SEARCH · Search PubMed

Results for “Directive Counseling”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 685 records · Page 38Linked to original sources

PubMed1987

Study of the women overdue for a smear test in a general practice cervical screening programme.

Of the 1527 women aged 30-59 years in one general practice who were eligible for a cervical smear examination 196 (12.8%) were overdue for the test. These women were contacted randomly by post or in person to ascertain their reasons for not responding to the practice screening programme. Of 118 women contacted personally 47% had no major objection to the smear test but had a low view of its priority. A further 24% gave incorrect reasons for thinking a smear test was unnecessary while 29% had strong reasons for not wanting to attend and probably never would. Social and medical factors from the medical records were also examined and compared with those of a group of age and sex matched controls. It was found that women overdue for a smear test lived in more ;socially stressed' areas and used their general practitioner much less than the controls. The theoretical upper limit for smear uptake in the practice was calculated to be around 96%. To help achieve this we need to ensure: (1) that all women understand that the test is to detect a stage before cancer; (2) that some women receive more counselling; and (3) that promotional material is directed at the families of women at risk.

Adult↗

PubMedDate not supplied

Comparison of HIV-risk behaviors and demographics of adolescents tested or not tested for HIV infection.

In a survey of 2,548 adolescents, 11.5 percent reported ever having had the human immunodeficiency virus (HIV) antibody test. Those who had been tested were significantly more likely to be male, black, and to reside in metropolitan areas than those who had not been tested. Tested adolescents were more than three times as likely to report having injected drugs and were more than twice as likely to have had sexual intercourse, had sexual intercourse at earlier ages, and with multiple partners. More than half of adolescents who had been HIV-tested had no reported risks for HIV infection. More than one-quarter of adolescents not tested reported at least one HIV risk factor. These data suggest the importance of discussing the HIV testing and counseling process within any HIV education program directed to adolescents.

Adolescent↗

PubMed1997

[Presymptomatic DNA diagnosis of spinocerebellar ataxia type 1].

Hereditary autosomal dominant ataxias is a clinically and genetically heterogeneous group of diseases characterized by a progressive ataxia combined with the signs of multisystem involvement of the brain and spinal cord. The modern classification of these disorders of the central nervous system is based on recent advances in molecular genetics. In a form of dominant ataxia, spinocerebellar ataxia type 1 (SCA1), the mutation consists of an increased number of copies (expansion) of trinucleotide repeats within the causative gene. This mutational mechanism is characteristic of a group of hereditary neurodegenerative diseases. Revealing this phenomenon provided a tool for direct DNA diagnosis of SCA1 at any stage of the disease, including the preclinical one. This is the first reported case of a direct DNA diagnosis of SCA1 in Russia. The diagnosis was performed in five healthy persons from the risk group, i.e., relatives of patients with a molecularly proven SCA1. Three persons were diagnosed to be presymptomatic carriers of the mutant SCA1 gene; in two persons, the mutation was not found. A complex of moral, ethical, medical, and social problems connected with the application of direct DNA testing of SCA1 in genetic counselling is discussed.

DNA↗

PubMed1992

The Patient Self-Determination Act. Advance directives available to Minnesota patients.

The Patient Self-Determination Act requires most health care institutions to inform patients of their right to refuse medical care and their right to provide advance direction regarding their wishes should they become incompetent. Although the PSDA does not apply to physicians, it will probably increase the demand for communication with patients on such matters. Patients will undoubtedly ask how to formulate advance directives. While physicians should make it clear that they are not providing legal advice to patients on such issues, they may wish to indicate that a guardianship and a living will are options available under Minnesota law. Additionally, as indicated above, a number of arguments exist that durable powers of attorney for health care are valid in Minnesota, as well. Physicians should familiarize themselves with living will forms and may wish to make them available to patients upon request. (Living will forms can be obtained by contacting the Minnesota Medical Association at 612/378-1875.) Patients with questions regarding durable powers of attorney should be advised to seek legal counsel.

Advance Directives↗

PubMed1977

[Genetic counselling (results of ten years experience). III. Evaluation of risk (author's transl)].

Among 924 consultations for definite or probable genetic disorders, two persons out of five seeking counselling run a high risk (10% or more) of having an affected child, one in five a risk varying between 1% and 9%, and two out of five a negligeable risk (less than 1%). In most cases (three out of four) individuals with affected relatives could be completely reassured, whilst one out of two affected persons seeking counselling ran a high risk of having a child who would suffer the same handicap. Among the normal parents with affected children, one out of three could be completely reassured, but on the other hand the same proportion ran a high risk of having another affected child. The calculated risks were compared in prenuptial, pre-pregnancy and prenatal counselling. The evaluation of the risk is only the first step in the counselling and certain special situations were chosen to demonstrate the factors which can modify the risk. The authors stress that genetic counselling, which is rarely simply indicative, should often be directive. In some cases, the prenatal diagnosis converts the theoretical risk into a certainty.

Genetic Counseling↗

PubMed2004

Cardiovascular disease prevention counseling in residency: resident and attending physician attitudes and practices.

PURPOSE: This study seeks to establish resident and attending physician attitudes and practice patterns with regard to cardiovascular disease (CVD) preventive counseling within a teaching hospital setting. METHODS: A 75-question survey was administered to residents and their attending physicians within a single academic medical residency program at a large, urban public hospital. RESULTS: Physician CVD risk factor counseling rates were lowest for exercise and diet (16% and 20%, respectively) and somewhat higher, although not ideal, for medication compliance and smoking (52% and 88%, respectively). Physicians did not often recommend behavior change strategies, and few physicians felt very effective in their counseling of smoking, exercise, diet, and weight reduction (25%, 24%, 27%, and 23%, respectively). Physicians acknowledged the existence of many patient, physician, and system barriers that interfered with providing more preventive counseling. There were few differences in counseling practices and attitudes between residents and attending physicians, and no significant gender differences. CONCLUSIONS: Our study found low counseling rates for CVD prevention, particularly in the areas of diet, exercise, and weight loss. Future interventions should highlight the importance of diet, exercise, and weight control in preventing CVD, and efforts should be directed toward training both resident and attending physicians, as counseling rates are low in both groups.

Adult↗

PubMed2004

Counseling children and parents about epilepsy.

In spite of remarkable progress in drug therapy, childhood and adolescent epilepsy is often a distressing condition lasting several years before possible recovery. Adaptation problems to the disease, and also to health recovery, are likely to occur. Stigma and discrimination may persist also after recovery. Learning problems involve a high number of patients. Neuropsychological problems related to localization of the epileptic focus may be present; intellectual deterioration in more severe cases and in some specific syndromes may occur. These problems are not unknown, but therapeutic effort is often directed only towards seizure control. The importance of counseling children and parents is stressed by the authors, and practical advice is given on planning doctor-patient dialogues, in order to prevent non-justified restrictions in day life, fears and negative reactions, and to ameliorate intrafamilial relation, integration in the school milieu and compliance towards drug intake. The role of neuropsychological evaluation and pedagogic advice is also emphasized. Children and adolescents with epilepsy and their families need more than medical therapeutic support to get an acceptable quality of life.

Adaptation, Psychological↗

PubMed1994

[Effects of personalized counseling in the reduction of pressure levels in patients with severe essential hypertension. WHO 1].

UNLABELLED: Two intervention systems to evaluate the effect of personalized counseling in severe essential hypertensive patients OMS I, oriented to reduce systolic and diastolic tension pressures and to increase self-esteem, were compared. The independent variable as an intervention method took place during 24 weeks. DEPENDENT VARIABLES: tension pressures and self-esteem were measured. The results showed that essential severe tension pressures and increased their self-esteem more than patients of control group. Finding also a direct dependence between weight and tension pressures Personalized Counseling showed to be a successful strategy of nursing for this group of patients.

Aged↗

PubMedDate not supplied

The knowledge, attitude and practice of voluntary counselling and testing (VCT) for HIV/AIDS among undergraduates in a polytechnic in southeast, Nigeria.

BACKGROUND: The identification of infected individuals is an important step in the control of the HIV epidemic. Voluntary counselling and testing (VCT) for HIV/AIDS is a concept developed in this direction. The objective of this study is to determine the level of knowledge, attitude and practice of Voluntary Counselling and Testing (VCT) for HIV/AIDS among undergraduates in a Nigerian tertiary institution. METHOD: This is a cross sectional study using a multistage sampling method to enroll students from different levels of the national diploma programme into the study. A structured questionnaire was administered to the 260 students with response rate of 70%. RESULT: Only 115 (63.2%) of the students were aware of VCT with 68 (59.1%) having heard of it at least one year prior to the study. Mass media and Churches were the highest sources of information on VCT Most of the students did not know where VCT services could be obtained and knowledge of what VCT entails was also low. However, 127 (69.8%) students approved the necessity of counselling prior to testing and 117 (64.3%) were ready to take a positive result in good fate. At least one out of every four students (54 of 182) had been sexually active within three months preceding the study Only 48 (26.4%) students had taken an HIV test at one time or the other before the study. Majority (62.5%) of those who had been tested went for the screening just to know their HIV status. Premarital testing (18.8%) was the second commonest reason for taken an HIV test. Majority of the respondents (74.2%) were willing to go for VCT Among those who were not willing to go for VCT the commonest reason given was that they were certain they were not infected. CONCLUSION: This study highlights the need to step up efforts to increase the students' awareness of VCT, deepen their knowledge and create the right attitude towards VCT through the mass media and religious bodies. Teaching on HIV/AIDS and VCT should also be incorporated into the school curriculum. A shift from the present clinic based approach to a more routine and widespread public health model will increase access to VCT Stand alone VCT centres should therefore be cited in educational institutions, community centres, marketplaces, youth friendly centres etc. for proximity to the people.

AIDS Serodiagnosis↗

PubMed2001

Cognitive-behavioral therapy to reduce weight concerns improves smoking cessation outcome in weight-concerned women.

Women smokers concerned about weight gain (N = 219) were randomly assigned to 1 of 3 adjunct treatments accompanying group smoking cessation counseling: (a) behavioral weight control to prevent weight gain (weight control); (b) cognitive-behavioral therapy (CBT) to directly reduce weight concern, in which dieting was discouraged; and (c) standard counseling alone (standard), in which weight gain was not explicitly addressed. Ten sessions were conducted over 7 weeks, and no medication was provided. Continuous abstinence was significantly higher at posttreatment and at 6 and 12 months of follow-up for CBT (56%, 28%, and 21%, respectively), but not for weight control (44%, 18%, and 13%, respectively), relative to standard (31%, 12%, and 9%, respectively). However, weight control, and to a lesser extent CBT, was associated with attenuation of negative mood after quitting. Prequit body mass index, but not change in weight or in weight concerns postquit, predicted cessation outcome at 1 year. In sum, CBT to reduce weight concerns, but not behavioral weight control counseling to prevent weight gain, improves smoking cessation outcome in weight-concerned women.

Adolescent↗

PubMedDate not supplied

Psychological factors: counseling and motivation of the contraceptive patient.

The stronger the desire to avoid conception, the more effective the contracepting. But motivation alone will not ensure success. Knowledge of all aspects of contraception is a prerequisite for optimal decision making, and such information and counseling should be readily available to all persons of reproductive age who are concerned about the use of medication, potential side effects and subsequent fertility. The counsel and opinion of physicians are sought with as much or greater frequency as their diagnostic or therapeutic skills. Yet, too often, the physician's attitude toward contraceptive use by others is colored by his own moral, religious or social philosophy. Subtle personality traits of the patient and attitudes of her partner control contraceptive disuse, misuse or rejection in most people. In the author's opinion, compliance with the use of contraception is directly related to the amount and intensity of counseling and the degree of motivation provided by the physician.

Contraception↗

PubMed1996

[Pregnancy and occupational environment. Counseling of pregnant women in the department of occupational medicine during the period 4 January--31 December 1992].

Since the new Sickness and Maternity Benefit Act was introduced in Denmark 1981, it has been possible to provide maintenance allowance for pregnant women working under conditions that might be harmful to the unborn child. The assessment of the risk is primarily undertaken by the general practitioner, but in cases of doubt, the pregnant women can be referred to the Department of Occupational Medicine. The assessment at the Department of Occupational Medicine is made one or two weeks after referral. It consists of a careful work history, which includes characterization of exposure, both qualitatively and quantitatively and a decision whether the exposure entails a risk to the foetus and which steps should be taken for the rest of the pregnancy. The purpose of this study was to describe the practice of risk assessment at the Department of Occupational Medicine in Denmark. Over a period of nine months all cases of pregnant women referred to 12 out of 14 departments were reviewed. Out of 60,000 births per year only 250 pregnant women were referred, which is less than 1%. Main risk factors in the assessment were of chemical (80%) or ergonomic (17%) origin. Forty-three percent were advised to leave work on maintenance allowance and 15% were advised to stay at work, on condition that the work environment was changed or they could be moved to a job without risk exposure. The study revealed big differences in referral incidence between the different counties as well as differences in risk assessment practice. It is concluded, that the best way to secure pregnant women and their foetus is by primary prophylactic measures at the workplace. Hopefully the new EU Directive 92/85 will be a step in that direction.

Counseling↗

PubMed2006

Reducing nursing home use through consumer-directed personal care services.

CONTEXT: Personal care services (PCS) are intended to enable beneficiaries with physical or cognitive impairments to live safely at home rather than in nursing facilities. The quality and flexibility of these services, typically provided by home care agencies, may not be sufficient to allow some beneficiaries to continue living at home. OBJECTIVE: We sought to test whether consumer direction of PCS under Arkansas's Cash and Counseling demonstration reduces nursing facility use and expenditures, compared with traditional Medicaid PCS, and how it affects total Medicaid cost. DESIGN: Interested adult Medicaid beneficiaries in Arkansas who were eligible to receive Medicaid PCS were randomly assigned (1) to have the option to receive an allowance instead of PCS (the treatment group) or (2) to receive traditional PCS through an agency (the control group). Between December 1998 and April 2001, 2008 beneficiaries enrolled. MEASURES: : Nursing facility use and costs, PCS costs, and total Medicaid costs (according to Medicaid claims data). RESULTS: Nursing facility use was 18% lower for the treatment group than for the control group during the 3-year follow-up period. Among those who had received PCS before the demonstration, nursing facility savings, together with savings in other long-term care costs, fully offset the higher PCS costs. These savings did not offset the higher PCS costs of new PCS applicants, since the increase in the proportion receiving paid care was so large for this subgroup. CONCLUSIONS: Consumer-directed PCS in Arkansas reduces nursing facility use and costs more effectively than providing services in the traditional manner. This favorable reduction in nursing facility costs was much more pronounced in Arkansas than in the other 2 states (New Jersey and Florida) where the Cash and Counseling demonstration was carried out.

Adult↗

PubMed1996

Control of beta-thalassaemia by carrier screening, genetic counselling and prenatal diagnosis: the Sardinian experience.

Homozygous beta-thalassaemia in a number of at-risk populations (Greek and Turkish Cypriots, Greeks, Continental Italians and Sardinians) has been prevented at the population level by programmes based on carrier screening, genetic counselling and prenatal diagnosis. The Sardinian experience is based on a 20-year programme. Voluntary screening has been offered to prospective parents and, primarily, to women with an ongoing pregnancy. Education of the population at large, training of health personnel, and use of posters and informative booklets have been critical elements for the success of the programme. Genetic counselling has been carried out in a non-directive manner following well-established guidelines. The use of extended family screening magnified the efficacy of the screening programme, allowing the identification of the large majority of parents at risk by screening only 13% of the population at child-bearing age. Following counselling, the large majority of parents accepted prenatal diagnosis. Definition of the parents' mutation and prenatal diagnosis were carried out by a number of PCR-based procedures. The programme was effective, as indicated by the reduction of the birth rate of thalassaemia major from 1:250 live births to 1:4000.

Genetic Counseling↗

PubMed2006

New RB1 oncogenic mutations and intronic polymorphisms in Serbian retinoblastoma patients: genetic counseling implications.

The purpose of this work was to identify germ line RB1 mutations in 16 Serbian retinoblastoma patients for genetic counselling. Mutation analysis was carried out by PCR directed sequencing of the 27 exons. Loss of heterozygosity for two RB1 intragenic markers was also analyzed in 14 tumour samples. Five new RB1 oncogenic mutations (g.2078 del C, g.77047_48 del GC, g.78117_8 del TT, g.160797 del T, and g.64439+2 T>C) and two recurrences (R445X and Q383X) have been found in this study. In addition, four intronic variants were observed germ line in some unilateral patients. Two of these variants (g.44668-15T/G, and g.166204-8T/A) are discussed as potential oncogenic mutation candidates. The results show the relevance of studies aimed to investigate the role of intronic variants in exon splicing regulation. Such studies will help to disclose hidden retinoblastoma susceptibilities, important for accurate genetic counselling.

DNA Mutational Analysis↗

PubMed1990

Chromosomal mosaicism in chorionic villus sampling.

The observation of multiple, chromosomally distinct cell lines in chorionic villus samples is not an unusual finding and occurs in 1 per 100 samples. This frequency is ten times greater than the level of mosaicism observed in newborn surveys and, thus, must reflect phenomenon other than true fetal mosaicism. Indeed, only 23% of mosaicism detected at CVS is confirmed in the fetus (2.3 per 1,000 CVS), which is much closer to the newborn rate (1 per 1,000). This indicates that most mosaicism encountered in CVS is unrelated to the fetal karyotype and as such is an inaccurate prediction of the fetal genotype, the purpose of prenatal diagnosis. Most of the mosaicism detected in CVS is due to confined placental mosaicism. Either as a result of error-prone cell division generating an excess of abnormal cells in extraembryonic tissues or reduced selection against aneuploid cells in these tissues allowing their persistence, chorionic villi and placenta appear to show much higher levels of mosaicism than seen in fetuses. This explains the more frequent finding of multiple cell lines in CVS than in amniocentesis or liveborn individuals. The discrepancy between levels of mosaicism present in chorionic villi and fetal tissues means that most instances of mosaicism detected in CVS are not associated with a fetal abnormality and should be evaluated by further prenatal testing, i.e., amniocentesis or fetal blood sampling. Because of the frequency of chromosomal mosaicism in CVS and its attendant need for further testing, a discussion of mosaicism should be included in counseling prior to CVS. The higher frequency of discrepant results in direct CVS preparation emphasizes the prudence of delaying decision making until the results of the CVS culture have been obtained. Although the observation of mosaicism clearly complicates genetic counseling and decision making, it does not appear to be associated with an adverse fetal outcome. Whereas most of the mosaicism observed in CVS is the result of confined placental mosaicism, other types of discrepancies also occur. Maternal cell contamination occurs in about 1% of cases, but is easily evaluated by examining the direct preparation and analyzing chromosome polymorphism. The incidence of pseudomosaicism in CVS cultures is unclear but probably low. Interestingly, CVS analysis has suggested that twinning may be a more common phenomenon at conception than reported at birth and that some discrepancies may reflect the nonviability of twins with abnormal karyotypes. Chorionic villi sampling remains a viable alternative to amniocentesis for early prenatal diagnosis. An understanding of the origins of mosaicism in CVS is necessary for

Chimera↗

PubMed1998

Model for using hip-hop music for small group HIV/AIDS prevention counseling with African American adolescents and young adults.

Currently little attention has been directed, with the exception of peer education efforts, to constructively develop new and innovative ways to promote HIV/AIDS primary prevention among African American (AA) adolescents and young adults. With this in mind, the aim of this conceptual effort is to present a HIV/AIDS preventive counseling protocol developed for use with AA young adults that makes use of hip-hop music, a form of music popularized by young AAs. The author contend that an increased understanding of the relationships that many AA young adults have with hip-hop music may be used by disease prevention personnel to educate these populations about protective factors for HIV. Making use of hip-hop music is one strategy for integrating counseling in prevention and health maintenance. The overall implications of using hip-hop music in health promotion are unlimited. First, this method makes use of cultural relevant materials to address the educational and health needs of the target community. Second, it is grounded in an approach that serves to stimulate cooperative learning based on peer developed content. Moreover, the use of this medium can be applied to other health promotion activities such as violence/harm reduction and substance abuse prevention, upon reviews of songs for appropriate content. The authors contend that such an approach holds heuristic value in dealing with HIV/AIDS prevention among AA young adults. Additional testing of the intervention is warranted in the refinement of this innovative intervention.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Impact of a cardiac risk reduction program in vulnerable patients hospitalized with coronary artery disease.

STUDY OBJECTIVE: To increase the use of guideline-based pharmacotherapy in vulnerable patients (ethnic minorities and the poor) with coronary artery disease (CAD) through a nurse-based quality-improvement program. DESIGN: Retrospective program evaluation. SETTING: Inner-city hospital in Denver, Colorado. PATIENTS: One hundred fifty-one consecutive patients hospitalized with a CAD-related diagnosis. INTERVENTION: A nurse-management program was initiated for patients with angiographically documented CAD, and rates of guideline-based care were compared with rates for historic controls. The intervention consisted of two key elements: patient counseling with language-appropriate education materials and direct physician education regarding the importance of cardioprotective drugs. The 151 patients in the intervention group were compared with 125 historic control patients hospitalized before the program was begun. Multivariable logistic regression analysis was used to assess differences in care with regard to ethnicity, education level, and insurance status, and to adjust for different baseline characteristics. MEASUREMENTS AND MAIN RESULTS: At hospital discharge, patients in the intervention group were more likely to receive statins (71% vs 52%, p=0.001) and angiotensin-converting enzyme inhibitors (79% vs 51%, p<0.001) compared with controls. These differences remained after adjusting for ethnicity, education level, insurance status, and baseline clinical characteristics. Also, a trend was noted toward greater use of aspirin (92% vs 86%, p=0.13) and beta-blockers (79% vs 73%, p=0.24) in the intervention group compared with controls. Patients in the intervention group were more likely to receive counseling for smoking cessation. CONCLUSION: An inpatient nurse-management program improved the quality of care for patients with CAD regardless of sociodemographic status. Properly designed disease-management initiatives can be effective for disadvantaged patients, who often obtain health care through emergency and inpatient services.

Colorado↗