Chronic Diseases Research

Arthritis Research                                                                                                                 

•  FOSTAR Study

The FOSTAR Study is a NHMRC-funded multicentre randomized clinical trial of low versus high dose liquid fish oil in knee osteoarthritis. Two hundred patients have been recruited in Adelaide, Sydney and Hobart with the co-ordinating centre at TQEH. The outcomes are pain and cartilage measured on MRI. The follow up of participants is due to finish in Feb 2011 with results expected in mid-2011.

•  Population studies of musculoskeletal diseases

Measurement of the burden of musculoskeletal diseases in the community were assessed in Stage 2, and currently in Stage 3, of the North West Adelaide Health Study (NWAHS). Current data has demonstrated a high prevalence (17%) of foot symptoms, the first population-based investigation of foot symptoms in Australia. In addition, we have published data on prevalence of hand and shoulder symptoms within this cohort.

•  South Australian Giant Cell Arteritis Registry

Giant Cell Arteritis (GCA) is the commonest form of vasculitis in the elderly. We have undertaken investigations of associations of malignancy with giant cell Arteritis. In 2010, we have established the SA Giant Cell Arteritis Registry to investigate, for the first time in Australia, the epidemiology, prognosis and treatment course of patient with biopsy-proven GCA.

Asthma Research

 This section is still under construction

Other Respiratory Diseases Research

 This section is still under construction

 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 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.

This focus on undiagnosed chronic conditions has led to the development of the NHMRC study entitled Lungs for Life (LuFli) which aims to develop diagnostic algorithms that will lead to more precise diagnosis and discrimination between various lung diseases.

• Undiagnosed Chronic disease

Undiagnosed chronic conditions are an important area of research activity for the Health Observatory. Major undiagnosed conditions are not only a health and economic problem, but attack the central importance of active ageing, which is based on the principles of health, participation in society and security.  Failure to detect chronic conditions, related complications and health behaviours and produce effective management plans, inhibit the individuals ability to actively engage in a range of life activities and build or maintain personal and/or family security.

•  The Disease Continuum

The disease continuum is an important conceptual framework of Observatory research.  As we move from left to right along the continuum in Figure 1, using diabetes as an example, the probability of disease diagnosis and related complications increase.  Identifying groups at each stage is facilitated by our population cohort studies.   This then allows us to identify how each group can be targeted with improved management, other interventions and health promotion.  The overall aim for our population is to minimize progression along the continuum.  Undiagnosed disease accelerates progression.

•  Research Priority

The Health Observatory has listed research into undiagnosed disease conditions as a priority area; first, because of its potential affect in active ageing, and second, because of its relationship with other Observatory priorities. While we acknowledge there are difficult diagnostic challenges in detecting disease and related complications at the earliest possible time, other factors associated with chronic conditions, which affect detection, management and improved health outcomes, can be identified and modified.  Some of the methods involved in the Observatories 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.

• Previous Research 

Following are a number of research papers where various aspects of undiagnosed disease is 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? Med J Aust 2010

 2.            Chittleborough CR, Burke M, Taylor AW, Wilson DH, Phillips PJ, Adams RJ, Ruffin RE. Medicare-related service use among people with diagnosed and undiagnosed diabetes and respiratory conditions. Aust Health Review 2009;33:107- 116

3.            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.

4.            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.

 5.            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.

 6.            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.

 7.            Wilson DH, Adams RJ, Appleton S, Ruffin RE. Undiagnosed asthma in older person – an underestimated problem. Med J Aust 2005;183:S20-S22.

8.      Adams RJ, Wilson DH, Taylor A, Appleton S, Ruffin RE. Underdiagnosed asthma in South Australia. Thorax 2003;58:846-850

  Problems related to Obesity

This section is still under construction