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Haque R, Alam K, Gow J, Neville C, Keramat SA. Age and Gender Differences in the Relationship Between Chronic Pain and Dementia Among Older Australians. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02805-5. [PMID: 39127253 DOI: 10.1016/j.jval.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 06/11/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES Chronic pain is a highly debilitating condition that affects older adults and has the potential to increase their odds of experiencing cognitive impairment. The primary objective of this study was to examine the correlation between chronic pain and dementia. Additionally, this research endeavors to ascertain whether the association between chronic pain and dementia differs by age and gender. METHODS Cross-sectional data were derived from the Survey of Disability, Ageing, and Carers. A total of 20 671 and 20 081 participants aged 65 years and older in 2015 and 2018, respectively, were included in this study. The pooled association between chronic pain and dementia was assessed using a multivariable logistic regression model. Furthermore, the study also examined the multiplicative interaction effects between chronic pain and age, as well as chronic pain and gender, with dementia. RESULTS The pooled analysis demonstrated that chronic pain was associated with a heightened odds of dementia (adjusted odds ratio 1.95; 95% CI 1.85-2.05) among older Australians compared with their counterparts without chronic pain. The interaction effect indicated that individuals with chronic pain across all age groups exhibited increased odds of living with dementia. Additionally, women with chronic pain had higher odds of dementia compared with their counterparts without chronic pain and being male. CONCLUSIONS A continuous, coordinated, and tailored healthcare strategy is necessary to determine the pain management goals and explore early treatment options for chronic pain in older adults, particularly in groups with the greatest need.
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Affiliation(s)
- Rezwanul Haque
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia.
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia; Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jeff Gow
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia; Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia; School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
| | - Christine Neville
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Syed Afroz Keramat
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Comachio J, Ferreira ML, Mork PJ, Holtermann A, Ho EKY, Wang DXM, Lan Q, Stamatakis E, Beckenkamp PR, Ferreira PH. Clinical guidelines are silent on the recommendation of physical activity and exercise therapy for low back pain: A systematic review. J Sci Med Sport 2024; 27:257-265. [PMID: 38267294 DOI: 10.1016/j.jsams.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES To synthesise and evaluate the quality of the recommendations for exercise therapy and physical activity from guidelines for the prevention and/or management of low back pain. DESIGN Systematic review. METHODS Included clinical practice guidelines for the management of low back pain published between 2014 and 2022 and searched in 9 databases until September 2022. The quality of evidence was evaluated with the Appraisal of Guidelines, Research and Evaluation tool (AGREE-II instrument). RESULTS After screening 3448 studies, 18 clinical practice guidelines were included in this review. Only five (27 %) guidelines were judged as having a satisfactory quality of evidence (i.e., rigour of development and applicability), and 13 (72 %) of guidelines are discussed and rated as critical. Regarding physical activity, no guidelines provided recommendations for the primary prevention of low back pain or incorporated adequate physical activity aspects considering type, dosage, frequency, and intensity. For exercises, all (100 %) guidelines recommended at least one type of supervised exercise in the management of low back pain, and 16 (88 %) provided an overall recommendation for people to stay active. CONCLUSIONS Guidelines offer minimal or, sometimes, no detail regarding physical activity or specific exercise regimens for the management and prevention of low back pain. When some guidance is provided, the recommendations typically lack specificity concerning the type, intensity, duration, and frequency of exercise and, in many cases, they represent a combination of scarce available evidence and stakeholder perspectives.
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Affiliation(s)
- Josielli Comachio
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Australia.
| | - Manuela Loureiro Ferreira
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | - Paul Jarle Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway
| | | | - Emma Kwan-Yee Ho
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - Daniel Xin Mo Wang
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - Qianwen Lan
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - Emmanuel Stamatakis
- School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - Paula R Beckenkamp
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - Paulo Henrique Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Australia
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Miao M, Morrow R, Salomon A, Mcculloch B, Evain JC, Wright MR, Murphy MT, Welsh M, Williams L, Power E, Rietdijk R, Debono D, Brunner M, Togher L. Digital Health Implementation Strategies Coproduced With Adults With Acquired Brain Injury, Their Close Others, and Clinicians: Mixed Methods Study With Collaborative Autoethnography and Network Analysis. J Med Internet Res 2023; 25:e46396. [PMID: 37725413 PMCID: PMC10548320 DOI: 10.2196/46396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/10/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Acquired brain injuries (ABIs), such as stroke and traumatic brain injury, commonly cause cognitive-communication disorders, in which underlying cognitive difficulties also impair communication. As communication is an exchange with others, close others such as family and friends also experience the impact of cognitive-communication impairment. It is therefore an internationally recommended best practice for speech-language pathologists to provide communication support to both people with ABI and the people who communicate with them. Current research also identifies a need for neurorehabilitation professionals to support digital communication, such as social media use, after ABI. However, with >135 million people worldwide affected by ABI, alternate and supplementary service delivery models are needed to meet these communication needs. The "Social Brain Toolkit" is a novel suite of 3 interventions to deliver communication rehabilitation via the internet. However, digital health implementation is complex, and minimal guidance exists for ABI. OBJECTIVE This study aimed to support the implementation of the Social Brain Toolkit by coproducing implementation knowledge with people with ABI, people who communicate with people with ABI, clinicians, and leaders in digital health implementation. METHODS A maximum variation sample (N=35) of individuals with living experience of ABI, close others, clinicians, and digital health implementation leaders participated in an explanatory sequential mixed methods design. Stakeholders quantitatively prioritized 4 of the 7 theoretical domains of the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework as being the most important for Social Brain Toolkit implementation. Qualitative interview and focus group data collection focused on these 4 domains. Data were deductively analyzed against the NASSS framework with stakeholder coauthors to determine implementation considerations and strategies. A collaborative autoethnography of the research was conducted. Interrelationships between considerations and strategies were identified through a post hoc network analysis. RESULTS Across the 4 prioritized domains of "condition," "technology," "value proposition," and "adopters," 48 digital health implementation considerations and 52 tailored developer and clinician implementation strategies were generated. Benefits and challenges of coproduction were identified. The post hoc network analysis revealed 172 unique relationships between the identified implementation considerations and strategies, with user and persona testing and responsive design identified as the potentially most impactful strategies. CONCLUSIONS People with ABI, close others, clinicians, and digital health leaders coproduced new knowledge of digital health implementation considerations for adults with ABI and the people who communicate with them, as well as tailored implementation strategies. Complexity-informed network analyses offered a data-driven method to identify the 2 most potentially impactful strategies. Although the study was limited by a focus on 4 NASSS domains and the underrepresentation of certain demographics, the wealth of actionable implementation knowledge produced supports future coproduction of implementation research with mutually beneficial outcomes for stakeholders and researchers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/35080.
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Affiliation(s)
- Melissa Miao
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rosemary Morrow
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Alexander Salomon
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Ben Mcculloch
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Jean-Christophe Evain
- Acquired Brain Injury Rehabilitation Ward, Caulfield Hospital, Alfred Health Network, Melbourne, Australia
- Stakeholder with living experience of acquired brain injury, Melbourne, Australia
| | - Meg Rebecca Wright
- Stakeholder with living experience of acquired brain injury, Blenheim, Australia
| | - Marie Therese Murphy
- Stakeholder with living experience as a communication partner of a person with acquired brain injury, Sydney, Australia
- Faculty of Education, Western Sydney University, Sydney, Australia
- Faculty of Education and Social Work, The University of Sydney, Sydney, Australia
| | - Monica Welsh
- Brain Injury Rehabilitation Unit, South Australian Brain Injury Rehabilitation Service, Adelaide, Australia
| | - Liz Williams
- Brain Injury Rehabilitation Community and Home (BIRCH), South Australian Brain Injury Rehabilitation Service, Adelaide, Australia
| | - Emma Power
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Deborah Debono
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Melissa Brunner
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Haque R, Alam K, Gow J, Neville C. Changes in the prevalence of dementia in Australia and its association with geographic remoteness. PLoS One 2023; 18:e0289505. [PMID: 37531396 PMCID: PMC10395934 DOI: 10.1371/journal.pone.0289505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The exact prevalence of dementia in Australia is ambiguous. Australia is a vast continent with a small population, and 80% of the population live in five cities. This study explores recent changes in the prevalence of dementia. It also investigates geographic remoteness as a potential risk factor for developing dementia. METHODS Survey of Disability, Ageing and Carers (SDAC), a nationally representative database, was used to conduct this study. A total of 74,862 and 65,487 individuals from 2015 and 2018, respectively, were considered for this study. A multivariable logistic regression model was used to evaluate the association between dementia and geographic remoteness for older adults aged 65 years and over. RESULTS The results reveal that from 2015 to 2018, the prevalence of dementia among adults aged 65 years and older was higher in 2018 (5,229 per 100,000) than in 2015 (5,099 per 100,000). Significant geographical differences in the prevalence of dementia are observed among Australian adults, and this trend appears to be increasing. Furthermore, the unadjusted model revealed that, in 2015, older adults living in major cities had 1.29 (AOR: 1.29, 95% CI: 1.17-1.41) times higher odds of having dementia compared with their counterparts from outer regional and remote areas. In 2018, the adjusted model found that older adults living in major cities had 1.12 (AOR: 1.12, 95% CI: 1.01-1.25) times elevated odds of having dementia than their peers living in outer regional and remote areas. CONCLUSION There is a rising prevalence of dementia in Australia. Further investigation is required to identify the causes of this increase. Increased public health initiatives should concentrate on behavioural characteristics and contextual environmental factors to ameliorate this trend.
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Affiliation(s)
- Rezwanul Haque
- Department of Economics, American International University-Bangladesh (AIUB), Dhaka, Bangladesh
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jeff Gow
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
| | - Christine Neville
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
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Mudiyanselage SB, Stevens J, Toscano J, Kotowicz MA, Steinfort CL, Hayles R, Watts JJ. Cost-effectiveness of personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial. PLoS One 2023; 18:e0286533. [PMID: 37319290 PMCID: PMC10270614 DOI: 10.1371/journal.pone.0286533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 05/18/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE The study aims to assess the cost-effectiveness of a personalised telehealth intervention to manage chronic disease in the long run. METHOD The Personalised Health Care (PHC) pilot study was a randomised trial with an economic evaluation alongside over 12 months. From a health service perspective, the primary analysis compared the costs and effectiveness of PHC telehealth monitoring with usual care. An incremental cost-effectiveness ratio was calculated based on costs and health-related quality of life. The PHC intervention was implemented in the Barwon Health region, Geelong, Australia, for patients with a diagnosis of COPD and/or diabetes who had a high likelihood of hospital readmission over 12 months. RESULTS When compared to usual care at 12 months, the PHC intervention cost AUD$714 extra per patient (95%CI -4879; 6308) with a significant improvement of 0.09 in health-related quality of life (95%CI: 0.05; 0.14). The probability of PHC being cost-effective by 12 months was close to 65%, at willingness to pay a threshold of AUD$50,000 per quality-adjusted life year. CONCLUSION Benefits of PHC to patients and the health system at 12 months translated to a gain in quality-adjusted life years with a non-significant cost difference between the intervention and control groups. Given the relatively high set-up costs of the PHC intervention, the program may need to be offered to a larger population to achieve cost-effectiveness. Long-term follow-up is required to assess the real health and economic benefits over time.
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Affiliation(s)
- Shalika Bohingamu Mudiyanselage
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Jo Stevens
- Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
| | - Julian Toscano
- Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
| | - Mark A. Kotowicz
- Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
- Deakin University School of Medicine, Geelong, VIC, Australia
- Melbourne Clinical School-Western Campus, Department of Medicine, The University of Melbourne, St Albans, VIC, Australia
| | - Christopher L. Steinfort
- Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
- Deakin University School of Medicine, Geelong, VIC, Australia
| | - Robyn Hayles
- Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
| | - Jennifer J. Watts
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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Schofield D, Zeppel MJB, Tanton R, Veerman JL, Kelly SJ, Passey ME, Shrestha RN. Individual and national financial impacts of informal caring for people with mental illness in Australia, projected to 2030. BJPsych Open 2022; 8:e136. [PMID: 35848155 PMCID: PMC9345331 DOI: 10.1192/bjo.2022.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mental illness has a significant impact not only on patients, but also on their carers' capacity to work. AIMS To estimate the costs associated with lost labour force participation due to the provision of informal care for people with mental illness in Australia, such as income loss for carers and lost tax revenue and increased welfare payments for government, from 2015 to 2030. METHOD The output data of a microsimulation model Care&WorkMOD were analysed to project the financial costs of informal care for people with mental illness, from 2015 to 2030. Care&WorkMOD is a population-representative microsimulation model of the Australian population aged between 15 and 64 years, built using the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers data and the data from other population-representative microsimulation models. RESULTS The total annual national loss of income for all carers due to caring for someone with mental illness was projected to rise from AU$451 million (£219.6 million) in 2015 to AU$645 million (£314 million) in 2030 in real terms. For the government, the total annual lost tax revenue was projected to rise from AU$121 million (£58.9 million) in 2015 to AU$170 million (£82.8 million) in 2030 and welfare payments to increase from AU$170 million (£82.8 million) to AU$220 million (£107 million) in 2030. CONCLUSIONS The costs associated with lost labour force participation due to the provision of informal care for people with mental illness are projected to increase for both carers and government, with a widening income gap between informal carers and employed non-carers, putting carers at risk of increased inequality.
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Affiliation(s)
- Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Melanie J B Zeppel
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Robert Tanton
- National Centre for Social and Economic Modelling, University of Canberra, Australian Capital Territory, Australia
| | | | - Simon J Kelly
- National Centre for Social and Economic Modelling, University of Canberra, Australian Capital Territory, Australia
| | - Megan E Passey
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Rupendra N Shrestha
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
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Mattingly TJ, Diaz Fernandez V, Seo D, Melgar Castillo AI. A review of caregiver costs included in cost-of-illness studies. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1051-1060. [PMID: 35607780 DOI: 10.1080/14737167.2022.2080056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Economic evaluations typically focus solely on patient-specific costs with economic spillovers to informal caregivers less frequently evaluated. This may systematically underestimate the burden resulting from disease. AREAS COVERED Cost-of-illness (COI) analyses that identified costs borne to caregiver(s) were identified using PubMed and Embase. We extracted study characteristics, clinical condition, costs, and cost methods. To compare caregiver costs reported across studies, estimated a single 'annual caregiver cost' amount in 2021 USD. EXPERT OPINION A total of 51 studies met our search criteria for inclusion with estimates ranging from $30 - $86,543. The majority (63%, 32/51) of studies estimated caregiver time costs with fewer studies reporting productivity or other types of costs. Caregiver costs were frequently reported descriptively (69%, 35/51), with fewer studies reporting more rigorous methods of estimating costs. Only 27% (14/51) of studies included used an incremental analysis approach for caregiver costs. In a subgroup analysis of dementia-focused studies (n = 16), we found the average annual cost of caregiving time for patients with dementia was $30,562, ranging from $4,914 to $86,543. We identified a wide range in annual caregiver cost estimates, even when limiting by condition and cost type.
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Affiliation(s)
- T Joseph Mattingly
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.,The PATIENTS Program, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Valeria Diaz Fernandez
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Dominique Seo
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Andrea I Melgar Castillo
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.,The PATIENTS Program, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
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Revisiting rural healthcare access through Held’s ethics of care. SOCIAL THEORY & HEALTH 2022. [DOI: 10.1057/s41285-022-00181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AbstractAccess to healthcare and health seeking behaviours of rural people often hinge on the existing relationships between healthcare providers and (prospective) healthcare users. However, rich micro-level health professional-healthcare user relationships and the unique relational context of rural settings are largely missing from dominant rural healthcare access conceptual frameworks. We argue rural healthcare access conceptualisations require revisiting from a relational perspective to ensure future healthcare access policy accounts for the relational nature of healthcare in rural contexts. Ethics of care is a moral theory informed by feminism which rejects liberal individualist notions and emphasises interdependence. We used Held’s ethics of care characteristics to examine Russell and colleagues’ healthcare access framework and dimensions for rural and remote populations. This process revealed Held’s ethics of care characteristics are only somewhat evident across Russell et al.’s dimensions: most evident in the acceptability and accommodation dimensions, and most absent in the availability and affordability dimensions. Future rural healthcare access frameworks need to pay further attention to the relational aspects of rural healthcare, particularly around the availability and affordability of healthcare, to bolster future efforts to improve healthcare access for rural people.
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Miao M, Power E, Rietdijk R, Debono D, Brunner M, Salomon A, Mcculloch B, Wright MR, Welsh M, Tremblay B, Rixon C, Williams L, Morrow R, Evain JC, Togher L. Coproducing Knowledge of the Implementation of Complex Digital Health Interventions for Adults with Acquired Brain Injury and their Communication Partners: Protocol for a Mixed Methods Study. JMIR Res Protoc 2022; 11:e35080. [PMID: 35006082 PMCID: PMC8787662 DOI: 10.2196/35080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
Background The Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors. Objective This study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit’s implementation. Methods Theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians. Results Ethical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022. Conclusions In this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners. International Registered Report Identifier (IRRID) DERR1-10.2196/35080
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Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | - Emma Power
- University of Technology Sydney, Sydney, Australia
| | | | | | | | | | | | | | - Monica Welsh
- See Authors' Contributions, Australia.,Brain Injury Rehabilitation Unit, South Australian Brain Injury Rehabilitation Service, Hampstead Rehabilitation Centre, Adelaide, Australia
| | | | - Caleb Rixon
- See Authors' Contributions, Australia.,Genyus Network, Melbourne, Australia
| | - Liz Williams
- See Authors' Contributions, Australia.,Brain Injury Rehabilitation Community and Home, South Australian Brain Injury Rehabilitation Service, Hampstead Rehabilitation Centre, Adelaide, Australia
| | | | - Jean-Christophe Evain
- See Authors' Contributions, Australia.,Acquired Brain Injury Rehabilitation Centre, Caulfield Hospital, Alfred Health Network, Melbourne, Australia
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Miao M, Power E, Rietdijk R, Brunner M, Debono D, Togher L. A Web-Based Service Delivery Model for Communication Training After Brain Injury: Protocol for a Mixed Methods, Prospective, Hybrid Type 2 Implementation-Effectiveness Study. JMIR Res Protoc 2021; 10:e31995. [PMID: 34889770 PMCID: PMC8704121 DOI: 10.2196/31995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Acquired brain injuries (ABIs) commonly cause cognitive-communication disorders, which can have a pervasive psychosocial impact on a person's life. More than 135 million people worldwide currently live with ABI, and this large and growing burden is increasingly surpassing global rehabilitation service capacity. A web-based service delivery model may offer a scalable solution. The Social Brain Toolkit is an evidence-based suite of 3 web-based communication training interventions for people with ABI and their communication partners. Successful real-world delivery of web-based interventions such as the Social Brain Toolkit requires investigation of intervention implementation in addition to efficacy and effectiveness. OBJECTIVE The aim of this study is to investigate the implementation and effectiveness of the Social Brain Toolkit as a web-based service delivery model. METHODS This is a mixed methods, prospective, hybrid type 2 implementation-effectiveness study, theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation. We will document implementation strategies preemptively deployed to support the launch of the Social Brain Toolkit interventions, as well as implementation strategies identified by end users through formative evaluation of the Social Brain Toolkit. We will prospectively observe implementation outcomes, selected on the basis of the NASSS framework, through quantitative web analytics of intervention use, qualitative and quantitative pre- and postintervention survey data from all users within a specified sample frame, and qualitative interviews with a subset of users of each intervention. Qualitative implementation data will be deductively analyzed against the NASSS framework. Quantitative implementation data will be analyzed descriptively. We will obtain effectiveness outcomes through web-based knowledge tests, custom user questionnaires, and formal clinical tools. Quantitative effectiveness outcomes will be analyzed through descriptive statistics and the Reliable Change Index, with repeated analysis of variance (pretraining, posttraining, and follow-up), to determine whether there is any significant improvement within this participant sample. RESULTS Data collection commenced on July 2, 2021, and is expected to conclude on June 1, 2022, after a 6-month sample frame of analytics for each Social Brain Toolkit intervention. Data analysis will occur concurrently with data collection until mid-2022, with results expected for publication late 2022 and early 2023. CONCLUSIONS End-user evaluation of the Social Brain Toolkit's implementation can guide intervention development and implementation to reach and meet community needs in a feasible, scalable, sustainable, and acceptable manner. End user feedback will be directly incorporated and addressed wherever possible in the next version of the Social Brain Toolkit. Learnings from these findings will benefit the implementation of this and future web-based psychosocial interventions for people with ABI and other populations. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry ACTRN12621001170819; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001170819, Australia and New Zealand Clinical Trials Registry ACTRN12621001177842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001177842, Australia and New Zealand Clinical Trials Registry ACTRN12621001180808; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001180808. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/31995.
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Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | - Emma Power
- University of Technology Sydney, Sydney, Australia
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11
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Miao M, Power E, Rietdijk R, Brunner M, Togher L. Implementation of online psychosocial interventions for people with neurological conditions and their caregivers: A systematic review protocol. Digit Health 2021; 7:20552076211035988. [PMID: 34567610 PMCID: PMC8456620 DOI: 10.1177/20552076211035988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background As the burden of neurological conditions increases globally, online psychosocial interventions offer a potentially scalable solution to enabling healthcare access. However, their successful development and implementation require research into electronic healthcare implementation specifically. Methods Using a search strategy combining the concepts of implementation, electronic healthcare, psychosocial interventions and neurological conditions, we will conduct comprehensive electronic searches for primary implementation evidence in MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, SpeechBITE and NeuroBITE databases. Included studies will be analysed according to the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability framework, appraised using the Mixed-Methods Appraisal Tool and evaluated for theoretical underpinning in implementation science, with hybrid studies of effectiveness-implementation research classified according to the type of hybrid design. Discussion This review will be the first to use a theoretical underpinning in the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability framework to evaluate strengths and gaps in existing implementation research into online psychosocial interventions for people with neurological conditions and/or their caregivers. The results may be useful to provide direction and recommendations for future clinical implementation and research into online psychosocial interventions for people with neurological conditions and/or their caregivers. Systematic review registration PROSPERO 2020: CRD42020186387.
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Affiliation(s)
- Melissa Miao
- Graduate School of Health, University of Technology Sydney, Australia
| | - Emma Power
- Graduate School of Health, University of Technology Sydney, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Melissa Brunner
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Australia
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12
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Scholten EW, Ketelaar M, Visser-Meily JM, Roels EH, Kouwenhoven M, Post MW. Prediction of Psychological Distress Among Persons With Spinal Cord Injury or Acquired Brain Injury and Their Significant Others. Arch Phys Med Rehabil 2020; 101:2093-2102. [DOI: 10.1016/j.apmr.2020.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/12/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
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13
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Kelada L, Wakefield CE, Vetsch J, Schofield D, Sansom-Daly UM, Hetherington K, O'Brien T, Cohn RJ, Anazodo A, Viney R, Zeppel MJB. Financial toxicity of childhood cancer and changes to parents' employment after treatment completion. Pediatr Blood Cancer 2020; 67:e28345. [PMID: 32333636 DOI: 10.1002/pbc.28345] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Childhood cancer can have short- and long-term impacts on parents' finances and employment. It is important to understand how families adjust to the financial and employment changes caused by childhood cancer, the ongoing impacts after treatment completion, and which families need more targeted support. Qualitative research is necessary to facilitate an in-depth understanding of the employment and financial impacts on families and to capture parents' complex and nuanced experiences and perspectives. METHODS We interviewed 56 parents of childhood cancer survivors (M = 2.13 years after treatment completion; 89% mothers) using the vocational and financial impact section of the Psychosocial Adjustment to Illness Scale-Carer Interview Form. We analyzed interviews using content analysis. RESULTS Parents reported multiple sources of financial toxicity including travel to and from the hospital and needing to reduce their working hours during their child's cancer treatment. Workplace flexibility was an important factor to protect against unwanted vocational changes. After treatment completion, families living in low socioeconomic areas commonly reported ongoing financial difficulties. Mothers, particularly those who were on maternity leave when their child was diagnosed with cancer, reported ongoing employment impacts including unemployment. CONCLUSIONS Clinical staff including social workers could more consistently assess families' financial distress and refer to professional services who can offer guidance for financial decision-making as standard care. Flexible workplace agreements appear important for parents of children with cancer. Our findings can assist organizations to understand that cancer-related disruptions are likely to continue after treatment completion, and therefore should offer benefits to parents where possible.
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Affiliation(s)
- Lauren Kelada
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Janine Vetsch
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia.,Institute for Applied Nursing Sciences IPW-FHS, University of Applied Sciences FHS St. Gallen, St. Gallen, Switzerland
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Ursula M Sansom-Daly
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Kate Hetherington
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Tracey O'Brien
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, High Street, Randwick, New South Wales, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, New South Wales, Australia
| | - Melanie J B Zeppel
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, Sydney, New South Wales, Australia
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Abstract
This study models the economic costs of informal caring for people with back pain, using a microsimulation model, Care&WorkMOD, from 2015 to 2030. Care&WorkMOD was based on 3 national Australian Surveys of Disability, Ageing and Carers (2003, 2009, 2012) data sets for individuals aged 15 to 64 years. Estimated national income loss due to caring for people with back pain was AU$258 million in 2015, increasing to $398 million in 2030 (54% increase). Lost income tax revenue to the Australian government due to informal care of people with back pain was estimated to be AU$78 million in 2015, increasing to AU$118 million in 2030 (50% increase), and additional welfare payments were estimated to rise from $132 million in 2015 to AU$180 in 2030 (36% increase). Larger growth in lost income, compared with the increase in welfare payments, means that there would be an increasing income gap between those out of the labour force providing informal care and noncarers who are in the labour force, leading to increased inequality. Informal carers are defined as providers of informal, unpaid assistance to someone with a health condition, for at least 6 months. Informal carers of people with back pain who are out of the labour force incur substantial economic costs. Furthermore, back pain is a large economic burden on national governments. Policies addressing back pain prevention and treatment, and supporting carers, may offset government welfare expenditure, while improving the socioeconomic well-being of carers and patients.
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Schofield D, Zeppel MJB, Tanton R, Veerman JL, Kelly SJ, Passey ME, Shrestha RN. Intellectual disability and autism: socioeconomic impacts of informal caring, projected to 2030. Br J Psychiatry 2019; 215:654-660. [PMID: 31524109 DOI: 10.1192/bjp.2019.204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Intellectual disability and autism spectrum disorder (ASD) influence the interactions of a person with their environment and generate economic and socioeconomic costs for the person, their family and society. AIMS To estimate costs of lost workforce participation due to informal caring for people with intellectual disability or autism spectrum disorders by estimating lost income to individuals, lost taxation payments to federal government and increased welfare payments. METHOD We used a microsimulation model based on the Australian Bureau of Statistics' Surveys of Disability, Ageing and Carers (population surveys of people aged 15-64), and projected costs of caring from 2015 in 5-year intervals to 2030. RESULTS The model estimated that informal carers of people with intellectual disability and/or ASD in Australia had aggregated lost income of AU$310 million, lost taxation of AU$100 million and increased welfare payments of AU$204 million in 2015. These are projected to increase to AU$432 million, AU$129 million and AU$254 million for income, taxation, and welfare respectively by 2030. The income gap of carers for people with intellectual disability and/or ASD is estimated to increase by 2030, meaning more financial stress for carers. CONCLUSIONS Informal carers of people with intellectual disability and/or ASD experience significant loss of income, leading to increased welfare payments and reduced taxation revenue for governments; these are all projected to increase. Strategic policies supporting informal carers wishing to return to work could improve the financial and psychological impact of having a family member with intellectual disability and/or ASD. DECLARATION OF INTEREST None.
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Affiliation(s)
- Deborah Schofield
- Professor of Health Economics, Centre for Economic Impacts of Genomic Medicine, Department of Economics, Faculty of Business and Economics, Macquarie University, Australia
| | - Melanie J B Zeppel
- Senior Research Fellow, Centre for Economic Impacts of Genomic Medicine, Department of Economics, Faculty of Business and Economics, Macquarie University, Australia
| | - Robert Tanton
- Professor, National Centre for Social and Economic Modelling, University of Canberra, Australia
| | | | - Simon J Kelly
- Professor, National Centre for Social and Economic Modelling, University of Canberra, Australia
| | - Megan E Passey
- Associate Professor, University Centre for Rural Health, University of Sydney, Australia
| | - Rupendra N Shrestha
- Senior Research Fellow, Centre for Economic Impacts of Genomic Medicine, Department of Economics, Faculty of Business and Economics, Macquarie University, Australia
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Connolly MP, Panda S, Kim HY. Estimating the Fiscal Costs of Osteoporosis in Korea Applying a Public Economic Perspective. J Bone Metab 2019; 26:253-261. [PMID: 31832391 PMCID: PMC6901696 DOI: 10.11005/jbm.2019.26.4.253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/23/2019] [Accepted: 10/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Osteoporosis and attributable fractures are disruptive health events that can cause short and long-term cost consequences for families, health service and government. In this fracture-based scenario analysis we evaluate the broader public economic consequences for the Korean government based on fractures that can occur at 3 different ages. METHODS We developed a public economic modelling framework based on population averages in Korea for earnings, direct taxes, indirect taxes, disability payments, retirement, pension payments, and osteoporosis health costs. Applying a scenario analysis, we estimated the cumulative average per person fiscal consequences of osteoporotic fractures occurring at different ages 55, 65, and 75 compared to average non-fracture individuals of comparable ages to estimate resulting costs for government in relation to lost tax revenue, disability payments, pension costs, and healthcare costs. All costs are calculated between the ages of 50 to 80 in Korean Won (KRW) and discounted at 0.5%. RESULTS From the scenarios explored, fractures occurring at age 55 are most costly for government with increased disability and pension payments of KRW 26,048,400 and KRW 41,094,206 per person, respectively, compared to the non-fracture population. A fracture can result in reduction in lifetime direct and indirect taxes resulting in KRW 53,648,886 lost tax revenue per person for government compared to general population. CONCLUSIONS The fiscal consequences of osteoporotic fractures for government vary depending on the age at which they occur. Fiscal benefits for government are greater when fractures are prevented early due to the potential to prevent early retirement and keeping people in the labor force to the degree that is observed in non-fracture population.
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Affiliation(s)
- Mark P. Connolly
- Unit of Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Global Market Access Solutions Sàrl, St-Prex, Switzerland
| | - Saswat Panda
- Global Market Access Solutions Sàrl, St-Prex, Switzerland
| | - Ha Young Kim
- Division of Endocrinology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
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