Published: 14 July 2020

HRB announces €3.7 million investment in twelve new health research fellowships

Health data, biomarkers for the early detection of dementia, and the influence of the food industry on public health policy in Ireland are just some of the areas that will come under the microscope in the twelve projects.

Dr Annalisa Montesanti, Programme Manager, HRB said:

‘These postdoctoral awardees have come through a very competitive process and represent the very best of the new crop of health researchers working in the Irish health research system. The standard was so high that the international review panels for each fellowship scheme could have recommended more applications for funding if budget had been available.

‘These are significant achievements in these researchers’ careers’.

The awards were made under two postdoctoral training schemes, Applying Research into Policy and Practice Fellowships, and Clinician Scientist Fellowships. Seven of the awards were made under the Applying Research into Policy and Practice scheme.  Five of the awards were made under the Clinician Scientist Fellowship scheme.

‘These form part of a structured award portfolio that the HRB has created. When combined, the suite of awards offer a very clear career pathway that develops and supports health researchers at every stage in their careers’, Dr Montesanti added.

Details about each awardee and their projects are below. If you would like further information about any individual project, or to speak to the researcher, please contact the Media / Communications office at the researcher’s host institution.

Applying Research into Policy and Practice Fellowships

This scheme is designed to support academic researchers on their journey from doctoral training to academic research leadership positions.

Full project summaries of each award are available further down this page.

List of awardees

1. Dr Elaine Toomey, Using Knowledge Translation to Enhance the Use of Evidence in Public Health Decision-making by Policymakers and Healthcare Managers in Ireland, University of Limerick €249,518
2. Dr Melissa Mialon, Industry Corporate Political Activity and its Potential Influence on Public Health Policy, Research and Practice in Ireland, Trinity College Dublin, €220,824
3. Dr Mary Walsh, Hip Fracture Outcome Recording and Geographic Equality, University College Dublin, €214,412
4. Dr Elaine McCarthy, Iron Deficiency Assessment for protection of the newborn brain, University College Cork, €241,040
5. Dr Eithne Sexton, Health services research, Scenario and Intervention Modelling in Ireland for Stroke: Evaluating the effect of alternative policy scenarios and interventions for stroke in Ireland on outcomes and costs, RCSI, €227,371
6. Dr Irina Kinchin, Measures of wellbeing for use in economic evaluation: valuing and assessing health outcomes in Ireland, Trinity College Dublin, €244,455
7. Dr Bridget Johnston, Progressing Sláintecare delivery from proposal to implementation: Insights from palliative care in Ireland, Trinity College Dublin, €240,598

Clinician Scientist Fellowships

This scheme is designed to support health and care practitioners on their journey from doctoral training to research leadership, while balancing their clinical commitments.

Full project summaries of each award are available further below.

List of awardees

1. Dr Martina Hayes, Oral Health in Adults with Cystic Fibrosis, University College Cork, €236,183
2. Dr Tomás Barry, Building research capacity, harnessing data and strengthening health systems to improve outcomes in community emergency and unscheduled care in Ireland, University College Dublin, €470,046
3. Dr Emer McGrath, Blood-based biomarkers for early detection of preclinical neurocognitive disorders, NUI Galway, €655,524
4. Dr Helen O'Leary, Exercise Therapy for Degenerative Meniscal Tears in the Primary Care - a Feasibility Cluster Randomised Controlled Trial, University of Limerick, €219,603
5. Dr Laura Gleeson, Manipulating macrophage bioenergetics to improve patient outcomes in TB infection, Trinity College Dublin, €523,127

Project summaries – Applying Research in Policy and Practice 2020

1. Dr Elaine Toomey, Using Knowledge Translation to Enhance the Use of Evidence in Public Health Decision-making by Policymakers and Healthcare Managers in Ireland, UL, €249,518

Project summary

Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society. Using high-quality evidence to inform how health policies are made is crucial to ensure safe and effective healthcare and to optimise patient and public health outcomes. Despite this, international research consistently shows that evidence is poorly used by those who develop policy and make decisions about healthcare delivery and services on a population level. This includes people like public health policymakers within the Department of Health or senior healthcare managers within the health service. However, the use of evidence within public health decision-making and how to support and improve its use has not been previously explored within an Irish context. This project aims to enhance the use of evidence within public health decision-making in Ireland by developing recommendations to be applied within a national setting.

In order to achieve this, we will:

• Compile information from existing studies that have examined which strategies work to improve the use of evidence within high-level public health decision-making.
• Survey national policymakers and healthcare managers to identify the current use of evidence within public health decision-making in Ireland and what is needed.
• Conduct individual interviews with national policymakers and healthcare managers to increase our understanding of how evidence is currently used in Irish public health decision-making, the factors that influence this and how it can be improved.

We will then bring together the findings of steps 1-3 to develop recommendations to enhance the use of evidence within public health decision-making in Ireland. Involving highly influential national decision-makers (e.g. from the Department of Health) as key members of our research team throughout the project will help ensure maximum impact of our findings and support the application of findings into a national setting.

2. Dr Melissa Mialon, Industry Corporate Political Activity and its Potential Influence on Public Health Policy, Research and Practice in Ireland, TCD, €220,824

Project summary

In Ireland, non-communicable diseases (NCD), which include diabetes, cardio-vascular diseases and cancers, contribute to premature death and increased suffering and disability. Unhealthy diets, particularly those high in ultra-processed food products, and obesity, are one of the primary risks factors for NCD. Internationally recommended policies, such as restrictions on the marketing of unhealthy food products to children, could prevent and control NCD, but have yet to be developed and implemented in Ireland. There is evidence that the main obstacle in relation to this is the influence of the food industry, whose profits are generated from the consumption of ultra-processed products. The extent of this influence in Ireland is unknown. In parallel, there is little information, globally, about solutions to mitigate that influence. We propose to identify the influence of the food industry on public health policy, research and practice in Ireland, through one historical study, which will use internal documents from the industry, and one study of its recent practices. In addition, we will conduct interviews with key informants in Ireland. We will also identify potential solutions and provide recommendations to mitigate that influence, through a document analysis, an online questionnaire coupled with a consultation with public health experts in academia, government and civil society, and a citizen jury. This work would build on the progress that has been made in Ireland in recent years since the introduction of public health policies, particularly tobacco and alcohol control. With the results from this project, policy makers, academics and public health professionals in Ireland will be equipped to identify and counter the arguments and actions of the food industry during the development of public health policies or programmes. The second half of this project will arm them with more effective, informed solutions to counter undue influence on public health policy, research and practice.

3. Dr Mary Walsh, Hip Fracture Outcome Recording and Geographic Equality, UCD, €214,412

Project summary

Hip fracture is a serious event in the lives of older people with around one in five individuals dying in the first year after their injury and many more losing their independence. Currently in Ireland, little is known about how people recover in the longer-term after hip fracture and many do not receive routine follow-up. In the last six years much work has been done to improve the care that people with hip fracture get in Irish hospitals including making sure they get to surgery as quickly as possible and that they have relevant tests and treatments. The Irish Hip Fracture Database is a national initiative that oversees and leads this work. We do not have information to show however, that these improvements are making a difference to the lives of people with hip fracture after they leave hospital. This project will support hospitals to begin recording this information as part of usual care. We will build on previous work carried out in Ireland and the UK to identify the best ways of following up patients with hip fracture. We will get input from persons who have experienced hip fractures and family members to do this. We will explore whether people who live in different areas of the country are getting equal standards of care in hospital after hip fracture and will look at reasons for differences that we find. We will develop new ways to make comparisons between hospitals as fair as possible by accounting for differences in the patients that they treat. This project will support the Irish Hip Fracture Database to focus improvements to areas in Ireland that need them most. It will also ensure that decision-makers focus on improving outcomes that matter to older people including quality of life, pain and ability to live independently.

4. Dr Elaine McCarthy, Iron Deficiency Assessment for protection of the newborn brain, UCC, €241,040

Project summary

Iron deficiency is the most common nutritional deficiency in the world. About 1 in 4 people do not have enough iron to stay healthy. Pregnant women, infants and young children are at high risk of iron deficiency, as they need more iron than other population groups to support growth and development. Maternal health, including body weight and lifestyle factors as well as pregnancy-related complications can affect iron transfer in the womb. Iron deficiency during pregnancy and early life can have serious consequences for a baby’s brain development, affecting their intelligence, emotions and behaviour. Therefore, we need to be able to identify the mothers and infants who are at the greatest risk so that they can receive treatment. In Ireland, there is no system to identify mothers and babies at risk and no testing for iron deficiency during pregnancy or at birth. This project aims to develop two screening tools to select those at risk of iron deficiency; one for use in pregnant women and their babies and the second for babies who are born preterm. The screening tools will collate medical and blood-related data collected during pregnancy and in babies from studies that we have already carried out. These two screening tools will then be tested in clinical practice and will be brought into clinical practice to ensure that iron deficiency in pregnant woman and infants is detected early. This will allow prompt, targeted treatment and will prevent the long-term developmental and health consequences of iron deficiency. This project will benefit the health and wellbeing of the Irish population, by protecting brain development, leading to improved education, job potential and life satisfaction.

5. Dr Eithne Sexton, Scenario and Intervention Modelling in Ireland for Stroke: Evaluating the effect of alternative policy scenarios and interventions for stroke in Ireland on outcomes and costs, RCSI, €227,371

Project summary

One in every four people in Ireland will have a stroke in their lifetime. People are less likely to die if they have a stroke than in previous decades, partly due to new treatments that prevent further strokes and improve outcomes.  For every three people who survive their stroke, two acquire some type of disability such as problems walking. For every five people who survive, three experience cognitive problems or problems with memory, attention and concentration.

There are gaps in health services for people that have had a stroke, especially after leaving hospital, and for problems that are less immediately obvious, such as cognitive problems. There are also limited funds available to introduce new services or develop existing ones. This makes it important to identify services that are most likely to benefit people who have had a stroke, or most likely to prevent strokes from happening at all.

Our research will include talking to key people in stroke care and policy making, and also to stroke patients and their families, to gather their views on how stroke services could be improved, for example, by making a service more widely available across the country. We will use what is already known about how well these services work and apply this to a computer simulation model that predicts what may happen to people with/without stroke if they do or do not receive the services, for example, how long they will survive, the level of disability and their quality of life.  We will then use the model to estimate the greatest future benefit for the Irish population – for example, reducing the number of people who have a stroke, or improving quality of life after stroke. We will communicate this back to policy makers, to inform future service planning for stroke in Ireland.

6. Dr Irina Kinchin, Measures of wellbeing for use in economic evaluation: valuing and assessing health outcomes in Ireland, TCD, €244,455

Project summary

In Ireland, healthcare decisions primarily concentrate on maximising health gain. However, with more integrated social care, there is growing recognition that this perspective is too narrow. Health maximisation is unlikely to be a relevant objective, particularly where demand for social care is high (e.g. in chronic diseases, palliative care) as service users have distinct priorities and needs other than just health maximisation.

A broader capability approach, defined as wellbeing in terms of an individual's ability to 'do' and 'be', is warranted.  The UK and the Netherlands have recently adopted the capability approach as a framework for wellbeing measurement to evaluating health and social care. Ireland has the opportunity to join them as a leader in economic valuation through this project.

This project seeks to establish how the Irish population would value states of broader wellbeing as captured by the ICECAP measures of wellbeing. The results gathered from this research are intended to directly inform the national policy makers Department of Health (DoH), Health Information and Quality Authority (HIQA), National Centre for Pharmacoeconomics (NCPE), Health Service Executive (HSE) and many other stakeholders who are seeking to allocate health resources in a manner that would not take into account not just health, but broader concept of wellbeing.

By capturing broader wellbeing in economic evaluations in Ireland, this work provides frameworks to reconsider if, and how, to fund health technologies as most valued by the Irish population.

7. Dr Bridget Johnston, Progressing Sláintecare delivery from proposal to implementation: Insights from palliative care in Ireland, TCD, €240,598

Project summary

Sláintecare, Ireland’s national ten-year reform plan recommends universal healthcare. This represents the biggest Irish health system reform since its inception. Using palliative care as an example this project examines the development of universal palliative care internationally and applies these learnings to Ireland.

Through a palliative care lens, this research explores what Ireland can learn from other countries. It then examines the supply-side factors to be addressed in meeting Sláintecare proposals. Finally, it analyses the barriers and facilitators to realising these reforms in practice. This a multi-methods design comprising; a comparative analyses of universal palliative care policy and implementation in five other countries and applying the lessons to the Irish context; modelling palliative care need between 2023 and 2040; estimating service capacity and workforce requirements in meeting policy commitments between 2023-2040; determining the applicability and acceptability of expanding the role of generalist palliative care in Ireland through stakeholder engagement.

This project is applied research in real-time evident in the multi-methods and the research team. The collaborators include the most senior national palliative and health reform leaders as well as experienced palliative care, health systems and policy researchers.

These findings will provide detailed evidence and guidance for the Sláintecare Implementation Office in delivering universal palliative care in Ireland specifically and offer wider learnings for universal healthcare implementation nationally and internationally.

Project summaries - Clinician Scientist Fellowships 2020

8. Dr Martina Hayes, Oral Health in Adults with Cystic Fibrosis, University College Cork, €236,183

Project summary

Approximately 1 in 19 Irish people are said to 'carry' one copy of the altered gene that causes Cystic Fibrosis (CF). Half of people born with cystic fibrosis in 2017 will live to at least 47. This is a remarkable medical advance, however this means that we now have a shortage of evidence for the healthcare management of adults with CF, as previously life expectancy did not extend far beyond their teenage years. Dental decay and gum disease are among the most common chronic infectious diseases globally. To date, there have been no studies on the oral health of adults with Cystic Fibrosis and this study aims to compare the levels of dental decay and gum disease among adults with Cystic Fibrosis and a comparison group of non-CF adults. Dentists are not currently part of the healthcare team involved in the management of those with CF, however if adults with CF are found to have high levels of dental disease there may be merit in integrating oral health-care in the patient pathway for those with CF.

9. Dr Tomás Barry, Building research capacity, harnessing data and strengthening health systems to improve outcomes in community emergency & unscheduled care in Ireland, University College Dublin, €470,046

Project summary

This research project aims to improve systems of community emergency care by focusing on a condition called Out-of-Hospital Cardiac Arrest (OHCA). OHCA is an emergency where a person’s heart suddenly stops pumping blood around the body. It happens without warning, often because of an abnormal heart rhythm. In Ireland 2500 people suffer this condition every year.  Survival is possible when quick treatments are available. The treatments that make the most difference are CPR (cardio-pulmonary resuscitation) and early defibrillation (providing an electrical ‘shock’ to the heart) with an AED (automatic external defibrillator).

Currently the survival in Ireland is low at less than 7%. Community and health system-based initiatives are trying to improve this; Although we know many of the treatments that work best in ‘OHCA’ designing a health system that gets these treatments to the right person at the right time and provides appropriate follow on care is a challenge.

Ireland collects high quality information about OHCA via an organisation called the Out-of- Hospital Cardiac Arrest Registry (OHCAR). We plan for the first time to link data from OHCAR with other important data about the Irish population (from the Central Statistics Office Census) and with data about emergency care resources that respond to and treat OHCA. All data will be anonymized so that no individual patient or carer can be identified.

We will specifically look at groups of patients considered most likely to survive and then use novel computer programs to explore how a range of different patient, community and health system factors interact to influence whether or not survival actually occurred. Ultimately, we will use this information to design and build better health systems that increase the amount of people that survive OHCA in Ireland. Improving our response to OHCA will also benefit other time critical emergency conditions.

10. Dr Emer McGrath, Blood-based biomarkers for early detection of preclinical neurocognitive disorders, National University of Ireland, Galway, €655,524

Project summary

With more people now living longer lives, dementia is becoming an increasingly important problem in society. One of the biggest challenges in designing studies of potential new treatments for dementia, is accurately predicting those most likely to develop dementia in the future. Often by the time a person shows signs of dementia, irreversible brain injury has already occurred and the opportunity for early disease-modifying treatment has been missed. If we could identify people at high risk of developing dementia at an early stage, i.e. before the onset of memory problems (e.g. by detecting elevated levels of proteins in the blood) we would have the greatest opportunity to prevent this disease.

In a series of research studies, we will investigate selected promising proteins in the blood (biomarkers) and determine:

• whether these biomarkers are different in people with and without features of early stage dementia on specialised brain scans, and
• whether these biomarkers can predict who will develop dementia in the future using the international PURE study. We will use these study findings to develop a simple risk score which can be used to calculate a person’s likelihood of developing dementia in the future, using both biomarkers (blood test) and clinical information (e.g. hypertension).

The results of this research are expected to have important public health benefits including:
1.    development of a risk score for dementia to quickly identify which people are at ‘high-risk’ of developing dementia,
2.    tailoring approaches to treatment based on an individuals’ biomarker signature, and
3.    improving our ability to find new treatments for dementia, by allowing better selection of individuals for clinical trials.

11. Dr Helen O'Leary, Exercise Therapy for Degenerative Meniscal Tears in the Primary Care - a Feasibility Cluster Randomised Controlled Trial, University of Limerick, €219,603

Project summary

Knee pain due to a degenerative meniscal tear is a common joint condition seen in Irish orthopaedic clinics. Changes to the knee joint and meniscus (cartilage within the knee that helps cushion the joint) occur normally with age but can become painful in some middle-aged adults. Exercise is recommended as the main treatment to aid recovery, while an arthroscopy (camera in the knee) to remove torn cartilage does not provide any additional benefit. Despite this, many patients in Ireland with degenerative meniscal tears are referred to an orthopaedic surgeon by their GP. Meanwhile, according to interviews with patients carried out by our research team, exercise is an underused treatment.

The overall aim of this project is to improve how people with degenerative meniscal tears are managed in the community setting by their GP, and to provide them with a good quality exercise programme. This could ultimately reduce the numbers referred to hospital orthopaedic clinics by their doctors. In preparation for carrying out a larger research study to test this theory, this project will run a smaller study to ensure treatment can be delivered as planned and it is acceptable to patients and GPs.

Firstly, GPs will be interviewed to gain insight into how they treat this knee problem. An educational programme will be designed for GPs with input from a panel of interested parties (patients and doctors, physiotherapists and managers).

Next, this educational programme and an exercise class specifically designed for degenerative meniscal tears will be tested out on approximately 12 GPs and 32 of their patients. Any changes in their symptoms will be compared to a group who are managed as usual by their doctor.

Finally, all GPs and patients will complete a satisfaction survey with some patients and doctors providing more in-depth feedback over the telephone.

12. Dr Laura Gleeson, Manipulating macrophage bioenergetics to improve patient outcomes in TB infection, Trinity College Dublin, €523,127

Project summary

Tuberculosis (TB) is the most lethal infectious disease worldwide, causing 1.8 million deaths annually. For the last four years in Ireland, we have seen a doubling of TB cases after the use of immuno-suppressants called TNF blockers, and the emergence of drug resistant TB in Irish people for the first time in this regard. Targeting and boosting the body’s natural immune response against the bacteria that causes the disease, Mycobacterium tuberculosis (Mtb), is a key strategy to develop new treatments to overcome drug resistant strains of the disease.

Central to this natural immune response is the lung macrophage, a cell that lives inside the lungs and is the first line of defence we have against infection with Mtb. There is evidence that while some lung macrophages live their whole lives in the lung, others travel to the lung from the bloodstream when an infection is present. It is likely that these two differing populations of lung macrophages – those that are always present in the lung, and those that are attracted there due to an infection – behave in different ways and have different abilities to fight infection with Mtb. Learning more about these differences and about ways to boost the infection-fighting properties of these different types of lung macrophages will lead to new treatments for TB.

Specifically, we will be looking at the role of cell metabolism (the way different lung macrophages take in energy sources such as sugars and fats and uses them) in the ability of the lung macrophages to kill Mtb, and how we can manipulate this metabolism to enhance the lung macrophage’s killing ability in order to improve TB treatments.