STudy Of Risk Assessment To Reduce Complications In Patients Following Noncardiac SurgerY (STRATIFY)
Funder
National Health and Medical Research Council
Funding Amount
$436,000.00
Summary
Cardiac problems account for many complications in patients undergoing major non-cardiac surgery, and even apparently minor cardiac damage is a marker of high risk for subsequent adverse events. Unfortunately, while money and effort is expended on identifying patients at risk, the appropriate response to this risk is quite unclear. The performance of bypass surgery or balloon angioplasty in order to treat the underlying coronary disease of at-risk patients is used in other situations, and reduce ....Cardiac problems account for many complications in patients undergoing major non-cardiac surgery, and even apparently minor cardiac damage is a marker of high risk for subsequent adverse events. Unfortunately, while money and effort is expended on identifying patients at risk, the appropriate response to this risk is quite unclear. The performance of bypass surgery or balloon angioplasty in order to treat the underlying coronary disease of at-risk patients is used in other situations, and reduces longterm risk. However, in many patients undergoing major noncardiac surgery, this approach may be inappropriately aggressive, as these patients are often elderly, have other diseases that make heart operations more difficult and risky than usual, and in any case may have a reduced life expectancy from the disease necessitating the operation. As the most critical issue is to ensure that patients undergo their surgery uneventfully, an alternative is the use of intensive medical therapy to protect the heart. This multicentre study, based at Brisbane hospitals that perform large numbers of major operations, will follow up patients for complications, and outcome (including quality of life) will be assessed six months after the operation. We will address two important questions about the efficacy and cost of risk reduction strategies. First, in patients at higher levels of risk and with a positive stress test, could a combination of medical therapy designed to protect the heart be as effective as current approaches, which include the performance of bypass surgery or coronary balloon angioplasty? Second, in patients identified as being at some risk - but low risk - are drugs sufficiently effective to avoid the need for further testing to quantify risk? As the population continues to age, the numbers of at risk patients undergoing major surgery will increase, and answers to these questions will provide important information to guide their management.Read moreRead less
Macrophages are white blood cells that provide front line defence against infection by initiating inflammatory responses by ingesting or phagocytosing microbes and by releasing soluble messengers (cytokines) to recruit other immune cells. These defensive functions require extensive trafficking of proteins within the macrophages. Protein trafficking is orchestrated in part by a family of membrane fusion proteins called SNAREs. By defining the relevant SNAREs, we have recently discovered a much ac ....Macrophages are white blood cells that provide front line defence against infection by initiating inflammatory responses by ingesting or phagocytosing microbes and by releasing soluble messengers (cytokines) to recruit other immune cells. These defensive functions require extensive trafficking of proteins within the macrophages. Protein trafficking is orchestrated in part by a family of membrane fusion proteins called SNAREs. By defining the relevant SNAREs, we have recently discovered a much acclaimed and novel pathway that allows efficient, combined cytokine secretion and phagocytosis in macrophages. Our studies proposed here will now expand on this discovery by comparing the phagocytic process, in terms of SNARE-mediated membrane and cytokine trafficking, for a wide range of microbes, highlighting differences that could provide new avenues for drug development. Moreover, since our strategy of using SNAREs to investigate and map trafficking pathways has proven so successful, we will now launch a major large-scale initiative to study ALL SNARE-mediated trafficking pathways in macrophages using a discovery pipeline of assays, including live cell imaging, we have developed. This will provide valuable information on many SNAREs including those associated with disease, and will elucidate trafficking pathways governing all macrophage actions in immunity, including cytokine secretion and antigen presentation. All of these pathways are highly relevant to current drug targets being used clinically or studied in inflammatory disease and for the development of vaccines.Read moreRead less
Mothers' History Of Mental Health Impairment And Its Impact During Mid-Life
Funder
National Health and Medical Research Council
Funding Amount
$421,580.00
Summary
There have been few specific studies of the health of women in mid-life. In mid-life, mental health impairment and health problems associated with biological and social transitions (e.g. menopause) are major concerns. National estimates indicate that between 15% and 20% of women in the mid-life age range have experienced a mental illness in the past year. The proportion of women experiencing a combination of emotional and physical symptoms, frequently associated with the menopause, is likely to ....There have been few specific studies of the health of women in mid-life. In mid-life, mental health impairment and health problems associated with biological and social transitions (e.g. menopause) are major concerns. National estimates indicate that between 15% and 20% of women in the mid-life age range have experienced a mental illness in the past year. The proportion of women experiencing a combination of emotional and physical symptoms, frequently associated with the menopause, is likely to be somewhat higher. This proposal involves merging information collected initially from 1981 onwards, with data on the mother's mental and physical health, to be collected in this follow-up. Women in this study (8556) were enrolled at their first obstetrical visit and they have been followed up shortly after the birth, when the child was 6 months, 5 years and 14 years. On each occasion extensive information has been obtained on the mother's mental and physical health, as well as on the child's health and development. This study will examine the chronicity of the mother's mental health symptoms over a 21-year period, and assess the association between her early mental health, the child's health and her current health status. This is the only large Australian cohort study to have followed a sample of women for 21 years. It will permit us to understand more of how women's health changes over time and the factors associated with these changes. It will provide the first large-scale study of factors influencing women's health transition through the menopause.Read moreRead less
Pathways To Mental Health And Obesity In Young Adults: A Longitudinal Study
Funder
National Health and Medical Research Council
Funding Amount
$698,510.00
Summary
While the health of the population has been gradually improving, there are some health problems which are increasing. The mental health of young people is one such area. Based on data relating to youth suicide, substance abuse, cigarette smoking by females and behavioural or mental health problems in the young, there has been evidence of a marked increase in some important health problems faced by the young. Little is known about the causes of these problems and even less is known about the reas ....While the health of the population has been gradually improving, there are some health problems which are increasing. The mental health of young people is one such area. Based on data relating to youth suicide, substance abuse, cigarette smoking by females and behavioural or mental health problems in the young, there has been evidence of a marked increase in some important health problems faced by the young. Little is known about the causes of these problems and even less is known about the reasons for the increase. Based on the available evidence, 20-25% of young persons manifest a mental health problem. A second area of marked health deterioration concerns youth (and adult) obesity. Existing research points to the accumulation of cardiovascular risk factors associated with obesity from a very early age. Over 10% of youth are obese and a substantially higher proportion are overweight. There is evidence that the rate of obesity has been substantially increasing. Again little is known about the factors that contribute to obesity or the causes of the increase in the rates of obesity in the population. This proposal is for a 21-year follow-up of a sample of youth first enrolled when their mothers attended for their first obstetrical visit. Using a substantial body of existing data, we propose to examine the changes in levels of mental health and obesity and to identify the factors which contribute to these changes. This study involves the largest Australian cohort ever assembled for such research. The main questions asked in this study concern the impact of the mother's social and economic circumstances, her physical health and well-being, her use of addictive substances (including alcohol, cigarettes, illicit drugs) on the youth's health. We will also examine the association between early indicators of mental health and well-being and subsequent youth health and development.Read moreRead less
The Effectiveness Of An Indicated Prevention Program For Anxiety
Funder
National Health and Medical Research Council
Funding Amount
$867,982.00
Summary
Generalised anxiety disorder (GAD) is a common disorder. In this research project, we evaluate the effectiveness of a new automated Internet program which is designed to reduce the risk of GAD and to promote self help. If found to be effective, this website will provide assistance to those at risk living in rural and remote areas without access to other resources, and individuals who prefer to seek help anonymously.
Impact Of An Infant Sleep Intervention On Infant Sleep And Maternal Wellbeing: A Cluster Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$205,500.00
Summary
Infant sleep problems and postnatal depression are common in the Australian community. Over a third of Australians report a problem with their infant's sleep in the second six months of life whilst 10-15% of Australian women will experience an episode of depression in the first year after their child is born. Both infant sleep problems and postnatal depression have been associated with serious outcomes including child abuse, child behaviour problems, maternal physical and emotional problems, fam ....Infant sleep problems and postnatal depression are common in the Australian community. Over a third of Australians report a problem with their infant's sleep in the second six months of life whilst 10-15% of Australian women will experience an episode of depression in the first year after their child is born. Both infant sleep problems and postnatal depression have been associated with serious outcomes including child abuse, child behaviour problems, maternal physical and emotional problems, family stress and family breakdown. This study builds on previous work conducted by researchers at the Centre for Community Child Health, Royal Children's Hospital, Melbourne. In this work, a brief behavioural intervention significantly decreased infant sleep problems and symptoms of maternal depression, particularly for depressed mothers. The intervention consisted of controlled crying and removal of sleep associations such as a dummy which the infant had become dependent upon to fall asleep. Mothers who received the intervention reported 20% fewer sleep problems and a 45% reduction in depression symptoms compared with mothers who did not receive the intervention. The interention also improved maternal sleep quality and quantity and reduced the need for professional sleep services. It was acceptable to mothers, of low cost and was minimally disruptive to families - in contrast to many current strategies directed primarily at postnatal depression. This trial aims to determine whther a similar intervention delivered by Victorian Maternal and Child health nurses within their usual practice settings can replicate these important benefits.Read moreRead less
A Supervised Exercise Programme Following Hospitalisation For Heart Failure: Does It Add To Disease Management?
Funder
National Health and Medical Research Council
Funding Amount
$730,966.00
Summary
Congestive heart failure (CHF) is a common, disabling condition. Outcomes are improved by a post-hospital disease management programme (DMP) including education, support and followup from a team of nurses, doctors and other health professionals. This study looks at whether adding a supervised exercise programme to a DMP can reduce death rates and hospital stays, and improve physical function and depression in patients with a recent hospital stay for CHF.