Challenges in health services and health systems research

The relationship between emerging trends in healthcare systems and the consequent research priorities will be explored.

Governments and policy makers in developed countries are increasingly focused on the management of chronic disease, reflecting demographic changes and shifts in the burden of disease. Systems of quality improvement and reward are increasingly based on performance in chronic disease management. There is some evidence that countries with well-developed systems of primary care, such as Australia, achieve better health outcomes at less cost. In the past 15 years, almost all developed countries have undergone some type of health care reform. There has been a major focus on reducing costs; often involving shifting services from secondary to primary care. While there are few international comparisons, most suggest a complex relationship between the strength of primary care within the overall health services system and good performance, particularly with regard to lower costs of care and particularly relevant measures of health.

Aims for 21st century health systems
What, then, are the issues which are shaping contemporary general practice in developed countries? There are several imperatives: Safety, effectiveness, patient-centredness, timeliness, efficiency and equity. A study by the Nuffield Trust (Dargie, 1999) projected the shape of healthcare for the first fifteen years of this century. The study identified six issues that need to be addressed in the process of formulating health systems policies:

• Peoples’ expectations and financial sustainability
• Demography and ageing
• Information and knowledge management
• Scientific advance and new technology
• Workforce education and training
• Systems performance and quality (efficiency, effectiveness, economy
and equity)

Each of these six issues requires innovative thinking and priority setting on the part of the health sector, such as the delivery of health services in new and creative ways. Furthermore, there is a clear need for a finely tuned research, development and evaluation strategies to match these goals.

Wayang mbeling : sastra Indonesia menjelang akhir Orde Baru

History and criticism on Indonesian literature and wayang plays in the 20th century.

History of amenorrhoea compromises some of the exercise-induced benefits in cortical and trabecular bone in the peripheral and axial skeleton : a study in retired elite gymnasts

Background : Female gymnasts frequently present with overt signs of hypoestrogenism, such as late menarche or menstrual dysfunction. The objective was to investigate the impact of history of amenorrhoea on the exercise-induced skeletal benefits in bone geometry and volumetric density in retired elite gymnasts.
Subjects and methods

24 retired artistic gymnasts, aged 17–36 years, who had been training for at least 15 h/week at the peak of their career and had been retired for 3–18 years were recruited. They had not been engaged in more than 2 h/week of regular physical activity since retirement. Former gymnasts who reported history of amenorrhoea (‘AME’, n = 12: either primary or secondary amenorrhoea) were compared with former gymnasts (‘NO-AME’, n = 12) and controls (‘C’, n = 26) who did not report history of amenorrhoea. Bone mineral content (BMC), total bone area (ToA) and total volumetric density (ToD) were measured by pQCT at the radius and tibia (4% and 66%). Trabecular volumetric density (TrD) and bone strength index (BSI) were measured at the 4% sites. Cortical area (CoA), cortical thickness (CoTh), medullary area (MedA), cortical volumetric density (CoD), stress–strain index (SSI) and muscle and fat area were measured at the 66% sites. Spinal BMC, areal BMD and bone mineral apparent density (BMAD) were measured by DXA.
Results

Menarcheal age was delayed in AME when compared to NO-AME (16.4 ± 0.5 years vs. 13.3 ± 0.4 years, p < 0.001). No differences were detected between AME and C for height-adjusted spinal BMC, aBMD and BMAD, TrD and BSI at the distal radius and tibia, CoA at the proximal radius, whereas these parameters were greater in NO-AME than C (p < 0.05–0.005). AME had lower TrD and BSI at the distal radius, and lower spinal BMAD than NO-AME (p < 0.05) but they had greater ToA at the distal radius (p < 0.05).
Conclusion

Greater spinal BMC, aBMD and BMAD as well as trabecular volumetric density and bone strength in the peripheral skeleton were found in former gymnasts without a history of menstrual dysfunction but not in those who reported either primary or secondary amenorrhoea. History of amenorrhoea may have compromised some of the skeletal benefits associated with high-impact gymnastics training.

Heritability of corticosterone response and changes in life history traits during selection in the zebra finch

Vertebrates respond to environmental stressors through the neuro-endocrine stress response, which involves the production of glucocorticoids. We have selected independent, duplicate divergent lines of zebra finches for high, low and control corticosterone responses to a mild stressor. This experiment has shown that over the first four generations, the high lines have demonstrated a significant realized heritability of about 20%. However, the low lines have apparently not changed significantly from controls. This asymmetry in response is potentially because of the fact that all birds appear to be showing increased adaptation to the environment in which they are housed, with significant declines in corticosterone response in control lines as well as low lines. Despite the existence of two- to threefold difference in mean corticosterone titre between high and low lines, there were no observed differences in testosterone titre in adult male birds from the different groups. In addition, there were no consistent, significant differences between the lines in any of the life history variables measured – number of eggs laid per clutch, number of clutches or broods produced per pair, number of fledglings produced per breeding attempt, nor in any of egg, nestling and fledgling mortality. These results highlight the fact that the mechanisms that underlie variation in the avian physiological system can be modified to respond to differences between environments through selection. This adds an additional level of flexibility to the avian physiological system, which will allow it to respond to environmental circumstances.

Human dimensions of wildlife population management in Australasia – history, approaches and directions

It is now widely accepted that it is important to understand the ‘human dimensions’ of wildlife management issues in order to achieve management goals. This growing field of study was born in the 1960s and involves an examination of societal values, knowledge and behaviours associated with wildlife and wildlife management issues. This paper provides an overview of the history and directions in human dimensions research, focusing specifically on its application for wildlife population management in Australasia (in particular, Australia and New Zealand). It also provides a ‘toolkit’ of methods and approaches for those wishing to undertake, interpret or utilise human dimensions enquiries.

Commonsense, manners, guts' : 'manliness' in the English school story 1887-1917

[No Abstract]

Event that never happened : the history and politics of decentralisation in Victoria and New South Wales 1885-1985

The thesis is an account of movements and policies for decentralisation of population and economic activity away from metropolitan to non-metropolitan areas in Victoria and N.S.W. in the period 1885-1985. It examines the pull from the country and the push from the capitals for decentralisation. Ballarat (Victoria) and Bathurst (N.S.W.) are used as case studies. Introductory chapters describe the historic pattern of population distribution in the two Colonies/States and discuss theories about the spatial distribution of population and industry. Chapters recounting and discussing the history and politics of decentralisation in Victoria and N.S.W. are organised in three periods: 1885-1940; 1940-1965; 1965-1985. A more decentralised distribution of population in Victoria and N.S.W. was almost always widely accepted as being in the public interest. Decentralisation rose and fell recurrently on the issue attention cycle. The pull from the country was fragmented and locally self-interested. The push from the capitals occurred only when life or its quality was perceived as threatened because of factors related to city size. Governments in both States introduced micro policies ostensibly to counter formidable centralising forces. In the 1970s there was an abortive attempt to implement a selective decentralisation policy in N.S.W. The thesis argues that decentralisation did not happen because: (1) there was not a consistent set of values and goals underlying the pull and push; (2) there was never a sustained, unified constituency for decentralisation, even in the country; (3) the power to influence, subvert or obstruct decentralisation policies was too widely diffused; (4) insufficient account was taken in decentralisation policymaking of the underlying economic, social and political dynamics.

At the limits : postcolonial and hyperreal translations of Australian poetry

This dissertation employs the methodologies of postcolonial theory and hyperreal theory (following Baudrillard), in order to investigate articulations of identity, nation and representation in contemporary Australian poetry. Informed by a comparative analysis of contemporary Latin American poetry and cultural theory (in translation), as a means of re-examining the Australian context, this dissertation develops a new transnational model of Australian poetics. The central thesis of this dissertation is that contemporary Australian poetry engages with the postcolonial at its limits. That is, at those sites of postcoloniality that are already mapped by theory, but also at those that occur beyond postcolonial theory. The hyperreal is understood as one such limit, traceable within the poetry but silenced in conventional postcolonial theory. As another limit to the postcolonial, this dissertation reads Latin American poetry and theory, in whose texts postcolonial theory is actively resisted, but where postcolonial and hyperreal poetics nevertheless intersect. The original critical context constructed by this dissertation enables a new set of readings of Australian identity through its poetry. Within this new interpretative context, the readings of contemporary Australian poetry articulate a psycho-social postcoloniality; offer a template for future transactions between national poetry and global politics; and develop a model of the postcolonial hyperreal.

Poetry and silence : "a sequence of disappearances"

[No Abstract]