The burden of cancer and its distribution and consequences for australia: evidence from health economic evaluation and advanced statistical modelling

Cancer is expected to rank as the most significant global public health problem and a leading cause of death and illness in the world in the 21st century. The burden of cancer is rapidly increasing globally, including Australia. The responses to this growing burden of cancer have been limited owing to a poor understanding of the long-term burden of cancer and its consequences. The overarching aim of this thesis is to investigate the burden of cancer on patients, households, as well as on society over time. This thesis also aims to generate evidence for health policymakers, who make nationwide cancer control and management decisions on cancer prevention (e.g., cancer vaccination) and cancer treatment programs. This thesis has examined the burden of cancer using a geographical lens, including regional, rural, and remote areas in Australia. To accomplish this aim, five empirical studies for assessing the impact of the cancer burden in terms of longterm cancer outcomes (an incidence-based approach); health status burden, chronic comorbid conditions, productivity-related work disability (mixedlongitudinal approach); and the economics of cancer vaccination (economic evaluation) have been conducted. This thesis is constructed using three main themes of study including ‘understanding the challenges of cancer outcomes’, ‘the long-term cancer burden (i.e., health status burden, chronic comorbid conditions, productivity-related work disability, and its consequences)’, and ‘evaluation of cancer vaccination’ in the context of Australia. These inter-related studies result in a thesis by publication. These studies are constructed based on a quantitative approach, using health economic evaluation and advanced statistical modelling. The thesis is based on six articles, national health data sets are utilised for the first article, three of them (Articles 2 to 4) being mixed-longitudinal nature survey-data driven from the Household Income and Labour Dynamics in Australia survey, and two of them (Articles 5 and 6) based on national and international contexts and published data sources related to cancer and health economics modelling. The findings of this thesis have been theorised inductively, which means the analytical exploration has been data-grounded, rather than theory-dictated. In this thesis, every finding is underpinned by a suitable theoretical framework. Three inductively generated theories are adopted: social conflict theory, stress-coping theory, and portfolio theory perspectives. The thesis revealed that all of these factors (e.g., cancer incidence, hospitalisation, cancer-related mortality, and burden of cancer) increased significantly over the period. Furthermore, survival inequality was most pronounced for cervix, prostate, melanoma, Non-Hodgkin Lymphoma, and breast cancers. Additionally, socioeconomically disadvantaged people were more likely to bear an increasing cancer burden in terms of incidence, mortality, and death. The findings of the thesis showed that approximately 36% of cancer patients had an initial high health status burden in 2013, which had declined significantly to 21% by 2017. Adequate levels of sleep, physical activity, social support, and higher economic status were significantly associated with improving health status. This thesis revealed that 61% of cancer patients experienced at least one chronic condition over the period, and 21% of patients experienced three or more chronic conditions. An inadequate level of physical activity, patients who suffered from extreme health burden or moderate health burden, and patients living in the poorest households were significantly associated with a higher risk of chronic comorbid conditions. This research also found that approximately 50% of cancer patients had experienced with long-term productivity-related work disability, 18% of patients had experienced extreme work disability, which was more pronounced with the magnitude of their health status burden. Finally, cancer prevention program (cancer vaccination) demonstrated ‘good value for money’, if the adopted vaccination strategies could accomplish a high vaccination coverage and provide protection. With a continued assessment of the potential vaccine properties as well as vaccine delivery and scale-up strategies, the two-dose 9vHPV vaccine would provide significant health and economic benefits for preadolescents and society. This thesis provides a better understanding of the challenges of cancer outcomes and long-term consequences on health status burden, chronic comorbid conditions, and productivity-related work disability, and has provided an evaluation of cancer vaccination for preventing cancer-related infections, along with contributing to the ongoing debate of cancer research. The findings are also significant for health care providers, including physical therapists and oncologists, who must manage the unique problems that challenge this population and who should advocate for prevention and evidence-based interventions that incorporate comprehensive social supports. The findings of this thesis will contribute to the decision-making process regarding the prevention of cancer illness, better outline the management of a sequelae course of treatment for cancer survivors, both of which aim to reduce the long-term burden in Australia

Experience of a hygiene project in Bangladesh: institutional learning

This paper, from practitioners’ point of view, draws some institutional lessons based on implementation experiences on a hygiene project- “Environmental Sanitation, Hygiene and Water Supply in Rural Areas” that aims at improving environmental sanitation and personal hygiene behavior at both households and community levels. Having analyzed the dynamics, strategies, implementation mechanism and institutional framework of the project it reveals that Department of Public Health Engineering (DPHE) being a government department has transformed itself as facilitator from its traditional role of implementer. It is worth mentioning that DPHE has been allocating government resources based on community action plans that have incorporated community needs and priorities regarding sanitation and hygiene. The success of the project lies in the fact that local government institutions have become interested to shoulder the responsibilities to bring positive changes towards environmental sanitation. This success is attributed to institutional framework that is worth to be replicated elsewhere

Process proved product: a case of hygiene project in Bangladesh

This paper deals with a Hygiene Project in Bangladesh, financially supported by the United Kingdom Department for International Development (DFID), technically assisted by the UNICEF and implemented by the Department of Public Health Engineering (DPHE) of the Government of Bangladesh. The project work started in November 2002 and ended in December 2005. The purpose of the project was to improve hygiene practice and behaviour, especially for the poor, and to contribute to reducing mortality, morbidity and malnutrition caused by poor sanitation and unsafe water related diseases, especially among women and children. The project adopted some participatory mechanisms that helped communities take the lead in planning, implementation and monitoring of the project activities. The project focused much on the community processes that led the community to achieve the project goal as the communities are at the centre of changing their own behaviour on a sustainable basis

Relationship Between Salinity and Crop Production in Different Hydrological Regimes Downstream of Muhuri Regulator

A large landmass was formed at the downstream of Feni river due to the construction of Muhuri regulator at a cross dam in Mirsaraiupazila of Chittagong district. But this land is more vulnerable to storm and tidal surges leading to saline water intrusion. The study site was selected from this area to investigate the relationship between salinity and crop production. Soil samples were collected from different hydrological regimes such as old protected area, new protected area, unprotected area and affected area from topsoil, subsoil and substratum in both wet and dry period. Crop yield of the sampling plots were recorded through farmer’s interview. It was found that, salinity of the study area was less than 4 dS/m both in aman and rabi season. Rice is a semi-tolerant crop (it can tolerate salinity up to 4 dS/m). So no significant relationship between soil salinity and rice yield was observed. Farmers of this area mainly cultivate khesari crop in rabi season. A significant positive correlation (correlation coefficient 0.97) was found between the soil salinity and khesari yield in unprotected area. Water salinity inside the cross dam was around 0.1 dS/m (rabi season), which is considered excellent for irrigation. But outside the cross dam it ranged in between 4.8-5.4 dS/m in aman season and 12.4-20.8 dS/m in rabi season, which was extremely toxic for irrigation for the cultivation boro rice. Although soil salinity permits to cultivate HYV rice in a man season but water logging is the main constraint. HYV rice in boro season can be cultivated in old and new protected area by utilizing Feni river water inside the Muhuri regulator and closure dam for irrigation purpose. But in unprotected area, it can not be cultivated due lack of suitable irrigation water and tidal flooding. In the study area, non-irrigated crop like khesari can be grown successfully just after aman season by utilizing residual soil moisture

Does Financial Flexibility foster Investment Efficiency? Evidence from an Emerging Market

This research aims to examine the relationship between financial flexibility and investment efficiency empirically, i.e., how financial flexibility effects suboptimal investments and efficiency. To attain the research objectives, we used panel data for 18 years (2000-2017) obtained from the CSMAR database; and also used the GMM estimation technique for research outcome. Our empirical results reveal that financial flexible firms can reduce the suboptimal investment by increasing investments compared to the inflexible firms and increases the investment efficiency. Also, financially flexible firms generate additional power to borrow external finance by showing a significant positive relationship with current and expected leverage. This research considers China as an emerging economy that is in the transition of being a developed country with a unique set of corporate governance, which ensures the independence of independent directors by providing authority to disclose important board decisions to the public. Besides, the governance system is highly monitored by the government, which in turn reduces and information asymmetry and enact to provide investment efficiency. Thus, the outcome of this research offers several conceptions for researchers and managers, which may be useful for both emerging and advanced countries. The results indicate that financial flexibilities lead to excess debt capacity, and this capacity can be used in the bad time when external financing is challenging to fund profitable projects, and also financial flexibility can be used to exploit lucrative projects and reduce the underinvestment or overinvestment entailing investment effectiveness. Previous research addresses the issue related to cost and benefit, information asymmetry, ownership concentration, and firms’ propensity to financial flexibility. A little research conducted on financial flexibility and investment efficiency in the developed market (in Europe and USA), and thus the issue of and financial flexibility measured in unused debt capacity and investment efficiency, is one of the fundamental research in the emerging economy

Performances of improved and traditional rice based jhum cultivation in a hill district of Bangladesh

Jhum is a customary farming which is very important for the livelihood of the alpine people of Bangladesh. Total productivity of the traditional practice of jhum cultivation is very low. The study was conducted to identify the yield gap between improved and local practices in Bandarban district of Bangladesh during March to September; 2017.The experiment was laid out in randomized complete block design (RCBD) with ten replications. Improved jhum practice produced the higher yields of rice (3113kg/ha), seed cotton (456 kg/ha), sesame (478 kg/ha) and maize (627 kg/ha) than traditional local jhum. Rice Equivalent Yield (REY) was also higher (40.23%) in improved jhum (6786.8kg/ha) than local jhum (4339.8 kg/ha). Improved jhum’s rate of returns (2.15) was higher than traditional jhum’s rate of returns (1.56). Improved practice in jhum cultivation increased yield and it was economically profitable over traditional practice

Avirulence gene based RFLP and rep-PCR distinguish the genetic variation of Xanthomonas oryzae pv. oryzae pathotypes in Bangladesh

Bacterial blight (BB) caused by X. oryzae pv. oryzae is one of the devastating diseases of rice mostly in Asia. Genomes of X. oryzae pv. oryzae is highly variable due to rearrangement of the large contents of transposable elements and dynamic changes of X. oryzae pv. oryzae population regulated efficiency of the control measures used for BB management of rice worldwide. In this study, genetic variation of X. oryzae pv. oryzae pathotypes of Bangladesh was studied using aviruelnce gene based RFLP and rep-PCR techniques aimed to formulate pathogen targeted effective control measures against BB of rice. Eight pathotypes of X. oryzae pv. oryzae field isolates were identified based on their reactions against 10 Near Isogenic Lines (NILs). Among eight pathotypes, pathotypes IV and V contained higher number of isolates which were 30.13% and 23.01% respectively while pathotype VIII revealed as minimum containing only 2.51% of total isolates. These eight pathotypes were studied for their genetic variation by RFLP using avrBs3 repeat domain as probe. The results conceded that Bangladeshi X. oryzae pv. oryzae strains seem carrying a minimum of two and maximum of nine avrBs3 family genes homologs. The resistance phenotype on IRBB7 and IRBB10 NILs also indicated presence of two major avrBs3 family genes viz. avrxa7 and avrXa10 in some pathotypes. Relationship of phylogenicity exhibited that X. oryzae pv. oryzae pathotypes assorted into two RFLP haplotypes as well as these haplotypes are largely distributed in Bangladesh. Phylogenetic analyses carried out by (REP, ERIC), rep-PCR and BOX depicted the presence of two main molecular haplotypes of X. oryzae pv. oryzae pathotypes. The relationship between pathotypes and molecular haplotypes of X. oryzae pv. oryzae in Bangladesh indicated that the same lineage possesses different pathotypes and different lineage possesses different pathotypes. The results indicated that eight different pathotypes might have originated from common inherited haplotypes with a wide genetic variation

Meta-Data Analysis to Explore the Hub of the Hub-Genes That Influence SARS-CoV-2 Infections Highlighting Their Pathogenetic Processes and Drugs Repurposing

The pandemic of SARS-CoV-2 infections is a severe threat to human life and the world economic condition. Although vaccination has reduced the outspread, but still the situation is not under control because of the instability of RNA sequence patterns of SARS-CoV-2, which requires effective drugs. Several studies have suggested that the SARS-CoV-2 infection causing hub differentially expressed genes (Hub-DEGs). However, we observed that there was not any common hub gene (Hub-DEGs) in our analyses. Therefore, it may be difficult to take a common treatment plan against SARS-CoV-2 infections globally. The goal of this study was to examine if more representative Hub-DEGs from published studies by means of hub of Hub-DEGs (hHub-DEGs) and associated potential candidate drugs. In this study, we reviewed 41 articles on transcriptomic data analysis of SARS-CoV-2 and found 370 unique hub genes or studied genes in total. Then, we selected 14 more representative Hub-DEGs (AKT1, APP, CXCL8, EGFR, IL6, INS, JUN, MAPK1, STAT3, TNF, TP53, UBA52, UBC, VEGFA) as hHub-DEGs by their protein-protein interaction analysis. Their associated biological functional processes, transcriptional, and post-transcriptional regulatory factors. Then we detected hHub-DEGs guided top-ranked nine candidate drug agents (Digoxin, Avermectin, Simeprevir, Nelfinavir Mesylate, Proscillaridin, Linifanib, Withaferin, Amuvatinib, Atazanavir) by molecular docking and cross-validation for treatment of SARS-CoV-2 infections. Therefore, the findings of this study could be useful in formulating a common treatment plan against SARS-CoV-2 infections globally

Wealth stratified inequalities in service utilisation of breast cancer screening across the geographical regions: A pooled decomposition analysis

Background Breast cancer is the most commonly occurring cancer among women in low-resourced countries. Reduction of its impacts is achievable with regular screening and early detection. The main aim of the study was to examine the role of wealth stratified inequality in the utilisation breast cancer screening (BCS) services and identified potential factors contribute to the observed inequalities. Methods A population-based cross-sectional multi-country analysis was used to study the utilisation of BCS services. Regression-based decomposition analyses were applied to examine the magnitude of the impact of inequalities on the utilisation of BCS services and to identify potential factors contributing to these outcomes. Observations from 140,974 women aged greater than or equal to 40 years were used in the analysis from 14 low-resource countries from the latest available national-level Demographic and Health Surveys (2008–09 to 2016). Results The population-weighted mean utilisation of BCS services was low at 15.41% (95% CI: 15.22, 15.60), varying from 80.82% in European countries to 25.26% in South American countries, 16.95% in North American countries, 15.06% in Asia and 13.84% in African countries. Women with higher socioeconomic status (SES) had higher utilisation of BCS services (15%) than those with lower SES (9%). A high degree of inequality in accessing and the use of BCS services existed in all study countries across geographical areas. Older women, access to limited mass media communication, being insured, rurality and low wealth score were found to be significantly associated with lower utilisation of BCS services. Together they explained approximately 60% in the total inequality in utilisation of BCS services. Conclusions The level of wealth relates to the inequality in accessing BCS amongst reproductive women in these 14 low-resource countries. The findings may assist policymakers to develop risk-pooling financial mechanisms and design strategies to increase community awareness of BCS services. These strategies may contribute to reducing inequalities associated with achieving higher rates of the utilisation of BCS services