Colorectal cancer screening in Australia: an economic evaluation of a potential biennial screening program using faecal occult blood tests

Objective: To evaluate whether the introduction of a national, co-ordinated screening program using the faecal occult blood test represents 'value-for-money' from the perspective of the Australian Government as third-party funder.  Methods: The annual equivalent costs and consequences of a   biennial screening program in 'steady-state' operation were estimated for the Australian population using 1996 as the reference year. Disability-adjusted life years (DALYs) and the years of life lost (YLLs) averted, and the health service costs were modelled, based on the epidemiology and the costs of colorectal cancer in Australia together with the mortality reduction achieved in randomised controlled trials. Uncertainty in the model was examined using Monte Carlo simulation methods. Results: We estimate a minimum or 'base program' of screening those aged 55 to 69 years could avert 250 deaths per annum (95% uncertainty interval 99–400), at a gross cost of $A55 million (95% UI $A46 million to $A96 million) and a gross incremental cost-effectiveness ratio of $A17,000/DALY (95% UI $A13,000/DALY to $A52,000/DALY). Extending the program to include 70 to 74-year-olds is a more effective option (cheaper and higher health gain) than including the 50 to 54-year-olds. Conclusions: The findings of this study support the case for a national program directed at the 55 to 69-year-old age group with extension to 70 to 74-year-olds if there are sufficient resources. The pilot tests recently announced in Australia provide an important opportunity to consider the age range for screening and the sources of uncertainty, identified in the modelled evaluation, to assist decisions on implementing a full national program.

Measurement of the economic impact of visual impairment from age-related macular degeneration in Australia

The purpose of this report was to: (i) outline the potential value of health economic studies into age-related macular degeneration (AMD); (ii) provide an overview of health economic studies pertinent to AMD; and (iii) outline the basic frame work of cost-of-illness studies (a useful first step in applying economic methods). The detection and management of sensory loss in the elderly plays a key role in the Australian Government's Healthy Ageing Strategy. Age-related macular degeneration is currently the leading cause of blindness in elderly Australians. Although a large proportion of AMD cases remain untreatable, the introduction of photo­dynamic therapy provides a relatively expensive and possibly cost-effective innovation for others. Antioxidant therapy has also been proven effective in reducing progression of early to late disease. The discipline of economics can contribute to an understanding of AMD prevention and treatment through: (i) describing the current burden of disease; (ii) predicting the changes in the burden of disease over time, and (iii) evaluating the efficiency of different interventions. Cost-of-illness studies have been performed in many fields of medicine. Little work, however, has been done on describing the economic impact from AMD. A number of different economic evaluation methods can be used in judging the efficiency of possible interventions to reduce the disease burden of AMD. Although complementary in nature, each has specific uses and limitations. Studies of the economic impact of eye diseases are both feasible and necessary for informed health care decision-making.

A review of play and play assessment used in occupational therapy

In occupational therapy play is regarded as important in itself. This view has been influenced by occupational science and the assumption that play is a child's primary occupation. To reflect this change in the view of play, assessments of play are now being developed which focus on aspects of behaviour which are unique to play. As a result of this work on play, play training programs have been developed which focus on teaching children how to play.

Management communication strategies determine job satisfaction in telecommuting

The aim of this article is to examine the relationships between several management communication strategies and the job satisfaction of telecommuters. A review of the literature revealed that several management communication strategies directly influence job satisfaction of telecommuters. However, this claim has not been objectively tested on Australian telecommuters. Hence, a sample of 43 telecommuters, mostly from IBM Australia, were surveyed and the results analysed using Pearson’s product-moment correlation. Eleven aspects of the strategies were found to have significant influence on the job satisfaction of telecommuters: communicating job responsibilities; goals and objectives; deadlines and job expectations; communicating freely and regularly; providing appropriate equipment; training and career development; and reviewing work and salary regularly. This article concludes that cultural, economic and social contexts may have a distinct part to play in the impact of management communication strategies on the job satisfaction of telecommuters.

Flexible delivery and student attrition in the vocational education and training sector: case studies of students who dropped out

Government policy in Australia is increasingly encouraging training organisations in the Vocational Education and Training (VET) sector to adopt flexible delivery approaches. This policy shift is supported by key VET stakeholders including Industry Training Advisory Boards. A recurring theme in VET policy documents is an apparent confidence that flexible delivery can meet the diverse needs of individual learners while at the same time providing cost savings. Yet evidence is emerging that Australian VET learners are not typically ready for flexible delivery, and this lack of readiness is reflected in high attrition rates and low pass rates in many flexibly delivered courses. One research project found that over 70% of learners in the Australian VET sector do not have the learning capabilities required to be ready for flexible delivery. A recent review of the module outcomes achieved by VET students nationally found that students studying by external/correspondence and self-paced unscheduled modes had lower module completion rates than students studying by other delivery strategies.

Research on student progress in flexible delivery within the Australian VET sector has largely been quantitative. That research provides useful statistical data on completion and attrition rates for various modes of delivery, but does not explore the reasons underlying the high attrition rates found in flexible delivery. The qualitative research that is available tends to focus on students who successfully complete their courses, not on those who withdraw. As a result, the Australian literature on flexible delivery in the VET sector is lacking in-depth qualitative information about students who enrol in courses but do not complete. In comparison, the broader literature on distance education and flexible delivery in other educational sectors offers some useful insights into student attrition, and can be can be used to inform research into attrition within the Australian VET sector.

This paper reports on aspects of a research project that followed up six adult learners who enrolled in VET courses but who either failed assessment or withdrew. The research project presented the students’ stories in the form of narrative case studies, focussing on the detailed examination of the barriers that each student experienced, and analysing these barriers in relation to issues raised in the literature. This paper reports on two particular themes that emerged from that research project. The literature on distance education and flexible delivery argues that:


· student dropout is often not determined by a single factor, but by the interaction of a number of factors that build up over time;

· students who experience difficulties when studying by flexible delivery can often be reluctant to access the support that is available to them.

This paper uses these themes as a point of reference in presenting the stories of some of the students who participated in the research project.
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Temporal causality and the dynamics of judicial appellate caseload, real income and socio-economic complexity in Australia

This study applies Granger causality tests within a multivariate error correction framework to examine the relationship between judicial caseload, real income and urbanization for Australia using annual data from 1904 to 2001. Decomposition of variance and impulse response functions are also considered. The Granger causality results as well as the decomposition of variance and impulse response functions suggest that urbanization is the most exogenous of the three variables in both the long run and short run while judicial caseload and real income are relatively exogenous in the short run.