Increasing substance use disorder counselors' self-efficacy and skills in talking to patients about sex and HIV risk: A randomized training trial.

BACKGROUND: People with substance use disorder (SUD) experience increased risk for HIV, Hepatitis C, and sexually transmitted illnesses via risky sex. This high-risk population would benefit from sexual risk reduction interventions integrated into SUD treatment. However, many SUD counselors report lack of skill or confidence in addressing sexual risk with patients. METHODS: This study was part of a larger nested 2 × 2 factorial repeated measures design, which compared two levels of counselor training (Basic-2 h versus Enhanced-10 h plus ongoing coaching). We determined whether counselors receiving Enhanced training addressing their motivation, confidence and skills (a) increased knowledge about sexual issues; (b) increased self-efficacy to discuss sex with patients; and (c) improved skills in discussing sex as part of SUD treatment, compared with those receiving shorter information-based training. Counselors providing individual therapy at two opioid treatment programs (OTP) and two psychosocial outpatient programs in the United States were eligible. Randomization occurred after Basic training. Measures included self-report (self-efficacy and knowledge) and blinded coding of standardized patient interviews (skill). RESULTS: Counselors receiving Enhanced training (n = 28) showed significant improvements compared to their Basic training counterparts (n = 32) in self-efficacy, use of reflections, and use of decision-making and communication strategies with standardized patients. These improvements were maintained from post-training to 3-month follow-up. No adverse effects of study participation were reported. CONCLUSIONS: Results suggest that counselors can improve their knowledge, self-efficacy and skill related to sexual risk conversations with patients based on modest skills-based training.

Could Blood Pressure Phobia Go Beyond the White Coat Effect?

BACKGROUND: While it is known that excessive anxiety surrounding the measuring of blood pressure may preclude an accurate measurement, it is not known whether it could also lead to phobic avoidance behavior. METHODS: Self-reported information was collected on 125 individuals who made postings on 5 internet-based medical forums. RESULTS: Qualitative thematic analysis revealed that these individuals reported experiencing intense fear associated with the measuring of blood pressure, that was excessive or irrational and which contributed to avoidance of medical treatment and interference with life decisions. CONCLUSIONS: Based on these preliminary observations, we are speculating that these symptoms could be considered consistent with a diagnosis of a Specific Phobia. Investigations using quantitative methods, representative samples, and standardized clinical instruments need to be conducted before definitive conclusions can be reached.

Improvement in uterine artery doppler indices via hysteroscopic metroplasty.

OBJECTIVE: the objective of our research was to study uterine artery doppler indices and their evolution over time after metroplasty and subsequent pregnancy in patients whose septate uterus was the only explanation for infertility. MATERIALS AND METHODS: a retrospective study. The uterine arteries of 78 patients with septate uteri were evaluated using endovaginal color doppler ultrasound before and after metroplasty. Fifty-one patients became pregnant after metroplasty and were selected as study group, pregnancy occurred within 17 months. By comparing uterine artery doppler indices before and after metroplasty, we observed that the resistive index (RI) and pulsatility index (PI) post surgery were significantly lower compared to premetroplasty levels. RESULTS: all pregnant women in the study group showed uterine resistive indexes within normal ranges, they all underwent scheduled cesarean in-tervention. Gestational evolution was normal in all patients (mean score of Apgar and birth weight); no neonatal complications were observed. CONCLUSION: metroplastic intervention in women with septate uterus as the sole cause of infertility may be a plausible alternative for patients wishing to carry a pregnancy.

Conjoined twins: what ultrasound may add to management.

INTRODUCTION: Conjoined twins occur in approximately 0.2:10,000 births; the obstetrician and sonographer only rarely examine them. In Western countries, discovery of conjoined twins is often made by the end of the first trimester; however, in the third world, conjoined twins are often discovered only at birth. OBJECTIVE: To evaluate how ultrasound techniques, when possibly available, may improve management and counseling when conjoined twins are confirmed. MATERIAL AND METHODS: The authors report two different cases of union of two equal twins with sole umbilical cord. RESULTS: The two cases presented with non contributive medical history and no prior teratogen exposure and an unfavorable prognosis. Early discovery of viable conjoined twins permits assessment of the best route of delivery and a planning for serial sonography and fast MRI to plan eventual separation surgery or fetus after-birth surviving possibilities.

Full-term-pregnancy effects of antenatal betamethasone administration on short-term variation as assessed by computerized cardiotocography.

OBJECTIVE: to verify whether there are other than transitory effects of antenatal betamethasone (administered for fetal lung maturity [FLM] enhancement) on fetal heart rate (FHR) variability detected by computerized cardiotocography (cCTG) in cases where formerly steroid-treated fetuses reached term. MATERIALS AND METHODS: cCTG of one hundred sixty-four women (study group) exposed to antenatal betamethasone for risk of preterm delivery in third trimester period were compared to controls (pregnancies who presented risk of preterm labour in the same period of cases, although with no steroids administration). cCTG was performed weekly as of standard schedule when pregnancies reach term from 37-40 weeks' gestation for cases and controls. RESULTS: regarding data concerning cCTG at term for cases and controls, no significant difference was found for FHR, Acc (accelerations) 10 min, and FM (fetal movements) between groups. LV (low variation)/min and LV/msec were absent in cCTG parameters of fetuses in the study group. Instead, for all weeks studied (37 to 40), cCTG parameters were higher for HV (high variation)/msec, STV(short term variation)/msec, and Acc 15 in cases with respect to controls. CONCLUSION: interestingly, maternal corticosteroid administration may be related to higher fetal reactivity when fetuses exposed to steroid therapy reach term. Our observation may help in the interpretation of a "more reactive" CTG trace in babies whose mothers previously received steroid therapy for FLM enhancement.

Betamethasone effects on umbilical arteries and ductus venosus Doppler velocity waveforms in growth-restricted fetuses.

UNLABELLED: We studied intrauterine-growth-restricted (IUGR) fetuses with absent or reversed umbilical artery end-diastolic flow (EDF) velocity in order to evaluate the benefit of antenatal steroid therapy. Perinatal outcomes after betamethasone were evaluated where end diastolic flow returned (group I), compared with data from fetuses with persistent absent-reverse end diastolic(ARED) flow (group II). OBJECTIVES/METHODS: We recruited sixty-four IUGR fetuses, 28-32 weeks' gestation, whose umbilical artery spectral tracings showed ARED flow and positive a-wave in the ductus venosus at admission. RESULTS: Group I, 21 cases of restored EDF after betamethasone: Significant, persistent return of umbilical artery EDF flow and persistent ductus venosus a-wave were documented. Group II, 43 cases of persistent ARED flow: Persistent ARED flow in umbilical arteries and deterioration of ductus venosus waveform with significant, increasing pulsatility index and/or a-wave disappearance were documented. In group I, cardiotocographic alterations were delayed contrasted with group II, (p = 0.03). Neonatal complications in group II were eight cases of intraventricular hemorrhage; two cases of retinopathy of prematurity; three neonatal deaths, one fetal demise; and a higher incidence of neonatal respiratory distress syndrome. CONCLUSIONS: Betamethasone treatment may have beneficial effects on restoring end-diastolic umbilical artery velocimetry and precordial waveforms. These spectral Doppler changes are related to delayed cardiotocographic alterations and to better perinatal outcomes.

Unicornuate uteri associated with contralateral renal agenesis and ovarian anomalies.

Our findings regarding two cases of unicornuate uterus validate that conventional transvaginal ultrasound is helpful in diagnosing uterine anomalies. Moreover, anomalies of the urinary system and the contralateral ovary should always be considered.

Passenger complaints about driver behaviors.

Fifty-two couples were surveyed about their behavior while driving together. Each was asked to individually rate the driver's behavior, the passenger's amount of complaining about the driver's behavior, the effect of that complaining on the driver, the driver's use of vengeance while driving, and the driver's ability and safety. Drivers and passengers gave similar responses: the riskier the driver's behavior, the more the passenger complained. The more the passenger complained, the less both reported that it helped. Judged ability of the driver was not related to the driver's risky behavior by either the drivers or passengers, although passengers, but not drivers, saw more risky driving behaviors as less safe.