OBJECTIVE: Increasing numbers of young people attending university has raised concerns about the capacity of student mental health services to support them. We conducted a randomised controlled trial (RCT) to explore whether provision of an 8 week mindfulness course adapted for university students (Mindfulness Skills for Students-MSS), compared with university mental health support as usual (SAU), reduced psychological distress during the examination period. Here, we conduct an economic evaluation of MSS+SAU compared with SAU. DESIGN AND SETTING: Economic evaluation conducted alongside a pragmatic, parallel, single-blinded RCT comparing provision of MSS+SAU to SAU. PARTICIPANTS: 616 university students randomised. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary economic evaluation assessed the cost per quality-adjusted life year (QALY) gained from the perspective of the university counselling service. Costs relate to staff time required to deliver counselling service offerings. QALYs were derived from the Clinical Outcomes in Routine Evaluation Dimension 6 Dimension (CORE-6D) preference based tool, which uses responses to six items of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM; primary clinical outcome measure). Primary follow-up duration was 5 and 7 months for the two recruitment cohorts. RESULTS: It was estimated to cost £1584 (2022 prices) to deliver an MSS course to 30 students, £52.82 per student. Both costs (adjusted mean difference: £48, 95% CI £40-£56) and QALYs (adjusted mean difference: 0.014, 95% CI 0.008 to 0.021) were significantly higher in the MSS arm compared with SAU. The incremental cost-effectiveness ratio (ICER) was £3355, with a very high (99.99%) probability of being cost-effective at a willingness-to-pay threshold of £20 000 per QALY. CONCLUSIONS: MSS leads to significantly improved outcomes at a moderate additional cost. The ICER of £3355 per QALY suggests that MSS is cost-effective when compared with the UK's National Institute for Health and Care Excellence thresholds of £20 000 per QALY. TRIAL REGISTRATION NUMBER: Australian and New Zealand Clinical Trials Registry, ACTRN12615001160527.
- MeSH
- analýza nákladů a výnosů MeSH
- kvalita života MeSH
- kvalitativně upravené roky života MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- psychický distres * MeSH
- studenti psychologie MeSH
- univerzity MeSH
- všímavost * MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- Publikační typ
- časopisecké články MeSH
- pragmatická klinická studie MeSH
- randomizované kontrolované studie MeSH
- Geografické názvy
- Austrálie MeSH
BACKGROUND: Population health is vital to a nation's overall well-being and development. To achieve sustainable human development, a reduction in health inequalities and an increase in interstate convergence in health indicators is necessary. Evaluation of the convergence patterns can aid the government in monitoring the health progress across the Indian states. This study investigates the progressive changes in the convergence and divergence patterns in health status across major states of India from 1990 to 2018. METHODS: Sigma plots (σ), kernel density plots, and log t-test methods are used to test the convergence, divergence, and club convergence patterns in the health indicators at the state level. RESULTS: The result of the sigma convergence suggests that life expectancy at birth has converged across all states. After 2006, however, the infant mortality rate, neonatal mortality rate, and total fertility rate experienced a divergence pattern. The study's findings indicate that life expectancy at birth converges in the same direction across all states, falling into the same club (Club One). However, considerable cross-state variations and evidence of clubs' convergence and divergence are observed in the domains of infant mortality rate, neonatal death rate, and total fertility rate. As suggested by the kernel density estimates, life expectancy at birth stratifies, polarizes, and becomes unimodal over time, although with a single stable state. A bimodal distribution was found for infant, neonatal, and total fertility rates. CONCLUSIONS: Therefore, healthcare strategies must consider each club's transition path while focusing on divergence states to reduce health variations and improve health outcomes for each group of individuals.
BACKGROUND: Oseltamivir is usually not often prescribed (or reimbursed) for non-high-risk patients consulting for influenza-like-illness (ILI) in primary care in Europe. We aimed to evaluate the cost-effectiveness of adding oseltamivir to usual primary care in adults/adolescents (13 years +) and children with ILI during seasonal influenza epidemics, using data collected in an open-label, multi-season, randomised controlled trial of oseltamivir in 15 European countries. METHODS: Direct and indirect cost estimates were based on patient reported resource use and official country-specific unit costs. Health-Related Quality of Life was assessed by EQ-5D questionnaires. Costs and quality adjusted life-years (QALY) were bootstrapped (N = 10,000) to estimate incremental cost-effectiveness ratios (ICER), from both the healthcare payers' and the societal perspectives, with uncertainty expressed through probabilistic sensitivity analysis and expected value for perfect information (EVPI) analysis. Additionally, scenario (self-reported spending), comorbidities subgroup and country-specific analyses were performed. RESULTS: The healthcare payers' expected ICERs of oseltamivir were €22,459 per QALY gained in adults/adolescents and €13,001 in children. From the societal perspective, oseltamivir was cost-saving in adults/adolescents, but the ICER is €8,344 in children. Large uncertainties were observed in subgroups with comorbidities, especially for children. The expected ICERs and extent of decision uncertainty varied between countries (EVPI ranged €1-€35 per patient). CONCLUSION: Adding oseltamivir to primary usual care in Europe is likely to be cost-effective for treating adults/adolescents and children with ILI from the healthcare payers' perspective (if willingness-to-pay per QALY gained > €22,459) and cost-saving in adults/adolescents from a societal perspective.
- MeSH
- analýza nákladů a výnosů MeSH
- chřipka lidská * farmakoterapie MeSH
- dítě MeSH
- dospělí MeSH
- kvalita života MeSH
- kvalitativně upravené roky života MeSH
- lidé MeSH
- mladiství MeSH
- oseltamivir terapeutické užití MeSH
- primární zdravotní péče MeSH
- virové nemoci * MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
- MeSH
- kongresy jako téma MeSH
- mikrobiota * MeSH
- očekávaný život ve zdraví MeSH
- osa mozek-střevo MeSH
- střevní mikroflóra MeSH
- Publikační typ
- zprávy MeSH
- MeSH
- kvalita života MeSH
- lidé MeSH
- mikrobiota MeSH
- očekávaný život ve zdraví * MeSH
- psychický stres MeSH
- stárnutí fyziologie psychologie MeSH
- zdraví MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- rozhovory MeSH
Cíl práce: Cílem práce bylo prostřednictvím podrobných anonymizovaných primárních údajů o zemřelých v letech 2010–2020 analyzovat vývoj úmrtnosti v Česku a na Slovensku, a především v jejich kontextu identifikovat různé aspekty dopadu pandemického roku 2020. Metodika: Prostřednictvím aplikace DeRaS byly zkonstruovány podrobné úmrtnostní tabulky podle pohlaví za Česko a Slovensko pro roky 2010–2020 a analyzován vývoj naděje dožití při narození a v přesném věku 65 let. Pomocí Pressatovy jednorozměrné dekompozice byl identifikován vliv jednotlivých věkových skupin ke změně naděje dožití při narození u mužů a žen mezi roky 2019 a 2020. Následně byly určeny také příspěvky věkových skupin k poklesu intervalové naděje dožití mezi přesnými věky 65 a 110 let. Vývoj úmrtností na jednotlivé hlavní skupiny příčin smrti byl analyzován prostřednictvím přímo standardizovaných měr úmrtnosti, přičemž jsme se podrobně zaměřili i na vybrané skupiny kardiovaskulárních onemocnění. Příspěvky nejvýznamnějších skupin příčin smrti k poklesu naděje dožití při narození mezi lety 2019 a 2020 byly empiricky identifikovány aplikací dvourozměrné dekompozice podle Pollardovy metody. Výsledky: V roce 2020 se v Česku zkrátila délka života právě narozených mužů o 1,05 roku a u žen o 0,76 roku. Na Slovensku byl pokles tohoto ukazatele u mužů o 0,67 let a u žen o 0,64 let. Ještě větší snížení jsme identifikovali u obou zemí v přesném věku 65 let. Hlavní příčinou tohoto stavu bylo především zhoršení úmrtnostních poměrů ve věku 65–89 let, a to zejména na onemocnění covid-19 a některé nemoci oběhové soustavy. Závěry: Studie identifikovala významné zkrácení délky života mužů i žen v Česku i na Slovensku mezi lety 2019 a 2020. Jako hlavní důvod můžeme určit růst úmrtnosti v seniorském věku, a to přibližně do věku 90 let. Zvýšení úmrtnosti se však netýkalo všech věkových skupin, ale pokles úrovně úmrtnosti v mladším věku nedokázal výrazněji kompenzovat negativní vliv starších věků. Studie potvrdila jako hlavní faktor poklesu naděje dožití při narození úmrtnost na onemocnění covid-19. Současně však zaznamenala i nezanedbatelný vliv zhoršení úmrtnostních poměrů na onemocnění oběhové soustavy. Negativní vliv obou skupin příčin smrti se projevil především ve věku 65 a více let.
Objective: The aim was to analyse the mortality trends in Czechia and Slovakia through detailed anonymized primary data on deaths in 2010–2020 and in particular to identify various aspects of the impact of the 2020 pandemic year in their context. Methods: Using the DeRaS application, complete life tables by sex for 2010–2020 were constructed for Czechia and Slovakia, and changes in life expectancy at birth and at the exact age of 65 years were analysed. Using Pressat’s univariate decomposition, the effect of different age groups on the change in life expectancy at birth for men and women between 2019 and 2020 was identified. Subsequently, age group contributions to the decline in temporary life expectancy between the exact ages of 65 and 110 were also determined. Trends in mortality rates for each of the major cause of death groups were analysed using directly standardized mortality rates, with a detailed focus on selected groups of cardiovascular disease. The contributions of the major cause of death groups to the decline in life expectancy at birth between 2019 and 2020 were empirically identified by applying bivariate decomposition according to the Pollard method. Results: In 2020, the life expectancy of newly born men in Czechia decreased by 1.05 years and that of women by 0.76 years. In Slovakia, the decrease was 0.67 years for men and 0.64 years for women. An even greater reduction was found for both countries at the exact age of 65. The main reason for this was the worsening of the mortality rates between the ages of 65 and 89 years, especially from COVID-19 and some diseases of the circulatory system. Conclusion: The study identified a significant reduction in life expectancy at birth for both men and women in Czechia and Slovakia between 2019 and 2020. The main reason for this phenomenon was the increase in mortality rates at senior ages, up to around age 90. However, the increase in mortality did not affect all age groups, but contributions at younger ages could not significantly compensate for the negative impact of older ages. The study confirmed mortality from COVID-19 as a major factor in declining life expectancy at birth but also noted a non-negligible effect of the worsened mortality rates from circulatory diseases. The negative impact of both groups of causes of death was particularly pronounced at the age of 65 and over.
- MeSH
- COVID-19 MeSH
- lidé MeSH
- naděje dožití MeSH
- pandemie * MeSH
- příčina smrti * MeSH
- věkové faktory MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Česká republika MeSH
- Slovenská republika MeSH
The common procedure for reconstructing growth and fertility rates from skeletal samples involves regressing a growth or fertility rate on the age-at-death ratio, an indicator that captures the proportion of children and juveniles in a skeletal sample. Current methods derive formulae for predicting growth and fertility rates in skeletal samples from modern reference populations with many deaths, although recent levels of mortality are not good proxies for prehistoric populations, and stochastic error may considerably affect the age distributions of deaths in small skeletal samples. This study addresses these issues and proposes a novel algorithm allowing a customized prediction formula to be produced for each target skeletal sample, which increases the accuracy of growth and fertility rate estimation. Every prediction equation is derived from a unique reference set of simulated skeletal samples that match the target skeletal sample in size and assumed mortality level of the population that the target skeletal sample represents. The mortality regimes of reference populations are based on model life tables in which life expectancy can be flexibly set between 18 and 80 years. Regression models provide a reliable prediction; the models explain 83-95% of total variance. Due to stochastic variation, the prediction error is large when the estimate is based on a small number of skeletons but decreases substantially with increasing sample size. The applicability of our approach is demonstrated by a comparison with baseline estimates, defined here as predictions based on the widely used Bocquet-Appel (2002, doi: 10.1086/342429) equation.
- MeSH
- celosvětové zdraví MeSH
- dítě MeSH
- fertilita MeSH
- lidé MeSH
- mortalita MeSH
- naděje dožití * MeSH
- porodnost * MeSH
- tabulky života MeSH
- věkové rozložení MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
PURPOSE: To test the effect of race/ethnicity on Social Security Administration (SSA) life tables' life expectancy (LE) predictions in localized prostate cancer (PCa) patients treated with either radical prostatectomy (RP) or external beam radiotherapy (EBRT). We hypothesized that LE will be affected by race/ethnicity. PATIENTS AND METHODS: We relied on the 2004-2006 Surveillance, Epidemiology, and End Results database to identify D'Amico intermediate- and high-risk PCa patients treated with either RP or EBRT. SSA life tables were used to compute 10-year LE predictions and were compared to OS. Stratification was performed according to treatment type (RP/EBRT) and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic/Latino, and Asian). RESULTS: Of 55,383 assessable patients, 40,490 were non-Hispanic White (RP 49.3% vs. EBRT 50.7%), 7194 non-Hispanic Black (RP 41.3% vs. EBRT 50.7%), 4716 Hispanic/Latino (RP 51.0% vs. EBRT 49.0%) and 2983 were Asian (RP 41.6% vs. EBRT 58.4%). In both RP and EBRT patients, OS exceeded life tables' LE predictions, except for non-Hispanic Blacks. However, in RP patients, the magnitude of the difference was greater than in EBRT. Moreover, in RP patients, OS of non-Hispanic Blacks virtually perfectly followed predicted LE. Conversely, in EBRT patients, the OS of non-Hispanic Black patients was worse than predicted LE. CONCLUSIONS: When comparing SEER-derived observed OS with SSA life table-derived predicted life expectancy, we recorded a survival disadvantage in non-Hispanic Black RP and EBRT patients, which was not the case in the three other races/ethnicities (non-Hispanic Whites, Hispanic/Latinos, and Asians). This discrepancy should ideally be confirmed within different registries, countries, and tumor entities. Furthermore, the source of these discrepant survival outcomes should be investigated and addressed by health care politics.
- MeSH
- etnicita MeSH
- lidé MeSH
- naděje dožití MeSH
- nádory prostaty * terapie patologie MeSH
- tabulky života MeSH
- Úřad Spojených států pro sociální zabezpečení * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Spojené státy americké MeSH
