Lifetime cost of stroke subtypes in Australia: findings from the North East Melbourne stroke incidence study (NEMESIS)

Background and Purpose-: Little is known about any variations in resource use and costs of care between stroke subtypes, especially nonhospital costs. The purpose of this study was to describe the patterns of resource use and to estimate the first-year and lifetime costs for stroke subtypes.

Methods-: A cost-of-illness model was used to estimate the total first-year costs and lifetime costs of stroke subtypes for all strokes (subarachnoid hemorrhages excluded) that occurred in Australia during 1997. For each subtype, average cost per case during the first year and the present value of average cost per case over a lifetime were calculated. Resource use data obtained in the North East Melbourne Stroke Incidence Study (NEMESIS) were used.

Results-: The present value of total lifetime costs for all strokes was Aus $1.3 billion (US $985 million). Total lifetime costs were greatest for ischemic stroke (72%; Aus $936.8 million; US $709.7 million), followed by intracerebral hemorrhage (26%; Aus $334.5 million; US $253.4 million) and unclassified stroke (2%; Aus $30 million; US $22.7 million). The average cost per case during the first year was greatest for total anterior circulation infarction (Aus $28 266). Over a lifetime, the present value of average costs was greatest for intracerebral hemorrhage (Aus $73 542), followed by total anterior circulation infarction (Aus $53 020), partial anterior circulation infarction (Aus $50 692), posterior circulation infarction (Aus $37 270), lacunar infarction (Aus $34 470), and unclassified stroke (Aus $12 031).

Conclusions-: First-year and lifetime costs vary considerably between stroke subtypes. Variation in average length of total hospital stay is the main explanation for differences in first-year costs.

Informal care for stroke survivors. Results from the North East Melbourne stroke incidence study (NEMESIS)

Background and Purpose-: Informal caregivers play an important role in the lives of stroke patients, but the cost of providing this care has not been estimated. The purpose of this study was to determine the nature and amount of informal care provided to stroke patients and to estimate the economic cost of that care.

Methods-: The primary caregivers of stroke patients registered in the North East Melbourne Stroke Incidence Study (NEMESIS) were interviewed at 3, 6, and 12 months after stroke, and the nature and amount of informal care provided were documented. The opportunity and replacement costs of informal care for all first-ever-in-a-lifetime strokes (excluding subarachnoid hemorrhages) that occurred in 1997 in Australia were estimated.

Results-: Among 3-month stroke survivors, 74% required assistance with activities of daily living and received informal care from family or friends. Two thirds of primary caregivers were women, and most primary caregivers (>90%) provided care during family or leisure time. Total first-year caregiver time costs for all first-ever-in-a-lifetime strokes were estimated to be A$21.7 million (opportunity cost approach) or A$42.5 million (replacement cost approach), and the present values of lifetime caregiver time costs were estimated to be A$171.4 million (opportunity cost approach) or A$331.8 million (replacement cost approach).

Conclusions-: Informal care for stroke survivors represents a significant hidden cost to Australian society. Because our community is rapidly aging, this informal care burden may increase significantly in the future.

Cost of stroke in Australia from a societal perspective: results from the north east Melbourne stroke incidence study (NEMESIS)

Background and Purpose—— Accurate information about resource use and costs of stroke is necessary for informed health service planning. The purpose of this study was to determine the patterns of resource use among stroke patients and to estimate the total costs (direct service use and indirect production losses) of stroke (excluding SAH) in Australia for 1997.

Methods—— An incidence-based cost-of-illness model was developed, incorporating data obtained from the North East Melbourne Stroke Incidence Study (NEMESIS). The costs of stroke during the first year after stroke and the present value of total lifetime costs of stroke were estimated.

Results—— The total first-year costs of all first-ever-in-a lifetime strokes (SAH excluded) that occurred in Australia during 1997 were estimated to be A$555 million (US$420 million), and the present value of lifetime costs was estimated to be A$1.3 billion (US$985 million). The average cost per case during the first 12 months and over a lifetime was A$18 956 (US$14 361) and A$44 428 (US$33 658), respectively. The most important categories of cost during the first year were acute hospitalization (A$154 million), inpatient rehabilitation (A$150 million), and nursing home care (A$63 million). The present value of lifetime indirect costs was estimated to be A$34 million.

Conclusions—— Similar to other studies, hospital and nursing home costs contributed most to the total cost of stroke (excluding SAH) in Australia. Inpatient rehabilitation accounts for {approx}27% of total first-year costs. Given the magnitude of these costs, investigation of the cost-effectiveness of rehabilitation services should become a priority in this community.

Regional variations in walking for different purposes : the south east Queensland quality of life study

Where people are located can influence behavioral choices and health outcomes through the effects of place on health. Walking is the most commonly reported form of nonoccupational and nonhousehold physical activity for adults. It is a behavior of particular interest to those in the transportation, urban planning, and public health fields. Researchers have examined patterns of walking from both an individual perspective (psychological and social factors) and from a broader community focus (location and built environment factors). The majority of studies have examined walking in the context of urban environments. Variations within regions (urban, periurban, and rural, for example) in walking have not been previously described. We use data from a regionally based quality of life survey to examine subregional variations in walking for particular purposes. Both the social and contextual variations that may underlie these differences are considered. This is useful in helping identify particular factors that may be further investigated in disaggregated analyses using GIS methods to identify specific differences in objective attributes between subregions that may influence peoples' choices to walk, such as walking infrastructure and the availability of destinations.

Unlocking Australia's relationship with the Middle East

Historically, Australia’s interests in the Middle East related primarily to its role in the Commonwealth imperial defence system which resulted in the deployment of Australian forces in the Middle East during both the First and Second World Wars. Similarly, the current involvement of Australian troops in Iraq and Afghanistan is driven by the country’s strategic alliance with the United States. However, Australia’s current involvement reflects a multifaceted relationship that spans economic, political and strategic spheres. Yet it is at the level of cultural and civilisational contacts that this relationship appears at its most vulnerable. This paper argues that a deeper understanding of this cultural dimension combined with a broader emphasis on good governance and human rights would be conducive to more robust ties in the longer term.

Understanding women's breast screening behaviour: a study carried out in South East London, with women aged 50-64 years

Objective To understand low uptake of breast cancer screening through exploring the personal reasoning underlying women's attendance or non-attendance, and identifying differences between those who attend and those who decline.

Design Cross-sectional survey.

Setting Community and home environments of women eligible for breast screening aged 50—64 years, living in South East London. Method Structured, self-completed or assisted-completion questionnaires.

Results The decision to attend or decline screening is rational and personally justifiable, engaging factors linked to emotions and attitude. Attitudes about breast screening and perceived personal importance of breast screening are the strongest predictors of attendance and non-attendance. There are differences between ethnic groups in perceptions of breast screening. Regular attendance at screening is associated with ethnicity, although consistent avoidance of mammography is not. Inconvenience is an important factor in missing appointments, and tends to be prolonged rather than specific to the time or day of the pre-booked invitation. GP and health worker advice are good persuaders towards attendance. Pain and anxiety during mammography are notable dissuaders against re-attending.

Conclusion Appropriate service provision requires consideration of local factors, as well as the medical needs of the population eligible for breast screening. Lay perceptions of potential personal costs of attending or not attending breast screening are important for guiding health promotion. Information providers should consider the language needs of a culturally and educationally mixed community. Health care professionals are well placed to encourage uptake of breast screening through disseminating information that promotes attendance, both within and outside the breast screening service.

A panel cointegration analysis of the demand for oil in the Middle East

This article applies recently developed panel unit root and panel cointegration techniques to estimate the long-run income and price elasticities for oil in the Middle East. The results for the panel indicate that demand for oil is highly price inelastic and slightly income elastic in the Middle East. There is considerable variation in the results for the income variable across countries, with the coefficient on the income variable statistically insignificant for several countries. The coefficient on the price variable is statistically significant in all cases with the expected sign and the price elasticity is uniformly low. While the results for the income variable differ across countries, the results for the panel as a whole suggest that the demand for oil in the Middle East is being driven largely by strong economic growth, while consumers are largely insensitive to price changes.

Fusulinoideans from the early Midian (late Middle Permian) Metadoliolina dutkevitchi-Monodiexodina sutchanica Zone of the Senkina Shapka section, South Primorye, Far East Russia.

Fusulinoideans from the Metadoliolina dutkevitchi-Monodiexodina sutchanica Zone of the lower part of the Chandalaz Formation in the Senkina Shapka section in South Primorye, Far East Russia, are described. The fusulinoidean zone is assigned to the early Midian (=Capitanian: late Middle Permian) based mainly on the morphologie and biostratigraphic characteristics of Metadoliolina dutkevitchi. Previously, a Midian age has been established for the Metadoliolina dutkevitchi-Monodiexodina sutchanica Zone by the coexistence of Lepidolina species. However, the occurrence of Lepidolina with the two zonal species in this area has not been verified by the illustration of Lepidolina specimens. We examined a fusulinoidean-bearing sample from the Metadoliolina dutkevitchi-Monodiexodina sutchanica Zone, and three fusulinoidean species, Monodiexodina sutchanica, Pseudofusulina sp. and Metadoliolina dutkevitchi, are de-scribed and illustrated.

Observations of the ecological impacts of Sambar Cervus unicolor in East Gippsland, Victoria, with reference to destruction of rainforest communities

Damage caused by Sambar, particularly browsing, antler rubbing and physical removal of particular plant species, is resulting in serious ecological consequences. Threatening processes instigated or maintained by Sambar include: loss of individual taxa, altered vegetation structure and massive
widespread removal and prevention of regeneration, which is now resulting in the loss of plant communities in some areas. These observations are particularly disturbing, as it is apparent that Sambar are yet to reach their full ecological and population potential in south-eastern Australia. The destruction documented ill this article is now so widespread and so severe that in places it represents an ecological disaster for specific plant and animal species, ecological vegetation classes and floristic communities. We strongly recommend that Sambar in particular, and feral deer in general. should no longer be protected under the Wildlife Act 1975 so that control methods can be devised and implemented. It now appears that such measures will he essential for the long-term survival of some fragile plant species and communities in Victoria. (Title: Victorian Naturalist 122(4) 2005, 189-200

Isogramma Meek and Worthen, 1870 (Dictyonellida, Brachiopoda) from the upper Palaeozoic of East Asia: implications for biogeography and evolutionary trends

Isogramma manchoukuoensis from the Upper Carboniferous of northeast China is redefined based on re-examination of the type specimens. Isogramma specimens from the Middle Permian of northeastern Japan are reassigned to I. aff. paotechowensis. A new family, Schizopleuroniidae, is proposed to include Schizopleuronia, but excludes Megapleuronia, which belongs to the Megapleuroniidae Liao, 1983. The family Isogrammidae is considered to be a transitional group in the eichwaldid-isogrammid-schizopleuronid evolutionary lineage within the Dictyonellida. A review of the global distribution of Isogramma species reveals that the genus has a total of 56 species ranging from the Mississippian (Early Carboniferous) to the Lopingian (Late Permian). Isogramma diversified rapidly after its origination in the middle Viséan and its species diversity remained high throughout the Mississippian. The genus possibly suffered a severe mid-Carboniferous boundary mass extinction, with no Early Carboniferous species surviving this event. Bashkirian Isogramma species show low diversity, followed by a global recovery in the Moscovian. During the latest Carboniferous Isogramma became highly diversified again. At the Carboniferous–Permian (C/P) transition Isogramma underwent another dramatic diversity drop, followed by several stepwise declines in diversity during the Early–Middle Permian. The Wuchiapingian I. sinosa is the last Isogramma species.

Ukraine was the possible centre of origin for Isogramma. From Ukraine Isogramma spread over the Moscow Basin of Russia, Central Europe (Germany, Austria), South Europe (Spain) and West Europe (England, Ireland and Scotland), and migrated to the North American midcontinent and South China during the late Viséan (Early Carboniferous). In Europe, Isogramma migrated to Spain and eastern Europe (Serbia) in the Moscovian, from there it then dispersed into Central Asia (Uzbekistan and Kazakhstan) in the Kasimovian-Gzhelian. In the Palaeo-Tethys Isogramma migrated from South China to northeast and northwest China in the Moscovian, spread over the North China Block during the C/P transition, moved to Russian Siberia, Japan and the Qiangtang terrane of the Palaeo-Tethys during the Early–Late Permian. In North America Isogramma spread over the midcontinent during the Late Carboniferous and Early–Middle Permian and migrated to South America (Bolivia) in latest Carboniferous. Biogeographically, Isogramma was confined principally to the palaeo-tropical and warm to temperate zones throughout the Late Palaeozoic, with the possible exception of the Artinskian, as a questionable species of the genus also occurs in the Transbaikal region of southeast Russia.

Out of pocket costs to stroke patients during the first year after stroke - results from the North East Melbourne stroke incidence study

Non-reimbursed ‘out of pocket’ costs to stroke patients have not been included in existing cost of illness studies. We aimed to determine the nature and magnitude of ‘out of pocket’ costs to stroke patients during the first year after stroke. ‘Out of pocket’ costs during the first year after stroke were documented for 165 persons registered in a community-based stroke incidence study during 1996/1997. Virtually all cases reported some ‘out of pocket’ costs. The average cost over 12 months was A$1110. The highest cost items were home modifications, aids and equipment. The most commonly incurred expense was for prescription medications. Total ‘out of pocket’ costs incurred by first-ever stroke patients in Australia in 1997 were estimated to be A$29 million or 5% of the total cost of stroke. The majority of ‘out of pocket’ costs relate to post-acute care aimed at minimising disability and handicap rather than to ‘acute’ healthcare.

The importance of national ICT visions for information society in South East Asia

This paper addresses the question ‘How necessary is a national information and communications technology (ICT) strategy/vision for the development of an information society?’ For the purpose of this paper, ‘information society’ is reduced to two key dimensions: penetration of ICT, and access to government information on-line. In considering the question, the paper calls on data contained in the International Telecommunication Union’s (ITU) case studies of e-readiness in eight South East Asian (SEA) nations (Cambodia, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam). The background to the paper includes an overview of the SEA nations in terms of demographics and a discussion of the dilemma of government involvement in developing an information society in the light of the ‘small government mantra’ that has dominated in recent years. National ICT strategies visions of each nation are presented, followed by on overview of their information society policies and practices and their ICT penetration. The importance of the vision is then contrasted with other factors including level of development and national income. The conclusions draw attention to the importance of a vision irrespective of level of development and resource availability. In fact, for the least developed nations, poor infrastructure may be an opportunity to leap frog to the most advanced networks supporting an information society, if the vision is relevant, powerful and broadly held.

South-East Asia : a political profile

"South-East Asia: A Political Profile outlines the political processes and institutions of the countries in South-East Asia, in particular tracing their past and explaining how they have come to be what they are." "The book is ideal for students of political science and South-East Asian studies at all levels."--BOOK JACKET.