Patterns of Treatment and Outcomes in Older Men With Penile Cancer: A SEER Dataset Analysis.

Purpose: To evaluate clinicopathologic and treatment characteristics from a population-based cohort of penile cancer, with an emphasis in older adults, due to incomplete evidence to guide therapy in this age subgroup. Materials and Methods: Patients with malignant penile tumors diagnosed 2004-2016 were identified in the Surveillance, Epidemiology and End Results Program (SEER)-18 dataset. Demographic and treatment characteristics were obtained. Population was analyzed by age at diagnosis (<65 vs ≥65 years). We examined univariate associations between age groups with Chi-square analysis. To study survival, we calculated Kaplan-Meier survival curves, but due to the high number of competing events, we also performed a univariate competing risk analysis using the cumulative incidence function, and a multivariate analysis using the Fine-Gray method. We also described competing mortality due to penile cancer and other causes of death. Results: We included 3,784 patients. Median age was 68 years, 58.7% were aged ≥65. Older patients were less likely to have received chemotherapy (p<0.001), primary site surgery (p = 0.002), or therapeutic regional surgery (p <0.001). Median overall survival (OS) in patients <65 years was not reached (95% CI incalculable) vs 49 months in those ≥65 years (95% CI 45-53, p <0.0001). On univariate analysis, age was associated with a lower incidence of penile cancer death. On multivariate analysis, stage at diagnosis, and receipt of primary site surgery were associated with a higher incidence of penile cancer death. Estimated penile cancer-specific mortality was higher in patients <65 years in stages II-IV. Estimated mortality due to other causes was higher in older patients across all stages. Conclusions: Older patients are less likely to receive surgery, chemotherapy and radiotherapy for penile cancer. Primary surgical resection was associated with better penile cancer-specific mortality on multivariate analysis. Competing mortality risks are highly relevant when considering OS in older adults with penile cancer. Factors associated with undertreatment of older patients with penile cancer need to be studied, in order to develop treatment strategies tailored for this population.

Effects of omega-3 supplementation on muscle damage after resistance exercise in young women: a randomized placebo-controlled trial.

BACKGROUND: Omega-3 is a nutritional strategie that have been used to recover muscles from exercise-induced muscle damage in a preventive perspective. AIM: To verify whether omega-3 (ω-3) supplementation after a session of resistance exercise facilitates muscle recovery in women undergoing a balanced diet. METHODS: This clinical trial was registered under the number NCT02839525. Thirty healthy women (22.2 ± 3.3 years) participated in this double-blinded, placebo-controlled trial. They were randomly distributed into ω-3 (n=15) and placebo (n=15) groups. They ingested ω-3 fish oil (3200 mg/day) or placebo (olive oil) at the dinner after the exercise bout (10 sets of 10 unilateral eccentric contractions in a knee extension chair), as well as at lunch for the three subsequent days. In addition, both groups followed a balanced diet along the four days. Muscle soreness and maximal isometric and isokinetic voluntary contractions were assessed immediately before, and 24, 48, and 72 hours after the resistance exercise. MAIN FINDINGS: There was no significant group-time interaction for any outcome. Participants presented increased levels of muscle soreness and reduced muscle strength capacity along the three days after exercise. There was no difference between placebo and ω-3 groups. CONCLUSION: Supplementation of ω-3 fish oil for three days after resistance exercise provided no additional benefits compared to placebo supplementation on recovery of healthy young women following a balanced diet.

Effectiveness of motivational interviewing in smoking groups in primary healthcare: a community-based randomized cluster trial.

Smoking is the main cause of avoidable death and a major public health problem worldwide, with primary healthcare being a strategic setting for treating this problem. Aims: to evaluate the effectiveness of motivational interviewing associated with the cognitive behavioral therapy (CBT) in smoking groups in primary healthcare. A community-based cluster randomized clinical trial was conducted in Brazil, starting in July 2016. Professionals in the test group were trained in motivational interviewing for eight hours to associate it with the CBT. The usual treatment for smoking cessation in groups consists of four structured weekly sessions of 90 minutes each using a CBT. Taylor's linearization was used to correct the p-values; the chi-square test with Pearson correlation was used for categorical variables, and analysis of variance as well as the Student t-test were used for continuous variables. In total, 44 smoking groups were conducted, totaling 329 patients (178 in the motivational interviewing group and 151 in the control group). The smoking cessation rate with motivational interviewing was 61.8%, with RR = 1.25 (95%CI: 1.01-1.54, p = 0.043), and 47.7% in the control group, in the fourth weekly group treatment session. Mean session attendance was 3.1 (95%CI: 2.9-3.3) in the motivational interviewing group and 2.9 (95%CI: 2.5-3.4) in the control group. The completion rate for the motivational interviewing group was 65.2% and for the control group, 57.6%. Motivational interviewing associated with the CBT was shown to be effective and superior to only CBT to smoking cessation in groups in the fourth weekly session and for the population profile of the study (women with an average age of 50.6 years).

Motivational Interviewing in the Management of Type 2 Diabetes Mellitus and Arterial Hypertension in Primary Health Care: An RCT.

INTRODUCTION: Motivational interviewing is an effective style of collaborative communication for the promotion of lifestyle changes in the management of Type 2 diabetes and arterial hypertension. This study evaluates the effectiveness of motivational interviewing in the management of these conditions in primary health care. STUDY DESIGN: This study is a double-blind parallel-group RCT performed between June 2018 and July 2019. SETTING/PARTICIPANTS: The RCT was conducted in Porto Alegre, Rio Grande do Sul, Brazil, and included individuals with Type 2 diabetes and arterial hypertension. INTERVENTION: The participants were randomized to the test/motivational interviewing and usual care groups. The test/motivational interviewing group received the nursing consultation intervention on the basis of motivational interviewing conducted by professionals with 20 hours of training, and the usual-care group received conventional nursing consultation. MAIN OUTCOME MEASURES: The main outcome measure was the mean difference in HbA1c. The secondary outcome measures were the mean differences in blood pressure and adherence levels. RESULTS: After a mean follow-up of 6 months, 174 participants completed the study (usual-care group=80; test/motivational interviewing group=94). There were statistically significant differences between the groups, with improvement in the test/motivational interviewing group for systolic blood pressure (p<0.01), diastolic blood pressure (p<0.01), and total adherence score as measured by the Martín-Bayarre-Grade questionnaire (p=0.01) and its operational dimensions of treatment adherence and personal involvement (p=0.03, p=0.03). The test/motivational interviewing group showed significantly reduced HbA1c levels (0.4%) at the end of the study (p<0.01). CONCLUSIONS: In the context of primary health care, the nursing consultation based on motivational interviewing was shown to be a more effective care strategy than usual care for improving blood pressure levels and adherence levels in individuals with Type 2 diabetes and arterial hypertension. Moreover, motivational interviewing was demonstrated to be useful in reducing HbA1c levels in diabetes management. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT03729323.

Motivational interviewing for preventing early childhood caries: A systematic review and meta-analysis.

OBJECTIVES: This systematic review with meta-analysis was performed to assess whether motivational interviewing (MI) is effective in the prevention of early childhood caries (ECC) and to examine potential sources of heterogeneity. METHODS: Interventions based on motivational interviewing were considered eligible. The main outcome was new caries lesions (some studies included white-spot lesions in total count), and secondary outcomes included caregivers' oral health knowledge, home-care behaviours, plaque index, gingival index and fluoride varnish applications. Controls were any type of oral health education or negative controls without any specific intervention. RESULTS: From a total of 1498 studies identified in the databases search, 1078 were assessed for eligibility by reading titles and abstracts, after removal of duplicates. Full-text screening was performed in 61 articles, with 18 reporting on 14 different studies included in the qualitative synthesis and 8 in the quantitative synthesis (four studies included new white-spot lesions in total count). Subgroup analysis was performed by the control group dmft/dmfs and the test for subgroup differences suggests that there is a subgroup effect (P = .06), so population caries experience modifies the effect of MI-based intervention. In populations with high caries experience, the MI-based approach proved preventing an average of 3.15 (95% CI: -6.14, -0.17) dmfs in young children. In samples with low caries experience, differences were smaller, since the caries levels were already lower (-0.31; 95% CI: -0.63, 0.00). CONCLUSION: Motivational interviewing has the potential to modify knowledge and behaviours and reduce ECC with a more significant impact on children with high caries experience.

Effectiveness of motivational interviewing in smoking groups in primary healthcare: a community-based randomized cluster trial / A efetividade da entrevista motivacional em grupos de tabagistas na atenção primária: um estudo randomizado de clusters comunitários / Efectividad de las entrevistas motivacionales en grupos de fumadores dentro de la atención primaria: un ensayo grupal aleatorio basado en comunidades

Smoking is the main cause of avoidable death and a major public health problem worldwide, with primary healthcare being a strategic setting for treating this problem. Aims: to evaluate the effectiveness of motivational interviewing associated with the cognitive behavioral therapy (CBT) in smoking groups in primary healthcare. A community-based cluster randomized clinical trial was conducted in Brazil, starting in July 2016. Professionals in the test group were trained in motivational interviewing for eight hours to associate it with the CBT. The usual treatment for smoking cessation in groups consists of four structured weekly sessions of 90 minutes each using a CBT. Taylor's linearization was used to correct the p-values; the chi-square test with Pearson correlation was used for categorical variables, and analysis of variance as well as the Student t-test were used for continuous variables. In total, 44 smoking groups were conducted, totaling 329 patients (178 in the motivational interviewing group and 151 in the control group). The smoking cessation rate with motivational interviewing was 61.8%, with RR = 1.25 (95%CI: 1.01-1.54, p = 0.043), and 47.7% in the control group, in the fourth weekly group treatment session. Mean session attendance was 3.1 (95%CI: 2.9-3.3) in the motivational interviewing group and 2.9 (95%CI: 2.5-3.4) in the control group. The completion rate for the motivational interviewing group was 65.2% and for the control group, 57.6%. Motivational interviewing associated with the CBT was shown to be effective and superior to only CBT to smoking cessation in groups in the fourth weekly session and for the population profile of the study (women with an average age of 50.6 years).

O tabagismo é a principal causa de morte evitável, e é um problema de saúde pública global. A atenção primária representa um contexto estratégico para enfrentar o problema. O objetivo foi avaliar a efetividade da entrevista motivacional associada à terapia cognitiva-comportamental (TCC) em grupos de tabagistas tratados na atenção primária. Foi realizado um estudo clínico randomizado de clusters comunitários, iniciado em julho de 2016. Os profissionais no grupo experimental foram treinados durante 8 horas na técnica de entrevista motivacional , com o propósito de associar a técnica à TCC. O tratamento usual para cessação de tabagismo em grupos consiste em quatro sessões estruturadas com duração de 90 minutos, uma por semana, com o uso da TCC. Foi aplicada a linearização de Taylor para corrigir os valores de p; o teste qui-quadrado de Pearson foi usado para variáveis categóricas e análise de variância, e o teste t de Student para variáveis contínuas. Foram organizados 44 grupos de tabagistas, com um total de 329 pacientes (178 no grupo entrevista motivacional e 151 no grupo controle). A taxa de cessação do tabagismo com entrevista motivacional foi 61,8%, com RR = 1,25 (IC95%: 1,01-1,54; p = 0,043), comparado com 47,7% no grupo controle, depois da quarta sessão semanal de terapia de grupo. A média de frequência foi de 3,1 sessões (IC95%: 2,9-3,3) no grupo entrevista motivacional e 2,9 (IC95%: 2,5-3,4) no grupo controle. A proporção de participação integral nas sessões foi 65,2% no gruo entrevista motivacional e 57,6% no grupo controle. A entrevista motivacional associada à TCC mostrou ser efetiva e superior à TCC isoladamente para cessação de tabagismo em grupos com quatro sessões semanais e para o perfil da população do estudo (mulheres com média de idade de 50,6 anos).

Fumar es la principal causa de muerte evitable, y uno de los mayores problemas de salud pública alrededor del mundo, siendo la atención primaria un eje estratégico para el tratamiento de este problema. El objetivo fue evaluar la efectividad de las entrevistas motivacionales, asociadas con la terapia comportamental cognitiva (TCC), en grupos de fumadores dentro de la atención primaria. El ensayo clínico grupal aleatorio basado en comunidades se realizó en Brasil, empezó en julio de 2016. Los profesionales en el grupo de prueba fueron entrenados en entrevistas motivacionales durante 8 horas para asociarlo con el TCC. El tratamiento habitual para dejar de fumar en grupos consistía en cuatro sesiones semanales, estructuradas en 90 minutos cada una, usando la TCC. Se aplicó la linealización de Taylor para corregir los valores de p; el test de chi-cuadrado con la correlación de Pearson se usó para las variables categóricas y se utilizaron el análisis de variancia y el test Student t para las variables continuas. Se monitorizaron 44 grupos de fumadores, totalizando 329 pacientes (178 en el entrevistas motivacionales grupo y 151 en el grupo de control). La tasa de abandono del tabaco con entrevistas motivacionales fue 61,8%, con RR = 1,25 (95%CI: 1,01-1,54; p = 0,043), y 47,7% en el grupo de control, en la cuarta sesión grupal de tratamiento semanal. La media de asistencia a sesiones fue 3,1 (95%CI: 2,9-3,3) en el grupo entrevistas motivacionales y 2,9 (95%CI: 2,5-3,4) en el grupo de control. La tasa de finalización para el grupo entrevistas motivacionales fue 65,2%, y para el grupo de control 57,6%. Las entrevistas motivacionales asociadas con la TCC demostró ser efectiva y superior para solamente la TCC de abandonar el tabaco en grupos en la cuarta sesión semanal y para el perfil de la población en estudio (mujeres con una media de edad de 50,6 años).

Motivational interviewing effects on caries prevention in children differ by income: A randomized cluster trial.

OBJECTIVES: This study aimed to investigate the differential preventive effect of motivational interviewing (MI) on early childhood caries (ECC) according to socioeconomic variables, using a community-based trial in a public healthcare setting. METHODS: A cluster-randomized, double-blind study with two parallel groups in healthcare clinical settings (HCCs) comparing conventional oral health education (CE) and MI aimed at mothers of children born in 2013 and 2014. The oral health team of 6 of the 12 HCCs were trained in MI. This training was intensive for active learning of the basic MI principles, conducted by a psychologist who is a PhD in psychiatry and has extensive experience in conducting MI training workshops. It was held in an experiential format divided into two 4-hour shifts, with a 1-week interval. Children who attended at least one dental visit in the first year of life at their HCC were clinically evaluated by trained examiners and parents responded to a questionnaire. The effect of MI on the caries outcome compared with CE was evaluated in different subgroups: family income, mother's education and skin colour. RESULTS: One hundred and eighty-six were included in the CE group and 228 in the MI group. The caries rate per 100 surface-year was 1.29 (95%CI: 0.92-1.80) in the CE group and 0.46 (95%CI: 0.29-0.73) in the MI group. The effect of MI was statistically significant in the lower-income category (P = .03); MI prevented 57% of carious lesions (IRR = 0.43, 95% CI 0.22-0.83) and reduced the occurrence of the disease on more than one surface per 100 followed surface-year in this same category in the equivalent income subgroup (IRD = -1.37, P = .04). CONCLUSIONS: Motivational interviewing had a greater preventive effect against caries in children whose families are of lower income.

Entrevista Motivacional para Estudantes da Área da Saúde: Resultados de um Treinamento / Motivational Interviewing for Health Sciences Students: The Results of Training

Resumo Este estudo procurou avaliar a efetividade de um treinamento em Entrevista Motivacional (EM) para estudantes do último ano de diferentes cursos na área da saúde. Usando um delineamento pré e pós-teste quase-experimental, 60 estudantes receberam um treinamento de oito horas de habilidades básicas da Entrevista Motivacional. As habilidades foram avaliadas por meio de uma vinheta clínica, das Réguas de Confiança e Importância e do Questionário de Resposta Útil, codificado utilizando o Motivational Interviewing Skill Code. O treinamento foi associado com melhora no uso das habilidades básicas da Entrevista Motivacional. Os alunos também aumentaram a percepção da importância em utilizar essas habilidades com os pacientes, mesmo com um treinamento breve.

Abstract This study sought to evaluate the effectiveness of Motivational Interviewing (MI) training on undergraduate students in the senior year of different healthcare courses. Using a pre and post-test quasi-experimental design, 60 undergraduate students received an eight-hour Motivational Interviewing basic skills training. Basic skills were assessed using a clinical vignette, the Confidence and Importance Ruler and The Helpful Responses Questionnaire, which was coded using the Motivational Interviewing Skill Code. The training was associated with improvements in motivational interviewing basic skills. Students also showed increased awareness of the importance of using these skills with patients, even after a brief training.

Motivational Interviewing in Preventing Early Childhood Caries in Primary Healthcare: A Community-based Randomized Cluster Trial.

OBJECTIVE: To assess the effectiveness of motivational interviewing in preventing early childhood caries compared with conventional oral health education. STUDY DESIGN: Twelve health care units in southern Brazil were randomly allocated in 2 groups of 6 and professionals in 1 group were trained in motivational interviewing. The mothers/children and external examiners were blinded to the intervention. The data were collected by calibrated examiners using questionnaires and a clinical examination based on modified International Caries Detection and Assessment System criteria. Of the 674 children born in the catchment area in the year 2013, 469 received the intervention (224 in the conventional oral health education group, 245 in the motivational interviewing group), and 320 were examined by the end of the study (145 in the conventional oral health education group, 175 in the motivational interviewing group), with mean age of 30 months. The final follow-up was 68%, after 3 years. RESULTS: Mean of decayed, missing, and filled surfaces at the end of the study period for the whole sample was 1.34 (95% CI 0.97-1.71). The caries rate per 100 surface-year in the conventional oral health education group was 1.74 (95% CI 1.14-2.34) and in the motivational interviewing group, it was 0.92 (95% CI 0.63-1.20). To correct for clustering effect and unbalanced factors, multilevel Poisson regression was fitted and the effect of motivational interviewing on the incidence rate ratio was 0.40 (95% CI 0.21-0.79). CONCLUSIONS: An intervention based on the principles of motivational interviewing style was more effective in reducing the number of surfaces affected by early childhood caries compared with conventional oral health education intervention. TRIAL REGISTRATION: ClinicalTrials.govNCT02578966, Brazilian Registry of Clinical Trials RBR-8fvwxq.

Entrevista motivacional como uma ferramenta no processo de trabalho do agente comunitário de saúde / Motivational interviewing as a tool in the work process of the community health worker / Entrevista motivacional como una herramienta en el proceso de trabajo del agente comunitario de salud

A entrevista motivacional (EM) caracteriza-se como uma forma refinada de guiar uma conversa por meio de estratégias específicas que buscam estimular mudanças de comportamento. Esta pesquisa teve como objetivo compreender a apropriação dos conceitos e técnicas da EM por agentes comunitários de saúde após treinamento específico realizado em um serviço de atenção primária à saúde (APS) no Sul do Brasil. Trata-se de um estudo de abordagem qualitativa que incluiu a participação de agentes comunitários de saúde (ACS) em um grupo focal. O material textual produzido foi analisado pela técnica da análise temática de conteúdo. As três categorias que emergiram do grupo focal destacaram expectativas e lembranças do treinamento em conceitos de EM, com significados para o trabalho do ACS, e suas possibilidades e desafios. Os ACS expressaram conexões dos aprendizados durante treinamento às situações de trabalho e de vida pessoal. Desafios foram identificados na aplicação da EM por questões relacionadas ao tempo para realizar uma visita domiciliar, à intensa demanda no trabalho diário, às mudanças no processo de trabalho e à realização de atividades administrativas. A EM mostrou-se uma ferramenta apropriada e viável para a prática profissional dos ACS no contexto da APS.

Motivational interviewing (MI) is characterized as a refined way of guiding a conversation through specific strategies that seek to stimulate behavioral change. This study analyzed the appropriation of MI concepts and techniques by Community Health Workers after specific training performed in a Primary Healthcare (PH) service in the South Region of Brazil. This is a qualitative study that included the participation of Community Health Workers (CHW) in a focus group. The textual material produced was analyzed by the thematic content analysis technique. The three categories that emerged from the focus group stressed expectations and reminders of MI training, concepts of MI that were relevant for the daily work of CHW, and the possibilities and challenges of MI. The CHW expressed the connections of learning at the time of MI training to work as well as personal life situations. Challenges were identified in the application of MI for time-related issues to conduct domestic visits, intense daily work demands, changes in the work process, and administrative activities. MI was proven to be an appropriate and feasible tool for the professional practice of PH.

La entrevista motivacional (EM) se caracteriza por una forma refinada de guiar una conversación mediante estrategias específicas que buscan estimular cambios de comportamiento. Esta investigación tuvo como objetivo comprender la apropiación de los conceptos y técnicas de la EM por agentes comunitarios de salud después de un entrenamiento específico, realizado en un servicio de atención primaria de salud (APS) en la región Sur de Brasil. Es un estudio de enfoque cualitativo que incluyó la participación de agentes comunitarios de salud (ACS) en un grupo focal. El material textual producido fue analizado por la técnica del análisis temático de contenido. Las tres categorías que emergieron del grupo focal destacaron expectativas y recuerdos del entrenamiento en EM, conceptos de la EM con significados para el cotidiano de trabajo del ACS y posibilidades y desafíos de la EM. Los ACS expresaron conexiones de los aprendizajes en el momento del entrenamiento sobre EM a las situaciones de trabajo y de vida personal. Los desafíos se identificaron en la aplicación de la EM por cuestiones relacionadas con el tiempo para realizar una visita domiciliaria, la intensa demanda en el trabajo diario, los cambios en el proceso de trabajo y la realización de actividades administrativas. La EM se mostró una herramienta apropiada y viable para la práctica profesional de los ACS en el contexto de la APS.

Effects of protein supplementation in older adults undergoing resistance training: a systematic review and meta-analysis.

BACKGROUND: Older individuals present reductions in muscle mass and physical function, as well as a blunted muscle protein synthesis response to amino acid administration and physical activity. Although resistance training is an effective intervention to slow down muscle impairments in the elderly, there is no consensus whether a combination with protein supplementation could offer additional benefits to an older population. OBJECTIVE: We aimed to systematically summarize and quantify whether protein supplementation could optimize the effects of resistance training on muscle mass and strength in an aged population. DESIGN: A structured literature search was conducted on MEDLINE (PubMed), Cochrane, EMBASE and LILACS databases. The search had no period or language restrictions. Inclusion criteria comprised study design (randomized controlled trials-RCTs), sample mean age (60 years and over) and intervention (a resistance training program for a period of 6 weeks or longer combined with protein or amino acids supplementation). Two independent reviewers performed the study selection and data extraction. Continuous data on fat-free mass, muscle mass and muscle strength were pooled using a random-effects model. RESULTS: Of the 540 articles reviewed, 29 eligible articles underwent full-text evaluation. Nine RCTs (462 subjects) met the inclusion criteria and were included in the study. The mean age of the participants ranged from 61 to 79 years old. Protein supplementation protocols varied widely throughout the studies. Three studies used quantities related to the body mass of the participants and the other six trials provided supplements in daily amounts, independently of subjects' body masses. Overall, protein supplementation in combination with resistance training was associated with gains in fat-free mass, resulting in a standardized mean difference (SMD) of 0.23 [95% confidence interval (CI), 0.05-0.42]. However, protein supplementation was not associated with changes in muscle mass (0.14, 95% CI -0.05 to 0.32) or muscle strength (0.13, 95% CI -0.06 to 0.32). LIMITATIONS: Studies among the very elderly population are scarce. The variation regarding the supplementation protocol, namely the different protein sources, amounts and timing of ingestion, also made it harder to compare the results. The general quality of the studies was low, reflecting increased risk of bias in some studies. Despite these limitations, this systematic review provides a general overview of the role of protein supplementation with no other added macronutrients to augment muscle mass and strength during resistance training in older adults. CONCLUSION: Combining protein supplementation with resistance training is effective for eliciting gains in fat-free mass among older adults, but does not seem to increase muscle mass or strength.

A entrevista motivacional no Brasil: uma revisão sistemática / Motivational Interviewing in Brazil: a Sistematic Review

A entrevista motivacional (EM) é uma técnica que visa aumentar a motivação das pessoas nos processos de mudança e que vem sendo descrita pela literatura mundial de forma consistente. O presente estudo objetivou identificar os estudos que vêm sendo realizados no Brasil, bem como identificar suas principais características. Foi realizada uma busca sistemática de estudos clínicos em amostras brasileiras nos últimos dez anos e foram analisados 13 estudos. A EM no Brasil vem sendo aplicada em contextos clínicos, na maioria dos estudos em comportamentos relacionados ao uso de drogas, no formato individual e associado a outras técnicas. Alguns resultados demonstram que ela aumentou a motivação no processo de mudança, mas ainda se fazem necessários mais estudos para verificação da efetividade desta técnica no Brasil. (AU)

Motivational Interviewing (MI) is a technique that aims at increasing the motivation of people in change processes and that has been consistently described by literature. This study aimed at identifying studies that have been conducted in Brazil and identify its main features. A systematic search of clinical studies was conducted in Brazilian samples over the past decade and 13 studies were analyzed. In most studies on behaviors related to drug use, IM in Brazil has been applied in clinical settings, in the individual format, and associated with other techniques. Some results show that it increased motivation in change processes, but still more studies are needed to check the effectivenessof this technique in Brazil. (AU)

A entrevista motivacional no Brasil: uma revisão sistemática / Motivational Interviewing in Brazil: a Sistematic Review

A entrevista motivacional (EM) é uma técnica que visa aumentar a motivação das pessoas nos processos de mudança e que vem sendo descrita pela literatura mundial de forma consistente. O presente estudo objetivou identificar os estudos que vêm sendo realizados no Brasil, bem como identificar suas principais características. Foi realizada uma busca sistemática de estudos clínicos em amostras brasileiras nos últimos dez anos e foram analisados 13 estudos. A EM no Brasil vem sendo aplicada em contextos clínicos, na maioria dos estudos em comportamentos relacionados ao uso de drogas, no formato individual e associado a outras técnicas. Alguns resultados demonstram que ela aumentou a motivação no processo de mudança, mas ainda se fazem necessários mais estudos para verificação da efetividade desta técnica no Brasil...

Motivational Interviewing (MI) is a technique that aims at increasing the motivation of people in change processes and that has been consistently described by literature. This study aimed at identifying studies that have been conducted in Brazil and identify its main features. A systematic search of clinical studies was conducted in Brazilian samples over the past decade and 13 studies were analyzed. In most studies on behaviors related to drug use, IM in Brazil has been applied in clinical settings, in the individual format, and associated with other techniques. Some results show that it increased motivation in change processes, but still more studies are needed to check the effectivenessof this technique in Brazil...

Patient and family factors associated with family accommodation in obsessive-compulsive disorder.

AIM: Obsessive-compulsive disorder (OCD) impacts family functioning as family members modify their personal and family routines, participate in rituals, and provide reassurance. These behaviors have been identified as family accommodation (FA), a phenomenon that, if ignored, may facilitate OCD symptoms and lead to poorer prognosis. Because FA has been recognized as a predictor of treatment outcome, we examined the prevalence of FA and identified patient and family sociodemographic and clinical variables associated with FA in an outpatient sample. METHODS: The study comprised 228 subjects, namely, 114 patients with OCD and 114 family members, assessed before the patients entered a 12-session cognitive behavioral group therapy program. A multivariate linear regression model was used to control for confounding factors and to evaluate variables independently associated with FA. FA was evaluated using the Family Accommodation Scale for Obsessive-Compulsive Disorder-Interviewer Rated. RESULTS: FA was found to be highly prevalent among family members. Two patient factors positively associated with FA were OCD severity as measured by the Clinical Global Impressions Scale and higher scores on the Obsessions dimension of the Obsessive-Compulsive Inventory-Revised. Family members' characteristics that were positively associated with FA were higher scores on the Obsessive-Compulsive Inventory - Revised hoarding subscale and being the patient's spouse. CONCLUSION: Our findings suggest that the early identification of patients and family members who could benefit from interventions aimed at reducing FA could improve treatment outcomes.

Psychometric properties of the Brazilian Portuguese version of the Obsessive-Compulsive Inventory - Revised (OCI-R).

OBJECTIVE: The present study was designed to evaluate the psychometric properties of the Brazilian Portuguese version of the Obsessive-Compulsive Inventory - Revised. METHOD: The Obsessive-Compulsive Inventory - Revised was administered to a total of 260 participants: a clinical sample of 130 patients with anxiety disorders (64 with a diagnosis of obsessive-compulsive disorder patients, 33 diagnosed with social phobia, and 33 with panic disorder) and a sample of 130 non-clinical subjects. RESULTS: The findings indicate that the Obsessive-Compulsive Inventory - Revised is a valid measure for identifying and assessing the severity of the six symptom subtypes in obsessive-compulsive disorder. The original factor structure of the instrument was replicated in an exploratory factor analysis. Test-retest reliability was examined using data from 64 obsessive-compulsive disorder patients who completed the inventory on two different occasions. In each sample, the overall and subscale scores showed moderate to good internal consistency, good convergent and divergent validity, and sensitivity to changes resulting from cognitive-behavioral group therapy. CONCLUSION: Our findings indicate that the Brazilian Portuguese version of the Obsessive-Compulsive Inventory - Revised retains the psychometric properties of its original version and the Spanish, German and Icelandic versions.

Psychometric properties of the Brazilian Portuguese version of the Obsessive-Compulsive Inventory - Revised (OCI-R) / Propriedades psicométricas da versão em português do Brasil da Obsessive-Compulsive Inventory - Revised (OCI-R)

OBJECTIVE: The present study was designed to evaluate the psychometric properties of the Brazilian Portuguese version of the Obsessive-Compulsive Inventory - Revised. METHOD: The Obsessive-Compulsive Inventory - Revised was administered to a total of 260 participants: a clinical sample of 130 patients with anxiety disorders (64 with a diagnosis of obsessive-compulsive disorder patients, 33 diagnosed with social phobia, and 33 with panic disorder) and a sample of 130 non-clinical subjects. RESULTS: The findings indicate that the Obsessive-Compulsive Inventory - Revised is a valid measure for identifying and assessing the severity of the six symptom subtypes in obsessive-compulsive disorder. The original factor structure of the instrument was replicated in an exploratory factor analysis. Test-retest reliability was examined using data from 64 obsessive-compulsive disorder patients who completed the inventory on two different occasions. In each sample, the overall and subscale scores showed moderate to good internal consistency, good convergent and divergent validity, and sensitivity to changes resulting from cognitive-behavioral group therapy. CONCLUSION: Our findings indicate that the Brazilian Portuguese version of the Obsessive-Compulsive Inventory - Revised retains the psychometric properties of its original version and the Spanish, German and Icelandic versions.

OBJETIVO: O presente estudo foi delineado para avaliar as propriedades psicométricas da versão em português do Brasil do Obsessive-Compulsive Inventory - Revised. MÉTODO: O Obsessive-Compulsive Inventory - Revised foi aplicado em um total de 260 indivíduos: em uma amostra clínica de 130 pacientes (64 pacientes com transtorno obsessivo-compulsivo, 33 pacientes com fobia social e 33 pacientes com transtorno do pânico) mais uma amostra não clínica de 130 sujeitos. RESULTADOS: Os resultados indicam que o Obsessive-Compulsive Inventory - Revised é uma medida válida para identificar e avaliar a severidade dos seis subtipos de sintomas do transtorno obsessivo-compulsivo. A estrutura fatorial do instrumento foi replicada em uma análise fatorial exploratória. A confiabilidade teste-reteste foi examinada usando os dados de 64 pacientes com transtorno obsessivo-compulsivo que completaram o inventário em dois momentos diferentes. Em cada amostra, os escores total e das subescalas mostraram consistência interna de boa a moderada, boa validade concorrente e discriminante, e sensibilidade para as mudanças da terapia cognitivo-comportamental em grupo. CONCLUSÃO: Nossos achados indicam que a versão para o português do Brasil do Obsessive-Compulsive Inventory - Revised manteve as propriedades psicométricas da versão original e das versões em espanhol, alemão e islandês.

A randomized clinical trial to examine enhancing cognitive-behavioral group therapy for obsessive-compulsive disorder with motivational interviewing and thought mapping.

BACKGROUND: Obsessive-compulsive disorder (OCD) is characterized by repeated and persistent attempts to control thoughts and actions with rituals. These rituals are used in order to prevent feared or personally distressing outcomes. Cognitive behavioral group therapy (CBGT) has been reported to be effective for treating OCD patients. However, about one-third (30%) of patients do not benefit from CBGT. Some of these patients do not show significant improvement and continue to use rituals following CBGT, partially because they fail to complete the exposure and ritual prevention (ERP) exercises. Consequently, it is important to motivate patients to fully engage in CBGT treatment and complete the ERP exercises. AIMS: A randomized behavioral trial examined 12 weeks of manual directed CBGT, with the addition of individual sessions of Motivational Interviewing (MI) and Thought Mapping (TM), and compared treatment outcome to the effectiveness of CBGT group alone. METHOD: Subjects were randomized (n=93) into a CBGT group or a CBGT group with MI+TM. RESULTS: When the two groups were compared, both groups reduced OCD symptoms. However, symptom reduction and remission were significantly higher in the MI+TM CBGT group. Positive outcomes were also maintained, with additional symptom reduction at the 3-month follow-up for the MI+TM CBGT group. CONCLUSIONS: Adding two individual sessions of MI and TM before CBGT successfully reduced OCD symptoms and was more effective than using CBGT group alone.

Adding motivational interviewing and thought mapping to cognitive-behavioral group therapy: results from a randomized clinical trial.

OBJECTIVE: Recent factor-analytic studies of obsessive-compulsive disorder identified consistent symptom dimensions. This study was designed in order to observe which obsessive compulsive symptom dimensions could be changed by adding two individual sessions of motivational interviewing and thought mapping of cognitive-behavioral group therapy using a randomized clinical trial. METHOD: Forty outpatients with a primary diagnosis of obsessive-compulsive disorder were randomly assigned to receive cognitive-behavioral group therapy (control group) or motivational interviewing+thought mapping plus cognitive-behavioral group therapy. To evaluate changes in symptom dimensions, the Dimensional Yale-Brown Obsessive-Compulsive Scale was administered at baseline and after treatment. RESULTS: At post-treatment, there were statistically significant differences between cognitive-behavioral group therapy and motivational interviewing+thought mapping+cognitive behavioral group therapy groups in the mean total Dimensional Yale-Brown Obsessive-Compulsive Scale score, and in the contamination and aggression dimension score. Hoarding showed a statistical trend towards improvement. CONCLUSION: These findings suggest that adding motivational interviewing+thought mapping to cognitive-behavioral group therapy can facilitate changes and bring about a decrease in the scores in different obsessive-compulsive disorder symptom dimensions, as measured by the Dimensional Yale-Brown Obsessive-Compulsive Scale. Nonetheless, additional trials are needed to confirm these results.

Adding motivational interviewing and thought mapping to cognitive-behavioral group therapy: results from a randomized clinical trial / Adicionando a entrevista motivacional e o mapeamento cognitivo à terapia cognitivo-comportamental em grupo: resultados de um ensaio clínico randomizado

OBJECTIVE: Recent factor-analytic studies of obsessive-compulsive disorder identified consistent symptom dimensions. This study was designed in order to observe which obsessive compulsive symptom dimensions could be changed by adding two individual sessions of motivational interviewing and thought mapping of cognitive-behavioral group therapy using a randomized clinical trial. METHOD: Forty outpatients with a primary diagnosis of obsessive-compulsive disorder were randomly assigned to receive cognitive-behavioral group therapy (control group) or motivational interviewing+thought mapping plus cognitive-behavioral group therapy. To evaluate changes in symptomdimensions, the Dimensional Yale-Brown Obsessive-Compulsive Scale was administered at baseline and after treatment. RESULTS: At post-treatment, there were statistically significant differences between cognitive-behavioral group therapy and motivational interviewing+thought mapping+cognitivebehavioral group therapy groups in the mean total Dimensional Yale-Brown Obsessive-Compulsive Scale score, and in the contamination and aggression dimension score. Hoarding showed a statistical trend towards improvement. CONCLUSION: These findings suggest that adding motivational interviewing+thought mapping to cognitive-behavioral group therapy can facilitate changes and bring about a decrease in the scores in different obsessive-compulsive disorder symptom dimensions, as measured by the Dimensional Yale-Brown Obsessive-Compulsive Scale. Nonetheless, additional trials are needed to confirm these results.

OBJETIVO: Recentes estudos utilizando análise fatorial no transtorno obsessivocompulsivo identificaram dimensões consistentes dos sintomas. Este estudo foi delineado para observar quais dimensões dos sintomas obsessivo-compulsivos podem ser modificadas adicionando duas sessões individuais de entrevista motivacional e mapeamento cognitivo à terapia cognitivo-comportamental em grupo usando um ensaio clínico randomizado. MÉTODO: Quarenta pacientes ambulatoriais com diagnóstico primário de transtorno obsessivo-compulsivo foram alocados aleatoriamente para receber terapia cognitivo-comportamental em grupo (grupo controle) ou entrevista motivacional+mapeamento cognitivo+terapia cognitivo-comportamental em grupo. Para avaliar mudanças nas dimensões dos sintomas, foi administrada a Escala Dimensional para Sintomas Obsessivo-Compulsivos de Yale-Brown antes do início e após o tratamento. RESULTADOS: Ao final do tratamento houve diferença estatisticamente significativa entre a terapia cognitivo-comportamental em grupo e entrevista motivacional+mapeamento cognitivo+terapia cognitivocomportamental em grupo na média do escore total da Escala Dimensional para Sintomas Obsessivo-Compulsivos de Yale-Brown e no escore da dimensão de contaminação e agressão. Colecionismo apresentou melhora com tendência estatística. CONCLUSÃO: Esses achados sugerem que acrescentar entrevista motivacional+mapeamento cognitivo à terapia cognitivo-comportamental em grupo pode facilitar mudanças na redução dos escores nas diferentes dimensões dos sintomas, como indicado pela Escala Dimensional para Sintomas Obsessivo-Compulsivos de Yale-Brown. No entanto, são necessários estudos adicionais para confirmar estes resultados.

Translation and adaptation into Brazilian Portuguese of the Family Accommodation Scale for Obsessive-Compulsive Disorder - interviewer-Rated (FAS-IR) / Tradução e adaptação para o português do Brasil da Escala de Acomodação Familiar - Pontuado pelo Entrevistador (FAS-IR)

OBJECTIVE: To describe the process of translation and adaptation into Brazilian Portuguese of the Family Accommodation Scale for Obsessive-Compulsive Disorder - Interviewer-Rated (FAS-IR). METHOD: The process of translation and adaptation of the scale involved four bilingual health professionals. The scale was initially translated into Brazilian Portuguese independently by two professionals. Then, the two versions were compared, resulting in a preliminary Portuguese version that was administered to 15 relatives of patients diagnosed with obsessive-compulsive disorder (OCD) with different education levels, deliberately chosen to collect language adjustment suggestions. Subsequently, the scale was translated back into English independently by two other professionals. After comparing the two back translations, a new English version was generated. This version was reviewed and approved by the authors of the original scale. RESULTS: The Brazilian Portuguese version of the FAS-IR proved to be easily understood and can be used in relatives of OCD patients from different socioeconomic backgrounds. CONCLUSION: Adaptation of the FAS-IR into Brazilian Portuguese will enable health professionals to assess the level of accommodation in relatives of OCD patients and allows the development of future studies aimed at 1) studying the influence of family accommodation on maintaining and possibly facilitating OCD symptoms, and 2) assessing the effect of family accommodation on treatment outcomes in Portuguese-speaking populations.

OBJETIVO: Descrever o processo de tradução e adaptação para o português do Brasil da Family Accommodation Scale for Obsessive-Compulsive Disorder - Interviewer-Rated (FAS-IR). MÉTODO: O processo de tradução e adaptação da escala envolveu quatro profissionais de saúde bilíngues. A escala foi inicialmente traduzida de forma independente para o português do Brasil por dois profissionais. A seguir, as duas versões foram comparadas, resultando em uma versão inicial em português que foi aplicada a 15 familiares de pacientes com transtorno obsessivo-compulsivo (TOC), com diferentes níveis de instrução, deliberadamente escolhidos para coletar as sugestões de ajuste linguístico. Subsequentemente, a escala foi retrotraduzida independentemente por outros dois profissionais da saúde. Depois de comparar as duas retrotraduções, uma nova versão da escala foi gerada em inglês. Essa versão foi revisada e aprovada pelos autores da escala original. RESULTADOS: A versão em português do Brasil da escala FAS-IR mostrou ser facilmente compreendida e pode ser usada em familiares de pacientes com TOC de diferentes níveis socioeconômicos. CONCLUSÃO: A FAS-IR adaptada ao português do Brasil fará com que profissionais de saúde possam avaliar o nível de acomodação em familiares de pacientes com TOC e permitirá a realização de futuros estudos com os objetivos de 1) estudar a influência da acomodação familiar na manutenção e, possivelmente, na facilitação dos sintomas do TOC e 2) examinar o efeito da acomodação familiar sobre os resultados do tratamento em populações de países de língua portuguesa.