Professor Adrian Esterman

Please keep media enquiries between 8am and 8pm ACT.

Welcome to my home page. I hope you enjoy your visit.

My favourite quotations/poem

"stara koka, dobra juha" which translated means "Older hens make the best soup"

Old Croation saying, mentioned in the wonderful movie Faraway

No act of kindness, however small, is ever wasted.

Aesop

A little bit about me

I attended Beal Grammar School for Boys in Essex, UK, and left to start work at the age of 16. After several years working as a junior clerk, I enrolled in an Honours degree in Statistics at the University of Bath, graduating in 1972.  This was followed by a Masters degree in Medical Statistics at the London School of Hygiene and Tropical Medicine in 1973, supervised by Professor Peter Armitage. I then took up a Junior Research Fellowship at the University of Aberdeen medical school in late 1973 before joining the World Health Organization in 1974. I worked for 5 years at the WHO head office in Geneva, followed by 2 years at the WHO European Regional Office in Copenhagen.

In 1981 I moved to Australia and worked for many years in the South Australian Department of Health as Principal Epidemiologist. In the mid-1990’s, I took a break from epidemiology, and became Managing Director of a market research company. This gave me great experience in survey research, and qualitative research, as well as HR management and sales. However, I eventually moved back into academic life, and in 2002 I received my PhD in epidemiology from Flinders University.

At the University of South Australia, one of my main roles is to provide advice on biostatistics and epidemiology to researchers in the health and medical areas. I am also a Chief Investigator on several research grants. I am the author of over 400 publications and have an h-index of 77. I am experienced at mentoring Research Fellows and junior staff, and of course PhD students. I am ranked by ScholarGPS in the top 0.5% of all scholars worlwide. In 2023 I was awarded Life Membership of the Australasian Epidemiological Association for my services to the AEA and epidemiology in Australia.

I really enjoy writing, and have written a number of articles about epidemiology and COVID-19 on the Medium  website. I have also written over 30 articles for The Conversation about COVID-19 and other topics, with over 2.5 million reads.  I have published a book on PhD supervision. I have also become an avid tweeter - @profesterman, with over 39,000 followers. I also give presentations on the current COVID-19 situation to community, business, academic and professional groups.

If you wish to visit me in person (post-COVID-19), it is worth your time checking this link:

How to read a Professor's door

Favourite Music

Barber Violin Concerto

Korngold Violin Concerto

Shostakovic Second Piano Conecto

Anything by Rachmaninov

Anything by Elgar

Favourite Movies 

Blade Runner (1982) 

Never Let Me Go (2010)

The Silence of the Lambs (1991)

Favourite Reading

Any good fantasy series.

PhD Supervision

My supervision philosophy is based on a wonderful poem by William Butler Yates:

I would spread the cloths under your feet

But I, being poor, have only my dreams

I have spread my dreams under your feet

Tread softly because you tread on my dreams.

My students have come from all areas of health, dentistry, or medicine - usually with an interest in evidence-based practice. I have so far had 29 PhD students successfuly complete (13 as Principal Supervisor), two of them winning the Ian Davies university prize for best thesis. I have been nominated by the University of South Australia for a national award for my PhD supervison. 

Current PhD students as Principal Supervisor

2019   Milina Crevar   Nutrition, contents and health warning labels on alcohol containers

2020   Kim Gibson   Predictors of adverse events in umbilical vascular access in neonates

Current PhD students as Co-supervisor

2021   Ethel Osazuwa   Rebuilding Life After Migration: Settlement Experiences of Refugee and Migrant Youth

2022  Tirani Kodippili   Examining the acculturation process of South Asian migrant youth and their parents in Australia

Current masters by Research as Co-supervisor

2022  Thomas Gleeson-Hammerton   Point-of-care ultrasound (POCUS) assessment of pre-hospital patients with suspected or confirmed COVID-19

A little bit about biostatistics

Biostatistics is somewhat different to the discipline of statistics in that biostatisticians are usually trained in university departments of public health, whereas statisticians are trained in university schools of mathematics and statistics. As well as standard statistical procedures, biostatisticians are experts in the design and analysis of clinical trials, the analysis of rates of disease, measures of the association between exposures and outcome, survival analysis, diagnostic testing, disease clustering and surveillance, disease screening, reliability and method comparison studies and biological assays. The statistical analysis of genetic studies has formed its own discipline called bioinformatics, which is somewhat different.

A little bit about epidemiology

Epidemiology is the study of diseases in populations. The majority of epidemiologists start with a medical degree, followed by postgraduate qualifications and training in public health and epidemiology. However, epidemiologists may also originally have started with degrees in medical statistics (like myself), psychology, nursing or many other discipline areas. Much of epidemiology is about the association between an exposure factor (which might be a risk factor like smoking, or an intervention) and an outcome (usually a disease).

This wonderful cartoon is definitely worth viewing:

How exposures are related to outcomes

Textbooks

I am often asked to recommend a good textbook. So here are my current thoughts:

• Basic biostatistics: Essential medical statistics by Kirkwood and Sterne
• Advanced biostatistics: Statistical methods in medical research by Armitage, Berry and Mathews
• Basic epidemiology: Epidemiology by Petra Buttner and Reinhold Muller
• Advanced epidemiology: Epidemiology: Study design and data analysis by Mark Woodward 

For those looking for free statistical software. I can highly recommend jamovi, which including addons which you can download, has a surprising number of features, and can directly import from Excel, SPSS and Stata. You can download it here:

https://www.jamovi.org/

2024 Publications

1. Gleeson-Hammerton T, Pearce J, Eckert M, Esterman A, Peters M. Paramedic assessment and referral of suspected or confirmed COVID-19 patients in the out-of-hospital environment: a scoping review protocol. JBI Evidence Synthesis (Accepted for publication 28 August 2024).
2. Maher C, Christian H, Nathan N, Okely A, Bogomolova S, Lewis LK, Cliff DP, Esterman A, Milte R, Rosenkranz RR, Curtis RG, Brinsley J, Ferguson T, Virgara R, Richardson M, Brannelly K, Stanley R, Schranz N, Campbell P, Weaver RG, Noetel M, Wolfenden L. Improving physical activity and screen time in Australian Outside School Hours Care: Study protocol. Pediatr Res. 2024 Aug 23. doi: 10.1038/s41390-024-03464-1. Online ahead of print. PMID: 39179874.
3. Edwards, H., Buisman-Pijlman, F. T. A., Esterman, A., Phillip, C., Orgeig, S., & Gordon, A. (in press). Exogenous oxytocin administered to induce or augment labour is positively associated with quality of observed mother-infant bonding. Comprehensive Psychoneuroendocrinology (Accepted for publication 24 August 2024). 
4. Curtis R, Hendrie G, Ferguson T, Olds T, Fraysse F, Dumuid D, Brown W, Esterman A, Maher C.  Annual and seasonal patterns in dietary intake in Australian adults: a prospective cohort study Nutrients (Accepted for publication 14 August 2024).
5. Smart L, O’Shaughnessy K, Pelentsov L, Childs J, Williams N, Esterman A. Barlow, Ortolani, and Hippy Dolls: Understanding child health nurses practice when screening for Developmental Dysplasia of the Hip Australian Journal of Advanced Nursing (Accepted for publication 8 August 2024).
6. Smart L, Cundy W, Williams N, Arnold A, Childs J, Pelentsov L, Esterman A. Screening Accuracy for Developmental Dysplasia of the Hip. Children 2024, 11, 915. https://doi.org/10.3390/children11080915.
7. Christodoulou V, Liu D, Esterman A, Galletly C. Facilitators and barriers to recruitment in mental health research: a survey of psychiatrists and psychiatry registrars in training. Australasian Psychiatry (Accepted for publication 3 July 2024).
8. Edwards H, Buisman-Pijlman F, Esterman A, Phillips C, Smart L, Orgeig S, Goron A. Assessing mothre-infant bonding: reliability of the recorded interaction task. J Reproduct Infant Psychol 2024 Jun;42(3):517-527. doi: 10.1080/02646838.2022.2134848. Epub 2022 Oct 12.PMID: 36224742.
9. Au R, Hotham E, Esterman A, Shakib S, Suppiah V. Changes in sedative burden at discharge in hospitalised patients experiencing psychotropic polypharmacy. Schizophr Res. 2024 Apr:266:90-91. doi: 10.1016/j.schres.2024.02.014. Epub 2024 Feb 20.
10. Kodippili T, Ziaian T, Puvimanasinghe T, Esterman A, Clark Y. The impact of aculyuration and psychological wellbeing on South Asian immigrant adolescents and youth: a scoping review. Current Psychology (2024). https://doi.org/10.1007/s12144-024-05981-y.
11. Smart L, Pelentsov L, Childs J, Williams N, Esterman A. Nurses assessment of developmental hip dysplasia. 2024 Journal of Child Health Care 28(1): 132-149. doi: 10.1177/13674935221095647. Epub 2022 Jun 7. PMID: 35670703
12. Tszwai R, Hotham E, Esterman A, Shakib S, Suppiah V. Changes in sedative burden at discharge in hospitalised patients experiencing psychotropic polypharmacy. Schizophrenia Research (Accepted for publication 13 February 2024).
13. Gibson K, Smith A, Sharp R, Ullman A, Morris S, Esterman A. Adverse events associated with umbilical vascular catheters in the neonatal intensive care unit: a retrospective cohort study. Australian Critical Care (Accepted for publication 4 February 2024).
14. Pham B, Kim B, Esterman A, Brodaty H, Kurrle S, Nguyen TB, Nguyen TH, Roughead E, Hinton L, Dang T, Nguyen TD, Tran K, Crotty M, Du D, Nguyen TA. Knowledge, attitudes and self-confidence with skills required for providing dementia care in physicians at primary healthcare settings in Vietnam BMC Health Serv Res 24, 86 (2024). https://doi.org/10.1186/s12913-023-10460-4.
15. Lovell B, Brown A, Steen M, Esterman A. Parenting Education for Women Experiencing Incarceration: Views of Prison Staff 2024 Women & Criminal Justice, DOI: 10.1080/08974454.2023.2296636. 
16. Sharp R, Xu Q, Pumpa R, Elliot L, Corsini N, Marker J, Altschwager J, Ortmann A, Turner L, Jin L, Ullman A, Esterman A. Supportive care needs of adults living with a peripherally inserted central catheter (PICC) at home: a qualitative content analysis. BMC Nurs. 2024 Jan 2;23(1):4. doi: 10.1186/s12912-023-01614-0.PMID: 38163877. an 2;23(1):4. doi: 10.1186/s12912-023-01614-0.PMID: 38163877. 
17. Ferguson T, Curtis R, Fraysse F, Olds T, Dumuid D, Brown W, Esterman A, Maher C. The annual rhythms in sleep, sedentary behavior and physical activity of Australian adults: a prospective cohort study. Annals of Behavioral Medicine (Accepted for publication 9 January 2024).

Current grants

Mikocka-Walus A, McCaffrey N, Evans S, Knowles S, Andrews J, Esterman A, Fuller- Tyszkiewicz M. Grant Opportunity: 2021 MRFF Clinical Trials Activity: Randomized E-hypnotherapy for Chronic Pelvic Pain Syndrome Trial (REST). $1,300,459 2023 – 2028. (Application ID: 2022322). Through Deakin University.

Maher C, Bogomolva S, Esterman A, Curtis R. Improving physical activity and screen time in Outside School Hours Care through evidence-based guidelines: an effectiveness-implementation hybrid trial. NHMRC Partnership Grant.  $1,398,57. 2022-2026 (App 1105454).

Maher C, Christian H, Esterman A, Nathan N, Rosenkranz R, Lewis L, Cliff D, Milte R, Curtis R. A multi-site guideline implementation randomised controlled trial to improve physical activity and screen time in Out of School Hours Care. MRFF - PPHR Initiative - 2020 Maternal First 2000 Days and Childhood Health. $1,499,840 2022-2024 (APP 2007395).

Nguyen T, Brodaty H, Xiao L, Brijnath B, Schofield P, Esterman A, Crotty M, Andrade A, Bhar S, Kurrle S. e-DiVA (empowering Dementia Carers with an iSupport Virtual Assistant). NHMRC e-Asia. $1,857,364 2021 – 2024 (APP 105614).

Hillier S, Olds T, Maher C, Gill T, Esterman A, Khadka J, Adams R, Hill C, Keogh J.   Healthy Choices: Co-designed community programs to enhance healthy lifestyle choices for people with chronic conditions Medical Research Future Fund (MRFF) – Preventive and Public Health Research Initiative. $780,670. 2020 – 2025. (APP 105492).

Evans S, Mikocka-Walus A, Watts J, Esterman A, Skvarc D. A Randomized Controlled Trial Comparing Yoga, Cognitive Behaviour Therapy and Education to Improve Quality of Life and Reduce Healthcare Costs in Endometriosis. MRFF Endometriosis Grant $893,981. 2020 – 2024. (Through Deakin University). (APP1200214).  

Ziaian T, Augoustinos M, Esterman A, Baddeley M, Arthur N, de Anstiss H, Tsoulis E, Stewart-Jones T, Ghassemi E, Tahereh Pir / Pirhekayaty T. Rebuilding Life After Migration for Young Refugees and Migrants. ARC Linkage Grant $710,889. 2020 - 2023. (APP 104134)

STATISTICAL TIPS

Multiple testing

The concern when testing m hypotheses simultaneously is to control the familywise error rate, the probability of making any false discovery.  For example, if you undertake 10 hypothesis tests, each at the p=0.05 level, then the chance of any one not being statistically significant is 0.95. The probability of all 10 not being statistically is 0.95^10 = 0.60. Hence the probability of at least one being statistically significant by chance is 0.40. In other words, there is a 40% chance of a false positive.

To avoid this, we adjust the p-values to take into account multiple testing. For example, suppose you conducted 5 hypothesis tests, and obtained the following p-values.

Hypothesis                    3                4              1                    2                  5

Original p-values        0.003        0.008       0.013        0.048       0.233 

Without any adjustment, we would reject the null hypothesis of no difference for hypotheses 3, 4, 1 and 2.

The simplest adjustment that can be made is that attributed to Bonferroni. Here you simply divide the nominal p-value (0.05) by the number of tests and use that as the criterion. In our case, since there were 5 tests, we would compare the result of each test to 0.05/5=0.01, and that would be our new criterion.  In that case, only hypotheses 3 and 4 would be stataistically significant.

However, Bonferroni has been shown to be overly conservative, and a better adjustment called the Holme-Bonferroni can be used. First sort the m p-values into size order as above. Then compare the most significant against 0.05/m, the next against 0.05/(m-1), the next 0.05/(m-2) etc. Now hypotheses 3, 4 and 1 are statistically significant. 

 Finally, we can use a technique that controls the false discovery rate (FDR). There are many methods for doing this, but the one I recommend is by Benjamani, Krieger and Yekutieli (2006). There is a Stata do file for obtaining these adjusted p-values called fdr_sharpened_qvalues.do which I can supply if you contact me. It uses a method called sharpened q-values.

Hypothesis                    3                4              1                    2                5

Original p-values        0.003        0.008       0.013        0.048       0.233 

Sharpened q-values   0.016        0.017       0.018        0.025       0.064

The conclusions are the same as when using the unadjusted p-values.  So, you can see that the sharpened q-value method is the most powerful of adjustments for multiple testing.

Australasian Epidemiology Association (AEA)

Clinical Oncological Society of Australia (COSA)

Australian Vascular Access Society

Qualifications

• Doctor of Philosophy Flinders University

• Master of Science (Medical Statistics) University of London

• Postgraduate Diploma London School of Hygiene and Tropical Medicine

• Bachelor of Science (Honours) University of Bath