Public Health - Journal Articleshttps://hdl.handle.net/10468/712024-03-28T19:35:37Z2024-03-28T19:35:37Z3991'Working away in that Grey Area...' A qualitative exploration of the challenges general practitioners experience when managing behavioural and psychological symptoms of dementiaJennings, Aisling A.Foley, TonyMcHugh, Sheena M.Browne, John P.Bradley, Colin P.https://hdl.handle.net/10468/52132023-04-05T06:39:20Z2017-12-06T00:00:00Zdc.title: 'Working away in that Grey Area...' A qualitative exploration of the challenges general practitioners experience when managing behavioural and psychological symptoms of dementia
dc.contributor.author: Jennings, Aisling A.; Foley, Tony; McHugh, Sheena M.; Browne, John P.; Bradley, Colin P.
dc.description.abstract: Background: general practitioners (GPs) have identified the management of behavioural and psychological symptoms of dementia (BPSD) as a particularly challenging aspect of dementia care. However, there is a paucity of research on why GPs find BPSD challenging and how this influences the care they offer to their patients with dementia. Objectives: to establish the challenges GPs experience when managing BPSD; to explore how these challenges influence GPs’ management decisions; and to identify strategies for overcoming these challenges. Design: qualitative study of GPs experiences of managing BPSD. Methods: semi-structured interviews were conducted with 16 GPs in the Republic of Ireland. GPs were purposively recruited to include participants with differing levels of experience caring for people with BPSD in nursing homes and in community settings to provide maximum diversity of views. Interviews were analysed thematically. Results: three main challenges of managing BPSD were identified; lack of clinical guidance, stretched resources and difficulties managing expectations. The lack of relevant clinical guidance available affected GPs’ confidence when managing BPSD. In the absence of appropriate resources GPs felt reliant upon sedative medications. GPs believed their advocacy role was further compromised by the difficulties they experienced managing expectations of family caregivers and nursing home staff. Conclusions: this study helps to explain the apparent discrepancy between best practice recommendations in BPSD and real-life practice. It will be used to inform the design of an intervention to support the management of BPSD in general practice.
2017-12-06T00:00:00ZA cost-analysis of complex workplace nutrition education and environmental dietary modification interventionsFitzgerald, SarahKirby, AnnMurphy, AileenGeaney, FionaPerry, Ivan J.https://hdl.handle.net/10468/34742023-04-04T20:53:08Z2017-01-09T00:00:00Zdc.title: A cost-analysis of complex workplace nutrition education and environmental dietary modification interventions
dc.contributor.author: Fitzgerald, Sarah; Kirby, Ann; Murphy, Aileen; Geaney, Fiona; Perry, Ivan J.
dc.description.abstract: Background: The workplace has been identified as a priority setting to positively influence individuals’ dietary behaviours. However, a dearth of evidence exists regarding the costs of implementing and delivering workplace dietary interventions. This study aimed to conduct a cost-analysis of workplace nutrition education and environmental dietary modification interventions from an employer’s perspective. Methods: Cost data were obtained from a workplace dietary intervention trial, the Food Choice at Work Study. Micro-costing methods estimated costs associated with implementing and delivering the interventions for 1 year in four multinational manufacturing workplaces in Cork, Ireland. The workplaces were allocated to one of the following groups: control, nutrition education alone, environmental dietary modification alone and nutrition education and environmental dietary modification combined. A total of 850 employees were recruited across the four workplaces. For comparison purposes, total costs were standardised for 500 employees per workplace. Results: The combined intervention reported the highest total costs of €31,108. The nutrition education intervention reported total costs of €28,529. Total costs for the environmental dietary modification intervention were €3689. Total costs for the control workplace were zero. The average annual cost per employee was; combined intervention: €62, nutrition education: €57, environmental modification: €7 and control: €0. Nutritionist’s time was the main cost contributor across all interventions, (ranging from 53 to 75% of total costs). Conclusions: Within multi-component interventions, the relative cost of implementing and delivering nutrition education elements is high compared to environmental modification strategies. A workplace environmental modification strategy added marginal additional cost, relative to the control. Findings will inform employers and public health policy-makers regarding the economic feasibility of implementing and scaling dietary interventions. Trial registration: Current Controlled Trials: ISRCTN35108237. Date of registration: The trial was retrospectively registered on 02/07/2013.
2017-01-09T00:00:00ZA cost-effectiveness analysis of school-based suicide prevention programmesAhern, SusanBurke, Lee-AnnMcElroy, BrendanCorcoran, PaulMcMahon, Elaine M.Keeley, HelenCarli, VladimirWasserman, CamillaHoven, Christina W.Sarchiapone, MarcoApter, AlanBalazs, JuditBanzer, RaphaelaBobes, JulioBrunner, RomualdCosman, DoinaHaring, ChristianKaess, MichaelKahn, Jean-PierreKereszteny, AgnesPostuvan, VitaSáiz, Pilar A.Varnik, PeeterWasserman, Danutahttps://hdl.handle.net/10468/56212023-04-04T20:49:32Z2018-02-14T00:00:00Zdc.title: A cost-effectiveness analysis of school-based suicide prevention programmes
dc.contributor.author: Ahern, Susan; Burke, Lee-Ann; McElroy, Brendan; Corcoran, Paul; McMahon, Elaine M.; Keeley, Helen; Carli, Vladimir; Wasserman, Camilla; Hoven, Christina W.; Sarchiapone, Marco; Apter, Alan; Balazs, Judit; Banzer, Raphaela; Bobes, Julio; Brunner, Romuald; Cosman, Doina; Haring, Christian; Kaess, Michael; Kahn, Jean-Pierre; Kereszteny, Agnes; Postuvan, Vita; Sáiz, Pilar A.; Varnik, Peeter; Wasserman, Danuta
dc.description.abstract: Suicide is one of the leading causes of death among young people globally. In light of emerging evidence supporting the effectiveness of school-based suicide prevention programmes, an analysis of cost-effectiveness is required. We aimed to conduct a full cost-effectiveness analysis (CEA) of the large pan-European school-based RCT, Saving and Empowering Young Lives in Europe (SEYLE). The health outcomes of interest were suicide attempt and severe suicidal ideation with suicide plans. Adopting a payer’s perspective, three suicide prevention interventions were modelled with a Control over a 12-month time period. Incremental cost-effectiveness ratios (ICERs) indicate that the Youth Aware of Mental Health (YAM) programme has the lowest incremental cost per 1% point reduction in incident for both outcomes and per quality adjusted life year (QALY) gained versus the Control. The ICERs reported for YAM were €34.83 and €45.42 per 1% point reduction in incident suicide attempt and incident severe suicidal ideation, respectively, and a cost per QALY gained of €47,017 for suicide attempt and €48,216 for severe suicidal ideation. Cost-effectiveness acceptability curves were used to examine uncertainty in the QALY analysis, where cost-effectiveness probabilities were calculated using net monetary benefit analysis incorporating a two-stage bootstrapping technique. For suicide attempt, the probability that YAM was cost-effective at a willingness to pay of €47,000 was 39%. For severe suicidal ideation, the probability that YAM was cost-effective at a willingness to pay of €48,000 was 43%. This CEA supports YAM as the most cost-effective of the SEYLE interventions in preventing both a suicide attempt and severe suicidal ideation. Trial registration number DRKS00000214.
2018-02-14T00:00:00ZA cross-national study on gender differences in suicide intentFreeman, AislinneMergl, RolandKohls, ElisabethSzekely, AndrasGusmão, RicardoArensman, EllaKoburger, NicoleHegerl, UlrichRummel-Kluge, Christinehttps://hdl.handle.net/10468/47922023-04-05T07:13:13Z2017-01-01T00:00:00Zdc.title: A cross-national study on gender differences in suicide intent
dc.contributor.author: Freeman, Aislinne; Mergl, Roland; Kohls, Elisabeth; Szekely, Andras; Gusmão, Ricardo; Arensman, Ella; Koburger, Nicole; Hegerl, Ulrich; Rummel-Kluge, Christine
dc.description.abstract: Background: Suicide accounts for over 58,000 deaths in Europe per annum, where suicide attempts are estimated to be 20 times higher. Males have been found to have a disproportionately lower rate of suicide attempts and an excessively higher rate of suicides compared to females. The gender difference in suicide intent is postulated to contribute towards this gender imbalance. The aim of this study is to explore gender differences in suicide intent in a cross-national study of suicide attempts. The secondary aims are to investigate the gender differences in suicide attempt across age and country. Methods: Data on suicide attempts (acquired from the EU-funded OSPI-Europe project) was obtained from eight regions in Germany, Hungary, Ireland and Portugal. Suicide intent data was categorized into 'Non-habitual Deliberate Self-Harm' (DSH), 'Parasuicidal Pause' (SP), 'Parasuicidal Gesture' (SG), and 'Serious Suicide Attempt' (SSA), applying the Feuerlein scale. Gender differences in intent were explored for significance by using X-2-tests, odds ratios, and regression analyses. Results: Suicide intent data from 5212 participants was included in the analysis. A significant association between suicide intent and gender was found, where 'Serious Suicide Attempts' (SSA) were rated significantly more frequently in males than females (p < .001). There was a statistically significant gender difference in intent and age groups (p < .001) and between countries (p < .001). Furthermore, within the most utilised method, intentional drug overdose, 'Serious Suicide Attempt' (SSA) was rated significantly more often for males than females (p < .005). Conclusions: Considering the differences in suicidal intent between males and females highlighted by the current study, gender targeted prevention and intervention strategies would be recommended.
2017-01-01T00:00:00ZA different perspective on consumer engagement: exploring the experience of using health apps to support healthier food purchasingFlaherty, Sarah JaneMcCarthy, MaryCollins, Alan M.McAuliffe, Fionnuala M.https://hdl.handle.net/10468/114332023-04-04T20:51:06Z2019-02-18T00:00:00Zdc.title: A different perspective on consumer engagement: exploring the experience of using health apps to support healthier food purchasing
dc.contributor.author: Flaherty, Sarah Jane; McCarthy, Mary; Collins, Alan M.; McAuliffe, Fionnuala M.
dc.description.abstract: Healthy food purchasing behaviour may be facilitated through the use of health apps if used for the necessary time period. However, little is known on the factors that influence the user experience and facilitate or impede their continued use. The purpose of the present research is to explore the lived experience of using a health app to support healthier food purchasing behaviour. Findings identify the presence of behaviour change motivation and anticipated effort levels as drivers of app engagement. It appeared that behavioural, cognitive and emotional dimensions of engagement may influence one another, driven by contextual influences, to simultaneously contribute to the intrinsic experience of engagement. The research makes practical and theoretical contributions to the consumer engagement literature and highlights the need to focus on understanding and capturing the specific engagement context to better understand engagement.
2019-02-18T00:00:00ZA digital substance-use harm reduction intervention for students in higher education (MyUSE): Protocol for project developmentDick, SamanthaVasiliou, Vasilis S.Davoren, Martin P.Dockray, SamanthaHeavin, CiaraLinehan, ConorByrne, Michaelhttps://hdl.handle.net/10468/104432023-04-04T12:09:44Z2020-08-01T00:00:00Zdc.title: A digital substance-use harm reduction intervention for students in higher education (MyUSE): Protocol for project development
dc.contributor.author: Dick, Samantha; Vasiliou, Vasilis S.; Davoren, Martin P.; Dockray, Samantha; Heavin, Ciara; Linehan, Conor; Byrne, Michael
dc.description.abstract: Background: Digital interventions have been identified as a possible tool for reducing the harm caused by illicit drug use among students attending higher education (ie, college students). However, the success of interventions in this area has been hampered by a lack of user involvement and behavior change theory in their design. The My Understanding of Substance use Experiences (MyUSE) project combines a rigorous user-centered design (UCD) methodology and a robust behavioral change framework to develop a digitally delivered harm reduction intervention for illicit drug use among students in higher education. Objective: This project aims to design and develop a digital intervention that targets drug use–related harm among students in higher education. Methods: The MyUSE project will take place over 3 phases. The first phase was exploratory in nature, involving 3 systematic reviews, a large survey, and student workshops to gather a comprehensive evidence base to guide the project. The second phase is the development stage of the project, involving the use of the Behavior Change Wheel theoretical framework to determine the behavior change techniques of the intervention and the use of the UCD methodology to guide the development of the digital intervention. The third phase is the evaluation stage, whereby the intervention will undergo a 5-stage evaluation process to comprehensively evaluate its impacts. Results: The exploratory phase 1 of the MyUSE project was completed in December 2018. Phase 2 is currently underway, and phase 3 is due to begin in September 2020. Conclusions: Higher education institutions (HEIs) are ideally placed to intervene and support students in the area of illicit drug use but are constrained by limited resources. Current digital interventions in this area are sparse and have several weaknesses. The MyUSE project combines a UCD approach with a robust behavior change framework to develop a digitally delivered intervention that is economically viable, effective in changing behavior, usable and acceptable to students, and able to sustain long-term implementation in HEIs.
2020-08-01T00:00:00ZA national case fatality study of drugs taken in intentional overdoseDaly, CarolineGriffin, EveCorcoran, PaulWebb, Roger T.Ashcroft, Darren M.Perry, Ivan J.Arensman, Ellahttps://hdl.handle.net/10468/94572023-04-05T07:11:44Z2019-12-26T00:00:00Zdc.title: A national case fatality study of drugs taken in intentional overdose
dc.contributor.author: Daly, Caroline; Griffin, Eve; Corcoran, Paul; Webb, Roger T.; Ashcroft, Darren M.; Perry, Ivan J.; Arensman, Ella
dc.description.abstract: Background: Intentional drug overdose (IDO) has been linked with marked increases in premature mortality risk due to suicide, accidents and other causes, yet little is known about how case fatality risk varies according to the type of drug/s taken. This study aimed to examine the incidence of IDO, to identify the predictors of fatal IDO and to establish which drugs are linked with greater risk of a fatal outcome. Methods: Data from the National Self-Harm Registry, and the National Drug-Related Deaths Index, 2007–2014, were used to calculate incidence, examine overdose characteristics and estimate case fatality risk ratios. Results: We examined 63,831 non-fatal and 364 fatal IDOs (incidence: 148.8 and 1.01 per 100,000 respectively). Compared to non-fatal IDOs, fatal cases were more often male (55.2% vs. 42.0%), older in age (median 44 vs. 35 years), and more frequently involved multiple drugs (78.3% vs. 48.5%). Tricyclic antidepressants were associated with a 15-fold increased risk of death and opioids a 12-fold increased risk, relative to the reference category (non-opioid analgesics). While the risk of fatal outcome was higher for males than females, the elevation in risk was greater in females when tricyclic antidepressants or opioids were taken. Conclusion: Male gender, increasing age and multiple drug use were associated with fatal IDO outcome. Tricyclic antidepressants and opioids were associated with a significantly increased risk of death following intentional overdose. Clinicians need to consider the case fatality risk of drugs when determining treatment for patients at risk of or those who have previously harmed themselves.
2019-12-26T00:00:00ZA perspective on pre-eclampsia and neurodevelopmental outcomes in the offspring: does maternal inflammation play a role?Maher, Gillian M.McCarthy, Fergus P.McCarthy, Cathal M.Kenny, Louise C.Kearney, Patricia M.Khashan, Ali S.O'Keeffe, Gerard W.https://hdl.handle.net/10468/71372023-04-05T06:36:38Z2018-11-02T00:00:00Zdc.title: A perspective on pre-eclampsia and neurodevelopmental outcomes in the offspring: does maternal inflammation play a role?
dc.contributor.author: Maher, Gillian M.; McCarthy, Fergus P.; McCarthy, Cathal M.; Kenny, Louise C.; Kearney, Patricia M.; Khashan, Ali S.; O'Keeffe, Gerard W.
dc.description.abstract: Pre-eclampsia is a leading cause of maternal death and maternal and perinatal morbidity. Whilst the clinical manifestations of pre-eclampsia often occur in late pregnancy, the molecular events leading into the onset of this disease are thought to originate in early pregnancy and result in insufficient placentation. Although the causative molecular basis of pre-eclampsia remains poorly understood, maternal inflammation is recognised as a core clinical feature. While the adverse effects of pre-eclampsia on maternal and fetal health in pregnancy is well-recognised, the long-term impact of pre-eclampsia exposure on the risk of autism spectrum disorder (ASD) in exposed offspring is a topic of on-going debate. In particular, a recent systematic review has reported an association between exposure to pre-eclampsia and increased risk of ASD, however the molecular basis of this association is unknown. Here we review recent evidence for; 1) maternal inflammation in pre-eclampsia; 2) epidemiological evidence for alterations in neurodevelopmental outcomes in offspring exposed to pre-eclampsia; 3) long-term changes in the brains of offspring exposed to pre-eclampsia; and 4) how maternal inflammation may lead to altered neurodevelopmental outcomes in pre-eclampsia exposed offspring. Finally, we discuss the implications of this for the development of future studies in this field.
2018-11-02T00:00:00ZA phenomenological exploration of change towards healthier food purchasing behaviour in women from a lower socioeconomic background using a health appFlaherty, Sarah JaneMcCarthy, MaryCollins, Alan M.McCafferty, ClaireMcAuliffe, Fionnuala M.https://hdl.handle.net/10468/114322023-04-04T20:50:24Z2019-12-19T00:00:00Zdc.title: A phenomenological exploration of change towards healthier food purchasing behaviour in women from a lower socioeconomic background using a health app
dc.contributor.author: Flaherty, Sarah Jane; McCarthy, Mary; Collins, Alan M.; McCafferty, Claire; McAuliffe, Fionnuala M.
dc.description.abstract: Food purchasing is dominated by routines and habits that may hamper the use of reflective decision-making and impede change. Disrupting existing behavioural patterns may address this challenge. Individuals from a lower socioeconomic background are more likely to report unhealthier purchasing and targeted initiatives are required. Health apps offer a potential approach although little evidence is available for this specific context. This research examines the individual's experience of changing food purchasing behaviour using an app focusing on women from a lower socioeconomic background. Multiple methods across different time-points explored the individual's experience over an 8–11 week period. An accompanied shop, incorporating think-aloud and researcher observations, was undertaken at baseline, followed by an in-depth interview and questionnaire. A reflective account of the individual's experience was recorded at four weeks and grocery receipts were shared for the duration. At follow-up, an accompanied shop, in-depth interview, and questionnaire were again used. Data were analysed using interpretative phenomenological analysis. The app appeared to disrupt existing behaviour by encouraging a more conscious approach to food purchasing. Self-monitoring, problem solving, and behavioural prompts were expressed as the most effective techniques. Due to the retail environment, self-control was necessary to create and maintain healthier behaviour. Individual higher-order goals appeared to influence behaviour change and the extent to which reflective cognition was employed. The role of retailers in directing behaviour was acknowledged but it appeared that change was still viewed as individual responsibility. In conclusion, apps may facilitate healthier purchasing via specific behaviour change techniques but personal and environmental factors may influence the change process. A range of strategies may be necessary to support sufficient and sustained change.
2019-12-19T00:00:00ZA prospective study of placental growth factor in twin pregnancy and development of a dichorionic twin pregnancy specific reference rangeHayes-Ryan, DeirdreMeaney, SarahFitzgerald, Anthony P.O'Mahony, E.Normile, C.Kenny, Louise C.O'Donogue, Keelinhttps://hdl.handle.net/10468/106882023-04-05T06:53:58Z2020-09-18T00:00:00Zdc.title: A prospective study of placental growth factor in twin pregnancy and development of a dichorionic twin pregnancy specific reference range
dc.contributor.author: Hayes-Ryan, Deirdre; Meaney, Sarah; Fitzgerald, Anthony P.; O'Mahony, E.; Normile, C.; Kenny, Louise C.; O'Donogue, Keelin
dc.description.abstract: Objective: To develop a dichorionic twin pregnancy specific reference range for placental growth factor (PlGF), and to compare gestation‐specific placental growth factor levels in twin pregnancies later complicated by pre‐eclampsia, hypertensive disorder of pregnancy or fetal growth restriction with control pregnancies. Design: Prospective observational study. Setting: Single large tertiary maternity unit in Ireland. Population or Sample: Women with a twin pregnancy. Methods: Consenting pregnant women, across a variety of gestations, had a single blood sample taken at one time‐point only during their pregnancy. The plasma was initially biobanked and PlGF was measured later in batches using the point of care Triage® PlGF test. Main outcome measures: Development of pre‐eclampsia, hypertensive disorder of pregnancy or fetal growth restriction. Results: Placental growth factor levels in uncomplicated dichorionic twin pregnancies were significantly lower in the women who later developed pre‐eclampsia than in the controls at all gestational intervals. In those that later developed any hypertensive disorder of pregnancy, median PlGF was lower only in those recruited before 24 weeks of gestation, whereas in infants with a customised birthweight below the third centile, PlGF was lower only in those sampled after 24 weeks of gestation. Conclusions: Placental growth factor levels in twin pregnancy differ significantly between those women with a pregnancy that will later be complicated by pre‐eclampsia and those that will not. This difference is present many weeks before clinical signs or symptoms of disease are present. Using cross‐sectional values from uncomplicated twin pregnancies, we have developed a dichorionic twin pregnancy specific reference range for PlGF.
2020-09-18T00:00:00Z