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Objective: Policy development is the biggest gap for health-promoting sports clubs. The present study aims to identify Irish sports club's involvement in health promotion (HP) policy development. Design: Mixed methods concurrent survey design, with quantitative data providing insights into priorities, activities and documentation and qualitative data documenting stakeholders' perceived needs. Setting: Two hundred and thirty-nine sports clubs in Ireland. Method: The survey measured perceptions of HP, the importance of promoting 10 health topics (e.g. suicide prevention, healthy eating, addictive behaviours) and corresponding actions relevant to HP in club policy documents and future needs. Quantitative data were analysed using multivariate statistics. The policy cycle was used to conduct a deductive analysis of qualitative data on sports clubs' perceived needs. Results: A high importance score (>70%) was found for the 10 health topics. Sports clubs reported their greatest investment was in physical activity promotion, and the lowest investment was in supporting the participation of disabled people. Up to two thirds of sports clubs had no HP policy. Irish sports clubs' perceptions of HP showed higher but similar patterns of response relative to sports clubs in other countries. Conclusion: Findings suggest that sports clubs consider HP to be an important part of their remit, but up to 66% have no policy in this regard. The policy cycle analysis helped identify the key tools needed to promote sports clubs' HP policy development. Practical implications include fostering the inclusion of HP in sports clubs' development plans by establishing templates and receiving support from sports federations.

A parallel system of inclusive and special education persists in Ireland despite attempts to move towards integrated provision for students with Special Educational Needs and Disabilities (SEND) along a flexible continuum of support. Even in mainstream schools, duality exists and discrete delivery of special education continues to create 'siloed' approaches to education for some students. This paper outlines a research and knowledge exchange initiative involving a higher education institution and a management body for post-primary schools in Ireland attempting to develop integrated, school-wide, systematic and collaborative approaches to inclusive and special education. Theoretically underpinned by Hornby's model of Inclusive Special Education (2015) and a conceptualisation of the SENCO role in the Irish context, a pilot process was implemented to support the development of an integrated response to a continuum of need. A year after initial implementation a review was undertaken. Focus group and individual interviews with SENCOs, Curriculum Leaders and Principals in six schools indicate that the initiative, while still in its infancy, raised awareness about inclusive special education amongst staff and provided data-informed approaches to education. The centrality of leadership in promoting school-wide approaches to inclusive special education also emerged. Finally, the importance of situated community of practice approaches to professional learning were identified as critical to leading change in schools.

Background: Over the past two decades, many countries have reported an increased percentage of female staff in the general practice workforce. Considering the importance of general practice workforce planning, it is necessary to investigate the current working patterns of female GPs. Aim: To describe the female GP workforce in Ireland and to investigate factors that may affect their long-term commitment to general practice. Design & setting: Descriptive, cross-sectional study conducted with female GPs in Ireland. Method: A 'membership survey' was emailed to 1985 female GPs in November 2021. In total, 345 female GPs responded, providing a response rate of 17.4%. Results: The study revealed that a majority of the female GP workforce in Ireland worked in the position of the GP principal (62.3%), but also provided out-of- hours services (64.3%), and undertook caring responsibilities (84.1%). In total, 41.2% of the responders disclosed having at least one paid additional role, mainly in the field of academia and teaching. Most female GPs worked fewer than eight clinical sessions a week (80.5%). GPs who held General Medical Services (GMS) contracts (72.8%) were significantly more likely to work more clinical sessions a week and had been longer employed in general practices (>5 years) than GPs who did not have GMS contracts. Conclusion: Irish female GPs demonstrated a significant adjustment of their working patterns, including reducing their number of clinical sessions and balancing between additional roles, to ensure their long-term commitment to general practice. Current practices and vision on GP roles must be recognised and supported to allow for adequate workforce planning. [ABSTRACT FROM AUTHOR]

Background Worldwide, atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults and poses a significant burden to patients, physicians, and healthcare systems. We developed a quality of care score based on the Atrial Fibrillation Better Care pathway recommended by the European Society of Cardiology and the European Heart Rhythm Association guidelines. This is a 14-point score that we have termed the MAGIC score(Management of Atrial Fibrillation in Integrated Care and General Practice). Objective The objective of this pilot study was to develop and test a quality of care score for patients with permanent AF in general practice. Methods An observational cross-sectional pilot study was undertaken. Proportionate sampling was used across 11 practices from the Ireland East practice-based research network. The GPs completed a report form on each patient by undertaking a retrospective chart review. Eleven practices participated with a total of 1855 patients with AF. We received data on 153 patients. Results The main findings were that no patient met all 14 guideline based recommendations. The mean MAGIC score was 11.3. Points were most commonly deducted because the creatinine clearance and HAS-BLED score were not recorded, and the patient was not on the correct dose of oral anti-coagulation. Conclusion This study demonstrates the feasibility of using a quality of care score to measure the quality of AF management in general practice. This scoring system, which is based on internationally recognized quality of care markers, highlights key areas that can be targeted with quality improvement intervention. [ABSTRACT FROM AUTHOR]

A large proportion of jockeys report symptoms associated with mental health difficulties (MHDs), yet most do not seek help from professional mental health support services. Due to the paucity of literature in this field, this study sought to explore jockeys' barriers to, and facilitators of, help-seeking for MHDs. Twelve jockeys participated in semistructured interviews, subsequently analyzed via reflexive thematic analysis. Barriers to help-seeking included the negative perceptions of others (stigma and career implications), cultural norms (masculinity and self-reliance), and low mental health literacy (not knowing where to seek help, minimization of MHDs, negative perceptions of treatment, and recognizing symptoms). Facilitators to help-seeking included education (exposure to psychological support at a younger age), social support (from professionals, jockeys, family, and friends), and media campaigns (high-profile disclosures from jockeys). Findings are consistent with barrier and facilitator studies among general and athletic populations. Applied recommendations and future research considerations are presented throughout the manuscript. [ABSTRACT FROM AUTHOR]

The World Health Organization and American Academy of Paediatrics recommend exclusive breastfeeding until 6 months of age, with continued breastfeeding along with complementary solid foods for up to 2 years and beyond. Despite the well-established importance of breastfeeding, Irish rates remain the lowest in Europe. Healthcare professionals' breastfeeding knowledge and skills have a positive impact on increasing breastfeeding rates. There is limited evidence of the knowledge, attitudes or practices of general practitioners (GPs) and general practice nurses (GPNs), which is essential to breastfeeding in Ireland. The aim of this study was to evaluate the breastfeeding knowledge, attitudes and practices of GPs and GPNs in one community healthcare organisation (CHO) in Ireland. A co-designed evaluation study was used following low-risk ethical exemption (LS-LR-22-161). A modified version of a validated breastfeeding questionnaire was developed. A Project Steering Committee was established that included patient, and public involvement stakeholders. The anonymised survey was distributed via online Qualtrics platform (November 2022–February 2023). STROBE Guidelines were utilised. The overall response rate was 25.9% (n  = 121) and valid responses were reported in the article. The total population size was n  = 468 (GPs n  = 290 and GPNs n  = 178). Our pilot study identified that 42.7% (n  = 47/110) of respondents never attended a breastfeeding education programme, and 53.9% (n  = 55/102) identified that their knowledge could be improved. The majority of respondents, 92.9% (n  = 92/99) wish to complete further education in breastfeeding. The results of this pilot study in one CHO in Ireland indicate a gap in knowledge and a need for specific breastfeeding and lactation theoretical and skills training for GPs and GPNs working in primary care to support, promote and protect breastfeeding. [ABSTRACT FROM AUTHOR]

Research to date has focused on the potential issues arising from chemsex and often seeks to uncover what is 'wrong' with those who are motivated to engage in chemsex. Critical chemsex studies reaches beyond this harm-orientated focus and instead adopts a social justice approach that recognises chemsex participants as legitimate sexual citizens. The present study – comprising eight interviews with gay men living in Ireland – is situated within this critical research praxis. Using a critical discursive psychology framework, our analysis demonstrates how participants draw on various interpretative repertoires to discursively negotiate chemsex identities in a bid to position themselves in a culturally intelligible manner. Participants deployed three key repertoires, centred around (i) harm, (ii) essentialism, and (iii) ethics. These repertoires are deployed in an interweaving manner to ultimately construct a dynamic, hierarchal continuum of chemsex participants – from flourishing, to flailing. Our analysis demonstrates how chemsex participants construct 'other' chemsex users as 'flailing' towards the bottom of the continuum by mobilising repertoires that draw upon prevailing moralistic notions of 'good' sexual citizenship. We argue that the mainstream construction of chemsex as inevitably harmful is restrictive and produces a deficit understanding of chemsex participants, and discuss the possibilities for discursively reimagining chemsex participation. [ABSTRACT FROM AUTHOR]

The advent of deinstitutionalisation and the introduction of community care in the latter part of the twentieth century have revolutionised mental-health service provision across Europe, although implementation, timing and services have varied widely in different countries. This article compares the changing dimensions of mental-health provision in post-independence Ireland with that in England, and will shed light on the current state of mental healthcare in both countries. The article calls for more research into the impact of deinstitutionalisation, such as the challenges faced in the community for those in need of continuing care. [ABSTRACT FROM AUTHOR]

Physical activity (PA) promotion is a complex challenge, with the Global Action Plan on Physical Activity (GAPPA) endorsing a systems approach and recommending countries assess existing areas of progress which can be strengthened. This paper reports a process facilitating a systems approach for identifying current good practice and gaps for promoting PA in Ireland. Elements of participatory action research were enabled through 3 stages: (1) aligning examples of actions from Irish policy documents (n = 3) to the GAPPA, (2) workshop with stakeholders across multiple sectors, and (3) review of outputs. Data collected through the workshop were analyzed using a deductive thematic analysis guided by the GAPPA. The policy context in Ireland aligns closely to the GAPPA with the creation of Active Systems the most common strategic objective across policy documents. Forty participants (50% male) took part in the systems approach workshop, which after revision resulted in 80 examples of good practice and 121 actions for greater impact. A pragmatic and replicable process facilitating a systems approach was adopted and showed current Irish policy and practices align with the GAPPA "good practices." The process provides existing areas of progress which can be strengthened, as well as the policy opportunities and practice gaps. [ABSTRACT FROM AUTHOR]

Purpose: Throughout the world, healthcare policy has committed to delivering integrated models of care. The interface between primary–secondary care has been identified as a particularly challenging area in this regard. To that end, this study aimed to examine the issue of integrated care from general practitioners' (GPs) perspectives in Ireland. Design/methodology/approach: This multimethod study involved a cross-sectional survey and semi-structured interviews with GPs in the Ireland East region. A total of 1,274 GPs were identified from publicly available data as practising in the region, of whom the study team were able to identify 430 GPs with email addresses. An email invite was sent to 430 potential participants asking them to complete a 34-item online questionnaire and, for those who were willing, an in-depth interview was conducted with a member of the study team. Findings: In total, 116 GPs completed the survey. Most GPs felt that enhancing integration between primary and secondary care in Ireland was a priority (n = 109, 93.9%). Five themes concerning the state of integrated care and initiatives to improve matters were identified from semi-structured interviews with 12 GPs. Originality/value: The uniqueness of this study is that it uses a multimethod approach to provide insight into current GP views on the state of integrated care in Ireland, as well as their perspectives on how to improve integration within the Irish healthcare system. [ABSTRACT FROM AUTHOR]

The use of student response systems is becoming more prevalent in higher level education. Evidence on the effectiveness of this technology can be an important resource for tutors seeking to engage with learners and raise the quality of learning experiences. Student response systems have been found to increase student engagement and participation in the classroom, yet few studies examine why this is so. This research seeks to explore the effects of student response systems on student participation in large classes. The methods used included both quantitative and qualitative data. A pre-test/mid-test/post-test design (quantitative approach) was deployed to examine the effects of a classroom response system on interactivity. Students involved in a final year undergraduate business course took part in investigating the use of student response systems from the student perspective. Qualitative data were collected to identify the strengths and weaknesses of using a classroom response system to enhance classroom interaction through semi-structured interviews. This research builds on previous studies by investigating why students become more participatory, interactive and engaged during learning sessions which utilise student response systems. Implications for teaching practice are discussed, and avenues for future research on student response systems and student engagement in large class scenarios are outlined.

Aim: To investigate whether there is an association between subgingival microbial diversity and reduced respiratory function. Materials and Methods: A group of dentate 58–72‐year‐old men in Northern Ireland had a comprehensive periodontal examination including subgingival plaque sampling. DNA was extracted from plaque samples and the V1–V3 regions of the 16S rRNA gene were analysed by high‐throughput sequencing and a microbial diversity index (MDI) was derived. Spirometry measurements were made using a wedge bellows spirometer. The primary outcome variable of interest was the percentage of predicted forced expiratory volume in 1 s (% predicted FEV1). Analysis included multiple linear regression with adjustment for various confounders. Results: Five‐hundred and seven men were included in the analysis. The mean age was 63.6 years (SD = 3.1). Of these, 304 (60.0%) men had no or mild periodontitis, 105 (20.7%) had moderate periodontitis and 98 (19.3%) had severe periodontitis. Multiple linear regression analysis showed that a one unit increase in MDI was associated with a 0.71% loss (95% confidence interval: 0.06%–1.35%; p =.03) in % predicted FEV1 after adjustment for all confounders. Conclusions: In this group of dentate men from Northern Ireland, subgingival microbial diversity was associated with reduced respiratory function. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal conditions are common in primary care, causing significant morbidity. Intra-articular and soft tissue corticosteroid injections are commonly performed by GPs internationally. It is unknown how commonly they are performed by GPs in the Republic of Ireland. Aim: To determine the frequency and type of joint and soft tissue injections performed by GPs in the Republic of Ireland and investigate factors affecting their use. Design & setting: A cross-sectional online questionnaire, which was based on previous international research, was devised for completion by GPs practising in the Republic of Ireland. Method: GPs were invited to electronically complete a questionnaire on their practices and attitudes regarding joint and soft tissue injections. Results: A total of 147 of 204 GPs (72.1%) had performed an intra-articular or soft tissue injection in the preceding year. GPs who were principals or partners, male, or worked in a rural or mixed urban and rural practice setting were more likely to perform these procedures. The most common injection sites were the shoulder and knee. Participants were confident about performing joint and soft tissue injections. It was found that 80.4% had received prior training in this treatment modality, most commonly during their GP training programme. A prolonged wait for secondary care intervention, symptom duration, and symptom severity were factors that increased the likelihood of performing injections. Difficulty maintaining skills and medicolegal concerns were common barriers to performing joint and soft tissue injections. Conclusion: Most GPs surveyed carried out joint and soft tissue injections, most commonly injecting the shoulder and knee. Irish GPs experience many of the same barriers to performing intra-articular injection as experienced internationally. [ABSTRACT FROM AUTHOR]

The current study examined the malleability of implicit attitudes using the Implicit Relational Assessment Procedure (IRAP). In Experiment 1, "similar" and "opposite" were presented as response options with the sample terms "old people" and "young people" and various positive and negative target stimuli. Results showed significantly faster response latencies for consistent (e.g., Similar-Positive-Young People) compared to inconsistent tasks (e.g., Similar-Positive-Old People). Explicit measures did not correlate with this IRAP effect. Experiment 2 determined whether prior exposure to pictures of admired and disliked old and young individuals had an impact on IRAP performance. Results revealed that pro-old exemplars reduced the pro-young IRAP effect, but reversed the anti-old effect, and this held for 24 h; explicit measures were largely unaffected. The findings suggest that the IRAP provides an informative measure of attitude-change following pro- versus anti-exemplar training. (Contains 4 figures, 4 tables and 5 footnotes.)

This analysis highlights the potential value in reanalysing early national meteorological records from around the world. These were oftentimes measured via techniques that preceded standardisation of instrumentation and methods of observation and thus could be subject to considerable biases and uncertainties. This analysis uses the techniques pioneered by WMO record assessment teams. The highest currently recognised air temperature (33.3 ∘ C) ever recorded in the Republic of Ireland was logged at Kilkenny Castle in 1887. The original observational record however no longer exists. Given that Ireland is now the only country in Europe to have a national heat record that was set in the 19th century, a reassessment of the verity of this record is both timely and valuable. The present analysis undertakes a fundamental reassessment of the plausibility of the 1887 temperature record using methods similar to those used to assess various weather extremes under WMO auspices over recent years. Specifically, we undertake an inter-station reassessment using sparse available records and make recourse to the new and improved 20CRv3 sparse-input reanalysis product. Neither surrounding available stations nor the reanalysis offer substantive support for the Kilkenny record of 33.3 ∘ C being correct. Moreover, recent data rescue efforts have uncovered several earlier extreme values, one of which exceeds the Kilkenny value (33.5 ∘ C on 16 July 1876 recorded at the Phoenix Park). However, the sparsity of early observational networks, a distinct lack of synoptic support from 20CRv3 for many of the extreme heat values, and the fact that these measurements were obtained using non-standard exposures lead us to conclude that there is grossly insufficient evidence to support any of these 19th century extremes as robust national heat record candidates. Data from the early 20th century onwards benefit from a denser network of stations undertaking measurements in a more standardised manner, many under the direct auspices of Met Éireann and its predecessors, adhering to WMO guidance and protocols. This enables more robust cross-checking of records. We argue that the Met Éireann-recognised 20th century heat record from Boora in 1976 is verified as the most plausible robust national temperature record based upon the synoptic situation and comparisons with nearby neighbouring stations. This measurement of 32.5 ∘ C thus likely constitutes the highest reliably recorded temperature measurement in the Republic of Ireland. Ultimately, the formal decision on any reassessment and reassignment of the national record rests with the national meteorological service, Met Éireann. [ABSTRACT FROM AUTHOR]

Background: Rare diseases (RDs) are often complex, serious, chronic and multi-systemic conditions, associated with physical, sensory and intellectual disability. Patients require follow-up management from multiple medical specialists and health and social care professionals involving a high level of integrated care, service coordination and specified care pathways.Methods and Objectives: This pilot study aimed to explore the best approach for developing national RD care pathways in the Irish healthcare system in the context of a lack of agreed methodology. Irish clinical specialists and patient/lived experience experts were asked to map existing practice against evidence-based clinical practice guidelines (CPGs) and best practice recommendations from the European Reference Networks (ERNs) to develop optimal care pathways. The study focused on the more prevalent, multisystemic rare conditions that require multidisciplinary care, services, supports and therapeutic interventions.Results: 29 rare conditions were selected across 18 ERNs, for care pathway development. Multidisciplinary input from multiple specialisms was relevant for all pathways. A high level of engagement was experienced from clinical leads and patient organisations. CPGs were identified for 26 of the conditions. Nurse specialist, Psychology, Medical Social Work and Database Manager roles were deemed essential for all care pathways. Access to the therapeutic Health Service Professionals: Physiotherapy, Occupational Therapy, and Speech and Language Therapy were seen as key requirements for holistic care. Genetic counselling was highlighted as a core discipline in 27 pathways demonstrating the importance of access to Clinical Genetics services for many people with RDs.Conclusions: This study proposes a methodology for Irish RD care pathway development, in collaboration with patient/service user advocates. Common RD patient needs and health care professional interventions across all pathways were identified. Key RD stakeholders have endorsed this national care pathway initiative. Future research focused on the implementation of such care pathways is a priority. [ABSTRACT FROM AUTHOR]

Currently, there are limited data comparing demographic and clinical characteristics of individuals who died by probable suicide and who did and did not previously attend mental health services (MHSs). This study compared demographic and clinical factors for both groups, in a Western region of Ireland over a 13-year period. Postmortem reports between January 1, 2006 and March 31, 2019 were reviewed for 400 individuals who died by probable suicide. Relevant sociodemographic and clinical data were extracted from individuals’ lifetime case notes. One hundred and fifty nine individuals (40%) had attended MHSs at some stage (“attendee”). Hanging was the most common method of suicide (61%), followed by drowning (18%) for both attendees and nonattendees of MHSs, with more violent methods utilized overall by nonattendees (p = 0.028). Sixty-eight percent of individuals who previously attempted hanging subsequently died utilizing this method. A higher proportion of attendees were female compared to nonattendees of MHSs (28.9 vs. 14.5%, p = 0.001). Recurrent depressive disorder (55%) was the most common diagnosed mental health disorder. For individuals with a diagnosis of schizophrenia, 39% had antipsychotic medications detectable in their toxicology reports. In conclusion, the majority of people who died by probable suicide had never had contact with MHSs, and nonattendees overall were more likely to utilize violent methods of suicide. Non)concordance with psychotropic medications in psychotic patients and previous hanging attempt were highlighted as potential risk factors for death by probable suicide. [ABSTRACT FROM AUTHOR]

Myeloproliferative neoplasms (MPNs) are associated with a high disease burden, reduced quality of life and shortened survival. The aim of this questionnaire was to gain patients' and caregivers' perspectives on the impact of living with an MPN in the Republic of Ireland. An Irish adaptation of the 'Global MPN Landmark survey' was conducted. Fifty-one patients and 44 caregivers completed the questionnaire. Patients reported a wide variety of symptoms at the time of questionnaire completion; fatigue, bone pain and pruritus being most frequently reported. Approximately one-third of respondents from each of the groups (patients and caregivers) reported a negative impact of MPNs on their emotional wellbeing and daily lives. The study findings revealed that, despite treatment, symptom burden remains high, and several unmet needs exist, including educational, emotional and peer group support. Interventions that focus on reducing symptom burden and addressing these unmet needs, may improve the quality of life for patients with MPNs and their caregivers. [ABSTRACT FROM AUTHOR]

Aim: Self‐harm is common among adolescents and young adults and carries increased risk of suicide and other negative outcomes, yet only a small proportion will seek professional help. General practitioners (GPs) are a potentially valuable source of help as most young people visit their GP regularly for other reasons. The primary aim of this research was to explore GPs' empathy and attitudes towards young people who self‐harm and how these are related to GP specialist training. Method: GPs completed questionnaires regarding their training, levels of empathy, perceived knowledge and attitudes towards young people who self‐harm. The cross‐sectional design included a random sample of 178 GPs and 47 GPs‐in‐training in the Republic of Ireland. Bootstrapped mediation analysis using structural equation modelling (SEM) was applied to explore the pattern of relationships among GP‐training, empathy, perceived knowledge of self‐harm and attitudes towards youth who self‐harm. Results: The SEM results revealed that the model had a very good fit to the data. Empathy was the strongest predictor of attitudes towards self‐harm even if GPs had received youth mental health training and fully mediated the effect of youth mental health training on perceived knowledge of self‐harm. Specialized training in self‐harm was a stronger predictor of perceived knowledge than empathy but had no association with negative attitudes. Conclusions: The findings emphasize positive outcomes associated with GP training and highlight potential differences in the effects associated with specific vs general training in youth mental health. These differences may be used to inform the design and implementation of continuing professional development. [ABSTRACT FROM AUTHOR]

Background New psychoactive substance (NPS) use can negatively impact health and may result in drug-related hospital admissions (DRHAs). Irish youth reported very high rates of NPS use by international standards, the most common being synthetic cannabinoids and cathinones. There was a rapid expansion in specialist shops, called head shops, selling NPS in 2010. Government responded to public protests about head shops by enacting legislation in May and August 2010 to end this trade. Many academics argued that such actions would prove futile. We sought to determine if changes in head shop activity coincided with changes in DRHA. Methods The national database on admissions to general hospitals hospital in-patient enquiry was examined focusing on young adults admitted from 2008 to 2012, and all emergency admissions with an International Classification of Diseases-10 diagnosis of mental disorder related to any drug (F11–F19) were identified. Joinpoint regression analysis was utilized to explore for the presence of trend changes in DRHA. Results Joinpoint regression analysis identified a significant downward trend change which occurred in June 2010 (95% CI February 2010 to January 2011). DRHA increased by 0.5% (95% CI 0.1–0.9) per month prior to this and then fell by 2.6% (95% CI −1.4 to −3.8) per month over the next 16 months. Conclusions Cessation of NPS sale by head shops coincided with a reversal in the upward trend of emergency hospital admissions related to drugs. Although correlation does not confirm causation, legislation which successfully curtails the commercial sale of NPS may result in reduced hospitalizations. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) levels are a key performance indicator for policy documents in Ireland. The first Ireland Report Card on Physical Activity in Children and Youth aims to set a robust baseline for future surveillance of indicators related to PA in children and youth. Methods: Data collected between 2003-2010 on more than 35,000 7- to 18-year-old children and youth were used and graded using a standardized grading system for 10 indicators. Results: Grades assigned for the indicators were as follows: overall physical activity levels, D-; sedentary behavior (TV viewing), C-; organized sport participation, C-: physical education, D-; active play, inconclusive (INC); active transportation, D; school, C-, community and the built environment, B; family, INC; and government, INC. Conclusions: PA recommendations exist in Ireland but this Report Card has shown that participation is still low. A number of promising policies, programs and services are in place but these require thorough evaluation and adequate resourcing. Agreement and implementation of a common framework for the systematic surveillance of indictors related to PA of children and youth is necessary to monitor change over time and ensure the impact of promising work is captured. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is a well-established therapeutic modality for the maintenance and improvement of long-term health in cystic fibrosis (CF). Healthcare professionals (HCP) are considered credible and well-placed messengers for the delivery of PA advice. Limited research exists investigating the extent of PA prescription within CF care. This study aimed to identify Irish HCP i) knowledge and practice of, and ii) motivators and barriers to PA prescription, and iii) proposed strategies to optimize PA promotion and prescription in CF populations.Methods: HCP from six designated CF centres in Ireland and members of the national physiotherapy CF clinical interest group were invited to participate. Following an expression of interest, each HCP (n = 81) received an email containing the plain language statement and link to the online survey. 48 HCP (physiotherapists n = 24, other n = 24) completed the 30-item investigator-developed survey, which included multiple choice single answer, matrix style and open-ended questions.Results: Most HCP (81%) acknowledged that discussing PA with CF patients was part of their professional role. Almost all physiotherapists (95%) reported having sufficient knowledge regarding PA prescription, compared to 17% of other HCP. All physiotherapists reported discussing PA at every patient interaction, with 81% employing the current consensus guidelines, compared to 33 and 5% of other HCP, respectively. Among the most common barriers reported by HCP to recommending PA to their CF patients were; lack of motivation and compliance among patients to adhere to PA advice, limited availability of PA programmes to refer their patients to, limited time with patients during clinic visits and a lack of knowledge regarding PA prescription for CF care. Three-quarters of HCP reported a need to improve PA services for CF patients in Ireland.Conclusion: As people with CF are living longer, it is imperative that HCP are expanding their scope of practice to include discussions around PA at every patient visit. Formal educational opportunities in the form of continuing professional development programmes are warranted for CF HCP to optimize long-term patient management and outcomes. There is also a need to develop patient-centered and evidence-based PA programmes underpinned by theories of behaviour change to enhance motivation and compliance among CF patients. [ABSTRACT FROM AUTHOR]

This article features an investigation into the semantics of the term 'practice' coexisting in a multidisciplinary research context. The background of the discussion is a government-funded study with refugees and asylum seekers in Ireland, where process drama, music and dance were used to facilitate second language learning – an approach known as performative language pedagogy. The research is framed by exploratory practice, a methodology that considers 'practice-as-research' and 'understanding-for-practice' in second language education. An investigation of the meaning(s) of the term 'practice' was imperative as a semantic gap existed between the use of the term 'practice' in exploratory practice (the research methodology underpinning the study) and the concept of 'practice' in performative language pedagogy (the teaching approach used in the study). This article presents findings from twelve qualitative interviews with teacher/artists and practitioners that point towards a shared understanding of practice when working with refugees in language education settings. [ABSTRACT FROM AUTHOR]

Studies which report outcomes of continuing medical education (CME) interventions for rural general practitioners (GPs) are limited. This mixed methods study recruited GPs from four CME small group learning (SGL) tutor groups based in different rural locations in the Republic of Ireland. A two-hour teaching module on deprescribing in older patients was devised and implemented. Assessment of educational outcomes was via questionnaires, prescribing audits and qualitative focus groups. All GPs (n = 43) in these CME-SGL groups agreed to participate, 27 of whom (63%) self-identified as being in rural practice. Rural GPs were more likely to be male (56%), in practice for longer (19 years), and attending CME for longer (13 years). The questionnaires indicated learning outcomes were achieved knowledge increased immediately after the education, and was maintained 6 months later. Twenty-four GPs completed audits involving 191 patients. Of these, 152 (79.6%) were de-prescribed medication. In the qualitative focus groups, GPs reported sharing experiences with their peers during CME-SGL helped them to improve patient care and ensured that clinical practice is more consistent across the group. For rural GPs, CME-SGL involving discussion of cases and the practical implementation of guidelines, associated with audit, can lead to changes in patient care. [ABSTRACT FROM AUTHOR]

Background: A well-functioning general practice sector that has a strong research component is recognised as a key foundation of any modern health system. General practitioners (GPs) are more likely to collaborate in research if they are part of an established research network. The primary aims of this study are to describe Ireland's newest general practice-based research network and to analyse the perspectives of the network's members on research engagement. Method: A survey was sent to all GPs participating in the network in order to document practice characteristics so that this research network's profile could be compared to other national profiles of Irish general practice. In depth interviews were then conducted and analysed thematically to explore the experiences and views of a selection of these GPs on research engagement. Results: All 134 GPs responded to the survey. Practices have similar characteristics to the national profile in terms of location, size, computerisation, type of premises and out of hours arrangements. Twenty-two GPs were interviewed and the resulting data was categorised into subthemes and four related overarching themes: GPs described catalysts for research in their practices, the need for coherence in how research is understood in this context, systems failures, whereby the current health system design is prohibitive of GP participation and aspirations for a better future. Conclusion: This study has demonstrated that the research network under examination is representative of current trends in Irish general practice. It has elucidated a better understanding of factors that need to be addressed in order to encourage more GPs to engage in the research process. [ABSTRACT FROM AUTHOR]

Abortion stigma, while observable as a global phenomenon, is constructed locally through various pathways and institutions, and at the intersection of transnational and local discourses. Stigmatisation of abortion has been challenged in varied ways by pro-choice adherents. This article investigates strategies for identifying and opposing stigmatisation of abortion in Ireland and Poland, focusing on campaigns aimed in one context, at repealing a near total prohibition of abortion, and in another, on resisting further restrictions concerning reproductive rights. We examine how mobilisation on sexual and reproductive health (SRH) in both contexts worked to address stigma and discrimination in SRH, drawing on the concept of framing and showing similarities between these two national contexts. Our analysis explains how the logic of inclusion and exclusion works in efforts at destigmatising abortion. [ABSTRACT FROM AUTHOR]

Ideational and gender discursive approaches are used to examine how implementing actors discursively engage with processes of marketization within home care policy in Ireland. Front line service providers, including private actors, non-profits and migrant care workers' problem representations, solutions and underlying assumptions about what a care market is and should be offer insights into how practical experiences of market mechanisms are perceived to shape policy implementation. A focus on how implementing actors mobilize discursively on home care underlines how implementation should be viewed as a process that continues to be negotiated, often contested or even resisted, as it is implemented. Implementing actors' legitimize, contest and adapt to the marketization of home care in divergent and overlapping ways as discursive agents that mediate between policy design and implementation reproducing in turn gendered and racialized ideas about care and care work. [ABSTRACT FROM AUTHOR]

The World Health Organisation policy of improving retention of rural health care practitioners recommended that continuing medical education (CME) programmes addressing their needs should be accessible and delivered where they live and work. This cross-sectional study involved a self-administered anonymous questionnaire completed by GPs attending CME small groups (CME-SGL) in Ireland. All GPs attending CME-SGL in a one-month period were invited to complete the questionnaire which examined demographic details, distance to travel to educational meetings/nearest regional hospital, barriers to accessing continuing education, whether CME-SGL met their educational needs, morale and professional isolation. A total of 1,686 responses were collected, of which 332 (19.6%) were from rural GPs. Of these, 289 (87%) reported that their educational needs were fully or mostly met by attending CME-SGL. Compared to urban doctors, rural GPs had further to travel to CME-SGL meetings, were further from the nearest regional hospital, and reported increased barriers to accessing continuing education. Rural GPs reported lower morale and greater levels of professional isolation. Despite considerable barriers to accessing continuing education, rural GPs reported that CME-SGL meets their educational needs. Future research should focus on the potential positive impact this may have on professional isolation and morale. [ABSTRACT FROM AUTHOR]

Objectives: Emerging cancer-survivorship research suggests that self-management can lead to improved outcomes. However, research examining the impact of self-management behaviours on quality of life (QoL) and fear of recurrence (FoR) in cancer survivors is lacking. This study investigated the relationship between self-management behaviours and QoL and FoR following treatment for head and neck cancer (HNC).Methods: Postal surveys were sent to 734 eligible HNC survivors (ICD10 C01-C14; C32) in the Republic of Ireland who were 12- to 60-months post diagnosis. QoL and FoR were measured using the Functional Assessment of Cancer Therapy (FACT-G and Head and Neck Cancer Subscale) measure and Fear of Relapse/Recurrence Scale, respectively. Seven self-management behaviours were measured using the Health Education Impact Questionnaire.Results: Three hundred and ninety-five HNC survivors completed surveys (50.3% response rate). After controlling for sociodemographic and clinical characteristics, self-management behaviours accounted for 20% to 39.4% of the variance in QoL and FoR. Higher scores on positive and active engagement in life, constructive attitudes and approaches, and skill and technique acquisition were significantly associated with higher global QoL and lower FoR, whilst higher scores on positive and active engagement in life and constructive attitudes and approaches only were significantly associated with higher HNC-specific QoL. Additionally, lower scores on self-monitoring and insight were significantly associated with higher HNC-specific and global QoL and lower FoR.Conclusions: The findings highlight the potential utility of self-management interventions promoting active problem solving, positive self-talk, and skill acquisition amongst cancer survivors. However, increased self-monitoring may relate to negative outcomes in HNC, a finding that warrants further investigation. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) is one of the main causes of chronic liver disease worldwide. Prevalence of HCV in homeless populations ranges from 3.9 to 36.2%. The HepCheck study sought to investigate and establish the characterisation of HCV burden among individuals who attended an intensified screening programme for HCV in homeless services in Dublin, Ireland.Methods: The HepCheck study was conducted as part of a larger European wide initiative called HepCare Europe. The study consisted of three phases; 1) all subjects completed a short survey and were offered a rapid oral HCV test; 2) a convenience sample of HCV positive participants from phase 1 were selected to complete a survey on health and social risk factors and 3) subjects were tracked along the referral pathway to identify whether they were referred to a specialist clinic, attended the specialist clinic, were assessed for cirrhosis by transient elastography (Fibroscan) and were treated for HCV.Results: Five hundred ninety-seven individuals were offered HCV screening, 73% were male and 63% reported having had a previous HCV screening. We screened 538 (90%) of those offered screening, with 37% testing positive. Among those who tested positive, 112 (56%) were 'new positives' and 44% were 'known positives'. Undiagnosed HCV was prevalent in 19% of the study sample. Active past 30-day drug use was common, along with attendance for drug treatment. Unstable accommodation was the most common barrier to attending specialist appointments and accessing treatment. Depression and anxiety, dental problems and respiratory conditions were common reported health problems. Forty-six subjects were referred to specialised services and two subjects completed HCV treatment.Conclusions: This study demonstrates that the current hospital-based model of care is inadequate in addressing the specific needs of a homeless population and emphasises the need for a community-based treatment approach. Findings are intended to inform HepCare Europe in their development of a community-based model of care in order to engage with homeless individuals with multiple co-morbidities including substance abuse, who are affected by or infected with HCV. [ABSTRACT FROM AUTHOR]

This project quantified the impact that voluntary reformulation efforts of the food industry had on the Irish population's nutrient intake. Nutrient composition data on reformulated products were collected from 14 major food companies for two years, 2005 and 2012. Probabilistic intake assessments were performed using the Irish national food consumption surveys as dietary intake data. The nutrient data were weighted by market shares replacing existing food composition data for these products. The reformulation efforts assessed, significantly reduced mean energy intakes by up to 12 kcal/d (adults), 15 kcal/d (teens), 19 kcal/d (children) and 9 kcal/d (pre-schoolers). Mean daily fat intakes were reduced by up to 1.3 g/d, 1.3 g/d, 0.9 g/d and 0.6 g/d, saturated fat intakes by up to 1.7 g/d, 2.3 g/d, 1.8 g/d and 1 g/d, sugar intakes by up to 1 g/d, 2 g/d, 3.5 g/d and 1 g/d and sodium intakes by up to 0.6 g/d, 0.5 g/d, 0.2 g/d, 0.3 g/d for adults, teenagers, children and pre-school children, respectively. This model enables to assess the impact of industry reformulation amongst Irish consumers' nutrient intakes, using consumption, food composition and market share data. [ABSTRACT FROM AUTHOR]

Context: Point-to-point racing may place jockeys at risk of serious injuries due to the high incidence of falls as previously reported. Despite many advances in health and safety strategies, the incidence of falls and injuries in point-to-point racing has not been reported since 2006. Objectives: To provide a longitudinal analysis of the fall and injury incidence in point-to-point horse racing jockeys in Ireland from 2007 to 2015 and compare these findings with the previous literature. Design: Descriptive epidemiologic study. Setting: All injuries that occurred due to a fall at every official point-to-point race meeting from 2007 to 2015 were recorded by a medical doctor using a standardized injury report form. Main Outcome Measure(s): Falls and injury rates and their 95% confidence intervals were calculated. Incidence rate ratios (IRRs), 95% confidence intervals and percentage change were compared between point-to-point and professional racing, between previous data and the current results, and from 2007 to 2015. Results: An average of 67.40 injuries/1000 falls and 9.08 injuries/1000 rides occurred in point-to-point racing, and this was reduced compared with the previous analysis. Amateur jockeys sustained an overall mean of 134.77 falls/1000 rides and the yearly means decreased over the 9 years of the study. Amateur jockeys sustained a higher fall rate than professional jockeys (flat: IRR = 35.47 [31.03, 40.54]; jump: IRR = 2.72 [2.63, 2.82]); however, their injuries/1000 falls rate was lower (flat: IRR=0.19 [0.15, 0.24]; jump: IRR = 0.33 [0.30, 0.63]). Soft tissue injuries were predominant (43.09%), with 26.06 fractures and 9.98 concussions/1000 falls occurring. Conclusions: Although injuries have been reduced since the previous analysis, more serious injuries such as fractures and concussions were more common in point-to-point racing than professional racing, possibly due to their higher fall risk. Thus, identifying strategies to reduce the fall risk in point-to-point racing should be a priority. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify, at different stages of nursing education, the extent to which nursing students appreciate altruism, honesty, religiosity and other, sometimes contrasting, values in practice. Background: Nursing is informed by values that guide care ethos and activities. Embodiment of these core values has become a matter of concern. Reports outlining deficiencies in health care followed by polemics in nursing journals have called into question whether nursing students are sufficiently motivated by values and educated in their application. This study explores these values among undergraduate nursing students in the Republic of Ireland. Considering the strong religious tradition in health care in Ireland, religiosity was also included. Design: A link to an online survey was distributed via email to all nursing students in the thirteen Schools of Nursing in the Republic of Ireland. Method: Quantitative data were collected using an adaptation of the Salford‐Scott (Journal of Advanced Nursing, 57(8), 2007, 366) Nursing Values Questionnaire. Results: Participants (n = 158) reported positively to statements related to honesty and altruism. Both altruism and religiosity received support, but the latter was to a lesser extent. Students considered their professionalism more important than altruism, and honesty varied according to the situation. Conclusions: This study adds new information by confirming that students exhibit support for two of the most essential values in nursing: altruism and honesty. The adapted Salford‐Scott instrument has shown reliability and promise in further empirical study in nursing. Relevance to clinical practice: Priority given to professionalism over altruism reflects concerns highlighted in the international literature around overly task‐oriented care in which compassion gets lost. Also, when loyalty supersedes honesty, problems with accountability in health care may emerge. Uncertainty around religiosity in health care may reflect limitations in competence in nurses to relate to patients with religions or spirituality other than their own. [ABSTRACT FROM AUTHOR]

The European Parliament (EP) is credited as an important actor in improving the rights of women in Ireland. Lacking a power base in national political parties, Irish feminists and European Union (EU) officials, including members of the EP (MEPs), have worked to secure progress on gender equality. This research explores whether, in the contemporary context, Irish female MEPs remain critical actors for women's interests at the EU level. Findings show that although Irish female MEPs have a limited record of involvement with the EP's main site for gender equality, the Committee on Women's Rights and Gender Equality, they do act in a variety of ways on women's interests. These include mobilization on gendered occupational roles and traditionally gendered areas such as care work, child poverty, and issues constructed as affecting women outside the EU. Irish female MEPs also facilitate forms of supranational lobbying in their support of EU-level advocacy for domestic gendered civil society and campaign groups. However, ideology and party political discipline, the pull toward local and national interests, and an absence of strong feminist agency work to diminish opportunities for female MEPs to act as critical actors and deliver critical acts on women's interests. [ABSTRACT FROM AUTHOR]

Background: Second trimester miscarriage is defined as pregnancy loss after 12 weeks and before 24 weeks gestation. The care that parents receive has been shown to greatly influence the woman's recovery after pregnancy. Aims: To explore parents' experiences of hospital care during a second trimester miscarriage, from the time of diagnosis through to follow-up care. Methods: A focused ethnographic design to conduct semi-structured interviews with 14 bereaved parents before thematic data analysis. Findings: Parents highlighted the need for effective medical care in relation to medical treatment, pain relief and length of hospital stay, going home to prepare for the delivery and follow-up care. Parents emphasised the importance of appropriate facilities and being separate from other parents and babies. Clear communication and finding a cause for their miscarriage was also important for parents. Conclusion: Second trimester miscarriage is a significant life event for parents. Effective, individualised clinical care is needed to meet the medical needs of bereaved parents. [ABSTRACT FROM AUTHOR]

Context: Wet bulb globe temperature (WBGT) is the gold standard for assessing environmental heat stress during physical activity. Many manufacturers of commercially available instruments fail to report WBGT accuracy. Objective: To determine the accuracy of several commercially available WBGT monitors compared with a standardized reference device. Design: Observational study. Setting: Field test. Patients or Other Participants: Six commercially available WBGT devices. Main Outcome Measure(s): Data were recorded for 3 sessions (1 in the morning and 2 in the afternoon) at 2-minute intervals for at least 2 hours. Mean absolute error (MAE), root mean square error (RMSE), mean bias error (MBE), and the Pearson correlation coefficient (r) were calculated to determine instrument performance compared with the reference unit. Results: The QUESTemp8 34 (MAE ± 0.248C, RMSE ± 0.448C, MBE±-0.64%) and Extech HT30 Heat Stress Wet Bulb Globe Temperature Meter (Extech; MAE ± 0.618C, RMSE ± 0.798C, MBE±0.44%) demonstrated the least error in relation to the reference standard, whereas the General WBGT8778 Heat Index Checker (General; MAE±1.188C, RMSE±1.348C, MBE± 4.25%) performed the poorest. The QUESTemp8 34 and Kestrel 4400 Heat Stress Tracker units provided conservative measurements that slightly overestimated the WBGT provided by the reference unit. Finally, instruments using the psychrometric wet bulb temperature (General, REED Heat Index WBGT Meter, and WBGT-103 Heat Stroke Checker) tended to underestimate the WBGT, and the resulting values more frequently fell into WBGTbased activity categories with fewer restrictions as defined by the American College of Sports Medicine. Conclusions: The QUESTemp8 34, followed by the Extech, had the smallest error compared with the reference unit. Moreover, the QUESTemp8 34, Extech, and Kestrel units appeared to offer conservative yet accurate assessments of the WBGT, potentially minimizing the risk of allowing physical activity to continue in stressful heat environments. Instruments using the psychrometric wet bulb temperature tended to underestimate WBGT under low wind-speed conditions. Accurate WBGT interpretations are important to enable clinicians to guide activities in hot and humid weather conditions. [ABSTRACT FROM AUTHOR]

The nineteenth-century artist, Erskine Nicol (1825–1904) is well known for his anecdotal and humorous paintings of Irish themes. This article analyses one of his larger oils to show that on occasion he attempted a more serious representation of the rural Irish figure which asks for empathy as opposed to ridicule. The focus is on An Irish Emigrant Landing in Liverpool (signed and dated 1871; Scottish National Gallery). A key part of the analysis is an exploration of the relationship between the painting and a published account of a visit to England by the Irish emigrant depicted. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the physiological profile and activity pattern in club- and county-level under-18 (U-18) Gaelic football players relative to playing position. Participants (n = 85) were analyzed during 17 official 15-a-side matches using global positioning system technology (SPI Pro X II; GPSports Systems, Canberra, Australia) and heart rate (HR) telemetry. During the second part of this study, 63 participants underwent an incremental treadmill test to assess their maximal oxygen uptake (...o2max) and peak HR (HRmax). Players covered a mean distance of 5,774 ± 737 m during a full 60-minute match. The mean %HRmax and %... O2max observed during the match play were 81.6 ± 4.3% and 70.1 ± 7.75%, respectively. The playing level had no effect on the distance covered, player movement patterns, or %HRmax observed during match play. Midfield players covered significantly greater distance than defenders (p = 0.033). Playing position had no effect on %HRmax or the frequency of sprinting or high-intensity running during match play. The frequency of jogging, cruise running, striding (p = 0.000), and walking (p = 0.003) was greater in the midfield position than in the forward position. Time had a significant effect (F(1,39) = 33.512, p-value = 0.000, and ηp²= 0.462) on distance covered and %HRmax, both of which showed a reduction between playing periods. Gaelic football is predominantly characterized by low-to-moderate intensity activity interspersed with periods of high-intensity running. The information provided may be used as a framework for coaches in the design and prescription of training strategies. Positional specific training may be warranted given the comparatively greater demands observed in the midfield playing position. Replicating the demands of match play in training may reduce the decline in distance covered and %HRmax observed during the second half of match play. [ABSTRACT FROM AUTHOR]

Background Second-trimester miscarriage is defined as pregnancy loss after 12 and before 24 weeks’ gestation. Little is known about parents’ experiences of hospital care during a second trimester miscarriage in Ireland. Aims This study aimed to explore parents’ experiences of hospital care during a second-trimester miscarriage. Methods A focused ethnographic design was used. A series of semi-structured interviews were completed with 14 bereaved parents. The data were analysed using thematic network data analysis. Findings This paper discusses the global theme of relational and social experiences of miscarriage. Parents highlighted the need for compassionate care and expressed the importance of empathy and sensitivity from hospital staff to avoid further distress. Conclusions Compassionate care received by bereaved parents positively influenced their hospital experience, whereas a perceived lack of compassion or insensitivity had a lasting negative impact on bereaved parents. [ABSTRACT FROM AUTHOR]

Background: Primary care is the cornerstone of healthcare reform with policies across jurisdictions promoting interdisciplinary team working. The effective implementation of such health policies requires understanding the perspectives of all actors. However, there is a lack of research about health professionals' views of this process. This study compares Primary Healthcare Professionals' perceptions of the effectiveness of the Primary Care Strategy and Primary Care Team (PCT) implementation in Ireland. Methods: Design and Setting: e-survey of (1) General Practitioners (GPs) associated with a Graduate Medical School (N = 100) and (2) Primary Care Professionals in 3 of 4 Health Service Executive (HSE) regions (N = 2309). After piloting, snowball sampling was used to administer the survey. Descriptive analysis was carried out using SPSS. Ratings across groups were compared using non-parametric tests. Results: There were 569 responses. Response rates varied across disciplines (71 % for GPs, 22 % for other Primary Healthcare Professionals (PCPs). Respondents across all disciplines viewed interdisciplinary working as important. Respondents agreed on lack of progress of implementation of formal PCTs (median rating of 2, where 1 is no progress at all and 5 is complete implementation). GPs were more negative about the effectiveness of the Strategy to promote different disciplines to work together (median rating of 2 compared to 3 for clinical therapists and 3.5 for nurses, P = 0.001). Respondents identified resources and GP participation as most important for effective team working. Protected time for meetings and capacity to manage workload for meetings were rated as very important factors for effective team working by GPs, clinical therapists and nurses. A building for co-location of teams was rated as an important factor by nurses and clinical therapists though GPs rated it as less important. Payment to attend meetings and contractual arrangements were considered important factors by GPs but not by nurses or clinical therapists. Conclusion: PCPs and GPs agree there is limited PCT implementation. GPs are most negative about this implementation. There is some disagreement about which resources are most important for effective PCT working. These findings provide valuable data for clinicians and policy makers about implementation of interdisciplinary teams in primary care. [ABSTRACT FROM AUTHOR]

Screening for concomitant atherosclerotic disease is important in cardiovascular risk reduction. This study assessed the prevalence of carotid artery disease (CAD) and peripheral arterial disease (PAD) in patients with known abdominal aortic aneurysms (AAAs). All patients with AAA attending the vascular laboratory between the January 1, 2007, and December 31, 2009, were eligible for a carotid ultrasound and measurement of ankle brachial indices. A total of 389 (305 males) patients were identified on the AAA surveillance program with a mean (±standard deviation) age of 76 (±8) years. The mean age of the males was 75.4 (±7.8) years, and the mean age of the females was 77 (±11) years. A total of 332 patients were assessed for CAD, and 101 (30.4%) of those were found to have significant disease. A total of 289 patients were assessed for PAD of which 131 (45.3%) were found to have PAD at rest, and 289 patients were assessed for both and 59 (20.4%) patients had significant CAD + PAD. Patients with AAAs are at high risk of other atherosclerotic disorders, and, therefore, they should receive intensive medical optimization. [ABSTRACT FROM AUTHOR]

This research note examines how the terms ‘pagan’ and ‘paganism’ have variously been used in Irish national print media. It does this to investigate how Irish identity was constructed as the Republic of Ireland changed to a secularising society where the hegemony of the Roman Catholic Church substantially weakened. It finds that the trope of ‘pagan’ has been used to represent moral threats or political threats (such as the growth of Nazism or secularism) or acknowledge the influence of paganism (defined as ancient religious elements) on Irish culture. Research on Irish Pagans and related eco-spiritualities is a nascent field of study and this research note aims to contribute to its development. Limitations of the present study are outlined and avenues for future research are discussed. [ABSTRACT FROM PUBLISHER]

Background: Internationally, continuing professional competence (CPC) is an increasingly important issue for all health professionals. With the introduction of the first CPC framework for Emergency Medical Technicians (EMTs) and the imminent introduction of CPC for Paramedics and Advanced Paramedics (APs) in Ireland, this study aimed to identify attitudes towards CPC and factors that might influence such a framework.Methods: All EMTs (n = 925), Paramedics and APs (n = 1816) registered in Ireland were invited by email to complete an anonymous on-line survey. The study instrument was designed based on continuous professional development (CPD) questionnaires used by other healthcare professions. Quantitative and qualitative analyses were performed.Results: The overall response rates were: EMTs 43% (n = 399), Paramedics and APs 43% (n = 789), with 82% of APs and 38% of Paramedics participating. The majority of participants in all groups agreed that registration was of personal importance and that evidence of CPC should be maintained; 39% of Paramedics/APs and 78% of EMTs believed that persistent failure to meet CPC requirements should mandate denial of registration. From a pre-determined list of activities, in excess of 88% of all respondents indicated practical training scenarios, cardiac re-certification, e-learning supplemented by related practice, and training with simulation manikins were most relevant to these roles. However, least relevant to them were: e-learning alone (Paramedic/AP 36%; EMT 35%); project work (Paramedic/AP 27%; EMT 48%); and appraisal of journal articles (Paramedic/AP 24%; EMT 39%).Conclusion: Irish EMTs, Paramedics and Advanced Paramedics were supportive of CPC and favoured a 'mixed' model approach which includes: blended learning, practical skills, simulation, practical/team-based exercises, e-learning combined with practical skills, and evidence of patient contact. It is hoped that these insights will inform the CPC guidelines to be introduced. [ABSTRACT FROM AUTHOR]

Jockeys regularly engage in rapid weight-loss practices in preparation for competition. These practices are thought to impair cognitive function, although the evidence in support of this theory remains inconclusive. The purpose of this study was to examine the effects of making-weight on cognitive function in apprentice jockeys in a simulated and competitive environment. Apprentice jockeys (n = 12) reduced their body mass by 4% in 48 h in a simulated environment using weight-loss methods typically adopted in preparation for racing. Simple and choice reaction time, attention, learning and memory were assessed before and after the weight loss. A further 10 apprentice jockeys performed the cognitive function assessment in a competitive racing environment at both a self-reported “normal” and “light” body mass. Hydration status and body mass were assessed in all trials. In the simulated environment, body mass was reduced by 4.2 ± 0.3%, yet no change in cognitive function was observed. Cognitive function also remained unchanged in the competitive environment after a body mass loss of 5.7 ± 1.9%. Typical reductions in body mass in preparation for racing have no effect on cognitive function in apprentice jockeys in a simulated and competitive environment. Further research is required to investigate the physiological mechanisms preventing the adverse effects of making-weight on cognitive function in jockeys. [ABSTRACT FROM AUTHOR]

Team working is an integral aspect of primary care, but barriers to effective team working can limit the effectiveness of a primary care team ( PCT). The establishment of new PCTs in Ireland provides an excellent opportunity to explore team working in action. The aim of this qualitative study was to explore the experiences of team members working in a PCT. Team members ( n = 19) from two PCTs were interviewed from May to June 2010 using a semi-structured interview guide. All interviews were audio-recorded and transcribed. Data were analysed using NVivo (version 8). Thematic analysis was used to explore the data. We identified five main themes that described the experiences of the team members. The themes were support for primary care, managing change, communication, evolution of roles and benefits of team working. Team members were generally supportive of primary care and had experienced benefits to their practice and to the care of their patients from participation in the team. Regular team meetings enabled communication and discussion of complex cases. Despite the significant scope for role conflict due to the varied employment arrangements of the team members, neither role nor interpersonal conflict was evident in the teams studied. In addition, despite the unusual team structure in Irish PCTs - where there is no formally appointed team leader or manager - general issues around team working and its benefits and challenges were very similar to those found in other international studies. This suggests, in contrast to some studies, that some aspects of the leadership role may not be as important in successful PCT functioning as previously thought. Nonetheless, team leadership was identified as an important issue in the further development of the teams. [ABSTRACT FROM AUTHOR]

Background: In November 2013, the Irish Regulator for emergency medical technicians (EMTs) introduced the first mandatory requirement for registrants to demonstrate evidence of continuous professional development (CPD)/ continuous professional competence (CPC). This qualitative study assessed the experience of practitioners with CPC-related materials provided to them by the Regulator in addition to identifying perceived or encountered practical challenges and suggested improvements six months following introduction of the requirement. Methods: Five fora were utilised, comprising two distinct groupings: a group of student EMTs (n = 62) and four discrete groups of qualified EMTs (total n = 131) all of whom had commenced the newly-introduced CPC process. All 193 volunteers were members of the Civil Defence (an auxiliary/voluntary organisation) and represented a nationwide distribution of personnel. Responses were categorised as 'perceived' challenges to CPC, relating to student EMTs, and 'experienced' challenges to CPC, relating to qualified EMTs. Responses also included suggestions from both groups of EMTs on how to improve the current system and guidance material. Audio/visual recordings were made, transcribed and then analysed using NVivo (version 10). A coding framework was developed which identified unifying themes. Results: All participants agreed that CPC for pre-hospital practitioners was a welcomed initiative believing that CPC activities would help ensure that EMTs maintain or enhance their skills and be better enabled to provide quality care to the patients they might encounter. Two specific areas were identified by both groups as being challenging: 1) the practicalities of completing CPC and 2) the governance and administration of the CPC process. Challenging practicalities included: ability of voluntary EMTs to gain access to operational placements with paramedics and advanced paramedics; the ability to experience the number of patient contacts required and the definition of what constitutes a 'patient contact'. With regard to the governance and administration of CPC, it was suggested that in order to enhance the process, the Regulator should provide: an outline of the CPC audit process; examples of cases studies and reflective practice; templates for portfolios; and should establish a central hub for CPC information. Conclusion: These groups of Irish EMTs appeared keen to participate in continuous professional competence activities. In addition, these EMTs identified areas that, in their opinion, required clarification by the Regulator related to the practicalities of CPC and the governance and administration of CPC. More information, dissemination of sample requirements and further effective engagement with the Regulator could be used to refine the current CPC requirements for EMTs. [ABSTRACT FROM AUTHOR]

Objective:Many individuals receiving methadone maintenance receive their treatment through their primary care provider. As many also drink alcohol excessively, there is a need to address alcohol use to improve health outcomes for these individuals. We examined problem alcohol use and its treatment among people attending primary care for methadone maintenance treatment, using baseline data from a feasibility study of an evidence-based complex intervention to improve care.Methods:Data on addiction care processes were collected by (1) reviewing clinical records (n= 129) of people who attended 16 general practices for methadone maintenance treatment and (2) administering structured questionnaires to both patients (n= 106) and general practitioners (GPs) (n= 15).Results:Clinical records indicated that 24 patients (19%) were screened for problem alcohol use in the 12 months prior to data collection, with problem alcohol use identified in 14 (58% of those screened, 11% of the full sample). Of those who had positive screening results for problem alcohol use, five received a brief intervention by a GP and none were referred to specialist treatment. Scores on the Alcohol Use Disorders Identification Test (AUDIT) revealed the prevalence of hazardous, harmful, and dependent drinking to be 25% (n= 26), 6% (n= 6), and 16% (n= 17), respectively. The intraclass correlation coefficient (ICC) for the proportion of patients with negative AUDITs was 0.038 (SE= 0.01). The ICCs for screening, brief intervention, and/or referral to treatment (SBIRT) were 0.16 (SE= 0.014), −0.06 (SE= 0.017), and 0.22 (SE= 0.026), respectively. Only 12 (11.3%) AUDIT questionnaires concurred with corresponding clinical records that a patient had any/no problem alcohol use. Regular use of primary care was evident, as 25% had visited their GP more than 12 times during the past 3 months.Conclusions:Comparing clinical records with patients’ experience of SBIRT can shed light on the process of care. Alcohol screening in people who attend primary care for substance use treatment is not routinely conducted. Interventions that enhance the care of problem alcohol use among this high-risk group are a priority. [ABSTRACT FROM AUTHOR]