Covid 19 Vaccines and the Australian health care state.

Objectives: Australia had one of the most successful early responses to the COVID-19 pandemic. Border closures and effective public health responses to outbreaks kept infection and death rates to amongst the lowest in the world. The strategy was premised on an eventual escape through the development and availability of vaccines. While effective vaccines appeared earlier than many expected, Australia's the next stage of crisis management stalled. Vaccination rates were, in mid-2021, one of the lowest in the OECD. By the end of 2021, however, Australia had a comparatively high vaccination rate. This paper accounts for this paradoxical situation. Methods: The analysis uses Moran and Tuohy's concept of the 'health care state' to show how interlocking elements of consumption, production, governance and statecraft created the conditions for Australia's contradictory response to the crisis. Results: The paper locates problems commonly attributed to 'leadership failure' in an analysis of the evolving dynamics of the Australian healthcare state and the governance regimes concerning collective consumption, the health professions, and technologies. Vaccine supply was delayed by the Federal government's preference for local production. The initial problems of the vaccine rollout arose from a failed experiment with outsourcing, initiated at the height of the crisis. Conclusion: Australia's ultimate success in achieving high vaccination rates emerged from the agile stability embedded in its health care state. This delivered where 'market inspired innovation' had failed.

Driving reaction time following periacetabular osteotomy.

INTRODUCTION: Periacetabular osteotomy (PAO) is increasingly being used to treat young adults with symptomatic hip dysplasia. Currently there is a lack of evidence to guide return to driving after this procedure. This study aimed to identify the length of time required after a Periacetabular Osteotomy procedure before a patient can safely return to driving. METHODS: All patients undergoing PAO were assessed for suitability for the study. Inclusion criteria were: currently driving with a valid licence; and being able to attend follow-up assessment. Baseline driving reaction time was assessed using a driving simulator preoperatively. The simulation was repeated 5 times for each patient and reaction times recorded (Thinking time, Action time and Total reaction time for braking at 30 mph). The driving simulation was repeated using the same methods at 6 weeks and 12 weeks postoperatively. Pre- and postoperative times were compared. RESULTS: 26 patients were included (24 females, 2 males) with a mean age of 32 (range 19-50) years. The mean preoperative times were: Thinking time 0.48, Action time 0.21, Total time 0.69 seconds. At 6 weeks postoperatively, mean Action time increased to 0.26 seconds (p = 0.012) and mean Total time increased to 0.78 seconds (p = 0.013). By 12 weeks post procedure, there was no significant difference in reaction times compared to baseline (mean Thinking time 0.47 seconds, Action time 0.23, Total time 0.72; p > 0.05). CONCLUSIONS: Most patients may not be safe to drive at 6 weeks following PAO procedures but should be safe to drive at 12 weeks postoperatively. Individual patient factors should also be taken into consideration.

Changes in public perceptions and experiences of the Australian health-care system: A decade of change.

BACKGROUND: The views and experiences of the Australian public are an important barometer of the health system. This study provides key findings about the changing views held by Australians over time regarding their individual experiences and perceptions of the overall performance of the health system. METHODS: A population-based online survey was conducted in 2018 (N = 1024). Participants were recruited through market research panels. The results were compared with previous Australian population survey data sets from 2008 (N = 1146), 2010 (N = 1201) and 2012 (N = 1200), each of which used different population samples. The survey included questions consistent with previous surveys regarding self-reported health status, and questions about use, opinions and experiences of the health system. RESULTS: Overall, there has been a shift in views from 2008 to 2018, with a higher proportion of respondents now viewing the Australian health-care system more positively (X2 (2, N = 4543) = 96.59, P < .001). In 2018, areas for attention continued to include the following: the need for more doctors, nurses and other health workers (29.0%); lower costs for care or Orion medicines (27.8%); more access to care (13.1%); and enhancements in residential aged care (17.3% rated these services as 'bad' or 'very bad'). CONCLUSIONS: This research suggests that Australians' perceptions of their health-care system have significantly improved over the last decade; however, concerns have emerged over access to medicines, inadequate workforce capacity and the quality of aged care facilities. Our study highlights the value of periodically conducting public sentiment surveys to identify potential emerging health system problems.

A spatial analysis of referrals to a primary mental health programme in Western Sydney from 2012 to 2015.

Access to Allied Psychological Services is a primary mental health programme targeting hard-to-reach populations throughout Australia. This research aims to identify patterns of referrals to the programme in the Western Sydney Primary Health Network region from 2012 to 2015. The referral rates were analysed by using spatial autocorrelation indexes and spatial regression. The study area was described through the identification of the most disadvantaged areas and through consideration of three socio-economic indicators: percentage of Aboriginal and Torres Strait Islander Australians, low educational attainment and low weekly incomes. A large hot spot (identifying high referral rates) was located across the duration of the study in the south-western urban area that partially covered a disadvantaged area. The main cold spot (identifying low referral rates) was located in the south-eastern urban area, covering another disadvantaged area, however critically this association disappeared over time. Our modelling showed that the referral rates had a direct association with the percentage of Aboriginal and Torres Strait Islander peoples with low incomes, and an indirect association with low educational attainment. The results and technique are useful in monitoring and addressing inequality in health planning and policy.

Partners in Recovery program evaluation: changes in unmet needs and recovery.

Objective Partners in Recovery (PIR) is an Australian government initiative designed to provide support and service linkage for individuals with complex needs living with severe and persistent mental illness. The aim of the present study was to examine whether consumers engaged in PIR programs in two large regions of Sydney experienced: (1) a reduction in unmet needs (either via self- or staff report); and (2) progress in their self-reported mental health recovery. Methods Unmet needs were measured using the Camberwell Assessment of Need Short Appraisal Scale and recovery was measured using the Recovery Assessment Scale - Domains and Stages. For individuals with initial and follow-up data, paired t-tests were used to examine change over time. Results At follow-up, individuals reported an average of two to three fewer unmet needs, and recovery scores increased by approximately 5% across each domain and the total score. At follow-up, the most common unmet needs were in the areas of 'company' and 'daytime activities'. Conclusions The results of the present study suggest that PIR services in these two geographical regions have achieved positive results. Individuals with severe and persistent mental illness engaged with PIR appear to have reduced their unmet needs and enhanced their mental health recovery. What is known about the topic? PIR services were established to support individuals with severe and persistent mental illness by creating service linkages to address unmet needs in order to facilitate recovery. Services were delivered through the new role of 'support facilitator'. What does this paper add? By examining routinely collected outcome measures, this paper shows the success of the PIR program. Individuals engaged with PIR reported fewer unmet needs and enhanced recovery over the time they were involved with the program. However, they still faced serious challenges in building successful social interactions, such as developing friendships, and participating in meaningful activities. What are the implications for practitioners? The support facilitator role developed as part of PIR appears to be a useful method of supporting individuals to reduce unmet needs and enhance recovery. However, further work is required to address the challenges associated with overcoming social isolation and participation in meaningful activities.

Implementing system-wide risk stratification approaches: A review of critical success and failure factors.

Risk stratification has become a widely used tool for linking people identified at risk of health deterioration to the most appropriate evidence-based care. This article systematically reviews recent literature to determine key factors that have been identified as critical enablers and/or barriers to successful implementation of risk stratification tools at a system level. A systematic search found 23 articles and four promising protocols for inclusion in the review, covering the use to 20 different risk stratification tools. These articles reported on only a small fraction of the risk stratification tools used in health systems; suggesting that while the development and statistical validation of risk stratification algorithms is widely reported, there has been little published evaluation of how they are implemented in real-world settings. Controlled studies provided some evidence that the use of risk stratification tools in combination with a care management plan offer patient benefits and that the use of a risk stratification tool to determine components of a care management plan may contribute to reductions in hospital readmissions, patient satisfaction and improved patient outcomes. Studies with the strongest focus on implementation used qualitative and case study methods. Among these, the literature converged on four key areas of implementation that were found to be critical for overcoming barriers to success: the engagement of clinicians and safeguarding equity, both of which address barriers of acceptance; the health system context to address administrative, political and system design barriers; and data management and integration to address logistical barriers.

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations.

Objective Australian mental health care remains hospital centric and fragmented; it is riddled with gaps and does little to promote recovery. Reform must be built on better knowledge of the shape of existing services. Mental health atlases are an essential part of this knowledge base, enabling comparison with other regions and jurisdictions, but must be based on a rigorous classification of services. The main aim of this study is to create an integrated mental health atlas of the Western Sydney LHD in order to help decision makers to better plan informed by local evidence. Methods The standard classification system, namely the Description and Evaluation of Services and Directories in Europe for Long-term Care model, was used to describe and classify adult mental health services in the Western Sydney Local Health District (LHD). This information provided the foundation for accessibility maps and the analysis of the provision of care for people with a lived experience of mental illness in Western Sydney LHD. All this data was used to create the Integrated Mental Health Atlas of Western Sydney LHD. Results The atlas identified four major gaps in mental health care in Western Sydney LHD: (1) a lack of acute and sub-acute community residential care; (2) an absence of services providing acute day care and non-acute day care; (3) low availability of specific employment services for people with a lived experience of mental ill-health; and (4) a lack of comprehensive data on the availability of supported housing. Conclusions The integrated mental health atlas of the Western Sydney LHD provides a tool for evidence-informed planning and critical analysis of the pattern of adult mental health care. What is known about the topic? Several reports have highlighted that the Australian mental health system is hospital based and fragmented. However, this knowledge has had little effect on actually changing the system. What does this paper add? This paper provides a critical analysis of the pattern of adult mental health care provided within the boundaries of the Western Sydney LHD using a standard, internationally validated tool to describe and classify the services. This provides a good picture of the availability of adult mental health care at the local level that was hitherto lacking. What are the implications for practitioners? The data presented herein provide a better understanding of the context in which mental health practitioners work. Managers and planners of services providing care for people with a lived experience of mental illness can use the information herein for better planning informed by local evidence.

Is the Partners in Recovery program connecting with the intended population of people living with severe and persistent mental illness? What are their prioritised needs?

Objective The Partners in Recovery (PIR) program is an Australian government initiative designed to make the mental health and social care sectors work in more coordinated ways to meet the needs of those with severe and complex mental illness. Herein we reflect on demographic data collected during evaluation of PIR implementation in two Western Sydney sites. The aims of the present study were to: (1) explore whether two Sydney-based PIR programs had recruited their intended population, namely people living with severe and persistent mental illness; and (2) learn more about this relatively unknown population and their self-identified need priorities. Methods Routinely collected initial client assessment data were analysed descriptively. Results The data suggest that the two programs are engaging the intended population. The highest unmet needs identified included psychological distress, lack of daytime activities and company, poor physical health and inadequate accommodation. Some groups remain hard to connect, including people from Aboriginal and other culturally diverse communities. Conclusions The data confirm that the PIR program, at least in the two regions evaluated, is mostly reaching its intended audience. Some data were being collected inconsistently, limiting the usefulness of the data and the ability to build on PIR findings to develop ongoing support for this population. What is known about the topic? PIR is a unique national program funded to engage with and address the needs of Australians living with severe and persistent mental illness by facilitating service access. What does this paper add? This paper reports on recruitment of people living with severe and persistent mental illness, their need priorities and data collection. These are three central elements to successful roll-out of the much anticipated mental health component of the National Disability Insurance Scheme, as well as ongoing PIR operation. What are the implications for practitioners? Active recruitment, exploration of self-reported need priorities and routine outcome measurement are essential yet challenging work practices when working with people living with severe and persistent mental illness.

Noise production in ceramic-on-ceramic total hip arthroplasty is associated with lower patient satisfaction and hip scores.

BACKGROUND: Ceramic-on-ceramic total hip arthroplasties (THA) are commonly implanted. We investigated the incidence of noise in ceramic-on-ceramic and determined any association with patient satisfaction and hip scores. METHODS: We recruited 140 THA. Questionnaires were completed to assess the incidence and frequency of noise, and satisfaction level. Hip and SF-12 scores were recorded. RESULTS: Forty-two patients (30%) were aware of noise production. Patients with noise production had lower satisfaction, mean hip and SF-12 scores than those with silent hips. CONCLUSION: Given the high incidence of noise in ceramic-on-ceramic THA, patients should be counselled on this risk pre-operatively.

Use of the trochanteric flip osteotomy to facilitate internal fixation of a femoral head fracture.

We report the case of a 42-year-old male who suffered a fracture-dislocation of the femoral head. After a closed reduction of the hip, this proceeded to an open reduction with internal fixation of the fractured femoral head, in addition to labral repair and micro-fracture of an articular cartilage defect. After considering the risks to the femoral head blood supply, the trochanteric flip osteotomy was used. This provided ample and safe exposure. At 14 months follow-up, the patient-reported outcome measures are favourable: modified Harris Hip Score (81/100), the non-arthritic hip score (92.5/100) and SF-12 (41/48).

Bridging the chronic care gap: HealthOne Mt Druitt, Australia.

HealthOne was part of a state-wide initiative to invest in new community-based facilities for collocating services. The HealthOne Mount Druitt is a virtual hub and spoke organisation established in 2006 in a socially disadvantaged part of Western Sydney based out of a new community health hub. The model is based on 'virtual' care planning and aims to improve coordination of care for older people with complex health needs, reduce unnecessary hospitalisations and ensure appropriate referral to community and specialist health services. General practitioner liaison nurses (GPLNs) work closely with clients as well as general practitioners (GPs) and other health care providers. Primary health care providers reported improved communication and coordination of services, and there have been lower levels of utilisation of the emergency department (ED) for patients following enrolment in the programme. HealthOne provides an example of how a virtual organisation together with highly skilled care coordinators can overcome some of the barriers to providing integrated care created by fragmented funding streams and care delivery systems.

Coordinated care versus standard care in hospital admissions of people with chronic illness: a randomised controlled trial.

OBJECTIVE: To determine whether Care Navigation (CN), a nurse-led hospital-based coordinated care intervention, reduced the use of hospital services and improved quality of life for patients with chronic illness. DESIGN: Randomised controlled trial; participants were allocated to CN or standard care. PARTICIPANTS AND SETTING: Patients with chronic illness presenting to the emergency department of Nepean Hospital, Sydney, New South Wales. High-risk status for an unplanned admission was defined as i) three or more unplanned hospital admissions in 12 months for patients aged ≥ 70 or at least one admission for cardiac or respiratory disease in patients aged 16-69 years; or ii) judged by a CN nurse to be high risk and likely to benefit. MAIN OUTCOME MEASURES: Numbers of re-presentations or readmissions, quality of life, time to re-presentation, readmission or death, length of stay, and access to hospital and community health services. RESULTS: 500 participants were randomised between May 2010 and February 2011; 359 by previous unplanned admission and 141 by clinical impression. The CN group received more community health services (rate ratio, 1.94; 95% CI, 1.35-2.81; P < 0.001) than participants receiving standard care; however, this did not result in statistically significant differences in number of re-presentations (rate ratio, 0.83; 95% CI, 0.68-1.01; P = 0.07), number of readmissions (rate ratio, 0.85; 95% CI, 0.70-1.04; P = 0.11), quality of life at 24 months (mean difference, 0; 95% CI, - 0.10 to 0.09, P = 0.93), or other measures. CONCLUSIONS: CN did not improve quality of life or reduce unplanned hospital presentations or admissions despite community health services almost doubling. Future service development should explore potential benefits of linking navigated intrahospital care to ongoing, proactive care planning and delivery in the community. TRIAL REGISTRATION: ACTRN12609000554268.

Living with economic hardship at the end of life.

BACKGROUND: Dying patients and their families often face an added burden of economic hardship, especially if they have become ill in the years before expected retirement. In Australia, patients can fall through the cracks of the national system of social protection because there are gaps in the access to and provision of healthcare and social assistance at the end of life. DESIGN: A mixed-method, prospective case study of individuals and their family carers, recruited from a specialist palliative care service in Melbourne, Australia, is presented. Participants were interviewed and followed up over 6 months and completed a 2-week diary of all services used and out-of-pocket costs. RESULTS: Mean out-of-pocket spending was $A369 per month (median: $A176, IQR: 356) ($A1=US$1=€0.73=£0.62; January 2011). Households with economic hardship were more likely to have a patient who was male, had ceased paid employment earlier than expected due to illness, reported a reduction in income due to illness, had less access to financial resources and used significantly fewer health-related community services. Three factors shaped the participants' experience of hardship: (1) the premature loss of employment capacity and income; (2) the affordability of care and; (3) a welfare system that could not accommodate their complex needs. CONCLUSIONS: These results demonstrate the multidimensional nature of the economic burden experienced at the end of life and imply the need for nuanced solutions to better support patients and their families. If terminally ill people wish to die at home and are to be supported to do so, policies must take account of the shift in economic burden from the health system onto families.

Internet search patterns of human immunodeficiency virus and the digital divide in the Russian Federation: infoveillance study.

BACKGROUND: Human immunodeficiency virus (HIV) is a serious health problem in the Russian Federation. However, the true scale of HIV in Russia has long been the subject of considerable debate. Using digital surveillance to monitor diseases has become increasingly popular in high income countries. But Internet users may not be representative of overall populations, and the characteristics of the Internet-using population cannot be directly ascertained from search pattern data. This exploratory infoveillance study examined if Internet search patterns can be used for disease surveillance in a large middle-income country with a dispersed population. OBJECTIVE: This study had two main objectives: (1) to validate Internet search patterns against national HIV prevalence data, and (2) to investigate the relationship between search patterns and the determinants of Internet access. METHODS: We first assessed whether online surveillance is a valid and reliable method for monitoring HIV in the Russian Federation. Yandex and Google both provided tools to study search patterns in the Russian Federation. We evaluated the relationship between both Yandex and Google aggregated search patterns and HIV prevalence in 2011 at national and regional tiers. Second, we analyzed the determinants of Internet access to determine the extent to which they explained regional variations in searches for the Russian terms for "HIV" and "AIDS". We sought to extend understanding of the characteristics of Internet searching populations by data matching the determinants of Internet access (age, education, income, broadband access price, and urbanization ratios) and searches for the term "HIV" using principal component analysis (PCA). RESULTS: We found generally strong correlations between HIV prevalence and searches for the terms "HIV" and "AIDS". National correlations for Yandex searches for "HIV" were very strongly correlated with HIV prevalence (Spearman rank-order coefficient [rs]=.881, P ≤ .001) and strongly correlated for "AIDS" (rs = .714, P ≤ .001). The strength of correlations varied across Russian regions. National correlations in Google for the term "HIV" (rs = .672, P = .004) and "AIDS" (rs = .584, P ≤ .001) were weaker than for Yandex. Second, we examined the relationship between the determinants of Internet access and search patterns for the term "HIV" across Russia using PCA. At the national level, we found Principal Component 1 loadings, including age (-0.56), HIV search (-0.533), and education (-0.479) contributed 32% of the variance. Principal Component 2 contributed 22% of national variance (income, -0.652 and broadband price, -0.460). CONCLUSIONS: This study contributes to the methodological literature on search patterns in public health. Based on our preliminary research, we suggest that PCA may be used to evaluate the relationship between the determinants of Internet access and searches for health problems beyond high-income countries. We believe it is in middle-income countries that search methods can make the greatest contribution to public health.

Navigating public health chemicals policy in Australia: a policy maker's and practitioner's guide.

Chemicals are ubiquitous in everyday life. Environmental health practitioners rely on a complex web of regulators and policy bodies to ensure the protection of public health, yet few understand the full extent of this web. A lack of understanding can hamper public health response and impede policy development. In this paper we map the public health chemicals policy landscape in Australia and conclude that an understanding of this system is essential for effective environmental health responses and policy development.

Searching for truth: internet search patterns as a method of investigating online responses to a Russian illicit drug policy debate.

BACKGROUND: This is a methodological study investigating the online responses to a national debate over an important health and social problem in Russia. Russia is the largest Internet market in Europe, exceeding Germany in the absolute number of users. However, Russia is unusual in that the main search provider is not Google, but Yandex. OBJECTIVE: This study had two main objectives. First, to validate Yandex search patterns against those provided by Google, and second, to test this method's adequacy for investigating online interest in a 2010 national debate over Russian illicit drug policy. We hoped to learn what search patterns and specific search terms could reveal about the relative importance and geographic distribution of interest in this debate. METHODS: A national drug debate, centering on the anti-drug campaigner Egor Bychkov, was one of the main Russian domestic news events of 2010. Public interest in this episode was accompanied by increased Internet search. First, we measured the search patterns for 13 search terms related to the Bychkov episode and concurrent domestic events by extracting data from Google Insights for Search (GIFS) and Yandex WordStat (YaW). We conducted Spearman Rank Correlation of GIFS and YaW search data series. Second, we coded all 420 primary posts from Bychkov's personal blog between March 2010 and March 2012 to identify the main themes. Third, we compared GIFS and Yandex policies concerning the public release of search volume data. Finally, we established the relationship between salient drug issues and the Bychkov episode. RESULTS: We found a consistent pattern of strong to moderate positive correlations between Google and Yandex for the terms "Egor Bychkov" (r(s) = 0.88, P < .001), "Bychkov" (r(s) = .78, P < .001) and "Khimki"(r(s) = 0.92, P < .001). Peak search volumes for the Bychkov episode were comparable to other prominent domestic political events during 2010. Monthly search counts were 146,689 for "Bychkov" and 48,084 for "Egor Bychkov", compared to 53,403 for "Khimki" in Yandex. We found Google potentially provides timely search results, whereas Yandex provides more accurate geographic localization. The correlation was moderate to strong between search terms representing the Bychkov episode and terms representing salient drug issues in Yandex-"illicit drug treatment" (r(s) = .90, P < .001), "illicit drugs" (r(s) = .76, P < .001), and "drug addiction" (r(s) = .74, P < .001). Google correlations were weaker or absent-"illicit drug treatment" (r(s) = .12, P = .58), "illicit drugs " (r(s) = -0.29, P = .17), and "drug addiction" (r(s) = .68, P < .001). CONCLUSIONS: This study contributes to the methodological literature on the analysis of search patterns for public health. This paper investigated the relationship between Google and Yandex, and contributed to the broader methods literature by highlighting both the potential and limitations of these two search providers. We believe that Yandex Wordstat is a potentially valuable, and underused data source for researchers working on Russian-related illicit drug policy and other public health problems. The Russian Federation, with its large, geographically dispersed, and politically engaged online population presents unique opportunities for studying the evolving influence of the Internet on politics and policy, using low cost methods resilient against potential increases in censorship.

Coordination of care in Australian mental health policy.

OBJECTIVE: To review Australian mental health initiatives involving coordination of care. METHODS: Commonwealth government websites were systematically searched for mental health policy documents. Database searches were also conducted using the terms 'coordination' or 'integration' and 'mental health' or 'mental illness' and 'Australia'. We assessed the extent to which informational, relational and management continuity have been addressed in three example programs. RESULTS: The lack of definition of coordination at the policy level reduces opportunities for developing actionable and measurable programs. Of the 51 mental health initiatives identified, the three examples studied all demonstrated some use of the dimensions of continuity to facilitate coordination. However, problems with funding, implementation, evaluation and competing agendas between key stakeholders were barriers to improving coordination. CONCLUSIONS: Coordination is possible and can improve both relationships between providers and care provided. However, clear leadership, governance and funding structures are needed to manage the challenges encountered, and evaluation using appropriate outcome measures, structured to assess the elements of continuity, is necessary to detect improvements in coordination.

Identifying trustworthy experts: how do policymakers find and assess public health researchers worth consulting or collaborating with?

This paper reports data from semi-structured interviews on how 26 Australian civil servants, ministers and ministerial advisors find and evaluate researchers with whom they wish to consult or collaborate. Policymakers valued researchers who had credibility across the three attributes seen as contributing to trustworthiness: competence (an exemplary academic reputation complemented by pragmatism, understanding of government processes, and effective collaboration and communication skills); integrity (independence, "authenticity", and faithful reporting of research); and benevolence (commitment to the policy reform agenda). The emphases given to these assessment criteria appeared to be shaped in part by policymakers' roles and the type and phase of policy development in which they were engaged. Policymakers are encouraged to reassess their methods for engaging researchers and to maximise information flow and support in these relationships. Researchers who wish to influence policy are advised to develop relationships across the policy community, but also to engage in other complementary strategies for promoting research-informed policy, including the strategic use of mass media.

Colorectal cancer screening: why immunochemical fecal occult blood tests may be the best option.

BACKGROUND: There are many test options available for colorectal cancer screening. The choice of test relates to the objectives of those offering or considering screening. DISCUSSION: While all screening programs aim to detect disease early in order to improve the length and/or quality of life for the individual, some organizations and individuals prefer screening tests that offer the opportunity for cancer prevention. Others favor maximizing participation or the opportunity for shared decision-making, including discussion of information on test quality and availability. We propose three additional objectives for screening: minimizing harms, optimizing economic efficiency and maximizing equity of access to screening. SUMMARY: Applying these objectives to colorectal cancer screening, we advocate the use of immunochemical FOBTs as the preferred screening strategy, as it satisfies all three of these important objectives.