RESUMEN
Background: Guidance on how different disciplines from the natural, behavioural and social sciences can collaborate to resolve complex public health problems is lacking. This article presents a checklist to support researchers and principle investigators to develop and implement interdisciplinary collaborations. Methods: Fourteen individuals, representing 10 disciplines, participated in in-depth interviews to explore the strengths and challenges of working together on an interdisciplinary project to identify the determinants of substance use and gambling disorders, and to make recommendations for future interdisciplinary teams. Data were analysed thematically and a checklist was derived from insights offered by participants during interview and discussion among the authors on the implications of findings. Results: Participants identified 18 scientific, interactional and structural strengths and challenges of interdisciplinary research. These findings were used to develop an 18-item BASICS checklist to support future interdisciplinary collaborations. The five domains of the checklist are: (i) Blueprint, (ii) Attitudes, (iii) Staffing, (iv) Interactions and (v) Core Science. Conclusion: Interdisciplinary work has the potential to advance public health science but the numerous challenges should not be underestimated. Use of a checklist, such as BASICS, when planning and managing projects may help future collaborations to avoid some of the common pitfalls of interdisciplinary research.
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Lista de Verificación , Guías como Asunto , Investigación sobre Servicios de Salud/organización & administración , Comunicación Interdisciplinaria , Salud Pública/métodos , Conducta Cooperativa , Investigación sobre Servicios de Salud/normas , Entrevistas como Asunto , InvestigadoresRESUMEN
It has been argued that transition points in life, such as the approach towards, and early years of retirement present key opportunities for interventions to improve the health of the population. Research has also highlighted inequalities in health status in the retired population and in response to interventions which should be addressed. We aimed to conduct a systematic review to synthesise international evidence on the types and effectiveness of interventions to increase physical activity among people around the time of retirement. A systematic review of literature was carried out between February 2014 and April 2015. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for identification of relevant studies included electronic database searching, reference list checking, and citation searching. Systematic search of the literature identified 104 papers which described study populations as being older adults. However, we found only one paper which specifically referred to their participants as being around the time of retirement. The intervention approaches for older adults encompassed: training of health care professionals; counselling and advice giving; group sessions; individual training sessions; in-home exercise programmes; in-home computer-delivered programmes; in-home telephone support; in-home diet and exercise programmes; and community-wide initiatives. The majority of papers reported some intervention effect, with evidence of positive outcomes for all types of programmes. A wide range of different measures were used to evaluate effectiveness, many were self-reported and few studies included evaluation of sedentary time. While the retirement transition is considered a significant point of life change, little research has been conducted to assess whether physical activity interventions at this time may be effective in promoting or maintaining activity, or reducing health inequalities. We were unable to find any evidence that the transition to retirement period was, or was not a significant point for intervention. Studies in older adults more generally indicated that a range of interventions might be effective for people around retirement age.
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Empleo , Ejercicio Físico , Promoción de la Salud , Jubilación , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Actividad MotoraRESUMEN
OBJECTIVE: To examine if and how older adults modify their drinking after health deterioration, and the factors that motivate changing or maintaining stable drinking behaviour. STUDY DESIGN: Explanatory follow-up mixed-methods research. METHODS: The association between health deterioration and changes in alcohol consumption was examined using secondary data from the English Longitudinal Study of Ageing, a biennial prospective cohort study of a random sample of adults aged 50 years and older living in England. Data were collected through a personal interview and self-completion questionnaire across three waves between 2004 and 2009. The sample size (response rate) across the three waves was 8781 (49.9%), 7168 (40.3%) and 6623 (37.3%). The Chi-squared test was used to examine associations between diagnosis with a long-term condition or a worsening of self-rated health (e.g. from good to fair or fair to poor) and changes in drinking frequency (e.g. everyday, 5-6 days per week, etc.) and volume (ethanol consumed on a drinking day) between successive waves. In-depth interviews with 19 older adults recently diagnosed with a long-term condition were used to explore the factors that influenced change or maintenance in alcohol consumption over time. A purposive sampling strategy was used to recruit a diverse sample of current and former drinkers from voluntary and community organizations in the north of England. An inductive approach was used to analyze the data, facilitating the development of an a posteriori framework for understanding drinking change. RESULTS: There was no significant relationship between health deterioration and changes in drinking volume over time. There was however a significant association between health deterioration and changes in drinking frequency between successive waves (χ2 = 15.24, P < 0.001 and χ2 = 17.28, P < 0.001). For example, of participants reporting health deterioration between the first two waves, 47.6% had stable drinking frequency, 23.4% increased their drinking frequency and 29% reported decreased drinking frequency. In comparison, of participants reporting no health deterioration, 52.7% reported stable frequency, 20.8% increased frequency and 26.4% decreased frequency. In qualitative interviews, older adults described a wide range of factors that influence changes in drinking behaviour: knowledge gained from talking to healthcare professionals, online and in the media; tangible negative experiences that were attributed to drinking; mood and emotions (e.g. joy); the cost of alcohol; pub closures; and changes in social roles and activities. Health was just one part of a complex mix of factors that influenced drinking among older adults. CONCLUSION: Patterns of drinking change after health deterioration in older adults are diverse, including stable, increasing and decreasing alcohol consumption over time. Although health motivations to change drinking influence behaviour in some older adults, social and financial motivations to drink are also important in later life and thus a holistic approach is required to influence behaviour.
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Consumo de Bebidas Alcohólicas/psicología , Estado de Salud , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Inglaterra/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Motivación , Estudios Prospectivos , Investigación Cualitativa , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Low socioeconomic status (SES) is a risk factor for type 2 diabetes and changes in diet and physical activity can prevent diabetes. We assessed the effectiveness and acceptability of community-based dietary and physical activity interventions among low-SES groups in the UK. METHOD: We searched relevant databases and web resources from 1990 to November 2009 to identify relevant published and grey literature using an iterative approach, focusing on UK studies. RESULTS: Thirty-five relevant papers (nine quantitative, 23 qualitative and three mixed methods studies) were data extracted, quality assessed and synthesised using narrative synthesis and thematic analysis. The relationship between interventions and barriers and facilitators was also examined. Dietary/nutritional, food retail, physical activity and multi-component interventions demonstrated mixed effectiveness. Qualitative studies indicated a range of barriers and facilitators, which spanned pragmatic, social and psychological issues. The more effective interventions used a range of techniques to address some surface-level psychological and pragmatic concerns, however many deeper-level social, psychological and pragmatic concerns were not addressed. CONCLUSION: Evidence on the effectiveness of community-based dietary and physical activity interventions is inconclusive. A range of barriers and facilitators exist, some of which were addressed by interventions but some of which require consideration in future research.
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Servicios de Salud Comunitaria , Diabetes Mellitus Tipo 2/prevención & control , Adolescente , Adulto , Anciano , Dieta , Humanos , Persona de Mediana Edad , Actividad Motora , Aceptación de la Atención de Salud , Factores de Riesgo , Clase Social , Resultado del Tratamiento , Reino Unido , Adulto JovenRESUMEN
Looked-after children and young people (LACYP) are recognized as a high-risk group for behavioural and emotional problems, and additional specialist training for foster carers may reduce such problems. This systematic review aimed to identify and synthesize evidence on the effectiveness of additional training and support provided to approved carers, professionals and volunteers on the physical and emotional health and well-being of LACYP (including problem behaviours and placement stability). Searches of health and social science databases were conducted and records were screened for inclusion criteria. Citation and reference list searches were conducted on included studies. Included studies were synthesized and critically appraised. Six studies were included (five randomized controlled trials and one prospective cohort study), all of which focused on foster carers. Three studies reported a benefit of training and three reported no benefit but no detriment. Those reporting a benefit of training were conducted in the USA, and had longer-duration training, shorter follow-up assessment and recruited carers of younger children than studies that reported no benefit of training, which were conducted in the UK. Whether the difference in results is due to the type of training or to cultural or population differences is unclear. The findings suggest a mixed effect of training for foster carers on problem behaviours of LACYP. The evidence identified appears to suggest that longer-duration training programmes have a beneficial effect on the behaviour problems of LACYP, although future research should examine the impact of training durations and intensity on short-medium and longer-term outcomes of LACYP of different ages. Only training and support for foster carers was identified.
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Protección a la Infancia , Educación/normas , Cuidados en el Hogar de Adopción , Evaluación de Resultado en la Atención de Salud , Adolescente , Cuidadores , Niño , Preescolar , Estudios de Cohortes , Humanos , Lactante , Recién Nacido , Trastornos Mentales , Salud Mental , Psicología InfantilRESUMEN
This systematic review aimed to synthesize evidence on the effectiveness of transition support services (TSSs) that are delivered towards the end of care for looked-after young people (LAYP) on their adult outcomes, including education, employment, substance misuse, criminal and offending behaviour, parenthood, housing and homelessness and health. Searches of health, social science and social care bibliographic databases were conducted and records were screened for relevance. Citation and reference list searches were conducted on included studies. Relevant studies were synthesized and critically appraised. Seven studies were identified (five retrospective and two prospective cohort studies), six of which were conducted in the USA and one in the UK. Overall, LAYP who received TSSs were more likely to complete compulsory education with formal qualifications, be in current employment, be living independently and less likely to be young parents. There was no reported effect of the impact of TSSs on crime or mental health, and mixed findings for homelessness. The range of TSS components investigated and reported varied considerably within and between studies, with limited evidence of long-term outcomes. The literature reviewed offers no reliable conclusions on the effectiveness of TSSs at this time due to variations in research quality and because few formal evaluations of existing TSSs have been conducted, resulting in mixed evidence in terms of positive, negative and neutral impact on outcomes. Further high-quality, robust research to evaluate the effectiveness of TSSs on adult outcomes for young people in the short, medium and longer term is needed to address the health inequalities experienced by this small but vulnerable group and to inform decision making about service provision.
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Conducta del Adolescente/psicología , Protección a la Infancia/psicología , Vida Independiente/psicología , Evaluación de Resultado en la Atención de Salud/métodos , Apoyo Social , Transición a la Atención de Adultos , Adolescente , Factores de Edad , Niño , Crimen , Humanos , Salud Mental , Poder Psicológico , Riesgo , Adulto JovenRESUMEN
In 2008, the Department of Health made a referral to the National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence to develop joint public health guidance on improving the physical and emotional health and well-being of children and young people looked after by the local authority/state. To help inform the decision-making process by identifying potential research questions pertinent to the outcomes of looked-after children and young people (LACYP), a correlates review was undertaken. Iterative searches of health and social science databases were undertaken; searches of reference lists and citation searches were conducted and all included studies were critically appraised. The correlates review is a mapping review conducted using systematic and transparent methodology. Interventions and factors that are associated (or correlated) with outcomes for LACYP were identified and presented as conceptual maps. This review maps the breadth (rather than depth) of the evidence and represents an attempt to use the existing evidence base to map associations between potential risk factors, protective factors, interventions and outcomes for LACYP. Ninety-two studies were included: four systematic reviews, five non-systematic reviews, eight randomized controlled trials, 66 cohort studies and nine cross-sectional studies. The conceptual maps provide an overview of the key relationships addressed in the current literature, in particular, placement stability and emotional and behavioural factors in mediating outcomes. From the maps, there appear to be some key factors that are associated with a range of outcomes, in particular, number of placements, behavioural problems and age at first placement. Placement stability seems to be a key mediator of directional associations. The correlates review identified key areas where sufficient evidence to conduct a systematic review might exist. These were: transition support, training and support for carers and access to services.
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Protección a la Infancia/tendencias , Cuidados en el Hogar de Adopción/métodos , Bienestar del Lactante/tendencias , Adolescente , Niño , Protección a la Infancia/estadística & datos numéricos , Preescolar , Inglaterra , Femenino , Cuidados en el Hogar de Adopción/psicología , Humanos , Lactante , Bienestar del Lactante/estadística & datos numéricos , Masculino , Evaluación de Resultado en la Atención de Salud , Mejoramiento de la Calidad , Factores de Riesgo , Conducta Social , Estadística como AsuntoRESUMEN
Despite the growing number of studies on the health effects of passive smoke exposure, few data exist on the quality of questionnaire data on passive smoking. To measure the reliability of passive smoking histories, re-interviews were conducted for 110 subjects (37 cases and 73 controls) as part of a larger study of lung cancer among non-smoking women in Missouri. Agreement was high both for parental smoking status (94% concordance; kappa = 0.82) and for spousal smoking status (84% concordance; kappa = 0.67). Concordance also was relatively high for cigarette pack-years of exposure due to the parents or spouse. Reliability tended to be somewhat higher among controls than among cases, and for exposure due to a parent or spouse than for that due to other household members. Questions on the perceived harmfulness of passive smoke exposure showed no differences between cases and controls. These findings indicate a high degree of repeatability in responses regarding passive smoking, but also suggest the potential for misclassification of passive smoke exposure status, the desirability of standardized questions on passive smoking, and the need for additional studies of reliability and validity.
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Neoplasias Pulmonares/epidemiología , Anamnesis , Contaminación por Humo de Tabaco/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Entrevistas como Asunto , Neoplasias Pulmonares/etiología , Persona de Mediana Edad , Missouri/epidemiología , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Contaminación por Humo de Tabaco/estadística & datos numéricosRESUMEN
OBJECTIVES: To examine whether children with Navy mothers exhibit higher levels of internalizing and externalizing behavior than children in civilian families and whether deployment affects children's internalizing and externalizing behavior. METHOD: Navy mothers who experienced deployment completed a measure assessing children's internalizing and externalizing behavior before and after a deployment (and at similar intervals for the Navy and civilian comparison groups). Data collection took place between 1996 and 1998. RESULTS: Navy children with deployed mothers exhibited higher levels of internalizing behavior than children with nondeployed Navy mothers. Navy children whose mothers experienced deployment were more likely to exhibit clinical levels of internalizing behavior than Navy children with nondeployed mothers or civilian children. Group differences, however, were modest and overall mean scores were in the normal range. CONCLUSIONS: Findings do not suggest greater pathology in children of Navy mothers; however, findings do indicate we should be particularly attentive of deployed mothers and their children.
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Trastornos de la Conducta Infantil/psicología , Personal Militar , Trastornos de la Personalidad/psicología , Adulto , Ansiedad de Separación , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Relaciones Madre-HijoRESUMEN
Guided primarily by attachment theory, this longitudinal study explored how adult mental representations of attachment relationships and memories of childhood experiences with parents contributed to a mother's anxiety about separation from her own infant. The Maternal Separation Anxiety Scale, the Adult Attachment Interview, and the Mother-Father-Peer Scale were administered to a sample of 49 first-time mothers. The mothers with insecure attachment representations, when asked to remember details of their own childhood, reported more negative recollections of early parental caregiving, particularly rejection and discouragement of independence. When their own infants were 2 months old, these mothers experienced heightened levels of maternal separation anxiety. The findings provide theoretical and empirical support for the view that very high levels of maternal separation anxiety may indicate dysfunction.
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Ansiedad de Separación/psicología , Relaciones Madre-Hijo , Apego a Objetos , Responsabilidad Parental/psicología , Adulto , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Recuerdo Mental , Desarrollo de la PersonalidadRESUMEN
The aim of this study was to develop a conceptual model that would clarify how a woman's recollections of peer and parent rejection in childhood influence her emotional well-being and, resultantly, her own child's behavior problems. Given current interest in peer versus parent influences, the authors used a design and analysis to reveal the unique contributions of peer and parent rejection. The participants were a community sample of 88 mothers and their 2 1/2-year-old children. The study found that mothers' recollections of peer rejection in childhood were significantly associated with depressive symptomatology, but recollections of parental rejection in childhood were unrelated to current depressive symptoms. Recollections of peer rejection during childhood, internal representation of self, and depressive symptoms made significant, unique contributions to the variance in behavior problems in their children. Together, these variables significantly explained 27% of the variance in the final model.
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Trastornos de la Conducta Infantil/etiología , Trastornos de la Conducta Infantil/psicología , Depresión/psicología , Relaciones Interpersonales , Madres/psicología , Grupo Paritario , Rechazo en Psicología , Adulto , Preescolar , Femenino , Humanos , Masculino , Encuestas y CuestionariosRESUMEN
The relation of maternal and paternal depressive symptoms to problem behaviors in a nonclinical sample of preschool children was examined. Data were collected from 46 women, their husbands, and their 4-year-old, first-born children. Observed maternal restrictive and punishing behavior and attachment security of the child were considered additional sources of risk for externalizing and internalizing problem behaviors. Different predictors for child externalizing and internalizing behaviors were identified via hierarchical multiple regression analyses. Maternal and paternal depressive symptoms and maternal restrictive and punishing behavior emerged as salient predictors of child internalizing behaviors. For externalizing behaviors, there were significant gender differences: For girls, maternal depressive symptoms made a significant contribution to the model; the model for boys was not significant. The results perhaps reflect different etiological pathways for externalizing and internalizing behaviors, supporting the suggestion that those behaviors are distinct clinical phenomena, even among very young children. The findings also suggest that nonclinical levels of parental symptomatology show systematic relations to children's problem behaviors.
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Trastornos de la Conducta Infantil/psicología , Depresión/psicología , Padres/psicología , Adulto , Trastornos de la Conducta Infantil/diagnóstico , Preescolar , Depresión/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Apego a Objetos , Relaciones Padres-HijoRESUMEN
Social behaviors of 60, 12-month-old infants were studied, with the use of a structured observational technique. Infants behaviors were related to sex of infant and to experience in one of three types of care: maternal home rearing, individual babysitter, or group day care. The provision of nonmaternal care and the specific type of nonmaternal care appeared to influence the social behaviors of the two sexes differently. Home-reared girls tended to exhibit fewer and less intense behaviors that were aimed at maintaining or regaining maternal proximity. Girls experiencing nonmaternal care exhibited more maternal proximity attaining behaviors than did home-rearing girls, whereas boys experiencing nonmaternal care exhibited fewer maternal proximity attaining behaviors than home-reared boys. The interactions of type of care and sex of infant led to a consideration of differential sensitivity of the sexes to rearing conditions.
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Guarderías Infantiles , Relaciones Madre-Hijo , Conducta Social , Femenino , Humanos , Lactante , Masculino , Factores SexualesRESUMEN
Twenty-one 13-month-old infants, nine male and 12 female, were assigned to one of seven playgroups convening for 15 consecutive weekdays . Present at each 20-minute play session were three same-sexed peers with their mothers and an assortment of toys. There were systematic fluctuations in infants' attention to mother, peers, and toys. There findings suggest that a mother may serve different functions at different points in time: (a) as a secure base in initial sessions, (b) as a refueling stop when the infant grew tired, and (c) as an attractive alternative when the infant became bored with toys and peers. Within-day analyses revealed that activity level and toy exploration linearly decreased over time, while intentional contact with mother significantly increased. Social interaction with peers correlated negatively with interaction with mother over the course of the study. Sex differences over time were found to be significant: boys on day one were more interactive with both peers and toys but this level declined thereafter, while girls on day one spent more time in close proximity to mother and later, on subsequent days, increased their peer and toy play.
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Desarrollo Infantil , Relaciones Madre-Hijo , Grupo Paritario , Juego e Implementos de Juego , Femenino , Humanos , Lactante , Masculino , Factores Sexuales , Conducta SocialRESUMEN
Noncompliant behavior in early childhood (i.e., exaggerated, but age-appropriate negativism) has been inadequately studied. This longitudinal study explores preschool temperament and maternal behavior as current correlates of negativistic behavior at age 4, and early maternal characteristics and infant temperament as etiological variables in the production of negativism. Longitudinal evidence was collected from 62 mother-child dyads, representative of all social classes. This evidence included home observations of maternal and child behavior at 4 years, a temperament questionnaire at 4 years, a questionnaire about infant temperament, and observational and interview measures at various stages from birth to 3 years, of infant behavior and maternal characteristics. The findings suggest that infant and childhood temperament (especially the degree of infant fussiness) are highly predictive of physical noncompliance, and that physical noncompliance is unrelated to maternal or demographic variables. A combination of maternal variables including warmth, closeness, and verbal directiveness, both positive and negative, as well as child variables, predict verbal noncompliance. Demographic variables, temperament, and maternal attitudes predict passive noncompliance. Noncompliance is viewed as a complex phenomenon in which constitutional and environmental variables interact.
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Trastornos de la Conducta Infantil/psicología , Conducta Cooperativa , Desarrollo de la Personalidad , Personalidad , Temperamento , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Estudios Longitudinales , Masculino , Conducta Materna , Relaciones Madre-Hijo , NegativismoRESUMEN
RATIONALE: The effects of acute bouts of physical activity (PA) on Strength of Desire (SoD) and Desire to Smoke (DtS) using individual participant data (IPD) from 19 acute randomised controlled studies were quantified. However, there is a need to identify factors influencing this relationship. OBJECTIVES: To understand who most benefits from PA, whether changes in affect mediate these effects and whether any specific attributes of PA are associated with cigarette cravings. METHODS: IPD (n = 930) contributed to one-stage IPD meta-analyses. Participants engaging in PA were compared against controls, using post-intervention DtS and SoD (when DtS is not available) with baseline adjustments. The craving scales were linearly rescaled to 0-100 % (a mean difference between groups of -10 would indicate that post-intervention cravings were 10 % lower in the PA compared with the control group). Demographic, smoking and other characteristics were examined as predictors and potential moderators, whereas change in affect was considered as a mediator. PA was categorised according to type, duration and intensity, to determine PA attributes associated with cravings reduction. RESULTS: None of the included covariates were shown to moderate or mediate the effects of PA. Intensity of PA was significantly associated with a reduction in cravings; moderate and vigorous intensity PA offered the most benefits. A one-stage IPD meta-analysis yielded effect sizes of -9.22 (-15.24; -3.20) for light, -34.57 (-42.64; -26.50) for moderate and -31.29 (-38.00; -24.57) for vigorous intensity in comparison with controls. CONCLUSIONS: Moderate intensity PA could be recommended to all smokers regardless of demographic, smoking and other characteristics.
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Conducta Adictiva/psicología , Actividad Motora/fisiología , Fumar/psicología , Afecto , HumanosRESUMEN
BACKGROUND: Varicose veins are enlarged, visibly lumpy knotted veins, usually in the legs. Uncomplicated varicose veins can cause major discomfort and some complications. They are part of chronic venous disease (CVD), which is reported to have a substantial negative impact on health-related quality of life (HRQoL). Traditional treatments for varicose veins involve surgical stripping and ligation and liquid sclerotherapy (LS), but can be invasive and painful. New minimally invasive treatments offer an alternative. These treatments typically involve use of laser, radiofrequency or foam sclerosant. They are increasingly widely used and offer potential benefits such as reduced complications, faster recovery, fewer physical limitations and improved quality of life. OBJECTIVE: The aim of this report is to evaluate the clinical effectiveness, safety and cost-effectiveness of the minimally invasive techniques of foam sclerotherapy (FS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in comparison with other techniques, including traditional surgical techniques, LS and conservative management, in the management of varicose veins. DATA SOURCES: A systematic search was made of 11 bibliographic databases of published and unpublished literature from their inception to July 2011: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library; Biological Abstracts; Science Citation Index (SCI); Social Sciences Citation Index; Conference Proceedings Citation Index-Science; UK Clinical Research Network; Current Controlled Trials; and ClinicalTrials.gov. REVIEW METHODS: A systematic review of randomised controlled trials (RCTs) to assess the clinical effectiveness of minimally invasive techniques compared with other treatments, principally surgical stripping, in terms of recurrence of varicose veins, retreatment and clinical symptoms, as measured by the Venous Clinical Severity Score (VCSS), pain and quality of life. Network meta-analysis and exploratory cost-effectiveness modelling were performed. RESULTS: The literature search identified 1453 unique citations, of which 34 RCTs (54 papers) satisfied the criteria for the clinical effectiveness review. The minimally invasive techniques reported clinical outcomes similar to surgery. Rates of recurrence were slightly lower for EVLA, RFA and FS, especially for longer follow-up periods; VCSS score was lower for EVLA and FS than for stripping, but slightly higher for RFA; short-term pain was less for FS and RFA but higher for EVLA; higher quality-of-life scores were reported for all evaluated interventions than for stripping. Differences between treatments were therefore negligible in terms of clinical outcomes, so the treatment with the lowest cost appears to be most cost-effective. Our central estimate is that total FS costs were lowest and FS is marginally more effective than stripping. However, this result was sensitive to the model time horizon. Threshold analysis indicated that EVLA and RFA might be considered cost-effective if their costs are equivalent to stripping. These findings are subject to uncertainty on account of the risk of bias present in the evidence base and the variation in costs. LIMITATIONS: The relative clinical effectiveness and cost-effectiveness of the techniques are principally based on rates of post-operative technical recurrence rather than symptomatic recurrence, as this was the reported outcome in all trials. The true proportion of treated individuals who are likely to present with symptoms of recurrence requiring retreatment is therefore not certain. A figure reflecting the likely proportion of treated individuals who would experience symptomatic recurrence requiring retreatment (with its associated costs), therefore, had to be calculated by the authors based on a small number of studies. The findings of this report also need to be verified by data from future trials with longer follow-up and using more standardised outcome measures. CONCLUSIONS: This assessment of the currently available evidence suggests there is little to choose between the minimally invasive techniques in terms of efficacy or cost, and each offers a viable, clinically effective alternative to stripping. FS might offer the most cost-effective alternative to stripping, within certain time parameters. High-quality RCT evidence is needed. Future trials should aim to measure and report outcomes in a standardised manner, which would permit more efficient pooling of their results. STUDY REGISTRATION: PROSPERO number CRD42011001355. FUNDING: The National Institute for Health Research Health Technology Assessment programme.
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Ablación por Catéter/economía , Terapia por Láser/economía , Escleroterapia/economía , Várices/terapia , Ablación por Catéter/métodos , Análisis Costo-Beneficio , Gastos en Salud , Humanos , Terapia por Láser/métodos , Años de Vida Ajustados por Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Escleroterapia/métodosRESUMEN
The purpose of this longitudinal study was to compare maternal separation anxiety by gender of infants and sibling dyad in 40 employed, second-time mothers. Subjects completed two parallel measures of separation anxiety, the Maternal Separation Anxiety. Scale (MSAS) and the Interview-Based Rating Scales (IBRS). The mothers completed the MSAS when the first infant was born and again 2 years later when their second infant was 7 months old (mean age). Following completion of the MSAS (for the second child), the mothers were interviewed and rated on their separation concerns (IBRS) related to both children. No gender differences were noted when t-tests were computed on mothers' MSAS mean scores, but the IBRS revealed that mothers of second-born sons were significantly more anxious about separation (t = 2.01, p < .05) than were mothers of second-born daughters. One-way General Linear Model comparisons of both measures, for the four sibling dyads, revealed significant differences related to the dyad composition. Mothers of girl/girl dyads were significantly more anxious about separation as measured by the MSAS. On the IBRS, mothers of boy/boy dyads were significantly more anxious and mothers of boy/girl dyads were significantly less anxious when compared to mothers of the other dyads.
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Ansiedad de Separación/psicología , Madres/psicología , Relaciones entre Hermanos , Mujeres Trabajadoras/psicología , Adulto , Ansiedad de Separación/diagnóstico , Ansiedad de Separación/epidemiología , Actitud , Orden de Nacimiento , Factores de Confusión Epidemiológicos , Femenino , Humanos , Lactante , Recién Nacido , Modelos Lineales , Estudios Longitudinales , Masculino , Ohio/epidemiología , Factores Sexuales , Encuestas y CuestionariosRESUMEN
The effect of birth order on mothers' anxiety about separation from their infants was examined. Forty employed mothers were assessed in 1982 when their firstborns were 7 months old and again when their second-borns were 7 months old. Assessment included two measures: an Interview-Based Rating Scale (IBRS) and the Maternal Separation Anxiety Scale (MSAS). Findings revealed that mothers felt less guilt and anxiety about separation from their second-borns than they had from their first-borns at a similar age. They were more positive about the effects of separation on the child; however, their concerns about employment-related separation did not change.