Searching for the best of both worlds
Dr Alexis Hure is investigating ways to improve health at both ends of the lifespan.
Alexis is a Novocastrian through and through, completing her undergraduate, doctorate, and post-doctoral work at the University of Newcastle.
Currently a Hunter Medical Research Institute (HMRI) Public Health Postdoctoral Research Fellow, Alexis is part of a team led by Professor John Attia on two projects in the area of medical epidemiology.
The first project is a large randomised trial looking at whether pneumococcal vaccine may prevent vascular disease. The second is focused on decreasing unnecessary pathology tests ordered through the hospital system.
“That's my epidemiology hat,” Alexis says.
“But my background is actually nutrition and dietetics - I am a dietician by training.”
In her work with mothers and babies she looks at the developmental origins of health and disease.
“What we do before pregnancy, during pregnancy and in the first two years is a critical window for setting up long term health for our children,” she imparts.
Alexis is part of the multi-institution Australian Study for the Prevention through Immunisation of Cardiovascular Events (AUSPICE) team, investigating whether the vaccine for invasive pneumococcal could reduce the risk of stroke and heart attack.
Already in use for the past 30 years to fight pneumococcal, it is hoped that the vaccine being trialed in this study is just as effective at fighting vascular disease.
Laboratory studies suggest that a component of the vaccine may be mistaken for ‘bad cholesterol’ by the body, resulting in the creation of antibodies that bind to, and reduce, actual cholesterol.
Alexis is also part of a team looking at ways to reduce the burden on our health care system by minimising the number of pathology tests ordered through the hospital system.
“While some tests for patients can take weeks or months to change, tests are often ordered in duplicate or inappropriately, which can actually harm the patient,” she says.
“Complicated hospital systems, levels of hierarchy, even upcoming electronic ordering systems all need to be assessed so that we can implement a procedure to prevent unnecessary testing.”
MATERNAL NUTRITION AS A KEY INDICATOR
Alexis’ expertise in nutrition and dietetics has been utilised across many projects and collaborations - from fetal programming and breast-feeding, to alcohol use and depression.
Her focus on mothers and babies grew partly from her interest in the work of the late Professor David Barker, who introduced the hypothesis that maternal nutrition is a key predictor of the child's long term health, particularly for things like cardiovascular disease, diabetes and hypertension.
A mother herself, Alexis wants to further understand ways to create positive maternal impacts on children’s health.
“We should be creating constructive health messages and translating guidelines into something reasonable,” she explains.
“I don’t want women thinking they are harming their baby because they ate a runny egg.”
“There some simple modifiable steps women can take, like eat plenty of fruit and vegetables when they are pregnant.”
“It’s not easy though, when all you hear about in the media is what you can’t do.”
During her PhD studies, Alexis set up the Women And Their Children (WATCH) study, a prospective longitudinal cohort of almost 180 expectant women. The purpose of this study is to generate comprehensive longitudinal data around the impact of a mother’s health during pregnancy, on the long-term health of the child.
The mothers were seen four times during their pregnancies, with ultrasounds and physical measurement data, as well as questionnaires on everything from diet to sleep patterns.
The children born to these mothers were then examined four times in the first year, then annually at 2, 3 and 4 years of age. The children also undertook cognitive testing before they began school.
“We are building this great little data set that is very comprehensive, that has been collected very methodically and very rigorously,” Alexis advises.
“It's only a small group so we can't conclusively answer questions but we can at least start asking some important questions.”
“And our learnings are transferrable, with information from WATCH being used for the Gomeroi Gaaynggal project in Tamworth for Indigenous mothers.”
SERVICES AND SUPPORT
A senior lecturer in the school of medicine and public health, Alexis enjoys teaching, supervising, and collaborating with students.
She recently teamed up with a PhD student to review drinking habits of pregnant women in Australia. Another student study focused on quantifying the helpfulness of food guidelines during pregnancy.
Both studies showed that fear campaigns create stress which may cause harm, as most women were doing the right thing.
Alexis would like to see more support services in place for women who need help modifying their behavior. This in turn will create better outcomes for their children.
“Provide help, provide support, provide strategies, provide services, don't just tell women they are doing the wrong thing all the time, that is not helpful,” she says.
As it happens, Alexis claims it’s not just the choices of mothers that predict the health and wellbeing of their children.
“I'm now looking at the activities of mothers, fathers and even grandparents, investigating how that affects the next generation in terms of their health, both in the long and short term,” Alexis says.
BOOK-ENDING THE LIFE SPAN
From work experience in Year 10, through to her newest project investigating a possible link between iron supplements and gestational diabetes, Alexis has been single minded in her commitment to understanding how what we put into our bodies, affects our bodies.
From obesity through to fetal programming, chronic disease to breast-feeding, depression to low birth weight, Alexis will continue to work across the spectrum.
In collaboration with colleagues, Alexis will continue to look at the impact the start of life can have on the end of life, and deliver new information to doctors and midwives to ensure her research is translated into practice.
With the help of her research students, she will continue monitoring the development of the WATCH cohort, using data from this and other studies to measure impacts.
Just don’t ask Alexis if she prefers the mothers and babies work to the broader field of epidemiology.
“I don’t believe it's an either/or proposition. I can do both, and for me, it is almost like book-ending the lifespan,” Alexis muses.
“I can keep working on mothers and babies projects, while focusing on improving health services so that people get the best treatment as adults.”
“It really is the best of both worlds.”