Access to alcohol outlets and harmful alcohol consumption : a multi-level study in Melbourne, Australia

Aims To assess the association between access to off-premises alcohol outlets and harmful alcohol consumption.
Design, setting and participants Multi-level study of 2334 adults aged 18–75 years from 49 census collector districts (the smallest spatial unit in Australia at the time of survey) in metropolitan Melbourne.
Measurements Alcohol outlet density was defined as the number of outlets within a 1-km road network of respondents’ homes and proximity was the shortest road network distance to the closest outlet from their home. Using multi-level logistic regression we estimated the association between outlet density and proximity and four measures of harmful alcohol consumption: drinking at levels associated with short-term harm at least weekly and monthly; drinking at levels associated with long-term harm and frequency of consumption.
Findings Density of alcohol outlets was associated with increased risk of drinking alcohol at levels associated with harm. The strongest association was for short-term harm at least weekly [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.04–1.16]. When density was fitted as a categorical variable, the highest risk of drinking at levels associated with short-term harm was when there were eight or more outlets (short-term harm weekly: OR 2.36, 95% CI 1.22–4.54 and short-term harm monthly: OR 1.80, 95% CI 1.07–3.04). We found no evidence to support an association between proximity and harmful alcohol consumption.
Conclusions The number of off-premises alcohol outlets in a locality is associated with the level of harmful alcohol consumption in that area. Reducing the number of off-premises alcohol outlets could reduce levels of harmful alcohol consumption.

EU-India free trade negotiations threatening access to medicines

Indian firms are major global producers of relatively affordable generic medicines. Access to such drugs makes the difference between life and death for billions of people in the Global South. The Economist noted recently that ‘America should not use trade deals to swaddle drugmakers in excessive patent protections’. Nor should the European Union (EU) impose obstacles to the supply of generic drugs by Indian firms beyond those already mandated by the Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Free trade negotiations between the EU (reported to be close to completion) constitute a clear threat to the role of India as the ‘pharmacy of the developing world’.

Access to information about donors by donor-conceieved individuals : a human rights analysis

While assisted reproductive treatment using donated gametes is widespread, and in many places, widely accepted, it has historically been shrouded in secrecy. Over time, however, there has been an increasing call from donor-conceived people, recipient parents and some donors to end the secrecy, and to release identifying information about donors to donor-conceived people. "Rights-based" arguments have at times been used to justify this call. This article examines whether a human rights framework supports the release of information and how such a framework might be applied when there are competing rights. It argues that the current balancing approach used to resolve such issues weighs in favour of release. Legal action has the potential to be legitimate and justifiable. A measure such as a contact veto system, which would serve to prevent unwanted contact with the person lodging the veto (either the donor or the donor-conceived person), would ensure proportionality. In this way, both donor-conceived people's rights to private life, identity and family, and donors' rights to privacy may be recognised and balanced.

An efficient solution for privacy-preserving, secure remote access to sensitive data

Sharing data that contains personally identifiable or sensitive information, such as medical records, always has privacy and security implications. The issues can become rather complex when the methods of access can vary, and accurate individual data needs to be provided whilst mass data release for specific purposes (for example for medical research) also has to be catered for. Although various solutions have been proposed to address the different aspects individually, a comprehensive approach is highly desirable. This paper presents a solution for maintaining the privacy of data released en masse in a controlled manner, and for providing secure access to the original data for authorized users. The results show that the solution is provably secure and maintains privacy in a more efficient manner than previous solutions.

Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division, Australia

Summary
In 2007, Medicare Australia revised reimbursement guidelines for dual energy X-ray absorptiometry (DXA) for Australians aged ≥70 years; we examined whether these changes increased DXA referrals in older adults. Proportions of DXA referrals doubled for men and tripled for women from 2003 to 2010; however, rates of utilization remained low.

Introduction
On April 1, 2007 Medicare Australia revised reimbursement guidelines for DXA for Australians aged ≥70 year; changes that were intended to increase the proportion of older adults being tested. We examined whether changes to reimbursement increased DXA referrals in older adults, and whether any sex differences in referrals were observed in the Barwon Statistical Division.

Methods
Proportions of DXA referrals 2003–2010 based on the population at risk ascertained from Australian Census data and annual referral rates and rate ratios stratified by sex, year of DXA, and 5-year age groups. Persons aged ≥70 years referred to the major public health service provider for DXA clinical purposes (n = 6,096; 21 % men).

Results
DXA referrals. Proportions of DXA referrals for men doubled from 0.8 % (2003) to 1.8 % (2010) and tripled from 2.0 to 6.3 % for women (all p < 0.001). For 2003–2006, referral ratios of men/women ranged between 1:1.9 and 1:3.0 and for 2007–2010 were 1:2.3 to 1:3.4. Referral ratios <2007:≥2007 were 1:1.7 for men aged 70–79 years (p < 0.001), 1:1.2 for men aged 80–84 years (p = 0.06), and 1:1.3 for men 85+ years (p = 0.16). For women, the ratios <2007:≥2007 were 1:2.1 (70–79 years), 1.1.5 (80–84 years), and 1:1.4 (85+ years) (all p < 0.001).

Conclusions
DXA referral ratios were 1:1.6 (men) and 1:1.8 (women) for 2007–2010 vs. 2003–2006; proportions of referrals doubled for men and tripled for women from 2003 to 2010. Overall, rates of DXA utilization remained low. Policy changes may have had minimal influence on referral; thus, ongoing evaluation over time is warranted.

The `knowledge-intensive development' agenda and equitable access to knowledge: higher education in Ethiopia

In light of the normative assumption of the role of knowledge in economic productivity and in response to strong exogenous policy orientations (mainly from the World Bank), the government of Ethiopia has restructured and expanded the higher education (HE) subsystem since the late 1990s. In critically analysing selected policy documents, this article seeks to understand the seemingly unlinked agendas of strengthening the role of HE in supporting the knowledge-intensive development agenda and the representation of the problem of inequality in access to and success in HE. It has been shown that the economic value of knowledge has been echoed in the reforms of Ethiopia, and that the problem of inequality has been superficially represented just as inequality of access while serious challenges that hinder participation and success of women, non-traditional students and ethnically and regionally disadvantaged groups remain unchallenged. Hence, the analysis indicates that under a situation of unequal opportunity to knowledge, the knowledge-intensive development agenda appears to be empty policy rhetoric.