The Contribution of Child Behaviour Problems to the Health of Caregivers

Caregivers of children with health problems have been demonstrated to show poorer physical and psychological health than caregivers of healthy children. It has been suggested that child behavioural problems are key and account for a large proportion of the variance in caregiver health. Currently, the relation between behaviour problems and caregiver health remains unclear. We conducted a meta-analysis and a secondary data analysis using national data to describe and compare the associations between internalizing and externalizing behaviour problems and caregiver health. Meta-analytical results suggest an association between child behaviour problems and parental stress, depression, and presence of psychiatric symptoms. National data analyses suggested an important association between child behaviour problems, particularly externalizing behaviour problems, and caregiver physical and psychological health when accounting for socioeconomic variables. Results suggest mothers may be more impacted than fathers, and that externalizing behaviour problems may contribute to bigger caregiver health effects than internalizing behaviour problems

Effet d’une intervention basée sur la thérapie comportementale dialectique sur les acquis développementaux de jeunes de 9e et 10e années : résultats d’un essai randomisé

La santé mentale des jeunes constitue une préoccupation croissante au Nouveau-Brunswick comme dans le reste du Canada. Devant ce constat, les gouvernements canadien et néo-brunswickois désirent impliquer davantage les écoles dans les efforts de prévention et de dépistage. Pour ce faire, les écoles auraient notamment un rôle à jouer dans le développement de facteurs de protection favorisant la résilience. Le cadre des acquis développementaux du Search Institute donne prise aux interventions en suggérant un inventaire de ressources internes et externes que les jeunes devraient pouvoir déployer devant l’adversité. La thérapie comportementale dialectique (TCD) constitue une forme d’intervention visant le développement des capacités des individus à faire face à l’adversité. Cet article présente les résultats d’un essai randomisé étudiant l’effet d’une intervention basée sur la TCD sur la progression des acquis développementaux. L’intervention consistait en six séances hebdomadaires de 70 minutes durant lesquelles des formations aux compétences sociales et émotionnelles étaient offertes à des groupes de 25 à 30 élèves. Les participants à l’étude sont 146 jeunes de 9e et 10e années de deux écoles secondaires francophones du Nouveau-Brunswick. Ces jeunes ont été répartis aléatoirement en trois groupes (expérimental, placebo et contrôle) et ont complété la version française du Developmental Assets Profile avant et un mois après l’intervention. Les résultats démontrent un effet positif de l’intervention sur quatre types d’acquis (soutien, prise en charge, encadrement et attentes et engagement envers l’apprentissage) et ce, surtout pour les jeunes ayant démontré les niveaux les plus faibles d’acquis au pré-test. Les retombées pratiques et les limites de l’étude sont discutées.Youths’ mental health is a growing concern in New Brunswick as in the rest of Canada. Faced with this observation, the governments of Canada and New Brunswick wish for a greater involvement of schools in prevention and detection efforts. To do this, schools would notably play a role in the development of protective factors that foster resilience in youth. The Search Institute’s developmental assets framework provides a target for interventions by suggesting a list of internal and external resources that youth should be able to draw on to face adversity. Dialectic behavioural therapy (DBT) constitutes one form of intervention that aims at developing individuals’ capabilities to deal with adversity. This paper presents results from a randomized trial that examined the effect of a DBT-based intervention on the progression of developmental assets. The intervention consisted in six weekly sessions of 70 minutes during which social and emotional competency training was offered to groups of 25 to 30 pupils. There were 146 study participants, grade 9 and 10, from two francophone schools in New Brunswick. Pupils were randomly assigned to one of three groups (experimental, placebo and control) and completed the French version of the Developmental Assets Profile before the intervention as well as one month after. Results suggest a positive effect of the intervention on four types of assets (support, empowerment, boundaries and expectations, and commitment to learning), especially for pupils with the lowest developmental asset scores at baseline. Practical implications of these findings and limitations to the study are discussed

Critical care at the end of life: a population-level cohort study of cost and outcomes

Abstract Background Despite the high cost associated with ICU use at the end of life, very little is known at a population level about the characteristics of users and their end of life experience. In this study, our goal was to characterize decedents who received intensive care near the end of life and examine their overall health care use prior to death. Methods This was a retrospective cohort study that examined all deaths in a 3-year period from April 2010 to March 2013 in Ontario, Canada. Using population-based health administrative databases, we examined healthcare use and cost in the last year of life. Results There were 264,754 individuals included in the study, of whom 18% used the ICU in the last 90 days of life; 34.5% of these ICU users were older than 80 years of age and 53.0% had more than five chronic conditions. The average cost of stay for these decedents was CA$15,511 to CA$25,526 greater than for those who were not admitted to the ICU. These individuals also died more frequently in hospital (88.7% vs 36.2%), and spent more time in acute-care settings (18.7 days vs. 10.5 days). Conclusions We showed at a population level that a significant proportion of those with ICU use close to death are older, multi-morbid individuals who incur significantly greater costs and die largely in hospital, with higher rates of readmission, longer lengths of stay and higher rates of aggressive care

Multiple linear regression model of number of hospital days per person in the last 90 days of life.

<p>Multiple linear regression model of number of hospital days per person in the last 90 days of life.</p

High end of life health care costs and hospitalization burden in inflammatory bowel disease patients: A population-based study

<div><p>Background</p><p>End of life (EOL) care is associated with greater costs, particularly for acute care services. In patients with inflammatory bowel disease (IBD), EOL costs may be accentuated due to reliance on hospital-based services and expensive diagnostic tests and treatments. We aimed to compare EOL health care use and costs between IBD and non-IBD decedents.</p><p>Methods</p><p>We conducted a retrospective cohort study of all decedents of Ontario, Canada between 2010 and 2013 using linked health administrative data. IBD (N = 2,214) and non-IBD (N = 262,540) decedents were compared on total direct health care costs in the last year of life and hospitalization time during the last 90 days of life.</p><p>Results</p><p>During the last 90 days of life, IBD patients spent an average of 16 days in hospital, equal to 2.1 greater adjusted hospital days (95% confidence interval [CI] 1.5–2.8 days) than non-IBD patients. IBD diagnosis was associated with $7,210 CAD (95$5,005 - $9,464) higher adjusted per-patient cost in the last year of life, of which 76% was due to excess hospitalization costs. EOL cost of IBD care was higher than 15 of 16 studied chronic conditions. Health care costs rose sharply in the last 90 days of life, primarily due to escalating hospitalization costs.</p><p>Conclusions</p><p>IBD patients spend more time in hospital and incur substantially greater health care costs than other decedents as they approach the EOL. These excess costs could be curtailed through avoidance of unnecessary hospitalizations and expensive treatments in the setting of irreversible deterioration.</p></div

Baseline characteristics of study patients.

<p>Baseline characteristics of study patients.</p

Mean individual direct health care costs per month over the last year of life.

<p>Top Panel: Total costs in IBD and non-IBD patients. Middle Panel: Total and sector-specific costs in IBD patients. Bottom Panel: Total and sector-specific costs in non-IBD patients.</p

Multiple linear regression model of health care costs per person in the last year of life.^a

<p>Multiple linear regression model of health care costs per person in the last year of life.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0177211#t003fn001" target="_blank">^a</a></p

Mean direct health care costs per patient in the last year of life across various chronic diseases.

<p>Mean direct health care costs per patient in the last year of life across various chronic diseases.</p

Mean health care sector costs per patient and frequency of health care sector usage in the last year of life among IBD and non-IBD decedents.

<p>Mean health care sector costs per patient and frequency of health care sector usage in the last year of life among IBD and non-IBD decedents.</p