The Last Right: Australians take sides on the right to die

This is the text of an out-of-print book first published in 1995 by Mandarin Books, Port Melbourne. Edited by Professors Simon Chapman and Stephen Leeder, it features contributions from 63 prominent Australians both supportive and opposed to voluntary euthanasia. It was published at the time of the Northern Territory's Marshall Peron's attempt to introduce a voluntary enthanasia bill in the Territory parliament

Disability income support design and mental illness: a summary of the grey literature

Aim: Mental illnesses have many distinctive features such as their fluctuating nature, invisibility and lack of diagnostic clarity that make determining eligibility for disability income support challenging. How do policy-makers deal with these features when designing disability income support? More specifically, ‘How do mental illnesses come to be considered eligible disabilities?’, ‘What tools are used to assess mental illness for eligibility?’, ‘What challenges exist in this process?’ and ‘What approaches are used to address these challenges?’ We aimed to determine what evidence is available to policy-makers in Australia and Ontario (Canada) to answer these questions. Methods: Ten electronic databases and grey literature in both jurisdictions were searched using key words including disability income support, disability pension, mental illness, mental disability, addiction, depression and schizophrenia for articles published between 1991 and June 2013 yielding 1,341 articles of which 20 met the inclusion criteria and were critically appraised. Results: Results revealed that there is limited evidence available on disability income support design and mental illness in the Australian and Ontarian setting. Most of the evidence available is from the grey literature and draws on evidence from case law. Many documents reviewed argued that current policy in Australia and Ontario is frequently based on negative assumptions about mental illnesses rather than available evidence (either peer-reviewed or grey literature). Results showed that problems related to mental illness are largely related to the interpretation of the definition rather than the definition itself. Conclusions: The review confirmed that mental illnesses present many challenges when designing disability income support and that academic as well as grey literature, especially case law, provide insight into these challenges. More research is needed on addressing these challenges identified, particularly in these contexts, with the intention that more evidence on this topic could lead to policies for those with mental illness that are well-informed and do not reinforce societal prejudices

A health policy for hearing impairment in older Australians: what should it include?

BACKGROUND: As in all western countries, Australia's older population experiences high levels of hearing impairment coupled with relatively low levels of hearing device usage. Poor hearing diminishes the quality of life of affected individuals and their families. This paper discusses how to improve Australian hearing health policies in order to better combat this impairment amongst older Australians. METHOD: We searched the databases Medline, Meditext and Web of Science to find articles that discussed strategies and innovations to assist the hearing health of older people, and related this material to observations made during the Blue Mountains Hearing Study in NSW between 1997 and 2003. RESULTS AND DISCUSSION: The literature search identified five areas for inclusion in a comprehensive hearing health policy in Australia. These are: early intervention; addressing of hearing aid expense; the use of assisted listening devices; hearing rehabilitation, and; screening and education. Further research in Australia is critical if we are to develop a strong approach to the increasing prevalence of age-related hearing loss. CONCLUSION: Australia needs to act now to address hearing impairment as it is a major cause of disability in those aged 55 and over. Federal and State governments should collaborate to construct a comprehensive hearing health policy that tackles poor levels of hearing health through early intervention, addressing hearing aid expense, encouraging the use of assisted listening devices, rehabilitation, screening and education. A good start would be to declare age related hearing impairment as a National Health Priority Area

Compliance With Protocols for Prevention of Neonatal Group B Streptococcal Sepsis: Practicalities and Limitations

Objective: To compare two protocols for intrapartum antibiotic prophylaxis (IAP) against neonatal group B streptococcal (GBS) sepsis, with respect to staff compliance, in a prospective cohort study in the obstetric units of a community hospital (A) and a university teaching hospital (B). Methods: Cohorts comprised about 500 women attending antenatal clinics at each hospital (total 1096). Women identified as GBS carriers at 26–32 weeks'gestation and those who had intrapartum clinical risk factors (CRF) were eligible for IAP. Compliance was defined as the proportion of women eligible for IAP who received it according to protocol–as determined by audit of case records–and compared between hospitals and according to indication. Results: Overall, 39% of women were eligible for IAP. Indications were GBS carriage alone (21%), CRF alone (13% ) and both (5% ). Compliance was similar for GBS carriers at both hospitals: 78% at Hospital A and 76% at Hospital B. However, because of the poor predictive value of screening before 32 weeks, only 65%of intrapartum GBS carriers actually received IAP. For women with CRF only, compliance was significantly lower at Hospital B than Hospital A (56 vs. 75%; p= 0.03). Conclusions: According to currently recommended protocols, about one-third of healthy women are eligible for intrapartum antibiotics to prevent neonatal GBS sepsis. In practice, antibiotics are often used inefficiently because of poor compliance with protocols and poor predictive values of selection criteria. Better implementation strategies should improve compliance, but GBS vaccines are needed to replace prophylactic antibiotic use, with its associated disadvantages

Zinc for the prevention or treatment of acute viral respiratory tract infections in adults : a rapid systematic review and meta-analysis of randomised controlled trials

Objective To evaluate the benefits and risks of zinc formulations compared with controls for prevention or treatment of acute viral respiratory tract infections (RTIs) in adults. Method Seventeen English and Chinese databases were searched in April/May 2020 for randomised controlled trials (RCTs), and from April/May 2020 to August 2020 for SARS-CoV-2 RCTs. Cochrane rapid review methods were applied. Quality appraisals used the Risk of Bias 2.0 and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results Twenty-eight RCTs with 5446 participants were identified. None were specific to SARS-CoV-2. Compared with placebo, oral or intranasal zinc prevented 5 RTIs per 100 person-months (95% CI 1 to 8, numbers needed to treat (NNT)=20, moderate-certainty/quality). Sublingual zinc did not prevent clinical colds following human rhinovirus inoculations (relative risk, RR 0.96, 95% CI 0.77 to 1.21, moderate-certainty/quality). On average, symptoms resolved 2 days earlier with sublingual or intranasal zinc compared with placebo (95% CI 0.61 to 3.50, very low-certainty/quality) and 19 more adults per 100 were likely to remain symptomatic on day 7 without zinc (95% CI 2 to 38, NNT=5, low-certainty/quality). There were clinically significant reductions in day 3 symptom severity scores (mean difference, MD-1.20 points, 95% CI-0.66 to-1.74, low-certainty/quality), but not average daily symptom severity scores (standardised MD-0.15, 95% CI-0.43 to 0.13, low-certainty/quality). Non-serious adverse events (AEs) (eg, nausea, mouth/nasal irritation) were higher (RR 1.41, 95% CI 1.17 to 1.69, NNHarm=7, moderate-certainty/quality). Compared with active controls, there were no differences in illness duration or AEs (low-certainty/quality). No serious AEs were reported in the 25 RCTs that monitored them (low-certainty/quality). Conclusions In adult populations unlikely to be zinc deficient, there was some evidence suggesting zinc might prevent RTIs symptoms and shorten duration. Non-serious AEs may limit tolerability for some. The comparative efficacy/effectiveness of different zinc formulations and doses were unclear. The GRADE-certainty/quality of the evidence was limited by a high risk of bias, small sample sizes and/or heterogeneity. Further research, including SARS-CoV-2 clinical trials is warranted

Challenges in assessing the characteristics of influential public health research.

The development of frameworks to effectively measure both the scientific and social impact of research is a topic of international debate. This paper examines how Australian public health researchers in six fields (alcohol, drugs, injury, obesity, skin cancer and tobacco) classified the scientific and social impact of what they judged to be their five most influential papers. We compared classifications of researchers rated as most influential by their peers with those not as highly ranked. Highly ranked researchers more often indicated social impact characteristics (Χ2 = 8.13; P = 0.004) than their less influential colleagues. Traditional measures of scientific impact (publication in high impact journals and high citations) were nominated by all researchers regardless of peer-nominated research influence status. There was strong consensus on who were the most influential researchers in five of the six research fields examined. This would appear to provide a sound platform on which to base more qualitative, interview or portfolio-based investigations into the complexities of wider conceptions of research and researcher influence

A cross-sectional study of vascular risk factors in a rural South African population : data from the Southern African Stroke Prevention Initiative (SASPI)

Background: Rural sub-Saharan Africa is at an early stage of economic and health transition. It is predicted that the 21st century will see a serious added economic burden from non-communicable disease including vascular disease in low-income countries as they progress through the transition. The stage of vascular disease in a population is thought to result from the prevalence of vascular risk factors. Already hypertension and stroke are common in adults in sub-Saharan Africa. Using a multidisciplinary approach we aimed to assess the prevalence of several vascular risk factors in Agincourt, a rural demographic surveillance site in South Africa. Methods: We performed a cross sectional random sample survey of adults aged over 35 in Agincourt (population ≈ 70 000). Participants were visited at home by a trained nurse who administered a questionnaire, carried out clinical measurements and took a blood sample. From this we assessed participants' history of vascular risk, blood pressure using an OMRON 705 CP monitor, waist circumference, body mass index (BMI), ankle brachial index (ABI), and total and HDL cholesterol. Results: 402 people (24% men) participated. There was a high prevalence of smoking in men, but the number of cigarettes smoked was small. There was a striking difference in mean BMI between men and women (22.8 kg/m2 versus 27.2 kg/m2), but levels of blood pressure were very similar. 43% of participants had a blood pressure greater than 140/90 or were on anti-hypertensive treatment and 37% of participants identified with measured high blood pressure were on pharmacological treatment. 12% of participants had an ABI of < 0.9, sugesting the presence of sub-clinical atheroma. 25.6% of participants had a total cholesterol level > 5 mmol/l. Conclusion: We found a high prevalence of hypertension, obesity in women, and a suggestion of subclinical atheroma despite relatively favourable cholesterol levels in a rural South African population. South Africa is facing the challenge of an emerging epidemic of vascular disease. Research to establish the social determinates of these risk factors and interventions to reduce both individual and population risk are required

A pathway to a stronger research culture in health policy

There are currently limited pathways into a career in health policy research in Australia, due in part to a serious absence of health policy research capability in Australian universities. The authors define what they consider health policy research and education should comprise, then examine what is currently on offer and propose ways to strengthen health policy research in Australia. This paper, which is part analysis and part commentary, is offered to provoke wider debate about how health policy research can be nurtured in Australia