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Data literacy has been defined as "the ability to read, work with, analyze and argue with data". The United Nations has highlighted a growing risk of inequality for people excluded from the new world of data by lack of education, language, poverty, and discrimination and has called for the development of data literacy at all levels of society. Responses to data are shaped by personal, social and cultural influences, as well as by trust in the source. The arts can play an important role in regulating our responses to information and increasing accessibility, engagement and sense-making of data. However, to our knowledge, to date, there has been no comprehensive review of publications on the role of the arts in the context of data literacy. This paper presents a protocol and a methodological framework to perform a scoping review to identify and map the available evidence for the role of the arts in enhancing data literacy. The review aims to provide an overview of research over the past twenty years to develop a clearer understanding of (a) which art forms are represented in the literature (b) which population groups and settings are identified (c) and the rationale for using the arts to enhance data literacy. [ABSTRACT FROM AUTHOR]

Background: Social exclusion is a complex concept that is recognised as a key determinant of health. Many measurement tools developed looked at people from single excluded groups in isolation. We know from experience and literature that exclusion is often intersectional and multi-layered. Therefore, the aim of this research was to develop a social exclusion measurement tool for use in healthcare settings with individuals from any excluded group that would include questions to investigate socioeconomic elements and subjective experiences in their lives. Methods: Inductive and deductive methods were used to develop the tool. Early drafts were tested with experts (both academic and experts by experience) and modified in line with feedback received. The tool was then piloted with people in the community, and this allowed us to assess the internal consistency and validity of the tool. Exploratory factor analysis was carried out as part of this evaluation. Results: The measurement tool was initially evaluated by 17 academic and 'real world' experts. It was then piloted with seven experts by experience, two gatekeepers and two participants who were presumed not to be excluded, resulting in the development of the final tool. This was then tested with 276 participants (127 presumed excluded, 149 presumed not excluded). The socioeconomic characteristics of these participants were documented, and exploratory factor analysis was carried out on data relating to subjective items. A four-factor structure emerged comprising 22 items. Internal consistency of the factors was high, and their ability to discriminate between the two groups was notable. Conclusions: A tool for measuring the social exclusion of individuals has been developed by engaging with people from a variety of excluded groups. Socioeconomic indicators were combined with subjective items. The input of experts by experience, academics and others was sought to enhance the tool. The tool was applied to two distinct samples, showing obvious differences both in the socioeconomic items, and the items included in the factor analysis. The potential use of this tool could have positive implications for people who are excluded. [ABSTRACT FROM AUTHOR]

Introduction: Individual placental and umbilical cord morphometry have been previously identified to have an association with fetal growth. This study aims to identify which of the morphometric measurements in combination are associated with pregnancies with small for gestational age (SGA) infants using digital imaging of the delivered placenta.Material and methods: This study examined 1005 placentas from consecutively delivered singleton pregnancies in a tertiary center. Standardized images of each placenta were taken. Placental weight and thickness; umbilical cord length and diameter were measured on gross examination. Distance from the placental cord insertion site to placental margin, length and breadth of the placenta and placental chorionic surface area were measured digitally using ImageJ software. Logistic regression models and area under the curve (AUC) were used to identify the best subset of morphometric measurements to classify infants as SGA (<10th centile).Results: Overall, 141 (14%) infants were SGA. The morphometric measurements at delivery most strongly associated with the classification of infants as SGA were placental weight (AUC = 0.806) and placental surface area (AUC = 0.749). Of the potential antenatal morphometric measurements, umbilical cord diameters, both placental (AUC = 0.644) and fetal end (AUC = 0.629) were most strongly associated with SGA. A logistic regression model with maternal age, smoking status, current history of preeclampsia, umbilical cord length, placental weight, birthweight-to-placental weight ratio and umbilical cord diameter (placental end) had a sensitivity of 53% and a false-positive rate of 2% (AUC = 0.945) for the classification of infants as SGA.Conclusion: Placental and umbilical cord morphometry measured at delivery are different between SGA and non-SGA infants. Further studies are warranted to investigate the feasibility and accuracy of ultrasound to measure placental and umbilical cord morphometry during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Parental incarceration (PI) is associated with adverse developmental outcomes for children affected. However, research in this area often reports conflicting results with few studies following children across time in non‐U.S. populations. Additionally, more research is called for using multi‐informant perspectives rather than relying on adult reports of child outcomes alone. Methods: This study used data from the first two waves of a nationally representative cohort study of 8,568 children aged 9 years and followed up at age 13 living in the Republic of Ireland (2007–2012). Propensity score matching was used to match children who had experienced PI by the age of nine to children who had not experienced PI by sociodemographics and experience of other stressful events. Mental health, as measured by self‐concept (Piers‐Harris II) and externalizing and internalizing difficulties (strength and difficulties questionnaire), was compared across both groups. Results: Fifty of the 8,568 children (weighted percentage 0.9%) reported experiencing PI by the age of nine. These children came from more socially disadvantaged homes and were more likely to have experienced other potentially stressful life events. In comparison to a matched sample of children not affected by PI, children affected by PI reported higher levels of anxiety at age nine. Longitudinal analysis indicated these children affected by PI also reported lower levels of happiness at age 13 with higher levels of emotional difficulties reported by their primary caregiver. Conclusions: Children of incarcerated parents face a greater array of life challenges. PI had an association with child‐reported levels of anxiety at age nine. PI also had a medium‐term association on caregiver assessments of emotional difficulties of children affected as well child‐reported levels of happiness over time. [ABSTRACT FROM AUTHOR]

Background: Timely and accurate communication between primary and secondary care is essential for delivering high-quality patient care.Objective: The aim of this study is to evaluate the content contained in both referral and response letters between primary and secondary care and measure this against the recommended national guidelines.Methods: Using an observational design, senior medical students and their general practice supervisors applied practice management software to identify 100 randomly selected adults, aged greater than 50 years, from a generated list of consults over a 2-year period (2013-2015). All data included in referral and response letters for these adults were examined and compared with the gold standard templates that were informed by international guidelines.Results: Data from 3293 referral letters and 2468 response letters from 68 general practices and 17 hospitals were analysed. The median time that had elapsed between a patient being referred and receiving a response letter was 4 weeks, ranging from 1 week for Emergency Department referral letters to 7 weeks for orthopaedic surgery referral letters. Referral letters included the reason for referral (98%), history of complaint (90%) and current medications (82%). Less commonly included were management prior to referral (65%) and medication allergies (57%). The majority of response letters included information on investigations (73%), results (70%) and follow-up plan (85%). Less commonly, response letters included medication changes (30%), medication lists (33%) and secondary diagnoses (13%).Conclusions: Future research should be aimed at developing robust strategies to addressing communication gaps reported in this study. [ABSTRACT FROM AUTHOR]

Objectives  This article prospectively examines the use of ultrasound for antenatal detection of abnormal placental cord insertion (PCI) and compares the antenatal classification with delivered placental classification. Study Design  This prospective cohort study examined 277 singleton pregnancies in a tertiary center. Scans were performed between 10 and 14, 18 and 22, and 32 and 34 weeks where PCI site was identified and its shortest distance to margin measured. Standardized images of delivered placentas were taken and digitally measured. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of antenatal classification compared with delivered placental classification were calculated. Results  Abnormal PCI (distance < 2 cm from margin) was confirmed in 30/277 (11%) placentas at delivery. Note that 102/277 (37%) of PCI sites were classified as abnormal in the first trimester (T1), 43/277 (16%) in the second trimester (T2), and 28/277 (10%) in the third trimester (T3). Sensitivity (73%) and specificity (91%) were highest at T2. The PPVs were low (22% in T1, 51% in T2, and 64% in T3) and the NPVs were high (96% in T1 and 97% in both T2 and T3) for all scans. Conclusion  Abnormal PCI can be detected antenatally with optimal agreement with postnatal classification in T2. However, the incidence is overestimated at early scans with low PPVs. [ABSTRACT FROM AUTHOR]

Background: In the European Union (EU), discrimination based on racial and ethnic origin is prohibited under the Racial Equality Directive. Ireland is one of only three EU countries where a legal duty of equality data collection is placed on public bodies. It provides an important context in which to study ethnic equality monitoring; however no systematic mapping of where it occurs in health information systems has been carried out. The aim of this study is to identify all existing national health and social care data collections with information on ethnicity and to explore how this data has been collected and used. Methods: An electronic search of a national catalogue of health and social care data collections (N = 97) was carried out to identify any collections which contained information on ethnicity. Data dictionaries were searched and key informants contacted. For each of the data collections that collected information on ethnicity, data was extracted on the ethnic categories used and how this data is collected; the completeness of ethnicity recording; and other measures related to ethnicity in the data collection. Relevant outputs for these data collections, related to ethnicity, were identified through key informants and electronic searches. Results: Of the 97 data collections, 14 (14%) collected information on ethnic or cultural background. Country of birth was collected by 10 of these 14 data collections. Most used the ethnic categories in the Census and recommended that ethnicity should be self-identified and not assigned. Reported rates of identification were generally high (≥90%). Data collections which recorded ethnicity tended to be focused on potentially high-risk populations with no routine recording in primary care. There were some examples of where ethnic equality monitoring had informed targeted interventions e.g. vaccination awareness initiatives or cultural training for healthcare staff. Conclusions: Despite strong policy and legal imperatives, there is limited data collection of ethnicity in health and social care data collections in Ireland. While there are some examples of where differences by ethnicity have been identified and acted upon, a more coordinated and comprehensive approach to the collection, quality and utilization of ethnicity data is needed to promote health equity. [ABSTRACT FROM AUTHOR]

Objective: Knowledge of outcome in psychotic illness is limited by the paucity of very long-term epidemiologically representative studies of incidence first episode psychosis (FEP) cohorts that measure and compare outcomes reflecting modern clinical practice, mental health policy and research agendas. Our study aimed to address this gap. Method: iHOPE-20 is a prospective 20-year follow-up study of a FEP incidence cohort (N = 171) conducted between 2014 and 2017 in Ireland. Data from previous studies and medical records were used to recruit cohort members. We assessed remission, clinical recovery, personal recovery and resilience at 20 years; explored the relationships between these outcomes and examined the predictive value of baseline characteristics in determining them. Results: At follow-up, 20 out of 171 cohort members (11.70%) were deceased. We assessed 80 out of 151 alive cohort members (53% recruitment rate); 65% were in remission; 35.2% were in Full Functional Recovery and 53.7% confirmed they were fully recovered according to their personal definition of recovery. A complex array of relationships between outcomes was found. Outcomes were better for people who had a short duration of untreated psychosis, displayed higher premorbid social adjustment (between the ages of 5–11) and at baseline, were older, not living alone, in full-time employment, given a non-affective diagnosis, and had lower Global Assessment of Functioning scores. Conclusion: Among participants, full remission of psychotic symptoms and personally defined recovery was not just possible but likely in the very long term. However, attaining positive functional outcomes and building resilience in FEP remain key challenges for mental health services. [ABSTRACT FROM AUTHOR]

Background: The majority of studies included in recent reviews of impact for public and patient involvement (PPI) in health research had a qualitative design. PPI in solely quantitative designs is underexplored, particularly its impact on statistical analysis. Statisticians in practice have a long history of working in both consultative (indirect) and collaborative (direct) roles in health research, yet their perspective on PPI in quantitative health research has never been explicitly examined. Objective: To explore the potential and challenges of PPI from a statistical perspective at distinct stages of quantitative research, that is sampling, measurement and statistical analysis, distinguishing between indirect and direct PPI. Conclusions: Statistical analysis is underpinned by having a representative sample, and a collaborative or direct approach to PPI may help achieve that by supporting access to and increasing participation of under‐represented groups in the population. Acknowledging and valuing the role of lay knowledge of the context in statistical analysis and in deciding what variables to measure may support collective learning and advance scientific understanding, as evidenced by the use of participatory modelling in other disciplines. A recurring issue for quantitative researchers, which reflects quantitative sampling methods, is the selection and required number of PPI contributors, and this requires further methodological development. Direct approaches to PPI in quantitative health research may potentially increase its impact, but the facilitation and partnership skills required may require further training for all stakeholders, including statisticians. [ABSTRACT FROM AUTHOR]

Background: Analysis of general practice records can address the information gap on the epidemiology of type 2 diabetes (T2DM) in Ireland, informing practice and the development of interventions in primary care. The aim of this study was to identify patients with poor glycaemic control, risk factors for complications and evidence of end organ damage in a large multi-practice study and to profile their characteristics. Methods: Patients with T2DM were identified using disease coding in Health One practice management software in 41 general practices. Patients' demographics and clinical data were extracted. Rates of poor glycaemic control (glycated haemoglobin > 58 mmol/mol) and albumin creatinine ratio > 3 mg/mmol were calculated. A multilevel logistic regression analysis using both patient and practice variables was conducted. Results: Data was collected from 3188 patients of whom 29% (95% CI 28 to 31%) had poor glycaemic control, which was associated with younger age, higher BMI and higher total cholesterol. Only 42% of patients (n = 1332) had albumin creatinine ratio measured with 42% (95% CI 40 to 45%) of these having values > 3 mg/mmol. Older age groups, men, those with hypertension, eGFR < 60 ml/min/1.73m2 and poor glycaemic control were most associated with higher values of albumin creatinine ratio. Conclusions: Analysing this large multi-practice dataset gives important information on the prevalence and characteristics of diabetic patients who are most at risk of poor outcomes. It highlights that recording of some data could be improved. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Currently, Ireland has the fourth highest rate of youth suicide in the European Union with psychological morbidity ranging from 21% to 27% in young adults. Primary care is ideally situated to address mental health problems and provide direction and support to young adults. This study investigates the prevalence and management of young adults aged 18–25 presenting to their general practitioner with a psychological problem as part of a larger study on all adults. Methods: A random sample of 100 patients aged 18 and over with a consultation in the previous 2 years was selected from the practice management systems of 40 general practices in Ireland. Clinical records of active patients (excluding temporary visitors to the practice) were examined using a standardized reporting tool to extract information on demographics, prevalence, diagnoses and treatments for psychological problems. Results: Of the 3845 active patients sampled aged 18 and over, 479 were in the target age group of 18–25. Of the 479 young adults identified (51% female, 60% fee paying), 57 (12%, 95% CI: 9–15%) had a documented psychological problem within the previous 2 years. Those with psychological problems were more likely to be frequent attenders and eligible for free medical care. Depression (23%) and stress and anxiety (23%) were most commonly identified. Conclusions: The estimated prevalence rate is considerably lower than previous studies which may indicate reluctance among young adults in presenting to primary care or reflect under‐identification of psychological problems. Given the high rate of prescribing, enhancing access to non‐pharmacological treatments in primary care is a priority. [ABSTRACT FROM AUTHOR]

Record linkage algorithms aim to identify pairs of records that correspond to the same individual from two or more datasets. In general, fields that are common to both datasets are compared to determine which record-pairs to link. The classic model for probabilistic linkage was proposed by Fellegi and Sunter and assumes that individual fields common to both datasets are completely observed, and that the field agreement indicators are conditionally independent within the subsets of record pairs corresponding to the same and differing individuals. Herein, we propose a novel record linkage algorithm that is independent of these two baseline assumptions. We demonstrate improved performance of the algorithm in the presence of missing data and correlation patterns between the agreement indicators. The algorithm is computationally efficient and can be used to link large databases consisting of millions of record pairs. An R-package, corlink, has been developed to implement the new algorithm and can be downloaded from the CRAN repository. [ABSTRACT FROM AUTHOR]

Our objective was to compare breast cancer mortality in two regions of the Republic of Ireland that introduced a screening programme eight years apart, and to estimate the steady-state mortality deficits the programme will produce. We carried out age- and year-matched between-region comparison of breast cancer mortality rates, and of incidence rates of stage 2–4 breast cancer, in the eligible cohorts. The regions comprised counties that, beginning in early 2000 (region 1) and late 2007 (region 2), invited women aged 50–64 to biennial mammography screening. The data were supplied by the National Cancer Registry, Central Statistics Office. As impact measures, we used age-and-year-matched mortality (from breast cancers diagnosed from 2000 onwards), rate ratios and incidence rate ratios in the compared regions from 2000 to 2013. Ratios were adjusted for between-region differences in background rates. In cohorts too old to be invited, death rates in regions 1 and 2 were 702 per 0.91 and 727 per 0.90 million women-years respectively (Ratio 0.96). In the eligible cohorts, they were 1027 per 2.9 and 1095 per 2.67 (Ratio 0.88). Thus, rates in cohorts that could have benefitted were 9% lower in region 1 than region 2: (95%CI: -20%, +4%). The incidence rates of stage 2–4 breast cancer were 7% lower in region 2 than region 1 over the entire 14 year period, and 20% lower in 2007, i.e., before the screening in region 2 began to narrow the difference. Since mortality reductions due to screening only manifest after several years, the full impact of screening has not yet been realized in region 1. The lower rate observed in that region is a conservative estimate of the steady state benefit. Additional deaths would have been averted had screening continued beyond age 64. [ABSTRACT FROM AUTHOR]

Background: Abnormal placental cord insertion (PCI) includes marginal cord insertion (MCI) and velamentous cord insertion (VCI). VCI has been shown to be associated with adverse pregnancy outcomes. This systematic review and meta-analysis aims to determine the association of abnormal PCI and adverse pregnancy outcomes. Methods: Embase, Medline, CINAHL, Scopus, Web of Science, ClinicalTrials.gov, and Cochrane Databases were searched in December 2016 (from inception to December 2016). The reference lists of eligible studies were scrutinized to identify further studies. Potentially eligible studies were reviewed by two authors independently using the following inclusion criteria: singleton pregnancies, velamentous cord insertion, marginal cord insertion, and pregnancy outcomes. Case reports and series were excluded. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Outcomes for meta-analysis were dichotomous and results are presented as summary risk ratios with 95% confidence intervals. Results: Seventeen studies were included in the systematic review, all of which were assessed as good quality. Normal PCI and MCI were grouped together as non-VCI and compared with VCI in seven studies. Four studies compared MCI, VCI, and normal PCI separately. Two other studies compared MCI with normal PCI, and VCI was excluded from their analysis. Studies in this systematic review reported an association between abnormal PCI, defined differently across studies, with preterm birth, small for gestational age (SGA), low birthweight (< 2500 g), emergency cesarean delivery, and intrauterine fetal death. Four cohort studies comparing MCI, VCI, and normal PCI separately were included in a meta-analysis resulting in a statistically significant increased risk of emergency cesarean delivery for VCI (pooled RR 2.86, 95% CI 1.56-5.22, P = 0.0006) and abnormal PCI (pooled RR 1.77, 95% CI 1.33-2.36, P < 0.0001) compared to normal PCI. Conclusions: The available evidence suggests an association between abnormal PCI and emergency cesarean delivery. However, the number of studies with comparable definitions of abnormal PCI was small, limiting the analysis of other adverse pregnancy outcomes, and further research is required. [ABSTRACT FROM AUTHOR]

Objectives To prospectively measure the distance from the placental cord insertion (PCI) site to the placental margin using digital imaging and to examine the association between abnormal PCI and adverse pregnancy outcomes in singleton pregnancies. Study Design This prospective cohort study examined 1,005 placentas from consecutively delivered singleton pregnancies in a tertiary center. Standardized images of each placenta were taken and digital measurement was performed using ImageJ software. Results The rates of velamentous (insertion into the membrane) and marginal (<2 cm from placental margin) cord insertions in a total of 1,005 singleton pregnancies were 3.6% (n = 36; 95% confidence interval [CI] = 2.5-4.9%) and 6.4% (n = 64; 95% CI = 4.9-8.1%), respectively. Abnormal PCI was found to be more common among smokers compared with non-smokers (22.7 vs. 14.8%, p = 0.04). Abnormal PCI was found to be significantly associated with small for gestational age (adjusted odds ratio [OR]: 1.73; 95% CI: 1.01 -2.97, p = 0.047) and low birth weight (adjusted OR: 3.87; 95% CI: 1.728.71, p = 0.001). Conclusion Digital imaging analysis using ImageJ software mapped the surface of the placenta and provided objective measurement of PCI site. In this large prospective cohort, abnormal PCIs were significantly associated with an increased risk of small for gestational age and low birth weight. [ABSTRACT FROM AUTHOR]

Chronic pain is a public health concern affecting 20% to 30% of the population of Western countries. Psychological risk factors can worsen chronic pain patients. Themes of perceived injustice ( PI) and pain catastrophizing are related to poor clinical outcomes. Particularly, perceived injustice has not been assessed systematically in patients at their first presentation in chronic pain clinics in Ireland. This study aims to assess the Injustice Experience Questionnaire ( IEQ)'s internal consistency in the Irish population, assess PI in patients attending a chronic pain clinic in Ireland using the IEQ, investigate pain catastrophizing through the Pain Catastrophizing Scale ( PCS) and its relationship with IEQ scores, and explore their relationships with self-reported Numeric Pain Rating Scale. One hundred adult patients were randomly selected from those attending the clinic for the first time. Eighty completed the IEQ (mean age 49 years, ranged 22 to 90 years; 59% female). The internal consistency of the IEQ was excellent (Cronbach's alpha = 0.93). Twenty-six patients (33%) had IEQ scores classified as severe. Patients whose cause of pain was trauma or road traffic accidents were more likely to have clinically severe scores than all other causes of pain (47% vs. 23%, P = 0.03). This has clinical consequences and may have legal implications. Pain catastrophizing scores were strongly correlated with IEQ ( r = 0.60, P < 0.001). The correlation between IEQ and the Numeric Pain Rating Scale was weak ( r = 0.25, P = 0.048). The results suggest that the IEQ may provide an additional tool to assess psychological contributors in problematic chronic pain patients and to institute targeted therapies to improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Objectives:Most medical schools using progress tests (PTs) provide feedback by utilizing a traffic-light system of green (satisfactory), yellow (borderline) and red (unsatisfactory) categories. There is little research assessing students’ perceptions or usage of this feedback. Therefore this study proposed to determine the effectiveness of formative PTs at informing and supporting student progress. Methods:A mixed methods study was performed, involving a retrospective analysis of a results database to establish the predictive validity of PT categories and 11 semi-structured interviews to explore students’ perceptions of PT feedback in a graduate entry medical programme. Results:Quantitative analysis revealed that students who always scored green performed better in their summative exams and graduated with a higher final degree than those who received a yellow or red category at least once. Qualitative analysis revealed that just over half of the interviewed students perceived the PT as having informed their progress. Most participants agreed that the current feedback is insufficient and doesn’t guide their on-going learning. Conclusion:While this study demonstrated that the PT is a useful predictive tool for informing student progress, in its current format it’s not fulfilling a truly formative role and supporting student progress sufficiently. [ABSTRACT FROM PUBLISHER]

Epidemiological evidence suggests that obesity and depression are highly co-morbid. In a national cohort study, we examined whether parents caring for children with disabilities were more likely to be classified as obese compared to parents of children without disabilities and if obesity was associated with depressive symptoms or child behaviour characteristics. Using data from the Growing Up in Ireland National Longitudinal Study of Children (2006 to date), 627 parents of children with developmental disabilities were compared with 7941 parents of typically developing children on objectively measured levels of obesity (body mass index ≥30kg/m2), depression, health behaviours, chronic health conditions, socio-demographic and child behavioural characteristics. Parents of children with disabilities were more likely to be classified as obese compared to control parents (24.5% vs. 19.6%, p=0.005, Cramer's V<0.1). Depression was not associated with obesity. However, the odds of obesity increased with increasing child problem behaviour (OR 1.05, 95% CI 1.03-1.06). Over half (57%) of obese parents caring for children with disabilities reported trying to lose weight often or very often. This study has confirmed, in a population-based sample, the high risk of obesity in parents caring for children with disabilities after adjusting for the presence of depression and other health behaviours; increasing child problem behaviours were predictive of obesity. Importantly, given the negative health correlates of obesity, it is imperative that health professionals pay attention to weight issues in these parents and support their efforts in managing these issues. [ABSTRACT FROM AUTHOR]

Evidence of deficiencies in basic mathematical skills of beginning undergraduates has been documented worldwide. Many different theories have been set out as to why these declines in mathematical competency levels have occurred over time. One such theory is the widening access to higher education which has resulted in a less mathematically prepared profile of beginning undergraduates than ever before. In response to this situation, the present study details the examination of a range of methods through which a student's mathematical performance in higher education could be predicted at the beginning of their third-level studies. Several statistical prediction methods were examined and the most effective method in predicting students’ mathematical performance was discriminant analysis. The discriminant analysis correctly classified 71.3% of students in terms of mathematics performance. An ability to carry out such a prediction in turn allows for appropriate mathematics remediation to be offered to students predicted to fail third-level mathematics. The results of the prediction of mathematical performance, which was carried out using a database consisting of over 1000 beginning undergraduates over a 3-year period, are detailed in this article along with the implications of such findings to educational policy and practice. [ABSTRACT FROM PUBLISHER]

Highlights: [•] Parents of children with disabilities are at an increased risk of depression. [•] The excess risk was independent of their physical health status. [•] Depression was most likely to manifest after the birth of the child. [Copyright &y& Elsevier]

Objectives: This study describes the pitfalls for commonly used statistical techniques in dental research and gives some recommendations for avoiding them. It also explores the potential of some of the newer statistical techniques for dental research. Methods: Each of the commonly used techniques e.g. descriptive statistics, correlation and regression, hypothesis tests (parametric and non-parametric) and survival analysis are explored with examples and recommendations for their use are provided. Common sources of error including those of study design, insufficient information, ignoring the impact of clustering and underuse of confidence intervals are outlined. The potential of statistical techniques such as multivariate survival models, generalized estimating equations and multilevel models are also explored. Conclusions: Reviews of published dental research repeatedly identify statistical errors in the design, analysis and conclusions of the study. Educating researchers on common pitfalls and giving recommendations for avoiding them may help researchers to eliminate statistical errors. Developments in statistical methodology should be routinely monitored to ensure the most appropriate statistical methods are used in dental research. [ABSTRACT FROM AUTHOR]

Ireland's ‘mathematics problem’ is well-documented and extensively reported in the media and elsewhere (Expert Group on Future Skills Needs (EGFSN) 2008; Task Force on the Physical Sciences 2002). Concern primarily lies with post-primary students’ underperformance in mathematics coupled with a failure to make a successful transition to third level scientifically and mathematically orientated undergraduate courses. Teacher qualification is believed to be one of the most important factors affecting students’ mathematical learning. Research has demonstrated that students learn more from teachers who are skilled, experienced, and know what and how to teach (Darling-Hammond 2000). The aim of this study is to investigate the level of out-of-field teaching occurring in Irish post-primary mathematics classrooms and the deployment of these teachers in Irish second level school. Findings reveal that 48% of teachers teaching mathematics in this study are unqualified to do so and are primarily assigned Junior Cycle classes, non-exam years and Ordinary level or lower mathematics. [ABSTRACT FROM PUBLISHER]

This article reports on the mathematical competency of students entering third-level education in the University of Limerick (UL). Data from diagnostic testing, gathered on 5,949 students between the years 1998 and 2008, are used to demonstrate the changes in competency levels of students entering UL. There has been a significant decline in the performance of students in the diagnostic test over time. The performance, on average, of students with the same leaving certificate mathematics grade on entry into university has not changed significantly over time. However, the profile of the entrants has changed considerably and this is contributing to the overall decline in mathematical competency. [ABSTRACT FROM PUBLISHER]

Background Care is regularly provided on an informal basis by family and friends and it is well established that caregivers experience high rates of depression. The majority of research on caregivers tends to focus on older, full-time caregivers, with less attention paid to working caregivers (in paid employment). The aim of this study is to explore the impact of work status on depression in caregivers. Methods A sample of individuals from the 2014 European Social Survey dataset, aged 18 and older, who reported being a caregiver, were investigated (n  = 11 177). Differences in sociodemographic, mental and physical health and social network variables, between working and non-working caregivers, were investigated. Hierarchical logistic regression models were used to investigate associations between the caregivers' work status and depression. This study was developed in partnership with a panel of caregivers who contributed to the conceptualization and interpretation of the statistical analysis. Results Findings showed that 51% of caregivers reported being in paid employment. Non-working caregivers were more likely to be female, older, widowed, have lower education levels and provide intensive caring hours. They were also more likely to report depressive symptoms than working caregivers after controlling for sociodemographic, social networks and intensity of caring (adjusted odds ratio = 1.77, 95% confidence interval = 1.54–2.03). The panel considered policies to support continued work important as a means of maintaining positive mental health for caregivers. Conclusions Supportive policies, such as flexible working and care leave, are recommended to allow caregivers to continue in paid work and better manage their health, caring and working responsibilities. [ABSTRACT FROM AUTHOR]

Defensive medicine describes behaviours engaged in by physicians, for the purposes of averting the threat of medical negligence litigation and/or complaints. Defensive practice typically encompasses 'assurance' or 'avoidance' behaviours, or 'positive' or 'negative' defensive medicine. Assurance behaviours include, for example, meticulous notetaking and ordering further clinically unnecessary tests, whereas avoidance behaviours encompass actions such as refusing to engage with a patient perceived to be high-risk. Whilst such practices may be understandable, defensive medicine is problematic for a number of reasons: it may result in a lower standard of patient care, where for example, a patient is exposed to unnecessary risk(s); and it can increase healthcare costs, which in turn limits resources. Drawing on the findings of a survey of surgeons in Ireland, this study investigates the existence of defensive practices, and explores the impact of the civil and regulatory responses to patient safety incidents on surgical practice. Given the increasing emphasis on patient safety and cultivating a "no-blame" culture both nationally and internationally, the findings of this research illustrate the tension between the current medico-legal and regulatory environment and medical practice, with implications for quality and safety. [ABSTRACT FROM AUTHOR]

Context: The use of ethnic identifiers in health systems is recommended in several European countries as a means to identify and address heath inequities. There are barriers to implementation that have not been researched. Objective: This study examines whether and how ethnicity data can be collected in Irish general practices in a meaningful and acceptable way. Methods: Qualitative case study data generation was informed by Normalization Process Theory (NPT) constructs about 'sense' making and 'engagement'. It consisted of individual interviews and focus group discussions based on visual participatory techniques. There were 70 informants, including 62 general practitioner (GP) users of diverse ethnic backgrounds recruited through community organisations and eight GPs identified through an inter-agency steering group. Data were analysed according to principles of thematic analysis using NPT. Results: The link between ethnicity and health was often considered relevant because GP users grasped connections with genetic (skin colour, lactose intolerance), geographic (prevalence of disease, early years exposure), behavioural (culture/food) and social determinant (housing) factors. The link was less clear with religion. There was some scepticism and questions about how the collection of data would benefit GP consultations and concerns regarding confidentiality and the actual uses of these data (e.g. risk of discrimination, social control). For GPs, the main theme discussed was relevance: what added value would it bring to their consultations and was it was their role to collect these data? Their biggest concern was about data protection issues in light of the European Union (EU) General Data Protection Regulation (GDPR). The difficulty in explaining a complex concept such as 'ethnicity' in the limited time available in consultations was also worrying. Conclusions: Implementation of an ethnicity identifier in Irish general practices will require a strong rationale that makes sense to GP users, and specific measures to ensure that its benefits outweigh any potential harm. This is in line with both our participants' views and the EU GDPR. [ABSTRACT FROM AUTHOR]

Background: Migration to European countries has increased in number and diversity in recent years. Factors such as access to healthcare, language barriers and legal status can impact the health outcomes of migrant groups. However, little is known about the evidence base on the health status of migrants in the Republic of Ireland. Our aim was to scope existing peer-reviewed research on the health of migrants in Ireland and identify any gaps in the evidence.Methods: We conducted a scoping review of peer-reviewed research on the health of migrants in the Republic of Ireland. Eleven electronic databases were searched for peer-reviewed, empirical articles published between 2001 and 2017. Search terms were adapted from a World Health Organisation review. Findings were analysed using the 2016 World Health Organisation Strategy and Action Plan for Refugee and Migrant Health in the World Health Organisation European region, which outlines nine strategic areas that require collaborative action.Results: Of 9396 articles retrieved, 80 met inclusion criteria, with the majority (81%) published since 2009. More than half of the studies had a quantitative design (65%). Migrants studied came from Eastern Europe, Asia and Africa and included labour migrants, refugees and asylum seekers. Most studies related to two World Health Organisation strategic areas; 4: "achieving public health preparedness and ensuring an effective response", and 5: "strengthening health systems and their resilience".Conclusion: There is growing attention to migrant health in Ireland with a balance of qualitative and quantitative research. While much of the identified research is relevant to three of the World Health Organisation strategic areas, there are significant gaps in the other six areas. The study design could be replicated in other countries to examine and inform migrant health research. [ABSTRACT FROM AUTHOR]

Aim: Although the relationships between duration of untreated psychosis (DUP) and outcomes are often assumed to be linear, few studies have explored the functional form of these relationships. The aim of this study is to demonstrate the potential of recent advances in curve fitting approaches (splines) to explore the form of the relationship between DUP and global assessment of functioning (GAF). Methods: Curve fitting approaches were used in models to predict change in GAF at long‐term follow‐up using DUP for a sample of 83 individuals with schizophrenia. Results: The form of the relationship between DUP and GAF was non‐linear. Accounting for non‐linearity increased the percentage of variance in GAF explained by the model, resulting in better prediction and understanding of the relationship. Conclusion: The relationship between DUP and outcomes may be complex and model fit may be improved by accounting for the form of the relationship. This should be routinely assessed and new statistical approaches for non‐linear relationships exploited, if appropriate. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the effect of timing of antibiotics on the mortality of patients suffering from severe sepsis and septic shock. In the study, four measures of quality were used, namely, study design, identification of patients with sepsis, sampling method, and quality of the data on timing of antibiotics. Also cited is the 2004 edition of the surviving sepsis campaign (SSC) guidelines.

Purpose: Increased mortality rates have been found in those with a diagnosis of psychosis; studies suggest a shortened life expectancy of up to 20 years less than that of the general population. This study aimed to investigate the mortality of a first episode psychosis cohort at 20-year follow-up, compare it to that of the general Irish population, and explore whether the mortality gap has changed over time.Methods: 171 individuals diagnosed with a first episode psychosis identified between 1995 and 1999 in a community mental health service were traced. Mortality was established by matching death certificates to deceased cohort members (using name, age at date of death, and address at date of death). Date of first presentation to service was used as date of entry point and date of death or end of follow-up as the end point.Results: Of the 171 cases there were 20 deaths during follow-up. Nine deaths were attributed to natural causes; 7 to unnatural causes; and 4 were unknown. Comparing standardised mortality rates at 20-year follow-up to those at 12 year showed a reduction in rates over time.Conclusion: Findings suggest that the mortality gap in people with schizophrenia and other psychoses remains high, especially in young males. [ABSTRACT FROM AUTHOR]

Information graphics or infographics combine visual representations of information or data with text. They have been used in health research to disseminate research findings, translate knowledge and address challenges in health communication to lay audiences. There is emerging evidence of the design of infographics with the involvement of patients and the public in health research. Approaches to involvement include public and patient involvement, patient engagement and participatory research approaches. To date, there has been no comprehensive review of the literature on the design of infographics with patients and the public in health research. This paper presents a protocol and methodological framework for a scoping review to identify and map the available evidence for the involvement of patients and the public in infographics design in health research. It has been informed by preliminary searches and discussions and will guide the conduct and reporting of this review. [ABSTRACT FROM AUTHOR]

Background: Community participation in primary care is enshrined in international and Irish health policy. However, there is a lack of evidence about how stakeholders work collectively to implement community participation within interdisciplinary teams; community perspectives are rarely captured, and a theoretical underpinning for implementation of community participation in primary care is absent. Objective: To conduct a theoretically informed, multiperspectival empirical analysis of the implementation of community participation via primary care teams (PCTs) in Ireland. Methods/Design/Participants: Participatory learning and action (PLA) focus groups and interviews were held with 39 participants across four case study sites within a nationally funded programme designed to enable disadvantaged communities to participate in primary care. Normalization process theory (NPT) informed data generation and analysis of how diverse stakeholder groups worked together to implement community participation via PCTs. Results: The various stakeholders had a shared understanding of the value of community participation on PCTs. Motivations to get involved in this work varied, but were strong overall. Challenges to enacting community participation on PCTs included problems with the functioning of PCTs and a lack of clarity and confidence in the role of community representatives at PCT meetings. Informal appraisals were positive, but formal appraisal was limited. Discussion and Conclusion: The implementation and sustainability of community participation on PCTs in Ireland will be limited unless (i) the functioning of PCTs is strong, (ii) there is increased confidence and clarity on community representatives' roles among all health‐care professionals, and (iii) more sophisticated methods for formal appraisal are used. [ABSTRACT FROM AUTHOR]

Predictors of depression over time were examined in parental carers of children with developmental disabilities (DD) and parents of typically developing children (controls) who participated in the Growing up in Ireland Study. Parents completed measures of depression, the Centre for Epidemiological Depression Scale (CES-D) and child problem behaviours, the Strength and Difficulties Questionnaire when the children were aged 9 (Wave 1) and 13 (Wave 2). Using CES-D cut-off scores to indicate probable depression, caregivers were more likely to be depressed at both waves compared to controls with a Wave 1 rate of depression of 14.6% vs. 7.9% (p < 0.001, Cramer`s V = 0.059) and Wave 2 (14.8% vs. 10%, p = 0.003, Cramer`s V = 0.038). While overall rates of depression were stable for caregivers, a shifting pattern emerged; 59.6% of those who were depressed at Wave 1, were not at Wave 2; similarly, 10.9% who were not depressed at Wave 1, were at Wave 2. Parents of children with DD were also more likely to report greater problem behaviours in their children compared to controls at both waves. Depression in caregivers at Wave 1 and persistent child problem behaviours were significant predictors of depression at Wave 2. In conclusion, while overall rates of depression remain stable in caregivers, there are shifting patterns evident with prior depression and persistent behaviour problems predictive of ongoing depression. [ABSTRACT FROM AUTHOR]

Background Recognizing expectations and concerns of patients leads to more specialized management plans and greater adherence to treatment and improves outcomes. Little is known about how age impacts on expectations or concerns regarding pain in patients attending a chronic pain clinic. Methods We prospectively assessed the expectations and concerns of 100 adult patients at their first visit to a pain clinic. Patients reported their expectations and concerns for the clinic visit using a self-completed questionnaire. Categories of concerns and expectations were compared across age groups (≤ 65 years, > 65 years) using the chi-square test and Fisher's exact test. Results Thirty-nine patients (39%) were over 65 years of age (older patients). The most frequently stated site of pain was the lumbar spine for all patients regardless of age. Common concerns of all patients related to sleep and mobility, and the most common expectation related to analgesia. Younger patients were more concerned about employment (23% vs. 3% of older patients, P = 0.005) and social participation (21% vs. 5%, P = 0.03), whereas older patients were more likely to be concerned about mobility (46% vs. 15% of younger patients, P = 0.001). More younger patients expected education on the source of pain than did older patients (23% vs. 3%, P = 0.005), whereas older patients were more likely to be unsure or have no expectations (26% vs. 3%, P = 0.005). Conclusion We found differences in patient expectations and concerns by age of those attending a chronic pain clinic. These differences can inform the communication process between physician and patient on treatment plans and outcomes. [ABSTRACT FROM AUTHOR]

Objectives To prospectively measure the distance from the placental cord insertion (PCI) site to the placental margin using digital imaging and to examine the association between abnormal PCI and adverse pregnancy outcomes in singleton pregnancies. Study Design This prospective cohort study examined 1,005 placentas from consecutively delivered singleton pregnancies in a tertiary center. Standardized images of each placenta were taken and digital measurement was performed using ImageJ software. Results The rates of velamentous (insertion into the membrane) and marginal (<2 cm from placental margin) cord insertions in a total of 1,005 singleton pregnancies were 3.6% (n = 36; 95% confidence interval [CI] = 2.5-4.9%) and 6.4% (n = 64; 95% Cl = 4.9-8.1%), respectively. Abnormal PCI was found to be more common among smokers compared with non-smokers (22.7 vs. 14.8%, p = 0.04). Abnormal PCI was found to be significantly associated with small for gestational age (adjusted odds ratio [OR]: 1.73; 95% CI: 1.01 -2.97, p = 0.047) and low birth weight (adjusted OR: 3.87; 95% CI: 1.72- 8.71, p = 0.001). Conclusion Digital imaging analysis using ImageJ software mapped the surface of the placenta and provided objective measurement of PCI site. In this large prospective cohort, abnormal PCIs were significantly associated with an increased risk of small for gestational age and low birth weight. [ABSTRACT FROM AUTHOR]

Total hip arthroplasty (THA) is a very successful procedure. Revision THA is becoming increasingly common. Recent developments to improve outcomes include the development of large trabecular metal (TM) acetabular cups and augments. There is a paucity of data on the benefit of these new techniques.~Introduction~Background~A single-centre retrospective review consisting of a radiological review of post-op revision THA anteroposterior pelvis. Data collection was performed using the Irish National Orthopaedic Register (INOR) and from a previous project. We used a technique developed by Fessy et al in 1999 to measure the centre of rotation (COR) of the hip. We then compared our study to that of a study measuring the COR of healthy native hips.~Methods~Methods~127 revision THA analysed. Native COR calculated by Fessy et al showed a mean horizontal (x) axis 33.6 mm (standard deviation [SD] 5.74) and a vertical (y) axis 16.4 mm (SD 4.67). Non-TM revisions showed a mean x axis of 29 mm (SD 3.9) and y axis 17.9 (SD 5.9). TM Augments had a mean x axis 29.2 mm (SD 7.9) and y axis of 21.5 (SD 8.4). TM Cups alone had a mean x axis 27 mm (SD 6.9) and y axis 22 mm (SD 10.18).~Results~Results~COR of TM implants showed considerable deviation from the norm. Non-TM implants showed a COR within acceptable physiological range. TM components consistently failed to restore a natural COR in our cohort. The implications of this remain uncertain but must be considered in any decision to use TM.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Migration is a longstanding, growing global phenomenon. As a social determinant of health, migration can lead to health inequities between people on the move and host populations. Thus, it is imperative that there is a coordinated effort to advance migration‐ and health‐related goals. WHO has a specific remit to support evidence‐based decision‐making in its Member States. As part of that remit, WHO Europe presents this Framework for Refugee and Migrant Health Research in the WHO European Region. It is designed as a starting point for debating and analysing a broad range of options and approaches to help inform a WHO global research agenda on health and migration. This is important because refugee and migrant health research is a complex interdisciplinary field that is expanding in a fast‐changing socio‐political environment. The Framework is intended for all stakeholders involved: academic, civil society organisations, refugees, migrants, policy‐makers, healthcare providers, educators and funders. It is developed by academics in consultation with these stakeholder groups. It reflects on three specific interrelated dynamics in research practice. These are (i) research prioritisation; (ii) study samples and (iii) research design. The Framework offers recommendations to consider for each one of these. It elucidates the value of involving refugees and migrants in research and research agendas and the need to develop an ecosystem that will support and sustain participatory, interdisciplinary, transdisciplinary and inter‐sectoral projects. [ABSTRACT FROM AUTHOR]

Background: while polypharmacy and multimorbidity predict healthcare utilisation among older people, the influence of differing pain profiles on healthcare utilisation is unclear. Objective: to compare healthcare utilisation between people with different pain profiles. Methods: baseline data from The Irish LongituDinal study on Ageing (TILDA), a population-representative cohort study involving over 8,171 community living people resident in Ireland aged 50 or over, was used. Following the creation of four novel pain profiles, variables relating to healthcare utilisation were compared across the different profiles using chi-square tests and logistic regression. Results: healthcare utilisation differed across the four pain profiles, with pain being an independent predictor of resource use. Pain profiles 3 and 4 had higher use of general practitioner (GP) care and outpatient visits than people with no pain and pain that had less impact. The odds of being a frequent GP attender increased across pain profiles, with those in profile 4 being almost three times as likely to be frequent attenders compared to those with no pain (adjusted odds ratio (OR) = 2.79; 95% CI 2.74, 2.83). People in profile 4 were almost twice as likely to have a hospital outpatient visit compared to people with no pain (adjusted OR = 1.75; 95% 1.73, 1.78). Conclusions: healthcare utilisation differed between the four pain profiles, with people in profiles 3 and 4 having greater usage of primary and secondary healthcare resources. Pain profile membership was a significant independent predictor of the utilisation of GP care and hospital outpatient visits. [ABSTRACT FROM AUTHOR]

Every student who enrols in a degree programme involving service mathematics in the University of Limerick in Ireland is given a mathematics diagnostic test. The diagnostic test was developed due to mathematics lecturers’ anxiety regarding students’ mathematical competency levels. Students receive the 40 question paper-based test in their first service mathematics lecture without prior notification. Initial analysis of students’ work revealed that many students were having difficulties with basic algebra and arithmetic in particular [Gill, O. 2006. “What Counts as Service Mathematics? An Investigation into the ‘Mathematics Problem’ in Ireland.” PhD diss., University of Limerick]. Further research highlighted the significant decline in diagnostic test performance and the changing profile of service mathematics students between 1998 and 2008 [Faulkner, Fiona, Ailish Hannigan, and Olivia Gill. 2010. “Trends in the Mathematical Competency of University Entrants in Ireland by Leaving Certificate Mathematics Grade.”Teaching Mathematics and Its Applications29 (2): 76–93]. One of the most notable changes to the student profile over time was the increase in mature students (non-standard students) entering service mathematics programmes. Although non-standard students had a lower mean performance in the diagnostic test, they were found to have a higher mean performance in some cases in service mathematics compared to standard students. This paper explores some of the possible reasons for such findings. [ABSTRACT FROM PUBLISHER]

Objectives: To examine the relationship between maternal self-reported and measured height and weight, maternal perceived weight status and measured body mass index (BMI), and maternal perceived child weight status and measured child BMI.Setting and Design: Population-representative National Longitudinal Study of Children Growing Up in Ireland.Methods: Height and weight of 7655 mothers and their 9-year-old children were objectively measured using standard measurement techniques. Mothers' perceptions of their own weight status and the weight status of their child were reported. The association between accurate perceptions of the mother for herself and her child was tested.Results: Mothers overestimated their height by a mean of 0.5 cm (SD=2.9), underestimated their weight by a mean of 1.4 kg (SD=3.8), consequently underestimating their BMI by a mean of 0.6 kg/m(2) (SD=1.7). The majority (60%) of obese mothers correctly categorised their own weight status. Only 17% of mothers of obese children correctly categorised the weight status of their child. Overweight/obese mothers who correctly categorised their own weight status were more likely to correctly categorise their overweight/obese child compared with those who incorrectly categorised their own weight status (44% vs 23%, 95% CI for difference 13% to 28%, p<0.001 for girls; 37% vs 27%, 95% CI 2% to 18%, p=0.02 for boys; significantly greater difference for girls compared with boys, p=0.04).Conclusions: Maternal perceptions of their own weight status tend to be more accurate than maternal perceptions of their overweight or obese child. Overweight/obese mothers who correctly categorised their own weight status were more likely to correctly categorise their overweight/obese child. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify, using cluster analysis, novel sleep phenotypes in a population based cohort of infants, and to explore the associations between infant sleep profiles and their mothers' health and well-being. 11,134 mothers of 9-month old infants were interviewed as part of the Growing Up in Ireland National Longitudinal study and reported on their health and infant's sleep patterns. 16 infant sleep variables were recorded together with measures of parental stress, depression, health and well-being. Multiple iterations of a two-step hierarchical cluster analysis were carried out to identify the optimum number of clusters and the subset of parental-reported sleep variables required to identify distinct sleep profiles. Four distinct sleep profiles were identified based on the following variables; (1) infant sleep duration at night, (2) parental sleep duration, (3) does baby wake during night (yes, no)? (4) Usual sleep location for most of the night and, (5) parental reporting of problem infant sleep patterns. This identified two less favorable profiles with both infants and mothers sleeping less and where mothers are more likely to report their infants' sleep patterns as problematic. Mothers of infants belonging to these sleep profiles were more likely to have higher levels of stress, depressive symptoms, and poorer self-reported health than other sleep profiles. Breastfeeding was associated with both groups and rates were highest in a group of infants that were more likely to co-sleep with their parents and have diverse ethnic backgrounds. This study demonstrates, for the first time, two infant sleep profiles with distinct phenotypical frameworks that are significantly associated with maternal stress, depression, and poorer self-report of health. [ABSTRACT FROM AUTHOR]

An investigation into prospective mathematics/statistics teachers’ (n = 134) conceptual understanding of statistics and attitudes to statistics carried out at the University of Limerick revealed an overall positive attitude to statistics but a perception that it can be a difficult subject, in particular that it requires a great deal of discipline and time to learn. This latter result motivated a follow-up qualitative study (n = 9) to uncover the factors contributing to positive attitude and the concomitant perceptions of difficulty. What emerged was evidence of the lasting impact secondary teachers and their perceptions of statistics had on these students. The study also reveals the potential of teaching practice to act as a vehicle to challenge the perceived difficulty of learning statistics and provide prospective teachers with the opportunity to develop confidence in statistics as both learners and teachers. [ABSTRACT FROM PUBLISHER]

INTRODUCTION: Sedentary behavior (SB) research has relied on accelerometer thresholds to distinguish between sitting/lying time (SLT) and light-intensity physical activity (LIPA). Such methods may misclassify SLT, standing time (StT), and LIPA. This study examines the association between directly measured SB, physical activity (PA), and adiposity in an adolescent female sample. METHODS: Female adolescents (n = 195; mean age, 15.7 yr (SD, 0.9)) had body mass index (BMI) (median, 21.7 kg•m-2 (interquartile range, 5.2 kg•m-2)) and four-site sum of skinfolds (median, 62.0 mm; interquartile range, 37.1 mm) measured and wore an activPAL™ activity monitor for 7 d. SLT, StT, breaks in SLT, and bouts of SLT <30 and ≥30 min were determined from activPAL outputs. A threshold of 2997 counts per 15 s determined moderate-to-vigorous PA. All remaining time was quantified as LIPA. Mixed linear regression models examined associations between PA variables, SB variables, and adiposity. RESULTS: Participants spent a mean of 65.3% (SD, 7.1) of the waking day in SLT, 23.0% (SD, 5.3) in StT, 5.6% (SD, 1.5) in LIPA, and 6.1% (SD, 2.4) in moderate-to-vigorous PA. Significant effects for the percentage of LIPA (which excluded StT) with both BMI (β = -4.38, P = 0.0006) and sum of skinfolds (β = -4.05, P = 0.006) were identified. Significant effects for breaks in SLT with BMI (β = -0.30, P = 0.04) were also observed. No additional significant associations were found between activity measures and adiposity. CONCLUSIONS: Increased LIPA (excluding StT) and breaks in SLT were negatively associated with adiposity in this sample, independent of age. Interventional work should examine whether reducing SLT through breaks and increasing LIPA may prevent increases in adiposity in adolescent females. [ABSTRACT FROM AUTHOR]

Background: As prevalence of multimorbidity and polypharmacy rise, health care systems must respond to these challenges. Data is needed from general practice regarding the impact of age, number of chronic illnesses and medications on specific metrics of healthcare utilisation. Methods: This was a retrospective study of general practices in a university-affiliated education and research network, consisting of 72 practices. Records from a random sample of 100 patients aged 50 years and over who attended each participating practice in the previous two years were analysed. Through manual record searching, data were collected on patient demographics, number of chronic illnesses and medications, numbers of attendances to the general practitioner (GP), practice nurse, home visits and referrals to a hospital doctor. Attendance and referral rates were expressed per person-years for each demographic variable and the ratio of attendance to referral rate was also calculated. Results: Of the 72 practices invited to participate, 68 (94%) accepted, providing complete data on a total of 6603 patients' records and 89,667 consultations with the GP or practice nurse; 50.1% of patients had been referred to hospital in the previous two years. The attendance rate to general practice was 4.94 per person per year and the referral rate to the hospital was 0.6 per person per year, giving a ratio of over eight attendances for every referral. Increasing age, number of chronic illnesses and number of medications were associated with increased attendance rates to the GP and practice nurse and home visits but did not significantly increase the ratio of attendance to referral rate. Discussion: As age, morbidity and number of medications rise, so too do all types of consultations in general practice. However, the rate of referral remains relatively stable. General practice must be supported to provide person centred care to an ageing population with rising rates of multi-morbidity and polypharmacy. [ABSTRACT FROM AUTHOR]

Introduction To assess the accuracy of CT pixel analysis for fat attenuation in pulmonary hamartomas. Methods Retrospective review identified 32 patients in three separate groups; pathologically proven hamartoma ( n = 11), hamartoma diagnosed on imaging ( n = 9) and a control group ( n = 14) of pathology-proven non-hamartomatous smoothly marginated solitary pulmonary nodules. All lesions were assessed using: visual assessment for fat, pixel analysis of the inner 2/3rds and mean attenuation of the entire lesion, using an internal reference for fat. Fat percentages on CT and at histology were compared. Results Visual assessment for macroscopic fat was the most reliable method for diagnosing pulmonary hamartoma. Combining percentage of fat-attenuation pixels in the inner 2/3rds of the lesion improved specificity to 100%. Mean attenuation or pixel analysis in isolation were not helpful in lesional characterization. Conclusion Combining percentage fat-attenuating pixels in the inner 2/3rds with visual assessment for macroscopic fat improves specificity for diagnosing pulmonary hamartomas. [ABSTRACT FROM AUTHOR]

The article presents a study which aims at assessing information on generic medicines that a searcher in Ireland is likely to find online. It notes the completion of Internet searches using a computer with an Irish Internet protocol address and the identification of correlations between readability statistics and Google search engine results page ranking. It reveals that none of the websites demonstrated the desired combination of scoring highly for both quality of information and readability.

Background: The relationship between economic conditions and health can depend on both the health outcome measured and the composition of the population. Analysis of outcomes by both ethnicity and country of birth has been recommended. The aim of our study is to explore the impact of recession on self-rated health and depression of migrant fathers in Ireland over time, considering both ethnicity and country of birth.Methods: Longitudinal data from waves of a population-representative cohort study (Growing up in Ireland, 2008-2013) was used with Wave 1 collected before the recession and Wave 2 collecting information on how the recession affected families. Socio-demographic variables, self-rated health and depression were compared across three groups of fathers classified by self-identified ethnicity and country of birth: White Irish (n = 5628), Other White European (EU-10) (n = 431), and Black African (n = 192) using chi-square tests and logistic regression models. Rates of follow-up were compared across groups at Wave 3.Results: Prior to the recession, the rate of employment was lowest for African fathers (51% vs 81% for EU-10 fathers and 92% for Irish fathers, p < 0.001). At Wave 2, African families were more likely to have experienced a very significant effect of the recession (40.1% compared to 22.4% for families from EU-10 and 21.3% for Irish families, p < 0.001). However, the impact of the recession on depression and self-rated health was only found in Irish fathers. By Wave 3, rates of follow-up were lower for migrant fathers, particularly for EU-10 fathers.Conclusions: Understanding the relationship between economic conditions and health is complex and may be related to multiple dimensions of socio-economic advantage and disadvantage. African families were already more likely to be disadvantaged prior to the recession and that pattern persisted during the recession. Further research on attrition rates of migrants in population cohort studies is needed and the development of effective strategies for recruitment, follow-up and analysis. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for falling for people with Multiple Sclerosis. Design: Prospective cohort study. Setting: Neurology service in a tertiary hospital. Subjects: Participants were 101 people with Multiple Sclerosis and Expanded Disability Status Score of 3-6.5. One participant withdrew after the baseline assessment; data were analysed for 100 participants. Interventions: No intervention. Main measures: Outcome was rate of falls, and predictors were Timed Up and Go, Symbol Digit Modalities test, demographics and 15 self-report questions about various symptoms including fatigue, concentration, dual tasking, bladder and bowel control. Three-month prospective diaries recorded falls. Results: There were 791 falls reported over the 3-month period from a total of 56 fallers. Falls rate per person-year was 32.08 falls. Following multivariable regression analysis, the model with the greatest levels of clinical utility and discriminative ability (sensitivity 88% and area under the receiving operating curve statistic = 0.72, 95% CI 0.62–0.82), included the variables of history of a fall, not having visual problems, problems with bladder control and a slower speed on the Timed Up and Go. Conclusion: This study confirms the high incidence of falls for people with Multiple Sclerosis and provides a risk prediction model including fall history, problems with bladder control, not having visual problems and a slower Timed Up and Go speed that may be used to identify those at greater risk and in need of tailored falls prevention intervention. [ABSTRACT FROM AUTHOR]

Objective: To audit the demand and radiation exposure of conventional radiography in a regional neonatal intensive care unit (NICU) in Ireland.Methods: A retrospective study of radiographs performed on all admissions to the NICU in University Maternity Hospital Limerick (UMHL) over 2 years.Results: A total of 1405 radiographs were performed on 506 infants. 153.5 radiographs per 1000 live births was the observed demand and 44% of radiographs were done out of hours. 47% of all radiographs were performed on infants <1500 g. Median number of radiographs per infant was one (IQR 1-2; range 1-39). Significant negative correlation was observed between number of radiographs and gestational age. Mean lung radiation doses estimated using published values for normal weight (>2500 g), very low birth weight (VLBW), and extremely low birth weight (ELBW) infants based on the median number of chest X-rays were 31.7 µGym, 84.66 and 232.75 µGy, respectively.Conclusions: Conventional radiography remains a key diagnostic tool in neonatology particularly in VLBW and ELBW infants and is invaluable in supporting timely clinical decision making. Clinicians should be aware of the cost and potential hazards of neonatal radiography and is recommend that the cumulative radiation exposure among the ELBW and VLBW infants is monitored. Increasing awareness and standardisation of point-of-care ultrasonography could decrease the reliance on conventional radiography in neonatal units. [ABSTRACT FROM AUTHOR]