Consumer preferences for teledermoscopy screening to detect melanoma early

Introduction: ‘Store and forward’ teledermoscopy is a technology with potential advantages for melanoma screening. Any large-scale implementation of this technology is dependent on consumer acceptance. Aim: To investigate preferences for melanoma screening options compared with skin self-examination in adults considered to be at increased risk of developing skin cancer. Methods: A discrete choice experiment was completed by 35 consumers, all of whom had prior experience with the use of teledermoscopy, in Queensland, Australia. Participants made 12 choices between screening alternatives described by seven attributes including monetary cost. A mixed logit model was used to estimate the relative weights that consumers place on different aspects of screening, along with the marginal willingness to pay for teledermoscopy as opposed to screening at a clinic. Results: Overall, participants preferred screening/diagnosis by a health professional rather than skin self-examination. Key drivers of screening choice were for results to be reviewed by a dermatologist; a higher detection rate; fewer non-cancerous moles being removed in relation to every skin cancer detected; and less time spent away from usual activities. On average, participants were willing to pay AUD110 to have teledermoscopy with dermatologist review available to them as a screening option. Discussion and conclusions: Consumers preferentially value aspects of care that are more feasible with a teledermoscopy screening model, as compared with other skin cancer screening and diagnosis options. This study adds to previous literature in the area which has relied on the use of consumer satisfaction scales to assess the acceptability of teledermoscopy

Final Report on the Consequences of LHC Civil Engineering for the SPS and LEP

The excavation of the shafts and caverns for the ATLAS and CMS experiments and the transfer lines between the SPS and LHC will start whilst LEP and the SPS are running. This will be during a period when LEP should be at its peak performance and the SPS will be providing beams for LEP, fixed target physics and LHC test beams. Simulations show that movements of the machine tunnels can be expected during the excavation and it is essential that this does not affect the performance of the SPS and LEP. The predicted movements are of sufficient amplitude to prevent machine operation if no precautions are taken. This report contains the conclusions of the working group which has been studying these problems

The First New Zealanders: Patterns of Diet and Mobility Revealed through Isotope Analysis

Direct evidence of the environmental impact of human colonization and subsequent human adaptational responses to new environments is extremely rare anywhere in the world. New Zealand was the last Polynesian island group to be settled by humans, who arrived around the end of the 13th century AD. Little is known about the nature of human adaptation and mobility during the initial phase of colonization. We report the results of the isotopic analysis (carbon, nitrogen and strontium) of the oldest prehistoric skeletons discovered in New Zealand to assess diet and migration patterns. The isotope data show that the culturally distinctive burials, Group 1, had similar diets and childhood origins, supporting the assertion that this group was distinct from Group 2/3 and may have been part of the initial colonizing population at the site. The Group 2/3 individuals displayed highly variable diets and likely lived in different regions of the country before their burial at Wairau Bar, supporting the archaeological evidence that people were highly mobile in New Zealand since the initial phase of human settlement.: University of Otago Research Grant (http://www.otago.ac.nz/research/otago004140.html); A grant-in-aid by the School of Medical Sciences, University of Otago (http://osms.otago.ac.nz/); The Mason Foundation (http://research-hub.griffith.edu.au/display/fosc_MASONG); Royal Society of New Zealand Marsden Fund (http://www.royalsociety.org.nz/programmes/funds/marsden/) grant number UOO0711. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Antibiotic-Resistant Pathogenic Escherichia Coli Isolated from Rooftop Rainwater-Harvesting Tanks in the Eastern Cape, South Africa

Although many developing countries use harvested rainwater (HRW) for drinking and other household purposes, its quality is seldom monitored. Continuous assessment of the microbial quality of HRW would ensure the safety of users of such water. The current study investigated the prevalence of pathogenic Escherichia coli strains and their antimicrobial resistance patterns in HRW tanks in the Eastern Cape, South Africa. Rainwater samples were collected weekly between June and September 2016 from 11 tanks in various areas of the province. Enumeration of E. coli was performed using the Colilert®18/Quanti-Tray® 2000 method. E. coli isolates were obtained and screened for their virulence potentials using polymerase chain reaction (PCR), and subsequently tested for antibiotic resistance using the disc-diffusion method against 11 antibiotics. The pathotype most detected was the neonatal meningitis E. coli (NMEC) (ibeA 28%) while pathotype enteroaggregative E. coli (EAEC) was not detected. The highest resistance of the E. coli isolates was observed against Cephalothin (76%). All tested pathotypes were susceptible to Gentamicin, and 52% demonstrated multiple-antibiotic resistance (MAR). The results of the current study are of public health concern since the use of untreated harvested rainwater for potable purposes may pose a risk of transmission of pathogenic and antimicrobial-resistant E. coli

Cross country comparisons of technical efficiency of health production: a demonstration of pitfalls.

It has been proposed that cross-country comparisons of the technical efficiency of health production, estimated using data envelopment analysis (DEA), have useful applications for policy makers. In theory such an analysis utilizes measures of the socioeconomic determinants of health relevant to all social policy, not just health policy. Using OECD and WHO data, this article critically analyses a number of outstanding theoretical questions regarding the use of DEA in this setting. It concludes that until such questions are addressed, the resultant implications for policy will be based on misleading information

Policy Implications of Complementary and Alternative Medicine Use in Australia: Data from the National Health Survey

Objectives: The objective of this study was to investigate the drivers of complementary and alternative medicine (CAM) use in the general population in Australia and to identify key policy implications. Data and methods: The National Health Survey 2007/2008, a representative survey of the Australian population, provides information on CAM use (practitioners and products) in the last 12 months. All adult respondents (N=15,779) aged 18 years or older are included in this study. Logistic regression is employed to determine the effect of socio-economic, condition-specific, health behavior variables, and private health insurance status on CAM use. Results: In addition to socio-economic variables known to affect CAM use, individuals who have a chronic condition, particularly a mental health condition, are more likely to use CAM. There does not appear to be a correlation between CAM use and more frequent General Practitioner use; however, ancillary private health insurance is correlated with a greater likelihood of CAM use, as expected. Conclusions: The Australian government does not currently intervene in the CAM market in a systematic way. CAM is clearly considered to be a legitimate and important component of health care for many Australians, despite the limited availability of clinical evidence for its efficacy and safety. Policy interventions may include the regulation of CAM products, practitioners, and information as well as providing subsidies for cost-effective modalities

Economic considerations of complementary and alternative medicine (CAM) use in Australia

The term ‘Complementary and Alternative Medicine’ (CAM) is used to describe “a broad set of health care practices that are not part of the dominant health care system”. Much of the CAM literature to date has been published in clinical, public health or psychology journals, owing to the multidisciplinary nature of various aspects of use. However, given high levels of expenditure and prevalence of use in many countries, including Australia, there is now a small but expanding health economics literature. This thesis contains seven self-contained chapters which have all been published or submitted to peer-reviewed journals and which contribute significantly to this area. The overarching objective of this thesis is to better understand the policy implications of CAM use in Australia from a health economics perspective. This thesis also forms the health economics component of a large, interdisciplinary, National Health and Medical Research Council (NHMRC) funded project titled ‘Complementary and Alternative Medicine, Economics, Lifestyle and Other Therapeutic approaches for chronic conditions’ (CAMelot). The project focuses on the strong link between CAM use and chronic illness, especially two of the most prevalent and resource consuming chronic conditions in Australia - type 2 diabetes and cardiovascular disease. One of the important contributions of this thesis is to characterise the use of CAM in the general population and compare and contrast this to the sub-group of people living with chronic illness. Throughout the chapters, differences emerged between different types of CAM use, for example, different explanatory factors were associated with CAM practitioner use compared with product use. Chronic illnesses, particularly mental health conditions, are found to be predictive of both CAM practitioner and product use. In contrast, healthy behaviours such as being a healthy weight, exercising and not smoking were more likely to be associated with CAM users compared with non-users, perhaps suggesting two different ‘types’ of CAM user – a more healthy, motivated CAM user and one who is likely to have one or more chronic illnesses. In terms of the consequences of CAM use by people with chronic illness, a consistent negative correlation was found between CAM use and QoL. It is plausible that this association may work in either direction. Low QoL may be seen as a driver of CAM use, perhaps suggesting that CAM is utilised to mitigate against side effects of conventional treatment or as a ‘last resort’. Alternatively, inappropriate or ineffective CAM use may lead to a decrease in QoL. If the latter is true, it supports the notion of additional consumer support by way of regulation or the provision of (trustworthy) information upon which to base an informed decision. The final two chapters of the thesis explore the potential effect of proposed changes to the labelling of CMs in Australia. Chapter Six uses new generation eye-tracking to better understand how consumers process information during in a complex decision-making environment. In particular we find evidence of decision rules, or simplifying heuristics which may be used as a coping mechanism and have implications for the design of preferences studies in healthcare more generally. In Chapter Seven, results of a discrete choice experiment are presented which suggest that additional labelling has the potential to change consumer behaviour and therefore may be a useful policy intervention. In particular, positively worded statement regarding the regulation status of products are preferred to negatively worded ones and the addition of a traffic-light system to summarise evidence of effectiveness, side-effects and interactions was generally utility enhancing for consumers. Overall, this thesis contributes significantly in an under researched area, given such high prevalence and expenditure, presenting novel and exciting research, in an area which offers many opportunities for future health economics insights. Future research may include an expansion of health technology assessment of individual CAM modalities and treatments; the likely effect of public subsidy of selected CAM modalities on the use of existing subsidised conventional services; and consumer preferences for CAM therapies for different health complaints

Are the economics of Complementary and Alternative Medicine (CAM) different to conventional medicine?

Griffith Health FacultyNo Full Tex

Economic considerations of complementary and alternative medicine (CAM) use in Australia

The term ‘Complementary and Alternative Medicine’ (CAM) is used to describe “a broad set of health care practices that are not part of the dominant health care system”. Much of the CAM literature to date has been published in clinical, public health or psychology journals, owing to the multidisciplinary nature of various aspects of use. However, given high levels of expenditure and prevalence of use in many countries, including Australia, there is now a small but expanding health economics literature. This thesis contains seven self-contained chapters which have all been published or submitted to peer-reviewed journals and which contribute significantly to this area. The overarching objective of this thesis is to better understand the policy implications of CAM use in Australia from a health economics perspective. This thesis also forms the health economics component of a large, interdisciplinary, National Health and Medical Research Council (NHMRC) funded project titled ‘Complementary and Alternative Medicine, Economics, Lifestyle and Other Therapeutic approaches for chronic conditions’ (CAMelot). The project focuses on the strong link between CAM use and chronic illness, especially two of the most prevalent and resource consuming chronic conditions in Australia - type 2 diabetes and cardiovascular disease. One of the important contributions of this thesis is to characterise the use of CAM in the general population and compare and contrast this to the sub-group of people living with chronic illness. Throughout the chapters, differences emerged between different types of CAM use, for example, different explanatory factors were associated with CAM practitioner use compared with product use. Chronic illnesses, particularly mental health conditions, are found to be predictive of both CAM practitioner and product use. In contrast, healthy behaviours such as being a healthy weight, exercising and not smoking were more likely to be associated with CAM users compared with non-users, perhaps suggesting two different ‘types’ of CAM user – a more healthy, motivated CAM user and one who is likely to have one or more chronic illnesses. In terms of the consequences of CAM use by people with chronic illness, a consistent negative correlation was found between CAM use and QoL. It is plausible that this association may work in either direction. Low QoL may be seen as a driver of CAM use, perhaps suggesting that CAM is utilised to mitigate against side effects of conventional treatment or as a ‘last resort’. Alternatively, inappropriate or ineffective CAM use may lead to a decrease in QoL. If the latter is true, it supports the notion of additional consumer support by way of regulation or the provision of (trustworthy) information upon which to base an informed decision. The final two chapters of the thesis explore the potential effect of proposed changes to the labelling of CMs in Australia. Chapter Six uses new generation eye-tracking to better understand how consumers process information during in a complex decision-making environment. In particular we find evidence of decision rules, or simplifying heuristics which may be used as a coping mechanism and have implications for the design of preferences studies in healthcare more generally. In Chapter Seven, results of a discrete choice experiment are presented which suggest that additional labelling has the potential to change consumer behaviour and therefore may be a useful policy intervention. In particular, positively worded statement regarding the regulation status of products are preferred to negatively worded ones and the addition of a traffic-light system to summarise evidence of effectiveness, side-effects and interactions was generally utility enhancing for consumers. Overall, this thesis contributes significantly in an under researched area, given such high prevalence and expenditure, presenting novel and exciting research, in an area which offers many opportunities for future health economics insights. Future research may include an expansion of health technology assessment of individual CAM modalities and treatments; the likely effect of public subsidy of selected CAM modalities on the use of existing subsidised conventional services; and consumer preferences for CAM therapies for different health complaints