Using Health Information Technology to Engage African American Women on Nutrition and Supplement Use During the Preconception Period.

Importance: Healthy nutrition and appropriate supplementation during preconception have important implications for the health of the mother and newborn. The best way to deliver preconception care to address health risks related to nutrition is unknown. Methods: We conducted a secondary analysis of data from a randomized controlled trial designed to study the impact of conversational agent technology in 13 domains of preconception care among 528 non-pregnant African American and Black women. This analysis is restricted to those 480 women who reported at least one of the ten risks related to nutrition and dietary supplement use. Interventions: An online conversational agent, called "Gabby", assesses health risks and delivers 12 months of tailored dialogue for over 100 preconception health risks, including ten nutrition and supplement risks, using behavioral change techniques like shared decision making and motivational interviewing. The control group received a letter listing their preconception risks and encouraging them to talk to a health care provider. Results: After 6 months, women using Gabby (a) reported progressing forward on the stage of change scale for, on average, 52.9% (SD, 35.1%) of nutrition and supplement risks compared to 42.9% (SD, 35.4) in the control group (IRR 1.22, 95% CI 1.03-1.45, P = 0.019); and (b) reported achieving the action and maintenance stage of change for, on average, 52.8% (SD 37.1) of the nutrition and supplement risks compared to 42.8% (SD, 37.9) in the control group (IRR 1.26, 96% CI 1.08-1.48, P = 0.004). For subjects beginning the study at the contemplation stage of change, intervention subjects reported progressing forward on the stage of change scale for 75.0% (SD, 36.3%) of their health risks compared to 52.1% (SD, 47.1%) in the control group (P = 0.006). Conclusion: The scalability of Gabby has the potential to improve women's nutritional health as an adjunct to clinical care or at the population health level. Further studies are needed to determine if improving nutrition and supplement risks can impact clinical outcomes including optimization of weight. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT01827215.

Dyadic, longitudinal associations among outcome expectation and alliance, and their indirect effects on patient outcome.

Research indicates that patient outcome expectation (OE) correlates with improvement, and that this association may be mediated by better patient-therapist alliances. However, despite OE and alliance being dyadic and dynamic constructs, most research on these direct and indirect associations has assessed these variables from only one dyad member's perspective and at single time points. Addressing these gaps, we used a longitudinal actor-partner interdependence model to first examine OE-alliance associations. Namely, we assessed "actor" effects (relation between each member's OE at 1 session and his or her own next session alliance) and "partner" effects (relation between each member's partner's OE at 1 session and his or her own next session alliance). Second, we tested whether significant actor or partner effects of OE on alliance translated into better patient outcomes (indirect effects). Analyses were conducted at within- and between-dyad levels. Data derived from a generalized anxiety disorder trial in which 85 patients received 15 sessions of either cognitive-behavioral therapy (CBT) or CBT integrated with motivational interviewing. After every session, patients and therapists rated OE and alliance, and patients rated their worry. At the within-dyad level, there were OE-alliance actor effects for both patients and therapists. There was also a within-dyad partner effect; when patients had greater OE at one session their therapists reported better next-session alliances. Finally, all within-dyad effects in turn related to lower subsequent worry. Results reveal ways in which session-by-session fluctuations in both patient and therapist OE translate into better outcomes through their influence on alliance quality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

¿Es efectiva la entrevista motivacional individual en la malnutrición por exceso? Una revisión sistemática de la literatura / Is the individual motivational interviewing effective in overweight and obesity treatment? A systematic review

Objetivo: Analizar la efectividad de la entrevista motivacional (EM) individual en el tratamiento ambulatorio de la malnutrición por exceso. Diseño: Revisión sistemática de literatura con protocolo registrado en PROSPERO con N.° CDR42017058814. Fuentes de datos: EBSCO-CINAHL, Pubmed, Scielo, PsycINFO de 2010 a 2017. Selección de estudios: Se incluyeron estudios con participantes adultos con sobrepeso u obesidad, pertenecientes a estudios aleatorizados controlados y caso-control con EM individual y presencial, con resultados primarios, secundarios o intermedios, incluyendo cambios de composición corporal (peso o IMC). Se incluyeron estudios en inglés o español, con texto disponible y publicados en revistas con revisión de pares. Extracción de datos: Las variables principales fueron antropométricas, conductuales, psicosociales u otras variables de efecto de la EM, además de aquellas variables descriptivas de la intervención. Resultados: Once artículos fueron incluidos en esta revisión. Existe una gran variabilidad entre los estudios respecto a población, tipo de intervención y tiempo de seguimiento. En la mayoría se expresó algún efecto en la reducción de peso corporal, con un máximo de 7 kg en el grupo que recibió la intervención. Se aprecian variaciones en variables mediadoras psicosociales y metabólicas en los estudios. Conclusiones: Las intervenciones individuales de EM tienen un efecto modesto sobre la variación del peso corporal, pero podrían tener buenos resultados en variables conductuales, psicosociales y otras. Más estudios son necesarios para dilucidar la mejor forma de aplicación de EM para tener efectividad en distintas variables. Es aquí donde la atención primaria de salud presenta ventajas para generar investigación en esta estrategia

Objective: To analyze the effectiveness of individual motivational interviewing (MI) in the ambulatory treatment of the overweight and obese. Design: The protocol of this systematic review is registered in PROSPERO N° CDR42017058814. Databases: EBSCO-CINAHL, Pubmed, Scielo, PsycoINFO from 2010 to 2017. Study selection: We included studies with overweight and obese adult participants, randomized trial and case control studies, with MI being applied individually and face to face, with primary or secondary results in changes in body composition (weight or BMI), published in English or Spanish, with available text and in peer-reviewed journals. Data extraction: We obtained anthropometric, behavioral, psychosocial, and other variables as effects of MI. In addition, we collected descriptive variables of the interventions. Results: Eleven articles were included in this revision. There is a great variability between the studies in terms of population, kind of intervention, and time of follow-up. In most of them, some effect was observed in reducing bodyweight, reaching a maximum of 7 kg in the group that received the MI. There are positive variations in psychosocial and metabolic variables in the studies. Conclusions: Individual MI interventions have a modest effect on the variation of bodyweight, and could have a positive impact on behavioral, psychosocial, and other variables. More studies are needed to elucidate the best form of MI application with regard to effectiveness on different variables. The primary healthcare system is in an advantageous position for generating fruitful research on this motivational strategy

Examining motivational interviewing's effect on confidence and commitment using daily data.

Mechanisms of behavior change (MOBC) within Motivational Interviewing (MI) are thought to operate via both relational and technical elements. These elements are hypothesized to increase client motivation and self-efficacy for change and subsequently decrease drinking. Only partial support for this causal chain exists, particularly when using within-session change talk as the primary intervening variable. This study explored whether commitment to moderate or abstain from drinking and confidence to moderate drinking in the next day measured via ecological momentary assessment (EMA) provided alternative support for the theory. Data were from a pilot randomized controlled trial testing active ingredients of MI. Problem drinkers (N = 89) seeking to moderate their drinking were randomly assigned to one of the three conditions: 1) MI; 2) Spirit only MI (SOMI), consisting of non-directive elements of MI, e.g., reflective listening; and 3) a non-therapy control. Participants completed daily EMA that measured confidence, both types of commitment, and drinks per day for a week prior to and during seven weeks of treatment. Hypotheses were not supported, and results were unexpected. Participants in SOMI were more likely to have higher daily confidence than those in MI; there were no condition differences for either type of commitment. All daily measures significantly predicted drinking; however, the MI group did not demonstrate a stronger relationship between the intervening variables and drinking, as hypothesized. Instead, participants in SOMI yielded the strongest relationship between daily commitment to abstain and drinking compared to the other two conditions. Multiple possible explanations for the unexpected findings are discussed.

Brief Motivational Interventions Are Associated with Reductions in Alcohol-Induced Blackouts Among Heavy Drinking College Students.

BACKGROUND: Alcohol-induced blackouts, a form of anterograde amnesia that restricts the encoding of short-term memories into long-term ones, are among the most severe alcohol-related consequences. College students are at high risk of experiencing alcohol-induced blackouts, and there is a need to determine whether alcohol interventions can effectively reduce blackouts in this population. The current study uses data from 3 randomized clinical trials to examine the effect of various intervention approaches on alcohol-induced blackouts. METHODS: Four interventions were compared over 3 studies: (i) a computerized feedback intervention (electronic Check-Up To Go [e-Chug]; Study 1); (ii) a single-session brief motivational intervention (BMI; Study 1); (iii) a BMI plus behavioral economic session focused on increasing substance-free activities (BMI + Substance-Free Activity Session [SFAS]; Studies 2 and 3); and (iv) a BMI plus supplemental Relaxation Training session (BMI + Relaxation Training; Studies 2 and 3). Studies 1 and 3 also included an assessment-only control condition. For each study, participants reported whether they had experienced an alcohol-induced blackout at each time point; binary logistic regressions examined differential likelihood of experiencing an alcohol-induced blackout over time. RESULTS: Neither the single-session BMI nor e-Chug reduced alcohol-induced blackouts over assessment only; however, participants in the BMI + SFAS or BMI + Relaxation Training condition were significantly less likely to experience an alcohol-induced blackout compared to assessment only at 1-month (Wald = 4.77, odds ratio [OR] = 0.53, p = 0.03) and 6-month follow-ups (Wald = 5.72, OR = 0.52, p = 0.02). Study 2 also revealed a larger effect for the BMI + SFAS over the BMI + Relaxation Training condition at 6 months (Wald = 4.11 OR = 0.22, p = 0.043), although this was not replicated in Study 3. The effects for the 2-session BMIs lasted 6 months, at which point maturation effects diminished differences between assessment-only and intervention conditions. CONCLUSIONS: Two sessions of BMI are a substantial enough dose to result in reductions in alcohol-induced blackouts among college student heavy drinkers.

Does Motivation Impact OCD Symptom Severity? An Exploration of Longitudinal Effects.

Understanding the role of patient motivation in OCD treatment is of clinical importance given the requisite autonomous role of patients in Exposure and Response Prevention. The present study investigated state- and trait-like relations between three variables: two previously established motivational constructs, readiness to change (RTC) and committed action (CA), derived from the University of Rhode Island Change Assessment, and OCD symptom severity as measured by the self-report Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR). Utilizing a random-intercept cross-lagged panel model (RI-CLPM) design, we assessed autoregressive, within-time correlations, and cross-lagged effects of RTC, CA, and Y-BOCS-SR scores at admission, month 1 of treatment, and discharge from an intensive/residential treatment program for OCD. Results revealed significant autoregressive (i.e., state-like) effects for CA and Y-BOCS-SR, negative within-time correlations between state CA and Y-BOCS-SR across all time points, a positive within-time correlation between state CA and RTC at admission, and a cross-lagged effect between state Y-BOCS-SR at month 1 of treatment and state RTC at discharge. Results also demonstrated that the stability of the RTC variable was attributable to trait-like factors in the present sample. This study is novel in its use of RI-CLPM in an OCD sample and represents an important addition to the literature on the longitudinal impacts of dynamic constructs of motivation. Our findings may provide future researchers with strategies to supplement ERP with CA-driven motivational interviewing.

Readiness to change and commitment as predictors of therapy compliance in adolescents with Delayed Sleep-Wake Phase Disorder.

OBJECTIVES: Recent evidence indicates that adolescents' motivation to change sleep-wake patterns is low, despite significant impact of adolescent sleep problems on many areas of daytime functioning. The aim of the present study is to evaluate components of adolescents' motivation, and subsequent changes in behaviour. METHODS: Fifty-six adolescents, aged 13-23 (M = 15.8 ± 2.3 y; 38% m) diagnosed with Delayed Sleep-Wake Phase Disorder (DSWPD) underwent three therapy sessions involving bright light therapy to phase advance sleep patterns. Adolescents were instructed to advance wake-up times by 30-min daily. Motivation ratings of desire, ability, reason, need and commitment to change sleep patterns were taken at baseline. Sleep diaries were taken at the end of treatment session 1, with sequentially earlier wake-up times in 30-min intervals indicating compliance. RESULTS: At the outset of therapy, adolescents indicated strong desire, reasons and need, yet moderate ability and commitment to advance their sleep-wake patterns. Following therapy, sleep-onset times were significantly advanced, total sleep time increased and sleep latency decreased (all p < 0.05). Therapy lasted 6-27 days (M = 13.9 ± 4.5) and clients complied for approximately half the time (between 3 and 15 days; M = 8.8 ± 2.7). Commitment was associated with ability (r = 0.66, p < 0.001) but not desire, reason or need (all p > 0.05). Adolescents' desire to change (r = 0.30, p = 0.03) and commitment (r = 0.30, p = 0.03) were positively correlated with behaviour change, but their need, ability and reasons were not. A mediation analysis showed that ability and desire were important in predicting behaviour change, by total effects through commitment (ie, indirectly and directly). CONCLUSION: Our findings suggest that the total effects of ability (ie, confidence) and desire to change are the best predictors of behavioural changes, thus clinicians should focus on these components of the readiness to change model when undertaking treatments with sleep-disordered adolescents.

Effect of a Structured Pharmaceutical Care Intervention Versus Usual Care on Cardiovascular Risk in HIV Patients on Antiretroviral Therapy: INFAMERICA Study.

BACKGROUND: HIV+ patients have increased their life expectancy with a parallel increase in age-associated comorbidities. OBJECTIVE: To determine the effectiveness of an intensive pharmaceutical care follow-up program in comparison to a traditional model among HIV-infected patients with moderate/high cardiovascular risk. METHOD: This was a multicenter, prospective, randomized study of a structured health intervention conducted between January-2014 and June-2015 with 12 months of follow-up at outpatient pharmacy services. The selected patients were randomized to a control group (usual care) or intervention group (intensive pharmaceutical care). The interventional program included follow-up of all medication taken by the patient to detect and work toward the achievement of pharmacotherapeutic objectives related to cardiovascular risk and making recommendations for improving diet, exercising, and smoking cessation. Individual motivational interview and periodic contact by text messages about health promotion were used. The primary end point was the percentage of patients who had reduced the cardiovascular risk index, according to the Framingham-score. RESULTS: A total of 53 patients were included. As regards the main variable, 20.7% of patients reduced their Framingham-score from high/very high to moderate/low cardiovascular risk versus 12.5% in the control group ( P=0.016). In the intervention group, the number of patients with controlled blood pressure increased by 32.1% ( P=0.012); 37.9% of patients overall stopped smoking ( P=0.001), and concomitant medication adherence increased by 39.4% at the 48-week follow-up ( P=0.002). Conclusion and Relevance: Tailored pharmaceutical care based on risk stratification, motivational interviewing, and new technologies might lead to improved health outcomes in HIV+ patients at greater cardiovascular risk.

Guiding patients through complexity: Motivational interviewing for patients with multimorbidity

BACKGROUND: Multimorbidity is an increasing and complex issue in Australian general practice. General practitioners (GPs) face the challenge of navigating multiple potential intervention pathways. Emerging guidelines for multimorbidity recommend patient-centred care and addressing the lifestyle factors of the patient. Motivational interviewing is a patient-centred approach that is focused on behavioural change and effective across a range of lifestyle factors. OBJECTIVE: The aim of this article is to provide a practical introduction to motivational interviewing skills that may be helpful in working with patients who have multimorbidity. Key skills discussed in this article include agenda setting, giving advice, responding to resistance, and asking questions to evoke a patient’s own motivation for change. DISCUSSION: GPs are ideally placed to assist patients with multimorbidity to navigate recommendations and identify which recommendations will work. Navigating complexity is at the heart of general practice, and multimorbidity demands more than an ‘assess-and-advise’ model of care. Motivational interviewing provides a promising and readily applicable framework to empower patients living with multimorbidity.

Motivational Advising Workshop: Utilizing Motivational Interviewing Theory to Facilitate and Engage Intrinsic Motivation to Change Learners' Behavior.

Introduction: Motivational interviewing (MI) is a counseling method that utilizes a patient's own motivation to effect personal change. MI has been applied routinely and successfully to managing medical conditions (e.g., substance abuse). Employing MI techniques to engage medical learners (termed motivational advising [MA]) may help them overcome professional and/or personal challenges limiting their career development. Methods: Medical educators from four academic medical centers developed a module focused on teaching fellow educators MI theory and techniques for MA using didactic and interactive components. Participants participated in facilitated role-plays to practice MA delivery techniques and observed videos of a traditional advisor-advisee interaction as well as an MA-focused engagement. A postworkshop survey was used to evaluate the workshop. Results: In a survey of 48 educators attending the workshop at two medical conferences, over 80% of respondents demonstrated an interest in learning more about MA. Additionally, over 60% indicated that they would seek opportunities to practice and/or implement MA with their advisees. Knowledge of the technical components of MA also increased significantly in pre- and posttest analysis. Discussion: This module introducing the concept of MA was well received by medical educators and was viewed as a valuable tool in advising medical learners. The provided components enable replication of this workshop in other settings with or without an expert in MI techniques. Although the workshop has been conducted with physicians involved in medical education, it would be applicable to other health professionals who advise trainees such as nursing, dentistry, pharmacy, or veterinary medicine.

Twelve-Month Outcomes of a Group-Randomized Community Health Advocate-Led Smoking Cessation Intervention in Public Housing.

Background: Lower rates of smoking cessation are a major reason for the higher prevalence of smoking among socioeconomically disadvantaged adults. Because barriers to quitting are both more numerous and severe, socioeconomically disadvantaged smokers may benefit from more intensive intervention. We sought to determine whether a smoking cessation intervention delivered by public housing residents trained as Tobacco Treatment Advocates (TTAs) could increase utilization of cessation resources and increase abstinence. Methods: We conducted a group-randomized trial among Boston public housing residents who were interested in quitting smoking. Participants at control sites received standard cessation materials and a one-time visit from a TTA who provided basic counseling and information about cessation resources. Participants at intervention sites were eligible for multiple visits by a TTA who employed motivational interviewing, cessation counseling, and navigation to encourage smokers to utilize cessation treatment (Smokers' Quitline and clinic-based programs). Utilization and 7-day and 30-day point prevalence abstinence were assessed at 12 months. Self-reported abstinence was biochemically verified. Results: Intervention participants (n = 121) were more likely than control participants (n = 129) to both utilize treatment programs (adjusted odds ratio [aOR]: 2.15; 95% confidence interval [CI]: 0.93-4.91) and 7-day and 30-day point prevalence abstinence (aOR: 2.60 (1.72-3.94); 2.98 (1.56-5.68), respectively). Mediation analysis indicated that the higher level of utilization did not explain the intervention effect. Conclusions: An intervention delivered by peer health advocates was able to increase utilization of treatment programs and smoking abstinence among public housing residents. Future studies of similar types of interventions should identify the key mechanisms responsible for success. Implications: In order to narrow the large and growing socioeconomic disparity in smoking rates, more effective cessation interventions are needed for low-income smokers. Individual culturally-relevant coaching provided in smokers' residences may help overcome the heightened barriers to cessation experienced by this group of smokers. In this study among smokers residing in public housing, an intervention delivered by peer health advocates trained in motivational interviewing, basic smoking cessation skills, and client navigation significantly increased abstinence at 12 months. Future research should address whether these findings are replicable in other settings both within and outside of public housing.

Aproximación al consumo de materiales de contenido sexual explícito en adolescentes y jóvenes / Approach to the consumption of materials with explicit sexual contents by adolescents and youths

Introducción: la sexualidad humana es considerada un fenómeno pluridimensional que comprende aspectos biológicos, psicosociales, conductuales, clínicos, morales y culturales, expresándose en todas las dimensiones existenciales. Objetivo: determinar las motivaciones acerca del consumo y reproducción de materiales de contenido sexual explícito. Métodos: estudio descriptivo, transversal, en el Instituto Politécnico 5 de Septiembre en Cienfuegos, del 1ro de septiembre de 2014 al 31 de mayo de 2015. El universo fueron 109 estudiantes de 2do año de carreras técnicas de oficio, la muestra, 29 seleccionados de forma no probabilística. Fueron revisados el diagnóstico y caracterización psicopedagógica grupal e individual para obtener datos que fueron tabulados mediante el coeficiente de concordancia de Kendall. Resultados: existe poco conocimiento sobre sexualidad en los adolescentes estudiados, así como poca percepción de riesgo por las familias y las instituciones con respecto al consumo y reproducción de materiales de contenido sexual explícito por los adolescentes y jóvenes. Conclusiones: los adolescentes encuentran motivaciones intrínsecas para el consumo de materiales de contenido sexual explícito, a partir de necesidades centradas en la satisfacción sexual, intereses pobres que orientan a la búsqueda de información, con sentidos personales, ideales concretos, hábitos y prácticas habituales de genitalidad y actitudes marcadas por los estereotipo de género. Las motivaciones extrínsecas son evidenciadas en los mecanismos de presión social, de imitación o contagio y de aprendizaje social, reforzado por la insuficiente educación de la sexualidad y el fácil acceso a las nuevas tecnologías de información y comunicación, que condicionan actitudes y conductas que propician el consumo de materiales pornográficos, o incluso su reproducción(AU)

Introduction: Human sexuality is considered a pluridimensional phenomenon enclosing biological, psychosocial, behavioral, clinical, moral, and cultural aspects, expressed through all existentional dimensions. Objective: Determine the motivations for the consumption and reproduction of materials with explicit sexual contents. Methods: Descriptive, cross-sectional study at 5 de Septiembre Polytechnic Institute of Cienfuegos, from September 1 2014 to May 31 2015. The target group was made up by 109 students of second year from technical trade majors. The sample was 29 chosen by a nonprobabilistic way. We reviewed both the group and individual diagnosis and psychopedagogical characterization to obtain data that were tabulated using Kendall's coefficient of concordance. Results: There is scarce knowledge about sexuality in the adolescents studied, as well as a low perception regarding the consumption and reproduction of materials with explicit sexual contents by the adolescents and youths. Conclusions: The adolescent find intrinsic motivations for the consumption of materials with explicit sexual contents, starting in need centered around sexual satisfaction, poor interests that orientate towards the search for information, with personal senses, concrete ideals, habitual practices of genitality and attitudes marked by the gender stereotypes. The intrinsic motivations evidence the social pressure mechanisms, others of imitations or contagion and of social learning, reinforced by the scarce sexuality education and the easy access to the new information and communication technologies, which condition attitudes and behaviors the foster the consumption of pornographic materials, and event their reproduction(AU)

Aproximación al consumo de materiales de contenido sexual explícito en adolescentes y jóvenes / Approach to the consumption of materials with explicit sexual contents by adolescents and youths

Introducción: la sexualidad humana es considerada un fenómeno pluridimensional que comprende aspectos biológicos, psicosociales, conductuales, clínicos, morales y culturales, expresándose en todas las dimensiones existenciales. Objetivo: determinar las motivaciones acerca del consumo y reproducción de materiales de contenido sexual explícito. Métodos: estudio descriptivo, transversal, en el Instituto Politécnico 5 de Septiembre en Cienfuegos, del 1ro de septiembre de 2014 al 31 de mayo de 2015. El universo fueron 109 estudiantes de 2do año de carreras técnicas de oficio, la muestra, 29 seleccionados de forma no probabilística. Fueron revisados el diagnóstico y caracterización psicopedagógica grupal e individual para obtener datos que fueron tabulados mediante el coeficiente de concordancia de Kendall. Resultados: existe poco conocimiento sobre sexualidad en los adolescentes estudiados, así como poca percepción de riesgo por las familias y las instituciones con respecto al consumo y reproducción de materiales de contenido sexual explícito por los adolescentes y jóvenes. Conclusiones: los adolescentes encuentran motivaciones intrínsecas para el consumo de materiales de contenido sexual explícito, a partir de necesidades centradas en la satisfacción sexual, intereses pobres que orientan a la búsqueda de información, con sentidos personales, ideales concretos, hábitos y prácticas habituales de genitalidad y actitudes marcadas por los estereotipo de género. Las motivaciones extrínsecas son evidenciadas en los mecanismos de presión social, de imitación o contagio y de aprendizaje social, reforzado por la insuficiente educación de la sexualidad y el fácil acceso a las nuevas tecnologías de información y comunicación, que condicionan actitudes y conductas que propician el consumo de materiales pornográficos, o incluso su reproducción(AU)

Introduction: Human sexuality is considered a pluridimensional phenomenon enclosing biological, psychosocial, behavioral, clinical, moral, and cultural aspects, expressed through all existentional dimensions. Objective: Determine the motivations for the consumption and reproduction of materials with explicit sexual contents. Methods: Descriptive, cross-sectional study at 5 de Septiembre Polytechnic Institute of Cienfuegos, from September 1 2014 to May 31 2015. The target group was made up by 109 students of second year from technical trade majors. The sample was 29 chosen by a nonprobabilistic way. We reviewed both the group and individual diagnosis and psychopedagogical characterization to obtain data that were tabulated using Kendall's coefficient of concordance. Results: There is scarce knowledge about sexuality in the adolescents studied, as well as a low perception regarding the consumption and reproduction of materials with explicit sexual contents by the adolescents and youths. Conclusions: The adolescent find intrinsic motivations for the consumption of materials with explicit sexual contents, starting in need centered around sexual satisfaction, poor interests that orientate towards the search for information, with personal senses, concrete ideals, habitual practices of genitality and attitudes marked by the gender stereotypes. The intrinsic motivations evidence the social pressure mechanisms, others of imitations or contagion and of social learning, reinforced by the scarce sexuality education and the easy access to the new information and communication technologies, which condition attitudes and behaviors the foster the consumption of pornographic materials, and event their reproduction(AU)

La entrevista motivacional en dermatología / Motivational interviewing in dermatology

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Advances in Motivational Interviewing for Pediatric Obesity: Results of the Brief Motivational Interviewing to Reduce Body Mass Index Trial and Future Directions.

Rates of childhood obesity in the United States remain at historic highs. The pediatric primary care office represents an important yet underused setting to intervene with families. One factor contributing to underuse of the primary care setting is lack of effective available interventions. One evidence-based method to help engage and motivate patients is motivational interviewing, a client-centered and goal-oriented style of counseling used extensively to increase autonomous motivation and modify health behaviors. This article summarizes the methods and results from a large trial implemented in primary care pediatric office and concludes with recommendations for improving the intervention and increasing its dissemination.

Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis.

BACKGROUND: Randomized clinical trials (RCTs), mostly conducted among minority populations, have reported that motivational interviewing (MI) can improve medication adherence. OBJECTIVES: To evaluate the impact of MI and of the MI delivery format, fidelity assessment, fidelity-based feedback, counselors' background and MI exposure time on adherence. DATA SOURCES: We searched the MEDLINE database for studies published from 1966 until February 2015. STUDY ELIGIBILITY CRITERIA: We included RCTs that compared MI to a control group and reported a numerical measure of medication adherence. DATA SYNTHESIS: The main outcome was medication adherence defined as any subjective or objective measure reported as the proportion of subjects with adequate adherence or mean adherence and standard deviation. For categorical variables we calculated the relative risk (RR) of medication adherence, and for continuous variables we calculated the standardized mean difference (SMD) between the MI and control groups. RESULTS: We included 17 RCTs. Ten targeted adherence to HAART. For studies reporting a categorical measure (n = 11), the pooled RR for medication adherence was higher for MI compared with control (1.17; 95 % CI 1.05- 1.31; p < 0.01). For studies reporting a continuous measure (n = 11), the pooled SMD for medication adherence was positive (0.70; 95 % CI 0.15-1.25; p < 0.01) for MI compared with control. The characteristics that were significantly (p < 0.05) associated with medication adherence were telephonic MI and fidelity-based feedback among studies reporting categorical measures, group MI and fidelity assessment among studies reporting continuous measures and delivery by nurses or research assistants. Effect sizes differed in magnitude, creating high heterogeneity. CONCLUSION: MI improves medication adherence at different exposure times and counselors' educational level. However, the evaluation of MI characteristics associated with success had inconsistent results. Larger studies targeting diverse populations with a variety of chronic conditions are needed to clarify the effect of different MI delivery modes, fidelity assessment and provision of fidelity based-feedback.

Selecting an optimal instrument to identify active ingredients of the motivational interviewing-process.

OBJECTIVE: Motivational Interviewing (MI) can effectively stimulate motivation for health behavior change, but the active ingredients of MI are not well known. To help clinicians further stimulate motivation, they need to know the active ingredients of MI. A psychometrically sound instrument is required to identify those ingredients. The purpose of this study is to describe and evaluate the capability of existing instruments to reliably measure one or more potential active ingredients in the MI process between clients and MI-therapists. METHODS: We systematically searched MedLine, Embase, Cinahl, PsycInfo, Cochrane Central, specialised websites and reference lists of selected articles. RESULTS: We found 406 papers, 60 papers were retrieved for further evaluation, based on prespecified criteria. Seventeen instruments that were specifically designed to measure MI or aspects of MI were identified. Fifteen papers met all inclusion criteria, and reported on seven instruments that assess potential active ingredients of the interactive MI process. The capability of these instruments to measure potential active ingredients in detail and as a part of the interactive MI process varies considerably. Three of these instruments measure one or more potential active ingredients in a reliable and valid way. CONCLUSION: To identify the potential active ingredients in the interactive MI process, a combination of the SCOPE (which measures potential technical active ingredients) and the GROMIT or the global ratings of the MISC2 (to measure potential relational ingredients) seems favourable.

Psychosocial approaches to alcohol use disorders since 1940: a review.

OBJECTIVE: A review of psychosocial approaches to alcohol use disorders (AUDs) was performed to identify and contextualize trends in major treatment approaches and special populations and provide possible future directions for alcohol research. METHOD: The PsycINFO database was searched for peer-reviewed articles relevant to psychosocial approaches to AUDs for each decade since the 1940s, resulting in approximately 4,246 articles for review. Topics were included if they made up at least 4% of the relevant articles for any one decade. Nine treatment and seven special population topics were identified for the current review. RESULTS: Psychoanalytic/psychodynamic and aversion therapies were major topics in the 1940s and 1950s, but few articles have been published recently. Other topics have shown consistent representation in the literature, including criminal justice and military populations, self-help groups, group therapies, couples and family therapies, behavioral treatments and cognitive-behavioral therapy, and complementary/ alternative treatments. The majority of the specific population topics and two newer treatment approaches have appeared more recently in significant proportions, including adolescents, college students, women, ethnic minorities, and dually diagnosed populations; newer treatments include brief interventions and motivational interviewing approaches. CONCLUSIONS: The number of articles on psychosocial approaches to AUDs has been increasing since the 1940s. There have been recent surges in alcohol research on specific populations, an increase in the integration of alcohol treatment with primary care, and a continued emphasis on empirically supported and cost-effective treatments for AUDs; these trends likely will continue into the future.

Motivational interviewing: a novel intervention for translating rehabilitation research into practice.

PURPOSE: Despite recent advances in rehabilitation research, moving evidence into clinical practice remains a challenge. This article explores a novel approach to knowledge translation (KT) - motivational interviewing (MI). MI is a style of communication that is typically used to facilitate health related behavior change in patients. Here we explore its potential use as a KT intervention aimed at clinicians. METHODS: Commentary. Relevant literature on MI and KT is summarized and discussed by considering how MI could be used in a KT strategy aimed at rehabilitation clinicians. RESULTS: Clinician motivation and readiness to change are key issues influencing implementation of evidence-based practice. We provide an argument suggesting that clinicians' readiness to change clinical practices can potentially be enhanced through MI. The MI conceptual framework, principles, and strategies, typically used in patients, are discussed here in a novel context - enhancing clinician change in practice. CONCLUSIONS: MI is an effective intervention when the goal is to motivate individuals to change a current behavior. We suggest that MI is an evidence-based intervention that has been proven to be effective with patients and warrants study as a promising KT intervention. IMPLICATIONS FOR REHABILITATION: • Despite recent advances in rehabilitation research, moving evidence into practice remains a challenge. • Clinician motivation is one key issue influencing the implementation of evidence-based practice. • Clinician motivation to implement evidence-based practice can potentially be enhanced through an approach called motivational interviewing (MI). • Motivational interviewing is an evidence-based intervention that has proven to be effective in promoting behavioral change in patients, and warrants study in terms of its potential as a KT intervention.