Novel Nutrition Education Approaches for Health Promotion: From Investigating Problems to Finding Solutions.

The aim of the Nutrients Special Issue "Implications of Nutrition Education, for Health, Behavior, and Lifestyle" is to publish original research articles and reviews that report the design and implementation of nutrition education intervention programs and their effectiveness in terms of lifestyle, health, and wellbeing [...].

An investigation of Australian midwifery curricula for obesity management and health behaviour change training.

INTRODUCTION: Fifty percent of Australian women enter pregnancy overweight or obese. Unfortunately, few women receive weight management advice from health professionals during pregnancy. The aim of this study was to investigate current midwifery curricula from Australian universities to identify strengths and deficits in the teaching of preconception and antenatal weight management. METHODS: Midwifery courses from 20 universities were identified. Of the 568 units taught at these universities, 252 course outlines were obtained. Data were coded using the qualitative analysis technique of Framework Analysis for the following main themes: 1) the effect of weight, diet and physical activity on health outcomes for women who are pregnant or planning a pregnancy; 2) weight management advice in any population; and 3) health behaviour change techniques in any context. RESULTS: Analysis revealed a variety of teaching methods and skills training that emphasised the importance of clinical judgement and autonomous clinical practice, in conjunction with critical enquiry and sourcing reputable evidence. There was little evidence, however, that weight management advice was taught explicitly to midwifery students in the curricula. DISCUSSION: A greater emphasis on skilling midwifery students to address weight gain during pregnancy, and behavioural techniques to achieve this, is required.

Developing behavioural training services to meet defined standards within an Australian statewide disability service system and the associated client outcomes.

BACKGROUND: LaVigna, Christian, and Willis (2005) reported on a project where Institute for Applied Behaviour Analysis (IABA) staff trained a professional team in New Zealand (NZ) to provide behavioural services that met defined criteria. The NZ team was then trained to train other practitioners to meet the same professional standards. However, no client outcomes were reported in that study. METHOD: This study replicates the NZ study within disability services in Tasmania, Australia. Further, this study examined the associated client outcomes and the impact of the training on severity ratings of subsequent referrals. RESULTS: Tasmanian trainers trained participants to provide behavioural services that met the same professional standards. Client behavioural outcome data showed significant improvement. Referral data showed decreases in severity ratings. CONCLUSIONS: The trainer of trainers process is effective in training staff to meet defined professional standards, including desired client outcomes, and to effectively make positive behaviour support accessible to a large number of people.

What's new in sex therapy (CME).

INTRODUCTION: "Is there anything new in sex therapy?" Has the field of sex therapy been stagnating and failing to develop new treatments? Clearly, the important pharmaceutical advances of the past 11 years have overshadowed the developments in the field of sex therapy. AIM: The goal of this manuscript is to call attention to the recent innovations in the field of sex therapy. METHOD: Review of the literature. RESULTS: There are four candidates to consider: (i) combination medical and psychological therapy; (ii) the technique of mindfulness for women with complaints of arousal disorder and low sexual desire; (iii) Internet sexual therapy and; and (iv) reconceptualization of genital pain and psychological interventions for women with these complaints. This article reviews the literature in these areas and offers commentary regarding the benefits and limitations of the research. Finally, future directions for research in these four areas are discussed. CONCLUSIONS: Psychological innovation and intervention remains a vital aspect in the field of sexual medicine. New methods continue to be developed and appraised and the methodology, design, and sophistication of sex therapy outcome research have significantly advanced.

Evaluation of an efficient method for training staff to implement stimulus preference assessments.

We used a brief training procedure that incorporated feedback and role-play practice to train staff members to conduct stimulus preference assessments, and we used group-comparison methods to evaluate the effects of training. Staff members were trained to implement the multiple-stimulus-without-replacement assessment in a single session and the paired-stimulus method in another single session. In all 16 cases (2 assessments for 8 trainees), correct responding increased to over 80% accuracy; in 14 of those 16 cases, it increased to over 90% accuracy. Thus, training produced mastery-level performance in a single training session in almost all cases.

ACT team members' responses to training in recovery-oriented practices.

To further our understanding of the consequences of training in recovery principles and practices, this study examined ACT team workers' responses to a state-wide recovery training initiative. Analysis of trainees' comments revealed ten themes expressing endorsement of or difficulties with recovery-oriented practices. Trainees' comments supporting a recovery orientation described service recipients in holistic terms and described using various techniques to attain "client-centered" goals. Recovery-oriented tasks that posed dilemmas for trainees were: reconciling system-centered goals with recipients' goals, establishing collaborative relationships with recipients, and using a recovery orientation with recipients who are in crisis and/or who "don't admit to being mentally ill."

[KES--training for parents of children with conduct behaviour problems]. / Kompetenztraining für Eltern sozial auffälliger und aufmerksamkeitsgestörter Kinder (KES).

Conduct behaviour problems are the most frequent problems in childhood and adolescence. They make special demands on parenting. Possible causes for the emergence and maintenance of this distinctive features can be summarized in a bio-psychosocial disturbance model. The parental educating behaviour is thereby usually not the cause of the childlike behaviour problems, but can stabilize initial behaviour problems. Parenting trainings are therefore considered as an effective possibility of intervention and prevention of childlike behaviour disturbances. In this article contents and effectiveness of the "Kompetenztraining für Eltern sozial auffälliger und aufmerksamkeitsgestörter Kinder (KES)" (Lauth a. Heubeck 2005) are to be represented. The KES is a secondary preventive parenting training, which is offered as an intensive short time intervention and accomplished in groups. The contents of the training fit with the individual problems of parents' everyday educating situations. In the available study this training is operate in three variants in order to examine differential training effects apart from the general effectiveness. The results show a general effectiveness of the KES. Burdens in family educating situations can be reduced likewise the experienced stress in the family. The results also indicate, that the parents of the group with behaviour exercises seems to benefit most from the training. They do not only speak about their problems (alternative treatment) or get suggestions for changes in the educating behaviour (group without behaviour exercises). They are also requested to practice the connected skills in the form of role plays and homework to be able to transfer into everyday life.

Enhancing treatment team process through mindfulness-based mentoring in an inpatient psychiatric hospital.

The authors investigated changes in treatment team functioning in an adult inpatient psychiatric hospital after the implementation of a mindfulness-based mentoring intervention. Using a multiple baseline across treatment teams design, the authors assessed levels of functioning of three treatment teams using a 50-item rating scale and then introduced mindfulness-based mentoring successively across the treatment teams. Following intervention, four follow-up assessments at 3-month intervals were undertaken to assess the durability of the enhanced treatment team functioning levels in the absence of mentoring. Results showed that with the introduction of mindfulness-based mentoring, treatment team performance was enhanced, patients'attendance at therapeutic groups and individual therapy sessions was maximized, and patient and staff satisfaction with treatment team functioning was substantially increased, with patient satisfaction showing greater gains than staff satisfaction. Mindfulness-based mentoring may be an efficient and effective intervention for enhancing and maintaining the performance of treatment teams in adult psychiatric hospitals.

A systems approach to behavioral neurobiology: integrating psychodynamics and neuroscience in a psychiatric curriculum.

In the practice of medicine, an understanding of the biological functioning of organs and organ systems is the basis for theories of pathology and clinical practice. If psychoanalysis is to be accepted by the medical and psychiatric community, it must be based on a sophisticated understanding of the organ from which mental and emotional experiences emanate and use scientifically acceptable language. Each approach to psychotherapy has its own vocabulary for describing neuropsychological processes. Neurobiological vocabulary provides the various factions "neutral ground" upon which to carry on a multidisciplinary integrative dialogue. An understanding of behavioral neuroscience allows the therapist to look beyond the labels that spawn division and identify unifying biological principles that are described in a variety of ways in a multitude of theories. We contend that the neural network/representational approach to neurobiology views human mental experience as the result of multiple complex integrated systems, and is therefore holistic and antireductionistic in its perspective. Such a biologically informed psychotherapy facilitates integration of skill sets and flexibility in technique. With these principles in mind, the therapist can base his or her approach to the patient based on these principles rather than on devotion to one particular "school" or another. Because behavioral neuroscience supports many of the basic tenets of psychoanalytic theory, such an integrative psychotherapy would be psychodynamically informed. In this paper, we outline some of the ideas we present in our neuroscience course and how we relate biological concepts with some core principles of psychodynamics and psychotherapy.

The preliminary effectiveness of migraine lay trainers in a home-based behavioural management training.

OBJECTIVES: This pilot study examined the effectiveness and trainer skills of the first migraine lay trainers (MLTs). METHODS: In a stepwise training program eight MLTs participated in a behavioural management training (BMT) aimed at the prevention of migraine attacks by proactive relaxation and trigger management. After successful reduction of their migraine attacks, three MLTs provided BMT under supervision at home to one fellow patient and subsequently to a small group. RESULTS: Migraine frequency was significantly reduced in five out of eight patients trained by MLTs (mean 48%) and medication use decreased substantially in four patients (mean 47%). Qualities of MLTs concerned their motivational assistance, knowledge of premonitory symptoms and exchange of disease specific problems. Pitfalls were that migraine symptoms hampered an active guidance of the sessions and providing tailored feedback was difficult. CONCLUSION: The first MLTs were successful in training fellow patients in behavioural prevention of migraine attacks. PRACTICE IMPLICATIONS: Continuous supervision of MLTs health and trainer skills is recommended but is likely to have implications for cost-effectiveness.

Implementing integrated treatment for co-existing substance use and severe mental health problems in assertive outreach teams: training issues.

This study sought to evaluate systematically training and implementation of a specific integrated treatment approach for co-occurring problem substance use and mental health within existing assertive outreach (AO) teams. The AO team was treated as a whole unit rather than as individual clinicians. They were provided with training and supervision to deliver a cognitive--behavioural integrated treatment approach. In a quasi-experimental time-lag design three teams were trained immediately and two others after an 18-month delay. There was evidence that teams acquired confidence and skills relevant to working with combined problems and that these gains were maintained over time. These results were replicated in the two teams trained after the delay. This study suggests that training mental health staff to use an integrated treatment approach is well received and produces lasting changes in confidence and skills. However, there are a number of issues related to staff training, shifting attitudes and implementation of integrated approaches into routine mental health practice. These issues are considered and suggestions made for staff training.

Effectiveness of smoking cessation interventions: review of evidence and implications for best practice in Australian health care settings.

OBJECTIVE: To review the evidence of the effectiveness of various smoking cessation methods and appropriateness for use in Australian health care settings. METHODS: Cochrane and other existing reviews and meta-analyses of evidence were the basis for the review. Systematic literature searches were also conducted to identify relevant controlled trials published internationally between January 1999 and May 2002. The main inclusion criteria for studies were use of a controlled evaluation design and an outcome measure of continuous abstinence from smoking for at least five months. A three-tiered grading system for strength of evidence was used. RESULTS: Clinic and hospital systems to assess and document tobacco use and routine provision of cessation advice can double long-term quit rates. While brief intervention can achieve a significant effect at population level, at individual level there is a strong dose response between the number and length of sessions of tobacco cessation counselling and its effectiveness. Effective behavioural interventions can increase cessation rates by 50-100% compared with no intervention. Some pharmacotherapies are safe and also help to substantially increase cessation rates. CONCLUSIONS: Effective behavioural and pharmacological methods of tobacco cessation are available. IMPLICATIONS: Every smoker should be offered evidence-based advice and treatment to quit smoking. This includes pharmacotherapy, unless contra-indicated. Health professionals and health care settings can play a significant role in motivating and assisting smokers to quit.

Mentoring treatment teams to integrate behavioral and psychopharmacological treatments in developmental disabilities.

Individuals with developmental disabilities often have a concomitant psychiatric disorder severe enough to require treatment. The behavioral endpoint of psychiatric disorders may require integrated behavioral and psychopharmacological treatments to stabilize their condition and enhance their quality of life. We used a mindfulness-based mentoring model to facilitate the integration of behavioral and psychopharmacological treatments at the treatment team level. Using a multiple baseline design across treatment teams, we assessed the degree of integration of these two treatment modalities using a 23-item rating scale, and then introduced mentoring successively across the three treatment teams. Following mentoring, six follow-up assessments at monthly intervals were undertaken to assess functioning of the treatment teams in the absence of mentoring. The low levels of integration of behavioral and psychopharmacological treatments occurring during baseline improved significantly within each team commensurate with the mentoring. Further, the enhanced treatment team functioning was maintained during a 6-month follow-up period. Mentoring of treatment teams may be an effective first step in integrating behavioral and psychopharmacological treatments that are deemed essential in the care and treatment of individuals with developmental disabilities and mental illness.

Effects of training in management of child behavior for dental hygiene students.

The reliability and validity of a Confidence of Dental Hygienist in Child Management Scale were examined. Forty-eight dental hygiene students, nine dental staff, and thirty-one dentists were subjects for the reliability and validity scale. The acceptable level of the reliability on the Scale was shown by internal consistency and stability. The confidence scores of the clinician's group were significantly higher than the confidence scores of the students. The reliability and validity of the Confidence Scale were established. Next, we evaluated the effect of behavioral science training, using videotape feedback and role playing on twelve dental hygiene students. Six students received the training, the other six students, the controls, had no training. The confidence scores of the training group were significantly higher than those of the control group, demonstrating that the training was effective for dental hygiene students.

Beyond the herring sandwich phenomenon: a holistic constructivist approach to teacher education.

This article explains how key principles of holistic constructivism were used to revise a graduate teacher education program and develop a portfolio model of evaluation. The program is built around individualized portfolios, applied projects, collaborative work, student evaluation, and professional presentation of student work. Three students in the program discuss how the principles of the revised program and the portfolio process affected their education and their teaching. The authors present strategies for helping teacher education students create innovative educational programs in their schools.

Modifying the behavior of the violent patient.

Different behavioral techniques are briefly described for treating the violent patient in a hospital setting. Emphasis is placed on doing a careful assessment of the situation and behavior before attempting a behavioral intervention. It is also emphasized that all staff members involved be adequately trained, otherwise the procedures tend to fail. Techniques include strategies for changing the environment, as well as using relaxation procedures, systematic desensitization, differential reinforcement schedules, token economies, response cost, time out, and social skills training. Multi-component programs are also briefly mentioned. The paper emphasizes that violent behavior can be greatly reduced if approached in a systematic way, using procedures based on sound research methodology.

Teaching parents to conduct behavioral relaxation training with their hyperactive children.

Three boys meeting multiple criteria for hyperactivity received Behavioral Relaxation Training (BRT) in their homes from their parents, under the supervision of the experimenter. BRT involved modeling, prompting, token reinforcement, and praise, for ten overt relaxed behaviors. All children learned to relax to a criterion of at least 80% on the Behavioral Relaxation Scale (BRS), an objective measure of relaxation. Frontalis EMG levels were correlated with BRS scores for two children. Proficiency was maintained at one and three-month follow-ups. All children were removed from medication by follow-up. Parent ratings of hyperactive behavior on two standardized questionnaires showed improvements from baseline to follow-up. Teacher ratings of problem behavior were less consistently positive. The concept of relaxation as a skill rather than a state, and its implications as an alternative to medication therapy, are discussed.

Contingency contracting with delinquents: effects of a brief training manual on staff contract negotiation and writing skills.

A brief training manual was developed for the purpose of teaching child-care workers to contingency contract with delinquent youths living in residential care facilities. The manual was designed to require minimal supplementary training by a professional. In Experiment 1 a multiple baseline design was used to assess the effect of the manual on 4 child-care workers' contract negotiation and writing behaviors. Experiment 2 consisted of four A-B systematic replications. Behaviors were assessed within the context of analogue training simulations and generalization tests with delinquent youths. Results from the analogue simulations indicated that the manual was successful in increasing both types of behaviors to a level of proficiency that equaled or surpassed that of behaviorally trained graduate students, and results from the generalization tests indicated that the child-care workers were able to apply their newly acquired contracting skills with delinquent youths. Procedural reliability varied across child-care workers, but was usually high.