A Validation Study of Self-reported Weights and Heights in the NSW Health Survey

V Flood, G Pang, K Webb, R Lazarus, L Baur.
Funded by NSW Health, this project examined the validity and precision of self-reported heights and weights from the NSW Health Survey. A sub-sample of the original survey participants willing to be contacted about further studies were telephoned, and if willing, an interview to measure their weight and height was arranged (n=227). While the mean differences between self-reported and measured weights and heights were small (weight -2.4kg, height 1.3cm), the total effect of exaggeration of height and under-reporting of weight on calculated body mass index (BMI) was substantial in population terms. From weight categories based on measured data, over half the participants (54%) were classified as overweight or obese, whereas in the weight categories based on the self-reported data, only 35% of participants were classified as overweight or obese. It was concluded that the use of self-reported heights and weights would result in substantial underestimation of BMI in population studies and that this tended to be worse among more obese subjects.

National Food and Nutrition Monitoring Project

G Marks, K Webb, I Coles-Rutishauser.
Dr. Geoff Marks, University of Queensland, Dr. Karen Webb, U Sydney, and Ms. Ingrid Coles-Rutishauser, Deakin University have been contracted by the Commonwealth Dept Health and Aged Care to develop a National Food and Nutrition Monitoring System. The two-year contract of 1.2 million will start off the system with a series of approximately twenty reports. One group of reports will summarise the results of recent national data collections, another group will report on methodological studies undertaken for the project, and another group of reports with the elements of building a sustainable system for nutrition monitoring. Among the reports will be: a guide to appropriately interpreting the dietary data from the National Nutrition Survey of 1995; Progress towards meeting the nutrition goals and targets; an interim evaluation of the folate fortification program; a bridging study to link the 1983 and 85 National Dietary Surveys with the 1995 Nutrition Survey; Standardised instruments and protocols for measuring food habits in health surveys; and Approaches to measurement and national monitoring of food "access" including price, availability and quality.

Folate and B12 in Older People

K Webb, W Smith, V Flood, P Mitchell.
Voluntary folate fortification legislation now permits selected food processors to add folate to their products. The public health aim of this legislation is to prevent Neural Tube defects in susceptible women. As with all public health interventions there are potential side effects, both harmful and beneficial. Older people are at risk of B12 deficiency, and folate fortification may mask the neurologic degeneration that occurs with B12 deficiency. On the potentially beneficial side, folate fortification may reduce the risk of folate deficiency in older people and reduce the risk of heart disease due to high levels of blood homocysteine. As a starting point, it is important to document the prevalence of B12 and folate deficiency in older Australian populations, both from diet and by biochemical measures. This grant supports the blood assays of folate, B-12 in the Blue Mountains Eye Study population, from specimens collected in the 1997-99 follow-up.

Locational Disadvantage: focusing on place to improve health

Harris E, Harris M, Madden L, Wise M, Sainsbury P, McDonald J, Gill B.

The study aimed to develop an applied approach to assess the capacity of the pbulic health workforce to understand the causes, context and consequences of locational disadvantage and the action that can be taken to address the health inequalities that emerge in these communities. The study achieved this by:

• developing a generic framework for assessing workforce development needs in the public health workforce;
• identifying best practice in addressing the needs of locationally disadvantaged communities;
• undertaking a needs assessment of the public health workforce in three Area Health Services in NSW using the generic workforce needs assessment framework;
• recommending action required to increase the capacity of the public health workforce to address the needs of locationally disadvantaged communities.

A report on the study has been published: Travaglia J, Harris E, Harris M, Madden L, Sainsbury P, Wise M, McDonald J. and Gill, B. 2006. Locational disadvantage: focusing on place to improve health. Sydney: Centre for Health Equity Training, Research and Evaluation, UNSW.

The competencies required by public health and health professionals working in locationally disadvantaged communities have been mapped and a 2 or 3 day training course has is being developed. We hope that after it has been pilot tested it will be incorporated into the regular training and education program of one of the NSW area health services.

National Diabetes Programs (NDP) Survey.

Colagiuri R. Buckley A.

As part of the implementation of the UN Resolution, the International Diabetes Federation (IDF) has established a Task Force on National Diabetes Policy and Action (chaired by RC) to promote and support the implementation of national diabetes programmes (NDPs) and strategies globally.

In support of this program, The Diabetes Unit is developing a handbook of resource material for developing and implementing NDPs including measuring the problem (disease prevalence, morbidity, costs), intervening to mitigate the problem and evaluating the impact of the interventions. Between now and the end of 2009 workshops will be conducted in each of the 7 IDF Regions of the world to provide mentoring, technical support, advice and raise government awareness of NDPs. The workshops will be held in partnership with the IDF Regional Offices.

National Diabetes Programs (NDP) Toolbox

Colagiuri R, Buckley A.

A policy and practice handbook on National Diabetes Programs (NDPs) for global distribution through the International Diabetes Federation (IDF) is being developed. A series of workshops on developing and implementing NDPs are being planned for each of the 7 IDF regions to provide mentoring, technical support, advice and raise awareness of NDPs. These workshops will be held in partnership with the IDF Regional Offices.

International Physical Activity Prevalence & Validation studies

Bauman A, Smith B, Bowles H, Merom D, van der Ploeg H, Chey T.

The Centre for Physical Activity and Health is acting as the data management centre for the International Physical Activity Prevalence and Validation studies, which is being carried out in 20 countries. Tasks here include investigating the prevalence of levels and types of physical activity undertaken in the countries taking part in the study; as well as determining reliability and validity of measuring physical activity internationally.

Physical Activity Measurement Study (PAMS)

Cust A, Smith B, Chau J, van der Ploeg H, Friedenreich C, Armstrong B, Bauman A.

This study is comprehensively evaluating the accuracy and reliability of three common physical activity questionnaires being used worldwide in cancer epidemiological studies. This project will help us to improve the measurement and analysis of physical activity in such studies, understand more clearly how physical activity is linked to cancer and other chronic diseases, and ultimately influence public health initiatives concerning the benefits of physical activity for cancer prevention and treatment.

New National Co-operative Oncology Groups

J Emery, J Gunn, M Pirotta, L Trevena, A Barratt, K McCaffery, G Mitchell, S Kilbreath, L Monterosso, L Foreman, P Booth, D Weller, K Forster, M King.

Primary care cooperative cancer clinical trials group. Cancer Australia - $219,564.

2009

Development of a set of core HPV messages to promote informed choice for both tests and vaccination for use in primary care and broader UK settings.

S. Wilkinson, S Wilson, P Sasieni, J Patnick, M Hendry, J Austoker, D Weller, T Marteau, K McCaffery, C Bankhead.

Cancer Research UK Project Grant(GBP 225,871; A$540,000). 2008-2011.

Surveillance of noncommunicable disease risk factors in Nauru

Phongsavan P, Smith B.

This is an international collaborative project between the World Health Organization, Nauru Ministry of Health and the Centre for Physical Activity and Health, School of Public Health to design and implement a nation-wide survey of non-communicable disease (heart disease, diabetes, stroke, obesity) risk factors in the Republic of Nauru. These surveys are a part of a global drive to instigate non-communicable disease risk factors surveillance in developing countries, including the Pacific Island Countries.

Type 2 Diabetes Guidelines

Colagiuri R(Project Director), Gomez M(Research Officer - Primary Prevention), Merry L(Project Management)

The Diabetes Unit has been subcontracted by and is partnering with Diabetes Australia (DA) to lead and manage the development and updating of four evidence based NHMRC guidelines for diabetes. The contract covers development of 2 new guidelines (Renal; Patient Education), plus the updating of 2 existing guidelines (Primary Prevention; Case detection and diagnosis).

The Guideline Consortium is headed by Diabetes Australia and includes:

• The Australian Diabetes Society
• The Australian Diabetes Educators Association
• The Royal Australian College of General Practitioners
• The Australian Cochrane Diabetes Satellite (at The Diabetes Unit- AHPI).

Collaborators are:

• The NSW Centre of Evidence Based Health Care (University of Western Sydney
• The Cochrane Renal Review Group (Westmead Children's Hospital)
• The Cochrane Consumer Network
• The Caring for Australians with Renal Impairment Guidelines Group (CARI), Kidney Australia.

Formative research concerning health risks among women with past gestational diabetes mellitus (GDM)

van der Ploeg H, Cheung W, Smith B, Razee H, Blignault I, Bauman A, McLean M, McElduff A, Ross G.

Women who have gestational diabetes (GDM) are a group who are at high risk for the development of frank diabetes. About one third of women in Australia who develop diabetes might have had an earlier GDM pregnancy. This study is investigating the efficacy of a physical activity and dietary intervention to bring about behaviour change and reduce the risk of future frank diabetes. The challenge is to develop a cost-effective program which is acceptable and effective for women who have had GDM.

Developing Methods for the Evaluation of Screening Programs and Diagnostic Tests

L.Irwig.
Improving design and analysis of studies

• The design and analysis of primary studies and meta-analyses to compare performance characteristics of two or more tests
• The detection of and correction for publication bias in meta-analyses of test performance
• Correcting for misclassification of the reference (gold) standard when assessing test performance.

Measuring patient preferences for treatment of colorectal cancer using discrete choice modeling

Salkeld G, Solomon M, Short L and Butow P.

The aims of this project are:

• To determine which characteristics of colorectal cancer treatment patients regard as being important.
• To quantify the kind of trade-offs patients make between these characteristics.
• To explore how variations in levels of these characteristics influence their choice of treatment.
• To recommend ways in which discrete choice modeling can be used to help patients make treatment choices.

Evidence-based patient choice in surgery

Salkeld G.
Evidence based patient choice (EBPC) encapsulates two movements in western health care systems. The first is the role of evidence-based information. The second is the centrality of individual patient choices and values. In practice, EBPC may lead to greater involvement of the individual patient in deliberations about appropriate forms of clinical management. Economics recognizes that there will always be asymmetry of information between surgeon and patient due to the complexities of synthesizing probabilistic information on the outcomes of treatment. For this reason an agency relationship exists whereby the surgeon supplies information to a patient and it is the patient who decides treatment (or where the choice is made to transfer the responsibility of a treatment decision back to the surgeon). In its most paternalistic form, the surgeon gathers medical information from a patient and decides upon treatment without considering patient preferences. Evidence based patient choice represents a shift away from a paternalistic model to one that actively considers the values, wishes and desires of patients.

Evidence-based patient choice throws out a challenge; how do surgeons get behind patient values and translate this into actual treatment choices? A research program is being designed around issues relating to evidence-based patient choice in surgery.

Smoking and mental health: a literature review.

Authors: Ragg M, Ahmed T

Commissioned by The Cancer Council NSW.

Smoking is the leading cause of death for people with mental illness, yet it is often not considered important by people working in the field. This review was commissioned to establish a baseline for action by the Cancer Council, and to inform debate. It will contribute to the Cancer Council's social equity strategy of reducing smoking among disadvantaged populations.

Clinical Monitoring in Renal Transplant Recipients

Cross N, Craig J, O'Connell P.

Renal transplantation is the best treatment for patients with end-stage renal failure. Patients are monitored following transplantation in an effort to maintain health of the recipient and function of the graft, using clinical, laboratory and radiologic measurements. Variation in clinical or laboratory observations may occur for many reasons, some of which are not due to a change in clinical status. Scientific methods exist for the analysis of variation, and have been widely applied for monitoring purposes in non-medical settings such as manufacturing.

This project aims to assess application of such methods to the process of detecting clinical events in renal transplant recipients, with the aim of improving renal transplant outcomes.

Hip fracture multiple intervention RCT: HIPFIT

Fiatarone Singh M, Quine S, Singh N.
Physical, functional, psychological and quality of life outcomes for older people following hip fracture remain poor, relative to pre-fracture, for those surviving the first 12 months following fracture. Strategies to improve these outcomes are needed, and have potential not only to improve the factors listed above, but also to reduce hospital re-admissions and institutionalisation. This innovative project incorporates a randomised controlled trial design, with the control group receiving usual care. The intervention group will receive a multiple pronged, targeted intervention program, founded on current research evidence of effective strategies. These comprise: strength and balance training, hip protectors, minimisation of polypharmacy, enhancement of social support networks, social participation and self-efficiacy, environmental modifications in the home, assessment and treatment of cognitive impairment and depression, minimisation or accommodation of visual impairment, protein and energy nutritional supplementation, vitamin D and calcium repletion. The interventions are designed to minimise or eliminate existing remediable problems. Each patient in the intervention group is assessed to determine which interventions are appropriate for their particular needs. The research team is multi-disciplinary and the project is funded on a $815,000 NHMRC project grant over a 5 year period. Recruitment into the study commenced in 2003.

Functional Ageing, Health and Services (FAHS): a Longitudinal Outcomes Study

Kendig H, Browning C, Fiatarone Singh M, Quine S, Thomas S.

The FAHS study of healthy ageing examines ways in which functional ageing, medical conditions, and health related behaviours influence the health and service use of aging Australian individuals. The study builds on the baseline data obtained from the 1994-7 VicHealth Status of Older People study (n=1,000) and subsequent follow-ups as part of the NHMRC funded 1998-2000 Health Behaviours and Outcomes of Older People study. The FAHS project has added two further data collections: a mail survey(conducted in 2003) and a telephone survey(2004). This will extend the annual longitudinal data set to ten years, thus providing high yields in terms of key outcomes as the respondents reach and move into late life. Baseline measures include medical conditions (specific diseases, cardiovascular and musculo-skeletal disorders, confusion, incontinence, depression and mental health, falls and injuries, functional capacities, medication use, pain); clinical measures (weight, height and sensory loss); health behaviours (exercise, nutrition, social activity, sleep, etc.), attitudes and life histories. Subsequent annual outcome measures will include: survival, functional capacities, use of health and community services, entry to residential care, and well-being. Baseline data will be used to predict outcomes using multiple regression, logistic regression and survival analysis, as appropriate. The results will inform the design and targeting of interventions in clinical practice and health promotion. The established multi-disciplinary research team combines expertise in epidemiology, medicine, psychology, sociology, occupational therapy and health services research, across La Trobe University and the University of Sydney. The three year project is funded through a $211,465 NHMRC Healthy Ageing Strategic Research Development grant.

A Qualitative Study of Australian Suicide Notes

Quine S, Duflou J, Carter G, Hobbs C.

The object of the research is to identify possible modifiable factors which could inform preventive suicide strategies and thereby reduce the incidence of future suicides. This is a descriptive qualitative study based on thematic content analysis of the suicide notes left by completed suicide cases. Demographic and autopsy data will also be used to examine the identified themes in relation to information about the suicide incident.

2007-2010

Cross sectional survey to examine and assess the nature of the relationship between resilience and health behaviour among Indigenous and non-Indigenous adolescents attending school, and among Indigenous adolescents who are out of school.

Hearn S, Nutbeam D, Bauman A, Wise M.

The purpose of this study is to measure and better understand the concept of resilience among indigenous and non-indigenous students, and to examine the extent to which different measures of resilience predicts the likelihood of students engaging in a range of behaviours that either support, or potentially compromise their health status and education attainment.

HPV testing Decision Aid for women with Minor Atypia on Pap smear (The IMAP Study)

McCaffery K, Irwig L, Howard K, Davey E, Barratt A, Salkeld G, Lewicka M, Weisberg E.

This study will compare the psychosocial outcomes of different management strategies for women with a mildly abnormal Pap smear: (a) usual care (repeat Pap smear), (b) HPV testing, a new management proposed for this group, and (c) the choice of either management using a decision aid to support women to make their preferred choice. The study will assess psychosocial and quality of life outcomes and will model the effectiveness of each management strategy.

Process tools for evidence-policy transfer in Indigenous-mainstream primary health care partnerships.

Fuller J, Passey M, Hermeston W.

The evidence-policy transfer in two programs related to different chronic conditions (mental health and diabetes) will be examined. The cases are (1) the RAISE Wellbeing Program (social and emotional wellbeing) operating out of the Pika Wiya Health Service in Pt Augusta, SA and (2) the Goorie Diabetes Complication and Assessment Clinic (DCAC) operating out of the Dharah Gibinj Aboriginal Medical Service in Casino, NSW.

Each case study involves links between an Aboriginal health service and mainstream private and public health care services that operate under a state system of area health governance. Comparative case analysis will be used to examine the development, sustainability and transferability of Indigenous and mainstream primary health care partnership programs into policy.

Action research using network analysis and role clarification will be used to engage the stakeholders, who will include service delivery staff and managers, area health specialists and directors, state health policy officers and community representatives. In both cases, networks will be bound to the information sharing, client servicing and resource links between local Aboriginal and mainstream health services, area health and the state health department. Within-case and cross-case analysis of qualitative and quantitative data will provide evidence about the use of network analysis and role clarification tools by the partner stakeholders to develop and sustain each partnership.

The case findings will then be considered against a relevant systematic literature review to inform policy. This analysis will illustrate how these tools helped to facilitate transfer of evidence about the partnerships into policy for wider application. The outcome will be tried process tools that can be used for evidence-policy transfer in Indigenous-mainstream primary health care partnerships.

Australian Primary Health Care Research Institute ($313,000): 2006-2008

Evaluation of cervical cytology accuracy according to different strategies of providing information to cytologists

Davey E, Macaskill P, Irwig L This study, in collaboration with a large pathology laboratory, examines how the accuracy of cervical cytology reading varies according to whether cytologists have no information on client details or previous cytology and histology results when they evaluate slides, read slides with these details available or read slides initially with no access to information and again after provision of such information. Cytology slides from over 600 women will be used amongst 9 cytologists, with all cytologists examining all slides blind to others' results and blind to histology. Histology will be used as a reference standard in all cases.

A Decision Aid in the management of patients with locally advanced rectal cancer

Butow P, Solomon M, Whelen T, Salkeld G, Tattersall M, Rhuby G, Young J.

This project is a collaboration between the Surgical Outcomes Research Centre in Australia and Dr Tim Whelen, in Canada, and is developing a decision aid for patients with locally advanced rectal cancer deciding whether or not to have adjuvant chemo/radiotherapy before or after their surgery. The aid will be on a computer screen used interactively in the surgical consultation, with patients provided with the same material in a booklet form to take home. The decision aid was piloted in 2003, and a randomized controlled trial in 2004.

Diabco$t - Type 1: Assessing the burden of Type 1 Diabetes in Australia.

Colagiuri R(Chief Investigator), Gomez M(Project Officer)

This project describes the cost of type 1 diabetes in direct health system costs, indirect costs and intangible costs. These costs were assessed by means of a national survey of people with type 1 diabetes aged at least 5 years and above, and parents or carers of people with type 1 diabetes. It seeks information on service utilisation, impact on work or school attendance, additional personal costs incurred in relation to diabetes, and quality of life. It follows DiabCo$t - Type 2 (2003), a nation wide survey of 11,000 adults with type 2 diabetes. The significance of the DiabCo$t studies is in their provision of locally generated, population scale costing data to inform policy and planning where this information was previously extrapolated from overseas data. The project has been completed and a report on the findings is currently being prepared.

Collaborators: Diabetes Australia, Eli Lilly Company - Australia, The Diabetes Centre - Prince of Wales Hospital, The Juvenile Diabetes Research Foundation Australia.

FEVER Project

Craig J, Deeks J, Codarini M, Chan S, Macaskill P.
In this project we plan to develop and test a new model to help clinicians make better informed diagnostic decisions. Currently clinicians are expected to make accurate and prompt diagnostic decisions without the support of the full range of information available to them. This is a complex task. Interpretation of a patient's test result should take into account the probability of the disease before the test, the patient's test result and the accuracy of the test. When multiple tests are done, and combined with a patient's history and physical examination, the complexity is substantially increased. In practice patient's results are compared to a normal range, ignoring the accuracy of the tests and probability of disease. This project is about developing and testing a system that incorporates all the test components and presents the information to the clinician as an explicit probability of disease. We will then determine whether this improves.

Virtual Colonoscopy Project

Howard K, Salkeld G.
In Australia, conventional colonoscopy is the diagnostic test of choice for the investigation of patients suspected of having colorectal disease. The number of colonoscopy procedures reimbursed through the nations universal health insurance scheme, Medicare, has risen exponentially over recent years. This rise has occurred in spite of a 20% reduction in the Medicare fee schedule in 2002. However, an alternative diagnostic test, a virtual colonoscopy, could potentially offer a cheaper and less invasive means of diagnosing colorectal disease. Virtual colonoscopy (VC) is a non-invasive procedure performed by a helical CT scan of the colon. In 2002, a National Bowel Cancer Screening Pilot Program has been established in Australia. If successful, these pilots will be a forerunner to a national mass colorectal cancer (CRC) screening program. Hence the Australian government is keen to explore whether resources should be allocated to virtual colonoscopy as a possible alternative to conventional colonoscopy in some patients. For this reason, a trial of the diagnostic accuracy of virtual colonoscopy and conventional colonoscopy is being conducted as part of the screening pilot of FOBTs (faecal occult blood tests). The trial will assess the diagnostic accuracy of the two procedures, the costs as well as patient preferences in a group of patients suspected of having colorectal disease. A discrete choice study of patient preferences for VC compared to conventional colonoscopy is being conducted to inform policy makers and clinicians about optimal service delivery for the investigation of patients suspected of having colorectal disease.

Applying Clinical Evidence: a randomized trial of consumers asking questions

Barratt A, Tattersall M, Trevena L, del Mar C, Carey-Hazell K, Butow P, McGeechan K.

The study is to evaluate the use of a set of consumer questions on patient doctor communication. The questions have been developed jointly by researchers and consumers and are advocated by consumer groups. In the study we will train and deploy Standardized Patients who will audiorecord their consultations. The audiorecordings will be analysed using a newly developed coding scheme. The study is taking place in both general practice and specialist practice (with oncologists).

Australian Screening Mammography Decision Aid Trial Online ( Mammography Decision Aid for women aged 40 years)

Mathieu E, Barratt A, Howard K, McGeechan K, Davey H, Houssami N.

This decision aid aims to help women around 40 years of age make an informed choice about whether to begin screening for breast cancer or wait until later (50 years). The decision aid is available on on-line at www.mammogram.med.usyd.edu.au. It has been evaluated in a randomized controlled trial conducted on-line and is now in publication process. The decision aid increased knowledge, and decreased the proportion of women who were undecided. The trial demonstrated the usefulness and feasibility of an on-line decision aid to help women make this decision.

Discrete choice experiments for dialysis modality decision making

Morton RL, Howard K.

Discrete choice experiments (DCE's) are a methodology for taking account of preferences that can be applied in the health care setting. DCE's have been shown to be sensitive to health outcomes such as survival and quality of life, as well as non-health outcomes or process attributes such as distance to a health centre. In the end stage kidney disease population we will determine the health attributes, assign levels to the characteristics, design choice scenarios and conduct choice experiments. Regression techniques will be used to analyse the responses.

Managing Return-to-play Decisions Following Mild Traumatic Brain Injury - mTBI

Stevenson M, Hollis S, Taylor C, Finch C, McIntosh A, Shores A, Collins M

*through the George Institute*

The study will estimate the incidence of mild traumatic brain injury in Rugby players, assess the risk and protective factors for injury and recovery and, will develop recommendations on return-to-play following mTBI.

World Health Organisation (WHO) Review of the Western Pacific Diabetes Plan of Action.

Colagiuri R, Buckley A.

To address the increasing burden of diabetes in the Western Pacific Region (WPR), the WHO - WPRO, the International Diabetes Federation (IDF) WPR and the Secretariat of the Pacific Community (SPC) jointly developed a Declaration on Diabetes and supporting Plan of Action based on 3 goals relating to primary prevention, secondary prevention and strengthening national health systems. The purpose of the Declaration and the Plan of Action was to provide a framework, advocacy tool and strategic direction for diabetes prevention and care programmes in the region. It was developed by RC and launched in 2000.

The Diabetes Unit was commissioned by the WHO-WPRO in late 2007 to map and review the progress on implementation of the Plan of Action. The review involved:

• surveying member associations of the IDF-WPR regarding the diabetes-related policies, programs and activities implemented in their countries since 2000,
• interviewing key personnel,
• reviewing relevant IDF, SPC and WHO reports reviewed to gain further insight into the progress achieved on a regional level.

PRIVENT: Prevention of Recurrent urinary tract Infection in children with VEsicoureteric reflux and Normal renal tracts Trial

Study Coordinator: Alison Lowe. Gunasekera H, Craig J, Hodson E, Roy P, Hartley M, Taylor S.

PRIVENT is an NHMRC funded, multicentre double blind randomised controlled trial designed to determine whether long-term antibiotics prevents urinary tract infection in children. Antibiotics are given daily to the children over 1 year in which investigators, pharmacy staff and outcome assessors are all blind to the treatment allocation. It aims to enrol 780 children with urine infection and randomise them to receive antibiotic prophylaxis or placebo. 480 children have been enrolled to date.

Nephrotic Syndrome Research

Hodson E, Willis N, Fletcher J, Faniran S, Craig J

This is a series of systematic reviews of the treatment of childhood nephrotic syndrome for the Cochrane Renal Group. In addition the group had undertaken a prospective surveillance of the incidence of nephrotic syndrome in childhood through the The Australian Paediatric Surveillance Unit (APSU).

Study of Environment on Aboriginal Resilience and Child Health [SEARCH]

Craig J, Gunasekera H.

SEARCH is the result of a collaboration between a number of organisations, including the Coalition for Research to Improve Aboriginal Health (comprising the Aboriginal Health and Medical Research Council and the Sax Institute), NSW Department of Health, the University of Sydney and six Aboriginal Medical Services across New South Wales.

The SEARCH program aims: a) to describe and investigate the causes of health and illness in Aboriginal children with a focus on healthy environments and selected child health problems by; a cross sectional study of 800 families in urban and large regional centres, a prospective cohort study of the 800 families over 5 years, and a prospective cohort study of the 800 families over 20 years. b) to determine whether a community appointed health broker in (i) a randomised trial focussed on otitis media and (ii) a feasibility trial of housing improvement is an effective, sustainable agent for improving the environment and health of aboriginal children and their families.

ARDAC - Antecendants for Renal Disease in Aboriginal Children

Haysom L, Williams R, Lopez-Vargas P, Hodson E. Craig J, Roy P, Lyle D

We are undertaking a screening study of 1000 Aboriginal and 1000 non-Aboriginal primary school children in NSW: - to determine how commonly Aboriginal and non-Aboriginal primary school children have blood and protein in their urine. - to investigate whether these numbers vary between urban, rural and remote communities - to determine whether there are any associations between these kidney disease markers and the children\'s height, weight and blood pressure levels.

Use of evidence about diabetes by GPs

Entwistle, Barratt A, Trevena L.

This is a qualitative study about the use of evidence in practice- joint study between Sydney and Dundee.

HPV vaccination survey of GPs

Jackson, Leask, McCaffery K, Trevena L, Brotherton.

This project is a survey of GPs on implementation of HPV vaccination program.

University of North Carolina - collaboration in the development of a decision aid for older people considering colonoscopy screening for colon cancer in the US

Lewis, Pignone, Trevena L

This project develops and evaluates a decision aid for people over the age of 75 years who are considering whether they should continue colonoscopy screening for bowel cancer in the US setting.

A randomized trial of a web-based toolkit for applying evidence in the general practice cervical cancer prevention visit

Chief Investigators: Trevena L, McCaffery K, Barratt A, Leask J, Brotherton J, Dobbins T.

Research Coordinator: Wadolowski M.

This project is funded by the Cancer Council NSW and involves the development and evaluation of a website for young women who are considering a Pap smear. It will include a randomised trial in general practice.

Determinants of overweight and obesity - energy balance and physical activity

Allman-Farinelli M, Bauman A.

We have found age period and birth cohort effects on rates of obesity and are examining likely etiological factors. Energy balance including leisure time physical activity and occupational activity expenditure are being studied using the data sets from the National Health Surveys.

Early detection and treatment of Rheumatoid Arthritis - Guidelines for General Practice

Trevena L,RACGP working group

An RACGP project funded by DoHA to develop guidelines for the diagnosis and treatment of rheumatoid arthritis in general practice.

Comparison of accuracy of liquid-based cervical cytology evaluated using the ThinPrep Imager (TPI) with conventional cytology evaluated manually

Davey E, Macaskill P, Irwig L, Chan SF, D'Assuncao J

The relative performance of manually-read LBC and conventional cytology (CC) has been evaluated in several studies, and substantial evidence suggests that LBC slides are faster to read than CC slides. However, the introduction of computer-assisted reading of LBC slides, such as with the TPI, may affect the accuracy of LBC relative to CC, may affect laboratory performance if timing alters, and may therefore change the cost-effectiveness of LBC relative to CC. This is important in countries such as Australia and NZ that have not already adopted LBC into screening programs. Our study, in collaboration with a large pathology laboratory, compares the accuracy of more than 50,000 pairs of TPI-read LBC slides with that of manually read CC slides, using re-reading of histology and Pap Test Register reports as the reference standard.

A substudy examines the time required to read TPI-processed LBC slides and CC slides amongst 41 cytolgists under normal laboratory conditions over 5-7 months, and analyses these times according to years of cytologists' experience.

Vitamin D following primary treatment of melanoma at high risk of recurrence. Placebo controlled randomised phase II study

Armstrong BK, Mason R, Saw R, Morton RL
This randomised controlled trial aims to assess the feasibility, the safety and the toxicity of an oral loading dose of Vitamin D (500,000IU) followed by an oral dose of 50,000 IU of Vitamin D for 2 years. The target population are patients aged 18-79 who have completed primary (surgical) treatment for cutaneous malignant melanoma and considered to be at high risk for recurrence: Stage IIb, IIc, IIIa (N1a) and IIIb (N1a, N2a). The primary end points are dose sufficiency, dose compliance and safety. The project commenced in 2009 and is expected to be completed in 2013.

B Positive project - optimising the diagnosis and treatment of chronic hepatitis B to prevent liver cancer

Robotin M, George J, Dore G, Batey R, Levy M, Tipper S.

This project aims to determine the acceptability and feasibility of early detection and intervention in chronic hepatitis B infection to reduce liver cancer risk in at risk communities in South Western Sydney. Study recruitment commenced in February 2009.

Blue Mountains Eye Study

Mitchell P, Smith W, Cumming R, Leeder SR, Wang JJ, Mann G.

The Blue Mountains Eye Study (BMES) was the first large population-based assessment of visual impairment and common eye diseases of a representative older Australian community sample. Baseline data collection took place in 1992-1994 with 3654 residents. Follow-up assessments have been conducted at 5 year (BMES2); 10 year (BMES3) and 15 year intervals (BMES4). From BMES2, the design of the study was extended to include detailed hearing assessment (BMHS) conducted by audiologists, giving a more comprehensive picture of sensory functioning in older Australians. As part of the BMEHS an NHMRC capacity building research grant has been awarded, allowing a postdoctoral researcher to focus on identifying the health policy implications of the data.

NHMRC Capacity Building Grant in Population Health Research. 2003 - 2009

Anthropology: a generic companion

Heil D, Macdonald G.

A handbook for anthropology students and provides a more generic introduction for an interested public to the discipline of anthropology, its background and the study skills that can be acquired. The book covers the history of the discipline of anthropology, its major debates and contemporary challenges. To be published by Palgrave macmillan, hampshire, UK in 2008

An interactive decision aid for prioritising health-check activities

Trevena L, Barratt A, Del Mar, Dobbins T, McCaffery K,

This will involve a randomized controlled trial of a web-based tool for health check activities amongst healthy Australians presenting to the GP for a check-up. It is funded by NSW Cancer Council for three years.

Healthy Beginnings - early intervention to prevent childhood obesity

Wen LM, Alperstein G, Bauer L, Rissel C.

Funded by the NHMRC, this family-based randomised controlled trial features a series of developmentally staged home visits by early childhood nurses to address risk factors associated with overweight and obesity. The protocol is available on-line in the BMC Public Health 2007, 7:76.

2006-2009

Development and evaluation of a literacy sensitive decision aid for colorectal cancer screening

McCaffery K, Smith S, Trevena L, Barratt A, Simpson J, Nutbeam D.

Associate investigators:Butow P, Irwig L

This project is funded by the Sydney Cancer Research Fund and the NHMRC. The project will develop and evaluate by randomised trial a FOBT screening decision aid for adults with limited literacy. The project also includes a substudy investigating optimal graphic formats for presenting risk information to adults with limited literacy and numeracy skills. The findings from this will inform the prsentation of quantitative risk information included in the decision aid.

Sydney Cancer Research Fund. $100,000.

Exercise and falls prevention after stroke

Dean C, Rissel R, Sherrington C, Cumming R.

Funded by a NSW Health Promotion Demonstration Grant, this randomised controlled trial seeks to prevent falls and fall related injury among people with a stroke. Working with NSW Stroke Clubs, the intervention group will receive a lower limb physical activity program, and the control group another program.

2006-2009

Case-control studies of suicide and attempted suicide in young people in NSW

Taylor R, Dudley M, Carter G, Duflou J. Hobbs, C. Project Co-ordinator

This study aims to delineate and quantify risk factors and population characteristics of both suicide and attempted suicide in young people age 18-34 years from New South Wales across urban and rural areas, and aims to elucidate predictors for completed suicide compared to those who attempt suicide. There are very few analytic studies of young adult suicide (based on individuals) in the literature, none in rural areas, and none in Australia. The project involves 3 case-control studies: suicides compared to controls, attempted suicides compared to controls, and suicides compared to attempted suicides. The case-control design will have sufficient numbers of cases and controls to investigate suicide in a multi-level framework combining individual and psychiatric risk factors with contextual and geographic socio-demographic factors. The findings will be generalisable to young populations in metropolitan and rural NSW and Australia, and will be of international relevance to young!

Populations in other similar developed countries. Specifically, the study aims to quantify individual risk factors in combination with socio-demographic factors as contributors to suicide outcomes, and to establish relationships between suicide and attempted suicide risk factors as they occur as background to, and precipitant(s) of, a suicide event.

2004-2009

Air Quality & Respiratory Health Study

Cowie, C will be managing this study. Marks G, Cortes A, Ezz W.

The Air Quality & Respiratory Health Study (AQRHS) is being conducted to determine whether the effects of changes in air quality arising from traffic-related air pollution are associated with changes in respiratory health in people living around the Lane Cove Tunnel. A study cohort (2-75 yr olds) has been established in four locations around the Lane Cove area. These four locations are expected to experience varying changes in traffic related air pollution as a result of the road changes in the area. A study population of around 3,000 people has been recruited into a questionnaire survey of respiratory and irritant health. A sub-group of 360 people has also been recruited to a diary study where peak flow measurements and respiratory symptoms are being recorded twice daily. Each part of the study is being conducted both before and after opening of the tunnel, with pre-opening data being collected in 2006. The tunnel opened in March 2007. Various methodologies for assigning individual exposure to traffic related air pollution are also being explored in this study.

Collection for health outcome data for this project is being funded through the CRC for Asthma and Airways and the NSW Health Department, with the study being conducted through the Woolcock Institute of Medical Research.

Due to be completed in 2008.

Clinical Pathways in Acute Coronary Syndromes in China Study – CPACS

Patel A, Turnbull F, Lu X, Chen L.

*through the George Institute*

Collaboration:

• The Chinese Society of Cardiology
• Peking University Health Science Center

The overall objective of this project is to develop, implement and evaluate clinical pathways for the management of acute coronary syndromes (ACS) in tertiary and non-tertiary centers in China.

Understanding the impact of social, economic and geographic disadvantage on the health of Australians in mid - later life: what are the opportunities for prevention?

Bauman A, Redman S, Bailey S, Bambrick H, Banks E, Beard J, Broom D, Byles J, Clark J, Harris M, Jalaludin B, Jorm L, McMichael A, Nutbeam D, Rodgers B, Schofield D, Woodruff R, Woodward M.

Social, economic and environmental factors play a key role in the health of all Australians. As the Australian population ages, there is an urgent need to understand how people can remain healthy and independent for as long as possible. This research will examine the ways in which social, economic and environmental factors contribute to the health of Australians in mid to later life. It will help identify ways in which policy and preventive programs can contribute to improving health in mid to later life particularly among disadvantaged Australians. We will explore in detail social, economic and environmental factors in 100,000 people aged 45 and over; this will be the largest study of its kind ever undertaken in Australia. We will examine the relationship between these social, economic factors, and lifestyle factors such as smoking, physical activity, environmental and obesity. We will look at how these factors contribute to health and health service use. Because of the large numbers of people participating in the study, we will be able to investigate for the first time, the ways in which these factors affect each other and their importance in different subgroups in the population. This will enable us to identify where programs and policies should be directed to most rapidly improve the health of disadvantaged Australians.

NHMRC Program Grant: ($1.8m 2007-11)

Heart Outcomes Prevention Evaluation: SOLARIS Study of Lipid Modification and Blood Pressure Reduction in People at Average Risk - HOPE-3

Patel A, Groenestein P

*through the George Institute*

Collaboration:

• The Population Health Research Institute, McMaster University, Canada
• The Centre for Clinical Research Excellence in Therapeutics, Monash University, Melbourne
• The University of Sydney School of Rural Health, Dubbo

The HOPE-3 trial will evaluate the benefits of combined cholesterol and blood pressure lowering therapies in reducing cardiovascular risk in a wide group of people without vascular disease.

Blood Pressure Lowering Treatment Trialists Collaboration – BPLTTC

Turnbull F, Algert C, Neal B, MacMahon S, Perkovic V, Chalmers J, Woodward M.

*through the George Institute*

This study aims to provide reliable evidence about the effects of different classes of blood pressure lowering drugs on cardiovascular mortality and morbidity in a variety of patient groups.

The MMR (measles-mumps-rubella) vaccine decision aid. An online tool for parents.

Wallace C, Leask J, Trevena L, Butow P, McIntyre P.

This study was the first published study to apply decision aids in the child vaccination arena. The pilot study tested the effects of an online decision aid for parents concerned about the safety of the MMR vaccine. The decision aid provided evidence based information on the risks and benefits of MMR vaccination and the diseases it prevents via a 21 screen online tool. The study showed a significant positive shift in attitudes to MMR vaccination. Further results have been published. A collaboration with Leeds University (UK) is underway.

Electronic Decision Support Study

Patel A, Peiris D, Turnbull F, Groenestein P, Joshi R, Webster R

Collaboration: Western Clinical School: University of Sydney
*through the George Institute*
This study involves the preliminary assessment of a novel electronic decision support tool that integrates risk assessment with multiple Australian guidelines to provide individualized treatment recommendations for patients.

The Pfizer CVL research grant.

The Kanyini Vascular Collaboration

*through the George Institute*

Improving health outcomes for Aboriginal Australians with chronic disease through strategies to reduce systems barriers to necessary care

The Guidelines Adherence with the Polypill Study – GAP

Patel A, Groenestein P, Jan S, Neal B

• Collaboration: Clinical Trials Research Unit, School of Population Health, University of Auckland
• Department of Epidemiology and Preventative Medicine, Monash University, Victoria

*through the George Institute*
NHMRC project grant
This is an Australian trial evaluating whether a "polypill" will help patients who have to take multiple medicines to help prevent cardiovascular events.

RCT of Normal vs. Augmented Level of Renal Replacement Therapy in ICU - RENAL

*through the George Institute*

This study is looking at the effect of different doses of dialysis (renal replacement therapy) in patients with severe, acute kidney failure in the intensive care unit (ICU).

The Burden of Chronic Kidney Disease

*through the George Institute*

This study aims to establish the human and financial burden of chronic kidney disease in Australia and internationally and to explore the cost-effectiveness of screening and intervention to prevent progression of disease.

Funded by Kidney Health Australia

Study of Heart and Renal Protection- SHARP

*through the George Institute*

This Study aims to determine the effects of cholesterol lowering with a combination of simvastatin and ezetimibe on the risk of major vascular complications in patients with chronic kidney diseases.

Improving Indigenous Patient Access to Kidney Transplantation - IMPAKT

*through the George Institute*

IMPAKT comprises five component studies aimed at identifying Indigenous Australians' barriers to accessing renal transplantation, and proposing strategies to reduce disparities in Indigenous Australians' access to renal transplantation.

Retrospective Analysis of Trauma Transfers - RATTS study

Stevenson M, Taylor C, Fitzharris M, Middleton P, Sinclair G

*through the George Institute*

The study aims to identify rates of compliance to protocol 4 (the trauma by-pass protocol), estimate the time to definitive care in rural NSW and determine the impact of interventions implemented by the NSW Ambulance Service on adherence to protocol 4.

Internet based randomized trials

Barratt A, Mathieu E, McGeechan K, Trevena L, Tattersall M, Herbert R

Very little is known about the quality of data and results, generated by web-based (or on-line) trials. This is important as investigators look to the web to implement trials. Our study will address whether data quality and results are affected by on-line participation in trials. To do this we will run a web-based trial and assess its data quality and any biases.

NHMRC Grant, 2008-2010

Review and update of the Commonwealth guidelines for treatment of alcohol problems and supplementary booklets

Haber P, Lintzeris N, Proude E, Cooney A.

Funded by the Department of Health & Ageing. The aim of this project is to provide up-to-date evidence-based information to health professionals treating alcohol problems to guide management, treatment, education and professional development. The project will utilise various methodologies to ensure two core aims (1) updating the evidence and guidelines to reflect current evidence and the new NHMRC guidelines; and (2) ensuring that the dissemination materials are well-suited to the target audiences identified.

Pharmacokinetic and pharmacodynamic properties of intranasal, sublingual and intravenous buprenorphine in buprenorphine maintained patients.

Lintzeris N, Haber P, Murnion B, Savage S.

Funded by Reckitt Benckiser. The aim of the study is to investigate the feasibility of using a buprenorphine intranasal spray in buprenorphine maintained individuals for the management of opioid dependence. The study will compare the pharmacokinetic and pharmacodynamic profile of equivalent doses of intravenous and intranasal and sublingual buprenorphine products in buprenorphine patients. The primary research objective of the study is to characterise the pharmacodynamic (subjective, physiological and cognitive−performance) profile of the different routes of administration. Secondary objectives of the project are 1. To compare the pharmacokinetic profile (AUC, Cmax, Tmax) and the degree of individual variability for the intranasal route compared to sublingual and intravenous routes over a 24 hour dosing period. 2. To compare the patient acceptability and adverse events of each route of administration as a potential treatment modality in this group.

The effects of methadone, alone and in combination with alcohol and alprazolam, on simulated driving performance

Leung S, Lintzeris N, Haber P.

Funded by a competitive peer reviewed grant from the Mental Health and Drug and Alcohol Office, NSW Department of Health. The aim of this project is to gain direct experimental evidence of the effect of methadone and other commonly taken substances on driving performance using a state-of-the-art STISIM driving simulator. Using an open label within- and between-subjects crossover design, an Experimental group comprising of 12 stable methadone-maintained clients and a Control group comprising of 12 healthy non-methadone using volunteers matched by age, gender and education level will be recruited. Each subject will undergo a total of 4 x 5 hour test sessions. At each test session, participants will be administered (under double-blind conditions) their routine methadone dose (Experimental group only) and the study medication (placebo, 2mg alprazolam or 0.7g/kg alcohol), and will be asked to complete a simulated driving test.

Pharmacological investigation of alprazolam administration in buprenorphine and methadone maintained individuals

Lintzeris N, Nielsen S, McDonough M, Haber P, Leung S, Savage S.

Funded by Turning Point, VIC. Buprenophine (BPN) and methadone are used for treating heroin dependence. There are concerns regarding their safety when used with benodiazepines - present in >50% of all methadone/buprenorphine-related deaths. Whilst BPN is safe when taken sublingually, most BPN-related deaths occur in individuals injecting BPN and co-using benzodiazepines. This project examines the pharmacological effects of alprazolam (a benzodiazepine) administered to methadone and buprenorphine patients under laboratory conditions. Buprenorphine will be administered sublingually (therapeutic) and intravenously (abuse conditions), providing a better understanding of the risks associated with BPN abuse, and methadone/buprenorphine-benzodiazepine interactions; and enhancing safer prescribing in this high-risk group.

Genetic determinants of the response to pharmacotherapy for alcohol dependence

Morley K, Haber P, Seth D.

Funded by NSW Health. The aim of the proposed project is to build on pharmacotherapy research by adopting a novel approach to improving treatment success for alcohol dependence. Certain genetic mutations selectively alter brain function and may compromise the effectiveness of medications, in this case, acamprosate, naltrexone and baclofen. Genotyping for such mutations of biologically relevant genes may be an efficient way to identify patients who may not respond to medication. The proposed project will be the first to investigate genetic predictors of treatment response to all three pharmacotherapies from clinical trials run at Royal Prince Alfred Hospital and our overseas collaborators. The findings will allow targeting of treatment to those more likely to benefit and avoid exposure of others to unnecessary cost and risks of ineffective medication.

Novel treatments for young people with harmful alcohol use

Haber P, Teeson M, Baillie A, Leung S, Sannibale C, Schneiring C, Rapee C.

A trial of structured stepped-care intervention for psychiatric comorbidity. Funded by the Mental Health and Drug and Alcohol NSW Department of Health. The purpose of this study is to investigate the effectiveness of a novel, integrated, stepped-care treatment for harmful alcohol use and comorbid anxiety or depression in youths. Despite the high prevalence of these co-existing conditions, there are surprisingly few services available to young sufferers seeking help. The proposed \"stepped care\" model entails assessing the outcome of primary treatment and systematically offering a secondary treatment where indicated. This approach is consistent with good clinical care. It has the potential to provide a clearly structured, logical and economical treatment. Furthermore, through the implementation of a youth-focused therapy treatment it is hoped that adolescent/young adult sufferers will respond encouragingly and consequently maintain a positive treatment outcome.

Novel treatments for alcohol dependence

Haber P, Teesson M, Baillie A, Sannibale C, Morley K, Leung S, (project coordinator) Weltman M, Phung N, Thiagarajan S, (NDARC).

Funded by the Alcohol Rehabilitation and Education Foundation (AERF). A randomised trial of structured stepped-care intervention for psychiatric co-morbidity (3 yr study): Co-morbid depression and anxiety are a critical issue in the management of alcohol dependence due to the high prevalence, debilitating effects and challenges in treatment. This study seeks to generate and evaluate a novel, integrated treatment for comorbid anxiety or depressive disorder.

Prevalence of methamphetamine use amongst patients accessing Sydney South West Area Drug Health Services and Emergency Departments

Haber P, Becker K, Proude E, Lintzeris N.

The use of methamphetamine (ice) is reportedly growing in the Sydney area. Harms related to this substance can be psychological as well as physical in nature. The primary aim of the study is to investigate the current use of ice amongst patients attending the services described below, if they have any physical or psychological problems relating to its use, and whether they have sought any treatment for this drug. Patients aged 17 and over will be administered a short questionnaire by a health worker or researcher over a one-week period.

Adolescent experiences and perspectives following transplantation

Tong A, Howard K, Morton RL, Craig JC.
Organ transplantation has improved survival for adolescents with kidney disease, but little is known about its impact on quality of life from their perspective. The uncertainty of graft survival, lifestyle and family readjustment, and treatment side effects significantly impact on the physical and psychosocial outcomes in transplant recipients. This project aims to examine adolescents' experiences and perceptions of their quality of life, to elicit strategies from them on ways to improve their quality of life, and to evaluate the health status and health-related quality of life in adolescents who have received a kidney transplant. In-depth, face-to-face interviews will be conducted with approximately 25-30 adolescent kidney transplant recipients (aged 12 - 18 years). The participants will be asked about their experiences and perspectives of transplantation and how it has impacted their quality of life. They will also be asked to suggest ways to improve care and support delivered to adolescent transplant recipients. The interviews will general qualitative data that will be thematically analysed to identify and understand recurring (and uncommon) adolescent experiences, needs and perspectives. The adolescents' health related quality of life will be evaluated using standard questionnaires that measure factors including physical functioning, mental health, self-esteem, general health perceptions and role functioning. Utility based quality of life will be assessed using the HUI2 multi-attribute utility instrument and the time trade off (TTO) method.

Evaluation of Addiction Medicine OP Clinic linked to CL

Ramasamy P, Lintzeris N, Sutton Y, Haber P.

Evaluation of Outpatient Clinic in Addiction Medicine established in Liverpool Hospital to facilitate after-care in Consultation Liaison patients discharged from hospital. Evaluation consists of pre-post service evaluation of DHS referral uptake in CL patients from Liverpool Hospital, patient satisfaction surveys & key-informant interviews.

HBV vaccination rates and seroconverion following rapid immunation schedule in OTP patients at Liverpool Hospital

Ramasamy P, Lintzeris N, Sutton Y, Haber P.

Retrospective study of HBV vaccination rates of completion and seroconverison in a group of 143 methadone patients conducted in 1999. Data analysed and submitted for publication.

The establishment of a cohort of substance using pregnant women and their babies

Haber P, Stephens C, Burns L, (NDARC), Sinclair H, Conroy E.

Although the consequences of illicit drug use in pregnancy can be severe, in Australia there is no comprehensive research available about the socio-demographic characteristics or health needs of these women and children. In particular, no Australian study has yet described in detail the socio-demographic, obstetric, mental and physical health and antenatal care of this group of pregnant women. Neither is there any longer term information available about the health status of these women or of their children as they grow. The specific aims of this study are therefore to (1) conduct a pilot study measuring the maternal and neonatal characteristics of pregnant women seeking substance use treatment and, (2) to establish the most cost-effective methods of recruitment and follow-up of this cohort.

Attitudes and barriers to hepatitis C treatment uptake among methadone maintenance clients

Day C, (project coordinator), Rutter S, Pritchard-Jones J, Haber P.

The aim of this project is to examine attitudes and barriers to hepatitis C treatment among methadone maintenance treatment (MMT) clients. Clients attending three private and one public MMT clinic will be surveyed concerning their knowledge and attitudes to hepatitis C treatment. Referrals to both formal and informal assessment will be provided for those interested in treatment and treatment uptake and outcomes will be assessed.

Integrating treatment for PTSD and alcohol use problems

Sannibale C, Teesson M, Sitharthan T, Creamer M, Mills K, Bryant R, Haber P, Taylor K, (project coordinator).

This study tests the efficacy of treatment for posttraumatic stress disorder (PTSD) when delivered to participants with alcohol use problems. Two-hundred and sixty-four individuals, who meet criteria for current PTSD and are drinking at risky levels, will be screened for risky alcohol consumption and current PTSD, assessed, and randomly allocated to either 16 sessions of simultaneous treatment of alcohol use and PTSD or to 16 sessions of treatment for alcohol use problems alone supplemented by a control condition. Participants will be reassessed three and six months following treatment completion. The primary outcome measures will be alcohol consumption and PTSD symptoms.

A retrospective cohort of hepatitis C treatment outcomes in the opioid pharmacotherapy treatment setting

Day C, (project coordinator), Haber P, Dore G, Batey R.

The prevalence of HCV in the opioid replacement treatment (ORT) settings is around 70%, and currently <5% receive treatment, therefore a large number of people in these settings require HCV treatment assessment. There is currently very little known about the long term impact of HCV treatment for injecting drug users or those receiving ORT. The purpose of the study is to assess a group of ORT clients for HCV treatment and establish a longitudinal cohort of those who successfully commence on treatment. A retrospective/prospective cohort design will be employed using a network of tertiary care clinics and public and private methadone clinics undertaking HCV treatment assessment and monitoring.

Munch and Move: promoting health eating and physical activity in early childhood services

King, L, Hardy, L, Farrell L, Howlett S.

Munch and Move is an intervention research study investigating the effectiveness of an intervention to promote health eating and physical activity within early childhood settings.

Evaluation of the Good for Kids child obesity prevention program in Hunter New England Area Health Service

Hardy L, King L

The Prevention Research Centres are collaborating with NSW Health Department and Hunter New England Area Health Service on the evaluation of this large, multi-strategic community-based intervention, which is currently underway.

Human papillomavirus in oropharyngeal carcingoma: prognostic significance & interaction with radiation therapy.

Hong A, Rose B, Soon Lee C, Tran N, Dobbins T.

Our major objective is to identify one or more molecular markers that accurately predict(s) prognosis and response to definitive radiation therapy in squamous cell carcinoma of the oropharynx. It is funded by Cancer Australia for three years.

Evaluation and enhancement of treatment services to Aboriginal communities in an urban area.

Conigrave K, Becker K, Kelaher B, Simpson L, Long G, Wade V.

Trials of approaches to increase implementation of screening and early intervention for alcohol problems.Studies of approaches to increase access to the full range of treatments for alcohol problems for Aboriginal communities in urban and rural settings. Five-year NHMRC funded project to reduce smoking in remote Aboriginal communities

A randomised controlled trial of a decision aid for bowel cancer screening for adults with low education and literacy

McCaffrey K, Barrett A, Simpson J, Nutbeam D.

This project is an investigation of whether a patient decision aid tailored to the needs of low literacy users can inform and support health decision making among adults with low education and literacy. The study will: (i) Determine optimal strategies for communicating quantitative risk information to the target group. (ii) Test the effectiveness of a patient decision aid tailored to the needs of adults with low education and literacy to (a) increase knowledge of a screening procedure (faecal occult blood testing (FOBT)), (b) enhance participation in decision making and (c) examine the impact on screening intentions and behaviour.

NHMRC Project Grant ($230,000; 2006-8)

Paediatric Trauma Case Management Study: A randomised controlled trial

Lawrence Lam, Frank Ross, Fiona Fahy, SVS Soundappan, Daniel Cass

This study aims to evaluate the effectiveness of a case management approach using senior trauma nurses in providing trauma care services to children who have been moderately or severely injured and hospitalised. This is a randomised control trial with outcomes of improving clinical information gathering, service quality, and clinician-patient-parent communication and thus patients' satisfaction.

Funding body: Motor Accident Authority

Commenced in 2007, expected to finish in 2009.

Childhood mental health longitudinal study in China

Lawrence Lam, ZiWen Peng

This project aims to investigate the current mental health status of children residing in GuangZhou city in determining the extend of childhood mental well-being or mental problems within the population. A cohort of primary school children will be recruited and followed for 3 years longitudinally. The mental health of these children will be assessed clinically aiming to identify at risk individuals for early intervention.

Mental health of elite young athletes in China

Lawrence Lam, ZiWen Peng

This project aims to investigate the current mental health status of a special group of adolescent elite athletes in GuangZhou city in determining the extend of mental well-being or mental problems within the population.

Commenced and finished in 2008.

The use of evidence by policy makers in cancer screening programs.

Salkeld G, Flitcroft K.

This qualitative PhD project involves interviews with key informants about how policies concerning colorectal cancer screening have come to be made. More specifically, it considers the importance of research evidence in decision-making about colorectal cancer screening in Austraila, New Zealand and the UK. A systematic review of the use of evidence about the benefits, harms and net benefits in screening criteria has been conducted as part of this project.

Voluntary clinical teachers at the University of Sydney: barriers and motivating factors

Investigators Birden, H. Usherwood, T. Reid S.

This is a qualitative study to determine the motivators and barriers faced by clinicians through their efforts to provide voluntary teaching services to the Faculty of Medicine. A qualitative research method is appropriate for achieving an in-depth understanding of the experience of voluntary clinical teachers in the context of an ever changing medico-political, clinical and educational environment. Since the participation of voluntary clinical teachers is an essential component of the University of Sydney medical education program, this study will add knowledge relevant to the recruitment and retention of such clinicians.

Year to commence: 2008 Finish year: 2009

Chlamydia incidence and re-infection (CIRIS) study: a longitudinal study of young Australian Women

Investigators: Hudson Birden, Jane Hocking, Jane Walker, Christopher Fairley, Frank Bowden, Basil Donovan, John Kaldor, Jane Gunn, Marie Pirotta, Harindra Veerakathy, Lyle Gurrin, Suzanne Garland, Kathleen McNamee

Cohort study to determine: Prevalence of Chlamydia and Mycoplasma genitalium in young a Australian women. And how many young women with Chlamydia become re-infected (infected again) over a year.

Year to commence 2008 Finish year 2009

Using health economics to strengthen ties between evidence, policy and practice in chronic disease

Jan S, Clarke P, Howard K, Salkeld G, Chalmers JP, Leeder SR

There is a major shortage of researchers with health economics expertise in Australia. This grant will provide training and development for a team of health economists to research chronic diseases covering issues such as: What is the value for money from investment in different treatments? How do such diseases affect the economic circumstances of families? How do we ensure that strategies to address illness work in practice and can be sustained? How do these issues get put on the policy agenda?

NHMRC Capacity Building Grant. 2009 - 2013

Proposal to study the district health system in a sample of districts in Java

Heywood P

The project seeks to analyze the nature and current functioning of the health system at the district level in Java and to make recommendations on how the performance of the system may be improved. This is being done through analysis and synthesis of a combination of existing and new data on three aspects of the health system at the district level, concentrated on a sample of 15 districts in East, Central and West Java.

Funded by a Ford Foundation Grant. 2007-2009

Menzies Centre for Health Policy

Wells R, Leeder SR

The Menzies Centre for Health Policy was established in 2006 through a competitive grant from the Sir Robert Menzies Memorial Foundation. Since its inception the Menzies Foundation has committed more than $20 million to a number of program initiatives. The Menzies Centre for Health Policy is the most recent of these.

The Menzies Centre for Health Policy is a joint venture between The Australian National University and the University of Sydney. It aims to provide the Australian people with a better understanding of their health system and what it provides for them. The Centre encourages informed debate about how Australians can influence health policy to ensure that it is consistent with their values and priorities and is able to deliver safe, high quality health care that is sustainable in the long term.

Menzies Foundation grant. 2006-2010

Approved Sound Practice: Supporting sustainable careers in orchestral musicians through Occupational Health and Safety initiatives.

Dr. BJ Ackermann, Prof DT Kenny, A/Prof. TR Driscoll

The performing arts enrich Australia's life and build its image as an innovative and sophisticated nation. This impacts on the global perception of nations as much as do economic and other indicators. Classical orchestral and ensemble music are an important part of the performing arts and an essential component of Australian cultural life. It also makes a major contribution to the Australian economy. Australia has 8 major professional orchestras including 6 symphony state orchestras and 2 opera and ballet orchestras. The Orchestras of Australia association website1 lists 165 orchestras as members within Australia. There are 335,000 people involved in the music industry of whom 118,800 received an income from this work2; 88% of the adult population attend a cultural event or venue within a twelve month period (ABS 2005/6)3.

Specifically, the AIMS of this project are to:
• 1. Establish an effective and reliable prospective injury surveillance system for orchestras
• 2. Establish a systematic assessment protocol to identify risk factors for pain/injury in musicians.
• 3. Conduct a risk factor analysis that can identify potential targeted interventions for musician sub-groups.
• 4. Assess and prioritise impact of risk factors in terms of injuries, days lost from work and insurance premiums (cost).

The data obtained form the injury surveillance project will enable inferences to be made on injury causality of identified risk factors. Data will be analysed to prioritise risk factors, and this will lead to further planning of intervention trials that aim to address these identified risk factors. By establishing baseline information we can clearly identify risks particular to instrumental groups and particular orchestras as well as professional orchestral musicians as an occupational group. In addition, the physical and psychological screening measurements will enable identification of characteristics that may make an individual more vulnerable to injury, allowing targeted prevention approaches.

An ARC Linkage Grant $734,042

2009-2013

Popping the Bubblewrap, Unleashing the Power of Play.

A Bundy; GA Naughton; PJ Tranter; SR Wyver; Prof LA Baur; WE Schiller; Prof. A Bauman.

ARC Discovery Grant $398,923

2009-2011

Food and drink company sponsorship of children's sport: publicity or philanthropy?

Prof LA Baur; Prof. A Bauman; B Smith; K Chapman.

ARC Linkage $290,000

2009-2011

The use of Web 2.0 internet sites to undermine tobacco advertising bans and to mobilise tobacco control advocates

Chapman S, R Freeman R, Assunta Kolandai M.

NHMRC project grant #570869. $351,000

2009-2011

What is influential public health research?

Chapman SF, Hall WD, Redman S, Leeder SR, Gillespie JJ.

NHMRC project grant #570870. $433,500

2009-2010

Sex-related changes in asthmas during the transition through puberty in the CAPS birth cohort.

Marks GB, Toelle BG, Leeder SR, Cowell CT, Tovey ER, Almqvist CES.

Early adolescence is a critical period in the life of people with asthma. Some children "grow out" of their asthma and others acquire the disease for the first time. There are important sex differences in the pattern of change. We believe these changes are related to the passage through puberty. This study will examine changes in the features of asthma and allergy during this period and their relation to early life and current environmental exposures.

We will follow-up a high risk cohort for asthma that was recruited antenatally between 1997 and 2000. During their first five years of life, the children were participants in a randomised controlled trial of two interventions, house dust mite avoidance and modification of dietary fatty acids, to prevent the onset of asthma. The members of cohort were last assessed at age eight years. In the study proposed here, we will obtain data on growth in height at three monthly intervals and self-reported stages of puberty, including age at menarche (in girls) and the development of secondary sexual characteristics, at yearly intervals from age 11 years. At ages 11 ½ and 14 years, we will undertake detailed assessments of environmental exposures, pubertal stage (including sex-hormone levels) and respiratory and allergic outcomes. This cohort analysis will allow us to examine the relation among early and current environmental exposures, stages of puberty and sex-specific changes in the course of asthma during early-to-mid adolescence.

NHMRC project grant #570919. $783,875

2009-2013

Improving quality of life at the end of life. RCT of a doctor/nurse/patient intervention

Butow PN, Tattersall MHN, Clayton JM, Young JM, Davidson PM, Epstein RM.

NHMRC project grant #571346 $660,800

2009-2011

Nutrition and genome damage in children

Milne E, Fenech MF, Armstrong BK, de Klerk NH, Miller M.

NHMRC grant project #572623. $686,600

2009-2011

Infection, lifestyle and skin cancer.

NSW Cancer Council Sitas F, Armstrong BK, Banks E, Kricker A, Weber M, Pawlita M.

NHMRC project grant with the NSW Cancer Council $953,200

2009-2011

CHALLENGE: Colon Health And Life Long Exercise ChaNGE

Vardy J, Dhillon HM, van der Ploeg HP, Zalcberg JR, Courneya KS, Meyer RM. AI's Simes J, Bauman A, Karapetis C, Walpole E, Clarke S, Goldstein D.

NHMRC project grant #570907. $2,418,375

2009-2013

Australian Placental Transfusion Study (APTS)

Prof WO Tarnow-Mordi, A/Prof DA Osborn, Prof D Isaacs, Prof JP Newnham, A/Prof N Evans A/Prof K Simmer

*through the NHMRC Clinical Trials Centre*

NHMRC project grant #571309 $2,696,700

Aspirin to prevent recurrent deep vein thrombosis or pulmonary embolism

Brighton T, Simes J, Eikelboom J, Gallus A, Agnelli G, Kakkar A.

*through the NHMRC Clinical Trials Centre*

NHMRC project grant #570967. $1,916,600

Does palliative chemotherapy palliate?

Prof M Friedlander, A/Prof M King, Dr M Gainford, Prof At OzA (ANZGOG Study)

*through the NHMRC Clinical Trials Centre*

NHMRC project grant #570893. $502,250

PORTEC-3

Prof M Quinn, Dr L Mileshkin, Dr P Khaw, Dr C Creutzberg, Prof M Friedlander, Dr M Gainford, (ANZGOG study)

*through the NHMRC Clinical Trials Centre*

NHMRC Project Grant #570894. $443,125

Guidelines for designing and appraising studies investigating the impactof a diagnostic test on patient management.

Lord SJ. Chen RYM,

*through the NHMRC Clinical Trials Centre*

NHMRC Project Grant #571044. $128,638

ACTIVE Dialysis: A Clinical Trial of InvesiVE Dialysis

Cass A, Perkovic V, Howard K, McDagar JW, Hawley C, Kerr PG.

*through the George Institute*

NHMRC Project Grant #571045. $1,248,175

People with kidney disease requiring dialysis have substantially reduced life expectancy and quality of life. Better treatments are therefore urgently required. ACTIVE Dialysis is a clinical trial that aims to assess whether increased duration of dialysis improves these critical outcomes for affected patients. A formal cost-effectiveness analysis will also be performed. The results of this study have the potential to improve the health and longevity of many thousands of Australians.

2009-2012

Erythropoiesis Stimulating Agents Trialists\' Collaboration

Cass A, Perkovic V, Huxley R, Baigent D, Levin A.

*through the George Institute*

NHMRC Project Grant # 571047. $104,750

Erythropoiesis Stimulating Agents are used to correct the anaemia associated with kidney disease, and cost Australia around $100m in 2004. The optimal target haemoglobin remains the subject of intense debate despite several large trials in the area. This project will use pooled data from these trials to provide a definitive analysis of the overall harms and benefits associated with different targets for the first time and will guide the use of these expensive drugs to maximise patient benefit.

2009-2011

Passive mechanical properties of muscle fascicles and tendons of people

A/Professor R Herbert

*through the George Institute*

NHMRC Project Grant # $179,398

Muscle contracture - abnormal stiffening of muscles - is common in many conditions, including stroke, spinal cord injury and multiple sclerosis. Contractures can be very disabling.The mechanisms of muscle contracture are poorly understood. This study will determine whether contractures of calf muscles in people with stroke, spinal cord injury and multiple sclerosis are due to changes in the mechanical properties of muscle fascicles or tendons.

2009-2010

Exercise self-management to improve long-term functioning & prevent falls after hip fracture

Sherrington C, Clemson L, Lord SR, Howard K, Moseley AM, Vogler CM

*through the George Institute*

NHMRC Project Grant #570886. $809,875

Up to 20,000 older Australians suffer hip fractures each year. Many people don't fully recover. We have designed a self-management training program which incorporates individualised exercise prescription. This novel program is designed for people who have completed usual treatment and rehabilitation for hip fracture. We will conduct a well-designed randomised controlled trial to test the effects of this program on disability, falls and hospital readmissions and to assess its cost-effectiveness.

2009-2012

A randomised controlled trial of a promising new treatment for chronic whiplash

Maher C, Latimer J. Sterling M, Jull MA, Connelly LB.

*through the George Institute*

NHMRC Project Grant #570884. $598,025

Following a whiplash injury about one third of people develop persisting pain and disability i.e. chronic whiplash. In a series of pilot trials we have developed a new physiotherapy treatment for chronic whiplash. Initial results are very promising. We now propose to definitively establish the effectiveness of this new treatment in a large clinical trial. At the same time we will evaluate the cost-effectiveness of the treatment.

2009-2011

The first placebo-controlled trial of paracetamol for back pain.

Latimer J, Maher C McLachlan AJ, Cooper CW, Hancock MJ.

*through the George Institute*

NHMRC Project Grant #570883. $602,625

Each year in Australia over $1Billion is spent on treatments for low back pain yet despite this expenditure symptoms persist in about 10% of patients. An important approach to solving this problem is to evaluate back pain treatments that are readily available, safe, cheap and effective. Our previous work suggests that regular paracetamol may be such a treatment. We propose to conduct the first ever placebo controlled trial of paracetamol for acute low back pain in a large clinical trial.

2009-2011

Buckle up safely

Ivers R, Bilston L, Stevenson M, Brown J, Simpson JM.

*through the George Institute*

NHMRC project Grant #570853. $703,200

Despite overwhelming evidence that child restraints dramatically reduce the risk of death and injury there are currently a large number of children globally who either do not use appropriate child restraints, or misuse them, contributing to the overwhelming burden of road traffic injury in children. This project, using rigorous methodology, will assess the efficacy of feasible, evidence based interventions aimed at increased use of appropriate restraints, and decreasing misuse.

2009-2011

Triggers for preeclampsia.

Ford JB, Roberts CL, A/Prof RD Herbert Prof JM Morris, Dr CH Raynes-Greenow, Mr CS Algert

*through the Kolling Institute*

NHMRC Project Grant #570903. $199,500

2009-2011

Pertussis vaccine for newborns

Prof P McIntyre, Prof T Nolan, Dr. N Wood, Dr. H Marshall, Dr. J Rowe *throught the National Centre for Immunisation Research and Surveillance*

NHMRC Project Grant #570756. $1,450,206

Over 80% of hospitalistions and all deaths from pertussis in children currently occur under the age of 4 months but the first vaccine dose is not given until 2 months and at least 2 doses are required for protection, with second dose at 4 months. This randomised controlled trial will test whether the addition of a monovalent acellular pertussis vaccine at birth to an accelerated schedule of diphtheria, tetanus and pertussis vaccination commencing at 6 instead of 8 weeks provides the antibodies required for protection against pertussis by 2 months of age. Amount Awarded: $1,450,206 + in kind contribution of monovalent vaccine and laboratory testing from Glaxo Smith Kline of > $750,000.

Supporting Mums to Quit: smoking intervention research for pregnant rural Aboriginal women

M Passey, R Sanson-Fischer, J Gale, B Holt, R Martin, C Leatherday

* through UDRH Northern Rivers*

Indigenous Tobacco Control Initiative, Australian Government Department of Health & Ageing

$620,000

Systematic Review - Effectiveness of strategies to improve linkage in primary mental health care

Fuller J, Perkins D, Kelly B, Fragar L.

Australian Primary Health Care Research Insitute

National policies advocate linkages (partnership) between specialist mental health, generalist primary health and other human services, however partnership as a form of service organisation can be problematic. Hence health service decision-makers need evidence based support in order to overcome the barriers to successful linkages in primary mental health care in Australia.

This systematic review and stakeholder consultation will synthesise the evidence into a decision making support framework around the following questions.

1. What are the drivers of and barriers to successful linkage between primary mental health care sub-sectors (including specialist mental health services, general practice, community health services and other government and non-government services involved in mental health care)?

2. What are the drivers of and barriers to appropriate integrated referral arrangements in primary mental health care in Australia?

3. Are the drivers of and barriers to successful linkage in primary mental health care services different for patients in different priority groups, such as low socio-economic status groups, Indigenous Australians, elderly people, people with cultural or linguistic disadvantages or people with high prevalence compared to low prevalence mental disorders?

4. Which of these drivers are the most cost effective? What strategies could be implemented to strengthen the most effective and cost effective drivers to enhance linkage and collaboration? What would be the benefits in terms of collaboration and what would be the costs of implementing such strategies?

Start date 1 Jan 2009, End date 30 Dec 2009

$275,000

Baseline study of knowledge and awareness of anti-doping in the sporting community

Orr R, Bauman A, Macniven R Despite the implementation of a standard Anti-doping Code by the World Anti-Doping Agency (WADA), doping in sport by the taking of banned performance enhancing drugs continues. Despite the willingness of some athletes to engage in doping behaviour, their knowledge and understanding of these substances is commonly lacking. The study will examine awareness and knowledge of anti-doping policy and testing procedures, investigate level of knowledge about prohibited substances, look at attitudes towards doping in sport, and investigate any links between knowledge and attitudes to doping in sport in high performance athletes and coaches. Australian Government of Health and Ageing through the Anti-Doping Research Program $167,200

BEACH (Bettering the Evaluation and Care of Health)

Britt H, Miller G.

The BEACH program is a continuous, national, cross-sectional study of general practice activity in Australia. Each year, approximately 1,000 randomly sampled recognised, practising GPs from across the country provide details about 100,000 clinical encounters with (unidentified) patients. BEACH is unique, being the only continuous randomised study of general practice activity in the world, and the only national program that provides direct linkage of management actions (e.g. prescriptions, referrals, investigations) to the problem under management.

BEACH is conducted by the Australian General Practice Statistics and Classification Centre (AGPSCC), a collaborating centre of the Family Medicine Research Centre (FMRC) at the University of Sydney and the Australian Institute of Health and Welfare (AIHW). The program's aims are to provide a reliable and valid data collection process for general practice that is responsive to the ever-changing needs of information users; to establish an ongoing database of GP-patient encounter information; and to assess patient risk factors and health states, and the relationship these factors have with health service delivery. The program commenced in 1998 and has attracted funding of more than $12 million to date from government instrumentalities and private industry.

Design and preparation of a pilot project to reduce maternal and neonatal mortality through demand side interventions in West Java Province, Indonesia

Heywood P.

There is an identified need in Indonesia to introduce demand side instruments that protect families against maternal and neonatal mortality resulting from a high proportion of in-home births. This project seeks to design a demand-side voucher system to encourage expectant mothers to deliver in health facilities. The project seeks to identify access barriers and develop social marketing tools which can be implemented in a later pilot project.

Funded by a Ford Foundation Grant. 2009 -2011

“Pacific Focus”: Understanding Health Policy Development and Capacity in the Pacific

Negin J.

Consultancy project conducted for the Australian International Health Institute, University of Melbourne.

In the arena of Global Health, health policy is one of the key areas in which many of the actors such as international agencies, donors, researchers, NGO's, national governments are involved. Much of the health policy emphasis globally has been on what health policy reforms countries should introduce. (Walt and Gilson 1994) The Pacific is no exception: debates have persisted regarding health sector reforms, financing options, and disease control priorities. What has received little analysis is how countries carry out reforms, how policy is developed and implemented, and who is involved in these processes. (ibid.) This project looks at the "how" of policy development by applying the lens of health policy analysis.

2009

Survey on Attitudes towards the Australian health system

Gillespie J.

The Menzies Centre for Health Policy and The Nous Group recently surveyed 1200 Australians to understand their attitudes towards the health system. The survey covered the following topics:

* Expectations, confidence and satisfaction with the system

* Health literacy and the ability to access care

* Cost-related access and private health insurance

* Privacy

* Commonwealth-State relations

The results of the survey will be progressively released from October 2008 through early 2009. Further information, latest results, along with media releases and articles can be found at the Menzies website

2008 - ongoing