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Farris M, Goodall S, De Abreu Lourenco R, Mulhern B, Manipis K, Meshcheriakova E, Lewandowska M. Estimating Australian Population Utilities for Inherited Retinal Disease Using Time Trade-Off. PHARMACOECONOMICS - OPEN 2024:10.1007/s41669-024-00515-5. [PMID: 39102180 DOI: 10.1007/s41669-024-00515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE Inherited retinal disease (IRD) causes progressive loss of visual function, degenerating towards complete blindness. Economic evaluation of gene therapies for rare forms of genetic IRDs have had to rely on health-related quality of life (HR-QoL) estimates from other diseases because there is limited data available for such a rare condition. This study aimed to estimate Australian societal-based utility values for IRD health states that can be used in cost-utility analyses (CUA) using a time trade-off (TTO) protocol adapted from a UK study. METHODS The EuroQol Valuation Technology (EQVT) protocol composite TTO (cTTO) framework was followed, which includes worse-than-death (WTD) states and quality control (QC) measures. Preferences were collected from a general population sample of 110 Australian adult participants. Five health state vignettes from the UK study which had been validated with patients and clinicians were presented randomly to participants during videoconferencing (VC) interviews with one of four interviewers. Technical and protocol feasibility were assessed in a pilot of 10 interviews. QC measures were used to monitor interviewers' performance during the study. RESULTS One participant withdrew consent. The final analysis was conducted on 109 respondents (including 4 non-traders). The average time to complete the interview was 44.2 minutes (SD 8.7). Participants reported mean visual analogue scale (VAS) scores between 63.15 for 'moderate impairment' and 17.98 for 'hand motion' to 'no light perception'. Mean health state utilities (HSU) varied between 0.76 (SD 0.26) in 'moderate impairment', and 0.20 (SD 0.58) in 'hand motion' to 'no light perception'. Of all HSU evaluations, 14% were considered WTD which most commonly occurred in the most severe visually impaired health state. CONCLUSION This study provides valuable information on HSUs across a range of IRD health states from the Australian general population perspective. The utilities obtained in this study can be used as inputs into CUA of IRD therapies.
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Affiliation(s)
- Maria Farris
- Novartis Pharmaceuticals Australia, Macquarie Park, Australia.
| | - Stephen Goodall
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Brendan Mulhern
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Kathleen Manipis
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Elena Meshcheriakova
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Milena Lewandowska
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Sydney, Australia
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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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Farrell M, Shahbazi J, Chambers M, Byrne M, Gholami J, Zahra E, Grebely J, Lintzeris N, Larance B, Ali R, Nielsen S, Dunlop A, Dore GJ, McDonough M, Montebello M, Weiss R, Rodgers C, Cook J, Degenhardt L. 96-week retention in treatment with extended-release subcutaneous buprenorphine depot injections among people with opioid dependence: Extended follow-up after a single-arm trial. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104390. [PMID: 38522175 DOI: 10.1016/j.drugpo.2024.104390] [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: 09/25/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The most recent formulation of buprenorphine treatment is extended-release depot injections (BUP-XR) that are administered subcutaneously by health care professionals. This study aimed to observe treatment outcomes of BUP-XR delivered in standard practice during a 96-week follow-up period in a community setting. METHODS This study is an extension of the CoLAB study, a prospective single-arm, multicentre, open label trial (N=100, 7 sites in Australia) among people with opioid dependence who received monthly injections of BUP-XR to evaluate the retention in treatment. Participants were followed for 96 weeks, comprising 48 weeks of the CoLAB study followed by a 48-week extension. RESULTS Of 100 participants at baseline, 47 were retained on BUP-XR at 96 weeks. The median time retained on monthly depot was 90 weeks. Heroin use (adjusted OR=0.19, P=0.012) in the month prior to baseline was associated with lower odds of retention on BUP-XR. Older age at first opioid use (adjusted OR= 1.08, P=0.009) and longer duration in OAT at baseline (adjusted OR= 1.12, P=0.001) were associated with increased retention. Prevalence of past four-weeks opioid use was estimated at 4% at 96 weeks of treatment (prevalence 0.04, 95%CI: 0.00-0.11) compared to 15% at baseline. Quality of life and medication treatment satisfaction improved over time for those retained in treatment. CONCLUSION This is one of the few studies to describe long term (96 week) retention in treatment with BUP-XR in a community setting. It displayed retention rates with 47% of participants completing 96 weeks of treatment with BUP-XR. Patient reported outcomes suggest improvements in client wellbeing. FUNDING Indivior.
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Affiliation(s)
| | | | - Mark Chambers
- National Drug and Alcohol Research Centre, UNSW, Australia
| | - Marianne Byrne
- National Drug and Alcohol Research Centre, UNSW, Australia; The Kirby Institute, UNSW, Australia
| | - Jaleh Gholami
- National Drug and Alcohol Research Centre, UNSW, Australia
| | - Emma Zahra
- National Drug and Alcohol Research Centre, UNSW, Australia
| | | | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, NSW, Australia; Drug and Alcohol Services, South East Sydney Local Health District, Surry Hills, NSW, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW, Australia; School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Robert Ali
- National Drug and Alcohol Research Centre, UNSW, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW, Australia; Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | | | - Michael McDonough
- Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia
| | - Mark Montebello
- National Drug and Alcohol Research Centre, UNSW, Australia; Discipline of Addiction Medicine, University of Sydney, NSW, Australia; Drug and Alcohol Services, North Sydney Local Health District, St Leonards, NSW, Australia
| | - Rob Weiss
- Frankston Healthcare, Frankston, Victoria, Australia
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst NSW Australia
| | - Jon Cook
- Drug and Alcohol Clinical Advisory Service, Western Health, Victoria, Australia
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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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Lebenbaum M, Hassan SA. Screening and Treatment of Posttraumatic Stress Disorder in Wildfire Evacuees: A Cost-Utility Analysis. MDM Policy Pract 2024; 9:23814683241260423. [PMID: 38904072 PMCID: PMC11189003 DOI: 10.1177/23814683241260423] [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: 02/13/2023] [Accepted: 03/24/2024] [Indexed: 06/22/2024] Open
Abstract
Background. Global climate change is resulting in dramatic increases in wildfires. Individuals exposed to wildfires experience a high burden of posttraumatic stress disorder (PTSD), and the cost-effectiveness of the treatment options to address PTSD from wildfires has not been studied. The objective of this study was to conduct a cost-utility analysis comparing screening followed by treatment with paroxetine or trauma-focused cognitive behavioral therapy (TF-CBT) versus no screening in Canadian adult wildfire evacuees. Methods. Using a Markov model, quality-adjusted life-years (QALYs) and costs were evaluated over a 5-y time horizon using health care and societal perspectives. All costs and utilities in the model were discounted at 1.5%. Probabilistic and deterministic sensitivity analyses examined the uncertainty in the incremental net monetary benefit (INMB) under a willingness-to-pay threshold of $50,000. Results. From a societal perspective, no screening (NMB = $177,641) was dominated by screening followed by treatment with paroxetine (NMB = $180,733) and TF-CBT (NMB = $181,787), with TF-CBT having the highest likelihood of being cost-effective at a willingness-to-pay threshold of $50,000 per QALY (probability = 0.649). The initial prevalence of PTSD, probability of acceptance of treatment, and costs of productivity had the largest impact on the INMB of both paroxetine or TF-CBT versus no screening. Neither intervention was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective. Interpretation. Screening followed by treatment with paroxetine or TF-CBT compared with no screening was found to be cost-saving while providing additional QALYs in wildfire evacuees. Governments should consider funding screening programs for PTSD followed by treatment with TF-CBT for wildfire evacuees. Highlights Two prior studies examined the cost-effectiveness of screening followed by treatment for PTSD among individuals exposed to other disaster-type events (i.e., terrorist attack and Hurricane Sandy) and found screening followed by treatment (i.e., cognitive behavioral therapy [CBT]) to be highly cost-effective.Among wildfire evacuees, screening followed by treatment with paroxetine or trauma-focused (TF)-CBT provides additional quality-adjusted life-years (QALYs) and is cost-saving from a societal perspective. TF-CBT was the treatment option found most likely to be cost-effective.Neither treatment option was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective.Screening programs for PTSD should be considered for wildfire evacuees, and individuals diagnosed with PTSD could be prescribed either TF-CBT or paroxetine depending on their preference and resources availability.
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Affiliation(s)
- Michael Lebenbaum
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
- Canadian Centre for Health Economics, Toronto, ON, Canada
- Center for Demography of Health and Aging, University of Wisconsin–Madison, Madison, WI, USA
| | - S. Ahmed Hassan
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
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Taylor K, Ratcliffe J, Bessarab D, Smith K. Valuing indigenous quality of life: A review of preference-based quality of life instruments and elicitation techniques with global older indigenous populations. Soc Sci Med 2023; 336:116271. [PMID: 37806146 DOI: 10.1016/j.socscimed.2023.116271] [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: 03/17/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023]
Abstract
Indigenous perspectives of quality of life (QoL) are different to that of non-Indigenous populations. Determining how to identify and value what is important to QoL for people from diverse cultural backgrounds is crucial for assessing effective outcomes for quality assessment and health economic evaluation to guide evidence-based decision making. This is particularly important for older Indigenous people who have complex care and support needs within health and aged-care systems. This scoping review aims to assess the existing literature in this field by firstly identifying preference based instruments that have been applied with older Indigenous peoples and secondly, exploring the extent to which existing preference based instruments applied with older Indigenous peoples encompass older Indigenous peoples QoL perspectives in their design and application. The inclusion criteria for the review were studies using preference based QoL instruments with an Indigenous population where the cohort was aged 50 years or over. This resulted in the critical analysis of 12 studies. The review identified that preference based QoL instruments have rarely been applied to date with older Indigenous populations with most instruments found to be designed for non-Indigenous adults. Typically, instruments have not incorporated Indigenous worldviews of QoL into either the content of the descriptive system or the elicitation techniques and corresponding value sets generated. To encapsulate Indigenous cultural perspectives accurately in economic evaluation, further research is required as to how QoL domains in preference based instruments for Indigenous peoples can be reflective of Indigenous perspectives. It is imperative that the QoL preferences of older Indigenous peoples are adequately captured within preference based QoL instruments applied with this population.
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Affiliation(s)
- Kevin Taylor
- Good Spirit Good Life Centre of Research Excellence, Centre for Aboriginal Medical and Dental Health, University of Western Australia, M303, 35 Stirling Hwy Crawley, 6004, Perth, Western Australia, Australia; School of Indigenous Studies, University of Western Australia, M303, 35 Stirling Hwy Crawley, 6004, Perth, Western Australia, Australia.
| | - Julie Ratcliffe
- Good Spirit Good Life Centre of Research Excellence, Centre for Aboriginal Medical and Dental Health, University of Western Australia, M303, 35 Stirling Hwy Crawley, 6004, Perth, Western Australia, Australia; Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt North (N206), GPO Box 2100, Adelaide, 5001, South Australia, Australia.
| | - Dawn Bessarab
- Good Spirit Good Life Centre of Research Excellence, Centre for Aboriginal Medical and Dental Health, University of Western Australia, M303, 35 Stirling Hwy Crawley, 6004, Perth, Western Australia, Australia; Centre for Aboriginal Medical and Dental Health, Medical School, University of Western Australian, M303, 35 Stirling Hwy Crawley, 6004, Perth, Western Australia, Australia.
| | - Kate Smith
- Good Spirit Good Life Centre of Research Excellence, Centre for Aboriginal Medical and Dental Health, University of Western Australia, M303, 35 Stirling Hwy Crawley, 6004, Perth, Western Australia, Australia; Centre for Aboriginal Medical and Dental Health, Medical School, University of Western Australian, M303, 35 Stirling Hwy Crawley, 6004, Perth, Western Australia, Australia.
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Koh U, Cust AE, Fernández-Peñas P, Mann G, Morton R, Wolfe R, Payne E, Horsham C, Kwaan G, Mahumud RA, Sashindranath M, Soyer HP, Mar V, Janda M. ACEMID cohort study: protocol of a prospective cohort study using 3D total body photography for melanoma imaging and diagnosis. BMJ Open 2023; 13:e072788. [PMID: 37770274 PMCID: PMC10546123 DOI: 10.1136/bmjopen-2023-072788] [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: 02/15/2023] [Accepted: 08/20/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Three-dimensional (3D) total body photography may improve early detection of melanoma and facilitate surveillance, leading to better prognosis and lower healthcare costs. The Australian Centre of Excellence in Melanoma Imaging and Diagnosis (ACEMID) cohort study will assess long-term outcomes from delivery of a precision strategy of monitoring skin lesions using skin surface imaging technology embedded into health services across Australia. METHODS AND ANALYSIS A prospective cohort study will enrol 15 000 participants aged 18 years and above, across 15 Australian sites. Participants will attend study visits according to their melanoma risk category: very high risk, high risk or low/average risk, every 6, 12 and 24 months, respectively, over 3 years. Participants will undergo 3D total body photography and dermoscopy imaging at study visits. A baseline questionnaire will be administered to collect sociodemographic, phenotypic, quality of life and sun behaviour data. A follow-up questionnaire will be administered every 12 months to obtain changes in sun behaviour and quality of life. A saliva sample will be collected at the baseline visit from a subsample. ETHICS AND DISSEMINATION The ACEMID cohort study was approved by the Metro South Health Human Research Ethics Committee (approval number: HREC/2019/QMS/57206) and the University of Queensland Human Research Ethics Committee (approval number: 2019003077). The findings will be reported through peer-reviewed and lay publications and presentations at conferences. TRIAL REGISTRATION NUMBER ACTRN12619001706167.
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Affiliation(s)
- Uyen Koh
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Anne E Cust
- The Daffodil Centre (A Joint Venture with Cancer Council NSW), The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Pablo Fernández-Peñas
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Graham Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rachael Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth Payne
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Grace Kwaan
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Rashidul Alam Mahumud
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Maithili Sashindranath
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hans Peter Soyer
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Smith AB, Cooper S, Hanning J, Buckley C. The humanistic and economic burden of work-related musculoskeletal pain: a cross-sectional survey of workers in the United Kingdom. BMC Res Notes 2023; 16:186. [PMID: 37620927 PMCID: PMC10463619 DOI: 10.1186/s13104-023-06461-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of work-related musculoskeletal (MSK) lower body pain on health-related quality of life (HRQoL) and work productivity in a large sample of workers in the United Kingdom, as well as evaluating the potential economic impact of MSK pain. METHODS Participants with self-reported work-related MSK pain were recruited from an online panel maintained by a third party (Qualtrics LLC). Participants completed three validated instruments online: the Brief Pain Inventory (BPI), the Assessment of Quality of Life Instrument (AQoL-4D), and the 6-item Work Productivity and Activity Impairment Questionnaire (WPAI). Sociodemographic details, work patterns and healthcare resource utilisation were also reported. One-way analysis of variance (ANOVA) and t-tests were used to explore differences between variables. Linear regression was applied to determine the impact of work-related MSK pain on HRQoL. RESULTS All 1035 recruited participants completed the survey (57.4% female; mean age 43.4 years). Participants reported spending all (25.2%) or most (53%) of their time at work on their feet. Mean pain severity was 4.63 (standard deviation: 2.07); mean pain interference was 4.37 (2.49). There was a linear relationship between length of shift, time on feet and pain. Mean AQoL-4D scores were 0.609 (0.254). A mean of 4.12 h was lost per week due to pain. Absenteeism (last 7 days) was 9.5% (20.7%), and presenteeism 33.3% (24.9%). An average 1.55 visits were made to family practitioners (total cost: £19,866) and 1 hospital visit (£37,320) due to work-related MSK pain. CONCLUSION This study demonstrated that work-related lower body pain has a significant impact in terms of individual HRQoL and as an economic societal burden.
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Le LKD, Flego A, Krysinska K, Andriessen K, Bandara P, Page A, Schlichthorst M, Pirkis J, Mihalopoulos C, Carter G, Reifels L. Modelling the cost-effectiveness of brief aftercare interventions following hospital-treated self-harm. BJPsych Open 2023; 9:e139. [PMID: 37525591 PMCID: PMC10486225 DOI: 10.1192/bjo.2023.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Prior self-harm represents the most significant risk factor for future self-harm or suicide. AIM To evaluate the cost-effectiveness of a theoretical brief aftercare intervention (involving brief follow-up contact, care coordination and safety planning), following a hospital-treated self-harm episode, for reducing repeated self-harm within the Australian context. METHOD We employed economic modelling techniques to undertake: (a) a return-on-investment analysis, which compared the cost-savings generated by the intervention with the overall cost of implementing the intervention; and (b) a cost-utility analysis, which compared the net costs of the intervention with health outcomes measured in quality-adjusted life years (QALYs). We considered cost offsets associated with hospital admission for self-harm and the cost of suicide over a period of 10 years in the base case analysis. Uncertainty and one-way sensitivity analyses were also conducted. RESULTS The brief aftercare intervention resulted in net cost-savings of AUD$7.5 M (95% uncertainty interval: -56.2 M to 15.1 M) and was associated with a gain of 222 (95% uncertainty interval: 45 to 563) QALYs over a 10-year period. The estimated return-on-investment ratio for the intervention's modelled cost in relation to cost-savings was 1.58 (95% uncertainty interval: -0.17 to 5.33). Eighty-seven per cent of uncertainty iterations showed that the intervention could be considered cost-effective, either through cost-savings or with an acceptable cost-effectiveness ratio of 50 000 per QALY gained. The results remained robust across sensitivity analyses. CONCLUSIONS A theoretical brief aftercare intervention is highly likely to be cost-effective for preventing suicide and self-harm among individuals with a history of self-harm.
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Affiliation(s)
- Long Khanh-Dao Le
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anna Flego
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Cathrine Mihalopoulos
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Greg Carter
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
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Bryant R, Dawson K, Azevedo S, Yadav S, Tran J, Choi-Christou J, Andrew E, Beames J, Keyan D. Positive affect training to reduce mental health problems during the COVID-19 pandemic: a proof-of-concept randomised clinical trial. BMJ MENTAL HEALTH 2023; 26:e300737. [PMID: 37385663 PMCID: PMC10577780 DOI: 10.1136/bmjment-2023-300737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The social restrictions occurring during the pandemic contributed to loss of many sources of reward, which contributes to poor mental health. OBJECTIVE This trial evaluated a brief positive affect training programme to reduce anxiety, depression and suicidality during the pandemic. METHODS In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-19-related psychological distress across Australia were randomly allocated to either a 6-session group-based programme based on positive affect training (n=87) or enhanced usual care (EUC, n=87). Primary outcome was total score on the Hospital Anxiety and Depression Scale-anxiety and depression subscales assessed at baseline, 1-week post-treatment, 3 months (primary outcome time point) as well as secondary outcome measures of suicidality, generalised anxiety disorder, sleep impairment, positive and negative mood and COVID-19-related stress. FINDINGS Between 20 September 2020 and 16 September 2021, 174 participants were enrolled into the trial. Relative to EUC, at 3-month follow-up the intervention led to greater reduction on depression (mean difference 1.2 (95% CI 0.4 to 1.9)), p=0.003), with a moderate effect size (0.5 (95% CI 0.2 to 0.9)). There were also greater reduction of suicidality and improvement in quality of life. There were no differences in anxiety, generalised anxiety, anhedonia, sleep impairment, positive or negative mood or COVID-19 concerns. CONCLUSIONS This intervention was able to reduce depression and suicidality during adverse experiences when rewarding events were diminished, such as pandemics. CLINICAL IMPLICATIONS Strategies to improve positive affect may be useful to reduce mental health issues. TRIAL REGISTRATION NUMBER ACTRN12620000811909.
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Affiliation(s)
- Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Katie Dawson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanna Azevedo
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Srishti Yadav
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmine Choi-Christou
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Elpiniki Andrew
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Joanne Beames
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Dharani Keyan
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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Ross MH, Prguda E, Setchell J. Exploring the Experiences of Australian Veterans with Accessing Healthcare: A Qualitative Study. JOURNAL OF VETERANS STUDIES 2023. [DOI: 10.21061/jvs.v9i1.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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12
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Plaza A, Paratz J, Cottrell M. A six-week physical therapy exercise program delivered via home-based telerehabilitation is comparable to in-person programs for patients with burn injuries: A randomized, controlled, non-inferiority clinical pilot trial. Burns 2023; 49:55-67. [PMID: 36115795 DOI: 10.1016/j.burns.2022.08.014] [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: 02/06/2022] [Revised: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Exercise programmes are essential for burn rehabilitation, however patients often have barriers accessing these services. Home-based telerehabilitation (HBT) may be an alternative. This study aimed to determine if exercise programs delivered via HBT were as effective as in-person (IP) programs with respect to clinical outcomes and participant and therapist satisfaction. METHODS A single center, randomized, controlled, non-inferiority pilot trial with blinded assessment was undertaken. Forty-five adults with ≤ 25% total body surface area (TBSA) burns were randomized to receive a 6-week exercise program delivered either by HBT or IP. The primary outcome was burn-specific quality of life (Burn Specific Health Scale - Brief). Secondary outcomes included health-related quality of life, burn scar-specific outcomes, exercise self-efficacy, pain severity, muscle strength and range of motion (ROM). Participant and therapist satisfaction, technical disruptions and adverse events were also recorded. RESULTS We found no significant within- or between-group differences for any outcome measures except ROM. Achievement of full ROM was significantly different between groups at Week 12 (IP=100% vs HBT=70%, p = 0.005). Non-inferiority was inconclusive. Participant satisfaction was high (median ≥ 9.8/10), with no significant between-group differences. Therapist satisfaction was high (median ≥ 8.9/10), major technical disruptions low (8%) and no adverse events reported. CONCLUSION HBT is a safe, effective option to deliver exercise programs for patients with burn injuries ≤ 25% TBSA with comparable clinical outcomes to in-person programmes. Ongoing research is required to further analyze ROM and investigate the effectiveness of HBT for patients with larger burns.
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Affiliation(s)
- Anita Plaza
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia; Professor Stuart Pegg Adult Burn Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.
| | - Jennifer Paratz
- Physiotherapy Department, Griffith University, Brisbane, QLD 4222, Australia
| | - Michelle Cottrell
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
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13
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Long-term benefits for lower socioeconomic groups by improving bowel screening participation in South Australia: A modelling study. PLoS One 2022; 17:e0279177. [PMID: 36542644 PMCID: PMC9770333 DOI: 10.1371/journal.pone.0279177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The gap in bowel cancer screening participation rates between the lowest socioeconomic position (SEP) groups and the highest in Australia is widening. This study estimates the long-term health impacts and healthcare costs at current colorectal cancer (CRC) screening participation rates by SEP in South Australia (SA). METHODS A Markov microsimulation model for each socioeconomic quintile in SA estimated health outcomes over the lifetime of a population aged 50-74 years (total n = 513,000). The model simulated the development of CRC, considering participation rates in the National Bowel Cancer Screening Program and estimated numbers of cases of CRC, CRC deaths, adenomas detected, mean costs of screening and treatment, and quality adjusted life years. Screened status, stage of diagnosis and survival were obtained for patients diagnosed with CRC in 2006-2013 using data linked to the SA Cancer Registry. RESULTS We predict 10915 cases of CRC (95%CI: 8017─13812) in the lowest quintile (Q1), 17% more than the highest quintile (Q5) and 3265 CRC deaths (95%CI: 2120─4410) in Q1, 24% more than Q5. Average costs per person, were 29% higher in Q1 at $11997 ($8754─$15240) compared to Q5 $9281 ($6555─$12007). When substituting Q1 screening and diagnostic testing rates with Q5's, 17% more colonoscopies occur and adenomas and cancers detected increase by 102% in Q1. CONCLUSION Inequalities were evident in CRC cases and deaths, as well as adenomas and cancers that could be detected earlier. Implementing programs to increase screening uptake and follow-up tests for lower socioeconomic groups is critical to improve the health of these priority population groups.
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14
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Engel L, Brijnath B, Chong TWH, Hills D, Hjorth L, Loi S, Majmudar I, Mihalopoulos C, Gerber K. Quality of life and loneliness post-bereavement: Results from a nationwide survey of bereaved older adults. DEATH STUDIES 2022:1-12. [PMID: 36527685 DOI: 10.1080/07481187.2022.2155887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Older people experience bereavements more often than any other age group. National survey data collected across Australia from 633 bereaved adults aged 65+ years showed that 21% met the criteria for prolonged grief. Their quality of life was significantly lower and loneliness significantly higher compared to older people in the general population. Risk factors for the low quality of life and high loneliness post-bereavement included being female, experiencing the death of a partner, and being the full-time carer of the deceased. Time since bereavement, expectedness, and cause of death were not significantly associated with quality of life and loneliness.
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Affiliation(s)
- Lidia Engel
- Monash University, Melbourne, Australia
- National Ageing Research Institute, Parkville, Australia
| | - Bianca Brijnath
- National Ageing Research Institute, Parkville, Australia
- Curtin University, Perth, Australia
- University of Western Australia, Perth, Australia
| | - Terence W H Chong
- The University of Melbourne, Parkville, Australia
- St. Vincent's Hospital Melbourne, Kew, Australia
- The Royal Melbourne Hospital, Parkville, Australia
| | - Danny Hills
- Federation University Australia, Brisbane, Australia
| | | | - Samantha Loi
- The University of Melbourne, Parkville, Australia
- The Royal Melbourne Hospital, Parkville, Australia
| | | | | | - Katrin Gerber
- National Ageing Research Institute, Parkville, Australia
- The University of Melbourne, Parkville, Australia
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15
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Gao L, Moodie M. Offering a lifestyle intervention to women of premenopausal age as primary prevention for cardiovascular disease? - assessing its cost-effectiveness. Int J Behav Nutr Phys Act 2022; 19:152. [PMID: 36517831 PMCID: PMC9749355 DOI: 10.1186/s12966-022-01384-z] [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: 09/02/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is limited evidence of cost-effective primary prevention interventions for cardiovascular disease (CVD) in young women. This study aimed to assess the value for money of primary prevention of CVD in this population. METHODS A Markov microsimulation model consisting of both first-ever and recurrent CVD events was developed to simulate the lifetime intervention impact on cost and health outcomes in women of premenopausal age (30 to 54 years) from the Australian healthcare system perspective. The latest wave of the Australian National Health Survey defined the modelled population's characteristics. The intervention effectiveness of a lifestyle modification program involving changes in diet and physical activity demonstrated to be effective in this population was sourced from a systematic review and meta-analysis. The first-ever and recurrent CVD probabilities were derived from the CVD risk calculators accounting for socio-demographic and clinical characteristics. Costs and utility weights associated with CVD events and long-term management post-CVD were informed by national statistics/published literature. Sensitivity analyses were undertaken to examine the robustness of base case results. RESULTS The lifestyle modification program was associated with both higher costs and benefits (in terms of quality-adjusted life years, QALYs) as a primary prevention measure of CVD in premenopausal women, with an ICER of $96,377/QALY or $130,469/LY. The intervention led to fewer first-ever (N = -19) and recurrent CVD events (N = -23) per 10,000 women over the modelled life horizon. The avoided cost due to reduced hospitalisations (-$24) and management (-$164) of CVD could partially offset the cost associated with the intervention ($1560). Sensitivity analysis indicated that time horizon, starting age of the intervention, discount rate, and intervention effectiveness were the key drivers of the results. If the intervention was scaled up to the national level (N = 502,095 at-risk premenopausal women), the total intervention cost would be $794 million with $95 million in healthcare cost-savings. CONCLUSION Offering a lifestyle modification program to premenopausal women in Australia as primary prevention of CVD is not cost-effective from a healthcare system perspective. We should continue to search for new or adapt/optimise existing effective and cost-effective primary prevention measures of CVD for women.
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Affiliation(s)
- Lan Gao
- grid.1021.20000 0001 0526 7079Deakin Health Economics, Institute for Health Transformation, School of Health & Social Development, Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood, Melbourne, Australia
| | - Marj Moodie
- grid.1021.20000 0001 0526 7079Deakin Health Economics, Institute for Health Transformation, School of Health & Social Development, Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood, Melbourne, Australia
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16
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Freene N, Wallett H, Flynn A, Preston E, Cowans S, Lueck C, Niyonsenga T, Mohanty I, Davey R. Cardiovascular Rehabilitation for transient ischaemic Attack and Mild Stroke: the CRAMS effectiveness-implementation hybrid study protocol. BMC Health Serv Res 2022; 22:1391. [PMID: 36419153 PMCID: PMC9682670 DOI: 10.1186/s12913-022-08797-3] [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: 10/03/2022] [Accepted: 11/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Internationally, stroke and cardiac rehabilitation clinicians agree that current cardiac rehabilitation models are a suitable secondary prevention program for people following a transient ischaemic attack (TIA) or mild stroke. There is strong evidence for exercise-based cardiac rehabilitation in people with heart disease, however, the evidence for cardiac rehabilitation post-TIA or stroke is limited. Here we will explore the effectiveness and implementation of an integrated (TIA, mild stroke, heart disease) traditional exercise-based cardiovascular rehabilitation (CVR) program for people with TIA or mild stroke over 6-months. METHODS This type 1 effectiveness-implementation hybrid study will use a 2-arm single-centre assessor-blind randomised controlled trial design, recruiting 140 participants. Adults who have had a TIA or mild stroke in the last 12-months will be recruited by health professionals from hospital and primary healthcare services. Participants will be assessed and randomly allocated (1:1) to the 6-week CVR program or the usual care 6-month wait-list control group. Distance completed in the 6-min walk test will be the primary effectiveness outcome, with outcomes collected at baseline, 6-weeks (complete CVR) and 6-months in both groups. Other effectiveness outcome measures include unplanned cardiovascular disease-related emergency department and hospital admissions, daily minutes of accelerometer moderate-to-vigorous physical activity, body mass index, waist circumference, blood pressure, quality of life, anxiety and depression. Implementation outcomes will be assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, including a cost-effectiveness analysis. Semi-structured interviews will be conducted with participants and CVR program health professionals, investigating the acceptability, value, and impact of the CVR program. Qualitative analyses will be guided by the Consolidated Framework for Implementation Research. DISCUSSION Few studies have assessed the effectiveness of cardiac rehabilitation for people with TIA and mild stroke, and no studies appear to have investigated the cost-effectiveness or implementation determinants of such programs. If successful, the CVR program will improve health outcomes and quality of life of people who have had a TIA or mild stroke, guiding future research, policy, and clinical practice, reducing the risk of repeat heart attacks and strokes for this population. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621001586808 , Registered 19 November 2021.
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Affiliation(s)
- Nicole Freene
- grid.1039.b0000 0004 0385 7472Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT Australia ,grid.1039.b0000 0004 0385 7472Health Research Institute, University of Canberra, Bruce, ACT Australia
| | - Hannah Wallett
- grid.1039.b0000 0004 0385 7472Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT Australia
| | - Allyson Flynn
- grid.1039.b0000 0004 0385 7472Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT Australia
| | - Elisabeth Preston
- grid.1039.b0000 0004 0385 7472Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT Australia
| | - Shahla Cowans
- Neurology, Canberra Health Services, Garran, ACT Australia
| | | | - Theophile Niyonsenga
- grid.1039.b0000 0004 0385 7472Health Research Institute, University of Canberra, Bruce, ACT Australia
| | - Itismita Mohanty
- grid.1039.b0000 0004 0385 7472Health Research Institute, University of Canberra, Bruce, ACT Australia
| | - Rachel Davey
- grid.1039.b0000 0004 0385 7472Health Research Institute, University of Canberra, Bruce, ACT Australia
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17
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Robinson ES, Cyarto E, Ogrin R, Green M, Lowthian JA. Quality of life of older Australians receiving home nursing services for complex care needs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6091-e6101. [PMID: 36200317 DOI: 10.1111/hsc.14046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/04/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Older Australians may live up to 10 years in ill health, most likely chronic disease-related. Those with multimorbidity report more healthcare visits, poorer health and take more medications compared with people with a single chronic disease. They are also at higher risk of hospital admission and poor quality of life. People living with multimorbidity are considered to have "complex care" needs. A person-centred approach to healthcare has led to increasing use of in-home nursing support, enabling older people to receive care at home. Our prospective observational study describes the profile and management of home-based care for older people with complex care needs and examines changes in their quality of life over 12 months. Routinely collected data were analysed, including demographics, medical history, medications and the visit activity of staff providing care to participants. Additional health-related quality of life and hospitalisation data were collected via quarterly surveys and analysed. Fifty-two participants (mean age 76.6 years, 54% female) with an average of eight diagnosed health conditions, received an average of four home care visits per week. Almost half the participants were hospitalised once during the 12-month period and experienced a significant decline in overall quality of life and in the dimensions measuring independent living and relationships over the study period. If ageing in place with good quality of life is to be realised by older adults with multimorbidity, support services including home nursing need to consider both the biomedical and social determinants perspectives when addressing health and social care needs.
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Affiliation(s)
| | - Elizabeth Cyarto
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Rajna Ogrin
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Department of Business Strategy and Innovation, Griffith University, Nathan, Queensland, Australia
| | - Maja Green
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
| | - Judy A Lowthian
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- School of Public Health & Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
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18
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Archibald AD, McClaren BJ, Caruana J, Tutty E, King EA, Halliday JL, Best S, Kanga-Parabia A, Bennetts BH, Cliffe CC, Madelli EO, Ho G, Liebelt J, Long JC, Braithwaite J, Kennedy J, Massie J, Emery JD, McGaughran J, Marum JE, Boggs K, Barlow-Stewart K, Burnett L, Dive L, Freeman L, Davis MR, Downes MJ, Wallis M, Ferrie MM, Pachter N, Scuffham PA, Casella R, Allcock RJN, Ong R, Edwards S, Righetti S, Lunke S, Lewis S, Walker SP, Boughtwood TF, Hardy T, Newson AJ, Kirk EP, Laing NG, Delatycki MB. The Australian Reproductive Genetic Carrier Screening Project (Mackenzie's Mission): Design and Implementation. J Pers Med 2022; 12:1781. [PMID: 36579509 PMCID: PMC9698511 DOI: 10.3390/jpm12111781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 01/01/2023] Open
Abstract
Reproductive genetic carrier screening (RGCS) provides people with information about their chance of having children with autosomal recessive or X-linked genetic conditions, enabling informed reproductive decision-making. RGCS is recommended to be offered to all couples during preconception or in early pregnancy. However, cost and a lack of awareness may prevent access. To address this, the Australian Government funded Mackenzie’s Mission—the Australian Reproductive Genetic Carrier Screening Project. Mackenzie’s Mission aims to assess the acceptability and feasibility of an easily accessible RGCS program, provided free of charge to the participant. In study Phase 1, implementation needs were mapped, and key study elements were developed. In Phase 2, RGCS is being offered by healthcare providers educated by the study team. Reproductive couples who provide consent are screened for over 1200 genes associated with >750 serious, childhood-onset genetic conditions. Those with an increased chance result are provided comprehensive genetic counseling support. Reproductive couples, recruiting healthcare providers, and study team members are also invited to complete surveys and/or interviews. In Phase 3, a mixed-methods analysis will be undertaken to assess the program outcomes, psychosocial implications and implementation considerations alongside an ongoing bioethical analysis and a health economic evaluation. Findings will inform the implementation of an ethically robust RGCS program.
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Affiliation(s)
- Alison D. Archibald
- Victorian Clinical Genetics Services, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Belinda J. McClaren
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Jade Caruana
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Australian Genomics, Parkville, VIC 3052, Australia
| | - Erin Tutty
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Emily A. King
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
- Bruce Lefroy Centre, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Jane L. Halliday
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Stephanie Best
- Australian Genomics, Parkville, VIC 3052, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Anaita Kanga-Parabia
- Victorian Clinical Genetics Services, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Bruce H. Bennetts
- Sydney Genome Diagnostics, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Specialty of Genomic Medicine, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Corrina C. Cliffe
- NSW Health Pathology Randwick Genomics Laboratory, Randwick, NSW 2031, Australia
| | - Evanthia O. Madelli
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Australian Genomics, Parkville, VIC 3052, Australia
| | - Gladys Ho
- Sydney Genome Diagnostics, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Specialty of Genomic Medicine, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Jan Liebelt
- South Australian Clinical Genetics Service, North Adelaide, SA 5006, Australia
- Women’s and Children’s Hospital, North Adelaide, SA 5006, Australia
- Repromed, Dulwich, SA 5065, Australia
| | - Janet C. Long
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Genomics, Parkville, VIC 3052, Australia
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
- International Society for Quality in Health Care, D02 YY23 Dublin, Ireland
| | - Jillian Kennedy
- Genetic Services of Western Australia, Subiaco, WA 6008, Australia
| | - John Massie
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
- Department of Respiratory Medicine, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Jon D. Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Julie McGaughran
- Genetic Health Queensland, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia
- School of Medicine, University of Queensland, St Lucia, QLD 4072, Australia
| | - Justine E. Marum
- Victorian Clinical Genetics Services, Parkville, VIC 3052, Australia
| | - Kirsten Boggs
- Australian Genomics, Parkville, VIC 3052, Australia
- Centre for Clinical Genetics, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Department of Clinical Genetics, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Leslie Burnett
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
- St Vincent’s Clinical School, University of New South Wales, Darlinghurst, NSW 2010, Australia
- Invitae Australia, Alexandria, NSW 2015, Australia
| | - Lisa Dive
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Lucinda Freeman
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
- School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW 2031, Australia
| | - Mark R. Davis
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Nedlands, WA 6009, Australia
- Centre for Medical Research, University of Western Australia, Nedlands, WA 6009, Australia
| | - Martin J. Downes
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD 4111, Australia
| | - Mathew Wallis
- Tasmanian Clinical Genetics Service, Tasmanian Health Service, Hobart, TAS 7000, Australia
- School of Medicine and Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Monica M. Ferrie
- Victorian Clinical Genetics Services, Parkville, VIC 3052, Australia
- Genetic Support Network of Victoria, Parkville, VIC 3052, Australia
| | - Nicholas Pachter
- Genetic Services of Western Australia, Subiaco, WA 6008, Australia
- King Edward Memorial Hospital, Subiaco, WA 6008, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Paul A. Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD 4111, Australia
| | | | - Richard J. N. Allcock
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Nedlands, WA 6009, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia
| | - Royston Ong
- Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia
| | - Samantha Edwards
- Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia
| | - Sarah Righetti
- Centre for Clinical Genetics, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW 2031, Australia
| | - Sebastian Lunke
- Victorian Clinical Genetics Services, Parkville, VIC 3052, Australia
- Department of Pathology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Sharon Lewis
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Susan P. Walker
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Tiffany F. Boughtwood
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Australian Genomics, Parkville, VIC 3052, Australia
| | - Tristan Hardy
- Monash IVF Group, Richmond, VIC 3121, Australia
- SA Pathology, Adelaide, SA 5000, Australia
| | - Ainsley J. Newson
- Australian Genomics, Parkville, VIC 3052, Australia
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Edwin P. Kirk
- NSW Health Pathology Randwick Genomics Laboratory, Randwick, NSW 2031, Australia
- Centre for Clinical Genetics, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW 2031, Australia
| | - Nigel G. Laing
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Nedlands, WA 6009, Australia
- Centre for Medical Research, University of Western Australia, Nedlands, WA 6009, Australia
- Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia
| | - Martin B. Delatycki
- Victorian Clinical Genetics Services, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
- Bruce Lefroy Centre, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
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19
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Flego A, Reifels L, Mihalopoulos C, Bandara P, Page A, Fox T, Skehan J, Hill NTM, Krysinska K, Andriessen K, Schlichthorst M, Pirkis J, Le LK. Cost-effectiveness of media reporting guidelines for the prevention of suicide. Suicide Life Threat Behav 2022; 52:1048-1057. [PMID: 36106404 PMCID: PMC9825953 DOI: 10.1111/sltb.12902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/14/2022] [Accepted: 06/21/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Media guidelines for the responsible reporting of suicide are a recognized universal suicide prevention intervention. While implemented in numerous countries, including Australia, little is known about whether they are cost-effective. We aimed to determine the cost-effectiveness of Mindframe, the national initiative implementing media guidelines in Australia. METHOD We conducted a modelled economic evaluation (5-year time-horizon) incorporating two types of economic analysis: (i) return-on-investment (ROI) comparing estimated cost savings from the intervention to the total intervention cost, and (ii) cost-effectiveness analysis comparing the net intervention costs to health outcomes: suicide deaths prevented and quality-adjusted life-years (QALYs). We also included uncertainty analyses to propagate parameter uncertainty and sensitivity analyses to test the robustness of the model outputs to changes in input parameters and assumptions. RESULTS The estimated ROI ratio for the main analysis was 94:1 (95% uncertainty interval [UI]: 37 to 170). The intervention was associated with cost savings of A$596M (95% UI: A$228M to A$1,081M), 139 (95% UI: 55 to 252) suicides prevented and 107 (95% UI: 42 to 192) QALYs gained. The intervention was dominant, or cost-saving, compared with no intervention with results being robust to sensitivity analysis but varying based on the conservativeness of the parameters entered. CONCLUSION Mindframe was found to be cost-saving, and therefore, worthy of investment and inclusion as part of national suicide prevention strategies.
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Affiliation(s)
- Anna Flego
- Centre for Mental Health, Melbourne School of Population and Global HealthThe University of MelbourneAustralia
| | - Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global HealthThe University of MelbourneAustralia
| | - Cathrine Mihalopoulos
- Health Economics Division, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney UniversityNSWAustralia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney UniversityNSWAustralia
| | | | - Jaelea Skehan
- EverymindNSWAustralia,School of Medicine and Public HealthUniversity of NewcastleAustralia
| | - Nicole T. M. Hill
- Telethon Kids InstituteWestern Australia,University of Western AustraliaWestern Australia
| | - Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global HealthThe University of MelbourneAustralia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global HealthThe University of MelbourneAustralia
| | - Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global HealthThe University of MelbourneAustralia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global HealthThe University of MelbourneAustralia
| | - Long Khanh‐Dao Le
- Health Economics Division, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
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20
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Ngo PJ, Wade S, Banks E, Karikios DJ, Canfell K, Weber MF. Large-Scale Population-Based Surveys Linked to Administrative Health Databases as a Source of Data on Health Utilities in Australia. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1634-1643. [PMID: 35527166 DOI: 10.1016/j.jval.2022.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/09/2022] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Large-scale health surveys that contain quality-of-life instruments are a rich source of health utility data for health economic evaluations, especially when linked to routinely collected, administrative health databases. We derived health utility values for a wide range of health conditions using a large Australian cohort study linked to population-wide health databases. METHODS Short-Form 6-Dimension utility values were calculated for 56 094 adults, aged 47+ years, in the New South Wales 45 and Up Study who completed the Social, Economic, and Environmental Factors survey (2010-2011). Mean utilities were summarized for major health conditions identified through self-report, hospital records, primary cancer notifications, and claims for government-subsidized prescription medicines and medical services. To identify unique associations between health conditions and utilities, beta regression was performed. Utility values were analyzed by time to death using linked death records. RESULTS Mean Short-Form 6-Dimension utility was 0.810 (95% confidence interval [CI] 0.809-0.811), was age dependent, and was higher in men than women. Utilities for serious health conditions ranged from 0.685 (95% CI 0.652-0.718) for lung cancer to 0.800 (95% CI 0.787-0.812) for melanoma whereas disease-free respondents had a mean of 0.859 (95% CI 0.858-0.861). Most health conditions were independently associated with poorer quality of life. Utility values also declined by proximity to death where participants sampled 6 months before death had a mean score of 0.637 (95% CI 0.613-0.662). CONCLUSIONS Our data offer a snapshot of the health status of an older Australian population and show that record linkage can enable comprehensive ascertainment of utility values for use in health economic modeling.
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Affiliation(s)
- Preston J Ngo
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.
| | - Stephen Wade
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Deme J Karikios
- Nepean Cancer Care Centre, Nepean Hospital, Kingswood, NSW, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Marianne F Weber
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
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21
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Tjahjono R, Salati H, Inthavong K, Singh N. Correlation of Nasal Mucosal Temperature and Nasal Patency—A Computational Fluid Dynamics Study. Laryngoscope 2022; 133:1328-1335. [PMID: 37158263 DOI: 10.1002/lary.30327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/06/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Recent evidence suggests that detection of nasal mucosal temperature, rather than direct airflow detection, is the primary determinant of subjective nasal patency. This study examines the role of nasal mucosal temperature in the perception of nasal patency using in vivo and computational fluid dynamics (CFD) measurements. METHODS Healthy adult participants completed Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scale (VAS) questionnaires. A temperature probe measured nasal mucosal temperature at the vestibule, inferior turbinate, middle turbinate, and nasopharynx bilaterally. Participants underwent a CT scan, used to create a 3D nasal anatomy model to perform CFD analysis of nasal mucosal and inspired air temperature and heat flux along with mucosal surface area where heat flux >50 W/m2 (SAHF50). RESULTS Eleven participants with a median age of 27 (IQR 24; 48) were recruited. Probe-measured temperature values correlated strongly with CFD-derived values (r = 0.87, p < 0.05). Correlations were seen anteriorly in the vestibule and inferior turbinate regions between nasal mucosal temperature and unilateral VAS (r = 0.42-0.46; p < 0.05), between SAHF50 and unilateral VAS (r = -0.31 to -0.36; p < 0.05) and between nasal mucosal temperature and SAHF50 (r = -0.37 to -0.41; p < 0.05). Subjects with high patency (VAS ≤10) had increased heat flux anteriorly compared with lower patency subjects (VAS >10; p < 0.05). CONCLUSION Lower nasal mucosal temperature and higher heat flux within the anterior nasal cavity correlates with a perception of improved unilateral nasal patency in healthy individuals. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1328-1335, 2023.
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Affiliation(s)
- Richard Tjahjono
- Department of Otolaryngology Head and Neck Surgery Westmead Hospital Sydney New South Wales Australia
- Sydney Medical School, University of Sydney Sydney New South Wales Australia
| | - Hana Salati
- Faculty of Engineering RMIT University Melbourne Victoria Australia
| | - Kiao Inthavong
- Faculty of Engineering RMIT University Melbourne Victoria Australia
| | - Narinder Singh
- Department of Otolaryngology Head and Neck Surgery Westmead Hospital Sydney New South Wales Australia
- Sydney Medical School, University of Sydney Sydney New South Wales Australia
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22
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Smyth W, McArdle J, Body-Dempsey J, Manickam V, Swinbourne A, Lee I, Holdsworth J, Omonaiye O, Nagle C. Immersive virtual reality in a northern Queensland haemodialysis unit: Study protocol for a cross-over randomized controlled feasibility trial (ACTRN12621000732886). Contemp Clin Trials Commun 2022; 28:100956. [PMID: 35812818 PMCID: PMC9256545 DOI: 10.1016/j.conctc.2022.100956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 05/30/2022] [Accepted: 06/23/2022] [Indexed: 10/27/2022] Open
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23
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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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24
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Ngo PJ, Wade S, Vaneckova P, Behar-Harpaz S, Caruana M, Cressman S, Tammemagi M, Karikios D, Canfell K, Weber M. Health utilities for participants in a population-based sample who meet eligibility criteria for lung cancer screening. Lung Cancer 2022; 169:47-54. [DOI: 10.1016/j.lungcan.2022.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 12/17/2022]
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Gall A, Diaz A, Garvey G, Anderson K, Lindsay D, Howard K. Self-reported wellbeing and health-related quality of life of Aboriginal and Torres Strait Islander people pre and post the first wave of the COVID-19 2020 pandemic. Aust N Z J Public Health 2022; 46:170-176. [PMID: 34939687 PMCID: PMC9968567 DOI: 10.1111/1753-6405.13199] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/01/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Quantify change in wellbeing and health-related quality-of-life (HRQoL) in Aboriginal and Torres Strait Islander adults pre and post Australia's initial COVID-19 lockdown. METHODS Aboriginal and Torres Strait Islander adults completed an online survey at Time 1 (October-November 2019; before the initial Australian COVID-19 outbreak) and Time 2 (August-September 2020; after the first Australian lockdown). We assessed wellbeing using a visual analogue scale (VAS) and HRQoL using the Assessment of Quality of Life (AQoL-4D) instrument. Participants who completed both surveys (n=42) were included to quantify change in outcomes over time and by comorbidity and demographic factors. RESULTS Mean reduction in wellbeing over time was 6.4 points (95%CI -14.2 to 1.4) and was associated with age (18-54yo), financial instability and mental health comorbidity. Mean reduction in HRQoL over time was 0.06 (95%CI -0.12 to 0.01) and was associated with financial instability, high physical comorbidity level and mental health comorbidity. CONCLUSIONS Aboriginal and Torres Strait Islanders aged 18-54yo, who were financially unstable or had elevated comorbidity during COVID lockdowns experienced greater reductions in wellbeing and HRQoL. IMPLICATIONS FOR PUBLIC HEALTH As the COVID-19 pandemic continues in Australia, both urgent and forward planning is needed, especially for the priority groups identified.
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Affiliation(s)
- Alana Gall
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory,Correspondence to: Alana Gall, Menzies School of Health Research, PO Box 41096, Casuarina, Northern Territory, 0811
| | - Abbey Diaz
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory,School of Public Health, University of Queensland, Brisbane, Queensland
| | - Gail Garvey
- School of Public Health, University of Queensland, Brisbane, Queensland,School of Public Health, Faculty of Medicine & Health, University of Sydney, New South Wales
| | - Kate Anderson
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory,School of Public Health, University of Queensland, Brisbane, Queensland
| | - Daniel Lindsay
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory,School of Public Health, University of Queensland, Brisbane, Queensland
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine & Health, University of Sydney, New South Wales,Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, New South Wales
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26
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Tan E, Gao L, Collier JM, Ellery F, Dewey HM, Bernhardt J, Moodie M. The economic and health burden of stroke among younger adults in Australia from a societal perspective. BMC Public Health 2022; 22:218. [PMID: 35114974 PMCID: PMC8811989 DOI: 10.1186/s12889-021-12400-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/17/2021] [Indexed: 01/27/2023] Open
Abstract
Background To estimate the short term (5 years) and long term (30 years) economic burden of stroke among younger adults (18–64 years), and to calculate the loss of health-related quality of life in these individuals, in Australia. Methods A Markov microsimulation model was built to simulate incidence of stroke among younger adults in Australia. Younger adults with stroke commenced in the model via health states defined by the modified Rankin Scale at 12 months from the AVERT study (A Very Early Rehabilitation Trial), and transitioned through these health states. Costs in Australian dollars (AUD) were measured from a societal perspective for a 2018 reference year and categorised into medical, non-medical and indirect costs. Probabilistic sensitivity analyses were performed to test the robustness around the cost of illness estimates. The loss of health-related quality of life due to stroke among younger adults was calculated by determining the difference in estimated quality-adjusted life years (QALYs) between the stroke population and the general population. This was determined by multiplying the predicted remaining life years for the modelled stroke cohort and the age-matched general population, by their corresponding age-dependent utilities. Results The economic burden of stroke among younger adults was estimated to be AUD2.0 billion over 5 years, corresponding to a mean of $149,180 per stroke patient. Over 30 years, the economic impact was AUD3.4 billion, equating to a mean of $249,780 per case. Probabilistic sensitivity analyses revealed a mean cost per patient of $153,410 in the short term, and a mean cost per patient of $273,496 in the long term. Compared to the age-matched general population, younger adults with stroke experienced a loss of 4.58 life years and 9.21 QALYs. Conclusions The results of our study suggests high economic and health burden of stroke among younger adults and highlights the need for preventive interventions targeting this age group. Trial registration ACTRN12606000185561, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12400-5.
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Affiliation(s)
- Elise Tan
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Janice M Collier
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Fiona Ellery
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Helen M Dewey
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | | | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
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The impact of loneliness and social isolation on health state utility values: a systematic literature review. Qual Life Res 2022; 31:1977-1997. [PMID: 35072904 PMCID: PMC8785005 DOI: 10.1007/s11136-021-03063-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 01/11/2023]
Abstract
Abstract
Background
Loneliness and social isolation are recognised as social problems and denote a significant health burden. The aim of this study was to conduct a systematic literature review to explore the health state utility values (HSUVs) associated with loneliness and/or social isolation.
Method
Peer-reviewed journals published in English language that reported both HSUVs along with loneliness and/or social isolation scores were identified through five databases. No restrictions were made relating to the population, study design or utility estimation method used.
Results
In total, 19 papers were included; 12 included a measure of loneliness, four studies included a measure of social isolation and three studies considered both loneliness and social isolation. All studies focused on individuals with pre-existing health conditions—where the EQ-5D-3L instrument was most frequently used to assess HSUVs. HSUVs ranged from 0.5 to 0.95 in those who reported not being lonely, 0.42 to 0.97 in those who experienced some level of loneliness, 0.3 to 0.87 in those who were socially isolated and 0.63 to 0.94 in those who were not socially isolated.
Conclusion
There was significant variation in HSUVs complicated by the presence of co-morbidities, population heterogeneity, variations in methods used to derive utility scores and differences in the measurement of loneliness and/or social isolation. Nevertheless, the lower HSUVs observed should be considered to significantly impact quality of life, though we also note the need for further research to explore the unique impact of loneliness and social isolation on HSUVs that can be used in the future economic evaluations.
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Hanly G, Campbell E, Bartlem K, Dray J, Fehily C, Bradley T, Murray S, Lecathelinais C, Wiggers J, Wolfenden L, Reid K, Reynolds T, Bowman J. Effectiveness of referral to a population-level telephone coaching service for improving health risk behaviours in people with a mental health condition: study protocol for a randomised controlled trial. Trials 2022; 23:49. [PMID: 35039058 PMCID: PMC8762844 DOI: 10.1186/s13063-021-05971-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with a mental health condition have a shorter life expectancy than the general population. This is largely attributable to higher rates of chronic disease and a higher prevalence of modifiable health risk behaviours including tobacco smoking, alcohol consumption, poor nutrition, and physical inactivity. Telephone support services offer a viable option to provide support to reduce these health risk behaviours at a population-level; however, whilst there is some research pertaining to Quitlines, there is limited other research investigating whether telephone services may offer effective support for people with a mental health condition. This protocol describes a randomised controlled trial that aims to evaluate the referral of people with a mental health condition to a population-level telephone coaching service to increase physical activity, healthy eating, or weight management, and increase attempts to do so. METHODS A parallel-group randomised controlled trial will be conducted recruiting participants with a mental health condition through community mental health services and advertisement on social media. Participants will be randomly assigned to receive either a health information pack only (control) or a health information pack and a proactive referral to a free, government-funded telephone coaching service, the NSW Get Healthy Coaching and Information Service® (intervention), which offers up to 13 telephone coaching calls with a University Qualified Health Coach to assist with client-identified goals relating to physical activity, healthy eating, weight management, or alcohol reduction. Data will be collected via telephone surveys at baseline and 6 months post-recruitment. Primary outcomes are as follows: (1) minutes of moderate to vigorous physical activity per week, (2) serves of fruit consumed per day, (3) serves of vegetables consumed per day, and (4) a composite measure assessing attempts to change at least one health risk behaviour (any attempts to change physical activity, fruit consumption, vegetable consumption, or other parts of nutrition). Secondary outcomes include weight and body mass index. DISCUSSION This study is the first to evaluate the effectiveness of referral to a population-level telephone support service for reducing health risk behaviours relating to physical activity, healthy eating, and weight in people with a mental health condition. Results will inform future policy and practice regarding the delivery of telephone-based behaviour change coaching services and the management of physical health for this population to reduce health inequity and the burden of chronic disease. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry ACTRN12620000351910 . Retrospectively registered on 12 March 2020.
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Affiliation(s)
- Grace Hanly
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Elizabeth Campbell
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
| | - Kate Bartlem
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Julia Dray
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Caitlin Fehily
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Tegan Bradley
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Sonya Murray
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Christophe Lecathelinais
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - John Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
| | - Luke Wolfenden
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
| | - Kate Reid
- NSW Office of Preventive Health, Liverpool, NSW Australia
| | | | - Jenny Bowman
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
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Beck B, Rubin C, Harding A, Paul S, Forwood M. The effect of low-intensity whole-body vibration with or without high-intensity resistance and impact training on risk factors for proximal femur fragility fracture in postmenopausal women with low bone mass: study protocol for the VIBMOR randomized controlled trial. Trials 2022; 23:15. [PMID: 34991684 PMCID: PMC8734256 DOI: 10.1186/s13063-021-05911-4] [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: 05/25/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The prevailing medical opinion is that medication is the primary (some might argue, only) effective intervention for osteoporosis. It is nevertheless recognized that osteoporosis medications are not universally effective, tolerated, or acceptable to patients. Mechanical loading, such as vibration and exercise, can also be osteogenic but the degree, relative efficacy, and combined effect is unknown. The purpose of the VIBMOR trial is to determine the efficacy of low-intensity whole-body vibration (LIV), bone-targeted, high-intensity resistance and impact training (HiRIT), or the combination of LIV and HiRIT on risk factors for hip fracture in postmenopausal women with osteopenia and osteoporosis. METHODS Postmenopausal women with low areal bone mineral density (aBMD) at the proximal femur and/or lumbar spine, with or without a history of fragility fracture, and either on or off osteoporosis medications will be recruited. Eligible participants will be randomly allocated to one of four trial arms for 9 months: LIV, HiRIT, LIV + HiRIT, or control (low-intensity, home-based exercise). Allocation will be block-randomized, stratified by use of osteoporosis medications. Testing will be performed at three time points: baseline (T0), post-intervention (T1; 9 months), and 1 year thereafter (T2; 21 months) to examine detraining effects. The primary outcome measure will be total hip aBMD determined by dual-energy X-ray absorptiometry (DXA). Secondary outcomes will include aBMD at other regions, anthropometrics, and other indices of bone strength, body composition, physical function, kyphosis, muscle strength and power, balance, falls, and intervention compliance. Exploratory outcomes include bone turnover markers, pelvic floor health, quality of life, physical activity enjoyment, adverse events, and fracture. An economic evaluation will also be conducted. DISCUSSION No previous studies have compared the effect of LIV alone or in combination with bone-targeted HiRIT (with or without osteoporosis medications) on risk factors for hip fracture in postmenopausal women with low bone mass. Should either, both, or combined mechanical interventions be safe and efficacious, alternative therapeutic avenues will be available to individuals at elevated risk of fragility fracture who are unresponsive to or unwilling or unable to take osteoporosis medications. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (www. anzctr.org.au ) (Trial number ANZCTR12615000848505, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 368962 ); date of registration 14/08/2015 (prospectively registered). Universal Trial Number: U1111-1172-3652.
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Affiliation(s)
- Belinda Beck
- Menzies Health Institute Queensland, School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD Australia
| | - Clinton Rubin
- Department of Biomedical Engineering, State University of New York at Stony Brook, New York, NY USA
| | - Amy Harding
- Menzies Health Institute Queensland, School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD Australia
| | - Sanjoy Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, VIC Australia
| | - Mark Forwood
- School of Pharmacy and Medical Sciences, Gold Coast, QLD 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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Elder-Robinson E, Diaz A, Howard K, Parikh DR, Kar G, Garvey G. Quality of Life in the First Year of Cancer Diagnosis among Aboriginal and Non-Aboriginal People Living in Regional and Remote Areas of Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:330. [PMID: 35010591 PMCID: PMC8751055 DOI: 10.3390/ijerph19010330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Little is known of the quality of life (QoL) of cancer patients in the Northern Territory (NT) of Australia, where healthcare delivery is geographically challenged. This exploratory study describes QoL among Aboriginal and non-Aboriginal cancer patients in the NT, in the first year of diagnosis. Participants were recruited from the only cancer care centre in the NT and completed the Assessment of Quality-of-Life questionnaire (AQoL-4D). The results were descriptively analysed. The participants' (n = 63; mean age 58.8 years) mean AQoL utility score was 0.72 (SD 0.26); patients scored lowest in the relationships and mental health dimensions of the questionnaire (mean 0.89, SD 0.19, and 0.89, SD 0.17, respectively). Participants living in remote and very remote areas (46%) reported higher QoL scores, compared with participants in the outer regional capital city of the NT in the overall (mean 0.76, SD 0.22 and 0.78, SD 0.20 vs. 0.67, SD 0.29, respectively), and mental health dimensions (mean 0.92, SD 0.09 and mean 0.94, SD 0.06 vs. 0.85, SD 0.22, respectively). The findings were suggestive of clinically meaningful differences across socioeconomic groups, cancer and treatment types, and comorbidity status. Mean QoL scores were consistent with previous reports in other Australian cancer cohorts. The findings suggest a need to support cancer patients' mental health and relationships during the diagnosis and treatment phase of their cancer journey.
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Affiliation(s)
- Elaina Elder-Robinson
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia; (A.D.); (G.G.)
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia
| | - Abbey Diaz
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia; (A.D.); (G.G.)
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia;
| | - Darshit Rajeshkumar Parikh
- School of Psychological and Clinical Sciences, Charles Darwin University, Causarina, NT 0810, Australia;
| | - Giam Kar
- Alan Walker Cancer Care Centre, Royal Darwin Hospital, Casuarina, NT 0810, Australia;
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia; (A.D.); (G.G.)
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia
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32
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Steele Gray C, Chau E, Tahsin F, Harvey S, Loganathan M, McKinstry B, Mercer SW, Nie JX, Palen TE, Ramsay T, Thavorn K, Upshur R, Wodchis WP. Assessing the Implementation and Effectiveness of the Electronic Patient-Reported Outcome Tool for Older Adults With Complex Care Needs: Mixed Methods Study. J Med Internet Res 2021; 23:e29071. [PMID: 34860675 PMCID: PMC8726765 DOI: 10.2196/29071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/19/2021] [Accepted: 09/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background Goal-oriented care is being adopted to deliver person-centered primary care to older adults with multimorbidity and complex care needs. Although this model holds promise, its implementation remains a challenge. Digital health solutions may enable processes to improve adoption; however, they require evaluation to determine feasibility and impact. Objective This study aims to evaluate the implementation and effectiveness of the electronic Patient-Reported Outcome (ePRO) mobile app and portal system, designed to enable goal-oriented care delivery in interprofessional primary care practices. The research questions driving this study are as follows: Does ePRO improve quality of life and self-management in older adults with complex needs? What mechanisms are likely driving observed outcomes? Methods A multimethod, pragmatic randomized controlled trial using a stepped-wedge design and ethnographic case studies was conducted over a 15-month period in 6 comprehensive primary care practices across Ontario with a target enrollment of 176 patients. The 6 practices were randomized into either early (3-month control period; 12-month intervention) or late (6-month control period; 9-month intervention) groups. The primary outcome measure of interest was the Assessment of Quality of Life-4D (AQoL-4D). Data were collected at baseline and at 3 monthly intervals for the duration of the trial. Ethnographic data included observations and interviews with patients and providers at the midpoint and end of the intervention. Outcome data were analyzed using linear models conducted at the individual level, accounting for cluster effects at the practice level, and ethnographic data were analyzed using qualitative description and framework analysis methods. Results Recruitment challenges resulted in fewer sites and participants than expected; of the 176 target, only 142 (80.6%) patients were identified as eligible to participate because of lower-than-expected provider participation and fewer-than-expected patients willing to participate or perceived as ready to engage in goal-setting. Of the 142 patients approached, 45 (32%) participated. Patients set a variety of goals related to self-management, mental health, social health, and overall well-being. Owing to underpowering, the impact of ePRO on quality of life could not be definitively assessed; however, the intervention group, ePRO plus usual care (mean 15.28, SD 18.60) demonstrated a nonsignificant decrease in quality of life (t24=−1.20; P=.24) when compared with usual care only (mean 21.76, SD 2.17). The ethnographic data reveal a complex implementation process in which the meaningfulness (or coherence) of the technology to individuals’ lives and work acted as a key driver of adoption and tool appraisal. Conclusions This trial experienced many unexpected and significant implementation challenges related to recruitment and engagement. Future studies could be improved through better alignment of the research methods and intervention to the complex and diverse clinical settings, dynamic goal-oriented care process, and readiness of provider and patient participants. Trial Registration ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954
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Affiliation(s)
- Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenebaum Research Institute, Sinai Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Edward Chau
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Farah Tahsin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah Harvey
- Logibec Inc (QoC Health Inc), Toronto, ON, Canada
| | - Mayura Loganathan
- Ray D Wolfe Department of Family Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brian McKinstry
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Ted E Palen
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenebaum Research Institute, Sinai Health, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
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The Cost Consequences of the Gold Coast Integrated Care Programme. Int J Integr Care 2021; 21:9. [PMID: 34611459 PMCID: PMC8447978 DOI: 10.5334/ijic.5542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/02/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction The Australian Gold Coast Integrated Care programme trialled a model of care targeting those with chronic and complex conditions at highest risk of hospitalisation with the goal of producing the best patient outcomes at no additional cost to the healthcare system. This paper reports the economic findings of the trial. Methods A pragmatic non-randomised controlled study assessed differences between patients enrolled in the programme (intervention group) and patients who received usual care (control group), in health service utilisation, including Medicare Benefits Schedule and Pharmaceutical Benefits Scheme claims, patient-reported outcome measures, including health-related quality of life, mortality risk, and cost. Results A total of 1,549 intervention participants were enrolled and matched on the basis of patient level data to 3,042 controls. We found no difference in quality of life between groups, but a greater decrease in capability, social support and satisfaction with care scores and higher hospital service use for the intervention group, leading to a greater cost to the healthcare system of AUD$6,400 per person per year. In addition, the per person per year cost of being in the GCIC programme was AUD$8,700 equating to total healthcare expenditures of AUD$15,100 more for the intervention group than the control group. Conclusion The GCIC programme did not show value for money, incurring additional costs to the health system and demonstrating no significant improvements in health-related quality of life. Because patient recruitment was gradual throughout the trial, we had only one year of complete data for analysis which may be too short a period to determine the true cost-consequences of the program.
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Chan HY, Wijnen BFM, Hiligsmann M, Smit F, Leenen LAM, Majoie MHJM, Evers SMAA. Assessment of Quality of Life 8-Dimension (AQoL-8D): translation, validation, and application in two Dutch trials in patients with epilepsy and schizophrenia. Expert Rev Pharmacoecon Outcomes Res 2021; 22:795-803. [PMID: 34553651 DOI: 10.1080/14737167.2021.1981861] [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: 10/20/2022]
Abstract
BACKGROUND To translate and linguistically validate the Assessment of Quality of Life 8-dimensions (AQoL-8D) for use in the Netherlands and to compare the psychometric properties of AQoL-8D with the EuroQol 5-dimensions 5-levels (EQ-5D-5L) in two patient samples. METHODS AQoL-8D was translated from English into Dutch. The translated AQoL-8D was then administered alongside the EQ-5D-5L at baseline and follow-up of two Dutch randomized controlled trials among patients with epilepsy and schizophrenia. These data were subjected to a post-hoc analysis assessing the psychometric properties of AQol-8D vis-à-vis EQ-5D-5L in terms of known-groups construct validity, responsiveness, and floor/ceiling effects. RESULTS In total, 103 epilepsy patients and 99 schizophrenia patients were included in this study. In both datasets, the two instruments discriminated between known-groups, but in schizophrenia, AQoL-8D showed higher responsiveness than EQ-5D-5L, while both instruments showed equal responsiveness in epilepsy. Ceiling effects were only found for EQ-5D-5L in both epilepsy (26.6%) and schizophrenia (6.1%). CONCLUSION Our results have shown that, among other things, AQoL-8D presents better ability to discriminate between known-groups and shows no ceiling effect. Based on our results, we would recommend the use of AQoL-8D in addition to EQ-5D-5L in trials assessing patient's quality of life in patients with epilepsy or schizophrenia.
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Affiliation(s)
- Hoi Yau Chan
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Ben F M Wijnen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of Research and Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Filip Smit
- Center for Economic Evaluation and Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,Department of Clinical, Neuro and Developmental Psychology and Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | - Loes A M Leenen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of Research and Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands
| | - Marian H J M Majoie
- Department of Research and Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.,MHeNS, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, Academic Centre for Epileptology, Epilepsy Centre Kempenhaeghe & Maastricht University Medical Centre, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Center for Economic Evaluation and Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
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Santora L, Byrne D, Klöckner C. Exploring Quality of Life Reported by Norwegian Older Adults Using Classification Tree Approach on Group Profiles. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09454-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AbstractThis study aims to explore the variation between- and within subgroups of older adults with regard to low, medium, and high levels of self-reported quality of life (QoL) measured by the WHOQOL-BREF scale. The contribution of interacting personal and contextual life conditions to QoL was examined in a sample of 1,910 (sample frame 6,000) Norwegian men and women aged 62 to 99 years. The data collected by a postal questionnaire were analyzed using the Chi-square Automatic Interaction Detection (CHAID) classification method in order to detect unique profiles of groups who shared common characteristics. The CHAID model revealed 15 relatively homogenous groups, but distinct from one another, whose profiles were defined by unique constellations of several interacting variables significantly related to a given QoL level. Mental functioning was predominantly linked to perception of life meaning along with health status, and/or in some cases living arrangement, loneliness, neighborhood quality, and satisfaction with income, and placed an individual at different likelihood levels of reporting low, medium, or high QoL. Socio-demographics had no statistically significant impact on QoL for any subgroup. Through this individual-oriented approach, a periodically ongoing assessment of subjective quality of life (QoL) may be sufficiently powerful to allow detecting and addressing personal concerns and specific needs that detract from quality of life in advancing age.
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Ho EK, Ferreira ML, Bauman A, Hodges PW, Maher CG, Simic M, Morton RL, Lonsdale C, Li Q, Baysari MT, Amorim AB, Ceprnja D, Clavisi O, Halliday M, Jennings M, Kongsted A, Maka K, Reid K, Reynolds T, Ferreira PH. Effectiveness of a coordinated support system linking public hospitals to a health coaching service compared with usual care at discharge for patients with chronic low back pain: protocol for a randomised controlled trial. BMC Musculoskelet Disord 2021; 22:611. [PMID: 34243746 PMCID: PMC8272287 DOI: 10.1186/s12891-021-04479-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Although many people with chronic low back pain (LBP) improve following conservative treatment, one in five will experience worsening symptoms after discharge from treatment and seek health care again. The current LBP clinical care pathway in many health services lacks a well-integrated, systematic approach to support patients to remain physically active and self-manage their symptoms following discharge from treatment. Health coaching can support people to improve physical activity levels and may potentially reduce health care utilisation for LBP. The primary aim of this study is to evaluate the effect of introducing a coordinated support system (linking hospital outpatient physiotherapy services to a public health coaching service) at discharge from LBP treatment, on the future use of hospital, medical, and health services for LBP, compared with usual care provided at discharge. Methods Three hundred and seventy-four adults with chronic non-specific LBP will be recruited from the outpatient physiotherapy departments of public hospitals in New South Wales, Australia. Participants will be individually randomised to a support system (n = 187) or usual care group (n = 187). All participants will receive usual care provided at discharge from treatment. Participants allocated to the support system will also receive up to 10 telephone-based health coaching sessions, delivered by the Get Healthy Service®, over a 6-month period. Health coaches will monitor and support participants to improve physical activity levels and achieve personal health-related goals. The primary outcome is the total number of encounters with hospital, medical, and health services for LBP, at 12 months from baseline. A within-trial economic evaluation will quantify the incremental costs and benefits of the support system from a health system perspective, to support reimbursement decision making. Discussion This study will establish the effect of a coordinated support system, introduced at discharge from treatment, on the future use of hospital, medical, and health services for LBP and various health outcomes. Conclusion Innovative community-driven solutions to support people with chronic LBP after discharge from treatment are urgently needed. Study findings will help inform health care policy and clinical practice in Australia. Trial Registration Prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12620000889954) on 10/09/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04479-z.
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Affiliation(s)
- Emma K Ho
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia.
| | - Manuela L Ferreira
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Adrian Bauman
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Paul W Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Milena Simic
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Chris Lonsdale
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Anita B Amorim
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Dragana Ceprnja
- Physiotherapy Department, Westmead Hospital, Sydney, NSW, Australia
| | - Ornella Clavisi
- Musculoskeletal Australia, Muscle Bone & Joint Health Ltd, Melbourne, VIC, Australia
| | - Mark Halliday
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Matthew Jennings
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Alice Kongsted
- Department of Sports Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Katherine Maka
- Physiotherapy Department, Westmead Hospital, Sydney, NSW, Australia
| | - Kate Reid
- The Centre for Population Health, NSW Ministry of Health, Sydney, NSW, Australia
| | - Tahlia Reynolds
- The Centre for Population Health, NSW Ministry of Health, Sydney, NSW, Australia
| | - Paulo H Ferreira
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
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Zhao T, Ahmad H, Winzenberg T, Aitken D, Graaff BD, Jones G, Palmer AJ. Cross-sectional and temporal differences in health-related quality of life of people with and without osteoarthritis: a 10-year prospective study. Rheumatology (Oxford) 2021; 60:3352-3359. [PMID: 33452525 DOI: 10.1093/rheumatology/keaa787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/15/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To describe the impact of OA on health-related quality of life (HRQoL) in the forms of health state utilities (HSUs) and health-dimension scores, and to compare the longitudinal changes in HRQoL for people with and without OA, using an Australian population-based longitudinal cohort. METHODS Participants of the Tasmanian Older Adult Cohort with data on OA diagnosis and HRQoL were included [interviewed at baseline (n = 1093), 2.5 years (n = 871), 5 years (n = 760) and 10 years (n = 562)]. HRQoL was assessed using the Assessment of Quality of Life four-dimensions and analysed using multivariable linear mixed regressions. RESULTS Compared with participants without OA, HSUs for those with OA were 0.07 (95% confidence interval: 0.09, 0.05) units lower on average over 10 years. HSUs for participants with knee and/or hip OA were similar to those with other types of OA at the 2.5 year follow-up and then diverged, with HSUs of the former being up to 0.09 units lower than the latter. Those with OA had lower scores for psychological wellness, independent living and social relationships compared with those without OA. Independent living and social relationships were mainly impacted by knee and/or hip OA, with the effect on the former increasing over time. CONCLUSION Interventions to improve HRQoL should be tailored to specific OA types, health dimensions, and times. Support for maintaining psychological wellness should be provided, irrespective of OA type and duration. However, support for maintaining independent living could be more relevant to knee and/or hip OA patients living with the disease for longer.
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Affiliation(s)
- Ting Zhao
- The Health Economics Research Unit, Menzies Institute for Medical Research, University of Tasmania, Hobart
| | - Hasnat Ahmad
- The Health Economics Research Unit, Menzies Institute for Medical Research, University of Tasmania, Hobart
| | - Tania Winzenberg
- The Health Economics Research Unit, Menzies Institute for Medical Research, University of Tasmania, Hobart
| | - Dawn Aitken
- The Health Economics Research Unit, Menzies Institute for Medical Research, University of Tasmania, Hobart
| | - Barbara de Graaff
- The Health Economics Research Unit, Menzies Institute for Medical Research, University of Tasmania, Hobart
| | - Graeme Jones
- The Health Economics Research Unit, Menzies Institute for Medical Research, University of Tasmania, Hobart
| | - Andrew J Palmer
- The Health Economics Research Unit, Menzies Institute for Medical Research, University of Tasmania, Hobart.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Carrello J, Hayes A, Killedar A, Von Huben A, Baur LA, Petrou S, Lung T. Utility Decrements Associated with Adult Overweight and Obesity in Australia: A Systematic Review and Meta-Analysis. PHARMACOECONOMICS 2021; 39:503-519. [PMID: 33615427 DOI: 10.1007/s40273-021-01004-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim was to conduct a systematic review and meta-analysis of health state utility decrements associated with overweight and obesity in adults 18 years and over, for use in modelled economic evaluations in Australia. METHODS A systematic review was conducted in nine databases to identify studies that reported health state utility values by weight status. Random-effects meta-analysis was used to synthesise average utility decrements (from healthy weight) associated with overweight, all obesity and obesity classes 1, 2 and 3. Heterogeneity surrounding utility decrements was assessed via sub-group analysis, random-effects meta-regression and sensitivity analyses. RESULTS Twelve studies were found for which data were used to synthesise utility decrements, estimated as overweight = 0.020 (95% confidence interval 0.010-0.030), all obesity = 0.055 (0.034-0.076), obesity class 1 = 0.047 (0.017-0.077), class 2 = 0.072 (0.028-0.116) and class 3 = 0.084 (0.039-0.130). There was considerable heterogeneity in our results, which could be accounted for by the different ages and utility instruments used in the contributing studies. CONCLUSIONS Our results demonstrate that elevated weight status is associated with small but statistically significant reductions in utility compared with healthy weight, which will result in reduced quality-adjusted life years when extrapolated across time and used in economic evaluations.
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Affiliation(s)
- Joseph Carrello
- School of Public Health, Edward Ford Building, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Alison Hayes
- School of Public Health, Edward Ford Building, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Anagha Killedar
- School of Public Health, Edward Ford Building, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Amy Von Huben
- School of Public Health, Edward Ford Building, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Louise A Baur
- School of Public Health, Edward Ford Building, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Thomas Lung
- School of Public Health, Edward Ford Building, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
- Health Economics and Process Evaluation, The George Institute for Global Health, University of New South Wales, Kensington, Australia
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Hogan S, Steffens D, Vuong K, Rangan A, Solomon M, Carey S. Preoperative nutritional status impacts clinical outcome and hospital length of stay in pelvic exenteration patients - a retrospective study. Nutr Health 2021; 28:41-48. [PMID: 33858255 DOI: 10.1177/02601060211009067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preoperative malnutrition is common in surgical oncology patients and can have negative effects on postoperative outcomes. Pelvic exenteration is major surgery associated with high morbidity rates. Associations between preoperative malnutrition, determined using the patient-generated subjective global assessment, and postoperative outcomes in this patient cohort has not yet been investigated. AIM To determine if preoperative nutritional status is associated with postoperative surgical and quality of life (QoL) outcomes after pelvic exenteration surgery. METHODS A retrospective cohort study was conducted at a quaternary hospital investigating 123 patients who had pelvic exenteration surgery from January 2017 to August 2019. Preoperative nutritional status and postoperative surgical and QoL outcomes were collected and analysed to determine any associations. RESULTS Overall, 49.6% of patients were female with a median age of 59 years. Forty patients (32.5%) were malnourished and 83 (67.5%) were well nourished before surgery. Well-nourished patients had a shorter length of hospital stay (p = 0.034) and at 6 months post-surgery, presented with a significantly better physical and mental QoL score (p = 0.038 and p = 0.001 respectively). The regression analyses showed that intensive care unit (ICU) readmission rates were 7.19 times more likely to occur in malnourished patients (p = 0.022). CONCLUSIONS Preoperative malnutrition is associated with increased length of stay, ICU readmissions and poorer QoL following pelvic exenteration. Nutrition screening, assessment and optimisation of management are essential in this patient cohort to improve patient outcomes. Future studies are needed to measure the effect of interventions and identify the most beneficial model of care for this complex patient group.
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Affiliation(s)
- Sophie Hogan
- 2205Royal Prince Alfred Hospital, Australia.,4334University of Sydney, Australia
| | - Daniel Steffens
- 2205Royal Prince Alfred Hospital, Australia.,4334University of Sydney, Australia
| | | | | | - Michael Solomon
- 2205Royal Prince Alfred Hospital, Australia.,4334University of Sydney, Australia
| | - Sharon Carey
- 2205Royal Prince Alfred Hospital, Australia.,4334University of Sydney, Australia
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Bahrampour M, Downes M, Scuffham PA, Byrnes J. Comparing multi-attribute utility instruments: CP-6D, a Cerebral palsy specific instrument, vs AQoL-4D. Expert Rev Pharmacoecon Outcomes Res 2021; 22:217-224. [PMID: 33779449 DOI: 10.1080/14737167.2021.1909477] [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: 10/21/2022]
Abstract
Background: Economic-evaluations of Cerebral palsy (CP) were based on utility estimates of health-related quality of life (HRQoL) from generic multi-attribute utility instruments (MAUIs). However, generic instruments had limited use as they could not capture some of the important aspects of living with CP. The Cerebral palsy 6 Dimension (CP-6D) is a disease specific MAUI. In this study, we compared the results of CP-6D with the Assessment of Quality of Life (AQoL-4D), a generic MAUI, and tested the criterion validity of the CP-6D in the general population.Methods:An online survey of the Australian general population (n = 2002), who completed both the AQoL-4D and CP-6D MAUIs, was conducted. Validity was assessed from the correlations between the domains, items and instruments. ANOVA and t-tests were used to assess the instrument's discrimination in different social demographic categories.Results:There was a moderate correlation between the instruments (0.64). Differences in socio-demographic characteristics showed a medium effect size (p < 0.001) in both instruments and had a similar effect on utility weights in both instruments. Although the CP-6D was more sensitive to changes in income and education.Conclusions: Our results suggest that CP-6D and AQoL-4D were measuring a similar underlying construct. Both instruments responded similarly to socio-demographic differences.
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Affiliation(s)
- Mina Bahrampour
- Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Martin Downes
- Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine & Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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Ackerman IN, Fotis K, Pearson L, Schoch P, Broughton N, Brennan-Olsen SL, Bucknill A, Cross E, Bunting-Frame N, Page RS. Impaired health-related quality of life, psychological distress, and productivity loss in younger people with persistent shoulder pain: a cross-sectional analysis. Disabil Rehabil 2021; 44:3785-3794. [PMID: 33620022 DOI: 10.1080/09638288.2021.1887376] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate wellbeing and work impacts in younger people with persistent shoulder pain. MATERIALS AND METHODS People aged 20-55 years with shoulder pain of >6 weeks' duration (excluding those with recent fracture or dislocation) were recruited from orthopaedic clinics at three major public hospitals. Health-related quality of life (HRQoL) and psychological distress were evaluated using the Assessment of Quality of Life (AQoL) and K10 instruments and compared to population norms. Shoulder-related absenteeism and presenteeism were quantified using the Work Productivity and Activity Impairment (WPAI) Questionnaire. RESULTS Of the 81 participants (54% male), 69% had shoulder pain for over 12 months. Substantial HRQoL impairment was evident (mean reduction from population norms 0.33 AQoL units, 95% CI -0.38 to -0.27; minimal important difference 0.06 AQoL units). High or very high psychological distress was three times more prevalent among participants than the general population (relative risk 3.67, 95% CI 2.94 to 4.59). One-quarter of participants had ceased paid employment due to shoulder pain and 77% reported shoulder-related impairment at work. CONCLUSIONS The broader impacts of painful shoulder conditions on younger people extend well beyond pain and upper limb functional limitations. In particular, the work-related impacts should form a routine part of patient assessment and rehabilitation.Implications for rehabilitationPersistent shoulder pain in younger people (aged 20-55 years) is associated with substantially reduced health-related quality of life and greater psychological distress, compared to population norms, as well as work participation and productivity impacts.As rotator cuff conditions, shoulder capsule pathology, and glenohumeral instability are relatively common, our data suggest that persistent shoulder pain is likely to have a high community impact among people of working age.Information resources that people with painful shoulder conditions can share with their families, employers, and colleagues may assist others to better understand the broader impacts of these conditions.Work-related challenges associated with shoulder pain should be considered within routine clinical care, and may require referral to an occupational health clinician or vocational rehabilitation service.
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Affiliation(s)
- Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kathy Fotis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lauren Pearson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Schoch
- Physiotherapy Department, Barwon Health, Geelong, Australia
| | - Nigel Broughton
- Orthopaedic Department, Frankston Hospital, Frankston, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Australian Institute for Musculoskeletal Science, Melbourne, Australia.,School of Health and Social Development, Deakin University, Geelong, Australia.,Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Emily Cross
- Physiotherapy Department, The Royal Melbourne Hospital, Melbourne, Australia
| | | | - Richard S Page
- Barwon Centre for Orthopaedic Research and Education (B-CORE), St John of God Hospital and Barwon Health, Geelong, Australia.,School of Medicine, Deakin University, Geelong, Australia
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Correlation between nasal mucosal temperature change and the perception of nasal patency: a literature review. The Journal of Laryngology & Otology 2021; 135:104-109. [PMID: 33612130 DOI: 10.1017/s0022215121000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The mechanism of nasal airflow sensation is poorly understood. This study aimed to examine the role of nasal mucosal temperature change in the subjective perception of nasal patency and the methods by which it can be quantified. METHOD Medline and PubMed database searches were performed to retrieve literature relevant to the topic. RESULTS The primary mechanism producing the sensation of nasal patency is thought to be the activation of transient receptor potential melastatin family member 8 ('TRPM8'), a thermoreceptor that is activated by nasal mucosal cooling. Computational fluid dynamics studies have demonstrated that increased airflow and heat flux are correlated with better patient-reported outcome measure scores. Similarly, physical measurements of the nasal cavity using temperature probes have shown a correlation between lower nasal mucosal temperatures and better patient-reported outcome measure scores. CONCLUSION Nasal mucosal temperature change may be correlated with the perception of improved nasal patency. Future research should quantify the impact of mucosal cooling on the perception of nasal airway obstruction.
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Australian adolescent population norms for the child health utility index 9D-results from the young minds matter survey. Qual Life Res 2021; 30:2895-2906. [PMID: 33999321 PMCID: PMC8126511 DOI: 10.1007/s11136-021-02864-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Patient-reported outcomes of health-related quality-of-life (HRQoL) are important descriptors of population health. A recent Australian adolescent population survey provided a unique opportunity to derive preference-based HRQoL. METHODS Data from 2967 adolescents aged 11-17 years were analysed. An interviewer-led parent/carer questionnaire was administered for demographic variables and mental disorders of adolescents during previous 12 months using the Diagnostic Interview Schedule for Children. A self-report survey was administered to derive HRQoL using the child health utility nine-dimensions instrument (CHU-9D). Weighted HRQoL was derived for several demographic groups, mental disorder diagnosis, and youth risk behaviours. RESULTS The total population had a mean utility of 0.78 [standard deviation (SD): 0.20]. Males had a significantly higher mean utility (0.81, SD 0.18) than females (0.76, SD: 0.21) (Cohen's d = 0.23, p < 0.001), and utility decreased with age for both males and females (p < 0.001). Family type and some parent/carer variables were associated with significant lower HRQoL scores with small effect size. Youth risk behaviours were associated with reduced HRQoL with moderate effect sizes. Adolescents who self-harmed, had suicidal ideation, or had a mental disorder had significantly lower utilities scores with moderate to large effect sizes compared to those who did not have such conditions. CONCLUSIONS This study has provided contemporary Australian population norms for HRQoL in adolescents that may be used as cross comparison between studies as well as indicators allowing estimation of population health (e.g. estimation of the burden of disease) and can be used to populate future economic models.
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Patterson K, Davey R, Keegan R, Niyonsenga T, Mohanty I, van Berlo S, Freene N. A smartphone app for sedentary behaviour change in cardiac rehabilitation and the effect on hospital admissions: the ToDo-CR randomised controlled trial study protocol. BMJ Open 2020; 10:e040479. [PMID: 33323435 PMCID: PMC7745513 DOI: 10.1136/bmjopen-2020-040479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is recommended for secondary prevention of cardiovascular disease and reducing the risk of repeat cardiac events. Physical activity is a core component of CR; however, studies show that participants remain largely sedentary. Sedentary behaviour is an independent risk factor for all-cause mortality. Strategies to encourage sedentary behaviour change are needed. This study will explore the effectiveness and costs of a smartphone application (Vire) and an individualised online behaviour change program (ToDo-CR) in reducing sedentary behaviour, all-cause hospital admissions and emergency department visits over 12 months after commencing CR. METHODS AND ANALYSIS A multicentre, assessor-blind parallel randomised controlled trial will be conducted with 144 participants (18+ years). Participants will be recruited from three phase-II CR centres. They will be assessed on admission to CR and randomly assigned (1:1) to one of two groups: CR plus the ToDo-CR 6-month programme or usual care CR. Both groups will be re-assessed at 6 months and 12 months for the primary outcome of all-cause hospital admissions and presentations to the emergency department. Accelerometer-measured changes in sedentary behaviour and physical activity will also be assessed. Logistic regression models will be used for the primary outcome of hospital admissions and emergency department visits. Methods for repeated measures analysis will be used for all other outcomes. A cost-effectiveness analysis will be conducted to evaluate the effects of the intervention on the rates of hospital admissions and emergency department visits within the 12 months post commencing CR. ETHICS AND DISSEMINATION This study received ethical approval from the Australian Capital Territory Health (2019.ETH.00162), Calvary Public Hospital Bruce (20-2019) and the University of Canberra (HREC-2325) Human Research Ethics Committees (HREC). Results will be disseminated through peer-reviewed academic journals. Results will be made available to participants on request. TRIAL REGISTRATION NUMBER ACTRN12619001223123.
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Affiliation(s)
- Kacie Patterson
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Richard Keegan
- Research Institute for Sports and Exercise (UCRISE), Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia
| | - Theophile Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | | | - Nicole Freene
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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Thompson KN, Jackson H, Cavelti M, Betts J, McCutcheon L, Jovev M, Chanen AM. Number of Borderline Personality Disorder Criteria and Depression Predict Poor Functioning and Quality of Life in Outpatient Youth. J Pers Disord 2020; 34:785-798. [PMID: 30689518 DOI: 10.1521/pedi_2019_33_411] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to investigate which factors contribute to poor functioning and poor quality of life in youth (aged 15-25 years) with borderline personality disorder (BPD), and whether the number of BPD criteria might be an independent predictor of these outcomes. A sample of 499 help-seeking outpatient youth, aged 15-25 years, was assessed. Stepwise multiple regression analyses showed that the number of BPD criteria was the best predictor of poor functioning, followed by number of mental health visits in the past month, female sex, and a current diagnosis of depression. Current depression was the best predictor of Assessment of Quality of Life utility score, followed by the number of BPD criteria. These findings underscore the clinical significance of DSM-IV BPD features (even when subthreshold for a categorical diagnosis) in youth and their effects upon social and occupational functioning and quality of life early in the course of BPD.
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Affiliation(s)
- Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Henry Jackson
- School of Psychological Sciences, The University of Melbourne, Australia
| | - Marialuisa Cavelti
- Centre for Youth Mental Health, The University of Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Australia.,University Hospital of Psychiatry and Psychotherapy Bern, Switzerland
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | | | - Martina Jovev
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia.,Orygen Youth Health, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia.,Orygen Youth Health, Australia
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McCaffrey N, Bucholc J, Rand S, Hoefman R, Ugalde A, Muldowney A, Mihalopoulos C, Engel L. Head-to-Head Comparison of the Psychometric Properties of 3 Carer-Related Preference-Based Instruments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1477-1488. [PMID: 33127019 DOI: 10.1016/j.jval.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To compare the psychometric properties of the Adult Social Care Outcomes Toolkit for carers (ASCOT-Carer), the Carer Experience Scale (CES), and the Care-related Quality of Life (CarerQol) to inform the choice of instrument in future studies. METHODS Data were derived from a 2018 online survey of informal carers in Australia. Reliability was assessed via internal consistency (Cronbach alpha, α) and test-retest reliability (intraclass correlation coefficient, ICC) for respondents who self-reported no change in their quality of life as a carer over 2 weeks. Convergent validity was evaluated via predetermined hypotheses about associations (Spearman's rank correlation) with existing, validated measures. Discriminative validity was assessed based on the ability of the carer-related scores to distinguish between different informal care situations (Mann-Whitney U, Kruskal-Wallis one-way analysis of variance). RESULTS Data from 500 carers were analyzed. The ASCOT-Carer demonstrated a higher degree of internal consistency, possibly due to a unidimensional structure, and test-retest reliability than the CarerQol and CES (α = 0.87, 0.65, 0.59; ICC, 0.87, 0.67, 0.81, respectively). All 3 instruments exhibited convergent validity and detected statistically significant associations between carer-related scores and different informal care situations, except for the CarerQol-7D and sole carer status. CONCLUSIONS The ASCOT-Carer, CarerQol, and CES performed reasonably well psychometrically; the ASCOT-Carer exhibited the best psychometric properties overall in this sample of Australian informal carers. Findings should be used in conjunction with consideration of research goals, carer population, targeted carer-related constructs, and prevailing perspectives on the economic evaluation to inform choice of instrument in future studies.
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Affiliation(s)
- Nikki McCaffrey
- Deakin University, School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Burwood, Victoria, Australia.
| | - Jessica Bucholc
- Deakin University, School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Stacey Rand
- Personal Social Services Research Unit (PSSRU), Cornwallis Building, University of Kent, Canterbury, UK
| | - Renske Hoefman
- The Netherlands Institute for Social Research (SCP), The Hague, The Netherlands
| | - Anna Ugalde
- Deakin University, School of Nursing and Midwifery, Quality and Patient Safety, Institute for Health Transformation, Burwood, Victoria, Australia
| | | | - Cathrine Mihalopoulos
- Deakin University, School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Lidia Engel
- Deakin University, School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Burwood, Victoria, Australia
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Busija L, Ackerman IN, Haas R, Wallis J, Nolte S, Bentley S, Miura D, Hawkins M, Buchbinder R. Adult Measures of General Health and Health‐Related Quality of Life. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:522-564. [DOI: 10.1002/acr.24216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Romi Haas
- Cabrini Institute, Malvern, Victoria, Australia, and Monash University Melbourne Victoria Australia
| | - Jason Wallis
- Cabrini Institute, Malvern, Victoria, Australia, and Monash University Melbourne Victoria Australia
| | - Sandra Nolte
- Charité – Universitätsmedizin Berlin and Berlin Institute of Health, Berlin, Germany, ICON GmbH, Munich, Germany, and Deakin University Burwood Victoria Australia
| | - Sharon Bentley
- Queensland University of Technology Kelvin Grove Queensland Australia
| | | | - Melanie Hawkins
- Deakin University, Burwood, Victoria, Australia, and Swinburne University of Technology Melbourne Victoria Australia
| | - Rachelle Buchbinder
- Cabrini Institute, Malvern, Victoria, Australia, and Monash University Melbourne Victoria Australia
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Tu S, Liew D, Ademi Z, Owen AJ, Zomer E. The Health and Productivity Burden of Migraines in Australia. Headache 2020; 60:2291-2303. [PMID: 33026675 DOI: 10.1111/head.13969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/31/2020] [Accepted: 08/29/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to quantify the health and productivity burden of migraines in Australia, measured by quality-adjusted life years (QALYs), productivity-adjusted life years (PALYs, a novel measure of productivity), and associated health-care and broader economic costs. METHODS A Markov state-transition model was constructed to simulate follow-up of Australians aged 20-64 years over the next 10 years. The model was first run using current prevalence estimates of migraine. It was then rerun assuming that people with migraine hypothetically did not have the condition. Differences in outcomes between the 2 model simulations represented the health and productivity burden attributable to migraine. All data inputs were obtained from published sources. Gross domestic product (GDP) per equivalent full-time worker in Australia was used to reflect the cost of each PALY (AU$177,092). Future costs and outcomes were discounted by 5% annually. RESULTS Currently, 1,274,319 million (8.5%) Australians aged 20-64 years have migraine. Over the next 10 years, migraine was predicted to lead to a loss of 2,577,783 (95% confidence interval [CI] 2,054,980 to 3,000,784) QALYs among this cohort (2.02 per person and 2.43% of total QALYs), and AU$1.67 (95% CI $1.16 to $2.37) billion in health-care costs (AU$1313 per person, 95% CI $914 to $1862). There would also be 384,740 (95% CI 299,102 to 479,803) PALYs lost (0.30 per person and 0.53% of total PALYs), resulting in AU$68.13 (95% CI $44.42 to $98.25) billion of lost GDP (AU$53,467 per person, 95% CI $34,855 to $77,102). CONCLUSION Migraines impose a substantial health and economic burden on Australians of working age. Funding interventions that reduce the prevalence of migraines and/or its effects are likely to provide sound return on investment.
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Affiliation(s)
- Susan Tu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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Cost effectiveness of treatment models of care for hepatitis C: the South Australian state-wide experience. Eur J Gastroenterol Hepatol 2020; 32:1381-1389. [PMID: 31895911 DOI: 10.1097/meg.0000000000001659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM The objective was to study the long-term (lifetime) cost effectiveness of four different hepatitis C virus (HCV) treatment models of care (MOC) with directly acting antiviral drugs. METHODS A cohort Markov model-based probabilistic cost-effectiveness analysis (CEA) was undertaken extrapolating to up to 30 years from cost and outcome data collected from a primary study involving a real-life Australian cohort. In this study, noncirrhotic patients treated for HCV from 1 March 2016 to 28 February 2017 at four major public hospitals and liaising sites in South Australia were studied retrospectively. The MOC were classified depending on the person providing patient workup, treatment and monitoring into MOC1 (specialist), MOC2 (mixed specialist and hepatitis nurse), MOC3 (hepatitis nurse) and MOC4 (general practitioner, GP). Incremental costs were estimated from the Medicare perspective. Incremental outcomes were estimated based on the quality-adjusted life years (QALY) gained by achieving a sustained virological response. A cost-effectiveness threshold of Australian dollar 50 000 per QALY gained, the implicit criterion used for assessing the cost-effectiveness of new pharmaceuticals and medical services in Australia was assumed. Net monetary benefit (NMB) estimates based on this threshold were calculated. RESULTS A total of 1373 patients, 64% males, mean age 50 (SD ±11) years, were studied. In the CEA, MOC4 and MOC2 clearly dominated MOC1 over 30 years with lower costs and higher QALYs. Similarly, NMB was the highest in MOC4, followed by MOC2. CONCLUSION Decentralized care using GP and mixed consultant nurse models were cost-effective ways of promoting HCV treatment uptake in the setting of unrestricted access to new antivirals.
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Collins A, McLachlan SA, Hill M, Collins S, Philip J. A randomised phase II trial testing the acceptability and feasibility of a narrative approach to public health communication to increase community engagement with palliative care. Palliat Med 2020; 34:1108-1117. [PMID: 32552310 DOI: 10.1177/0269216320932766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Communities have limited understanding of palliative care, creating barriers to informed choice around consideration of a full range of care options in the event of serious illness. Few empirically tested interventions are available to educate community about palliative care, and ultimately improve timely access to these services. AIM To test the acceptability (primary outcome), and feasibility of a narrative approach to public health communication seeking to improve attitudes to possible access to palliative care in the event of serious illness. DESIGN Randomised phase II trial with six parallel experimental conditions. Outcomes tested included measures of acceptability, feasibility and change in attitudes to possible access to palliative care post-intervention. Contrasts planned for exploratory testing included format, message content and narrator. SETTING/PARTICIPANTS Community-based sample of consecutive English-speaking adults who volunteered their participation in response to a study advertisement distributed online through established community groups. RESULTS A narrative approach to public health communication was found to be acceptable to community members, and feasible to deliver online. Exploratory data suggested it immediately improved attitudes towards possible access to palliative care in the event of serious illness, with the narrative detailing a description of the evidence delivered by a healthcare professional appearing to be the most promising strategy. CONCLUSIONS This study provides preliminary data to inform a future, longitudinal trial evaluating effectiveness and ultimately other evidence-based, public health approaches to improve community engagement with palliative care. Further studies are required to confirm the generalisability of findings to a broader representative sample and other settings including internationally.
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Affiliation(s)
- Anna Collins
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Sue-Anne McLachlan
- Medical Oncology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Mike Hill
- Moonshine Agency, Cremorne, VIC, Australia
| | | | - Jennifer Philip
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia.,Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
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