Using Mathematical Models To Assess The Impact Of Interventions To Reduce Sexually Transmitted Infections In Australia
Funder
National Health and Medical Research Council
Funding Amount
$562,276.00
Summary
Sexually transmitted infections (STIs) are an increasing public health problem in Australia. Australia's recent National Transmissible Infections Strategy identified chlamydia control, STI prevention in gay men and STIs in Aboriginal and Torres Strait Islander communities as priority areas. We propose to develop mathematical models of STI transmission and use these to help understand and identify the most cost-effective interventions to reduce the impact of STIs on Australian populations.
Re-participation In Screening For Colorectal Cancer: Behavioural Outcomes And Predictors.
Funder
National Health and Medical Research Council
Funding Amount
$687,438.00
Summary
Screening for bowel cancer (CRC) is an important public health initiative. It is most effective when undertaken regularly but there is little research on what personal factors relate to ongoing participation in a screening program. This study will determine the factors associated with ongoing participation in CRC screening and will lead to better screening programs and improved health benefits. This study directly addresses the Cancer Australia priority area re improving screening programs.
BEST-Australia: A Phase II Study Of Non-Endoscopic Screening For Barretts Oesophagus In Primary Care
Funder
National Health and Medical Research Council
Funding Amount
$513,481.00
Summary
Barrett's oesophagus is common in people with heartburn and may progress to oesophageal cancer. Most cases of oesophageal cancer are diagnosed at a late stage when chances of survival are poor. Currently Barrett's is only diagnosed by endoscopy. We will test how effective and acceptable a non-endoscopic sponge capsule and novel laboratory test is at detecting Barrett's oesophagus early. This could potentially enable early detection of this pre-cancerous condition in general practice.
Screening For Colorectal Cancer: Attitudes Affecting Participation And Implementation Of Strategies For Improvement.
Funder
National Health and Medical Research Council
Funding Amount
$468,760.00
Summary
There is good evidence that population screening for bowel cancer (CRC), based on the detection of blood in stools, is effective in reducing deaths from bowel cancer by around 30-40%. Screening depends on the use of a simple test to identify those who most need the complex and costly test which is capable of accurately detecting curable cancers and precancer lesions. This can be achieved with moderate effectiveness using simple tests (FOBTs) which detect microscopic amounts of blood in the faece ....There is good evidence that population screening for bowel cancer (CRC), based on the detection of blood in stools, is effective in reducing deaths from bowel cancer by around 30-40%. Screening depends on the use of a simple test to identify those who most need the complex and costly test which is capable of accurately detecting curable cancers and precancer lesions. This can be achieved with moderate effectiveness using simple tests (FOBTs) which detect microscopic amounts of blood in the faeces. If we are to reduce the rate of death from CRC, we must have an effective way of encouraging people to do these tests. While much has been learnt from experience with screening for breast and cervical cancer, CRC presents a series of quite different issues that have never been comprehensively studied. These are: (1) men and women need to be screened. (2) symptoms due to CRC are more complex , (3) the high-risk settings for CRC are much more complex), (4) the community is not as aware of the benefit of screening, (5) the initial test can be performed at personal convenience in one's home, (6) participants must handle bodily excretions, and (7) inconvenience of attending a central facility is avoided. We will survey participants and non-participants to more accurately identify the barriers to screening, and the proportion who have not participated for informed reasons. To test the real value of attempts to overcome these, we will then offer screening by various approaches designed to overcome these. We are in a unique position to do this as we have well-identified populations who have been offered faecal occult blood test (FOBT)-based screening These studies will assist in the design and implementation of effective screening programs for the early detection of CRC in Australia, which in the long term will significantly reduce deaths from this disease.Read moreRead less
EVALUATION OF THE EFFECTIVENESS OF EXPANDED NEWBORN SCREENING BY TANDEM MASS SPECTROMETRY
Funder
National Health and Medical Research Council
Funding Amount
$375,250.00
Summary
Newborn babies in Australia are routinely tested for certain treatable disorders. Testing began in the 1960's with systematic testing for phenylketonuria, a rare amino acid enzyme defect. It causes severe mental retardation which can only be prevented if treatment is begun in the first few weeks of life. By 1997, only three other disorders, congenital hypothyroidism, cystic fibrosis, and galactosaemia, had been added to the testing protocol as tests became available. Using the new technology of ....Newborn babies in Australia are routinely tested for certain treatable disorders. Testing began in the 1960's with systematic testing for phenylketonuria, a rare amino acid enzyme defect. It causes severe mental retardation which can only be prevented if treatment is begun in the first few weeks of life. By 1997, only three other disorders, congenital hypothyroidism, cystic fibrosis, and galactosaemia, had been added to the testing protocol as tests became available. Using the new technology of tandem mass spectrometry (MSMS) it is now possible to screen for up to 30 extremely rare, treatable metabolic disorders simultaneously and cheaply, but it is not clear how effective this is. A formal trial of MSMS screening, randomly assigning babies to be tested or not tested, does not seem feasible because of the rarity of the individual disorders (most with a birth prevalence much less than 1: 50,000). Huge numbers would be needed in the trial for statistical significance. We began MSMS screening in NSW April 1998 and in South Australia in February 1999. Victoria is proposing to start screening now, but there are as yet no plans for this screening in the other states. We would like to assess the effectiveness of MSMS newborn screening using the best possible evidence drawn from all data available in the whole of Australia. We plan to undertake an economic evaluation, comparing costs and benefits such as development, hospitalisations, medical complications and other outcome measures, in screened and unscreened babies and also assess harms from screening. Because only 6 specialised laboratories in Australia, in Brisbane (2), Sydney, Melbourne, Adelaide, and Perth can diagnose these disorders, we are confident that we know of all diagnosed cases of the disorders in question. We hope to be able to show whether or not there is a benefit to affected babies by implementing newborn screening tests for these rare diseases.Read moreRead less
Atherosclerotic vascular disease cause considerable morbidity, mortality and use of health services in Australia. Current known risk factors explain approximately half of all cardiovascular diseases. The search for new risk factors is therefore a high priority. Evidence suggests that chronic inflammation is closely involved in the process of atherosclerosis and its clinical complications. This study aims to determine if sensitive serum markers of inflammation and gene-environment interactions th ....Atherosclerotic vascular disease cause considerable morbidity, mortality and use of health services in Australia. Current known risk factors explain approximately half of all cardiovascular diseases. The search for new risk factors is therefore a high priority. Evidence suggests that chronic inflammation is closely involved in the process of atherosclerosis and its clinical complications. This study aims to determine if sensitive serum markers of inflammation and gene-environment interactions that affect inflammation will predict the extent and progression of carotid atherosclerosis in an Aboriginal and a non Aboriginal community population and in patients with premature coronary heart disease. This study should provide a greater understanding of the mechanisms involved in the development and progression of atherosclerosis. It is likely that we will find that some inflammatory markers and candidate gene polymorphisms will help identify individuals at increased cardiovascular risk, and who require earlier treatment to prevent disease. In particular, it would focus on preventive therapies that reduce atherosclerosis through anti-inflammatory targets. This study represents a crucial step towards improving our understanding of the aetiology of cardiovascular diseases, and in developing new ways to prevent heart disease and stroke. Progress in these areas will likely have significant public health benefitsRead moreRead less
RCT Of An Intervention To Improve The Health Of Adolescents With Intellectual Disability.
Funder
National Health and Medical Research Council
Funding Amount
$803,146.00
Summary
A high number of people with intellectual disability die at a younger age than the general population - 5 to 20 years younger. The standard of their health is low compared with others. They experience high levels of unrecognised disease and do not receive health promotion or health screening. As they comprise 2.7% of our population (502,000 Australians) - this situation is unjust and should be rectified. The barriers to good health for them include communication difficulties, impaired recall of ....A high number of people with intellectual disability die at a younger age than the general population - 5 to 20 years younger. The standard of their health is low compared with others. They experience high levels of unrecognised disease and do not receive health promotion or health screening. As they comprise 2.7% of our population (502,000 Australians) - this situation is unjust and should be rectified. The barriers to good health for them include communication difficulties, impaired recall of significant health information, negative social attitudes and inadequate training about disability for health service providers. This project is an attempt to minimise some of these barriers by examining the use of a Health Intervention Package. We want to give young people with intellectual disabilty the chance of similar health standards to the rest of the population. This package includes a comprehensive health review, a diary for collecting and storing health information, and advocacy training. We specifically want to examine if adolescents with intellectual disabilty using this package will receive better healthcare and improved health outcomes. We envisage that if successful, the intervention will establish good health practices for the rest of the young person's life. This group of young people is particularly at risk as they move from care provided by specialist paediatricians to accessing General Practitioners' services. To achieve this, the study will seek to recruit 1000 young people (and their parents and teachers) in Special Schools in Queensland. We have already shown that the comprehensive health review does improve health outcomes adults with intellectual disabilty, and the health information and advocacy training has received very positive evaluation. We now need to investigate the effect of both these processes in adolscence and establish if evidence exists to support wider implementation throughout the sector.Read moreRead less
Population Testing Of An Internet-based Personalised Decision Support System For Colorectal Cancer Screening
Funder
National Health and Medical Research Council
Funding Amount
$480,230.00
Summary
This study will determine the impact of a fully developed computerised Personalised Decision Support (PDS) package on colorectal cancer screening participation. The PDS tool is designed to guide people through the decision processes relevant to deciding whether to undertake screening. The PDS presents personally tailored messages aimed at progressing individuals towards screening test use and has the potential to supplement traditional paper methods of increasing screening participation.
A Population Based Communication Strategy To Optimise Colorectal Cancer Screening Behaviour In Australia.
Funder
National Health and Medical Research Council
Funding Amount
$532,425.00
Summary
There is good evidence that population screening, based on the detection of blood in faeces, is effective in reducing deaths from bowel cancer (CRC) by around 30-40%. The process depends on the use of a simple faecal occult blood test (FOBT) to identify those who need a more complex and costly test (colonoscopy), which is capable of accurately detecting curable cancers and precancers so that they can be removed. If we are to reduce deaths from CRC at the population level, we must have an effecti ....There is good evidence that population screening, based on the detection of blood in faeces, is effective in reducing deaths from bowel cancer (CRC) by around 30-40%. The process depends on the use of a simple faecal occult blood test (FOBT) to identify those who need a more complex and costly test (colonoscopy), which is capable of accurately detecting curable cancers and precancers so that they can be removed. If we are to reduce deaths from CRC at the population level, we must have an effective way of encouraging as many people as possible to do FOBT tests. While much has been learnt about how to offer screening from experience with programs for breast and cervical cancer, CRC screening involves different behavioural, psychological and social issues. We need to better understand how these factors influence participation in CRC screening. We plan a series of studies that will lead to improvements in participation in CRC screening programs: a) a survey of a randomly selected group of the general population to measure a range of behavioural features that are of importance to CRC screening, especially as they relate to participation. b) an offer of FOBTscreening to those invited to complete the survey, to match population characteristics with intentions and actual participation, c) on the basis of these studies, to design new screening program strategies, especially in relation to the communication of messages to encourage community participation, d) to test the effectiveness of the new communication strategies by offering FOBT screening to another randomly selected group from the general population. This will allow us to optimise the delivery of messages that encourage participation. If we can design a better communication strategy that achieves an increase in screening participation and has minimum cost implications, we will substantially reduce the number of deaths from CRC in Australia.Read moreRead less
Assessing The Health Needs Of Older Indigenous Australians Living In The Kimberley
Funder
National Health and Medical Research Council
Funding Amount
$242,000.00
Summary
This study was designed to address the need for accurate assessment of the health care needs of older Indigenous people, particularly in remote regions of Australia. Indigenous people have higher rates of premature chronic medical illness, and there is substantial evidence that chronic functional disorders start at younger ages in this population. Common conditions of older age, such as dementia, falls and incontinence, are associated with substantial morbidity, disability and health care expend ....This study was designed to address the need for accurate assessment of the health care needs of older Indigenous people, particularly in remote regions of Australia. Indigenous people have higher rates of premature chronic medical illness, and there is substantial evidence that chronic functional disorders start at younger ages in this population. Common conditions of older age, such as dementia, falls and incontinence, are associated with substantial morbidity, disability and health care expenditure; yet, little is known about the extent of these problems amongst Indigenous Australians. This study builds on a successful project conducted in the Kimberley in 2003 that was designed with the aim of developing and validating a screening instrument for the assessment of dementia amongst Indigenous people. The present project proposes to expand the scope of our previous work to include the assessment of other common conditions associated with older age, such as depression, incontinence and falls and determine use of health services and potential impediments to their access.Read moreRead less