Identification of families in need of support : correlates of adverse childhood experiences in the right@home sustained nurse home visiting program

Background Little is known about the efficacy of pregnancy screening tools using non-sensitive sociodemographic questions to identify the possible presence of as yet undiagnosed disease in individuals and later adverse childhood events disclosure. Objectives The study aims were to: 1) record the prevalence of risk disclosed by families during receipt of a sustained nurse home visiting program; and 2) explore patterns of relationships between the disclosed risks for their child having adverse experiences and the antenatal screening tool, which used non-sensitive demographic questions. Design Retrospective, observational study. Participants and methods Data about the participants in the intervention arm of the Australian right@home trial, which is scaffolded on the Maternal Early Childhood Sustained Home-visiting model, collected between 2013 and 2017 were used. Screening data from the 10-item antenatal survey of non-sensitive demographic risk factors and disclosed risks recorded by the nurse in audited case files during the subsequent 2 year intervention were examined (n = 348). Prevalence of disclosed risks for their child having adverse experiences were analysed in 2019 using multiple response frequencies. Phi correlations were conducted to test associations between screening factors and disclosed risks. Results Among the 348 intervention participants whose files were audited, 300 were noted by nurses to have disclosed risks during the intervention, with an average of four disclosures. The most prevalent maternal disclosures were depression or anxiety (57.8%). Mental health issues were the most prevalent partner and family disclosures. Screening tool questions on maternal smoking in pregnancy, not living with another adult, poverty and self-reporting anxious mood were significantly associated with a number of disclosed risks for their child having adverse experiences. Conclusions These findings suggest that a non-sensitive sociodemographic screening tool may help to identify families at higher risk for adverse childhood experiences for whom support from a sustained nurse home visiting program may be beneficial

Economic evaluation of an Australian nurse home visiting programme : a randomised trial at 3 years

Objectives To investigate the additional programme cost and cost-effectiveness of ‘right@home’ Nurse Home Visiting (NHV) programme in relation to improving maternal and child outcomes at child age 3 years compared with usual care. Design A cost–utility analysis from a government-as-payer perspective alongside a randomised trial of NHV over 3-year period. Costs and quality-adjusted lifeyears (QALYs) were discounted at 5%. Analysis used an intention-to-treat approach with multiple imputation. Setting The right@home was implemented from 2013 in Victoria and Tasmania states of Australia, as a primary care service for pregnant women, delivered until child age 2 years. Participants 722 pregnant Australian women experiencing adversity received NHV (n=363) or usual care (clinic visits) (n=359). Primary and secondary outcome measures First, a cost–consequences analysis to compare the additional costs of NHV over usual care, accounting for any reduced costs of service use, and impacts on all maternal and child outcomes assessed at 3 years. Second, cost–utility analysis from a government-as-payer perspective compared additional costs to maternal QALYs to express cost-effectiveness in terms of additional cost per additional QALY gained. Results When compared with usual care at child age 3 years, the right@home intervention cost $A7685 extra per woman (95$A7006 to $A8364) and generated 0.01 more QALYs (95$A50 000 per QALY. Conclusions Benefits of NHV to parenting at 2 years and maternal health and well-being at 3 years translate into marginal maternal QALY gains. Like previous cost-effectiveness results for NHV programmes, right@home is not cost-effective at 3 years. Given the relatively high up-front costs of NHV, long-term follow-up is needed to assess the accrual of health and economic benefits over time

Evidence for a comprehensive approach to Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews among Indigenous peoples

BACKGROUND: Tobacco smoking is a leading cause of disease and premature mortality among Aboriginal and Torres Strait Islander (Indigenous) Australians. While the daily smoking prevalence among Indigenous Australians has declined significantly from 49% in 2001, it remains about three times higher than that of non-Indigenous Australians (39 and 14%, respectively, for age ≥15 years in 2014-15). This overview of systematic reviews aimed to synthesise evidence about reducing tobacco consumption among Indigenous peoples using a comprehensive framework for Indigenous tobacco control in Australia comprised of the National Tobacco Strategy (NTS) and National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) principles and priorities. METHODS: MEDLINE, EMBASE, systematic review and Indigenous health databases were searched (2000 to Jan 2016) for reviews examining the effects of tobacco control interventions among Indigenous peoples. Two reviewers independently screened reviews, extracted data, and assessed review quality using Assessing the Methodological Quality of Systematic Reviews. Data were synthesised narratively by framework domain. Reporting followed the PRISMA statement. RESULTS: Twenty-one reviews of varying quality were included. There was generally limited Indigenous-specific evidence of effective interventions for reducing smoking; however, many reviewers recommended multifaceted interventions which incorporate Indigenous leadership, partnership and engagement and cultural tailoring. Under the NTS priority areas, reviewers reported evidence for brief smoking cessation interventions and pharmacological support, mass media campaigns (on knowledge and attitudes) and reducing affordability and regulation of tobacco sales. Aspects of intervention implementation related to the NATSIHP domains were less well described and evidence was limited; however, reviewers suggested that cultural tailoring, holistic approaches and building workforce capacity were important strategies to address barriers. There was limited evidence regarding social media and mobile applications, for Indigenous youth, pregnant women and prisoners, and no evidence regarding interventions to protect communities from industry interference, the use of electronic cigarettes, interventions for people experiencing mental illness, juvenile justice, linguistic diversity or 'pubs, clubs and restaurants'. CONCLUSIONS: There is limited Indigenous-specific evidence for most tobacco interventions. A 'comprehensive approach' incorporating NTS and NATSIHP Principles and Priorities of partnership and engagement, evidence from other settings, programme logic and responsive evaluation plans may improve intervention acceptability, effectiveness and implementation and mitigate risks of adapting tobacco evidence for Indigenous Australians.This overview was supported by The Australian Prevention Partnership Centre through the NHMRC partnership centre grant scheme (Grant ID: GNT9100001) with the Australian Government Department of Health, NSW Health, ACT Health, HCF, and the HCF Research Foundation. Catherine Chamberlain is supported by an NHMRC Early Career Fellowship (1088813). Emily Banks is supported by an NHMRC Senior Research Fellowship (1402717)

Psychosocial interventions for supporting women to stop smoking in pregnancy

Background: Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries. Objectives: To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. Search methods: In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors. Selection criteria: Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation interventions during pregnancy. Data collection and analysis: Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, with meta-regression conducted in STATA 14. Main results: The overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination. In separate comparisons, there is high-quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small. Evidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention. There was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20). High-quality evidence suggests incentive-based interventions are effective when compared with an alternative (non-contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I2 = 93%). High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health. The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32). Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions. The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions. Authors' conclusions: Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update

An investigation of the implementation of Victorian smoking cessation guidelines in public antenatal care services

© 2015 Dr. Susan M. PerlenBackground: Modifying smoking behaviour in pregnancy can contribute to a significant improvement in infant health outcomes. Systematic review evidence supports the effectiveness of antenatal smoking cessation interventions to reduce smoking and improve infant health outcomes, such as preterm births and low birthweight. Victorian antenatal smoking cessation guidelines were developed in the early 2000s, and follow a 5As approach (five steps to ask, assess, advise, assist and ask again about smoking behaviour). The annual auditing of Victorian public maternity hospitals, available in State Government reports, indicates that not all women are being offered smoking cessation support, and that variation exists between hospitals in the proportion of women offered initial and follow-up support. At the time of designing this study, no other evidence was available documenting how antenatal smoking cessation guidelines have been implemented in Victoria, and how implementation might be improved. Aim: The overall aim of this PhD study is to examine the implementation of Victorian smoking cessation guidelines in public antenatal care services. The primary research questions are: 1. To what extent, and how, have antenatal smoking cessation guidelines been implemented in Victorian public maternity hospitals? 2. How can implementation be improved? Methods: The study uses a mixed methods approach, with a sequential explanatory research design with two phases: 1. Secondary analyses of data from a Victorian population-based survey of women who gave birth in 2007. 2. An exploratory qualitative study with healthcare providers and managers at two Victorian public maternity hospitals.   Results: The survey results show that smoking cessation guidelines in Victoria are poorly implemented, with only 9.4% of women (36/381) reporting that they had received all of the 5As. Most women smoking in pregnancy reported that they had been asked about smoking (352/377, 93.4%), and told about the harmful effects of smoking (290/350, 82.9%). However, less than half of women were offered advice (169/349, 48.4%) or given written information (159/349, 45.6%). One in five women reported being told about stop smoking programs (76/349, 21.8%), and one-third said that caregivers had discussed smoking with them on more than one occasion (135/349, 38.7%). The qualitative study shows that provision of smoking cessation advice and support is inconsistent and varies according to the model of care a woman is enrolled in, her level of medical risk, the timing of the first pregnancy visit, and social circumstances. The study also identified that the provision of smoking cessation support is influenced by organisational systems that support clinicians in their clinical practice; the relationship that develops between health professionals and individual women; health professionals’ knowledge, experience, beliefs, and understanding of risk; and the level of priority that health professionals place on smoking cessation conversations. The survey results show that women experience mixed feelings about being asked by health professionals about smoking. Approximately three-quarters of women were happy to be asked about smoking; however, one-third of women felt like they were being judged. Women who smoke during pregnancy are more likely to experience multiple stressful life events and social health issues. However, tailoring of smoking cessation support to specific populations or women’s social circumstances is not routine practice. Implications for policy and practice: Organisations and health professionals are struggling to provide smoking cessation advice and support according to the guidelines. Currently, apart from the annual auditing of the maternity performance indicator for the hospital provision of smoking cessation support, there is little innovation or guidance from the Victorian Department of Health to support hospitals to implement the Victorian smoking cessation guidelines. Funding constraints have resulted in Quit Victoria having limited capacity to provide ongoing state-wide training to support maternity healthcare organisations and health professionals to implement smoking cessation guidelines. Additionally, the findings from this study show little return on the investment for previous state-wide training initiatives, suggesting that a new approach needs to be considered for future training initiatives. Conclusion: Evidence from this study illustrates major gaps in the provision of smoking cessation support, and identifies organisational, people, and systems barriers to implementation. There needs to be a ‘whole of systems’ approach to thinking about improvements, with careful consideration given to the interactions between different parts of the system and the contextual environment. Key recommendations arising from the findings address six major areas where action is needed to improve the implementation of the guidelines. This includes the development and application of a ‘whole of systems’ approach, training, smoking cessation resources, data systems, flow of communication between GPs and public maternity hospitals, and tailored approaches to specific populations

Innovative laboratory activities using LASER

The objective of this study is to develop Physics laboratory activities using LASER. However, before laboratory activities could be formulated, it was necessary to come up with LASER accessories. This study, therefore, presents fourteen improvised LASER accessories, three laboratory set-ups, and eleven laboratory activities. Given the proper orientation (say, 24-hour orientation), any Physics laboratory teacher, can perform any or all of the eleven activities using LASER and the improvised LASER accessories in this study. The improvised LASER accessories are: 1. Beam Position Adjuster 2. Optical Bench 3. Multi-purpose Stand 4. Holders 5. LASER Beam Splitter 6. Rotational Reflector 7. Smoke Box 8. Improvised Voltage Amplifier 9. Sound Modulated Reflector 10. Octagonal Reflector 11. Motor Speed Controller 12. Vertical Oscillator 13. Horizontal Oscillator Reflector 14. Signal Generator. This research work also presents three laboratory set ups, namely: 1. LASER Oscilloscope 2. Sound Transmission Reception LASER Kit 3. LASER Power Meter. The laboratory activities presented in this study are: 1. Linear Polarization (A Characteristic of LASER Light) 2. Optical Fiber 3. LASER Power Meter 4. Color 5. Viewing Interference Patterns 6. Lenses 7. Generation of Surfaces and Patterns 8. Distance Measurement by Triangulation 9. Sound Transmission Reception Through LASER 10. Combinations of Motions with the same Frequencies 11. Generation of a Sine Wave. The study was done in four phases, namely: 1. Design and Development Phase 2. Descriptive Phase 3. Testing Phase 4. Revision and Final Write Up Phase. The researcher acknowledges that this study is exploratory in nature. Thus, the results presented here could serve as a springboard for other researchers to further investigate and develop. Also, since the improvised LASER accessories and the LASER are quite useful in demonstrating concepts especially in sound and optics, the researcher hopes to disseminate and share his findings with other interested Physics teachers throughout the country

A Doctrinal Analysis of the Academic Judgment Immunity within Higher Education in England

In England, decisions involving matters of academic judgment are the only type of university decision provided with legal immunity. However, adverse academic decisions with respect to assessment can have long-lasting impacts upon students. A significant issue with respect to the academic judgment immunity is that it is opaque. No singular legal definition or legal test exists despite being applied by the judiciary for centuries and subsequently codified into legislation. Further, academic judgment is a core component of academic decision-making in the university context but remains an elusive concept in higher education research. To define what academic judgment encompasses, the doctrinal research methodology was applied to analyse 76 cases and to interpret relevant legislation. To avoid a highly theoretical outcome, higher education literature was utilised to establish where academic judgment resides in the university context. The outcomes of this thesis have provided several significant original contributions to knowledge including articulating the scope of the academic judgment immunity in the university context, defining the scope of the academic judgment immunity in the legal context, developing a common law and legislative definition of academic judgment, and explaining the importance of following prescribed university policies and procedures. A further significant outcome, and original contribution of this thesis, was the determination that while decisions made with respect to a student’s final assessment result were protected by the academic judgment immunity this did not extend to decisions made with respect to the assessment process. It was determined that a student can challenge a university decision, even when it touches upon matters of academic judgment, where it can be evidenced that a university has failed to follow its own internal assessment processes and procedures or, where there is an element of unfairness in the decision-making process