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Aims and objectives. To determine the effectiveness of an improvement methodology initiative, directed at refining the quality of acute pain management of patients in the first 24 hours post major surgery using the Revised American Pain Society Patient Outcome Questionnaire, pre- and post development of a 'subject matter experts' acute pain programme. Background. Accurately measuring effectiveness of acute pain management post major surgery is intertwined with measuring overall patient satisfaction. A critical element of quality evaluation is obtaining direct feedback from patients about the here-and-now pain experiences post major surgery. Methods. A prospective cross-sectional, observational study was conducted in a large university hospital in Ireland. The questionnaire was completed with patients within 24 hours post major surgery, i.e., cardiothoracic, breast, gynaecological, gastrointestinal and urology surgery. The nurse participants were selected based on their commitment to play a key role in acute pain management. The study consisted of: a pre programme phase (n = 100 patients), an intervention phase - 'subject matter experts' acute pain programme (n = 24 nurses) and a postprogramme phase (n = 100 patients). Results. Over a quarter of patients were in severe pain for long periods in the first 24 hours post major surgery. These findings were linked not only to ineffective analgesia from some pain drug therapies but also to contradictory messages from nurses. Over half of the patients' pre- and postintervention reported satisfaction with acute pain management, whereas the remainder were dissatisfied and some sought answers to their suboptimum pain status. The 'subject matter experts' had a noteworthy impact on the patients' pain beliefs. Conclusions. The findings revealed that a 'subject matter experts' acute pain programme can have a positive impact on pain management in the immediate phase post major surgery. Relevance to clinical practice. The role making of 'subject matter experts' in acute pain is a tactical approach towards achieving optimum patient pain control in the immediate phase post major surgery. [ABSTRACT FROM AUTHOR]

Background: Alcohol plays a complex role in society. A recent study showed that over half of Irish adults drink hazardously. Adolescents report increased levels of alcohol consumption. Previous research has inferred the influence of the parent on their adolescent. Thus, the aim of the current study was to investigate the association between adolescent alcohol consumption and their parent's consumption pattern and attitude toward alcohol use in Southern Ireland.Methods: A cross-sectional survey was undertaken in November 2014. This involved distributing a survey to adolescents (n = 982) in their final two years of second level education and at least one of their parents from a local electorate area in Southern Ireland. This survey included: alcohol use, self- reported height and weight, smoking status, mental health and well-being along with attitudinal questions. Chi-square tests and multivariate logistic regression were utilised.Results: A 37 % response rate was achieved. Over one-third (34.2 %) of adolescents and 47 % of parents surveyed reported hazardous drinking. Over 90 % of parents disagreed with allowing their adolescent to get drunk and rejected the idea that getting drunk is part of having fun as an adolescent. The majority (79.5 %) of parents surveyed believed that their alcohol consumption pattern set a good example for their adolescent. Multivariate logistic regression highlights the association between adolescent hazardous alcohol consumption and hazardous drinking by the father. Furthermore either parent permitting their adolescent to drink alcohol on special occasions was associated with hazardous alcohol consumption in the adolescent.Conclusion: The findings of this research notes a liberal attitude to alcohol and increased levels of consumption by the parent are linked to hazardous adolescent drinking behaviour. Future action plans aimed at combatting adolescent hazardous alcohol consumption should also be aimed at tackling parents' attitudes towards and consumption of alcohol. [ABSTRACT FROM AUTHOR]

Background: Considering the chronic and debilitating nature of HIV infection, health-related quality of life (HRQoL) is an important patient-reported clinical outcome to better understand the effects of this infection and its treatment on patients' lives. The purpose of this study was to assess the HRQoL and its association with sociodemographic, behavioural, clinical, nutrition-related factors and social support in an Irish HIV cohort.Methods: A cross-sectional, prospective study using the Medical Outcomes Study HIV Health survey assessed the 10 dimensions of HRQoL and summarised as Physical Health Summary (PHS) and Mental Health Summary (MHS) scores. Participants were categorised as having good or poor PHS and MHS using the standardised mean score of 50. The variables independently associated with PHS and MHS were identified using multivariable logistic regression models.Results: Overall, 521 participants completed the HRQoL questionnaire. The median (IQR) PHS and MHS scores were 56 (47-60) and 51 (41-58) respectively. All the covariate groups had lower MHS than PHS. Participants with symptoms of HIV reported the lowest median (IQR) PHS score 44.7 (32.-54.5) and MHS score 36.1 (28.6-48.4). Of the 10 dimensions of HRQoL, the lowest scores were for the energy level and general health. Symptoms of HIV, co-morbidities, social support, employment and ethnicity had independent association with both PHS and MHS. Gender, education, alcohol intake and HIV-complications were associated with PHS. Age, illicit drugs, BMI and malnutrition were associated with MHS. However, CD4 count and viral load were not independently associated with PHS and MHS in multivariable regression models.Conclusion: Overall, HIV-infected people in this cohort had an average level of HRQoL. However, it is impaired in people with symptoms and co-morbidities, and not independently associated with CD4 and viral load. Alleviating HIV symptoms and preventing co-morbidities are important in managing HIV. Providing psychosocial supports for behaviour modification and return to work or exploring new opportunities will help to improve HRQoL. Healthcare providers and policy makers need to plan and implement programs to routinely assess the HRQoL in a systematic method to facilitate a holistic management of HIV. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify and describe the triggers of emotional distress among long-term caregivers (more than 1 year postdiagnosis) of people with head and neck cancer. Background Limited research has been conducted on the factors that cause head and neck cancer caregivers to become distressed. Design Qualitative cross-sectional. Methods In-depth semi-structured interviews. Interviews were conducted via telephone. The study setting was the Republic of Ireland. Results Interviews were conducted with 31 long-term caregivers (mean time since diagnosis 5·7 years, SD 2·9 years). Head and neck cancer caregivers experienced significant distress. Six key triggers of emotional distress were identified: understandings and fears of illness, lifestyle restrictions and competing demands, facial disfigurement, financial problems, comorbid health problems and witnessing suffering. Cutting across all of these individual causes of distress was a strong feeling of loss caused by head and neck cancer. Conclusions Some head and neck cancer caregivers became considerably distressed by their caring role. Although distress appears to decline with time for many caregivers, some continue to be distressed for years following the patient's diagnosis. It would be useful for future research to explicitly investigate caregivers' experiences of loss. Relevance to clinical practice Health professionals may be able to reduce distress in this group if they can help caregivers to access resources that can be used to buffer financial problems. Health professionals may also be able to reduce distress if they can work with caregivers to help them to obtain something of personal value or significance from their experience of loss and suffering. [ABSTRACT FROM AUTHOR]

Objective: There has been an increase in new HIV diagnoses among young men who have sex with men (YMSM) over the past decade in both UK and US contexts, with online sex-seeking implicated in driving this development. This study sought to examine YMSM's use of a variety of social and sexual networking websites and 'apps', and assess sexual risk behaviours.Design: YMSM were recruited from across four countries in Britain and Ireland, via an online survey using convenience sampling. Data were collected from 2668 men, of whom 702 were aged 18-25 years.Results: Facebook use was almost ubiquitous and for largely social reasons; sexual media use was common with 52% using gay sexual networking (GSN) websites frequently and 44% using similar apps frequently. We found increased odds of high-risk condomless anal intercourse associated with the length of time users had been using GSN websites and lower levels of education. We found no significant differences across the four countries in sexual risk behaviours.Conclusions: YMSM are a heterogeneous population with varied sexual health needs. For young men with digital literacy, individual-level online interventions, targeted and tailored, could be directed towards frequent users with lower levels of education. Variation in demographic characteristics of GSN websites and app users may affect who interventions are likely to reach, depending on where they are targeted. However, interventions, which may catch young men earlier, also provide a major opportunity for reducing sexual health inequalities. [ABSTRACT FROM AUTHOR]

Background: As myocardial salvage is time dependent, prompt emergency department attendance is imperative in the presence of unresolved acute coronary syndrome symptoms. Although ambulance use is the recommended mode of transport during an acute coronary syndrome event, people regularly have misperceptions about its role. Consequently, many fail to use this service when warranted. Aim: To evaluate factors associated with ambulance usage among patients admitted to emergency departments with acute coronary syndrome symptoms in Ireland. Methods: Patients (N=1947) diagnosed with acute coronary syndrome were recruited across five hospitals. The ACS Response Index was used to identify mode of transport to access the emergency department, symptom context and experience and the rationale for non-ambulance use. Using logistic regression, predictors of ambulance use were identified. Results: Only 40.1% of the sample used an ambulance. The primary reason for non-ambulance use was the perception that it was unwarranted (31%). A further 23.8% thought another mode of transportation would be faster. Independent predictors of ambulance usage differed among the three sub-diagnoses of acute coronary syndrome. For each group, visiting the general practitioner with symptoms was associated with a greater likelihood of not using an ambulance. Conclusion: The use of ambulance services is not positively embraced by the public. Furthermore, it appears that general practitioners may not always promote its use, particularly in the early stages of acute coronary syndrome symptom onset. The findings from our study suggest that a public education drive is necessary to promote ambulance usage during an acute coronary syndrome event. [ABSTRACT FROM AUTHOR]

Background: Health behaviour patterns in older groups, including tobacco and alcohol use, are key factors in chronic disease prevention. We explore ageing self-perceptions as motivating factors behind smoking and drinking alcohol in older adults, and the complex reasons why individuals engage harmfully in these behaviours.Methods: Cigarette and alcohol use was assessed in a large cross-sectional national sample aged 50 years and above from the Irish Longitudinal Study on Ageing (TILDA) (n = 6,576). The Brief Ageing Perceptions Questionnaire (BAPQ) assessed individual's views of their own ageing across five domains. Study hypothesis that stronger beliefs on each of the BAPQ domains would be related to drinking and smoking was examined using multinomial logit models (MNLM). Regression parameter estimates for all variables were estimated relative risk ratios (RRR).Results: More women were non-drinkers (30 % vs. 20 %) and men displayed significantly higher alcohol use patterns. One in five older Irish adults was a current smoker (16.8 % of women, 17 % of men), and smoking and harmful drinking were strongly associated (P < .001). Some domains of ageing perceptions were significantly associated with harmful drinking and smoking. While the risk of being be harmful drinker decreased with stronger beliefs about the positive consequences of ageing (RRR 0.89), it increased with higher scores on both emotional representation and control positive domains. Greater awareness of ageing and stronger emotional reaction to ageing increased likelihood of smoking. A greater sense of control over the outcomes of ageing was associated with increased risk of both harmful drinking (RRR control positive 1.16) and smoking (RRR control and consequences negative 1.25). This suggests optimistic bias in relation to perceived health risk from smoking and harmful drinking as a potential adverse effect of perceptions of control. Risks of concurrent smoking and harmful drinking increased with chronic awareness of ageing (RRR 1.24), and negative emotional responses to it (RRR 1.21), and decreased with stronger perceptions of the positive consequences of ageing (RRR 0.85).Conclusions: The relationship between ageing perceptions, smoking and drinking is complex. Altering perceptions of ageing may be a useful intervention target aimed at facilitating engagement in preventative health behaviours in older people. [ABSTRACT FROM AUTHOR]

Background: To evaluate the extent of the difference in elective (ELCS) and emergency (EMCS) caesarean section (CS) rates between nulliparous women in public maternity hospitals in Ireland by model of care, and to quantify the contribution of maternal, clinical, and hospital characteristics in explaining the difference in the rates.Methods: Cross-sectional analysis using a combination of two routinely collected administrative databases was performed. A non-linear extension of the Oaxaca-Blinder method is used to decompose the difference between public and private ELCS and EMCS rates into the proportion explained by the differences in observable maternal, clinical, and hospital characteristics and the proportion that remains unexplained.Results: Of the 29,870 babies delivered to nulliparous women, 7,792 were delivered via CS (26.1 %), 79.6 % of which were coded as EMCS. Higher prevalence of ELCS was associated with breech presentation, other malpresentation, and the mother being over 40 years old. Higher prevalence of EMCS was associated with placenta praevia or placental abruption, diabetes (pre-existing and gestational), and being over 40 years old. The private model of care is associated with ELCS and EMCS rates 6 percentage points higher compared than the public model of care but this differential is insignificant in the fully adjusted models for EMCS. Just over half (53 %) of the 6 percentage point difference in ELCS rates between the two models of care can be accounted for by maternal, clinical and hospital characteristics. Almost 80 % of the difference for EMCS can be accounted for.Conclusions: The majority of the difference in EMCS rates across models of care can be explained by differing characteristics between the two groups of women. The main contributor to the difference was advancing maternal age. The unexplained component of the difference for ELCS is larger; an excess private effect remains after accounting for maternal, clinical, and hospital characteristics. This requires further investigation and may be mitigated in future with the introduction of clinical guidelines related to CS. [ABSTRACT FROM AUTHOR]

Background: International recruitment is a common strategy used by high-income countries to meet their medical workforce needs. Ireland, despite training sufficient doctors to meet its internal demand, continues to be heavily dependent on foreign-trained doctors, many of whom may migrate onwards to new destination countries. A cross-sectional study was conducted to measure and analyse the factors associated with the migratory intentions of foreign doctors in Ireland.Methods: A total of 366 non-European nationals registered as medical doctors in Ireland completed an online survey assessing their reasons for migrating to Ireland, their experiences whilst working and living in Ireland, and their future plans. Factors associated with future plans - whether to remain in Ireland, return home or migrate to a new destination country - were tested by bivariate and multivariate analyses, including discriminant analysis.Results: Of the 345 foreign doctors who responded to the question regarding their future plans, 16 % of whom were Irish-trained, 30 % planned to remain in Ireland, 23 % planned to return home and 47 % to migrate onwards. Country of origin, personal and professional reasons for migrating, experiences of training and supervision, opportunities for career progression, type of employment contract, citizenship status, and satisfaction with life in Ireland were all factors statistically significantly associated with the three migratory outcomes.Conclusion: Reported plans may not result in enacted emigration. However, the findings support a growing body of evidence highlighting dissatisfaction with current career opportunities, contributing to the emigration of Irish doctors and onward migration of foreign doctors. Implementation of the WHO Global Code, which requires member states to train and retain their own health workforce, could also help reduce onward migration of foreign doctors to new destination countries. Ireland has initiated the provision of tailored postgraduate training to doctors from Pakistan, enabling these doctors to return home with improved skills of benefit to the source country. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine if a potential relationship among physical activity (PA), fundamental movement skills and weight status exists amongst early adolescent youth. Participants were a sample of 85 students; 54 boys (mean age = 12.94 ± 0.33 years) and 31 girls (mean age = 12.75 ± 0.43 years). Data gathered during physical education class included PA (accelerometry), fundamental movement skills and anthropometric measurements. Standard multiple regression revealed that PA and total fundamental movement skill proficiency scores explained 16.5% (P < 0.001) of the variance in the prediction of body mass index. Chi-square tests for independence further indicated that compared with overweight or obese adolescents, a significantly higher proportion of adolescents classified as normal weight achieved mastery/near-mastery in fundamental movement skills. Results from the current investigation indicate that weight status is an important correlate of fundamental movement skill proficiency during adolescence. Aligned with most recent research, school- and community-based programmes that include developmentally structured learning experiences delivered by specialists can significantly improve fundamental movement skill proficiency in youth. [ABSTRACT FROM AUTHOR]

Nurses' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design ( n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care. [ABSTRACT FROM AUTHOR]

Objectives.This study examined variations inthe main and buffering effectsof ethnic and nonethnic social support on depressive symptoms associated with discrimination among five immigrant groups in Toronto. Design.Data were taken from the Toronto Study of Settlement and Health, a cross-sectional survey of adult immigrants from five ethnic communities (Vietnamese, Ethiopian, Iranian, Korean, and Irish) in Toronto. A total of 900 surveys were collected through face-to-face interviews conducted between April and September 2001. Results.Significant ethnic variations were observed inthe effectsof both ethnic and nonethnic social supports on discrimination-related depressive symptoms. Regarding the main effect,ethnic social supportwas significantly stronger for Iranian, Ethiopian, and Korean immigrants than for Irish immigrants. The benefits of nonethnic support were stronger for Iranian immigrants compared to the effect found in the Irish sample. With respect to stress-buffering or stress-moderating effects of social support, ethnic support was significant in all ethnic groups, except the Vietnamese group. Nonethnic support aggravated the negative impact of discrimination on depressive symptoms in the Irish group, but exerted a stress-buffering effect in the Iranian group. Conclusions.Overall, social supports received from fellow ethnic group members had significant main effects (suppressing depressive symptoms) and stress-buffering effects and were most pronounced in the minority ethnic immigrant groups of Ethiopians, Koreans, and Iranians. The effects were least evident among the Vietnamese and Irish. Evidence for the stress-suppressing and stress-buffering role of cross-ethnic group supports was unclear, and even inverted among Irish immigrants. Empirical evidence from the current study seems to support the sociocultural similarity hypothesis of social support. [ABSTRACT FROM PUBLISHER]

Aims and objectives To examine the unmet supportive care needs of long-term head and neck cancer caregivers, and the factors associated with those needs. Background Research on the unmet needs of head and neck cancer caregivers is lacking, particularly in the long-term survivorship period. Design Survey of 197 caregivers. Methods The study collected information on caregivers' demographic characteristics and their unmet supportive care needs (as measured by the Partners and Caregivers Supportive Care Needs Survey). An overall score of unmet need was generated, as were scores for four separate domains of unmet needs (emotional, health, information and work/social). Results Seventy six percentage of respondents were female, and 88% reported being married or living with a partner. Mean age was 57 years. Most caregivers had low levels of unmet needs. Managing fears about the cancer recurring was the most commonly reported individual need, described by slightly more than one in five respondents. The highest levels of need were located in the emotional and the health services domains. Loneliness and financial stress were consistently and significantly associated with high levels of unmet need in the multivariable analysis. Conclusions Most head and neck cancer caregivers appear to have low levels of unmet need in the extended survivorship period. The greatest levels of unmet need that are experienced occur in relation to emotional and health service domains. Needs diminish over time. Relevance to clinical practice Health professionals should be aware that a minority of long-term head and neck caregivers continue to experience strong fears of cancer recurrence. To reduce unmet needs across multiple domains, health professionals should seek to reduce caregivers' feelings of loneliness, and to assist caregivers to reduce the financial burdens that they experience as a result of long-term caring. [ABSTRACT FROM AUTHOR]

Objective: To assess the awareness and acceptability of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and use sociosexual media at high risk of HIV infection in four Celtic nations.Design: Cross-sectional study.Methods: Online self-complete survey of 386 HIV-negative/status unknown MSM who reported condomless anal intercourse (CAI) with ≥2 men in the last year, recruited from gay sociosexual media.Results: One-third (34.5%, 132/386) of the participants were aware of PrEP but over half (58.5%, 226/356) reported that they would be willing to use PrEP if it were available to them. Only men who regularly tested for HIV every 6 months (adjusted OR 2.89, 95% CI 1.54 to 5.42) were more likely to be aware of PrEP. PrEP acceptability was only associated with reporting ≥5 CAI partners (OR 2.04, 95% CI 1.2 to 3.46) in the last year.Conclusions: Low levels of PrEP awareness were reported across these Celtic nations. Only one-third of high-risk MSM had heard of PrEP but over one-half would be willing to take a daily pill to prevent HIV infection. Sociodemographic factors, commercial gay scene proximity and social network use were unrelated to considering PrEP use. However, those reporting most CAI partners were more likely to consider PrEP use. [ABSTRACT FROM AUTHOR]

Objective: As countries struggle to meet the set targets for population salt intake, there have been calls for more regulated approaches to reducing dietary salt intake. However, little is known about how the public perceives various salt reduction policies; an important line of investigation given that the implementation and success of these policies often depend on public sentiment. We investigated the attitudes and beliefs of consumers towards salt reduction and their support for thirteen different government-led salt reduction policies.Design: A cross-sectional online survey measured participants' knowledge, beliefs and attitudes in relation to salt reduction.Setting: The survey was carried out with participants from the Republic of Ireland.Subjects: Five hundred and one participants recruited via a market research agency completed the survey.Results: We found that the vast majority of participants supported eleven of the government-led salt reduction policies, which included measures such as education, labelling and salt restriction in foods (both voluntary and regulated, across a range of settings). The two proposed fiscal policies (subsidising low-salt foods and taxing high-salt foods) received less support in comparison, with the majority of participants opposed to a tax on high-salt foods. A series of multiple regressions revealed that individual attitudes and beliefs related to health and salt were stronger predictors of support than sociodemographic factors, lifestyle or knowledge.Conclusions: The study provides an important evidence base from which policy makers may draw when making decisions on future policy steps to help achieve national salt targets. [ABSTRACT FROM AUTHOR]

Background: There is an unclear relationship between mental health literacy (MHL) and psychiatric stigma. MHL is associated with both positive and negative attitudes to mental illness. To our knowledge, no published peer reviewed study has examined this relationship in the Republic of Ireland. Aims: This study was conducted to assess MHL regarding schizophrenia and the degree of psychiatric stigma displayed by the general public in the Republic of Ireland. Method: A face-to-face in-home omnibus survey was conducted with a representative sample of residents of the Republic of Ireland. Participants (N = 1001) were presented with a vignette depicting schizophrenia and were asked questions to determine their ability to recognise the condition and to ascertain their attitudes towards schizophrenia and mental illness. Results: Among the participants, 34.1% correctly identified schizophrenia. Higher age, higher socioeconomic status, and an urban geographic location predicted identification. Those who did not correctly identify schizophrenia were significantly more optimistic about recovery and perceived people with schizophrenia as less dangerous. However, only the relationship with perceived dangerousness was considered robust. Conclusions: Participants with higher MHL displayed more negative attitudes to mental illness. Findings have implications internationally for MHL and anti-stigma campaigns. [ABSTRACT FROM AUTHOR]

Aim: This study explores the prevalence and management of wounds within an urban setting in Ireland. Method: It employs a cross-sectional survey design, using a predesigned, validated data-collection instrument. Findings: The point prevalence of wounds was 3.7% (n=445), with surgical wounds being the most prevalent (43%; n=189). Wound care was provided across a wide variety of clinical settings, with the majority of patients (60%; n=271) managed in the acute care setting. Most dressings were changed 2-3 times a week (60%; n=271). The mean dressing time was 15 minutes (SD: 12.4 minutes), varying from 2 minutes to 90 minutes. The mean nurse travel time was 3 minutes (SD: 6.5 minutes), varying from 0-60 minutes. Among participants managed using silver and iodine dressings, 53% (n=10, silver) and 78% (n=50, iodine) were prescribed for wounds described as being not infected. Alginate dressings were used incorrectly in 75% of cases, foam dressings in 63% of cases and Hydrofiber dressings in 63% of cases. Conclusion: Wound management within the explored geographical area is an important clinical intervention. This study identified areas of practice that need to be addressed, primarily those related to the topical management of the wound and use of offloading. The data has been used to inform practice, education, and further research in this important clinical specialty. [ABSTRACT FROM AUTHOR]

Background: Early childhood development is a multifaceted construct encompassing physical, social, emotional and intellectual competencies. The Early Development Instrument (EDI) is a population-level measure of five domains of early childhood development on which extensive psychometric testing has been conducted using traditional methods. This study builds on previous psychometric analysis by providing the first large-scale Rasch analysis of the EDI. The aim of the study was to perform a definitive analysis of the psychometric properties of the EDI domains within the Rasch paradigm.Methods: Data from a large EDI study conducted in a major Irish urban centre were used for the analysis. The unidimensional Rasch model was used to examine whether the EDI scales met the measurement requirement of invariance, allowing responses to be summated across items. Differential item functioning for gender was also analysed.Results: Data were available for 1344 children. All scales apart from the Physical Health and Well-Being scale reliably discriminated between children of different levels of ability. However, all the scales also had some misfitting items and problems with measuring higher levels of ability. Differential item functioning for gender was particularly evident in the emotional maturity scale with almost one-third of items (9 out of 30) on this scale biased in favour of girls.Conclusion: The study points to a number of areas where the EDI could be improved. [ABSTRACT FROM AUTHOR]

Pain is the most common symptom in the emergency setting and remains one of the most challenging problems for emergency care providers, particularly in the pediatric population. The primary objective of this study was to determine the prevalence of acute pain in children attending emergency departments (EDs) in Ireland by ambulance. In addition, this study sought to describe the prehospital and initial ED management of pain in this population, with specific reference to etiology of pain, frequency of pain assessment, pain severity, and pharmacological analgesic interventions. A prospective cross-sectional study was undertaken over a 12-month period of all pediatric patients transported by emergency ambulance to four tertiary referral hospitals in Ireland. All children (<16 years) who had pain as a symptom (regardless of cause) at any stage during the prehospital phase of care were included in this study. Over the study period, 6,371 children attended the four EDs by emergency ambulance, of which 2,635 (41.4%, 95% confidence interval 40.2–42.3%) had pain as a documented symptom on the ambulance patient care report (PCR) form. Overall 32% (n= 856) of children who complained of pain were subject to a formal pain assessment during the prehospital phase of care. Younger age, short transfer time to the ED, and emergency calls between midnight and 6 am were independently associated with decreased likelihood of having a documented assessment of pain intensity during the prehospital phase of care. Of the 2,635 children who had documented pain on the ambulance PCR, 26% (n= 689) received some form of analgesic agent prior to ED arrival. Upon ED arrival 54% (n= 1,422) of children had a documented pain assessment and some form of analgesic agent was administered to 50% (n= 1,324). Approximately 41% of children who attend EDs in Ireland by ambulance have pain documented as their primary symptom. This study suggests that the management of acute pain in children transferred by ambulance to the ED in Ireland is currently poor, with documentary evidence of only 26% receiving prehospital analgesic agents. [ABSTRACT FROM PUBLISHER]

Objectives: The advent of the COVID‐19 pandemic has resulted in periods of nationwide restrictions in Ireland including school and workplace closures. The authors hypothesised that this disruption to society may have led to a change in patterns of suspected physical abuse (SPA) presentations to the paediatric emergency department (ED), whilst ED attendance fell dramatically during the period. We reviewed data to determine whether there was an increase in presentations of SPA during periods of social restrictions. Methods: The National Integrated Medical Imaging Service was searched for all skeletal survey examinations performed between the dates of the 1 March 2016 and 28 Feb 2021 for studies performed in cases of SPA. Electronic records of attendance were extracted from the emergency department administrative system at the three paediatric emergency departments which serve the 400,000 children regionally. The data were reviewed to determine if SPA presentations increased during restriction periods. Results: 311 individual paediatric patients aged 24 months and under were referred for SPA skeletal survey during the study period. During the 2020/2021 period, 60 children were referred for SPA workup and there was no statistically significant difference between monthly referrals (mean 5, sd 2.92) in this period and matched periods over the preceding 4 years (mean 5.23, sd 2.69). Conclusions: The incidence of SPA did not increase during the period of national restrictions during the COVID‐19 pandemic. Advances in knowledge: Periods of social restrictions taken to protect the public health during a pandemic do not result in short term increases in suspected physical abuse in the regional paediatric population. [ABSTRACT FROM AUTHOR]

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Study design: Cross-sectional design. Objectives: To investigate whether the Fly Test can be used to differentiate patients with whiplash-associated disorders (WAD) from asymptomatic persons who deliberately feign symptoms and from WAD patients exaggerating symptoms. Background: The lack of valid clinical tests makes it difficult to detect a justifiable cause for compensation claims in traumatic neck-pain disorders. Methods: The Fly Test recorded the accuracy of neck movements in patients with WAD ( n = 34) and asymptomatic persons ( n = 31). The participants followed a moving 'Fly' on a computer screen with a cursor from sensors mounted on the head. Two conditions were tested, sincere versus feigned efforts. In the former, the participants moved their neck as accurately as possible. In the latter, a short text was presented describing a fictitious accident (asymptomatic group) or imagining more intense pain/suffering (WAD group), and the test was performed as affected by these more serious conditions. Amplitude accuracy (AA), time on target (ToT) and jerk index (JI) were compared across patterns, conditions and groups. Results: The sincere effort in the WAD group was significant compared to the feigned effort of the asymptomatic group ( p < 0.001). For AA, correct categorization of 81.5% of the performances was made, where a mean score above 5.5 mm differentiated feigned versus sincere efforts in asymptomatic and WAD groups (sensitivity 79.4%, specificity 67.7%). For ToT, score above 11% indicated correctly categorized WAD patients (sensitivity 82.4%, specificity 64.5%). Conclusion: The Fly Test can provide clinicians a clue when patients with mild to moderate pain/disability are feigning or exaggerating symptoms. [ABSTRACT FROM AUTHOR]

Background: The benefits of breastfeeding for babies, mothers and society have been demonstrated in a large scientific literature. Irish rates of breastfeeding are amongst the lowest in Europe (in 2010, Ireland had the lowest breastfeeding initiation rate of 14 European countries). One of the most distinctive features of breastfeeding behaviour in Ireland is the large difference in breastfeeding rates between immigrants to Ireland and the Irishborn. Data from the 2010 Irish National Perinatal Reporting System show that just 46.1% of Irish-born mothers were breastfeeding at hospital discharge, in comparison with 84.2% of immigrant mothers. Descriptive patterns suggest that breastfeeding behaviour in Ireland may exhibit a ‘healthy immigrant' effect, whereby the health status and behaviours of immigrants are better than the native-born on arrival, but converge to native levels as length of time since migration increases. Methods: Using nationally representative data from two cohorts of children in Ireland, the purpose of this article is to examine the evidence for a ‘healthy immigrant' effect with respect to breastfeeding behaviour. Results: The results indicate that immigrants are significantly more likely to breastfeed than Irish-born mothers, but that immigrant breastfeeding rates converge towards Irish-born rates of breastfeeding as length of time since migration increases. Conclusion: The decline in breastfeeding behaviour among immigrants to Ireland with length of time since migration highlights the need for appropriate interventions aimed at countering the particular negative attitudes to breastfeeding that are observed in Irish society. [ABSTRACT FROM AUTHOR]

Objectives:The effect of chronic disease status on quality of life (QoL) has been well established. However, less is known about how chronic diseases affect QoL. This article examines impairment in three domains of the WHO International Classification of Functioning, Health and Disability (ICF) – body function, activity and participation, as well as affective well-being, – as potential mediators of the relationship between chronic disease and QoL. Method:A cross-sectional sample (n= 4961) of the general Irish community-dwelling population aged 50+ years was obtained from the Irish Longitudinal Study of Ageing (TILDA). The CASP measure of QoL was examined as two dimensions – control/autonomy and self-realisation/pleasure. Structural equation modelling was used to test the direct and indirect effects of chronic disease on QoL, via variables capturing body function, activity, participation and positive affect. Results:A factor analysis showed that indicators of body function and activity loaded onto a single overall physical impairment factor. This physical impairment factor fully mediated the effect of chronic disease on positive affect and QoL. The total effect of chronic disease on control/autonomy (−0.160) was primarily composed of an indirect effect via physical impairment (−0.86), and via physical impairment and positive affect (−0.45). The decomposition of effects on self-realisation/pleasure was similar, although the direct effect of physical impairment was weaker. The model fitted the data well (RMSEA = 0.02, TLI = 0.96, CFI = 0.96). Conclusion:Chronic disease affects QoL through increased deficits in physical body function and activity. This overall physical impairment affects QoL both directly and indirectly via reduced positive affect. [ABSTRACT FROM AUTHOR]

Adolescents are a vulnerable population, not only to the acquisition of HIV, but also to poor adherence to antiretroviral therapy (ART) associated with disease progression and a increased risk of onward viral transmission. The aim of the study was to examine the factors that aid or act as barriers to adherence in a UK population of adolescents and young adults receiving ART. A cross-sectional survey was completed of 138 adolescents (12-24 years) across 14 clinical and community sites in the UK and Ireland. Analysis of results was undertaken using Chi-square testing in SPSS. Of the 138 patients, 48% were female, and 52% were born outside of the UK. Fifty-two of the 138 (43%) reported being on ART for at least 8 years. More than a third of the patients have ever interrupted treatment since initiating ART. One hundred four of the 138 (75%) patients self-reported being >85% adherent to medication for 7 day recall. Self-motivation (e.g., having a routine, specific goal) was cited as being most helpful in medication compliance (33%), followed by reminders by friends and family (25%), with 20% identifing no specific factor. Only 15% chose interventions such as an adherence diary or mobile phone reminders as helpful factors, and 1% chose healthcare professional input such as home visits. This study highlights the importance of self-motivation and social support in medication adherence in an HIV-infected adolescent population, in preference to healthcare professional input. Education and motivational strategies may confer the biggest impact on sustained ART adherence amongst this vulnerable group. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop a healthy eating motivation score and to determine if dietary, lifestyle and activity behaviours vary across levels of motivation to eat a healthy diet with a view to informing health promotion interventions. Methods: A cross-sectional survey of food intake, physical activity, lifestyles and food choice attitudes was conducted in a nationally representative sample of 1262 adults in the Republic of Ireland aged 18 years and over. Results: Increasing score for health motivation was significantly and positively related to healthy eating and exercise. Women, increasing age, normal BMI, regular exercise and increasing intakes of fruit and vegetables were associated with a higher odds ratio (OR) for having a high healthy eating motivation score. However, despite a high motivation score only 31 % of consumers in the strong motivation group achieved the recommendations for daily fruit and vegetable consumption, while 57 % achieved the fat recommendation. A higher intake of calorie dense foods from the top shelf of the food pyramid and increased time spent watching T.V. was associated with a decreased OR for positive motivation towards healthy eating. Conclusions: Healthy eating promotions directed at women and older adults should focus on supporting people's motivations to attain a healthy diet by addressing issues such as dietary self-control and self-regulation. For men and younger adults, healthy eating promotions will need to address the issues underlying their weak attitudes towards healthy eating. [ABSTRACT FROM AUTHOR]

Background: Adherence to treatment is often reported to be low in children with cystic fibrosis. Adherence in cystic fibrosis is an important research area and more research is needed to better understand family barriers to adherence in order for clinicians to provide appropriate intervention. The aim of this study was to evaluate adherence to enzyme supplements, vitamins and chest physiotherapy in children with cystic fibrosis and to determine if any modifiable risk factors are associated with adherence. Methods: A sample of 100 children (≤18 years) with cystic fibrosis (44 male; median [range] 10.1 [0.2-18.6] years) and their parents were recruited to the study from the Northern Ireland Paediatric Cystic Fibrosis Centre. Adherence to enzyme supplements, vitamins and chest physiotherapy was assessed using a multi-method approach including; Medication Adherence Report Scale, pharmacy prescription refill data and general practitioner prescription issue data. Beliefs about treatments were assessed using refined versions of the Beliefs about Medicines Questionnaire-specific. Parental depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results: Using the multi-method approach 72% of children were classified as low-adherers to enzyme supplements, 59% low-adherers to vitamins and 49% low-adherers to chest physiotherapy. Variations in adherence were observed between measurement methods, treatments and respondents. Parental necessity beliefs and child age were significant independent predictors of child adherence to enzyme supplements and chest physiotherapy, but parental depressive symptoms were not found to be predictive of adherence. Conclusions: Child age and parental beliefs about treatments should be taken into account by clinicians when addressing adherence at routine clinic appointments. Low adherence is more likely to occur in older children, whereas, better adherence to cystic fibrosis therapies is more likely in children whose parents strongly believe the treatments are necessary. The necessity of treatments should be reinforced regularly to both parents and children. [ABSTRACT FROM AUTHOR]

Background: Findings on the demographic and sexual health characteristics associated with the experience of a crisis pregnancy are important to inform the public health policy of a country, including Ireland. Studies from other jurisdictions have suggested that certain demographic groups are at risk for unintended pregnancies and the disparity between the groups has been growing in recent years. Ireland is a country which experienced much economic and societal change in the first decade of the 21st century; changes which are likely to have affected demographic variables pertaining to sexual health. The current study had two aims: to investigate changes in the socioeconomic characteristics associated with crisis pregnancies over a seven year period [2003 to 2010], and to investigate the recent [2010] socioeconomic risk factors associated with crisis pregnancies in Ireland. Methods: The study compared the results from 18-45 year old women using data from three broadly similar nationally representative Irish sexual health surveys carried out in 2003, 2004-2006 and 2010. Chi square analysis compared of the socioeconomic characteristics across the seven year period. A logistic regression then investigated the sexual health history and socioeconomic factors associated with the experience of a recent crisis pregnancy using the most recent 2010 data. Results: In 2010, 74% of women experienced parenthood and 23% experienced abortion as the outcome of their crisis pregnancy. Receipt of sex education and contraception use at first sex significantly predicted the experiencing of a recent crisis pregnancy. Younger women and those with a lower level of education were more likely to report having experienced a recent crisis pregnancy. Conclusion: Similar demographic groups are at risk for experiencing a crisis pregnancy in Ireland compared with international research, yet the disparities between demographic groups who have experienced a crisis pregnancy appear to be decreasing rather than increasing over a seven year period. Recommendations are made with regard to the provision of continued sex education throughout the lifespan, particularly for those women who are at an increased risk of experiencing a crisis pregnancy. [ABSTRACT FROM AUTHOR]

The current study aimed to test a key theoretical prediction of rational emotive behavior therapy (REBT) theory by assessing the role of general and trauma-specific irrational beliefs in the prediction of posttraumatic stress responses. A sample (N = 313) of trauma-exposed emergency service workers participated in the study. Structural equation modeling results demonstrated that an REBT-based model provided satisfactory model fit and explained 89% of variance in posttraumatic stress symptomatology. Theoretical predictions were supported, with results demonstrating that general-level irrationality indirectly impacted posttraumatic stress responses via a set of trauma-specific irrational beliefs. Results indicate the importance of irrational beliefs in predicting posttraumatic stress responses. [ABSTRACT FROM PUBLISHER]

Objective:To (1) examine the opinions of medical staff working in spinal cord injury (SCI) centres (SCICs); (2) evaluate their knowledge, attitudes and practices towards obesity prevention and management; (3) report the number of beds and dietitians available at each SCIC.Methods:A 37-item questionnaire was sent to 23 SCICs in the UK, the Netherlands, Belgium and the Republic of Ireland between September 2012 and January 2013.Results:Eighteen SCICs returned the questionnaires for analysis. All respondents stated that they had an interest in obesity treatment but only 2.3% of the respondents received training in obesity management. Sixty-one percent of staff did not consider body mass index (BMI) to be appropriate for use in SCI patients and subsequently less than half of the respondents use BMI routinely. The majority of respondents reported that they are confident in dealing with overweight (74.5%) and obese (66.1%) SCI adults, less than half (44.1%) are confident in treating overweight and obese SCI children. Respondents also indicated the need for nationally adopted guidelines and a lack of physical activity provision. There were 17.5 whole-time equivalent (WTE) dietitians recorded in 22 SCICs, equivalent to 47.8 beds per WTE dietitians (range 10-420). Non-UK SCIC dietitians are significantly better resourced than in UK SCICs (beds per WTE dietitian: 36 vs 124, P=0.035).Conclusion:Medical staff expressed the need to participate in obesity prevention and management. Appropriate training should be considered for all medical staff and the development of specific weight management guidelines and dietetic provision should be considered. [ABSTRACT FROM AUTHOR]

The ethnic profile in Ireland has changed in recent years with an increase in the number of immigrant families. No previous studies have examined mental health issues in immigrant children in Ireland. This study aimed to examine the rates of psychological disturbance in a sample of second-generation immigrant children and to compare them with a group of Irish children living in the same geographic area. Primary school-aged children were recruited from a randomly selected school in Dublin, the capital city, and examined using Child Behavior Checklist 1.5-5 (CBCL). In addition to CBCL, parents also filled in a family background questionnaire. The CBCL revealed that immigrant girls had a significant higher mean score of internalising score (14.56; SD = 3.03) than Irish boys (8.38, SD = 6.5). Immigrant girls also had a higher mean score (4.8; SD = 2.4) on withdrawn scale in comparison to Irish girls (2; SD = 1.7) and Irish boys (2; SD = 1.83). Borderline clinically significant means were detected for the Pervasive developmental problem on the CBCL-DSM orientated subscale in immigrant children. Despite the detected borderline clinically significant means for the Pervasive developmental problem in immigrant children and the higher scores of immigrant girls on internalising and withdrawn scales, larger studies are still needed to replicate the results. [ABSTRACT FROM AUTHOR]

This study examines ethnic and gender differences in exposure to discrimination and its association with depressive symptoms among five immigrant groups. Data were derived from a cross-sectional survey of 900 adult immigrants (50.8 % men, 49.2 % women) sampled from five ethnic immigrant communities in Toronto between April and September 2001. Men reported higher levels of discrimination than women. Ethiopians had the highest perception of discrimination followed by Korean, Iranian, Vietnamese, and Irish immigrants. With regard to discrimination-related depressive symptoms, Iranian and Korean men showed a greater risk than their Irish counterparts. Among women, Vietnamese and Irish seemed to be more vulnerable to discrimination than other ethnic groups. Despite experiencing the highest level of discrimination, Ethiopian men and women showed no association between discrimination and depressive symptoms. The exposure and psychological response to discrimination vary significantly across ethnicities and gender. [ABSTRACT FROM AUTHOR]

Background. Vitamin D has important skeletal and extraskeletal roles but those living at northerly latitudes are at risk of suboptimal levels because of reduced sunlight exposure. Aim. To describe the vitamin D status of Irish children and identify factors predictive of vitamin D status. Methods. A prospective cross sectional study was undertaken over a 12 month period. Two hundred and fifty two healthy children attending for minor medical or surgical procedures were recruited. All had 25-hydroxyvitamin D (25OHD), parathyroid hormone and bone profiles measured. Results. The mean (standard deviation) for 25OHD was 51(25) nmol/L (20.4 (10) ng/mL). Forty-five percent had levels >50 nmol/L (20 ng/mL). The following variables were significantly associated with 25OHD levels >50 nmol/L (20 ng/mL): sample drawn in April-September, use of vitamin D supplements, consumption of formula milk, and non-African ethnicity. Conclusion. More than half of the children in this study had 25OHD levels less than 50 nmol/L (20 ng/mL). Vitamin D status was significantly improved by augmented oral vitamin D intake. [ABSTRACT FROM PUBLISHER]

Objective The study sought to assess opinions and attitudes of general practitioners ( GPs) in Ireland towards fitness to drive ( FTD) assessment in people older than 65 years old as well as to gather information on current assessment practices. Method A postal-based cross-sectional survey was carried out with 603 GP practices randomly selected using the Irish College of General Practitioners database. Results Response rate was 42.6%. The prevalence of GPs not confident in assessing FTD was less than 15% with 81% reporting the need for more education on assessing FTD, and 82% identifying that mandatory reporting of unsafe drivers posed a conflict of interest. Only 37% of GPs always/often used the Irish Road Safety Authority handbook when assessing FTD with 14% not aware of its existence. Of responders, 89% were of the opinion that a clinical assessment tool would be of benefit in assessing FTD. Conclusion Our study highlights the need for education and training for Irish GPs on FTD assessment in the older people patient population. [ABSTRACT FROM AUTHOR]

Little is known about the extent of exercise prescription within cancer care. This cross-sectional survey aims to identify Irish oncology nurses and physiotherapists' current knowledge and practice in prescribing exercise for cancer care and barriers to such prescription. An online survey was distributed to the Chartered Physiotherapists in Oncology and Palliative Care ( n = 35) and the Irish Association for Nurses in Oncology ( n = 170). The response rate was 74% (26/35) for physiotherapists and 34% (58/170) for oncology nurses. Three quarters of physiotherapists recommended/prescribed exercise with 81% or more of cancer patients in the past 6 months, with the exercises prescribed largely in line with current guidelines. Patients' family/friends advising rest was the most commonly reported exercise barrier by physiotherapists [89% (17/19)], with a lack of exercise guidelines for cancer patients being most problematic for oncology nurses [93% (50/54)]. Only 33% (18/54) of oncology nurses felt they had sufficient knowledge regarding exercise in cancer care. In conclusion, exercise prescription by physiotherapists largely corresponds with current guidelines. A minority of nurses felt they had sufficient knowledge of exercise for this population. Further formal postgraduate educational opportunities are needed for oncology nurses and physiotherapists in this area. [ABSTRACT FROM AUTHOR]

What is already known about this subject Active video games (AVGs) are being marketed as exercise tools., AVG play can result in light-to-moderate intensity physical activity., What this study adds A comparison correcting for body size between the energy expended by children with obesity and those of a healthy weight playing AVGs., An examination of several variables related to the energy cost of AVG play including steps taken and rate of perceived exertion., There may be some differences in how children with obesity and children of a healthy weight play AVGs., Background Increasing physical activity and reducing sedentary behaviour form a large part of the treatment of paediatric obesity. However, many children today spend prolonged periods of time playing sedentary video games. Active video games (AVGs) represent a novel and child friendly form of physical activity. Objectives To measure the energy cost of playing two AVGs in children with obesity and healthy age- and gender-matched children. Methods The energy cost of gaming and heart rates achieved during gaming conditions were compared between groups. Results AVG play can result in light-to-moderate intensity physical activity (2.7-5.4 metabolic equivalents). When corrected for fat-free mass those with obesity expended significantly less energy than healthy weight peers playing Nintendo Wii Fit Free Jogging ( P = 0.017). No significant difference was seen between groups in the energy cost of playing Boxing. Conclusion Certain AVGs, particularly those that require lower limb movement, could be used to increase total energy expenditure, replace more sedentary activities, or achieve moderate intensity physical activity among children with obesity. There seems to be some differences in how children with obesity and children of a healthy weight play AVGs. This could result in those with obesity expending less energy than their lean peers during AVG play. [ABSTRACT FROM AUTHOR]

Stress among nurses leads to absenteeism, reduced efficiency, long-term health problems and a decrease in the quality of patient care delivered. A quantitative cross-sectional study was conducted. The study’s aim was to identify perceived stressors and influencing factors among nurses working in the critical and non-critical care practice areas. A convenience sample of 200 nurses were invited to complete the Bianchi Stress Questionnaire. Information was collected on demographics and daily nursing practice. Findings indicated that perceived stressors were similar in both groups. The most severe stressors included redeployment to work in other areas and staffing levels. Results from this study suggest that age, job title, professional experience and formal post-registration qualifications had no influence on stress perception. These results will increase awareness of nurses’ occupational stress in Ireland. [ABSTRACT FROM AUTHOR]

Background Prostate cancer incidence has risen considerably in recent years, primarily due to Prostate Specific Antigen (PSA) testing in primary care. The objective of this study was to investigate associations between PSA testing and the psychological and physical health, and healthcare utilisation of men in a population where PSA testing is widespread. Methods A cross-sectional study was carried out in a population-representative sample of men ⩾50 years enrolled in The Irish Longitudinal Study on Ageing (TILDA). TILDA participants underwent structured interviews, health assessments and completed standardised questionnaires. Men were classified as ever/never having received a PSA test. Multivariate logistic regression (Odds Ratios (OR) and 95% Confidence Intervals (CI) was used to determine associations between PSA testing, and men's psychological and physical health and healthcare utilisation. Results This analysis included 3,628 men, 68.2% of whom ever had a PSA test. In adjusted analysis, men with sub-threshold depression were significantly less likely to have had a PSA test, (OR = 0.79, 95% CI 0.64-0.97). Likelihood of having a PSA test was inversely associated with anxiety, but this was not significant (OR = 0.79, 95% CI 0.57-1.09). Frailty (OR = 0.61, 95% CI 0.31-1.05) and eligibility for free primary care (OR = 0.63, 95% CI 0.52-0.77) were also inversely associated with PSA testing. Positive associations were observed between PSA testing and more chronic illnesses (OR = 1.11, 95% CI 1.05-1.19), more primary care visits (OR = 1.03, 95% CI 1.01-1.05) and preventative health practices, including cholesterol testing and influenza vaccination (OR = 1.35, 95% CI 1.13-1.60). Conclusions Men's psychological and physical health and their healthcare utilisation are associated with PSA testing in primary care. The association between poorer psychological health, in particular sub-threshold depression, and reduced likelihood of PSA testing in primary care requires further investigation. These findings may have wider implications for other cancer screening. [ABSTRACT FROM AUTHOR]

Aim The aim was to identify key patient outcomes and to compare these outcomes across services that employed clinical specialists (either nurse or midwife) or advanced nurse practitioners with matched, non post-holding services. Background In nursing and evaluation research, it is recognized that, further patient outcome studies, which measure and evaluate the impact of the new advanced roles, are urgently needed. Design A cross-sectional study design with a comparison group was implemented across Ireland. Method A total of 279 surveys were completed by service users in 41 services in 2009/10. Key outcomes were identified, then chosen as primary outcomes and assessed for differences across post-holding and the matched comparison sites. To identify the priority of importance of the key outcomes, a logistic regression model was computed with difference in overall care observed (yes or no) as the dependent variable, and gender, age grouping and the key outcomes as the independent predictors. Results Analysis revealed that the key outcomes were, on anxieties, dignity and respect, time waited, confidence in the clinician and the clinician making a positive difference. Results of the logistic modelling of the key outcome on noticing any difference in the care given by the clinical specialists or advanced nurse practitioners compared with the care from others revealed that the single most important predictor was being treated with respect. Conclusion Further studies evaluating advanced health professions roles measuring these six key outcomes, at a minimum, will ensure that service users' main concerns are being accounted for. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between school sex education and sexual health behaviours at first sex and later in adulthood, using nationally representative data. Respondents were adults from the 2010 Irish Contraception and Crisis Pregnancy Survey, a cross-sectional survey designed to assess knowledge, attitudes and behaviours relating to sex, contraception and pregnancy in Ireland. Results indicate that respondents who received sex education were more likely to have first sex at an older age and use contraception on this occasion. Sex education also significantly increased the likelihood of using contraception at first sex, when first sex occurred before 17 years of age. The effect of sex education and sexual health behaviours into adulthood was also investigated. Sex education increased the likelihood of having a history of sexually transmitted infection testing and decreased the likelihood of having experienced a crisis pregnancy. No association was found between sex education and contraception use over the past year. Findings suggest that sex education is an important factor in the context of first sex and later sexual health, and programmes should continue to equip young people as they make immediate sexual behaviour decisions and further sexual health-related decisions throughout their lifespan. [ABSTRACT FROM AUTHOR]

Aim To investigate the use of psychosocial interventions by mental health nurses following training and perceived benefits to service users. Background Psychosocial interventions are recommended to support the recovery of persons with enduring mental illness. Despite two decades of postgraduate training in psychosocial interventions internationally, implementation challenges still remain. Design A cross-sectional exploratory, descriptive survey was employed. Methods A survey was mailed to the total population of nurses ( n = 58) working in some health regions in Ireland who completed training in psychosocial interventions between 2005-2010. Data were collected between November 2011-January 2012, yielding a response rate of 64%. Descriptive and correlational statistics were used to analyse the data. Results There were statistically significant increases in the use of psychosocial interventions post training. Cognitive behavioural therapy and family interventions were the least used interventions. Assessment and outcome measures, concordance therapy and relapse prevention were preferential interventions. Perceived outcomes for service users were awareness of relapse indicators, enhanced coping skills and fewer admissions. Case load demands, lack of access to supervision and time constraints prevented implementation. Free text comments indicated a dissonance between generic nursing roles and implementation of structured psychosocial interventions in practice. Conclusions The findings indicate a requirement for nursing leadership to legitimize psychosocial interventions as core nursing work. For service users to experience this type of nursing, we propose the nomination of dedicated psychosocial intervention nurses to multidisciplinary teams. Support through guidelines, clinical supervision and audit by senior nurse managers is critical to implementation. [ABSTRACT FROM AUTHOR]

Background Historically, breastfeeding rates in Ireland have been low compared with international averages. It has been suggested that maternal ethnicity and citizenship may influence breastfeeding rates, with ethnic minorities thought more likely to breast feed. Aim The aim of this study is to investigate the association among maternal citizenship, ethnicity, birthplace and breast feeding. It is hypothesised that Irish mothers (identified through Irish citizenship, self-identified Irish ethnicity or Irish birthplace) are less likely to breast feed than non-Irish mothers. Methods The study population of Growing Up in Ireland: the National Longitudinal Study of Children was used for this study. Analysis was restricted to 11 092 biological mother and infant pairs with a complete breastfeeding history. Logistic regression analysis was used to estimate ORs and 95% CIs for breast feeding relative to maternal citizenship and ethnicity, controlling for the confounding effects of other maternal variables. Results Results indicated that 55.9% (6202 of 11 092) of mothers had initiated breast feeding, with only 7.9% (874 of 11 092) of mothers currently breast feeding their infant (at 9 months of age). Irish citizens (4693 of 9368, 50.0%) were significantly less likely to have initiated breast feeding compared with non-Irish citizens (1503 of 1695, 88.7%). Irish born mothers (4179 of 8627, 48.8%) were also significantly less likely to have initiated breast feeding than mothers born elsewhere (2023 of 2462, 82.2%). Conclusions Maternal citizenship and ethnicity appear to be the strongest influencing factors on breastfeeding initiation and duration. However, this raises a possibility that the increase in breastfeeding rates seen recently may be the result of increased immigration into Ireland, rather than the success of policy and research efforts. [ABSTRACT FROM AUTHOR]

Objectives The ability to sustain single leg stance and tandem stance is often used to determine the balance abilities of children, particularly after ankle or foot injury. The aim of this study was to assess performance norms on timed static balance tests in children aged 4 to 15 years. Design Cross-sectional study Methods Children from schools across the Republic of Ireland ( n = 534) were tested on six balance tests as well as a standing broad jump. Results Interquartile ranges for the tests are presented for each age group (4-5, 6-7, 8-9, 10-11 and 12+ years). The results confirm the improvement in balance performance as children age especially after the 7 to 8th year. Girls tend to outperform boys across all balance tests. There is a ceiling effect for some single leg stance and tandem stance tests after the age of 7 years. Conclusions Results can be used for comparative purposes against age appropriate normative balance test scores. This removes the estimation from balance testing and the risk of applying an insufficient cut-off time. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore contact with and knowledge regarding chest drain management among nurses. Background Chest drains are commonly used in both adult and paediatric settings, for example, for cardiothoracic patients or postspinal surgery, where they are inserted intra-operatively to drain excess fluid. Despite a large number of children requiring chest drain insertion annually, current literature suggests that many nurses have reduced contact with chest drains and a knowledge deficit regarding their management. Furthermore, the literature is limited in relation to chest drain management in the paediatric patient. Mismanagement of chest drains can have devastating consequences for patients. Design A standardised descriptive survey approach was employed. Methods The sample consisted of 121 critical care and ward nurses from a large urban paediatric hospital, who cared for chest drains on a regular basis. Data were collected using a 37-item questionnaire, adapted from a study in the adult setting. Statistical analysis was performed using spss V15. Results The findings demonstrate that increased exposure to caring for children with chest drains is synonymous with a greater perception of knowledge levels in this area of practice. While critical care nurses looked after children with chest drains more frequently than ward nurses, there was no difference in the knowledge assessment section of the questionnaire. This research identified where knowledge deficits exist. Conclusions This study identified the key areas where overall uncertainties existed leading to a decreased knowledge perception. Nurses are engaging with methods of knowledge acquisition; however, those who have less contact with chest drains require regular updates. Relevance to clinical practice Addressing misconceptions about chest drain management is imperative. Providing up to date guidelines in clinical areas will improve chest drain management. Strategic educational initiatives are in place to ensure identified knowledge deficits are addressed and a complete revision of chest drain guidelines has been undertaken. [ABSTRACT FROM AUTHOR]

A growing body of evidence supports the inclusion of whole grain foods in the diet to help prevent certain chronic diseases. Although much of the research has been conducted in adult cohorts, it is thought that younger populations may also benefit from whole-grain-rich diets. The aim of the present study was to quantify the intake of whole grain in Irish children and teenagers, and assess the major sources of intake. Data used in the present study were from the National Children's Food Survey and the National Teens' Food Survey, which used 7 d food diaries to collect data on habitual food and beverage consumption in representative samples of Irish children and teenagers. Results showed that over 90 % of children (5–12 years) and over 86 % of teenagers (13–17 years) are consumers of whole grain, with mean daily intakes of 18·5 and 23·2 g/d, respectively. Ready-to-eat breakfast cereals made the greatest contribution to whole grain intakes for both children and teenagers (59·3 and 44·3 %), followed by bread (14·4 and 26·5 %), with wheat being the major source of intake, accounting for over 65 % of all whole grains consumed. Whole grain consumers had significantly higher intakes of fibre, P and Mg in comparison with non-consumers of whole grain, even though whole grain intakes in this sample were well below the recommendation of three servings or 48 g/d. The present study characterises, for the first time, the patterns of whole grain consumption in Irish children and teenagers and shows whole grain intake to be low. [ABSTRACT FROM PUBLISHER]