Health Research Board

The Sociodemographic Index (SDI) captures a country's or region's relative socioeconomic development and has been linked to age-related disease burden and life expectancy. Frailty is a multidimensional geriatric syndrome associated with adverse health outcomes and mortality. This study examined the relationship between country-level SDI, frailty prevalence, and mortality across Europe. We conducted a secondary analysis of community-dwelling adults aged 50 years and older from 12 countries participating in the Survey of Health, Ageing and Retirement in Europe (SHARE). Frailty status and SDI were assessed at Wave 2 (2007), with mortality follow-up at Wave 4 (2011). Countries were categorised into lower- and higher-SDI groups using the median as a cut-off. Frailty was measured using a 70-item frailty index (FI ≥ 0.25) and a modified Fried frailty phenotype (FP ≥ 3 criteria). Frailty prevalence varied substantially by country and assessment method, ranging from 7 to 40% using the FI and 4-21% using the FP. Prevalence was lowest in Switzerland and highest in Poland and was strongly correlated with national SDI scores (r ≥ 0.8). After adjustment for age and sex, lower SDI was independently associated with higher odds of frailty using both frailty measures. Although mortality was lower in higher-SDI countries, this association was not statistically significant after adjusting for age, sex, and frailty. Lower social development was strongly associated with frailty prevalence but did not independently predict mortality, highlighting frailty as a potential pathway linking social context to later-life health outcomes in Europe.

Sleep disturbance is common among people with cognitive impairment and, when present, is an important target for intervention because it potentially leads to negative outcomes and cognitive decline. Given this association, sleep represents a potential public health target, although evidence for efficacy is lacking. For this study, a systematic review and meta-analysis was undertaken of controlled clinical trials of pharmacological and non-pharmacological interventions to improve sleep in mild cognitive impairment and dementia. A total of 144 trials involving 13,471 participants (median 50 per trial) were included. To measure sleep, 68 trials used subjective measures exclusively, and 41 used only objective measures, while 35 used a combination. In all, 287 discrete sleep outcome measures were reported. Bright light therapy was the most frequently examined non-pharmacological intervention, but results were equivocal. Other non-pharmacological interventions (such as physical activity, cognitive behavioural therapy for insomnia, music, and continuous positive airway pressure) showed promise but require further evidence. Results for melatonin, the most frequently examined pharmacological intervention, were inconclusive, but lower doses may be more effective. Other pharmacological interventions (such as trazadone and orexin-receptor antagonists) demonstrated effectiveness in a small number of trials but require further evidence. Overall, there is insufficient evidence upon which to base clinical decisions regarding the treatment of sleep disturbance in this population. Existing research is marked by wide heterogeneity, which limits opportunities for data synthesis. A core outcome set is urgently required to ensure that future research provides more coherent and reliable evidence to improve outcomes for people with cognitive impairment and sleep disturbance.

Gambling related harms are vast and varied. There is evidence that gambling is associated with increased risk of suicidal ideation and attempts. Our aim was to identify and profile individuals who died by suicide and had gambling documented in their coronial file. The Irish Probable Suicide Death Study dataset contains all (n=3,625) coroner and research-determined suicide deaths between 2015 and 2020. It was systematically searched to identify all deaths where gambling was recorded in coroner's files. Relevant data were extracted and included in a new database for further qualitative-driven analysis. Long-term distal (or chronic) and short-term proximal (or acute) risk factors were used as a framework for the analysis of the data. Gambling was recorded in 23 coroners' files, representing 0.6% of all suicides during the six-year period. Males were overrepresented and less than half were in employment at the time of death. Distal risk factors included co-occurring mental health conditions (notably mood disorders), a history of drug and alcohol dependency, past suicide intent and/or behaviour, and exposure to suicide. Key proximal risk factors included acute mental health symptoms, financial issues, interpersonal problems, intoxication, and recent stressful life events. We found that 23 people who died by suicide had gambling documented in their coronial file between 2015 and 2020. Numerous socioeconomic factors, interpersonal issues, and mental health conditions including addiction were also present at the time of death. The numbers in this study are likely an underrepresentation and support the need for improvements in data collection.

Research has demonstrated positive associations between adverse childhood experiences (ACEs) and alcohol use behaviours in young adults. However, many of these are based on cross-sectional data. The pathway between ACEs and alcohol misuse among emerging adults is not fully understood and there is a lack of data on how parental and peer relationships may mediate this relationship. To examine ACE exposure relationships with alcohol use behaviours and determine if associations between ACEs and harmful alcohol use are mediated by parent and peer relationships and school engagement. Participants (n=4729) were a cohort of children recruited to the Growing Up in Ireland study, a nationally representative longitudinal sample of children. Linear and logistic regression analyses examined individual and cumulative ACE exposure relationships with alcohol use behaviours at age 20years. Mediation analyses assessed whether parental and peer relationships and school engagement mediate ACE history associations with harmful alcohol use. Exposure to ACEs in childhood was associated with higher Alcohol Use Disorders Identification Test (AUDIT) scores and alcohol dependence at age 20. Young adults who experienced 3+ ACEs had a three-fold (OR=3.33, 95% CI: 2.00, 5.55) increased odds of alcohol dependence when compared to participants who experienced no ACEs. Mediation analyses suggested that parent and peer relationships partially mediate associations between ACEs and harmful alcohol use behaviours. Children who have experienced ACEs are at higher risk of harmful alcohol use. In supporting these children, identified mediators may help guide selection of prevention interventions.

AimGestational diabetes (GDM) poses risks of short‐ and long‐term complications for mother and infant, emphasising the importance of antenatal and postpartum education and support. We aimed to understand the experiences and views of women with GDM in the Republic of Ireland.MethodsWomen with current or previous GDM were invited to complete an online cross‐sectional survey (April–June 2022). Recruitment utilised social media, local media and personal networks. The survey addressed demographics, GDM knowledge and experiences, breastfeeding and weight management during pregnancy and post‐pregnancy GDM support needs. Descriptive statistics were conducted, and between‐group comparisons were undertaken using the chi‐square test. Content analysis was applied to free text data.ResultsAmongst 231 respondents, most were aged 35–39 (42%); 70% experienced a single GDM pregnancy. Only 6% correctly identified their increased level of risk for developing type 2 diabetes. Under half (44.5%) of respondents reported sufficient time with health professionals to address GDM‐related questions. Just over half (54.3%) reported attending for diabetes screening at 6–12 weeks postpartum. The majority (66%) expressed a desire for postpartum information, particularly on healthy eating and physical activity. Having a more recent GDM experience was associated with a stronger preference for weaning (p ≤ 0.001) and weight management information (p = 0.025). Qualitative analysis identified inconsistencies in healthcare messaging, significant concerns about a GDM diagnosis' impact on the pregnancy experience, and financial costs of diagnosis.ConclusionsThe findings underscore women's desire for appropriate information and support during and after pregnancy with GDM. Future interventions should address these needs to effectively promote chronic disease prevention after GDM.

Abstract Background Adolescence is a pivotal life stage marked by educational advancement, entry into the workforce and formation of lasting relationships. Globally, adolescence is also the peak period during which individuals first engage in alcohol and/or drug consumption. This scoping review aimed to summarize existing longitudinal research on factors and outcomes related to adolescent substance use to identify gaps in existing evidence. Methods A scoping review was conducted in accordance with the PRISMA extension for scoping reviews. A systematic literature search was conducted on PubMed. Additional studies were identified through hand-searching key reference lists and Google Scholar searches. A narrative synthesis was completed. Results 123 studies were included; 12 reviews and 111 cohort studies. 60% of cohort studies originated from North America, 29% Europe, 7% Australia/New Zealand, 2% South America and 2% Asia. Factors consistently associated with increased risk of ASU include male sex, increasing age, externalizing disorders, adverse childhood experiences and peer or parental substance use. Few studies considered wider community or neighbourhood factors. Early initiation and higher frequency of adolescent drug use were predictive of later-life substance use patterns, education derailment, contact with the justice system and mental health disorders. Conclusions The body of longitudinal evidence on adolescent substance use is rapidly expanding yet significant research gaps exist. Rising levels of cocaine use and its substantial health impacts motivate further research on all potentially important factors associated with cocaine use to guide interventions for prevention and treatment. Key messages • There are important gaps in existing research on adolescent substance use. • These include neighbourhood influences and factors associated with initiation of illicit drugs other than cannabis.

Ireland has had an historic over-reliance on inpatient mental health care accompanied by poorly resourced community provision. There has been an increasing policy focus on provision of mental health care in the community to facilitate diversion from, or shorten stays in, inpatient care. However, little is known about the determinants of psychiatric inpatient length of stay (LOS) to allow for the targeting of community services. To use a large cross-sectional national dataset to examine the determinants of psychiatric inpatient LOS in the Irish context. Using information on 60,607 discharges from adult acute psychiatric units in Ireland between 2015 and 2019, the study employs both descriptive and regression analysis. Using negative binomial regression models, we control for patient demographic, socioeconomic, and clinical characteristics. In addition, as LOS may be related to provision of non-acute services in the patient area of residence, the analysis also controls for aspects of community service provision. The study finds that longer LOS is associated with older age, being female, and having an involuntary admission. Clinical diagnosis significantly impacts LOS, with diagnoses such as schizophrenia being associated with longer LOS. There is also significant variation in LOS across region of residence, with discharges from some regions staying up to 5days longer. The regional variation observed in inpatient LOS supports the assumption that increased provision of community services diverts or reduces the quantum of care required in inpatient settings. However, without substantive improvement in the community data collected and reported, future planning of mental health services, both community and inpatient, will be substantially curtailed.

Testicular cancer is among the most common malignancies in men under the age of 50 years. Most testicular symptoms are linked to benign diseases. Men's awareness of testicular diseases and testicular self-examination behaviours are suboptimal. In this pilot feasibility study and process evaluation we examine the feasibility of conducting a future definitive randomised controlled trial (RCT) to test the effect of the Enhancing Men's Awareness of Testicular Diseases using Virtual Reality intervention (E-MATVR) compared to the Enhancing Men's Awareness of Testicular Diseases using Electric information control (E-MATE). The study protocol is registered on ClinicalTrials.gov (NCT05146466). Male athletes, engaged in Gaelic games, and aged 18 to 50 years were included. Recruitment was via FacebookTM, XTM (formerly TwitterTM), and posters. Participants were individually randomised to either E-MATVR or E-MATE. Data were collected at baseline (T0), immediately post-test (T1), and three months post-test (T2) using surveys. Qualitative interviews were conducted with participants and researchers. Data were collected from 74 participants. Of those, 66 were retained. All E-MATVR participants and most E-MATE participants (n = 33, 89.2%) agreed/strongly agreed that the device was easy to use and that they were engaged to learn by the device. Most E-MATVR participants (n = 34, 91.9%) and all E-MATE participants agreed/strongly agreed that the time it took them to complete the intervention was reasonable. All 74 participants were extremely satisfied/somewhat satisfied with their overall participation in the study. E-MATVR was described as interactive, easy, fun, and close to real life. Initial difficulty using VR equipment, nausea, and technical issues were identified as challenges to engaging with E-MATVR. Recommendations were made to make VR more accessible, shorten the survey, and incorporate more interactivity. Across all participants, mean testicular knowledge scores (range 0-1) increased from 0.4 (SD 0.2) at T0 to 0.8 (SD 0.2) at T1. At T2, overall mean scores for participants were 0.7 (SD 0.2). Mean knowledge scores did not differ by trial arm at any timepoint. At T2, all E-MATVR participants and 29/32 E-MATE participants (90.6%) reported purposefully examining their testes within the past three months. Findings are promising, highlighting the feasibility of using VR to promote young athletes' awareness of testicular diseases. Considering the strengths, limitations, and lessons learned from this study, some modifications are required prior to conducing an RCT. These include but are not limited to shortening survey questions, incorporating more interactivity and visual content, and targeting more heterogenous male-dominated environments.

Gestational diabetes confers short- and long-term risk of mother and offspring health complications. Healthcare professionals such as endocrinologists, diabetes nurses, dietitians, midwives and general practitioners provide gestational diabetes care. We sought to explore healthcare professionals' perspectives on gestational diabetes care during pregnancy and postpartum. Healthcare professionals in the Republic of Ireland, whose role included gestational diabetes care were invited to complete an online 20-item survey between June and September 2022. Social media, professional organisations and personal networks were used for recruitment. Questions included guideline use, postpartum diabetes screening and advice practices. Analyses were performed using SPSS statistical software and free text was coded using NVivo. Seventeen healthcare professions across primary and secondary care settings participated (n = 127). No differences were noted between groups (medical, nursing/midwifery, allied health/other); therefore, findings were reported as a single group. Healthcare professionals reported using multiple different guidelines to support gestational diabetes management (n = 14). The most cited were 'Health Service Executive guidelines' (24.5%), 'local guidelines' (13.2%) and National Institute for Clinical Excellence guidelines (11.3%); 12.3% cited uncertainty, and 27.5% reported not to follow any named guidelines. For postpartum follow-up, 39% felt clear guidelines were available to support practice, 37% felt appropriate systems were in place and 29% reported effective communication between primary and secondary care services. Qualitative findings emphasised a desire for improved communication between systems, participants and providers, clear interdisciplinary guidelines, and adequate resourcing for gestational diabetes management and postpartum diabetes prevention, including comprehensive support and follow-up. System-level challenges and ineffective communication across settings are barriers to optimum postpartum care. Nationally agreed guidelines for best practice gestational diabetes management including postpartum diabetes prevention are needed.

Frailty is common among older hospital inpatients. While studies describe frailty prevalence in acute hospitals, it is usually based upon retrospective hospital-coded data or brief screening on admission rather than comprehensive geriatric assessment (CGA). Further, little is known about differences between pre-admission and current frailty status. Given this, we investigated the prevalence of pre-frailty and frailty among adult inpatients in a large university hospital after CGA. Of the 410 inpatients available, 398 were included in the study, with a median age of 70 years; 56% were male. The median length of stay (LOS) at review was 8 days. The point prevalence of frailty was 30% versus 14% for pre-frailty. The median Clinical Frailty Scale score pre-admission was 3/9, which was significantly lower than at review, which was 4/9 (p < 0.001). After adjusting for age and sex, frailty was associated with greater odds of prolonged LOS (odds ratio [OR] 1.7, p = 0.045), one-year mortality (OR 2.1, p = 0.006), and one-year institutionalisation (OR 9, p < 0.001) but not re-admission. Frailty was most prevalent on medical and orthopaedic wards. In conclusion, CGA is an important risk assessment for hospitalised patients. Frailty was highly prevalent and associated with poor healthcare outcomes. Frailty status appears to worsen significantly during admission, likely reflecting acute illness, and it may not reflect a patient’s true frailty level. The development of frailty clinical care pathways is recommended in order to address the poor prognosis associated with a diagnosis of frailty in this setting.