Research Projects

The Childhood Asthma Prevention Study

Leeder S, Marks G, Kemp A, Peat J, Mellis C.

The Childhood Asthma Prevention Study (CAPS) is the first and only randomised controlled trial of the effectiveness of both house dust mite avoidance and modification of dietary intake of fatty acids, both implemented from birth, for the prevention of asthma and other allergic disease during childhood. In 2006 the study reported that neither house dust mite avoidance nor omega-3 fatty acid supplementation had a beneficial effect in reducing the risk that children will develop asthma or allergy in the first five years. A fourth clinical assessment of the cohort at age eight years is currently being undertaken because it is possible that the benefits of the measures taken in early life may not become apparent until this time. The eight year assessments are due to be completed in January 2008.

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.

Dietary Assessments in the Childhood Asthma Prevention Study

K Webb, J Peat, G Marks, C Mellis, S Leeder.
The Childhood Asthma Prevention Study is a randomised trial of two interventions: a diet high in omega 3 fatty acids, and house dust mite reduction, introduced at birth, for the primary prevention of asthma. At 18-months of age, all study children (n=600) will have a dietary assessment and blood assays of fatty acids. These will provide measurements of the level of compliance with the fish oil capsules as well as intakes of potential dietary confounders including sodium, fatty acid intake in the "base diet", and antioxidant vitamins. Diets will be assessed using 3-day weighed food records. The information obtained will also provide the first large data base about the range and quantities of foods eaten by 18-month old Australian children, and will be useful in devising a set of short questions that can be used in state health surveys for assessment of diet in young children.

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.

News coverage of overweight and obesity

Bonfiglioli C, King L, Smith B, Chapman S, Holding S.

The media are recognised as one of the key sociocultural and environmental influences on overweight and obesity. The news media are a key source of health information for the millions of people they reach as well as an important influence on policy making and health behaviour. The NSW Centre for Overweight and Obesity's Media Project is conducting Australia's first academic analyses of televison news coverage of overweight and obesity. Our first study examines issues including: what causes of obesity are highlighted in the news, whose voices are heard in the debate, what solutions are presented and who is seen as responsible for solving the problem. Results from this study were presented at The International Congress on Obesity in September 2006 and two papers arising from this research have been accepted for publication.

Collaborative centres: NSW Centre for Overweight and Obesity - The University of Sydney, Department of Health Science - Monash University, School of Public Health - The University of Sydney.

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.

Improving vision to prevent falls

Cumming R, Mitchell P, Ivers R, Clemson L.

Poor vision is a strong risk factor for falls and fractures. However, there have been no randomized trials of vision testing and treatment for falls preventuion. We recruited 616 people into this trial, with 309 being assessed by the study optometrist. The study optometrist arranaged free spectacles for those who needed them and made referrals to ophthalmologists, as necessary. Data analysis is underway.

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.

The Economics of Screening and Diagnostic Test Evaluation A research theme of STEP (NHMRC Program Grant 2002 - 2006)

STEP Chief Investigators: Irwig L, Glasziou P, Craig J, Barratt A, Salkeld G and Macaskill P.

The economics aspects of STEP focus on the following research themes:
• Modelling the costs and (utility-based) outcomes of screening, with application to screening for breast cancer, colorectal cancer and cervical cancer.
• The effect of participation on the cost effectiveness of screening
• The application of discrete choice modeling as a technique to elicit community preferences for screening
• Methodological issues on elicitation of preferences for screening, including the impact of decision heuristics
• The cost effectiveness of screening for protein urea.

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.

Faecal Occult Blood Test (FOBT) screening Decision Aid

Tevena L, Barratt A, Irwig L, Isaacs A.

A series of age, gender and family history-specific decision aids have been developed for people aged 50-74 considering FOBT screening for colorectal cancer. This has been evaluated through a general practice-based randomized controlled trial. We are particularly interested in the effect of this decision aid on peoples knowledge about the risks of colorectal cancer, the harms and benefits of screening, the elicitation of the preferences and the impact on screening decisions and behaviour.

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.

Motorcycle systematic reviews

R Ivers, M Stevenson, R Norton and S Blows.
This series of Cochrane systematic reviews is investigating the effectiveness of interventions to improve safety for motorcycle riders. The study is funded by a University of Sydney Sesqui Research and Development grant.

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.

Food marketing to children

Kelly B, Hattersley L, King L, Bauman A.

Centre for Overweight and Obesity (COO) researchers are involved in conducting studies on food marketing and using the findings as a basis for public health advocacy.

Studies have assessed the extent and nature of children's exposure to food advertising on commercial television, as well as the use of persuasive marketing techniques in food advertising (such as celebrities, cartoons and competitions or give-aways) and nutrition contect claims. One study has assessed teh extent and nature of children's exposure to food marketing on their way to and from school. Further studies on parental attitudes about the marketing of high fat/high sugar foods have also been conducted and published.

B Positive project

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

This project aims to etermine 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.

Blue Mountains Eye Study

P. Mitchell, W. Smith, J. Wang, R. Cumming

The Blue Mountains Eye Study commenced in 1992-94, when 3,654 people aged 49 to 97 years were recruited from an area west of Sydney. The participation rate was a remarkabkle 83%. Subjects had a 3 hour examination that included photographing the lens and retina. Repeat assessments were completed in 1997-99 and 2002-04. More than 100 papers have resulted, and continue to be written, from this study (see publication list).

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

Oxford- Sydney Collaboration on the implementation of bowel cancer screening decision aid within UK and Australian screening programs

Trevena L, Irwig L, Barratt A, Austoker, Patnick

This study assesses the uptake of the FOBT decision aid for colorectal cancer screening within new colorectal cancer screening programs in both countries. It is jointly funded by STEP and by the NSW Cancer Institute in collaboration with Oxford University.

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.

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.

An interactive decision tool for preventive health-check activities in general practice

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

This is a three-year project commencing in 2006 and funded by the NSW Cancer Council to develop a 'meta-decision aid' for prioritising preventive health activities in general practice. It seeks to use the RACGP 'Red Book' guidelines for this purpose and includes a randomised controlled trial and qualitative exploration of consultation processes. This project is also part of the 'Oxford-Sydney Collaboration for evidence-based cancer prevention activities in general practice' with some funding from NSW Cancer Institute.

HPV testing Decision Aid for women with Minor Atypia on Pap smear (The IMAP Study). Assessment of Psychosocial and QOL Outcomes

McCaffery K, Irwig L, Howard K, Davey E, Clarke J, Barratt A, Salkeld A, 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 outcomes over 12 months.

International Patient Decision Aids Standards (IPDAS)

Barratt A.

Alex Barratt is a member of the steering committee for the development of international standards for decision aid development. Other contributors include Kirsten McCaffery, Phyllis Butow and Lyndal Trevena. The project is coordinated by the Ottawa Health Research Group Canada, led by Annette O'Connor. Further information about this project is available online at this site [http://ipdas.ohri.ca/].

Australian Screening Mammography Decision Aid Trial (Mammography Decision Aid for women over 70 years)

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

This decision aid was developed to help women around 70 years of age make an informed choice about whether to continue having a screening mammogram every two years. The data in the decision aid comes from a model of the outcomes of screening mammography for Australian women. The decision aid was evaluated in a randomized controlled trial of 700 NSW women, with the assistance of BreastScreen NSW. The decision aid increased women’s knowledge about the pros and cons of screening, and helped women make an informed choice about whether to continue screening. The results of the trial were published in Archives of Internal Medicine (Mathieu E, Barratt AL, Davey HM, McGeechan K, Howard K, Houssami N. Informed choice in mammography screening: A randomized trial of a decision aid for 70 year old women. Archives of Internal Medicine, 2007; 167(19): 2039-2046.)

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.

Making decisions: Should I use hormone replacement therapy? An evidence-based decision aid

Trevena L, Barratt A, McCaffery K, Armstrong B, O’Connor A.

The Sydney Health Decision Group was contracted by the Australian Government’s National Health & Medical Research Council to develop a decision aid about the benefits and risks of HRT. The issues were also discussed in an ABC Radio Series for the Health Report. A report on focus testing of this tool with women from a range of socioeconomic and ethnic backgrounds can be downloaded.

Communication Aid for genetic counselling consultations for women at high risk of breast cancer

Butow P, Barratt A, Tucker K, Kirk J, Moore A, Butt D, Lobb L

This project has produced a communication aid to facilitate the communication of risk to women from high risk breast cancer families attending a genetic counseling consultation. The aid is in booklet form, includes text and graphics, and is used interactively in the consultation. A pilot study has shown that the aid is regarded as helpful by both women and geneticists/genetic counselors, does not increase anxiety, and may improve recall, risk perception and understanding.

Decision aid for women with a breech presentation at term

Nassar N, Roberts C, Barratt A, Raynes-Greenow C, Peat B, Henderson-Smart D.

A decision aid was developed for pregnant women diagnosed with a breech presentation (when a baby presents with feet or buttocks rather than head-first) in late pregnancy to inform them about safe and effective options for the management of breech presentation. The decision aid comprised a 24-page workbook, a 30 minute audio-CD and worksheet and was designed in a format that could be taken home and reviewed with a partner. The effectiveness of the decision aid compared with usual care was evaluated in a randomised controlled trial in four Australian obstetric hospitals. In the trial, women were randomised to either receive the decision aid in addition to usual care or to receive usual care only - with standard counselling from their usual pregnancy care provider. Approximately 200 women were randomised to the study and we found women reviewing the decision aid experienced significantly lower decisional conflict- uncertainty (mean difference -8.92; 95%CI -13.18, -4.66), increased knowledge (mean difference 8.40; 95%CI 3.10, 13.71), no increase in anxiety and reported greater satisfaction with decision-making and overall experience of pregnancy and childbirth. Overall, we found the decision aid to be an effective and acceptable tool for pregnant women that provides an important adjunct to standard counselling for the management of breech presentation.

Systematic review of the literature on communicating with patients about evidence

Trevena L, Davey H, Barratt A, Butow P, Caldwell P.

This is a summary of the evidence on effective strategies for increasing patient understanding, for communicating probabilistic information and for eliciting patient preferences. It is available online. For more information or reprints contact Lyndal Trevena

Model of outcomes of screening mammography: information to support informed choices.

Barratt A, Howard K, Irwig L, Salkeld G, Houssami N.

OBJECTIVE: To provide easy to use estimates of the benefits and harms of biennial screening mammography for women aged 40, 50, 60, and 70 years.

DESIGN: Markov process model, with data from BreastScreen Australia, the Australian Institute of Health and Welfare, and the Australian Bureau of Statistics.

MAIN OUTCOME MEASURE: Age specific outcomes expressed per 1000 women over 10 years.

RESULTS: For every 1000 women screened over 10 years, 167-251 (depending on age) receive an abnormal result; 56-64 of these women undergo at least one biopsy, 9-26 have an invasive cancer detected by screening, and 3-6 have ductal carcinoma in situ (DCIS) detected by screening. More breast cancers (both invasive and DCIS) are diagnosed among screened than unscreened women. There are about 0.5, 2, 3, and 2 fewer deaths from breast cancer over 10 years per 1000 women aged 40, 50, 60, and 70, respectively, who choose to be screened compared with women who decline screening at times determined by relevant policy.

CONCLUSION: Benefits and harms of screening mammography are relatively finely balanced. Quantitative estimates such as these can be used to support individual informed choices about screening.

These results have been published.

Molecular pathogenesis of alcohol liver disease

Haber P, Seth D.

This study was initially funded by the Australian Brewers Foundation and successfully gained NHMRC/Veterans Affairs funding for a further 3 years (ending Dec 05). This study has identified novel molecules and mechanisms associated with progression of ALD with the aim of developing new approaches to prevention or thera