Dr Patricia Valery

Position: Research Officer (QIMR) / Lecturer (UQ)
Major area of interest: Epidemiology

Clinical trial of Zinc and Vitamin A with A Chang (Alice Springs Division, Flinders University NT Clinical School), P Torzillo (RPAH Medical Centre), A Leach (Menzies School of Health Research), J Wakerman (Centre for Remote Health), and A White (Remote Health/Paediatrics/Medicine)

The burden of respiratory and diarrhoea illness in Indigenous Australians is unacceptably very high. Within the Northern Territory, in the 0-4 years age group, respiratory disease is still the leading cause of preventable mortality with rates of 5x that of non-Aboriginal Territorians. Zinc and vitamin A are known to decrease the prevalence/incidence of these illnesses in developing countries by up to 42%. We are currently running a project that will evaluate the potential benefits of zinc and Vitamin A in reducing the burden of these diseases in children. The Alice Springs Hospital, in conjunction with the QIMR (Dr Patricia Valery), is conducting a controlled factorial 2 by 2 double-blinded trial of supplementation of zinc and vitamin A. We originally planned this study in 2 phases: hospital (Alice Springs Hospital -ASH) (data collection under way) and community phases (not funded for at this stage). During the hospital phase all eligible children admitted into ASH with pneumonia and/or diarrhoea (approximately 500 children included to date) during the period April 2001 and December 2001 will be invited to participate in the study.

Asthma in children in the Torres Strait with B Masters (Royal Children's Hospital), A Chang (Alice Springs Division, Flinders University NT Clinical School), C Shannon (ACITHN)

Dr Patricia Valery, in conjunction with the Indigenous Health Program (ACITHN, UQ) and the team from the Respiratory Unit (Royal Children's Hospital and nurses from the Mater Children's Hospital), has been doing work in the Torres Strait Health Districts. To date, the team have seen over 500 Indigenous children and treated approximately 150 asthmatics. In addition to the clinical arm of this project, we have also conducted a study to measure occurrence of asthma in Indigenous communities. 1650 children were included in the study and we found that as much as 20% of these children have had asthma symptoms some time in the past. Australian non-Indigenous children have some of the highest known prevalence rates of asthma, ranging from 17 to 19.5%; we have shown with this study that Indigenous children, at least Torres Strait Islanders, are not far behind. However, amongst Aboriginal and Torres Strait Islander children, data on asthma prevalence are sparse and controversial. Indeed, the prevalence of asthma in Indigenous communities in Australia was thought to be extremely low (0-3.3%). These results exemplify the need for further studies on asthma in Indigenous Australian children.

Diabetes type 2 in children in the Torres Strait with A Green,QIMR, A Sinha (specialist physician in theTorres Strait and NPA), D McIntyre (Mater Children's Hospital)

Diabetes Mellitus, particularly Type 2 diabetes is the second leading cause of morbidity and mortality amongst Aboriginal and Torres Strait Islander people. In the Torres Strait and Northern Peninsula Area, Type 2 diabetes affects approximately 24% of all persons over the age of fifteen years. In recent years, a number of Indigenous youths, living in the Torres Strait and Northern Peninsula Area, have been identified with Type 2 diabetes. Accurate measures of and knowledge about Type 2 diabetes amongst Indigenous youths in this region is minimal to non-existent; however this information is vital to plan health services and set priorities for future interventions and research. The proposed study will aim to: describe the prevalence of Type 2 diabetes and Impaired Glucose Tolerance in Indigenous youths in the Torres Strait and Northern Peninsula Area, and to assess risk factors associated with Type 2 diabetes and Impaired Glucose Tolerance in Indigenous youths in the Torres Strait and Northern Peninsula Area through a nested case control study. Ethical clearance and community consultation are currently under way, along with other preparations such as data collection sheets. Data collection is planned to occur early 2003. A PhD student is conducting the study under the supervision of Dr Patricia Valery.

Case control study on children with bronchiectasis with P Torzillo, K Mullholland, N Boyce, A Chang

This study aims to determine if pneumonia or recurrent pneumonia leads to bronchiectasis in Aboriginal children living in remote/rural communities, and to determine the risk factors for bronchiectasis in Aboriginal children. The study has being undertaken at the Alice Springs Hospital (ASH), Northern Territory. All eligible children < 18 years with radiologically defined bronchiectasis diagnosed before 28 Feb 2002 were included in the study (61 children) along with three matched controls. The list of admissions from the ASH were the source of controls. Controls (3 per case) were matched to cases by gender and date of birth (± 6 months). Dr Patricia Valery is the study co-ordinator, and is currently analysing data collected.

Nambour skin cancer study with A Green, G Williams, R Neale, V Hart, et al

Study participants were originally randomly-chosen residents of Nambour, a township in the Sunshine Coast district of southeast Queensland, who were aged between 20 and 69 years when they took part in a skin cancer survey in 1986. Those approximately 1102 people who took part in the Nambour Trial, a randomised trial of skin cancer prevention based on a 2 x 2 factorial design and who are current being followed up, will be included in the present study. Since 1996, with funding from NHMRC for two part-time research assistants, we have continued intermittent contact with our remaining 1102 study participants. In 1996 there were 1350 participants being monitored - 83% of the original trial participants, subsequent attrition is almost all due to ill health and deaths. The aim of the Nambour study now at is to twice yearly contact participants, continue to track and validate the occurrence of skin cancers as well as periodically updating current sun exposure and protection behaviours at a summary level. We are also maintaining the Nambour study database. Dr Valery is responsible for follow up of study participants as well as occurrence of skin cancers.

Cancer in Aboriginal and Torres Strait Islander Queenslanders A Green, QIMR, and M Coory, Queensland Health

It is well known that Indigenous people have poorer health than non-Indigenous Australians and this is partly due to higher overall death rates from cancer. The present data on cancer rates in Indigenous people is of poor quality; the lack of accurate and consistent recording of Indigenous status is the main reason for this. In a joint effort between QIMR and Queensland Health, a pilot study was conducted in 2001 under Dr Patricia Valery's supervision. Medical charts of Indigenous and non-Indigenous cancer patients were examined at the Royal Brisbane Hospital, Royal Children's Hospital, and Prince Charles Hospital, and a small sample of patients interviewed. Queensland Health has linked the data obtained from all hospitals in Queensland with data obtained from the Queensland Cancer Registry. All Indigenous diagnosed with cancer over a 2-year period (1998-1999) and identified as an 'Indigenous person' either on the Queensland Cancer Registry or/and at the hospital where the person was diagnosed and/or treated were included in this database (approximately 500 Indigenous patients). Dr Valery is trying to get funds to do a Queensland wide study to assess incidence of all types of cancer in all ATSI patients treated in major Queensland hospitals, describe the breakdown of cancers affecting ATSI people in Qld, assess survival of these cases (up to 2004) and compare stage of the tumour at diagnosis of Indigenous and non-Indigenous cancer patients.

Epidemiologic study of risk factors for Ewing's sarcoma family of tumours in Australia (Dr P Valery PhD thesis)

Ewing's sarcoma family of tumours (ESFT) represents a group of rare neoplasms that includes Ewing's sarcoma of the bone and soft tissue and peripheral primitive neuroectodermal tumours of the bone and soft tissue. There are only a few reasonably detailed aetiological studies of Ewing's sarcoma of the bone in the literature. While several associations were suggested, particularly paternal occupation on farming, results were not consistent across the studies and analysis relied on relatively small sample sizes. Three major groups of factors were associated with ES in these, some pregnancy related factors, subject's medical history, as well as paternal occupation in agriculture and other farm relate exposures such as farm residency, exposure to cows and to herbicides. This case-control study of ESFT was undertaken to provide additional detailed epidemiologic characteristics about this disease, to investigate suggested associations described above, and to develop new aetiologic hypothesis. Cases of ESFT diagnosed in Australia between January, 1991 and June, 1996 who were under 40 years at diagnosis (132) were compared with a population based control (428) subjects frequency matched to cases date of birth and State of residency. Two research publications came out of this project, and Dr Valery is working on a third one. In addition, Dr Valery will pool the data of this study with data from two other case-control studies done in the USA and Canada.