Economic models of preventive dentistry for Australian children and adolescents

Purpose:
To identify economic evaluation models and parameters that could be replicated or adapted to construct a generic model to assess cost-effectiveness of and prioritise a wide range of community-based oral disease prevention programmes in an Australian context.
Methods:
The literature search was conducted using MEDLINE, ERIC, PsycINFO, CINHAL (EBSCOhost), EMBASE (Ovid), CRD, DARE, NHSEED, HTA, all databases in the Cochrane library, Scopus and ScienceDirect databases from their inception to November 2012.
Results:
Thirty-three articles met the criteria for inclusion in this review (7 were Australian studies, 26 articles were international). Existing models focused primarily on dental caries. Periodontal disease, another common oral health problem, was lacking. Among caries prevention studies, there was an absence of clear evidence showing continuous benefits from primary through to permanent dentition and the long-term effects of oral health promotion.
Conclusion:
No generic model was identified from previous studies that could be immediately adopted or adapted for our purposes of simulating and prioritising a diverse range of oral health interventions for Australian children and adolescents. Nevertheless, data sources specified in the existing Australian-based models will be useful for developing a generic model for such purposes.

Ethical considerations in preventive interventions for bipolar disorder

AIM: Early intervention and prevention of serious mental disorders such as bipolar disorder has the promise of decreasing the burden associated with these disorders. With increasing early and preventive intervention efforts among cohorts such as those with a familial risk for bipolar disorder, there is a need to examine the associated ethical concerns. The aim of this review was to examine the ethical issues underpinning the clinical research on pre-onset identification and preventive interventions for bipolar disorder.

METHODS: We undertook a PubMed search updated to November 2014 incorporating search terms such as bipolar, mania, hypomania, ethic*(truncated), early intervention, prevention, genetic and family.

RESULTS: Fifty-six articles that were identified by this method as well as other relevant articles were examined within a framework of ethical principles including beneficence, non-maleficence, respect for autonomy and justice. The primary risks associated with research and clinical interventions include stigma and labelling, especially among familial high-risk youth. Side effects from interventions are another concern. The benefits of preventive or early interventions were in the amelioration of symptoms as well as the possibility of minimizing disability, cognitive impairment and progression of the illness. Supporting the autonomy of individuals and improving access to stigma-free care may help moderate the potential challenges associated with the risks of interventions.

CONCLUSIONS: Concerns about the risks of early identification and pre-onset interventions should be balanced against the potential benefits, the individuals' right to choice and by improving availability of services that balance such dilemmas.

Preventive social health programs : are they Australia's answer to rising health care costs in rural communities?

Although we have good evidence to support the notion that early intervention, prevention and community education programs can mitigate the impact of preventable disease, expanded primary health care is also being promoted by Australian governments as a panacea for reducing growth in demand generally. While preventive programs do reduce acute demand, they may not do so the extent that resources, currently allocated to the acute sector, can be substituted to provide the additional primary care services necessary to reduce acute demand permanently. These developments have particular relevance for rural and isolated communities where access to acute services is already very limited. What appears to be occurring, in rural South Australia at least, is that traditional acute services are being reduced and replaced with lower level care and social intervention programs. This is well and good, but eventually the acute care being provided in rural health units now will still need to be provided by other units elsewhere and probably at much higher cost to the system and to consumers. Where rural communities have previously managed much of their own acute service demand, they may now be forced to send patients to more distant centres for care but at much greater social and economic cost to individuals and the system.

Secrecy and human rights abuse in Australia’s offshore immigration detention centres

All asylum seekers who arrive in Australia’s territorial waters by boat are subject to mandatory, indefinite and unreviewable detention on Nauru and Papua New Guinea. This offshore detention regime is characterised by a high degree of secrecy, low levels of transparency and accountability, and few opportunities for external oversight. This has created a closed, controlled environment, in which people are routinely neglected and harmed. To better understand the human impact of Australia’s offshore detention regime, this article draws on research from social psychology regarding human behaviour in closed institutions. This research – which has substantially informed prison policies throughout the Western world – demonstrates the critical importance of external oversight, openness and transparency for the protection of human rights of people in closed institutions. This knowledge has not been applied to Australia’s offshore immigration detention regime. To the contrary: creating a closed, opaque system of detention has been an explicit policy goal of the Australian government. By actively restricting transparency, this research demonstrates that not only are the abuses of detainees’ human rights hidden from the public eye, they are inevitable.

Effect of Preventive Chlamydia abortus Vaccination in Offspring Development in Sheep Challenged Experimentally

Ovine enzootic abortion, caused by Chlamydia abortus, leads to important economic losses worldwide. In addition to reproductive failures, infection may impact lamb growth during the first weeks after birth, yet this effect has not been well characterized. Vaccination can help to control the disease but variable efficacy values have been described, possibly related with factors associated with the host, the vaccine, the parameter used for efficacy determination and the challenge conditions. In this context, we evaluated the efficacy of an inactivated standard commercial vaccine and a 1/2 diluted dose in pregnant sheep challenged with C. abortus by examining multiple indicators ofvaccine effect (including incidence of reproductive failures, bacterial excretion, and evolution of weight gain of viable lambs during the first month of life). Three groups of ewes [control non-vaccinated, C (n = 18); vaccinated with standard dose, SV (n = 16) and vaccinated with 1/2 dose, DV (n = 17)], were challenged approximately 90 days post-mating and tested using direct PCR (tissue samples and vaginal swabs) and ELISA (serum) until 31 days post-reproductive outcome. There were not significant differences in the proportions of reproductive failures or bacterial shedding after birth/abortion regardless the vaccination protocol. However, a beneficial effect of vaccination on offspring growth was detected in both vaccinated groups compared with the controls, with a mean increase in weight measured at 30 days of life of 1.5 and 2.5 Kg (p = 0.056) and an increase in the geometric mean of the daily gain of 8.4 and 9.7% in lambs born from DV and SV ewes compared to controls, respectively. Our results demonstrate the effect of an inactivated vaccine in the development of the offspring of C. abortus-infected ewes at a standard and a diluted dose, an interesting finding given the difficulty in achieving sufficient antigen concentration in the production of EAE-commercial vaccines.

Migration-related detention: A focus on the Italian context

Inspired by a community psychology ecological perspective, this chapter addresses migration-related detention as part of that set of practices implemented by the EU and the Schengen Area to ensure internal security by strengthening external borders control. In particular, it focuses on the Italian context. Starting from a historical overview of the Italian legal and policy framework on migration, a critical analysis of the rationale for migrant detention and deportation is developed, highlighting the business interests at stake. In this regard, the concept of immigration industrial complex is utilized, emphasizing its similarities with the military and prison industrial complexes. Finally, the case of an Italian migration-related detention center is illustrated. We argue for the use of ecological multilevel analysis to grasp the complexity of these sites of confinement, and shed light on the forces and interests that revolve around them. Alternatives are advocated based on freedom and justice for all.

Immigration detention: the migration of a policy and its human impact

Before the turn of the century, few states used immigration detention. Today, nearly every state around the world has adopted immigration detention policy in some form. States practice detention as a means to address both the accelerating numbers of people crossing their borders, and the populations residing in their states without authorisation. This edited volume examines the contemporary diffusion of immigration detention policy throughout the world and the impact of this expansion on the prospects of protection for people seeking asylum. It includes contributions by immigration detention experts working in Australasia, the Americas, Europe, Africa and the Middle East. It is the first to set out a systematic comparison of immigration detention policy across these regions and to examine how immigration detention has become a ubiquitous part of border and immigration control strategies globally. In so doing, the volume presents a global perspective on the diversity of immigration detention policies and practices, how these circumstances developed, and the human impact of states exchanging individuals' rights to liberty for the collective assurance of border and immigration control. This text will be of key interest to scholars, students and practitioners of immigration, migration, public administration, comparative policy studies, comparative politics and international political economy.