IntroductionComplex trauma can have serious impacts on the health and well-being of Aboriginal and Torres Strait Islander families. The perinatal period represents a ‘critical window’ for recovery ...and transforming cycles of trauma into cycles of healing. The Healing the Past by Nurturing the Future (HPNF) project aims to implement and evaluate a programme of strategies to improve support for Aboriginal and Torres Strait islander families experiencing complex trauma.MethodThe HPNF programme was codesigned over 4 years to improve awareness, support, recognition and assessment of trauma. Components include (1) a trauma-aware, healing-informed training and resource package for service providers; (2) trauma-awareness resources for parents; (3) organisational readiness assessment; (4) a database for parents and service providers to identify accessible and appropriate additional support and (5) piloting safe recognition and assessment processes. The programme will be implemented in a large rural health service in Victoria, Australia, over 12 months. Evaluation using a mixed-methods approach will assess feasibility, acceptability, cost, effectiveness and sustainability. This will include service user and provider interviews; service usage and cost auditing; and an administrative linked data study of parent and infant outcomes.AnalysisQualitative data will be analysed using reflexive thematic analysis. Quantitative and service usage outcomes will be described as counts and proportions. Evaluation of health outcomes will use interrupted time series analyses. Triangulation of data will be conducted and mapped to the Consolidated Framework for Implementation Research and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks to understand factors influencing feasibility, acceptability, effectiveness, cost and sustainability.Ethics and disseminationApproval granted from St Vincent’s Melbourne Ethics Committee (approval no. 239/22). Data will be disseminated according to the strategy outlined in the codesign study protocol, in-line with the National Health and Medical Research Council Aboriginal and Torres Strait Islander Research Excellence criteria.
Background: Depression and anxiety are routinely screened as part of perinatal care. However, other Axis 1 disorders and specific anxiety disorders are less likely to be screened or assessed as part ...of obstetric care. The objective of this study was to determine whether the Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a potentially useful tool to screen for psychiatric conditions in pregnant and postpartum women in a community setting. Methods: We compared the prevalence of DSM Axis I disorders obtained on the PDSQ with: (1) the prevalence of these disorders reported in previous studies of pregnant and postpartum women, and (2) scores obtained on the Edinburgh Postpartum Depression Scale (EPDS) and the Symptom Checklist-90-Revised (SCL-90R) anxiety scale. Data were obtained from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Results: The PDSQ was completed by 1575 women prenatally and 1481 postnatally. The three most prevalent PDSQ conditions were social phobia, somatic disorder, and obsessive–compulsive disorder (OCD). The prevalence of social phobia, alcohol disorder, OCD and psychosis were higher in the APrON cohort compared with statistics in the literature. The proportion of women meeting depression and anxiety cut-offs on the PDSQ were lower than for the EPDS and the SCL-90R. The Cohens Kappa index (k) indicated poor to fair agreement between the measures in classifying pregnant women as depressed or anxious. Conclusions: The PDSQ subscales may not be appropriate for the pregnant population. Research into instruments more specific to pregnant and postpartum women are needed to determine the prevalence of psychiatric disorders in this population.
Objective: To describe the implementation and evaluation of a pilot multidisciplinary disease state management (DSM) program for diabetes, hypertension, and hyperlipidemia at a private, self-insured ...university (over 900 covered lives). Methods: Enrollees met with a pharmacist, nurse, exercise physiologist, and students in these disciplines to improve clinical outcomes and fitness parameters. Clinical values, quality of life, patient knowledge of disease states, and patient satisfaction were assessed. Results: Of the 20 patients in the pilot program, 17 completed 1 nursing and 2 pharmacist visits; 8 completed exercise physiology visits. At baseline, elevated blood pressure readings were observed in 64.7% (11 of 17) of patients, 20% of those with diabetes (1 of 5) had an elevated hemoglobin A1c value (HbA1c), and 82.4% (14 of 17) had a cholesterol value that was not at goal. At least 1 medication-related problem was observed in 16 patients (94.1%). At 3 months, all patients with diabetes achieved HbA1c levels at or below 7%, 4 patients attained blood pressure control, and 1 achieved normal cholesterol readings. Patients characterized participation in the program as valuable and convenient. Conclusions: Patients involved in the multidisciplinary DSM showed improved clinical outcomes after 3 months. Ongoing analysis of patient outcomes will determine the long-term effectiveness of the DSM.
This analysis describes the development of technology for home self-infusion of factor VII in the treatment of hemophilia and its clinical, economic, and social consequences, and uses the case study ...of such home care treatment to illustrate the potentials and pitfalls of formal economic analyses of programs to treat chronically ill children. A comprehensive review of all original data on hemophilia programs, their related costs, and outcomes, conducted from 1966 through 1993, examined the economic outcomes for two hypothetical cohorts, one aged 0-4 years and the other aged 30-34 years. Including the measurement of treatment effects on the productivity of parental caregivers substantially increases the benefit-cost relationship of an intervention directed at chronically ill children. Increased economic productivity and societal return resulting from such a program for young adults exceeds those for a cohort of children, primarily due to assumptions related to discounting. However, estimation of quality-adjusted life years favors the younger age cohort, since children survive for a longer period of time and with each year survived comes a higher quality of life. Unlike simpler instances in which economic benefits can be shown to outweigh resource costs, policy decisions concerning services for chronically ill children raise an additional set of complex analytic issues. Inclusion of the benefits in productivity experienced by family caregivers provides an important added dimension to such analyses. The development of cost-benefit or cost-effectiveness analyses of these programs illustrates the importance of careful measurement of outcomes and explicit statements of underlying assumptions. Such an analysis of home care for children with hemophilia therefore demonstrates both the strengths and the limitations of this approach.
Calculators can move students from manipulative, concrete activities to symbolic, abstract representations (Berlin and White 1987), and they can be used to give meaning to concepts and help students ...develop explanations of mathematics topics. Calculators allow students to examine many examples and nonexamples; the speed and power of calculators can make problems more realistic and interesting. In short, calculators help focus students' attention on mathematical processes (Comstock and Demana 1987). The worksheets in this month's “Teaching Mathematics with Technology” show how we have used calculators to introduce, and then expand, instruction on powers of numbers.
