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Abstract: This retrospective cross-sectional paper examines the relationship between early breastfeeding exposure and children’s academic test scores at nine years of age independent of a wide range of possible confounders. The final sample comprised 8226 nine-year-old school children participating in the first wave of the Growing Up in Ireland study. The children were selected through the Irish national school system using a 2-stage sampling method and were representative of the nine-year population. Information relating to breastfeeding initiation and exposure duration was obtained retrospectively at nine years of age via parental recall and children’s academic performance was assessed using standardised reading and mathematics tests. Hierarchical linear regression analysis with robust standard errors to control for clustering at the school level was used to quantify the effect of breastfeeding on children’s test scores. Propensity score matching was used to compare treatment effects across groups defined by their propensity to breastfeed. In unadjusted analysis, children who were breastfed scored 8.67 percentage points higher on reading and 7.42 percentage points higher on mathematics compared to those who were never breastfed. While the breastfeeding advantage attenuated appreciably when adjusted for a range of child, maternal, socio-economic and socio-environmental characteristics, children who were breastfed continued to enjoy a significant test score advantage of 3.24 (p <0.001) and 2.23 (p <0.001) percentage points on reading and mathematics respectively compared to those who were never breastfed. Any amount of breastfeeding was associated with significantly higher test scores than no exposure, but evidence of a dose-response relationship was weak. The results of the propensity score matching analysis indicated that the test score advantage of breastfed children is robust and that the magnitude of the effect varies across groups defined by their propensity to breastfeed, being largest amongst the most socially disadvantaged and falling to near zero among the most advantaged group. [Copyright &y& Elsevier]

Abstract: Despite its growth experience, Ireland still lags behind in international league tables on broadband adoption and within Ireland great disparities exist between central and peripheral regions. This paper explores the context-specific determinants of broadband adoption among Irish small- and medium-sized enterprises (SMEs), attempting to shed some light on the sources of the considerable geographic variation in particular. Drawing from determinants of broadband adoption identified in literature the authors develop a number of plausible hypotheses. Using cross-section data from a ComReg survey of Irish-based SMEs, a logit model of broadband adoption is estimated. Among other factors, a company''s industrial sector and other demand proxies are good predictors of broadband adoption. Controlling for other factors, regional ISP market concentration appears to be negatively associated with the probability of broadband adoption. It is argued that, in the absence of more detailed information, statistics on regional-level market structure could be a promising indicator of the supply-side. [Copyright &y& Elsevier]

Depression and anxiety are highly comorbid constructs. However little is known about the mechanisms that underpin this comorbidity/connectivity or the divergence between constructs that seems to occur in adolescence. The current study targeted emotion regulation (ER) as a potential plausible mechanism for explaining how anxiety and depression symptoms in adolescence might begin to connect, perpetuate, and ultimately diverge from one another. Using data from a cross-sectional school-based study, of adolescent females (age 11–18 years; N = 615; majority were white (97.7%)), we modelled variation in ER using latent profile analysis. Then, using network analysis (NA), we generated separate depression-anxiety symptom networks for adolescents at varying levels of ER. Three latent classes of ER were identified (low ER 15%, intermediate ER 34%, high ER 51%). The results of the network comparison test found no significant differences in global strength between the 'low ER' and the 'intermediate ER' ability network. This study is among the first to attempt to model change in depression-anxiety symptom connectivity in adolescence in relation to a common contextual/risk factor. The current study therefore offers a unique contribution to the examination of the role of transdiagnostic factors in the study of adolescent depression and anxiety from a network perspective, and provides a promising framework for the study of ER among anxiety and depression symptomatology in adolescence. [ABSTRACT FROM AUTHOR]

Background: This study examines overweight/obesity and chronic health conditions (CHCs) in older people with intellectual disability (ID). Methods: Data for this cross‐sectional observational study emanated from Wave 2 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, a longitudinal study assessing the health and well‐being of older Irish adults with ID aged ≥40 years across all levels of ID. Participation involves an interview process and collation of objective health measures. In this study, body mass index (BMI) (n = 572), used as a measure of weight status, was examined with clustered doctor's diagnosed CHCs. Descriptive analysis was conducted where counts (n) and proportions (%) were used to summarise the variables univariately, while cross‐tabulations were used for bivariate summary into counts and proportions. With overweight/obesity prevalence established and patterns described using logistical regression, Pearson's chi‐squared test was used to test for significant associations. Results: Overweight/obesity identified in 69% of participants occurred with greater frequency in women (72%). A higher percentage of participants aged <50 years (72.5%) were overweight/obese than those aged 50–64 (70%) and 65+ (61.4%). Level of ID and residence type were significantly associated with weight status (P < 0.001), with overweight/obesity more prevalent in mild (85.7%) than moderate (72%) or severe/profound ID (51.4%). Of those who lived independently/with family, 78.4% were overweight/obese, as were 74% living in a community group home (P < 0.001). Almost all overweight/obese participants' waist measurements were in the substantially increased risk of metabolic disease waist measurement category (92%, P < 0.001). Logistical regression used to model CHCs on BMI showed significant association between BMI and gastrointestinal tract [odds ratio (OR) = 0.57, P < 0.008, 95% confidence interval (CI) = (0.37; 0.86)], respiratory condition [OR = 8.95, P < 0.004, 95% CI = (2.57; 56.72)] and musculoskeletal disorders [OR = 0.40, P < 0.001, 95% CI = (0.25; 0.63)]. Conclusions: The findings illustrate the strong cross‐sectional association between overweight/obesity and CHCs. These findings suggest a need to prioritise weight status as a health risk to people with ID as they age. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to (1) use the objective activPAL activity monitor to assess physical activity behaviors, including sitting/lying, standing, and both light (LIPA) and moderate-to-vigorous physical activity (MVPA); (2) to develop distinct activity profiles based on lime spent in each behavior in a sample of adolescent females; and (3) examine whether levels of adiposity differ across these activity profiles. Methods: Female adolescents (n = 195: 14-18 y) had body mass index (median = 21.7 [IQR = 5.2] kg/m2) and 4-site skinfold thickness (median 62.0 mm; IQR = 37.1) measured. Physical activity behaviors were measured using the activPAL. Hierarchical cluster analysis grouped participants into activity profiles based on similar physical activity characteristics. Linear mixed models explored differences in body composition across activity profiles. Results: Three activity profiles were identified, a low (n = 35), moderate (n = 110), and a high activity profile (n = 50). Significant differences across activity profiles were observed for skinfold thickness (p = .046), with higher values observed in the low activity profile compared with the high activity profile. Conclusions: Profiling free-living activity using behaviors from across the activity intensity continuum may account for more of the variability in energy expenditure then examining specific activity intensities, such as MVPA alone. The use of activity profiles may enable the identification of individuals with unhealthy activity behaviors, leading to the development and implementation of more targeted interventions. [ABSTRACT FROM AUTHOR]

Objectives: To establish the supervision models used during physiotherapy practice placements and to determine student and practice educators' evaluations of the quality of these placements. Design: Cross-sectional study set in clinical sites providing placements for physiotherapy students in Ireland. Participants: Practice educators and students completing placements in 2015/16. Outcome Measure: Questionnaire which measured 18 indicators linked to quality assured placements. Eight additional indicators in the practice educator questionnaire addressed the overall feasibility of the supervision model. Two open-ended questions captured comments on the benefits and challenges of each model. Results: The overall response rate was 72% (112/155). The majority (75%, n = 84) of participants reported a 1:1 (one student: one educator) model of supervision. Fourteen percent (n = 16) reported a 1.2 (one student: two educators) model and 9% (n = 10) a 2.1 (two students: one educator) model. There was generally positive agreement with the questionnaire indicating that all placements, irrespective of supervision model were positively evaluated by participants. Students, however, indicated a more negative evaluation of the placement than practice educators in indictors related to communication, the provision of feedback, establishing an effective relationship with their educator and diversity of available learning opportunities. Indicators relating to productivity and the placement representing an efficient use of resources and personnel received more negative or equivocal ratings by educators. Conclusions: While the 1.1 model remains the most widely used supervision model in physiotherapy practice education, other models also score positively, offering choice to placement providers when determining the model that best suits their service. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization published updated Environmental Noise Guidelines in 2018. Included are recommended limit values for environmental noise exposure based on systematic reviews for a range of health outcomes, including cognitive impairment. There is emerging evidence in the literature that chronic exposure to road traffic noise may affect cognitive function in older adults, but this relationship is not well established. This study spatially linked nationally representative health microdata from The Irish Longitudinal Study on Ageing to building-level modelled noise data for two cities in the Republic of Ireland. This was used to investigate associations between exposure to road traffic noise and cognitive function in a sample of older adults, independent of a range of socio-demographic and behavioural characteristics, as well as exposure to air pollution.Methods: We used the Predictor-LimA Advanced V2019.02 software package to estimate noise originating from road traffic for the cities of Dublin and Cork in Ireland according to the new common noise assessment methodology for the European Union (CNOSSOS-EU). Noise exposure values were calculated for each building and spatially linked with geo-coded TILDA microdata for 1706 individuals aged 54 and over in the two cities. Ordinary least squares linear regression models were estimated for eight standardised cognitive tests including noise exposure as an independent variable, with standard errors clustered at the household level. Models were adjusted for individual sociodemographic, behavioural and environmental characteristics.Results: We find some evidence that road traffic noise exposure is negatively associated with executive function, as measured by the Animal Naming Test, among our sample of older adults. This association appears to be accounted for by exposure to air pollution when focusing on a sub-sample. We do not find evidence of an association between noise exposure and memory or processing speed.Conclusions: Long term exposure to road traffic noise may be negatively associated with executive function among older adults. [ABSTRACT FROM AUTHOR]

The recent study of prospective doctor migration and retention suggests that more than half of junior doctors intend to migrate from Ireland. While intent is not necessarily outcome, such intentions match similar survey results in Ireland and elsewhere. The rationale for migration is described as a function of difficult workplace circumstances (notably long hours and mismanagement). Lifestyle factors may however also be important for both migration and significant levels of return migration. These are related to family formation, and to an established culture of migration, that has contributed to a considerable circularity of mobility and migration, primarily between Anglophone countries. International migration may also have unspecified regional variations and impacts. Migration has taken a similar form for half a century and longstanding policies to constrain its more damaging impacts have been conspicuously unsuccessful yet responses remain urgent. [ABSTRACT FROM AUTHOR]

The issue of doctor retention has been a challenge in Ireland for many years. Poor working conditions including poor supervision, cost of training, bullying, worsening mentoring experiences and speciality specific issues are a substantial challenge faced by doctors in Ireland, thus leading to a higher degree of emigration. While some changes have been introduced to the system and have some positive effects, the root causes of doctor emigration have not been addressed. This commentary reviews the publication by Brugha et al published in the IJHPM in April 2020 on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle" and explains why the current system needs to change for the benefit of patient safety, doctor well-being and better patient care. Ireland's Health Service Executive intends to take steps towards developing a new model of medical workforce to address the issue of recruitment and retention challenges within the healthcare system. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine mealtime and patient factors associated with meal completion among hospitalised older patients. We also considered contextual factors such as staffing levels and ward communication. Background: Sub‐optimum nutrition is a modifiable risk factor for hospital associated decline (HAD) in older patients. Yet, the quality of mealtime experiences can be overlooked within ward routinised practice. Design: Cross sectional, descriptive observation study. Methods: We undertook structured observation of mealtimes examining patient positioning, mealtime set‐up and feeding assistance. The outcome was meal completion categorised as 0, 25%, 50%, 75% or 100%. Data were collected on patient characteristics and ward context. We used mixed‐effects ordinal regression models to examine patient and mealtime factors associated with higher meal completion producing odds ratios (OR) and 95% confidence intervals (CI). The study was reported as per STROBE guidelines. Results: We included 60 patients with a median age of 82 years (IQR 76–87) and clinical frailty score of 5 IQR (4–6). Of the 279 meals, 51% were eaten completely, 6% three quarters, 15% half, 18% a quarter and 10% were not eaten at all. Mealtime predictors with a weak association with less‐meal completion were requiring assistance, special diets, lying in bed, and red tray (indicator of nutrition risk), but were not statistically significant. Significant patient‐level factors were higher values for frailty (OR 0.34 [0.11–1.04]) and Malnutrition Universal Screening Tool (OR 0.22 [0.08–0.62]). The average nurse‐to‐patient ratio was 1:5.5. Conclusion: Patient factors were the strongest predictors for meal completion, but mealtime factors had a subtle influence. The nursing teams' capacity to prioritise mealtimes above competing demands is important as part of a comprehensive nutrition strategy. Relevance to clinical practise: Nurses are central to optimising nutrition for frail older patients. It requires ward leadership to instil a culture of prioritising assisted mealtimes, improved communication, greater autonomy to tailor nutrition strategies and safe staffing levels. [ABSTRACT FROM AUTHOR]

Health policy in many countries is underpinned by a commitment to support dependent older people to remain in their own home for as long as possible and practicable. This study explores factors affecting both admission to long-stay residential care (LSRC) and mortality among people with and without dementia who are currently living at home with intensive formal care support. This is a cross-sectional study based on administrative data collected on 429 dependent older people in Ireland, 269 of whom were people with dementia. A cause-specific hazard model was used to investigate the hazard of admission to LSRC, while accounting for mortality as a competing risk and vice versa. Admission to LSRC was higher for people with dementia relative to people without and for those receiving lower amounts of informal care. The hazard of mortality was significantly higher for older people aged 85+, whereas it was lower for individuals with a medium level of dependency relative to those with high levels of dependency. The hazard of mortality was also influenced by the amount of informal care provision. People with dementia are more likely to be admitted to LSRC than people without. Care for people with dementia needs to be more specialised and personal, and intensity of provision should not be equated to the number of care hours on offer. Informal care provision may help to prevent admission to LSRC. Advanced age, physical dependency and informal care provision affect mortality, raising interesting issues in relation to resource allocation. [ABSTRACT FROM AUTHOR]

Background: Women across the world value choice and control throughout their maternity care experiences. In response to this health policy and frameworks are adapting and developing. The concepts of choice and control are extrinsically complex and open to interpretation by healthcare professionals and service users, with the two not necessarily aligning. Depending on a number of factors, women's experiences of choice and control within the same maternity care system may be very different. This study aimed to investigate the factors influencing women's perceptions of choice and control during pregnancy and birth in Ireland.Methods: We conducted a cross-sectional study using an adapted version of the UK national maternity experience survey (National Perinatal Epidemiology Unit). During March - July 2017, a sample of 1277 women were recruited from the postnatal wards of three maternity units and a tertiary maternity hospital. Poisson regression was used to assess the association between twelve factors and a series of measures of the women's perception of choice and control.Results: Most women reported not having choice in the model or location of their maternity care but most reported being involved enough in decision-making, especially during birth. Women who availed of private maternity care reported higher levels of choice and control than those who availed of public maternity care. This factor was the most influential factor on almost all choice and control measures.Conclusion: Most women experiencing maternity care in Ireland report not having choice in the model and location of care. These are core elements of the Irish maternity strategy and significant investment will be required if improved choice is to be provided. Availing of private maternity care has the strongest influence on a woman's perceived choice and control but many women cannot afford this type of care, nor may they want this model of care. [ABSTRACT FROM AUTHOR]

Background: Several kinds of motor dysfunction can predict future cognitive impairment in elderly individuals. However, the ability of the fine motor index (FINEA) and gross motor index (GROSSA) to predict the risk of cognitive impairment has not been assessed.Objective: We investigated the associations between FINEA/GROSSA and cognitive impairment.Methods: The data of 4,745 participants from The Irish Longitudinal Study on Ageing (TILDA) were analyzed. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). We first assessed the correlation between the FINEA/GROSSA and MMSE in a cross-sectional study. Then, we further investigated the predictive role of the incidence of cognitive impairment in a prospective cohort study.Results: We found that both FINEA and GROSSA were negatively correlated with MMSE in both the unadjusted (FINEA: B = -1.00, 95%confidence intervals (CI): -1.17, -0.83, t = -11.53, p < 0.001; GROSSA: B = -0.85, 95%CI: -0.94, -0.76, t = -18.29, p < 0.001) and adjusted (FINEA: B = -0.63, 95%CI: -0.79, -0.47, t = -7.77, p < 0.001; GROSSA: B = -0.57, 95%CI: -0.66, -0.48, t = -12.61, p < 0.001) analyses in a cross-sectional study. In a prospective cohort study, both high FINEA and high GROSSA were associated with an increased incidence of cognitive function impairment (FINEA: adjusted odds ratios (OR) = 2.35, 95%CI: 1.05, 5.23, p = 0.036; GROSSA adjusted OR = 3.00, 95%CI: 1.49, 6.03, p = 0.002) after 2 years of follow-up.Conclusion: Higher FINEA and GROSSA scores were both associated with an increased incidence of cognitive impairment. FINEA or GROSSA might be a simple tool for identifying patients with cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists (SLTs) working with dysphagia have had to radically alter diagnostic and rehabilitation services during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, hereafter referred to as coronavirus disease (COVID-19). Given the aerosol-generating procedures inherent in swallow assessment and interventions, these SLTs have also been particularly susceptible to virus exposure. Aims: To investigate the psychological impact of COVID-19 on SLTs working with adult dysphagia across the Republic of Ireland and to identify the personal and professional factors associated with depression, anxiety, stress and posttraumatic stress disorder (PTSD). To explore SLT perspectives regarding their experiences during the COVID-19 pandemic. Methods&Procedures: A cross-sectional 34-itemonline surveywas developed and piloted. The survey collected demographic details and professional factors and it incorporated the Depression, Anxiety, and Stress Scale--21 (DASS-21) and the Impact of Event Scale--Revised (IES-R). The survey also sought SLT perspectives regarding their experiences during the pandemic. It was distributed to Irish SLTmanagers, the Irish Association of Speech and Language Therapists (IASLT) and the Irish Dysphagia Special Interest Group (SIG) for dissemination. Outcomes & Results: A total of 94 SLTs working with adults with dysphagia across Ireland responded. In total, 60% of respondents screened positive for depression, anxiety, stress and/or PTSD. Based on the DASS-21, 38% screened positive for depression (mean score = 8.0; SD = 6.3), 36% screened positive for anxiety (mean score = 6.5; SD = 6.0), and 49% screened positive for stress (mean score = 15.4; SD = 6.9). A total of 26% of respondents screened positive for PTSD (mean IES-R total score = 22.6; SD = 16.0). Factors associated with depression, anxiety, stress and PTSD were young age (p = 0.002), limited clinical experience (p=0.01) and not livingwith children (p=0.02). Athematic analysis of SLT perspectives identified four main themes: 'fear of COVID-19 infection and transmission', 'uncertainty regarding policies and procedures', 'changes in SLT roles and responsibilities' and 'increased workload'. Conclusions & Implications: This study highlights the psychological impact of COVID-19 on SLTs working with adults with dysphagia in Ireland and identifies SLTs who are at risk of depression, anxiety, stress and PTSD during the COVID-19 pandemic. Findings may assist employers to identify staff who require psychological support and long-term follow-up during this pandemic and any future health emergencies. [ABSTRACT FROM AUTHOR]

Background: In the pre-COVID-19 era, healthcare professionals experienced stress and burnout. The international literature confirms that COVID-19 placed significant additional burdens on healthcare workers. Aim: To describe and characterise the magnitude and variety of ways in which the COVID-19 pandemic affected the personal, social and professional lives of healthcare workers representing several multidisciplinary specialties in a fully-integrated palliative and elderly care service. Design: All staff were invited to complete an anonymised standardised questionnaire evaluating the impact of COVID-19 across a diverse range of domains. The study was conducted over a 6-week period commencing 11 September 2020. Setting: The setting incorporates two distinct but integrated services operating under a single management structure in Ireland: (i) Specialist palliative care across hospice (44 beds), community and hospitals and (ii) Elderly Care Service (long-term and respite care) delivered in a 63-bed inpatient unit. Results: 250 respondents (69.8%) completed the questionnaire. Nurses and healthcare assistants comprised the majority of respondents (60%) and other disciplines were represented proportionately. 230 participants (92%) agreed that their personal workload had changed significantly in response to COVID-19 and 182 (72.8%) agreed that their responsibilities had increased. 196 (78.4%) reported greater work-related stress. Highest-rated sources of stress included fear of contracting COVID-19 or transmitting it to friends/family, interacting with isolated frail/dying patients, changes to workplace protocols and reduced social interaction with colleagues. Conclusions: This study demonstrates the profound impact of COVID-19 on personal and professional wellbeing of staff. The greatest burden was carried by those providing prolonged, direct and intimate patient care. [ABSTRACT FROM AUTHOR]

Background: Medical emergency teams constitute part of the escalation protocol of early warning systems in many hospitals. The literature indicates that medical emergency teams may reduce hospital mortality and cardiac arrest. A greater understanding of pathways of patients who experience multiple medical emergency team reviews will inform clinical decision-making. Objectives: To explore differences between patients who require a single medical emergency team review and those who require multiple reviews, and to identify any differences between patients who were reviewed only once during admission and patients who required multiple reviews. Methods: Data for this retrospective cross-sectional review, including demographic data, call triggers, outcomes, and interventions, were routinely collected from January 2013 through December 2015. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) collaborative's cross-sectional studies checklist (version 4). Results: Of 54 787 admitted patients, 1274 (2%) required a call to a medical emergency team; of those, 260 patients (20%) needed multiple calls. Patients requiring multiple calls demonstrated higher mortality (odds ratio, 1.49 [95% CI, 1.12–1.98]). A logistic regression model identified surgical patients and those receiving antibiotics and respiratory interventions at the first medical emergency team review as being more likely to require multiple reviews. Patients transferred to a higher level of care after the first review were less likely to require another review. Conclusions: Patients requiring multiple medical emergency team reviews have higher mortality. Surgical patients have a higher risk of requiring multiple reviews. Hospitals need to include more details on surgical patients when auditing medical emergency team activation. [ABSTRACT FROM AUTHOR]

New mothers in Western societies report being influenced by ideologies which suggest mothering comes naturally to women and is joyful and fulfilling. However, research reveals motherhood-related negative thoughts are common even among non-depressed new mothers, and it has been suggested experiencing such thoughts may be related to guilt and shame. This study updates and extends Hall and Wittkowski's (2006) prevalence survey of motherhood-related negative thoughts by assessing new mothers' perceptions of the social acceptability of negative thoughts, and by exploring relationships with guilt, shame and psychological distress. A cross-sectional survey design was used. A self-selected sample of non-clinical new mothers (N = 395) from the United Kingdom and Ireland completed online questionnaires including measures of the frequency and social acceptability of motherhood-related negative thoughts, shame and guilt proneness, depression and motherhood experience. Hierarchical regression analyses were used to explore relationships between variables. The frequency of negative thoughts was much higher than reported by Hall and Wittkowski. After controlling for demographic variables and social support, frequency of negative thoughts significantly predicted shame and guilt, whereas social acceptability of negative thoughts significantly predicted guilt. Negative thoughts, shame, guilt and motherhood experience relative to expectations significantly predicted depression score. These results suggest that negative thoughts are more common in early motherhood than previously reported, are considered socially unacceptable, and are related to guilt, shame and depression scores. The findings increase our understanding of postnatal distress in non-clinical populations. Future research should explore information and/or interventions aimed at "normalising" negative thoughts in early motherhood. Highlights: Negative thoughts were more frequent in non-clinical new mothers than previously reported. New mothers found negative thoughts related to motherhood difficult to share with others. Frequency of negative thoughts in new mothers was related to guilt and shame. Frequency of negative thoughts, guilt and shame were related to depression score. Interventions for mothers that "normalise" negative thoughts should be considered. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn about the differences between psychiatric intensive care, low secure and locked rehabilitation units • To understand how service provision in psychiatric intensive care, low secure and locked rehabilitation units has changed since 2006 • To gather information on the types of interventions offered by the different psychiatric intensive care facilities Psychiatric intensive care can take place in a variety of settings, including psychiatric intensive care units (PICUs), low secure units (LSUs) and locked rehabilitation units (LRUs). These units have a range of referral, admission and discharge care pathways, staffing profiles and core interventions. The aim of this service evaluation was to compare present provision in PICUs and LSUs with results from the first national survey of PICUs and LSUs in 2006. The service evaluation also aimed to define the role of LRUs. The authors used a cross-sectional, 'census day' questionnaire with six-month follow-up design. Overall, 111 NHS units participated in the evaluation. Results included that PICUs were smaller and usually had a mixed-sex distribution of service users; LSUs mostly comprised single-sex facilities; and LRUs mostly comprised single-sex units with a significantly longer mean length of stay than the other types of unit. PICUs primarily cared for service users exhibiting acute behavioural disturbance, first-episode psychosis or psychotic crisis and, compared with the other types of unit, more often used high-dose medication and electroconvulsive therapy. [ABSTRACT FROM AUTHOR]

Objective: To determine the current practices of Irish healthcare professionals working in the oncology setting of three hospitals in the north‐west of Ireland with regard to nutrition screening, provision of nutrition advice and training needs. Methods: This cross‐sectional study distributed a questionnaire to healthcare professionals in the oncology departments of three hospitals between November 2018 and April 2019. Data were analysed using SPSS, and one open‐ended question underwent thematic analysis. Results: Fifty‐one individuals completed the survey. 98.1% rated nutrition as very or critically important in cancer management. 74.5% nutritionally screen inpatients while only 17.6% screen outpatients. The majority (86.3%) provide nutrition advice to patients, yet only 19.6% collect data on nutrition status. Doctors and nurses report low levels of confidence and lack of awareness of guidelines. 78.4% of respondents were interested in further training in oncology nutrition, preferably through a conference study day. Respondents reported that early nutrition intervention and integration into current practice is important, there is a current lack of resources and they recognised a need for different interventions depending on cancer type and stage. Conclusion: Current practice varies; however, positive attitudes towards nutrition and interest in additional training were found. [ABSTRACT FROM AUTHOR]

Purpose. School is a primary setting for pediatric occupational therapy practice, yet little is known about the provision of school-based occupational therapy in many countries internationally. The purpose of this study was to explore current school-based occupational therapy practice for the first time in Ireland to gain insight into current and potential service provision and to identify new directions and potential pathways for development. Methods. This descriptive quantitative study utilized a cross-sectional online survey to gain the perspectives of the population of pediatric occupational therapists working regularly in schools across Ireland. Respondents were recruited through convenience and snowball sampling. Data were analysed through qualitative content analysis and descriptive statistics. Results. The survey elicited 35 responses, yielding a 21.2% estimated response rate. Findings demonstrated that respondents provided therapy services in schools most commonly on a weekly (28.6%) or monthly (34.3%) basis, with only 5.0% working in the same school on a weekly or fortnightly basis. The majority of respondents (54.3%) used a direct therapy approach with a child, rather than coaching or modelling, to primarily address sensory, hand function, or daily living needs. None used a whole class or whole school (universal or tiered) approach. While respondents (54.3%) generally viewed collaborative practice as a strength of school-based practice, they also identified barriers to collaboration in schools. A core barrier is related to how services are constructed across health and education, with differing philosophies of service provision. The majority of respondents (75.0%) reported that they had not received any training to deliver evidence-based practice in therapy provision specific to school-based practice. Implications for Practice. This study indicates that therapists require continual education on evidence-based school practice as it applies in an Irish context. Furthermore, clarification of school therapy roles and service delivery models are required in order to determine how they contrast with traditional clinic roles. This will enable therapists to strengthen the coordination of service delivery between health and educational services to maximize the outcomes of school-based practice. [ABSTRACT FROM AUTHOR]

Objectives: To describe the eating behaviour styles of Irish teens and to explore the relationships between demographic factors, BMI and dietary intake and these eating behaviour styles.Design: Cross-sectional data from the Irish National Teens' Food Survey (2005-2006). The Dutch Eating Behaviour Questionnaire assessed three eating behaviour styles in teens: restrained, emotional and external eating. Data were stratified by sex and age groups.Setting: The Republic of Ireland.Participants: Nationally representative sample of teens aged 13-17 years (n 441).Results: The highest scoring eating behaviour style was external eating (2·83 external v. 1·79 restraint and 1·84 emotional). Girls scored higher than boys on all three scales (Restraint: 2·04 v. 1·56, P < 0·001, Emotional: 2·15 v. 1·55, P < 0·001 and External: 2·91 v. 2·76, P = 0·03), and older teens scored higher than younger teens on the Emotional (1·97 v. 1·67, P < 0·001) and External scales (2·91 v. 2·72, P = 0·01). Teens classified as overweight/obese scored higher than those classified as normal weight on the Restraint scale (2·15 v. 1·71, P < 0·001) and lower on the External scale (2·67 v. 2·87, P < 0·03). Daily energy intake was negatively correlated with the Restraint (r -0·343, P < 0·001) and Emotional scales (r -0·137, P = 0·004) and positively correlated with the External scale (r 0·110, P = 0·02).Conclusions: External eating is the predominant eating behaviour style among Irish teens, but sex, age, BMI and dietary differences exist for each eating behaviour style. Including measures of eating behaviour styles into future dietary research could help understand both how and why as well as what people eat. [ABSTRACT FROM AUTHOR]

Purpose: To examine the impact of new controlled drugs legislation introduced in May 2017 on benzodiazepine receptor agonist (BZRA) prescribing in Ireland. Methods: A repeated cross-sectional analysis was conducted using publically available monthly pharmacy claims data from the General Medical Services (GMS) database. The study population comprised all GMS-eligible individuals aged ≥ 16 years from January 2016 to September 2019. Monthly prevalence rates of individuals receiving BZRA prescriptions per 10,000 eligible population were calculated and trends examined over time. Segmented linear regression of prevalence rates was used to examine changes before and after introduction of the legislation stratified by gender and age groups. Regression coefficients (β) and 95% confidence intervals (CIs) for monthly change were calculated. Results: Pre-legislation (January 2016 to April 2017), there was a significant monthly decline in benzodiazepine prevalence rate (β = − 1.18; 95% CI − 1.84, − 0.51; p < 0.001) but no significant change in Z-drug prescribing. Post-legislation (May 2017 to September 2019), increases in prevalence rates were observed for benzodiazepines (β = 1.04; 95% CI 0.17, 1.92; p = 0.021) and Z-drugs (β = 1.04; 95% CI 0.26, 1.83; p = 0.010). Post-legislation trends showed increases in BZRA prevalence rates among the youngest subgroup (16–44 years), with variable changes in the middle-aged subgroup (45–64 years) and no changes in the oldest subgroup (≥ 65 years). Conclusions: This study indicates that introduction of new legislation had limited impact on BZRA prescribing on the main public health scheme in Ireland. Interventions targeting specific population subgroups may be required to achieve sustained reductions in prescribing. [ABSTRACT FROM AUTHOR]

Choking is a serious and under-recognised condition for adults with intellectual disability (ID), with health, psychological and potentially fatal consequences. This study aims to determine the prevalence and risk factors for choking in a population-based sample of older adults with ID. 597 adults with ID (mean age: 60 years old; SD = 8) were selected as part of The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing. Information was collected on choking history, comorbidities, challenging behaviours and eating difficulties. Logistic regression was employed to determine risk factors for choking history. 17.3% of participants reported choking history. Eating difficulties, cerebral palsy, visual impairment, being ≥ 65 years old and antipsychotic use increased the odds of choking history. Choking is prevalent in our sample. Managing choking risk requires specific responsibilities from the multidisciplinary team. Risk assessment, training staff and caregivers should be implemented in usual care. [ABSTRACT FROM AUTHOR]

Aim: To describe variation in the initial management of children presenting to Emergency Departments (ED) with coins lodged in the oesophagus. To determine the usage of hand-held metal detectors (HHMDs) in EDs, including their role in clinical decision-making, and training in their use.Methods: Online multicentre cross-sectional survey of EDs in the UK and Ireland, with results described using descriptive statistics.Results: Fifty-five (90%) of 61 sites responded. The two main strategies described for lodged oesophageal coins were endoscopic removal or observation with reassessment, dependent on location. For coins in the proximal third of the oesophagus 43/55 (78.2%) referred for endoscopic removal, 6/55 (10.9%) observed and the remaining 10.9% used a variety of methods, including: Foley catheter removal with fluoroscopy, blind Foley catheter removal, referral to paediatric surgery/ENT. Thirty (55%) of 55 used HHMDs, 21/30 (70%) had guidelines for their use, and 3/30 (10%) provided formal training. Twenty (67%) of 30 used the xiphisternum as the anatomical cut-off for assuming safe passage of metallic foreign bodies (FB) beyond the lower oesophageal sphincter.Conclusions: There is considerable variation in the management of oesophageal coins in children, though two dominant strategies were identified. As endoscopy is significantly more invasive than observation, future research should aim to determine whether either is more effective and safer in children. There is a clear division in departmental adoption of HHMDs. However, in those sites using HHMDs there was little formal training in their use, and there are large variations in techniques and their role in clinical decision-making. [ABSTRACT FROM AUTHOR]

Over 70 prevalence studies of schizophrenia published since 1948 are reviewed. Despite problems of method, the studies suggest that there may be significant differences in prevalence among different populations and that prevalence may change over time. Further research is needed on how much differences in diagnosis or the course of schizophrenia contribute to the variable prevalence rates. The paper suggests the following as areas for additional enquiry: a possible north-south gradient, special populations (e.g. American Hutterites, northern Swedes, western Irish, castes in India) and ongoing case registers in areas of suspected high and low prevalence. [ABSTRACT FROM AUTHOR]

Objective: To examine current dietary fat intakes and compliance in Irish children and to examine changes in intakes from 2005 to 2019.Design: Analyses were based on data from the Irish National Children's Food Survey (NCFS) and the NSFS II, two cross-sectional studies that collected detailed food and beverage intake data through 7-day and 4-day weighed food diaries, respectively.Setting: NCFS and NCFS II, Republic of Ireland.Participants: A nationally representative sample of 594 (NCFS) and 600 (NCFS II) children aged 5-12 years. Current intakes from the NCFS II were compared with those previously reported in the NCFS (www.iuna.net).Results: Current intakes of total fat, SFA, MUFA, PUFA and trans fat as a percentage of total energy are 33·3, 14·0, 13·6, 5·6 and 0·5 %, respectively. Total fat, SFA and trans fat intakes since 2005 remained largely stable over time with all displaying minor decreases of <1 %. Adherence to SFA recommendations remains inadequate, with only 7 % of the population complying. Insufficient compliance with PUFA (71 %) and EPA and DHA (DHA; 16 %) recommendations was also noted.Conclusion: Children in Ireland continue to meet the total fat and trans fat target goals. Adherence to MUFA and PUFA recommendations has also significantly improved. However, deviations for some fats remain, in particular SFA. These findings are useful for the development of dietary strategies to improve compliance with current recommendations. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the characteristic, content, and role of Paediatric Intensive Care Units (PICUs) in the provision of follow‐up for children and their families' post‐intensive care discharge in the United Kingdom (UK) and Republic of Ireland (RoI). The study followed a descriptive self‐reported, web‐based survey design. "In‐hospital PICU follow‐up" was defined as follow‐up delivered by the PICU team following PICU discharge but before hospital discharge and "post‐discharge PICU follow‐up" was defined as follow‐up delivered by the PICU team following hospital discharge. The survey was administered to all 28 PICUs in the UK and RoI. Paediatric intensive care medical directors or delegated individuals participated. Data were collected between September 2017 and January 2018 with a response rate of 79% (n = 22/28). Twelve units provided either in‐hospital and/or post‐discharge PICU follow‐up. Ten (45%) PICUs reported providing in‐hospital follow‐up, with half (n = 5) using an eligibility criteria for in‐hospital follow‐up, which related to disease groups. The most frequently reported form of in‐hospital PICU follow‐up consisted of face‐to‐face patient consultation (n = 8) by a PICU doctor (n = 5) and/or nurse (n = 4). The time at which initial contact was made was usually not predetermined (n = 4) and the assessment of care needs included are tracheostomy care (n = 4), respiratory care (n = 4), and sedative medication weaning plan (n = 5). Four PICUs reported to provide post‐discharge follow‐up. This involved telephone (n = 2), follow‐up clinic consultations (n = 1) or home visits (n = 1), provided predominantly by PICU doctors (n = 2), with their activity directed by patient needs (n = 3). Despite increasing evidence to suggest PICU survivors and their families experience negative sequalae post‐PICU discharge, less than half of PICUs surveyed provide in‐hospital follow‐up and only a minority provide post‐discharge follow‐up. There is variation in the delivery, content, and format of in‐hospital and post‐discharge PICU follow‐up in the UK and RoI. [ABSTRACT FROM AUTHOR]

Aims: To examine the factors influencing final‐year nursing/midwifery students' intentions to migrate following graduation. Background: With expanding global staff shortages, effective recruitment and retention strategies targeted at new nursing/midwifery graduates are necessary. Understanding factors that influence graduates' decisions to migrate or remain in the health care organisation that supported their education is essential but under‐researched. Methods: A cross‐sectional electronic survey was distributed to graduating nursing/midwifery students across nine higher education institutions in Ireland with a 36% (N = 407) response rate. Results: 85% of Irish (n = 376) nursing/midwifery graduating students reported an intention to migrate overseas and 70% intend to return within 5 years. Pay, working conditions and career were ranked as influencing intentions to migrate. Multivariable analysis illustrated that educational opportunities and friends predict migration, while family and obligation were protective factors. Conclusion: Nursing and midwifery leaders and policymakers must reconsider recruitment and retention strategies and embrace innovative and responsive approaches to address migration intentions and trends. Implications for nursing/midwifery management: Strategic leadership is required to develop effective structures that support personal, professional and career opportunities for new graduates. Targeted recruitment innovations to entice graduates back into the health service are recommended. [ABSTRACT FROM AUTHOR]

Background: Independent associations between screen time (ST)/physical activity (PA) and overweight (OW)/obesity have been demonstrated but little research exists on the role of ST among sufficiently active children. Purpose: To examine the combined influence of ST and PA on risk of OW/obesity in a nationally representative sample of 9-year-old Irish children. Methods: The sample in this cross sectional analysis contained 8568 children. Self-report parent data were used to group children into ST and PA categories and related to OW/obesity using forced entry logistic regression. Results: High ST (> 3 hours/day), bedroom TV and mobile phone ownership increased risk of OW/obesity in high and low active children (P < .05). Low PA (<9 bouts fortnightly) was also associated with OW/obesity. In combined analyses, OW/obesity was lowest in the reference low ST/high PA group with ORs of 1.38, 1.63, and 2.07, respectively, in the low ST/low PA, high ST/high PA, and high ST/low PA groups. Access to electronic media, low socioeconomic status, parental obesity, and not engaging in sports were all related to high ST (P < .05). Conclusion: This study supports findings that ST is associated with OW/Obesity demonstrating this separately in high and low active children. [ABSTRACT FROM AUTHOR]

Background: General practice plays a central role in the Irish health system. This study aimed to determine a baseline estimate of the number of consultations completed in general practice in Ireland annually to facilitate evidence-based healthcare planning. Methods: A survey was emailed to all 3378 individual members of the Irish College of General Practitioners in February 2020 asking each practice to report on consultations by general practitioners and practice nurses occurring on the previous day of practice. Results: A total of 507 practices responded to the survey, reporting 34,594 general practitioner consultations and 13,161 nurse consultations on one day. Extrapolating this figure nationally, we estimate 21,353,731 GP consultations and 7,749,615 practice nurse consultations occur in Ireland annually. An Irish person visits their GP an estimated 4.34 times a year and the average consultation time is 13.7 min. Conclusions: This study shows that over 29.1 million consultations take place in Irish general practice every year. Innovative interventions to increase the capacity of general practice are needed to ensure high-quality care continues to be accessible in Ireland. [ABSTRACT FROM AUTHOR]

Introduction: Stillbirth remains an often unpredictable and devastating pregnancy outcome, and despite thorough investigation, the number of stillbirths attributable to unexplained causes remains high. Placental examination has become increasingly important where access to perinatal autopsy is limited. We aimed to examine the causes of stillbirth in normally formed infants over 30 years and whether a declining autopsy rate has affected our ability to determine a cause for stillbirths.Material and Methods: All cases of normally formed singleton infants weighing ≥500 g that died prior to the onset of labor from 1989 to 2018 were examined. Trends for specific causes and uptake of perinatal autopsy were analyzed individually.Results: In all, 229 641 infants were delivered, with 840 stillbirths giving a rate of 3.66/1000. The rate of stillbirth declined from 4.84/1000 in 1989 to 2.51 in 2018 (P < .001). There was no difference in the rate of stillbirth between nulliparous and multiparous women (4.25 vs 3.66 per 1000, P = .026). Deaths from placental abruption fell (1.13/1000 in 1989 to 0 in 2018, P < .001) and the relative contribution of placental abruption to the incidence of stillbirth also fell, from 23.3% (7/30) in 1989 to 0.0% (0/19) in 2018 (P < .001). Stillbirth attributed to infection remained static (0.31/1000 in 1989 to 0.13 in 2018, P = .131), while a specific causal organism was found in 79.2% (42/53) of cases. Unexplained stillbirths decreased from 2.58/1000 (16/6200) in 1989 to 0.13 (1/7581) in 2018 (P < .001) despite a fall in the uptake of perinatal autopsy (96.7% [29/30] in 1989 to 36.8% (7/19) in 2018; P < .001). Placental disease emerged as a significant cause of stillbirth from 2004 onwards (89.5% [17/19] in 2018).Conclusions: The present analysis is one of the largest single-center studies on stillbirth published to date. Stillbirth rates have fallen across the study period across parity. A decrease in deaths secondary to placental abruption contributed largely to this. Infection-related deaths are static; however, in one-fifth of cases a causative organism was not found. Despite a decreasing autopsy rate, the number of unexplained stillbirths continues to fall as the importance of placental pathology is increasingly recognized. [ABSTRACT FROM AUTHOR]

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Concussions are a global public health concern, and education on the importance of self-reporting may not reach all athletes to the same degree around the world. To determine if differences were present in the concussion awareness, understanding, and -reporting behaviors of collegiate athletes' in 3 countries with varied degrees of concussion publicity. Cross-sectional survey. Collegiate sports medicine clinics. Collegiate athletes in the United States (n = 964; high publicity), Ireland (n = 302; moderate publicity), and Jordan (n = 129; low publicity). The degree of concussion publicity was categorized based on the extent of national public health awareness initiatives, care guidelines, research publications, and mass media coverage. Participants completed a 10- to 15-minute survey on concussion awareness, understanding, and -reporting behaviors. The main outcome measures were concussion education (awareness; 21 options; select all sources of concussion information), concussion knowledge (understanding; maximum score of 49), and diagnosed/nondisclosed concussion history (reporting behaviors; self-report yes/no items). A higher proportion of Jordanian athletes reported never having received concussion information previously (73.6%) than Irish (24.2%) or US athletes (9.4%). Knowledge differed among countries (P <.0001, η2 =.28), with US athletes displaying higher total knowledge scores (40.9 ± 4.5) than Jordanian (35.1 ± 5.6) and Irish (32.1 ± 3.5) athletes. Greater percentages of Irish and US athletes reported a history of a diagnosed concussion (31.8% and 29.6%, respectively) and history of concussion nondisclosure (25.2% and 15.5%, respectively) than Jordanian athletes (2.3% and 0.0% for history of a diagnosed concussion and history of concussion nondisclosure, respectively). In the United States, where concussion publicity is high, formal legislation exists, and sports medicine resources and concussion awareness and understanding were increased. More culturally appropriate concussion initiatives are needed globally to ensure that athletes around the world can identify concussive injuries and understand the dangers of continued sport participation while concussed. [ABSTRACT FROM AUTHOR]

Living well with post‐stroke aphasia is supported by responsive, collaborative heath and related services, aphasia information and training for people with aphasia (PWA) and their social networks, and opportunities to contribute and participate autonomously in their communities. Several international surveys indicate shortcomings in the provision of long‐term support and, in Ireland, while there is a lack of data around service provision for PWA, there is evidence that post‐acute stroke services are fragmented and under‐resourced. The aim of this study was to survey Speech & Language Therapists (SLTs), due to their unique role in aphasia management, to understand what SLT and related support services and aphasia information and training are currently available to support living well with aphasia in Ireland. We developed and piloted a self‐administered, web‐based cross‐sectional survey with questions informed by a systematic review and qualitative evidence synthesis around living well with aphasia, and with input from a Public and Patient Involvement aphasia advisory group. Data from 95 SLTs working with PWA were analysed using descriptive statistics. Although SLT was generally available for PWA, the results highlight access barriers and evidence‐practice gaps in terms of the amount, intensity and timing of SLT to be maximally effective and there was a lack of PWA input into service design and evaluation. Access to other relevant supports such as mental health services was inconsistent and there was a lack of community support for families. There were shortcomings in access to aphasia information/training for PWA, families, friends and other healthcare professionals. There is a need for a coordinated and standardised approach to supporting PWA across Ireland. This study addresses an evidence gap around the provision of stroke services for PWA and is part of a larger project aiming to produce recommendations for improving person‐centred support to facilitate living well with aphasia. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate international oesophageal screening (OS) practices during videofluoroscopy (VFS) amongst speech-language pathologists (SLPs) and to establish SLP perspectives regarding OS during VFS. Method: A 25-item online survey was developed and disseminated internationally. Respondents were SLPs with dysphagia and VFS experience. Information was sought on OS practices and perspectives. Descriptive statistics were used to analyse results. Result: A total of 202 SLPs completed the survey from USA, UK, Ireland, New Zealand, Australia and Austria. Fifty-eight per cent (n = 117/202) of SLPs internationally include an OS during VFS. This rate varies across USA (81%; 91/113), UK (69%; 18/26) and Ireland (60%; 18/30). Only 25% (29/117) of SLPs use a validated OS protocol. Most SLPs perform an OS in an anterior–posterior view (55%; 64/117) with patients seated (54%; 64/117). Bolus consistencies administered vary greatly. SLPs evaluate oesophageal bolus clearance (81% (95/117), bolus redirection (64%; 75/117), oesophageal transit time (49%; 57/117) and oesophageal pathology (11%; 13/117). Perceived challenges include scope of practice, patient positioning, protocol uncertainty and multidisciplinary support. Conclusion: Over half of SLPs internationally responding to the survey include an OS during VFS. Few follow validated protocols and analysis practices vary. OS guidelines and training opportunities are needed to ensure validated OS protocols are adopted into clinical practice. [ABSTRACT FROM AUTHOR]

Aims: Orthostatic hypotension is a recognized complication of diabetes, but studies examining prevalence in diabetes are limited. The aim of this study was to ascertain the prevalence of orthostatic hypotension and the pattern of orthostatic BP response in a cohort of people with diabetes aged ≥ 50 years, embedded within the Irish Longitudinal Study of Ageing. Methods: Orthostatic hypotension was defined as a drop in systolic blood pressure (SBP) ≥ 20 mmHg or drop in diastolic blood pressure (DBP) ≥ 10 mmHg at 30 s after standing. Diabetes was defined by self‐report but cross‐checked against HbA1c and medication records. Multilevel mixed effects linear regression models were used to compare orthostatic BP in people with and without diabetes. Results: Some 3222 people were included, 7% (213 of 3222) of whom had diabetes. Prevalence of orthostatic hypotension in the group with diabetes was 22% (46 of 213) vs. 13% in those without diabetes; χ2 = 12.43; P < 0.001. Multilevel models demonstrated prolonged recovery of DBP in people with diabetes, with only 41% (87 of 213) returning to baseline by 60 s. Logistic regression models demonstrated that diabetes was associated with a significantly increased likelihood of orthostatic hypotension (odds ratio 1.84, 95% confidence interval 1.30–2.59; P = 0.001) and this remained robust after controlling for covariates. Conclusion: Over one‐fifth of older people with diabetes had orthostatic hypotension. Recovery of DBP is related to dynamic changes in total peripheral resistance and impairment of this baroreflex‐mediated response may explain the higher prevalence in diabetes. Given the prognostic implications when co‐existing with diabetes, orthostatic hypotension may represent a potentially modifiable risk factor for adverse outcomes in late‐life diabetes. What's new?: Older people with diabetes are thought to have impaired blood pressure (BP) recovery after standing but their pattern of orthostatic BP is not yet known and the prevalence of orthostatic hypotension in late‐life diabetes has not been established.We found that older people with diabetes have a 70% increased likelihood of having orthostatic hypotension at 30 s after standing.Recovery of diastolic BP is particularly slow, suggesting impairment of dynamic adjustments to total peripheral resistance may underpin this.Impaired BP recovery may represent an important modifiable risk factor for poorer outcomes in diabetes in later life, particularly in brain health. [ABSTRACT FROM AUTHOR]

Background: Uncontrolled blood pressure (BP) is an important modifiable risk factor for recurrent stroke. Secondary prevention measures when implemented can reduce stroke re-occurrence by 80%. However, hypertension control rates remain sub-optimal, and little data is available from primary care where most management occurs. The aim of this study was to describe BP control in primary care-based patients with a previous stroke or transient ischaemic attack (TIA) in Ireland, and to concurrently examine antihypertensive medication-dosing. Methods: Study participants most recent office-based BP reading was compared with the NICE (NG136) and European Society of Hypertension/ European Society of Cardiology (ESH/ESC 2013) goal of BP < 140/90 mmHg. Optimal anti-hypertensive medication dosing was determined by benchmarking prescribed doses for each drug with the World Health Organisation-Defined Daily Dosing (WHO-DDD) recommendations. Results: We identified 328 patients with a previous stroke or TIA in 10 practices. Blood pressure was controlled in almost two thirds of patients when measured against the ESH/ESC and NICE guidelines (63.1%, n = 207). Of those with BP ≥140/90 (n = 116), just under half (n = 44, 47.3%) were adequately dosed in all anti-hypertensive medications when compared with the WHO-DDD recommendations. Conclusion: Blood pressure control in patients post stroke/TIA appears sub-optimal in over one third of patients. A comparison of drug doses with WHO-DDD recommendations suggests that 47% of patients may benefit from drug-dose improvements. Further work is required to assess how best to manage blood pressure in patients with a previous stroke or TIA in Primary Care, as most consultations for hypertension take place in this setting. [ABSTRACT FROM AUTHOR]

Background: The uptake of continuous subcutaneous insulin infusion (CSII) therapy in those with type 1 diabetes varies internationally and is mainly determined by the national healthcare reimbursement systems. The aim of this study is to estimate national and regional uptake of CSII therapy in children, adolescents and adults with type 1 diabetes in Ireland. Methods: A retrospective cross-sectional study was conducted utilizing the national pharmacy claims database in 2016. Individuals using CSII were identified by dispensing of infusion sets. The uptake of CSII was calculated as the percentage of people with type 1 diabetes claiming CSII sets in 2016, both in children and adolescent (age < 18 years) and adult populations (≥ 18 years). Descriptive statistics including percentages with 95% confidence intervals (CIs) are presented, stratified by age-groups and geographical regions, and chi-square tests used for comparisons. Results: Of 20,081 people with type 1 diabetes, 2111 (10.5, 95% CI: 10.1–10.9%) were using CSII in 2016. Uptake was five-fold higher in children and adolescents at 34.7% (95% CI: 32.9–36.5%) than in adults at 6.8% (95% CI: 6.4–7.2%). Significant geographical heterogeneity in CSII uptake was found, from 12.6 to 53.7% in children and adolescents (p < 0.001), and 2 to 9.6% in adults (p < 0.001). Conclusions: Uptake of CSII in people with type 1 diabetes is low in Ireland, particularly in those ≥18 years. Identification of barriers to uptake, particularly in this group, is required. [ABSTRACT FROM AUTHOR]

Background: While exposure to urban green spaces has been associated with various physical health benefits, the evidence linking these spaces to lower BMI, particularly among older people, is mixed. We ask whether footpath availability, generally unobserved in the existing literature, may mediate exposure to urban green space and help explain this volatility in results. The aim of this study is to add to the literature on the association between urban green space and BMI by considering alternative measures of urban green space that incorporate measures of footpath availability.Methods: We conduct a cross-sectional study combining data from The Irish Longitudinal Study on Ageing and detailed land use information. We proxy respondents' exposure to urban green spaces at their residential addresses using street-side and area buffers that take account of the presence of footpaths. Generalised linear models are used to test the association between exposure to several measures of urban green space and BMI.Results: Relative to the third quintile, exposure to the lowest quintile of urban green space, as measured within a 1600 m footpath-accessible network buffer, is associated with slightly higher BMI (marginal effect: 0.80; 95% CI: 0.16-1.44). The results, however, are not robust to small changes in how green space is measured and no statistically significant association between urban green spaces and BMI is found under other variants of our regression model.Conclusion: The relationship between urban green spaces and BMI among older adults is highly sensitive to the characterisation of local green space. Our results suggest that there are some unobserved factors other than footpath availability that mediate the relationship between urban green spaces and weight status. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding in public continues to be contentious with qualitative evidence confirming that women face many challenges. It is therefore important to gain understanding of not only the challenges but also what women perceive is helpful to breastfeed in public. Methods: A cross-sectional study was conducted with women living in Australia, Ireland or Sweden currently breastfeeding or having breastfed within the previous 2 years. Our objective was to explore and compare what women do when faced with having to breastfeed in the presence of someone they are uncomfortable with and what women think is helpful and challenging when considering whether to breastfeed in public. Data were collected in 2018 from an online survey over a 4 week period in each country. Content analysis revealed data similarity and theme names and definitions were negotiated until consensus was reached. How often each theme was cited was counted to report frequencies. Helpful and challenging aspects were also ranked by women to allow international comparison. Results: Ten themes emerged around women facing someone they were uncomfortable to breastfeed in the presence of with the most frequently cited being: 'made the effort to be discreet'; 'moved to a private location'; 'turned away' and 'just got on with breastfeeding'. Nine themes captured challenges to breastfeed in public with the following ranked in the top five across countries: 'unwanted attention'; 'no comfortable place to sit'; 'environment not suitable'; 'awkward audience' and 'not wearing appropriate clothing'. Nine themes revealed what was helpful to breastfeed in public with the top five: 'supportive network'; 'quiet private suitable environment'; 'comfortable seating'; 'understanding and acceptance of others' and 'seeing other mothers' breastfeed'. Conclusions: When breastfeeding in public women are challenged by shared concerns around unwanted attention, coping with an awkward audience and unsuitable environments. Women want to feel comfortable when breastfeeding in a public space. How women respond to situations where they are uncomfortable is counterproductive to what they share would be helpful, namely seeing other mothers breastfeed. Themes reveal issues beyond the control of the individual and highlight how the support required by breastfeeding women is a public health responsibility. [ABSTRACT FROM AUTHOR]

Background: Falls in older people are common and can result in loss of confidence, fear of falling, restriction in activity and loss of independence. Causes of falls are multi-factorial. There is a paucity of research assessing the footwear characteristics among older people who are at high risk of falls, internationally and in the Irish setting. The aim of this study was to examine the proportion of older adults attending a geriatric day hospital in Ireland who were wearing incorrectly sized shoes.Methods: A consecutive sample of 111 older adults aged 60 years and over attending a geriatric day hospital in a large Irish teaching hospital was recruited. Demographic data including age, mobility, medications, co-habitation status, footwear worn at home and falls history were recorded. Shoe size and foot length were measured in millimetres using an internal shoe gauge and SATRA shoe size stick, respectively. Participants' self-reported shoe size was recorded. Footwear was assessed using the Footwear Assessment Form (FAF). A Timed Up and Go (TUG) score was recorded. Functional independence was assessed using the Nottingham Extended Activities of Daily Living (NEADL) Scale. The primary outcome of interest in this study was selected as having footwear within the suggested range (10 to 15 mm) on at least one foot. Participants who met this definition were compared to those with ill-fitting footwear on both feet using Chi-square tests, T-tests or Mann-Whitney U tests.Results: The mean difference between shoe length and foot length was 18.6 mm (SD: 9.6 mm). Overall, 72% of participants were wearing footwear that did not fit correctly on both feet, 90% had shoes with smooth, partly worn or fully worn sole treading and 67% reported wearing slippers at home. Participant age, TUG score and NEADL score were not associated with ill-fitting footwear.Conclusions: Wearing incorrectly fitting shoes and shoes with unsafe features was common among older adults attending geriatric day services in this study. A large number of participants reported wearing slippers at home. [ABSTRACT FROM AUTHOR]

Background: While research in high‐income countries (HICs) has established high costs associated with alcohol's harm to others (AHTO) in the workplace, scant attention has been paid to AHTO in the workplace in lower‐ or middle‐income countries (LMICs). Aim: To compare estimates and predictors of alcohol's impacts upon coworkers among workers in 12 countries. Methods: Cross‐sectional surveys from 9,693 men and 8,606 women employed in Switzerland, Australia, the United States, Ireland, New Zealand, Chile, Nigeria, Lao PDR, Thailand, Vietnam, India, and Sri Lanka. Five questions were asked about harms in the past year because of coworkers' drinking: Had they (i) covered for another worker; (ii) worked extra hours; (iii) been involved in an accident or close call; or had their (iv) own productivity been reduced; or (v) ability to do their job been affected? Logistic regression and meta‐analyses were estimated with 1 or more harms (vs. none) as the dependent variable, adjusting for age, sex, rurality of location, and the respondent worker's own drinking. Results: Between 1% (New Zealand) and 16% (Thailand) of workers reported that they had been adversely affected by a coworker's drinking in the previous year (with most countries in the 6 to 13% range). Smaller percentages (<1% to 12%) reported being in an accident or close call due to others' drinking. Employed men were more likely to report harm from coworkers' drinking than employed women in all countries apart from the United States, New Zealand, and Vietnam, and own drinking pattern was associated with increased harm in 5 countries. Harms were distributed fairly equally across age and geographic regions. Harm from coworkers' drinking was less prevalent among men in HICs compared with LMICs. Conclusions: Workforce impairment because of drinking extends beyond the drinker in a range of countries and impacts productivity and economic development, particularly affecting men in LMICs. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the prescribing behaviours and practices of registered nurse and midwife prescribers and to explore experiences of enablers and barriers to prescribing practices. Background: The extension of prescriptive authority to nurses and midwives internationally has created new opportunities for them to expand their scope of practice and is of significant benefit to effective and efficient health service provision. Design: Cross‐sectional national survey of registered nurse and midwife prescribers. Methods: Data were collected through an online survey between April–July 2018. A total of 84 nurse and midwife prescribers participated. The STROBE checklist was applied as the reporting guideline for this study. Results: Respondents estimated that two‐fifths of their consultations involved an episode of prescribing. Nurse and midwife prescribers engaged in similar prescribing behaviours spanning the range of activities from initiating new medications to ceasing medicines. The most frequently selected criterion for prescribing was clinical effectiveness. Prescribing was viewed as essential to respondents' clinical practice, allowing them to provide a complete episode of care and leading to a reduction in medication errors and reduced delays and waiting times for patients. Enablers of prescribing included knowledge, experience, education and access to continuous professional development, as well as support from colleagues and organisations. Conclusion: Little is known about the prescribing behaviours and practices of registered nurse and midwife prescribers. While prescribing authority enables nurse and midwife practitioners to deliver holistic care, there remain significant barriers and challenges including increased workloads, lack of continuous professional development, lack of support and overly restrictive rules and policies governing prescribing. Relevance to clinical practice: Addressing the barriers identified in this study could enable more nurse and midwife prescribers to work to their full scope of practice, enabling populations to fully capitalise on the contributions of registered nurse and midwife prescribing services. [ABSTRACT FROM AUTHOR]

Aims and objectives: To measure cancer‐related fatigue (CRF), self‐care agency (SCA) and fatigue self‐care strategies, and to explore the relationship between CRF and SCA. Background: Cancer‐related fatigue has been consistently rated as the most elusive, common and severe of symptoms that patients with cancer undergoing chemotherapy experience. Despite its frequency and severity, CRF is poorly managed. A renewed focus on supporting self‐care among patients with cancer has been found to reduce symptom burden, empower patients and improve patient satisfaction. Understanding the link between self‐care agency (i.e. capability and willingness to self‐care) and CRF levels will help practitioners to better support individuals on the cancer journey. Design: A descriptive, correlational survey design was employed. Methods: Patients (n = 362) undergoing chemotherapy with a primary diagnosis of breast, colorectal, Hodgkin's and non‐Hodgkin's lymphoma cancers were recruited from four oncology centres in one city in the South of Ireland. Participants completed the Piper Fatigue Scale‐Revised, Appraisal of Self‐care Agency Scale and a researcher‐developed Fatigue Self‐Care Survey. Multivariate logistic regression was used to examine the relationship between CRF and self‐care agency using a dichotomous dependent variable score of four as the cut‐off between those deemed to be fatigued (≥4) and those not fatigued (<4). As recommended by the EQUATOR Network, the STROBE checklist of items for cross‐sectional studies is used to report the study. Results: The incidence of CRF was high with 75% of participants scoring clinically relevant CRF. Higher SCA (OR = 0.96, 95% CI = 0.93–0.99, p = .011) was associated with decreased odds of developing CRF. Having non‐Hodgkin's lymphoma (OR = 3.02, 95% CI = 1.29–7.07, p = .011) was associated with increased odds of developing CRF. Conclusions: Patient's undergoing chemotherapy experience significant fatigue. Higher capability for self‐care is associated with lower fatigue. The promotion of SCA and self‐care strategies can impact on CRF. Relevance to clinical practice: Understanding the link between self‐care abilities and fatigue can lead to more individualised and tailored approaches to CRF. [ABSTRACT FROM AUTHOR]

Brugha et al provide convincing evidence that Ireland stills need to overcome many hurdles, including poor training and working experiences in Irish hospitals, before it can significantly improve its record on doctor retention. The findings reported by Brugha et al are particularly disappointing in light of the fact that Ireland implemented a doctor retention strategy in early 2015. Ultimately, doctor retention is important because it can help alleviate the health workforce shortages that many countries face currently and that are projected to worsen over the next decade. The purpose of this commentary is to highlight two additional strategies for alleviating health workforce shortages - expanding medical education and task shifting. [ABSTRACT FROM AUTHOR]

The study of healthcare personnel migration in Ireland reports that most medical graduates plan to leave the country's health system. It may be possible to address this challenge by understanding and addressing the reasons why young doctors plan to leave. Future studies should contribute to the retention of early career doctors in highincome countries such as Ireland. This will help reduce the migration of doctors from low- and middle-income countries in order to address the global health workforce crisis and its impact on the attainment of universal health coverage in all health systems. [ABSTRACT FROM AUTHOR]

Aim: To explore the differences in perceived importance and actual performance of clinical leadership for all grades of nurses and midwives engaged in clinical practice. Background: Clinical leadership is central to the provision of person‐centred care. However, little is known about how nurses and midwives perceive this in practice. Methods: Data were collected on a sample of nurses and midwives in the Republic of Ireland, using a cross‐sectional study design (n = 324). The clinical leadership needs analysis instrument was used to measure perceived importance and performance of clinical leadership in practice. Grades of nurses/midwives included; staff, manager, advanced practitioner and senior manager. Results: Senior managers were more likely to report significantly higher scores than staff grades for perceived importance of Technology & Care Initiatives (p < .01) and Financial & Service Management (p = .02). Performance of Staff & Care Delivery was significantly higher for senior managers than staff grades [F(5,309) = 6.06 p < .01]. Conclusion: There was a mismatch between the perceived importance and actual performance of clinical leadership in practice between different grades of staff. Implications for Nursing Management: Leadership training for all grades and mentoring of staff grades can promote the building of confidence and empower staff in leading clinical practice. [ABSTRACT FROM AUTHOR]

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Background: Sensitivity‐related trait characteristics involving physical and emotional sensitivities and high trait anxiety personality types have been observed in individuals with nonspecific chronic low back pain (NSCLBP). High trait sensitivity to sensory stimulation combined with interpretation biases based on personality type may contribute to the development of central sensitization (CS) symptoms. To date, there is limited research that has considered both sensitivity levels and personality type in NSCLBP with CS. The purpose of this study was to investigate (1) relationships between trait sensory profiles, trait anxiety, and CS symptoms, and (2) the predictive capacity of sensory profiles, trait anxiety, and personality types on CS symptoms in people with NSCLBP. Methods: This was a cross‐sectional observational study using 4 self‐report measures on adults (N = 165, mean age = 45 ± 12 [standard deviation] years) from physiotherapy clinics in England, Ireland, and New Zealand. Inclusion: NSCLBP > 6 months, age 18 to 64 years, predominant CS pain presentation, no other pathology. Parametric and nonparametric correlation statistics and regression analyses were used. Results: Positive correlations were found between central sensitization inventory (CSI) scores and sensory hypersensitivity profiles and trait anxiety. CSI score increases could be predicted by sensory‐sensitive, low‐registration profiles; trait anxiety scores; and extreme defensive high anxious personality type. Conclusions: Trait sensory hyper‐ and/or hyposensitivity and high trait anxiety–related personality type characteristics predict the extent of CS symptoms in people with NSCLBP. Further investigation is required to establish causality between these characteristics and CS symptoms. [ABSTRACT FROM AUTHOR]