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Objectives: To identify factors predicting use, adherence and attrition with a nurse-moderated webbased group intervention designed to support mothers of infants aged 0-6 months. Design: 9-Month observational study. Setting: Community maternal and child health service. Participants: 240 mothers attending initial postnatal health checks at community clinics who were randomly assigned to the intervention arm of a pragmatic preference randomised trial (total randomised controlled trial, n=819; response rate=45%). Intervention: In the first week (phase I), mothers were assisted with their first website login by a research assistant. In weeks 2-7 (phase II), mothers participated in the web-based intervention with an expectation of weekly logins. The web-based intervention was comparable to traditional face-to-face new mothers' groups. During weeks 8-26 (phase III), mothers participated in an extended programme at a frequency of their choosing. Primary outcome measures: Number of logins and posted messages. Standard self-report measures assessed maternal demographic and psychosocial characteristics. Results: In phase II, the median number of logins was 9 logins (IQR=1-25), and in phase III, it was 10 logins (IQR=0-39). Incident risk ratios from multivariable analyses indicated that compared to mothers with the lowest third of logins in phase I, those with the highest third had 6.43 times as many logins in phase II and 7.14 times in phase III. Fifty per cent of mothers logged-in at least once every 30 days for 147 days after phase I and 44% logged-in at least once in the last 30 days of the intervention. Frequency of logins during phase I was a stronger predictor of mothers' level of engagement with the intervention than their demographic and psychosocial characteristics. Conclusions: Mothers' early use of web-based interventions could be employed to customise engagement protocols to the circumstances of individual mothers with the aim of improving adherence and reducing attrition with web-based interventions. [ABSTRACT FROM AUTHOR]

Debate about the extent of breast cancer over-diagnosis due to mammography screening has continued for over a decade, without consensus. Estimates range from 0 to 54%, but many studies have been criticized for having flawed methodology. In this study we used a novel study design to estimate over-diagnosis due to organised mammography screening in South Australia (SA). To estimate breast cancer incidence at and following screening we used a population-based, age-matched case-control design involving 4,931 breast cancer cases and 22,914 controls to obtain OR for yearly time intervals since women's last screening mammogram. The level of over-diagnosis was estimated by comparing the cumulative breast cancer incidence with and without screening. The former was derived by applying ORs for each time window to incidence rates in the absence of screening, and the latter, by projecting pre-screening incidence rates. Sensitivity analyses were undertaken to assess potential biases. Over-diagnosis was estimated to be 8% (95%CI 2-14%) and 14% (95%CI 8-19%) among SA women aged 45 to 85 years from 2006-2010, for invasive breast cancer and all breast cancer respectively. These estimates were robust when applying various sensitivity analyses, except for adjustment for potential confounding assuming higher risk among screened than non-screened women, which reduced levels of over-diagnosis to 1% (95%CI 5-7%) and 8% (95%CI 2-14%) respectively when incidence rates for screening participants were adjusted by 10%. Our results indicate that the level of over-diagnosis due to mammography screening is modest and considerably lower than many previous estimates, including others for Australia. [ABSTRACT FROM AUTHOR]

Randomized controlled trial evidence shows that interventions before age 5 can improve skills necessary for educational success; the effect of these interventions on socioeconomic inequalities is unknown. Using trial effect estimates, and marginal structural models with data from the Avon Longitudinal Study of Parents and Children (n = 11,764, imputed), simulated effects of plausible interventions to improve school entry academic skills on socioeconomic inequality in educational achievement at age 16 were examined. Progressive universal interventions (i.e., more intense intervention for those with greater need) to improve school entry academic skills could raise population levels of educational achievement by 5% and reduce absolute socioeconomic inequality in poor educational achievement by 15%. [ABSTRACT FROM AUTHOR]

Objectives: This study developed predictive models for one‐week acute and six‐month persistent pain following root canal treatment (RCT). An additional aim was to study the gain in predictive efficacy of models containing clinical factors only, over models containing sociodemographic characteristics. Methods: A secondary data analysis of 708 patients who received RCTs was conducted. Three sets of predictors were used: (1) combined set, containing all predictors in the data set; (2) clinical set and (3) sociodemographic set. Missing data were handled by multiple imputation using the missing indicator method. The multilevel least absolute selection and shrinkage operator (LASSO) regression was used to select predictors into the final multilevel logistic models. Three measures, the area under the receiver operating characteristic curve (AUROC) and precision‐recall curve (AUPRC) and calibration curves, were used to assess the predictive performance of the models. Results: The selected‐in factors in the final models, using LASSO regression, are related to pre‐ and intra‐treatment clinical symptoms and pain experience. Predictive performance of the models remained the same with the inclusion (exclusion) of the socio‐demographic factors. For predicting one‐week outcome, the model built with combined set of predictors yielded the highest AUROC and AUPRC of 0.85 and 0.72, followed by the models built with clinical factors (AUROC = 0.82, AUPRC = 0.66). The lowest predictive ability was found in models with only sociodemographic characteristics (AUROC = 0.68, AUPRC = 0.40). Similar patterns were observed in predicting six‐month outcome, where the AUROC for models with combined, clinical and sociodemographic sets of predictors were 0.85, 0.89 and 0.66, respectively, and the AUPRC were 0.48, 0.53 and 0.22, respectively. Conclusions: Clinical factors such as the severity and experience of pre‐operative and intra‐operative pain were discovered important to the subsequent development of pain following RCTs. Adding sociodemographic characteristics to the models with clinical factors did not change the models' predictive performance or the proportion of explained variance. [ABSTRACT FROM AUTHOR]

Background There is limited longitudinal data from high-income countries on the sequelae of anaemia during pregnancy. The aim of this study is to examine whether anaemia of pregnancy is associated with adverse perinatal outcomes and with children's developmental vulnerability. Methods We conducted a population-based study to link routinely collected government administrative data that involved all live births in the state of South Australia 1999-2005 ( n = 124 061) and a subset for whom developmental data were collected during a national census of children attending their first year of school in 2009 ( n = 13 654). Perinatal outcomes were recorded by midwives using a validated, standardised form. Development was recorded by schoolteachers using the Australian Early Development Index ( AEDI). Children in the lowest 10% of AEDI scores are indicative of developmental vulnerability. Results There were 8764/124 061 (7.1%) cases of anaemia. After adjustment for a range of potentially confounding factors, anaemia of pregnancy was associated with a higher risk of fetal distress [incident rate ratio ( IRR) 1.20 [95% CI 1.13, 1.27]] and preterm birth <37 weeks gestation ( IRR 1.23 [1.15, 1.31]), slightly higher birthweight [14 g (2, 26)] and newborns were less likely to require resuscitation ( IRR 0.94 [0.91, 0.097]). Anaemia of pregnancy was not associated with children's developmental vulnerability after adjustment for maternal, obstetric and sociodemographic covariables, either in complete case analyses ( n = 11 949) or after imputation for missing data ( n = 13 654). Conclusions Anaemia of pregnancy is associated with perinatal complications but not with children's developmental vulnerability at school entry. [ABSTRACT FROM AUTHOR]