Preventing and Managing Chronic Disease

DOMTRU

The Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU) (opens in a new window) is committed to reversing the impact of diabetes on our region and around the world. DOMTRU research and practice looks at prevention of obesity and diabetes, prevention of complications among those with diabetes and studies the mechanisms behind the causes and development of obesity and diabetes and their complications.
 

Current Research

PAL@Rehabilitation

  • Researchers: Dafna Merom, Donna Gillies, Andrew Page, Gregory Kolt
  • Funding: Western Sydney Partners in Recovery

This study aims to reduce cardio-metabolic risk factors among Cumberland Hospital clients diagnosed with severe mental illness by incorporating physical activity and nutritional programs into clinical services in preparation for independent community living.

Applying health informatics to map disease transition in China

  • Researchers: Andrew Page, Thomas Astell-Burt, Xiaoqi Feng, Linhong Wang, Maigeng Zhou, Anthony Maeder, Xiaofeng Liang
  • Funding: Australia-China Science and Research Fund

This series of studies has incorporated approaches from health informatics, epidemiology, and data modelling to strengthen the understanding of trends and geographic differences in non-communicable disease in China, including the impacts of health policies and services and socio-economic development on population health. This ongoing collaboration has been conducted under a Memorandum of Understanding between Western Sydney University and the National Chinese Centre for Disease Control and Prevention.

"From Grandparent to Grandchild: Family health across the years in South Western Sydney": A pilot intergenerational public health observatory.

  • Researchers: Andrew Page, Alex Hendry, Felix Ogbo, John Eastwood, Vicki Blight, Anne McKenzie
  • Funding: Western Sydney University; Ingham Institute of Applied Medical Research; Child and Family Health, South Western Sydney Local Health District

This study aims to investigate the effects of changes in socio-economic status within and between family generations (children, parents, and grandparents) on child and family health in a population-based cohort of SW Sydney Local Health District residents, and how such changes differ by migrant-status and ethnicity. Findings from this study aim to inform social and health policy and community-level services that particularly relate to breaking cycles of social deprivation across generations.

A microsimulation model for the prediction of health and health care utilization in NSW

  • Researchers: Shima Ghassem Pour, Amir Marashi, Federico Girosi

What are the costs of obesity and smoking? What if we could reduce the incidence of diabetes by 30%? What if we could eliminate hypertension? Which types of cancer should we target for prevention? How should the medical workforce look like 30 years from now? Policy makers commonly ask questions of this type, but they lack tools that can provide them with a view of how the future looks like under different policy scenarios. We will remedy this situation by developing a predictive model of the trajectories of the population in both the health and the health care utilization domains. The model will be able to simulate a variety of policy scenarios and predict, over the next 30 years, the health and functional status of the NSW population over age 45 as well as its health care utilization and expenditures. The scenarios include the status quo (that is business as usual, without policy changes), interventions aimed to reduce risk factors and the introduction of new treatment/technologies that can alter the course of disease or prevent it from occurring. For each scenario the model will be able to project outcomes such as prevalence and incidence of several chronic conditions, the disability status of the population, hospital/MBS/PBS costs and demand for services such as primary care, specialist visits and hospital beds.

A clinical guidelines recommender system

  • Researchers: Ehsan Zare-Borzeshi (CMCRC), Federico Girosi

Studies in the US and in Australia  have shown that people receive from health providers only 50-60% of the recommended level of care. It is not known what portion of this number is due to health providers lacking the right information. However, medical literature and clinical guidelines are growing at staggering pace and this is only going to make it more difficult for health providers to keep up to date with recent recommendations and incorporate them into their practice. Therefore, there is a need for tools that can make it easier for providers to read medical information that is relevant to them.

We are developing a software tool that parses the massive and ever changing amount of clinical guidelines and give providers a prioritized list of guidelines that is specific to the set of patients they are currently treating. We refer to this tool as a Clinical Guideline Recommender (CGR). A CGR will take as input the latest set of clinical guidelines (in text form) and the unstructured or partially structured information residing in the clinical notes of a patient. The output of the CGR is the list of guidelines that apply to a specific patient. A CGR could run interactively, as data for the patient are entered, or in batch mode, on an entire population of patients. A CGR could be developed as a stand-alone tool that interfaces with electronic medical records system, or as part of a more complex Clinical Decision System.

The CGR is designed in a way that automatically provides complementary, relevant and verified information to assist any health provider in making clinical decisions for their patients. Health providers could be GPs, specialists or any other providers that maintain clinical notes for their patients.

Screening tools and predictive models for diabetes

  • Researchers: Evan Atlantis, Shima Ghassem Pour, Federico Girosi

Effective prevention of type 2 diabetes (T2D) requires early identification of high-risk individuals who might benefit from intervention. We are investigating whether brief screening for anxiety and/or depression, a novel risk factor for T2D, adds clinically meaningful information beyond current T2D risk models. We are also investigating the value of adding few additional socio-economic variables to current screening tests.The main data set for this study is the 45 and Up Study, a large-scale prospective cohort study of men and women aged 45 years and over from the general population of the state of New South Wales, Australia. 53,197 participants without diabetes at baseline (2006-2009) were followed up for approximately 3 years (2010). T2D was defined by self-reported medical history of diabetes. Current symptoms of anxiety and/or depression were measured by the 10-item Kessler Psychological Distress Scale (K10). Risk models were tested using logistic regression models. Sensitivity, specificity, positive predictive values (PPV) where used to identify the optimal cut-off point for K10 scores for incident T2D and both the Tjur test and the area under the receiver operating characteristic (AROC) curve were used to measure the predictive power of the model.

Cluster Randomised Controlled Trial of the Impact of Enhanced Inpatient Diabetes Teams in Public Hospitals in SWSLHD

  • Researchers: David Simmons, Milan Piya, Vincent Wong, Jeff Flack, Namson Lau, Haider Mannan

One in five patients in hospital has diabetes, and local audits have consistently shown that glycaemic control for inpatients with diabetes was poorly managed. Inpatients with diabetes have longer length of stay and greater rates of complications. South Western Sydney Local Health District (SWSLHD) has recently funded a small enhancement for Inpatient Diabetes Teams (IPDT) – consisting of a diabetes educator, dietitian and endocrinologist. We hypothesize that the IPDT will result in earlier, better glycaemic control for inpatients with diabetes leading to reduced complications including hypoglycaemia, insulin errors and infections (secondary aims), which in turn lead to shorter length of stay and re-admissions (primary aims). To achieve these research objectives, a cluster randomised controlled trial is underway across 20 wards in 4 hospitals in SWSLHD. Studying the secondary aims are dependent on getting funding for which a SWSLDH grant has been sought by the primary investigator of the project.

Early infant feeding of formula or solid foods and risk of childhood overweight or obesity  in South Western Sydney and comparison among children having Lebanese descent living in Australia and Lebanon

  • Researchers: Haider Mannan, Yonna Sacre

Among the developed nations, Australia has amongst the highest childhood obesity rates with approximately 20% of children at 2–3 years of age being overweight or obese. Within Australia, South Western Sydney has the highest childhood obesity rate and early introduction to formula or solids is also quite common. Research for the first part of the project has been completed using the Longitudinal Study for Australian Children data (LSAC). For this dataset, the outcome risk of overweight or obesity was measured at every two year interval of children aged 0-1 year at baseline until they reached age 10 or 11, defined by BMI≥ 85th percentile, using the CDC growth charts. For the comparative study between Australian Lebanese children and those living in Lebanon of the same descent, data collection for Lebanon will commence in summer this year through the efforts of co-investigator Dr Yonna Sacre who is based in Lebanon.

Empowering Consumers through Timely Context Based Information

  • Researchers: Maneesh Mathai, Athula Ginige, Uma Srinivasan, Federico Girosi

Timely information and education can enhance the ability of consumers to make informed choices about their health, lifestyle and modify disease risk factors. Due to its unstructured and varied format, and lack of targeted delivery methods, available information and knowledge does not often reach consumers, when they need it most. The aim of this project is to explore ways to provide personalised, context-specific, relevant information for consumers to better manage chronic diseases.  We will initially develop a mobile based system for managing diabetes; especially type II which is preventable in many cases. The learnings will then be generalised to cover other chronic diseases.

To provide context based information to consumers we need to find their information needs and the associated context for each of the needs. This we need to find from literature, diabetes educators and if possible from some patients.  Also we will obtain insights by analysing claim data to understand various episodes relating to diabetes patients, demography, co-morbidity issues and corresponding patient pathways. Based on above findings and literature a context model will be developed. Some of the parameter values in the context model such as type of diabetes, age, gender, current medications etc. can be pre-entered to create a user profile. Other parameters such as location, time, amount of exercise the user has done and the types of food being consumed in the last few days need to be captured through sensors in mobile phones.Based on specific values of various context model parameters at a given instance the relevant information can be filtered from an existing pool of knowledge to provide to the user as actionable information.Based on the above research findings a prototype mobile based app will be developed to provide necessary actionable information in context to diabetes patients.

The WATCH trial: Randomised controlled trial of antimicrobial treatment versus watchful waiting for acute otitis media without perforation in low-risk Aboriginal children

  • Researchers:  Jennifer Reath,  Penny Abbott, Hasantha Gunasekera, Amanda Leach, Deborah Askew, R Walsh, Kelvin Kong, Federico Girosi, Chelsea Bond, Peter Morris, San Lujic, Wendy Hu,  David Peiris, Geoffrey Spurling, Timothy Usherwood, Nadeem Siddiqui, Markeeta Douglas, Tallulah Lett & Cheryl Woodall, Keitha Rabbitt
  • Funding: NHMRC Project Grant

Professor Jennifer Reath, Dr Penelope Abbott and Professor Wendy Hu of the School of Medicine, and Associate Professor Federico Girosi of the Centre for Health Research, with research partners including five Aboriginal Community Controlled Primary Health Care Services and Inala Aboriginal & Torres Strait Islander Primary Health Care Service are investigating ways to manage ear infections in urban Aboriginal children.The National Health and Medical Research Council funded project will compare a "watchful waiting approach" used for non-Aboriginal children with the immediate use of antibiotics recommended for Aboriginal children living in remote areas. 'Acute otitis media [middle ear infection] is a major cause of ill health in children and a common reason for antibiotic prescriptions,' Professor Reath says. 'Ear health is an important Aboriginal health issue. Aboriginal children have higher rates of middle ear infections than other children, and complications of ear disease include hearing impairment which can affect education and quality of life. Also antibiotic resistance is growing in Aboriginal communities.'National guidelines recommend observation and waiting to see if antibiotics are needed. This "watchful waiting approach" is now recommended for urban Aboriginal children at low risk of complications. Professor Reath and her team will study the relative effectiveness of the watchful waiting approach while also gauging its cost-effectiveness and assessing its acceptability among parents, carers and health care providers. Avoidable hearing loss and chronic infection must be prevented and this study will inform the treatment of ear infections in Aboriginal children.

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The Treatment Of Booking Gestational diabetes Mellitus Study: The TOBOGM study

  • Researchers: David Simmons, William Hague, Helena Teede, Ngai Cheung, Christopher Nolan,Federico Girosi, Michael Peek, Christopher Cowell
  • Funding: NHMRC Project Grant

Gestational diabetes mellitus (GDM) related pregnancy complications are reduced with treatment from 24-28 weeks pregnant. Many women are diagnosed/treated earlier without evidence of benefit and possible risk of harm. In TOBOGM women under 20 weeks pregnant with mildly raised blood glucose will be allocated by chance to either immediate treatment, or awaiting a repeat diabetes test at 24-28 weeks pregnant to decide treatment. Harmful and beneficial effects on mother and baby will be compared.

The efficiency and equity impact of cardiovascular screening programmes

  • Researchers: Kenny Lawson, John Tayu Lee, Christopher Millett

The World Health Organisation (WHO) and several national (e.g. UK) and regional (e.g. Europe) cardiovascular (CVD) societies recommend the implementation of population-wide CVD risk assessment programmes worldwide, including within low resource countries. However, there is on-going debate whether these are effective, cost effective and there are concerns that health inequalities could increase. This project aims to conduct a systematic review of previous population-wide programmes, and also undertake simulation of screening programmes to project likely cost effectiveness and equity impacts.

Reducing the Impact of Diabetes and its Complications in the Greater Western Sydney Samoan Community

  • Researchers: MacMillan, F., Reath, J., Abbott, P., Alofivae-Doorbinnia, O., Cook, A., Smith, E., Lawson, K., Agho, K., Ravulo, J., Simmons, D.

Over half (79%) of the Greater Western Sydney (GWS) population is overweight or obese. Diabetes prevalence is higher in GWS than the state and national rates - 93,374 people have known diabetes. The leading cause of end-stage kidney disease is diabetes and 65% of all cardiovascular disease mortalities are due to diabetes and pre-diabetes. The annual cost of diabetes in Australia is $6 billion and growing. The health and economic burden of diabetes is greater in the GWS region compared to the rest of Australia. There are a range of other socioeconomic, cultural and other barriers to diabetes prevention and management. Current mainstream approaches to diabetes prevention are not impacting sufficiently on the Samoan community. Their high rates of diabetes related end stage renal failure/dialysis and other complications, have led their diabetes to be recognised as a major public health problem by Local Health Districts(LHDs), Primary Health Networks (PHNs) and other health organisations in GWS. The aims of the research are to increase our knowledge and translational skills on effective diabetes prevention and management support programs in the Samoan community living in South Western Sydney (SWS). To strengthen our relationships with the Samoan community, Local Health District (LHD) and Primary Heath Network (PHN) partners in SWS, WS and Nepean Blue Mountains (NBM), for an NHMRC proposal in 2018 exploring sustainability of a diabetes prevention and management support program.

Patient centred medical home models of primary health care in Western Sydney: Understanding implementation and preparing for evaluation

  • Researchers: Jenny Reath, Kenny Lawson, Lisa Angus, Tim Usherwood, Walter Kmet, Ian Corless, Jaspreet Saini, Shahana Ferdousi

WentWest Ltd and the Western Sydney and Sydney University Departments of General Practice in the west of Sydney work together through a Partnership titled "Partners in Education Evaluation and Research Western Sydney" (PEER). One key area of discussion within this partnership has been WentWest initiatives aimed at working with lead General Practices in Western Sydney to develop Patient Centred Medical Home (PCMH) style models of practice. With development of the new models of care there is an important opportunity to describe the processes undertaken, outcomes of these innovations, and the costs of health care provided. Implementation processes can be described as the PCHM is rolled-out. However, the impacts of PCMH on improving actual patient health will take time to emerge. This research is intended to address both implementation and capture outcomes, by putting in place a research framework alongside the roll-out of the PCHM, and prepare for future large scale outcome and economic evaluation.

Assessing the impact of anti-smoking law on mortality in Australia using epidemiological modelling

  • Researcher: Haider Mannan

Given the Australian government policy to cut down on prevalence of cigarette smoking, it is important to model the likely impact of this policy on all-cause mortality. This study will develop a number of scenarios related to reduction in prevalence and/or intensity of smoking and test the impact of each of them on all-cause mortality. Currently, the two basic strategies which have been adopted in the Australian population to control smoking prevalence are through subsidised smoking cessation medication and anti-smoking public health programs. Currently, I am modelling whether anti-smoking programs should be targeted towards high prevalent smoking sub-populations. This will assist policy makers to determine whether and where more resources for anti-smoking programs need to be installed for better prevention of mortality. The differential effectiveness of anti-smoking programs and subsidised smoking cessation medication will be determined in terms of their effectiveness in reducing the mortality related to smoking. I will develop predictions of outcomes of each strategy based on a range of assumptions and these will assist policy makers in developing a rational balance of the available funds between these two basic strategies.

Completed Research

Evaluation of the relative efficacy and mechanisms of a couple based intervention for Premenstrual Syndrome through a randomised control trial using mixed methods

  • Researchers: Jane Ussher, Janette Perz, & Edith Weisberg
  • Funded by an ARC Discovery Grant ($430,000)

Of 9,689 Australian women recently surveyed nationally, 33% reported moderate or severe premenstrual symptoms (PMS). Whilst relationships have been identified as a significant factor in the experience of premenstrual distress, to date, there has been no systematic description or evaluation of couple-based PMS interventions. This research study will do this, comparing couple-based support to both one-to-one and self-help support, helping health-care providers understand the experience and treatment of PMS in the context of family relationships, thereby reducing PMS, and the physical and psychological distress associated with it. This will lead to improved psychological wellbeing and quality of life for women and their families, a priority area for the ARC.

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