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Chronic Diseases and Population Health Research GroupChronic Diseases and Population Health Research Group Professor Robert Adams Associate Professor Renuka Visvanathan Associate Professor Catherine Hill Dr Sarah Appleton Dr Cynthia Piantadosi Dr Kirsten Dunn Professor Gary Wittert The North West Adelaide Health Study Researchers at The Health Observatory are Principal and Chief Investigators of The North West Adelaide Health Study (see http://www.nwadelaidehealthstudy.org/) A biomedical and biographical cohort study of the North West Adelaide population that has just completed clinic visits in Stage 3 of the study, providing 10 years of longitudinal data on biomedical, psychosocial, behavioural, environmental and health service variables. This rich data source is being used to examine a wide range of research questions related to chronic diseases, using multi-method and multi-disciplinary research techniques. Collaborations with colleagues from Psychiatry, Psychology, Economics, Nutrition, Nursing, Geography, Health policy, Public Health, Primary Care as well as a number of Medical Specialities provide opportunities for a rich research experience across disciplines and research methods. Health Literacy Health literacy is a core concept in the ability to understand health information, interpret what this means to the individual, create plans of action and communicate with relevant health professionals or others. Australia lags well behind other nations in examining this issue. We are currently conducting research to: 1) measure the impact of health literacy on health status, quality of life and health care costs; 2) determine if there are modifiable risk factors that influence health literacy in the Australian setting; 3) determine which current instrument, or derived instrument, best measures health literacy; 4) develop pilot interventions to improve health literacy in at-risk population sub-groups. Obesity Extending working life (Nutrition Obesity Lifestyle & Environment (NOBLE II) Study). An ARC-funded multi-disciplinary study of obesity in South Australia currently focused on the obesity problem among the baby-boomer population, particularly in relation to the effects on workforce participation and extending working life. We have established a multi disciplinary team that will identify and investigate behaviour influencing the eating and exercise patterns, as well as biomedical risks of these groups using a high quality set of quantitative and qualitative data in home place and work place situations. The emphasis is upon using this understanding to identify key intervention points and providing policy makers with evidence and guidance for targeted interventions. Opportunities exist for research interests in economics, psychology, health behaviours, nutrition, health services, and population health. Healthy obesity The notion of healthy obesity has been reported in the press however little evidence exists supporting this. The North West Adelaide Health Study provides an opportunity to study individuals with excess adiposity but who are otherwise healthy in that they do not display cardiovascular disease risk factors typically seen in obese people. The reasons for this are unclear and this research is important in order to avoid dissemination of inappropriate messages about the risks of obesity. Lung Health The Health Observatory has had a long standing interest in the epidemiology of lung diseases including asthma and chronic obstructive pulmonary disease. These interests include trends in asthma and the relationship of asthma with obesity given published data linking the concomitant rise in asthma and obesity. Further work is required to identify cellular and biochemical mechanisms linking these two conditions. Using longitudinal cohort data we are exploring ohenotypes for obstructive lung disease (asthma/COPD) and the relationship between lung function and different health outcomes. Vitamin D deficiency has been proposed to be related to the asthma epidemic, and further research is required to support calls for Vitamin D supplementation to reduce asthma risk. Poor asthma control results in avoidable morbidity and mortality. Identifying reasons for poor control using a number of databases and technologies will improve quality of life for those with asthma. Selected references
Sleep disordered breathing Males Androgen Inflammation Lifestyle Environment Study (MAILES) MAILES is an NHMRC-funded research program assessing the impact of inflammation, obesity and male sex hormones on cardiovascular disease and diabetes, and their interaction with traditional lifestyle risk factors in men followed in FAMAS and NWAHS. At The Health Observatory (in collaboration with Prof Doug McEvoy at The Adelaide Institute for Sleep Health) we are conducting an important sub-study that is looking at sleep disorders and obesity and their relationship to cardio-metabolic disease in men. This will involve Level 3 home sleep studies on 1,000 men over the next 12 months. This data will then be linked to the large longitudinal biomedical and psychosocial data of the NWAHS and FAMAS cohorts. Geo-spatial / environmental effects on health Place and Metabolic Syndrome Study (PAMS) An NHMRC-funded project in collaboration with colleagues at the University of South Australia (Prof Mark Daniels) which is utilising sophisticated geo-spatial modelling techniques to examine the relationship of place- of work, living, social interactions, environment- on cardiometabolic risk factors and diseases. This study is unique as it uses both a multilevel and longitudinal approach to investigate these important issues. Air quality In collaboration with colleagues in the Department of Public Health and at the SA Environmental Protection Agency we are examining the relationship between traffic emissions and general air quality and health, including lung function and cardiovascular disease. Health Services Research Undiagnosed and Under-managed Diseases The North West Adelaide Health Cohort Study identified that significant proportions of people were undiagnosed for a number of chronic conditions. These were diabetes, asthma, chronic obstructive airways disease, mental health conditions and arthritis. This points to significant issues for the health system to improve earlier diagnosis. Failure to do so means that people will be diagnosed at a later and more complex stage of the disease when treatment becomes more problematic and requires additional resources. In addition, in a number of chronic conditions people are not receiving the full range of care that evidence indicates is optimal. Some of the methods involved in the Observatory research portfolio that will address these factors include: Characterizing vulnerable groups on the continuum of disease for improved policy development and targeting in health promotion and management programs. Partnership studies with health authorities and industry to improve policy for at risk groups. Development of improved diagnostic techniques such as algorithms. Research on health literacy of populations and sub-groups and development of improved interventions. In depth qualitative research to elicit target group explanations of their conditions and health related behaviours.
Following are a number of research papers where various aspects of undiagnosed disease are considered. 1. Adams RJ, Appleton SL, Gill T, Taylor AW, Wilson DH, Hill CL. Use of non-steroidal inflammatory medications in the community - cause for concern? BMC Family Practice 2011 2.Adams RJ, Appleton S, Wilson D, Price K, Taylor A, Dal Grande E, Chittleborough C, Gill T, Ruffin RE. Cholesterol lowering and the Australian Pharmaceutical Benefits Scheme: a population study. Aust Health Review 2009;33:325-333. 3. Adams RJ, Appleton S, Hill C, Wilson D, Taylor A, Dal Grande E, Chittleborough C, Gill T, Phillips P, Ruffin RE. Hemoglobin A1C and risk of macrovascular disease in people with and without diabetes is independent of adiposity- An Australian population study. Obesity 2009;17:559-563. 4. Appleton S, Adams RJ, Wilson DH, Taylor AW. Ruffin RE. Spirometric criteria for asthma: adding further evidence to the debate. J Allergy Clin Immunol 2005;116:976-982. 5. Wilson DH, Adams RJ, Appleton S, Ruffin RE. Difficulties identifying and targeting COPD and attributable risk of smoking - A population study. Chest 2005;128:2035-2042.
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