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Marion Haas

Publications and source records attributed to Marion Haas.

11 recordsLinked to original sources
PubMed2007

Outcome of neonatal screening for medium-chain acyl-CoA dehydrogenase deficiency in Australia: a cohort study.

BACKGROUND: Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is the disorder thought most to justify neonatal screening by tandem-mass spectrometry because, without screening, there seems to be substantial morbidity and mortality. Our aim was to assess the overall effectiveness of neonatal screening for MCAD deficiency in Australia. METHODS: We identified MCAD-deficient patients from a total population of 2,495,000 Australian neonates (810,000 screened) born between April 1, 1994, and March 31, 2004. Those from a cohort of 1,995,000 (460,000 screened) were followed up for at least 4 years, and we recorded number of deaths and severe episodes, medical and neuropsychological outcome, and hospital admissions within the screened and unscreened groups. FINDINGS: In cohorts aged at least 4 years there were 35 MCAD-deficient patients in those not screened (2.28 per 100,000 total population) and 24 in the screened population (5.2 per 100,000). We estimated that patients with this disorder in the unscreened cohort remained undiagnosed. Before 4 years of age, three screened patients had an episode of severe decompensation (including one neonatal death) versus 23 unscreened patients (including five deaths). At the most conservative estimate, relative risk of an adverse event was 0.44 (95% CI 0.13-1.45). In the larger cohort the relative risk (screened vs unscreened) of an adverse event by age 2 years was 0.26 (95% CI 0.07-0.97), also a conservative estimate. 38 of 52 living patients had neuropsychological testing, with no suggestions of significant differences in general cognitive outcome between the groups. INTERPRETATION: Screening is effective in patients with MCAD deficiency since early diagnosis reduces deaths and severe adverse events in children up to the age of 4 years.

Acyl-CoA Dehydrogenase↗
PubMed2006

Effectiveness of joint mobilisation after cast immobilisation for ankle fracture: a protocol for a randomised controlled trial [ACTRN012605000143628].

BACKGROUND: Passive joint mobilisation is a technique frequently used by physiotherapists to reduce pain, improve joint movement and facilitate a return to activities after injury, but its use after ankle fracture is currently based on limited evidence. The primary aim of this trial is to determine if adding joint mobilisation to a standard exercise programme is effective and cost-effective after cast immobilisation for ankle fracture in adults. METHODS/DESIGN: Ninety participants will be recruited from the physiotherapy departments of three teaching hospitals and randomly allocated to treatment or control groups using a concealed procedure. All participants will perform an exercise programme. Participants in the treatment group will also receive joint mobilisation twice a week for four weeks. Blinded follow-up assessments will be conducted four, 12 and 24 weeks after randomisation. The primary outcome measures will be the Lower Extremity Functional Scale and the Assessment of Quality of Life. Secondary outcomes will include measures of impairments, activity limitation and participation. Data on the use of physiotherapy services and participants' out-of-pocket costs will be collected for the cost-effective and cost-utility analyses. To test the effects of treatment, between-group differences will be examined with analysis of covariance using a regression approach. The primary conclusions will be based on the four-week follow-up data. DISCUSSION: This trial incorporates features known to minimise bias. It uses a pragmatic design to reflect clinical practice and maximise generalisability. Results from this trial will contribute to an evidence-based approach for rehabilitation after ankle fracture.

Ankle Injuries↗
PubMed2006

Why worry about awareness in choice problems? Econometric analysis of screening for cervical cancer.

The decision to undertake a screening test is conditional upon awareness of screening. From an econometric perspective there is a potential selection problem, if no distinction is made between aware and unaware non-screeners. This paper explores this problem through analysis of the determinants of cervical screening in Australia. Cervical cancer is one of the most preventable and curable forms of cancer. Since 1991 there has been a concerted effort in Australia to recommend and encourage women to have Pap smears every two years. The success of this program can be partly gauged by exploring the determinants of screening for cervical cancer. Using unit record data from the 1995 National Health Survey, an econometric model is developed for whether women have ever screened or not. A proportion of women in the sample contend that they have never heard of a Pap test. The analysis characterizes this group of women and accounts for their presence in the modelling. The paper demonstrates failing to model awareness can result in inconsistent parameter estimates even when the degree of censoring in the sample is relatively small.

Adolescent↗
PubMed2005

Assessing the capacity of the health services research community in Australia and New Zealand.

BACKGROUND: In order to profile the health services research community in Australia and New Zealand and describe its capacity, a web-based survey was administered to members of the Health Services Research Association of Australia and New Zealand (HSRAANZ) and delegates of the HSRAANZ's Third Health Services Research and Policy Conference. RESULTS: Responses were received from 191 individuals (68%). The responses of the 165 (86%) who conducted or managed health services research indicated that the health services research community in Australia and New Zealand is characterised by highly qualified professionals who have come to health services research via a range of academic and professional routes (including clinical backgrounds), the majority of whom are women aged between 35 and 54 who have mid- to senior- level appointments. They are primarily employed in universities and, to a lesser extent, government departments and health services. Although most are employed in full time positions, many are only able to devote part of their time to health services research, often juggling this with other professional roles. They rely heavily on external funding, as only half have core funding from their employing institution and around one third have employment contracts of one year or less. Many view issues around building the capacity of the health services research community and addressing funding deficits as crucial if health services research is to be translated into policy and practice. Despite the difficulties they face, most are positive about the support and advice available from peers in their work settings, and many are actively contributing to knowledge through academic and other written outputs. CONCLUSION: If health services research is to achieve its potential in Australia and New Zealand, policy-makers and funders must take the concerns of the health services research community seriously, foster its development, and contribute to maximising its capacity through a sustainable approach to funding. There is a clear need for a strategic approach, where the health services research community collaborates with competitive granting bodies and government departments to define and fund a research agenda that balances priority-driven and investigator-driven research and which provides support for training and career development.

Journal Article↗
PubMed2004

Cost-effectiveness analysis of the New South Wales adult drug court program.

In New South Wales, Australia, a cost-effectiveness evaluation was conducted of an adult drug court (ADC) program as an alternative to jail for criminal offenders addicted to illicit drugs. This article describes the program, the cost-effectiveness analysis, and the results. The results of this study reveal that, for the 23-month period of the evaluation, the ADC was as cost-effective as were conventional sanctions in delaying the time to the first offense and more cost-effective in reducing the frequency of offending for those outcome measures selected. Although the evaluation was conducted using the traditional steps of a cost-effectiveness analysis, because of the complexity of the program and data limitations it was not always possible to adhere to textbook procedures. As such, each step involved in undertaking the cost-effectiveness analysis is discussed, highlighting the key issues faced in the evaluation.

Cost-Benefit Analysis↗
PubMed2004

Health services research in Australia: an investigation of its current status.

OBJECTIVES: The objectives of this audit were to document the current status of health services research (HSR) in Australia in terms of inputs and outputs. Inputs were defined as the number of organised centres or groups undertaking HSR, the extent to which HSR was being developed and the funding available for HSR. Outputs were measured as the number of peer-reviewed papers. METHODS: Centres or groups were identified via the membership of the HSRAANZ and a web-based search. Information from annual reports and/or other published sources was used to determine the extent of capacity building and available funding. The tables of contents of 21 journals published over a 10-year period were searched for articles reporting Australian HSR. RESULTS: Eighteen groups were identified that undertook HSR as their predominant activity, while twelve were involved in HSR as a collaborative activity. No HSR-specific training (in terms of under- or postgraduate degrees) was identified, although more than 400 postgraduate students were being supervised in the university departments where HSR groups were situated. Between 1998 and 2001, more than 13 million Australian dollars was awarded for HSR, most of it by the National Health and Medical Research Council (NHMRC). Over the past 10 years, 482 articles about Australian health services have been published in the peer-reviewed journals audited. CONCLUSIONS: Although HSR is widespread in Australia, no specific training appears to be available to build capacity. Overall, HSR is not well-funded especially by organisations outside the NHMRC or Australian Research Council. Thus, it is not surprising that the output of Australian HSR, in terms of peer-reviewed articles, is slight.

Australia↗
PubMed2003

Do participants understand a stated preference health survey? A qualitative approach to assessing validity.

OBJECTIVES: Examine the validity of using a self-completed Stated Preference Discrete Choice Modeling (SPDCM) questionnaire to measure parents' preferences for vaccinating their children against varicella. METHODS: A qualitative approach was used to assess the way parents understood the technical information in the questionnaire and the factors they considered to be important to the immunization decision. After completion of the SPDCM questionnaire, thirty-four participants completed a semistructured interview by telephone. Interview transcripts were analyzed by using content analysis. Comparisons were then made with the SPDCM questionnaire results. RESULTS: The technical information used to describe the program attributes appeared to be used appropriately by participants, although their explanations indicated that their understanding did not always come from the questionnaire information. Only one participant appeared to misunderstand the stated preference task, and a small number thought that the complexity and length should be reduced. The results of analysis of the questionnaire data were supported by the qualitative study, with the notable features of the model being reflected in the views commonly expressed about the immunization decision. Several additional factors were identified as important to the choice, including beliefs about vaccination generally and perceptions of the seriousness of varicella. CONCLUSIONS: Although more research is required to investigate the validity of SPDCM for the measurement of preferences in health care, this study supports the validity of its use in childhood immunization where parents are familiar with the decision context.

Adult↗
PubMed2002

Measuring health system resource use for economic evaluation: a comparison of data sources.

A key challenge for evaluators and health system planners is the identification, measurement and valuation of resource use for economic evaluation. Accurately capturing all significant resource use is particularly difficult in the Australian context where there is no comprehensive database from which researchers can draw. Evaluators and health system planners need to consider different approaches to data collection for estimating resource use for economic evaluation, and the relative merits of the different data sources available. This paper illustrates the issues that arise in using different data sources using a sub-sample of the data being collected for an economic evaluation. Specifically, it compares the use of Australia's largest administrative database on resource use, the Health Insurance Commission database, with the use of patient-supplied data. The extent of agreement and discrepancies between the two data sources is investigated. Findings from this study and recommendations as to how to deal with different data sources are presented.

Administrative Personnel↗
PubMed1999

The relationship between expectations and satisfaction: a qualitative study of patients' experiences of surgery for gynaecological cancer.

It is important that a patient perspective is introduced to the identification and measurement of the outcomes of health care. The aim of this study was to use qualitative methods to examine the presence or absence of expectations prior to the experience of health care and the relationship between expectations, satisfaction and dissatisfaction in a group of women undergoing surgery in a large teaching hospital. Nineteen women with a diagnosis of gynaecological cancer were interviewed on two occasions, before and after surgery. A thematic analysis was undertaken. The results suggest that there is not a clear relationship between expectations and satisfaction. Women had different levels of expectations about different types of care and different aspects of care. Unfulfilled expectations did not lead to less satisfaction. The women were able to express satisfaction either with the care overall or with specific aspects of care, as well as being able to distinguish aspects of care with which they were dissatisfied.

Journal Article↗