Polypharmacy among inpatients aged 70 years or older in Australia

Objectives To investigate medication changes for older patients admitted to hospital and to explore associations between patient characteristics and polypharmacy. Design Prospective cohort study. Participants and setting Patients aged 70 years or older admitted to general medical units of 11 acute care hospitals in two Australian states between July 2005 and May 2010. All patients were assessed using the interRAI assessment system for acute care. Main outcome measures Measures of physical, cognitive and psychosocial functioning; and number of regular prescribed medications categorised into three groups: non-polypharmacy (0–4 drugs), polypharmacy (5–9 drugs) and hyperpolypharmacy (≥ 10 drugs). Results Of 1220 patients who were recruited for the study, medication records at admission were available for 1216. Mean age was 81.3 years (SD, 6.8 years), and 659 patients (54.2%) were women. For the 1187 patients with complete medication records on admission and discharge, there was a small but statistically significant increase in mean number of regular medications per day between admission and discharge (7.1 v 7.6), while the prevalence of medications such as statins (459 [38.7%] v 457 [38.5%] patients), opioid analgesics (155 [13.1%] v 166 [14.0%] patients), antipsychotics (59 [5.0%] v 65 [5.5%] patients) and benzodiazepines (122 [10.3%] v 135 [11.4%] patients) did not change significantly. Being in a higher polypharmacy category was significantly associated with increase in comorbidities (odds ratio [OR], 1.27; 95% CI, 1.20–1.34), presence of pain (OR, 1.31; 1.05–1.64), dyspnoea (OR, 1.64; 1.30–2.07) and dependence in terms of instrumental activities of daily living (OR, 1.70; 1.20–2.41). Hyperpolypharmacy was observed in 290/1216 patients (23.8%) at admission and 336/1187 patients (28.3%) on discharge, and the proportion of preventive medication in the hyperpolypharmacy category at both points in time remained high (1209/3371 [35.9%] at admission v 1508/4117 [36.6%] at discharge). Conclusions Polypharmacy is common among older people admitted to general medical units of Australian hospitals, with no clinically meaningful change to the number or classification (symptom control, prevention or both) of drugs made by treating physicians.

Penology from city to country: Rurality and penality in Australia

There is a long tradition of social inquiry concerned with locational patterns and place-based explanations of crime in which urban/rural differences have been regarded as of cardinal importance. The geographical and socio-spatial aspects of punishment have on the other hand been widely neglected. One reason for this is that cities have been treated as the site of the major crime problems, presenting a contrast with what are commonly assumed (often without careful empirical research) to be the naturally cohesive character of rural communities. Thus punishment, like crime, is not a significant or distinctive issue in rural communities, requiring the attention of criminologists. But just as there are significant and distinctive dimensions to rural crime, the practice of punishment in rural contexts raises important questions worthy of attention. These questions relate to (1) the demand for punishment (i.e. the penal sensibilities to be found in rural communities); (2) the supply of punishment according to principles of legal equality (notably the question of the effective availability in rural courts of the full range of penalties administered by urban courts, in particular alternatives to incarceration); and (3) the differential impact of the same penalties when imposed in different geographical settings (e.g. imprisonment may involve distant removal from an offender’s community in addition to segregation from it; license disqualification is a great deal more consequential in settings where public transport is unavailable). The chapter examines these questions by reference to available knowledge concerning patterns of punishment in rural Australia. This will be set against the background of an analysis of the differential social organisation of penality in rural and urban settings. The generally more attenuated nature of the social state and social provision in rural contexts can, depending upon the profile of particular communities (and in particular their degree of social homogeneity), produce very different penal consequences: more heavy reliance on the penal state on the one hand, or greater recourse to informal social controls on the other.

Assessing infant exposure to persistent organic pollutants via dietary intake in Australia

Persistent organic pollutants (POPs) including polybrominated diphenyl ethers (PBDEs); organochlorine pesticides (OCPs); and polychlorinated biphenyls (PCBs) persist in the environment, bioaccumulate, and pose a risk of causing adverse human health effects. Typically, exposure assessments undertaken by modeling existing intake data underestimate the concentrations of these chemicals in infants. This study aimed to determine concentrations of POPs in infant foods, assess exposure via dietary intake and compare this to historical exposure. Fruit purees, meat and vegetables, dairy desserts, cereals and jelly foods (n = 33) purchased in 2013 in Brisbane, Australia were analyzed. For OCPs and PCBs, concentrations ranged up to 95 pg/g fw and for PBDEs up to 32 pg/g fw with most analytes below the limit of detection. Daily intake is dependent on type and quantity of foods consumed. Consumption of a 140 g meal would result in intake ranging from 0 to 4.2 ng/day, 4.4 ng/day and 13.3 ng/day, for OCPs, PBDEs and PCBs, respectively. PBDEs were detected in 3/33 samples, OCPs in 9/33 samples and PCBs in 13/33 samples. Results from this study indicate exposure for infants via dietary (in contrast to dust and breast milk) intake in Australia contribute only a minor component to total exposure.

Work, aging, and retirement in Australia: Introduction to the special issue

Australia has an aging population and workforce, and policy makers and organizations increasingly encourage older workers to remain on the job longer and even beyond traditional retirement age. After a brief review of important demographic and political developments, we introduce the 8 articles included in this special issue on work, aging, and retirement in Australia. The articles include an overview of the Australian retirement income system, 6 articles reporting quantitative analyses of cross-sectional and longitudinal data provided by large samples of Australian workers and retirees, and a qualitative study which analyzes interviews with human resource managers. Overall, the articles demonstrate that research on work, aging, and retirement in Australia is flourishing, sophisticated, and diverse both in terms of content and methodologies. We close with a brief review of topics and research questions related to work, aging, and retirement that remain to be addressed in the Australian context in future research.

The experience of Indigenous students in a Bachelor of Nursing Program in Australia: cultural safety and decolonising nurse education

Background In Australia significant health inequalities, such as an 11year life expectancy gap, impact on the continent’s traditional owners, the Aboriginal peoples and Torres Strait Islanders. Evidence suggests links between improved Indigenous health and a greater proportion of Indigenous people employed in all sectors. Achieving a greater proportion of Indigenous people in health services and in the health education workforce, requires improved higher education completion rates. Currently Indigenous people are under-represented in higher education and attrition rates amongst those who do participate are high. We argue these circumstances make health and education matters of social justice, largely related to unexamined relations of power within universities where the pedagogical and social environment revolve around the norms and common-sense of the dominant culture. Project Research at Queensland University of Technology in 2010-2012, aimed to gain insights into attrition/retention in the Bachelor of Nursing. A literature review on Indigenous participation in higher education in nursing contextualised a mixed methods study. The project examined enrolment, attrition and success by an analysis of enrolment data from 1984-2012. Using Indigenous Research Assistants we then conducted 20 in-depth interviews with Indigenous students followed by a thematic analysis seeking to gain insights into the impact of students’ university experience on retention. Our findings indicate that cultural safety, mentorship, acceptance and support are crucial in student academic success. They also indicate that inflexible systems based on ethnocentric assumptions exacerbate the structural issues that impact on the students’ everyday life and are also part of the story of attrition. The findings reinforced the assumption that educational environments and processes are inherently cultural and political. This perspective calls into question the role of the students’ cultural experience at university in attrition rates. A partnership between the School of Nursing and the Indigenous Education Unit is working to better support Indigenous students.

Case study 1: Nursing informatics and eHealth in Australia

There are currently many changes happening in nursing and healthcare in Australia. Healthcare reform has been high on the national government agenda and has created many changes in healthcare including eHealth. Healthcare information technologies and informatics are providing many challenges and excitement for the future of healthcare in Australia. The challenge for professional nursing organisations and nursing leaders of Australia is to be proactive in developments and initiatives for nursing to remain visible and viable in health care systems to safeguard the profession for the future as health care reform is implemented.

Changes in energy efficiency in Australia: A decomposition of aggregate energy intensity using logarithmic mean Divisia approach

This paper provides an empirical estimation of energy efficiency and other proximate factors that explain energy intensity in Australia for the period 1978-2009. The analysis is performed by decomposing the changes in energy intensity by means of energy efficiency, fuel mix and structural changes using sectoral and sub-sectoral levels of data. The results show that the driving forces behind the decrease in energy intensity in Australia are efficiency effect and sectoral composition effect, where the former is found to be more prominent than the latter. Moreover, the favourable impact of the composition effect has slowed consistently in recent years. A perfect positive association characterizes the relationship between energy intensity and carbon intensity in Australia. The decomposition results indicate that Australia needs to improve energy efficiency further to reduce energy intensity and carbon emissions. © 2012 Elsevier Ltd.

Information technology and its changing roles to economic growth and productivity in Australia

In this paper we describe our investigation of the role of investment in information technology (IT) on economic output and productivity in Australia over a period of about four decades. The framework used in this paper is the aggregate production function, where IT capital is considered as a separate input of production along with non-IT capital and labour. The empirical results from the study indicate the evidence of robust technical progress in the Australian economy in the 1990s. IT capital had a significant impact on output, labour productivity and technical progress in the 1990s. In recent years, however, the contribution of IT capital on output and labour productivity has slowed down. Regaining the IT capital productivity therefore remains as a key challenge for Australia, especially in the context of greater IT investment in the future.

Interfuel substitution in Australia: A way forward to achieve environmental sustainability

This paper examines the possibilities for interfuel substitution in Australia in view of the need to shift towards a cleaner mix of fuels and technologies to meet future energy demand and environmental goals. The translog cost function is estimated for the aggregate economy, the manufacturing sector and its subsectors, and the electricity generation subsector. The advantages of this work over previous literature relating to the Australian case are that it uses relatively recent data, focuses on energy-intensive subsectors and estimates the Morishima elasticities of substitution. The empirical evidence shown herein indicates weak-form substitutability between different energy types, and higher possibilities for substitution at lower levels of aggregation, compared with the aggregate economy. For the electricity generation subsector, which is at the centre of the CO2 emissions problem in Australia, significant but weak substitutability exists between coal and gas when the price of coal changes. A higher substitution possibility exists between coal and oil in this subsector. The evidence for the own- and cross-price elasticities, together with the results for fuel efficiencies, indicates that a large increase in relative prices could be justified to further stimulate the market for low-emission technologies.

On the contribution of information and communication technology to productivity growth in Australia

This paper revisits the so-called ‘ICT-productivity paradox’ from a long-run perspective by using annual Australian data for 1965–2013. It provides estimates of long-run and short-run elasticities of labour productivity with respect to ICT capital deepening, and explores the nature of long-run causality among productivity growth and ICT and non-ICT capital deepening. The estimates of long-run elasticities are derived by employing both time-series and panel data econometric techniques. The empirical results provide strong confirmatory evidence of the long-run impact of ICT capital deepening on labour productivity in Australia.

Decomposition of energy-related CO2 emissions in Australia: Challenges and policy implications

Changes in energy-related CO2 emissions aggregate intensity, total CO2 emissions and per-capita CO2 emissions in Australia are decomposed by using a Logarithmic Mean Divisia Index (LMDI) method for the period 1978-2010. Results indicate improvements in energy efficiency played a dominant role in the measured 17% reduction in CO2 emissions aggregate intensity in Australia over the period. Structural changes in the economy, such as changes in the relative importance of the services sector vis-à-vis manufacturing, have also played a major role in achieving this outcome. Results also suggest that, without these mitigating factors, income per capita and population effects could well have produced an increase in total emissions of more than 50% higher than actually occurred over the period. Perhaps most starkly, the results indicate that, without these mitigating factors, the growth in CO2 emissions per capita could have been over 150% higher than actually observed. Notwithstanding this, the study suggests that, for Australia to meet its Copenhagen commitment, the relative average per annum effectiveness of these mitigating factors during 2010-2020 probably needs to be almost three times what it was in the 2005-2010 period-a very daunting challenge indeed for Australia's policymakers.

Co2 emissions and income trajectory in Australia: The role of technological change

This study investigates the relationship between per capita carbon dioxide (CO2) emissions and per capita GDP in Australia, while controlling for technological state as measured by multifactor productivity and export of black coal. Although technological progress seems to play a critical role in achieving long term goals of CO2 reduction and economic growth, empirical studies have often considered time trend to proxy technological change. However, as discoveries and diffusion of new technologies may not progress smoothly with time, the assumption of a deterministic technological progress may be incorrect in the long run. The use of multifactor productivity as a measure of technological state, therefore, overcomes the limitations and provides practical policy directions. This study uses recently developed bound-testing approach, which is complemented by Johansen- Juselius maximum likelihood approach and a reasonably large sample size to investigate the cointegration relationship. Both of the techniques suggest that cointegration relationship exists among the variables. The long-run and short-run coefficients of CO2 emissions function is estimated using ARDL approach. The empirical findings in the study show evidence of the existence of Environmental Kuznets Curve type relationship for per capita CO2 emissions in the Australian context. The technology as measured by the multifactor productivity, however, is not found as an influencing variable in emissionsincome trajectory.

Energy-output linkages in Australia: Implications for emissions reduction policies

The study investigates the long-run and dynamic relationships between energy consumption and output in Australia using a multivariate cointegration and causality framework. Using both Engle-Granger and Johansen cointegration approaches, the study finds that energy consumption and real Gross Domestic Product are cointegrated. The Granger causality tests suggest bidirectional Granger causality between energy consumption and real GDP, and Granger endogeineity in the system. Since the energy sector largely contributes to carbon emissions in Australia, we suggest that direct measures to reduce carbon by putting constraints on the energy consumption would pose significant economic costs for the Australian economy.

A study of professional advisers in Australia

Since 2002, ACPNS has been surveying professional advisers to affluent Australians intermittently to seek their views and experiences around client and personal philanthropy. Why?: because professional advisers on finance, wealth management, law, accounting, taxation, estate management and beyond are an important nexus with people who have the capacity to channel significant funding into community need. Overall, this study suggests a slight shift away from advising affluent clients on philanthropic matters. It also highlights some perceived lack of organisational and professional association support and the feeling of many advisers that they do not have the expertise yet to advise in this area. These results provide thought fodder for advisers, their organisations and sector bodies.

Policing online fraud in Australia: The emergence of a victim‐oriented approach

Online fraud is a global problem. Millions of individuals worldwide are losing money and experiencing the devastation associated with becoming a victim of online fraud. In 2014, Australians reported losses of $82 million as a result of online fraud to the Australian Competition and Consumer Commission (ACCC). Given that the ACCC is one of many agencies that receives victim complaints, and the extent of under‐reporting of online fraud, this figure is likely to represent only a fraction of the actual monetary losses incurred. The successful policing of online fraud is hampered by its transnational nature, the prevalence of false/stolen identities used by offenders, and a lack of resources available to investigate offences. In addition, police are restricted by the geographical boundaries of their own jurisdictions which conflicts with the lack of boundaries afforded to offenders by the virtual world. In response to this, Australia is witnessing the emergence of victim‐oriented policing approaches to counter online fraud victimisation. This incorporates the use of financial intelligence as a tool to proactively notify potential victims of online fraud. Using a variety of Australian examples, this paper documents the history to this new approach and considers the significance that such a shift represents to policing in a broader context. It also details the value that this approach can have to both victims and law enforcement agencies. Overall, it is argued that a victim‐oriented approach to policing online fraud can have substantial benefits to police and victims alike.