***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 Forty-four prenatally depressed women were r and omly assigned to peer support or interpersonal psychotherapy groups at 22 weeks gestation . The peer support group participated in a 20-minute group session once per week for 12 weeks , and the interpersonal psychotherapy group met for one hour per week for 12 weeks . Assessment s were conducted before and after the sessions at 22 and 34 weeks gestation . Despite the peer support group having lower socioeconomic status and higher depression scores at the beginning of the treatment period and having shorter group sessions , both groups had lower summary depression ( CES-D ) scores and lower anxiety ( STAI ) scores by the end of the treatment period . In addition , cortisol levels decreased for both groups after the last day session , although the decrease was greater for the peer support group . The groups did not differ on neonatal outcomes including gestational age and birthweight . These data suggest that peer support group sessions may be a cost-effective form of treatment for prenatal depression OBJECTIVES This study aim ed to measure the effect and the total cost per woman of providing postnatal support at home , based on a Dutch model . The research hypothesis was furnished by some existing evidence that postnatal support could reduce the risk of postnatal depression and encourage breastfeeding . DESIGN The r and omised controlled trial aim ed to measure differences in health status in a group of women who were offered postnatal support from a community midwifery support worker ( SW ) compared with a  control group of women who were not offered this support .  Women were followed-up by postal question naire at 6 weeks and 6 months postnatally . SETTING AND SUBJECTS All women who delivered a baby at the recruiting hospital were eligible to take part in the trial if they lived within the study area , were aged 17 years or over , and could underst and English . INTERVENTION The intervention consisted of the SW offering practical and emotional support and to help women rest and recover after childbirth . The SW offered ten visits in the first 28 days postnatally , for up to 3 hours per day . The SW 's activities included housework , talking with the mother , and care for the baby or other siblings . The service was provided in addition to routine visits by the community midwife . MAIN OUTCOME MEASURES The primary outcome was the general health perception domain of the Short Form-36 at 6 weeks . Secondary outcomes were mean Edinburgh Postnatal Depression Scale ( EPDS ) , Duke Functional Social Support ( DUFSS ) scores and breastfeeding rates . RESULTS The 623 r and omised women were well-matched by group with a good response to follow-up . At 6 weeks there was no evidence of a significant difference between the two groups for the primary outcome . There was a non-significant trend for the control group to have better mean DUFSS and EPDS scores at 6 weeks . Breastfeeding rates were not significantly different at follow-up . At 6 months , both groups had similar health status . Satisfaction with the service was higher than for all other services received . The incremental cost of introducing the service comprised setting up and running the service . There were no differences between the groups in other re source use ( general practitioner contacts , hospital services , prescriptions or medicines bought for mothers and babies ) to 6-month follow-up . The total mean NHS cost to 6-month follow-up for the intervention group was pound180 per woman greater than for the control group ( confidence interval , pound79.60 , pound272.40 ) . CONCLUSIONS Although women valued the service , there was no evidence of any health benefit at the 6-week or 6-month follow-up , no difference in use of NHS services , and the additional cost of the service provision would be around pound 180 per woman BACKGROUND Recently enacted federal legislation m and ates insurance coverage of at least 48 hours of postpartum hospitalization , but most mothers and newborns in the United States will continue to go home before the third postpartum day . National guidelines recommend a follow-up visit on the third or fourth postpartum day , but scant evidence exists about whether home or clinic visits are more effective . METHODS We enrolled 1163 medically and socially low-risk mother-newborn pairs with uncomplicated delivery and r and omly assigned them to receive home visits by nurses or pediatric clinic visits by nurse practitioners or physicians on the third or fourth postpartum day . In contrast with the 20-minute pediatric clinic visits , the home visits were longer ( median : 70 minutes ) , included preventive counseling about the home environment , and included a physical examination of the mother . Clinical utilization and costs were studied using computerized data bases . Breastfeeding continuation , maternal depressive symptoms , and maternal satisfaction were assessed by means of telephone interviews at 2 weeks ' postpartum . RESULTS Comparing the 580 pairs in the home visit group and the 583 pairs in the pediatric clinic visit group , no significant differences occurred in clinical outcomes as measured by maternal or newborn rehospitalization within 10 days postpartum , maternal or newborn urgent clinic visits within 10 days postpartum , or breastfeeding discontinuation or maternal depressive symptoms at the 2-week interview . The same was true for a combined clinical outcome measure indicating whether a mother-newborn pair had any of the above outcomes . In contrast , higher proportions of mothers in the home visit group rated as excellent or very good the preventive advice delivered ( 80 % vs 44 % ) , the provider 's skills and abilities ( 87 % vs 63 % ) , the newborn 's posthospital care ( 87 % vs 59 % ) , and their own posthospital care ( 75 % vs 47 % ) . On average , a home visit cost $ 255 and a pediatric clinic visit cost $ 120 . CONCLUSIONS For low-risk mothers and newborns in this integrated health maintenance organization , home visits compared with pediatric clinic visits on the third or fourth postpartum hospital day were more costly , but were associated with equivalent clinical outcomes and markedly higher maternal satisfaction . This study had limited power to identify group differences in rehospitalization , and may not be generalizable to higher-risk population s without comparable access to integrated hospital and outpatient care BACKGROUND This prospect i ve cohort study assessed the cost-effectiveness of treating 30 women with postnatal depression ( PND ) at a specialised psychiatric Parent and Baby Day Unit ( PBDU ) , compared to 30 women treated using routine primary care ( RPC ) .  METHODS Following recruitment , the women were assessed on three occasions ( initially , 3- and 6-months ) , using a variety of social and psychiatric outcome measures . Direct and indirect costs were collated using structured interviews , retrospective analysis of case notes and routinely collated NHS cost data . Sensitivity analysis was also carried out . RESULTS There was no significant difference between the women in the two groups initially in terms of their socio-demographic characteristics , or scores on the outcome measures . However , at 6-months , 21 women in the PBDU group were no longer depressed compared to only seven women in the RPC group . The total cost was 46,211 pounds for the PBDU group and 18,973 pounds for the RPC group . Moving from RPC to a PBDU would involve an additional expenditure of 27,238 pounds ( 46,211 - 18,973 ) whilst delivering 14 more positive outcomes . The move from RPC to PBDU would incur an additional cost per successfully treated woman of 1945 pounds ( 27,238/14 ) . This compares favourably with the current cost per successfully treated woman in the RPC group of 2710 pounds ( 18,973/7 ) . CONCLUSIONS RPC is dominated on the grounds of cost-effectiveness by PBDU treatment and so PBDU treatment should be recommended to health care decision-makers . LIMITATIONS OF THE STUDY The results were sensitive to the inclusion of primary care contacts and the costs of medication Purpose : The purpose of this study was to pilot a stepped collaborative care intervention for women with postpartum depression and evaluate health differences between self-diagnosed depressed and nondepressed women . Methods : Five hundred six mothers of infants from 7 clinics completed surveys at 0 to 1 , 2 , 4 , 6 , and 9 months postpartum and a Structured Clinical Interview for DSM-IV ( SCID ) . SCID-positive depressed women were r and omized to stepped collaborative care or usual care . Nine-month treatment , health , and work outcomes were evaluated for stepped care women ( n = 19 ) versus control depressed women ( n = 20 ) , and self-diagnosed depressed women ( n = 122 ) versus nondepressed women ( n = 344 ) . Results : Forty-five women had SCID-positive depression whereas 122 had self-diagnosed depression . For SCID-positive depressed women , the stepped care intervention increased mothers ’ awareness of their depression diagnosis ( 100 % vs 61 % ; P = .008 ) and their receipt of treatment ( 94 % vs 56 % ; P = .019 ) . Self-diagnosed depressed women ( vs nondepressed women ) had more depressive symptoms and acute care visits , worse general and mental health , and greater impact of health problems on regular activities . Conclusions : The stepped care intervention improved women 's knowledge of their postpartum depression diagnosis and their receipt of treatment . However , our formal diagnostic procedures missed many women whose depressed mood interfered with their health and function 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 ) Objectives Postnatal maternal mental health problems , including depression and anxiety , entail a significant burden globally , and finding cost-effective preventive solutions is a public policy priority . This paper presents a cost-effectiveness analysis of the intervention , What Were We Thinking ( WWWT ) , for the prevention of postnatal maternal mental health problems . Design The economic evaluation , including cost-effectiveness and cost-utility analyses , was conducted alongside a cluster-r and omised trial . Setting 48 Maternal and Child Health Centres in Victoria , Australia . Participants Participants were English-speaking first-time mothers attending participating Maternal and Child Health Centres . Full data were collected for 175 participants in the control arm and 184 in the intervention arm .  Intervention WWWT is a psychoeducational intervention targeted at the partner relationship , management of 
    Output:
    
However , the two interventions incorporating identification plus treatment of perinatal depression were both likely to be cost-effective .