Previous research has shown that predictors of activity in adults depend upon the method of measurement. This study is designed to assess the predictors of activity in a sample of 59 obese children. Activity was measured using self-reported and TriTrac accelerometer METs. Self-report and TriTrac accelerometer measures were moderately correlated, r = 0.46, with the self-reported activity (2.3 METs) significantly greater than TriTrac (1.6 METs). Hierarchical regression analysis examined the influence of socioeconomic level, body composition, fitness, hedonics of child and adult activity behaviors, and decisional balance on self-reported and accelerometer-measured activity, controlling for child and parent psychopathology. Child and parent psychological symptoms accounted for 8.3% and 3.4% of the variance in accelerometer and self-reported METs, respectively. The model for accelerometer-measured activity showed socioeconomic level and parent self-report of activity accounted for 14.8% of the incremental variance in child activity. The model for self-report of child activity found that child fitness accounted for 23.5% of the incremental variance in child activity. These results suggest that the predictors of activity level are different based upon the method of measurement, consistent with research in adults.
EPSTEIN, LEONARD H, MICHELLE D MYERS,KATARINA ANDERSON. The association of maternal psychopathology and family socioeconomic status with psychological problems in obese children. Obes Res, 1996;4:65-74. In an earlier study we found parental psychiatric symptoms to be a better correlate of behavioral problems in obese children than either child or parental obesity. This study sought to extend this research by assessing the association of general maternal distress, specific maternal psychopathology, family socioeconomic status and child obesity with the psychological problems of 152 children seeking treatment for obesity in two cohorts. Child psychological problems were measured using the Child Behavior Checklist/4-18 (CBCL) in each cohort. In sample 1 maternal general psychiatric symptoms were measured using the Cornell Medical Index (psychiatric subscales) and the Inventory of Interpersonal Problems whereas specific psychopathology was assessed with the Beck Depression Inventory and the Bulimia Test. In sample 2 the Symptom Checklist-90 and Binge Eating Scale provided general and specific measures of psychopathology. In the combined sample, 58% percent of the boys and 44 % of the girls met criteria on at least one CBCL behavioral problem scale, with Social Problems the most prevalent problem in both boys and girls. For both samples, child obesity did not account for any variance in child psychosocial problems beyond that accounted for by maternal psychopathology and family SES. Family SES accounted for a significant increment in variance in child behavioral problems in only two scales. This study systematically replicates previous research, adding support for a broader conceptualization of factors that influence psychological problems in obese treatment-seeking children than one which focuses on child obesity.
Introduction
Partial thickness burns not undergoing surgical excision are treated with topical silver products including silver sulfadiazine (SSD) and Mepilex Ag. Skin allograft is a more costly alternative that acts as definitive wound coverage until autogenous epithelialization. Economic constraints and the movement toward value-based care demand cost and outcome justification prior to adopting more costly products.
Methods
A cost-utility analysis was performed comparing skin allograft to SSD and Mepilex Ag using decision tree analysis. The base case modeled a superficial partial thickness 20% total body surface area burn. Utilities were derived from expert opinion on the basis of personal experience. Costs were derived from 2019 Medicare payments. Quality adjusted life years were calculated using rollback method assuming standard life expectancies in the United States. Probabilistic sensitivity analysis was performed to asses model robustness.
Results
The incremental costs of skin allograft to Mepilex Ag and SSD were $907.71 and $1257.86, respectively. The incremental quality adjusted life year (QALY) gains from allograft over Mepilex Ag and SSD were 0.011 and 0.016. This yielded an incremental cost-utility ratio for allograft vs. Mepilex Ag of $84,189.29/QALY compared with an incremental cost-utility ratio of $79,684.63/QALY for allograft vs. SSD. Assuming willingness-to-pay thresholds of $100,000/QALY, probabilistic sensitivity analysis demonstrated that allograft was cost effective to Mepilex Ag in 62.1% of scenarios, and cost effective to SSD in 64.9% of simulations.
Conclusion
Skin allograft showed greater QALYs compared with topical silver dressings at a higher cost. Depending on willingness-to-pay thresholds, skin allograft may be a considered a cost-effective treatment of partial-thickness burns.
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