15 results on '"Pulkki-Brannstrom, Anni-Maria"'
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2. Maternal and neonatal health expenditure in mumbai slums (India): A cross sectional study
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Joshi Wasundhara, More Neena S, Das Sushmita, Bapat Ujwala, Pace Noemi, Skordis-Worrall Jolene, Pulkki-Brannstrom Anni-Maria, and Osrin David
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background The cost of maternity care can be a barrier to access that may increase maternal and neonatal mortality risk. We analyzed spending on maternity care in urban slum communities in Mumbai to better understand the equity of spending and the impact of spending on household poverty. Methods We used expenditure data for maternal and neonatal care, collected during post-partum interviews. Interviews were conducted in 2005-2006, with a sample of 1200 slum residents in Mumbai (India). We analysed expenditure by socio-economic status (SES), calculating a Kakwani Index for a range of spending categories. We also calculated catastrophic health spending both with and without adjustment for coping strategies. This identified the level of catastrophic payments incurred by a household and the prevalence of catastrophic payments in this population. The analysis also gave an understanding of the protection from medical poverty afforded by coping strategies (for example saving and borrowing). Results A high proportion of respondents spent catastrophically on care. Lower SES was associated with a higher proportion of informal payments. Indirect health expenditure was found to be (weakly) regressive as the poorest were more likely to use wage income to meet health expenses, while the less poor were more likely to use savings. Overall, the incidence of catastrophic maternity expenditure was 41%, or 15% when controlling for coping strategies. We found no significant difference in the incidence of catastrophic spending across wealth quintiles, nor could we conclude that total expenditure is regressive. Conclusions High expenditure as a proportion of household resources should alert policymakers to the burden of maternal spending in this context. Differences in informal payments, significantly regressive indirect spending and the use of savings versus wages to finance spending, all highlight the heavier burden borne by the most poor. If a policy objective is to increase institutional deliveries without forcing households deeper into poverty, these inequities will need to be addressed. Reducing out-of-pocket payments and better regulating informal payments should have direct benefits for the most poor. Alternatively, targeted schemes aimed at assisting the most poor in coping with maternal spending (including indirect spending) could reduce the household impact of high costs.
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- 2011
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3. Experiences in running a complex electronic data capture system using mobile phones in a large-scale population trial in southern Nepal
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Style, Sarah, Beard, B. James, Harris-Fry, Helen, Sengupta, Aman, Jha, Sonali, Shrestha, Bhim P., Rai, Anjana, Paudel, Vikas, Thondoo, Meelan, Pulkki-Brannstrom, Anni-Maria, Skordis-Worrall, Jolene, Manandhar, Dharma S., Costello, Anthony, and Saville, Naomi M.
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electronic data capture ,Adult ,Rural Population ,Text Messaging ,Study Design Article ,lcsh:Public aspects of medicine ,Data Collection ,Social Support ,lcsh:RA1-1270 ,Public Assistance ,Article ,mHealth ,Nepal ,Pregnancy ,CommCare ,mobile data ,Humans ,Female ,ODK Collect ,Cell Phone - Abstract
The increasing availability and capabilities of mobile phones make them a feasible means of data collection. Electronic Data Capture (EDC) systems have been used widely for public health monitoring and surveillance activities, but documentation of their use in complicated research studies requiring multiple systems is limited. This paper shares our experiences of designing and implementing a complex multi-component EDC system for a community-based four-armed cluster-Randomised Controlled Trial in the rural plains of Nepal, to help other researchers planning to use EDC for complex studies in low-income settings. We designed and implemented three interrelated mobile phone data collection systems to enrol and follow-up pregnant women (trial participants), and to support the implementation of trial interventions (women’s groups, food and cash transfers). 720 field staff used basic phones to send simple coded text messages, 539 women’s group facilitators used Android smartphones with Open Data Kit Collect, and 112 Interviewers, Coordinators and Supervisors used smartphones with CommCare. Barcoded photo ID cards encoded with participant information were generated for each enrolled woman. Automated systems were developed to download, recode and merge data for nearly real-time access by researchers. The systems were successfully rolled out and used by 1371 staff. A total of 25,089 pregnant women were enrolled, and 17,839 follow-up forms completed. Women’s group facilitators recorded 5717 women’s groups and the distribution of 14,647 food and 13,482 cash transfers. Using EDC sped up data collection and processing, although time needed for programming and set-up delayed the study inception. EDC using three interlinked mobile data management systems (FrontlineSMS, ODK and CommCare) was a feasible and effective method of data capture in a complex large-scale trial in the plains of Nepal. Despite challenges including prolonged set-up times, the systems met multiple data collection needs for users with varying levels of literacy and experience.
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- 2017
4. Protocol of the Low Birth Weight South Asia Trial (LBWSAT), a cluster-randomised controlled trial testing impact on birth weight and infant nutrition of Participatory Learning and Action through women's groups, with and without unconditional transfers of fortified food or cash during pregnancy in Nepal
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Saville, Naomi M., Shrestha, Bhim P., Style, Sarah, Harris-Fry, Helen, Beard, B. James, Sengupta, Aman, Jha, Sonali, Rai, Anjana, Paudel, Vikas, Pulkki-Brannstrom, Anni-Maria, Copas, Andrew, Skordis-Worrall, Jolene, Bhandari, Bishnu, Neupane, Rishi, Morrison, Joanna, Gram, Lu, Sah, Raghbendra, Basnet, Machhindra, Harthan, Jayne, Manandhar, Dharma S., Osrin, David, and Costello, Anthony
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Adult ,Male ,Food supplement ,Nutritional Status ,Study Protocol ,Young Adult ,Nepal ,Prenatal Education ,Reward ,Pregnancy ,Obstetrics and Gynaecology ,Cluster Analysis ,Humans ,Learning ,Women ,Infant Nutritional Physiological Phenomena ,Nutrition ,Infant, Newborn ,Pregnancy Outcome ,Infant ,Feeding Behavior ,Infant, Low Birth Weight ,Newborn ,Low birth weight ,Food, Fortified ,Female ,Maternal health ,Cash transfer ,Program Evaluation - Abstract
Background Low birth weight (LBW, < 2500 g) affects one third of newborn infants in rural south Asia and compromises child survival, infant growth, educational performance and economic prospects. We aimed to assess the impact on birth weight and weight-for-age Z-score in children aged 0–16 months of a nutrition Participatory Learning and Action behaviour change strategy (PLA) for pregnant women through women’s groups, with or without unconditional transfers of food or cash to pregnant women in two districts of southern Nepal. Methods The study is a cluster randomised controlled trial (non-blinded). PLA comprises women’s groups that discuss, and form strategies about, nutrition in pregnancy, low birth weight and hygiene. Women receive up to 7 monthly transfers per pregnancy: cash is NPR 750 (~US$7) and food is 10 kg of fortified sweetened wheat-soya Super Cereal per month. The unit of randomisation is a rural village development committee (VDC) cluster (population 4000–9200, mean 6150) in southern Dhanusha or Mahottari districts. 80 VDCs are randomised to four arms using a participatory ‘tombola’ method. Twenty clusters each receive: PLA; PLA plus food; PLA plus cash; and standard care (control). Participants are (mostly Maithili-speaking) pregnant women identified from 8 weeks’ gestation onwards, and their infants (target sample size 8880 birth weights). After pregnancy verification, mothers may be followed up in early and late pregnancy, within 72 h, after 42 days and within 22 months of birth. Outcomes pertain to the individual level. Primary outcomes include birth weight within 72 h of birth and infant weight-for-age Z-score measured cross-sectionally on children born of the study. Secondary outcomes include prevalence of LBW, eating behaviour and weight during pregnancy, maternal and newborn illness, preterm delivery, miscarriage, stillbirth or neonatal mortality, infant Z-scores for length-for-age and weight-for-length, head circumference, and postnatal maternal BMI and mid-upper arm circumference. Exposure to women’s groups, food or cash transfers, home visits, and group interventions are measured. Discussion Determining the relative importance to birth weight and early childhood nutrition of adding food or cash transfers to PLA women’s groups will inform design of nutrition interventions in pregnancy. Trial registration ISRCTN75964374, 12 Jul 2013 Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1102-x) contains supplementary material, which is available to authorized users.
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- 2016
5. Association between clean delivery kit use, clean delivery practices, and neonatal survival: pooled analysis of data from three sites in South Asia
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Seward, Nadine, Osrin, David, Li, Leah, Costello, Anthony, Pulkki-Brannstrom, Anni-Maria, Houweling, Tanja A.J., Morrison, Joanna, Nair, Nirmala, Tripathy, Prasanta, Azad, Kishwar, Manandhar, Dharma, and Prost, Audrey
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Medical equipment -- Management ,Medicine -- Practice ,Physiological apparatus -- Management ,Infants (Newborn) -- Physiological aspects -- Care and treatment ,Company business management ,Biological sciences - Abstract
Background: Sepsis accounts for up to 15% of an estimated 3.3 million annual neonatal deaths globally. We used data collected from the control arms of three previously conducted cluster-randomised controlled trials in rural Bangladesh, India, and Nepal to examine the association between clean delivery kit use or clean delivery practices and neonatal mortality among home births. Methods and Findings: Hierarchical, logistic regression models were used to explore the association between neonatal mortality and clean delivery kit use or clean delivery practices in 19,754 home births, controlling for confounders common to all study sites. We tested the association between kit use and neonatal mortality using a pooled dataset from all three sites and separately for each site. We then examined the association between individual clean delivery practices addressed in the contents of the kit (boiled blade and thread, plastic sheet, gloves, hand washing, and appropriate cord care) and neonatal mortality. Finally, we examined the combined association between mortality and four specific clean delivery practices (boiled blade and thread, hand washing, and plastic sheet). Using the pooled dataset, we found that kit use was associated with a relative reduction in neonatal mortality (adjusted odds ratio 0.52, 95% CI 0.39-0.68). While use of a clean delivery kit was not always accompanied by clean delivery practices, using a plastic sheet during delivery, a boiled blade to cut the cord, a boiled thread to tie the cord, and antiseptic to clean the umbilicus were each significantly associated with relative reductions in mortality, independently of kit use. Each additional clean delivery practice used was associated with a 16% relative reduction in neonatal mortality (odds ratio 0.84, 95% CI 0.77-0.92). Conclusions: The appropriate use of a clean delivery kit or clean delivery practices is associated with relative reductions in neonatal mortality among home births in underserved, rural populations. Please see later in the article for the Editors' Summary., Introduction Every year, an estimated 3.3 million newborn infants worldwide die in the first month of life, 99% of them in low- and middle-income countries, and 35% of them in [...]
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- 2012
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6. Experiences in running a complex electronic data capture system using mobile phones in a large-scale population trial in southern Nepal
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Style, Sarah, primary, Beard, B. James, additional, Harris-Fry, Helen, additional, Sengupta, Aman, additional, Jha, Sonali, additional, Shrestha, Bhim P., additional, Rai, Anjana, additional, Paudel, Vikas, additional, Thondoo, Meelan, additional, Pulkki-Brannstrom, Anni-Maria, additional, Skordis-Worrall, Jolene, additional, Manandhar, Dharma S., additional, Costello, Anthony, additional, and Saville, Naomi M., additional
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- 2017
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7. Comparing the cost effectiveness of harm reduction strategies : a case study of the Ukraine
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Kim, Sung, Pulkki-Brannstrom, Anni-Maria, and Skordis-Worrall, Jolene
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Opioid substitution therapy ,Harm reduction ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Global Fund ,Cost effectiveness analysis ,Health Policy ,Research ,Needle and syringe programme ,Public Health, Global Health, Social Medicine and Epidemiology ,Ukraine ,health care economics and organizations ,Markov Monte Carlo simulation - Abstract
Background Harm reduction strategies commonly include needle and syringe programmes (NSP), opioid substitution therapy (OST) and interventions combining these two strategies. Despite the proven effectiveness of harm-reduction strategies in reducing human immunodeficiency virus (HIV) infection among injecting drug users (IDUs), no study has compared the cost-effectiveness of these interventions, nor the incremental cost effectiveness of combined therapy. Using data from the Global Fund, this study compares the cost-effectiveness of harm reduction strategies in Eastern Europe and Central Asia, using the Ukraine as a case study. Methods A Markov Monte Carlo simulation is carried out using parameters from the literature and cost data from the Global Fund. Effectiveness is presented as both QALYs and infections averted. Costs are measured in 2011 US dollars. Results The Markov Monte Carlo simulation estimates the cost-effectiveness ratio per infection averted as $487.4 [95% CI: 488.47-486.35] in NSP and $1145.9 [95% CI: 1143.39-1148.43] in OST. Combined intervention is more costly but more effective than the alternative strategies with a cost effectiveness ratio of $851.6[95% CI: 849.82-853.55]. The ICER of the combined strategy is $1086.9/QALY [95% CI: 1077.76:1096.24] compared with NSP, and $461.0/infection averted [95% CI: 452.98:469.04] compared with OST. These results are consistent with previous studies. Conclusions Despite the inherent limitations of retrospective data, this study provides evidence that harm-reduction interventions are a cost-effective way to reduce HIV prevalence. More research on into cost effectiveness in different settings, and the availability of fiscal space for government uptake of programmes, is required.
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- 2014
8. Comparing the cost effectiveness of harm reduction strategies: a case study of the Ukraine
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Kim, Sung, primary, Pulkki-Brannstrom, Anni-Maria, additional, and Skordis-Worrall, Jolene, additional
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- 2014
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9. The Effect of Increased Coverage of Participatory Women’s Groups on Neonatal Mortality in Bangladesh
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Fottrell, Edward, primary, Azad, Kishwar, additional, Kuddus, Abdul, additional, Younes, Layla, additional, Shaha, Sanjit, additional, Nahar, Tasmin, additional, Aumon, Bedowra Haq, additional, Hossen, Munir, additional, Beard, James, additional, Hossain, Tanvir, additional, Pulkki-Brannstrom, Anni-Maria, additional, Skordis-Worrall, Jolene, additional, Prost, Audrey, additional, Costello, Anthony, additional, and Houweling, Tanja A. J., additional
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- 2013
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10. Maternal and neonatal health expenditure in mumbai slums (India): A cross sectional study
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Skordis-Worrall, Jolene, primary, Pace, Noemi, additional, Bapat, Ujwala, additional, Das, Sushmita, additional, More, Neena S, additional, Joshi, Wasundhara, additional, Pulkki-Brannstrom, Anni-Maria, additional, and Osrin, David, additional
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- 2011
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11. Comparing the cost effectiveness of harm reduction strategies: a case study of the Ukraine.
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Sung Wook Kim, Pulkki-Brannstrom, Anni-Maria, and Skordis-Worrall, Jolene
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ECONOMIC statistics , *HIV prevention , *METHADONE treatment programs , *PREVENTION of infectious disease transmission , *ECONOMICS , *COMBINED modality therapy , *COMPUTER simulation , *CONFIDENCE intervals , *COST effectiveness , *CASE studies , *NEEDLE exchange programs , *QUESTIONNAIRES , *HARM reduction , *INTRAVENOUS drug abusers , *PREDICTIVE validity , *TREATMENT effectiveness , *RETROSPECTIVE studies , *DESCRIPTIVE statistics - Abstract
Background Harm reduction strategies commonly include needle and syringe programmes (NSP), opioid substitution therapy (OST) and interventions combining these two strategies. Despite the proven effectiveness of harm-reduction strategies in reducing human immunodeficiency virus (HIV) infection among injecting drug users (IDUs), no study has compared the cost- effectiveness of these interventions, nor the incremental cost effectiveness of combined therapy. Using data from the Global Fund, this study compares the cost-effectiveness of harm reduction strategies in Eastern Europe and Central Asia, using the Ukraine as a case study. Methods A Markov Monte Carlo simulation is carried out using parameters from the literature and cost data from the Global Fund. Effectiveness is presented as both QALYs and infections averted. Costs are measured in 2011 US dollars. Results The Markov Monte Carlo simulation estimates the cost-effectiveness ratio per infection averted as $487.4 [95% CI: 488.47-486.35] in NSP and $1145.9 [95% CI: 1143.39-1148.43] in OST. Combined intervention is more costly but more effective than the alternative strategies with a cost effectiveness ratio of $851.6[95% CI: 849.82-853.55]. The ICER of the combined strategy is $1086.9/QALY [95% CI:1077.76:1096.24] compared with NSP, and $461.0/infection averted [95% CI: 452.98:469.04] compared with OST. These results are consistent with previous studies. Conclusions Despite the inherent limitations of retrospective data, this study provides evidence that harm- reduction interventions are a cost-effective way to reduce HIV prevalence. More research on into cost effectiveness in different settings, and the availability of fiscal space for government uptake of programmes, is required. [ABSTRACT FROM AUTHOR]
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- 2014
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12. Tobacco-Free Duo Adult-Child Contract for Prevention of Tobacco Use Among Adolescents and Parents: Protocol for a Mixed-Design Evaluation
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Galanti, Maria Rosaria, Pulkki-Brännström, Anni-Maria, and Nilsson, Maria
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Medicine ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
BackgroundUniversal tobacco-prevention programs targeting youths usually involve significant adults, who are assumed to be important social influences. Commitment not to use tobacco, or to quit use, as a formal contract between an adolescent and a significant adult is a preventive model that has not been widely practiced or explored and has been formally evaluated even less. In this paper, we present the rationale and protocol for the evaluation of the Swedish Tobacco-free Duo program, a multicomponent school-based program the core of which rests on a formal agreement between an adolescent and an adult. The adolescent’s commitment mainly concerns avoiding the onset of any tobacco use while the adult commits to support the adolescent in staying tobacco free, being a role model by not using tobacco themselves. ObjectiveTo assess (1) whether Tobacco-free Duo is superior to an education-only program in preventing smoking onset among adolescents and promoting cessation among their parents, (2) whether exposure to core components (adult-child agreement) entails more positive effects than exposure to other components, (3) the impact of the program on whole school tobacco use, (4) potential negative side effects, and (5) school-level factors related to fidelity of the program’s implementation. MethodsA mixed-design approach was developed. First, a cluster randomized controlled trial was designed with schools randomly assigned to either the comprehensive multicomponent program or its educational component only. Primary outcome at the adolescent level was identified as not having tried tobacco during the 3-year junior high school compulsory grades (12-15 years of age). An intention-to-treat cohort-wise approach and an as-treated approach complemented with a whole school repeated cross-sectional approach was devised as analytical methods of the trial data. Second, an observational study was added in order to compare smoking incidence in the schools participating in the experiment with that of a convenience sample of schools that were not part of the experimental study. Diverse secondary outcomes at both adolescent and adult levels were also included. ResultsThe study was approved by the Umeå Regional Ethics Review Board (registration number 2017/255-31) in 2017. Recruitment of schools started in fall 2017 and continued until June 2018. In total, 43 schools were recruited to the experimental study, and 16 schools were recruited to the observational study. Data collection started in the fall 2018, is ongoing, and is planned to be finished in spring 2021. ConclusionsMethodological, ethical, and practical implications of the evaluation protocol were discussed, especially the advantage of combining several sources of data, to triangulate the study questions. The results of these studies will help revise the agenda of this program as well as those of similar programs. Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 52858080; https://doi.org/10.1186/ISRCTN52858080 International Registered Report Identifier (IRRID)DERR1-10.2196/21100
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- 2020
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13. Development and Formative Evaluation of a Visual E-Tool to Help Decision Makers Navigate the Evidence Around Health Financing
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Skordis-Worrall, Jolene, Pulkki-Brännström, Anni-Maria, Utley, Martin, Kembhavi, Gayatri, Bricki, Nouria, Dutoit, Xavier, Rosato, Mikey, and Pagel, Christina
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Medicine ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
BackgroundThere are calls for low and middle income countries to develop robust health financing policies to increase service coverage. However, existing evidence around financing options is complex and often difficult for policy makers to access. ObjectiveTo summarize the evidence on the impact of financing health systems and develop an e-tool to help decision makers navigate the findings. MethodsAfter reviewing the literature, we used thematic analysis to summarize the impact of 7 common health financing mechanisms on 5 common health system goals. Information on the relevance of each study to a user’s context was provided by 11 country indicators. A Web-based e-tool was then developed to assist users in navigating the literature review. This tool was evaluated using feedback from early users, collected using an online survey and in-depth interviews with key informants. ResultsThe e-tool provides graphical summaries that allow a user to assess the following parameters with a single snapshot: the number of relevant studies available in the literature, the heterogeneity of evidence, where key evidence is lacking, and how closely the evidence matches their own context. Users particularly liked the visual display and found navigating the tool intuitive. However there was concern that a lack of evidence on positive impact might be construed as evidence against a financing option and that the tool might over-simplify the available financing options. ConclusionsComplex evidence can be made more easily accessible and potentially more understandable using basic Web-based technology and innovative graphical representations that match findings to the users’ goals and context.
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- 2012
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14. Cost-effectiveness of Radiofrequency Denervation for Zygapophyseal Joint Pain.
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Hambraeus J, Pulkki-Brannstrom AM, and Lindholm L
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- Arthralgia, Cost-Benefit Analysis, Denervation, Humans, Quality of Life, Quality-Adjusted Life Years, Zygapophyseal Joint surgery
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Background: Chronic pain is a leading cause of disability. Radiofrequency denervation (RFD) is effective when performed according to guidelines for patients with correctly diagnosed zygapophyseal joint pain (ZJP). However, the cost-effectiveness of this method has not been fully explored., Objective: The aim of this study was to analyze whether RFD is cost-effective for ZJP from a societal perspective., Study Design: Cost effectiveness study based on an observational study., Setting: An interventional pain management clinic in central Sweden., Methods: Patients - This cost-effectiveness study was performed for all patients (n = 873) assessed between 2010 and 2016 at a specialized interventional pain clinic in Sweden. Those diagnosed with ZJP (n = 331, 37.9%) were treated with RFD and followed up for 1 year after the RFD. Using data collected from national registers, we determined the health care costs, medication costs, the patients' time and travel costs, and the patients' ability to work. The effects of RFD on quality-adjusted life years (QALY) and cost/QALY gained were calculated., Results: On average, patients reported very low health-related quality of life (HRQoL; EQ-5D index: 0.212). After RFD, HRQoL increased significantly to 0.530 (P < 0.0001). Drug consumption and specialized health care consumption were reduced by 54% and 81%, respectively, and the cost/QALY gained from a societal perspective was 221,324 Swedish krona (USD ~26,008). The sensitivity analysis showed that the treatment was cost-effective in all scenarios evaluated, using the patients as their own controls. The cost/QALY gained from a health care perspective was 72,749 Swedish krona (USD ~8,548)., Limitations: The results are based on data collected at one center. The results need to be compared with those from pain rehabilitation programs and should be confirmed using data from other centers., Conclusions: Patients referred for RFD in Sweden report extremely low HRQoL. HRQoL significantly increased following RFD in patients with ZJP. Medications and health care consumption decreased after RFD. RFD was cost-effective, and the sensitivity analysis yielded stable results in different scenarios. Therefore, RFD is a cost-effective treatment that meets the Swedish National Board of Health and Welfare criteria for a high priority treatment., Trial Registration: The study was registered at ClinicalTrials.gov (NCT01835704) with Protocol ID SE-Dnr-2012-446-31M-1. https://clinicaltrials.gov/ct2/show/NCT01835704.
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- 2021
15. Protocol of the Low Birth Weight South Asia Trial (LBWSAT), a cluster-randomised controlled trial testing impact on birth weight and infant nutrition of Participatory Learning and Action through women's groups, with and without unconditional transfers of fortified food or cash during pregnancy in Nepal.
- Author
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Saville NM, Shrestha BP, Style S, Harris-Fry H, Beard BJ, Sengupta A, Jha S, Rai A, Paudel V, Pulkki-Brannstrom AM, Copas A, Skordis-Worrall J, Bhandari B, Neupane R, Morrison J, Gram L, Sah R, Basnet M, Harthan J, Manandhar DS, Osrin D, and Costello A
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- Adult, Cluster Analysis, Female, Food, Fortified, Humans, Infant, Infant Nutritional Physiological Phenomena, Infant, Newborn, Learning, Male, Nepal, Nutritional Status, Pregnancy, Pregnancy Outcome, Program Evaluation methods, Young Adult, Feeding Behavior psychology, Infant, Low Birth Weight, Prenatal Education methods, Reward, Women
- Abstract
Background: Low birth weight (LBW, < 2500 g) affects one third of newborn infants in rural south Asia and compromises child survival, infant growth, educational performance and economic prospects. We aimed to assess the impact on birth weight and weight-for-age Z-score in children aged 0-16 months of a nutrition Participatory Learning and Action behaviour change strategy (PLA) for pregnant women through women's groups, with or without unconditional transfers of food or cash to pregnant women in two districts of southern Nepal., Methods: The study is a cluster randomised controlled trial (non-blinded). PLA comprises women's groups that discuss, and form strategies about, nutrition in pregnancy, low birth weight and hygiene. Women receive up to 7 monthly transfers per pregnancy: cash is NPR 750 (~US$7) and food is 10 kg of fortified sweetened wheat-soya Super Cereal per month. The unit of randomisation is a rural village development committee (VDC) cluster (population 4000-9200, mean 6150) in southern Dhanusha or Mahottari districts. 80 VDCs are randomised to four arms using a participatory 'tombola' method. Twenty clusters each receive: PLA; PLA plus food; PLA plus cash; and standard care (control). Participants are (mostly Maithili-speaking) pregnant women identified from 8 weeks' gestation onwards, and their infants (target sample size 8880 birth weights). After pregnancy verification, mothers may be followed up in early and late pregnancy, within 72 h, after 42 days and within 22 months of birth. Outcomes pertain to the individual level. Primary outcomes include birth weight within 72 h of birth and infant weight-for-age Z-score measured cross-sectionally on children born of the study. Secondary outcomes include prevalence of LBW, eating behaviour and weight during pregnancy, maternal and newborn illness, preterm delivery, miscarriage, stillbirth or neonatal mortality, infant Z-scores for length-for-age and weight-for-length, head circumference, and postnatal maternal BMI and mid-upper arm circumference. Exposure to women's groups, food or cash transfers, home visits, and group interventions are measured., Discussion: Determining the relative importance to birth weight and early childhood nutrition of adding food or cash transfers to PLA women's groups will inform design of nutrition interventions in pregnancy., Trial Registration: ISRCTN75964374 , 12 Jul 2013.
- Published
- 2016
- Full Text
- View/download PDF
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