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PubMed2006

HIV voluntary counseling and testing and HIV incidence in male injecting drug users in northern Thailand: evidence of an urgent need for HIV prevention.

HIV voluntary counseling and testing (VCT), an important strategy for HIV prevention and care, has been available in all government hospitals in Thailand since 1992. We assessed factors associated with HIV testing, its uptake, and estimates of HIV incidence after HIV testing among male northern Thai injecting drug users (IDUs) admitted for inpatient drug treatment. Participants were interviewed about risk behaviors and HIV testing history before VCT was provided as part of the study. Of 825 IDUs who participated, 36% reported a prior HIV test. Factors associated with prior HIV testing in multiple logistic regression analysis included higher education and having >1 lifetime sex partner. Needle sharing was not associated with prior HIV testing. Of the 298 men with a prior test, 80% reported a negative result on their last prior HIV test, of whom 28% tested positive in our study, leading to an estimated incidence rate of 10.2 per 100 person-years. Fifty-nine percent of the IDUs who reported a prior HIV test stated that they did not receive pre- and/or posttest counseling. HIV incidence among IDUs remains high despite having VCT. Extending HIV prevention and harm reduction programs is urgently needed for IDUs in the region.

AIDS Serodiagnosis↗
PubMed2005

Patient knowledge, beliefs, and behavior concerning the prevention and treatment of glucocorticoid-induced osteoporosis.

OBJECTIVE: To obtain descriptive information concerning the extent to which patients taking oral glucocorticoids recall receiving osteoporosis prevention counseling, and to identify factors associated with the practice of 3 behaviors (i.e., calcium intake, vitamin D intake, and bone mineral density [BMD] testing) recommended for patients receiving glucocorticoid therapy. METHODS: The study assessed cross-sectional data derived from telephone interviews and mailed questionnaires completed by 227 patients who were currently taking oral prednisone. Questions assessed current calcium and vitamin D intake and history of BMD testing. RESULTS: Approximately one-third of participants (36.3%) reported that they had received osteoporosis prevention counseling. Among those who reported receiving counseling, most (73.2%) remembered being told about the importance of obtaining an adequate amount of calcium. Other topics were remembered less frequently. Slightly more than half of study participants (51.1%) were obtaining the recommended amount of calcium. Fewer were obtaining the recommended amount of vitamin D (35.2%) or had received a BMD test within the past year (33.5%). The most consistent predictors of behavior were counseling status and patients' perceptions of the difficulty associated with performing the behavior. CONCLUSION: Most patients receiving oral glucocorticoids receive insufficient counseling concerning the prevention of osteoporosis; patients either are not being counseled or they are being counseled in a manner that is not sufficient to promote subsequent recall and behavior change. Research is needed to develop effective strategies to educate patients about the prevention of glucocorticoid-induced osteoporosis.

Administration, Oral↗
PubMed2005

ACOG committee opinion. Number 316, October 2005. Smoking cessation during pregnancy.

Smoking is one of the most important modifiable causes of poor pregnancy outcomes in the United States. An office-based protocol that systematically identifies pregnant women who smoke and offers treatment has been proven to increase quit rates. For pregnant women who are light to moderate smokers, a short counseling session with pregnancy-specific educational materials often is an effective intervention for smoking cessation. The 5 A's is an office-based intervention developed for use by trained practitioners. Techniques for smoking reduction, pharmacotherapy, and health care support systems can help smokers quit.

Directive Counseling↗
PubMed2005

Evidence-based prenatal care: Part I. General prenatal care and counseling issues.

Effective prenatal care should integrate the best available evidence into a model of shared decision making. Pregnant women should be counseled about the risks of smoking and alcohol and drug use. Structured educational programs to promote breastfeeding are effective. Routine fetal heart auscultation, urinalysis, and assessment of maternal weight, blood pressure, and fundal height generally are recommended, although the evidence for these interventions is variable. Women should be offered ABO and Rh blood typing and screening for anemia during the first prenatal visit. Genetic counseling and testing should be offered to couples with a family history of genetic disorders, a previously affected fetus or child, or a history of recurrent miscarriage. All women should be offered prenatal serum marker screening for neural tube defects and aneuploidy. Women at increased risk for aneuploidy should be offered amniocentesis or chorionic villus sampling. Counseling about the limitations and risks of these tests, as well as their psychologic implications, is necessary. Folic acid supplementation beginning in the preconception period reduces the incidence of neural tube defects. There is limited evidence that routine use of other dietary supplements may improve outcomes for the mother and infant.

Blood Grouping and Crossmatching↗
PubMed2006

Counselling overweight and obese patients in primary care: a prospective cohort study.

BACKGROUND: Primary care physicians are well positioned to provide counselling for overweight and obese patients, but no prospective study has assessed the effectiveness of this counselling in primary care. We aimed to evaluate weight reduction counselling by primary care physicians, and its relationship with weight change and patients' behaviour to control weight. DESIGN: A prospective cohort study. METHODS: We enrolled 523 consecutive overweight and obese patients from two Swiss academic primary care clinics. Physicians and patients were blinded to the study aims. We assessed the use of 10 predefined counselling strategies for weight reduction, and weight change and behaviour to control weight after 1 year. RESULTS: Sixty-five per cent of patients received some form of weight reduction counselling whereas 35% received no counselling. A total of 407 patients completed the 1-year follow-up. Those who received counselling lost on average (SD) 1.0 (5.0) kg after 1 year, whereas those who were not advised gained 0.3 (5.0) kg (P = 0.02). In multivariate analysis, each additional counselling strategy was associated with a mean weight loss of 0.2 kg (95% confidence interval 0.03-0.4, P = 0.02). Patients counselled by their physician had more favourable behaviour to control weight than those not counselled, such as setting a target weight (56 versus 36%) or visiting a dietician (23 versus 10%, both P < 0.001). CONCLUSIONS: Weight reduction counselling by primary care physicians is associated with a modest weight loss and favourable behaviour to control weight. However, many obese and overweight patients receive no advice on weight loss during primary care visits.

Adult↗
PubMed2003

Four studies extending the utility of the Schwartz Outcome Scale (SOS-10).

The Schwartz Outcome Scale (SOS-10; Blais et al., 1999) is a brief, cost free, and easy to administer assessment device designed to measure a broad domain of psychological health. The 4 studies using the SOS-10 reported here extend the initial reliability and validity studies beyond psychiatric patients in a hospital setting to examine (a) test-retest reliability in a college student population, (b) concurrent validity with college students using an indirect technique assessing maladjustment, (c) concurrent validity with college counseling center clients using a self-report measure of client distress, and (d) sensitivity to treatment changes with outpatient clients. These studies lend further support for using the SOS-10 as a measure of psychological well-being and as an outcome measure in varied settings.

Directive Counseling↗
PubMed2004

Applying motivational interviewing to contraceptive counseling: ESP for clinicians.

Healthcare providers are in a unique position to address women's risk of unintended pregnancy and sexually transmitted infections (STIs), yet evidence for effective counseling strategies is limited. One approach to developing effective contraceptive counseling methods may be the application of theory-based behavior counseling models. One such model, motivational interviewing (MI), is a promising approach for addressing risk-taking behaviors of many kinds. We propose application of MI to contraceptive counseling. This process, ESP, involves Exploring discrepancies between pregnancy intention and contraceptive use and between risk of STIs and condom use, Sharing information and Promoting behaviors to reduce risk. This model emphasizes the importance of identifying discrepancies between goals and behaviors and supporting women's confidence in using appropriate contraceptive methods

Contraception↗
PubMed2003

Psychological outcomes and risk perception after genetic testing and counselling in breast cancer: a systematic review.

OBJECTIVES: To conduct a systematic review of the effects of genetic counselling and testing for familial breast cancer on women's perception of risk and psychological morbidity. DATA SOURCES: MEDLINE, PsychLIT and EMBASE were searched for the period 1980-2001. STUDY SELECTION: Studies were eligible if published in a peer-reviewed journal in English, included women with a family history of breast cancer who underwent genetic counselling or testing and had either a randomised controlled trial or prospective design, with a pre- and at least one post-counselling assessment. DATA SYNTHESIS: As there was considerable heterogeneity in populations and measures, results were summarised rather than subjected to meta-analysis. RESULTS: Overall, genetic counselling and testing appear to produce psychological benefits and to improve accuracy of risk perception. Carriers of mutations in cancer predisposition genes did not experience significant increases in depression and anxiety after disclosure of their mutation status, while non-carriers experienced significant relief. Women who were tested but declined to learn their results seemed to be at greater risk of a worse psychological outcome. CONCLUSIONS: To date, the data on psychological outcomes after genetic counselling and testing are reassuring. However, few studies used a randomised trial design, limiting the strength of the conclusions. Follow-up to date has been short, and we know little about the long-term impact of testing on patient behaviours, perceptions and psychological state.

Adaptation, Psychological↗
PubMed2005

Pre-natal counselling--helping couples make decisions following the diagnosis of severe heart disease.

The prenatal diagnosis of a major cardiac abnormality tends to precipitate a crisis for the affected parents. In a setting of grief and emotional distress, there is the challenge to provide meaningful information of the abnormality, its need for intervention and likely outcome, so as to enable the parents, if allowed the option, to come to a fully informed decision as to whether to continue with the pregnancy. This discussion paper reviews the difficulties encountered in counselling affected parents being mindful of the psychological constraints prevalent at the time. While an accurate and detailed diagnosis is important for the professionals, the information required by the parents needs to be simple and focussed on the questions raised by them as they relate to quality of life issues to be experienced by their yet unborn infant/child growing into an adult.

Directive Counseling↗
PubMed2006

Impact of repeated lifestyle counselling in an atherosclerosis prevention trial on parental smoking and children's exposure to tobacco smoke.

AIM: To determine whether repeated infancy-onset lifestyle counselling alters parental smoking and children's exposure to tobacco smoke. METHODS: In 1990, 1062 healthy infants were recruited to a randomized, ongoing atherosclerosis prevention trial (STRIP). Intervention families received at least twice a year individualized nutrition and lifestyle counselling. By 1999, 652 8-y-old children continued participation. Exposure to tobacco smoke was evaluated using serum cotinine concentration. Parents' smoking was also assessed using questionnaires and interviews. RESULTS: Parents' smoking decreased during the study similarly in the intervention and control groups. Of the 8-y-old children, 46% had detectable serum cotinine concentration, suggesting exposure to tobacco smoke during the past few days. All children were non-smokers. Serum cotinine concentrations did not differ between the intervention and control children. Children's cotinine values were highest in the families where either father or both parents were smokers. CONCLUSION: Participation in the atherosclerosis prevention trial slightly decreased smoking among the intervention and control parents. However, counselling led to no differences in parental smoking between the two groups, or in exposure of the intervention and control children to tobacco smoke. This study suggests that more detailed and targeted intervention is required to achieve a significant effect on children's tobacco smoke exposure.

Adult↗
PubMed2004

Alcohol-related advice for Veterans Affairs primary care patients: Who gets it? Who gives it?

OBJECTIVE: Most patients who misuse alcohol do not receive alcohol counseling from their providers. This study evaluated primary care patient and provider characteristics associated with receipt of alcohol-related advice and whether patients were advised to drink less or to abstain. METHOD: Outpatients from seven Veterans Affairs (VA) general medicine clinics were eligible if they screened positive for alcohol misuse, completed the Alcohol Use Disorders Identification Test (AUDIT) and answered questions about alcohol-related treatment and advice. Hierarchical logistic regression was used to evaluate patient and provider characteristics associated with patient reports of alcohol-related advice from a primary care provider in the past year. RESULTS: Among 5191 patients with alcohol misuse in the past year, 1554 (30%) reported receiving alcohol-related advice from their primary care provider during that time. Of patients advised, 73% reported advice to abstain. The likelihood of reporting advice increased as AUDIT scores increased: from 13% of patients with AUDIT scores <8 to 71% of those with scores > or =20. After adjustment for important confounders, measures reflecting the severity of alcohol misuse were most strongly associated with receipt of alcohol-related advice. Adjusted analyses also revealed increased odds of receiving advice among patients who reported liver disease, hypertension, current smoking or continuity of care. No measured provider characteristic was associated with giving advice in the fully adjusted model. CONCLUSIONS: This multisite VA study found that most patients with alcohol misuse did not receive alcohol counseling from a primary care provider. Moreover, providers predominantly offered advice to abstain, and they appeared to focus on patients with the most severe problems due to drinking or medical contraindications to drinking.

Aged↗
PubMed2002

Choroid plexus cysts in the mid-trimester fetus--practical application suggests superiority of an individualized risk method of counseling for trisomy 18.

OBJECTIVES: Analysis of a referral population of patients with choroid plexus cysts (CPCs) was performed to compare an average risk method of counseling to an individualized risk method. METHODS: A total of 395 patients referred to a Prenatal Diagnosis Center were included, of whom 341 had isolated CPCs and 54 had associated ultrasound abnormalities. For isolated CPCs, an average risk of 1/150 for aneuploidy was compared to an individualized risk assessment [prior risk as determined by maternal age or serum screening multiplied by the likelihood ratio established by Gupta et al. (1997)]. Accuracy, cost, and procedure-related losses were assessed. RESULTS: Both methods resulted in 100% sensitivity. The individualized method resulted in greater specificity, decreased costs, and (theoretically) fewer procedure-related pregnancy losses. CONCLUSIONS: An individualized risk method of counseling utilizing the likelihood ratios established by Gupta et al. (1997) was superior to an average risk method for assessing trisomy 18 risk in the setting of CPC detected in mid-trimester.

Adult↗
PubMed2005

Use and effectiveness of tobacco telephone counseling and nicotine therapy in Maine.

BACKGROUND: Since 2001, the Maine Bureau of Health has offered free evidence-based treatment for tobacco dependence, including telephonic counseling and nicotine replacement therapy (NRT). This study examined the utilization of treatment services, evaluated quit outcomes, and estimated the population impact of treatment. METHODS: This is a descriptive study of tobacco users receiving treatment services from the Maine Tobacco HelpLine from January 2003 to December 2004. Demographics of callers were compared to adult smokers statewide, and NRT utilization was examined among callers eligible for therapy. Quit outcomes were assessed by telephone interview among a sample of callers registered November 15, 2003 to January 31, 2004 (n=535), 6 months after assistance. The population impact of treatment was estimated by applying intent-to-treat (30-day point prevalence) quit rates to services delivered in 2003 and 2004. Analyses were conducted in 2005. RESULTS: A total of 12,479 adult smokers (3% of smokers annually) utilized Maine's tobacco services during 2003 and 2004. Compared to smokers statewide, callers were more likely to be aged 45 to 64, female, or uninsured. A total of 82.3% of callers who were eligible for NRT and received counseling obtained free NRT. Intent-to-treat quit rates at 6 months were 12.3% (95% confidence interval [CI]=8.1-17.6) for counseling, and 22.5% (95% CI=19.1-26.3) for counseling plus NRT. An estimated 1864 smokers calling in 2003-2004 had successfully quit. CONCLUSIONS: The Maine Tobacco HelpLine and NRT programs have demonstrated effectiveness and population outreach, particularly to uninsured smokers. This study suggests that for quit lines to maximize their impact, tobacco medication access may be important.

Adolescent↗
PubMed2005

Sodium reduction for hypertension prevention in overweight adults: further results from the Trials of Hypertension Prevention Phase II.

Sodium reduction is efficacious for primary prevention of hypertension, but the feasibility of achieving this effect is unclear. The objective of the paper is detailed analyses of adherence to and effects of the sodium reduction intervention among overweight adults in the Trials of Hypertension Prevention, Phase II. Sodium reduction (comprehensive education and counselling about how to reduce sodium intake) was tested vs no dietary intervention (usual care) for 36-48 months. A total of 956 white and 203 black adults, ages 30-54 years, with diastolic blood pressure 83-89 mmHg, systolic blood pressure (SBP) <140 mmHg, and body weight 110-165% of gender-specific standard weight were included in the study. At 36 months, urinary sodium excretion was 40.4 mmol/24 h (24.4%) lower in sodium reduction compared to usual care participants (P<0.0001), but only 21% of sodium reduction participants achieved the targeted level of sodium excretion below 80 mmol/24 h. Adherence was positively related to attendance at face-to-face contacts. Net decreases in SBP at 6, 18, and 36 months of 2.9 (P<0.001), 2.0 (P<0.001), and 1.3 (P=0.02) mmHg in sodium reduction vs usual care were associated with an overall 18% lower incidence of hypertension (P=0.048); were relatively unchanged by adjustment for ethnicity, gender, age, and baseline blood pressure, BMI, and sodium excretion; and were observed in both black and white men and women. From these beneficial but modest results with highly motivated and extensively counselled individuals, sodium reduction sufficient to favourably influence the population blood pressure distribution will be difficult to achieve without food supply changes.

Adult↗
PubMedDate not supplied

The cancer patient at work.

The person who has been treated for cancer may have unique problems resuming employment or starting a new job. Cancer represents a spectrum of diseases, and posttreatment impairments may vary from none, in the majority of cases, to major functional disability. Employers understandably have difficulty recognizing the variability that exists, both in terms of functional capacity and prognosis, and they are often unaware of the improved prognosis for many cancers. Today, many patients receive adjuvant chemotherapy or prolonged intermittent treatment and need to adjust their work schedule to allow for this. Some people need job training or vocational counseling; in many states, vocational rehabilitation agencies now have an increased interest in providing services to cancer patients. Discrimination against the cancer patient has been demonstrated; the major problems are in the area of hiring practices. Efforts need to be continued to educate employers and the public and to ensure that the rights of the cancer patient are recognized. We may, however, do our patients a disservice if we overemphasize potential problems to a degree that increases patient fear and insecurity in regard to employment. Instead, we as physicians may be able to help prevent problems by more effective communication with employers on behalf of our patients, as well as by direct patient counseling. The insurance problems of cancer patients, particularly those relating to health insurance, do require major attention. The potential productivity, as well as the quality of life, of the cancer patient are jeopardized when he or she feels unable to change jobs because of fear of loss of insurance coverage. The relatively high number of reported cancellations and changes in insurance benefits that have been reported by cancer patients also represents an area of concern, since some of these appear medically unjustified. The physician's opinion and input may be of importance in preventing or solving individual insurance problems. The physician can also help the cancer patient who has employment problems by providing information about available resources. The above-mentioned employment booklet (#4585-PS), available from the ACS, may be useful and contains information about legal resources. Referral to a vocational rehabilitation agency may be indicated. The best medicine of all may be a positive and optimistic attitude toward the patient's participation in the work force.

Adaptation, Psychological↗
PubMed2003

The cost effectiveness of 5 interventions to increase mammography adherence in a managed care population.

OBJECTIVE: To determine the cost effectiveness of 5 combinations of strategies for increasing adherence to mammography recommendations in a population of women between the ages of 50 and 85 years enrolled in a large midwestern health maintenance organization. STUDY DESIGN: A randomized control trial comparing interventions believed to increase mammography adherence. PATIENTS AND METHODS: Intervention strategies included 5 combinations of physician recommendation, telephone, and in-person counseling. A total of 652 participants were randomly assigned to 1 of 6 intervention groups and 628 (95.9%) were available at 6-month follow-up. A logistic regression model with adherence as the dependent variable and group as the independent variable was used to test for significant differences between groups. A ratio of cost to improvement in mammogram adherence evaluated the cost effectiveness at 6 months. RESULTS: All 5 interventions resulted in significantly higher rates of adherence compared to no intervention. However, when considering costs, only 1 emerged as the superior strategy for the overall study population. In-person counseling was the most cost-effective strategy overall, followed closely by in-person counseling and physician's letter intervention. For women contemplating mammography, the telephone contact and physician's letter combination was the most cost-effective intervention. For women not contemplating mammography, the physician's letter was superior. The physician's letter worked best with women who had previous mammograms. For women with no mammogram history, the in-person counseling and physician's letter combination was clearly superior. CONCLUSIONS: The cost effectiveness of mammography screening interventions varies based on women's prior history of mammograms and their future intent. Further, managed care organization member characteristics can be used to determine the most cost-effective mammography screening intervention based on individual readiness.

Aged↗
PubMed2004

Pre-departure counselling and an email contact service for patients with epilepsy faring abroad for long periods of time.

The fate and management of 50 patients with epilepsy is described whilst they undertook varied gap year experiences in various countries. Despite initial apprehension on my part almost all had no change in their epilepsy (or had actual improvement) and it turned out to be a positive experience for all. With the ready availability of email it is suggested that the home clinic keeps in touch with gap year students whilst they are away and provides them with basic information and an assessment before they go, information which they can then take with them.

Adolescent↗