RESUMO
BACKGROUND: Although there are few interventions available to provide screening and brief intervention targeted toward problematic gambling, Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based intervention that has demonstrated effectiveness in reducing gambling behaviors. METHODS: The goal of this pilot study was to evaluate the feasibility, acceptability and preliminary outcomes of a gambling specific SBIRT intervention in a medical setting. Fifteen participants were recruited from an urban HIV/Primary Care clinic to receive the gambling specific SBIRT intervention delivered by 3 clinicians. Process and gambling specific outcome measures were evaluated at baseline, immediately after the intervention and at 1-month follow-up. RESULTS: On average, patient participants were 49 years and self-described themselves as male (60%) and Black or African American (86.7%). Three (20%) participants met 4 or more criteria of the DSM-5 gambling disorder. Compared to baseline, those who participated in the intervention decreased both the median number of days gambled (1 days vs. 0 days), as well as the median money gambled at 1-month follow-up ($7 vs. $1). Participants with 4 or more criteria of DSM-5 gambling had the greatest reduction (days gambled: (26 days vs. 21 days); money spent: (($400 vs. $65)). Participants reported that the intervention was acceptable. Clinician participants found the intervention to be easy to deliver. CONCLUSIONS: A gambling specific SBIRT intervention was feasible to deliver and acceptable to participants. Gambling specific outcome measures were reduced at 1-month follow-up. A randomized control trial to evaluate the efficacy of the intervention is a recommended next step.
Assuntos
Jogo de Azar , Infecções por HIV , Intervenção em Crise , Estudos de Viabilidade , Jogo de Azar/psicologia , Infecções por HIV/terapia , Humanos , Masculino , Projetos Piloto , Encaminhamento e ConsultaRESUMO
[This corrects the article DOI: 10.1371/journal.pone.0200342.].
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OBJECTIVE: We sought to define the intrinsic stem cell capacity in pediatric heart lesions, and the effects of diagnosis and of age, in order to inform evidence-based use of potential autologous stem cell sources for regenerative medicine therapy. METHODS: Ventricular explants derived from patients with hypoplastic left heart syndrome (HLHS), tetralogy of Fallot (TF), dilated cardiomyopathy (DCM) and ventricular septal defect (VSD) were analyzed following standard in vitro culture conditions, which yielded cardiospheres (C-spheres), indicative of endogenous stem cell capacity. C-sphere counts generated per 5 mm3 tissue explant and the presence of cardiac progenitor cells were correlated to patient age, diagnosis and echocardiographic function. RESULTS: Cardiac explants from patients less than one year of age with TF and DCM robustly generated c-kit- and/or vimentin-positive cardiac mesenchymal cells (CMCs), populating spontaneously forming C-spheres. Beyond one year of age, there was a marked reduction or absence of cardiac explant-derivable cardiac stem cell content in patients with TF, VSD and DCM. Stem cell content in HLHS and DCM strongly correlated to the echocardiographic function in the corresponding ventricular chamber, with better echocardiographic function correlating to a more robust regenerative cellular content. CONCLUSIONS: We conclude that autologous cardiomyogenic potential in pediatric heart lesions is robust during the first year of life and uniformly declines thereafter. Depletion of stem cell content occurs at an earlier age in HLHS with the onset of ventricular failure in a chamber-specific pattern that correlates directly to ventricular dysfunction. These data suggest that regenerative therapies using autologous cellular sources should be implemented in the neonatal period before the potentially rapid onset of single ventricle failure in HLHS or the evolution of biventricular failure in DCM.
Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Comunicação Interventricular/fisiopatologia , Ventrículos do Coração/fisiopatologia , Síndrome do Coração Esquerdo Hipoplásico/fisiopatologia , Regeneração , Tetralogia de Fallot/fisiopatologia , Adolescente , Envelhecimento/patologia , Envelhecimento/fisiologia , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/patologia , Cardiomiopatia Dilatada/cirurgia , Células Cultivadas , Criança , Pré-Escolar , Eletrocardiografia , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/patologia , Comunicação Interventricular/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico por imagem , Síndrome do Coração Esquerdo Hipoplásico/patologia , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Lactente , Recém-Nascido , Células-Tronco Mesenquimais/patologia , Células-Tronco Mesenquimais/fisiologia , Miócitos Cardíacos/patologia , Miócitos Cardíacos/fisiologia , Regeneração/fisiologia , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/patologia , Tetralogia de Fallot/cirurgia , Técnicas de Cultura de TecidosRESUMO
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective means of identifying problematic substance use. We evaluated the acceptability of SBIRT in an abortion clinic via an anonymous survey of 100 participants. Clients were comfortable being asked about their substance use, receiving counseling, and treatment referral (mean Likert 1.1, 1.5, and 1.6, respectively) and were only minimally embarrassed when asked about substance use (mean Likert 3.6). These findings suggest that integrating SBIRT into an abortion clinic may be feasible. However, future studies are needed to assess the efficacy of abortion clinic SBIRT in reducing risky substance use.
Assuntos
Aspirantes a Aborto , Instituições de Assistência Ambulatorial , Atitude Frente a Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Encaminhamento e Consulta , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Adulto , Alcoolismo/diagnóstico , Alcoolismo/psicologia , Alcoolismo/terapia , Feminino , Humanos , Fumar Maconha/psicologia , Fumar Maconha/terapia , Programas de Rastreamento , Fumar/psicologia , Fumar/terapia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: This paper reports on consultants' self-assessed changes in their teaching and training practices over an 8-10-month period. It compares the changes between a group undergoing a 3-day teaching course (participants) and a sample group taken from the course waiting list (controls). METHOD: A questionnaire listing 18 teaching skills was given to the participants immediately prior to the course and 8-10 months later, and to the controls at the same time intervals. Respondents were asked to rate their ability, frequency of use of each skill, as well as their teaching confidence and effectiveness. Additionally, the second questionnaire asked respondents to identify changes they had made to their teaching. A total of 63% (54) of participants and 51% (23) of controls completed both questionnaires. Changes of 2 + on the rating scales were seen as genuine. The number of such changes was calculated for each individual and on each skill for the 2 groups. Data were analysed using a Mann-Whitney U-test. RESULTS: The majority of course participants reported positive changes in teaching ability on a significantly greater number of skills than did the control group. As a group, changes in ability in 16 of the teaching skills were significantly greater for the participants than for the controls. Increased ability resulted in participants' increased frequency of use of only 4 of the teaching skills. The majority in the participant group reported changes to their teaching. Only a minority in the control group reported such changes. These changes were consistent with course topics and the teaching skills needed to meet General Medical Council recommendations for the education of new doctors. CONCLUSIONS: The teaching course is an effective vehicle for increasing consultants' teaching skills.