Patricia Fitzpatrick

Background: Irish Travellers are a distinct minority ethnic group with a long tradition of nomadism on the island of Ireland. Travellers have a significantly reduced life expectancy and experience greater health inequalities. Limited evidence describes how cancer awareness and engagement with prevention, screening and early diagnosis are shaped by structural and service contexts. Methods: This qualitative study was undertaken as part of a larger multi‐method study co‐developed with the Health Service Executive, National Cancer Control Programme, National Social Inclusion Office, and Pavee Point Traveller and Roma Centre‐ a human rights advocacy and Irish Non‐Governmental Organisation (NGO). The study aimed to understand cancer awareness and attitudes among Irish Travellers, identify barriers and enablers to cancer risk reduction behaviours and early diagnosis of cancer. In‐person interviews were completed with 22 adult Irish Travellers (18 individual interviews and two group interviews with two participants each) and were transcribed verbatim and analysed using collaborative reflexive thematic analysis. Results: Four themes described the interactions between everyday structural disadvantage, culture, privacy, fear and family roles; systems‐level barriers; and Traveller‐led and service‐level enablers. Awareness did not always translate into an opportunity to act. Racism and discrimination, literacy barriers, living conditions, limited service choice, inaccessible communication and inflexible appointment systems constrained engagement. Pride in Traveller identity, trusted relationships, Traveller Community Health Workers, accessible information and culturally safe services supported engagement. Conclusions: Improving cancer awareness requires more than individual behaviour change. Equitable engagement with prevention, screening and early diagnosis depends on anti‐racist, accessible and flexible mainstream services developed in partnership with Travellers and their organisations. Traveller Community Health Workers are a major strength, and their expertise should be harnessed within health systems. Patient and Public Contribution: The study was co‐developed with Pavee Point Traveller and Roma Centre, who are represented as co‐authors on the paper and were members of the study working group. They took part in all aspects of the study, including providing anti‐discrimination training, recruitment, interpretation of findings, and providing lived‐experience expertise throughout the drafting of the paper.

Patients with infection present to emergency departments (EDs) through multiple referral pathways, including general practitioner (GP) referral and self/ambulance presentation. The impact of referral sources on presentation characteristics, ED processes, and clinical outcomes remains poorly characterised. A retrospective observational study examined ED presentations with infection across eight sampling points in 2025 in an inner-city ED located in an area of severe deprivation. Patients were stratified into general practitioner (GP)/GP out-of-hours (GP-OOH) referrals and other referral pathways. Demographic characteristics, physiological observations, ED process measures, and clinical outcomes were compared using unadjusted analyses, with multivariable median regression used to adjust the principal exploratory ED process outcomes for clinically relevant covariates. Among 277 patients, 55 (19.9%) were referred by GP/GP-OOH and 222 (80.1%) via other routes. GP-referred patients more frequently presented on weekdays and arrived by private transport (both p < 0.001). No statistically detectable differences were observed in most demographic, clinical, and physiological measures, although the study was not designed or powered to establish equivalence. GP-referred patients experienced longer times to triage (p < 0.001) and first physician assessment (p = 0.003). GP-referred patients represented a minority of infection presentations. No statistically significant differences were detected in most clinical outcomes, although admission was less frequent among GP-referred patients (36.4% vs. 51.8%; absolute difference −15.4 percentage points; risk ratio 0.70, 95% CI 0.48–1.02), and clinically important differences cannot be excluded. GP referral was associated with longer waits for early ED assessment, while differences in downstream treatment and clinical outcomes should be interpreted cautiously given the exploratory nature of these comparisons and the small number of GP-referred patients.

Objectives: Self-sampling for human papillomavirus (HPV) is being considered as an additional cervical screening method in Ireland. As sample takers play a central role in cervical screening and their support would be essential to the successful delivery of any HPV self-sampling programme, this survey aimed to assess sample takers’ views on HPV self-sampling. Methods: An anonymous, online survey of HPV sample takers registered with CervicalCheck was conducted. Survey questions focused on sample takers’ views on the introduction of HPV self-sampling in Ireland, advantages and disadvantages for them and the role sample takers might play in delivering self-sampling. Results: Of the 200 sample takers who completed the survey, 175 (87.5%) were nurses and the remainder doctors. Two-thirds (67%, 95% confidence interval: 60.5–73.5%; n = 134) supported introducing HPV self-sampling, 9% (5.0–13.0%; n = 18) did not, and 24% (18.1–29.9%; n = 48) were unsure. The reasons respondents supported introducing HPV self-sampling included a potential to increase screening uptake and provide a better experience for participants. Those opposed were concerned self-sampling would represent a missed opportunity for clinical examination of the cervix, to counsel patients about screening, and discuss other health concerns, while a minority reported concerns about the accuracy of self-sampled tests. No clear differences in views were observed by professional role. Conclusions: Most respondents supported HPV self-sampling as an additional cervical screening method, but some were concerned about the potential reduction in important clinical encounters and accuracy of self-sampled tests. The benefits and limitations of HPV self-sampling should be carefully considered before introducing any self-sampling programme in Ireland.

Background: As a part of the Irish Comparative Outcome national cohort study of childhood CF, this cross‐sectional study investigated challenges faced by parents of children with CF (CWCF) in the Republic of Ireland using a newly validated modified tool. Methods: Parents completed the modified “Challenge of Living with Cystic Fibrosis‐Short Form” (CLCF‐SF), developed to determine caregiver burden for parents of CWCF, with limited items ( N = 15) to complete. Linear regression examined associations between CLCF‐SF scores and demographic and clinical factors. Results: 263 of 357 (73.6%) responded. Parents reported marginal to great difficulty in balancing daily lives and CF care (31%), managing extra expenses (46.8%), and establishing care routines (76.5%). Parents felt supported by medical teams. Parents of younger children reported more difficulties juggling CF demands with family needs (39.3% vs 25.0%), a more stressful family lifestyle (51.4% vs 39.1%). A greater proportion of parents of older CWCF (48.1% vs 28%) and of CWCF on CFTR modulator therapy (45% vs 27%) reported moodiness. Cronbach's α was 0.87, indicating very good internal consistency. Conclusion: This was the first use of the modified CLCF‐SF in a population setting. High response rates indicate ease of completion. This study provides an assessment of internal consistency, usability, and performance of the modified version of the new tool; the need for age‐adequate financial and psychological support is highlighted.

Background: The Traveller population is a distinct minority ethnic group, formally recognised by the Irish Government in 2017. Irish Travellers have a lower life expectancy and poorer health expectancy than the general population. Internationally, HPV self-sampling is being considered as an option to improve uptake in cervical screening, particularly in underrepresented groups. It is not currently offered in Ireland, but assessment of acceptability is ongoing. The aim of this study was to determine the uptake of cervical screening and the acceptability of HPV self-sampling in eligible Traveller women. Methods: A face-to-face survey by and with Travellers, adapted from the National Cancer Control Programme’s (NCCP) 2022 National Survey on Cancer Awareness, was conducted by Traveller Community Health workers in partnership with Pavee Point Traveller and Roma Centre. Results: 483 Travellers participated; 306 (63.1%) were women and 191 (39.5%) were in the eligible group for cervical screening (women aged 25-65). Of these, 142 (74%) had ever received an invitation; of those who received an invitation, 125 (89%) attended at least once. Over 73% of those attending cervical screening advised they attended all screening appointments. 37 (19.4%) reported HPV self-sampling as acceptable, 87 (45.5%) as unacceptable to them and 31 (16.2%) were unsure and would like more information. Of the 37 who reported HPV self-sampling as acceptable, 18 (50%) were non (7) or irregular (11) attenders at screening. Conclusion: HPV self-sampling has the potential to overcome, for some Traveller women, the practical and personal barriers which may prevent them from responding to standard cervical cancer screening.

Aim: Electronic cigarette usage has become increasingly popular in recent years, advertised as a safe alternative to smoking. However, the long‐term impact on prenatal development is not well understood. The aim of this systematic review and meta‐analysis is to investigate the impact of prenatal electronic cigarette exposure on self‐regulation and motor development in existing human and animal research and to identify the common assessment measures. Methods: 2116 records from six databases were retrieved, of which 70 (56 human; 14 animal) were retained for review. Random‐effects meta‐analyses were conducted on eligible studies. Results: The emerging animal literature provides evidence for the impact of electronic cigarette exposure on offspring development. Meta‐analysis results of 42 eligible human studies indicated that prenatal exposure to nicotine or cannabis by combustible or electronic cigarette was associated with deficits in cognitive, emotional, and behavioural self‐regulatory domains, as well as motor function and neuromotor development. Only one human study included electronic cigarettes. Conclusions: The combined findings of human and animal literature suggest overlapping influences of combustible and electronic cigarettes across self‐regulation and motor domains. Given the policy implications, there is an urgent need for more research on electronic cigarette use in humans during pregnancy.

Serious outcomes of COVID-19 may include admission to an intensive care unit (ICU) or death. Multiple risk factors exist which may contribute to these outcomes. The aim of the study, employing a large national dataset, was to assess roles of smoking, body mass index, metabolic and underlying clinical conditions in ICU admissions and death among those with COVID-19 in Ireland. The analysis comprised all 1.4 million adult patients who tested positive with COVID-19 between April 2020 and December 2022. A pseudonymised dataset from the Central Statistics Office (CSO) was used; informed consent was waived by the National Health Research Consent Declaration Committee. Key variables above were used, employing both univariate and multivariate analysis. Outcomes were ICU admission and death with COVID-19. Mean age was 42 years (Standard Deviation (SD) 16.8) and 53% were males. Those admitted to hospital were older (59.2 (14.2)) than those who died (74.9 (12.0)). Increased odds ratios (95% CI) each significantly associated with ICU admission in multivariate models were, current/ex-smokers (2.4 (2.2–2.6)), males (1.8, (1.7–1.9)), and individuals with an underlying clinical condition (10.2 (7.9–13.2)). Odds of death were also significantly increased in presence of an underlying condition (186.129 (137.987-251.066)) but not when age was taken into account as an interaction term. This comprehensive study confirmed international findings associated with poor outcomes in COVID-19. Whilst clinical indications for ICU admission and overall mortality may differ in hospitalised patients, the main drivers of mortality are age, underlying conditions and disease severity, irrespective of location.

Introduction: This study sought to determine participation by eligible Irish Travellers, a minority ethnic group, in the cancer screening programmes in Ireland (bowel, breast and cervical screening) and to determine barriers/facilitators to screening. Methodology: This study was co-designed with the National Cancer Control Programme (NCCP) and Pavee Point Traveller and Roma Centre, Ireland. A survey questionnaire, adapted from the NCCP's 2022 National Survey on Cancer Awareness, was disseminated to Travellers via Traveller Community Health Workers (TCHWs). Results: A total of 574 survey questionnaires were distributed across 12 different Primary Health Care Traveller Projects in the Republic of Ireland and 483 (84%) were returned completed; 148 (30.6%) were from men and 306 (63.1%) from women (6.3%, missing data). High proportions had ever attended breast (72.6%) and cervical (65.4%) screening. Bowel screening uptake was low in both men (12.5%) and women (19.2%). Low proportions recalled receiving an invitation to programmes. The faecal immunochemical test test used in the BowelScreen programme prompted embarrassment as a barrier in eligible men (62.5%); embarrassment was lower in women for bowel (38.5%), breast (32.9%) and cervical (30.4%) screening. Fear was the second highest barrier. The main facilitators of screening attendance were talking to TCHW and an invitation respectively, particularly in women eligible for bowel (50%; 53.8%), breast (49.3%; 50.7%) and cervical screening (47.6%; 48.2%), but lower in men (25%; 37.5%); 25% cited the family doctor as facilitator. Conclusion: Travellers face barriers accessing mainstream health services; easy access to screening must be ensured . The TCHW is a key facilitator. There is a need for universal ethnic identifiers to facilitate routine monitoring of participation and outcomes for Travellers in screening.

Introduction: In 2018, nondisclosure of results of retrospective audits of cytology in interval cancers precipitated a crisis in the Irish national cervical screening programme. In response, an Expert Reference Group was convened which recommended a collaborative approach to the development of a new key performance indicator, the interval cancer rate. The Expert Reference Group also recommended that the Irish programme should collaborate with international colleagues to reach consensus on (i) the definition of an interval cervical cancer, (ii) the methodology to calculate the interval cancer rate, and (iii) benchmarking with other international programs. This study was undertaken to determine if a consensus regarding the definition of an interval cervical cancer and the calculation of an interval cancer rate exists.Material and Methods: A web‐based questionnaire was sent to 18 population‐based cervical screening programs. Inclusion criteria involved (1) a national or regional population‐based cervical screening prograe; (2) a country or region with a population ≥population of Ireland; (3) programs located in Europe, Australia, or Canada; (4) programs that had responded to a previously published international survey on the disclosure of retrospective cytology reviews in cervical cancer cases.Results: The response rate was nine out of 18. Of nine respondents, six had an agreed definition of interval cervical cancer, and four of these calculated an interval cancer rate. Three programs neither calculated interval cancer rates nor had any guidelines related to this. Of the six with an agreed definition, all respondents defined the numerator as invasive cancers in the screening age group, with four including microinvasive disease. Respondents included cancers diagnosed 3–5 years after the last screening test had been taken. Three respondents also included cancers diagnosed in women up to 3.5 years after they exited the screening program. Countries use different denominators, including (i) per women years, (ii) per number of screens, and (iii) per total cancers in screened population.Conclusions: There is variation in the parameters used in interval cancer rate calculation. To allow benchmarking of cervical screening program performance, there is a need for consensus on a standardized method of interval cancer definition and interval cancer rate calculation.

Background Cardiovascular disease (CVD) is the leading cause of death worldwide and disproportionately affects individuals from low socioeconomic (LSE) areas. Self-management interventions in general practice targeted towards people from LSE areas may positively impact patients’ health. The High Risk Prevention Programme (HRPP), developed by the Ireland’s Health Service Executive (HSE), the Irish Heart Foundation and the University College Dublin School of Medicine is a behavioural self-management intervention promoting positive lifestyle changes for patients with high CVD risk. Six general practices from LSE areas in Ireland delivered the intervention. This study aimed to evaluate the acceptability and feasibility of the HRPP by employing qualitative methods to investigate the experiences of participating patients and healthcare staff. Methods Twenty-eight participants (18 patients and 10 healthcare staff) were interviewed. The intervention’s feasibility was assessed according to Braun and Clarke’s thematic analysis approach. Results Four key themes were identified among patients: (1) motivation to change health behaviours, (2) practical benefits for patients, (3) challenges experiences by patients, (4) lifestyle management and healthcare supports. Four themes were also identified among healthcare staff: (1) positive experience of the programme and its benefits, (2) logistical challenges, (3) patient engagement, (4) programme management. Conclusion The HRPP showed high levels of acceptability and feasibility. Future studies should assess this intervention’s likely effectiveness and consider scaling-up the intervention by including younger patients and by think of ways how to better manage the workload of healthcare staff responsible for delivering the intervention. The HRPP could be incorporated into the HSE’s nationwide ‘Chronic Disease Management Programme’.