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Background: : Dysphagia is prevalent in subjects with Parkinson's disease (PD). Swallowing intervention to improve or maintain swallowing function is of major importance as dysphagia may considerably impact physical and psycho‐social health. Aims: : A mixed methods systematic review was conducted to summarize and appraise literature reporting (1) effects of behavioural interventions for swallowing in individuals with PD; and (2) participants' perspectives of swallowing interventions. Methods & Procedures: : Electronic databases were searched systematically in July 2020 for articles published between 2014 and 2020. In addition, studies published between 2000 and 2014 were identified non‐systematically through previous reviews. Peer‐reviewed quantitative and qualitative research in English or German documenting behavioural interventions for swallowing in individuals with a diagnosis of PD was eligible for inclusion. Participants at all disease stages were included. Behavioural interventions included rehabilitative and compensatory strategies. Studies reporting swallowing outcomes with and without a comparative group were included. For each study, the National Health and Medical Research Council level of evidence was defined. Included studies were critically appraised using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. An integrated synthesis was performed after separate analysis of effect data and data reflecting participants' experiences. This review was conducted based on published JBI methodology and the guideline from the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis system was followed. Main Contribution: : A total of 33 studies published in English met the inclusion criteria. Thirty‐one studies reported quantitative data, one was qualitative and one was mixed methods. Intervention effects on swallowing function, swallowing safety and swallowing‐related quality of life were reported for various treatment approaches. Three studies explored how participants perceived the intervention. Overriding themes including subjects' views regarding treatment schedules and levels of effort or comfort associated with the intervention were identified across these studies. Combining evidence of intervention effects and subjects' experiences was possible for one rehabilitative and one compensatory intervention. Conclusions & Implications: : Beneficial effects of swallowing interventions have been reported; however, most experiments were case studies of variable methodological quality. Randomized‐controlled trials with robust methodology to explore treatment effects in larger samples is needed to guide clinical practice. Research reporting subjects' views is scarce. More studies exploring how individuals perceive behavioural interventions for swallowing are necessary to inform clinical decision‐making. WHAT THIS PAPER ADDS: What is already known on the subject: Dysphagia is common in individuals with PD. Swallowing intervention is of major importance as dysphagia may negatively affect physical and psycho‐social health of subjects with PD. What this study adds: Beneficial effects of behavioural interventions for swallowing, including rehabilitative and compensatory strategies, have been reported; however, available data are mostly based on case studies of variable quality. Data on how participants perceive specific behavioural interventions are lacking. Based on the available data, integration of efficacy data and individuals' experiences is limited. What are the clinical implications of this work?: Given the current evidence of intervention effects and individuals' views on behavioural treatment strategies, interventions implemented into clinical practice require careful evaluation on a case‐by‐case basis. More high‐quality research is needed to examine interventions' short‐ and long‐term effects in larger samples to guide clinical practice. In addition to studies evaluating intervention effects, research exploring participants' experiences with interventions is required as a foundation for clinical decision‐making. [ABSTRACT FROM AUTHOR]

Estimates suggest that up to one quarter of people who have a severe learning disability engage in self injurious behaviour (SIB). SIB poses serious risks, both to the person’s physical health and their quality of life. Behavioural approaches have made a contribution to supporting people who engage in SIB, although the last review of these approaches was completed in 2001. The current study provides an update to this review,and has considered papers published over the last 10 years. A systematic search of peer reviewed journals and the ‘grey’ literature identified 34 relevant documents, the majority of which were single case studies. These papers tended to report only on changes in the frequency of SIB during the intervention; one cannot conclude, therefore, about the long term efficacy and generalisability of these approaches. Reductions in SIB were highly variable, often produced in controlled environments and with the use of aversive interventions. The current study presents implications for research and clinical practice and highlights the need for more research reporting on the effectiveness of new interventions such as positive behavioural support. [ABSTRACT FROM AUTHOR]

Background: Despite its importance within behavioural intervention, it remains unclear how best to achieve high procedural fidelity. This paper reviewed studies on improving procedural fidelity of behavioural interventions for individuals with intellectual and developmental disabilities (IDD). Method: A systematic literature search was conducted, which identified 20 studies meeting inclusion criteria. Data were extracted on study design, participant characteristics, intervention, target behaviours, effect sizes, maintenance, generalization and social validity. A quality rating was also applied. Results: A total of 100 participants took part in the included studies. Most participants were teachers working with children in school settings. There was a significant positive correlation between level of procedural fidelity and client outcomes. Feedback was the most commonly employed intervention to improve procedural fidelity. Conclusions: More research should be conducted in environments with high levels of variability such as community homes to determine how to reach and maintain high levels of procedural fidelity. [ABSTRACT FROM AUTHOR]

Objectives: The public health impact of the Irish Making Every Contact Count (MECC) brief intervention programme is dependent on delivery by health care professionals. We aimed to identify enablers and modifiable barriers to MECC intervention delivery to optimize MECC implementation. Design: Online cross‐sectional survey design. Methods: Health care professionals (n = 4050) who completed MECC eLearning were invited to complete an online survey based on the Theoretical Domains Framework (TDF). Multiple regression analysis identified predictors of MECC delivery (logistic regression to predict delivery or not; linear regression to predict frequency of delivery). Data were visualized using Confidence Interval‐Based Estimates of Relevance (CIBER). Results: Seventy‐nine per cent of participants (n = 283/357) had delivered a MECC intervention. In the multiple logistic regression (Nagelkerke's R2 =.34), the significant enablers of intervention delivery were 'professional role' (OR = 1.86 [1.10, 3.15]) and 'intentions/goals' (OR = 4.75 [1.97, 11.45]); significant barriers included 'optimistic beliefs about consequences' (OR =.41 [.18,.94]) and 'negative emotions' (OR =.50 [.32,.77]). In the multiple linear regression (R2 =.29), the significant enablers of frequency of MECC delivery were 'intentions/goals' (b = 10.16, p =.02) and professional role (b = 6.72, p =.03); the significant barriers were 'negative emotions' (b = −4.74, p =.04) and 'barriers to prioritisation' (b = −5.00, p =.01). CIBER analyses suggested six predictive domains with substantial room for improvement: 'intentions and goals', 'barriers to prioritisation', 'environmental resources', 'beliefs about capabilities', 'negative emotions' and 'skills'. Conclusion: Implementation interventions to enhance MECC delivery should target intentions and goals, beliefs about capabilities, negative emotions, environmental resources, skills and barriers to prioritization. [ABSTRACT FROM AUTHOR]

Objectives: Adequate oral hygiene, that is self‐performed infection control, is crucial to prevent periodontal disease. Epidemiological studies reveal poor oral hygiene conditions among Swedish adolescents and indicate a need for more effective prevention programs. The aim of the current study was to analyse adolescents' experiences of a person‐centred, theory‐based, oral health education program for improved oral hygiene. Methods: Data were obtained by interviewing 19 adolescents treated by dental hygienists in accord with the person‐centred education program in a preceding clinical field study (ClinicalTrials.gov NCT02906098). Study participants were selected to reflect a variation of male and female adolescents, treated at clinics in areas with various socio‐demographic profiles within Region Västra Götaland, Sweden. Interviews were audio‐taped, transcribed verbatim and analysed with qualitative content analysis. Results: A main theme was identified: 'Adolescents on a guided and challenging journey towards beneficial oral hygiene behavior'. The results elucidate the importance of a person‐centred approach in therapy. The adolescents described insight on a personal level about the importance of improved oral hygiene as fundamental for behavioural change. Planning and monitoring of the behaviour, with guidance and support by the dental hygienist, was considered to facilitate change and encouraged further behavioural efforts. However, the adolescents expressed a need of reminders and support to keep up oral hygiene routines over time. Conclusions: The study brings knowledge on factors of importance in educational interventions to increase beneficial health behaviours among adolescents and emphasize areas for further improvements of such interventions. [ABSTRACT FROM AUTHOR]

Summary: Insomnia is the most frequent sleep disorder, and the COVID‐19 crisis has massively increased its prevalence in the population, due to psychosocial stress or direct viral contamination. KANOPEE_2 is a smartphone‐based application that provides interactions with a virtual agent to autonomously screen and alleviate insomnia symptoms through an intervention programme giving personalized advices regarding sleep hygiene, relaxation techniques and stimulus‐control. In this proof‐of‐concept study, we tested the effects of KANOPEE_2 among users from all over the country (France) who downloaded the app between 1 June and 26 October 2020 (to focus on effects after the end of COVID‐19 confinement). Outcome measures include insomnia severity (Insomnia Severity Index) and sleep/wake schedules measured by a sleep diary. One‐thousand and thirty‐four users answered the screening interview (Mage = 43.76 years; SD = 13.14), and 108 completed the two‐step programme (Mage = 46.64 years; SD = 13.63). Of those who answered the screening, 42.8% did not report sleep complaints, while 57.2% presented mild‐to‐severe insomnia symptoms. At the end of the intervention, users reported significantly fewer sleep complaints compared with the beginning of the intervention (Insomnia Severity Indexbeginning = 13.58; Insomnia Severity Indexend = 11.30; p < 0.001), and significantly increased their sleep efficiency (sleep efficiencybeginning = 76.46%; sleep efficiencyend = 80.17%; p = 0.013). KANOPEE_2 is a promising solution both to provide autonomous evaluation of individuals' sleep hygiene and reduce insomnia symptoms over a brief and simple intervention. These results are very encouraging for addressing the issue of insomnia management in people exposed to major psychosocial stress and the consequences of COVID‐19 infection. [ABSTRACT FROM AUTHOR]

Summary: Background: Access to evidence‐ and family‐based childhood obesity (FBCO) treatment interventions is a challenge, especially in underserved regions where childhood obesity disparities persist. Objective: Compare two 6‐month FBCO treatment interventions, iChoose (high intensity, parent–child dyads) and Family Connections (low intensity, parents only), in one underserved US region. Methods: This unblinded, RCT reports on effectiveness and implementation outcomes. Eligibility included children ages 5–12 with BMI ≥85th percentile. Analyses included descriptive statistics and intention‐to‐treat Heckman treatment effect models. Results: Enrolled children (n = 139, mean age 10.1 ± 1.7 years, 30% with overweight, 70% with obesity, 45% black, 63% Medicaid) were randomly assigned to iChoose (n = 70) or Family Connections (n = 69). Retention rates were 63% for iChoose and 84% for Family Connection. Among children, 6‐month BMI z‐score changes were not statistically significant within iChoose [BMI z‐score 0.03 (95% CI = −0.13, 0.19)] or Family Connections [BMI z‐score 0.00 (95% CI = −0.16, 0.16)]. Likewise, parents' BMI changes were not statistically significant. No adverse events were reported. Both programmes were delivered with high fidelity (77%–100%). Engagement in core components was 25%–36% for iChoose and 52%–61% for Family Connections. Implementation costs per child with improved BMI z‐score were $2841 for iChoose and $955 for Family Connections. Conclusions: Neither intervention yielded significant improvements in child BMI z‐score or parent BMI, yet both were delivered with high fidelity. Relative to iChoose, descriptive data indicated higher retention, better engagement, and lower costs for Family Connections—suggesting that a lower intensity and parent‐focused programme may better fit the intended audience's context. [ABSTRACT FROM AUTHOR]

Summary: Understanding the predictors of weight loss with lifestyle interventions can help to ascertain the probable outcomes of individuals with obesity who undergo such interventions. This systematic review assessed the evidence of predictors of successful weight loss among individuals who are overweight or with obesity undergoing lifestyle interventions. Four electronic databases (PubMed, Cochrane Reviews, PsychInfo and Wiley) were searched to find relevant literature published in the past 20 years. A total of 1351 titles were identified in the initial search, of which 23 studies were finally included. Predictors were synthesized in the domains of socio‐demographic factors, anthropometric parameters, psychological and behavioural factors and intervention‐based factors. The overall quality of evidence on predictors was then appraised using an adapted GRADE approach. Patient‐specific factors such as being male, older in age, having existing cardiometabolic comorbidities and limited fat intake were significantly associated with weight loss success. Amongst intervention specific predictors, greater initial weight loss and higher adherence to lifestyle advice were associated with greater weight loss success. In this review, initial weight loss came out to be as the most important predictor of successful weight loss outcome. [ABSTRACT FROM AUTHOR]

Pica is the persistent consumption of non‐nutritive, nonfood substances and is associated with adverse health complications. However, there is limited research on interventions for pica in youth. The objective of this study is to systematically review the empirical evidence for the effectiveness of behavioural interventions for pica in children and adolescents and to generate treatment recommendations. A systematic search yielded 823 articles extracted from five databases: CINALH, Family and Society Studies Worldwide, Medline, PsycINFO, and Web of Science. Two reviewers completed initial sorting based on article titles and abstracts. Five reviewers completed sorting based on full article review. Thirty articles were included and double coded for demographic information, co‐morbid conditions, and intervention characteristics. These studies were case studies involving behavioural treatments for pica. Seventeen behavioural interventions were categorized into four treatment approaches: reinforcement‐based, response interruption, "other" interventions, and punishment‐based procedures. Interventions that resulted in near‐zero rates of pica were deemed effective. Findings showed support for contingent reinforcement, discrimination training as part of a combination treatment, physical restraint, time out, and contingent aversive stimulus. No evidence supported the effectiveness of response interruption procedures, including response blocking and visual facial screen. Other coded procedures did not appear effective. We recommend that the least restrictive procedures are implemented first, including a combination treatment with contingent reinforcement and discrimination training. As needed, more restrictive procedures can be added to the treatment package. This review will facilitate future empirical work and assist clinicians with treatment options for pica in youth. High‐quality trials are needed. [ABSTRACT FROM AUTHOR]

Introduction: India's national AIDS Control Organization implemented World Health Organization's option B+ HIV prevention of mother‐to‐child transmission (PMTCT) guidelines in 2013. However, scalable strategies to improve uptake of new PMTCT guidelines to reduce new infection rates are needed. This study assessed impact of Mobile Health‐Facilitated Behavioral Intervention on the uptake of PMTCT services. Methods: A cluster‐randomized trial of a mobile health (mHealth)‐supported behavioural training intervention targeting outreach workers (ORWs) was conducted in four districts of Maharashtra, India. Clusters (one Integrated Counselling and Testing Center (ICTC, n = 119), all affiliated ORWs (n = 116) and their assigned HIV‐positive pregnant/postpartum clients (n = 1191)) were randomized to standard‐of‐care (SOC) ORW training vs. the COMmunity home Based INDia (COMBIND) intervention – specialized behavioural training plus a tablet‐based mHealth application to support ORW‐patient communication and patient engagement in HIV care. Impact on uptake of maternal antiretroviral therapy at delivery, exclusive breastfeeding at six months, infant nevirapine prophylaxis, and early infant diagnosis at six months was assessed using multi‐level random‐effects logistic regression models. Results: Of 1191 HIV‐positive pregnant/postpartum women, 884 were eligible for primary outcome assessment; 487 were randomized to COMBIND. Multivariable analyses identified no statistically significant differences in any primary outcome by study arm. COMBIND was associated with higher uptake of exclusive breastfeeding at two months (adjusted Odds Ratio (aOR), 2.10; 95% CI 1.06 to 4.15) and early infant diagnosis at six weeks (aOR, 2.19; 95% CI 1.05 to 3.98) than SOC. Conclusions: The COMBIND intervention was easily integrated into India's existing PMTCT programme and improved early uptake of two PMTCT components that require self‐motivated health‐seeking behaviour, thus providing preliminary evidence to support COMBIND as a potentially scalable PMTCT strategy. Further study would identify modifications needed to optimize other PMTCT outcomes. [ABSTRACT FROM AUTHOR]

Background Behavioural interventions are frequently used to address sleep problems in people with intellectual disabilities (ID). The current study aimed to systematically review evidence on the efficacy of behavioural interventions for children and adults with ID and sleep problems. Method Electronic and hand searches identified seven studies for inclusion ( N = 169). Standardised mean difference effect sizes ( d) were calculated for group studies ( N = 4). Non-overlap effect sizes (Tau-U) were calculated for single case experimental design studies (SCEDs; N = 3). Results A large effect size (weighted d = 0.923, confidence interval: 0.705 to 1.151) across group studies indicated large improvements in sleep problems following behavioural intervention. Effect size across SCEDs (weighted Tau-U: 0.528, confidence interval: 0.351 to 0.705) indicated a 53% improvement compared with baseline. Sleep initiation and sleep maintenance problems showed significant improvements post-intervention. Follow-up effects were less consistent across study designs and suggested that some sleep problems maintain gains better than others. Conclusion Meta-analytic evidence from group and SCEDs can provide complementary information about efficacy. Findings propose that behavioural interventions are a promising evidence-based practice for improving sleep problems in people with ID. [ABSTRACT FROM AUTHOR]

Recent research has provided evidence that bariatric surgery maximizes long-term weight loss in patients with severe obesity. However, a substantial number of patients experience poor weight loss outcome and weight regain over time. Post-operative behavioural management may facilitate long-term weight control in bariatric surgery population. The objective of this systematic review and meta-analysis was to determine the effects of post-operative behavioural management on weight loss following bariatric surgery. Eligible articles were systematically searched in electronic databases. Among the 414 citations, five randomized controlled trials, two prospective and eight retrospective cohort trials analysing behavioural lifestyle interventions and support groups fulfilled the inclusion criteria. The main finding is that behavioural management had a positive effect on weight loss following surgery. In 13 studies, patients receiving behavioural management had greater weight loss than patients receiving usual care or no treatment. A meta-analysis of five randomized controlled trials suggests greater weight loss in patients with behavioural lifestyle interventions compared with control groups. Post-operative behavioural management has the potential to facilitate optimal weight loss following bariatric surgery, but conclusions were limited by the small and heterogeneous samples of studies. A more rigorous empirical evaluation on its clinical significance is warranted to improve effectiveness of bariatric surgery. [ABSTRACT FROM AUTHOR]

Aims To conduct an updated systematic review and the first meta-analysis of experimental trials investigating the acute effects of short bouts of physical activity ( PA) on strength of desire ( SoD) and desire to smoke ( DtS) using individual participant data ( IPD). Methods A systematic review of literature and IPD meta-analyses included trials assessing the acute effects of shorts bouts of PA on SoD and DtS among temporarily abstaining smokers not using pharmaceutical aids for smoking cessation. Authors of eligible studies were contacted and raw IPD were obtained. Two-stage and one-stage IPD random-effects meta-analyses were conducted. Participants engaging in PA were compared against control participants, using post-intervention SoD and DtS with baseline adjustments. Results A two-stage IPD meta-analysis assessing effects of PA on SoD yielded an average standardized mean difference ( SMD) between PA and control conditions (across 15 primary studies) of −1.91 [95% confidence interval ( CI): −2.59 to −1.22]. A two-stage IPD meta-analysis assessing effects of PA on DtS yielded an average SMD between PA and control conditions (across 17 primary studies) of −2.03 (95% CI: −2.60 to −1.46). Additional meta-analyses, including those using a one-stage model, those including only parallel arm studies and meta-analyses comparing only moderate exercise against a control condition, showed significant craving reduction following PA. Despite a high degree of between-study heterogeneity, effects sizes of all primary studies were in the same direction, with PA showing a greater reduction in cravings compared with controls. Conclusions There is strong evidence that physical activity acutely reduces cigarette craving. [ABSTRACT FROM AUTHOR]

Background This review describes procedures to reduce and eliminate physical restraint of people with intellectual disability. One approach is to assess antecedent conditions associated with restraint and change them so that they no longer produce restraint-provoking behaviour. A second approach is to decrease the duration of restraint by establishing a fixed-time release (FTR) criterion. Methods Research supporting these approaches within community-based service settings are presented. Results Physical restraint can be effectively reduced and eliminated using antecedent intervention procedures and FTR contingencies. Conclusions Future research on physical restraint reduction and elimination should be conducted among people with intellectual disability. Intervention should include explicit therapeutic goals and methods that are acceptable to service providers. Outcome evaluation should focus on long-term follow-up over months and years. Finally, organizations serving people who have intellectual disability should approach physical restraint reduction and elimination by dedicating sufficient resources and adopting evidence-based practices. [ABSTRACT FROM AUTHOR]

Aim To review the effects of a single session of exercise on cigarette cravings, withdrawal symptoms and smoking behaviour. Methods A systematic search and critical appraisal of all 14 relevant studies. Results All 12 studies that compared a bout of exercise with a passive condition reported a positive effect on cigarette cravings, withdrawal symptoms and smoking behaviour. Two other studies that compared two intensities of exercise revealed no differences in outcomes. Single and multi-item measures of cigarette cravings, withdrawal symptoms and negative affect decreased rapidly during exercise and remained reduced for up to 50 minutes after exercise. Effect sizes for seven studies that assessed ‘strength of desire to smoke’ showed a mean reduction, 10 minutes after exercise, of 1.1 (SD 0.9). Four studies reported a two- to threefold longer time to the next cigarette following exercise. Cravings and withdrawal symptoms were reduced with an exercise intensity from as high as 60–85% heart rate reserve (HRR) (lasting 30–40 minutes) to as low as 24% HRR (lasting 15 minutes), and also with isometric exercise (for 5 minutes). All but one study involved participants temporarily abstaining for the purposes of the experiment. Distraction was probably not the primary reason for the effects. Conclusions Relatively small doses of exercise should be recommended as an aid to managing cigarette cravings and withdrawal symptoms. Further research to understand the mechanisms involved, such as stress reduction or neurobiological mechanisms, could lead to development of more effective and practical methods to reduce withdrawal phenomena. [ABSTRACT FROM AUTHOR]

This is a personal retrospective in which I describe my career as a smoking cessation researcher and place cessation into an overall perspective of tobacco reduction. I spent approximately the first 15 years focusing primarily upon small group approaches to cessation emphasising relatively intensive behavioural interventions. It became apparent, however, that these types of approaches in isolation, even if broadly disseminated, would have relatively minimal impact on overall tobacco use. In part because I became discouraged with the potential of group programmes to reduce overall smoking prevalence, I began to focus more on population-based studies, especially in the context of ‘teachable moments’ including pregnancy, hospitalisation, forced abstinence in the military and existing smoking-related disease. I became concerned especially with the fact that there has been relatively little work with hard-core medically compromised smokers. It also became apparent that promoting cessation would be most likely to be effective with a comprehensive evidence-based tobacco reduction strategy including school and community-based prevention programmes, enforcement of ordinances restricting minors' access to tobacco, restrictions on tobacco advertising and promotion, counter advertising and strong smoke-free policies. In recent years I have become very concerned about the overall global tobacco epidemic and the projections of dramatically increasing tobacco morbidity and mortality in developing countries. I am now devoting my primary career emphasis to global tobacco reduction initiatives, including cessation research in India and Indonesia, cessation as part of broader tobacco reduction strategies and networking to increase resources and emphasis devoted to global tobacco reduction. [Lando HA. Reflections on 30+ years of smoking cessation research: from the individual to the world . Drug Alcohol Rev 2006;25:5–14] [ABSTRACT FROM AUTHOR]

Parent–child attunement therapy (PCAT) is a promising intervention for toddlers (aged 12–30 months) who have experienced maltreatment. PCAT has two overall purposes: (1) to strengthen caregivers' relationship with their children; and (2) to facilitate caregivers' learning of appropriate child management techniques. PCAT represents an adaptation of parent–child interaction therapy (PCIT), which has been empirically documented in preschool and early elementary schoolchildren to improve behavioural adjustment and engender a stronger bond between caregiver and child. There is, however, a noted paucity of intervention research for toddlers, specifically maltreated toddlers. As toddlerhood represents a critical period for enhancing the relationship between caregivers and children and is a stage when youngsters are at increased risk for maltreatment, the objectives of PCAT become even more salient during the toddler years. The purpose of this study, therefore, is to introduce PCAT and then examine its effectiveness through a single case study of a 23-month-old maltreated toddler and his biological mother. Pre- and post-assessment measures included the Parenting Stress Index, the Dyadic Parent–Child Interaction Coding System (DPICS), the Achenbach Child Behavior Checklist (CBCL), the Emotional Availability (EA) Scales and the Eyberg Child Behavior Inventory (ECBI). The results of this study demonstrate the effectiveness of PCAT in increasing the number of positive caregiver–toddler interactions and enhancing the overall quality of the caregiver–toddler relationship. Practitioners will be able to use the techniques described in this manuscript to improve the parent–toddler relationship and ameliorate many commonly experienced behavioural difficulties found among maltreatment-prone parent–toddler dyads. Therapeutic progress is easily charted so that effectiveness may be documented and termination of therapy may be easily discerned. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract Background Although international interest in intensive home-based early behavioural intervention for children with autism is increasing, there is little or no published research on the experiences of families conducting these programmes. Methods One hundred and forty-one UK parents conducting Lovaas-style interventions with their young child with autism were asked to identify factors that acted as facilitative factors and barriers to the implementation of these programmes. Parents responded to written questions contained within a questionnaire survey, and their responses were subjected to a content analysis procedure. Results Several of the facilitative factors and barriers were found to be similar. For example, a supportive therapy team was the most frequently cited facilitative factor, and problems recruiting and maintaining a suitable team was the most frequently reported barrier. Other factors seemed to be more independent constructs. For example, an important barrier was the lack of time and personal energy, but plenty of time and energy was not cited as a facilitative factor. Conclusions The practical implications of these results for families and for services supporting families engaged in intensive early behavioural intervention are discussed. In addition, more general implications for the designers of behavioural intervention programmes are identified. [ABSTRACT FROM AUTHOR]

Aim To discuss the results of combined pharmacotherapies and behavioural interventions for alcohol dependence as presented by the COMBINE study. Methods and results Although the main hypothesis in the COMBINE study was to determine if improvements in treatment outcome can be achieved by combining pharmacotherapy and behavioural interventions, the lack of support for this idea in the results of the study is merely mentioned in passing, but not really discussed. Instead, the COMBINE study group claims that the results of their study constitute support for the use of naltrexone in primary care settings. However, the empirical basis for this recommendation appears somewhat weak. Furthermore, the COMBINE study group's discussions of the results could have benefited from a discussion of the treatment mechanisms that are supposed to have generated the improvement in the participants' drinking practices: what importance should we attribute to common mechanisms that are embedded in the treatment context, and what weight should we ascribe to the pharmacological interventions and the specific behavioural intervention? Conclusions In the context of other major studies within the alcohol field, such as Project MATCH and the UK Alcohol Treatment Trial (UKATT) study, and contemporary psychotherapy research, it seems reasonable to regard the main results from the COMBINE as supportive of a need to change the focus of future addiction treatment research. [ABSTRACT FROM AUTHOR]

Aims and objectives: Five of the eight focus areas of Bowen's Feasibility Framework were utilised to assess the feasibility of implementing the Safe Walking Program (SWP) with people with severe dementia who wander in long‐term care (LTC). Background: Dementia‐related wandering in LTC is associated with adverse outcomes related to intensity (malnutrition, exhaustion and pain, injury) and type of walking (sleep deprivation, resident violence and elopement, death). There is little evidence guiding best practice for managing wandering in LTC. Design: The SWP involved a three‐week trial of taking residents (n = 7) for a 30‐min supervised walk, 30 min before individual peak walking activity periods (PWAP), outside the care facility. Quantitative (real‐time observation and 24/7 Actigraph™ data: not reported here) and qualitative data were collected pre‐, during and postintervention. Methods: Feasibility to implement the SWP protocol was evaluated using a protocol fidelity checklist completed at the end of each scheduled intervention. Acceptability and sustainability of the programme were evaluated through staff interviews. Results: Eighty per cent of scheduled walks commenced and were completed, with 91% of walks lasting the full 30 min. Care staff reported benefits for participants and care staff. The perceived sustainability of the SWP in the LTC setting was impacted by the strict timing of the walk to coincide with participant's individual PWAP. The use of care staff to lead some scheduled walks was seen as interfering with care routines. Conclusions: To enhance the acceptability/sustainability of the SWP in LTC, further testing of the importance of dose and timing is required. Consideration needs to be given to suggested modifications to the protocol. Implications for practice: The SWP is an acceptable and enjoyable activity for people with severe dementia who wander. Utilising walking tracks around the neighbourhood was perceived as being an important element of the programme. [ABSTRACT FROM AUTHOR]