SPHeRE Network 2nd Annual Conference - Book of Abstracts

SPHeRE network2nd  Annual  Conference“Population  health  and  health  services  research  in  Ireland:  current  trends  and  future  directions”Monday,    29th  of  February,  2016Royal  College  of  Surgeons  in  Ireland123  St  Stephens  GreenDublin  2

SPHeRE  TEAM  &  IMPORTANT  CONTACTS THANK  YOU The  SPHeRE  Network  would  like  to   SCIENTIFIC  COMMITTEE thank  all  Alumni  and  SPHeRE  Scholars   Chair:  Prof  John  Browne–  UCC who  have  contributed  to  the  smooth   Dr  Lisa  Mellon–  RCSI Dr  Suzanne  Timmons–  UCC running  of  the  conference.  In   Dr  Tamisine  Grimes–  TCD par cular,  those  who  have  facilitated   Dr  Kate  Irving–  DCU Dr  Jan  Rigby–  MU tables,  taken  notes  and  provided   Dr  Janas  Harrington–  UCC support  throughout  the  day. Prof  Susan  Smith–  RCSI Dr  Deirdre  Hurley-Osing–  UCD IMPORTANT  CONTACTS SPHeRE  Conference  Office SPHERE  DIRECTORS Prof.  Steve  Thomas  - Tel:  01  402  2735 SPHeRE  Director  (TCD) Email:  [email protected] www.sphereprogramme.com Prof.  Anne  Hickey  -   @sphereprogramme         SPHeRE  Co-director  (RCSI) #sphere16 Prof.  John  Browne  -   SPHeRE  Co-director  (UCC) SPHeRE  TEAM Dr.  Margaret  Cur n  -   SPHeRE  Assistant  Director  Networks  (UCC) Dr.  Sarah  Barry  -   SPHeRE  Assistant  Director   Teaching  &  Learning  (TCD) Mr  Carlos  Bruen- SPHeRE  Assistant  Director   Academic  Affairs  (RCSI) Ms.  Elaine  Healy  -   SPHeRE  Programme  Co-ordinator  (RCSI) Ms.  Rebecca  Kirrane  -   SPHeRE  Learning  Technologist  (RCSI) Ms.  Maureen  McDade- SPHeRE  Programme  Admin  (UCC) Ms.  Sheena  Cleary  - Programme  Admin  (TCD) Ms.  Mary  Morrissey  -   Conference  Scholar  Representa ve  (RCIS)

CONFERENCE  DETAILS  &  VENUE  MAP  —  INDEX SPHeRE  Team  &  Important  Contacts Conference  Details  &  Venue  MapConference  Venue Welcome  by  the  Programme  Director               Session  GuidelinesThe  2nd  Annual  Conference  of  the  SPHeRE  Network  will  be  held  at  the  Royal  College  of  Surgeons  in  Ireland  on  the  29th   Keynote  Speaker—Prof  B.  LawlorFeb,  2016. Keynote  Speaker—Prof  H.  BrugRegistra on  Desk SPHeRE  PhD  RecruitmentThe  registra on  desk  will  be  located  in  the  concourse  area  of   Conference  Programmethe  Royal  College  of  Surgeons,  near  the  York  St.  entrance.  It   Speaker  Abstractswill  be  open  from  8:30am-10am.  An  informa on  desk  will  be   Poster  Abstractsavailable  in  the  Exam  Hall  from  10am-6pm. List  of  DelegatesCoffee  BreaksDuring  the  breaks  in  the  morning  and  a ernoon,  there  will  be  coffee,  tea  and  water  provided  in  the  Exam  Hall.LunchTea,  coffee  &  sandwiches  will  be  available  in  the  Exam  Hall.WiFi  InternetFree  Internet  AccessNetwork:  RCSI-GuestUsername:  #sphere16Password:  #sphere16 TR  2-3 TR1 St.  Stephen’s  Green Houston   Theatre TR4 Concourse Stairs  up  to   Exam  Hall York  St.  Entrance  -   York  St. Main  Recep on

WELCOME  BY  THE  PROGRAMME  DIRECTOR SESSION  GUIDELINES Dear  Delegate,   Please  check  the  detailed  Programme  for   the   loca on   and   me   of   different   ses-­‐ We  are  delighted  to  welcome  you  to  the   second  annual  conference  of   sions. the   SPHeRE   Network.   We   are   very   excited   about   the   range   and   quality   of  research  on  display  today  showcasing  the  growing  excellence  of  Irish   The   Presenters   and   Chairs   are   kindly   popula on   health   and   health   services   research.   Nevertheless,   equally   asked   to   be   in   the   room   allocated   to   important  is  the  building  of  linkages  and  understanding  across  all  groups   their  session  5-  10  mins  or  earlier  before   involved   in   popula on   health   and   health   services,   whether   service   the   session   will   start,   to   check   their   providers,  health  service  managers,   policy  makers  or  researchers.  Only   equipment   is   working   correctly   and   the   with  a  strong  and  vibrant  network  can  policy  and  prac ce  appropriately   presenta ons  are  correctly  loaded,  or  to   inform   research   development,   and   research   findings   best   inform   policy   upload   their   presenta ons.   It   is   recom-­‐ and  prac ce. mended   that   the   presenters   keep   close   A er  the  success  of  the  first  conference,  we  have  decided  to  capitalise   track   on   me   and   (op onally)   provide   a   on   the   profile   of   our   conference   a endees   by   crea ng   an   innova ve   number   of   copies   of   their   presenta ons   space   for  shared  reflec on.  Our  conference  theme  of  reviewing  trends   (i.e.   handouts)   to   distribute   to   the   inter-­‐ and   planning   future   direc ons   will   therefore   take   shape   in   a   research   ested  par cipants.   priori sa on   exercise.   During   that   exercise   we   will   iden fy   together   what   the   conference   considers   the   most   important   research   ques ons   Papers   (individual   oral   presenta ons)   that   should   shape   not   only   the   SPHeRE   Programme   and   popula on   will   be   presented   in   chaired   thema c   health   and   health   services   research   agenda   specifically;   but   also   the   paper   sessions   and   divided     by   strand   ongoing   drive   for   evidence-based   policy,   be er   service   provision   and   (i.e.   best   prac ce   or   scien fic   strand).   health  system  development  in  Ireland  generally.     Each   presenta on   lasts   15   mins   with   5   mins   of   scheduled   me   for   discussion   We  hope  that  you  enjoy  the  day,  make  new  connec ons  and  take  home   and  ques ons.   fresh  understanding  into  your  own  spheres  of  influence. Posters   (individual   posters   in   IOS   A0   for-­‐ Prof.  Steve  Thomas,  SPHeRE  Director mat)   will   be   presented   in   the   Exam   Hall.   Prof.  Anne  Hickey,  SPHeRE  Co-Director Informal   sessions   will   be   organised   for   Prof.  John  Browne,  SPHeRE  Co-Director conference   par cipants   to   interact   with   authors,   from   10:30-10:55am   and   from   4:00-4:20pm.   The   presenters   are   kindly   asked  that  they  stand  next  to  their  post-­‐ er(s)   during   both   sessions   for   discussion   and  ques ons.

KEYNOTE  SPEAKER  1       Prof.  Brian  LawlorDirector  of  the  Memory  Clinic  at  the  Mercer's  Ins tute  for  Research  on  AgeingConolly  Norman  Professor  of  Old  Age  Psychiatry,  Trinity  College  Dublin  Consultant  Psychiatrist  for  the  Elderly  at  St  Patrick's  &  St  James's  Hospitals,  Dublin  The  Dementia  Research  Landscape:  From  Darkness  into  Light?   Professor   Lawlor   is   Conolly   Norman   Professor   of   Old   Age   Psychiatry   at   TCD   and  Up  un l  recently,  the  demen a  research  landscape  has  looked  rela vely   Director   of   the   Memory   Clinic   at   St,   James's  bleak.   There   have   been   no   new   drugs   licensed   for   Alzheimer’s   disease   Hospital,  Dublin.  His  research  interests  are  in  since   2002   and   there   are   currently   no   disease   modifying   treatments;   the  early  detec on,  diagnosis  and  treatment  research  funding  in  demen a  has  been  dispropor onately  low  compared   of  Alzheimer's  disease,  the  neurobiology  and  to   other   major   illnesses   such   as   cancer   and   people   with   demen a   and   treatment   of   behavioural   and   psychological  their   caregivers   have   been   placed   rela vely   low   on   the   priority   list   in   symptoms   in   demen a   and   the   study   of  terms  of  research  investment  and  innova on.   mental   disorders   and   loneliness   in   the   community  dwelling  elderly.  The  overarching  Many  young  researchers  have  le  the  field  of  demen a  research  within   aims   of   his   research   programmes   are   to  four   years   of   comple ng   their   PhD.   However,   the   de   may   be   turning:   develop   clinical,   neuropsychological   and  na onal   governments   are   beginning   to   make   demen a   a   priority;   biological   markers   of   Alzheimer's   disease   at  popula on   and   public   health   measures   appear   promising   as   ways   to   the   earliest   possible   stage   and   to   test  modify  risk  and  poten ally  prevent  demen a;  there  is  a  new  impetus  in   promising   new   interven ons   in   clinical  the   care,   caregiver   and   policy   space;   broader   molecular   targets   in   popula ons.  demen a   and   Alzheimer’s   disease   are   being   brought   into   focus   and  advocacy   by   people   with   demen a   themselves   is   becoming   a   growing   His   research   involves   collabora ve  force  worldwide.   partnership   with   disciplines   from   basic   science   (developing   animal   models   of  Greater   confidence   within   the   field   is   spurring   new   hope   but   we   need   Alzheimer's   disease)   through   to   health  research  leaders  to  accelerate  the  development  of  new  interven ons  and   service   development,   clinical   trials   and  treatments   that   are   evidenced   based.   Years   of   chronic   underinvestment   implementa on.  His  current  research  ac vity  means  that  there  are  simply  not  enough  researchers  working  in  the  field.   is  focused  on  CSF  biomarkers  for  Alzheimer’s  There  must  be  sustainable  and  sustained  investment  in  new  blood  so  that   disease  as  part  of  BiomarkAPD,  coordina ng  young   researchers   can   develop   and   be   supported   through   the   early   NILVAD,   a   major   inves gator   driven   clinical  stages   of   their   career.   We   must   establish   clear   career   pathways   and   trial  of  nilvadipine  in  Alzheimer’s  disease  and  mechanisms   to   encourage   a   broad   range   of   interdisciplinary   researchers   an   exercise   interven on   trial   in   mild  to  become  leaders  in  demen a  research  before  it’s  too  late.   cogni ve   impairment.   In   addi on,   he   is   working   with   a   research   team   exploring   cogni on   and   caregiver   stress,   hearing   impairment   and   cogni ve   reserve   in   older   people   at   the   Memory   Research   Unit   within   the  NEIL  Research  Programme  at  TCD.

KEYNOTE  SPEAKER  2 Prof.  Johannes  Brug Dean  and  member  of  the  execu ve  board;  Professor  of  Epidemiology VU  University  Medical  Center,  Amsterdam,  The  Netherlands.  Prof   Brug   received   a   M.Sc.   degree   in   Human   Motivation,  abilities  and  opportunities;;  the  holy  trinity  to  promote  Nutri on   from   Wageningen   University   and   a   healthy  diets  and  active  life  stylesM.Sc.   in   Epidemiology   from   the   Dutch  Epidemiology   Ins tute.   He   obtained   his   PhD   Unhealthy   diets   and   lack   of   physical   ac vity   are   –next   to   smoking-   the  (Public   Health)   at   Maastricht   University.   He   is   main   causes   for   avoidable   burden   of   disease   in   Europe.   To   inform  now   Dean   and   member   of   the   execu ve   interven ons   and   policies   to   promote   healthier   ea ng,   more   physical  board   at   the   VU   University   Medical   Center   in   ac vity  and  less  sedentary   me,  insight  in  the  ‘causes  of  the  causes’,  i.e.  in  Amsterdam.   He   is   Professor   of   Epidemiology   the  determinants  of  engaging  in  these  behaviours  is  needed.  and   an   honorary   professor   at   the   School   of  Nutri on   and   Exercise   Sciences   of   Deakin   For   long,   such   research   into   these   ‘causes   of   the   causes’   mainly   focused  University,  Melbourne  Australia. on  individual  level  determinants  of  health  behaviours,  such  as  knowledge,   a tudes  and  mo va ons,  resul ng  in  health  educa on-like  interven ons  Prof  Brug  worked  for  the  Dutch  TNO  Nutri on   to   promote   healthier   lifestyles.   In   the   last   decades   the   focus   has   shi ed  Ins tute,  the  Dutch  Cancer  Society,  the  School   towards   contextual   or   environmental   ‘causes   of   the   causes’,   i.e.   focusing  of   Social   Sciences   of   the   Netherlands   Open   on   availability   and   accessibility   of   healthy   and   unhealthy   choices.   This  University  (as  Dean  of  Educa on),  the  Faculty   resulted   in   calls   for   policy  interven ons   to   change   the   food   and   physical  of  Health  Sciences  at  Maastricht  University  (as   ac vity  environment  to  make  the  healthy  choice  the  easy  choice  or  even  Professor  of  Nutri on  Educa on  and  Director   the  default  choice.of  Educa on),  and  for  the  Erasmus  University  Medical   Center   (as   Professor   of   Determinants   A  need  for  further  research  was  recognized  across  Europe  and  resulted  in  of  Popula on  Health).  In  2007  he  took  on  the   a  first  joint  ac on  of  the  European  Joint  Programming  Ini a ve  A  healthy  posi on  of  director  of  the  EMGO  Ins tute  for   Diet   for   a   Healthy   Life.   This   DEDIPAC   (Determinants   of   Diet   and   Physical  Health  and  Care  Research  at  the  VU  University   Ac vity)   joint   ac on   brings   together   researchers   and   research   groups   to  Medical  Center  in   Amsterdam,  where  he  also   further   build   and   strengthen   the   evidence-base   regarding   these  held   posi ons   as   Head   of   Department   and   determinants,   to   inform   interven ons   and   policies   promo ng   healthy  Head   of   Division.   Prof   Brug’s   main   research   lifestyles  across  Europe.interests   are   in   behaviour   epidemiology,   with  a   special   interest   in   behavioral   nutri on   and  physical  ac vity.  His  research  covers  the  scope  from  studies  on  the  determinants  of  nutri on  and   physical   ac vity   behaviours,   small-scale  experimenta on   with   innova ve   ICT  supported   health   educa on   interven ons,  and   larger-scale   field   experiments   in   which  the   efficacy   and   external   validity   of   health  behaviour  promo ng  interven ons  are  tested.

SPHeRE  PhD  RECRUITMENT  2016-17 Applica ons  for  the  SPHeRE  PhD  Programme  are  now  open!          The   SPHeRE  PhD  Programme   in  Popula on   Health   and   Health   services   Research   (PHHSR)   aspires   to   cul vate  world-class  researchers  through  a  four-year  structured  PhD  Programme.  The  SPHeRE  Programme  can  also  be  undertaken  over  a  longer   me   period   on   a   part- me   basis.   The   Programme   is   a   joint   ini a ve   of   the   Royal   College   of   Surgeons   in   Ireland,   Trinity  College  Dublin  and  University  College  Cork,   with  funded  Scholars  having  the  op on  to  also  register  at   University  College  Dublin,  NUI  Galway,  Maynooth  University,  the  University  of  Limerick  or  Dublin  City  University.  We  welcome  applicants  with  an  interest  in  carrying  out  research  on  popula on  health  and/or  health  services  in  the  Irish  context   and   from   a   wide   range   of   academic   and   clinical   disciplines,   including   public   health,   health   psychology,   health  economics,  health  policy,  general  prac ce,  biosta s cs,  health  geography  and  social  science  among  others. The  full- me  funded  4  year  Structured  PhD  Programme  features:   Six  taught  modules  completed  in  the  first  year  of  the  programme 8-week  specialist  rota ons  in  Irish  health-related  agencies  in  the  first  year Opportuni es  for  mul disciplinary  research Supervision  by  interna onally  renowned  Principal  Inves gators Placement  with  a  pres gious  overseas  agency  to  further  PhD  project  development  in  the  2nd/3rd  years Professional  skills  training  allowance Travel  funds  to  na onal  training  days  and  interna onal  conferences Annual  s pend  of  €18,000  plus  laptop  computer  plus  PhD  feesThis   programme   provides   excellent   training   for   scholars   in   core   health   services   and   popula on   health   research   skills.  Applicants  who  have  already  secured  funding  for  their  PhD  and  applicants  who  wish  to  pursue  the  programme  on  a  part- me  basis  are  also  welcome  to  apply.  The  SPHeRE  Programme  is  subject  to  funding  by  the  HRB.Applica on  ProcedureApplicants  are  asked  to  complete  an  online  applica on  form  and  submit  a  one-page  cover  le er  and  a  two-page  Curriculum  Vitae  (including  grades  and  contact  details  for  two  referees).  In  your  cover  le er,  please  discuss  your  educa on,  training  and   experience   (research   and/or   prac ce)   in   popula on   health   and   health   services   research   and   provide   evidence   of  leadership  (in  an  academic  and/or  non-academic  capacity).  When  comple ng  your  applica on,  be  aware  that  only  applicants  who  intend  to  complete  the  Programme  on  a  full- me  basis  are  eligible  for  funding.  Further  informa on  on  part- me,  self  funded  posi ons  are  available  on  our  website.Please   visit   www.sphereprogramme.ie   for   further   informa on   and   to   apply   online.   The   applica on   process   will   open   in  February  2016.  

CONFERENCE  PROGRAMMEMORNING08:30 Registra on Front  Hall,  York  St.  Entrance09:30 Welcome  Address     Exam  Hall Prof.  Charles  Normand,  TCD09:40 Keynote  Address:  The  demen a  research  landscape—darkness  into  light?   Prof.  Brian  Lawlor,  TCD.  Chaired  by:  Prof.  Charles  Normand,  TCD  10:30 Coffee  Break  &  Poster  Presenta on Exam  Hall10:55 Parallel  Sessions  1  11:00 TR1 TR2-3 TR4 Houston  Theatre Health  Systems Research  Methods  including   Interven ons  &   Dementia Chair:  Ms  Mary  Morrissey Biosta s cs Implementa on  Science Dr  Elsa  Droog,  UCC  Developing   reconfigura on  plans  for   Chair:  Mr.  Carlos  Bruen Chair:  Dr.  Jan  Rigby Chair:  Dr.  Kate  Irving integrated  urgent  and  emergency   care  systems:  an  examina on  of   Ms  Mary  Walsh,  RCSI  The   Ms  Diana  van  Doorn,  Irish  Heart   Ms  Deirdre  Shanagher,  Irish   the  perceived  drivers  of  change valida on  of  two  risk  predic on   Founda on  Farmers  Have  Hearts:     Hospice  Foundation,  Advance   models  for  repeat  falls  in  the   Impact  of  opportunis c   Care  Planning  and  Advance   first  year  a er  stroke   Cardiovascular  Disease  (CVD)  risk   Healthcare  Directives  With   assessment  among  farmers People  With  Dementia11:20 Ms  Orla  Caffrey,  TCD  Is  Irish   Mr  David  O  Riordan,  UCC  The   Ms  Sarah  Cronin,  Irish  Hospice   Prof  John  Browne,  UCC  11:40 Experiments  in  system  12:00 Mul morbidity  Profile  Changing   effect  of  pharmacist-led   Foundation  Supporting  People   reconfigura on:  a  typology  of  12:20 models  for  changing  urgent  and   among  an  Older  Popula on? interven ons  in  op mising   with  Dementia  to  Die  at  Home   emergency  care  services  in  one   country prescribing  in  older  adults  in   in  Ireland primary  care:  a  systema c  review   and  meta-analysis   Mr  Chris  Brown,  Na onal   Dr  Ciara  Close,  Queen's   Dr  Patricia  McParland,  DCU  A   Mr  Conor  Keegan,  TCD  Switching   benefits  and  costs  in  the  Irish   Cancer  Registry  Ireland  Cau on   University  Belfast  The  evalua on   Dementia  Review:  What  have   private  health  insurance  market:   An  analysis  of  consumer  surveys in   me-to-event  models  where   of  an  early  interven on  to  reduce   we  learned  from  reviewing   a  pre-event  state  modifies   me- alcohol  consump on  and  related   policy,  research  and  data  on   varying  exposure harm  in  non-dependent  drinkers the  island  of  Ireland Mr  Jamie  Madden,  UCC  Short- Dr  Deirdre  Hurley,  UCD  Detailing   Ms  Emma  O’Shea,  UCC  Acute   Ms  Nora-Ann,  Donnelly,  RCSI   term  Blood  Pressure  Variability   the  use  of  the  interven on   hospital  dementia  care:  a  four   What  are  the  main  factors   over  24  hours  using  Mixed- mapping  process  to  develop  a   country  comparison influencing  long-term  care   effects  Models theory  driven,  group-based   admissions  in  Ireland?  Qualita ve   complex  interven on  and   insights  from  healthcare   feasibility  trial  in  Ireland’s   professionals  and  carers   primary  care  health   Ms  Elaine  Toomey,  UCD   Mr  Padraic  Fleming,  Maynooth   Mr  Kieran  Walsh,  UCC  Patterns   Ms  Sharon  Cadogan,  UCC   of  Prescribing  in  Older  People   Varia on  in  primary  care   Exploring  implementa on   University  Individualised  funding   with  and  without  Dementia  on   reques ng  pa erns  for  laboratory   Admission  to  Irish  Hospitals tests:  physician,  prac ce  or   fidelity  of  behaviour  change   for  people  with  a  disability  in   pa ent  factors?  A  mul -level   analysis interven ons  in  an  Irish  health   Ireland:  The  successes  and   service  research  context  using  a   challenges  of  implemen ng  four   mixed  methods  approach pilot  ini a ves12:40 Lunch

CONFERENCE  PROGRAMME AFTERNOON13:20 Parallel  Sessions  2  13:25 TR1 TR2-3 TR4 Houston  Theatre13:4514:05 Medica on  &  Care   Chronic  Condi ons Popula on  Health Health  of  Children  &  Young  14:25 Approaches People14:45 Chair:  Prof.  Susan  Smith Chair:  Dr.  Deirdre  Hurley-Osing Chair:  Prof.  Molly  Byrne Chair:  Dr.  Janas  Harrington Dr  Emma  Wallace,  RCSI  Impact   Dr  Mark  Murphy,  RCSI  Varia on   Ms  Gillian  Maher,  UCC   Ms  Eileen  Curran,  UCC  The  effect   of  poten ally  inappropriate   in  prescribing  of  new  injectable   Protec ve  lifestyle  behaviours   of  hypertensive  disorders  in  preg-­‐ prescribing  on  adverse  health   medica ons  for  type  2  diabetes   and  depression  in  middle  aged   nancy  on  the  risk  of  attention   outcomes  in  community- mellitus  in  Ireland  in  2013 Irish  men  and  women:  a   deficit  hyperactivity  disorder dwelling  older  people:  a   secondary  analysis. prospec ve  cohort  study Ms  Chris na  Hansen,  UCC   Mr  Frank  Moriarty,  RCSI   Ms  Sarah  Fitzgerald,  UCC   Dr  Eimear  Keane,  NUIG  Self- Obesity,  diet  quality  and   reported  exposure  to  cigarette   Experiences  of  intern  doctors  in   Poten ally  inappropriate   absenteeism  in  a  working   pack  warnings  in  the  last  6   popula on   months  and  perceptions  of  smok-­‐ prescribing  pa ents  in  hospital:   prescribing  (PIP)  in  two   ing-related  harm  in  school  aged   children a  systema c  review  of  the   popula ons  with  differing  socio- qualita ve  literature economic  profiles:  a  cross- sec onal  database  study  using   the  PROMPT  criteria Dr  Elaine  Walsh,  UCC  Economic   Dr  Sara  Hayes,  University  of   Ms  Aine  Ryan,  RCSI   Dr  Siobhán  O'Higgins,  NUIG  Not   Impact  of  medica on  error:  a   Limerick  The  independent   Mul morbidity  and  func onal   seeing  eye-to-eye:    Differential   systema c  review associa ons  between  Social   decline  in  community  dwelling   reporting  of  chronic  pain  by  chil-­‐ Cogni ve  Theory  domains  and   adults:  a  systema c  review dren  and  their  parents  (PRIME  C) physical  ac vity  among  people   with  Mul ple  Sclerosis  in  Ireland Ms  Caragh  Flannery,  NUIG   Ms  Marian  Hernon,  UCD   Dr  Frank  Doyle,  RCSI  A tudes   Ms  Christine  Deasy,  University  of   to  organ  dona on:  Overcoming   Limerick,  Psychological  distress   Experiences  of  lifestyle   Systema c  review  of  costs  and   the  'ick  factor'  and  medical   and  help  seeking  among  higher   distrust  to  increase  inten on  to   education  students management  and  support   effects  of  self-management   donate during  pregnancy:  a  qualita ve   interven ons  for  chronic   study  of  the  a tudes  and   musculoskeletal  pain:  spotlight   experiences  of  pregnant  women   on  analy c  perspec ves  and   and  healthcare  professionals outcomes  assessment Ms  Marcella  McGovern,  UCD  A   Mr  Conor  Kerley,  Connolly   Dr  Catriona  Murphy,  TCD  Cross   Ms  Emily  Kelleher,  UCC  Barriers   conceptual  model  for  the   and  facilitators  associated  with   implementa on  of  horizontal   Hospital  Blanchardstown,  Dietary   sec onal  and  longitudinal  trend   initial  and  continued  attendance   integra on  in  primary  care   at  community-based  interven-­‐ teams nitrate:  a  novel,  innova ve  roles   in  serum  total  cholesterol  in   tions  among  families  of  over-­‐ weight  and  obese  children in  common,  diverse,   older  adults:  results  from  the   cardiorespiratory  disorders   Irish  Longitudinal  Study  on   Ageing  (TILDA)15:10 Round-Table  Discussion   Exam  Hall Chaired  by  Prof.  Steve  Thomas,  TCD  16:00 Coffee  Break Exam  Hall16:20 Feedback  from  Round-Table  Discussion   Exam  Hall Exam  Hall16:40 Keynote  Address:  Mo va on,  Abili es  and  opportuni es;  the  holy  trinity... Prof.  Johannes  Brug,  VU  Uinversity,  Amsterdam.  Chaired  by:  Prof.  John  Browne,  UCC Exam  Hall Exam  Hall17:30 Poster  Award  Presenta on  by  Prof.  John  Browne17:35 Conference  Closing Dr.  Graham  Love,  HRB  

POSTER  PRESENTATIONS HEALTH  OF  OLDER  PEOPLE  A1 Cronin Sarah Irish  Hospice   Loss  and  Grief  in  Demen aA2 Cronin Sarah Founda onA3 O'  Shea EmmaA4 Healy Chiara Irish  Hospice   Dying  to  talk:  Facilita ng  Discussion  on  Future  and  End-  of  -Life  care  with  people  with  A5 Healy Chiara Founda on demen aA6 Moore PatrickA7 Leahy Siobhan UCC Acute  Hospital  Demen a  Care:  A  Four  Country  ComparisonA8 Moore Patrick UL Clean  mouths  save  lives—risks  of  pneumonia  in  the  elderly  due  to  poor  oral  hygiene.  A   review  of  the  literature  with  recommenda ons  for  the  mul -disciplinary  team UL Health  issues  in  older  pensioners—iden fying  the  poten al  markers  for  dysphagia TCD The  Impact  of  Sta n  Use  on  Health  Behaviours:  complement  or  subs tute? TCD Diabetes  and  Depressive  Symptoms  in  Older  Age:  Evidence  From  The  Irish  Longitudinal   Study  on  Ageing TCD The  Impact  on  Medica on  Use  of  a  Change  in  Health  Insurance  Status:  Evidence  from   the  Irish  Longitudinal  Study  on  Ageing  (TILDA) HEALTH  INTERVENTIONS  AND  TECHNOLOGIES  B1 Cadogan Sharon UCC Evalua on  of  guidelines  combined  with  automated  educa onal  messages  for  improving  B2 Casey Bláthín the  use  of  laboratory  tests  among  Primary  Care  physicians:  An  Interrupted  Time  SeriesB3 Manning Molly UL Changing  Physical  Ac vity  Behaviour  in  People  with  Mul ple  Sclerosis:  A  Systema c   Review UL Applica on  of  Cogni ve  Grammar  to  the  analysis  of  aphasic  discourse:  A  pilot  study.B4 Murphy Mark Effec veness  of  interven ons  in  primary  care  to  improve  glycated  haemoglobin  (HbA1c)   RCSI and  cardiovascular  risk  factor  levels  in  pa ents  with  poorly-controlled  type  2  diabetes   mellitus:  a  systema c  review.B5 Sweeney Janice UCC Point  of  care  coding:  a  feasibility  studyB6 Moore Gemma ARCH  UCD Clinical  Engagement  as  a  Key  Enabler  to  the  Adop on  of  Connected  Health   Technologies  in  Irish  HealthcareB7 O'Mahony James TCD Revisi ng  the  Simula on  Evidence  for  the  Incremental  Cost-Effec veness  of  Biennial   Breast  Cancer  Screening  of  Average-Risk  WomenB8 Monk Gary HSE Connolly  Hospital—the  NIMIS  PFT  Experience POPULATION  HEALTH  C1 Burns Anne e RCSI Exploring  smoking,  mental  health  and  smoking-related  disease  in  older  adultsC2 Close CiaraC3 Fawsi Christopher QUB The  mental  health  and  well-being  of  first  genera on  migrants.  A  review  of  reviewsC4 Shanagher Deirdre TILDA Examining  the  role  of  public  healthcare  eligibility  in  determining  undiagnosed  C5 Shanagher Deirdre hypertension  and  high  cholesterol  among  older  adults  in  Ireland:  analysis  using  C6 Smith Amelia Irish  Hospice   informa on  from  the  Irish  Longitudinal  Study  on  Ageing  (TILDA)C7 Curran Eileen Founda onC8 Huynh Maily Irish  Hospice   A  Night  Nursing  Service  For  People  With  a  Non-Malignant  Illness Founda on TCD The  GP  OOH  Pallia ve  Care  Handover  Project UCC De-novo  post-diagnos c  sta n  ini a on  and  mortality  in  women  with  stage  I-III  breast   cancer. University  of   Birth  by  Caesarean  sec on  and  the  risk  of  adult  psychosis:  a  popula on-based  cohort   Saskatchewan study Informing  a  public  health  surveillance  strategy  using  recrea onal  water  quality  data  to   address  the  rise  in  cyanobacterial  blooms  in  Saskatchewan,  Canada

POSTER  PRESENTATIONSD1 Al  Shehhi Maryam OLCHC HEALTH  SYSTEMS  D2 CadoganD3 Day Sharon UCC Impact  of  Advanced  Genomics  on  Health  Services;  Department  of  Clinical  Gene cs  as  An  D4 Lynch Mary  Rose UCC exampleD5 O'Rourke Brenda UCC General  Prac oners’  a tudes  towards  serum  immunoglobulin  tes ng  in  the  South  of   Niamh HSE Ireland:  a  qualita ve  studyE1 Gormley Prevalence  of  Self-Neglect  on  Public  Health  Nurses  CaseloadsE2 FoleyE3 Horgan Case  fatality  ra os  for  emergency  condi ons:  regional  varia on  in  Ireland  2000-2012E4 HorganE5 McGillicuddy Non-medical  factors  influencing  medical  decisions:  a  study  of  breast  cancer  referral   pa erns  in  IrelandF1 FlahertyF2 O'  Donovan QUALITY  OF  CARE  F3 ShanleyF4 Perry Emer Centre  for  Pain   Using  Interac ve  Management  to  Model  Factors  Influencing  the  Applica on  of   Research Biospsychosocial  Perspec ves  in  Clinical  Judgment  of  Chronic  Pain  Cases Conor UCC Pa ent  sa sfac on  with  urgent  and  emergency  care  in  Ireland:  local,  regional  and   interna onal  comparisons. Frances RCSI Frances RCSI Exploring  the  factors  related  to  return  to  work  a er  stroke  in  Ireland Aoife UCC Factors  associated  with  return  to  work  a er  stroke:  a  qualita ve  meta-synthesis Oral  dosage  forms;  Are  we  mee ng  the  individual  needs  of  the  older  pa ent? Sarah  Jane UCC FOOD  AND  HEALTH   Exploring  the  reflec ve  processes  and  determinants  of  healthy  ea ng  habits Fiona RCSI Inves ga ng  the  cogni ve  benefits  associated  with  the  consump on  of  omega  -3   Sinead polyunsaturated  fa y  acids  (PUFAs)  enriched  foods  products Irish  Heart   Founda on Food  Provision  in  Post  Primary  Schools.    Feasibility  of  a  na onal  Healthy  Catering  Award. Catherine NUIG The  associa on  between  markers  of  diet  quality  and  wellbeing  in  adolescents

SPEAKER  ABSTRACTS Brown,  Chris,  Na onal  Cancer  Registry  Ireland Caution  in  time-to-event  models  where  a  pre-event  state  modifies  time-varying  exposure T.  Barron                   Background:  In  cancer  outcome  studies  it  is  important  to  dis nguish  between  effects  of  pre-  and  post-diagnos c  exposures.  A  common  approach  to   this  is  conduct  a  single  analysis  of  fixed  and   me-varying  exposures  with  naïve  mutual  adjustment.  However,  if  changes  in  prognosis  (i.e.  recurrence)   influence  post-diagnos c  exposure,  this  may  introduce  collider  stra fica on  bias  (CSB).  We  conducted  a  simula on  study  to  quan fy  the  influence  of   CSB  in  studies  of  drug  exposures  and  cancer  outcomes. Methods:  We  simulated  event   mes  for  2000  observa ons  with  binomial  pre-diagnos c  exposure:  p=0.25,  null  hazard  ra o  (HR)=1  (max   me:5.5   years,  event  rate:  0.02%/day).  Subsequently  we  generated  a   me-varying  con nua on  of  post-diagnos c  exposure  with  fixed  start/stop  probabili es   (start=10%/year,  stop=3%/year).  To  illustrate  CSB  we  modified  stop  probabili es  in  the  year  prior  to  death  by  a  pre-death  probability  factor  (PDPF)  1x -5x.  HR  for  pre-diagnos c  (Pre-HR)  and  post-diagnos c  (Post-HR)  exposures  were  es mated  using  Cox  regression. Results:  In  50  simulated  datasets,  models  with  no  PDPF  had  mean  Post-HR=1.01,  Pre-HR=1.01.  Where  stop  probability  was  doubled  (PDPF=2)  effects   were  clear  (Post-HR=0.78,  Pre-HR=1.37).  In  the  extreme  (realis c)  scenario  (PDPF=5)  effects  were  substan al  (Post-HR=0.29,  Pre-HR=2.11). Conclusions:  In  scenarios  where  post-diagnos c  exposure  is  modified  by  changes  in  prognosis,  naïve  adjustment  leads  to  spurious  effect  observa ons   for  pre-/post-diagnos c  exposures. Cadogan,  Sharon,  UCC Variation  in  primary  care  requesting  patterns  for  laboratory  tests:  physician,  practice  or  patient  factors?  A  multi-level  analysis J.  Browne,  C.  Bradley,  M.  Cahill           Background:  The  volume  of  test  requests  rise  annually  by  3-6%  despite  a  similar  level  of  morbidity  in  the  popula on.  This  research  aimed  to  iden fy   the  factors  associated  with  higher  reques ng  pa erns. Methods:  Cross-sec onal  analysis  of  rou ne  laboratory  data  on  serum  immunoglobulin  (Ig)  test  requests  by  486  GPs  in  the  South  of  Ireland.  Data   were  extracted  (2013)  from  the  Health  Service  Execu ve’s  APEX  laboratory  system.  Data  included  physician  level  (gender,  years’  experience,  universi-­‐ ty),  prac ce  level  (urban/rural,  prac ce  type,  size  of  prac ce)  and  pa ent  level  factors  (gender,  age,  loca on).  Using  stata  v12,  mul level  Poison  re-­‐ gression  analysis  were  performed  to  iden fy  factors  associated  with  higher  reques ng  pa erns. Results:  In  2013,  over  18,000  Ig  tests  for  approximately  6,000  primary  care  pa ents  in  the  South  of  Ireland.  Male  physicians’  (OR:  1.19;  95%CI:  1.11- 1.28),  medical  degree  from  a  local  university  (OR:  1.55;  95%CI:  1.43-1.68),  single-handed  prac ces  (OR:  1.58  (1.04-2.39),  urban  prac ces  (OR:  2.16;   95%CI:  1.41-3.32)  and  physician’s  years  of  experience  (OR:  1.01;  95%CI:  1.006-1.01)  were  posi vely  associated  with  higher  reques ng  pa erns  (p- value  <0.05).   Conclusions:  Physician  and  prac ce  level  factors  appear  to  have  the  greatest  effect  on  laboratory  reques ng  pa erns.  The  design  of  future  interven-­‐ ons  aimed  at  op mizing  laboratory  use  in  Primary  Care  should  consider  these  factors. Caffrey,  Orla,  TCD Is  Irish  multimorbidity  profile  changing  among  an  older  population? C.  Normand,  O.  Cleary,  M.  Lee           Introduc on:  The  presence  of  two  or  more  chronic  condi ons  (mul morbidity)  among  older  adults  is  prevalent  in  Ireland  and  shown  to  be  increasing   in  other  countries.  This  study  extends  previous  Irish  evidence  to  explore  mul morbidity  changes  over   me  and  enable  cross-country  comparison.     Methods:  Sta s cal  analyses  (survey  weighted)  were  conducted  in  STATA  (v.12.1)  on  6,991  people  aged  50  over  two  consecu ve  waves  within  “The   Irish  Longitudinal  Study  of  Ageing”  (TILDA).  Mul morbidity  was  defined  as  the  presence  of  2+,  2,3  and  4+  condi ons  to  explore  the  impact  of  in-­‐ creased  complexity  on  demographics  and  health  u lisa on.  Dyadic  and  triadic  condi on  combina ons  were  also  explored. Results:    Wave  two  saw  149  new  cases  of  mul morbidity  (3,772  vs.  3,921).    Almost  all  frail  individuals  were  mul morbid  (372/382;  435/444).  Differ-­‐ ent  mul morbidity  complexity  was  associated  with  different  demographic  characteris cs  (p<0.05)  and  health  u lisa on.  High  blood  pressure  and   high  cholesterol  were  the  most  prevalent  dyadic  combina on  (13.9%  vs.  16.6%).  The  most  prevalent  triad  was  achieved  with  the  addi on  of  hip  frac-­‐ tures  to  this  pairing  (2.6%  vs.  4.5%)  

SPEAKER  ABSTRACTSClose,  Ciara,  Queen's  University  BelfastThe  evaluation  of  an  early  intervention  to  reduce  alcohol  consumption  and  related  harm  in  non-dependent  drinkers                    Background:  Over  half  of  adults  in  Ireland  drink  at  a  harmful  level,  a  situa on  requiring  urgent  a en on  given  the  link  between  harmful  drinking  and  long-term  health.    Early  interven ons  are  recommended  to  reduce  alcohol-related  harm  but  these  are  scare.  The  Alcohol  and  You  (AAY)  Project  (2012-2016)  supports  adults  drinking  harmfully,  not  mee ng  dependence  criteria.    Support,  includes  self-help  web-based  support  ,  a  brief  interven on  service,  and  a  counselling  service.  The  evalua on  of  AAY  aimed  to  assess  the  projects  effec veness  in  reducing  alcohol-related  harm  in  harmful  drink-­‐ers.Methods:  Before  and  a er  treatment  ques onnaires  on  alcohol  consump on  and  depression  were  administered  to  face  to  face  service  users  along  with  a  survey  to  web  self-help  users.  SPSS  was  used  for  analysis.Results:  3678  accessed  AAY,  mostly  through  the  website  (82%).  Most  self-help  users  reported  web  support  would  make  them  think  more  about  their  drinking  (59%)  and  would  make  them  reduce  their  drinking  (64%).  Face  to  face  interven ons  significantly  reduced  severity  of  alcohol  dependence  and  depression  scores.Conclusion:  Self-help  and  face  to  face  interven ons  resulted  in  posi ve  changes  in  alcohol  behavior.  The  wide  reach  and  posi ve  impact  of  web-based  self-help  for  alcohol,  suggest  this  interven on  may  be  effec ve  for  reducing  alcohol  related  harm  at  a  popula on  level.Cronin,  Sarah,  Irish  Hospice  Founda onSupporting  people  with  dementia  to  die  at  home  in  IrelandM.  Lynch                  Background:  The  number  of  people  with  demen a  referred  to  the  night  nursing  service  (NNC)  has  risen  significantly  since  2007  with  86  people  with  demen a  accessing  the  service  in  2014.  The  aim  was  to  explore  components  of  care  which  support  a  person  with  demen a  who  accessed  the  night  nursing  service  to  die  at  home.  Method:  Supplementary  informa on  from  specialist  pallia ve  care  teams  (SPCT)  was  gathered  for  50  demen a  referrals  to  the  night  nursing  service  between  May  and  December  2015.  Results:  Preliminary  analysis  indicates  that  families  are  providing  between  12-  24  hours  of  care  per  day  to  people  with  demen a  dying  at  home.  Most  people  were  referred  to  SPCT  when  they  were  imminently  dying,  with  the  main  reason  for  referral  to  NNC  being  symptom  control.  Conclusion:  This  audit  demonstrates  the  range  of  supports  and  services  that  people  with  demen a  need  to  die  at  home.  There  is  a  need  to  increase  awareness  of  the  pallia ve  care  needs  of  people  with  demen a.Deasy,  Chris ne,  ULPsychological  distress  and  help  seeking  among  higher  education  studentsB  .  Coughlan,  D.  Jourdan,  J.  Pironom,  P.  Mannix-McNamara,      Background:  Higher  educa on  students  evidence  high  levels  of  psychological  distress  (PD),  which  can  adversely  impact  academic  performance,  reten-­‐ on,  mental  health  and  lifestyle.  This  mixed  method  study  aimed  to  examine  PD,  sources  of  PD  and  students  help  seeking  behaviours.Methods:  Undergraduate  nursing/midwifery  and  teacher  educa on  students  at  an  Irish  university  (n=1112)  completed  a  survey  comprising  the  Gen-­‐eral  Health  Ques onnaire  (GHQ)  to  measure  self  reported  PD  and  the  Lifestyle  Behaviour  Ques onnaire  to  determine  sources  of  distress,  lifestyle  and  demographic  indicators.  Individual  interviews  (n=59)  explored  student  experiences  of  PD  and  their  help  seeking  behaviours.  Results:  Forty  two  per  cent  of  respondents  exceeded  the  GHQ  threshold  -  5,  which  signifies  risk  of  mental  or  physical  health  problems.  Students  re-­‐ported  academic,  financial  and  psychosocial  stressors.  Regression  analysis  iden fied  that  demographic,  programma c  and  lifestyle  variables  predict-­‐ed  GHQ  scores.  Despite  the  elevated  PD  students  were  reluctant  users  of  support  services.  Decisions  to  seek  help  were  complex  and  grouped  under  four  themes:  reluctance  to  admit  vulnerability;  s gma;  lack  of  awareness\understanding  and  prior  experience  of  accessing  support.  Conclusion:  The  extent  of  PD  among  this  popula on  is  a  concern.  Educa on  providers  must  be  vigilant  for  PD  and  provide  effec ve  interven ons,  cognisant  of  the  impact  of  s gma  on  help  seeking.

SPEAKER  ABSTRACTS Donnelly,  Nora-Ann,  RCSI What  are  the  main  factors  influencing  long-term  care  admissions  in  Ireland?  Qualitative  insights  from  healthcare  professionals  and  carers. N  .  Humphries,  A.  Hickey,  F.  Doyle           Background:  This  study  builds  on  the  findings  from  a  systema c  review  and  meta-analysis  which  found  that  while  carer  stress  has  a  significant  effect   on  long-term  care  admission,  the  overall  effect  size  was  negligible.  The  results  suggest  that  other  factors  are  probably  more  important  in  long-term   care  admission  and  should  be  inves gated.    Hence  this  study  analyses  healthcare  professionals  and  carers  percep on  of  the  main  factors  influencing   long-term  care  admission  in  Ireland.   Methods:  Thirty-eight  qualita ve  in-depth  interviews  with  healthcare  professionals  and  carers.  Interviews  focused  on  healthcare  professionals  and   carers  percep ons  of  the  main  factors  which  influence  admission  to  long-term  care.Thema c  analysis  was  employed  to  analyse  the  data. Results:  Ini al  analysis  suggests  the  inability  to  meet  care  recipient’s  needs  at  home  in  conjunc on  with  associated  health  system  factors  drives  carer   stress.  Thus,  while  carer  stress  is  important,  health  system  factors  are  cri cal  to  nursing  home  placement.  These  include  difficul es  in  naviga ng  ser-­‐ vices,  service  delivery  being  both  suppor ve  and  counter-produc ve  and  the  pivotal  influence  of  acute  admissions. Conclusion:  The  study  highlights  the  par cular  influence  health  system  factors  have  in  the  long-term  care  admission  process  in  Ireland. Doyle,  Frank,  RCSI Attitudes  to  organ  donation:  Overcoming  the  'ick  factor'  and  medical  distrust  to  increase  intention  to  donate E.  Dolan,  J.  Flynn,  R.  O'Carroll,  S.  Doherty       Background:  Cogni ve  evalua ons  of  the  evidence  around  organ  dona on  are  less  important  than  emo onal  or  visceral  beliefs  or  reac ons,  known   as  ‘affec ve  a tudes’,  supers on  or  medical  distrust,  for  predic ng  inten on  to  donate.  However,  actually  discussing  such  beliefs  with  people  may   nega vely  impact  on  poten al  donors’  inten on  to  donate.  We  inves gated  this  in  a  randomised  trial.   Methods:  Par cipants  (n=578)  in  four  shopping  centres  were  surveyed  on  their  a tudes  to  organ  dona on.  Non-donors  (n=349)  were  randomly  as-­‐ signed  to  one  of  three  groups:  Group  1  completed  items  on  affec ve  and  cogni ve  a tudes  to  dona on  and  other  psychological  predictors.  Groups  2   and  3  completed  all  items  above  but  excluded  affec ve  a tudes  (group  2)  or  omi ed  nega vely-worded  affec ve  a tudes  only  (group  3).  Inten on   to  donate  was  the  primary  outcome,  and  was  predicted  using  linear  regression. Results:  Affec ve  a tudes,  medical  distrust  and  supers on  discriminated  between  donors  and  non-donors.  Group  2  had  the  highest  mean  inten on   to  donate  score,  which  was  significantly  higher  than  group  1  (β=0.518,  95%  confidence  interval  0.18–0.86). Conclusion:  While  affec ve  a tudes  do  predict  dona on,  public  health  campaigns  to  increase  organ  dona on  need  to  be  aware  that  specifically  elic-­‐ i ng  such  a tudes  may  have  a  nega ve  impact  on  inten on  to  donate. Droog,  Elsa,  UCC Developing  reconfiguration  plans  for  integrated  urgent  and  emergency  care  systems:  an  examination  of  the  perceived  drivers  of  change C.  Foley,  O.  Healy,  C.  Buckley,  M.  Boyce,  J.  Browne Background:  The  Health  Service  Execu ve  has  embarked  on  a  series  of  regional  reconfigura on  programmes  to  radically  change  the  organisa on  of   urgent  and  emergency  care  delivery  in  Ireland,  amidst  substan al  budget  and  staffing  reduc ons  and  heightened  awareness  of  problems  around   quality  and  safety.  Our  aim  was  to  analyse  the  interplay  of  access,  quality  and  cost  drivers  behind  this  process. Methods:  A  documentary  analysis  was  conducted  of  na onal  and  regional  policy  documents.  Also,  200  semi-structured  interviews  were  conducted   with  stakeholders  (healthcare  providers,  hospital  campaign  groups,  poli cians,  etc.)  in  eight  geographical  regions  across  Ireland.  A  framework  analysis   approach  was  used.  Yin’s  mul ple  case  study  methodology  was  employed  to  compare  and  contrast  findings  across  the  eight  regions. Results:  While  quality  and  safety  goals  were  documented  as  driving  reconfigura on,  there  was  some  cynicism  among  stakeholders  as  to  the  true  mo-­‐ va ons  behind  this  process.  Decision-making  around  service  changes  was  broadly  perceived  as  opaque  and  influenced  by  poli cal  and  cost-saving   concerns,  given  funding  cutbacks  associated  with  Ireland’s  economic  recession.   Conclusion:  While  the  recession  appears  to  have  presented  an  opportunity  for  change,  it  nonetheless  hampered  its  implementa on  and  coloured   views  on  its  purpose.  Unmet  promises  outlined  in  policy  documents  have  fostered  cynicism  over  mo va ons  behind  service  reconfigura ons.

SPEAKER  ABSTRACTSFitzgerald,  Sarah,  UCCObesity,  diet  quality  and  absenteeism  in  a  working  populationA  .  Kirby,  A.  Murphy,  F.  Geaney          Research  has  indicated  that  obesity  and  obesity-related  diseases  (cardiovascular  disease,  stroke  and  diabetes)  are  associated  with  absenteeism.  How-­‐ever,  the  rela onship  between  absenteeism  and  adverse  lifestyle  factors  remains  ambiguous.  Using  objec ve  measures  for  absenteeism  and  health  status,  this  study  aimed  to  inves gate  what  health  status  and  lifestyle  factors  influence  workplace  absenteeism.Cross-sec onal  data  were  obtained  from  a  workplace  dietary  interven on  trial.  Par cipants  included  540  randomly  selected  employees  from  four  mul na onal  manufacturing  workplaces  in  Cork.  Annual  count  absenteeism  data  were  collected.  Physical  assessments  included  measures  of  obesity  and  blood  pressure.  Food  Frequency  Ques onnaires  measured  diet  quality  from  which  DASH  (Dietary  Approaches  to  Stop  Hypertension)  scores  were  constructed.  A  zero-inflated  nega ve  binomial  (zinb)  regression  model  examined  associa ons  between  health  status,  lifestyle  characteris cs  and  absenteeism.The  mean  number  of  days  absent  was  2.5  days  (standard  devia on:  4.5).  Central  obesity  increased  expected  rate  of  absences  by  72%.  Consuming  a  high  quality  diet  and  engaging  in  moderate  physical  ac vity  levels  reduced  expected  frequency  by  50%  and  36%.  Being  in  a  managerial/supervisory  posi on  also  reduced  expected  frequency  of  absenteeism  by  50%.Workplace  health  promo on  policies  should  incorporate  recommenda ons  that  are  designed  to  prevent  and  manage  excess  weight,  improve  diet  Flannery,  Caragh,  NUIGExperiences  of  lifestyle  management  and  support  during  pregnancy:  a  qualitative  study  of  the  attitudes  and  experiences  of  pregnant  women  and  healthcare  professionalsS.  McHugh,  M.  O'Riordan,  L.  Kenny,  M.  Byrne,  P.  KearneyBackground:  Pregnancy  has  been  iden fied  as  a  ‘teachable  moment’,  an  opportunity  to  intervene  to  improve  lifestyle  behaviours.    Studies  have  var-­‐ied  in  their  effec veness  to  change  behaviour  therefore  our  aim  is  to  iden fy  the  barriers  and  enablers  to  behaviour  change  from  the  perspec ve  of  both  pregnant  women  and  healthcare  providers  (HCP).Methods:  Semi-structured  interviews  were  conducted  with  overweight  or  obese  pregnant  women,  recruited  from  the  maternity  hospital  in  Cork  (CUMH)  (n=22).    A  purposive  sample  of  HCP  will  also  be  recruited  (n=10-15).  The  Framework  approach  is  being  used  for  analysis,  drawing  on  the  The-­‐ore cal  Domains  Framework  (TDF)  and  the  COM-B  model.  Results:  The  TDF  domains  ‘Op mism’  and  ‘Professional/social  role  and  iden ty’  did  not  match  to  the  data.  ‘Knowledge’  was  iden fied  by  women  as  a  barrier,  par cularly  the  lack  of  lifestyle  informa on  on  physical  ac vity.  ‘Social  influences’  were  iden fied  as  enablers;  pregnant  woman  suggested  behaviour  change  was  easier  when  supported  by  their  partners.  ‘Beliefs  about  consequences’  were  also  iden fied  as  enablers;  awareness  of  weight  issues  and  fear  of  gesta onal  diabetes  influenced  women’s  dietary  and  physical  ac vity  behaviour.Conclusion:  The  results  will  be  used  to  inform  the  development  of  a  lifestyle  interven on  to  improve  diet  and  increase  physical  ac vity  levels  among  Fleming,  Padraic,  Maynooth  UniversityIndividualised  funding  for  people  with  a  disability  in  Ireland:  the  successes  and  challenges  of  implementing  four  pilot  initiativesS.  McGilloway,  S.  Barry              Background:  The  disability  sector  shi  toward  community-based  services  led,  in  parallel,  to  the  development  of  innova ve  new  models  of  support  based  on  individualised-funding.  These  aim  to  ensure  that  people  with  disabili es  are  fully  autonomous  and  self-determined  members  of  society.Methods:  A  mul -phase  mixed  methods  evalua on  of  the  implementa on  of  four  individualised-funding  pilot  ini a ves  in  Ireland.  Phase  one  -  re-­‐ported  here  -  included  a  documentary  analysis,  in-depth  interviews  (n=44)  and  a  par cipatory  workshop  (n=20).  Results:  Individuals  reported  improvements  in  self-image,  as  well  as,  personal  and  social  skills  due  to  individualised-funding.  Community  engagement  also  increased  whilst  new  opportuni es  (e.g.  travelling  independently)  emerged.      Natural  supports  underpinned  the  process.  The  broker  role  and  administra ve  tools  were  developed  to  engage  individuals,  iden fy  ac vi es  and  manage  logis cs.  Organisa ons  reportedly  achieved  value  for  mon-­‐ey,  challenged  the  status  quo  and  improved  client  outcomes.  Challenges  included:  clients  need  for  guidance  during  the  transi on;  managing  overprotec ve  behaviour  which  some mes  reinforced  disability  and  administra ve  burden;  addi onal   me  requirements;  managing  complex  rela onships;  accessing  community-based  ac vi es;  accessing  funding;  and  managing  change.  Conclusions:  Individualised-funding,  whilst  challenging,  was  reported  to  be  effec ve  in  improving  health  and  social  care  outcomes;  feasible  within  an  

SPEAKER  ABSTRACTS Foley,  Conor,  UCC Experiments  in  system  reconfiguration:  a  typology  of  models  for  changing  urgent  and  emergency  care  services  in  one  country E.  Droog,  O.  Healy,  C.  Buckley,  M.  Boyce,  J.  Browne Background:  The  Health  Service  Execu ve  has  embarked  on  a  series  of  regional  system  reconfigura ons  to  change  the  organisa on  of  urgent  and   emergency  care  delivery  in  Ireland.  The  stated  purpose  is  to  increase  efficiency  and  improve  performance  by  developing  integrated  services.  Our  aim   was  to  iden fy  and  describe  the  typology  of  models  employed  in  reconfigura on  of  urgent  and  emergency  care  services. Methods:  A  documentary  analysis  was  conducted  of  na onal  and  regional  policy  documents.  Also,  200  semi-structured  interviews  were  conducted   with  stakeholders  (healthcare  providers,  hospital  campaign  groups,  poli cians,  etc.)  in  each  of  eight  geographical  regions  across  Ireland.  A  framework   analysis  approach  was  used.  Yin’s  mul ple  case  study  methodology  was  employed  to  compare  and  contrast  findings  across  the  eight  regions. Results:  Planning  documents  outlined  ‘hub  and  spoke’  models  of  care.  In  reconfigura ons  carried  out  to  date,  three  models  are  iden fied  with  vary-­‐ ing  degrees  of  centralisa on  and  governance,  from  ‘Loosely  Defined’  to  ‘Par al  Hub  and  Spoke’  and  also  ‘Regional  Hub  and  Spoke’  models. Conclusion:  There  has  been  some  progress  in  system  reconfigura on  but  the  argument  made  is  that  “easy”  reconfigura ons  have  been  completed.   Frequent  shi s  in  policy,  resource  availability  and  stakeholder  buy-in  will  influence  eventual  configura on  of  urgent  and  emergency  care  systems   across  Ireland. Hansen,  Chris na,  UCC Experiences  of  intern  doctors  in  prescribing  patients  in  hospital:  a  systematic  review  of  the  qualitative  literature C.  Bradley,  L.  Sahm               Background:  Prescribing  errors  are  a  substan al  cause  of  pa ent  harm  and  are  known  to  account  for  a  large  propor on  of  all  preventable  medica on   errors  in  hospital.  As  the  majority  of  prescribing  in  hospital  is  undertaken  by  intern  doctors,  it  is  understandable  that  a  considerable  body  of  research   has  focused  on  this  target  group.  The  aim  of  this  systema c  review  was  to  synthesise  the  evidence  of  the  qualita ve  literature  on  the  views  and  expe-­‐ riences  of  intern  doctors  in  prescribing.   Methods:  PubMed,  EMBASE,  CINAHL,  Cochrane  Central  Registrar  for  Controlled  Trials,  Google  Scholar,  PsycINFO  and  Web  of  Science  were  searched.   Original  and  qualita ve  studies  that  explored  the  experiences  of  interns  on  prescribing  were  included.  The  Cri cal  Appraisal  Skills  Programme  was   used  to  assess  the  quality.  The  findings  were  synthesised  using  thema c  analysis.     Results:  Seven  publica ons  were  included.  Factors  influencing  prescribing  behaviour  were  related  to  the  environment;  communica on  and  collabora-­‐ on  in  medical  teams;  hierarchical  structures;  pa ent  factors;  and  individual  factors. Conclusions:  This  review  confirmed  that  intern’s  prescribing  behaviour  is  influenced  by  mul ple  iden fiable  factors.    Reducing  prescribing  errors  will   require  interven ons  which  supports  the  intern  comple ng  the  prescribing  task  in  a  complex  environment  rather  than  just  educa on  to  address  pre-­‐ sumed  knowledge  gap(s). Hayes,  Sara,  UL e  independent  associations  between  Social  Cognitive  Theory  domains  and  physical  activity  among  people  with  Multiple  Sclerosis  in  Ireland R.  Motl,  S.  Gallagher,  S.  Coote           Background:  Physical  ac vity  (PA)  has  posi ve  effects  on  health  outcomes  in  people  with  Mul ple  Sclerosis  (pwMS),  but  this  popula on  has  poor   uptake  and  rates  of  par cipa on.  Social  Cogni ve  Theory  (SCT)  is  a  widely-adopted  theory  for  explaining  PA  behavior  and  designing  interven ons  for   increasing  uptake  and  par cipa on.  This  study  examined  the  independent  associa ons  between  SCT  domains  and  PA  among  pwMS  in  Ireland. Methods:  PwMS  were  recruited  through  MS  Ireland  and  provided  cross-sec onal  data  from  an  online  survey.  Self-reported  PA  was  measured  using   the  Godin  Leisure-Time  Exercise  Ques onnaire.  Exercise  self-efficacy,  exercise  goal-se ng,  exercise  planning,  outcome  expecta ons  and  social  provi-­‐ sion  were  measured  as  SCT  domains.  Stepwise  mul ple  linear  regression  analysis  iden fied  the  independent  associa ons  between  SCT  domains  and   PA.   Results:  Par cipants  (N=340)  were  mostly  female  (n=214,  81%)  with  a  median  (IQR)  age  46  (18)  years.  The  sample  mostly  had  relapsing-remi ng  MS   (n=189,  64%)  with  a  median  dura on  of  7  (11.1)  years.  SCT  domains  explained  44%  of  the  variance  in  PA,  and  exercise  self-efficacy  and  exercise  goal   se ng  were  sta s cally  (p<0.01)  and  independently  associated  with  PA  (β=0.40  and  β=0.23,  respec vely). Conclusion:  The  current  findings  will  contribute  to  the  design  of  theory-driven  interven ons  that  promote  long-term  PA  behaviour  among  pwMS.

SPEAKER  ABSTRACTSHernon,  Marian,  UCDSystematic  review  of  costs  and  effects  of  self-management  interventions  for  chronic  musculoskeletal  pain:  spotlight  on  analytic  perspectives  and  out-­comes  assessmentA.M.  Hall,  J.  O'Mahony,  C.  Normand,  D.  Hurley,      Background:  Self-management  (SM)  is  recommended  for  chronic  musculoskeletal  pain  (CMP),  but  evidence  of  its  cost-effec veness  is  limited  and  inconsistent.  While  the  health-payer  perspec ve  (HPP)  is  commonly  used  in  cost-effec veness  analysis,  the  broader  societal  perspec ve  (SP)  is  argua-­‐bly  more  appropriate,  as  it  captures  many  outcomes  relevant  to  SM.  The    primary  aim  of  this  review  was  to  iden fy  how  costs  and  effects  have  been  assessed  for  SM  interven ons,  and  the  effect  of  the  chosen  perspec ve  on  conclusions  regarding  cost-effec veness.Methods:  Five  databases  were  systema cally  searched;  inclusion  criteria  were  (i)  adults  with  CMP,  (ii)  SM  interven on,  (iii)  conducted  a  cost  analysis.  Descrip ve  data  were  extracted  by  one  reviewer  and  checked  by  a  second  reviewer.Results:  In  total,  48  studies  were  iden fied:  63%  (n=30)  chose  the  SP,  of  which,  87%  (n=26)  captured  healthcare  u liza on,  87%  (n=26)  captured  la-­‐bour  produc vity,  and  60%  (n=18)  captured  pa ent/families  costs.  Within  these  categories  cost  items  varied.  Eight  studies  conducted  analyses  from  both  perspec ves;  with  seven  finding  no  difference  in  overall  cost-effec veness.  Conclusions:  There  was  substan al  heterogeneity  in  the  cost  components  included  in  the  analyses,  irrespec ve  of  perspec ve.  Before  any  conclu-­‐sions  can  be  drawn  on  the  societal  impact  of  SM,  greater  focus  on  complete  and  consistent  cos ng  is  needed.Hurley,  Deirdre,  UCDDetailing  the  use  of  the  intervention  mapping  process  to  develop  a  theory  driven,  group-based  complex  intervention  and  feasibility  trial  in  Ireland’s  primary  care  health  system:  Self-management  of  Osteoarthritis  and  Low  back  pain  through  Activity  and  SkilL.  Murphy,  D.  Hayes,  A.  Hall,  E.  Toomey,  S.  McDonoughBackground:  The  MRC  framework  emphasises  robust  interven on  design  and  considera on  of  implementa on  prac cali es  through  engagement  with  stakeholders  in  the  development  phase.  This  study  describes  the  use  of  interven on  mapping  (IM)  in  the  design  of  a  complex  interven on  and  feasibility  trial  to  promote  self-management  (SM)  in  primary  care  physiotherapy  in  Ireland.Methods:  The  IM  protocol  was  systema cally  applied  to  develop  the  Self-management  of  Osteoarthri s  and  Low  back  pain  through  Ac vity  and  Skills  (SOLAS)  interven on  and  feasibility  trial  [ISRCTN49875385].  Following  a  mul -method  needs  assessment  of  local  service  context  and  the  current  evi-­‐dence,  the  resultant  SOLAS  interven on  desired  outcomes,  performance  and  change  objec ves  were  specified,  prac cal  applica on  methods  select-­‐ed,  followed  by  organised  programme,  adop on,  implementa on  and  evalua on  plans  underpinned  by  behaviour  change  theory.Results:  The  SOLAS  interven on  is  designed  to  promote  physical  ac vity  and  the  use  of  evidence-based  SM  techniques  through  targe ng  of  individual  determinants  of  SM  behaviour,  delivered  by  a  trained  physiotherapist  in  a  needs  suppor ve  environment.  Effec ve  adop on  and  implementa on  strategies  included  a  consensus  building  workshop  with  physiotherapy  stakeholders  and  a  pilot  feasibility  trial.Conclusions:  IM  is  a   me  intensive,  collabora ve  and  worthwhile  process,  the  range  of  methods  and  lessons  learnt  will  be  invaluable  to  future  com-­‐Keane,  Eimear,  NUIGSelf  reported  exposure  to  cigarette  pack  warnings  in  the  last  six  months  and  perceptions  of  smoking  related  harm  in  school  aged  childrenM.  Molcho,  C.  Kelly,  F.  Howell,  S.  Nic  Gabhainn      Background:  Tobacco  use  is  a  leading  preventable  cause  of  death  globally.  Efforts  to  communicate  the  nega ve  consequences  of  smoking  include  the  placement  of  warnings  on  cigare e  packs.  This  paper  examines  if  exposure  to  cigare e  pack  warnings  is  associated  with  percep ons  of  smoking-related  harm  in  children.  Methods:  Par cipants  aged  14-17  years  (n=5069)  from  the  na onally  representa ve  2014  Irish  Health  Behaviour  in  School-aged  Children  study  com-­‐pleted  self-report  ques ons  including  smoking  behaviour,  exposure  to  cigare e  packs/warnings,  and  percep ons  on  ten  poten al  consequences  of  smoking.  Logis c  regression  analyses  assessed  rela onships  between  exposure  to  cigare e  packs/warnings  and  percep ons  of  smoking-related  harm.Results:  The  prevalence  of  current  smokers  was  12.2%  (95%  CI,  11.3%-13.1%).  One  quarter  (26.6%,  95%  CI,  25.3%-27.8%)  of  children  had  not  seen  a  cigare e  pack.  A  higher  propor on  of  smokers  reported  reading  warnings  on  cigare e  packs  compared  to  non-smokers  (79.3%  vs.  54.0%,  p=0.000).  Between  66.0%  and  97.7%  of  children  agreed  with  each  risk  percep on  statement.  Non-smokers  were  73%  more  likely  to  agree  to  all  ten  statement  than  smokers  (1.73,  95%  CI  1.30-2.30).Conclusions:  Children  were  not  fully  informed  about  the  risks  of  smoking,  especially  current  smokers.  We  need  to  target  social  norms  associated  with  smoking  and  provide  further  educa on  on  the  harms  of  smoking.

SPEAKER  ABSTRACTS Keegan,  Conor,  TCD Switching  benefits  and  costs  in  the  Irish  private  health  insurance  market:  an  analysis  of  consumer  surveys B  .  Turner,  C.  Teljeur,  S.  Thomans           Background:  Theore cal  assump ons  underlying  compe ve  health  insurance  markets  dictate  that  consumers  behave  ra onally,  will  switch  insurer   in  response  to  price  and  quality  incen ves  and  do  not  face  significant  barriers  to  switching.  Moreover,  problems  arise  if  certain  groups  face  greater   barriers  to  switching  than  others.    This  study  examines  these  issues  in  terms  of  the  Irish  private  health  insurance  market. Methods:  Switching  behaviours  in  the  Irish  market  are  measured  using  data  on  three  waves  (2010,  2012,  2014)  of  HIA  consumer  surveys  (N=  1,703).   Differences  between  groups  are  measured  by  way  of  binary  logis c  regression. Results:  Price  more  so  than  dimensions  of  quality  mo vate  switching,  while  low-risks  are  more  price  sensi ve  than  high-risks.  Barriers  to  switching   iden fied  relate  to  transac on  costs,  search  costs  and  non-ra onal  psychological  costs.  Moreover,  high-  risks  are  more  likely  to  encounter  these  bar-­‐ riers.  This  is  also  reflected  in  actual  switching  behaviour  whereby  low-risks  (younger,  healthier)  are  more  likely  to  switch  insurer. Conclusions:  Non-ra onal  switching  costs  raise  concerns  over  the  ability  of  the  compe ve  health  insurance  market  to  func on  effec vely.  Origins  of   differen al  barriers  to  switching  between  consumers  also  need  to  be  established  and  addressed  if  improvements  to  the  compe ve  market  environ-­‐ ment  are  to  be  made. Kelleher,  Emily,  UCC Barriers  and  facilitators  associated  with  initial  and  continued  attendance  at  community-based  interventions  among  families  of  overweight  and  obese   children S.  McHugh,  F.  Shiely,  I.  Perry,  M.  Davoren,  J.  Harrington Family-based  lifestyle  programmes  are  effec ve  in  trea ng  paediatric  obesity.  However,  success  relies  heavily  on  family  a endance  and  reten on.   While  a endance  offers  the  support  to  make  posi ve  lifestyle  changes,  in  addi on  to  opportuni es  to  iden fy  underlying  health  issues,  the  majority   of  families  referred  to  treatment  decline.  Moreover,  for  those  who  do  a end,  benefits  are  o en  compromised  by  high  programme  a ri on.  This   review  aimed  to  inves gate  the  factors  influencing  a endance  at  community-based  lifestyle  programmes  among  families  of  overweight  or  obese   children.  A  narra ve  synthesis  approach  was  used  to  allow  for  inclusion  of  a  range  of  research  designs.  Thirteen  studies  were  included.  Predictors  of   a endance  varied  greatly.  Children  enrolled  simply  to  have  fun  and  make  friends.  However,  the  s gma  associated  with  a ending  these  programmes   discouraged  others.  For  parents,  the  main  factors  influencing  enrolment  included  concern  for  their  child’s  psychological  health,  the  desire  to  reduce   bullying  and  to  increase  their  child’s  self-confidence.  Logis cal  factors  such  as   me,  transport,  conflic ng  schedules  and  changing  family  circumstanc-­‐ es  influenced  families’  decisions  to  drop  out  of  treatment  while  group  support  encouraged  con nued  a endance.  In  conclusion,  strategies  to  boost   recruitment  and  avoid  and  minimise  a ri on  are  urgently  required  to  op mise  the  effec veness  of  childhood  obesity  treatment  in  the  community   se ng. Kerley,  Conor,  Connolly  Hospital Dietary  nitrate:  a  novel,  innovative  roles  in  common,  diverse,  cardiorespiratory  disorders E.  Dolan,  J.  O'  Neill,  J.  Faul,  L.  Cormican       Several  cardiorespiratory  disorders  are  associated  with  decreased  nitric  oxide  (NO)  bioavailability,  including  hypertension  (HTN),  obstruc ve  sleep   apnoea  (OSA),  dilated  cardiomyopathy  (DCM)  and  chronic  obstruc ve  pulmonary  disease  (COPD).  NO  synthesis  in  vivo  can  be  facilitated  by  sreduc-­‐ on  of  dietary  nitrate  (NO3-)  to  NO,  possibly  providing  therapue c  effect.   Ini al  crossover  trials  examined  the  acute  effect  of  NO3-    (beetroot  juice)  on  exercise  capacity  in  COPD  (n=11)  and  DCM  (n=11)  where  we  assessed   exercise  capacity  with  the  incremental  shu le  walk  text  (ISWT)  before  and  a er  NO3-  and  placebo  (NO3-  depleted  beetroot-juice).  We  conducted   pilot  studies  inves ga ng  ambulatory  blood  pressure  in  untreated  OSA  (n=3)  and  HTN  (n=19)  before  and  a er  NO3-.  Subsequent  14d  crossover  trials   were  conducted  in  COPD  (n=8)  and  untreated  OSA  (n=11).   Ini al  trials  demonstrated  that  acute  NO3-  adminstra on  could  acutely  increase  exercise  capacity  in  both  COPD  (p=0.0012)  and  DCM  (p=0.006)  com-­‐ pared  to  placebo.  Pilot  studies  demonstrated  a  hypotensive  effect  of  NO3-  in  both  OSA  (-17/7mmHg)  and  HTN  (-3/3mmHg).  Our  subsequent  14d   trials  demonstrated  that  NO3-  could  decrease  nocturnal  blood  pressure  in  OSA  (-8/6mmHg;  p=0.035)  and  increase  exercise  capacity  in  COPD   (p<0.05). NO3-  is  poten ally  effec ve  adjunc ve  strategy  to  the  exisitng  nutri onal  and  medical  management  of  cardiorespiratory  disorders.  Our  preliminary  

SPEAKER  ABSTRACTSMadden,  Jamie,  UCCShort-term  blood  pressure  variability  over  24  hours  using  mixed-effects  modelsX.  Li,  P.  Kearney,  A.  Fitzgerald          The  benefits  of  using  ambulatory  blood  pressure  measurements  (ABPM)  in  addi on  to  clinic  measurements  in  the  management  of  hypertension  are  well  established.    As  well  as  mean  day,  night  and  dip  values,  measures  of  short-term  blood  pressure  variability  (BPV)  can  also  be  obtained  from  ABPM.  Long  term  BPV  has  been  associated  with  cardiovascular  events  but  the  prognos c  significance  of  short-term  BPV  remains  uncertain.  The  ma-­‐jority  of  studies  have  focused  on  summary  measures  of  BPV  such  as  standard  devia on  but  there  is  uncertainty  in  how  accurately  these  indexes  cap-­‐ture  the  true  variability.  We  obtained  data  from  the  Mitchelstown  Study,  a  cross-sec onal  study  of  Irish  adults  aged  47-73  years  (n=2,047).  A  subsam-­‐ple  (1,207)  underwent  24-h  ABPM.  In  addi on  to  using  tradi onal  measures  of  variability  such  as  standard  devia on  this  analysis  makes  full  use  of  the  longitudinal  and  circadian  nature  of  ABPM  data  by  applying  mixed-effects  models  to  determine  subject-specific  trajectories  over   me.  Piecewise  re-­‐gression  techniques  were  u lised  on  the  data.  Varia ons  across  different  segments  of  the  day  were  examined  along  with  the  extent  to  which  this  varia on  was  explained  by  subclinical  target  organ  damage  (documented  by  microalbuminuria).Maher,  Gillian,  UCCProtective  lifestyle  behaviours  and  depression  in  middle  aged  Irish  men  and  women:  a  secondary  analysisI.  Perry,  J.  Harrington,  C.  Perry          Background:  Protec ve  lifestyle  behaviours  (PLBs)  (non-smoker,  moderate  alcohol,  physical  ac vity,  fruit/vegetable  intake)  are  thought  to  protect  against  many  chronic  diseases.  This  study  aims  to  examine  the  associa on  between  PLBs  and  depression  in  middle-aged  Irish  men  and  women.Methods:  Secondary  analysis  of  a  cross-sec onal  study  of  50-69  year  olds  (n=2,047).  A  general  health  and  lifestyle  ques onnaire  and  validated  Food  Frequency  Ques onnaire  assessed  PLBs.  The  Centre  for  Epidemiological  Studies  Scale  assessed  depression.  PLBs  and  demographics  were  cross  tabu-­‐lated  with  a  chi  square  test.  Binary  logis c  regression  examined  the  rela onship  between  PLBs  and  depression,  adjus ng  for  age,  gender,  educa on  and  body  mass  index.  Results:  Over  8%  of  par cipants  engaged  in  zero/one  PLBs,  23.9%  and  39.4%  had  two  and  three  respec vely,  while  28.3%  had  four  PLBs.  Those  adher-­‐ing  to  three/four  PLBs  were  more  likely  to  be  female,  more  educated,  overweight,  and  less  likely  to  portray  depressive  symptoms.  Binary  logis c  re-­‐gression  suggested  that  zero/one  PLBs  was  associated  with  an  increased  odds  of  depression  when  compared  to  four  PLBs.  Results  remained  signifi-­‐cant  a er  adjus ng  for  confounders  (OR:  2.2  [95%  CI:1.2-4.0]).Conclusion:  The  recommenda on  of  healthy  behaviours  may  play  a  vital  role  in  the  promo on  of  posi ve  mental  health,  especially  when  considering  the  modifiable  nature  of  lifestyle.Mc  Parland,  Patricia,  DCUA  Dementia  Review:  What  have  we  learned  from  reviewing  policy,  research  and  data  on  the  island  of  IrelandM.  Pierce                  Background:  This  paper  reports  on  a  review  of  demen a  policy,  research  and  data  on  the  island  of  Ireland,  (2010-2014)  and  its  presenta on  in  a  form  that  is  transferable  to  an  online  resource,  making  it  more  accessible  to  policymakers  and  other  stakeholders.  In  addi on  to  describing  the  approach  adopted  and  the  findings  of  the  review,  insights  gained  about  demen a  research  on  the  island  of  Ireland  are  offered.  Methods:  Different  approaches  were  necessarily  required  for  iden fying  and  reviewing  demen a  policy,  research  and  data.  Specific  strategies  were  developed  for  each.  Results:  Both  jurisdic ons  have  demen a-specific  policies  and  while  both  have  produced  other  policy  in  areas  that  are  relevant  for  people  with  de-­‐men a,  not  all  make  reference  to  demen a.  75  full-text  journal  ar cles  and  53  items  of  grey  literature  were  iden fied,  summarised  and  organised  thema cally.  Insights  gained  include  that  li le  demen a  research  is  conducted  on  an  all-Ireland  basis;  several  gaps  and  imbalances  exist;  and  the  voice  of  people  with  demen a  remains  notably  absent.Conclusion:  A  review  developed  for  transfer  to  an  online  resource  for  use  by  various  stakeholders  in  the  policy-making  process  is  also  useful  as  a  re-­‐source  for  providing  a  snapshot  of,  insights  into  and  future  direc ons  for  demen a  policy,  research  and  data.

SPEAKER  ABSTRACTS McGovern,  Marcella,  UCD A  conceptual  model  for  the  implementation  of  horizontal  integration  in  primary  care  teams                     Background:  This  paper  uses  a  realis c  evalua on  (Pawson  &  Tilley,  1997)  approach  to  iden fy  the  components  and  mechanisms  of  a  horizontal  inte-­‐ gra on  strategy  for  Primary  Care  Teams  (PCTs)  (i.e.  integra on  between  PCT  members),  as  well  as  the  contextual  factors  that  either  help  or  hinder   their  implementa on. Methods:  Five  case  study  Irish  PCTs  were  recruited  to  par cipate  in  a  mixed  method  methodology,  including  concept  mapping  (Trochim,  1989)  and   semi-structured  interviews.  ARIADNE  3.0  so ware  was  used  to  generate  the  Concept  Maps  and  SPSS  20  was  used  to  test  their  reliability  and  validity.   The  16-ques on  interview  schedule  was  devised  using  the  Normaliza on  Process  Theory  toolkit  (May  et  al.  2011)  and  transcripts  were  thema cally   analysed  through  NVIVO  10. Results:  The  concept  mapping  procedure  provided  a  systema c  approach  for  structuring  the  Conceptual  Model  on  four  dimensions,  with  six  strategy   components  and  the  semi-structured  interviews  provided  empirical  descrip ons  of  nine  dis nct  mechanisms  used  to  implement  horizontal  integra-­‐ on  by  PCTs  and  nine  contextual  factors  that  can  either  help  or  hinder  those  mechanisms  in  being  ac vated. Conclusion:  This  conceptual  model  offers  PCTs,  their  managers  and  policy  makers  a  comprehensive  illustra on  of  the  implementa on  of  horizontal   integra on  from  the  PCT  perspec ve. Moriarty,  Frank,  RCSI Potentially  inappropriate  prescribing  (PIP)  in  two  populations  with  differing  socio-economic  profiles:  a  cross-sectional  database  study  using  the   PROMPT  criteria J.  Cooper,  K.  Benne ,  T.  Fahey,  C.  Cahir,  C.  Hughes Background:  PIP  in  middle-aged  adults  (45-64  years)  has  been  under  researched  and  this  study  compares  the  prevalence  in  two  popula ons  with   differing  socio-economic  profiles,  and  inves gates  factors  associated  with  PIP,  using  the  PROMPT  (PRescribing  Op mally  in  Middle-aged  People’s   Treatments)  criteria. Methods:  Prevalence  of  PIP  in  2012  was  determined  in  middle-aged  individuals  in  the  Enhanced  Prescribing  Database  (EPD),  covering  the  full  popula-­‐ on  in  Northern  Ireland  and  the  Health  Services  Execu ve  Primary  Care  Reimbursement  Service  (HSE-PCRS)  database,  covering  the  most  socio- economically  deprived  third  of  individuals  in  the  Republic  of  Ireland.    Logis c  regression  examined  the  associa on  between  PIP  and  gender,  age  group   and  polypharmacy.     Results:  This  study  included  441,925  and  309,748  individuals  from  the  EPD  and  HSE-PCRS  database  respec vely.  Polypharmacy  (taking  -4  medicines)   was  common  (46.7%  in  HSE-PCRS  and  20.3%  in  EPD).  The  prevalence  of  PIP  was  higher  in  the  HSE-PCRS  (42.9%,  95%CI  42.7-43.1)  compared  to  the   EPD  (21.1%,  95%CI  21.0-21.2).    Age  group,  female  gender  and  polypharmacy  were  significantly  associated  with  PIP  in  both  popula ons.  Polypharmacy   had  the  strongest  associa on. Murphy,  Mark,  RCSI Variation  in  prescribing  of  new  injectable  medications  for  type  2  diabetes  mellitus  in  Ireland  in  2013 T.  Fahey,  K.  Benne ,  S.  Smith           Background:  Type  2  diabetes  mellitus  (T2DM)  management  has  seen  the  arrival  of  several  new  classes  of  medica ons  in  recent  years.  Examples  in-­‐ clude  DPP4-Inhibitors  and  GLP-1  Agonists,  which  can  be  effec ve,  especially  in  overweight  pa ents,  but  are  more  expensive.  Our  aim  was  to  assess   varia on  in  their  prescribing  around  Ireland,  which  could  have  implica ons  on  cost  and  may  reflect  unwarranted  varia on  in  the  quality  of  care. Methods:  A  cross  sec onal  study  was  undertaken  on  the  prescribing  databases  for  T2DM  (both  the  PCRS  and  Long-term  Illness  datasets)  for  2013.  We   directly  standardized  the  rates  of  GLP-1  Agonist  and  DPP4-Inhibitor  prescribing  per  100,  000,  compared  to  the  European  standardised  popula on.   Results:  GLP-1  Agonist  prescribing  varied  considerably  by  geographical  area  from  270  prescrip ons  per  100,  000  in  Clare  to  1,059  per  100,  000  in  Wa-­‐ terford.  DPP4-Inhibitor  prescribing  also  varied  considerably  from  1,215  per  100,  000  in  Carlow/  Kilkenny,  to  3,812  per  100,  000  in  Waterford.   Conclusion:  A  fourfold  and  threefold  difference  in  geographical  varia on  exists  in  the  2013  prescribing  of  GLP-1  Agonists  and  DPP4-Inhibitors  respec-­‐ vely,  highligh ng  significant  varia on  in  the  applica on  of  guidelines  in  T2DM  management  in  Ireland.  Loca on  of  primary  care  diabetes  schemes   and  specialist  services  did  not  seem  to  affect  prescribing.

SPEAKER  ABSTRACTSMurphy,  Catriona,  Irish  Longitudinal  Study  on  Ageing  (TILDA)Cross  sectional  and  longitudinal  trend  in  serum  total  cholesterol  in  older  adults:  results  from  the  Irish  Longitudinal  Study  on  Ageing  (TILDA)N.  O'Leary,  E.  Shelley,  T.  Fahey,  R.A.  Kenny      Background:  Raised  serum  total  cholesterol  (TC)  is  an  important  modifiable  risk  factor  for  cardiovascular  disease.  The  aim  of  this  study  was  to  (1)  Describe  the  distribu on  of  serum  TC  in  adults  aged  50  years  and  older,  (2)  Iden fy  longitudinal  trends  in  serum  TC  between  2009-2011  and  2013-2015.Methods:  Cross  sec onal  (n=5634)  and  longitudinal  (n=3439)  analysis  (preliminary)  of  non-fas ng  serum  TC  was  conducted  on  a  na onally  repre-­‐senta ve  sample  of  community  living  adults.  Results:  At  baseline  (n=5634),  the  weighted  mean  TC  was  5.31  mmol/L  (95%  CI  5.27-5.36)  for  women  and  4.85  mmol/L  (95%  CI  4.80-4.89)  for  men.  One-third,  34.8%  (95%  CI  33.3%-36.3%),  were  using  lipid  lowering  medica on  (LLM).  The  weighted  mean  TC  in  those  not  on  LLM  was  5.56  mmol/L      (95%  CI  5.52-5.61)  for  women  and  5.15  mmol/L  (95%  CI  5.10-5.20)  for  men.  A er  four  years  the  unweighted  mean  change  in  TC  in  those  who  had  complete  data  at  both   me  points  (n=3439)  was  -0.32  mmol/L  (Standard  Devia-­‐ on  (SD)  0.95)  in  women  and  -0.37  mmol/L  (SD  0.89)  in  men.Conclusion:  This  study  provides  a  comprehensive  es mate  of  TC  distribu on  in  older  adults  in  Ireland.  Preliminary  data  reveal  a  downward  trend  in  serum  TC  over  a  four  year  period.O  Riordan,  David,  UCCThe  effect  of  pharmacist-led  interventions  in  optimising  prescribing  in  older  adults  in  primary  care:  a  systematic  review  and  meta-analysisK.  Walsh,  R.  Galvin,  C.  Sinno ,  P.  Kearney,  S.  ByrneBackground:  Medica on  related  problems  are  common  in  older  people  and  place  a  significant  burden  on  health  care  resources.  Pharmacists  can  play  a  key  role  in  gate-keeping  medica on  appropriateness  by  enhancing  the  quality  and  safety  of  prescribing.  To  conduct  a  systema c  review  and  meta-analysis  to  assess  the  effect  of  pharmacist-led  interven ons  in  op mising  prescribing  in  community-dwelling  older  adults.  Methods:  Studies  were  included  if  they  were  randomised  controlled  trials  (RCTs)  or  quasi-randomised  studies  involving  a  pharmacist  interven on  compared  to  usual/rou ne  care  to  reduce  poten ally  inappropriate  prescribing  (PIP)  in  older  adults  in  primary  care.  The  primary  outcome  of  interest  was  the  change  in  appropriateness  of  prescribing  using  a  validated  tool  for  the  detec on  of  PIP.  Results:  Five  eligible  studies  were  iden fied..  Two  of  the  five  studies  provided  data  in  the  appropriate  format  for  a  meta-analysis.    The  Medica on  Appropriateness  Index  (MAI)  demonstrated  significantly  lower  levels  of  PIP  in  the  interven on  group  when  compared  to  the  control  group  post-interven on  (mean  difference  3.96,  95%  CI  2.35-5.58,  p=<0.001).  Conclusions:  This  review  demonstrates  that  pharmacist-led  interven ons  to  op mise  prescribing  in  primary  care  can  improve  prescribing  appropri-­‐ateness  in  community-dwelling  older  adults.  Further  high-quality  research  should  be  conducted  to  explore  the  generalizability  of  these  interven ons.O'Higgins,  Siobhán,  NUIGNot  seeing  eye-to-eye:  differential  reporting  of  chronic  pain  by  children  and  their  parents  (Prime  C)H.  Durand,  E.  Doherty,  S.  Nic  Gabhainn,  B.  McGuire      Background:  Prime  C  was  the  first  study  to  explore  chronic  pain  extensively  among  children  living  in  Ireland:  prevalence,  persistence,  impact  and  cost  of  chronic  pain  among  5  –  12  year  olds  were  inves gated.  One  aspect  of  the  data  suggested  parents  may  underes mate  and  under-report  extent  and  impact  of  chronic  pain  for  their  children.  Methods:  A  longitudinal  quan ta ve  survey  with  child  self-report  and  parental  report  was  used  to  assess  loca on,  quality,  intensity,  impact  and  cost  of  pain.  Qualita ve  data  was  generated  as  par cipants  shared  their  pain  stories.  Results:  Data  collected  from  3113  children  (54.23%  female).  Among  parents,  4%  (n=64)  reported  that  one  or  more  of  their  children  had  chronic  pain  compared  to  10%  of  children’s  self-reported  pain.  Only  23%  of  children  who  self-reported  chronic  pain  had  a  confirmatory  parental  report.  Similarly,  when  parents  stated  that  their  child  had  chronic  pain  this  was  not  reported  by  the  child  themselves  in  20%  of  cases.  Majority  of  these  children  were  reported  (by  teachers  and  parents)  as  living  with  chronic,  painful  condi ons,  yet  the  children  did  not  report  any  associated  chronic  pain.  Conclusion:  There  were  significant  inconsistencies  between  children’s  self-report  and  parental  reports  of  pain,  indica ng  a  need  to  further  under-­‐stand  this  mismatch  of  views.

SPEAKER  ABSTRACTS O'Neill,  Sinead  ,  UCC Birth  by  caesarean  section  and  the  risk  of  adult  psychosis:  a  population-based  cohort  study E.  Curran,  C.  Dalman,  L.  Kenny,  P.  Kearney,  G.  Clarke Background:  Despite  the  biological  plausibility  of  an  associa on  between  obstetric  mode  of  delivery  and  psychosis  in  later  life,  studies  to  date  have   been  inconclusive.  We  assessed  the  associa on  between  mode  of  delivery  and  risk  of  psychosis  in  the  offspring. Methods:  All  singleton  live  births  in  Sweden  from  1982-1995  were  iden fied  using  the  Swedish  Na onal  Registers  (n=1,345,210).  Mode  of  delivery   was  classified  into  unassisted  vaginal  delivery  (VD),  assisted  VD,  elec ve  Caesarean  sec on  (CS)  and  emergency  CS.  Outcomes  included  any  psychosis;   non-affec ve  psychoses,  and  affec ve-psychoses  (diagnosed  age  16  or  later).  Cox  regression  was  used  for  data  analysis  adjus ng  for  several  poten al   confounders.  Sibling-matched  Cox  regression  was  performed  to  adjust  for  familial  confounding  factors. Results:  In  adjusted  analyses,  elec ve  CS  was  significantly  associated  with  any  psychosis  (HR=1.13,  [95%CI:1.03-1.24]).  Similar  findings  were  found  for   non-affec ve  psychoses  (HR=1.13,  [95%CI:0.99-1.29])  and  affec ve  psychoses  (HR=1.17,  [95%CI:1.05-1.31])(Chi2  for  heterogeneity  p=0.69).  In  the   sibling-matched  Cox  regression,  this  associa on  was  no  longer  evident  (HR=1.03,  [95%CI:0.78-1.37]).  No  associa on  was  found  between  assisted  VD   or  emergency  CS  and  psychosis. Conclusion:  Elec ve  CS  was  associated  with  an  increase  in  offspring  psychosis.  However,  the  associa on  did  not  persist  in  the  sibling-matched  analy-­‐ sis,  implying  the  associa on  is  likely  due  to  familial  confounding  by  unmeasured  factors. O'Shea,  Emma,  UCC Acute  hospital  dementia  care:  A  four  country  comparison D.  O  Neill,  S.  Kennelly,  P.  Gallagher,  S.  Timmons       Background:  Acute  care  providers  are  faced  with  a  growing  number  of  older  pa ents  with  demen a  and  outcomes  post-discharge  are  poor.  This   study  compares  demen a  care  across  health  services  spanning  four  countries  (England  and  Wales  (EW),  Northern  Ireland  (NI)  and  the  Republic  of   Ireland  (ROI)). Method:  Case-note  reviews  were  conducted  using  the  same  tool  across  countries.  Inclusion  criteria  included  LOS  >5days  and  a  recorded  demen a   diagnosis;  210/215  hospitals  in  E&W,  all  12  in  NI,  and  all  35  in  the  ROI  were  included,  yielding  7987,  240  and  660  case-notes. Results:  Pa ent  demographics  were  similar  across  countries;  83-84  years,  mostly  female  (62-73%),  and  mostly  admi ed  from  home  (52-63%).  LOS   ranged  10-14  days,  ins tu onalisa on  post-discharge  was  11-20%  and  in-hospital  mortality  was  8-13%.  Mental  assessment  (cogni on,  delirium,   mood,  BPSD)  was  poorer  than  physical  assessment  (BMI/weight,  func onal  ability,  con nence,  pressure  sore  risk,  nutri on,  pain)  across  countries.   EW  and  NI  evidenced  lower  in-hospital  an psycho c  prescrip on  (6%,  5%)  than  ROI  (24%),  and  be er  recorded  the  prescrip on  reason(s)  (95%,  80%)   than  ROI  (50%).  Agita on  was  the  most  common  reason  across  countries. Conclusion:  There  are  common  challenges  in  acute  demen a  care  across  countries;  staff  educa on  and  be er  hospital  policy  is  crucial  to  improved   services  and  outcomes  for  people  with  demen a. Ryan,  Aine,  RCSI Multimorbidity  and  functional  decline  in  community  dwelling  adults:  a  systematic  review E.  Wallace,  P.  O'Hara,  S.  Smith           Background:  Mul morbidity  is  recognised  interna onally  as  having  a  serious  impact  on  health  outcomes.  Func onal  decline  is  independently  associ-­‐ ated  with  poorer  health  outcomes.  The  aim  of  this  systema c  review  was  to  examine  the  associa on  between  mul morbidity  and  func onal  decline. Methods:  A  systema c  literature  search  (1990-2014)  and  narra ve  analysis  was  conducted.  Inclusion  criteria:  Popula on;  Community-dwelling  adults   (-18  years),  Risk;  Mul morbidity  defined  as  the  presence  of  -2  chronic  condi ons,  Primary  outcome;  func onal  decline  measured  using  a  validated   instrument,  Study  design;  cross-sec onal  or  cohort  studies.   Results:  A  total  of  37  studies  were  eligible  for  inclusion  (28  cross-sec onal  studies  and  9  cohort  studies).  The  majority  of  studies  (n=31)  demonstrated   a  consistent  associa on  between  mul morbidity  and  func onal  decline.  Twelve  cross-sec onal  studies  and  five  cohort  studies  reported  that  increas-­‐ ing  numbers  of  condi ons  were  associated  with  worsening  func onal  decline.  One  cohort  study  found  that  disease  severity  also  predicted  greater   func onal  decline.  Overall,  studies  were  of  good  methodological  quality  but  were  mixed  in  terms  of  par cipants,  mul morbidity  defini ons  and  out-­‐ come  measures.   Conclusions:  The  available  evidence  indicates  that  mul morbidity  predicts  future  func onal  decline,  which  in  turn  leads  to  worse  health  outcomes.   Interven ons  are  required  to  protect  physical  func on  par cularly  for  pa ents  with  higher  numbers  of  condi ons  and  greater  disease  severity.

SPEAKER  ABSTRACTSShanagher,  Deirdre,  Irish  Hospice  Founda onAdvance  care  planning  and  advance  healthcare  directives  with  People  with  dementiaM.  Lynch,  W.  Molloy,  S.  Bea y,  P.  Rickard  Clarke,  G.  McCarthyBackground:  Demen a  is  a  progressive  life  limi ng  illness.  Within  Ireland  the  Assisted  Decision  Making  (Capacity)  Bill  is  awai ng  to  be  signed  into  law.  People  with  demen a  value  planning  ahead  as  it  allows  them  to  express  wishes  and  preferences,  put  affairs  in  order,  reduce  anxiety  and  help  family  members  to  know  wishes  and  preferences  for  the  future.  Addi onally  healthcare  staff  are  o en  uncertain  and  lack  confidence  with  regard  to  carrying  out  advance  care  planning  and  use  advance  healthcare  direc ves.Methods:  An  Expert  Advisory  Group  (EAG)  was  convened  to  develop  guidance  in  this  area.  A  systema c  literature  review  was  completed  by  searching  the  online  databases  of  CINAHL  and  PubMed.  Grey  literature  was  also  accessed.  The  literature  was  reviewed  and  themes  iden fied.  These  themes  directed  the  scope  of  the  guidance.Results:  The  themes  from  the  literature  include:  1.   Advance  Care  Planning  &  Advance  Healthcare  Direc ves  with  People  with  Demen a;  2.  decision  making  representa ves  and  co-decision  makers;  3.  professional  uncertainty;  4.  advance  care  planning  tools.  Conclusion:  Guidance  is  re-­‐quired  for  people  with  demen a,  their  family  members  and  healthcare  staff  with  regard  to  advance  care  planning  and  the  various  roles  that  can  be  undertaken  when  assis ng  a  person  with  demen a  making  a  decision.Toomey,  Elaine,  UCDExploring  implementation  fidelity  of  behaviour  change  interventions  in  an  Irish  health  service  research  context  using  a  mixed  methods  approachJ.  Ma hews,  D.  Hurley              Background:  Implementa on  fidelity  (IF)  increases  confidence  that  changes  in  study  outcomes  are  due  to  the  effect  of  the  interven on  and  not  due  to  variability  in  implementa on.  IF  is  o en  not  fully  addressed  within  Irish  clinical  research  and  Na onal  Ins tutes  of  Health  (NIH)  IF  guidance  is  infre-­‐quently  applied.  This  study  aimed  to  explore  the  applica on  of  NIH  guidance  within  a  feasibility  trial  of  a  complex  behaviour  change  interven on  in  Irish  primary  care  physiotherapy  (SOLAS  ISRCTN49875385).    Methods:  An  IF  protocol  was  developed  using  a  literature  review  and  pre/post  interviews  with  interven on  providers  and  par cipants.  A er  pilo ng  the  protocol  to  test  for  feasibility,  it  was  refined  and  applied  to  the  SOLAS  trial  using  direct  observa ons,  audio-recordings,  self-report  and  qualita ve  interviews  to  assess  IF.  Results:  The  SOLAS  interven on  was  delivered  with  high  fidelity  according  to  all  methods  (81.7-92.7%),  with  significant  varia on  between  physiother-­‐apists  and  interven on  categories.  Physiotherapist  interviews  found  that  knowledge  and  experience  influence  delivery  fidelity,  as  well  as  par cipant  and  programme  factors  such  as  group  dynamics  or  amount  of  interven on  content  to  deliver.  van  Doorn,  Diana,  Irish  Heart  Founda onFarmers  Have  Hearts:    Impact  of  opportunistic  Cardiovascular  Disease  (CVD)  risk  assessment  among  farmers                    Irish  male  farmers  are  seven   mes  more  likely  to  die  from  CVD  than  other  occupa ons.    The  Irish  Heart  Founda on  (IHF)  with  funding  from  the  Health  Services  Execu ve  (HSE)  provide  full  CVD  risk  assessment  and  lifestyle  counselling  to  farmers  at  their  local  marts.  The  study  aimed  to  assess  the  impact  of  Farmers  Have  Hearts’  (FHH)  programme  –  the  follow  up  referral  to  GP  and  health  behaviour  change.    Data  were  collected  in  two  follow  up  ques onnaires  by  phone  at  Week  1  and  Week  12  from  a  sub-sample  (n=310)  of  farmers  who  par cipated  in  the  programme.    80%  of  famers  were  found  to  have  four  or  more  CVD  risk  factors  and  79%  were  referred  to  their  GP,  however  only  a  third  of  those  referred  to  their  GP  actually  did  so  by  Week  12.  At  Week  1,  74%  reported  that  contempla ng  health  behaviour  change,  with  48%  at  Week  12  reported  having  made  changes.This  study  provides  valuable  insights  into  the  cardiovascular  health  status  of  farmers,  the  poten al  of  workplace  health  checks  to  influence  farmers’  

SPEAKER  ABSTRACTS Wallace,  Emma,  RCSI Impact  of  potentially  inappropriate  prescribing  on  adverse  health  outcomes  in  community-dwelling  older  people:  a  prospective  cohort  study R.  McDowell,  K.  Benne ,  T.  Fahey,  S.  Smith       Background:  Poten ally  inappropriate  prescribing  (PIP)  describes  media ons  where  risk  generally  outweighs  benefit  for  older  people.  This  study  in-­‐ ves gates  the  associa on  of  PIP  with  adverse  drug  events  (ADEs),  health  related  quality  of  life  (HRQoL)  and  emergency  department  (ED)  visits.   Methods:  Study  design:  Two  year  (2010-2012)  prospec ve  cohort  study  (n=904,  -70  years,  community-dwelling)  with  linked  pharmacy  dispensing   data.  Exposure:  Baseline  PIP:  STOPP  applied  12  months  prior.  Study  outcomes:  ADEs  (pa ent  interview),  HRQoL  (EQ-5D-3L:  pa ent  ques onnaire)   and  ED  visits  (general  prac ce  medical  record  review).  Sta s cal  analysis:  Descrip ve  sta s cs,  logis c  (odds  ra o  (OR)  (95%  CI)),  Poisson  (incidence   rate  ra o  (IRR)  (95%  CI)  and  linear  regression  models  (regression  co-efficient  (95%  CI)). Results:  Of  791  par cipants  eligible  for  follow-up,  673  (85%)  returned  a  ques onnaire  and  605  (77%)  also  completed  an  ADE  interview.  Baseline  PIP   prevalence  was  42%  and  445  (74%)  pa ents  reported  -1  ADE  at  follow-up.  In  mul variable  analysis,  -2  STOPP  PIP  was  associated  with  ADEs  (adjusted   IRR:  1.29  (95%  CI  1.03,  1.85,  p=0.03);  poorer  HRQoL  (adjusted  regression  co-efficient:  -0.11  (-0.16,  -0.06;  p<0.001));  and,  -1  ED  visit  (adjusted  OR:  1.85   (1.06,  3.24;  p=0.03)). Discussion:  Older  community-dwelling  people,  prescribed  -2  PIP,  are  more  likely  to  report  ADEs,  poorer  HRQoL  and  a end  the  ED  over  two  year  fol-­‐ low-up. Walsh,  Kieran,  UCC Patterns  of  prescribing  in  older  people  with  and  without  dementia  on  admission  to  Irish  hospitals S.  Byrne,  J.  Browne,  S.  Timmons           Background:  The  objec ve  of  this  study  was  to  describe  the  use  of  psychotropic,  an cholinergic  and  deliriogenic  medica ons  among  older  people   with  and  without  demen a  who  were  admi ed  to  six  acute  Irish  hospitals. Methods:  All  people  -  70  years  old  that  had  elec ve  or  emergency  admissions  to  the  six  hospitals  were  eligible  for  inclusion  in  a  longitudinal  observa-­‐ onal  study  (n=676).  598  pa ents  were  recruited  and  diagnosed  with  demen a  by  medical  experts.  A  retrospec ve  cross-sec onal  analysis  of  medi-­‐ ca on  data  on  admission  was  conducted  for  all  recruited  pa ents  that  had  completed  medica on  data  (n=583). Results:  Out  of  583  pa ents,  79%  experienced  polypharmacy  (-  5  medica ons).  People  with  Demen a  (PwD)  were  significantly  more  likely  to  be  pre-­‐ scribed  at  least  one  psychotropic  or  an cholinergic  agent  (p  <  0.05).  PwD  were  also  more  likely  to  experience  psychotropic  polypharmacy  (-  two  psy-­‐ chotropics)  (p  0.05)  except  for  nervous  system  drugs. Conclusion:  Psychotropic,  an cholinergic  and  deliriogenic  drug  use  is  highly  prevalent  in  older  hospitalised  pa ents,  especially  in  PwD.  Hospital  ad-­‐ mission  presents  an  ideal   me  for  review  of  these  medica ons  in  PwD. Walsh,  Mary,  RCSI The  validation  of  two  risk  prediction  models  for  repeat  falls  in  the  first  year  after  stroke R.  Galvin,  F.  Boland,  F.  Horgan           Background:  Several  mul variable  models  have  been  derived  in  the  literature  to  predict  post-stroke  falls.  These  require  external  valida on  before   facilita ng  decision-making.  This  study  aimed  to  validate  two  models  that  predict  repeat  falls  in  the  community  within  the  first  year  post-stroke. Methods:  Stroke  survivors  were  recruited  consecu vely  from  five  hospitals  and  falls  were  recorded  for  12  months.  Poten al  fall  predictors  were  as-­‐ sessed  prior  to  discharge:  inpa ent  falls,  inpa ent  near-falls,  hemi-neglect,  cogni on,  arm  func on,  mobility,  balance,  gait  speed,  falls-efficacy  and   mood.  Model  1,  incorpora ng  inpa ent  fall-history  and  balance,  and  model  2  incorpora ng  inpa ent  near-fall  history  and  arm  func on,  were  applied   to  the  data.  C-sta s c,  sensi vity  and  specificity  within  the  valida on  sample  were  calculated  using  STATA  13.1.   Results:  128  par cipants  (65%  male,  mean  age  68.3  SD  13.1)  were  recruited.  Falls  data  was  available  for  110  par cipants  at  12  months.  28  par ci-­‐ pants  (26%)  fell  repeatedly.  The  model  1  c-sta s c  was  0.55  (sensi vity  14.8%,  specificity  94.9%).  The  model  2  c-sta s c  was  0.56  (sensi vity  46.4%,   specificity  65.8%). Conclusion:  Neither  model  achieved  acceptable  discrimina on  in  the  valida on  sample.  Further  work  is  ongoing  to  recalibrate,  revise  and  extend   model  2.  The  resul ng  predic on  model  will  require  both  internal  and  external  valida on  before  it's  clinical  impact  can  be  evaluated.

SPEAKER  ABSTRACTSWalsh,  Elaine,  UCCEconomic  Impact  of  medication  error:  a  systematic  reviewC.  Hansen,  L.  Sahm,  P.  Kearney,  C.  Bradley      Background:  Medica on  error  is  a  significant  source  of  morbidity  and  mortality  among  pa ents  (1).  Clinical  and  cost-effec veness  evidence  are  re-­‐quired  for  the  implementa on  of  quality  of  care  interven ons.  Reduc on  of  error-related  cost  is  a  key  poten al  benefit  of  interven ons  addressing  medica on  error.    The  aim  of  this  review  was  to  quan fy  and  describe  the  economic  burden  associated  with  medica on  error.  Methods:  PubMed,  Cochrane,  Embase,  CINAHL,  EconLit,  ABI/INFORM,  Business  Source  Complete  were  searched.  Studies  published  2004-2015  defin-­‐ing  medica on  error  as  “any  preventable  event  that  may  cause  or  lead  to  inappropriate  medica on  use  or  pa ent  harm”  (2)  were  included.  The  New-­‐castle-O awa  scale  was  used  to  assess  quality.    A  narra ve  synthesis  was  performed.Results:  14  studies  were  included  with  4  being  of  high  quality.  13  studies  expressed  economic  impact  in  monetary  terms.  Cost  per  error  ranged  from  €2.29  to  €93,  415.24.  4  studies  included  costs  incurred  in  primary  care.    All  studies  measured  direct  costs  with  2  measuring  addi onal  indirect  or  op-­‐portunity  costs.    Conclusion:  Considerable  variability  existed  between  studies  in  terms  of  financial  cost.  Many  were  of  poor  quality.  Assessment  of  economic  impact  was  conducted  predominantly  in  the  hospital  se ng  with  li le  assessment  of  primary  care  impact.    Limited  parameters  were  used  to  establish  eco-­‐nomic  impact.



POSTER  ABSTRACTSAl  Shehhi,  Maryam,  OLCHCImpact  of  advanced  genomics  on  health  services;;  department  of  clinical  genetics  as  an  exampleR.  Kelly,  S.A.  Lynch              Background:  The  advances  in  genomics  holds  tremendous  poten al  for  improving  health  globally.  The  challenge  for  the  clinical  gene cs  service  would  be  how  to  deal  with  the  massive  genomics  revolu on  and  its  many  complex  scien fic,  medical,  economic,  social  and  ethical  concerns.  We  here  pre-­‐sent  our  audit  of  referrals  to  clinical  gene cs  service  and  highlight  important  results.Methods:  Cross  sec onal  method  was  used  and  data  was  analysed  by  IBM  SPSS  22.Results:  We  audited  287  referrals  out  of  1223  over  a  period  of  4  months  (April-Aug  2015).  Out  of  theses  referrals  11%  were  asking  for  interpreta on  of  results  of  a  new  technology  in  gene c  tes ng;  called  array  CGH.  Findings  on  these  tests  can  be  challenging  given  the  growing  knowledge  about  human  genome  and  interpreta on  must  be  difficult  with  lack  of  knowledge.  There  is  no  control  on  gene c  tes ng  as  a  diagnos c  tool  in  the  ROI  and  this  re-­‐sults  in  a  massive  number  of  generated  reports  to  be  interpreted  by  our  overstretched  service.  In  the  other  hand  60%  of  these  referrals  have  no  re-­‐ports  a ached,  half  of  which  were  done  abroad.Conclusion:  The  current  knowledge  and  advanced  technologies  in  genomic  medicine  holds  considerable  poten al  for  the  development  of  new  health  care  innova ons  overBrannigan,  Colm,  RCSIFactors  associated  with  return  to  work  after  stroke:  a  qualitative  meta-synthesisM.  Walsh,  R.  Galvin,  C.  Macey,  M.  Delargy,  F.  HorganBackground:  Return  to  work  a er  stroke  is  o en  perceived  as  a  cri cal  marker  of  recovery  and  contributes  to  overall  well-being  and  life  sa sfac on  for  many  of  these  survivors.  The  aim  of  this  systema c  review  was  to  examine  barriers  and  facilitators  of  return  to  work  a er  stroke  from  the  perspec-­‐ ve  of  people  with  stroke  though  the  process  of  qualita ve  meta-synthesis.Methods:  A  systema c  literature  search  was  conducted.  Papers  that  used  qualita ve  methods  to  explore  the  experiences  of  individuals  with  stroke  around  return  to  work  were  included.  Two  reviewers  independently  assessed  the  methodological  quality  of  papers  using  the  CASP  criteria.  Themes,  concepts  and  interpreta ons  were  extracted  from  each  study,  compared  and  meta-synthesised.Results:  Fi een  studies  were  included  and  the  overall  methodological  quality  of  the  studies  was  good.  Several  barriers  and  facilitators  around  return  to  work  a er  stroke  were  iden fied:  Facilitators  included  family  and  spouse  support,  employer/organisa on  adapta ons  and  a tudes,  and  access  to  voca onal  training  services.  Barriers  to  returning  to  work  a er  stroke  included  level  of  impairment  following  stroke,  invisible  deficits,  and  employer’s  a tudes.  Conclusion:  Return  to  work  a er  stroke  is  a  complex  process,  which  can  be  facilitated  or  impeded  by  organisa onal,  social  or  personal  factors,  as  well  Burns,  Anne e,  RCSIExploring  smoking,  mental  health  and  smoking-related  disease  in  older  adultsJ.  Strawbridge,  L.  Clancy,  K.  Benne ,  F.  Doyle      Background:  Smoking  is  common  among  people  with  mental  disorders,  and  tobacco  has  been  established  as  the  leading  preventable  cause  of  death  among  individuals  with  mental  illness.  We  inves gated  the  associa ons  among  chronic  disease,  mental  health  and  smoking  in  older  Irish  adults.      Methods:  A  retrospec ve  secondary  analysis  of  the  TILDA  (The  Irish  Longitudinal  Study  on  Ageing)  dataset  was  conducted.  The  primary  outcomes  were:  diagnosed  respiratory,  cardiovascular  diseases  and  cancers.  Predictors  were  variables  indica ng  evidence  of  mental  health  difficul es.  Smoking  status  was  added  to  the  model  to  determine  any  media ng  effects.  Mul variate  logis c  regression  was  used  to  assess  the  associa ons  between  men-­‐tal  health  difficul es  and  smoking  and  between  mental  health  difficul es  and  smoking-related  illnesses.  Results:  A er  adjustment,  self-repor ng  ever  having  been  diagnosed  with  ‘an  emo onal,  nervous  or  psychiatric  problem’  was  significantly  associated  with  increased  likelihood  of  having  ever  been  a  smoker  (OR=1.58  p<0.05).  Self-repor ng  a  doctor  diagnosed  mental  health  problem  was  also  signifi-­‐cantly  associated  with  increased  likelihood  of  cardiovascular  disease,  a  respiratory  disease  or  a  smoking-related  cancer  (Adjusted  OR  for  diseases  com-­‐bined=1.23,  p=0.040).  Conclusion:  Self-reported  doctor  diagnosed  mental  health  difficul es  are  associated  with  smoking  and  with  smoking-related  illnesses  in  older  adults.  

POSTER  ABSTRACTSCadogan,  Sharon,  UCCEvaluation  of  guidelines  combined  with  automated  educational  messages  for  improving  the  use  of  laboratory  tests  among  primary  care  physicians:  an  interrupted  time  seriesJ.  Browne,  C.  Bradley,  M.  Cahill          Background:  Laboratory  tes ng  is  a  major  component  of  healthcare  budgets,  and  demand  for  laboratory  tes ng  is  increasing  faster  than  medical  ac v-­‐ity.  The  objec ves  of  the  current  study  are  to  a)  implement  a  mul faceted  educa on-based  strategy  among  General  Prac oners  (GPs)  in  the  South  of  Ireland  and,  b)  to  evaluate  the  effec veness  of  this  strategy.Methods:  This  interven on  consists  of  two  components  aimed  at  targe ng  two  key  test  reques ng  behaviour  issues  raised  by  GPs  in  our  qualita ve  interviews:  issues  with  a)  interpre ng  the  results  and  b)  a  lack  of  knowledge  about  when  to  request  the  test.  The  combined  guidelines  and  educa onal  messages  interven on  will  be  evaluated  using  a  quasi-experimental  Interrupted  Time  Series  design.  Phase  1  (implementa on  stage)  of  the  study  in-­‐volves  crea ng  and  adding  educa onal  messages  messages  to  the  hospitals  laboratory  system  and  sending  guidelines  to  all  GPs  (Oct  2015).  Phase  2  will  evaluate  the  effect  on  GP  reques ng  pa erns  using  ITS  analysis  (Jan  2016).  Results:  Results  for  the  three  month  follow  up  will  be  available  in  January  2016.Conclusion:  This  interven on  study  could  lead  to  more  effec ve  use  of  laboratory  services  in  the  South  of  Ireland.  The  effects  of  this  interven on  Cadogan,  Sharon,  UCCGeneral  Practitioners’  attitudes  towards  serum  immunoglobulin  testing  in  the  South  of  Ireland:  a  qualitative  studyS.  McHugh,  C.  Bradley,  J.  Browne,  M.  Cahill      Background:  Test  ordering  pa erns  vary  significantly  between  General  Prac oners  (GPs).  This  study  aims  to  explore  GP  views  on  tes ng  to  iden fy  the  determinants  of  behaviour  and  recommend  feasible  interven on  strategies  for  improving  immunoglobulin  test  use  in  General  Prac ce.  Methods:  Qualita ve  semi-structured  interviews  were  conducted  (Dec  2014-  Feb  2015)  with  16  GPs  reques ng  laboratory  tests  in  the  South  of  Ire-­‐land.  GPs  were  purposively  sampled.  Interviews  were  transcribed  verba m  using  NVivo  10  so ware,  and  analysed  itera vely  using  thema c  analysis.  Emerging  themes  were  then  mapped  to  the  theore cal  domains  framework  (TDF).  The  behaviour  change  wheel  and  behaviour  change  technique  (BCT)  taxonomy  were  then  used  to  recommend  poten al  interven on  strategies.  Results:  Using  the  TDF  and  BCT  taxonomy,  this  study  found  serum  immunoglobulin  test  use  in  General  Prac ce  is  influenced  by  many  social  and  con-­‐textual  factors.  The  main  TDF  domains  which  emerged  were:  ‘knowledge’,  ‘environmental  context  and  resources’,  ‘social  influences’,  ‘beliefs  about  capabili es’,  ‘beliefs  about  consequences’,  while  findings  iden fied  a  need  for  ‘shaping  knowledge’.  When  BCT  taxonomy  was  applied;  educa on,  persuasive  and  environmental  regula on  and  enablement  strategies  were  iden fied  as  feasible  interven ons  to  change  GP  behaviour.Casey,  Bláthín,  ULChanging  physical  behaviour  in  people  with  multiple  sclerosis:  a  sysematic  reviewS.  Hayes,  S.  Gallagher,  S.  Coote          Background:  Posi ve  effects  of  exercise  for  people  with  Mul ple  Sclerosis  (pwMS)  are  well-established.  Despite  this,  pwMS  are  largely  inac ve.  The  aim  of  this  review  was  to  iden fy  behavioural  interven ons  for  pwMS  that  aim  to  change  PA  and  to  explore  if  these  interven ons  are  theory-based  and  employ  known  behaviour  change  techniques  (BCTs).Methods:  A  systema c  review  used  the  search  terms  “physical  ac vity/exercise”,  “mul ple  sclerosis”  and  keywords  associated  with  behaviour  change.  The  resul ng  behavioural  interven ons  were  coded  using  ‘The  Theory  Coding  Scheme’  and  the  ‘CALO-RE  Taxonomy’  to  assess  if  interven ons  were  truly  theory-based  and  to  iden fy  what  BCTs  were  employed.    Results:  Six  randomised  control  trials  (RCTs)  were  included.  Behaviour  change  theories  included  Social  Cogni ve  Theory  (SCT)  (n=4),  TransTheoretcial  Model  (TTM)  (n=1)  and  a  mix  of  SCT  and  TTM  (n=1).  Studies  did  not  meet  the  defini on  of  “theory-based”  and  failed  to  discuss  their  results  in  rela on  to  theory  and  did  not  a empt  to  refine  theory.  Coverage  of  BCTs  reached  a  mean  of  44.7%  as  per  the  CALO-RE  Taxonomy.      Conclusion:  There  are  few  behavioural  interven ons  to  change  PA  behaviour  in  pwMS  published.  These  findings  suggest  that  these  behavioural  inter-­‐ven ons  cannot  be  defined  as  theory-based,  with  greater  use  of  BCTs  to  change  PA  behaviour  required.

POSTER  ABSTRACTSClose,  Ciara,  Queen's  University  BelfastThe  mental  health  and  well-being  of  first  generation  migrants.  A  review  of  reviewsBackground:  Migrants  reportedly  have  poorer  mental  health  than  na ves.  Given  increased  migra on  to  Ireland  in  recent  years,  a  be er  understanding  of  the  risk  of  Mental  Health  Condi ons  (MHC)  in  migrants  and  associated  risk  factors  is  needed.  Methods:  The  researcher  aimed  to  conduct  a  review  of  reviews  to  synthesis  evidence  from  systema c  reviews  on  the  prevalence/  risk  of  MHC  in  mi-­‐grants  and  risk  factors.  Five  databases  were  searched  for  systema c  reviews  on  the  mental  health  of  first  genera on  migrants  (FGM’s)  with  a  quan -­‐ta ve  assessment  of  prevalence/  risk  factors  for  MHC.Results:  7  reviews  were  included,  all  repor ng  that  FGM’s  were  at  increased  risk  of  at  least  one  MHC.  Compared  with  the  general  popula on  common  mental  health  disorders  were  six   mes  higher  in  adult  FGM’s  not  separated  by  migra on  reason,  and  almost  four   mes  higher  in  adult  and  children  refugees.  Psycho c  disorders  were  six   mes  more  likely  to  occur  in  adult  FGM’s  not  separated  by  migra on  reason.  Risk  factors  for  MHC  in  FGM’s,  included,  social  mobility  and  skin  colour.Conclusion:  FGM’s  had  an  increased  risk  of  MHC  and  several  factors  were  associated  with  this  increase.  The  present  findings  may  help  iden fy  vulner-­‐ability  which  could  enable  improved  public  mental  health  responses.Cronin,  Sarah,  The  Irish  Hospice  Founda onDying  to  talk:  facilitating  discussion  on  end-of-life  care  with  people  with  dementiaM.  Lynch,  D.  Shanagher,  C.  Collins,  S.  Timmons,  L.  MaguireBackground:  Discussions  with  a  person  with  demen a  about  future  and  end  end-of-life  care  (EOLC)  should  take  place  as  early  as  possible  with  a  per-­‐son  with  demen a.  Staff  may  lack  confidence  and  feel  unprepared  to  undertake  these  discussions.  The  aim  was  to  develop  guidance  document  and  factsheet  to  support  healthcare  staff  to  facilitate  discussions  on  future  and  end-of-life  care  with  people  with  demen a.Methods:  An  Expert  Advisory  Group  (EAG)  was  convened.  The  group  followed  the  NCEC  approach  to  developing  guidelines  which  included  literature  reviews,  consensus  building  and  consulta on  with  key  stakeholders.Results:  The  guidance  document  and  factsheet  is  available  to  support  healthcare  staff  to  ini ate  and  facilitate  EOLC  discussions  with  people  who  have  demen a.  The  document  lists  5  key  considera ons  to  inform  good  prac ce  in  communica ng  with  a  person  with  demen a  and  lists  guidance  and  resources  for  staff.Conclusion:  Communica ng  with  a  person  with  demen a  requires  staff  to  be  flexible  and  skilled  in  their  approach.  Further  supports  and  training  are  required  to  support  healthcare  staff  to  communicate  with  people  who  have  demen a  about  their  future  and  end-of-life  care.Cronin,  Sarah,  The  Irish  Hospice  Founda onLoss  and  grief  in  dementiaM.  Lynch,  O.  Keegan,  S.  Delaney,  B.  McGuinness,  A.  DillonBackground:  A  range  of  losses  occur  throughout  a  person’s  journey  with  demen a.  Losses  occur  for  the  person  and  for  their  families  as  the  disease  progresses.  Grief  as  a  result  of  these  losses  is  under-recognised  and  under-reported  by  people  with  demen a  and  their  families.  The  aim  was  to  to  develop  a  guidance  document  and  factsheet  to  support  healthcare  staff  to  recognise,  acknowledge  and  respond  to  loss  and  grief  in  demen a.Methods:  An  Expert  Advisory  Group  (EAG)  was  convened.  The  group  followed  the  NCEC  approach  to  developing  guidelines  which  included  literature  reviews,  consensus  building  and  consulta on  with  key  stakeholders.Results:  The  guidance  document  and  fact  sheets  will  be  available  in  March  2015  to  support  healthcare  staff  in  working  with  loss  and  grief  in  demen a.  Key  considera ons  for  good  prac ce  will  be  listed.  The  guidance  will  focus  on  3  key  areas:  loss  and  grief  for  the  person  with  demen a,  loss  and  grief  for  families  and  loss  and  grief  for  staff.  Resources  will  be  listed  for  each  of  these  areas.Conclusion:  Recognising  loss  and  grief  as  part  of  the  experience  of  having  demen a  is  a  core  part  of  good  demen a  care.  Provision  of  supports  to  peo-­‐ple  and  their  families  at  transi on  points  is  essen al.

POSTER  ABSTRACTSDay,  Mary  Rose,  UCCPrevalence  of  self-neglect  on  public  health  nurses  case  loadsM.R  Day,  H.  Mulcahy,  J.  Downey          Background:  The  extent  of  self-neglect  (SN)  on  Public  Health  Nurses  (PHNs)  caseloads  is  unknown.  People  who  SN  are  largely  hidden  and  consequently  difficult  to  profile.  PHN’s  in  Ireland  profile  their  areas  to  iden fy  nursing  needs  of  their  popula on.  The  objec ves  of  this  review  is  to  collate  caseload  prevalence  of  SN  from  Community  Profile  and  Health  Needs  Assessment  (CPHNA)  and  iden fy  the  geographical  and  demographic  factors  within  which  self-neglect  cases  were  found.    Methods:  A  retrospec ve  review  of  CPHNA  of  student  PHNs  (n  =  88)  was  undertaken  from  2010  -  2014  in  one  University  in  Ireland.    Analysis  used  descrip ve  data.    Results:  A  total  of  374  SN  cases  were  iden fied,  79  cases  were  younger  (18-64  years)  and  295  cases  were  older  people  (65+  years).  The  overall  preva-­‐lence  rate  for  SN  was  142  per  100,000  popula on.    SN  was  associated  with  higher  popula on  of  older  people,  depriva on,  disadvantage  and  cultural  diversity.  Conclusion:  The  CPHNA  established  for  the  first   me  an  es mated  prevalence  of  SN  in  PHN  caseloads.    Prevalence  data  coincides  with  data  collected  from  primary  care  in  Scotland.  The  CPHNA  has  promoted  visibility  of  the  social  and  economic  condi ons  associated  with  SN  cases.    Training  or  educa-­‐Dwyer,  Christopher,  Centre  for  Pain  ResearchUsing  interactive  management  to  model  factors  influencing  the  application  of  biospsychosocial  perspectives  in  clinical  judgement  of  chronic  pain  casesP.  McKenna-Plumley,  E.  Gormley,  B.  Sla ery,  B.  McGuire      Though  there  is  wide  support  for  the  applica on  of  biospsychosocial  perspec ves  in  clinical  judgment  of  chronic  pain  cases,  such  perspec ves  are  o en  overlooked  in  the  judgment  of  such  cases  due  to  either  inadequate  training  or  a tudes  favouring  a  biomedical  approach.  Recent  research  has  also  indicated  that  despite  such  explana ons,  both  established  GPs  and  medical  students  do  account  for  some  psychosocial  factors  when  making  clini-­‐cal  judgments  regarding  chronic  pain  cases,  but  report  not  being  likely  to  apply  these  psychological  factors  in  real-world,  clinical  se ngs  as  a  result  of  numerous  other  factors,  including  available   me  with  pa ents.  Given  such  ambiguity,  it  is  evident  that  a  greater  understanding  of  clinical  judgment-making  processes  and  the  factors  that  affect  the  applica on  of  these  processes  is  required,  par cularly  those  regarding  chronic  pain.  The  current  study  inves gated  medical  students’  conceptualisa ons  of  the  factors  (both  posi ve  and  nega ve)  that  influence  the  applica on  of  a  biopsychosocial  approach  to  clinical  judgment-making  in  cases  of  chronic  pain    using  a  collec ve  intelligence  methodology:  interac ve  management.  Interac ve  man-­‐agement  (IM)  is  a  computer-assisted  process  that  allows  a  group  to  build  a  structural  model  describing  rela ons  between  elements  in  a  system.  Re-­‐sults  of  IM  group  work  are  discussed  in  light  of  extant  research  and  theory.Fawsi ,  Christopher,  Irish  Longitudinal  Study  on  Ageing  (TILDA)Examining  the  role  of  public  healthcare  eligibility  in  determining  undiagnosed  hypertension  and  high  cholesterol  among  older  adults  in  Ireland:  analy-­sis  using  information  from  the  Irish  Longitudinal  Study  on  Ageing  (TILDA)A.  Nolan,  S.  Lyons,  R.  Layte,  A.  Barre ,  R.A.  KennyBackground:  The  determinants  of  undiagnosed  hypertension  and  high  cholesterol  among  older  adults  in  Ireland  are  unknown.  This  study  inves gates  the  extent  that  undiagnosed  illness  is  influenced  by  public  healthcare  eligibility.Methods:  Novel  data  from  the  first  wave  of  the  Irish  Longitudinal  Study  on  Ageing  (TILDA)  on  subjec ve  and  objec ve  indicators  of  hypertension  and  high  cholesterol  are  used  to  construct  informa on  on  undiagnosed  illness.  A  probit  model  is  es mated  to  inves gate  the  probability  that  undiagnosed  illness  varies  by  public  healthcare  eligibility  (i.e.,  medical  card  status,  private  health  insurance  cover),  while  controlling  for  age,  sex,  physical  and  men-­‐tal  health  status,  socio-economic  characteris cs,  family/household  structure  and  supply-side  factors.Results:  Among  those  with  hypertension  and  high  cholesterol,  63%  (95%  CI  56-68%)  and  74%  (95%  CI  69-79%)  with  no  public  or  private  cover  are  undi-­‐agnosed  compared  to  46%  (95%  CI  42-49%)  and  63%  (95%  CI  59-65%)  of  those  with  public  cover,  respec vely.  (Mul variate  modelling  is  ongoing  and  will  be  completed  shortly.)Conclusion:  Early  indica ons  suggest  public  healthcare  eligibility  is  adversely  associated  with  undiagnosed  hypertension  and  high  cholesterol.  By  iden-­‐

POSTER  ABSTRACTSFoley,  Conor,  UCCPatient  satisfaction  with  urgent  and  emergency  care  in  Ireland:  local,  regional  and  international  comparisonsE.  Droog,  S.  Boyle,  J.  Browne          Background:  The  ongoing  reconfigura on  of  urgent  and  emergency  care  services  in  Ireland  has  drama cally  altered  how  this  care  is  provided.  Recon-­‐figura ons  across  Ireland  to  date  have  varied  in  scope  and  occurred  against  a  backdrop  of  heightened  awareness  of  problems  around  quality  and  safe-­‐ty.  Our  aim  was  to  analyse  pa ent  sa sfac on  across  the  country  and  compare  against  interna onal  benchmarks.Methods:  A  cross-sec onal  survey-based  design  was  used,  employing  the  Urgent  Care  System  Ques onnaire  in  order  to  explore  three  dimensions  of  pa ent  sa sfac on  and  sugges ons  for  system  improvement.  Computer  assisted  telephone  interviews  with  8,002  members  of  the  public  were  con-­‐ducted  across  8  regions,  yielding  1,205  recent  urgent  and  emergency  care  service  users.  Hierarchical  mul ple  regression  and  content  analysis  were  used  to  analyse  responses.Results:  Pa ent  sa sfac on  scores  were  comparable  across  the  8  study  regions,  and  to  those  found  in  the  UK.  When  assessed  at  county  level,  a  num-­‐ber  of  significant  differences  in  pa ent  sa sfac on  were  found.  In  addi on,  service  users  demonstrated  different  priori es  in  rela on  to  desired  ser-­‐vice  improvements  when  compared  to  non-users.Conclusion:  Results  suggest  the  importance  of  assessing  pa ent  sa sfac on  at  a  local  level.  Sensi vity  to  differences  may  be  lost  at  regional  or  na on-­‐Healy,  Chiara,  ULHealth  issues  of  older  prisonsers  -  identifying  the  potential  markers  for  dysphagiaA.  McCur n                  Background:  The  popula on  of  older  prisoners  is  increasing  drama cally  across  much  of  the  developed  world.    The  prevalence  of  chronic  illnesses  and  accelerated  ageing  among  the  older  prisoner  popula on  points  to  the  poten al  for  dysphagia.    Dysphagia  is  a  difficulty  with  ea ng,  drinking  and/or  swallowing  and  is  strongly  associated  with  ageing  and  various  chronic  illnesses.  It  has  a  significant  nega ve  impact  on  respiratory  safety,  nutri on,  and  overall  health.    Methods:  This  subject  is  explored  using  a  systema c  review  by  means  of  specified  search  terms  in  electronic  databases,  hand-searching,  and  examina-­‐ on  of  grey  literature.Results:  The  systema c  search  did  not  iden fy  specific  dysphagia  studies  rela ng  to  this  popula on,  therefore  a  further  search  explored  the  literature  to  iden fy  poten al  markers  for  dysphagia.    This  iden fied  numerous  poten al  factors  which  might  contribute  to,  or  exacerbate,  dysphagia  including  prison  regime,  mul ple  health  issues,  co-morbidi es,  and  the  impact  of  accelerated  biological  ageing.  Conclusions:  Highligh ng  the  levels  of  chronic  illnesses  experienced  by  older  prisoners  is  not  only  important  to  iden fy  the  poten al  for  dysphagia  but  also  provides  important  informa on  for  other  healthcare  professionals.  Prisoners  exist  in  a  context  where  medical  and  therapeu c  interven on  is  at  Healy,  Chiara,  ULClean  mouths  save  lives  -  risks  of  pneumonia  in  elderly  due  to  poor  oral  hygiene.  A  review  of  the  literature  with  recommendations  for  the  multidiscipli-­nary  teamK.  Robinson,  A.  McCur n              Background:  Approximately  10%  of  deaths  from  healthcare  associated  pneumonia  among  nursing  home  elderly  could  be  prevented  by  improving  oral  hygiene  prac ces.    Basic  oral  healthcare  is  commonly  neglected  and  o en  not  adequately  addressed  in  personal  hygiene  protocols.    This  study  iden -­‐fied  the  nega ve  health  impacts  of  poor  oral  hygiene  and  the  rela onship  between  poor  oral  hygiene  and  risks  for  the  development  of  pneumonia  in  the  elderly  popula on.Methods:  This  subject  is  explored  by  means  of  a  comprehensive  review  of  the  literature  using  specific  search  terms  in  electronic  databases  and  hand-searching  of  reference  lists.Results:  Poor  oral  hygiene  has  a  detrimental  impact  on  health  and  well-being  of  elders.    There  are  strong  associa ons  between  poor  oral  hygiene  and  the  development  of  pneumonia  and  exacerba on  of  systemic  condi ons.    Knowledge,  pa ent,  and  system  barriers  interfere  with  the  implementa on  of  essen al  interven on.    Management  of  oral  health  problems  requires  a  mul disciplinary  approach  to  ensure  the  iden fica on  of  oral  hygiene  is-­‐sues  and  the  provision  of  effec ve  recommenda ons  for  prac ce.

POSTER  ABSTRACTSHuynh,  Maily,  University  of  SaskatchewanInforming  a  public  health  surveillance  strategy  using  recreational  water  quality  data  to  address  the  rise  in  cyanobacterial  blooms  in  Saskatchewan,  CanadaL.  Bharadwaj,  R.  Engler-Stringer              Background:  Poor  fresh-water  quality  can  directly  and  indirectly  affect  the  health  of  ecosystems,  individuals  and  communi es.    Nutrient  run-off  from  agricultural  prac ces  can  lead  to  eutrophica on  of  recrea onal  lakes,  op mal  condi ons  for  Cyanobacterial  blooms.    Exposure  to  toxins  o en  re-­‐leased  by  Cyanobacteria  could  result  in  symptoms  such  as  skin  irrita ons,  headaches,  liver  complica ons  and  death.This  study  aims  to  iden fy,  map  the  extent,  and  determine  the  presence  and  quan ty  of  Cyanobacterial  blooms  and  cyanotoxins  at  recrea onal  lakes  in  Saskatchewan,  an  agriculture  rich  province,  to  inform  the  development  of  a  public  health  surveillance  strategy.Methods:  Saskatchewan  beach  sites  were  inspected  for  algal  blooms.    Water  samples  were  tested  for  quality  by  the  Saskatchewan  Disease  Control  Laboratory  in  the  summer  of  2013  and  2014.    ArcGIS®  was  used  for  spa al  data  analysis.Results:  Algal  blooms  were  present  more  frequently  at  Southern  lakes,  especially  near  agricultural  fields  as  hypothesized.    Many  lakes  posi ve  for  Leahy,  Siobhan,  TCDDiabetes  and  depressive  symptoms  in  older  age:  evidence  from  The  Irish  Longitudinal  Study  on  AgeingN.  O'  Leary,  R.A.  Kenny              Background:  Diabetes  and  depression  are  leading  causes  of  disability  globally  and  frequently  co-occur.  This  cross-sec onal  study  inves gates  the  asso-­‐cia on  between  type  2  diabetes  and  depressive  symptoms  in  community  dwelling  older  adults.Methods:  Data  from  5364  adults  age  50-98  from  The  Irish  Longitudinal  Study  of  Ageing  were  analysed.  Diabetes  was  defined  using  a  combina on  of  self-report  doctors  diagnosis,  an -diabe c  medica on  use  and  glycated  haemoglobin  (HbA1c)  analysis.  Depressive  symptoms  were  scored  using  the  Centre  for  Epidemiology  Studies  Depression  (CESD)  scale.  Poisson  regression  was  u lised  to  examine  the  rela onship  between  diabetes  and  CESD  score,  adjusted  for  social  and  health  covariates.  Results:  Mean  (SD)  age  of  the  sample  was  62.9  (9.2)  years,  46.6%  were  male.  8%  (n=430)  of  the  sample  were  classified  as  having  type  2  diabetes:  10%  of  cases  were  undiagnosed.    Older  adults  with  diabetes  had  a  10%  (Coefficient:  0.10,  95%  Confidence  Intervals  (CI):0.06,0.15)  increased  CESD  score  compared  to  those  without  diabetes.  There  was  no  difference  in  CESD  scores  in  those  with  undiagnosed  versus  diagnosed  diabetes  (Coefficient:  0.05,  95%  CI:-0.09,0.18).  Conclusion:  This  study  confirms  an  associa on  between  diabetes  and  depressive  symptoms  in  a  large  sample  of  older  adults.  Future  work  should  ex-­‐Lynch,  Brenda,  UCCCase  fatality  ratios  for  emergency  conditions:  regional  variation  in  Ireland  2000-2012T.  Fitzgerald,  J.  Browne              Background:  The  SIREN  project  aims  to  describe  and  evaluate  the  performance  of  different  emergency  and  urgent  care  systems  (EUCS)  in  Ireland.  Methods:  Crude  and  directly  age  and  case  mix  -standardised  case  fatality  ra os  (CFRs)  were  assessed  at  a  regional  level  for  a  series  of  emergency  con-­‐di ons.The  standard  popula on  was  based  on  the  annual  number  of  emergency  condi on  events  seen  na onally  by  age  group  and  condi on.  The  regional  rates  were  weighted  by  the  standard  popula on  to  yield  the  age  and  case-mix  adjusted  case  fatality  ra os.  Results:  •  Decreases  in  CFRs  were  seen  at  a  na onal  level  from  2000-2012.  • A  decline  in  CFR  results  was  seen  across  all  regions  and  was  maintained  across  two   me  periods,  2000-2006  and  2007-2012.  • Consistent  regional  varia on,  over   me  and  condi on,  with  Eastern  regions  performing  be er  than  the  South  and  West.• The  correla on  between  CFRs  for  two   me  periods,  2000-2006  and  2007-2012,  was  significant  for  the  crude  (0.7,  p=0.03)  but  not  for  the  age-standardised  ra os  (0.4,  p=0.28).  Conclusion:  Despite  a  fall  in  CFRs,  both  na onally  and  across  regions,  a  dis nct  pa ern  between  the  East  and  West/South  existed  for  the  two   me  periods.  Future  study  will  explore  this  geographical  varia on.

POSTER  ABSTRACTSManning,  Molly,  ULApplication  of  cognitive  grammar  to  the  analysis  of  aphasic  discourse:  A  pilot  study.S.  Franklin                  Background:  Aphasia  is  a  language  impairment  acquired  following  brain  injury.  It  is  tradi onally  described  as  a  purely  linguis c  deficit.  Real-life  com-­‐munica on  (discourse)  requires  skills  that  are  not  purely  language-based  (e.g.  ‘macro’  planning,  sequencing).  Common  therapies  focusing  on  words  and  sentences  do  not  carryover  to  discourse.  We  lack  therapies  that  are  underpinned  by  rich  conceptualisa ons  of  discourse.  Cogni ve  Grammar  (CG)  proposes  that  language  is  interlinked  with  more  general  cogni ve  processes.  We  applied  CG  analysis  to  inves gate  if  people  with  aphasia  (PWA)  have  macro  discourse  problems,  and  are  these  associated  with  naming  used  as  a  general  measure  of  severity.Methods:  Narra ve  samples  from  22  PWA  (6  fluent,  16  non-fluent)  were  compared  with  samples  from  10  par cipants  without  aphasia.  Between-group  differences  were  tested  sta s cally.  Results:  PWA  had  significant  difficulty  with  temporal  sequencing  of  events  (macro  level).  For  some,  these  problems  were  doubly  dissociated  with  nam-­‐ing.  Conclusions:  Impaired  temporal  sequencing  suggests  problems  that  are  not  uniquely  linguis c.  Double  dissocia on  with  naming  indicates  that  cogni-­‐ ve  linguis c  difficul es  are  not  linked  with  severity  level  or  more  widespread  brain  damage.  Further  inves ga on  may  lead  to  therapy  approaches  McCarthy,  Mary,  UCCExploring  the  reflective  processes  and  determinants  of  healthy  eating  habitsA.  Collins,  S.J.  Flaherty,  S.  McCarthy          Background:  Ea ng  healthily  has  long  been  highlighted  as  a  significant  part  of  protec ng  oneself  against  disease.  It  is  important  to  understand  every-­‐day  ea ng  habits  to  iden fy  how  best  to  achieve  healthier  ea ng  behaviour.  The  aim  of  this  research  is  to  develop  a  structural  model  that  explores  the  different  determinants  for  a  healthy  ea ng  habit  and  the  subsequent  extent  of  these  influences.Methods:  Structural  equa on  modelling  was  performed  on  a  sub-sample  of  respondents  (1,109)  who  completed  a  food  choice  ques onnaire  as  part  of  the  Irish  Na onal  Adult  Nutri on  Survey  (NANS).  Results:  Healthy  ea ng  goals  and  health  conscious  iden ty  were  found  to  have  the  greatest  influence  on  healthy  ea ng  habit  in  our  model.  Perceived  self-control,  food  worry  (lack  of),  and  human  capital  resources  were  also  found  to  have  significant  effects.  Emo onal  goals  did  not  directly  influence  healthy  ea ng  habit  but  had  an  indirect  nega ve  effect  mediated  through  perceived  self-control.  Conclusion:  Future  ini a ves  to  support  healthier  food  habits  should  capitalise  on  the  importance  of  personal  goals,  self-iden ty,  and  perceived  self-control.  A  number  of  poten al  approaches  are  outlined  in  the  paper.  A  partnership  approach  between  health,  food  and  retail  sectors  is  recommend-­‐ed.McGillicuddy,  Aoife,  UCCOral  dosage  forms:  are  we  meeting  the  individual  needs  of  the  older  patient?A.  Carmichael,  C.  Sweeney,  A.  Crean,  L.J.  Sahm      Background:  Medicines  are  generally  formulated  as  solid  oral  dosage  forms  (ODF).  This  limits  dosing  flexibility  and  may  prove  problema c  for  pa ents  with  swallowing  difficul es  [1,  2].  This  study  aims  to  assess  the  prevalence  of;  and  the  reasons  for;  ODF  manipula on  and  to  assess  whether  the  ODF  manipula on  complies  with  the  product  licence.Methods:  Pa ents  aged  65  years  or  older  and  resident  in  con nuing  care  in  an  aged  care  facility  in  Cork  on  31st  of  December  2014  were  iden fied.  Details  of  all  medica ons  administered  to  residents  during  2014,  including  details  of  any  ODF  modifica ons  and  the  appropriateness  of  the  modifica-­‐ on,  were  recorded.  Data  were  analysed  using  SPSS  v22.Results:  Of  the  41  pa ents  (26.8%  male;  mean  age  (SD);  83.4  years  (+/-8.9))  who  met  the  inclusion  criteria,  51.3%  received  modified  ODF.  The  most  common  reason  for  medicine  modifica on  was  to  facilitate  frac onal  dosing  (81.0%),  followed  by  to  ameliorate  swallowing  difficul es  (9.5%).  Of  the  modifica ons  performed  to  overcome  swallowing  difficul es  75%  were  unlicensed  compared  with  46.2%  of  modifica ons  for  frac onal  dosing.Conclusion:  ODF  are  o en  manipulated  to  facilitate  administra on,  with  frac onal  dosing  being  the  most  common  reason.  Many  of  these  manipula-­‐ ons  are  unlicensed  which  raises  concerns  for  prac oners  and  pa ents.

POSTER  ABSTRACTSMonk,  Gary,  HSEConnolly  Hospital  -  The  NIMIS  PFT  ExperienceA.  McGowan                  In  August  of  2007  the  HSE  ini ated  the  Na onal  Integrated  Medical  Imaging  System  (NIMIS)  project  to  achieve:  (1) The  installa on  of  a  filmless  PACS/RIS  solu on  including  electronic  ordering  and  repor ng  for  Radiology  imaging  in  HSE  hospitals;  (2) To  integrate  all  HSE  sites  to  facilitate  the  controlled,  rapid  and  secure  movement  of  pa ent  image  data  throughout  the  en re  health  service;  (3) To  deliver  a  large  range  of  iden fied  ben-­‐efits  obtained  with  the  installa on  of  such  systems.Nimis  has  revolu onised  the  management  and  availability  of  radiology  exams  na onally.  Part  of  the  technology  used  is  termed  dicom.  Up  to  recently,  dicom  was  exclusively  used  in  radiology.  Why  should  this  be  so?  Pulmonary  Func on  Tests  face  similar  problems  to  radiology  with  increasing  large  volumes  of  requests,  exams  and  reports  to  manage,  with  the  current  paper  based  system  inadequate  to  cope  with  modern  healthcare  demands.Connolly’s  Nimis  and  Respiratory  departments  have  worked  with  industry  partners  to  use  the  Nimis/  dicom  technology  to  provide  a  modern,  na onal  electronic  solu on  for  Pulmonary  func on  tests.  This  is  our  three  year  journey  delivering  this  electronic  solu on  which  poten ally  could  be  the  na on-­‐al  PFT  management  system.Moore,  Gemma,  ARCH  UCDClinical  engagement  as  a  key  enabler  to  the  adoption  of  connected  health  technologies  in  Irish  healthcareM.  Quinlan,  S.  Geiger,  G.  Doyle          Background:  The  Irish  eHealth  strategy  (2013)  represents  the  HSE’s  vision  for  Connected  Health  in  Irish  healthcare  over  the  next  5  years.  This  paper  discusses  the  importance  of  clinical  engagement  as  a  key  enabler  for  the  successful  adop on  of  Connected  Health  in  the  Na onal  Electronic  General  GP  Referral  Pilot  Project.  Managed  by  the  Cork  and  Kerry  Reconfigura on  Team,  the  pilot  introduced  an  electronic  pathway  for  GPs  to  refer  pa ents  to  acute  hospitals  in  Cork  and  Kerry  and  to  Paediatric  Services  in  Tallaght  Hospital.  Methods:  Part  of  a  larger  study  in  which  ARCH  has  partnered  with  the  HSE  to  examine  the  na onal  rollout  of  the  eReferral  system,  this  paper  reports  on  the  findings  from  interviews  with  members  of  the  project  team  and  staff  involved  in  its  implementa on  in  two  of  the  seven  pilot  hospitals.  Results:  The  results  confirm  the  importance  of  clinical  engagement  for  the  successful  adop on  of  eHealth  solu ons  in  Irish  Healthcare.  Conclusion:  Our  findings  indicate  how  a  defined  communica on  and  engagement  plan  can  overcome  the  barriers  to  the  changes  required  to  establish  new  ways  of  working  that  eHealth  technologies  necessitate.  The  paper  concludes  by  addressing  how  clinical  engagement  is  being  used  as  a  key  ena-­‐bler  in  the  HSE’s  eHealth  strategy.Moore,  Patrick,  TCDThe  impact  on  medication  use  of  a  change  in  health  insurance  status:  evidence  from  the  Irish  Longitudinal  Study  on  Ageing  (TILDA)Y.  Ma,  A.  Nolan,              The  Irish  healthcare  system  operates  a  system  of  medica on  subsidies  via  a  public  health  insurance  scheme  based  on  income,  age  and  usage.  While  there  is  a  large  body  of  evidence  on  health  care  u liza on  previous  research  has  not  examined  the  use  of  medica ons  by  individuals  who  gain  a  subsi-­‐dy  or  lose  a  subsidy.  Using  na onally  representa ve  data  on  a  large  sample  of  individuals  aged  50  years  or  older,  from  the  first  two  waves  of  Irish  Lon-­‐gitudinal  Study  on  Ageing  (TILDA),  this  paper  examines  the  impact  on  medica on  use  of  a  change  in  health  subsidy  status.  Propensity  score  matching  is  used  to  ensure  that  differences  in  pa ent  characteris cs  are  unrelated  to  the  change  in  their  access  to  a  medica on  sub-­‐sidy.  Two  comparisons  of  medica on  use  are  employed:  firstly  between  those  who  retained  a  subsidy  at  both  waves  and  those  who  lost  it  at  wave  two  and  secondly  between  those  who  never  had  a  subsidy  at  both  waves  and  those  who  gain  a  subsidy  at  wave  two.Similar  to  the  other  healthcare  u lisa on  literature  we  find  evidence  to  support  an  increase  in  use  of  medica ons  in  those  who  gain  a  subsidy  howev-­‐er  we  find  no  effect  for  those  who  lose  their  subsidy.

POSTER  ABSTRACTSMoore,  Patrick,  TCDThe  impact  of  Statin  use  on  health  behaviours:  complement  or  substitute?C.  Murphy,  A.  Nolan,  R.A.  Kenny          Changes  in  EU  guidelines  on  sta n  use  recommend  medica on  interven on  at  lower  levels  of  LDL  cholesterol.  This  implies  greater  numbers  of  the  older  popula on  will  be  taking  sta ns  throughout  their  life me.  The  aim  of  this  study  is  to  ascertain  if  sta ns  are  a  subs tute  or  a  complement  for  health  behaviours  such  as  smoking,  alcohol  use,  exercise  and  diet.  Data  from  three  waves  of  a  na onally-representa ve  longitudinal  survey  of  the  popula on  aged  50+  in  Ireland  is  used.  Cross  sec onal  OLS  regression  es ma on  at  wave  1  show  a  sta s cally  significant  effect  of  body  mass  index  (BMI)  and  waist  circumference  for  sta n  users  while  probit  models  suggest  no  associa on  with  sta n  use  for  smoking,  alcohol  consump on  or  physical  ac vity.  However,  over   me  there  may  be  a  change  in  behaviours,  especially  for  new  sta n  users.  A  fixed  effect  regression  model  shows  the  associa ons  between  each  health  behaviour  and  sta n  use.  This  approach  will  exploit  the  three  waves  of  data  and  within  person  varia on  in  sta n  use  controlling  for  personal  characteris cs  and  whether  an  individual  has  had  a  CVD  event.This  study  provides  evidence  on  whether  individuals  are  using  sta ns  as  a  complement  or  a  subs tute  for  healthy  behaviour  which  will  inform  policy.Murphy,  Mark,  RCSIEffectiveness  of  interventions  in  primary  care  to  improve  glycated  haemoglobin  (HbA1c)  and  cardiovascular  risk  factor  levels  in  patients  with  poorly-controlled  type  2  diabetes  mellitus:  a  systematic  reviewR.  Galvin,  M.  Byrne,  T.  Fahey,  S.  Smith,      Background:  Poorly-controlled  type  2  diabetes  mellitus  (T2DM)  is  associated  with  significant  morbidity  and  socio-economic  costs.  Our  aim  was  to  as-­‐sess  the  effec veness  of  healthcare  professional-led  interven ons,  which  target  poorly-controlled  T2DM  that  seek  to  improve  glycaemic  control  and  cardiovascular  risk  in  community  se ngs.Methods:  A  systema c  review  of  randomised  controlled  trials  (RCTs)  was  undertaken.  Poor  control  was  defined  as  a  HbA1c  over  7.5%  (68  mmol/  mol).  Outcomes  included  HbA1c,  blood  pressure  and  lipids.  Results:  12,181   tles  were  screened.  The  32  eligible  studies  were  RCTs,  comprising  3,815  pa ents.  The  risk  of  bias  was  predominantly  unclear  or  low.  Mean  baseline  HbA1c  of  par cipants  was  9.4%.  The  predominant  interven on-types  were  pa ent-directed  (47%)  or  organiza onal  (41%).  In  studies  with  shorter  follow  up  (-7  months),  interven ons  reduced  HbA1c  compared  to  controls  (MD  -0.30  (-0.50,  -0.10);  I2  =  59%),  with  pa ent-directed  inter-­‐ven ons  or  interven ons  on  those  with  baseline  HbA1c  over  9.5%  showing  the  greatest  benefit.  In  studies  with  longer  follow-up,  interven ons  also  reduced  HbA1c  compared  to  controls  (MD  -0.47  (-0.67,  -0.27)  but  had  high  heterogeneity.O'Mahony,  James,  TCDRevisiting  the  simulation  evidence  for  the  incremental  cost-effectiveness  of  biennial  breast  cancer  screening  of  average-risk  womenBackground:  Breast  cancer  screening  is  established  prac ce  in  developed  countries,  typically  with  a  two-year  screening  interval.  The  cost-effec veness  of  such  screening  is  typically  es mated  using  simula on  models.  If  the  incremental  cost-effec veness  ra o  (ICER)  of  biennial  screening  is  to  be  es -­‐mated  correctly,  then  cost-effec veness  analyses  (CEAs)  should  include  triennial  strategies  as  comparators.  This  study’s  objec ve  is  to  assess  how  many  simula on-based  CEAs  of  breast  screening  include  triennial  strategies.  Methods:  We  assessed  26  CEAs  of  breast  screening  of  average-risk  wom-­‐en  iden fied  in  a  recently  published  systema c  review.  We  assessed  how  many  included  triennial  comparators  to  biennial  screening  and  the  relevant  ICERs.  Results:  Of  the  26  CEAs,  18  did  not  include  comparators  with  intervals  of  three  years  or  more.  Of  the  remaining  studies,  six  included  the  neces-­‐sary  triennial  comparators.  Of  these,  two  report  ICERs  of  biennial  screening  that  are  clearly  acceptable  rela ve  to  commonly  cited  cost-effec veness  thresholds.  The  results  from  the  remaining  four  studies  leave  it  unclear  if  biennial  screening  is  cost-effec ve.  Conclusion:  The  propor on  of  published  CEAs  that  provide  appropriately  es mated  ICERs  of  biennial  screening  is  small  and  the  number  clearly  indica ng  biennial  screening  is  cost-effec ve  is  even  smaller.  Most  CEAs  of  breast  screening  do  not  present  sufficient  evidence  to  demonstrate  cost-effec veness.

POSTER  ABSTRACTSO'Rourke,  Niamh,  Dept  of  HealthNon-medical  factors  influencing  medical  decisions:  a  study  of  breast  cancer  referral  patterns  in  IrelandH.  Murphy,  A.  Hickey              Background:  New  referrals  to  the  Symptoma c  Breast  Disease  Units  in  Ireland  have  increased  by  almost  60%  in  five  years,  without  a  corresponding  increase  in  breast  cancers  detected.  This  study  aimed  to  inves gate  the  health  service  factors,  GP  factors  and  social  factors  influencing  GP  referrals  to  symptoma c  breast  units  in  Ireland.Methods:  In-depth  semi-structured  interviews  were  conducted  with  28  randomly  selected  GPs,  to  explore  the  factors  influencing  referral  pa erns  from  primary  to  secondary  care.  Thema c  analysis  was  conducted  using  matrices  in  NVivo,  according  to  a ributes.  Theory  of  Behaviour  Change  using  the  Theore cal  Domains  Framework  and  the  Behaviour  Change  Wheel  was  used  to  iden fy  barriers  and  facilitators  in  rela on  to  referral  prac ce  and  use  of  guidelines.    Results:  Factors  other  than  medical  factors  influenced  GP  referral  decisions,  which  included:    social  influences,  resources,  beliefs  about  consequences,  professional  roles  and  emo on.    Conclusion:  GP  referral  prac ces  are  influenced  by  pa ent,  provider  and  health  service  factors.  These  can  be  both  social  and  contextual  in  nature  and  do  not  follow  strictly  Bayesian  reasoning.    Social  influences  coupled  with  beliefs  about  consequences  are  challenging  barriers  to  address  and  will  re-­‐Perry,  Catherine,  NUIGThe  association  between  markers  of  diet  quality  and  wellbeing  in  adolescentsE.  Keane,  M.  Molcho,  C.  Kelly,  S.  Nic  Gabhainn      Background:  posi ve  wellbeing  in  adolescence  can  ease  the  transi on  into  adulthood.  Research  has  found  that  up  to  50%  of  all  adult  mental  disorders  have  their  onset  in  adolescence.  Associa ons  between  nutri on  and  mental  health  have  been  explored  in  adults  but  not  as  extensively  in  adolescents.  This  paper  inves gates  if  fruit,  vegetable  and  Sugar  Sweetened  Beverage  (SSB)  intake  are  associated  with  adolescent  wellbeing.  Methods:  data  for  adolescents  aged  13-18  from  the  2014  Irish  Health  Behaviour  in  School-aged  Children  (HBSC)  study  were  analysed  (n=5393).    Infor-­‐ma on  on  diet,  health  and  life  sa sfac on  were  self-reported.  Separate  logis c  regression  models  explored  associa ons  between  dietary  variables,  general  health  and  life  sa sfac on,  whilst  adjus ng  for  important  socio-demographic,  risky  lifestyle  behaviours  and  perceived  social-support  con-­‐founders.  Results:  overall  15%  and  19%  of  adolescents  reported  that  their  health  and  life  sa sfac on  were  fair/poor.  In  fully  adjusted  models,  adolescents  who  ate  fruit  or  vegetables  less  than  once  a  week/never  and  those  who  consumed  SSBs  everyday  had  a  significantly  higher  odds  of  repor ng  that  their  general  health  (ORs  3.38,  2.12,  1.68)  and  life  sa sfac on  (ORs  2.10,  1.57  [NS],  1.56)  were  fair/poor,  respec vely.    Conclusion:  a  good  quality  diet  may  have  posi ve  impact  on  general  health  and  wellbeing  in  adolescents.Shanagher,  Deirdre,  Irish  HospiceFounda onA  night  nursing  service  for  people  with  a  non-malignant  illnessM.  Lynch                  Background:  Most  people  in  Ireland  want  to  die  at  home.  In  2006,  a  na onal  night  nursing  service  that  enables  people  with  cancer  to  die  at  home  was  extended  to  people  with  non-malignant  disease.  The  Irish  Hospice  Founda ons  nurses  for  night  care  (NNC)  service  will  be  outlined  in  comparison  to  Irish  and  United  Kingdom  (UK)  informa on  to  determine  trends  in  access  to  specialist  pallia ve  care  (SPC)  by  people  with  a  non-malignant  illness.  Methods:  Informa on  from  the  NNC  service,  Minimum  Data  Set  and  informa on  from  UK  was  evaluated  to  determine  trends,  similari es  and  incon-­‐sistencies.Results:  1.  consistent  increase  in  demand  for  the  NNC  service  2. Non-malignant  illness  accounts  for  between  19  and  26%  of  SPC  services    accessed  in  Ireland  compared  to  16  and  17%  in  the  UK  3. There  are  inconsistencies  in  access  to  the  service  na onally  when  compared  to  MDS  informa on.Conclusion:  The  IHF  NNC  service  supports  healthcare  policy  in  rela on  to  provision  of  care  and  is  an  important  aspect  to  consider  when  service  plan-­‐ning.  The  service  supports  con nuity  of  care  whereby  people  are  supported  to  die  at  home.  Results  suggest  inequi es  exist  when  accessing  the  ser-­‐vice.  As  well  as  underu lisa on,  there  may  also  be  over  use  of  the  service.

POSTER  ABSTRACTSShanagher,  Deirdre,  Irish  HospiceFounda onThe  GP  OOH  palliative  care  handover  projectM.  Lynch,  J.  Weafer,  P.  Gregan,  E.  Shanahan,  A.  HeffernanBackground:  The  need  to  develop  a  standardised  informa on  transfer  process  from  GPs  to  the  Out-of-hours  (OOH)  service  for  pa ents  with  pallia ve  care  needs  was  iden fied  as  a  priority  in  the  Irish  Hospice  Founda on  Primary  Pallia ve  Care  in  Ireland  report  (2011)  and  is  supported  by  Kiely  (2013).    A  GP   OOH  Pallia ve  Care  handover  form  was  developed  and  piloted  in  2014  in  southdoc.Methods:  A  mixed  methods  approach:  Quan ta ve  data  from  sixty  forms  received  during  6  months.  Qualita ve  interviews  with  GPs  (N=7),  triage  nurses  (N=7),  healthcare  workers  in  residen al  centres  (n=5)  and  specialist  pallia ve  care  professionals  (N=3).  Interviews  were  recorded  and  analysed  for  themes.Results:  Themes  arising  from  evalua on:1. The  form  aids  communica on  between  GPs  and  the  OOH  service  provider.2. The  form  benefits  pa ents  with  pallia ve  care  needs  -supports  con nuity  of  care  3. An  electronic  version  would  be  useful.4. Educa on  is  required  re  not  a emp ng  cardiopulmonary  resuscita on  Smith,  Amelia,  TCDDe-novo  post-diagnostic  statin  initiation  and  mortality  in  women  with  stage  I-III  breast  cancer.L.  Murphy,  L.  Sharp,  K.  Benne ,  I.  Barron      Background:  Preclinical  evidence  suggests  an  an cancer  role  for  sta ns.  However,  epidemiological  studies  in  this  se ng  have  varying  methodologies  and  yield  conflic ng  results.  This  study  inves gates  associa ons  between  sta n-use  ini ated  a er  a  breast  cancer  diagnosis,  and  breast  cancer-specific  and  all-cause  mortality.  We  also  inves gate  if  these  associa ons  are  modified  by  type  of  sta n  received  (hydrophilic,  lipophilic,  both),  intensity  of  sta n  use,  and  ER  status.  Methods:  Breast  cancer  pa ents  were  iden fied  from  the  Na onal  Cancer  Registry  of  Ireland,  with  linked  prescribing  data  from  the  Primary  Care  Re-­‐imbursement  Services.  Mul variate  Cox  propor onal  hazard  models  were  used  to  es mate  hazard  ra os  (HR)  and  95%  confidence  intervals  (CIs)  for  associa ons  between  post-diagnos c  sta n  use  and  mortality.  Exposures  were  lagged  by  2  years  in  analyses  to  reduce  the  likelihood  of  reverse  causa-­‐ on.  Results:  No  associa on  was  found  between  de-novo  sta n  ini a on  and  breast  cancer-specific  mortality  (HR  0.88,  CI  0.66,  1.17)  or  all-cause  mortality  (HR  0.79,  CI  0.59,  1.06).  Similar  null  results  were  found  when  stra fied  by  type  of  sta n  received,  sta n  intensity,  and  ER  statusConclusion:  This  study  suggests  that  sta n  use,  ini ated  a er  a  breast  cancer  diagnosis,  is  not  associated  with  reduc ons  in  mortality,  in  a  popula on  Stanton,  Alice,  RCSIInvestigating  the  cognitive  benefits  associated  with  the  consumption  of  omega  -3  polyunsaturated  fatty  acids  (PUFAs)  enriched  foods  productsN.  Pender,  F.  O'Donovan,  E.  Dolan,  N.  Moran,  D.  WilliamsIt  is  widely  acknowledged  that  omega  3  poly  unsaturated  fa y  acids  (PUFAs)  are  crucial  for  op mal  brain  development,  func on  and  mood.    However,  consump on  of  omega  3  PUFAs,  through  oily  fish,  is  low.  An  alterna ve  way  to  boost  dietary  intake  is  to  enrich  other  food  products  with  omega-3  PUFAs.    Objec ve:  This  ongoing  double  blind,  randomised,  controlled  study  is  inves ga ng  whether  regular  consump on  of  omega  3  PUFA  enriched  food  products  over  a  6  month  period    results  in  improved  cogni ve  func on  and/or  mood.  Methods:  160  healthy  adults  are  being  recruited  and  ran-­‐domised  to  ea ng  either  omega-3-enriched  diet  or  control  (non-omega-3  enriched)  diet.  Both  groups  will  consume  a  specified  number  of  servings  of  assigned  foods  per  week  for  six  months.  Par cipants  will  be  tested  at  baseline  (0  months)  and  at  the  end  of  the  study  (6  months)  using  a  comprehen-­‐sive  ba ery  of  cogni ve  assessment  tests.  Results/Discussion:  This  study  will  examine  whether  the  omega  3  group  display  significantly  improved  cog-­‐ni ve  performance  and/or  mood  6  months  from  baseline,  as  compared  to  the  control  group.  If  cogni ve  benefits  are  achieved  through  consump on  of    omega-3  PUFA  enriched  food  products  other  than  oily  fish,  this  could  facilitate  the  sustainable  provision  of  protec on  against  cogni ve  impairment  in  large  popula ons.

POSTER  ABSTRACTSSweeney,  Janice,  UCCPoint  of  care  coding:  a  feasibility  studyP.  Kearney,  I.  Perry              Background:  A  primary  use  of  clinical  data  is  to  support  pa ent  care,  therefore  effec ve  management  of  clinical  informa on  is  essen al.  Harmonisa-­‐ on  and  op miza on  of  data  are  of  paramount  importance  for  aggrega ng  databases  to  help  answer  strategic  ques ons.  To  support  this  data  needs  to  be  of  high  quality  and  in  the  same  format.  Clinical  coding  is  a  way  to  record  structured  data  that  can  be  rapidly  retrieved.  Coded  data  has  the  poten-­‐ al  to  assist  with  monitoring  the  health  of  individuals  and  popula ons,  as  well  as  contribu ng  to  health  services  analysis.  The  importance  of  clinical  coding  is  recognized  but  there  has  been  incomplete  and  inconsistent  implementa on  to  date.  This  study  outlines  the  feasibility  of  improving  coding  in  primary  care  in  Ireland.Methods:  Following  training  in  the  use  of  ICD-10  and  ICPC-2,  nurses  remotely  coded  the  electronic  health  records  (EHR)  of  the  over  65’s  popula on  of  2  rural  and  1  urban  general  prac ce  for  3  months.Results:  7647  electronic  health  records  were  reviewed,  3810  were  iden fied  for  coding  and  10,591  codes,  specific  to  each  pa ent,  were  entered  into  the  general  prac ces  databases.  Conclusion:  The  results  demonstrate  the  poten al  for  expanding  standardized  point-of-care  clinically  validated  coding  and  developing  na onal  prima-­‐

LIST  OF  DELEGATESDr Maryam Alshehhi OLCHCMs Niamh Aspell TCDDr Myles Balfe UCCDr Caragh Behan DETECT/UCDDr Kathleen Benne RCSIDr Fiona Boland RCSIMs Rita Boland Health  Research  Ins tute,  ULMr Jonathan Briody SPHERE  UCDMr Chris Brown Na onal  Cancer  Registry  IrelandDr Claire Buckley UCCMs Anne e Burns RCSIMs Sharon Cadogan UCCMs Orla Caffrey RCSIMs Aoife Cannon Health  Research  BoardMiss Blathin Casey University  of  LimerickDr Olga Cleary Ins tute  of  Public  HealthDr Ciara Close Queen's  University  BelfastDr Barbara Clyne RCSIDr Anne Cody HRBMiss Louisa Conlon Na onal  Children's  Research  CentreMs Leona Connolly sphereMiss Aislinn Conway HRB-TMRN  &  NUIGMs Sarah Cronin The  Irish  Hospice  Founda onDr. John Cullinan NUIGMs Eileen Curran UCCDr Mary  Rose Day UCC Deasy University  of  Limerick Chris ne Dennehy UCCMs Rebecca Donnelly RCSIMs Nora Doyle RCSIDr Frank Droog UCCDr Elsa Duggan-Walls Health  Research  BoardMs Kay Fawsi TILDA/ESRIDr Christopher Fitzgerald UCCMs Sarah Flaherty UCCMs Sarah  Jane Flannery NUIGMs Caragh Fleming Maynooth  UniversityMr Padraic Foley Maynooth  UniversityDr Ronan Fuller Sports  Surgery  Clinic Gajewska Royal  College  of  Surgeons,  Ireland Colm Gallagher ULMs Katarzyna Galvin HRB-TMRNMs Aoife Gormley Centre  for  Pain,  NUI  GalwayDr Sandra Grimes TCD  and  Tallaght  HospitalMiss Emer Grove Maynooth  UniversityDr Tamasine Guidon RCSIMiss Hannah Hamilton HSEProf Marie Harrington UCCDr Douglas Harrison Health  Research  BoardDr JanasDr Alan

LIST  OF  DELEGATESProf Catherine Hayes TCDMs Mairead Heffron Royal  College  of  Physicians  of  IrelandDr Siobhan Hendrick Health  Research  BoardMs Sarah Hennessy HSEMs Marita Hennessy NUI  GalwayMs Marian Hernon SPHeRE  UCDDr Frances Horgan RCSIDr Deirdre Hurley University  College  DublinMs Eimir Hurley TCDMs Caroline Hurley University  College  CorkMrs Maily Huynh University  of  SaskatchewanDr Peter Hyde HRB/DDUHDr Kate Irving DCUDr Zubair Kabir UCCDr Eimear Keane NUIGProf Patricia Kearney UCCMs Teresa Kea ng Ins tute  of  Public  HealthMr Conor Keegan Economic  and  Social  Research  Ins tuteMs Emily Kelleher UCCMr Brendan Kennelly NUI  GalwayDt Fiona Keogh GenioDr Conor Kerley DCU  and  HeartBeatDr Ali Khashan University  College  CorkMr Gary Killeen RCPIMs Siobhan Leahy TILDAMs Cliona Loughnane Irish  Heart  Founda onMs Brenda Lynch UCCDr Therese Lynn Health  Research  BoardMr Chris Macey IHFMr Jamie Madden UCCMr Alan Maddock TCDDr Teresa Maguire HRBMs Gillian Maher UCCMs Anne  Marie Malone TCDMs Molly Manning University  of  limerickMs Siobhan Masterson NUIGMs Aoife Mc  Gillicuddy UCCDr Patricia Mc  Parland DCUDr Jenny Mc  Sharry NUIGMs Niamh McAlinden HSEMs Ethna McFerran Queens  University  BelfastDr Sinead McGilloway Maynooth  UniversityMs Aisling Mcgowan DIT  and  Connolly  hospitalMs Caroline McHugh BrandwellMs Niamh McMahon TCD/St  James's  hospitalMs Sara McQuinn DCUDr Lisa Mellon RCSIDr Annalisa Montesan Health  Research  BoardDr Patrick Moore TILDA/TCDDr Gemma Moore ARCH  UCD

LIST  OF  DELEGATESDr Patrick Moran TCDMr Frank Moriarty RCSIMs Mary Morrissey RCSIMs Eimear Morrissey NUIGDr Mark Murphy RCSIDr Linda Murphy HIQAProf Charles Normand TCDMs Siobhain O'  Doherty Maynooth  UniversityMs Fiona O'  Donovan RCSIMr David O  Riordan UCCMs Emma O'  Shea Dublin  City  UniversityDr Marita O'Brien Age  Ac onDr Patrick O'Donnell University  of  Limerick  /  Partnership  for  Health  EquityDr Anne O'Farrell HSEDr Siobhan O'Higgins NUIGMs Kate O'Neill UCCDr Niamh O'Rourke Department  of  HealthMr Fergal O'Shaughnessy RCSIMs Marie O'Shea ICGPMs Catherine Perry NUIGDr Maria Pierce GenioMs Chris na Raae-Hansen UCCDr Natasha Ra er RCSIMs Bennery Rickard HSEDr Jan Rigby Maynooth  UniversityMs Fiona Riordan UCCDr G Robbins NUIGMs Daniela Rohde RCSIMs Áine Ryan RCSIAnne Anne Sexton CobraFIT.ieMs Deirdre Shanagher Irish  Hospice  Founda onProf Susan Smith RCSIMs Amelia Smith TCDMs Ailbhe Spillane UCCProf Anthony Staines DCUDr Conor Teljeur Health  Informa on  and  Quality  AuthorityMs Carline Thompson Stewarts  CareMs Elaine Toomey UCDDr Emma Wallace RCSIDr Elaine Walsh UCCMr Kieran Walsh UCCMs Mary Walsh RCSIMs Oonagh Ward Health  Research  BoardMr Colin White Irish  Kidney  Associa onMs Pauline Wilsons St  James  HospitalDr Catriona Murphy TILDAMiss Rhona Conlon HSEDr Padhraig   RyanDr Eithne Sexton TCDMs Paula   Byrne NUIG

LIST  OF  DELEGATESDr Mary-Ann   O'Donovan TCDMs Diana van  Doorm Carlow  ITDr Maebh NiFhalluin RCPIMr Niall Turner St  John  of  GodsDr Rosemarie Derwin RCSIDr Declan Bedford RCSIMs Niamh Gately NUIGMs Laura Keever SafefoodMs Chris na Hansen UCCMs Marcella McGovern UCDDr Sarah Hayes ULMs Ka e Lonergan TCDDr   Graham Love Health  Research  BoardDr Molly Byrne NUIGProf Steve Thomas TCDProf John Browne UCCDr Sarah Barry TCDDr Margaret Cur n UCCMs Elaine Healy RCSIMr Carlos Bruen RCSIMs Rebecca Kirranne RCSI

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