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Occhipinti JA, Skinner A, Doraiswamy PM, Saxena S, Eyre HA, Hynes W, Geli P, Jeste DV, Graham C, Song C, Prodan A, Ujdur G, Buchanan J, Rosenberg S, Crosland P, Hickie IB. The influence of economic policies on social environments and mental health. Bull World Health Organ 2024; 102:323-329. [PMID: 38680470 PMCID: PMC11046160 DOI: 10.2471/blt.23.290286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 05/01/2024] Open
Abstract
Despite increased advocacy and investments in mental health systems globally, there has been limited progress in reducing mental disorder prevalence. In this paper, we argue that meaningful advancements in population mental health necessitate addressing the fundamental sources of shared distress. Using a systems perspective, economic structures and policies are identified as the potential cause of causes of mental ill-health. Neoliberal ideologies, prioritizing economic optimization and continuous growth, contribute to the promotion of individualism, job insecurity, increasing demands on workers, parental stress, social disconnection and a broad range of manifestations well-recognized to erode mental health. We emphasize the need for mental health researchers and advocates to increasingly engage with the economic policy discourse to draw attention to mental health and well-being implications. We call for a shift towards a well-being economy to better align commercial interests with collective well-being and social prosperity. The involvement of individuals with lived mental ill-health experiences, practitioners and researchers is needed to mobilize communities for change and influence economic policies to safeguard well-being. Additionally, we call for the establishment of national mental wealth observatories to inform coordinated health, social and economic policies and realize the transition to a more sustainable well-being economy that offers promise for progress on population mental health outcomes.
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Affiliation(s)
- Jo-An Occhipinti
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
| | - Adam Skinner
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
| | - P Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, United States of America (USA)
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, USA
| | - Harris A Eyre
- Baker Institute for Public Policy, Rice University, Houston, USA
| | | | - Patricia Geli
- Reform for Resilience Commission, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Dilip V Jeste
- Global Research Network on Social Determinants of Mental Health and Exposomics, San Diego, USA
| | | | - Christine Song
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
| | - Ante Prodan
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, Australia
| | - Goran Ujdur
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
| | - John Buchanan
- Business School, University of Sydney, Sydney, Australia
| | - Sebastian Rosenberg
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
| | - Paul Crosland
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
| | - Ian B Hickie
- The Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, New South Wales2050, Australia
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Crosland P, Ho N, Hosseini SH, Vacher C, Skinner A, Natsky AN, Rosenberg S, Hasudungan R, Huntley S, Song YJC, Lee GY, Marshall DA, Occhipinti JA, Hickie IB. Cost-effectiveness of system-level mental health strategies for young people in the Australian Capital Territory: a dynamic simulation modelling study. Lancet Psychiatry 2024; 11:123-133. [PMID: 38245017 DOI: 10.1016/s2215-0366(23)00396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Regional mental health planning is a key challenge for decision makers because mental health care is a complex, dynamic system. Economic evaluation using a system dynamics modelling approach presents an opportunity for more sophisticated planning and important evidence on the value of alternative investments. We aimed to investigate the cost-effectiveness of eight systems-based interventions targeted at improving the mental health and wellbeing of children, adolescents, and young adults in the Australian Capital Territory (ACT). METHODS We assessed eight interventions for children and young people (aged ≤25 years) with low, moderate, and high-to-very-high psychological distress: technology-enabled integrated care, emergency department-based suicide prevention, crisis response service, family education programme, online parenting programme, school-based suicide prevention programme, trauma service for youths, and multicultural-informed care. We developed a system dynamics model for the ACT through a participatory process and calibrated the model with historical data, including population demographics, the prevalence of psychological distress, and mental health services provision. We calculated incremental cost-effectiveness ratios compared with business as usual for cost (AU$) per: quality-adjusted life-year (QALY), suicide death avoided, self-harm related hospital admissions avoided, and mental health-related emergency department presentation, using a 10-year time horizon for health-care and societal perspectives. We investigated uncertainty through probabilistic sensitivity analysis and deterministic sensitivity analysis, including using a 30-year timeframe. FINDINGS From a societal perspective, increased investment in technology-enabled integrated care, family education, an online parenting programme, and multicultural-informed care were expected to improve health outcomes (incremental QALYs 4517 [95% UI -3135 to 14 507] for technology-enabled integrated care; 339 [91 to 661] for family education; 724 [114 to 1149] for the online parenting programme; and 137 [88 to 194] for multicultural-informed care) and reduce costs ($-91·4 million [-382·7 to 100·7]; $-12·8 million [-21·0 to -6·6]; $-3·6 million [-6·3 to 0·2]; and $-3·1 million [-4·5 to -1·8], respectively) compared with business as usual using a 10-year time horizon. The incremental net monetary benefit for the societal perspective for these four interventions was $452 million (-351 to 1555), $40 million (14 to 74), $61 million (9 to 98), and $14 million (9 to 20), respectively, compared with business as usual, when QALYs were monetised using a willingness to pay of $79 930 per QALY. Synergistic effects are anticipated if these interventions were to be implemented concurrently. The univariate and probabilistic sensitivity analyses indicated a high level of certainty in the results. Although emergency department-based suicide prevention and school-based suicide prevention were not cost effective in the base case (41 QALYs [0 to 48], incremental cost $4·1 million [1·2 to 8·2] for emergency department-based suicide prevention; -234 QALYs [-764 to 12], incremental cost $90·3 million [72·2 to 111·0] for school-based suicide prevention) compared with business as usual, there were scenarios for which these interventions could be considered cost effective. A dedicated trauma service for young people (9 QALYs gained [4 to 16], incremental cost $8·3 million [6·8 to 10·0]) and a crisis response service (-11 QALYs gained [-12 to -10], incremental cost $7·8 million [5·1 to 11·0]) were unlikely to be cost effective in terms of QALYs. INTERPRETATION Synergistic effects were identified, supporting the combined implementation of technology-enabled integrated care, family education, an online parenting programme, and multicultural-informed care. Synergistic effects, emergent outcomes in the form of unintended consequences, the capability to account for service capacity constraints, and ease of use by stakeholders are unique attributes of a system dynamics modelling approach to economic evaluation. FUNDING BHP Foundation.
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Affiliation(s)
- Paul Crosland
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia.
| | - Nicholas Ho
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Seyed Hossein Hosseini
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Catherine Vacher
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Adam Skinner
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Andrea N Natsky
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Sebastian Rosenberg
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Raphael Hasudungan
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Sam Huntley
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Yun Ju Christine Song
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Grace Yeeun Lee
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Deborah A Marshall
- Cumming School of Medicine, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Jo-An Occhipinti
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
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R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, 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S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Whiteford H, Bagheri N, Diminic S, Enticott J, Gao CX, Hamilton M, Hickie IB, Khanh-Dao Le L, Lee YY, Long KM, McGorry P, Meadows G, Mihalopoulos C, Occhipinti JA, Rock D, Rosenberg S, Salvador-Carulla L, Skinner A. Mental health systems modelling for evidence-informed service reform in Australia. Aust N Z J Psychiatry 2023; 57:1417-1427. [PMID: 37183347 DOI: 10.1177/00048674231172113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Australia's Fifth National Mental Health Plan required governments to report, not only on the progress of changes to mental health service delivery, but to also plan for services that should be provided. Future population demand for treatment and care is challenging to predict and one solution involves modelling the uncertain demands on the system. Modelling can help decision-makers understand likely future changes in mental health service demand and more intelligently choose appropriate responses. It can also support greater scrutiny, accountability and transparency of these processes. Australia has an emerging national capacity for systems modelling in mental health which can enhance the next phase of mental health reform. This paper introduces concepts useful for understanding mental health modelling and identifies where modelling approaches can support health service planners to make evidence-informed decisions regarding planning and investment for the Australian population.
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Affiliation(s)
- Harvey Whiteford
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Nasser Bagheri
- Mental Health Policy Unit, Health Research Institute, University of Canberra
| | - Sandra Diminic
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Joanne Enticott
- Southern Synergy, Monash Centre of Health Research & Implementation, Monash University, Dandenong, VIC, Australia
| | - Caroline X Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University
| | - Matthew Hamilton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Long Khanh-Dao Le
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yong Yi Lee
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Katrina M Long
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Patrick McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Graham Meadows
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Dandenong, VIC, Australia
| | - Cathrine Mihalopoulos
- Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jo-An Occhipinti
- Systems Modelling, Simulation & Data Science, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney
| | - Daniel Rock
- WA Primary Health Alliance, Perth, Australia
- Discipline of Psychiatry, Medical School University of Western Australia
- Faculty of Health, University of Canberra
| | - Sebastian Rosenberg
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Rosenberg S, Carulla LS, Rosen A. Mental health reform in Australia - unfinished business. BJPsych Int 2023; 20:99-101. [PMID: 38029430 PMCID: PMC10659841 DOI: 10.1192/bji.2023.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/24/2023] [Accepted: 06/08/2023] [Indexed: 12/01/2023] Open
Abstract
Australia was one of the first countries to develop a national mental health strategy. This article reviews the progress of reform, outlining some strengths, weaknesses and prospective challenges.
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Affiliation(s)
- Sebastian Rosenberg
- Senior Lecturer, Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia. Email
| | - Luis Salvador Carulla
- Professor, Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Alan Rosen
- Professor, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Occhipinti JA, Hynes W, Geli P, Eyre HA, Song Y, Prodan A, Skinner A, Ujdur G, Buchanan J, Green R, Rosenberg S, Fels A, Hickie IB. Building systemic resilience, productivity and well-being: a Mental Wealth perspective. BMJ Glob Health 2023; 8:e012942. [PMID: 37748793 PMCID: PMC10533664 DOI: 10.1136/bmjgh-2023-012942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/06/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, New South Wales, Australia
| | - William Hynes
- New Approaches to Economic Challenges, Office of the Chief Economist, OECD, Paris, France
- Santa Fe Institute, Santa Fe, New Mexico, USA
| | - Patricia Geli
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Reform for Resilience Commission, Secretariat, Boston, Massachusetts, USA
| | - Harris A Eyre
- Brain Capital Alliance, San Francisco, California, USA
- Neuroscience-inspired Policy Initiative (NIPI), New Approaches to Economic Challenges, Office of the Chief Economist, Organisation for Economic Co-Operation and Development, Paris, France
- Center for Health and Biosciences, The Baker Institute for Public Policy, Rice University, Houston, Texas, USA
- Meadows Mental Health Policy Institute, Dallas, Texas, USA
- Euro-Mediterranean Economists Association, Barcelona, Spain
- Global Brain Health Institute, University of California, San Francisco (UCSF), San Francisco, California and Trinity College, Dublin, Dublin, Ireland
| | - Yun Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
| | - Ante Prodan
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, New South Wales, Australia
- School of Computer Science, Engineering and Mathematics, Western Sydney University, Penrith South, New South Wales, Australia
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
| | - Goran Ujdur
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, New South Wales, Australia
| | - John Buchanan
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Business School, University of Sydney, Australia, University of Sydney, Sydney, New South Wales, Australia
| | - Roy Green
- University of Technology Sydney, Broadway, Sydney, Australia
| | - Sebastian Rosenberg
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
| | - Allan Fels
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
- Melbourne Institute of Applied Economic and Social Research, Melbourne Law School, University of Melbourne, Melbourne, Victoria, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, New South Wales, Australia
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Vacher C, Skinner A, Occhipinti J, Rosenberg S, Ho N, Song YJC, Hickie IB. Improving access to mental health care: a system dynamics model of direct access to specialist care and accelerated specialist service capacity growth. Med J Aust 2023; 218:309-314. [PMID: 36971040 PMCID: PMC10952178 DOI: 10.5694/mja2.51903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To simulate the impact on population mental health indicators of allowing people to book some Medicare-subsidised sessions with psychologists and other mental health care professionals without a referral (direct access), and of increasing the annual growth rate in specialist mental health care capacity (consultations). DESIGN System dynamics model, calibrated using historical time series data from the Australian Bureau of Statistics, HealthStats NSW, the Australian Institute of Health and Welfare, and the Australian Early Development Census. Parameter values that could not be derived from these sources were estimated by constrained optimisation. SETTING New South Wales, 1 September 2021 - 1 September 2028. MAIN OUTCOME MEASURES Projected mental health-related emergency department presentations, hospitalisations following self-harm, and deaths by suicide, both overall and for people aged 15-24 years. RESULTS Direct access (for 10-50% of people requiring specialist mental health care) would lead to increases in the numbers of mental health-related emergency department presentations (0.33-1.68% of baseline), hospitalisations with self-harm (0.16-0.77%), and deaths by suicide (0.19-0.90%), as waiting times for consultations would increase, leading to disengagement and consequently to increases in adverse outcomes. Increasing the annual rate of growth of mental health service capacity (two- to fivefold) would reduce the frequency of all three outcomes; combining direct access to a proportion of services with increased growth in capacity achieved substantially greater gains than an increase in service capacity alone. A fivefold increase in the annual service growth rate would increase capacity by 71.6% by the end of 2028, compared with current projections; combined with direct access to 50% of mental health consultations, 26 616 emergency department presentations (3.6%), 1199 hospitalisations following self-harm (1.9%), and 158 deaths by suicide (2.1%) could be averted. CONCLUSION The optimal combination of increased service capacity growth (fivefold) and direct access (50% of consultations) would have double the impact over seven years of accelerated capacity growth alone. Our model highlights the risks of implementing individual reforms without knowledge of their overall system effect.
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Affiliation(s)
| | | | - Jo‐An Occhipinti
- The University of SydneySydneyNSW
- Computer Simulation and Advanced Research Technologies (CSART)SydneyNSW
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9
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Tran K, Buchanan J, Song YJC, Rosenberg S, Occhipinti JA, Hickie IB. A Mental Wealth perspective: crossing disciplines to understand the value of collective mental and social assets in the post-COVID-19 era. Int J Ment Health Syst 2022; 16:56. [PMID: 36503682 PMCID: PMC9742032 DOI: 10.1186/s13033-022-00568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A reconceptualised global strategy is key as nations begin to shift from crisis management to medium- and long-term planning to rebuild and strengthen their economic, social and public health systems. Efforts towards measuring, modelling, and forecasting Mental Wealth could serve as the catalyst for this reconceptualization. The Mental Wealth approach builds systemic resilience through investments which promote collective cognitive and emotional wellbeing. This paper presents the theoretical foundations for Mental Wealth. It presents, for the first time, literature across the disciplines of health and social sciences, economics, business, and humanities to underpin the development of an operational metric of Mental Wealth. DISCUSSION An approach which embeds social and psychological dimensions of prosperity, alongside the economic, is needed to inform the effective allocation of investments in the post-pandemic world. The authors advocate for a transdisciplinary framework of Mental Wealth to be applied in innovating population-level policy interventions to address the growing challenges brought on by COVID-19. Mental Wealth highlights the value generated by the deployment of collective mental assets and supporting social infrastructure. In order to inform this position, a review of the literature on the concepts underpinning Mental Wealth is presented, limitations of current measurement tools of mental and social resources are evaluated, and a framework for development of a Mental Wealth metric is proposed. CONCLUSION There are challenges in developing an operational Mental Wealth metric. The breadth of conceptual foundations to be considered is extensive, and there may be a lack of agreement on the appropriate tools for its measurement. While variability across current measurement approaches in social resources, wellbeing and mental assets contributes to the difficulty creating a holistic and generic metric, these variations are now clearer. The operationalisation of the Mental Wealth metric will require comprehensive mapping of the elements to be included against the data available.
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Affiliation(s)
- Kristen Tran
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia ,grid.1013.30000 0004 1936 834XMental Wealth Initiative, University of Sydney, Camperdown, Australia
| | - John Buchanan
- grid.1013.30000 0004 1936 834XMental Wealth Initiative, University of Sydney, Camperdown, Australia ,grid.1013.30000 0004 1936 834X Sydney Business School, University of Sydney, Sydney, Australia
| | - Yun Ju Christine Song
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia ,grid.1013.30000 0004 1936 834XMental Wealth Initiative, University of Sydney, Camperdown, Australia
| | - Sebastian Rosenberg
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia ,grid.1013.30000 0004 1936 834XMental Wealth Initiative, University of Sydney, Camperdown, Australia
| | - Jo-An Occhipinti
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia ,grid.1013.30000 0004 1936 834XMental Wealth Initiative, University of Sydney, Camperdown, Australia ,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia
| | - Ian B. Hickie
- grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia ,grid.1013.30000 0004 1936 834XMental Wealth Initiative, University of Sydney, Camperdown, Australia
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10
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Rosenberg S, Hickie I. Shaping Mental Health Reform - Key Tasks for an Incoming Government. Australas Psychiatry 2022; 30:746-749. [PMID: 35852298 DOI: 10.1177/10398562221115637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe a recent process by which mental health service sector leaders identified key elements of strategic, systemic and structural mental health reform. These elements could guide an incoming Federal government. METHOD The paper describes the process undertaken by the Sydney Mental Health Policy Forum between 2019 and 2022. This work generated principles, key domains and finally a set of actions. RESULTS Five immediate actions were identified that are cost neutral or require minimal investment. Five further actions requiring realignment of existing funds and/or new funds were also identified. CONCLUSIONS The task of mental health reform in Australia is both large and overdue. Continued investment in fragmented or piecemeal programmes and services will not propel desired change. Reform must facilitate new regional control of planning, funding and responding to community mental health needs. The actions identified by the Forum set out a menu of opportunities to guide reform over the life of the next Parliament, starting now.
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Affiliation(s)
| | - Ian Hickie
- Brain & Mind Centre, 4334University of Sydney, Camperdown, NSW, Australia
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11
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Rosenberg S, Park SH, Hickie I. Paying the price – out-of-pocket payments for mental health care in Australia. AUST HEALTH REV 2022; 46:660-666. [PMID: 36288722 DOI: 10.1071/ah22154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/30/2022] [Indexed: 12/13/2022]
Abstract
Objective This study set out to present data on out-of-pocket payments for Medicare mental health services provided by general practitioners (GP), psychiatrists, clinical psychologists and other psychologists, to explore how much is spent on out-of-pocket payments for mental health; if any trends could be seen; and what variations exist across regions. Methods We performed secondary analysis of publicly available data on Medicare-subsidised GP, allied health and specialist health care across Australia. We merged and interrogated data covering the period 2013-19 and 2019-21 to create a data set covering eight full years of Medicare mental health services, arranged by profession and by region. Results Out-of-pocket payments for mental health care in Australia have been rising consistently over the period 2013-21, at a considerably faster rate than overall expenditure on mental health care. There is wide variation in out-of-pocket payments depending on where you live. Conclusions The impact of out-of-pocket payments on community access to mental health care is growing. This has implications, especially in poorer communities, for access to care. This should be an important consideration taken as the Australian Government considers next steps in national mental health reform, including the Better Access Program, currently under evaluation.
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Affiliation(s)
- Sebastian Rosenberg
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia
| | - Shin Ho Park
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia
| | - Ian Hickie
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia
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12
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Rosenberg S, Salvador-Carulla L, Strazdins L, Katruss N. Adjusting tertiary mental health education during Covid-19: an Australian experience. Salud Publica Mex 2022; 64:560-564. [PMID: 36750091 DOI: 10.21149/12681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/05/2022] [Indexed: 01/20/2023] Open
Abstract
Globally, tertiary education has been greatly affected by the Covid-19 crisis. In this essay we explore the impact of the pandemic on this educational sector in an Australian setting; specifically, we discuss how the Research School of Population Health at the Australian National University adjusted and adapted to the changing circumstances arising from the pandemic. In this respect, two adjustments (both described in detail in the text) in the way mental health education was delivered at the School were proposed to mitigate the impact of Covid-19 and enhance the university's capacity to provide quality public health education to students. Thus, this essay shows that it is possible to design educational interventions that surmount the challenges posed by the pandemic. In addition, educators may use the examples cited in this paper to guide them to respond appropriately to the challenges that have arisen in terms of health education due to Covid-19.
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Affiliation(s)
- Sebastian Rosenberg
- Health Research Institute, Faculty of Health, University of Canberra. Bruce, Canberra, Australia..
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra. Bruce, Canberra, Australia..
| | - Lyndall Strazdins
- National Centre for Epidemiology and Population Health, Australian National University. Acton, Canberra, Australia.
| | - Natasha Katruss
- Centre for Mental Health Research, Australian National University. Acton, Canberra, Australia.
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13
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Salvador-Carulla L, Furst MA, Gillespie J, Rosenberg S, Aryani A, Anthes L, Ferdousi S, Salinas-Perez JA. Regional evolution of psychosocial services in Australia before and after the implementation of the National Disability Insurance Scheme. Aust N Z J Psychiatry 2022; 57:875-883. [PMID: 36208005 DOI: 10.1177/00048674221130981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This paper compares the evolution of the psychosocial sector in two Australian regions pre and post introduction of the National Disability Insurance Scheme - a major reform to the financing, planning and provision of disability services in Australia, intended to create greater competition and efficiency in the market, and more choice for service users. METHODS We used a standardised service classification instrument based on a health ecosystems approach to assess service availability and diversity of psychosocial services provided by non-government organisations in two Primary Health Network regions. RESULTS We identified very different evolutionary pathways in the two regions. Service availability increased in Western Sydney but decreased in the Australian Capital Territory. The diversity of services available did not increase in either Primary Health Network 4 years after the reform. Many services were experiencing ongoing funding uncertainty. CONCLUSION Assumptions of increased efficiency through organisational scaling up, and a greater diversity in range of service availability were not borne out. IMPLICATIONS This study shows the urgent need for evaluation of the effects of the NDIS on the provision of psychosocial care in Australia. Four years after the implementation of the NDIS at vast expense key objectives not been met for consumers or for the system as a whole, and an environment of uncertainty has been created for providers. It demonstrates the importance of standardised service mapping to monitor the effects of major reforms on mental health care as well as the need for a focus at the local level.
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Affiliation(s)
- Luis Salvador-Carulla
- Health Research Institute, University of Canberra, Bruce, ACT, Australia.,Menzies Centre for Health Policy and Economics and Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Mary Anne Furst
- Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - James Gillespie
- Menzies Centre for Health Policy and Economics and Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | | | - Amir Aryani
- Centre for Transformative Innovation Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | | | - Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Dos Hermanas, Spain.,Psicost Research Association, Jerez de la Frontera, Spain
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14
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Occhipinti JA, Buchanan J, Skinner A, Song YJC, Tran K, Rosenberg S, Fels A, Doraiswamy PM, Meier P, Prodan A, Hickie IB. Measuring, Modeling, and Forecasting the Mental Wealth of Nations. Front Public Health 2022; 10:879183. [PMID: 35968431 PMCID: PMC9368578 DOI: 10.3389/fpubh.2022.879183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has exposed the deep links and fragility of economic, health and social systems. Discussions of reconstruction include renewed interest in moving beyond GDP and recognizing "human capital", "brain capital", "mental capital", and "wellbeing" as assets fundamental to economic reimagining, productivity, and prosperity. This paper describes how the conceptualization of Mental Wealth provides an important framing for measuring and shaping social and economic renewal to underpin healthy, productive, resilient, and thriving communities. We propose a transdisciplinary application of systems modeling to forecast a nation's Mental Wealth and understand the extent to which policy-mediated changes in economic, social, and health sectors could enhance collective mental health and wellbeing, social cohesion, and national prosperity. Specifically, simulation will allow comparison of the projected impacts of a range of cross-sector strategies (education sector, mental health system, labor market, and macroeconomic reforms) on GDP and national Mental Wealth, and provide decision support capability for future investments and actions to foster Mental Wealth. Finally, this paper introduces the Mental Wealth Initiative that is harnessing complex systems science to examine the interrelationships between social, commercial, and structural determinants of mental health and wellbeing, and working to empirically challenge the notion that fostering universal social prosperity is at odds with economic and commercial interests.
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Affiliation(s)
- Jo-An Occhipinti
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Computer Simulation and Advanced Research Technologies, Sydney, NSW, Australia
| | - John Buchanan
- Mental Wealth Initiative, University of Sydney, Sydney, NSW, Australia
| | - Adam Skinner
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Yun Ju C. Song
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Kristen Tran
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Sebastian Rosenberg
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Allan Fels
- Melbourne Institute of Applied Economic and Social Research, Melbourne Law School, University of Melbourne, Melbourne, VIC, Australia
| | - P. Murali Doraiswamy
- Departments of Psychiatry and Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Petra Meier
- Systems Science in Public Health, University of Glasgow, Glasgow, United Kingdom
| | - Ante Prodan
- Computer Simulation and Advanced Research Technologies, Sydney, NSW, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Ian B. Hickie
- Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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15
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Song YJC, Rosenberg S, Smith B, Occhipinti JA, Mendoza J, Freebairn L, Skinner A, Hickie IB. Missing in action: the right to the highest attainable standard of mental health care. Int J Ment Health Syst 2022; 16:26. [PMID: 35690833 PMCID: PMC9187849 DOI: 10.1186/s13033-022-00537-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The right to the highest attainable standard of mental health remains a distant goal worldwide. The Report of the UN Special Rapporteur on the right of all people to enjoyment of the highest attainable standard of physical and mental health pleaded the urgent need for governments to act through appropriate laws and policies. We argue that Australia is in breach of international obligations, with inadequate access to mental health services, inconsistent mental health legislation across jurisdictions and ongoing structural (systematic) and individual discrimination. DISCUSSION Inadequate access to mental health services is a worldwide phenomenon. Australia has committed to international law obligations under the Convention on the Rights of Persons with Disabilities (CRPD) to 'promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disability, with respect to their inherent dignity'. This includes people with mental health impairment and this convention includes the right to 'the highest attainable standard of mental health'. Under the Australian Constitution, ratification of this convention enables the national government to pass laws to implement the convention obligations, and such national laws would prevail over any inconsistent state (or territory) laws governing mental health service provision. The authors argue that enabling positive rights through legislation and legally binding mental health service standards may facilitate enhanced accountability and enforcement of such rights. These steps may support critical key stakeholders to improve the standards of mental health service provision supported by the implementation of international obligations, thereby accelerating mental health system reform. Improved legislation would encourage better governance and the evolution of better services, making mental health care more accessible, without structural or individual discrimination, enabling all people to enjoy the highest attainable standard of health.
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Affiliation(s)
- Yun Ju C Song
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia. .,Mental Wealth Initiative, University of Sydney, Camperdown, Australia.
| | - Sebastian Rosenberg
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia.,Mental Wealth Initiative, University of Sydney, Camperdown, Australia
| | - Belinda Smith
- Sydney Law School, University of Sydney, Camperdown, Australia
| | - Jo-An Occhipinti
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia.,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia.,Mental Wealth Initiative, University of Sydney, Camperdown, Australia
| | - John Mendoza
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia.,Health and Sport Science, University of Sunshine Coast, Sippy Downs, Australia
| | - Louise Freebairn
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia.,Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Adam Skinner
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia
| | - Ian B Hickie
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia.,Mental Wealth Initiative, University of Sydney, Camperdown, Australia
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16
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Sandoval M, Sim A, Bhandari M, Wuthrick E, Perez B, Dilling T, Redler G, Andreozzi J, Nardella L, Feygelman V, Latifi K, Rosenberg S. OC-0421 MR-Guided SBRT/Hypofractionated RT for Metastatic and Primary Ultracentral and Central Lung Lesions. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Occhipinti JA, Rose D, Skinner A, Rock D, Song YJC, Prodan A, Rosenberg S, Freebairn L, Vacher C, Hickie IB. Sound Decision Making in Uncertain Times: Can Systems Modelling Be Useful for Informing Policy and Planning for Suicide Prevention? Int J Environ Res Public Health 2022; 19:ijerph19031468. [PMID: 35162491 PMCID: PMC8835017 DOI: 10.3390/ijerph19031468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic demonstrated the significant value of systems modelling in supporting proactive and effective public health decision making despite the complexities and uncertainties that characterise an evolving crisis. The same approach is possible in the field of mental health. However, a commonly levelled (but misguided) criticism prevents systems modelling from being more routinely adopted, namely, that the presence of uncertainty around key model input parameters renders a model useless. This study explored whether radically different simulated trajectories of suicide would result in different advice to decision makers regarding the optimal strategy to mitigate the impacts of the pandemic on mental health. Using an existing system dynamics model developed in August 2020 for a regional catchment of Western Australia, four scenarios were simulated to model the possible effect of the COVID-19 pandemic on levels of psychological distress. The scenarios produced a range of projected impacts on suicide deaths, ranging from a relatively small to a dramatic increase. Discordance in the sets of best-performing intervention scenarios across the divergent COVID-mental health trajectories was assessed by comparing differences in projected numbers of suicides between the baseline scenario and each of 286 possible intervention scenarios calculated for two time horizons; 2026 and 2041. The best performing intervention combinations over the period 2021–2041 (i.e., post-suicide attempt assertive aftercare, community support programs to increase community connectedness, and technology enabled care coordination) were highly consistent across all four COVID-19 mental health trajectories, reducing suicide deaths by between 23.9–24.6% against the baseline. However, the ranking of best performing intervention combinations does alter depending on the time horizon under consideration due to non-linear intervention impacts. These findings suggest that systems models can retain value in informing robust decision making despite uncertainty in the trajectories of population mental health outcomes. It is recommended that the time horizon under consideration be sufficiently long to capture the full effects of interventions, and efforts should be made to achieve more timely tracking and access to key population mental health indicators to inform model refinements over time and reduce uncertainty in mental health policy and planning decisions.
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Affiliation(s)
- Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW 2021, Australia
- Correspondence: ; Tel.: +61-467-522-766
| | - Danya Rose
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
| | - Daniel Rock
- Medical School, University of Western Australia, Perth, WA 6009, Australia;
- WA Primary Health Alliance, Perth, WA 6008, Australia
| | - Yun Ju C. Song
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
| | - Ante Prodan
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW 2021, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, NSW 2751, Australia
| | - Sebastian Rosenberg
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
| | - Louise Freebairn
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW 2021, Australia
| | - Catherine Vacher
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
- St Vincent’s Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (D.R.); (A.S.); (Y.J.C.S.); (A.P.); (S.R.); (L.F.); (C.V.); (I.B.H.)
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18
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Enticott J, Dawadi S, Shawyer F, Inder B, Fossey E, Teede H, Rosenberg S, Ozols Am I, Meadows G. Corrigendum: Mental Health in Australia: Psychological Distress Reported in Six Consecutive Cross-Sectional National Surveys From 2001 to 2018. Front Psychiatry 2022; 13:934065. [PMID: 35832592 PMCID: PMC9272476 DOI: 10.3389/fpsyt.2022.934065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyt.2022.815904.].
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Affiliation(s)
- Joanne Enticott
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, VIC, Australia.,Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Shrinkhala Dawadi
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, VIC, Australia.,Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Frances Shawyer
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Brett Inder
- Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, Monash University Peninsula Campus, Melbourne, VIC, Australia.,School of Primary and Allied Health Care, Monash University, Victoria, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Sebastian Rosenberg
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Ingrid Ozols Am
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, VIC, Australia.,Mental Health at Work, Melbourne, VIC, Australia
| | - Graham Meadows
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, VIC, Australia.,Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.,School of Primary and Allied Health Care, Monash University, Victoria, VIC, Australia.,Centre for Mental Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Monash Health, Dandenong, VIC, Australia
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19
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Enticott J, Dawadi S, Shawyer F, Inder B, Fossey E, Teede H, Rosenberg S, Ozols Am I, Meadows G. Mental Health in Australia: Psychological Distress Reported in Six Consecutive Cross-Sectional National Surveys From 2001 to 2018. Front Psychiatry 2022; 13:815904. [PMID: 35432016 PMCID: PMC9010616 DOI: 10.3389/fpsyt.2022.815904] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To examine Australian psychological distress trends from 2001 to 2017/18, including analysis by age, sex, location, and household income. METHODS Secondary analysis of the working age population (18-64 years) in six successive representative national health surveys. Measures were prevalence of psychological distress at very-high symptom level (defined by a Kessler Psychological Distress Scale (K10) score of 30 or more) and combined high/very-high level (K10 score of 22 or more). Very-high K10 scores are associated with mental health problems meeting diagnostic thresholds in past year. RESULTS From 2001 to 2017/18 Australian rates of K10 very-high distress rose significantly from 3.8 to 5.1% and combined high/very-high from 13.2 to 14.8%. In women aged 55-64, very-high distress rose significantly and substantially from 3.5 to 7.2% and high/very-high distress from 12.4 to 18.7%. In men aged 25-34, very-high distress increased from 2.1 to 4.0% and high/very-high from 10.6 to 11.5%. Income was strongly and inversely associated with distress (lowest vs. highest quintile adjusted OR 11.4). An apparent association of increased distress with regional location disappeared with adjustment for income. CONCLUSION Australia's population level of psychological distress increased significantly from 2001-2017/18, with levels highest in women and with rates inversely associated with income. This is likely to be indicative of increased community rates of mental disorders. Given that this has occurred whilst mental healthcare expenditure has increased, there is an urgent need to reconsider how best to respond to mental illness, including targeting the most vulnerable based on social determinants such as age, gender, and lower incomes.
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Affiliation(s)
- Joanne Enticott
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, VIC, Australia.,Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Shrinkhala Dawadi
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, VIC, Australia.,Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Frances Shawyer
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Brett Inder
- Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, Monash University Peninsula Campus, Melbourne, VIC, Australia.,School of Primary and Allied Health Care, Monash University, Victoria, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Sebastian Rosenberg
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Ingrid Ozols Am
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, VIC, Australia.,Mental Health at Work, Melbourne, VIC, Australia
| | - Graham Meadows
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, VIC, Australia.,Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.,School of Primary and Allied Health Care, Monash University, Victoria, VIC, Australia.,Centre for Mental Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Monash Health, Dandenong, VIC, Australia
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Abstract
This analysis identifies the significant problem of ambiguity, variation and vagueness in relation to the intervention described as 'psychotherapy'. Its purpose is to raise international awareness of this problem and alternative solutions.
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Affiliation(s)
- Giulio Castelpietra
- In-patient and Out-patient Care Service, Central Health Directorate, Regione Autonoma Friuli Venezia Giulia, Trieste; and Department of Medicine (DAME), University of Udine, Italy
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Austria; and Department of Psychiatry, University of Oxford; and Oxford Health NHS Trust, Warneford Hospital, Oxford, UK
| | | | - Sebastian Rosenberg
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra; and Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Australia
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21
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Reyes NM, Moody E, Hightshoe K, Davidon S, Rosenberg S, Dahl E, Kubicek LF. Factors That May Influence Social Communication Questionnaire (SCQ) Scores: An Examination of the Spanish and English SCQ in School-Aged Students. School Psychology Review 2021. [DOI: 10.1080/2372966x.2021.1927830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Koehler L, Rosenberg S, Cater J, Mikolajczyk K, Moran A, Metz C, Monson S. QUALITY OF LIFE IN BREAST CANCER SURVIVORS: AN ASSESSMENT OF INTERNATIONAL BREAST CANCER DRAGON BOAT RACERS. Lymphology 2021. [DOI: 10.2458/lymph.4671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Resistance exercise is deemed safe for women recovering from conventional breast cancer therapies but few clinicians are aware that dragon boat racing, as a form of resistive exercise, is available to the breast cancer community. The objectives of this study were to 1) increase clinician awareness of dragon boat racing (DBR) in breast cancer survivors as a community-based physical activity, and 2) evaluate quality of life (QOL) in breast cancer survivors with or without lymphedema who participate in DBR. This prospective, observational study surveyed 1,069 international breast cancer dragon boat racers from eight countries to compare function, activity, and participation in women with and without self-reported lymphedema using the Lymph-ICF questionnaire. Seventy-one percent of women (n=758) completed the questionnaires. Results revealed significantly higher Lymph-ICF scores in the lymphedema participants, signifying reduced QOL, when compared to the nonlymphedema participants (p<0.05), except for "go on vacation" for which no statistical difference was reported (p=0.20). International breast cancer survivors with lymphedema participating in DBR at an international competition had reduced function, limited activity, and restricted participation compared to participants without lymphedema. Clinicians should consider utilizing DBR as a community-based activity to support exercise and physical activity after a breast cancer diagnosis.
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23
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Rosenberg S, Harvey C. Mental Health in Australia and the Challenge of Community Mental Health Reform. Consort Psychiatr 2021; 2:40-46. [PMID: 38601099 PMCID: PMC11003349 DOI: 10.17816/cp44] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/02/2021] [Indexed: 11/08/2022] Open
Abstract
Australia was one of the first countries to develop and implement a national mental health plan, 30 years ago. This national approach belied the countrys federal structure, in which the federal government takes responsibility for primary care while state and territory governments manage acute and hospital mental health care. This arrangement has led to significant variations across jurisdictions. It has also left secondary care, often provided in the community, outside of this governance arrangement. This article explores this dilemma and its implications for community mental health, and suggests key steps towards more effective reform of this vital element of mental health care.
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24
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Rosenberg S. Combatting Commission fatigue: what does real reform in mental health look like? AUST HEALTH REV 2020; 44:816-817. [PMID: 33264587 DOI: 10.1071/ahv44n6_ed2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Abstract
AIM To summarise commonalities and variations in the mental health response to COVID-19 across different sites and countries, with a view to better understanding key steps not only in crisis management, but for future systemic reform of mental health care. METHOD We conducted a Rapid Synthesis and Translation Process of lessons learned from an international panel of experts, collecting on the ground experiences of the pandemic as it evolved in real time. Digital conferencing and individual interviews were used to rapidly acquire knowledge on the COVID-19 outbreak across 16 locations in Australia, Denmark, Italy, Spain, Taiwan, the UK, and the USA. RESULTS COVID-19 has had massive impacts on mental health care internationally. Most systems were under-resourced and under-prepared, struggling to manage both existing and new clients. There were significant differences between sites, depending on the explosivity the pandemic and the readiness of the mental health system. Integrated, community mental health systems exhibited greater adaptability in contrast to services which depended on face-to-face and hospital-based care. COVID-19 has demonstrated the need for a new approach to rapid response to crisis in mental health. New decision support system tools are necessary to ensure local decision-makers can effectively respond to the enormous practical challenges posed in these circumstances. CONCLUSIONS The process we have undertaken has generated clear lessons for mental health policymakers worldwide, beyond pandemic planning and response to guide next steps in systemic mental health reform. Key here is achieving some balance between national leadership and local context adaptation of evidence.
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Affiliation(s)
- Sebastian Rosenberg
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Australia
- Mental Health Policy Unit, Brain & Mind Centre, University of Sydney, Australia
| | - John Mendoza
- Faculty of Medicine, University of Sydney, Australia
- Mental Health Centre, Adelaide Local Health Network, Australia
| | - Hossein Tabatabaei-Jafari
- Centre for Mental Health Research, Research School of Population Health ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd, Acton ACT 2601 Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Australia
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26
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Salvador-Carulla L, Rosenberg S, Mendoza J, Tabatabaei-Jafari H. Rapid response to crisis: Health system lessons from the active period of COVID-19. Health Policy Technol 2020; 9:578-586. [PMID: 32874862 PMCID: PMC7450947 DOI: 10.1016/j.hlpt.2020.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This paper outlines the need for a health systems approach and rapid response strategy for gathering information necessary for policy decisions during pandemics and similar crises. It suggests a new framework for assessing the phases of the pandemic. METHOD The paper draws its information and conclusions from a rapid synthesis and translation process (RSTP) of a series of webinars and online discussions from the Pandemic-Mental Health International Network (Pan-MHIN) - policy experts from across 16 locations in Australia, Denmark, Italy, Spain, Taiwan, the UK and the USA. While the initial focus of this research was on mental health, COVID-19 has raised much broader issues and questions for health planners. RESULTS We identified gaps affecting the capacity to respond effectively and quickly, including in relation to system indicators, the inadequacy of the prior classification of the phases of the pandemic, the absences of a healthcare ecosystem approach, and the quick shift to digital technologies. The strengths and weaknesses of COVID-19 responses across different systems, services, sites and countries been identified and compared, including both low and high impacted areas. CONCLUSIONS There is an urgent need for managerial epidemiology based on healthcare ecosystem research encompassing multidisciplinary teams, visualization tools and decision analytics for rapid response. Policy and healthcare context played a key role in the response to COVID-19. Its severity, the containment measures and the societal response varied greatly across sites and countries. Understanding this variation is vital to assess the impact of COVID-19 in specific areas such as ageing or mental health.
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Affiliation(s)
- Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd, Acton ACT 2601 Australia
| | - Sebastian Rosenberg
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd, Acton ACT 2601 Australia
- Mental Health Policy Unit, Brain & Mind Centre, University of Sydney, Australia
| | - John Mendoza
- Faculty of Medicine, University of Sydney, Australia
- Mental Health Centre, Adelaide Local Health Network, Australia
| | - Hossein Tabatabaei-Jafari
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd, Acton ACT 2601 Australia
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Affiliation(s)
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Australia
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28
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Atkinson JA, Skinner A, Lawson K, Rosenberg S, Hickie IB. Bringing new tools, a regional focus, resource-sensitivity, local engagement and necessary discipline to mental health policy and planning. BMC Public Health 2020; 20:814. [PMID: 32498676 PMCID: PMC7273655 DOI: 10.1186/s12889-020-08948-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background While reducing the burden of mental and substance use disorders is a global challenge, it is played out locally. Mental disorders have early ages of onset, syndromal complexity and high individual variability in course and response to treatment. As most locally-delivered health systems do not account for this complexity in their design, implementation, scale or evaluation they often result in disappointing impacts. Discussion In this viewpoint, we contend that the absence of an appropriate predictive planning framework is one critical reason that countries fail to make substantial progress in mental health outcomes. Addressing this missing infrastructure is vital to guide and coordinate national and regional (local) investments, to ensure limited mental health resources are put to best use, and to strengthen health systems to achieve the mental health targets of the 2015 Sustainable Development Goals. Most broad national policies over-emphasize provision of single elements of care (e.g. medicines, individual psychological therapies) and assess their population-level impact through static, linear and program logic-based evaluation. More sophisticated decision analytic approaches that can account for complexity have long been successfully used in non-health sectors and are now emerging in mental health research and practice. We argue that utilization of advanced decision support tools such as systems modelling and simulation, is now required to bring a necessary discipline to new national and local investments in transforming mental health systems. Conclusion Systems modelling and simulation delivers an interactive decision analytic tool to test mental health reform and service planning scenarios in a safe environment before implementing them in the real world. The approach drives better decision-making and can inform the scale up of effective and contextually relevant strategies to reduce the burden of mental disorder and enhance the mental wealth of nations.
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Affiliation(s)
- Jo-An Atkinson
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,Computer Simulation and Advanced Research Technologies, Sydney, Australia. .,Menzies Centre for Health Policy, The University of Sydney, Sydney, Australia. .,Translational Health Research Institute, Western Sydney University, Penrith, Australia.
| | - Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Menzies Centre for Health Policy, The University of Sydney, Sydney, Australia
| | - Kenny Lawson
- Translational Health Research Institute, Western Sydney University, Penrith, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Sebastian Rosenberg
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Research School of Population Health, The Australian National University, Canberra, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Abstract
OBJECTIVE To consider the changing profile of Australia's mental health workforce and the implications, particularly for specialist psychiatry services. METHOD We analyse data from a national collection that describes changes in the workforce over a decade, to 2017-2018. RESULTS While single practitioner-based psychological services flourish, other areas of more complex and team-based care are struggling to remain relevant. Psychiatry and mental health nursing, two areas that previously led Australia's response to complex mental illness, are under enormous pressure. CONCLUSION The shifting balance of specialised mental health workforces is affecting the mental healthcare available in each region of Australia. Questions arise regarding the desired or optimal mix of professionals we wish to deploy. What roles should each professional group play and how should they work together? What does this mean for how various groups should be trained and paid? These data challenge the role specialist psychiatry wishes to play in leading reform. Current mental health reforms risk foundering should psychiatrists fail to take up the challenge of leadership.
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Affiliation(s)
- Sebastian Rosenberg
- Mental Health Policy Unit, Centre for Mental Health Research, Australian National University, Australia.,Brain and Mind Centre, University of Sydney, Australia
| | - Ian Hickie
- Health and Policy, Brain and Mind Centre, University of Sydney, Australia
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30
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Bourdillon P, Ferrand-Sorbet S, Apra C, Chipaux M, Raffo E, Rosenberg S, Bulteau C, Dorison N, Bekaert O, Dinkelacker V, Le Guérinel C, Fohlen M, Dorfmüller G. Surgical treatment of hypothalamic hamartomas. Neurosurg Rev 2020; 44:753-762. [PMID: 32318922 DOI: 10.1007/s10143-020-01298-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 12/15/2022]
Abstract
Hypothalamic hamartomas are aberrant masses, composed of abnormally distributed neurons and glia. Along endocrine and cognitive symptoms, they may cause epileptic seizures, including the specific gelastic and dacrystic seizures. Surgery is the treatment of drug-resistant hamartoma epilepsy, with associated positive results on endocrine, psychiatric, and cognitive symptoms. Recently, alternatives to open microsurgical treatment have been proposed. We review these techniques and compare their efficacy and safety. Open resection or disconnection of the hamartoma, either through pterional, transcallosal, or transventricular approach, leads to good epileptological control, but its high complication rate, up to 30%, limits its indications. The purely cisternal peduncular forms remain the only indication of open, pterional approach, while other strategies have been developed to overcome the neurological, endocrine, behavioral, or cognitive complications. Laser and radiofrequency thermocoagulation-based disconnection through robot-guided stereo-endoscopy has been proposed as an alternative to open microsurgical resection and stereotactic destruction. The goal is to allow safe and complete disconnection of a possibly complex attachment zone, through a single intraparenchymal trajectory which allows multiple laser or radiofrequency probe trajectory inside the ventricle. The efficacy was high, with 78% of favorable outcome, and the overall complication rate was 8%. It was especially effective in patients with isolated gelastic seizures and pure intraventricular hamartomas. Stereotactic radiosurgery has proved as efficacious and safer than open microsurgery, with around 60% of seizure control and a very low complication rate. Multiple stereotactic thermocoagulation showed very interesting results with 71% of seizure freedom and 2% of permanent complications. Stereotactic laser interstitial thermotherapy (LiTT) seems as effective as open microsurgery (from 76 to 81% of seizure freedom) but causes up to 20% of permanent complications. This technique has however been highly improved by targeting only the epileptogenic onset zone in the hamartoma, as shown on preoperative functional MRI, leading to an improvement of epilepsy control by 45% (92% of seizure freedom) with no postoperative morbidity. All these results suggest that the impact of the surgical procedure does not depend on purely technical matters (laser vs radiofrequency thermocoagulation or stereotactic vs robot-guided stereo-endoscopy) but relies on the understanding of the epileptic network, including inside the hamartoma, the aim being to plan an effective disconnection or lesion of the epileptogenic part while sparing the adjacent functional structures.
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Affiliation(s)
- Pierre Bourdillon
- Department of Neurosurgery, Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France. .,Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France. .,Sorbonne Université, Paris, France. .,INSERM U1127, CNRS, UMR7225, Brain and Spine Institute, Paris, France.
| | - S Ferrand-Sorbet
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - C Apra
- Sorbonne Université, Paris, France.,INSERM U1127, CNRS, UMR7225, Brain and Spine Institute, Paris, France.,Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | - M Chipaux
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - E Raffo
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France.,Université de Lorraine, Nancy, France
| | - S Rosenberg
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - C Bulteau
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France.,Université de Paris, Paris, France
| | - N Dorison
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - O Bekaert
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - V Dinkelacker
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
| | - C Le Guérinel
- Department of Neurosurgery, Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France
| | - M Fohlen
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - G Dorfmüller
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
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Chung Y, Bagheri N, Salinas-Perez JA, Smurthwaite K, Walsh E, Furst M, Rosenberg S, Salvador-Carulla L. Role of visual analytics in supporting mental healthcare systems research and policy: A systematic scoping review. International Journal of Information Management 2020. [DOI: 10.1016/j.ijinfomgt.2019.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Koehler L, Rosenberg S, Cater J, Mikolajczyk K, Moran A, Metz C, Monson S. Quality of life in breast cancer survivors: An assessment of international breast cancer dragon boat racers. Lymphology 2020; 53:195-203. [PMID: 33721925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Resistance exercise is deemed safe for women recovering from conventional breast cancer therapies but few clinicians are aware that dragon boat racing, as a form of resistive exercise, is available to the breast cancer community. The objectives of this study were to 1) increase clinician awareness of dragon boat racing (DBR) in breast cancer survivors as a community-based physical activity, and 2) evaluate quality of life (QOL) in breast cancer survivors with or without lymphedema who participate in DBR. This prospective, observational study surveyed 1,069 international breast cancer dragon boat racers from eight countries to compare function, activity, and participation in women with and without selfreported lymphedema using the Lymph-ICF questionnaire. Seventy-one percent of women (n=758) completed the questionnaires. Results revealed significantly higher Lymph-ICF scores in the lymphedema participants, signifying reduced QOL, when compared to the nonlymphedema participants (p<0.05), except for "go on vacation" for which no statistical difference was reported (p=0.20). International breast cancer survivors with lymphedema participating in DBR at an international competition had reduced function, limited activity, and restricted participation compared to participants without lymphedema. Clinicians should consider utilizing DBR as a community-based activity to support exercise and physical activity after a breast cancer diagnosis.
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Affiliation(s)
- L Koehler
- Division of Physical Therapy, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Division of Rehabilitation Science, Rehabilitation Medicine Department, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - S Rosenberg
- M Health Fairview, Vascular, Vein, and Wound, Maplewood, Minnesota, USA
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Paul Dragon Divas Dragon Boat Team St. Paul, Minnesota, USA
| | - J Cater
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
- Paul Dragon Divas Dragon Boat Team St. Paul, Minnesota, USA
| | - K Mikolajczyk
- Division of Physical Therapy, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - A Moran
- Division of Physical Therapy, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - C Metz
- Division of Physical Therapy, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - S Monson
- Division of Physical Therapy, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Rosenberg S, Redmond C, Boyer P, Gleeson P, Russell P. Culture clash? Recovery in mental health under Australia’s National Disability Insurance Scheme – a case study. Public Health Res Pract 2019; 29:29011902. [DOI: 10.17061/phrp29011902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Maas C, Salinas-Perez JA, Bagheri N, Rosenberg S, Campos W, Gillespie JA, Salvador-Carulla L. A spatial analysis of referrals to a primary mental health programme in Western Sydney from 2012 to 2015. Geospat Health 2019; 14. [PMID: 31724369 DOI: 10.4081/gh.2019.773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/12/2019] [Indexed: 06/10/2023]
Abstract
Access to Allied Psychological Services is a primary mental health programme targeting hard-to-reach populations throughout Australia. This research aims to identify patterns of referrals to the programme in the Western Sydney Primary Health Network region from 2012 to 2015. The referral rates were analysed by using spatial autocorrelation indexes and spatial regression. The study area was described through the identification of the most disadvantaged areas and through consideration of three socio-economic indicators: percentage of Aboriginal and Torres Strait Islander Australians, low educational attainment and low weekly incomes. A large hot spot (identifying high referral rates) was located across the duration of the study in the south-western urban area that partially covered a disadvantaged area. The main cold spot (identifying low referral rates) was located in the south-eastern urban area, covering another disadvantaged area, however critically this association disappeared over time. Our modelling showed that the referral rates had a direct association with the percentage of Aboriginal and Torres Strait Islander peoples with low incomes, and an indirect association with low educational attainment. The results and technique are useful in monitoring and addressing inequality in health planning and policy.
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Affiliation(s)
- Cailin Maas
- Brain and Mind Centre, University of Sydney, Camperdown NSW.
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35
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Abstract
OBJECTIVE To explore the impact of proposed expansion of Australia's Better Access Program and alternatives. METHOD Australia's Better Access Program, which costs taxpayers AUD28 million every week, is once again the focus of national political and professional scrutiny. The current Medicare Review calls for a massive expansion. This article reviews its history and context. It challenges the recommendations made by the Review. It also provides three scenarios which model the proposed expansion, with significant implications for consumers, the workforce and taxpayers. RESULTS The capacity for continued growth of the Program is demonstrated. At the same time. CONCLUSION There has been recent evidence suggesting the impact of the programme on key mental health indicators in Australia has been negligible, while also perpetuating social, economic and geographic inequities. While advocacy for increased mental health expenditure is easy, active reform of existing patterns of service is hard. Nonetheless, this article suggests that it is timely to reconsider the structure and scale of this AUD1.5 billion annual investment, which has the potential to grow to up to AUD10 billion per year over the next decade. In our view, it is possible to make the programme fit for purpose in the 21st century. Specifically, the principal focus could be shifted to better support the interdisciplinary, team-based care that responds to the needs of people with more complex mental health problems. An increased role for incorporation of digital technologies alongside clinical services is part of the mix. The combination of changes suggested would suggest that the programme could be rebranded as 'Better Access and Quality'. This shift in the primary focus of the clinical programme away from brief interventions for those with lower needs to more sustained interventions with those with greater impairment requires new service models, as well as new regionally based health care systems. In addition, we propose specific outcomes that can be measured regionally, and collated nationally, to properly evaluate the impact of the programme and drive systemic quality improvement.
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Affiliation(s)
- Sebastian Rosenberg
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Acton, ACT, Australia.,Brain and Mind Centre, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ian Hickie Am
- Brain and Mind Centre, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Gandré C, Rosenberg S, Coldefy M, Or Z. Experimenting locally with a stepped-care approach for the treatment of mild to moderate mental disorders in France: Challenges and opportunities. Health Policy 2019; 123:1021-1027. [PMID: 31495560 DOI: 10.1016/j.healthpol.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/28/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
In France, publicly funded mental care services are mostly hospital-based and focused on treating severe illnesses. Mild to moderate mental disorders are typically managed by general practitioners (GP) who often lack specific training to treat these conditions. Antidepressant prescribing levels for mild to moderate conditions are inadequately high. Public reimbursement for psychotherapies provided by psychologists is generally not available. This paper presents a local experiment with a stepped-care approach for the treatment of mild to moderate mental disorders in four French départements launched in 2018. The experiment includes the introduction of a standardized assessment protocol for GPs, clear referral guidelines, and full reimbursement of visits to psychologists upon GP referral. Seemingly simple, the policy raises several issues related to the regulation, training and reimbursement of psychologists, and illustrates the need for careful preparation and workforce planning to ensure success and stakeholder support. An independent evaluation of the local experiments is planned, which provides the opportunity to fine-tune the policy before any broader rollout. The issues raised in France and the on-going debate is relevant for other countries preparing similar policies for improving mental care.
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Affiliation(s)
- Coralie Gandré
- Institut de recherche et documentation en économie de la santé (IRDES), France.
| | - Sebastian Rosenberg
- Brain and Mind Centre, University of Sydney, NSW, Australia; Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Magali Coldefy
- Institut de recherche et documentation en économie de la santé (IRDES), France
| | - Zeynep Or
- Institut de recherche et documentation en économie de la santé (IRDES), France
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Meadows GN, Prodan A, Patten S, Shawyer F, Francis S, Enticott J, Rosenberg S, Atkinson JA, Fossey E, Kakuma R. Resolving the paradox of increased mental health expenditure and stable prevalence. Aust N Z J Psychiatry 2019; 53:844-850. [PMID: 31238699 PMCID: PMC6724452 DOI: 10.1177/0004867419857821] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A doubling of Australian expenditure on mental health services over two decades, inflation-adjusted, has reduced prevalence of neither psychological distress nor mental disorders. Low rates of help-seeking, and inadequate and inequitable delivery of effective care may explain this partially, but not fully. Focusing on depressive disorders, drawing initially on ideas from the work of philosopher and socio-cultural critic Ivan Illich, we use evidence-based medicine statistics and simulation modelling approaches to develop testable hypotheses as to how iatrogenic influences on the course of depression may help explain this seeming paradox. Combined psychological treatment and antidepressant medication may be available, and beneficial, for depressed people in socioeconomically advantaged areas. But more Australians with depression live in disadvantaged areas where antidepressant medication provision without formal psychotherapy is more typical; there also are urban/non-urban disparities. Depressed people often engage in self-help strategies consistent with psychological treatments, probably often with some benefit to these people. We propose then, if people are encouraged to rely heavily on antidepressant medication only, and if they consequently reduce spontaneous self-help activity, that the benefits of the antidepressant medication may be more than offset by reductions in beneficial effects as a consequence of reduced self-help activity. While in advantaged areas, more comprehensive service delivery may result in observed prevalence lower than it would be without services, in less well-serviced areas, observed prevalence may be higher than it would otherwise be. Overall, then, we see no change. If the hypotheses receive support from the proposed research, then implications for service prioritisation and delivery could include a case for wider application of recovery-oriented practice. Critically, it would strengthen the case for action to correct inequities in the delivery of psychological treatments for depression in Australia so that combined psychological therapy and antidepressant medication, accessible and administered within an empowering framework, should be a nationally implemented standard.
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Affiliation(s)
- Graham N Meadows
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Adult Mental Health, Monash Health, Melbourne, VIC, Australia,Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia,Graham N Meadows, Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Dandenong Hospital, 126 - 128 Cleeland St, Dandenong VIC 3175 Australia.
| | - Ante Prodan
- Computing & ICT Organisational Unit, School of Computing, Engineering and Mathematics, Western Sydney University, Sydney, NSW, Australia,Decision Analytics, Sax Institute, Sydney, NSW, Australia
| | - Scott Patten
- Department of Community Health Sciences and Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Frances Shawyer
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Sarah Francis
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Joanne Enticott
- Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Sebastian Rosenberg
- Brain and Mind Centre, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia,Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Jo-An Atkinson
- Department of Community Health Sciences and Psychiatry, University of Calgary, Calgary, AB, Canada,Menzies Centre for Health Policy, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia,Simulation for Policy, The Australian Prevention Partnership Centre, Sydney, NSW, Australia,Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ritsuko Kakuma
- Faculty of Epidemiology and Population Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Scott A, Kim P, Tran H, Brambatti M, Ignatyeva Y, Rosenberg S, Kligerman S, Hsiao A, Pretorius V, Adler E, Contijoch F. Cardiac CT Provides Complementary Parameters of Right Ventricle Function in LVAD Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Kim HJ, Dominici L, Rosenberg S, Pak LM, Poorvu PD, Ruddy K, Tamimi R, Schapira L, Come S, Peppercorn J, Borges V, Warner E, Vardeh H, Collins L, King T, Partridge A. Abstract GS6-01: Surgical treatment after neoadjuvant systemic therapy in young women with breast cancer: Results from a prospective cohort study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs6-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Young women are more likely than older women to present with higher stage breast cancer (BC) and may benefit to a greater extent from downstaging with neoadjuvant systemic treatment (NST). Young age is also associated with greater likelihood of pathologic complete response (pCR). Using a large prospective cohort of young women with BC, we investigated response to neoadjuvant therapy, eligibility for breast conserving surgery (BCS) pre- and post-NST, and surgical treatment.
Methods
The Young Women's Breast Cancer Study (YWS) is a multi-center cohort of women diagnosed with BC at age ≤40, that enrolled 1302 patients from 2006 to 2016. Disease characteristics and treatment information were obtained through medical record and central pathology review. Surgical recommendation before and after NST, conversion from BCS borderline/ineligible to BCS eligible, surgery, documented reasons for choosing mastectomy (MTX) among BCS eligible women, and final pathologic response were independently reviewed.
Results
Among 1302 women enrolled in YWS, 801 (62%) presented with unilateral stage I-III breast cancer and 317(40%) received NST. Median age was 36 years old (22-40). Pre-NST, 85/317 (27%) were BCS eligible, 49 (15%) were borderline, and 169 (53%) were not eligible (16 inflammatory breast cancer (IBC), 88 large tumor size /cosmetic, 48 diffuse calcifications, and 83 multicentricity). Among the 218 patients who were BCS ineligible/borderline pre-NST, 82 (38%) became eligible for BCS after NST. 4 patients who were BCS eligible pre-NST became ineligible. Of all patients eligible for BCS post-NST (n=163), 80 (49%) attempted BCS, 74 (93%) of whom were successful, and 83 (51%) chose MTX. Reasons for choosing MTX included: patient preference (38/83 (46%)), BRCA or TP53 mutation (31 (37%)), family history (3 (4%)), unknown (11 (13%)). On final pathology, 75 (24%) patients had pCR. Among patients who achieved a pCR, 48 (64%) underwent MTX, fewer than half (21/48 (44%)) were for anatomic indications (IBC, large tumor at diagnosis, diffuse calcifications, multicentric disease).
Conclusion
While NST doubled the proportion of young women eligible for BCS, nearly half chose MTX regardless of response to NST, mostly for personal preference or high-risk preventative reasons. These data highlight that surgical decision making among young women with breast cancer is often driven by factors beyond extent of disease and clinical response to therapy.
Table 1.Clinical-pathologic characteristicsCharacteristicsNumber%Pre NST surgical recommendation BCS eligible8526.8Borderline4915.5BCS ineligible16953.3Unknown144.4Clinical Response Complete20263.7Partial9229.0Stable30.9Progressing72.2Unknown134.1Pathologic Response pCR (No invasive or DCIS)7524No pCR24276Post NST Surgical recommendation BCS eligible16351.4BCS ineligible14445.4Unknown103.2Attempted surgery BCS8025.2MTX23674.1Unknown20.6Final Surgery BCS7423.3MTX24176unknown20.6
Citation Format: Kim HJ, Dominici L, Rosenberg S, Pak LM, Poorvu PD, Ruddy K, Tamimi R, Schapira L, Come S, Peppercorn J, Borges V, Warner E, Vardeh H, Collins L, King T, Partridge A. Surgical treatment after neoadjuvant systemic therapy in young women with breast cancer: Results from a prospective cohort study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS6-01.
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Affiliation(s)
- HJ Kim
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - L Dominici
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - S Rosenberg
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - LM Pak
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - PD Poorvu
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - K Ruddy
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - R Tamimi
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - L Schapira
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - S Come
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - J Peppercorn
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - V Borges
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - E Warner
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - H Vardeh
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - L Collins
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - T King
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
| | - A Partridge
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Stanford University, Palo Alto, CA; Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts General Hospital, Boston; University of Colorado Cancer Center, Aurora, CO; Sunnybrook Health Science Center, Toronto, Canada
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Gast KC, Cathcart-Rake EJ, Norman A, Eshragi L, Obidegwu N, Yost K, Nichols HB, Rosenberg S, Su HI, Stewart E, Couch F, Vachon C, Ruddy KJ. Abstract P1-12-10: Regimen-specific rates of chemotherapy-related amenorrhea in breast cancer survivors. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-12-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Chemotherapy can damage the ovaries and cause amenorrhea, a surrogate for infertility. Young women often wish to understand and minimize their risk of chemotherapy-related amenorrhea (CRA). However, the incidence of CRA with regimens that do not include either an anthracycline or cyclophosphamide is poorly studied. For patients with HER-2 positive disease, these anthracycline and cyclophosphamide-sparing regimens (e.g., docetaxel-carboplatin) are common (in combination with Her-2 directed therapy) in both the neoadjuvant and adjuvant settings.
Methods: Women diagnosed with breast cancer under age 50 and within the past 10 years were recruited through a Dr. Susan Love Research Foundation Army of Women e-mail blast. Those who provided their contact information were mailed a consent form and medical record authorization form. Participants then received a web-based survey that inquired about receipt of and type of chemotherapy (including date of last dose) and date of last menstrual period (LMP). Patient-reported LMP was compared to date of final chemotherapy dose to determine if the LMP occurred before (defined as “CRA”) or after the last chemotherapy dose. When available, medical record data was used in place of survey data regarding type of chemotherapy used. Exclusion criteria included: LMP prior to diagnosis date, receipt of multiple chemotherapy regimens or no chemotherapy regimens, receipt of ovarian suppression medications (which interfere with interpretation of menstrual data), surgical menopause prior to or at the same time as diagnosis, a cancer diagnosis more than 10 years prior, incomplete menstrual data on the survey, report of an unknown chemotherapy regimen, and no date available for the last chemotherapy dose without an LMP within a month prior to survey completion. Fisher Exact test was used to compare CRA rates between regimens. Rates after two anthracycline-sparing regimens (taxane/cyclophosphamide; taxane/carboplatin) were compared to rates after anthracycline/cyclophosphamide/taxane.
Results: 273 women consented to participate in this study, 258 of whom filled out the web survey. 151 of them were eligible for this analysis with a median age at diagnosis of 41 (range 24-49) and a median time from last chemotherapy dose to survey of 62.5 months (range 2-138). CRA occurred in 51.2% of the 86 participants who received an anthracycline, cyclophosphamide, and a taxane, in 41.9% of the 43 participants who received only a taxane and cyclophosphamide (p=0.35), and in 13.3% of the 15 participants who received carboplatin with a taxane (p=0.01). When the 11 patients who were <12 months since last chemotherapy were excluded, CRA rates changed minimally. Age did not differ by regimen, but median time since chemotherapy was shorter in the taxane/carboplatin group (35 months vs. 68 months). Trastuzumab with or without pertuzumab was administered in 100% of patients who received carboplatin/taxane, in 23.3% of patients who received taxane and cyclophosphamide, and in 22.1% of patients who received anthracycline/cyclophosphamide/taxane.
Conclusions: This study suggests that carboplatin/taxane may be substantially less gonadotoxic than cyclophosphamide-based (neo)adjuvant regimens. Further research is necessary to confirm these findings.
Citation Format: Gast KC, Cathcart-Rake EJ, Norman A, Eshragi L, Obidegwu N, Yost K, Nichols HB, Rosenberg S, Su HI, Stewart E, Couch F, Vachon C, Ruddy KJ. Regimen-specific rates of chemotherapy-related amenorrhea in breast cancer survivors [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-10.
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Affiliation(s)
- KC Gast
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
| | - EJ Cathcart-Rake
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
| | - A Norman
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
| | - L Eshragi
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
| | - N Obidegwu
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
| | - K Yost
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
| | - HB Nichols
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
| | - S Rosenberg
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
| | - HI Su
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
| | - E Stewart
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
| | - F Couch
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
| | - C Vachon
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
| | - KJ Ruddy
- Mayo Clinic, Rochester, MN; Dr. Susan Love Research Foundation, Encino, CA; University of North Carolina, Chapel Hill, NC; Dana Farber Cancer Institute, Boston, MA; University of California San Diego, San Diego, CA
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Abstract
OBJECTIVE: The objective of this study was to present an assessment of Australia's mental health system performance, within its social context, by comparison with other countries. METHOD: A review of existing literature and databases from both Australia and overseas was undertaken. Systems permitting international comparison of mental health and its social context are few. The review is limited in scope. RESULTS: Although Australia was one of the first nations to develop and adopt a national mental health policy (in 1992), the data that are available suggest that we are not World leaders across the identified domains. CONCLUSIONS: While international benchmarking can play an important role in fostering quality improvement, there are only limited mental health or social system performance data sources to utilise. It would be desirable for a more systematic international process to be established to review existing approaches and design a new multilateral strategy. It would be important that this new strategy reflected the full experience of mental health and its broader social context.
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Affiliation(s)
- Sebastian Rosenberg
- Fellow, Centre for Mental Health Research, Australian National University, Canberra, ACT, and; Senior Lecturer, Mental Health Policy Unit, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Co-Director, Health and Policy, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Ian Hickie
- Co-Director, Health and Policy, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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Rosenberg S. Activity-based funding and mental health: a rejoinder. Australas Psychiatry 2018; 26:325. [PMID: 29873560 DOI: 10.1177/1039856217749673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
We wanted the best, but it turned out like always. Victor Chernomydrin) 1 According to literary legend, Shangri-La is an idyllic and harmonious place. Mental health is aspiring to its own Shangri-La in the shape of better integrated care. But do current reforms make integrated practice more or less likely? And what can be done to increase the chances of success? The aim of this article is to review the current state of mental health reforms in Australia now under way across Primary Health Networks, the National Disability Insurance Scheme, psychosocial support services and elsewhere. What are these changes and what are the implications for the future of integrated mental health care? Is Shangri-La just over the horizon, or have we embarked instead on a fool's errand?
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Rosenberg S, Dehais C, Ducray F, Alentron A, Tanguy M, De Reyneis A, Elarouci N, Figarella-Branger D, Delattre J, Idbaih A. OS11.3 Machine learning for better prognostic stratification and driver genes identification in 1p/19q-codeleted grade III gliomas. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rosenberg S, Salvador-Carulla L. PERSPECTIVES: Accountability for Mental Health: The Australian Experience. J Ment Health Policy Econ 2017; 20:37-54. [PMID: 28418836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 08/20/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Australia was one of the first countries to develop a national policy for mental health. A persistent characteristic of all these policies has been their reference to the importance of accountability. What does this mean exactly and have we achieved it? Can Australia tell if anybody is getting better? AIMS OF THE STUDY To review accountability for mental health in Australia and question whether two decades of Australian rhetoric around accountability for mental health has been fulfilled. METHODS This paper first considers the concept of accountability and its application to mental health. We then draw on existing literature, reports, and empirical data from national and state governments to illustrate historical and current approaches to accountability for mental health. We provide a content analysis of the most current set of national indicators. The paper also briefly considers some relevant international processes to compare Australia's progress in establishing accountability for mental health. RESULTS Australia's federated system of government permits competing approaches to accountability, with multiple and overlapping data sets. A clear national approach to accountability for mental health has failed to emerge. Existing data focuses on administrative and health service indicators, failing to reflect broader social factors which reveal quality of life. In spite of twenty years of investment and effort Australia has been described as outcome blind, unable to demonstrate the merit of USD 8bn spent on mental health annually. DISCUSSION AND LIMITATIONS While it may be prolific, existing administrative data provide little outcomes information against which Australia can genuinely assess the health and welfare of people with a mental illness. International efforts are evolving slowly. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE Even in high income countries such as Australia, resources for mental health services are constrained. Countries cannot afford to continue to invest in services or programs that fail to demonstrate good outcomes for people with a mental illness or are not value for money. IMPLICATIONS FOR HEALTH POLICIES New approaches are needed which ensure that chosen accountability indicators reflect national health and social priorities. Such priorities must be meaningful to a range of stakeholders and the community about the state of mental health. They must drive an agenda of continuous improvement relevant to those most affected by mental disorders. These approaches should be operable in emerging international contexts. IMPLICATIONS FOR FURTHER RESEARCH Australia must further develop its approach to health accountability in relation to mental health. A limited set of new preferred national mental health indicators should be agreed. These should be tested, both domestically and internationally, for their capacity to inform and drive quality improvement processes in mental health. CONCLUSION Existing systems of accountability are not fit for purpose, incapable of firing necessary quality improvement processes. Supported by adequate resources, realistic targets and a culture of openness, new accountability could drive real quality improvement processes for mental health, facilitate jurisdictional comparisons in Australia, and contribute to new efforts to benchmark mental health internationally.
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Affiliation(s)
- Sebastian Rosenberg
- Mental Health Policy Unit, Brain and Mind Centre, Faculty of Health Sciences, University of Sydney,
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Zick A, Peretz T, Lotem M, Hubert A, Katz D, Temper M, Rottenberg Y, Uziely B, Nechushtan H, Meirovitz A, Sonnenblick A, Sapir E, Edelman D, Goldberg Y, Lossos A, Rosenberg S, Fried I, Finklstein R, Pikarsky E, Goldshmidt H. Treatment inferred from mutations identified using massive parallel sequencing leads to clinical benefit in some heavily pretreated cancer patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mittauer K, Rosenberg S, Geurts M, Bassetti M, Chen I, Henke L, Olsen J, Kashani R, Wojcieszynski A, Harari P, Labby Z, Hill P, Paliwal B, Parikh P, Bayouth J. TU-AB-BRA-11: Indications for Online Adaptive Radiotherapy Based On Dosimetric Consequences of Interfractional Pancreas-To-Duodenum Motion in MRI-Guided Pancreatic Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4957421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Rosenberg S, Ruddy K, Tamimi R, Gelber S, Schapira L, Come S, Borges V, Larsen B, Garber J, Partridge A. PO18 BRCA1/BRCA2 (BRCA) testing in young women with breast cancer: patterns; motivations and implications for treatment decisions. Breast 2014. [DOI: 10.1016/s0960-9776(14)70028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rosenberg S, Meirrovitz A, Leker R, Mordechai A, Linetzky E, Cohen J, Peretz T, Lossos A. P18.05 * TREATMENT OF ACUTE ISCHEMIC STROKE IN CANCER PATIENTS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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