A preliminary analysis of the cost-effectiveness of the National Bowel Cancer Screening Program – demonstrating the potential value of comprehensive real world data

Background The complexity and cost of treating cancer patients is escalating rapidly and increasingly difficult decisions are being made regarding which interventions provide value for money. BioGrid Australia supports collection and analysis of comprehensive treatment and outcome data across multiple sites. Here we use preliminary data regarding the National Bowel Cancer Screening Program (NBCSP) and stage-specific treatment costs for colorectal cancer (CRC) to demonstrate the potential value of real world data for cost-effectiveness analyses (CEA).

Methods Data regarding the impact of NBCSP on stage at diagnosis was combined with stage-specific CRC treatment costs and existing literature. An incremental CEA was undertaken from a government healthcare perspective, comparing NBCSP to no-screening. The 2008 invited population (n=681,915) was modelled in both scenarios. Effectiveness was expressed as CRC-related life years saved (LYS). Costs and benefits were discounted at 3% per annum.

Results Over the lifetime and relative to no-screening, NBCSP was predicted to save 1,265 life-years, prevent 225 CRC cases and cost an additional $48.3 million, equivalent to a cost-effectiveness ratio of $38,217 per LYS. A scenario analysis assuming full participation improved this to $23,395.

Conclusions This preliminary CEA based largely on contemporary real world data suggests population-based FOBT screening for CRC is attractive. Planned ongoing data collection will enable repeated analyses over time, using the same methodology in the same patient populations, permitting an accurate analysis of the impact of new therapies and changing practice. Similar CEA using real world data related to other disease types and interventions appears desirable.

Improving care for people with osteoarthritis of the hip and 'knee : how has national policy for osteoarthritis been translated into service models in Australia?

There is strong rationale for improving care for people with chronic conditions, including osteoarthritis (OA). Successful implementation of healthcare reform requires new concepts and directions that are strongly supported by policy, new models of care (service redesign) and changes in day-to-day practice (healthcare provider and patient practice). In this paper we discuss the extent to which policy about management of OA of the hip and knee has been translated into new service models in Australia. A structured search of government and other key health websites in Australia was performed to identify policy, funding initiatives and new services models for managing OA of the hip and knee. This search was supported by a literature review. Musculoskeletal conditions were designated a National Health Priority in Australia in 2002. Under the Better Arthritis and Osteoporosis Care initiative, Australia has developed a national policy for OA care and national evidence-based clinical practice guidelines for management of OA of the hip and knee. Only two well described examples of new chronic disease management service models, the Osteoarthritis Clinical Pathway (OACP) model and the Osteoarthritis Hip and Knee Service (OAHKS) were identified. Primarily focused within acute care public hospital settings, these have been shown to be feasible and acceptable but have limited data on clinical impact and cost-effectiveness. While policy is extant, implementation has not been systematic and comprehensive. Clinicians have evidence-based recommendations for OA management but are poorly supported by service models to deliver these effectively and efficiently.

Reimagining poetry : innovative literacies, national agendas and digital landscapes

Renewing engagement with literature and integrating technologies in order to address the needs of an increasingly diverse student cohort are some of the challenges confronting 21st century English teachers as they go about implementing the Australian Curriculum: English. This chapter reports on an action research cycle of classroom inquiry into the interpretation and creation of poetry, drawing on both multimodal and traditional poetic forms. Three middle school teachers, in partnership with three university-based researchers, sought to explore the possibilities of one-to-one computing for creating differentiated literacy curriculum based on personalised learning goals and harnessing the affordances of multimodal literacy pedagogies. The learning gains achieved through this collaboration exceeded the expectations of all concerned: teachers, students and researchers. Student achievement was shown by their enhanced knowledge and creativity when interpreting and composing poetry. Furthermore, students increased their capacities in other ways, through collaborating and problem-solving, as well as increased technological mastery, meta-cognition and self-assessment. Such transformations in student learning challenge standardised notions of accomplishment in English and the kinds of pedagogy necessary to support their learning. The teachers involved in this research engaged in rich forms of collaboration, engaging in professional learning that matched the learning of their students. For academics, the co-creation of professional praxis with middle years teachers and students reaffirmed their sense of the value of generating literacy pedagogies through reflective dialogue within local, situated knowledge communities

The evolution of national level historic district registration and conservation in China: the Beijing Yandaixiejie and Beijing Guozijian districts in Beijing, China

From the 1980s, Chinese experts from some mainland universities, such as Tongji Universtiy in Shanghai and Tsinghua University in Beijing, commenced research into heritage management and historic architectural conservation in China. With the announcement of the First and Second Lists of 10 Chinese Historic and Cultural Districts in 2009 and 2010, the conservation of historic districts was generally received and elevated in agreements from state-level government to local level governments. This paper considers literature about international and Chinese regulations and presents the evolution of historic district conservation in China. The paper explores the effective and ineffective results of the “Selection Contest of Chinese Top 10 Historic and Cultural Districts” in two cases selected from the First and Second Lists of 10 Chinese Historical and Cultural Districts during upon recent research and investigations. In each example, the paper provides a detailed examination of public awareness and their evaluation of conservation effectiveness through questionnaires.

Censorship, resistance and transformation in modern Indonesian literature

This paper investigates the way in which Indonesian literature has reflected violations of human rights in Indonesia in the last decade of the New Order (1990-1998). The regime was authoritarian and responded harshly to any challenge which could cause trouble to national stability. Some writers, such as Seno Gumira Ajidarma, used the power of allegory to resist this oppression. The three works examined here – ‘Saksi Mata’, ‘Pelajaran Sejarah’, and ‘Misteri Kota Ninggi’ – can be considered as a form of resistance literature.

Psychosocial risk factors for coronary heart disease: a consensus statement from the National Heart Foundation of Australia

In 2003, the National Heart Foundation of Australia published a position statement on psychosocial risk factors and coronary heart disease (CHD). This consensus statement provides an updated review of the literature on psychosocial stressors, including chronic stressors (in particular, work stress), acute individual stressors and acute population stressors, to guide health professionals based on current evidence. It complements a separate updated statement on depression and CHD.

Perceived chronic job strain and shift work are associated with a small absolute increased risk of developing CHD, but there is limited evidence regarding their effect on the prognosis of CHD. Evidence regarding a relationship between CHD and job (in)security, job satisfaction, working hours, effort-reward imbalance and job loss is inconclusive.

Expert consensus is that workplace programs aimed at weight loss, exercise and other standard cardiovascular risk factors may have positive outcomes for these risk factors, but no evidence is available regarding the effect of such programs on the development of CHD.

Social isolation after myocardial infarction (MI) is associated with an adverse prognosis. Expert consensus is that although measures to reduce social isolation are likely to produce positive psychosocial effects, it is unclear whether this would also improve CHD outcomes. Acute emotional stress may trigger MI or takotsubo ("stress") cardiomyopathy, but the absolute increase in transient risk from an individual stressor is low. Psychosocial stressors have an impact on CHD, but clinical significance and prevention require further study.

Awareness of the potential for increased cardiovascular risk among populations exposed to natural disasters and other conditions of extreme stress may be useful for emergency services response planning. Wider public access to defibrillators should be available where large populations gather, such as sporting venues and airports, and as part of the response to natural and other disasters.

Analyses and comparison of counter-movement jump performance and self-rated recovery in state under-18s Australian Rules Football players during a national championship

Recovery of team sport athletes during multiple competitive games is an important area for strength and conditioning coaches to monitor as it facilitates for athletes to be ready to perform (11,13). Utilising athletic performance data in conjunction with self-rated reporting measures can help determine if in fact a player or team has recovered sufficiently or shown a trend towards recovery prior to a competitive match (11). Positive improvement in recovery variables can provide confidence in the effectiveness of recovery methods used and assist in determining the training schedule in order to positively manipulate the fitness-fatigue relationship (3).

Various methods of analysing the recovery of athletes have been reported in the literature and are available to the strength and conditioning coach. These include subjective, self-rated scales and perceived level of recovery questionnaires (11,12,13). Athletic performance measures during exercises such as the counter movement jump (CMJ) have also been analysed, predominantly utilising force plates to obtain kinetic data. (5,13,14). However, such equipment can be difficult to transport, requires continual calibration and is costly to purchase. A linear transducer can provide important information on CMJ variables in the assessment of athletic movements and due to its size and portability could serve as a valuable tool to assist strength and conditioning coaches, (8,10), and potentially enable the monitoring of recovery.

Previous studies have investigated the fatigue effects of competitive games in various sports (11,13,14) including Australian Rules Football (AFL) at the senior elite league level (5, 6). To the authors’ knowledge, however, there is yet to be a study investigating the recovery response in AFL players, specifically in players 18 years and under competing in the National Under 18s Championships. Australian Rules football is an extremely physically demanding and fatiguing sport where players participate in games time exceeding 120 minutes duration, covering large distances (~12-18km, position dependent) with many high intensity efforts performed at random times throughout the game (2,6,16). Hence, it would seem pertinent to analyse the fatigue effects of competitive matches in an Australian Rules Under-18’s National Championship and the subsequent recovery from these games.

The aim of this study was to analyse and compare two self-rated subjective measures of recovery; they being muscle soreness (MS) of the lower body, overall perceived total recovery (TR), and the performance measure of peak velocity (PV) obtained from a CMJ analysed with a linear transducer. Data collection occurred between rounds four and five of the Australian Football League Under-18’s National Championship, representing a four-day recovery analysis period between matches.

Q-fever and Australian farmers: is the health system paying enough attention? A literature review

Introduction: Q-fever is caused by Coxiella burnetii, a Gram-negative bacterium and Rickettsia-like organism. Transmitted from wild and domestic animals to humans, the most common route is inhalation of contaminated dust; however the oral route can be considered as a second pathway. Aim: to understand the reasons behind not including farming workforce and their families in the national vaccinations program. Discussion: In 1977 Q-fever became a notifiable disease nationally. Australia is the only country to have a registered Q-fever vaccine. As a result of the cost of the vaccine, Department of Health and Ageing (DoHA) supply and subsidised program arrangements are based on the active cases count per year (by occupation), rather than for occupations that expose workers to high level of possible "risk". Conclusion: Australian farmers, farm managers, farm workers and their families need to be well educated about Q-fever and included in the national vaccination program.

Cross-continental comparison of national food consumption survey methods—A narrative review

Food consumption surveys are performed in many countries. Comparison of results from those surveys across nations is difficult because of differences in methodological approaches. While consensus about the preferred methodology associated with national food consumption surveys is increasing, no inventory of methodological aspects across continents is available. The aims of the present review are (1) to develop a framework of key methodological elements related to national food consumption surveys, (2) to create an inventory of these properties of surveys performed in the continents North- America, South-America, Asia and Australasia, and (3) to discuss and compare these methodological properties cross-continentally. A literature search was performed using a fixed set of search terms in different databases. The inventory was completed with all accessible information from all retrieved publications and corresponding authors were requested to provide additional information where missing. Surveys from ten individual countries, originating from four continents are listed in the inventory. The results are presented according to six major aspects of food consumption surveys. The most common dietary intake assessment method used in food consumption surveys worldwide is the 24-HDR (24 h dietary recall), occasionally administered repeatedly, mostly using interview software. Only three countries have incorporated their national food consumption surveys into continuous national health and nutrition examination surveys.

Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Background: Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65·3 years (UI 65·0-65·6) in 1990, to 71·5 years (UI 71·0-71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8-48·2) to 54·9 million (UI 53·6-56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased.For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.

Factors influencing compliance to universal precautions in healthcare workers: a systematic literature review

Background: Occupational exposure to blood borne viruses involving hollow bore needles is one of the most commonly reported adverse events affecting staff in the National Health Service in the UK. Universal Precautions Guidelines were originally developed in 1987 in order to minimise the risk of contact with body fluid. Universal precautions not only protect staff against blood borne pathogens but are also considered as an efficient mean to reduce the spread of pathogens from patients to patients via healthcare workers.Aim of the study: The aim of this study was to identify and evaluate the objective evidence on factors influencing healthcare workers compliance to universal precautions through a systematic literature review.Methodology: This systematic review was conducted in 2009 and studies were retrieved through electronic databases, manual journal searches and communications with experts in the field. Studies of cross sectional survey design and observational design were included in the review as they constituted the most commonly used research design evaluating compliance to universal precautions.A quality checklist was developed based on existing assessment criteria.Findings: Studies conducted to ascertain compliance to universal precautions are plentiful but remain of low quality. Sixty studies were retrieved and evaluated for potential inclusion in this study. Four studies met the inclusion criteria. Three were of cross-sectional survey design and one of direct observational design.Conclusions: Uptake of universal precautions remains low despite known benefits. Lack of time, resources and lack of knowledge have been shown as being factors negatively influencing healthcare workers compliance with universal precautions.This paper also highlights the issues surrounding the inclusion of low grade evidence in systematic literature reviews and the implications of reviews including low grade evidence on practice.Type of article: Research paperKeywords: systematic review, universal precautions, standard precautions, compliance, healthcare worker.

Gen green 4 Australia: a national study of demand for and supply of skills for sustainability

In this research, skills for sustainability are broadly conceived as including skills for social, economic and environmental sustainability – a triple bottom-line approach. Since 2009 Australian governments have been implementing an agreement that embeds skills for sustainability into vocational education and training, despite scant information about the actual levels of demand for, and supply of these skills. This study provides evidence on the actual depth and breadth of the take-up of these skills within Australian training organisations and workplaces. The demand studied in this research is that expressed by the primary consumers of Australian Vocational Education and Training (VET) services, students who engage in VET studies, this is known in the literature as social demand for education. VET students and teachers responded to two survey instruments that explored the sustainability values, behaviours, learning and teaching of Australian apprentices, trainees and their teachers. The results of this study show ‘a social demand’ for skills for sustainability. In summary, the results show that: •Apprentices, trainees and their teachers cared a great deal about social, economic and environmental sustainability; •Supply was closely aligned to social demand for skills for sustainability so that demand for skills for sustainability from VET students was almost entirely met; •There are important differences in the teaching, learning and utilisation of skills for sustainability that are related to gender and age; and •In-class learning of environmental skills has increased over time and now slightly outweighs learning of these skills at work, however community learning of these skills outweighs both. The findings suggest that: •Further action is required to embed green skills into the VET system, especially in the areas of energy efficiency and supply chains; •The VET system plays an important role in supporting community cohesion and economic literacy, especially for women; •It is important that social sustainability is properly considered in analysis informing VET policy; and •Gender differences in values and behaviours and gender and age differences in learning skills for sustainability have important implications for the design of future skills for sustainability programs. VET students and their teachers have unique insights into the supply of and demand for skills for sustainability, and this viewpoint can contribute, now and in the future, to the further development of skills for sustainability in Australia.