Assessing cost-effectiveness - Mental health: introduction to the study and methods

Objective: The Assessing Cost-Effectiveness - Mental Health (ACE-MH) study aims to assess from a health sector perspective, whether there are options for change that could improve the effectiveness and efficiency of Australia's current mental health services by directing available resources toward 'best practice' cost-effective services. Method: The use of standardized evaluation methods addresses the reservations expressed by many economists about the simplistic use of League Tables based on economic studies confounded by differences in methods, context and setting. The cost-effectiveness ratio for each intervention is calculated using economic and epidemiological data. This includes systematic reviews and randomised controlled trials for efficacy, the Australian Surveys of Mental Health and Wellbeing for current practice and a combination of trials and longitudinal studies for adherence. The cost-effectiveness ratios are presented as cost (A$) per disability-adjusted life year (DALY) saved with a 95% uncertainty interval based on Monte Carlo simulation modelling. An assessment of interventions on 'second filter' criteria ('equity', 'strength of evidence', 'feasibility' and 'acceptability to stakeholders') allows broader concepts of 'benefit' to be taken into account, as well as factors that might influence policy judgements in addition to cost-effectiveness ratios. Conclusions: The main limitation of the study is in the translation of the effect size from trials into a change in the DALY disability weight, which required the use of newly developed methods. While comparisons within disorders are valid, comparisons across disorders should be made with caution. A series of articles is planned to present the results.

Child psychiatry takes to the streets: A developmental partnership between a university institute and children and adolescents from the streets of Sao Paulo, Brazil

Objective: High levels of domestic violence, mental illness, and alienation from authorities are associated with high incidence of children/adolescents living on the streets in low and middle income countries. The Equilibrium Project (Programa Equilibrio) was created to facilitate social reintegration through a virtual partnership between an academic psychiatric institute and highly vulnerable children and adolescents living on the streets, in group shelter with supervision, and in other high risk situations. Methods: Descriptive presentation of qualitative data and analysis of preliminary empirical data collected over a 24-month period. Results: Dialogue between academic professionals, street children, and city officials shaped The Equilibrium Project over the last 2 years. The program has progressively moved from a professional clinic setting to a community-based but protected activity center with recreational and professional services and an emphasis on linkage with social service agencies, city government and law enforcement officials in an academic research context. A total of 351 patients have been served of whom virtually all were neglected by their parents, 58.4% report physical or sexual abuse, 88.89% have been diagnosed with a psychiatric disorder, 40.4% drug use. After 2 years of operation, 63.5% (n = 223) successfully completed or continue in treatment and 34.8% (n = 122) were reunited with their families. Conclusions and Practice implications: Program development guided by consumer input led to a successful program offering professional services in a protected community setting that facilitates social reintegration by providing ""go between"" services integrating relationships between alienated consumers and formal psychiatric, pediatric, social service, and criminal justice systems. (C) 2011 Elsevier Ltd. All rights reserved.

Pectenotoxins - an issue for public health - A review of their comparative toxicology and metabolism

Pectenotoxins (PTXs) are a group of toxins associated with diarrhetic shellfish poisoning (DSP) and isolated from DSP toxin-producing dinoflagellate algae. Consumption of shellfish contaminated with PTXs has been associated with incidences of severe diarrhetic illness resulting in hospitalisation. Concern has been raised for public health following the discovery that these toxins are not only hepatotoxic and can cause diarrhetic effects in mammals, but that they are potently cytotoxic to human cancer cell lines and have been found to be tumour promoters in animals. With advances in knowledge and technology, more PTXs are being identified, but little is known of their toxicology and the potential impact these toxins may have on public health in the long term. Without such information, adequate health-risk assessments for the consumption of shellfish contaminated with PTXs cannot be performed. This review gives a brief introduction to diarrhetic shellfish toxins, details the known toxicology and metabolism of PTXs in animals, and discusses known incidences of PTX poisoning in humans. (C) 2001 Elsevier Science Ltd. All rights reserved.

Patterns of governance: The curious case of non-profit community services in Australia

Community has taken on a new significance in Australian social policy discourse. Seemingly sound and morally justifiable, in the context Of neo-liberalism the language of community positions non-profit delivery of services as superior to state-provided services. As a consequence, non-profit community services are being centrally positioned to mediate the relationship between the state and citizen subjects. In the first part of this paper we trace some of the key historical developments in Australia's welfare state and patterns of governance that are propelling the non-profit sector firm the margins to the centre. The second section examines the relationship between Australia's shifting political landscape and the emerging welfare regime. One key feature of this new regime is the attempt to relocate citizenship away from the domain of the state and into that of civil society. The article concludes by sketching out some research themes, focusing, for example, on the impact of devolution of governance in terms of client rights and public accountability.

Harm minimization in a prohibition context - Australia

Australia ranks high internationally in the prevalence of cannabis and other illicit drug use, with the prevalence of all illicit drug use increasing since the 1970s. There are two distinctive features associated with harms from injecting drug use-high rates of death from heroin overdose and low rates of HIV infection. Australia has largely avoided a punitive and moralistic drug policy, developing instead harm minimization strategies and a robust treatment framework embedded in a strong law enforcement regime. Two illustrations of Australian drug policy are presented: legislation that provides for the expiation of simple cannabis offences by payment of a fine and the widespread implementation of agonist maintenance treatment for heroin dependence.

Food safety and development of the beef industry in China

Food safety concerns have escalated in China as they have elsewhere, especially in relation to meats. Beef production and consumption has increased proportionately faster than all other meats over the last two decades. Yet the slaughtering, processing and marketing of beef remains, for the most part, extremely primitive when compared with Western beef supply chains. By comparing the economics of household slaughtering with that of various types of abattoirs, this paper explains why household slaughtering and wet markets still dominate beef processing and distribution in China. The negative economic, social and industry development implications of enforcing more stringent food safety regulations are highlighted. The willingness/capacity of consumers to pay the added cost of better inspection and other services to guarantee food safety is investigated. In this context, the paper also evaluates the market opportunities for both domestic and imported Green Beef. The paper questions the merit of policy initiatives aimed at modernising Chinese beef supply chains for the mass market along Western lines. (C) 2002 Elsevier Science Ltd. All rights reserved.

An e-marketplace of healthcare and social care services: the perceived interest

Purpose – The health and social care sector is receiving growing attention due to the increased life expectancy and to the public demand for a better quality of life and better health services. New cost-efficient approaches are required, and the paper aims to present and discuss the main results of a study undertaken in a Portuguese municipality on the perceived relevance of an e-marketplace of social and healthcare services for the inhabitants in general, and for people with special needs in particular, and the identification of the most relevant services to be offered through this platform. Design/methodology/approach – A wide survey was undertaken to identify the needs of potential users and their expectancies with relation to the proposed platform. The results of the study are a support for the project promoters to understand the viability of the solution and the requirements to the deployment of the pilot experiment, as well as to drive the selection of domains of activities/classes of services to be offered by the platform. Findings – Services such as information about healthcare services, home monitoring/accompanying services 24 hours per day, and personal hygiene services provided at home are the ones recognized by the inquired citizens as the most important, which indicates that the potential users will be mostly people with special needs or their family or caregivers. Originality/value – While still at a preliminary development phase, the project represents a good opportunity to develop a totally innovative service with high potential impact for the senior population and for individuals with special needs.

An e-marketplace of healthcare and social care services: the perceived interest

The health and social care sector is receiving growing attention for the last years, due to the increased life expectancy, the public demand for a better quality of life and for better health services. These requirements can be met with more cost-efficient approaches and using new technology-based solutions for providing services. The paper presents and discusses some of the main results of a study undertaken in Guimarães, a Municipality at the North of Portugal, on the perceived relevance of an e-Marketplace of social and healthcare services for the inhabitants in general, and in particular for people with special needs; the study also included the identification of the most relevant services to be offered by this platform and allowed concluding that such an e-Marketplace is of recognized relevance and that it is expected a good adhesion from the population.

Contribution towards a reflection about methodological strategies in design education and the function of drawing in design

This work presents a reflection on Design education and specifically on the role of Drawing in this area. As a subject, Design has expanded its field of action expanding into new areas such as Experience Design or Service Design. It became necessary for the designer to have more than an education based on technological knowledge or know-how. Many authors like Meredith Davis, Don Norman or Jamie Hobson point out the urgency to review the curricula of Design courses because nowadays “… design is more than appearance, design is about interaction, about strategy and about services. Designers change social behavior” (Norman 2011). When shifting from a product-centered design to a person-centered design (in a structure, a service or in a relationship) what should the function of drawing in a design course be? What should its curriculum be? Our work methodology will be to confront today’s perspectives on design theory and practice in an attempt to add to the discussion on the methodological strategies in design teaching in the contemporary context.

Contribution towards a reflection about methodological strategies in Design Education and the function of Drawing in Design

This work presents a reflection on Design education and specifically on the role of Drawing in this area. As a subject, Design has expanded its field of action expanding into new areas such as Experience Design or Service Design. It became necessary for the designer to have more than an education based on technological knowledge or know-how. Many authors like Meredith Davis, Don Norman or Jamie Hobson point out the urgency to review the curricula of Design courses because nowadays “ … design is more than appearance, design is about interaction, about strategy and about services. Designers change social behavior” (Norman, 2011) When shifting from a product-centered design to a person-centered design (in a structure, a service or in a relationship) what should the function of drawing in a design course be? What should its curriculum be? Our work methodology will be to confront today’s perspectives on design theory and practice in an attempt to add to the discussion on the methodological strategies in design teaching in the contemporary context.

Information technology supporting healthcare and social care services

The authors are developing a pilot project for a Municipality in the North of Portugal, envisaging the definition and implementation of an e-marketplace for healthcare and social services, in order to facilitate the interaction between healthcare and social services professionals and people with special needs (or their relatives). Based on the results of a survey on user needs analysis and expectations conducted in 2011, the paper discusses the relevance and interest of such platforms and the main drivers and motivations of the population for using such services, as well as which services would motivate citizens to use the platform. The results of the study will be used to select the products and services perceived to be the most desired by the potential users. The paper thus makes three main contributions: (1) the results of the study confirm the interest and the perceived potential of such a service, from the end-users perspective; (2) the findings support the advantage of expanding this pilot project to a full scale implementation; and (3) the performed analysis improves our understanding of the relations between the characteristics of the inquired population and the perceived interest in such platforms.

The impact of the digital divide on the perceived interest of an e-Marketplace to support healthcare and social care services

In a Europe increasingly aging, it is now recognized the importance and potential of the service industry for ageing well based on information and communication technologies (ICT), as exemplified by the electronic market of social services and health care, the GuiMarket, proposed by the authors. However, this new range of services requires that individuals have advanced digital skills to fully participate in society. Based on the results of a survey made on a sample of 315 individuals, this paper discusses the importance granted GuiMarket and the intended frequency of use, concluding there is a close relationship between ICT access and use that respondents anticipate making of GuiMarket and alike services.

Shopping center tracking and recommendation systems

Shopping centers present a rich and heterogeneous environment, where IT systems can be implemented in order to support the needs of its actors. However, due to the environment complexity, several feasibility issues emerge when designing both the logical and physical architecture of such systems. Additionally, the system must be able to cope with the individual needs of each actor, and provide services that are easily adopted by them, taking into account several sociological and economical aspects. In this sense, we present an overview of current support systems for shopping center environments. From this overview, a high-level model of the domain (involving actors and services) is described along with challenges and possible features in the context of current Semantic Web, mobile device and sensor technologies.