Associations between selected immune-mediated diseases and tuberculosis: record-linkage studies

PMCID: PMC3616814This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Consumers of Higher Education in Australia : do the unfair contract term provisions in the Australian Consumer Law provide effective protection for students as consumers of educational services?

Extensive consumer protection legislation has existed in Australia for nearly four decades. The new Australian Consumer Law (‘ACL’) in schedule 2 of the Competition and Consumer Act 2010 (Cth) (‘CCA’)1 is the most significant change to consumer rights since the introduction of the Trade Practices Act 1974 (Cth) (‘TPA’). Over a corresponding period of time, the landscape of the higher education sector has been transformed into a culture of consumerism with the student at the centre as the consumer. However, students have seldom sought redress in relation to infringement of their rights as consumers under consumer protection legislation and more rarely successfully. It is recognised that some rights do accrue to students as consumers of educational services under the ACL, principally with regard to promotional activities of higher education institutions (‘HEI’).2 It is not certain that the ACL can provide effective protection for students as consumers of educational services beyond this known application to address issues regarding the nature of the service provided. This research is specifically concerned with whether the introduction of an Unfair Contract Terms (‘UCT’)3 regime in the ACL overcomes identifiable barriers faced by students using consumer protection as a means to ensure they receive services as promised and advances their rights as consumers.The ACL saw the introduction of an UCT regime, which previously had only existed in limited jurisdictions in Australia, notably Victoria, as a means of protection in consumer contracts. Now any term in a consumer contract that is an unfair term as defined under the ACL is void. The application of these provisions in the context of the student as a consumer of educational services will require first an assessment of whether there exists in Australia a contract between the student and HEI. Further, for the UCT to apply, the student–HEI contract must be a ‘standard form’ ‘consumer contract’4, for ‘services’ occurring in ‘trade or commerce’5. Importantly the analysis will identify any connection between the UCT provisions regarding substantive unfairness and the protection this affords students in the context of the provision of educational services, such as the design and delivery of courses, as distinct from promotional activities.Ordinarily, claims concerned with the nature of the educational service provided are considered matters that involve questions of academic judgement. Courts have been consistent in their reluctance to examine matters relating to the exercise of academic judgement and accordingly such matters are considered non-justiciable. The significance of the UCT provisions is that rather than just focusing on procedural unfairness, they attempt to deal with substantive unfairness.6 In the context of the student–HEI contract and provision of educational services, the UCT provisions have the potential to ensure that the student–HEI contract does not contain terms that are substantively unfair. Consequently, HEIs may now be obliged to provide educational services in a manner students might reasonably expect upon entering the student– HEI contract. Thus the new UCT regime may deal with claims concerning the provision of educational services more effectively than other actionable rights that require the court to examine matters of academic judgement in relation to the nature of educational services provided. The analysis will evaluate the implications for the higher education sector and make recommendations for change in the current practice

Unethical aspects of homeopathic dentistry

In the last year there has been a great deal of public debate about homeopathy, the system of alternative medicine whose main principles are that like cures like and that potency increases relative to dilution. The House of Commons Select Committee on Science and Technology concluded in November 2009 that there is no evidence base for homeopathy, and agreed with some academic commentators that homeopathy should not be funded by the NHS. While homeopathic doctors and hospitals are quite commonplace, some might be surprised to learn that there are also many homeopathic dentists practising in the UK. This paper examines the statements made by several organisations on behalf of homeopathic dentistry and suggests that they are not entirely ethical and may be in breach of various professional guidelines

Hospital admissions for vitamin D related conditions and subsequent immune-mediated disease: record-linkage studies

PMCID: PMC3729414The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1741-7015/11/171. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

General practitioners’ risk literacy and real-world prescribing of potentially hazardous drugs: a cross-sectional study

Background: Overuse of medical care is a pervasive problem. Studies using hypothetical scenarios suggest that physicians’ risk literacy influences medical decisions; real-world correlations, however, are lacking. We sought to determine the association between physicians’ risk literacy and their real-world prescriptions of potentially hazardous drugs, accounting for conflicts of interest and perceptions of benefit–harm ratios in low-value prescribing scenarios. Setting and sample: Cross-sectional study—conducted online between June and October 2023 via field panels of Sermo (Hamburg, Germany)—with a convenience sample of 304 English general practitioners (GPs). Methods: GPs’ survey responses on their treatment-related risk literacy, conflicts of interest and perceptions of the benefit–harm ratio in low-value prescribing scenarios were matched to their UK National Health Service records of prescribing volumes for antibiotics, opioids, gabapentin and benzodiazepines and analysed for differences. Results: 204 GPs (67.1%) worked in practices with ≥6 practising GPs and 226 (76.0%) reported 10–39 years of experience. Compared with GPs demonstrating low risk literacy, GPs with high literacy prescribed fewer opioids (mean (M): 60.60 vs 43.88 prescribed volumes/1000 patients/6 months, p=0.016), less gabapentin (M: 23.84 vs 18.34 prescribed volumes/1000 patients/6 months, p=0.023), and fewer benzodiazepines (M: 17.23 vs 13.58 prescribed volumes/1000 patients/6 months, p=0.037), but comparable volumes of antibiotics (M: 48.84 vs 40.61 prescribed volumes/1000 patients/6 months, p=0.076). High-risk literacy was associated with lower conflicts of interest (ϕ = 0.12, p=0.031) and higher perception of harms outweighing benefits in low-value prescribing scenarios (p=0.007). Conflicts of interest and benefit–harm perceptions were not independently associated with prescribing behaviour (all ps >0.05). Conclusions and relevance: The observed association between GPs with higher risk literacy and the prescription of fewer hazardous drugs suggests the importance of risk literacy in enhancing patient safety and quality of care

Admission to hospital for bronchiolitis in England: Trends over five decades, geographical variation and association with perinatal characteristics and subsequent asthma

Background: Admission of infants to hospital with bronchiolitis consumes considerable healthcare resources each winter. We report an analysis of hospital admissions in England over five decades. Methods: Data were analysed from the Hospital In-Patient Enquiry (HIPE, 1968-1985), Hospital Episode Statistics (HES, 1989-2011), Oxford Record Linkage Study (ORLS, 1963-2011) and Paediatric Intensive Care Audit Network (PICANet, 2003-2012). Cases were identified using International Classification of Diseases (ICD) codes in discharge records. Bronchiolitis was given a separate code in ICD9 (used in England from 1979). Geographical variation was analysed using Local Authority area boundaries. Maternal and perinatal risk factors associated with bronchiolitis and subsequent admissions for asthma were analysed using record-linkage. Results: All-England HIPE and HES data recorded 468 138 episodes of admission for bronchiolitis in infants aged <1 year between 1979 and 2011. In 2011 the estimated annual hospital admission rate was 46.1 (95% CI 45.6 to 46.6) per 1000 infants aged <1 year. Between 2004 and 2011 the rates rose by an average of 1.8% per year in the all-England HES data, whereas admission rates to paediatric intensive care changed little (1.3 to 1.6 per 1000 infants aged <1 year). A fivefold geographical variation in hospital admission rates was observed. Young maternal age, low social class, low birth weight and maternal smoking were among factors associated with an increased risk of hospital admission with bronchiolitis. Conclusions: Hospital admissions for infants with bronchiolitis have increased substantially in recent years. However, cases requiring intensive care have changed little since 2004

The characteristics of suicides within a week of discharge after psychiatric hospitalisation – a nationwide register study

BACKGROUND: The characteristics of victims of immediate post-discharge suicides are not well known. We explored these characteristics for the purposes of better recognition and preventive efforts of potential immediate post-discharge suicides. METHODS: Suicides from a Finnish nationwide register were linked with preceding periods of psychiatric inpatient treatment. Characteristics of suicides within a week of discharge were compared to those occurring later after discharge. RESULTS: Compared to other previously hospitalised suicide victims, those committing suicide within a week of discharge were more often female, unmarried, had a higher grade of education and a diagnosis of schizophrenia spectrum or affective disorder, tended to use more drowning and jumping from heights as the methods for suicide and had gained a smaller improvement in psychological functioning during hospitalization. CONCLUSION: These characteristics indicate a more severe psychopathology, relatively poorer level of functioning, less global response to hospitalisation, and a more frequent choice of lethal and easily available method for suicide. Potentially suicidal psychiatric patients should be better recognized and an immediate follow-up arranged if it is decided they be discharged

Newly qualified doctors' views about whether their medical school had trained them well: questionnaire surveys

A survey of newly qualified doctors in the UK in 2000/2001 found that 42% of them felt unprepared for their first year of employment in clinical posts. We report on how UK qualifiers' preparedness has changed since then, and on the impact of course changes upon preparedness. Methods Postal questionnaires were sent to all doctors who qualified from UK medical schools, in their first year of clinical work, in 2003 (n = 4257) and 2005 (n = 4784); and findings were compared with those in 2000/2001 (n = 5330). The response rates were 67% in 2000/2001, 65% in 2003, and 43% in 2005. The outcome measure was the percentage of doctors agreeing with the statement "My experience at medical school has prepared me well for the jobs I have undertaken so far". Results In the 2000/2001 survey 36.3% strongly agreed or agreed with the statement, as did 50.3% in the 2003 survey and 58.5% in 2005 (chi-squared test for linear trend: χ2 = 259.5; df = 1; p < 0.001). Substantial variation in preparedness between doctors from different medical schools, reported in the first survey, was still present in 2003 and 2005. Between 1998 and 2006 all UK medical schools updated their courses. Within each cohort a significantly higher percentage of the respondents from schools with updated courses felt well prepared. Conclusion UK medical schools are now training doctors who feel better prepared for work than in the past. Some of the improvement may be attributable to curricular change