Current Research Projects

Below are links to the information pages on the current KAMS and Kimberley RCSWA research projects (currently being updated):

Diabetes

ORCHID Study: Predicting gestational diabetes mellitus in rural communities

Developing algorithms to improve predicting the development of and screening for GDM in rural communities

Gestational diabetes mellitus (GDM) is impaired glucose tolerance first detected in pregnancy. GDM is associated with a range of adverse neonatal and maternal outcomes. GDM is the commonest maternal antenatal abnormality in Australia. Screening is conducted in order to detect women at risk of disease, facilitating earlier management and treatment. Currently available evidence indicates that treatment of GDM with dietary modifications, glucose monitoring, and metformin and insulin (if needed) can significantly reduce the risk for adverse birth outcomes.

Current screening recommendations are for all pregnant women who are not known to have diabetes or GDM to have an oral glucose tolerance test (OGTT) at 24-28 weeks gestation. Women need to be fasted for this test and blood samples are taken immediately prior to consumption of a 75g glucose drink, and 1 and 2 hours later. Many women decline screening.

Alternative methods for diagnosing GDM or alternative methods for screening that lead to a reduction in the number of OGTTs required need to be found if we are to improve screening rates. We want to see if levels of glycation products such as HbA1c at first and third trimester antenatal visit predict the risk of developing GDM later in pregnancy or can be used instead of OGTT where an OGTT is difficult to achieve or refused by the patient.

The aims of this project are:

  • To determine at baseline the number of 24-28 week OGTTs completed on at least 100 antenatal patients in each study region expected to have had an OGTT.
  • To determine the relationship between first trimester antenatal information, including glycation products such as HbA1c, blood sugar levels, family history, obesity, maternal age, ethnic background, and 24-28 week glycation products, with 24-28 week OGTT.
  • To determine the proportion of women enrolled in the study requiring an OGTT who complete the OGTT at 24-28 weeks gestation.
  • To increase research interest and capacity among health service and RCSWA staff and students, and to build skills in rural and remote health service research.

To ensure that the project findings are generalisable to the broader regional, remote primary health care environment, it will be carried out in a range of health care services across Western Australia: Kimberley, Southwest, Greater South, Midwest and Goldfields.

This project is a collaboration between The Rural Clinical School of WA, KAMS, WA Country Health Services – Kimberley, Harry Perkins Institute and is funded in part through an RCSWA Multi-site Project Grant, Lishman Health Foundation grant and Diabetes Australia grant.

Progress to date: We are in the final stages of data collection.

Researchers:

  • Assoc Prof Julia Marley, RCSWA Broome
  • Erica Spry, KAMS
  • Emma Jamieson, RCSWA Bunbury
  • Assoc Prof Andrew Kirke, RCSWA Bunbury
  • Assoc Prof Kylie Sterry, RCSWA Kalgoorlie
  • Assoc Prof Sarah Moore, RCSWA Bussleton
  • Assoc Prof Carly Roxburgh, RCSWA Albany
  • Assoc Prof Susie Grainger, RCSWA Carnarvon
  • Dr Sally Singleton, KAMS
  • Dr Emma Griffiths, KAMS
  • Dr Cynthia Porter, GRAMS
  • Dr Jaye Martin, WACHS-K
  • Prof David Atkinson, RCSWA Broome

Prevention of type 2 diabetes amongst young Aboriginal people in Derby, Western Australia

Type 2 diabetes (T2DM) is a largely preventable disease that involves a significant burden on individuals and communities. Aboriginal and Torres Strait Islander people have higher rates of T2DM than other Australians in all age groups, with larger differences in younger age groups – a time when the onset of diabetes is associated with earlier progression to serious health complications.

The primary prevention of T2DM though lifestyle modification, for people who may have pre-diabetes and for communities in general, is considered to be a beneficial approach. In this project, under the guidance of Derby Aboriginal Health Service (DAHS), young people in Derby will be actively involved in developing and implementing an intervention to support lifestyle changes with a view to preventing T2DM. The overall aim of this PhD project is to contribute to the prevention of type 2 diabetes amongst young people in Derby through supporting healthy lifestyle changes.

The specific aims of this project are to:

  • Describe the pattern of glycated haemoglobin (HbA1c) levels in young Aboriginal people in Derby (15-39 years of age, with a major focus on 15-25 years of age), and identify the factors associated with individuals having improved glycaemic control over time.
  • Identify lifestyle interventions that are acceptable to young people in Derby and are considered to be of most potential benefit for them.
  • Trial a pilot community-driven lifestyle intervention with Derby Aboriginal Health Service (DAHS) and assess acceptability and the short-term outcomes of this intervention.

Researchers:

  • Kimberley Seear, PhD Candidate, RCSWA Derby
  • Assoc Prof Julia Marley, RCSWA Broome
  • Erica Spry, KAMS
  • Dr Lynn Henderson-Yates, DAHS
  • Prof David Atkinson, RCSWA Broome

Qualitative and quantitative effects of exenatide use in Kimberley Aboriginal patients with type 2 diabetes

There are many Aboriginal patients in the Kimberley with type 2 diabetes, and the care of these patients poses significant challenges throughout the Kimberley. The mainstay of treatment until recently was lifestyle advice, oral tablets and insulin. In 2015 a new injectable medication, exenatide,  was added as a therapeutic option. It works via a different mechanism to insulin and is often used in combination with oral tablets. Previous studies have shown benefits in reducing blood sugar levels, assisting in weight loss, and being well tolerated. The injection is usually given twice a day, but is now also available in a weekly dose.

Aims

The overall aim of the project is to contribute to improving the management of type 2 diabetes in Kimberley Aboriginal patients. The specific aims are to:

  • To evaluate the acceptability of exenatide among Kimberley Aboriginal patients with type 2 diabetes.
  • To describe the efficacy of exenatide among the study population to improve glycaemic control and other components of the metabolic syndrome.
  • To use this project and the findings to build capacity amongst the local Aboriginal community regarding diabetes management and skills for future research.
  • To provide feedback to local clinicians regarding the use of exenatide in local Aboriginal communities.

Researchers

  • Dr Sarah Straw, Advanced Trainee in General Medicine – WACHS Kimberley Regional Physician Team
  • Denetta Cox, Aboriginal Health Worker, Beagle Bay, KAMS
  • Erica Cox, Aboriginal Health Worker, Beagle Bay, KAMS
  • Luiey Anawana, Aboriginal Health Worker, Bidyadanga, KAMS
  • Vaughan Matsumoto, Beagle Bay Coordinator, KAMS
  • Erica Spry, Aboriginal Research Officer, KAMS
  • Dr Lydia Scott WACHS Kimberley Regional Physician, General Medicine Consultant
  • Dr Sally Singleton KAMS General Practitioner, Bidyadanga
  • Dr Naomi Houston KAMS General Practitioner, Dampier Peninsula
  • Assoc Professor Julia Marley

Kidney Disease

Clinical review of dialysis patients originating in the Kimberley region

Over the past 20 years an epidemic of end-stage kidney disease (ESKD) has occurred among Aboriginal and Torres Strait Islander people in remote areas of Australia. The Kimberley Satellite Dialysis Centre (KSDC) was established in October 2002 in recognition of the growing need for dialysis in the Kimberley and after requests from patients to be able to dialyse in the region. Prior to this patients requiring haemodialysis either relocated to Perth for treatment or stayed at home to die.

Most reports on kidney disease in the Australian Aboriginal and Torres Strait Islander population in scientific journals describe the progression of kidney disease and treatment options prior to dialysis. There are very few published reports on health outcomes, including survival times for Aboriginal and Torres Strait Islander patients on dialysis.

The aims of this study are:

  • To determine the future need for dialysis in the Kimberley
  • To undertake a clinical audit of the implementation of best-practice guidelines for Kimberley clients with proteinuria and chronic kidney disease
  • To determine the outcomes of haemodialysis and peritoneal patients in the Kimberley

Researchers:

  • Assoc Prof Julia Marley
  • Prof David Atkinson

Progression of chronic kidney disease to end stage: A retrospective cohort study from the Kimberley region

Chronic kidney disease (CKD) is a significant health problem within Australia; accounting for almost $900 million in health care expenditure in 2004-05. Rates of detected CKD in the Kimberley region continue to increase.

Within Australia, rural and remote Aboriginal and Torres Strait Islander people are some of the most significantly affected by CKD. This is reflected by higher incidence rates of CKD within this population, particularly end-stage kidney disease (ESKD) where renal replacement therapy (RRT) is required to sustain life.

Certain risk factors have been well established to contribute to the development, and worsening of pre-existing CKD. These include diabetes, cardiovascular disease and smoking. A growing body of evidence is also supporting a link between acute kidney injury and the progression of exiting CKD. The relative contribution of acute and chronic stressors to the progression of CKD in the Aboriginal population has not been previously documented. This study will aim to address this gap.

The aims of this study are:

  • To identify the number of episodes of acute kidney injury in a cohort of patients with CKD
  • To describe the cause and severity of these acute kidney injury episodes
  • To compare the progression of chronic kidney disease towards ESKD between people with CKD with and without a history of acute kidney injury, whilst identifying and controlling for chronic disease indicators that are known to increase the risk of progression to ESKD
  • To document service indicators (care provided by the Kimberley Renal Services and visiting nephrology services) and the impact on risk of progression to ESKD.

Researchers:

  • Dr Emma Griffiths
  • Joseph Mohan
  • Marcin Skladaniec
  • Prof David Atkinson
  • Assoc Prof Julia Marley

Palliative care in end stage kidney disease: Are we meeting the needs of our Indigenous clients?

Palliative care has been integrated into the kidney disease pathway care plan in the last few years. However no study to date has been done to ascertain if we are meeting the needs of our renal clients in their last days and weeks of life. As the burden of kidney disease has reached epidemic proportions in the Kimberley it is important to ensure that renal clients have an understanding of palliative care and the support it can provide. In order to deliver a quality service in line with the National guidelines it is imperative that we seek clarification from our Aboriginal clients on what their needs are in end of life care. This will help determine if we are meeting the needs of our Aboriginal renal clients.

We will conduct a twofold study to investigate this question further. Firstly a retrospective case note study from 5-10 renal clients who either opted to discontinue dialysis or renal replacement therapy was no longer an option. We will identify their use, if any, of palliative care and when discussions around end of life took place.

The second part of the project will be a qualitative investigation in the form of open ended interviews with a cohort of 10-12 renal clients. The participants will be from amongst the clients who attend the Kimberley Satellite Dialysis Centre. Questions will be aimed at learning end of life wishes, palliative care conceptions and when initial palliative care discussions first began and how these were perceived. This will give insight into the expectations of clients in their last days and weeks of life and their understanding of palliative care.

It is hoped that following evaluation of this research it will inform future program development and improve quality of palliative care service delivery for renal clients in a culturally appropriate and timely manner.

Researchers:

  • Jenny Costigan
  • Assoc Prof Julia Marley
  • Prof David Paul
  • Prof David Atkinson

Social & Emotional Wellbeing

Improving mental health screening for Aboriginal and Torres Strait Islander pregnant women and mothers of young children

This study aims to improve screening for, and contribute to addressing, mental health issues during pregnancy and the first 12 months after the birth of the baby.

The locally developed, culturally appropriate and user friendly Kimberley Mum’s Mood Scale (KMMS) was validated against clinical assessment in a sample of 91 Kimberley Aboriginal women. Kimberley regional guidelines now recommend using the KMMS to screen for anxiety and depression during the perinatal period for Aboriginal women. The next step for Kimberley health services are to increase and improve KMMS screening in pregnancy and postnatally and address identified mental health issues. Project staff will work closely with Kimberley services to find out:

  • How the KMMS can best be implemented into routine practice in each service
  • If, during routine use:
    • The KMMS cut point of moderate still detects everyone with GP assessed clinically moderate or high severity depression and anxiety, and:
    • That the management plans developed during the KMMS for those at lower risk are appropriate.

In order to meaningfully assess the above and to test for applicability in other remote regions to inform recommendations for wider use, it is important to re-evaluate the KMMS in a larger population during real world implementation. In partnership with health services and Aboriginal communities in northern Western Australia (WA) and Far North Queensland (FNQ), this study aims to:

  • adapt the Kimberley Mum’s Mood Scale (KMMS) and develop locally appropriate versions for participating partners as required;
  • evaluate the real-world performance of KMMS in the Kimberley and other remote regions in northern Australia; and
  • evaluate the process of implementation.

Researchers:

Project Staff:

  • Emma Carlin, Research Fellow, RCSWA
  • Diana Jans, KMMS Research Project Officer, Apunipima Cape York Health Council, Cairns

Chief investigators:

  • Professor David Atkinson, RCSWA
  • A/Professor Julia Marley, RCSWA
  • A/Professor Mark Wenitong, Apunipima Cape York Health Council, Cairns
  • Professor Karen Edmond, Unicef and University of Western Australia
  • Dr Ernest Hunter, James Cook University, Cairns
  • Dr Catherine Engelke, Rural Clinical School of WA, WA Country Health Service – Kimberley, Kununurra
  • Professor Rhonda Marriott, Murdoch University, WA Department of Health, Perth
  • Dr Sandra Campbell, James Cook University, Cairns
  • Dr Stephanie Trust, Kununurra Medical, Kununurra
  • A/Professor Murray Chapman, Abbotsford Psychiatry, Perth

Partner Investigators

  • Ms Janet de San Miguel, KAMS, Broome
  • Dr Emma Griffiths, KAMS and RCSWA, Broome
  • A/Professor Rubin, Apunipima Cape York Health Council, Cairns
  • Dr Karla Canuto, Apunipima Cape York Health Council, Cairns
  • Ms Melissa Williams, WA Country Health Service – Kimberley, Broome
  • Dr David Cutts, WA Country Health Service – Pilbara
  • Dr Sarah McEwan, WA Country Health Service – Pilbara
  • Dr Kylee Cox, WA Country Health Service – Central Office, Perth

Associate Investigators

  • Donna Stephen, KAMS
  • Jayne Kotz, Murdoch University, Perth
  • Dr Sharon Evans, RCSWA, Perth

Aged Care

Health outcomes of older Indigenous Australians: a 5 year follow up study of a population at risk

Health outcomes of older Indigenous Australians: a 5 year follow up study of a population at risk

We have been involved in landmark research addressing dementia in older Aboriginal and Torres Strait Islander peoples since 2003. The initial development and validation of a culturally appropriate cognitive assessment tool (Kimberley Indigenous Cognitive Assessment- KICA)  facilitated accurate screening for dementia in Aboriginal and Torres Strait Islander peoples living in rural and remote areas, which was not previously possible. We completed a dementia prevalence study of 363 people over the age of 45 years in the Kimberley during 2004-2006, documenting levels of dementia at a rate of 12.4%, rates that are much higher than non Indigenous Australians.

In this project, which will be based in Derby, it is proposed that the participants of the initial prevalence study cohort of 363 people, who would now be 50 years and over, will be re-assessed. A new cohort of those aged between 45-50 years in the same communities will be reviewed, to allow comparison with the previous study and to determine new cases of dementia and other aged care conditions, such as falls, depression and incontinence, in a comprehensive and standardised manner. Risk and protective factors for ongoing morbidity, functional decline and death will be determined. In addition documentation of community service utilisation will be undertaken and the extent and causes of carer burden would be quantified. This data is required for adequate planning and service provision for the older Aboriginal population, and to improve knowledge on preventative strategies for Aboriginal Australians.

Publications:

LoGiudice, D. C.; Smith, K.; Atkinson, D.; Dwyer, A.; Lautenschlager, N.; Almeida, O. A.; Flicker, L. Preliminary evaluation of the prevalence of falls, pain and urinary incontinence in remote living Indigenous Australians over the age of 45 years  Intern Med J.  2012;42(6): e102-7

Smith K, Flicker L, Dwyer A, Atkinson D, Almeida OP, Lautenschlager NT, LoGiudice D.  Factors associated with dementia in Aboriginal Australians. Aust N Z J Psychiatry 2010;44(10):888-893

Researchers:

Dr Dina LoGiudice
Prof Leon Flicker
Prof David Atkinson
Dr Kate Smith
Vicki O’Donnell
Stephanie Waters
Ruth Crawford
Prof Osvaldo Almeida
Geraldine Shadforth