ORCID Profile
0000-0002-3672-4030
Current Organisation
University of Queensland
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Information Systems | Econometric and Statistical Methods | Information Systems Management | Health Economics | Econometrics | Organisation and Management Theory
Management | Preference, Behaviour and Welfare | Public Sector Productivity | Electronic Information Storage and Retrieval Services | Health Policy Evaluation |
Publisher: Oxford University Press (OUP)
Date: 10-2013
DOI: 10.1111/PME.12202
Abstract: The objective of the study was to collect data on the direct and indirect economic cost of chronic pain among patients attending a pain management clinic in Ireland. A tertiary pain management clinic serving a mixed urban and rural area in the West of Ireland. Data were collected from 100 patients using the Client Services Receipt Inventory and focused on direct and indirect costs of chronic pain. Patients were questioned about health service utilization, payment methods, and relevant sociodemographics. Unit costs were multiplied by resource use data to obtain full costs. Cost drivers were then estimated. Our study showed a cost per patient of US$24,043 over a 12-month period. Over half of this was attributable to wage replacement costs and lost productivity in those unable to work because of pain. Hospital stays and outpatient hospital services were the main drivers for health care utilization costs, together accounting for 63% of the direct medical costs per study participant attending the pain clinic. The cost of chronic pain among intensive service users is significant, and when extrapolated to a population level, these costs represent a very substantial economic burden.
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-023526
Abstract: The European population is rapidly ageing. In order to handle substantial future challenges in the healthcare system, we need to shift focus from treatment towards health promotion. The PreventIT project has adapted the Lifestyle-integrated Exercise (LiFE) programme and developed an intervention for healthy young older adults at risk of accelerated functional decline. The intervention targets balance, muscle strength and physical activity, and is delivered either via a smartphone application (enhanced LiFE, eLiFE) or by use of paper manuals (adapted LiFE, aLiFE). The PreventIT study is a multicentre, three-armed feasibility randomised controlled trial, comparing eLiFE and aLiFE against a control group that receives international guidelines of physical activity. It is performed in three European cities in Norway, Germany, and The Netherlands. The primary objective is to assess the feasibility and usability of the interventions, and to assess changes in daily life function as measured by the Late-Life Function and Disability Instrument scale and a physical behaviour complexity metric. Participants are assessed at baseline, after the 6 months intervention period and at 1 year after randomisation. Men and women between 61 and 70 years of age are randomly drawn from regional registries and respondents screened for risk of functional decline to recruit and randomise 180 participants (60 participants per study arm). Ethical approval was received at all three trial sites. Baseline results are intended to be published by late 2018, with final study findings expected in early 2019. Subgroup and further in-depth analyses will subsequently be published. NCT03065088 Pre-results.
Publisher: Wiley
Date: 10-12-2023
DOI: 10.1002/HEC.4641
Abstract: The prevalence of mental health disorders in young adults is increasing, yet there is limited empirical evidence on its economic consequences. We contribute to the literature by estimating the healthcare costs of psychological distress using panel data of young women (aged 18–23 years with a 5‐year follow‐up) from the Australian Longitudinal Study on Women's Health and linked administrative data from Medicare Australia. Our empirical strategy is based on the classical two‐part model of healthcare costs with in idual specific fixed‐effects. We complement our analysis with a test for selection on unobservables to address potential concerns of endogeneity. We find that young women with psychological distress have 15% higher annual healthcare costs (excluding hospital costs) than women with no psychological distress. A large proportion of these costs is driven by the use of antidepressants and the services of psychiatrists and psychologists. We further find that women with psychological distress have higher out‐of‐pocket costs on these mental health related services compared to non‐mental health specific services. Additionally, we show that the effect of psychological distress on healthcare costs is highest during the first 6 months of onset, which gradually decreases afterwards. The findings justify the importance of policy initiatives towards early prevention and treatment of psychological distress, especially among young women.
Publisher: Springer Science and Business Media LLC
Date: 11-07-2016
Publisher: Springer Science and Business Media LLC
Date: 19-01-2013
Publisher: Elsevier BV
Date: 03-2012
Publisher: Wiley
Date: 24-03-2011
DOI: 10.1002/HEC.1619
Abstract: Addressing the extra economic costs of disability is a logical step towards alleviating elements of social exclusion for people with disabilities. This study estimates the long-run economic cost of disability in Ireland in terms of the additional spending needs that arise due to disability. It defines and estimates models of the private costs borne by families with in iduals who have a disability in Ireland when compared with the wider population, both in general and by severity of disability. Our modelling framework is based on the standard of living approach to estimating the cost of disability. We extend on previous research by applying panel ordered probit models to living in Ireland survey data 1995-2001 in order to control for the effects of previous disability and income and correlated unobserved heterogeneity. The approach allows us to quantify, for the first time, the additional long-run economic costs of living associated with disability. Our findings suggest that the extra economic cost of disability in Ireland is large and varies by severity of disability, with important implications for measures of poverty.
Publisher: BMJ
Date: 02-2019
DOI: 10.1136/BMJOPEN-2018-025997
Abstract: Emergency intubation of children with abnormal respiratory or cardiac physiology is a high-risk procedure and associated with a high incidence of adverse events including hypoxemia. Successful emergency intubation is dependent on inter-related patient and operator factors. Preoxygenation has been used to maximise oxygen reserves in the patient and to prolong the safe apnoeic time during the intubation phase. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) prolongs the safe apnoeic window for a safe intubation during elective intubation. We designed a clinical trial to test the hypothesis that THRIVE reduces the frequency of adverse and hypoxemic events during emergency intubation in children and to test the hypothesis that this treatment is cost-effective compared with standard care. The Kids THRIVE trial is a multicentre randomised controlled trial performed in participating emergency departments and paediatric intensive care units. 960 infants and children aged 0–16 years requiring emergency intubation for all reasons will be enrolled and allocated to THRIVE or control in a 1:1 allocation with stratification by site, age ( , 1–7 and years) and operator (junior and senior). Children allocated to THRIVE will receive weight appropriate transnasal flow rates with 100% oxygen, whereas children in the control arm will not receive any transnasal oxygen insufflation. The primary outcomes are defined as follows: (1) hypoxemic event during the intubation phase defined as SpO 2 % (patient-dependent variable) and (2) first intubation attempt success without hypoxemia (operator-dependent variable). Analyses will be conducted on an intention-to-treat basis. Ethics approval for the protocol and consent process has been obtained (HREC/16/QRCH/81). The trial has been actively recruiting since May 2017. The study findings will be submitted for publication in a peer-reviewed journal. ACTRN12617000147381.
Publisher: Wiley
Date: 12-2020
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.IJMEDINF.2019.01.015
Abstract: The primary study objective was to describe the development of a data dictionary for a feasibility analysis of 11 emergency department (ED) key performance indicators (KPIs). The secondary objective was to internally validate the data dictionary by measuring the inter-observer agreement between data abstractors at participating study sites. A list of data variables based on the minimum data set elements relevant to the KPIs was developed by a panel of emergency medicine (EM) specialists and from the EM literature. A summit involving the relevant stakeholders, including ED frontline staff, a health economist, an ED clinical data manager and a health care informatician, was convened. For the feasibility analysis project, each data abstractor was furnished with a copy of the data dictionary and attended a one-hour training session prior to commencing data abstraction. Data was independently abstracted for each KPI by two abstractors at each of 12 participating EDs. Inter-rater agreement between abstractors was calculated using Cohen's kappa and results were reported using the Landis and Koch criteria. A data dictionary was developed by creating clear definitions and establishing abstraction instructions for each variable. A total of 43 data variables were included in the study data dictionary: 4 on patient demographics 19 time variables 5 outcome variables 8 ED service and staffing units and 7 medical definitions. A clear definition and a set of data abstraction instructions including data sources were developed for each variable to aid data abstraction during the feasibility analysis. Overall 9,276 ED patient records were used for data abstraction to internally validate the data dictionary. The median Cohen kappa score ranged between 0.56 to 0.81. There is a continued need to standardize definitions of KPIs for the purpose of comparing ED performance and for research purposes. This is a necessary first step in the implementation of valid and reliable ED performance measures. This study successfully developed an internally valid data dictionary that can be used for day-to-day ED operations and for research purposes.
Publisher: Wiley
Date: 2005
DOI: 10.1002/HEC.1044
Abstract: This paper aims to analyse the effect of disability on participation in the labour force, using the Irish component of the European Community Household Panel Survey 1995-2000. A range of panel models are considered, but to allow for any unobserved influences or state dependence in labour force participation, our preferred model is a dynamic panel model. We show how the estimates of current disability are changed once we control for the effect of past disability and previous participation. We compare base estimates of disability with those controlling for unobserved heterogeneity and past participation. The results suggest that the base effect of disability is overestimated by between 40-60% for men and by 5-10% for women.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2017
Publisher: National Institute for Health and Care Research
Date: 03-2020
DOI: 10.3310/HSDR08170
Abstract: Therapy is key to effective stroke care, but many patients receive little. To understand how stroke therapy is delivered in England, Wales and Northern Ireland, and which factors are associated with dose, outcome and resource use. Secondary analysis of the Sentinel Stroke National Audit Programme, using standard descriptive statistics and multilevel mixed-effects regression models, while adjusting for all known and measured confounders. Stroke services in England, Wales and Northern Ireland. A total of 94,905 adults admitted with stroke, who remained an inpatient for 72 hours. Routes through stroke services were highly varied ( 800), but four common stroke pathways emerged. Seven distinct impairment-based patient subgroups were characterised. The average amount of therapy was very low. Modifiable factors associated with the average amount of inpatient therapy were type of stroke team, timely therapy assessments, staffing levels and model of therapy provision. More (of any type of) therapy was associated with shorter length of stay, less resource use and lower mortality. More occupational therapy, speech therapy and psychology were also associated with less disability and institutionalisation. Large amounts of physiotherapy were associated with greater disability and institutionalisation. Use of observational data does not infer causation. All efforts were made to adjust for all known and measured confounding factors but some may remain. We categorised participants using the National Institutes of Health Stroke Scale, which measures a limited number of impairments relatively crudely, so mild or rare impairments may have been missed. Stroke patients receive very little therapy. Modifiable organisational factors associated with greater amounts of therapy were identified, and positive associations between amount of therapy and outcome were confirmed. The reason for the unexpected associations between large amounts of physiotherapy, disability and institutionalisation is unknown. Prospective work is urgently needed to investigate further. Future work needs to investigate (1) prospectively, the association between physiotherapy and outcome (2) the optimal amount of therapy to provide for different patient groups (3) the most effective way of organising stroke therapy/rehabilitation services, including service configuration, staffing levels and working hours and (4) how to reduce unexplained variation in resource use. This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research Vol. 8, No. 17. See the NIHR Journals Library website for further project information.
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Springer Science and Business Media LLC
Date: 08-10-2013
DOI: 10.1007/S10198-011-0357-4
Abstract: Recent data analysed for Ireland suggest a strong link between disability status and household poverty, while there exists substantial evidence to suggest that disability is highly prevalent among persons of older age. Within this context, this paper estimates the welfare implications of disability for older people in Ireland. We define and estimate models of the private costs borne by households with older persons who have a disability in Ireland, both in general and by severity of illness or condition. Our modelling framework is based on the standard of living approach to estimating the cost of disability. The model quantifies the extra costs of living associated with disability and is estimated by comparing the standard of living of households with and without disabled members at a given income, controlling for other sources of variation. The analysis suggests that the estimated economic cost of disability for older people in Ireland is significant and varies by severity of disability, as well as by household type. The results also suggest that the cost of disability increases in proportionate terms as the number of people in the household decreases. Our results are important when considering the effectiveness of policies that aim to address the economic problems associated with disability for older people, suggesting that current policy in Ireland does not go far enough. They indicate that older people face a double jeopardy through age and disability, which is not reflected in official poverty rates and support the case for the introduction of disability-adjusted poverty payments.
Publisher: Informa UK Limited
Date: 02-2008
Publisher: SAGE Publications
Date: 06-03-2020
Abstract: To map and describe how patients pass through stroke services. Data from 94,905 stroke patients (July 2013–July 2015) who were still inpatients 72 hours after hospital admission were extracted from a national stroke register and were used to identify the routes patients took through hospital and community stroke services. We sought to categorize these routes through iterative consultations with clinical experts and to describe patient characteristics, therapy provision, outcomes and costs within each category. We identified 874 routes defined by the type of admitting stroke team and subsequent transfer history. We consolidated these into nine distinct routes and further summarized these into three overlapping ‘pathways’ that accounted for 99% of the patients. These were direct discharge (44%), community rehabilitation (47%) and inpatient transfer (19%) with 12% of the patients receiving both inpatient transfer and community rehabilitation. Patients with the mildest and most severe strokes were more likely to follow the direct discharge pathway. Those perceived to need most therapy were more likely to follow the inpatient transfer pathway. Costs were lowest and mortality was highest for patients on the direct discharge pathway. Outcomes were best for patients on the community rehabilitation pathway and costs were highest where patients underwent inpatient transfers. Three overarching stroke care pathways were identified which differ according to patient characteristics, therapy needs and outcomes. This pathway mapping provides a benchmark to develop and plan clinical services, and for future research.
Publisher: Wiley
Date: 19-12-2011
DOI: 10.1111/J.1468-1331.2011.03590.X
Abstract: In 2005, we presented for the first time overall estimates of annual costs for brain disorders (mental and neurologic disorders) in Europe. This new report presents updated, more accurate, and comprehensive 2010 estimates for 30 European countries. One-year prevalence and annual cost per person of 19 major groups of disorders are based on 'best estimates' derived from systematic literature reviews by panels of experts in epidemiology and health economics. Our cost estimation model was populated with national statistics from Eurostat to adjust to 2010 values, converting all local currencies to Euros (€), imputing cost for countries where no data were available, and aggregating country estimates to purchasing power parity-adjusted estimates of the total cost of brain disorders in Europe in 2010. Total European 2010 cost of brain disorders was €798 billion, of which direct health care cost 37%, direct non-medical cost 23%, and indirect cost 40%. Average cost per inhabitant was €5.550. The European average cost per person with a disorder of the brain ranged between €285 for headache and €30 000 for neuromuscular disorders. Total annual cost per disorder (in billion € 2010) was as follows: addiction 65.7 anxiety disorders 74.4 brain tumor 5.2 child/adolescent disorders 21.3 dementia 105.2 eating disorders 0.8 epilepsy 13.8 headache 43.5 mental retardation 43.3 mood disorders 113.4 multiple sclerosis 14.6 neuromuscular disorders 7.7 Parkinson's disease 13.9 personality disorders 27.3 psychotic disorders 93.9 sleep disorders 35.4 somatoform disorder 21.2 stroke 64.1 and traumatic brain injury 33.0. Our cost model revealed that brain disorders overall are much more costly than previously estimated constituting a major health economic challenge for Europe. Our estimate should be regarded as conservative because many disorders or cost items could not be included because of lack of data.
Publisher: Wiley
Date: 09-2001
Publisher: Frontiers Media SA
Date: 31-07-2020
Publisher: BMJ
Date: 12-2019
DOI: 10.1136/BMJOPEN-2019-030516
Abstract: Acute hypoxaemic respiratory failure (AHRF) in children is the most frequent reason for non-elective hospital admission. During the initial phase, AHRF is a clinical syndrome defined for the purpose of this study by an oxygen requirement and caused by pneumonia, lower respiratory tract infections, asthma or bronchiolitis. Up to 20% of these children with AHRF can rapidly deteriorate requiring non-invasive or invasive ventilation. Nasal high-flow (NHF) therapy has been used by clinicians for oxygen therapy outside intensive care settings to prevent escalation of care. A recent randomised trial in infants with bronchiolitis has shown that NHF therapy reduces the need to escalate therapy. No similar data is available in the older children presenting with AHRF. In this study we aim to investigate in children aged 1 to 4 years presenting with AHRF if early NHF therapy compared with standard-oxygen therapy reduces hospital length of stay and if this is cost-effective compared with standard treatment. The study design is an open-labelled randomised multicentre trial comparing early NHF and standard-oxygen therapy and will be stratified by sites and into obstructive and non-obstructive groups. Children aged 1 to 4 years (n=1512) presenting with AHRF to one of the participating emergency departments will be randomly allocated to NHF or standard-oxygen therapy once the eligibility criteria have been met (oxygen requirement with transcutaneous saturation %/90% (dependant on hospital standard threshold), diagnosis of AHRF, admission to hospital and tachypnoea ≥35 breaths/min). Children in the standard-oxygen group can receive rescue NHF therapy if escalation is required. The primary outcome is hospital length of stay. Secondary outcomes will include length of oxygen therapy, proportion of intensive care admissions, healthcare resource utilisation and associated costs. Analyses will be conducted on an intention-to-treat basis. Ethics approval has been obtained in Australia (HREC/15/QRCH/159) and New Zealand (HDEC 17/NTA/135). The trial commenced recruitment in December 2017. The study findings will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. Authorship of all publications will be decided by mutual consensus of the research team. ACTRN12618000210279
Publisher: Wiley
Date: 07-2009
DOI: 10.1002/HEC.1399
Abstract: Self-reported disability status is often relied upon in labour force participation models, but this may be reported with error for economic or psychological reasons and can lead to a bias in the effect of disability on participation. In this paper, we explore the possibility that reported limitations in daily activities are mis-reported, in particular for those who define their labour force status as disabled/ill, and assess if economic incentives influence this group to mis-report. The main questions we wish to address therefore are: (1) was there state-dependent reporting error and did economic incentives play a role, and (2) did this change over the years 1995-2001? Using a generalised ordered response model, we compute cleansed measures of disability that correspond to predicted responses in iduals would have made if employed. Unobserved differences between the employed and non-employed may exist therefore, we control for this via correlated random effects. The results indicate that the disabled/ill group did over-report and the difference between actual and predicted probabilities only marginally changed between 1995 and 2001. The extent of this measurement error is lower once we control for unobserved heterogeneity.
Publisher: Elsevier BV
Date: 2021
Publisher: Springer Science and Business Media LLC
Date: 24-08-2017
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.EURONEURO.2011.08.008
Abstract: The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people. To estimate the number of persons with defined disorders of the brain in Europe in 2010, the total cost per person related to each disease in terms of direct and indirect costs, and an estimate of the total cost per disorder and country. The best available estimates of the prevalence and cost per person for 19 groups of disorders of the brain (covering well over 100 specific disorders) were identified via a systematic review of the published literature. Together with the twelve disorders included in 2004, the following range of mental and neurologic groups of disorders is covered: addictive disorders, affective disorders, anxiety disorders, brain tumor, childhood and adolescent disorders (developmental disorders), dementia, eating disorders, epilepsy, mental retardation, migraine, multiple sclerosis, neuromuscular disorders, Parkinson's disease, personality disorders, psychotic disorders, sleep disorders, somatoform disorders, stroke, and traumatic brain injury. Epidemiologic panels were charged to complete the literature review for each disorder in order to estimate the 12-month prevalence, and health economic panels were charged to estimate best cost-estimates. A cost model was developed to combine the epidemiologic and economic data and estimate the total cost of each disorder in each of 30 European countries (EU27+Iceland, Norway and Switzerland). The cost model was populated with national statistics from Eurostat to adjust all costs to 2010 values, converting all local currencies to Euro, imputing costs for countries where no data were available, and aggregating country estimates to purchasing power parity adjusted estimates for the total cost of disorders of the brain in Europe 2010. The total cost of disorders of the brain was estimated at €798 billion in 2010. Direct costs constitute the majority of costs (37% direct healthcare costs and 23% direct non-medical costs) whereas the remaining 40% were indirect costs associated with patients' production losses. On average, the estimated cost per person with a disorder of the brain in Europe ranged between €285 for headache and €30,000 for neuromuscular disorders. The European per capita cost of disorders of the brain was €1550 on average but varied by country. The cost (in billion €PPP 2010) of the disorders of the brain included in this study was as follows: addiction: €65.7 anxiety disorders: €74.4 brain tumor: €5.2 child/adolescent disorders: €21.3 dementia: €105.2 eating disorders: €0.8 epilepsy: €13.8 headache: €43.5 mental retardation: €43.3 mood disorders: €113.4 multiple sclerosis: €14.6 neuromuscular disorders: €7.7 Parkinson's disease: €13.9 personality disorders: €27.3 psychotic disorders: €93.9 sleep disorders: €35.4 somatoform disorder: €21.2 stroke: €64.1 traumatic brain injury: €33.0. It should be noted that the revised estimate of those disorders included in the previous 2004 report constituted €477 billion, by and large confirming our previous study results after considering the inflation and population increase since 2004. Further, our results were consistent with administrative data on the health care expenditure in Europe, and comparable to previous studies on the cost of specific disorders in Europe. Our estimates were lower than comparable estimates from the US. This study was based on the best currently available data in Europe and our model enabled extrapolation to countries where no data could be found. Still, the scarcity of data is an important source of uncertainty in our estimates and may imply over- or underestimations in some disorders and countries. Even though this review included many disorders, diagnoses, age groups and cost items that were omitted in 2004, there are still remaining disorders that could not be included due to limitations in the available data. We therefore consider our estimate of the total cost of the disorders of the brain in Europe to be conservative. In terms of the health economic burden outlined in this report, disorders of the brain likely constitute the number one economic challenge for European health care, now and in the future. Data presented in this report should be considered by all stakeholder groups, including policy makers, industry and patient advocacy groups, to reconsider the current science, research and public health agenda and define a coordinated plan of action of various levels to address the associated challenges. Political action is required in light of the present high cost of disorders of the brain. Funding of brain research must be increased care for patients with brain disorders as well as teaching at medical schools and other health related educations must be quantitatively and qualitatively improved, including psychological treatments. The current move of the pharmaceutical industry away from brain related indications must be halted and reversed. Continued research into the cost of the many disorders not included in the present study is warranted. It is essential that not only the EU but also the national governments forcefully support these initiatives.
Publisher: SAGE Publications
Date: 24-07-2013
Abstract: The aim of this paper is to increase awareness of the prevalence and cost of psychiatric and neurological disorders (brain disorders) in the UK. UK data for 18 brain disorders were extracted from a systematic review of European epidemiological data and prevalence rates and the costs of each disorder were summarized (2010 values). There were approximately 45 million cases of brain disorders in the UK, with a cost of €134 billion per annum. The most prevalent were headache, anxiety disorders, sleep disorders, mood disorders and somatoform disorders. However, the five most costly disorders (€ million) were: dementia: €22,164 psychotic disorders: €16,717 mood disorders: €19,238 addiction: €11,719 anxiety disorders: €11,687. Apart from psychosis, these five disorders ranked amongst those with the lowest direct medical expenditure per subject ( €3000). The approximate breakdown of costs was: 50% indirect costs, 25% direct non-medical and 25% direct healthcare costs. The prevalence and cost of UK brain disorders is likely to increase given the ageing population. Translational neurosciences research has the potential to develop more effective treatments but is underfunded. Addressing the clinical and economic challenges posed by brain disorders requires a coordinated effort at an EU and national level to transform the current scientific, healthcare and educational agenda.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Elsevier BV
Date: 04-2021
Publisher: Springer Science and Business Media LLC
Date: 04-2015
Publisher: Springer Science and Business Media LLC
Date: 26-01-2017
Publisher: Springer Science and Business Media LLC
Date: 04-06-2022
DOI: 10.1186/S12884-022-04795-9
Abstract: There are very few developed countries where physical isolation and low community transmission has been reported for COVID-19 but this has been the experience of Australia. The impact of physical isolation combined with low disease transmission on the mental health of pregnant women is currently unknown and there have been no studies examining the psychological experience for partners of pregnant women during lockdown. The aim of the current study was to examine the impact of the first COVID-19 lockdown in March 2020 and post lockdown from August 2020 on the mental health of pregnant women or postpartum women and their partners. Pregnant women and their partners were prospectively recruited to the study before 24 weeks gestation and completed various questionnaires related to mental health and general wellbeing at 24 weeks gestation and then again at 6 weeks postpartum. The Depression, Anxiety and Stress Scale (DASS-21) and the Edinburgh Postnatal Depression Scale (EPDS) were used as outcome measures for the assessment of mental health in women and DASS-21 was administered to their partners. This analysis encompasses 3 time points where families were recruited before the pandemic (Aug 2018-Feb 2020), during lockdown (Mar-Aug 2020) and after the first lockdown was over (Sept-Dec 2020). There was no significant effect of COVID-19 lockdown and post lockdown on depression or postnatal depression in women when compared to a pre-COVID-19 subgroup. The odds of pregnant women or postpartum women experiencing severe anxiety was more than halved in women during lockdown relative to women in the pre-COVID-19 period (OR = 0.47 95%CI: 0.27–0.81 P = 0.006). Following lockdown severe anxiety was comparable to the pre-COVID-19 women. Lockdown did not have any substantial effects on stress scores for pregnant and postpartum women. However, a substantial decrease of over 70% in the odds of severe stress was observed post-lockdown relative to pre-COVID-19 levels. Partner’s depression, anxiety and stress did not change significantly with lockdown or post lockdown. A reproductive age population appear to be able to manage the impact of lockdown and the pandemic with some benefits related to reduced anxiety.
Publisher: Informa UK Limited
Date: 24-01-2011
Publisher: SAGE Publications
Date: 06-2011
DOI: 10.1177/138826271101300201
Abstract: This paper investigates the pension policies and outcomes of two countries, Austria and Ireland, representing two different welfare models. How do these different systems perform in terms of income adequacy, labour supply incentives for older workers, and actuarial fairness? Although there is no ‘optimal’ design for a pension system, there seems to be a convergence in systems between countries. Countries with established welfare models that have evolved over time need to rethink the basic paradigms of their pension policies for the future. This paper contains specific policy recommendations about pension reform. We highlight the importance of behavioural incentives with respect to raising average retirement ages, and the need for government engagement in providing an adequate retirement income.
Publisher: Informa UK Limited
Date: 07-2018
Publisher: Springer Science and Business Media LLC
Date: 09-06-2018
DOI: 10.1007/S40258-018-0400-Z
Abstract: Diabetic foot ulceration (DFU) is a common and serious complication among diabetic patients. A medical device has been developed to prevent the occurrence of DFU. The aim of this study was to investigate the willingness to pay (WTP) for this device among the general public in the UK. A contingent valuation survey was administered to 1051 participants through an online survey including questions on socio-demographic characteristics, self-reported health, knowledge of diabetes and medical devices, and WTP. A two-part model was used to analyse determinants of WTP, including a logistic model in the first part and a generalised linear model with a log-transformed WTP in the second part. More than half (55.9%) of the participants expressed a positive WTP. The annual mean (standard deviation) and median (interquartile range) WTP values were £76.9 (69.1) and £50 (80), respectively. Older age, middle-level education, good/excellent self-reported health, visiting doctors once/2-5 times, diabetes experience, medical device experience and more than average self-perceived likelihood of using similar devices were associated with a higher likelihood of willingness to pay. Younger age, male gender and higher household income were associated with higher WTP values. This study demonstrated that people are willing to pay for this device and they tend to contribute when they have experience of diabetes or similar devices and perceive self-benefit.
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.HEALTHPOL.2008.03.018
Abstract: The proportion of total health care expenditure devoted to mental health care in Ireland, at just below 7%, is low relative to other countries. There have been few studies that have examined the relationship between public preferences for different kinds of health care expenditure and priority setting as undertaken by policy-makers and governments. This paper examines citizen's rankings and willingness to pay for a community-based mental health care programme in Ireland relative to two other programmes: cancer and elderly care. Respondents rank cancer as the most important programme, followed by elderly care and then mental health care. The contingent valuation survey demonstrated that people are willing to make significant tax contributions to new community-based services for people with mental health problems, counteracting the view sometimes expressed that people do not care at all about mental health care provision. However, the survey also found that people tend to value additional spending on mental health care lower than cancer and elderly care programmes.
Publisher: Elsevier BV
Date: 03-2021
DOI: 10.51893/2021.1.OA4
Abstract: Abstract Background: The NITric oxide during cardiopulmonary bypass (CPB) to improve Recovery in Infants with Congenital heart defects (NITRIC) trial, a 1320-patient, multicentre, randomised controlled trial, is aiming to improve survival free of ventilation after CPB by using nitric oxide delivered into the oxygenator of the CPB. Objective: To provide a statistical analysis plan before completion of patient recruitment and data monitoring. Final analyses for this study will adhere to this statistical analysis plan, which details all key pre-planned analyses. Stata scripts for analyses have been prepared alongside this statistical analysis plan. Methods: The statistical analysis plan was designed collaboratively by the chief investigators and trial statistician and builds on the previously published study protocol. All authors remain blinded to treatment allocation. Detail is provided on statistical analyses including cohort description, analysis of primary and secondary outcomes and adverse events. Statistical methods to compare outcomes are planned in detail to ensure methods are verifiable and reproducible. Results: The statistical analysis plan developed provides the trial outline, list of mock tables, and analysis scripts. The plan describes statistical analyses on cohort and baseline description, primary and secondary outcome analyses, process of care measures, physiological descriptors, and safety and adverse event reporting. We define the pre-specified subgroup analyses and the respective statistical tests used to compare subgroups. Conclusion: The statistical analysis plan for the NITRIC trial establishes detailed pre-planned analyses alongside Stata scripts to analyse the largest trial in the field of neonatal and paediatric heart surgery. The plan ensures standards for trial analysis validity aiming to minimise bias of analyses. Trial registration: ACTRN12617000821392
Publisher: SAGE Publications
Date: 07-06-2020
Abstract: To understand why most stroke patients receive little therapy. We investigated the factors associated with the amount of stroke therapy delivered. Data regarding adults admitted to hospital with stroke for at least 72 hours (July 2013–July 2015) were extracted from the UK’s Sentinel Stroke National Audit Programme. Descriptive statistics and multilevel mixed effects regression models explored the factors that influenced the amount of therapy received while adjusting for confounding. Of the 94,905 patients in the study cohort (mean age: 76 (SD: 13.2) years, 78% had a mild or moderate severity stroke. In all, 92% required physiotherapy, 87% required occupational therapy, 57% required speech therapy but only 5% were considered to need psychology. The average amount of therapy ranged from 2 minutes (psychology) to 14 minutes (physiotherapy) per day of inpatient stay. Unmodifiable characteristics (such as stroke severity) dominated the variation in the amount of therapy. However important, modifiable organizational factors were the day and time of admission, type of stroke team, timely therapy assessments, therapy and nursing staffing levels (qualified and support staff), and presence of weekend or early supported discharge services. The amount of stroke therapy is associated with unmodifiable patient-related characteristics and modifiable organizational factors in that more therapy was associated with higher therapy and nurse staffing levels, specialist stroke rehabilitation services, timely therapy assessments, and the presence of weekend and early discharge services.
Publisher: Wiley
Date: 10-08-2018
DOI: 10.1002/GPS.4771
Abstract: Knowledge is limited about the standardised instruments used to collect resource use and quality of life data alongside trials of dementia interventions. This review aimed to identify the trials using such instruments in order to guide the design of future trial-based cost-effectiveness studies. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, this review examined all original, peer-reviewed research in major databases and general searches published until June 2017, including randomised clinical trials, pilot studies, or feasibility studies about interventions for older adults with dementia or cognitive impairment. Forty-one studies were identified. Only 8 collected the resource use data using adapted Client Service Receipt Inventory (CSRI), Resource Use Inventory (RUI), cost diary, or study-specific questionnaire. Quality of life was assessed using a wide range of instruments. The most frequently used dementia-specific instrument was Quality of Life in Alzheimer's Disease (QOL-AD) and Dementia Quality of Life questionnaire (DEMQOL). Among the generic measures, EuroQol 5-dimentison (EQ-5D) was mostly used to collect health utility data, and Short Form surveys (SF-36 or SF-12) were widely to measure general health. Several useful resource use and quality of life measurement instruments have been identified by this review. For resource use, CSRI was mostly used, but no studies have used Resource Utilisation in Dementia (RUD) for quality of life, we recommend the inclusion of dementia-specific DEMQOL, generic SF-12, and health utility EQ-5D-5L, based on both self-report and proxy-report.
Publisher: Springer Science and Business Media LLC
Date: 15-05-2010
DOI: 10.1007/S10198-010-0247-1
Abstract: This paper focuses on current use of elderly care services in Ireland and France. In light of health care resource allocation problems, it is important to know the level of current use of home care on which future projections may be based. With the availability of SHARE (Survey of Health Ageing and Retirement in Europe) data, it is now possible to analyse this process and estimate the relationship between formal and informal care, and our econometric model tests for endogeneity of informal care. Previous research has not included Ireland into the analysis. Given that Ireland has a younger population base, lessons could be learned from countries with older populations, such as France. Results suggest informal care is endogenous and negatively linked with formal care in the pooled (France and Ireland) model. There is a higher unmet need for care in Ireland. These results have important policy implications for Ireland as the demographic makeup will change from 11 per cent to 15 per cent of older people over the next 10 years.
Publisher: BMJ
Date: 09-2019
DOI: 10.1136/BMJOPEN-2019-030426
Abstract: To identify the main drivers of inpatient stroke care resource use, estimate the influence of stroke teams on the length of stay (LoS) of its patients and analyse the variation in relative performance across teams. For each of four types of stroke care teams, a two-level count data model describing the variation in LoS and identifying the team influence on LoS purged of patient and treatment characteristics was estimated. Each team effect was interpreted as a measure of stroke care relative performance and its variation was analysed. This study used data from 145 396 admissions in 256 inpatient stroke care teams between June 2013 and July 2015 included in the national stroke register of England, Wales and Northern Ireland—Sentinel Stroke National Audit Programme. The main driver of LoS, and thus resource use, was the need for stroke therapy even after stroke severity was taken into account. Conditional on needing the therapy in question, an increase in the average amount of therapy received per inpatient day was associated with shorter LoS. Important variations in stroke care performance were found within each team category. Resource use was strongly associated with stroke severity, the need for therapy and the amount of therapy received. The variations in stroke care performance were not explained by measurable patient or team characteristics. Further operational and financial analyses are needed to unmask the causes of this unexplained variation.
Publisher: Elsevier BV
Date: 04-2007
DOI: 10.1016/J.SOCSCIMED.2006.11.021
Abstract: As the extent of disability increases in society, there is an increasing need to understand its consequences for many aspects of social inclusion. Using the Living in Ireland Survey 1995-2001 (n=2727 adults), we provide a rigorous analysis of the transitions into and out of disability and the related consequences for various characteristics of social inclusion. We compare the effect of onset, exit and persistent disability on household income and the probability of being in poverty. We also look at the impact on daily societal participation for in iduals with varying durations of disability. Results show that people with disabilities have much lower levels of social inclusion and imply that related policy should focus on the heterogeneity of disabled people, depending on their respective transitions into disability and the duration of their disability.
Publisher: Wiley
Date: 12-11-2012
DOI: 10.1016/J.JALZ.2012.06.008
Abstract: The Resource Utilization in Dementia (RUD) questionnaire is the most widely used instrument for resource use data collection in dementia, enabling comparison of costs of care across countries with differing health care provisions. Recent feedback from payers questioned its face validity given that health care provisions have changed since the initial development of the RUD in 1998. The aim of this study was to update the RUD to improve its face validity in Alzheimer's disease (AD) clinical research and its utility for health care resource allocation. An extensive PubMed review was conducted of current relevant resource items in AD in 15 countries. The findings were complemented by interviews with local care providers and experts in dementia care and health economics. Their proposed revisions were discussed with five leading dementia experts in North and South America, northern and southern Europe, and Asia. A new version of the RUD was developed based on their recommendations. RUD users identified a need for more information relevant to coverage decisions. Proposed revisions included changes to existing questions (e.g., to capture more accurately the number and type of health care visits) and the addition of new questions (e.g., on informal caregiver hours and the primary caregiver's hours of sleep). Several minor changes were made to the RUD instrument to improve the accuracy and precision of the data while maintaining comparability with the original version and reflecting current medical practice. The RUD Complete Version 4.0 is now available for use in future AD clinical trials.
Publisher: Wiley
Date: 22-07-2014
DOI: 10.1002/HEC.3088
Abstract: This paper considers the relationship between social capital and health in the years before, at and after retirement. This adds to the current literature that only investigates this relationship in either the population as a whole or two subpopulations, pre-retirement and post-retirement. We now investigate if there are further additional subpopulations in the years to and from retirement. We take an information criteria approach to select the optimal model of subpopulations from a full range of potential models. This approach is similar to that proposed for linear models. Our contribution is to show how this may also be applied to nonlinear models and without the need for estimating subsequent subpopulations conditional on previous fixed subpopulations. Our main finding is that the association of social capital with health diminishes at retirement, and this decreases further 10 years after retirement. We find a strong positive significant association of social capital with health, although this turns negative after 20 years, indicating potential unobserved heterogeneity. The types of social capital may differ in later years (e.g., less volunteering) and hence overall social capital may have less of an influence on health in later years.
Publisher: Springer Science and Business Media LLC
Date: 24-05-2022
DOI: 10.1007/S00181-022-02256-Y
Abstract: This paper attempts to provide new evidence on the indirect cost of neighbourhood crime rates on mental wellbeing of residents. Crime places a heavy burden on the economy, and it receives significant attention from the public. Yet, the connection between crime and health for victims and non-victims is not well captured in the literature. Using spatial methodology, we differentiate the effect on mental wellbeing of residents due to the crime rates in their immediate neighbourhood (local) and crime rates in the surrounding areas (spatial). The main innovation of the paper is to use these crime rates at small geographical level (around 8500 residents) to better translate the changes in crime in the neighbourhoods and their effects on a person’s mental wellbeing. This is different to other studies that looked at crime incidences in larger geographical units. Our estimation results show that the increase in local and spatial crime rates against the property negatively affect the mental wellbeing of residents. The negative impact of spatial crime rates against the person is also present and is 6.7 times larger than the effect of property crime rates.
Publisher: Wiley
Date: 16-02-2020
DOI: 10.1111/AJAG.12775
Publisher: BMJ
Date: 08-2019
DOI: 10.1136/BMJOPEN-2018-026664
Abstract: Congenital heart disease (CHD) is a major cause of infant mortality. Many infants with CHD require corrective surgery with most operations requiring cardiopulmonary bypass (CPB). CPB triggers a systemic inflammatory response which is associated with low cardiac output syndrome (LCOS), postoperative morbidity and mortality. Delivery of nitric oxide (NO) into CPB circuits can provide myocardial protection and reduce bypass-induced inflammation, leading to less LCOS and improved recovery. We hypothesised that using NO during CPB increases ventilator-free days (VFD) (the number of days patients spend alive and free from invasive mechanical ventilation up until day 28) compared with standard care. Here, we describe the NITRIC trial protocol. The NITRIC trial is a randomised, double-blind, controlled, parallel-group, two-sided superiority trial to be conducted in six paediatric cardiac surgical centres. One thousand three-hundred and twenty infants years of age undergoing cardiac surgery with CPB will be randomly assigned to NO at 20 ppm administered into the CPB oxygenator for the duration of CPB or standard care (no NO) in a 1:1 ratio with stratification by age ( and ≥6 weeks), single ventricle physiology (Y/N) and study centre. The primary outcome will be VFD to day 28. Secondary outcomes include a composite of LCOS, need for extracorporeal membrane oxygenation or death within 28 days of surgery length of stay in intensive care and in hospital and, healthcare costs. Analyses will be conducted on an intention-to-treat basis. Preplanned secondary analyses will investigate the impact of NO on host inflammatory profiles postsurgery. The study has ethical approval (HREC/17/QRCH/43, dated 26 April 2017), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12617000821392) and commenced recruitment in July 2017. The primary manuscript will be submitted for publication in a peer-reviewed journal. ACTRN12617000821392
Publisher: Elsevier BV
Date: 10-2011
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.SOCSCIMED.2009.04.013
Abstract: This paper estimates the level of explained and unexplained factors that contribute to the wage gap between workers with and without disabilities, providing benchmark estimates for Ireland. It separates out the confounding impact of productivity differences between disabled and non-disabled, by comparing wage differentials across three groups, disabled with limitations, disabled without limitations and non-disabled. Furthermore, data are analysed for the years 1995-2001 and two sub-s les pre and post 1998 allow us to decompose wage differentials before and after the Employment Equality Act 1998. Results are comparable to those of the UK and the unexplained component (upper bound of discrimination) is lower once we control for productivity differences. The lower bound level depends on the contribution of unobserved effects and the validity of the selection component in the decomposition model.
Publisher: Springer Science and Business Media LLC
Date: 06-09-2018
Publisher: Informa UK Limited
Date: 29-05-2014
Publisher: Springer Science and Business Media LLC
Date: 16-06-2014
Publisher: Springer Science and Business Media LLC
Date: 20-07-2018
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 10-2014
End Date: 06-2019
Amount: $341,000.00
Funder: Australian Research Council
View Funded ActivityStart Date: 01-2019
End Date: 12-2023
Amount: $330,000.00
Funder: Australian Research Council
View Funded Activity