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Migrants in Europe are shown to have consistently lower uptake of preventive healthcare compared to European host populations. This paper examines how the transnational preventive care use of Eastern European migrants in their country of origin may be associated with preventive care uptake in their European host country. Preventive care use data in Ireland was collected on 119 Polish migrants and 123 native Irish from June 2018 to September 2019. Preventive care use data was also collected on the Polish migrant group in Poland during the same period. Preventive care use was captured by examining general practitioner visits, blood or urine test uptake, and cancer screening uptake. Probit models were first estimated to examine whether the Polish migrants were more or less likely to have used each service in Ireland than the native Irish. Second, three bivariate probit models were estimated to examine the use of each service by the Polish migrants only in Ireland and Poland as the two dependant variables. The Polish migrants are less likely to have GP visits, blood or urine test uptake, and cancer screening uptake in Ireland compared to the native Irish. The Polish migrants from this study are also shown to potentially substitute blood or urine test uptake in Ireland for uptake in Poland. Transnational ties can determine the preventive care utilisation of migrants in Europe.

Background: The provision of unscheduled healthcare for children with intellectual disability is less researched than that focused on hospital settings or for adult ser-vices. The aim of the scoping review was to map the evidence base in this area and identify areas for future study. Method: A five-stage scoping review framework was adopted. CINAHL, PubMed ,SCOPUS, PsycINFO, Embase, ProQuest Dissertation & Theses and Google Scholar were searched. Studies published in English after 1/1/2000 were considered eligible for inclusion. Results: A total of 3158 titles and abstracts were screened, 137 full-text articles were reviewed, and 25 papers met the inclusion criteria. Descriptive themes focused on inequities, needs and experiences of families', poor GP training, and limitations of existing evidence. Conclusion: Describing trends in healthcare utilisation by this population is valuable for monitoring quality of healthcare, however, addressing observed inequities will require approaches that recognise specific issues within the health system that result in inequities

Poor quality diets represent major risk factors for the global burden of disease. Modeling studies indicate a potential for diet-related fiscal and pricing policies (FPs) to improve health. There is real-world evidence (RWE) that such policies can change behavior; however, the evidence regarding health is less clear. We conducted an umbrella review of the effectiveness of FPs on food and non-alcoholic beverages in influencing health or intermediate outcomes like consumption. We considered FPs applied to an entire population within a jurisdiction and included four systematic reviews in our final sample. Quality appraisal, an examination of excluded reviews, and a literature review of recent primary studies assessed the robustness of our results. Taxes and, to some extent, subsidies are effective in changing consumption of taxed/subsidized items; however, substitution is likely to occur. There is a lack of RWE supporting the effectiveness of FPs in improving health but this does not mean that they are ineffective. FPs may be important for improving health but their design is critical. Poorly designed FPs may fail to improve health and could reduce support for such policies or be used to support their repeal. More high-quality RWE on the impact of FPs on health is needed.

ContextPoor diet has been implicated in a range of noncommunicable diseases. Fiscal and pricing policies (FPs) may offer a means by which consumption of food and non-alcoholic beverages with links to such diseases can be influenced to improve public health.ObjectiveTo examine the acceptability of FPs to reduce diet-related noncommunicable disease, based on systematic review evidence.Data SourcesMEDLINE, EMBASE, PsychInfo, SCI, SSCI, Web of Science, Scopus, EconLit, the Cochrane Library, Epistemonikos, and the Campbell Collaboration Library were searched for relevant studies published between January 1, 1990 and June 2021.Data ExtractionThe studies included systematic reviews of diet-related FPs and: used real-world evidence; examined real or perceived barriers/facilitators; targeted the price of food or non-alcoholic beverages; and applied to entire populations within a jurisdiction. A total of 9996 unique relevant records were identified, which were augmented by a search of bibliographies and recommendations from an external expert advisory panel. Following screening, 4 systematic reviews remained.Data AnalysisQuality appraisal was conducted using the AMSTAR 2 tool. A narrative synthesis was undertaken, with outcomes grouped according to the WHO-INTEGRATE criteria. The findings indicated a paucity of high-quality systematic review evidence and limited public support for the use of FPs to change dietary habits. This lack of support was related to a number of factors that included: their perceived potential to be regressive; a lack of transparency, ie, there was mistrust around the use of revenues raised; a paucity of evidence around health benefits; the deliberate choice of rates that were lower than those considered necessary to affect diet; and concerns about the potential of such FPs to harm economic outcomes such as employment.ConclusionThe findings underscore the need for high-quality systematic review evidence on this topic, and the importance of responding to public concerns and putting in place mechanisms to address these when implementing FPs. This study was funded by Safefood [02A-2020].Systematic Review RegistrationPROSPERO registration no. CRD42021274454.

IntroductionMigrants have different utilisation of healthcare services and health-related behaviours than host populations. A potential factor that may contribute to the notable differences in healthcare use and health-related behaviours between migrants and host populations is how these groups value health. Those who place a high value on health have greater healthcare-seeking practices than those who do not.ObjectiveThe aim of this study was to examine how Polish migrants and native Irish differ in health state utility valuations using a novel application of a smaller design EQ-5D-5L valuation study.MethodsThis study uses health preferences as a predictor of how one values health. We examined the EQ-5D-5L health preferences of 119 Polish migrants and 123 native Irish, both residing full-time in Ireland. To do so, we used a novel application of a smaller design EQ-5D-5L valuation study that consisted of 30 health states and a targeted sampling strategy coupled with a Bayesian statistical nonparametric model. We collected data from June 2018 to September 2019.ResultsOur results highlight that Polish migrants and native Irish differ in their health preferences for and valuation of severe health states. Polish migrants place meaningfully higher utility valuations of 0.1 or more on the three most severe health states compared with the native Irish.ConclusionThis study can provide an understanding of a potential new factor underpinning some of the disparities in healthcare utilisation and health-related behaviours among migrants and host populations in Europe. This study also provides proof of principle for using a smaller design EQ-5D-5L valuation study to explore differences in health preferences among other minority subgroups, which can otherwise be hard to uncover when using the secondary analysis of national EQ-5D-5L valuation studies.

Treatment options for weight loss vary considerably with regard to risks and benefits, but the relative importance of treatment characteristics in patient decision-making is largely unknown, particularly amongst patients with severe obesity. Developing such services requires insight into the preferences of recipients for service attributes. The objective of this study was to quantify, using a discrete choice experiment, the preferences of treatment-seeking patients with severe obesity within the Irish population regarding different attributes of various obesity treatments. Within a cohort of patients with severe obesity attending a hospital-based weight management programme, patients’ attitudes to and perceptions of three distinct treatment modalities were compared to those regarding not having treatment. The treatments included a structured lifestyle modification programme, lifestyle modification alongside weight loss medication, and bariatric surgery. On average, patients with severe and complicated obesity who were attending a weight management programme were more enthusiastic about participating in a programme to help improve their diet and physical activity than they were about having surgery if the methods of treatment had equivalent results and costs. The findings provide insights into preferences that might assist the development of more appropriate treatments for severe obesity.

Community-based care for people with dementia is mainly provided by family carers, many of whom experience decreased mental, physical and financial well-being due to their caring role. Many countries are now implementing ageing-in-place policies that have increased pressure on family carers as care-work is redistributed from residential to community-based settings. Family caring responsibilities for people with dementia are made even more complicated by the economic, social and cultural expectations that underpin existing provision. Support for family carers is, therefore, an important policy topic across many countries. The focus of this paper is on the propensity of citizens to support enhanced care for family carers in Ireland, as demonstrated by their willingness-to-pay additional taxation to fund different combinations of carer support measures, developed through careful and sustained dialogue with multiple stakeholders, especially family carers themselves. We carried out a discrete choice experiment (DCE) with 509 members of the general public in Ireland between January and February 2021. Using mixed logit models, our findings show that citizens value four key attributes: regular caring breaks for family carers (day-care and long-break respite); financial compensation (carer's allowance); and emotional support (carer peer support groups). We also estimated the welfare impact of moving from current provision to enhanced support packages for family carers of people with dementia. The welfare gains accumulate to €1035.80 for the most complete levels of provision across the four support attributes. Overall, respondents in this paper showed empathy and understanding towards family carers of people with dementia through their willingness to contribute to funding additional services and supports.

Background:Generic measures of health-related quality of life (HRQoL) permit comparisons of competing demands forhealthcare resources using outcomes that reflect the preferences of tax payers. EQ-5D instruments are the most commonlyused generic, preference-based measures of HRQoL. The EQ-5D-5L enables respondents to describe their health state usingfive dimensions of health, each with five response levels. The standardised protocol for the valuation of EQ-5D-5L healthstates comprises use of the composite time trade-off valuation technique, supplemented by a discrete choice experiment(DCE).Objective: This paper presents the first exploration on attribute non-attendance (ANA) to the dimensions of the EQ-5D-5Lusing DCE data collected following the standardised protocol.Method: This paper uses the equality constrained latent class model and the endogenous attribute attendance model toexamine ANA to the dimensions of the EQ-5D-5L.Results: The results suggest that respondents are less likely to consider the physical dimensions of the EQ-5D-5L (such asself-care and usual activities) when evaluating the health states. The effects of ANA on utility scores depends on the interpretationof the underlying reasons for ANA.Conclusions: We recommend that future value sets based in whole or in part on DCE data examine the impact of and reasonsfor non-attendance in national valuation studies.

Objective To estimate the budget impact from the perspective of the Irish health-care system attributable to a reconfiguration in the diagnostic care pathway for patients with suspected RA by adopting an early identification and referral model (EIM). Methods The budget impact model evaluated the total health-care use and costs attributable to an EIM to diagnose patients with suspected RA relative to the reference scenario of current practice. The modelling also assessed a primary outcome of effect, which examined how many patients can be diagnosed by a rheumatologist within 3 months of symptom onset. The budget impact analysis model was estimated over a 5-year time frame. Results The EIM generated a cost saving for the Irish health-care system of €237 547 over the time frame relative to current practice. The cost savings were realized owing to a reduction in the number of general practitioner (GP) visits of 18 790 and a reduction in diagnostic tests carried out by GPs. The results showed that 1027 (510%) more patients were diagnosed within 3 months of symptom onset in the EIM compared with current practice. Conclusion This paper has presented an alternative rheumatologist-led service design that can be used in diagnosing patients with suspected RA. The rheumatologist-led service provision detailed in this study has the potential simultaneously to reduce demand for primary care services and to improve the health outcomes of patients. The use of an EIM sees rheumatologist activity incorporate patient demand.

Agriculture represents one of the most vulnerable sectors to extreme weather events that are projected to increase with climate change. Insurance has been advocated as a more efficient means to ensure financial security to farmers, than post-disaster aid for damages. A potential drawback of insurance however, is that unless carefully designed it could dis-incentivise farmers to engage in wider farm adaptation measures or lead to more risk-taking behaviour. This paper analyses the attractiveness of publicly-backed climate risk insurance offerings to farmers and explores their preferences for elements of insurance schemes that do not negatively affect incentives for wider farm adaptation. Specifically, a discrete choice experiment is used to reveal Irish farmers' preferences for multi-annual insurance contracts and weather-indexed versus traditional indemnity insurance and cost. Results indicate that a majority of farmers are willing to buy publicly-backed insurance for protection from extreme weather events. Younger farmers, farmers who currently have farm insurance, farmers from certain geographical locations and farmers who have been previously affected by extreme weather events are more likely to buy insurance. With respect to the design of insurance schemes, farmers prefer multi-annual coverage versus annual renewal. They also prefer indexed-insurance and have a strong preference for cheaper coverage. Despite the important role that insurance could play in protecting farms financially from damage caused by extreme weather events, few studies have examined preference for weather-indexed insurance within a European context. New evidence on farmer preferences and intended behaviours is therefore critical to inform policy in this area.

Highlights • Very significant effects on health and well-being from the COVID-19 virus and the associated lockdown. • As of July 19th, 1,753 people have died and 25,766 have tested positive with the virus. • Raid growth in new cases and deaths in the first six weeks of the pandemic. • Subsequent fall in cases and deaths until late July. • Generally a very high level of compliance with public health measures., Objectives To outline the situation in Ireland with regard to the COVID-19 pandemic. Methods Analyse the evolution of the COVID-19 pandemic in Ireland. Review the key public health and health system responses. Results Over 1700 people have died with COVID-19 by July 19th while almost 3000 people had been admitted to hospital with COVID-19. A high proportion of the deaths occurred in nursing homes and other residential centres who did not receive sufficient attention during the early phase of the pandemic. Conclusions Ireland's response to the COVID-19 crisis has been comprehensive and timely. Transparency, a commitment to a relatively open data policy, the use of traditional and social media to inform the population, and the frequency of updates from the Department of Health and the Health Services Executive are all commendable and have led to a high level of compliance among the general public with the various non-medical measures introduced by the government.

Despite the economic and health benefits of preventive care being well established, the uptake of many cost-effective preventive services remains lower than desired in many cases, especially among specific sub-populations. The value an individual places on health can influence their uptake of preventive care. One way to capture the value an individual places on health and future health status is to examine their health preferences. This study used a novel use of EQ-5D-5L health preferences to determine if health preferences are associated with the uptake of a range of preventive care services, including a cancer screening, blood pressure check, cholesterol check, blood test and urine test. We collected EQ-5D-5L composite time trade-off data in 2018/2019 on 242 respondents residing in Ireland. We estimated an initial tobit model to predict an individual’s health preference to capture health preferences as a regressor. We then estimated a bivariate probit model to examine the uptake of each preventive service and GP use. Each model controlled for health preferences, education, sex, type of health coverage, self-reported health, employment status, age and marital status. Health preferences are a significant determinant of all five preventive services while controlling for other covariates. The results shows that the higher an individual values good health, the more likely they are to avail of preventive care. Health preferences can be noted as a potential determinant of preventive care use that could guide policy responses seeking to increase demand-side factors for preventive care uptake.

Rising levels of childhood overweight and obesity represent a major global public health challenge. A number of studies have explored the association between childhood overweight and obesity and healthcare utilisation and costs. This paper adds to the literature by estimating the causal effect of child overweight and obesity status on use of general practitioner (GP) and hospital inpatient stays at two time points using instrumental variable (IV) methods The paper uses data from two waves of the Growing Up in Ireland survey of children when they are 9 and 13 years respectively and uses the biological mother's body mass index (BMI) as an instrument for the child's BMI. Our results demonstrate that child overweight and obesity status do not have a significant effect on healthcare utilisation for children when they are 9 years, but do have a large and significant effect at 13 years. Across all our models, the effects on both GP and hospital inpatient stays are found to be larger when endogeneity in childhood BMI status is addressed. Previous studies that did not address endogeneity concerns are likely to have significantly underestimated the impact of child overweight and obesity status on healthcare utilisation.

Using the first wave of the Growing Up in Ireland Survey of nine year old children we examine whether a teacher's assessment of their pupil's academic ability is influenced by the weight status of the child and/or the child's mother. Multivariate regression analyses of the teacher's assessment, controlling for the child's actual test performance, their BMI, their mother's BMI, other socio-demographic and teacher characteristics were undertaken. The study highlighted that child BMI was not a significant determinant but that children whose mother was obese were more likely to be rated as below average in reading and in maths compared to those whose mother was leaner, after adjusting for their measured ability. The potential for mother's weight status to influence teachers’ assessments of their children's perceived ability could have long term ramifications for educational outcomes and warrants further study.

Purpose Medication error is a significant source of morbidity and mortality among patients. Clinical and cost-effectiveness evidence are required for the implementation of quality of care interventions. Reduction of error-related cost is a key potential benefit of interventions addressing medication error. The aim of this review was to describe and quantify the economic burden associated with medication error. Methods PubMed, Cochrane, Embase, CINAHL, EconLit, ABI/INFORM, Business Source Complete were searched. Studies published 2004–2016 assessing the economic impact of medication error were included. Cost values were expressed in Euro 2015. A narrative synthesis was performed. Results A total of 4572 articles were identified from database searching, and 16 were included in the review. One study met all applicable quality criteria. Fifteen studies expressed economic impact in monetary terms. Mean cost per error per study ranged from €2.58 to €111 727.08. Healthcare costs were used to measure economic impact in 15 of the included studies with one study measuring litigation costs. Four studies included costs incurred in primary care with the remaining 12 measuring hospital costs. Five studies looked at general medication error in a general population with 11 studies reporting the economic impact of an individual type of medication error or error within a specific patient population. Conclusions Considerable variability existed between studies in terms of financial cost, patients, settings and errors included. Many were of poor quality. Assessment of economic impact was conducted predominantly in the hospital setting with little assessment of primary care impact. Limited parameters were used to establish economic impact. Copyright © 2017 John Wiley & Sons, Ltd.

Objectives and design There is growing recognition of the need for effective behaviour change interventions to prevent chronic diseases that are feasible and sustainable and can be implemented within routine health care systems. Focusing on implementation from the outset of intervention development, and incorporating multiple stakeholder perspectives to achieve this, is therefore essential. This study explores the development of the Choosing Healthy Eating for Infant Health (CHErIsH) childhood obesity prevention intervention and implementation strategy to improve infant feeding behaviours. Methods Five qualitative and quantitative evidence syntheses, two primary qualitative studies, and formal/informal consultations were conducted with practice, policy, research, and parent stakeholders. The Behaviour Change Wheel was used to guide the integration of findings. Results The CHErIsH intervention targets parent-level behaviour change and comprises (1) brief verbal messages and (2) trustworthy resources, to be delivered by health care professionals (HCPs) during routine infant vaccination visits. The implementation strategy targets HCP-level behaviour change and comprises (1) a local opinion leader, (2) incentivized training, (3) HCP resources and educational materials, (4) electronic delivery prompts, (5) awareness-raising across all primary care HCPs, and (6) local technical support. Conclusions This study provides a rigorous example of the development of an evidence-based intervention aimed at improving parental infant feeding behaviours, alongside an evidence-based behaviour change strategy to facilitate implementation and sustainability in primary care. This approach demonstrates how to systematically incorporate multiple stakeholder perspectives with existing literature and move from multiple evidence sources to clearly specified intervention components for both the intervention and implementation strategy. Statement of Contribution What is already known? Incorporating insights from practice, policy, and public/patient stakeholders plays a key role in developing behaviour change interventions that are feasible and sustainable and can be implemented within routine health care systems. However, there are limited examples that provide in-depth guidance of how to do this using a systematic approach. What this study adds? This study describes an innovative use of the Behaviour Change Wheel to integrate multiple sources of evidence collected from practice, policy, research, and parent stakeholders to concurrently develop an evidence-based intervention to improve parental infant feeding behaviours and an implementation strategy to facilitate sustainable delivery by health care professionals in routine primary care.

Introduction Childhood obesity is a public health challenge. There is evidence for associations between parentsâ feeding behaviours and childhood obesity risk. Primary care provides a unique opportunity for delivery of infant feeding interventions for childhood obesity prevention. Implementation strategies are needed to support infant feeding intervention delivery. The Choosing Healthy Eating for Infant Health (CHErIsH) intervention is a complex infant feeding intervention delivered at infant vaccination visits, alongside a healthcare professional (HCP)-level implementation strategy to support delivery.Methods and analysis This protocol provides a description of a non-randomised feasibility study of an infant feeding intervention and implementation strategy, with an embedded process evaluation and economic evaluation. Intervention participants will be parents of infants aged â ¤6 weeks at recruitment, attending a participating HCP in a primary care practice. The intervention will be delivered at the infantâ s 2, 4, 6, 12 and 13â month vaccination visits and involves brief verbal infant feeding messages and additional resources, including a leaflet, magnet, infant bib and sign-posting to an information website. The implementation strategy encompasses a local opinion leader, HCP training delivered prior to intervention delivery, electronic delivery prompts and additional resources, including a training manual, poster and support from the research team. An embedded mixed-methods process evaluation will examine the acceptability and feasibility of the intervention, the implementation strategy and study processes including data collection. Qualitative interviews will explore parent and HCP experiences and perspectives of delivery and receipt of the intervention and implementation strategy. Self-report surveys will examine fidelity of delivery and receipt, and acceptability, suitability and comprehensiveness of the intervention, implementation strategy and study processes. Data from electronic delivery prompts will also be collected to examine implementation of the intervention. A costâ outcome description will be conducted to measure costs of the intervention and the implementation strategy.Ethics and dissemination This study received approval from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Study findings will be disseminated via peer-reviewed publications and conference presentations. The authors would like to thank Charlotte Griffin, Lisa Delaney and Jennifer Cooney who worked as research assistants on this project. We would like to thank the staff at the Mallow Primary Healthcare Centre, in particular Ms Ruth Haugh, Mr Carl Beame and Mr Conor Healy. We would like to thank Dr Phil Jennings and Ms Anne Pardy from the HSE National Healthy Childhood Programme, and Ms Joanne O Halloran from the HSE for their assistance in development and refinement of the infant feeding messages. We would like to thank Holly McGrath for her graphic design work on the intervention materials. We would also like to thank all the attendees of the 2018 CHErIsH Steering Committee meeting for their feedback and input on the project. peer-reviewed

The concept of transnationalism may provide an alternative rationale to observed differences in patterns of migrant healthcare use and health-related behaviours. In this study, we examined the health preferences of Eastern European migrants residing in another European state relative to comparable natives through the prism of transnationalism. For the analysis, we focused on the health preferences of 87 Polish migrants living full-time in Ireland compared to 87 Irish natives. We used EQ-5D-5L composite Time Trade-Off (cTTO) utility data collected as part of the Irish value set during 2015/2016 to examine the health preferences of both groups. Propensity score matching was utilised to match comparable Irish respondents to Polish migrants with 1:1 matching. Since cTTO utility data is censored, a random effects Tobit model was used to explore differences in utility valuations, and in a secondary analysis, we examined the likelihood of applying a negative utility valuation using a random effects logit model. The results from this study demonstrate that on average Polish migrants apply a significantly greater disutility valuation to health states and are more likely to apply a negative utility valuation to a given health state when compared to comparable natives. Differences in utility valuations can be seen as indicative of time preference with a greater disutility valuation being associated with a higher rate of time preference. This finding may be suggestive of health-related behaviours, such as a greater likelihood of not engaging with preventive service use in as far as those with high rates of time preference have low uptake. Transnationalism can underpin the observed differences in health preferences between the Polish migrants and comparable Irish natives. Transnational ties shape health-related behaviours of migrants from the use of healthcare services to health preferences. The results of this study will be of interest to policymakers in Ireland and Europe.

Aim Attending routine outpatient clinic appointments is a central self-management behaviour of individuals living with Type 1 diabetes. A large number of young adults with Type 1 diabetes disengage from diabetes services, which may contribute to poor psychosocial and diabetes outcomes. The aim of this study is to elicit preferences from young adults with Type 1 diabetes regarding clinic-related services to inform service delivery. Methods A discrete choice experiment was developed to understand the preferences of young adults with Type 1 diabetes for clinic-related services. Results Young adults recruited from young adult Type 1 diabetes clinics in 2016 completed the experiment (n = 105). Young adults with Type 1 diabetes showed a preference for shorter waiting times, seeing a nurse and a consultant, relative to a nurse alone, and a flexible booking system compared with fixed appointment times. Results suggest no preference for a nurse and a doctor, relative to a nurse alone, or other optional services (e.g. seeing dietitians or psychologists), type of HbA1c test and digital blood glucose diaries over paper-based diaries. Conclusions This study highlights aspects of routine clinic appointments that are valued by young adults living with Type 1 diabetes, namely shorter waiting times at clinic, the option to see both a nurse and consultant at each visit and a flexible clinic appointment booking system. These findings suggest young adults with Type 1 diabetes value convenience and should help services to restructure their clinics to be more responsive to the needs of young adults.

Chronic low back pain is a major healthcare burden that has wide ranging effects on the individual, their family, society and the workplace. However, appropriate management and treatment is often difficult, as a majority of cases are non-specific in terms of underlying pathology. As a result, there are extensive differences in both individual patient preferences for treatment and treatment decisions amongst general practitioners. The current study examined the clinical judgements of GPs in Ireland, regarding fictional patients’ case severity and future risk of disability, through judgement analysis. Judgement analysis (JA) is an idiographic regression modelling technique that has been utilised in extant healthcare research for the purpose of allocating weighting to judgement criteria, or cues, observed by professionals in their clinical decision-making. The primary aim of the study was to model two critical information utilisation tasks performed by GPs with regard to CLBP–in combining information cues to form a judgement about current case severity and a judgement about the same patient’s risk of future disability. It was hypothesised that the judgement weighting would differ across the two judgements and that judgements regarding future risk of disability would be less consistent among GPs than judgements about case severity. Results from the regression-based judgement analysis and subsequent follow-up statistical analysis provided support for both study hypotheses. Study findings are discussed in light of theory and research on judgement, clinical decision-making and chronic low back pain.

peer-reviewed Background: Maternal recognition of overweight/obesity during early childhood is a key determinant in achieving healthy weight status in children. The aim of this study is to 1) investigate maternal perceptions of their child weight, focusing on whether or not mothers accurately identify if their child is overweight or obese at three years old and five years old; 2) identify the factors influencing maternal misperceptions regarding their child’s weight at three years old and five years old, 3) ascertain if a failure to recognize overweight/obesity at three years old is associated with the likelihood of doing so at five years old. Methods: Using two waves of the longitudinal Growing Up in Ireland study data regarding child, maternal, and household characteristics as well as healthcare access and utilization variables were obtained for mothers when their children are three and five years old respectively. Multivariate logistic analysis was used to examine the factors associated with mothers inaccurately perceiving their child to be of normal weight status when the child is in fact either clinically overweight or obese. Results: In wave 2, 22% of mothers failed to accurately identify their child to be overweight or obese. This inaccuracy decreased to 18% in wave 3. A failure of mothers to identify their child’s overweight/obesity was more likely to occur if the child was a girl (OR: 1.25) (OR: 1.37), had a higher birth weight (OR:1.00), if the mother was obese (OR: 1.50), (OR: 1.72) or working (OR:1.25) (OR:1.16) in wave 2 and wave 3, respectively. Other factors affecting the odds of misperceiving child’s weight include gestation age, income and urban living. Conclusion: These findings suggest that mothers of overweight or obese three and five year olds show poor awareness of their child’s weight status. Both child and mother characteristics play a role in influencing this awareness. Mothers unable to accurately identify their child’s overweight or obesity status at three years old are likely to do again when the child is five years old. This study highlights the need for increased support to help improve mothers’ understanding of healthy body size in preschool aged children PUBLISHED peer-reviewed

Dementia is a progressive and debilitating neurodegenerative condition which significantly impacts on quality of life and the ability to live independently. It is a leading cause of disability in older populations and carries significant economic and social costs. It is no wonder, therefore, that dementia has been identified as a major global health and social care challenge, especially with prevalence projected to triple by 2050. In many countries, the stated policy aim is to care for people with dementia in their own homes for as long as possible and practicable. However, home care systems vary significantly across countries in their approach to personhood in dementia, particularly the extent to which care provision reflects the needs and preferences of recipients. In this paper, we undertook a discrete choice experiment, with data collected from 551 individuals in Ireland between November and December 2018, to elicit public preferences for personhood-oriented home care services for people with moderate dementia. We capture the concept of personhood with two attributes, one that refers to whether care provision is flexible and tailored to the individual needs of the person with dementia, and a second that refers to whether communication with the person with dementia is expressed in a personalised manner. Using mixed logit models, we find that flexible service provision, personalised communication and increased home care hours are highly valued by citizens. While people are indifferent to a means-tested co-payment for home care relative to no co-payment, they are opposed to a universal co-payment. We also estimate the welfare impact of a move from the status quo to alternative personhood-oriented home care arrangements, providing useful insights for policymakers regarding the future design and funding of home care services. The paper has significant implications for the recalibration of health and social care systems towards personhood in dementia care.

Purpose – This paper aims to explore the relationship between consumer demand for enhanced food safety features and regional identification of food amongst consumers across Great Britain and the Republic of Ireland. Design/methodology/approach – The paper uses the choice experiment method to determine preferences for food testing standards, traceability standards, health and welfare standards, region of origin and price. Findings – The results show that substantial differences exist in preferences for the features between consumers in both countries. In addition, while stark differences are apparent between the two countries, in their preferences for food originating from their local region, the results suggest that consumers perceive significant substitutability between the enhanced safety features and the local regional label in both countries. Originality/value – This paper provides a unique insight into preferences for a wide range of enhanced food safety features amongst consumers in these two countries. This is the first study to undertake a comparison of these countries using the choice experiment method. In addition, the paper provides a thorough overview of how consumers perceive the relationship between enhanced safety features and region of origin of food.

As demands on the environment and associated ecosystem services increase, the need for a more integrated approach to managing the exploitation of these natural resources also increases. This is particularly true for the alternative types of water bodies such as a sea, river and/or a lake. The purpose of this paper is to explore the preferences of residents in the Republic of Ireland for a number of ecosystem services provided by Irish water bodies. In particular the paper examines whether, and how, preferences for the same ecosystem services differ when the public is asked to consider the alternative water body types (sea, river and lake). This is relevant as the ecosystem services' economic benefits are not necessarily uniform across water bodies, a factor that has not been explored in detail previously.

With the development of online open courses, tailoring assignment systems to help students achieve their individual learning objectives will be possible. It is important therefore, from both an educational and business perspective, to understand more about how students value the different characteristics of assignment systems. The main contribution of this paper is the use of a discrete choice experiment to elicit students’ preferences for various possible attributes of alternative assignment systems. Our results indicate that students have the strongest preference for assignment systems containing questions that have a high relevance for exam preparation. Our results also indicate that there is a high degree of heterogeneity within the student cohort in their preferences towards various attributes of assignment systems.

Farmland can confer significant public good benefits to society aside from its role in agricultural production. In this article, we investigate preferences of rural residents for the use of farmland as a recreational resource. In particular, we use a choice experiment to determine preferences for the development of farmland walking trails. Our modelling approach uses a series of mixed logit models to assess the impact of alternative distributional assumptions for the cost coefficient on the welfare estimates associated with the provision of the trails. Our results reveal that using a mixture of discrete and continuous distributions to represent cost heterogeneity leads to a better model fit and lower welfare estimates. Our results further reveal that Irish rural residents show positive preferences for the development of farmland walking trails in the Irish countryside.

Medication error is a significant source of morbidity and mortality among patients. Clinical and cost-effectiveness evidence are required for the implementation of quality of care interventions. Reduction of error-related cost is a key potential benefit of interventions addressing medication error. The aim of this review was to describe and quantify the economic burden associated with medication error.PubMed, Cochrane, Embase, CINAHL, EconLit, ABI/INFORM, Business Source Complete were searched. Studies published 2004-2016 assessing the economic impact of medication error were included. Cost values were expressed in Euro 2015. A narrative synthesis was performed.A total of 4572 articles were identified from database searching, and 16 were included in the review. One study met all applicable quality criteria. Fifteen studies expressed economic impact in monetary terms. Mean cost per error per study ranged from €2.58 to €111 727.08. Healthcare costs were used to measure economic impact in 15 of the included studies with one study measuring litigation costs. Four studies included costs incurred in primary care with the remaining 12 measuring hospital costs. Five studies looked at general medication error in a general population with 11 studies reporting the economic impact of an individual type of medication error or error within a specific patient population.Considerable variability existed between studies in terms of financial cost, patients, settings and errors included. Many were of poor quality. Assessment of economic impact was conducted predominantly in the hospital setting with little assessment of primary care impact. Limited parameters were used to establish economic impact. Copyright © 2017 John WileySons, Ltd.

This paper explores the demand and willingness to pay (WTP) for value-added services to chicken. Since the demand for such services are likely to be highly segmented and often applies only to a market niche, models based on assumptions of homogeneity among consumers are likely to be inappropriate. For this reason, this paper combines discrete and continuous mixing distributions to concurrently identify the size of the niche market and the heterogeneity among consumers within the market niche. Failing to account for the niche market nature of value-added services is shown to have implications for predictions of WTP, demand and total revenue. , Oxford University Press.

Despite the potential benefits accruing from use of the rural landscape, access to farmland is a contentious issue with many landowners restricting public access. Within this context, this paper first explores general public preferences and willingness to pay for farmland walking trails in the Irish countryside. Second this paper examines farmers’ willingness to participate in a hypothetical walking scheme whereby the general public will be allowed access to specific trails. Results suggest that individuals are not a homogeneous group with regard to their preferences for farmland walking trails. From a supply perspective, this paper identified significant regional variations in farmers’ attitudes relating to public access. More generally, the analysis presented here would suggest that there is significant scope for policy intervention to improve public access to the countryside.

Background Childhood obesity is an urgent global concern with a complex multifactorial aetiology. Infant feeding behaviours are a potential target for childhood obesity prevention. However, evidence for the effectiveness of interventions to improve infant feeding behaviours is inconsistent, and knowledge of how interventions have been implemented, what aspects work, and why, is lacking. This review aimed to synthesise qualitative evidence about parents' and health-care professionals' views and experiences of infant feeding interventions, and identify factors influencing intervention implementation. Methods A systematic review and synthesis of qualitative evidence was conducted. CINAHL, Medline, PsycINFO, Embase, and SCOPUS were searched from database inception to Sept 25, 2017, for English-language qualitative studies reporting the implementation of infant feeding interventions from the perspectives of health-care workers, parents, or both. 4794 studies were screened using a-priori inclusion and exclusion criteria. Two reviewers independently extracted data and judged quality. A framework synthesis was conducted and GRADE-CERQual was used to assess confidence in findings. This review is registered with PROSPERO, number CRD42016039652. Findings Of 4794 screened studies, 13 UK, US, and Australian-based studies were included. Supportive relationships and environments were integral to the successful implementation of infant feeding interventions for both health-care professionals and parents. Issues with capacity (ie, time and resources) negatively influenced implementation by health-care professionals; for parents, a focus on practical elements and sustainability beyond the intervention was crucial to ensure success. Interpretation This review provides valuable information to enable informed and robust decisions about future infant feeding interventions and policy development, ensuring that these decisions are guided by stakeholder experiences and are cognisant of previous implementation challenges or successes. Methodologically, this study provides an innovative example of using qualitative evidence synthesis to explore factors influencing intervention implementation and engagement from both provider and participant perspectives. This review provides deeper insight into potential interactions between provider and participant experiences, and a comprehensive holistic overview of factors that are important to consider for future infant feeding interventions. Funding Health Research Board Interdisciplinary Capacity Enhancement Award 2015-1026.

The Vaccines for Children program is a US government intervention aimed at increasing vaccination uptake by removing financial barriers that may prevent US children from accessing vaccinations. This study examined the impact that this intervention had on race and ethnicity-related and income-related disparities for diphtheria-tetanus-acellular pertussis, measles-mumps-rubella, and polio vaccinations, using data from the National Immunization Survey, 1995-2013. Vaccination rates increased across all races, ethnicities, and income groups following the introduction of the Vaccines for Children program. Disparities among race and ethnic groups narrowed considerably over time since the introduction of the vaccine program, although income-related disparities changed at different rates within racial and ethnic groups and in some cases increased. Government interventions aimed solely at reducing certain financial barriers to vaccination may fail to address other important aspects of cost or perceived benefits that influence vaccination uptake, especially among poorer children.

While the repeated nature of discrete choice experiments is advantageous from a sampling efficiency perspective, patterns of choice may differ across the tasks, due, in part, to learning and fatigue. Using probabilistic decision process models, we find in a field study that learning and fatigue behavior may only be exhibited by a small subset of respondents. Most respondents in our sample show preference and variance stability consistent with rational pre-existent and well formed preferences. Nearly all of the remainder exhibit both learning and fatigue effects. An important aspect of our approach is that it enables learning and fatigue effects to be explored, even though they were not envisaged during survey design or data collection.

Internet-delivered psychological interventions among people with chronic pain have the potential to overcome environmental and economic barriers to the provision of evidence-based psychological treatment in the Irish health service context. While the use of internet-delivered cognitive-behavioural therapy programmes has been consistently shown to have small-to-moderate effects in the management of chronic pain, there is a paucity in the research regarding the effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) programme among people with chronic pain. The current study will compare the clinical-effectiveness and cost-effectiveness of an online ACT intervention with a waitlist control condition in terms of the management of pain-related functional interference among people with chronic pain. Participants with non-malignant pain that persists for at least 3¿months will be randomised to one of two study conditions. The experimental group will undergo an eight-session internet-delivered ACT programme over an 8-week period. The control group will be a waiting list group and will be offered the ACT intervention after the 3-month follow-up period. Participants will be assessed preintervention, postintervention and at a 3-month follow-up. The primary outcome will be pain-related functional interference. Secondary outcomes will include: pain intensity, depression, global impression of change, acceptance of chronic pain and quality of life. A qualitative evaluation of the perspectives of the participants regarding the ACT intervention will be completed after the trial. The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee (12/05/05). The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. ISRCTN18166896. This work is supported by the Irish Health Research Board Interdisciplinary Capacity Enhancement Award, grant number (ICE/2011/19). peer-reviewed

Obesity has received increased attention arising from its increasing prevalence and the implications of obesity-related problems for society and the wider economy. To estimate healthcare and non-healthcare obesity impacts, many studies rely on body mass index (BMI) as a measure of obesity. However BMI is considered to be a noisy measure of total body fat that unlike some other measures does not capture fat distribution. This study uses one such measure, the waist-to-hip ratio, as both an alternative and in conjunction with BMI in the estimation of the relationship between adiposity and health service use. The article uses data from a large-scale study of older adults living in Ireland (the Tilda data set). The findings indicate that studies that include both measures of general and central adiposity may provide a more comprehensive characterisation of the relationship between healthcare service use and adiposity.

Background: Overweight and obesity prevalence has risen dramatically in recent decades. While it is known that overweight and obesity is associated with a wide range of chronic diseases, the cumulative burden of chronic disease in the population associated with overweight and obesity is not well quantified. The aims of this paper were to examine the associations between BMI and chronic disease prevalence; to calculate Population Attributable Fractions (PAFs) associated with overweight and obesity; and to estimate the impact of a one unit reduction in BMI on the population prevalence of chronic disease. Methods: A cross-sectional analysis of 10,364 adults aged >= 18 years from the Republic of Ireland National Survey of Lifestyle, Attitudes and Nutrition (SLAN 2007) was performed. Using binary regression, we examined the relationship between BMI and the selected chronic diseases. In further analyses, we calculated PAFs of selected chronic diseases attributable to overweight and obesity and we assessed the impact of a one unit reduction in BMI on the overall burden of chronic disease. Results: Overweight and obesity prevalence was higher in men (43.0% and 16.1%) compared to women (29.2% and 13.4%), respectively. The most prevalent chronic conditions were lower back pain, hypertension, and raised cholesterol. Prevalence of chronic disease generally increased with increasing BMI. Compared to normal weight persons, the strongest associations were found in obese women for diabetes (RR 3.9, 95% CI 2.5-6.3), followed by hypertension (RR 2.9, 95% CI 2.3-3.6); and in obese men for hypertension (RR 2.1, 95% CI 1.6-2.7), followed by osteoarthritis (RR 2.0, 95% CI 1.2-3.2). Calculated PAFs indicated that a large proportion of chronic disease is attributable to increased BMI, most noticeably for diabetes in women (42%) and for hypertension in men (30%). Overall, a one unit decrease in BMI results in 26 and 28 fewer cases of chronic disease per 1,000 men and women, respectively. Conclusions: Overweight and obesity are major contributors to the burden of chronic disease in the population. The achievement of a relatively modest reduction in average BMI in the population has the potential to make a significant impact on the burden of chronic disease.

Background An ageing population leads to increasing prevalence of age-related chronic conditions that present challenges to the health-care services. Despite this, in countries including Ireland, little is known about the health-care impact of conditions such as osteoarthritis or rheumatoid arthritis amongst older adults. Methods A series of count models are developed to investigate the incremental health-care usage of individuals with either osteoarthritis or rheumatoid arthritis on the use of general practitioners (GP) services, outpatients’ services, accident and emergency visits and inpatient nights. Results Both types of arthritic conditions lead to increased usage of GP and outpatients’ services but not other hospital services. Differences in entitlements to care, as captured by the presence of a medical card in Ireland, lead to different health-care usage among arthritis sufferers. Translating the additional utilization into cost suggests a combined incremental annual cost of both types of arthritis of E13.6 million. Conclusions Osteoarthritis and rheumatoid arthritis present challenges to health-care services in the context of an ageing population. In the case of Ireland the burden falls predominantly on primary health-care and outpatient services. Within the context of changing health-care service provision in Ireland, the results of this study have implications for future planning of service delivery.

Background In Europe, overweight and obesity have increased rapidly. Concern about this led to a collaborative study (2011-2012) to estimate the total costs of overweight/obesity to the island of Ireland. A component of that work involved analysis, for the Republic of Ireland (ROI), of the impact of claims for sickness benefit attributable to overweight or obesity, on absence from work, and the associated productivity losses, and on the social welfare bill. Methods Analysis was performed on a dataset from the ROI’s Department …

Background\ud There is limited knowledge of the extent of or factors underlying inequalities in uptake of childhood vaccination in Ireland. This paper aims to measure and decompose socioeconomic inequalities in childhood vaccination in the Republic of Ireland.\ud \ud Methods\ud The analysis was performed using data from the first wave of the Growing Up in Ireland survey, a nationally representative survey of the carers of over 11,000 nine-month old babies collected in 2008 and 2009. Multivariate analysis was conducted to explore the child and parental factors, including socioeconomic factors that were associated with non-vaccination of children. A concentration index was calculated to measure inequality in childhood vaccination. Subsequent decomposition analysis identified key factors underpinning observed inequalities.\ud \ud Results\ud Overall the results confirm a strong socioeconomic gradient in childhood vaccination in the Republic of Ireland. Concentration indices of vaccination (CI = −0.19) show a substantial pro-rich gradient. Results from the decomposition analysis suggest that a substantial proportion of the inequality is explained by household level variables such as socioeconomic status, household structure, income and entitlement to publicly funded care (29.9%, 24% 30.6% and 12.9% respectively). Substantial differences are also observed between children of Irish mothers and immigrant mothers from developing countries.\ud \ud Conclusions\ud Vaccination was less likely in lower than in higher income households. Access to publicly funded services was an important factor in explaining inequalities.