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Item Prescriber adherence to antihypertensive prescription guidelines and the impact of patient socioeconomic factors: a cross‐sectional study using data from the irish longitudinal study on ageing(Wiley, 2024) Akhtar, Alizeh; Burton, Edel; Bermingham, Margaret; Kearney, Patricia M.; Irish Research eLibraryPurpose Uncontrolled hypertension causes significant morbidity and mortality worldwide. Several prescribing guidelines have been created to address this, however, prescriber adherence to guidelines is influenced by various sociodemographic patient factors. This study aims to determine the effects of these patient factors on prescriber adherence to antihypertensive prescription guidelines. Methods A secondary analysis of data from the first wave of The Irish Longitudinal Study on Ageing (TILDA), was conducted. Participants were included if they reported previous hypertension diagnoses. Antihypertensive medication regimes were compared with the prescribing guidance in the 2011 NICE hypertension guidelines. The effects of patient sociodemographic factors on prescriber adherence to guidelines, and the effect of prescriber adherence on blood pressure control (≥ 140/90 mmHg), were determined using binomial logistic regression models. Results A total of 2992 participants were included in this analysis; 54.9% female with mean age 65.7 years (±9.23). Male sex and older age, and lower socioeconomic status were associated with increased prescriber guideline adherence. Prescribers were less likely to adhere to guidelines in female patients ≥ 55 years (Relative Risk [RR] 0.75 [0.62, 0.91]), and female patients across all age groups (RR 0.80 [0.67, 0.95]). Better blood pressure control was seen with medication regimes adherent to prescription guidelines (140.38 (±18.98)/83.09 (±11.02) mmHg adherent vs. 141.66 (±19.86)/84.77 (±11.71) mmHg non-adherent). Conclusions This study highlights the effect of patient sex on prescriber adherence to antihypertensive prescription guidelines, emphasizing a larger issue of systemic undertreatment of females observed within healthcare. Further research is needed to determine the reasons for such differences in hypertensive care.Item A case report of monkeypox as a result of conflict in the context of a measles campaign(Elsevier, 2022-09-12) Jarman, E. L.; Alain, M.; Conroy, Niall; Omam, L. A.; UNICEFIntroduction: Northwest and Southwest Cameroon suffer with ongoing conflict, associated with internal displacement of communities into bushland, violence and destruction of the health system. Case presentation: During a measles immunisation and surveillance campaign, following a measles outbreak, a 14-year-old boy was identified as having fever and a rash. This developed following close contact with a giant forest rat. He was diagnosed with monkeypox and this was confirmed by PCR. He was treated with oral cloxacillin and topical tetracycline for superadded bacterial skin and eye infections, and isolation policies were put in place. His rash improved over 7 days, when it scabbed over and his fever settled. Discussion: Recent displacement into a bush settlement away from agricultural opportunities increased his family’s reliance on bush meat. Displacement away from established surveillance systems increased the risk of undetected transmission. This is the second confirmed case of Monkeypox in Cameroon in the last year, and the first in the Southwest region. Conclusion: Conflict led to the breakdown of surveillance systems, a lack of health personnel, destruction of health facilities and displacement of communities, which raised the risk of monkeypox outbreaks within Northwest and Southwest Cameroon. Surveillance for monkeypox is challenging due to clinical similarity to chickenpox. There is a risk of emergence in new regions with suitable hosts. The factors underlying the establishment of monkeypox infections in new regions are multifactorial and require a strong public health response for prevention and control. A OneHealth approach to emerging infectious diseases is essential.Item Suicide and self-harm risk assessment: A systematic review of prospective research(Taylor & Francis, 2021-07-01) Saab, Mohamad M.; Murphy, Margaret; Meehan, Elaine; Dillon, Christina B.; O'Connell, Selena; Hegarty, Josephine; Heffernan, Sinead; Greaney, Sonya; Kilty, Caroline; Goodwin, John; Hartigan, Irene; O'Brien, Maidy; Chambers, Derek; Twomey, Una; O'Donovan, Aine; Health Service ExecutiveObjective: Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. Method: Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. Results: Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. Conclusions: There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide.Item Obesity in adults: a 2022 adapted clinical practice guideline for Ireland(S. Karger AG, 2022) Breen, Cathy; O'Connell, Jean; Geoghegan, Justin; O'Shea, Donal; Birney, Susie; Tully, Louise; Gaynor, Karen; O'Kelly, Mark; O'Malley, Grace; O'Donovan, Claire; Lyons, Oonagh; Flynn, Mary; Allen, Suzanne; Arthurs, Niamh; Browne, Sarah; Byrne, Molly; Callaghan, Shauna; Collins, Chris; Courtney, Aoife; Crotty, Michael; Donohue, Ciara; Donovan, Caroline; Dunlevy, Colin; Duggan, Diarmuid; Fearon, Naomi; Finucane, Francis; Fitzgerald, Ita; Foy, Siobhan; Garvey, John; Gibson, Irene; Glynn, Liam; Gregg, Edward; Griffin, Anne; Harrington, Janas M.; Heary, Caroline; Heneghan, Helen; Hogan, Andrew; Hynes, Mary; Kearney, Claire; Kelly, Dervla; Neff, Karl; le Roux, Carel W.; Manning, Sean; McAuliffe, Fionnuala; Moore, Susan; Moran, Niamh; Murphy, Maura; Murrin, Celine; O'Brien, Sarah M.; O'Donnell, Caitríona; O'Dwyer, Sarah; O'Grada, Cara; O'Malley, Emer; O'Reilly, Orlaith; O'Reilly, Sharleen; Porter, Olivia; Roche, Helen M.; Rhynehart, Amanda; Ryan, Leona; Seery, Suzanne; Soare, Corina; Shaamile, Ferrah; Walsh, Abigail; Woods, Catherine; Woods, Conor; Yoder, Ruth; Canadian Institutes of Health ResearchThis Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients' lived experiences; move beyond simplistic approaches of "eat less, move more" and address the root drivers of obesity. People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health-need rather than ability to pay.Item What do patients value as incentives for participation in clinical trials? A pilot discrete choice experiment(SAGE Publications, 2020-01-21) Vellinga, Akke; Devine, Colum; Ho, Min Yun; Clarke, Colin; Leahy, Patrick; Bourke, Jane; Devane, Declan; Duane, Sinead; Kearney, PatriciaIncentivising has shown to improve participation in clinical trials. However, ethical concerns suggest that incentives may be coercive, obscure trial risks and encourage individuals to enrol in clinical trials for the wrong reasons. The aim of our study was to develop and pilot a discrete choice experiment (DCE) to explore and identify preferences for incentives. A DCE was designed by including following attributes (and levels) of incentives: value, method, and time involvement. To account for trial benefit and risk, each was included as an attribute with levels low, medium and high. For testing purposes, the DCE was administrated using SurveyMonkey in a population of third level students. A total of 245 students, representative of the general student population, participated in the online DCE. The results provide a template to assess and explore the use of different incentive methods in clinical trials. The template can be used in its current format or adapted to particular scenarios. This pilot study provides a feasible methodology to explore the use of incentives for participation in clinical trials and can be adapted to specific trial requirements to provide information for ethical applications or identify the most favourable incentive for participation in clinical trials.