Cost analysis of the CTLB Study, a multitherapy antenatal education programme to reduce routine interventions in labour

Objective: To assess whether the multitherapy antenatal education ‘CTLB’ (Complementary Therapies for Labour and Birth) Study programme leads to net cost savings. Design: Cost analysis of the CTLB Study, using analysis of outcomes and hospital funding data. Methods: We take a payer perspective and use Australian Refined Diagnosis-Related Group (AR-DRG) cost data to estimate the potential savings per woman to the payer (government or private insurer). We consider scenarios in which the intervention cost is either borne by the woman or by the payer. Savings are computed as the difference in total cost between the control group and the study group. Results: If the cost of the intervention is not borne by the payer, the average saving to the payer was calculated to be $A808 per woman. If the payer covers the cost of the programme, this figure reduces to$A659 since the average cost of delivering the programme was $A149 per woman. All these findings are significant at the 95Conclusion: The CTLB antenatal education programme leads to significant savings to payers that come from reduced use of hospital resources. Depending on which perspective is considered, and who is responsible for covering the cost of the programme, the net savings vary from$A659 to $A808 per woman. Compared with the average cost of birth in the control group, we conclude that the programme could lead to a reduction in birth-related healthcare costs of approximately 9%. Trial registration number: ACTRN12611001126909

More than needles : the importance of explanations and self-care advice in treating primary dysmenorrhea with acupuncture

Background. Primary dysmenorrhea is a common gynaecological condition. Traditional Chinese medicine (TCM) acupuncturists commonly treat primary dysmenorrhea and dispense specific self-care advice for this condition. The impact of self-care advice on primary dysmenorrhea is unknown. Methods. 19 TCM acupuncture practitioners from New Zealand or Australia and 12 New Zealand women who had recently undergone acupuncture treatment for primary dysmenorrhea as part of a randomised controlled trial participated in this qualitative, pragmatic study. Focus groups and semistructured interviews were used to collect data. These were recorded, transcribed, and analysed using thematic analysis. Results. The overarching theme was that an acupuncture treatment consisted of “more than needles” for both practitioners and participants. Practitioners and participants both discussed the partnership they engaged in during treatment, based on openness and trust. Women felt that the TCM self-care advice was related to positive outcomes for their dysmenorrhea and increased their feelings of control over their menstrual symptoms. Conclusions. Most of the women in this study found improved symptom control and reduced pain. A contributing factor for these improvements may be an increased internal health locus of control and an increase in self-efficacy resulting from the self-care advice given during the clinical trial. (** PLEASE NOTE: a corrigendum for this article is available via https://doi.org/10.1155/2018/8468376

Harnessing Whole Genome Polygenic Risk Scores to Stratify Individuals Based on Cardiometabolic Risk Factors and Biomarkers at Age 10 in the Lifecourse - Brief Report

In this study, we investigated the capability of polygenic risk scores to stratify a cohort of young individuals into risk deciles based on 10 different cardiovascular traits and circulating biomarkers. METHODS: We first conducted large-scale genome-wide association studies using data on adults (mean age 56.5 years) enrolled in the UK Biobank study (n=393 193 to n=461 460). Traits and biomarkers analyzed were body mass index, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, apolipoprotein B, apolipoprotein A-I, C-reactive protein and vitamin D. Findings were then leveraged to build whole genome polygenic risk scores in participants from the Avon Longitudinal Study of Parents and Children (mean age, 9.9 years) which were used to stratify this cohort into deciles in turn and analyzed against their respective traits. RESULTS: For each of the 10 different traits assessed, we found strong evidence of an incremental trend across deciles (all P<0.0001). Large differences were identified when comparing top and bottom deciles; for example, using the apolipoprotein B polygenic risk scores there was a mean difference of 13.2 mg/dL for this established risk factor of coronary heart disease in later life. CONCLUSIONS: Although the use of polygenic prediction in a clinical setting may currently be premature, our findings suggest they are becoming increasingly powerful as a means of predicting complex trait variation at an early stage in the lifecourse

Playing to Live: Outcome Evaluation of a Community-Based Psychosocial Expressive Arts Program for Children During the Liberian Ebola Epidemic

Background. This paper reviews the efficacy of a community psychosocial arts program focused on building mental health capacity within post-Ebola Liberia. The aim of this paper was to evaluate the outcome effects of two groups using pre- and post-treatment data. We hypothesized that there would be a difference in symptoms pre- and post-treatment, and the longer program would yield more significant results. Methods. There was a total of 870 child participants. Of 40 sites, 24 were selected for a 5-month treatment (TG1) while the remaining 16 sites received 3 months of treatment (TG2). Paired t tests and a mixed-model analysis of variance (ANOVA) were used to analyse pre- and post-psychological stress symptoms (PSS) for samples from both groups. Results. Separately, treatment group 1 (TG1) and treatment group 2\u27s (TG2) paired t test yielded significant results (p \u3c 0.001) for the decrease of PSS. The mixed-model ANOVA found that there were significant differences in total pre- and post-test PSS and a significant difference in PSS means over time. Conclusions. Results indicated that there was a statistically significant decrease in reported symptoms in both treatment groups pre- to post-intervention and a significant difference in total symptoms over time. However, the findings do not indicate that the longer programming was statistically different compared to the shorter programming. The study presented had gaps in data, largely due to limits in research during the crisis. However, this paper provides a unique case study for challenges that can be faced for project evaluation in emergency settings

An education intervention to improve decision making and health literacy among older Australians: A randomised controlled trial

Background: National policies seek to involve older Australian’s in decisions regarding their care; however, research has found varying levels of decision self-efficacy and health literacy skills. An increasing number of older Australians use complementary medicine (CM). We examined the effectiveness of a CM educational intervention delivered using a web or DVD plus booklet format to increase older adults’ decision self-efficacy and health literacy. Methods: A randomised controlled trial was conducted. We recruited individuals aged over 65years living in retirement villages or participating in community groups, in Sydney Australia. Participants were randomly allocated to receive a CM education intervention delivered using a website or DVD plus booklet versus booklet only. The primary outcome was decision self-efficacy. A secondary outcome included the Preparation for Decision-Making scale and health literacy. Outcomes were collected at 3 weeks, and 2 months from baseline, and analysed using an adjusted ANOVA, or repeated measures ANOVA. Result: We randomised 153 participants. Follow up at 3 weeks and 2 months was completed by 131 participants. There was a 14% (n =22) attrition rate. At the end of the intervention, we found no significant differences between groups for decision self-efficacy (mean difference (MD) 3.8, 95% confidence interval (CI) -2.0 to 9.6 p =0.20), there were no differences between groups on nine health literacy domains, and the Preparation for Decision-Making scale. Over 80% of participants in both groups rated the content as excellent or good. Conclusion: Decision self-efficacy improved for participants, but did not differ between groups. Decision self-efficacy and health literacy outcomes were not influenced by the delivery of education using a website, DVD or booklet. Participants found the resources useful, and rated the content as good or excellent. CM Web or DVD and booklet resources have the potential for wider application. Trial registration: The trial was registered with the Australian New Zealand Clinical Trials Registry: ACTRN (ACTRN12616000135415). The trial was registered on 5 February 2016

The effectiveness and safety of complementary health approaches to managing postpartum pain : a systematic review and meta-analysis

Background: Women experience pain from a number of causes during the postpartum period. Although pharmacological pain relief has shown to be effective, the efficacy of non-pharmacological methods of pain relief will be of interest to breastfeeding women. The aim of this systematic review was to examine the efficacy and safety of complementary approaches to manage postpartum pain. Methods: A search of English language databases from their inception to 2020 was undertaken for randomised controlled trials and included primiparous and multiparous women who experienced postpartum pain up to two weeks post birth. The primary outcome was pain. The risk of bias was assessed using the Cochrane risk of bias tool. Results. Thirty trials were included in the review, 25 trials (2,413 women) were included in the meta-analysis. Two trials of massage found a reduction in pain following caesarean birth within the first 24 hours post birth (MD -2.64, 95% -2.82 to -2.46, 184 women, I2 0%), and at seven days postpartum (MD -1.91, 95%CI -2.42 to -1.40, 2 trials, 120 women I2 37%). Two trials conducted with women receiving an episiotomy found reduction in perineal pain from herbal ointments within 24 hours (MD -1.33, 95% CI -.96 to -0.70, 221 women) and at 14 days postpartum (MD -0.74, 95% CI -1.02 to -0.47, 4 trials). Few trials reported on safety, few trials were at an overall low risk of bias, and overall the quality of evidence was very low. Conclusion. Further high quality trials are needed to determine the safety and effectiveness of herbal ointment and massage during the early postpartum period