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Summary: Sleep disturbances in children with epilepsy are prevalent, and are associated with substantial adverse medical and psychosocial consequences. This study is a 5‐year follow‐up of a clinic‐based sleep intervention study that randomized 100 toddlers and preschool‐age children with epilepsy to a usual care group or a sleep intervention group. The intervention group received standard paediatric neurology care plus three education sessions during the child's routine clinic visit. The outcomes measured were: (1) child sleep by actigraphy and parental report; and (2) maternal sleep and depression. We aimed to evaluate the long‐term benefits of a clinic‐based sleep intervention for paediatric epilepsy. In total, 42 families (42.0%) participated. The average child's age at follow‐up was 9.55 years. Thirty‐eight (90.5%) children were not obtaining sufficient sleep at baseline, and 40 (95.2%) at the 5‐year follow‐up. The numbers of children with clinically significant sleep disturbances were 40 (95.2%) at baseline and 36 (85.7%) at the 5‐year follow‐up. Fourteen mothers (33.3%) had poor sleep quality and high depressive symptoms at both assessment time points. There were no differences (P > 0.05) in the child and maternal outcomes between the two trial arms. Overall, there was no evidence that a clinic‐based sleep intervention that effectively improved multiple aspects of sleep in toddlers and preschool‐age children with epilepsy had long‐lasting beneficial effects. Our findings suggest that sleep interventions for families of children with epilepsy require ongoing reinforcement and monitoring during routine paediatric neurology care to prevent sleep problems from persisting or recurring. [ABSTRACT FROM AUTHOR]

Aim: To analyse adolescents' self‐reported experiences and behavioural outcomes of a person‐centred, theory‐based intervention in comparison with conventional information/instruction for improved oral hygiene. Materials and Methods: Data were derived from a prospective, multi‐centred, two‐arm, quasi‐randomized field study focusing on the effectiveness of educational interventions for improved oral hygiene. Dental hygienists working within the Public Dental Service, Västra Götaland, Sweden, provided treatments, and adolescents with poor oral hygiene conditions were eligible for participation. The person‐centred test intervention was based on social cognitive constructs, and motivational interviewing was used as an approach in communication. The control intervention included conventional information/instructions. Clinical examinations were performed, and questionnaires were distributed at baseline and at 6 months. Three‐hundred and twelve patients were enrolled, and data from 276 patients, following treatment per protocol, were analysed. Results: The test group was more satisfied with the education about gingivitis (very good: 61% vs. 37%) and communication during therapy (very good: 69% vs. 50%) and reported to a larger extent that they were much more careful regarding their oral hygiene after the treatment (30% vs. 15%) and had higher confidence about keeping up healthy gingival conditions, in comparison with the control group (all p <.01). Conclusions: The person‐centred, theory‐based intervention was superior in terms of adolescents' experiences of education and communication during therapy and self‐reported oral hygiene behavioural outcomes at 6 months, in comparison with conventional information/instruction. [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]

Summary: We assessed the preference for two behavioural weight loss programs, Diabetes Prevention Program (DPP) and Healthy Weight for Living (HWL) in adults with obesity. A cross‐sectional survey was fielded on the Amazon Mechanical Turk. Eligibility criteria included reporting BMI ≥30 and at least two chronic health conditions. Participants read about the programs, selected their preferred program, and answered follow‐up questions. The estimated probability of choosing either program was not significantly different from.5 (N = 1005, 50.8% DPP and 49.2% HWL, p =.61). Participants' expectations about adherence, weight loss magnitude, and dropout likelihood were associated with their choice (p <.0001). Non‐White participants (p =.040) and those with monthly income greater than $4999 (p =.002) were less likely to choose DPP. Participants who had postgraduate education (p =.007), did not report high serum cholesterol (p =.028), and reported not having tried losing weight before (p =.025) were more likely to choose DPP. Those who chose HWL were marginally more likely to report that being offered two different programs rather than one would likely affect their decision to enrol in one of the two (p =.052). The enrolment into DPP and HWL was balanced, but race, educational attainment, income, previous attempt to lose weight, and serum cholesterol levels had significant associations with the choice of weight loss program. [ABSTRACT FROM AUTHOR]

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]

Background and objective: Individuals with asthma are more likely to develop sleep‐disordered breathing. Exercise training improves sleep; however, the effect of physical activity (PA) on improving sleep quality remains unknown. This study had two objectives: (i) to evaluate the effect of a behavioural intervention to increase physical activity in daily living (PADL) on sleep quality in adults with asthma; (ii) to verify the association between a change in sleep quality, quality of life, anxiety, depression and asthma symptoms. Methods: This randomized controlled clinical trial included adults physically inactive with asthma. Participants were randomized into the control (CG; n = 25) and intervention groups (IG; n = 24). IG was submitted to a behavioural intervention to increase PADL, and CG received the usual care. Pre‐ and post‐intervention assessments of sleep quality (by actigraphy and questionnaire), PADL level (by accelerometry), asthma control, health‐related quality of life and anxiety and depression levels were conducted. Results: Both groups were similar at baseline. After the intervention, IG increased daily steps and moderate to vigorous PA levels. IG also improved sleep efficiency and latency as well as increased asthma‐symptom‐free days compared to CG. In addition, a greater proportion of participants in the IG had improved sleep quality after the intervention. Lastly, IG presented clinical improvement in the asthma‐related quality of life questionnaire and a reduction in anxiety symptoms. Conclusion: Our results demonstrate that a behavioural intervention can increase PA, enhance behavioural sleep quality, efficiency and quality of life and reduce asthma and anxiety symptoms. [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]

Background and purpose: Medication overuse headache is a prevalent disorder, with a strong biobehavioural component. Hence, behavioural interventions might effectuate reduction of the overused medication. We assessed in a double‐blind manner the efficacy of a behavioural intervention during medication withdrawal therapy. Methods: In this concealed, double‐blind, randomized controlled trial in medication overuse headache, conducted at the Leiden University Medical Centre, we compared the effect of maximal versus minimal behavioural intervention by a headache nurse during withdrawal therapy. Maximal intervention consisted of an intensive contact schedule, comprising education, motivational interviewing, and value‐based activity planning during 12 weeks of withdrawal therapy. Minimal intervention consisted of a short contact only. Patients were unaware of the existence of these treatment arms, as the trial was concealed in another trial investigating botulinum toxin A. Endpoints were successful withdrawal and monthly days of acute medication use after the withdrawal period. Results: We enrolled 179 patients (90 maximal, 89 minimal intervention). At Week 12, most patients achieved withdrawal in both groups (82/90 [93%] maximal intervention vs. 75/89 [86%] minimal intervention, odds ratio = 2.44, 95% confidence interval [CI] = 0.83–7.23, p = 0.107). At Week 24, patients in the maximal intervention group had fewer medication days (mean difference = −2.23, 95% CI = −3.76 to −0.70, p = 0.005). This difference receded over time. Change in monthly migraine days did not differ between groups (−6.75 vs. −6.22). Conclusions: This trial suggests modest benefit of behavioural intervention by a headache nurse during withdrawal therapy for medication overuse headache, to reduce acute medication use during and shortly after intervention, but extension seems warranted for a prolonged effect [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]

Aim: To test the effectiveness of a person‐centred and theory‐based educational intervention to increase adolescents′ adherence to adequate oral hygiene behaviour, that is, self‐performed periodontal infection control. Materials and Methods: Data were derived from a prospective, multi‐centred, two‐arm, quasi‐randomized field study in which treatment was performed by dental hygienists (DHs) within the Public Dental Service, Västra Götaland, Sweden. Adolescents with poor oral hygiene conditions were invited to participate. The test intervention was based on cognitive behavioural theory and principles, and the DHs used a collaborative communicative approach, inspired by motivational interviewing. The control intervention consisted of conventional information/instruction. Clinical assessments and oral hygiene behaviours were evaluated at 6 months. Results: Three‐hundred and twelve adolescents were enrolled, of whom 274 followed the treatment to 6‐month follow‐up. There were significant improvements in gingival bleeding and plaque scores for both treatment groups at 6 months, with significantly greater improvements in the test group. Adolescents in the test group brushed their teeth and used interdental cleaning aids more frequently compared to participants in the control group at 6 months. Conclusion: A person‐centred and theory‐based oral health education programme is more effective than conventional oral health education in improving adolescents' oral hygiene behaviour and periodontal infection control. ClinicalTrials.gov (NCT02906098). [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: Infant sleep problems are one of the first challenges for parents, negatively influencing infants and mothers. The present study examined the effects of preventive behavioural sleep intervention (BSI) on infant sleep patterns, maternal sleep quality, and depression. A clinical randomised multicentre controlled trial was conducted involving 82 mothers and their infants aged 2–4 months in Iran from August 2018 to April 2019. The intervention group received BSI, which included one individual 90‐min class session, booklet, voice messages, and follow‐up calls; while the control group received training on general infant safety. Details of infant sleep, maternal sleep quality, and postnatal depression were measured through the sleep diary, Pittsburgh Sleep Quality Index, and Edinburgh Postnatal Depression Scale, respectively, before and at 8 weeks after the training. In the intervention group, both the mean infant "night‐time sleep period" and infant "longest self‐regulated sleep period" were 81 min longer than the controls (p <.001). With an improvement of 160 min, the mean infant bedtime was decreased to 22:20 hours in the intervention group, substantially earlier than the controls (00:30 hours). The mean infant "night‐time awakenings with signals" did not significantly change (2.6‐ and 2.5‐times in the intervention and control groups, respectively). The intervention led to a significant improvement in maternal sleep quality and depression (p <.05). The present study acknowledges the positive effects of an early preventive infant BSI on infant sleep, maternal mood, and maternal sleep. Our present results also imply the importance of considering sleep patterns differences and cultural‐based intervention's design. [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]

Background: Multimodal intervention incorporating psychosocial intervention and medication is recommended for school‐aged children with attention deficit hyperactivity disorder (ADHD). This randomized controlled trial (RCT) investigates the adjunctive benefit of the self‐help version of the New Forest Parenting Programme (NFPP‐SH) when offered in addition to treatment as usual (TAU) compared with TAU alone. Method: Fifty‐two children, receiving medication for ADHD as part of their usual care, were randomized to receive NFPP‐SH + TAU or TAU alone. Results: When used in adjunct to TAU, NFPP‐SH may have beneficial effects for parenting efficacy (F = 6.28, p = 0.02), child social performance in school and negative comments made by parents during a recorded speech sample. However, the self‐help intervention did not have any additional effect on child behaviour. Conclusions: This study provides further support for self‐help interventions as potentially low‐intensity and cost‐effective alternatives to therapist‐led parenting interventions. The findings require replication in larger samples before any firm conclusions about adjunctive efficacy of NFPP‐SH can be drawn but underline the potential for self‐help within routine treatment (ClinicalTrials.gov Identifier: NCT02174952). [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]

Aim: The aim of this review was to evaluate the evidence for interventions for behavioural sleep problem in infants.Methods: Systematic review based on a search in MEDLINE, Web of Science and PsychINFO in December 2017 for articles published in English during 2007-2017 about preventive and treatment interventions for sleep problems in infants. The review included controlled trials and meta-analyses with at least 20 infants in study groups assessed according to the Grading of Recommendations Assessment, Development and Evaluation criteria.Results: Out of 476 original articles assessed for eligibility, 12 studies were included in the synthesis. Interventions with behavioural, educational and massage strategies were evaluated. No intervention was evaluated in more than one trial. Five interventions with behavioural methods for establishing consistent routines or controlled crying showed modest short-term effects, while the evidence for elements of education was inconsistent. Studies of massage were of poor quality. Knowledge gaps were identified regarding interventions in cross-cultural context, involving fathers, in children below six months of age, in high-risk populations and consequences of interventions that include extinction.Conclusion: Some support for short-term effects of behavioural treatment strategies was found, but more studies are needed to establish evidence. [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: 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]

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]

Background Randomized controlled psychosocial treatment studies on selective mutism ( SM) are lacking. Method Overall, 24 children with SM, aged 3-9 years, were randomized to 3 months treatment ( n = 12) or wait list ( n = 12). Primary outcome measure was the School Speech Questionnaire. Results A significant time by group interaction was found ( p = .029) with significantly increased speech in the treatment group ( p = .004) and no change in wait list controls ( p = .936). A time by age interaction favoured younger children ( p = .029). Clinical trail registration: Norwegian Research CouncilNCT01002196. Conclusions The treatment significantly improved speech. Greater improvement in the younger age group highlights the importance of an early intervention. [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]

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]

The article presents oral abstracts on intellectual disability research to be presented at the 2010 Society for the Study of Behavioural Phenotypes (SSBP) Annual Scientific Meeting including a study on language impairments and fragile X syndrome (FXS), influence of the parent-of-origin of the supernumerary X chromosome on autistic and schizotypal symptom profiles in Klinefelter syndrome (KS), and the causal effect of seizures on learning and memory and social behaviour phenotypes.

Aim: Regular dental flossing has been widely recommended to prevent periodontal diseases. Nevertheless, compliance is below a desirable level. This study evaluates the effects of a brief behavioural intervention on dental flossing and determines whether the effects of such an intervention are stronger in a specific subgroup of individuals (those intending to floss regularly=implemental mindset). Materials and Method: Behavioural intervention (planning when, where and how to floss) trial was conducting with 194 participants assigned to an intervention or a control group by a random time schedule; the primary outcome was validated self-report of flossing behaviour. Follow-up data were collected 2 and 8 weeks post-intervention. Results: Individuals receiving the planning intervention significantly outperformed those in the control condition at both the 2- and the 8-week follow-up (4.24 times flossing/week versus 3.9 at 2 weeks; 4.02 versus 2.98 at 8 weeks). Intervention effects were stronger in individuals in the implemental mindset. Dropout rates were higher for participants who received the planning intervention but were not in the implemental mindset. Conclusion: Planning interventions are an economic and effective way to change oral self-care behaviour, and are more effective in individuals in an implemental mindset. [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]

Carers’ behaviour is thought to contribute to the development and maintenance of challenging behaviour in people with learning disabilities ( Emerson et al. 1995 ; Hastings & Remington 1994 ). The present study sought to investigate the effectiveness of a behavioural intervention in the management of such problem behaviours by means of a long-term follow-up single case study. This study describes the prevalence and management of the severe challenging behaviours of a 55-year-old man, (Paul) 1 , with severe learning disabilities. The functional assessment showed a significant decrease in challenging behaviour after implementation of guidelines. However, effective dental treatment produced a further reduction in challenging behaviour, posing many implications for healthcare assessment and practice. The results of this single case study are discussed in the context of relocation practices, holistic assessment and service provision. [ABSTRACT FROM AUTHOR]

Aims To assess the effects of cognitive behavioural group training (CBGT) on glycaemic control, diabetes self-efficacy and well-being in Type 1 diabetes patients in persistent poor glycaemic control. Methods In a randomized controlled trial, a total of 107 patients with Type 1 diabetes in poor glycaemic control (HbA1c≥ 8%) were assigned to a 6-week CBGT or blood glucose awareness training (BGAT) as control condition. The intervention was preceded by a 3-month run-in period. Glycaemic control (HbA1c), diabetes-specific self-efficacy (CIDS), diabetes-related distress (PAID) and depressive symptoms (CES-D), were assessed at baseline (T1), directly before (T2) and 3 months after (T3) the intervention. Results No significant changes in HbA1c were found after CBGT, whilst diabetes self-efficacy increased (mean CIDS score 71.6 ± 14.0 to 74.3 ± 12.2) and diabetes-related distress (mean PAID score 47.0 ± 21.6 to 42.6 ± 20.8) and depressive symptoms decreased (mean CES-D score 16.9 ± 12.8 to 13.5 ± 12.6). Changes in psychological outcomes were similar for both treatment groups. Diabetes self-care behaviours improved equally. Drop-out rate, which was higher among CBGT participants, was relatively low overall (total n = 15, 17.05%), and both interventions were well-appreciated by the participants. Conclusions CBGT was successful in improving self-efficacy, diabetes-related distress and mood at 3 months’ follow-up, but not in improving glycaemic control. [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]

Objective: To assess the effectiveness of a behavioural programme introduced in the first 3 months of age in preventing infant crying and sleeping problems. Two issues were addressed: (i) which elements of the behavioural programme would parents implement; and (ii) whether the behavioural programme was more effective in reducing infant crying and encouraging night-time sleeping than an educational intervention or the routine services.Methodology: Mothers and newborns were assigned at random to the behavioural programme (n = 205), educational intervention (n = 202), or control (n = 203) group. Behaviour diaries kept before randomization and at 3, 6, 9 and 12 weeks of age were used to measure implementation of the interventions and infant behaviour, including crying and sleeping. Crying and sleeping problems were followed up using questionnaire measures at 9 months of age.Results: The educational intervention did not change parental care behaviour. One element of the behavioural programme, a focal feed between 10 PM and midnight, was not implemented. A second element, stretching of interfeed intervals after 3 weeks of age, was implemented initially, but not maintained at older ages. The third element, which asked parents to emphasise day and night differences in the environment, and to settle their babies in the cot and minimise interaction at night, was carried out by more parents in the behavioural group than in the other groups. This led to an increase of around 10% in the number of babies who slept for 5 or more hours at night (a definition of sleeping through the night) at 12 weeks of age. Fewer behavioural programme parents sought help for crying and sleeping problems between 3 and 9 months of age.Conclusion: The behavioural programme produced a modest increase in the number of infants who slept through the night by 12 weeks of age. The results are discussed in relation to other findings, which bear on the programme's adoption for routine health-care policy and practice. [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]

The evidence that early intensive behavioural intervention (IBI) is effective for young children with autism has persuaded parents worldwide to finance and advocate for IBI. Intensive behavioural intervention uses applied behavioural analysis to address the deficits of autism with an individualized and systematic approach. Communication, social, cognitive and adaptive gains are seen in the majority of children; a sizeable minority can catch up to near normal functioning, under ideal conditions. However there is not universal acceptance amongst professionals that IBI is the most proven intervention. What level of evidence is required for Australian states to provide adequate public funds for IBI? [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]