Child maltreatment (CM), and domestic violence and abuse (DVA) are highly prevalent violations of human rights, associated with a spectrum of adverse short- and long-term impacts on the health, wellbeing and life opportunities of affected individuals.

Both CM and DVA share multiple common family and environmental risk factors, leading to co-occurrence of CM and DVA in approximately 30% to 60% of households. To date, economic impact studies have considered CM or DVA individually but have not accounted for the impact of co-occurrence on outcomes and subsequent costs to society.

Aims:

• Develop a multi-sectoral incidence-based cost model to quantify the combined lifetime UK societal costs associated with CM and DVA in families.
• Develop an economic model accounting for the interaction between CM, DVA, to estimate the lifetime societal cost, and to evaluate the cost-effectiveness of relevant interventions.
• Develop a web-based resource for the use of local and national decision-makers to explore the impact of adopting alternative policies under user-defined scenarios and assumptions.

Methods:

• Scoping review of relevant economic impact studies focused on CM and/or DVA.
• Systematic review of the current literature to identify all short- and long-term outcomes arising from exposure to CM and DVA in the UK, and to derive the best available estimates for the risks, resource use, health-related quality of life (HRQoL) and costs associated with these outcomes.
• De novo analyses of relevant electronic patient record databases and longitudinal cohort study data to extend the evidence base for costs associated with CM and DVA.
• Using the evidence from objectives 1, 2 and 3, develop an incidence-based cost model to quantify the combined lifetime costs of CM and DVA in families from a societal perspective.
• Identification of interventions and policies suitable for inclusion in a full economic model.
• Develop a full economic model with a lifetime (up to 85 years of age) time horizon, to evaluate the cost-effectiveness of interventions identified in objective  4.

1. investigate  the effectiveness of previous methods of single time point screening for AF , in particular pulse checking at routine influenza vaccination.
2. describe the changing patterns of anticoagulation for AF in the UK over the last 10 years.

Data from the feasibility study of the SAFER programme (https://www.safer.phpc.cam.ac.uk/) will be used to investigate the optimum frequency and pattern of 30 second AF screening using a handheld electronic device.

Systematic reviews of the prognosis of asymptomatic atrial fibrillation as an indication of the prognosis of screen detected AF and of methods of screening for paroxysmal AF (single time point/intermittent/continuous) will be completed.