title: Cost-effectiveness of preventive occupational therapy for independent-living older adults. Promoting mental health in small-medium enterprises: An evaluation of the "Business in Mind" program (Cost)effectiveness of life review for Older Adults: Design of a randomized controlled trial [Effects of a home visiting program for older people with poor health status: a randomized, clinical trial in the Netherlands]. Costs and effectiveness of community postnatal support workers: randomised controlled trial Postnatal support for mothers living in disadvantaged inner city areas: a randomised controlled trial Modeling the Impact of Enhanced Depression Treatment on Workplace Functioning and Costs: A Cost–Benefit Approach Long-term economic costs of psychological problems during childhood. Parenting programme for parents of children at risk of developing conduct disorder: cost effectiveness analysis Impact of a parenting program in a high-risk, multi-ethnic community: the PALS trial. Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. Cost-utility of a visiting service for older widowed individuals: Randomised trial Preventing adolescent health-risk behaviors by strengthening protection during childhood. Home visiting by paraprofessionals and by nurses: a randomized, controlled trial. Design of an internet-based health economic evaluation of a preventive group-intervention for children of parents with mental illness or substance use disorders Promoting positive adult functioning through social development intervention in childhood: long-term effects from the Seattle Social Development Project. Measuring the impact and costs of a universal group based parenting programme: protocol and implementation of a trial Cost-effectiveness of an activating intervention by social workers for patients with minor mental disorders on sick leave: a randomized controlled trial. Cost effectiveness of a community based exercise programme in over 65 year olds: cluster randomised trial The clinical effectiveness of different parenting programmes for children with conduct problems: a systematic review of randomised controlled trials (Cost)-effectiveness of family meetings on indicated prevention of anxiety and depressive symptoms and disorders of primary family caregivers of patients with dementia: design of a randomized controlled trial Is stacking intervention components cost-effective? An analysis of the Incredible Years program. Large group community-based parenting programs for families of preschoolers at risk for disruptive behaviour disorders: utilization, cost effectiveness, and outcome. Role of home visiting in improving parenting and health in families at risk of abuse and neglect: results of a multicentre randomised controlled trial and economic evaluation A Novel Stress and Coping Workplace Program Reduces Illness and Healthcare Utilization Effect of Prenatal and Infancy Nurse Home Visitation on Government Spending Improving infant sleep and maternal mental health: a cluster randomised trial Effects on health care use and associated cost of a home visiting program for older people with poor health status: a randomized clinical trial in the Netherlands. Effects of psychosocial group rehabilitation on health, use of health care services, and mortality of older persons suffering from loneliness: a randomized, controlled trial. Psychological interventions for postnatal depression: cluster randomised trial and economic evaluation. The PoNDER trial. Cost-effectiveness of a preventive counseling and support package for postnatal depression. Costs and effectiveness of the fast track intervention for antisocial behavior. Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: randomised trial. The Social Support and Family Health Study: a randomised controlled trial and economic evaluation of two alternative forms of postnatal support for mothers living in disadvantaged inner-city areas. Targeting early antecedents to prevent tobacco smoking: findings from an epidemiologically based randomized field trial. Health promotion for frail older home care clients. Economic evaluation of an intensive home visiting programme for vulnerable families: a cost-effectiveness analysis of a public health intervention. Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial. Can sickness absence be reduced by stress reduction programs: on the effectiveness of two approaches 'Right from the Start': randomized trial comparing an attachment group intervention to supportive home visiting.
abstract: OBJECTIVES To evaluate the cost-effectiveness of a 9-month preventive occupational therapy ( OT ) program in the Well-Elderly Study : a r and omized trial in independent-living older adults that found significant health , function , and quality of life benefits attributable to preventive OT . DESIGN A r and omized trial . SETTING Two government-subsidized apartment complexes . PARTICIPANTS One hundred sixty-three culturally diverse volunteers aged 60 and older . INTERVENTION An OT group , a social activity group ( active control ) , and a nontreatment group ( passive control ) . MEASUREMENTS Use of healthcare services was determined by telephone interview during and after the treatment phase . A conversion algorithm was applied to the R AND 36-item Short Form Health Survey to derive a preference-based health-related quality of life index , quality -adjusted life years ( QALYs ) , and the incremental cost-effectiveness ratio for preventive OT relative to the combined control group . RESULTS Costs for the 9-month OT program averaged $ 548 per subject . Postintervention healthcare costs were lower for the OT group ( $ 967 ) than for the active control group ( $ 1,726 ) , the passive control group ( $ 3,334 ) , or a combination of the control groups ( $ 2,593 ) . The quality of life index showed a 4.5 % QALY differential ( OT vs combined control ) , P < .001 . The cost per QALY estimates for the OT group was $ 10,666 ( 95 % confidence interval = $ 6,747-$25,430 ) . For the passive and active control groups , the corresponding costs per QALY were $ 13,784 and $ 7,820 , respectively . CONCLUSION In this study , preventive OT demonstrated cost-effectiveness in conjunction with a trend toward decreased medical expenditures Background Workplace mental health promotion ( WMHP ) aims to prevent and effectively manage the social and economic costs of common mental illnesses such as depression . The mental health of managers and employees within small-medium enterprises ( SMEs ) is a neglected sector in occupational health research and practice , despite the fact that this sector is the most common work setting in most economies . The availability and propensity of SME staff to attend face-to-face training/therapy or workshop style interventions often seen in corporate or public sector work setting s is a widely recognised problem . The ' Business in Mind ' program employs a DVD mode of delivery that is convenient for SME managers , particularly those operating in regional and remote areas where internet delivery may not be optimal . The objective of the intervention program is to improve the mental health of SME managers , and examine whether employees of managers ' whose mental health improves , report positive change in their psychosocial work environment . The mechanisms via which we aim to improve managers ' mental health are through the development of their psychological capital ( a higher order construct comprised of hope , self efficacy , resilience and optimism ) and their skills and capacities for coping with work stress . Methods / Design The effectiveness of two versions of the program ( self administered and telephone facilitated ) will be assessed using a r and omised trial with an active control condition ( psychoeducation only ) . We aim to recruit a minimum of 249 managers and a sample of their employees . This design allows for 83 managers per group , as power analyses showed that this number would allow for attrition of 20 % and still enable detection of an effect size of 0.5 . The intervention will be implemented over a three month period and postal surveys will assess managers and employees in each group at baseline , intervention completion , and at 6 month follow up . The intervention groups ( managers only ) will also be assessed at 12 and 24 month follow-up to examine maintenance of effects . Primary outcomes are managers ' levels of psychological capital ( hope , resilience , self-efficacy and optimism ) , coping strategies , anxiety and depression symptoms , self-reported health , job satisfaction and job tension . Secondary outcomes are participating managers subordinates ' perceptions of manager support , relational justice , emotional climate and job tension . In order to provide an economic evaluation of the intervention , both employees and manager rates of absenteeism and presenteeism will also be assessed . Discussion The intervention being trialled is expected to improve both primary and secondary outcomes . If proven efficacious , the intervention could be disseminated to reach a much larger proportion of the business community . Trial registration Current controlled trials IS RCT N Background  Depression in older adults is a serious health problem with a poor prognosis . There is a need for indicated preventive psychological interventions for older adults , that show to be promising in preventing depressive disorders . Methods / design This manuscript describes the design of a study evaluating ' Looking for Meaning ' , a newly developed prevention course for older adults with depressive symptoms , based on life- review . Both clinical and economic effectiveness are evaluated in a pragmatic r and omized controlled trial . The control condition of this 12-session preventive intervention is a 20-minute video movie . The primary outcome is symptoms of depression at post-treatment and follow-up ( 6 months after post-treatment ) . Secondary outcomes are symptoms of anxiety , satisfaction with life , mastery , reminiscence styles , quality of life , and health care costs . An additional result of this study is the insight into the working elements of the course , provided by the qualitative study . The qualitative data , mainly based on 20 open-ended interviews with participants , are to be analyzed with an emphasis on newly emerging insight . Discussion This study will add to the existing scientific knowledge in several ways , especially by also including an economic evaluation and a qualitative study to gain insight into the working mechanisms of the course , both rather new in the field of life review . Positive results of this study will make an evidence -based intervention to improve public health among older people available . Trial registration Current Controlled Trials Ltd , IS RCT OBJECTIVES : To evaluate the effectiveness of a home visiting program on health-related measures in a population of older people with poor health status . DESIGN : R and omized , clinical trial . SETTING : Community-dwelling citizens in the Netherl and s. PARTICIPANTS : Three hundred thirty people aged 70 to 84 r and omly assigned to an intervention group ( n=160 ) or a control group ( n=170 ) . INTERVENTION : Eight home visits , lasting 1 hour or more , with telephone follow-up , over an 18-month period , conducted by experienced home nurses under supervision of a public health nurse ; key elements of the ( systematic ) visits were assessment of health problems and risks , advice , and referral to professional and community services . MEASUREMENTS : Self-rated health , functional status , quality of life , and changes in self-reported problems . RESULTS : No differences were found between the intervention and control group in these and other outcome measures at the end of the intervention Abstract Objectives : To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives . Design : R and omised controlled trial with six month follow up . Setting : Recruitment in a university teaching hospital and care provided in women 's homes . Participants : 623 postnatal women allocated at r and om to intervention ( 311 ) or control ( 312 ) group . Intervention : Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker . Main outcome measure : General health status as measured by the SF-36 and risk of postnatal depression . Breast feeding rates , satisfaction with care , use of services , and personal costs . Results : At six weeks there was no significant improvement in health status among the women in the intervention group . At six weeks the mean total NHS costs were £ 635 for the intervention group and £ 456 for the control group ( P=0.001 ) . At six months figures were £ 815 and £ 639 ( P=0.001 ) . There were no differences between the groups in use of social services or personal costs . The women in the intervention group were very satisfied with the support worker visits . Conclusions : There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36 . There were no savings to the NHS over six months after the introduction of the community postnatal support worker service Study objective : To evaluate the effect of two forms of postnatal social support for disadvantaged inner city mothers on  maternal and child health outcomes . Design : R and omised controlled trial with economic and process evaluations and follow up at 12 and 18 months . The two intervention groups received either the offer of a year of monthly supportive listening home visits by a support health visitor ( SHV ) , or a year of support from community groups providing drop in sessions , home visiting and /or telephone support ( CGS ) . Each was compared with a control group that received st and ard health visitor services . Setting : Two disadvantaged boroughs of London , United Kingdom . Participants : 731 women from culturally diverse background s with infants . Main results : At 12 and 18 months , there was little impact for either intervention on the main outcomes : child injury ( SHV : relative risk 0.99 ; 95 % confidence intervals 0.68 to 1.45 , CGS : 0.91 ; 0.61 to1.36 ) , maternal smoking ( SHV : 0.86 ; 0.62 to 1.19 , CGS : 0.97 ; 0.72 to 1.33 ) or maternal depression ( SHV : 0.86 ; 0.62 to1.19 , CGS : 0.93 ; 0.69 to 1.27 ) . SHV women had different patterns of health service use ( with fewer taking their children to the GP ) and had less anxious experiences of motherhood than control women . User satisfaction with the SHV intervention was high . Uptake of the CGS intervention was low : 19 % , compared with 94 % for the SHV intervention . Conclusions : There was no evidence of impact on the primary outcomes of either intervention among this culturally diverse population . The SHV intervention was associated with improvement in some of the secondary outcomes Background : The impact of depression on the workplace has been widely observed in studies examining absenteeism and reduced productivity during days at work . However , there is little scientific evidence about whether depression interventions are cost-beneficial to employers . Objective : We construct a cost – benefit analysis of depression treatment under different workplace assumptions better reflecting the nature of employment . Research Design : Data from a r and omized controlled trial in which employed primary care patients with depression were treated in practice s r and omly assigned to an enhanced treatment intervention or usual care were used to construct a cost – benefit model from an employer perspective under different assumptions regarding employment . Subjects : A national sample of 198 workers employed in a range of positions by companies was studied . Measures : Benefits included self-reported productivity and absenteeism ; costs included intervention and treatment costs . Net benefit was calculated under different scenarios and return on investment ( ROI ) is derived . Results : Enhanced depression treatment result ed in an average net benefit to the employer of $ 30 per participating worker in Year 1 of the intervention and $ 257 per participating worker in Year 2 , for an estimated ROI during the 2-year period of 302 % . ROI increased in firms that rely on team production , hire more costly substitute labor , or realize penalties for output shortfalls . ROI decreased in firms that have a large fraction of employees with dependent coverage and experience high turnover rates . Results also are sensitive to how subjectively reported productivity is valued . Conclusion : Many employers will receive a potentially significant ROI from depression treatment models that improve absenteeism and productivity at work Childhood psychological conditions including depression and substance abuse are a growing concern among American children , but their long-term economic costs are unknown . This paper uses unique data from the US Panel Study of Income Dynamics ( PSID ) following groups of siblings and their parents for up to 40 years prospect ively collecting information on education , income , work  , and marriage . Following siblings offers an opportunity to control for unobserved family and neighborhood effects . A retrospective child health history design ed by the author was placed into the 2007 PSID wave measuring whether respondents had any of 14 childhood physical illnesses or suffered from depression , substance abuse , or other psychological conditions . Large effects are found on the ability of affected children to work and earn as adults . Educational accomplishments are diminished , and adult family incomes are reduced by 20 % or $ 10,400 per year with $ 18,000 less family household assets . Lost income is partly a consequence of seven fewer weeks worked per year . There is also an 11 % point lower probability of being married . Controlling for physical childhood diseases shows that these effects are not due to the co-existence of psychological and physical diseases , and estimates controlling for within-sibling differences demonstrate that these effects are not due to unobserved common family differences . The long-term economic damages of childhood psychological problems are large-a lifetime cost in lost family income of approximately $ 300,000 , and total lifetime economic cost for all those affected of 2.1 trillion dollars Objective To investigate the cost effectiveness of a parenting programme . Design An incremental cost effectiveness analysis alongside a pragmatic r and omised controlled trial of the effectiveness of a group parenting programme delivered through Sure Start in the community . Setting Sure Start areas in north and mid Wales . Participants Parents of 116 children aged 36 - 59 months ( 87 % of the clinical sample ) at risk of developing conduct disorders defined by scoring over the clinical cut off on the Eyberg child behaviour inventory ) . Children were identified by health visitors and recruited by the research team . Intervention The Webster-Stratton Incredible Years basic parenting programme or a six month waiting list control . Main outcome measure Incremental cost per unit of improvement on the intensity score of the Eyberg child behaviour inventory . Results The bootstrapped incremental cost effectiveness ratio point estimate was � 73 ( € 109 , $ 142 ) per one point improvement on the intensity score ( 95 % confidence interval � 42 to � 140 ) . It would cost � 5486 ( € 8190 , $ 10 666 ) to bring the child with the highest intensity score to below the clinical cut-off point and � 1344 ( € 2006 , $ 2618 ) to bring the average child in the intervention group within the non- clinical limits on the intensity score ( below 127 ) . For a ceiling ratio of � 100 ( € 149 , $ 194 ) per point increase in intensity score , there is an 83.9 % chance of the intervention being cost effective . The mean cost per child attending the parenting group was � 1934 ( € 2887 , $ 3760 ) for eight children and � 1289 ( € 1924 , $ 2506 ) for 12 children , including initial costs and material s for training group leaders . When we categorised the sample into relatively mild , moderate , and severe behaviour groups based on intensity scores at baseline the intervention seemed more cost effective in those with the highest risk of developing conduct disorder . Conclusion This parenting programme improves child behaviour as measured by the intensity score of the Eyberg child behaviour inventory at a relatively low cost and was cost effective  compared with the waiting list control . This parenting programme involves modest costs and demonstrates strong clinical effect , suggesting it would represent good value for money for public spending BACKGROUND Parenting programs have been shown to work when delivered to motivated ethnic majority parents in demonstration projects , but comparatively little is known about their impact when delivered to high-risk , multi-ethnic population s by routine local services . METHODS The Primary Age Learning Skills ( PALS ) trial was a r and omized controlled trial of an evidence -based parenting-group program that targeted the parent-child relationship and child literacy . Parents of 174 children were selected from a population of 672 5- and 6-year-olds attending four primary schools in a high-risk , ethnically diverse , inner-city area . Eighty-eight children were allocated to the Incredible Years preventive program plus a shortened six-week version of the SPOKES literacy program , delivered by local services ; 86 to usual community services ; 152/174 ( 87 % ) of families were successfully followed up . Parent-child relationship quality and child behavior were measured using direct observation and parent interview ; child reading was assessed psychometrically . RESULTS Two-thirds ( 58/89 ) of those offered the parenting program attended at least one session , with similar enrollment rates across the Black African , African-Caribbean , White-British and Other ethnic groups . Mean attendance was four relationship-building sessions and one literacy-development session . Satisfaction question naires were completed by 43/58 starters ; 93 % said they were well or extremely satisfied , with equally high rates across ethnic groups . At follow-up after one year , those allocated to the intervention showed significant improvements in the parent-child relationship on observation and at interview compared to controls ; effects were similar across all ethnic groups . However , child behavior problems and reading did not improve . The cost was £ 1,343 ( $ 2,100 ) per child . CONCLUSIONS Programs can be organized to be engaging and effective in improving parenting among high-risk , multi-ethnic communities , which is of considerable value . To also be cost-effective in achieving child changes may require a set-up that enables parents to attend more sessions and /or an exclusive focus on children with clinical ly significant behavior problems CONTEXT Home-visitation services have been promoted as a means of improving maternal and child health and functioning . However , long-term effects have not been examined . OBJECTIVE To examine the long-term effects of a program of prenatal and early childhood home visitation by nurses on women 's life course and child abuse and neglect . DESIGN R and omized trial . SETTING Semirural community in New York . PARTICIPANTS Of 400 consecutive pregnant women with no previous live births enrolled , 324 participated in a follow-up study when their children were 15 years old . INTERVENTION Families received a mean of 9 home visits during pregnancy and 23 home visits from the child 's birth through the second birthday . DATA SOURCES AND MEASURES : Women 's use of welfare and number of subsequent children were based on self-report ; their arrests and convictions were based on self-report and archived data from New York State . Verified reports of child abuse and neglect were abstract ed from state records . MAIN RESULTS During the 15-year period after the birth of their first child , in contrast to women in the comparison group , women who were visited by nurses during pregnancy and infancy were identified as perpetrators of child abuse and neglect in 0.29 vs 0.54 verified reports ( P<.001 ) . Among women who were unmarried and from households of low socioeconomic status at initial enrollment , in contrast to those in the comparison group , nurse-visited women had 1.3 vs 1.6 subsequent births ( P=.02 ) , 65 vs 37 months between the birth of the first and a second child ( P=.001 ) , 60 vs 90 months ' receiving Aid to Families With Dependent Children ( P=.005 ) , 0.41 vs 0.73 behavioral impairments due to use of alcohol and other drugs ( P=.03 ) , 0.18 vs 0.58 arrests by self-report ( P<.001 ) , and 0.16 vs 0.90 arrests disclosed by New York State records ( P<.001 ) . CONCLUSIONS This program of prenatal and early childhood home visitation by nurses can reduce the number of subsequent pregnancies , the use of welfare , child abuse and neglect , and criminal behavior on the part of low-income , unmarried mothers for up to 15 years after the birth of the first child Background Despite a growing underst and ing of the effectiveness of bereavement interventions and the groups that benefit most from them , we know little about the cost-effectiveness of bereavement interventions . Methods We conducted a cost-utility analysis alongside a r and omized clinical trial on a visiting service for older widowed individuals ( n = 110 ) versus care as usual ( CAU ; n = 106 ) .  The visiting service is a selective bereavement intervention that offers social support to lonely widows and widowers by a trained volunteer . Participants were contacted 6–9 months post-loss . Eleven percent of all contacted persons responded and eight percent participated in the trial . The primary outcome measure was quality adjusted life years ( QALYs ) gained ( assessed with the EQ-5D ) , which is a generic measure of health status . Costs were calculated from a societal perspective excluding costs arising from productivity losses . Using the bootstrap method , we obtained the incremental cost utility ratio ( ICUR ) , projected these on a cost-utility plane and presented as an acceptability curve . Results Overall , the experimental group demonstrated slightly better results against slightly higher costs . Whether the visiting service is acceptable depends on the willingness to pay : at a willingness to pay equal to zero per QALY gained , the visiting service has a probability of 31 % of being acceptable ; beyond € 20,000 , the visiting service has a probability of 70 % of being more acceptable than CAU . ConclusionS elective bereavement interventions like the visiting service will not produce large benefits from the health economic point of view , when targeted towards the entire population of all widowed individuals . We recommend that in depth analyses are conducted to identify who benefits most from this kind of interventions , and in what subgroups the incremental cost-utility is best . In the future bereavement interventions are then best directed to these groups . Trial registration Controlled trials IS RCT OBJECTIVE To examine the long-term effects of an intervention combining teacher training , parent education , and social competence training for children during the elementary grade s on adolescent health-risk behaviors at age 18 years . DESIGN Nonr and omized controlled trial with follow-up 6 years after intervention . SETTING Public elementary schools serving high-crime areas in Seattle , Wash. PARTICIPANTS Of the fifth- grade students enrolled in participating schools , 643 ( 76 % ) were given written parental consent for the longitudinal study and 598 ( 93 % ) were followed up and interviewed at age 18 years . INTERVENTIONS A full intervention provided in grade s 1 through 6 of 5 days of in-service training for teachers each intervention year , developmentally appropriate parenting classes offered to parents when children were in grade s 1 through 3 and 5 through 6 , and developmentally adjusted social competence training for children in grade s 1 and 6 . A late intervention , provided in grade s 5 and 6 only , paralleled the full intervention at these grade s. MAIN OUTCOME MEASURES Self-reported violent and nonviolent crime , substance use , sexual activity , pregnancy , bonding to school , school achievement , grade repetition and school dropout , suspension and /or expulsion , and school misbehavior ; delinquency charges from court records ; grade point average ; California Achievement Test scores : and disciplinary action reports from school records . RESULTS Fewer students receiving full intervention than control students reported violent delinquent acts ( 48.3 % vs 59.7 % ; P=.04 ) , heavy drinking ( 15.4 % vs 25.6 % ; P=.04 ) , sexual intercourse ( 72.1 % vs 83.0 % ; P=.02 ) , having multiple sex partners ( 49.7 % vs 61.5 % ; P=.04 ) , and pregnancy or causing pregnancy ( 17.1 % vs 26.4 % ; P=.06 ) by age 18 years . The full intervention student group reported more commitment ( P=.03 ) and attachment ( P=.006 ) to school , better academic achievement ( P=.01 ) , and less school misbehavior ( P=.02 ) than control students . Late intervention in grade s 5 and 6 only did not significantly affect health-risk behaviors in adolescence . CONCLUSIONS A package of interventions with teachers , parents , and children provided throughout the elementary grade s can have enduring effects in reducing violent behavior , heavy drinking , and sexual intercourse by age 18 years among multiethnic urban children . Results are consistent with the theoretical model guiding the intervention and support efforts to reduce health-risk behaviors through universal interventions in selected communities or schools serving high-crime neighborhoods OBJECTIVE To examine the effectiveness of home visiting by paraprofessionals and by nurses as separate means of improving maternal and child health when both types of visitors are trained in a program model that has demonstrated effectiveness when delivered by nurses . METHODS A r and omized , controlled trial was conducted in public- and private-care setting s in Denver , Colorado . One thous and one hundred seventy-eight consecutive pregnant women with no previous live births who were eligible for Medicaid or who had no private health insurance were invited to participate . Seven hundred thirty-five women were r and omized to control , paraprofessional , or nurse conditions . Nurses completed an average of 6.5 home visits during pregnancy and 21 visits from birth to the children 's second birthdays . Paraprofessionals completed an average of 6.3 home visits during pregnancy and 16 visits from birth to the children 's second birthdays . The main outcomes consisted of changes in women 's urine cotinine over the course of pregnancy ; women 's use of ancillary services during pregnancy ; subsequent pregnancies and births , educational achievement , workforce participation , and use of welfare ; mother-infant responsive interaction ; families ' home environments ; infants ' emotional vulnerability in response to fear stimuli and low emotional vitality in response to joy and anger stimuli ; and children 's language and mental development , temperament , and behavioral problems . RESULTS Paraprofessional-visited mother-child pairs in which the mother had low psychological re sources interacted with one another more responsively than their control-group counterparts ( 99.45 vs 97.54 st and ard score points ) . There were no other statistically significant paraprofessional effects . In contrast to their control-group counterparts , nurse-visited smokers had greater reductions in cotinine levels from intake to the end of pregnancy ( 259.0 vs 12.32 ng/mL ) ; by the study child 's second birthday , women visited by nurses had fewer subsequent pregnancies ( 29 % vs 41 % ) and births ( 12 % vs 19 % ) ; they delayed subsequent pregnancies for longer intervals ; and during the second year after the birth of their first child , they worked more than women in the control group ( 6.83 vs 5.65 months ) . Nurse-visited mother-child pairs interacted with one another more responsively than those in the control group ( 100.31 vs 98.99 st and ard score points ) . At 6 months of age , nurse-visited infants , in contrast to their control-group counterparts , were less likely to exhibit emotional vulnerability in response to fear stimuli ( 16 % vs 25 % ) and nurse-visited infants born to women with low psychological re sources were less likely to exhibit low emotional vitality in response to joy and anger stimuli ( 24 % vs 40 % and 13 % vs 33 % ) . At 21 months , nurse-visited children born to women with low psychological re sources were less likely to exhibit language delays ( 7 % vs 18 % ) ; and at 24 months , they exhibited superior mental development ( 90.18 vs 86.20 Mental Development Index scores ) than their control-group counterparts . There were no statistically significant program effects for the nurses on  women 's  use of ancillary prenatal services , educational achievement , use of welfare , or their children 's temperament or behavior problems . For most outcomes on which either visitor produced significant effects , the paraprofessionals typically had effects that were about half the size of those produced by nurses . CONCLUSIONS When trained in a model program of prenatal and infancy home visiting , paraprofessionals produced small effects that rarely achieved statistical or clinical significance ; the absence of statistical significance for some outcomes is probably attributable to limited statistical power to detect small effects . Nurses produced significant effects on a wide range of maternal and child outcomes Background Preventive interventions are developed for children of parents with mental and substance use disorders ( COPMI ) , because these children have a higher risk of developing a psychological or behavioral disorder in the future . Mental health and substance use disorders contribute significantly to the global burden of disease . Although the exact number of parents with a mental illness is unclear , the subject of mentally ill parents is gaining attention . Moreover there is a lack of interventions for COPMI-children , as well of ( cost- ) effectiveness studies evaluating COPMI interventions . Innovative interventions such as e-health provide a new field for exploration . There is no knowledge about the opportunities for using the internet to prevent problems in children at risk . In the current study we will focus on the ( cost- ) effectiveness of an online health prevention program for COPMI-children . Methods / Design We design ed a r and omized controlled trial to examine the ( cost- ) effectiveness of the  Kopstoring intervention . Kopstoring is an online intervention for COPMI-children to strengthen their coping skills and prevent behavioral and psychological problems . We will compare the Kopstoring intervention with ( waiting list ) care as usual . This trial will be conducted entirely over the internet . An economic evaluation , from a societal perspective will be conducted , to examine the trial 's cost-effectiveness . Power calculations show that 214 participants are needed , aged 16 - 25 . Possible participants will be recruited via media announcements and banners on the internet . After screening and completing informed consent procedures , participants will be r and omized . The main outcome is internalizing and externalizing symptoms as measured by the Youth Self Report . For the economic evaluation , healthcare costs and costs outside the healthcare sector will be measured at the same time as the clinical measures , at baseline , 3 , 6 and 9 months . An extended measure for the intervention group will be provided at 12 months , to examine the long-term effects . In addition , a process evaluation will be conducted . Discussion Recent developments , such as international conferences and policy discussion s , show the pressing need to study the ( cost- ) effectiveness of interventions for vulnerable groups of children . This study will shed light on the ( cost- ) effectiveness of an online preventive intervention . Trial registration OBJECTIVE To examine the long-term effects of the Seattle Social Development Project intervention in promoting positive adult functioning and preventing mental health problems , crime , and substance use ( including tobacco , alcohol , and other drugs ) at 21 years of age . DESIGN This nonr and omized controlled trial followed up participants to 21 years of age , 9 years after the intervention ended . We compared the following 3 intervention conditions : a full 6-year intervention ( grade s 1 through 6 ) ; a late 2-year intervention ( grade s 5 and 6 only ) ; and a no-treatment control condition . SETTING Eighteen public elementary schools serving diverse neighborhoods , including high-crime neighborhoods , of Seattle , Wash. PARTICIPANTS A sex-balanced , multiethnic sample of 605 participants across the 3 conditions who completed interviews at 21 years of age ( 94 % of the original sample in these conditions ) . INTERVENTIONS Teacher training in classroom instruction and management , child social and emotional skill development , and parent training . MAIN OUTCOME MEASURES Self-reports of functioning in school and work , emotional and mental health , and crime and substance use at 21 years of age and official court records . RESULTS Broad significant effects on functioning in school and work and on emotional and mental health were found . Fewer significant effects on crime and substance use were found at 21 years of age . Most outcomes had a consistent dose effect , with the strongest effects in subjects in the full-intervention group and effects in the late-intervention group between those in the full-intervention and control groups . CONCLUSIONS A theory-guided preventive intervention that strengthened teaching and parenting practice s and taught children interpersonal skills during the elementary grade s had wide-ranging beneficial effects on functioning in early adulthood Background Sub-optimal parenting is a common risk factor for a wide range of negative health , social and educational outcomes . Most parenting programmes have been developed in the USA in the context of delinquency prevention for targeted or indicated groups and the main theoretical underpinning for these programmes is behaviour management . The Family Links Nurturing Programme ( FLNP ) focuses on family relationships as well as behaviour management and is offered on a universal basis . As a result it may be better placed to improve health and educational outcomes . Developed in the UK voluntary sector , FLNP is popular with practitioners , has impressed policy makers throughout the UK , has been found to be effective in before/after and qualitative studies , but lacks a r and omised controlled trial ( RCT ) evidence base . Methods / Design A multi-centre , investigator blind , r and omised controlled trial of the FLNP with a target sample of 288 south Wales families who have a child aged 2 - 4 yrs living in or near to Flying Start/Sure Start areas . Changes in parenting , parent child relations and parent and child wellbeing are assessed with vali date d measures immediately and at 6 months post intervention . Economic components include cost consequences and cost utility analyses based on parental ranking of states of quality of life . Attendance and completion rates and fidelity to the FLNP course delivery are assessed . A nested qualitative study will assess reasons for participation and non-participation and the perceived value of the programme to families . By the end of May 2010 , 287 families have been recruited into the trial across four areas of south Wales . Recruitment has not met the planned timescales with barriers including professional anxiety about families entering the control arm of the trial , family concern about video and audio recording , programme facilitator concern about the recording of FLNP sessions for fidelity purpose s and delays due to the new UK research governance procedures . Discussion Whilst there are strong theoretical arguments to support universal provision of parenting programmes , few universal programmes have been subjected to r and omised controlled trials . In this paper we describe a RCT protocol with quantitative and qualitative outcome measures and an economic evaluation design ed to provide clear evidence with regard to effectiveness and costs . We describe challenges implementing the protocol and how we are addressing these . Trial Registration Current Controlled Trials IS RCT BACKGROUND Sickness absence often occurs in patients with emotional distress or minor mental disorders . In several European countries , these patients are over-represented among those receiving illness benefits , and interventions are needed . The aim of this study was to evaluate the cost-effectiveness of an intervention conducted by social workers , design ed to reduce sick leave duration in patients absent from work owing to emotional distress or minor mental disorders . METHODS In this R and omized Controlled Trial , patients were recruited by GPs . The intervention group ( N = 98 ) received an activating , structured treatment by social workers , the  control group ( N = 96 ) received routine GP care .  Sick leave duration , clinical symptoms , and medical consumption ( consumption of medical staffs ' time as well as consumption of drugs ) were measured at baseline and 3 , 6 , and 18 months later . RESULTS Neither for sick leave duration nor for clinical improvement over time were significant differences found between the groups . Also the associated costs were not significantly lower in the intervention group . CONCLUSIONS Compared with usual GP care , the activating social work intervention was not superior in reducing sick leave duration , improving clinical symptoms , and decreasing medical consumption . It was also not cost-effective compared with GP routine care in the treatment of minor mental disorders . Therefore , further implementation of the intervention is not justified . Potentially , programmes aim ed at reducing sick leave duration in patients with minor mental disorders carried out closer to the workplace ( e.g. by occupational physicians ) are more successful than programmes in primary care Objective : To assess the cost effectiveness of a community based exercise programme as a population wide public health intervention for older adults . Design : Pragmatic , cluster r and omised community intervention trial . Setting : 12 general practice s in Sheffield ; four r and omly selected as intervention population s , and eight as control population s. Participants : All those aged 65 and over in the least active four fifths of the population responding to a baseline survey . There were 2283 eligible participants from intervention practice s and 4137 from control practice s. Intervention : Eligible subjects were invited to free locally held exercise classes , made available for two years . Main outcome measures : All cause and exercise related cause specific mortality and hospital service use at two years , and health status assessed at baseline , one , and two years using the SF-36 . A cost utility analysis was also undertaken . Results : Twenty six per cent of the eligible intervention practice population attended one or more  exercise sessions  . There were no significant differences in mortality rates , survival times , or admissions . After adjusting for baseline characteristics , patients in intervention practice s had a lower decline in health status , although this reached significance only for the energy dimension and two composite scores ( p<0.05 ) . The incremental average QALY gain of 0.011 per person in the intervention population result ed in an incremental cost per QALY ratio of € 17 174 ( 95 % CI = € 8300 to € 87 120 ) . Conclusions : Despite a low level of adherence to the exercise programme , there were significant gains in health related quality of life . The programme was more cost effective than many existing medical interventions , and would be practical for primary care commissioning agencies to implement Background Conduct problems are common , disabling and costly . The prognosis for children with conduct problems is poor , with outcomes in adulthood including criminal behaviour , alcoholism , drug abuse , domestic violence , child abuse and a range of psychiatric disorders . There has been a rapid expansion of group based parent-training programmes for the treatment of children with conduct problems  in a number of countries over the past 10 years . Existing review s of parent training have method ological limitations such as inclusion of non-r and omised studies , the absence of investigation for heterogeneity prior to meta- analysis or failure to report confidence intervals . The objective of the current study was to systematic ally review r and omised controlled trials of parenting programmes for the treatment of children with conduct problems .  Methods St and ard systematic review methods were followed including duplicate inclusion decisions , data extraction and quality assessment . Twenty electronic data bases from the fields of medicine , psychology , social science and education were comprehensively search ed for RCTs and systematic review s to February 2006 . Inclusion criteria were : r and omised controlled trial ; of structured , repeatable parenting programmes ; for parents/carers of children up to the age of 18 with a conduct problem ; and at least one measure of child behaviour . Meta- analysis and qualitative synthesis were used to summarise included studies . Results 57 RCTs were included . Studies were small with an average group size of 21 . Meta-analyses using both parent ( SMD -0.67 ; 95 % CI : -0.91 , -0.42 ) and independent ( SMD -0.44 ; 95 % CI : -0.66 , -0.23 ) reports of outcome showed significant differences favouring the intervention group . There was insufficient evidence to determine the relative effectiveness of different approaches to delivering parenting programmes . Conclusion Parenting programmes are an effective treatment for children with conduct problems . The relative effectiveness of different parenting programmes requires further research Background Dementia is a major public health problem with enormous costs to society and major consequences for both patients and their relatives . Family members of persons with dementia provide much of the care for older adults with dementia in the community . Caring for a demented relative is not easy and fraught with emotional strain , distress , and physical exhaustion . Family caregivers of dementia patients have an extremely high risk developing affective disorders such as major depression and anxiety disorder . Family meetings appear to be among the most powerful psychosocial interventions to reduce depression in caregivers . An American l and mark study reported substantial beneficial effects of a multifaceted intervention where family meetings had a central place on depression in family caregivers as well as on delay of institutionalization of patients . These effects were not replicated in other countries yet . We perform the first trial comparing only structured family meetings with significant others versus usual care among primary family caregivers of community dwelling demented patients and measure the effectiveness on both depression and anxiety in the primary caregiver , both on disorder and symptom levels . Methods / design In this r and omized controlled trial effectiveness as well as cost-effectiveness of family meetings is evaluated . The intervention group receives  four family meetings with family and close friends of the primary family caregiver of a community dwelling patient with a clinical diagnosis of dementia . Dyads of patients and their primary caregiver are followed up to one year after baseline assessment . The main outcome measures are the incidence of anxiety and depressive disorders assessed with the Mini-International Neuropsychiatric Interview ( MINI ) and the severity of anxiety and depressive symptoms in caregivers is measured by vali date d self report instruments : the Centre for Epidemiologic Studies Depression Scale ( CES-D ) for depression and the anxiety scales of the Hospital Anxiety and Depression scales ( HADS ) for anxiety . The economic evaluation is performed from a societal perspective . Discussion By evaluating the effectiveness of only structured family meetings organized in the Netherl and s , this study will contribute to the existing literature about the value of psychosocial interventions for dementia caregivers . Trial registration Dutch Trial Registry IS RCT OBJECTIVE Research demonstrates that interventions targeting multiple setting s within a child 's life are more effective in treating or preventing conduct disorder . One such program is the Incredible Years Series , which comprises three treatment components , each focused on a different context and type of daily social interaction that a child encounters . This article explores the cost-effectiveness of stacking multiple intervention components versus delivering single intervention components . METHOD The data involved 459 children , ages 3 to 8 , who participated in clinical trials of the Incredible Years Series . Children r and omized to one of six treatment conditions received one or more of the three following program components : a child-based program , a parent training program , and a teacher-based program instructing teachers in classroom management and in the delivery of a classroom-based social skills curriculum . RESULTS Per-child treatment costs and child behavior outcomes ( observer and teacher reported ) were used to generate cost-effectiveness acceptability curves ; results suggest that stacking intervention components is likely cost-effective , at least for willingness to pay above $ 3,000 per child treated . CONCLUSIONS Economic data may be used to compare competing intervention formats . In the case of this program , providing multiple intervention components was cost-effective A significant percentage of children with disruptive behavior disorders do not receive mental health assistance . Utilization is lowest among groups whose children are at greatest risk . To increase the availability , accessibility , and cost efficacy of parent training programs , this prospect i ve r and omized trial compared a large group community-based parent training program to a clinic-based individual parent training ( PT ) programs .  All families of junior kindergartners in the Hamilton public and separate school boards were sent a checklist regarding problems at home . Those returning question naires above the 90th percentile were block r and omly assigned to : ( 1 ) a 12-week clinic-based individual parent training ( Clinic/Individual ) , ( 2 ) a 12-week community-based large group parent training ( Community/Group ) , or ( 3 ) a waiting list control condition .  Immigrant families , those using English as a second language , and parents of children with severe behaviour problems were significantly more likely to enroll in Community/Groups than Clinic/Individual PT . Parents in Community/Groups reported greater improvements in behaviour problems at home and better maintenance of these gains at 6-month follow-up . A cost analysis showed that , with groups of 18 families , Community/Groups are more than six times as cost effective as Clinic/Individual programs Objectives : To evaluate the effectiveness and cost effectiveness of an intensive home visiting programme in improving outcomes for vulnerable families . Design : Multicentre r and omised controlled trial in which eligible women were allocated to receive home visiting  ( n = 67 ) or  st and ard services ( n = 64 ) . Incremental cost analysis . Setting : 40 general practitioner practice s across 2 counties in the UK . Participants : 131 vulnerable pregnant women . Intervention : Selected health visitors were trained in the Family Partnership Model to provide a weekly home visiting service from 6 months antenatally to 12 months postnatally . Main outcome measures : Mother – child interaction , maternal psychological health attitudes and behaviour , infant functioning and development , and risk of neglect or abuse . Results : At 12 months , differences favouring the home-visited group were observed on an independent assessment of maternal sensitivity ( p<0.04 ) and infant cooperativeness ( p<0.02 ) . No differences were identified on any other measures . A non-significant increase in the likelihood of intervention group infants being the subject of child protection proceedings , or being removed from the home , and one death in the control group were found . The mean incremental cost per infant of the home visiting intervention was £ 3246 ( bootstrapped 95 % CI for the difference £ 1645–4803 ) . Conclusion : This intervention may have the potential to improve parenting and increase the identification of infants at risk of abuse and neglect in vulnerable families . Further investigation is needed , along with long-term follow-up to assess possible sleeper effects Objective The purpose of this study was to determine if a novel workplace stress management program , delivered either face-to-face or by self-help , would reduce  illness and health services utilization among participants . Methods Five hundred one volunteers were r and omly allocated to one of three groups : full intervention , which received assessment and personalized self- study feedback and was offered six face-to-face , small-group sessions ; partial intervention , a self-help group that received assessment and personalized feedback by mail ; and a wait-list control group . All participants completed question naires for stress , anxiety , and coping at the start of the study and 6 and 12 months later . Health reports were completed at 0 , 3 , 6 , 9 , and 12 months . A sub sample of subjects who subscribed to a single health maintenance organization provided objective ly recorded doctor visit data across the study year . Results All three groups reported significant improvement in their stress , anxiety , and coping across the year . Full intervention participants showed a more rapid reduction in negative responses to stress than did participants from the other groups . Full-intervention subjects also reported fewer days of illness than subjects in the other groups . Objective ly measured physician visits showed a large ( 34 % ) reduction in healthcare utilization for full intervention subjects in the HMO sub sample . Conclusions These results indicated that a work-site program that focuses on stress , anxiety , and coping measurement along with small-group educational intervention can significantly reduce illness and healthcare utilization A completed series of reports on a r and omized trial ( N=400 ) indicated that , in contrast to comparison services , prenatal and infancy nurse home visitation improved a wide range of maternal and child health outcomes among poor , unmarried , and teenaged women bearing first children in a semirural county in upstate New York . Eighty-nine percent of the sample was white , and all analyses focused on this group . In this article , an analysis of the net cost of the home-visitation program from the perspective of government spending is presented . The average per-family cost of the program in 1980 dollars was $ 3,246 for the sample as a whole , and $ 3,133 for low-income families . Treatment differences in government expenditures for Aid to Families with Dependent Children , Food Stamps , Medicaid , and Child Protective Services , minus tax revenues due to maternal employment ( also expressed in 1980 dollars ) , were conceived as government savings . By the time the children were 4 years of age , government savings were $ 1,772 ( 95 % confidence interval [ CI ] : -$557 , $ 4,102 ) for the sample as a whole , and $ 3,498 ( 95 % CI : $ 569 , $ 6,427 ) for low-income families . Within 2 years after the program ended , after discounting , the net cost of the program ( program costs minus savings ) for the sample as a whole was $ 1,582 per family . For low-income families , the cost of the program was recovered with a dividend of $ 180 per family Objectives : To determine whether a community-delivered intervention targeting infant sleep problems  improves  infant sleep and maternal well-being and to report the costs of this approach to the healthcare system . Design : Cluster r and omised trial . Setting : 49 Maternal and Child Health ( MCH ) centres ( clusters ) in Melbourne , Australia . Participants : 328 mothers reporting an infant sleep problem at 7 months recruited during October – November 2003 . Intervention : Behavioural strategies delivered over individual structured MCH consultations versus usual care . Main outcome measures : Maternal report of infant sleep problem , depression symptoms ( Edinburgh Postnatal Depression Scale ( EPDS ) ) , and SF-12 mental and physical health scores when infants were 10 and 12 months old . Costs included MCH sleep consultations , other healthcare services and intervention costs . Results : Prevalence of infant sleep problems was lower in the intervention than control group at 10 months ( 56 % vs 68 % ; adjusted OR 0.58 ( 95 % CI : 0.36 to 0.94 ) ) and 12 months ( 39 % vs 55 % ; adjusted OR 0.50 ( 0.31 to 0.80 ) ) . EPDS scores indicated less depression at 10 months ( adjusted mean difference −1.4 ( −2.3 to −0.4 ) and 12 months ( −1.7 ( −2.6 to −0.7 ) ) . SF-12 mental health scores indicated better health at 10 months ( adjusted mean difference 3.7 ( 1.5 to 5.8 ) ) and 12 months ( 3.9 ( 1.8 to 6.1 ) ) . Total mean costs including intervention design , delivery and use of non-MCH nurse services were £ 96.93 and £ 116.79 per intervention and control family , respectively . Conclusions : Implementing this sleep intervention may lead to health gains for infants and mothers and re source savings for the healthcare system . Trial registration : Current Controlled Trial Registry , number IS RCT N48752250 ( registered November 2004 ) BACKGROUND Home visiting programs have been developed to improve the functional abilities of older people and subsequently to reduce the use of institutional care services . The results of trials have been inconsistent and their cost-effectiveness uncertain . Home visits for a high-risk population rather than the general population seems a promising approach . We therefore studied the effects of a home visiting program for older people with poor health . This article describes the effects on health care use and associated cost . METHODS We conducted a r and omized clinical trial among 330 community-dwelling citizens , aged 70 - 84 years , in the Netherl and s. Participants in the intervention group ( n = 160 ) received eight home visits by a trained home nurse over an 18-month period ; a multidimensional geriatric assessment of problems was included . The main outcomes are : admissions to hospital , nursing home , and home for older persons ; contacts with medical specialists , general practitioners , and paramedics ; and hours of home care help . The data on health care use were mostly obtained from computerized data bases of various medical administration offices ; the follow-up period was 24 months . RESULTS Inpatient and outpatient health care use was similar for both groups , with the exception of a higher distribution of aids and in-home modifications in favor of the intervention group . No differences were found between the intervention and control group in health care cost . CONCLUSION The home visiting program did not appear to have any effect on the health care use of older people with poor health and had a low chance of being cost-effective . We conclude that these visits are probably not beneficial for such persons within the health care setting in the Netherl and s or comparable setting s in other Western countries BACKGROUND Loneliness is a distressing feeling of a lack of satisfying human relationships . It is associated with poor quality of life , impaired health , and increased mortality among older individuals . The study aim was to determine the effects of new psychosocial group rehabilitation on the subjective health , use and costs of health services , and mortality of lonely older individuals . METHODS This r and omized , controlled trial was performed in seven day care centers . A total of 235 older people ( > 74 years ) suffering from loneliness participated . Intervention was implemented in 15 groups ( each with 7 - 8 participants and 2 professional group leaders ) meeting for 3 months altogether 12 times . Group intervention aim ed to empower elderly people , and to promote their peer support and social integration . Intervention was based on the effects of closed-group dynamics . The groups had the following activities according to the participants ' interests : ( a ) therapeutic writing and group psychotherapy , ( b ) group exercise and discussion s , and ( c ) art activities . Group leaders received thorough training and tutoring .  Subjective health , use and costs of health services , and mortality were measured . RESULTS At 2 years , survival was 97 % in the intervention group ( 95 % confidence interval [ CI ] , 91 - 99 ) and 90 % in the control group ( 95 % CI , 85 - 95 ) ( p = .047 ) . The intervention group showed a significant improvement in subjective health , thus result ing in significantly lower health care costs during the follow-up : the difference between the groups was -943 euro/person per y ( 95 % CI -1955 to -127 ; p = .039 ) . CONCLUSIONS Psychosocial group rehabilitation was associated with lower mortality and less use of health services OBJECTIVES To investigate outcomes for postnatal women attributed to special training for health visitors ( HVs )  in systematic ally identifying postnatal depression and delivering psychologically informed interventions , and to establish the cost-effectiveness of the intervention . DESIGN A pragmatic r and omised cluster trial with clusters allocated to experimental HV training arms or control , with an 18-month follow-up . SETTING GP practice s in the former Trent Regional Health Authority . PARTICIPANTS Women registered with participating GP practice s who became 36 weeks pregnant during the recruitment phase of the trial , had a live baby and were on a collaborating HV 's caseload for 4 months postnatally . INTERVENTION HV training in the assessment of postnatal women , combined with either cognitive behavioural approach ( CBA ) or person-centred approach ( PCA ) sessions for eligible women , plus the option of a selective serotonin reuptake inhibitor if indicated . MAIN OUTCOME MEASURES The primary outcome was the proportion of at-risk women with a 6-month Edinburgh Postnatal Depression Scale ( EPDS ) score > or = 12 . The primary comparison was between at-risk women in the combined clusters r and omised to HV training and women in practice s r and omised to provide HV usual care . The secondary comparison was to determine any differences between the proportions of women with a 6-month EPDS score > or = 12 in the CBA and PCA groups . RESULTS HVs in 101 clusters in 29 primary care trusts collaborated in the study . From 7649 eligible women 4084 ( 53.4 % ) consented to take part : 17.3 % ( 595/3449 ) of women who returned a 6-week question naire had a 6-week EPDS score > or = 12 and were at-risk women ; 70.3 % ( 418/595 ) of at-risk women had a 6-month EPDS score available . In total , 45.6 % ( 67/147 ) of control group ( CG ) at-risk women had a 6-month EPDS score > or = 12 versus 33.9 % ( 93/271 ) of intervention group ( IG ) women ( p = 0.036 ) . A total of 32.9 % ( 46/140 ) of at-risk women in the CBA group versus 35.1 % ( 46/131 ) in the PCA group had a 6-month EPDS score > or = 12 ( p = 0.74 ) . The CG mean 6-month EPDS score for at-risk women was 11.3 ( SD 5.8 ) versus 9.2 ( SD 5.4 ) for the IG ( p = 0.002 ) and this remained statistically significant after adjusting for 6-week variables ( p = 0.001 ) . In total , 16.4 % ( 150/914 ) of all women in the CG had a 6-month EPDS score > or = 12 compared with 11.7 % ( 205/1745 ) in the IG ( p = 0.003 ) . The CG mean 6-month EPDS score for all women was 6.4 ( SD 5.2 ) compared with 5.5 ( SD 4.7 ) for the IG ( p < 0.001 ) . The economic analysis results showed a consistent pattern of psychological approaches being cost-effective at funding levels used by the National Institute for Health and Clinical Excellence . CONCLUSIONS HV training was effective compared with HV usual care in reducing the proportion of at-risk women with a 6-month EPDS score > or = 12 , with a wide confidence interval for the estimated intervention effect , suggesting that the true treatment effect may be small . The effect remained for 1 year . The economic evaluation demonstrated that the HV intervention was highly likely to be cost-effective compared with the control . There was no difference in outcomes between the CBA and the PCA groups OBJECTIVES This study reports the cost-effectiveness of a preventive intervention , consisting of counseling and specific support for the mother-infant relationship , targeted at women at high risk of developing postnatal depression . METHODS A prospect i ve economic evaluation was conducted alongside a pragmatic r and omized controlled trial in which women considered at high risk of developing postnatal depression were allocated r and omly to the preventive intervention ( n = 74 ) or to routine primary care ( n = 77 ) . The primary outcome measure was the duration of postnatal depression experienced during the first 18 months postpartum . Data on health and social care use by women and their infants up to 18 months postpartum were collected , using a combination of prospect i ve diaries and face-to-face interviews , and then were combined with unit costs ( pound , year 2000 prices ) to obtain a net cost per mother-infant dyad . The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics at alternative willingness to pay thresholds held by decision makers for preventing 1 month of postnatal depression . RESULTS Women in the preventive intervention group were depressed for an average of 2.21 months ( 9.57 weeks ) during the study period , whereas women in the routine primary care group were depressed for an average of 2.70 months ( 11.71 weeks ) . The mean health and social care costs were estimated at pounds sterling 2,396.9 per mother-infant dyad in the preventive intervention group and pounds sterling 2,277.5 per mother-infant dyad in the routine primary care group , providing a mean cost difference of pounds sterling 119.5 ( bootstrap 95 percent confidence interval [ CI ] , -535.4 , 784.9 ) . At a willingness to pay threshold of pounds sterling 1,000 per month of postnatal depression avoided , the probability that the preventive intervention is cost-effective is .71 and the mean net benefit is pounds sterling 383.4 ( bootstrap 95 percent CI , - pounds sterling 863.3- pounds sterling 1,581.5 ) . CONCLUSIONS The preventive intervention is likely to be cost-effective even at relatively low willingness to pay thresholds for preventing 1 month of postnatal depression during the first 18 months postpartum . Given the negative impact of postnatal depression on later child development , further research is required that investigates the longer-term cost-effectiveness of the preventive intervention in high risk women BACKGROUND Antisocial behavior is enormously costly to the youth involved , their families , victims , taxpayers and other members of society . These costs are generated by school failure , delinquency and involvement in the juvenile justice system , drug use , health services and other services . For prevention programs to be cost effective , they must reduce these costly behaviors and outcomes . AIM The Fast Track intervention is a 10-year , multi-component prevention program targeting antisocial behavior . The intervention identified children at school entry and provided intervention services over a 10-year period . This study examined the intervention 's impact on outcomes affecting societal costs using data through late adolescence . METHODOLOGY The intervention is being evaluated through a multi-cohort , multi-site , multi-year r and omized control trial of program participants and comparable children and youth in similar schools , and that study provides the data for these analyses . Schools within four sites ( Durham , NC ; Nashville , TN ; Seattle , WA ; and rural central Pennsylvania ) were selected as high-risk based on crime and poverty statistics of the neighborhoods they served . Within each site , schools were divided into multiple sets matched for demographics ( size , percentage free/reduced lunch , ethnic composition ) ; one set within each pair was r and omly assigned to the intervention and one to the control condition . Within participating schools , high-risk children were identified using a multiple-gating procedure . For each of three annual cohorts , all kindergarteners ( 9,594 total ) in 54 schools were screened for classroom conduct problems by teachers . Those children scoring in the top 40 % within cohort and site were then solicited for the next stage of screening for home behavior problems by the parents , and 91 % agreed ( n = 3,274 ) . The teacher and parent screening scores were then st and ardized within site and combined into a sum score . These summed scores represented a total severity-of-risk screen score .  Children were selected for inclusion into the study based on this screen score , moving from the highest score downward until desired sample sizes were reached within sites , cohorts , and conditions . RESULTS AND DISCUSSION The intervention lacked both the breadth and depth of effects on costly outcomes to demonstrate cost-effectiveness or even effectiveness . LIMITATIONS The outcomes examined here reflect effects observed during measurement windows that are not complete for every outcome . Data are lacking on some potential outcomes , such as the use of mental health services before year 7 . CONCLUSION AND IMPLICATION S The most intensive psychosocial intervention ever fielded did not produce meaningful and consistent effects on costly outcomes . The lack of effects through high school suggests that the intervention will not become cost-effective as participants progress through adulthood . FUTURE RESEARCH Future research should consider alternative approaches to prevention  youth violence BACKGROUND There is an urgent need for the development of cost-effective preventive strategies to reduce the onset of mental disorders . AIMS To establish the cost-effectiveness of a stepped care preventive intervention for depression and anxiety disorders in older people at high risk of these conditions , compared with routine primary care . METHOD An economic evaluation was conducted alongside a pragmatic r and omised controlled trial ( IS RCT N26474556 ) . Consenting individuals presenting with subthreshold levels of depressive or anxiety symptoms were r and omly assigned to a preventive stepped care programme ( n = 86 ) or to routine primary care ( n = 84 ) . RESULTS The intervention was successful in halving the incidence rate of depression and anxiety at euro563 ( pound412 ) per recipient and euro4367 ( pound3196 ) per disorder-free year gained , compared with routine primary care . The latter would represent good value for money if the willingness to pay for a disorder-free year is at least euro5000 . CONCLUSIONS The prevention programme generated depression- and anxiety-free survival years in the older population at affordable cost OBJECTIVES To determine whether increased postnatal support could influence  maternal and child health outcomes . DESIGN This was a r and omised controlled trial comparing maternal and child health outcomes for women offered either of the support interventions with those for control women receiving st and ard services only . Outcome data were collected through question naires distributed 12 and 18 months postr and omisation . Process data were also collected . There was also an integral economic evaluation . SETTING AND PARTICIPANTS Women living in deprived enumeration districts in selected London boroughs were eligible for the trial if they gave birth between 1 January and 30 September 1999 . RESULTS The 731 participants were found to be well matched in terms of socio-economic characteristics and health and support variables ( 14 % of the participants were non-English speaking ) . Response rates at the two follow-up points were 90 % and 82 % . At both points there were no differences that could not be attributed to chance on the primary outcomes of maternal depression , child injury or maternal smoking . At the first follow-up , there was reduced use of general practitioners by support health visitor ( SHV ) children , but increased use of NHS health visitors and social workers by mothers . At the second follow-up , both community group support ( CGS ) and SHV mothers had less use of midwifery services ( fewer were pregnant ) , and SHV mothers were less worried about their child 's health and development . Uptake of the CGS intervention was low : 19 % , compared with 94 % for the SHV intervention . Satisfaction with the intervention among women in the SHV group was high . Based on the assumptions and conditions of the costing methods , the economic evaluation found no net economic cost or benefit of choosing either of the two interventions . CONCLUSIONS There was no evidence of impact on the primary outcomes of either intervention . The SHV intervention was popular with women , and was associated with improvement in some of the secondary outcomes . This suggests that greater emphasis on the social support role of health visitors could improve some measures of family well-being . Possible areas for future research include a systematic review of social support and its effect on health ; developing and testing other postnatal models of support that match more closely the age of the baby and the changing patterns of mothers ' needs ; evaluating other strategies for mobilising ' non-professional ' support ; developing and testing more culturally specific support interventions ; developing more culturally appropriate st and ardised measures of health outcomes ; providing longer term follow-up of social support interventions ; and exploring the role of social support on the delay in subsequent pregnancy OBJECTIVES This study examined whether interventions aim ed at aggressive/disruptive classroom behavior and poor academic achievement would reduce the incidence of initiation of smoking . METHODS An epidemiologically based , universal r and omized preventive trial involved 2311 children in 2 classroom-based preventive interventions or controls .  Each intervention was directed at 1 of the aforementioned 2 antecedents over first and second grade s in 19 urban schools . RESULTS Smoking initiation was reduced in both cohorts for boys assigned to the behavioral intervention . CONCLUSIONS Targeting early risk antecedents such as aggressive behavior appears to be an important smoking prevention strategy AIM This paper reports a study evaluating the comparative effects and costs of a proactive nursing health promotion intervention in addition to usual home care for older people compared with usual home care services alone . BACKGROUND An ageing population , budget constraints and technological advances in many countries have increased the pressure on home care re sources . The result is a shift in nursing services from health promotion to meet the more pressing need for postacute care . For frail older people with long-term needs , these changes combine to create a fragmented system of health service delivery , characterized by providing nursing on dem and rather than proactively . METHODS A two-armed , single-blind , r and omized controlled trial was carried out with older people > or = 75 years and eligible for personal support services through a home care programme in Ontario , Canada . Participants were r and omly allocated either to usual home care ( control ) or to a nursing ( experimental ) group . In addition to usual home care , the nursing group received a health assessment combined with regular home visits or telephone contacts , health education about management of illness , coordination of community services , and use of empowerment strategies to enhance independence . The data were collected in 2001 - 2002 . RESULTS Of the 288 older people who were r and omly allocated at baseline , 242 ( 84 % ) completed the study ( 120 nursing group ; 122  control group ) . Proactively providing older people with nursing health promotion , compared with providing nursing services on-dem and , result ed in better mental health functioning ( P = 0.009 ) , a reduction in depression ( P = 0.009 ) , and enhanced perceptions of social support ( P = 0.009 ) at no additional cost from a societal perspective . CONCLUSIONS Home based nursing health promotion , proactively provided to frail older people with chronic health needs , enhances quality of life while not increasing the overall costs of health care . The results underscore the need to re-invest in nursing services for health promotion for older clients receiving home care BACKGROUND Recent review s have shown that home visiting programmes that address parenting have the potential to improve long term health and social outcomes for children . However there are few studies exploring the cost-effectiveness of such interventions . The objective of this study was to evaluate the cost-effectiveness of an intensive home visiting programme directed at vulnerable families during the antenatal and postnatal periods . METHODS The design was an economic evaluation alongside a multicentre r and omized controlled trial , in which 131 eligible women were r and omly allocated to receive 18 months of intensive home visiting ( n=67 ) or st and ard services ( n=64 ) . Due to the public health nature of the intervention a cost-effectiveness analysis was undertaken from a societal perspective . RESULTS The mean ' societal costs ' in the control and intervention arms were 3874 pounds and 7120 pounds , respectively , a difference of 3246 pounds ( p<0.000 ) . The mean ' health service only ' costs were 3324 pounds and 5685 pounds respectively , a difference of 2361 pounds ( p<0.000 ) . As well as significant improvements in maternal sensitivity and infant cooperativeness there was also a non-significant increase in the likelihood of the intervention group infants being removed from the home due to abuse and neglect . These incremental benefits were delivered at an incremental societal cost of 3246 pounds per woman . CONCLUSIONS The results of the study provide evidence to suggest that , within the context of regular home visits , specially trained home visitors can increase maternal sensitivity and infant cooperativeness and are better able to identify infants in need of removal from the home for child protection . The extent to which these benefits are ' worth ' the societal cost of 3246 pounds per woman however is a matter of judgment OBJECTIVES To determine whether a social support intervention ( access to an employed befriending facilitator in addition to usual care ) is effective compared with usual care alone . Also to document direct and indirect costs , and establish incremental cost-effectiveness . DESIGN The Befriending and Costs of Caring ( BECCA ) trial was a cost-effectiveness r and omised controlled trial . Data on well-being and re source use were collected through interviews with participants at baseline and at 6 , 15 and 24 months . SETTING This research was carried out in the English counties of Norfolk and Suffolk , and the London Borough of Havering . It was a community-based study . PARTICIPANTS Participants were family carers who were cohabiting with , or providing at least 20 hours ' care per week for , a community-dwelling relative with a primary progressive dementia . INTERVENTIONS The intervention was ' access to a befriender facilitator ' ( BF ) . BFs , based with charitable/voluntary-sector organisations , were responsible for local befriending schemes , including recruitment , screening , training and ongoing support of befriending volunteers , and for matching carers with befrienders . The role of befrienders was to provide emotional support for carers . The target duration for befriending relationships was 6 months or more . MAIN OUTCOME MEASURES Depression was measured by the Hospital Anxiety and Depression Scale ( HADS ) at 15 months postr and omisation . The health-related quality of life scale EQ-5D ( EuroQol 5 Dimensions ) was used to derive utilities for the calculation of quality -adjusted life-years ( QALYs ) . RESULTS A total of 236 carers were r and omised into the trial ( 116 intervention ; 120 control ) . At final follow-up , 190 carers ( 93 intervention ; 97 control ) were still involved in the trial ( 19 % attrition ) . There was no evidence of effectiveness or cost-effectiveness from the primary analyses on the intention-to-treat population . The mean incremental cost per incremental QALY gained was in excess of 100,000 pounds , with only a 42.2 % probability of being below 30,000 pounds per QALY gained . Where care-recipient QALYs were included , mean incremental cost per incremental QALY gained was 26,848 pounds , with a 51.4 % probability of being below 30,000 pounds per QALY gained . Only 60 carers ( 52 % ) took up the offer of being matched with a trained lay befriender , and of these only 37 ( 32 % ) were befriended for 6 months or more . A subgroup analysis of controls versus those befriended for 6 months or more found a reduction in HADS-depression scores that approached statistical significance ( 95 % CI -0.09 to 2.84 ) . CONCLUSIONS ' Access to a befriender facilitator ' is neither an effective nor a cost-effective intervention in the support of carers of people with dementia , although there is a suggestion of cost-effectiveness for the care dyad ( carer and care recipient ) . In common with many services for carers of people with dementia , uptake of befriending services was not high . However , the small number of carers who engaged with befrienders for 6 months or more reported a reduction in scores on HADS depression that approached statistical significance compared with controls ( 95 % CI -0.09 to 2.84 ) . While providing only weak evidence of any beneficial effect , further research into befriending interventions for carers is warranted Objectives The aim of the study was to evaluate the effectiveness of two brief preventive stress reduction programs — a cognitive focused program and a combined intervention of physical exercise and relaxation — on  sickness absence in stressed and non-stressed employees working in various jobs in a telecom company . Methods The study was design ed as an a priori r and omized trial and the follow-up period for sickness absence was 1 year .  Sickness absence data of 242 employees were analyzed with respect to spells of sickness ( frequency , incidence rate ) , days ( length , duration ) and time between intervention and first subsequent absent spell . Results For stressed employees this study suggests that the illness burden represented by absenteeism is not affected by the interventions . There is no substantial difference in effectiveness between the cognitive and physical interventions . However , in comparison with the physical intervention the cognitive intervention decreases the period between the intervention and the first recurrence of a sick leave period with 144 days ( marginal significant ) . Conclusion The illness burden represented by absenteeism is effected in detail but not substantially by the interventions BACKGROUND  Infant attachment security is a protective factor for future mental health , and may be promoted by individual interventions . Given service dem and s , it is important to determine if a group-based intervention for parents  could be used to enhance infant attachment security . METHODS In a r and omized trial involving 76 mothers , an 8-session attachment group called ' Right from the Start ' ( RFTS ) was compared to home visiting ( treatment as usual ) . RESULTS Intention-to-treat analyses indicated no significant differences between RFTS and home visiting , with both groups showing small improvements in infant attachment security and maternal sensitivity .  RFTS  cost significantly less and was more cost effective than home visiting , and was not significantly different in terms of participation ratings , client satisfaction , or follow-up service requests . There was differential compliance for the two interventions , with 89 % and 58 % attending 4 or more sessions of home visiting and RFTS , respectively . Secondary analyses considering non-attenders as a separate ( nonr and omized ) group indicated a significant advantage for those who attended RFTS on pre-test/post-test maternal sensitivity change scores ( d = .52 ) and pre-test/6-month follow-up infant attachment security changes scores ( d = .55 ) . CONCLUSIONS RFTS is as effective as home visiting in improving infant attachment security and maternal sensitivity . The effect sizes for RFTS were comparable to those of individual attachment interventions in this relatively inexpensive , community-based group intervention
target: Caution must therefore be exercised in interpreting results , but the case for investment in parenting and health visitor-related programmes appears most strong , especially when impacts beyond the health sector are taken into account .
  In the workplace an economic return on investment in a number of comprehensive workplace health promotion programmes and stress management projects ( largely in the USA ) was reported , while group-based exercise and psychosocial interventions are of potential benefit to older people .
background: nan