The population cost-effectiveness of a parenting intervention designed to prevent anxiety disorders in children

BACKGROUND: Prevention and early intervention for anxiety disorders has lagged behind many other forms of mental disorder. Recent research has demonstrated the efficacy of a parent-focussed psycho-educational programme. The programme is directed at parents of inhibited preschool children and has been shown to reduce anxiety disorders at 1 and 3 years following intervention. The current study assesses the cost-effectiveness of this intervention to determine whether it could provide value-for-money across a population. METHOD: A cost-utility economic framework, using Disability-Adjusted-Life-Years (DALYs) as the outcome, was adopted. Economic modelling techniques were used to assess the incremental cost-effectiveness ratio (ICER) of the intervention within the Australian population context, which was modelled as add-on to current practice. The perspective was the health sector. Uncertainty was measured using multivariate probabilistic testing and key assumptions were tested using univariate sensitivity analysis. RESULTS: The median ICER for the intervention was AUD$8,000 per DALY averted with 99.8% of the uncertainty iterations falling below the threshold value-for-money criterion of AUD$50,000 per DALY averted. The results were robust to sensitivity testing. CONCLUSIONS: Screening young children in a preschool setting for an inhibited temperament and providing a brief intervention to the parents of children with high levels of inhibition appears to provide very good value-for-money and worth considering in any package of preventive care. Further evaluation of this intervention under routine health service conditions will strengthen conclusions. Acceptability issues associated with this intervention, particularly to preschool staff and parents, need to be considered before wide-scale adoption is undertaken.

Respecting our elders: evaluation of an educational program for adolescent students to promote respect toward older adults

The current project explored issues related to respect for older people, and then developed, implemented, and evaluated an educational intervention program for adolescents to raise understanding and improve attitudes toward older people. In Study 1, 46 focus groups were conducted, with participants (n = 211) drawn from older people, carers of older people, and adolescents to inform on issues related to the expression of respect to older people. The emergent themes were used to inform the design of the educational program delivered to adolescents and evaluated in Study 2. A total of 118 year-9 students were allocated to an intervention or control condition. The intervention group participated in 4 educational sessions focused on developing understanding of and respect for older adults, and promoting positive interactions with older people. Participants in both conditions completed measures of knowledge and attitudes to aging to determine whether the intervention had effected change at post-program and at 6-months follow-up. Analyses indicated significant improvements in knowledge, attitudes, and social skills related to older people in the intervention group compared to the control group. The findings from these studies provide a better understanding of what constitutes respect for older people, and a method for improving this in adolescents.

Randomized controlled trial of proactive web-based alcohol screening and brief intervention for university students

BACKGROUND: University students drink more heavily than their nonstudent peers and are often unaware that their drinking is risky and exceeds normative levels. We tested the efficacy of a proactive Web-based alcohol screening and brief intervention program. METHODS: A randomized controlled trial was conducted at an Australian university in 2007. Invitations were sent to 13 000 undergraduates (age range, 17-24 years) to complete a Web-based Alcohol Use Disorders Identification Test. Of 7237 students who responded, 2435 scored in the hazardous/harmful range (> or =8) and were randomized, and 2050 (84%) completed at least 1 follow-up assessment. Intervention was 10 minutes of Web-based motivational assessment and personalized feedback. Controls received only screening. Follow-up assessments were conducted at 1 and 6 months with observers and participants blinded to allocation. Outcome measures were drinking frequency, typical occasion quantity, overall volume, number of personal problems, an academic problems score, prevalence of binge drinking, and prevalence of heavy drinking. RESULTS: Mean (SD) baseline Alcohol Use Disorders Identification Test scores for control and intervention groups were 14.3 (5.1) and 14.2 (5.1), respectively. After 1 month, participants receiving intervention drank less often (rate ratio [RR], 0.89; 95% confidence interval [CI], 0.83-0.94), smaller quantities per occasion (RR, 0.93; 95% CI, 0.88-0.98), and less alcohol overall (RR, 0.83; 95% CI, 0.78-0.90) than did controls. Differences in alcohol-related harms were nonsignificant. At 6 months, intervention effects persisted for drinking frequency (RR, 0.91; 95% CI, 0.85-0.97) and overall volume (RR, 0.89; 95% CI, 0.82-0.96) but not for other variables. CONCLUSION: Proactive Web-based screening and intervention reduces drinking in undergraduates, and such a program could be implemented widely.

An efficacy trial of brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial)

Background
Lifestyle risk factors, in particular smoking, nutrition, alcohol consumption and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care (PHC) has been shown to be an effective setting to address lifestyle risk factors at the individual level. However much of the focus of research to date has been in general practice. Relatively little attention has been paid to the role of nurses working in the PHC setting. Community health nurses are well placed to provide lifestyle intervention as they often see clients in their own homes over an extended period of time, providing the opportunity to offer intervention and enhance motivation through repeated contacts. The overall aim of this study is to evaluate the impact of a brief lifestyle intervention delivered by community nurses in routine practice on changes in clients' SNAP risk factors.

Methods/Design
The trial uses a quasi-experimental design involving four generalist community nursing services in NSW Australia. Services have been randomly allocated to an 'early intervention' group or 'late intervention' (comparison) group. 'Early intervention' sites are provided with training and support for nurses in identifying and offering brief lifestyle intervention for clients during routine consultations. 'Late intervention site' provide usual care and will be offered the study intervention following the final data collection point. A total of 720 generalist community nursing clients will be recruited at the time of referral from participating sites. Data collection consists of 1) telephone surveys with clients at baseline, three months and six months to examine change in SNAP risk factors and readiness to change 2) nurse survey at baseline, six and 12 months to examine changes in nurse confidence, attitudes and practices in the assessment and management of SNAP risk factors 3) semi-structured interviews/focus with nurses, managers and clients in 'early intervention' sites to explore the feasibility, acceptability and sustainability of the intervention.

Discussion
The study will provide evidence about the effectiveness and feasibility of brief lifestyle interventions delivered by generalist community nurses as part of routine practice. This will inform future community nursing practice and PHC policy.

Change in well-being amongst participants in a four-month pedometer-based workplace health program

BACKGROUND: There is increasing uptake of workplace physical activity programs to prevent chronic disease. While they are frequently evaluated for improvement in biomedical risk factors there has been little evaluation of additional benefits for psychosocial health. We aimed to evaluate whether participation in a four-month, team-based, pedometer-based workplace health program known to improve biomedical risk factors is associated with an improvement in well-being, immediately after the program and eight-months after program completion.

METHODS: At baseline (2008), 762 adults (aged 40 ± 10 SD years, 42% male) employed in primarily sedentary occupations and voluntarily enrolled in a physical activity program were recruited from ten Australian worksites. Data was collected at baseline, at the completion of the four-month program and eight-months after program completion. The outcome was the WHO-Five Well-being Index (WHO-5), a self-administered five-item scale that can be dichotomised as 'poor' (less than 52%) or 'positive' (more than or equal to 52%) well-being.

RESULTS: At baseline, 75% of participants had positive well-being (mean: 60 ± 19 SD WHO-5 units). On average, well-being improved immediately after the health program (+3.5 units, p < 0.001) and was sustained eight-months later (+3.4 units from baseline, p < 0.001). In the 25% with poor well-being at baseline, 49.5% moved into the positive well-being category immediately after program completion, sustained eight-months later (p < 0.001).

CONCLUSIONS: Clinically relevant immediate and sustained improvements in well-being were observed after participation in the health program. These results suggest that participation in workplace programs, such as the one evaluated here, also has the potential to improve well-being.

The baby makes 3 plus project in the Great South Coast region: final report from the external evaluator, January 2016

This report presents the evaluation of the Baby Makes 3 Plus project in the Great South Coast region of Victoria. Baby Makes 3 Plus was one of 12 projects funded by the Department of Justice and Regulation in Victoria under initiative to support primary prevention and early intervention-focused partnership projects to address violence against women and children. The project provided the Baby Makes 3 relationship education program to new parents across the region, and conducted a variety of training to increase the skills of Great South Coast early years practitioners (the Plus component of the project). The three key objectives of the project were:• To increase the capacity of first time parents to build equal and respectful relationships in response to the lifestyle and relationship changes that follow the birth of a child.• To increase the capacity of health professionals and organisations to promote equal and respectful relationships during the transition to parenthood.• To building capacity to identify women at risk of experiencing family violence through a gender equity component of in-service training.

Including play in a social skills intervention for children with autism

Group-based social skills training (SST), is a common treatment for individuals diagnosed with Autism Spectrum Disorder (ASD) - a condition characterised by social impairments. The aim of this study was to evaluate the effectiveness of an 8-week SST intervention with a play component (unstructured versus semi-structured) for children with ASD. Forty-five children aged 8 to 12 years participated in the study. Data were collected from a parent, teacher and the child at pre-test, post-test and at 3-month follow-up. Compared to a waitlist control group, children who participated in the SST intervention showed significant gains in social skills and social competence and they exhibited a reduction in social worries and emotional distress over time. Observational data during SST sessions, however, revealed that those in the unstructured play environment exhibited lower levels of social participation and engagement with peers compared to children assigned to semi-structured play.

The oral language skills of young offenders: a pilot invesitgation

Although there is a large body of evidence attesting to the poor social skills of juvenile offenders, few workers have examined the underlying language skills of this population. This pilot study investigated the language skills of a group of young offenders in comparison to non-offending school students. Data were gathered from 15 community-based young offender males, aged between 13 and 21 years (M = 16.5 years, SD = 2.1) from the Victorian southern region Juvenile Justice Units. The comparison group comprised 15 male students, aged between 15 and 17 years (M = I 6.4 years; SD = 0.5 I) from government high schools in south-eastern metropolitan Melbourne. Each participant completed a narrative discourse task and measures of speed of processing, and abstract language. It was hypothesised that the young offender group would perform more poorly on each of the language tasks than the comparison group. Independent t tests (with a modified alpha level to control for family-wise error rates) showed that there were significant differences in the expected direction, on all language measures. Notwithstanding the pilot nature of the investigation, implications of these findings for both further research and intervention/early intervention are described.

Menstrual dysfunction and bone health in female athletes

Female athletes are generally considered to be at Iow risk of osteoporosis because of the skeletal loading associated with sports participation. Sites that are exposed to long-term high-impact loading are consistently reported to be higher than the same sites in their sedentary peers. However, weight-bearing exercise does not always ensure that athletes will have high bone-mineral density, as the hormonal environment, dietary factors, and loading history all influence bone-mineral density, In particular, menstrual dysfunction, which can occur with intense training or disordered eating, is a significant risk factor for Iow bone-mineral density. Exercise history before menstrual dysfunction is likely to offer some protection for Iow bone-mineral density, particularly at the hip, Resumption of menses is unlikely to restore bone-mineral density to levels reported in eumenorrheic athletes or even sedentary peers, Athletes at risk of amenorrhea should be identified and their training loads and energy intakes monitored to ensure normal menstrual function, Athletes who remain amenorrheic should be counseled about the possible negative effects of amenorrhea and monitored for bone loss. Early intervention is recommended for amenorrheic athletes with Iow bone-mineral density.

Editorial : when do repeated intrusions become stalking?

Stalking is a prevalent crime which can significantly compromise the victim's quality of life. It occurs when one person repeatedly inflicts on another unwanted contacts or communications which induce fear. Many of the behaviours associated with stalking overlap with common, albeit irritating, experiences (e.g. being persistently telephoned or approached for a date). The difficulty for victims is recognizing the difference between brief episodes of intrusiveness or social awkwardness, and the beginnings of a more persistent campaign of harassment. This study sought to define empirically the foremost juncture at which instances of intrusiveness can be distinguished from persistent stalking which is ultimately damaging to the victim's psychosocial functioning. The results indicate that continuation of unwanted intrusions beyond a threshold of 2 weeks is associated with a more intrusive, threatening and psychologically damaging course of harassment. Recognition that 2 weeks is the watershed between brief, self-limiting instances of intrusiveness and protracted stalking allows an opportunity for early intervention to assist victims of this crime.

Health and well-being naturally: 'contact with nature' in health promotion for targeted individuals, communities and populations

Issue addressed: The increase in mental health disorders worldwide makes it important to recognise health promotion interventions that are effective, accessible and affordable. Although natural spaces are coming to be recognised as health-promoting settings for general populations, little is understood about the use of nature contact in treatment and care for individuals experiencing ill-health.

Methods: This paper provides a summary of key research findings and presents a case study examining the self reported health and well-being benefits of nature contact for a small clinical sample. The 'Spectrum of Interventions for Mental Health Problems and Mental Disorders' provides a conceptual framework for ordering current and future information relating to nature-based interventions.

Results: Evidence demonstrates that separately, physical activity, social connection, and contact with nature enhance human health and well-being. The case example illustrates how 'active', 'social' and 'adventurous' contact with nature may be combined within a treatment intervention to protect and enhance the health of individuals experiencing chronic mental, emotional and physical health difficulties.

Conclusions: 'Contact with nature' constitutes a health promotion strategy with potential application in prevention, early intervention, treatment and care. Recommendations include further research to investigate the benefits of nature contact within existing interventions, and the impacts of 'active' and 'social' nature contact within tailored interventions for targeted individuals and communities.

Can health promoting schools contribute to the better health and wellbeing of young people? The Hong Kong experience.

Background: The Health Promoting School (HPS) is a WHO sponsored framework, compiled to enable education and health sectors to be more effective in school based initiatives.

Aims: This study attempted to test the hypothesis that students from schools that had comprehensively embraced the HPS concept as indicated by the Healthy School Award, were better, in terms of health risk behaviour, self reported health status, and academic results, than students from schools that did not reach the standard of the award.

Methods and Results: The results presented came from nine schools (four primary and five secondary) applying for accreditation of the Healthy Schools Award after adopting the HPS framework for two years. Regular consultancy support and training were available to all schools. Students had completed before and after surveys to assess their health behaviours, self reported health status, and academic standing before the two year intervention, and at its end. Data from the before and after surveys of the students attending schools that reached certain level of HPS standard as indicated by the award, were compared with students whose schools did not receive the award, and the results showed differences. Some differences were found to be more significant among the primary school students than secondary schools students. This illustrated early intervention for lifestyle changes to be more effective. Students’ satisfaction with life also improved if their schools adopted the concept of HPS comprehensively.

Conclusions: The results suggest that comprehensive implementation of HPS would contribute to differences in certain behaviours and self reported health and academic status.

Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from zero to five years. A systematic review of the literature

Preventing the development of obesity in children is an international health priority. To assess the effectiveness of interventions designed to prevent obesity, promote healthy eating and/or physical activity and/or to reduce sedentary behaviours in 0–5-year-old children, a systematic review of the literature was performed. Literature searches were limited to articles published between January 1995 and June 2006, printed in English and sampling children aged 0–5-years. Searches excluded literature concerned with breastfeeding, eating disorders, and interventions which were school-based or concerned with obesity treatment. Two reviewers independently extracted data and assessed study strengths and weaknesses. Nine included studies were grouped based on the settings in which they were delivered. Most studies involved multi-approach interventions, were conducted in the USA and varied in study designs and quality. All showed some level of effectiveness on at least one obesity-behaviour in young children. These studies support, at a range of levels, the premise that parents are receptive to and capable of some behavioural changes that may promote healthy weight in their young children. The small quantity of research heralds the need, particularly given the potential for early intervention to have long-lasting impacts on individual and population health, to build in a substantial way upon this evidence base.

Training general practitioners in the assessment of childhood mental health problems

Epidemiological studies have found that most children with mental health problems are not receiving appropriate help. The aim of this study was to assess an approach to train general practitioners (GPs) to detect mental health problems early, engage the families, and assist them in the access of service. Five GPs were given three hours of training on a brief assessment method. Each then interviewed parents whose children they suspected might have a mental health problem. An experienced research clinician then repeated the assessment. This information was fed back to the GP who then assisted the family in obtaining appropriate help. Twenty-nine parents were interviewed in six months. The research clinician and the GPs were in agreement for 90% of the cases for the recognition of mental health problems. GPs’ opinions on the brief assessment method were: easy to use (100%), helpful in obtaining information (100%) and helpful in engaging the parent (100%). The parents were followed up by telephone 3-4 months after the interview. Eighty-eight percent reported that the process was helpful, 67% had received help from services and 67% had improved. We conclude that with brief training, the GPs in this study were able to improve their capacity to provide early intervention for childhood mental health problems.

Resilience: a protector from depression

Personality type and resilient behaviors provide protection from the experience of depression, and resilience can increase the risk of not being depressed. Psychiatric–mental health nurses are well positioned to facilitate the development of resilience qualities in people who are depressed. Clinical strategies, which could be undertaken by the psychiatric–mental health nurse, include early intervention, promoting a positive social and familial climate, promoting self-esteem and support building, social and life skills/vocational education, and linking and brokering clients into extracurricular activities.