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We used a retrospective cohort study to measure the impact of caring for children on female Australian researchers. Our aim was to see whether caring for children was associated with reduced outputs and collaboration. Women were randomly selected for inclusion if they published a first author paper in one of three Australian journals during 2007 to 2015, women who did not publish during this time were not included. One-hundred and sixty women were approached and 95 (59%) completed a survey on their history of caring for children. Two key outcomes were the women's publication and citation counts, which were accessed from Scopus. We also examined the number of authors, affiliations and countries on their published papers, as a reduction in these numbers could indicate an impaired ability to collaborate. We examined the probability of being first or last author as a measure of esteem. There was a small increase in publication counts after the first child that was reversed after the second child. Average citations counts declined after children, particularly after the second child. There was some evidence of a reduced collaboration with overseas collaborators after the first child. The probability of being the last author increased after the second child. Three women were identified as statistically influential and all three had children and were in the top 10% of overall publications and citations. After removing these women the estimated changes in outcomes were noticeably different for most of the outcomes. The repeated presence of statistically influential women shows that it may be impossible to find an "average impact" of caring for children when considering research output. Adjustments may need to be made individually, with women explaining how caring for children has altered their career. [ABSTRACT FROM AUTHOR]

This paper reports the impact of a major life event–death–on the physical, psychological and social well-being of the deceased’s close friends. We utilised data from a large longitudinal survey covering a period of 14 years (2002–2015) consisting a cohort of 26,515 individuals in Australia, of whom 9,586 had experienced the death of at least one close friend. This longitudinal cohort dataset comprises responses to the SF-36 (health related quality of life measure) and allowed for analysis of the short and longer-term impacts of bereavement. In order to manage the heterogeneity of the socio-demographics of respondents who did/not experience a death event, we use a new and robust approach known as the Entropy Balancing method to construct a set of weights applied to the bereaved group and the control group (the group that did not experience death). This approach enables us to match the two groups so that the distribution of socio-demographic variables between the two groups are balanced. These variables included gender, age, marital status, ethnicity, personality traits, religion, relative socio-economic disadvantage, economic resources, and education and occupation and where they resided. The data show, for the first time, a range of negative and enduring consequences experienced by people following the death of a close friend. Significant adverse physical and psychological well-being, poorer mental health and social functioning occur up to four years following bereavement. Bereaved females experienced a sharper fall in vitality, suffered greater deterioration in mental health, impaired emotional and social functioning than the male counterparts up to four years after the death. The data show that the level of social connectedness plays an important role in bereavement outcomes. Specifically, we found that less socially active respondents experienced a longer deterioration in physical and psychological health. Finally, we found evidence that the death of a close friend lowered the respondent’s satisfaction with their health. Since death of friends is a universal phenomenon, we conclude the paper by reflecting on the need to recognise the death of a close friend as a substantial experience, and to offer support and services to address this disenfranchised grief. Recognising bereaved friends as a group experiencing adverse outcomes can be used internationally to prompt health and psychological services to assist this specific group, noting that there may be substantial longevity to the negative sequelae of the death of a friend. Facilitating bereaved people’s support networks may be a fruitful approach to minimising these negative outcomes. [ABSTRACT FROM AUTHOR]

This paper estimates the cost-effectiveness of a 20% price discount on healthy food and beverages with and without consumer nutrition education, as trialled in remote Northern Australia. Changes in actual store sales, from the pre-discount baseline period, were analysed for population impact on consumption of fruit and vegetables, water and artificially sweetened soft drinks, in addition with total dietary weight (grams), energy (Mega Joules), and sodium (milligrams). Disability Adjusted Life Years (DALYs), arising from changes in dietary risk factor prevalence in the population, were estimated as the primary health outcome in a multi health-state Markov model. The costs of the strategies were sourced from paid invoices and time estimates of staff providing store-based discount promotion and consumer education. The incremental cost-effectiveness ratio adopted a partial societal perspective, (including health and retail sector costs), as cost per DALY averted and was presented in 2011 Australian dollars. The price discount, helped address a gap in food price equity for residents of remote communities. However, the discount strategy, with or without consumer education led to a net loss of population health –36 95%CI (-47,-25) or -21(-28, -15) DALYs respectively, at increased cost to the retail and health sectors, of AUD860000 95%CI (710000, 1million) or AUD500000 (410000, 590000). The strategies trialled were thereby categorised as dominated by current practice while acknowledging considerable uncertainty surrounding the health outcome estimates. The 20% discount on limited targeted products appeared to need to be considered in conjunction with other marketing strategies to support healthy food choices, if remote Australian Indigenous population health is to be improved. [ABSTRACT FROM AUTHOR]

Risk exposures and predictions of child development outcomes typically estimate the independent effects of individual exposures. As a rule though, children are not exposed piecemeal to individual or single risks but, rather, they are exposed to clusters of risk. Many of these clusters of risks are better thought of as comprising a developmental “circumstance” with a substantial duration, over which period, additional risk exposures also accumulate. In this paper we examined the distribution of 16 single risk exposures for low language ability using latent class analysis across a sample of approximately 4000 children from the Longitudinal Study of Australian Children. The best fitting model identified six distinct classes. 46% of children were in a Developmentally Enabled group, 20% were in a group typified as Working Poor families, 10% of children were in group typified as Overwhelmed group, 9% of children were in a group defined by Child Developmental Delay, 8% of children were in a group defined by Low Human Capital, and 7% of children were in a group defined by Resource Poor non-English Speaking background families. These groups had quantitatively and qualitatively distinct patterns of risk factors and showed different onward trajectories of receptive vocabulary. Our results demonstrate a range of multiple risk profiles in a population-representative sample of Australian children and highlight the mix of risk factors faced by children. Children with distinct patterns of risk factors have different onward trajectories of receptive vocabulary development. [ABSTRACT FROM AUTHOR]

In recent years policy makers and social scientists have devoted considerable attention to wellbeing, a concept that refers to people’s capacity to live healthy, creative and fulfilling lives. Two conceptual approaches dominate wellbeing research. The objective approach examines the objective components of a good life. The subjective approach examines people’s subjective evaluations of their lives. In the objective approach how subjective wellbeing relates to objective wellbeing is not a relevant research question. The subjective approach does investigate how objective wellbeing relates to subjective wellbeing, but has focused primarily on one objective wellbeing indicator, income, rather than the comprehensive indicator set implied by the objective approach. This paper attempts to contribute by examining relationships between a comprehensive set of objective wellbeing measures and subjective wellbeing, and by linking wellbeing research to inequality research by also investigating how subjective and objective wellbeing relate to class, gender, age and ethnicity. We use three waves of a representative state-level household panel study from Queensland, Australia, undertaken from 2008 to 2010, to investigate how objective measures of wellbeing are socially distributed by gender, class, age, and ethnicity. We also examine relationships between objective wellbeing and overall life satisfaction, providing one of the first longitudinal analyses linking objective wellbeing with subjective evaluations. Objective aspects of wellbeing are unequally distributed by gender, age, class and ethnicity and are strongly associated with life satisfaction. Moreover, associations between gender, ethnicity, class and life satisfaction persist after controlling for objective wellbeing, suggesting that mechanisms in addition to objective wellbeing link structural dimensions of inequality to life satisfaction. [ABSTRACT FROM AUTHOR]

Introduction: A Job Exposure Matrix (JEM) for psychosocial job stressors allows assessment of these exposures at a population level. JEMs are particularly useful in situations when information on psychosocial job stressors were not collected individually and can help eliminate the biases that may be present in individual self-report accounts. This research paper describes the development of a JEM in the Australian context. Methods: The Household Income Labour Dynamics in Australia (HILDA) survey was used to construct a JEM for job control, job demands and complexity, job insecurity, and fairness of pay. Population median values of these variables for all employed people (n = 20,428) were used to define individual exposures across the period 2001 to 2012. The JEM was calculated for the Australian and New Zealand Standard Classification of Occupations (ANZSCO) at the four-digit level, which represents 358 occupations. Both continuous and binary exposures to job stressors were calculated at the 4-digit level. We assessed concordance between the JEM-assigned and individually-reported exposures using the Kappa statistic, sensitivity and specificity assessments. We conducted regression analysis using mental health as an outcome measure. Results: Kappa statistics indicate good agreement between individually-reported and JEM-assigned dichotomous measures for job demands and control, and moderate agreement for job insecurity and fairness of pay. Job control, job demands and security had the highest sensitivity, while specificity was relatively high for the four exposures. Regression analysis shows that most individually reported and JEM measures were significantly associated with mental health, and individually-reported exposures produced much stronger effects on mental health than the JEM-assigned exposures. Discussion: These JEM-based estimates of stressors exposure provide a conservative proxy for individual-level data, and can be applied to a range of health and organisational outcomes. [ABSTRACT FROM AUTHOR]

Materials and Methods: In this paper, we propose a theoretical model based upon previous studies about personal and social network dynamics of job performance. We provide empirical support for this model using real-world data within the context of the Australian radiology profession. An examination of radiologists’ professional network topology through structural-positional and relational dimensions and radiologists’ personal characteristics in terms of knowledge, experience and self-esteem is provided. Thirty one breast imaging radiologists completed a purpose designed questionnaire regarding their network characteristics and personal attributes. These radiologists also independently read a test set of 60 mammographic cases: 20 cases with cancer and 40 normal cases. A Jackknife free response operating characteristic (JAFROC) method was used to measure the performance of the radiologists’ in detecting breast cancers. Results: Correlational analyses showed that reader performance was positively correlated with the social network variables of degree centrality and effective size, but negatively correlated with constraint and hierarchy. For personal characteristics, the number of mammograms read per year and self-esteem (self-evaluation) positively correlated with reader performance. Hierarchical multiple regression analysis indicated that the combination of number of mammograms read per year and network’s effective size, hierarchy and tie strength was the best fitting model, explaining 63.4% of the variance in reader performance. The results from this study indicate the positive relationship between reading high volumes of cases by radiologists and expertise development, but also strongly emphasise the association between effective social/professional interactions and informal knowledge sharing with high performance. [ABSTRACT FROM AUTHOR]

Demand for training life scientists in bioinformatics skills led to the development of a train-the-trainer collaboration between the European Molecular Biology Laboratory–European Bioinformatics Institute (EMBL-EBI) and 2 Australian organisations, Bioplatforms Australia and Commonwealth Scientific and Industrial Research Organisation (CSIRO) in 2012. The goal of the collaboration was to establish a group of trained instructors who could develop and deliver short bioinformatics courses nationally. A train-the-trainer course introduces instructors to aspects of andragogy and evidence-based learning principles to help them better design, develop, and deliver high-quality training. Since then, both the number of trainers in the network and the course portfolio have grown. Best practises have been developed and shared between the Australian cohort and EMBL-EBI to address common challenges in bioinformatics training. The Australian trainer cohort undertook a train-the-trainer instructor course, again with EMBL-EBI, and subsequently successfully delivered train-the-trainer courses to interested bioinformatics trainers within Australia. We conclude that a train-the-trainer approach can help build national capacity and maintain a critical mass of trained instructors. [ABSTRACT FROM AUTHOR]

The study of domestic money goes at the heart of debates about independence and equality in intimate relationships. It provides an important window on the individualization of family life and how couples reconcile ideals around egalitarian marriage ideologies with enduring gender inequality in society and the labor market. This study approaches these issues from the prism of couples’ banking arrangements (separate vs. joint accounts), an aspect of financial organization that approximates the executive management of household resources and which has received comparatively little attention. As such, it is amongst the first to deploy large-scale, household panel data (Household, Income and Labour Dynamics in Australia Survey, n = 15,379 observations from 7,054 couples) and binary and multinomial random-effect logistic regression models to examine trends over time in couples’ banking arrangements and their socio-demographic predictors. Key findings indicate that a large share of couples in Australia favors ‘mixed’ bank account strategies (i.e., holding both joint and separate accounts), but ‘egalitarian’ choices (i.e., dual separate accounts) are prevalent and on the rise. Couples’ bank account choices are influenced in theoretically-meaningful ways by economic resources, transaction costs, relationship history, gender-role attitudes, and family background. [ABSTRACT FROM AUTHOR]

Background: The benefits of clinical supervision are more pronounced for health professionals in rural and remote areas. Most clinical supervision studies to date have occurred in metropolitan centres and have used the survey methodology to capture participant experiences. There is a lack of qualitative research that captures participants’ lived experiences with clinical supervision at the frontline. Methods: Participants were recruited from rural and remote sites of two Australian states using a purposive maximum variation sampling strategy. Data were collected through individual, semi-structured interviews with participants. Data were analysed using content analysis and themes were developed. Sixteen participants from six professions completed the interviews. Results: Eight themes were developed including the content of supervision, context of supervision, value of supervision, increased need for professional support and unique characteristics of rural and remote clinical supervision. Conclusions: This study has highlighted the value of clinical supervision for the rural and remote health professional workforce. Furthermore, it has shed light on the unique characteristics of clinical supervision in this population. This information can be used by organisations and health professionals to ensure clinical supervision partnerships are effective thereby enhancing rural and remote workforce recruitment and retention. [ABSTRACT FROM AUTHOR]

Immigration from collectivist cultures to Western countries often results in loss of social capital and changing family dynamics leading to isolation and acculturative stress. This study explored the impact of social and cultural changes experienced by seven migrant communities residing in Greater Western Sydney, Australia. It deconstructed the role of local community and networks in their initial settlement in absence of traditional forms of community support. Data were collected through fourteen focus group discussions (164 participants). Five major themes emerged: (i) changing gender roles and women empowerment; (ii) sending money home; (iii) culture shock and increased intercultural conflict; (iv) change in lifestyle from collective to individual culture; and (v) role of extended community in mitigating culture shock. These findings suggest that community interventions aimed at improving cultural and social engagement of migrants employ social capital framework. This will ensure enhanced communication within migrant families and communities from different cultural and linguistic backgrounds. [ABSTRACT FROM AUTHOR]

Objectives: Across high-income countries, unemployment rates among workers with disabilities are disproportionately high. The aim of this study was to identify characteristics of employment associated with dropping out of work and assess whether these were different for workers with versus without disabilities. Methods: Using a longitudinal panel study of working Australians (2001 to 2015), the current study estimated Kaplan–Meier curves and Cox proportional hazard regression models to identify predictors of leaving employment, including psychosocial job quality, employment arrangement, and occupational skill level. Effect modification by disability status of the relationship between employment-related factors and exit from the labour market were assessed by including interaction terms and assessing model fit with a likelihood ratio test. Models were adjusted for a range of socio-demographic and health related factors. Results: Compared to those without disability, those with disability had a greater risk of leaving employment (HR 1.26, 95% CI 1.18 to 1.35, p<0.001). Other predictors of exit from work included low-skilled occupation (HR 1.18, 95% CI 1.07 to 1.29, p = 0.001), being in a job with low psychosocial job quality (HR 1.11, 95% CI 1.03 to 1.19, p = 0.007), and casual, labour hire or fixed-term contract employment (HR 1.58, 95% CI 1.48 to 1.69, p<0.001). There was no effect modification by disability status. Conclusions: More research is needed to understand the experiences of workers with disabilities who stay in and leave employment. [ABSTRACT FROM AUTHOR]

Background: Cancer care represents a substantial and rapidly rising healthcare cost in Australia. Our aim was to provide accurate population-based estimates of the health services cost of cancer care using large-scale linked patient-level data. Methods: We analysed data for incident cancers diagnosed 2006–2010 and followed to 2014 among 266,793 eligible participants in the 45 and Up Study. Health system costs included Medicare and pharmaceutical claims, inpatient hospital episodes and emergency department presentations. Costs for cancer cases and matched cancer-free controls were compared, to estimate monthly/annual excess costs of cancer care by cancer type, before and after diagnosis and by phase of care (initial, continuing, terminal). Total costs incurred in 2013 were also estimated for all people diagnosed in Australia 2009–2013. Results: 7624 participants diagnosed with cancer were matched with up to three controls. The mean excess cost of care per case was AUD$1,622 for the year before diagnosis, $33,944 for the first year post-diagnosis and $8,796 for the second year post-diagnosis, with considerable variation by cancer type. Mean annual cost after the initial treatment phase was $4,474/case and the mean cost for the last year of life was $49,733/case. In 2013 the cost for cancers among people in Australia diagnosed during 2009–2013 was ~$6.3billion (0.4% of Gross Domestic Product; $272 per capita), with the largest costs for colorectal cancer ($1.1billion), breast cancer ($0.8billion), lung cancer ($0.6billion) and prostate cancer ($0.5billion). Conclusions: The cost of cancer care is substantial and varies by cancer type and time since diagnosis. These findings emphasise the economic importance of effective primary and secondary cancer prevention strategies. [ABSTRACT FROM AUTHOR]

Background: This study aims to examine the costs associated with a Hospital in the Nursing Home (HiNH) program in Queensland Australia directed at patients from residential aged care facilities (RACFs) with emergency care needs. Methods: A cost analysis was undertaken comparing the costs under the HiNH program and the current practice, in parallel with a pre-post controlled study design. The study was conducted in two Queensland public hospitals: the Royal Brisbane and Women’s Hospital (intervention hospital) and the Logan Hospital (control hospital). Main outcome measures were the associated incremental costs or savings concerning the HiNH program provision and the acute hospital care utilisation over one year after intervention. Results: The initial deterministic analysis calculated the total induced mean costs associated with providing the HiNH program over one year as AU$488,116, and the total induced savings relating to acute hospital care service utilisation of AU$8,659,788. The total net costs to the health service providers were thus calculated at -AU$8,171,671 per annum. Results from the probabilistic sensitivity analysis (based on 10,000 simulations) showed the mean and median annual net costs associated with the HiNH program implementation were -AU$8,444,512 and–AU$8,202,676, and a standard deviation of 2,955,346. There was 95% certainty that the values of net costs would fall within the range from -AU$15,018,055 to -AU$3,358,820. Conclusions: The costs relating to implementing the HiNH program appear to be much less than the savings in terms of associated decreases in acute hospital service utilisation. The HiNH service model is likely to have the cost-saving potential while improving the emergency care provision for RACF residents. [ABSTRACT FROM AUTHOR]

Background: Acute gastroenteritis illness is a common illness that causes considerable morbidity, but current estimates of the cost to the Australian healthcare system are unknown. Objective: To estimate the current healthcare utilisation and direct public healthcare system costs attributable to acute gastroenteritis illness in Australia. Methods: This is an incidence-based cost-of-illness study focused on quantifying direct health care costs using a bottom-up approach. Data on general practitioner consultations, prescribed medications, diagnostic tests, specialist consultations, emergency department visits and hospital admissions were collected from national reports. Results: Using 2016 prices, the estimated annual direct per capita cost of acute gastroenteritis illness was AUD$14.87 (USD$10.71), equating to AUD$20.27 (USD$14.59) per case. The estimated overall economic burden in Australia was AUD$359 million (USD$258 million; AUD$1.5 million per 100,000 people). The major contributors to this cost were hospital admissions (57.1%), emergency department visits (17.7%), and general practitioner consultations (14.0%). Children under five years of age have the highest per capita rates of acute gastroenteritis illness; however, service utilisation rates vary by age group and both young children and older adults accounted for a substantial proportion of the overall economic burden attributable to acute gastroenteritis illness. Conclusions: Although chronic diseases comprise a large cost burden on the healthcare system, acute illnesses, including acute gastroenteritis illness, also impose substantial direct healthcare system costs. Providing data on current cost estimates is useful for prioritizing public health interventions, with our findings suggesting that it would be ideal if targeted interventions to reduce hospitalisation rates among young children and older adults were available. [ABSTRACT FROM AUTHOR]

Background: Disinvestment (removal, reduction, or reallocation) of routinely provided health services can be difficult when there is little published evidence examining whether the services are effective or not. Evidence is required to understand if removing these services produces outcomes that are inferior to keeping such services in place. However, organisational imperatives, such as budget cuts, may force healthcare providers to disinvest from these services before the required evidence becomes available. There are presently no experimental studies examining the effectiveness of allied health services (e.g., physical therapy, occupational therapy, and social work) provided on weekends across acute medical and surgical hospital wards, despite these services being routinely provided internationally. The aim of this study was to understand the impact of removing weekend allied health services from acute medical and surgical wards using a disinvestment-specific non-inferiority research design.Methods and Findings: We conducted 2 stepped-wedge cluster randomised controlled trials between 1 February 2014 and 30 April 2015 among patients on 12 acute medical or surgical hospital wards spread across 2 hospitals. The hospitals involved were 2 metropolitan teaching hospitals in Melbourne, Australia. Data from n = 14,834 patients were collected for inclusion in Trial 1, and n = 12,674 in Trial 2. Trial 1 was a disinvestment-specific non-inferiority stepped-wedge trial where the 'current' weekend allied health service was incrementally removed from participating wards each calendar month, in a random order, while Trial 2 used a conventional non-inferiority stepped-wedge design, where a 'newly developed' service was incrementally reinstated on the same wards as in Trial 1. Primary outcome measures were patient length of stay (proportion staying longer than expected and mean length of stay), the proportion of patients experiencing any adverse event, and the proportion with an unplanned readmission within 28 days of discharge. The 'no weekend allied health service' condition was considered to be not inferior if the 95% CIs of the differences between this condition and the condition with weekend allied health service delivery were below a 2% increase in the proportion of patients who stayed in hospital longer than expected, a 2% increase in the proportion who had an unplanned readmission within 28 days, a 2% increase in the proportion who had any adverse event, and a 1-day increase in the mean length of stay. The current weekend allied health service included physical therapy, occupational therapy, speech therapy, dietetics, social work, and allied health assistant services in line with usual care at the participating sites. The newly developed weekend allied health service allowed managers at each site to reprioritise tasks being performed and the balance of hours provided by each professional group and on which days they were provided. Analyses conducted on an intention-to-treat basis demonstrated that there was no estimated effect size difference between groups in the proportion of patients staying longer than expected (weekend versus no weekend; estimated effect size difference [95% CI], p-value) in Trial 1 (0.40 versus 0.38; estimated effect size difference 0.01 [-0.01 to 0.04], p = 0.31, CI was both above and below non-inferiority margin), but the proportion staying longer than expected was greater with the newly developed service compared to its no weekend service control condition (0.39 versus 0.40; estimated effect size difference 0.02 [0.01 to 0.04], p = 0.04, CI was completely below non-inferiority margin) in Trial 2. Trial 1 and 2 findings were discordant for the mean length of stay outcome (Trial 1: 5.5 versus 6.3 days; estimated effect size difference 1.3 days [0.9 to 1.8], p < 0.001, CI was both above and below non-inferiority margin; Trial 2: 5.9 versus 5.0 days; estimated effect size difference -1.6 days [-2.0 to -1.1], p < 0.001, CI was completely below non-inferiority margin). There was no difference between conditions for the proportion who had an unplanned readmission within 28 days in either trial (Trial 1: 0.01 [-0.01 to 0.03], p = 0.18, CI was both above and below non-inferiority margin; Trial 2: -0.01 [-0.02 to 0.01], p = 0.62, CI completely below non-inferiority margin). There was no difference between conditions in the proportion of patients who experienced any adverse event in Trial 1 (0.01 [-0.01 to 0.03], p = 0.33, CI was both above and below non-inferiority margin), but a lower proportion of patients had an adverse event in Trial 2 when exposed to the no weekend allied health condition (-0.03 [-0.05 to -0.004], p = 0.02, CI completely below non-inferiority margin). Limitations of this research were that 1 of the trial wards was closed by the healthcare provider after Trial 1 and could not be included in Trial 2, and that both withdrawing the current weekend allied health service model and installing a new one may have led to an accommodation period for staff to adapt to the new service settings. Stepped-wedge trials are potentially susceptible to bias from naturally occurring change over time at the service level; however, this was adjusted for in our analyses.Conclusions: In Trial 1, criteria to say that the no weekend allied health condition was non-inferior to current weekend allied health condition were not met, while neither the no weekend nor current weekend allied health condition demonstrated superiority. In Trial 2, the no weekend allied health condition was non-inferior to the newly developed weekend allied health condition across all primary outcomes, and superior for the outcomes proportion of patients staying longer than expected, proportion experiencing any adverse event, and mean length of stay.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613001231730 and ACTRN12613001361796. [ABSTRACT FROM AUTHOR]

Objectives: The importance of adolescent engagement in health decisions and public health programs such as immunisation is becoming increasingly recognised. Understanding adolescent preferences and further identifying barriers and facilitators for immunisation acceptance is critical to the success of adolescent immunisation programs. This study applied a discrete choice experiment (DCE) to assess vaccination preferences in adolescents. Methods: This study was conducted as a cross-sectional, national online survey in Australian adolescents. The DCE survey evaluated adolescent vaccination preferences. Six attributes were assessed including disease severity, target for protection, price, location of vaccination provision, potential side effects and vaccine delivery method. A mixed logit model was used to analyse DCE data. Results: This survey was conducted between December 2014 and January 2015. Of 800 adolescents aged 15 to 19 years, stronger preferences were observed overall for: vaccination in the case of a life threatening illness (p<0.001), lower price vaccinations (p<0.001), mild but common side effects (p = 0.004), delivery via a skin patch (p<0.001) and being administered by a family practitioner (p<0.001). Participants suggested that they and their families would be willing to pay AU$394.28 (95%CI: AU$348.40 to AU$446.92) more for a vaccine targeting a life threatening illness than a mild-moderate illness, AU$37.94 (95%CI: AU$19.22 to AU$57.39) more for being vaccinated at a family practitioner clinic than a council immunisation clinic, AU$23.01 (95%CI: AU$7.12 to AU$39.24) more for common but mild and resolving side effects compared to rare but serious side effects, and AU$51.80 (95%CI: AU$30.42 to AU$73.70) more for delivery via a skin patch than injection. Conclusions: Consideration of adolescent preferences may result in improved acceptance of, engagement in and uptake of immunisation programs targeted for this age group. [ABSTRACT FROM AUTHOR]

Background: Missing more than one tablet of contemporary antiretroviral therapy (ART) per month increases the risk of virological failure. Recent studies evaluating a comprehensive range of potential risk factors for suboptimal adherence are not available for high-income settings. Methods: Adults on ART with undetectable viral load (UDVL) were recruited into a national, multi-centre cohort, completing a comprehensive survey assessing demographics, socio-economic indicators, physical health, well-being, life stressors, social supports, HIV disclosure, HIV-related stigma and discrimination, healthcare access, ART regimen, adherence, side effects, costs and treatment beliefs. Baseline data were assessed, and suboptimal adherence was defined as self-reported missing ≥1 ART dose/month over the previous 3-months; associated factors were identified using bivariate and multivariate binary logistic regression. Results: We assessed 522 participants (494 [94.5%] men, mean age = 50.8 years, median duration UDVL = 3.3 years [IQR = 1.2–6.8]) at 17 sexual health, hospital, and general practice clinics across Australia. Seventy-eight participants (14.9%) reported missing ≥1 dose/month over the previous three months, which was independently associated with: being Australian-born (AOR [adjusted odds ratio] = 2.4 [95%CI = 1.2–4.9], p = 0.014), not being in a relationship (AOR = 3.3 [95%CI = 1.5–7.3], p = 0.004), reaching the “Medicare safety net” (capping annual medical/pharmaceutical costs) (AOR = 2.2 [95%CI = 1.1–4.5], p = 0.024), living in subsidised housing (AOR = 2.5 [95%CI = 1.0–6.2], p = 0.045), receiving home-care services (AOR = 4.4 [95%CI = 1.0–18.8], p = 0.046), HIV community/outreach services linkage (AOR = 2.4 [95%CI = 1.1–5.4], p = 0.033), and starting ART following self-request (AOR = 3.0 [95%CI = 1.3–7.0], p = 0.012). Conclusions: In this population, 15% reported recent suboptimal ART adherence at levels associated in prospective studies with subsequent virological failure, despite all having an undetectable viral load. Associations were with social/economic/cultural/patient engagement factors, but not ART regimen/clinical factors. These associations may help identify those at higher risk of future virological failure and guide patient education and support. [ABSTRACT FROM AUTHOR]

Aim: To estimate the productivity costs of premature mortality due to cancer in Australia, in aggregate and for the 26 most prevalent cancer sites. Methods: A human capital approach was adopted to estimate the long term impacts of Australian cancer deaths in 2003. Using population mortality data, the labour force participation and the present value of lifetime income (PVLI) forgone due to premature mortality was estimated based on individual characteristics at the time of death including age, sex and socioeconomic status. Outcomes were modelled to the year 2030 using economic data from a national microsimulation model. A discount rate of 3% was applied and costs were reported in 2016 Australian dollars. Results: Premature deaths from cancer in 2003 resulted in 88,000 working years lost and a cost of $4.2 billion in the PVLI forgone. Costs were close to three times higher in males than females due to the higher number of premature deaths in men, combined with higher levels of workforce participation and income. Lung, colorectal and brain cancers accounted for the highest proportion of costs, while testicular cancer was the most costly cancer site per death. Conclusions: The productivity costs of premature mortality due to cancer are significant. These results provide an economic measure of the cancer burden which may assist decision makers in allocating scare resources amongst competing priorities. [ABSTRACT FROM AUTHOR]

Background: People released from prison are at increased risk of death. However, no country has established a system for routine monitoring of mortality in this population. The aims of this study were to (a) evaluate a system for routine monitoring of deaths after release from prison in Australia and (b) estimate the number of deaths annually within 28 and 365 days of prison release from 2000 to 2013. Methods: Persons released from prison and deaths were identified in records held by Centrelink, Australia’s national provider of unemployment benefits. Estimates generated in this manner were compared with those from a study that probabilistically linked correctional records with the National Death Index (NDI), for each calendar year 2000 to 2007. Using Centrelink data, national estimates of mortality within 28 and 365 days of release were produced for each calendar year 2000 to 2013. Findings: Compared with estimates based on linkage with the NDI, the estimated crude mortality rate based on Centrelink records was on average 52% lower for deaths within 28 days of release and 24% lower for deaths within 365 days of release. Nationally, over the period 2000 to 2013, we identified an average of 32 deaths per year within 28 days of release and 188 deaths per year within 365 days of release. The crude mortality rate for deaths within both 28 and 365 days of release increased over this time. Conclusions: Using routinely collected unemployment benefits data we detected the majority of deaths in people recently released from prison in Australia. These data may be sufficient for routine monitoring purposes and it may be possible to adopt a similar approach in other countries. Routine surveillance of mortality in ex-prisoners serves to highlight their extreme vulnerability and provides a basis for evaluating policy reforms designed to reduce preventable deaths. [ABSTRACT FROM AUTHOR]

Background: Indigenous infants (infants aged under 12 months) have the highest hospital admission and emergency department presentation risks in Australia. However, there have been no recent reports comparing hospital utilisation between Indigenous and non-Indigenous infants. Methods: Our primary objective was to use a large prospective population-based linked dataset to assess the risk of all-cause hospital admission and emergency department presentation in Indigenous compared to non-Indigenous infants in Western Australia (WA). Secondary objectives were to assess the effect of socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD]) on hospital utilisation and to understand the causes of hospital utilisation. Findings: There were 3,382 (5.4%) Indigenous and 59,583 (94.6%) non-Indigenous live births in WA from 1 January 2010 to 31 December 2011. Indigenous infants had a greater risk of hospital admission (adjusted odds ratio [aOR] 1.90, 95% confidence interval [95% CI] 1.77–2.04, p = <0.001) and emergency department presentation (aOR 2.15, 95% CI 1.98–2.33, p = <0.001) compared to non-Indigenous infants. Fifty nine percent (59.0%) of admissions in Indigenous children were classified as preventable compared to 31.2% of admissions in non-Indigenous infants (aOR 2.12, 95% CI 1.88–2.39). The risk of hospital admission in the most disadvantaged (IRSD 1) infants in the total cohort (35.7%) was similar to the risk in the least disadvantaged (IRSD 5) infants (30.6%) (aOR 1.04, 95% CI 0.96–1.13, p = 0.356). Interpretation: WA Indigenous infants have much higher hospital utilisation than non Indigenous infants. WA health services should prioritise Indigenous infants regardless of their socio economic status or where they live. [ABSTRACT FROM AUTHOR]

Threatened species programs need a social license to justify public funding. A contingent valuation survey of a broadly representative sample of the Australian public found that almost two thirds (63%) supported funding of threatened bird conservation. These included 45% of a sample of 645 respondents willing to pay into a fund for threatened bird conservation, 3% who already supported bird conservation in another form, and 15% who could not afford to pay into a conservation fund but who nevertheless thought that humans have a moral obligation to protect threatened birds. Only 6% explicitly opposed such payments. Respondents were willing to pay about AUD 11 annually into a conservation fund (median value), including those who would pay nothing. Highest values were offered by young or middle aged men, and those with knowledge of birds and those with an emotional response to encountering an endangered bird. However, the prospect of a bird going extinct alarmed almost everybody, even most of those inclined to put the interests of people ahead of birds and those who resent the way threatened species sometimes hold up development. The results suggest that funding for threatened birds has widespread popular support among the Australian population. Conservatively they would be willing to pay about AUD 14 million per year, and realistically about AUD 70 million, which is substantially more than the AUD 10 million currently thought to be required to prevent Australian bird extinctions. [ABSTRACT FROM AUTHOR]