Evaluating Australia's National Medicines Policy using geographical mapping

Background: There has been a proliferation of quality use of medicines activities in Australia since the 1990s. However, knowledge of the nature and extent of these activities was lacking. A mechanism was required to map the activities to enable their coordination. Aims: To develop a geographical mapping facility as an evaluative tool to assist the planning and implementation of Australia's policy on the quality use of medicines. Methods: A web-based database incorporating geographical mapping software was developed. Quality use of medicines projects implemented across the country was identified from project listings funded by the Quality Use of Medicines Evaluation Program, the National Health and Medical Research Council, Mental Health Strategy, Rural Health Support, Education and Training Program, the Healthy Seniors Initiative, the General Practice Evaluation Program and the Drug Utilisation Evaluation Network. In addition, projects were identified through direct mail to persons working in the field. Results: The Quality Use of Medicines Mapping Project (QUMMP) was developed, providing a Web-based database that can be continuously updated. This database showed the distribution of quality use of medicines activities by: (i) geographical region, (ii) project type, (iii) target group, (iv) stakeholder involvement, (v) funding body and (vi) evaluation method. At September 2001, the database included 901 projects. Sixty-two per cent of projects had been conducted in Australian capital cities, where approximately 63% of the population reside. Distribution of projects varied between States. In Western Australia and Queensland, 36 and 73 projects had been conducted, respectively, representing approximately two projects per 100 000 people. By comparison, in South Australia and Tasmania approximately seven projects per 100 000 people were recorded, with six per 100 000 people in Victoria and three per 100 000 people in New South Wales. Rural and remote areas of the country had more limited project activity. Conclusions: The mapping of projects by geographical location enabled easy identification of high and low activity areas. Analysis of the types of projects undertaken in each region enabled identification of target groups that had not been involved or services that had not yet been developed. This served as a powerful tool for policy planning and implementation and will be used to support the continued implementation of Australia's policy on the quality use of medicines.

Rural lines of flight: Telecommunications and post-metro dreaming

Information and communications technologies hold a prominent place in the cultural imagination of many people living outside the Australian metropolis, especially recent émigrés. A vision of a wired pastoral conjures up the possibilities of city work, connections and pleasures accompanying the flight to the country. Such aspirations have given a twist to one of the great topos of Australian post-invasion communications history, communications ameliorating the perceived isolation in the bush. This article examines important changes to rural telecommunications in the 1990s coinciding with post-metro dreaming and digital convergence, namely the rise of local telecommunications. Neo-Foucauldian accounts of citizenship hold some promise for explaining the criss-cross of tangled lines of flight in regional communications in the twenty-first century: emergent subjectivities, utopian digital modes of becoming, new politics of infrastructure, reconfigured relationships among state, market and citizen.

Impact numbers in health policy decisions

Objective: To outline the major methodological issues appropriate to the use of the population impact number (PIN) and the disease impact number (DIN) in health policy decision making. Design: Review of literature and calculation of PIN and DIN statistics in different settings. Setting: Previously proposed extensions to the number needed to treat (NNT): the DIN and the PIN, which give a population perspective to this measure. Main results: The PIN and DIN allow us to compare the population impact of different interventions either within the same disease or in different diseases or conditions. The primary studies used for relative risk estimates should have outcomes, time periods and comparison groups that are congruent and relevant to the local setting. These need to be combined with local data on disease rates and population size. Depending on the particular problem, the target may be disease incidence or prevalence and the effects of interest may be either the incremental impact or the total impact of each intervention. For practical application, it will be important to use sensitivity analyses to determine plausible intervals for the impact numbers. Conclusions: Attention to various methodological issues will permit the DIN and PIN to be used to assist health policy makers assign a population perspective to measures of risk.

Communicating vegetation management science to land managers and other stakeholders

Science communication. including extension services. plays a key role in achieving sustainable native vegetation management. One of the pivotal aspects of the debate on sustainable vegetation management is the scientific information underpinning policy-making. In recent years. extension services have Shifted their focus from top-down technology transfer to bottom-up participation and empowerment. I here has also been a broadening of communication strategies to recognise the range of stakeholders involved in native vegetation management and to encompass environmental concerns. This paper examines the differences between government approaches to extension services to deliver policy and the need for effective communication to address broader science issues that underpin native vegetation management. The importance of knowing the learning styles of the stakeholders involved in native vegetation management is discussed at a time of increasing reliance on mass communication for information exchange and the importance of personal communication to achieve on-ground sustainable management. Critical factors for effective science-management communication are identified Such as: (i) undertaking scientific studies (research) with community involvement, acceptance and agreed understanding of project objectives (ii) realistic community consultation periods: (iii) matching communication channels with stakeholder needs; (iv) combining scientific with local knowledge in in holistic (biophysical and social) approach to understanding in issued and (v) regional partnerships. These communication factors are considered to be essential to implementing on-ground natural resource management strategics and actions, including those concerned with native vegetation management.

Organizational responses to a changing aid environment: the German Agency for Technical Cooperation (GTZ)

As a major European donor, German government development assistance faces a series of challenges. Recent political changes have raised expectations for demonstrable health outcomes as a result of German development assistance; there has been a deepened commitment to collaboration with other bilateral and multilateral donors; and partner countries are increasingly open to new approaches to development. German development assistance also reflects a new ethos of partnership and the shift to programmatic and sector based development approaches. At the same time, its particular organizational structure and administrative framework highlight the extent of structural and systems reforms required of donors by changing development relationships, and the tensions created in responding to these. This paper examines organizational changes within the German Agency for Technical Cooperation (Deutsche Gesellschaft fur Technische Zusammenarbeit) (GTZ), aimed at increasing its Regional, Sectoral, Managerial and Process competence as they affect health and related sectors. These include the decentralization of GTZ, the trend to integration of projects, the increasing focus on policy and health systems reform, increased inter-sectoral collaboration, changes in recruitment and training, new perspectives in planning and evaluation and the introduction of a quality management programme. Copyright (C) 2002 John Wiley Sons, Ltd.

Public policy and the prevention of substance-use disorders

Drug prevention has traditionally focused on influencing individual attitudes and behaviours. In particular, efforts have been directed towards adolescents in the school setting. However, evaluations of school-based drug education have identified limited success. There is increasing recognition that drug abuse is one of a number of risk behaviours, including truancy, delinquency and mental health problems, which share common antecedents that begin in the early years of childhood. Furthermore, these behaviours are shaped by macroenvironmental influences including the economic, social, cultural, and physical environment. Drug prevention needs to adopt a broader perspective: with greater collaboration in related programmes such as crime prevention and suicide prevention; with greater attention to the macroenvironmental influences on problem behaviours; and with greater attention to healthy development in the first years of childhood. (C) 2002 Lippincott Williams Wilkins.

Dispersal patterns in a regional koala population in south-east Queensland

Koala dispersal was investigated as part of a detailed ecological study of a nationally significant koala population located 20 km south-east of Brisbane, Queensland. From 1996 to 2000, 195 koalas from three sites were captured and fitted with radio-collars. A total of 40 koalas ( 23 males and 17 females) dispersed from these sites. Most (93%) dispersing individuals were 20 - 36 months of age. Three adult females ( more than 36 months old) dispersed and no adult males dispersed during the study. A significantly higher proportion of young males dispersed than females. Dispersal occurred between June and December, with most dispersal of males commencing in July and August and that of females commencing between September and November prior to, and early in, the annual breeding season. The mean straight-line distance between the natal and breeding home ranges for males and females was similar and was measured at 3.5 km ( range 1.1 - 9.7 km) and 3.4 km ( range 0.3 - 10.6 km) respectively. Dispersing males and females tended to successfully disperse south and west of their natal home ranges and were generally unable to successfully disperse to urban areas within the study area, as a high proportion of the mortality of dispersing koalas was associated with attacks by domestic dogs and with collisions with vehicles on roads. Information from other studies indicates that most young koalas disperse from their natal areas. It is likely that the social behaviour and mating systems of koala populations provide mechanisms for young koalas to disperse. The potential role of dispersal in the dynamics of regional koala populations is discussed.

Determination of regional flow by use of intravascular PET tracers: Microvascular theory and experimental validation for pig livers

Today, the standard approach for the kinetic analysis of dynamic PET studies is compartment models, in which the tracer and its metabolites are confined to a few well-mixed compartments. We examine whether the standard model is suitable for modern PET data or whether theories including more physiologic realism can advance the interpretation of dynamic PET data. A more detailed microvascular theory is developed for intravascular tracers in single-capillary and multiple-capillary systems. The microvascular models, which account for concentration gradients in capillaries, are validated and compared with the standard model in a pig liver study. Methods: Eight pigs underwent a 5-min dynamic PET study after O-15-carbon monoxide inhalation. Throughout each experiment, hepatic arterial blood and portal venous blood were sampled, and flow was measured with transit-time flow meters. The hepatic dual-inlet concentration was calculated as the flow-weighted inlet concentration. Dynamic PET data were analyzed with a traditional single-compartment model and 2 microvascular models. Results: Microvascular models provided a better fit of the tissue activity of an intravascular tracer than did the compartment model. In particular, the early dynamic phase after a tracer bolus injection was much improved. The regional hepatic blood flow estimates provided by the microvascular models (1.3 +/- 0.3 mL min(-1) mL(-1) for the single-capillary model and 1.14 +/- 0.14 min(-1) mL(-1) for the multiple-capillary model) (mean +/- SEM mL of blood min(-1) mL of liver tissue(-1)) were in agreement with the total blood flow measured by flow meters and normalized to liver weight (1.03 +/- 0.12 mL min(-1) mL(-1)). Conclusion: Compared with the standard compartment model, the 2 microvascular models provide a superior description of tissue activity after an intravascular tracer bolus injection. The microvascular models include only parameters with a clear-cut physiologic interpretation and are applicable to capillary beds in any organ. In this study, the microvascular models were validated for the liver and provided quantitative regional flow estimates in agreement with flow measurements.