Introduction:The purpose of this study was to develop and validate a new survey instrument to evaluate employee adaptation during the COVID-19 pandemic in Ireland, with the intention that the instrument could be adapted for use in future pandemic scenarios. Methods:The survey was developed iteratively by a multidisciplinary research team based on five previously identified key themes: (1) support received from the organisation, (2) adaptation pressure, (3) work-life balance, (4) health condition and (5) workload/working hours. From November 2021, employees from six organisations participated in a two-round pilot study (total n=589). Exploratory factor analysis (EFA) was conducted using data from the first round in IBM SPSS V.27 to refine the survey items, followed by confirmatory factor analysis (CFA) in IBM AMOS V.24 using data from the second round to test the factor structure. Results:The initial survey demonstrated good internal consistency (n=63, Cronbach's α=0.963). EFA identified a five-dimension structure corresponding to the predefined themes. After the removal of 19 items, the initial model fit was suboptimal (χ²/df=2.17, p<0.001; Comparative Fit Index (CFI)=0.864; standardised root mean square residual (SRMR)=0.066; root mean square error of approximation (RMSEA)=0.079). Subsequent CFA-based refinements improved the model fit substantially. The final model consisted of 25 items across five dimensions, with acceptable fit indices (χ²/df=1.76, p<0.001; CFI=0.926; SRMR=0.061; RMSEA=0.064). Conclusions:This study presents the first validated survey instrument specifically designed to evaluate employee adaptation experiences during the COVID-19 pandemic. The survey provides a valuable tool for human resources and occupational health professionals to monitor employee well-being during periods of organisational and environmental disruption. Furthermore, the selected items can be adapted for broader application across different working settings and future public health emergencies.

Background: Worsening health disparities amongst individuals experiencing co-occurring homelessness and addiction underline a need to examine potential pathways towards recovery. This study consists of a secondary analysis to identify barriers and enablers of addiction recovery amongst people experiencing homelessness (PEH) in Dublin, Ireland, and to propose a conceptual framework adapted from the Recovery Capital Assessment & Recovery Planning Tool (REC-CAP). Methods: The analysis drew on two data sources collected between September 2022 and April 2023 as part of a qualitative, community health needs assessment: in-depth interviews with 19 providers working with PEH in Dublin, and ethnographic fieldwork conducted with 40 homeless clients attending a primary care and addiction services clinic in the city. Results: In addition to widely reported barriers to recovery such as limited access to housing, clients' recovery progress was blocked by unaddressed physical and psychological health conditions, and by harmful attitudes and beliefs about themselves, their substance use, and their treatment options. Societal stigma perpetuated those harmful beliefs and unfair access to recovery resources. Despite these barriers, once an individual found sufficient motivation to recover and reached a minimum threshold of physiological health and stability in their substance use, key elements of personal, social and community capital intersected and built upon each other to aid in recovery. Conclusion: Key elements of recovery capital for PEH include a combination of self-confidence and self-efficacy, autonomy and freedom of choice, meaningful activities, social support, and access to satisfactory mental health, addiction, family, primary care, and housing supports. Though not essential for starting recovery, a safe and stable home is crucial for sustaining it.

AbstractThis study used an ethnographic approach grounded in a social constructivist research paradigm to explore the perspectives of people in homelessness attending a primary care and addiction service on their priority health and healthcare needs. Participant observations and informal interviews were conducted with homeless clients attending the service for three hours every Monday morning between October 2022 and April 2023. Field note data from active participant observation and informal conversations were collected, anonymised, and analysed using inductive thematic analysis in accordance with the Declaration of Helsinki and the researchers’ institutional Research Ethics Committee. Three main themes emerged from the analysis: self-identified priorities, satisfaction with services, and migrant health. Clients’ priority concerns relate to their mental health, maintaining ties with children and families, navigating complex romantic relationships, finding meaningful activities, and feeling better physically. These challenges differ from those of the general population in terms of their severity observed both prior to and during experiences of homelessness, coupled with disproportionately high levels of loss, fear, injury, pain, disability, fatigue, and isolation. In terms of services, clients are satisfied with their ability to access primary care and harm reduction in a social environment where positive exchanges with friends and providers take place. Conversely, barriers to accessing mental health and addiction services persist including the internalised belief that one is beyond help, lack of access to information on available services and their entry requirements, and lingering stigma within a health system that treats addiction as separate to health. Moving forward, health practitioners may consider holding more regular and open conversations with homeless clients about the care they are receiving, its rationale, and whether or not changes are desired that can be safely made. The health needs of migrants and asylum seekers entering homelessness in Ireland are urgent and should be prioritised in future research.

Community health needs assessments (CHNA) involving qualitative techniques help tailor health services to the specific needs of the population groups for whom they are designed. In light of increasing health disparities amongst people experiencing homelessness (PEH)-and to ensure the integration of their voices into a larger CHNA-this study used an ethnographic approach grounded in a social constructivist research paradigm to explore the perspectives of PEH attending a primary care and addiction service in Ireland on their priority health and healthcare needs. Participant observations and informal interviews were conducted with clients experiencing homelessness attending the service for three hours every Monday morning between October 2022 and April 2023. Field note data from active participant observation and informal conversations were collected, anonymised, and analysed using inductive thematic analysis in accordance with the Declaration of Helsinki and the researchers' institutional Research Ethics Committee. Three main themes emerged from the analysis: self-identified priorities, satisfaction with health services, and migrant health. Clients' priority concerns relate to their mental health and personal safety, strengthening ties with children and families, finding a sense of purpose, and feeling better physically. These challenges differ from those of the general population in terms of their severity observed both prior to and during experiences of homelessness, coupled with disproportionately high levels of loss, fear, pain, fatigue, social stigma and other barriers to accessing satisfactory housing. In terms of services, clients are satisfied with their ability to access primary care and harm reduction in a social environment where positive exchanges with friends and providers take place. Conversely, barriers to accessing mental health and addiction services persist including the internalised belief that one is beyond help, lack of access to information on available services and their entry requirements, and lingering stigma within a health system that treats addiction as separate to health. Moving forward, health practitioners may consider holding more regular and open conversations with clients experiencing homelessness about the care they are receiving, its rationale, and whether or not changes are desired that can be safely made. The health needs of migrants and asylum seekers entering homelessness in Ireland are urgent and should be prioritised in future research.

Background Prior to any infectious disease emergence as a public health concern, early occupational preparedness is crucial for protecting employees from novel pathogens- coronavirus disease 2019 (COVID-19) is no different.Aims This study ascertains how occupational safety and health (OSH)/Human Resource (HR) professionals in the Republic of Ireland had managed to prepare their workplaces prior to the advent of COVID-19.Methods As part of a larger COVID-19 workplace study, online focus groups were conducted with OSH/HR professionals. Collected data were transcribed verbatim and entered into NVivo for thematic analysis incorporating intercoder reliability testing.Results Fifteen focus groups were conducted with OSH/HR professionals (n = 60) from various occupational settings. Three levels of organizational preparedness were identified: 'early awareness and preparation'; 'unaware and not ready' and 'aware, but not ready'. Most organizations were aware of the COVID-19 severity, but not fully prepared for the pandemic, especially stand-alone enterprises that may not have sufficient resources to cope with an unanticipated crisis. The experiences shared by OSH professionals illustrate their agility in applying risk management and control skills to unanticipated public/occupational health crises that arise.Conclusions General pandemic preparedness such as the availability of work-from-home policies, emergency scenario planning and prior experience in workplace outbreaks of infectious diseases were helpful for workplace-associated COVID-19 prevention. This is the first study conducted with OSH/HR professionals in Ireland regarding COVID-19 preparedness in workplaces, which provides valuable insights into research literature, as well as empirical experience for the preparation of future public health emergencies. Looking back on how we dealt with coronavirus disease 2019 (COVID-19) in our workplaces, is there anything else we could have done to be better prepared? This study explores how workplaces in Ireland prepared for the pandemic before it spread to the country. By interviewing experienced occupational safety and health and related personnel, this study found that understanding the virus' severity, and accessibility to sufficient resources and guidance were most important in preventing workplace infections.

An investigation of Irish workplace adaptation to COVID-19 was conducted to assess impact to workers, their organisations and to develop new occupational hygiene and health adaptation mechanisms for future pandemic emergencies. As part of the study, occupational safety and health (OSH) professionals (n=60) that held responsibilities for occupational hygiene and occupational health risk management, took part in a series of semi-structured mixed-method online focus groups. Each focus group incorporated twenty quantitative questions that were answered anonymously via a poll function. 58% of workplaces began pandemic occupational hygiene and health risk management preparations prior to COVID-19s emergence in Ireland. 66% of workplaces remained open while 27% were partially closed. 34% of workplaces had over half their workforce working from home (as opposed to 5% pre-pandemic). 54% of workplaces had existing occupational hygiene and health risk assessments that incorporated infectious disease considerations prior to the pandemic. 41% of workplaces had identified a viral pandemic scenario as part of its emergency planning prior to COVID-19. The majority (63%) of workers understood the occupational hygiene and health control measures instigated as a response to COVID-19 with a greater majority (90%) more willing to accept future workplace changes if they know it is to keep them safe and healthy. Irish workplaces adapted well to the changing OSH landscape that emerged in response to COVID-19. Irish workplaces are now more likely to be able to adapt and respond well to future similar public health emergencies.

This study aimed to evaluate the hypothesis that active smoking impacts upon mediators and abundance of circulating fibrocyte cells in smoking-related disease characterised by fibrosis. Flow cytometry and enzyme-linked immunosorbent assays were used to investigate blood from five patient groups: healthy never-smokers, healthy current smokers, stable chronic obstructive pulmonary disease (COPD) active smokers, idiopathic pulmonary fibrosis (IPF) never-smokers, and IPF active smokers. A significant inverse dose–response relationship was observed in healthy smokers among cumulative smoking burden (pack-years) and fibrocyte abundance (p = 0.006, r = −0.86). Among serum profibrotic fibrocyte chemokines measured, CCL18 rose significantly alongside fibrocyte numbers in all five subject groups, while having an inverse dose–response relationship with pack-year burden in healthy smokers (p = 0.003, r = −0.89). In IPF, CCL2 rose in direct proportion to fibrocyte abundance irrespective of smoking status but had lower serum levels in those currently smoking (p = < 0.001). For the study population, CXCL12 was decreased in pooled current smokers versus never-smokers (p = 0.03). The suppressive effect of current, as distinct from former, chronic smoking on circulating fibrocyte abundance in healthy smokers, and modulation of regulatory chemokine levels by active smoking may have implications for future studies of fibrocytes in smoking-related lung diseases as a potential confounding variable.

BACKGROUND:Training has been used to develop research skills among sexual and reproductive health and rights (SRHR) researchers. Remote education may accelerate transfer of skills and reduce barriers to strengthening research capacity. This systematic review aimed to assess the effectiveness of remote training on SRHR research and describe enablers and barriers of effective remote training. METHODS:PubMed, Embase, and Scielo were searched up to December 2022 for studies that evaluated in any language online research training programmes either on a SRHR topic or tailored for professionals working in SRHR published since 1990. Characteristics of included studies, the programmes they evaluated, the programme's effectiveness, and reported barriers and enablers to remote learning were extracted. Three researchers synthesized and described findings on effectiveness, impact and outcomes mapping them against the Kirkpatrick model. Additionally, thematic analysis from qualitative data was conducted to identify themes relating to the barriers and enablers of remote learning. RESULTS:Of 1,510 articles retrieved, six studies that included 2,058 remote learners met the inclusion criteria. Five out of six studies described empirical improvements in participant research knowledge/skills and three studies reported improvements in attitudes/self-efficacy towards research. Follow-up surveys from four studies revealed frequent application of new research skills and improved opportunities for career advancement and publication following online trainings. Cited barriers to effective online SRHR research training included time management challenges and participants' competing professional obligations; limited opportunities for interaction; and lack of support from home institutions. Cited enablers included well-structured and clear courses, learning objectives and expectations with participants; ensuring a manageable workload; facilitating interactions with mentors and hands-on experience; and selecting programme topics relevant to participants' jobs. CONCLUSION:Remote SRHR training can lead to improvements in research knowledge, skills, and attitudes, particularly when course learning objectives, structure, and expectations are outlined clearly, and ongoing mentorship is provided.

Aim: The aim of this study was to explore key informants' views on and experiences with Covid-19 vac-cine hesitancy in a Dublin community with a high concentration of economic and social disadvantage and to identify feasible, community-centred solutions for improving vaccination acceptance and uptake. Methods: Qualitative, semi-structured interviews were carried out at a local community-centre and a central hair salon. Twelve key informants from the target community were selected based on their pro-fessional experience with vulnerable population groups: the unemployed, adults in recovery from addic-tion, the elderly, and Irish Travellers. Inductive thematic framework analysis was conducted to identify emergent themes and sub-themes. Results: Drivers of vaccine hesitancy identified by key informants largely fell under the WHO '3Cs' model of hesitancy: lack of confidence in the vaccine and its providers, complacency towards the health risks of Covid-19, and inconvenient access conditions. Covid-19 Communications emerged as a fourth 'C' whereby unclear and negative messages, confusing public health measures, and unmet expectations of the vaccine's effectiveness exacerbated anti-authority sentiments and vaccine scepticism during the pan-demic. Community-specific solutions involve the provision of accurate and accessible information, col-laborating with community-based organizations to build trust in the vaccine through relationship building and ongoing dialogue, and ensuring acceptable access conditions. Conclusions: The proposed Confidence, Complacency, Convenience, Covid-19 Communications ('4Cs') model provides a tool for considering vaccine hesitancy in disadvantaged urban communities reacting to the rapid development and distribution of a novel vaccine. The model and in-depth key informants' perspectives can be used to compliment equitable vaccination efforts currently underway by public health agencies and non-governmental organizations. (c) 2022 Published by Elsevier Ltd.

In light of evidence that housing-related disparities in mortality are worsening over time, this study aimed to explore the perspectives of experts working in homeless health and addiction services on priority healthcare needs amongst people experiencing homelessness in Dublin, Ireland, a city facing problematic increases in homelessness. As part of a larger qualitative study, a series of semi-structured interviews were carried out with 19 community experts followed by inductive thematic framework analysis to identify emergent themes and sub-themes relating to priority healthcare needs. At the societal level, community experts identified a need to promote a culture that values health equity. At the policy level, accelerating action in addressing health inequalities was recommended with an emphasis on strategic planning, Housing First, social support options, interagency collaboration, improved data linkage and sharing, and auditing. At the health services level, removing barriers to access will require the provision of more and safer mental health, addiction, women-centred, and general practice services; resolved care pathways in relation to crisis points and multi-morbidity; expanded trauma-informed education and training and hospital-led Inclusion Health programmes; and outreach programmes and peer support for chronic disease management. The voices of people experiencing homelessness, including representatives from specific homeless groups such as migrants, youth, and the elderly, must be thoroughly embedded into health and social service design and delivery to facilitate impactful change.

To map existing research on homelessness and health in the Republic of Ireland, and to synthesize the evidence on housing-related disparities in health. Peer-reviewed articles and conference abstracts published in English between 2012–2022 were retrieved from 11 bibliographic databases if they contained empirical data on homelessness and health in Ireland, and – in a subsequent screening stage – at least one measure of health disparity between the homeless and general populations. Reviewers extracted relative risks (RR), 95

Objectives To understand how essential workers with confirmed infections responded to information on COVID-19. Design Qualitative analysis of semistructured interviews conducted in collaboration with the national contact tracing management programme in Ireland. Setting Semistructured interviews conducted via telephone and Zoom Meetings. Participants 18 people in Ireland with laboratory confirmed SARS-CoV-2 infections using real-time PCR testing of oropharyngeal and nasopharyngeal swabs. All individuals were identified as part of workplace outbreaks defined as ≥2 individuals with epidemiologically linked infections. Results A total of four high-order themes were identified: (1) accessing essential information early, (2) responses to emerging ‘infodemic’, (3) barriers to ongoing engagement and (4) communication strategies. Thirteen lower order or subthemes were identified and agreed on by the researchers. Conclusions Our findings provide insights into how people infected with COVID-19 sought and processed related health information throughout the pandemic. We describe strategies used to navigate excessive and incomplete information and how perceptions of information providers evolve overtime. These results can inform future communication strategies on COVID-19.

AbstractBackgroundThis paper reports on postpartum women's mode of birth (MOB) preferences across five public maternity hospitals in Argentina, the variables and motives associated with those preferences, and hospital services preparedness.MethodsA cross‐sectional study was conducted with postpartum women aged 15 years or older in geographically diverse public hospitals in Argentina between November 2018 to June 2019. Data on obstetric history, companionship, and MOB preference and motives were collected from mothers using a semistructured interviewer‐administered questionnaire. Hospital and participant characteristics, MOB preferences, and perceived advantages and disadvantages were described. Associations between vaginal birth preference, participant characteristics, and hospitals were assessed using odds ratios generated from mixed‐effect logistic regression analyses.ResultsThe sample included 621 postpartum women, 60% of whom had a vaginal birth. In three of the participating hospitals, most women indicated vaginal birth as their preferred MOB (90%); however, the preference for a vaginal birth was lower in the remaining two hospitals (67%). Differences in preferences across hospitals remained after adjusting by women's age or obstetric history. Cited motives for vaginal birth preference included faster recovery, feeling ready for a vaginal birth, and considering it a more natural process. Preference for a caesarean birth was based on perceptions of increased safety and avoiding pain.ConclusionsThe characteristics of obstetric services revealed they are prepared for obstetric emergencies but have limited resources and support to sustain the process of vaginal birth. Despite the limited support, women giving birth in public maternity hospitals preferred vaginal delivery to a caesarean section. This study could not identify hospital variables associated with women's birth preferences across hospitals.

Aim: The aim of this study was to explore key informants’ views on and experiences with Covid-19 vaccine hesitancy in a Dublin community of low socioeconomic status (SES) and to identify feasible, community-centred solutions for improving vaccination acceptance and uptake.Methods: Qualitative, semi-structured interviews were carried out at a local community-centre and a central hair salon. Twelve key informants from the target community were selected based on their professional experience with vulnerable population groups: the unemployed, adults in recovery from addiction, the elderly, and Irish Travellers. Inductive thematic framework analysis was conducted to identify emergent themes and sub-themes. Results: Drivers of vaccine hesitancy identified by key informants largely fell under the WHO ‘3Cs’ model of hesitancy: lack of confidence in the vaccine and its providers, complacency towards the health risks of Covid-19, and inconvenient access conditions. Covid-19 Communications emerged as a fourth ‘C’ whereby unclear and negative messages, confusing public health measures, and unmet expectations of the vaccine’s effectiveness exacerbated anti-authority sentiments and vaccine scepticism during the pandemic. Community-specific recommendations involved the provision of accurate and accessible information, collaborating with community-based organizations to build trust in the vaccine through relationship building and ongoing dialogue, and ensuring acceptable access conditions.Conclusions: A Confidence, Complacency, Convenience, Communications, Community-centred Solutions (‘5Cs’) model of vaccine hesitancy emerged through inductive analysis of key informant interviews in a low-SES urban community. The model and in-depth key informants’ perspectives can be used to compliment equitable vaccination efforts currently underway by Health Services Executive Ireland and non-governmental organizations.

Abstract Background Developing a public health workforce that can understand problems from a population perspective is essential in the design of impactful user-centred responses to current population health challenges. Design Thinking, a user-driven process for problem-defining and solution-finding, not only has utility in the field of public health but stands as a potential mechanism for developing critical skills -such as empathy, creativity and innovation- amongst future professionals. Though the literature reflects the use of DT across many health sciences disciplines, less research has been published on how students apply learned concepts using real-world challenges of their choice and what difficulties they face during the process. Methods This case study evaluates achieved learning outcomes after the introduction of a design thinking block into post-graduate public health curriculum at the University College Dublin. Two independent assessors evaluated student learning outcomes and observed difficulties during the process by assessing group presentations to identify and understand any learning difficulties using an ad-hoc designed tool. The tool consisted of twelve items scored using a 5-point Likert scale. Student feedback, in the form of an online survey, was also analysed to determine their level of enjoyment, perceived learning outcomes and opinions on the course content. Results The assessors evaluated thirteen DT group presentations and reports from 50 students. The groups chose a range of topics from socialization of college students during Covid-19 to mental health challenges in a low-income country. Independent assessment of assignments revealed that the highest scores were reached by groups who explored a challenge relevant to their own lives (more than 80% of total possible points versus 60% class average). The groups that explored challenges more distant to themselves struggled with problem finding with a mean score of 2.05 (SD ± 1.2) out of 5 in that domain. The greatest difficulties were observed in problem finding and ideation. Though most students found the design thinking block enjoyable and relevant to their education, they recommended that the DT block be a stand-alone module. Students recognized that groups who chose a familiar topic experienced fewer difficulties throughout the process. Conclusion The study showed that DT learning outcomes were best achieved when students focused on challenges, they had either personally experienced or were familiar with. These findings provide insight for future iterations of DT workshops and support the teaching of user-centred approaches to future public health practitioners.

Objectives: This study aims to understand mental health issues among Irish employees arising from COVID-19 adaptation from the perspective of Occupational Safety and Health (OSH) and/or Human Resource (HR) professionals. Methods: Fifteen focus groups including 60 OSH/HR professionals from various sectors were conducted covering four predetermined themes. The data were transcribed verbatim, with transcripts entered into Nvivo for thematic analysis incorporating intercoder reliability testing. Results: The mental health impacts among employees are identified from three stages: pre-adaptation, during adaptation, and post-adaptation. Most issues were reported during the second stage when working conditions dramatically changed to follow emerging COVID-19 policies. The identified mental health support from participating organizations included providing timely and reliable information, Employee Assistance Programme (EAP), informal communication channels, hybrid work schedules and reinforcement of control measures. Conclusion: This study explores the challenges facing employees during the different stages of COVID-19 adaptation and the associated mental health impacts. Gender’s influence on mental health consultations should be considered when planning for public health emergencies, and further research conducted in male dominated industries.

Few studies have assessed how the intersection of social determinants of health and environmental hazards contributes to racial disparities in COVID-19. The aim of our study was to compare COVID-19 disparities in testing and positivity to cumulative environmental health impacts, and to assess how unique social and environmental determinants of health relate to COVID-19 positivity in Seattle, King County, WA, at the census tract level. Publicly available data (n = 397 census tracts) were obtained from Public Health–Seattle & King County, 2018 ACS 5-year estimates, and the Washington Tracking Network. COVID-19 testing and positive case rates as of July 12, 2020, were mapped and compared to Washington State Environmental Health Disparities (EHD) Map cumulative impact rankings. We calculated odds ratios from a series of univariable and multivariable logistic regression analyses using cumulative impact rankings, and community-level socioeconomic, health, and environmental factors as predictors and having ≥ 10% or < 10% census tract positivity as the binary outcome variable. We found a remarkable overlap between Washington EHD cumulative impact rankings and COVID-19 positivity in King County. Census tracts with ≥ 10 % COVID-19 positivity had significantly lower COVID-19 testing rates and higher proportions of people of color and faced a combination of low socioeconomic status–related outcomes, poor community health outcomes, and significantly higher concentrations of fine particulate matter (PM 2.5 ). King County communities experiencing high rates of COVID-19 face a disproportionate cumulative burden of environmental and social inequities. Cumulative environmental health impacts should therefore systematically be considered when assessing for risk of exposure to and health complications resulting from COVID-19.

The emergence of COVID-19 has resulted in workplace adaptations globally. This study aims to understand the challenges faced by employees during COVID-19 workplace adaptation that could cause mental health distress. Fifteen focus groups were conducted with Occupational Safety and Health (OSH) and/or human resource professionals (n=60) from various occupational settings in Ireland between April and May 2021. The findings showed that stress arose from three primary sources: technostress, work-from-home adaptation, and COVID-19 longevity. Supports from organizations, such as providing timely information, Employee Assistance Programs, informal communication channels and the reinforcement of COVID-19 control measures, are discussed as the possible solutions to mitigate employees’ mental stress. This study contributes to the understanding of employees’ stress and the development of an intervention plan for alleviating the mental health impacts arising from occupational adaption due to COVID-19. The findings also have implications for workplace coping strategies during future global public health crises.