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1.
JAMA ; 324(18): 1844-1854, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33170240

RESUMEN

Importance: Electronic cigarettes (e-cigarettes) for smoking cessation remain controversial. Objective: To evaluate e-cigarettes with individual counseling for smoking cessation. Design, Setting, and Participants: A randomized clinical trial enrolled adults motivated to quit smoking from November 2016 to September 2019 at 17 Canadian sites (801 individuals screened; 274 ineligible and 151 declined). Manufacturing delays resulted in early termination (376/486 participants, 77% of target). Outcomes through 24 weeks (March 2020) are reported. Interventions: Randomization to nicotine e-cigarettes (n = 128), nonnicotine e-cigarettes (n = 127), or no e-cigarettes (n = 121) for 12 weeks. All groups received individual counseling. Main Outcomes and Measures: The primary end point was point prevalence abstinence (7-day recall, biochemically validated using expired carbon monoxide) at 12 weeks, changed from 52 weeks following early termination. Participants missing data were assumed to be smoking. The 7 secondary end points, examined at multiple follow-ups, were point prevalence abstinence at other follow-ups, continuous abstinence, daily cigarette consumption change, serious adverse events, adverse events, dropouts due to adverse effects, and treatment adherence. Results: Among 376 randomized participants (mean age, 52 years; 178 women [47%]), 299 (80%) and 278 (74%) self-reported smoking status at 12 and 24 weeks, respectively. Point prevalence abstinence was significantly greater for nicotine e-cigarettes plus counseling vs counseling alone at 12 weeks (21.9% vs 9.1%; risk difference [RD], 12.8 [95% CI, 4.0 to 21.6]) but not 24 weeks (17.2% vs 9.9%; RD, 7.3 [95% CI, -1.2 to 15.7]). Point prevalence abstinence for nonnicotine e-cigarettes plus counseling was not significantly different from counseling alone at 12 weeks (17.3% vs 9.1%; RD, 8.2 [95% CI, -0.1 to 16.6]), but was significantly greater at 24 weeks (20.5% vs 9.9%; RD, 10.6 [95% CI, 1.8 to 19.4]). Adverse events were common (nicotine e-cigarette with counseling: 120 [94%]; nonnicotine e-cigarette with counseling: 118 [93%]; counseling only: 88 [73%]), with the most common being cough (64%) and dry mouth (53%). Conclusions and Relevance: Among adults motivated to quit smoking, nicotine e-cigarettes plus counseling vs counseling alone significantly increased point prevalence abstinence at 12 weeks. However, the difference was no longer significant at 24 weeks, and trial interpretation is limited by early termination and inconsistent findings for nicotine and nonnicotine e-cigarettes, suggesting further research is needed. Trial Registration: ClinicalTrials.gov Identifier: NCT02417467.


Asunto(s)
Consejo , Sistemas Electrónicos de Liberación de Nicotina , Cese del Hábito de Fumar/métodos , Reducción del Consumo de Tabaco/estadística & datos numéricos , Tabaquismo/terapia , Adulto , Terapia Combinada , Terminación Anticipada de los Ensayos Clínicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autoinforme , Dispositivos para Dejar de Fumar Tabaco
4.
JAMA ; 324(14): 1406-1418, 2020 10 13.
Artículo en Inglés | MEDLINE | ID: mdl-33048154

RESUMEN

Importance: Persistent smoking may cause adverse outcomes among patients with cancer. Many cancer centers have not fully implemented evidence-based tobacco treatment into routine care. Objective: To determine the effectiveness of sustained telephone counseling and medication (intensive treatment) compared with shorter-term telephone counseling and medication advice (standard treatment) to assist patients recently diagnosed with cancer to quit smoking. Design, Setting, and Participants: This unblinded randomized clinical trial was conducted at Massachusetts General Hospital/Dana-Farber/Harvard Cancer Center and Memorial Sloan Kettering Cancer Center. Adults who had smoked 1 cigarette or more within 30 days, spoke English or Spanish, and had recently diagnosed breast, gastrointestinal, genitourinary, gynecological, head and neck, lung, lymphoma, or melanoma cancers were eligible. Enrollment occurred between November 2013 and July 2017; assessments were completed by the end of February 2018. Interventions: Participants randomized to the intensive treatment (n = 153) and the standard treatment (n = 150) received 4 weekly telephone counseling sessions and medication advice. The intensive treatment group also received 4 biweekly and 3 monthly telephone counseling sessions and choice of Food and Drug Administration-approved cessation medication (nicotine replacement therapy, bupropion, or varenicline). Main Outcome and Measures: The primary outcome was biochemically confirmed 7-day point prevalence tobacco abstinence at 6-month follow-up. Secondary outcomes were treatment utilization rates. Results: Among 303 patients who were randomized (mean age, 58.3 years; 170 women [56.1%]), 221 (78.1%) completed the trial. Six-month biochemically confirmed quit rates were 34.5% (n = 51 in the intensive treatment group) vs 21.5% (n = 29 in the standard treatment group) (difference, 13.0% [95% CI, 3.0%-23.3%]; odds ratio, 1.92 [95% CI, 1.13-3.27]; P < .02). The median number of counseling sessions completed was 8 (interquartile range, 4-11) in the intensive treatment group. A total of 97 intensive treatment participants (77.0%) vs 68 standard treatment participants (59.1%) reported cessation medication use (difference, 17.9% [95% CI, 6.3%-29.5%]; odds ratio, 2.31 [95% CI, 1.32-4.04]; P = .003). The most common adverse events in the intensive treatment and standard treatment groups, respectively, were nausea (n = 13 and n = 6), rash (n = 4 and n = 1), hiccups (n = 4 and n = 1), mouth irritation (n = 4 and n = 0), difficulty sleeping (n = 3 and n = 2), and vivid dreams (n = 3 and n = 2). Conclusions and Relevance: Among smokers recently diagnosed with cancer in 2 National Cancer Institute-designated Comprehensive Cancer Centers, sustained counseling and provision of free cessation medication compared with 4-week counseling and medication advice resulted in higher 6-month biochemically confirmed quit rates. However, the generalizability of the study findings is uncertain and requires further research. Trial Registration: ClinicalTrials.gov Identifier: NCT01871506.


Asunto(s)
Consejo/métodos , Neoplasias/diagnóstico , Cese del Hábito de Fumar/psicología , Templanza/psicología , Dispositivos para Dejar de Fumar Tabaco , Anciano , Bupropión/efectos adversos , Bupropión/uso terapéutico , Cotinina/análisis , Consejo/estadística & datos numéricos , Técnicas de Apoyo para la Decisión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Entrevista Motivacional , Satisfacción del Paciente , Selección de Paciente , Saliva/química , Fumar/tratamiento farmacológico , Fumar/epidemiología , Fumar/psicología , Agentes para el Cese del Hábito de Fumar/efectos adversos , Agentes para el Cese del Hábito de Fumar/uso terapéutico , Teléfono , Dispositivos para Dejar de Fumar Tabaco/efectos adversos , Vareniclina/efectos adversos , Vareniclina/uso terapéutico
5.
BMC Infect Dis ; 20(1): 773, 2020 Oct 19.
Artículo en Inglés | MEDLINE | ID: mdl-33076866

RESUMEN

BACKGROUND: Globally, the majority of people living with HIV have no or only limited access to HIV drug resistance testing to guide the selection of antiretroviral drugs. This is of particular concern for children and adolescents, who experience high rates of treatment failure. The GIVE MOVE trial assesses the clinical impact and cost-effectiveness of routinely providing genotypic resistance testing (GRT) to children and adolescents living with HIV who have an unsuppressed viral load (VL) while taking antiretroviral therapy (ART). METHODS: GIVE MOVE is an open-label randomised clinical trial enrolling children and adolescents (≥6 months to <19 years) living with HIV with a VL ≥400 copies/mL (c/mL) while taking first-line ART. Recruitment takes place at sites in Lesotho and Tanzania. Participants are randomised in a 1:1 allocation to a control arm receiving the standard of care (3 sessions of enhanced adherence counselling, a follow-up VL test, continuation of the same regimen upon viral resuppression or empiric selection of a new regimen upon sustained elevated viremia) and an intervention arm (GRT to inform onward treatment). The composite primary endpoint is the occurrence of any one or more of the following events during the 36 weeks of follow-up period: i) death due to any cause; ii) HIV- or ART-related hospital admission of ≥24 h duration; iii) new clinical World Health Organisation stage 4 event (excluding lymph node tuberculosis, stunting, oral or genital herpes simplex infection and oesophageal candidiasis); and iv) no documented VL <50 c/mL at 36 weeks follow-up. Secondary and exploratory endpoints assess additional health-related outcomes, and a nested study will assess the cost-effectiveness of the intervention. Enrolment of a total of 276 participants is planned, with an interim analysis scheduled after the first 138 participants have completed follow-up. DISCUSSION: This randomised clinical trial will assess if the availability of resistance testing improves clinical outcomes in children and adolescents with elevated viremia while taking ART. TRIAL REGISTRATION: This trial is registered with ClinicalTrials.gov ( NCT04233242 ; registered 18.01.2020). More information: www.givemove.org .


Asunto(s)
Fármacos Anti-VIH/farmacología , Farmacorresistencia Viral , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , VIH/efectos de los fármacos , Adolescente , Fármacos Anti-VIH/uso terapéutico , Niño , Preescolar , Análisis Costo-Beneficio , Consejo , Femenino , Genotipo , Herpes Genital , Humanos , Lactante , Lesotho , Estudios Longitudinales , Masculino , Tanzanía , Insuficiencia del Tratamiento , Carga Viral , Viremia/tratamiento farmacológico , Viremia/virología
6.
Niger J Clin Pract ; 23(10): 1333-1338, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33047688

RESUMEN

Backround: The fiduciary duty of a managing physician makes paediatric discharges against medical advice (DAMA) particularly challenging as children lack the legal power or authority to make their health decisions. Aim: It is aimed in the present study to determine the prevalence of paediatric DAMA in a mission tertiary hospital. Methods: This was a prospective descriptive study carried out from June 2018 to May 2019 among paediatric inpatients at the Bowen University Teaching Hospital, Ogbomoso, Nigeria whose parent/ care giver signed DAMA, despite adequate counselling. Data was analysed using SPSS version 23. Results: The prevalence of DAMA in the study was of 4.1%, and the neonatal group accounted for the largest bulk of DAMA. Birth asphyxia was the commonest diagnosis among this group. There was a slight female predominance among the patients whose parents signed DAMA. Financial constraint was the commonest reason [13(30.2%)] given for DAMA and none of the children whose parents signed DAMA was enrolled on the National Health Insurance Scheme (NHIS). Conclusion: Rate of DAMA in a private mission tertiary hospital was lower than previously reported from government tertiary hospitals in the present-day Nigeria.


Asunto(s)
Cuidadores/estadística & datos numéricos , Hospitales Religiosos/estadística & datos numéricos , Padres/psicología , Alta del Paciente/estadística & datos numéricos , Pediatría , Negativa del Paciente al Tratamiento/estadística & datos numéricos , Cuidadores/psicología , Niño , Preescolar , Consejo , Femenino , Hospitales Privados , Humanos , Pacientes Internos , Masculino , Nigeria/epidemiología , Prevalencia , Estudios Prospectivos , Factores Socioeconómicos
7.
Artículo en Inglés | MEDLINE | ID: mdl-33096650

RESUMEN

The use of digital information and communication technologies (ICTs) has enabled many professionals to continue to provide their services during the COVID-19 pandemic. However, little is known about the adoption of ICTs by psychologists and the impact of such technologies on their practice. This study aimed to explore psychologists' practices related with the use of ICTs before and during the COVID-19 lockdown, to identify the main changes that the pandemic has brought and the impact that such changes have had on their practice with clients, and also identify the factors that potentially have affected such changes. The Portuguese Psychologists Association announced the study, and 108 psychologists responded to an online survey during the mandatory lockdown. The results showed that these professionals continued to provide their services due to having adopted ICTs. Comparing with face-to-face interventions, psychologists recognized that additional precautions/knowledge were needed to use such technologies. Despite the challenges identified, they described the experience with the use of ICTs as positive, meeting clients' adherence, and yielding positive results. Psychologists with the most years of professional experience maintained their services the most, but those with average experience showed the most favorable attitudes toward the use of technologies and web-based interventions.


Asunto(s)
Infecciones por Coronavirus/psicología , Consejo/tendencias , Intervención basada en la Internet/tendencias , Neumonía Viral/psicología , Psicoterapia/tendencias , Telemedicina/tendencias , Betacoronavirus , Humanos , Pandemias
8.
BMJ ; 371: m3797, 2020 10 14.
Artículo en Inglés | MEDLINE | ID: mdl-33055176

RESUMEN

OBJECTIVE: To compare several monetary incentive programmes for promoting smoking abstinence among employees who smoke at workplaces in a middle income country. DESIGN: Parallel group, open label, assessor blinded, cluster randomized controlled trial. SETTING: Large industrial workplaces in metropolitan Bangkok, Thailand. PARTICIPANTS: Employees who smoked cigarettes and planned to quit within six months recruited from 101 worksite clusters (84 different companies). INTERVENTIONS: Worksites were digitally cluster randomized by an independent investigator to usual care or usual care plus one of eight types of incentive programmes. Usual care consisted of one time group counseling and cessation support through a 28 day text messaging programme. The incentive programmes depended on abstinence at three months and varied on three intervention components: refundable deposits, assignment to a teammate, and bonus size ($20 (£15; €17) or $40). MAIN OUTCOME MEASURES: The primary outcome was biochemically verified seven day point prevalence smoking abstinence at 12 months. Secondary outcomes were programme acceptance at enrollment and smoking abstinence at three months (end of intervention) and at six months. All randomized participants who had complete baseline information were included in intention-to-treat analyses; participants with missing outcomes were coded as continuing smokers. RESULTS: Between April 2015 and August 2016, the trial enrolled 4190 participants. Eighteen were omitted because of missing baseline covariates and death before the primary endpoint, therefore 4172 participants were included in the intention-to-treat analyses. Programme acceptance was relatively high across all groups: 58.7% (2451/4172) overall and 61.3% (271/442) in the usual care group. Abstinence rates at 12 months did not differ among deposit programmes (336/2253, 14.9%) and non-deposit programmes (280/1919, 14.6%; adjusted difference 0.8 points, 95% confidence interval -2.7 to 4.3, P=0.65), but were somewhat lower for team based programmes (176/1348, 13.1%) than individual based programmes (440/2824, 15.6%; -3.2 points, -6.6 to -0.2, P=0.07), and higher for $40 bonus programmes (322/1954, 16.5%) than programmes with no bonus (148/1198, 12.4%; 5.9 points, 2.1 to 9.7, P=0.002). The $40 individual bonus was the most efficacious randomization group at all endpoints. Intervention components did not strongly interact with each other. CONCLUSIONS: Acceptance of monetary incentive programmes for promoting smoking abstinence was high across all groups. The $40 individual bonus programmes increased long term smoking abstinence compared with usual care, although several other incentive designs did not, such as team based programmes and deposit programmes. Incentive design in workplace wellness programmes might influence their effectiveness at reducing smoking rates in low resource settings. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02421224).


Asunto(s)
Fumar Cigarrillos/terapia , Motivación , Servicios de Salud del Trabajador/métodos , Fumadores/psicología , Cese del Hábito de Fumar/métodos , Adulto , Fumar Cigarrillos/psicología , Análisis por Conglomerados , Consejo , Femenino , Humanos , Masculino , Recompensa , Método Simple Ciego , Cese del Hábito de Fumar/psicología , Envío de Mensajes de Texto , Tailandia , Resultado del Tratamiento , Lugar de Trabajo/psicología
10.
Urologe A ; 59(11): 1312-1319, 2020 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-33084917

RESUMEN

INTRODUCTION: This paper introduces the German S3-guideline Gender Incongruence, Gender Dysphoria and Trans Health: Diagnostics, Counselling and Treatment that was finalized in October 2018. OBJECTIVES: The objective of the guideline group was to adapt the 1997 Standards for Treatment and Expert Opinion on Transsexuals to current scientific developments and research results and to make them applicable for appropriate health care in Germany. METHODS: The treatment recommendations of the guideline are based on empirical evidence which was systematically researched and evaluated. In a structured consensus process, the guideline group, who is representative for the target group, and a stakeholder group of trans people in Germany agreed on 100 recommendations. RESULTS: The guideline aims to individualize and deregulate the field of trans health care. Reasonable options for the treatment of gender incongruence and/or gender dysphoria are identified. Based on empirical and clinical evidence, a procedure is recommended which is tailored to the individual conditions of the treatment. CONCLUSION: The guideline reflects the current international state of trans health care on the basis of empirical evidence and relates it to the German health care system. Its application should be backed up by clinical and therapeutic expertise.


Asunto(s)
Disforia de Género , Personas Transgénero , Transexualidad , Consejo , Prestación de Atención de Salud , Disforia de Género/diagnóstico , Disforia de Género/terapia , Identidad de Género , Alemania , Humanos , Transexualidad/diagnóstico , Transexualidad/terapia
11.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(7): 812-818, 2020 Jul 28.
Artículo en Inglés, Chino | MEDLINE | ID: mdl-32879085

RESUMEN

OBJECTIVES: To explore the method and significance of prenatal counseling in cardiac surgery for fetal congenital heart disease (CHD). METHODS: The prenatal counseling should be provided by experienced CHD experts. The preliminary clinical diagnosis based on relevant data was carried out, the prognosis risk for fetal CHD was graded, and the pathophysiological process and potential hazards of the disease were analyzed. The current condition of CHD in the treatment plan, the long-term quality of life, and the special requirements of parturition in place, period and mode were described. A reliable follow-up system of the fetuses was established, the diagnosis after delivery was verified, and surgical treatment was carried out timely. RESULTS: From January 2016 to December 2018, 225 parents with fetal CHD received prenatal counseling, including 60 fetuses (26.7%) with simple CHD and 165 (73.3%) with complex CHD, among which 59 cases (98.3%) and 93 cases (56.4%) decided to continue the pregnancy, respectively. During the follow-up, 118 fetuses were born, of which 66 infants received surgical treatment within 6 months after birth, 63 infants (95.5%) recovered and 3 infants (4.5%) died. The rest 52 infants continued to be followed up. CONCLUSIONS: The prenatal counseling for fetal CHD can provide the parents a comprehensive medical information about CHD, which is beneficial to making appropriate pregnancy decisions, and can turn the fetuses from unreasonable birth and passive treatment to selective birth and active treatment in CHD.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Cardiopatías Congénitas/cirugía , Consejo , Femenino , Feto , Humanos , Embarazo , Diagnóstico Prenatal , Calidad de Vida , Ultrasonografía Prenatal
12.
Medicine (Baltimore) ; 99(33): e21484, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32871994

RESUMEN

BACKGROUND: The objective of this study is to investigate the effects of humanistic care and psychological counseling (HCPC) on psychological disorders (PD) in medical students after coronavirus disease 2019 (COVID-19) outbreak. METHODS: We will search randomized controlled trials or case-controlled studies of HCPC on PD in medical students after COVID-19 outbreak in the following electronic databases: PUBMED/MEDLINE, EMBASE, Cochrane Library, CINAHL, AMED, WANGFANG, and CNKI. The time is restricted from the construction of each database to the present. All process of study selection, data collection, and study quality evaluation will be carried out by two independent authors. Any different opinions will be solved by a third author through discussion. We will employ RevMan 5.3 software to conduct statistical analysis. RESULTS: This study will provide a better understanding of HCPC on PD in medical students after COVID-19 outbreak. CONCLUSIONS: This study may offer strong evidence for clinical practice to treat PD in medical students after COVID-19 outbreak. STUDY REGISTRATION: CRD42020193199.


Asunto(s)
Infecciones por Coronavirus/psicología , Consejo/métodos , Trastornos Mentales/terapia , Neumonía Viral/psicología , Psicoterapia/métodos , Estudiantes de Medicina/psicología , Adulto , Betacoronavirus , Estudios de Casos y Controles , Femenino , Humanismo , Humanos , Masculino , Trastornos Mentales/psicología , Pandemias , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Adulto Joven
13.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(6): 627-632, 2020 Jun 28.
Artículo en Inglés, Chino | MEDLINE | ID: mdl-32879118

RESUMEN

OBJECTIVES: To investigate the attitudes and skills of grief counseling in the front-line medical workers from coronavirus disease 2019 (COVID-19) designated hospitals in Wuhan for the bereaved family members and to provide the basis for proper hospital management strategies. METHODS: The convenience sampling method was applied to select 422 medical workers who kept touch with the bereaved family members in five COVID-19 designated hospitals in Wuhan from January to February 2020. Questionnaire regarding grief counseling attitudes and questionnaire regarding grief counseling skills were used to evaluate the attitudes and skills of grief counseling in medical workers. The scores of grief counseling attitudes and skills in group of different characteristics were further compared. Pearson correlation was used to analyze the attitudes and skills of grief counseling in medical workers. RESULTS: The scores of grief counseling attitudes in medical workers were 15-46 (33.00±9.31). Length of service, professional title, whether or not receiving relevant training, frequency of contact with bereaved family members contributed to impacting the medical workers' attitudes of grief counseling (all P<0.05). The scores of grief counseling skills in medical workers were 9-30 (19.30±4.42). Length of service, professional title, religion, whether or not receiving relevant training, frequency of contact with bereaved family members contributed to impacting the medical workers' skills of grief counseling (all P<0.05). There was a significant positive correlation between the attitudes and skills of grief counseling in the medical workers (r=0.608, P<0.01). CONCLUSIONS: The attitudes and skills of grief counseling in the medical workers from COVID-19 designated hospitals in Wuhan still need to be improved. Grief counseling group and a long-term, comprehensive training system are recommended.


Asunto(s)
Infecciones por Coronavirus/psicología , Consejo , Pesar , Personal de Salud/psicología , Neumonía Viral/psicología , Actitud del Personal de Salud , Betacoronavirus , China , Hospitales , Humanos , Pandemias
14.
Psychiatr Danub ; 32(Suppl 1): 21-23, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32890356

RESUMEN

BACKGROUND: Tobacco use is one of the major causes of morbidity and mortality amoung patients suffering from psychotic disorders. The association between severe COVID-19 and tobacco use is still debated. The aim of this paper is to enhance the importance of providing up to date informations about nicotine and tobacco use in connection with the SARS-CoV-2-related conditions. METHODS: We present 3 cases of sudden tobacco use cessation in 3 long-term heavy smokers receiving mental health care for chronic psychotic disorders. Fear of severe form of COVID-19 was their principal motivation. Nicotine replacement therapy and quitline counseling were provided and no major withdrawal symptoms were declared. RESULTS: As mass media later wrongly presented tobacco use as a protective factor regarding COVID-19, all three patients resumed smoking. Rigorous counseling took advantage of psychotic symptoms to correct false informations and finally promote tobacco use cessation. CONCLUSIONS: The COVID-19 pandemic might paradoxically represent a great motivational factor to quit smoking, espacially when considering patients suffering from severe mental health disorders. Beyond the terrible suffering it causes, we illustrate with a case serie that this opportunity must be exploited by mental health professionals to improve quality and life expectancy of their patients.


Asunto(s)
Infecciones por Coronavirus/psicología , Neumonía Viral/psicología , Trastornos Psicóticos/terapia , Cese del Uso de Tabaco/psicología , Betacoronavirus , Consejo , Humanos , Motivación , Pandemias , Dispositivos para Dejar de Fumar Tabaco
15.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32989082

RESUMEN

OBJECTIVES: We tested a Public Health Service 5As-based clinician-delivered smoking cessation counseling intervention with adolescent smokers in pediatric primary care practice. METHODS: We enrolled clinicians from 120 practices and recruited youth (age ≥14) from the American Academy of Pediatrics Pediatric Research in Office Settings practice-based research network. Practices were randomly assigned to training in smoking cessation (intervention) or social media counseling (attentional control). Youth recruited during clinical visits completed confidential screening forms. All self-reported smokers and a random sample of nonsmokers were offered enrollment and interviewed by phone at 4 to 6 weeks, 6 months, and 12 months after visits. Measures included adolescents' report of clinicians' delivery of screening and counseling, current tobacco use, and cessation behaviors and intentions. Analysis assessed receipt of screening and counseling, predictors of receiving 5As counseling, and effects of interventions on smoking behaviors and cessation at 6 and 12 months. RESULTS: Clinicians trained in the 5As intervention delivered more screening (ß = 1.0605, P < .0001) and counseling (ß = 0.4354, P < .0001). In both arms, clinicians more often screened smokers than nonsmokers. At 6 months, study arm was not significantly associated with successful cessation; however, smokers in the 5As group were more likely to have quit at 12 months. Addicted smokers more often were counseled, regardless of study arm, but were less likely to successfully quit smoking. CONCLUSIONS: Adolescent smokers whose clinicians were trained in 5As were more likely to receive smoking screening and counseling than controls, but the ability of this intervention to help adolescents quit smoking was limited.


Asunto(s)
Consejo/educación , Motivación , Cese del Hábito de Fumar/psicología , Adolescente , Femenino , Humanos , Masculino , No Fumadores/estadística & datos numéricos , Enfermeras Practicantes/educación , Pediatras/educación , Asistentes Médicos/educación , Fumadores/estadística & datos numéricos , Fumar
16.
J Pastoral Care Counsel ; 74(3): 166-174, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32967547

RESUMEN

Online/cyber counseling has been named as the best way to offer counseling services during the COVID-19 outbreak. The purpose of this article is to explore the use of online/cyber counseling during the COVID-19 outbreak to solve psychological problems. The author examines the history and concepts, the therapeutic relationship, transference and countertransference, the advantages along with the disadvantages, considerations, implications, and curriculum for online/cyber counseling during COVID-19 outbreak.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Consejo , Internet , Cuidado Pastoral , Neumonía Viral/epidemiología , Consulta Remota , Betacoronavirus , Humanos , Pandemias , Transferencia Psicológica
17.
Crit Rev Oncol Hematol ; 154: 103092, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32896752

RESUMEN

Fertility preservation in women with cervical cancer is a demanding but evolving issue. Some remarkable achievements have been reached, in particular the improvement of primary and secondary prevention and the broadening of the indications for conservative surgery up to FIGO 2018 stage IB2. Natural pregnancy rate and the rate of obstetrics complications following conservative approach is satisfactory even if not optimal. On the other hand, the use of classic strategies for fertility preservation such as oocytes or ovarian cortex freezing is extremely limited, being the uterus compromised by treatment in a high proportion of cases. In fact, the availability of uterine surrogacy can play a role in the counseling and the decision-making process. The recent advent of uterus transplantation is fascinating but, at present, cannot be viewed as a realistic solution.


Asunto(s)
Preservación de la Fertilidad , Neoplasias del Cuello Uterino , Consejo , Criopreservación , Femenino , Humanos , Oocitos , Ovario , Embarazo
18.
PLoS Negl Trop Dis ; 14(9): e0008556, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32925964

RESUMEN

Sexual transmission of Ebola virus (EBOV) is well established and has been implicated in multiple resurgences during the West African Ebola epidemic. Given the persistence of viral RNA in semen, guidelines from the World Health Organization (WHO) recommend abstinence or condom use for at least 1 year or until two semen PCR tests are negative. To better understand the impact of semen testing on sexual behavior, male EVD survivors were surveyed regarding their sexual behavior before and after semen testing. Of the 171 men who enrolled, 148 reported being sexually active following discharge from an ETU with 59% reporting episodes of condomless sex. At least one semen sample for testing was provided by 149 men and 13 of these men had EBOV RNA detected in their semen. When comparing sexual behaviors before and after semen testing, a positive semen test result had limited impact on behavior. Of those with seminal EBOV RNA detected, 61% reported no change in behavior pre- and post-semen testing with 46% engaging in condomless sex before and after testing and only 1 adopted safer sex behaviors following receipt of a positive result. Similarly, among men with undetectable EBOV in their semen, 66% reported no change in sexual behaviors with semen testing, with 55% forgoing condoms during sex. In only 11% was a negative semen result followed by abandoning condoms. There were no known sexual transmission events of Ebola virus in this cohort despite viral presence in semen during periods of condomless sex. This highlights the need to better understand the infectious potential of viral RNA persistence and determine what constitutes effective counseling for survivors and their partners.


Asunto(s)
Consejo , ARN Viral/análisis , Semen/virología , Conducta Sexual/psicología , Adolescente , Adulto , Portador Sano , Niño , Condones/estadística & datos numéricos , Ebolavirus , Fiebre Hemorrágica Ebola/prevención & control , Fiebre Hemorrágica Ebola/transmisión , Humanos , Liberia/epidemiología , Masculino , Persona de Mediana Edad , Conducta Sexual/estadística & datos numéricos , Encuestas y Cuestionarios , Sobrevivientes
20.
PLoS One ; 15(9): e0238645, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32898176

RESUMEN

INTRODUCTION: The participants' experience of low-energy total diet replacement (TDR) programmes delivered by lay counsellors in the community for the routine treatment of obesity is currently unclear. We interviewed a sample of twelve participants who took part in the Doctor Referral of Overweight People to Low-Energy total diet replacement Treatment (DROPLET) trial and were randomised to the TDR programme. METHODS: We purposively sampled twelve patients who took part in the DROPLET trial, and conducted in-depth telephone interviews, which were audio-recorded and transcribed verbatim. Interview questions focused on participants' experiences and perceptions of the TDR programme. We conducted a thematic analysis, actively developing themes from the data, and used the one sheet of paper (OSOP) technique to develop higher-level concepts. RESULTS: Nine key themes were identified; Reasons for taking part, Expectations, Support and guidance from the counsellor, Time to build a personal relationship, Following the TDR Programme, Adverse events, Outcomes from the TDR, Weight Loss Maintenance, Recommending TDR to others. The relationship between participants and the counsellor was central to many of the themes. Close relationships with counsellors facilitated TDR adherence through providing one-to-one support (including during difficult times), sharing expert knowledge, and building a close relationship. Adherence was also supported by the rapid weight loss that patients reported experiencing. Overall participants reported positive experiences of the TDR, and emphasised the positive impact on their wellbeing. DISCUSSION: Patients reported that a TDR programme delivered by lay counsellors in the community was a positive experience and effective in helping them to lose weight. Future trials should consider the central role of the person providing support and advice as a key component in the programme.


Asunto(s)
Restricción Calórica , Dieta , Investigación Cualitativa , Programas de Reducción de Peso , Adulto , Anciano , Restricción Calórica/efectos adversos , Consejo , Dieta/efectos adversos , Femenino , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Pérdida de Peso
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