Differences in primary health care delivery to Australia\u27s Indigenous population : a template for use in economic evaluations

Background Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia&rsquo;s Indigenous population. A template has been developed which can adapt mainstream health intervention data to the Indigenous setting.Methods The &lsquo;Indigenous Health Service Delivery Template&rsquo; has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs), and mainstream general practitioner (GP) practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream health intervention data to allow its economic evaluation as if delivered from an ACCHS.Results The template indicates that more resources are required in the delivery of health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly.Conclusions The Indigenous Health Service Delivery Template reveals significant differences in the way health interventions are delivered from ACCHSs compared to mainstream GP practices. It is important that these differences are included in the conduct of economic evaluations to ensure results are relevant to Indigenous Australians. Similar techniques would be generalisable to other disadvantaged minority populations. This will allow resource allocation decision-makers access to economic evidence that more accurately represents the needs and context of disadvantaged groups, which is particularly important if addressing health inequities is a stated goal.<br /

Epidemiology of a hybrid swarm: evidence of 11 feline infectious agents circulating in a population of sympatric European wildcat hybrids and free-living domestic cats, in Scotland:Epidemiology of a hybrid swarm

Hybridisation between wild and domestic species poses a serious challenge to conservation management and can, potentially, lead to extinction. Alongside it, disease transmission will inevitably occur. However, the link between these two phenomena has historically been neglected. In Scotland, the European wildcat is particularly threatened by hybridisation with the domestic cat, a process promoted by long-term habitat loss, human encroachment, and persecution. Between 2015 and 2019, free-living cats (n = 120) were captured in six conservation priority areas of northern Scotland. Samples were collected for infectious disease screening (feline immunodeficiency virus, feline leukaemia virus, feline calicivirus, feline herpesvirus, Chlamydia felis, Mycoplasma felis, Bordetella bronchiseptica, Mycoplasma haemofelis, Candidatus Mycoplasma haemominutum, Candidatus Mycoplasma turicensis, and Tritrichomonas foetus) and genetic analysis. Polymerase chain reaction and reverse transcriptionPCR were used to detect infectious DNA or RNA, respectively. The hybrid score (Q) for each individual cat was determined using a 35-SNP-marker test. Statistical analysis investigated the association between Q and probability of infection, accounting for spatial clustering. The results confirmed the presence of 11 infectious agents circulating in the free-living cat population of northern Scotland, which consists of a hybrid swarm between F. silvestris and F. catus. For eight of them (feline leukaemia virus, feline herpesvirus C. felis, B. bronchiseptica, M. felis, M. haemofelis, Ca. M. haemominutum, and T. foetus), there was no significant association between infection probability and Q, supporting our hypothesis that the hybrid swarm may be functioning as a single epidemiological unit. Considering the impact of infectious diseases on health, welfare, and population dynamics of domestic cats, their presence in the extremely fragile and hybridised population of F. silvestris in Scotland could be population limiting or, potentially, contribute to local extinction. Comprehensive disease surveillance, risk analysis, and domestic cat management will be essential for the European wildcat conservation, particularly where hybridisation is increasing and anthropogenic factors are prevalent

Cleaning up the cosmological constant

We present a novel idea for screening the vacuum energy contribution to the overall value of the cosmological constant, thereby enabling us to choose the bare value of the vacuum curvature empirically, without any need to worry about the zero-point energy contributions of each particle. The trick is to couple matter to a metric that is really a composite of other fields, with the property that the square-root of its determinant is the integrand of a topological invariant, and/or a total derivative. This ensures that the vacuum energy contribution to the Lagrangian is non-dynamical. We then give an explicit example of a theory with this property that is free from Ostrogradski ghosts, and is consistent with solar system physics and cosmological tests.Comment: 8 pages, typos corrected and more text added, version accepted for publication in JHE

Text messaging to help women with overweight or obesity lose weight after childbirth:the intervention adaptation and SMS feasibility RCT

Background There is a need to develop weight management interventions that fit seamlessly into the busy lives of women during the postpartum period. Objective The objective was to develop and pilot-test an evidence- and theory-based intervention, delivered by short message service, which supported weight loss and weight loss maintenance in the postpartum period. Design Stage 1 involved the development of a library of short message service messages to support weight loss and weight loss maintenance, with personal and public involvement, focusing on diet and physical activity with embedded behaviour change techniques, and the programming of a short message service platform to allow fully automated intervention delivery. Stage 2 comprised a 12-month, single-centre, two-arm, pilot, randomised controlled trial with an active control. Setting This study was set in Northern Ireland; women were recruited via community-based approaches. Participants A total of 100 women with overweight or obesity who had given birth in the previous 24 months were recruited. Interventions The intervention group received an automated short message service intervention about weight loss and weight loss maintenance for 12 months. The active control group received automated short message service messages about child health and development for 12 months. Main outcome measures The main outcomes measured were the feasibility of recruitment and retention, acceptability of the intervention and trial procedures, and evidence of positive indicative effects on weight. Weight, waist circumference and blood pressure were measured by the researchers; participants completed a questionnaire booklet and wore a sealed pedometer for 7 days at baseline, 3, 6, 9 and 12 months. Outcome assessments were collected during home visits and women received a voucher on completion of each of the assessments. Qualitative interviews were conducted with women at 3 and 12 months, to gather feedback on the intervention and active control and the study procedures. Quantitative and qualitative data were used to inform the process evaluation and to assess fidelity, acceptability, dose, reach, recruitment, retention, contamination and context. Results The recruitment target of 100 participants was achieved (intervention, n = 51; control, n = 49); the mean age was 32.5 years (standard deviation 4.3 years); 28 (28%) participants had a household income o

Correction: Virtual Morality: Transitioning from Moral Judgment to Moral Action?

[This corrects the article DOI: 10.1371/journal.pone.0164374.]