OBJECTIVE:To examine the impact of histopathological Fetal Inflammatory Response Syndrome (FIRS) on acute clinical outcomes in very preterm neonates. STUDY DESIGN:This was a two site cohort study based in tertiary maternity units in Dublin, Ireland. Admitted neonates with placental histology and without congenital anomalies < 32 weeks corrected gestational age born between 2018-2022 (n=955) Were assessed for exposure to Amsterdam consensus guideline defined FIRS and consequent acute neonatal outcomes by both univariate and multivariate methods. RESULTS:While univariate analysis showed an increased incidence of death and BPD, multivariate analysis adjusting for gestational age and birth weight demonstrated that very preterm neonates exposed to histopathological FIRS are at a lower risk of bronchopulmonary dysplasia, composite death or bronchopulmonary dysplasia and RDS requiring surfactant. Neonates exposed to FIRS were born earlier and smaller than their peers who were not, and when adjusting for gestational age there was no increase in odds of severe IVH, days of mechanical ventilation or diagnosis of sepsis. CONCLUSION:Very preterm neonates exposed to FIRS are at lower risk of developing death or bronchopulmonary dysplasia and requiring surfactant when adjusting for age and birth weight. No other acute outcomes were statistically significantly different.

OBJECTIVE:Accurate and timely injury documentation is essential to post-sexual assault care. Irish Sexual Assault Treatment Units (SATUs) have generally relied on police photographers to photo-document these injuries, leading to potential delays and additional patient distress. International models show that on-site forensic photography by trained forensic examiners improves efficiency and evidentiary quality. The aim of the present study was to evaluate the feasibility, acceptability and service impact of introducing forensic photography by forensic examiners within an Irish SATU. METHODS:An 11-month quality improvement pilot was undertaken at the Dublin SATU. A human-centered design approach incorporated staff surveys, forensic examiner reflections, observations and consultation with collaborating agencies. Eligible cases included patient's ≥14 years with visible (non-genital) injuries, examined by SATU forensic examiners who had completed additional training in forensic photography as part of the pilot and who provided informed consent for inclusion in research. RESULTS:Of 370 attending patients, 258 (69.7%) underwent a forensic examination. Among these, 69 (26.7%) were examined by pilot-trained staff and 23 (33.3%) consented to photography, representing 8.9% of the total cohort. Photography added a mean of 9 min to examination time. Examiner confidence improved substantially over the period of the pilot, and a secure chain-of-custody was established. Patient feedback indicated reduced anxiety when photography occurred within the SATU setting. A total of 103 patients with injuries in the non-pilot group received no photo-documentation due to unavailability of trained staff at the time of examination. CONCLUSION:The introduction of forensic photography within the Dublin SATU proved feasible, acceptable and legally robust. This pilot supports the integration of forensic photography as a trauma-informed component of sexual assault care and provides a foundation for national and international service development.

OBJECTIVE:To assess the diagnostic performance of interleukin-6 (IL-6) versus in-use inflammatory markers (C-reactive protein [CRP], procalcitonin [PCT], neutrophil-lymphocyte ratio [NLR]) in maternal sepsis. METHODS:This was a retrospective cohort study in a single Dublin maternity hospital. All maternity patients (conception to 6-weeks post-partum) in whom IL-6 was measured to investigate suspected sepsis in an 11-month period were included. Cases were categorized twice into physiological (normal, systemic inflammatory response syndrome, sepsis, septic shock) and etiological (bacterial, viral or no infection) categories. Biomarker performance was assessed by area under the receiver operating characteristic curves (AUC) and measures of diagnostic accuracy at optimal cut-offs. Serial sampling evaluated biomarker kinetics. RESULTS:Seventy-two patients were included, 31.9 % had sepsis/septic shock, and 70.9 % had bacterial infection. Significant differences between categories were seen for both physiological and etiological axes for IL-6, for physiological categories alone for NLR, and for neither for PCT and CRP. IL-6 had an AUC of 0.78 for the primary physiological endpoint, significantly higher than CRP and PCT (p = 0.02), but not NLR (AUC 0.72, p = 0.47). The IL-6 AUC for the primary etiological endpoint was 0.94, higher than all other biomarkers (p < 0.001). IL-6 was highly sensitive (91.4 %) but poorly specific (55.1 %) for the physiological endpoint, while both were high in the diagnosis of bacterial infection (88.2 % and 90.5 %). On serial sampling, IL-6 fell rapidly between first and second sampling, while others initially rose further. CONCLUSION:IL-6 exhibited significantly higher sensitivity compared to conventional sepsis biomarkers in detecting both bacterial infection and maternal sepsis.

OBJECTIVE:To detail the attendance of female Irish Travellers at the national Sexual Assault Treatment Unit (SATU) network. METHODS:Retrospective cross-sectional study examining the attendance of female patients who identified as members of the Irish Traveller community at the national SATU network between 2017 and 2023 and comparing them with all other female attenders. RESULTS:There were 5942 female attendances during the study period, of which 54 were Irish Traveller women with a mean age of 25.9 ± 11.5 years; with 35 (64.8%) presenting within 7 days of assault. Most attended with police involvement (40, 74.1%), assaults most commonly occurred in the victim's home (14, 25.9%) or outdoors (13, 24.1%), and perpetrators were frequently family members (13, 24.1%), intimate/ex-intimate partners (12 combined, 22.2%), acquaintances of more than 24 h (8, 14.8%), or strangers (9, 16.7%). Compared with other female attenders, Irish Traveller women were significantly less likely to present within 24 h (24.1% vs 39.7%; odds ratio [OR] 0.48 P = 0.02) and to report alcohol use in the preceding 24 h (OR 0.33, P < 0.001), but were significantly more likely to report a family member (OR 8.25, P < 0.001) or an intimate/ex-intimate partner (OR 2.04, P = 0.03) as the assailant. CONCLUSION:This study provides the first national analysis of Irish Traveller women attending SATU in Ireland and highlights distinct differences in the patterns of perpetrator relationship and timing of presentation compared with other female attenders.

Aim:This retrospective multi-site cohort study examined the association between FIRS and neurodevelopmental outcomes in infants born <32 weeks’ gestation. Preterm infants are highly vulnerable to inflammation-mediated brain injury, yet the long-term impact of histological FIRS remains unclear.Methods:Preterm infants (n=955) born between 2018 and 2022 in two tertiary maternity hospitals in Dublin, Ireland were included. FIRS and its severity were defined according to the Amsterdam Placental Workshop Group Consensus Statement. The primary outcome was a composite of death or neurodevelopmental impairment (NDI) at 22–26 months’ corrected age, assessed using Bayley-III scores.Results:Of the cohort, 27.9% were exposed to FIRS. Exposed infants were born at earlier gestations and lower birth weights. After adjustment for gestational age and birth weight, FIRS was not associated with increased odds of death or moderate NDI (OR 0.784, 95% CI 0.547–1.123). Severe FIRS (stage ≥2) was associated with reduced odds of severe NDI or death (OR 0.651, 95% CI 0.438–0.968, p = 0.034). Mortality was 12.15%, and follow-up data were available for 51.7% of infants.Conclusions:Histological FIRS was not associated with adverse early neurodevelopmental outcomes and may be linked to improved outcomes in severe cases, warranting further long-term investigation.

Background: Data on the prevalence of physical injury in men who experience sexual assault are underrepresented in the literature; the aim of this study is to inform this knowledge gap. It is vital that forensic examiners have access to up-to-date information regarding the prevalence of genito-anal and extra-genital injury, specific to their examination method (i.e. with or without proctoscopy), as well as any associations with injury in order to provide optimal responsive care and accurate testimony in the context of written and oral evidence. Methods: This is a cross-sectional study analysing the attendances of all males who attended the Dublin Sexual Assault Treatment Unit (SATU) for a forensic examination between 1/1/2017 and 31/12/2023. Results: During the study period there were 2495 attendances. Of these, 199 (8.0 %) were male, with 68.8 % (n = 137/199) undergoing a forensic examination. Within this cohort, genito-anal injury was identified in 19.7 % (n = 27/137). Anal injury was present in 14.6 % (n = 20/137) and genital injury was present in 5.8 % (n = 8/ 137). For those who disclosed completed anal penetration (either penile-anal, digital-anal penetration or objectanal penetration) and who underwent proctoscopic examination (n = 53) the injury rate was 24.5 % (n = 13/53). Extra-genital injuries were present in 40.1 % (n = 55/137). Those who had a genito-anal injury were significantly more likely to have been the victim of a multiple perpetrator assault (OR2.72 CI1.05-6.97 p = 0.03). Those who had extra-genital injuries were significantly more likely to have attended within 24 hours of the incident (OR2.89 CI1.03-4.22 p = 0.03). No other incident detail was found to have an association with the presence of genito-anal or extra-genital injury. Conclusions: Genital injuries and/or anal injuries were absent in a large proportion of men after sexual assault. Extra-genital injuries were found in a higher proportion of men. It is anticipated that these findings will better inform society, the police and also assist forensic examiners in providing accurate and informed prevalence rates for medico-legal evidence in the criminal justice system. These findings also underscore the importance of comprehensive medical examinations and timely medical intervention for assault victims, highlighting the need for targeted support and care strategies.

To investigate the prevalence of, and risk factors for, genito-anal injury in females who attended a Sexual Assault Treatment Unit in a capital city following sexual assault. Cross-sectional study. All females who underwent a genital and/or anal forensic examination between 1/1/2023 and 31/12/2023 were included. A standardised dataset of demographic and assault metrics was collated. Genito-anal injury data was contemporaneously collected by forensically trained specialist doctors and nurses using prescribed definitions and a standardised tool. Descriptive bivariate analysis and logistic regression analysis were performed on these data. Statistical significance was defined as a p-value < 0.05. During the study period, 405 women accessed this SATU service of whom 294 (72.6

OBJECTIVES:Perineal assessment and repair are fundamental to providing quality obstetric and midwifery care to women. Up to 80% of women sustain perineal trauma during vaginal delivery, and 70% require repair. This study aimed to establish baseline perineal anatomy knowledge, training exposure, and experience, and to assess whether ongoing training is needed to strengthen perineal repair education and skills. METHODS:This is a prospective multicenter observational study. Obstetricians and midwives actively involved in perineal repair were recruited in three maternity units between April and July 2024. A pre-survey was completed. A teaching intervention was delivered to participants. After the teaching intervention, a post-survey was completed. The sample size was appropriately powered and the data were analyzed accordingly. RESULTS:During the study period, 89 clinicians completed the pre-survey, and 72 attended the training initiative and completed the post-survey. A total of 84.3% of clinicians had prior training in assessing perineal injury, and 83.1% had some form of practical training in perineal repair. Only 75.3% had received training on assessing for obstetric anal sphincter injury. A total of 88.8% of clinicians felt confident performing an episiotomy, and only 69.7% felt confident in repairing an episiotomy. After the teaching intervention, the post-survey responses highlighted significant improvement in anatomical knowledge among clinicians conducting perineal repair (P = 0.0078). CONCLUSIONS:Ongoing learning is necessary for clinicians who are actively completing perineal repair. It results in increased knowledge, which should impact the quality of care for women requiring perineal repair.

Background Sexual assault (SA) is alarmingly prevalent, yet reporting rates remain disproportionately low. Forensic examinations (FE) play a crucial role in both immediate medical care and evidence collection, yet many victims/survivors may not report the crime initially, leading to the loss of vital forensic evidence. The storage of evidence “Option 3″ care alternative provides post-SA care including FE without initial police involvement. Methods This is a cross-sectional study analysing the attendances of people who chose to store evidence at the Dublin Sexual assault Treatment Unit (SATU) between January 1, 2017 and December 31, 2023. Results There were 238 storage of evidence FEs (‘Option 3’) performed during the study period, which represented 12.8 % of all FEs. The majority identified as female (89.1 %), with an average age of 26.6 years. 31.9 % attended within 24 h of the incident, and 51.3 % self-referred. Most assaults occurred over weekends (64.7 %), with alcohol consumption reported in 82.2 % of cases and drug-facilitated SA concerns in 20.2 %. Genital injuries were present in 17.9 % of females and 19 % of males.Those that availed of storage of evidence (compared with those who initially reported to the police) were significantly more likely to have consumed alcohol (p < 0.001) and the assault was more likely to have occurred indoors (p = 0.002). There was no significant difference in care option choice for those ‘unsure’ of the assault occurrence (p = 0.353).Among storage of evidence cases, 20.2 % subsequently reported to the police, with females more likely to report (p = 0.02), while people who were uncertain whether an assault had occurred were less likely to report (p = 0.04). Genital injury (p = 0.822), victim-assailant relationship (p = 0.465), assault location (p = 0.487), and substance consumption (p = 0.332) did not significantly affect subsequent reporting rates. Conclusions The availability of storage of evidence has afforded people the opportunity to access prompt, responsive SATU care including collection of forensic evidence which may have significant evidential value. This approach provides further opportunity for comprehensive detection of a crime, even if reporting to the police is delayed.

Sexual violence (SV) while travelling internationally is underreported and pre-travel advice is often focussed on broader tourist safety concerns. International travellers who experience sexual violence face particular challenges. The aim of this paper was to analyse the attendances of people who disclosed having been subjected to SV during international travel to the Sexual Assault Treatment Unit (SATU) network in the Republic of Ireland. Analysis of all people who attended the national SATU network who disclosed an incident of SV experienced during international travel, and comparison of these cases with domestic case attendances. During the 7-year period studied, there were 6,447 attendances to the national SATU network, with 443 incidents reported as occurring outside Ireland; in 66 separate countries. The mean age of international attendees was 26.61 years, with females representing 90.3

Background: Sexual assault (SA) poses a threat to all areas of contemporary society. Although older individuals represent a vulnerable demographic, a considerable gap exists in the literature regarding the context in which older individuals experience SA. This study aims to provide a comprehensive description of older individuals ' attendances at the Sexual Assault Treatment Unit (SATU) network in the Republic of Ireland. Methods: A 7 -year national cross-sectional study was performed to analyse the attendances of older people ( >= 65 years old) to the SATU network, and to compare them with younger attendances ( <65 years old), with a more in-depth subset analysis of Dublin SATU attendances. Results: During the study period, there were 6478 attendances to the SATU network, of which 0.93 % (n = 60) were older people. These included 59 females and 1 male, with the average age of 76.05 years +/- 8.16. Forensic examinations were performed in 81.7 %, with the majority seeking assistance within 7 days (80 %). Comparison of older ( >= 65 years) and younger ( <65 years) attendees revealed older individuals were more uncertain whether a sexual assault had occurred (35.5 % vs. 14.4 %, p < 0.001) but more likely to report the incident to the police (78.3 % vs. 64.3 %, p = 0.02). Assault by a person in authority was significantly more common in older age groups (11.7 % vs. 1.8 %, p < 0.001). Older individuals were significantly more likely to be assaulted in their own home (33.3 % vs. 21.5 p < 0.03) or in 'other -indoors ' settings (e.g. nursing home/hospital) (43.3 % vs. 23.4 % p < 0.001). They were less likely to be assaulted in the assailant 's home (5.0 % vs. 22.9 %, p < 0.001) or outdoors (5.0 % vs. 19.7 %, p = 0.004). In our subset analysis of 19 cases, 73.7 % occurred in healthcare facilities, 63.2 % had dementia, and 42.1 % were care dependent. Genital injuries were present in 44.4 % of patients and extra -genital injuries in 22.2 %. Conclusion: Unique patterns are evident in sexual assault experienced by older people, underscoring the necessity for tailored interventions and effective support systems for reporting and addressing this vulnerable demographic. This is especially crucial in healthcare environments, where a notable proportion of cases occur, frequently involving individuals with dementia and requiring care assistance.

Sexual violence is common in contemporary society and disproportionally affects adolescents. In order to develop effective treatment, awareness and prevention strategies it is vital that we understand the epidemiology of adolescent sexual assault (SA). The aim of this study is to evaluate attendances by female adolescents to the national sexual assault treatment unit (SATU) network and compare these attendances with adult women accessing the service. This is a cross-sectional study analysing the attendances of all adolescent female attendances at the 6 SATUs in the Republic of Ireland and comparing them with all adult female attendances between 1/1/2017 and 31/12/2022. There were 1014 female adolescent attendances and 3951 female adult attendances consecutively over the timeframe studied. Adult attenders were more likely to attend within 7-days of the alleged assault compared with adolescent attenders (80.3% V 70.2% OR1.513 CI 1.35-1.697 p < 0.001). When compared with adult attenders, adolescent attenders were significantly more likely to disclose being assaulted outdoors (40.9% V 15.7% OR2.607 CI 2.346-2.898 p < 0.01), during the day (58.4% V 34.4% OR1.673 CI 1.565-1.790 p < 0.01), assaulted by a friend/family member (28.9% V 16% OR 1.812 CI1.603-2.049 p < 0.01) and less likely to have consumed alcohol prior to the incident (45.6% V 25.3% OR1.807 CI 1.653-1.975 p < 0.001). Physical injuries were less likely in adolescent attenders (30% V 35.5% OR0.845 CI .758-.942 p = 0.02). A comparison of the characteristics of adolescent and adult female sexual assault disclosures identifies differences regarding location of the incident, relationship to perpetrator and prevalence of alcohol consumption. Knowledge of these factors support appropriate tailoring of treatment, prevention and awareness strategies to help modify the impact and reduce the incidence of SA in the vulnerable adolescent cohort.

As the busiest obstetric hospital in Europe, with an established multidisciplinary specialist Infectious Diseases Service, we sought to evaluate trends in incidence of selected infectious diseases in pregnancy and their rate of associated neonatal infection. This hospital provides a specialist multidisciplinary service to manage pregnancies complicated by certain infectious diseases. We interrogated a prospectively collected database for prevalence of these infections in pregnancy, incidence of newly diagnosed cases, and data on infected neonates. Comparisons were made across a 21 year time period using the Cochran-Armitage Test of Trend. Figure 1 demonstrates the incidence of new cases of Hepatitis B (HBV), Hepatitis C (HCV), syphilis and HIV in pregnancy during the last 21 years of operation of this specialist clinic, while Figure 2 shows the prevalence of each infection (new and pre-existing). There has been a significant decrease in the prevalence of all infections, with HBV declining from 14.5/1,000 in 2002 to 4.2/1,000 in 2022 (p< 0.0001), HCV declining from 11.5/1,000 in 2002 to 2.0/1,000 in 2022 (p< 0.0001), syphilis declining from 5.6/1,000 in 2002 to 2.5/1,000 in 2022 (p< 0.0001), and HIV declining from 7.3/1,000 in 2002 to 1.4/1,000 in 2022 (p< 0.0001). Similarly, declines were noted in the number of newly diagnosed cases for all infections over the 21 year time period. The number of infected neonates has remained low, with only one case of a neonate infected with HCV and one with syphilis in the last five years from 2018-2022 and no cases of neonates infected with HBV or HIV. There has been a marked reduction in incidence of HBV, HCV, syphilis and HIV in pregnancy over the last 21 years at the largest obstetric hospital in Europe. While it is reassuring to note such a significant drop in maternal infection, it is even more reassuring to see an almost complete absence of congenital infection with these infections. This likely underscores the critical importance of maintaining such a multidisciplinary specialist infectious diseases in pregnancy service.

Background: Sexual violence is common in contemporary society and disproportionally affects adolescents. In order to develop effective treatment, awareness and prevention strategies it is vital that we understand the epidemiology of adolescent sexual assault (SA). The aim of this study is to evaluate attendances by female adolescents to the national sexual assault treatment unit (SATU) network in the Republic of Ireland and compare these attendances with adult women accessing the service.Methods: This is a cross-sectional study analysing the attendances of all adolescent female attendances at the 6 SATUs in the Republic of Ireland and comparing them with all adult female attendances between 1/1/2017 and 31/12/2022.Results: There were 1014 female adolescent attendances and 3951 female adult attendances over the timeframe studied. Adult attenders were more likely to attend within 7-days of the alleged assault compared with adolescent attenders (80.3% V 70.2% OR1.513 CI 1.35-1.697 p < 0.001). When compared with adult attenders, adolescent attenders were significantly more likely to disclose being assaulted outdoors (40.9% V 15.7% OR2.607 CI 2.346-2.898 p < 0.01), during the day (58.4% V 34.4% OR1.673 CI 1.565-1.790 p < 0.01), assaulted by a friend/family member (28.9% V 16% OR 1.812 CI1.603-2.049 p < 0.01) and less likely to have consumed alcohol prior to the incident (45.6% V 25.3% OR1.807 CI 1.653-1.975 p < 0.001). Physical injuries were less likely in adolescent attenders (30% V 35.5% OR0.845 CI 0.758-0.942 p = 0.02).Conclusion: A comparison of the characteristics of adolescent and adult female sexual assault disclosures identifies differences regarding location of the incident, relationship to perpetrator and prevalence of alcohol consumption. Knowledge of these factors support appropriate tailoring of treatment, prevention and awareness strategies to help modify the impact and reduce the incidence of SA in the vulnerable adolescent cohort.

Background: Sexual violence is a crime that affects people of all genders. While focus is frequently on female survivors, it is crucial to acknowledge that males also experience sexual violence and to ensure that gendersensitive services are available to all survivors. Understanding the prevalence of, and factors associated with, sexual violence against males is a critical first step in addressing this issue. We aim to address the lack of data in relation to sexual violence against males. Methods: A cross-sectional study of all male attendances at 6 Sexual Assault Treatment Units (SATU) in the Republic of Ireland over a 6-year period and, where applicable, comparison with corresponding female attendances. Results: There were 381 male attendances with an average age of 28.5 years over the study period, representing 7 % of all SATU patients. There was a 24 % increase in male attendances during the study period. 39.1 % presented within 24 h of the assault. 61.9 % reported the crime to the police. Employment status included 37.3 % employed, 24.9 % unemployed, and 26.2 % students, with 86.7 % being Irish nationals. Most incidents occurred on weekdays (53.3 %) and at night (56.7 %). Referrals were primarily from police (55.9 %), and psychological support was provided in 62.3 % of cases. Alcohol (60.4 %) and illicit drugs (20.5 %) were reported before assaults. 18.6 % suspected drug-facilitated assaults. Male assailants constituted 90.1 %, with 13.9 % involving multiple assailants. Male attenders were significantly more likely than females to be assaulted in their assailant's home and to be assaulted by more than one assailant. They were significantly less likely than females to report the crime to the police or to have consumed alcohol. Conclusion: To our knowledge, this is one of the largest case series of male patients attending a sexual assault treatment service to be published in the international literature. Male patients are a distinct group that are increasingly accessing SATU services. Significant differences exist between male and female patients' reported experiences of sexual violence. Knowledge of these factors will support appropriate tailoring of treatment & service provision, prevention and awareness strategies to help modify the impact and reduce the incidence of sexual violence in this cohort.

Objective: Sexual assault is pervasive in today's society, with the numbers of those reporting it increasing. In Ireland, 50% of women will experience some form of sexual violence in their lifetime. We sought to describe the incident details of females presenting to the Sexual Assault Treatment Unit (SATU) network in the Republic of Ireland and to determine associations between incident characteristics and: (1) victim age, (2) presence of injury, (3) victim-perpetrator relationship, and (4) number of assailants. Methods: This was a retrospective cross-sectional study of all females who attended between 2017 and 2023. Descriptive bivariate analysis was performed. Results: There were 5942 female attendances, with an average age of 26 years. The largest age group was women between 18 and 25 years (38.1%, n = 2263). Forensic examinations were performed in 76.6% (n = 4549). Assailants were male in 92% (n = 5469) of incidents, with multiple assailants disclosed in 7.3% (n = 435). Strangers or recent acquaintances were the assailant in 38.5% (n = 2290) of incidents, and close associates in 22.9% (n = 1359). Incidents occurred at the survivor's home in 22% (n = 1306) of incidents, and in the assailant's home in 22.6% (n = 1342). Drug use within 24 h was reported in 15.1% (n = 897) of cases, and alcohol use in 72% (n = 4276). Drug-facilitated assault was suspected by 16.1% (n = 955). Injuries (genital and extra-genital) occurred in 30.3% (n = 1800) of attendances and were more likely to be seen in those who disclosed ingesting alcohol (Relative risk [RR] 1.325, P < 0.001) or drugs (RR 1.111, P = 0.04) in the 24 h preceding the incident, in those who presented within 24 h (RR 1.646, P < 0.001), those aged 18 years or older (RR 1.07, P = 0.003), and those where the incident occurred outdoors (RR 1.24, P < 0.001). Conclusion: This study, one of the largest on female attendances to a national SATU network, offers detailed insights into demographics, incident details, and circumstances. Most were young women, mainly 18 years and older, many of whom were full-time students. Forensic examinations were the primary reason for attendance, underscoring the network's key role in evidence collection. The study also identified factors linked to a higher risk of injury detection, such as immediate post-incident attendance, being over 18, outdoor incidents, perpetration by a stranger, and prior alcohol or drug use.