Explore the vast range of titles available.

Premji and McNeil examine the effectiveness and cost-effectiveness of postpartum depression (PPD) screening. Screening was effective at directing resources to Albertans in need; patients screened at high risk of PPD were nearly 4 times more likely to receive a diagnosis for PPD than those who were not screened. At a population level, screening identified an additional 813 patients with PPD relative to not screening, and was considered cost-effective. Although the Task Force made a key assumption that, as part of usual care, providers routinely inquire about and are attentive to maternal mental health and well-being, our research did not have to make this assumption; we were able to test it directly.

Background Evidence is needed to support local action to reduce the adverse health impacts of climate change and maximise the health co-benefits of climate action. Focused on England, the study identifies priority areas for research to inform local decision making. Methods Firstly, potential priority areas for research were identified from a brief review of UK policy documents, and feedback invited from public and policy stakeholders. This included a survey of Directors of Public Health (DsPH) in England, the local government officers responsible for public health. Secondly, rapid reviews of research evidence examined whether there was UK evidence relating to the priorities identified in the survey. Results The brief policy review pointed to the importance of evidence in two broad areas: (i) community engagement in local level action on the health impacts of climate change and (ii) the economic (cost) implications of such action. The DsPH survey ( n  = 57) confirmed these priorities. With respect to community engagement, public understanding of climate change’s health impacts and the public acceptability of local climate actions were identified as key evidence gaps. With respect to economic implications, the gaps related to evidence on the health and non-health-related costs and benefits of climate action and the short, medium and longer-term budgetary implications of such action, particularly with respect to investments in the built environment. Across both areas, the need for evidence relating to impacts across income groups was highlighted, a point also emphasised by the public involvement panel. The rapid reviews confirmed these evidence gaps (relating to public understanding, public acceptability, economic evaluation and social inequalities). In addition, public and policy stakeholders pointed to other barriers to action, including financial pressures, noting that better evidence is insufficient to enable effective local action. Conclusions There is limited evidence to inform health-centred local action on climate change. More evidence is required on public perspectives on, and the economic dimensions of, local climate action. Investment in locally focused research is urgently needed if local governments are to develop and implement evidence-based policies to protect public health from climate change and maximise the health co-benefits of local action.

Background Prospective cohorts may be vulnerable to bias due to attrition. Inverse probability weights have been proposed as a method to help mitigate this bias. The current study used the “All Our Families” longitudinal pregnancy cohort of 3351 maternal-infant pairs and aimed to develop inverse probability weights using logistic regression models to predict study continuation versus drop-out from baseline to the three-year data collection wave. Methods Two methods of variable selection took place. One method was a knowledge-based a priori variable selection approach, while the second used Least Absolute Shrinkage and Selection Operator (LASSO). The ability of each model to predict continuing participation through discrimination and calibration for both approaches were evaluated by examining area under the receiver operating curve (AUROC) and calibration plots, respectively. Stabilized inverse probability weights were generated using predicted probabilities. Weight performance was assessed using standardized differences of baseline characteristics for those who continue in study and those that do not, with and without weights (unadjusted estimates). Results The a priori and LASSO variable selection method prediction models had good and fair discrimination with AUROC of 0.69 (95% Confidence Interval [CI]: 0.67–0.71) and 0.73 (95% CI: 0.71–0.75), respectively. Calibration plots and non-significant Hosmer-Lemeshow Goodness of Fit Tests indicated that both the a priori (p = 0.329) and LASSO model (p = 0.242) were well-calibrated. Unweighted results indicated large (> 10%) standardized differences in 15 demographic variables (range: 11 − 29%), when comparing those who continued in the study with those that did not. Weights derived from the a priori and LASSO models reduced standardized differences relative to unadjusted estimates, with the largest differences of 13% and 5%, respectively. Additionally, when applying the same LASSO variable selection method to develop weights in future data collection waves, standardized differences remained below 10% for each demographic variable. Conclusion The LASSO variable selection approach produced robust weights that addressed non-response bias more than the knowledge-driven approach. These weights can be applied to analyses across multiple longitudinal waves of data collection to reduce bias.

Pregnancy is a critical time for fetal development, and education of women regarding healthy lifestyle choices is an important function for prenatal care providers, those that provide care to women during pregnancy. Within Canada, women choose to receive pregnancy care from one of a variety of publicly funded care providers. This study examines the association between the type of care provider(s) seen during pregnancy and the provision of advice related to nutrition, weight management and substance abuse. Using data from the Alberta-based All Our Families prospective pregnancy cohort, we conducted bivariate and multivariate analyses to determine the likelihood of receiving advice related to nutrition, weight management, and substance abuse across provider(s) seen. Of 3341 women in our sample, 38% saw a single provider during pregnancy and 56% received care from multiple providers. Advice on nutrition was more likely to be provided across all providers, while weight management and substance abuse was less frequently and less consistently discussed. Relative to doctors in low-risk maternity clinics, midwives were most likely to provide nutrition (OR: 3.09, 95% CI: 1.19-8.01) and weight management (OR: 1.99, 95% CI: 1.13-3.50) advice to women. Findings suggest that the type of prenatal advice received by women depends on the provider(s) seen during pregnancy. Substance abuse was least likely to be discussed across providers, suggesting important implications given recent cannabis legalization.

IntroductionRaCeR 2 is a pragmatic multicentre, open-label, randomised controlled trial, with full economic evaluation. The primary aim is to assess whether individualised (early) patient-directed rehabilitation (EPDR) results in less shoulder pain and disability at 12 weeks postrandomisation following surgical repair of full-thickness tears of the rotator cuff of the shoulder compared with the current standard (delayed) rehabilitation. This paper provides the protocol for the RaCeR 2 health economic evaluation.Methods and analysisThe health economic analysis of RaCeR 2 is made up of three phases: (1) development of an initial state-transition model structure, (2) within-trial cost consequence analysis and (3) long-term model-based cost-effectiveness analysis (CEA) from the National Health Service and Personal Social Service perspective in England. Descriptive statistics (eg, mean, standard deviation, 95% confidence intervals and minimum and maximum values) will be reported for within-trial resource use, costs and health-related quality of life (HRQoL). Health state-specific costs and HRQoL will be estimated using regression model approaches and used to inform a state-transition simulation model designed to quantify the long-term costs and quality-adjusted life years (QALYs) experienced by patients over the model’s time horizon. Where appropriate, final CEA model results will be reported as cost per QALY gained for individualised EPDR versus standard (delayed) rehabilitation. Model assumptions and overall parameter uncertainty will be tested using probabilistic sensitivity analysis and scenario analyses. All regression analyses will be adjusted for baseline participant demographic and symptomatic characteristics.Ethics and disseminationA favourable ethical review was granted by London-Stanmore Research Ethics Committee (23/LO/0195) on 13 April 2023. Findings will be disseminated in peer-reviewed journals, at scientific conferences, and via the study website.Trial registration numberISRCTN11499185

Background Children of substance-involved mothers are at especially high risk for exposure to adverse childhood experiences (ACEs) and poor mental health and development. Early interventions that support mothers, children, and the mother-child relationship have the greatest potential to reduce exposure to early adversity and the mental health problems associated with these exposures. Currently, there is a lack of evidence from the real-world setting demonstrating effectiveness and return on investment for intervention programs that focus on the mother-child relationship in children of substance-involved mothers. Methods One hundred substance-involved pregnant and/or parenting women with children between the ages of 0–6 years old will be recruited through the Breaking the Cycle and Maxxine Wright intervention programs, in Toronto, Ontario, Canada and Surrey, British Columbia, Canada, respectively. Children’s socioemotional development and exposure to risk and protective factors, mothers’ mental health and history of ACEs, and mother-child relationship quality will be assessed in both intervention programs. Assessments will occur at three time points: pre-intervention, 12-, and 24-months after engagement in the intervention program. Discussion There is a pressing need to identify interventions that promote the mental health of infants and young children exposed to early adversity. Bringing together an inter-disciplinary research team and community partners, this study aligns with national strategies to establish strong evidence for infant mental health interventions that reduce child exposure to ACEs and support the mother-child relationship. This study was registered with clinicaltrials.gov (NCT05768815) on March 14, 2023.

IntroductionDespite a recognized association between maternal postpartum depression (PPD) and adverse child health outcomes, evidence examining the relationship between PPD symptoms and associated child health service utilization and costs remains unclear. In addition, there is a paucity of evidence describing the relationship between early identification of maternal PPD and associated health service utilization and costs for children. This study aims to address this gap by describing the secondary associations of screening for maternal PPD and annual health service utilization and costs for children over their first five years of life.MethodsMothers and children enrolled in the prospective All Our Families cohort were linked to provincial administrative data in Alberta, Canada. Multivariable generalized linear models were used to estimate the average annual inpatient, outpatient, physician, and total health service utilization and costs from a public health system perspective for children of mothers screened high risk for PPD, low/moderate risk for PPD, or unscreened.ResultsTotal mean costs were greatest for children during their first year of life than other years. Those whose mothers were not screened had significantly lower costs compared to those whose mothers were screened low/moderate risk, despite equivalent health service utilization.DiscussionFindings from this study describe the secondary associations of screening for maternal PPD using a public health system perspective. More research is required to fully understand variations in health costs for children across maternal PPD screening categories.SignificanceThis study describes the relationship between maternal PPD screening status and annual child health service utilization and costs over the first five years of age. Findings from this administrative data study will support decision-makers in understanding the secondary effects associated with maternal PPD screening and inform future cost-effectiveness analyses of PPD screening interventions using a maternal-child health perspective.

Patients visiting an Emergency Department (ED) due to violence who are unable or unwilling to disclose that their injury is violence-related are unlikely to receive support for associated psychosocial vulnerabilities. Nurse-led hospital-based violence intervention programmes (HVIPs) are an additional resource in ED providing support to patients exposed to violence. Our objective was to determine whether HVIPs can overcome barriers to disclosure and what patient characteristics are associated with non-disclosure under usual care. A natural longitudinal experiment, including routine health data from 2012 to 2024, comparing intervention EDs with HVIPs to control EDs. Multi-level logistic difference-in-difference models with unplanned visits clustered by patient on the probability that a visit (N = 6,724,446) was recorded as violence-related in ED or subsequently in HVIP data from Wales, UK: nine control EDs without an HVIP were compared with two intervention sites with nurse-led HVIPs. Secondary analyses assessed the characteristics of patients disclosing to the HVIP, but not under usual care by age, gender, ethnicity, and residential deprivation. The probability that a visit was designated as assault-related increased in intervention EDs following HVIP implementation (Cardiff β = 0.37, 95 % CI 0.31 to 0.44; Swansea β = 0.19, 95 % CI 0.14 to 0.25). Male, younger, those residing in deprived neighbourhoods, and black or mixed ethnicity patients were more likely to be missed under usual care. Non-disclosure is a significant barrier in provisioning support to those who are psychosocially vulnerable and likely to revisit ED. Nurse-led HVIPs can overcome inequalities in ED, reaching patient groups that are not otherwise able or willing to disclose their exposure to violence. HVIPs offer the prospect of reducing inequality in patients' visiting ED due to violence. ISRCTN Registration: 68945844 (12 August 2022). Many of those exposed to violence can transfer directly to the Emergency Department (ED) and are unknown to law enforcement and affiliated services. ED is uniquely placed to provide patients with support for psychosocial vulnerabilities associated with violence and repeat visits to ED. Evidence from health and allied fields document a reluctance for some patients to disclose their exposure to violence. It is not known whether the implementation of nurse-led Hospital Violence Intervention Programmes (HVIPs) in ED can overcome barriers to disclosure in ED. Nurse-led HVIPs in ED, working as part of the clinical team, can identify violence-related visits not otherwise captured under usual care and therefore address inequalities in emergency healthcare. Those missed under usual care are typically male, younger, black or mixed ethnicity and live in more deprived neighbourhoods. Policies aiming to address inequality in the health service response to violence can be supported through nurse-led HVIPs in ED.

Studies of public views on stem cell research have traditionally focused on human embryonic stem cells. With more recent scientific research on developing other stem cell sources, a series of focus group studies was undertaken with Canadian adults to examine their views on different stem cell sources (adult, umbilical cord blood, human embryonic stem cells, somatic cell nuclear transfer or SCNT, and interspecies nuclear transfer, or iSCNT). Views on three different policy models--a permissive, middle-of-the-road and restrictive policy approach--were also explored. Participants were recruited from several different social groups including patients, young adults, seniors, members of two ethnic communities, and a mixed group of adults. Participants were generally supportive of the use of adult stem cell sources. While there was also majority support for the use of hESC and SCNT, this was conditional on strict regulatory oversight. There was also majority support for a permissive policy which allows research on hESC and SCNT. General themes that cut across different groups included the potential cost of new technologies to the health care system, issues around who would gain access to these technologies, and trust in the scientific establishment and regulatory systems. A diversity of viewpoints was found as participants justified their positions on stem cell sources and policy approaches, showing more complexity and nuance than has been generally portrayed.

Hospital-Based Violence Intervention Programs (HVIPs), based in Emergency Departments (EDs), have been proposed as a public health response to violence. These programs address the underlying reasons why patients are exposed to violence. In addressing any underlying modifiable risks and vulnerabilities HVIPs can reduce patients' exposure to violence and therefore subsequent unplanned attendance into ED. The objectives of this study are to (1) assess whether patient involvement with a HVIP reduces the likelihood of unscheduled ED reattendance, (2) determine whether the presence of the HVIP improves ascertainment of violence in ED attendances, and (3) derive the costs of the HVIP and compare those to the benefits of the intervention and understand whether the HVIP represents value for money from a health service perspective. If an effect is observed, then models will estimate the health impacts, costs and potential savings over a longer time (eg, 10 years) period and for a national roll-out. ED patients are eligible for inclusion in the evaluation if they are normally resident in Wales, United Kingdom, aged 11 years and older. A controlled longitudinal natural experiment will be undertaken. The primary outcome is derived from the Emergency Department Dataset, routinely collected for all EDs in Wales, and is subsequent unplanned ED attendance. Case patients will be matched to control patients attending EDs without an HVIP. Analysis will derive the hazard rate for subsequent unplanned ED attendances using recurrent event analysis. The total monthly count of patients identified as attending because of violence in intervention EDs will be compared to the total count of Welsh control EDs in an interrupted time-series analysis to determine whether HVIPS increase violence ascertainment. To determine whether referral, versus no referral, to the HVIP represents value for money, we will undertake a cost-effectiveness analysis from the perspective of the National Health Service. The approval to access and analyze data housed in the Secure Anonymized Information Linkage (SAIL) databank, an ISO (International Organization for Standardization) 27001 certified and UK Statistics Authority accredited secure data environment, was granted by the SAIL independent Information Governance Review Panel (Ref: 1421). Findings will be presented at local, national, and international conferences and disseminated by peer-reviewed publication. Design inputs arising from public patient involvement and engagement (PPIE) are reported. As a protocol, no further results are available. Novel methods are developed to provide the first robust evaluation of Emergency Department Violence Intervention Programs (EDVIPs). ISRCTN Registry ISRCTN68945844; https://www.isrctn.com/ISRCTN68945844?q=68945844&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10. PRR1-10.2196/86247.