The impact of badmouthing of medical specialties to medical students.

OBJECTIVES: This study aimed to evaluate the proportion of Irish medical students exposed to 'badmouthing' of different specialities and to ascertain: the degree of criticism of specialities based on the seniority of clinical or academic members of staff; if 'badmouthing' influenced student career choice in psychiatry; and attitudes of medical students towards psychiatry as a speciality and career choice. METHODS: Medical students in three Irish universities were invited to complete an online survey to determine the frequency and effect of non-constructive criticism on choice of medical specialty. The online questionnaire was distributed to Royal College of Surgeons in Ireland (RCSI), University of Galway (UoG) and University College Dublin (UCD) in the academic year 2020-2021. RESULTS: General practice (69%), surgery (65%) and psychiatry (50%) were the most criticised specialties. Criticism was most likely to be heard from medical students. 46% of students reported reconsidering a career in psychiatry due to criticism from junior doctors. There was a positive perception of psychiatry with 27% of respondents considering psychiatry as a first-choice specialty. CONCLUSIONS: Criticism of psychiatry by doctors, academics and student peers negatively influences students' career choice, which could be contributing to recruitment difficulties in psychiatry.

Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis.

Background: Epidemiological data are crucial to monitoring progress towards the 2030 Hepatitis C Virus (HCV) elimination targets. Our aim was to estimate the prevalence of chronic HCV infection (cHCV) in the European Union (EU)/European Economic Area (EEA) countries in 2019. Methods: Multi-parameter evidence synthesis (MPES) was used to produce national estimates of cHCV defined as: π = πrecρrec + πexρex + πnonρnon; πrec, πex, and πnon represent cHCV prevalence among recent people who inject drugs (PWID), ex-PWID, and non-PWID, respectively, while ρrec, ρex, and ρnon represent the proportions of these groups in the population. Information sources included the European Centre for Disease Prevention and Control (ECDC) national operational contact points (NCPs) and prevalence database, the European Monitoring Centre for Drugs and Drug Addiction databases, and the published literature. Findings: The cHCV prevalence in 29 of 30 EU/EEA countries in 2019 was 0.50% [95% Credible Interval (CrI): 0.46%, 0.55%]. The highest cHCV prevalence was observed in the eastern EU/EEA (0.88%; 95% CrI: 0.81%, 0.94%). At least 35.76% (95% CrI: 33.07%, 38.60%) of the overall cHCV prevalence in EU/EEA countries was associated with injecting drugs. Interpretation: Using MPES and collaborating with ECDC NCPs, we estimated the prevalence of cHCV in the EU/EEA to be low. Some areas experience higher cHCV prevalence while a third of prevalent cHCV infections was attributed to PWID. Further efforts are needed to scale up prevention measures and the diagnosis and treatment of infected individuals, especially in the east of the EU/EEA and among PWID. Funding: ECDC.

The experiences of individuals living with HIV in Ireland attending out-patient physiotherapy.

People living with HIV (PLWH) are living longer and are becoming increasingly susceptible to multi-morbidity resulting in disability. Physiotherapy is an important component in the care of PLWH, increasing functional capacity and quality of life. However, few PLWH access physiotherapy services due to a lack of specialised services, relapses in medical conditions and financial barriers. This study aimed to gather feedback from PLWH in a tertiary infection centre in Ireland attending out-patient physiotherapy on their experiences of physiotherapy. Eleven PLWH completed a semi-structured feedback survey focusing on their expectations and experiences of physiotherapy. Participants reported an overall positive experience of physiotherapy especially in terms of improving movement, confidence, physical activity level and sense of control. In addition, participants highlighted the importance of a physiotherapist with specialist knowledge of HIV. Barriers to participation in physiotherapy included potential relapses in other medical conditions, lack of time due to work and lack of flexibility or availability of physiotherapy appointments. This study highlights the important role of physiotherapy in the care of PLWH, several potential barriers to participation in physiotherapy for PLWH and the importance of the participation of PLWH in the co-design of services.

Exploring exercise, physical wellbeing and the role of physiotherapy: perspectives from people with narcolepsy.

Narcolepsy is associated with reduced quality of life and physical performance. The study aimed to explore the attitudes of people with Type 1 narcolepsy towards exercise and physical activity, their physical wellbeing, and the potential role of physiotherapy. Semi-structured interviews were conducted with 22 people with narcolepsy attending a dedicated outpatient narcolepsy clinic located in Dublin, Ireland. Transcripts were iteratively coded; a thematic analysis was undertaken, and key themes were identified. Four themes were identified: 'Barriers and Facilitators to Exercising', 'Social Concerns', 'Health Concerns' and 'Suggestions for the Role of Physiotherapy'. Future research should explore the potential role of exercise to help manage narcolepsy-related symptoms in this population.

An Unusual Complication of Infective Endocarditis Treated by Percutaneous Intervention.

Mycotic pseudoaneurysms (PA) are an infrequent complication of infective endocarditis (IE). However, due to advanced imaging modality and early therapy, this complication has been seen less frequently in the past few years. The reported incidence is 5%-15% of the patients, with the most common site being intracranial vessels (up to 65%), followed by abdominal and then peripheral vessels. We describe a young patient with a bicuspid aortic valve complicated by IE, who developed a giant mycotic PA. This was treated with a cover stent of the aneurysmal segment, which was complicated by distal stent migration and eventually managed with bypass surgery.

Advancing urban green and blue space contributions to public health.

Urban green and blue spaces (UGBS) have the potential to improve public health and wellbeing, address health inequities, and provide co-benefits for the environment, economy, and society. To achieve these ambitions, researchers should engage with communities, practitioners, and policy makers in a virtuous circle of research, policy, implementation, and active citizenship using the principles of co-design, co-implementation, co-evaluation, and co-translation. This Viewpoint provides an integrated perspective on the challenges that hinder the delivery of health-enhancing UGBS and recommendations to address them. Our recommendations include: strengthening the evidence beyond cross-sectional research designs, strengthening the evidence base on UGBS intervention approaches, evaluating the effects on diverse population groups and communities, addressing inequities in the distribution and quality of UGBS, accelerating research on blue space, providing evidence for environmental effects, incorporating co-design approaches, developing innovative modelling methods, fostering whole-system evidence, harnessing political drivers, creating collaborations for sustainable UGBS action, and advancing evidence in low-income and middle-income countries. The full potential of UGBS as public health, social, economic, and environmental assets is yet to be realised. Acting on the research and translation recommendations will aid in addressing these challenges in collaboration with research, policy, practice, and communities.

Trends in recreational walking trail usage in Ireland during the COVID-19 pandemic: Implications for practice.

Despite its potential utility for the outdoor recreation sector, there is no centralised surveillance system for recreational walking trails in Ireland and thus trail usage in Ireland during the COVID-19 pandemic is unknown. This paper aims to report trends in footfall count data on Irish trails during the COVID-19 period and to triangulate findings with openly available mobility data. This descriptive study analysed changes in footfall counts gathered from passive infrared sensors on 33 of Ireland's recreational walking trails between January 2019 and December 2020. The relationship between Google Community Mobility Report (GCMR) data and footfall counts was analysed to corroborate trends in footfall data. Total footfall increased by 6% between 2019 and 2020 on trails included in this analysis. Notably, mean trail usage was between 26% and 47% higher in October-December 2020 than during the same period in 2019. A strong correlation between GCMR data from 'parks' and footfall count data was found. The conclusions of this study are twofold. Firstly, the COVID-19 pandemic increased trail usage in Ireland, especially on trails closer to urban areas and there is potential for this to be a lasting legacy. Secondly, combining multiple data sources can provide trail managers with more detailed representations of trail usage and currently these are not harmonised. Future research should examine ways to encourage sustained recreational walking trail use in new users and implement novel ways to coordinate datasets across systems to monitor visitors on Irish recreational walking trails. Management implications: This paper presents a number of implications for trail management teams to consider:•Openly available datasets pertaining to mobility, such as Google Community Mobility Reports, can be utilised to corroborate data collected from footfall sensors in place on trails. Furthermore, there may be potential for Google Trends data to help trail management teams gauge interest in specific trails and parks during defined time frames.•There is considerable potential to sustain the COVID-19 legacy of increased trail use, especially for trails closer to urban areas, through promotional campaigns and continued trail maintenance.•There is a need to work across sectors and disciplines within the recreational walking system to identify potential data sources and opportunities for further data collection.

Beyond the big city: using a systems approach to cultivate a cycling culture in small cities and towns in Ireland.

Urban mobility and how people move in our towns and cities is garnering more attention, as solutions are sought to multiple challenges faced by residents; health and physical inactivity, climate change, air quality, urbanisation and accessibility. Traditional, siloed approaches limit impact and collaborative, systems approaches hold promise. However, systems approaches often remain theoretical and few practical applications of their added value have been demonstrated. This study illustrates how a systems approach can be used to underpin the development of a 9-step process to generate solutions for action on active mobility. The development of a systems map and a theory of change framework are key outputs of this 9-step process. The purpose of this paper is to describe how a systems map was developed in an Irish town utilising broad stakeholder engagement to map the variables that influence cycling in the town and to identify the leverage points for transformational interventions.

Implementing a physiotherapy led cancer exercise programme in a National Cancer Centre: the FIXCAS study.

OBJECTIVES: To examine the feasibility of implementing a 10-week exercise-based cancer rehabilitation programme in a national cancer centre. DESIGN: A single-arm prospective feasibility study. SETTING: An outpatient physiotherapy department. PARTICIPANTS: Forty de-conditioned cancer survivors (<1 year post completion of treatment). INTERVENTIONS: A 10-week programme of twice weekly group-based supervised exercise sessions. MAIN OUTCOME MEASURES: A mixed methods approach was used. The primary outcome of the study was feasibility, evaluated in terms of recruitment, adherence, attrition and stakeholder acceptance of the programme. Secondary outcomes examined the effect of the exercise intervention on physical function and quality of life measures. RESULTS: Forty patients (age 60 (SD 10.6) years; n = 12 breast cancer, n = 11 lung cancer, n = 7 prostate cancer, n = 5 colorectal cancer, n = 5 other) participated. In total 82% (n = 33) participants completed the post-programme assessment. Deterioration of health and concerns over COVID-19 were the most common reasons for dropout (both n = 2). Adherence to both the supervised exercise classes and home exercise programme was high (78% and 94% respectively). No adverse events were recorded during the intervention or assessments. Qualitative feedback from stakeholders highlighted the acceptability of the programme as well as many perceived benefits of the exercise programme. Improvements in three quality of life sub-scales (physical function, role function and emotional function), physical activity levels and aerobic fitness levels were found post-intervention. CONCLUSION: It appears feasible to offer a 10-week exercise programme to patients attending a national cancer centre, with adequate recruitment, retention and adherence rates and high acceptability among stakeholders. CONTRIBUTION OF THE PAPER.

Engaging adults in organized physical activity: a scoping review of recruitment strategies.

Scaling up established physical activity (PA) opportunities for broader population reach requires practitioners to carefully consider strategies implemented to recruit and attract new participants to their PA programs. This scoping review examines the effectiveness of recruitment strategies for engaging adults in organized (established and sustained) PA programs. Electronic databases were searched for articles published between March 1995 and September 2022. Qualitative, quantitative and mixed methods papers were included. Recruitment strategies were assessed against Foster et al. (Recruiting participants to walking intervention studies: a systematic review. Int J Behav Nutr Phys Act 2011;8:137-137.) assessment of quality for reporting recruitment and the determinants of recruitment rates were examined. 8394 titles and abstracts were screened; 22 articles were assessed for eligibility; 9 papers were included. Three of the 6 quantitative papers adopted a combination of passive and active recruitment strategies and 3 relied solely on active strategies. All 6 quantitative papers reported on recruitment rates; 2 evaluated the efficacy of recruitment strategies based on the achieved levels of participation. The evaluation evidence on how individuals are successfully recruited into organized PA programs, and how recruitment strategies influence or address inequities in PA participation, is limited. Culturally sensitive, gender sensitive and socially inclusive recruitment strategies based on building personal relationships show promise for engaging hard-to-reach populations. Improving the reporting and measurement of recruitment strategies into PA programs is essential to better understand which strategies are attracting various population groups thus allowing program implementers to employ recruitment strategies best suited to the needs of their community while making efficient use of program funding.

Despite sustained investments into organized physical activity (PA) opportunities for adults the uptake has not been equal across populations. Achieving broad population reach requires practitioners to consider the strategies adopted to recruit and attract new participants to PA programs. This scoping review examines the effectiveness and determinants of recruitment strategies for engaging adults in organized (established and sustained) PA programs. Electronic database searching yielded 9 papers published between March 1995 and September 2022 for inclusion. Three of the 6 quantitative papers used a combination of passive (such as flyers, TV broadcasts, print, and radio) and active (such as targeted letters, GP referrals, and word of mouth) recruitment strategies. The evaluation evidence on how individuals are successfully recruited into organized PA programs and how recruitment strategies influence or address inequities in PA participation is limited. Culturally sensitive, gender sensitive and socially inclusive recruitment strategies based on building personal relationships show promise for engaging hard-to-reach populations. Improving the measurement and reporting of recruitment strategies into PA programs will assist program implementers to adopt recruitment strategies best suited to the needs of their community while allowing for efficient use of program funding.

A critical analysis of walking policy in Ireland and its contribution to both national and international development goals.

Introduction: Increasing population levels of walking holds benefits for public and planetary health. While individual level interventions to promote walking have been shown to be efficacious, upstream interventions such as policies harness the greatest potential for impact at the population level. However, little is known about the nature and presence of walking policy in Ireland and the extent to which it aligns to national and global goals. This paper aims to provide an overview of local and national walking policy in Ireland and to understand the potential of Irish walking policy to contribute to national and global targets. Methods: This study used multiple methods to provide a critical overview of walking policy. Firstly, a six-phase process was employed to conduct a content analysis of local and national walking policy in Ireland. Secondly, conceptual linkage exercises were conducted to assess the contribution of walking, and national walking policy in Ireland, to Ireland's National Strategic Outcomes and the United Nations Sustainable Development Goals. Results: Overall, half (n = 13) of the counties in the Republic of Ireland were found to have no local level walking policies. Results from the content analysis suggest that counties which had walking specific local level policies (n = 2) were outdated by almost two decades. Walking was identified to hold the potential to contribute to over half (n = 6) of Ireland's National Strategic Outcomes, and over half (n = 7) of the United Nations Sustainable Development Goals. Ireland's only national level walking specific policy, the Get Ireland Walking Strategy and Action Plan 2017-2020, was identified to potentially contribute to four of Ireland's National Strategic Outcomes and three United Nations Sustainable Development Goals. Discussion: Multidisciplinary action is required to update walking-related policy with embedded evaluation and governance mechanisms in all local walking systems. Furthermore, given sufficient collaboration across sectors, walking policy in Ireland has the potential to contribute to a wider breadth of national and global targets beyond the health, sport, tourism, and transport sectors.

Effects of engaging in mass participation sporting events on physical activity behaviour,: a systematic review.

Mass participation sports event (MPSE)s have been identified as a potential referral pathway for engaging inactive patients in regular physical activity. This study aimed to review evidence of physical activity behaviour and associated health-related outcomes of engaging in MPSEs among the general population. A systematic review was performed of quantitative studies that examined the relationship between MPSEs and physical activity behaviour or secondary outcomes (e.g. physical activity motivation or confidence, physical or mental health) or any intervention to maintain physical activity following MPSEs. Search methods included searching five electronic databases and checking reference lists. Methodological quality was assessed using the Mixed Methods Appraisal Tool. A total of 2079 papers were identified, 142 were independently assessed for eligibility and 39 were included. Data from prospective cohort studies suggested that levels of physical activity achieved in training for MPSEs tended to drop in the months after, but increases were reported in some studies of novice participants. Interventions involving health promotion materials provided post-event led to small increases in physical activity. Perceived benefits of participating in MPSEs included physical and mental health, fitness, self-efficacy and social connections. Existing evidence suggests that MPSEs can act as a motivator to initiate exercise in preparation for the event, but there is limited evidence on how best to sustain physical activity post-event. Given the short duration of most studies, longer prospective analyses are needed to delineate patterns of habitual and event-related activity and account for seasonal effects.

Mass participation sporting events can be attractive to low-active participants as well as regular exercisers, with a notable proportion identified as low active (one-fifth). Overall levels of physical activity tend to decline after event completion, suggesting that training in preparation for events was not maintained. There is some evidence of increased exercise post-event reported among novice participants, though evidence is limited on effective ways to sustain exercise after event completion. Regularly held events such as parkrun or booster interventions following events helped maintain exercise levels over 12 months.

Factors related to the implementation and scale-up of physical activity interventions in Ireland: a qualitative study with policy makers, funders, researchers and practitioners.

BACKGROUND: Current literature reports a gap between development of effective interventions to promote physical activity and the systematic uptake into real-world settings. Factors relating to implementation and scale-up of physical activity interventions have been examined, however the perspectives of multiple stakeholders from different domains are not well researched. The purpose of this study was to examine the perceived factors related to physical activity intervention implementation and scale-up in different domains from different stakeholders on the island of Ireland. METHODS: Practitioners, researchers, funders and policy makers in Ireland were invited to take part in a semi-structured interview exploring factors related to the implementation and scale-up of eleven different physical activity interventions. A thematic analysis was conducted to identify factors related to the implementation and scale-up of the included interventions. The data collection and analysis were guided by the Consolidated Framework for Implementation Research. RESULTS: Thirty-eight participants took part in the interviews which identified factors related to 1) intervention planning and practical considerations; 2) organisational structures, staffing and resources related to delivery; 3) reflection, evaluation and updating of the intervention; and 4) practical consideration related to scale-up. Furthermore, participants referred to the ongoing commitment, engagement, and support needed throughout the implementation process. CONCLUSIONS: Future research and practice needs to consider how different factors are experienced at different implementation stages and by the different stakeholder groups involved. The findings highlight multiple inter-related factors that influence the implementation and scale-up of physical activity interventions, but also identifies many strategies that can be utilised to aid future successes.

Understanding shedders: Which socio-demographic, health and wellbeing characteristics best inform appropriate health promotion action in men's sheds and a 'Shed for Life'?

ISSUE ADDRESSED: Men's sheds ('Sheds') have been identified as inherently health promoting and as potential settings to engage 'hard-to-reach' men in more structured health promotion initiatives. However, little is known about the socio-demographic or health and wellbeing characteristics of Shed members ('Shedders') on which such initiatives might be based. This study captures a baseline cross-sectional analysis of Shedders (n = 384) who participated in 'Sheds for Life', a health promotion initiative tailored to Sheds. METHODS: Objective health measures (body composition, blood pressure, blood lipids) captured via health screening as well as socio-demographic and health and wellbeing measures (physical activity, subjective wellbeing, mental health, social capital, cooking and diet) via questionnaires were assessed. Descriptive statistics were generated and differences between groups were determined via parametric and non-parametric testing. Bivariate analysis was used to determine associations and regression analysis then estimated various predictors on mental wellbeing, life satisfaction and loneliness. RESULTS: Participants were mostly over 65 years (77.3%), retired (88.6%) with limited educational attainment (77%). The majority were in the 'at-risk' categories for objective health measures, with most being referred to their GP following health screening (79.6%). Older Shedders were also more likely to meet physical activity guidelines. Mental wellbeing was positively correlated with life satisfaction and increased social capital and these were also positively correlated with physical activity (P < .05). CONCLUSIONS: Findings highlight the potential of Sheds in reaching a 'hard-to-reach' and 'at-risk' cohort of men. Despite a high prevalence of 'at-risk' objective health measures, participants report their health in positive terms. Future health promotion initiatives should capitalise on the inherent health-promoting properties of Sheds. SO WHAT?: Findings raise important implications for prioritising and designing health promotion initiatives in Shed settings.

Adherence to aerobic and muscle-strengthening components of the physical activity guidelines and mental health.

Despite a clear distinction between aerobic and muscle strengthening (MS) components in the physical activity guidelines, public health surveillance has largely focused only on aerobic components, limiting the reach of epidemiological research on the physical activity guidelines. Hence, this study investigated the association between adherence to both components (i.e. aerobic and muscle-strengthening) of the World Health Organization's physical activity guidelines and mental health among the college student population. A cross-sectional study was conducted among a nationally representative sample of Irish college students (7088 participants, M age: 23.17 years; 50.9% female). Participants were categorized as meeting both components of the guidelines (n = 41%), only the aerobic component (n = 25.3%) or the MS component (n = 7.3%), and neither (n = 26.4%). Group membership effects on mental health was determined through mixed univariate ANOVAs, with a Bonferroni correction for post hoc analyses to assess multiple comparisons. Results revealed that meeting both components of the guidelines was significantly (all p < 0.01) associated with greater self-reported happiness, body image and general health, and less mental ill-being, relative to all other respective groupings. Meeting aerobic or MS components in isolation was significantly (p < 0.05) associated with better happiness, general health and body image compared to not meeting either component. To conclude, 59% of the college-aged population are insufficiently active, and adherence to both guideline components is positively associated with mental health. Co-produced, evidence-based, physical activity interventions are needed in students and could contribute to mental health promotion.

'Sheds for Life': delivering a gender-transformative approach to health promotion in Men's Sheds.

Research has highlighted the importance of gendered approaches to engage men with health. Sheds for Life (SFL) is a health and wellbeing initiative that utilizes evidence-based and gender-specific approaches to engage hard to reach men with health promotion directly in the Men's Sheds (Sheds) setting. To understand the impact of SFL and how participants (Shedders) experienced SFL in practice, this qualitative study applied a framework of constructivism and aimed to explore how gendered approaches impacted engagement with SFL through Shedder's own accounts of their attitudes, opinions and experiences. Qualitative methods incorporating ethnographical observations, focus groups (n = 8) and short semi-structured interviews (n = 19) were conducted with SFL participants in the Shed setting. Reflexive thematic analysis was used to analyse the data to faithfully capture Shedders' experiences while acknowledging the reflexive influence of the researcher. Findings led to three key themes: Creating the 'right environment'; Normalizing meaningful conversations; a legacy for 'talking health' with subthemes of creating safety and trust and strengthening of bonds; and transforming perceptions of how men 'do health' with subthemes of reaping the benefits of engaging with health and reframing attitudes towards health. This is first study to capture Shedders' experiences of a structured health promotion initiative in the Shed setting. Findings highlight the value in utilizing the Shed setting to engage men with health and the importance of gender-specific strategies which encourage a gender-transformative approach to men's health promotion.

Age-specific associations between underlying health conditions and hospitalisation, death and in-hospital death among confirmed COVID-19 cases: a multi-country study based on surveillance data, June to December 2020.

BackgroundUnderlying conditions are risk factors for severe COVID-19 outcomes but evidence is limited about how risks differ with age.AimWe sought to estimate age-specific associations between underlying conditions and hospitalisation, death and in-hospital death among COVID-19 cases.MethodsWe analysed case-based COVID-19 data submitted to The European Surveillance System between 2 June and 13 December 2020 by nine European countries. Eleven underlying conditions among cases with only one condition and the number of underlying conditions among multimorbid cases were used as exposures. Adjusted odds ratios (aOR) were estimated using 39 different age-adjusted and age-interaction multivariable logistic regression models, with marginal means from the latter used to estimate probabilities of severe outcome for each condition-age group combination.ResultsCancer, cardiac disorder, diabetes, immunodeficiency, kidney, liver and lung disease, neurological disorders and obesity were associated with elevated risk (aOR: 1.5-5.6) of hospitalisation and death, after controlling for age, sex, reporting period and country. As age increased, age-specific aOR were lower and predicted probabilities higher. However, for some conditions, predicted probabilities were at least as high in younger individuals with the condition as in older cases without it. In multimorbid patients, the aOR for severe disease increased with number of conditions for all outcomes and in all age groups.ConclusionWhile supporting age-based vaccine roll-out, our findings could inform a more nuanced, age- and condition-specific approach to vaccine prioritisation. This is relevant as countries consider vaccination of younger people, boosters and dosing intervals in response to vaccine escape variants.

Case Report: An Uncommon Etiology of Vulvar Irritation and Swelling in an Adolescent Patient.

INTRODUCTION: Vulvovaginal concerns are common among adolescent patients. In postmenarchal patients, common etiologies include poor hygiene, contact irritants, and infection. CASE: A 14-year-old transgender male presented with concerns of vulvar irritation and significant labial enlargement. Comprehensive workup including tissue biopsies and imaging suggested chronic inflammation. His clinical course was complicated by an episode of methemoglobinemia secondary to local anesthetic toxicity, at which time his care team recognized use of large quantities of Vagisil, which contains benzocaine. Ultimately, vulvar changes were recognized to be secondary to chronic Vagisil use. SUMMARY AND CONCLUSION: This case highlights the potential dangers of off-the-shelf products, such as Vagisil. In patients presenting with vulvovaginal complaints, care providers should carefully screen for use of "hygiene products" as part of exposure history.

Hepatitis of unknown aetiology in children - epidemiological overview of cases reported in Europe, 1 January to 16 June 2022.

Following the report of an excess in paediatric cases of severe acute hepatitis of unknown aetiology by the United Kingdom (UK) on 5 April 2022, 427 cases were reported from 20 countries in the World Health Organization European Region to the European Surveillance System TESSy from 1 January 2022 to 16 June 2022. Here, we analysed demographic, epidemiological, clinical and microbiological data available in TESSy. Of the reported cases, 77.3% were 5 years or younger and 53.5% had a positive test for adenovirus, 10.4% had a positive RT-PCR for SARS-CoV-2 and 10.3% were coinfected with both pathogens. Cases with adenovirus infections were significantly more likely to be admitted to intensive care or high-dependency units (OR = 2.11; 95% CI: 1.18-3.74) and transplanted (OR = 3.36; 95% CI: 1.19-9.55) than cases with a negative test result for adenovirus, but this was no longer observed when looking at this association separately between the UK and other countries. Aetiological studies are needed to ascertain if adenovirus plays a role in this possible emergence of hepatitis cases in children and, if confirmed, the mechanisms that could be involved.

Sheds for life: health and wellbeing outcomes of a tailored community-based health promotion initiative for men's sheds in Ireland.

BACKGROUND: Gender is increasingly recognised as a critical factor in designing community-based health promotion programmes. Men's Sheds ('Sheds') are community-based informal environments that represent a safe space in which to engage cohorts of hard-to-reach (HTR) men in health promotion. Sheds for Life (SFL), the first structured health promotion initiative evaluated globally in Sheds, is a 10-week initiative co-designed with Shed Members (Shedders) and delivered directly in the Shed setting in Ireland. This research describes the health and wellbeing outcomes experienced by SFL participants. METHODS: Purposive sampling was used to recruit a diverse representation of Shedders (n = 421) participating in SFL alongside a wait list control (n = 86). Questionnaires assessing constructs of health and wellbeing were administered one-to-one in Sheds at baseline, 3, 6 and 12 months. Descriptive data for health outcomes were generated for each time point and assessed for significant changes using inferential testing, while considering COVID-19 impact. RESULTS: Outcomes related to subjective wellbeing, mental wellbeing, physical activity, social capital and healthy eating significantly increased post SFL (p < 0.05). Mental wellbeing scores (SWEMWBS) post SFL remained significantly higher than baseline despite COVID-19 impact (p < 0.05). Binary logistic regression indicated that the odds of a meaningful SWEMWBS change was significantly higher for shedders that had lower SWEMWBS (OR 0.804), less loneliness (OR 0.638) and lived alone (OR 0.456) at baseline. Shedders with lower SWEMBWS had higher odds of experiencing positive changes in life satisfaction (OR 0.911) and trust (OR 0.928), while Shedders who lived alone had also higher odds of experience positive changes in healthy eating (OR 0.481). Finally, inactive Shedders at baseline had higher odds of experiencing increased levels of physical activity (OR 0.582). CONCLUSIONS: Findings suggest that the inclusive, community-based SFL model is effective in engaging Shedders and facilitating positive and sustained changes in health and wellbeing outcomes. Using gender-specific approaches in the informal and safe environment of the Shed are effective in engaging men in structured health and wellbeing initiatives, particularly those who may be more vulnerable, isolated or lonely. TRIAL REGISTRATION: This study has been retrospectively registered with the 'International Standard Randomised Controlled Trial Number' registry (ISRCTN79921361) as of 05/03/2021.