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Henson GJ, van der Mei I, Taylor BV, Claflin SB, Palmer AJ, Campbell JA, Chen G. The subjective wellbeing of people living with Multiple Sclerosis in Australia: insights from the Personal Wellbeing Index. Health Qual Life Outcomes 2024; 22:83. [PMID: 39350168 PMCID: PMC11443857 DOI: 10.1186/s12955-024-02278-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 07/29/2024] [Indexed: 10/04/2024] Open
Abstract
OBJECTIVES Subjective wellbeing has been defined as an individual's personal appraisal of their quality of life. Subjective wellbeing is associated with positive health behaviours and improved coping abilities. This study aimed to investigate the subjective wellbeing of people living with multiple sclerosis (MS), using the novel Personal Wellbeing Index, and make comparisons with the general population. METHODS Cross-sectional data was obtained from the Australian Multiple Sclerosis Longitudinal Study and the How Is Your Life Australian general population study in August-October 2020. Subjective wellbeing was measured as life satisfaction using the Personal Wellbeing Index. This instrument measures life satisfaction globally and in seven life domains, allowing the importance of domain-specific life satisfaction to be explored. Descriptive and multivariable regression analyses were conducted. RESULTS One thousand six hundred eighty-three MS and 1,021 general population participants entered the study (mean age 52.4 and 58.6; female 79.9% and 52.4%, respectively). For people living with MS the most important life domains were standard of living and achieving in life. The domain of personal health was more influential for people living with MS (p < 0.01) than the general population. The life domains most susceptible to MS-related disability were personal health, achieving in life, and community connectedness (p < 0.01 for these domains). CONCLUSION Personal health and achieving in life are key domains through which the subjective wellbeing of people living with MS is modified. This study recommends the development of interventions to support healthy perceptions of illness and continued employment as paramount in improving the subjective wellbeing of people living with MS.
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Affiliation(s)
- Glen J Henson
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia.
| | - Gang Chen
- Centre for Health Economics, Monash University, Caulfield East, Victoria, Australia
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Sebalo I, Sebalo Vňuková M, Anders M, Ptáček R, Páv M. Markers of predicting discharge from forensic psychiatric hospitals in Czechia. Int J Soc Psychiatry 2024; 70:1075-1082. [PMID: 38845176 PMCID: PMC11402263 DOI: 10.1177/00207640241255575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND Secure forensic hospital treatments are resource-intensive, aiming to rehabilitate offenders and enhance public safety. While these treatments consume significant portions of mental health budgets and show efficacy in some countries, their effectiveness in Czechia remains underexplored. Previous research has highlighted various factors influencing the likelihood of discharge from these institutions. Notably, the role of sociodemographic variables and the length of stay (LoS) in the context of forensic treatments has presented inconsistent findings across studies. METHODS The study, part of the 'Deinstitutionalization project' in Czechia, collected data from all inpatient forensic care hospitals. A total of 793 patients (711 male, 79 female and 3 unknown) were included. Data collection spanned 6 months, with tools like HoNOS, HoNOS-Secure, MOAS, HCR-20V3 and AQoL-8D employed to assess various aspects of patient health, behaviour, risk and quality of life. RESULTS The study revealed several determinants influencing patient discharge from forensic hospitals. Key assessment tools, such as HoNOS secure scores and the HCR-20 clinical subscale, showed that higher scores equated to lower chances of release. Furthermore, specific diagnoses like substance use disorder increased discharge odds, while a mental retardation diagnosis significantly reduced it. The type of index offense showed no influence on discharge decisions. CONCLUSION Factors like reduced risk behaviours, absence of mental retardation diagnosis, social support and secure post-release housing plans played significant roles. The results underscored the importance of using standardized assessment tools over clinical judgement. A standout insight was the unique challenges faced by patients diagnosed with mental retardation, emphasizing a need for specialized care units or tailored programmes.
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Affiliation(s)
- Ivan Sebalo
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Martina Sebalo Vňuková
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Martin Anders
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Radek Ptáček
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Marek Páv
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
- Psychiatric Hospital Bohnice, Prague, Czechia
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Hulme A, Sangelaji B, Walker C, Fallon T, Denham J, Martin P, Woodruffe S, Bell K, Aniftos M, Kirkpatrick J, Cotter N, Osborn D, Argus G. Efficacy of a student-led interprofessional health clinic in regional Australia for preventing and managing chronic disease. J Interprof Care 2024; 38:893-906. [PMID: 39045867 DOI: 10.1080/13561820.2024.2380436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 07/03/2024] [Accepted: 07/06/2024] [Indexed: 07/25/2024]
Abstract
Increasing chronic disease rates in regional Australian communities necessitates innovative models of healthcare. We evaluated the efficacy of an interprofessional chronic disease program, delivered within a regional student-led nursing and allied health clinic in Southern Queensland, Australia. Changes to anthropometric, aerobic fitness and strength, and quality of life outcomes were examined at four time points spanning 16 months: intake, program transition (4 months), 6 and 12 months (post-transition). Our primary aim was to investigate whether the health improvements achieved during the program were sustained at 12 months in a subset of participants who provided complete data. Significant improvements were found in 6 of 11 measures, including the 6-minute walk test, grip strength, and self-reported quality of life across physical and psychosocial dimensions, with these improvements maintained to final review. No significant changes were found in body mass index (BMI), waist circumference, fat mass, or muscle mass. This is the first health clinic in regional Australia to deliver a student-led model of interprofessional and collaborative service to tackle the increasing burden of chronic disease in the community. The cost-effectiveness of this service and other potential clinical and social benefits remain to be investigated.
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Affiliation(s)
- Adam Hulme
- Southern Queensland Rural Health (SQRH), Faculty of Health and Behavioural Science, The University of Queensland, Toowoomba, Queensland, Australia
| | - Bahram Sangelaji
- Southern Queensland Rural Health (SQRH), Faculty of Health and Behavioural Science, The University of Queensland, Toowoomba, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Clara Walker
- Southern Queensland Rural Health (SQRH), Faculty of Health and Behavioural Science, The University of Queensland, Toowoomba, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Tony Fallon
- Southern Queensland Rural Health (SQRH), Faculty of Health and Behavioural Science, The University of Queensland, Toowoomba, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Joshua Denham
- Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Health and Medical Sciences Ipswich Campus, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Priya Martin
- Rural Clinical School (RCS), Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Steve Woodruffe
- Southern Queensland Rural Health (SQRH), Faculty of Health and Behavioural Science, The University of Queensland, Toowoomba, Queensland, Australia
| | - Kate Bell
- Southern Queensland Rural Health (SQRH), Faculty of Health and Behavioural Science, The University of Queensland, Toowoomba, Queensland, Australia
| | - Michelle Aniftos
- Southern Queensland Rural Health (SQRH), Faculty of Health and Behavioural Science, The University of Queensland, Toowoomba, Queensland, Australia
| | - Jayne Kirkpatrick
- Southern Queensland Rural Health (SQRH), Faculty of Health and Behavioural Science, The University of Queensland, Toowoomba, Queensland, Australia
| | - Nicola Cotter
- Southern Queensland Rural Health (SQRH), Faculty of Health and Behavioural Science, The University of Queensland, Toowoomba, Queensland, Australia
| | - Dayle Osborn
- Southern Queensland Rural Health (SQRH), Faculty of Health and Behavioural Science, The University of Queensland, Toowoomba, Queensland, Australia
| | - Geoff Argus
- Southern Queensland Rural Health (SQRH), Faculty of Health and Behavioural Science, The University of Queensland, Toowoomba, Queensland, Australia
- School of Psychology and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia
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Austen E, Griffiths S. Body fat and muscularity dissatisfaction are not prospectively associated with psychological wellbeing among sexual minority men: A case for separating within- and between-person variation in examinations of body image phenomena and their outcomes. Body Image 2024; 51:101783. [PMID: 39153449 DOI: 10.1016/j.bodyim.2024.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/31/2024] [Accepted: 08/11/2024] [Indexed: 08/19/2024]
Abstract
Extensive cross-sectional research reports that body fat and muscularity dissatisfaction contribute to negative psychological outcomes among sexual minority men; however, longitudinal models are necessary for accurately quantifying the strength and direction of these relationships. We investigated the bidirectional longitudinal relationships of body fat and muscularity dissatisfaction with psychological quality of life among 2953 sexual minority men using random intercept cross-lagged panel models. Consistent with existing literature, we found that higher average muscularity and body fat dissatisfaction were associated with higher average psychological quality of life impairment between-persons. Unexpectedly, these constructs were not significantly associated within-persons/longitudinally. These findings conflict existing literature's conclusions that muscularity and body fat dissatisfaction consistently contribute to poorer psychological wellbeing in this population. A significant between-person relationship in the absence of within-person relationships suggests that intermediary constructs (e.g., body ideal internalization) may account for the between-person effects of muscularity and body fat dissatisfaction on psychological wellbeing. Future research can accurately estimate these effects and identify reliable intervention targets by ensuring that within- and between-person relationships are examined separately, rather than being conflated.
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Affiliation(s)
- Emma Austen
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Tan YJ, Ong SC. Direct and Indirect Mapping of Assessment of Quality of Life - 6 Dimensions (AQoL-6D) Onto EQ-5D-5L Utilities Using Data From a Multicenter, Cross-Sectional Study of Malaysians With Chronic Heart Failure. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02799-2. [PMID: 39127252 DOI: 10.1016/j.jval.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/19/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES The Assessment of Quality of Life - 6 Dimensions (AQoL-6D), a generic preference-based measure, is an appealing alternative to EQ-5D-5L for assessing health status in patients with chronic heart failure (HF), given its expanded scope. However, without a Malaysian value set, the AQoL-6D cannot generate health state utility values (HSUVs) to support local economic evaluations. This study intended to develop algorithms for predicting EQ-5D-5L HSUVs from AQoL-6D in an HF population. METHODS Cross-sectional data from a multicenter cohort of 419 HF outpatients were used. Both direct and indirect mapping approaches were attempted using 5 sets of explanatory variables and 8 models (ordinary least squares, Tobit, censored least absolute deviations, generalized linear model, 2-part model [TPM], beta regression-based model, adjusted limited dependent variable mixture model, and multinomial ordinal regression [MLOGIT]). The models' predictive performance was assessed through 10-fold cross-validated mean absolute error [MAE] and root mean squared error [RMSE]). Potential prediction bias was also examined graphically. The best-performing models, with the lowest RMSE and no bias, were then identified. RESULTS Among the models evaluated, TPM, which included age, sex, and 5 AQoL-6D dimension scores as predictors, appears to be the best-performing model for directly predicting EQ-5D-5L HSUVs from AQoL-6D. TPM yielded the lowest MAE (0.0802) and RMSE (0.1116), and demonstrated predictive accuracy for HSUVs >0.2 without significant bias. A MLOGIT model developed for response mapping had suboptimal predictive accuracy. CONCLUSIONS This study developed potentially useful mapping algorithms for generating Malaysian EQ-5D-5L HSUVs from AQoL-6D responses among patients with HF when direct EQ-5D-5L data are unavailable.
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Affiliation(s)
- Yi Jing Tan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; Seri Manjung Hospital, Ministry of Health Malaysia, Seri Manjung, Malaysia
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
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Rodgers C, Siefried KJ, Ritter A, Belackova V, Treloar C, Jauncey M, Ezard N, Roberts D, Steele M, van den Brink W, Strang J, Oviedo-Joekes E, Lintzeris N, Dunlop AJ, Bell J. Implementation of time-limited parenteral hydromorphone in people with treatment-resistant injecting opioid use disorder: a protocol for a single-site, uncontrolled, open-label study to assess feasibility, safety and cost. BMJ Open 2024; 14:e082553. [PMID: 39097309 PMCID: PMC11298717 DOI: 10.1136/bmjopen-2023-082553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 07/19/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Supervised injectable opioid treatment (SIOT) is an evidence-based intervention targeting opioid-dependent people for whom existing treatments have been ineffective. This project will primarily assess the feasibility and the acceptability of time-limited SIOT using injectable hydromorphone delivered in an existing Australian public opioid treatment programme, with secondary outcomes of safety, cost, changes in drug use and other health outcomes. If feasible, the goal is to scale up the intervention to be more widely available in Australia. METHODS AND ANALYSIS Between 20 and 30 participants will be offered two times per day hydromorphone to inject under direct observation, in addition to their current opioid agonist treatment (OAT), for up to 2 years. At the end of 2 years of supervised hydromorphone treatment, participants will be continued on standard OAT only. Informed consent will be obtained from all participants included in the study. This is a single-site, uncontrolled, open-label study where quantitative and qualitative interview data will be collected at baseline, 12 months and lastly at 3 months following their final hydromorphone dose. The main outcome measures are feasibility, as assessed by recruitment, retention and participation in treatment, and acceptability to participants, clinic staff and other stakeholders assessed by qualitative interviews. Secondary outcome measures of safety, as assessed by adverse events, and cost will also be assessed, as well as a range of other drug and health outcomes. ETHICS AND DISSEMINATION This study received ethical approval from the St Vincent's Hospital Human Research Ethics Committee (2019/ETH00418). This will be the first study of time-limited SIOT in the Australian setting. All results will be submitted to peer-reviewed journals, scientific conferences and local practice meetings. A preliminary report on outcomes will also be presented to local health policy makers. A consumer and community forum will also be held to feedback results to a broader audience. TRIAL REGISTRATION NUMBER ACTRN12621001729819.
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Affiliation(s)
- Craig Rodgers
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Krista J Siefried
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Carla Treloar
- University of South Wales, Sydney, New South Wales, Australia
| | | | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Darren Roberts
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Maureen Steele
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | | | - John Strang
- Addictions, Kings College London, London, UK
| | - Eugenia Oviedo-Joekes
- University of British Columbia Centre for Health Evaluation, Vancouver, British Columbia, Canada
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Surry Hills, New South Wales, Australia
- The Langton Centre, South East Sydney Local Health District, Surry Hills, New South Wales, Australia
| | - Adrian John Dunlop
- Drug and Alcohol Clinical Services Research, Hunter New England Health, Newcastle, New South Wales, Australia
- The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - James Bell
- University of New South Wales, Sydney, New South Wales, Australia
- King’s College London, London, UK
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Kreienkamp M, Wheatley D, Ndobo A. Assessing the efficacy of a resilience training intervention for long-term improvements in well-being and resilience. Appl Psychol Health Well Being 2024; 16:1197-1223. [PMID: 38226711 DOI: 10.1111/aphw.12525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 12/24/2023] [Indexed: 01/17/2024]
Abstract
This article has two aims: (1) to assess the impacts of a novel training intervention for individual well-being and (2) to measure the trajectory of resilience over the training period dependent on reported significant life events. Using a randomised controlled trial with a diverse German sample with the majority drawn from a student population, we measure the effects of the intervention to provide insight into its impacts and act as a proof of concept for the training. We find that the training intervention boosts resilience and other related well-being measures with a high effect size in comparison with a control group and compared with existing resilience training studies.
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Affiliation(s)
- Martin Kreienkamp
- Fachbereich Psychologie, HMKW Hochschule für Medien, Kommunikation und Wirtschaft, Cologne, Germany
| | - Daniel Wheatley
- Birmingham Business School, University of Birmingham, Birmingham, UK
| | - André Ndobo
- Laboratoire de Psychologie des Pays de la Loire, Nantes Université, Univ Angers, Nantes, France
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Koitschev A, Neudert M, Lenarz T. [Transcutaneous bone conduction implant with self-drilling screws : A new method for fixation of an active transcutaneous bone conduction implant. German version]. HNO 2024; 72:554-560. [PMID: 37106143 DOI: 10.1007/s00106-023-01294-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The active transcutaneous bone conduction implant (tBCI; BONEBRIDGE™ BCI 601; MED-EL, Innsbruck, Austria) is fixed to the skull with two self-tapping screws in predrilled screw channels. The aim of this prospective study was to evaluate the safety and effectiveness of fixation with self-drilling screws instead of the self-tapping screws, in order to simplify the surgical procedure. MATERIALS AND METHODS Nine patients (mean age 37 ± 16 years, range 14-57 years) were examined pre- and 12 months postoperatively for word recognition scores (WRS) at 65 dB SPL, sound-field (SF) thresholds, bone conduction thresholds (BC), health-related quality of life (Assessment of Quality of Life, AQOL-8D questionnaire), and adverse events (AE). RESULTS Due to avoidance of one surgical step, the surgical technique was simplified. Mean WRS in SF was 11.1 ± 22.2% (range 0-55%) pre- and 77.2 ± 19.9% (range 30-95%) postoperatively; mean SF threshold (pure tone audiometry, PTA4) improved from 61.2 ± 14.3 dB HL (range 37.0-75.3 dB HL) to 31.9 ± 7.2 dB HL (range 22.8-45.0 dB HL); mean BC thresholds were constant at 16.7 ± 6.8 dB HL (range 6.3-27.5 dB HL) pre- and 14.2 ± 6.2 dB HL (range 5.8-23.8 dB HL) postoperatively. AQOL-8D mean utility score increased from 0.65 ± 0.18 preoperatively to 0.82 ± 0.17 postoperatively. No device-related adverse events occurred. CONCLUSION Implant fixation by means of self-drilling screws was safe and effective in all nine patients. There was significant audiological benefit 12 months after implantation.
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Affiliation(s)
- Assen Koitschev
- Klinik für Hals‑, Nasen‑, Ohrenkrankheiten , Plastische Operationen, Klinikum Stuttgart - Olgahospital, Kriegsbergstr. 62, 70174, Stuttgart, Deutschland.
| | - Marcus Neudert
- Klinik und Poliklinik für HNO, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Deutschland
| | - Thomas Lenarz
- Klinik für Hals-Nasen-Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland
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Tan YJ, Ong SC, Goh SP, Chen G, Yong VS, Khor WW, Kan YM, Choong YY, Zameram AM, Tan LY, Voo JYH, Lam KK, Yen CH, Wahab MJA, Abdulla ZB. Translation, cross-cultural adaptation, and psychometric validation of the Malay version of the Assessment of Quality of Life-6 Dimensions (Malay-AQoL-6D) instrument among Malaysians living with chronic heart failure. J Patient Rep Outcomes 2024; 8:79. [PMID: 39052204 PMCID: PMC11272755 DOI: 10.1186/s41687-024-00763-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND This study aimed to translate and culturally adapt the Assessment of Quality of Life (AQoL)-6D into Malay (Malay-AQoL-6D), and assesses the instrument's acceptability, reliability, and validity among Malaysians living with chronic heart failure (HF). METHODS The translation and cross-cultural adaptation process adhered to international guidelines. The Malay-AQoL-6D underwent content and face validity assessments via expert review, and pretesting among healthy individuals and patients with chronic conditions. Subsequent psychometric validation utilised clinico-sociodemographic data and paired AQoL-6D and EQ-5D-5L data from a health-related quality-of-life (HRQoL) survey involving Malay-speaking patients with HF, which encompassed assessments of Malay-AQoL-6D acceptability, internal consistency and test-retest reliability, as well as its construct, concurrent, convergent and divergent, and known-group validity. RESULTS The Malay-AQoL-6D was deemed acceptable among clinicians and local patients, achieving a 90.8% completion rate among 314 patients surveyed. The instrument demonstrated strong content validity (item-level content validity index [CVI]: 0.83-1.00, average CVI: 0.98), internal consistency (Cronbach's alpha: 0.72-0.89; MacDonald's omega: 0.82-0.90, excluding the Senses dimension), and test-retest reliability (average intraclass correlation coefficients: 0.79-0.95). Confirmatory factor analysis confirmed the instrument's two-level, six-factor structure (Satorra-Bentler [SB]-scaled χ2(df: 164): 283.67, p-value < 0.001; root mean square error of approximation [RMSEA]: 0.051; comparative fix index [CFI]: 0.945, Tucker-Lewis index [TLI]: 0.937; standardised root mean-squared error [SRMR]: 0.058). The Malay-AQoL-6D's concurrent validity was evident through its good agreement with EQ-5D-5L. Multiple hypothesis tests further affirmed its construct and known-group validity. The Malay-AQoL-6D's psychometric properties remained consistent across different missing data techniques. CONCLUSION The findings suggest that Malay-AQoL-6D could be a culturally acceptable, reliable, and valid HRQoL measure for quantifying HRQoL among the local HF population. Future studies are necessary to further validate the instrument against other measures and confirm the instrument's test-retest reliability and responsiveness, which are possible with the availability of the Malay-AQoL-6D.
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Affiliation(s)
- Yi Jing Tan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, 11800, Malaysia
- Seri Manjung Hospital, Ministry of Health Malaysia, Seri Manjung, Perak, 32040, Malaysia
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, 11800, Malaysia.
| | - Sook Pin Goh
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, 11800, Malaysia
- Tapah Hospital, Ministry of Health Malaysia, Tapah, Perak, 35000, Malaysia
| | - Gang Chen
- Centre for Health Economics, Monash University, Caulfield East, VIC, 3145, Australia
| | - Vee Sim Yong
- Clinical Research Centre, Hospital Queen Elizabeth II, Institute for Clinical Research, National Institute of Health, Ministry of Health Malaysia, Kota Kinabalu, Sabah, 88300, Malaysia
| | - Wei Wern Khor
- Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, 93586, Malaysia
| | - Ying Min Kan
- Sungai Dua Health Clinic, Ministry of Health Malaysia, Butterworth, Penang, 13800, Malaysia
| | - Yong Ying Choong
- Seri Manjung Hospital, Ministry of Health Malaysia, Seri Manjung, Perak, 32040, Malaysia
| | | | - Lin Yuing Tan
- Teluk Intan Hospital, Ministry of Health Malaysia, Teluk Intan, Perak, 36000, Malaysia
| | - James Yau Hon Voo
- Duchess of Kent Hospital, Ministry of Health Malaysia, Sandakan, Sabah, 90000, Malaysia
| | - Kar Kei Lam
- Duchess of Kent Hospital, Ministry of Health Malaysia, Sandakan, Sabah, 90000, Malaysia
| | - Chia How Yen
- Clinical Research Centre, Hospital Queen Elizabeth II, Institute for Clinical Research, National Institute of Health, Ministry of Health Malaysia, Kota Kinabalu, Sabah, 88300, Malaysia
| | | | - Zarina Banu Abdulla
- Penang General Hospital, Ministry of Health Malaysia, Georgetown, Penang, 10990, Malaysia
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Henson GJ, van der Mei I, Taylor BV, Blacklow P, Claflin SB, Palmer AJ, Hurst C, Campbell JA. The quality of life impact of the COVID-19 pandemic and lockdowns for people living with multiple sclerosis (MS): evidence from the Australian MS Longitudinal Study. Qual Life Res 2024; 33:1675-1689. [PMID: 38578380 PMCID: PMC11116258 DOI: 10.1007/s11136-024-03620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE People living with multiple sclerosis (PwMS) in metropolitan Victoria, Australia, experienced a 112-day, COVID-19-related lockdown in mid-2020. Contemporaneously, Australian PwMS elsewhere experienced minimal restrictions, resulting in a natural experiment. This study investigated the relationships between lockdowns, COVID-19-related adversity, and health-related quality of life (HRQoL). It also generated health state utilities (HSU) representative of changes in HRQoL. METHODS Data were extracted from Australian MS Longitudinal Study surveys, which included the Assessment of Quality of Life-Eight Dimensions (AQoL-8D) instrument and a COVID-19 questionnaire. This COVID-19 questionnaire required participants to rank their COVID-19-related adversity across seven health dimensions. Ordered probits were used to identify variables contributing to adversity. Linear and logit regressions were applied to determine the impact of adversity on HRQoL, defined using AQoL-8D HSUs. Qualitative data were examined thematically. RESULTS N = 1666 PwMS (average age 58.5; 79.8% female; consistent with the clinical presentation of MS) entered the study, with n = 367 (22.0%) exposed to the 112-day lockdown. Lockdown exposure and disability severity were strongly associated with higher adversity rankings (p < 0.01). Higher adversity rankings were associated with lower HSUs. Participants reporting major adversity, across measured health dimensions, had a mean HSU 0.161 (p < 0.01) lower than participants reporting no adversity and were more likely (OR: 2.716, p < 0.01) to report a clinically significant HSU reduction. Themes in qualitative data supported quantitative findings. CONCLUSIONS We found that COVID-19-related adversity reduced the HRQoL of PwMS. Our HSU estimates can be used in health economic models to evaluate lockdown cost-effectiveness for people with complex and chronic (mainly neurological) diseases.
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Affiliation(s)
- Glen J Henson
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia
| | - Paul Blacklow
- Tasmanian School of Business and Economics, University of Tasmania, Churchill Avenue, Sandy Bay, 7005, Australia
| | - Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia
| | - Carol Hurst
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia.
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11
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Zarski AC, Weisel KK, Berger T, Krieger T, Schaub MP, Berking M, Görlich D, Jacobi C, Ebert DD. Efficacy of an Internet- and Mobile-Based Intervention for Subclinical Anxiety and Depression (ICare Prevent) with Two Guidance Formats: Results from a Three-Armed Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:155-168. [PMID: 38688243 PMCID: PMC11151970 DOI: 10.1159/000536149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/29/2023] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Limited research exists on intervention efficacy for comorbid subclinical anxiety and depressive disorders, despite their common co-occurrence. Internet- and mobile-based interventions (IMIs) are promising to reach individuals facing subclinical symptoms. OBJECTIVE This study aimed to evaluate the efficacy of a transdiagnostic and self-tailored IMI in reducing subclinical anxiety and depressive symptom severity with either individualized (IG-IMI) or automated (AG-IMI) guidance compared to a waitlist control group with care-as-usual access (WLC). METHODS Participants included 566 adults with subclinical anxiety (GAD-7 ≥ 5) and/or depressive (CES-D ≥16) symptoms, who did not meet criteria for a full-syndrome depressive or anxiety disorder. In a three-arm randomized clinical trial, participants were randomized to a cognitive behavioral 7-session IMI plus booster session with IG-IMI (n = 186) or AG-IMI (n = 189) or WLC (n = 191). Primary outcomes included observer-rated anxiety (HAM-A) and depressive (QIDS) symptom severity 8 weeks after randomization assessed by blinded raters via telephone. Follow-up outcomes at 6 and 12 months are reported. RESULTS Symptom severity was significantly lower with small to medium effects in IG-IMI (anxiety: d = 0.45, depression: d = 0.43) and AG-IMI (anxiety: d = 0.31, depression: d = 0.32) compared to WLC. No significant differences emerged between guidance formats in primary outcomes. There was a significant effect in HAM-A after 6 months favoring AG-IMI. On average, participants completed 85.38% of IG-IMI and 77.38% of AG-IMI. CONCLUSIONS A transdiagnostic, self-tailored IMI can reduce subclinical anxiety and depressive symptom severity, but 12-month long-term effects were absent. Automated guidance holds promise for enhancing the scalability of IMIs in broad prevention initiatives.
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Affiliation(s)
- Anna-Carlotta Zarski
- Division of eHealth in Clinical Psychology, Department of Clinical Psychology, Philipps University of Marburg, Marburg, Germany
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kiona K. Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael P. Schaub
- Swiss Research Institute for Public Health and Addiction (ISGF), Associated to the University of Zurich, Zurich, Switzerland
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Corinna Jacobi
- Institute for Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - David D. Ebert
- Professorship Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany
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12
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Trenaman L, Guh D, Bansback N, Sawatzky R, Sun H, Cuthbertson L, Whitehurst DGT. Quality of life of the Canadian population using the VR-12: population norms for health utility values, summary component scores and domain scores. Qual Life Res 2024; 33:453-465. [PMID: 37938404 PMCID: PMC10850034 DOI: 10.1007/s11136-023-03536-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES To estimate Canadian population norms (health utility values, summary component scores and domain scores) for the VR-12. METHODS English and French speaking Canadians aged 18 and older completed an online survey that included sociodemographic questions and standardized health status instruments, including the VR-12. Responses to the VR-12 were summarized as: (i) a health utility value; (ii) mental and physical component summary scores (MCS and PCS, respectively), and (iii) eight domain scores. Norms were calculated for the full sample and by gender, age group, and province/territory (univariate), and for several multivariate stratifications (e.g., age group and gender). Results were summarized using descriptive statistics, including number of respondents, mean and standard deviation (SD), median and percentiles (25th and 75th), and minimum and maximum. RESULTS A total of 6761 people who clicked on the survey link completed the survey (83.4% completion rate), of whom 6741 (99.7%) were included in the analysis. The mean health utility score was 0.698 (SD = 0.216). Mean health utility scores tended to be higher in older age groups, ranging from 0.661 (SD = 0.214) in those aged 18-29 to 0.728 (SD = 0.310) in those aged 80+. Average MCS scores were higher in older age groups, while PCS scores were lower. Females consistently reported lower mean health utility values, summary component scores and domain scores compared with males. CONCLUSIONS This is the first study to present Canadian norms for the VR-12. Health utility norms can serve as a valuable input for Canadian economic models, while summary component and domain norms can help interpret routinely-collected data.
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Affiliation(s)
- Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Fourth Floor, Box 351621, Seattle, WA, 98195, USA.
| | - Daphne Guh
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | - Nick Bansback
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Richard Sawatzky
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- School of Nursing, Trinity Western University, Vancouver, BC, Canada
| | - Huiying Sun
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | - Lena Cuthbertson
- British Columbia Office of Patient-Centred Measurement, Ministry of Health/Providence Health Care, Vancouver, BC, Canada
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13
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Orji NC, Cox IA, Jason LA, Chen G, Zhao T, Rogerson MJ, Kelly RM, Wills K, Hensher M, Palmer AJ, de Graaff B, Campbell JA. Assessing health state utilities for people with myalgic encephalomyelitis/chronic fatigue syndrome in Australia using the EQ-5D-5L, AQoL-8D and EQ-5D-5L-psychosocial instruments. Qual Life Res 2024; 33:45-57. [PMID: 37561337 PMCID: PMC10784392 DOI: 10.1007/s11136-023-03498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic condition with a constellation of symptoms presenting as severe and profound fatigue of ≥ 6 months not relieved by rest. ME/CFS affects health-related quality of life (HRQoL), which can be measured using multi-attribute health state utility (HSU) instruments. The aims of this study were to quantify HSUs for people living with ME/CFS, and to identify an instrument that is preferentially sensitive for ME/CFS. METHODS Cross-sectional national survey of people with ME/CFS using the AQoL-8D and EQ-5D-5L. Additional questions from the AQoL-8D were used as 'bolt-ons' to the EQ-5D-5L (i.e., EQ-5D-5L-Psychosocial). Disability and fatigue severity were assessed using the De Paul Symptom Questionnaire-Short Form (DSQ-SF). HSUs were generated using Australian tariffs. Mean HSUs were stratified for sociodemographic and clinical factors. Bland-Altman plots were used to compare the three HSU instruments. RESULTS For the 198 participants, mean HSUs (95% confidence intervals) were EQ-5D-5L: 0.46 (0.42-0.50); AQoL-8D: 0.43 (0.41-0.45); EQ-5D-5L-Psychosocial: 0.44 (0.42-0.46). HSUs were substantially lower than population norms: EQ-5D-5L: 0.89; AQoL-8D: 0.77. As disability and fatigue severity increased, HSUs decreased in all three instruments. Bland-Altman plots revealed interchangeability between the AQoL-8D and EQ-5D-5LPsychosocial. Floor and ceiling effects of 13.5% and 2.5% respectively were observed for the EQ-5D-5L instrument only. CONCLUSIONS ME/CFS has a profound impact on HRQoL. The AQoL-8D and EQ-5D-5L-Psychosocial can be used interchangeably: the latter represents a reduced participant burden.
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Affiliation(s)
- Nneka C Orji
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid A Cox
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Leonard A Jason
- DePaul University Center for Community Research, Chicago, IL, USA
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - Ting Zhao
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Melissa J Rogerson
- School of Computing & Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Ryan M Kelly
- School of Computing & Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Martin Hensher
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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14
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Ivanova E, Fondberg R, Flygare O, Sannemalm M, Asplund S, Dahlén S, Sampaio F, Andersson E, Mataix-Cols D, Ivanov VZ, Rück C. Study protocol for a single-blind, parallel-group, randomised, controlled non-inferiority trial of 4-day intensive versus standard cognitive behavioural therapy for adults with obsessive-compulsive disorder. BMJ Open 2023; 13:e076361. [PMID: 38101824 PMCID: PMC10729159 DOI: 10.1136/bmjopen-2023-076361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/31/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Individual cognitive behavioural therapy (CBT) with exposure and response prevention is an effective treatment for obsessive-compulsive disorder (OCD). However, individual CBT is costly and time-consuming, requiring weekly therapy sessions for 3-4 months. A 4-day intensive version of CBT for OCD delivered in group format has been recently developed in Norway (Bergen 4-day treatment, B4DT). B4DT has shown promising results in several uncontrolled and one small, randomised trial, but its non-inferiority to the gold standard treatment has not been established. METHODS AND ANALYSIS This single-blind, randomised controlled trial including 120 patients (60 per arm) will compare B4DT to individual CBT. The primary outcome is the blind assessor-rated Yale-Brown Obsessive Compulsive Scale (Y-BOCS). We hypothesise that B4DT will be non-inferior to gold standard CBT 15 weeks after treatment start. The non-inferiority margin is set at four points on the Y-BOCS. Secondary outcomes include time to treatment response, cost-effectiveness, response and remission rates, drop-out rates and adverse events. ETHICS AND DISSEMINATION This study has been approved by the Swedish Ethical Review Authority. Hypotheses were specified and analysis code published before data collection started. Results from all analyses will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials and Consolidated Health Economic Evaluation Reporting Standards irrespective of outcome. TRIAL REGISTRATION NUMBER NCT05608278.
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Affiliation(s)
- Ekaterina Ivanova
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Robin Fondberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Flygare
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Max Sannemalm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Sofia Asplund
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sofia Dahlén
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Volen Z Ivanov
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
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15
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Pan T, Wu Y, Buchanan J, Goranitis I. QALYs and rare diseases: exploring the responsiveness of SF-6D, EQ-5D-5L and AQoL-8D following genomic testing for childhood and adult-onset rare genetic conditions in Australia. Health Qual Life Outcomes 2023; 21:132. [PMID: 38087302 PMCID: PMC10717517 DOI: 10.1186/s12955-023-02216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Genomic testing transforms the diagnosis and management of rare conditions. However, uncertainty exists on how to best measure genomic outcomes for informing healthcare priorities. Using the HTA-preferred method should be the starting point to improve the evidence-base. This study explores the responsiveness of SF-6D, EQ-5D-5L and AQoL-8D following genomic testing across childhood and adult-onset genetic conditions. METHOD Self-reported patient-reported outcomes (PRO) were obtained from: primary caregivers of children with suspected neurodevelopmental disorders (NDs) or genetic kidney diseases (GKDs) (carers' own PRO), adults with suspected GKDs using SF-12v2; adults with suspected complex neurological disorders (CNDs) using EQ-5D-5L; and adults with dilated cardiomyopathy (DCM) using AQol-8D. Responsiveness was assessed using the standardised response mean effect-size based on diagnostic (having a confirmed genomic diagnosis), personal (usefulness of genomic information to individuals or families), and clinical (clinical usefulness of genomic information) utility anchors. RESULTS In total, 254 people completed PRO measures before genomic testing and after receiving results. For diagnostic utility, a nearly moderate positive effect size was identified by the AQoL-8D in adult DCM patients. Declines in physical health domains masked any improvements in mental or psychosocial domains in parents of children affected by NDs and adult CNDs and DCM patients with confirmed diagnosis. However, the magnitude of the changes was small and we did not find statistically significant evidence of these changes. No other responsiveness evidence related to diagnostic, clinical, and personal utility of genomic testing was identified. CONCLUSION Generic PRO measures may lack responsiveness to the diagnostic, clinical and personal outcomes of genomics, but further research is needed to establish their measurement properties and relevant evaluative space in the context of rare conditions. Expected declines in the physical health of people experiencing rare conditions may further challenge the conventional application of quality of life assessments.
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Affiliation(s)
- Tianxin Pan
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - You Wu
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
- Australian Genomics Health Alliance, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - James Buchanan
- Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
- Health Economics and Policy Research Unit, Queen Mary University of London, London, United Kingdom
| | - Ilias Goranitis
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
- Australian Genomics Health Alliance, Melbourne, Victoria, Australia.
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
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16
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Gundacker G, Trales DE, Stefanescu HE. Quality of Life and Audiological Benefits in Pediatric Cochlear Implant Users in Romania: Systematic Review and Cohort Study. J Pers Med 2023; 13:1610. [PMID: 38003925 PMCID: PMC10672230 DOI: 10.3390/jpm13111610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Profound sensorineural hearing loss (SNHL) can be successfully treated with a cochlear implant (CI), and treatment is usually accompanied by increased quality of life (QoL). Therefore, the aim of this study was to investigate generic and health-related QoL, as well as the level of audiological outcomes, of CI users, in addition to whether Qol can be restored to the extent of those with normal hearing. Furthermore, different implantation timepoints were compared (early vs. late), and a possible correlation between health and generic QoL questionnaires was investigated. The outcomes from 93 pediatric CI users from Romania were analyzed in the study. Two QoL questionnaires (SSQ12, AQoL-6D), as well as the HSM sentence test and Soundfield measurements, were assessed. The outcomes revealed that the CI users were able to achieve the same QoL as their age- and-gender matched peers with normal hearing, and hearing was restored with good speech comprehension. No significant difference between early- and late-implanted children was detected, although a tendency of a better Word Recognition Score (+10%) in the early-implanted group was discovered. A moderate and significant correlation between the generic and health-related Qol questionnaire was observed. Audiological examinations are still the standard practice by which to measure the benefit of any hearing intervention; nonetheless, generic and health-related QoL should be assessed in order to provide a full picture of a successful and patient-satisfactory cochlear implant procedure.
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Affiliation(s)
- Gina Gundacker
- Life Science Department, University of Applied Sciences Technikum Vienna, 1200 Vienna, Austria
| | - Delia Emilia Trales
- Department of Otolaryngology, Victor Babeș Medical and Pharmaceutical University, 300041 Timișoara, Romania; (D.E.T.); (H.E.S.)
| | - Horatiu Eugen Stefanescu
- Department of Otolaryngology, Victor Babeș Medical and Pharmaceutical University, 300041 Timișoara, Romania; (D.E.T.); (H.E.S.)
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17
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Dell L, Sbisa AM, Forbes A, O'Donnell M, Bryant R, Hodson S, Morton D, Battersby M, Tuerk PW, Elliott P, Wallace D, Forbes D. Massed v. standard prolonged exposure therapy for PTSD in military personnel and veterans: 12-month follow-up of a non-inferiority randomised controlled trial. Psychol Med 2023; 53:7070-7077. [PMID: 36911997 PMCID: PMC10719628 DOI: 10.1017/s0033291723000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/30/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND The utilisation of massed therapy for treating posttraumatic stress disorder (PTSD) is gaining strength, especially prolonged exposure. However, it is unknown whether massed prolonged exposure (MPE) is non-inferior to standard prolonged exposure (SPE) protocols in the long term. The current study aimed to assess whether MPE was non-inferior to SPE at 12 months post-treatment, and to ascertain changes in secondary measure outcomes. METHODS A multi-site non-inferiority randomised controlled trial (RCT) compared SPE with MPE in 12 clinics. The primary outcome was PTSD symptom severity (CAPS-5) at 12 months post-treatment commencement. Secondary outcome measures included symptoms of depression, anxiety, anger, disability, and quality of life at 12 weeks and 12 months post-treatment commencement. Outcome assessors were blinded to treatment allocation. The intention-to-treat sample included 138 Australian military members and veterans and data were analysed for 134 participants (SPE = 71, MPE = 63). RESULTS Reductions in PTSD severity were maintained at 12 months and MPE remained non-inferior to SPE. Both treatment groups experienced a reduction in depression, anxiety, anger, and improvements in quality of life at 12 weeks and 12 months post-treatment commencement. Treatment effects for self-reported disability in the SPE group at 12 weeks were not maintained, with neither group registering significant effects at 12 months. CONCLUSIONS The emergence of massed protocols for PTSD is an important advancement. The current study provides RCT evidence for the longevity of MPE treatment gains at 12 months post-treatment commencement and demonstrated non-inferiority to SPE. Promisingly, both treatments also significantly reduced the severity of comorbid symptoms commonly occurring alongside PTSD.
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Affiliation(s)
- Lisa Dell
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alyssa M Sbisa
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Meaghan O'Donnell
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephanie Hodson
- Department of Veteran's Affairs, Canberra, Australian Capital Territory, Australia
| | - David Morton
- Defence, Canberra, Australian Capital Territory, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Peter W Tuerk
- Department of Human Services, Sheila C. Jonson Center for Clinical Services, University of Virginia, Charlottesville, Virginia, USA
| | - Peter Elliott
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Duncan Wallace
- Australian Defence Force Centre for Mental Health, Sydney, New South Wales, Australia
| | - David Forbes
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
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18
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Koitschev A, Neudert M, Lenarz T. A bone conduction implant using self-drilling screws : Self-drilling screws as a new fixation method of an active transcutaneous bone conduction hearing implant. HNO 2023; 71:61-66. [PMID: 37322168 DOI: 10.1007/s00106-023-01295-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The active transcutaneous bone conduction implant (tBCI; BONEBRIDGE™ BCI 601; MED-EL, Innsbruck, Austria) is fixed to the skull with two self-tapping screws in predrilled screw channels. The aim of this prospective study was to evaluate the safety and effectiveness of fixation with self-drilling screws instead of the self-tapping screws, in order to simplify the surgical procedure. MATERIALS AND METHODS Nine patients (mean age 37 ± 16 years, range 14-57 years) were examined pre- and 12 months postoperatively for word recognition scores (WRS) at 65 dB SPL, sound-field (SF) thresholds, bone conduction thresholds (BC), health-related quality of life (Assessment of Quality of Life, AQOL-8D questionnaire), and adverse events (AE). RESULTS Due to avoidance of one surgical step, the surgical technique was simplified. Mean WRS in SF was 11.1 ± 22.2% (range 0-55%) pre- and 77.2 ± 19.9% (range 30-95%) postoperatively; mean SF threshold (pure tone audiometry, PTA4) improved from 61.2 ± 14.3 dB HL (range 37.0-75.3 dB HL) to 31.9 ± 7.2 dB HL (range 22.8-45.0 dB HL); mean BC thresholds were constant at 16.7 ± 6.8 dB HL (range 6.3-27.5 dB HL) pre- and 14.2 ± 6.2 dB HL (range 5.8-23.8 dB HL) postoperatively. AQOL-8D mean utility score increased from 0.65 ± 0.18 preoperatively to 0.82 ± 0.17 postoperatively. No device-related adverse events occurred. CONCLUSION Implant fixation by means of self-drilling screws was safe and effective in all nine patients. There was significant audiological benefit 12 months after implantation.
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Affiliation(s)
- Assen Koitschev
- Klinik für Hals‑, Nasen‑, Ohrenkrankheiten, Plastische Operationen, Klinikum Stuttgart-Olgahospital, Kriegsbergstraße 62, 70174, Stuttgart, Germany.
| | - Marcus Neudert
- Klinik für Hals‑, Nasen‑, Ohrenkrankheiten, Plastische Operationen, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Germany
| | - Thomas Lenarz
- Klinik für Hals‑, Nasen‑, Ohrenkrankheiten, Plastische Operationen, Medizinische Hochschule Hannover, Hannover, Germany
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Lau W, Chisholm K, Gallagher M, Felmingham K, Murray K, Pearce A, Doyle N, Alexander S, O'Brien H, Putica A, Khatri J, Bockelmann P, Hosseiny F, Librado A, Notarianni M, O'Donnell M. Comparing the unified protocol for transdiagnostic treatment of emotional disorders to prolonged exposure for the treatment of PTSD: Design of a non-inferiority randomized controlled trial. Contemp Clin Trials Commun 2023; 33:101134. [PMID: 37228903 PMCID: PMC10205430 DOI: 10.1016/j.conctc.2023.101134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/21/2023] [Accepted: 04/10/2023] [Indexed: 05/27/2023] Open
Abstract
Background Prolonged Exposure (PE), a trauma-focused therapy, is one of the most efficacious treatments available for PTSD. However, many people with PTSD do not lose their diagnosis following delivery of PE. The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is a non-trauma focused treatment that may offer an alternative treatment for PTSD. Methods This paper describes the study protocol for IMPACT, an assessor-blinded randomized controlled trial that examines the non-inferiority of UP relative to PE for participants who meet DSM-5 criteria for current PTSD. One hundred and twenty adult participants with PTSD will be randomized to receive either 10 × 90-min sessions of UP or PE with a trained provider. The primary outcome is severity of PTSD symptoms assessed by the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) at post-treatment. Discussion While evidence-based treatments are available for PTSD, high levels of treatment dropout and non-response require new approaches to be tested. The UP is based on emotion regulation theory and is effective in treating anxiety and depressive disorders, however, there has been limited application to PTSD. This is the first rigorous study comparing UP to PE in a non-inferiority randomized controlled trial and may help improve clinical outcomes for those with PTSD. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry, Trial ID (ACTRN12619000543189).
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Affiliation(s)
- W. Lau
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - K. Chisholm
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - M.W. Gallagher
- Department of Psychology, The University of Houston, TX, USA
| | - K. Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - K. Murray
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - A. Pearce
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - N. Doyle
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - S. Alexander
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - H. O'Brien
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - A. Putica
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - J. Khatri
- Canberra Health Services, Australian Capital Territory Government, Canberra, Australia
| | - P. Bockelmann
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - F. Hosseiny
- Atlas Institute for Veterans and Families, Ottawa, Canada
- University of Ottawa Institute of Mental Health Research at The Royal, Canada
| | - A. Librado
- Atlas Institute for Veterans and Families, Ottawa, Canada
| | - M. Notarianni
- Atlas Institute for Veterans and Families, Ottawa, Canada
- University of Ottawa Institute of Mental Health Research at The Royal, Canada
| | - M.L. O'Donnell
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Victoria, Australia
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Harris A, Hinman RS, Lawford BJ, Egerton T, Keating C, Brown C, Metcalf B, Spiers L, Sumithran P, Quicke JG, Bennell KL. Cost-Effectiveness of Telehealth-Delivered Exercise and Dietary Weight Loss Programs for Knee Osteoarthritis Within a Twelve-Month Randomized Trial. Arthritis Care Res (Hoboken) 2023; 75:1311-1319. [PMID: 36106928 PMCID: PMC10953202 DOI: 10.1002/acr.25022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/23/2022] [Accepted: 09/13/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of telehealth-delivered exercise and diet-plus-exercise programs within 12 months. METHODS An economic evaluation within a 12-month, 3-arm, parallel randomized trial of two 6-month telehealth-delivered exercise programs, with and without a dietary component. A total of 415 people with knee osteoarthritis ages 45-80 years and body mass index of 28-40 kg/m2 were assigned to 1 of 2 telehealth-delivered exercise programs, 1 without (n = 172) and 1 with (n = 175) a dietary component (ketogenic very low calorie diet), or to an education control (n = 67), for 6 months, with 6 months follow-up. The primary economic outcomes were quality-adjusted life years (QALYs) and health system costs. Measured costs were the direct intervention (consultations, equipment/resources, and meal replacements) and health care use in 2020 Australian dollars ($AU1.5 = $US1). Secondary analysis included weight loss and work productivity gains. RESULTS The clinical trial demonstrated greater improvements in pain and function compared to information only for individuals with knee osteoarthritis and overweight/obesity. We can be 88% confident that diet plus exercise is cost effective ($45,500 per QALY), 53% confident that exercise is cost-effective ($67,600 per QALY) compared to the control, and 86% confident that augmenting exercise with the diet program is cost effective ($21,100 per QALY). CONCLUSION Telehealth-delivered programs targeting exercise with dietary intervention for people with knee osteoarthritis who have overweight/obesity are likely to be cost-effective, particularly if potential long-term gains from weight loss and work productivity are realized.
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Affiliation(s)
| | | | | | | | | | | | - Ben Metcalf
- University of MelbourneMelbourneVictoriaAustralia
| | - Libby Spiers
- University of MelbourneMelbourneVictoriaAustralia
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21
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Lembacher MJ, Arnoldner C, Landegger LD. Patient Acceptance of Novel Therapeutic Options for Sensorineural Hearing Loss-A Pilot Study. Otol Neurotol 2023; 44:e204-e210. [PMID: 36791369 DOI: 10.1097/mao.0000000000003828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Numerous preclinical experiments over the past years have shown the potential of novel therapeutic approaches for sensorineural hearing loss (SNHL) that are now awaiting clinical translation. In this pilot study, we aimed to evaluate the patient acceptance of these future innovative therapies in individuals with SNHL. STUDY DESIGN Cross-sectional exploratory pilot study. SETTING Tertiary care academic hospital. PATIENTS In total, 72 individuals (43 female and 29 male, 59 affected subjects and 13 parents) with different types of SNHL were surveyed between May 2020 and November 2020. INTERVENTION The interest/willingness to consider new therapeutic options (viral vectors, stem cells, CRISPR/Cas) for themselves or their children was assessed with the help of a questionnaire, and the answers were matched with a quality-of-life score and sociodemographic as well as clinical characteristics. MAIN OUTCOME MEASURE Acceptance of new therapeutic strategies for SNHL in a representative population. RESULTS Even with the currently associated treatment uncertainties, 48 patients (66.7%) suffering from SNHL stated that new therapies could be a potential future option for them. Half of these (24 individuals; 33.3%) expressed high acceptance toward the novel strategies. Subjects with a positive attitude toward new therapies in general and viral vectors specifically were significantly older. CONCLUSION With two-thirds of patients affected by SNHL expressing acceptance toward novel therapies, this pilot study highlights the importance of investigating such attitudes and motivates further translational research to offer additional treatment strategies to this patient population.
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Affiliation(s)
- Matthias J Lembacher
- Department of Otorhinolaryngology-Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna
| | - Christoph Arnoldner
- Department of Otorhinolaryngology-Head and Neck Surgery, Vienna General Hospital, Medical University of Vienna
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Gough C, Barr C, Lewis LK, Hutchinson C, Maeder A, George S. Older adults' community participation, physical activity, and social interactions during and following COVID-19 restrictions in Australia: a mixed methods approach. BMC Public Health 2023; 23:172. [PMID: 36698158 PMCID: PMC9875767 DOI: 10.1186/s12889-023-15093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND With the increasing age of the global population, key components of healthy ageing including community, physical, and social participation continue to gain traction. However, management of the COVID-19 pandemic aimed to protect older adults and reduce the spread of the virus, this restricted community participation and reduced the opportunities for social interaction. METHODS This mixed methods study investigates community dwelling older adults' community participation; physical activity and social interaction prior to, during, and following the COVID-19 lockdown in Adelaide, Australia. Twenty-six community dwelling older adults were monitored over three time-points between November 2018 and October 2020, with Global Positioning Systems, accelerometry and self-reported diaries. In addition, nineteen participants completed semi-structured interviews. RESULTS Community participation varied across the three time points, with significant reduction in the number of trips taken out-of-home (p = 0.021), social interactions (p = 0.001) and sleep quality (p = 0.008) during restrictions. Five themes were identified to explain personal experiences of community participation during restrictions: (1) Reframing of meaning, (2) Redefining to maintain activities, (3) Revision of risk, (4) Reflection and renewal and (5) Future planning. CONCLUSION During COVID-19 the physical and social activities of community dwelling older adults changed. Services that support older adults to adapt their activities , considering their capacities and preferences, to facilitate community participation are required.
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Affiliation(s)
- Claire Gough
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Chris Barr
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Lucy K Lewis
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Claire Hutchinson
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Anthony Maeder
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia. .,Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia. .,Caring Futures Institute, Flinders University, Adelaide, Australia.
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Nguo K, Truby H, Porter J. Total Energy Expenditure in Healthy Ambulatory Older Adults Aged ≥80 Years: A Doubly Labelled Water Study. ANNALS OF NUTRITION & METABOLISM 2023; 79:263-273. [PMID: 36592624 DOI: 10.1159/000528872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The life expectancy of older adults continues to increase; however, knowledge regarding their total energy requirements is lacking. This study aimed to compare the total energy expenditure (TEE) of older adults ≥80 years measured using doubly labelled water (DLW), with estimated TEE. The hypothesis was that the Mifflin, Ikeda, and Livingston equations will more closely estimate energy requirements than the commonly used Schofield equation. METHODS Resting metabolic rate (RMR) and TEE were measured using the reference methods of indirect calorimetry and DLW, respectively. Bland-Altman plots compared measured RMR and TEE with predicted RMR using equations (Mifflin, Ikeda, Livingston, Schofield) and predicted TEE (predicted RMR × physical activity level). RESULTS Twenty-one older adults (age range 80.7-90.1 years, BMI 26.1 ± 5.5 kg/m2) were included. The Schofield equation demonstrated the greatest bias from measured RMR, overestimating approximately up to double the mean difference (865 ± 662 kJ/day) compared with the three other equations. The Schofield equation exhibited the greatest bias (overestimation of 641 ± 1,066 kJ/day) compared with measured TEE. The other three equations underestimated TEE, with the least bias from Ikeda (37 ± 1,103 kJ/day), followed by Livingston (251 ± 1,108 kJ/day), and Mifflin (354 ± 1,140 kJ/day). Data are mean ± SD. CONCLUSIONS In older adults ≥80 years, the Ikeda, Mifflin, and Livingston equations provide closer estimates of TEE than the widely used Schofield equation. The development of nutrition guidelines therefore should consider the utilization of equations which more accurately reflect age-specific requirements.
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Affiliation(s)
- Kay Nguo
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Science, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Campbell JA, Ahmad H, Chen G, van der Mei I, Taylor BV, Claflin S, Henson GJ, Simpson-Yap S, Laslett LL, Hawkes K, Hurst C, Waugh H, Palmer AJ. Validation of the EQ-5D-5L and psychosocial bolt-ons in a large cohort of people living with multiple sclerosis in Australia. Qual Life Res 2023; 32:553-568. [PMID: 36036311 PMCID: PMC9911481 DOI: 10.1007/s11136-022-03214-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an inflammatory, neurodegenerative disease of the central nervous system which results in disability over time and reduced quality of life. To increase the sensitivity of the EQ-5D-5L for psychosocial health, four bolt-on items from the AQoL-8D were used to create the nine-item EQ-5D-5L-Psychosocial. We aimed to externally validate the EQ-5D-5L-Psychosocial in a large cohort of people with MS (pwMS) and explore the discriminatory power of the new instrument with EQ-5D-5L/AQoL-8D. METHODS A large representative sample from the Australian MS Longitudinal Study completed the AQoL-8D and EQ-5D-5L (including EQ VAS) and both instruments health state utilities (HSUs) were scored using Australian tariffs. Sociodemographic/clinical data were also collected. External validity of EQ-5D-5L-Psychosocial scoring algorithm was assessed with mean absolute errors (MAE) and Spearman's correlation coefficient. Discriminatory sensitivity was assessed with an examination of ceiling/floor effects, and disability severity classifications. RESULTS Among 1683 participants (mean age: 58.6 years; 80% female), over half (55%) had moderate or severe disability. MAE (0.063) and the distribution of the prediction error were similar to the original development study. Mean (± standard deviation) HSUs were EQ-5D-5L: 0.58 ± 0.32, EQ-5D-5L-Psychosocial 0.62 ± 0.29, and AQoL-8D: 0.63 ± 0.20. N = 157 (10%) scored perfect health (i.e. HSU = 1.0) on the EQ-5D-5L, but reported a mean HSU of 0.90 on the alternative instruments. The Sleep bolt-on dimension was particularly important for pwMS. CONCLUSIONS The EQ-5D-5L-Psychosocial is more sensitive than the EQ-5D-5L in pwMS whose HSUs approach those reflecting full health. When respondent burden is taken into account, the EQ-5D-5L-Psychosocial is preferential to the AQoL-8D. We suggest a larger confirmatory study comparing all prevalent multi-attribute utility instruments for pwMS.
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Affiliation(s)
- Julie A. Campbell
- University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS Australia
| | - Hasnat Ahmad
- University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, VIC, Australia
| | - Ingrid van der Mei
- University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS Australia
| | - Bruce V. Taylor
- University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS Australia
| | - Suzi Claflin
- University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS Australia
| | - Glen J. Henson
- University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS Australia
| | - Steve Simpson-Yap
- School of Population and Global Health, Neuroepidemioloy Unit, The University of Melbourne, Melbourne VIC, Australia
| | - Laura L. Laslett
- University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS Australia
| | - Kirsty Hawkes
- University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS Australia
| | - Carol Hurst
- University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS Australia
| | - Hilary Waugh
- University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS Australia
| | - Andrew J. Palmer
- University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS Australia ,School of Population and Global Health, Health Economics Unit, The University of Melbourne, Melbourne VIC, Australia
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Cox IA, Campbell J, de Graaff B, Otahal P, Corte TJ, Moodley Y, Hopkins P, Macansh S, Walters EH, Palmer AJ. Assessment of health-related quality of life in Australian patients with idiopathic pulmonary fibrosis: a comparison of the EQ-5D-5L and the AQoL-8D. Qual Life Res 2023; 32:473-493. [PMID: 35927542 PMCID: PMC9911478 DOI: 10.1007/s11136-022-03205-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Idiopathic pulmonary fibrosis (IPF) is a progressive and debilitating chronic lung disease with a high symptom burden, which has a substantial impact on health-related quality of life (HRQoL). Our study aimed to assess the suitability of the EuroQol five-dimension (EQ-5D-5L) and the Assessment of Quality of Life- eight-dimension (AQoL-8D) questionnaires in measuring HRQoL as health state utility values (HSUVs) in an Australian IPF cohort. METHODS Data for estimation of health state utility values (HSUVs) were collected from participants of the Australian IPF Registry (AIPFR) using self-administered surveys which included the EQ-5D-5L and the AQoL-8D. Data on lung function and disease specific HRQoL instruments were collected from the AIPFR. Performance of the two instruments was evaluated based on questionnaire practicality, agreement between the two instruments and test performance (internal and construct validity). RESULTS Overall completion rates for the EQ-5D-5L and AQoL-8D were 96% and 85%, respectively. Mean (median) HSUVs were 0.65 (0.70) and 0.69 (0.72) for the EQ-5D-5L and AQoL-8D, respectively. There was reasonable agreement between the two instruments based on the Bland-Altman plot mean difference (-0.04) and intraclass correlation coefficient (0.84), however there were some fundamental differences. A larger range of values was observed with the EQ-5D-5L (-0.57-1.00 vs 0.16-1.00). The EQ-5D-5L had a greater divergent sensitivity and efficacy in relation to assessing HSUVs between clinical groupings. The AQoL-8D ,however, had a higher sensitivity to measure psychosocial aspects of HRQoL in IPF. CONCLUSION The EQ-5D-5L demonstrated superior performance when compared to AQoL-8D in persons with IPF. This may be attributable to the high symptom burden which is physically debilitating to which the EQ-5D-5L may be more sensitive.
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Affiliation(s)
- Ingrid A. Cox
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Melbourne, Australia
| | - Julie Campbell
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Melbourne, Australia
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS Australia
| | - Tamera J. Corte
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Melbourne, Australia
- Central Clinical School, The University of Sydney, Camperdown, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Yuben Moodley
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Melbourne, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Institute of Respiratory Health, The University of Western Australia, Perth, Australia
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Australia
| | - Peter Hopkins
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Melbourne, Australia
- Queensland Centre for Pulmonary Transplantation and Vascular Disease, The Prince Charles Hospital, Chermside, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD Australia
| | - Sacha Macansh
- Australian Idiopathic Pulmonary Fibrosis Registry, Lung Foundation of Australia, New South Wales, Australia
| | - E. Haydn Walters
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Melbourne, Australia
| | - Andrew J. Palmer
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Melbourne, Australia
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Zheng Q, Cox IA, de Graaff B, Campbell JA, Corte TJ, Glaspole I, Navaratnam V, Hopkins P, Zappala C, Ahmad H, Zhao T, Macansh S, Walters EH, Palmer AJ. The relative contribution of co-morbidities to health-related quality of life of people with idiopathic pulmonary fibrosis using the Assessment of Quality of Life-8-Dimension multi-attribute utility instrument. Qual Life Res 2022; 32:1609-1619. [PMID: 36572788 DOI: 10.1007/s11136-022-03331-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Little is known about the impact of co-morbidities on health-related quality of life (HRQoL) for people with idiopathic pulmonary fibrosis (IPF). We aimed to investigate the relative contribution of co-morbidities to HRQoL of people with IPF. METHODS N = 157 participants were recruited from the Australian IPF Registry (AIPFR). Health state utilities (HSUs), and the super-dimensions of physical and psychosocial scores were measured using the Assessment of Quality of Life-8-Dimensions (AQoL-8D). The impact of co-morbidities on HRQoL was investigated using linear regression and general dominance analyses. RESULTS A higher number of co-morbidities was associated with lower HSUs (p trend = 0.002). Co-morbidities explained 9.1% of the variance of HSUs, 16.0% of physical super-dimensional scores, and 4.2% of psychosocial super-dimensional scores. Arthritis was associated with a significant reduction on HSUs (β = - 0.09, 95% confidence interval [CI] - 0.16 to - 0.02), largely driven by reduced scores on the physical super-dimension (β = - 0.13, 95% CI - 0.20 to - 0.06). Heart diseases were associated with a significant reduction on HSUs (β = - 0.09, 95% CI - 0.16 to - 0.02), driven by reduced scores on physical (β = - 0.09, 95% CI - 0.16 to - 0.02) and psychosocial (β = -0.10, 95% CI - 0.17 to - 0.02) super-dimensions. CONCLUSIONS Co-morbidities significantly impact HRQoL of people with IPF, with markedly negative impacts on their HSUs and physical health. A more holistic approach to the care of people with IPF is important as better management of these co-morbidities could lead to improved HRQoL in people with IPF.
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Affiliation(s)
- Qiang Zheng
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7001, Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia
- Department of Anaesthesiology (High-Tech Branch), the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ingrid A Cox
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7001, Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7001, Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7001, Australia
| | - Tamera J Corte
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia
- Central Clinical School, The University of Sydney, Camperdown, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ian Glaspole
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia
- Department of Allergy and Respiratory Medicine, The Alfred Hospital, Melbourne, Australia
- Faculty of Medicine, Monash University, Melbourne, Australia
| | - Vidya Navaratnam
- Australian Idiopathic Pulmonary Fibrosis Registry, Lung Foundation of Australia, Camperdown, NSW, Australia
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia
| | - Peter Hopkins
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia
- Queensland Centre for Pulmonary Transplantation and Vascular Disease, The Prince Charles Hospital, Chermside, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Chris Zappala
- Department of Thoracic Medicine, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7001, Australia
- Australian Government Department of Health and Aged Care, Tasmania (TAS) Office, Australia
| | - Ting Zhao
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7001, Australia
| | - Sacha Macansh
- Australian Idiopathic Pulmonary Fibrosis Registry, Lung Foundation of Australia, Camperdown, NSW, Australia
| | - E Haydn Walters
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7001, Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7001, Australia.
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia.
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Herselman MF, Bailey S, Deo P, Zhou XF, Gunn KM, Bobrovskaya L. The Effects of Walnuts and Academic Stress on Mental Health, General Well-Being and the Gut Microbiota in a Sample of University Students: A Randomised Clinical Trial. Nutrients 2022; 14:4776. [PMID: 36432461 PMCID: PMC9697272 DOI: 10.3390/nu14224776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Poorer mental health is common in undergraduate students due to academic stress. An interplay between stress and diet exists, with stress influencing food choices. Nutritional interventions may be effective in preventing mental health decline due to complex bidirectional interactions between the brain, the gut and the gut microbiota. Previous studies have shown walnut consumption has a positive effect on mental health. Here, using a randomized clinical trial (Australian New Zealand Clinical Trials Registry, #ACTRN12619000972123), we aimed to investigate the effects of academic stress and daily walnut consumption in university students on mental health, biochemical markers of general health, and the gut microbiota. We found academic stress had a negative impact on self-reported mood and mental health status, while daily walnut consumption improved mental health indicators and protected against some of the negative effects of academic stress on metabolic and stress biomarkers. Academic stress was associated with lower gut microbial diversity in females, which was improved by walnut consumption. The effects of academic stress or walnut consumption in male participants could not be established due to small numbers of participants. Thus, walnut consumption may have a protective effect against some of the negative impacts of academic stress, however sex-dependent mechanisms require further study.
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Affiliation(s)
- Mauritz F. Herselman
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Sheree Bailey
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Permal Deo
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Xin-Fu Zhou
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Kate M. Gunn
- Allied Health & Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Larisa Bobrovskaya
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
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BREAST-Q Breast-Conserving Therapy Module: Normative Data from a Dutch Sample of 9059 Women. Plast Reconstr Surg 2022; 150:985-993. [PMID: 35994350 PMCID: PMC9586822 DOI: 10.1097/prs.0000000000009607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND BREAST-Q, a patient-reported outcome measure for cosmetic and reconstructive breast surgery, is widely used in both clinical research and practice. The aim of this study was to acquire normative data of BREAST-Q's Breast-Conserving Therapy Module from a Dutch population sample and to compare it with existing normative BREAST-Q values. METHODS Flyers with QR codes, WhatsApp, and one academic center's Facebook and LinkedIn platforms were used to direct participants to self-complete an online version of four domains of the preoperative BREAST-Q Breast-Conserving Therapy Module. BREAST-Q domain scores were log transformed to normalize the distribution. Univariable regression analyses were used to assess (nonlinear) associations between age and BREAST-Q domain scores. RESULTS Overall, 9059 questionnaire responses were analyzed. Median (±SD) BREAST-Q domain scores were 64.0 ± 18.0 (satisfaction with breasts), 69.0 ± 21.0 (psychosocial well-being), 92.0 ± 20 (physical well-being), and 59.0 ± 15.0 (sexual well-being). Age as a linear term was associated with log-transformed satisfaction with breasts, psychosocial well-being, and physical well-being; sexual well-being was a quadratic function of age. Previous breast surgery unrelated to breast cancer was a significant predictor for higher log-transformed satisfaction with breasts (β = 0.04, p < 0.001) and higher sexual well-being score (β = -0.05, p < 0.001). Compared with previously published normative data, small differences were found in mean BREAST-Q domain scores (mean differences ranging between 2.45 and 6.24). CONCLUSIONS Normative Dutch BREAST-Q scores follow similar patterns across domains in comparison with previously published normative data. Normative Dutch BREAST-Q data enable future comparisons in breast-related satisfaction and quality of life issues of Dutch patients with breast cancer compared with their age-matched peers.
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Braun L, Terhorst Y, Titzler I, Freund J, Thielecke J, Ebert DD, Baumeister H. Lessons Learned from an Attempted Pragmatic Randomized Controlled Trial for Improvement of Chronic Pain-Associated Disability in Green Professions: Long-Term Effectiveness of a Guided Online-Based Acceptance and Commitment Therapy (PACT-A). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13858. [PMID: 36360738 PMCID: PMC9655679 DOI: 10.3390/ijerph192113858] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Musculoskeletal symptoms are increased in farmers, whereas the prevalence of chronified pain is unknown. Online interventions based on acceptance and commitment therapy (ACT) have shown encouraging results in the general population, representing a promising approach for reducing pain interference in green professions (i.e., farmers, foresters, gardeners). We conducted a pragmatic RCT comparing a guided ACT-based online intervention to enhanced treatment-as-usual in entrepreneurs, contributing spouses, family members and pensioners in green professions with chronic pain (CPG: ≥grade II, ≥6 months). Recruitment was terminated prematurely after 2.5 years at N = 89 (of planned N = 286). Assessments were conducted at 9 weeks (T1), 6 months (T2) and 12 months (T3) post-randomization. The primary outcome was pain interference (T1). The secondary outcomes encompassed pain-, health- and intervention-related variables. No treatment effect for reduction of pain interference was found at T1 (β = -0.16, 95%CI: -0.64-0.32, p = 0.256). Improvements in cognitive fusion, pain acceptance, anxiety, perceived stress and quality of life were found only at T3. Intervention satisfaction as well as therapeutic and technological alliances were moderate, and uptake and adherence were low. Results are restricted by low statistical power due to recruitment issues, high study attrition and low intervention adherence, standing in contrast to previous studies. Further research is warranted regarding the use of ACT-based online interventions for chronic pain in this occupational group. Trial registration: German Clinical Trial Registration: DRKS00014619. Registered: 16 April 2018.
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Affiliation(s)
- Lina Braun
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, 89081 Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, 89081 Ulm, Germany
- Department of Research Methods, Institute of Psychology and Education, University of Ulm, 89081 Ulm, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander University of Erlangen-Nürnberg, 91052 Erlangen, Germany
| | - Johanna Freund
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander University of Erlangen-Nürnberg, 91052 Erlangen, Germany
- Faculty TUM Department of Sport and Health Sciences, TU Munich, 80992 Munich, Germany
| | - Janika Thielecke
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander University of Erlangen-Nürnberg, 91052 Erlangen, Germany
- Faculty TUM Department of Sport and Health Sciences, TU Munich, 80992 Munich, Germany
| | - David Daniel Ebert
- Faculty TUM Department of Sport and Health Sciences, TU Munich, 80992 Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, 89081 Ulm, Germany
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30
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Singh A, Aitken D, Moonaz S, Palmer AJ, Blizzard L, Ding C, Drummen S, Jones G, Bennell K, Antony B. A Randomised Controlled Trial of YOGa and Strengthening Exercise for Knee Osteo Arthritis: Protocol for a Comparative Effectiveness Trial (YOGA Trial). J Funct Morphol Kinesiol 2022; 7:jfmk7040084. [PMID: 36278745 PMCID: PMC9624302 DOI: 10.3390/jfmk7040084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Osteoarthritis (OA) is a common joint disorder for which there is no cure. Current treatments are suboptimal. Exercise is a core treatment for knee OA, with muscle strengthening exercise commonly recommended. Yoga is a mind-body exercise intervention that can improve flexibility, muscle strength, balance, and fitness and potentially reduce symptoms of OA. However, there is a scarcity of robust, high-quality conclusive evidence on the efficacy of yoga in knee OA. We are currently conducting the first randomised comparative effectiveness and cost-effectiveness trial of a yoga program compared with a strengthening exercise program in patients with symptomatic knee OA. This study protocol describes the design and conduct of this trial. The YOGA study is a phase III, single-centre, parallel, superiority, randomised, active-controlled trial which will be conducted in Hobart, Australia. One hundred and twenty-six participants (63 in each arm) aged over 40 years with symptomatic knee OA will be recruited from the community and randomly allocated to receive either a 24-week yoga program (3×/week) or a strengthening exercise program (3×/week). The primary outcome will be change in knee pain over 12 weeks, assessed using a 100 mm visual analogue scale (VAS). The secondary outcomes include change in knee pain, patient global assessment, physical function, quality of life, gait speed, biomarkers, and others over 12 and 24 weeks. We will also assess whether the presence of neuropathic pain moderates the effects of yoga compared to strengthening exercise. Additional data, such as cost and resource utilization, will be collected for the cost-effectiveness analysis. The primary analysis will be conducted using an intention-to-treat approach. Adverse events will be monitored throughout the study. Once completed, this trial will contribute to the knowledge of whether yoga can be used as a simple, effective, low-cost option for the management of knee OA, thus saving economic costs in the healthcare system.
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Affiliation(s)
- Ambrish Singh
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Steffany Moonaz
- Department of Health Services Research, Southern California University of Health Sciences, Whittier, CA 90604, USA
- Research Department, Maryland University of Integrative Health, Laurel, MD 20723, USA
| | - Andrew J. Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou 510000, China
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Stan Drummen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Kim Bennell
- Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
- Correspondence: ; Tel.: +61-3-6226-4255
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Clark IN, Ip-Winfield V, Murphy M, Shanahan E, Grocke D. The Bonny Method of Guided Imagery and Music for family caregivers of people with dementia: A within subject feasibility study. NORDIC JOURNAL OF MUSIC THERAPY 2022. [DOI: 10.1080/08098131.2022.2113913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Affiliation(s)
- Imogen N. Clark
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, University of Melbourne, Victoria, Australia
| | | | - Melissa Murphy
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, University of Melbourne, Victoria, Australia
| | | | - Denise Grocke
- Melbourne Conservatorium of Music, Faculty of Fine Arts and Music, University of Melbourne, Victoria, Australia
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Beretzky Z, Rencz F, Brodszky V. Normative data and socio-demographic determinants of the Dermatology Life Quality Index in a large online sample of the Hungarian population. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1153-1161. [PMID: 35912947 DOI: 10.1080/14737167.2022.2108793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Population norms are available for several generic health-related quality of life questionnaires, but rarely for disease- or specialty-specific questionnaires. OBJECTIVES The aim of our study was to calculate population norms for the Dermatology Life Quality Index (DLQI) score. METHODS We conducted an online self-completed questionnaire survey on a large sample of the general Hungarian adult population. Respondents' socio-demographic characteristics and dermatology-related quality of life aspects were recorded. RESULTS A total of 2,001 participants completed the questionnaire, with the average age of 48.2 (SD = 16.6) years, half of the respondents in our sample (n = 981) reported long-standing health problems. The average DLQI score was 1.9 (SD = 4.0) with women having a higher average (2.0, SD = 3.9) than men (1.8, SD = 4.0; p=<0.001). The DLQI score differed among age-groups with younger people having relatively higher DLQI averages. When the multivariate linear regression model was applied, it showed that young age, lower income and unemployment status were associated with higher DLQI scores, while controlling for the existence of skin disease (p<0.05). CONCLUSIONS This study esthablished DLQI population norms among the general population, which may provide a reference point in health-policy and financing decision-making.
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Affiliation(s)
- Z Beretzky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093, Budapest, Hungary
| | - F Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093, Budapest, Hungary
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093, Budapest, Hungary
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Chadwick C, Burton PR, Reilly J, Playfair J, Laurie C, Shaw K, Brown WA. Comprehensive Analysis of Improvements in Health-Related Quality of Life and Establishment of QALY Gains in a Government-Funded Bariatric Surgical Program with 5-Year Follow-up. Obes Surg 2022; 32:3571-3580. [PMID: 35895247 PMCID: PMC9327972 DOI: 10.1007/s11695-022-06216-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/03/2022]
Abstract
Purpose Bariatric surgery is an efficacious intervention for substantial and sustained weight reduction in individuals with morbid obesity resulting in health improvements. However, the changes to a patient’s health related quality of life (HRQoL) in the medium to longer term after bariatric surgery have not been adequately characterized. Our aim was to evaluate the change to patient HRQoL 5 years following bariatric surgery in an Australian government-funded hospital system and determine the significance of relationships between change in physical and mental assessment scores and HRQoL utility scores. Materials and Methods We performed a longitudinal panel study of 81 adult patients who underwent primary bariatric surgery at an Australian tertiary government-funded hospital and completed multi-attribute utility (MAU), multi-attribute non-utility (MA), and disease-specific adjusted quality of life (AQoL) questionnaires before and after bariatric surgery. Results At a mean (SD) 5.72 (1.07) years postbariatric surgery, participants demonstrated statistically significant improvements in mean AQoL-8D utility (0.135 (0.21); P < 0.0001), yielding a mean 3.2 (1.67) QALYs gained. Beck Depression Inventory-II scores improved (baseline mean 17.35 (9.57); 5-year mean 14.7 (11.57); P = 0.037). Short Form-36 scores improved in the domains of physical functioning and role limitations due to physical health and general health. Change in depression scores and patient satisfaction with surgery were found to be significant predictors of follow up AQoL utility scores. Conclusions Bariatric surgery improves physical and psychological quality of life measures over 5 years. The improvement of patient QALYs provide insight to the potential cost utility of publicly funded bariatric surgery in the medium term. Graphical abstract ![]()
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Affiliation(s)
- Chiara Chadwick
- Department of Surgery, Central Clinical School, Monash University, Alfred Health, Melbourne, VIC, Australia.
- Oesophago-Gastric and Bariatric Unit, Alfred Health. Melbourne, Victoria, Australia.
| | - Paul R Burton
- Department of Surgery, Central Clinical School, Monash University, Alfred Health, Melbourne, VIC, Australia
- Oesophago-Gastric and Bariatric Unit, Alfred Health. Melbourne, Victoria, Australia
| | - Jennifer Reilly
- Department of Surgery, Central Clinical School, Monash University, Alfred Health, Melbourne, VIC, Australia
- Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Julie Playfair
- Department of Surgery, Central Clinical School, Monash University, Alfred Health, Melbourne, VIC, Australia
| | - Cheryl Laurie
- Department of Surgery, Central Clinical School, Monash University, Alfred Health, Melbourne, VIC, Australia
| | - Kalai Shaw
- Department of Surgery, Central Clinical School, Monash University, Alfred Health, Melbourne, VIC, Australia
- Oesophago-Gastric and Bariatric Unit, Alfred Health. Melbourne, Victoria, Australia
| | - Wendy A Brown
- Department of Surgery, Central Clinical School, Monash University, Alfred Health, Melbourne, VIC, Australia
- Oesophago-Gastric and Bariatric Unit, Alfred Health. Melbourne, Victoria, Australia
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Heterogeneity of quality of life in young people attending primary mental health services. Epidemiol Psychiatr Sci 2022; 31:e55. [PMID: 35856272 PMCID: PMC9305730 DOI: 10.1017/s2045796022000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIMS The utility of quality of life (QoL) as an outcome measure in youth-specific primary mental health care settings has yet to be determined. We aimed to determine: (i) whether heterogeneity on individual items of a QoL measure could be used to identify distinct groups of help-seeking young people; and (ii) the validity of these groups based on having clinically meaningful differences in demographic and clinical characteristics. METHODS Young people, at their first presentation to one of five primary mental health services, completed a range of questionnaires, including the Assessment of Quality of Life-6 dimensions adolescent version (AQoL-6D). Latent class analysis (LCA) and multivariate multinomial logistic regression were used to define classes based on AQoL-6D and determine demographic and clinical characteristics associated with class membership. RESULTS 1107 young people (12-25 years) participated. Four groups were identified: (i) no-to-mild impairment in QoL; (ii) moderate impairment across dimensions but especially mental health and coping; (iii) moderate impairment across dimensions but especially on the pain dimension; and (iv) poor QoL across all dimensions along with a greater likelihood of complex and severe clinical presentations. Differences between groups were observed with respect to demographic and clinical features. CONCLUSIONS Adding multi-attribute utility instruments such as the AQoL-6D to routine data collection in mental health services might generate insights into the care needs of young people beyond reducing psychological distress and promoting symptom recovery. In young people with impairments across all QoL dimensions, the need for a holistic and personalised approach to treatment and recovery is heightened.
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Chen JTH, Wuthrich VM, Rapee RM, Draper B, Brodaty H, Cutler H, Low LF, Georgiou A, Johnco C, Jones M, Meuldijk D, Partington A. Improving mental health and social participation outcomes in older adults with depression and anxiety: Study protocol for a randomised controlled trial. PLoS One 2022; 17:e0269981. [PMID: 35759476 PMCID: PMC9236237 DOI: 10.1371/journal.pone.0269981] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background Increasing both the frequency and quality of social interactions within treatments for anxiety and depressive disorders in older adults may improve their mental health outcomes and quality of life. This study aims to evaluate the clinical efficacy and cost utility of an enhanced cognitive behavioural therapy (CBT) plus social participation program in a sample of older adults with depression and/or anxiety. Methods A total of 172 community-dwelling adults aged 65 years or older with an anxiety and/or depressive disorder will be randomly allocated to either an enhanced CBT plus social participation program (n = 86) or standard CBT (n = 86). Both treatments will be delivered during 12 weekly individual sessions utilising structured manuals and workbooks. Participants will be assessed at pre-treatment, post-treatment, and 12-month follow-up. The primary outcome evaluates mean change in clinician-rated diagnostic severity of anxiety and depressive disorders from baseline to post-treatment (primary endpoint) based on a semi-structured diagnostic interview. Secondary outcomes evaluate changes in symptomatology on self-report anxiety and depression measures, as well as changes in social/community participation, social network, and perceived social support, loneliness, quality of life, and use of health services. Economic benefits will be evaluated using a cost-utility analysis to derive the incremental cost utility ratios for the enhanced CBT program. Discussion Outcomes from this study will provide support for the establishment of improved psychosocial treatment for older adults with anxiety and/or depression. Study outcomes will also provide health systems with a clear means to reduce the impact of poor emotional health in older age and its associated economic burden. In addition to the empirical validation of a novel treatment, the current study will contribute to the current understanding of the role of social participation in older adult wellbeing. Trial registration Prospectively registered on the Australian New Zealand Clinical Trials Registry (ID: ACTRN12619000242123; registered 19th February 2019) and the ISRCTN registry (ID: ISRCTN78951376; registered 10th July 2019).
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Affiliation(s)
- Jessamine Tsan-Hsiang Chen
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- * E-mail:
| | - Viviana M. Wuthrich
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ronald M. Rapee
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Brian Draper
- Older Persons’ Mental Health Services, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Centre of Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Older Persons’ Mental Health Services, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Centre of Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry Cutler
- Macquarie Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Lee-Fay Low
- Ageing, Work and Health Research Unit, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Carly Johnco
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Michael Jones
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Denise Meuldijk
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Partington
- Macquarie Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
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Brakenridge CJ, Gardiner PA, Grigg RV, Winkler EAH, Fjeldsoe BS, Schaumberg MA, Owen N, Eakin EG, Biddle SJH, Moodie M, Daly RM, Green DJ, Cohen N, Gray L, Comans T, Buman MP, Goode AD, Nguyen P, Gao L, Healy GN, Dunstan DW. Sitting less and moving more for improved metabolic and brain health in type 2 diabetes: 'OPTIMISE your health' trial protocol. BMC Public Health 2022; 22:929. [PMID: 35538430 PMCID: PMC9086419 DOI: 10.1186/s12889-022-13123-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Clinical practice guidelines recommend that adults with type 2 diabetes (T2D) sit less and move more throughout the day. The 18-month OPTIMISE Your Health Clinical Trial was developed to support desk-based workers with T2D achieve these recommendations. The two-arm protocol consists of an intervention and control arms. The intervention arm receives 6 months health coaching, a sit-stand desktop workstation and an activity tracker, followed by 6 months of text message support, then 6 months maintenance. The control arm receives a delayed modified intervention after 12 months of usual care. This paper describes the methods of a randomised controlled trial (RCT) evaluating the effectiveness and cost-effectiveness of the intervention, compared to a delayed intervention control. METHODS This is a two-arm RCT being conducted in Melbourne, Australia. Desk-based workers (≥0.8 full-time equivalent) aged 35-65 years, ambulatory, and with T2D and managed glycaemic control (6.5-10.0% HbA1c), are randomised to the multicomponent intervention (target n = 125) or delayed-intervention control (target n = 125) conditions. All intervention participants receive 6 months of tailored health coaching assisting them to "sit less" and "move more" at work and throughout the day, supported by a sit-stand desktop workstation and an activity tracker (Fitbit). Participants receive text message-based extended care for a further 6-months (6-12 months) followed by 6-months of non-contact (12-18 months: maintenance). Delayed intervention occurs at 12-18 months for the control arm. Assessments are undertaken at baseline, 3, 6, 12, 15 and 18-months. Primary outcomes are activPAL-measured sitting time (h/16 h day), glycosylated haemoglobin (HbA1c; %, mmol/mol) and, cognitive function measures (visual learning and new memory; Paired Associates Learning Total Errors [adjusted]). Secondary, exploratory, and process outcomes will also be collected throughout the trial. DISCUSSION The OPTIMISE Your Health trial will provide unique insights into the benefits of an intervention aimed at sitting less and moving more in desk-bound office workers with T2D, with outcomes relevant to glycaemic control, and to cardiometabolic and brain health. Findings will contribute new insights to add to the evidence base on initiating and maintaining behaviour change with clinical populations and inform practice in diabetes management. TRIAL REGISTRATION ANZCTRN12618001159246 .
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Affiliation(s)
- Christian J Brakenridge
- Baker Heart & Diabetes Institute, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
- Australian Catholic University, Mary Mackillop Institute of Health Research, Melbourne, Australia.
| | - Paul A Gardiner
- University of Southern Queensland, School of Health and Medical Sciences, Ipswich, Australia
- University of Southern Queensland, Centre for Health Research, Springfield, Australia
- The University of Queensland, Centre for Health Services Research, Brisbane, Australia
| | - Ruth V Grigg
- Baker Heart & Diabetes Institute, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Elisabeth A H Winkler
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia
| | - Brianna S Fjeldsoe
- The University of Queensland, School of Public Health, Brisbane, Australia
| | - Mia A Schaumberg
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia
- University of Sunshine Coast, School of Health and Behavioural Sciences, Sunshine Coast, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - Neville Owen
- Baker Heart & Diabetes Institute, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Swinburne University, School of Health Sciences, Melbourne, Australia
| | - Elizabeth G Eakin
- The University of Queensland, School of Public Health, Brisbane, Australia
| | - Stuart J H Biddle
- University of Southern Queensland, Centre for Health Research, Springfield, Australia
| | - Marjory Moodie
- Deakin University, School of Health and Social Development, Melbourne, Australia
| | - Robin M Daly
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Melbourne, Australia
| | - Daniel J Green
- University of Western Australia, School of Sport Science, Exercise & Health, Perth, Australia
| | - Neale Cohen
- Baker Heart & Diabetes Institute, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Len Gray
- The University of Queensland, Centre for Health Services Research, Brisbane, Australia
| | - Tracy Comans
- The University of Queensland, Centre for Health Services Research, Brisbane, Australia
| | - Matthew P Buman
- Arizona State University, College of Health Solutions, Tempe, USA
| | - Ana D Goode
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia
| | - Phuong Nguyen
- Deakin University, School of Health and Social Development, Melbourne, Australia
| | - Lan Gao
- Deakin University, School of Health and Social Development, Melbourne, Australia
| | - Genevieve N Healy
- Baker Heart & Diabetes Institute, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Australia
| | - David W Dunstan
- Baker Heart & Diabetes Institute, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Melbourne, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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Lailach S, Zahnert T. Results and Quality of Life after Implantation of Active Middle Ear Implants. Laryngorhinootologie 2022; 101:S3-S35. [PMID: 35605611 DOI: 10.1055/a-1647-8616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The provision of implantable hearing aids represents an area with high development and innovation potential. On the one hand, this review article provides an overview of current indication criteria for the treatment with active middle ear implants. On the other hand, outcome parameters as well as functional results after implantation of active middle ear implants are demonstrated and discussed. The focus is mainly placed on audiological results as well as the subjective health status. "Patient Reported Outcome Measures" (PROMs) have become an integral part of the evaluation of hearing implant treatment. Due to low evidence level criteria, the study situation regarding audiological as well as subjective outcome parameters is not satisfactory. The lack of an international consensus on accepted outcome parameters makes a meta-analytical analysis of results immensely difficult. In the studies published to date, patients with sensorineural hearing loss and patients with conductive or mixed hearing loss offered better speech recognition after implantation of an active middle ear implant compared to conventional hearing aids. Current analyses show a significant improvement in general as well as hearing-specific quality of life after implantation of an active middle ear implant. To date, no validated, hearing-specific quality-of-life measurement instruments exist for assessing the success of fitting in children. Especially in children with complex malformations of the outer ear and the middle ear, excellent audiological results were shown. However, these results need to be substantiated by quality-of-life measurements in future.
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Affiliation(s)
- Susen Lailach
- Universitätsklinikum Dresden Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie (Klinikdirektor: Prof. Dr.med. Dr. h.c. Thomas Zahnert) Dresden
| | - Thomas Zahnert
- Universitätsklinikum Dresden Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie (Klinikdirektor: Prof. Dr.med. Dr. h.c. Thomas Zahnert) Dresden
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Goodwin BC, Crawford-Williams F, Ireland M, March S, Chambers SK, Aitken JF, Dunn J. The quality of life of regional and remote cancer caregivers in Australia. Eur J Cancer Care (Engl) 2022; 31:e13587. [PMID: 35411632 PMCID: PMC9542032 DOI: 10.1111/ecc.13587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/21/2021] [Accepted: 03/28/2022] [Indexed: 01/18/2023]
Abstract
Objective This study compares the well‐being of rural caregivers with that of the general population and explores the potential drivers of poorer outcomes. Method Patient–caregiver dyads (n = 241) residing in regional or remote Queensland, Australia, reported on QoL, chronic illness, caregiver burden, depression, anxiety and stress. Caregiver outcomes were compared with population norms and patient outcomes. Multiple regressions were conducted to identify factors associated with poorer caregiver outcomes. Results Caregivers reported lower mental health‐related QoL (M = 0.436, 95% CI = 0.410–0.462) in comparison with age‐matched population norms (M = 0.556, 95% CI = 0.532–0.580). No differences existed between caregiver and population norms for anxiety, stress and depression. Caregiver chronic illness and higher burden were associated with poorer mental and physical QoL, depression, anxiety and stress (η2s ranging from 0.03 to 0.30). These associations were slightly stronger for male caregivers when compared with female caregivers (η2s ranging from 0.03 to 0.08). Conclusion It is vital that efforts are made to improve rural caregivers' mental and emotional well‐being. Interventions that support caregivers with chronic conditions reduce caregiver burden and take into consideration the unique experience of male caregivers will go some way to addressing this. Future research is needed to identify other drivers of health outcomes in this group.
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Affiliation(s)
- Belinda C Goodwin
- Cancer Council Queensland, Fortitude Valley.,Centre for Health Research, University of Southern Queensland, Springfield
| | - Fiona Crawford-Williams
- Cancer Council Queensland, Fortitude Valley.,Centre for Health Research, University of Southern Queensland, Springfield.,Cancer Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, Australia
| | - Michael Ireland
- Centre for Health Research, University of Southern Queensland, Springfield.,School of Psychology, University of Southern Queensland, Springfield, Australia
| | - Sonja March
- Centre for Health Research, University of Southern Queensland, Springfield.,School of Psychology, University of Southern Queensland, Springfield, Australia
| | - Suzanne K Chambers
- Faculty of Health, University of Technology Sydney, NSW, Australia.,Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Fortitude Valley.,Centre for Health Research, University of Southern Queensland, Springfield.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
| | - Jeff Dunn
- Cancer Council Queensland, Fortitude Valley.,Centre for Health Research, University of Southern Queensland, Springfield.,Faculty of Health, University of Technology Sydney, NSW, Australia.,Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia.,Prostate Cancer Foundation of Australia, Sydney, NSW, Australia
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Economic evaluations for intensive care unit randomised clinical trials in Australia and New Zealand: Practical recommendations for researchers. Aust Crit Care 2022; 36:431-437. [PMID: 35341668 DOI: 10.1016/j.aucc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Economic evaluations of intensive care unit (ICU) interventions have specific considerations, including how to cost ICU stays and accurately measure quality of life in survivors. The aim of this article was to develop best practice recommendations for economic evaluations alongside future ICU randomised controlled trials (RCTs). REVIEW METHODS We collated our experience based on expert consensus across several recent economic evaluations to provide best-practice, practical recommendations for researchers conducting economic evaluations alongside RCTs in the ICU. Recommendations were structured according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Task Force Report. RESULTS We discuss recommendations across the components of economic evaluations, including: types of economic evaluation, the population and sample size, study perspective, comparators, time horizon, choice of health outcomes, measurement of effectiveness, measurement and valuation of quality of life, estimating resources and costs, analytical methods, and the increment cost-effectiveness ratio. We also provide future directions for research with regard to developing more robust economic evaluations for the ICU. CONCLUSION Economic evaluations should be built alongside ICU RCTs and should be designed a priori using appropriate follow-up and data collection to capture patient-relevant outcomes. Further work is needed to improve the quality of data available for linkage in Australia as well as developing costing methods for the ICU and appropriate quality of life measurements.
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Jones P, Drummond P. Construction and evaluation of a mindfulness-based quality of life and well-being program (MQW) in a randomized trial. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02672-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractDue to the multi-factorial nature of the self-report of happiness, an enhancement program was designed that focused on mental style (subjective processes), and relationships, work, money, health, and leisure (objective life domains). An examination of interventions revealed mindfulness training (subjective factors) and goal setting (objective factors) as effective change modalities. To address this, the Mindfulness-based Quality of Life and Well-being Program (MQW) was developed and evaluated against the Mindfulness Attention Awareness Scale, Quality of Life Index, Personal Wellbeing Index–Adult, Positive and Negative Affect Scale, the Satisfaction with Life scale, and the newly developed Clinical Quality of Life Scale (CLINQOL). To explore training protocol effects, the program was delivered in a graduated (6 weekly sessions x 2 hours) and intensive (2 consecutive days x 6 hours) format. Using a randomized trial, participants were allocated across these conditions and a control. A total of 191 participants completed the study and were assessed at pre, post and follow up time points. Increases in mindfulness, quality of life, subjective well-being, and positive and negative affect (not life satisfaction), were greater in treated (combined formats) than control participants at post-test, and for mindfulness at follow up. Other than an increase in mindfulness for the 2 day condition at follow up, changes were similar in both intervention formats. Finally, to investigate what unique difference the MQW might have in comparison to teaching just mindfulness, the full version of the program was compared to an expanded section of the mindfulness component of the program. A total of 74 subjects began the program and filled out assessments across the three time periods. There was no difference between groups or an interaction between group and time. Overall, the findings provide preliminary evidence that a multi-dimensional training approach, using mindfulness and goal setting, may be a beneficial intervention model to enhance subjective and objective components in the perception of quality of life and well-being. However, further investigation into its added benefit to mindfulness alone is required.
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Payten CL, Nguyen DD, Novakovic D, O'Neill J, Chacon AM, Weir KA, Madill CJ. Telehealth voice assessment by speech language pathologists during a global pandemic using principles of a primary contact model: an observational cohort study protocol. BMJ Open 2022; 12:e052518. [PMID: 35039289 PMCID: PMC8764716 DOI: 10.1136/bmjopen-2021-052518] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION SARS-CoV-2, a highly contagious severe acute respiratory syndrome, has spread to most countries in the world and resulted in a change to practice patterns for the assessment and diagnosis of people with voice disorders. Many services are transitioning to telehealth models to maintain physical distancing measures and conserve personal protective equipment used by healthcare workers during laryngoscopy examinations. The speech-language pathology primary contact (SLPPC) assessment for patients referred to ear, nose and throat (ENT) services in Australia has been shown to reduce waiting times for assessment while streamlining access to ENT assessment and allied health practitioner treatment pathways. METHODS AND ANALYSIS A prospective observational cohort study will see patients in a newly developed telehealth model which uses the principles from a usual care SLPPC assessment protocol. Participants will be offered an initial telehealth assessment (speech-language pathology primary contact telehealth (SLPPC-T)) prior to being prioritised for a face-to-face laryngoscopy assessment to complete the diagnostic process. The telehealth assessment will collect sociodemographic information, personal and family medical history, key symptoms, onset and variability of symptoms, red-flag signs or symptoms for laryngeal malignancy, and clinical voice assessment data for auditory-perceptual and acoustic analysis. The study outcomes include (1) association of signs, symptoms and specific voice measures collected during SLPPC-T with voice disorder classification provided after laryngoscopy; (2) degree of concordance between voice disorder classification after SLPPC-T and after laryngoscopy; (3) health service and patient-related costs and health outcomes of the SLPPC-T; (4) patient and stakeholder views and beliefs about the SLPPC-T process. ETHICS AND DISSEMINATION Ethical approval has been granted prior to commencement of the study enrolment by the Gold Coast Hospital and Health Service Human Research Ethics Committee (reference number HREC/2020/QGC/62832). Results will be shared through the publication of articles in peer-reviewed medical journals and presentation at national and international scientific meetings. TRIAL REGISTRATION NUMBER ACTRN12621000427875.
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Affiliation(s)
- Christopher L Payten
- Department of Speech Pathology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Duy Duong Nguyen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Novakovic
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John O'Neill
- Department of Ear, Nose and Throat, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Antonia M Chacon
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kelly A Weir
- School of Allied Health Sciences, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
- Department of Research and Education, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Catherine J Madill
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Chanen AM, Betts JK, Jackson H, Cotton SM, Gleeson J, Davey CG, Thompson K, Perera S, Rayner V, Chong SY, McCutcheon L. A Comparison of Adolescent versus Young Adult Outpatients with First-Presentation Borderline Personality Disorder: Findings from the MOBY Randomized Controlled Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:26-38. [PMID: 33576244 PMCID: PMC8811246 DOI: 10.1177/0706743721992677] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The increasing focus on adolescent personality disorder has tended to ignore evidence of the developmental continuity of the period from puberty to young adulthood. This study aims to: (1) describe the characteristics of a sample of young people with borderline personality disorder (BPD) who had no previous history of evidence-based treatment for the disorder and (2) compare their characteristics by participant age group. METHODS One hundred and thirty-nine young people (15 to 25 years) with BPD, newly enrolled in the Monitoring Outcomes of BPD in Youth randomized controlled trial, completed semi-structured interview and self-report measures assessing demographic, clinical, and functional characteristics. Younger (aged 15 to 17 years; n = 64) and older (aged 18 to 25 years; n = 75) participants were compared on these same variables using t-tests, chi-square tests, and logistic regression. RESULTS Young outpatients with BPD had extensive and severe psychopathology and were functioning poorly. Adolescents and young adults with BPD showed substantial similarities on 20 key aspects of their presentation. Significant between-groups differences were observed in household makeup, treatment history, antisocial personality disorder, emotion dysregulation, substance use, age of commencement and extent of self-harm, and achievement of age-appropriate educational milestones. Adolescent BPD group membership was predicted by family composition and self-harm, whereas young adult BPD group membership was predicted by not achieving age-appropriate milestones, vocational disengagement, and emotion dysregulation. The final model explained 54% of the variance and correctly classified 80.2% of the sample by age. CONCLUSIONS Both adolescents and young adults with early stage BPD present with severe and often similar problems to one another, supporting developmental continuity across this age range. However, there are also meaningful differences in presentation, suggesting that pathways to care might differ by age and/or developmental stage. Detection and intervention for personality disorder should not be delayed until individuals reach 18 years of age.
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Affiliation(s)
- Andrew M Chanen
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Jennifer K Betts
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Henry Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Sue M Cotton
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne Campus, Australia
| | - Christopher G Davey
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia.,Department of Psychiatry, The University of Melbourne, Australia
| | - Katherine Thompson
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Sharnel Perera
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Victoria Rayner
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Sinn Yuin Chong
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
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Ryan P, Preisz A. Towards a broader concept of wellbeing in evaluating paediatric quality of life. J Paediatr Child Health 2022; 58:24-29. [PMID: 34605591 DOI: 10.1111/jpc.15773] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
Paediatric health-care professionals have a primary duty to promote the best interests of their patients. This is reiterated in article 3 of the United Nations Convention on the Rights of the Child and is predicated on promoting children's health and wellbeing. However, there is ambiguity over what standard applies when evaluating whether a paediatric health-care decision supports good outcomes. Values like 'best interests', 'doing no harm' or 'quality of life' may be indeterminate or vague and clinicians may have difficulty in conceptualising what exactly constitutes 'a good life' for children. This uncertainty leads to the question: how do we best evaluate paediatric health decisions and outcomes? Patient-reported outcome measures (PROMs) are questionnaires that aim to achieve this by attaining data on a patient's quality of life and wellbeing. While PROMs originated with adult cohorts, they have since been applied to paediatric populations. Children are vulnerable due to their interdependency; and this raises ethical tensions regarding the potential benefits of such data, respect for autonomy and assent/consent of the individual child in clinical settings. These inherent tensions should be balanced by realising a collective good for children. PROMs should be a robust data collection source that facilitates substantive justice, both procedurally and in distributing limited health resources via accurate quality-adjusted life-years generation. This article aims to (i) overview the traditional and emerging paediatric PROMs; (ii) outline the tensions of using PROMS for children in a clinical setting and (iii) analyse the ability of traditional and emerging PROMs to promote justice in paediatric resource allocation.
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Affiliation(s)
- Patrick Ryan
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne Preisz
- Clinical Ethics, Clinical Governance Unit, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
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Baker AL, McCarter K, Brophy L, Castle D, Kelly PJ, Cocks N, McKinlay ML, Brasier C, Borland R, Bonevski B, Segan C, Baird DE, Turner A, Williams JM, Forbes E, Hayes L, Attia J, Lambkin D, Barker D, Sweeney R. Adapting Peer Researcher Facilitated Strategies to Recruit People Receiving Mental Health Services to a Tobacco Treatment Trial. Front Psychiatry 2022; 13:869169. [PMID: 35722563 PMCID: PMC9199858 DOI: 10.3389/fpsyt.2022.869169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/26/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION One of the most challenging aspects of conducting intervention trials among people who experience severe mental illness (SMI) and who smoke tobacco, is recruitment. In our parent "QuitLink" randomized controlled trial (RCT), slower than expected peer researcher facilitated recruitment, along with the impact of COVID-19 pandemic restrictions, necessitated an adaptive recruitment response. The objectives of the present study were to: (i) describe adaptive peer researcher facilitated recruitment strategies; (ii) explore the effectiveness of these strategies; (iii) investigate whether recruitment strategies reached different subgroups of participants; and (iv) examine the costs and resources required for implementing these strategies. Finally, we offer experience-based lessons in a Peer Researcher Commentary. METHODS People were included in the RCT if they smoked at least 10 cigarettes a day and were accessing mental health support from the project's two partnering mental health organizations in Victoria, Australia. The majority of people accessing these services will have been diagnosed with SMI. Recruitment occurred over 2 years. We began with peer facilitated recruitment strategies delivered face-to-face, then replaced this with direct mail postcards followed by telephone contact. In the final 4 months of the study, we began online recruitment, broadening it to people who smoked and were accessing support or treatment (including from general practitioners) for mental health and/or alcohol or other drug problems, anywhere in the state of Victoria. Differences between recruitment strategies on key participant variables were assessed. We calculated the average cost per enrolee of the different recruitment approaches. RESULTS Only 109 people were recruited from a target of 382: 29 via face-to-face (March 2019 to April 2020), 66 from postcards (May 2020 to November 2020), and 14 from online (November to December 2020 and January to March 2021) strategies. Reflecting our initial focus on recruiting from supported independent living accommodation facilities, participants recruited face-to-face were significantly more likely to be living in partially or fully supported independent living (n = 29, <0.001), but the samples were otherwise similar. After the initial investment in training and equipping peer researchers, the average cost of recruitment was AU$1,182 per participant-~US$850. Face-to-face recruitment was the most expensive approach and postcard recruitment the least (AU$1,648 and AU$928 per participant). DISCUSSION Peer researcher facilitated recruitment into a tobacco treatment trial was difficult and expensive. Widely dispersed services and COVID-19 restrictions necessitated non-face-to-face recruitment strategies, such as direct mail postcards, which improved recruitment and may be worthy of further research. CLINICAL TRIAL REGISTRATION The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN12619000244101 prior to the accrual of the first participant and updated regularly as per registry guidelines. The trial sponsor was the University of Newcastle, NSW, Australia.
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Affiliation(s)
- Amanda L Baker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Kristen McCarter
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, NSW, Australia
| | - Lisa Brophy
- Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University Melbourne, Melbourne, VIC, Australia.,Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - David Castle
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Peter J Kelly
- Illawarra Health and Medical Research Institute and the School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Nadine Cocks
- Research, Advocacy and Policy Development, Mind Australia Limited, Heidelberg, VIC, Australia
| | - Melissa L McKinlay
- Department of Mental Health, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Catherine Brasier
- Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University Melbourne, Melbourne, VIC, Australia
| | - Ron Borland
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Cancer Council Victoria, Melbourne, VIC, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute (FHMRI), College of Medicine & Public Health, Flinders University, Bedford Park, SA, Australia
| | - Catherine Segan
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Donita E Baird
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Alyna Turner
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,School of Medicine, IMPACT, Institute for Innovation in Physical and Mental Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Jill M Williams
- Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Erin Forbes
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Laura Hayes
- Research, Advocacy and Policy Development, Mind Australia Limited, Heidelberg, VIC, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - David Lambkin
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Daniel Barker
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Rohan Sweeney
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
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Ebert DD, Franke M, Zarski AC, Berking M, Riper H, Cuijpers P, Funk B, Lehr D. Effectiveness and Moderators of an Internet-Based Mobile-Supported Stress Management Intervention as a Universal Prevention Approach: Randomized Controlled Trial. J Med Internet Res 2021; 23:e22107. [PMID: 34941541 PMCID: PMC8734929 DOI: 10.2196/22107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/15/2020] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background Emerging evidence indicates the effectiveness of internet-based mobile-supported stress management interventions (iSMIs) in highly stressed employees. It is yet unclear, however, whether iSMIs are also effective without a preselection process in a universal prevention approach, which more closely resembles routine occupational health care. Moreover, evidence for whom iSMIs might be suitable and for whom not is scarce. Objective The aim of this study was to evaluate the iSMI GET.ON Stress in a universal prevention approach without baseline inclusion criteria and to examine the moderators of the intervention effects. Methods A total of 396 employees were randomly assigned to the intervention group or the 6-month waiting list control group. The iSMI consisted of 7 sessions and 1 booster session and offered no therapeutic guidance. Self-report data were assessed at baseline, 7 weeks, and at 6 months following randomization. The primary outcome was perceived stress. Several a priori defined moderators were explored as potential effect modifiers. Results Participants in the intervention group reported significantly lower perceived stress at posttreatment (d=0.71, 95% CI 0.51-0.91) and at 6-month follow-up (d=0.61, 95% CI 0.41-0.81) compared to those in the waiting list control group. Significant differences with medium-to-large effect sizes were found for all mental health and most work-related outcomes. Resilience (at 7 weeks, P=.04; at 6 months, P=.01), agreeableness (at 7 weeks, P=.01), psychological strain (at 6 months, P=.04), and self-regulation (at 6 months, P=.04) moderated the intervention effects. Conclusions This study indicates that iSMIs can be effective in a broad range of employees with no need for preselection to achieve substantial effects. The subgroups that might not profit had extreme values on the respective measures and represented only a very small proportion of the investigated sample, thereby indicating the broad applicability of GET.ON Stress. Trial Registration German Clinical Trials Register DRKS00005699; https://www.drks.de/DRKS00005699
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Affiliation(s)
- David Daniel Ebert
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Marvin Franke
- Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Anna-Carlotta Zarski
- Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Berking
- Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Burkhardt Funk
- Department of Health Psychology and Applied Biological Psychology, Leuphana University of Lueneburg, Lueneburg, Germany
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, Leuphana University of Lueneburg, Lueneburg, Germany
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BERES E, BABES K, BERES ZL, DAINA LG, DAINA CM, CHEREGI C, CIUMARNEAN L, DOGARU G. Cost-effectiveness of home non-invasive ventilation in COPD group GOLD D patients. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, estimated to be the third most common cause of death by 2020. The natural evolution of the disease is characterized by frequent exacerbations, severe exacerbations evolving with respiratory acidosis. Introducing home non-invasive ventilation (NIV) in the management of COPD group GOLD (Global Initiative for Chronic Obstructive Lung Disease) D patients generates supplementary costs, but the decreasing of the number of severe exacerbations will decrease the costs of drug treatment and hospitalization. This balance can be verified through a careful study of cost-effectiveness through modern methods of assessing the costs and years of life gained in relation to quality of life.
Material and method. This prospective study took place in the Emergency Department of the Bihor County Clinical Emergency Hospital, Oradea, between 01 October 2017 – 31 October2018, with a follow-up period of 2 years. We included 36 Group risk D COPD patients, presented with severe exacerbation that required NIV; the patients were divided into two study groups according to the treatment scheme after discharge (standard medication according to GOLD guidelines and long-term oxygen therapy - LTOT vs. LTOT + NIV). We follow-up at 2 years with the study group, and analyze the following: number of exacerbations (moderate and severe), number of hospitalizations, mortality rate in two years, average costs for the treatment of exacerbations and for stable COPD periods, quality adjusted life year (QALY).
Results and discussions. From 36 enrolled, 10 patients benefited from home NIV. The number of exacerbations was significantly lower in the NIV group compared with the LTOT group (1.72±0.79 vs 3.54±1.18). The incremental cost-effectiveness ratio (ICER) showed a net gain of 31% from gross product (GDP) per capita (5,641.71 ± 1,737.0-euro vs 9,272.3 ± 3,681.9 euro) per quality adjusted life year (QALY) for each patient.
Conclusions. Introduction home-NIV demonstrated clinical improvement and higher cost-effectiveness over LTOT alone in Class Risk D, COPD patients after discharge following a severe exacerbation.
Keywords: chronic obstructive pulmonary disease, non-invasive ventilation, cost-effectiveness, quality adjusted life year,
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Affiliation(s)
- Enikő BERES
- Cardiology Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania
| | - Katalin BABES
- Cardiology Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania
| | | | - Lucia Georgeta DAINA
- Psycho-neurosciences and Recovery Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania
| | - Cristian Marius DAINA
- Psycho-neurosciences and Recovery Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania
| | - Cornel CHEREGI
- Surgery Department, University of Oradea, Faculty of Medicine and Pharmacy, Romania
| | - Lorena CIUMARNEAN
- Internal Medicine Department, University of Medicine and Pharmacy „Iuliu Hatieganu”Cluj Napoca, Romania
| | - Gabriela DOGARU
- Medical Rehabilitation Department, University of Medicine and Pharmacy „Iuliu Hatieganu”Cluj Napoca, Romania
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Bohingamu Mudiyanselage S, Price AMH, Mensah FK, Bryson HE, Perlen S, Orsini F, Hiscock H, Dakin P, Harris D, Noble K, Bruce T, Kemp L, Goldfeld S, Gold L. Economic evaluation of an Australian nurse home visiting programme: a randomised trial at 3 years. BMJ Open 2021; 11:e052156. [PMID: 34873002 PMCID: PMC8650480 DOI: 10.1136/bmjopen-2021-052156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate the additional programme cost and cost-effectiveness of 'right@home' Nurse Home Visiting (NHV) programme in relation to improving maternal and child outcomes at child age 3 years compared with usual care. DESIGN A cost-utility analysis from a government-as-payer perspective alongside a randomised trial of NHV over 3-year period. Costs and quality-adjusted life-years (QALYs) were discounted at 5%. Analysis used an intention-to-treat approach with multiple imputation. SETTING The right@home was implemented from 2013 in Victoria and Tasmania states of Australia, as a primary care service for pregnant women, delivered until child age 2 years. PARTICIPANTS 722 pregnant Australian women experiencing adversity received NHV (n=363) or usual care (clinic visits) (n=359). PRIMARY AND SECONDARY OUTCOME MEASURES First, a cost-consequences analysis to compare the additional costs of NHV over usual care, accounting for any reduced costs of service use, and impacts on all maternal and child outcomes assessed at 3 years. Second, cost-utility analysis from a government-as-payer perspective compared additional costs to maternal QALYs to express cost-effectiveness in terms of additional cost per additional QALY gained. RESULTS When compared with usual care at child age 3 years, the right@home intervention cost $A7685 extra per woman (95% CI $A7006 to $A8364) and generated 0.01 more QALYs (95% CI -0.01 to 0.02). The probability of right@home being cost-effective by child age 3 years is less than 20%, at a willingness-to-pay threshold of $A50 000 per QALY. CONCLUSIONS Benefits of NHV to parenting at 2 years and maternal health and well-being at 3 years translate into marginal maternal QALY gains. Like previous cost-effectiveness results for NHV programmes, right@home is not cost-effective at 3 years. Given the relatively high up-front costs of NHV, long-term follow-up is needed to assess the accrual of health and economic benefits over time. TRIAL REGISTRATION NUMBER ISRCTN89962120.
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Affiliation(s)
| | - Anna M H Price
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Fiona K Mensah
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Hannah E Bryson
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Susan Perlen
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Francesca Orsini
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Harriet Hiscock
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Penelope Dakin
- Australian Research Alliance for Children and Youth, Canberra City, ACT, 2601, Australia
| | - Diana Harris
- Australian Research Alliance for Children and Youth, Canberra City, ACT, 2601, Australia
| | - Kristy Noble
- Australian Research Alliance for Children and Youth, Canberra City, ACT, 2601, Australia
| | - Tracey Bruce
- Ingham Institute, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Lynn Kemp
- Ingham Institute, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Sharon Goldfeld
- Population Health, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Burwood, VIC, 3125, Australia
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Smith MD, Rhodes J, Al Mahrouqi M, MacDonald DA, Vicenzino B. Balance is impaired in symptomatic ankle osteoarthritis: A cross-sectional study. Gait Posture 2021; 90:61-66. [PMID: 34399156 DOI: 10.1016/j.gaitpost.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/14/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ankle osteoarthritis (OA) is associated with several physical impairments but investigations into balance impairments in this population are limited. Understanding balance impairments in ankle OA may help inform the management of this condition. RESEARCH QUESTION Does balance overall performance differ between individuals with symptomatic radiographic ankle OA, asymptomatic radiographic ankle OA and healthy controls? Are there any differences in mediolateral or anteroposterior balance, or confidence to perform balance tasks between these groups? METHODS Ninety-six volunteers (31 symptomatic radiographic ankle OA, 41 asymptomatic radiographic ankle OA and 24 healthy controls) completed six static balance tasks: bilateral stance on a firm surface, bilateral stance on foam, and tandem stance, all performed with eyes open and closed. Centre of pressure (COP) data were collected using force plates. Confidence to perform each balance task was collected using an 11-point numerical rating scale. RESULTS Compared to controls, participants with symptomatic radiographic ankle OA had greater COP area when standing on a firm surface, foam and in tandem with eyes closed (all p < 0.05) and greater total COP sway in both firm surface and tandem stance conditions (p < 0.04). Participants with symptomatic ankle OA had greater COP area (p < 0.04) and total COP sway (p = 0.01) than those with asymptomatic ankle OA during tandem stance. Total COP sway and area were similar between asymptomatic ankle OA and control participants. Some differences in mediolateral and anteroposterior balance were identified between groups. Individuals with symptomatic ankle OA had lower confidence to perform the tandem stance eyes closed task compared to controls. SIGNIFICANCE Balance impairments and decreased balance confidence were identified in those with symptomatic radiographic ankle OA compared to asymptomatic individuals with and without radiographic ankle OA. This suggests that balance deficits in ankle OA may be related to symptoms, rather than radiographic evidence of disease.
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Affiliation(s)
- Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Division of Physiotherapy, Brisbane, QLD, 4072, Australia.
| | - Jonah Rhodes
- The University of Queensland, School of Health and Rehabilitation Sciences, Division of Physiotherapy, Brisbane, QLD, 4072, Australia
| | - Munira Al Mahrouqi
- The University of Queensland, School of Health and Rehabilitation Sciences, Division of Physiotherapy, Brisbane, QLD, 4072, Australia; Oman College of Health Sciences, Division of Physiotherapy, Ministry of Health, Muscat, P.O. Box 3720, PC 112, Oman
| | - David A MacDonald
- The University of Queensland, School of Health and Rehabilitation Sciences, Division of Physiotherapy, Brisbane, QLD, 4072, Australia; Griffith University, School of Allied Health Sciences, Gold Coast, QLD, 4222, Australia
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Division of Physiotherapy, Brisbane, QLD, 4072, Australia
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Murnane A, Kiss N, Fraser SF, Lewin J. Health-related quality of life, fatigue and health behaviours in Australian adolescent and young adult cancer survivors. Pediatr Blood Cancer 2021; 68:e29243. [PMID: 34309171 DOI: 10.1002/pbc.29243] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Current knowledge of the long-term health behaviours and well-being of adolescent and yong adult (AYA) cancer survivors is limited. The aim of this study was to evaluate the health behaviours of AYA cancer survivors compared to Australian normative data and describe their health-related quality of life (HR-QoL) and levels of fatigue. METHOD A cross-sectional online survey of participants aged 15-25 years at diagnosis and 2-7 years post treatment completion was conducted at a comprehensive cancer centre. Validated questionnaires assessed health behaviours and functioning including current physical activity (PA) levels, diet quality, fatigue (FACIT-F) and HR-QoL (AQoL-6D, Short Form 36v2 [SF-36v2]) were compared to Australian normative data. RESULTS Ninety individuals completed the survey (26% response rate) with a mean age of 25.4 years and median time post treatment of 61 months (24-85 months). Compared to normative data, a higher proportion of AYA cancer survivors was consuming the recommended daily serves of fruit and vegetables (16.7% vs. 3.9%, p < .0001), had a lower presence of overweight or obesity (46.7% vs. 57.7%, p = .04) and lower percentage of current smokers (2.2% vs. 16.7%, p < .0001). However, AYA cancer survivors reported increased fatigue (t[df = 596] = -4.1, p < .0001) and reduced HR-QoL compared to normative data (t[df = 533] = 9.2, p < .0001) along with a higher proportion suffering from one or more chronic health conditions (65% vs. 40%, p < .0001). CONCLUSION AYA cancer survivors from a single Australian institution, who were on average 5 years post treatment, exhibited better health behaviours compared to Australian normative data, but still below recommended guidelines. However, they continue to experience issues with fatigue and reduced HR-QoL, especially in those not meeting the PA guidelines.
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Affiliation(s)
- Andrew Murnane
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia.,Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Jeremy Lewin
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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Wluka AE, Urquhart DM, Teichtahl AJ, Hussain SM, Forbes A, Arnold C, Wang Y, Cicuttini FM. Effect of low-dose amitriptyline on reducing pain in clinical knee osteoarthritis compared to benztropine: study protocol of a randomised, double blind, placebo-controlled trial. BMC Musculoskelet Disord 2021; 22:826. [PMID: 34579675 PMCID: PMC8474789 DOI: 10.1186/s12891-021-04690-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/07/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Knee osteoarthritis is a major cause of pain and disability. Pain control is poor, with most patients remaining in moderate to severe pain. This may be because central causes of pain, a common contributor to knee pain, are not affected by current treatment strategies. Antidepressants, such as amitriptyline, have been used to treat chronic pain in other conditions. The aim of this randomised, double blind, controlled trial, is to determine whether low dose amitriptyline reduces pain in people with painful knee osteoarthritis over 3 months compared to benztropine, an active placebo. METHODS/DESIGN One hundred and sixty people with painful radiographic knee osteoarthritis will be recruited via clinicians, local and social media advertising. Participants will be randomly allocated in a 1:1 ratio to receive either low dose amitriptyline (25 mg) or active placebo (benztropine mesylate, 1 mg) for 3 months. The primary outcome is change from baseline in knee pain (WOMAC pain subscale) at 12 weeks. Secondary outcomes include change in function (total WOMAC) and the proportion of individuals achieving a substantial response (≥ 50% reduction in pain intensity, measured by Visual Analog Scale, VAS, from no pain to worst pain imaginable, 0-100 mm) and moderate response (≥ 30% reduction in pain intensity, measured by VAS) at 12 weeks. Intention to treat analyses will be performed. Subgroup analyses will be done. DISCUSSION This study will provide high level evidence regarding the effectiveness of low dose amitriptyline compared to benztropine in reducing pain and improving function in knee OA. This trial has the potential to provide an effective new therapeutic approach for pain management in knee osteoarthritis, with the potential of ready translation into clinical practice, as it is repurposing an old drug, which is familiar to clinicians and with a well described safety record. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry prior to recruitment commencing ( ACTRN12615000301561 , March 31, 2015, amended 14 December 2018, February 2021). Additional amendment requested 18 July 2021.
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Affiliation(s)
- Anita E Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Donna M Urquhart
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew J Teichtahl
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sultana Monira Hussain
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Carolyn Arnold
- Alfred Health, Commercial Road, Melbourne, Victoria, Australia
| | - Yuanyuan Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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