A Randomised Placebo-controlled Trial Of Antibiotics To Prevent Urinary Tract Infection In Children
Funder
National Health and Medical Research Council
Funding Amount
$735,000.00
Summary
This study is needed to determine whether a common clinical practice long-term antibiotic treatment for children following urinary tract infection (UTI) - is safe and effective in preventing further UTI and if so, whether all appropriate children are being treated. UTI will affect about 10% of Australian children by high school age (88,000 children per year). Because UTI may damage the kidneys, the management priority for children with UTI has been prevention of further infection. Currently this ....This study is needed to determine whether a common clinical practice long-term antibiotic treatment for children following urinary tract infection (UTI) - is safe and effective in preventing further UTI and if so, whether all appropriate children are being treated. UTI will affect about 10% of Australian children by high school age (88,000 children per year). Because UTI may damage the kidneys, the management priority for children with UTI has been prevention of further infection. Currently this means the identification of children thought to be most at risk of recurrent UTI by renal tract imaging. Those found to have reflux of urine from the bladder to the kidney (present in about 30% of those with UTI) are then placed on antibiotics fro 2-5 years. Unfortunately there has never been a properly designed trial to test whether antibiotics do really prevent UTI and if so, whether children with reflux are the appropriate and only group requiring treatment. Long term antibiotics may in fact do more harm than good because of side effects like skin, bowel and blood problems and because resistant bacteria may develop. The design of this study involves the random allocation of placebo or antibiotic (cotrimoxazole, the usual antibiotic given in this case) to about 800 children after their first symptomatic UTI. These children are treated and followed for one year to determine the rate of futher UTI in both groups. Any difference in outcome between the two groups of children will be because of the antibiotic treatment. This study may prove long-term antibiotics are ineffective and therefore should not be routinely used. In this case investigation of children to detect vesicoureteric reflux would serve little purpose and should be abandoned. Alternatively antibiotic treatment may be shown as effective treatment for preventing further UTI and in this case the study will clearly identify those children who will benefit.Read moreRead less
Immunising Aboriginal Mothers With Pneumococcal Polysaccharide Vaccine To Prevent Infant Ear Disease And Carriage
Funder
National Health and Medical Research Council
Funding Amount
$1,131,530.00
Summary
Aboriginal children experience the highest rates of acute and chronic ear infections in the world, with resultant permanent ear damage, hearing loss and educational disadvantage. These infections are mainly bacterial, and Streptococcus pneumoniae (pneumococcus) is the predominant pathogen. Pneumococcal colonisation and infection begins within days of birth, many months before any potential immunological protection from infant pneumococcal conjugate vaccine may be expected. New strategies are nee ....Aboriginal children experience the highest rates of acute and chronic ear infections in the world, with resultant permanent ear damage, hearing loss and educational disadvantage. These infections are mainly bacterial, and Streptococcus pneumoniae (pneumococcus) is the predominant pathogen. Pneumococcal colonisation and infection begins within days of birth, many months before any potential immunological protection from infant pneumococcal conjugate vaccine may be expected. New strategies are needed to eliminate, or at least delay, this early-onset pneumococcal colonisation. One such strategy is the administration to the mother of pneumococcal vaccine, which may protect the newborn infant by leading to higher titres of transplacental or breast milk pneumococcal antibodies and-or by reducing carriage (and transmission to the infant) of maternal pneumococci. Previous small studies using this strategy have been encouraging, but there have been no studies properly evaluating carriage or disease endpoints in infants. The polysaccharide pneumococcal vaccine is currently recommended for all Aboriginal and Torres Islander persons aged 15 years or more in the Northern Territory but uptake of the vaccine has been poor. We propose to conduct a pilot study to determine if maternal immunisation with this vaccine, either in the third trimester of pregancy of immediately following delivery, can reduce pneumococcal carriage and the prevalence of middle ear disease among Aboriginal infants at seven months of age. We aim to recruit 210 Aboriginal women who have uncomplicated pregnancies from Darwin and remote communities in the Top End of the Northern Territory. Each subject and their infant offspring will be followed-up after vaccination and at birth, one , two and seven months after birth.Read moreRead less
Centre Of Research Excellence On Sitting Time And Chronic Disease Prevention – Mechanisms, Measurement And Interventions
Funder
National Health and Medical Research Council
Funding Amount
$2,657,874.00
Summary
Australian research has identified serious health consequences arising from the 7 to 10 hours of daily sitting that most people do, especially in relation to ‘diseases of inactivity’ – type 2 diabetes, coronary heart disease and breast and colon cancer – that are an unwelcome burden on individuals, families and health systems. This new research examines the practical feasibility and the preventive-health benefits of changing children’s and adults’ sitting time in schools, workplaces and the home ....Australian research has identified serious health consequences arising from the 7 to 10 hours of daily sitting that most people do, especially in relation to ‘diseases of inactivity’ – type 2 diabetes, coronary heart disease and breast and colon cancer – that are an unwelcome burden on individuals, families and health systems. This new research examines the practical feasibility and the preventive-health benefits of changing children’s and adults’ sitting time in schools, workplaces and the home environment.Read moreRead less
A Study To Investigate Alternative Regimens For Pneumococcal Vaccination Of Infants In A Developing Country
Funder
National Health and Medical Research Council
Funding Amount
$1,622,210.00
Summary
Streptococcus pneumoniae (Pnc) is the leading vaccine preventable cause of serious infection in infants. The current Pnc conjugate vaccine is very expensive (approximately USD $200-infant) so it is unlikely to be affordable for most developing countries. Moreover, as health care access in developing countries may be episodic and unreliable, many children do not receive either complete or timely vaccine courses. Therefore, it is important to investigate affordable and flexible ways to deliver thi ....Streptococcus pneumoniae (Pnc) is the leading vaccine preventable cause of serious infection in infants. The current Pnc conjugate vaccine is very expensive (approximately USD $200-infant) so it is unlikely to be affordable for most developing countries. Moreover, as health care access in developing countries may be episodic and unreliable, many children do not receive either complete or timely vaccine courses. Therefore, it is important to investigate affordable and flexible ways to deliver this vaccine, which are safe and effective. A recent WHO-GAVI meeting to address impediments to the introduction of these vaccines in developing countries recognized the need to evaluate other regimens of Pnc conjugate vaccine as an important research priority. This study has been deliberately formulated with that need in mind. The site for this research is Fiji. Although health services are good, Pnc disease, particularly pneumonia, remains the commonest cause of childhood morbidity and mortality. Fiji has good vaccine coverage and was the first Pacific country to introduce Hib vaccine. The arrival of the new, expensive Pnc conjugate vaccine presents a dilemma for Fiji and many similar countries. The expense of this vaccine would consume a large portion of the health budget. This study has two components: 1. A Phase 2 immunogenicity study (involving 750 infants) to evaluate regimens using reduced numbers of doses of Pnc conjugate vaccine, and using timing of dosing and combinations with the Pnc polysaccharide (PS) vaccine that may be more suited to the epidemiology of Pnc disease in developing countries. 2. An epidemiological study will measure the burden of invasive Pnc disease and pneumonia in Fiji. This will be part of a global effort to address these issues, and will be used to develop rapid assessment tools for these diseases in developing countries. We will seek cofounding for this component.Read moreRead less
Innovative Health Programs To Reduce Inequality In Heart Disease
Funder
National Health and Medical Research Council
Funding Amount
$876,005.00
Summary
As part of his Senior NHMRC Fellowship, Prof Simon Stewart, a world-renowned health services researcher, will lead an internationally linked team of researchers from a broad range of health disciplines to undertake a program of research designed to improve the lives of those most vulnerable to heart disease and poor health outcomes. His program of research will focus on Indigenous Australians, patients with complex forms of heart disease and urban African communities in economic transition.
A Behavioural Intervention For The Adoption & Maintenance Of Physical Activity In Type 2 Diabetes
Funder
National Health and Medical Research Council
Funding Amount
$334,955.00
Summary
For people with type 2 diabetes (T2DM) it is essential that blood glucose levels are managed well to reduce the risk of developing complications. Physical activity is essential for maintaining glucose levels because it helps make the muscles use glucose more effectively. In particular, being active through strength training not only improves blood glucose levels, but can be very effective for maintaining good physical functioning, which is known to be reduced by having T2DM. This study builds on ....For people with type 2 diabetes (T2DM) it is essential that blood glucose levels are managed well to reduce the risk of developing complications. Physical activity is essential for maintaining glucose levels because it helps make the muscles use glucose more effectively. In particular, being active through strength training not only improves blood glucose levels, but can be very effective for maintaining good physical functioning, which is known to be reduced by having T2DM. This study builds on our earlier research which demonstrated significantly improved blood glucose levels from a strength training program for older adults with T2DM. The strength training program is to be administered nationally in a research to practice trial (Lift for Life); however, the original research found that those who did not complete the program as it was intended (ie, poor adherence) did not show significant improvements in blood glucose levels. Furthermore, maintenance of strength training exercises after completion of the program was poor and resulted in return of blood glucose levels back to pre-starting levels. In people without diabetes, we have collected pilot data that shows that the use of behavioural strategies based on behavioural theories whereby each person's motivations and barriers are taken into consideration is more effective than the traditional one-treatment-fits-all approach. This study will evaluate the effectiveness of using behavioural strategies for improving adherence and maintenance to the Lift for Life strength training program (Enhanced L4L) for older adults with T2DM compared with the Standard L4L program. It will also follow-up participants 6 months later to determine the extent to which the changes in behaviour can be maintained. The study will provide information that will assist in the design, delivery and uptake of programs to improve treatment strategies in older adults with T2DM through the maintenance of healthier behaviours and lifestyles.Read moreRead less
The demographic consequences of migration to, from and within Australia. The long-term demographic consequences of migration to, from and within Australia, and the dynamic pathways that produced them, will be studied. This will involve the identification of the specific contributions made by international and internal migration to the age and sex population compositions of nine birthplace-specific populations from 1981 to 2011. To do this, publically available data will be collected and augmente ....The demographic consequences of migration to, from and within Australia. The long-term demographic consequences of migration to, from and within Australia, and the dynamic pathways that produced them, will be studied. This will involve the identification of the specific contributions made by international and internal migration to the age and sex population compositions of nine birthplace-specific populations from 1981 to 2011. To do this, publically available data will be collected and augmented with statistical methods to provide a complete, consistent account of population change for around 60 subnational areas. As migration and population change underpins many aspects of societal change in Australia, this research aims to provide an invaluable resource to other scientists and policy makers.Read moreRead less
Where migrants go: A study of immigrants' post-arrival moves in Australia . The project aims to establish the geographical and occupational trajectories of different migrant groups after arrival in Australia. Migration within Australia is a key driver of economic, demographic and social change. Recognising the growing diversity of immigrants, including the rapid rise in temporary migration, the project examines post-arrival moves of immigrants by visa type, country of birth and year of arrival. ....Where migrants go: A study of immigrants' post-arrival moves in Australia . The project aims to establish the geographical and occupational trajectories of different migrant groups after arrival in Australia. Migration within Australia is a key driver of economic, demographic and social change. Recognising the growing diversity of immigrants, including the rapid rise in temporary migration, the project examines post-arrival moves of immigrants by visa type, country of birth and year of arrival. It seeks to improve understanding of the incidence, spatial patterns and drivers of migrants’ movement within Australia and the socio-demographic impact on regions and individuals. Such understanding is an essential first step to the formulation of effective immigration and settlement policies and programs.Read moreRead less
Developing Robust Small Area Population Forecasts for Planning and Policy. This project aims to create more robust, detailed, and accurate small area population forecasts, and implement them in a sophisticated forecasting system for one jurisdiction in Australia, USA, UK and Canada. The project is significant as it expects to generate a suite of new and innovative methods, theory, and population forecasts that will be useful to researchers and planners both in Australia and overseas. Expected ou ....Developing Robust Small Area Population Forecasts for Planning and Policy. This project aims to create more robust, detailed, and accurate small area population forecasts, and implement them in a sophisticated forecasting system for one jurisdiction in Australia, USA, UK and Canada. The project is significant as it expects to generate a suite of new and innovative methods, theory, and population forecasts that will be useful to researchers and planners both in Australia and overseas. Expected outcomes include new forecasting methods, associated computer code, many open-access academic papers, and new international collaborations. More detailed and reliable population forecasts will bring substantial benefits to those planning our future infrastructure requirements (e.g. schools, hospitals, housing and transport).
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The Macroderma initiative: conserving ghost bats and informing development. This project aims to improve methods for capturing biological information required for environmental assessments of highly mobile species and enable strategic environmental planning in Northern Australia. Using Australia’s iconic ghost bat as a focus, the project will test and apply emerging technologies to obtain key information on a species’ population status and its critical resources to inform assessments of ecologic ....The Macroderma initiative: conserving ghost bats and informing development. This project aims to improve methods for capturing biological information required for environmental assessments of highly mobile species and enable strategic environmental planning in Northern Australia. Using Australia’s iconic ghost bat as a focus, the project will test and apply emerging technologies to obtain key information on a species’ population status and its critical resources to inform assessments of ecological impacts of industry development. Important benefits of the project include information and tools for streamlining development approvals and accurately assessing risks to threatened species to improve outcomes for both our economy and our natural environment.Read moreRead less