General Sir John Monash Research Centre Capability Statement Advancing Military and Veterans’ Health www.monash.edu Acknowledgement: Images on pages ii, 2 and 6 were obtained from Australian Defence Force websites: http://images.navy.gov.au/20100825ran8484535_054.jpg http://www.defence.gov.au/opex/exercises/ts09/gallery/20090718/20090717adf8262658_121.jpg http://images.defence.gov.au/20110903adf8106603_132.jpg http://images.navy.gov.au/20120524ran8109938_261.jpg Executive Summary Monash University and its clinical academic partners at The Alfred Hospital are proposing to bring together their extensive clinical and public health research and education expertise across a wide range of disciplines relevant to the health of military personnel and veterans by establishing the General Sir John Monash Research Centre: Advancing military and veterans’ health. This centre will build upon a strong existing track record of achievement in this field and develop new areas of research and education to provide evidence-based research to deal with emerging issues relevant to these groups to assist with policy development and practice for the Departments of Defence and Veterans’ Affairs. The Centre has a skill base, resources and record of achievement which will enable it to accomplish the following: „ Investigate longer term health outcomes, including the most effective models of care, rehabilitation and health promotion programs „ Continue existing longitudinal studies and develop new cohorts and/or registries to monitor the health of specific military and veteran groups, including those in transition to civilian life, at the Monash Centre for Occupational and Environmental Health (MonCOEH) „ Collate and analyse existing DVA and Defence health and exposure data to address important questions regarding risk factors for diseases and injury and health services use, using expertise from the Biostatistics Unit „ Undertake clinical research into the treatment of trauma, burns and other acute health events, as well as use of blood products, employing established registries for burns, trauma (VSTORM) and massive transfusion „ Undertake predictive modelling to estimate trends of disease incidence into the future to assist health service planning, using the expertise of the Epidemiological Modelling Unit, the Health Services Management Unit, and the Centre for Research Excellence in Patient Safety (CREPS) „ Investigate compensation systems and models of care, including international benchmarking, in collaboration with the Institute for Safety, Compensation and Recovery Research (ISCRR; a Monash University entity) „ Investigate the most effective means of translating research findings into practice and effective dissemination to relevant stakeholders in collaboration with the Australasian Cochrane Centre and ISCRR „ Teach short courses in areas of need for continuing professional development, such as the Australian Certificate in Civil Aviation which is currently offered through Monash University „ Train clinical personnel in the specialist treatment of trauma, burns and other acute health outcomes, as well as the longer term management of these conditions. „ Train clinical professionals ranging from nurses and paramedics to medical specialists. This research community, at Monash University and The Alfred Hospital, also has in place extensive collaborative networks to add in further specialist research capability, where needed. It also has a strong track record of attracting NHMRC and ARC support which can supplement available DVA and Defence research funds. Research centres and units aligned to the Monash Centre have a history of working closely with government and industry sectors, as well as ex-service organisations, military personnel and veterans. General Sir John Monash Research Centre Capability Statement i Contents Executive Summary ......................................................................................................................................i Introduction .................................................................................................................................................1 Veterans’ Health - Research Domains ........................................................................................................2 Monitoring the long-term health of veterans (longitudinal studies) .............................................................2 Modelling the future health status of veterans ...........................................................................................3 Clinical trials to improve the health of veterans (intervention studies) .........................................................3 Research into compensation and rehabilitation issues affecting veterans ..................................................3 Evidence synthesis relating to veterans’ health issues ...............................................................................3 Studies of specific health issues affecting veterans ...................................................................................3 Defence Health – Research .........................................................................................................................5 Improving the management of trauma ......................................................................................................5 Improving the emergency care provided by first responders .....................................................................6 Preventing accidents and chronic disease among service personnel .........................................................6 Preventing and treating mental illness among service personnel ...............................................................7 Preventing infectious diseases among service personnel ..........................................................................7 Defence Health – Education .......................................................................................................................8 Master of Public Health ............................................................................................................................8 Practical training for clinical staff ...............................................................................................................9 Workforce development and management ...............................................................................................9 Capacity Relevant to both Defence and Veterans’ Health ......................................................................10 Men’s Health ..........................................................................................................................................10 Health Economics ..................................................................................................................................10 Health Policy ..........................................................................................................................................10 Database Management and Registry Science .........................................................................................10 Information resource relating to military and veterans’ health ...................................................................11 Key Collaborators ......................................................................................................................................11 Key Personnel ............................................................................................................................................12 General Sir John Monash Research Centre Capability Statement iii iv General Sir John Monash Research Centre Capability Statement Introduction Australia has approximately 58,000 active service men and women, as well as 22,000 active reservists. Many of these personnel have been deployed in combat and peace-keeping missions. These operations put personnel at risk of being disabled by illness, physical injury, post-traumatic stress disorders and other mental health problems. There is a strong obligation to provide for the health needs of military personnel and to ensure access to the necessary health services for military veterans and their families. In addition, the health services supporting the military should be prepared for future innovations in warfare which may present new health challenges for soldiers and other personnel. The capabilities required to meet these challenges are ideally located in a strong research environment with access to high level expertise in relevant areas. They include: „ Training: including clinical training and post-graduate education in areas including pre-hospital care, trauma surgery, clinical medicine, public health, occupational health and environmental health „ Research: including observational cohort studies of veterans, clinical trials, predictive modelling and the ability to analyse large datasets „ Information resource: including high level expertise in medical specialities, psychiatry, public and occupational health, rehabilitation, compensation and a variety of related fields The essential skill base includes surgery, clinical medicine, allied health, public health, epidemiology and other research methods. Close links must be available with a variety of external parties such as ambulance authorities, Red Cross blood transfusion services, research organisations and health departments. In this document, we outline the capabilities present at Monash University and the Alfred Hospital, particularly at the Alfred Medical Research and Education Precinct (AMREP) which are relevant to the support of military and veterans’ health. General Sir John Monash Research Centre Capability Statement 1 Veterans’ Health – Research Domains Monitoring the long-term health of veterans (longitudinal studies) The Monash University Centre for Occupational and Environmental Health (MonCOEH) has more than a decade of conducting longitudinal studies of the physical and mental health of veterans: „ Australian Gulf War Veterans’ Health Study (baseline and follow-up studies) „ Korean War Veterans’ Health Study „ Systematic reviews of mental health outcomes in veterans populations „ Contribution to the Australian Peacekeepers’ Health study and the Middle East Area of Operations study „ Joint Australian and US comparative study of Veterans’ health service use Health outcomes investigated in these studies include: „ Cancer and mortality patterns „ Life satisfaction, quality of life and functional measures „ Uptake of vaccinations and health effects „ Neurological status „ Respiratory health after exposure to dust storms and oil fire smoke „ Health services utilisation using DVA, Medicare and Pharmaceutical Benefits Scheme data „ Post-traumatic stress disorder, depression, alcohol use and other mental health outcomes This research has been led by Professor Malcolm Sim, and MonCOEH has a wide range of skills and experience to enable it to conduct very large longitudinal epidemiological studies, including linkage to other databases for outcomes such as cancer diagnoses and death, with a high degree of competence. 2 General Sir John Monash Research Centre Capability Statement Modelling the future health status of veterans A joint initiative in epidemiological modelling has recently been established between the School of Public Health and Preventive Medicine and the CSIRO’s Preventative Health Flagship and Complex Systems Science to conduct research to predict trends in chronic disease and future health service requirements. Associate Professor Manoj Gambhir, from Imperial College London, who has done extensive work modelling trends in infectious diseases in developed and developing countries, will lead the program following his appointment in December 2013. Clinical trials to improve the health of veterans (intervention studies) Monash University has a long history of conducting randomised controlled trials which are widely recognised internationally and published in top-ranked journals. For example, a study of particular relevance to healthy elderly veterans and their spouses/partners, ASPREE, is currently underway. ASPREE is a randomised controlled trial designed to assess whether daily low dose aspirin therapy prolongs healthy lifespan through the prevention of heart attack, stroke, cognitive decline, physical decline and some cancers such as bowel cancer. The study is recruiting 19,000 healthy individuals aged 70 years or more in Australia (Victoria, Tasmania, South Australia, NSW and ACT) and the USA. It has substantial funding from the USA, National Institutes of Health ($50 million USD), as well as contributions from Australia. In addition, there are sub-studies: „ ASPREE Biobank involves collecting blood samples to identify parameters for earlier prediction of serious disease „ ASPREE-ALSOP for the improved understanding of the problems of ageing including those related to mobility, hearing, eyesight, dental care, diet and exercise. „ A study investigating the significance of biomarkers for cancer development and the effect of low-dose aspirin on cancer prevention (funded by the Victorian Cancer Agency and US National Institute of Cancer) „ Other sub-studies are investigating outcomes such as macular degeneration and sepsis Should DVA or Defence identify suitable research questions in relation to healthy elderly veterans, sub-studies could be added for investigation among those included in the ASPREE study. Research into compensation and rehabilitation issues affecting veterans DVA and Defence have recognised the need to improve rehabilitation and compensation of veterans. The Institute for Safety, Compensation and Recovery Research (ISCRR), a joint initiative of WorkSafe Victoria, the Transport Accident Commission (TAC) and Monash University, was formed in 2009 to facilitate research and best practice in injury prevention, rehabilitation and compensation systems. In addition, Monash University and the Alfred Hospital are at the cutting edge of rehabilitation research and practice, particularly following brain and spinal injury and amputation, through the research of the Monash Epworth Rehabilitation Research Centre and the Caulfield Acquired Brain Injury Rehabilitation Centre. Evidence synthesis relating to veterans’ health issues The Australasian Cochrane Centre (directed by Professor Sally Green) provides training and support for authors conducting Cochrane systematic reviews and advocates for the use of evidence to underpin clinical practice, policy for government and industry, and international benchmarking. ISCRR also has research translation in regard to compensation, occupational health and safety, and rehabilitation as part of its research program. Studies of specific health issues affecting veterans As well as health problems related to their military service and deployments, military personnel and veterans are subject to the health problems and concerns that are also found in the general population. Monash University also conducts research in relevant areas: „ Women’s health (Centre for Women’s Health, Directed by Professor Susan Davis) − Premenstrual syndrome − Management of menopause − Optimising treatment of breast cancer (ATLAS study; US military grant) General Sir John Monash Research Centre Capability Statement 3 „ Men’s health (see also Men’s health, Page 10) − Prostate disease, including prostate cancer − Testicular cancer − Male infertility − Use and abuse of testosterone treatments − Sexual dysfunction, including impotence „ Public health − Prevention and management of diabetes (with Baker IDI) − Obesity (with Baker IDI) − Hypertension and heart disease (with Baker IDI) − Stroke − Cancer − Allergies, asthma and respiratory diseases (Professor Robyn O’Hehir) − Mental health treatment and research (Monash Alfred Psychiatric Research Centre) In relation to cancer and other major health problems, the School of Public Health and Preventive Medicine is a leading centre of registry science with existing registries for trauma, fractures, burns, cancers, blood transfusions and cardiac procedures. The William Buckland Radiotherapy Centre, Alfred Hospital is a leader in research and treatment using targeted radiotherapy for cancer, including prostate, lung, spinal and brain. 4 General Sir John Monash Research Centre Capability Statement