The following researchers were recently awarded Research grants under the PHCRED Strategy. Here are summaries of what they will be undertaking.
LYNNE DANIELS
Positive feeding practices and food preferences in very early childhood: an innovative approach to obesity prevention.
Professor Lynne Daniels at QUT and her colleagues at Flinders University in Adelaide have been awarded NH&MRC Primary Health Care funding to evaluate a community-based intervention to promote early feeding practices that will foster healthy food preferences and preserve the innate capacity to self-regulate food intake in young children.
Early feeding practices determine infant exposure to food (type, amount, frequency) and include responses to infant feeding behaviour (eg. food refusal). Evidence suggests both current early feeding practices and intakes are of concern. Despite the potential role in developing healthy eating habits and promoting healthy weight in early childhood and in later life, studies that focus on early feeding practices are very rare.
The 18-month study will use a randomised controlled design and aims to enrol 830 first time mothers with healthy term infants in Brisbane and Adelaide. The intervention will provide anticipatory guidance via 2x12-week parent education and peer support modules (6x1.5 hour group sessions), each followed by 6xmonthly maintenance contacts (choice phone/email). The modules will commence at ages 4-7 and 13-16 months to coincide with establishment of solid feeding and development of autonomy and independence. Although not the focus of the study, breast feeding will be actively encouraged. The intervention will be delivered in established community child health clinics in Brisbane and Adelaide. Outcome measures will be assessed at baseline (age 4-7m), 9 m (age 13-16m) and 18 m (final, age 2y) and will include infant food intake and preferences, feeding behaviour and growth and maternal feeding style/practices, parenting efficacy and BMI. Assessment sessions will also be conducted by study staff at child health clinics.
This study will provide the first Level II evidence for efficacy of a comprehensive, structured intervention to promote positive feeding practices on early childhood intake and food preferences. It is consistent with current community interest in early childhood as the foundation for health and well being and addresses National Research Priority 2: Promoting and maintaining heath – ‘A healthy start to life' and ‘Preventive health care'.
Lynne Daniels,
QUT
E: l2.daniels@qut.edu.au
HYLTON B MENZ
I am a podiatrist with a special research interest in balance and falls in older people. My NHMRC post-doctoral fellowship research clearly identified that foot problems were associated with impaired balance and functional ability, and were a significant independent risk factor for falls. The aim of my NHMRC Primary Care Research Grant project is to design and evaluate a multifactorial podiatry intervention program to improve balance and prevent falls. The intervention package will include a combination of stretching and strengthening exercises, footwear advice and modification, orthotic therapy and ongoing podiatry management of painful foot lesions. The intervention package has been designed in such a way that it could be easily implemented within existing podiatry services. To assess the efficacy of the intervention, the intervention group will be compared to a “usual care” group, who will continue to receive general maintenance treatment from a podiatrist. Falls will then be monitored over a period of 12 months.
This study will be the first ever controlled trial undertaken to determine the efficacy of podiatry for older people in relation to foot pain, mobility and falls. Given the high prevalence of foot-related disability and falls in older people and their associated health care costs, the study findings will be of considerable public health importance. If the intervention is found to be clinically effective and cost-effective, expansion of the role of the podiatrist in falls prevention, both in private and public sector settings, would reduce healthcare costs and enable a large number of older people to benefit. Furthermore, the intervention is based on currently available expertise and low-cost equipment and resources, so it could be easily implemented into a range of healthcare settings.
Hylton B Menz,
La Trobe University
E: H.Menz@latrobe.edu.au
ELIZABETH WATERS
Waters E., Kilpatrick N, Dashper S., Lo S.K., Nicholson J., Gussy M. Environmental, socio-behavioural and biological predictors of early childhood caries: a rural longitudinal birth cohort study.
The team involved in this new study are absolutely thrilled it has been funded and want to thank PHCRED and NHMRC sincerely. As a group we are particularly interested in preschool oral health inequalities and identifying the combination of factors that should be the core components of prevention campaigns. In the context of caries, the majority of previous literature has not integrated the knowledge that caries is an infectious disease, and that a range of environmental, behavioural and social factors all contribute. Rather, the evidence is likely to have examine bugs with caries, or nutrition on caries, or behaviours with nutrition, making it inordinately hard to know whether the best bet is environmental fluoride, accompanied by hygiene, nutritional behaviours, or whether just focusing on hygiene and bugs, or just fluoride exposure in high risk areas, will be able to redress this issue. So this study brings together all the putative risk and protective factors and will follow children and their families from birth to school age. Pilot tests have demonstrated huge interest in the study, and we have demonstrated 98% retention rate capacity to retain babies and their families over this timespan. The study will have the potential to be at the cutting edge in relation to health birth cohorts, nutrition, oral health and social factors. It is likely to be called the VicGeneration Study.
Elizabeth Waters,
Deakin University
E: elizabeth.waters@deakin.edu.au
The following researchers were recently awarded Research Fellowships under the PHCRED Strategy. Here are their profiles:
LYNN KEMP
The PHCRED Fellowship has provided me with a great opportunity to develop my research program, and increase my research output and competitiveness. I am a ‘mid-level' primary health care researcher who is actively developing an early childhood research agenda that seeks to identify the specific contributions that the range of primary health care providers make to the development of a comprehensive and integrated early childhood primary health care system. The aims of my research are:
to develop, support and evaluate the effectiveness of primary health care interventions in early childhood for vulnerable and at-risk populations, and to develop frameworks, resources and workforces to support primary health care interventions in early childhood for vulnerable and at-risk populations.
My focus on early childhood research and health inequity has both immediate and long term implications for improving the health of the Australian population. Investing in the Early Years of Life is one of Australia's research priorities in recognition that early life experiences provide the trajectories for opportunities in later life. It is also recognised that early life experiences are important in the prevention of risk factors for chronic disease later in life. My work recognises the disproportionate burden of disease experienced in disadvantaged communities and seeks to find ways of making services to children and families in these areas accessible and effective.
My past and current research projects are leading to a more substantial piece of work that examines the roles, relationships between and integration of primary health care service providers across the continuum of needs of families with young children. My location within the UNSW Research Centre for Primary Health Care & Equity will support development of a stronger focus on General Practice, the role of Practice Nurses and Pharmacists, in addition to Primary Health Nurses.
Lynn Kemp,
University of NSW
E: l.kemp@unsw.edu.au
MARIE PIROTTA
The PHCRED mid-career fellowships present a wonderful opportunity for budding researchers like myself to really focus on developing their research skills and careers, while also in the broader perspective, assisting to develop research capacity in new researchers and, ultimately, to benefit the community through posing and answering research questions of direct benefit to clinical care.
I have a range of research interests, but will concentrate over the next four years on women's health, in particular, on bacterial vaginosis and chlamydia. I am currently involved in several trials with colleagues from the Melbourne Sexual Health Centre.
Bacterial vaginosis (BV) is an interesting clinical problem. Its aetiology and pathogenesis are not understood, women suffer frequent recurrences of infection and BV makes women more vulnerable to sexually transmitted infection, such as HIV/AIDs. The bacterial vaginosis antibiotic probiotic study (BVAPS) is about to commence. This randomised controlled trial will compare current recommended treatment for BV with current treatment plus a vaginal antibiotic or a vaginal probiotic. We will also be collecting behavioral, demographic, microbiological and immunological data to try to tease out the origins and mechanisms of infection in BV.
My other work is mainly examining methods to improve screening for young women in general practices for chlamydia. Genital chlamydia infections are often asymptomatic, yet the impact on women's fertility can be devastating. A series of trials is underway using various simple interventions and measuring their impact on screening rates for this important sexually transmitted infection.
The results of all these trials will inform health care workers about management of these conditions and should eventually assist in decreasing the burden of these diseases in the community.
Dr Marie Pirotta,
University of Melbourne
E: m.pirotta@unimelb.edu.au
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