The Early Prevention of Obesity in CHildren (EPOCH) collaboration : an individual patient data prospective meta-analysis

Background
Efforts to prevent the development of overweight and obesity have increasingly focused early in the life course as we recognise that both metabolic and behavioural patterns are often established within the first few years of life. Randomised controlled trials (RCTs) of interventions are even more powerful when, with forethought, they are synthesised into an individual patient data (IPD) prospective meta-analysis (PMA). An IPD PMA is a unique research design where several trials are identified for inclusion in an analysis before any of the individual trial results become known and the data are provided for each randomised patient. This methodology minimises the publication and selection bias often associated with a retrospective meta-analysis by allowing hypotheses, analysis methods and selection criteria to be specified a priori.

Methods/Design
The Early Prevention of Obesity in CHildren (EPOCH) Collaboration was formed in 2009. The main objective of the EPOCH Collaboration is to determine if early intervention for childhood obesity impacts on body mass index (BMI) z scores at age 18-24 months. Additional research questions will focus on whether early intervention has an impact on children's dietary quality, TV viewing time, duration of breastfeeding and parenting styles. This protocol includes the hypotheses, inclusion criteria and outcome measures to be used in the IPD PMA. The sample size of the combined dataset at final outcome assessment (approximately 1800 infants) will allow greater precision when exploring differences in the effect of early intervention with respect to pre-specified participant- and intervention-level characteristics.

Discussion
Finalisation of the data collection procedures and analysis plans will be complete by the end of 2010. Data collection and analysis will occur during 2011-2012 and results should be available by 2013.

A pathway to enhancing professionalism: building a bridge between TAFE and university early childhood qualifications

It has been argued that a key strategy to improve developmental and educational outcomes for young children is to increase the number of childcare staff with early childhood university degrees (Saracho & Spodek, 2007). In order to upgrade the qualifications of staff, a number of Australian universities provide pathways that enable graduates of early childhood diploma programs to complete a degree. Several impediments, including institutional structures and individual contextual and personal factors, may affect these pathways. Although a range of organisations offer diploma programs, TAFE (Tertiary and Further Education) is a major provider. The aim of the present study was to investigate student transition between early childhood programs in TAFE and university. The research drew on several data sources, including a survey of the perceptions of students at various points of undertaking the transition. The current credit arrangement for TAFE Diploma graduates was found to be satisfactory; however, gaps were identified between the TAFE and university teaching and learning arrangements with regard to curriculum structures, teaching styles and assessment. Graduates of both programs considered that the completion of both awards would have a positive effect on their careers.

Indigenous family violence : an attempt to understand the problems and inform appropriate and effective responses to criminal justice system intervention

Whilst high levels of concern about the prevalence of family violence within Indigenous communities have long been expressed, progress in the development of evidence-based intervention programs for known perpetrators has been slow. This review of the literature aims to provide a resource for practitioners who work in this area, and a framework from within which culturally specific violence prevention programs can be developed and delivered. It is suggested that effective responses to Indigenous family violence need to be informed by culturally informed models of violence, and that significant work is needed to develop interventions that successfully manage the risk of perpetrators of family violence committing further offences.

Interrogating the ethics of literacy intervention in Indigenous schools

Recognising that literacy is fundamental to the educational success of Indigenous students, this essay reviews current literacy intervention programs from a social justice perspective. It reveals the tension between policies and initiatives that have addressed the two key rights of Indigenous people – the right to access mainstream knowledge and language through the provision of empowering education and the right to sustain their own languages and cultures through culturally responsive education. In particular, the essay focuses on the National Accelerated Literacy Program (NALP) – a large-scale initiative supported by the former Liberal and the current Labour government in 2004-2008. A spin-off from NALP has been the formation of the Accelerated Literacy Consultants’ Network that provides professional development sessions in Accelerated Literacy and literacy education more broadly to teachers from Aboriginal Independent Community Schools across Australia. The essay questions the view of justice in the NALP’s theoretical and pedagogical design and its effects on teaching and learning in Aboriginal schools. The paper, then, discusses the primacy of ethics in literacy education in order to make it more hospitable and responsive to cultural-linguistic differences.

Cognitive intervention in autism using multimedia stimulus

We demonstrate an open multimedia-based system for delivering early intervention therapy for autism. Using exible multi-touch interfaces together with principled ways to access rich content and tasks, we show how a syllabus can be translated into stimulus sets for early intervention. Media stimuli are able to be presented agnostic to language and media modality due to a semantic network of concepts and relations that are fundamental to language and cognitive development, which enable stimulus complexity to be adjusted to child performance. Being open, the system is able to assemble enough media stimuli to avoid children over-learning, and is able to be customised to a specific child which aids with engagement. Computer-based delivery enables automation of session logging and reporting, a fundamental and time-consuming part of therapy.

Preventing mental health problems in children : the families in mind population-based cluster randomised controlled trial.

Background

Externalising and internalising problems affect one in seven school-aged children and are the single strongest predictor of mental health problems into early adolescence. As the burden of mental health problems persists globally, childhood prevention of mental health problems is paramount. Prevention can be offered to all children (universal) or to children at risk of developing mental health problems (targeted). The relative effectiveness and costs of a targeted only versus combined universal and targeted approach are unknown. This study aims to the effectiveness, costs and uptake of two approaches to early childhood prevention of mental health problems ie: a Combined universal-targeted approach, versus a Targeted only approach, in comparison to current primary care services (Usual care).
Design

Three armed, population-level cluster randomised trial (2010-2014) within the universal, well child Maternal Child Health system, attended by more than 80% of families in Victoria, Australia at infant age eight months. Participants: Families of eight month old children from nine participating local government areas. Randomised to one of three groups: Combined, Targeted or Usual care. Intervention: (a) the Combined universal and targeted program where all families are offered the universal Toddlers Without Tears group parenting program followed by the targeted Family Check-Up one-on-one program or (b) the Targeted Family Check-Up program. The Family Check-Up program is only offered to children at risk of behavioural problems. Analysis: Participants will be analysed according to the trial arm to which they were randomised, using logistic and linear regression models to compare primary and secondary outcomes. An economic evaluation (cost consequences analysis) will compare incremental costs to all incremental outcomes from a societal perspective.
Discussion

This trial will inform public health policy by making recommendations about the effectiveness and cost-effectiveness of these early prevention programs. If effective prevention programs can be implemented at the population level, the growing burden of mental health problems could be curbed.

The influence of families on early adolescent school connectedness : evidence that this association varies with adolescent involvement in peer drinking networks

School connectedness is central to the long term well-being of adolescents, and high quality parent–child relationships facilitate school connectedness. This study examined the extent to which family relationship quality is associated with the school connectedness of pre- and early teenagers, and how this association varies with adolescent involvement in peer drinking networks. The sample consisted of 7,372 10–14 year olds recruited from 231 schools in 30 Australian communities. Participants completed the Communities that Care youth survey. A multi-level model of school connectedness was used, with a random term for school-level variation. Key independent variables included family relationship quality, peer drinking networks, and school grade. Control variables included child gender, sensation seeking, depression, child alcohol use, parent education, and language spoken at home. For grade 6 students, the association of family relationship quality and school connectedness was lower when peer drinking networks were present, and this effect was nonsignificant for older (grade 8) students. Post hoc analyses indicated that the effect for family relationship quality on school connectedness was nonsignificant when adolescents in grade 6 reported that the majority of friends consumed alcohol. The results point to the importance of family-school partnerships in early intervention and prevention.

Can a targeted psychological intervention be effective for young people following a first manic episode? Results from an 18-month pilot study

Aim: There is a scarce literature describing psychological interventions for a young, first-episode cohort who have experienced psychotic mania. This study aimed to assess whether a manualized psychological intervention could be effective in reducing symptomatology and relapse, and improve functional outcome in this population.

Methods: The study was an open-label design, drawn from a larger pharmacotherapy trial. All participants in the pharmacotherapy trial were offered a manualized psychological intervention in addition to case management. Inclusion in the psychotherapy group was based on participant's choice, and on completion of four or more of the eight modules offered. All clinical files were audited to ensure accuracy of group allocation. Forty young people aged 15 to 25 years old who had experienced a manic episode with psychotic features were recruited into the study, with 20 people in the combined treatment as usual plus psychotherapy group (P+TAU), and an equal number of matched control participants who received treatment as usual (TAU) within the same service. All participants were prescribed antipsychotic and mood-stabilizing medication. Symptomatic, functional and relapse measures were taken both at baseline and at 18-month follow-up.

Results: Manic symptoms improved significantly for both groups, with no differences between groups. Depression scores and overall symptom severity were significantly lower in the P + TAU group. No differences were evident between groups with regard to numbers or type of relapse. The P + TAU group had significantly better social and occupational functioning after 18 months.

Conclusion: This study suggests that a manualized psychological intervention targeted to a first-episode population can be effective in reducing depression and overall symptom severity, and can improve functional outcome following a first episode of psychotic mania.

Beginning the search for core principles underpinning literacy development in the early years

Providing opportunities for all people to become literate is now a global imperative (World Bank 2008). There are many and varied reasons underlying this emphasis including global, national, community and personal perspectives (Friere & Macedo 2000) and countries world-wide are investing more money into their early childhood programs and the development of associated policies (Oberhuemer 2005). From a socio-cultural view, literacy development is emergent, ongoing (Cook-Gumperz 2006) and multifaceted (New London Group 1999). Literacy involves far more than reading and writing and encompasses listening, speaking and critical thinking (Department of Education, Science and Training 2005, Luke & Freebody 1997). Literacy is not merely a curricular area, but an important empowering life skill (Harrison 2012, Friere & Macedo 2000). It seems logical then, to search for and identify if there are core principles underpinning early years literacy development.In seeking to identify core principles for emergent literacy development, the study reported here adopted Wiersma & Jurs' (2005) 'Four Step' Historical Research methodological approach involving the identification of a research problem, collection and evaluation of source materials, synthesis of information from the source materials and finally, the analysis, interpretation and the formulation of conclusions. The historical research approach requires creative interpretation (Keastle 1988) and is valued for its effectiveness in sourcing ideas, enlightening current debates, empowering decision-making (Stricker 1992) and influencing policy formation (Wiersma & Jurs 2005).This study involved analysis of Early Years Language and Emergent Literacy Research from the past decade, sourced via education and social sciences databases, as well as information gathered from correspondence with Australian government departments, their websites and policies. The findings from a synthesis of these data sources led to the identification of nine core principles viewed as underpinning children's emergent literacy development. Interested in exploring the relevance and application of these principles to the field of early childhood in Australia, additionally, the researcher has embarked upon a mapping exercise that reveals how the recently introduced Early Years Learning Frameworks align with these principles. Furthermore, in recognition of the importance of the early years as a crucial time in a child's literacy development (Cook-Gumperz 2006, Raban & Nolan 2005, Hall, Larson & Marsh 2003), it is argued that these literacy principles will be valuable to the development of a range of educational tools to be used by Pre-service and practicing Early years educators.

The impact of a brief lifestyle intervention delivered by generalist community nurses (CN SNap trial)

Background
The risk factors for chronic disease, smoking, poor nutrition, hazardous alcohol consumption, physical inactivity and weight (SNAPW) are common in primary health care (PHC) affording opportunity for preventive interventions. Community nurses are an important component of PHC in Australia. However there has been little research evaluating the effectiveness of lifestyle interventions in routine community nursing practice. This study aimed to address this gap in our knowledge.

Methods
The study was a quasi-experimental trial involving four generalist community nursing (CN) services in New South Wales, Australia. Two services were randomly allocated to an ‘early intervention’ and two to a ‘late intervention’ group. Nurses in the early intervention group received training and support in identifying risk factors and offering brief lifestyle intervention for clients. Those in the late intervention group provided usual care for the first 6 months and then received training. Clients aged 30–80 years who were referred to the services between September 2009 and September 2010 were recruited prior to being seen by the nurse and baseline self-reported data collected. Data on their SNAPW risk factors, readiness to change these behaviours and advice and referral received about their risk factors in the previous 3 months were collected at baseline, 3 and 6 months. Analysis compared changes using univariate and multilevel regression techniques.

Results
804 participants were recruited from 2361 (34.1%) eligible clients. The proportion of clients who recalled receiving dietary or physical activity advice increased between baseline and 3 months in the early intervention group (from 12.9 to 23.3% and 12.3 to 19.1% respectively) as did the proportion who recalled being referred for dietary or physical activity interventions (from 9.5 to 15.6% and 5.8 to 21.0% respectively). There was no change in the late intervention group. There a shift towards greater readiness to change in those who were physically inactive in the early but not the comparison group. Clients in both groups reported being more physically active and eating more fruit and vegetables but there were no significant differences between groups at 6 months.

Conclusion
The study demonstrated that although the intervention was associated with increases in advice and referral for diet or physical activity and readiness for change in physical activity, this did not translate into significant changes in lifestyle behaviours or weight. This suggests a need to facilitate referral to more intensive long-term interventions for clients with risk factors identified by primary health care nurses.

What works in secondary schools? A systematic review of classroom-based body image programs

Governments, schools, and curriculum authorities are increasingly recognizing that body image during adolescence is a public health issue that warrants attention in the school setting. After 30 years of eating disorder prevention research, and given the current interest in this area, it seems timely to review the research on interventions to improve body image in schools. We reviewed universal-selective, classroom-based programs that have been conducted since the year 2000, among adolescents, and found 16 eligible intervention programs. Seven of these programs were effective in improving body image on at least one measure, from pre to post test, though effect sizes were small (d = 0.22–0.48). These effective programs were conducted among younger adolescents 12.33–13.62 years, and included activities focusing on media literacy, self esteem, and the influence of peers. Implications for school personnel and curriculum authorities are discussed, and we provide recommendations for a strategic approach to future research in this area.

Randomized trial of a population-based, home-delivered intervention for preschool language delay

OBJECTIVE: 

How do early childhood teachers understand and support the needs of young English language Learners

In Australia, over one third of all children in Early Childhood programs speak a first language other than English. Despite considerable work into teachers' beliefs on cultural diversity, attention to aspects of second language acquisition in the Early Years has been limited within the Early Childhood field. This paper reports on a small study investigating how four early childhood educators understand theory of Second Language Acquisition (SLA) and bilingualism, and how they cater for language-minority students in their programs. The findings revealed a complex interplay between the way participants interpret and support the needs of these children, their experience in the field, and professional education. The teachers in the study reveal various perspectives on how SLA and bilingualism manifest during the early years, and how they affect the learning of children with a Language Background other than English (LBOTE). The teachers also seemed to rely on experiential and intuitive approaches in planning and teaching English Language Learners (ELLs). This study brings new perspectives to understanding the nature of teachers' beliefs and practice regarding English language learners.

Process evaluation of a community-based intervention program: Healthy Youth Healthy Communities, an adolescent obesity prevention project in Fiji

Nearly one-half of the adult population in Fiji between the ages of 15–64 years is either overweight or obese; and rates amongst school children have, on average, doubled during the last decade. There is an urgent need to scale up the promotion of healthy behaviors and environments using a multi-sectoral approach. The Healthy Youth Healthy Community (HYHC) project in Fiji used a settings approach in secondary schools and faith-based organizations to increase the capacity of the whole community, including churches, mosques and temples, to promote healthy eating and regular physical activity, and to prevent unhealthy weight gain in adolescents aged 13–18 years. The team consisted of a study manager, project coordinator and four research assistants (RAs) committed to planning, designing and facilitating the implementation of intervention programs in collaboration with other stakeholders, such as the wider school communities, government and non-governmental organizations and business partners. Process data were collected on all intervention activities and analyzed by dose, frequency and reach for each specific strategy. The Fiji Action Plan included nine objectives for the school settings; four were based on nutrition and two on physical activity in schools, plus three general objectives, namely capacity building, social marketing and evaluation. Long-term change in nutritional behavior was difficult to achieve; a key contributor to this was the unhealthy food served in the school canteens. Whilst capacity-building proved to be one of the best mechanisms for intervening, it is important to consider the cultural and social factors influencing health behaviors and affecting specific groups.

Pharmacological treatment in the early phase of bipolar disorders: what stage are we at?

To review available guidelines, explore treatment strategies currently applied, identify critical issues and propose direction for new developments.