Effect of waiting time on health outcomes and service utilization : A prospective randomized study on patients admitted to hospital for hip or knee replacement

Although the principle of equal access to medically justified treatment has been promoted by official health policies in many Western health care systems, practices do not completely meet policy targets. Waiting times for elective surgery vary between patient groups and regions, and growing problems in the availability of services threaten equal access to treatment. Waiting times have come to the attention of decision-makers, and several policy initiatives have been introduced to ensure the availability of care within a reasonable time. In Finland, for example, the treatment guarantee came into force in 2005. However, no consensus exists on optimal waiting time for different patient groups. The purpose of this multi-centre randomized controlled trial was to analyse health-related quality of life, pain and physical function in total hip or knee replacement patients during the waiting time and to evaluate whether the waiting time is associated with patients health outcomes at admission. This study also assessed whether the length of waiting time is associated with social and health services utilization in patients awaiting total hip or knee replacement. In addition, patients health-related quality of life was compared with that of the general population. Consecutive patients with a need for a primary total hip or knee replacement due to osteoarthritis were placed on the waiting list between August 2002 and November 2003. Patients were randomly assigned to a short waiting time (maximum 3 months) or a non-fixed waiting time (waiting time not fixed in advance, instead the patient followed the hospitals routine practice). Patients health-related quality of life was measured upon being placed on the waiting list and again at hospital admission using the generic 15D instrument. Pain and physical function were evaluated using the self-report Harris Hip Score for hip patients and a scale modified from the Knee Society Clinical Rating System for knee patients. Utilization measures were the use of home health care, rehabilitation and social services, physician visits and inpatient care. Health and social services use was low in both waiting time groups. The most common services used while waiting were rehabilitation services and informal care, including unpaid care provided by relatives, neighbours and volunteers. Although patients suffered from clear restrictions in usual activities and physical functioning, they seemed primarily to lean on informal care and personal networks instead of professional care. While longer waiting time did not result in poorer health-related quality of life at admission and use of services during the waiting time was similar to that at the time of placement on the list, there is likely to be higher costs of waiting by people who wait longer simply because they are using services for a longer period. In economic terms, this would represent a negative impact of waiting. Only a few reports have been published of the health-related quality of life of patients awaiting total hip or knee replacement. These findings demonstrate that, in addition to physical dimensions of health, patients suffered from restrictions in psychological well-being such as depression, distress and reduced vitality. This raises the question of how to support patients who suffer from psychological distress during the waiting time and how to develop strategies to improve patients initiatives to reduce symptoms and the burden of waiting. Key words: waiting time, total hip replacement, total knee replacement, health-related quality of life, randomized controlled trial, outcome assessment, social service, utilization of health services

Alternative fruit fly management for market access for apples

Difficulty with control of Queensland fruit fly with four cultivars of apples on the Granite Belt, Qld. Warnings that the insecticides dimethoate & fenthion might be removed from the market for apples, had been current for several years. Dimethoate was widely used as a post harvest control measure as well as an in-field treatment. Fenthion also had and still has in-field usage. The project attempted to find a replacement for these control measures.

Improving avocado fruit quality and market potential by pre and post harvest factors

Improving avocado fruit quality and market potential by pre and post harvest factors.

Alternative fruit fly control for market access and to enhance IPM in eggplant

Eggplant was identified as another fruit fly host commodity where recent changes to interstate market access requirements are causing problems for industry. The proposed research aims to develop a systems approach to meet interstate market access requirements.

Management of fruit quality and pest infestations of mango and mangosteen for Market access requirements

Management of fruit quality and pest infestations of mango and mangosteen for Market access requirements.

Enhancing development outcomes for smallholder farmers through closer collaboration between ACIAR’s landcare and other projects

Improving development outcomes for smallholder farmers through closer collaboration between landcare and other ACIAR projects.

Alternative fruit fly treatment for interstate market access for strawberries

This project aims to provide further data to support the winter window option for interstate marker access for strawberries from south east Queensland.

Selling surf, sun and fitness: Queensland's mass-market fashion

How two powerhouse brands, Billabong and Lorna Jane, took the quintessential Queensland lifestyle to the world stage.

Integrated Cotton Farming Systems for Central Queensland

This project has delivered outcomes that address major agronomic and crop protection issues closely linked to the profitability and sustainability of cotton production enterprises in CQ. From an agronomic perspective, the CQ environment was always though to support economically viable cotton production in a wide sowing window from the middle of September to early January prior to this research. The ideal positioning of Bollgard II varieties in the CQ planting window was, therefore, critical to the future of the local cotton industry because growers needed baseline information to determine how best to take advantage of the higher yield potential offered by the Bt cotton technology, optimise irrigation water use and fibre characteristics. The project’s outputs include a number of key agronomic findings. Over three growing seasons, Bollgard II crop planted in the traditional sowing window from the middle of September to the end of October consistently produced the highest yields. The project delivers a clear and quantitative assessment of the impacts of planting outside the traditional cropping window - a yield penalty of between 1-4 bales/ha for November and December planted cotton. Whilst yield penalties associated with December-planted crops are clearly linked to declining heat units in the second half of the crop and a cool finish, those associated with November-planted cotton are not consistent with the theoretical yield potential for this sowing date. Further research to understand and minimize the physiological constraints on November-planted cotton would give CQ cotton growers far greater flexibility to develop mixed/double/rotation cropping farming systems that are relevant to the rapidly evolving nature of Agricultural production in Australia. The equivalence of cultivar types with clearly distinguishable, genetically based growth habits, demonstrated in this project, gives growers important information for making varietal choices. The entomological outcomes of this project represent strategic and tactical tools that are highly relevant to the viability and profitability of the cotton industry in Australia. The future of the cotton industry is inextricably linked to the survival and efficacy of GM cotton. Research done in the Callide irrigation area demonstrates the unquestionable potential for development of alternative and highly effective resistance management strategies for Bollgard II using novel technologies and strategies based on products such as Magnet®. Magnet® and similar technologies will be increasingly important in strategies to preserve the shelf life and efficacy of current and future generations of GM technology. However, more research will be required to address logistical and operational issues related to these new technologies before they can be fully exploited in commercial production systems. From an economic perspective, SLW is the sleeping giant in terms of insect nemeses of cotton, particularly from the standpoint of climate change and an increasingly warmer production environment. An effective sampling and management strategy for SLW which has been delivered by this project will go a long way towards minimising production costs in an environment characterised by rapidly rising input costs. SLW has the potential to permanently debilitate the national cotton industry by influencing market sentiment and quality perceptions. Field validation of the SLW population sampling models and management options in the Dawson irrigation area cotton and southern Queensland during 2006-07 documents the robustness of the entomological research outcomes achieved through this project.

Flat grain beetle fumigation protocol

Flat grain beetle (FGB) is a major emergency plant pest (EPP) of stored grain in Australia. Populations of FGB have recently developed high level resistance to phosphine (the only viable fumigant available for non-quarantine use) resulting in control failures with current dosage regimes. As there is no practical alternative to phosphine, failure to control FGB with phosphine places at risk market access for Australian grain worth up to $7 billion in annual trade. Therefore there is an urgent need to develop appropriate phosphine fumigation protocols to eradicate outbreaks of strongly resistant FGB. Research outcomes: - Characterisation of high resistance to phosphine in flat grain beetles (FGB) for the first time internationally. - Establishment of fumigation protocols and an eradication strategy that will enable industry to eradicate infestations of phosphine-resistant flat grain beetle and prevent or delay further selection for resistance to phosphine. - Development of a rapid test to detect highly resistant FGB. -Facilitate continued market access of Australian grain.

CRC50089 Grain Insect Ecology

Resistance to phosphine in target pests threatens market access for Australian grain. While the grains industry is now attempting to develop an effective and sustainable strategy to manage this resistance, action is severely limited by significant gaps in our knowledge of the key ecological factors that influence the development of resistance. There is a need to research this information as a foundation for a rational approach to managing phosphine resistance in the Australian grains industry. Research outcomes: The project has provided critical research methodologies and preliminary data to fill the large gaps in our knowledge of the ecology of two key pests, Rhyzopertha dominica and Tribolium castaneum, and how this may drive the development of phosphine resistance. This information will contribute to the groundwork for future research needed to provide a scientific basis for a rational resistance management strategy.

A market assessment and evaluation of structural roundwood products from hardwood pulp plantations.

Roundwood structures have always been used for temporary and low cost shelters and other fleeting structures. Novel concepts for the use of plantation hardwoods in roundwood form in construction were developed and circulated along with an electronic questionnaire to stakeholders representing growers, designers and users of hardwood. Responses indicate that there is a high level of interest in developing products from the emerging small roundwood resource and a detailed program of research was supported and recommended by the majority of participants in the survey. These results indicate a high level of support for further investigation into the use of plantation hardwood for roundwood components. Respondents representing a wide range of stakeholders have indicated that to gain benefit from a detailed project they would require solutions for connection systems and protection from pests and weathering, indications of cost and assurance of ongoing supply for niche applications, data for strength, acoustic dampening and thermal insulation properties, acceptance by regulatory authorities and training for on-site construction.

Economically viable land regeneration in Central Queensland and improved water quality outcomes for the Great Barrier Reef

The impact of excessive sediment loads entering into the Great Barrier Reef lagoon has led to increased awareness of land condition in grazing lands. Improved ground cover and land condition have been identified as two important factors in reducing sediment loads. This paper reports the economics of land regeneration using case studies for two different land types in the Fitzroy Basin. The results suggest that for sediment reduction to be achieved from land regeneration of more fertile land types (brigalow blackbutt) the most efficient method of allocating funds would be through extension and education. However for less productive country (narrow leaved ironbark woodlands) incentives will be required. The analysis also highlights the need for further scientific data to undertake similar financial assessments of land regeneration for other locations in Queensland.

Risk-based surveillance for avian influenza control along poultry market chains in South China: The value of social network analysis.

Over the past two decades, the poultry sector in China went through a phase of tremendous growth as well as rapid intensification and concentration. Highly pathogenic avian influenza virus (HPAIV) subtype H5N1 was first detected in 1996 in Guangdong province, South China and started spreading throughout Asia in early 2004. Since then, control of the disease in China has relied heavily on wide-scale preventive vaccination combined with movement control, quarantine and stamping out. This strategy has been successful in drastically reducing the number of outbreaks during the past 5 years. However, HPAIV H5N1 is still circulating and is regularly isolated in traditional live bird markets (LBMs) where viral infection can persist, which represent a public health hazard for people visiting them. The use of social network analysis in combination with epidemiological surveillance in South China has identified areas where the success of current strategies for HPAI control in the poultry production sector may benefit from better knowledge of poultry trading patterns and the LBM network configuration as well as their capacity for maintaining HPAIV H5N1 infection. We produced a set of LBM network maps and estimated the associated risk of HPAIV H5N1 within LBMs and along poultry market chains, providing new insights into how live poultry trade and infection are intertwined. More specifically, our study provides evidence that several biosecurity factors such as daily cage cleaning, daily cage disinfection or manure processing contribute to a reduction in HPAIV H5N1 presence in LBMs. Of significant importance is that the results of our study also show the association between social network indicators and the presence of HPAIV H5N1 in specific network configurations such as the one represented by the counties of origin of the birds traded in LBMs. This new information could be used to develop more targeted and effective control interventions.