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Background: Variation persists in the quality of end-of-life-care (EOLC) for people with cancer. This study aims to describe the characteristics of, and examine factors associated with, indicators of potentially burdensome care provided in hospital, and use of hospital services in the last 12 months of life for people who had a death from cancer. Method: A population-based retrospective cohort study of people aged ≥ 20 years who died with a cancer-related cause of death during 2014–2019 in New South Wales, Australia using linked hospital, cancer registry and mortality records. Ten indicators of potentially burdensome care were examined. Multinominal logistic regression examined predictors of a composite measure of potentially burdensome care, consisting of > 1 ED presentation or > 1 hospital admission or ≥ 1 ICU admission within 30 days of death, or died in acute care. Results: Of the 80,005 cancer-related deaths, 86.9% were hospitalised in the 12 months prior to death. Fifteen percent had > 1 ED presentation, 9.9% had > 1 hospital admission, 8.6% spent ≥ 14 days in hospital, 3.6% had ≥ 1 intensive care unit admission, and 1.2% received mechanical ventilation on ≥ 1 occasion in the last 30 days of life. Seventeen percent died in acute care. The potentially burdensome care composite measure identified 20.0% had 1 indicator, and 10.9% had ≥ 2 indicators of potentially burdensome care. Compared to having no indicators of potentially burdensome care, people who smoked, lived in rural areas, were most socially economically disadvantaged, and had their last admission in a private hospital were more likely to experience potentially burdensome care. Older people (≥ 55 years), females, people with 1 or ≥ 2 Charlson comorbidities, people with neurological cancers, and people who died in 2018–2019 were less likely to experience potentially burdensome care. Compared to people with head and neck cancer, people with all cancer types (except breast and neurological) were more likely to experience ≥ 2 indicators of potentially burdensome care versus none. Conclusion: This study shows the challenge of delivering health services at end-of-life. Opportunities to address potentially burdensome EOLC could involve taking a person-centric approach to integrate oncology and palliative care around individual needs and preferences. [ABSTRACT FROM AUTHOR]

Emissions from road traffic, power generation and industry were substantially reduced during pandemic lockdown periods globally. Thus, we analysed reductions in traffic-related air pollution in Australian capital cities during March–April 2020 and then modelled the mortality benefits that could be realised if similar reductions were sustained by structural policy interventions. Satellite, air pollution monitor and land use observations were used to estimate ground-level nitrogen dioxide (NO 2) concentrations in all Australian capital cities during: (a) a typical year with no prolonged air pollution events; (b) a hypothetical sustained reduction in NO 2 equivalent to the COVID-19 lockdowns. We use the WHO recommended NO 2 exposure-response coefficient for mortality (1.023, 95 % CI: 1.008–1.037, per 10 μg/m3 annual average) to assess gains in life expectancy and population-wide years of life from reduced exposure to traffic-related air pollution. We attribute 1.1 % of deaths to anthropogenic NO 2 exposures in Australian cities, corresponding to a total of 13,340 years of life lost annually. Although COVID-19-related reductions in NO 2 varied widely between Australian cities during April 2020, equivalent and sustained reductions in NO 2 emissions could reduce NO 2 -attributable deaths by 27 %, resulting in 3348 years of life gained annually. COVID-19 mobility restrictions reduced NO 2 emissions and population-wide exposures in Australian cities. When sustained to the same extent by policy interventions that reduce fossil fuel consumption by favouring the uptake of electric vehicles, active travel and public transport, the health, mortality and economic benefits will be measurable in Australian cities. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Diabetes-related foot disease (DFD) is a common, costly, and severe complication of diabetes mellitus. DFD is associated with high rates of morbidity and mortality and poses a significant burden on patients, healthcare systems and society. While the detrimental impact of DFD is widely recognised, the precise financial implications of its management in Australia remain unclear due to inconsistent and inconclusive contemporary data. Therefore, the aim of this review was to identify, summarise and synthesise existing evidence to estimate the costs associated with DFD management in Australia. Methods: Searches were conducted in MEDLINE, Embase, AMED, CINAHL, Joanna Briggs Institute EBP, and the Cochrane Library from November 2011 to July 2023. Australian studies investigating costs associated with DFD management were eligible for inclusion. Two independent reviewers performed the study selection, data extraction and quality assessment steps. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklist was used to assess study quality. A descriptive analysis was performed due to limited existing evidence and large heterogeneity between study populations to conduct meta-analyses. Results: Three economic evaluations were included in the review. One study was rated as 'poor', one as 'very good' and one as 'excellent' when assessed against the CHEERS checklist. The estimated cost of DFD management varied between studies and comparisons were not possible due to the different methodological approaches and data sources. The studies were unable to provide an overall cost of DFD with respect to all aspects of care as they did not capture the multi-faceted level of care throughout the entire patient journey between sectors and over time. Conclusion: There is limited contemporary evidence for the costs associated with DFD management within Australia, particularly related to direct costs and resource utilisation. Further research into the economic impact of DFD management is needed to inform optimisation of national service delivery and improve health outcomes for individuals with DFD in Australia. Integrating real-world data on impact of clinical interventions with parallel economic evaluation could be a valuable approach for future research, which would offer a more comprehensive understanding of the clinical and economic outcomes beyond solely model-based evaluations. Trial registration: PROSPERO Registration No. CRD42022290910. [ABSTRACT FROM AUTHOR]

Religiosity potentially has a significant economic impact in Australia, but we do not currently have a good understanding of that impact. Research sponsored by the research project called 'The Study for the Economic Impact of Religion on Society' (SEIROS) has sought to capture, in part, the role religiosity plays in contributing to economic life in Australia by measuring how religious commitment enhances volunteering and donation behaviour. That research focuses on an individual's commitment rather than their institutional engagement with religious organisations. Based on a survey of religious engagement, and building on the approach of Lyons and Nivison-Smith (2006), SEIROS engaged Deloitte Access Economics (DAE) to build a logistic regression model which captured a positive impact of religiosity on volunteering and giving, measured by comparing persons coming to faith in adult life against people who never identify as being religious. However, this article argues that the DAE study suffers from the limitation of measuring religiosity as a 'treatment effect' captured by conversion in adult life and excludes the cohort of persons who have been religious since youth. As a result, the impact of religious engagement on giving of time and money may be understated. [ABSTRACT FROM AUTHOR]

Health promotion is conceived as a unifying concept for improving the health of populations. This means addressing the socio-cultural, economic and commercial causes of ill-health, which are necessarily informed by past policies and socio-cultural contexts. However, historical scholarship has rarely figured in health promotion practice or scholarship. This gap resides in the determinants of health, and notably in the analyses of tobacco control and skin cancer prevention, two long-running campaigns that have shaped modern health promotion in Australia. Both highlight a need for understanding the profound impact of history on the present and the value of learning from past successes and failures. Doing so requires integrating historical analyses into existing health promotion scholarship. To achieve this aim, we present a new 'public health humanities' methodology. This novel interdisciplinary framework is conceived as a spectrum in which historical studies integrate with existing health promotion disciplines to solve complex health problems. We draw on the many calls for more interdisciplinarity in health promotion and derive this methodology from proposals in the medical humanities and cognate fields that have wrestled with combining history and present-focused disciplines. Using tobacco control and skin cancer prevention as case studies, we demonstrate how public health humanities uses interdisciplinary teams and shared research questions to generate valuable new knowledge unavailable with traditional methods. Furthermore, we show how it creates evaluation criteria to consider the powerful impact of issues like colonialism on current inequities that hinder health promotion strategies, and from which lessons may be derived for the future. [ABSTRACT FROM AUTHOR]

Objective: To quantify the full life cycle impacts of ultra-processed foods (UPF) for key environmental, economic and nutritional indicators to identify trade-offs between UPF contribution to broad-scope sustainability. Design: Using 24-h dietary recalls along with an input–output database for the Australian economy, dietary environmental and economic impacts were quantified in this national representative cross-sectional analysis. Food items were classified into non-UPF and UPF using the NOVA system, and dietary energy contribution from non-UPF and UPF fractions in diets was estimated. Thereafter, associations between nutritional, environmental and economic impacts of non-UPF and UPF fractions of diets were examined using a multi-dimensional nutritional geometry representation. Setting: National Nutrition and Physical Activity Survey 2011–2012 of Australia. Participants: Respondents (n 5344) aged > 18 years with 1 d of 24-h dietary recall data excluding respondents with missing values and outlier data points and under reporters. Results: Australian diets rich in UPF were associated with reduced nutritional quality, high greenhouse gas emissions, energy use, and increased employment and income associated with the food supply chains. The environmental and economic impacts associated with the UPF portion of diets become more distinct when the diets are standardised to average protein recommendation. Conclusion: Increased consumption of UPF has socio-economic benefits, but this comes with adverse effects on the environment and public health. Consideration of such trade-offs is important in identifying policy and other mechanisms regarding UPF for establishing healthy and sustainable food systems. [ABSTRACT FROM AUTHOR]

Aim: To identify the barriers associated with inadequate antenatal attendance by disadvantaged women in Australia and to further explore how these barriers are experienced by this population group. Design: A qualitative descriptive study utilizing semi‐structured interviews and thematic analysis. Methods: Interviews were conducted with 11 pregnant women who self‐identified as experiencing disadvantage, purposively sampled from a local government area of Victoria, Australia, characterized by socio‐economic disadvantage. Data were collected from February to July 2019. Results: Study participants reported a range of barriers to receiving timely and adequate antenatal care (ANC). For several women, a combination of personal (e.g., emotions, knowledge), health service provision (e.g., limited access to continuity of care provider and continuity of information, inflexible scheduling, difficulty travelling, staff attitudes), and broader social‐contextual factors (e.g., financial situation, language, cultural norms) were ultimately insurmountable. Whereas some barriers were experienced as hassles or annoyances, others were unacceptable, overwhelming, or humiliating. Conclusion: Women experiencing disadvantage in Australia value ANC but face multiple and complex barriers that undermine timely and regular access. Implications for the Profession and/Patient Care: A wide range of strategies targeting barriers across multiple levels of the social‐ecological environment are required if ANC attendance rates are to improve and ultimately redress existing health disparities. Various continuity of care models are well‐placed to address many of the identified barriers and should be made more accessible to women, and particularly those women experiencing disadvantage. Impact: Antenatal care appointments promote the health of women and their babies during pregnancy, but for many women, particularly those experiencing disadvantage, access is delayed or inadequate. ANC providers play a critical role in facilitating timely and adequate care. Health service practitioners and management, and health services policymakers need to understand the complexity of the barriers women encounter. These stakeholders can utilize the findings reported herein to develop more effective strategies for overcoming multiple and multi‐level barriers. Reporting Method: The study is reported in accordance with the relevant EQUATOR guidelines: the standards for reporting qualitative research (SRQR) and consolidated criteria for reporting qualitative research (COREQ). Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

The article "Philanthropy in Australia and Aotearoa 2020-2023" examines the impact of recessions on philanthropy and investigates the trends in giving during the COVID-19 pandemic. The study finds that while there were disruptions to economies during the pandemic, philanthropic revenue did not significantly decrease. In Australia, individual giving declined in 2020 but increased in 2021, while giving by high-net-worth individuals and through private ancillary funds continued to rise. In Aotearoa, the number of individuals giving decreased in 2020, but the total value of gifts grew in 2020, 2021, and 2022. Grant giving in Australia increased in 2020 and 2021, and corporate community investment also increased during this period. However, company charitable giving in Aotearoa decreased from 2019 to 2023. The study highlights the need for better collection and analysis of giving data in Aotearoa and acknowledges the challenges that charities and nonprofits face during downturns. [Extracted from the article]

Background: Effective and scalable prevention approaches are urgently needed to address the rapidly increasing rates of e-cigarette use among adolescents. School-based eHealth interventions can be an efficient, effective, and economical approach, yet there are none targeting e-cigarettes within Australia. This paper describes the protocol of the OurFutures Vaping Trial which aims to evaluate the efficacy and cost-effectiveness of the first school-based eHealth intervention targeting e-cigarettes in Australia. Methods: A two-arm cluster randomised controlled trial will be conducted among Year 7 and 8 students (aged 12–14 years) in 42 secondary schools across New South Wales, Western Australia and Queensland, Australia. Using stratified block randomisation, schools will be assigned to either the OurFutures Vaping Program intervention group or an active control group (health education as usual). The intervention consists of four web-based cartoon lessons and accompanying activities delivered during health education over a four-week period. Whilst primarily focused on e-cigarette use, the program simultaneously addresses tobacco cigarette use. Students will complete online self-report surveys at baseline, post-intervention, 6-, 12-, 24-, and 36-months after baseline. The primary outcome is the uptake of e-cigarette use at 12-month follow-up. Secondary outcomes include the uptake of tobacco smoking, frequency/quantity of e-cigarettes use and tobacco smoking, intentions to use e-cigarettes/tobacco cigarettes, knowledge about e-cigarettes/tobacco cigarettes, motives and attitudes relating to e-cigarettes, self-efficacy to resist peer pressure and refuse e-cigarettes, mental health, quality of life, and resource utilisation. Generalized mixed effects regression will investigate whether receiving the intervention reduces the likelihood of primary and secondary outcomes. Cost-effectiveness and the effect on primary and secondary outcomes will also be examined over the longer-term. Discussion: If effective, the intervention will be readily accessible to schools via the OurFutures platform and has the potential to make substantial health and economic impact. Without such intervention, young Australians will be the first generation to use nicotine at higher rates than previous generations, thereby undoing decades of effective tobacco control. Trial registration: The trial has been prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12623000022662; date registered: 10/01/2023). [ABSTRACT FROM AUTHOR]

Objectives: This study explored publicly funded health system and patient expenditure in the post-acute phase following discharge from inpatient acquired brain injury (ABI) or spinal cord injury (SCI) rehabilitation. The secondary aim was to explore sociodemographic and injury characteristics associated with high costs. Methods: This was a prospective cohort study. 153 patients (ABI: n = 85; SCI: n = 68) who consented to the use of their Medicare data were recruited between March 2017 and March 2018, at the point of discharge from ABI or SCI specialist rehabilitation units. The main outcome measure involved linkage of the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data for the 12 months following discharge from rehabilitation. Bayesian penalised regression was used to determine characteristics associated with high costs. Results: The median number of MBS items used in the 12 months after discharge was 33 (IQR: 21–52). General practitioners and allied health services were accessed by 100% and 41% of the cohort, respectively. The median MBS system cost (in Australian dollars) was $2006 (IQR: $162–$3090). Almost half (46%) of the participants had no MBS patient expenditure. The median PBS system cost was $541 (IQR: $62–$1574). For people with ABI, having a traumatic injury or one comorbidity was associated with lower PBS system costs by on average $119 and $134, respectively. We also found that hospitalisation in ABI was associated with higher PBS system costs, by on average $669. Conclusion: There was evidence of high and variable MBS and PBS costs, raising concerns about financial hardship. Future research should focus on identifying any unmet service and prescription needs in the post-acute rehabilitation phase for these populations. What is known about the topic? Acquired brain injury and spinal cord injury incur high long-term health costs, yet little is known about Medicare service use and costs in the early post-acute phase. What does this paper add? This study provides insight into service use and the burden of injury on Medicare Benefits Schedule and Pharmaceutical Benefits Scheme systems in the 12 months after hospital discharge. High and variable system and patient expenditure are most notable. What are the implications? Highly variable patient costs raise concerns about the access and affordability of sufficient healthcare services in the post-acute rehabilitation period. [ABSTRACT FROM AUTHOR]

This study evaluates the economic potential for Area Wide Management (AWM) of the Queensland fruit fly (Qfly) using the Sterile Insect Technique (SIT) through three case studies across endemic and Pest-Free Areas (PFA) in south-east Australia. The cost of Qfly needs to be identified before the potential benefit of AWM and SIT can be evaluated. We use results from grower workshops and expert elicitation to identify the financial cost of Qfly to growers (the baseline) and the potential impact of AWM as a precursor to SIT (scenarios). Results show a net benefit from maintaining PFA status. In endemic regions, the potential financial benefits to growers of are low. Avoided adjustment costs that contribute to a net benefit in PFA's are sunk in endemic regions. The low threshold for Qfly in markets and on-farm, and availability of cost-effective management options, implies limited benefits from avoided management costs. Market access is uncertain and AWM and SIT alone are not sufficient to access these benefits. Although there may be exceptions, we find limited grower benefits from AWM and SIT in Qfly endemic growing regions. [ABSTRACT FROM AUTHOR]

Objective: The Continuous Glucose Monitoring (CGM) Initiative recently introduced universal subsidized CGM funding for people with type 1 diabetes under 21 years of age in Australia. We thus aimed to evaluate the cost-effectiveness of this CGM Initiative based on national implementation data and project the economic impact of extending the subsidy to all age-groups.Research Design and Methods: We used a patient-level Markov model to simulate disease progression for young people with type 1 diabetes and compared government-subsidized access to CGM with the previous user-funded system. Three years of real-world clinical input data were sourced from analysis of the Australasian Diabetes Data Network and National Diabetes Services Scheme registries. Costs were considered from the Australian health care system's perspective. An annual discount rate of 5% was applied to future costs and outcomes. Uncertainty was evaluated with probabilistic and deterministic sensitivity analyses.Results: Government-subsidized CGM funding for young people with type 1 diabetes compared with a completely user-funded model resulted in an incremental cost-effectiveness ratio (ICER) of AUD 39,518 per quality-adjusted life-year (QALY) gained. Most simulations (85%) were below the commonly accepted willingness-to-pay threshold of AUD 50,000 per QALY gained in Australia. Sensitivity analyses indicated that base-case results were robust, though strongly impacted by the cost of CGM devices. Extending the CGM Initiative throughout adulthood resulted in an ICER of AUD 34,890 per QALY gained.Conclusions: Providing subsidized access to CGM for people with type 1 diabetes was found to be cost-effective compared with a completely user-funded model in Australia. [ABSTRACT FROM AUTHOR]

Purpose: The Australian prisoner population has experienced a dramatic increase in the number of older inmates over the past decade, consistent with the greying of the prisoner population that is being observed worldwide. Reviews suggest the need for further evidence and practice outside of the USA. This paper aims to review and discuss the cost and social implications of the rising health-care needs of this population in Australia. Design/methodology/approach: A review of international research and policies is presented, as well as the results of basic economic modelling relating to the expected rise in health-care costs of the ageing prisoner population in Australia. Findings: Taking into consideration the continued rise in incarceration rates, the calculations show that the health costs of prisoners could increase by anywhere between 17% and 90% depending on whether the increase of older prisoners continues as it has in the past decade. These trends are likely to continue over the next decade and will result in higher health costs of prisons under a number of different imprisonment scenarios. Policy responses in Australia have been slow so far, with most initiatives being undertaken in the USA with promising results. Practical implications: The authors suggest that in the absence of a coordinated policy response, covering a range of interventions, costs will continue to increase, particularly as this population continues to age more rapidly than the general population due to an accumulation of risk factors. Well-conceived interventions would be a worthwhile investment from both financial and social perspectives. Originality/value: To the best of the authors' knowledge, this is the first commentary to acknowledge this rising public health issue and to both review and model its implications for the future. [ABSTRACT FROM AUTHOR]

Does compulsory voting (CV) result in divergent voting paths? Using the heterogeneous attribution thesis, we test whether compelled voters are less likely to rely on egotropic perceptions of the economy than voluntary voters, depressing the impact of economic voting. Our results show that compelled voters refrain from accurately relying on egotropic perceptions of the economy. Our findings question whether CV does in fact increase accountability to the electorate. While many advocates of CV believe it empowers low SES voters, our findings suggest that even if this is the case, it does so at the expense of holding incumbents accountable for poor economic performance. [ABSTRACT FROM AUTHOR]

Farming women have rarely been the focus of scholarly work on drought and/or distress. This article focuses on farming women's lived experience of drought and distress, drawing on a participatory filmmaking project created by a small group of farming women from Southern Australia. Feminist materialism and Barad's (2003) concept of 'intra‐action' provides a useful lens to examine both the film as an artefact as well as the discussions among the women during its creation. Intra‐action enables an exploration of how farming women's bodies come into being as distressed in moments of time through and with drought as a complex constellation of multiple 'matter'. The film and narratives show distressed bodies emerging with dust, wind, objects and the suffering of non‐human animals. For these women, distress emerges from hearing, sensing, seeing and feeling the irritation of dirt splattered against window panes, the emotional pain and economic consequences of topsoil blowing across paddocks and as feed becomes hard to source, the recognition of the suffering of sheep. The power of these animate and inanimate 'things'—windmills, windows, troughs, work boots, animals and soil—were sensorily entangled with women's bodies. For farming women, distress materialises within their bodies through processes of intra‐action in their more‐than‐human worlds. [ABSTRACT FROM AUTHOR]

We examined systems-level costs before and after the implementation of an emergency department paediatric sepsis screening, recognition and treatment pathway. Aggregated hospital admissions for all children aged < 18y with a diagnosis code of sepsis upon admission in Queensland, Australia were compared for 16 participating and 32 non-participating hospitals before and after pathway implementation. Monte Carlo simulation was used to generate uncertainty intervals. Policy impacts were estimated using difference-in-difference analysis comparing observed and expected results. We compared 1055 patient episodes before (77.6% in-pathway) and 1504 after (80.5% in-pathway) implementation. Reductions were likely for non-intensive length of stay (− 20.8 h [− 36.1, − 8.0]) but not intensive care (–9.4 h [− 24.4, 5.0]). Non-pathway utilisation was likely unchanged for interhospital transfers (+ 3.2% [− 5.0%, 11.4%]), non-intensive (− 4.5 h [− 19.0, 9.8]) and intensive (+ 7.7 h, [− 20.9, 37.7]) care length of stay. After difference-in-difference adjustment, estimated savings were 596 [277, 942] non-intensive and 172 [148, 222] intensive care days. The program was cost-saving in 63.4% of simulations, with a mean value of $97,019 [− $857,273, $1,654,925] over 24 months. A paediatric sepsis pathway in Queensland emergency departments was associated with potential reductions in hospital utilisation and costs. [ABSTRACT FROM AUTHOR]

Objective: The objective is to estimate the economic benefits of trading zones as part of foot‐and‐mouth disease (FMD) control measures for limited duration outbreaks. Design: The proposed trading zones for FMD at the state level are determined using multiple tools. Eleven individual incursion scenarios in six Australian states are simulated within the Australian Animal Disease Spread epidemiological model to identify the potential geographic extent of outbreaks, as well as the number of animals infected and the duration of outbreaks. The disease spread information is used to identify the boundaries of trading zones. The outbreak duration data are combined with historical export data to estimate the share of Australian exports that could be embargoed. The market impacts of the potential export embargoes including changes in equilibrium quantities, prices and revenue are simulated within the Australian Bureau of Agricultural and Resource Economics and Sciences' AgEmissions partial equilibrium model of Australian agriculture. Results: Results emphasize the importance of jurisdictional and outbreak characteristics in determining trading zones. Should Australia effectively implement trading zones at the state level in response to small FMD outbreaks, the potential reductions of embargoed exports lead to a reduction in estimated producer revenue losses compared with losses under a national embargo. Producer revenue losses are reduced between $3 billion and $9 billion estimated in present value terms over 10 years at a 7% discount rate. Conclusion: Economic analysis of the implications of trading zones identifies additional investments that would be of value to livestock industries. [ABSTRACT FROM AUTHOR]

Background: Women make up a significant proportion of all gamblers globally. However, there has been limited research which has explored women's gambling and the factors that may make women, and subgroups of women, vulnerable to harm. Methods: Using a Constructivist Grounded Theory approach, semistructured interviews were conducted with 20 women aged 55 years and over who regularly gambled on electronic gambling machines (EGMs). Results Key factors were identified to illustrate older women's experiences of gambling and are presented according to four determinants of health: Individual; socio-cultural; environmental; and commercial. While this research confirms that older women's gambling behaviors are strongly influenced by individual and socio-cultural factors, gambling environments, and industry practices are also influential. Conclusion A model illustrates the interplay of individual, socio-cultural, environmental, and commercial determinants, and the article proposes how they may contribute to gambling harm in older Australian women. [ABSTRACT FROM AUTHOR]

Vaccination is a vital health care initiative to prevent individual and population infection. To increase vaccination rates the federal government implemented the 'No Jab, No Pay' policy, where eligibility for several government benefits required children to be fully vaccinated by removing 'conscientious objections' and expanding the age range of children whose families receive benefits. This study assesses the impact of this policy at a local area within a single medical practice community in NSW, Australia. A retrospective clinical audit was performed between 2012 and 2017 on a single general practice's vaccination records for children ≤19 years. Catch‐up vaccinations were assessed based on age at vaccination. Incidence of catch‐up vaccinations was assessed for each of four years before and two years after the implementation of the 'No Jab, No Pay' policy in January 2016, along with the age of children and vaccination(s) given. Catch‐up vaccinations were assessed temporally either side of implementation of 'No Jab, No Pay'. Comparing the average annual vaccination catch‐up incidence rate of 6.2% pre‐implementation (2012–2015), there was an increase to 9.2% in 2016 (p <.001) and 7.8% in 2017 (p =.027). Secondary outcome measurement of catch‐up vaccination incidence rates before (2012–2015) and after (2016–2017) 'No Jab, No Pay' implementation showed statistically significant increases for children aged 8–11 years (3.2%–5.6%, p =.038), 12–15 years (7.5%–14.7%, p <.001) and 16–19 years (3.3%–10.2%, p <.001) along with a statistically significant reduction in children aged 1–3 years (11.4%–6.2%, p =.015). Also, catch‐up rates for DTPa significantly increased after program implementation. This study demonstrates that the Australian federal government vaccination policy 'No Jab, No Pay' was coincident with an increase in catch‐up vaccinations within a rural NSW community served by one medical practice, especially for older children. [ABSTRACT FROM AUTHOR]

Background The impact of research findings on clinical practice usually remains uncertain and unmeasured. To address this problem, we examined the long-term clinical and economic impact of the Initiating Dialysis Early and Late (IDEAL) trial using data from the Australia and New Zealand Dialysis and Transplant Registry. Methods We performed a registry-based study including all incident adult dialysis patients in Australia and New Zealand from July 2000 to June 2018. A piecewise linear regression model was used to examine differences in mean estimated glomerular filtration rate (eGFR) at dialysis commencement for the years prior to (2000–2010) and following (2010–2018) publication of the IDEAL trial results. The return on investment (ROI) was calculated using the total cost of performing the IDEAL trial and the cost or savings accruing in Australia and New Zealand from changes in dialysis initiation practice. Results From July 2000 to June 2010, mean eGFR at dialysis commencement increased at a rate of 0.21 mL/min/1.73 m2/year [95% confidence interval (CI) 0.19–0.23]. After the IDEAL trial results were published, mean eGFR at dialysis commencement did not show any temporal change [−0.01 mL/min/1.73 m2/year (95% CI −0.03–0.01)]. The ROI of the IDEAL trial was AU$35.70/AU$1 spent, an estimated savings to the Australian and New Zealand health systems of up to AU$84 million/year. Conclusions The previous trend to higher eGFR at dialysis commencement changed following publication of the IDEAL trial results to a steady eGFR that has continued for a decade, avoiding unnecessary dialysis treatments and accruing savings to the Australian and New Zealand health systems. [ABSTRACT FROM AUTHOR]

This study presents a technoeconomic analysis of renewables-based hydrogen production in Queensland, Australia under Optimistic, Reference and Pessimistic scenarios to address uncertainty in cost predictions. The goal of the work was to ascertain if the target fam-gate cost of AUD 3/kg (approx. USD 2/kg) could be reached. Economies of scale and the learning rate concept were factored into the economic model to account for the effect of scale-up and cost reductions as electrolyser manufacturing capacity grows. The model assumes that small-scale to large-scale wind turbine (WT)-based and photovoltaic (PV)-based power generation plants are directly coupled with an electrolyser array and utilises hourly generation data for the Gladstone hydrogen-hub region. Employing first a commonly used simplified approach, the electrolyser array was sized based on the maximum hourly power available for hydrogen production. The initial results indicated that scale-up is very beneficial: the levelised cost of green hydrogen (LCOH) could decrease by 49% from $6.1/kg to $3.1/kg when scaling PV-based plant from 10 MW to 1 GW, and for WT-based plant by 36% from $5.8/kg to $3.7/kg. Then, impacts on the LCOH of incorporating curtailment of ineffective peak power and electrolyser overload capacity were investigated and shown to be significant. Also significant was the beneficial effect of recognising that electrolyser efficiency depends on input power. The latter two factors have mostly been overlooked in the literature. Incorporating in the model the influence on the LCOH of real-world electrolyser operational characteristics overcomes a shortcoming of the simplified sizing method, namely that a large portion of electrolyser capacity is under-utilised, leading to unnecessarily high values of the LCOH. It was found that AUD 3/kg is achievable if the electrolyser array is properly sized, which should help to incentivise large-scale renewable hydrogen projects in Australia and elsewhere. • Three electrolyser sizing methods examined to estimate LCOH. • Overload capacity and dynamic efficiency of the electrolyser incorporated, revealing their substantial impact. • Proper sizing of the electrolyser is required to reach LCOH = AUD 3/kg (USD 2/kg). • Scale-up from MW to GW power can approximately halve LCOH through reduced CAPEX. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the lifetime health and economic outcomes of selecting active surveillance (AS), radical prostatectomy (RP), or radiation therapy (RT) as initial management for low- or favorable-risk localized prostate cancer.Methods: A discrete-event simulation model was developed using evidence from published randomized trials. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Costs were included from a public payer perspective in Australian dollars. Outcomes were discounted at 5% over a lifetime horizon. Probabilistic and scenario analyses quantified parameter and structural uncertainty.Results: A total of 60% of patients in the AS arm eventually received radical treatment (surgery or radiotherapy) compared with 90% for RP and 91% for RT. Although AS resulted in fewer treatment-related complications, it led to increased clinical progression (AS 40.7%, RP 17.6%, RT 19.9%) and metastatic disease (AS 13.4%, RP 6.1%, RT 7.0%). QALYs were 10.88 for AS, 11.10 for RP, and 11.13 for RT. Total costs were A$17 912 for AS, A$15 609 for RP, and A$15 118 for RT. At a willingness to pay of A$20 000/QALY, RT had a 61.4% chance of being cost-effective compared to 38.5% for RP and 0.1% for AS.Conclusions: Although AS resulted in fewer and delayed treatment-related complications, it was not found to be a cost-effective strategy for favorable-risk localized prostate cancer over a lifetime horizon because of an increase in the number of patients developing metastatic disease. RT was the dominant strategy yielding higher QALYs at lower cost although differences compared with RP were small. [ABSTRACT FROM AUTHOR]

Background: This study explored the experiences of people from culturally and linguistically diverse (CALD) backgrounds in Greater Western Sydney, Australia, in selected livelihood items during COVID-19 and the perceived impacts of the pandemic on their lives.Methods: A cross-sectional survey was used to collect data between 25 August and 30 September 2020 among CALD communities in Greater Western Sydney. Information was collected on respondents' experiences in selected livelihood items, including housing, finances, safety, accessing social services and activities, finding work, food, clothing, and relationships during COVID-19 and the pandemic's perceived impact on their lives. Descriptive and non-parametric statistics were used to analyze the data.Results: One hundred and ninety-eight participants were included in the study, 45.5% male and 54.5% female. Many respondents reported their experience in the selected livelihood items as "worse" during COVID-19 at the time of the study. The feeling of safety was most disrupted, with 56% of respondents rating their experience as "worse". This experience was followed by accessing social support group activities, with 50% of respondents stating their experience of using this service had worsened. The experience of accessing social services and financial situation was rated as "worse" by 41% of respondents. Experience in finding work, housing, and attending schools were all rated as "worse". The median perceived impact of COVID-19 among respondents who rated their experience in the selected livelihood items as "worse" were statistically higher than those who rated their experience as the "same". Respondents' characteristics also predicted the perceived impact of COVID-19. Unemployed respondents were 3.53 (95% CI: 1.16-10.73, p = 0.026) times more likely to perceive the impact of COVID-19 on their lives as "high" compared to employed respondents.Conclusions: The finding demonstrates that the "high" number of respondents had the same situation as before COVID-19 and highlights the level of resilience exhibited by CALD communities in the Australian context. It also suggests that services in Australia were good during the pandemic. However, enhanced policy and initiatives designed to meet the CALD population's needs are required, particularly in the areas most reported to have been disrupted by changes associated with COVID-19. [ABSTRACT FROM AUTHOR]

In light of the dramatic increase in economic impacts due to wildfires over recent years, the need for globally consistent impact modelling of wildfire damages is ever increasing. Insurance companies, individual households, humanitarian organizations, governmental authorities, and investors and portfolio owners are increasingly required to account for climate-related physical risks. In response to these societal challenges, we present an extension to the open-source and open-access risk modelling platform CLIMADA (CLImate ADAptation) for modelling economic impacts of wildfires in a globally consistent and spatially explicit approach. All input data are free, public and globally available, ensuring applicability in data-scarce regions of the Global South. The model was calibrated at resolutions of 1, 4 and 10 km using information on past wildfire damage reported by the disaster database EM-DAT. Despite the large remaining uncertainties, the model yields sound damage estimates with a model performance well in line with the results of other natural catastrophe impact models, such as for tropical cyclones. To complement the global perspective of this study, we conducted two case studies on the recent megafires in Chile (2017) and Australia (2020). The model is made available online as part of a Python package, ready for application in practical contexts such as disaster risk assessment, near-real-time impact estimates or physical climate risk disclosure. [ABSTRACT FROM AUTHOR]

Objectives: Pre‐eclampsia (PE) causes substantial maternal and neonatal mortality and morbidity. In addition to the personal impact on women, children and their families, PE has a significant economic impact on our society. Recent research suggests that a first‐trimester multivariate model is highly predictive of preterm (< 37 weeks' gestation) PE and can be combined successfully with targeted prophylaxis (low‐dose aspirin), resulting in an 80% reduction in prevalence of disease. The aim of this study was to examine the potential health outcomes and cost implications following introduction of first‐trimester prediction and prevention of preterm PE within a public healthcare setting, compared with usual care, and to conduct a cost‐effectiveness analysis to inform health‐service decisions regarding implementation of such a program. Methods: A decision‐analytic model was used to compare usual care with the proposed first‐trimester screening intervention within the obstetric population (n = 6822) attending two public hospitals within a metropolitan district health service in New South Wales, Australia, between January 2015 and December 2016. The model, applied from early pregnancy, included exposure to a variety of healthcare professionals and addressed type of risk assessment (usual care or first‐trimester screening) and use of (compliance with) low‐dose aspirin prescribed prophylactically for prevention of PE. All pathways culminated in six possible health outcomes, ranging from no PE to maternal death. Results were presented as the number of cases of PE gained/avoided and the incremental increase/decrease in economic costs arising from the intervention compared with usual care. Significant assumptions were tested in sensitivity/uncertainty analyses. Results: The intervention produced, across all gestational ages, 31 fewer cases of PE and reduced aggregate economic health‐service costs by 1 431 186 Australian dollars over the 2‐year period. None of the tested iterations of uncertainty analyses reported additional cases of PE or higher economic costs. The new intervention based on first‐trimester screening dominated usual care. Conclusion: This cost‐effectiveness analysis demonstrated a reduction in prevalence of preterm PE and substantial cost savings associated with a population‐based program of first‐trimester prediction and prevention of PE, and supports implementation of such a policy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology [ABSTRACT FROM AUTHOR]

Fire is one of the most notorious hazards in Australia, with important economic impacts and damage to ecosystems. There is a concern of worsening fire conditions under climate variability, but there is little understanding of the variability in fire occurrence related to climate patterns. We present a statistical decomposition for spatio-temporal analysis of changes in fire occurrence in Australia and its association with climate factors. We found evidence of variability in the trend results for fire occurrence, and also some evidence that this variation is related to climate patterns. Our approach has applicability to other climate-related issues, providing a useful tool to identify possible changes in the intensity of occurrence over time, capturing long-term changes, and also seasonal and cyclical effects. [ABSTRACT FROM AUTHOR]

Aim: Decreased cancer incidence and reported changes to clinical management indicate that the COVID‐19 pandemic has delayed cancer diagnosis and treatment. This study aimed to develop and apply a flexible model to estimate the impact of delayed diagnosis and treatment on survival outcomes and healthcare costs based on a shift in the disease stage at treatment initiation. Methods: A model was developed and made publicly available to estimate population‐level health economic outcomes by extrapolating and weighing stage‐specific outcomes by the distribution of stages at treatment initiation. It was applied to estimate the impact of 3‐ and 6‐month delays based on Australian data for stage I breast cancer, colorectal cancer, and lung cancer patients, and for T1 melanoma. Two approaches were explored to estimate stage shifts following a delay: (a) based on the relation between time to treatment initiation and overall survival (breast, colorectal, and lung cancer), and (b) based on the tumor growth rate (melanoma). Results: Using a conservative once‐off 3‐month delay and considering only shifts from stage I/T1 to stage II/T2, 88 excess deaths and $12 million excess healthcare costs were predicted in Australia over 5 years for all patients diagnosed in 2020. For a 6‐month delay, excess mortality and healthcare costs were 349 deaths and $46 million over 5 years. Conclusions: The health and economic impacts of delays in treatment initiation cause an imminent policy concern. More accurate individual patient data on shifts in stage of disease during and after the COVID‐19 pandemic are critical for further analyses. [ABSTRACT FROM AUTHOR]

Aims: To better understand the longstanding inequalities concerning alcohol and tobacco use, we aimed to quantify the effect of household economic security on alcohol and tobacco consumption and expenditure. Design Longitudinal analysis using data from the Household, Income and Labour Dynamics in Australia survey (2001–2018). Setting: Australia Participants: A nationally representative cohort of 24 134 adults aged 25–64 years (187 378 observations). Measurements Tobacco and alcohol use (Yes/No), frequency of use of each per week, household expenditure on each per week, household weekly income (Consumer Price Index [CPI]‐adjusted), employment security (based on conditions of employment) and housing affordability (housing costs relative to household income). Findings At baseline, one‐quarter of the sample used tobacco and 87% used alcohol. Annual increases in household income were associated with the increased use of both tobacco and alcohol for people in households in the lowest 40% of the national income distribution (OR = 1.13, 95% CI = 1.03–1.23 and OR = 1.12, 95% CI = 1.04–1.20, respectively) with no similar income effect observed for higher‐income households. In relation to smoking, the odds of a resident's tobacco use increased when their household was unemployed (OR = 1.32, 95% CI = 1.07–1.62). In relation to alcohol, the odds of use decreased when households were insecurely employed or unemployed, or housing costs were unaffordable (OR = 0.87, 95% CI = 0.77–0.98, OR = 0.66, 95% CI = 0.55–0.80 and OR = 0.84, 95% CI = 0.75–0.93, respectively). This was also reflected in the reduced odds of risky drinking (defined in accordance with Australian guidelines) when housing became unaffordable or households became unemployed (OR = 0.90, 95% CI = 0.81–0.99; OR = 0.82, 95% CI = 0.69–0.98, respectively). Conclusions: In Australia, smoking and drinking appear to exhibit different socio‐behavioural characteristics and household unemployment appears to be a strong determinant of smoking. [ABSTRACT FROM AUTHOR]

Background: Rates of end-stage kidney disease in Australia are highest in the Northern Territory (NT), with the burden of disease heaviest in remote areas. However, the high cost of delivering dialysis services in remote areas has resulted in centralisation, requiring many people to relocate for treatment. Patients argue that treatment closer to home improves health outcomes and reduces downstream healthcare use. Existing dialysis cost studies have not compared total health care costs associated with treatment in different locations.Objective: To estimate and compare, from a payer perspective, the observed health service costs (all cause hospital admissions, emergency department presentations and maintenance dialysis) associated with different dialysis models in urban, rural and remote locations.Methods: Using cost weights attributed to diagnostic codes in the NT Department of Health's hospital admission data set (2008-2014), we calculated the mean (SD) total annual health service costs by dialysis model for 995 dialysis patients. Generalized linear modeling with bootstrapping tested the marginal cost differences between different explanatory variables to estimate 'best casemix'/'worst casemix' cost scenarios.Results: The mean annual patient hospital expenditure was highest for urban models at $97 928 (SD $21 261) and $43 440 (SD $5 048) and lowest for remote at $19 584 (SD $4 394). When combined with the observed maintenance dialysis costs, expenditure was the highest for urban models at $148 510 (SD $19 774). The incremental cost increase of dialysing in an urban area, compared with a rural area, for a relocated person from a remote area, was $5 648 more and increased further for those from remote and very remote areas to $10 785 and $15 118 respectively.Conclusions: This study demonstrates that dialysis treatment in urban areas for relocated people has health and cost implications that maybe greater than the cost of remote service delivery. The study emphasises the importance of considering all health service costs and cost consequences of service delivery models.Key Points For Decision Makers: Relocation for dialysis treatment has serious health and economic consequences. Relocated people have low dialysis attendance and high hospital costs in urban areas. While remote dialysis service models are more expensive than urban models, the comparative cost differences are significantly reduced when all health service costs are included. The delivery of equitable and accessible dialysis service models requires a holistic approach that incorporates the needs of the patient; hence dialysis cost studies must consider the full range of cost impacts beyond the dialysis treatments alone. [ABSTRACT FROM AUTHOR]

There is a significant challenge in responding to second waves of COVID-19 cases, with governments being hesitant in introducing hard lockdown measures given the resulting economic impact. In addition, rising case numbers reflect an increase in coronavirus transmission some time previously, so timing of response measures is highly important. Australia experienced a second wave from June 2020 onwards, confined to greater Melbourne, with initial social distancing measures failing to reduce rapidly increasing case numbers. We conducted a detailed analysis of this outbreak, together with an evaluation of the effectiveness of alternative response strategies, to provide guidance to countries experiencing second waves of SARS-Cov-2 transmission. An individual-based transmission model was used to (1) describe a second-wave COVID-19 epidemic in Australia; (2) evaluate the impact of lockdown strategies used; and (3) evaluate effectiveness of alternative mitigation strategies. The model was calibrated using daily diagnosed case data prior to lockdown. Specific social distancing interventions were modelled by adjusting person-to-person contacts in mixing locations. Modelling earlier activation of lockdown measures are predicted to reduce total case numbers by more than 50%. Epidemic peaks and duration of the second wave were also shown to reduce. Our results suggest that activating lockdown measures when second-wave case numbers first indicated exponential growth, would have been highly effective in reducing COVID-19 cases. The model was shown to realistically predict the epidemic growth rate under the social distancing measures applied, validating the methods applied. The timing of social distancing activation is shown to be critical to their effectiveness. Data showing exponential rise in cases, doubling every 7–10 days, can be used to trigger early lockdown measures. Such measures are shown to be necessary to reduce daily and total case numbers, and the consequential health burden, so preventing health care facilities being overwhelmed. Early control of second wave resurgence potentially permits strict lockdown measures to be eased earlier. [ABSTRACT FROM AUTHOR]

Background: There are 20,000 sudden cardiac arrests (SCAs) in Australia annually, with 90% case-fatality.Objective: The present study calculated both the health and economic impact of SCAs in Victoria, Australia.Methods: Data on all SCAs attended by Ambulance Victoria from July 2017 to June 2018 were collected regarding age, gender, and survival to hospital, discharge and 12 months. Pre-SCA employment status of all patients was modelled using age and gender-matched Australian economic data. A Markov state-transition model with a five-year horizon calculated health and economic impact in years of life lived (YLL), productivity-adjusted life years (PALYs) and gross domestic product (GDP) lost. A counterfactual Markov state-transition model assessed outcomes of an identical cohort of patients who did not experience SCA. All values were discounted by 5%.Results: In 12 months, 4637 people suffered SCAs in Victoria, of whom 1516 (32.7%) were working at the time. 695 patients (15.0%) survived to hospital, 325 (7.0%) to discharge, and 303 (6.5%) to 12 months. In five years following their SCA, the cohort lost 15,922 years of life and 2327 PALYs. Reduced productivity led to GDP losses of AUD$448 million (92.8% relative reduction). Extrapolated to the 20,000 SCAs occurring across all of Australia, total GDP losses approached AUD$2 billion.Conclusion: The health and economic burden of SCAs is high, predominantly underpinned by very high mortality. Annual national losses approach AUD$2 billion (USD$1.42 billion) and are comparable to productivity losses from all cancers combined. Prioritising research and state-of-the-art care for SCA patients appears economically sound. [ABSTRACT FROM AUTHOR]

Aim: To characterise the physical, psychological, and quality of life burden associated with serogroup B invasive meningococcal disease (IMD) in children. Methods: Children aged up to 14 years at the time of serogroup B IMD, who were admitted to intensive care units of two tertiary paediatric hospitals in New South Wales, Australia between January 2009 and December 2013 were recruited. Children underwent clinical and neuropsychological assessments up to 6 years post‐disease. Results: Eleven children were assessed, with a median age of 16 months (range 4–46 months) at time of disease. The median follow‐up time was 50 months (range 10–67 months). Seven (63.6%) cases had one or more long‐term sequelae involving permanent and evolving physical disability. Three cases had ongoing medical conditions including two with seizures and one with ataxia and hypermetropia. Five required ongoing medical and allied health care. Other complications identified included anxiety, speech delay, low average full‐scale IQ score (median 85, interquartile range 89–103) and borderline memory impairment. Conclusions: Serogroup B IMD is associated with significant long‐term morbidity and burden on the child and family with substantial economic implications. The impact of this on the total cost of IMD needs to be further quantified, and better considered in vaccine cost‐effectiveness analyses. [ABSTRACT FROM AUTHOR]

Australia reported 909 fatalities by the end of 2020 from 28,408 infectious cases with over 600 people dying in Victoria alone, with 54 deaths in New South Wales (NSW) and 13 deaths in Tasmania compared to just a handful across the other states. Scott Morrison whipped up a media storm in October when he stated in Question Time that Chief Executive Officer (CEO) of Australia Post, Christine Holgate, should stand aside and "if she doesn't wish to do that, she can go". China was also incensed that the federal government passed legislation preventing states like Victoria from signing "Belt and Road Initiative" agreements with foreign nations, especially directed at China. Australia endured the so-called "second wave" of COVID-19 in the latter half of 2020, but nationally experienced significantly different impacts and policy responses. [Extracted from the article]

Indigenous Australian landowners are increasingly seeking to develop agricultural production on their lands to improve the welfare and economic opportunities of their communities. This can require substantial capital input and, in the absence of enough government funding, Indigenous groups are turning to private investors. Development literature has explored private sector‐led and 'financialized' approaches to development at a macro level as something that is done to communities; however, less research has examined how remote communities themselves seek to develop their natural assets through partnerships with businesses and with global finance. This article examines the work being done to prepare land for external investment. It provides an example of emergent assetization processes being undertaken outside the financial sector, driven by social outcomes seemingly beyond the domain of shareholder value. Paradoxically, individuals engaged in these asset‐making processes may oppose the withdrawal of direct funding for community development associated with a financialization of development, yet they are left with few options but to further these efforts by seeking private finance themselves — facilitating financialization for development. This interaction of structural effects and local agency complicates narratives of financialization as they are commonly presented and has important implications for Indigenous economic development in Northern Australia. [ABSTRACT FROM AUTHOR]

It is well established that relationship separation has greater negative economic consequences for mothers than for fathers in Australia and other developed countries. While research has shown that, at an aggregate level, such negative impacts tend to diminish with time, the rate of change is generally slower for mothers than fathers, and a higher proportion of mothers than fathers continue to experience entrenched financial difficulties. Less is known about the variability of economic journeys experienced by women and men, taken separately, and factors influencing diverse economic trajectories. Drawing on data from the Longitudinal Study of Separated Families (LSSF), which followed up a large sample parents at three post‐separation points, this article examines poverty rates across a 4‐year period, transitions into and out of poverty and factors affecting these pathways. [ABSTRACT FROM AUTHOR]

Chickpeas (Cicer arietinum L.) are a high value crop for farmers, but price penalties will be imposed or grain rejected whenever the standards are not met by growers whose crops suffer grain defects in a particular season. Australian chickpeas are renowned for their high quality and are generally in high demand globally because of good farming practice and strict grain quality standards. However, small quantities of defective seed in grain loads can reduce the price paid to individual farmers, with significant financial impacts. Information is scarce on the types of defects causing price penalties and there is no information on the magnitude of those penalties. An online farmer survey was conducted to capture information on the types of grain defects, price penalties imposed and load rejections with respect to the delivery of their 2017 chickpea crop. Here we show that the cost to individual chickpea farmers affected by price penalties or load rejections ranged from AU$743 to $1 293 750. Furthermore, the total cost of seed defects was calculated to be $154.2 million in that season, equating to a revenue loss of 23.7% of gross value of production in Australia. Chickpea seed defects also contributed to additional costs including seed cleaning, further transport costs and harvest delays, with subsequent risk of yield losses and further quality defects. Too often, crop yields are the focus while seed quality is overlooked as an essential driver of farmer profitability. We demonstrate how important seed quality is to farmer profitability; if 'yield is King' then seed quality is certainly Queen. We suggest that farmers prioritise harvest of their chickpea crops ahead of harvest of cereal crops to minimise the risk of chickpea seed defects and seed loss, and to maximise profits from this higher value crop. Additional surveys over several seasons are warranted to refine information on the types of seed defects occurring in chickpea and their financial impacts on farmers, and they could be expanded to other crops and countries. We suggest that misclassification of seed defects needs further exploration, as does research into minimising the major causes of seed defects. Improvements to grain classification systems globally should be sought to provide better support for farmer profitability so that they can continue to feed the world. In addition to yield, seed quality is an important driver of farmer profitability. Our survey showed a revenue loss of 23% of gross value of production for chickpea farmers solely from grain quality penalties. In addition, some 'seed markings' were misclassified as 'mould', which has a lower threshold and harsher price penalties. Improvements in grain classification globally are needed to ensure that farmers are appropriately rewarded for good quality, remain financially viable, and continue to feed the expanding global population. [ABSTRACT FROM AUTHOR]

Biological invasions are accelerating, and invasive species can have large economic impacts as well as severe consequences for biodiversity. During invasions, species can interact, potentially resulting in hybridization. Here, we examined two Cakile species, C. edentula and C. maritima (Brassicaceae), that co‐occur and may hybridize during range expansion in separate regions of the globe. Cakile edentula invaded each location first, while C. maritima established later, apparently replacing the former. We assessed the evidence for hybridization in western North America and Australia, where both species have been introduced, and identified source populations with 4561 SNPs using Genotype‐by‐Sequencing. Our results indicate that C. edentula in Australia originated from one region of eastern North America while in western North America it is probably from multiple sources. Cakile maritima in Australia is derived from at least two different parts of Europe while the introduction in western North America is from one. Although morphological evidence of hybridization is generally limited to mixed species populations in Australia and virtually absent elsewhere, our genetic analysis revealed relatively high levels of hybridization in Australia (58% hybrids using Admixture) and supported the presence of hybrids in western North America (16% hybrids using Admixture) and New Zealand. Hybrids might be commonly overlooked in invaders, as identification based solely on morphological traits may represent only the tip of the iceberg. Our study reveals a repeated pattern of invasion, hybridization and apparent replacement of one species by another, which offers an opportunity to investigate the role of hybridization and introgression during invasion. [ABSTRACT FROM AUTHOR]

Religiosity potentially has a significant economic impact in Australia, but we do not currently have a good understanding of that impact. Research sponsored by the research project called 'The Study for the Economic Impact of Religion on Society' (SEIROS) has sought to capture, in part, the role religiosity plays in contributing to economic life in Australia by measuring how religious commitment enhances volunteering and donation behaviour. That research focuses on an individual's commitment rather than their institutional engagement with religious organisations. Based on a survey of religious engagement, and building on the approach of Lyons and Nivison-Smith (2006), SEIROS engaged Deloitte Access Economics (DAE) to build a logistic regression model which captured a positive impact of religiosity on volunteering and giving, measured by comparing persons coming to faith in adult life against people who never identify as being religious. However, this article argues that the DAE study suffers from the limitation of measuring religiosity as a 'treatment effect' captured by conversion in adult life and excludes the cohort of persons who have been religious since youth. As a result, the impact of religious engagement on giving of time and money may be understated. [ABSTRACT FROM AUTHOR]

Australian undergraduate students are facing difficult economic circumstances and rates of psychological distress are well above the general population. Many are combining their study with paid work to manage financially. There is, however, little to no research on the relationship between economic pressures, academic demands and health (mental and physical) among these young adults. This study used a mixed-methods approach, combining semi-structured interviews with health measures to investigate the interactions and interconnections between work, study and health among 22 Australian undergraduate students. Thematic data analysis concentrated on the effect of time constraints on health, due to the financial and academic demands of contemporary undergraduate life. We found that students felt time-pressured, and commonly sacrificed sleep, nutrition, exercise and lecture attendance as a way of managing employment demands. These strategies contributed to poor health; we observed very high rates of psychological distress, poor sleep, diet and exercise, peaking during exams. Our in-depth study illustrates the challenges facing the current generation of undergraduate students in Australia, raising their study–work conflict as a genuine public health and social equity issue. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori infection has had a major impact on the global health of billions of people. Triple therapy was extensively used in Australia by 1986 for H pylori eradication after its discovery in 1984 and was critical in reducing the morbidity and mortality associated with this infection. Aims: This study analyzed hospital admission, mortality, and therapeutic data to determine the economic and clinical impact that antibiotic triple therapy had on peptic ulcer disease (PUD) in Australia. Methods: An analysis of indirect and direct cost‐savings in Australia between 1990 and 2015 associated with triple therapy and the impact on PUD mortality and hospital admissions. Results: The direct and indirect impacts of PUD treated by triple therapy between 1990 and 2015 suggest that triple therapy is likely to have prevented 18 665 deaths, and saved 258 887 life years and 33 776 productive life years. The total savings, over the 26‐year period, including direct and indirect costs, are calculated to be $10.03 billion, equating to an average annual saving of $393.419 million. Conclusions: This study highlights the enormous benefits to Australia's health care of the discovery of triple therapy, a relatively low‐cost antibiotic regimen which brought considerable savings via the reduction in morbidity (hospital admissions) and mortality related to PUD. It is likely that benefits of similar scale occurred internationally. [ABSTRACT FROM AUTHOR]

What is known about the topic? When assessing real growth in costs, it is important to adjust for inflation through indexation to the Consumer Price Index (CPI). The change in prices or costs over time can be calculated in constant currency amounts by adjusting by a ratio of the CPI in the year of interest to the CPI in the baseline year. What does this paper add? Rosenberg et al. (2022) did not calculate out-of-pocket costs in constant currency, which does not give an accurate estimation of costs adjusted for inflation. What are the implications for practitioners? We calculated examples to illustrate the impact of such adjustments, which substantially impact the results of the study. [ABSTRACT FROM AUTHOR]

Background: Of all cancer types, healthcare for lung cancer is the third most costly in Australia, but there is little detailed information about these costs. Our aim was to provide detailed population-based estimates of health system costs for lung cancer care, as a benchmark prior to wider availability of targeted therapies/immunotherapy and to inform cost-effectiveness analyses of lung cancer screening and other interventions in Australia. Methods: Health system costs were estimated for incident lung cancers in the Australian 45 and Up Study cohort, diagnosed between recruitment (2006–2009) and 2013. Costs to June 2016 included services reimbursed via the Medicare Benefits Schedule, medicines reimbursed via the Pharmaceutical Benefits Scheme, inpatient hospitalisations, and emergency department presentations. Costs for cases and matched, cancer-free controls were compared to derive excess costs of care. Costs were disaggregated by patient and tumour characteristics. Data for more recent cases identified in hospital records provided preliminary information on targeted therapy/immunotherapy. Results: 994 eligible cases were diagnosed with lung cancer 2006–2013; 51% and 74% died within one and three years respectively. Excess costs from one-year pre-diagnosis to three years post-diagnosis averaged ~$51,900 per case. Observed costs were higher for cases diagnosed at age 45–59 ($67,700) or 60–69 ($63,500), and lower for cases aged ≥80 ($29,500) and those with unspecified histology ($31,700) or unknown stage ($36,500). Factors associated with lower costs generally related to shorter survival: older age (p<0.0001), smoking (p<0.0001) and unknown stage (p = 0.002). There was no evidence of differences by year of diagnosis or sex (both p>0.50). For 465 cases diagnosed 2014–2015, 29% had subsidised molecular testing for targeted therapy/immunotherapy and 4% had subsidised targeted therapies. Conclusions: Lung cancer healthcare costs are strongly associated with survival-related factors. Costs appeared stable over the period 2006–2013. This study provides a framework for evaluating the health/economic impact of introducing lung cancer screening and other interventions in Australia. [ABSTRACT FROM AUTHOR]

Urban greening can enhance sustainability and liveability, through conserving biodiversity, mitigating urban heat and enhancing people's health and wellbeing. However, urban greening is complex, as it occurs in unique ecological settings, with social, cultural and economic factors shaping the forms it takes. This raises questions about the governance of urban greening, including what counts as 'good governance'. In this paper, we first outline principles of good governance drawn from the natural resource management context. We then present four urban greening initiatives from Melbourne Australia representing different scales, land tenures and organising structures. Following this, we analyse how governance of the four initiatives addresses good governance principles. Our analysis shows that there are diverse ways in which urban greening can be practiced and governed. The importance of more 'informal' initiatives should not be discounted relative to formalised initiatives, as a spectrum of approaches can be seen as strength. Further, in determining what constitutes good governance, the standards against which initiatives are assessed should be tailored to their specific circumstances, and consider impacts to the environment itself. These findings point to good urban greening governance being both situated and principled. [ABSTRACT FROM AUTHOR]

Importance: This is the first study to estimate the lifetime costs associated with keratoconus based on a questionnaire completed by patients and highlights the significant economic burden of the disease. As keratoconus affects individuals from a young age, the study highlights keratoconus as a public health concern. Background: Keratoconus is a disorder characterized by corneal steepening and thinning, leading to reduced visual acuity. To date, there have been no studies evaluating the economic costs of keratoconus from a patient's perspective. Design: A randomized cross‐sectional study undertaken in Australia where keratoconus subjects were recruited from public and private ophthalmology and optometry clinics. Participants: A total of 100 participants completed the questionnaire: median age was 31 years and 57% were males. Methods: A keratoconus health expenditure questionnaire was designed to assess direct and indirect expenditures for each individual. Main Outcome Measures: Total direct and indirect costs associated with the condition were calculated along with the estimated lifetime per capita costs. Results: The total cost related to direct and indirect care was estimated to be AUD 3365. By applying our cost data to keratoconus prevalence data for the Australian population, the total cost is estimated to be approximately AUD 44.7 million per year in Australia. Conclusions and Relevance: Our results show that the costs associated with the diagnosis and management of keratoconus represent a significant cost to patients. An understanding of this is important not only to individuals and their families, but also health care providers, health insurers and the wider health system. [ABSTRACT FROM AUTHOR]

Air travel has become central to Australian academic practice, with flying increasingly seen as crucial to the progression of successful academic careers. This paper seeks to understand why academic air travel has come to be perceived as so necessary, particularly given its significant environmental, social, and economic implications. Drawing on the mobilities paradigm and social practice theory, we seek to understand how air travel practices are a key part of contemporary academic careers. We conducted an online survey of 301 academics and 24 in depth semi-structured interviews to understand academic air travel in Australia, finding that it is seen as a means to connect and collaborate within and between academic communities, and to counteract the effects of 'remoteness'. This remoteness is experienced domestically and internationally, by Australian academics who feel they must travel to perceived centres of knowledge production to further their careers. Academics often frame their 'need' for connections as necessarily involving physical co-presence. Air travel offers career benefits for those who can take advantage of it, and corresponding drawbacks for those 'stuck on the ground'. We conclude by discussing the need for valuing localised forms of collaboration as markers of success, and developing imaginative alternatives to academic flying. [ABSTRACT FROM AUTHOR]

Share housing is changing. Once considered a form of short-term housing and a lifestyle choice for young adults fresh out of the family home, share housing is increasingly playing a broader role into advanced adulthood. Recent work has claimed the emergence of Generation Rent; however, the reconfiguration of housing experiences is illustrated not only by renting but also by an increase in house sharing and the emergence of 'Generation Share' within the renting cohort. We know surprisingly little about share housing and its increasingly important role in housing. This paper draws upon exploratory research conducted on share housing in Sydney, Australia, and argues that share housing as traditionally understood is changing. Share housing has a widening demographic and it is driven primarily by economic factors. Despite this, the social affordances offered by share housing are highly valued. Share housing therefore offers us a unique lens into changing housing pathways and values and provokes us to think of ways to produce more socially, economically, and environmentally sustainable housing. [ABSTRACT FROM AUTHOR]

There are a range of priority setting methods for non-communicable disease (NCDs) prevention. However, existing methods are often designed without detailed consideration of local context and political economy– critical success factors for implementation. In Australia, codes of practice under state government Public Health Acts could be used for NCD prevention. To inform the potential development of codes of practice under Public Health Acts, this study aimed to co-create a priority setting framework that accounts for local context and the prevailing regulatory agenda. A priority setting framework was co-produced by a multidisciplinary technical advisory group consisting of government representatives, public health lawyers and academic experts. It incorporated general prioritisation criteria (evidence, cost-effectiveness, equity, burden of disease) and local contextual criteria (legal compatibility, unmet-needs, political acceptability, structural and technical feasibility, community support). The framework was then applied in practice through surveys and policy dialogue workshops to discuss political economy factors. Policies were limited to nutrition, alcohol and physical activity risk factors. Through the prioritisation process, the most impactful, feasible and acceptable policies for NCD prevention via state government codes of practice were: restrictions on in-store placement of unhealthy products, enhancing data systems and capabilities for health surveillance and implementation monitoring, removal of unhealthy foods and drinks sold and supplied in public institutions, prohibition of marketing of unhealthy foods and drinks on assets controlled by government, and implementation of subsidies or grants to increase fruit and vegetable intake. The process illustrated that explicit consideration of local context, legal compatibility and the political economy had a substantial influence on the prioritised list of actions. The proposed priority setting framework is designed to be flexible and adaptable to varying contexts, can be embedded in government processes or utilised by researchers and practitioners to co-produce a regulatory agenda that is locally relevant. • Priority setting methods lack consideration of local context and political economy factors • Our framework considers evidence, legal compatibility, local context and political economy • Priority policies varied when political economy was added to traditional evidence-based • Many evidence-based policies are not legally compatible in a local context • Legal compatibility and political feasibility are critical success factors for implementation [ABSTRACT FROM AUTHOR]

Women during midlife are consuming larger quantities of alcohol than any other age group of women and any other generation of midlife women previously. This is concerning given alcohol related-health risks coalesce with age-related health risks for women, in particular, breast cancer. In-depth interviews with 50 Australian midlife women (aged 45–64) from different social classes explored women's personal accounts of midlife transitions and their descriptions of the role of alcohol in navigating these life experiences; both daily occurrences as well as significant moments in the life course. Our findings point to the complex, confusing and co-existing biographical transitions women experience during midlife (generational, embodied/physiological and material changes) that sharpen a role for alcohol in women's lives and are nuanced by social class (volumes of social, economic and cultural capital). We pay close attention to women's affective interpretations of these transitions and ways alcohol is used to feel robust in navigating daily life or easing their prospective futures. Critically, for women living with limited access to capital, and who could not 'measure up' to social ideals by comparison with the achievements and trajectories of other midlife women, alcohol reconciled their disappointment. Our exploration shows how the social class conditions that shape how women make sense of their transitions through midlife might be differently shaped to enable different options forreducing drinking. Policy must address the social and emotional concerns women experience through midlife transitions that give alcohol a worthwhile place in their lives. A first step might be responding to the absence of community and leisure spaces for midlife women especially those that do not integrate alcohol, with benefits including addressing loneliness, isolation and feeling invisible, and enabling positive constructions of midlife identities. Structural barriers to participation and feelings of worth must be removed for women who lack social, cultural and economic resources. [ABSTRACT FROM AUTHOR]

Objective: Since legislative changes in 2010, certain health care services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for reimbursement under the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). The aim of the present study was to describe survey results relating to the care provided by PPNPs subsidised through the MBS and PBS. Methods: PPNPs in Australia were invited to complete an electronic survey exploring their practice activities. Quantitative data were analysed using descriptive statistics and 95% confidence intervals were calculated for percentages where relevant. Free text data were analysed using thematic analysis. Results: Seventy-three PPNPs completed the survey. The most common form of payment reported (34%; n = 25) was payment by direct fee for service (MBS rebate only, also known as bulk billing). Seventy-five per cent of participants (n = 55) identified that there were aspects of care delivery not adequately described and compensated by the current nurse practitioner (NP) MBS item numbers. 87.7% (n = 64) reported having a PBS prescriber authorisation number. Themes identified within the free text data that related to the constraints of the MBS and PBS included 'duplication of services' and 'level of reimbursement'. Conclusion: The findings of the present study suggest that PPNPs are providing subsidised care through the MBS and PBS. The PPNPs in the present study reported challenges with the current structure and breadth of the NP MBS and PBS items, which restrict them from providing complete episodes of patient care. What is known about the topic?: Since the introduction of legislative changes in 2010, services provided by PPNPs in Australia have been eligible for subsidisation through the MBS and PBS. What does this paper add?: This paper provides data on PPNPs' provision of care subsidised through the MBS and PBS. What are the implications for practitioners?: Eligibility to provide care subsidised through the MBS and PBS has enabled the establishment of PPNP services. The current breadth and structure of the NP MBS and PBS item numbers have restricted the capacity of PPNPs to provide complete episodes of patient care. [ABSTRACT FROM AUTHOR]