Osteoporosis is a major and increasing public health problem. Fracture, the ultimate consequence of osteoporosis is associated with significant morbidity, mortality and economic costs. The Dubbo Osteoporosis Epidemiology Study, starting in 1989, with over 2000 women and men, is one of the longest running epidemiological studies in osteoporosis worldwide. It has been at the forefront of epidemiological advances in osteoporosis. It has identified osteoporotic fracture risks including low bone dens ....Osteoporosis is a major and increasing public health problem. Fracture, the ultimate consequence of osteoporosis is associated with significant morbidity, mortality and economic costs. The Dubbo Osteoporosis Epidemiology Study, starting in 1989, with over 2000 women and men, is one of the longest running epidemiological studies in osteoporosis worldwide. It has been at the forefront of epidemiological advances in osteoporosis. It has identified osteoporotic fracture risks including low bone density and bone loss, muscle weakness and postural instability, as well as the extent of the problem in men, and the significant costs, ill-heath and mortality associated with fracture. Despite the clarification of risk factors over the past decade, there are significant gaps in knowledge about osteoporosis, particularly in the accurate prediction of fracture risk and in identification of factors related to fracture-associated mortality and survival post fracture. Although bone density is one of the best predictors of fracture risk, it incompletely discriminates between those who will fracture from those who will not. Although a number of clinical risk factors, and other measures of bone strength, such as quantitative ultrasound and geometry, have been shown to be independent predictors of fracture risk, it is not clear that these measures can be integrated with BMD to improve fracture prediction. The aim of the current study, is to develop and validate models using bone density, other measures of bone strength and clinical parameters that will more accurately predict fracture risk and mortality following fracture in older men and women. The more precise identification of those at high risk of fracture and at risk for poor outcomes following fracture will provide a rational basis for the development of more cost effective interventions for prevention of fracture and its associated morbidity and mortality.Read moreRead less
The Diagnosis Of Obstructive Sleep Apnea In Primary Care
Funder
National Health and Medical Research Council
Funding Amount
$295,075.00
Summary
The gold standard method for diagnosis of sleep apnea is the overnight sleep study. These tests are expensive, have long waiting lists and are hard to access outside larger cities. We aim to determine if general practitioners can combine information from questionnaires and a simple home diagnostic test, to confirm or rule out sleep apnea. The results of this study will eventually lead to more accessible and efficient diagnosis and treatment of this common condition.
The Interaction Between Sexually Transmissible Infections And Human Immunodeficiency Virus Infection In Homosexual Men
Funder
National Health and Medical Research Council
Funding Amount
$635,931.00
Summary
This project examines the inter-relationship between HIV infection and sexually transmitted infections (STIs) in homosexual men. The overall goal of the projet is to inform the development of STI prevention and treatment strategies which may be important in reducing HIV incidence in this population. Homosexual men comprise over 80% of people diagnosed with HIV infecton in Australia, and in many developed nations are one of the largest groups affected by HIV. Rates of other STIs are also increase ....This project examines the inter-relationship between HIV infection and sexually transmitted infections (STIs) in homosexual men. The overall goal of the projet is to inform the development of STI prevention and treatment strategies which may be important in reducing HIV incidence in this population. Homosexual men comprise over 80% of people diagnosed with HIV infecton in Australia, and in many developed nations are one of the largest groups affected by HIV. Rates of other STIs are also increased in homosexual men. Currently, HIV rates are increasing in Australia and in many developed countries. We are in need of new and effective methods of HIV prevention. Data in heterosexuals suggest that where STIs are common, the early detection and treatment of these infections may help reduce HIV incidence. There are few data on this relationship in homosexual men. We propose to utilise an existing Sydney cohort of homosexual men to collect data on biologic tests for STIs, history of recent diagnosis of STIs, and symptoms, to allow a comprehensive description of the epidemiology of STIs and their overlap with HIV. The quality of data on the interaction between HIV and STIs in this cohort will be superior to any previously collected in homosexual men, as it will include data on self-reported doctor diagnosed illness, state of the art biologic testing, and symptom data, for the full spectrum of important STIs. The results of this study will be helpful in determining strategies for HIV and STI screening, education and control in the population which comprises the great majority of cases of HIV infection in Australia, and one of the largest risk groups for HIV infection in the developed world. Screening coupled with treatment of asymptomatic STIs may be an effective new approach to HIV prevention in this population.Read moreRead less
We will conduct a survey of respiratory symptoms, lung function, smoking status, occupational exposures, and other risk factors among 3200 people aged 40 years and over living in five Australian communities: Melbourne, Sydney, Tasmania, Busselton (WA), and the Kimberley region (WA). In the Kimberley we will survey 400 Aboriginal people and 400 non-Aboriginal people. We will use a survey methodology that has been developed by an international expert panel and has been implemented in many other co ....We will conduct a survey of respiratory symptoms, lung function, smoking status, occupational exposures, and other risk factors among 3200 people aged 40 years and over living in five Australian communities: Melbourne, Sydney, Tasmania, Busselton (WA), and the Kimberley region (WA). In the Kimberley we will survey 400 Aboriginal people and 400 non-Aboriginal people. We will use a survey methodology that has been developed by an international expert panel and has been implemented in many other countries (in North and South America, Asia, and Europe). This study will provide the first nationally-representative information on the burden of chronic obstructive pulmonary disease (COPD) and the opportunities for health gain by improving the management of this illness. In Australia, COPD is a relatively silent and under-recognised disease but nevertheless is the third most important contributor to the burden of disease and the third leading cause of hospital admission as well as being the underlying cause of 4.2% of all deaths. The information we will collect is needed to form a basis for prevention and disease management interventions to reduce the burden of COPD, particularly among population sub-groups who are disproportionately affected, either due to greater exposure to risk factors (mainly tobacco smoking and occupation), greater susceptibility, under-recognition and under-diagnosis, or inadequate disease management. Importantly, the study will serve to raise awareness about the hazards of smoking for all Australians. By identifying target groups, prevalent exposures and management deficiencies, it will lead the way towards policy-relevant randomised controlled trials testing community-based interventions to prevent COPD and-or manage it more effectively. The information collected will help advance knowledge of the prevalence, burden and treatment of COPD that will be relevant to communities throughout the world.Read moreRead less
Using Epidemiology To Inform Psychiatric Classification (DSM-V And ICD-11)
Funder
National Health and Medical Research Council
Funding Amount
$631,502.00
Summary
Classification systems are vital for scientific progress. The classifications of mental disorders of the World Health Organization and the American Psychiatric Association are both being revised and this Australian team is a principal contributor to both processes. We have access to three national epidemiological surveys (n-30,000) that will inform fundamental issues by developing models of mental disorder typology and identifying practical improvements in the classification systems.
Alcohol Use Disorders In Young Adults: Youthful Epidemic Or Diagnostic Bias?
Funder
National Health and Medical Research Council
Funding Amount
$198,874.00
Summary
Epidemiological studies show that 1 in 5 Australians aged 18-24 are diagnosed as having an alcohol use disorder. However, there is evidence to suggest that young adults may interpret the diagnostic criteria differently to older adults. The current study aims to validate the alcohol use disorder criteria in younger populations through the use of novel cognitive interviewing techniques.
LONGITUDINAL STUDY OF BEHAVIOUR AND EMOTIONAL PROBLEMS IN YOUNG PEOPLE WITH INTELLECTUAL DISABILITIES
Funder
National Health and Medical Research Council
Funding Amount
$761,790.00
Summary
Families caring for young people with intellectual disabilities face major burdens of care if the young person also has serious behaviour problems. These behaviour problems are also costly for our community. This project is intended to assist young people and their carers by providing new information about the factors contributing to these behaviour problems and how they develop over time. The project makes use of an internationally unique follow up study which has followed a group of young peop ....Families caring for young people with intellectual disabilities face major burdens of care if the young person also has serious behaviour problems. These behaviour problems are also costly for our community. This project is intended to assist young people and their carers by providing new information about the factors contributing to these behaviour problems and how they develop over time. The project makes use of an internationally unique follow up study which has followed a group of young people aged 4-18 for the last eight years. The young people are now entering a critical age band facing many changes in their lives such as the possibility of independent living, work challenges, as well as a search for new social relationships and day activities in the post-school period. Also they face increased risk for mental health problems which most commonly emerge in this age group, particularly psychosis and depression. This project promises to determine how the young people cope with these challenges and what steps our community needs to make to assist them and their families to reach an optimal adjustment.Read moreRead less
A Longitudinal Study Of Psychopathology In People With Intellectual Disability
Funder
National Health and Medical Research Council
Funding Amount
$999,803.00
Summary
This project will further develop the research opportunities of an internationally unique 15 year follow up study of the mental health of young Australians with ID. We have shown that this group has 2-3 times the risk of suffering serious emotional and behavioural problems that are an added heavy burden on the individual, their family and carers and the community. These problems often are not recognised but are as common as schizophrenia in the community. The study will continue to use a combina ....This project will further develop the research opportunities of an internationally unique 15 year follow up study of the mental health of young Australians with ID. We have shown that this group has 2-3 times the risk of suffering serious emotional and behavioural problems that are an added heavy burden on the individual, their family and carers and the community. These problems often are not recognised but are as common as schizophrenia in the community. The study will continue to use a combination of questionnaire survey and in depth interviews of the young adults and their families or carers to track the course of their mental health. The study commenced in 1990 with nearly 1000 young people with ID aged 4-18 years and their progress has been reviewed every 2-3 years in over 75% of the original group. During the next 5 years we plan to follow their mental health during the critical stage of young adult life. During this time there is the greatest risk of mental illnesses such as depression and schizophrenia and the stresses of adjusting to new daily occupations, independent living or residential care and social contact away from the family. We will be able to study the specific emotional and behavioural problems faced by young adults with the main known causes of ID such as Down, Fragile X, Prader Willi and William Syndromes, as well as those who have autism. The great benefit of a long term follow up study is that it allows us to study the links between earlier family environmental, psychological and biological factors and subsequent mental health problems. We can also demonstrate the impact that mental illness in a young person with ID has on the family and parental mental health. The findings have implications for better diagnosis, improved care and management, early intervention and prevention of these common severe and under recognized mental health problems in this disadvantaged group of young Australians and their families and carers.Read moreRead less
A Cluster Randomised Controlled Trial Of Nurse And General Practitioner Partnership For Care Of COPD
Funder
National Health and Medical Research Council
Funding Amount
$449,377.00
Summary
Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease that can progress to severe disability and use of hospital services. It is an important cause of both death and disability in Australia. Specifically it is the third leading cause of disease burden after heart disease and stroke. Smoking is the most important cause of the disease and there is strong evidence that smoking cessation will largely prevent progression of COPD. National evidence based guidelines for management of COPD w ....Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease that can progress to severe disability and use of hospital services. It is an important cause of both death and disability in Australia. Specifically it is the third leading cause of disease burden after heart disease and stroke. Smoking is the most important cause of the disease and there is strong evidence that smoking cessation will largely prevent progression of COPD. National evidence based guidelines for management of COPD were published in 2003 but these need to be implemented in the community. General practice is well placed to have a key role in early intervention and evidence based management of COPD. There is evidence that specialised nurses working in collaboration with GPs can improve the care the chronic illnesses including COPD. Care Plans with input from health professionals from a range of disciplines have been recommended for COPD but there are barriers to implementing these in general practice. This project brings together nurse assistance and care planning in a model of care designed to deliver best practice management of COPD in the community. The aim of this research is to evaluate the impact of anurse and GP partnership for care of COPD. We will examine the effect on quality of care and health outcomes at 6 and 12 months follow up. Our hypothesis is that the use of a nurse to work as a team with the patient and GP to develop and implement a care plan based on clinical practice guidelines will improve the quality of care received and have a beneficial effect on the patients' respiratory and overall health. This research will be of major significance for improving COPD care in the community and will have far reaching implications for both policy and practice. It will also define a new role for nurses and GPs working in partnership.Read moreRead less
Mathematical Modelling Of Bacterial Carriage In Children
Funder
National Health and Medical Research Council
Funding Amount
$421,746.00
Summary
Children exposed to larger numbers of other children are at risk of persistent bacterial infections. Such circumstances explain the high rates of ear and chest infections, and skin sores seen in children in historical times. Changing social circumstances (smaller families, better housing, nutrition and hygiene), as well as the introduction of antibiotics, explain the decline of such infections in affluent communities since the early 20th century. However, even today, in affluent countries, child ....Children exposed to larger numbers of other children are at risk of persistent bacterial infections. Such circumstances explain the high rates of ear and chest infections, and skin sores seen in children in historical times. Changing social circumstances (smaller families, better housing, nutrition and hygiene), as well as the introduction of antibiotics, explain the decline of such infections in affluent communities since the early 20th century. However, even today, in affluent countries, children attending group child care are at high risk of ear infections. As many bacteria are resistant, antibiotics are now much less effective than when they were first introduced. Furthermore, there is a continuing load of infection for children in Aboriginal communities, in PNG and other developing countries, causing hearing loss, chronic respiratory problems, and heart disease and renal disease in later life. Using data previously collected from other studies in Indigenous communities and children in child care, mathematical models allow us to ask what if?, and answer important public health questions: 1. What environmental and public health measures can reduce the cycle of cross-infection in child-care and high-risk populations? 2. What coverage rates with pneumococcal vaccine will eliminate the vaccine-specific bacteria from child care centres, from the wider community, and from high risk populations? 3. Will infections with bacteria not covered by vaccine then increase? 4. Will the resistant bacteria tend to disappear if antibiotic use is restricted? 5. Under what circumstances will antibiotics help to control infection? The modelling will promote understanding of the social and health costs of bacterial infection in Aboriginal communities and child care and use educational scenarios to promote uptake of the most cost-effective and socially acceptable interventions.Read moreRead less