Cost-effectiveness Of Interventions For Children Research Articles

Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review.

This systematic review protocol aims to examine the evidence of effectiveness and cost-effectiveness of interventions for children and adolescents with, or at risk of developing mental disorders in low- and middle-income countries (LAMICs). We will search Medline Ovid, EMBASE Ovid, PsycINFO Ovid, CINAHL, LILACS, BDENF and IBECS. We will include randomised and non-randomised controlled trials, economic modelling studies and economic evaluations. Participants are 6 to 18 year-old children and adolescents who live in a LAMIC and who present with, or are at high risk of developing, one or more of the conditions: depression, anxiety, behavioural disorders, eating disorders, psychosis, substance abuse, autism and intellectual disabilities as defined by the DSM-V. Interventions which address suicide, self-harm will also be included, if identified during the extraction process. We will include in person or e-health interventions which have some evidence of effectiveness (in relation to clinical and/or functional outcomes) and which have been delivered to young people in LAMICs. We will consider a wide range of delivery channels (e.g., in person, web-based or virtual, phone), different practitioners (healthcare practitioners, teachers, lay health care providers) and sectors (i.e., primary, secondary and tertiary health care, education, guardianship councils). In the pilot of screening procedures, 5% of all references will be screened by two reviewers. Divergences will be resolved by one expert in mental health research. Reviewers will be retrained afterwards to ensure reliability. The remaining 95% will be screened by one reviewer. Covidence web-based tool will be used to perform screening of references and full text paper, and data extraction. The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. The results will be presented descriptively and, if possible, meta-analysis will be conducted. Ethical approval is not needed for anonymised secondary data. the systematic review could help health specialists and other professionals to identify evidence-based strategies to deal with child and adolescents with mental health conditions.

The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome.

New insights into the phenotype of Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome-hypermobile type (hEDS) have raised many issues in relation to classification, diagnosis, assessment, and treatment. Within the multidisciplinary team, physical therapy plays a central role in management of individuals with hypermobility related disorders. However, many physical therapists are not familiar with the diagnostic criteria, prevalence, common clinical presentation, and management. This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children, adolescents, and adults with JHS/hEDS. Due to the complexity of the symptoms in the profile of JHS/hEDS, the International Classification of Functioning, Disability and Health (ICF) is adopted as a central framework whereby the umbrella term of disability is used to encompass functions, activities and participation, as well as environmental and personal factors. The current evidence-based literature regarding the management of JHS/hEDS is limited in size and quality and there is insufficient research exploring the clinical outcomes of a number of interventions. Multicenter randomized controlled trials are warranted to assess the clinical and cost-effectiveness of interventions for children and adults. Until further multicenter trials are conducted, clinical decision-making should be based on theoretical and the current limited research evidence. For all individuals diagnosed with JHS/hEDS, international consensus and combined efforts to identify risk profiles would create a better understanding of the pathological mechanisms and the potential for optimizing health care for affected individuals. © 2017 Wiley Periodicals, Inc.

Community preventive interventions for children of parents with serious mental illness: a commentary on the evidence base

Improving the lives of children of parents with serious mental illnesses (SMI) such as schizophrenia, major depression and bipolar disorder is of urgent political and public health concern. Parental SMI is associated with increased risk of multiple adverse child outcomes including poorer short-term mental and physical health, behavioural, social and educational difficulties, maltreatment and neglect (Goodman et al., 2011; Royal College of Psychiatrists [RCPsych], 2011). Longer term outcomes can extend into adulthood and include increased risk of psychiatric morbidity, socio-occupational dysfunction, alcohol or substance misuse and premature death (Goodman et al., 2011; RCPsych, 2011; Weissman, Warner, Wickramaratne, Moreau, & Olfson, 1997). This commentary discusses the existing evidence base for community-based interventions in maintaining or improving health and well-being in the children of parents with SMI, based on the findings of a recent systematic review.National initiatives such as the Australian children of parents with mental illness (COPMI) programme aim to promote better mental health outcomes for the COPMI. The rationale for such initiatives is attracting international support, with contemporary health and social-care policies in countries such as the UK similarly asking for enhanced service provision and family support (Diggins, 2011). The key challenge we are left with is in knowing when and how best to intervene. With increasing emphasis on evidence-based practice, there is a pressing need to demonstrate the clinical effectiveness and cost-effectiveness of interventions for children and families living with parental mental illness.A recent systematic review, funded by the UK National Institute for Health Research, has evaluated the international evidence base for the clinical and cost-effectiveness of community-based interventions for enhancing or maintaining quality of life (QoL) in children living with parents with serious mental illness (Bee et al., 2014). This commissioned review is the largest and most comprehensive review of the international evidence for preventative interventions for families living with SMI to date, and the first and only review focussed on maintaining children's QoL.Our review confirms that the existing evidence for community interventions to enhance the QoL of children of parents with SMI is severely lacking and, in its current form, cannot provide an adequate rationale on which to base practice or service development. Despite thorough and comprehensive searches, we were only able to identify three randomized controlled trials, all conducted in the USA more than two decades previously. All three trials evaluated interventions for maternal psychosis and were heavily targeted towards group-based models seeking to enhance parenting behaviours in the mothers of children aged less than 12 years old. No validated measures of children's QoL or emotional well-being were reported and secondary outcomes were focused on observer ratings of child behaviour and cognitive function. The relevance of these data to current healthcare systems is unclear. Service configuration models and the interface between adult psychiatric services, children's services and social care will vary considerably, both between countries and over time. Equally, children's own QoL judgements are likely to be influenced by the cultural and temporal contexts in which they occur. Doubt therefore exists as to the generalizability of this evidence to contemporary children living with serious parental mental illness.In our review, contemporary evidence of the effectiveness of community interventions to enhance life quality in the children of parents with severe mental illness was limited to a small number of non-randomized studies, traditionally considered lower quality evidence than well-conducted randomized trials capable of demonstrating cause and effect. Four non-randomized trials were eligible for inclusion in our review, three of which were Australian studies published within the last 4 years (i. …

The development of a preference-based measure of health in children with atopic dermatitis

Outcomes of health care interventions can be measured in many different ways, but there has been growing interest in the role that quality-adjusted life-years (QALYs) can play in informing priorities in health care. While existing generic preference-based measures can be used to obtain QALYs, these measures may often be inappropriate for some conditions such as atopic dermatitis (AD). These measures are also usually developed for adults and may not capture the domains pertinent to children. To develop a preference-based quality-of-life measure for use in children with AD. Items generated from interviews conducted with parents of children with AD were used to form a health state classification system that gives 16 unique health states. One hundred and fifty members of the general population were interviewed to derive preference weights for these states, following the methods used in the valuation of the Health Utilities Index 2 (HUI 2). Each person valued 10 health states using the standard gamble technique. The primary analysis was the estimation of mean health state values for each of the 16 states. Mean values across the 16 health states range from 0.36 (SD = 0.36) for the worst state to 0.84 (SD = 0.19) on a scale from zero to one, where zero is for health states thought to be as bad as being dead and one is for perfect health. There was some support for the validity of the values from the fact that the values were logically consistent with the ordering of the health state classification system. These results show the perceived importance of the defined health states of childhood AD to the general population. The resultant health state classification and values can be used to calculate QALYs for use in assessing the cost-effectiveness of interventions for children with AD.