Brief evidence-based interventions for universal child health services: a restricted evidence assessment of the literature.

BACKGROUND: Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. We aimed to identify brief, evidence-based interventions for common health and developmental problems that could be potentially implemented in UCHS. METHODS: A restricted evidence assessment (REA) of electronic databases and grey literature was undertaken covering January 2006 to August 2019. Studies were eligible if (i) outcomes related to one or more of four areas: child social and emotional wellbeing (SEWB), infant sleep, home learning environment or parent mental health, (ii) a comparison group was used, (iii) universal or targeted intervention were delivered in non-tertiary settings, (iv) interventions did not last more than 4 sessions, and (v) children were aged between 2 weeks postpartum and 5 years at baseline. RESULTS: Seventeen studies met the eligibility criteria. Of these, three interventions could possibly be implemented at scale within UCHS platforms: (1) a universal child behavioural intervention which did not affect its primary outcome of infant sleep but improved parental mental health, (2) a universal screening programme which improved maternal mental health, and (3) a targeted child behavioural intervention which improved parent-reported infant sleep problems and parental mental health. Key lessons learnt include: (1) Interventions should impart the maximal amount of information within an initial session with future sessions reinforcing key messages, (2) Interventions should see the family as a holistic unit by considering the needs of parents with an emphasis on identification, triage and referral, and (3) Brief interventions may be more acceptable for stigmatized topics, but still entail considerable barriers that deter the most vulnerable. CONCLUSIONS: Delivery and evaluation of brief evidence-based interventions from a UCHS could lead to improved maternal and child health outcomes through a more responsive and equitable service. We recommend three interventions that meet our criteria of "best bet" interventions.

Understanding the factors affecting self-management of COPD from the perspectives of healthcare practitioners: a qualitative study.

Self-management is recognised as an essential criteria for the provision of high quality care for chronic obstructive pulmonary disease (COPD). The management of COPD is usually delivered by a wide range of healthcare practitioners. This study aimed to understand the factors affecting self-management of COPD from the perspectives of the different multidisciplinary healthcare teams involved in COPD care. Semi-structured interviews were conducted with participants from primary care, specialist respiratory and pulmonary rehabilitation (PR) teams. Purposive sampling and snowballing were employed in participant recruitment. All interviews were audio-recorded and transcribed verbatim and data were analysed thematically. A total of 20 participants (eight primary care practitioners, seven respiratory specialists and five PR practitioners) were interviewed until data saturation was reached. Participants identified a range of complex and interrelated factors affecting COPD self-management that were grouped into three broad categories-patient, practitioner and organisational/system-level factors. Patient-level factors were predominantly considered as barriers, with COPD knowledge and understanding, and the individual patients' life circumstances/context being the most prominent issues. Practitioner-level factors identified were practitioners' speciality, interest and experience in respiratory conditions as the overarching factor that influenced how self-management was understood and practiced. A number of organisational/system-level factors were identified by all practitioners, including inconsistency of referral pathways and the wide variations of different self-management planning tools. Factors affecting self-management of COPD across these three levels need to be tackled equally in order to improve the effectiveness of interventions and to embed and integrate self-management support approaches into routine practice. CHRONIC LUNG DISEASE: A BALANCED APPROACH FOR IMPROVED SELF-MANAGEMENT: Better co-ordination between healthcare services, practitioners and patients may help improve self-management for chronic lung disease. Self-management is crucial for patients with chronic obstructive pulmonary disease (COPD), but it can be difficult for healthcare workers to monitor and support patient progress. Oladapo Ogunbayo at Newcastle University, UK, and co-workers conducted interviews with healthcare practitioners to explore perceived barriers to successful self-management of COPD. Three distinct categories emerged; those at patient level, practitioner level and organisational level, the needs of which should be carefully balanced to improved self-management. Patient knowledge and understanding of COPD, alongside individual life circumstances, were often barriers to effective self-care. Those practitioners with specialist respiratory knowledge took a more holistic approach to self-management than their primary care counterparts. A lack of continuity between services and across self-management planning tools presented further barriers.

Effects of antenatal yoga on maternal anxiety and depression: a randomized controlled trial.

BACKGROUND: Antenatal depression and anxiety are associated with adverse obstetric and mental health outcomes, yet practicable nonpharmacological therapies, particularly for the latter, are lacking. Yoga incorporates relaxation and breathing techniques with postures that can be customized for pregnant women. This study tested the efficacy of yoga as an intervention for reducing maternal anxiety during pregnancy. METHODS: Fifty-nine primiparous, low-risk pregnant women completed questionnaires assessing state (State Trait Anxiety Inventory; STAI-State), trait (STAI-Trait), and pregnancy-specific anxiety (Wijma Delivery Expectancy Questionnaire; WDEQ) and depression (Edinburgh Postnatal Depression Scale; EPDS) before randomization (baseline) to either an 8-week course of antenatal yoga or treatment-as-usual (TAU); both groups repeated the questionnaires at follow-up. The yoga group also completed pre- and postsession state anxiety and stress hormone assessments at both the first and last session of the 8-week course. RESULTS: A single session of yoga reduced both subjective and physiological measures of state anxiety (STAI-S and cortisol); and this class-induced reduction in anxiety remained at the final session of the intervention. Multiple linear regression analyses identified allocation to yoga as predictive of greater reduction in WDEQ scores (B = -9.59; BCa 95% CI = -18.25 to -0.43; P = .014; d = -0.57), while allocation to TAU was predictive of significantly increased elevation in EPDS scores (B = -3.06; BCa 95% CI = -5.9 to -0.17; P = .042; d = -0.5). No significant differences were observed in state or trait anxiety scores between baseline and follow-up. CONCLUSION: Antenatal yoga seems to be useful for reducing women's anxieties toward childbirth and preventing increases in depressive symptomatology.

State-trait anxiety inventory (STAI) scores during pregnancy following intervention with complementary therapies.

OBJECTIVE: We review intervention trials that have used the State-Trait Anxiety inventory (STAI) as a measure of maternal anxiety in pregnancy in order to provide ranges in scores before and after participation in complementary therapy-based interventions to highlight the expected ranges of scores in pregnancy and determine whether anxiety in pregnancy is amenable to change when measured by the STAI. METHODS: Combinations of the key words "STAI", "state anxiety", "pregnancy", "anxiety", "maternal", "stress", "outcome" and "intervention" were used to search publications between January 1970 and January 2011. Studies eligible for inclusion recruited low risk, adult women to a non-pharmacological intervention or a comparator group, and measured anxiety at baseline and post-intervention. RESULTS: Ten studies were eligible. Scores were routinely high compared to expected ranges in non-pregnant populations. Studies examining the immediate effects of an intervention consistently reported significantly lowered STAI scores after a single session. Likewise, studies examining the effect of interventions consisting of multiple sessions over the course of pregnancy found that those in the intervention group were more likely to show an improvement in STAI scores. LIMITATIONS: Heterogeneity in type and duration of intervention prevent drawing conclusions on which were most effective in reducing anxiety. CONCLUSION: Scores on the STAI appear amenable to change during pregnancy, both after a single session and multiple sessions of interventions designed to reduce maternal anxiety. This review offers a guideline for the expected range of scores for future studies examining the efficacy of interventions in pregnancy when using the STAI.