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Tanara Sousa

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Papers by Tanara Sousa

Comparing Health Gains, Costs and Cost-Effectiveness of 100s of Interventions in Australia and New Zealand: An Online Interactive League Table

Research Square (Research Square), Jan 4, 2022

Background This study compares the health gains, costs, and cost-effectiveness of hundreds of Aus... more Background This study compares the health gains, costs, and cost-effectiveness of hundreds of Australian and New Zealand (NZ) health interventions conducted with comparable methods in an online interactive league table designed to inform policy. Methods A literature review was conducted to identify peer-reviewed evaluations (2010 to 2018) arising from the Australia Cost-Effectiveness (ACE) research and NZ Burden of Disease Epidemiology, Equity and Cost-Effectiveness (BODE3) Programmes, or using similar methodology, with: health gains quanti ed as health-adjusted life years (HALYs); net health system costs and/or incremental cost-effectiveness ratio; time horizon of at least 10 years; and 3-5% discount rates. Results We identi ed 384 evaluations that met the inclusion criteria, covering 14 intervention domains: alcohol; cancer; cannabis; communicable disease; cardiovascular disease; diabetes; diet; injury; mental illness; other non-communicable disease; overweight and obesity; physical inactivity; salt; tobacco. There were large variations in health gain across evaluations: 33.9% gained less than 0.1 HALYs per 1000 people in the total population over the remainder of their lifespan, through to 13.0% gaining >10 HALYs per 1000 people. Over a third (38.8%) of evaluations were cost-saving.

Statistical analysis plan for HOMESIDE: a randomised controlled trial for home-based family caregiver-delivered music and reading interventions for people living with dementia

Trials, May 8, 2023

Background Most people with dementia live in the community, not in residential care. Therefore, q... more Background Most people with dementia live in the community, not in residential care. Therefore, quality informal care for them is critical for managing behavioural and psychological symptoms of dementia (BPSD). Music therapy has been shown to reduce BPSD. However, no randomised controlled trial has examined the effects of music interventions delivered by caregivers in home settings. The HOME-based caregiver-delivered music intervention for people living with dementia (HOMESIDE) trial aims to evaluate the effectiveness of a 12-week music intervention in addition to standard care for BPSD. This article describes the statistical analysis plan. Methods and analysis HOMESIDE is a large, pragmatic international three-arm parallel-group randomised controlled trial. Dyads (persons with dementia and caregiver) in Australia, Germany, the UK, Poland and Norway were randomised to receive music and standard care, reading and standard care or standard care alone. The primary outcome is BPSD (proxy) of the person living with dementia, measured using the Neuropsychiatric Inventory-Questionnaire (NPI-Q) at 90 and 180 days post-randomisation. Longitudinal analysis will compare NPI-Q severity between music and standard care versus standard care alone. Secondary outcomes include quality of life and depression (both person with dementia and caregiver), cognition (person with dementia only), distress, resilience, competence and caregiverpatient relationship (caregiver only). Treatment effects will be obtained at 90 and 180 days post-randomisation, where applicable. Safety outcomes (adverse events, hospitalisations, deaths) will be summarised. Discussion This statistical analysis plan provides a detailed methodology for the analysis of HOMESIDE and will improve the validity of the study and reduce the potential for bias.

$Research paper thumbnail of Drug use and driving behaviors among drivers with and without alcohol-related infractions$

Drug use and driving behaviors among drivers with and without alcohol-related infractions

Trends in Psychiatry and Psychotherapy, Sep 1, 2020

Introduction: Brazil is one of the countries with the highest rates of alcohol-related traffic in... more Introduction: Brazil is one of the countries with the highest rates of alcohol-related traffic infractions, but little is known about the profile of the drivers who commit them. Identifying the characteristics of impaired drivers is essential for planning preventive actions. Objective: To compare drug use and driving behavior profiles of drivers with and without alcohol-related infractions. Methods: 178 drivers stopped at routine roadblocks were assessed by traffic agents who conducted standard roadblock procedures (document verification; request of a breathalyzer test [BT]). Drug use and driving behavior data were collected through semi-structured interviews. Subjects were divided into three groups: drivers who refused the BT (RDs, n = 72), drivers who tested positive on the BT (PDs, n = 34), and drivers who had committed other infractions (ODs, n = 72). Results: The proportion of alcohol use in the last year was higher among RDs (100%) than in the PD and OD groups (97.1% and 72.2% respectively, p < 0.001). Lifetime prevalence of cannabis and cocaine use for the overall sample was 44.3% and 18.2%, respectively. Fewer individuals in the OD group (31.5%) reported having been stopped at roadblocks in the previous year compared to the PDs (55.9%) and RDs (48.6%, p = 0.03). However, a higher proportion of RDs reported drunk driving in the same period (87.5%; PD 69.7%; OD 26.9%; p < 0.001). Conclusion: Essential differences among groups were observed. RDs had a higher proportion of alcohol use and drunk driving in the previous year; drivers who fit into this particular group may be unresponsive or less responsive to social deterrence and enforcement actions.

Effects of macroeconomic conditions on health in Brazil

Revista De Saude Publica, Apr 1, 2010

OBJECTIVE: To analyze the relationship between macroeconomic conditions and health in Brazil. MET... more OBJECTIVE: To analyze the relationship between macroeconomic conditions and health in Brazil. METHODS: The analysis of the impact of employment and income on mortality in Brazil was based on panel data from Brazilian states between 1981 and 2002. Mortality rates obtained from the national mortality database was used as a proxy for health status, whereas the variables employment, income, and illiteracy rates were used as proxies for macroeconomic and socioeconomic conditions. Static and dynamic models were applied for the analysis of two hypotheses: a) there is a positive relationship between mortality rates and income and employment, as suggested by Ruhm; b) there is a negative relationship between mortality rates and income and employment, as suggested by Brenner. RESULTS: There was found a negative relationship between mortality rates (proxy for health) and macroeconomic conditions (measured by employment rate). The estimates indicated that the overall mortality rate was higher during economic recession, suggesting that as macroeconomic conditions improved, increasing employment rates, there was a decrease in the mortality rate. The estimate for the relationship between illiteracy (proxy for education level) and mortality rate showed that higher levels of education can improve health. CONCLUSIONS: The results from the static and dynamic models support Brenner's hypothesis that there is a negative relationship between mortality rates and macroeconomic conditions.

[Panel data analysis of health status in Northeast Brazil]

Revista De Saude Publica, Oct 1, 2008

Análise por dados em painel do status de saúde no Nordeste Brasileiro Panel data analysis of heal... more Análise por dados em painel do status de saúde no Nordeste Brasileiro Panel data analysis of health status in Northeast Brazil RESUMO OBJETIVO: Analisar fatores determinantes do status de saúde em cada estado da Região Nordeste do Brasil. MÉTODOS: Estudo utilizando a metodologia de dados em painel, com informações agregadas para municípios. Os dados compreendem os anos de 1991 e 2000, e foram obtidos no Atlas do Desenvolvimento Humano do Programa das Nações Unidas para o Desenvolvimento, e Secretaria do Tesouro Nacional. Utilizou-se como indicador do status de saúde, a taxa de mortalidade infantil, e como determinantes as variáveis: gastos com saúde e saneamento per capita, números de médicos por mil habitantes, acesso à água tratada, taxa de fecundidade e de analfabetismo, percentual de mães adolescentes, renda per capita e índice de Gini. RESULTADOS: As taxas de mortalidade infantil na região Nordeste reduziramse em 31,8% no período analisado, desempenho pouco superior ao apresentado para a média nacional. No entanto, em alguns estados, como Rio Grande do Norte, Bahia, Ceará e Alagoas, a redução foi mais signifi cativa. Isso pode ser atribuído à melhora de alguns indicadores que são os principais determinantes da redução da taxa de mortalidade infantil: maior acesso à educação, redução da taxa de fecundidade, aumento da renda, e do acesso à água. CONCLUSÕES: Os estados que apresentaram maiores ganhos no acesso à água tratada, educação, renda e redução da taxa de fecundidade, foram também os que obtiveram maiores ganhos na redução da mortalidade de menores de um ano de idade.

Content development and validation for a mobile application designed to train family caregivers in the use of music to support care of people living with dementia

Frontiers in Medicine, May 12, 2023

Background: Music therapy is increasingly recognized as an effective support for people living wi... more Background: Music therapy is increasingly recognized as an effective support for people living with dementia. However, with incidences of dementia increasing, and limited availability of music therapists, there is a need for affordable and accessible ways that caregivers can learn to use music-therapy based strategies to support the people they care for. The MATCH project aims to address this by creating a mobile application that can train family caregivers in the use of music to support people living with dementia. Methods: This study details the development and validation of training material for the MATCH mobile application. Training modules developed based on existing research were assessed by 10 experienced music therapist clinician-researchers, and seven family caregivers who had previously completed personalized training in music therapy strategies via the HOMESIDE project. Participants reviewed the content and scored each training module based on content (music therapists) and face (caregivers) validity scales. Descriptive statistics were used to calculate scores on the scales, while thematic analysis was used to analyze short-answer feedback. Results: Participants scored the content as valid and relevant, however, they provided additional suggestions for improvement via short-answer feedback. Conclusion: The content developed for the MATCH application is valid and will be trailed by family caregivers and people living with dementia in a future study.

Music interventions for dementia and depression in elderly care (MIDDEL): The Australian part of an international cluster randomised controlled trial

Alzheimers & Dementia, Dec 1, 2021

Dementia and depression are highly prevalent, comorbid conditions in older adults residing in car... more Dementia and depression are highly prevalent, comorbid conditions in older adults residing in care homes and are associated with individual distress and associated challenges for care staff. Music‐based interventions are widely used and potentially effective nonpharmacological interventions, due to the relative preservation of the ability of people with dementia to respond to music even with disease progression. However, there is a lack of large‐scale studies evaluating the effectiveness of music‐based interventions in dementia care. Music Interventions for Dementia and Depression in the Elderly (MIDDEL) is the first large‐scale international cluster‐randomised controlled trial to investigate the effectiveness of small group music therapy (GMT), recreational choir singing (RCS) and their combination on levels of depression in residents with dementia. The trial is currently being conducted across six countries, and this presentation will outline the study outcomes from the Australian arm of the trial.

Demographic and clinical profile of residents living with dementia and depressive symptoms in Australian private residential aged care: Data from the Music Interventions for Dementia and Depression in ELderly care ( <scp>MIDDEL</scp> ) cluster‐randomised controlled trial

Australasian Journal on Ageing, Jul 8, 2022

Clinical effectiveness of music interventions for dementia and depression in elderly care (MIDDEL): Australian cohort of an international pragmatic cluster-randomised controlled trial

The Lancet Healthy Longevity, Mar 1, 2022

Background: Dementia and depression are highly prevalent and comorbid conditions among older adul... more Background: Dementia and depression are highly prevalent and comorbid conditions among older adults living in care homes and are associated with individual distress and rising societal costs. Effective, scalable, and feasible interventions are needed. Music interventions have shown promising effects, but the current evidence base is inconclusive. The present study aimed to determine the effectiveness of two different music interventions on the depressive symptoms of people with dementia living in residential aged care. Methods: We implemented a 2 × 2 factorial cluster-randomised controlled trial to determine whether group music therapy (GMT) is more effective than no GMT with standard care, or recreational choir singing (RCS) is more effective than no RCS with standard care, for reducing depressive symptoms and other secondary outcomes in people with dementia with mild to severe depressive symptoms living in residential aged care. Care home units with at least ten residents were allocated to GMT, RCS, GMT plus RCS, or standard care, using a computer-generated list with block randomisation (block size four). The protocolised interventions were delivered by music therapists (GMT) and community musicians (RCS). The primary outcome was Montgomery-Åsberg Depression Rating Scale score at 6 months, assessed by a masked assessor and analysed on an intention-to-treat basis using linear mixed-effects models, which examined the effects of GMT versus no-GMT and RCS versus no-RCS, as well as interaction effects of GMT and RCS. We report on the Australian cohort of an international trial. This trial is registered with ClinicalTrials.gov, NCT03496675, and anzctr.org.au, ACTRN12618000156280. Findings: Between June 15, 2018, and Feb 18, 2020, we approached 12 RAC facilities with 26 eligible care home units and, excluding six units who could not be enrolled due to COVID-19 lockdowns, we screened 818 residents. Between July 18, 2018, and Nov 26, 2019, 20 care home units were randomised (318 residents). Recruitment ceased on March 17, 2020, due to COVID-19. The primary endpoint, available from 20 care home units (214 residents), suggested beneficial effects of RCS (mean difference –4·25, 95% CI –7·89 to –0·62;p=0·0221) but not GMT (mean difference –0·44, –4·32 to 3·43;p=0·8224). No related serious adverse events occurred. Interpretation: Our study supports implementing recreational choir singing as a clinically relevant therapeutic intervention in reducing depressive symptoms for people with dementia in the Australian care home context. Funding: National Health and Medical Research Council, Australia. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

Avaliação econômica no âmbito das doenças raras: isto é possível?

Cadernos De Saude Publica, Mar 1, 2015

Economic evaluation in the context of rare diseases: is it possible? Avaliação econômica no âmbit... more

Risk factors associated with recurrent DUI offenses in Brazil

International Conference on Alcohol, Drugs and Traffic Safety (T2013), 20th, 2013, Brisbane, Queensland, Australia, Aug 1, 2013

Alcohol in blood is a major factor for traffic accidents; high blood alcohol concentrations (BAC)... more Alcohol in blood is a major factor for traffic accidents; high blood alcohol concentrations (BAC) increase the risk of involvement in offenses, and it is hypothesized that traffic injuries and casualty rates are partly attributed to recurrent offending behavior. The objective of this paper is to analyze and compare risk and protective factors among Brazilian repeat DUI offenders in 2009/2010. Cross-sectional study with 12,204 DUI offenders from the State Traffic Department was carried out using descriptive statistics and Poisson regression analysis. Drivers, age, sex, education level, time license to drive and license category were assessed. Drivers were considered repeat offenders if convicted of DUI more than once among 2009/2010. 538 drivers (4.41 per cent) were repeat offenders. The risk factors with the highest rates were age between 41 and 50, being licensed for 12 years or more, having a motorcycle/car/truck license, having a restricted license for psychological reasons, and driving a truck or similar at the moment of notification. Protective factors were female sex, professional driver, and high levels of education. An inverse relation was observed between repeat offending and education level, suggesting that mass media dissemination of the new law is not reaching the lowest education strata. As for professional drivers, the fear of losing a job may be an influence on driving behavior. Internationally reported rates of one-time and repeat DUI offenses are higher than here reported, probably as a result of the poor law enforcement in Brazil.

Death rates from alcohol-associated road traffic crashes among vulnerable road users in 5 Brazilian capital cities

International Conference on Alcohol, Drugs and Traffic Safety (T2013), 20th, 2013, Brisbane, Queensland, Australia, Aug 1, 2013

In Brazil, vulnerable road users (VRUs) including motorcyclists, pedestrians, and bicyclists, com... more In Brazil, vulnerable road users (VRUs) including motorcyclists, pedestrians, and bicyclists, comprised more than half of all fatal road traffic injuries (RTIs) in 2010. Alcohol is a major risk factor for RTI, which is being targeted by the Global Road Safety Initiative (RS10) in five capitals. Few published studies on alcohol-associated RTI exist at the national level. To analyze the prevalence of blood alcohol content among motorcyclists and pedestrians involved in fatal traffic crashes in five intervention Brazilian cities from 2000-2010: Palmas (North); Teresina (Northeast); Campo Grande (Midwest); Belo Horizonte (Southeast); and Curitiba (South). Mortality rates were calculated based on Brazilian Ministry of Health data using ICD- 10 codes, and disaggregated by sex, age, and city. The prevalence of alcohol associated RTI mortality was estimated after applying the proportion of deaths found to be positive for alcohol in another Brazilian capital. The prevalence of blood alcohol content among VRUs was highest in Palmas and lowest in Belo Horizonte; compare 10.07/100,000 inhabitants and 5.95/100,000 inhabitants respectively. The rates observed in Palmas and Teresina (9.91) are well above the national rate of 6.9/100,000 inhabitants. The blood alcohol content among VRUS in Curitiba and Campo Grande (both 6.61) are slightly below the five Brazilian capital cities rate. Blood alcohol content in fatal traffic crashes among VRUs indicates the need for policy reform and renewed enforcement, including increased breath testing. Further analyses can help target interventions toward at-risk groups.

P020 Polysomnographic titration of non-invasive ventilation in motor neurone disease (3TLA): Study protocol for a randomised controlled trial

Sleep advances, Oct 1, 2022

Approximately 1 in 150 people in Australia are diagnosed with Autism Spectrum Disorder (ASD) (Aus... more Approximately 1 in 150 people in Australia are diagnosed with Autism Spectrum Disorder (ASD) (Australian Institute of Health and Welfare, 2017). Studies suggest up to 80% of children diagnosed with ASD experience sleep difficulties (Cortesi et al., 2010). Behavioural sleep intervention is effective to improve sleep difficulties for children diagnosed with ASD (Jin, Hanley & Beaulieu, 2013). Additionally, caregiver support via telehealth can provide clients with greater access and flexibility of services. This paper will explore the current research on behavioural sleep intervention from a Behaviour-Analytic perspective and provide a model for behavioural sleep intervention via telehealth. This three-phase model includes: (1) an initial comprehensive behavioural sleep assessment, including the Sleep Assessment and Treatment Tool (Hanley, 2005) and baseline data collection to gather information on the child's current sleep schedule and behaviours, (2) supporting caregiver implementation of an individualised behavioural sleep intervention via telehealth, including daily data collection and graphing to monitor efficacy throughout the intervention, and (3) ongoing review and revision alongside the caregiver until their and their child's sleep goal has been achieved. By providing evidence-based behavioural sleep intervention via telehealth, children diagnosed with ASD can achieve healthy sleep.

An evidence-base for the implementation of hospital-based palliative care programs in routine cancer practice: A systematic review

Palliative Medicine

Background: Despite global support, there remain gaps in the integration of early palliative care... more Background: Despite global support, there remain gaps in the integration of early palliative care into cancer care. The methods of implementation whereby evidence of benefits of palliative care is translated into practice deserve attention. Aim: To identify implementation frameworks utilised in integrated palliative care in hospital-based oncology services and to describe the associated enablers and barriers to service integration. Design: Systematic review with a narrative synthesis including qualitative, mixed methods, pre-post and quasi experimental designs following the guidance by the Centre for Reviews and Dissemination (PROSPERO registration CRD42021252092). Data sources: Six databases searched in 2021: EMBASE, EMCARE, APA PsycINFO, CINAHL, Cochrane Library and Ovid MEDLINE searched in 2023. Included were qualitative or quantitative studies, in English language, involving adults >18 years, and implementing hospital-based palliative care into cancer care. Critical appraisal...

Perfil das vítimas fatais “Vulnerable Road Users” na região sul do Brasil

Cannabis and Traffic Accidents

Evidence regarding how drugs other than alcohol are associated to traffic accidents (TAs) has inc... more Evidence regarding how drugs other than alcohol are associated to traffic accidents (TAs) has increased in recent years. In many settings, cannabis is the most frequent illicit drug detected among drivers, and its prevalence is typically lower among drivers on the road, compared to injured drivers. Most case-control studies have found an increased chance of TAs among individuals who tested positive for cannabis. However, the findings depend on which cannabis components are analyzed, and whether the results originated from the analysis of blood, oral fluid, or urine. Whole blood sampling is the most effective confirmatory test, although the most accessible matrix for the roadside detection is oral fluid. Given the difficulties in establishing impairment based on toxicological tests, countries are struggling to enact legislation that regulates driving under the influence of cannabis. Overall, the laws that regulate driving under the influence of psychoactive and illegal drugs also reg...

Analytical reliability of four oral fluid point-of-collection testing devices for drug detection in drivers

Forensic Science International, 2020

Background: Point-of-collection testing (POCT) devices for psychoactive substance detection throu... more Background: Point-of-collection testing (POCT) devices for psychoactive substance detection through oral fluid samples are used in several countries for traffic enforcement. However, the reported reliability of such devices is quite heterogeneous among studies, and evaluating and comparing their analytical performance is of paramount importance to guide enforcement policies. Aim: To evaluate the analytical reliability of four POCT devices for the detection of cocaine and cannabinoids using oral fluid samples of Brazilian drivers. Method: A total of 168 drivers were recruited during standard roadblockfI procedures in Southern Brazil. Subjects were screened using one of the following POCT devices: the DDS2 TM , the DOA MultiScreen TM , the Dräger Drug Test 5000 TM and the Multi-Drug Multi-Line Twist Screen Device TM (MDML). Results of the screening tests were compared with chromatographic analyses in order to obtain the reliability parameters. Results: The prevalence of confirmed positive samples for cocaine and cannabinoids were 9 % and 4.4 %, respectively. For cocaine, three POCT devices (MDML TM , Dräger DrugTest 5000 TM , DOA MultiScreen TM) showed good reliability, greater than 80 % of performance measures, using guidelines for research on drugged driving published by Walsh et al. (cutoff 10 ng/mL). However, for cannabinoids, the devices had low reliability-only Dräger DrugTest 5000 TM had good performance using cutoffs proposed by Walsh et al. (cutoff 2 ng/mL). Conclusion: We observed a high prevalence of drivers testing positive for cocaine and cannabinoids. Most devices achieved good reliability performance for cocaine detection using cutoffs proposed by Walsh et al. or using the device's own cutoff. Instead, the reliability for cannabinoid detection obtained the desired parameters in just one device using cutoffs proposed by Walsh et al. and its own cutoff. Difficulties in detecting cannabinoids at the roadside should be better evaluated before the implementation of such tests.

Reliability of point-of-collection testing devices for drugs of abuse in oral fluid: A systematic review and meta-analysis

Journal of Pharmaceutical and Biomedical Analysis, 2017

Reliability of pointof-collection testing devices for drugs of abuse in oral fluid: A systematic ... more

Risk behavior, sensation seeking and impulsivity: study comparing drunk drivers with sober drivers

Scientific evidences show that drivers who drink and drive tend to be more impulsive and high sen... more Scientific evidences show that drivers who drink and drive tend to be more impulsive and high sensation seekers, as well as more susceptible to risky behaviors and traffic accidents. This research compares drivers who had DUI infractions in the previous year with drivers who did not in relation to their rates of impulsivity, sensation seeking (SS) and traffic risk behaviors. The sample comprised 50 drivers with infractions (86 per cent male) and 106 with no infraction (73.6 per cent males) recruited in the Brazilian Traffic Department and three Driving Training Centers. Measures utilized were the Barrat Impulsivity Scale (BIS-11), the Sensation Seeking Inventory of Arnett (AISS) and the Driver Behavior Questionnaire (DBQ). We compared groups using chi-square with a 5 per cent level of significance. Offenders showed higher means in the violation scores of the DBQ. Lifetime involvement with accidents were more prevalent among offenders. A statistical difference was verified among the groups also in the impulsiveness and sensation seeking scores. Data suggest that offenders for DUI differ from non-offenders in relation to personality traits - sensation seeking and impulsivity - and they would tend to commit other traffic violations. Although preliminary, our results may help discuss measures for assessment, rehabilitation and traffic enforcement.

Home-Based Family Caregiver-Delivered Music And Reading Interventions for People Living With Dementia: An International Randomised Controlled Trial (HOMESIDE Trial)

Comparing Health Gains, Costs and Cost-Effectiveness of 100s of Interventions in Australia and New Zealand: An Online Interactive League Table

Research Square (Research Square), Jan 4, 2022

Background This study compares the health gains, costs, and cost-effectiveness of hundreds of Aus... more Background This study compares the health gains, costs, and cost-effectiveness of hundreds of Australian and New Zealand (NZ) health interventions conducted with comparable methods in an online interactive league table designed to inform policy. Methods A literature review was conducted to identify peer-reviewed evaluations (2010 to 2018) arising from the Australia Cost-Effectiveness (ACE) research and NZ Burden of Disease Epidemiology, Equity and Cost-Effectiveness (BODE3) Programmes, or using similar methodology, with: health gains quanti ed as health-adjusted life years (HALYs); net health system costs and/or incremental cost-effectiveness ratio; time horizon of at least 10 years; and 3-5% discount rates. Results We identi ed 384 evaluations that met the inclusion criteria, covering 14 intervention domains: alcohol; cancer; cannabis; communicable disease; cardiovascular disease; diabetes; diet; injury; mental illness; other non-communicable disease; overweight and obesity; physical inactivity; salt; tobacco. There were large variations in health gain across evaluations: 33.9% gained less than 0.1 HALYs per 1000 people in the total population over the remainder of their lifespan, through to 13.0% gaining >10 HALYs per 1000 people. Over a third (38.8%) of evaluations were cost-saving.

Statistical analysis plan for HOMESIDE: a randomised controlled trial for home-based family caregiver-delivered music and reading interventions for people living with dementia

Trials, May 8, 2023

Background Most people with dementia live in the community, not in residential care. Therefore, q... more Background Most people with dementia live in the community, not in residential care. Therefore, quality informal care for them is critical for managing behavioural and psychological symptoms of dementia (BPSD). Music therapy has been shown to reduce BPSD. However, no randomised controlled trial has examined the effects of music interventions delivered by caregivers in home settings. The HOME-based caregiver-delivered music intervention for people living with dementia (HOMESIDE) trial aims to evaluate the effectiveness of a 12-week music intervention in addition to standard care for BPSD. This article describes the statistical analysis plan. Methods and analysis HOMESIDE is a large, pragmatic international three-arm parallel-group randomised controlled trial. Dyads (persons with dementia and caregiver) in Australia, Germany, the UK, Poland and Norway were randomised to receive music and standard care, reading and standard care or standard care alone. The primary outcome is BPSD (proxy) of the person living with dementia, measured using the Neuropsychiatric Inventory-Questionnaire (NPI-Q) at 90 and 180 days post-randomisation. Longitudinal analysis will compare NPI-Q severity between music and standard care versus standard care alone. Secondary outcomes include quality of life and depression (both person with dementia and caregiver), cognition (person with dementia only), distress, resilience, competence and caregiverpatient relationship (caregiver only). Treatment effects will be obtained at 90 and 180 days post-randomisation, where applicable. Safety outcomes (adverse events, hospitalisations, deaths) will be summarised. Discussion This statistical analysis plan provides a detailed methodology for the analysis of HOMESIDE and will improve the validity of the study and reduce the potential for bias.

$Research paper thumbnail of Drug use and driving behaviors among drivers with and without alcohol-related infractions$

Drug use and driving behaviors among drivers with and without alcohol-related infractions

Trends in Psychiatry and Psychotherapy, Sep 1, 2020

Introduction: Brazil is one of the countries with the highest rates of alcohol-related traffic in... more Introduction: Brazil is one of the countries with the highest rates of alcohol-related traffic infractions, but little is known about the profile of the drivers who commit them. Identifying the characteristics of impaired drivers is essential for planning preventive actions. Objective: To compare drug use and driving behavior profiles of drivers with and without alcohol-related infractions. Methods: 178 drivers stopped at routine roadblocks were assessed by traffic agents who conducted standard roadblock procedures (document verification; request of a breathalyzer test [BT]). Drug use and driving behavior data were collected through semi-structured interviews. Subjects were divided into three groups: drivers who refused the BT (RDs, n = 72), drivers who tested positive on the BT (PDs, n = 34), and drivers who had committed other infractions (ODs, n = 72). Results: The proportion of alcohol use in the last year was higher among RDs (100%) than in the PD and OD groups (97.1% and 72.2% respectively, p < 0.001). Lifetime prevalence of cannabis and cocaine use for the overall sample was 44.3% and 18.2%, respectively. Fewer individuals in the OD group (31.5%) reported having been stopped at roadblocks in the previous year compared to the PDs (55.9%) and RDs (48.6%, p = 0.03). However, a higher proportion of RDs reported drunk driving in the same period (87.5%; PD 69.7%; OD 26.9%; p < 0.001). Conclusion: Essential differences among groups were observed. RDs had a higher proportion of alcohol use and drunk driving in the previous year; drivers who fit into this particular group may be unresponsive or less responsive to social deterrence and enforcement actions.

Effects of macroeconomic conditions on health in Brazil

Revista De Saude Publica, Apr 1, 2010

OBJECTIVE: To analyze the relationship between macroeconomic conditions and health in Brazil. MET... more OBJECTIVE: To analyze the relationship between macroeconomic conditions and health in Brazil. METHODS: The analysis of the impact of employment and income on mortality in Brazil was based on panel data from Brazilian states between 1981 and 2002. Mortality rates obtained from the national mortality database was used as a proxy for health status, whereas the variables employment, income, and illiteracy rates were used as proxies for macroeconomic and socioeconomic conditions. Static and dynamic models were applied for the analysis of two hypotheses: a) there is a positive relationship between mortality rates and income and employment, as suggested by Ruhm; b) there is a negative relationship between mortality rates and income and employment, as suggested by Brenner. RESULTS: There was found a negative relationship between mortality rates (proxy for health) and macroeconomic conditions (measured by employment rate). The estimates indicated that the overall mortality rate was higher during economic recession, suggesting that as macroeconomic conditions improved, increasing employment rates, there was a decrease in the mortality rate. The estimate for the relationship between illiteracy (proxy for education level) and mortality rate showed that higher levels of education can improve health. CONCLUSIONS: The results from the static and dynamic models support Brenner's hypothesis that there is a negative relationship between mortality rates and macroeconomic conditions.

[Panel data analysis of health status in Northeast Brazil]

Revista De Saude Publica, Oct 1, 2008

Análise por dados em painel do status de saúde no Nordeste Brasileiro Panel data analysis of heal... more Análise por dados em painel do status de saúde no Nordeste Brasileiro Panel data analysis of health status in Northeast Brazil RESUMO OBJETIVO: Analisar fatores determinantes do status de saúde em cada estado da Região Nordeste do Brasil. MÉTODOS: Estudo utilizando a metodologia de dados em painel, com informações agregadas para municípios. Os dados compreendem os anos de 1991 e 2000, e foram obtidos no Atlas do Desenvolvimento Humano do Programa das Nações Unidas para o Desenvolvimento, e Secretaria do Tesouro Nacional. Utilizou-se como indicador do status de saúde, a taxa de mortalidade infantil, e como determinantes as variáveis: gastos com saúde e saneamento per capita, números de médicos por mil habitantes, acesso à água tratada, taxa de fecundidade e de analfabetismo, percentual de mães adolescentes, renda per capita e índice de Gini. RESULTADOS: As taxas de mortalidade infantil na região Nordeste reduziramse em 31,8% no período analisado, desempenho pouco superior ao apresentado para a média nacional. No entanto, em alguns estados, como Rio Grande do Norte, Bahia, Ceará e Alagoas, a redução foi mais signifi cativa. Isso pode ser atribuído à melhora de alguns indicadores que são os principais determinantes da redução da taxa de mortalidade infantil: maior acesso à educação, redução da taxa de fecundidade, aumento da renda, e do acesso à água. CONCLUSÕES: Os estados que apresentaram maiores ganhos no acesso à água tratada, educação, renda e redução da taxa de fecundidade, foram também os que obtiveram maiores ganhos na redução da mortalidade de menores de um ano de idade.

Content development and validation for a mobile application designed to train family caregivers in the use of music to support care of people living with dementia

Frontiers in Medicine, May 12, 2023

Background: Music therapy is increasingly recognized as an effective support for people living wi... more Background: Music therapy is increasingly recognized as an effective support for people living with dementia. However, with incidences of dementia increasing, and limited availability of music therapists, there is a need for affordable and accessible ways that caregivers can learn to use music-therapy based strategies to support the people they care for. The MATCH project aims to address this by creating a mobile application that can train family caregivers in the use of music to support people living with dementia. Methods: This study details the development and validation of training material for the MATCH mobile application. Training modules developed based on existing research were assessed by 10 experienced music therapist clinician-researchers, and seven family caregivers who had previously completed personalized training in music therapy strategies via the HOMESIDE project. Participants reviewed the content and scored each training module based on content (music therapists) and face (caregivers) validity scales. Descriptive statistics were used to calculate scores on the scales, while thematic analysis was used to analyze short-answer feedback. Results: Participants scored the content as valid and relevant, however, they provided additional suggestions for improvement via short-answer feedback. Conclusion: The content developed for the MATCH application is valid and will be trailed by family caregivers and people living with dementia in a future study.

Music interventions for dementia and depression in elderly care (MIDDEL): The Australian part of an international cluster randomised controlled trial

Alzheimers & Dementia, Dec 1, 2021

Dementia and depression are highly prevalent, comorbid conditions in older adults residing in car... more Dementia and depression are highly prevalent, comorbid conditions in older adults residing in care homes and are associated with individual distress and associated challenges for care staff. Music‐based interventions are widely used and potentially effective nonpharmacological interventions, due to the relative preservation of the ability of people with dementia to respond to music even with disease progression. However, there is a lack of large‐scale studies evaluating the effectiveness of music‐based interventions in dementia care. Music Interventions for Dementia and Depression in the Elderly (MIDDEL) is the first large‐scale international cluster‐randomised controlled trial to investigate the effectiveness of small group music therapy (GMT), recreational choir singing (RCS) and their combination on levels of depression in residents with dementia. The trial is currently being conducted across six countries, and this presentation will outline the study outcomes from the Australian arm of the trial.

Demographic and clinical profile of residents living with dementia and depressive symptoms in Australian private residential aged care: Data from the Music Interventions for Dementia and Depression in ELderly care ( <scp>MIDDEL</scp> ) cluster‐randomised controlled trial

Australasian Journal on Ageing, Jul 8, 2022

Clinical effectiveness of music interventions for dementia and depression in elderly care (MIDDEL): Australian cohort of an international pragmatic cluster-randomised controlled trial

The Lancet Healthy Longevity, Mar 1, 2022

Background: Dementia and depression are highly prevalent and comorbid conditions among older adul... more Background: Dementia and depression are highly prevalent and comorbid conditions among older adults living in care homes and are associated with individual distress and rising societal costs. Effective, scalable, and feasible interventions are needed. Music interventions have shown promising effects, but the current evidence base is inconclusive. The present study aimed to determine the effectiveness of two different music interventions on the depressive symptoms of people with dementia living in residential aged care. Methods: We implemented a 2 × 2 factorial cluster-randomised controlled trial to determine whether group music therapy (GMT) is more effective than no GMT with standard care, or recreational choir singing (RCS) is more effective than no RCS with standard care, for reducing depressive symptoms and other secondary outcomes in people with dementia with mild to severe depressive symptoms living in residential aged care. Care home units with at least ten residents were allocated to GMT, RCS, GMT plus RCS, or standard care, using a computer-generated list with block randomisation (block size four). The protocolised interventions were delivered by music therapists (GMT) and community musicians (RCS). The primary outcome was Montgomery-Åsberg Depression Rating Scale score at 6 months, assessed by a masked assessor and analysed on an intention-to-treat basis using linear mixed-effects models, which examined the effects of GMT versus no-GMT and RCS versus no-RCS, as well as interaction effects of GMT and RCS. We report on the Australian cohort of an international trial. This trial is registered with ClinicalTrials.gov, NCT03496675, and anzctr.org.au, ACTRN12618000156280. Findings: Between June 15, 2018, and Feb 18, 2020, we approached 12 RAC facilities with 26 eligible care home units and, excluding six units who could not be enrolled due to COVID-19 lockdowns, we screened 818 residents. Between July 18, 2018, and Nov 26, 2019, 20 care home units were randomised (318 residents). Recruitment ceased on March 17, 2020, due to COVID-19. The primary endpoint, available from 20 care home units (214 residents), suggested beneficial effects of RCS (mean difference –4·25, 95% CI –7·89 to –0·62;p=0·0221) but not GMT (mean difference –0·44, –4·32 to 3·43;p=0·8224). No related serious adverse events occurred. Interpretation: Our study supports implementing recreational choir singing as a clinically relevant therapeutic intervention in reducing depressive symptoms for people with dementia in the Australian care home context. Funding: National Health and Medical Research Council, Australia. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

Avaliação econômica no âmbito das doenças raras: isto é possível?

Cadernos De Saude Publica, Mar 1, 2015

Economic evaluation in the context of rare diseases: is it possible? Avaliação econômica no âmbit... more

Risk factors associated with recurrent DUI offenses in Brazil

International Conference on Alcohol, Drugs and Traffic Safety (T2013), 20th, 2013, Brisbane, Queensland, Australia, Aug 1, 2013

Alcohol in blood is a major factor for traffic accidents; high blood alcohol concentrations (BAC)... more Alcohol in blood is a major factor for traffic accidents; high blood alcohol concentrations (BAC) increase the risk of involvement in offenses, and it is hypothesized that traffic injuries and casualty rates are partly attributed to recurrent offending behavior. The objective of this paper is to analyze and compare risk and protective factors among Brazilian repeat DUI offenders in 2009/2010. Cross-sectional study with 12,204 DUI offenders from the State Traffic Department was carried out using descriptive statistics and Poisson regression analysis. Drivers, age, sex, education level, time license to drive and license category were assessed. Drivers were considered repeat offenders if convicted of DUI more than once among 2009/2010. 538 drivers (4.41 per cent) were repeat offenders. The risk factors with the highest rates were age between 41 and 50, being licensed for 12 years or more, having a motorcycle/car/truck license, having a restricted license for psychological reasons, and driving a truck or similar at the moment of notification. Protective factors were female sex, professional driver, and high levels of education. An inverse relation was observed between repeat offending and education level, suggesting that mass media dissemination of the new law is not reaching the lowest education strata. As for professional drivers, the fear of losing a job may be an influence on driving behavior. Internationally reported rates of one-time and repeat DUI offenses are higher than here reported, probably as a result of the poor law enforcement in Brazil.

Death rates from alcohol-associated road traffic crashes among vulnerable road users in 5 Brazilian capital cities

International Conference on Alcohol, Drugs and Traffic Safety (T2013), 20th, 2013, Brisbane, Queensland, Australia, Aug 1, 2013

In Brazil, vulnerable road users (VRUs) including motorcyclists, pedestrians, and bicyclists, com... more In Brazil, vulnerable road users (VRUs) including motorcyclists, pedestrians, and bicyclists, comprised more than half of all fatal road traffic injuries (RTIs) in 2010. Alcohol is a major risk factor for RTI, which is being targeted by the Global Road Safety Initiative (RS10) in five capitals. Few published studies on alcohol-associated RTI exist at the national level. To analyze the prevalence of blood alcohol content among motorcyclists and pedestrians involved in fatal traffic crashes in five intervention Brazilian cities from 2000-2010: Palmas (North); Teresina (Northeast); Campo Grande (Midwest); Belo Horizonte (Southeast); and Curitiba (South). Mortality rates were calculated based on Brazilian Ministry of Health data using ICD- 10 codes, and disaggregated by sex, age, and city. The prevalence of alcohol associated RTI mortality was estimated after applying the proportion of deaths found to be positive for alcohol in another Brazilian capital. The prevalence of blood alcohol content among VRUs was highest in Palmas and lowest in Belo Horizonte; compare 10.07/100,000 inhabitants and 5.95/100,000 inhabitants respectively. The rates observed in Palmas and Teresina (9.91) are well above the national rate of 6.9/100,000 inhabitants. The blood alcohol content among VRUS in Curitiba and Campo Grande (both 6.61) are slightly below the five Brazilian capital cities rate. Blood alcohol content in fatal traffic crashes among VRUs indicates the need for policy reform and renewed enforcement, including increased breath testing. Further analyses can help target interventions toward at-risk groups.

P020 Polysomnographic titration of non-invasive ventilation in motor neurone disease (3TLA): Study protocol for a randomised controlled trial

Sleep advances, Oct 1, 2022

Approximately 1 in 150 people in Australia are diagnosed with Autism Spectrum Disorder (ASD) (Aus... more Approximately 1 in 150 people in Australia are diagnosed with Autism Spectrum Disorder (ASD) (Australian Institute of Health and Welfare, 2017). Studies suggest up to 80% of children diagnosed with ASD experience sleep difficulties (Cortesi et al., 2010). Behavioural sleep intervention is effective to improve sleep difficulties for children diagnosed with ASD (Jin, Hanley & Beaulieu, 2013). Additionally, caregiver support via telehealth can provide clients with greater access and flexibility of services. This paper will explore the current research on behavioural sleep intervention from a Behaviour-Analytic perspective and provide a model for behavioural sleep intervention via telehealth. This three-phase model includes: (1) an initial comprehensive behavioural sleep assessment, including the Sleep Assessment and Treatment Tool (Hanley, 2005) and baseline data collection to gather information on the child's current sleep schedule and behaviours, (2) supporting caregiver implementation of an individualised behavioural sleep intervention via telehealth, including daily data collection and graphing to monitor efficacy throughout the intervention, and (3) ongoing review and revision alongside the caregiver until their and their child's sleep goal has been achieved. By providing evidence-based behavioural sleep intervention via telehealth, children diagnosed with ASD can achieve healthy sleep.

An evidence-base for the implementation of hospital-based palliative care programs in routine cancer practice: A systematic review

Palliative Medicine

Background: Despite global support, there remain gaps in the integration of early palliative care... more Background: Despite global support, there remain gaps in the integration of early palliative care into cancer care. The methods of implementation whereby evidence of benefits of palliative care is translated into practice deserve attention. Aim: To identify implementation frameworks utilised in integrated palliative care in hospital-based oncology services and to describe the associated enablers and barriers to service integration. Design: Systematic review with a narrative synthesis including qualitative, mixed methods, pre-post and quasi experimental designs following the guidance by the Centre for Reviews and Dissemination (PROSPERO registration CRD42021252092). Data sources: Six databases searched in 2021: EMBASE, EMCARE, APA PsycINFO, CINAHL, Cochrane Library and Ovid MEDLINE searched in 2023. Included were qualitative or quantitative studies, in English language, involving adults >18 years, and implementing hospital-based palliative care into cancer care. Critical appraisal...

Perfil das vítimas fatais “Vulnerable Road Users” na região sul do Brasil

Cannabis and Traffic Accidents

Evidence regarding how drugs other than alcohol are associated to traffic accidents (TAs) has inc... more Evidence regarding how drugs other than alcohol are associated to traffic accidents (TAs) has increased in recent years. In many settings, cannabis is the most frequent illicit drug detected among drivers, and its prevalence is typically lower among drivers on the road, compared to injured drivers. Most case-control studies have found an increased chance of TAs among individuals who tested positive for cannabis. However, the findings depend on which cannabis components are analyzed, and whether the results originated from the analysis of blood, oral fluid, or urine. Whole blood sampling is the most effective confirmatory test, although the most accessible matrix for the roadside detection is oral fluid. Given the difficulties in establishing impairment based on toxicological tests, countries are struggling to enact legislation that regulates driving under the influence of cannabis. Overall, the laws that regulate driving under the influence of psychoactive and illegal drugs also reg...

Analytical reliability of four oral fluid point-of-collection testing devices for drug detection in drivers

Forensic Science International, 2020

Background: Point-of-collection testing (POCT) devices for psychoactive substance detection throu... more Background: Point-of-collection testing (POCT) devices for psychoactive substance detection through oral fluid samples are used in several countries for traffic enforcement. However, the reported reliability of such devices is quite heterogeneous among studies, and evaluating and comparing their analytical performance is of paramount importance to guide enforcement policies. Aim: To evaluate the analytical reliability of four POCT devices for the detection of cocaine and cannabinoids using oral fluid samples of Brazilian drivers. Method: A total of 168 drivers were recruited during standard roadblockfI procedures in Southern Brazil. Subjects were screened using one of the following POCT devices: the DDS2 TM , the DOA MultiScreen TM , the Dräger Drug Test 5000 TM and the Multi-Drug Multi-Line Twist Screen Device TM (MDML). Results of the screening tests were compared with chromatographic analyses in order to obtain the reliability parameters. Results: The prevalence of confirmed positive samples for cocaine and cannabinoids were 9 % and 4.4 %, respectively. For cocaine, three POCT devices (MDML TM , Dräger DrugTest 5000 TM , DOA MultiScreen TM) showed good reliability, greater than 80 % of performance measures, using guidelines for research on drugged driving published by Walsh et al. (cutoff 10 ng/mL). However, for cannabinoids, the devices had low reliability-only Dräger DrugTest 5000 TM had good performance using cutoffs proposed by Walsh et al. (cutoff 2 ng/mL). Conclusion: We observed a high prevalence of drivers testing positive for cocaine and cannabinoids. Most devices achieved good reliability performance for cocaine detection using cutoffs proposed by Walsh et al. or using the device's own cutoff. Instead, the reliability for cannabinoid detection obtained the desired parameters in just one device using cutoffs proposed by Walsh et al. and its own cutoff. Difficulties in detecting cannabinoids at the roadside should be better evaluated before the implementation of such tests.

Reliability of point-of-collection testing devices for drugs of abuse in oral fluid: A systematic review and meta-analysis

Journal of Pharmaceutical and Biomedical Analysis, 2017

Reliability of pointof-collection testing devices for drugs of abuse in oral fluid: A systematic ... more

Risk behavior, sensation seeking and impulsivity: study comparing drunk drivers with sober drivers

Scientific evidences show that drivers who drink and drive tend to be more impulsive and high sen... more Scientific evidences show that drivers who drink and drive tend to be more impulsive and high sensation seekers, as well as more susceptible to risky behaviors and traffic accidents. This research compares drivers who had DUI infractions in the previous year with drivers who did not in relation to their rates of impulsivity, sensation seeking (SS) and traffic risk behaviors. The sample comprised 50 drivers with infractions (86 per cent male) and 106 with no infraction (73.6 per cent males) recruited in the Brazilian Traffic Department and three Driving Training Centers. Measures utilized were the Barrat Impulsivity Scale (BIS-11), the Sensation Seeking Inventory of Arnett (AISS) and the Driver Behavior Questionnaire (DBQ). We compared groups using chi-square with a 5 per cent level of significance. Offenders showed higher means in the violation scores of the DBQ. Lifetime involvement with accidents were more prevalent among offenders. A statistical difference was verified among the groups also in the impulsiveness and sensation seeking scores. Data suggest that offenders for DUI differ from non-offenders in relation to personality traits - sensation seeking and impulsivity - and they would tend to commit other traffic violations. Although preliminary, our results may help discuss measures for assessment, rehabilitation and traffic enforcement.

Home-Based Family Caregiver-Delivered Music And Reading Interventions for People Living With Dementia: An International Randomised Controlled Trial (HOMESIDE Trial)