Health Systems and Sustainability: Doctors and Consumers Differ on Threats and Solutions

Background: Healthcare systems face the problem of insufficient resources to meet the needs of ageing populations and increasing demands for access to new treatments. It is unclear whether doctors and consumers agree on the main challenges to health system sustainability. Methodology: We conducted a mail survey of Australian doctors (specialists and general practitioners) and a computer assisted telephone interview (CATI) of consumers to determine their views on contributors to increasing health care costs, rationing of services and involvement in health resource allocation decisions. Differences in responses are reported as odds ratios (OR) and 99% confidence intervals (CI). Results: Of 2948 doctors, 1139 (38.6%) responded; 533 of 826 consumers responded (64.5% response). Doctors were more concerned than consumers with the effects of an ageing population (OR 3.0; 99% CI 1.7, 5.4), and costs of new drugs and technologies (OR 5.1; CI 3.3, 8.0), but less likely to consider pharmaceutical promotional activities as a cost driver (OR 0.29, CI 0.22, 0.39). Doctors were more likely than consumers to view ‘community demand’ for new technologies as a major cost driver, (OR 1.6; 1.2, 2.2), but less likely to attribute increased costs to patients failing to take responsibility for their own health (OR 0.35; 0.24, 0.49). Like doctors, the majority of consumers saw a need for public consultation in decisions about funding for new treatments. Conclusions: Australian doctors and consumers hold different views on the sustainability of the healthcare system, and a number of key issues relating to costs, cost drivers, roles and responsibilities. Doctors recognise their dual responsibility to patients and society, see an important role for physicians in influencing resource allocation, and acknowledge their lack of skills in assessing treatments of marginal value. Consumers recognise cost pressures on the health system, but express willingness to be involved in health care decision making

Disability activism and the politics of scale

In this paper, we examine the role of spatial scale in mediating and shaping political struggles between disabled people and the state. Specifically, we draw on recent theoretical developments concerning the social construction of spatial scale to interpret two case studies of disability activism within Canada and Ireland. In particular, we provide an analysis of how successful the disability movement in each locale has been at 'jumping scale' and enacting change, as well as examining what the consequences of such scaling-up have been for the movement itself. We demonstrate that the political structures operating in each country markedly affect the scaled nature of disability issues and the effectiveness of political mobilization at different scales

Is sex determination in Merinos heritable?

This paper investigates the ability of different linear mixed models to estimate the heritability of sex determination in a sub-set of the Australian Merino population. The dataset used was from Centre Plus Merinos in central-west New South Wales with 25 plus years of full pedigree collection and over 20,000 lambing events where the sex of the progeny were recorded. This study used sex of a lamb as a trait, (i.e. zero phenotype for female and one phenotype for male). We observed a significant, yet normal, amount of phenotypic variation in the sex ratio of progeny for dams, sires, maternal grand sires and maternal grand dams. However, no model was able to estimate significant genetic variation in sex determination and failed to return a heritability above 0.01. Consequently, it can be concluded within this dataset that it would not be possible to select to alter sex determination in Merinos

Measured Goats in the Rangelands: An overview of a meat goat reference population

New South Wales Department of Primary Industries' second-most western station, Condobolin Agricultural Research and Advisory Station will be host to the "Measured Goats in the Rangelands project". This five-year co-investment between New South Wales Department of Primary Industries and the Meat and Livestock Donor Company project will also work collaboratively with the Animal Genetics and Breeding Unit. The project will utilise three goat breeds – Boer, Kalahari Red and wild "Rangeland", both in purebred and crossbred forms to become a multi-breed genomic reference population. All project animals born will have a goat specific 70k SNP genomic test to identify parentage, breed composition and heterozygosity. Furthermore, performance, health, reproduction and structural traits will be recorded in large contemporary groups. The aim is to breed and measure over 8,000 animals in a self-replacing style breeding nucleus over 4 years. This project aims to provide trait and breed means, update genetic parameter estimates for meat goats, obtain heterosis estimates, and provide new links into the KIDPLAN database. The project will also generate new traits and knowledge to update the assumptions used for the KIDPLAN analysis. Finally, the project has a major adoption and extension focus to increase the uptake and adoption of KIDPLAN breeding values at a seedstock and commercial level

Progress of the Southern Multi-Breed Resource Population: Hard-to-measure phenotypes to drive genomic selection

This paper describes the progress in the first half of a large, 5-year breeding project run across New South Wales involving five temperate beef breeds and the Brahman breed. The project's purpose is to generate up to 8,000 progeny that allows the benefits of genomic selection to be captured, particularly for traits that are lowly recorded due to being difficult or costly to record or which are yet to be routinely included in genetic evaluations, e.g., fertility, health, and resilience. The project has generated 4,886 progeny from three cohorts, with another 1,990 females to calve in mid-2023. Cohort one, born in 2020, has now had all steers complete feedlot finishing with carcass traits recorded, with the heifers having completed their first calving and subsequent rebreed. Details concerning the recording of hard-to-measure traits to this point in the project are provided. The high-density SNP genotypes collected, and the recording of these traits will contribute to the genomic reference populations and BREEDPLAN evaluations of the breeds involved

Preliminary evaluation of the impact of visual traits on lifetime ewe performance

Visual traits are considered valuable components within the breeding objectives of many Merino breeders. This paper aimed to estimate genetic and phenotypic correlations between visual traits and growth, body composition, reproduction and survival in adult ewes. The data were derived from Merino Lifetime Productivity (MLP) sites. Heritability estimates were high for body weight, eye muscle depth, fat depth, body wrinkle, breech wrinkle, breech cover and classer grade (0.32 – 0.64), moderate for urine stain (0.21) and legs score (0.23) and low for weaning rate (0.07) and ewe survival (0.06). Low to moderate negative (favourable) genetic correlations were estimated between the visual traits and body weight and composition, reproduction, and survival traits. Phenotypic correlations between the visual traits and adult body composition and weaning rate traits were negative and low. The genetic and phenotypic correlations estimated in this study were generally favourable hence consideration of visual traits in selection and classing may have beneficial effects on adult ewe performance

Initiating the Southern Multi-Breed Resource population

This paper describes the first year of a large 5-year breeding project being conducted across New South Wales involving five temperate beef breeds and the Brahman breed. Artificial insemination and back-up matings were designed to produce progeny that are representative of the genetic diversity in the national herd of each breed. Sires and dams were selected with a focus on high accuracies for the 400-day weight estimated breeding value (EBV) and reproduction EBVs. The project progeny will be managed in mixed-breed groups and intensively recorded head-to-head for current BREEDPLAN and new economically important traits such as early-in-life female reproduction and worm egg counts. All animals will have high density SNP genotypes taken to contribute to the breeds’ genomic reference populations and for inclusion in BREEDPLAN genomic evaluations. The project design will facilitate development of genomic EBVs to allow across-breed comparisons, assist in increasing selection accuracy, particularly for young bulls, allow genotype by environment (GxE) investigations, and the potential development of new traits