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The George Institute for Global Health
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Predicting cardiovascular risk using routine mammograms

Background Cardiovascular disease (CVD) is a leading cause of death in women, but women are less likely to have a heart health check than a mammogram. Women at risk of cardiovascular disease are often unaware of their risk. Breast arterial calcification (BAC) identified on a mammogram is a strong predictor of subsequent cardiovascular disease. Aims To use routine mammograms to predict the risk of a major adverse cardiovascular event in women Method This study uses data provided from Lifepool, a cohort of 54,000 women across Australia. All women within this cohort have completed a comprehensive baseline health survey and 99.9% have consented to have their Lifepool information linked to routinely collected health administrative datasets. Potential Impact Creating a CVD risk algorithm using routine mammograms will allow mammography to be used as a ‘2 for 1’ screening test in women, potentially identifying more women at risk. Fast Facts 1.4 million Australian

Reducing under-representation of women in stroke clinical trials

Background Women are disproportionately underrepresented in stroke trials relative to the burden of disease in the population. While women and men have a similar lifetime risk of stroke (one-in-four), women are more disabled, have worse quality of life, and require more supportive care. One way to address disparities in such outcomes is to ensure sufficient representation of women in stroke clinical trials, thereby increasing the likelihood that results are generalisable to women in the population. Clear guidance and effective implementation strategies are required to improve the inclusion of women in clinical trials. Aim To provide evidence regarding the effectiveness of strategies to improve recruitment and retention of women in stroke trials. Method Assess screening logs from two completed and one ongoing international trial. Conduct a survey and focus group discussion with stroke survivors to explore barriers and facilitators of participation in stroke trials. Develop

DIVINE NSW: Preventing Type 2 Diabetes among women who experience gestational diabetes

Background Gestational Diabetes Mellitus (GDM), once thought to be fully reversed after pregnancy, is now a firmly established independent risk factor for Type 2 Diabetes Mellitus (T2DM), cardiovascular disease and other chronic conditions. Given the high levels of risk, low-cost and scalable pharmacological preventive approaches may prove an effective tool for prevention of GDM. While there is strong rationale for preventive strategies focused on behavioural modification in women with prior GDM, the early years after pregnancy present unique challenges to mothers. Aims This study will: Measure prevalence and identify predictors of persisting abnormal blood sugar levels (dysglycaemia) among women with recent GDM. Identify women’s views and the views of their healthcare providers on the long-term risks of T2DM. Examine the feasibility of a randomised controlled trial of preventive drug therapies, in addition to lifestyle interventions, among this population. Method One

Scaling-up The Competency of Primary Care Workers to Manage Epilepsy by Task-Sharing (STOP-Epilepsy)

Background Most people in low and middle-income countries (LMICs) such as India cannot access quality healthcare. A paucity of healthcare workers, particularly specialist physicians, is one of the main reasons. Task-sharing approaches in LMICs were recently reviewed and found to be a viable option to improve disease outcomes while also leading to capacity building and cost savings. Epilepsy, one of the commonest neurological disorders, affects 50 million people worldwide, of whom, a fifth live in India. It accounts for 14 million disability-adjusted life years and 1,26,000 deaths worldwide each year. The treatment gap is high, almost 50-80% in India. A professional resource gap is one of the important reasons for the treatment gap. There is a lack of specialists to manage epilepsy across the country. Our previous study points towards an unmet need for a comprehensive approach towards epilepsy care in the community, which should essentially include capacity building among care providers, raising commu

George Institute submission on Transforming Australian Food Systems

Policy & Practice Report

Reducing stigma and increasing the mental wellbeing of Scheduled Tribe communities in India (SATHI)

BackgroundThe Scheduled Tribe (ST) population is a marginalised community in India and has greater vulnerability to mental health issues for multiple reasons, including the impact of rapid social changes altering their lifestyles, beliefs and community living; the strain of acculturation when moving to urban spaces; and the use of alcohol and other substances.Our pilot study among ST communities in Andra Pradesh, where they constitute about 7% of the population, found a lack of mental health awareness and limited mental health care facilities.A more sustainable model involving the community and empowering members to act as change agents to enhance mental health facilities is needed to bring about sustainable improvements in mental health and wellbeing. AimsTo address selected social determinants of mental health to promote mental health and well-being among ST communities over three years by building the capacities of community members to act as lay counsellors and strengthening the capacity of the publi

How can Local Health Districts and Networks cultivate anti-racist hospitals?

Background Racism has been clearly identified as a determinant of health and wellbeing for Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander people continue to experience racism and discrimination within the Australian healthcare system. Racism is causing dire health consequences and inhibiting access to quality and safe healthcare services.  Aims To comprehensively understand and address the complex dynamics of racism, bias and colonisation in reforming hospital care for Aboriginal and Torres Strait Islander people and families. Methods Decolonise existing tools such as the Readiness to Change Assessment (RCTA) and Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Evaluate health organisations’ readiness to change beliefs, attitudes and processes that maintain inequity. Undertake Aboriginal patient journey mapping and review governance structures, workforce development, current quality indicators and processes f

Risk Elimination on Walks to School (REmWalkS)

Every year, an estimated 350,000 children and adolescents are killed in road traffic crashes (RTCs) or by the effects of urban outdoor air pollution, to which road traffic is a significant contributor. RTCs are the leading cause of death for children and adolescents worldwide but those in resource-limited settings are disproportionately affected with 93% of child road traffic deaths occurring in low- and middle-income countries. In addition to the deaths, injuries and disabilities caused by road collisions, children in urban areas often also sustain insidious damage to their developing lungs and brains by breathing traffic-related air pollutants (TRAP). TRAP exposure can result in growth stunting, delays in cognitive development  and chronic respiratory problems. Due to the many overlapping causal factors linking road safety and personal air pollution exposure, there are significant opportunities for complementary mitigation measures to drive improvements in child health, safety, and wellbeing. In

Submission to WHO public consultation on the draft guideline ‘fiscal policies to promote healthy diets’

Policy & Practice Report

Health service delivery reforms during and after economic crisis

Policy & Practice Report

Awareness, familiarity, and use of core outcome sets by Indian trialists and systematic reviewers

Background Evidence-based medicine is informed by randomised control trials (RCT) and systematic reviews. Outcomes chosen in these research methods are important in determining if interventions are effective and safe. Research outcomes chosen based on previous research or stakeholder opinions tend to be inconsistent across studies. This variability and lack in consistency makes it difficult to pool data to inform healthcare practice and policy. Core outcome sets (COS) are consensus-derived, standardised sets of outcomes that should be minimally measured in trials on a specific health condition or disease. Using COS enhances the ability to identify meaningful comparisons across research and examine the benefits or harms of interventions. However, COS usage still varies widely across areas of healthcare research. Only 2% of reviewed late-phase clinical trials published 2019-2020 reported using a COS, and just 65% of trialists surveyed in 2021 were familiar with COS. Understanding the current awareness

Towards 2030 and beyond – launch of report from roundtable on building inclusive, sustainable economies that deliver health and wellbeing

Policy & Practice Report

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