Disparities in cataract surgery between Aboriginal and non-Aboriginal people in New South Wales, Australia

<b>Background:</b> To investigate variation in rates of cataract surgery in New South Wales (NSW), Australia by area of residence for Aboriginal and non-Aboriginal adults.<p></p> <b>Design:</b> Observational data linkage study of hospital admissions.<p></p> <b>Participants:</b> 289 646 NSW residents aged 30 years and over admitted to NSW hospitals for 444 551 cataract surgery procedures between 2001 and 2008.<p></p> <b>Methods:</b> Analysis of linked routinely collected hospital data using direct standardisation and multilevel negative binomial regression models accounting for clustering of individuals within Statistical Local Areas (SLAs).<p></p> <b>Main outcome measures:</b> Age-standardised cataract surgery rates and adjusted rate ratios (ARRs).<p></p> <b>Results:</b> Aboriginal people had lower rates of cataract procedures than non-Aboriginal people of the same age and sex, living in the same SLA (ARR 0.71, 95% CI 0.68-0.75). There was significant variation in cataract surgery rates across SLAs for both Aboriginal and non-Aboriginal people, with the disparity higher in major cities and less disadvantaged areas. Rates of surgery were lower for Aboriginal than non-Aboriginal people in most SLAs, but in a few, the rates were similar or higher for Aboriginal people.<p></p> <b>Conclusions:</b> Aboriginal people in NSW received less cataract surgery than non-Aboriginal people, despite evidence of higher cataract rates. This disparity was greatest in urban and wealthier areas. Higher rates of surgery for Aboriginal people observed in some specific locations are likely to reflect the availability of public ophthalmology services, targeted services for Aboriginal people and higher demand for surgery in these populations.<p></p&gt

The European economy in 1999 and 2000: Report

World economic growth this year is likely to remain as weak as in 1998, despite a gradual acceleration in the course of the year. The volume of world trade is estimated to have fallen significantly in the latter half of last year, and to date there are few signs of a rapid recovery. However, there are indications of improved investor sentiment in a number of emerging market economies, and the monetary authorities in many industrial economies have lowered shortterm interest rates significantly since last autumn. In the absence of further financial market turmoil, a modest global recovery is expected to develop this year, led by improved prospects for the Asian economies. World GDP is expected to rise by 3 per cent in 2000, after growth of 2V4 per cent this year (Table 1). The industrial economies as a group are not expected to contribute significantly to the overall rebound. The economy of the United States has remained much stronger than expected, but could experience a soft landing next year, particularly if the Federal Reserve decides to tighten monetary policy. Activity in Japan may at best stabilise next year after two years of declining GDP, with many firms continuing to have excess capacity, and domestic demand expected to remain weak. The continuing weakness of Japan will help to keep the upturn in the emerging markets within bounds. Growth should pick up in Western Europe over the next eighteen months, helped by the present relaxed monetary conditions. However, a recovery this year remains far from assured, with activity likely to be particularly weak in Germany and Italy. The present, historically low, rate of inflation in the industrial world may rise slightly, partly as a result of some recovery in world prices for primary commodities, recently in particular for oil. In the euro area, import prices will also rise as a result of the recent depreciation of the euro against the dollar. The continued strength of the dollar can be partly attributed to the very strong performance of the American economy compared with the European economy, and to the rising interest rate differentials with Europe. We expect that developments in the opposite direction will weaken the dollar again. Section VI of this report illustrates a scenario with a more substantial weakening in the aftermath of a collapse in equity prices. The Western European economy has been strongly affected by the adverse developments in the crisis regions. This has depressed industrial production significantly over the past year. The prospects for Europe are heavily dependent on the timing and extent to which these effects fade away. The American economy has been a strong engine for world economic growth up to now, but there are several imbalances that may lead to a slowdown over the next eighteen months. This could have a substantial impact on the European economy. --

The European economy in 1998 and 1999: An update

A. Situation and Prospects for the European Economy 3 I. Slower Growth of the World Economy 3 II. Weaker Expansion of the European Economy 5 III. Economic Policy 7 B. Country Reports 9 I. Germany: Upturn Continues Despite Financial Turbulence 9 II. Confidence Still High in France, Though Off Its Peak 9 III. Downturn in the UK Economy 10 IV. Italy: A Fragile Recovery 11 --

Exploring disparities in acute myocardial infarction events between Aboriginal and non-Aboriginal Australians: roles of age, gender, geography and area-level disadvantage

We investigated disparities in rates of acute myocardial infarction (AMI) between Aboriginal and non-Aboriginal people in the 199 Statistical Local Areas (SLAs) in New South Wales, Australia. Using routinely collected and linked hospital and mortality data from 2002 to 2007, we developed multilevel Poisson regression models to estimate the relative rates of first AMI events in the study period accounting for area of residence. Rates of AMI in Aboriginal people were more than two times that in non-Aboriginal people, with the disparity greatest in more disadvantaged and remote areas. AMI rates in Aboriginal people varied significantly by SLA, as did the Aboriginal to non-Aboriginal rate ratio. We identified almost 30 priority areas for universal and targeted preventive interventions that had both high rates of AMI for Aboriginal people and large disparities in rates

Does it pay to move from welfare to work?

The 1996 Personal Responsibility and Work Opportunity Reconciliation Act requires welfare recipients to lookfor work and has made it more difficult for nonworking recipients to remain on the welfare rolls. In addition,the economic boom of the 1990s and changes in federal and state policies have raised the net income gainassociated with moving from welfare to work. This paper analyzes data from a panel survey of single mothers, allof whom received welfare in February 1997. In 1999, those who left welfare and were working had a higherhousehold income and lower poverty rate, experienced a similar level of material hardship, engaged in feweractivities to make ends meet, and had lower expectations of experiencing hardship in the near future than didnonworking welfare recipients. Estimations of fixed-effect regressions of income that control for bothobservable and unobservable time-invariant characteristics show that monthly net income increases by$2.63 for every additional hour of work effort. About 60 percent of the observed monthly incomedifference between wage-reliant and welfare-reliant mothers can be attributed to differences intheir work effort. Thus, after welfare reform, it does pay to move from welfare to work. © 2002 by theAssociation for Public Policy Analysis and Management.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34846/1/10080_ftp.pd

Insights from birthing experiences of fistula survivors in North-central Nigeria: Interplay of structural violence

Obstetric Fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour. Studies indicate that delays in accessing maternal care and home birth contribute to the development of fistula. Survivors are usually women of low socioeconomic status residing in rural locations. This study explores the birthing experiences of 15 fistula survivors through a narrative inquiry approach at a repair centre in North-central Nigeria. Using structural violence as a lens, it describes the role of social, political and health systems in the inequitable access to care for women. For women opting for home births, preference for home delivery was mainly due to lack of finances, poor health systems and cultural practices. Rural location inhibited access as, women seeking facility delivery faced transfer delays to referral centres when complications developed. Inequitable maternal health services in rural locations in Nigeria are inherently linked to access to health care; and these contribute to the increased incidences of fistulae. Structural intervention is a health policy priority to address poor health systems and achieve universal health coverage to address maternal health issues in Nigeria

Assessment of solar shading strategies in low-income tropical housing: the case of Uganda

Developing countries in tropical and subtropical areas will be the worst hit by climate change. Very little research has been done to assess the impact of climate change on thermal comfort in low-income housing in these regions. The effects of solar shading strategies and solar absorptance properties of walls and roofs on thermal comfort in Ugandan low-income housing are studied in this paper. Various shading strategies including curtains, roof and window overhangs, veranda and trees as well as effects of painting on solar heat gain and thermal comfort are modelled using EnergyPlus software. An adaptive approach for naturally ventilated buildings defined by the European Committee for Standardization standard BS EN 15251:2007 is used to assess the conditions. According to the results, solar shading is less effective in meeting thermal comfort requirements and it should be used in conjunction with other strategies to achieve desirable results. White painting, in contrast, significantly improved the conditions and significantly reduced the risk of overheating. Solar shading proved to be effective during the hottest periods of the year, reducing the risk of extreme overheating by up to 52%