Cost-utility analysis of a telehealth psychological support intervention for people with primary brain tumor: Telehealth Making Sense of brain tumor.

OBJECTIVE: To undertake an economic evaluation of a telehealth psychological support intervention for patients with primary brain tumor (PBT). METHODS: A within-trial cost-utility analysis over 6 months was performed comparing a tailored telehealth-psychological support intervention with standard care (SC) in a randomized control trial. Data were sourced from the Telehealth Making Sense of Brain Tumor (Tele-MAST) trial survey data, project records, and administrative healthcare claims. Quality-adjusted life years (QALYs) were calculated based on the EuroQol-5D-5L. Non-parametric bootstrapping with 2000 iterations was used to determine sampling uncertainty. Multiple imputation was used for handling missing data. RESULTS: The Tele-MAST trial included 82 participants and was conducted in Queensland, Australia during 2018-2021. When all healthcare claims were included, the incremental cost savings from Tele-MAST were -AU$4,327 (95% CI: -$8637, -$18) while incremental QALY gains were small at 0.03 (95% CI: -0.02, 0.08). The likelihood of Tele-MAST being cost-effective versus SC was 87% at a willingness-to-pay threshold of AU$50,000 per QALY gain. When psychological-related healthcare costs were included only, the incremental cost per QALY gain was AU$10,685 (95% CI: dominant, $24,566) and net monetary benefits were AU$534 (95% CI: $466, $602) with a 65% likelihood of the intervention being cost-effective. CONCLUSIONS: Based on this small randomized controlled trial, the Tele-MAST intervention is a cost-effective intervention for improving the quality of life of people with PBT in Australia. Patients receiving the intervention incurred significantly lower overall healthcare costs than patients in SC. There was no significant difference in costs incurred for psychological health services.

Individuals' perceptions of health and well-being in the context of stereotactic radiosurgery for benign brain tumour: A longitudinal qualitative investigation.

BACKGROUND AND OBJECTIVES: Treatment-related outcomes after Gamma Knife Stereotactic Radiosurgery (GKSRS) for benign brain tumour are well-established; yet patient reported outcomes have been largely overlooked. This study explored individuals' perspectives of their health and well-being prior to and following GKSRS. METHOD: Twenty adults (65% female) aged 24-71 years with benign brain tumour were recruited from a major metropolitan hospital and assessed approximately one week prior to, two weeks after, and at three months following GKSRS. They completed telephone-based interviews focusing on general health, symptoms, and well-being. Interviews were transcribed and analysed using thematic analysis. RESULTS: Three major themes characterized individuals' perceptions of their health and well-being. "Understanding my Illness and Treatment" reflected individuals' efforts to make sense of their illness and symptoms to reduce ambiguity and increase sense of control. "Experiencing Gamma Knife" related to expectations of the procedure, outcomes, daily impacts, and emotional reactions. "Adjusting one's Mindset and Coping" characterised how peoples' approaches to coping with their illness were altered over time. CONCLUSIONS: Coping and adjustment is highly individualistic in the context of GKSRS. Over time, most individuals were able to make sense of their illness, adjust their mindset and utilize behavioural strategies and support systems to cope with the long-term effects.

Evaluation of the telehealth making sense of brain tumor psychological support intervention for people with primary brain tumor and their caregivers: A randomized controlled trial.

OBJECTIVE: This pragmatic randomized control trial aimed to evaluate clinical efficacy of the Making Sense of Brain Tumour program delivered via videoconferencing (Tele-MAST) for improving mental health and quality of life (QoL) relative to standard care in individuals with primary brain tumor (PBT). METHOD: Adults with PBT experiencing at least mild distress (Distress Thermometer ≥4) and caregivers were randomly allocated to the 10-session Tele-MAST program or standard care. Mental health and QoL were assessed pre-intervention, post-intervention (primary endpoint), and 6-weeks and 6-months follow-up. The primary outcome was clinician-rated depressive symptoms on the Montgomery-Asberg Depression Rating Scale. RESULTS: 82 participants with PBT (34% benign, 20% lower-grade glioma, 46% high-grade glioma) and 36 caregivers were recruited (2018-2021). Controlling for baseline functioning, Tele-MAST participants with PBT had lower depressive symptoms at post-intervention (95% CI: 10.2-14.6, vs. 15.2-19.6, p = 0.002) and 6-weeks post-intervention (95% CI: 11.5-15.8 vs. 15.6-19.9, p = 0.010) than standard care, and were almost 4 times more likely to experience clinically reduced depression (OR, 3.89; 95% CI: 1.5-9.9). Tele-MAST participants with PBT also reported significantly better global QoL, emotional QoL and lower anxiety at post-intervention and 6-weeks post-intervention than standard care. There were no significant intervention effects for caregivers. At 6-months follow-up participants with PBT who received Tele-MAST reported significantly better mental health and QoL relative to pre-intervention. CONCLUSIONS: Tele-MAST was found to be more effective for reducing depressive symptoms at post-intervention than standard care for people with PBT but not caregivers. Tailored and extended psychological support may be beneficial for people with PBT.

The spatial extent of focused attention modulates attentional disengagement.

Attention can be flexibly changed to optimize visual processing: it can be oriented, resized, or even divided. Although much is known about these processes individually, much less is known about how they interact with one another. In the present study we examined how the spatial extent of the attentional focus modulates the efficiency of the first component of attentional orienting, the disengagement of attention. To this end, we used abrupt-onset stimuli of different sizes to trigger the reflexive resizing of the attentional focus (Castiello and Umiltà in Acta Psychol 73:195-209, 1990), combined with a gap task to assess the efficiency of attentional disengagement (Mackeben and Nakayama in Vis Res 33:85-90, 1993). The results of five experiments showed that the magnitude of the gap effect is significantly greater when the scope of attention is small than when it is large, indicating that disengaging attention is delayed when attention is highly focused. Furthermore, these findings highlight that different aspects of attentional control interact with one another, emphasizing the importance of studying them in conjunction.

Perceived Parental Rearing in Paediatric Obsessive-Compulsive Disorder: Examining the Factor Structure of the EMBU Child and Parent Versions and Associations with OCD Symptoms.

Parental rearing behaviours characterised by high levels of rejection and overprotection have been implicated in the development and maintenance of child psychopathology, including paediatric obsessive-compulsive disorder (OCD). The Egna Minnen Beträffande Uppfostran (EMBU) is a commonly used measure of perceived parental rearing. Using confirmatory factor analysis, the factor structure of the EMBU child and parent versions were examined in a sample of children and youth with OCD (n = 176), and their mothers (n = 162). Associations between rearing and clinical correlates of OCD were explored. For parents, a 4-factor model provided the best fit. For children, a higher order model was the best fit. Greater parent and child perceived negative rearing behaviours and lower perceived positive behaviours were associated with greater OCD severity, comorbid symptoms and impairment. The EMBU has a conceptually meaningful factor structure and provides a useful measure for assessing perceived rearing behaviours within paediatric OCD.

Inflated Responsibility Beliefs in Paediatric OCD: Exploring the Role of Parental Rearing and Child Age.

Cognitive-behavioural models of obsessive-compulsive disorder (OCD) propose that inflated responsibility beliefs are central to the maintenance of the disorder and are proposed to originate during early childhood via experiences of harsh and/or controlling parenting. The current study aimed to examine the associations between perceived parental rearing behaviours, inflated responsibility/threat beliefs, and OCD severity and impairment in children (aged 7-12 years) and adolescents (aged 13-17 years) with OCD (n = 136). Results indicated that for younger children, greater child perceptions of overprotection and anxious rearing were each associated with increased inflated responsibility beliefs. For older children, these positive associations remained, and furthermore, inflated responsibility beliefs mediated the association between perceived maternal anxious rearing and OCD impairment. Results highlight the role of the family in the development of inflated responsibility bias and OCD-related impairment.

Evaluation of a telehealth psychological support intervention for people with primary brain tumour and their family members: Study protocol for a randomised controlled trial.

OBJECTIVE: There is a lack of research on interventions that address the specific psychosocial needs of people with brain tumour and their families. This paper describes the protocol for a pragmatic randomised control trial (RCT) evaluating the clinical efficacy and cost-effectiveness of the Making Sense of Brain Tumour program delivered via telehealth (Tele-MAST) relative to standard care. METHODS: The 148 adults with primary brain tumour will be randomly allocated to the 10-session Tele-MAST videoconferencing program or standard care from a cancer counselling service. The primary outcome is level of depression and secondary outcomes are quality of life, mental health and incremental cost per quality-adjusted life year. The mental health and quality of life of family members will also be assessed. Assessments will be conducted at pre-intervention, post-intervention (primary endpoint), 6-weeks post-intervention and 6-months post-intervention. The main analysis will determine whether the Tele-MAST intervention is more effective than standard care at post-intervention, and whether these effects are sustained at follow-up. CONCLUSION: Results will indicate whether the Tele-MAST program is associated with better clinical outcomes and is more cost-effective than existing cancer support services. Such outcomes will contribute to effective and accessible psychosocial care for the brain tumour population.

Perceptual processing deficits underlying reduced FFOV efficiency in older adults.

Older adults are known to perform more poorly on measures of the functional field of view (FFOV) than younger adults. Specific contributions by poor bottom-up and or top-down control of visual attention to the reduced FFOV of older adults were investigated. Error rates of older and younger adults were compared on a FFOV task in which a central identification task, peripheral localization task, and peripheral distractors were presented in high and low contrast. Older adults made more errors in all conditions. The effect of age was independent of the contrast of the peripheral target or distractors. The performance cost of including the central task was measured and found to be negligible for younger adults. For older adults performance costs were present in all conditions, greater with distractors than without, and greater for a low rather than high contrast central stimulus when the peripheral target was high contrast. These results are consistent with older adults compensating for reduced sensory input or bottom-up capture of attention by relying more heavily on top-down control for which they are resource limited.

The Impact of Older Age and Sex on Motion Discrimination.

Background/Study Context: Reports of age-related differences on motion discrimination tasks have produced inconsistent findings concerning the influence of sex. Some studies have reported that older women have higher thresholds than older men, with others finding that women have higher motion thresholds regardless of age group. Reports of the age at which declines in motion discrimination first occur also differ, with some studies reporting declines only in groups aged over 70 years, with others reporting that age-related decline occurs at a younger age. The current study aimed to determine whether the sex differences found occur because relative to men, women have greater difficulty extracting motion signals from noise (Experiment 1) or have greater difficulty making use of the available motion cues (Experiment 2) in these complex moving stimuli. In addition, the influence of these manipulations on groups aged under and over 70 years was explored. METHODS: Motion discrimination measures were obtained using 39 older adults aged between 60 and 85 years (21 women) and 40 younger adults aged between 20 and 45 years (20 women). In Experiment 1, coherent motion and relative motion displacement thresholds were obtained. In Experiment 2, coherent motion thresholds were obtained for stimuli containing either 150 or 600 dots. RESULTS: In Experiment 1, the older group had significantly higher thresholds on the relative motion displacement and coherent motion tasks than a younger group. No differences in motion sensitivity were found in the older groups aged under or over 70 years. Women regardless of age group had significantly higher thresholds than men on both tasks. In Experiment 2, the older group had higher coherence thresholds than the younger group, and the number of dots presented had no influence on thresholds, for the older group or older women specifically. In the younger group, women had higher coherence thresholds than men with presentation of 150 but not 600 dots. There were 51% of the older group who showed evidence of age-related decline on all the motion coherence tasks conducted, with half of these in each the group aged under and over 70 years. CONCLUSION: Difficulties with noise exclusion failed to explain the sex differences found. The increased number of motion cues present when a larger number of dots were included was sufficient to reduce coherence thresholds in younger women but not older men or women. In addition to age, developmental history and sex may provide further predictors in older individuals of decline on measures of motion discrimination.

Comorbidity in Emetophobia (Specific Phobia of Vomiting).

BACKGROUND: Emetophobia (fear of vomiting) is an anxiety disorder in which individuals report clinical levels of fear that they may vomit or be exposed to the vomit of others. The prevalence of comorbidity of emetophobia with other conditions has previously only been investigated using self-report instruments. METHOD: Sixty-four adults with emetophobia participated in an online structured clinical diagnostic interview assessing the presence of emetophobia and other conditions. RESULTS: Higher comorbidity for depression, generalized anxiety disorder, panic disorder, social anxiety disorder and obsessive-compulsive disorder were found in participants compared with general population norms. CONCLUSIONS: Emetophobia is commonly comorbid with other anxiety and depressive disorders. Comorbidity rates, when assessed using a structured clinical interview, were lower than previously reported using self-report alone. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Emetophobia (specific phobia of vomiting) is a clinical fear of vomiting. Individuals with emetophobia show high comorbidity with other anxiety and mood disorders. The most common comorbid conditions were generalized anxiety disorder, panic disorder, hypochondriasis and obsessive-compulsive disorder. Clinicians should ensure that they assess for the presence of comorbid conditions when treating emetophobia.

An investigation into the relationship between persistent pain, psychological distress and emotional connectedness.

Previous research into the social consequences of persistent pain has shown that relationship difficulties and marital distress are major factors that contribute to negative outcomes for sufferers. Furthermore, psychological distress is often co-morbid with persistent pain. This study explored the relationship between persistent pain, psychological distress and emotional connectedness. It involved a cross-sectional design utilising an online survey of 388 Australian women with persistent pain. Self-report measures of pain severity, psychological distress and emotional connectedness were administered. Results confirmed that many women in persistent pain experience relationship and emotional connectedness difficulties which they attribute to the experience of persistent pain. Additionally, psychological distress significantly mediated the relationship between pain severity and emotional connectedness. It was concluded that, in this sample of persistent pain sufferers, pain severity and psychological distress had significant impact on a women's ability to connect emotionally to those closest to them. The implications of these findings for intervening with women who suffer with persistent pain are discussed.

Does a sensory processing deficit explain counting accuracy on rapid visual sequencing tasks in adults with and without dyslexia?

The experiments conducted aimed to investigate whether reduced accuracy when counting stimuli presented in rapid temporal sequence in adults with dyslexia could be explained by a sensory processing deficit, a general slowing in processing speed or difficulties shifting attention between stimuli. To achieve these aims, the influence of the inter-stimulus interval (ISI), stimulus duration, and sequence length were evaluated in two experiments. In the first that used skilled readers only, significantly more errors were found with presentation of long sequences when the ISI or stimulus durations were short. Experiment 2 used a wider range of ISIs and stimulus durations. Compared to skilled readers, a group with dyslexia had reduced accuracy on two-stimulus sequences when the ISI was short, but not when the ISI was long. Although reduced accuracy was found on all short and long sequences by the group with dyslexia, when performance on two-stimulus sequences was used as an index of sensory processing efficiency and controlled, group differences were found with presentation of stimuli of short duration only. We concluded that continuous, repetitive stimulation to the same visual area can produce a capacity limitation on rapid counting tasks in all readers when the ISIs or stimulus durations are short. While reduced accuracy on rapid sequential counting tasks can be explained by a sensory processing deficit when the stimulus duration is long, slower processing speed in the group with dyslexia explains the greater inaccuracy found as sequence length is increased when the stimulus duration is short.

The Functional Field of View of Older Adults is Associated With Contrast Discrimination in the Magnocellular not Parvocellular Pathway.

OBJECTIVES: As we age, the functional field of view (FFOV) declines and these declines predict falls and motor vehicle accidents in older adults (Owsley, C. (2013). Visual processing speed. Vision Research, 90, 52-56. doi:10.1016/j.visres.2012.11.014). To increase understanding of possible causes of this decline, the current study explored whether the FFOV in older adults is associated with the sensitivity of the magnocellular and parvocellular sub-cortical pathways. METHOD: Forty-four younger (M = 27.18, SD = 5.40 years) and 44 older (M = 72.18, SD = 5.82 years) adults completed an FFOV test and the steady- and pulsed-pedestal paradigms of Pokorny and Smith (Pokorny, J., & Smith, V. C. (1997). Psychophysical signatures associated with magnocellular and parvocellular pathway contrast gain. Journal of the Optical Society of America. A, Optics, Image Science, and Vision, 14, 2477-2486. doi:10.1364/josaa.14.002477) as measures of magnocellular and parvocellular pathways, respectively. RESULTS: Older adults made more FFOV errors and had higher contrast discrimination thresholds in both the steady- and pulsed-pedestal paradigms, than younger adults. FFOV errors in the younger group were not related to contrast discrimination thresholds. In multiple regression, older group FFOV errors showed a strong unique association with contrast discrimination thresholds mediated via the magnocellular, but not the parvocellular pathway. DISCUSSION: We infer that reduced magnocellular pathway contrast sensitivity may contribute to reduced functional vision in older adults.

Tactical and strategic driving behaviour in older drivers: The importance of readiness to change.

The aim of this study was to explore the way in which reports of strategic and tactical driving self-regulation are influenced by readiness to change driving behaviour in older men and women, either reporting or not reporting modification of driving behaviour for health-related reasons, and/or increased driving difficulty. Current Australian drivers aged over 60 years (N = 258) responded to a self-report questionnaire. Hierarchical regression analyses indicated increased use of tactical behaviours were associated with greater driving difficulty, more readiness to change and male gender (R2 = 23.2%) . These effects were moderated by a significant association between readiness to change, driving modifications for health reasons and age (R2chg = 2.9%). Greater readiness to change was associated with increased use of tactical behaviours for older drivers who did not modify driving for health reasons, independent of ageIndependent of age. This association was also found for younger old drivers with health difficulties, but not for older old drivers with health difficulties. Hierarchical regression indicated that greater readiness to change, increased driving difficulty, female gender and modification of driving for health reasons were associated with reports of increased strategic self-regulation (R2 = 50.8%). These effects were moderated by readiness to change and age, and readiness to change and gender (R2chg = 2.1%). The association between readiness to change and strategic self-regulation was stronger for women than men, and the strength of this association became substantially stronger with increasing age. It was concluded that readiness to change driving behaviour may promote different forms of driving self-regulation for different individuals, and that older drivers may use the different forms of driving self-regulation independently of one another.

Relationships between global motion and global form processing, practice, cognitive and visual processing in adults with dyslexia or visual discomfort.

The aim of the first of two experiments was to investigate the effect of practice on sensitivity to global motion and global form in a group of adults with dyslexia, a group of normal readers with visual discomfort, a group with dyslexia and visual discomfort, and a control group. In comparison to the control group, and regardless of the effect of practice, the group with dyslexia was significantly less sensitive to global motion. No differences in global motion sensitivity were found when individuals with dyslexia, with or without visual discomfort, were compared. The normal reading group with visual discomfort was less sensitive to global motion than the control group at baseline, but not when a second estimate of motion sensitivity was obtained. About 30% of the group with dyslexia had a global motion deficit on each threshold estimate. In contrast, there were no significant effects of practice or group on sensitivity to global form. In Experiment 2, performance on a number of cognitive and visual processing tasks was measured in four groups: two with dyslexia; one with and one without a global motion deficit, a normal reading group with visual discomfort, and a control group. The group with visual discomfort had reduced visual processing speed only. Regardless of whether a global motion processing deficit was present or absent in individuals with dyslexia, reduced accuracy was found on the language and visual processing measures, and on a rapid temporal sequencing task. Individuals with dyslexia and a global motion deficit had poorer accuracy than individuals with dyslexia and no motion deficit on the phonological processing and verbal short term memory tasks. We concluded that some adults with dyslexia have a persistent deficit when processing global motion but not global form. This is consistent with reports of a magnocellular pathway deficit in this group. Individuals with visual discomfort do not have a magnocellular processing deficit, but have perceptual difficulties when performing complex visual processing tasks.

A Comparison of Two Chronic Skin Conditions: Atopic Dermatitis and Psoriasis.

Atopic dermatitis (eczema) and psoriasis are two common chronic skin diseases that affect many people, including active- duty military Servicemembers and their families. Both conditions have significant psychosocial impacts and can lead to substantial morbidity if undiagnosed and left untreated. We compare and contrast atopic dermatitis and psoriasis in terms of epidemiology, etiology, presentation, diagnosis, and treatment. The goal is to help military medical providers distinguish between the two diseases and provide practical steps for treatment and long-term management.

Relational thinking in later adulthood.

The research addressed the role of relational processing capacity in cognitive aging focusing on (a) age-differences in complex relational processing, (b) the domain-generality of complex relational processing, and (c) associations of complex relational processing with other processes. Participants were 125 adults in three groups with mean ages of 30.55 (younger), 53.43 (middle), and 74.41 years (older). Each relational processing task (sentence comprehension, n-term premise integration, Latin square) included items at three complexity levels. Accuracy was lower on more complex items and relational complexity had a greater effect in the older group. Confirmatory factor analyses confirmed a single complex relational processing factor, consistent with a domain-general capacity. Relational processing was related to other executive processes. This relationship was stronger in the older than younger and middle groups, possibly reflecting dedifferentiation or neural noise. In structural models with planning (Tower of London) and class reasoning as outcome variables, complex relational processing had a significant impact (ß = .455, p < .001 and ß = .661, p < .001, respectively) over and above age, processing speed, working memory, task switching, response inhibition, and Stroop interference. In the structural model with fluid intelligence (matrix reasoning) as the outcome variable, age had a significant impact (ß = -.222, p < .001), over and above all other variables, suggesting that the processes underpinning age-related declines in matrix reasoning are more diverse than those assessed in the current research. Complex relational processing is an important factor in cognitive aging, possibly reflecting its reliance on prefrontal brain regions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Factors Associated With Growth After Deceased and Live Donor Pediatric Liver Transplantation.

BACKGROUND: There are limited data on predictors of growth after pediatric liver transplantation. METHODS: We reviewed the impact of graft type, ethnicity, and biliary complications (BC) on growth after pediatric liver transplantation (LT). We compared preoperative and 6-, 12-, and 24-month weight, height, and body mass index (BMI) percentiles between living donor (LD), deceased donor full-size (DD-full), and deceased donor split (DD-split) graft recipients. We also compared length of stay (LOS) between groups. RESULTS: We had 98 patients (DD-split: 32; DD-full: 43, LD: 23). The Median Pediatric End-stage Liver Disease (PELD) scores, exception points, albumin, bilirubin, failure to thrive, and presence of ascites were similar among groups. The DD-full group had the lowest preoperative percentiles in all categories and exceeded these at 24 months. The DD-split group was at preoperative percentiles at 24 months. The LD group had parallel weight curves compared to the DD-full group and exceeded only the preoperative weight percentile at 24 months. Black patients had the lowest percentiles in all categories (P < .01). The BC group caught up weight and BMI percentile at 24 months but had persistent decrease in height percentiles. Patients without BC exceeded preoperative height percentiles. The longer LOS group had lower height and BMI percentiles at 24 months; however, there was no statistical difference. CONCLUSION: DD-full and black patients seem to benefit the most from LT in terms of growth. BC seems to affect height percentiles. Patients with longer LOS had lower height and BMI percentiles (P>.05). Longer follow up and larger cohorts are necessary to improve the power of these findings.

The influence of age-related health difficulties and attitudes toward driving on driving self-regulation in the baby boomer and older adult generations.

Our study aimed to determine how age- and disease-related difficulties were associated with attitudes and beliefs about driving self-regulation in men and women in the baby boomer and older generations. Three hundred and ninety-nine men (n=204) and women (n=195) aged between 48 and 91 years participated in a cross-sectional study of Australian drivers. Demographic characteristics and measures of driving confidence, driving difficulty and driving self-regulation; perceptions of visual, physical and cognitive capacity; and attitudes and beliefs about driving were obtained. Driving self-regulation in men and women was explained by different mechanisms. For men, self-report of visual and cognitive difficulties and poor driving confidence predicted driving self-regulation. For women, negative attitudes toward driving mediated the associations found between health-related difficulties and driving self-regulation. Barriers to driving self-regulation were not associated with the driving self-regulatory practices of men or women. Regardless of generation, women reported poorer driving confidence, greater driving difficulty and more driving self-regulation than men. We concluded that age- and disease-related difficulties are related to increasing driving self-regulation in mature men and women. These results indicate that different pathways are needed in models of driving self-regulation for men and women regardless of generational cohort.