Economic evaluations of guideline-based care for chronic wounds: a systematic review

Objectives: The aim of this study was to review all published economic evaluations of guideline-based care for chronic wounds and to assess how useful these studies are for decision making in health services. Methods: Embase, PubMed, Scopus, Health Technology Assessment (HTA) and National Health Service Economic Evaluation Database (NHS EED) were searched on April 16th, 2018. We included studies that evaluated the economic impact and health outcomes associated with implementing evidence-based guidelines as a bundle of care for the prevention and/or treatment of chronic wounds. Information was extracted from each eligible study and organized by the type of chronic wound. The quality of published economic evaluation studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Results: A total of 24 economic evaluation studies met the inclusion criteria, of which 12 applied decision analytic models. The compliance with the CHEERS checklist ranged between 43 and 83%. Limitations: We may have missed some economic evaluation studies despite the use of broad search terms. The quality assessment was conducted based on judgment. Using the CHEERS checklist may reflect the way evaluations were reported rather than conducted. Conclusions and Implications of Key Findings: We found that guideline-based care may be cost-saving or cost-effective in most circumstances. The quality and usefulness of reviewed studies for decision making were variable. Better information and higher-quality economic evaluations will increase decision makers’ confidence to promote guideline-based care

Alesco and Mark Resources: Cross-Border Tax Arbitrage, Economic Reality, and Anti-Avoidance Rules in New Zealand and Canada

This essay compares the role given to the concept of economic reality in New Zealand and Canadian cross-border tax arbitrage decisions, particularly Alesco and Mark Resources. Alesco and Mark Resources both address the problem of drawing the line between acceptable tax mitigation and unacceptable avoidance, and adopt economic substance as a key indicator of where this line lies. This essay considers how the concept of economic reality pervades these cases and evaluates the influence of legislative and judicial context to the significance afforded to the concept of economic reality in the two decisions, as well as reviewing how the economic realities jurisprudence has evolved following these cases

Prevalence of diverse genders and sexualities in Australia and associations with five forms of child maltreatment and multi-type maltreatment

This study presents the most comprehensive national prevalence estimates of diverse gender and sexuality identities in Australians, and the associations with five separate types of child maltreatment and their overlap (multi-type maltreatment). Using Australian Child Maltreatment Study (ACMS) data (N = 8503), 9.5% of participants identified with a diverse sexuality and.9% with a diverse gender. Diverse identities were more prevalent in the youth cohort, with 17.7% of 16–24 years olds identifying with a diverse sexuality and 2.3% with a diverse gender. Gender and sexuality diversity also intersect – for example, with women (aged 16–24 and 25–44) more likely than men to identify as bisexual. The prevalence of physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence was very high for those with diverse sexuality and/or gender identities. Maltreatment was most prevalent for participants in the youth cohort with diverse gender identities (90.5% experiencing some form of child maltreatment; 77% multi-type maltreatment) or diverse sexualities (85.3% reporting any child maltreatment; 64.3% multi-type maltreatment). The strong association found between child maltreatment and diverse sexuality and gender identities is critical for understanding the social and mental health vulnerabilities of these groups, and informing services needed to support them.</p

The global disability burden of diabetes-related lower extremity complications, in 1990 and 2016

Objective: No study has reported global disability burden estimates for individual diabetes-related lower extremity complications (DRLECs). The Global Burden of Diseases (GBD) study presents a robust opportunity to address this gap. Research Design and Methods: GBD 2016 data including prevalence and years lived with disability (YLDs) for the DRLECs of diabetic neuropathy, foot ulcer, and amputation with, and without prosthesis were used. GBD estimated prevalence using data from systematic reviews and DisMod-MR 2.1, a Bayesian meta-regression tool. YLDs were estimated as the product of prevalence estimates and disability weights for each DRLEC. We reported global, sex-, age-, region- and country-specific estimates for each DRLEC for 1990 and 2016. Results: In 2016, an estimated 131 million (1.8% of the global population) had DRLECs. An estimated 16.8 million YLDs (2.1% global YLDs) were caused by DRLECs, including 12.9 million (95% uncertainty interval: 8.30 to 18.8) from neuropathy only, 2.5 million (1.7 to 3.6) foot ulcers, 1.1 million (0.7 to 1.4) amputation without prosthesis, and 0.4 million (0.3 to 0.5) amputation with prosthesis. Age-standardised YLDs rates of all DRLECs increased by between 14.6% to 31.0% from 1990 estimates. Male-to-female YLD ratios ranged from 0.96 for neuropathy only to 1.93 for foot ulcers. Aged groups 50-69 years accounted for 47.8% of all YLDs from DRLECs. Conclusions: These first ever global estimates suggest DRLECs are a large and growing contributor to the disability burden worldwide, and disproportionately affect males and middle-to-older aged populations. These findings should facilitate policymakers worldwide to target strategies at populations disproportionately affected by DRLECs

Adaptation and validation of the Juvenile Victimization Questionnaire-R2 for a national study of child maltreatment in Australia

Background: To establish national prevalence of child maltreatment, reliable, valid and contextually appropriate measurement is needed. This paper outlines the refinement, adaptation and testing of child maltreatment sections of the Juvenile Victimization Questionnaire (JVQ)-R2 for use in the Australian context. Methods: Three phases were undertaken: 1) Conceptual analysis of the five forms of child maltreatment (physical abuse, sexual abuse, emotional or psychological abuse, neglect, and experience of domestic violence), item mapping and review, item development, and independent expert review; 2) Cognitive testing with members of the general population, and individuals who have experienced maltreatment; and 3) Pilot testing and quantitative psychometric assessment with a random sample of Australians aged 16–65+ years. Results: The final measure included a total of 17 child maltreatment screener items, assessing Physical Abuse (2 items), Sexual abuse (5 items (including 2 non-contact items and 3 contact items), Emotional Abuse (3 items), Neglect (3 items), and Experience of Domestic Violence (4 items). Screener items were also included on corporal punishment (1 item), and internet sexual victimization (2 items). The final 17-item revised JVQ had high face and conceptual validity and good internal reliability (α = 0.86 and Ω = 0.87). Test re-test reliability was moderate to high for individual screeners ranging from k = 0.45 to 0.89. Conclusions: Results indicate the Juvenile Victimization Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study) is a suitable instrument for assessing population-wide prevalence of maltreatment. It is congruent with conceptual models of maltreatment and shows good reliability and validity in this Australian sample.</p

Child sexual abuse by different classes and types of perpetrator: prevalence and trends from an Australian national survey

Background Little evidence exists about the prevalence of child sexual abuse (CSA) inflicted by different relational classes of perpetrators (e.g., parents; institutional adults; adolescents), and by individual types of perpetrators (e.g., fathers and male relatives; male teachers and male clergy; known and unknown adolescents). Objective To generate evidence of the prevalence of CSA by different perpetrators, and trends by victim gender and age group. Participants and setting The Australian Child Maltreatment Study collected information about CSA victimisation from a nationally-representative sample of 8503 individuals aged 16 and over. Methods We analysed data about 42 perpetrator types, collapsed into eight classes. We generated national prevalence estimates of CSA inflicted by each perpetrator class and individual perpetrator type, and compared results by victim gender and age group. Results Australian CSA prevalence was 28.5%, with the following prevalence by perpetrator classes: other known adolescents (non-romantic): 10.0%; parents/caregivers in the home: 7.8%; other known adults: 7.5%; unknown adults: 4.9%; adolescents (current/former romantic partners): 2.5%; institutional caregivers: 2.0%; siblings: 1.6%; unknown adolescents: 1.4%. Women experienced more CSA by all perpetrator classes except institutional caregivers. Age group comparison showed significant declines in CSA by parents/caregivers, and other known adults; and increases in CSA by adolescents (current/former romantic partners). Individual perpetrator type comparison showed declines in CSA by fathers, male relatives living in the home, non-resident male relatives, and other known male adults; and increases in CSA by known male adolescents, current boyfriends, and former boyfriends. Conclusions CSA by adults has declined, indicating positive impacts of prevention efforts. However, CSA by adolescents has increased. Further declines in CSA by adults are required and possible. Targeted prevention of CSA by adolescents must be prioritised

The prevalence and nature of multi‐type child maltreatment in Australia

Objectives To determine the prevalence in Australia of multi-type child maltreatment, defined as two or more maltreatment types (physical abuse, sexual abuse, emotional abuse, neglect, or exposure to domestic violence) and to examine its nature, family risk factors, and gender and age cohort differences. Design Retrospective cross-sectional survey using a validated questionnaire. Setting and participants Mobile phone random digit-dial sample of the Australian population aged 16 years and older. Main outcome measures National estimates of multi-type child maltreatment up to age 18 years using the Juvenile Victimisation Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study). Results Of 8503 participants, 62.2% (95% CI, 60.9–63.6%) experienced one or more types of child maltreatment. Prevalence of single-type maltreatment was 22.8% (95% CI, 21.7–24.0%), whereas 39.4% (95% CI, 38.1–40.7%) of participants reported multi-type maltreatment and 3.5% (95% CI, 3.0–4.0%) reported all five types. Multi-type maltreatment was more common for gender diverse participants (66.1% [95% CI, 53.7–78.7%]) and women (43.2% [95% CI, 41.3–45.1%]) than for men (34.9% [95% CI, 33.0–36.7%]). Multi-type maltreatment prevalence was highest for those aged 25–44 years. Family-related adverse childhood experiences — especially mental illness and alcohol or substance misuse — increased risk. Exposure to domestic violence was the maltreatment type most often present in multi-type maltreatment patterns. Conclusions Multi-type child maltreatment is prevalent in Australia and more common in women and gender diverse individuals. Child protection services, health practitioners, and prevention and intervention services must assess and manage multi-type maltreatment in children and address its health consequences across the lifespan. Public health policy should consider prevention services or strategies that target multi-type child maltreatment

The association between child maltreatment and mental disorders in the Australian Child Maltreatment Study

Objectives To examine the associations between experiences of child maltreatment and mental disorders in the Australian population. Design Population-representative survey conducted by computer-assisted telephone interviewing. Setting, participants Australian residents aged 16 years and older. Main outcome measures Mental disorder diagnoses of lifetime major depressive disorder, current alcohol use disorder (mild, moderate and severe), current generalised anxiety disorder and current post-traumatic stress disorder. Results More than one in three Australians (3606/8503 surveyed participants; 38.0%; 95% CI, 36.7–39.3%) met the diagnostic criteria for a mental disorder. The prevalence of mental disorders in non-maltreated participants was 21.6% (95% CI, 19.9–23.3%; n = 851). This increased to 36.2% (95% CI, 33.5–38.9%; n = 764) for those who experienced a single type of maltreatment and 54.8% (95% CI, 52.6–56.9%; n = 1991) for participants who experienced multi-type maltreatment. Compared with non-maltreated Australians, maltreated participants had about three times the odds of any mental disorder (odds ratio [OR], 2.82; 95% CI, 2.47–3.22), generalised anxiety disorder (OR, 3.14; 95% CI, 2.48–3.97), major depressive disorder (OR, 3.19; 95% CI, 2.68–3.80) and severe alcohol use disorder (OR, 2.62; 95% CI, 1.83–3.76), and almost five times the odds of post-traumatic stress disorder (OR, 4.60; 95% CI, 3.00–7.07). Associations between experiences of child maltreatment and mental disorders were strongest for sexual abuse, emotional abuse and multi-type maltreatment. The strength of the associations did not differ by gender. Adjustment for childhood and current financial hardship and for current socio-economic status did not significantly attenuate the associations. Conclusions Mental disorders are significantly more likely to occur in individuals who experience child maltreatment, particularly multi-type maltreatment. Prevention of child maltreatment provides an opportunity to substantially reduce the prevalence of mental illness and improve the health of the Australian population

The prevalence of peer sexual harassment during childhood in Australia

Sexual harassment inflicted by adolescents on their peers is a major public health issue, but its prevalence across childhood is not known. We provide the first nationally representative data on the prevalence of peer sexual harassment across childhood, using cross-sectional data from the Australian Child Maltreatment Study (ACMS). The ACMS surveyed 8,503 people aged 16 and over about their experiences of child maltreatment and associated health outcomes. The prevalence of peer sexual harassment was assessed using the Juvenile Victimization Questionnaire (JVQ)-R2 Adapted Version (ACMS), with survey data weighted to reflect characteristics of the Australian population. Overall, 1 in 10 (10.4% (95% Confidence Intervals (CI) [9.7, 11.3])) Australians experienced peer sexual harassment during childhood. Peer sexual harassment is an issue disproportionately affecting gender-diverse individuals (24.0%, 95% CI [15.5, 35.2]) and women (15.3%, 95% CI [14.0, 16.7%]), compared to men (5.0%, 95% CI [4.3, 5.9]). Rates of peer sexual harassment were also very high among sexuality diverse participants (prevalence estimates ranging between 14.2% and 29.8%). Peer sexual harassment was predominately inflicted by male peers (9.6%, 95% CI [8.9, 10.4]), compared to 1.8% (95% CI [1.5, 2.2]) reporting harassment from female peers. These findings have implications for understanding and reducing attitudes supporting peer sexual harassment in childhood, particularly against girls and gender and sexuality diverse youth, and associations with other gendered violence both in childhood and later life

The prevalence of child maltreatment in Australia: findings from a national survey

Objectives To estimate the prevalence in Australia of each type of child maltreatment; to identify gender- and age group-related differences in prevalence. Design, setting Cross-sectional national survey; mobile telephone interviews using random digit dialling (computer-generated), Australia, 9 April – 11 October 2021. Retrospective self-report data using validated questionnaire (Juvenile Victimisation Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study). Participants People aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16–24 years and 1000 respondents each from five further age groups (25–34, 35–44, 45–54, 55–64, 65 years or more). Main outcome measures Proportions of respondents reporting physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence to age 18 years, assessed with the Juvenile Victimization Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study), overall and by gender and age group, and weighted to reflect characteristics of the Australian population aged 16 years or more in 2016. Results Complete survey data were available for 8503 eligible participants (14% response rate). Physical abuse was reported by 32.0% of respondents (95% confidence interval [CI], 30.7–33.3%), sexual abuse by 28.5% (95% CI, 27.3–29.8%), emotional abuse by 30.9% (95% CI, 29.7–32.2%), neglect by 8.9% (95% CI, 8.1–9.7%), and exposure to domestic violence by 39.6% (95% CI, 38.3–40.9%). The proportions of respondents who reported sexual abuse, emotional abuse, or neglect were each statistically significantly larger for women than men. The reported prevalence of physical abuse by respondents aged 16–24 years was lower than for those aged 25–34 years, and that of sexual abuse was lower than for those aged 35–44 years, suggesting recent declines in the prevalence of these maltreatment types. Conclusions Child maltreatment is common in Australia, and larger proportions of women than men report having experienced sexual abuse, emotional abuse, and neglect during childhood. As physical and sexual abuse may have declined recently, public health policy and practice may have positive effects, justifying continued monitoring and prevention activities