A six-year descriptive analysis of hospitalisations for ambulatory care sensitive conditions among people born in refugee-source countries

Background: Hospitalisation for ambulatory care sensitive conditions (ACSHs) has become a recognised tool to measure access to primary care. Timely and effective outpatient care is highly relevant to refugee populations given the past exposure to torture and trauma, and poor access to adequate health care in their countries of origin and during flight. Little is known about ACSHs among resettled refugee populations. With the aim of examining the hypothesis that people from refugee backgrounds have higher ACSHs than people born in the country of hospitalisation, this study analysed a six-year state-wide hospital discharge dataset to estimate ACSH rates for residents born in refugee-source countries and compared them with the Australia-born population. Methods: Hospital discharge data between 1 July 1998 and 30 June 2004 from the Victorian Admitted Episodes Dataset were used to assess ACSH rates among residents born in eight refugee-source countries, and compare them with the Australia-born average. Rate ratios and 95% confidence levels were used to illustrate these comparisons. Four categories of ambulatory care sensitive conditions were measured: total, acute, chronic and vaccine-preventable. Country of birth was used as a proxy indicator of refugee status. Results: When compared with the Australia-born population, hospitalisations for total and acute ambulatory care sensitive conditions were lower among refugee-born persons over the six-year period. Chronic and vaccine-preventable ACSHs were largely similar between the two population groups. Conclusion: Contrary to our hypothesis, preventable hospitalisation rates among people born in refugee-source countries were no higher than Australia-born population averages. More research is needed to elucidate whether low rates of preventable hospitalisation indicate better health status, appropriate health habits, timely and effective care-seeking behaviour and outpatient care, or overall low levels of health care-seeking due to other more pressing needs during the initial period of resettlement. It is important to unpack dimensions of health status and health care access in refugee populations through ad-hoc surveys as the refugee population is not a homogenous group despite sharing a common experience of forced displacement and violence-related trauma.

Hospital utilisation among people born in refugee-source countries : an analysis of hospital admissions, Victoria, 1998–2004

Objective: To investigate whether hospital utilisation and health outcomes in Victoria differ between people born in refugee-source countries and those born in Australia. Design and setting: Analysis of a statewide hospital discharge dataset for the 6 financial years from 1 July 1998 to 30 June 2004. Hospital admissions of people born in eight countries for which the majority of entrants to Australia arrived as refugees were included in the analysis. Main outcome measures: Age-standardised rates and rate ratios for: total hospital admissions; emergency admissions; surgical admissions; total days in hospital; discharge at own risk; hospital deaths; admissions due to infectious and parasitic diseases; and admissions due to mental and behavioural disorders. Results: In 2003–04, compared with the Australia-born Victorian population, people born in refugee-source countries had lower rates of surgical admission (rate ratio [RR], 0.85; 95% CI, 0.81–0.88), total days in hospital (RR, 0.74; 95% CI, 0.73–0.75), and admission due to mental and behavioural disorders (RR, 0.70; 95% CI, 0.65–0.76). Over the 6-year period, rates of total days in hospital and rates of admission due to mental and behavioural disorders for people born in refugee-source countries increased towards Australian-born averages, while rates of total admissions, emergency admissions, and admissions due to infectious and parasitic diseases increased above the Australian-born averages. Conclusions: Use of hospital services among people born in refugee-source countries is not higher than that of the Australian-born population and shows a trend towards Australian-born averages. Our findings indicate that the Refugee and Humanitarian Program does not currently place a burden on the Australian hospital system.

Good chronological history detected but critical analysis on the missing list

Invited book review of Carolyn Carpan, 2009, Sisters, Schoolgirls and Sleuths : Girls' Series Books in America, MD: Scarecrow Press

Why do policy decision-makers opt for command and control environmental regulation? An economic analysis with special reference to Sri Lanka

This chapter examines why policy decision-makers opt for command and control environmental regulation despite the availability of a plethora of market-based instruments which are more efficient and cost-effective. Interestingly, Sri Lanka has adopted a wholly command and control system, during both the pre and post liberalisation economic policies. This chapter first examines the merits and demerits of command and control and market-based approaches and then looks at Sri Lanka’s extensive environmental regulatory framework. The chapter then examines the likely reasons as to why the country has gone down the path of inflexible regulatory measures and has become entrenched in them. The various hypotheses are discussed and empirical evidence is provided. The chapter also discusses the consequences of an environmentally slack economy and policy implications stemming from adopting a wholly regulatory approach. The chapter concludes with a discussion of the main results.

Determinants of health costs due to farmers’ exposure to pesticides: an empirical analysis

Pesticide spraying by farmers has an adverse impact on their health. However, in studies to date examining farmers’ exposure to pesticides, the costs of ill health and their determinants have been based on information provided by farmers themselves. Some doubt has therefore been cast on the reliability of these estimates. In this study, we address this by conducting surveys among two groups of farmers who use pesticides on a regular basis. The first group is made up of farmers who perceive that their ill health is due to exposure to pesticides and have obtained at least some form of treatment (described in this article as the ‘general farmer group’). The second group is composed of farmers whose ill health has been diagnosed by doctors and who have been treated in hospital for exposure to pesticides (described here as the ‘hospitalised farmer group’). Cost comparisons are made between the two groups of farmers. Regression analysis of the determinants of health costs show that the most important determinants of medical costs for both samples are the defensive expenditure, the quantity of pesticides used per acre per month, frequency of pesticide use and number of pesticides used per hour per day. The results have important policy implications.

Nitrous oxide emissions from subtropical horticultural soils : a time series analysis

Time series regression models were used to examine the influence of environmental factors (soil water content and soil temperature) on the emissions of nitrous oxide (N2O) from subtropical soils, by taking into account temporal lagged environmental factors, autoregressive processes, and seasonality for three horticultural crops in a subtropical region of Australia. Fluxes of N2O, soil water content, and soil temperature were determined simultaneously on a weekly basis over a 12-month period in South East Queensland. Annual N2O emissions for soils under mango, pineapple, and custard apple were 1590, 1156, and 2038 g N2O-N/ha, respectively, with most emissions attributed to nitrification. The N2O-N emitted from the pineapple and custard apple crops was equivalent to 0.26 and 2.22%, respectively, of the applied mineral N. The change in soil water content was the key variable for describing N2O emissions at the weekly time-scale, with soil temperature at a lag of 1 month having a significant influence on average N2O emissions (averaged) at the monthly time-scale across the three crops. After accounting for soil temperature and soil water content, both the weekly and monthly time series regression models exhibited significant autocorrelation at lags of 1–2 weeks and 1–2 months, and significant seasonality for weekly N2O emissions for mango crop and for monthly N2O emissions for mango and custard apple crops in this location over this time-frame. Time series regression models can explain a higher percentage of the temporal variation of N2O emission compared with simple regression models using soil temperature and soil water content as drivers. Taking into account seasonal variability and temporal persistence in N2O emissions associated with soil water content and soil temperature may lead to a reduction in the uncertainty surrounding estimates of N2O emissions based on limited sampling effort.

A distributional analysis of the native-immigrant wage gap : the importance of employment discrimination

It is well documented that immigrants earn less than natives in the United States, and various attempts have been made to determine whether these earnings differentials reflect underlying differences in skill or ethnic discrimination in the labor market. The earnings of immigrants and ethnic minorities is an extensively studied area focusing on the economic integration of immigrants (e.g., Chiswick (1978), Lalonde and Topel (1993), Borjas (1995)). Yet, the role of occupational segregation as a mechanism for discrimination is yet to be addressed (to our knowledge). Discrimination can be effective at either of two stages in the earnings process – in the assignment of earnings to people within occupational groups (henceforth referred to as wage discrimination) or in the allocation of people to occupations (henceforth referred to as employment discrimination). While it would be premature to attribute the underlying cause to discriminatory hiring policies of employers, it would be of social-political and economic interest to investigate the possibility.

Allegations of child sexual abuse in family court cases : a qualitative analysis of psychiatric evidence

Allegations of child sexual abuse in Family Court cases have gained increasing attention. The study investigates factors involved in Family Court cases involving allegations of child sexual abuse. A qualitative methodology was employed to examine Records of Judgement and Psychiatric Reports for 20 cases distilled from the data corpus of 102 cases. A seven-stage methodology was developed utilising a thematic analysis process informed by principles of grounded theory and phenomenology. The explication of eight thematic clusters was undertaken. The findings point to complex issues and dynamics in which child sexual abuse allegations have been raised. The alleging parent’s allegations of sexual abuse against their ex-partner may be: the expression of unconscious deep fears for their children’s welfare, or an action to meet their needs for personal affirmation in the context of the painful upheaval of a relationship break-up. Implications of the findings are discussed.

An analysis of the corporate governance practices of smaller listed Australian companies

We examine the corporate governance environment of smaller listed Australian firms to investigate the factors that determine how firms respond to recommendations contained in corporate governance codes. We group corporate governance recommendations into three distinct categories and argue that differences in adoption costs between categories, together with firm specific factors, determine a firm’s decision to conform with the recommendation or to explain the reasons for non-conformance. Analysis of the conformance by smaller firms with governance recommendations highlights substantial differences in adoption rates between categories of recommendations. Our results also reveal that the cost of adopting specific recommendations, together with profitability, external audit quality, and ownership dispersion, jointly explain a firm’s decision to ‘comply or explain’. This study provides insights for policy makers and regulators regarding the appropriateness of corporate governance recommendations for smaller firms

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.

Making space for knowledge generation and place for knowledge communities : an analysis of the Australian practice

In the era of global knowledge economy, urban regions—seeking to increase their competitive edge, become destinations for talent and investment, and provide prosperity and quality of life to their inhabitants—have little chance achieving their development goals without forming effective knowledge-based urban development strategies. This paper aims to shed light on the planning and development processes of the knowledge-based urban development phenomenon with respect to the construction of knowledge community precincts aimed at making space for knowledge generation and place for knowledge communities. Following to a thorough review of the literature on knowledge-based urban development and strategic asset-based planning, the paper undertakes policy and best practice analyses to learn from the planning and development processes of internationally renowned knowledge community precincts—from Copenhagen, Eindhoven and Singapore. In the light of the analyses findings, this paper scrutinises major Australian knowledge community precinct initiatives—from Sydney, Melbourne and Brisbane—to better understand the dynamics of national practices, and benchmark them against the international best practice cases. The paper concludes with a discussion on the study findings and recommendations for successfully establishing space and place for both knowledge economy and society in Australian cities.