Highlights & Awards

	2006		2005		2004		2003		2002		Awards

2006 Highlights

The award of a Capacity-Building in Public Health Grant ($2.33M over five years) and the resultant strengthening of ten year links with Dr Christine MacArthur, Professor of Maternal and Child Health Epidemiology at the University of Birmingham was a culmination of much of MCHR's achievements. Christine will be a visiting Lead Investigator. Other MCHR participants are Stephanie Brown, Rhonda Small and Jeanne Daly , together with Professor Jane Gunn, from the Primary Care Research Unit at the University of Melbourne .

Two grant applications with a focus on maternity care and maternal health were also successful (led by Stephanie Brown), as was a collaborative application from the Royal Women's Hospital, the La Trobe School of Nursing and Midwifery and MCHR, for a randomised controlled trial of ‘caseload midwifery' . This trial will facilitate our continuing collaborations with Professor Ulla Waldenström from the Karolinska Institute in Sweden , and Professor Leah Albers from the University of New Mexico .Strong research collaboration around postnatal care in Victorian hospitals with input from a range of interested parties, led to four papers being published so far with sustained interest in the findings. The implications for practice and research are substantial.
International links with the Canadian Perinatal Surveillance System, the National Perinatal Epidemiology Unit in Britain , and widespread collaborations on maternal and perinatal care and analysis (ROAM, PREBIC, CHIMICA, and EURO-PERISTAT ), involving groups in Canada , US and Scandinavia , China and the European Union benefit, inter ali, MCHR's work with immigrant and Indigenous women. The PRISM trial's main paper, published in BMC Public Health received a Biomed Central Research Award in Medicine. Stephanie Brown and Jane Yelland took up positions at the Murdoch Childrens Research Institute from 2007, with Ellie McDonald , Sue Perlen, Maggie Flood, Liesje Bryce and Hannah Woolhouse providing research support. MCHR moved from Carlton to Little Lonsdale St in the city, thanks to Paul Toomey's planning and staff teamwork.

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2005 Highlights

Dr Mary Grace, on study leave from Victoria University , shared her challenging data on incomes after childbearing from the Australian Bureau of Statistics 2001 Census and brought a new perspective to considering unpredicted study findings. Dr David Tappin from the Paediatric Epidemiology and Community Health (PEACH) Unit at the University of Glasgow discussed with us his randomised trial of motivational interviewing to reduce smoking during pregnancy, analysed the women's comments and sharpened our recognition of the huge differences in smoking and breastfeeding between Scotland and Victoria. The serendipity of the International Midwives Conference being in Australia led to renewed contacts and future research planning with Professors Christine MacArthur and Debra Bick from the UK and with Professor Ulla Waldenström, who was the first Professor of Midwifery at La Trobe University. The identification of postnatal care as the aspect of maternity care which women were least happy with led to a group of MCHR staff carrying out a review of postnatal care in hospital (PinC) in Victoria . Their report which was launched in May 2005 received substantial media coverage, especially in rural areas of VictoriaThe community-randomised trial PRISM ( Program of Resources, Information and Support for Mothers ), implemented in 16 local government areas across Victoria , was published at the end of the year [ PRISM ]. A long-term follow-up of women who had taken part in a trial in the 1990s to assess whether midwife-led debriefing reduced depression after birth found neither benefits nor any harm resulted. The follow-up of ‘Tall Girls' who had been treated in adolescence to reduce their adult height, identified a lack of satisfaction with the treatment they had received and found a higher prevalence of depression in adult life. Three doctoral students (Lisa Amir, Della Forster and Jane Yelland) were awarded a PhD by La Trobe University
Lisa also received an NHMRC Health Practitioner Fellowship.
Lyn Watson was awarded an NHMRC Public Health Scholarship to carry out her PhD
Sue Armstrong a La Trobe University Postgraduate Research Scholarship. Two large grants were a highlight late in the year:
Angela Taft, Rhonda Small , Judith Lumley and Associate Professor Kelsey Hegarty (Department of General Practice, University Of Melbourne) were awarded a Community Support Grant of $472,891 for the MOSAIC project; and
an Australia-wide group involved in maternal and perinatal trials were successful in their application for an NHMRC Enabling Grant ($1.04 million, entitled WOMBAT) to provide better support and staff development for these trials in the next four years.

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2004 Highlights

This year's highlights included publications from large projects first planned almost a decade ago. The original grant applications for the community-based and community-randomised trial PRISM (Program of Resources, Information and Support for Mothers) were submitted in 1994 and 1996. Three papers about the protocol, design and implementation of PRISM have appeared so far. The application for the randomised trial within the Royal Women's Hospital to compare novel strategies for increasing the initiation and duration of breastfeeding with standard care, ABFAB (Attachment to the Breast and Family Attitudes to Breastfeeding) was submitted in 1997. The three published ABFAB papers include the primary outcomes, and a paper showing that the prevalence of breast abscess is substantially lower in the last five years among women giving birth than in all earlier studies. Another such application was for the ‘ Tall Girls' project. Findings from Tall Girls about the impact of treatment in adolescence on adult fertility have been widely reported, leading to several commentaries in medical journals, often with an emphasis on the need for greater caution with respect to other, newer, well-intentioned ‘preventive' interventions in adolescents. Participation in large collaborative projects with other researchers and clinicians involved Stephanie Brown as a member of the Steering Committee of the diamond consortium: a project on the natural history of depression in primary care initiated by Associate Professor Jane Gunn Department of General Practice and Primary Care at the University of Melbourne . Rhonda Small is part of an international collaboration led by Associate Professor Anita Gagnon from McGill University with other Canadian and European researchers whose focus is health and health care among immigrant women, especially in maternity and perinatal care. Angela Taft is part of an international effort to summarise what is known about the effectiveness of interventions to reduce intimate partner abuse and minimise its impact on women and children. Two papers were published on collaborations of MCHR staff with Aboriginal health services providing maternity care. Sandy Campbell and Stephanie Brown carried out one project with the Mildura Women's Business Service. The other involved Elizabeth Carter and Stephanie Bell from Congress Alukura in Alice Springs, together with Gai Wilson from La Trobe University and myself. In a joint project with Helen McLachlan from the School of Midwifery, Jane Yelland , Della Forster and Jo Rayner initiated a statewide review of in-hospital postnatal care (PinC) , which, while completely different from the Review of Obstetric care completed five years ago participation across Victoria has been very similar to the earlier review. The Surveys of Recent Mothers have also contributed to the planned Maternity Experiences Survey under development by a subcommittee of the Canadian Perinatal Surveillance Steering Committee we are seeking funding to carry out a fourth Survey in 2007.. We are particularly grateful for the funding from trusts and foundations listed at the end of the Annual Report making PinC possible and in other projects, for example Early Births and MOSAIC , possible . Unfortunately, health services research remains in a funding no man's land. It is not part of biomedical science, social science, economics, epidemiology or health promotion, though it requires some understanding of all these disciplines. Major contributions to research include reviewing for peer-reviewed journals and research grant applications. MCHR aims to encourage and support all staff members and postgraduate students to acquire and exercise these skills. Lisa Amir is starting a new Biomed Central (Open Access) international journal with a focus on breastfeeding Mary-Ann Davey, Fiona Bruinsma and Jo Rayner have taken on co-editing the Australasian Epidemiology Journal. Stephanie Brown was promoted to Associate Professor. Change of name In 2004, the centre adopted a change of name to: Mother & Child Health Research
believing that a simplified title and logo for the centre explains better what we are about, and that regular readers and old friends will recognize the strong continuity of the research program.

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2003 Highlights

Violence and depression, and associations of violence with adverse reproductive outcomes have become important new research themes at MCHR since 1999.Angela Taft and colleagues were awarded NHMRC funding to for the research component of a cluster-randomised trial ( MOSAIC) offering a supportive intervention by community mothers aimed at reducing the impact of abuse and depression on mothers and their young children. This is a collaboration with the NorthWest Division of General Practice, the women's community-based health service Women's Health West, and the Department of General Practice at the University of Melbourne , building on our previous experience with the community intervention trial PRISM (Program of Resources, Information and Support for Mothers.) MOSAIC is a research program within one of the national research priority areas, A Healthy Start to Life.Angela Taft from MCHR, together with Helen McLachlan, Clinical School of Midwifery and Neonatal Nursing Studies, La Trobe University, organised a very successful seminar of health professionals across Victoria to hear Professor Judith Macfarlane speak about her sustained program of work in this area in Texas, with local speakers contributing as well. Professor Jackie Campbell from Johns Hopkins University, also spoke at a meeting in June, organised by Angela Taft in conjunction with the Public Health Association of Australia. Angela Taft and Lyn Watson are collaborating with the Australian Women's Longitudinal Health Study in analyses of relevant data in the youngest cohort.The launch of the PRISM project website by Rob Moodie, was an exciting event, attended by a range of people from all the 16 participating communities. The website, developed by Rhonda Small, makes available a very large proportion of the documentation of PRISM, as well as the resources developed for it, local initiatives undertaken in support of mothers, support for program implementation, feedback to communities, newsletters, and the materials provided to maternal and child health nurses and general practitioners within the continuing education component.

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Collaboration with hospitals

EPOCS - Evaluating practice and organisation of care at Southern Health and Sandringham.
The project was funded by the Department of Human Services. Final project reports were launched by the Parliamentary Secretary for Health and local member for Mulgrave, who described them as “taking the guesswork out of deciding what innovations are better for recent mothers”. EPOCS included a strong Vietnamese component, using the strategies for recruitment, participation and feedback, pioneered in the Mothers in a New Country (MINC) project.The ANEW project, involves MCHR ( Stephanie Brown and Judith Lumley ), the Department of General Practice, University of Melbourne (Kelsey Hegarty and Jane Gunn) and the Mercy Hospital for Women ( Julie Collette and Della Forster) in the development of an alternative approach to ‘paper-based screening' for psychosocial issues during pregnancy. It is providing midwives, shared care general practitioners, and hospital medical staff with a multifaceted innovative training program in the areas of active listening, picking up on cues and appropriate responding skills (patient centred care). The final results of this exciting project should be available in 2004.The Maternal Health Study has very strong interest and support from the four participating large Melbourne hospitals. Stephanie Brown , Ellie McDonald and Ann Krastev are following a cohort of women from early in their first pregnancy to 18 months after birth with a focus on maternal health after birth. ‘Early Births', another large and complex project, is a state-wide case-control study of births before 32 weeks of pregnancywhich involves all maternity hospitals across Victoria. Led by Lyn Watson and Jo Rayner, data collection is due for completion in 2004.HARP - Health and recovery after operative birth - is a longer-term follow-up of our earlier trial of debriefing after operative birth at the Royal Women's Hospital. Rhonda Small and colleagues have been successful in re-establishing contact with a large number of the women involved in the original trial.

Contributing to the evidence base for clinical practice and health policy

One of MCHR's major tasks is the completion of new research to inform policy and practice in maternity care, but contributions other than new primary research can be at least as important.Three relevant areas of major activity in 2003 were systematic reviews.Psychosocial screening in antenatal care. A disturbing finding, given current policy and practice in Victoria , was that none of the 16 published instruments developed for antenatal screening to predict postnatal depression performed adequately as a screening tool.A review of interventions to reduce maternal depression after birth, updated throughout 2003, has been able to distinguish effective intervention strategies from those for which there is no evidence at present.Catherine Chamberlain , a Public Health Fellow on placement at MCHR in 2003 with Judith Lumley , completed an update of the Cochrane Review on interventions to promote smoking cessation during pregnancy. The updated review strengthens the evidence that these interventions reduce preterm birth and low birthweight, as well as increasing the proportion of women who stop smoking in pregnancy. The 2000 Survey of Recent Mothers showed very disappointing implementation of smoking cessation strategies in Victorian maternity hospitals. We hope that policy changes in the last two years will show an impact on smoking in pregnancy within the planned 2006 Survey.Philanthropic funding has made a real difference to establishing and supporting new research in the past two years. MOSAIC would probably not have been funded by NHMRC without the benefits of earlier philanthropic funding. Similarly, the recently established project reviewing postnatal care across Victoria would not be happening at all without the two grants from foundations, and last year's work on very preterm birth would have been curtailed without philanthropic support.

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2002 Highlights

The importance of the evidence base for health promotion and illness prevention and the Centre's contribution to this was emphasised at the 15th anniversary of the foundation of VicHealth. Cochrane Review of the evidence from randomised trials about the safety of early postnatal hospital discharge in association with Peter Davis and Brenda Faber from the Royal Women's Hospital. Cochrane Review update on interventions to promote smoking cessation during pregnancy in collaboration with:
- University of London
- University of Hertfordshire
- University of MelbourneActivity relevant to current policy and practice in Australia - The state of the evidence on methods for preventing or reducing depression after birth in collaboration with Mood Disorders Unit, Black Dog Institute, at the University of New South Wales . Collaboration between the Centre, the Department of General Practice, University of Melbourne and the Mercy Hospital for Women is the development of an alternative approach to 'paper-based screening' for responding to psychosocial issues during pregnancy. Two projects at the other end of the research cycle from intervention studies and research synthesis are seeking more detailed information about causal factors: one in relation to extremely preterm birth, the other in relation to maternal health problems after birth,

The Maternal Health Study, a cohort study of women having a first birth, had an excellent start in 2002 with very strong interest from senior staff in the five participating large Melbourne hospitals. Three statewide Surveys of Recent Mothers (1989 - 2000) all demonstrated that immigrant women of non-English speaking backgrounds were much more likely than women born in Australia to be unhappy with their maternity care.

Two new projects received funding towards the end of the year .
Longer-term perinatal outcomes in women who had been referred for assessment and possible treatment of cervical dysplasia funded by NHMRC.
MOSAIC, a project in respect of Advocacy issues funded by The Telstra Foundation, in a competitive research grant process.

Major Events

2002

The Fourth Triennial Review convened by VicHealth.
The Panel was extremely impressed by the productivity of the Centre and the extremely high quality of its research output, noting:

• completion all of the work that was projected at the last Review
• the capacity to work in partnerships with health service providers…and influence policy relating to maternal care in hospitals.
• the evaluation of maternal care initiatives enabled the Centre to make timely and influential interventions, and resulted in significant policy changes
• extremely important and successful dissemination of research findings done by Centre staff is not recognised as a significant criteria for success by [some] fund granting bodies.
• randomized trials had been particularly successful, with a demonstrated capacity to recruit and retain large cohorts
• the work of the Centre is unique, and much of the work is done in difficult, and sometimes controversial areas
• the high level of achievement
• the ability to attract and supervise quality higher degree students.
• the thorough dissemination of research findings, many of which have the potential to influence policy at state, national and international levels
• the maintenance of high publication output in the period between reviews
• success in continually increasing its overall revenue base, and in particular its outstanding success in obtaining competitive grants funding
• the continued practice of published reports, demonstrating the Centre's commitment to ensuring that it produced research findings in ways that were accessible to communities that had participated in research.

Vichealth celebrated the 15th Anniversary of its Foundation and the importance of the evidence base for health promotion and illness prevention was emphasised at its Annual General Meeting.

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Awards

Public Health Association of Australia: Sidney Sax Public Health Medal - Judith Lumley (2002)

The Lancet - International Advisory Board membership - Judith Lumley (2002)
Victorian Department of Human Services: Best poster prize - Jane Yelland and Ann Krastev (2002)
Perinatal Society of Australia and New Zealand: New investigator award - Jane Yelland (2002)
Perinatal Society of Australia and New Zealand: New Investigator Award - Angela Taft (2003)
Vera Scantlebury Brown Memorial Scholarship: Mary-Ann Davey (2003)
Australian Epidemological Association: Student Award: Mary-Ann Davey (2003)
Public Health Association of Australia: Mental Health Special Interest Group Travel Award: Michelle Kealy (2003)
The Bulletin's 'Smart 100': Finalist, Health and Medicine - Judith Lumley (2003)

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PhD Scholarships

National Health and Medical Research Council:
Michelle Kealy (2002-2005): Project grant
Lisa Gold (2003-2005)
Jo Rayner (2006-2007)
Fiona Bruinsma (2006-2007)
Lyn Watson (2006-2007)

Australian Postgraduate Research Award:
Jane Yelland (2003-2004)

Victorian Health Promotion Foundation:
Della Forster(2003-2004) Public Health Research: ABFAB

Career Development Awards

National Health and Medical Research Council:
Dr Rhonda Small ( 2005-2009)

Research Fellowships

NHMRC:
Dr Lisa Amir (2005- 2010)

Victorian Health Promotion Foundation:
Dr Angela Taft (2005-2009)
Dr Stephanie Brown (2001 -2006)

Higher degrees awarded

Doctors of Philosophy (PhD) :

Jenny Hunt - ‘ Trying to make a difference. Improving pregnancy outcomes, care and services for Australian Indigenous women' (2003)
Helen McLachlan
Lisa Amir (2005)
Della Forster (2005)
Jane Yelland (2005)

Masters of Applied Science (Research):
Beth Rankin - A complex pilot study of the maternal health impact of a music and movement program for mothers and babies. (2003)
Hua Xu -

Masters of Public Health
Ruth Bergman (2002)

Enrolments:

Doctorate of Public Health: Creina Mitchell - (2002)

PhD: Jo Rayner; Fiona Bruinsma; Lyn Watson; Mary-Ann Davey; Michelle Kealy; Melissa Hobbs; Touran Shafiei (initially Masters of Public Health)

Public Health Trainees
Nilva Egana (2008)
Kerryn O'Rourke (2007)
Sharon Rayner (2006)
Dianne Beck (2005)
Andrea Neale (2005)
Liz Moore (2004)
Catherine Chamberlain (2003)
Penny Smithers (EcoPRISM 2002)
Natasha Davidson and Bernadette Pound (PRISM)

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