Reproductive, maternal and child health research news

• Theme co-leaders, Cheryl Jones and Christopher O'Neill
• Pre-eclampsia: screening, assessment and management
• Improving rural health

Theme co-leaders, Cheryl Jones and Christopher O'Neill

Cheryl Jones is an Professor with the University of Sydney, and a paediatrician and infectious diseases specialist at The Children’s Hospital at Westmead. Professor Jones is head of the Centre for Perinatal Infection Research at the Kids’ Research Institute and a member of the University’s newly established Sydney Emerging Infectious Diseases and Biosecuity Institute. She heads a research program spanning clinical and laboratory investigations into immunobiology, surveillance, prevention and treatment of viral infections in pregnancy and transmission to the newborn.

Professor Jones has a special interest in viruses of the herpesvirus family (such as herpes simplex virus and cytomegalovirus) and in emerging infectious diseases such as influenza and arboviral causes of encephalitis.

Professor Jones became a clinical academic with the University in 2003, where she has held roles of Sub Dean postgraduate studies and then Sub Dean Research for the Discipline of Paediatrics and Child Health. She was awarded the Sydney Medical School Award for excellence in postgraduate research supervision, 2009, and highly commended for the Vice Chancellor’s Award in Postgraduate Research Excellence (2009).

Christopher O’Neill is an Associate Professor with the University of Sydney, Director of Sydney Centre for Developmental and Regenerative Medicine, Head - Division of Regenerative Medicine at the Kolling Institute of Medical Research, and Head of the Human Reproduction Unit at Royal North Shore Hospital.

Associate Professor O'Neill has a long-term interest in all aspects of conception and early pregnancy. He is one of the pioneers of modern assisted reproductive technologies. His current research interests include: regulation of survival and induction of pluripotency in the early embryo, activation of embryonic transcription, epigenetic reprogramming in the early embryo, and the long-term epigenetic and homeostatic consequences of ART on progeny, formation and genetic stability of pluripotent stem cells.

He has supervised more than 20 Postgraduate students and 25 honours students, and has held NHMRC project grant funding for the last 25 years. He is the founder and current convenor of Sydney University Reproduction Forum (the SURF club).

Professor Kathryn North - Investigating Neuromuscular Disorders

Professor Kathryn North is the Douglas Burrows Professor of Paediatrics at the University of Sydney, and Head of the Institute for Neuroscience and Muscle Research at the Children's Hospital at Westmead in Sydney. She is a world leader in neuromuscular disorders. Professor North’s muscle research focuses on the molecular basis of inherited muscle disorders, particularly the muscular dystrophies and congenital myopathies, to investigate the cause, understand the mechanism and develop specific therapies.

Professor North leads a large multi-disciplinary research team of more than 40 personnel including 20 laboratory based research scientists and postgraduate students as well as clinical researchers, physiotherapists, psychologists and genetic counsellors, working to find cures and develop and evaluate effective therapies. Professor North and her team care for over 900 children with a range of neuromuscular disorders. It is a team that has a direct focus on health outcomes for children and adults with incurable disorders.

She has made major innovations in the areas of gene discovery, improved diagnosis and prevention, understanding of disease mechanism and the development and evaluation of novel therapies through clinical trials. Professor North’s research has not only significantly advanced the understanding of neuromuscular disorders, but has had an immeasurable impact on the lives of those suffering from these disorders by offering improved diagnosis and disease management.

Her research has lead to two significant achievements in Biomedical Science. In the process of studying genes implicated in muscle disease, Professor North discovered a common null polymorphism in the gene encoding α-actinin-3 which is a major structural component of fast muscle fibres. α-actinin-3-deficient individuals express only α-actinin-2 in their skeletal muscle. In 2003, she demonstrated an association between α-actinin-3 and skeletal muscle performance, where the expression of α-actinin-3 appears necessary for optimal forceful and rapid muscle contractions (to date no Olympic sprint athlete is deficient in α-actinin-3) and the absence of α-actinin-3 benefits endurance activities (reduced ability of the muscle to generate explosive power). Professor North demonstrated that α-actinin-3 represents an important genetic factor influencing variations in muscle performance in humans. She has pioneered research into the basis of human skeletal muscle performance and mechanisms underlying neuromuscular disorders.

Professor North leads a newly awarded NHMRC Centre for Research Excellence in Childhood Neuromuscular Disease.

Professor Lesley Barclay - Improving Rural Health

Lesley Barclay (AO PhD) is the newly appointed Professor and Director of the Northern Rivers University Department of Rural Health in Lismore. She is set to make a significant contribution to the development of research capacity in rural New South Wales.

As foundation Professor of Health Services Development at Charles Darwin University, Professor Barclay led the Graduate School for Health Practice that introduced a range of post graduate education for health professionals in the Northern Territory. She is a maternal child health researcher and health system reformer whose projects have improved maternity services in remote and urban Australia and internationally. Much of her recent research has been rural, remote or indigenous focused.

Professor Barclay has led over 30 competitive research projects in the last decade, and has been a CI on 12 NHMRC and ARC funded projects in this period, leading 8 of these. In the last 10 years she has supervised 25 doctoral students, published an international prize winning book with another to be published this year in the United States. Professor Barclay has also written 51 refereed research based journal articles and over 15 major reports for governments.

Professor Barclay has worked in international development for nearly 20 years with AusAID, World Bank and WHO, providing advice in primary health care, maternal infant/child health and capacity building in health worker education systems in Asia, Melanesia and the Pacific Islands. She was awarded an AO in 2004 in recognition of her contribution to professional and international development and child health.

2011 NHMRC GRANTS SUCCESS

In November 2011 the NHMRC announced the results of its project funding round. The University of Sydney received the highest amount of funding nationally, an outstanding result. Researchers from the Reproductive and Child Health Research Theme secured funding for projects ranging from gene therapy to reproductive diseases and child health.

There were two new NHMRC Centres of Research Excellence awarded:

• CRE in Neuromuscular disorders ($2,496,650- over 5b years). Led by Prof. Kathryn North (CHW clinical School/ Kids Research Institute).
• CRE in Immunisation in understudied and special risk populations led by Profs. Raina McIntyre (UNSW) and Prof. Peter McIntyre (CHW/NCIRS/KRI) ($2,499,969 over 5 years).

A number of theme Early Career Researchers were also successful in fellowships:

• Kirsty Walters won the Dean’s prize at this year’s theme meeting and was awarded an ARC Discovery Early Career Researcher Award.
• Nigel Clarke (KRI/CHW) received an NHMRC Career Development Award.
• Thomas Snelling (KRI SCHN), Jane Seto (KRI/ CHW) and Charmaine Tam (KRI/CHW) were all awarded NHMRC Early Career Researcher fellowships;

And Prof. Elizabeth Elliott (CHW/KRI) was awarded an NHMRC practitioner fellowship.

Associate Professor Christine Roberts, University of Sydney has been awarded a prestigious NHMRC Elizabeth Blackburn Fellowship for 2011. Associate Professor Christine Roberts is research director of Clinical and Population Perinatal Health Research at the University of Sydney’s Kolling Institute. Prior to her career in public health, she was a medical epidemiologist with clinical experience in obstetrics, paediatrics and neonatology. Her research focuses on utilising population health data to improve health, health service delivery, health policy and planning. She has published 135 papers in national and international journals, is a sought-after international speaker and an active member of research, government and professional organisations.

An overview of successfully funded projects can be found below. If you would like to feature your project on this site, please contact

The development of a composite index of need for regional maternity services: The Australian Regional Birthing Index (ARBI)

Overview: To develop and test an index that calculates the appropriate level of maternity service for populations under 25,000 in Australia. This will be achieved through the development and validation of an evidence based composite index of need, using birth rates, social vulnerability, isolation factors and service capacity. We will use an iterative, mathematical approach informed by complex adaptive systems theory with a range of data generated from a range of sources for regional communities to develop this population based score; the Australian Regional Birth Index (ARBI). The ARBI will be a robust tool that can inform policy decisions about the provision of maternity services in regional Australia. The process will be based on, and extend the principles, used to calculate the Canadian Rural Birth Index (RBI).

Contact: Lesley Barclay AO PhD
University Centre for Rural Health, North Coast

Gene discovery and functional studies to reveal mechanisms underlying mitochondrial respiratory chain disorders.

Overview: Mitochondrial respiratory chain (RC) disorders are a relatively common heterogeneous group of inborn errors of metabolism with devastating effects, where the underlying genetic defect is unknown ~70% of cases. Phenotypic variability and tissue specificity further complicate diagnosis and genetic counselling. Currently treatment options are poor and genetic counselling is limited in cases where the genetic aetiology is unknown.

We have a cohort of patients with mitochondrial RC disorders in whom the genetic cause is unknown, and for which we have DNA samples, primary cell lines and biopsies, and have developed an effective pipeline for gene discovery and functional analysis of RC disorders. As the majority of undiagnosed RC disorders arise from nuclear defects, we will use homozygosity mapping of consanguineous families to identify chromosomal regions that may harbour pathogenic mutations and whole exome sequencing to identify novel disease genes in small nuclear families with no known consanguinity. Once the causative gene has been identified, functional studies will then be undertaken to elucidate the pathogenesis and investigate phenotypic variability and tissue specificity where applicable.

Identification of mutations responsible for mitochondrial RC disorders would greatly improve the accuracy and usefulness of genetic counselling, and an understanding of their pathogenesis may assist the development of effective therapies.

Contacts:
Professor John Christodoulou
Dr Sandra Cooper
Children’s Hospital at Westmead

Role of androgens in polycystic ovary syndrome

Overview: Polycystic ovary syndrome (PCOS) affects 5-10% of women worldwide, yet its origins remain unknown. Androgens are implicated in the pathogenesis of PCOS, but the decisive, invasive studies needed to confirm and elucidate their roles are not feasible in women. Hence, we aim to use our innovative mouse models of androgen resistant female mice in combination with our PCOS rodent model to determine the role of androgens in PCOS aiming to better understand, and identify new treatments for this common female reproductive disorder.

Contact: Dr Kirsty Walters
ANZAC Research Institute

Generating evidence of reduced rates of overweight/obesity in children: value adding to four established Australasian early intervention trials.

Overview: We have established the Early Prevention of Obesity in CHildhood (EPOCH) Collaboration, comprising four innovative early obesity prevention trials currently underway in Australasia. We will combine the line-by-line raw data from each patient in each of these trials to achieve a final sample size of over 1,800 children. This methodology, known as Individual Participant Data (IPD) Meta-Analysis, will enable us to reliably test several key hypotheses, including whether such interventions reduce the prevalence of overweight/obese children in an Australasian setting.

Contacts:
Dr Lisa Askie
NHMRC Clinical Trials Centre, University of Sydney
Professor Louise Baur
Discipline of Paediatrics and Child Health, University of Sydney

Pain Mechanisms in Endometriosis

Overview: Our group received from the NHMRC $476,925 over a period of 3 years for research on endometriosis.

Three projects were funded:
1. Investigate the expression profiles and cellular localisations of candidate and novel molecules and genes that regulate cyclical neurogenesis in the female reproductive tract.
2. Undertake functional studies of nociceptive pathways and changes in activation and/or sensitisation during the menstrual cycle.
3. Exploration of sensitivity levels to external sensory stimuli in women with endometriosis-associated chronic pelvic pain compared with women without endometriosis.

Contact: Dr Robert Markham
QEII Research Institute for Mothers and Infants

FluMum Study

Overview: In Australia, influenza vaccination is recommended for all pregnant women who will be in their second or third trimester during the influenza season. Vaccine becomes available in February/March each year with the influenza season generally falling between May-October in the temperate regions and all year round in the tropical regions. As such, few pregnancies would not warrant vaccination. Although this national recommendation has been in place for the past decade, there has been no systematic monitoring of influenza vaccine uptake in pregnancy. In this multi-centre study in Darwin, Brisbane, Sydney, Melbourne, Adelaide and Perth, commencing in 2012, a prospective cohort of mother-infant pairs will be recruited through maternity units in the six sites over a 4-year period. The primary aim is to determine the effectiveness of maternal influenza vaccination against laboratory confirmed influenza among infant offspring during the first 6-months of life. In addition this study will report validated maternal influenza vaccine uptake rates across the country annually and assess the factors that influence the decision to receive influenza vaccination during pregnancy and examine why women aren't being vaccinated in pregnancy.

Contact: Dr Nicholas Wood
Children’s Hospital Westmead

Use of blood products in mothers and babies

Overview: This project will explore the safety and appropriate use of blood and blood products during pregnancy, childbirth and the newborn period. Partners in this research include the NSW Clinical Excellence Commission and the Australian Red Cross Blood Service. The $750,000 grant involves linkage of existing NSW population data (patient level outcome data on birth, hospitalisation, neonatal intensive care admission, deaths) with blood bank, blood product and pathology data. Co-investigators include Assoc Prof Christine Roberts, Prof David Irving, Ms Bernadette Harrison, Prof Jonathan Morris, Dr Jenny Bowen, Prof James Isbister and Dr Hugh Capper.

Contact: Dr Jane Ford
Clinical Population and Perinatal Health Research,
Northern Clinical School

Dr Tom Snelling named as Frank Fenner NHRMC Early Career Fellow

Dr Thomas (Tom) Snelling has been just announced as the “FRANK FENNER” NHRMC early career fellow, supporting his research project entitled "Applying active hospital-based case ascertainment to assess vaccine effectiveness and safety".

Australia makes a considerable investment in vaccination, and the public are entitled to expect that vaccines are both safe and effective. The growing complexity of the vaccine schedule requires the development of new and flexible systems to monitor vaccine performance. This project aims to do this using surveillance nurses embedded in children's hospitals to actively find cases of diseases which are potentially vaccine-preventable as well as those which might have occurred as a side effect of vaccination.

SYRENS HEALTHY TRAJECTORY

A network proposal to the Vice Chancellors SyReNS research network scheme was successful in the EOI phase. A full proposal was submitted in November entitled, The “Healthy Trajectories Research network in Child and Adolescent well being” by theme members Kate Steinbeck (Network leader), Cheryl Jones, Jonathan Morris, Julie Leask, Elizabeth Elliott, Chris Cowell, Kathryn North, Christine Roberts, Camille Raynes-Greenow, Rachel Skinner, Emily Klein, Heather Jeffrey among others. The proposed network will link the Reproductive Maternal and Child Health Research Stream encompassing Kids Research Institute Kolling Research Institute, School of Public Health (HJ, CRG, JL, SC) with Sydney Nursing school , w multiple initiatives in the Faculty of Education and Social work including The University of Sydney Network for Child and Youth Research, the Centre for Health Governance, Law and Ethics and a family law/ child protection research team in the Faculty of Law, and with complimentary expertise in Media and Communications , Science and Health Sciences (ML). This network aims to bring researchers with common interests together to discover fresh approaches for knowledge translation and novel directions for research informed by participant values. Fingers crossed!

NEWBORN PERTUSSIS VACCINE STUDY

In Australia and comparable countries, 90% of severe pertussis occurs under 6 months, despite >90% immunisation coverage in children over 6 months of age. Demonstrating that pertussis vaccine at birth is immunogenic and safe would be significant worldwide. This NHMRC study is the first to establish if earlier protection from severe disease due to Bordetella pertussis, as measured by antibody (Ab) and cell mediated immune (CMI) responses, is achieved by monovalent acellular pertussis vaccine (Pa) at birth versus vaccination schedules commencing at 6-8 weeks of age. To date, 400 babies have been recruited in 4 sites, Sydney, Melbourne, Adelaide and Perth and preliminary results are expected in 2012. Please contact for more information.

SOCIETY FOR REPRODUCTIVE BIOLOGY (SRB) MEETING

Congratulations to A/Prof Chris O’Neill from the Kolling Institute of Medical Research, selected as Founders Lecturer for the annual Society for Reproductive Biology (SRB) meeting held in October at Cairns. Chris presented an engaging and thoughtful overview of his research achievements while dutifully updating the audience with the concurrent Wallabies vs Springboks World Cup scores.
Two PhD students, Yan Ru Gao and Rasmani Hazra, from the ANZAC Research Institute gave presentations in the highly competitive SRB New Investigator Award Session. This year the SRB meeting was immediately followed by the 2nd World Congress on Reproductive Biology (WCRB), which was well-represented by senior researchers and students from the University of Sydney. The WCRB was a tremendous success, maintaining important momentum for this new congress to be continued in Edinburgh in 2014.

AUSTRALASIAN CHILD AND ADOLESCENT OBESITY RESEARCH NETWORK (ACAORN)

ACAORN (yes, pronounced like “acorn”!) was established in November 2002 by University of Sydney researchers in response to the challenges posed by the epidemic of child and adolescent obesity. The founding ACAORN members recognised that there was much to gain from collaborative projects given the relatively small pool of obesity researchers (and available funds) in Australia and New Zealand. ACAORN aims to foster research collaboration among Australian and New Zealand child and adolescent obesity research groups, to identify and answer key research questions with high quality research. ACAORN is a growing organisation, now with a membership of over 80 researchers, including clinicians, educators, and public health practitioners, who have significant track records in child and adolescent obesity, nutrition, and physical activity research. There are also a range of affiliated PhD students and post-doctoral researchers.

ACAORN’s core work focuses around projects within its five active Stream groups associated with paediatric obesity, namely: Food and Nutrition; Physical Activity and Sedentary Behaviour; Prevention of Obesity; Management of Obesity; and Parenting, Child Behaviour and Wellbeing.

ACAORN members meet face-to-face approximately once each year to discuss research problems and solutions, and to form collaborative research groups. These face-to-face annual meetings are supplemented by electronic communication via email and an online, password protected discussion tool (the ACAORN MediaWiki). Examples of collaboration to date have included joint research grants (including at least three multi-site NHMRC project grants), co-supervision of higher degree research students, published research papers, and the development of a publicly available website to disseminate and share resources and ideas with policy-makers and practitioners.

ACAORN’s activities have been funded by grants from NSW Health, Queensland Health, and the Foundation for Children. These funds have been used to support some of the costs of face to face meetings, some of the work of the Streams, a part-time project officer, and administrative support. ACAORN runs on a very tight budget. Louise Baur, in the Discipline of Paediatrics & Child Health at USyd, is a Founding Director of ACAORN. The ACAORN web-site provides further information.

EARLY PREVENTION OF OBESITY IN CHILDHOOD (EPOCH) COLLABORATION

In 2007, four paediatric obesity researchers – from Sydney, Melbourne, Brisbane and Dunedin – shared a table at the ANZ Obesity Society annual dinner. They enjoyed the food – always good at obesity meetings! – and they started chatting about recent grant successes or plans. And they found that all four were embarking on obesity prevention interventions in the first year of life! From this meeting came the idea of a prospective meta-analysis (PMA) of individual patient data from the four respective trials. Fortunately, the group had the bright idea of involving Lisa Askie, from the NHMRC Clinical Trials Centre at USyd. Lisa has great expertise in PMAs and has expertly guided the group in establishing the EPOCH Collaboration. A protocol has been published and we have also just received a (modestly funded!) NHMRC project grant to support the work over the period 2012-2014.

The individual trials are the very first such RCTs internationally to look at primary prevention of obesity in early childhood. When all the data are combined (an estimated 1800 participants by age 2 years) there will be a wealth of information.

The four trials involved in the PMA:

• Healthy Beginnings Trial (USyd and SSWAHS; Li Ming Wen, Louise Baur, Chris Rissel, Judy Simpson)
• InFANT (Deakin University)
• Nourish (QUT and Flinders)
• POI.NZ (Otago)

For more information:
NHMRC Clinical Trials Centre; CIA of the EPOCH study
CHW Clinical School and School of Public Health
School of Public Health
Health Promotion Unit, Sydney South West Area Health Service; CIA of the Healthy Beginnings Trial

MEDITATION IN SCHOOL AS A PREVENTATIVE MENTAL HEALTH STRATEGY FOR CHILDREN

There is broad agreement amongst experts that resilience skills are an important tool to prevent youth depression, suicide, self-harm, violence, problematic substance abuse. Young people tend to spend most of their time at home or at school so logically these are the two most important places where resilience skills are learned. Schools are the most effective places in which resilience can be formally and systematically taught.

The outcomes of our pilot research suggests that meditation is a particularly suitable resilience building strategy because it is easy to learn, can be taught in a standardised format that is suitable to a broad cross section of candidates and provides immediate impacts across a range of challenges that young people might encounter that challenge their resilience. We have used a form of meditation that focuses on the experience of mental silence, which can be taught at no or minimal cost using a variety of different but pre-existing infrastructures to both small or large groups. It is time to evaluate the potential of meditation as a population wide primary prevention strategy for mental health. For more information,

PROFESSORS NORTH, BAUR & CHRISTODOULOU ON NHMRC COMMITTEES

Congratulations to Professors Kathryn North, Louise Baur and John Christodoulou, who have been appointed to NHMRC committees for the triennium 2012 to 2015.

Kathy has been appointed Chair of the NHMRC Research Committee (RC). RC covers health and medical research, including public health. It is responsible for overseeing the allocation of NHMRC research grants on the basis of scientific quality, as judged by peer-review across the entire spectrum of health, medical and public health research. It also provides research support through a variety of mechanisms, including support for individual research projects, broad programs of research, training awards and fellowships, and special research units. Kathy is the first paediatrician to be appointed to Chair this committee. She has also been appointed as a member of the NHMRC Research Council.

Louise has been appointed to the NHMRC Prevention and Community Health Committee (PCHC). PCHC provides evidence-based health advice to NHMRC on a range of matters in community and population health, prevention, and environmental health. It consults with the community, health care professionals and all levels of government in identifying emerging issues and gaps in knowledge, and developing and maintaining standards for the development of health advice.

John has been appointed to the NHMRC Human Genetics Advisory Committee (HGAC). HGAC provides on-going advice to the NHMRC on high-level technical and strategic issues in human genetics and on the social, ethical and legal implications of human genetics and related technologies. HGAC also provides national leadership in responding to new developments in these technologies.

Avant sponsors young medical researchers – Dr Gulam Khandaker, Children’s Hospital Westmead

Avant has provided $200,000 to fund six medical research scholarships comprising two full time scholarships worth $50,000 each and four part time scholarships worth $25,000 each.

The two inaugural recipients of the full time Avant Doctor in Training Research Scholarships are Dr Arjun Iyer and Dr Peter Khong. The part time recipients are Dr Susan Feng, Dr Matthew Roberts, Dr Gulam Khandaker and Dr Warren Rozen.

Dr Khandaker is a Paediatric Specialist trainee at the Children’s Hospital Westmead. He is also a PhD candidate at the University of Sydney and holds a Masters of Public Health from the University of Wollongong.

Title of scholarship research paper: “Long term outcomes of neonatal herpes simplex infections in Australian children.”

Research outline: HSV infection in the first weeks of life carries a 25% mortality and for those newborns that do survive there is a high incidence of morbidity despite the availability of effective therapies. Given that the neonatal HSV infection is relatively uncommon, long term outcomes for these children are poorly defined.

Dr Khandaker’s study will evaluate the degree of clinical and psycho-social impairment among children infected with HSV in the first months of life in Australia. The study will compare health service use and clinical, social and educational outcomes between these children and an aged matched cohort of children without HSV infection in the newborn period. The findings from this research will offer world first knowledge about the long term consequences of this uncommon but devastating disease.

Dr Khandaker’s Career highlights are:

18 peer reviewed publications
Involvement with eight clinical trials (including NHMRC funded trials) as either an investigator or trial physician
10 conference presentations
Reviewer for six international journal

For more information go to http://www.avant.org.au/News/20120904-avant-sponsors-young-medical-researchers/


Congratulations to Dr Galum Khandaker.

Professor Elizabeth Elliott recognised with a 100 Women of Influence Award

Congratulations to Professor Elizabeth Elliott, Kids Research Institute’s Head of the Australian Paediatric Surveillance Unit, for being recognised with a 100 Women of Influence Award by The Australian Financial Review and Westpac.

More than 350 women were nominated for these prestigious awards. The finalists were selected from across the economy by a panel of leading Australians. Those chosen have been successful in their careers and influential in shaping a bold and diverse future for Australia.

Congratulations Elizabeth on this well-deserved recognition.