Diversifying selection identified in immune epitopes of bovine coronavirus isolates from Irish cattle.

Bovine betacoronavirus (BoCoV) is a pneumoenteric pathogen of cattle that is closely related to human coronavirus OC43. Vaccines are administered to protect against diseases caused by BoCoV, but knowledge gaps exist with regard to correlates of protection and the effect of immune evasion on driving evolution. In this study, immune epitopes were mapped onto BoCoV structural proteins, including spike and haemagglutinin esterase (HE), and then supported with targeted gene sequencing of Irish clinical isolates and selective pressure analysis. Increased prevalence of diversifying selection and amino acid changes in some mapped immune epitopes suggests that immune escape is selecting for non-synonymous mutations arising in these regions. Selection analysis and sequencing provided increased support for neutralising antibody (nAb) epitopes compared to others, suggesting that nAbs are an important arm of the immune response to BoCoV. Phylogenetic analysis of spike and HE sequences showed that Irish isolates from this study were in the European clade, except for one HE sequence that sat in the Asian/American clade, while the spike gene of this sample was in the European clade. Recombination between a European and an Asian/American isolate would give rise to such a sequence. This study has gathered evidence suggesting that pressure to evade the nAb response is contributing to BoCoV evolution.

Is COVID-19 finally just a bad flu? Follow-up study comparing disease severity among COVID-19 and seasonal influenza hospital in-patients across pandemic waves in Ireland.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) was a more severe illness than seasonal influenza in hospitalised cohorts during the early phase of the pandemic. This study's aim was to determine if COVID-19 severity, relative to seasonal influenza, evolved across subsequent disease waves. STUDY DESIGN: Retrospective population-based cohort study. METHODS: COVID-19 hospital episodes and seasonal influenza hospital episodes were identified using relevant International Classification of Disease (ICD-10) codes from the Irish national hospitalisation dataset. Descriptive comparative analysis of each group was carried out using Pearson's Chi-squared tests. Length of stay (LOS), intensive care unit (ICU) admission and in-hospital mortality were measured and compared using logistic regression analysis. RESULTS: Compared to influenza episodes, COVID-19 episodes for all ages and all waves combined, had a longer mean LOS (15.8 days, vs 11.4 days, P < 0.001); were more likely to receive ICU care (OR 1.24 95% CI 1.15-1.33, P < 0.001) and were more likely to die in hospital (OR 2.61, 95% CI 2.36-2-88). Despite the reduction in the proportion of patients with an intensive care unit (ICU) stay and dying in hospital in Wave 5 compared to the previous waves, the risk of having an ICU admission or dying in hospital remained higher in patients with COVID-19 in Wave 5 compared to those with influenza diagnosis. CONCLUSION: While the severity of COVID-19 has reduced with successive pandemic waves, it remains a more severe disease than influenza. Despite changes in strain, population immunity, vaccination and treatment, policymakers and the public must continue to approach COVID-19 as more than 'just a bad flu'.

Patterns of antidepressant prescribing and health-related outcomes among older adults in Northern Ireland: an administrative data study.

OBJECTIVES: This study identifies patterns of antidepressant prescribing and subsequent hospital admissions from 2010 to 2018 amongst older adults in Northern Ireland (NI). METHOD: Participants comprised all General Practitioner (GP)-registered adults aged fifty-five years and above on 01/01/2010 (n = 386,119). Administrative data linkage included demographic information; antidepressant prescribing data from the NI Enhanced Prescribing Database (EPD); and hospital patient admissions. Repeated measures latent class analysis (RMLCA) identified patterns of antidepressant prescribing (from 2010 to 2018). RESULTS: RMLCA identified four latent classes: decreasing antidepressant prescribing (5.9%); increasing antidepressant prescribing (8.0%); no-antidepressant prescribing (68.7%); and long-term antidepressant prescribing (17.5%). Compared with those in no-antidepressant prescribing class, persons in the remaining classes were more likely to be female and younger, and less likely to live in either rural areas or less-deprived areas. Compared with no-antidepressant prescribing, those with increasing antidepressant prescribing were 60% and 52% more likely to be admitted to hospital in 2019 and 2020, respectively, and their admission rate per year was 11% and 8% higher in 2019 and 2020, respectively. Similarly, those with long-term prescriptions were 70% and 67% more likely to be admitted to hospital in 2019 and 2020, respectively, and their admission rate per year was 14% and 9% higher in 2019 and 2020, respectively. CONCLUSION: Findings show that approximately 26% of the NI hospital admissions population were impacted by sustained or increasing antidepressant prescribing. Because of their increased likelihood of hospitalization, these individuals may benefit from psychosocial support and social prescribing alternatives to psychopharmacological treatment.

Effects of a telehealth-delivered Mediterranean diet intervention in adults with Rheumatoid Arthritis (MEDRA): a randomised controlled trial.

OBJECTIVE: To compare the effects a Mediterranean diet (MedDiet) versus the Irish Healthy Eating Guidelines (HEG) on physical function and quality of life in adults with rheumatoid arthritis (RA) in Ireland. METHODS: Forty-four adults with RA were randomised (1:1) to the MedDiet or HEG for 12 weeks. The intervention included three video teleconsultations and two follow-up telephone calls facilitated by a Registered Dietitian (RD). Changes in physical function by Health Assessment Questionnaire- Disability Index (HAQ-DI) and quality of life by Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL) were the primary outcomes measured. Secondary outcomes included changes in dietary adherence, physical activity by Yale Physical Activity survey (YPAS), patient-perceived pain and general health, and anthropometric measures. All measurements were administered at baseline and repeated at 6 and 12 weeks. RESULTS: Forty participants completed the study. Participants were primarily females (87.5%), mean age was 47.5 ± 10.9 years. At the end of the intervention, participants in the MedDiet group reported significantly better physical function (p = 0.006) and quality of life (p = 0.037) compared to HEG group. From baseline to 12 weeks, physical function significantly improved in both diet groups, MedDiet (0.9 ± 0.5 to 0.5 ± 0.4 units, p < 0.001) and HEG (1.4 ± 0.7 to 1.0 ± 0.6 units, p < 0.001). Quality of life also significantly improved in the MedDiet (10.1 ± 7.5 to 4.0 ± 4.7 units, p < 0.001) and HEG group (11.25 ± 7.2 to 7.9 ± 6.4 units, p = 0.048). Physical activity improved significantly in the MedDiet (56.7 ± 28.6 to 70.6 ± 33.5 points, p = 0.01) but not within the HEG group despite similar recommendations. CONCLUSION: Adhering to the MedDiet and Irish Healthy Eating Guidelines resulted in improvements in RA patient-reported outcomes. The changes observed in both diet groups are likely due to the improvement in overall diet quality irrespective of dietary prescription. TRIAL REGISTRATION NUMBER: NCT04262505.

Recent trends in psychotropic medication use in children and adolescents in Ireland.

In response to concerns regarding overprescribing of psychotropic medication in children/adolescents, this study examined trends in psychotropic medication use in Ireland by age group and gender. A retrospective, repeated, cross-sectional study of the Irish pharmacy claims database was conducted. Yearly prevalence of children/adolescents receiving dispensed psychotropic medications was analysed from January 2017 to December 2021 and compared across years, age groups (5-15 years, and stratified as 5-11 and 12-15 years) and gender. Yearly prevalence was defined as the mean number of patients in receipt of medication per month per 1000 eligible population during a given calendar year. Negative binomial regression was used to examine the association of year, age group and gender on prevalence. Prevalence ratios (PRs) per year (average change in prevalence between each year) were presented with 95% confidence intervals (CIs). The prevalence of included psychotropic medications dispensed in the 5-15 years group increased from 6.41 (95% CI: 6.22, 6.59) in 2017 to 8.46 (95% CI: 8.26, 8.68) in 2021 per 1000 eligible population (32% increase). The PR per year (adjusting for age category and gender) was 1.07 (95% CI: 1.035, 1.107; p < 0.001). An increasing trend over time was also observed for all individual drug classes. These findings suggest increased use of psychotropic medication in children/adolescents from 2017 to 2021. However, despite increased prevalence over time, comparison with the literature shows that psychotropic medication use in Ireland remains lower than international comparators.

Identifying the essential elements to inform the development of a research agenda for Paramedicine in Ireland: a Delphi Study.

BACKGROUND: Paramedicine is a dynamic profession which has evolved from a "treat and transport" service into a complex network of health professionals working in a diverse range of clinical roles. Research is challenging in the paramedicine context, and internationally, research capacity and culture has developed slowly. International examples of research agendas and strategies in paramedicine exist, however, research priorities have not previously been identified in Ireland. METHODS: This study was a three round electronic modified Delphi design which aimed to establish the key aspects of the research priorities via end-user consensus. Participants included interested stakeholders involved in prehospital care or research in Ireland. The first round questionnaire consisted of open-ended questions with results coded and developed into themes for the closed-ended questions used in the second and third round questionnaires. A consensus level of 70% was set a priori for second and third rounds. RESULTS: Research Priorities that reached consensus included Staff Wellbeing, Education and Professionalism and Acute Medical Conditions. Respondents indicated that these three areas should be a priority in the next 2 years. Education, Staffing and Leadership were imperative Key Resources that required change. Education was a Key Processes change deemed imperative to allow the future research to occur. Outcomes that should be included in the future research strategy were Patient Outcomes, Practitioner Development, Practitioner Wellbeing, Alternate Pathways, Evidence-based Practice and Staff Satisfaction. CONCLUSION: The results of this study are similar to previously published international studies, with some key differences. There was a greater emphasis on Education and Practitioner Wellbeing with the latter possibly attributed to the timing of the research in relation to the COVID-19 pandemic. The disseminated findings of this study should inform sustainable funding models to aid the development of paramedicine research in Ireland.

Longitudinal relations between child emotional difficulties and parent-child closeness: a stability and malleability analysis using the STARTS model.

BACKGROUND: Past empirical evidence on the longitudinal relations between emotional mental health symptoms and parent-child close relationships has produced mixed and inconclusive results. Some studies suggest a unidirectional relation, whereas other studies point toward a bidirectional association. Additionally, most of the past research has been carried out with adolescent samples, rather than children. Hence, this study aimed to estimate the longitudinal relations between children's trait emotional difficulties and trait parent-child closeness, accounting for the time-invariant and time-varying state components of each factor. METHODS: Participants were 7,507 children (ages 3 years, 5 years, 7 years, and 9 years) from the Growing Up in Ireland cohort. Α bivariate stable trait, autoregressive trait, and state (STARTS) model was estimated using Bayesian structural equation modelling. RESULTS: The STARTS model revealed that children's emotional difficulties and parent-child closeness were relatively stable across time, and these overarching traits were strongly negatively correlated. Children's earlier trait emotional difficulties predicted later trait parent-child closeness and vice versa between 3 years and 5 years, and between 5 years and 7 years, but these effects disappeared between 7 years and 9 years. At all pairs of time points, state emotional difficulties and state parent-child closeness were weakly negatively correlated. CONCLUSIONS: Overall, the results suggest that early and middle childhood are critical stages for improving parent-child relationships and reducing children's emotional difficulties. Developing close parent-child relationships in childhood appears to be a key factor in reducing children's subsequent emotional difficulties. Children who face greater than usual emotional difficulties tend to be more withdrawn and less receptive to close parent-child relationships and this could serve as an important screening indicator.

Quantification of antimicrobial use on Irish dairy farms: A comparison of three recording methods.

Antimicrobial use (AMU) data are essential for monitoring usage over time, facilitating reduction strategies to combat the threat of antimicrobial resistance (AMR) to both human and animal health. The objective of this study was to measure and describe AMU over a 12-mo period in Irish dairy herds and compare 3 different recording methods to a reference method. A sample of 33 Irish dairy herds were randomly selected from 6 private veterinary practices across Ireland. The herds were followed for a 12-mo period and their AMU was monitored using 3 recording methods: 1. Veterinary prescription data (VET), 2. The inventory of medicine bins on the farms (BIN), and 3. Farmer treatment records from herd recording software (APP). Each recording method was compared with a previously developed reference method for AMU. The reference method used was based on pre- and poststudy medicine stock on the farms combined with veterinary prescription data. Antimicrobial use was analyzed using both mass- and dosed-based metrics, including mass (mg) of antimicrobial active ingredient per population correction unit (mg/PCU), defined daily doses for animals (DDDVET) and defined course doses for animals (DCDVET). Median AMU was 16.24, 10.47, 8.87 and 15.55 mg/PCU by mass, and 2.43, 1.55, 1.19 and 2.26 DDDVET by dose for VET, BIN, APP, and reference method data, respectively. Reliability of the agreement between each pair of methods was quantified using the concordance correlation coefficient (CCC). When compared with the reference method, VET data had excellent reliability [95% confidence interval (CI) of CCC: 0.992-0.998]. The BIN data had good to excellent reliability [95% CI of CCC: 0.776-0.936]. The APP data had poor reliability when compared with the reference method [95% CI of CCC: -0.167-0.156]. Our results highlight that a small number of herds were contributing most to overall use and farmers showed varying levels of consistency in recording AMU. Veterinary data were the most reliable approach for assessing AMU when compared with a reference method of AMU. This is an important finding for the future monitoring of AMU at a national level.

When missing becomes murder: An analysis of missing-femicide cases from the Republic of Ireland.

Many femicide cases are initially reported as missing persons to the police. Women who go missing have a greater risk of being a victim of homicide. This study explores the circumstances surrounding the disappearance and killing of women and girls in the Republic of Ireland from 1962 to 2023. A total of fifty-four cases were analysed, 52 cases were homicides. Most femicides occurred during 1990-1999 (n = 13; 24%) and 2000-2009 (n = 17; 32%). Twenty-five victims knew the offender and the leading cause of death was strangulation with 27 cases. Dumping/leaving the body on open ground with little or no concealment was the predominant method of disposal. The leading risk factors were the engagement of the victim in a fight or row before disappearance and domestic violence. The 'suicide narrative' should be treated with extreme caution in the disappearance of women.

Maximizing Satisfaction in Orthopedic Outpatient Clinics: Evidence From Ireland.

Background Patient satisfaction is a critical metric in healthcare, reflecting the quality of care provided and influencing clinical outcomes and healthcare utilization. In orthopedic outpatient clinics, patient satisfaction affects patient adherence to treatment plans and overall health outcomes. This study aims to identify and analyze key factors influencing patient satisfaction in orthopedic outpatient clinics. Methodology This cross-sectional study was conducted from April to May 2024 across 10 orthopedic outpatient clinics. In this study, family members were included as respondents to the Patient Satisfaction Questionnaire (PSQ) when patients were unable to complete the survey due to age, cognitive impairment, or physical disabilities. This approach was adopted to ensure that the experiences of all patients, particularly minors, elderly individuals, and those with disabilities, were accurately captured. The PSQ assessed various aspects of patient satisfaction, including communication, treatment plans, addressing concerns, clinic environment, and overall satisfaction. Quantitative data were analyzed using SPSS version 27.0 (IBM Corp., Armonk, NY, USA). Results The study included 172 respondents. High levels of overall satisfaction were reported, with 142 (82.6%) respondents very satisfied and 28 (16.2%) somewhat satisfied. Significant associations were found between overall satisfaction and several factors, namely, effective communication, thorough explanation of treatment plans, addressing patient concerns, and a clean, comfortable clinic environment. Shorter waiting times were also associated with higher satisfaction. Regression analysis revealed that staff rating and the thoroughness of treatment plans were significant predictors of overall satisfaction. Conclusions Effective communication, thorough treatment explanations, addressing patient concerns, and maintaining a clean clinic environment are key determinants of patient satisfaction in orthopedic outpatient clinics. Reducing waiting times and investing in staff training on communication and empathetic care can further enhance patient satisfaction. These findings provide valuable insights for healthcare providers and administrators aiming to improve patient experiences in orthopedic outpatient settings. Further research is recommended to explore these relationships in diverse settings and develop targeted interventions.

Risk-Based Targeting of Animals for Ancillary Testing during a Bovine Tuberculosis Breakdown Is Associated with a Reduced Time to Test Failure: Indirect Evidence of Mycobacterium bovis Exposure?

Bovine tuberculosis (bTB) continues to have significant economic and veterinary health impacts on cattle herds where the disease remains endemic. The continual tailoring of policies to address such maintenance requires an in-depth analysis of national data, underpinning new control strategies. In Ireland, when outbreaks occur, ancillary testing of herd mates deemed to be at the highest risk of exposure to reactors is undertaken using the interferon gamma (GIF) test. This highest risk cohort was hypothesised to be of a higher future risk despite this ancillary testing. We used a dataset from Ireland to model bovine test failure to the comparative tuberculin skin test using a survival analysis (observations: 39,248). Our primary exposure of interest was whether an animal that tested negative had a GIF test after the disclosure of infection within a herd during a bTB breakdown. There was evidence that animals with a negative GIF test during a breakdown had an increased risk of failing a test relative to other animals from the same herds without this exposure. The time to failure was 48.8% (95%CI: 38.3-57.5%) shorter for the exposed group relative to the unexposed group during a two-year follow-up period (2019-2022; time ratio: 0.51; 95%CI: 0.43-0.62; p < 0.001). The results from this study suggest that animals who were GIF-tested, having been deemed to have a higher risk of exposure, subsequently had shorter time-to-test failure periods. The absolute numbers of failure are small (only 2.5% of animals go on to fail during 2-year follow-up). Importantly, however, a high proportion of these high-risk herds included in the dataset failed at least one test at the follow-up (21/54 herds), impacting breakdown duration or recurrence. Such risk-informed targeting of animals could be utilised in future control policies, though further research is warranted.

Mitigation of ammonia and methane emissions with manure amendments during storage of cattle slurry.

This study aimed at assessing the efficacy of manure amendments in abating ammonia (NH3) and methane (CH4) emissions during storage. Two experiments were carried out. Experiment 1 was conducted using 20 L of slurry for 98 days. Treatments were: aluminium sulphate (alum), lactogypsum, zeolite, actiglene, ammonium thiosulphate, biochar, dairy processing waste, Digest-IT and control (without amendment). Experiment 2 was conducted using 660 L of slurry in underground storage tanks for 77 days. Treatments were: sulphuric acid, gypsum, biochar and control (without amendment). NH3 measurements for experiment 1 and experiment 2 were conducted using the photoacoustic gas monitor and dynamic chamber techniques, respectively. CH4 was measured using the static chamber technique in both experiments. The effect of amendments on slurry composition was determined at the end of the experiments. Experiment 1 showed a significant reduction in NH3 emissions in the alum (82%), lactogypsum (46%) and zeolite (32%) treatments relative to the control (100.3% total ammoniacal nitrogen (TAN)). CH4 was reduced significantly in the alum (87%), ammonium thiosulphate (64%) and lactogypsum (67%) relative to the control (291.9 g m-2). Experiment 2 showed a significant reduction (32%) in NH3 emissions in the sulphuric acid relative to the control (4.4% TAN). CH4 was reduced significantly in the sulphuric acid (46%), gypsum (39%) and biochar (15%) treatments relative to the control (291.9 g m-2). In general, amendments altered slurry composition such as dry matter, volatile solids, carbon and nitrogen contents at the end of storage. Lactogypsum, alum and sulphuric acid were effective in abating both NH3 and CH4 emissions and can contribute to improving air quality.

Overcoming socioeconomic adversity: Academic resilience in mathematics achievement among children and adolescents in Ireland.

Although socioeconomic disadvantage is linked with academic underachievement, many children from low-income backgrounds perform well in school. Which modifiable factors predict this academic resilience? We examine between- and within-person predictors of one important academic metric - mathematics performance - across adolescence in 1715 (796 male, 919 female) youth living in poverty in Ireland, using data from three waves (9, 13, and 17/18 years) of the Growing Up in Ireland study. Using linear mixed models, math performance was worse when adolescents had more socioemotional and behavioural difficulties, more child-parent relationship conflict, parents had lower expectations of the adolescent's educational achievement, and when primary caregivers had less education. Adolescents who had better intellectual self-concept and attended a non-disadvantaged school had greater math performance. This research adds to the growing body of work suggesting academic resilience is dynamic and multisystemic; it provides potential targets at multiple levels to promote such resilience.

SARS-CoV-2 Seropositivity in Urban Population of Wild Fallow Deer, Dublin, Ireland, 2020-2022.

SARS-CoV-2 can infect wildlife, and SARS-CoV-2 variants of concern might expand into novel animal reservoirs, potentially by reverse zoonosis. White-tailed deer and mule deer of North America are the only deer species in which SARS-CoV-2 has been documented, raising the question of whether other reservoir species exist. We report cases of SARS-CoV-2 seropositivity in a fallow deer population located in Dublin, Ireland. Sampled deer were seronegative in 2020 when the Alpha variant was circulating in humans, 1 deer was seropositive for the Delta variant in 2021, and 12/21 (57%) sampled deer were seropositive for the Omicron variant in 2022, suggesting host tropism expansion as new variants emerged in humans. Omicron BA.1 was capable of infecting fallow deer lung type-2 pneumocytes and type-1-like pneumocytes or endothelial cells ex vivo. Ongoing surveillance to identify novel SARS-CoV-2 reservoirs is needed to prevent public health risks during human-animal interactions in periurban settings.

Direct healthcare costs in the first 2 years of life: A comparison of screened and clinically diagnosed children with cystic fibrosis - The Irish comparative outcomes study of CF (ICOS).

BACKGROUND: In July 2011, Cystic Fibrosis (CF) was added to the Newborn Bloodspot Screening Programme in Ireland. The Irish Comparative Outcomes Study (ICOS) is a historical cohort study established to compare outcomes between clinically-detected and screen-detected children with CF. Here we present the results of economic analysis comparing direct healthcare costs in the first 2 years of life of children born between mid-2008 and mid-2016, in the pre-CF transmembrane conductance regulator modulator era. METHODS: Healthcare resource use information was obtained from Cystic Fibrosis Registry of Ireland (CFRI), medical records and parental questionnaire. Hospital admissions, emergency department visits, outpatient appointments, antibiotics and maintenance medications were included. Costs were estimated using the Health Service Executive Casemix, Irish Medicines Formulary and hospital pharmacy data, adjusted for inflation using Consumer Price Index data from the Central Statistics Office. A Negative Binomial regression was used, with time in the study as an offset. RESULTS: Overall participation was 93 %. After exclusion of those with meconium ileus, data from 139 patients, with follow-up to 2 years of age, were available. 72 (51.8 %) were from the clinically diagnosed cohort. In the final model (n=105), clinically diagnosed children had 2.62-fold higher costs per annum (p<0.0001), when adjusted for confounders, including homozygous ΔF508 or G511D mutation, socio-demographic factors and time between diagnosis and first CFRI interaction. CONCLUSIONS: There are few studies evaluating economic aspects of newborn screening for CF using routine care data. These results imply that the benefits of newborn screening extend to direct healthcare costs borne by the State.

Through Patients' Eyes: Evaluating the Consent Process in Elective Orthopedic Surgery at a Tertiary Referral Center in Ireland.

BACKGROUND: Informed consent is a critical component of ethical clinical practice, particularly in elective orthopedic procedures. It ensures that patients understand the nature, benefits, and risks of the medical procedures they agree to undergo. This study aims to evaluate the informed consent process at Merlin Park University Hospital from the patient's perspective. METHODS: This cross-sectional observational study included 140 participants undergoing elective orthopedic procedures. Data were collected via a questionnaire focusing on socio-demographic information and the informed consent process, including details on who provided the information, where and when the consent was signed, and patient understanding and satisfaction. Responses were analyzed using SPSS version 26 (IBM Corp., Armonk, NY). RESULTS: The majority of participants were females, with 80 (57.1%) women and 60 (42.9%) men. The average age of the participants was 60.86 years. Most participants were employed, constituting 75 (53.6%) of the sample, and 55 (39.3%) had attained university or higher education. The most common procedures were total hip replacement, with 30 (21.4%) participants, and total knee replacement, with 20 (14.3%) participants. Information during the consent process was primarily provided by consultants in 80 (57.1%) cases. High satisfaction levels were reported, with 139 (99.3%) participants expressing satisfaction. Significant correlations were found between satisfaction and the type of healthcare provider, type of operation, and educational level. CONCLUSION: The informed consent process at Merlin Park University Hospital is generally effective, with high patient satisfaction and understanding. However, there is a preference for concise information delivery. Enhancing the process through personalized information delivery could further improve patient satisfaction and comprehension. These findings contribute valuable insights into patient-centered care and informed consent in elective orthopedic surgeries.

Financial incentives to stop smoking: Potential financial consequences of different reward schedules.

INTRODUCTION: Financial incentives to stop smoking (FISS) programs have been implemented internationally to encourage people who smoke to quit smoking. However, such programs require that the financial reward structure and its resulting effects on smoking quit rates are considered. We analyzed a number of scenarios for FISS reward schedules for current smoking individuals in Ireland, with a view to identify the potential implications in terms of financial consequences and expected effects. METHODS: Using national QuitManager services data 2021-2023, we defined smoking quit rates for smokers currently using the national Health Services Executive stop smoking services in Ireland. Smoking quit rates at 4, 12 and 52 weeks were defined, and additionally defined by sex, age and education level. Using scenarios assuming different FISS reward sizes, structures and targeted population sub-groups, we estimated the number of additional quitters, budget impact, and incremental cost-effectiveness ratio. RESULTS: A FISS program, if implemented for a cohort of 3500 smokers can result in a budget impact ranging €250000 - €870000. The cost-effectiveness trade-off between different payment schedules and the expected effect size suggested that FISS are cost-effective even at a moderate effect size. A FISS program implemented to approximately 20000 smokers nationally would cost between €2.0 million and €4.8 million, subject to the chosen reward schedule. Across social groups, FISS is more cost-effective for females, individuals in the youngest age group, and individuals with a medium level of education. CONCLUSIONS: This analysis highlights the importance of considering different FISS schedules and potential quit effects, when designing such programs. We highlight that FISS programs should be targeted at certain social groups to achieve highest long-term smoking cessation rates. We also identified important challenges that decision-makers face when designing the reward structure of FISS programs. The acceptability or otherwise of the FISS structures may differ among stakeholders and should be explored.

Distribution models of baleen whale species in the Irish Exclusive Economic Zone to inform management and conservation.

Irish waters are under increasing pressure from anthropogenic sources including the development of offshore renewable energy, vessel traffic and fishing activity. Spatial planning requires robust datasets on species distribution and the identification of important habitats to inform the planning process. Despite limited survey effort, long-term citizen science data on whale presence are available and provide an opportunity to fill information gaps. Using presence-only data as well as a variety of environmental variables, we constructed seasonal ensemble species distribution models based on five different algorithms for minke whales, fin whales, humpback whales, sei whales, and blue whales. The models predicted that the coastal waters off the south and west of Ireland are particularly suitable for minke, fin and humpback whales. Offshore waters in the Porcupine Seabight area were identified as a relevant habitat for fin whales, sei whales and blue whales. We combined model outputs with data on maritime traffic, fishing activity and offshore wind farms to measure the exposure of all the species to these pressures, identifying areas of concern. This study serves as a baseline for the species presence in Irish waters over the last two decades to help develop appropriate marine spatial plans in the future.

The reform of Irish mental health law: Aligning with human rights obligations?

This article critically examines the proposed reforms to Irish mental health law the Mental Health Act 2001 (2001 Act). The article will provide background to the 2001 Act and the lengthy law reform process, which has resulted in the publication of the Heads of Bill that propose significant amendments. The article assesses the suggested reforms, considering Ireland's 2018 ratification of the UN Convention on the Rights of Persons with Disabilities (CRPD), which provides important context to the law reform process. The 2001 Act is the primary piece of legislation regulating mental health services and safeguarding the rights of persons subject to the legislation in Ireland. While passed in 2001, the legislation did not come into effect until 2006. The 2001 Act was seen as bringing Irish mental health law into compliance with international human rights law, in particular the European Convention on Human Rights (ECHR). However, Ireland's ratification of the CRPD has necessitated closer scrutiny of the legislation. This review has culminated in the publication of a Heads of Bill in July 2021 and pre-legislative scrutiny by the responsible parliamentary committee in 2022. The long title of the Heads of Bill explicitly states its goal of safeguarding individual autonomy and underscores its commitment to upholding and advancing the rights of people subject to the legislation. The analysis of the Heads of Bill addresses several key areas. These areas include a background to the long process of review, new guiding principles, the category of persons under the mental health legislation, mental health tribunals, consent to treatment, advance healthcare directives, provisions relating to children and young people, and independent advocacy. Based on this analysis of the Heads of Bill, recommendations are suggested which would strengthen respect for the human rights of persons subject to the legislation.

Long-term exposure to PM2.5 air pollution and mental health: a retrospective cohort study in Ireland.

BACKGROUND: Mental illness is the leading cause of years lived with disability, and the global disease burden of mental ill-health has increased substantially in the last number of decades. There is now increasing evidence that environmental conditions, and in particular poor air quality, may be associated with mental health and wellbeing. METHODS: This cross-sectional analysis uses data on mental health and wellbeing from The Irish Longitudinal Study on Ageing (TILDA), a nationally representative survey of the population aged 50+ in Ireland. Annual average PM2.5 concentrations at respondents' residential addresses over the period 1998-2014 are used to measure long-term exposure to ambient PM2.5. RESULTS: We find evidence of associations between long-term exposure to ambient PM2.5 and depression and anxiety. The measured associations are strong, and are comparable with effect sizes for variables such as sex. Effects are also evident at relatively low concentrations by international standards. However, we find no evidence of associations between long-term ambient particulate pollution and other indicators of mental health and well-being such as stress, worry and quality of life. CONCLUSIONS: The measured associations are strong, particularly considering the relatively low PM2.5 concentrations prevailing in Ireland compared to many other countries. While it is estimated that over 90 per cent of the world's population lives in areas with annual mean PM2.5 concentrations greater than 10 µg/m3, these results contribute to the increasing evidence that suggests that harmful effects can be detected at even low levels of air pollution.