Short-term international study programs and intercultural maturity development : does an enhanced appreciation for differing cultural perspectives continue to progress when students return home?

Numerous studies have shown that international mobility programmes enhance students’ intercultural maturity development, regardless of duration, few have attempted to ascertain whether this change is long lasting. This study tested students two years after their participation to see if their intercultural maturity levels continued to progress, plateaued, or regressed in the intervening period. 93% of the study cohort continued to progress in their level of intercultural maturity in at least one dimension, with none regressing, and only one plateauing. This suggests that the shifts in identity, values, and skills that the students develop are far-reaching and profound

Health impacts and economic costs of residential fires (RESFIRES study) : protocol for a population-based cohort study using linked administrative data

Introduction: Residential fires remain a significant global public health problem. It is recognised that the reported number of residential fires, fire-related injuries and deaths significantly underestimate the true number. Australian surveys show that around two-thirds of respondents who experience a residential fire are unwilling to call the fire service, and international studies highlight that many individuals who access medical treatment for fire-related injuries do not have an associated fire incident report. The objectives of this study are to quantify the incidence, health impacts, risk factors and economic costs of residential fires in New South Wales (NSW), Australia. Methods and analysis: The RESFIRE cohort will include all persons living at an NSW residential address which experienced a fire over the period 2005–2014. Nine data sources will be linked to provide a comprehensive picture of individual trajectories from fire event to first responder use (fire and ambulance services), emergency department presentations, hospital admissions, burn out-patient clinic use and death. These data will be used to describe the circumstances and characteristics of residential fires, provide a profile of fire-related injuries, examine trends over time, and explore the relationship between fire circumstance, emergency and health services utilisation, and health outcomes. Regression modelling, including multilevel modelling techniques, will be used to explore factors that impact on these relationships. Costing models will be constructed. Ethics and dissemination: Ethical approval for this study has been obtained from the NSW Population and Health Service Research Ethics Committee and Western Sydney University Human Research Ethics Committee. The study reference group comprises key stakeholders including Fire and Rescue NSW, policy agencies, health service providers and burns clinicians ensuring wide dissemination of results and translation of data to inform practice and identify areas for targeted prevention. Summary reports in formats designed for policy audiences in parallel with scientific papers will be produced

The impact of reduced fire risk cigarettes regulation on residential fire incidents, mortality and health service utilisation in New South Wales, Australia

Smoking materials are a common ignition source for residential fires. In Australia, reduced fire risk (RFR) cigarettes regulation was implemented in 2010. However, the impact of this regulation on residential fires is unknown. This paper examines the impact of the RFR cigarettes regulation on the severity and health outcomes of fire incidents in New South Wales (NSW), Australia, from 2005 to 2014. Fire department data from 2005 to 2014 were linked with ambulance, emergency department, hospital, outpatient burns clinic and mortality datasets for NSW. Negative binomial regression analysis was performed to assess the changes to fire incidents’ severity pre- and post-RFR cigarettes regulation. There was an 8% reduction in total fire incidents caused by smokers’ materials post-RFR cigarettes regulation. Smokers’ materials fire incidents that damaged both contents and structure of the building, where fire flames extended beyond the room of fire origin, with over AUD 1000 monetary damage loss, decreased by 18, 22 and 12%, respectively. RFR cigarettes regulation as a fire risk mitigation has positively impacted the residential fire incident outcomes. This provides support for regulation of fire risk protective measures and bestows some direction for other fire safety policies and regulations

Comparison of causes, characteristics and consequences of residential fires in social and non-social housing dwellings in New South Wales, Australia

There are over 17,000 residential fire incidents in Australia annually, of which 6,500 occur in New South Wales (NSW). The number of state-provided accommodations for those on low incomes (social housing), is over 437,000 in Australia of which 34% are located in NSW. This study compared causes, characteristics and consequences of residential fires in social and non-social housing in NSW, Australia. This population-based study used linked fire brigade and health service data to identify those who experienced a residential fire incident from 2005 to 2014. Over the study period, 43,707 residential fires were reported, of which 5,073 (11.6%) occurred in social housing properties. Fires in social housing were more likely to occur in apartments (RR 1.85, 95%CI 1.75–1.96), caused by matches and lighters (RR 1.62, 95%CI 1.51–1.74) and smokers’ materials (RR 1.51, 95%CI 1.34 – 1.71). The risk of health service utilisation or hospital admission was 16% (RR 1.16, 95%CI 1.04–1.28) and 25% (RR 1.25, 95%CI 1.02–1.51) higher in social housing respectively. Those aged 25–65 were at 40% (RR 1.40, 95%CI 1.14 – 1.73) higher risk of using residential fire-related health services. Almost 88% of social housing properties did not have a functioning fire detector of any type, and 1.2% were equipped with sprinklers. Overall, the risk of residential fire incidents and associated injuries was higher for residents in social housing. Risk mitigation strategies beyond the current provision of smoke alarms are required to reduce the impact of residential fires in social and non-social housing

Estimating the economic burden of low health literacy in the Blacktown community in Sydney, Australia : a population-based study

Evidence shows that inadequate or low health literacy (LHL) levels are significantly associated with economic ramifications at the individual, employer, and health care system levels. Therefore, this study aims to estimate the economic burden of LHL among a culturally and linguistically diverse (CALD) community in Blacktown: a local government area (LGA) in Sydney, Australia. This study is a secondary analysis of cross-sectional data from publicly available datasets, including 2011 and 2016 census data and National Health Survey (NHS) data (2017–2018) from the Australian Bureau of Statistics (ABS), and figures on Disease Expenditure in Australia for 2015–2016 provided by the Australian Institute of Health and Welfare (AIHW). This study found that 20% of Blacktown residents reported low levels of active engagement with health care providers (Domain 6 of the Health Literacy Questionnaire (HLQ)), with 14% reporting a limited understanding of the health information required to take action towards improving health or making health care decisions (Domain 9 of the HLQ). The overall extra/delta cost (direct and indirect health care costs) associated with LHL in the Blacktown LGA was estimated to be between $11,785,528 and$15,432,239 in 2020. This is projected to increase to between $18,922,844 and$24,191,911 in 2030. Additionally, the extra disability-adjusted life year (DALY) value in 2020, for all chronic diseases and age-groups—comprising the extra costs incurred due to years of life lost (YLL) and years lived with disability (YLD)—was estimated at $414,231,335. The findings of our study may enable policymakers to have a deeper understanding of the economic burden of LHL in terms of its impact on the health care system and the production economy

Estimating the total number of residential fire-related incidents and underreported residential fire incidents in New South Wales, Australia by using linked administrative data

The rate of fires, and particularly residential fires, is a serious concern in industrialized countries. However, there is considerable uncertainty regarding the reported numbers of residential fire incidents as official figures are based on fires reported to fire response agencies only. This population-based study aims to quantify the total number of residential fire incidents regardless of reporting status. The cohort comprised linked person-level data from Fire and Rescue New South Wales (FRNSW) and health system and death records. It included all persons residing at a residential address in New South Wales, Australia, that experienced a fire between 1 January 2005 and 31 December 2014. The capture-recapture method was used to estimate the underreporting number of residential fire-related incidents. Over the study period, 43,707 residential fire incidents were reported to FRNSW, and there were 2795 residential fire-related health service utilizations, of which 2380 were not reported. Using the capture-recapture method, the total number of residential fire incidents was estimated at 267,815 to 319,719, which is more than six times the official records. This study found that 15% of residential fire incidents that were identified in health administrative dataset were reported. The residential fire incidents that were not reported occurred mainly in socio-economically disadvantaged areas among males and adults

Social determinants of diabetes-related foot disease among older adults in New South Wales, Australia : evidence from a population-based study

Background: Diabetes-related foot is the largest burden to the health sector compared to other diabetes-related complications in Australia, including New South Wales (NSW). Understanding of social determinants of diabetes-related foot disease has not been definitive in Australian studies. This study aimed to investigate the social determinants of diabetes-related foot disease in NSW. Methodology: The first wave of the 45 and Up Study survey data was linked with NSW Admitted Patient Data Collection, Emergency Department Data Collection, and Pharmaceutical Benefits Scheme data resulting in 28,210 individuals with diabetes aged 45 years and older in NSW, Australia. Three outcome variables were used: diabetes-related foot disease (DFD), diabetic foot ulcer (DFU), and diabetic foot infection (DFI). They were classified as binary, and survey logistic regression was used to determine the association between each outcome measure and associated factors after adjusting for sampling weights. Results: The prevalence of DFD, DFU and DFI were 10.8%, 5.4% and 5.2%, respectively, among people with diabetes. Multivariate analyses revealed that the common factors associated with DFD, DFU and DFI were older age (75 years or more), male, single status, background in English speaking countries, and coming from lower-income households (less than AUD 20,000 per year). Furthermore, common lifestyle and health factors associated with DFD, DFU, and DFI were low physical activity (< 150 min of moderate-to-vigorous physical activity per week), history of diabetes for over 15 years, and having cardiovascular disease. Conclusion: Our study showed that about 1 in 10 adults with diabetes aged 45 years and older in NSW reported DFD. Interventions, including the provision of related health services aimed at reducing all forms of DFD in NSW, are recommended to target older individuals with a long history of diabetes, and coming from lower-income households

Developing indicators and measures of high-quality for Australian general practice

Background: Rising health costs and health inequity are major challenges in Australia, as internationally. Strong primary health care is well evidenced to address these challenges. Primary Health Networks (PHNs) work with general practices to collect data and support quality improvement; however, there is no consensus regarding what defines high quality. This paper describes the development of an evidence-based suite of indicators and measures of high-quality general practice for the Australian context. Methods: We reviewed the literature to develop a suitable framework and revise quality assurance measures currently in use, then reviewed these in three workshops with general practitioners, practice managers, nurses, consumers and PHN staff in western Sydney. We used a descriptive qualitative research approach to analyse the data. Results: A total of 125 evidence-based indicators were agreed to be relevant, and 80 were deemed both relevant and feasible. These were arranged across a framework based on the Quadruple Aim, and include structure, process and outcome measures. Conclusions: The agreed suite of indicators and measures will be further validated in collaboration with PHNs across Australia. This work has the potential to inform health systems innovation both nationally and internationally

Exclusive breastfeeding rates and associated factors in 13 "Economic Community of West African States" (ECOWAS) countries

Exclusive breastfeeding (EBF) has important protective effects on child survival and also increases the growth and development of infants. This paper examined EBF rates and associated factors in 13 “Economic Community of West African States” (ECOWAS) countries. A weighted sample of 19,735 infants from the recent Demographic and Health Survey dataset in ECOWAS countries for the period of 2010–2018 was used. Survey logistic regression analyses that adjusted for clustering and sampling weights were used to determine the factors associated with EBF. In ECOWAS countries, EBF rates for infants 6 months or younger ranged from 13.0% in Côte d’Ivoire to 58.0% in Togo. EBF decreased significantly by 33% as the infant age (in months) increased. Multivariate analyses revealed that mothers with at least primary education, older mothers (35–49 years), and those who lived in rural areas were significantly more likely to engage in EBF. Mothers who made four or more antenatal visits (ANC) were significantly more likely to exclusively breastfeed their babies compared to those who had no ANC visits. Our study shows that EBF rates are still suboptimal in most ECOWAS countries. EBF policy interventions in ECOWAS countries should target mothers with no schooling and those who do not attend ANC. Higher rates of EBF are likely to decrease the burden of infant morbidity and mortality in ECOWAS countries due to non-exposure to contaminated water or other liquids

The economic cost of unwanted automatic fire alarms

Although automatic fire alarm (AFA) systems are vital technologies for informing building occupants of a fire, each year Fire and Rescue NSW (FRNSW) responds to tens of thousands of unwanted AFA activations; equating to approximately 97% of all call-outs. The aim of this study was to estimate the economic burden of false AFA system activations by using data collected in NSW for the period 2008–2018. Costs were considered as comprising: business/government productivity losses and other related costs such as false alarm fees; injuries or fatalities sustained in collisions with a responding fire brigade vehicle; wages of FRNSW personnel and other service responders; utility costs of FRNSW; and opportunity costs to the fire brigade, residents and bystanders. This study found that in 2018/19 false AFA system activations resulted in an average economic cost of AUD$246 million per annum to NSW society in a best-case scenario, and AUD$349 million per annum in a base-case scenario; equating to an average cost of between AUD$4952 and AUD$7403 per system initiated false alarm incident. The economic cost of these unwarranted call-outs is prohibitively high and this study indicates the importance of further initiatives geared toward safely reducing the frequency of false AFA system activations