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Avellar S.A.,Mathematica Policy Research | Supplee L.H.,Research and Evaluation
Pediatrics | Year: 2013

BACKGROUND AND OBJECTIVE: The Patient Protection and Affordable Care Act established the Maternal, Infant, and Early Childhood Home Visiting Program, which provides $1.5 billion to states over 5 years for home visiting program models serving at-risk pregnant women and children from birth to age 5. The act stipulates that 75% of the funds must be used for programs with evidence of effectiveness based on rigorous evaluation research. Home Visiting Evidence of Effectiveness reviewed the home visiting research literature and provided an assessment of the evidence of effectiveness for program models that serve families with pregnant women and children from birth to age 5. METHODS: Home Visiting Evidence of Effectiveness included a systematic search and screening process, a review of the research quality, and an assessment of program effectiveness. Reviewers rated studies' capacity to provide unbiased estimates of program impacts and determined whether a program met the Department of Health and Human Services' criteria for an evidence-based model. RESULTS: As of July 2012, 32 models were reviewed, of which 12 met the Department of Health and Human Services criteria. Most of these models were shown to have favorable effects on child development. Other common favorable effects included health care usage and reductions in child maltreatment. Less common were favorable effects on birth outcomes. CONCLUSIONS: Home visiting is a promising way to serve families who may be difficult to engage in supportive services. Existing rigorous research indicates that home visiting has the potential for positive results among high-risk families, particularly on health care usage and child development. Pediatrics 2013;132:S90-S99. © 2013 by the American Academy of Pediatrics. Source

De-Regil L.M.,Research and Evaluation | Palacios C.,University of Puerto Rico at San Juan | Lombardo L.K.,Indiana University | Pena-Rosas J.P.,World Health Organization
Cochrane Database of Systematic Reviews | Year: 2016

Background: Vitamin D deficiency or insufficiency is thought to be common among pregnant women. Vitamin D supplementation during pregnancy has been suggested as an intervention to protect against adverse pregnancy outcomes. Objectives: To examine whether oral supplements with vitamin D alone or in combination with calcium or other vitamins and minerals given to women during pregnancy can safely improve maternal and neonatal outcomes. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (23 February 2015), the International Clinical Trials Registry Platform (31 January 2015), the Networked Digital Library of Theses and Dissertations (28 January 2015) and also contacted relevant organisations (31 January 2015). Selection criteria: Randomised and quasi-randomised trials with randomisation at either individual or cluster level, evaluating the effect of supplementation with vitamin D alone or in combination with other micronutrients for women during pregnancy. Data collection and analysis: Two review authors independently i) assessed the eligibility of studies against the inclusion criteria ii) extracted data from included studies, and iii) assessed the risk of bias of the included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach. Main results: In this updated review we included 15 trials assessing a total of 2833 women, excluded 27 trials, and 23 trials are still ongoing or unpublished. Nine trials compared the effects of vitamin D alone versus no supplementation or a placebo and six trials compared the effects of vitamin D and calcium with no supplementation. Risk of bias in the majority of trials was unclear and many studies were at high risk of bias for blinding and attrition rates. Vitamin D alone versus no supplementation or a placebo Data from seven trials involving 868 women consistently show that women who received vitamin D supplements alone, particularly on a daily basis, had higher 25-hydroxyvitamin D than those receiving no intervention or placebo, but this response was highly heterogeneous. Also, data from two trials involving 219 women suggest that women who received vitamin D supplements may have a lower risk of pre-eclampsia than those receiving no intervention or placebo (8.9% versus 15.5%; risk ratio (RR) 0.52; 95% CI 0.25 to 1.05, low quality). Data from two trials involving 219 women suggest a similar risk of gestational diabetes among those taking vitamin D supplements or no intervention/placebo (RR 0.43; 95% CI 0.05, 3.45, very low quality). There were no clear differences in adverse effects, with only one reported case of nephritic syndrome in the control group in one study (RR 0.17; 95% CI 0.01 to 4.06; one trial, 135 women, low quality). Given the scarcity of data for this outcome, no firm conclusions can be drawn. No other adverse effects were reported in any of the other studies. With respect to infant outcomes, data from three trials involving 477 women suggest that vitamin D supplementation during pregnancy reduces the risk preterm birth compared to no intervention or placebo (8.9% versus 15.5%; RR 0.36; 95% CI 0.14 to 0.93, moderate quality). Data from three trials involving 493 women also suggest that women who receive vitamin D supplements during pregnancy less frequently had a baby with a birthweight below 2500 g than those receiving no intervention or placebo (RR 0.40; 95% CI 0.24 to 0.67, moderate quality). In terms of other outcomes, there were no clear differences in caesarean section (RR 0.95; 95% CI 0.69 to 1.31; two trials; 312 women); stillbirths (RR 0.35 95% CI 0.06, 1.99; three trials, 540 women); or neonatal deaths (RR 0.27; 95% CI 0.04, 1.67; two trials, 282 women). There was some indication that vitamin D supplementation increases infant length (mean difference (MD) 0.70, 95% CI -0.02 to 1.43; four trials, 638 infants) and head circumference at birth (MD 0.43, 95% CI 0.03 to 0.83; four trials, 638 women). Vitamin D and calcium versus no supplementation or a placebo Women who received vitamin D with calcium had a lower risk of pre-eclampsia than those not receiving any intervention (RR 0.51; 95% CI 0.32 to 0.80; three trials; 1114 women, moderate quality), but also an increased risk of preterm birth (RR 1.57; 95% CI 1.02 to 2.43, three studies, 798 women, moderate quality). Maternal vitamin D concentration at term, gestational diabetes, adverse effects and low birthweight were not reported in any trial or reported only by one study. Authors' conclusions: New studies have provided more evidence on the effects of supplementing pregnant women with vitamin D alone or with calcium on pregnancy outcomes. Supplementing pregnant women with vitamin D in a single or continued dose increases serum 25-hydroxyvitamin D at term and may reduce the risk of pre-eclampsia, low birthweight and preterm birth. However, when vitamin D and calcium are combined, the risk of preterm birth is increased. The clinical significance of the increased serum 25-hydroxyvitamin D concentrations is still unclear. In light of this, these results need to be interpreted with caution. Data on adverse effects were lacking in all studies. The evidence on whether vitamin D supplementation should be given as a part of routine antenatal care to all women to improve maternal and infant outcomes remains unclear. While there is some indication that vitamin D supplementation could reduce the risk of pre-eclampsia and increase length and head circumference at birth, further rigorous randomised trials are required to confirm these effects. © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Source

Auerbach J.D.,Research and Evaluation | Parkhurst J.O.,London School of Hygiene and Tropical Medicine | Caceres C.F.,University of Lima
Global Public Health | Year: 2011

A key component of the shift from an emergency to a long-term response to AIDS is a change in focus from HIV prevention interventions focused on individuals to a comprehensive strategy in which social/structural approaches are core elements. Such approaches aim to modify social conditions by addressing key drivers of HIV vulnerability that affect the ability of individuals to protect themselves and others from HIV. The development and implementation of evidence-based social/structural interventions have been hampered by both scientific and political obstacles that have not been fully explored or redressed. This paper provides a framework, examples, and some guidance for how to conceptualise, operationalise, measure, and evaluate complex social/structural approaches to HIV prevention to help situate them more concretely in a long-term strategy to end AIDS. © 2011 Copyright Taylor and Francis Group, LLC. Source

Tewksbury R.,University of Louisville | Jennings W.G.,University of South Florida | Zgoba K.M.,Research and Evaluation
Behavioral Sciences and the Law | Year: 2012

The goals of the present study were to examine the recidivism rates of two matched samples of sexual offenders, those released prior to and after sex offender registration and notification (SORN) in New Jersey. The pre-SORN group (1990-1994) included 247 offenders, while the post-SORN group (1996-2000) included 248 offenders. The longitudinal analysis demonstrated that for sex offenders released from prison both prior to and after implementation of SORN, there are clearly two distinguishable groups of sex offenders in relation to patterns of recidivism. More than three-quarters of sex offenders were identified as at low risk of recidivism, with low rates of repeat criminal offenses. By contrast, the high-risk group of offenders was not only more likely to commit future criminal offenses, including sex offenses, but they were also more likely to commit significantly more offenses and to do so fairly quickly following release. Analyses also include an examination of the influence of demographics, substance abuse and mental health issues, treatment history, sex offense incident characteristics, and criminal history on recidivism. Finally, SORN status was not a significant predictor of sex or general recidivism. The study limitations and policy implications are discussed. © 2011 John Wiley & Sons, Ltd. Source

Chiasson M.A.,Research and Evaluation | Chiasson M.A.,Columbia University | Hirshfield S.,Research and Evaluation | Rietmeijer C.,Applied Technology Internet
Journal of Acquired Immune Deficiency Syndromes | Year: 2010

Objectives: To describe the technologic advances in the digital media, including computers, mobile phones, and the Internet, that have greatly expanded opportunities to deliver evidence-based HIV education, prevention, and treatment programs. Methods: This article examines the use of digital media in the United States and its potential role in HIV prevention and care. Results: Although the "digital divide" is shrinking, access varies by age, race/ethnicity, and education. The Internet is an important medium for delivering universal and targeted HIV education and prevention, especially for men who have sex with men, who report going online to seek health information online and for social and sexual networking. Online and off-line behavioral interventions using digital media range from computerized multimedia interventions that take into account individual behaviors to brief untailored video interventions. Numerous Web sites facilitate access to care by providing a variety of services, including location of and linkage to HIV testing and treatment sites. HIV treatment and adherence programs that use online medical records text messaging, paging, and tablet computer-based counseling tools are also being developed. Conclusions: HIV prevention and care programs using digital media have great potential to cost-effectively meet the complex needs of diverse and often underserved populations living with or at high risk of HIV. Copyright © 2010 by Lippincott Williams & Wilkins. Source

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