Exposures to outdoor environments have great potential to be protective factors for the mental health of young people. In a national analysis of Canadian adolescents, we explored how such exposures, as well as self-perceptions of connectedness with nature, each related to the prevalence of recurrent psychosomatic symptoms. The data source for this cross-sectional study, consisting of a weighted sample of 29,784 students aged 11-15 years from 377 schools, was the 2013/2014 cycle of the Health Behaviour in School-aged Children (HBSC) study. We modeled reports of exposure to the outdoors and then perceived connection(s) to nature as correlates of reduced psychosomatic symptoms. Associations varied by sex. Among girls, spending on average >0.5 h/week outdoors was associated with a 24% (95% CI: 5%, 40%) lower prevalence of high psychosomatic symptoms, compared to those who averaged no time playing outdoors. No such relationship was observed among boys. Perception of connection to nature as 'important' was similarly associated with a 25% (95% CI: 9%, 38%) reduction in the prevalence of high psychosomatic symptoms; this association did not differ by sex or age. Our analysis highlights the potential importance of adolescent engagement with nature as protective for their psychological well-being. It also emphasizes the importance of accounting for differences between boys and girls when researching, planning, and implementing public mental health initiatives that consider exposure to the outdoors.
Earlier access to intensive behavioral intervention (IBI) is associated with improved outcomes for children with severe autism spectrum disorder (ASD); however, there are long waiting times for this program. No analyses have been performed modeling the cost-effectiveness of wait time reduction for IBI. OBJECTIVES To model the starting age for IBI with reduced wait time (RWT) (by half) and eliminated wait time (EWT), and perform a cost-effectiveness analysis comparing RWT and EWT with current wait time (CWT) from government and societal perspectives. DESIGN, SETTING, AND PARTICIPANTS Published waiting times were used to model the mean starting age for IBI for CWT, RWT, and EWT in children diagnosed with severe ASD who were treated at Ontario's Autism Intervention Program. Inputs were loaded into a decision analytic model, with an annual discount rate of 3% applied. Incremental cost-effectiveness ratios (ICERs) were determined. One-way and probabilistic sensitivity analyses were performed to assess the effect of model uncertainty. We used data from the year 2012 (January 1 through December 31) provided from the Children's Hospital of Eastern Ontario IBI center for the starting ages. Data analysis was done from May through July 2015. MAIN OUTCOMES AND MEASURES The outcome was independence measured in dependency-free life-years (DFLYs) to 65 years of age. To derive this, expected IQ was modeled based on probability of early (age <4 years) or late (age Ն4 years) access to IBI. Probabilities of having an IQ in the normal (Ն70) or intellectual disability (<70) range were calculated. The IQ strata were assigned probabilities of achieving an independent (60 DFLYs), semidependent (30 DFLYs), or dependent (0 DFLYs) outcome. Costs were calculated for provincial government and societal perspectives in Canadian dollars (Can$1 = US$0.78). RESULTS The mean starting ages for IBI were 5.24 years for CWT, 3.89 years for RWT, and 2.71 years for EWT. From the provincial government perspective, EWT was the dominant strategy, generating the most DFLYs for Can$53 000 less per individual to 65 years of age than CWT. From the societal perspective, EWT produced lifetime savings of Can$267 000 per individual compared with CWT. The ICERs were most sensitive to uncertainty in the starting age for IBI and in achieving a normal IQ based on starting age. CONCLUSIONS AND RELEVANCE This study predicts the long-term effect of the current disparity between IBI service needs and the amount of IBI being delivered in the province of Ontario. The results suggest that providing timely access optimizes IBI outcomes, improves future independence, and lessens costs from provincial and societal perspectives.
Background Computerized algorithms known as symptom checkers aim to help patients decide what to do should they have a new medical concern. However, despite widespread implementation, most studies on symptom checkers have involved simulated patients. Only limited evidence currently exists about symptom checker safety or accuracy when used by real patients. We developed a new prototype symptom checker and assessed its safety and accuracy in a prospective cohort of patients presenting to primary care and emergency departments with new medical concerns. Method A prospective cohort study was done to assess the prototype’s performance. The cohort consisted of adult patients (≥16 years old) who presented to hospital emergency departments and family physician clinics. Primary outcomes were safety and accuracy of triage recommendations to seek hospital care, seek primary care, or manage symptoms at home. Results Data from 281 hospital patients and 300 clinic patients were collected and analyzed. Sensitivity to emergencies was 100% (10/10 encounters). Sensitivity to urgencies was 90% (73/81) and 97% (34/35) for hospital and primary care patients, respectively. The prototype was significantly more accurate than patients at triage (73% versus 58%, p<0.01). Compliance with triage recommendations in this cohort using this iteration of the symptom checker would have reduced hospital visits by 55% but cause potential harm in 2–3% from delay in care. Interpretation The prototype symptom checker was superior to patients in deciding the most appropriate treatment setting for medical issues. This symptom checker could reduce a significant number of unnecessary hospital visits, with accuracy and safety outcomes comparable to existing data on telephone triage.
New technologies, especially those based in robotics and artificial intelligence, have potential to vastly change how healthcare is delivered from managing patient information to diagnosis and prognosis to performing medical procedures. Such technologies are constantly being developed, trialed, and implemented and thus, many have yet to be investigated in terms of long-term costs and effects. Using robot-assisted prostatectomy as an example, this article explores how new technologies are often associated with high initial costs and positive short-term effects but their long-term cost-effectiveness remains unknown. This idea has important implications for widespread implementation of new technologies and for clinical decision making.
Prescription opioid use has historically been a regular component of the management of chronic nonmalignant pain in Canada. However, the economic implications of high rates of addiction and abuse have motivated consideration of more cost-effective management strategies for chronic pain. The economic burden imposed by prescription opioid use relates in part to lost workplace productivity, increased addiction treatment program costs, and increased overall healthcare expenditure for these patients. In this article, we present research on the economic implications of the current rates of opioid prescription, and report on the specific economic advantages realized in alternative therapeutic approaches to pain management.
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