Colorectal cancer screening in Australia: an economic evaluation of a potential biennial screening program using faecal occult blood tests

Objective: To evaluate whether the introduction of a national, co-ordinated screening program using the faecal occult blood test represents 'value-for-money' from the perspective of the Australian Government as third-party funder. Methods: The annual equivalent costs and consequences of a biennial screening program in 'steady-state' operation were estimated for the Australian population using 1996 as the reference year. Disability-adjusted life years (DALYs) and the years of life lost (YLLs) averted, and the health service costs were modelled, based on the epidemiology and the costs of colorectal cancer in Australia together with the mortality reduction achieved in randomised controlled trials. Uncertainty in the model was examined using Monte Carlo simulation methods. Results: We estimate a minimum or 'base program' of screening those aged 55 to 69 years could avert 250 deaths per annum (95% uncertainty interval 99-400), at a gross cost of $A55 million (95% UI $A46 million to $A96 million) and a gross incremental cost-effectiveness ratio of $A17,000/DALY (95% UI $A13,000/DALY to $A52,000/DALY). Extending the program to include 70 to 74-year-olds is a more effective option (cheaper and higher health gain) than including the 50 to 54-year-olds. Conclusions: The findings of this study support the case for a national program directed at the 55 to 69-year-old age group with extension to 70 to 74-year-olds if there are sufficient resources. The pilot tests recently announced in Australia provide an important opportunity to consider the age range for screening and the sources of uncertainty, identified in the modelled evaluation, to assist decisions on implementing a full national program.

Options for guaranteeing the effective management of the world's protected areas

A rapid increase in the number and size of protected areas has prompted interest in their effectiveness and calls for guarantees that they are providing a good return on investment by maintaining their values. Research reviewed here suggests that many remain under threat and a significant number are already suffering deterioration. One suggestion for encouraging good management is to develop a protected-area certification system: however this idea remains controversial and has created intense debate. We list a typology of options for guaranteeing good protected-area management, and give examples, including: danger lists; self-reporting systems against individual or standardised criteria; and independent assessment including standardised third-party reporting, use of existing certification systems such as those for forestry and farming and certification tailored specifically to protected areas. We review the arguments for and against certification and identify some options, such as: development of an accreditation scheme to ensure that assessment systems meet minimum standards; building up experience from projects that are experimenting with certification in protected areas; and initiating certification schemes for specific users such as private protected areas or institutions like the World Heritage Convention.

Stakeholder opinion of functional communication activities following traumatic brain injury

Primary objective : To establish a process whereby assessment of functional communication reflects the authentic communication of the target population. The major functional communication assessments available from the USA may not be as relevant to those who reside elsewhere, nor assessments developed primarily for persons who have had a stroke as relevant for traumatic brain injury rehabilitation. Research design : The investigation used the Nominal Group Technique to elicit free opinion and support individuals who have compromised communication ability. A survey mailed out sampled a larger number of stakeholders to test out differences among groups. Methods and procedures : Five stakeholder groups generated items and the survey determined relative 'importance'. The stakeholder groups in both studies comprised individuals with traumatic brain injury and their families, health professionals, third-party payers, employers, and Maori, the indigenous population of New Zealand. Main outcomes and results : There was no statistically significant difference found between groups for 19 of the 31 items. Only half of the items explicitly appear on a well-known USA functional communication assessment. Conclusions : The present study has implications for whether functional communication assessments are valid across cultures and the type of impairment.

With friends like these... The role of prejudice and situational norms on discriminatory helping behavior

An experiment was conducted to examine the impact of homophobic attitudes and situational norms for helping on discriminatory behavior against a gay male. In a partial replication of Frey and Gaertner (1986), participants were asked to provide help to a confederate portrayed to be either gay or heterosexual who either requested help for himself (ambiguous situational norm) or for whom a third party requested help (unambiguous situational norm). Participants' levels of homophobia were assessed either before or after the main helping task. The results indicated that when norms for helping were ambiguous those participants higher in homophobia discriminated against the gay male, but only on subtle indicators of discrimination. In the unambiguous norm condition, participants higher in homophobia discriminated against the heterosexual male. Those lower in homophobia did not discriminate under either norm condition. The results show that it may be sufficient for those with prejudiced attitudes just to believe that it is not the wrong thing to do for their attitudes to be translated into some form of discriminatory behavior.