Addressing Australia's Housing Shortage Through Improved Housing Utilisation

Australia currently suffers from a well documented housing shortage, particularly in the area of affordable housing. the reasons for this shortage are equally well documented, with supply-side constraints being generally regarded as the root of the problem. Governments at all levels have made various attempts to relieve the acuity of the problem, which has become something of a policy debate football, with most responses on the need to create more housing. However, the creation of additional new housing stock is highly costly and can involve considerable time lags, through various barriers to completion. New home construction can also be quite environmentally unsustainable, having a high carbon footprint. Therefore, it is proposed that another, although partial, solution may lie in addressing the demanside for housing, via the utilisation of existing housing stock. This paper explores the current level of utilisation of Australia's existing housing stock and identifies significant underutilisation by international standards. Using detached housing in the Sydney metropolitan area as a proxy, examination of 2006 Census data has shown that there is substantial underutilisation of housing stock. The need to explore policy initiatives that can encourage a higher utilisation of existing housing stock is highlighted, including removing the existing barriers to housing substitution for retirees. A central conclusion of this research is that if a significantly higher housing stock utilisation could be achieved the potential time and capital savings, and importantly, carbon footprint reduction, could be significant by comparison to the construction of new dwellings

The Epidemiology of Osteoporosis in the Frail Institutionalized Elderly

As our population ages, the proportion of frail elderly people requiring assisted accommodation in aged care facilities is increasing. This population is at high risk of falls and fractures, which bring significant morbidity and mortality. The prevalence of osteoporosis also increases with age, but there have been few studies of bone density in residents of hostels and nursing homes. This thesis looked at the prevalence of osteoporosis and falls in elderly people in residential care, to define the size of the problem and identify risk factors for low bone density and falling, with particular reference to vitamin D levels. Two thousand and five men and women aged between 65 and 104 years were enrolled in the Falls and Fracture Risk in the Elderly Epidemiology (FREE) study between 1999 and 2003. The key findings from analysis of this population were firstly, that quantitative ultrasound (QUS) measures were higher in men than women independent of age, and that in men there was no significant decline in either BUA or VOS, but in women BUA declined by over 3% per decade and VOS by 1% per decade. Both ultrasound machines used in the study were shown to be reliable, with precision unaffected by advanced age. QUS was found to be sensitive to longitudinal change even in this frail elderly cohort. Vitamin D deficiency was found in the majority of elderly aged care facility residents but supplementation conferred higher serum 25-OH-vitamin D levels. Vitamin D levels were not shown to be related to BUA, VOS or the risk of falling in this population. Serum parathyroid hormone might be important in determining future falls risk. In summary, the results of this thesis give an important insight into the prevalence of osteoporosis and falls in the frail elderly, and how these might be predicted. Future study of prospective fracture rates in this group will then be able to assess relative risk factors for osteoporotic fracture, and identify those individuals who might benefit from directed fracture prevention strategies

The Epidemiology of Osteoporosis in the Frail Institutionalized Elderly

As our population ages, the proportion of frail elderly people requiring assisted accommodation in aged care facilities is increasing. This population is at high risk of falls and fractures, which bring significant morbidity and mortality. The prevalence of osteoporosis also increases with age, but there have been few studies of bone density in residents of hostels and nursing homes. This thesis looked at the prevalence of osteoporosis and falls in elderly people in residential care, to define the size of the problem and identify risk factors for low bone density and falling, with particular reference to vitamin D levels. Two thousand and five men and women aged between 65 and 104 years were enrolled in the Falls and Fracture Risk in the Elderly Epidemiology (FREE) study between 1999 and 2003. The key findings from analysis of this population were firstly, that quantitative ultrasound (QUS) measures were higher in men than women independent of age, and that in men there was no significant decline in either BUA or VOS, but in women BUA declined by over 3% per decade and VOS by 1% per decade. Both ultrasound machines used in the study were shown to be reliable, with precision unaffected by advanced age. QUS was found to be sensitive to longitudinal change even in this frail elderly cohort. Vitamin D deficiency was found in the majority of elderly aged care facility residents but supplementation conferred higher serum 25-OH-vitamin D levels. Vitamin D levels were not shown to be related to BUA, VOS or the risk of falling in this population. Serum parathyroid hormone might be important in determining future falls risk. In summary, the results of this thesis give an important insight into the prevalence of osteoporosis and falls in the frail elderly, and how these might be predicted. Future study of prospective fracture rates in this group will then be able to assess relative risk factors for osteoporotic fracture, and identify those individuals who might benefit from directed fracture prevention strategies

REIT Takeovers: An Evaluation of Barriers to Activity

The global financial crisis in September 2007 resulted in the most significant downturn in global real estate markets in decades. Listed real estate markets were particularly affected, as the combination of high leverage and collapsing real estate values led to massive erosion of shareholder value and investment confidence. The Australian real estate investment trust (A-REIT) market suffered one of the largest downturns relative to its global peers. Currently the downturn appears to be abating, with most A-REITs having undertaken a process of balance sheet reconstruction, via asset sales, equity raisings and debt reduction. However, many A-REITs continue to trade at a significant discount to underlying net asset values. Such circumstances typically provide takeover opportunities that may unlock significant value. However, despite the potentially attractive values, we have seen limited recent takeover activity in Australia. This paucity of A-REIT takeovers suggests there may be barriers to such activity. This research examines the barriers to takeovers currently existing in the A- REIT market

Distribution payout practices and the collapse of A-REITs

In the lead up to the Global Financial Crisis, A-REITS pursued aggressive distribution practices. Payout ratios significantly in excess of 100% of underlying earnings became common place, funded largely from increased borrowings. The GFC painfully exposed the unsustainability of this practice. A-REITs were punished when the global debt markets froze and property values crashed, leading to massive equity destruction for over geared A- REITs.This research explores the pre-GFC distributions practices of A- REITs. Annual report financial data analysis and semi-structured interviews with five industry experts were conducted to examine A-REIT distribution practices. The results reveal a clear systematic decline in the relationship between underlying earnings and distributions. It is further discovered that the since abandoned practice of distributing un-realised profits was designed to boost share prices. Paradoxically, it eventually led to their decline and the A-REIT sector's demise

The association of low complement with disease activity in systemic sclerosis: a prospective cohort study

Background: In some rheumatic diseases such as systemic lupus erythematosus (SLE), low serum complement ('hypocomplementaemia') is a feature of active disease. However, the role of hypocomplementaemia in systemic sclerosis (SSc) is unknown. We sought to determine the frequency, clinical associations and relationship to disease activity of hypocomplementaemia in SSc. Methods: The study included 1140 patients fulfilling the 2013 American College of Rheumatology criteria for SSc. Demographic, serological and clinical data, obtained prospectively through annual review, were analysed using univariable methods. Linear and logistic regression, together with generalised estimating equations, were used to determine the independent correlates of hypocomplementaemia ever, and at each visit, respectively. Results: At least one episode of hypocomplementaemia (low C3 and/or low C4) occurred in 24.1 % of patients over 1893 visits; these patients were more likely to be seropositive for anti-ribonucleoprotein (OR = 3.8, p = 0.002), anti-Ro (OR = 2.2, p = 0.002), anti-Smith (OR = 6.3, p = 0.035) and anti-phospholipid antibodies (OR = 1.4, p = 0.021) and were more likely to display features of overlap connective tissue disease, in particular polymyositis (OR = 16.0, p = 0.012). However, no association was found between hypocomplementaemia and either the European Scleroderma Study Group disease activity score or any of its component variables (including erythrocyte sedimentation rate) in univariate analysis. Among patients with SSc overlap disease features, those who were hypocomplementaemic were more likely to have digital ulcers (OR = 1.6, p = 0.034), tendon friction rubs (OR = 2.4, p = 0.037), forced vital capacity <80 % predicted (OR = 2.9, p = 0.008) and lower body mass index (BMI) (OR for BMI = 0.9, p < 0.0005) at that visit, all of which are features associated with SSc disease activity and/or severity. Conclusions: While hypocomplementaemia is not associated with disease activity in patients with non-overlap SSc, it is associated with some features of increased SSc disease activity in patients with overlap disease features.James Esposito, Zoe Brown, Wendy Stevens, Joanne Sahhar, Candice Rabusa, Jane Zochling, Janet Roddy, Jennifer Walker, Susanna M. Proudman, and Mandana Nikpo

Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set : translation and cross-cultural adaptation into 15 languages

Introduction: The Assessments of SpondyloArthritis international society Health Index (ASAS HI) measures functioning and health in patients with spondyloarthritis (SpA) across 17 aspects of health and 9 environmental factors (EF). The objective was to translate and adapt the original English version of the ASAS HI, including the EF Item Set, cross-culturally into 15 languages. Methods: Translation and cross-cultural adaptation has been carried out following the forward-backward procedure. In the cognitive debriefing, 10 patients/country across a broad spectrum of sociodemographic background, were included. Results: The ASAS HI and the EF Item Set were translated into Arabic, Chinese, Croatian, Dutch, French, German, Greek, Hungarian, Italian, Korean, Portuguese, Russian, Spanish, Thai and Turkish. Some difficulties were experienced with translation of the contextual factors indicating that these concepts may be more culturally-dependent. A total of 215 patients with axial SpA across 23 countries (62.3% men, mean (SD) age 42.4 (13.9) years) participated in the field test. Cognitive debriefing showed that items of the ASAS HI and EF Item Set are clear, relevant and comprehensive. All versions were accepted with minor modifications with respect to item wording and response option. The wording of three items had to be adapted to improve clarity. As a result of cognitive debriefing, a new response option 'not applicable' was added to two items of the ASAS HI to improve appropriateness. Discussion: This study showed that the items of the ASAS HI including the EFs were readily adaptable throughout all countries, indicating that the concepts covered were comprehensive, clear and meaningful in different cultures

Epidemiology and disease characteristics of systemic sclerosis-related pulmonary arterial hypertension: results from a real-life screening programme

Pulmonary arterial hypertension (PAH) is the leading cause of death in systemic sclerosis (SSc). Annual screening with echocardiogram (ECHO) is recommended. We present the methodological aspects of a PAH screening programme in a large Australian SSc cohort, the epidemiology of SSc-PAH in this cohort, and an evaluation of factors influencing physician adherence to PAH screening guidelines.Patient characteristics and results of PAH screening were determined in all patients enrolled in a SSc longitudinal cohort study. Adherence to PAH screening guidelines was assessed by a survey of Australian rheumatologists. Summary statistics, chi-square tests, univariate and multivariable logistic regression were used to determine the associations of risk factors with PAH.Among 1636 patients with SSc, 194 (11.9%) had PAH proven by right-heart catheter. Of these, 160 were detected by screening. The annual incidence of PAH was 1.4%. Patients with PAH diagnosed on subsequent screens, compared with patients in whom PAH was diagnosed on first screen, were more likely to have diffuse SSc (p = 0.03), be in a better World Health Organisation (WHO) Functional Class at PAH diagnosis (p = 0.01) and have less advanced PAH evidenced by higher mean six-minute walk distance (p = 0.03), lower mean pulmonary arterial pressure (p = 0.009), lower mean pulmonary vascular resistance (p = 0.006) and fewer non-trivial pericardial effusions (p = 0.03). Adherence to annual PAH screening using an ECHO-based algorithm was poor among Australian rheumatologists, with less than half screening their patients with SSc of more than ten years disease duration.PAH is a common complication of SSc. Physician adherence to PAH screening recommendations remains poor. Identifying modifiable barriers to screening may improve adherence and ultimately patient outcomes.Kathleen Morrisroe, Wendy Stevens, Joanne Sahhar, Candice Rabusa, Mandana Nikpour, Susanna Proudman and the Australian Scleroderma Interest Group (ASIG