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Yeshitila YG, Gold L, Riggs E, Abimanyi-Ochom J, Sweet L, Le HND. Trends and disparities in perinatal health outcomes among women from refugee backgrounds in Victoria, Australia: A population-based study. Midwifery 2024; 132:103980. [PMID: 38547597 DOI: 10.1016/j.midw.2024.103980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Women from refugee backgrounds generally experience poorer pregnancy-related outcomes compared to host populations. AIM To examine the trend and disparities in adverse perinatal outcomes among women of refugee background using population-based data from 2003 to 2017. METHODS A population-based cross-sectional study of 754,270 singleton births in Victoria compared mothers of refugee backgrounds with Australian-born mothers. Inferential statistics, including Pearson chi-square and binary logistic regression, were conducted. Multiple logistic regression was conducted to explore the relationship between adverse perinatal outcomes and the women's refugee status. FINDINGS Women of refugee background had higher odds of adverse neonatal and maternal outcomes, including stillbirth, neonatal death, low APGAR score, small for gestational age, postpartum haemorrhage, abnormal labour, perineal tear, and maternal admission to intensive care compared to Australian-born women. However, they had lower odds of neonatal admission to intensive care, pre-eclampsia, and maternal postnatal depression. The trend analysis showed limited signs of gaps closing over time in adverse perinatal outcomes. DISCUSSION AND CONCLUSION Refugee background was associated with unfavourable perinatal outcomes, highlighting the negative influence of refugee status on perinatal health. This evidences the need to address the unique healthcare requirements of this vulnerable population to enhance the well-being of mothers and newborns. Implementing targeted interventions and policies is crucial to meet the healthcare requirements of women of refugee backgrounds. Collaborative efforts between healthcare organisations, government agencies and non-governmental organisations are essential in establishing comprehensive support systems to assist refugee women throughout their perinatal journey.
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Affiliation(s)
- Yordanos Gizachew Yeshitila
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia; School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia; Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Lisa Gold
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of General Practice, The University of Melbourne, Victoria, Melbourne, Australia
| | - Julie Abimanyi-Ochom
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Institute for Health Transformation, Victoria, Australia
| | - Ha N D Le
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia
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Ho TQA, Le LKD, Engel L, Le N, Melvin G, Le HND, Mihalopoulos C. Barriers to and facilitators of user engagement with web-based mental health interventions in young people: a systematic review. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02386-x. [PMID: 38356043 DOI: 10.1007/s00787-024-02386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
Many young people (YP) are diagnosed with mental illnesses and require support. Web-based mental health interventions (W-MHIs) have been increasingly utilized by YP, healthcare providers, and parents due to reasons including convenience and anonymity. W-MHIs are effective in improving mental health in YP. However, real-world engagement with W-MHIs remains low. Therefore, understanding barriers/facilitators of user engagement with W-MHIs is necessary to promote W-MHIs and help users gain optimal benefits through higher engagement. This review aims to identify barriers/facilitators of user engagement with W-MHIs in YP aged 10-24 years. A systematic search of five databases for English language, peer-reviewed publications was conducted between January 2010 and February 2023. Studies examining factors influencing user engagement with W-MHIs, described as barriers or facilitators, were included. Study quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was performed. Of 4088 articles identified, 69 studies were included. Barriers/facilitators were reported by young people (63 studies), providers (17 studies), and parents/caregivers (8 studies). YP perceived that usefulness and connectedness were the most common facilitators, whereas low-perceived need was the most reported barrier. Both providers and parents reported that perceived usefulness for YP was the most common facilitator, whereas concerns about program effectiveness and privacy were noted as barriers. This review found that program- and individual-related factors were important determinants of engagement with W-MHIs. This review provides guidance on the future design and development of new interventions, narrowing the gap between existing W-MHIs and unmet needs of users.
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Affiliation(s)
- Thi Quynh Anh Ho
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia.
| | - Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ngoc Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ha N D Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Thai TTH, Le HND, Mihalopoulos C, Austin SB, Le LKD. Economic costs associated with unhealthy weight control behaviors among Australian adolescents. Int J Eat Disord 2024; 57:341-352. [PMID: 38054343 DOI: 10.1002/eat.24107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This study explored the relationship between unhealthy weight control behaviors (UWCBs) and their associated economic costs among adolescents using the 2014-2018 Longitudinal Study of Australian Children (LSAC). METHODS LSAC data in Wave 6 (n = 3538 adolescents aged 14-15 years), Wave 7 n = 3089 adolescents aged 16-17 years), and Wave 8 (n = 3037 adolescents aged 18-19 years) were derived from a representative sample of Australian adolescents. UWCBs were measured using the self-reported Branched Eating Disorder Test questionnaire. UWCBs were sub-classified into having fasting behaviors, using weight loss supplements or purging behaviors. Economic costs include healthcare and productivity costs to caregivers. Healthcare costs were measured using data from the Medicare and Pharmaceutical Benefits, which includes both medical and pharmaceutical costs. Productivity losses were measured using caregivers' lost leisure time due to UWCBs among adolescents. RESULTS The mixed effect model identified statistically significant higher economic costs (mean difference = $453, 95% CIs $154, $752), higher health care costs (mean difference = $399, 95% CIs $102, $695), and higher productivity costs (mean difference = $59, 95% CIs $29, $90) for adolescents with UWCBs compared to their peers with no UWCBs. Subgroup analysis revealed that higher costs were associated with fasting and purging behaviors. DISCUSSION UWCBs were associated with increased economic costs during adolescence. Our finding suggests there should be a policy focus on tackling UWCBs to reduce the economic burden on the healthcare system and society. PUBLIC SIGNIFICANCE The study contributes to existing knowledge by investigating the direct healthcare costs and productivity losses associated with unhealthy weight control behaviors in Australian adolescents (14-18 years old) using a dataset that follows Australian adolescents over time. We found that engaging in unhealthy weight control behaviors such as fasting, using weight loss supplements, and purging was linked to higher costs among adolescents, suggesting policies should focus on addressing these behaviors.
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Affiliation(s)
- Thao T H Thai
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ha N D Le
- Institute of Health Transformation, Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Long Khanh-Dao Le
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Dodds M, Wanni Arachchige Dona S, Gold L, Coghill D, Le HND. Economic Burden and Service Utilization of Children With Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Value Health 2024; 27:247-264. [PMID: 38043710 DOI: 10.1016/j.jval.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/18/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. This study aims to systematically synthesize the literature on service utilization and costs for children with ADHD. METHODS The search included 9 databases for peer-reviewed primary studies in English from 2007 to 2023. Two independent reviewers conducted title/abstract and full-text screenings and quality assessment. Meta-analysis was conducted on direct medical costs. RESULTS Thirty-two studies were included. Children with ADHD have used more pharmaceuticals, mental health, and special education services than children without ADHD (counterparts). Nevertheless, one study found that children with ADHD were twice as likely to have unmet health needs than their counterparts. Annual health system costs per patient were highly varied and higher in children with ADHD ($722-$11 555) than their counterparts ($179-$3646). From a societal perspective, children with ADHD were associated with higher costs ($162-$18 340) than their counterparts ($0-2540). The overall weighted mean direct medical cost was $5319 for children with ADHD compared with $1152 for their counterparts when all studies with different sample sizes were considered together, with the difference being $4167. Limited literature on productivity losses associated with ADHD reported them as a substantial cost. ADHD in children had a "large" effect on the increment of direct medical costs. CONCLUSIONS ADHD was associated with increased service utilization and costs. However, unmet health needs or underuse among children with ADHD was also evident. Governments should endeavor to improve access to effective services for children with ADHD to mitigate the impact of ADHD.
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Affiliation(s)
- Mitchell Dodds
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Sithara Wanni Arachchige Dona
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia.
| | - Lisa Gold
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - David Coghill
- Murdoch Children's Research Institute, Royal Children's Hospital, Victoria, Australia; Departments of Paediatrics and Psychiatry, Faculty of Medicine, The University of Melbourne, Victoria, Australia
| | - Ha N D Le
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
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McKenna K, Wanni Arachchige Dona S, Gold L, Dew A, Le HND. Barriers and Enablers of Service Access and Utilization for Children and Adolescents With Attention Deficit Hyperactivity Disorder: A Systematic Review. J Atten Disord 2024; 28:259-278. [PMID: 38084035 PMCID: PMC10838487 DOI: 10.1177/10870547231214002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To update a systematic review of the literature on the barriers and enablers of service access and utilization for children and adolescents with a diagnosis, or symptoms of attention deficit/hyperactivity disorder (ADHD), from the perspective of caregivers, clinicians, and teachers. METHODS Five databases were searched for peer-reviewed literature published from May 2012 to March 2023. Two independent reviewers completed a two-stage screening process and quality assessment. RESULTS Of 4,523 search results, 30 studies were included. Five main themes were generated: 1) Awareness of ADHD, 2) Stigma, 3) Parental choice and partnerships, 4) Education services as an integral component, 5) Referrals, waiting times, and logistics. More than half of the studies reported poor acknowledgement, expertise of ADHD, and stigma. CONCLUSION Findings highlight the need for ongoing ADHD education for all involved and policy changes to service delivery systems to increase the availability of health providers with specialist ADHD expertise.
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Affiliation(s)
| | | | - Lisa Gold
- Deakin University, Burwood, Australia
| | | | - Ha N D Le
- Deakin University, Burwood, Australia
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Wanni Arachchige Dona S, Badloe N, Sciberras E, Gold L, Coghill D, Le HND. The Impact of Childhood Attention-Deficit/Hyperactivity Disorder (ADHD) on Children's Health-Related Quality of Life: A Systematic Review and Meta-Analysis. J Atten Disord 2023; 27:598-611. [PMID: 36800919 PMCID: PMC10068409 DOI: 10.1177/10870547231155438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To investigate the association between children's health-related quality of life (HRQoL) and childhood attention-deficit/hyperactivity disorder (ADHD). METHOD Databases were systematically searched for peer-reviewed literature published between 2010 and 2022. Two reviewers independently screened and assessed the quality of included studies. Meta-analysis was conducted for studies that used the Pediatric Quality of Life Inventory (PedsQL). RESULTS Twenty-three studies were included, with most rated as "good" quality. Meta-analysis found "very large" effect in both parent- (Hedges' g -1.67, 95% CI [-2.57, -0.78]) and child-reported (Hedges' g -1.28, 95% CI [-2.01, -0.56]) HRQoL for children with ADHD compared to children without ADHD. No difference between parent- and child-reported HRQoL in children with and without ADHD was found. However, parent-reported HRQoL was lower than child-reported HRQoL among children with ADHD. CONCLUSION ADHD was associated with substantially poorer children's HRQoL. Among children with ADHD, parents rated their children's HRQoL lower than the children themselves.
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Affiliation(s)
- Sithara Wanni Arachchige Dona
- Deakin University, Burwood, VIC,
Australia
- Sithara Wanni Arachchige Dona, Deakin
Health Economics, School of Health and Social Development, Faculty of Health,
Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.
| | | | - Emma Sciberras
- Deakin University, Burwood, VIC,
Australia
- Royal Children’s Hospital, Parkville,
VIC, Australia
- The University of Melbourne, Parkville,
VIC, Australia
| | - Lisa Gold
- Deakin University, Burwood, VIC,
Australia
| | - David Coghill
- Royal Children’s Hospital, Parkville,
VIC, Australia
- The University of Melbourne, Parkville,
VIC, Australia
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Le HND, Mensah F, Eadie P, McKean C, Sciberras E, Bavin EL, Reilly S, Gold L. Health-related quality of life of children with low language from early childhood to adolescence: results from an Australian longitudinal population-based study. J Child Psychol Psychiatry 2021; 62:349-356. [PMID: 32488955 DOI: 10.1111/jcpp.13277] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Low language abilities are known to be associated with significant adverse long-term outcomes. However, associations between low language and health-related quality of life (HRQoL) are unclear. We aimed to (a) examine the association between low language and HRQoL from 4 to 13 years and (b) classify the children's trajectories of HRQoL and language and examine the association between language and HRQoL trajectories. METHODS Data were from an Australian community-based cohort of children. HRQoL was measured at ages 4-13 years using the parent-reported Pediatric Quality of Life Inventory 4.0. Language was assessed using the Clinical Evaluation of Language Fundamentals (CELF)-Preschool 2nd edition at 4 years and the CELF-4th edition at 5, 7 and 11 years. Multivariable linear regression and mixed effect modelling were used to estimate cross-sectional and longitudinal associations between low language and HRQoL from 4 to 13 years. A joint group-based trajectory model was used to characterize associations between HRQoL and language trajectories over childhood. RESULTS Children with low language had substantially lower HRQoL than children with typical language from 4 to 13 years. Higher language scores were associated with better HRQoL, particularly in social and school functioning. Three HRQoL trajectories were identified: stable-high (51% of children), reduced with slow decline (40%) and low with rapid decline (9%). Children with low language were less likely to follow a stable-high HRQoL trajectory (40%) while 26% and 34% followed the reduced with slow decline and low with rapid decline trajectories, respectively. CONCLUSIONS Children with low language experienced reduced HRQoL from 4 to 13 years. More than half had declining trajectories in HRQoL highlighting the need to monitor these children over time. Interventions should not only aim to improve children's language ability but also address the wider functional impacts of low language.
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Affiliation(s)
- Ha N D Le
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Pediatrics, Univey of Melbourne, Melbourne, Vic., Australia.,Royal Children's Hospital, Melbourne, Vic., Australia
| | - Patricia Eadie
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Vic., Australia
| | - Cristina McKean
- Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Speech and Language Sciences, School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia
| | - Emma Sciberras
- Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Pediatrics, Univey of Melbourne, Melbourne, Vic., Australia.,School of Psychology, Deakin University, Geelong, Vic., Australia
| | - Edith L Bavin
- Murdoch Children's Research Institute, Melbourne, Vic., Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Sheena Reilly
- Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Pediatrics, Univey of Melbourne, Melbourne, Vic., Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia
| | - Lisa Gold
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia
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Le HND, Petersen S, Mensah F, Gold L, Wake M, Reilly S. Health-Related Quality of Life in Children With Low Language or Congenital Hearing Loss, as Measured by the PedsQL and Health Utility Index Mark 3. Value Health 2020; 23:164-170. [PMID: 32113621 DOI: 10.1016/j.jval.2019.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 05/08/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To examine health-related quality of life (HRQoL) in young children with low language or congenital hearing loss and to explore the value of assessing HRQoL by concurrently administering 2 HRQoL instruments in populations of children. METHODS Data were from 2 Australian community-based studies: Language for Learning (children with typical and low language at age 4 years, n = 1012) and the Statewide Comparison of Outcomes study (children with hearing loss, n = 108). HRQoL was measured using the parent-reported Health Utilities Index Mark 3 (HUI3) and the Pediatrics Quality of Life Inventory 4.0 (PedsQL) generic core scale. Agreement between the HRQoL instruments was assessed using intraclass correlation and Bland-Altman plots. RESULTS Children with low language and with hearing loss had lower HRQoL than children with normal language; the worst HRQoL was experienced by children with both. The lower HRQoL was mainly due to impaired school functioning (PedsQL) and speech and cognition (HUI3). Children with hearing loss also had impaired physical and social functioning (PedsQL), vision, hearing, dexterity, and ambulation (HUI3). Correlations between instruments were poor to moderate, with low agreement. CONCLUSIONS Children with low language and congenital hearing loss might benefit from interventions targeting overall health and well-being, not just their impairments. The HUI3 and PedsQL each seemed to provide unique information and thus may supplement each other in assessing HRQoL of young children, including those with low language or congenital hearing loss.
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Affiliation(s)
- Ha N D Le
- Deakin Health Economics, Deakin University, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Melbourne, Australia.
| | - Solveig Petersen
- Deakin Health Economics, Deakin University, Geelong, Victoria, Australia; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Fiona Mensah
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia; Department of Pediatrics, The University of Melbourne, Parkville, Melbourne, Australia; Royal Children's Hospital, Parkville, Melbourne, Australia
| | - Lisa Gold
- Deakin Health Economics, Deakin University, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Melbourne, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia; Department of Pediatrics, The University of Melbourne, Parkville, Melbourne, Australia; Department of Paediatrics and the Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Sheena Reilly
- Murdoch Children's Research Institute, Parkville, Melbourne, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Le HND, Le LKD, Nguyen PK, Mudiyanselage SB, Eadie P, Mensah F, Sciberras E, Gold L. Health-related quality of life, service utilization and costs of low language: A systematic review. Int J Lang Commun Disord 2020; 55:3-25. [PMID: 31556211 DOI: 10.1111/1460-6984.12503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 09/02/2019] [Accepted: 09/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Low language (LL) is a common childhood condition affecting 7-17% of children. It is associated with life-long adverse outcomes and can affect various aspects of a child's life. However, the literature on its impact on health-related quality of life (HRQoL), service use and costs are limited. To date, there has been no systematic review of the overall economic burden of LL. A systematic review regarding the economic burden of LL is important for clinical, educational, policy decision-making and theoretical aspects. We adopted the term 'low language' to refer to children whose language performance falls below well-recognized cut-points regardless of known or unknown aetiology. AIMS To review the literature systematically on how LL is associated with HRQoL, service utilization and costs. METHODS & PROCEDURES A systematic search was conducted across various databases, including MEDLINE, Embase, PsycINFO, CINAHL, up to July 2017. Data on study design, population and outcomes were extracted and screened by two pairs of reviewers with the revision of other experts in the panel on any discrepancies. The Effective Public Health Practice Project tool was used to assess the risk of bias of the included studies. The findings of the included studies were summarized in a narrative synthesis. OUTCOMES & RESULTS We identified 22 relevant articles, of which 12 reported HRQoL and 11 reported service utilization and costs associated with LL. Preference-based instruments, which include the relative importance attached to different aspects of HRQoL, were less employed in the literature. Most studies found poorer HRQoL in children with LL compared with their peers. About half the families having children with LL did not actively seek professional help, and many families felt they did not receive sufficient services when needed. Healthcare costs associated with LL were substantial. Non-healthcare costs were largely unexplored. CONCLUSIONS & IMPLICATIONS LL was associated with reduced children's HRQoL, higher service use and costs. Under-servicing was evident in children with LL. LL also imposed large costs on the healthcare system. Further research is required to examine (1) the overall HRQoL of children with LL, in particular studies using and testing the performance of preference-based instruments; and (2) the service use and costs specific to LL, especially non-healthcare costs.
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Affiliation(s)
- Ha N D Le
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
- Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia
| | - Long K D Le
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Phuong K Nguyen
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | | | - Patricia Eadie
- Melbourne Graduate School of Education, The University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia
- Royal Children's Hospital, Parkville, Melbourne, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - Emma Sciberras
- Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia
- School Psychology, Deakin University, Geelong, VIC, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
- Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia
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Saeidi H, Le HND, Opfermann JD, Leonard S, Kim A, Hsieh MH, Kang JU, Krieger A. Autonomous Laparoscopic Robotic Suturing with a Novel Actuated Suturing Tool and 3D Endoscope. IEEE Int Conf Robot Autom 2019; 2019:1541-1547. [PMID: 33628614 PMCID: PMC7901147 DOI: 10.1109/icra.2019.8794306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Compared to open surgical techniques, laparoscopic surgical methods aim to reduce the collateral tissue damage and hence decrease the patient recovery time. However, constraints imposed by the laparoscopic surgery, i.e. the operation of surgical tools in limited spaces, turn simple surgical tasks such as suturing into time-consuming and inconsistent tasks for surgeons. In this paper, we develop an autonomous laparoscopic robotic suturing system. More specific, we expand our smart tissue anastomosis robot (STAR) by developing i) a new 3D imaging endoscope, ii) a novel actuated laparoscopic suturing tool, and iii) a suture planning strategy for the autonomous suturing. We experimentally test the accuracy and consistency of our developed system and compare it to sutures performed manually by surgeons. Our test results on suture pads indicate that STAR can reach 2.9 times better consistency in suture spacing compared to manual method and also eliminate suture repositioning and adjustments. Moreover, the consistency of suture bite sizes obtained by STAR matches with those obtained by manual suturing.
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Affiliation(s)
- H Saeidi
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - H N D Le
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211
| | - J D Opfermann
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Health System, 111 Michigan Ave. N.W., Washington, DC 20010
| | - S Leonard
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211
| | - A Kim
- University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - M H Hsieh
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Health System, 111 Michigan Ave. N.W., Washington, DC 20010
| | - J U Kang
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211
| | - A Krieger
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
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Reilly S, Cini E, Gold L, Goldfeld S, Law J, Levickis P, Mensah F, Morgan A, Nicholson JM, Le HND, Pezic A, Tomblin B, Wake M, Wardrop L. Data resource profile: The Child LAnguage REpository (CLARE). Int J Epidemiol 2018; 47:688-688j. [DOI: 10.1093/ije/dyy034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/07/2018] [Accepted: 02/21/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sheena Reilly
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Eileen Cini
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Burwood, VIC, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Sharon Goldfeld
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, Australia
| | - James Law
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Penny Levickis
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Mensah
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Angela Morgan
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, VIC, Australia
| | - Jan M Nicholson
- Judith Lumley Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Ha N D Le
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, Australia
- Population Health Strategic Research Center, Deakin Health Economics, Deakin University, Geelong, VIC, Australia
| | - Angela Pezic
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Bruce Tomblin
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
| | - Melissa Wake
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Department of Paediatrics and Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Louise Wardrop
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville, VIC, Australia
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Goldfeld S, Snow P, Eadie P, Munro J, Gold L, Le HND, Orsini F, Shingles B, Lee K, Connell J, Watts A. Classroom Promotion of Oral Language (CPOL): protocol for a cluster randomised controlled trial of a school-based intervention to improve children's literacy outcomes at grade 3, oral language and mental health. BMJ Open 2017; 7:e016574. [PMID: 29162571 PMCID: PMC5719328 DOI: 10.1136/bmjopen-2017-016574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Oral language and literacy competence are major influences on children's developmental pathways and life success. Children who do not develop the necessary language and literacy skills in the early years of school then go on to face long-term difficulties. Improving teacher effectiveness may be a critical step in lifting oral language and literacy outcomes. The Classroom Promotion of Oral Language trial aims to determine whether a specifically designed teacher professional learning programme focusing on promoting oral language can lead to improved teacher knowledge and practice, and advance outcomes in oral language and literacy for early years school children, compared with usual practice. METHODS AND ANALYSIS This is a two-arm cluster multisite randomised controlled trial conducted within Catholic and Government primary schools across Victoria, Australia. The intervention comprises 4 days of face-to-face professional learning for teachers and ongoing implementation support via a specific worker. The primary outcome is reading ability of the students at grade 3, and the secondary outcomes are teacher knowledge and practice, student mental health, reading comprehension and language ability at grade 1; and literacy, writing and numeracy at grade 3. Economic evaluation will compare the incremental costs of the intervention to the measured primary and secondary outcomes. ETHICS AND DISSEMINATION This trial was approved by the Monash University Human Research Ethics Committee #CF13/2634-2013001403 and later transferred to the University of Melbourne #1545540. The investigators (including Government and Catholic partners) will communicate trial results to stakeholders, collaborators and participating schools and teachers via appropriate presentations and publications. TRIAL REGISTRATION NUMBER ISRCTN77681972; Pre-results.
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Affiliation(s)
- Sharon Goldfeld
- Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Pamela Snow
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Patricia Eadie
- Melbourne Graduate School of Education, The University of Melbourne Parkville, Parkville, Victoria, Australia
| | - John Munro
- Melbourne Graduate School of Education, The University of Melbourne Parkville, Parkville, Victoria, Australia
| | - Lisa Gold
- Deakin University, Geelong, Victoria, Australia
| | - Ha N D Le
- Deakin University, Geelong, Victoria, Australia
| | - Francesca Orsini
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Beth Shingles
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Katherine Lee
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Judy Connell
- Catholic Education Melbourne, East Melbourne, Victoria, Australia
| | - Amy Watts
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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Le HND, Gold L, Mensah F, Eadie P, Bavin EL, Bretherton L, Reilly S. Service utilisation and costs of language impairment in children: The early language in Victoria Australian population-based study. Int J Speech Lang Pathol 2017; 19:360-369. [PMID: 27467452 DOI: 10.1080/17549507.2016.1209559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 04/12/2016] [Accepted: 05/23/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To examine (1) the patterns of service use and costs associated with language impairment in a community cohort of children from ages 4-9 years and (2) the relationship between language impairment and health service utilisation. METHOD Participants were children and caregivers of six local government areas in Melbourne participating in the community-based Early Language in Victoria Study (ELVS). Health service use was reported by parents. Costs were valued in Australian dollars in 2014, from the government and family perspectives. Depending on age, the Australian adapted Clinical Evaluation of Language Fundamentals - Pre-school, 2nd Edition (CELF-P2) or the CELF, 4th Edition (CELF4) was used to assess expressive and receptive language. RESULT At 5, 7 and 9 years respectively 21%, 11% and 8% of families reported using services for speech and/or language concerns. The annual costs associated with using services averaged A$612 (A$255 to government, A$357 to family) at 5 years and A$992 (A$317 to government, A$675 to family) at 7 years. Children with persistent language impairment had significantly higher service costs than those with typical language. CONCLUSION Language impairment in 4-9-year-old children is associated with higher use of services and costs to both families and government compared to typical language.
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Affiliation(s)
- Ha N D Le
- a Population Health Strategic Research Center , Deakin Health Economics, Deakin University , Burwood , Victoria , Australia
- b Center for Community Child Health , The Royal Children's Hospital , Parkville , Victoria , Australia
| | - Lisa Gold
- a Population Health Strategic Research Center , Deakin Health Economics, Deakin University , Burwood , Victoria , Australia
- b Center for Community Child Health , The Royal Children's Hospital , Parkville , Victoria , Australia
| | - Fiona Mensah
- c Murdoch Children's Research Institute , The Royal Children's Hospital , Parkville , Victoria , Australia
- d Department of Paediatrics , The University of Melbourne , Melbourne , Victoria , Australia
| | - Patricia Eadie
- e Melbourne Graduate School of Education , University of Melbourne , Melbourne , Victoria , Australia
| | - Edith L Bavin
- f School of Psychology and Public Health , La Trobe University , Melbourne , Victoria , Australia
| | - Lesley Bretherton
- c Murdoch Children's Research Institute , The Royal Children's Hospital , Parkville , Victoria , Australia
- d Department of Paediatrics , The University of Melbourne , Melbourne , Victoria , Australia
- g Faculty of Medicine, Melbourne School of Psychological Sciences , Dentistry, and Health Sciences, University of Melbourne , Melbourne , Victoria , Australia , and
| | - Sheena Reilly
- c Murdoch Children's Research Institute , The Royal Children's Hospital , Parkville , Victoria , Australia
- d Department of Paediatrics , The University of Melbourne , Melbourne , Victoria , Australia
- h Menzies Health Institute Queensland , Griffith University , QLD , Australia
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14
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Le HND, Gold L, Mensah FK, Cook F, Bayer JK, Hiscock H. Health service use and costs for infant behaviour problems and maternal stress. J Paediatr Child Health 2016; 52:402-9. [PMID: 27145503 DOI: 10.1111/jpc.13095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/20/2015] [Accepted: 10/23/2015] [Indexed: 11/28/2022]
Abstract
AIM We aim to describe health service (HS) use in the first 6 months post-partum and to examine the associations between service costs, infant behaviour and maternal depressive symptoms. METHODS Participants were 781 infants and mothers in Melbourne, Australia. Mothers reported infant feeding, sleeping and crying problems, depressive symptoms and health service use. Costs were valued in 2012 Australian dollars. RESULTS The most common services used were maternal child health nurses, general practitioners (GP) and allied health. Infant feeding problems were associated with increased costs for services relevant to infant behaviour including maternal child health nurses (P = 0.007), GP (P = 0.008) and paediatricians (P = 0.03). Maternal depressive symptoms were associated with increased costs for services relevant to depressive symptoms including parenting centres (P = 0.04), GP (P = 0.004), psychiatrists (P = 0.02) and psychologists (P = 0.001). Mothers who completed high school had higher service costs for infant problems than those with lower education (P = 0.02). Single mothers had higher costs for services used for their depressive symptoms than partnered mothers (P < 0.001). Mothers with English as a second language had lower service costs for their depressive symptoms (P = 0.02). CONCLUSIONS Infant feeding problems and maternal depressive symptoms are associated with higher costs for health services relevant to these conditions. Cost-effective strategies to manage these conditions are needed with accessibility being ensured for mothers who are experiencing social adversity.
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Affiliation(s)
- Ha N D Le
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia.,Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lisa Gold
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia.,Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Fiona K Mensah
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Fallon Cook
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Parenting Research Centre, Melbourne, Victoria, Australia
| | - Jordana K Bayer
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Wake M, Levickis P, Tobin S, Gold L, Ukoumunne OC, Goldfeld S, Zens N, Le HND, Law J, Reilly S. Two-Year Outcomes of a Population-Based Intervention for Preschool Language Delay: An RCT. Pediatrics 2015; 136:e838-47. [PMID: 26347428 DOI: 10.1542/peds.2015-1337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We have previously shown short-term benefits to phonology, letter knowledge, and possibly expressive language from systematically ascertaining language delay at age 4 years followed by the Language for Learning intervention. Here, we report the trial's definitive 6-year outcomes. METHODS Randomized trial nested in a population-based ascertainment. Children with language scores >1.25 SD below the mean at age 4 were randomized, with intervention children receiving 18 1-hour home-based therapy sessions. Primary outcome was receptive/expressive language. Secondary outcomes were phonological, receptive vocabulary, literacy, and narrative skills; parent-reported pragmatic language, behavior, and health-related quality of life; costs of intervention; and health service use. For intention-to-treat analyses, trial arms were compared using linear regression models. RESULTS Of 1464 children assessed at age 4, 266 were eligible and 200 randomized; 90% and 82% of intervention and control children were retained respectively. By age 6, mean language scores had normalized, but there was little evidence of a treatment effect for receptive (adjusted mean difference 2.3; 95% confidence interval [CI] -1.2 to 5.7; P = .20) or expressive (0.8; 95% CI -1.6 to 3.2; P = .49) language. Of the secondary outcomes, only phonological awareness skills (effect size 0.36; 95% CI 0.08-0.65; P = .01) showed benefit. Costs were higher for intervention families (mean difference AU$4276; 95% CI: $3424 to $5128). CONCLUSIONS Population-based intervention targeting 4-year-old language delay was feasible but did not have lasting impacts on language, possibly reflecting resolution in both groups. Long-term literacy benefits remain possible but must be weighed against its cost.
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Affiliation(s)
- Melissa Wake
- Centre for Community Child Health, Royal Children's Hospital, Parkville, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Australia;
| | - Penny Levickis
- Centre for Community Child Health, Royal Children's Hospital, Parkville, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Melbourne, Australia
| | - Sherryn Tobin
- Centre for Community Child Health, Royal Children's Hospital, Parkville, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Melbourne, Australia
| | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, Australia
| | - Obioha C Ukoumunne
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, United Kingdom; and
| | - Sharon Goldfeld
- Centre for Community Child Health, Royal Children's Hospital, Parkville, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Australia
| | - Naomi Zens
- Centre for Community Child Health, Royal Children's Hospital, Parkville, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Melbourne, Australia
| | - Ha N D Le
- Deakin Health Economics, Deakin University, Burwood, Australia
| | - James Law
- Institute of Health and Society, School of Education, Communication and Language Sciences, University of Newcastle, United Kingdom
| | - Sheena Reilly
- Murdoch Childrens Research Institute, Parkville, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Australia
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Ball K, McNaughton SA, Le HND, Gold L, Ni Mhurchu C, Abbott G, Pollard C, Crawford D. Influence of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: outcomes of the Supermarket Healthy Eating for Life randomized controlled trial. Am J Clin Nutr 2015; 101:1055-64. [PMID: 25877492 DOI: 10.3945/ajcn.114.096735] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 03/04/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fiscal strategies are increasingly considered upstream nutrition promotion measures. However, few trials have investigated the effectiveness or cost effectiveness of pricing manipulations on diet in real-world settings. OBJECTIVE We assessed the effects on fruit, vegetable, and beverage purchasing and consumption of a 20% price-reduction intervention, a tailored skills-based behavior-change intervention, and a combined intervention compared with a control condition. DESIGN The Supermarket Healthy Eating for Life trial was a randomized controlled trial conducted over 3 mo [baseline (time 1) to postintervention (time 2) with a 6-mo follow-up (time 3)]. Female primary household shoppers in Melbourne, Australia, were randomly assigned to a 1) skill-building (n = 160), 2) price-reduction (n = 161), 3) combined skill-building and price-reduction (n = 160), or 4) control (n = 161) group. Supermarket transaction data and surveys were used to measure the following study outcomes: fruit, vegetable, and beverage purchases and self-reported fruit and vegetable consumption at each time point. RESULTS At 3 mo (time 2), price reduction-alone participants purchased more total vegetables and frozen vegetables than did controls. Price reduction-alone and price reduction-plus-skill-building participants purchased more fruit than did controls. Relative to controls, in the price-reduction group, total vegetable consumption increased by 233 g/wk (3.1 servings or 15% more than at baseline), and fruit purchases increased by 364 g/wk (2.4 servings; 35% more than at baseline). Increases were not maintained 6 mo postintervention (time 3). Price reduction-alone participants showed a tendency for a slight increase in fruit consumption at time 2 (P = 0.09) that was maintained at time 3 (P = 0.014). No intervention improved purchases of bottled water or low-calorie beverages. CONCLUSIONS A 20% price reduction in fruit and vegetables resulted in increased purchasing per household of 35% for fruit and 15% for vegetables over the price-reduction period. These findings show that price modifications can directly increase produce purchases. The Supermarket Healthy Eating for Life trial was registered at Current Controlled Trials Registration as ISRCTN39432901.
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Affiliation(s)
- Kylie Ball
- From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP)
| | - Sarah A McNaughton
- From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP)
| | - Ha N D Le
- From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP)
| | - Lisa Gold
- From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP)
| | - Cliona Ni Mhurchu
- From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP)
| | - Gavin Abbott
- From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP)
| | - Christina Pollard
- From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP)
| | - David Crawford
- From the Centre for Physical Activity and Nutrition Research (KB, SAM, GA, and DC) and Deakin Health Economics (HNDL and LG), Deakin University, Burwood, Australia; the National Institute for Health Innovation, University of Auckland, Auckland, New Zealand (CNM); and the School of Public Health, Curtin University, Perth, Australia (CP)
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Connelly LB, Le HND. Cost-effectiveness of a bivalent human papillomavirus vaccination program in Japan. Sex Health 2015; 12:520-31. [DOI: 10.1071/sh14241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 06/17/2015] [Indexed: 11/23/2022]
Abstract
Background
Human papillomavirus (HPV) vaccines and their widespread adoption have the potential to relieve a large part of the burden of cervical cancer morbidity and mortality, particularly in countries that have low screening rates or, like Japan, lack a cohesive universal screening program. An economic evaluation was conducted to assess the cost-effectiveness of introducing a bivalent HPV vaccination program in Japan from a healthcare perspective. Methods: A Markov model of the natural history of HPV infection that incorporates both vaccination and screening was developed for Japan. The modelled intervention, a bivalent HPV vaccine with a 100% lifetime vaccine efficacy and 80% vaccine coverage, given to a cohort of 12-year-old Japanese girls in conjunction with the current screening program, was compared with screening alone in terms of costs and effectiveness. A discount rate of 5% was applied to both costs and utilities where relevant. Results: Vaccination alongside screening compared with screening alone is associated with an incremental cost-effectiveness ratio (ICER) of US$20 315 per quality-adjusted-life-year gained if 80% coverage is assumed. The ICER at 5% coverage with the vaccine plus screening, compared with screening alone, is US$1158. Conclusion: The cost-effectiveness results suggest that the addition of a HPV vaccination program to Japan’s cervical cancer screening program is highly likely to prove a cost-effective way to reduce the burden of cervical cancer, precancerous lesions and HPV16/18-related diseases.
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Hiscock H, Cook F, Bayer J, Le HND, Mensah F, Cann W, Symon B, St James-Roberts I. Preventing early infant sleep and crying problems and postnatal depression: a randomized trial. Pediatrics 2014; 133:e346-54. [PMID: 24394682 DOI: 10.1542/peds.2013-1886] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate a prevention program for infant sleep and cry problems and postnatal depression. METHODS Randomized controlled trial with 781 infants born at 32 weeks or later in 42 well-child centers, Melbourne, Australia. Follow-up occurred at infant age 4 and 6 months. The intervention including supplying information about normal infant sleep and cry patterns, settling techniques, medical causes of crying and parent self-care, delivered via booklet and DVD (at infant age 4 weeks), telephone consultation (8 weeks), and parent group (13 weeks) versus well-child care. Outcomes included caregiver-reported infant night sleep problem (primary outcome), infant daytime sleep, cry and feeding problems, crying and sleep duration, caregiver depression symptoms, attendance at night wakings, and formula changes. RESULTS Infant outcomes were similar between groups. Relative to control caregivers, intervention caregivers at 6 months were less likely to score >9 on the Edinburgh Postnatal Depression Scale (7.9%, vs 12.9%, adjusted odds ratio [OR] 0.57, 95% confidence interval [CI] 0.34 to 0.94), spend >20 minutes attending infant wakings (41% vs 51%, adjusted OR 0.66, 95% CI 0.46 to 0.95), or change formula (13% vs 23%, P < .05). Infant frequent feeders (>11 feeds/24 hours) in the intervention group were less likely to have daytime sleep (OR 0.13, 95% CI 0.03 to 0.54) or cry problems (OR 0.27, 95% CI 0.08 to 0.86) at 4 months. CONCLUSIONS An education program reduces postnatal depression symptoms, as well as sleep and cry problems in infants who are frequent feeders. The program may be best targeted to frequent feeders.
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Affiliation(s)
- Harriet Hiscock
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Australia
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Wake M, Levickis P, Tobin S, Zens N, Law J, Gold L, Ukoumunne OC, Goldfeld S, Le HND, Skeat J, Reilly S. Improving outcomes of preschool language delay in the community: protocol for the Language for Learning randomised controlled trial. BMC Pediatr 2012; 12:96. [PMID: 22776103 PMCID: PMC3504523 DOI: 10.1186/1471-2431-12-96] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 06/15/2012] [Indexed: 12/03/2022] Open
Abstract
Background Early language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system. Methods/Design A large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or ‘usual care’ control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a ‘step up-step down’ therapeutic approach depending on the child’s language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills. Discussion A key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework. Trial registration Current Controlled Trials ISRCTN03981121.
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Affiliation(s)
- Melissa Wake
- Centre for Community Child Health, Royal Children's Hospital, Parkville, Australia.
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Ball K, McNaughton SA, Mhurchu CN, Andrianopoulos N, Inglis V, McNeilly B, Le HND, Leslie D, Pollard C, Crawford D. Supermarket Healthy Eating for Life (SHELf): protocol of a randomised controlled trial promoting healthy food and beverage consumption through price reduction and skill-building strategies. BMC Public Health 2011; 11:715. [PMID: 21936957 PMCID: PMC3186753 DOI: 10.1186/1471-2458-11-715] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 09/22/2011] [Indexed: 11/27/2022] Open
Abstract
Background In the context of rising food prices, there is a need for evidence on the most effective approaches for promoting healthy eating. Individually-targeted behavioural interventions for increasing food-related skills show promise, but are unlikely to be effective in the absence of structural supports. Fiscal policies have been advocated as a means of promoting healthy eating and reducing obesity and nutrition-related disease, but there is little empirical evidence of their effectiveness. This paper describes the Supermarket Healthy Eating for LiFe (SHELf) study, a randomised controlled trial to investigate effectiveness and cost-effectiveness of a tailored skill-building intervention and a price reduction intervention, separately and in combination, against a control condition for promoting purchase and consumption of healthy foods and beverages in women from high and low socioeconomic groups. Methods/design SHELf comprises a randomised controlled trial design, with participants randomised to receive either (1) a skill-building intervention; (2) price reductions on fruits, vegetables and low-joule soft drink beverages and water; (3) a combination of skill-building and price reductions; or (4) a control condition. Five hundred women from high and low socioeconomic areas will be recruited through a store loyalty card program and local media. Randomisation will occur on receipt of informed consent and baseline questionnaire. An economic evaluation from a societal perspective using a cost-consequences approach will compare the costs and outcomes between intervention and control groups. Discussion This study will build on a pivotal partnership with a major national supermarket chain and the Heart Foundation to investigate the effectiveness of intervention strategies aimed at increasing women's purchasing and consumption of fruits and vegetables and decreased purchasing and consumption of sugar-sweetened beverages. It will be among the first internationally to examine the effects of two promising approaches - skill-building and price reductions - on diet amongst women. Trial Registration Current Controlled Trials ISRCTN39432901
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Affiliation(s)
- Kylie Ball
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood Hwy, Burwood, 3125, Australia.
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