Can Skin Infection With Group A Streptococcus Cause Acute Rheumatic Fever?
Funder
National Health and Medical Research Council
Funding Amount
$459,450.00
Summary
It is traditionally taught that the cause of acute rheumatic fever (ARF) is always infection of the throat with the bacterium group A streptococcus (GAS). However, in Aboriginal communities of the Top End of the Northern Territory the incidence of ARF is the highest reported in the world, yet GAS is uncommonly isolated from the throat. There is further information to suggest that GAS skin sores may underlie many cases of ARF. If this were proven, it would completely alter the traditional view of ....It is traditionally taught that the cause of acute rheumatic fever (ARF) is always infection of the throat with the bacterium group A streptococcus (GAS). However, in Aboriginal communities of the Top End of the Northern Territory the incidence of ARF is the highest reported in the world, yet GAS is uncommonly isolated from the throat. There is further information to suggest that GAS skin sores may underlie many cases of ARF. If this were proven, it would completely alter the traditional view of the cause of ARF, and have important implications for prevention of ARF around the world. Presently, these approaches focus on diagnosing and treating sore throat, but no country has proven that such a program can be successful in substantially reducing new cases of ARF. If it was known that skin infection could lead to ARF, then countries (including Australia) could emphasise the importance of skin health programs. A further benefit of this knowledge would be to influence GAS vaccine development, which presently is largely focused on the prevention of sore throat. A different possibility has recently been raised - that the cause of ARF may not always be GAS, but instead that the related bacteria GCS and GGS may have the potential to cause this disease. Proof of this hypothesis would even more dramatically alter our understanding of disease causation, prevention, and vaccine development. We propose to determine the cause of ARF in Aboriginal communities by regularly swabbing families of people with a history of ARF, and using genetic fingerprinting of the bacteria from the skin and throat swabs. When cases of ARF occur, we will be able to determine the site and type of infection that precipitated the attack. We will conduct a related study in more communities, in which we will swab family members of people with ARF and of control families (without ARF) to determine the bacteria most commonly isolated from ARF families.Read moreRead less
Estimating The Burden Of Group A Streptococcal Diseases In Victoria
Funder
National Health and Medical Research Council
Funding Amount
$386,760.00
Summary
Despite the considerable advances in the diagnosis and treatment of group A streptococcal (GAS) diseases made during the last century, the impressive spectrum of infections caused by this organism continues to have a significant impact in developed countries. This spectrum includes diseases that are mild but common (e.g. sore throat, skin sores), rare but very severe (e.g. bloodstream infections, flesh-eating bacteria) and those that are more common in developing countries and the Aboriginal pop ....Despite the considerable advances in the diagnosis and treatment of group A streptococcal (GAS) diseases made during the last century, the impressive spectrum of infections caused by this organism continues to have a significant impact in developed countries. This spectrum includes diseases that are mild but common (e.g. sore throat, skin sores), rare but very severe (e.g. bloodstream infections, flesh-eating bacteria) and those that are more common in developing countries and the Aboriginal population (e.g. rheumatic fever, kidney disease). Streptococcal sore throat remains one of the most common childhood infections, and severe group A streptococcal diseases are thought to be increasing in incidence in Australia. Yet, there are no accurate data on the incidence and costs of these or other GAS diseases in non-Aboriginal Australians, or in most other populations around the world. It is becoming more urgent to collect this data as numerous vaccine candidates are entering human trials, new approaches to the treatment of sore throat are emerging, and new strategies to treat and control the spread of severe disease are being developed. We propose a comprehensive strategy to measure the incidence, prevalence and costs of each group of GAS diseases. We will follow a group of families for 12 months to detect cases of GAS sore throat and skin sores and measure the impact on the family. We will survey children in schools to estimate the prevalence of skin sores. We will check hospital records to calculate the number of cases of rheumatic fever and kidney disease. And we will maintain surveillance for severe diseases by checking hospital and laboratory records. We will also check to see if family members of people with severe disease have the GAS bacterium in their throats. We will then compile these data into a comprehensive estimate of the burden of disease in Victoria, and estimate the cost-effectiveness of different treatment and prevention strategies.Read moreRead less
A study investigating the feasibility of implementing a national approach to child and family health services. Understanding and strengthening the way in which universal health services are provided to pregnant women, children and families has the potential to impact over a million Australian families annually. The findings of this study will have national application as federal, state and territory governments work towards implementing a national approach to child and family health services. Th ....A study investigating the feasibility of implementing a national approach to child and family health services. Understanding and strengthening the way in which universal health services are provided to pregnant women, children and families has the potential to impact over a million Australian families annually. The findings of this study will have national application as federal, state and territory governments work towards implementing a national approach to child and family health services. The findings will inform effective multidisciplinary collaboration and service integration, address service gaps and duplication and lead to increased access to services. This study will generate new knowledge about characteristics of organisations, service delivery and professions that facilitate or hinder innovation.Read moreRead less
The impact and cost of short-term health staffing in remote communities. This project aims to examine the impact of the increasing levels of short-term health staffing in remote communities upon service acceptability to patients, workload and attitudes of long-term resident primary health care staff, and the effectiveness and cost of health services. There is a dearth of information about this 'fly in/fly out' (FIFO) workforce in remote communities, which have the worst health outcomes in the co ....The impact and cost of short-term health staffing in remote communities. This project aims to examine the impact of the increasing levels of short-term health staffing in remote communities upon service acceptability to patients, workload and attitudes of long-term resident primary health care staff, and the effectiveness and cost of health services. There is a dearth of information about this 'fly in/fly out' (FIFO) workforce in remote communities, which have the worst health outcomes in the country. The project aims to inform consumers, health practitioners, health service planners and policy-makers about the impact of FIFO, as well as to contribute to the development of strategies designed to stabilise the remote health workforce.Read moreRead less
Staffing practices in Aboriginal primary health care services. This project aims to generate new knowledge about the impact of short-term staffing in remote Aboriginal Community Controlled Health Services on service acceptability to patients, workload and attitudes of long-term staff and the effectiveness and cost of services. The project intends to compare these results to recent findings about the impact of short-term staffing in government-run clinics, in order to quantify and describe the po ....Staffing practices in Aboriginal primary health care services. This project aims to generate new knowledge about the impact of short-term staffing in remote Aboriginal Community Controlled Health Services on service acceptability to patients, workload and attitudes of long-term staff and the effectiveness and cost of services. The project intends to compare these results to recent findings about the impact of short-term staffing in government-run clinics, in order to quantify and describe the potential positive effect of community control. Expected outcomes include rigorous evidence about the 'fly in/fly out' workforce and the impact of community control which can inform new policy that will stabilise the remote health workforce, save money and contribute to 'closing the gap' in health outcomes.Read moreRead less
Assessing supportive care needs of Indigenous cancer survivors' caregivers. This project aims to gather data about the needs of partners and caregivers of Aboriginal and Torres Strait Islander cancer survivors. The project will undertake a comprehensive exploration of the experiences of caregivers and develop a psychometrically tested tool to assist in identifying unmet needs. The project expects to provide new knowledge about the needs of this population and a validated tool to better assess th ....Assessing supportive care needs of Indigenous cancer survivors' caregivers. This project aims to gather data about the needs of partners and caregivers of Aboriginal and Torres Strait Islander cancer survivors. The project will undertake a comprehensive exploration of the experiences of caregivers and develop a psychometrically tested tool to assist in identifying unmet needs. The project expects to provide new knowledge about the needs of this population and a validated tool to better assess these needs. The project will result in improvements in the assessment of unmet supportive care needs in caregivers of Indigenous cancer survivors, leading to more timely interventions, and a better quality of life for patients and caregivers.Read moreRead less
Culture, context and Risk: socio-cultural influences on the sexual health of Indigenous young people. The health of Indigenous young people is a national priority, and it is clear in the area of sexual health that they suffer disproportionately when compared to the non-Indigenous population. Existing interventions are not acheiving the desired changes in sexual health. This project explores sexuality from the perspective of Indigenous youth in order to develop interventions that are appropriate ....Culture, context and Risk: socio-cultural influences on the sexual health of Indigenous young people. The health of Indigenous young people is a national priority, and it is clear in the area of sexual health that they suffer disproportionately when compared to the non-Indigenous population. Existing interventions are not acheiving the desired changes in sexual health. This project explores sexuality from the perspective of Indigenous youth in order to develop interventions that are appropriate and sustainable. Read moreRead less
Yarning with our mob about human papillomavirus (HPV) vaccination uptake. This project aims to identify a range of modifiable factors that affect the participation of Indigenous adolescents in human papillomavirus (HPV) vaccination school programs. The project expects to generate new knowledge by combining Indigenous methodologies and a socioecological model to explore policy, community, interpersonal and intrapersonal factors impacting HPV vaccination uptake for this population. Expected outcom ....Yarning with our mob about human papillomavirus (HPV) vaccination uptake. This project aims to identify a range of modifiable factors that affect the participation of Indigenous adolescents in human papillomavirus (HPV) vaccination school programs. The project expects to generate new knowledge by combining Indigenous methodologies and a socioecological model to explore policy, community, interpersonal and intrapersonal factors impacting HPV vaccination uptake for this population. Expected outcomes include a more comprehensive understanding of the factors behind the low rates of HPV vaccination among Indigenous adolescents. This information should provide significant benefits including the identification of modifiable factors to increase HPV vaccination rates for Indigenous adolescents.Read moreRead less
1+1- A Healthy Start To Life:Targeting The Year Before And The Year After Birth In Aboriginal Children In Remote Areas
Funder
National Health and Medical Research Council
Funding Amount
$587,272.00
Summary
Indigenous Australians in remote communities are less healthy and more socially disadvantaged than other Australians. This influences the quality of the intrauterine environment. Babies often suffer malnutrition and recurring infections during infancy which are exacerbated by their less than optimal birth status and contribute to chronic conditions (diabetes, cardiovascular disease, renal failure) in adulthood. Existing health services are costly to Government and do not achieve their potential ....Indigenous Australians in remote communities are less healthy and more socially disadvantaged than other Australians. This influences the quality of the intrauterine environment. Babies often suffer malnutrition and recurring infections during infancy which are exacerbated by their less than optimal birth status and contribute to chronic conditions (diabetes, cardiovascular disease, renal failure) in adulthood. Existing health services are costly to Government and do not achieve their potential for promoting health and providing quality care. Evidence suggests redesigned models based on continuity of care, focused, proactive family support and workload reform will improve maternal and infant outcomes. New models need to be developed, costed, implemented and evaluated providing governments with the evidence base to initiate service improvement. Such models will have applicability elsewhere in Australia. Professor Lesley Barclay and her team of researchers from Charles Darwin University will conduct research into developing such a model. The project aims to improve the quality of care for remote dwelling Aboriginal women and infants in the year before, during and the year after birth by providing evidence for, and facilitating changes to, service delivery. This will enhance the potential for the development of resilience and well-being of their children. It will also test if service improvements can improve the health of women and reduce childhood disease and therefore reduce the impact of health conditions occurring in adulthood which have their origins in the early stages of life.Read moreRead less
Improving Birth Outcomes in China: consequences and potentials of policy, state and professional interactions. The aim of the project is to reduce morbidity and mortality associated with birth by informing health systems improvement in China. We will develop an innovative methodology to study consequences of policy, state and professional interactions on birth outcomes. This work is also relevant in other settings. Macro economic reforms in China have produced paradoxical disparities between ri ....Improving Birth Outcomes in China: consequences and potentials of policy, state and professional interactions. The aim of the project is to reduce morbidity and mortality associated with birth by informing health systems improvement in China. We will develop an innovative methodology to study consequences of policy, state and professional interactions on birth outcomes. This work is also relevant in other settings. Macro economic reforms in China have produced paradoxical disparities between rich and poor and urban and rural populations evident in maternal morbidity and mortality. Results will inform facilitative policies and models of service to optimise safety and increase effectiveness in deployment of human and monetary resources.Read moreRead less