Goodness-of-fit Testing Of Log-link Models For Categorical Outcome Data
Funder
National Health and Medical Research Council
Funding Amount
$260,863.00
Summary
Information about the health consequences of exposure to causal factors is obtained from mathematical models of observed data. Incorrect inferences are possible if the model does not adequately represent the data. Relative risk models are recommended for observations over time on a cohort of subjects, but it is not known how best to assess the adequacy of such models. This project will assess the performance of summary measures of goodness-of-fit when applied to relative risk models.
Is Infection An Acute Trigger For Preeclampsia? A Case-crossover Study.
Funder
National Health and Medical Research Council
Funding Amount
$207,761.00
Summary
Preeclampsia is a multisystem hypertensive disease affecting up to 10% of pregnancies. It puts both mother and baby at increased risk of major illness and death. The cause is unknown but inflammation appears to play a key role. We will use an innovative design to determine whether recent maternal infection triggers the onset of preeclampsia. If preeclampsia is associated with infection, preventative strategies can be developed.
An Oral Health Literacy Intervention Among Rural Indigenous Adults
Funder
National Health and Medical Research Council
Funding Amount
$568,566.00
Summary
The relationship between oral health literacy and positive oral health literacy-related outcomes, both of which are low among the Indigenous Australian population, is established. This study seeks to determine if implementation of a functional, context-specific oral health literacy intervention leads to improved oral health literacy-related outcomes among rural-dwelling Indigenous adults. There may be benefit in applying this model to other areas of Indigenous health research.
Methods For Evaluating The Therapeutic Impact Of Diagnostic Tests - Development Of Guidelines
Funder
National Health and Medical Research Council
Funding Amount
$132,325.00
Summary
New diagnostic tests are frequently adopted in clinical practice without any evidence that they improve patient outcomes. This project will produce the first guidelines about the role and optimal design of studies assessing the impact of a new test on therapeutic decisions for conclusions about its clinical value. This work will inform researchers and clinicians to improve evidence-based diagnostic practice and promote the more efficient use of limited health care resources.
Exploring The Contributions Of Individual-, Area- And Service- Level Factors To Indigenous Health Outcomes
Funder
National Health and Medical Research Council
Funding Amount
$486,919.00
Summary
We will use linked hospital and death data, and multilevel models, to estimate the contributions of individual-, area- and service-level factors to inequalities in the outcomes of hospital care between Indigenous and non-Indigenous people. Factors investigated will include socioeconomic status, remoteness, access to primary care services, and hospital characteristics. Conditions explored will include heart disease, stroke, diabetes, chronic obstructive pulmonary disease and asthma.
Novel Statistical Methods For The Analysis Of Meausred Genetic And Environmental Risk Factors In Twin Studies
Funder
National Health and Medical Research Council
Funding Amount
$478,314.00
Summary
Studies on twins are an important way to determine whether the risk of disease is likely to be influenced by genetic factors but have traditionally focussed on unmeasured factors. New epidemiological studies measure thousands of genetic variants on many participants. This project will extend methods for analysing data within and between twin pairs to determine whether risk factors are likely to be causal and therefore should be the subject of further designed studies based on intervention.
Does Place Of Birth Influence A Healthy Start To Life?
Funder
National Health and Medical Research Council
Funding Amount
$343,050.00
Summary
There are over 255,000 births in Australia each year and a major challenge in terms of planning and provision is to ensure that these babies are born in hospitals with the appropriate facilities to care for them. International studies suggest that transferring the mother before birth results in better infant outcomes than transferring the baby after birth. In Australia births occur in a range of hospitals, from small rural hospitals to tertiary obstetric and neonatal centres. However, few Austra ....There are over 255,000 births in Australia each year and a major challenge in terms of planning and provision is to ensure that these babies are born in hospitals with the appropriate facilities to care for them. International studies suggest that transferring the mother before birth results in better infant outcomes than transferring the baby after birth. In Australia births occur in a range of hospitals, from small rural hospitals to tertiary obstetric and neonatal centres. However, few Australian studies have looked at infant outcomes based on place of birth. This study will use existing population health data sets to evaluate the provision of care prior to and at birth and the impact it has on infant outcomes up to one year of age. It will also describe for the first time the hospital care utilisation associated with birth and infant health. Information will be obtained from routinely-collected birth, death and birth defect registers, and hospital, midwives and perinatal death review data. Variations in health outcomes for babies may be due to factors that occur before or during pregnancy, or may be due to differences in the care provided at birth. We need to take account of maternal factors to comprehensively assess the role of level of care at birth. We will use statistical techniques to 'predict' infant health outcomes and see if differences between places of birth are real or not. If variations are explained by different levels of care then there is enormous potential for improvement in the provision of pregnancy and newborn services. We will also compare the benefits and consequences of maternal versus neonatal transfer, and assess hospital costs. The results of this study could be applied to direct health services policy and organisational changes to improve pregnancy care and optimise infant outcomes for a healthy start to life.Read moreRead less
Regionalised Maternity Care - Is There Room For Improvement?
Funder
National Health and Medical Research Council
Funding Amount
$467,752.00
Summary
A central dilemma in the provision of maternity care is that some mothers and babies need access to expertise and sophisticated technologies, but most do not. In Australia regionalised maternity care aims to ensure the provision of the appropriate level of care to all women, via antenatal identification of at-risk pregnancies and subsequent transfer to risk-appropriate settings, should the need arise. Furthermore, delayed childbearing and increasing rates of caesarean section are increasing the ....A central dilemma in the provision of maternity care is that some mothers and babies need access to expertise and sophisticated technologies, but most do not. In Australia regionalised maternity care aims to ensure the provision of the appropriate level of care to all women, via antenatal identification of at-risk pregnancies and subsequent transfer to risk-appropriate settings, should the need arise. Furthermore, delayed childbearing and increasing rates of caesarean section are increasing the pool of women with existing medical conditions and risk factors for adverse pregnancy outcomes. There is an urgent need to identify risk-appropriate levels of maternity care based on women's antenatal conditions and risk factors that can be identified early or during pregnancy. The project will use existing population health data sets to determine to what extent regionalised maternity care is delivering women and their babies in risk-appropriate settings or whether there is room for improvement through increased transfer of at-risk pregnancies to higher levels of care. Variations in outcomes for mothers and babies may be due to factors that occur before or during pregnancy, or may be due to differences in the level of maternity care provided. We need to take account of maternal factors to fairly assess the role of the level of maternity care. To do this our project will develop and utilise innovative statistical techniques to look at the risk factors associated with poor outcomes (severe illness or death) for mothers and their babies. We will then be able to 'predict' outcomes and see if differences between levels of maternity care are real or not. If variations are explained by different levels of care then there is enormous potential for improvement in the provision of maternity services. Results could be applied to direct health services policy and organisational changes to improve maternity care and optimise pregnancy outcomes for a healthy start to life.Read moreRead less
Identifying Risk For Second And Subsequent Pregnancies: A Longitudinal Record Linkage Study
Funder
National Health and Medical Research Council
Funding Amount
$586,129.00
Summary
Interventions (eg. induction of labour) or conditions (eg bleeding) in one pregnancy may affect outcomes in the next pregnancy (eg. risk of complications). These relationships are under-investigated. Using population data on over 194,000 women we can look at repeat pregnancies experienced by individual women. We will use this data to investigate whether interventions in one pregnancy affect subsequent birth outcomes (for mother or baby) and whether particular conditions are likely to recur.
A Prospective Study Of The Effects Of Early Life Growth On Adult Mammographic Density
Funder
National Health and Medical Research Council
Funding Amount
$460,517.00
Summary
It is now well-known that a woman's breast density, as measured by a breast scan, is a predictor of her future risk of breast cancer. It is also known that women who are heavier as babies and grow rapidly before age 7 are more likely to develop breast cancer in adult life. The effects were strongest in women who had early puberty. It has been suggested that there are critical points in early life growth that contribute to higher breast density in middle-age. Population-based surveys with early l ....It is now well-known that a woman's breast density, as measured by a breast scan, is a predictor of her future risk of breast cancer. It is also known that women who are heavier as babies and grow rapidly before age 7 are more likely to develop breast cancer in adult life. The effects were strongest in women who had early puberty. It has been suggested that there are critical points in early life growth that contribute to higher breast density in middle-age. Population-based surveys with early life growth data on large numbers of women that span birth to adulthood are necessary to estimate accurately the association between early life growth and breast density in middle age. Few such studies exist; Tasmanian Asthma Study is one of them. In 1968, all 4,194 female Tasmanian school children born in 1961 were surveyed and height and weight measured. Subsequently, weight and height measurements were carried out on samples of this cohort. We are currently conducting the 37-year follow-up of the TAS and to date have traced 87% and achieved a response rate of 77% (2,850) for a postal survey. This included self-reported weight and height measurements and detailed information reproductive history and the use of hormones. Weight, height and waist to hip ratio are currently measured on 600 of these respondents. We have access to school medical records of the full cohort, which have weight and height data measured at school medical inspections throughout school years, and maternal records so far for half of the total cohort, which have information on birth weight and length, and period of gestation. Hence, TAS now provides an ideal opportunity, unique within Australia, to investigate prospectively the association between early life growth and mammographic density in middle-age women. We will measure breast density in these women now they are in their late 40s, using the Australian Mammographic Density Research Facility at The University of Melbourne.Read moreRead less