Health systems worldwide are experiencing profound shocks resulting from the COVID-19 pandemic, with increased attention to health system resilience and researching ways to endure shocks. Pre-COVID-19, Ireland had begun a ten-year programme of reform, Sláintecare, aiming to deliver universal, timely access to integrated care. This study examines whether and how the Irish government's pandemic response contributed to health system reform and increased resilience including delivering universal healthcare. Documentary analysis identified and critiqued relevant government, health system and budgetary documents, published March 2020 - May 2021. Thirteen national policy documents were found, showing increased policy rhetoric and intent to implement reform, demonstrated by increased policy alignment with and budgetary allocation to Sláintecare, alongside implementation of key innovations. Ireland's health system response to COVID-19 offers a unique opportunity to advance understanding of government efforts to reform amidst a global pandemic. It indicated policy intent and funding to manage the Irish COVID-19 crisis, but to also build health system resilience through implementing Sláintecare. This case study has international significance, enabling policy development with potential for long-term health system transformation.

Objective: We aimed to investigate the hypothesis that interferon (IFN)–stimulated gene (ISG) expression in systemic lupus erythematosus (SLE) monocytes is linked to changes in metabolic reprogramming and epigenetic regulation of ISG expression.Methods: Monocytes from healthy volunteers and patients with SLE at baseline or following IFNα treatment were analyzed by extracellular flux analysis, proteomics, metabolomics, chromatin immunoprecipitation, and gene expression. The histone demethylases KDM6A/B were inhibited using glycogen synthase kinase J4 (GSK‐J4). GSK‐J4 was tested in pristane and resiquimod (R848) models of IFN‐driven SLE.Results: SLE monocytes had enhanced rates of glycolysis and oxidative phosphorylation compared to healthy control monocytes, as well as increased levels of isocitrate dehydrogenase and its product, α‐ketoglutarate (α‐KG). Because α‐KG is a required cofactor for histone demethylases KDM6A and KDM6B, we hypothesized that IFNα may be driving “trained immune” responses through altering histone methylation. IFNα priming (day 1) resulted in a sustained increase in the expression of ISGs in primed cells (day 5) and enhanced expression on restimulation with IFNα. Importantly, decreased H3K27 trimethylation was observed at the promoters of ISGs following IFNα priming. Finally, GSK‐J4 (KDM6A/B inhibitor) resulted in decreased ISG expression in SLE patient monocytes, as well as reduced autoantibody production, ISG expression, and kidney pathology in R848‐treated BALB/c mice.Conclusion: Our study suggests long‐term IFNα exposure alters the epigenetic regulation of ISG expression in SLE monocytes via changes in immunometabolism, a mechanism reflecting trained immunity to type I IFN. Importantly, it opens the possibility that targeting histone‐modifying enzymes, such as KDM6A/B, may reduce IFN responses in SLE. image

While access to housing has been identified as a crucial enabler to young people exiting homelessness, relatively little is known about the experiences of youth who encounter barriers in their attempts to secure housing. Mobilizing a pathways approach, this paper examines homeless young people’s experiences of seeking housing in a context of housing market forces that blocked their efforts to carve a route out of homelessness. The research, which is biographical and longitudinal, was conducted in Ireland between 2013 and 2016 and involved the collection of data at two points in time. At baseline, 40 young people aged 16–24 years and 10 of their family members were recruited (Phase 1) and, at the point of follow-up two years later (Phase 2), 74% of participants were retained in the study. By Phase 2, just 24% of the study’s young people were housed, pointing to significant barriers of access to housing. Moving beyond the identification of the impact of housing market forces on young people’s ability to exit homelessness, the analysis examines young people’s responses, focussing on the strategies used by them as they attempted to reclaim autonomy and control over their housing futures. Implications for the development of sustainable housing solutions that specifically cater to the needs of homeless youth are discussed.

Background: Effective governance arrangements are central to the successful functioning of health systems. While the significance of governance as a concept is acknowledged within health systems research, its interplay with health system reform initiatives remains underexplored in the literature. This study focuses on the development of new regional health structures in Ireland in the period 2018–2023, one part of a broader health system reform programme aimed at greater universalism, in order to scrutinise how aspects of governance impact on the reform process, from policy design through to implementation.Methods: This qualitative, multi-method study draws on document analysis of official documents relevant to the reform process, as well as twelve semi-structured interviews with key informants from across the health sector. Interviews were analysed according to thematic analysis methodology. Conceiving governance as comprising five domains (Transparency, Accountability, Participation, Integrity, Capacity) the research uses the TAPIC framework for health governance as a conceptual starting point and as initial, deductive analytic categories for data analysis.Results: The analysis reveals important lessons for policymakers across the five TAPIC domains of governance. These include deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders and the public, and periods during which a lack of clarity in terms of roles and responsibilities for various process and key decisions related to the reform were identified. Inadequate resourcing of implementation capacity, competing policy visions and changing decision-making arrangements, among others, were found to have originated in and continuously reproduced a lack of trust between key institutional actors. The findings highlight how these challenges can be addressed through strengthening governance arrangements and processes. Importantly, the research reveals the interwoven nature of the five TAPIC dimensions of governance and the need to engage with the complexity and relationality of health system reform processes.Conclusions: Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and be able to address these, and to move beyond formulaic prescriptions, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed.

Analyses of the relevance of family for young people are more visible than previously within youth research. Nonetheless, understanding of the nature and meaning of family relationships for those who experience separation from their family, including homeless youth, is relatively weak. Based on selected findings from a qualitative longitudinal study, this article explores the meaning-making processes of homeless young people with explicit attention to the ways in which “family” is produced and (re)negotiated in their lives over time. Four themes are presented—family as reliable and supportive; family as interrupted and “broken”; family as fragile and elusive; and family as fluid and ambiguous—revealing the unfolding nature of young people’s constructions of family and family relationships. The enduring impact of separation, dislocation, and conflict on how young people “make sense” of familial experiences is discussed, and we conclude with the practice implications arising from the findings.

Background:Population-based resource allocation is a specific approach to population health planning that is used to address differences in population need to promote equity and efficiency in health and health system outcomes. However, while previous studies havedescribedthis type of funding model, they have not comparedhowsuch policies and practices have been implemented across jurisdictions. This research examined the impacts and outcomes of population-based resource allocation across six high-income countries, with a view to informing strategic decision-making as Ireland progresses its universal healthcare reform agenda. Methods:A concurrent multi-method approach was employed to examine the experiences of six jurisdictions selected for analysis: Australia (New South Wales), Canada (Alberta), England, New Zealand, Scotland and Sweden (Stockholm). A documentary analysis of key policy, strategy and planning publications was combined with a narrative rapid review of peer-reviewed and grey literature (n = 8) to determine how population-based resource allocation is specified and implemented. The findings were checked and verified by national experts. Results:Notable differences were observed across countries in terms of the stated objectives and descriptions of models as well as the criteria for choosing variables and the variables ultimately used in funding formulae. While population-based resource allocation can help improve equity related to healthcare outcomes and access, a number of tensions were revealed between the need to ensure alignment between policy goals and model design; transition between models; support regionalisation policies; and develop robust governance and monitoring mechanisms to maximise outcomes. Conclusions:The review progresses ‘thinking’ about population-based resource allocation beyond the technical aspects of model or formulae construction. Population-based resource allocation should be viewed as just one lever of large-scale health system reform that can be thoughtfully developed, monitored and adjusted in a way that supports the goals of Sláintecare and the delivery of universal healthcare.