Comprehensive Primary Health Care in Australia

Objectives: To identify the extent to which the Alma Ata defined Comprehensive Primary Health Care (CPHC) approach is practised and evaluated in Australia and to describe the role that GPs and other medical practitioners play in it along with implications of this for future policy in light of the Health and Hospital Reform Commission (HHRC) and Primary Health Care taskforce reports, 2009 recommendations.Methods: We conducted a narrative review of the literature (published and grey) from 1987 to mid 2007 as part of a global review carried out by teams of researchers in six regions in 2007.  Results: In Australia, the CPHC approach occurs chiefly in Aboriginal Controlled Community Health Services, state funded community health and in rural/remote and inner city areas.  Participation by GPs in CPHC is limited by funding structures, workforce shortages and heavy workloads.  Factors that facilitated the CPHC approach include flexibility in funding and service provision, cultural appropriateness of services, participation and ownership by local consumers and communities and willingness to address the social determinants of health.Conclusions: The recent HHRC and Primary Health Care Taskforce reports recommend an expansion of CPHC services as a means of tackling health inequities. The findings of this review suggest that resources will need to be directed beyond individual treatment to population health issues, cross-sectorcollaboration and consumer participation in order to realise the CPHC model. Without attention to these areas PHC will not be comprehensive and its ability to contribute to reducing inequities will be severely hampered. The absence of an evaluation culture supported with resources for CPHC programs and services also hinders the ability of practitioners and policy makers to assess the benefits of these programs and how their implementation can be improved. Funding structures, workforce issues and evaluation of programs will all need to be addressed if the health sector is to contribute to the goal of reducing health inequities

Economic Slowdown: Issues and Policies

This report discusses about the Issues and Policies on Economic Slowdown. recent policies have sought to contain damages spilling over from housing and financial markets to border economy

Social Gerontology- Integrative and Territorial Aspects: A Citation Analysis of Subject Scatter and Database Coverage

To determine the mix of resources used in social gerontology research, a citation analysis was conducted. A representative sample of citations was selected from three prominent gerontology journals and information was added to determine subject scatter and database coverage for the cited materials. Results indicate that a significant portion of gerontology research, even from a social science perspective, relies roughly equally on medical resources as it does social science resources. Furthermore, there is a small but defined core of literature constituting scholarly “territory” unique to gerontology. Analysis of database indexing indicated that broad, interdisciplinary databases provide more comprehensive coverage of the cited materials than do subject-specific databases

Measuring capacity building in communities: a review of the literature

<p>Abstract</p> <p>Background</p> <p>Although communities have long been exhorted to make efforts to enhance their own health, such approaches have often floundered and resulted in little or no health benefits when the capacity of the community has not been adequately strengthened. Thus being able to assess the capacity building process is paramount in facilitating action in communities for social and health improvement. The current review aims to i) identify all domains used in systematically documented frameworks developed by other authors to assess community capacity building; and ii) to identify the dimensions and attributes of each of the domains as ascribed by these authors and reassemble them into a comprehensive compilation.</p> <p>Methods</p> <p>Relevant published articles were identified through systematic electronic searches of selected databases and the examination of the bibliographies of retrieved articles. Studies assessing capacity building or community development or community participation were selected and assessed for methodological quality, and quality in relation to the development and application of domains which were identified as constituents of community capacity building. Data extraction and analysis were undertaken using a realist synthesis approach.</p> <p>Results</p> <p>Eighteen articles met the criteria for this review. The various domains to assess community capacity building were identified and reassembled into nine comprehensive domains: "learning opportunities and skills development", "resource mobilization", "partnership/linkages/networking", "leadership", "participatory decision-making", "assets-based approach", "sense of community", "communication", and "development pathway". Six sub-domains were also identified: "shared vision and clear goals", "community needs assessment", "process and outcome monitoring", "sustainability", "commitment to action" and "dissemination".</p> <p>Conclusions</p> <p>The set of domains compiled in this review serve as a foundation for community-based work by those in the field seeking to support and nurture the development of competent communities. Further research is required to examine the robustness of capacity domains over time and to examine capacity development in association with health or other social outcomes.</p

3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial

Background: Liraglutide 3·0 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes. Methods: In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3·0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219. Findings: The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2·7 times longer with liraglutide than with placebo (95% CI 1·9 to 3·9, p&lt;0·0001), corresponding with a hazard ratio of 0·21 (95% CI 0·13–0·34). Liraglutide induced greater weight loss than placebo at week 160 (–6·1 [SD 7·3] vs −1·9% [6·3]; estimated treatment difference −4·3%, 95% CI −4·9 to −3·7, p&lt;0·0001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group. Interpretation: In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3·0 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes. Funding: Novo Nordisk, Denmark

Enantioselective transition-metal catalysis in fragrance chemistry: a new synthesis of Galaxolide

Objectives: To identify the extent to which the Alma Ata defined Comprehensive Primary Health Care (CPHC) approach is practised and evaluated in Australia and to describe the role that GPs and other medical practitioners play in it along with implications of this for future policy in light of the Health and Hospital Reform Commission (HHRC) and Primary Health Care taskforce reports, 2009 recommendations. Methods: We conducted a narrative review of the literature (published and grey) from 1987 to mid 2007 as part of a global review carried out by teams of researchers in six regions in 2007. Results: In Australia, the CPHC approach occurs chiefly in Aboriginal Controlled Community Health Services, state funded community health and in rural/remote and inner city areas. Participation by GPs in CPHC is limited by funding structures, workforce shortages and heavy workloads. Factors that facilitated the CPHC approach include flexibility in funding and service provision, cultural appropriateness of services, participation and ownership by local consumers and communities and willingness to address the social determinants of health. Conclusions: The recent HHRC and Primary Health Care Taskforce reports recommend an expansion of CPHC services as a means of tackling health inequities. The findings of this review suggest that resources will need to be directed beyond individual treatment to population health issues, cross-sector collaboration and consumer participation in order to realise the CPHC model. Without attention to these areas PHC will not be comprehensive and its ability to contribute to reducing inequities will be severely hampered. The absence of an evaluation culture supported with resources for CPHC programs and services also hinders the ability of practitioners and policy makers to assess the benefits of these programs and how their implementation can be improved. Funding structures, workforce issues and evaluation of programs will all need to be addressed if the health sector is to contribute to the goal of reducing health inequities

Economic Slowdown: Issues and Policies

This report first discusses the current state of the economy, including measures that have already been taken by the monetary authorities, and assesses the need for and potential consequences of fiscal stimulus. The second part of the report reviews the proposals discussed during debate on the recently enacted fiscal stimulus, both those adopted and those considered but not adopted. The various stimulus packages differed somewhat, and the report briefly describes those differences. This section includes a discussion of the potential elements of a second stimulus proposal and concludes with a discussion of the macroeconomic effects of the proposals

Economic Slowdown: Issues and Policies

This report first discusses the current state of the economy, including measures that have already been taken by the monetary authorities, and assesses the need for and potential consequences of fiscal stimulus. The second part of the report reviews the proposals discussed during debate on the recently enacted fiscal stimulus, both those adopted and those considered but not adopted. The various stimulus packages differed somewhat, and the report briefly describes those differences. This section also includes a discussion of the potential elements of a second stimulus proposal, and concludes with a discussion of the macroeconomic effects of the proposals. The final section of the paper discusses recent and proposed financial interventions

Economic Slowdown: Issues and Policies

This report first discusses the current state of the economy, including measures that have already been taken by the monetary authorities, and assesses the need for and potential consequences of fiscal stimulus. The second part of the report reviews the proposals discussed during debate on the recently enacted fiscal stimulus, both those adopted and those considered but not adopted. The various stimulus packages differed somewhat, and the report briefly describes those differences. This section also includes a discussion of the potential elements of a second stimulus proposal, and concludes with a discussion of the macroeconomic effects of the proposals. The final section of the paper discusses recent and proposed financial interventions