The starting point for this project is the recent finding that women who experience miscarriages or terminations of pregnancy before theuir first birth have an increased risk of having a preterm (premature) infant. These findings have prompted a re-evaluation of the relationship between the number of pregnancies a women has had and the likely outcome in later pregnancies. It will take into account the stage at which prior pregnancies ended, what the outcomes of the pregnancies were (birth, healt ....The starting point for this project is the recent finding that women who experience miscarriages or terminations of pregnancy before theuir first birth have an increased risk of having a preterm (premature) infant. These findings have prompted a re-evaluation of the relationship between the number of pregnancies a women has had and the likely outcome in later pregnancies. It will take into account the stage at which prior pregnancies ended, what the outcomes of the pregnancies were (birth, health baby, death, baby with a birth defect, termination, miscarriage etc), as well as factors such as maternal age, in relation to the risks in subsequent pregnancies. The expected outcomes and significance of the study are: * new evidence about factors causing adverse outcomes of pregnancy; * better information on the risk of recuurence of common birth defects; * more precise information on risks of adverse pregnancy outcomes for users and planners of maternity services.Read moreRead less
Antiplatelets For Prevention Of Pre-eclampsia: An Individual Patient Data Review
Funder
National Health and Medical Research Council
Funding Amount
$274,000.00
Summary
High blood pressure is a common complication of pregnancy affecting ~20,000 Australian women each year. Although most women and their babies do well, pre-eclampsia, defined as high blood pressure together with protein in the urine is a more serious problem. Severe pre-eclampsia is associated with 10-15% of maternal deaths. Fetal and newborn baby deaths are also increased. Mother and baby morbidity is high principally due to the associated complications in pregnancy, increased obstetric intervent ....High blood pressure is a common complication of pregnancy affecting ~20,000 Australian women each year. Although most women and their babies do well, pre-eclampsia, defined as high blood pressure together with protein in the urine is a more serious problem. Severe pre-eclampsia is associated with 10-15% of maternal deaths. Fetal and newborn baby deaths are also increased. Mother and baby morbidity is high principally due to the associated complications in pregnancy, increased obstetric interventions, fetal growth restriction and preterm birth. As yet we have no safe and effective way of preventing this life threatening condition. Aggregation of platelets (involved in blood clotting) is known to be part of the disease and could lead to the disturbances in the circulation of the mother and the placenta. Antiplatelet agents, low dose aspirin in particular, might prevent or delay the development of pre-eclampsia. Some trials and a Cochrane systematic review of all trials (involving over 30,000 women) suggest that pre-eclampsia, preterm birth and perinatal death could be reduced. However, it is still not clear which women will benefit, when in pregnancy the treatment should start and what dose of aspirin is both effective and safe. This proposed individual patient data review in which data on all women who have been entered in trials is gathered from the original investigators, including missing information on potential harms. This proposal represents a good investment of resources to obtain the information needed by women and health professional to make decisions about the use of aspirin. International investigators from all the primary trials have already formed a collaboration to oversee the project: the Perinatal Antiplatelet Review of International Studies (PARIS) Collaboration Furthermore, working through an international collaboration will ensure the highest quality in data availability, as well endorsement and implementation of the results in practice.Read moreRead less
Improving Research Evidence Quality Using Individual Patient Data, Prospective Meta-analysis And Trial Registration
Funder
National Health and Medical Research Council
Funding Amount
$387,489.00
Summary
The quality of evidence we use to make health care decisions can be improved if we use systematic reviews that are planned ahead, that use raw data from each participant and include all the trials that have looked at the clinical problem. This research program will utilise these three ways of obtaining better quality data and will thus make research results more reliable. In particular, we will use these techniques to address health problems in mothers and babies.
Why Do Some Breast Cancers Present At An Advanced Stage In Women In Australia?
Funder
National Health and Medical Research Council
Funding Amount
$682,950.00
Summary
Each year since 1994, some 10,000 Australian women have been diagnosed with breast cancer and 2,500 have died from it; these deaths have led to loss of some 31,000 years of life before 75 years of age. There is no effective way to prevent breast cancer in most women at risk of it, the only possible intervention is early detection and treatment to reduce the impact of being diagnosed with the disease. The smaller the cancer at treatment, the better the outcome. The national mammographic screening ....Each year since 1994, some 10,000 Australian women have been diagnosed with breast cancer and 2,500 have died from it; these deaths have led to loss of some 31,000 years of life before 75 years of age. There is no effective way to prevent breast cancer in most women at risk of it, the only possible intervention is early detection and treatment to reduce the impact of being diagnosed with the disease. The smaller the cancer at treatment, the better the outcome. The national mammographic screening program, BreastScreen Australia, began in 1991. We expect that screening, through early detection, would reduce the numbers of women who die of breast cancer. Death rates from breast cancer have been falling in Australia since 1994. Despite this program, however, rates of larger breast cancers, more likely to have spread beyond the breast, are not falling. In 1997-98, the woman or her doctor detected nearly half of all breast cancers diagnosed outside of screening by detecting a change in the breast. Given that screening can detect cancers when they are small and that women themselves are also able to detect symptoms that may be small breast cancers and seek medical advice, we must ask why so many cancers are not diagnosed and treated until they are 2cm or larger and threaten life. This project aims to examine reasons in three broad areas: the woman herself, the cancer, and the wider health system, including the medical practitioner to whom symptoms or signs are first presented. Our study aims to understand the factors that contribute the most to the occurrence of larger breast cancers so that public health campaigns can be designed to increase the numbers detected at an early stage.Read moreRead less
ENDOPHTHALMITIS IN WESTERN AUSTRALIA (1980-2002): INCIDENCE, MANAGEMENT AND EFFECTIVENESS OF CHEMOPROPHYLAXIS
Funder
National Health and Medical Research Council
Funding Amount
$348,942.00
Summary
Endophthalmitis is a serious sight threatening infection of the internal cavities of the eye. Although endophthalmitis is not a common post-operative complication of eye surgery, 200 cases of this serious sight threatening infection occur each year in Australia following cataract surgery. Not only is this condition extremely distressing to the patients and surgeons alike, around A$4 million per year is spent each year treating the infection. Also, there is significant expenditure on methods to p ....Endophthalmitis is a serious sight threatening infection of the internal cavities of the eye. Although endophthalmitis is not a common post-operative complication of eye surgery, 200 cases of this serious sight threatening infection occur each year in Australia following cataract surgery. Not only is this condition extremely distressing to the patients and surgeons alike, around A$4 million per year is spent each year treating the infection. Also, there is significant expenditure on methods to prevent the infection that have not, as yet, been demonstrated beneficial. Our study will use a multidisciplinary team consisting of consultant ophthalmologists, public health researchers, a biostatistician and health economist to assess the impact of endophthalmitis in WA from 1980-2002 (around 480 cases). The population-based WA Linked Database provides a unique opportunity to produce what will be the largest population study of endophthalmitis. Data from the study will provide important information to develop best-practice treatment guidelines to prevent endophthalmitis following cataract surgery. The significance of this study will be that accurate information on the clinical epidemiology and true cost of endophthalmitis will be obtained for WA. By studying the records of patients with endophthalmitis and comparing them with matched patients, who did not have post-operative endophthalmitis following cataract surgery, we will characterise the risks for this severe complication by identifying the underlying factors that are responsible for the infection. We will also better understand the effect of methods used to prevent the infection. The use of a whole population-based study to assess methods of endophthalmitis prevention has not been done before and will have a significant beneficial impact on health policy and best-practice, not only in Australia, but also internationally.Read moreRead less
Burden Of Disease&cost Effectiveness Of Intervention Options:informing Policy Choices & Health System Reform In Thailand
Funder
National Health and Medical Research Council
Funding Amount
$787,978.00
Summary
This research project aims to improve the scientific basis for health services provision in Thailand by filling important gaps in knowledge about the causes of disease and the possibility of effectively intervening to reduce them. Since the accuracy of the routine death registration system in Thailand is unknown, it cannot be confidently used to guide policy. The team will evaluate how accurately causes of death are being recorded, both in urban and rural areas. It will also calculate how much d ....This research project aims to improve the scientific basis for health services provision in Thailand by filling important gaps in knowledge about the causes of disease and the possibility of effectively intervening to reduce them. Since the accuracy of the routine death registration system in Thailand is unknown, it cannot be confidently used to guide policy. The team will evaluate how accurately causes of death are being recorded, both in urban and rural areas. It will also calculate how much disease and injury in Thailand is being caused by major risk factors, such as tobacco and unsafe sex. Using this information the team will evaluate the effectiveness of the major interventions to reduces diseases and injuries from risk factors that are affordable and applicable in the Thai context.Read moreRead less
Psychosocial Disability And Return To Work In Younger Stroke Survivors
Funder
National Health and Medical Research Council
Funding Amount
$511,216.00
Summary
Each year about 12,000 Australians of working age survive a stroke. These younger survivors have responsibility for generating an income or providing care for families and state that their main objective is to return to work for financial reasons and to help rebuild confidence and independence. This observational 3 year study will determine thefactors are associated with returning to work, improving the wellbeing of thousands of stroke survivors and their families using multivariate regression.