Infectious Diseases and Immigrant Health
Monitoring the efficacy of a training program in gastroenterology in the Pacific
Supervisors: Professor Finlay Macrae
Location: Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital
Contact: Professor Finlay Macrae T: +61 3 9347 0788 E: finlay.macrae@mh.org.au
Diseases in the GI tract are common in the South Pacific. GI Endoscopy access is limited, and training even less available. In association with the World Gastroenterology Organization, we have recently introduced a training program in gastroenterology to support postgraduate training in gastroenterology at the Fiji School of Medicine, with expertise provided from Australia. The project is designed to monitor the effects of this across the South Pacific, through documentation of higher levels of service delivery in the region, epidemiology of disease detection (eg helicobacter pylori) and skills' acquisition by graduates of the program that can be applied in remote communities in the South Pacific with high GI disease burdens. The applicant would be required to visit South Pacific regions to assess qualitatively and quantitavely, disease burdens and the provision of services to address these needs, with a view to reports for Faculty, the Gastroenterological Society of Australia, the World Gastroenterology Organization and the Australian Government (AusAid).
Supervisor: Professor Finlay Macrae
Dept of Colorectal Medicine and Genetics The Royal Melbourne Hospital
Prevalence and management of infectious diseases and nutritional disorders in refugees and immigrants living in Melbourne
Supervisors: Dr. Karin Leder/A/Prof Beverly Biggs
Location: Department of Medicine (RMH/WH), Royal Melbourne Hospital
Contact: A/Professor Beverly Biggs T: 8344 3256/7 E: babiggs@unimelb.edu.au
Web link: www.internationalhealth.unimelb.edu.au
Overview of the Immigrant and International Health Group
The Immigrant and International Health Group in the Department of Medicine, University of Melbourne, have research activities in the area of infectious diseases and nutritional disorders in immigrants and refugees in Melbourne, and in women and children living in rural India and Vietnam. The group works closely with the Victorian Infectious Diseases Services at the Royal Melbourne Hospital and the Nossal Institute for Global Health.
Project Overview
Appropriate screening of recently arrived immigrants/refugees to Australia can be complex as there are multiple medical, social and psychological issues to consider. Additionally, there are knowledge gaps regarding the optimal approach to some diseases, especially for infections for which the prevalence in immigrants is unknown. A good example can be seen with Helicobacter pylori infections. Often the presence or absence of symptoms is used to determine whether screening for H. pylori is performed, and this is the approach recommended in the Guidelines for diagnosis and management of infections in recently arrived refugees recently released by the Australasian Society of Infectious Diseases. However, routine population-based screening and treatment for H. pylori in particularly high-risk population settings has
Prevalence of anxiety and depression among refugee patients at a tertiary referral clinic
Supervisor: Dr Chris Lemoh, Dr Caroline Marshall, Dr Karin Leder, Prof Fiona Judd; A/Professor Beverly-Ann Biggs,
Location: The Department of Medicine (RMH/WH), The Royal Melbourne Hospital ; Centre for Women’s Mental Health, Royal Women’s Hospital
Contact: Dr Chris Lemoh T: 8344 6252 E: c.lemoh@pgrad.unimelb.edu.au
A/Professor Beverly Biggs T: 8344 3256 E: babiggs@unimelb.edu.au
Background: Many patients referred to the refugee health clinic have had previous traumatic experiences and face ongoing psychosocial stresses during resettlement in Australia. Undiagnosed mental illness may have a significant impact on quality of life and success of resettlement, but the proportion of patients with undiagnosed depression or anxiety disorders is not known.
Aim: To estimate the proportion of patients referred to the refugee clinic that have symptoms that fit diagnostic criteria for depression and anxiety disorders, but have not been formally diagnosed with or treated for such conditions.
Methods: The anxiety and depression modules from the Patient Health questionnaire (PHQ9; to assess depressive disorder, generalised anxiety disorder and panic disorder) will be administered to patients of the refugee health clinic who have migrated to Australia as refugees and have not previously been diagnosed with or managed for either depression or an anxiety disorder since their arrival in Australia. The proportion of patients with responses that met criteria for DSM-1V disorders will be measured. In addition, the Posttraumatic Stress Disorder Checklist- Civilian Version (PCL-C) will be used to screen for symptoms indicative of PTSD
Outcome: This study will provide an estimate of the proportion of patients referred to the refugee clinic that may benefit from formal psychiatric assessment but have not previously been identified. It will provide information that can be used to plan the provision of coordinated mental and physical health care for refugees by hospital-based and primary care services.
Concepts of mental health and illness among refugee patients at a tertiary referral clinic
Supervisor: Dr Chris Lemoh, Dr Caroline Marshall, Dr Karin Leder, Prof Fiona Judd, A/Professor Beverly-Ann Biggs,
Location: The Department of Medicine (RMH/WH), The Royal Melbourne Hospital, The Centre for Womens Mental Health, Royal Womens Hospital
Contact: Dr Chris Lemoh T: 8344 6252 E: c.lemoh@pgrad.unimelb.edu.au
A/Professor Beverly Biggs T: 8344 3256 E: babiggs@unimelb.edu.au
Background: Many patients referred to the refugee health clinic have had previous traumatic experiences and face ongoing psychosocial stresses during resettlement in Australia. Undiagnosed mental illness may have a significant impact on quality of life and success of resettlement, but the subjective experience and verbal descriptions of the symptoms of mood and anxiety disorders may be influenced by cultural background and linguistic medium of communication. Standardised screening tools used to detect depression and anxiety disorders may over- or underestimate the prevalence of these conditions in refugees from non-English speaking backgrounds. Refugees from underdeveloped countries may also have poor physical health due to lack of access to health care, poor living conditions and exposure to infectious diseases. It may be difficult to distinguish between conditions that require physical or pharmaceutical intervention, from those that require psychological intervention.
Aim: To explore concepts of health and illness among refugees from Africa and South East Asia attending a refugee health clinic, focusing particularly on the subjective distinction between symptoms of illness attributed to physical causes and those attributed to psychosocial causes.
Methods: In depth, semi-structured interviews with patients born in Africa or South East Asia who arrived as refugees and are attending the refugee health clinic. Interviews will be recorded, transcribed and analysed thematically to identify key themes concerning concepts of health and illness, and the physical and psychosocial causes to which symptoms of illness are attributed.
Outcome: Improved understanding by clinicians of concepts of health and illness among patients attending the refugee health clinic, which will provide a basis for better identification and interpretation of symptoms elicited during clinical consultation, with more appropriate investigation and management of physical and psychological symptoms.
Diet and gastrointestinal symptoms among refugee patients at a tertiary referral clinic
Supervisor: Dr Chris Lemoh, Dr Caroline Marshall, Dr Karin Leder, A/Professor Beverly-Ann Biggs
Location: The Department of Medicine (RMH/WH), The Royal Melbourne Hospital
Contact: Dr Chris Lemoh T: 8344 6252 E: c.lemoh@pgrad.unimelb.edu.au
Dr Caroline Marshall T :9342 8891 E : caroline.marshall@mh.org.au
A/Professor Beverly Biggs T: 8344 3256 E: babiggs@unimelb.edu.au
Background: Patients attending the refugee health clinic have often experienced poor living conditions with difficulties maintaining adequate and balanced nutrition. Following migration, maintaining a healthy diet may be rendered difficult by poverty, unfamiliarity with locally available foods, and cultural concepts of healthy eating. Both gastrointestinal symptoms and enteric pathogens are common in this patient population, but the contribution of dietary habits to gastrointestinal symptoms is not clear.
Aims: To describe the type and prevalence of gastrointestinal symptoms, the dietary habits and concepts of healthy eating among patients attending the refugee clinic.
Methods:
- In-depth semi-structured interviews with patients attending the refugee clinic. Interviews will be recorded, transcribed and analysed thematically to identify key themes concerning concepts of healthy eating and difficulties encountered in maintaining a healthy diet.
- One month dietary diary of eating habits of patients who participate in in-depth interviews.
- Cross-sectional survey of patients attending the refugee health clinic, measuring the type and prevalence of gastrointestinal symptoms, as well the type and prevalence of diagnosed gastrointestinal infections and diseases established through routine clinical evaluation.
Outcome: Improved understanding of patient concepts of healthy diet and difficulties encountered in maintaining healthy eating habits during resettlement in Australia will enable clinicians and clinical nutritionists to engage more effectively in promotion of healthy eating habits for refugees attending the clinic, with appropriate provision of opportunities for clinical consultation and patient information about healthy eating in Australia.
Patient perceptions of health care at a hospital-based refugee health clinic
Supervisor: Dr Chris Lemoh, Dr Caroline Marshall, Dr Karin Leder, A/Professor Beverly-Ann Biggs
Location: The Department of Medicine (RMH/WH), The Royal Melbourne Hospital
Contact: Dr Chris Lemoh T: 8344 6252 E: c.lemoh@pgrad.unimelb.edu.au
Dr Caroline Marshall T :9342 8891 E : caroline.marshall@mh.org.au
A/Professor Beverly Biggs T: 8344 3256 E: babiggs@unimelb.edu.au
Background: Patients attending the refugee health clinic are referred by primary health care providers for investigation and management of a number of conditions that have few or no symptoms but carry risks of potentially preventable serious adverse health outcomes. Investigation and management of such conditions may result in short term physical discomfort, financial expense and psychosocial stresses for patients attending the clinic that may prejudice clinic attendance or compliance with prescribed therapy.
Aims: To understand patient concepts of the purpose and outcome of their assessment and management at the refugee health clinic.
Methods: Serial in-depth semi-structured interviews with patients attending the refugee health clinic for the first time. Interviews will be recorded, transcribed and analysed thematically to identify key themes concerning concepts concerning patient concepts of the purpose and outcome of their attendance at the refugee health clinic.
Outcome: Improved understanding by clinicians and clinic staff of patient concepts of the purpose of their assessment and management at the refugee clinic, enabling clearer explanation to patients of the purpose of the consultations, goals to be attained, and expected outcomes. It is hoped that clearer explanation to patients will result in more consistent attendance at appointments and improved compliance with prescribed therapy, as well as better patient satisfaction with the outcome of clinic consultation.
Mannose-binding lectin’s contribution to ocular defences against infection.
Supervisors: Associate Professors Damon Eisen and Mark Daniell, Victorian Infectious Diseases Service and Department of Ophthalmology, Royal Melbourne Hospital.
Location: Victorian Infectious Diseases Service, RMH.
Contact: A/Professor Damon Eisen T :9342 8818 E: damon.eisen@mh.org.au
Mannose-binding lectin (MBL) is a pattern recognition receptor of the innate immune system that contributes to killing of a broad range of micro-organisms. Deficiency of this serum protein is common and predisposes to numerous infectious diseases. MBL is present in small concentrations in the lungs, joints and, as shown by our group, eyes if they are inflamed and probably contributes to local defences against pathogens. A recent study of fungal keratitis in murine corneas has shown that MBL is one of a handful of inflammatory pathway genes that are upregulated. Furthermore, MBL was shown to be produced locally in murine corneas which is a particularly notable finding. These data suggest that MBL is important in the local response to corneal infection. The contribution of MBL to prevention of endophthalmitis is undefined.
This honours project will explore human correlates of the murine keratitis study. Human corneal cells from cell cultures will be infected with Pseudomonas aeruginosa, a common cause of keratitis, and MBL mRNA will be measured by RT-PCR. Immunohistochemical staining of corneal rims will also be undertaken to establish whether MBL is produced locally in human corneal cells. To investigate the link between endophthalmitis and MBL deficiency both a case control study of endophthalmitis and analysis of an animal model may be undertaken.
Note: this project is also listed under Ophthalmology
Could aspirin improve outcomes in severe staphylococcal infections.
Supervisors: Associate Professor Damon Eisen and Dr Anna Walduck, Victorian Infectious Diseases Service, Royal Melbourne Hospital and Department of Microbiology and Immunology, University of Melbourne.
Location: Victorian Infectious Diseases Service, RMH.
Contact: A/Professor Damon Eisen T :9342 8818 E: damon.eisen@mh.org.au
Aspirin is one of the most widely used medicines and it may have a novel effect in reducing the severity of infections, particularly due to Staphylococcus aureus. This gram-positive bacteria is a common cause of severe disease in both community and nosocomial settings. Aspirin has already been shown to have benefits in-vivo and in animal models of S. aureus infective endocarditis. Here, aspirin is able to inhibit S. aureus virulence determinants such as fibronectin binding protein and alpha-toxin. Aspirin reduces the size of vegetations and the frequency of embolic events in animals with experimental S. aureus endocarditis. A recent development in staphylococcal infections is the role played by non-multiresistant MRSA or caMRSA that causes severe skin disease and necrotising pneumonias particularly in patients from the community.
This honours project will investigate other pathogenic determinants in the S. aureus agr operon particularly lukS/F and spa that encode Panton-Valentine leukocidin and protein a respectively. These are both thought to be critical to the development of severe caMRSA disease. Type strains and clinical isolates of caMRSA will be investigated to see whether aspirin is able to inhibit PVL and spa in-vitro. Animal models of necrotising pneumonia will also be investigated to see whether aspirin can improve outcomes in this devastating disease through inhibition of the virulence determinants mentioned.
Targeted analysis of Victorian Sentinel Surveillance data for HV and other STIs
Supervisor: Dr Mark Stoove, Head HIV/STI Research Group Centre for Population Health, Burnet Institute
Location: Centre for Population Health, Burnet Institute
Contact: Dr Mark Stoove E: stoove@burnet.edu.au
The Burnet Institute manages the Victorian Primary Care Network for Sentinel Surveillance on BBVs and STIs on behalf the Department of Human Services. The surveillance system collects demographic and risk behaviour data from patients attending clinical sites that see high caseloads of key at risk populations for HIV and other STIs, such as gay men and young people. The system then links this information with laboratory test results, allowing for crude estimates of transmission incidence and testing histories. Opportunities exist for targeted epidemiological analyses of these data, including cohort analyses, to answer key questions relating to HIV and other STI risk and prevention. Such questions include, but not limited to, an assessment of the accuracy of self-reported HIV testing histories and an examination of socio-demographic correlates of risk behaviour and HIV and other STI transmission.
Patterns of drug dependence treatment and other health service utilisation among post-release prisoners with a history of injecting drug use
Supervisor: Dr Mark Stoove, Head HIV/STI Research Group Centre for Population Health, Burnet Institute
Location: Centre for Population Health, Burnet Institute
Contact: Dr Mark Stoove E: stoove@burnet.edu.au
Recruitment and prospective data collection from a cohort of post-release prisoners with a history of injecting drug use is currently being undertaken at the Burnet Institute. This project will involve the targeted analysis of this prospective data to examine factors related to entry and maintenance in post-release drug treatment programs in the first six months post-prison release. This data will be augmented by qualitative interviews with key informant service providers to examine personal, social and structural factors that facilitate or impede successful drug dependence treatment outcomes in this population.
Social networking sites for sexual health promotion to at-risk populations
Supervisor: A/Professor Margaret Hellard, Head, Centre for Population Health, Burnet Institute and Dr Mark Stoove, Head HIV/STI Research Group Centre for Population Health, Burnet Institute
Location: Centre for Population Health, Burnet Institute
Contact: A/Prof Margaret Hellard. T: 03 9282 2163 Email: Hellard@burnet.edu.au
Dr Mark Stoove E: stoove@burnet.edu.au
The Burnet Institute is conducting project using social online networking sites such as Facebook to disseminate sexual health promotion messages to gay men and young heterosexual populations through the establishment of a fictitious group of “friends”. In collaboration with the University of Melbourne and the Victorian College of the Arts, background preparation and planning for this project is being conducted in 2009 with the project “going live” during 2010. An opportunity exists to evaluate this project through a mixed-method approach. Narrative analysis of online dialogue, interviews with participants and quantitative analysis of evaluation data will inform recommendations and implications regarding the use of new technologies and online social networking for sexual health promotion, particularly to young people.
HIV infection in the heterosexual community – understanding the changing epidemic in Victoria
Supervisor: Dr Mark Stoove, Head HIV/STI Research Group Centre for Population Health, Burnet Institute and Dr Isabel Bergeri, Surveillance manager, Centre for Population Health, Burnet Institute
Location: Centre for Population Health, Burnet Institute
Contact: Dr Mark Stoove E: stoove@burnet.edu.au
The Burnet Institute manages a variety of HIV surveillance systems on behalf the Department of Human Services, including HIV Passive Surveillance (all notifications data) and a Sentinel Surveillance Network of Primary Care Providers (clinics that see a high caseload of at-risk populations). Recent surveillance data suggests that Victoria is witnessing a diversification of HIV epidemiology, including higher rates of notifications among heterosexual populations. An opportunity exists to work with an expert and experienced team of public health epidemiologists to examine in detail the changing patterns of heterosexual transmissions of HIV in Victoria. The project will work with existing HIV surveillance data at Burnet and elsewhere and collect new data to examine potential correlates of increasing heterosexual notifications to guide public health interventions and inform policy responses.
Coming of age: A study of opiate use after 50
Supervisor: Dr Peter Higgs, Centre for Population Health, Burnet Institute
Location: Centre for Population Health, Burnet Institute
Contact: Dr Peter Higgs E: peterh@burnet.edu.au/ phiggs@nchecr.unsw.edu.au
Data on both illicit opiates like heroin and licit opiates such as methadone among those aged over 50 years are scarce. The data collected on people accessing needle and syringe programs in Melbourne shows that for the period 2006-2007 those aged over 46 years made up between 5-8% of the total contacts.
This pilot study will utilise a number of research methods. These include the running of focus groups, structured surveys and in-depth interviews.
All participants will be aged over 50 years. 75 participants (half in a formal methadone program and half who are using illicit opiates only) will be recruited to the structured quantitative survey. We will conduct about 20 in-depth qualitative interviews with participants with the aim of recruiting half from each group (licit and illicit opiates).
In Australia there has yet to be any in-depth study of the effects of methadone in maintenance doses on people who have been using it for many years. The advent of a more maintenance style pharmacotherapy program in Australia during the mid 1980s means that there are likely to be people who have been enrolled in methadone for over 20 years now.
The pilot data collected in this study will inform the development of a more in-depth study with possible funding sourced from the National Health and Medical Research Council. We also envisage that there will be peer review manuscripts developed based on the data and submitted for publication in suitable scientific journals.
Abstracts will also be developed for local and international conferences.
The PADIE II project: drug use, health and risky behaviour in the emergency department
Supervisor: Dr Stuart Kinner, Centre for Population Health, Burnet Institute
Location: Centre for Population Health, Burnet Institute
Contact: Dr Stuart Kinner. T: 03 8506 2368 E: kinner@burnet.edu.au
The Patterns of Alcohol and Drug Use in Emergency (PADIE II) study involved face-to-face interviews with patients who presented to the Gold Coast (QLD) hospital emergency department over a 2 weeks period, 24 hours a day, 7 days a week. In total, around 1,200 patients completed an interview exploring a range of health issues including the nature of their presentation, their alcohol and other drug use history, sexual risk behaviour, mental health and general health. This project will involve analysis of this large dataset and publication of a paper, with a focus on the links between substance use, mental health and sexual risk behaviour.
Monitoring and improving the health of ex-prisoners: A randomized controlled trial
Supervisor: Dr Stuart Kinner, Centre for Population Health, Burnet Institute
Location: Centre for Population Health, Burnet Institute
Contact: Dr Stuart Kinner. T: 03 8506 2368 E: kinner@burnet.edu.au
The Passports to Advantage project is a world-first: a large, randomised controlled trial of a health intervention for adult ex-prisoners in Queensland, Australia. The project involves 1,500 adult men and women completing a comprehensive health assessment in the weeks prior to their release from custody, and again 1, 3 and 6 months post-release. Half of the sample will receive a tailored support package both prior to and after their release from custody. This project involves analysis of the baseline data, with a particular focus on the links between drug use, mental illness and infectious disease.
Drug Trend Monitoring in Regional Victoria
Supervisor: A/Professor Paul Dietze, Head, Alcohol and Drugs Research Group, Centre for Population Health, Burnet Institute and Mr Brendan Quinn, Alcohol and Drugs Research Group, Centre for Population Health, Burnet Institute
Location: Centre for Population Health, Burnet Institute
Contact: A/Prof Paul Dietze. T: 03 9282 2134 E: pauld@burnet.edu.au
The aim of this project will be to investigate patterns of injecting drug use and characteristics of drug markets in a site in regional Victoria. The Illicit Drug Reporting System (IDRS), established in Melbourne in 1997 has added considerably to our understanding of patterns of injecting drug use and harm along with the characteristics of illicit drug markets in Melbourne. However, in general the IDRS is limited to a consideration of these drug-related issues in metropolitan Melbourne. Indeed, there is little known about drug consumption in Victoria outside of metropolitan Melbourne other than in relation to tobacco and alcohol. The absence of such data presents a significant impediment to the formation of effective policy responses. The implementation of the IDRS methodology in a regional setting will provide useful information on trends in drug use in non-metropolitan Victoria.
Media reporting on alcohol in Victoria since 2007
Supervisor: A/Professor Paul Dietze, Head, Alcohol and Drugs Research Group, Centre for Population Health, Burnet Institute and Professor Robin Room, University of Melbourne
Location: Centre for Population Health, Burnet Institute
Contact: A/Prof Paul Dietze. T: 03 9282 2134 E: pauld@burnet.edu.au
Professor Robin Room. E: rroom@unimelb.edu.au
From 2007 onwards there has been a dramatic increase in the amount of media reporting on alcohol and alcohol-related issues in the Victorian community. The aim of this project will be to document and analyse the content of this media reporting with a view to describing the main issues examined and better understand the place of key players (eg alcohol industry, researchers, government) and their role in the media portrayal of alcohol.
The experience of violence among injecting drug users
Supervisor: A/Professor Paul Dietze, Head, Alcohol and Drugs Research Group, Centre for Population Health, Burnet Institute and Ms Lucy Frankin, Alcohol and Drugs Research Group, Centre for Population Health, Burnet Institute
Location: Centre for Population Health, Burnet Institute
Contact: A/Prof Paul Dietze. T: 03 9282 2134 E: pauld@burnet.edu.au
Overseas experience shows that injecting drug users are known to experience violence, as both victims and perpetrators. In this project existing data will be analysed to document the nature and extent of violence amongst a sample of injecting drug users. This analysis will be supplemented by a series of qualitative interviews with participants to better understand the context in which some of the experienced violence has occurred.