The burden of attempted hanging and drowning presenting to hospitals in Ireland between 2007 and 2019: a national registry-based study.

PURPOSE: To measure the impact of hospital-treated self-harm by hanging and drowning in Ireland in 2007-2019 and identify risk factors for these methods of self-harm. METHOD: Data on all self-harm presentations to Irish hospitals between 2007 and 2019 were obtained from the National Self-Harm Registry Ireland, a national self-harm surveillance system. Multinomial regression was used to explore factors associated with attempted hanging and drowning. RESULTS: The age-standardised incidence rate of attempted hanging and drowning increased by 126% and 45%, respectively, between 2007 and 2019. The incidence of both methods was highest among young people aged 15-24 years. The odds of presenting to hospital for attempted hanging were highest in males (aOR 2.85, 95% CI 2.72-3.00), people experiencing homelessness (aOR 1.32, 95% CI 1.16-1.49) and individuals living in the capital, Dublin (aOR 1.23, 95% CI 1.17-1.29). The odds of presenting for attempted drowning were highest in males (aOR 1.68, 95% CI 1.58-1.78) and people experiencing homelessness (aOR 2.69, 95% CI 2.41-2.99). CONCLUSION: The incidence of hospital-treated self-harm by hanging and drowning is increasing in Ireland and is highest among adolescents and young adults. Males and people experiencing homelessness may be at highest risk and warrant targeted preventive interventions.

Executive function profiles of preschool children with autism spectrum disorder and attention-deficit/hyperactivity disorder: A systematic review.

Background: Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are both associated with differences in Executive Functioning (EF). There is lack of clarity around the specificity or overlap of EF differences in early childhood when both disorders are first emerging. Method: This systematic review aims to delineate preschool EF profiles by examining studies comparing the EF profiles of children with and without ASD or ADHD. Five electronic databases were systematically searched (last search in May 2022) to identify published, quantitative studies of global and specific EF (Inhibition, Shifting, Working Memory (WM), Planning and Attentional Control), comparing children aged 2-6 with a diagnosis of ASD or ADHD to peers without ASD or ADHD. Results: Thirty-one empirical studies (10 ADHD and 21 ASD studies) met criteria for inclusion. EF profiles in preschool ASD were characterised by consistent Shifting, and, in most cases, Inhibition impairments. ADHD studies consistently reported impairments in Inhibition and Planning, and in most cases WM. Findings with regards to sustained Attention and Shifting in ADHD and WM and Planning in ASD were mixed. Conclusions: Overall, current evidence indicates overlap but also some specificity in EF impairments in preschool ASD and ADHD. There were differences in the degree to which individual domains were impaired, with Shifting more consistently impaired in ASD, and Inhibition, WM and Planning in ADHD. Methodological issues and differences in methods of outcome measurement could potentially underlie mixed findings, as informant-based measures revealed more robust EF impairments than laboratory-based tasks.

Limited transmission of SARS-CoV-2 in schools in Ireland during the 2020-2021 school year.

BackgroundThe role of schools in SARS-CoV-2 transmission has been a debated topic since the beginning of the COVID-19 pandemic.AimTo examine SARS-CoV-2 transmission in all schools in Ireland during the 2020-21 school year.MethodsIn a national descriptive cross-sectional study, we investigated PCR-confirmed cases of COVID-19 among students (aged < 20 years) and staff (aged ≥ 20 years) who attended school during their infectious period to identify school close contacts. SARS-CoV-2 PCR test results of all school close contacts were pooled to obtain an overall positivity rate and to stratify positivity rate by school setting and role (i.e. student or staff).ResultsIn total, 100,474 individuals were tested as close contacts in 1,771 schools during the 2020-21 school year. An overall close contact positivity rate of 2.4% was observed across all schools (n = 2,373 secondary cases). The highest positivity rate was seen in special schools (3.4%), followed by primary (2.5%) and post-primary schools (1.8%) (p < 0.001). Of the close contacts identified, 90.5% (n = 90,953) were students and 9.5% (n = 9,521) were staff. Overall, students had a significantly higher positivity rate than staff (2.4% vs 1.8%, p < 0.001).ConclusionThis study demonstrated that a low level of SARS-CoV-2 transmission occurred in Irish schools during the 2020-21 academic year. In the event of future pandemics, and as the COVID-19 pandemic continues, there is a need to carefully weigh up the harms and benefits associated with disrupted education to mitigate infectious disease transmission before reflexively closing classes or schools.

Country learning on maintaining quality essential health services during COVID-19 in Timor-Leste: a qualitative analysis.

OBJECTIVE: This case study examines the enabling factors, strengths, challenges and lessons learnt from Timor-Leste (TLS) as it sought to maintain quality essential health services (EHS) during the COVID-19 pandemic. DESIGN: A qualitative case study triangulated information from 22 documents, 44 key informant interviews and 6 focus group discussions. The framework method was used to thematically examine the factors impacting quality EHS in TLS. SETTING: National, municipal, facility levels in Baucau, Dili and Ermera municipalities in TLS. RESULTS: Based on the TLS National Health Statistics Reports, a reduction in outpatient, emergency department and primary care service delivery visits was observed in 2020 when compared with 2019. However, in contrast, maternal child health services simultaneously improved in the areas of skilled birth attendants, prenatal coverage and vitamin A distribution, for example. From the thematic analysis, five themes emerged as contributing to or impeding the maintenance of quality EHS including (1) high-level strategy for maintaining quality EHS, (2) measurement for quality and factors affecting service utilisation, (3) challenges in implementation of quality activities across the three levels of the health system, (4) the impact of quality improvement leadership in health facilities during COVID-19 and (5) learning systems for maintaining quality EHS now and for the future. CONCLUSION: The maintenance of quality EHS is critical to mitigate adverse health effects from the COVID-19 pandemic. When quality health services are delivered prior to and maintained during public health emergencies, they build trust within the health system and promote healthcare-seeking behaviour. Planning for quality as part of emergency preparedness can facilitate a high standard of care by ensuring health services continue to provide a safe environment, reduce harm, improve clinical care and engage patients, facilities and communities.

An audit of COVID-19 death reporting in counties Cork and Kerry, Ireland, winter 2021-2022.

BACKGROUND: In Ireland, a 'COVID-19 death' is defined as any death in which the decedent was COVID-19 positive and had no clear alternative cause of death unrelated to COVID-19, a definition based on World Health Organization guidance. AIMS: The objectives of this audit were to determine the proportion of COVID-19 deaths notified in the Cork/Kerry region of Ireland during winter 2021-2022 which adhered to this national definition, and to determine whether COVID-19 was deemed to be the primary cause of death, or a contributory or incidental factor. METHODS: A review of all deaths in individuals who were COVID-19 positive at the time of death notified to the Department of Public Health for Cork and Kerry between 22 November 2021 and 31 January 2022 was conducted to determine whether each death adhered to the national COVID-19 death definition. The clinical opinion on cause of death was obtained by contacting decedents' clinicians. RESULTS: Sixty deaths in individuals who were COVID-19 positive at the time of death were notified to the Department in the study period. Of deaths notified as being due to COVID-19, COVID-19 was deemed the primary cause of death, a contributory factor or an incidental factor in 72.7%, 21.8%, and 5.5% of cases, respectively. Most (93.3%) notified deaths adhered to the national COVID-19 death definition. CONCLUSIONS: The COVID-19 death definition in Ireland may require revision so it can distinguish between deaths caused by COVID-19 and those in which COVID-19 played a less direct role. The current COVID-19 mortality reporting system may also need updating to capture more clinical nuance.

Hepatitis A and B vaccination in gbMSM in Ireland: findings from the European MSM Internet Survey 2017 (EMIS-2017).

OBJECTIVES: Gay, bisexual and other men who have sex with men (gbMSM) have a higher risk of acquiring hepatitis A and B viruses (HAV and HBV) than the general population and are recommended for vaccination against both in Ireland. This study aims to determine the prevalence of self-reported HAV and HBV infection and vaccination among gbMSM in Ireland and explore factors associated with self-reported HAV and HBV vaccination among gbMSM. METHODS: This study analysed Irish data from the European MSM Internet Survey 2017 (EMIS-2017) to measure the prevalence of self-reported HAV and HBV infection and vaccination among gbMSM in Ireland. Multivariable logistic regression was used to explore the associations between sociodemographic, healthcare-related and behavioural factors and self-reported vaccination. RESULTS: There were 2083 EMIS-2017 respondents in Ireland. Among HIV-negative gbMSM, 4.6% and 4.4% reported previous HAV and HBV infection, respectively, and 51% and 57% reported the receipt of one or more vaccine dose for HAV and HBV, respectively. In the multivariable analysis, HIV-negative gbMSM had lower odds of self-reported HAV vaccination if they lived outside the capital, Dublin (aOR 0.61, 95% CI: 0.48 to 0.78), had no third-level education (aOR 0.65, 95% CI: 0.45 to 0.92), were not tested for HIV in the last year (aOR 0.39, 95% CI: 0.31 to 0.50), had never tried to obtain pre-exposure prophylaxis (PrEP, aOR 0.60, 95% CI: 0.38 to 0.96) and had not been diagnosed with a sexually transmitted infection (STI) in the previous year (aOR 0.42, 95% CI: 0.28 to 0.63). Similar associations were observed for self-reported HBV vaccination. CONCLUSIONS: Self-reported vaccination against HAV and HBV among gbMSM in Ireland is high, but the level of vaccination remains insufficient to protect against future HAV and HBV infections and outbreaks. Efforts to increase vaccination coverage among gbMSM should focus on men who live outside the capital, have lower educational attainment and do not engage with sexual health services.

Pathways to adaptive functioning in autism from early childhood to adolescence.

Adaptive functioning is lower in many autistic individuals to a greater extent than would be expected based on IQ. However, the clinical features associated with these difficulties are less well understood. This study examines longitudinal and contemporaneous associations of adaptive functioning in autistic youth across a wide ability range. Parent-reported autism symptoms, co-occurring emotional, behavioral and attention deficit hyperactivity disorder (ADHD) symptoms, and IQ were assessed in early childhood (M age 7 years; T1) and 6 years later in adolescence (M age 13 years; T2) in 179 autistic youth. Adaptive functioning was assessed at T2. Structural equation modeling estimated pathways to adaptive functioning from autism, and psychiatric symptoms at T1 and T2, testing whether associations were driven by continuity of behaviors from T1 to T2 or their contemporaneous effect at T2, or both, controlling for T1 IQ. Lower adaptive functioning at T2 was associated with higher T1 and T2 ADHD symptoms (ß = -0.14, and ß = -0.21) but not behavioral nor emotional symptoms at either timepoint. Lower adaptive functioning at T2 was also associated with lower T1 IQ (ß = 0.43) and higher social communication symptoms (ß = -0.37) at T2 but not T1, but the relationship with ADHD symptoms remained. Paths were not moderated by sex or IQ. Increased symptoms of ADHD, both in early childhood and contemporaneously, were associated with reduced adaptive functioning in adolescence. Co-occurring ADHD may be a modifiable risk factor for adaptive function impairments and should be routinely assessed and when present evidence-based treatments initiated which may benefit adaptive functioning outcomes. LAY SUMMARY: Adaptive functioning is lower in many autistic individuals to a greater extent than would be expected based on IQ. However, the clinical features associated with these difficulties are less well understood. In a community sample higher attention deficit/hyperactivity disorder (ADHD) symptoms, but not emotional or behavioral symptoms, in both early childhood and contemporaneously were associated with lower adaptive functioning in autistic adolescents. Co-occurring ADHD may be a modifiable risk factor for adaptive function difficulties in autism.

Transmission of SARS-CoV-2 arising from international flights arriving in Ireland in December 2020: a descriptive analysis using national surveillance data.

OBJECTIVES: There is limited evidence on the risk of in-flight transmission of SARS-CoV-2. This study estimated the extent of in-flight SARS-CoV-2 transmission on international flights arriving in Ireland during December 2020. STUDY DESIGN: This was a cross-sectional analysis. METHODS: National surveillance data identified all notified cases of COVID-19 who were infectious while travelling on international flights to Ireland during December 2020. Close contacts of cases were tested for SARS-CoV-2, and the results were collated to estimate the pooled secondary attack rate across all flights. Laboratory and epidemiological data were obtained from the Health Service Executive Covid Care Tracker, a national database of COVID-19 cases in Ireland. RESULTS: A total of 165 infectious cases of COVID-19 were identified on 134 incoming flights; 40.0% were symptomatic on board. There were 2099 flight close contacts identified, of whom 40.9% had results of a SARS-CoV-2 polymerase chain reaction test within 14 days of arrival. The pooled secondary attack rate for these contacts was 7.0% and was higher among those on flights of ≥5-hour duration (P = 0.008). More than half (59.1%) of close contacts had no SARS-CoV-2 test result recorded; the reasons included incorrect or absent contact details (26.5%) and no response when contacted (17.8%). CONCLUSIONS: In this national study investigating transmission of SARS-CoV-2 from international flights arriving into Ireland, the pooled secondary attack rate was 7.0%. International travel is likely to have contributed to the third wave of SARS-CoV-2 infections in Ireland in early 2021. Application of non-pharmaceutical interventions remains central to mitigating the risk of in-flight transmission.

An investigation into the rates of transmission of SARS-CoV-2 during the first 6 weeks of the 2020-2021 academic year in primary and post-primary schools in Cork and Kerry, Ireland.

BACKGROUND: Schools in Ireland closed in March 2020 as part of a national strategy to contain the spread of severe acute respiratory syndrome (SARS-CoV-2). The extent to which schools contribute to the overall propagation of SARS-CoV-2 was continuing to evolve internationally. AIMS: To examine regional data on SARS-CoV-2 transmission in primary, post-primary and special schools in Cork and Kerry, two counties in southwest Ireland, during the first 6 weeks of the 2020-2021 academic year and determine the rate of in-school transmission. METHODS: Data were obtained from the Computerised Infectious Disease Reporting (CIDR) system and supplemented with digital records from the regional Department of Public Health (Dept PH) and from the Health Service Executive (HSE) Covid Care Tracker application. The positivity rate among school close contacts was calculated to determine the rate of in-school SARS-CoV-2 transmission. RESULTS: The overall rate of in-school transmission of SARS-CoV-2 was low at 4.1%. Positivity rates among students and staff who were close contacts were similarly low (3.1% vs. 6.9%, p = 0.07). One secondary case of coronavirus disease 2019 (COVID-19) emerged, on average, for every 7.6 infectious days spent by an index case in school. Schools accounted for 2.2% of all notified cases of COVID-19 in the region during the observation period. CONCLUSIONS: During the first 6 weeks of the academic year, the rate of in-school SARS-CoV-2 transmission in the region was low, and schools did not contribute substantially to the overall burden of COVID-19.

Lessons from inter-disciplinary collaboration to mitigate SARS-CoV-2 transmission in schools, Ireland, 2020/2021, to inform health systems and multisectoral recovery.

Introduction: School closures associated with the COVID-19 pandemic resulted in the loss of educational and social supports for up to 1,000,000 students in Ireland and disproportionately affected students from lower socio-economic backgrounds. For the 2020/2021 school year, multisectoral and interdisciplinary "Schools Teams" were established within Public Health departments to maintain in-person education by minimizing transmission of SARS-CoV-2 in schools. This study aimed to describe this model and explore the experiences of Schools Team members in the East of Ireland to identify factors that influenced effective working that can be sustained in the context of health systems and multisectoral recovery. Methods: Schools Teams were comprised of multidisciplinary staff from regional Public Health departments and redeployed staff from the Education sector. Governance rested with Public Health departments. All staff operated to nationally agreed protocols following training. The experiences of the East Schools Team members were explored through an online survey and semi-structured interviews. Results: The survey response rate was 53/70 (75.7%). Participants reported clear channels of communication within the team (44, 83.0%), feeling comfortable in their role following training (43, 82.7%) and a positive team culture (51, 96.2%) as key facilitators of effective inter-disciplinary working. Insufficient administrative support and mixed messaging to schools were identified as barriers to efficient team collaboration. Discussion: The Schools Team model illustrates the potential for multisectoral partnerships to effectively address complex public health priorities and contribute toward health system resilience to health threats. By recognizing and leveraging the ability of allied sectors such as the education sector, to contribute to public health goals, countries can move toward the kind of whole-of-government approach to health recognized as key to health system resilience. The strong links between the education and public health sectors developed through this collaboration could be extended and strengthened to more effectively pursue public health priorities in school settings. More broadly, mechanisms to support multisectoral working should be developed, expanding beyond reactive interventions to proactively address key health priorities and build resilience across health systems and communities. Such collaborations would promote healthier populations by promoting and encouraging a public health perspective among other sectors and embedding "health in all policies".

Behavioural and physiological response to frustration in autistic youth: associations with irritability.

BACKGROUND: Irritability is a common and impairing occurrence in autistic youth, yet the underlying mechanisms are not well-known. In typically developing populations, differences in frustration response have been suggested as important driver of the behavioural symptoms of irritability. Research exploring the role of frustration response as a risk factor for irritability in autistic populations is limited and often uses parent report or observer ratings; objective measures of frustration response appropriate for use in autistic populations are required to advance the field. METHODS: In the current study, fifty-two autistic adolescents aged 13-17 years from a population-based longitudinal study completed an experimental task designed to induce frustration through exposure to periods of unexpected delay. Behavioural (number of button presses) and physiological (heart rate; HR) metrics were collected during delay periods. Irritability was measured using the parent-rated Affective Reactivity Index (ARI). Analyses used mixed-level models to test whether irritability was associated with different slopes of behavioural and physiological response to experimentally induced frustration during the task. Age and baseline HR (for the physiological data only) were included as covariates. RESULTS: Analyses showed a marginal association between irritability and the slope of behavioural response (incident rate ratio (IRR) =.98, p=.06), and a significant association with the slope of physiological response (b=-.10, p=.04); higher levels of irritability were associated with a dampened behavioural and physiological response, as indicated by flatter slopes of change over the course of the task. The pattern of results largely remained in sensitivity analyses, although the association with physiological response became non-significant when adjusting for IQ, autism symptom severity, and medication use (b=-.10, p=.10). CONCLUSIONS: Results suggest that the current experimental task may be a useful objective measure of frustration response for use with autistic populations, and that a non-adaptive response to frustration may be one biological mechanism underpinning irritability in autistic youth. This may represent an important target for future intervention studies.

Navigating the Digital Divide: Barriers to Telehealth in Rural Areas.

Telehealth allows information-sharing and clinical care at a distance via telecommunication and information technologies. While telehealth promises to increase access for underserved populations (particularly those in rural areas), roadblocks are slowing widespread availability. These roadblocks have created disparities that are most acute in rural areas, and for racial minorities, the elderly, and those with low levels of educational attainment. The success of telehealth relies on having reliable, high-quality broadband access, facilitating interstate licensing for providers and parity in reimbursement for telehealth. However, due to various structural barriers, telehealth is not being adopted as quickly in rural areas, where it is most needed. We describe broadband access by state, state adoption of the Interstate Medical Licensure Compacts (IMLCs), which facilitates the practice of telehealth across states, and state adoption of telehealth parity laws. We discuss each of these in turn and provide policy recommendations.

A service model for delivering care closer to home.

Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient.This is a practical example of early implementation of the principles underlying the Department of Health's (DH) recent Best Practice Guidance, 'Delivering Care Closer to Home' (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the 'Customer Care' award by 'Management in Practice'. The Surgery was also awarded the 'Practice of the Year' award for this and a number of other customer-focussed projects.