Lisa Gold

Health-related quality of life: population epidemiology and concordance in Australian children aged 11–12 years and their parents

Publisher: BMJ

Date: 07-2019

DOI: 10.1136/BMJOPEN-2018-022398

Abstract: To describe the distribution of health-related quality of life (HRQL) in a national s le of Australian children aged 11–12 years and their parents, and examine associations within parent–child dyads. The Child Health CheckPoint, a population-based cross-sectional study nested between waves 6 and 7 of the Longitudinal Study of Australian Children (LSAC). Assessment centres in seven Australian cities and eight regional towns, or home visit February 2015 to March 2016. Of all participating CheckPoint families (n=1874), 1853 children (49.0% girls) and 1863 parents (87.7% mothers) with HRQL data were included (1786 pairs). HRQL was self-reported using preference-based (Child Health Utility 9Dimension, CHU9D) and non-preference-based (Pediatric Quality of Life, PedsQL V.4.0) measures for children and preference-based measures for parents (CHU9D Assessment of Quality of Life 8 Dimension, AQoL-8D). Utility scores from preference-based measures were calculated using existing Australian algorithms to present a score on a 0–1 scale, where 1 represents full health. Parent–child concordance was assessed using Pearson’s correlation coefficients and adjusted linear regression models. Survey weights and methods were applied to account for LSAC’s complex s le design, stratification and clustering within postcodes. Children’s means and SD were 0.81 (SD 0.16) for CHU9D and 78.3 (SD 13.03) for PedsQL. In adults, mean HRQL for AQoL-8D and CHU9D were 0.78 (SD 0.16) and 0.89 (SD 0.10), respectively. Mean HRQL was similar for boys and girls, but slightly higher for fathers than mothers. The Pearson correlation coefficient for parent–child CHU9D values was 0.13 (95% CI 0.09 to 0.18). Percentiles and concordance are presented for both s les for males and females separately and together. We provide Australian paediatric population values for HRQL measures, and the first national CHU9D values for mid-life adults. At age 11–12 years in this relatively healthy s le, parent–child concordance in HRQL was small.

Academic, behavioural and quality of life outcomes of slight to mild hearing loss in late childhood: A population-based study

Publisher: BMJ

Date: 11-05-2019

DOI: 10.1136/ARCHDISCHILD-2019-316917

Abstract: To investigate the associations of hearing thresholds and slight to mild hearing loss with academic, behavioural and quality of life outcomes in children at a population level. Design and participants: children aged 11–12 years in the population-based cross-sectional Child Health CheckPoint study within the Longitudinal Study of Australian Children. Audiometry: mean hearing threshold across 1, 2 and 4 kHz (better and worse ear) slight/mild hearing loss (threshold of 16–40 decibels hearing loss (dB HL)). Outcomes: National Assessment Program – Literacy and Numeracy, language, teacher-reported learning, parent and teacher reported behaviour and self-reported quality of life. Analysis: linear regression quantified associations of hearing threshold/loss with outcomes. Of 1483 children (mean age 11.5 years), 9.2% and 13.1% had slight/mild bilateral and unilateral hearing loss, respectively. Per SD increment in better ear threshold (5.7 dB HL), scores were worse on several academic outcomes (eg, reading 0.11 SD, 95% CI 0.05 to 0.16), parent-reported behaviour (0.06 SD, 95% CI 0.01 to 0.11) and physical (0.09 SD, 95% CI 0.04 to 0.14) and psychosocial (0.06 SD, 95% CI 0.01 to 0.11) Pediatric Quality of Life Inventory (PedsQL). Compared with normally hearing children, children with bilateral slight/mild losses scored 0.2–0.3 SDs lower in sentence repetition, teacher-reported learning and physical PedsQL but not other outcomes. Similar but attenuated patterns were seen in unilateral slight/mild losses. Hearing thresholds and slight/mild hearing loss showed small but important associations with some child outcomes at 11–12 years. Justifying hearing screening or intervention at this age would require better understanding of its longitudinal and indirect effects, alongside effective management and appropriate early identification programmes.

Nurse Home Visiting for Families Experiencing Adversity: A Randomized Trial

Publisher: American Academy of Pediatrics (AAP)

Date: 2019

DOI: 10.1542/PEDS.2018-1206

Abstract: Nurse home visiting (NHV) may redress inequities in children’s health and development evident by school entry. We tested the effectiveness of an Australian NHV program (right@home), offered to pregnant women experiencing adversity, hypothesizing improvements in (1) parent care, (2) responsivity, and (3) the home learning environment at child age 2 years. A randomized controlled trial of NHV delivered via universal child and family health services was conducted. Pregnant women experiencing adversity (≥2 of 10 risk factors) with sufficient English proficiency were recruited from antenatal clinics at 10 hospitals across 2 states. The intervention comprised 25 nurse visits to child age 2 years. Researchers blinded to randomization assessed 13 primary outcomes, including Home Observation of the Environment (HOME) Inventory (6 subscales) and 25 secondary outcomes. Of 1427 eligible women, 722 (50.6%) were randomly assigned 306 of 363 (84%) women in the intervention and 290 of 359 (81%) women in the control group provided 2-year data. Compared with women in the control group, those in the intervention reported more regular child bedtimes (adjusted odds ratio 1.76 95% confidence interval [CI] 1.25 to 2.48), increased safety (adjusted mean difference [AMD] 0.22 95% CI 0.07 to 0.37), increased warm parenting (AMD 0.09 95% CI 0.02 to 0.16), less hostile parenting (reverse scored AMD 0.29 95% CI 0.16 to 0.41), increased HOME parental involvement (AMD 0.26 95% CI 0.14 to 0.38), and increased HOME variety in experience (AMD 0.20 95% CI 0.07 to 0.34). The right@home program improved parenting and home environment determinants of children’s health and development. With replicability possible at scale, it could be integrated into Australian child and family health services or trialed in countries with similar child health services.

A Parent-Focused Intervention to Reduce Infant Obesity Risk Behaviors: A Randomized Trial

Publisher: American Academy of Pediatrics (AAP)

Date: 04-2013

DOI: 10.1542/PEDS.2012-2576

Abstract: To assess the effectiveness of a parent-focused intervention on infants’ obesity-risk behaviors and BMI. This cluster randomized controlled trial recruited 542 parents and their infants (mean age 3.8 months at baseline) from 62 first-time parent groups. Parents were offered six 2-hour dietitian-delivered sessions over 15 months focusing on parental knowledge, skills, and social support around infant feeding, diet, physical activity, and television viewing. Control group parents received 6 newsletters on nonobesity-focused themes all parents received usual care from child health nurses. The primary outcomes of interest were child diet (3 × 24-hour diet recalls), child physical activity (accelerometry), and child TV viewing (parent report). Secondary outcomes included BMI z-scores (measured). Data were collected when children were 4, 9, and 20 months of age. Unadjusted analyses showed that, compared with controls, intervention group children consumed fewer grams of noncore drinks (mean difference = –4.45 95% confidence interval [CI]: –7.92 to –0.99 P = .01) and were less likely to consume any noncore drinks (odds ratio = 0.48 95% CI: 0.24 to 0.95 P = .034) midintervention (mean age 9 months). At intervention conclusion (mean age 19.8 months), intervention group children consumed fewer grams of sweet snacks (mean difference = –3.69 95% CI: –6.41 to –0.96 P = .008) and viewed fewer daily minutes of television (mean difference = –15.97: 95% CI: –25.97 to –5.96 P = .002). There was little statistical evidence of differences in fruit, vegetable, savory snack, or water consumption or in BMI z-scores or physical activity. This intervention resulted in reductions in sweet snack consumption and television viewing in 20-month-old children.

Food rescue – an Australian example

Publisher: Emerald

Date: 26-08-2014

DOI: 10.1108/BFJ-01-2014-0053

Abstract: – Food rescue is used in the emergency food sector internationally to reduce waste and improve food supplies to frontline providers and their clients. The purpose of this paper is to provide a perspective on why and how food rescue occurs in Australia. It also examines food rescue as a potential evolution within the emergency food setting. – A descriptive study of SecondBite, an Australian food rescue organisation, was conducted. Documents were reviewed, 14 weeks of participant observation occurred, and two focus group discussions were held. Framing analysis was used to design the research questions (why rescue food? and how?). The description of the organisation was then examined against critical literature to establish how food rescue conforms to and/or challenges the traditional limitations of emergency food. – Food rescue requires multiple resources within the emergency food space including surplus food, funding and labour. The frames used to justify this work provide an insight into the “problem” of food poverty in Australia and the “solution” of food rescue. The script for “people in need” requiring “fresh food” is well developed by SecondBite, with some tension around food waste reduction as a competing and yet complementary mission. – In light of the growing role of the not for profit sector in a “big society” political order, the rescuing of nutritious food for emergency parcels and meals, may provide some benefits for people already using emergency food. The opportunity for food rescue organisations to play a role in food poverty prevention requires further attention.

Health-care costs of underweight, overweight and obesity: Australian population-based study

Publisher: Wiley

Date: 08-06-2015

DOI: 10.1111/JPC.12932

The cost of healthcare for children with mental health difficulties

Publisher: SAGE Publications

Date: 29-05-2013

DOI: 10.1177/0004867413491152

Abstract: Childhood mental health difficulties affect one in every seven children in Australia, posing a potential financial burden to society. This paper reports on the early lifetime in idual and population non-hospital healthcare costs to the Australian Federal Government for children experiencing mental health difficulties. It also reports on the use and cost of particular categories of service use, including the Medicare Benefits Schedule (MBS) mental health items introduced in 2006. Data from the Longitudinal Study of Australian Children (LSAC) were used to calculate total Medicare costs (government subsidised healthcare attendances and prescription medications) from birth to the 8th birthday associated with childhood mental health difficulties measured to 8–9 years of age. Costs were higher among children with mental health difficulties than those without difficulties. While in idual costs increased with the persistence of difficulties, population-level costs were highest for those with transient mental health difficulties. Although attenuated, these patterns persisted after child, parent and family characteristics were taken into account. Use of the MBS-reimbursed mental health services among children with a mental health difficulty was very low (around 2%). Australian healthcare costs for young children with mental health difficulties are substantial and provide further justification for early intervention and prevention. The current provision of Medicare-rebated mental health services does not appear to be reaching young children with mental health difficulties.

Tier 2 oral language and early reading interventions for preschool to grade 2 children: a restricted systematic review

Publisher: Informa UK Limited

Date: 30-12-2021

DOI: 10.1080/19404158.2021.2011754

Use of time and adolescent health-related quality of life/well-being: a scoping review

Publisher: Wiley

Date: 10-07-2017

DOI: 10.1111/APA.13929

Abstract: Time use could profoundly affect adolescents' health-related quality of life (HRQL). Ideally, overall time use patterns would be considered, because activities within a 24-hour day are inherently correlated (more in one activity means less in another). This review focused on the associations of (i) overall time use patterns and (ii) components of time use patterns with HRQL in adolescents. More physical activity, less screen time and more/adequate sleep, in isolation, are associated with better profile-based HRQL subscales. Greater understanding of adolescents' overall time use patterns and HRQL is, therefore, a priority for policy development.

Economic evaluation of a primary care trial to reduce weight gain in overweight/obese children: The LEAP trial

Publisher: Elsevier BV

Date: 09-2008

DOI: 10.1016/J.AMBP.2008.06.006

Abstract: A common policy response to the childhood obesity epidemic is to recommend that primary care physicians screen for and offer counseling to the overweight/obese. As the literature suggests, this approach may be ineffective it is important to document the opportunity costs incurred by brief primary care obesity interventions that ultimately may not alter body mass index (BMI) trajectory. Live, Eat and Play (LEAP) was a randomized controlled trial of a brief secondary prevention intervention delivered by family physicians in 2002-2003 that targeted overweight/mildly obese children aged 5 to 9 years. Primary care utilization was prospectively audited via medical records, and parents reported family resource use by written questionnaire. Outcome measures were BMI (primary) and parent-reported physical activity and dietary habits (secondary) in intervention compared with control children. The cost of LEAP per intervention family was AU $4094 greater than for control families, mainly due to increased family resources devoted to child physical activity. Total health sector costs were AU $873 per intervention family and AU $64 per control, a difference of AU $809 (P < .001). At 15 months, intervention children did not differ significantly in adjusted BMI or daily physical activity scores compared with the control group, but dietary habits had improved. This brief intervention resulted in higher costs to families and the health care sector, which could have been devoted to other uses that do create benefits to health and/or family well-being. This has implications for countries such as the United States, the United Kingdom, and Australia, whose current guidelines recommend routine surveillance and counseling for high child BMI in the primary care sector.

Socioeconomic Position Is Associated With Carotid Intima–Media Thickness in Mid‐Childhood: The Longitudinal Study of Australian Children

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 02-08-2017

DOI: 10.1161/JAHA.117.005925

Abstract: Lower socioeconomic position ( SEP ) predicts higher cardiovascular risk in adults. Few studies differentiate between neighborhood and family SEP or have repeated measures through childhood, which would inform understanding of potential mechanisms and the timing of interventions. We investigated whether neighborhood and family SEP , measured biennially from ages 0 to 1 year onward, was associated with carotid intima–media thickness ( IMT ) at ages 11 to 12 years. Data were obtained from 1477 families participating in the Child Health CheckPoint study, nested within the Longitudinal Study of Australian Children. Disadvantaged family and neighborhood SEP was cross‐sectionally associated with thicker maximum carotid IMT in separate univariable linear regression models. Associations with family SEP were not attenuated in multivariable analyses, and associations with neighborhood SEP were attenuated only in models adjusted for family SEP . The difference in maximum carotid IMT between the highest and lowest family SEP quartile measured at ages 10 to 11 years was 10.7 μm (95% CI , 3.4–18.0 P =0.004), adjusted for age, sex, pubertal status, passive smoking exposure, body mass index, blood pressure, and arterial lumen diameter. In longitudinal analyses, family SEP measured as early as age 2 to 3 years was associated with maximum carotid IMT at ages 11 to 12 years (difference between highest and lowest quartile: 8.5 μm 95% CI , 1.3–15.8 P =0.02). No associations were observed between SEP and mean carotid IMT . We report a robust association between lower SEP in early childhood and carotid IMT in mid‐childhood. Further investigation of mechanisms may inform pediatric cardiovascular risk assessment and prevention strategies.

Growing Community

Publisher: SAGE Publications

Date: 13-12-2011

DOI: 10.1177/1090198111422937

Abstract: This article presents results from a mixed-method evaluation of a structured cooking and gardening program in Australian primary schools, focusing on program impacts on the social and learning environment of the school. In particular, we address the Stephanie Alexander Kitchen Garden Program objective of providing a pleasurable experience that has a positive impact on student engagement, social connections, and confidence within and beyond the school gates. Primary evidence for the research question came from qualitative data collected from students, parents, teachers, volunteers, school principals, and specialist staff through interviews, focus groups, and participant observations. This was supported by analyses of quantitative data on child quality of life, cooperative behaviors, teacher perceptions of the school environment, and school-level educational outcome and absenteeism data. Results showed that some of the program attributes valued most highly by study participants included increased student engagement and confidence, opportunities for experiential and integrated learning, teamwork, building social skills, and connections and links between schools and their communities. In this analysis, quantitative findings failed to support findings from the primary analysis. Limitations as well as benefits of a mixed-methods approach to evaluation of complex community interventions are discussed.

Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non‐epidural comparison group

Publisher: Wiley

Date: 21-12-2009

DOI: 10.1111/J.1365-2044.2009.06136.X

Abstract: We compared breastfeeding initiation and duration in 1054 nulliaparae randomised to bupivacaine Control epidural, Combined Spinal Epidural or Low Dose Infusion and 351 matched non-epidural comparisons. Women were interviewed after delivery and completed a postal questionnaire at 12 months. Regression analysis determined factors which independently predicted breastfeeding initiation. Breastfeeding duration was subjected to Kaplan-Meier analysis. A similar proportion of women in each epidural group initiated breastfeeding. Women with no epidural did not report a higher initiation rate relative to epidural groups and those who received pethidine reported a lower initiation rate than control epidural (p = 0.002). Older age groups (p < 0.001) and non-white ethnicity (p < 0.026) were predictive of breastfeeding. Epidural fentanyl dose, delivery mode and trial group were not predictive. Mean duration for breastfeeding was similar across epidural groups (Control 13.3, Combined Spinal Epidural 15.5, Low Dose Infusion 15.0 weeks). Our data do not support an effect of epidural fentanyl on breastfeeding initiation.

An online healthy relationship tool and safety decision aid for women experiencing intimate partner violence (I-DECIDE): a randomised controlled trial

Publisher: Elsevier BV

Date: 06-2019

DOI: 10.1016/S2468-2667(19)30079-9

Correction to: Mapping PedsQL™ scores onto CHU9D utility scores: estimation, validation and a comparison of alternative instrument versions (Quality of Life Research, (2020), 29, 3, (639-652), 10.1007/s11136-019-02357-9)

Publisher: Springer Science and Business Media LLC

Date: 28-01-2020

DOI: 10.1007/S11136-019-02382-8

Abstract: In the original publication of the article, the equation CHU9D

Health-related quality of life of caregivers of children with low language: Results from two Australian population-based studies

Publisher: Informa UK Limited

Date: 21-09-2022

DOI: 10.1080/17549507.2021.1976836

The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review

Publisher: Elsevier BV

Date: 2001

DOI: 10.1016/S0306-5456(00)00020-6

‘right@home’: a randomised controlled trial of sustained nurse home visiting from pregnancy to child age 2 years, versus usual care, to improve parent care, parent responsivity and the home learning e

Publisher: BMJ

Date: 03-2017

DOI: 10.1136/BMJOPEN-2016-013307

A settings‐based theoretical framework for obesity prevention community interventions and research

Publisher: Elsevier BV

Date: 04-2011

DOI: 10.1111/J.1753-6405.2010.00688.X

Group Pregnancy Care for refugee background women: a codesigned, multimethod evaluation protocol applying a community engagement framework and an interrupted time series design

Publisher: BMJ

Date: 07-2021

DOI: 10.1136/BMJOPEN-2020-048271

Abstract: Pregnancy and early parenthood are key opportunities for interaction with health services and connecting to other families at the same life stage. Public antenatal care should be accessible to all, however barriers persist for families from refugee communities to access, navigate and optimise healthcare during pregnancy. Group Pregnancy Care is an innovative model of care codesigned with a community from a refugee background and other key stakeholders in Melbourne, Australia. Group Pregnancy Care aims to provide a culturally safe and supportive environment for women to participate in antenatal care in a language they understand, to improve health literacy and promote social connections and inclusion. This paper outlines Froup Pregnancy Care and provides details of the evaluation framework. The evaluation uses community-based participatory research methods to engage stakeholders in codesign of evaluation methods. The study is being conducted across multiple sites and involves multiple phases, use of quantitative and qualitative methods, and an interrupted time series design. Process and cost-effectiveness measures will be incorporated into quality improvement cycles. Evaluation measures will be developed using codesign and participatory principles informed by community and stakeholder engagement and will be piloted prior to implementation. Ethics approvals have been provided by all six relevant authorities. Study findings will be shared with communities and stakeholders via agreed pathways including community forums, partnership meetings, conferences, policy and practice briefs and journal articles. Dissemination activities will be developed using codesign and participatory principles.

Predictors in Infancy for Language and Academic Outcomes at 11 Years

Publisher: American Academy of Pediatrics (AAP)

Date: 02-2021

DOI: 10.1542/PEDS.2020-1712

Abstract: To examine the contribution of early life factors and preschool- and school-aged language abilities to children’s 11-year language and academic outcomes. Participants (N = 839) were from a prospective community cohort study of 1910 infants recruited at 8 to 10 months of age. Early life factors included a combination of child (prematurity, birth weight), family (socioeconomic disadvantage, family history of language difficulties), and maternal factors (education, vocabulary, and age). Language (standardized assessment of receptive and expressive skills) and academic (national assessment) outcomes at 11 years were predicted by using a series of multivariable regression models. Early life factors explained 11% to 12% of variance in language scores at 11 years. The variance explained increased to 47% to 64% when language scores from 2 to 7 years were included. The largest increase in variance explained was with 4-year language scores. The same early life factors explained 13% to 14% of academic scores at 11 years, with increases to 43% to 54% when language scores from 2 to 11 years were included. Early life factors adequately discriminated between children with typical and low language scores but were much better discriminators of children with typical and low academic scores. When earlier language scores were added to models then the area under the curve increased to 0.9 and above. Children’s language outcomes at 11 years are accurately predicted by their 4-year language ability and their academic outcomes at 11 years are predicted by early family and home environment factors. Children with low language abilities at 11 years consistently performed more poorly on national assessments of literacy and numeracy.

Safety and efficacy of antenatal milk expressing for women with diabetes in pregnancy: Protocol for a randomised controlled trial

Publisher: BMJ

Date: 10-2014

DOI: 10.1136/BMJOPEN-2014-006571

Abstract: Many maternity providers recommend that women with diabetes in pregnancy express and store breast milk in late pregnancy so breast milk is available after birth, given (1) infants of these women are at increased risk of hypoglycaemia in the first 24 h of life and (2) the delay in lactogenesis II compared with women without diabetes that increases their infant's risk of receiving infant formula. The Diabetes and Antenatal Milk Expressing (DAME) trial will establish whether advising women with diabetes in pregnancy (pre-existing or gestational) to express breast milk from 36 weeks gestation increases the proportion of infants who require admission to special or neonatal intensive care units (SCN/NICU) compared with infants of women receiving standard care. Secondary outcomes include birth gestation, breastfeeding outcomes and economic impact. Women will be recruited from 34 weeks gestation to a multicentre, two arm, unblinded randomised controlled trial. The intervention starts at 36 weeks. Randomisation will be stratified by site, parity and diabetes type. Women allocated to the intervention will be taught expressing and encouraged to hand express twice daily for 10 min and keep an expressing diary. The s le size of 658 (329 per group) will detect a 10% difference in proportion of babies admitted to SCN/NICU (85% power, α 0.05). Data are collected at recruitment (structured questionnaire), after birth (abstracted from medical record blinded to group), and 2 and 12 weeks postpartum (telephone interview). Data analysis: the intervention group will be compared with the standard care group by intention to treat analysis, and the primary outcome compared using χ 2 and ORs. Research ethics approval will be obtained from participating sites. Results will be published in peer-reviewed journals and presented to clinicians, policymakers and study participants. Australian Controlled Trials Register ACTRN12611000217909.

Ringing Up about Breastfeeding: a randomised controlled trial exploring early telephone peer support for breastfeeding (RUBY) - trial protocol.

Publisher: Springer Science and Business Media LLC

Date: 28-05-2014

DOI: 10.1186/1471-2393-14-177

Primary healthcare costs associated with sleep problems up to age 7 years: Australian population-based study

Publisher: BMJ

Date: 2013

DOI: 10.1136/BMJOPEN-2012-002419

Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity.

Publisher: Springer Science and Business Media LLC

Date: 12-12-2007

DOI: 10.1038/SJ.IJO.0803509

Abstract: To reduce gain in body mass index (BMI) in overweight/mildly obese children in the primary care setting. Randomized controlled trial (RCT) nested within a baseline cross-sectional BMI survey. Twenty nine general practices, Melbourne, Australia. (1) BMI survey: 2112 children visiting their general practitioner (GP) April-December 2002 (2) RCT: in idually randomized overweight/mildly obese (BMI z-score <3.0) children aged 5 years 0 months-9 years 11 months (82 intervention, 81 control). Four standard GP consultations over 12 weeks, targeting change in nutrition, physical activity and sedentary behaviour, supported by purpose-designed family materials. Primary: BMI at 9 and 15 months post-randomization. Secondary: Parent-reported child nutrition, physical activity and health status child-reported health status, body satisfaction and appearance/self-worth. Attrition was 10%. The adjusted mean difference (intervention-control) in BMI was -0.2 kg/m(2) (95% CI: -0.6 to 0.1 P=0.25) at 9 months and -0.0 kg/m(2) (95% CI: -0.5 to 0.5 P=1.00) at 15 months. There was a relative improvement in nutrition scores in the intervention arm at both 9 and 15 months. There was weak evidence of an increase in daily physical activity in the intervention arm. Health status and body image were similar in the trial arms. This intervention did not result in a sustained BMI reduction, despite the improvement in parent-reported nutrition. Brief in idualized solution-focused approaches may not be an effective approach to childhood overweight. Alternatively, this intervention may not have been intensive enough or the GP training may have been insufficient however, increasing either would have significant cost and resource implications at a population level.

Economic evaluation of community acquired pneumonia management strategies: A systematic review of literature

Publisher: Public Library of Science (PLoS)

Date: 24-10-2019

DOI: 10.1371/JOURNAL.PONE.0224170

Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: The COSMOS randomised controlled trial

Publisher: Wiley

Date: 25-07-2012

DOI: 10.1111/J.1471-0528.2012.03446.X

Abstract: To determine whether primary midwife care (caseload midwifery) decreases the caesarean section rate compared with standard maternity care. Randomised controlled trial. Tertiary-care women's hospital in Melbourne, Australia. A total of 2314 low-risk pregnant women. Women randomised to caseload received antenatal, intrapartum and postpartum care from a primary midwife with some care by 'back-up' midwives. Women randomised to standard care received either midwifery or obstetric-trainee care with varying levels of continuity, or community-based general practitioner care. caesarean birth. Secondary outcomes included instrumental vaginal births, analgesia, perineal trauma, induction of labour, infant admission to special/neonatal intensive care, gestational age, Apgar scores and birthweight. In total 2314 women were randomised-1156 to caseload and 1158 to standard care. Women allocated to caseload were less likely to have a caesarean section (19.4% versus 24.9% risk ratio [RR] 0.78 95% CI 0.67-0.91 P = 0.001) more likely to have a spontaneous vaginal birth (63.0% versus 55.7% RR 1.13 95% CI 1.06-1.21 P < 0.001) less likely to have epidural analgesia (30.5% versus 34.6% RR 0.88 95% CI 0.79-0.996 P = 0.04) and less likely to have an episiotomy (23.1% versus 29.4% RR 0.79 95% CI 0.67-0.92 P = 0.003). Infants of women allocated to caseload were less likely to be admitted to special or neonatal intensive care (4.0% versus 6.4% RR 0.63 95% CI 0.44-0.90 P = 0.01). No infant outcomes favoured standard care. In settings with a relatively high baseline caesarean section rate, caseload midwifery for women at low obstetric risk in early pregnancy shows promise for reducing caesarean births.

Health-Related Quality of Life in Children With Low Language or Congenital Hearing Loss, as Measured by the PedsQL and Health Utility Index Mark 3

Publisher: Elsevier BV

Date: 02-2019

DOI: 10.1016/J.JVAL.2019.07.019

Teacher Knowledge of Oral Language and Literacy Constructs: Results of a Randomized Controlled Trial Evaluating the Effectiveness of a Professional Learning Intervention

Publisher: Informa UK Limited

Date: 11-02-2021

DOI: 10.1080/10888438.2020.1714629

The impact of community-delivered models of malaria control and elimination: a systematic review.

Publisher: Springer Science and Business Media LLC

Date: 06-08-2019

DOI: 10.1186/S12936-019-2900-1

Improving outcomes of preschool language delay in the community: protocol for the Language for Learning randomised controlled trial

Publisher: Springer Science and Business Media LLC

Date: 09-07-2012

DOI: 10.1186/1471-2431-12-96

The costs of a community-based intervention to promote maternal health

Publisher: Oxford University Press (OUP)

Date: 23-10-2007

DOI: 10.1093/HER/CYL127

Abstract: The costs of community-level interventions are rarely reported, although such insights are needed if intervention research is to be useful to practitioners seeking to understand what might be involved in replicating interventions in different contexts. We report the costs of a 2-year community-based intervention to promote the health of recent mothers in Victoria, Australia. Program of Resources, Information and Support for Mothers was an integrated programme of primary care and community-based strategies. It had health care professional training, health education and community development components as well as an emphasis on creating 'mother-friendly' environments. Costs included the programme costs [primarily the salaries of the community development officers (CDO) in the field] and also 'induced' costs that relate to the CDOs' successes in attracting additional resources to the intervention from the local community. The total cost averaged A$272,490 per rural community and A$313,900 per urban community, equivalent to A$172.40 and A$128.70 per mother, respectively. For every A$10 of public funds initially invested in the project, the CDOs were able to attract a further A$1-2 worth of local resources, predominantly in the form of volunteer time or donated services.

High prevalence of slight and mild hearing loss across mid-life: a cross-sectional national Australian study

Publisher: Elsevier BV

Date: 03-2019

DOI: 10.1016/J.PUHE.2018.11.017

Abstract: Although presbycusis typically becomes symptomatic only in older age, slight and mild hearing loss may be detectable well before this. We studied current prevalence and characteristics of hearing loss in Australian mid-life adults. This was a population-derived national cross-sectional study nested within the Longitudinal Study of Australian Children. A total of 1485 parents/guardians (87.3% female) aged 30-59 years underwent air-conduction audiometry. Hearing loss was defined in three ways to maximize cross-study comparability: high Fletcher index (mean of 1, 2 and 4 kHz primary outcome relevant to speech perception), lower frequency (mean of 1 and 2 kHz) and higher frequency (mean of 4 and 8 kHz). Multivariable logistic regression examined how losses vary by age, sex and neighbourhood disadvantage. On high Fletcher index, 27.3% had bilateral and 23.8% unilateral thresholds >15 dB hearing level (HL) (slight or worse), and 4.9% had bilateral and 6.3% unilateral thresholds >25 dB HL (mild or worse). Bilateral higher frequency losses were more common than lower frequency losses for thresholds >15 dB HL (30.9% vs. 26.4%) and >25 dB HL (11.0% vs. 4.6%). Age increased the risk of bilateral speech and higher frequency losses (all P for trend 25 dB HL. Although sex was not associated with speech and lower frequency losses, men were more likely to have bilateral higher frequency losses (e.g. >15 dB HL: odds ratio [OR]: 2.2 95% confidence interval [CI]: 1.5-3.2, P < 0.001). Both slight and mild hearing loss show high and rising prevalence across mid-life. This offers opportunities to prevent progression to reduce the profound later burden of age-related hearing loss.

Schooling duration rather than chronological age predicts working memory between 6 and 7 years: Memory Maestros Study.

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 02-2015

DOI: 10.1097/DBP.0000000000000121

Economic evaluation of an Australian nurse home visiting programme: a randomised trial at 3 years

Publisher: BMJ

Date: 12-2021

DOI: 10.1136/BMJOPEN-2021-052156

Abstract: To investigate the additional programme cost and cost-effectiveness of ‘right@home’ Nurse Home Visiting (NHV) programme in relation to improving maternal and child outcomes at child age 3 years compared with usual care. A cost–utility analysis from a government-as-payer perspective alongside a randomised trial of NHV over 3-year period. Costs and quality-adjusted life-years (QALYs) were discounted at 5%. Analysis used an intention-to-treat approach with multiple imputation. The right@home was implemented from 2013 in Victoria and Tasmania states of Australia, as a primary care service for pregnant women, delivered until child age 2 years. 722 pregnant Australian women experiencing adversity received NHV (n=363) or usual care (clinic visits) (n=359). First, a cost–consequences analysis to compare the additional costs of NHV over usual care, accounting for any reduced costs of service use, and impacts on all maternal and child outcomes assessed at 3 years. Second, cost–utility analysis from a government-as-payer perspective compared additional costs to maternal QALYs to express cost-effectiveness in terms of additional cost per additional QALY gained. When compared with usual care at child age 3 years, the right@home intervention cost $A7685 extra per woman (95% CI $A7006 to $A8364) and generated 0.01 more QALYs (95% CI −0.01 to 0.02). The probability of right@home being cost-effective by child age 3 years is less than 20%, at a willingness-to-pay threshold of $A50 000 per QALY. Benefits of NHV to parenting at 2 years and maternal health and well-being at 3 years translate into marginal maternal QALY gains. Like previous cost-effectiveness results for NHV programmes, right@home is not cost-effective at 3 years. Given the relatively high up-front costs of NHV, long-term follow-up is needed to assess the accrual of health and economic benefits over time. ISRCTN89962120 .

Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial

Publisher: Elsevier BV

Date: 06-2017

DOI: 10.1016/S0140-6736(17)31373-9

Probiotics, prematurity and neurodevelopment: follow-up of a randomised trial.

Publisher: BMJ

Date: 11-2017

DOI: 10.1136/BMJPO-2017-000176

Volunteering in a School Kitchen Garden Program: Cooking Up Confidence, Capabilities, and Connections!

Publisher: Springer Science and Business Media LLC

Date: 25-09-2012

DOI: 10.1007/S11266-012-9334-5

The Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program follow-up

Publisher: Elsevier BV

Date: 2013

DOI: 10.1016/J.CCT.2012.10.008

Abstract: The Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program, is a community-based, cluster-randomised controlled trial of an obesity prevention intervention delivered to first-time parents of infants from age 4-20 months. Conducted from 2008 to 2010, the program had high uptake and retention and showed positive impacts on some dietary outcomes and television viewing. Funding was secured for a follow-up study of participants two and 3.5 years post intervention (at child ages ~3.5 and 5 years). The follow-up study aims to assess intervention effects, mediators and moderators of effects, and program cost-effectiveness over the longer term. The 492 families still enrolled in the Melbourne InFANT Program at intervention conclusion will be recontacted and renewed consent sought to participate in this follow-up study. No further intervention will occur. Home visit data collections will occur approximately two and 3.5 years post intervention. Main outcomes to be assessed include child body mass index, waist circumference, diet (3 × 24-hour recalls food frequency questionnaire), physical activity (8 days ActiGraph accelerometer data parent reported active play) and sedentary time (8days ActiGraph accelerometer and ActivPAL inclinometer data parent reported screen time). Follow-up of participants of the Melbourne InFANT Program at two and 3.5 years post intervention will allow assessment of longer term intervention effects, investigation of potential mediators and moderators of such effects, and economic evaluation of the longer term outcomes. This information will be valuable to researchers and policy makers in progressing the field of early childhood obesity prevention.

Economic evaluation of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: The SHELf randomized controlled trial

Publisher: Elsevier BV

Date: 06-2016

DOI: 10.1016/J.SOCSCIMED.2016.04.015

Abstract: Pricing strategies are a promising approach for promoting healthier dietary choices. However, robust evidence of the cost-effectiveness of pricing manipulations on dietary behaviour is limited. We aimed to assess the cost-effectiveness of a 20% price reduction on fruits and vegetables and a combined skills-based behaviour change and price reduction intervention. Cost-effectiveness analysis from a societal perspective was undertaken for the randomized controlled trial Supermarket Healthy Eating for Life (SHELf). Female shoppers in Melbourne, Australia were randomized to: (1) skill-building (n = 160) (2) price reductions (n = 161) (3) combined skill-building and price reduction (n = 161) or (4) control group (n = 161). The intervention was implemented for three months followed by a six month follow-up. Costs were measured in 2012 Australian dollars. Fruit and vegetable purchasing and consumption were measured in grams/week. At three months, compared to control participants, price reduction participants increased vegetable purchases by 233 g/week (95% CI 4 to 462, p = 0.046) and fruit purchases by 364 g/week (95% CI 95 to 633, p = 0.008). Participants in the combined group purchased 280 g/week more fruits (95% CI 27 to 533, p = 0.03) than participants in the control group. Increases were not maintained six-month post intervention. No effect was noticed in the skill-building group. Compared to the control group, the price reduction intervention cost an additional A$2.3 per increased serving of vegetables purchased per week or an additional A$3 per increased serving of fruit purchased per week. The combined intervention cost an additional A$12 per increased serving of fruit purchased per week compared to the control group. A 20% discount on fruits and vegetables was effective in promoting overall fruit and vegetable purchases during the period the discount was active and may be cost-effective. The price discount program gave better value for money than the combined price reduction and skill-building intervention. The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901.

Systematic review and meta-analysis of evidence for increasing numbers of drugs in antiretroviral combination therapy

Publisher: BMJ

Date: 30-03-2002

DOI: 10.1136/BMJ.324.7340.757

Abstract: To assess the evidence for the effectiveness of increasing numbers of drugs in antiretroviral combination therapy. Systematic review, meta-analysis, and meta-regression of fully reported randomised controlled trials. All studies included compared quadruple versus triple therapy, triple versus double therapy, double versus monotherapy, or monotherapy versus placebo or no treatment. Patients with any stage of HIV infection who had not received antiretroviral therapy. Changes in disease progression or death (clinical outcomes) CD4 count and plasma viral load (surrogate markers). Six electronic databases, including Medline, Embase, and the Cochrane Library, searched up to February 2001. 54 randomised controlled trials, most of good quality, with 66 comparison groups were included in the analysis. For both the clinical outcomes and surrogate markers, combinations with up to and including three (triple therapy) were progressively and significantly more effective. The odds ratio for disease progression or death for triple therapy compared with double therapy was 0.6 (95% confidence interval 0.5 to 0.8). Heterogeneity in effect sizes was present in many outcomes but was largely related to the drugs used and trial quality. Evidence from randomised controlled trials supports the use of triple therapy. Research is needed on the effectiveness of quadruple therapies and the relative effectiveness of specific combinations of drugs.

An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds: a protocol paper for Teeth Tales

Publisher: BMJ

Date: 03-2014

DOI: 10.1136/BMJOPEN-2013-004260

The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review.

Publisher: Wiley

Date: 2001

DOI: 10.1111/J.1471-0528.2001.00020.X

Abstract: To determine whether the levonorgestrel-releasing intrauterine device (LNG-IUS), licensed at present for contraceptive use, may reduce menstrual blood loss with few side effects. If effective, surgery could be avoided with consequent resource savings. A systematic review addressing the effectiveness and cost effectiveness of the LNG-IUS for menorrhagia was undertaken. Five controlled trials and five case series were found which measured menstrual blood loss. Nine studies recorded statistically significant average menstrual blood loss reductions with LNG-IUS (range 74%-97%). Another showed reduction in menstrual disturbance score. The LNG-IUS was more effective than tranexamic acid, but slightly less effective than endometrial resection at reducing menstrual blood loss. In one study, 64% of women cancelled surgery at six months, compared with 14% of control group women. In another, 82% were taken off surgical waiting lists at one year. No cost effectiveness studies were found. Small studies of moderate quality indicate the LNG-IUS is an effective treatment for menorrhagia. Costs may be less than for tranexamic acid in primary and secondary care. Although its use may reduce surgical waiting lists, cost effectiveness assessment requires longer follow up. Effectiveness and cost effectiveness relative to other treatments and the effect on surgical waiting lists can only be established in larger trials measuring patient-centred outcomes in women with menorrhagia.

Clinical, financial and social impacts of COVID-19 and their associations with mental health for mothers and children experiencing adversity in Australia

Publisher: Public Library of Science (PLoS)

Date: 13-09-2021

DOI: 10.1371/JOURNAL.PONE.0257357

Abstract: Australia has maintained low rates of SARS-COV-2 (COVID-19) infection, due to geographic location and strict public health restrictions. However, the financial and social impacts of these restrictions can negatively affect parents’ and children’s mental health. In an existing cohort of mothers recruited for their experience of adversity, this study examined: 1) families’ experiences of the COVID-19 pandemic and public health restrictions in terms of clinical exposure, financial hardship family stress, and family resilience (termed ‘COVID-19 impacts’) and 2) associations between COVID-19 impacts and maternal and child mental health. Participants were mothers recruited during pregnancy (2013–14) across two Australian states (Victoria and Tasmania) for the ‘right@home’ trial. A COVID-19 survey was conducted from May-December 2020, when children were 5.9–7.2 years old. Mothers reported COVID-19 impacts, their own mental health (Depression, Anxiety, Stress Scales short-form) and their child’s mental health (CoRonavIruS Health and Impact Survey subscale). Associations between COVID-19 impacts and mental health were examined using regression models controlling for pre-COVID-19 characteristics. 319/406 (79%) mothers completed the COVID-19 survey. Only one reported having had COVID-19. Rates of self-quarantine (20%), job or income loss (27%) and family stress (e.g., difficulty managing children’s at-home learning (40%)) were high. Many mothers also reported family resilience (e.g., family found good ways of coping (49%)). COVID-19 impacts associated with poorer mental health (standardised coefficients) included self-quarantine (mother: β = 0.46, child: β = 0.46), financial hardship (mother: β = 0.27, child: β = 0.37) and family stress (mother: β = 0.49, child: β = 0.74). Family resilience was associated with better mental health (mother: β = -0.40, child: β = -0.46). The financial and social impacts of Australia’s public health restrictions have substantially affected families experiencing adversity, and their mental health. These impacts are likely to exacerbate inequities arising from adversity. To recover from COVID-19, policy investment should include income support and universal access to family health services.

Cross-sectional metabolic profiles of mental health in population-based cohorts of 11- to 12-year-olds and mid-life adults: The Longitudinal Study of Australian Children

Publisher: SAGE Publications

Date: 23-05-2020

DOI: 10.1177/0004867420924092

Abstract: Poorer mental health in adulthood is associated with increased risk of cardiovascular disease and reduced life expectancy. However, little is known of the molecular pathways underpinning this relationship and how early in life adverse metabolite profiles relate to self-reported variation in mental health. We examined cross-sectional associations between mental health and serum metabolites indicative of cardiovascular health, in large Australian population-based cohorts at two stages of the life-course. We characterised cross-sectional serum nuclear magnetic resonance metabolite profiles of positively and negatively framed mental health in a large population-based s le of Australian 11- to 12-year-olds ( n = 1172 51% girls) and mid-life adults (n = 1322 mean age 45 years 87% women). We examined multiple standard self-report mental health scales, spanning psychosocial health, general well-being, life satisfaction, and health-related quality of life. Linear regression was used to investigate the cross-sectional association between mental health and each metabolite (n = 73) in children and adults separately, unadjusted and adjusted for age, sex, socioeconomic position and body mass index. Better child and adult mental health were associated with lower levels of the inflammatory marker glycoprotein acetyls, and a favourable, less atherogenic lipid/lipoprotein profile. Patterns of association in children were generally weaker than in adults. Associations were generally modest and partially attenuated when adjusted for body mass index. In general, metabolite profiles associated with better child and adult mental health closely aligned with those predictive of better cardiovascular health in adults. Our findings support previous evidence for the likely bidirectional relationship between mental health and cardiovascular disease risk, by extending this evidence base to the molecular level and in children.

Hospital Drg Costing and Health Services Use of Very Pre-Term Infants From the Proprems Neuro Study Across 10 Hospitals in Australia and New Zealand.

Publisher: Elsevier BV

Date: 11-2014

DOI: 10.1016/J.JVAL.2014.08.1613

Effect of Type and Severity of Intimate Partner Violence on Women's Health and Service Use: Findings From a Primary Care Trial of Women Afraid of Their Partners

Publisher: SAGE Publications

Date: 27-08-2013

DOI: 10.1177/0886260512454722

Abstract: Intimate partner violence (IPV) has major affects on women’s wellbeing. There has been limited investigation of the association between type and severity of IPV and health outcomes. This article describes socio-demographic characteristics, experiences of abuse, health, safety, and use of services in women enrolled in the Women’s Evaluation of Abuse and Violence Care (WEAVE) project. We explored associations between type and severity of abuse and women’s health, quality of life, and help seeking. Women (aged 16–50 years) attending 52 Australian general practices, reporting fear of partners in last 12 months were mailed a survey between June 2008 and May 2010. Response rate was 70.5% (272/386). In the last 12 months, one third (33.0%) experienced Severe Combined Abuse, 26.2% Physical and Emotional Abuse, 26.6% Emotional Abuse and/or Harassment only, 2.7% Physical Abuse only and 12.4% scored negative on the Composite Abuse Scale. A total of 31.6% of participants reported poor or fair health and 67.9% poor social support. In the last year, one third had seen a psychologist (36.6%) or had 5 or more general practitioner visits (34.3%) 14.7% contacted IPV services and 24.4% had made a safety plan. Compared to other abuse groups, women with Severe Combined Abuse had poor quality of life and mental health, despite using more medications, counseling, and IPV services and were more likely to have days out of role because of emotional issues. In summary, women who were fearful of partners in the last year, have poor mental health and quality of life, attend health care services frequently, and domestic violence services infrequently. Those women experiencing severe combined physical, emotional, and sexual abuse have poorer quality of life and mental health than women experiencing other abuse types. Health practitioners should take a history of type and severity of abuse for women with mental health issues to assist access to appropriate specialist support.

A qualitative study of the factors that influence mothers when choosing drinks for their young children

Publisher: Springer Science and Business Media LLC

Date: 05-07-2014

DOI: 10.1186/1756-0500-7-430

Are Australian parents following feeding guidelines that will reduce their child's risk of dental caries?

Publisher: Wiley

Date: 14-04-2020

DOI: 10.1111/CCH.12768

Cohort Profile: The Early Language in Victoria Study (ELVS)

Publisher: Oxford University Press (OUP)

Date: 14-06-2017

DOI: 10.1093/IJE/DYX079

Health‐related quality of life of children with low language from early childhood to adolescence: results from an Australian longitudinal population‐based study

Publisher: Wiley

Date: 02-06-2020

DOI: 10.1111/JCPP.13277

Abstract: Low language abilities are known to be associated with significant adverse long-term outcomes. However, associations between low language and health-related quality of life (HRQoL) are unclear. We aimed to (a) examine the association between low language and HRQoL from 4 to 13 years and (b) classify the children's trajectories of HRQoL and language and examine the association between language and HRQoL trajectories. Data were from an Australian community-based cohort of children. HRQoL was measured at ages 4-13 years using the parent-reported Pediatric Quality of Life Inventory 4.0. Language was assessed using the Clinical Evaluation of Language Fundamentals (CELF)-Preschool 2nd edition at 4 years and the CELF-4th edition at 5, 7 and 11 years. Multivariable linear regression and mixed effect modelling were used to estimate cross-sectional and longitudinal associations between low language and HRQoL from 4 to 13 years. A joint group-based trajectory model was used to characterize associations between HRQoL and language trajectories over childhood. Children with low language had substantially lower HRQoL than children with typical language from 4 to 13 years. Higher language scores were associated with better HRQoL, particularly in social and school functioning. Three HRQoL trajectories were identified: stable-high (51% of children), reduced with slow decline (40%) and low with rapid decline (9%). Children with low language were less likely to follow a stable-high HRQoL trajectory (40%) while 26% and 34% followed the reduced with slow decline and low with rapid decline trajectories, respectively. Children with low language experienced reduced HRQoL from 4 to 13 years. More than half had declining trajectories in HRQoL highlighting the need to monitor these children over time. Interventions should not only aim to improve children's language ability but also address the wider functional impacts of low language.

Teacher Talk in Early Years Classrooms following an Oral Language and Literacy Professional Learning Program

Publisher: Informa UK Limited

Date: 09-12-2022

DOI: 10.1080/19345747.2021.1998938

Outcomes of population based language promotion for slow to talk toddlers at ages 2 and 3 years: Let's Learn Language cluster randomised controlled trial

Publisher: BMJ

Date: 18-08-2011

DOI: 10.1136/BMJ.D4741

MOSAIC (mothers' advocates in the community): Protocol and sample description of a cluster randomised trial of mentor mother support to reduce intimate partner violence among pregnant or recent mothers

Publisher: Springer Science and Business Media LLC

Date: 27-05-2009

DOI: 10.1186/1471-2458-9-159

Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial

Publisher: BMJ

Date: 03-09-2009

DOI: 10.1136/BMJ.B3308

Primary health-care costs associated with special health care needs up to age 7 years: Australian population-based study.

Publisher: Wiley

Date: 13-06-2014

DOI: 10.1111/JPC.12649

Abstract: We studied infants and children with and without special health care needs (SHCN) during the first 8 years of life to compare the (i) types and costs to the government's Medicare system of non-hospital health-care services and prescription medication in each year and (ii) cumulative costs according to persistence of SHCN. Data from the first two biennial waves of the nationally representative Longitudinal Study of Australian Children, comprising two independent cohorts recruited in 2004, at ages 0-1 (n = 5107) and 4-5 (n = 4983) years. Exposure condition: parent-reported Children with Special Health Care Needs Screener at both waves, spanning ages 0-7 years. Federal Government Medicare expenditure, via data linkage to the Medicare database, on non-hospital health-care attendances and prescriptions from birth to 8 years. At both waves and in both cohorts, >92% of children had complete SHCN and Medicare data. The proportion of children with SHCN increased from 6.1% at age 0-1 years to 15.0% at age 6-7 years. Their additional Medicare costs ranged from $491 per child at 6-7 years to $1202 at 0-1 year. This equates to an additional $161.8 million annual cost or 0.8% of federal funding for non-hospital-based health care. In both cohorts, costs were highest for children with persistent SHCNs. SHCNs incur substantial non-hospital costs to Medicare, and no doubt other sources of care, from early childhood. This suggests that economic evaluations of early prevention and intervention services for SHCNs should consider impacts on not only the child and family but also the health-care system.

Teeth Tales: a community-based child oral health promotion trial with migrant families in Australia

Publisher: BMJ

Date: 11-06-2015

DOI: 10.1136/BMJOPEN-2014-007321

Public purse, private service: The perceptions of public funding models of Australian independent speech-language pathologists

Publisher: Informa UK Limited

Date: 04-05-2023

DOI: 10.1080/17549507.2023.2213864

Preference measurement using conjoint methods: an empirical investigation of reliability.

Publisher: Wiley

Date: 2000

DOI: 10.1002/1099-1050(200007)9:5<385::AID-HEC533>3.0.CO;2-W

Abstract: The application of conjoint measurement to the field of health economics is relatively new, although there is growing interest and there have been a number of studies undertaken recently. Wider acceptance of the technique requires methodological issues concerning both reliability and validity to be addressed. This paper reports an empirical investigation of the test-retest reliability of the discrete choice conjoint measurement approach in health care. This investigation of conjoint reliability was framed using the clinical context of investigation and treatment of knee injuries. A high level of reliability at both the input data and results levels was demonstrated.

Cluster randomised trial of a school-community child health promotion and obesity prevention intervention: findings from the evaluation of fun ‘n healthy in Moreland!

Publisher: Springer Science and Business Media LLC

Date: 03-08-2017

DOI: 10.1186/S12889-017-4625-9

Exploring child dental service use among migrant families in metropolitan Melbourne, Australia

Publisher: Wiley

Date: 19-05-2015

DOI: 10.1111/ADJ.12321

Abstract: This study describes and explores factors related to dental service use among migrant children. A cross-sectional analysis of baseline data from Teeth Tales, an exploratory trial implementing a community based child oral health promotion intervention. The s le size and target population was 600 families with 1-4 year old children from Iraqi, Lebanese and Pakistani backgrounds residing in metropolitan Melbourne. Participants were recruited into the study using purposive and snowball s ling techniques. Most (88% 550/625) children had never visited the dentist (mean (SD) age 3.06 years (1.11)). In the fully adjusted model the variable most significantly associated with child dental visiting was parent reported 'no reason for child to visit the dentist' (OR = 0.07, p < 0.001). Of those children whose parents reported their child had no reason to visit the dentist, 22% (37/165) experienced dental caries with 8% (13/165) at the level of cavitation. Dental service use by migrant preschool children was very low. The relationship between perceived dental need and dental service use is currently not aligned. One in 10 children of select migrant background had visited a dentist, which is in the context of 1 in 3 with dental caries. To improve utilization, health services should consider organizational cultural competence, outreach and increased engagement with the migrant community.

The cost-effectiveness of universal newborn screening for bilateral permanent congenital hearing impairment: Systematic review

Publisher: Elsevier BV

Date: 05-2012

DOI: 10.1016/J.ACAP.2012.02.002

Long-term outcomes (2 and 3.5 years post-intervention) of the INFANT early childhood intervention to improve health behaviors and reduce obesity: cluster randomised controlled trial follow-up

Publisher: Springer Science and Business Media LLC

Date: 25-07-2020

DOI: 10.1186/S12966-020-00994-9

Abstract: The few health behavior interventions commencing in infancy have shown promising effects. Greater insight into their longer-term benefits is required. This study aimed to assess post-intervention effects of the Melbourne INFANT Program to child age 5y on diet, movement and adiposity. Two and 3.5y post-intervention follow-up (2011–13 analyses completed 2019) of participants retained in the Melbourne INFANT Program at its conclusion (child age ~ 19 m 2008–10) was conducted. The Melbourne INFANT Program is a 15-month, six session program delivered within first-time parent groups in Melbourne, Australia, between child age 4-19 m. It involves strategies to help parents promote healthy diet, physical activity and reduced sedentary behavior in their infants. No intervention was delivered during the follow-up period reported in this paper. At all time points height, weight and waist circumference were measured by researchers, children wore Actigraph and activPAL accelerometers for 8-days, mothers reported children’s television viewing and use of health services. Children’s dietary intake was reported by mothers in three unscheduled telephone-administered 24-h recalls. Of those retained at program conclusion (child age 18 m, n = 480 89%), 361 families (75% retention) participated in the first follow-up (2y post-intervention age 3.6y) and 337 (70% retention) in the second follow-up (3.5y post-intervention age 5y). At 3.6y children in the intervention group had higher fruit (adjusted mean difference [MD] = 25.34 g CI 95 :1.68,48.99), vegetable (MD = 19.41 CI 95 :3.15,35.67) and water intake (MD = 113.33 CI 95 :40.42,186.25), than controls. At 5y they consumed less non-core drinks (MD = -27.60 CI 95 :-54.58,-0.62). Sweet snack intake was lower for intervention children at both 3.6y (MD = -5.70 CI 95 :-9.75,-1.65) and 5y (MD = -6.84 CI 95 :-12.47,-1.21). Intervention group children viewed approximately 10 min/day less television than controls at both follow-ups, although the confidence intervals spanned zero (MD = -9.63 CI 95 :-30.79,11.53 MD = -11.34 CI 95 :-25.02,2.34, respectively). There was no evidence for effect on zBMI, waist circumference z-score or physical activity. The impact of this low-dose intervention delivered during infancy was still evident up to school commencement age for several targeted health behaviors but not adiposity. Some of these effects were only observed after the conclusion of the intervention, demonstrating the importance of long-term follow-up of interventions delivered during early childhood. ISRCTN Register ISRCTN81847050 , registered 7th November 2007.

Women's views of postnatal care in the context of the increasing pressure on postnatal beds in Australia

Publisher: Elsevier BV

Date: 12-2009

DOI: 10.1016/J.WOMBI.2009.04.003

Abstract: Despite limited evidence evaluating early postnatal discharge, length of hospital stay has declined dramatically in Australia since the 1980s. The recent rising birth rate in Victoria, Australia has increased pressure on hospital beds, and many services have responded by discharging women earlier than planned, often with little preparation during pregnancy. We aimed to explore the views of women and their partners regarding a number of theoretical postnatal care 'packages' that could provide an alternative approach to early postnatal care. Eight focus groups and four interviews were held in rural and metropolitan Victoria in 2006 with participants who had experienced a mix of public and private maternity care. These included 8 pregnant women, 42 recent mothers and 2 male partners. All were fluent in English. Focus groups explored participants' experiences and/or expectations of early postnatal care in hospital and at home and their views of alternative packages of postnatal care where location of care shifted from hospital to home and/or hotel. This paper describes the packages and explores and describes what 'value' women placed on the various components of care. Overall, women expressed a preference for what they had experienced or expected, which may be explained by the 'what is must be best' phenomenon where women place value on the status quo. They generally did not respond favourably towards the alternative postnatal care packages, with concerns about any shorter length of hospital stay, especially for first time mothers. Women were concerned about the safety and wellbeing of their new baby and reported that they lacked confidence in their ability to care for their baby. The physical presence and availability of professional support was seen to alleviate these concerns, especially for first time mothers. Participants did not believe that increased domiciliary visits compensated for forgoing the perceived security and value of staying in hospital. Women generally valued staying in hospital for the length of time they felt they needed above all other factors. Women were concerned about shortened postnatal length of hospital stay and these concerns must be considered when changes are planned in maternity service provision. Any moves towards shorter postnatal length of stay must be comprehensively evaluated with consideration given to exploring consumer views and satisfaction. There is also a need for flexibility in postnatal care that acknowledges women's in idual needs.

Methodology for the evaluation of the Stephanie Alexander Kitchen Garden program

Publisher: Wiley

Date: 27-03-2013

DOI: 10.1071/HE12905

Longitudinal study of Consumer Price Index (CPI) trends in core and non-core foods in Australia

Publisher: Elsevier BV

Date: 10-2008

DOI: 10.1111/J.1753-6405.2008.00278.X

Abstract: This study examined trends in the price of healthy and less-healthy foods from 1989 to 2007 using the Australian Consumer Price Index (CPI). CPI food expenditure classes were classified as 'core' or 'non-core'. Trends in the CPI were analysed to examine the rise in prices of core compared with non-core foods. On average, the CPI for core foods has risen at a slightly higher, though not statistically significant, rate than non-core foods. Furthermore, selected groupings reveal interesting patterns. 'Bread' has risen in price significantly more than 'cakes and biscuits', and 'milk' has risen in price significantly more than 'soft drinks, waters and juices'. This investigation of food price trends reveals notable differences between core and non-core foods. This should be investigated further to determine the extent to which this contributes to the higher prevalence of diet-related diseases in low socio-economic groups.

Methods for exploring implementation variation and local context within a cluster randomised community intervention trial

Publisher: BMJ

Date: 09-2004

DOI: 10.1136/JECH.2003.014415

Time-Use Patterns and Health-Related Quality of Life in Adolescents

Publisher: American Academy of Pediatrics (AAP)

Date: 07-2017

DOI: 10.1542/PEDS.2016-3656

Abstract: To describe 24-hour time-use patterns and their association with health-related quality of life (HRQoL) in early adolescence. The Child Health CheckPoint was a cross-sectional study nested between Waves 6 and 7 of the Longitudinal Study of Australian Children. The participants were 1455 11- to 12-year-olds (39% of Wave 6 51% boys). The exposure was 24-hour time use measured across 259 activities using the Multimedia Activity Recall for Children and Adolescents. “Average” days were generated from 1 school and 1 nonschool day. Time-use clusters were derived from cluster analysis with compositional inputs. The outcomes were self-reported HRQoL (Physical and Psychosocial Health [PedsQL] summary scores Child Health Utility 9D [CHU9D] health utility). Four time-use clusters emerged: “studious actives” (22% highest school-related time, low screen time), “techno-actives” (33% highest physical activity, lowest school-related time), “stay home screenies” (23% highest screen time, lowest passive transport), and “potterers” (21% low physical activity). Linear regression models, adjusted for a priori confounders, showed that compared with the healthiest “studious actives” (mean [SD]: CHU9D 0.84 [0.14], PedsQL physical 86.8 [10.8], PedsQL psychosocial 79.9 [12.6]), HRQoL in “potterers” was 0.2 to 0.5 SDs lower (mean differences [95% confidence interval]: CHU9D −0.03 [−0.05 to −0.00], PedsQL physical −5.5 [−7.4 to −3.5], PedsQL psychosocial −5.8 [−8.0 to −3.5]). Discrete time-use patterns exist in Australian young adolescents. The cluster characterized by low physical activity and moderate screen time was associated with the lowest HRQoL. Whether this pattern translates into precursors of noncommunicable diseases remains to be determined.

Cross-sectional epidemiology of hearing loss in Australian children aged 11-12 years old and 25-year secular trends

Publisher: BMJ

Date: 31-01-2018

DOI: 10.1136/ARCHDISCHILD-2017-313505

Abstract: In a national study of Australian children aged 11–12 years old, we examined the (1) prevalence and characteristics of hearing loss, (2) its demographic risk factors and (3) evidence for secular increases since 1990. This is a cross-sectional CheckPoint wave within the Longitudinal Study of Australian Children. 1485 children (49.8% retention 49.7% boys) underwent air-conduction audiometry. Aim 1: hearing loss (≥16 decibels hearing level (dB HL)) was defined in four ways to enable prior/future comparisons: high Fletcher Index (mean of 1, 2 and 4 kHz primary outcome relevant to speech perception), four-frequency (1, 2, 4 and 8 kHz), lower frequency (1 and 2 kHz) and higher frequency (4 and 8 kHz) aim 2: logistic regression of hearing loss by age, gender and disadvantage index and aim 3: P for trend examining CheckPoint and reported prevalence in studies arranged by date since 1990. For high Fletcher Index, the prevalence of bilateral and unilateral hearing loss ≥16 dB HL was 9.3% and 13.3%, respectively. Slight losses (16–25 dB HL) were more prevalent than mild or greater (≥26 dB HL) losses (bilateral 8.5% vs 0.8% unilateral 12.5% vs 0.9%), and lower frequency more prevalent than higher frequency losses (bilateral 11.0% vs 6.9% unilateral 15.4% vs 11.5%). Demographic characteristics did not convincingly predict hearing loss. Prevalence of bilateral/unilateral lower and higher frequency losses ≥16 dB HL has risen since 1990 (all P for trend .001). Childhood hearing loss is prevalent and has risen since 1990. Future research should investigate the causes, course and impact of these changes.

The early postnatal period: Exploring women's views, expectations and experiences of care using focus groups in Victoria, Australia

Publisher: Springer Science and Business Media LLC

Date: 22-07-2008

DOI: 10.1186/1471-2393-8-27

Patterns of maternal depression, anxiety, and stress symptoms from pregnancy to 5 years postpartum in an Australian cohort experiencing adversity

Publisher: Springer Science and Business Media LLC

Date: 25-05-2021

DOI: 10.1007/S00737-021-01145-0

Utility‐based quality of life in mothers of children with behaviour problems: A population‐based study

Publisher: Wiley

Date: 06-09-2016

DOI: 10.1111/JPC.13269

Abstract: To examine the relationship between mothers' health-related quality of life (HRQoL) and child behaviour problems at age 2 years. To investigate whether the relationship between maternal HRQoL and child behaviour problems is independent of maternal mental health. Cross-sectional survey nested within a population-level, cluster randomised trial, which aims to prevent early child behaviour problems. One hundred and sixty mothers of 2-year-old children, in nine local government areas in Victoria, Australia. HRQoL was measured using the Assessment of Quality of Life 6D and child behaviour was measured using the child behaviour checklist (CBCL/1.5-5 years). Maternal mental health was measured using the Depression Anxiety Stress Scale. Data were collected at child age 2 years demographic data were collected at child age 8 months. HRQoL was lower for mothers with children that had borderline/clinical behaviour problems compared to those with children without problems (mean difference -0.14, 95% confidence interval (CI): -0.16 to -0.12, P < 0.001). The finding did not markedly change when adjusting for household income, financial security, child gender, child temperament and intervention group status at child age 8 months (mean difference -0.12, 95% CI: -0.15 to -0.09, P < 0.001), but did attenuate when additionally adjusting for concurrent maternal mental health (mean difference -0.03, 95% CI: -0.05 to -0.02, P < 0.001). Child behaviour problems were associated with lower maternal HRQoL. Child behaviour problems prevention programmes could consider this association with maternal HRQoL and be designed to improve and report both mothers' and their child's health and wellbeing.

Splash!: A prospective birth cohort study of the impact of environmental, social and family-level influences on child oral health and obesity related risk factors and outcomes

Publisher: Springer Science and Business Media LLC

Date: 27-06-2011

DOI: 10.1186/1471-2458-11-505

Household economic burden of childhood severe pneumonia in Bangladesh: a cost-of-illness study

Publisher: BMJ

Date: 27-04-2021

DOI: 10.1136/ARCHDISCHILD-2020-320834

Abstract: To estimate household cost of illness (COI) for children with severe pneumonia in Bangladesh. An incidence-based COI study was performed for one episode of childhood severe pneumonia from a household perspective. Face-to-face interviews collected data on socioeconomic, resource use and cost from caregivers. A micro-costing bottom-up approach was applied to calculate medical, non-medical and time costs. Multiple regression analysis was applied to explore the factors associated with COI. Sensitivity analysis explored the robustness of cost parameters. Four urban and rural study sites from two districts in Bangladesh. Children aged 2–59 months with severe pneumonia. 1472 children with severe pneumonia were enrolled between November 2015 and March 2019. The mean age of children was 12 months (SD ±10.2) and 64% were male. The mean household cost per episode was US$147 (95% CI 141.1 to 152.7). Indirect costs were the main cost drivers (65%, US$96). Household costs for the poorest income quintile were lower in absolute terms, but formed a higher proportion of monthly income. COI was significantly higher if treatment was received from urban health facilities compared with rural health facilities (difference US$84.9, 95% CI 73.3 to 96.3). Child age, household income, healthcare facility and hospital length of stay (LoS) were significant predictors of household COI. Costs were most sensitive to hospital LoS and productivity loss. Severe pneumonia in young children is associated with high household economic burden and cost varies significantly across socioeconomic parameters. Management strategies with improved accessibility are needed particularly for the poor to make treatment affordable in order to reduce household economic burden.

Translating evidence into practice: Implementing culturally safe continuity of midwifery care for First Nations women in three maternity services in Victoria, Australia

Publisher: Elsevier BV

Date: 05-2022

DOI: 10.1016/J.ECLINM.2022.101415

An exploration of the views of Australian mothers on promoting child oral health.

Publisher: Wiley

Date: 26-02-2016

DOI: 10.1111/ADJ.12332

Abstract: An important role for parents and caregivers in the prevention of dental caries in children is the early establishment of health promoting behaviours. This study aimed to examine mothers' views on barriers and facilitators to promoting child and family oral health. Semi-structured interviews were undertaken with a purposive s le of mothers (n = 32) of young children. Inductive thematic analysis was conducted. Parental knowledge and beliefs, past experiences and child behaviour emerged as major influences on children's oral health. Child temperament and parental time pressures were identified as barriers to good oral health with various strategies reported for dealing with uncooperative children at toothbrushing time. Parental oral health knowledge and beliefs emerged as positive influences on child oral health however, while most mothers were aware of the common causes of dental caries, very few knew of other risk factors such as bedtime feeding. Parents' own oral health experiences were also seen to positively influence child oral health, regardless of whether these were positive or negative experiences. Understanding parental oral health beliefs is essential to overcoming barriers and promoting enablers for good child oral health. Improving child oral health also requires consideration of child behaviour, family influences, and increasing awareness of lesser-known influencing factors.

Mapping PedsQLTM scores onto CHU9D utility scores: estimation, validation and a comparison of alternative instrument versions.

Publisher: Springer Science and Business Media LLC

Date: 19-11-2019

DOI: 10.1007/S11136-019-02357-9

Abstract: The Paediatric Quality of Life Inventory To develop a mapping algorithm for converting the 23-item PedsQL instrument onto the CHU9D instrument and provide an external validation of two recently published algorithms that might be considered alternatives. Data from children in the Longitudinal Study of Australian Children (LSAC) were used (N = 1801). Six econometric methods were compared to identify the best algorithms, assessed against a series of goodness-of-fit criteria. The same data and goodness-of-fit criteria were used in the external validation exercise for previously published mapping algorithms. The optimal mapping algorithm was identified, which used PedsQL dimension scores to predict the CHU9D utilities. It performed well against standard goodness-of-fit tests. The external validation exercise revealed the recently published alternative algorithms also performed relatively well. The identified mapping algorithms can be used to facilitate cost-utility analysis in comparable populations when only the PedsQL instrument is available. Results from this population indicate the algorithms identified in this paper are well suited for estimating CHU9D self-report utilities when the full 23-item self-report PedsQL instrument has been used.

An Economic Evaluation of Australia's Newborn Hearing Screening Program: A Within-Study Cost-Effectiveness Analysis.

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 11-11-2021

DOI: 10.1097/AUD.0000000000001153

Abstract: Hearing loss is one of the most prevalent congenital disorders among children. Many countries have implemented universal newborn hearing screening (UNHS) for the early diagnosis and treatment of hearing loss. Despite widespread implementation, the value for money of UNHS is unclear due to lack of cost and outcomes data from rigorous study designs. The objective of this research is to conduct a within-study cost-effectiveness analysis of UNHS compared with targeted screening (targeting children with risk factors of hearing loss) from the Australian healthcare system perspective. This evaluation is the first economic evaluation to assess the cost-effectiveness of UNHS compared to targeted screening using real-world data from a natural experiment. The evaluation assumed the Australian healthcare system perspective and considered a time horizon of 5 years. Utilities were estimated using responses to the Health Utilities Index Mark III. Screening costs were estimated based on the Victorian Infant Hearing Screening Program. Ongoing costs were estimated based on administrative data, while external data sources were used to estimate costs related to hearing services. Missing data were handled using the multiple imputation method. Outcome measures included quality-adjusted life years (QALYs) and four language and communication-related outcomes: Peabody Picture Vocabulary Test, Wechsler Nonverbal Scale of Ability, Progressive Achievement Test, and comprehensive, expressive, and total language scores based on the Preschool Language Scale. On average, the UNHS cost an extra Australian dollar (A$)22,000 per diagnosed child and was associated with 0.45 more QALYs per diagnosed child compared with targeted screening to 5 years, resulting in an incremental cost-effectiveness ratio (ICER) of A$48,000 per QALY gained. The ICERs for language outcomes lay between A$3,900 (for expressive language score) and A$83,500 per one-point improvement in language score (for Wechsler Nonverbal Scale of Ability). UNHS had a 69% probability of being more cost-effective compared to targeted screening at a willingness to pay threshold of A$60,000 per QALY gained. ICERs were most sensitive to the screening costs. The evaluation demonstrated the usefulness of a within-study economic evaluation to understand the value for money of the UNHS program in the Australian context. Findings from this evaluation suggested that screening costs were the key driver of cost-effectiveness results. Most outcomes were not significantly different between UNHS and targeted screening groups. The ICER may be overestimated due to the short follow-up period. Further research is warranted to include long-term resource use and outcome data, late diagnosis, transition and remission between severity levels, and timing of diagnosis and treatment.

Cost-effectiveness of a family-based GP-mediated intervention targeting overweight and moderately obese children

Publisher: Elsevier BV

Date: 12-2008

DOI: 10.1016/J.EHB.2008.06.001

Abstract: To assess from a societal perspective the incremental cost-effectiveness of a family-based GP-mediated intervention targeting overweight and moderately obese children. The intervention was modelled on the LEAP (live, eat and play) trial, a randomised controlled trial conducted by the Centre for Community Child Health, Melbourne, Australia in 2002-2003. This study was undertaken as part of the assessing cost-effectiveness (ACE) in obesity project which evaluated, using consistent methods, 13 interventions targeting unhealthy weight gain in children and adolescents. A logic pathway was used to model the effects of the intervention compared to no intervention on body mass index (BMI) and health outcomes (disability-adjusted life years-DALYs). Disease costs and health benefits were tracked until the cohort of eligible children reached the age of 100 years or death. Simulation-modelling techniques were used to present a 95% uncertainty interval around the cost-effectiveness ratio. The intervention was also assessed against a series of filters ('equity', 'strength of evidence', 'acceptability', 'feasibility', sustainability' and 'side-effects') to incorporate additional factors that impact on resource allocation decisions. The intervention, as modelled, reached 9685 children aged 5-9 years with a BMI z-score of >or=3.0, and cost $AUD6.3M (or $AUD4.8M excluding time costs). It resulted in an incremental saving of 2300 BMI units which translated to 511 DALYs. The cost-offsets stemming from the intervention totalled $AUD3.6M, resulting in a net cost per DALY saved of $AUD4670 (dominated $0.1M) (dominated means intervention costs more for less effect). Compared to a 'no intervention' control group, the intervention was cost-effective under current assumptions, although the uncertainty intervals were wide. A key question related to the long-term sustainability of the small incremental weight loss reported, based on the 9-month follow-up results for LEAP.

Health economics on the internet.

Publisher: The Sax Institute

Date: 2002

DOI: 10.1071/NB02073

Is proactive telephone-based breastfeeding peer support a cost-effective intervention? A within-trial cost-effectiveness analysis of the ‘Ringing Up about Breastfeeding earlY’ (RUBY) randomised contro

Publisher: BMJ

Date: 06-2023

DOI: 10.1136/BMJOPEN-2022-067049

Abstract: The ‘Ringing Up about Breastfeeding earlY’ (RUBY) randomised controlled trial showed increased breastfeeding at 6 months in participants who received the proactive telephone-based peer support breastfeeding intervention compared with participants allocated to receive standard care and supports. The present study aimed to evaluate if the intervention was cost-effective. A within-trial cost-effectiveness analysis. Three metropolitan maternity services in Melbourne, Victoria, Australia. First time mothers intending to breastfeed their infant (1152) and peer volunteers (246). The intervention comprised proactive telephone-based support from a peer volunteer from early postpartum up to 6 months. Participants were allocated to usual care (n=578) or the intervention (n=574). Costs during a 6-month follow-up period including in idual healthcare, breastfeeding support and intervention costs in all participants, and an incremental cost-effectiveness ratio. Costs per mother supported were valued at $263.75 (or $90.33 excluding costs of donated volunteer time). There was no difference between the two arms in costs for infant and mothers in healthcare and breastfeeding support costs. These figures result in an incremental cost-effectiveness ratio of $4146 ($1393 if volunteer time excluded) per additional mother breast feeding at 6 months. Considering the significant improvement in breastfeeding outcomes, this intervention is potentially cost-effective. These findings, along with the high value placed on the intervention by women and peer volunteers provides robust evidence to upscale the implementation of this intervention. ACTRN12612001024831.

Expanding Children’s Food Experiences: The Impact of a School-Based Kitchen Garden Program

Publisher: Elsevier BV

Date: 03-2013

DOI: 10.1016/J.JNEB.2012.09.004

Abstract: Evaluate achievement of the Stephanie Alexander Kitchen Garden Program in increasing child appreciation of erse, healthy foods. Comparative 2-year study. Six program and 6 comparison primary schools in rural and metropolitan Victoria, Australia, matched for socioeconomic status and size. A total of 764 children in grades 3 to 6 (8-12 years of age) and 562 parents recruited. Retention rates at follow-up included 85% children and 75% parents. Each week of the school year, children spent 45 to 60 minutes in a garden class and 90 minutes in a kitchen class. Program impact on children's willingness to try new foods, capacity to describe foods, and healthy eating. Qualitative data analyzed using inductive thematic analysis. Quantitative data analyzed using random-effects linear regressions adjusted for school clustering. Child and parent qualitative and quantitative measures (if never tried before, odds ratio 2.0 confidence interval, 1.06-3.58) showed increases in children's reported willingness to try new foods. No differences in articulation of food descriptions (program vs comparison groups). Qualitative evidence showed that the program extended its influence to healthy eating, but this was not reflected in the quantitative evidence. Findings indicate program success in achieving its primary objective, meriting further program research.

Improving infant sleep and maternal mental health: a cluster randomised trial

Publisher: BMJ

Date: 22-03-2007

DOI: 10.1136/ADC.2006.099812

Academic Outcomes 2 Years After Working Memory Training for Children With Low Working Memory: A Randomized Clinical Trial.

Publisher: American Medical Association (AMA)

Date: 02-05-2016

DOI: 10.1001/JAMAPEDIATRICS.2015.4568

Health Care Costs Associated With Parent-Reported ADHD: A Longitudinal Australian Population–Based Study

Publisher: SAGE Publications

Date: 07-2013

DOI: 10.1177/1087054713491494

Abstract: Objective: To examine the health care costs associated with ADHD within a nationally representative s le of children. Method: Data were from Waves 1 to 3 (4-9 years) of the Longitudinal Study of Australian Children ( N = 4,983). ADHD was defined by previous diagnosis and a measure of ADHD symptoms (Strengths and Difficulties Questionnaire [SDQ]). Participant data were linked to administrative data on health care costs. Analyses controlled for demographic factors and internalizing and externalizing comorbidities. Results: Costs associated with health care attendances and medications were higher for children with parent-reported ADHD at each age. Cost differences were highest at 8 to 9 years for both health care attendances and medications. Persistent symptoms were associated with higher costs ( p .001). Excess population health care costs amounted to Aus$25 to Aus$30 million over 6 years, from 4 to 9 years of age. Conclusion: ADHD is associated with significant health care costs from early in life. Understanding the costs associated with ADHD is an important first step in helping to plan for service-system changes.

Optimizing Myanmar’s community-delivered malaria volunteer model: a qualitative study of stakeholders’ perspectives

Publisher: Springer Science and Business Media LLC

Date: 08-02-2021

DOI: 10.1186/S12936-021-03612-6

Abstract: In parallel with the change of malaria policy from control to elimination and declines in the malaria burden in Greater Mekong Sub-region, the motivation and social role of malaria volunteers has declined. To address this public health problem, in Myanmar, the role and responsibilities of malaria volunteers have been transformed into integrated community malaria volunteers (ICMV), that includes the integration of activities for five additional diseases (dengue, lymphatic filariasis, tuberculosis, HIV/AIDS and leprosy) into their current activities. However, this transformation was not evidence-based and did not consider inputs of different stakeholders. Therefore, qualitative stakeholder consultations were performed to optimize future malaria volunteer models in Myanmar. Semi-structured interviews were conducted with key health stakeholders from the Myanmar Ministry of Health and Sports (MoHS) and malaria implementing partners to obtain their perspectives on community-delivered malaria models. A qualitative descriptive approach was used to explore the experiences of the stakeholders in policymaking and programme implementation. Interview topic guides were used during the interviews and inductive thematic data analysis was performed. While ICMVs successfully provided malaria services in the community, the stakeholders considered the ICMV model as not optimal and suggested that many aspects needed to be improved including better training, supervision, support, and basic health staff’s recognition for ICMVs. Stakeholders believe that the upgraded ICMV model could contribute significantly to achieving malaria elimination and universal health care in Myanmar. In the context of high community demand for non-malaria treatment services from volunteers, the integrated volunteer service package must be developed carefully in order to make it effective in malaria elimination programme and to contribute in Myanmar’s pathway to universal health coverage (UHC), but without harming the community. An evidenced-based, community-delivered and preferred model, that is also accepted by the MoHS, is yet to be developed to effectively contribute to achieving malaria elimination and UHC goals in Myanmar by 2030.

Sleep well--be well study: improving school transition by improving child sleep: a translational randomised trial.

Publisher: BMJ

Date: 10-2013

DOI: 10.1136/BMJOPEN-2013-004009

Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): A cluster randomised controlled trial

Publisher: Elsevier BV

Date: 07-2013

DOI: 10.1016/S0140-6736(13)60052-5

Two-year follow up of a cluster randomised controlled trial for women experiencing intimate partner violence: effect of screening and family doctor-delivered counselling on quality of life, mental and

Publisher: BMJ

Date: 12-2020

DOI: 10.1136/BMJOPEN-2019-034295

Abstract: This was a 2-year follow-up study of a primary care-based counselling intervention (weave) for women experiencing intimate partner violence (IPV). We aimed to assess whether differences in depression found at 12 months (lower depression for intervention than control participants) would be sustained at 24 months and differences in quality in life, general mental and physical health and IPV would emerge. Cluster randomised controlled trial. Researchers blinded to allocation. Unit of randomisation: family doctors. Fifty-two primary care clinics, Victoria, Australia. Baseline: 272 English-speaking, female patients (intervention n=137, doctors=35 control n=135, doctors=37), who screened positive for fear of partner in past 12 months. Twenty-four-month response rates: intervention 59% (81/137), control 63% (85/135). Intervention doctors received training to deliver brief, woman-centred counselling. Intervention patients were invited to receive this counselling (uptake rate: 49%). Control doctors received standard IPV information delivered usual care. Twenty-four months primary outcomes: WHO Quality of Life-Bref dimensions, Short-Form Health Survey (SF-12) mental health. Secondary outcomes: SF-12 physical health and caseness for depression and anxiety (Hospital Anxiety Depression Scale), post-traumatic stress disorder (Check List-Civilian), IPV (Composite Abuse Scale), physical symptoms (≥6 in last month). Data collected through postal survey. Mixed-effects regressions adjusted for location (rural/urban) and clustering. No differences detected between groups on quality of life (physical: 1.5, 95% CI −2.9 to 5.9 psychological: −0.2, 95% CI −4.8 to 4.4, social: −1.4, 95% CI −8.2 to 5.4 environmental: −0.8, 95% CI −4.0 to 2.5), mental health status (−1.6, 95% CI −5.3 to 2.1) or secondary outcomes. Both groups improved on primary outcomes, IPV, anxiety. Intervention was no more effective than usual care in improving 2-year quality of life, mental and physical health and IPV, despite differences in depression at 12 months. Future refinement and testing of type, duration and intensity of primary care IPV interventions is needed. ACTRN12608000032358.

Cost-effectiveness of health care interventions to address intimate partner violence: What do we know and what else should we look for?

Publisher: SAGE Publications

Date: 22-02-2011

DOI: 10.1177/1077801211398639

Abstract: Intimate partner violence (IPV) creates a substantial burden of disease and significant costs to families, communities, and governments. Building the evidence for effective interventions to reduce violence and its sequelae requires increased use of economic evaluation to inform policy through the analysis of costs and potential savings of interventions. The authors review existing economic evaluations and present case studies of current research from the United Kingdom and Australia to illustrate the strengths and limitations of two approaches to generating economic evidence: economic evaluation alongside randomized controlled trials and economic modeling. Economic evaluation should always be considered in the design of IPV intervention research.

Preventing mental health problems in children: The Families in Mind population-based cluster randomised controlled trial

Publisher: Springer Science and Business Media LLC

Date: 08-06-2012

DOI: 10.1186/1471-2458-12-420

Nurse Home Visiting and Maternal Mental Health: 3-Year Follow-Up of a Randomized Trial

Publisher: American Academy of Pediatrics (AAP)

Date: 22-01-2021

DOI: 10.1542/PEDS.2020-025361

How effective is outpatient care compared to inpatient care for the treatment of anorexia nervosa? a systematic review

Publisher: Wiley

Date: 2001

DOI: 10.1002/ERV.406

Contingent valuation in health care and the persistence of embedding effects without the warm glow

Publisher: Elsevier BV

Date: 04-2002

DOI: 10.1016/S0167-4870(02)00066-1

COSMOS: COmparing Standard Maternity care with one-to-one midwifery support: A randomised controlled trial

Publisher: Springer Science and Business Media LLC

Date: 05-08-2008

DOI: 10.1186/1471-2393-8-35

Complex interventions or complex systems? Implications for health economic evaluation.

Publisher: BMJ

Date: 05-06-2008

DOI: 10.1136/BMJ.39569.510521.AD

Influence of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: outcomes of the Supermarket Healthy Eating for Life randomized controlled trial

Publisher: Elsevier BV

Date: 05-2015

DOI: 10.3945/AJCN.114.096735

Abstract: Fiscal strategies are increasingly considered upstream nutrition promotion measures. However, few trials have investigated the effectiveness or cost effectiveness of pricing manipulations on diet in real-world settings. We assessed the effects on fruit, vegetable, and beverage purchasing and consumption of a 20% price-reduction intervention, a tailored skills-based behavior-change intervention, and a combined intervention compared with a control condition. The Supermarket Healthy Eating for Life trial was a randomized controlled trial conducted over 3 mo [baseline (time 1) to postintervention (time 2) with a 6-mo follow-up (time 3)]. Female primary household shoppers in Melbourne, Australia, were randomly assigned to a 1) skill-building (n = 160), 2) price-reduction (n = 161), 3) combined skill-building and price-reduction (n = 160), or 4) control (n = 161) group. Supermarket transaction data and surveys were used to measure the following study outcomes: fruit, vegetable, and beverage purchases and self-reported fruit and vegetable consumption at each time point. At 3 mo (time 2), price reduction-alone participants purchased more total vegetables and frozen vegetables than did controls. Price reduction-alone and price reduction-plus-skill-building participants purchased more fruit than did controls. Relative to controls, in the price-reduction group, total vegetable consumption increased by 233 g/wk (3.1 servings or 15% more than at baseline), and fruit purchases increased by 364 g/wk (2.4 servings 35% more than at baseline). Increases were not maintained 6 mo postintervention (time 3). Price reduction-alone participants showed a tendency for a slight increase in fruit consumption at time 2 (P = 0.09) that was maintained at time 3 (P = 0.014). No intervention improved purchases of bottled water or low-calorie beverages. A 20% price reduction in fruit and vegetables resulted in increased purchasing per household of 35% for fruit and 15% for vegetables over the price-reduction period. These findings show that price modifications can directly increase produce purchases. The Supermarket Healthy Eating for Life trial was registered at Current Controlled Trials Registration as ISRCTN39432901.

Diet quality trajectories and cardiovascular phenotypes/metabolic syndrome risk by 11–12 years

Publisher: Springer Science and Business Media LLC

Date: 06-04-2021

DOI: 10.1038/S41366-021-00800-X

Abstract: To investigate associations between early-life diet trajectories and preclinical cardiovascular phenotypes and metabolic risk by age 12 years. Participants were 1861 children (51% male) from the Longitudinal Study of Australian Children. At five biennial waves from 2-3 to 10-11 years: Every 2 years from 2006 to 2014, diet quality scores were collected from brief 24-h parent/self-reported dietary recalls and then classified using group-based trajectory modeling as 'never healthy' (7%), 'becoming less healthy' (17%), 'moderately healthy' (21%), and 'always healthy' (56%). At 11-12 years: During children's physical health Child Health CheckPoint (2015-2016), we measured cardiovascular functional (resting heart rate, blood pressure, pulse wave velocity, carotid elasticity/distensibility) and structural (carotid intima-media thickness, retinal microvasculature) phenotypes, and metabolic risk score (composite of body mass index z-score, systolic blood pressure, high-density lipoproteins cholesterol, triglycerides, and glucose). Associations were estimated using linear regression models (n = 1100-1800) adjusted for age, sex, and socioeconomic position. Compared to 'always healthy', the 'never healthy' trajectory had higher resting heart rate (2.6 bpm, 95% CI 0.4, 4.7) and metabolic risk score (0.23, 95% CI 0.01, 0.45), and lower arterial elasticity (-0.3% per 10 mmHg, 95% CI -0.6, -0.1) and distensibility (-1.2%, 95% CI -1.9, -0.5) (all effect sizes 0.3-0.4). Heart rate, distensibility, and diastolic blood pressure were progressively poorer for less healthy diet trajectories (linear trends p ≤ 0.02). Effects for systolic blood pressure, pulse wave velocity, and structural phenotypes were less evident. Children following the least healthy diet trajectory had poorer functional cardiovascular phenotypes and metabolic syndrome risk, including higher resting heart rate, one of the strongest precursors of all-cause mortality. Structural phenotypes were not associated with diet trajectories, suggesting the window to prevent permanent changes remains open to at least late childhood.

Does a brief, behavioural intervention, delivered by paediatricians or psychologists improve sleep problems for children with ADHD? Protocol for a cluster-randomised, translational trial

Publisher: BMJ

Date: 04-2017

DOI: 10.1136/BMJOPEN-2016-014158

Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial

Publisher: Springer Science and Business Media LLC

Date: 03-02-2016

DOI: 10.1186/S12884-016-0798-Y

Child and adult snack food intake in response to manipulated pre-packaged snack item quantity/variety and snack box size: a population-based randomized trial

Publisher: Springer Science and Business Media LLC

Date: 18-07-2019

DOI: 10.1038/S41366-019-0407-Z

Abstract: Snacks contribute to overconsumption of energy-dense foods and thence obesity. Previous studies in this area are limited by self-reported data and small s les. In a large population-based cohort of parent-child dyads, we investigated how modification of pre-packaged snack food, i.e. (a) item quantity and variety, and (b) dishware (boxed container) size affected intake. Design: Randomized trial nested within the cross-sectional Child Health CheckPoint of the Longitudinal Study of Australian Children, clustered by day of visit. 1299 11-12 year olds, 1274 parents. 2 × 2 manipulation of snack box container size and item quantity/variety: (1) small box, few items, (2) large box, few items, (3) small box, more items, (4) large box, more items. Participants received a snack box during a 15 min break within their 3.5 h visit any snacks remaining were weighed. Consumed quantity (grams) and energy intake (kilojoules). Unadjusted linear regression. Children who were offered a greater quantity and variety of snack items consumed considerably more energy and a slightly higher food mass (main effect for energy intake: 349 kJ, 95% CI 282-416, standardized mean difference (effect size) 0.66 main effect for mass: 10 g, 95% CI 3-17, effect size 0.17). In contrast, manipulating box size had little effect on child consumption, and neither box size nor quantity/variety of items consistently affected adults' consumption. In children, reducing the number and variety of snack food items available may be a more fruitful intervention than focusing on container or dishware size. Effects observed among adults were small, although we could not exclude social desirability bias in adults aware of observation.

Impact of a Behavioral Sleep Intervention on New School Entrants' Social Emotional Functioning and Sleep: A Translational Randomized Trial.

Publisher: Informa UK Limited

Date: 14-05-2018

DOI: 10.1080/15402002.2018.1469493

Data resource profile: The Child LAnguage REpository (CLARE)

Publisher: Oxford University Press (OUP)

Date: 19-03-2018

DOI: 10.1093/IJE/DYY034

A brief survey to identify pregnant women experiencing increased psychosocial and socioeconomic risk

Publisher: Elsevier BV

Date: 06-2019

DOI: 10.1016/J.WOMBI.2018.08.162

Abstract: Identifying pregnant women whose children are at risk of poorer development in a rapid, acceptable and feasible way. A range of antenatal psychosocial and socioeconomic risk factors adversely impact children's health, behaviour and cognition. Investigate whether a brief, waiting room survey of risk factors identifies women experiencing increased antenatal psychosocial and socioeconomic risk when asked in a private, in-home interview. Brief 10-item survey (including age, social support, health, smoking, stress/anxious mood, education, household income, employment) collected from pregnant women attending 10 Australian public birthing hospitals, used to determine eligibility (at least 2 adverse items) for the "right@home" trial. 735 eligible women completed a private, in-home interview (including mental health, wellbeing, substance use, domestic violence, housing problems). Regression models tested for dose-response trends between the survey risk factor count and interview measures. 38%, 31%, 15% and 16% of women reported a survey count of 2, 3, 4 and 5 or more adverse risk factors, respectively. Dose-response relationships were evident between the survey count and interview measures, e.g. of women with a survey count of 2, 8% reported ever having a drug problem, 4% experienced domestic violence in the last year and 10% experienced housing problems, contrasting with 31%, 31% and 26%, respectively, for women reporting a survey count of 5 or more. A brief, waiting room survey of psychosocial and socioeconomic risk factors concurs with a private antenatal risk factor interview, and could help health professionals quickly identify which women would benefit from more support.

EHLS at School: school-age follow-up of the Early Home Learning Study cluster randomized controlled trial

Publisher: Springer Science and Business Media LLC

Date: 02-05-2018

DOI: 10.1186/S12887-018-1122-Y

Can improving working memory prevent academic difficulties? A school based randomised controlled trial.

Publisher: Springer Science and Business Media LLC

Date: 20-06-2011

DOI: 10.1186/1471-2431-11-57

Population Outcomes of Three Approaches to Detection of Congenital Hearing Loss

Publisher: American Academy of Pediatrics (AAP)

Date: 2016

DOI: 10.1542/PEDS.2015-1722

Abstract: Universal newborn hearing screening was implemented worldwide largely on modeled, not measured, long-term benefits. Comparative quantification of population benefits would justify its high cost. Natural experiment comparing 3 population approaches to detecting bilateral congenital hearing loss (& dB, better ear) in Australian states with similar demographics and services: (1) universal newborn hearing screening, New South Wales 2003–2005, n = 69 (2) Risk factor screening (neonatal intensive care screening + universal risk factor referral), Victoria 2003–2005, n = 65 and (3) largely opportunistic detection, Victoria 1991–1993, n = 86. Children in (1) and (2) were followed at age 5 to 6 years and in (3) at 7 to 8 years. Outcomes were compared between states using adjusted linear regression. Children were diagnosed younger with universal than risk factor screening (adjusted mean difference –8.0 months, 95% confidence interval –12.3 to –3.7). For children without intellectual disability, moving from opportunistic to risk factor to universal screening incrementally improved age of diagnosis (22.5 vs 16.2 vs 8.1 months, P & .001), receptive (81.8 vs 83.0 vs 88.9, P = .05) and expressive (74.9 vs 80.7 vs 89.3, P & .001) language and receptive vocabulary (79.4 vs 83.8 vs 91.5, P & .001) these nonetheless remained well short of cognition (mean 103.4, SD 15.2). Behavior and health-related quality of life were unaffected. With new randomized trials unlikely, this may represent the most definitive population-based evidence supporting universal newborn hearing screening. Although outperforming risk factor screening, school entry language still lagged cognitive abilities by nearly a SD. Prompt intervention and efficacy research are needed for children to reach their potential.

Variations in utilisation of colorectal cancer services in South Australia indicated by MBS/PBS benefits: a benefit incidence analysis

Publisher: Elsevier BV

Date: 04-2022

DOI: 10.1111/1753-6405.13197

Preventing Preschool Mental Health Problems: Population-Based Cluster Randomized Controlled Trial.

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 2017

DOI: 10.1097/DBP.0000000000000502

Protocol for a randomised controlled trial of a web-based healthy relationship tool and safety decision aid for women experiencing domestic violence (I-DECIDE)

Publisher: Springer Science and Business Media LLC

Date: 08-2015

DOI: 10.1186/S12889-015-2072-Z

The costs of preschool communication problems

Publisher: AMPCo

Date: 09-2011

DOI: 10.5694/MJA11.10254

A cost-consequences analysis of a Midwifery Group Practice for Aboriginal mothers and infants in the Top End of the Northern Territory, Australia

Publisher: Elsevier BV

Date: 04-2014

DOI: 10.1016/J.MIDW.2013.04.004

Abstract: to compare the cost-effectiveness of two models of service delivery: Midwifery Group Practice (MGP) and baseline cohort. a retrospective and prospective cohort study. a regional hospital in Northern Territory (NT), Australia. baseline cohort included all Aboriginal mothers (n=412), and their infants (n=416), from two remote communities who gave birth between 2004 and 2006. The MGP cohort included all Aboriginal mothers (n=310), and their infants (n=315), from seven communities who gave birth between 2009 and 2011. The baseline cohort mothers and infant's medical records were retrospectively audited and the MGP cohort data were prospectively collected. All the direct costs, from the Department of Health (DH) perspective, occurred from the first antenatal presentation to six weeks post partum for mothers and up to 28 days post births for infants were included for analysis. analysis was performed with SPSS 19.0 and Stata 12.1. Independent s le of t-tests and χ2 were conducted. women receiving MGP care had significantly more antenatal care, more ultrasounds, were more likely to be admitted to hospital antenatally, and had more postnatal care in town. The MGP cohort had significantly reduced average length of stay for infants admitted to Special Care Nursery (SCN). There was no significant difference between the two cohorts for major birth outcomes such as mode of birth, preterm birth rate and low birth weight. Costs savings (mean A$703) were found, although these were not statistically significant, for women and their infants receiving MGP care compared to the baseline cohort. for remote dwelling Aboriginal women of all risk who travelled to town for birth, MGP was likely to be cost effective, and women received better care and resulting in equivalent birth outcomes compared with the baseline maternity care.

Impact of a behavioral intervention, delivered by pediatricians or psychologists, on sleep problems in children with ADHD: a cluster-randomized, translational trial

Publisher: Wiley

Date: 11-06-2019

DOI: 10.1111/JCPP.13083

Abstract: We have demonstrated the efficacy of a brief behavioral intervention for sleep in children with ADHD in a previous randomized controlled trial and now aim to examine whether this intervention is effective and cost-effective when delivered by pediatricians or psychologists in community settings. Translational, cluster-randomized trial of a behavioral intervention versus usual care from 19th January, 2015 to 30th June, 2017. Participants (n = 361) were children aged 5-13 years with ADHD and parent report of a moderate/severe sleep problem who met criteria for American Academy of Sleep Medicine criteria for chronic insomnia disorder, delayed sleep-wake phase disorder, or were experiencing sleep-related anxiety. Participants were randomized at the level of the pediatrician (n = 61) to intervention (n = 183) or usual care (n = 178). Families in the intervention group received two consultations with a pediatrician or a psychologist covering sleep hygiene and tailored behavioral strategies. In an intention-to-treat analysis, at 3 and 6 months respectively, the proportion of children with moderate to severe sleep problems was lower in the intervention (28.0%, 35.8%) compared with usual care group (55.4%, 60.1% 3 month: risk ratio (RR): 0.51, 95% CI 0.37, 0.70, p < .001 6 month: RR: 0.58 95% CI 0.45, 0.76, p < .001). Intervention children had improvements across multiple Children's Sleep Habits Questionnaire subscales at 3 and 6 months. No benefits of the intervention were observed in other domains. Cost-effectiveness of the intervention was AUD 13 per percentage point reduction in child sleep problem at 3 months. A low-cost brief behavioral sleep intervention is effective in improving sleep problems when delivered by community clinicians. Greater s le comorbidity, lower intervention dose or insufficient clinician supervisions may have contributed to the lack benefits seen in our previous trial.

Cost-effectiveness of a post-splenectomy registry for prevention of sepsis in the asplenic.

Publisher: Elsevier BV

Date: 12-2006

DOI: 10.1111/J.1467-842X.2006.TB00786.X

Abstract: Overwhelming, sometimes fatal infections represent a lifelong risk after surgical removal of the spleen, or in patients who develop hyposplenism as a consequence of illnesses. This risk may be reduced by all or a combination of vaccination, antibiotic prophylaxis and education. We aimed to determine if a registry approach to delivering these interventions would be cost effective using our own experience and published data. The decision model compared a cohort of 1,000 people covered by a registry to a cohort of 1,000 people with no registry. The impact of the registry was assessed in terms of achieved rates of vaccination, chemoprophylaxis and education, consequent outcomes of overwhelming post-splenectomy infection (OPSI) and mortality (years of life lived). The cost-effectiveness of the registry compared with no registry was estimated in terms of additional cost per case of OPSI avoided and as additional cost per life year gained. In the first two years, the additional cost of the registry was dollar 152,611 per case of OPSI avoided or dollar 205,931 per life year gained. After this initial registration period the cost-effectiveness improves over time, such that over the cohort lifetime a post-splenectomy register is associated with an additional cost of dollar 105,159 per case of OPSI avoided or dollar 16,113 per life year gained. A registry-based approach is likely to prove cost effective in terms of mortality and rates of OPSI avoided.

Health‐related quality of life, service utilization and costs of low language: A systematic review

Publisher: Wiley

Date: 25-09-2019

DOI: 10.1111/1460-6984.12503

Abstract: Low language (LL) is a common childhood condition affecting 7-17% of children. It is associated with life-long adverse outcomes and can affect various aspects of a child's life. However, the literature on its impact on health-related quality of life (HRQoL), service use and costs are limited. To date, there has been no systematic review of the overall economic burden of LL. A systematic review regarding the economic burden of LL is important for clinical, educational, policy decision-making and theoretical aspects. We adopted the term 'low language' to refer to children whose language performance falls below well-recognized cut-points regardless of known or unknown aetiology. To review the literature systematically on how LL is associated with HRQoL, service utilization and costs. A systematic search was conducted across various databases, including MEDLINE, Embase, PsycINFO, CINAHL, up to July 2017. Data on study design, population and outcomes were extracted and screened by two pairs of reviewers with the revision of other experts in the panel on any discrepancies. The Effective Public Health Practice Project tool was used to assess the risk of bias of the included studies. The findings of the included studies were summarized in a narrative synthesis. We identified 22 relevant articles, of which 12 reported HRQoL and 11 reported service utilization and costs associated with LL. Preference-based instruments, which include the relative importance attached to different aspects of HRQoL, were less employed in the literature. Most studies found poorer HRQoL in children with LL compared with their peers. About half the families having children with LL did not actively seek professional help, and many families felt they did not receive sufficient services when needed. Healthcare costs associated with LL were substantial. Non-healthcare costs were largely unexplored. LL was associated with reduced children's HRQoL, higher service use and costs. Under-servicing was evident in children with LL. LL also imposed large costs on the healthcare system. Further research is required to examine (1) the overall HRQoL of children with LL, in particular studies using and testing the performance of preference-based instruments and (2) the service use and costs specific to LL, especially non-healthcare costs.

Randomized Controlled Trial Comparing Traditional with Two “Mobile” Epidural Techniques

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 12-2002

DOI: 10.1097/00000542-200212000-00032

Abstract: The authors recently showed that "mobile" epidural analgesia, using low-dose local anesthetic-opioid mixtures, reduces the impact of epidural analgesia on instrumental vaginal delivery, relative to a traditional technique. The main prespecified assessment of pain relief efficacy, women's postpartum estimates of labor pain after epidural insertion, did not differ. The detailed analgesic efficacy and the anesthetic characteristics of the techniques are reported here. A total of 1,054 nulliparous women were randomized, in labor, to receive boluses of 10 ml 0.25% bupivacaine (traditional), combined spinal-epidural (CSE) analgesia, or low-dose infusion (LDI), the latter groups utilizing 0.1% bupivacaine with 2 microg/ml fentanyl. Visual analog scale pain assessments were collected throughout labor and delivery and 24 h later. Details of the conduct of epidural analgesia, drug utilization, and requirement for anesthesiologist reattendance were recorded. A total of 353 women were randomized to receive traditional epidural analgesia, 351 received CSE, and 350 received LDI. CSE was associated with a more rapid onset of analgesia, lower median visual analog scale pain scores than traditional in the first hour after epidural insertion, and a significant reduction in bupivacaine dose given during labor. Pain scores reported by women receiving LDI were similar to those in the traditional group throughout labor and delivery. Anesthesiologist reattendance was low but greater with each mobile technique. Relative to traditional epidural analgesia, LDI is at least as effective and CSE provided better pain relief in the early stages after insertion. The proven efficacy of mobile epidurals and their beneficial impact on delivery mode make them the preferred techniques for epidural pain relief in labor.

Mothers' AdvocateS in the Community (MOSAIC)-non-professional mentor support to reduce intimate partner violence and depression in mothers: A cluster randomised trial in primary care

Publisher: Springer Science and Business Media LLC

Date: 23-03-2011

DOI: 10.1186/1471-2458-11-178

If the price is right: Vagueness and values clarification in contigent valuation

Publisher: Wiley

Date: 2003

DOI: 10.1002/HEC.777

Abstract: The use of willingness to pay to value the benefits of health care is increasing. Much of this work assumes that health preferences are well formed or 'complete' and readily revealed if the right question is asked in the right way. We examined this assumption, seeking evidence in a mixed-methods study that explored the meaning and implications of vague responses to a payment-scale based willingness to pay exercise.One-half of the s le said that their vagueness meant that their maximum willingness to pay was actually greater than the amount that they had previously said it was. Thirty percent agreed that they would probably pay pound 10 more than a sum that they had previously said they would most definitely not pay, if they found this to be the cost of the vaccine. Interview data supported the view that the payment scale had failed to elicit the maximum willingness to pay and that some participants used the information on cost to help clarify their values, in contrast to the theory underpinning willingness to pay. The results suggest a need to consider values-clarification in health economic evaluations.

Individualised, flexible postnatal care: a feasibility study for a randomised controlled trial.

Publisher: Springer Science and Business Media LLC

Date: 25-11-2014

DOI: 10.1186/S12913-014-0569-2

Increasing the number of drugs in antiretroviral therapy may improve survival in people with HIV infection

Publisher: Elsevier BV

Date: 12-2002

DOI: 10.1054/EBHC.2002.0542

Health service use and costs for infant behaviour problems and maternal stress

Publisher: Wiley

Date: 04-2016

DOI: 10.1111/JPC.13095

Abstract: We aim to describe health service (HS) use in the first 6 months post-partum and to examine the associations between service costs, infant behaviour and maternal depressive symptoms. Participants were 781 infants and mothers in Melbourne, Australia. Mothers reported infant feeding, sleeping and crying problems, depressive symptoms and health service use. Costs were valued in 2012 Australian dollars. The most common services used were maternal child health nurses, general practitioners (GP) and allied health. Infant feeding problems were associated with increased costs for services relevant to infant behaviour including maternal child health nurses (P = 0.007), GP (P = 0.008) and paediatricians (P = 0.03). Maternal depressive symptoms were associated with increased costs for services relevant to depressive symptoms including parenting centres (P = 0.04), GP (P = 0.004), psychiatrists (P = 0.02) and psychologists (P = 0.001). Mothers who completed high school had higher service costs for infant problems than those with lower education (P = 0.02). Single mothers had higher costs for services used for their depressive symptoms than partnered mothers (P < 0.001). Mothers with English as a second language had lower service costs for their depressive symptoms (P = 0.02). Infant feeding problems and maternal depressive symptoms are associated with higher costs for health services relevant to these conditions. Cost-effective strategies to manage these conditions are needed with accessibility being ensured for mothers who are experiencing social adversity.

Two-Year Outcomes of a Population-Based Intervention for Preschool Language Delay: An RCT

Publisher: American Academy of Pediatrics (AAP)

Date: 10-2015

DOI: 10.1542/PEDS.2015-1337

Abstract: We have previously shown short-term benefits to phonology, letter knowledge, and possibly expressive language from systematically ascertaining language delay at age 4 years followed by the Language for Learning intervention. Here, we report the trial’s definitive 6-year outcomes. Randomized trial nested in a population-based ascertainment. Children with language scores & .25 SD below the mean at age 4 were randomized, with intervention children receiving 18 1-hour home-based therapy sessions. Primary outcome was receptive/expressive language. Secondary outcomes were phonological, receptive vocabulary, literacy, and narrative skills parent-reported pragmatic language, behavior, and health-related quality of life costs of intervention and health service use. For intention-to-treat analyses, trial arms were compared using linear regression models. Of 1464 children assessed at age 4, 266 were eligible and 200 randomized 90% and 82% of intervention and control children were retained respectively. By age 6, mean language scores had normalized, but there was little evidence of a treatment effect for receptive (adjusted mean difference 2.3 95% confidence interval [CI] –1.2 to 5.7 P = .20) or expressive (0.8 95% CI –1.6 to 3.2 P = .49) language. Of the secondary outcomes, only phonological awareness skills (effect size 0.36 95% CI 0.08–0.65 P = .01) showed benefit. Costs were higher for intervention families (mean difference AU$4276 95% CI: $3424 to $5128). Population-based intervention targeting 4-year-old language delay was feasible but did not have lasting impacts on language, possibly reflecting resolution in both groups. Long-term literacy benefits remain possible but must be weighed against its cost.

Community demand for comprehensive primary health care from malaria volunteers in South-East Myanmar: a qualitative study

Publisher: Springer Science and Business Media LLC

Date: 06-01-2021

DOI: 10.1186/S12936-020-03555-4

Abstract: Malaria volunteers have contributed significantly to malaria control achieving a reduction of annual parasite incidence to pre-elimination levels in several townships across Myanmar. However, the volunteers’ role is changing as Myanmar transitions from a malaria control to elimination programme and towards the goal of universal health coverage. The aim of the study is to explore the perspectives of community leaders, members and malaria volunteers in South-East Myanmar on community-delivered models to inform an optimal design that targets malaria elimination in the context of primary health care in Myanmar. Qualitative methods including focus group discussions (FGDs) with community members and current or ex-malaria volunteers, and participatory workshops with community leaders were conducted. All data collection tools were pilot tested with similar participants. The FGDs were stratified into male and female participants in consideration of erse gender roles among the ethnic groups of Myanmar. Data saturation was the key cut-off point to cease recruitment of participants. Inductive thematic analysis was used. Community members were willing to be tested for malaria because they were concerned about the consequences of malaria although they were aware that malaria prevalence is low in their villages. Malaria volunteers were the main service providers for malaria and other infectious diseases in the community. Apart from malaria, the community identified common health problems such as the flu (fever, sneezing and coughing), diarrhoea, skin infections and tuberculosis as priority diseases in this order. Incorporating preventive, and whenever possible curative, services for those diseases into the current malaria volunteer model was recommended. There was a gap between the communities’ expectations of health services and the health services currently being delivered by volunteers in the community that highlights the need for reassessment and reform of the volunteer model in the changing context. An evidence-based, community preferred, pragmatic community-delivered integrated model should be constructed based on the context of malaria elimination and progressing towards universal health coverage in Myanmar.

Strengthening Support to Families: Basing a Family Support Worker at a Primary School in Melbourne, Australia

Publisher: Springer Science and Business Media LLC

Date: 05-05-2016

DOI: 10.1007/S10560-016-0445-5

Proactive Peer (Mother-to-Mother) Breastfeeding Support by Telephone (Ringing up About Breastfeeding Early [RUBY]): A Multicentre, Unblinded, Randomised Controlled Trial

Publisher: Elsevier BV

Date: 02-2019

DOI: 10.1016/J.ECLINM.2019.02.003

Satisfaction, control and pain relief: short- and long-term assessments in a randomised controlled trial of low-dose and traditional epidurals and a non-epidural comparison group

Publisher: Elsevier BV

Date: 2010

DOI: 10.1016/J.IJOA.2009.05.004

Abstract: Childbirth is an important life event for which a positive experience is important to many women. As secondary outcomes from the randomised controlled Comparative Obstetric Mobile Epidural Trial, various aspects of satisfaction were assessed in women who had one of three types of regional analgesia (two of which were low-dose techniques and a high-dose control using 0.25% epidural bupivacaine) and a comparison group who did not have epidural analgesia, shortly after delivery and 12 months later. The predominant finding was satisfaction with spontaneous vaginal delivery whatever the mode of analgesia. The overall immediate and long-term satisfaction was similar for all three neuraxial techniques. Satisfaction with the speed of pain relief and the amount of mobility were significantly greater for the combined spinal-epidural technique compared with the low-dose infusion (P<0.001). The degree of control felt by women who had combined spinal-epidural analgesia was greater than with the high-dose (P<0.05). Women in the non-epidural comparison group did not report a greater feeling of control. Among those who delivered spontaneously, more women in the combined spinal-epidural group (30%) felt in full control compared with the high-dose group (17%) (P<0.05). By comparison 22% in the low-dose infusion group and only 15% who had no epidural felt in full control. Whilst satisfaction with the experience of childbirth appears intimately related to the attainment of a spontaneous delivery, mobile epidurals enhance women's feeling of control in labour and are popular for future choice of regional analgesia.

Randomized trial of a population-based, home-delivered intervention for preschool language delay

Publisher: American Academy of Pediatrics (AAP)

Date: 10-2013

DOI: 10.1542/PEDS.2012-3878

Abstract: Population approaches to lessen the adverse impacts of preschool language delay remain elusive. We aimed to determine whether systematic ascertainment of language delay at age 4 years, followed by a 10-month, 1-on-1 intervention, improves language and related outcomes at age 5 years. A randomized trial nested within a cross-sectional ascertainment of language delay. Children with expressive and/or receptive language scores more than 1.25 SD below the mean at age 4 years entered the trial. Children randomly allocated to the intervention received 18 1-hour home-based therapy sessions. The primary outcomes were receptive and expressive language (Clinical Evaluation of Language Fundamentals – Preschool, 2nd Edition) and secondary outcomes were child phonological skills, letter awareness, pragmatic skills, behavior, and quality of life. A total of 1464 children were assessed for language delay at age 4 years. Of 266 eligible children, 200 (13.6%) entered the trial, with 91 intervention (92% of 99) and 88 control (87% of 101) children retained at age 5 years. At age 5 years, there was weak evidence of benefit to expressive (adjusted mean difference, intervention − control, 2.0 95% confidence interval [CI] −0.5 to 4.4 P = .12) but not receptive (0.6 95% CI −2.5 to 3.8 P = .69) language. The intervention improved phonological awareness skills (5.0 95% CI 2.2 to 7.8 P & .001) and letter knowledge (2.4 95% CI 0.3 to 4.5 P = .03), but not other secondary outcomes. A standardized yet flexible 18-session language intervention was successfully delivered by non-specialist staff, found to be acceptable and feasible, and has the potential to improve long-term consequences of early language delay within a public health framework.

Supporting educators’ emotional work with infants and their families around transitions at the start the day

Publisher: Informa UK Limited

Date: 27-05-2023

DOI: 10.1080/09575146.2023.2235911

Double disadvantage: the influence of ethnicity over socioeconomic position on childhood overweight and obesity: findings from an inner urban population of primary school children

Publisher: Informa UK Limited

Date: 2008

DOI: 10.1080/17477160802141846

Abstract: To examine the relationship between overweight/obesity in children, socioeconomic status and ethnicity/cultural background. Cross-sectional survey of children aged 4-13 years. A total of 23 primary (elementary) schools in an inner urban municipality of Melbourne, Australia. Participants. A total of 2685 children aged 4-13 years and their parents. Ethnicity/cultural background - maternal region of birth socioeconomic position (SEP) indicators - maternal and paternal educational attainment, family employment status, possession of a healthcare card, ability to buy food, indicator of disadvantage (Socioeconomic Index for Areas, SEIFA) score for school parental weight status. Main outcome measure. Prevalence of overweight/obesity. Prevalence of overweight/obesity approached 1 in 3 (31%) in this s le. Prevalence of overweight/obesity was greater for children of both North Africa and Middle Eastern background and children of Southern, South Eastern and Eastern European background compared with children of Australian background. This difference remained after adjusting for age, sex, height, clustering by school, SEP indicators and parental weight status odds ratio, OR=1.57 (95% confidence interval, CI 1.12-2.19) and 1.88 (95%CI 1.24-2.85), respectively. There is a clear independent effect of ethnicity above and beyond the effect of socioeconomic status on overweight and obesity in children. Further research is required to explore the mediators of this gradient.

Community‐based healthcare costs for children born low birthweight, preterm and/or small for gestational age: data from the Longitudinal Study of Australian C

Publisher: Wiley

Date: 05-03-2013

DOI: 10.1111/CCH.12040

Abstract: Children born low birthweight, preterm and/or small for gestational age (SGA) sustain substantially increased costs for hospital-based health care and additional educational support in the first few years of life. This is the first study internationally to investigate costs beyond hospital care, to community-based health care and prescription medicines across early and middle childhood with actual cost data, and to examine these costs according to the severity of perinatal risk. In the prospective Longitudinal Study of Australian Children, we followed two cohorts of children from age of 0 to 5 years (no increased perinatal risk, n = 3973 mild risk, n = 442 and moderate-to-high risk, n = 297), and from age of 4 to 9 years (no increased perinatal risk, n = 3629 mild risk, n = 465 and moderate-to-high risk, n = 361). Children were defined as mild risk if born 32-36 weeks, with birthweight 1500-2499 g, and/or SGA (<5-9th percentile), and moderate-to-high risk if born <32 weeks, birthweight <1500 g and/or extremely SGA (<5th percentile). Federal government expenditure (2011 $AUD) on healthcare attendances and prescription medication from birth to 9 years were calculated via data linkage to the Australian Medicare records. Mean costs per child were A$362 higher (95% CI $156 568) from 0 to 5 years and A$306 higher (95% CI $137 475) from 4 to 9 years, for children with any compared with no increased perinatal risk (P < 0.001). At the population level, an additional A$32m was spent per year for children 0-9 years with any relative to no increased perinatal risk. Perinatal risk is a major public health issue conferring considerable additional expense to community-based health care, most marked in the first year of life but persisting up to at least 10 years. Even without additionally considering burden, these findings add to the urgency of identifying effective mechanisms to reduce perinatal risk across its full spectrum.

Can a teacher-led mindfulness intervention for new school entrants improve child outcomes? Protocol for a school cluster randomised controlled trial

Publisher: BMJ

Date: 05-2020

DOI: 10.1136/BMJOPEN-2019-036523

Abstract: The first years of school are critical in establishing a foundation for positive long-term academic, social and well-being outcomes. Mindfulness-based interventions may help students transition well into school, but few robust studies have been conducted in this age group. We aim to determine whether compared with controls, children who receive a mindfulness intervention within the first years of primary school have better: (1) immediate attention/short-term memory at 18 months post-randomisation (primary outcome) (2) inhibition, working memory and cognitive flexibility at 18 months post-randomisation (3) socio-emotional well-being, emotion-regulation and mental health-related behaviours at 6 and 18 months post-randomisation (4) sustained changes in teacher practice and classroom interactions at 18 months post-randomisation. Furthermore, we aim to determine whether the implementation predicts the efficacy of the intervention, and the cost effectiveness relative to outcomes. This cluster randomised controlled trial will be conducted in 22 primary schools in disadvantaged areas of Melbourne, Australia. 826 students in the first year of primary school will be recruited to detect between groups differences of Cohen’s d=0.25 at the 18-month follow-up. Parent, teacher and child-assessment measures of child attention, emotion-regulation, executive functioning, socio-emotional well-being, mental health-related behaviour and learning, parent mental well-being, teacher well-being will be collected 6 and 18 months post-randomisation. Implementation factors will be measured throughout the study. Intention-to-treat analyses, accounting for clustering within schools and classes, will adopt a two-level random effects linear regression model to examine outcomes for the intervention versus control students. Unadjusted and analyses adjusted for baseline scores, baseline age, gender and family socioeconomic status will be conducted. Ethics approval has been received by the Human Research Ethics Committee at the University of Melbourne. Findings will be reported in peer-review publications, national and international conference presentations and research snapshots directly provided to participating schools and families. Australian New Zealand Clinical Trials Registry (ACTRN12619000326190).

Healthcare costs associated with language difficulties up to 9 years of age: Australian population-based study

Publisher: Informa UK Limited

Date: 06-05-2014

DOI: 10.3109/17549507.2014.898095

Abstract: This study aimed to quantify the non-hospital healthcare costs associated with language difficulties within two nationally representative s les of children. Data were from three biennial waves (2004-2008) of the Longitudinal Study of Australian Children (B cohort: 0-5 years K cohort: 4-9 years). Language difficulties were defined as scores ≤ 1.25 SD below the mean on measures of parent-reported communication (0-3 years) and directly assessed vocabulary (4-9 years). Participant data were linked to administrative data on non-hospital healthcare attendances and prescription medications from the universal Australian Medicare subsidized healthcare scheme. It was found that healthcare costs over each 2-year age band were higher for children with than without language difficulties at 0-1, 2-3, and 4-5 years, notably 36% higher (mean difference = $AU206, 95% CI = $90, $321) at 4-5 years (B cohort). The slightly higher 2-year healthcare costs for children with language difficulties at 6-7 and 8-9 years were not statistically different from those without language difficulties. Modelled to the corresponding Australian child population, 2-year government costs ranged from $AU1.2-$AU12.1 million (depending on age examined). Six-year healthcare costs increased with the persistence of language difficulties in the K cohort, with total Medicare costs increasing by $192 (95% CI = $74, $311 p = .002) for each additional wave of language difficulties. Language difficulties (whether transient or persistent) were associated with substantial excess population healthcare costs in childhood, which are in addition to the known broader costs incurred through the education system. It is unclear whether healthcare costs were specifically due to the assessment and/or treatment of language difficulties, as opposed to conditions that may be co-morbid with or may cause language difficulties.

Using simulated patients to develop doctors' skills in facilitating behaviour change: Addressing childhood obesity

Publisher: Wiley

Date: 15-06-2010

DOI: 10.1111/J.1365-2923.2010.03686.X

Abstract: This study aimed to describe the application, feasibility and outcomes of using simulated patients (SPs) to increase the skills of general practitioners (GPs) delivering a behavioural intervention to reduce childhood overweight and mild obesity. Five female actors were trained as SPs. A total of 67 GPs from 46 general practices in Melbourne, Victoria, Australia, conducted two simulated consultation visits regarding healthy lifestyle family behaviour change, during which they practised their skills and received formative feedback. The GPs and SPs rated GP performance immediately after each consultation. Subsequently, 139 parents of overweight or obese 5-9-year-old children rated GP performance during real-life consultations. Other measures included child body mass index (BMI) Z-scores (at baseline and at a 9-month follow-up) and GP-reported levels of comfort and competence and the perceived value of SP visits. Simulated patient ratings, but not GP self-ratings, of GP performance predicted both parent ratings of real-life consultations (Spearman's rho 0.39 for correlation with SP rating at Visit 1) and subsequent reductions in BMI Z-scores between baseline and follow-up (Visit 1, rho-0.45 Visit 2, rho-0.46). GP levels of comfort and competence were maintained during and after the SP visits. A total of 95% of GPs rated simulated consultations as useful, although only 18% said they would pay for them. Simulated patient assessment may predict real patient feedback and clinical outcomes, helping to identify doctors who require further training in behaviour change techniques. Randomised controlled trials may establish whether SPs actually raise skills or improve outcomes.

Still serving hot soup? Two hundred years of a charitable food sector in Australia: a narrative review

Publisher: Elsevier BV

Date: 08-2015

DOI: 10.1111/1753-6405.12311

Abstract: Despite the importance of the charitable food sector for a proportion of the Australian population, there is uncertainty about its present and future contributions to wellbeing. This paper describes its nature and examines its scope for improving health and food security. The review, using systematic methods for public health research, identified peer-reviewed and grey literature relevant to Australian charitable food programs (2002 to 2012). Seventy publications met the criteria and informed this paper. The sector includes food banks, more than 3,000 community agencies and 800 school breakfast programs. It provides food for up to two million people annually. The scope extends beyond emergency food relief and includes case management, advocacy and other support. Weaknesses include a food supply that is sub-optimal, resource limitations and lack of evidence to evaluate or support their work towards food security. The sector supports people experiencing disadvantage and involves multiple organisations, working in a variety of settings, to provide food for up to 8% of the population. The limits on the sector's capacity to address food insecurity by itself must be acknowledged so that civil society, government and the food industry can support sufficient, nutritious and affordable food for all.

Choosing foods for infants: a qualitative study of the factors that influence mothers

Publisher: Wiley

Date: 03-03-2016

DOI: 10.1111/CCH.12323

Abstract: Examining the experiences of parents making food choices for infants is important because ultimately this influences what infants eat. Infancy is a critical period when food preferences and eating behaviour begin to develop, shaping dietary patterns, growth and health outcomes. There is limited evidence regarding what or why foods are chosen for infants. To describe the experiences of mothers making food choices for their infant children. Semi-structured interviews with 32 Australian mothers of infants aged four to 15 months from a range of socioeconomic backgrounds. An inductive thematic analysis through a process of constant comparison was conducted on transcribed interviews. Mothers described many ideas and circumstances which influenced food choices they made for infants. Themes were developed which encapsulate how the wider environment and in idual circumstances combine to result in the food choices made for infants. Beliefs, values, norms and knowledge were a central influence on choices. Cost, quality and availabilities of various foods were also key factors. Related to this, and combined with inherent factors such as perishability and infant acceptability, fresh fruits and vegetables were often singled out as an easy or difficult choice. Influences of time, parents' capacities, social connections and different information sources were clearly apparent. Finally infants' own preferences and how parents helped infants with learning to eat were also key influences on food choices. Choosing foods for infants is a complex social practice. An ecological framework depicting the multiple influences on what people eat and sociological theory on food choice regarding the role of 'social structure' and 'human agency' are both applicable to the process of choosing foods for infants. Equity issues may be key regarding the degree to which mothers can choose particular foods for infants (e.g. choosing foods which promote health).

Initial modelling and updates on cost effectiveness from the first 10 years of a spleen registry.

Publisher: Elsevier BV

Date: 10-2018

DOI: 10.1111/1753-6405.12832

Abstract: To validate our estimates from our original model and re-evaluate the cost-effectiveness of Spleen Australia, the Australian post-splenectomy registry, using our original model with updated model parameters based on advances in the literature and experience of the registry over the past decade. We revisited a decision model from 2005, comparing 1,000 hypothetical registered patients with asplenia or hyposplenism against 1,000 who were not registered, and updated the model parameters. The cost-effectiveness of the registry was evaluated from a healthcare perspective in terms of additional cost per case of overwhelming post-splenectomy infection (OPSI) avoided and as additional cost per life year gained. Over a cohort lifetime the registry was associated with an additional cost of $125,724 per case of OPSI avoided or $19,286 per life year gained. Despite our initial over-estimation of immunisation and chemoprophylaxis uptake and increases in unit costs, our re-evaluation confirmed use of the registry to be cost-effective. Implications for public health: Improved outcomes for patients with asplenia or hyposplenism can be achieved by a cost-effective registry. Additional research into effectiveness of interventions, OPSI prevalence associated with varying intervention use, and compliance rates over time after registration would provide improved accuracy of cost-effectiveness estimates.

Service utilisation and costs of language impairment in children: The early language in Victoria Australian population-based study

Publisher: Informa UK Limited

Date: 28-07-2016

DOI: 10.1080/17549507.2016.1209559

Abstract: To examine (1) the patterns of service use and costs associated with language impairment in a community cohort of children from ages 4-9 years and (2) the relationship between language impairment and health service utilisation. Participants were children and caregivers of six local government areas in Melbourne participating in the community-based Early Language in Victoria Study (ELVS). Health service use was reported by parents. Costs were valued in Australian dollars in 2014, from the government and family perspectives. Depending on age, the Australian adapted Clinical Evaluation of Language Fundamentals - Pre-school, 2nd Edition (CELF-P2) or the CELF, 4th Edition (CELF4) was used to assess expressive and receptive language. At 5, 7 and 9 years respectively 21%, 11% and 8% of families reported using services for speech and/or language concerns. The annual costs associated with using services averaged A$612 (A$255 to government, A$357 to family) at 5 years and A$992 (A$317 to government, A$675 to family) at 7 years. Children with persistent language impairment had significantly higher service costs than those with typical language. Language impairment in 4-9-year-old children is associated with higher use of services and costs to both families and government compared to typical language.

Deakin University

Location: Australia

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University Of Cambridge

Location: United Kingdom of Great Britain and Northern Ireland

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La Trobe University

Location: Australia

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University Of Oxford

Location: United Kingdom of Great Britain and Northern Ireland

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Linkage Projects - Grant ID: LP0990182

Start Date: 07-2009

End Date: 12-2014

Amount: $316,029.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP130100308

Start Date: 06-2014

End Date: 02-2018

Amount: $570,000.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP190100504

Start Date: 03-2019

End Date: 12-2023

Amount: $586,900.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP100100223

Start Date: 09-2010

End Date: 12-2014

Amount: $491,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0989576

Start Date: 05-2009

End Date: 05-2015

Amount: $662,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0883525

Start Date: 02-2009

End Date: 12-2011

Amount: $144,344.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP130102799

Start Date: 06-2013

End Date: 06-2017

Amount: $717,831.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP200300530

Start Date: 02-2022

End Date: 01-2025

Amount: $637,834.00

Funder: Australian Research Council