitamin B12 or folate deficiency.

Purpose -This study aims to investigate teacher perspectives on teaching handwriting to children with autistic spectrum disorder (ASD) and collaboration with occupational therapists.Design/methodology/approach -A descriptive design was applied. Purpose-designed surveys were distributed to teachers of children with ASD (aged 4-12 years) in the Republic of Ireland. A response rate of 35 per cent (N = 75) was obtained, with 25 responses analysed using descriptive statistics of closed questions and content analysis of open-ended questions.Findings -Of 139 children with ASD, 80 (58 per cent) were reported to have difficulties with handwriting.Teachers reported specific difficulties with pencil grasp, letter formation and task concept among the children with ASD. Fourteen (56 per cent, N = 25) respondents did not give handwriting as homework. Teachers valued occupational therapy advice, individualised programmes and ongoing consultation during implementation. Interest in occupational therapy education regarding handwriting was reported.Practical implications -Occupational therapy collaboration to address handwriting difficulties for children with ASD should include involvement in teacher education, coordination of teacher-parent collaboration and the need for involvement in early intervention provision within an emergent literacy framework.Originality/value -Handwriting development is challenging for children with ASD. There is limited information on teaching or teacher-occupational therapy collaborative practices to address handwriting difficulties of children with ASD.

Variation in the lower and upper limits of haemoglobin (Hb) ranges will alter diagnosis and referral rates of anaemia or erythrocytosis. The haemoglobin ranges for adults in Irish laboratories were applied in the context of haemoglobin levels of a representative sample of Irish adults (SLAN). Between 2.8% and 8.5% of men would be diagnosed with anaemia in different laboratories for lower limit between 130-140g/L. For women, diagnosis of anaemia would range from 0.7% to 7.3% for the lower limit between 110-125g/L. Similar reference range variations occur in UK laboratories. A suggested "normal reference range" is extrapolated from the SLAN cohort.