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
Genetic and environmental causes of asthma are poorly understood. The WATCH for asthma project will study Western Australian (WA) families in which there was a twin or higher order multiple birth (twin families) in order to measure inherited and environmental contributions to the development of asthma. All WA twin families, whose infants were born during 1990 to 1995, will be invited to become part of an existing Healthway funded, population based registry of WA Twin Child Health (the WATCH stud ....Genetic and environmental causes of asthma are poorly understood. The WATCH for asthma project will study Western Australian (WA) families in which there was a twin or higher order multiple birth (twin families) in order to measure inherited and environmental contributions to the development of asthma. All WA twin families, whose infants were born during 1990 to 1995, will be invited to become part of an existing Healthway funded, population based registry of WA Twin Child Health (the WATCH study). The WATCH study has already invited 2,751 WA twin families to participate and is the only population based twin study in Australia. Funding of this study by NH and MRC will enable the extension of this unique registry to include more specific clinical information about those families in which one or more of the twins has asthma. In addition to questionnaire data, DNA and physiological information will be collected, including a potentially important new measure of airway inflammation, exhaled nitric oxide which has yet to be studied for familial aggregation. We will use the extended WATCH dataset to undertake a comprehensive investigation of the genetic epidemiology of childhood asthma. This work offers the potential to advance our current understanding of the causes of both childhood asthma and associated traits (e.g., 'twitchy' airways). By exploring the relationships between different components of asthma, we will generate information to assist us to design better epidemiological and genetic studies of asthma. At the time of recruitment, if consent is given, blood will also be taken for DNA extraction and frozen storage. This will generate a powerful data base that can later be used for to search at a molecular level for genes potentially important in causing childhood asthma. Finally, by extending the WATCH study database we will be enhancing a research resource that could potentially be used for future studies of common complex diseases other than asthma.Read moreRead less
Design And Analysis Of Interrupted Time Series Studies In Health Care Research: Resolution Of Methodological Issues
Funder
National Health and Medical Research Council
Funding Amount
$307,125.00
Summary
An interrupted time series (ITS) study involves a population observed on multiple occasions before and after the implementation of an intervention program. However, methods for statistical analysis and designing such studies have not been well developed and many statistical analyses of such studies are flawed. This proposal will investigate appropriate methods for design and analysis, and develop guidelines and software for its implementation by health researchers.
Use And Adequacy Of Diabetic Retinopathy Screening: A Whole Population Linked Data Study
Funder
National Health and Medical Research Council
Funding Amount
$219,382.00
Summary
Diabetes and its health complications are major public health issues presently facing Australia. Currently, around 7% of Australians have diabetes and it is estimated that 300 million people will be diabetic within 20-years. One major complication of diabetes is diabetic retinopathy, which is the most common cause of blindness in working-age adults. Although early treatment can prevent vision loss from diabetic retinopathy, often there are no visual symptoms until the condition is more advanced ....Diabetes and its health complications are major public health issues presently facing Australia. Currently, around 7% of Australians have diabetes and it is estimated that 300 million people will be diabetic within 20-years. One major complication of diabetes is diabetic retinopathy, which is the most common cause of blindness in working-age adults. Although early treatment can prevent vision loss from diabetic retinopathy, often there are no visual symptoms until the condition is more advanced and less treatable. Consequently, it is vital that people with diabetes have their eyes examined regularly. We aim to investigate the use of eye services by people with diabetes. The WA Data Linkage System provides the unique opportunity to efficiently examine the benefits of specialist eye care in diabetics within WA over a 17-year period. The study period encompasses the introduction of NHMRC guidelines for diabetic retinopathy screening in 1997. This will enable us to examine the effectiveness of these guidelines in increasing ophthalmic services use by people with diabetes. Evaluating these trends will provide important data on the effectiveness of policy and NHMRC guidelines in improving diabetic eye care, which has never been comprehensively investigated. Early intervention can prevent and delay vision loss from diabetic retinopathy, substantially reducing the personal and community burden from diabetes. The identification of poorly screened groups will enable more targeted programs to improve the use of ophthalmic series, which in turn may reduce the risk of: i) eye surgery related to diabetes, ii) injury resulting from diabetes-related vision disorder or iii) blindness. The feasibility of using linked health data to evaluate eye screening in diabetics will enable future work addressing processes of care in the prevention of other diabetic complications to be undertaken quickly and cost-effectively.Read moreRead less
Morbidity, Mortality And Health Service Use Among Criminal Offenders: A Western Australian Population-based Study
Funder
National Health and Medical Research Council
Funding Amount
$133,750.00
Summary
This study will focus on the health of criminal offenders, as a most likely marginalised and neglected section of the community, in order to identify areas of need that if addressed will possess benefits for both offenders and the general community. A research team will apply their public health, criminology and forensic psychology expertise, in partnership with the WA Police Service, to provide information on the health outcomes and health service use of adult offenders in WA. Four themes will ....This study will focus on the health of criminal offenders, as a most likely marginalised and neglected section of the community, in order to identify areas of need that if addressed will possess benefits for both offenders and the general community. A research team will apply their public health, criminology and forensic psychology expertise, in partnership with the WA Police Service, to provide information on the health outcomes and health service use of adult offenders in WA. Four themes will be explored: (1) Health Status, to estimate the prevalence of overall and cause-specific hospital-treated morbidity (2) Mortality, to estimate the prevalence of overall and cause-specific mortality, (3) Health Service Use, focussing on both the rate of primary and secondary health service use; and (4) Inequalities In Health Outcomes, firstly comparing the health outcomes of adult offenders with the general WA population, and secondly, comparing the health outcomes of adult offenders based on sanction severity and custodial setting. This investigation is one of only a few worldwide to study health among criminal offenders. Offenders are a neglected section of the Australian health system. Responding to their needs is not possible without an understanding of their health outcomes and the disparities that exist. An important public health opportunity therefore exists to investigate the health of this socially disadvantaged group. This study will provide more detailed data regarding offender-health than currently exists internationally or nationally. Results can be used by health and-or justice administrators as indicators of program and service performance, and potentially lead to improved collaboration between these sectors. The methods used for outcome evaluation can be used readily for the routine evaluation of health performance indicators for offenders.Read moreRead less
Investigating Best Practice Primary Care For Older Australians With Diabetes Using Data Linkage
Funder
National Health and Medical Research Council
Funding Amount
$522,278.00
Summary
This study will use data linkage to examine questions about health service use by older Australians to manage chronic conditions such as diabetes. It will lead to a better understanding of the uptake of community based care initiatives and incentives through general practice, the factors that assist or impede uptake, and the impact of these on patient outcomes such as hospitalisation. The research findings will address important questions of interest to practitioners and policy advisors.
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.
An Examination Of The Causes Of Mortality Following Imprisonment In New South Wales Using Data-linkage.
Funder
National Health and Medical Research Council
Funding Amount
$205,500.00
Summary
Prisoner populations are characterised by poor health status including infectious diseases, injury, risk taking behaviours (eg. smoking and self-harm), mental illness, and substance abuse. Serosurveys of blood borne viruses such as hepatitis C and hepatitis B conducted in Australian and overseas prison settings have found that over one third of inmates have been exposed to these viruses with higher rates detected in injecting drug users and female inmates. Few attempts have been made to examine ....Prisoner populations are characterised by poor health status including infectious diseases, injury, risk taking behaviours (eg. smoking and self-harm), mental illness, and substance abuse. Serosurveys of blood borne viruses such as hepatitis C and hepatitis B conducted in Australian and overseas prison settings have found that over one third of inmates have been exposed to these viruses with higher rates detected in injecting drug users and female inmates. Few attempts have been made to examine the causes of mortality among prisoners following release from detention. Most interest has focused on overdoses in the period immediately following release; the aim of this study will examine all causes of death among individuals exposed to the correctional environment and compare these to death rates for NSW. Correctional centres house a largely male (94% in NSW) population with backgrounds of disadvantage in all areas, including Indigenous Australians, people of lower socio-economic status, those with a mental illness, and the intellectually disabled. There are currently over 21,000 (June 2001) prisoners detained in Australian correctional centres with approximately 39% housed in NSW. Fifteen percent of the NSW prisoners are Indigenous but comprise only 2% of the general population. The aims of this project will be to: (1) Identify all causes of death among ex-prisoners in NSW for the period 1985 to 2001; (2). Compare death rates in the study group with those in the NSW community; (3) Correlate pre-release health information contained in medical records with specific causes of death; (4) Compare causes of mortality among various sub-groups eg. injecting drug users, the mentally ill, violent offenders, and the intellectually disabled; (5) Examine causes of mortality between Indigenous and non-Indigenous inmates; and (6) use this information to develop pre-release programmes aimed at reducing excess mortality among this group.Read moreRead less