Adaptations to a cohort study in response to the COVID-19 pandemic: insights from Growing Up in Ireland.

Growing Up in Ireland (GUI) is the national longitudinal study of children and young people in the Republic of Ireland and has followed two cohorts for over ten years to date: Cohort '98 who were recruited into the study at age nine years and Cohort '08, recruited at age nine months. The study aims to describe the lives of Irish children and young people in terms of their development, with a view to positively affecting policies and services available for them. Traditionally, data collection involved in-home visits from an interviewer who conducted face-to-face interviews, recorded physical measurements of study participants and administered cognitive assessments. However, with the onset of the COVID-19 pandemic and the associated restrictions, significant adaptations were required to these methods to ensure data collection for the pilot and main fieldwork for Cohort '08 at age 13 could continue to the expected timeline. Face-to-face interviews with participants were replaced with telephone and web-based modes, interviewer training was conducted online, online resources were made available for interviewers and participants and COVID-19 related items were added to questionnaires. In addition to the scheduled data collection, a special COVID-19 survey was also conducted on both GUI cohorts in December 2020 to explore the impact of the pandemic on participants' lives. This paper outlines the adaptations made to traditional data collection methods in GUI, highlighting the challenges that were met, but also the benefits of some changes that may be worth incorporating into future waves of GUI.

'An extra level of kind of torment': Views and experiences of recurrent miscarriage care during the initial phases of COVID-19 in Ireland-A qualitative interview study.

INTRODUCTION: Maternity services underwent much change during the COVID-19 pandemic. Research on the impact on miscarriage care and experiences during this time is sparse. Within a national evaluation of recurrent miscarriage care, we qualitatively explored stakeholder views and experiences of recurrent miscarriage services in Ireland. This study describes the impact of the COVID-19 pandemic on those experiences and perceptions of care. METHODS: People with professional and lived experience of recurrent miscarriage and service engagement were actively involved in this qualitative study from idea generation to analysis and reporting. We recruited women and men with two or more consecutive first-trimester miscarriages, and people involved in the management/delivery of recurrent miscarriage services and supports. We used purposive sampling to ensure that perspectives across disciplinary or lived experience, geographical, and health service administrative areas, were included. We conducted semi-structured interviews, virtually all due to COVID-19 restrictions, between June 2020 and February 2021. These were audio-recorded, and data were transcribed, and subsequently analyzed using reflexive thematic analysis. RESULTS: We interviewed 42 service providers and 13 women and 7 men with experience of recurrent miscarriage. We actively generated two central themes during data analysis. The first-'Disconnected'-describes how many women navigated miscarriage diagnosis and management and care in subsequent pregnancies alone; many felt that this resulted in increased trauma. At the same time, men struggled with not being present to support their partners and described feeling disconnected. The second theme highlighted 'The perceived dispensability of recurrent miscarriage services and supports'. Some service providers felt that service reduction and redeployment demonstrated a lack of value in the service. Virtual clinics facilitated access to services, but a preference for in-person care was highlighted. CONCLUSION: Our analysis provides rich insights into the significant impacts that the COVID-19 pandemic has had on the way recurrent miscarriage care is provided and experienced, with important implications for early pregnancy, miscarriage and recurrent miscarriage care. Services have undergone significant changes and, while these may be temporary, how services should be delivered in the future requires consideration, particularly given the deficits in care and care experiences highlighted prepandemic. PATIENT OR PUBLIC CONTRIBUTION: Members of the multidisciplinary RE:CURRENT Project Research Advisory Group (including four parent advocates, two of whom are co-authors on this article) were actively involved throughout the study, including the generation of topic guides and the refining of themes.

Establishing severe acute respiratory infection (SARI) surveillance in a sentinel hospital, Ireland, 2021 to 2022.

BackgroundIn 2020, due to the COVID-19 pandemic, the European Centre for Disease Prevention and Control (ECDC) accelerated development of European-level severe acute respiratory infection (SARI) surveillance.AimWe aimed to establish SARI surveillance in one Irish hospital as part of a European network E-SARI-NET.MethodsWe used routine emergency department records to identify cases in one adult acute hospital. The SARI case definition was adapted from the ECDC clinical criteria for a possible COVID-19 case. Clinical data were collected using an online questionnaire. Cases were tested for SARS-CoV-2, influenza and respiratory syncytial virus (RSV), including whole genome sequencing (WGS) on SARS-CoV-2 RNA-positive samples and viral characterisation/sequencing on influenza RNA-positive samples. Descriptive analysis was conducted for SARI cases hospitalised between July 2021 and April 2022.ResultsOverall, we identified 437 SARI cases, the incidence ranged from two to 28 cases per week (0.7-9.2/100,000 hospital catchment population). Of 431 cases tested for SARS-CoV-2 RNA, 226 (52%) were positive. Of 349 (80%) cases tested for influenza and RSV RNA, 15 (4.3%) were positive for influenza and eight (2.3%) for RSV. Using WGS, we identified Delta- and Omicron-dominant periods. The resource-intensive nature of manual clinical data collection, specimen management and laboratory supply shortages for influenza and RSV testing were challenging.ConclusionWe successfully established SARI surveillance as part of E-SARI-NET. Expansion to additional sentinel sites is planned following formal evaluation of the existing system. SARI surveillance requires multidisciplinary collaboration, automated data collection where possible, and dedicated personnel resources, including for specimen management.

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.

'Attorneys of the Poor': the lived experience of general practitioners working in disadvantaged parts of rural Ireland.

INTRODUCTION: The experience of structural violence impacts not only patients but also GPs who deliver their primary care. Farmer (1999) claims that 'sickness due to structural violence results from neither culture nor pure individual will, but historically given and economically driven processes and forces that conspire to constrain individual agency'. I aimed to explore qualitatively the lived experience of GPs in remote rural areas who cared for disadvantaged populations selected from the Haase-Pratschke Deprivation Index (2016). METHODS: I visited ten GPs in remote rural areas, did semi-structured interviews, explored the hinterland of their practices and observed the historical geography of their locality. In all cases, interviews were transcribed verbatim. NVivo was used for thematic analysis using Grounded Theory. Findings were framed in the literature around postcolonial geographies, care and societal inequality. RESULTS: Participants were aged from 35 years to 65 years; half were women and half were men. Three main themes emerged: GPs value their lifeworld; they feel at high risk from over-work, inaccessible secondary care for patients and under-acknowledgment of their work; and they experience satisfaction in providing lifelong primary care. They fear that difficulties recruiting younger doctors may terminate the continuity of care that creates a sense of place. DISCUSSION: Rural GPs are linchpins of community for disadvantaged people. But GPs suffer the effects of structural violence and feel alienated from being their personal and professional best. Factors to consider are the roll-out of the Irish government's 2017 healthcare policy, Sláintecare, changes wrought by the COVID-19 pandemic in the Irish healthcare system and poor retention of Irish-trained doctors.

Reducing rural isolation through music: telehealth music therapy for community dwelling people living with dementia and their family caregivers in rural Ireland.

INTRODUCTION: Since the outset of COVID-19, we have become more reliant on technology to stay connected to others. Notable benefits of telehealth have been observed, including increased access to health and community support services for community dwelling people living with dementia and their family caregivers and diminishing barriers such as geographical location, mobility issues and increased cognitive decline. Music therapy is an evidence-based intervention for people living with dementia and has been proven to promote improved quality of life, increase social interaction and provide a form of meaningful communication and expression when language becomes difficult. This project is one of the first internationally to pilot telehealth music therapy for this population. METHODS: This mixed methods action research project has six iterative phases of planning, research, action, evaluation, and monitoring. Public and Patient Involvement (PPI) has been sought from members of The Dementia Research Advisory Team at the Alzheimer Society of Ireland at all stages of the research process to ensure the research remains relevant and applicable to those with dementia. The presentation will briefly outline the phases of the project. RESULTS: Preliminary results from this ongoing research suggest that there is feasibility for telehealth music therapy to provide psychosocial support to this population. Collaboration with PPI contributors resulted in the following research priorities: (1) ensuring a person-centered approach; (2) advanced care planning using music; and (3) the signposting of music related supports for community dwelling people living with dementia. Music therapy is being piloted currently and preliminary results will be outlined. DISCUSSION: Telehealth music therapy has the potential to complement existing rural health and community services for people living with dementia, in particular addressing social isolation. Recommendations regarding the relevance of cultural and leisure pursuits on health and well-being of people living with dementia will be discussed, particularly the development of online access.

Immunocompromise among vaccinated versus unvaccinated COVID-19 cases admitted to critical care in Ireland, July to October 2021.

As the COVID-19 pandemic progressed, so too did the proportion of cases admitted to critical care in Ireland who were fully vaccinated. Reporting of this observation has public health implications as incorrect interpretation may affect public confidence in COVID-19 vaccines. A potential explanation is the reduced ability of those who are immunocompromised to produce an adequate, sustained immune response to vaccination. We conducted an analysis of the association between COVID-19 vaccination status and underlying degree of immunocompromise among a cohort of critical care patients all with a confirmed diagnosis of COVID-19 admitted to critical care between July and October 2021. Multinomial logistic regression was used to estimate an odds ratio of immunocompromise among vaccinated COVID-19 cases in critical care compared to unvaccinated cases. In this study, we found a statistically significant association between the vaccination status of severe COVID-19 cases requiring critical care admission and underlying immunocompromise. Fully vaccinated patients were significantly more likely to be highly (OR = 19.3, 95 % CI 7.7-48.1) or moderately immunocompromised (OR = 9.6, 95 % CI 5.0-18.1) compared to unvaccinated patients with COVID-19. These findings support our hypothesis, that highly immunocompromised patients are less likely to produce an adequate and sustained immune response to COVID-19 vaccination, and are therefore more likely to require critical care admission for COVID-19 infection.

How to not revert to type: Complexity-informed learnings from the pandemic response for health system reform and universal access to integrated care.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Background: COVID-19 has highlighted existing health inequalities and health system deficiencies both in Ireland and internationally; however, understanding of the critical opportunities for health system change that have arisen during the pandemic is still emerging and largely descriptive. This research is situated in the Irish health reform context of Sláintecare, the reform programme which aims to deliver universal healthcare by strengthening public health, primary and community healthcare functions as well as tackling system and societal health inequities. Aims and objectives: This study set out to advance understanding of how and to what extent COVID-19 has highlighted opportunities for change that enabled better access to universal, integrated care in Ireland, with a view to informing universal health system reform and implementation. Methods: The study, which is qualitative, was underpinned by a co-production approach with Irish health system leadership. Semi-structured interviews were conducted with sixteen health system professionals (including managers and frontline workers) from a range of responses to explore their experiences and interpretations of social processes of change that enabled (or hindered) better access to universal integrated care during the pandemic. A complexity-informed approach was mobilized to theorize the processes that impacted on access to universal, integrated care in Ireland in the COVID-19 context. Findings: A range of circumstances, strategies and mechanisms that created favorable system conditions in which new integrated care trajectories emerged during the crisis. Three key learnings from the pandemic response are presented: (1) nurturing whole-system thinking through a clear, common goal and shared information base; (2) harnessing, sharing and supporting innovation; and (3) prioritizing trust and relationship-building in a social, human-centered health system. Policy and practice implications for health reform are discussed.

Impact of changes to the delivery of opioid agonist treatment, introduced during the COVID-19 pandemic, on treatment access and dropout in Ireland: An interrupted time series analysis.

BACKGROUND: Following the emergence of COVID-19, Ireland introduced national contingency guidelines to ensure rapid and uninterrupted access to opioid agonist treatment (OAT). This study aims to assess the impact of changes introduced to the delivery of OAT on the number of people accessing treatment and treatment dropout. METHODS: The study conducted interrupted time series analyses, with separate segmented regression models (March 2019-February 2020) vs (April 2020-March 2021), for (A) total number of people accessing OAT, (B) the number initiating treatment, and (C) the number dropping out of treatment, using data from the National OAT treatment register. The study examined immediate (change in level or intercept: ß2) and long-term impacts (change in slope; i.e., the difference between the slope before and after the intervention: ß3). We performed total and stratified analyses by gender, age group (<40/≥40 years), and OAT drug (methadone or buprenorphine). RESULTS: A total of 10,251 people accessed OAT in Ireland in March 2019 (2 % buprenorphine, n = 178), increasing to 11,441 (4 % buprenorphine, n = 471) in March 2021. The study observed an immediate (ß2 = 504.3, p < 0.001) and continued (ß3 = 31.9, p < 0.001) increase of people accessing treatment following the introduction of the OAT contingency guidelines. In contrast, observed changes in level and slope were not significant for treatment initiation or dropout. The study did find, however, a modest reduction in dropout among those receiving buprenorphine (ß3 = -0.6, p = 0.036). CONCLUSIONS: Changes introduced to the delivery of OAT, under the COVID-19 contingency guidelines, are associated with increased access to OAT in Ireland, with no evidence of increase in treatment dropout. Whether these effects will be maintained over time remains to be seen.

My Health, My Language - multilingual video messages on health in Ireland.

INTRODUCTION: In Ireland, 12% of the population was born outside of Ireland. Issues such as language, knowledge of entitlements and health systems may impact the health of some migrants and public health. Multilingual video messages have the potential to overcome some of these issues. METHOD: Video messages on twenty-one health topics in up to twenty-six languages have been created. They are presented by healthcare workers living and working in Ireland who originate from other countries in a friendly relaxed style. Videos are commissioned by the Health Service Executive, Ireland's national health service. Scripts are written with medical, communication and migrant expertise. Videos are platformed on the HSE website, shared on social media, via QR code posters and by individual clinicians. RESULTS: Video topics to date include how to access health care in Ireland, the role of a GP, screening services, vaccinations, antenatal care, postnatal health, contraception and breastfeeding. There have been over 200,000 views of videos. Evaluation is underway. DISCUSSION: The importance of trusted information has been highlighted by the COVID-19 pandemic. Video messages presented by a professional who is culturally familiar have the potential to improve self-care, appropriate use of health services and uptake of prevention programmes. The format overcomes issues with literacy and a person can watch a video multiple times. Limitations include reaching those without internet access. Videos do not replace the need for interpreters but are a tool to improve understanding of systems, entitlements and health information, efficient for clinicians and empowering for individuals.

A national Delphi study: experiences of general practitioner (GP) trainees in the Republic of Ireland undertaking online small group learning as part of the GP Training Programme during COVID-19.

INTRODUCTION: During the COVID-19 pandemic, GP training day release was redirected from face-to-face to an online setting. With this study, our aim was to assess trainee experiences of online small group learning and to make recommendations with regards to future GP training. METHODS: A qualitative study using the Delphi survey technique, approved by the Irish College of General Practitioners (ICGP) Ethics Committee. A series of three sequential online questionnaires were sent to our trainee cohort in all 14 training schemes in Ireland. The first questionnaire explored GP trainee experiences and key themes were generated. Subsequent questionnaires were developed using these themes, with second and third round questionnaires establishing consensus on these experiences. RESULTS: In total, 64 GP trainees responded. Each training scheme was represented. Response rates for round 1 and 2 were 76% and 56% respectively, with round 3 currently underway. Trainees felt that online teaching was convenient, reduced commuting costs, and provided peer support. They also reported loss in unstructured discussion, practical teaching sessions and relationship building. Seven key themes were generated: future format of GP training; accessibility and flexibility; teaching experience; provision of GP training; support and collegiality; educational experience; and technical problems. There is a consensus that some online teaching should be retained for the future. DISCUSSION: Online teaching provided a continuation in training that was more convenient and accessible but affected social interactions and relationship building amongst trainees. Future online sessions could be utilised in a hybrid model of teaching going forward.

Point prevalence audit surveys of respiratory tract infection consultations and antibiotic prescribing in primary care before and during the COVID-19 pandemic in Ireland.

BACKGROUND: Respiratory tract infections (RTIs) are the most common reason for prescribing antibiotics in general practice. The COVID-19 pandemic has impacted on antibiotic prescribing and delivery of primary care in Ireland. OBJECTIVES: To assess the quality of antibiotic prescribing, the impact of the COVID-19 pandemic and identify opportunities for antimicrobial stewardship (AMS) in Ireland. METHODS: Point prevalence audit surveys for RTI consultations were conducted as part of a European study at three time periods: January-February 2020, March-May 2020 and March-May 2021. Antibiotic prescribing was assessed and comparisons made between the three time periods. RESULTS: In total, 765 consultations were recorded, which were mainly face to face before the pandemic, but changed to predominantly remote consultations during the pandemic surveys in 2020 and 2021 (82% and 75%). Antibiotics were prescribed in 54% of RTI consultations before the pandemic. During pandemic surveys, this dropped to 23% in 2020 and 21% in 2021. There was a decrease in prescribing of Red (reserve) agents in 2021. Assessment against indication-specific quality indicators showed a high proportion of consultations for bronchitis and tonsillitis resulting in an antibiotic prescription (67% and 85%). Point-of-care testing (POCT) to aid diagnosis of RTIs were utilized in less than 1% of consultations. CONCLUSIONS: During the COVID-19 pandemic, there was a reduction in antibiotic prescribing. Opportunities identified to support AMS in primary care in Ireland are targeted initiatives to reduce antibiotic prescribing for bronchitis and tonsillitis and introducing POCT to support appropriate antibiotic prescribing.

A novel approach to utilizing the essential public health functions in Ireland's health system recovery and reform.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict.' The COVID-19 pandemic presented a challenge to health systems and exposed weaknesses in public health capacities globally. As Ireland looks to recovery, strengthening public health capacities to support health systems resilience has been identified as a priority. The Essential Public Health Functions (EPHFs) provide an integrated approach to health systems strengthening with allied sectors and their operationalization supports health systems and multi-sectoral engagement to meet population needs and anticipate evolving demands. The Health Systems Resilience team (World Health Organization, HQ) in collaboration with the Department of Health (Ireland) developed a novel approach to the assessment of the EPHFs in Ireland. The approach involved a strategic and focused review of the delivery and consideration of EPHFs in relation to policy and planning, infrastructure, service delivery, coordination and integration, monitoring and evaluation and learning. Informed by a literature review and key document search, key stakeholder mapping and key informant interviews, lessons learned from experience with COVID-19 nationally and internationally, strengths as well as potential areas of improvement to optimize delivery of EPHFs were identified. Mapping of the EPHFs in Ireland revealed that there is evidence of delivery of all 12 EPHFs to varying degrees; however a number of challenges were identified, as well as numerous strengths and opportunities. Recommendations to optimize the delivery of EPHFs in Ireland include to integrate and coordinate EPHFs, increase the visibility of the public health agenda, leverage existing mechanisms, recognize and develop the workforce, and address issues with the Health Information System. There is a public health reform process currently underway in Ireland, with some of these recommendations already being addressed. The findings of this process can help further inform and support the reform process. Given the current focus on strengthening public health capacities globally, the findings in Ireland have applicability and relevance in other WHO regions and member states for health systems recovery and building back better, fairer and more resilient health systems.

Impact of the COVID-19 pandemic on cancer care in Ireland - Perspectives from a COVID-19 and Cancer Working Group.

Upon the COVID-19 pandemic onset in Ireland, cancer service disruptions occurred due to prioritisation of COVID-19 related care, redeployment of staff, initial pausing of screening, diagnostic, medical and surgical oncology procedures, staff shortages due to COVID-19 infection and impacts on the physical and mental health of cancer healthcare workers. This was coupled with reluctance among people with symptoms suspicious for cancer to attend for clinical evaluation, due to concerns of contracting the virus. This was further compounded by a cyber-attack on national health service IT systems on May 14th 2021. The Irish Cancer Society, a national cancer charity with a role in advocacy, research and patient supports, convened a multi-disciplinary stakeholder group (COVID-19 and Cancer Working Group) to reflect on and understand the impact of the pandemic on cancer patients and services in Ireland, and discuss potential mitigation strategies. Perspectives on experiences were gathered across domains including timeliness of data acquisition and its conversion into intelligence, and the resourcing of cancer care to address cancer service impacts. The group highlighted aspects for future research to understand the long-term pandemic impact on cancer outcomes, while also highlighting potential strategies to support cancer services, build resilience and address delayed diagnosis. Additional measures include the need for cancer workforce recruitment and retention, increased mental health supports for both patients and oncology professionals, improvements to public health messaging, a near real-time multimodal national cancer database, and robust digital and physical infrastructure to mitigate impacts of the current pandemic and future challenges to cancer care systems.

Pop-up COVID-19 vaccination clinics for vulnerable groups in the Midlands.

INTRODUCTION: Roma, travellers and the homeless suffer from a higher risk of both COVID-19 infection and severe disease relative to the general population. The purpose of this project was to ensure as many members as possible from vulnerable groups in the Midlands availed of COVID-19 vaccines. METHODS: Following on from successful testing of vulnerable populations in the Midlands of Ireland in March/April 2021, a collaboration of HSE Midland's Department of Public Health, Safetynet Primary Care and the HSE Midlands Traveller Health Unit (MTHU) operated pop-up vaccination clinics in June/July 2021, targeting the same populations. Clinics delivered the first dose of the Pfizer/BioNTech COVID-19 vaccine, registering clients for second doses in Community Vaccination Centres (CVCs). RESULTS: Thirteen clinics were hosted between 8 June 2021 and 20 July 2021, resulting in 890 first-dose Pfizer vaccinations delivered to vulnerable populations. DISCUSSION: Trust established months prior with our grassroots testing service resulted in strong vaccine uptake, with the quality service provided seeding further demand over time. This service integrated into the national system and allowed individuals to receive their second doses within the community.

A methodological approach to intra-action reviews - application and adaptation of existing global guidance during the COVID-19 pandemic response in Ireland, 2021.

Many countries were under-prepared for the arrival of an emergency such as the COVID-19 pandemic. An intra-action review allows countries, systems and services to reflect on their preparedness and response to date, and revise their policies and approaches as needed. We describe the approach to undertaking an intra-action review of Ireland's Health Protection COVID-19 response during 2021. A project team within National Health Protection developed a project plan, identified key stakeholders, trained facilitators and designed workshop programmes, employing integrated collaborative web tools. Multidisciplinary representatives participated in three half-day, independently facilitated workshops on challenges and solutions within specific response areas: communication, governance and cross-cutting themes such as staff well-being. An all-stakeholder survey sought further in-depth detail. Participants reviewed the ongoing pandemic response in terms of good practice and challenges and recommended implementable solutions. We customised our mixed-methods approach using existing ECDC/WHO guidance, producing consensus recommendations during Ireland's fourth wave of COVID-19, with particular focus on pathways to implementation. Our adaptations may help others in formulating and customising methodological approaches. During an emergency, identifying and reflecting on good practices to retain, and areas for strengthening, with a clear action plan of implementing recommendations, will enhance preparedness now, and for future emergencies.

Conceptualising the episodic nature of disability among adults living with Long COVID: a qualitative study.

INTRODUCTION: Our aim was to describe episodic nature of disability among adults living with Long COVID. METHODS: We conducted a community-engaged qualitative descriptive study involving online semistructured interviews and participant visual illustrations. We recruited participants via collaborator community organisations in Canada, Ireland, UK and USA.We recruited adults who self-identified as living with Long COVID with diversity in age, gender, race/ethnicity, sexual orientation and duration since initial COVID infection between December 2021 and May 2022. We used a semistructured interview guide to explore experiences of disability living with Long COVID, specifically health-related challenges and how they were experienced over time. We asked participants to draw their health trajectory and conducted a group-based content analysis. RESULTS: Among the 40 participants, the median age was 39 years (IQR: 32-49); majority were women (63%), white (73%), heterosexual (75%) and living with Long COVID for ≥1 year (83%). Participants described their disability experiences as episodic in nature, characterised by fluctuations in presence and severity of health-related challenges (disability) that may occur both within a day and over the long-term living with Long COVID. They described living with 'ups and downs', 'flare-ups' and 'peaks' followed by 'crashes', 'troughs' and 'valleys', likened to a 'yo-yo', 'rolling hills' and 'rollercoaster ride' with 'relapsing/remitting', 'waxing/waning', 'fluctuations' in health. Drawn illustrations demonstrated variety of trajectories across health dimensions, some more episodic than others. Uncertainty intersected with the episodic nature of disability, characterised as unpredictability of episodes, their length, severity and triggers, and process of long-term trajectory, which had implications on broader health. CONCLUSION: Among this sample of adults living with Long COVID, experiences of disability were described as episodic, characterised by fluctuating health challenges, which may be unpredictable in nature. Results can help to better understand experiences of disability among adults living with Long COVID to inform healthcare and rehabilitation.

Status of the health information system in Ireland and its fitness to support health system performance assessment: a multimethod assessment based on stakeholder involvement.

BACKGROUND: Between 2019 and 2021, the first Irish health system performance assessment (HSPA) framework was developed. As routinely collected health data are necessary to continuously populate indicators of an HSPA framework, a purpose-driven assessment of the health information system (HIS) in Ireland and its fitness to support the implementation of an HSPA framework was conducted. This study reports on the status of the Irish HIS through a multimethod assessment based on continuous broad stakeholder involvement. METHODS: Between May and November 2020, over 50 informants were engaged in individual and group interviews and stakeholder consultation workshops as part of the HIS assessment process. Descriptive themes and high-level data availability heatmaps were derived from interview and workshop data using thematic analysis. Indicator "passports" for the HSPA framework were populated during stakeholder consultation workshops and analysed using univariate descriptive statistics. RESULTS: The HIS in Ireland was able to provide administrative, survey and registry-based data for public sector acute care services, focusing on structure, process and output metrics. Significant data availability gaps, most notably from primary care, private hospitals and community care, were reported, with little availability of electronic health record and people-reported data. Data on outcome metrics were mostly missing, as were linkage possibilities across datasets for care pathway monitoring. The COVID-19 pandemic highlighted the national HIS's shortcomings but also the capacity for rapid development and improvement. CONCLUSIONS: A tailor-made assessment of the HIS in Ireland, involving a broad set of relevant stakeholders, revealed strengths, weaknesses and areas for improvement in the Irish health data landscape. It also contributed to the development of a national HSPA framework and momentum to further strengthen data infrastructure and governance, while working towards a more data-driven and person-centred healthcare system. This work demonstrates the utility of an inclusive HIS assessment process and is applicable beyond Ireland, where this case study was conducted.

Supporting radiography clinical placements in Ireland during the COVID-19 pandemic: The practice educators perspective.

INTRODUCTION: The COVID-19 pandemic has significantly impacted healthcare services and the clinical learning environment. Several studies have investigated radiography students' experiences of clinical placement during the pandemic; however, few have investigated the Clinical Practice Educator's (CPEs) perspective. CPEs play a pivotal role in supporting clinical education. METHOD: A qualitative study was conducted using a purposeful sample of twenty-two CPEs, each working in a different Irish hospital. Four semi-structured focus groups were used to gather data. To maintain reasonable homogeneity, CPEs who were new to the role (n = 8) were assigned a separate focus group from experienced CPEs (n = 14). Inductive thematic analysis was applied. RESULTS: CPEs experienced role expansion, particularly in managerial and administrative aspects of the role. They described arranging COVID-19 vaccinations locally for radiography students and the complexities of student rostering during the pandemic. CPEs perceived the pandemic to have impacted students' emotional wellbeing with 'high anxiety levels' and 'loneliness' being reported. They also perceived issues with clinical readiness and the student transition to clinical practice. Many challenges were faced by CPEs including arranging clinical recovery time for numerous students when sites were already at full capacity, fewer learning opportunities due to decreased patient throughput and range of imaging examinations, social distancing constraints, resistance from staff to student placements, and a shortage of staff for student supervision. Flexibility, communication, and multi-level support helped CPEs to fulfil their role. CONCLUSION: The results provide insight into how CPEs supported radiography clinical placements during the pandemic and into the challenges faced by CPEs in their role. CPEs supported student placement through multi-level communication, teamwork, flexibility, and student advocacy. IMPLICATIONS FOR PRACTICE: This will aid understanding of the support mechanisms needed by CPEs to provide quality clinical placements.

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".