Epidemiology And Community Consequences Of Asbestos Exposure In WA
Funder
National Health and Medical Research Council
Funding Amount
$879,876.00
Summary
We aim to explore the impact of asbestos exposure on the health of individuals using the Wittenoom workers and residents cohort studies and the Australian community with the formation of a new community based cohort study. Using data from the Wittenoom workers and residents studies, we will examine the impact of asbestos exposure on women�s health which has not been looked at before. We will examine if asbestos exposure affects psychosocial health and determine if long term supplementation with ....We aim to explore the impact of asbestos exposure on the health of individuals using the Wittenoom workers and residents cohort studies and the Australian community with the formation of a new community based cohort study. Using data from the Wittenoom workers and residents studies, we will examine the impact of asbestos exposure on women�s health which has not been looked at before. We will examine if asbestos exposure affects psychosocial health and determine if long term supplementation with Vitamin A for cancer prevention results in an increased risk of bone fractures. We will also examine the genetic susceptibility of asbestos related diseases in these cohorts, and create and validate an algorithm to derive measures of fibre counts from occupational histories. Earlier projections of mesothelioma in the general community have been based on extrapolations from disease incidence in the past. We intend collecting data on a new community based cohort, to examine the distribution of asbestos in the community in order to predict future cases of asbestos related disease and the perception, beliefs and knowledge that exists in the community of its potential health effects. With this new knowledge we will devise an intervention program with the aim of preventing future cases of asbestos related disease. As part of this process we will use a multimedia website as an information hub. This will allow us to experiment with the use of creative media to present personal and community experiences of living with asbestos and present scientific research and public health messages.Read moreRead less
1+1- A Healthy Start To Life:Targeting The Year Before And The Year After Birth In Aboriginal Children In Remote Areas
Funder
National Health and Medical Research Council
Funding Amount
$587,272.00
Summary
Indigenous Australians in remote communities are less healthy and more socially disadvantaged than other Australians. This influences the quality of the intrauterine environment. Babies often suffer malnutrition and recurring infections during infancy which are exacerbated by their less than optimal birth status and contribute to chronic conditions (diabetes, cardiovascular disease, renal failure) in adulthood. Existing health services are costly to Government and do not achieve their potential ....Indigenous Australians in remote communities are less healthy and more socially disadvantaged than other Australians. This influences the quality of the intrauterine environment. Babies often suffer malnutrition and recurring infections during infancy which are exacerbated by their less than optimal birth status and contribute to chronic conditions (diabetes, cardiovascular disease, renal failure) in adulthood. Existing health services are costly to Government and do not achieve their potential for promoting health and providing quality care. Evidence suggests redesigned models based on continuity of care, focused, proactive family support and workload reform will improve maternal and infant outcomes. New models need to be developed, costed, implemented and evaluated providing governments with the evidence base to initiate service improvement. Such models will have applicability elsewhere in Australia. Professor Lesley Barclay and her team of researchers from Charles Darwin University will conduct research into developing such a model. The project aims to improve the quality of care for remote dwelling Aboriginal women and infants in the year before, during and the year after birth by providing evidence for, and facilitating changes to, service delivery. This will enhance the potential for the development of resilience and well-being of their children. It will also test if service improvements can improve the health of women and reduce childhood disease and therefore reduce the impact of health conditions occurring in adulthood which have their origins in the early stages of life.Read moreRead less
Determining Critical Points In The Potential Palliative Care Pathway In The Last Year Of Life
Funder
National Health and Medical Research Council
Funding Amount
$356,461.00
Summary
People with serious illnesses who are approaching the end of their lives undergo a journey where, along the way, they experience several critical points. Although we know these critical points are crucial to how they might access the best kind of care, we are unsure exactly when these points may occur and how they may vary for different kinds of people. We need to know when is the best time to start withdrawing invasive and purely curative treatments, when are discussions about approaching death ....People with serious illnesses who are approaching the end of their lives undergo a journey where, along the way, they experience several critical points. Although we know these critical points are crucial to how they might access the best kind of care, we are unsure exactly when these points may occur and how they may vary for different kinds of people. We need to know when is the best time to start withdrawing invasive and purely curative treatments, when are discussions about approaching death best introduced and how we can care for people from a diverse range of backgrounds and beliefs within our current health care system. We also need to identify and promote the best possible ways of supporting patients at the end of life and their families as they negotiate the often complex path towards a good death. With this kind of information, health care practitioners, particularly those involved in palliative care, can design better services that put in place pathways where assessment of patient and family needs, referral to the most appropriate services and coordination of all the aspects of care are easy to understand and access for all people. This kind of care can be expensive so we need to use the money allocated to palliative care wisely. This can be achieved with thoughtful research that identifies those most in need, at the time of most need and investigates the best approaches to alleviating pain in suffering in the weeks and months before death. A fair and equitable health care system is not just about keeping people healthy, but also about dealing humanely with the inevitability of deathRead moreRead less
A Comprehensive Regulatory Strategy For Obesity Prevention In Australia
Funder
National Health and Medical Research Council
Funding Amount
$810,696.00
Summary
This research aims to develop regulatory approaches to obesity prevention and the reduction of socio-economic inequalities in obesity prevalence. Laws related to the provision, marketing, and labelling of food, urban planning, transportation, taxes and subsidies and so on will be comprehensively analysed and prioritised, and options proposed for legislative reform. The evidence-base and the implementation pathways will be developed contemporaneously and will be widely promoted to governments. A ....This research aims to develop regulatory approaches to obesity prevention and the reduction of socio-economic inequalities in obesity prevalence. Laws related to the provision, marketing, and labelling of food, urban planning, transportation, taxes and subsidies and so on will be comprehensively analysed and prioritised, and options proposed for legislative reform. The evidence-base and the implementation pathways will be developed contemporaneously and will be widely promoted to governments. A significant portion of time will be devoted to working closely with those within the bureaucracy who administer the law and legislators who together make the relevant policy decisions so that they may gain an understanding of the rationale behind each recommendation.Read moreRead less
Needs Based Access To Specialist Palliative Care Services: Development And Evaluation Of A Consumer Toolkit
Funder
National Health and Medical Research Council
Funding Amount
$286,572.00
Summary
The study will test the cost-effectiveness of two models of supportive care coordination for advanced cancer against _usual care�: a Telephone Caseworker model and an Oncologist-GP model. Both models are aimed at improving patients� and their informal caregivers� health and psychosocial status; are patient-centred, evidence based and readily transferable across health care settings. The Telephone Caseworker model has the additional advantage of reaching people isolated through geography, physica ....The study will test the cost-effectiveness of two models of supportive care coordination for advanced cancer against _usual care�: a Telephone Caseworker model and an Oncologist-GP model. Both models are aimed at improving patients� and their informal caregivers� health and psychosocial status; are patient-centred, evidence based and readily transferable across health care settings. The Telephone Caseworker model has the additional advantage of reaching people isolated through geography, physical disability or age.Read moreRead less
Improving Identification And Treatment Of Early-onset Behaviour Disorders In Children
Funder
National Health and Medical Research Council
Funding Amount
$498,869.00
Summary
Most mental health problems begin in childhood and adolescence. Of these, oppositional-defiant and conduct problems in childhood are the most common precursor of all types of adult mental health problems. These children are the most common referral to child mental health clinics but little is known about which of these children will go in which direction i.e., good health, chronic antisocial behaviour, depression and anxiety, substance abuse, the psychoses. Progress in more accurately defining s ....Most mental health problems begin in childhood and adolescence. Of these, oppositional-defiant and conduct problems in childhood are the most common precursor of all types of adult mental health problems. These children are the most common referral to child mental health clinics but little is known about which of these children will go in which direction i.e., good health, chronic antisocial behaviour, depression and anxiety, substance abuse, the psychoses. Progress in more accurately defining subgroups of these children would have huge implications for early intervention for mental health problems in our community. This project proposes the first large scale analysis of genetic distributions through to behavioural and treatment factors that characterise and differentiate a large representative sample of children with conduct problems. The project will test a model of child psychopathology that links genotype, via environmental risk and emotion processing problems, to an improved diagnostic-phenotypic model for treatment of the major childhood disorder. Clinical research activities will be structured into three intersecting arms: first, identifying the genetic and behavioural subtypes of early-onset conduct problems; second, innovative treatments for these children, and third, the dissemination of findings to these children and their families via the health care system. The research will build new collaborations between established and internationally recognised clinical research teams in childhood mental health, biological psychiatry, genetics and the Child and Adolescent Mental Health Statewide Network (CAMHSNET). CAMHSNET have specific responsibilities to NSW Health for expert advice and input on the development of child mental health services directions, dissemination, training, and effectiveness research.Read moreRead less
The Development And Evaluation Of Management Strategies Designed To Address Poly-morbidity In Older People: Implications
Funder
National Health and Medical Research Council
Funding Amount
$2,150,705.00
Summary
Medicines are used to prevent or manage the symptoms of chronic disease, and thus their appropriate use impacts significantly on the quality of life of the elderly. Poly-morbidity, multiple chronic health problems affecting the one individual, is a common and increasing issue in our ageing population. In Australia, 60% of 65 year olds have 2 or more chronic conditions, while 80% of 85 year olds have 4 or more chronic conditions. As a result, medicine use is almost universal in the older populati ....Medicines are used to prevent or manage the symptoms of chronic disease, and thus their appropriate use impacts significantly on the quality of life of the elderly. Poly-morbidity, multiple chronic health problems affecting the one individual, is a common and increasing issue in our ageing population. In Australia, 60% of 65 year olds have 2 or more chronic conditions, while 80% of 85 year olds have 4 or more chronic conditions. As a result, medicine use is almost universal in the older population and it is common for older patients to take multiple medications concurrently. There are no studies which report on current patterns of care and their outcomes in these patients. The use of individual disease-specific management guidelines may be problematic for those with poly-morbidity. Disease specific treatment guidelines often fail to take into account complexities that arise when patients suffer from more than one chronic disease particularly when it is common for one treatment to be both beneficial and harmful in the same person. In addition, the evidence for medicine-based treatment often comes from studies on younger people. Consequently, older patients with lower tolerance are at a greater risk of adverse drug reactions and are admitted to hospital as a result of such reactions at a disproportionately high rate. The aim of this study is to establish a methodology, by examination of two health databases, for developing guidelines to achieve the best possible outcomes for older Australians with common combinations of chronic conditions. This research will provide a better understanding of the consequences of current patterns of care for older people with multiple chronic conditions, and enable the development of improved approaches to care. We will demonstrate the methodology using selected commonly occurring combinations of chronic conditions in older Australians. More realistic guidelines generated by undertaking this analysis in these major population databases will reduce the extent to which the elderly are placed at risk of adverse drug reactions, and better enable health care practitioners, in consultation with their elderly patients, to ensure the best possible health and quality of life outcomes for many older Australian patients who suffer from two or more chronic conditions.Read moreRead less
Using Clinical And Economic Evidence To Infrom Local Decision Making In Cancer Care
Funder
National Health and Medical Research Council
Funding Amount
$1,836,745.00
Summary
Medicines used to treat cancer often come with a high price tag. Many countries, including Australia, are no longer able to provide free access to all medicines. For this reason, patients and their families, public hospitals and private health insurers are often asked to pay for these treatments. Currently, health professionals and patients are ill-equipped to make informed treatment choices, since both cost and efficacy must be considered. Our proposed research will address this important gap i ....Medicines used to treat cancer often come with a high price tag. Many countries, including Australia, are no longer able to provide free access to all medicines. For this reason, patients and their families, public hospitals and private health insurers are often asked to pay for these treatments. Currently, health professionals and patients are ill-equipped to make informed treatment choices, since both cost and efficacy must be considered. Our proposed research will address this important gap in current knowledge. We will use a unique web-based resource (Cancer Institute NSW Standard Cancer Treatment Program; CI-SCaT) to communicate the economic evidence needed to make informed decisions about cancer treatments. Our project will provide public access to information about the effectiveness and costs of cancer drugs. This is a world first. CI-SCaT is already the main vehicle of communication about cancer drug treatments in NSW and is widely used by cancer health professionals and patients to inform point-of-care decisions. Our project we will also identify the factors which influence the ability of cancer treatment centres to make best use of their drug budgets. By achieving this goal, we hope to demonstrate how to best use scarce resources for the benefit of all cancer patients.Read moreRead less
Helping Family Caregivers Of Palliative Care Patients Manage Their Roles: Evaluation Of A Hospital Based Group Education
Funder
National Health and Medical Research Council
Funding Amount
$219,810.00
Summary
While most people would prefer to die at home, the reality is that about two thirds of people die in in-patient settings, such as palliative care units. A home death is more likely if family caregivers are well prepared and supported in their role. Palliative care services are expected to support family caregivers. Research shows, however, that many family caregivers lack the required information to effectively manage their role. They are also prone to suffer psychological distress while support ....While most people would prefer to die at home, the reality is that about two thirds of people die in in-patient settings, such as palliative care units. A home death is more likely if family caregivers are well prepared and supported in their role. Palliative care services are expected to support family caregivers. Research shows, however, that many family caregivers lack the required information to effectively manage their role. They are also prone to suffer psychological distress while supporting their dying relative. Caregivers have expressed a desire for structured information to better prepare them for their role, whether their dying relative is in hospital, a palliative care unit or at home. The aim of this project is to develop and evaluate an educational program offered to family caregivers who are supporting a relative who is receiving palliative care in an inpatient setting. The education program seeks to help family caregivers manage their role and to prepare them for the patient�s home care where appropriate. It is hoped that family caregivers who have attended the program will be more competent, better prepared and more informed about their caregiving role. An additional benefit from attending the program will be the opportunity for family caregivers to meet others in similar situations to themselves. Each education program will involve approximately six family caregivers; it will be conducted very soon after their relative has been admitted to the palliative care unit. The program will be of two hours duration (including time for data collection) and will be facilitated by a suitably qualified health professional. Written resources will be provided and caregivers will be given the opportunity to meet with staff from the multidisciplinary team. Referrals for scheduled consultations will be made where relevant. The program will be conducted in three sites (two in Victoria and one in Western Australia) and will be comprehensively evaluated. The caregivers who attend the program will be invited to provide feedback by completing several questionnaires designed to determine the effectiveness of the program. Group education programs of this kind have previously not been rigorously developed and tested. We seek to address this and hope to demonstrate that we can positively influence the family care giving experience.Read moreRead less
Predictors And Consequences Of Allergies That Impact On Children Getting A Healthy Start To Life:a Prospective Study
Funder
National Health and Medical Research Council
Funding Amount
$893,559.00
Summary
Allergic diseases prevent Australian children getting a healthy start to life by causing long term illnesses. This group of diseases includes asthma, hay fever, eczema and food allergies. Half of all Australian children are born into families with a history of these conditions and these children are at increased risk. Some of these children develop allergies while the others do not. It is also known that allergic conditions change over time, but we have no information on causes of these changes. ....Allergic diseases prevent Australian children getting a healthy start to life by causing long term illnesses. This group of diseases includes asthma, hay fever, eczema and food allergies. Half of all Australian children are born into families with a history of these conditions and these children are at increased risk. Some of these children develop allergies while the others do not. It is also known that allergic conditions change over time, but we have no information on causes of these changes. For example some infants with eczema continue to have eczema or develop hay fever and asthma, while others do not. The aim of this study is to determine what factors cause allergies and what factors influence these changes. This will provide evidence to guide health policy and clinical practice. Looking at the different conditions in family members over time is a good way to answer these types of questions, because parents and siblings share similar exposures, but not all the same genes. This helps to disentangle the effects of the environment and genes. The Melbourne Atopic Cohort Study (MACS) is amongst the world�s major studies on the development of allergies. MACS commenced in 1991-94 by recruiting 620 babies prior to birth. Only infants born into families with a history of allergic disease were included. MACS is unique because all family members and the home environment were assessed at the time of birth of the child. These children have been followed regularly over the first ten years of their life. The MACS now provides a unique opportunity to conduct a family study that can examine genes, childhood environment and individual risk factors for allergies. This will also allow exploration of the impact of allergies on families and the health care system, and how we can reduce that impact. Such information will provide evidence to guide health care policy and clinical practice. Also, the current study will provide a platform for future studies to investigate the progression of allergies in this family cohort. This will be the world's only longitudinal family follow-up of allergies that spans all of childhood. It will assist in reducing the impact of these common conditions, and the findings will be original and significant not only in Australia but also internationally.Read moreRead less