Health Care Priorities: The Community's Preferences For Using Community Preferences
Funder
National Health and Medical Research Council
Funding Amount
$52,355.00
Summary
Determining how health care resources should be allocated - often termed rationing or priority setting - has traditionally been carried out by health care personnel, usually doctors but increasingly managers. More recently there has been a move to involve the general public in this process. Much of the research in this area has focussed on the methods used to elicit community preferences. While this is an important area of investigation, a prior issue of how community members feel about the use ....Determining how health care resources should be allocated - often termed rationing or priority setting - has traditionally been carried out by health care personnel, usually doctors but increasingly managers. More recently there has been a move to involve the general public in this process. Much of the research in this area has focussed on the methods used to elicit community preferences. While this is an important area of investigation, a prior issue of how community members feel about the use of their preferences in informing health care priorities needs to be investigated. Four specific questions will be addressed in this study: (i) do members of the general public feel that, as individuals, they have a legitimate role to play in informing priority decisions in health care? if so why? if not, why not? (ii) does the nature-level-setting of the decisions for which priorities are to be set affect whether individual members of the public would wish to participate in the priority setting process? (e.g. different health services, medical procedures-treatments, diseases) (iii) whose preferences should be used if not the community's? (iv) faced ex post with the preferences of the community and the preferences (possibly different) of health service decision makers (i.e. Oexperts'), does this knowledge affect preferences for having community preferences count? A number of health authorities are currently looking for ways of engaging local communities in health care decision making. This study will indicate the appropriate levels at which community preferences are to be elicited and the type of decisions and settings in which they are most relevant.Read moreRead less
A Clinical Trial Of The Effect Of Neuropsychological Treatments In Increasing Community Participation After Brain Injury
Funder
National Health and Medical Research Council
Funding Amount
$365,700.00
Summary
Traumatic brain injury is very common, with more than 2,000 people surviving serious brain injury in NSW each year. The survivors are most commonly young adult males and many are left with permanent brain damage, invariably affecting cognitive abilities. The impact of cognitive impairments on the person's capacity to resume their premorbid lifestyle is enormous. In one of our studies we found that 40% did not work but nor did they have any meaningful occupational activity to replace work. The cu ....Traumatic brain injury is very common, with more than 2,000 people surviving serious brain injury in NSW each year. The survivors are most commonly young adult males and many are left with permanent brain damage, invariably affecting cognitive abilities. The impact of cognitive impairments on the person's capacity to resume their premorbid lifestyle is enormous. In one of our studies we found that 40% did not work but nor did they have any meaningful occupational activity to replace work. The current project targets this large group of people in particular. The study aims to develop and test two alternative, intensive cognitive treatment programs that are geared to increasing community participation, everyday activities and psychological well-being. To date, no such therapies have been evaluated using powerful methodological designs. As a result of the study we will be able to incorporate the standardised interventions into a format that can be easily applied to Brain Injury Rehabilitation Services in Australia. The programs will not only improve the functioning of the individuals with brain injury, but will have a flow-on effect for their families and the community at large.Read moreRead less
Cataract Surgery And Risk Of Age-related Macular Degeneration (AMD)
Funder
National Health and Medical Research Council
Funding Amount
$339,750.00
Summary
Cataract surgery currently ranks as one of the most frequently performed and successful surgical procedures in Australia (125,000 operations-year). Age-related macular degeneration (AMD) is the principal cause of moderate visual impairment and blindness, currently accounting for blindness in between 17,300 and 30,400 Australians. Past studies have not shown a definite relationship between cataract and AMD. Follow-up data from clinical case series and from two older population-based studies (the ....Cataract surgery currently ranks as one of the most frequently performed and successful surgical procedures in Australia (125,000 operations-year). Age-related macular degeneration (AMD) is the principal cause of moderate visual impairment and blindness, currently accounting for blindness in between 17,300 and 30,400 Australians. Past studies have not shown a definite relationship between cataract and AMD. Follow-up data from clinical case series and from two older population-based studies (the Beaver Dam and Blue Mountains Eye Studies) suggested that cataract surgery might increase the risk of subsequent development of AMD in operated eyes of older persons. Such an increased AMD risk in eyes after cataract surgery appears to be both short term (observation from clinical case series) and long term (evidence from population-based studies), and persists after taking into consideration age, sex, smoking, preexisting early stage lesions of the disease and correlation between both eyes. The proposed study is to follow a large number of older patients who are undergoing cataract surgery in Western Sydney Eye Hospital and in two ophthalmologists' private rooms. Rates of subsequent development of AMD will be compared between operated and non-operated eyes, and also between the surgical cohort and the Blue Mountains Eye Study cohort. We will document macular conditions carefully before and after surgery to exclude the possibility of confounding issues. We will also investigate whether the increased risk occurs in certain subgroups of patients at high risk of AMD. If an increased AMD risk from cataract surgery is confirmed in subgroups of patients, a modified clinical practice may be indicated, to maximize cataract surgery benefit and minimize the risk of vision loss from AMD after surgery. Changes may include additional patient information and consent about this risk, delayed cataract surgery within limits of visual function, and close postoperative follow up.Read moreRead less
Mobile Phones, Radiofrequency Exposure And The Development Of Cognitive Function In Primary School Children
Funder
National Health and Medical Research Council
Funding Amount
$551,477.00
Summary
Increasingly widespread exposure to radiofrequency fields from mobile telephones has raised concern about potential adverse health effects. The WHO has called for further research in children. We will conduct a 3 year study of 600 primary school students focussing on their exposure to mobile phones and cognitive development. If there are no significant effects, the community can be reassured. However if effects are demonstrated, we would need to restrict the use of mobile phones by children.
Neurocognitive Studies Of Brain Plasticity Associated With Surgical Treatment Of Arteriovenous Malformations
Funder
National Health and Medical Research Council
Funding Amount
$701,922.00
Summary
We will use state-of-the-art brain imaging methods to test whether specific brain areas which have been chronically starved of adequate blood supply can regenerate, informing debate about limits on brain plasticity. Arteriovenous malformations (AVMs) are longstanding defects which can cause thinking skills to 'migrate' to other brain regions in childhood without noticeable impact. Surgical correction allows a test of what happens to the previously inactive area: Does the area 'start to think'?
Muscarinic M1 Receptor, Cognition And Schizophrenia
Funder
National Health and Medical Research Council
Funding Amount
$598,800.00
Summary
Schizophrenia is a serious psychiatric illness that affects approximately 1% of Australia's population. Whilst the prominent symptom of schizophrenia is psychosis, the majority of subjects with schizophrenia also show deficits in cognition. Unlike psychotic symptoms, deficits in cognition do not respond well to current antipsychotic drug treatment. We have been investigating the possible role for changes in a family of receptors, called muscarinic receptors, in the pathology of schizophrenia for ....Schizophrenia is a serious psychiatric illness that affects approximately 1% of Australia's population. Whilst the prominent symptom of schizophrenia is psychosis, the majority of subjects with schizophrenia also show deficits in cognition. Unlike psychotic symptoms, deficits in cognition do not respond well to current antipsychotic drug treatment. We have been investigating the possible role for changes in a family of receptors, called muscarinic receptors, in the pathology of schizophrenia for almost a decade. Our research has shown that two members of the muscarinic receptor family, the M1 and M4 receptors, may be differentially decreased in different brain regions of subjects with schizophrenia. Recently, we have shown that in the dorsolateral prefrontal cortex, the muscarinic receptor that is decreased in schizophrenia is the M1 receptor. Since we made this discovery another group has shown that a mutation in the M1 receptor may be a cause of cognitive deficits in schizophrenia. We are now proposing a study using parallel streams of research on postmortem brain tissue and in living subjects with schizophrenia to determine the likelihood that decreases in M1 receptors in the cortex may be the cause of cognitive deficits in schizophrenia. This will involve confirming that mutations in the M1 receptor, measured using DNA from white blood cells, are associated with cognitive deficits in schizophrenia. At the same time we will determine if the same mutation is associated with low levels of M1 receptors in cortex obtained postmortem from subjects with schizophrenia. If both these are true this will give us a strong platform to suggest that low levels of cortical M1 receptors are associated with cognitive deficits in schizophrenia.Read moreRead less
Predictive Models And Interventions For Coronary Heart Disease In Aboriginal And Torres Strait Islander People
Funder
National Health and Medical Research Council
Funding Amount
$203,125.00
Summary
The main causes of heart disease in western countries are smoking, high blood pressure and high cholesterol. However, in indigenous populations, other factors may be more important. We propose to look at these conventional risk factors and others like diabetes, blood clotting disorders and inflammation to see which are best for predicting heart attack in Aboriginal and Torres Strait Islander people . We will also examine the effect of heart disease prevention programs run by communities, to see ....The main causes of heart disease in western countries are smoking, high blood pressure and high cholesterol. However, in indigenous populations, other factors may be more important. We propose to look at these conventional risk factors and others like diabetes, blood clotting disorders and inflammation to see which are best for predicting heart attack in Aboriginal and Torres Strait Islander people . We will also examine the effect of heart disease prevention programs run by communities, to see if they can improve these risk factors. Finally, we will use this information to produce educational materials and clinical tools for health services.Read moreRead less