Current postgraduates by research

Promotion of physical activity in primary care: knowledge and practice of general practitioners and physiotherapists
Aim: Being physically active has many proven health benefits and promoting physical activity to patients in primary care is an important component of public health programmes.
This study examined the knowledge and practices of general practitioners and physiotherapists in the promotion of physical activity in primary care.
Subject and methods: A cross-sectional population survey was conducted in Ireland to establish participants’ knowledge of physical activity guidelines and current practice in the promotion of physical activity. A total of 342 general practitioners (response rate 65 %; n0543) and 89 physiotherapists (response rate 88 %; n0101) responded to the
survey.
Results: More physiotherapists (50.5 %; n045) than general practitioners (28 %; n097) correctly reported the minimal physical activity guidelines (X2016.56, p<.005, df01).  General practitioners reported screening physical activity opportunistically (41 %; n0139) and when related to a patient’s presenting complaint (37 %; n0126). Physiotherapists reported screening physical activity routinely (34 %; n030) and when related to the presenting complaint (28 %; n025).  With the exception of overweight patients, general practitioners were more likely than physiotherapists to promote physical activity to patients with known cardiovascular risk factors such as hypertension (X2049.65, p<.001, df02) and hypercholesterolemia (X2032.58, p<.001, df02). Physiotherapists, however, were more likely to promote physical activity to healthy populations (X209.91; p<.01, df02).  Education and advice was the intervention most frequently used (general practitioners 76 %; n0258, physiotherapists 97 %; n086). 
Conclusion: Despite high levels of awareness of physical activity promotion amongst general practitioners and physiotherapists, there is scope to improve physical activity promotion particularly to healthy populations and ongoing challenges to incorporate evidence based interventions into routine care.

Pathways to Rehabilitation: a cohort study of Opiate-dependent Patients Post-detoxification.
At present the treatment of choice for most opiate dependent persons in Europe is long term substitute prescribing. Given the poor evidence base and also the increased risk of overdose, following a period of abstinence, many clinicians opt to dissuade opiate dependent persons from detoxifying. Opiate detoxification is not an effective stand-alone treatment for opiate dependence but is nevertheless an essential step to recovery. However, there is no medium or long-term outcome data examining these issues for this population of patients in Ireland. The aim of the proposed study is to follow the treatment progress of a baseline sample of opiate dependent patients post detoxification. The purpose is to examine abstinence rates at 3, 6 and 9 month follow up and investigate the relationship between rehabilitation pathways and observed outcomes across each of the three rehabilitation pathways i.e. inpatient rehabilitation programmes, outpatient rehabilitation programmes or simply return to the community without any formal aftercare. The study sets out to comprehensively uncover factors that influence and predict rates of relapse to regular opiate use following residential detoxification.  There are three arms in the current study arm 1 is a Neuro-imaging arm (patients are given a base-line Functional Magnetic Image (fMRI) scan, arm 2 is Quantitative arm patients are given a battery of validated outcome measures at base-line and repeated at 3, 6, & 9 months post-detoxification) and a Qualitative arm 2, a sub-sample of patients are interviewed at base-line and repeated at 3, 6, & 9 months post-detoxification).  The projected completion of this project is March 2014.

An investigation of antibiotic use and health utilisation among infants and children, from the Growing up in Ireland (GUI) infant cohort.

Child health and survival in urban slums in Malawi: health care seeking behaviour and relative of health system factors in influencing care seeking decisions

The chronic-ills of ageing: an examination of multimorbidity and inequalities in Ireland's older population.
The growing prevalence of multimorbidity (defined as > 2 chronic conditions in an individual) has been identified as a substantial challenge to health services in future years (Guthrie 2011). Population ageing is likely to lead to a substantial increase in the absolute numbers of health conditions in the population, and the proportion of patients presenting with multimorbidities. The presence of more than one chronic condition in an individual predicts many adverse health outcomes, including the onset of additional health problems, functional impairment, progressive loss of mobility, hospitalisations, mortality, poor mental health symptoms and unfavourable self-assessed health status (Marengoni et al. 2011). This places a heavy burden on patients and on health and social care services (Broemeling, Watson, and Black 2005). Multimorbidity is associated with frequent use of healthcare services with significant economic consequences (Gijsen et al. 2001). There is a dearth of multimorbidity research in Ireland and appropriate responses to multimorbidity have yet to be integrated into health service planning and delivery in Ireland. The primary aim of this thesis is to gain a greater understanding of the prevalence and patterns of multimorbidity in Ireland’s older community-dwelling population, conducting secondary data analysis on first wave data from the Irish Longitudinal Study on Ageing. Increasing our knowledge of multimorbidity may contribute to improvements in the illness experience for people with multimorbidity and contribute towards improved healthcare provision for at risk populations.

A multi-level analysis of health and wellbeing in nine-year-old children.
The life and development of a human being, are shaped by an ongoing process of complex interactions between the individual and its environment.  Temporal and spatial modifications will occur throughout the individual's life within a social context as the concepts of health and wellbeing are embedded and altered in a multilayered framework.  The conceptual framework of Growing up in Ireland, the national longitudinal study of children, was used to describe health and wellbeing in nine-year-old children and to analyse associated factors by multi-level analyses of cross-sectional data derived from the first wave of the nationally representative population based cohort study.  The key findings of this research include the gender specific differences in the health and well being of children and underlines the necessity of evaluating health and behaviour-related outcomes from a gender-specific view, embedded in a multi-level approach.

Respiratory health among the infant cohort of 'Growing up in Ireland' and association with their environment.
Strategies to improve public health have suggested that creating physical environments, which promote good health, may be important in the fight to reduce health inequalities. The overall aim of this study was to identify living conditions associated with asthma and wheezing among infants, using data from the Growing up in Ireland infant cohort.  Results showed that exposure to other children in a crèche or at home was a major environmental factor that increased the risk of experiencing respiratory illnesses, suggesting that a significant proportion of respiratory problems are caused by viruses and bacteria passed from child to child.

The Association between breastfeeding and respiratory illness in Irish infants.
Respiratory illness is a major health concern for children worldwide and is a serious public health problem in developed and developing countries.  Acute respiratory infection is one of the leading causes of morbidity and mortality in children under five years of age.  The immaturity of the infant immune system results in a particular vulnerability to respiratory illnesses, thus it is essential to identify any protective factors for this population.

Alcohol intervention programme in a sporting setting:  A cluster randomised trial to evaluate a setting-based alcohol intervention programme in the GAA.
The link between alcohol and sport is pervasive in many countries including Ireland, but there is a dearth of information on alcohol use among amateur sporting organisations in Ireland and internationally.  This cluster randomised controlled trial was established to evaluate a community based alcohol intervention programme in the largest amateur sporting organisation in Ireland, namely the Gaelic Athletic Association (GAA) and to reduce alcohol related harms among GAA players.  Results showed that the community based intervention did not have a differential impact on alcohol outcome measures among the GAA players.  However, many alcohol outcome measures declined in both control and intervention players.

Peer support in type 2 diabetes: a randomised controlled trial in primary care.
Type 2 diabetes has reached epidemic proportions in many countries. Self-management programmes for this condition have moved away from the traditional didactic interventions to patient empowerment and peer-led programmes.  This study aimed to describe the implementation and evaluate the effectiveness of a face to face group peer support intervention for people with type 2 diabetes in the primary care setting in the east of Ireland.  The study was a cluster randomised controlled trial implemented using the MRC Framework for the evaluation of complex interventions to improve health.

Development of an adjusted scan statistic for the efficient detection of road collision 'hot spots' along the road network in Ireland.
Road traffic collisions impose a major burden on society, thus there is a real incentive for inter-sectoral collaboration when decisions and policies are being formulated.  This research was set in the context of the 5-year road safety strategy (2007-2011), which was developed to help reduce road fatalities and serious injuries in Ireland.  The main aim of the research was to develop the required efficient statistical method for identifying road traffic collision hot spots/corridors along the road network in Ireland and to assess the human, environmental and infrastructural factors associated with fatal/serious road traffic collision injuries from single vehicle and multi vehicle collisions.