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Article ; Online: Seasonal controls override forest harvesting effects on the composition of dissolved organic matter mobilized from boreal forest soil organic horizons

K. L. Bowering / K. A. Edwards / S. E. Ziegler

Biogeosciences, Vol 20, Pp 2189-

2023 Volume 2206

Abstract: ... a temporally dynamic flux of carbon (C) and nutrients, and the fate of this DOM in downstream pools is ... Soil moisture was negatively correlated to the C : N of DOM. These results suggest common seasonal controls ... character of DOM mobilized during winter and snowmelt: lower C : N, higher specific ultraviolet absorbance ...

Abstract	Dissolved organic matter (DOM) mobilized from the organic (O) horizons of forest soils is a temporally dynamic flux of carbon (C) and nutrients, and the fate of this DOM in downstream pools is dependent on the rate and pathways of water flow as well as its chemical composition. Here, we present observations of the composition of DOM mobilized weekly to monthly from O horizons in mature forest and adjacent harvested treatment plots. The study site was experimentally harvested, without replanting, 10-years prior to this study. Thus, the treatments differ significantly in terms of forest stand and soil properties, and they interact differently with the regional hydrometeorological conditions. This presented an opportunity to investigate the role of forest structure relative to environmental variation on soil DOM mobilization. On an annual basis, fluxes of total dissolved nitrogen (TDN) and dissolved organic nitrogen (DON) were largest from the warmer and thinner O horizons of the harvested (H) treatment compared to the forest (F) treatment; however, neither phosphate nor ammonium fluxes differed by treatment type. On a short-term basis in both H and F treatments, all fluxes were positively correlated to water input, and all concentrations were positively correlated to soil temperature and negatively correlated to water input. Soil moisture was negatively correlated to the C : N of DOM. These results suggest common seasonal controls on DOM mobilization regardless of harvesting treatment. Optical characterization of seasonally representative samples additionally supported a stronger control of season over harvesting. The chemical character of DOM mobilized during winter and snowmelt: lower C : N, higher specific ultraviolet absorbance and lower molecular weight of chromophoric DOM (CDOM; higher spectral slope ratio) were representative of relatively more decomposed DOM compared to that mobilized in summer and autumn. This shows that the decomposition of soil organic matter underneath a consistently deep snowpack is a ...
Keywords	Ecology ; QH540-549.5 ; Life ; QH501-531 ; Geology ; QE1-996.5
Subject code	550
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	Copernicus Publications
Document type	Article ; Online
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Article ; Online: Patient self-reporting of tolerability using PRO-CTCAE in a randomized double-blind, placebo-controlled phase II trial comparing gemcitabine in combination with adavosertib or placebo in patients with platinum resistant or refractory epithelial ovarian carcinoma.

Madariaga, Ainhoa / Mitchell, Sandra A / Pittman, Tyler / Wang, Lisa / Bowering, Valerie / Kavak, Nisan / Quintos, Judy / Chang, Karen / Ramsahai, Janelle / Karakasis, Katherine / Welch, Stephen A / Dhani, Neesha C / Lheureux, Stephanie / Oza, Amit M

Gynecologic oncology

2022 Volume 167, Issue 2, Page(s) 226–233

Abstract: Background: A double-blind, randomized, placebo-controlled, phase 2 trial assessed gemcitabine in combination with the wee1 inhibitor adavosertib or placebo in platinum resistant or refractory high grade serous ovarian cancer (HGSOC), demonstrating ... ...

Abstract	Background: A double-blind, randomized, placebo-controlled, phase 2 trial assessed gemcitabine in combination with the wee1 inhibitor adavosertib or placebo in platinum resistant or refractory high grade serous ovarian cancer (HGSOC), demonstrating improved progression free and overall survival favouring the adavosertib/gemcitabine arm. An exploratory objective of the study included the PRO-CTCAE assessment, to capture self-reporting of frequency, severity and/or interference of symptomatic adverse events (syAEs). Methods: PRO-CTCAE items at baseline, days 1 and 15 of each cycle and off treatment, were completed in two centres, with the objective of characterizing syAEs in the first three months of therapy. The maximum post-baseline score proportion for each syAE was tabulated per patient. The 12-week area under the curve (AUC12w) as a measure of syAE over-time and incremental AUC12w (iAUC12w) for adjustment to baseline syAEs. Results: Sixty-one patients were approached for PRO-CTCAE surveys and 55 were evaluable. Among patients with HGSOC, 28 received gemcitabine/adavosertib (arm A) and 19 gemcitabine/placebo (arm B). Survey completion rates were high. The proportion of participants with positive (≥1) PRO-CTCAE scores was higher for difficulty swallowing with gemcitabine/adavosertib (arm A 35.7% vs arm B 5.3%, p = 0.02). The high score (≥3) syAEs showed more frequent diarrhea with gemcitabine/adavosertib (arm A 25% vs arm B 0%, p = 0.03). The proportions of worsening syAEs over time were higher in patients receiving gemcitabine/adavosertib for difficulty swallowing (arm A 35.7% vs arm B 5.3%; p = 0.03) and fatigue severity (arm A 71.43% vs arm B 42.1%; p = 0.04). Conclusions: The longitudinal assessment of patient self-reported tolerability showed greater difficulty swallowing and fatigue severity in patients receiving gemcitabine/adavosertib, compared to gemcitabine/placebo. PRO-CTCAE provides complementary and objective assessment of drug tolerability from a patient's perspective.
MeSH term(s)	Female ; Humans ; Gemcitabine ; Carcinoma, Ovarian Epithelial/drug therapy ; Ovarian Neoplasms/pathology ; Platinum/therapeutic use ; Fatigue ; Double-Blind Method ; Antineoplastic Combined Chemotherapy Protocols/adverse effects
Chemical Substances	Gemcitabine ; adavosertib (K2T6HJX3I3) ; Platinum (49DFR088MY)
Language	English
Publishing date	2022-08-30
Publishing country	United States
Document type	Randomized Controlled Trial ; Clinical Trial, Phase II ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	801461-9
ISSN	1095-6859 ; 0090-8258
ISSN (online)	1095-6859
ISSN	0090-8258
DOI	10.1016/j.ygyno.2022.08.006
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Article ; Online: Supported self-management as a model for end-of-life care in the setting of malignant bowel obstruction: A qualitative study.

Cusimano, Maria C / Sajewycz, Katrina / Nelson, Michelle / Jivraj, Nazlin / Lee, Yeh Chen / Bowering, Valerie / Oza, Amit / Lheureux, Stephanie / Ferguson, Sarah E

Gynecologic oncology

2020 Volume 157, Issue 3, Page(s) 745–753

Abstract: Objective: Women with advanced gynecologic cancer and malignant bowel obstruction (MBO) undergo repeated hospitalizations, experience feelings of isolation and abandonment, and often die in acute settings. Innovative outpatient models of care are needed ...

Abstract	Objective: Women with advanced gynecologic cancer and malignant bowel obstruction (MBO) undergo repeated hospitalizations, experience feelings of isolation and abandonment, and often die in acute settings. Innovative outpatient models of care are needed to address the unmet needs of this population at the end-of-life. We implemented a novel supported self-management (SMS) program focused on increasing patients' skill and confidence in managing MBO proactively in the ambulatory setting. Methods: We performed a qualitative descriptive study embedded in a prospective single-arm evaluative trial (Clinicaltrials.gov ID: NCT03260647) to understand the impact of this program on patients' sense of support, degree of distress, quality of care, and capacity to self-manage. Semi-structured interviews were completed and analysed using the Chronic Care Model as a theoretical framework. Data saturation was confirmed after 15 interviews. Results: Fifteen patients (age range: 47-82) with diagnoses of advanced ovarian, endometrial, and cervical cancer were interviewed; 10 had died by end of follow-up, with a median interval from interview to death of 5 months. Patients were able to self-manage the: (i) medical aspects; (ii) psychological consequences, and (iii) changes in life roles and expectations resulting from their condition. Patients felt greatly supported, less isolated, and secure in their knowledge and ability to access care due to SMS. While patients understood their disease was not curative they did not fully appreciate that MBO signalled a significantly poorer prognosis. Conclusion: Outpatient SMS interventions can be successfully implemented even for rapidly fatal conditions at the end-of-life and offer significant benefit to gynecologic cancer patients with MBO. Counselling should focus on the specific trajectory of MBO, and early palliative care referrals should be standard practice.
MeSH term(s)	Aged ; Aged, 80 and over ; Female ; Humans ; Intestinal Obstruction/mortality ; Intestinal Obstruction/therapy ; Middle Aged ; Qualitative Research ; Self-Management/methods ; Survival Analysis ; Terminal Care/methods
Language	English
Publishing date	2020-03-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	801461-9
ISSN	1095-6859 ; 0090-8258
ISSN (online)	1095-6859
ISSN	0090-8258
DOI	10.1016/j.ygyno.2020.03.009
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Article: Diabetic foot ulcers. Pathophysiology, assessment, and therapy.

Bowering, C K

Canadian family physician Medecin de famille canadien

2001 Volume 47, Page(s) 1007–1016

Abstract: Objective: To review underlying causes of diabetic foot ulceration, provide a practical assessment of patients at risk, and outline an evidence-based approach to therapy for diabetic patients with foot ulcers.: Quality of evidence: A MEDLINE search ... ...

Abstract	Objective: To review underlying causes of diabetic foot ulceration, provide a practical assessment of patients at risk, and outline an evidence-based approach to therapy for diabetic patients with foot ulcers. Quality of evidence: A MEDLINE search was conducted for the period from 1979 to 1999 for articles relating to diabetic foot ulcers. Most studies found were case series or small controlled trials. Main message: Foot ulcers in diabetic patients are common and frequently lead to lower limb amputation unless a prompt, rational, multidisciplinary approach to therapy is taken. Factors that affect development and healing of diabetic patients' foot ulcers include the degree of metabolic control, the presence of ischemia or infection, and continuing trauma to feet from excessive plantar pressure or poorly fitting shoes. Appropriate wound care for diabetic patients addresses these issues and provides optimal local ulcer therapy with débridement of necrotic tissue and provision of a moist wound-healing environment. Therapies that have no known therapeutic value, such as foot soaking and topical antiseptics, can actually be harmful and should be avoided. Conclusion: Family physicians are often primary medical contacts for patients with diabetes. Patients should be screened regularly for diabetic foot complications, and preventive measures should be initiated for those at risk of ulceration.
MeSH term(s)	Diabetic Foot/complications ; Diabetic Foot/diagnosis ; Diabetic Foot/physiopathology ; Diabetic Foot/therapy ; Diagnostic Imaging ; Humans ; Neurologic Examination ; Orthopedic Equipment ; Patient Education as Topic ; Risk Factors ; Skin Care
Language	English
Publishing date	2001-05
Publishing country	Canada
Document type	Journal Article ; Review
ZDB-ID	603565-6
ISSN	0008-350X
ISSN	0008-350X
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Article ; Online: Dissolved organic carbon mobilized from organic horizons of mature and harvested black spruce plots in a mesic boreal region

K. L. Bowering / K. A. Edwards / K. Prestegaard / X. Zhu / S. E. Ziegler

Biogeosciences, Vol 17, Pp 581-

2020 Volume 595

Abstract: ... from this key C source. We specifically addressed (1) how DOC fluxes from O horizons vary on a weekly ... than in the forest plots (54 g C m −2 vs. 38 g C m −2 , respectively; p =0.008 ). This was despite smaller ... aboveground C inputs and smaller soil organic carbon stocks in the harvested plots but analogous to larger ...

Abstract	Boreal forests are subject to a wide range of temporally and spatially variable environmental conditions driven by season, climate, and disturbances such as forest harvesting and climate change. We captured dissolved organic carbon (DOC) from surface organic (O) horizons in a boreal forest hillslope using passive pan lysimeters in order to identify controls and hot moments of DOC mobilization from this key C source. We specifically addressed (1) how DOC fluxes from O horizons vary on a weekly to seasonal basis in forest and paired harvested plots and (2) how soil temperature, soil moisture, and water input relate to DOC flux trends in these plots over time. The total annual DOC flux from O horizons contain contributions from both vertical and lateral flow and was 30 % greater in the harvested plots than in the forest plots (54 g C m −2 vs. 38 g C m −2 , respectively; p =0.008 ). This was despite smaller aboveground C inputs and smaller soil organic carbon stocks in the harvested plots but analogous to larger annual O horizon water fluxes measured in the harvested plots. Water input, measured as rain, throughfall, and/or snowmelt depending on season and plot type, was positively correlated to variations in O horizon water fluxes and DOC fluxes within the study year. Soil temperature was positively correlated to temporal variations of DOC concentration ([DOC]) of soil water and negatively correlated with water fluxes, but no relationship existed between soil temperature and DOC fluxes at the weekly to monthly scale. The relationship between water input to soil and DOC fluxes was seasonally dependent in both plot types. In summer, a water limitation on DOC flux existed where weekly periods of no flux alternated with periods of large fluxes at high DOC concentrations. This suggests that DOC fluxes were water-limited and that increased water fluxes over this period result in proportional increases in DOC fluxes. In contrast, a flushing of DOC from O horizons (observed as decreasing DOC concentrations) occurred during ...
Keywords	Ecology ; QH540-549.5 ; Life ; QH501-531 ; Geology ; QE1-996.5
Language	English
Publishing date	2020-02-01T00:00:00Z
Publisher	Copernicus Publications
Document type	Article ; Online
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Article ; Online: Identifying Mechanisms of Resistance by Circulating Tumor DNA in EVOLVE, a Phase II Trial of Cediranib Plus Olaparib for Ovarian Cancer at Time of PARP Inhibitor Progression.

Clinical cancer research : an official journal of the American Association for Cancer Research

2023 Volume 29, Issue 18, Page(s) 3706–3716

Abstract: Purpose: To evaluate the use of blood cell-free DNA (cfDNA) to identify emerging mechanisms of resistance to PARP inhibitors (PARPi) in high-grade serous ovarian cancer (HGSOC).: Experimental design: We used targeted sequencing (TS) to analyze 78 ... ...

Abstract	Purpose: To evaluate the use of blood cell-free DNA (cfDNA) to identify emerging mechanisms of resistance to PARP inhibitors (PARPi) in high-grade serous ovarian cancer (HGSOC). Experimental design: We used targeted sequencing (TS) to analyze 78 longitudinal cfDNA samples collected from 30 patients with HGSOC enrolled in a phase II clinical trial evaluating cediranib (VEGF inhibitor) plus olaparib (PARPi) after progression on PARPi alone. cfDNA was collected at baseline, before treatment cycle 2, and at end of treatment. These were compared with whole-exome sequencing (WES) of baseline tumor tissues. Results: At baseline (time of initial PARPi progression), cfDNA tumor fractions were 0.2% to 67% (median, 3.25%), and patients with high ctDNA levels (>15%) had a higher tumor burden (sum of target lesions; P = 0.043). Across all timepoints, cfDNA detected 74.4% of mutations known from prior tumor WES, including three of five expected BRCA1/2 reversion mutations. In addition, cfDNA identified 10 novel mutations not detected by WES, including seven TP53 mutations annotated as pathogenic by ClinVar. cfDNA fragmentation analysis attributed five of these novel TP53 mutations to clonal hematopoiesis of indeterminate potential (CHIP). At baseline, samples with significant differences in mutant fragment size distribution had shorter time to progression (P = 0.001). Conclusions: Longitudinal testing of cfDNA by TS provides a noninvasive tool for detection of tumor-derived mutations and mechanisms of PARPi resistance that may aid in directing patients to appropriate therapeutic strategies. With cfDNA fragmentation analyses, CHIP was identified in several patients and warrants further investigation.
MeSH term(s)	Humans ; Female ; Poly(ADP-ribose) Polymerase Inhibitors/therapeutic use ; Poly(ADP-ribose) Polymerase Inhibitors/pharmacology ; Circulating Tumor DNA/genetics ; BRCA1 Protein/genetics ; BRCA2 Protein/genetics ; Ovarian Neoplasms/drug therapy ; Ovarian Neoplasms/genetics ; Ovarian Neoplasms/pathology ; Antineoplastic Agents/therapeutic use ; Cell-Free Nucleic Acids/genetics
Chemical Substances	Poly(ADP-ribose) Polymerase Inhibitors ; Circulating Tumor DNA ; cediranib (NQU9IPY4K9) ; BRCA1 protein, human ; BRCA1 Protein ; olaparib (WOH1JD9AR8) ; BRCA2 protein, human ; BRCA2 Protein ; Antineoplastic Agents ; Cell-Free Nucleic Acids
Language	English
Publishing date	2023-06-16
Publishing country	United States
Document type	Clinical Trial, Phase II ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1225457-5
ISSN	1557-3265 ; 1078-0432
ISSN (online)	1557-3265
ISSN	1078-0432
DOI	10.1158/1078-0432.CCR-23-0797
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Article: Dermagraft in the treatment of diabetic foot ulcers.

Bowering, C K

Journal of cutaneous medicine and surgery

1998 Volume 3 Suppl 1, Page(s) S1–29–32

MeSH term(s)	Biocompatible Materials ; Cells, Cultured ; Diabetic Foot/physiopathology ; Diabetic Foot/surgery ; Fibroblasts ; Humans ; Skin Transplantation/methods ; Skin, Artificial ; Wound Healing/physiology
Chemical Substances	Biocompatible Materials
Language	English
Publishing date	1998-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1361720-5
ISSN	1615-7109 ; 1203-4754
ISSN (online)	1615-7109
ISSN	1203-4754
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Article: Use of layered compression bandages in diabetic patients. Experience in patients with lower leg ulceration, peripheral edema, and features of venous and arterial disease.

Bowering, C K

Advances in wound care : the journal for prevention and healing

1998 Volume 11, Issue 3, Page(s) 129–135

Abstract: Layered compression therapy for venous leg ulcers and ulcers associated with chronic leg edema has been shown to be an effective treatment in patients with adequate arterial circulation. However, no study has looked specifically at compression therapy in ...

Abstract	Layered compression therapy for venous leg ulcers and ulcers associated with chronic leg edema has been shown to be an effective treatment in patients with adequate arterial circulation. However, no study has looked specifically at compression therapy in the diabetic population. This clinical case review examines outcomes in two groups of diabetic patients with edema and either venous ulcers or preulcerative conditions. Patients in Group 1 had clinically adequate arterial circulation and were treated with a four-layer compression bandage system. The highly elastic third layer was eliminated in the Group 2 patients, who had compromised peripheral arterial circulation. Healing occurred in 81% of patients in Group 1 and 67% of patients in Group 2. There was no acute progression of lower limb ischemia. Layered compression therapy was an effective and safe treatment in this diabetic population with adequate arterial circulation. Reduced compression also can be helpful in some patients with arterial compromise.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Arteries ; Bandages/standards ; Diabetic Angiopathies/complications ; Diabetic Angiopathies/therapy ; Diabetic Foot/therapy ; Edema/etiology ; Edema/therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Peripheral Vascular Diseases/etiology ; Peripheral Vascular Diseases/therapy ; Treatment Outcome ; Veins
Language	English
Publishing date	1998-05
Publishing country	United States
Document type	Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2381900-5
ISSN	2331-4192 ; 1076-2191
ISSN (online)	2331-4192
ISSN	1076-2191
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Article ; Online: Research biopsies in patients with gynecologic cancers: patient-reported outcomes, perceptions, and preferences.

Madariaga, Ainhoa / Bhat, Gita / Wilson, Michelle K / Li, Xuan / Cyriac, Sunu / Bowering, Valerie / Hunt, Wendy / Gutierrez, David / Bonilla, Luisa / Kasherman, Lawrence / McMullen, Michelle / Wang, Lisa / Ghai, Sangeet / Dhani, Neesha C / Oza, Amit M / Lheureux, Stephanie

American journal of obstetrics and gynecology

2021 Volume 225, Issue 6, Page(s) 658.e1–658.e9

Abstract: Background: Despite the growing integration of mandatory biopsies for correlative endpoints within oncology clinical trials, there are sparse data on patient-reported outcomes, perceptions, and preferences.: Objective: This study aimed to ... ...

Abstract	Background: Despite the growing integration of mandatory biopsies for correlative endpoints within oncology clinical trials, there are sparse data on patient-reported outcomes, perceptions, and preferences. Objective: This study aimed to prospectively assess the impact of research biopsies on the quality of life in patients with gynecologic cancer, evaluate patient-reported outcomes, and determine factors associated with patients' willingness to undergo sequential biopsies. Study design: We conducted a prospective study in patients with gynecologic malignancies undergoing research biopsies between 2015 and 2019 at Princess Margaret Cancer Centre (ClinicalTrials.gov Identifier: NCT02334761). Here, we report the results of the paper-based surveys performed before and 1 week after biopsy. Although the questionnaires each assessed the impact of anxiety using a modified version of the Hospital Anxiety and Depression Scale, the postbiopsy questionnaire specifically assessed the likelihood of future biopsies, postbiopsy symptoms, complications, and perceptions. Results: A total of 129 patients were enrolled, of which 91 (70.5%) completed at least 1 questionnaire. These patients had either ovarian (89%; 81 of 91) or endometrial cancer (11%; 10 of 91). Of all biopsies taken, 75% were from the abdomen or pelvis (67 of 89). There was 1 clinician-reported complication, a perihepatic hematoma (1%). Pain during the biopsy and physical discomfort were experienced by 60.3% (41 of 68) and 61.8% (42 of 68), respectively. Embarrassment and loss of dignity were experienced by 13.2% (9 of 68) and 11.8% (8 of 68), respectively. Although the mean Hospital Anxiety and Depression Scale score was in the normal range before and after biopsy, there was a significant decline in the total score after the biopsy (prebiopsy, 5.3 [standard deviation, 4.7] vs postbiopsy, 3.7 [standard deviation, 4.5]; P=.005); 84% of subjects (58 of 69) stated that they would definitely or likely consent to another biopsy. There was no impact on patients' willingness for future biopsies based on Eastern Cooperative Oncology Group status, biopsy site, age, number of cores, and pain during the biopsy; however, subjects who reported feeling physically uncomfortable (odds ratio, 0.14; P=.005), embarrassed (odds ratio, 0.03; P=.004) or experienced loss of dignity (odds ratio, 0.05; P=.01) during the biopsy and those who experienced flu-like symptoms (odds ratio, 0.2; P=.018) or felt feverish (odds ratio, 0.2; P=.035) 1 week after biopsy, were less likely to undergo a sequential biopsy. Similarly, those with higher Hospital Anxiety and Depression Scale scores before biopsy (odds ratio, 0.83; P=.008) and after biopsy (odds ratio, 0.8; P=.003) were less likely to consent for another biopsy. Conclusion: Research biopsies were generally well accepted. Most patients (83%) were willing to undergo serial biopsies if necessary. Addressing the potentially modifiable psychosocial aspects of the procedure may improve the experience with research biopsies for patients with gynecologic cancers.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Biopsy ; Clinical Trials as Topic ; Female ; Genital Neoplasms, Female/pathology ; Humans ; Middle Aged ; Patient Preference ; Patient Reported Outcome Measures ; Prospective Studies ; Surveys and Questionnaires
Language	English
Publishing date	2021-06-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2021.06.071
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Article ; Online: Nurse-Moderated Internet-Based Support for New Mothers: Non-Inferiority, Randomized Controlled Trial.

Sawyer, Michael G / Reece, Christy E / Bowering, Kerrie / Jeffs, Debra / Sawyer, Alyssa C P / Mittinty, Murthy / Lynch, John W

Journal of medical Internet research

2017 Volume 19, Issue 7, Page(s) e258

Abstract: Background: Internet-based interventions moderated by community nurses have the potential to improve support offered to new mothers, many of whom now make extensive use of the Internet to obtain information about infant care. However, evidence from ... ...

Abstract	Background: Internet-based interventions moderated by community nurses have the potential to improve support offered to new mothers, many of whom now make extensive use of the Internet to obtain information about infant care. However, evidence from population-based randomized controlled trials is lacking. Objective: The aim of this study was to test the non-inferiority of outcomes for mothers and infants who received a clinic-based postnatal health check plus nurse-moderated, Internet-based group support when infants were aged 1-7 months as compared with outcomes for those who received standard care consisting of postnatal home-based support provided by a community nurse. Methods: The design of the study was a pragmatic, preference, non-inferiority randomized control trial. Participants were recruited from mothers contacted for their postnatal health check, which is offered to all mothers in South Australia. Mothers were assigned either (1) on the basis of their preference to clinic+Internet or home-based support groups (n=328), or (2) randomly assigned to clinic+Internet or home-based groups if they declared no strong preference (n=491). The overall response rate was 44.8% (819/1827). The primary outcome was parenting self-competence, as measured by the Parenting Stress Index (PSI) Competence subscale, and the Karitane Parenting Confidence Scale scores. Secondary outcome measures included PSI Isolation, Interpersonal Support Evaluation List-Short Form, Maternal Support Scale, Ages and Stages Questionnaire-Social-Emotional and MacArthur Communicative Development Inventory (MCDI) scores. Assessments were completed offline via self-assessment questionnaires at enrolment (mean child age=4.1 weeks, SD 1.3) and again when infants were aged 9, 15, and 21 months. Results: Generalized estimating equations adjusting for post-randomization baseline imbalances showed that differences in outcomes between mothers in the clinic+Internet and home-based support groups did not exceed the pre-specified margin of inferiority (0.25 of a SD) on any outcome measure at any follow-up assessment, with the exception of MCDI scores assessing children's language development at 21 months for randomized mothers, and PSI Isolation scores at 9 months for preference mothers. Conclusion: Maternal and child outcomes from a clinic-based postnatal health check plus nurse-moderated Internet-based support were not inferior to those achieved by a universal home-based postnatal support program. Postnatal maternal and infant support using the Internet is a promising alternative to home-based universal support programs. Trial registration: Australian New Zealand Clinical Trials Registry Number (ANZCTR): ACTRN12613000204741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363712&isReview=true (Archived by WebCite at http://www.webcitation.org/6rZeCJ3k1).
MeSH term(s)	Adult ; Child, Preschool ; Female ; Humans ; Infant ; Internet/utilization ; Male ; Medical Informatics/methods ; Mothers/education ; Nurses/utilization ; Self-Assessment ; Surveys and Questionnaires
Language	English
Publishing date	2017-07-24
Publishing country	Canada
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1439-4456
ISSN (online)	1438-8871
ISSN	1439-4456
DOI	10.2196/jmir.6839
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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

Order via subito

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Order via subito

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In stock of ZB MED Cologne/Königswinter

Order via subito

More links

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Order via subito