John Cullinan’s research while affiliated with Galway University Hospitals and other places

The Covid-19 pandemic resulted in significant disruptions to both international student mobility and labour markets. Against this background, this scoping review documents findings from 35 studies, published between January 2020 and February 2024, that focused on international student mobility, Covid-19, labour market outcomes, and related regulations. The review shows that the Covid-19 pandemic negatively impacted (1) the labour market outcomes of international students before studying abroad, through changes in visa regulations, (2) skill acquisition during their mobility, (3) the duration of their studies, and (4) the availability of jobs during and after their mobility period. These negative impacts occurred at a time when international students’ needs for work were heightened. This ‘double whammy’ was more pronounced among international students from lower socio-economic backgrounds, increasing pre-existing inequalities. It was also affected by students’ residency status and policy changes. These findings underline the critical role that temporality plays in shaping the returns to international student mobility. However, the existing literature on the topic is relatively sparse and has primarily relied upon qualitative approaches and rapid research. Future studies are needed to better understand the impact of Covid-19 on the labour market outcomes of international students.

Study abroad experiences enhance skills such as adaptability, cross-cultural communication, and foreign language proficiency (1). Because of this, study abroad experience is often expected to be valued by employers. Nevertheless, scientific evidence on the value that employers attribute to international study experiences remains rather restricted, with mixed findings across countries. This policy brief synthesizes the global literature to explore how country context, employer type, candidate skills, and graduate nationality impact employers' perceptions of study abroad experiences.

Health spillovers arise when an individual's serious illness affects those close to them emotionally, psychologically, and/or physically. As a result, healthcare interventions that improve the lives of patients may also confer wider health benefits. However, contrary to widespread calls for health spillovers to be included in health economic evaluation, others have argued this could have adverse distributional consequences and equity implications. This paper presents a novel approach to spillover inclusion in health economic evaluation using a ‘prioritarian transformation’ of health gains that allows these equity concerns to be addressed. Affording greater weight to the incremental change in patient outcomes when incorporating carer/family health spillovers into resource allocation decisions, the method provides a feasible means of moderating the distributional impact of spillover inclusion. It also introduces a normative, theoretical perspective to a largely empirical extant literature and, as such, its axiomatic basis is examined. Finally, an illustrative example of the approach is presented to demonstrate its application.

Omission of family and caregiver health spillovers from the economic evaluation of healthcare interventions remains common practice. When reported, a high degree of methodological inconsistency in incorporating spillovers has been observed. To promote emerging good practice, this paper from the Spillovers in Health Economic Evaluation and Research (SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda and future practice. A modified nominal group technique was used to reach consensus on a set of recommendations, representative of the views of participating subject-matter experts. Through the structured discussions of the group, as well as on the basis of evidence identified during a review process, recommendations were proposed and voted upon, with voting being held over two rounds. This report describes 11 consensus recommendations for emerging good practice. SHEER advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. Where possible, spillovers related to displaced/foregone activities should be considered, as should the distributional consequences of inclusion. Time horizons ought to be sufficient to capture all relevant impacts. Currently, the collection of primary spillover data is preferred and clear justification should be provided when using secondary data. Transparency and consistency when reporting on the incorporation of health spillovers are crucial. In addition, given that the evidence base relating to health spillovers remains limited and requires much development, 12 avenues for future research are proposed. Consideration of health spillovers in economic evaluations has been called for by researchers and policymakers alike. Accordingly, it is hoped that the consensus recommendations of SHEER will motivate more widespread incorporation of health spillovers into analyses. The developing nature of spillover research necessitates that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for balance between consistency in approach, where valuable in a decision making context, and variation in application, to reflect differing decision maker perspectives and to support innovation.

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Without appropriate early resuscitation interventions, the prospect of survival is limited. This means that an effective community response is a critical enabler of increasing the number of people who survive. However, while OHCA incidence is higher in more deprived areas, propensity to volunteer is, in general, associated with higher socioeconomic status. In this context, we consider whether there are socioeconomic disparities in geographic accessibility to volunteer community first responders (CFRs) in Ireland, where CFR groups have developed organically and communities self-select to participate. We use geographic information systems and propensity score matching to generate a set of control areas with which to compare established CFR catchment areas. Differences between CFRs and controls in terms of the distribution of catchment deprivation and social fragmentation scores are assessed using two-sided Kolmogorov-Smirnov tests. Overall we find that while CFR schemes are centred in more deprived and socially fragmented areas, beyond a catchment of 4 min there is no evidence of differences in area-level deprivation or social fragmentation. Our findings show that self-selection as a model of CFR recruitment does not lead to more deprived areas being disadvantaged in terms of access to CFR schemes. This means that community-led health interventions can develop to the benefit of community members across the socioeconomic spectrum and may be relevant for other countries and jurisdictions looking to support similar models within communities.

Population-based breast screening programmes aim to improve clinical outcomes, alleviate health inequalities, and reduce healthcare costs. However, while screening can bring about immediate changes in mode of presentation and stage at diagnosis of breast cancer cases, the benefits and harms of these programmes can only be observed at a population level, and only over a long enough timeframe for the cascade of events triggered by screening to culminate in disease-specific mortality reductions. In this paper we exploit a natural experiment resulting from the phased geographic rollout of a national mammography screening programme to examine the impact of screening on breast cancer outcomes from both a patient cohort and a population perspective. Using data on 33,722 breast cancer cases over the period 1994–2011, we employ a difference-in-differences research design using ten-year follow-up data for cases diagnosed before and after the introduction of the programme in screened and unscreened regions. We conclude that although the programme produced the intended intermediate effects on breast cancer presentation and incidence, these failed to translate into significant decreases in overall population-level mortality, though screening may have helped to reduce socioeconomic disparities in late stage breast cancer incidence.

Methods A cross-sectional study was conducted in the various health facilities and institutions at national and sub-national levels in Uganda. The participants were health care workers and first responders working in the health sector during the COVID-19 pandemic in Uganda. The mental health status of the health workforce was measured using the Depression, Anxiety and Stress Scale 21 instrument. The Nurses Work Functioning Questionnaire was used to measure health work functioning. The data for the study was collected using the Survey Monkey tool and exported and cleaned in Microsoft Excel 2019. The data were analyzed using the Statistical Package of STATA® version 16. Descriptive statistics, such as mean values, percentages, frequencies, and charts, were used to summarize the findings. Multinomial logistics regression was used to estimate an ologit model of the relationship between mental health and health work functioning. The results were measured using odds ratio. Results A total of 533 responses were obtained between June and July 2021, from 90 districts in Uganda. Three of the respondents did not consent to the study. 29.26% of responses were excluded during the analysis of the results because of missing data. 374(70.17%) responses from 82 districts in Uganda was used for the analysis. The prevalence of depression was 40.37%, stress was 25.7% and, anxiety was 47.06% among health care workers during the response to the COVID-19 pandemic in Uganda. The factor of mental health associated with work function impairment were avoidance behavior and lack of energy and motivation. Conclusion The prevalence of depression, anxiety and stress was high in Uganda during the peak of the response. Avoidance behavior is a determinant of mental health associated with health work function impairment. The government of Uganda needs to develop interventions that will strengthen the mental health and psychosocial well-being of health workers when providing health care services.