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PubMed2003

A pilot study comparing motivational interviewing and an educational intervention in patients with schizophrenia and alcohol use disorders.

Thirty subjects with comorbid schizophrenia and alcohol use disorders were randomly assigned to receive either a Motivational Interviewing (MI) or Educational Treatment (ET) intervention with treatment goals of abstinence and/or decreased alcohol use. Subjects were followed up at 4, 8 and 24-weeks upon completion of the interventions. Outcome measures included number of drinking days, abstinence rates, average blood alcohol concentration and standard ethanol content per drinking day. Subjects randomized to the MI intervention had a significant reduction in drinking days and an increase in abstinence rates when compared to subjects receiving ET. Motivational Interviewing may be a useful treatment intervention for individuals with schizophrenia and alcoholism.

Adult↗
PubMed1999

Genetic aspects of population policy.

Every science begins in folklore and matures as it reacts against dogma and myth. Astronomy developed in the Neolithic, but it did not outgrow astrology until the sixteenth century. Chemistry discarded alchemy at about the same time. On the contrary, the short history of genetics has been concurrent with the pseudo-science of eugenics, which, at times, has been widely accepted and incorporated in population policy and directive genetic counselling, with rare opposition by geneticists. Societal pressures are likely to increase with the power of genetic technology, the fear it generates and the perception that population growth threatens human welfare. Without a pertinent ethical code, geneticists are vulnerable to both temptation and opprobrium. The intrusion of eugenics into genetic counselling has been a recent source of concern to societies and congresses of genetics. This review traces the causes of this concern and the manner of its expression in the absence of an international voice for genetics that could address ethical and other common interests.

Eugenics↗
PubMed2005

Two brief alcohol interventions for mandated college students.

Encouraging but limited research indicates that brief motivational interventions may be an effective way to reduce heavy episodic drinking in college students. At 2 campuses, students (83% male) mandated to a substance use prevention program were randomly assigned to 1 of 2 individually administered conditions: (a) a brief motivational interview (BMI; n = 34) or (b) an alcohol education session (AE; n = 30). Students in the BMI condition reported fewer alcohol-related problems than the AE students at 3-and 6-month assessments. Trends toward reductions in number of binge drinking episodes and typical blood alcohol levels were seen in both groups. Process measures confirmed the integrity of both interventions. The findings demonstrate that mandated BMIs can reduce alcohol problems in students referred for alcohol violations.

Adult↗
PubMed2005

Effect of lifestyle modifications on blood pressure by race, sex, hypertension status, and age.

Recommendations for control of high blood pressure (BP) emphasize lifestyle modification, including weight loss, reduced sodium intake, increased physical activity, and limited alcohol consumption. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern also lowers BP. The PREMIER randomized trial tested multicomponent lifestyle interventions on BP in demographic and clinical subgroups. Participants with above-optimal BP through stage 1 hypertension were randomized to an Advice Only group or one of two behavioural interventions that implement established recommendations (Est) or established recommendations plus DASH diet (Est plus DASH). The primary outcome was change in systolic BP at 6 months. The study population was 810 individuals with an average age of 50 years, 62% women, 34% African American (AA), 95% overweight/obese, and 38% hypertensive. Participants in all the three groups made lifestyle changes. Mean net reductions in systolic (S) BP in the Est intervention were 1.2 mmHg in AA women, 6.0 in AA men, 4.5 in non-AA women, and 4.2 in non-AA men. The mean effects of the Est Plus DASH intervention were 2.1, 4.6, 4.2, and 5.7 mmHg in the four race-sex subgroups, respectively. BP changes were consistently greater in hypertensives than in nonhypertensives, although interaction tests were nonsignificant. The Est intervention caused statistically significant BP reductions in individuals over and under age 50. The Est Plus DASH intervention lowered BP in both age groups, and significantly more so in older individuals. In conclusion, diverse groups of people can adopt multiple lifestyle changes that can lead to improved BP control and reduced CVD risk.

Adult↗
PubMed2005

Dose-response of sodium excretion and blood pressure change among overweight, nonhypertensive adults in a 3-year dietary intervention study.

A cross-sectional dose-response relationship between sodium intake and blood pressure (BP) has been demonstrated, but evidence for a graded longitudinal effect is limited. Evaluation of BP response to sodium reduction was assessed in a 3-year lifestyle dietary intervention trial. BP changes at 18 and 36 months after enrollment were analysed according to concurrent quantitative changes in sodium excretion and by categories of success in sodium reduction among 1157 men and women, ages 30-54 years, with a diastolic BP (DBP) 83-89 mmHg, systolic BP (SBP) <140 mmHg, body weight 110-165% of sex-specific standard weight, and valid baseline urinary sodium excretion. Participants were randomized to a Sodium Reduction intervention (n=581) or Usual Care (n=576). From a 187 mmol/24 h baseline mean sodium excretion, net decreases were 44 mmol/24 h at 18 months and 38 mmol/24 h at 36 months in Sodium Reduction vs Usual Care. Corresponding net decreases in SBP/DBP were 2.0/1.4 mmHg at 18 months, and 1.7/0.9 mmHg at 36 months. Significant dose-response trends in BP change over quintiles of achieved sodium excretion were seen at both 18 (SBP and DBP) and 36 (SBP only) months; effects appeared stronger among those maintaining sodium reduction. Estimated SBP decreases per 100 mmol/24 h reduction in sodium excretion at 18 and 36 months were 2.2 and 1.3 mmHg before and 7.0 and 3.6 mmHg after correction for measurement error, respectively. DBP changes were smaller and nonsignificant at 36 months. In conclusion, incremental decreases in BP with lower sodium excretion were observed in these overweight nonhypertensive individuals.

Adult↗
PubMed1984

Genetic aspects of "uncomplicated" hydrocephalus and its relationship to neural tube defect.

Congenital hydrocephalus is a relatively uncommon abnormality in population malformation surveys accounting for between four and ten out of every 10,000 births. In 30%, it is caused by aqueduct stenosis. The majority of cases have a multifactorial aetiology, the genetic component, which is polygenic, rendering the developing foetus susceptible to largely unidentified environmental factors in early development. Some cases are caused by single gene defects. Family studies suggest that the risk to siblings of a child with uncomplicated congenital hydrocephalus, where the anatomical site is not specified, is about 1 in 50 (1 in 40 for males, 1 in 80 for females). With aqueduct stenosis, the risk to brothers of affected boys is 1 in 22, to sisters only 1 in 50. The risks to siblings of sisters is less. Probably less than 2% of uncomplicated hydrocephalus has an X-linked basis and such an aetiology should be suspected if the special clinical features are present, there is more than one male sibling affected, or there are affected male relatives on the mother's side. Dandy-Walker's syndrome may be recessively inherited and there are some other, but very rare, monogenic causes for hydrocephalus. There is not obvious additional risk for neural tube defect. Non-directive genetic counselling should be given either at the genetic clinic or at a specially arranged clinic appointment and should include not only the risk to the family members, but also the options for avoiding recurrences, and any prenatal diagnostic tests available, such as high precision ultrasonography and a serum alphafetoprotein estimation at about sixteen weeks gestation.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Aqueduct↗
PubMedDate not supplied

The global problem of genetic disease.

Inherited haemoglobin disorders will undoubtedly cause an increasing health burden in many developing countries. Although much is known about their molecular pathology and the mechanisms for their phenotypic diversity, many important questions remain, not least the role of the environment in modifying the clinical course. Methods for screening these conditions are now well established and inexpensive and it is vital that they are applied to define the magnitude of the problem that will be posed by these conditions in the future. Similarly, they form the basis for widespread screening and counselling programmes directed at developing prenatal diagnosis expertise where this is not available. Answers to some relatively simple questions about the role of the environment could also make a major difference to the management of the haemoglobin disorders. There is a major case for the development of regional networks to apply such technology as has been developed for the control and prevention of the important haemoglobin disorders, particularly in Asian countries.

Developing Countries↗
PubMed2002

The influence of the therapeutic relationship in treatment for alcohol dependency.

The substance abuse field has been slow to embrace research into the impact of the therapeutic relationship on treatment outcome. Limited previous research has demonstrated that therapist factors such as unconditional regard and empathy are associated strongly with treatment outcome. This study examined the relationships between client perception of the therapist and client characteristics; client response to out-patient relapse prevention treatment; and client outcome 3 months following treatment for alcohol dependence. One hundred and sixty-one male clients of a 3-week relapse prevention programme participated in the research, completing questionnaires assessing their perception of therapist regard, empathy, congruence, attractiveness, expertness and trustworthiness. Treatment outcome was measured at the conclusion of treatment, and 3 months post-treatment. Clients who were more anxious and those with poorer cognitive functioning appeared to perceive therapists as showing less unconditional regard, empathy and congruence. Self-efficacy and coping skills acquisition measured at the end of treatment correlated significantly with clients' perceptions of the therapist as empathic, congruent and displaying high regard for them. Treatment outcome at 3 months was associated significantly with degree of perceived therapist expertness and empathy. These relationships held when cognitive functioning and skills acquisition were controlled for. Self-efficacy moderated the relationships between regard and empathy and outcome, but not perceived therapist expertness. A lower than desirable follow-up rate limits the generalizability of the findings. The quality of the therapeutic relationship as perceived by clients appears to be associated with client characteristics, response to treatment and treatment outcome.

Adult↗
PubMed2004

Brief interventions: good in theory but weak in practice.

A substantial body of research evidence has accumulated in support of the efficacy of brief interventions for a number of alcohol and drug-related problem areas, most notably alcohol and tobacco. This evidence has been used to exhort a range of professional groups such as general practitioners (GPs), and more recently emergency department hospital staff to engage in brief interventions. Internationally, however, these secondary prevention efforts have largely failed. Why have these proven interventions not been embraced by frontline workers? This is a little-asked question as efforts to press-gang unwilling professionals to take up the cudgel continue. This paper examines the characteristics of brief interventions and their principal delivery agents and explores reasons for the failure to move from efficacy to effectiveness. Given the prevention potential that rests with brief intervention, these are crucial questions to address. A key feature of brief intervention delivery also examined is the role of GPs versus the less well-explored option of the practice nurse. It will be proposed that perhaps we have the right vehicle but the wrong driver and that until closer scrutiny is made of this issue efforts in this key prevention area will continue to fail to achieve optimum results.

Alcoholism↗
PubMed2003

Genetic testing and primary care: a new ethic for a new setting.

For several decades, clinical geneticists have espoused two key ethical principles, nondirectiveness and confidentiality. These principles made a great deal of sense in the highly personal and controversial setting of reproductive genetics. Now that clinical genetics has entered the primary care setting, clinicians are rethinking the strength of their commitment to these traditional norms and they are revamping their ethical priorities. Patients increasingly need advice about whether they should take genetic tests and whether and how they should respond to the test results. Patients also need to know about how this information will impact family members and whether other members of their family should be tested. Clinical geneticists may even consider breaking individual confidentiality in order to prevent harms to family members. Although clinical geneticists do not need to abandon nondirectiveness and confidentiality in this new setting, they may not strictly adhere to these principles in some circumstances in order to benefit patients and their families.

Confidentiality↗
PubMed2004

A cost-effectiveness comparison of three tailored interventions to increase mammography screening.

BACKGROUND: Mammography is the primary method used for breast cancer screening. However, adherence to recommended screening practices is still below acceptable levels. This study examined the cost-effectiveness of three combinations of tailored telephone and mailed intervention strategies for increasing adherence to mammography. METHODS: There were 1044 participants who were randomly assigned to one of four groups. A logistic regression model with adherence as the dependent variable and group as the independent variable was used to test for significant differences, and a ratio of cost/improvement in mammogram adherence evaluated the cost-effectiveness. RESULTS: All three of the interventions (tailored telephone, tailored mail, and tailored telephone and mail) had significantly better adherence rates compared with the control group (usual care). However, when also considering costs, one emerged as the superior strategy. The cost-effectiveness ratios for the three interventions show that the tailored mail (letter) was the most cost-effective strategy, achieving 43.3% mammography adherence at a marginal cost of dollar 0.39 per 1% increase in women screened. The tailored mail plus telephone achieved greater adherence (49.4%), but at a higher cost (dollar 0.56 per 1% increase in women screened). CONCLUSIONS: A tailored mail reminder is an effective and economical intervention to increase mammography adherence. Future research should confirm this finding and address its applicability to practice in other settings.

Adult↗
PubMed1979

Quality of life after stroke: a three-year follow-up.

Forty-five people who had suffered a stroke three years previously were interviewed, as were their close relatives and friends. Changes in their lives which they attributed to stroke were explored, and information was gathered about health and social care resources they had used or needed. It was evident that stroke had devastated many peoples' lives: they ceased work prematurely, their interpersonal relations had deteriorated and over 70% viewed their future with uncertainty or gloom. Physical disability in itself was less important than peoples' response to their disability; inappropriate and dysfunctional responses were present in over half. In spite of adequate medical care, 40% of subjects would have been assisted by social work assessment, counseling and direction to appropriate community services.

Activities of Daily Living↗
PubMedDate not supplied

Pulmonary rehabilitation compared with brief advice given for severe chronic obstructive pulmonary disease.

PURPOSE: The objective of this study was to compare the effectiveness of a short-term pulmonary rehabilitation program with brief advice given to patients with severe ventilatory impairment due to chronic obstructive pulmonary disease (COPD). METHODS: One hundred three patients with severe COPD, defined as having forced expiratory volume in 1 second < 40% predicted, were randomly assigned to rehabilitation or to brief advice. Fifty-four patients attended a rehabilitation program twice a week for 6 weeks. Forty-nine patients attended a single session during which they were given printed educational materials and verbal advice and guidance about exercise. Subjects were reassessed at 3 months. RESULTS: The shuttle walking distance increased significantly in the rehabilitation group by 43 meters. The increase of 23 meters in the brief advice group was significantly less than in the rehabilitation group. Improvements in quality of life in the rehabilitation group were small and not clinically significant. CONCLUSIONS: In these patients with severe COPD, a short outpatient rehabilitation program of low intensity achieved small but significant improvement in shuttle walking distance, compared with brief advice. The improvements in quality of life were modest and did not reach statistical significance, although in some instances the confidence limits include differences that approach clinical significance. The relatively small effect may be due to the low intensity of the program or to the severity of the subjects' ventilatory impairment.

Aged↗
PubMed2005

Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain.

STUDY DESIGN: A prospective clinical randomized controlled trial. OBJECTIVES: To determine the long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic and recurrent low back pain (LBP). SUMMARY OF BACKGROUND DATA: There is agreement on the importance of exercise during the course of chronic LBP. However, it is well known that long-term adherence with exercises is particularly low. METHODS: A total of 93 patients with LBP were randomly assigned to the control group (standard exercise program) or the motivational group (combined exercise and motivational program). Follow-up assessments were performed at 3.5 weeks, 4 months, 12 months, and 5 years. Main outcome measures were disability scores, pain intensity, and working ability. In addition to classic statistics, the sophisticated linear partial credit model was used to test the effects of treatment on disability scores. RESULTS: In both groups, significant improvements in the disability scores were found at all points of follow-up assessment, however, the cumulative effect of the treatment in the motivational group was more than twice as much as in the control group. This result is in accordance with the increasing divergence in pain intensity between groups between 12 months and 5 years after intervention. A significant, positive long-term effect at the 5-year reassessment in working ability was only seen in the motivational group. All statistically significant results were confirmed by intention-to-treat analyses. CONCLUSIONS: Regarding long-term efficacy, the combined exercise and motivation program was superior to the standard exercise program. Five years after the supervised combined exercise and motivational program, patients had significant improvements in disability, pain intensity, and working ability.

Chronic Disease↗
PubMedDate not supplied

Coping effectiveness training for men living with HIV: results from a randomized clinical trial testing a group-based intervention.

OBJECTIVE: This randomized clinical trial was designed to compare the effects of a theory-based coping effectiveness training (CET) intervention with an active informational control (HIV-Info) condition and a waiting-list control (WLC) condition on psychological distress and positive mood in HIV-seropositive gay men. MATERIALS AND METHODS: The authors recruited 149 self-identified gay or bisexual men who were 21 to 60 years of age, reported depressed mood, and had CD4 levels of 200 to 700 cells/mm(3). CET and HIV-Info participants attended 10 90-minute group sessions during the 3-month intervention phase and six maintenance sessions over the remainder of the year. Participants were assessed at baseline and at 3, 6, and 12 months. Data were collected 1992 to 1994, before the introduction of HAART. Analyses were based on the 128 participants who completed the 3-month assessment. RESULTS: After the 3-month intervention phase, when compared with HIV-Info, CET participants showed significantly greater decreases in perceived stress and burnout, and regression analyses indicated that significant increases in coping self-efficacy mediated the improvements in perceived stress and burnout. Compared with WLC, CET participants also showed significantly greater decreases in anxiety, and regression analyses indicated that significant increases in positive states of mind mediated the improvements in anxiety. Significant treatment group differences for positive morale were maintained at 6 and 12 months. In addition, optimism continued to increase in the CET and HIV-Info treatment groups during the maintenance phase. CONCLUSIONS: CET can be an effective strategy for managing psychological distress and improving positive psychological states in patients confronting chronic illness.

Adaptation, Psychological↗