BackgroundThere is an evidence-gap on how different hearing devices influence cognition. This study aimed to simultaneously compare cognitive performance across key domains among hearing aid, cochlear implant and bimodal device users.MethodsCross-sectional data were collected and analyzed as part of the Hearing Impairment in Adults: A Longitudinal Outcomes Study, during 2022–24. Adults aged ≥40 years old using hearing aids, cochlear implants, or bimodal hearing devices were recruited. Of 1054 approached, 617 participants had complete data: 387, 127, and 103 hearing aid, cochlear implant and bimodal device users, respectively. Cognitive function was assessed using the Cogstate Brief Battery among the different device user groups.ResultsIn the overall population, no significant differences were observed in Cogstate Brief Battery scores between device users. Age-stratified analyses (<70 and ≥70 years) was conducted, and cochlear implant compared to hearing aid users aged <70 had better reaction times in the following test – Detection (psychomotor function): 2.54 versus 2.58 (p = 0.02). In participants aged ≥70, cochlear implant users compared to hearing aid users showed poorer visual attention or higher mean Identification test scores: 2.83 versus 2.78 (p = 0.02).ConclusionThese findings suggest that hearing device type is not uniformly associated with cognitive performance, but rather that age and cognitive domain critically shape observed differences. This underscores the importance of more targeted cognitive monitoring in adults with hearing loss.

BACKGROUND:Expanding access to oral contraceptive pills (OCPs) through over-the-counter (OTC) reclassification may reduce barriers to contraception, but Australian consumer preferences for OTC OCP access remain poorly understood. METHODS:We conducted a discrete choice experiment (DCE) to quantify women's preferences for OTC OCP access in Australia. The DCE incorporated five attributes: method of accessing OCPs, provider training, ability to discuss other health issues, consultation time, and out-of-pocket cost. A D-efficient design generated 12 choice sets. Data were collected through quota sampling from 878 women during November to December 2023, including 359 current OCP users and 519 non-OCP users. Preferences were analysed using mixed logit models. RESULTS:Women using less effective contraceptive methods or no contraception favoured OTC access, whereas current OCP users did not show the same preference. Across groups, online general practitioner consultations and pharmacist consultations without a private setting were strongly disliked. Predicted uptake of, and switching to, OTC options was highest when OCPs received a high level of government funding, pharmacists had additional training in contraceptive care, women could discuss other health issues, and consultations were brief. Current OCP users were more likely to switch to OTC OCPs if they faced GP co-payments. Support for OTC access was greater among younger women, high-income women, and those with greater household decision-making autonomy. CONCLUSIONS:OTC access to OCPs is likely to be acceptable to many Australian women, particularly if pharmacists have received additional training in contraceptive care and consultations are affordable, private, and sufficiently comprehensive. Careful policy design will be needed to ensure acceptability, support informed contraceptive choices, and maximise the potential public health benefits of OCP reclassification.

This study investigates how a comprehensive set of socio-emotional skills (the Big Five personality traits, locus of control, risk preference, time preference, and trust) shapes not only the decision to enter entrepreneurship, as measured by self-employment and incorporated self-employment, but also informs individuals’ ability to sustain the entrepreneurial state over time. Drawing on longitudinal data from the Australian HILDA Survey, we introduce two time-sensitive indices to measure entrepreneurship, chronicity and persistence, alongside conventional static measures of self-employment and incorporated self-employment. Results show that risk preference consistently emerges as the strongest predictor of entrepreneurial entry and persistence, while the roles of other socio-emotional traits are smaller and less consistent. Heterogeneity analyses suggest these results offer important caveats on the gender dimension of entrepreneurship. These findings remain robust under extensive sensitivity and bounds tests, underscoring the central role of risk preference in sustaining entrepreneurial activity.

Disability imposes substantial social and economic costs, particularly in developed countries like Australia. In this paper, we estimate the longitudinal association between the onset of hearing loss and both earnings and income using panel data from the Household, Income and Labour Dynamics in Australia (HILDA) survey. We used the propensity score matching with difference-in-difference (PSM-DID) method to estimate how the onset of hearing loss influences longitudinal earnings and income. We applied fixed-effect regression to estimate relative earnings and income mobility before and after the onset of hearing loss. We conducted a subgroup analysis to investigate sociodemographic heterogeneity in hearing loss-associated earnings and income dynamics over time. We found that the onset of hearing loss is associated with a significant decline in earnings and income, even 15 years after the onset of hearing loss. Our findings indicate that earnings and income losses were more pronounced among socioeconomically disadvantaged individuals. These findings have significant implications for informing policy aimed at supporting the economic well-being of individuals with hearing loss.

Entrepreneurial activity is shaped by the structure and functioning of the entrepreneurial ecosystem, yet there is limited consensus on how entrepreneurial resilience is defined or measured. This study protocol outlines the development of a novel, empirically grounded measure of entrepreneurial resilience, conceptualised as a multidimensional and dynamic capability that enables adaptation under contextual hardship and resource constraints. Guided by a capability-based framework, the study draws on prior literature and employs qualitative methods, including a multi-round Delphi study and stakeholder interviews and focus groups. The study components will identify context-specific mechanisms and translate expert consensus into measurable and policy-relevant indicators. By setting out a transparent and reproducible methodology, this protocol contributes to the entrepreneurship and behavioural economics literature and provides a foundation for future empirical work and targeted policy interventions to support business continuity in volatile environments.

INTRODUCTION:There is a high prevalence of undiagnosed and untreated hearing loss among older adults. Due to finite resources, task shifting to trained non-specialists is a strategy to improve equity of access to hearing health care. This pilot study aims to implement and evaluate a novel model of hearing care known as the SOUND-BITES program. This will leverage evidence-based mobile health technologies (Arclight otoscopy and Sound Scouts hearing screening app) and partnerships with Meals on Wheels New South Wales and Master of Clinical Audiology students. METHODS:SOUND-BITES provides a hearing health assessment involving otoscopy using Arclight, hearing screening using the Sound Scouts tablet-based app, and hearing health education to consenting Meals on Wheels clients and their household members. Volunteers from Meals on Wheels and audiology students will be trained to deliver the screening, education and referral components of this program. This pilot study utilises a mixed-methods approach to evaluation. The primary outcomes are program acceptability and feasibility; and secondary outcomes are actions taken by clients to address hearing loss, changes in hearing handicap and cost-benefits six months after program completion. Quantitative data will be collected from a pre- and post-program survey, and qualitative data from an optional post-program interview with clients and volunteers. Findings from the project will be disseminated through peer-reviewed journals and conferences as well as to relevant communities including the Meals on Wheels network.

OBJECTIVE:The aim of this qualitative study was to evaluate the barriers and enablers to current hearing health-care services in Australia for middle-aged and older adults who use cochlear implants (CI) and/or hearing aids. METHODS:Adults aged 40 years and older from the Hearing impairment Adults: a Longitudinal Outcomes Study (HALOS), with adequate English language skills, were invited to participate in a semi-structured interview about their hearing intervention journey. A thematic analysis was applied to the interview transcripts via inductive coding. RESULTS:Thirty-one hearing device users (15 hearing aid users, 9 CI users and 7 bimodal users) across Australia enrolled in the interview. Themes identified include hearing care management, alternative support services, patient self-management and accessibility to hearing services. CONCLUSIONS:Findings indicated the need for primary health and hearing care professionals to reconsider their clinical approach with individuals with hearing loss. Rehabilitation, primary health and hearing care services ought to work together to create an integrated hearing care journey for patients.

This study addresses growing concerns regarding childhood obesity and cardiovascular diseases by exploring the effects of possible policy measures on the intention to choose sugar-sweetened beverages (SSBs) in Mongolia, a low-income country. Focusing on parents' preferences for purchasing SSBs, we employed a stated preference choice experiment to analyse how various product attributes, including price, labelling, sugar content and store placement, affect parents' purchase decisions. Price increases were the most effective intervention, with larger increases leading to a substantial reduction in purchase probability. Labelling also played a crucial role, particularly graphic warnings, which strongly deterred selection. Reducing sugar content positively influenced preferences. Also, store placement at less prominent locations (e.g., back row and bottom shelf) was associated with lower selection probability; however, these results reflect stated preferences and should be interpreted cautiously given their hypothetical nature. Additionally, estimates of willingness to pay suggest consumers are less willing to purchase SSBs with graphic warning labels and placement in the back row and bottom level. These findings highlight the importance of integrating multiple regulatory measures to effectively curb SSB consumption and mitigate associated health risks in Mongolia.

OBJECTIVES:The value of information framework assesses whether further research is warranted, and recent approximation methods have made the value of information analysis more feasible. There is ongoing uncertainty regarding the cost-effectiveness of Australia's universal newborn hearing screening (UNHS) program. This study aimed to quantify the value of additional research to guide future research priorities, including estimating the value by type of evidence and sample size needed to maximize the value to decision making. METHODS:A decision-analytic model, comprising an initial decision tree followed by a Markov model, with a 26-year time horizon, was developed to evaluate the cost-effectiveness of UNHS compared with no screening. Model parameters, including costs, probabilities, and outcomes, were derived from 2 Australian longitudinal studies, alongside relevant published sources. The expected value of perfect information, the expected value of partial information, and the expected value of sample information were estimated. RESULTS:The incremental cost-effectiveness ratio was $39 400/quality-adjusted life-year, with approximately 50% probability of being cost-effective at the $40 900/quality-adjusted life-year threshold. The expected value of perfect information for 2.5 million newborns over 10 years was $130.30 million, and the expected value of partial information revealed that the utility values were the primary source of uncertainty, particularly the association between utilities and diagnosis age. The expected value of sample information indicated that collecting utility data from 300 to 500 additional children could significantly reduce uncertainty and be worth between $106.41 million and $113.91 million. CONCLUSIONS:UNHS had an incremental cost-effectiveness ratio below the threshold, with some uncertainty in cost-effectiveness. Collecting additional utility data would reduce uncertainty and reduce decision uncertainty in Australia and elsewhere.

This paper provides the first causal evidence of the impact of China's Targeted Poverty Alleviation (TPA) policy on household-level vulnerability to multidimensional poverty (VMP). Using nationally representative panel data from the China Household Finance Survey (CHFS), we employ a suite of quasi-experimental techniques-including twoway fixed effect (TWFE), Doubly Robust Difference in Difference (DRDiD), Synthetic DiD (SDiD), and Debiased Double Machine Learning Difference in Difference (DML-DiD)-to identify treatment effects while addressing selection bias, high dimensional covariates, and model misspecification. Our findings show that TPA significantly reduces VMP at the national level, with effects robust across alternative treatment and outcome definitions. However, the policy's effectiveness is uneven: households just outside the highest risk group-particularly those with limited human capital, low dependency burdens and restricted social and financial inclusion-experience the largest reduction in vulnerability. In contrast, the most deprived households and those with high dependency burden benefit less. Female-headed and non-communist party of China households benefit more, suggesting differential policy reach and uptake. By shifting the lens from income to multidimensional vulnerability this study shows that while TPA is broadly effective, it is not broadly efficient for tackling vulnerability to poverty. Moreover, we show that modern estimators like DML-DiD and SDiD outperform TWFE models in detecting policy impact under treatment effect heterogeneity.

Household indebtedness has risen sharply and reached unprecedented levels globally. Low-income households disproportionately bear the burden of this debt, making them particularly vulnerable to over-indebtedness and financial vulnerabilities. This article examines the complex relationship between household indebtedness and multidimensional poverty, accounting for household heterogeneity. Using data from the China Household Financial Survey, we employ both traditional linear regression models and semi-parametric Generalized Additive Models (GAM) to uncover a non-linear relationship between household indebtedness and multidimensional poverty. The analysis finds a dual-threshold impairing effect of household indebtedness on multidimensional poverty. Furthermore, the impact of indebtedness varies significantly across households based on financial and demographic characteristics. Households with solvency-strain, those with credit-constraints, minority households, female-household heads, and those without government subsidies, are disproportionately affected by these dual-threshold effects. Notably, these adverse effects are consistent across both rural and urban households. Robustness checks and endogeneity analyses, conducted using a two-step generalized additive model (2SGAM), validate the findings and reinforce the reliability of the results. Our findings provide new insights into the non-linear relationship between household indebtedness and multidimensional poverty and offer evidence for policymakers to guide accessibility of household credit facilities.

Hearing loss is a common but under-recognized condition among older adults, linked to fatigue, reduced productivity, social isolation, and early workforce exit. As developed countries face aging workforces, there is a critical need to understand how hearing device usage influences occupational outcomes. This study analyzed cross-sectional data from the Hearing Impairment in Adults: A Longitudinal Outcomes Study, involving 227 Australian adults aged 40 + using hearing aids, cochlear implants, or both (bimodal). We examined whether work functioning and performance differed between the three hearing device groups. After multivariate adjustment, total individual work performance scores were significantly higher (indicating a better outcome) among cochlear implant (2.26) and bimodal users (2.31) than hearing aid users (2.08, p < 0.05). Similarly, multivariate-adjusted mean total Utrecht Work Engagement Scale scores were significantly higher (better outcome) in cochlear implant (4.16) and bimodal users (4.50) than hearing aid users (3.97, p < 0.05). This novel study highlights that adult cochlear implant and bimodal users exhibit significantly better work performance and engagement compared to hearing aid users, ever after multivariate adjustment. These findings emphasize the importance of optimizing hearing care strategies, particularly in countries with rapidly aging workforces, to better support older adults’ occupational functioning and productivity.

BACKGROUND:Research suggests that early detection of hearing loss, coupled with prompt and appropriate treatment, can significantly alleviate its negative impacts. Routinely collected real-world data, such as those from electronic health records data, provide an opportunity to enhance our understanding of the management of hearing loss. This project aims to create the HEaring Impairment Data Infrastructure (HEIDI) data lake by assembling datasets from general practice (GP), audiology clinic registries, and cohort studies to investigate hearing-impaired patients' care pathways. This study seeks to answer key research questions such as "How do patients with hearing loss navigate the care pathway from general practice clinics to audiology clinics?". METHODS AND ANALYSIS:The HEIDI data lake will be hosted in a secure research environment at Macquarie University, Sydney, Australia, that complies with Australian legal and ethical requirements to protect patient privacy. Afterwards, new integrated datasets will be built through data linkage of hearing and GP datasets. Finally, the HEIDI data warehouse will be developed and used as a stand-alone dataset for future research. Descriptive and predictive analytics will be undertaken to answer our research questions with the data warehouse. Descriptive analysis will include both conventional and advanced statistical techniques and visualisation that will help us understand the journey of patients with hearing loss. Machine learning strategies such as deep neural networks, support vector machines, and random forests for predictive analytics will also be employed to identify participants that could benefit from proactive management by their GP and determine the effect of interventions through the patient's journey (e.g., referrals to specialist) on outcomes (e.g., adherence to the intervention). DISSEMINATION:The findings will be disseminated widely through academic journals, conferences and other presentations.

A quasi-experiment was created in Australian policy between 2012 and 2013 when workplace health and safety laws were harmonized in all but two jurisdictions. This reform expanded definitions for duty of care, introduced criminal enforcement, and increased penalties. Using stacked difference-in-difference estimation, we fail to find overall reduced workers' compensation probability over the post-reform period. However, we find significantly reduced workers' compensation probabilities for high-risk industry workers and workers in single-location employers. We conclude that more consistent laws may not reduce overall claims and injury if they do not reduce complexity or consider available inspectorate resources, and if jurisdictions have implementation flexibility.

ObjectiveHealth technology assessment is used extensively by the Pharmaceutical Benefits Advisory Committee (PBAC) to inform medicine funding recommendations in Australia. The PBAC often does not recommend medicines due to uncertainties in economic modelling that result in delaying access to medicines for patients. The systematic identification of which uncertainties can be reduced with alternative evidence or the collection of additional data can help inform recommendations. This study aims to characterise different types of uncertainty in economic models and empirically assess their association with the PBAC recommendations.MethodsA framework was developed to characterise four types of uncertainties: methodological, structural, generalisability and parameter uncertainty. The first two types were further subcategorised into parameterisable and unparameterisable uncertainty. Data on uncertainty and other factors were extracted from PBAC's Public Summary Documents of first submissions for 193 medicine (vaccine)-indication pairs including economic modelling between 2014 and 2021. Logistic regression was used to estimate the average marginal effect of each type of uncertainty on the probability of a positive recommendation.ResultsThe PBAC more often raised issues regarding parameter uncertainty (95%) and parameterisable structural uncertainty (83%) than generalisability uncertainty (48%) and unparameterisable methodological uncertainty (56%). The logistic regression results suggested that the PBAC was more likely to recommend a medicine without unparameterisable methodological, generalisability, and parameterisable structural uncertainty by 15.0%, 10.2 %, and 17.6%, respectively. Parameterisable methodological, unparameterisable structural and parameter uncertainty were not significantly associated with the PBAC recommendations.ConclusionsThis study identified the uncertainties that had significant associations with PBAC recommendations based on the first submission. This may help improve model quality and reduce resubmissions in the future, thus improving patients' access to medicines.

Introduction The COVID-19 pandemic has raised concerns about the persistence of symptoms after infection, commonly referred to as ‘post-COVID’ or ‘long-COVID’. While countries in high-resource countries have highlighted the increased risk of disadvantaged communities, there is limited understanding of how COVID-19 and post-COVID conditions affect marginalised populations in low-income and middle-income countries. We study the longitudinal patterns of COVID-19, post-COVID symptoms and their impact on the health-related quality of life through the IndiQol Project.Methods and analysis The IndiQol Project conducts household surveys across India to collect data on the incidence of COVID-19 and multidimensional well-being using a longitudinal design. We select a representative sample across six states surveyed over four waves. A two-stage sampling design was used to randomly select primary sampling units in rural and urban areas of each State. Using power analysis, we select an initial sample of 3000 household and survey all adult household members in each wave. The survey data will be analysed using limited dependent variable models and matching techniques to provide insights into the impact of COVID-19 pandemic and post-COVID on health and well-being of individuals in India.Ethics and dissemination Ethics approval for the IndiQol Project was obtained from the Macquarie University Human Research Ethics Committee in Sydney, Australia and Institutional Review Board of Morsel in India. The project results will be published in peer-reviewed journals. Data collected from the IndiQol project will be deposited with the EuroQol group and will be available to use by eligible researchers on approval of request.

Introduction The prevention of unintended pregnancy is a public health issue affecting women worldwide. In Australia, women are required to get a prescription to obtain the oral contraceptive pill (OCP), which may limit access and be a barrier to its initiation and continuing use. Changing the availability of the OCP from prescription-only to over-the-counter (OTC) is one solution, however, to ensure success policymakers need to understand women’s preferences. Telehealth services also might serve as an alternative to obtain prescriptions and increase accessibility to OCPs. This study aims to explore the preferences for OTC OCPs among Australian women, and whether the expansion of telehealth impacted women’s preferences. Methods A mixed methods approach was used to explore women’s preferences regarding access to the OCP. Focus group discussions (FGDs) were conducted to organically identify the preferences followed by an empirical ranking exercise. Three FGDs in two phases were conducted, pre and post-expansion of telehealth in Australia due to the COVID-19 pandemic. Convenience sampling was employed. The technique of constant comparison was used for thematic analysis where transcripts were analysed iteratively, and codes were allowed to emerge during the process to give the best chance for the attributes to develop from the data. Results Thematic analysis revealed that women perceived OTC availability of OCPs as a mechanism to increase the accessibility of contraception by reducing cost, travel time, waiting time, and increasing opening hours. They also believed that it would increase adherence to OCPs. However, some potential safety concerns and logistical issues were raised, including pharmacist training, access to patient’s medical history, the ability to discuss other health issues or undertake opportunistic health screening, adherence to checklists, and privacy in the pharmacy environment. Following the expansion of telehealth, accessibility issues such as opening hours, travel time, and location of the facility were considered less important. Conclusions The participants expressed their support for reclassifying OCPs to OTC, particularly for repeat prescriptions, as it would save valuable resources and time. However, some safety and logistical issues were raised. Women indicated they would balance these concerns with the benefits when deciding to use OTC OCPs. This could be explored using a discrete choice experiment. The expansion of telehealth was perceived to reduce barriers to accessing OCPs. The findings are likely to be informative for policymakers deciding whether to reclassify OCPs to OTC, and the concerns of women that need addressing to ensure the success of any policy change.

HIV/AIDS knowledge deprivation fosters fear, discrimination, and stigma and, thus, reduces the impact of prevention efforts. This article investigates the socioeconomic determinants of HIV/AIDS knowledge deprivation in Bangladesh, a country largely affected by HIV incidence, using the 2011 and 2014 waves of the Bangladesh Demographic and Health Survey. To analyze the factors impacting the unequal distribution of HIV/AIDS knowledge deprivation among socioeconomic groups, the study proposes a multidimensional knowledge deprivation index and constructs a knowledge deprivation concentration index. Results show that the concentration of knowledge deprivation among the most disadvantaged groups (those with low household wealth) significantly correlates with the concentration of women's empowerment among the least economically disadvantaged. These findings highlight the role of institutional support for programs improving women's agency as an important complement to programs that focus on traditional forms of deprivation and disadvantage.HIGHLIGHTSIn Bangladesh, women are disproportionally exposed to the risk of HIV/AIDS.Multidimensional HIV/AIDS knowledge deprivation is concentrated among disadvantaged women.Key prevention strategies are those focused on knowledge deprivation.Policies targeting women's education and employment will reduce the risk of infection.Women's empowerment and agency improve HIV/AIDS knowledge deprivation.

Background Often considered an “invisible disability”, hearing loss is one of the most prevalent chronic diseases and the third leading cause for years lived with disability worldwide. Hearing loss has substantial impacts on communication, psychological wellbeing, social connectedness, cognition, quality of life, and economic independence. The Hearing impairment in Adults: a Longitudinal Outcomes Study (HALOS) aims to evaluate the: (1) impacts of hearing devices (hearing aids and/or cochlear implants), (2) differences in timing of these interventions and in long-term outcomes between hearing aid and cochlear implant users, and (3) cost-effectiveness of early intervention for adult-onset hearing loss among hearing device users. Materials and methods HALOS is a mixed-methods study collecting cross-sectional and longitudinal data on health and social outcomes from 908 hearing aid and/or cochlear implant users aged ≥40 years, recruited from hearing service providers across Australia. The quantitative component will involve an online survey at baseline (time of recruitment), 24-months, and 48-months and will collect audiological, health, psychosocial, functional and employment outcomes using validated instruments. The qualitative component will be conducted in a subset of participants at baseline and involve semi-structured interviews to understand the patient journey and perspectives on the Australian hearing service model. Ethics This study has been approved by the Macquarie University Human Research Ethics Committee (ID: 11262) and Southern Adelaide Local Health Network (ID: LNR/22/SAC/88). Dissemination of results: Study findings will be disseminated to participants via a one-page summary, and to the public through publications in peer-reviewed journals and presentations at conferences. Trial registration Australia New Zealand Clinical Trial Registry (ANZCTR) registration number: ACTRN12622000752763.