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Abstract Since April 2021, COVID-19 vaccines have been recommended for pregnant women. Despite this, COVID-19 vaccine uptake in this group is low compared to the non-pregnant population of childbearing age. Our aim was to understand barriers and facilitators to COVID-19 vaccine uptake among pregnant women in Northern Ireland using the COM-B framework, and so to make recommendations for public health interventions. The COM-B proposes that human behaviour is influenced by the extent to which a person has the capability, opportunity, and motivation to enact that behaviour. Understanding the factors underpinning behaviour through this lens helps discern what needs to change to change behaviour, therefore supporting the development of targeted interventions. This study consisted of eight semi-structured interviews with new/expectant mothers who did not receive a COVID-19 vaccine dose while pregnant since April 2021, and a focus group with five participants who received at least one COVID-19 vaccine dose while pregnant. Interview and focus group data were analysed using semi-deductive reflexive thematic analysis framed by a subtle realist approach. The COM-B was used to categorise codes and subthemes were developed within each COM-B construct. Within Psychological Capability, subthemes captured the need for consistent and reliable COVID-19 vaccine information and access to balanced and jargon-free, risk–benefit information that is tailored to the pregnant individual. The behaviour/opinions of family, friends, and local healthcare providers had a powerful influence on COVID-19 vaccine decisions (Social Opportunity). Integrating the COVID-19 vaccine as part of routine antenatal pathways was believed to support access and sense of familiarity (Physical Opportunity). Participants valued health autonomy, however experienced internal conflict driven by concerns about long-term side effects for their baby (Reflective Motivation). Feelings of fear, lack of empathy from healthcare providers, and anticipated guilt commonly underpinned indecision as to whether to get the vaccine (Automatic Motivation). Our study highlighted that the choice to accept a vaccine during pregnancy generates internal conflict and worry. Several participants cited their concern was primarily around the safety for their baby. Healthcare professionals (HCPs) play a significant part when it comes to decision making about COVID-19 vaccines among pregnant women. HCPs and pregnant women should be involved in the development of interventions to improve the delivery and communication of information.

(1) Background: The evidence base for the management of spontaneous viral controllers in pregnancy is lacking. We describe the management outcomes of pregnancies in a series of UK women with spontaneous HIV viral control (p = 0.10. Pre-2012 pregnancies were predominantly managed with ZDVm (28/35) with pre-labour caesarean section (PLCS) (24/35). Post-2012 4/14 received ZDVm and 10/14 triple ART, p = 0.002. Post-2012 mode of delivery was varied (5 vaginal, 6 PLCS and 3 emergency CS). No intrapartum ZDV infusions were given post-2012 compared to 11/35 deliveries pre-2012. During pregnancy, HIV was detected (> 50 copies/mL) in 14/49 pregnancies (29%) (median 92, range 51–6084). Neonatal ZDV post-exposure prophylaxis was recorded for 45/49 infants. No transmissions were reported. (4) Conclusion: UK practice has been influenced by the change in guidelines, but this has had little impact on CS rates.

Background: Children with disabilities are at heightened risk of violence compared to their non-disabled peers. However, extant research suffers from several limitations, focusing on child abuse and one or few types of disability, ignoring conventional violent crimes. Objective: The aim was to assess 10 disabilities and to examine whether different disabilities vary in their risk of criminal victimization. Method: Using the Danish Psychiatric Case Register, the Criminal Register, and other population-based registers, we included nine birth cohorts (n = 570,351) and followed them until 18 years of age. We compared children exposed to violence with non-exposed children. We estimated odds ratios (ORs) for the disabilities and adjusted the ORs for several risk factors. Results: We identified 12,830 cases of reported violence (2.25% of the population) towards children and adolescents. Children with disabilities were overrepresented, as were boys and ethnic minorities. After controlling for risk factors, four disabilities had heightened risk for criminal violence: attention-deficit hyperactivity disorder (ADHD), brain injury, speech, and physical disabilities. When we compared risk factors controlling for the various disabilities, parental history of violence, family break-up, out-of-home placement, and parental unemployment contributed especially to the violence, while parental alcohol/drug abuse was no longer a predictor. Having several disabilities increased the risk of violence. Conclusions: Criminal victimization of children and adolescents with specific disabilities was common. However, compared to the previous decade, a considerable reduction of one-third has taken place. Four risk factors contributed particularly to the risk of violence; therefore, precautions should be taken to further reduce the violence.

Abstract Background Patients and the public have an integral role in educating healthcare professionals. Authentic partnerships between higher education institutions and patients and the public are essential. This study examined key stakeholders’ views, experiences and expectations of patient and public involvement (PPI) including the nature of the involvement and requirements for partnership. Methods Purposive and snowball sampling was used to recruit key stakeholders, including patients and members of the public involved in health professions education, and academics interested in PPI. Focus groups were held with patient and public participants, providing the opportunity to gain multiple perspectives in an interactive group setting. Academics with an interest in PPI were interviewed using a semi-structured approach. Topic guides were derived from the literature and piloted prior to data collection. Focus groups and interviews were conducted until data saturation was achieved. All data was audio-recorded, transcribed, anonymised and thematically analysed. Results Four focus groups were conducted involving 23 patient and public participants (median number of participants per focus group of 6). Nine interviews were conducted with academics (face-to-face [n = 8] or by telephone [n = 1]). Five themes were developed: previous experiences of PPI, training requirements, challenges/barriers to PPI, facilitators of PPI and future ideas for PPI. All participants held positive views of the value of PPI. Participants had mixed views in terms of training, which depended on the level of involvement, but similar views on the challenges and facilitators for PPI in education. There was agreement that PPI requires institutional vision and investment to build strong relationships and a culture of PPI best practice. Conclusions There is a need for more strategic and formal involvement of patients and the public to ensure that that PPI becomes sustainably embedded in health professions education.

IntroductionThere is a need to improve the implementation and provision of continuity of care between prison and community in order that people who have been in prison and have a history of low engagement with services or who are vulnerable receive appropriate and timely health care and treatment. Observational studies using record linkage have investigated continuity of care after release from prison but this type of research evidence has not been synthesised.ObjectiveThis paper presents a protocol designed to review record linkage studies about primary care utilisation after prison release in order to inform future research and guide service organisation and delivery towards people who are at-risk following release from prison.MethodsThis scoping review will follow the framework by Arksey and O'Malley (5 stages) and guidance developed by the Joanna Briggs Institute (JBI). MEDLINE, EMBASE and Web of Science Core Collection will be searched (January 2012-March 2023) using terms relating to (i) 'former prisoners' and (ii) 'primary care'. The review will focus on observational studies that have investigated this topic using linked data from two or more sources. Two authors will independently screen titles and abstracts (step 1) and full publications (step 2) using predefined eligibility criteria. Data will be extracted from included publications using a piloted data charting form. This review will map the findings in this research area by methodology, key findings and gaps in research, and current evidence will be synthesised narratively given the expected considerable heterogeneity across studies.DiscussionThis review is part of a work programme on health in prison (Administrative Data Research Centre, Northern Ireland). This work may be used to inform future research, policy and practice. Findings will be shared with stakeholders, published in a peer-reviewed journal and presented at relevant conferences. Ethical approval is not required.

Dan Graham's work with mirrors and installation from the 1970s provides an unexpected launchpad for understanding the structures underlying perception in Zoom interfaces. The article explores the intricacies of Graham's two-way mirrors as a means to articulate perceptual experiences of dancing in the Zoomosphere, with examples from teaching, choreographing and performing via Zoom during Covid 19 isolation conditions.

Abstract Background/aim Psychological violence is estimated to be the most common form of intimate partner violence (IPV). Despite this, research on the independent effect of psychological violence on mental health is scarce. Moreover, the lack of a clear and consistent definition of psychological violence has made results difficult to compare. The present study therefore aims to consolidate knowledge on psychological violence by conducting a systematic review and random-effects meta-analysis on the association between psychological violence and mental health problems, when controlling for other types of violence (e.g. physical and sexual) and taking into account severity, frequency, and duration of psychological violence. Method The present study is registered in the International Prospective Register for Systematic Reviews (PROSPERO; #CRD42018116026) and the study design follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Additional file 1). A dual search will be conducted in the electronic databases PsycINFO, PubMed, EMBASE, and Web of Science. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Metafor-package in the programming language R. The Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project will be used to assess the quality of the included studies (i.e. weak, moderate and strong). Results and discussion The present review will help consolidate knowledge on psychological violence by evaluating whether frequency, severity or actual “type” of psychological violence produces the most harm. A thorough quality assessment will help overcome potential limitations regarding expected variations in terminology and assessment of psychological violence. Systematic review registration PROSPERO CRD42018116026.

Abstract Background Adequate clinical skills training is a challenge for present day medical education. Simulation Based Education (SBE) is playing an increasingly important role in healthcare education worldwide to teach invasive procedures. The impact of this teaching on students along with retention of what is taught is not fully understood. The purpose of this study was to evaluate the retention levels of practical skills taught and assessed by SBE and to explore the degree of re-training required to restore decayed performance. In exploring this aim, the study further investigates how skilled performance decays over time and which dimensions of clinical skills were more likely to decay. Methods Study participants were 51 final year medical students. They were provided with online pre-course videos and procedural guides asynchronously with repeatedly access. 7 of the skills taught over 2 years using task trainers were selected. Following demonstration from faculty, students practiced in small groups with faculty facilitated supervision and peer support prior to formal testing. Score sheets with itemised procedure checklists detailing the minimum passing standard (MPS) for each skill were designed. To test retention of skills, 18 months later, there was an unannounced test to demonstrate proficiency in the skills. Students were asked to complete a questionnaire indicating how many times and where they had practiced or performed the skills. Results 55% of the students were deficient in 3 or more skills and 4% were not competent in 5 or more skills. A significant number of students had never practiced some skills following the initial teaching session. A relationship was noted with the number of times students self-declared that they had practiced and their performance. Decay is evident in both psychomotor and cognitive domains of the skills. Conclusion A curriculum with deliberate practice significantly increases the competence of students in defined clinical skills. Deliberate practice of clinical skills, under supervision of an engaged instructor, is a key component of the mastery model. Experiences and assessments in the clinical setting need to be augmented with focus on direct observation and focused feedback to reinforce the skills acquired in the simulated setting.

Background: Psychological trauma has only recently been considered a traumatic event. Therefore, research on Posttraumatic Stress Disorder (PTSD) and Complex-PTSD following exposure to psychological violence, is less studied compared with physical and sexual violence. Objectives: This study aimed to establish the prevalence of PTSD and C-PTSD of among female victims of partner violence (IPV) and examine the unique association between different subtypes of IPV (i.e. physical, psychological and sexual IPV) and the traumatic response. Methods: The study includes a shelter-based sample of female victims of IPV (N = 147). Validated measures were used to estimate IPV exposure and mental health outcomes. Partial Correlation and Hierarchical Regression was used to examine the association between IPV and PTSD and C-PTSD, respectively. Results: The study found a high prevalence of both PTSD (56.5%) and C-PTSD (21.1%) in the sample. Overall, when controlling for the other types of violence, psychological violence correlated with PTSD, C-PTSD, negative affect and somatization. When controlling for psychological violence, neither physical nor sexual violence correlated with any of the mental health outcomes. Hierarchical regression models helped explain 23.5% and 29.7% of the variance in symptoms of PTSD and C-PTSD, respectively. Conclusion: A relatively large subgroup of the women had symptoms of C-PTSD, which demonstrate a potentially unmet need for trauma-informed treatment services in Danish Women Shelters. Psychological violence was found to be the strongest risk factor for all mental health outcomes and thus, it is important to acknowledge the severity of this IPV subtype.

Background: Interpersonal violence is a pervasive global public health problem associated with myriad health, social and economic consequences. In recent years the rates of interpersonal violence have decreased, however, high numbers of individuals continue to present to emergency departments for non-fatal violence-related injuries. Objective: This study aimed to examine a range of risk factors associated with violence-related injuries in an emergency department in Denmark. Method: A case-control study was conducted on a sample of 3,940 victims of violence collected by the Accident Analysis Center for Aarhus County Municipality. Using the Danish Civil Registry System, controls were matched 10:1 on age, gender and municipality. Risk factors were rendered from Danish health and social registers five years prior to the violent assault. These included marital status, educational qualification, employment status, national origin, involvement with child protective services (CPS), prior convictions, and a diagnosis of adjustment disorder and alcohol and/or substance use disorders. Results: Multivariate logistic regression identified that being male, divorced, unmarried, non-Danish origin, attending compulsory education, being outside the labour force, students, involvement with CPS, prior criminal conviction and a diagnosis of alcohol and/or substance use disorders were associated with an increased likelihood of being exposed to violence. The dominant risk factors were alcohol and/or substance use disorders (OR = 3.62) and prior criminal conviction (OR = 3.54). Attainment of tertiary education was associated with a reduced likelihood of being a victim of violence. Conclusion: These findings highlight that research into effective interventions offered in emergency departments may help the public health effort to reduce the health, social and economic burden of interpersonal violence.

Objective The aim of this study was to explore how infection prevention and control (IPC) guidelines are used and understood by healthcare professionals, patients and families.Design Ethnographic study with 59 hours of non-participant observation and 57 conversational interviews. Data analysis was underpinned by the Normalization Process Theory (NPT) as a theoretical framework.Setting Four hospitals in Ireland.Participants Healthcare professionals, patient and families.Results Five themes emerged through the analysis. Four themes provided evidence of the NPT elements (coherence, cognitive participation, collective action and reflexive monitoring). Our findings revealed the existence of a ‘dissonance between IPC guidelines and the reality of clinical practice’ (theme 1) and ‘Challenges to legitimatize guidelines’ recommendations in practice’ (theme 3). These elements contributed to ‘Symbolic implementation of IPC guidelines’ (theme 2), which was also determined by a ‘Lack of shared reflection upon IPC practices’ (theme 4) and a clinical context of ‘Workforce fragmentation, time pressure and lack of prioritization of IPC’ (theme 5).Conclusions Our analysis identified themes that provide a comprehensive understanding of elements needed for the successful or unsuccessful implementation of IPC guidelines. Our findings suggest that implementation of IPC guidelines is regularly operationalised through the reproduction of IPC symbols, rather than through adherence to performance of the evidence-based recommendations. Our findings also provide insights into changes to make IPC guidelines that align with clinical work.

Background: The International Classification of Diseases (ICD-11) is currently under development with proposed changes recommended for the posttraumatic stress disorder (PTSD) diagnosis and the inclusion of a separate complex PTSD (CPTSD) disorder. Empirical studies support the distinction between PTSD and CPTSD; however, less research has focused on non-western populations. Objective: The aim of this study was to investigate whether distinct PTSD and CPTSD symptom classes emerged and to identify potential risk factors and the severity of impairment associated with resultant classes. Methods: A latent class analysis (LCA) and related analyses were conducted on 314 young adults from Northern Uganda. Fifty-one percent were female and participants were aged between 18 and 25 years. Forty percent of the participants were former child soldiers (n=124) while the remaining participants were civilians (n=190). Results: The LCA revealed three classes: a CPTSD class (40.2%), a PTSD class (43.8%), and a low symptom class (16%). Child soldier status was a significant predictor of both CPTSD and PTSD classes (OR=5.96 and 2.82, respectively). Classes differed significantly on measures of anxiety/depression, conduct problems, somatic complaints, and war experiences. Conclusions: To conclude, this study provides preliminary support for the proposed distinction between PTSD and CPTSD in a young adult sample from Northern Uganda. However, future studies are needed using larger samples to test alternative models before firm conclusions can be made.

Objective: The present study investigated the relationship between different types of childhood maltreatment (emotional, sexual, overall abuse, and no abuse) and the symptoms of attention deficit hyperactivity disorder (ADHD) in young adulthood. Method: Data were collected from a Danish national study conducted by The Danish National Centre for Social Research in 2008 and 2009. A sample of 4,718 young adults (24 years of age) were randomly selected using the total birth cohort of children born in 1984. Structured interviews were conducted with a response rate of 63%, equating to a total sample size of 2,980 participants. Results: Chi-square analyses revealed significant relationships between child maltreatment groups and a probable diagnosis of ADHD using the Adult ADHD Self-Report Scale (ASRS). Binary logistic regression analysis showed that the overall abuse class was more strongly associated with probable ADHD (OR=5.08), followed by emotional abuse (OR=3.09) and sexual abuse (OR=2.07). Conclusions: The results showed that childhood maltreatment was associated with increased risk of ADHD symptoms in young adulthood. The findings of this study are discussed within the existing literature and suggestions for future research are outlined in order to replicate these findings in other adult populations.

Background: Childhood sexual abuse (CSA) is a common occurrence and a robust, yet non-specific, predictor of adult psychopathology. While many demographic and abuse factors have been shown to impact this relationship, their common and specific effects remain poorly understood. Objective: This study sought to assess the prevalence of Axis I disorders in a large sample of help-seeking victims of sexual trauma, and to examine the common and specific effects of demographic and abuse characteristics across these different diagnoses. Method: The participants were attendees at four treatment centres in Denmark that provide psychological therapy for victims of CSA (N=434). Axis I disorders were assessed using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Multivariate logistic regression analysis was used to examine the associations between CSA characteristics (age of onset, duration, number of abusers, number of abusive acts) and 10 adult clinical syndromes. Results: There was significant variation in the prevalence of disorders and the abuse characteristics were differentially associated with the outcome variables. Having experienced sexual abuse from more than one perpetrator was the strongest predictor of psychopathology. Conclusions: The relationship between CSA and adult psychopathology is complex. Abuse characteristics have both unique and shared effects across different diagnoses.

Background Accurate assessment of childhood adversity is fundamental in understanding risk and resilient factors that can inform appropriate intervention and prevention strategies. Different statistical and methodological approaches (e.g., prospective, selfreported data) have been used to assess pathways and outcomes associated with childhood adversity, however, each is limited in a number of ways. Objectives Linking administrative data to population-based studies provides a powerful tool to overcome some of the challenges in trauma research and permits the estimation of temporally ordered models of risk. The current study seeks to assess the effect of childhood adversity on a diagnosis of traumatic disorder (TD). Methods Data were collected from a Danish national study in 2008/2009. A sample of 4,718 young adults were randomly selected from the birth cohort of children born in 1984. Structured interviews were conducted on 2,980 participants. This data was then linked with parental data (including 4 years prior to birth of child) and a ICD 10 diagnosis of a TD using information from the Danish registries. Findings Hierarchical regression analysis was used to examine parental risk factors, self-reported child maltreatment, experiencing violence in young adulthood and risk of a TD diagnosis at age 28. Findings indicated the dominant factor associated with TD was self-reported PTSD symptoms at age 24 (OR =3.82); followed by a parental mental health diagnosis (OR = 2.80). Being of female gender (OR = 2.42) and experiencing violence in young adulthood (OR = 1.94) also increased risk of a TD diagnosis. Conclusion This study highlights the benefits of incorporating administrative data with self-report data to provide a more nuanced understanding of childhood adversity across different developmental stages. These findings have important conceptual and methodological implications and may be useful in informing future trauma studies.

With the publication of the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11) due for release in 2018, a number of studies have assessed the factorial validity of the proposed post-traumatic stress disorder (PTSD) and complex (CPTSD) diagnostic criteria and whether the disorders are correlated but distinct constructs. As the specific nature of CPTSD symptoms has yet to be firmly established, this study aimed to examine the dimension of affect dysregulation as two separate constructs representing hyper-activation and hypo-activation. Seven alternative models were estimated within a confirmatory factor analytic framework using the International Trauma Questionnaire (ITQ). Data were analysed from a young adult sample from northern Uganda (n = 314), of which 51% were female and aged 18–25 years. Forty per cent of the participants were former child soldiers (n = 124) while the remainder were civilians (n = 190). The prevalence of CPTSD was 20.8% and PTSD was 13.1%. The results indicated that all models that estimated affective dysregulation as distinct but correlated constructs (i.e. hyper-activation and hypo-activation) provided satisfactory model fit, with statistical superiority for a seven-factor first-order correlated model. Furthermore, individuals who met the criteria for CPTSD reported higher levels of war experiences, symptoms of anxiety and depression, and somatic problems than those with PTSD only and no diagnosis. There was also a much larger proportion of former child soldiers that met the criteria for a CPTSD diagnosis. In conclusion, these results partly support the factorial validity of the ICD-11 proposals for PTSD and CPTSD in a non-Western culture exposed to mass violence. These findings highlight that more research is required across different cultural backgrounds before firm conclusions can be made regarding the factor structure of CPTSD using the ITQ.

Background: Based on Bowlby's attachment theory, Bartholomew proposed a four-category attachment typology by which individuals judged themselves and adult relationships. This explanatory model has since been used to help explain the risk of psychiatric comorbidity. Objective: The current study aimed to identify attachment typologies based on Bartholomew's attachment styles in a sample of bereaved parents on dimensions of closeness/dependency and anxiety. In addition, it sought to assess the relationship between the resultant attachment typology with a range of psychological trauma variables. Method: The current study was based on a sample of 445 bereaved parents who had experienced either peri- or post-natal death of an infant. Adult attachment was assessed using the Revised Adult Attachment Scale (RAAS) while reaction to trauma was assessed using the Trauma Symptom Checklist (TSC). A latent profile analysis was conducted on scores from the RAAS closeness/dependency and anxiety subscales to ascertain if there were underlying homogeneous attachment classes. Emergent classes were used to determine if these were significantly different in terms of mean scores on TSC scales. Results: A four-class solution was considered the optimal based on fit statistics and interpretability of the results. Classes were labelled “Fearful,” “Preoccupied,” “Dismissing,” and “Secure.” Females were almost eight times more likely than males to be members of the fearful attachment class. This class evidenced the highest scores across all TSC scales while the secure class showed the lowest scores. Conclusions: The results are consistent with Bartholomew's four-category attachment styles with classes representing secure, fearful, preoccupied, and dismissing types. While the loss of an infant is a devastating experience for any parent, securely attached individuals showed the lowest levels of psychopathology compared to fearful, preoccupied, or dismissing attachment styles. This may suggest that a secure attachment style is protective against trauma-related psychological distress.

Abstract Background Primary care plays a central role in most, if not all, health care systems including the care of vulnerable populations such as people who have been incarcerated. Studies linking incarceration records to health care data can improve understanding about health care access following release from prison. This review maps evidence from data-linkage studies about primary care use after prison release. Methods The framework by Arksey and O’Malley and guidance by the Joanna Briggs Institute (JBI) were used in this review. This scoping review followed methods published in a study protocol. Searches were performed (January 2012-March 2023) in MEDLINE, EMBASE and Web of Science Core Collection using key-terms relating to two areas: (i) people who have been incarcerated and (ii) primary care. Using eligibility criteria, two authors independently screened publication titles and abstracts (step 1), and subsequently, screened full text publications (step 2). Discrepancies were resolved with a third author. Two authors independently charted data from included publications. Findings were mapped by methodology, key findings and gaps in research. Results The database searches generated 1,050 publications which were screened by title and abstract. Following this, publications were fully screened (n = 63 reviewer 1 and n = 87 reviewer 2), leading to the inclusion of 17 publications. Among the included studies, primary care use after prison release was variable. Early contact with primary care services after prison release (e.g. first month) was positively associated with an increased health service use, but an investigation found that a large proportion of individuals did not access primary care during the first month. The quality of care was found to be largely inadequate (measured continuity of care) for moderate multimorbidity. There were lower levels of colorectal and breast cancer screening among people released from custody. The review identified studies of enhanced primary care programmes for individuals following release from prison, with studies reporting a reduction in reincarceration and criminal justice system costs. Conclusions This review has suggested mixed evidence regarding primary care use after prison release and has highlighted challenges and areas of suboptimal care. Further research has been discussed in relation to the scoping review findings.

Background and Objectives SARS-CoV-2 infection in children and young people (CYP) can lead to life threatening conditions including COVID-19, transmission to more vulnerable individuals, or even long COVID. Vaccination against COVID-19 reduces the chance of infection and transmission of the virus, but vaccine uptake in the UK has been shown to decrease with age. Approach We undertook a multistate-model approach to estimate hazard ratios on national cohorts constructed from linked health and administrative data, adjusting for several demographic factors. The models were applied to 3,433,483 CYP aged 5-17 years between 4th August 2021 and 31st May 2022. The results were combined in a random effects meta-analysis. Results Uptake of the first COVID-19 vaccine in CYP was lower compared to older age groups in the UK, and diminished further with subsequent doses (34%, 20% and 2% for 1st, 2nd, and booster dose respectively). Age of the CYP and vaccination status of the adults in the household were identified as important risk factors. For example, 5-11-year-olds were less likely to receive their first vaccine compared to 16-17-year-olds (adjusted Hazard Ratio [aHR]: 0.10 (95%CI: 0.06-0.19), and CYP in unvaccinated households were less likely to receive their first vaccine compared to partially vaccinated households (aHR: 0.19, 95%CI 0.13-0.29). Conclusions and Implications Our work highlights the need for targeted strategies to increase COVID-19 vaccine acceptance and uptake among CYP, especially considering the influence of parental consent and household factors. Further research could help identify risk factors in household types to investigate more direct associations, which may be influenced by factors such as living with vulnerable people, familial structure, or deprivation.

Objectives Homelessness is a complex and pressing issue affecting individuals and communities worldwide, including Northern Ireland. Understanding its root causes and associated risk factors is crucial for effective interventions. This study aims to identify primary contributors to homelessness and explore risk factors linked to chronic homelessness in Northern Ireland. Methods Utilizing an anonymized, linked dataset incorporating Northern Ireland Housing Executive (NIHE) and health and social care data, we will conduct a pioneering record linkage study. This analysis will focus on unravelling homelessness dynamics, particularly chronic homelessness, spanning from 2012 to 2022. Results Through our comprehensive analysis of using linked administrative datasets, we anticipate unveiling significant insights into the prevalence and persistence of chronic homelessness in Northern Ireland. By employing descriptive analyses, we will uncover nuanced patterns and trends, shedding light on the multifaceted dynamics of homelessness within the region. Moreover, our examination aims to identify key factors contributing to the persistence of chronic homelessness, providing crucial insights for developing targeted interventions and support systems. The outcomes of this analysis will not only contribute to a deeper understanding of the complexities surrounding homelessness but also serve as a foundation for evidence-based policymaking and community initiatives aimed at alleviating homelessness in Northern Ireland. Conclusion This study has the potential to increase our understanding about the characteristics, needs and outcomes of the homeless population in Northern Ireland. It is possible that the results may contribute to facilitating further cross-departmental integration and commitment to addressing vulnerable homeless households with complex needs.

Abstract SARS-CoV-2 infection in children and young people (CYP) can lead to life-threatening COVID-19, transmission within households and schools, and the development of long COVID. Using linked health and administrative data, we investigated vaccine uptake among 3,433,483 CYP aged 5–17 years across all UK nations between 4th August 2021 and 31st May 2022. We constructed national cohorts and undertook multi-state modelling and meta-analysis to identify associations between demographic variables and vaccine uptake. We found that uptake of the first COVID-19 vaccine among CYP was low across all four nations compared to other age groups and diminished with subsequent doses. Age and vaccination status of adults living in the same household were identified as important risk factors associated with vaccine uptake in CYP. For example, 5–11 year-olds were less likely to receive their first vaccine compared to 16–17 year-olds (adjusted Hazard Ratio [aHR]: 0.10 (95%CI: 0.06–0.19)), and CYP in unvaccinated households were less likely to receive their first vaccine compared to CYP in partially vaccinated households (aHR: 0.19, 95%CI 0.13–0.29).

Objectives Homelessness is a growing public health concern in Northern Ireland. Our study intends to measure the scale of homelessness in Northern Ireland and identify the potential of using linked administrative data to understand the complex needs of people who experience homelessness (PEH) and contribute to policy and service development. Methods All formal applications for homelessness go to one central body the Northern Ireland Housing Executive (NIHE). However, it is possible that a proportion might remain unknown to local housing authorities due to personal circumstances, changes in legislation or eligibility criteria etc, which might mean that formal applications underestimate the true scale of homelessness. In this study of the interplay of homelessness health and exposure to social services, we can identify emergency accommodation centres by using ArcGIS, a geographic information system that allows users to analyse maps and spatial data to identify individuals who have been residing at hostels, addiction centres or women's refuges. Results We identified 115 emergency accommodation centres. We plan to use this information to quantify the scale of homelessness in NI and compare the demographic profiles of those who may not be registered with local housing authorities. It is likely these individuals may represent a highly vulnerable population with complex needs and need tailored support packages. Conclusion We will discuss some of the limitations of housing-administrative data and the methodologies we explored to help identify those people who may not be known to local authorities that are experiencing homelessness. Our findings can be used to inform policy on providing continuity of care and support for all people experiencing homelessness and reduce barriers to timely access of this support.

Objectives The COVID-19 pandemic and associated societal changes including access to emergency departments (ED) may have influenced suicide ideation (SI) incidence and the case fatality rates. This study quantifies the numbers of individuals presenting to ED with SI before and during the pandemic and examines risk of subsequent presentation to ED with self-harm and mortality. Methods The Northern Ireland Self-Harm (SH) Registry provided data on suicide ideation and self-harm presentations across 12 ED departments in NI between January 2016 and September 2021. Linkage to health and mortality records provided follow up to September 2021. Cox proportional hazards regression models were employed to assess subsequent self-harm and mortality risk following initial presentation to ED with suicidal ideation. Results Preliminary findings indicate that during the study period there were 21,601 ED presentations with SI between made by 9184 individuals of whom 2,011 subsequently went on to self-harm. Presentations with SI increased in the four years prior to the pandemic with the highest occurring in 2019. The number of individuals presenting to ED then decreased substantially in March/April 2020 leading to a 37% and 47% reduction, corresponding to the first “lockdown”. Presentations remained lower until June 2020 when restrictions started to ease. Compared to the pre-pandemic period, individuals presenting with SI during the pandemic were approximately 60% less likely to ED with subsequent self-harm (ORadj = 0.41, 95% CI 0.29, 0.59) even after adjustment for variations in the demographic profile of individuals, and the care and management they received at the ED. Conclusion Rates of ideation followed similar trends to previous years except in the early months of the pandemic. Those presenting with SI during the pandemic conferred a reduced likelihood of re-attending at ED with subsequent self-harm compared to the pre-pandemic period. The possible underlying mechanisms behind these findings will be discussed.

Objectives A large proportion of those who die by suicide present to an Emergency Department (ED) with self-harm (SH) in the year before death. This study examines ‘does risk of death following ED presentation with SH vary according to hospital attended?’ Methods The Northern Ireland Self-Harm Registry provided data on SH presentations to 12 ED departments in NI between 2012-2019. Linkage to health and mortality records provided follow up to December 2019. Cox proportional hazards regression models were employed to assess mortality risk following presentation with SH among 12 ED departments in NI. Results Analysis of the 64,350 ED presentations for self-harm by 30,011 individuals confirmed a marked variation across EDs in proportion of patients receiving mental health assessment and likelihood of admission to general and psychiatric wards. There was a significant variation in suicide risk according to ED attended with the three-fold range between the lowest (HRadj 0.32 95%CIs 0.16, 0.67) and highest. These differences persisted even after adjustment for patient characteristics, variation in types of self-harm, and care management at the ED. Conclusion Management of SH cases in the ED is important, however, it is the availability, access and level of engagement with, care in the community rather than the immediate care at EDs that is most critical for patients presenting to ED with self-harm.

BackgroundThe Data and Connectivity COVID-19 Vaccines Pharmacovigilance (DaC-VaP) UK-wide collaboration was created to monitor vaccine uptake and effectiveness and provide pharmacovigilance using routine clinical and administrative data. To monitor these, pooled analyses may be needed. However, variation in terminologies present a barrier as England uses the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), while the rest of the United Kingdom uses the Read v2 terminology in primary care. The availability of data sources is not uniform across the United Kingdom. ObjectiveThis study aims to use the concept mappings in the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) to identify common concepts recorded and to report these in a repeated cross-sectional study. We planned to do this for vaccine coverage and 2 adverse events of interest (AEIs), cerebral venous sinus thrombosis (CVST) and anaphylaxis. We identified concept mappings to SNOMED CT, Read v2, the World Health Organization’s International Classification of Disease Tenth Revision (ICD-10) terminology, and the UK Dictionary of Medicines and Devices (dm+d). MethodsExposures and outcomes of interest to DaC-VaP for pharmacovigilance studies were selected. Mappings of these variables to different terminologies used across the United Kingdom’s devolved nations’ health services were identified from the Observational Health Data Sciences and Informatics (OHDSI) Automated Terminology Harmonization, Extraction, and Normalization for Analytics (ATHENA) online browser. Lead analysts from each nation then confirmed or added to the mappings identified. These mappings were then used to report AEIs in a common format. We reported rates for windows of 0-2 and 3-28 days postvaccine every 28 days. ResultsWe listed the mappings between Read v2, SNOMED CT, ICD-10, and dm+d. For vaccine exposure, we found clear mapping from OMOP to our clinical terminologies, though dm+d had codes not listed by OMOP at the time of searching. We found a list of CVST and anaphylaxis codes. For CVST, we had to use a broader cerebral venous thrombosis conceptual approach to include Read v2. We identified 56 SNOMED CT codes, of which we selected 47 (84%), and 15 Read v2 codes. For anaphylaxis, our refined search identified 60 SNOMED CT codes and 9 Read v2 codes, of which we selected 10 (17%) and 4 (44%), respectively, to include in our repeated cross-sectional studies. ConclusionsThis approach enables the use of mappings to different terminologies within the OMOP CDM without the need to catalogue an entire database. However, Read v2 has less granular concepts than some terminologies, such as SNOMED CT. Additionally, the OMOP CDM cannot compensate for limitations in the clinical coding system. Neither Read v2 nor ICD-10 is sufficiently granular to enable CVST to be specifically flagged. Hence, any pooled analysis will have to be at the less specific level of cerebrovascular venous thrombosis. Overall, the mappings within this CDM are useful, and our method could be used for rapid collaborations where there are only a limited number of concepts to pool.

Purpose: To enhance the learner's competence with knowledge of research data on topical zinc for treatment of chronic leg ulcers., Target Audience: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care., Objectives: After participating in this educational activity, the participant should be better able to:, Abstract: Venous leg ulcers (VLUs) are chronic leg wounds that can have a debilitating effect on the physical and psychological health of patients. Older patients, who are a vulnerable group, suffer from VLUs more frequently, and the prevalence of these ulcers increases as the population ages. Venous leg ulcers also pose a serious cost to the healthcare industry. Zinc, in the form of topical creams and lotions, has been used in wound care for more than 3,000 years and is now contained in a variety of wound care products that are used in the treatment of chronic VLUs., Objective: The aim of this review was to examine the current empirical evidence to assess if topical zinc-based wound products are effective in promoting the healing of VLUs., Methods: Following a systematic search and review of the literature, based on selected keywords, 11 studies were identified as being relevant, and data were extracted using content analysis., Results: The results show that there is currently very poor-quality evidence to suggest that topical zinc-based wound products are effective in healing VLUs, either in conjunction with compression therapy, as compression bandages themselves, or as a topical skin protectant. Some of the studies were sponsored by industry, which challenges the validity and reliability of their results., Conclusions: It is apparent that not only was much of the literature conducted on a small scale, it is also outdated and methodologically inconsistent. There is scant high-quality evidence to suggest that topical zinc-based wound products are effective in promoting the healing of VLUs. New studies are urgently needed that are larger, scientifically rigorous, and without bias from industry. This will enable clinicians to implement evidenced-based practice and choose the most appropriate wound management product to improve patient care and reduce the costs of healthcare.