Community Pharmacy Needle Exchange Programme: What Can Analysis of the Data Tell Us about the Changing Drug Market in Ireland?

Community Pharmacy Needle Exchanges are a harm reduction measure that have been established in a number of countries to provide access to sterile injecting equipment for people who inject drugs (PWID). To ensure that they are meeting needs, it is important to monitor the use of the services. This study aimed to determine patterns of needle distribution and return in community pharmacies in Ireland over time. The number of pharmacies, needle packs, clean needles and returned packs was obtained from the Health Service Executive (HSE) Planning and Business Information Unit (PBI). Yearly totals were calculated to show patterns from 2015 to 2022. There has been an 18% decline in the number of pharmacies providing the service since 2015, with a 19% decline in the number of packs provided and a 21% decline in the number of packs returned. The proportion of packs returned was 23% in 2015 and 18% in 2022. There has been a 16% decline in the number of sterile needles provided and a 6% reduction in the average number of needles per individual since 2017. Declining needle use and low rates of used needle return (against a backdrop of large numbers of PWID that have not significantly reduced over time) suggest that there is a need to investigate if community pharmacies in Ireland have the scope to improve their harm reduction impact. This raises questions in terms of the need to both improve and adapt the service against a backdrop of changing drug markets. Key recommendations include the need to review the harm reduction services employed by participating pharmacies when providing new equipment and organising the return of used equipment.

Social Connectedness and Smoking among Adolescents in Ireland: An Analysis of the Health Behaviour in Schoolchildren Study.

Continuing progress with preventing smoking initiation is a key to the tobacco endgame. Home- and school-based social networks shape the health behaviour of children and adolescents. This study described the relationship between social connectedness and smoking behaviour in school-aged children in Ireland. The 2014 Irish Health Behaviour in School-aged Children (HBSC) surveyed self-reported smoking status and measured perceptions of social connectedness and support with validated and reliable questions across a random stratified sample of 9623 schoolchildren (aged 10-19). Overall, 8% of school-aged children reported smoking, in the last 30 days 52% reported smoking daily, and prevalence increased with age (p < 0.001). Compared with schoolchildren who did not smoke, perceptions of social connectedness and perceptions of support at home, from peers, and at school were significantly poorer for schoolchildren who smoked across all measures examined (p < 0.001). The poorest rated measures were for school connectedness and teacher support for smokers. Policies and practices that build and support positive environments for schoolchildren must continue to be prioritised if progress on preventing smoking initiation is to be sustained.

Chemical Exposure: European Citizens' Perspectives, Trust, and Concerns on Human Biomonitoring Initiatives, Information Needs, and Scientific Results.

Over the last few decades, citizen awareness and perception of chemical products has been a topic of interest, particularly concerning national and international policy decision makers, expert/scientific platforms, and the European Union itself. To date, few qualitative studies on human biomonitoring have analysed communication materials, made recommendations in terms of biomonitoring surveillance, or asked for feedback in terms of specific biomonitoring methods. This paper provides in-depth insight on citizens' perceptions of knowledge of biomonitoring, impact of chemical exposure on daily life, and claims on how results of research should be used. Four semi-structured focus groups were held in Austria, Portugal, Ireland, and the United Kingdom (UK). The cross-sectional observational qualitative design of this study allows for better understanding of public concern regarding chemicals, application, and use of human biomonitoring. The main findings of this study include citizens' clear articulation on pathways of exposure, the demand on stakeholders for transparent decision-making, and sensitivity in communication of results to the public. Validated and trustful communication is perceived as key to empowering citizens to take action. The results can be used to facilitate decision-making and policy development, and feeds into the awareness needs of similar and future projects in human biomonitoring. Furthermore, it also brings to light ideas and concepts of citizens' in shaping collaborative knowledge between citizens', experts, scientists, and policy makers on equal terms.

Comparison of the health and well-being of smoking and non-smoking school-aged children in Ireland.

BACKGROUND: Although most young people are aware of the long-term consequences of smoking, it has been shown that young smokers expect to give up before any health damage occurs. Little is known in an Irish context about the association between smoking and young people's current health. This could be helpful to help reduce smoking initiation and encouraging quitting. The study aimed to determine the association between smoking and health and well-being indicators among Irish school-aged children. METHODS: The 2014 Irish Health Behaviour in School-aged Children study was analysed, which comprised a random stratified sample of 9,623 schoolchildren (aged 10-18). The prevalence of eight self-reported health complaints and two subjective well-being measures were compared across strata classified by self-reported smoking status using Pearson's chi square and independent t tests. Logistic regression and ordinal regression were used to control for age, gender, and social class. RESULTS: A significantly larger proportion of smokers (p < .001) reported fair to poor health (32% versus 11% for non-smokers), lower mean life satisfaction scores (6.2 compared with 7.5), and each of eight health complaints at least once a week (range = 25-50% compared with 15-21%). These patterns remained significant after adjusting for differences in age, gender, and social class profile (p < .001). CONCLUSIONS: The study demonstrates the potential of developing initiatives, which target smoking in adolescence as opposed to the longer term health effects of smoking which are well known. The findings can be utilized to counteract positive perceptions of smoking among schoolchildren. This, combined with providing supports to help children quit, may help achieve government targets to reduce smoking prevalence.

Push and stay factors affecting Irish medical student migration intentions.

BACKGROUND: A significant proportion of medical students in Ireland have demonstrated strong intentions to migrate following their graduation. Factors influencing these intentions are poorly understood. Our study aimed to investigate 'push' and 'stay' factors that may influence the migration plans of medical students. METHODS: Cross-sectional survey of 2273 medical students in Ireland using a mixed methods approach. Survey was completed by 2273 medical students, of which 263 provided free text data that are analysed in this paper. RESULTS: Identified push factors include negative perception regarding career opportunities, working conditions and lifestyle, while family was the only identified strong stay factor. Qualitative analysis of free text responses revealed themes that included training, career, personal and financial factors. CONCLUSION: This study has provided insight into the factors that influence medical student migration intentions. There is a strong need for all stakeholders to collectively discuss and engage in possible solutions.

Practise what you preach: health behaviours and stress among non-consultant hospital doctors.

High rates of psychological distress, depression and suicide have been reported among doctors. Furthermore, many doctors do not access healthcare by conventional means. This study aimed to increase understanding regarding non-consultant hospital doctors' (NCHDs') response to stress and barriers to accessing supports, and identify possible solutions. Medical manpower departments in 58 hospitals distributed a 25-item questionnaire to 4,074 NCHDs; we received 707 responses (response rate, 17.4%). 60% of NCHDs were unable to take time off work when unwell; 'letting teammates down' (90.8%) and 'difficulty covering call' (85.9%) were the leading reasons. 'Being too busy' (85%), 'self-prescription' (66.6%) and 'self-management' (53.1%) were ranked highest in deterring NCHDs from visiting a general practitioner (GP). 22.9% of NCHDs would not attend a GP with anxiety or depression until they began to feel hopeless, helpless or suicidal. 12.2% would not seek help at all. 55% of respondents (n = 330) had to move away from partners or dependants due to work, negatively affecting the social supports of 82.9%. Possible practical solutions were explored. NCHDS are a vulnerable population and have a particularly challenging lifestyle. Key recommendations include improved GP and counselling access for NCHDs, and addressing the culture of self-treatment and poor health behaviours through undergraduate and postgraduate education.

Ireland's medical brain drain: migration intentions of Irish medical students.

BACKGROUND: To provide the optimum level of healthcare, it is important that the supply of well-trained doctors meets the demand. However, despite many initiatives, Ireland continues to have a shortfall of physicians, which has been projected to persist. Our study aimed to investigate the migration intentions of Irish medical students and identify the factors that influence their decisions in order to design appropriate interventions to sustain the supply of trained doctors in order to maintain a viable medical system. METHODS: An online cross-sectional survey was undertaken of all Irish medical students studying in the Republic of Ireland. The survey included nominal, ordinal, and scale items to determine migration intentions, factors influencing their decisions, and understanding of the Irish healthcare system. RESULTS: A total of 2 273 medical students responded (37% response rate), of whom 1 519 were classified as Irish medical students (having completed secondary school in Ireland). Of these, 88% indicated they were either definitely migrating or contemplating migrating following graduation or completion of the pre-registration intern year. Forty percent expressed an intention of returning to Ireland within 5 years. The factors most influencing their decision to leave were career opportunities (85%), working conditions (83%), and lifestyle (80%). CONCLUSION: The migration intentions expressed in this study predict an immediate and severe threat to the sustainability of the Irish healthcare service. Urgent interventions such as providing information about career options and specialty training pathways are required. These must begin in the undergraduate phase and continue in postgraduate training and are needed to retain medical school graduates.

Mercury exposure in Ireland: results of the DEMOCOPHES human biomonitoring study.

BACKGROUND: Monitoring of human exposure to mercury is important due to its adverse health effects. This study aimed to determine the extent of mercury exposure among mothers and their children in Ireland, and to identify factors associated with elevated levels. It formed part of the Demonstration of a study to Coordinate and Perform Human Biomonitoring on a European Scale (DEMOCOPHES) pilot biomonitoring study. METHODS: Hair mercury concentrations were determined from a convenience sample of 120 mother/child pairs. Mothers also completed a questionnaire. Rigorous quality assurance within DEMOCOPHES guaranteed the accuracy and international comparability of results. RESULTS: Mercury was detected in 79.2% of the samples from mothers, and 62.5% of children's samples. Arithmetic mean levels in mothers (0.262 µg/g hair) and children (0.149 µg /g hair) did not exceed the US EPA guidance value. Levels were significantly higher for those with higher education, and those who consumed more fish. CONCLUSIONS: The study demonstrates the benefit of human biomonitoring for assessing and comparing internal exposure levels, both on a population and an individual basis. It enables the potential harmful impact of mercury to be minimised in those highly exposed, and can therefore significantly contribute to population health.

The farming population in Ireland: mortality trends during the 'Celtic Tiger' years.

BACKGROUND: Although the Irish farming population is a significant occupational group, analysis of their mortality patterns is limited. This study compared mortality trends with other occupational groups and assessed the impact of socio-economic factors. METHODS: Population and mortality data (2000-06) were obtained to calculate standardized mortality ratios (SMRs) by cause of death and matched with socio-economic data. The extent to which variation in mortality was explained by variations in the socio-economic data was determined using multiple regression. RESULTS: Farmers and agricultural workers experienced the highest levels of mortality for all causes of death (2000-06). Farmers are 5.14 times more likely and agricultural workers are 7.35 times more likely to die from any cause of death than the lowest risk group. Circulatory disease is a significant cause of mortality among farmers [SMR = 215.91, 95% confidence interval (CI) = 201.83-229.98]. Other significant causes include cancers (SMR = 156.60, CI = 146.73-166.48) and injuries and poisonings (SMR = 149.69, CI = 135.44-163.93). Agricultural workers have similar mortality trends: circulatory disease (SMR = 226.27; CI = 192.45-260.08), cancers (SMR = 221.44; CI = 193.88-249.00), and injuries and poisonings (SMR = 353.90; CI = 302.48-405.32). From 2000 to 2006, SMRs increased incrementally. Multiple regression identified farm size and income poverty risk as predictors of mortality. CONCLUSION: Irish farmers and agricultural workers have experienced a reversal of mortality trends compared to the 1980s and 1990 s. Policies should target them as a high-risk group.

Mouthguard use and dental injury in sport: a questionnaire study of national school children in the west of Ireland.

STATEMENT OF THE PROBLEM: The risk of children getting dental injuries during sport can be minimised by using a mouthguard. Within Ireland, information on mouthguard use and policy is limited. The extent of dental trauma experienced by children during sport is also unclear. PURPOSE OF THE STUDY: To determine the extent of mouthguard use, dental trauma and barriers to use among children. The survey also investigated school and sports club policy on mouthguard use in sport. MATERIALS AND METHODS: A questionnaire was sent to parents of 1,111 children aged nine to 13 years attending 25 randomly selected schools in the Health Service Executive West region of Ireland. It sought information about children's sporting activities, mouthguard policy and use, barriers to use, and dental accidents. RESULTS: A total of 505 questionnaires were returned (46%). More than nine out of ten children were involved in sport. Mouthguards were worn by 22% of children during sport. Less than one-third of schools and sports clubs that children attended had a mouthguard policy. Significantly more children used mouthguards where there was a mouthguard policy. Reasons for not wearing mouthguards included cost, lack of knowledge and information, and lack of a mouthguard policy. One in ten children had suffered a sports accident in the previous year, of which 51% injured teeth. Of these, 72% visited a dentist within two hours. CONCLUSIONS: The dental profession and individual practitioners should promote mouthguard use for children during sport and be advocates for the development of policies in schools and sporting organisations.

Environmental health organisations against tobacco.

Implementing the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) relies heavily on enforcement. Little is known of the way different enforcement agencies operate, prioritise or network. A questionnaire was sent to representatives of the International Federation of Environmental Health (IFEH) in 36 countries. Tobacco control was given low priority. Almost two thirds did not have any tobacco control policy. A third reported their organisation had worked with other agencies on tobacco control. Obstacles to addressing tobacco control included a lack of resources (61%) and absence of a coherent strategy (39%).

Nurses' knowledge and practice of vascular access infection control in haemodialysis patients in the Republic of Ireland.

Vascular access hygiene is an integral component of haemodialysis care. Ensuring nurses possess sufficient knowledge and utilise recommended guidelines on infection control is essential for safe practice and patient safety. The study aimed to investigate nurses' knowledge and practice of vascular access infection control among adult haemodialysis patients in the Republic of Ireland. A confidential self-completion questionnaire was sent to all 190 qualified nurses employed in nine haemodialysis units in the Republic of Ireland, which assessed knowledge and behaviour in infection control. Although 92% of respondents reported that policies had been developed by their units and 47% had received infection control education in the previous year, knowledge and adherence to best practice demonstrated significant scope for improvement. The study recommended the development of standard guidelines and regular reviews and updates of policies. Systems should also be developed to ensure a high level of compliance.