Study protocol for a real-world evaluation of an integrated child and family health hub for migrant and refugee women.

INTRODUCTION: Continuity of child and family healthcare is vital for optimal child health and development for developmentally vulnerable children. Migrant and refugee communities are often at-risk of poor health outcomes, facing barriers to health service attendance including cultural, language, limited health literacy, discrimination and unmet psychosocial needs. 'Integrated health-social care hubs' are physical hubs where health and social services are co-located, with shared referral pathways and care navigation. AIM: Our study will evaluate the impact, implementation and cost-benefit of the First 2000 Days Care Connect (FDCC) integrated hub model for pregnant migrant and refugee women and their infants. MATERIALS AND METHODS: This study has three components. Component 1 is a non-randomised controlled trial to compare the FDCC model of care with usual care. This trial will allocate eligible women to intervention and control groups based on their proximity to the Hub sites. Outcome measures include: the proportion of children attending child and family health (CFH) nurse services and completing their CFH checks to 12 months of age; improved surveillance of growth and development in children up to 12 months, post partum; improved breastfeeding rates; reduced emergency department presentations; and improved maternal well-being. These will be measured using linked medical record data and surveys. Component 2 will involve a mixed-method implementation evaluation to clarify how and why FDCC was implemented within the sites to inform future roll-out. Component 3 is a within-trial economic evaluation from a healthcare perspective to assess the cost-effectiveness of the Hubs relative to usual care and the implementation costs if Hubs were scaled and replicated. ETHICS AND DISSEMINATION: Ethical approval was granted by the South Eastern Sydney Local Health District Human Research Ethics Committee in July 2021 (Project ID: 020/ETH03295). Results will be submitted for publication in peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER: ACTRN12621001088831.

Disposition of ingested olestra in weanling mini-pigs.

The disposition of ingested olestra in Hanford mini-pigs was examined by following a single oral gavage dose of radiolabelled (U-14C-sucrose) olestra Eight dosed animal (four/sex) and one undosed animal were killed 1, 3 and 7 days after dosing, and tissues were collected and counted. Urine and faeces were collected continuously and counted. Tissue lipids were extracted and analysed for intact radiolabelled olestra by size exclusion chromatography. Sucrose will be excreted in urine if olestra is absorbed and metabolized. Mean recovery of radiolabel was 96.6% of the administered dose. Of the recovered radiolabel, more than 99.4%, on average, was not absorbed and found in faeces, or cage and animal wash solutions. The absorbed radiolabel (0.6%), was distributed across the carcass, all tissues and blood, or excreted in urine. This radiolabel primarily came from the metabolism of glucose and fructose resulting from the hydrolysis of the trace levels of penta- and lower sucrose esters present in the test material. No radiolabel was found in the olestra-containing fraction of liver lipids, the primary measure of absorbed and non-metabolized olestra, at a detection limit of 0.0002% of dose. A conservative estimate of the amount of 14C-sucrose excreted in the urine was 0.0012%. The total absorption of intact olestra was thus less than 0.0014% of the dose, the sum of the two measures. These results indicate that intact olestra is essentially not absorbed by the weanling mini-pig, an animal with a young developing gastrointestinal tract similar to that of young children (2-5 yr).