Small towns big returns: economic and social impact of the Karen resettlement in Nhill

Increased resettlement of migrants and refugees in regional Australia has been an on-going focus of the policies of successive governments. One recent regional resettlement experience, initiated at the local level, has yielded significant outcomes for a small regional community and the refugees involved. This case study – Small towns, Big returns – provides new and important insights into the economic and social value that can accrue through these initiatives, and identifies factors that contribute to their success. These insights can both create the case for, and inform planning of, resettlement in other Australian communities. Since early 2010, approximately 160 Karen refugees have resettled in Nhill, in north western Victoria. Nhill is a small, relatively isolated agricultural town in the wheat-belt Wimmera region of Victoria. Like a number of small regional towns, Nhill has faced a declining working-age population, which has had flow-on implications for the economic and social prosperity of the town. The context of a declining population, combined with very low unemployment, was a key catalyst in this resettlement. In particular there was a need for labour to support expansion of Luv-a-Duck, the largest local commercial business, and driven by a combination of economic and humanitarian motivations, Luv-a-Duck management identified the Karen as potential employees. Through a staged recruitment and resettlement process, the Karen community now comprises approximately 10% of the Nhill population, including significant numbers of working age adults and families with young children. Furthermore, labour force participation linked to this population increase is high. Fifty-four Karen are directly employed in Luv-a-Duck, and seven are employed in businesses that supply Luv-a-Duck. Beyond this, the increased population has enabled the creation and filling of additional jobs across a number of broader community businesses and services. A total of 70.5 Full Time Equivalent (FTE) positions have been added to the regional economy over the five year period of analysis, representing approximately 3% of total employment across Hindmarsh. The economic impact of this increased labour supply, in terms of Gross Regional Product – as modelled by Deloitte Access Economics, is estimated to be $41.5 million in net present value terms. The wider social impacts of the resettlement of the Karen in Nhill provide the story behind the numbers. In short the Karen resettlement in Nhill has helped to: • redress population decline for the township • revitalise local services and attract increased government funding • increase social capital across both communitie

Estimating the returns to UK publicly funded cancer-related research in terms of the net value of improved health outcomes

© 2014 Glover et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background - Building on an approach developed to assess the economic returns to cardiovascular research, we estimated the economic returns from UK public and charitable funded cancer-related research that arise from the net value of the improved health outcomes. Methods - To assess these economic returns from cancer-related research in the UK we estimated: 1) public and charitable expenditure on cancer-related research in the UK from 1970 to 2009; 2) net monetary benefit (NMB), that is, the health benefit measured in quality adjusted life years (QALYs) valued in monetary terms (using a base-case value of a QALY of GB£25,000) minus the cost of delivering that benefit, for a prioritised list of interventions from 1991 to 2010; 3) the proportion of NMB attributable to UK research; 4) the elapsed time between research funding and health gain; and 5) the internal rate of return (IRR) from cancer-related research investments on health benefits. We analysed the uncertainties in the IRR estimate using sensitivity analyses to illustrate the effect of some key parameters. Results - In 2011/12 prices, total expenditure on cancer-related research from 1970 to 2009 was £15 billion. The NMB of the 5.9 million QALYs gained from the prioritised interventions from 1991 to 2010 was £124 billion. Calculation of the IRR incorporated an estimated elapsed time of 15 years. We related 17% of the annual NMB estimated to be attributable to UK research (for each of the 20 years 1991 to 2010) to 20 years of research investment 15 years earlier (that is, for 1976 to 1995). This produced a best-estimate IRR of 10%, compared with 9% previously estimated for cardiovascular disease research. The sensitivity analysis demonstrated the importance of smoking reduction as a major source of improved cancer-related health outcomes. Conclusions - We have demonstrated a substantive IRR from net health gain to public and charitable funding of cancer-related research in the UK, and further validated the approach that we originally used in assessing the returns from cardiovascular research. In doing so, we have highlighted a number of weaknesses and key assumptions that need strengthening in further investigations. Nevertheless, these cautious estimates demonstrate that the returns from past cancer research have been substantial, and justify the investments made during the period 1976 to 1995.Wellcome Trust, Cancer Research UK, the National Institute of Health Research, and the Academy of Medical Sciences

Lack of asthma and rhinitis control in general practitioner-managed patients prescribed fixed-dose combination therapy in Australia

Peer reviewedPublisher PD

Clinical and cost-effectiveness of two ways of delivering guided self-help for people with an eating disorder: a multi-arm randomised controlled trial

Objective: Increasing the availability and accessibility of evidence-based treatments for eating disorders is an important goal. This study investigated the effectiveness and cost-effectiveness of guided self-help via face-to-face meetings (fGSH) and a more scalable method, providing support via email (eGSH). Method: A pragmatic, randomised controlled trial was conducted at three sites. Adults with binge-eating disorders were randomised to fGSH, eGSH, or a waiting list condition, each lasting 12 weeks. The primary outcome variable for clinical effectiveness was overall severity of eating psychopathology and, for cost-effectiveness, binge-free days, with explorative analyses using symptom abstinence. Costs were estimated from both a partial societal and healthcare provider perspective. Results: Sixty participants were included in each condition. Both forms of GSH were superior to the control condition in reducing eating psychopathology (IRR = -1.32 [95% CI -1.77, -0.87], p<0.0001; IRR = -1.62 [95% CI -2.25, -1.00], p<0.0001) and binge eating. Attrition was higher in eGSH. Probabilities that fGSH and eGSH were cost-effective compared with WL were 93% (99%) and 51% (79%), respectively, for a willingness to pay of £100 (£150) per additional binge-free day. Discussion: Both forms of GSH were associated with clinical improvement and were likely to be cost-effective compared with a waiting list condition. Provision of support via email is likely to be more convenient for many patients although the risk of non-completion is greater

The effectiveness of environment assessment tools to guide refurbishment of Australian residential aged care facilities: A systematic review

Objective: To determine applicability of environment assessment tools in guiding minor refurbishments of Australian residential aged care facilities. Method: Studies conducted in residential aged care settings using assessment tools which address the physical environment were eligible for inclusion in a systematic review. Given these studies are limited, tools which have not yet been utilised in research settings were also included. Tools were analysed using a critical appraisal screen. Results: Forty-three publications met the inclusion criteria. Ten environment assessment tools were identified, of which four addressed all seven minor refurbishment domains of lighting, colour and contrast, sound, flooring, furniture, signage and way finding. Only one had undergone reliability and validity testing. Conclusion: There are four tools which may be suitable to use for minor refurbishment of Australian residential aged care facilities. Data on their reliability, validity and quality are limited

Perspectives on Enabling Education for Indigenous Students at Three Comprehensive Universities in Regional Australia

Daniels, CR ORCiD: 0000-0002-0672-0450Indigenous students, particularly those from regional and remote areas, are under-represented in both higher education and vocational education in Australia. Enabling programs seek to address this under-representation. They offer pathways to higher education, are important in lifting participation rates and potentially encourage mobility between the sectors. However, strategic development of enabling programs is based on little evidence about student or staff experiences. This chapter presents a qualitative research project underpinned by the strengths-based approach of conscientisation, exploring how Indigenous learning journeys via enabling programs can respect and grow cultural identity, while simultaneously developing study skills. The research considered interpretations of ‘success’ from the perspectives of students and teachers participating in enabling courses. The research found that enabling programs were an ‘important’ and ‘exciting journey’ for students that brought about transformation of the inner self through the building of ‘resilience’, ‘strength’, ‘confidence’, ‘self-esteem’, ‘self-worth’, ‘cultural understanding’ and ‘identity’. Success was experienced across multiple dimensions of students’ lived experience including ‘cultural identity’, ‘voice’, self-realisation, self-acceptance and ‘pride’. Staff suggested that enabling programs imparted an ‘underlying layer’ of skills. Recognition of Indigenous people as ‘yarners’ and ‘story tellers’, along with ways of incorporating ‘both-ways’ methodologies, need to be considered when developing the curriculum. This chapter reports on research which will be used to inform the development of a best-practice framework for Indigenous education enabling programs in Australia, particularly in regional and comprehensive education settings

Age-related macular degeneration in a randomized controlled trial of low-dose aspirin: Rationale and study design of the ASPREE-AMD study

Purpose: Although aspirin therapy is used widely in older adults for prevention of cardiovascular disease, its impact on the incidence, progression and severity of age-related macular degeneration (AMD) is uncertain. The effect of low-dose aspirin on the course of AMD will be evaluated in this clinical trial. Design: A sub-study of the ‘ASPirin in Reducing Events in the Elderly’ (ASPREE) trial, ASPREE-AMD is a 5-year follow-up double-blind, placebo-controlled, randomized trial of the effect of 100 mg daily aspirin on the course of AMD in 5000 subjects aged 70 years or older, with normal cognitive function and without cardiovascular disease at baseline. Non-mydriatic fundus photography will be performed at baseline, 3-year and 5-year follow-up to determine AMD status. Primary outcome measures: The incidence and progression of AMD. Exploratory analyses will determine whether aspirin affects the risk of retinal hemorrhage in late AMD, and whether other factors, such as genotype, systemic disease, inflammatory biomarkers, influence the effect of aspirin on AMD. Conclusion: The study findings will be of significant clinical and public interest due to a potential to identify a possible low cost therapy for preventing AMD worldwide and to determine risk/benefit balance of the aspirin usage by the AMD-affected elderly. The ASPREE-AMD study provides a unique opportunity to determine the effect of aspirin on AMD incidence and progression, by adding retinal imaging to an ongoing, large-scale primary prevention randomized clinical trial

Mind the gap: What is the difference between alcohol treatment need and access for Aboriginal and Torres Strait Islander Australians?

Background: Alcohol-related harms cause great concern to Aboriginal and Torres Strait Islander (Indigenous) communities in Australia as well as challenges to policy makers. Treatment of alcohol use disorders forms one component of an effective public health response. While alcohol dependence typically behaves as a chronic relapsing condition, treatment has been shown to be both effective and cost-effective in improving outcomes. Provision of alcohol treatment services should be based on accurate assessment of treatment need. Aims: In this paper, we examine the likely extent of the gap between voluntary alcohol treatment need and accessibility. We also suggest potential approaches to improve the ability to assess unmet need. Discussion: Existing methods of assessing the treatment needs of Indigenous Australians are limited by incomplete and inaccurate survey data and an over-reliance on existing service use data. In addition to a shortage of services, cultural and logistical barriers may hamper access to alcohol treatment for Indigenous Australians. There is also a lack of services funded to a level that allows them to cope with clients with complex medical and physical comorbidity, and a lack of services for women, families and young people. A lack of voluntary treatment services also raises serious ethical concerns, given the expansion of mandatory treatment programmes and incarceration of Indigenous Australians for continued drinking. The use of modelling approaches, linkage of administrative data sets and strategies to improve data collection are discussed as possible methods to better assess treatment need

Looking in the mirror: Reflecting on 25 years of Inclusive Education in Australia

This is the author accepted manuscript. The final version is available from Taylor & Francis (Routledge) via the DOI in this record.Australia was an early signatory to the Salamanca Statement, and it espouses inclusive education (IE) as the overarching philosophy of education for all. A 2015 critique of IE in Australia (Anderson and Boyle 2015) found that while some gains had been made, particularly in the recognition of the needs of some of the nation’s minority groups, the lack of a nationally accepted understanding of IE meant that it was transpiring in fundamentally distinctive ways across the eight education jurisdictions, with different outcomes for different groups of students. This paper reflects upon why Australia has struggled to enact the recommendations outlined in the Salamanca Statement a quarter of a century ago. The impacts of current education reforms, including the current model of educational provision, the understanding of disability and educational need, and the neo-liberal concepts of standardisation, measurement, and choice are explored. It challenges the idea that IE is the work of schools, and instead argues the need for a national approach to IE. Governments must acknowledge the barriers that their current policies and structures erect and shift towards a more inclusive model of educational delivery – for the benefit of all children and young people in Australia

How do pharmacists in English general practices identify their impact? An exploratory qualitative study of measurement problems

Background: In England, there is an ongoing national pilot to expand pharmacists’ presence in general practice. Evaluation of the pilot includes numerical and survey-based Key Performance Indicators (KPIs) and requires pharmacists to electronically record their activities, possibly by using activity codes. At the time of the study (2016), no national evaluation of pharmacists’ impact in this environment had been formally announced. The aim of this qualitative study was to identify problems that English pharmacists face when measuring and recording their impact in general practice. Methods: All pharmacists, general practitioners (GPs) and practice managers working across two West London pilot sites were invited, via e-mail, to participate in a focus group study. Appropriately trained facilitators conducted two audio-recorded, semi-structured focus groups, each lasting approximately one hour, to explore experiences and perceptions associated with the KPIs. Audio-recordings were transcribed verbatim and the data analysed thematically. Results: In total, 13 pharmacists, one GP and one practice manager took part in the study. Four major themes were discerned: inappropriateness of the numerical national KPIs (“whether or not we actually have positive impact on KPIs is beyond our control”); depth and breadth of pharmacists’ activity (“we see a huge plethora of different patients and go through this holistic approach - everything is looked at”); awareness of practice based pharmacists’ roles (“I think the really important [thing] is that everyone knows what pharmacists in general practice are doing”); and central evaluation versus local initiatives (“the KPIs will be measured by National Health Service England regardless of what we think” versus “what I think is more pertinent, are there some local things we’re going to measure?”). Conclusions: Measures that will effectively capture pharmacists’ impact in general practice should be developed, along with a set of codes reflecting the whole spectrum of pharmacists’ activities. Our study also points out the significance of a transparent, robust national evaluation, including exploring the needs/expectations of practice staff and patients regarding pharmacists’ presence in general practice