Cost-effectiveness analysis of a kidney and cardiovascular disease treatment program in an Australian Aboriginal population

The objective of the study was to assess, from a health service perspective, whether a systematic program to modify kidney and cardiovascular disease reduced the costs of treating end-stage kidney failure. The participants in the study were 1,800 aboriginal adults with hypertension, diabetes with microalbuminuria or overt albuminuria, and overt albuminuria, living on two islands in the Northern Territory of Australia during 1995 to 2000. Perindopril was the primary treatment agent, and other medications were also used to control blood pressure. Control of glucose and lipid levels were attempted, and health education was offered. Evaluation of program resource use and costs for follow-up periods was done at 3 and 4.7 years. On an intention-to-treat basis, the number of dialysis starts and dialysis-years avoided were estimated by comparing the fate of the treatment group with that of historical control subjects, matched for disease severity, who were followed in the before the treatment program began. For the first three years, an estimated 11.6 person-years of dialysis were avoided, and over 4.7 years, 27.7 person-years of dialysis were avoided. The net cost of the program was 1,210 dollars more per person per year than status quo care, and dialyses avoided gave net savings of 1.0 million dollars at 3 years and 3.4 million dollars at 4.6 years. The treatment program provided significant health benefit and impressive cost savings in dialysis avoided.

Assessing Cardiovascular Risk in Regional Areas: The Healthy Hearts – Beyond City Limits Program

Background: Cardiovascular disease (CVD) is more prevalent in regional and remote Australia compared to metropolitan areas. The aim of Healthy Hearts was to determine age and sex specific CVD risk factor levels and the potential value of national risk clinics. Methods: Healthy Hearts was an observational research study conducted in four purposefully selected higher risk communities in regional Victoria, Australia. The main outcome measures were the proportion of participants with CVD risk factors with group comparisons to determine the adjusted likelihood of elevated risk factor levels. Trained personnel used a standardized protocol over four weeks per community to measure CVD risk factor levels, estimate absolute CVD risk and provide feedback and advice. Results: A total of 2125 self-selected participants were assessed (mean age 58 ± 15 years, 57% women). Overall, CVD risk factors were highly prevalent. More men than women had ≥ 2 modifiable CVD risk factors (76% vs. 68%, p < .001), pre-existing CVD (20 vs. 15%, p < .01) and a major ECG abnormality requiring follow-up (15% vs. 7%, p < .001) . Less men reported depressive symptoms compared to women (28% vs. 22%, p < .01). A higher proportion of women were obese (adjusted OR 1.36, 95% CI 1.13 to 1.63), and physically inactive (adjusted OR 1.32, 95% CI 1.07 to 1.63). Conclusions: High CVD risk factor levels were confirmed for regional Victoria. Close engagement with individuals and communities provides scope for the application of regional risk management clinics to reduce the burden of CVD risk in regional Australia.

Automated speed enforcement in Australia : recent examples of the influence of public opinion on program sustainability

In Australia, speeding remains a substantial contributor to road trauma. The National Road Safety Strategy (2011-2020) highlighted the need to harness community support for current and future speed management strategies. Australia is known for intensive speed camera programs which are both automated and manual, employing covert and overt methods. Recent developments in the area of automated speed enforcement in Australia help to illustrate the important link between community attitudes to speed enforcement and subsequent speed camera policy developments. A perceived lack of community confidence in camera programs prompted reviews in New South Wales and Victoria in 2011 by the jurisdictional Auditor-General. This paper explores automated speed camera enforcement in Australia with particular reference to the findings of these two reports as they relate to the level of public support for and community attitudes towards automated speed enforcement. It also provides comment on the evolving nature of automated speed enforcement according to previously identified controversies and dilemmas associated with speed camera programs.

Building intercultural competence one “Patch” at a time

This paper describes a program called Patches that was implemented to assist a group of Australian and Malaysian pre-service teachers to enhance their intercultural competence through their involvement in a series of reciprocal learning activities. Each learning experience was considered a “patch” that eventually created a “quilt of intercultural learning.” The purpose of this study was to enhance the intercultural competence of domestic and international students through organized intercultural activities, through a series of reflective writing sessions, and mutual engagement on a common project. The effectiveness of the Patches program was analysed in accordance with Deardorff’s elements of intercultural competence. The qualitative findings indicate that both cohorts of preservice teachers showed elements of intercultural competence through participation in the program, with both groups reporting a deeper appreciation and understanding of how to communicate more effectively in intercultural contexts.

Ask : a health advocacy program for adolescents with an intellectual disability : a cluster randomised controlled trial

Background Adolescents with intellectual disability often have poor health and healthcare. This is partly as a consequence of poor communication and recall difficulties, and the possible loss of specialised paediatric services. Methods/Design A cluster randomised trial was conducted with adolescents with intellectual disability to investigate a health intervention package to enhance interactions among adolescents with intellectual disability, their parents/carers, and general practitioners (GPs). The trial took place in Queensland, Australia, between February 2007 and September 2010. The intervention package was designed to improve communication with health professionals and families’ organisation of health information, and to increase clinical activities beneficial to improved health outcomes. It consisted of the Comprehensive Health Assessment Program (CHAP), a one-off health check, and the Ask Health Diary, designed for on-going use. Participants were drawn from Special Education Schools and Special Education Units. The education component of the intervention was delivered as part of the school curriculum. Educators were surveyed at baseline and followed-up four months later. Carers were surveyed at baseline and after 26 months. Evidence of health promotion, disease prevention and case-finding activities were extracted from GPs clinical records. Qualitative interviews of educators occurred after completion of the educational component of the intervention and with adolescents and carers after the CHAP. Discussion Adolescents with intellectual disability have difficulty obtaining many health services and often find it difficult to become empowered to improve and protect their health. The health intervention package proposed may aid them by augmenting communication, improving documentation of health encounters, and improving access to, and quality of, GP care. Recruitment strategies to consider for future studies in this population include ensuring potential participants can identify themselves with the individuals used in promotional study material, making direct contact with their families at the start of the study, and closely monitoring the implementation of the educational intervention.

Evaluating the QUT Homestay Program : lessons learnt in providing quality services to international students

The QUT Homestay Program is an essential part of the university’s commitment to meet the accommodation needs of international students. Despite the importance of this style of accommodation, there is very little research addressing issues related to homestay arrangements. The program at Queensland University of Technology (QUT) was evaluated in 2002 to develop a continuous improvement framework to ensure provision of quality homestay services to international students. This paper presents an overview of the evaluation and key lessons learnt in providing quality homestay services to international students. It will cover social and cross-cultural issues faced by providers and international students in the homestay environment, the homestay support needs, program information, policies, procedures and code of practice governing the program.

Early evidence for direct and indirect effects of the infant rotavirus vaccine program in Queensland

Objective: To assess the impact of introducing a publicly funded infant rotavirus vaccination program on disease notifications and on laboratory testing and results. Design and setting: Retrospective analysis of routinely collected data (rotavirus notifications [2006–2008] and laboratory rotavirus testing data from Queensland Health laboratories [2000–2008]) to monitor rotavirus trends before and after the introduction of a publicly funded infant rotavirus vaccination program in Queensland in July 2007. Main outcome measures: Age group-specific rotavirus notification trends; number of rotavirus tests performed and the proportion positive. Results: In the less than 2 years age group, rotavirus notifications declined by 53% (2007) and 65% (2008); the number of laboratory tests performed declined by 3% (2007) and 15% (2008); and the proportion of tests positive declined by 45% (2007) and 43% (2008) compared with data collected before introduction of the vaccination program. An indirect effect of infant vaccination was seen: notifications and the proportion of tests positive for rotavirus declined in older age groups as well. Conclusions: The publicly funded rotavirus vaccination program in Queensland is having an early impact, direct and indirect, on rotavirus disease as assessed using routinely collected data. Further observational studies are required to assess vaccine effectiveness. Parents and immunisation providers should ensure that all Australian children receive the recommended rotavirus vaccine doses in the required timeframe.

Application-level simulation for network security

NeSSi (network security simulator) is a novel network simulation tool which incorporates a variety of features relevant to network security distinguishing it from general-purpose network simulators. Its capabilities such as profile-based automated attack generation, traffic analysis and support for detection algorithm plug-ins allow it to be used for security research and evaluation purposes. NeSSi has been successfully used for testing intrusion detection algorithms, conducting network security analysis and developing overlay security frameworks. NeSSi is built upon the agent framework JIAC, resulting in a distributed and extensible architecture. In this paper, we provide an overview of the NeSSi architecture as well as its distinguishing features and briefly demonstrate its application to current security research projects.

Teamworking for security : the collaborative approach

Collaborative methods are promising tools for solving complex security tasks. In this context, the authors present the security overlay framework CIMD (Collaborative Intrusion and Malware Detection), enabling participants to state objectives and interests for joint intrusion detection and find groups for the exchange of security-related data such as monitoring or detection results accordingly; to these groups the authors refer as detection groups. First, the authors present and discuss a tree-oriented taxonomy for the representation of nodes within the collaboration model. Second, they introduce and evaluate an algorithm for the formation of detection groups. After conducting a vulnerability analysis of the system, the authors demonstrate the validity of CIMD by examining two different scenarios inspired sociology where the collaboration is advantageous compared to the non-collaborative approach. They evaluate the benefit of CIMD by simulation in a novel packet-level simulation environment called NeSSi (Network Security Simulator) and give a probabilistic analysis for the scenarios.

Human rights, the law, cyber-security and democracy : after the European Convention

Many commentators have treated the internet as a site of democratic freedom and as a new kind of public sphere. While there are good reasons for optimism, like any social space digital space also has its dark side. Citizens and governments alike have expressed anxiety about cybercrime and cyber-security. In August 2011, the Australian government introduced legislation to give effect to Australia becoming a signatory to the European Convention on Cybercrime (2001). At the time of writing, that legislation is still before the Parliament. In this article, attention is given to how the legal and policy-making process enabling Australia to be compliant with the European Convention on Cybercrime came about. Among the motivations that informed both the development of the Convention in Europe and then the Australian exercise of legislating for compliance with it was a range of legitimate concerns about the impact that cybercrime can have on individuals and communities. This article makes the case that equal attention also needs to be given to ensuring that legislators and policy makers differentiate between legitimate security imperatives and any over-reach evident in the implementation of this legislation that affects rule of law principles, our capacity to engage in democratic practices, and our civic and human rights.