ORCID Profile
0000-0003-2322-5555
Current Organisation
University of South Australia
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Nutrition and Dietetics | Nutrition And Dietetics | Mental Health | Public Health and Health Services | Human Movement And Sports Science Not Elsewhere Classified | Public Nutrition Intervention | Educational Psychology
ANZSRC Socio-Economic Objective (SEO)
Child health | Behaviour and health | Health related to ageing | Nutrition | Fish not elsewhere classified | Aboriginal and Torres Strait Islander health |
Related Links
Publications
The history of health technology assessment in Australia
Publisher: Cambridge University Press (CUP)
Date: 07-2009
DOI: 10.1017/S0266462309090436
Abstract: Objectives: To describe the development and application of health technology assessment (HTA) in Australia. Methods: Review of relevant literature and other documents related to HTA in Australia. Results: Most HTA activity in Australia has been associated with provision of advice for the two national subsidy programs, Medicare, and the Pharmaceutical Benefits Scheme (PBS). National advisory bodies established by the federal government have had a prominent role. Assessments from the advisory bodies have had a major influence on decisions related to Medicare and the PBS, and in some other areas. Technologies without links to the national subsidy schemes, and those that are widely distributed, have been less well covered by HTA. To some extent these are addressed by evaluations supported by state governments, but details of approaches taken are not readily available. Conclusions: HTA in Australia now has a long history and is well established as a source of advice to health decision makers. Challenges remain in extending the scope of assessments, developing more transparent approaches in some areas, and consistently applying appropriate standards.
Associations between parenting styles and nutrition knowledge and 2-5-year-old children's fruit, vegetable and non-core food consumption
Publisher: Cambridge University Press (CUP)
Date: 22-10-2013
DOI: 10.1017/S1368980012004648
Abstract: During the early years, parents have a major influence on children's diets and developing food choices. We investigated parenting styles as predictors of 2–5-year-old children's diets and whether general nutrition knowledge (GNK) mediated these influences. Cross-sectional research. Questionnaires measured demographic and lifestyle variables, family environment, parenting styles and feeding practices, child diet and GNK. Regression models tested GNK as a mediator of relationships between parenting variables and child diet (fruit/vegetable and non-core food consumption), controlling for confounders and family environment. Questionnaires were completed by main caregivers at home. Parents of children aged 2–5 years ( n 269). Higher child fruit/vegetable consumption was associated with lower over-reactive parenting and restriction, higher authoritative parenting and dining together as a family with lax parenting approaching statistical significance ( P = 0·083) and 19 % of variance explained by the model. GNK was not a significant predictor. Conversely, non-core food consumption was associated with higher over-reactive and lax parenting as well as child age, increased takeaway food consumption and higher television viewing GNK had a small effect ( P = 0·043) and 28 % of variance was explained by the model. GNK was a significant mediator only for authoritative parenting on non-core food (effect = −0·005). These findings highlight that young children's diets may be improved by interventions targeting a range of positive and supportive parenting practices in conjunction with nutrition knowledge education for parents of young children. Further insights will come from closer attention to the nature and role of restrictive feeding practices v . laxness and longitudinal research.
ASSESSMENT OF COSTS AND BENEFITS IN THE INTRODUCTION OF DIGITAL RADIOLOGY SYSTEMS
Publisher: Elsevier BV
Date: 1992
DOI: 10.1016/0020-7101(92)90058-Z
Abstract: A discussion is presented of cost and benefit considerations in establishing digital radiology systems and an approach to assessment of such factors. Costs of digital radiology systems need to be defined and compared appropriately. Assessments should consider capital and replacement costs, but also less tangible items such as effects on staff and training requirements, hospital infrastructure, productivity, file integrity and diagnostic accuracy. Benefits of digital radiology systems could be assessed using cost-benefit and social audit analysis techniques, yielding a matrix of monetary items and also summaries of non-monetary benefits. Such analysis would define the major participants in the digital radiology process and the nature of their interests and assess the costs and benefits impacting on each of them. Economic evaluation of digital radiology to date has focused on the cost side of the appraisal. Analyses of benefits of digital radiology systems have been limited and have given inconclusive results. There is a need for better definition of comparative costs and benefits to inform interested parties, including hospital staff and health policy makers. Such economic analysis is an important way of asking the right questions about resource usage and could usually be carried out in a pilot setting before there is wider diffusion of digital radiology systems.
Evaluation of a telepsychiatry pilot project
Publisher: SAGE Publications
Date: 03-1999
Abstract: We assessed a telepsychiatry pilot project in which a psychiatric hospital was linked with mental health clinics in five general hospitals. Information was collected through questionnaires administered to patients, service providers and psychiatric consultants, and by interviews. The technology was considered easy to use by participating health-care professionals and patients, and the quality of the sound and picture was adequate. Survey data suggested acceptance and satisfaction on the part of patients, service providers and psychiatric consultants. An economic analysis indicated that at 396 consultations per year the service cost the same as providing a travelling psychiatrist C 610 per consultation with more consultations, telepsychiatry was cheaper. Information gathered during the evaluation suggested that the use of videoconferencing for psychiatric consultations was a viable option for an integrated, community-based mental health service.
The role of socio-economic position as a moderator of children's healthy food intake
Publisher: Cambridge University Press (CUP)
Date: 23-06-2014
DOI: 10.1017/S0007114514001354
Abstract: Children of low socio-economic position (SEP) consume poorer diets than those of high SEP however, there is limited understanding of why socio-economic gradients in diet occur. Some evidence suggests that determinants of dietary intake may differ between SEP groups. The aim of the present study was to determine whether the associations between personal and environmental variables and children's fruit and vegetable intake, and healthy dietary behaviours are moderated by SEP. A total of 395 children aged 9 to 13 years and their parents were recruited in Adelaide, South Australia. Personal and environmental dietary predictors were measured using child-completed online questionnaires and telephone interviews with parents. Dietary intake was measured using an online FFQ. First, dietary predictors were identified using correlated component regression, and subsequently tested for moderation by four SEP indicators using partial least-squares structural equation modelling. Fruit and vegetable intake and healthy behaviours were predicted by self-efficacy, attitudes and a supportive home environment. For girls, only the associations of self-efficacy with healthy behaviours were moderated by occupation. For boys, income moderated the associations of fruit and vegetable intake with attitudes, and healthy behaviours with supportive home environments. Occupation and employment moderated the associations of boys' family environments and fruit intake, and attitudes with healthy behaviours. Reducing socio-economic disparities in children's healthy dietary intake may be more successfully achieved by tailoring health promotion policies and interventions according to variables that moderate the relationships between dietary intake and SEP.
Fish oil supplementation, learning and behaviour in Indigenous Australian children from a remote community school: a pilot feasibility study
Publisher: Elsevier BV
Date: 10-2011
Omega-3 and Omega-6 Polyunsaturated Fatty Acid Levels and Correlations with Symptoms in Children with Attention Deficit Hyperactivity Disorder, Autistic Spectrum Disorder and Typically Developing Cont
Publisher: Public Library of Science (PLoS)
Date: 27-05-2016
A short history of INAHTA
Publisher: Cambridge University Press (CUP)
Date: 1999
DOI: 10.1017/S0266462399015342
Abstract: The need for better communication and collaboration between health technology assessment agencies led to the formation of an International Network of Agencies for Health Technology Assessment (INAHTA). The network now comprises 27 agencies and has been successful in improving exchange of information and in undertaking joint health technology assessment projects. Issues for the future include possible changes to criteria for membership and identification of resources for more extensive programs.
The use of videoconferencing for mental health services in Finland
Publisher: SAGE Publications
Date: 07-2008
Abstract: The utilization of telemental health (TMH) services in Finland was surveyed in 2006. In total, 135 health-care units provided responses. Eighty-four responses were received from primary care units (health-care centres and clinics) and eight from other clinics, in all hospital districts. The overall rate of TMH consultations was 4 per 100,000 population. The highest TMH consultation per population ratio, 22 per 100,000, was in northern Finland. Most of the sites used telepsychiatry services for less than 10% of clinical outpatient services. The sites with over 20% utilization of clinical TMH services from all psychiatric consultations were all rural health centres. Compared with Finland, the utilization rates of TMH were higher in Canada that might be due to differences between the countries in the organization of mental health services in primary and specialized care. In Finland TMH consultations made up only a very small proportion of all mental health services. The use of TMH was particularly common in remote areas however, there were many rural centres that did not utilize clinical TMH. TMH was widely utilized for continuing and medical education.
Rapid reviews versus full systematic reviews: An inventory of current methods and practice in health technology assessment
Publisher: Cambridge University Press (CUP)
Date: 04-2008
DOI: 10.1017/S0266462308080185
Abstract: Objectives: This review assessed current practice in the preparation of rapid reviews by health technology assessment (HTA) organizations, both internationally and in the Australian context, and evaluated the available peer-reviewed literature pertaining to the methodology used in the preparation of these reviews. Methods: A survey tool was developed and distributed to a total of fifty International Network of Agencies for Health Technology Assessment (INAHTA) members and other selected HTA organizations. Data on a broad range of themes related to the conduct of rapid reviews were collated, discussed narratively, and subjected to simple statistical analysis where appropriate. Systematic searches of the Cochrane Library, EMBASE, MEDLINE, and the Australian Medical Index were undertaken in March 2007 to identify literature pertaining to rapid review methodology. Comparative studies, guidelines, program evaluations, methods studies, commentaries, and surveys were considered for inclusion. Results: Twenty-three surveys were returned (46 percent), with eighteen agencies reporting on thirty-six rapid review products. Axiomatic trends were identified, but there was little cohesion between organizations regarding the contents, methods, and definition of a rapid review. The twelve studies identified by the systematic literature search did not specifically address the methodology underpinning rapid review rather, many highlighted the complexity of the area. Authors suggested restricted research questions and truncated search strategies as methods to limit the time taken to complete a review. Conclusions: Rather than developing a formalized methodology by which to conduct rapid reviews, agencies should work toward increasing the transparency of the methods used for each review. It is perhaps the appropriate use, not the appropriate methodology, of a rapid review that requires future consideration.
Fish Oil and Impulsive Aggressive Behavior
Publisher: Mary Ann Liebert Inc
Date: 10-2016
People with schizophrenia and depression have a low omega-3 index
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.PLEFA.2016.05.007
Abstract: Cardiovascular disease (CVD) is higher in people with mental illness and is associated with a 30 year higher mortality rate in this population. Erythrocyte docosahexaenoic acid (DHA) plus eicosapentaenoic acid (EPA) (omega-3 index)≤4% is a marker for increased mortality risk from CVD while >8% is protective. Omega-3 polyunsaturated fatty acids are also important for brain function and may ameliorate symptoms of mental illness. We investigated the erythrocyte omega-3 index in people with mental illness. One hundred and thirty adults aged 18-65 years (32.6% male) with schizophrenia (n=14) and depression (n=116) provided blood s les and completed physiological assessments and questionnaires. Both populations had risk factors for metabolic syndrome and CVD. The average omega-3 index was 3.95% (SD=1.06), compared to an estimated 5% in the Australian population. These data indicate an unfavourable omega-3 profile in people with mental illness that could contribute to higher CVD risk.
Successes and challenges in a field-based, multi-method study of home telehealth
Publisher: SAGE Publications
Date: 11-2004
Abstract: We are conducting a three-year study of telehealth in 11 home care offices that serve rural clients in Alberta. Three hundred and twenty palliative home care clients are being recruited to participate in a randomized controlled trial (RCT) to answer three questions about the use of video-phones and their effect on symptom management, quality of life and cost, as well as readiness to use the technology. Both successes and challenges have been identified in three main areas: technology, people/organizational issues and study design. Maintaining study integrity has been the key factor in decision making, as adjustments from the original proposal are made. It is already clear that field-based RCTs are feasible, but require commitment and flexibility on the part of researchers and community partners to work through the study implementation.
The importance of long-term follow-up in child and adolescent obesity prevention interventions
Publisher: Informa UK Limited
Date: 08-2011
Describing socioeconomic gradients in children's diets - does the socioeconomic indicator used matter?
Publisher: Springer Science and Business Media LLC
Date: 2014
The influence of technology assessments by advisory bodies on health policy and practice
Publisher: Elsevier BV
Date: 10-1993
DOI: 10.1016/0168-8510(93)90018-K
Abstract: Assessments of 45 health technologies undertaken by Australian advisory bodies are considered in terms of the effect they have had on health care policy. The conduct and impact of the assessments was influenced by selection of topics, timing, other inputs to policy formulation and changes to policy areas and assessment agencies. Seventeen of 26 detailed assessments appear to have influenced policy, with greatest impact occurring when the technology was being introduced and there was collection of local primary data. Continued requests for the assessment reports suggests a possible longer term educational effect. All nine appraisals of proposals for nationally funded centres were influential, but the influence of guidelines for superspecialty services is less clear. Factors decreasing the influence of assessments included limitations of available policy instruments, lack of consensus between governments and professional groups and pressure of more urgent matters on the policy process.
International collaboration in health technology assessment: a study of technologies used in management of osteoporosis
Publisher: Elsevier BV
Date: 03-1998
DOI: 10.1016/S0168-8510(97)00099-7
Abstract: A collaborative study was undertaken by members of the International Network of Agencies for Health Technology Assessment (INAHTA). The evidence of the effectiveness of bone density measurement and selected treatments in preventing fractures in later life was reviewed. There was fair evidence that bone density measurement can predict risk of fractures and that hormone replacement therapy and intranasal salmon calcitonin preserve bone mass and decrease the risk of fractures. However, it was estimated that only 1-7% of hip fractures would be prevented if these technologies were used in a screening program for menopausal women. Results of the assessment were endorsed by 13 INAHTA members, disseminated widely and provided input to policy and further work in this area. The project demonstrated the feasibility of international collaborative health technology assessment.
The role of nutrition and diet in learning and behaviour of children with symptoms of attention deficit hyperactivity disorder
Publisher: Elsevier
Date: 2011
Recommendations and supporting evidence in guidelines for referral of patients to sleep laboratories
Publisher: Elsevier BV
Date: 08-2006
DOI: 10.1016/J.SMRV.2005.10.004
Abstract: At the request of Canadian health ministries, we reviewed recommendations in guidelines prepared by professional bodies on the referral of in iduals to sleep laboratories. Searching electronic databases and the Internet, we found 37 guidelines that covered 18 applications of sleep laboratory investigation including obstructive sleep apnea, other respiratory disorders, obstructive sleep apnea and other conditions in children, sudden infant death syndrome, treatment for snoring, insomnia, depression with insomnia, narcolepsy, restless legs syndrome eriodic limb movement disorder, parasomnias and circadian rhythm disorders. We identified recommendations on referral of patients for sleep studies and assessed the quality and relevance of evidence cited in support of these. Of 81 recommendations, 46 were supported by evidence from primary investigations. Only six cases cited evidence from well-conducted, prospective controlled studies. Evidence was highly relevant in 18 cases, of some relevance in 22 and of little or no relevance in six. No evidence was provided in support of 31 recommendations, and in four cases the guideline had identified an absence of available evidence. Although the publications from professional bodies that were reviewed contain much detailed information, evidence supporting many recommendations is limited. There is a need for further, good quality, studies of many sleep laboratory applications.
Eicosapentaenoic and docosahexaenoic acids, cognition, and behavior in children with attention-deficit/hyperactivity disorder: A randomized controlled trial
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.NUT.2011.12.009
Abstract: To determine the effects of an eicosapentaenoic acid (EPA)-rich oil and a docosahexaenoic acid (DHA)-rich oil versus an ω-6 polyunsaturated fatty acid-rich safflower oil (control) on literacy and behavior in children with attention-deficit/hyperactivity disorder (ADHD) in a randomized controlled trial. Supplements rich in EPA, DHA, or safflower oil were randomly allocated for 4 mo to 90 Australian children 7 to 12 y old with ADHD symptoms higher than the 90th percentile on the Conners Rating Scales. The effect of supplementation on cognition, literacy, and parent-rated behavior was assessed by linear mixed modeling. Pearson correlations determined associations between the changes in outcome measurements and the erythrocyte fatty acid content (percentage of total) from baseline to 4 mo. There were no significant differences between the supplement groups in the primary outcomes after 4 mo. However, the erythrocyte fatty acid profiles indicated that an increased proportion of DHA was associated with improved word reading (r = 0.394) and lower parent ratings of oppositional behavior (r = 0.392). These effects were more evident in a subgroup of 17 children with learning difficulties: an increased erythrocyte DHA was associated with improved word reading (r = 0.683), improved spelling (r = 0.556), an improved ability to ide attention (r = 0.676), and lower parent ratings of oppositional behavior (r = 0.777), hyperactivity (r = 0.702), restlessness (r = 0.705), and overall ADHD symptoms (r = 0.665). Increases in erythrocyte ω-3 polyunsaturated fatty acids, specifically DHA, may improve literacy and behavior in children with ADHD. The greatest benefit may be observed in children who have comorbid learning difficulties.
School-based obesity prevention interventions: Practicalities and considerations
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.ORCP.2013.10.004
Abstract: Pediatric obesity continues to be a major public health concern. Once established it is difficult to treat, therefore well-designed and evaluated prevention interventions are vitally important. Schools have an important role in the prevention of childhood obesity, however, their involvement can be limited by a number of constraints and barriers, which need to be considered when designing interventions. Members of the Prevention Stream of the Australasian Child and Adolescent Obesity Research Network have extensive experience in implementing and evaluating school-based obesity prevention initiatives. Based on their collective experience and evidence from implementation research, the aim of this paper was to highlight six areas to consider when designing, implementing and evaluating obesity prevention initiatives in schools. Further, this paper aimed to provide guidance for overcoming some of the challenges and barriers faced in school-based obesity prevention research. The six key areas discussed include: design and analysis school-community engagement planning and recruitment evaluation implementation and feedback and sustainability.
Parental nutrition knowledge and attitudes as predictors of 5-6-year-old children's healthy food knowledge
Publisher: Cambridge University Press (CUP)
Date: 14-12-2012
DOI: 10.1017/S1368980011003259
Abstract: Young children's knowledge about healthy food may influence the formation of their eating behaviours, and parents have a major influence on the development of children's knowledge in the early years. We investigated the extent to which parental nutrition knowledge and attitudes around food predicted young children's knowledge of healthy foods, controlling for other influences such as socio-economic status (SES) and parent education levels in a cross-sectional research design. Children were given a healthy food knowledge activity and parents completed questionnaires. Twenty primary schools in Adelaide, Australia, stratified by SES. We recruited 192 children aged 5–6 years and their parents. Structural equation modelling showed that parent nutrition knowledge predicted children's nutrition knowledge ( r = 0·30, P 0·001) independently of attitudes, SES and education level. Nutrition education for parents, targeted at low-SES areas at higher risk for obesity, may contribute to the development of healthy food knowledge in young children.
An assessment of intraoperative radiotherapy
Publisher: Elsevier BV
Date: 03-1996
DOI: 10.1016/0168-8510(95)00788-1
Abstract: An assessment of intraoperative radiotherapy (IORT) was undertaken to inform a decision on whether this technology should be introduced into the state of New South Wales. On the basis of a literature review, IORT appeared to be essentially an experimental technology, with limited data to demonstrate its comparative advantage over other treatments. Introduction of a dedicated IORT facility was technically feasible, but there appeared to be major uncertainties regarding selection and referral of suitable patients on a state-wide basis. The results of the assessment suggested that introduction of an IORT facility might have limited advantage for routine health services. A decision was subsequently taken not to support the introduction of this technology.
Physical fatty acid deficiency signs in children with ADHD symptoms
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.PLEFA.2007.08.002
Abstract: Fatty acid deficiency symptoms (FADS) of dry hair and skin, frequent thirst and urination have been observed to be higher in children with attention deficit hyperactivity disorder (ADHD). Two studies investigated FADS in 7-12-year-old children Study 1 in a general population (N=347) and Study 2 in children with ADHD symptoms (N=104). Correlations between FADS and ADHD-related symptoms were found at baseline in Study 1 but not Study 2. FADS did not improve after supplementation with omega-3 and omega-6 polyunsaturated fatty acids (PUFA) versus placebo after 15 weeks in Study 2, and were not related to improvements in ADHD symptoms in the PUFA groups. However, FADS did improve in all groups, possibly attributable to the linoleic acid present in both the PUFA and placebo (palm oil) supplements. FADS are not a reliable selection criterion for children with ADHD who might benefit from omega-3 PUFA supplementation.
Linking evidence from health technology assessments to policy and decision making: The Alberta Model
Publisher: Cambridge University Press (CUP)
Date: 04-2007
DOI: 10.1017/S0266462307070250
Abstract: Objectives: The objective of this study was to develop and implement a decision-making process for public funding of health services that links policy areas with health technology assessment and input from interested parties. Methods: Health authorities, assessment organizations, and healthcare professionals were consulted as a follow-up to recommendations of an expert panel established by the Alberta government. The methods involved formulation of an eight-stage, collaborative process that incorporates identification through the health ministry of health technologies requiring review, assessment of the technologies using expert groups in Alberta, and consultation and formulation of advice within the ministry to inform ministerial funding decisions. Results: All components of the decision process have been put in place and have collaborated to provide advice to inform policy on provincial health services. Of nineteen technologies selected for review, five have been completed and decisions made: laparoscopic adjustable gastric banding, fetal fibronectin assay for premature labor, newborn screening for cystic fibrosis, newborn screening for inborn errors of metabolism, and gastric electrical stimulation. A further six reviews are in progress, and reviews of the remaining technologies are planned for 2007. Conclusions: Bridging the evidence-to-policy gap is more likely to succeed when the policy community is actively engaged and an explicit model is used to put health technology assessment into practice.
Parental influences on the diets of 2-5-year-old children: Systematic review of interventions
Publisher: Informa UK Limited
Date: 07-2012
The efficacy and adverse effects of in vitro fertilization and embryo transfer
Publisher: Cambridge University Press (CUP)
Date: 1999
DOI: 10.1017/S0266462399015172
Abstract: This paper examines the current status of in vitro fertilization and embryo transfer (IVF-ET) as a treatment for various types of infertility. We reviewed studies on the efficacy and safety of IVF-ET and intracytoplasmic sperm injection (ICSI) plus IVF-ET, compared with conventional treatment or no treatment for various infertility diagnoses. Material retrieved included English language publications between 1992 and January 1997 that reported the results of prospective controlled clinical trials, cohort studies, and retrospective comparative studies with large series, and reviews presenting risks, complications, and longer-term health consequences associated with IVF-ET and ICSI. No adequate prospective comparative studies of sufficient power on the use of IVF-ET for specific infertility diagnoses have been reported to date. Most of the published reports concerning results with IVF-ET as a treatment of infertility have been based upon small, uncontrolled studies, with various methodological weaknesses. Reported results are not directly comparable. There are few follow-up data on outcomes after pregnancy is established or on long-term health consequences of the use of IVF-ET on mothers and their babies. IVF-ET has diffused widely without comprehensive assessment of its efficacy and safety. The available evidence supports its use only for severe bilateral tubal occlusion. For other diagnoses of infertility the evidence is limited and does not establish whether IVF-ET is effective. Long-term, well-designed, prospective clinical trials are required to determine when and for what indications IVF-ET is effective and what its health effects are on both mothers and their babies.
The Need for Economic Evaluation of Telemedicine to Evolve: The Experience in Alberta, Canada
Publisher: Mary Ann Liebert Inc
Date: 03-2004
DOI: 10.1089/153056204773644607
Abstract: Economic evaluation of telemedicine applications is required to provide decision makers in health care with appropriate information on costs and benefits of this information and communications technology. The level of economic evaluation should evolve as telemedicine applications mature. At the basic level, economic evaluation may include basic cost analysis and primarily observational data on nonmonetary benefits. The focus will change as telemedicine programs develop. At this intermediate level, practice patterns and workforce issues are addressed as they affect utilization and costs of telemedicine services. Longer-term economic evaluation, thus far not achieved in telemedicine assessment, should focus on assessment of health outcomes and economic impact. Alberta, Canada has made progress assessing telemedicine applications in psychiatry, radiology, rheumatology, and rehabilitation. Data availability and analytic resources continue to present challenges to economic assessment of telemedicine.
Associations between predictors of children's dietary intake and socioeconomic position: A systematic review of the literature
Publisher: Wiley
Date: 17-01-2014
DOI: 10.1111/OBR.12139
Abstract: Socioeconomically disadvantaged children are at higher risk of consuming poor diets, in particular less fruits and vegetables and more non-core foods and sweetened beverages. Currently the drivers of socioeconomically related differences in children's dietary intake are not well understood. This systematic review explored whether dietary predictors vary for children of different socioeconomic circumstances. Seven databases and reference lists of included material were searched for studies investigating predictors of 9-13-year-old children's diet in relation to socioeconomic position. In idual- and population-based cross-sectional, cohort and epidemiological studies published in English and conducted in developed countries were included. Twenty-eight studies were included in this review most were conducted in Europe (n = 12) or North America (n = 10). The most frequently used indicators of socioeconomic position were parent education and occupation. Predictors of children's dietary intake varied among children of different socioeconomic circumstances. Socioeconomic position was consistently associated with children's nutrition knowledge, parent modelling, home food availability and accessibility. Indeterminate associations with socioeconomic position were observed for parent feeding practices and food environment near school. Differences in the determinants of eating between socioeconomic groups provide a better understanding of the drivers of socioeconomic disparities in dietary intake, and how to develop targeted intervention strategies.
Reprocessing and Reuse of Single-Use Medical Devices: A National Survey of Canadian Acute-Care Hospitals
Publisher: Cambridge University Press (CUP)
Date: 05-2008
DOI: 10.1086/587648
Abstract: A national survey investigated the current practices of reprocessing and reusing single-use medical devices in Canadian acute-care hospitals. Our response rate was 72% (413 responses), and 28% of hospitals reprocess single-use devices. The results showed that Canadian hospital practices have not changed much in the past decade.
Effects of fish oil supplementation on learning and behaviour of children from Australian Indigenous remote community schools: A randomised controlled trial
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.PLEFA.2013.05.001
Abstract: Omega-3 fatty acids are essential for brain function. We recruited 409 children aged 3-13 years (M=8.27, SD=2.17) for a randomised controlled trial supplementing with placebo or fish oil capsules (providing 750mg docosahexaenoic plus eicosapentaenoic acids, and 60mg gamma linolenic acid/school day) for 20 school weeks (Phase 1) followed by one-way crossover to fish oil (Phase 2). Children undertook assessments of reading, spelling and non-verbal cognitive development (Draw-A-Person) at baseline, 20 and 40 weeks. Teachers completed Conners Behaviour Rating Scales (CBRS). The treatment group showed improvements in Draw-A-Person compared with the placebo during Phase 1 (p=0.029), with strongest effects in Indigenous 7-12 year olds (p=0.008). The placebo group showed significant within-group improvements after switching to treatment (p<0.001). There was no treatment effect for reading or spelling, and CBRS data were unable to be analysed. These findings may be understood in the context that sustained school attendance and nutrition interact to produce school-related achievement.
Increased Erythrocyte Eicosapentaenoic Acid and Docosahexaenoic Acid Are Associated With Improved Attention and Behavior in Children With ADHD in a Randomized Controlled Three-Way Crossover Trial
Publisher: SAGE Publications
Date: 08-11-2013
Abstract: Objective: To investigate effects of omega-3 polyunsaturated fatty acids (n-3 PUFA) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) on attention, literacy, and behavior in children with ADHD. Method: Ninety children were randomized to consume supplements high in EPA, DHA, or linoleic acid (control) for 4 months each in a crossover design. Erythrocyte fatty acids, attention, cognition, literacy, and Conners’ Parent Rating Scales (CPRS) were measured at 0, 4, 8, 12 months. Results: Fifty-three children completed the treatment. Outcome measures showed no significant differences between the three treatments. However, in children with blood s les ( n = 76-46), increased erythrocyte EPA + DHA was associated with improved spelling ( r = .365, p .001) and attention ( r = −.540, p .001) and reduced oppositional behavior ( r = −.301, p .003), hyperactivity ( r = −.310, p .001), cognitive problems ( r = −.326, p .001), Diagnostic and Statistical Manual of Mental Disorders (4th ed. DSM-IV) hyperactivity ( r = −.270, p = .002) and DSM-IV inattention ( r = −.343, p .001). Conclusion: Increasing erythrocyte DHA and EPA via dietary supplementation may improve behavior, attention, and literacy in children with ADHD.
The courts - A challenge to health technology assessment
Publisher: American Association for the Advancement of Science (AAAS)
Date: 09-07-1999
Health Behaviors, Knowledge, Life Satisfaction, and Wellbeing in People with Mental Illness across Four Countries and Comparisons with Normative Sample
Publisher: Frontiers Media SA
Date: 22-08-2016
Parenting styles, communication and child/adolescent diets and weight status: Let's talk about it
Publisher: Informa UK Limited
Date: 08-2012
Soya isoflavone supplementation enhances spatial working memory in men
Publisher: Cambridge University Press (CUP)
Date: 06-2009
DOI: 10.1017/S0007114509990201
Abstract: Females perform better in certain memory-related tasks than males. Sex differences in cognitive performance may be attributable to differences in circulating oestrogen acting on oestrogen β receptors (ERβ) which are prevalent in brain regions such as the hippoc us, frontal lobe and cortex that mediate cognitive functions. Since soya isoflavones are known to activate ERβ, chronic isoflavone supplementation in males may improve cognitive performance in memory-related tasks. A 12-week double-blind, placebo-controlled cross-over trial was conducted in thirty-four healthy men to investigate the effect of isoflavone supplementation on cognitive function. Volunteers were randomised to take four capsules/d containing soya isoflavones (116 mg isoflavone equivalents/d: 68 mg daidzein, 12 mg genistein, 36 mg glycitin) or placebo for 6 weeks, and the alternate treatment during the following 6 weeks. Assessments of memory (verbal episodic, auditory and working), executive function (planning, attention, mental flexibility) and visual-spatial processing were performed at baseline and after each treatment period. Isoflavone supplementation significantly improved spatial working memory ( P = 0·01), a test in which females consistently perform better than males. Compared with placebo supplementation, there were 18 % fewer attempts ( P = 0·01), 23 % fewer errors ( P = 0·02) and 17 % less time ( P = 0·03) required to correctly identify the requisite information. Isoflavones did not affect auditory and episodic memory (Paired Associate Learning, Rey's Auditory Verbal Learning Task, Backward Digit Span and Letter-Number Sequencing), executive function (Trail Making and Initial Letter Fluency Task) or visual-spatial processing (Mental Rotation Task). Isoflavone supplementation in healthy males may enhance cognitive processes which appear dependent on oestrogen activation.
Current evidence and future directions for research with omega-3 fatty acids and attention deficit hyperactivity disorder
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2015
Cognitive effects of polyunsaturated fatty acids in children with attention deficit hyperactivity disorder symptoms: A randomised controlled trial
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.PLEFA.2008.04.004
Abstract: This study investigated effects of PUFA and micronutrient supplementation on cognition in children with ADHD symptoms. In a randomised controlled trial, 7-12-year-old children with symptoms 2 S.D. on Conners' ADHD Index were given PUFA, PUFA+multivitamins/minerals (MVM), or placebo for 15 weeks, and then all children were given PUFA+MVM for an additional 15 weeks. After 15 weeks there were improvements in a test of the ability to switch and control attention (Creature Counting) in the PUFA groups compared to placebo (N=129, p=0.002). This improvement was also observed in the placebo group after taking PUFA from weeks 16 to 30 (N=104). There were no significant improvements in other cognitive measures, or with additional micronutrient supplementation. However, improvements in cognitive performance mediated previous parent-reported improvements in inattention, hyperactivity and impulsivity [N. Sinn, J. Bryan, Effect of supplementation with polyunsaturated fatty acids and micronutrients on ADHD-related problems with attention and behaviour, J. Dev. Behav. Pediatr. 28 (2) (2007) 82-91], suggestive of a common neurological mechanism for these symptoms.
Does emotional intelligence predict unique variance in life satisfaction beyond IQ and personality?
Publisher: Elsevier BV
Date: 04-2005
An assessment of gait analysis in the rehabilitation of children with walking difficulties
Publisher: Informa UK Limited
Date: 2000
Abstract: To assess the current status of computerized gait analysis techniques in the management of children with cerebral palsy or spina bifida who have significant walking disorders. Synthesis of available data from a review of the literature, drawing on MEDLINE, EMBASE, PRE-MEDLINE, HealthStar and PsychInfo. Other information was obtained from persons with expertise in computerized gait analysis. Cost data were obtained from Canadian rehabilitation centres and the provincial health ministry. This technology seems helpful in detecting gait changes. However, available evidence is insufficient to draw conclusions about the influence of computerized gait analysis on treatment outcomes. Part of the rationale for use of the technology is that costs of gait analysis (of the order of $ CAN 2,000 per examination) would be offset by a decrease in follow-up surgical procedures and associated hospital care. There could also be a major influence on children's independence and quality of life. However, there are as yet no convincing data to support these propositions. Computerized gait analysis is a potentially useful technology in the management of children with walking disabilities, but its efficacy is not established. It should be regarded as a developing technology and its clinical application linked to systematic collection and assessment of outcomes data.
Breastfeeding and child neurodevelopment - a role for gut microbiota?
Publisher: Wiley
Date: 30-10-2014
DOI: 10.1111/DMCN.12330
The Effect of Dietary Supplementation on Aggressive Behaviour in Australian Adult Male Prisoners: A Feasibility and Pilot Study for a Randomised, Double Blind Placebo Controlled Trial
Publisher: MDPI AG
Date: 27-08-2020
DOI: 10.3390/NU12092617
Abstract: This study aimed to assess the feasibility of conducting a nutrition trial in adult male prisoners. Adult male prisoners were recruited for a 16-week randomised control trial comparing the effect of ingestion of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) and multivitamin supplements versus placebo on aggressive behaviour. The baseline and post-intervention assessments from the participant blood s les were the erythrocyte n-3 LCPUFA levels as well as measures of aggressive behaviour determined through institutional records of misconduct (IRM), the Inmate Behaviour Observation Scale (IBOS), and questionnaires. A total of 136 adult male prisoners consented to the study with a retention rate of 60%, and 93% of blood s les were successfully collected. The IRM and IBOS scores were collected for 100% of participants, whilst 82–97% of participants completed the questionnaires. From the baseline data, the Odds Ratio shows that prisoners are 4.3 times more likely to have an IBOS if they are below the 6% cut off on the omega-3 index. Both groups improved across all outcome measures and, at the current s le size, no significant differences were seen between them. A power calculation suggests a total s le size of 600 participants is required to detect the effects of this dietary supplementation, and that this supplementation study is feasible in a Correctional Centre. Important criteria for the exclusion and consideration of logistics and compliance are presented.
A comparison of parental views of their pre-school children's 'healthy' versus 'unhealthy' diets. A qualitative study
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.APPET.2014.02.001
Abstract: Despite recommended dietary guidelines, recent population surveys have recorded low fruit and vegetable and high non-core food consumption by Australian children. Young children rely on parents or primary carers to provide their diets therefore pre-school age is an optimal time to promote and encourage healthy child eating behaviours. Identified contributing factors to a child's eating behaviour and diet in the home environment include parenting style, parent feeding practices and attitudes, parent nutrition knowledge, and home food availability. The aim of this study was to qualitatively explore perceptions, perceived influences, facilitators and barriers when providing healthy foods for young children via focus groups with parents of children with 'healthy' versus 'unhealthy' diets. Thematic analysis identified similarities across both groups including an intention to provide healthy food for their children with most parents involving their child in some level of meal preparation and most families dining together for the evening meal. Main points of difference included parents in the 'healthy' group having more partner support in relation to child diet, a willingness to say 'no' without wavering, and considering their child's daily physical activity when deciding appropriate food options. A majority of parents in the 'unhealthy' group attempted to disguise vegetables and healthy foods for their child and reported experiencing increased levels of stress regarding their child's fussy eating.
Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2007
Parental influences on the diets of 2- to 5-year-old children: Systematic review of qualitative research
Publisher: SAGE Publications
Date: 12-11-2014
Abstract: Parents have a major influence on young children’s diets, food choices and habit formation. However, research concerning parental influence on children’s diets is limited. Qualitative research informs quantitative research with a narrative of ‘what works’ and is a valuable tool to inform intervention design and practice. This article presents a systematic review of qualitative research with parents of preschool children and their influence on their child’s diet. Nine studies were identified. Findings highlight the need to promote culturally tailored programmes to combat specific cultural differences such as attitudes perceptions and concerns address common barriers to providing healthy foods and challenges faced by lower income families the use of food to shape a child’s behaviour that children will grow out of excess weight common misconceptions such as a heavier child is healthier and depriving a child’s food request could result in starvation. Research on parental understanding of healthy diets and feeding practices is lacking. Further insights into how to positively influence children’s diets will come from research examining parent feeding practices and nutrition knowledge.
Dietary recommendations for the prevention of depression
Publisher: Informa UK Limited
Date: 02-03-2016
Rapid reviews versus full systematic reviews: An inventory of current methods and practice in health technology assessment: Corrigendum
Publisher: Cambridge University Press (CUP)
Date: 07-2008
DOI: 10.1017/S0266462308080483
Abstract: In the article entitled “Rapid reviews versus full systematic reviews: An inventory of current methods and practice in health technology assessment,” by Watt et al. in volume 24 number 2 (Spring 2008) of International Journal of Technology Assessment in Health Care , the affiliation of Stephen Blamey is incorrectly listed as Department of Health & Ageing. Dr. Blamey is the current Chair of the Medical Services Advisory Committee (MSAC). MSAC is an independent scientific committee comprising in iduals with expertise in clinical medicine, health economics, and consumer matters. The Department of Health & Ageing administers funding and operations for MSAC. However, members of MSAC act independently of the Department. As Chair of MSAC, Dr. Blamey can be contacted through the Department. Dr. Blamey is not affiliated with the Department of Health and Ageing and his contribution to the above-mentioned article does not reflect its policy. Dr. Blamey wishes to apologize for this misunderstanding.
Reuse of single use medical devices in Canada: Clinical and economic outcomes, legal and ethical issues, and current hospital practice
Publisher: Cambridge University Press (CUP)
Date: 10-2008
DOI: 10.1017/S0266462308080562
Abstract: Objectives: The aim of this study was to assess the evidence that reuse of medical devices marketed for single use only (SUDs) is safe, effective and cost-effective, and to consider the use and health services impact of this practice in Canada. Methods: A systematic review was performed of studies that reported clinical or economic outcomes following reuse of SUDs in humans. Direct costs of adverse health events associated with SUD reuse and indications of budget impact were obtained using data for devices for laparoscopic cholecystectomy and coronary angioplasty. Legal and ethical issues were reviewed, drawing on material relevant to Canada. Data on current reuse of SUDs were obtained through a survey of Canadian acute care hospitals. Results: Studies of variable quality suggested that SUD reuse could be safe and effective, and would give cost savings, if there were no adverse events. Eliminating reuse of SUDs for laparoscopic cholecystectomy and coronary angioplasty would add less than 0.1 percent to costs of the procedures over 1 year. Adverse health events associated with device reuse create liability risks patients should be informed of any known or foreseeable risks of reuse. Most of the 28 percent (111/398) of acute hospitals that reprocess SUDs do so in-house. Some do not have a written policy or an incident reporting mechanism. Conclusions: There is insufficient evidence to establish the safety, efficacy and cost-effectiveness of reusing SUDs. Legal and ethical issues require attention to minimize liability and maintain patient safety and trust. Some hospitals that reprocess SUDs do not have adequate documentation. These findings do not support the reuse of SUDs in Canadian hospitals.
Polyunsaturated fatty acids, cognition and literacy in children with ADHD with and without learning difficulties
Publisher: SAGE Publications
Date: 09-08-2011
Abstract: Suboptimal omega-3 polyunsaturated fatty acid (n-3 PUFA) levels may contribute to attention deficit hyperactivity disorder (ADHD) and related developmental problems. Associations between n-3 and omega-6 (n-6) PUFA levels in red blood cells (erythrocytes) and learning and behaviour were investigated in 75 children aged 7-12 with ADHD. Children provided blood s les and underwent cognitive assessments. Parents completed questionnaires and Conners' Rating Scales. Controlling for covariates, higher n-3 PUFA predicted lower anxiety/shyness (β = -.27), higher docosahexaenoic acid (DHA) better word reading (β = .22), and higher n-6 PUFA poorer reading (β = -.34), vocabulary (β = .-.26), spelling (β = -.30) and attention (β = -.30). Thirty-six per cent of the s le with learning difficulties had lower DHA than those without (M = 3.26 ± 0.54 vs M = 3.68 ± 0.76, p = .02). This study is the first to compare erythrocyte PUFAs (a measure of PUFA status) in children who have ADHD with and without learning difficulties, and supports emerging indications that the former may be more likely responders to n-3 PUFAs.
Health care technology in Australia
Publisher: Elsevier BV
Date: 10-1994
DOI: 10.1016/0168-8510(94)00684-7
Abstract: The health care system in Australia is pluralistic, complex, and only loosely organized. The Commonwealth government is primarily concerned with funding programs and the development of broad policies. The introduction and diffusion of health care technologies in Australia is determined by a complex interaction of market forces, public funding, and regulation. Australia became involved in health care technology assessment in 1982. In 1990, activities were reorganized and the Australian Health Technology Advisory Committee (AHTAC) was formed at the national level. Despite limited funding, Australia has had some significant successes in informing policy through appropriately targeted, well-timed assessment.
Baseline omega-3 index correlates with aggressive and attention deficit disorder behaviours in adult prisoners
Publisher: Public Library of Science (PLoS)
Date: 20-03-2015
Commentary on the article Key principles for the improved conduct of health technology assessments for resource allocation decisions
Publisher: Cambridge University Press (CUP)
Date: 07-2008
DOI: 10.1017/S026646230808104X
Abstract: The paper presents a set of principles that cover the broad scope of HTA from formulation of the question to effects on the decision-making process. It also provides goals for HTA programs to aim for in producing assessments. The principles are supported by material that includes illustrations from the experience of several programs. The authors have had long contact with the field and are well able to authoritatively discuss a range of methodological and other topics. The paper includes a range of views and details that are relevant to those involved with HTA.
THE USE AND IMPACT OF RAPID HEALTH TECHNOLOGY ASSESSMENTS
Publisher: Cambridge University Press (CUP)
Date: 04-2000
DOI: 10.1017/S0266462300101205
Abstract: Objectives: To consider the impact of rapid health technology assessments undertaken as part of a program in a provincial healthcare system in response to urgent requests for advice. Methods: Review of the development and preparation of 20 rapid assessment reports, communication with decision makers within the healthcare system, and appraisal of data subsequent to preparation of the reports. Results: Fourteen of the assessments were judged to have had an influence on policy and other decisions, as judged by responses from those who had requested advice. Another four were considered to have provided guidance, while having less immediate influence on decisions, and two others had no apparent impact. Quality of the assessments was considered acceptable, on the basis of literature that subsequently became available and from comments received. Conclusions: These brief reports are considered to be a useful component of a health technology assessment program. However, they should be regarded as provisional appraisals and followed up with more detailed evaluation where possible.
Mental health benefits of omega-3 fatty acids may be mediated by improvements in cerebral vascular function
Publisher: Elsevier BV
Date: 2008
Adult Attention Deficit Disorder and Aggressive Behaviour: An Exploration of Relationships between Brown Attention-Deficit Disorder Scales and the Aggression Questionnaire
Publisher: Informa UK Limited
Date: 19-11-2015
Nutritional and dietary influences on attention deficit hyperactivity disorder
Publisher: Oxford University Press (OUP)
Date: 25-09-2008
DOI: 10.1111/J.1753-4887.2008.00107.X
Abstract: An abundance of research has investigated causes and treatments for attention deficit hyperactivity disorder (ADHD). The research includes identification of suboptimal levels of nutrients and sensitivities to certain foods and food additives. This review gives an overview of this research and provides an up-to-date account of clinical trials that have been conducted with zinc, iron, magnesium, Pycnogenol, omega-3 fatty acids, and food sensitivities. A literature search was conducted using PubMed, ISI Web of Knowledge, and Google Scholar and included studies published before April 2008. Although further research is required, the current evidence supports indications of nutritional and dietary influences on behavior and learning in these children, with the strongest support to date reported for omega-3s and behavioral food reactions.
Polyunsaturated fatty acid supplementation for adhd symptoms: Response to commentary
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2007
Caregivers' acceptance of electronic documentation in nursing homes
Publisher: SAGE Publications
Date: 07-2008
Abstract: A comparative study was conducted in two Australian nursing homes operated by the same organization. One home had implemented an electronic documentation system and the other remained paper-based. Survey questionnaires were answered by 14 of the 17 caregivers at the electronic documentation site (82%) and 10 of the 23 caregivers at the paper documentation site (43%). They provided opinions about satisfaction with their home's documentation system, and the training and support provided. Information was also obtained on the caregivers' attitudes towards using electronic documentation. The caregivers at the electronic documentation site quickly adapted to the use of the new technology after receiving effective training and support. Caregivers at both homes were satisfied with their homes' documentation system, and had positive attitudes towards using electronic documentation systems. As an important communication tool, electronic nursing documentation may lead to improved efficacy of telemedicine in nursing home settings.
Diet and sleep in children with attention deficit hyperactivity disorder: Preliminary data in Australian children
Publisher: SAGE Publications
Date: 11-02-2011
Abstract: Sleep disturbances are common and consequential in children with attention deficit hyperactivity disorder (ADHD). Diet also influences ADHD symptoms. Interrelationships between diet, sleep and behaviour in children diagnosed with ADHD are little studied. We investigated, via parental report, the relationships between sleep and diet in 88 Australian children aged 6—13 years old ( M = 8.94, SD = 1.78). This pilot data shows that 30 per cent of the children had sleep disturbance (≥ 2 standard deviations above the mean) with significant relationships between ADHD symptoms, sleep disturbance and diet. Parents who reported more sleep disturbance also reported a higher intake of carbohydrate, fats, and, most particularly, sugar which was also a significant predictor of night time sweating. These findings suggest an interrelationship between diet and sleep in children with ADHD. Given that both sleep and dietary intake are potentially modifiable behaviours within treatment regimes of children with ADHD, further investigation is needed.
Dietary Supplementation with Highly Unsaturated Fatty Acids: Implications for Interventions with Persons with Mental Retardation from Research on Infant Cognitive Development, ADHD, and Other Developm
Publisher: Elsevier
Date: 2006
The introduction and evaluation of magnetic resonance imaging in Australia
Publisher: Elsevier BV
Date: 02-1991
DOI: 10.1016/0168-8510(91)90115-E
Abstract: The introduction of magnetic resonance imaging (MRI) into Australia was linked to a formal assessment of the technology in public hospitals associated with restrictions on government funding. The assessment produced comprehensive data on the usage, cost and efficacy of MRI in the hospital setting. This paper summarises the major results of the assessment and considers issues related to the methodology used and the impact on the policy process.
Providing information on emerging health technologies to provincial decision makers: a pilot project
Publisher: Elsevier BV
Date: 10-2001
DOI: 10.1016/S0168-8510(01)00154-3
Abstract: A pilot project to provide advice on new and emerging medical technologies to decision makers in a provincial health care system was undertaken by a health technology assessment (HTA) program. Briefs were prepared on technologies which were not yet available in the province and which might have a significant impact on health care. These were sent to the ministry of health and regional health authorities and made available through the agency's website. Reaction to the briefs was sought from decision makers. Decision makers in the health ministry and health authorities found the briefs helpful, and wished to continue receiving them. They had made limited use of them for planning purposes, but the briefs provided useful input to further consideration of technologies in several cases. Within the HTA program, the briefs and the process that produced them were valuable in increasing awareness of new health technologies that might require assessment in future. This pilot project demonstrated the feasibility of providing timely advice on emerging health technologies within a provincial health system. However, while decision makers found the information provided to be useful, this had not yet been integrated with provincial health care planning. Necessary machinery within policy areas and communication with the HTA process appear to be in need of development.
A preliminary study into the economic burden of cerebral palsy in China
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.HEALTHPOL.2008.01.001
Abstract: To measure the economic burden of cerebral palsy (CP) in China is to provide information on CP's societal impacts to policy-makers. The economic burden of CP includes direct healthcare costs, direct non-healthcare costs, developmental costs and indirect costs such as productivity loss. The incidence approach is employed to estimate the lifetime economic burden of a new CP birth and that of all new cases in China in 2003. Caregivers of 319 CP patients were interviewed in specialty hospitals in five cities in 2004. Average expenditure and utilization rates for different services by age groups from this s le were obtained to estimate the economic burden of CP. Chinese CP patients' life expectancy and survival rate were simulated with reference to Australian data with Human Development Index adjustment. From the societal perspective, the average lifetime economic burden of a new CP case in China was US$ 67,044 in 2003, and the life-span total economic loss due to all new CP cases in 2003 amounted to US$ 2-4 billion. Indirect (productivity) costs are responsible for 93% of total economic loss, and direct healthcare and developmental costs make up 3% each. There are several factors which contribute to the extraordinarily high economic burden of CP, including productivity loss, reduced life expectancy, dependency, progressive deterioration of motor physical function, and recurrent use of rehabilitation services. The economic burden of CP in China is substantial for the family of a CP patient, as well as to society. Public provision and financing of necessary preventive and rehabilitative services is urgently needed to mitigate this heavy burden for patients and their families.
Laparoscopic hernia repair in Australia - some cost and effectiveness considerations
Publisher: Informa UK Limited
Date: 1995
A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED)
Publisher: Informa UK Limited
Date: 07-12-2017
Economic analysis of reprocessing single-use medical devices: A systematic literature review
Publisher: Cambridge University Press (CUP)
Date: 04-2008
DOI: 10.1086/529587
Abstract: Although an increasing number of medical devices are labeled “for single use only,” cleaning and reuse of single-use medical devices continues, because of the economic incentive. We conducted a survey of the economic literature to obtain the current evidence available and to assess the costs and benefits of reusing single-use medical devices. A comprehensive literature search was carried out to identify articles that compared single use and reuse of single-use medical devices and that met specific scientific criteria, including evaluation of economic outcomes. Each selected article was independently reviewed by 2 reviewers to extract cost and clinical outcome data and to assess the quality of the study. Nine published articles met the selection criteria. The savings were about 49% of the direct cost. These savings would be offset by adverse-event costs, but none were detected. However, quality of the studies was generally poor. There is little available evidence of quality in the published literature to assess the practice of reuse of single-use medical devices. Moreover, data on clinical outcomes are missing and, where available, cannot be attributed specifically to the reuse of single-use medical devices.
Health policy on bone density measurement technology in Sweden and Australia
Publisher: Elsevier BV
Date: 03-1996
DOI: 10.1016/0168-8510(95)00785-7
Abstract: The possible adverse consequences of osteoporosis, particularly hip fractures, are a considerable health concern that is particularly relevant for elderly women. Bone density measurement is a method to assess bone mineral that has grown rapidly in recent years in both Sweden and Australia. The types of technologies adopted, their location and their level of use reflect the characteristics of the different health care systems, health technology assessments and policies adopted by health authorities. The health policy issues related to use of these technologies are complex and include consideration of who should be examined and treated, potential risks and benefits, machine performance, patient compliance and evidence of benefit.
Socio-economic position as a moderator of 9-13-year-old children's non-core food intake
Publisher: Cambridge University Press (CUP)
Date: 23-04-2016
DOI: 10.1017/S1368980015001081
Abstract: There is limited understanding as to why children of low socio-economic position (SEP) consume poorer diets than children of high SEP. Evidence suggests that determinants of dietary intake may differ between SEP groups. The present study aimed to determine if SEP moderated associations of personal and environmental predictors with children’s non-core food and sweetened drink intakes and unhealthy dietary behaviours. Children completed online questionnaires and parents completed computer-assisted telephone interviews to assess intrapersonal and environmental dietary predictors. Dietary intake was measured using an FFQ. Parents reported demographic information for maternal education, occupation and employment, and household income. Twenty-six primary schools in South Australia, Australia. Children aged 9–13 years and their parents ( n 395). Multiple personal and home environment factors predicted non-core food and sweetened drink intakes, and these associations were moderated by SEP. Maternal education moderated associations of girls’ sweetened drink intake with self-efficacy, cooking skills and pressure to eat, and boys’ non-core food intake with monitoring, parent’s self-efficacy and home environment. Maternal occupation and employment moderated associations of sweetened drink intake with attitudes, self-efficacy, pressure to eat and food availability, and non-core food intake with parents’ self-efficacy and monitoring. Income moderated associations with pressure to eat and home environment. Identifying differences in dietary predictors between socio-economic groups informs understanding of why socio-economic gradients in dietary intake may occur. Tailoring interventions and health promotion to the particular needs of socio-economically disadvantaged children may produce more successful outcomes and reduce socio-economic disparities in dietary intake.
Study quality and evidence of benefit in recent assessments of telemedicine
Publisher: SAGE Publications
Date: 12-2004
Abstract: We carried out a systematic review of recent telemedicine assessments to identify scientifically credible studies that included comparison with a non-telemedicine alternative and that reported administrative changes, patient outcomes or the results of an economic assessment. From 605 publications identified in the literature search, 44 papers met the selection criteria and were included in the review. Four other publications were identified through references cited in one of the retrieved papers and from a separate project to give a total of 48 papers for consideration, which referred to 42 telemedicine programmes and 46 studies. Some kind of economic analysis was included in 25 (52%) of the papers. In considering the studies, we used a quality appraisal approach that took account of both study design and study performance. For those studies that included an economic analysis, a further quality-scoring approach was applied to indicate how well the economic aspects had been addressed. Twenty-four of the studies were judged to be of high or good quality and 11 of fair to good quality but with some limitations. Seven studies were regarded as having limited validity and a further four as being unacceptable for decision makers. New evidence on the efficacy and effectiveness of telemedicine was given by studies on geriatric care, intensive care and some of those on home care. For a number of other applications, reports of clinical or economic benefits essentially confirmed previous findings. Although further useful clinical and economic outcomes data have been obtained for some telemedicine applications, good-quality studies are still scarce.
Achievements and challenges on policies for allied health professionals who use telehealth in the Canadian Arctic
Publisher: SAGE Publications
Date: 12-2005
DOI: 10.1258/135763305775124650
Abstract: We formulated policies and procedures for allied health professionals (AHPs) who provide services using telehealth in Nunavut, Canada's newest Arctic territory. These are a supplement to the clinical policies and procedures already established for Nunavut physicians and nurses. The services were in the areas of audiology, dietetics/nutrition, midwifery, occupational therapy, ophthalmic services, pharmacy, physiotherapy, psychology, respiratory therapy, social work and speech therapy. Documents specific to each of the services were developed, drawing on information from Government of Nunavut data, Nunavut healthcare providers and links made through the Internet. Topics included the scope and limitations of telehealth services, staff responsibilities, training and reporting, professional standards and cultural considerations. We also considered generic policies covering common issues such as jurisdiction, licensing and liability. The policies and procedures for AHPs will enhance and expand the successes already achieved with telehealth in Nunavut. The challenges are to balance the preferred approaches to service provision with the realities of health care and communications in an Arctic setting.
Cost effectiveness and cost-utility analysis of a group-based diet intervention for treating major depression - the HELFIMED trial.
Publisher: Informa UK Limited
Date: 20-12-2020
A 6-month randomised controlled trial investigating effects of Mediterranean-style diet and fish oil supplementation on dietary behaviour change, mental and cardiometabolic health and health-related quality of life in adults with depression (HELFIMED): Study protocol
Publisher: Springer Science and Business Media LLC
Date: 19-08-2016
RAPID VERSUS FULL SYSTEMATIC REVIEWS: VALIDITY IN CLINICAL PRACTICE?
Publisher: Wiley
Date: 21-10-2008
DOI: 10.1111/J.1445-2197.2008.04730.X
Abstract: Rapid reviews are being produced with greater frequency by health technology assessment (HTA) agencies in response to increased pressure from end-user clinicians and policy-makers for rapid, evidence-based advice on health-care technologies. This comparative study examines the differences in methodologies and essential conclusions between rapid and full reviews on the same topic, with the aim of determining the validity of rapid reviews in the clinical context and making recommendations for their future application. Rapid reviews were located by Internet searching of international HTA agency websites, with any ambiguities resolved by further communication with the agencies. Comparator full systematic reviews were identified using the University of York Centre for Reviews and Dissemination HTA database. Data on a number of review components were extracted using standardized data extraction tables, then analysed and reported narratively. Axiomatic differences between all the rapid and full reviews were identified however, the essential conclusions of the rapid and full reviews did not differ extensively across the topics. For each of the four topics examined, it was clear that the scope of the rapid reviews was substantially narrower than that of full reviews. The methodology underpinning the rapid reviews was often inadequately described. Rapid reviews do not adhere to any single validated methodology. They frequently provide adequate advice on which to base clinical and policy decisions however, their scope is limited, which may compromise their appropriateness for evaluating technologies in certain circumstances.
A tool for assessing healthy food knowledge in 5-6-year-old Australian children
Publisher: Cambridge University Press (CUP)
Date: 03-02-2011
DOI: 10.1017/S1368980010003721
Abstract: In the early years of life, influential attributes are formed and may be difficult to change later in life. Early childhood is now recognised as a key target in the prevention of overweight and obesity, and the knowledge that children gain at this time about food and its health benefits may have an important influence on their dietary choices and preferences in later life. Therefore, an activity was designed using age-appropriate methods to assess nutrition knowledge of young children. The Healthy Food Knowledge Activity was developed using a list of thirty healthy and unhealthy foods and drinks generated from the Australian Guide to Healthy Eating. The activity was conducted with in idual children from reception classes of South Australian schools. Children aged 5–6 years undertook the activity in a pilot study ( n 13) and in the main study ( n 192). Pilot data indicated good test–retest reliability of the activity ( r = 0·84, P 0·01). In the main study, there was a good distribution of scores with acceptable skewness and kurtosis statistics. A breakdown of responses indicated good face validity, with more obvious foods being more correctly classified. Children as young as 5–6 years of age can correctly identify healthy foods, and this can be measured objectively. This activity also provides interesting insights regarding misconceptions about foods that could be attributed to influences such as media advertising and that can be addressed by educators of this age group.
An assessment framework for telemedicine applications
Publisher: SAGE Publications
Date: 06-07-1999
Abstract: Pressures for the adoption of telemedicine place increased demands on purchasers to assess applications of the technique. Assessment principles are helpful in defining an evaluation framework for use at the local level. We suggest an assessment approach that includes five specific elements: specification performance measures outcomes summary measures and operational and other considerations. The approach described here was developed to assist with the needs of in idual health authorities and institutions within the health-care system of Alberta. Aspects of the approach are illustrated using a telepsychiatry ex le under the assumptions made. Conventional psychiatry (where the patient visited the psychiatrist) was most expensive for the patient. The alternatives, telepsychiatry and outreach psychiatry (where the psychiatrist travelled to the patient), cost about the same from the service provider's perspective (and from that of society as a whole) they were both much cheaper for the patient. At higher volumes, telepsychiatry would be cheaper than outreach.
Cost-effectiveness and budget impact of adjunctive hyperbaric oxygen therapy for diabetic foot ulcers
Publisher: Cambridge University Press (CUP)
Date: 04-2008
DOI: 10.1017/S0266462308080252
Abstract: Background: Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunct to standard methods of care for diabetic foot ulcers (DFU). Its use may decrease the risk of infection and lower extremity utations (LEAs). As part of a Canadian assessment, we estimated the cost-effectiveness and budget impact of HBOT in this application. Methods: We developed a decision model comparing adjunctive HBOT with standard care alone. The population was a 65-year-old cohort with DFU. The time horizon was 12 years taken from a Ministry of Health perspective. The health states were a healed wound with or without a minor LEA, an unhealed wound with no related surgery, and a major LEA. Efficacy data were based on outcomes reported in studies included in a literature review. Cost and capacity needs for treating DFU patients in Canada were estimated using prevalence data from the literature, and cost and utilization data from government records. Results: The 12-year cost for patients receiving HBOT was CND$40,695 compared with CND$49,786 for standard care alone. Outcomes were 3.64 quality-adjusted life-years (QALYs) for those receiving HBOT and 3.01 QALYs for controls. Estimated cost to treat all prevalent DFU cases in Canada was CND$14.4–19.7 million/year over 4 years. If seven-person HBOT chambers were used, a further nineteen to thirty-five machines would be required nationally. Conclusions: Adjunctive HBOT for DFU is cost-effective compared with standard care. Additional HBOT capacity would be needed if it were to be adopted as the standard of care throughout Canada.
Polyunsaturated fatty acid status in attention deficit hyperactivity disorder, depression, and Alzheimer's disease: towards an omega-3 index for mental health?
Publisher: Oxford University Press (OUP)
Date: 10-2009
DOI: 10.1111/J.1753-4887.2009.00229.X
Abstract: Interest in the role of polyunsaturated fatty acids (PUFAs), particularly long-chain (LC) omega-3 (n-3) PUFAs, in mental health is increasing. This review investigates whether n-3 PUFA levels are abnormal in people with three prevalent mental health problems - attention deficit hyperactivity disorder, depression, and dementia. Data sources included PubMed, Web of Science, and bibliographies of papers published in English that describe PUFA levels in the circulation of in iduals who have these mental health conditions. Although abnormal blood PUFA levels were reported in a number of studies, weighted comparisons of PUFA status showed no significant differences overall between people with mental health problems and controls. Whether those with low n-3 PUFA status are likely to be more responsive to n-3 PUFA supplementation is not yet resolved. Further studies assessing PUFA levels and mental status with greater uniformity are required in order to clarify the relationship between LC n-3 PUFA status and mental health.
Nutritional modulation of cognitive function and mental health
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.JNUTBIO.2013.01.002
Abstract: The important role of diet in cardiometabolic health is generally well recognised for mental health, it is not so well understood. However, lifestyle risk factors for poor physical health are the same risk factors for mental illness, including poor diet. This is reflected by the high level of poor physical health in people with mental illness. Mediterranean, whole food diets have been associated with reduced risk for chronic disease, but very little research has investigated their mental health benefits. We provide a model for the pathways by which food components provided by a Mediterranean-style diet can facilitate healthy brain function. We then review evidence for the role of selected nutrients/food components - antioxidants, omega-3 fatty acids and B vitamins - in the brain and, hence, modulation of cognitive function and mental health. Converging evidence indicates multiple pathways by which these nutrients can assist in brain function, drawing from studies investigating them in isolation. There is very little work done on synergistic actions of nutrients and whole diets, highlighting a need for human intervention studies investigating benefits of Mediterranean-style diets for mental, as well as cardiometabolic health.
Telomere shortening in elderly individuals with mild cognitive impairment may be attenuated with ω-3 fatty acid supplementation: A randomized controlled pilot study
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.NUT.2013.09.013
Abstract: Excessive shortening of the telomeric ends of chromosomes is a marker of accelerated aging. Oxidative stress and nutritional deficiency may influence this process. The aim of this study was to investigate the effect of ω-3 polyunsaturated fatty acid (ω-3 PUFA) supplementation on telomeric shortening in elderly in iduals with mild cognitive impairment (MCI). Thirty-three adults ages > 65 y with MCI were randomized to receive a supplement rich in the long-chain ω-3 PUFAs eicosapentaenoic acid (EPA 1.67 g EPA + 0.16 g docosahexaenoic acid DHA/d n = 12) or DHA (1.55 g DHA + 0.40 g EPA/d n = 12), versus ω-6 PUFA linoleic acid (LA 2.2 g/d n = 9) for 6 mo. The intervention did not show an increase in telomere length with treatment and there was a trend toward telomere shortening during the intervention period. Linear mixed modeling produced a robust model although statistically underpowered. Telomere shortening was greatest in the LA group (d = 0.21) than in the DHA (d = 0.12) and EPA groups (d = 0.06). Increased erythrocyte DHA levels were associated with reduced telomere shortening (r = -0.67 P = 0.02) in the DHA group. Telomeric shortening may be attenuated by ω-3 PUFA supplementation, requiring further investigation in larger s les.
Telepsychiatry as a routine service -the perspective of the patient
Publisher: SAGE Publications
Date: 06-2001
Abstract: Patient perspectives were examined as part of an assessment of a routine telepsychiatry service in rural Alberta. Information was gathered through self-report questionnaires and telephone interviews. Of 379 questionnaires distributed to patients, 230 (61%) were returned. Of the patients who completed questionnaires, 89% reported being satisfied with the service and 96-99% were satisfied with the equipment and the room. Twenty-nine of 31 patients who were interviewed by telephone preferred telepsychiatry to waiting for a consultation, were willing to use the service again and would recommend telepsychiatry to a friend. While 25 of these 31 patients preferred telepsychiatry to travelling to a consultation, 15 indicated that they would prefer a face-to-face interview to telepsychiatry and a further seven were unsure. Twenty-three of the 31 patients interviewed would have had to miss time from work or pay for child care in order to travel to a conventional psychiatric consultation. The availability of telepsychiatry led to an estimated cost saving of $210 per consultation for patients who would otherwise have had to travel. From the patient's perspective, telepsychiatry was an acceptable technique in the management of mental health difficulties that both increased access to services and produced cost savings.
Guidance for preparing evaluation reports in telemedicine and health informatics generally
Publisher: SAGE Publications
Date: 10-2007
DOI: 10.1258/135763307782215352
Abstract: The European Federation for Medical Informatics is developing a detailed guideline for preparing evaluation reports. By doing this, it is hoped that the quality of evaluation studies in health informatics will improve and thus the evidence base. While much of the necessary information for preparing good quality evaluation publications is available in other documents, the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI) is valuable in bringing together many points into a single document. The current version is comprehensive and includes valuable information on a number of areas. A list of recommended items for inclusion in an evaluation report is given. There is perhaps a danger that some authors might be intimidated by the suggested detail to be provided. Nonetheless, the Federation is to be congratulated for putting together a comprehensive guideline which promises to be a useful contribution to improving the quality of evaluation studies in information technology, including telemedicine.
Published evidence on the success of telecardiology: A mixed record
Publisher: SAGE Publications
Date: 11-2004
Abstract: We carried out a systematic review of the literature on telecardiology assessment from 1992 to September 2003. We selected articles reporting clinical, economic or administrative outcomes. Quality of evidence was assessed using an approach that considered both study design and study performance. Forty-four studies met the selection criteria. Studies of home care applications, particularly management of congestive heart failure, were of highest quality, giving a high degree of confidence in their findings. Studies on paediatric and non-emergency adult hospital applications were of poorer quality they were mostly reports of case series and gave relatively little detail. Economic analysis was limited to cost studies and in most cases was judged to be of poor to fair quality. While telecardiology has been widely applied, there is still limited good-quality evidence of its benefits to health-care. Success in establishing the feasibility of telecardiology applications is offset by a failure to obtain convincing data on their influence on health outcomes and on their cost-effectiveness.
Limitations in the routine use of telepsychiatry
Publisher: SAGE Publications
Date: 2009
Abstract: Telepsychiatry is well established in many countries, but there is still little information about its use in routine health care. We reviewed the literature for information on the use of telepsychiatry in mental health services. From 1033 publications identified in the literature search and through references from a separate project, 16 studies or descriptions of the routine use of telepsychiatry services were selected for further review. Eleven of these articles dealt primarily with videoconferencing and five with telephone- based services. Clinical use of videoconferencing in the programmes described by the reviewed papers was modest, with an average of 16 consultations per month. Three of the telephone-based services had large numbers of clients. The papers we reviewed gave limited consideration to the healthcare systems in which telepsychiatry was provided and to the use of conventional mental health services. Telepsychiatry appears to still be a niche technology in many health systems. A lack of ch ions for the technology and reimbursement problems may contribute to the limited use of this area of telemedicine.
Oiling the Brain: A Review of Randomized Controlled Trials of Omega-3 Fatty Acids in Psychopathology across the Lifespan
Publisher: MDPI AG
Date: 09-02-2010
DOI: 10.3390/NU2020128
Influences of micronutrient and omega-3 fatty acid supplementation on cognition, learning, and behavior: Methodological considerations and implications for children and adolescents in developed societies
Publisher: Oxford University Press (OUP)
Date: 10-2012
DOI: 10.1111/J.1753-4887.2012.00516.X
Abstract: The purpose of this review is to outline the current evidence regarding the effects of micronutrient and omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation on the cognition, learning, and behavior of children and adolescents living in developed societies. Existing evidence suggests that children and adolescents in developed countries may perform better on tests of nonverbal intelligence and on behavioral measures after receiving vitamin and mineral supplements with or without n-3 PUFA supplementation compared with those receiving placebo, regardless of age and supplementation formula. The strongest effects were observed in trials that lasted over 3 months and in subgroups of children with low socioeconomic status, symptoms of attention deficit hyperactivity disorder, and/or learning disabilities. Future studies should focus on children and adolescents who have a low socioeconomic status or are likely to be suffering nutritional deficiencies to determine the impact of vitamin and mineral supplements with or without n-3 PUFA supplementation on their cognitive and behavioral functioning. These studies should ideally include blood s le analyses to help determine if nutritional status influences the response to supplementation and whether changes in blood status account for effects on cognition and behavior.
Survey on the involvement of consumers in health technology assessment programs
Publisher: Cambridge University Press (CUP)
Date: 19-09-2006
DOI: 10.1017/S0266462306051427
Abstract: Objectives: The aim of this study was to obtain information from members of the International Network of Agencies for Health Technology Assessment (INAHTA) on their involvement of consumers (patients, carers, and related organizations) in their programs. Methods: A questionnaire for a survey was developed and sent to member agencies in October 2005. Results: Of the thirty-seven agencies that provided responses, 57 percent involve consumers in some aspects of their HTA programs and 83 percent intend to involve consumers in the future. Summaries of HTA reports that are intended to be easily understood by consumers are prepared by 49 percent of the agencies, and 36 percent involve consumers in dissemination of HTA material. Conclusions: Most INAHTA members involve consumers in some aspects of their programs, although not always routinely. Involvement seems likely to increase in the future.
Treatment of adolescent overweight and obesity
Publisher: Springer Science and Business Media LLC
Date: 11-2008
DOI: 10.1007/S00431-007-0575-Z
Abstract: Adolescence is a vulnerable period for the development of obesity, and adolescent weight tracks strongly into adulthood. Previous reviews of treatment strategies have failed to discriminate between adolescents and children, thereby, disregarding the uniqueness of this population. Hence, this review aims to summarise the evidence for treatment approaches for adolescent obesity. Pubmed, OVID, EBSCOhost and Google Scholar were searched for randomised controlled trials, meta-analyses and systematic reviews testing treatments for overweight/obese adolescents (aged 12-19 years), published from 1982-2006 in English. Eligible studies had to assess either weight, percentage overweight, body mass index (BMI) or body fat. Thirty-four randomised controlled trials were eligible. The results of this review indicate that the safety and efficacy of surgical and pharmacotherapy treatments for adolescent obesity is uncertain. Diet and physical activity approaches may improve obese status in the short term. However, obesity interventions appear more effective when strategies are combined, rather than when used in isolation. Psychological interventions, such as behavioural and cognitive behavioural therapy, show promise in achieving the necessary lifestyle changes for obesity reduction however, long-term follow-up studies are needed. There were multiple limitations in appraising the literature. Inconsistent definitions of overweight/obesity make comparisons between studies difficult. Many studies have not used direct adiposity measures, have failed to assess pubertal status or have not used an exclusive adolescent s le. We conclude that, despite these limitations, current evidence indicates that behavioural and cognitive behavioural strategies combined with diet and physical activity approaches may assist in reducing adolescent obesity,although long-term follow-up studies are needed.
Evaluation and policy considerations in the introduction of extracorporeal membrane oxygenation
Publisher: Elsevier BV
Date: 10-1992
DOI: 10.1016/0168-8510(92)90002-S
Abstract: The introduction of extracorporeal membrane oxygenation (ECMO) in Australia was associated with establishment of the technology at two teaching hospitals followed by appraisal through a consensus conference and a subsequent synthesis report and cost analysis. The assessments and associated policy processes have helped to define the place of the technology, but many uncertainties remain due to limited relevance of results from other countries, the preliminary nature of local data and absence of controlled trials. This experience raises questions concerning approaches by professional groups, funding authorities and assessment agencies in dealing with specialised new techniques which are associated with a small national caseload.
I nternational S ociety for N utritional P sychiatry R esearch consensus position statement: nutritional medicine in modern psychiatry
Publisher: Wiley
Date: 25-09-2015
DOI: 10.1002/WPS.20223
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