Melbourne School of Population and Global Health - Research Publications
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ItemAre youth mentoring programs good value-for-money? An evaluation of the Big Brothers Big Sisters Melbourne Program(BMC, 2009-01-30)BACKGROUND: The Big Brothers Big Sisters (BBBS) program matches vulnerable young people with a trained, supervised adult volunteer as mentor. The young people are typically seriously disadvantaged, with multiple psychosocial problems. METHODS: Threshold analysis was undertaken to determine whether investment in the program was a worthwhile use of limited public funds. The potential cost savings were based on US estimates of life-time costs associated with high-risk youth who drop out-of-school and become adult criminals. The intervention was modelled for children aged 10-14 years residing in Melbourne in 2004. RESULTS: If the program serviced 2,208 of the most vulnerable young people, it would cost AUD 39.5 M. Assuming 50% were high-risk, the associated costs of their adult criminality would be AUD 3.3 billion. To break even, the program would need to avert high-risk behaviours in only 1.3% (14/1,104) of participants. CONCLUSION: This indicative evaluation suggests that the BBBS program represents excellent 'value for money'.
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ItemAssessing the health and development of ART-conceived young adults: A study of feasibility, parent recall, and acceptability.(Springer Science and Business Media LLC, 2008-10-28)BACKGROUND: Assisted reproductive technologies (ART) to treat infertility have been available for nearly three decades. There have been a number of systematic comparisons of the health and development of ART-conceived with spontaneously-conceived (SC) children. Data are equivocal, some finding no differences and others that there are more health and developmental problems in the ART group. It is agreed that perinatal mortality and morbidity are worse after assisted than spontaneous conception and the impact of the hormonally altered intrauterine environment on puberty and later fertility of offspring are unknown. To date however, there has been no investigation of the health and development of ART-conceived young adults, including from the world's few prospective cohorts of ART conceived children. Obtaining these data requires contact to be made with people at least twenty years after discharge from the treating service. Given the ethical difficulties of approaching families to participate in research up to two decades after cessation of treatment, the aim of this exploratory qualitative investigation was to assess the feasibility and acceptability of approaching mothers treated for infertility prior to 1988, and their recall of the health and development of their ART-conceived young adult children. METHODS: Mothers treated for infertility at the Royal Women's Hospital Reproductive Biology Unit in Melbourne, Australia prior to 1988 were approached by a senior clinician and invited to participate in individual semi-structured interviews which could include their partners and/or young adult children if they wished. Recruitment continued until theoretic saturation had been reached. RESULTS: Ten mothers, two of their husbands and five young adults participated in interviews, and the health and development of 15 ART-conceived young adults were described. The experience of conception, pregnancy, birth and the health and development of the children were recalled vividly and in detail. Families were pleased to have been approached and supported the need for systematic data collection. Mode of conception had been disclosed from childhood to all the offspring. CONCLUSION: With careful and sensitive recruitment strategies it is feasible and acceptable to contact women treated for infertility at least two decades ago and their families, to assess the health and development of ART-conceived young adults.
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ItemRelative socioeconomic advantage and mood during advanced pregnancy in women in Vietnam.(Springer Science and Business Media LLC, 2007-08-09)BACKGROUND: Mental health during pregnancy has not been investigated in Vietnam. Antenatal depression is an established risk factor for postpartum mood disturbance and two representative cohort studies have found rates of depression after childbirth in Vietnam two to three times higher than those in high income countries. AIM: The aim of this exploratory study was to investigate the prevalence and determinants of depression in a cohort of pregnant Vietnamese women. This was the subsidiary aim of an investigation of sexual beliefs and behaviours in pregnancy in Vietnam. METHODS: Participants were recruited from antenatal clinics at Hanoi Obstetric Hospital. Inclusion criteria were to be in advanced pregnancy and appear well educated and confident and therefore potentially be willing to discuss sexual matters. Data were collected by individual structured interviews assessing socio-demographic characteristics, reproductive health, quality of intimate relationship and adequacy of support. Emotional wellbeing was assessed by the Vietnamese translation of the Edinburgh Depression Scale (EDS). RESULTS: In total 61/74 (82%) of women approached to participate were recruited. The mean EDS score of 5.42 +/- 3.8, was similar to that of community cohorts in high income countries and only one participant scored above 15. The cohort was relatively socioeconomically advantaged with high rates of post-secondary education, secure salaried employment, reproductive autonomy and ability to afford higher quality antenatal care. Most participants were able to confide in their husbands and their pregnancies were welcome. Worse mood was associated with insecure casual work, crowded living conditions and experiencing critical coercion in the marital relationship. CONCLUSION: There is an apparently low prevalence of symptoms of depression in relatively socioeconomically advantaged pregnant women in Vietnam.
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ItemAntenatal mood and fetal attachment after assisted conception(Elsevier, 2007)Objective: Australian women conceiving with ART are at fourfold risk of admission to early parenting treatment programs compared to those conceiving spontaneously. The study aimed to identify prevalence and determinants of antenatal mood disturbance and other risks for early parenting difficulties after assisted conception. Design: A prospective longitudinal investigation from conception to 18 months postpartum using telephone interviews and self-report questionnaires. Setting: Melbourne IVF and Royal Women’s Hospital Reproductive Services, Victoria, Australia. Patient(s): A consecutive cohort of English-speaking women with ultrasound-confirmed ART -conceived pregnancies. Main outcome measure(s): Standardized psychometric measures of mood, quality of marital relationship, mother to fetus emotional attachment, and personality. Intervention(s): None Result(s): Of the 288 women with a confirmed pregnancy, 239 were contactable, 183 (77%) recruited and 95% completed both early and late pregnancy assessments. Participants were socioeconomically advantaged, had very good pregnancy health, exceptional marital relationships, normal personality styles and intense affectionate attachment to the fetus. Very few (< 5%) had clinically significant mood disturbance in late pregnancy. Conclusions: There were low rates of antenatal mood disturbance and other risk factors for postpartum depression. Pregnancy and motherhood might be idealised after ART conception and preparation for the realities of infant care might then be insufficient.
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ItemAssisted conception is a risk factor for postnatal mood disturbance and early parenting difficulties(Elsevier, 2005)Objective: To investigate whether assisted conception is associated with an increased risk of admission to a residential early parenting program for treatment of maternal mood disorder or infant feeding or sleeping disorders in the postpartum year. Design: Systematic audit of consecutive medical records. Setting: Masada Private Hospital Mother Baby Unit (MPHMBU), Melbourne, Australia Patients: Medical records of all mother-infant dyads admitted to MPHMBU between July 2000 and August 2002. Main outcome measures: Modes of conception and delivery of index infant, maternal and infant age on admission, multiplicity of birth, infant birthweight and Edinburgh Postnatal Depression Scale scores. Results: A total of 745 records were audited and mode of conception was recorded in 526 (70.6%) of records. Overall 6% (45 / 745) of the admitted infants had been conceived through ART compared to 1.52% in the general population (RR 4.0, 95% CI 3.0 - 5.4). Mothers who had conceived with ART were older and more likely to have had caesarean and multiple births than those who conceived spontaneously. Conclusions: Assisted conception appears to be associated with a significantly increased rate of early parenting difficulties. Women who experience assisted conception may require additional support after their babies are born.
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ItemEarly parenting difficulties: implications for health services policy( 2005)Australia’s residential early parenting centres are unique internationally and provide a highly valued service to parents and their very young children. Clinical practice in these services has been based on extensive experience, but now needs to be derived from an evidence base. In response to this need, Tweddle Child and Family Health Service (TCFHS) in Melbourne - a public access early parenting service - commissioned a review of literature relating to its practice and a prospective longitudinal survey of a consecutive group of mothers admitted with infants aged up to one year. This article summarises the main findings of both the literature review and the survey. Australia’s public access residential early parenting centres are a unique national resource and were established initially for the care of abandoned, relinquished or mistreated young children. Over time their purpose and function has altered to reflect social change associated with reduction in relinquishment of children for adoption, and policies that have sought to minimise removal of children from parental care. Now they focus on assisting parents to improve caretaking capacity. There are no equivalent services in any other country in the world. In general, services for parents experiencing difficulty caring for their infants in industrialised countries are based in primary health care of outreach home visiting services. Consumer satisfaction surveys indicate that parents value early parenting services highly, but as yet there is a limited evidence base to their clinical practice.