Diabetes and the use of primary care provider services in rural, remote and metropolitan Australia

Introduction: Public health agencies around the world are concerned about an ever-increasing burden of type 2 diabetes and related disability. Access to primary care providers (PCPs) can support early diagnosis and management. However, there is limited literature on how frequently older people with diabetes access PCPs, and their levels of access in rural Australia relative to metropolitan areas. Methods: In this research, patterns of PCP use among those with diagnosed diabetes and those without diagnosed diabetes (referred to as ‘healthy' individuals) were compared using a large survey of more than 230 000 people aged 45 years and older from New South Wales, Australia. A published model to study the PCP access patterns of a group of individuals with diabetes risk was used. Results: Annual visits to PCPs among people aged 45 years or more with diabetes in rural areas, while higher than for healthy rural residents, were significantly lower than their metropolitan counterparts, mirroring similar disparities in PCP use across the rural-urban divide in the healthy population. Similar patterns were present in the high-risk population. Nevertheless, people with diabetes visited PCPs around four times a year, which is around the recommended number of annual visits, although some groups (eg those with comorbidities) may need more visits. Conclusion: Patterns of PCP use among rural residents, while significantly less frequent than their metropolitan counterparts, are at the recommended level for people with diabetes

INFLATE : a protocol for a randomised controlled trial comparing nasal balloon autoinflation to no nasal balloon autoinflation for otitis media with effusion in Aboriginal and Torres Strait Islander children

Background: Otitis media with effusion (OME) is common and occurs at disproportionately higher rates among Indigenous children. Left untreated, OME can negatively affect language, development, learning, and health and wellbeing throughout the life-course. Currently, OME care includes observation for 3 months followed by consideration of surgical ventilation tube insertion. The use of a non-invasive, low-cost nasal balloon autoinflation device has been found beneficial in other populations but has not been investigated among Aboriginal and Torres Strait Islander children. Methods/design: This multi-centre, open-label, randomised controlled trial will determine the effectiveness of nasal balloon autoinflation compared to no nasal balloon autoinflation, for the treatment of OME among Aboriginal and Torres Strait Islander children in Australia. Children aged 3–16 years with unilateral or bilateral OME are being recruited from Aboriginal Health Services and the community. The primary outcome is the proportion of children showing tympanometric improvement of OME at 1 month. Improvement is defined as a change from bilateral type B tympanograms to at least one type A or C1 tympanogram, or from unilateral type B tympanogram to type A or C1 tympanogram in the index ear, without deterioration (type A or C1 to type C2, C3, or B tympanogram) in the contralateral ear. A sample size of 340 children (170 in each group) at 1 month will detect an absolute difference of 15% between groups with 80% power at 5% significance. Anticipating a 15% loss to follow-up, 400 children will be randomised. The primary analysis will be by intention to treat. Secondary outcomes include tympanometric changes at 3 and 6 months, hearing at 3 months, ear health-related quality of life (OMQ-14), and cost-effectiveness. A process evaluation including perspectives of parents or carers, health care providers, and researchers on trial implementation will also be undertaken. Discussion: INFLATE will answer the important clinical question of whether nasal balloon autoinflation is an effective and acceptable treatment for Aboriginal and Torres Strait Islander children with OME. INFLATE will help fill the evidence gap for safe, low-cost, accessible OME therapies. Trial registration: Australia New Zealand Clinical Trials Registry ACTRN12617001652369. Registered on 22 December 2017. The Australia New Zealand Clinical Trials Registry is a primary registry of the WHO ICTRP network and includes all items from the WHO Trial Registration data set. Retrospective registration.</p

Demographic Forecasting

Demographic Forecasting introduces new statistical tools that can greatly improve forecasts of population death rates. Mortality forecasting is used in a wide variety of academic fields, and for policymaking in global health, social security and retirement planning, and other areas. Federico Girosi and Gary King provide an innovative framework for forecasting age-sex-country-cause-specific variables that makes it possible to incorporate more information than standard approaches. These new methods more generally make it possible to include different explanatory variables in a time-series regression for each cross section while still borrowing strength from one regression to improve the estimation of all. The authors show that many existing Bayesian models with explanatory variables use prior densities that incorrectly formalize prior knowledge, and they show how to avoid these problems. They also explain how to incorporate a great deal of demographic knowledge into models with many fewer adjustable parameters than classic Bayesian approaches, and develop models with Bayesian priors in the presence of partial prior ignorance

Health issues and services : a complex socio-cognitive-technical system

This paper investigates the additional resources needed to care for patients with chronic conditions in Australian hospitals. A number of different methods are used to define chronic conditions, based on previous work. The analysis shows that within each Diagnosis Related Group (DRG) patients with chronic conditions utilize significant more resources than patients without. Since admissions within the same DRG are reimbursed at the same level, these results point to potential inefficiencies in the hospital reimbursement system

Data science and the policy completion problem

The link between policy analysis and data science is more delicate than it may appear. A new policy, by de_nition, will change the underlying data generating model, rendering classi_cation or supervised learning inapplicable. Perhaps eliciting causal relations from observational data is the correct framework for estimating policy impact. However, there are substantial gaps between the theory, practice and feasibility of causal models. In this paper we argue that transduction, a form of inference where we reason from speci _c training instances to speci_c test instances, may provide an appropriate framework for evidence-based policy analysis. In particular, we will demonstrate that the matrix completion problem, introduced in the data science community for making predictions in recommendation systems, can be a powerful tool for both predicting and evaluating the impact of new policy changes

Joint prediction of chronic conditions onset : comparing multivariate probits with multiclass support vector machines

We consider the problem of building accurate models that can predict, in the short term (2–3 years), the onset of one or more chronic conditions at individual level. Five chronic conditions are considered: heart disease, stroke, diabetes, hypertension and cancer. Covariates for the models include standard demographic/socio-economic variables, risk factors and the presence of the chronic conditions at baseline. We compare two predictive models. The first model is the multivariate probit (MVP), chosen because it allows to model correlated outcome variables. The second model is the Multiclass Support Vector Machine (MSVM), a leading predictive method in machine learning. We use Australian data from the Social, Economic, and Environmental Factory (SEEF) study, a follow up to the 45 and Up Study survey, that contains two repeated observations of 60,000 individuals in NSW, over age 45. We find that MSVMs predictions have specificity rates similar to those of MVPs, but sensitivity rates that are on average 12% points larger than those of MVPs, translating in a large average improvement in sensitivity of 30%

Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population

Background: New DSM-5 diagnostic criteria for eating disorders were published in 2013. Adolescent cohort studies in the Australian community indicate that the point prevalence of DSM-5 eating disorders may be as high as 15% in females and 3% in males. The goal of the current study was to determine the 3-month prevalence of DSM-5 disorders in a representative sample of Australian older adolescents and adults. A secondary aim was to explore the demographic correlates of these disorders, specifically, age, gender, income, and educational attainment and presence of obesity. Methods: We conducted and merged sequential cross-sectional population survey data of adults (aged over 15 years) collected in 2008 and in 2009 (n = 6041). Demographic information and the occurrence of regular (at least weekly over the past 3 months) objective and subjective binge eating, extreme dietary restriction, purging behaviors, and overvaluation of weight and/or shape, were assessed. Results: The 3-month prevalence of anorexia nervosa and bulimia nervosa were both under 1% whereas the prevalence of binge eating disorder (BED) and sub-threshold BED were 5.6-6.9%. The prevalence of BED including overvaluation of weight/shape was 3%. Other specified and unspecified eating disorders including purging disorder were less common, under 1% to 1.4%. While people with eating disorders were generally younger than others, the mean age was in the fourth decade for anorexia nervosa and bulimia nervosa and in the fourth or fifth decade for all other disorders. Most people with eating disorders had similar household incomes and educational attainments to the general population. People with bulimia nervosa, BED and sub-threshold bulimia nervosa were more likely to be obese than people without an eating disorder. Conclusions: The findings support the expanded demographic distribution of eating disorders. There is a relatively high prevalence of BED compared to anorexia nervosa and bulimia nervosa. As it is in BED, obesity is a very common co-morbidity in bulimia nervosa

The effects of the affordable care act on workers' health insurance coverage

Employer-sponsored health insurance is the cornerstone of the U.S. health insurance system. David Blumenthal, among others, has described this system as an “accident of history,” and he quotes Uwe Reinhardt, a leading authority on health care economics, as asserting that “If we had to do it over again, no policy analyst would recommend this model.”1 Nonetheless, the Patient Protection and Affordable Care Act of 2010 (the ACA) builds on, rather than eliminates, employer-sponsored insurance. However, because the ACA makes substantial changes to the employer-based system, some wonder whether the employers' role in providing insurance will diminish or disappear over time

Could we have covered more people at less cost? : technically, yes; politically, probably not

The process by which Congress considers legislation rarely affords the public an opportunity to examine how the outcomes might change if components of the law were structured differently. We evaluated how the recently enacted health reform law performed relative to a large number of alternative designs on measures of effectiveness and efficiency. We found that only a few different approaches would produce both more newly insured people and a lower cost to the government. However, these are characterized by design options that seemed political untenable, such as higher penalties, lower subsidies, or less generous Medicaid expansion

The effects of tobacco control policy on the Social Security trust fund

Smoking cessation will reduce mortality, and this reduction in mortality will affect Social Security in two main ways. First, more people will survive to retirement age, and these additional survivors will pay taxes, thus benefitting the Social Security trust fund. Second, because more people will reach retirement, and life expectancy following retirement will be higher, the outflow from the Social Security trust fund will also increase. Tobacco control policy may also affect Social Security in other ways. Because workers will be in better health and thus more productive, their earnings will be greater and they will retire somewhat later, thus increasing the inflow of taxes. In addition, because fewer workers will die, there will be a reduction in survivor benefits to underage children and their caretakers. The overall effect of a reduction in smoking on the Social Security trust fund is an empirical question that requires evaluation of these offsetting effects