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Kitzman, H., Olds, D. L., Henderson, C. R., Hanks, C., Cole, R., Tatelbaum, R., et al. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. JAMA: The Journal of the American Medical Association, 278(8), 644–652.

Manuscript screening details
Screening decision Screening conclusion HomVEE procedures and standards version
Passes screens Eligible for review Version 1
Study design details
Rating Design Attrition Baseline equivalence Compromised randomization Confounding factors Valid, reliable measure(s)
High Randomized controlled trial Low Difference in SES, but controlled in analysis. None None Not assessed in manuscripts reviewed before 2021
Notes:

In 2020, HomVEE updated this review to move the NCAST Child Responsiveness (total score) from the Child Development and School Readiness domain to the Positive Parenting Practices domain because ACF determined that outcomes assessed with the NCAST, including the NCAST total score, most appropriately belong in the Positive Parenting Practices domain.

Study characteristics
Study participants The sample included pregnant, first-time mothers who were less than 29 weeks pregnant. Women were recruited through an obstetrical clinic if they had no previous live births, no chronic illnesses linked to fetal growth retardation or preterm delivery, and at least two of the following sociodemographic characteristics: unmarried, less than 12 years of education, and unemployed. From June 1990 through August 1991, 1,290 women were invited to participate and 1,139 consented and were randomly assigned. At enrollment, 92 percent of the women enrolled were African American, 98 percent were unmarried, and 64 percent were age 18 or younger. This study measured the sample up through the child’s 24th month. At the 24-month follow-up, the sample included 675 women, 208 in the program group and 467 in the comparison group.
Setting Memphis, Tennessee
Intervention services The study included two treatment groups. The first treatment group received home visits from a nurse during pregnancy and two postpartum visits (one in the hospital prior to discharge and one in the home). The treatment group also received the screening and transportation services described below for the comparison groups. The second treatment group received the same services as the first treatment group, but the home visiting continued until the child was 2 years old. On average, the nurses completed 7 home visits during pregnancy and 26 home visits postpartum. Nurses used a detailed protocol for each visit, which focused on health-related behaviors, parenting, education, and employment. The two treatment groups were combined for the prenatal analysis. Only the second treatment group was followed for postnatal outcomes.
Comparison conditions The study included two comparison groups. The first comparison group received taxicab transportation for prenatal care appointments. The second comparison group received the transportation plus developmental screening and referral to services when the children were 6, 12, and 24 months old. The two comparison groups were combined for the prenatal analysis. Only the second group was followed for postnatal outcomes.
Subgroups examined This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report).
Subgroups are not listed for manuscripts reviewed before 2021.
Funding sources Five federal agencies: the National Institute of Nursing Research (grant NR01-01691-05); the Bureau of Maternal and Child Health (grant MCJ 360579); the Administration for Children and Families (grant 90PJ0003); the Office of the Assistant Secretary for Planning and Evaluation; and the National Center for Child Abuse and Neglect, through a transfer of funds to the National Institute of Nursing Research. Four private foundations: the Robert Wood Johnson Foundation, Princeton, NJ (grants 017934 and 11084); the Carnegie Corporation of New York, New York, NY (grant 5492); the Pew Charitable Trusts, Philadelphia, Pa (grants 88-0211-000 and 93-02363-000); and the William T. Grant Foundation, New York, NY (grants 88-1246-88 and 91-1246-88), including a William T. Grant Faculty Scholars Award 86108086) and a Senior Research Scientist Award (1-K05-MH01382-01) to Dr. Olds.
Author affiliation David L. Olds, a study author, is a developer of this model.
Peer reviewed Peer reviewed status is not listed for manuscripts reviewed before 2021.

Findings that rate moderate or high

Child development and school readiness
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High CBCL (total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 1,082 children Adjusted mean = 46.00 Adjusted mean = 49.20 Mean difference = -3.20 Not available Not statistically significant,
p > 0.05
High BSID (total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 1,082 children Adjusted mean = 94.50 Adjusted mean = 94.30 Mean difference = 0.20 Not available Not statistically significant,
p > 0.05
Child health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Birth weight, grams
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) Birth 1,082 children Adjusted mean = 3032.20 Adjusted mean = 3050.40 Mean difference = -18.20 Not available Not statistically significant,
p > 0.05
High 5-minute Apgar
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children Adjusted mean = 8.60 Adjusted mean = 8.70 Mean difference = -0.10 Not available Not statistically significant,
p > 0.05
High Gestational age, weeks
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children Adjusted mean = 39.00 Adjusted mean = 39.00 Mean difference = 0.00 Not available Not statistically significant,
p > 0.05
High Indicated preterm delivery (percentage)
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children % (adjusted) = 3.00 Adjusted mean % = 3.00 OR = 1.00 HomVEE calculated = 0.00 Not statistically significant,
p > 0.05

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Statistical significance reported on authors’ calculations of the odds ratio.

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The odds ratio compares the nurse-visited group to the comparison.

High Intrauterine growth restriction (percentage)
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children % (adjusted) = 9.00 Adjusted mean % = 9.00 OR = 1.00 HomVEE calculated = 0.00 Not statistically significant,
p > 0.05

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Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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The odds ratio compares the nurse-visited group to the comparison.

High Low birth weight (percentage < 2500 g)
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children % (adjusted) = 15.00 Adjusted mean % = 14.00 OR = 1.10 HomVEE calculated = 0.05 Not statistically significant,
p > 0.05

footnote2

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Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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The odds ratio compares the nurse-visited group to the comparison.

High Preterm (less than 37 weeks, percentage)
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children % (adjusted) = 11.00 Adjusted mean % = 13.00 OR = 0.80 HomVEE calculated = -0.12 Not statistically significant,
p > 0.05

footnote2

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Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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The odds ratio compares the nurse-visited group to the comparison.

High Spontaneous preterm delivery, percentage
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children % (adjusted) = 8.00 Adjusted mean % = 9.00 OR = 0.80 HomVEE calculated = -0.08 Not statistically significant,
p > 0.05

footnote2

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Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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The odds ratio compares the nurse-visited group to the comparison.

High Breastfeeding attempted, percentage
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children % (adjusted) = 26.00 Adjusted mean % = 16.00 OR = 1.90 HomVEE calculated = 0.37 Statistically significant,
p < 0.01

footnote6

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The odds ratio compares the nurse-visited group to the comparison.

High Immunizations up to date, percentage
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children % (adjusted) = 70.00 Adjusted mean % = 68.00 OR = 1.10 HomVEE calculated = 0.06 Not statistically significant,
p > 0.05

footnote6

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The odds ratio compares the nurse-visited group to the comparison.

High Number of well-child visits
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children Adjusted mean = 4.60 Adjusted mean = 4.80 Mean difference = -0.20 Not available Not statistically significant,
p > 0.05
Family economic self-sufficiency
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Employed during pregnancy
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers % (adjusted) = 6.00 Adjusted mean % = 3.00 OR = 2.00 HomVEE calculated = 0.44 Not statistically significant,
p > 0.05

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Authors report the difference in this outcome to be statistically significant, p < 0.10, which is greater than the acceptable alpha for this review (&alpha; = 0.05).

High In school during pregnancy
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers % (adjusted) = 44.00 Adjusted mean % = 41.00 OR = 1.20 HomVEE calculated = 0.07 Not statistically significant,
p > 0.05

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Statistical significance reported on authors’ calculations of the odds ratio.

High Used other community services
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers % (adjusted) = 29.00 Adjusted mean % = 20.00 OR = 1.80 HomVEE calculated = 0.30 Statistically significant,
p ≤ 0.01

footnote2

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Statistical significance reported on authors’ calculations of the odds ratio.

High Months worked, 0–12 months postpartum
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 681 mothers Adjusted mean = 2.20 Adjusted mean = 1.70 Mean difference = 0.50 Not available Not statistically significant,
p > 0.05
High Months on AFDC , 13–24 months postpartum
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers Adjusted mean = 7.80 Adjusted mean = 8.40 Mean difference = -0.60 Not available Not statistically significant,
p > 0.05

footnote3

Submitted by user on

Authors report the difference in this outcome to be statistically significant, p < 0.10, which is greater than the acceptable alpha for this review (&alpha; = 0.05).

High Months on AFDC , 0–12 months postpartum
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 681 mothers Adjusted mean = 7.30 Adjusted mean = 7.60 Mean difference = -0.30 Not available Not statistically significant,
p > 0.05
High Months worked, 13–24 months postpartum
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers Adjusted mean = 3.40 Adjusted mean = 3.40 Mean difference = 0.00 Not available Not statistically significant,
p > 0.05
Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Diastolic blood pressure
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 66.80 Adjusted mean = 67.50 Mean difference = -0.70 Not available Not statistically significant, p ≥ 0.05

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This mean difference, calculated by <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>, is within |0.01| of the difference reported by the authors, with the discrepancy likely due to rounding error.

High Gestational weight gain
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 14.60 Adjusted mean = 14.90 Mean difference = -0.30 Not available Not statistically significant, p ≥ 0.05
High Number of Gardnerella infections
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 0.06 Adjusted mean = 0.07 Mean difference = -0.01 Not available Not statistically significant, p ≥ 0.05

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Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of hospitalizations during pregnancy
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 0.15 Adjusted mean = 0.13 Mean difference = 0.02 Not available Not statistically significant, p ≥ 0.05

footnote1

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Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of sexually transmitted diseases
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 0.22 Adjusted mean = 0.21 Mean difference = 0.01 Not available Not statistically significant, p ≥ 0.05

footnote1

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Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of yeast infections
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 0.14 Adjusted mean = 0.19 Mean difference = -0.05 Not available Statistically significant,
p ≤ 0.05

footnote1

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Statistical significance reported on authors’ calculations of the log-incidence difference.

High Obstetrical evaluation visits (total)
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 2.80 Adjusted mean = 2.80 Mean difference = 0.00 Not available Not statistically significant, p ≥ 0.05

footnote9

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This mean difference, calculated by <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>, is within |0.01| of the difference reported by the authors, with the discrepancy likely due to rounding error.

High Pregnancy-induced hypertension (percentage)
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers % (adjusted) = 13.00 Adjusted mean % = 20.00 OR = 0.60 HomVEE calculated = -0.31 Statistically significant,
p ≤ 0.01

footnote2

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Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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The odds ratio compares the nurse-visited group to the comparison.

High Standard prenatal care visits (total)
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 6.20 Adjusted mean = 6.50 Mean difference = -0.30 Not available Not statistically significant, p ≥ 0.05
High Systolic blood pressure
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 111.70 Adjusted mean = 112.60 Mean difference = -0.90 Not available Not statistically significant, p ≥ 0.05
High Anxiety (MHI), 24 months postpartum, standardized
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers Adjusted mean = 99.10 Adjusted mean = 100.30 Mean difference = -1.20 Not available Not statistically significant, p ≥ 0.05
High Depression (MHI), 24 months postpartum, standardized
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers Adjusted mean = 99.50 Adjusted mean = 100.10 Mean difference = -0.06 Not available Not statistically significant, p ≥ 0.05
High Pearlin Mastery, 24 months postpartum, standardized
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers Adjusted mean = 101.60 Adjusted mean = 99.40 Mean difference = 2.20 Not available Statistically significant,
p < 0.01
High Spontaneous abortion, 0–24 months postpartum (percentage)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers % (adjusted) = 5.00 Adjusted mean % = 3.00 OR = 1.50 HomVEE calculated = 0.32 Not statistically significant, p ≥ 0.05

footnote6

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The odds ratio compares the nurse-visited group to the comparison.

High Subsequent live birth, 0–24 months postpartum (percentage)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers % (adjusted) = 22.00 Adjusted mean % = 31.00 OR = 0.60 HomVEE calculated = -0.28 Statistically significant,
p < 0.01

footnote2

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Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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The odds ratio compares the nurse-visited group to the comparison.

High Subsequent pregnancy, 0-24 months postpartum (percentage)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers % (adjusted) = 36.00 Adjusted mean % = 47.00 OR = 0.60 HomVEE calculated = -0.28 Statistically significant,
p < 0.01

footnote2

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Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

Submitted by user on

The odds ratio compares the nurse-visited group to the comparison.

High Therapeutic abortion, 0–24 months postpartum (percentage)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers % (adjusted) = 2.00 Adjusted mean % = 4.00 OR = 0.50 HomVEE calculated = -0.43 Not statistically significant, p ≥ 0.05

footnote6

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The odds ratio compares the nurse-visited group to the comparison.

Positive parenting practices
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High HOME (emotional/ cognitive stimulation)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 675 mothers Adjusted mean = 32.30 Adjusted mean = 30.90 Mean difference = 1.40 Not available Statistically significant,
p < 0.01
High NCAST Child Responsiveness (total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 1,082 children Adjusted mean = 17.70 Adjusted mean = 17.40 Mean difference = 0.30 Not available Not statistically significant,
p > 0.05
High NCAST Maternal Teaching (total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 675 mothers Adjusted mean = 36.70 Adjusted mean = 36.50 Mean difference = 0.20 Not available Not statistically significant,
p > 0.05
High Beliefs associated with child abuse (AAPI total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 672 mothers Adjusted mean = 98.70 Adjusted mean = 100.50 Mean difference = -1.80 Not available Statistically significant,
p < 0.01
Reductions in child maltreatment
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Number of days hospitalized–injuries/ingestions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children Adjusted mean = 0.04 Adjusted mean = 0.18 Mean difference = -0.14 Not available Statistically significant,
p < 0.01

footnote1

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Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of emergency department visits–injuries/ingestions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children Adjusted mean = 0.33 Adjusted mean = 0.34 Mean difference = -0.01 Not available Not statistically significant,
p > 0.05

footnote1

Submitted by user on

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of hospitalizations–injuries/ingestions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children Adjusted mean = 0.01 Adjusted mean = 0.03 Mean difference = -0.02 Not available Not statistically significant,
p > 0.05

footnote1

Submitted by user on

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of outpatient visits–injuries/ingestions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children Adjusted mean = 0.11 Adjusted mean = 0.20 Mean difference = -0.09 Not available Statistically significant,
p ≤ 0.05

footnote1

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Statistical significance reported on authors’ calculations of the log-incidence difference.

High Total number of health care encounters–injuries/ingestions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children Adjusted mean = 0.43 Adjusted mean = 0.56 Mean difference = -0.13 Not available Statistically significant,
p ≤ 0.05

footnote1

Submitted by user on

Statistical significance reported on authors’ calculations of the log-incidence difference.