Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia : does more equal less?

Aims and objectives : To compare the efficacy of chronic heart failure management programmes (CHF-MPs) according to a scoring algorithm used to quantify the level of applied interventions–the Heart Failure Intervention Score (HF-IS).

Background : The overall efficacy of heart failure programmes has been proven in several meta-analyses. However, the debate continues as to which components are essential in a heart failure programme to improve patient outcomes.

Design : Prospective cohort study of patients participating in heart failure programmes.

Method : Forty-eight of 62 (77%) programmes in Australia participating in a national register of CHF-MPs were evaluated using the HF-IS: derived from a summed and weighted score of each intervention applied by the CHF-MP (27 interventions overall). The CHF-MPs were prospectively categorised as relatively low (HF-IS < 190 – n = 39 programmes & 407 patients) or high (HF-IS ≥ 190 – n = 9 programmes & 166 patients) in complexity. Six-month morbidity and mortality rates in 573 consecutively recruited patients with systolic dysfunction and in New York Heart Association Class II–IV were prospectively examined.

Results : Patients exposed to CHF-MPs with a high HF-IS had a lower rate of unplanned, all-cause hospitalisation (n = 24, 14% vs. n = 102, 25%) compared with CHF-MPs with a low HF-IS within six months. On an adjusted basis, CHF-MPs with a high HF-IS were associated with a reduced risk of unplanned hospitalisation and/or death within six months and remained event-free longer.

Conclusion : High complexity CHF-MPs applying more evidence-based interventions are associated with a higher event-free survival over six months.

Relevance to clinical practice : The HF-IS is an easy-to-use evidence-based tool to assist programme coordinators to improve the quality of their heart failure programme which may also improve patient outcomes.

Costs of psychosis in 2010: findings from the second Australian national survey of psychosis

Objectives
To estimate the annual costs of psychosis in Australia from societal and government perspectives and assess whether average costs per person differ by principal service provider at time of census.

Methods
Costs of psychosis encompassing health sector costs, other sector costs, and productivity losses were assessed for 2010 using a prevalence-based, bottom-up approach. Resource use data were obtained from the second Australian National Survey of Psychosis and unit costs were from government and non-government organization (NGO) sources. Costs to society were assessed by principal service provider at census: public specialized mental health services (PSMHS) and NGOs during the census month (current clients), and PSMHS in the 11 months preceding census (recent clients), and any differences were ascertained.

Results
The average annual costs of psychosis to society are estimated at $77,297 per affected individual, comprising $40,941 in lost productivity, $21,714 in health sector costs, and $14,642 in other sector costs. Health sector costs are 3.9-times higher than those for the average Australian. Psychosis costs Australian society $4.91 billion per annum, and the Australian government almost $3.52 billion per annum. There are significant differences between principal service providers for each cost category. Current PSMHS clients had the highest health sector costs overall, and the highest mental health ambulatory, inpatient, and antipsychotic medication costs specifically. NGO clients had the highest other sector costs overall and the highest NGO assistance, supported employment, and supported accommodation costs. Recent PSMHS clients had the lowest productivity losses for reduced participation and the highest costs for absenteeism and presenteeism.

Conclusions
The costs of psychosis are broad ranging and very high. Development and implementation of cost-effective prevention, treatment, and support strategies is critical to maximizing the efficiency of service delivery. A needs-based framework based on principal service provider and recency of contact may facilitate this process.

Retirement or just a change of pace: an Australian national survey of disability day services used by older people with disabilities

The increasing number of people with disabilities surviving to old age raises questions regarding the type of day support programs necessary to meet their needs. In this paper the results of a national survey of specialist disability day programs used by older2 people with a lifelong disability are discussed. A postal survey of 596 day programs for people with disabilities was conducted, with a response rate of 28%. Findings show that only 19% of service users were aged over 55, and the largest subgroup were people with intellectual disability. Many older people attended programs that were not age specific and a typology of the seven program types utilised was constructed. Individualised planning, flexibility and choice were perceived as fundamental to a successful program. The location of activities in the community, maintenance of social relationships, and opportunities to develop new contacts were also seen as important. Little understanding, however, of the diversity of the ageing process or notions of healthy ageing was demonstrated by service providers, many of whom had limited expectations of older people. Challenges identified in providing day support for older people were lack of financial resources, knowledge and expertise amongst staff, and difficulties interfacing with other service systems.

National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers - a population-based survey among Danish adults

Health literacy is a multidimensional concept covering a range of cognitive and social skills necessary for participation in health care. Knowledge of health literacy levels in general populations and how health literacy levels impacts on social health inequity is lacking. The primary aim of this study was to perform a population-based assessment of dimensions of health literacy related to understanding health information and to engaging with healthcare providers. Secondly, the aim was to examine associations between socio-economic characteristics with these dimensions of health literacy.

A cross-national study of calculus

The results from a cross-national study comparing calculus performance of students at East China Normal University (ECNU) in Shanghai and students at the University of Michigan before and after their first university calculus course are presented. Overall, ECNU significantly outperformed Michigan on both the pre- and post-tests, but the Michigan students showed a larger gain and normalized gain, and hence narrowed the gap. ECNU's superior performance was especially striking on the subset of problems requiring only a pre-calculus background. On those, Michigan's post-test scores were below ECNU's pre-test scores and, indeed, ECNU's higher performance on both the overall pre-test and overall post-test is attributable to its success on these problems.

The four national taps of Singapore: a holistic approach to water resources management from drainage to drinking water

 Water resources in Singapore are managed following the principles of a closed loop hydrologic cycle by one agency, the Public Utility Board (PUB), which promotes its management philosophy through the Four National Taps of Singapore program. The four national taps are: water from local catchment areas; imported water (from Malaysia); reused water (known as NEWater); and desalinated water. Given the uncertainty of water imports, the remaining three national taps have become increasingly important and this paper begins with a general overview of the innovative programs implemented by PUB in support of these three taps. Stormwater runoff is captured from two-thirds of Singapore’s land area and stored in reservoirs for subsequent use. Stormwater management is an important component of the catchment area tap and extensive low impact development (LID) implementation has become a priority through the ABC (Active, Beautiful, Clean) Waters Program. Examples of several ABC Waters projects are discussed. NEWater currently supplies 30% of the country’s demand and this is projected to increase to 50% by 2060. NEWater plants take treated wastewater through the additional steps of microfiltration, reverse osmosis and ultraviolet treatment for use primarily in industry, although a portion also is blended into the municipal reservoirs. Singapore’s single desalination plant currently meets 10% of its demand, with a second plant to be completed in 2013 that will more than double production. Also discussed are the results of recently completed pilot projects related to stormwater management including testing of E. coli in runoff from high density residential areas, a blind taste test and survey on acceptance of NEWater, and a survey of Singaporean understanding about stormwater management issues.Water resources in Singapore are managed following the principles of a closed loop hydrologic cycle by one agency, the Public Utility Board (PUB), which promotes its management philosophy through the Four National Taps of Singapore program. The four national taps are: water from local catchment areas; imported water (from Malaysia); reused water (known as NEWater); and desalinated water. Given the uncertainty of water imports, the remaining three national taps have become increasingly important and this paper begins with a general overview of the innovative programs implemented by PUB in support of these three taps. Stormwater runoff is captured from two-thirds of Singapore’s land area and stored in reservoirs for subsequent use. Stormwater management is an important component of the catchment area tap and extensive low impact development (LID) implementation has become a priority through the ABC (Active, Beautiful, Clean) Waters Program. Examples of several ABC Waters projects are discussed. NEWater currently supplies 30% of the country’s demand and this is projected to increase to 50% by 2060. NEWater plants take treated wastewater through the additional steps of microfiltration, reverse osmosis and ultraviolet treatment for use primarily in industry, although a portion also is blended into the municipal reservoirs. Singapore’s single desalination plant currently meets 10% of its demand, with a second plant to be completed in 2013 that will more than double production. Also discussed are the results of recently completed pilot projects related to stormwater management including testing of E. coli in runoff from high density residential areas, a blind taste test and survey on acceptance of NEWater, and a survey of Singaporean understanding about stormwater management issues.

ePortfolios in business education: a national study of ePortfolio implementation 2013 to 2015

To be launched in March 2016, this study explores the transformative potential of ePortfolios in business education. Educators and higher education institutions are increasingly looking for innovative ways to enhance learning outcomes through technology. Given their potential to aid in the development of engaged, reflective lifelong learners, and develop and showcase employability skills, ePortfolios are increasingly being used around the globe.

This study shares the experience of, and lessons learned from, the implementation of ePortfolios in one general business management course and three accounting related courses at three higher education institutions. The recommendations and principles proposed provide benchmarks for best practice and practical guidance for embedding ePortfolios into business curricula.

Current and future friends of the earth: assessing cross-national theories of environmental attitudes

Empirical studies of public opinion on environmental protection have typically been grounded in Inglehart’s post-materialism thesis, proposing that societal affluence encourages materially-sated publics to look beyond their interests and value the environment. These studies are generally conducted within, or at best across, Western, democratic, industrialized countries. Absence of truly cross-cultural research means the theory’s limitations have gone undetected. This article draws on an exceptionally broad dataset—pooling cross-sectional survey data from 80 countries, each sampled at up to three different points over 15 years—to investigate environmental attitudes. We find that post-materialism provides little account of pro-environment attitudes across diverse cultures, and a far from adequate explanation even in the affluent West. We suggest that unique domestic interests, more than broad value systems, are driving emerging global trends in environmental attitudes. The environment’s future champions may be the far from ‘post-material’ citizens of those developing nations most at risk of real material harm from climate change and environmental degradation.

Psychosocial job quality in a national sample of working Australians: a comparison of persons working with versus without disability

Objectives: There is growing international policy interest in disability employment, yet there has been little investigation of job quality among people working with disability. This study uses Australian national data to compare the psychosocial job quality of people working with versus without disability. Methods: We used 10 annual waves of data from a large representative Australian panel survey to estimate the proportion of the population experiencing poorer psychosocial job quality (overall and by individual 'adversities' of low job control, high demands, high insecurity, and low fairness of pay) by disability status and impairment type. We used logistic regression to examine the pooled cross-sectional associations between disability and job quality, adjusting for age, sex, education and job type. Results: Those working with any disability showed approximately 25% higher odds of reporting one or more adversity at work (OR: 1.23, 95% CI: 1.15, 1.31), and this finding was consistent across impairment types with the exception of intellectual/developmental disability. Estimates were largely unchanged after adjustments. Similar results were found for reporting two or more adversities compared one or more. Conclusions: We observed that working people with a disability in Australia reported systematically poorer psychosocial job quality than those working without disability. These results suggest the need for further research to understand the reasons for these patterns, as well as policy and practice efforts to address this inequity.