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Key points• Vaccine injections performed in childhood are a substantial source of distress.• Untreated pain can have long-term consequences, including preprocedural anxiety, hyperalgesia, needle fears and avoidance of health care.• Simple, cost-effective, evidence-based pain-relieving strategies are available.• A "3-P" approach, combining pharmacologic, physical and psychological factors, improves pain relief.

Research RechercheT he psychosocial health of a pregnant woman and her family is a significant predictor of intrapartum, newborn and postpartum outcomes. [1][2][3][4] A critical review of the literature has identified an association between antenatal psychosocial risk factors and the poor postpartum outcomes of woman abuse, child abuse, postpartum depression and couple dysfunction. 5 Clinicians have indicated that a practical tool to help them systematically collect and record prenatal psychosocial information would be helpful. 6 Although specific and often wellvalidated tools are available to predict or detect child abuse, woman abuse or depression, [7][8][9][10] clinicians are unlikely to use them because of time constraints.1 Other forms aid in collecting more comprehensive antenatal psychosocial data, 11-14 but they are not evidence-based, and were developed to predict obstetric or newborn rather than psychosocial outcomes.In contrast, the Antenatal Psychosocial Health Assessment (ALPHA) form (Appendix 1) was designed to identify antenatal psychosocial risk factors for poor postnatal psychosocial outcomes. It incorporates 15 risk factors found through critical literature review 5 to be associated with woman abuse, child abuse, postpartum depression and couple dysfunction.15 These risk factors are grouped intuitively by topic, with suggested questions, into 4 categories: family factors, maternal factors, substance use and family violence. The ALPHA form has been field-tested by obstetricians, family physicians, midwives and nurses, 15,16 who have found using it to be feasible and useful. 15 Pregnant women appreciate and feel comfortable with the psychosocial enquiry. 15 The ALPHA form was developed as a screening tool to help providers systematically identify areas of psychosocial concern. Once feasibility was established, 15 the next step was to determine whether using it in regular practice would increase the number of concerns identified.We sought to determine whether health care providers using the ALPHA form detected more antenatal psychosocial concerns in their pregnant patients than clinicians practising usual prenatal care. A secondary objective was to determine women's and providers' satisfaction with the ALPHA form. MethodsFour communities in Ontario were chosen as study sites, including urban, suburban and small-town practices, with patients from diverse socioeconomic and ethnic backgrounds. Family physicians, obstetricians and midwives were approached at rounds We sought to determine whether health care providers using the ALPHA form detected more antenatal psychosocial concerns among pregnant women than providers practising usual prenatal care. Methods: A randomized controlled trial was conducted in 4 communities in Ontario. Family physicians, obstetricians and midwives who see at least 10 prenatal patients a year enrolled 5 eligible women each. Providers in the intervention group attended an educational workshop on using the ALPHA form and completed the form with enrolled women. The control grou...

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