The NOURISH randomised control trial : positive feeding practices and food preferences in early childhood - a primary prevention program for childhood obesity

Background Primary prevention of childhood overweight is an international priority. In Australia 20-25% of 2-8 year olds are already overweight. These children are at substantially increased the risk of becoming overweight adults, with attendant increased risk of morbidity and mortality. Early feeding practices determine infant exposure to food (type, amount, frequency) and include responses (eg coercion) to infant feeding behaviour (eg. food refusal). There is correlational evidence linking parenting style and early feeding practices to child eating behaviour and weight status. A focus on early feeding is consistent with the national focus on early childhood as the foundation for life-long health and well being. The NOURISH trial aims to implement and evaluate a community-based intervention to promote early feeding practices that will foster healthy food preferences and intake and preserve the innate capacity to self-regulate food intake in young children. Methods/Design This randomised controlled trial (RCT) aims to recruit 820 first-time mothers and their healthy term infants. A consecutive sample of eligible mothers will be approached postnatally at major maternity hospitals in Brisbane and Adelaide. Initial consent will be for re-contact for full enrolment when the infants are 4-7 months old. Individual mother- infant dyads will be randomised to usual care or the intervention. The intervention will provide anticipatory guidance via two modules of six fortnightly parent education and peer support group sessions, each followed by six months of regular maintenance contact. The modules will commence when the infants are aged 4-7 and 13-16 months to coincide with establishment of solid feeding, and autonomy and independence, respectively. Outcome measures will be assessed at baseline, with follow up at nine and 18 months. These will include infant intake (type and amount of foods), food preferences, feeding behaviour and growth and self-reported maternal feeding practices and parenting practices and efficacy. Covariates will include sociodemographics, infant feeding mode and temperament, maternal weight status and weight concern and child care exposure. Discussion Despite the strong rationale to focus on parents’ early feeding practices as a key determinant of child food preferences, intake and self-regulatory capacity, prospective longitudinal and intervention studies are rare. This trial will be amongst to provide Level II evidence regarding the impact of an intervention (commencing prior to age 12 months) on children’s eating patterns and behaviours. Trial Registration: ACTRN12608000056392

Self-esteem and self-talk enhancement in upper primary school children

Not all programmes aimed at enhancing children's self-esteem have been successful. This article evaluates the impact of two programmes and offers activities which can be used in the classroom.

Self-talk in upper primary school children : its relationship with irrational beliefs, self-esteem and depression

Self-talk, irrational beliefs, self-esteem and depression were measured in a sample of 105 elementary school children in Grades 4 to 7. Sex and grade differences in positive self-talk were found. The pattern of correlation coefficients for positive self-talk supported the substantive position that positive self-talk is positively related to self-esteem and negatively related to irrational beliefs and depression in a non-clinical sample of children. However, the same support was not forthcoming for the reverse relationships for negative self-talk. Therapeutic implications are outlined as are suggestions for future research in the area of children's self-talk.

Cooperative learning in Thailand : professional development to enhance primary education

The overall purpose of this study was to develop a model to inform the design of professional development programs and the implementation of cooperative learning within Thai primary school mathematics classrooms. Action research design, with interviews, surveys and observations, was used for this study. Survey questionnaires and classroom observations investigated the factors that influence the implementation of cooperative learning strategies and academic achievement in Thai primary school mathematics classrooms. The teachers’ interviews and classroom observation also examined the factors that need to be addressed in teacher professional development programs in order to facilitate cooperative learning in Thai mathematics classrooms. The outcome of this study was a model consisting of two sets of criteria to inform the successful implementation of cooperative learning in Thai primary schools. The first set of criteria was for proposers and developers of professional development programs. This set consists of macro- and micro-level criteria. The macro-level criteria focus on the overall structure of professional development programs and how and when the professional development programs should be implemented. The micro-level criteria focused on the specific topics that need to be included in professional development programs. The second set of criteria was for Thai principals and teachers to facilitate the introduction of cooperative learning in their classrooms. The research outcome also indicated that the attainment of these cooperative learning strategies and skills had a positive impact on the students’ learning of mathematics.

Interventions for co-occurring addictive and other mental disorders (AMDs)

While research on the management of co-occurring addictive and mental disorders (AMDs) has grown substantially in recent years, we still have little guidance on specific strategies. Consideration of epidemiological research and ethical principles can supplement existing clinical trials in providing a way forward. High frequencies of co-occurring disorders, equity of access for affected individuals and potential clashes between services in priorities and procedures, suggest that a stepped model of care by a single service may often be required. Typically, problems are multiple rather than dual, with potential for mutual influence, suggesting a need for interventions that are sensitive to and encompass complex co-occurring problems. Motivational problems are endemic, initial gains are often partial and unstable, and relapses potentially have serious consequences, suggesting a need for long-term, assertive follow-up. Principles such as these provide a solid framework for designing both services and interventions. However, there is a continuing need for controlled trials that unpack effective components of interventions, and increase their impact.

Integrated versus non-integrated management and care for clients with co-occurring mental health and substance use disorders : a qualitative systematic review of randomised controlled trials

The purpose of this paper is to conduct a qualitative review of randomised controlled trials in relation to the treatment of adults with co-occurring mental health and substance use disorder (MH/SUD). In particular, integrated approaches are compared with non-integrated approaches to treatment. Ten articles were identified for inclusion in the review. The findings are equivocal with regard to the superior efficacy of integrated approaches to treatment, although the many limitations of the studies need to be considered in our understanding of this finding. Clearly, this is an extremely challenging client group to engage and maintain in intervention research, and the complexity and variability of the problems render control particularly difficult. The lack of available evidence to support the superiority of integration is discussed in relation to these challenges. Much remains to be investigated with regard to integrated management and care for people with co-occurring and MH/SUD, particularly for specific combinations of dual diagnosis and giving consideration to the level of inter-relatedness between the disorders.

Demographic and clinical correlates of comorbid substance use disorders in psychosis : multivariate analyses from an epidemiological sample

Background: While there has been substantial research examining the correlates of comorbid substance abuse in psychotic disorders, it has been difficult to tease apart the relative importance of individual variables. Multivariate analyses are required, in which the relative contributions of risk factors to specific forms of substance misuse are examined, while taking into account the effects of other important correlates. Methods: This study used multivariate correlates of several forms of comorbid substance misuse in a large epidemiological sample of 852 Australians with DSMIII- R-diagnosed psychoses. Results: Multiple substance use was common and equally prevalent in nonaffective and affective psychoses. The most consistent correlate across the substance use disorders was male sex. Younger age groups were more likely to report the use of illegal drugs, while alcohol misuse was not associated with age. Side effects secondary to medication were associated with the misuse of cannabis and multiple substances, but not alcohol. Lower educational attainment was associated with cannabis misuse but not other forms of substance abuse. Conclusion: The profile of substance misuse in psychosis shows clinical and demographic gradients that can inform treatment and preventive research.

The future of cognitive and behavioral therapies in the prevention and early management of psychosis : opportunities and risks

Behavioral and cognitive interventions for people with psychosis have a long and distinguished history, although the evidence for their application to young people remains limited. We anticipate that the next decades will show substantial research into psychological intervention for this population. Important targets will include the management of environmental stressors, reduction of substance misuse, and promotion of early treatment. Psychological management of positive symptoms, depression, and suicidal behavior will continue to be critical objectives. Important secondary prevention goals will be the retention of cognitive functioning, vocational options, social skills, and social network support, including appropriate family support. We expect primary prevention to include both universal programs and interventions for adolescents at particularly high risk. Technical innovations will include increasing use of Internet-based intervention and behavior cueing devices. Pressures for intervention brevity will continue, as will problems with the systematic delivery of effective procedures.

Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders

Objectives: To determine opinions and experiences of health professionals concerning the management of people with comorbid substance misuse and mental health disorders. Method: We conducted a survey of staff from mental health services and alcohol and drug services across Queensland. Survey items on problems and potential solutions had been generated by focus groups. Results: We analysed responses from 112 staff of alcohol and drug services and 380 mental health staff, representing a return of 79% and 42% respectively of the distributed surveys. One or more issues presented a substantial clinical management problem for 98% of respondents. Needs for increased facilities or services for dual disorder clients figured prominently. These included accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent dual diagnosis services and after-hours alcohol and drug consultations were also reported. Each of these issues raised substantial problems for over 70% of staff. Another set of problems involved coordination of client care across mental health and alcohol and drug services, including disputes over duty of care. Difficulties with intersectoral liaison were more pronounced for alcohol and drug staff than for mental health. A majority of survey respondents identified 13 solutions as practical. These included routine screening for dual diagnosis at intake, and a range of proposals for closer intersectoral communication such as exchanging client information, developing shared treatment plans, conducting joint case conferences and offering consultation facilities. Conclusions: A wide range of problems for the management of comorbid disorders were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing services.

Behaviour disorders and teacher negligence

The purpose of this paper is to examine the legal implications of the continuing rise in the number of school children diagnosed with behaviour disorders. Not only are teachers now subject to a dense grid of legal regulation, they are also increasingly vulnerable to actions in tort. It will be argued here that as more and more children are labelled ‘disordered’, the duty of care become more onerous, and hence harder for teachers to meet. As a consequence, teachers are more likely to face claims of negligence. It is concluded that while the schooling system needs to retain a healthy scepticism about each new pathologising disorder that seeks special status for its sufferers, it also needs to provide greater training and resources for teachers regarding disorder management. It is also concluded that recent changes to negligence law regarding the issue of ‘reasonable foreseeability’ within breach of duty of care, may not be as significant as might have been hoped by the teaching community. Indeed, the elevated standard of care required by the increasing numbers of disordered pupils, places teachers in an ever more difficult legal position.

A thematic approach to integrating maths and science for pre-service primary teachers via sustainability

Efforts to improve mathematics and science content knowledge have in many institutions required redefining teacher education through new teaching and learning. See, for example, Peard & Pumadevi (2007) for an account of one such attempt involving the development of a Foundations Unit, Scientific and Quantitative Literacy. This unit is core for all first year pre-service primary teacher education students at Queensland University of Technology (QUT) and two Education Institutes in Malaysia, Institute Perguruan Raja Melewar (IPRM), and Institute Perguruan Teknik (IPT) Kuala Lumpur. Since then, QUT has modified the unit to adopt a thematic approach to the same content. An aim of the unit rewrite was the development of a positive attitude and disposition to the teaching and learning of mathematics and science, with a curiosity and willingness to speculate about and explore the world. Numeracy was specifically identified within the mathematics encountered and appropriately embedded in the science learning area. The importance of the ability to engage in communication of and about mathematics and science was considered crucial to the development of pre-service primary teachers. Cognisance was given to the appropriate selection and use of technology to enhance learning - digital technologies were embedded in the teaching, learning and assessment of the unit to avoid being considered as an optional extra. This was achieved around the theme of “the sustainable school”. This „sustainability‟ theme was selected due to its prominence in Australia‟s futures-oriented National Curriculum which will be implemented in 2011. This paper outlines the approach taken to the implementation of the unit and discusses early indicators of its effectiveness.

A thematic approach to integrating maths and science for pre-service primary teachers via sustainability

Efforts to improve mathematics and science content knowledge have in many institutions required redefining teacher education through new teaching and learning. See, for example, Peard & Pumadevi (2007) for an account of one such attempt involving the development of a Foundations Unit, Scientific and Quantitative Literacy. This unit is core for all first year pre-service primary teacher education students at Queensland University of Technology (QUT) and two Education Institutes in Malaysia, Institute Perguruan Raja Melewar (IPRM), and Institute Perguruan Teknik (IPT) Kuala Lumpur. Since then, QUT has modified the unit to adopt a thematic approach to the same content. An aim of the unit rewrite was the development of a positive attitude and disposition to the teaching and learning of mathematics and science, with a curiosity and willingness to speculate about and explore the world. Numeracy was specifically identified within the mathematics encountered and appropriately embedded in the science learning area. The importance of the ability to engage in communication of and about mathematics and science was considered crucial to the development of pre-service primary teachers. Cognisance was given to the appropriate selection and use of technology to enhance learning - digital technologies were embedded in the teaching, learning and assessment of the unit to avoid being considered as an optional extra. This was achieved around the theme of “the sustainable school”. This ‘sustainability’ theme was selected due to its prominence in Australia’s futures-oriented National Curriculum which will be implemented in 2011. This paper outlines the approach taken to the implementation of the unit and discusses early indicators of its effectiveness.

Too great expectations?

Teachers have always been charged with the task of turning out the next generation of citizens—educated, healthy in mind, and healthy in body. The central question here is: how far should this responsibility extend? Just how much can we reasonably expect teachers to be responsible for? And just what should schools be responsible for? Obviously, teachers ought to be responsible for the fundamentals of learning, but should they be held accountable for what the children eat, or how they choose to behave, or for every single risk, direct or indirect, that could conceivably occur within the school grounds? These are precisely the kinds of expectation that have become part of educational life. Bit by bit, new forms of responsibility are being added to the site of the school and, more specifically, to the professional life of the teacher. The intention here is not necessarily to challenge any of these diverse changes, but rather to express concern about their cumulative effect on the ability of the school to do its primary job effectively.

Behaviour disorders and the negligent teacher

The purpose of this paper is to examine the legal implications of the continuing rise in the number of school children diagnosed with behaviour disorders. Not only are teachers now subject to a dense grid of legal regulation, they are also increasingly vulnerable to actions in tort. It will be argued here that as more and more children are labelled ‘disordered’, then the concomitant duty of care requirements for teachers becomes more onerous. As a consequence, teachers are less likely to be able to defend themselves against claims of negligence. It is concluded that while the schooling system needs to retain a healthy scepticism about each new pathologising disorder that seeks special status for its sufferers, it also needs to provide greater training and resources for teachers regarding disorder management. It is also concluded that recent changes to negligence law regarding the issue of ‘reasonable foreseeability’ within breach of duty of care, may not be as significant as might have been hoped by the teaching community. Indeed, the elevated standard of care, as required by increasing numbers of disordered pupils, place teachers in an ever more difficult legal position.