PSA Testing: A Population-based Longitudinal Study Of Decision Making, Psychological Effects And Patterns Of Care
Funder
National Health and Medical Research Council
Funding Amount
$576,977.00
Summary
Prostate cancer is the most commonly diagnosed cancer in Australian men and the second most common cancer- related cause of death. Since being introduced into Australia in 1988 the Prostate Specific Antigen (PSA) blood test has been widely adopted as a method for detecting early-stage asymptomatic prostate cancer. However there is controversy about the potential benefits and harms of testing for prostate cancer. Little has been documented in Australia about the information men receive when consi ....Prostate cancer is the most commonly diagnosed cancer in Australian men and the second most common cancer- related cause of death. Since being introduced into Australia in 1988 the Prostate Specific Antigen (PSA) blood test has been widely adopted as a method for detecting early-stage asymptomatic prostate cancer. However there is controversy about the potential benefits and harms of testing for prostate cancer. Little has been documented in Australia about the information men receive when considering a PSA test, what happens to men after having an abnormal PSA test and the consequences of PSA testing (including physical and psychological effects). The aim of this study is to interview a representative community sample of men aged 50 to 84 years and resident in NSW to describe: (1) the decision-making process regarding PSA testing; (2) the psychological consequences of men's PSA testing experiences; and (3) patterns of care for men who have had an abnormal PSA test. The main outcomes from this study will include substantial information on the experiences of men regarding patterns of PSA participation (frequency of, and reasons for, testing), the clinical management of men who have had an abnormal PSA test, the psychological effects of PSA testing (both positive and negative) and how decisions about testing are being made. This will provide important information to assist GPs, urologists and Australian men make decisions about PSA testing. It will highlight areas of need regarding the information required by men for informed decision-making and the support they require when undergoing PSA testing to ensure positive psychological outcomes.Read moreRead less
Improving Understanding Of Psychostimulant-related Harms In Australia: An Integrated Ethno-epidemiological Approach
Funder
National Health and Medical Research Council
Funding Amount
$612,430.00
Summary
National drug surveys and surveillance systems have detected sharp increases in the use of 'psychostimulant' drugs such as the amphetamines, ecstasy and cocaine. The level of harms associated with excessive use of these drugs, such as mental health problems and drug dependence, has also increased, as has the use of these drugs via injection. These increases in the prevalence of use and related harms have also been detected internationally. Previous research on psychostimulant drugs, in Australia ....National drug surveys and surveillance systems have detected sharp increases in the use of 'psychostimulant' drugs such as the amphetamines, ecstasy and cocaine. The level of harms associated with excessive use of these drugs, such as mental health problems and drug dependence, has also increased, as has the use of these drugs via injection. These increases in the prevalence of use and related harms have also been detected internationally. Previous research on psychostimulant drugs, in Australia and overseas, has suggested that using these drugs in particular ways might be associated with a greater chance of contracting HIV and other blood-borne viruses such as hepatitis C (eg through sharing needles and syringes or other equipment associated with injecting drugs); sexually transmitted infections and other sexual health problems (eg through engaging in unsafe sex); and of being involved in violent incidents. Despite this previous research, however, little is known about the specific social and cultural contexts associated with psychostimulant-related harms, and this has stymied the development of appropriate responses to prevent such harms occurring. This research project will provide a greater understanding of the individual, social and cultural factors associated with pychostimulant-related harm through an innovative combination and integration of anthropological and epidemiological research methods known as 'ethno-epidemiology'. In order to access a range of psychostimulant-using contexts, research will focus on three sites: street-based drug users in Sydney, club drug users in Melbourne, and home-based recreational drug users in Perth. These groups have been chosen because they have high prevalences of psychostimulant use. The research project will provide important data that will inform future interventions, improve multidisciplinary models for drug research, and build Australia's capacity to conduct cutting-edge public health research.Read moreRead less
Chronic Disease Outcomes And Enhanced Primary Care In Seniors: A Cross-Jurisdictional Linkage Project
Funder
National Health and Medical Research Council
Funding Amount
$1,077,766.00
Summary
This project will provide evidence on how best to use the efforts of Australian GPs to obtain better outcomes in patients aged 65+ years who suffer from chronic diseases such as diabetes, heart disease and high blood pressure, asthma and emphysema, seizures and stomach disorders. It will also examine the best way that GP visits can promote healthier ageing in all older seniors, aged 75+ years. For each disease and in older seniors, the study will be able to detect which of the following factors ....This project will provide evidence on how best to use the efforts of Australian GPs to obtain better outcomes in patients aged 65+ years who suffer from chronic diseases such as diabetes, heart disease and high blood pressure, asthma and emphysema, seizures and stomach disorders. It will also examine the best way that GP visits can promote healthier ageing in all older seniors, aged 75+ years. For each disease and in older seniors, the study will be able to detect which of the following factors are the most important for better patient health: (i) seeing a GP more times, (ii) seeing a GP at more even intervals, (iii) seeing the same GP, or (iv) seeing a GP with a lot of experience in chronic diseases. Separate investigations will be made in older people living in hostels and nursing homes, because their needs may be different. The study will also evaluate the benefits of a major change that occurred to Medicare in 1999, when GPs were paid to perform health assessments and to prepare health plans (with other health workers) for patients with chronic health problems. The results will enable this important initiative to be further improved. The study will use a unique and new Australian research facility, which has brought together health data on the entire population of WA from both the State and Commonwealth levels, including information on Medicare use, pharmaceuticals, hospital stays and deaths. The facility works in such a way as to preserve patient and GP privacy. A strong feature of this research will be the degree of involvement of a representative and voluntary group of older Australian patients who attend GP clinics, and the GPs themselves, in advising the researchers on what's important to consumers and GPs.Read moreRead less
Overall Australia provides an ideal environment for research into the public health effects of prostitution laws. The eight states and territories effectively provide eight 'natural experiments' in legal responses to prostitution - ranging from prohibition through almost complete decriminalisation, with varying degrees of regulation and control in between these extremes. This project will examine how different legal and police responses to prostitution may affect the health of sex workers. These ....Overall Australia provides an ideal environment for research into the public health effects of prostitution laws. The eight states and territories effectively provide eight 'natural experiments' in legal responses to prostitution - ranging from prohibition through almost complete decriminalisation, with varying degrees of regulation and control in between these extremes. This project will examine how different legal and police responses to prostitution may affect the health of sex workers. These variable legal contexts guarantee international interest in this research. in addition this research team has extensive experience - dating back up to 20 years - in successfully researching even the most marginalised elements of the sex industry in Australia. By the conclusion of the project we will have assessed sex worker access to health promotion programs, including health services, in three states. We will be able to provide authorities with insights into the effects of prostitution laws and the enforcement of those laws on the health and welfare of sex workers. This finding will inform future interventions with sex industries in Australia and globally.Read moreRead less
Blue Mountains Cohort Study: Long-term (15-year) Incidence Of Eye Disease, Hearing Loss And Other Public Health Outcomes
Funder
National Health and Medical Research Council
Funding Amount
$837,919.00
Summary
The Blue Mountains Eye Study 15-year study will re-examine survivors of the 3,654 persons who participated in baseline BMES exams, to determine the long-term development and progression of sensory problems, including vision and hearing loss and eye diseases like macular degeneration, glaucoma, cataract or diabetic eye damage. The project will assess whether vascular conditions like high blood pressure, chronic medical conditions, medications, smoking, diet, blood, family and genetic factors pred ....The Blue Mountains Eye Study 15-year study will re-examine survivors of the 3,654 persons who participated in baseline BMES exams, to determine the long-term development and progression of sensory problems, including vision and hearing loss and eye diseases like macular degeneration, glaucoma, cataract or diabetic eye damage. The project will assess whether vascular conditions like high blood pressure, chronic medical conditions, medications, smoking, diet, blood, family and genetic factors predict the risk or age at onset of eye disease or hearing loss. We will assess impacts of vision and hearing loss on independence, falls, quality of life and development of memory loss and depression. This information will help to develop services, and to plan interventions to prevent and treat these conditions. Because of the exponential age-related increase in frequency of these diseases, this long follow-up will provide more disease events, and a longer interval to assess impacts from the exposures we measured when we started the BMES in 2002. It will enable us to estimate the strength of risk factors for eye disease and hearing loss with greater precision, essential to understand their evolution. Surviving participants from the original BMES will be invited to attend follow-up exams at our Katoomba clinic, or to attend mobile- nursing home exams. We will conduct similar exams to those previously to detect new or worsened eye disease or hearing loss. In 2002-4, we saw 82% of the population of 2 Blue Mountains postcodes aged 50 or older. At the 5- and 10-year exams we saw 75% of people still living. We expect the same proportion to participate this time. The BMES is one of Australia's main cohort studies with over 200 publications. It has yielded key findings on the frequency and causes of the major diseases threatening vision and hearing. Longer follow-up will greatly increase our power to detect predictors of these key age-dependent conditions.Read moreRead less
Extending The Australian Arm Of The International Tobacco Control Policy Evaluation Study
Funder
National Health and Medical Research Council
Funding Amount
$881,295.00
Summary
This project is to provide for the Australian arm of a large multi-national study to determine how tobacco control policies work. It is being conducted in the context of the implementation in 2005 of the World Health Organisation's Framework Convention on Tobacco Control, to which Australia is a party. We will provide new knowledge on the impacts of specific policies which are being implemented in Australia, as well as ones that occur in other countries that are part of the larger study. These i ....This project is to provide for the Australian arm of a large multi-national study to determine how tobacco control policies work. It is being conducted in the context of the implementation in 2005 of the World Health Organisation's Framework Convention on Tobacco Control, to which Australia is a party. We will provide new knowledge on the impacts of specific policies which are being implemented in Australia, as well as ones that occur in other countries that are part of the larger study. These include the adoption of graphic health warnings on tobacco packaging, removal of misleading constituents levels information from packs, bans of misleading descriptors such as Light and Mild, and implementation of smoke-free bars. In addition it will advance our understanding of how policy effects persist over time, their equity, and the means by which they contribute to increased cessation and reduced relapse. We do this by following smokers every year in each of the countries and asking them about their thinking and actions with regard to smoking, as well as about their awareness of the policies. By comparing the responses of smokers exposed to policies with those from other countries that are not exposed, we can work out the contribution of the policies to changes in smoking. Understanding policy effects on smokers and smoking cessation will lead to improved policies in Australia and the likelihood of improved dissemination of policies that work here to other countries. Similarly policies found to work in other countries, can be best adapted to Australia if we understand how they work. Taken in total, it should advance our efforts to reduce the burden of smoking-related harm both in Australia and the rest of the world.Read moreRead less
A Multilevel Study Of Socioeconomic Position And Physical Activity: Environmental And Individual-level Determinants
Funder
National Health and Medical Research Council
Funding Amount
$429,000.00
Summary
Regular physical activity offers many health benefits, whereas inadequate activity is a leading cause of premature death and disability and a major contributor to the increasing prevalence of overweight and obesity. Socioeconomically disadvantaged groups are least likely to be physically active, and they experience higher rates of death and morbidity for conditions directly linked to inactivity. Currently, our understanding of why socioeconomic groups differ in their physical activity is limited ....Regular physical activity offers many health benefits, whereas inadequate activity is a leading cause of premature death and disability and a major contributor to the increasing prevalence of overweight and obesity. Socioeconomically disadvantaged groups are least likely to be physically active, and they experience higher rates of death and morbidity for conditions directly linked to inactivity. Currently, our understanding of why socioeconomic groups differ in their physical activity is limited, and very little research has investigated this issue. This study will investigate why socioeconomic groups differ in their physical activity, by examining the influence of neighbourhood and individual-level factors. Neighbourhood factors include people's access to recreational facilities such as swimming pools, tennis courts, golf clubs, gyms, local parks, walking and bicycle paths; prices for entry to recreational facilities and opening hours; physical characteristics of the neighbourhood including public transport, presence of footpaths and street lighting, speed limits on local streets, availability of local services such as shops and schools, and; aesthetic characteristics, such as the presence and size of parks and green spaces, and traffic density. Individual factors include personal enjoyment, knowledge, confidence, type of occupation and hours worked, family responsibilities, age, health status, and whether other family member or friends engage in physical activity. A major aim of the study is to determine whether environmental or individual factors are more important in influencing participation in physical activity. The study will produce new knowledge to inform future public health strategies directed at increasing physical activity among socioeconomically disadvantaged groups, and these will have the potential to reduce socioeconomic health inequalities, as well as contribute to an overall reduction of the disease burden attributable to chronic conditions.Read moreRead less
Tai Chi For Independent Living: RCT Of Efficacy Of Tai Chi In Delaying Disability Among Older People.
Funder
National Health and Medical Research Council
Funding Amount
$1,157,574.00
Summary
This study addresses the issue of disability among our ageing population. Preservation of function among our older citizens, and their capacity to live independently, is of significant social, public health and economic benefit. The aims of this study are to (1) test the efficacy of Tai Chi in delaying disability among older people, prior to its onset, (2) investigate the mechanisms by which Tai Chi intervenes in the disability pathway, (3) determine the cost-benefits of Tai Chi for older people ....This study addresses the issue of disability among our ageing population. Preservation of function among our older citizens, and their capacity to live independently, is of significant social, public health and economic benefit. The aims of this study are to (1) test the efficacy of Tai Chi in delaying disability among older people, prior to its onset, (2) investigate the mechanisms by which Tai Chi intervenes in the disability pathway, (3) determine the cost-benefits of Tai Chi for older people. The study will recruit 670 people over 70 years of age and randomly assign them to receive either Tai Chi, or a stretching and relaxation program, for a period of 48 weeks. The groups will then be compared to determine if there is any difference in the development of disability as well as a range of functional outcomes such as strength, balance, depression, arthritic symptoms, life satisfaction, and falls. This will be the first study world-wide to test the impact of any exercise program on delaying the manifestation of disability among older people. Robust evidence that Tai Chi can in fact delay disability will have immediate and significant implications for the maintenance of independence among older people at a critical time for our ageing population. Translation of these research results to practice will decrease demand for support services for community dwelling older people, and for places in supported accommodation facilities. Older people will have improved quality of life, and government and non-government agencies will experience reduced demand for limited resources. This internationally significant study will also contribute to understanding the mechanisms by which disability develops, and create the valuable opportunity for continuing research on attrition of effect and long term adherence to exercise programs.Read moreRead less
Does Place Of Birth Influence A Healthy Start To Life?
Funder
National Health and Medical Research Council
Funding Amount
$343,050.00
Summary
There are over 255,000 births in Australia each year and a major challenge in terms of planning and provision is to ensure that these babies are born in hospitals with the appropriate facilities to care for them. International studies suggest that transferring the mother before birth results in better infant outcomes than transferring the baby after birth. In Australia births occur in a range of hospitals, from small rural hospitals to tertiary obstetric and neonatal centres. However, few Austra ....There are over 255,000 births in Australia each year and a major challenge in terms of planning and provision is to ensure that these babies are born in hospitals with the appropriate facilities to care for them. International studies suggest that transferring the mother before birth results in better infant outcomes than transferring the baby after birth. In Australia births occur in a range of hospitals, from small rural hospitals to tertiary obstetric and neonatal centres. However, few Australian studies have looked at infant outcomes based on place of birth. This study will use existing population health data sets to evaluate the provision of care prior to and at birth and the impact it has on infant outcomes up to one year of age. It will also describe for the first time the hospital care utilisation associated with birth and infant health. Information will be obtained from routinely-collected birth, death and birth defect registers, and hospital, midwives and perinatal death review data. Variations in health outcomes for babies may be due to factors that occur before or during pregnancy, or may be due to differences in the care provided at birth. We need to take account of maternal factors to comprehensively assess the role of level of care at birth. We will use statistical techniques to 'predict' infant health outcomes and see if differences between places of birth are real or not. If variations are explained by different levels of care then there is enormous potential for improvement in the provision of pregnancy and newborn services. We will also compare the benefits and consequences of maternal versus neonatal transfer, and assess hospital costs. The results of this study could be applied to direct health services policy and organisational changes to improve pregnancy care and optimise infant outcomes for a healthy start to life.Read moreRead less
A Randomised Controlled Trial Of A Bowel Cancer Screening Decision Aid For Adults With Low Education And Literacy
Funder
National Health and Medical Research Council
Funding Amount
$237,277.00
Summary
The Commonwealth has committed funds for a national bowel cancer screening program. This will involve mailing bowel testing kits direct to eligible consumers at their homes. To minimise inequalities in accessing screening and to ensure effectiveness of the program, information and instructions for testing will have to be accessible to participants from low as well as high educational backgrounds. This project will evaluate communication strategies to achieve this. Reliance on written information ....The Commonwealth has committed funds for a national bowel cancer screening program. This will involve mailing bowel testing kits direct to eligible consumers at their homes. To minimise inequalities in accessing screening and to ensure effectiveness of the program, information and instructions for testing will have to be accessible to participants from low as well as high educational backgrounds. This project will evaluate communication strategies to achieve this. Reliance on written information has rapidly increased within healthcare. In particular, the use of patient decision aids to support and inform health decisions is rapidly increasing. The need to improve information in screening programs has been particularly highlighted and decision aids provide an evidence based approach to achieve this. However, whilst there is level 1 evidence that decision aids improve the decision making process for consumers, research has been carried out almost exclusively among educated participants with high literacy. There is concern that the needs of adults with low education and limited literacy have been ignored. The proposed study is 2 phased. Phase I will test optimal quantitative risk communication formats for adults with low education and literacy. Phase 2 will evaluate a tailored low literacy decision aid for FOBT screening. The trial will test whether the decision aid can increase knowledge of screening, increase involvement in decisions and improve the quality of decision making among adults with low education, and will examine its impact on screening intentions and behaviour. This is a highly significant study. Screening providers need better ways to inform consumers of screening programs that are accessible to a diverse audience and equitable across the target population. This study will have direct implications for use in the national bowel cancer screening program.Read moreRead less