ORCID Profile
0000-0002-6391-6791
Current Organisation
University of South Australia
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Publisher: Springer Science and Business Media LLC
Date: 20-05-2008
Abstract: There is an increasing body of published cost-utility analyses of health interventions which we sought to draw together to inform research and policy. To achieve consistency in costing base and policy context, study scope was limited to Australian-based cost-effectiveness analyses. Through a comprehensive literature review we identified 245 health care interventions that met our study criteria. The median cost-effectiveness ratio was A$18,100 (~US$13,000) per QALY/DALY/LY (quality adjusted life year gained or, disability adjusted life year averted or life year gained). Some modalities tended to perform worse, such as vaccinations and diagnostics (median cost/QALY $58,000 and $68,000 respectively), than others such as allied health, lifestyle, in-patient interventions (median cost/QALY/DALY/LY all at ~A$9,000~US$6,500). Interventions addressing some diseases such as diabetes and impaired glucose tolerance or alcohol and drug dependence tended to perform well (median cost/QALY/DALY/LY A$3,700, US$5,000). Interventions targeting younger persons 25 years (median cost/QALY/DALY/LY A$41,200) tended to perform less well than those targeting adults 25 years (median cost/QALY/DALY/LY A$16,000). However, there was also substantial variation in the cost effectiveness of in idual interventions within and across all categories. For any given condition, modality or setting there are likely to be ex les of interventions that are cost effective and cost ineffective. It will be important for decision makers to make decisions based on the in idual merits of an intervention rather than rely on broad generalisations. Further evaluation is warranted to address gaps in the literature and to ensure that evaluations are performed in areas with greatest potential benefit.
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.APMR.2012.03.018
Abstract: To test the effect of tai chi on the progression of preclinical disability to manifest disability compared with seated flexibility exercise, and to examine whether tai chi mediates delayed disability by reducing impairments in musculoskeletal, cardiovascular, and neurologic systems, and related functional limitations. Multisite parallel group in idually randomized controlled trial. General community. Preclinically disabled community-dwelling people older than 70 years (n=503), without major medical conditions or moderate to severe cognitive impairment. Modified Sun style tai chi exercise compared with seated flexibility exercise, both programs delivered in groups for 60 minutes twice weekly for 24 weeks. Disability measured with the Late-Life Function and Disability Instrument. Secondary outcomes were impairments and functional limitations of the musculoskeletal, neurologic, and cardiovascular systems. There was little change within or between the 2 groups. The mean change in the Disability Frequency Score was 0.3 and 0.1 points (100-point scale) for the intervention and control groups, respectively (adjusted difference -.21 95% confidence interval [CI] -.99 to .56). The mean change in the Disability Limitation Score was -0.1 and -.04 points for the intervention and control groups, respectively (adjusted difference -0.6 95% CI -2.31 to 1.11). There was little effect on impairments or functional limitations. A higher proportion of intervention participants ceased attending the exercise program (difference=17.9%, 95% CI 9.6-25.8). Multiple imputation of missing data did not change the results. Modified Sun style tai chi did not have an impact on impairment, functional limitations, or disability in preclinically disabled older people when delivered for 24 weeks. Withdrawal from the exercise classes was high but did not explain the null result. Improved compliance, or a longer or more intensive program, may be required.
Publisher: Elsevier BV
Date: 04-1998
DOI: 10.1111/J.1467-842X.1998.TB01188.X
Abstract: With restricted public sector budgets, there is increasing pressure to obtain value for money in the allocation of health sector resources. Distortions and inefficiencies created by features of Australia's health funding arrangements prevent health resources moving from lower valued to higher valued activities. These distortions tend to restrict resources being allocated to disease prevention and health promotional approaches, favouring medical treatment. These propositions are illustrated, largely with reference to diabetes.
Publisher: Springer London
Date: 10-12-2012
Publisher: Wiley
Date: 16-10-2023
DOI: 10.1002/AJS4.296
Publisher: Public Library of Science (PLoS)
Date: 07-12-2018
Publisher: Wiley
Date: 21-04-2010
DOI: 10.1111/J.1464-5491.2010.02981.X
Abstract: Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely.
Publisher: Wiley
Date: 07-2011
DOI: 10.1002/CAR.1192
Publisher: BMJ
Date: 19-07-2010
Abstract: To model the population level impact of tai-chi on future rates of falls and fall-related injury in older people as a tool for policy development. An epidemiological and economic model for estimating population-level effectiveness of tai-chi. Australia, 2009. Patients or subjects Australian community-dwelling population aged 70+ years, ambulatory and without debilitating conditions or profound visual defects. Intervention Group-based tai-chi, for 1 h twice weekly for 26 weeks, assuming no sustained effect beyond the intervention period. Main outcome measure Total falls and fall-related hospitalisation prevented in 2009. Population-wide tai-chi delivery would prevent an estimated 5440 falls and 109 fall-related hospitalisations, resulting in a 0.18% reduction in the fall-related hospital admission rate for community-dwelling older people. The gross costs per fall and per fall-related hospital admission prevented were $A4414 (€3013) and $A220,712 (€150,684), respectively. A total investment of $A24.01 million (€16.39 million), equivalent to 4.2% of the cost of fall-related episodes of hospital care in 2003/4, would be required to provide tai-chi for 31,998 people and achieve this effect. Substantial investment in, and high population uptake of, tai-chi would be required to have a large effect on falls and fall-related hospitalisation rates. Although not accounted for in this study, investment in tai-chi is likely to be associated with additional significant health benefits beyond falls prevention. This approach could be applied to other interventions to assist selection of the most cost-effective falls-prevention portfolio for Australia and other countries.
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/AH080451
Abstract: This paper explores the economic implications of vouchers for chronic disease management with respect to achieving objectives of equity and efficiency. Vouchers as a payment policy instrument for health care services have a set of properties that suggest they may address both demand-side and supply-side issues, and contribute to equity and efficiency. They provide a means whereby health care services can be targeted at selected groups, enabling consumer choice of provider, and encouraging competition in the supply of health services. This analysis suggests that, when structured appropriately, vouchers can support consumers to choose services that will meet their health care needs and encourage competition among providers. Although they may not be appropriate across the entire health care system, there are features of vouchers that make them a potentially attractive option, especially for the management of chronic disease.
Publisher: Massachusetts Medical Society
Date: 09-10-2008
DOI: 10.1056/NEJMC086357
Publisher: Cambridge University Press (CUP)
Date: 05-09-2012
DOI: 10.1017/S0007114512003704
Abstract: Improving health through better nutrition of the population may contribute to enhanced efficiency and sustainability of healthcare systems. A recent expert meeting investigated in detail a number of methodological aspects related to the discipline of nutrition economics. The role of nutrition in health maintenance and in the prevention of non-communicable diseases is now generally recognised. However, the main scope of those seeking to contain healthcare expenditures tends to focus on the management of existing chronic diseases. Identifying additional relevant dimensions to measure and the context of use will become increasingly important in selecting and developing outcome measurements for nutrition interventions. The translation of nutrition-related research data into public health guidance raises the challenging issue of carrying out more pragmatic trials in many areas where these would generate the most useful evidence for health policy decision-making. Nutrition exemplifies all the types of interventions and policy which need evaluating across the health field. There is a need to start actively engaging key stakeholders in order to collect data and to widen health technology assessment approaches for achieving a policy shift from evidence-based medicine to evidence-based decision-making in the field of nutrition.
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.HEALTHPOL.2009.07.014
Abstract: Population modelling holds considerable promise for identifying the most efficient and cost-effective falls prevention measures, but the outcomes need to be in a readily useable form. This paper describes an iterative, collaborative process undertaken by researchers and falls prevention policy officers to develop such a format for falls prevention intervention evidence. The researchers developed a draft template that underwent several iterations and improvements, through three collaborative consultations with policy officers. Although the researchers initially identified many key information needs, active engagement with policy officers ensured that policy requirements were met and that the value of the reporting formats for policy decision-making was maximised. Importantly, they highlighted the need to articulate underlying modelling assumptions clearly. The resulting formats, with complete data, were given to policy officers to inform their local jurisdictional policy decisions. There is strong benefit in researchers and policy officers collaborating to develop optimal formats for presenting scientific evidence to inform policy decisions. Such a process can reduce concerns of researchers that evidence is not incorporated into policy decisions. They also meet policy officers' needs for evidence to be provided in a way that can directly inform their decision-making processes.
Publisher: Springer Science and Business Media LLC
Date: 03-08-2010
Abstract: Preventing disability and offering effective interventions to older people during early decline in function is most likely to be effective if those most at risk of progressive disablement are able to be identified. Similarly the ability to easily identify a group with similar functional profile from disparate sectors of the community is of significant benefit to researchers. This study aimed to (1) describe the use of a pre-clinical disability screening tool to select a functionally comparable group of older men and women with early functional limitation from different settings, and (2) explore factors associated with function and disability. Self-reported function and disability measured with the Late-Life Function and Disability Instrument along with a range of physical performance measurements were compared across residential settings and gender in a s le of 471 trial participants identified as pre-clinically disabled after being screened with the Fried pre-clinical disability tool. Factors that might lie on the pathway to progressive disablement were identified using multiple linear regression analysis. We found that a s le population, screened for pre-clinical disability, had a functional status and disability profile reflecting early functional limitation, regardless of residential setting or gender. Statistical models identified a range of factors associated with function and disability which explained a greater degree of the variation in function, than disability. We selected a group of people with a comparable function and disability profile, consistent with the pre-clinical stage of disability, from a s le of older Australian men and women from different residential settings using the Fried pre-clinical disability screening tool. The results suggest that the screening tool can be used with greater confidence for research, clinical and population health purposes. Further research is required to examine the validity of the tool. These findings offer insight into the type of impairment factors characterising early functional loss that could be addressed through disability prevention initiatives. ACTRN01206000431527
Publisher: Springer Science and Business Media LLC
Date: 18-06-2009
Publisher: SAGE Publications
Date: 13-03-2020
Abstract: Greater school absenteeism is associated with numerous negative educational outcomes. We used a retrospective cohort design with linked administrative data on 296,422 children to examine the relationship between school absenteeism and child protection system (CPS) involvement. Children with substantiated maltreatment had 4.1 times more unexplained and problem absences than children with no CPS involvement. In multivariate analyses, children with substantiated maltreatment had significantly greater “chronic” truancy ( OR = 3.41) and less “acceptable” levels of absences ( OR = 0.74) compared to children with no CPS involvement. Greater absenteeism was seen for children with substantiated neglect and who had their first CPS notification earlier in life. Being in out-of-home care for 3+ years was a protective factor for children who had a CPS notification before age 5. Additional adversities had a strong additive effect with CPS involvement on absenteeism and chronic truancy. This study demonstrates the potential scope for reducing problem absenteeism and helps inform the public debate regarding how the type and timing of CPS involvement might ameliorate or exacerbate harm for children.
Publisher: Springer Science and Business Media LLC
Date: 06-08-2011
Publisher: Oxford University Press (OUP)
Date: 1998
Publisher: Wiley
Date: 04-2010
DOI: 10.1002/HEC.1483
Abstract: Given resource scarcity, not all potentially beneficial health services can be funded. Choices are made, if not explicitly, implicitly as some health services are funded and others are not. But what are the primary influences on those choices? We sought to test whether funding decisions are linked to cost effectiveness and to quantify the influence of funding arrangements and community values arguments. We tested this via empirical analysis of 245 Australian health-care interventions for which cost-effectiveness estimates had been published. The likelihood of government funding was modelled as a function of cost effectiveness, patient/target group characteristics, intervention characteristics and publication characteristics, using multiple regression analysis. We found that higher cost effectiveness ratios were a significant predictor of funding rejection, but that cost effectiveness was not related to the level of funding. Intervention characteristics linked to funding and delivery arrangements and community values arguments were significant predictors of funding outcomes. Our analysis supports the hypothesis that funding and delivery arrangements influence both whether an intervention is funded and funding level even after controlling for community values and cost effectiveness. It suggests that adopting partial priority setting processes without regard to opportunity cost can have the perverse effect of compounding allocative inefficiencies.
Publisher: Wiley
Date: 03-2012
Publisher: Elsevier BV
Date: 09-2012
Publisher: Springer Science and Business Media LLC
Date: 17-04-2009
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.CHIABU.2019.104145
Abstract: Child protection services exist to reduce potential harms from child maltreatment. Many jurisdictions produce annual data on child protection system (CPS) involvement, leaving a gap in knowledge of lifetime involvement. To describe lifetime involvement in CPS, by type of contact. All 608,547 children born in South Australia (SA), Australia between 1986 and 2017. A retrospective cohort design using linked administrative data to report cumulative incidence of CPS involvement from birth to age <18 (or June30 2017) by Aboriginal status. CPS involvement was categorised into notifications (3 levels), investigations, substantiations and out-of-home care (OOHC). Cumulative incidence curves were derived for 5 birth cohorts. Across childhood (to age <18 years), substantiated maltreatment was experienced by 3.2-3.6% of non-Aboriginal and 19-25% of Aboriginal children, 7 times reported annual substantiation rates. For most CPS categories CPS involvement increased until 2010, and was occurring earlier in life. By age 3, 0.5% of non-Aboriginal and 4.5% of Aboriginal children born 1986-1991 were the subject of a substantiation compared with 1.9% and 15% of non-Aboriginal and Aboriginal children, respectively, born 2010-2017. Incidence rates beyond age 3 were similar. OOHC contact was similar across cohorts, with ˜1.5% of non-Aboriginal and 12.7% of Aboriginal children ever-placed in care. Data linkage is an essential tool for understanding life course involvement with the CPS and describing trends not observable from annual snapshots. Such information is critical for burden of disease estimates, informing policy and monitoring CPS performance.
Publisher: Informa UK Limited
Date: 17-08-2017
Publisher: Springer Science and Business Media LLC
Date: 03-07-2012
Publisher: Oxford University Press (OUP)
Date: 1998
Publisher: Informa UK Limited
Date: 10-2011
DOI: 10.1080/15299732.2011.593259
Abstract: Treatment options are limited for families in which the child has severe and intractable disturbances of emotion and behavior, in which there is suspected or confirmed maltreatment by the mother, and in which the mother has her own history of childhood neglect and abuse. This paper proposes a model for understanding maltreatment in mother-child dyads, drawing upon the developmental psychopathology, behavior, and trauma literatures. At the core of this model is the hypothesis that a mother's maltreating behavior arises from unconscious attempts to experientially avoid the reemergence of an attachment-related dissociative part of the personality that contains the distress arising from her own early experiences of attachment relationships. The implications of this model for therapy are considered.
Publisher: SPIE-Intl Soc Optical Eng
Date: 28-10-2022
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.MIDW.2018.06.019
Abstract: The Australian Nurse-Family Partnership Program is a home visiting program for Aboriginal mothers and infants (pregnancy to child's second birthday) adapted from the US Nurse Family Partnership program. It aims to improve outcomes for Australian Aboriginal mothers and babies, and disrupt intergenerational cycles of poor health and social and economic disadvantage. The aim of this study was to describe the complexity of Program clients in the Central Australian family partnership program, understand how client complexity affects program delivery and the implications for desirable program modification. Australian Nurse-Family Partnership Program data collected using standardised data forms by nurses during pregnancy home visits (n = 276 clients from 2009 to 2015) were used to describe client complexity and adversity in relation to demographic and economic characteristics, mental health and personal safety. Semi-structured interviews with 11 Australian Nurse-Family Partnership Program staff and key stakeholders explored in more depth the nature of client adversity and how this affected Program delivery. Most clients were described as "complicated" being exposed to extreme poverty (66% on welfare), living with insecure housing, many experiencing domestic violence (almost one third experiencing 2 + episodes of violence in 12 months). Sixty-six percent of clients had experienced four or more adversities. These adversities were found challenging for Program delivery. For ex le, housing conditions mean that around half of all 'home visits' could not be conducted in the home (held instead in staff cars or community locations) and together with exposure to violence undermined client capacity to translate program learnings into action. Crises with the basics of living regularly intruded into the delivery of program content, and low client literacy meant written hand-outs were unhelpful for many, requiring the development of pictorial-based program materials. Adversity increased the time needed to deliver program content. Modifications to the Australian Nurse-Family Partnership Program model to reflect the specific complexities and adversities faced by the client populations is important for effective service delivery and to maximise the chance of meeting program goals of improving the health and well-being of Australian Aboriginal mothers and their infants.
Publisher: Springer Science and Business Media LLC
Date: 18-06-2008
Publisher: Cambridge University Press (CUP)
Date: 17-09-2009
DOI: 10.1017/S1368980009991418
Abstract: To provide input to Australian and New Zealand government decision making regarding an optimal strategy to reduce the rate of neural tube defects (NTD). Standard comparative health economic evaluation techniques were employed for a set of intervention options for promoting folate/folic acid consumption in women capable of or planning a pregnancy. Evidence of effectiveness was informed by the international literature and costs were derived for Australia and New Zealand. Population-wide c aigns to promote supplement use and mandatory fortification were the most effective at reducing NTD, at an estimated 36 and 31 fewer cases per annum respectively for Australia and New Zealand, representing an 8 % reduction in the current annual NTD rate. Population-wide and targeted approaches to increase supplement use were cost-effective, at less than $AU 12 500 per disability-adjusted life year (DALY) averted ($US 9893, £5074), as was extending voluntary fortification. Mandatory fortification was not cost-effective for New Zealand at $AU 138 500 per DALY ($US 109 609, £56 216), with results uncertain for Australia, given widely varying cost estimates. Promoting a folate-rich diet was least cost-effective, with benefits restricted to impact on NTD. Several options for reducing NTD appear to fall well within accepted societal cost-effectiveness norms. All estimates are subject to considerable uncertainty, exacerbated by possible interactions between interventions, including impacts on currently effective strategies. The Australian and New Zealand governments have decided to proceed with mandatory fortification it is hoped they will support a rigorous evaluation which will contribute to the evidence base.
Publisher: Springer Science and Business Media LLC
Date: 30-09-2008
DOI: 10.1007/S11136-008-9395-5
Abstract: Utility scores for use in cost-utility analysis may be imputed from the SF-36 health instrument using various techniques, typically regression analysis. This paper explored imputation using partial credit Rasch analysis. Data from the Assessment of Quality of Life (AQoL) instrument validation study were re-analysed (n = 996 inpatients, outpatients and a community s le). For each AQoL item, factor analysis identified those SF-36 items forming a unidimensional scale. Rasch analysis located scale logit scores for these SF-36 items. The logit scores were used to assign AQoL item scores. The standard AQoL scoring algorithm was then applied to obtain the utility scores. Many SF-36 items were limited predictors of AQoL items some items from both instruments obtained disordered thresholds. All imputed scores were consistent with the AQoL model and fell within AQoL score boundaries. The explained variance between imputed and true AQoL scores was 61%. Rasch-imputed mapping, unlike many regression-based algorithms, produced results consistent with the axioms of utility measurement, while the proportion of explained variance was similar to regression-based modelling. Item properties on both instruments implied that some items should be revised using Rasch analysis. The methods and results may be used by researchers needing to impute utility scores from SF-36 health scores.
Publisher: Springer Science and Business Media LLC
Date: 1994
DOI: 10.2165/00019053-199400051-00009
Abstract: Obesity is a known risk factor for a number of diseases with serious mortality and morbidity implications. Thus, obesity is an economic burden to communities, since it reduces quality of life and leads to premature mortality in addition, healthcare resources are used to manage obesity-related disease. It was estimated that in 1989, management of disease due to obesity (defined as body mass index greater than 30) cost A$395 million. This estimate covers the healthcare costs for the management of obesity, non-insulin-dependent diabetes mellitus (NIDDM), gallstones, hypertension, coronary heart disease (CHD), breast cancer (among postmenopausal women), and colon cancer. As this estimate excludes the costs of some disease attributable to obesity, it is an underestimate of the true costs. Nonetheless, the estimated cost of the management of obesity-related conditions represents 86% of the healthcare costs used for the management of alcohol-related diseases in Australia. Healthcare costs attributable to obesity have not yet been estimated for countries elsewhere in Asia and the Pacific. However, it is acknowledged that obesity is a major problem in the Pacific, with exceptionally high prevalence rates and concomitant high rates of diseases for which obesity is a major risk factor, particularly NIDDM and CHD. It would, therefore, be useful to explore the cost of disease attributable to obesity in healthcare systems in these communities, and the potential for preventive programmes to reduce these costs.
Publisher: Springer Science and Business Media LLC
Date: 07-05-2009
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 09-2007
DOI: 10.1111/J.1524-4733.2007.00194.X
Abstract: Algorithms for mapping descriptive measures of health status into preference-based measures are now widely available and their application in economic evaluation is increasingly commonplace. Existing algorithms make use of scale, subscale, or item scores on descriptive measures. Item-based algorithms entail fewer restrictions than their scale or subscale-based equivalents but are subject to problems in estimation and application. The objective of the present study is to quantify any loss of predictive validity associated with using subscale or scale scores (rather than item scores) to derive conversion algorithms. Multiple linear regression methods to derive item-based, subscale-based, and scale-based algorithms for mapping SF-36 data into Assessment of Quality of Life (AQoL) utility scores in a stratified s le of persons aged more than 16 years and resident in Victoria, Australia. The theoretical consistency and predictive validity of competing algorithms is evaluated against criteria reflecting the intended use of predicted utility scores. Three mappings were suitable for between-group comparisons. There was no discernible increase in error associated with a move from the item-based mapping to either the subscale- or scale-based mapping. Our results do not support the hypothesis that fewer restrictions on functional form necessarily result in a lower magnitude of error when predicting between-group differences. Rather, it appears that the subscale-based mapping offers a good compromise--requiring fewer restrictions on the form of the relationship between SF-36 responses and the AQoL utility score than the scale-based mapping and permitting a more efficient use of SF-36 data than the item-based mapping.
Publisher: Wiley
Date: 11-05-2020
DOI: 10.1002/AUR.2296
Publisher: Wiley
Date: 2013
DOI: 10.1111/J.1445-5994.2012.02930.X
Abstract: Recently, the dual-energy X-ray absorptiometry (DXA) diagnostic cut-off (T-score) for Australian Pharmaceutical Benefits Scheme (PBS) supported primary fracture prevention therapy with alendronate for older women (>70 years) has been changed from -3.0 to -2.5. To examine the impact of the expanded criteria for PBS-supported fracture prevention therapy in older women on case finding and cost. One thousand, nine hundred and eighty-three women, median age 76 years, not previously known to have low bone mineral density by DXA or a vertebral fracture underwent DXA scanning and a thoracolumbar X-ray. A woman was considered eligible for fracture prevention therapy if she had a T-score ≤-2.5 at the femoral neck and/or the lumbar vertebrae (two to four) or at least one vertebral fracture of ≥20% deformity. Seven hundred and forty-six women (37.6%) met the new criteria as a case for PBS-subsidised fracture prevention therapy. Four hundred and thirty-one (21.7%) had a T-score ≤-2.5 on DXA compared with 10.6% (n = 210) with a T-score ≤-3.0. Four hundred and eighty-three (24.4%) had at least one vertebral fracture. Only 8.5% (n = 168) had both a T-score ≤-2.5 and a prevalent vertebral fracture. The cost per case found by DXA equated to $460 compared with $398 for screening by thoracolumbar X-ray. The use of either DXA or X-ray will identify approximately two-thirds of women aged 70 years and over who would be eligible for fracture prevention. The use of X-ray would identify a marginally larger number of women and at lower financial cost but involve substantially greater radiation exposure.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1111/J.1753-6405.2012.00870.X
Abstract: To describe the pattern of dairy consumption in Australians aged 12 years and over, and assess the extent to which the population meets national recommendations. We developed a new method of combining quantitative data from a 24-hour dietary recall questionnaire with semiquantitative data from a food frequency questionnaire (FFQ), to investigate the usual patterns of dairy consumption. We applied this technique to data from the 9,096 Australians aged 12 and over who completed the FFQ part of the most recent nationally representative nutrition study - the 1995 National Nutrition Survey. When weighted according to the characteristics of the Australian population, 58% of male and 73% of female FFQ respondents failed to regularly meet recommendations for consumption of dairy products. While mean dairy consumption was higher in adolescents, 62% of boys and 83% of girls failed to meet their higher recommendation of three serves per day. Breastfeeding women appeared to consume more dairy but 60% consumed less than two serves per day. Given accumulating evidence of protective effects of dairy foods for a range of metabolic and cardiovascular disorders, our observations warrant a focus on the development of cost-effective public health interventions to increase dairy consumption.
Publisher: Wiley
Date: 26-10-2022
DOI: 10.1111/PLB.13474
Abstract: Leaf stoichiometry can characterize plant ecological strategies and correlate with plant responses to climate change. The role of vascular epiphytes in the ecosystem processes of tropical and subtropical forest ecosystems cannot be ignored. Vascular epiphytes are very vulnerable to climate change, however, the relationship between the response of epiphytes to climate change and leaf stoichiometry is not well understood. We present data for 19 vascular epiphyte species that were collected during four consecutive censuses (in 2005, 2010, 2015, and 2020) over 15 years in a subtropical montane cloud forest. We assessed the relationships between the population dynamics and leaf stoichiometry of these vascular epiphytes. Experiencing an extreme drought, 14 of the 19 epiphyte species showed an obvious decrease in the number of in iduals, and all species showed negative growth in the number of populations. Subsequently, the total number of in iduals gradually recovered, increasing from 7,195 in 2010 to 10,121 in 2015, then to 13,667 in 2020. The increase in the number of vascular epiphyte in iduals from 2010 to 2015 was significantly negatively correlated with leaf nitrogen and phosphorus concentration, and was significantly positively correlated with the leaf carbon-nitrogen ratio. Vascular epiphyte populations with higher leaf nutrient concentrations exhibited weaker resilience to the extreme drought, which demonstrated that a resource-conservative strategy was advantageous for the recovery of epiphyte populations. Our findings suggest that ecological stoichiometry can be a useful framework for forecasting the dynamics of vascular epiphyte populations in response to climate change.
Publisher: Cambridge University Press (CUP)
Date: 23-01-2013
DOI: 10.1017/S0007114512005107
Abstract: Non-communicable diseases (NCD) are a major and increasing contributor to morbidity and mortality in developed and developing countries. Much of the chronic disease burden is preventable through modification of lifestyle behaviours, and increased attention is being focused on identifying and implementing effective preventative health strategies. Nutrition has been identified as a major modifiable determinant of NCD. The recent merging of health economics and nutritional sciences to form the nascent discipline of nutrition economics aims to assess the impact of diet on health and disease prevention, and to evaluate options for changing dietary choices, while incorporating an understanding of the immediate impacts and downstream consequences. In short, nutrition economics allows for generation of policy-relevant evidence, and as such the discipline is a crucial partner in achieving better population nutritional status and improvements in public health and wellness. The objective of the present paper is to summarise presentations made at a satellite symposium held during the 11th European Nutrition Conference, 28 October 2011, where the role of nutrition and its potential to reduce the public health burden through alleviating undernutrition and nutrition deficiencies, promoting better-quality diets and incorporating a role for functional foods were discussed.
Publisher: Wiley
Date: 09-07-2007
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH12186
Abstract: This paper provides an analysis of the national Indigenous reform strategy – known as Closing the Gap – in the context of broader health system reforms underway to assess whether current attempts at addressing Indigenous disadvantage are likely to be successful. Drawing upon economic theory and empirical evidence, the paper analyses key structural features necessary for securing system performance gains capable of reducing health disparities. Conceptual and empirical attention is given to the features of comprehensive primary healthcare, which encompasses the social determinants impacting on Indigenous health. An important structural prerequisite for securing genuine improvements in health outcomes is the unifying of all funding and policy responsibilities for comprehensive primary healthcare for Indigenous Australians within a single jurisdictional framework. This would provide the basis for implementing several key mutually reinforcing components necessary for enhancing primary healthcare system performance. The announcement to introduce a long-term health equality plan in partnership with Aboriginal people represents a promising development and may provide the window of opportunity needed for implementing structural reforms to primary healthcare. What is known about the topic? Notwithstanding the intention of previous policies, considerable health disparity exists between Indigenous and non-Indigenous Australians. Australia has now embarked on its most ambitious national Indigenous health reform strategy, but there has been little academic analysis of whether such reforms are capable of eliminating health disadvantage for Aboriginal people. What does the paper add? This paper provides a critical analysis of Indigenous health reforms to assess whether such policy initiatives are likely to be successful and outlines key structural changes to primary healthcare system arrangements that are necessary to secure genuine system performance gains and improve health outcomes for Indigenous Australians. What are the implications for practitioners? For policymakers, the need to establish genuine partnership and engagement between Aboriginal people and the Australian government in pursuing a national Indigenous reform agenda is of critical importance. The establishment of the National Congress of Australia’s First Peoples provides the opportunity for policymakers to give special status to Indigenous Australians in health policy development and create the institutional breakthrough necessary for effecting primary healthcare system change.
Publisher: Springer Science and Business Media LLC
Date: 27-03-2007
Publisher: American Diabetes Association
Date: 12-06-2013
DOI: 10.2337/DC12-1793
Abstract: Best-practice diabetes care can reduce the burden of diabetes and associated health care costs. But this requires access to a multidisciplinary team with the right skill mix. We applied a needs-driven evidence-based health workforce model to describe the primary care team required to support best-practice diabetes care, paying particular attention to erse clinic populations. Care protocols, by number and duration of consultations, were derived for twenty distinct competencies based on clinical practice guidelines and structured input from a multidisciplinary clinical panel. This was combined with a previously estimated population profile of persons across 26 patient attributes (i.e., type of diabetes, complications, and threats to self-care) to estimate clinician contact hours by competency required to deliver best-practice care in the study region. A primary care team of 22.1 full-time-equivalent (FTE) positions was needed to deliver best-practice primary care to a catchment of 1,000 persons with diabetes with the attributes of the Australian population. Competencies requiring greatest contact time were psychosocial issues and dietary advice at 3.5 and 3.3 FTE, respectively (1 FTE/∼300 persons) home (district) nursing at 3.2 FTE and diabetes education at 2.8 FTE. The annual cost of delivering care was estimated at just over 2,000 Australian dollars (∼2,090 USD) (2012) per person with diabetes. A needs-driven approach to primary care service planning identified a wider range of competencies in the diabetes primary and community care team than typically described. Access to psychosocial competences as well as medical management is required if clinical targets are to be met, especially in disadvantaged groups.
Publisher: Informa UK Limited
Date: 03-2013
Publisher: Elsevier BV
Date: 04-1997
DOI: 10.1016/S0140-6736(05)62334-3
Abstract: To investigate the effect of the ratio of the medial tibial plateau width to the total tibial plateau width on the therapeutic efficacy of high tibial osteotomy (HTO) on the medial side for the treatment of knee osteoarthritis. In this study, we retrospectively analyzed information of 278 patients who underwent medial HTO for knee osteoarthritis with varus deformity. The Tinetti Gait and Balance Assessment Tool, the Visual Analog Scale (VAS), and the Knee Society Scoring System (KSS) were used to comprehensively evaluate the function of the knee joint after HTO. After adjusting for potential confounding factors (i.e., age, gender, body mass index/BMI, and surgical site), the Tinetti assessment score was optimized when the degree of correction was 53.67%, with the β-value on the left and right sides of the inflection point of 0.49 (confidence interval, CI: 0.20, 0.78, P = 0.0009) and- 0.26 (95% CI: - 0.30, - 0.22, P < 0.0001), respectively. The KSS score was optimized when the degree of correction was 55.45%, with the β-value on the left and right sides of the inflection point of 2.77 (95% CI: 1.64, 3.90, P < 0.0001) and - 1.18 (95% CI: - 1.46, - 0.91, P < 0.0001), respectively. The VAS score was the lowest when the degree of correction was 55.00%, with the β-value on the left and right sides of the inflection point of - 0.16 (95% CI: - 0.29, - 0.03, P = 0.0146) and 0.08 (95% CI: 0.05, 0.10, P 28, the Tinetti assessment score showed a negative trend. The degree of lower-limb mechanical axis correction correlated with the functional status of the knee joint after MOW HTO. When the ratio of the medial tibial plateau width to the total tibial plateau width was approximately 55%, the post-MOW HTO outcomes were optimized and the patients experienced the highest satisfaction. In addition, very high BMI was not conducive for the postoperative recovery of the knee joint function. III Case-control study/Retrospective comparative study.
Publisher: Informa UK Limited
Date: 07-12-2017
Publisher: SAGE Publications
Date: 24-11-2011
DOI: 10.1111/J.1747-4949.2011.00686.X
Abstract: There is strong evidence for a dose–response relationship between physical therapy early after stroke and recovery of function. The optimal method of maximizing physical therapy within finite health care resources is unknown. To determine the effectiveness and cost-effectiveness of two alternative models of physical therapy service delivery (seven-days per week therapy services or group circuit class therapy over five-days a week) to usual care for people receiving inpatient rehabilitation after stroke. Multicenter, three-armed randomized controlled trial with blinded assessment of outcomes. A total of 282 people admitted to inpatient rehabilitation facilities after stroke with an admission functional independence measure (FIM) score within the moderate range (total 40–80 points or motor 38–62 points) will be randomized to receive one of three interventions: • usual care therapy over five-days a week • standard care therapy over seven-days a week, or • group circuit class therapy over five-days a week. Participants will receive the allocated intervention for the length of their hospital stay. Analysis will be by intention-to-treat. The primary outcome measure is walking ability (six-minute walk test) at four-week postintervention with three- and six-month follow-up. Economic analysis will include a costing analysis based on length of hospital stay and staffing/resource costs and a cost-utility analysis (incremental quality of life per incremental cost, relative to usual care). Secondary outcomes include walking speed and independence, ability to perform activities of daily living, arm function, quality of life and participant satisfaction.
Publisher: Springer Science and Business Media LLC
Date: 08-03-2013
Publisher: Informa UK Limited
Date: 20-12-2020
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1111/J.1753-6405.2010.00622.X
Abstract: A strong primary care sector is widely acknowledged as a fundamental component of a well functioning health system and thus has been the focus of strategic reforms in a number of countries. This paper provides an economic analysis of primary healthcare reform, with the aim of identifying the key structural elements that are necessary to support enhanced models of primary health in the Australian context. This paper utilises economic theory, and draws upon empirical evidence and international experience to analyse primary healthcare reform to identify the structural elements necessary for an enhanced primary care sector. The aim of which is to improve health system performance. These structural elements are then critically examined in the Australian health system setting. For enhanced models of primary healthcare to promote efficiency, they must incorporate a number of key structural elements notably: governance and purchasing responsibilities for primary care devolved to a meso-level organisational structure through capitated single fundholding arrangements blended payment methods for reimbursing providers the establishment of a national quality and performance framework and the development of primary care infrastructure. As the Federal government attempts to address recommendations of the National Health and Hospital Reform Commission, a window of opportunity now exists to pursue long overdue structural reforms to deal with the challenges facing the Australian health system. The paper advances the important structural features to primary healthcare that need to be embraced as the government attempts to pursue its health reform agenda.
Publisher: BMJ
Date: 04-07-2012
DOI: 10.1136/ARCHDISCHILD-2011-300795
Abstract: There is a body of published research on the effectiveness of home visiting for the prevention of child maltreatment, but little in the peer reviewed literature on cost-effectiveness or value to society. The authors sought to determine the cost-effectiveness of alternative home visiting programmes to inform policy. All trials reporting child maltreatment outcomes were identified through systematic review. Information on programme effectiveness and components were taken from identified studies, to which 2010 Australian unit costs were applied. Lifetime cost offsets associated with maltreatment were derived from a recent Australian study. Cost-effectiveness results were estimated as programme cost per case of maltreatment prevented and net benefit estimated by incorporating downstream cost savings. Sensitivity analyses were conducted. 33 home visiting programmes were evaluated and cost-effectiveness estimates derived for the 25 programmes not dominated. The incremental cost of home visiting compared to usual care ranged from A$1800 to A$30 000 (US$1800-US$30 000) per family. Cost-effectiveness estimates ranged from A$22 000 per case of maltreatment prevented to several million. Seven of the 22 programmes (32%) of at least adequate quality were cost saving when including lifetime cost offsets. There is great variation in the cost-effectiveness of home visiting programmes for the prevention of maltreatment. The most cost-effective programmes use professional home visitors in a multi-disciplinary team, target high risk populations and include more than just home visiting. Home visiting programmes must be carefully selected and well targeted if net social benefits are to be realised.
Publisher: Springer Science and Business Media LLC
Date: 03-07-2021
DOI: 10.1007/S10802-021-00838-5
Abstract: Child temperament and caregiver psychological distress have been independently associated with social-emotional difficulties among in iduals with autism. However, the interrelationship among these risk factors has rarely been investigated. We explored the reciprocal interplay between child temperament (surgency, negative affectivity, and self-regulation) and caregiver psychological distress in the development of child internalizing and externalizing symptoms, in a cohort of 103 infants showing early autism traits. Caregivers completed questionnaires when children were aged around 12-months (Time 1 [T1]), 18-months (Time 2 [T2]), and 24-months (Time 3 [T3]). Cross-lagged path models revealed a significant pathway from T1 caregiver psychological distress through lower T2 child self-regulation to subsequently greater T3 child internalizing symptoms. No such caregiver-driven pathway was evident through T2 child negative affectivity or in the prediction of T3 child externalizing symptoms. Further, no support was found for temperament-driven pathways through caregiver psychological distress to child social-emotional difficulties. Child surgency was mostly unrelated to caregiver psychological distress and social-emotional difficulties. These findings implicate the need to support the mental health of caregivers with an infant with autism traits in order to enhance the emotion regulation and social-emotional development of their infants.
Publisher: Elsevier BV
Date: 04-1998
DOI: 10.1016/S0168-8510(98)00007-4
Abstract: Health system reform is on the agenda in Australia, across Europe and North America and elsewhere. Reform is being driven by attempts to meet ever increasing health service demands in the face of cost containment pressures. There is little agreement concerning the preferred features of health funding models. A micro-economic framework is used to define universal performance characteristics for optimal health funding arrangements. Two principle requirements emerge. These are (1) demand side reform to empower consumers and (2) supply side reform, to promote opportunities and incentives for a responsive service system and competition amongst providers. A focus on supply side issues only, without recognition of the fundamental importance of consumer empowerment will fail to promote an efficient solution to the distribution of health resources. Mechanisms to promote active consumer involvement in health care decisions are identified as a central requirement in health system reform.
Publisher: Springer Science and Business Media LLC
Date: 10-04-2012
Publisher: Elsevier BV
Date: 2012
Publisher: Springer Science and Business Media LLC
Date: 19-09-2011
Publisher: SAGE Publications
Date: 19-07-2008
Abstract: Background . Algorithms for converting descriptive measures of health status into quality-adjusted life year (QALY)—weights are now widely available, and their application in economic evaluation is increasingly commonplace. The objective of this study is to describe and compare existing conversion algorithms and to highlight issues bearing on the derivation and interpretation of the QALY-weights so obtained. Methods . Systematic review of algorithms for converting descriptive measures of health status into QALY-weights. Results . The review identified a substantial body of literature comprising 46 derivation studies and 16 studies that provided evidence or commentary on the validity of conversion algorithms. Conversion algorithms were derived using 1 of 4 techniques: 1) transfer to utility regression, 2) response mapping, 3) effect size translation, and 4) “revaluing” outcome measures using preference-based scaling techniques. Although these techniques differ in their methodological/theoretical tradition, data requirements, and ease of derivation and application, the available evidence suggests that the sensitivity and validity of derived QALY-weights may be more dependent on the coverage and sensitivity of measures and the disease area atient group under evaluation than on the technique used in derivation. Conclusions . Despite the recent proliferation of conversion algorithms, a number of questions bearing on the derivation and interpretation of derived QALY-weights remain unresolved. These unresolved issues suggest directions for future research in this area. In the meantime, analysts seeking guidance in selecting derived QALY-weights should consider the validity and feasibility of each conversion algorithm in the disease area and patient group under evaluation rather than restricting their choice to weights from a particular derivation technique.
Publisher: Wiley
Date: 12-2010
No related grants have been discovered for Leonie Segal.