Value-based public health: Moving beyond value-based health care to support a wellbeing economy

While value-based health care (VBHC) is transforming Australia's health system, with its focus on patient-centred care and outcomes, it cannot transform Australia's health without policy action to address the social determinants of health. Australia is moving towards a wellbeing economy, but governments have not been explicit in the methods by which the health system will contribute to the development of a wellbeing economy at a macro level. It is also unclear how governments will ensure that approaches to valuing wellbeing will complement current health care innovations in defining and evaluating value in relation to health outcomes. To address this gap, we present a value-based public health (VBPH) framework to conceptualise a health-informed model to expand current thinking about defining, delivering and evaluating the value of population health and wellbeing. The framework provides a critical and innovative approach beyond VBHC for improving population health and wellbeing outcomes, in alignment with principles and measures being put forth in early examples of governments using wellbeing economy policies. In VBPH, the focus is on ensuring value in interventions to improve population outcomes. VBPH offers an approach for joined-up policy across government, using Health in All Policies for multi-sector public health interventions in response to population needs, across full cycles of policy development, implementation and evaluation. It promotes social return on investment methods to measure outcomes that matter to diverse stakeholders within and across communities. VBPH also requires cost estimation from a whole of government perspective, across complete cycles and stages of policy.

Australian health policies related to diagnostic imaging: too much of a good thing?

Diagnostic imaging is increasingly being used in Australia to aid clinician diagnostic and therapeutic decision-making. There is concern that this increased use represents an overconsumption of inappropriate health services, which wastes finite resources and may cause direct or indirect harm to the patient. Australian health policies have primarily focused on increasing patient access to diagnostic imaging. While these policies address inequitable access and may lead to timely diagnosis and improved health outcomes, these benefits have not been weighed against the unintended harms. This perspective article will explore the unintended consequences of increasing access to diagnostic imaging as well as provide potential solutions to improve the effectiveness of policies in this area.

Co-designing a dashboard of predictive analytics and decision support to drive care quality and client outcomes in aged care: a mixed-method study protocol

INTRODUCTION

There is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an 'at-a-glance' overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined.

METHODS

This mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop.

ETHICS AND DISSEMINATION

This study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University's Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations.

Asymmetrical nostril axis angle in the post traumatic nose

BACKGROUND

Nasal tip reconstruction is a challenging part of septorhinoplasty in post-traumatic patients. Aesthetic appearance of the nose is dependent on adequate tip definition, projection and rotation. Our aim is to establish if caudal septal dislocation (secondary to fracture or subluxation) is a significant factor in causing asymmetry in nostril axis angle (NAA) to effect surgical intervention. In addition, to assess if there is an association between the side of dislocation and the magnitude of NAA.

METHODOLOGY

Photographic assessment of NAA was measured in a study group of 26 patients with caudal dislocation of the septum and a control group of 26 patients without caudal septal dislocation. All 52 patients were awaiting a septorhinoplasty procedure due to nasal trauma.

RESULTS

Caudal septal dislocation causes a mean difference in NAA of 7.95o compared to 1.38o difference in the control group. We also found there is a greater degree of upward tip rotation on the side of the dislocation resulting in a larger NAA.

CONCLUSION

Caudal dislocation of the septum causes a significant asymmetry in NAA, with a greater degree of rotation on the side of the dislocation. We should be aware of this fallacy prior to surgery.

Heterogeneity in function of small artery smooth muscle BKCa: involvement of the beta1-subunit

Arteriolar myogenic vasoconstriction occurs when increased stretch or membrane tension leads to smooth muscle cell depolarization and opening of voltage-gated Ca2+ channels. To prevent positive feedback and excessive pressure-induced vasoconstriction, studies in cerebral artery smooth muscle have suggested that activation of large conductance, Ca2+-activated K+ channels (BKCa) provides an opposing hyperpolarizing influence reducing Ca2+ channel activity. We have hypothesized that this mechanism may not equally apply to all vascular beds. To establish the existence of such heterogeneity in vascular reactivity, studies were performed on rat vascular smooth muscle (VSM) cells from cremaster muscle arterioles and cerebral arteries. Whole cell K+ currents were determined at pipette [Ca2+] of 100 nM or 5 microM in the presence and absence of the BKCa inhibitor, iberiotoxin (IBTX; 0.1 microM). Similar outward current densities were observed for the two cell preparations at the lower pipette Ca2+ levels. At 5 microM Ca2+, cremaster VSM showed a significantly (P < 0.05) lower current density compared to cerebral VSM (34.5 +/- 1.9 vs 45.5 +/- 1.7 pA pF(-1) at +70 mV). Studies with IBTX suggested that the differences in K+ conductance at 5 microM intracellular [Ca2+] were largely due to activity of BKCa. 17beta-Oestradiol (1 microM), reported to potentiate BKCa current via the channel's beta-subunit, caused a greater effect on whole cell K+ currents in cerebral vessel smooth muscle cells (SMCs) compared to those of cremaster muscle. In contrast, the alpha-subunit-selective BKCa opener, NS-1619 (20 microM), exerted a similar effect in both preparations. Spontaneously transient outward currents (STOCs) were more apparent (frequency and amplitude) and occurred at more negative membrane potentials in cerebral compared to cremaster SMCs. Also consistent with decreased STOC activity in cremaster SMCs was an absence of detectable Ca2+ sparks (0 of 76 cells) compared to that in cerebral SMCs (76 of 105 cells). Quantitative PCR showed decreased mRNA expression for the beta1 subunit and a decrease in the beta1:alpha ratio in cremaster arterioles compared to cerebral vessels. Similarly, cremaster arterioles showed a decrease in total BKCa protein and the beta1:alpha-subunit ratio. The data support vascular heterogeneity with respect to the activity of BKCa in terms of both beta-subunit regulation and interaction with SR-mediated Ca2+ signalling.

Measles outbreaks in Micronesia, 1991 to 1994

BACKGROUND

Several islands in Micronesia experienced large measles outbreaks, during 1991 through 1994. Except for Guam, none of the islands had reported measles outbreaks during the previous 20 years.

METHODS

To characterize the outbreaks, measles surveillance data, hospital records and death certificates were reviewed. Preoutbreak vaccination coverage rates were assessed by reviewing public health vaccination records. Viral isolates were genetically sequenced to determine the source of transmission. Linear regression analysis was performed to assess the effectiveness of outbreak control measures.

RESULTS

Between 1991 and 1994 more than 1300 measles cases and 16 measles-related deaths were reported in Micronesia. Preoutbreak vaccination coverage rates among 2-year-old children were 55 to 94%. Genetic sequencing of the viral isolates and epidemiologic investigations suggested transmission between islands and new importations from outside of Micronesia. The highest attack rates were among children ages < 5 years (20/1000) and 10 to 19 years (38/1000). Compared with attack rates among children ages < 1 and 10 to 19 years, attack rates were lower among those ages 5 to 9 years, in whom 2-dose vaccination coverage rates were highest (P < 0.001). Early and rapid implementation of mass vaccination campaigns was significantly associated with shorter duration of outbreaks (P = 0.049).

CONCLUSION

The measles outbreaks in Micronesia show that island populations may be highly susceptible to measles. High two-dose vaccination coverage levels must be maintained to prevent such outbreaks. Early and rapidly implemented mass measles vaccination campaigns were effective in control of island outbreaks. Strengthening public health infrastructure and surveillance is necessary for early identification of outbreaks and rapid implementation of mass campaigns.

Synthesis and thin-layer chromatographic ultraviolet, and mass spectral properties of the anticoagulant phenprocoumon and its monohydroxylated derivatives

Phenprocoumon and all of its aromatic monohydroxylated derivatives have been synthesized and analyzed by TLC, uv, and chemical ionization mass spectroscopy. By utilization of various combinations of these analytical techniques all of the titled compounds can be uniquely identified.