Advice Intervention Research Articles

Effect of a Ketogenic Diet on Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Progression: A Randomized Controlled Trial.

Despite the popularity of a ketogenic diet, no randomized, controlled trials have evaluated its efficacy on metabolic dysfunction-associated steatotic liver disease (MASLD) progression. We conducted an 8-week, open-label, randomized controlled trial involving 24 patients with MASLD who were randomly assigned to either the home delivery ketogenic diet or a nutrition education program on adherence to the DASH diet. The primary outcome was a reduction in hepatic steatosis as measured by transient elastography. There were no significant differences between groups in liver stiffness and steatosis measurement after interventions. Subjects on a ketogenic diet had lost more weight than subjects in the control group at 8 weeks (mean change [95% CI], -6.16 [-7.22, -5.10] vs. -2.14 [-4.49, 0.21] kg; p = 0.001). The decrease in waist circumference, systolic blood pressure, fat mass, and visceral fat area was significantly greater among subjects on a ketogenic diet than among those in the control group. Laboratory parameters, including AST, triglyceride, and HDL were also significantly decreased among subjects on a ketogenic diet than among those in the control group. A ketogenic diet produced a significantly greater weight loss (absolute difference, approximately 4%) than did the general lifestyle advice intervention for the first 8 weeks. A ketogenic diet was associated with a greater improvement in some risk factors for coronary heart disease and MASLD. However, a ketogenic diet did not reduce steatosis nor worsen MASLD progression. Longer and larger studies are required to determine the long-term safety and efficacy of the ketogenic diet. Trial Registration: TCTR20220426005.

Current Situation and Countermeasures of Adolescent Mental Health in the Context of Social Media

In contemporary society, social media serves as both a means for students to connect and a source of entertainment and relaxation. Nevertheless, despite its many advantages, it can also lead to adverse psychological effects. The digital environment and the vast array of information available online significantly influence students' mental well-being. This article seeks to raise awareness about the negative consequences that social media has on students, the potential psychological issues they may encounter, and various recommendations from multiple perspectives. This includes strategies for students facing mental health challenges to find healing and resolution, as well as how educational institutions can support student mental wellness in relation to social media usage. In conclusion, the psychological ramifications of social media on students are significant; it is not only addictive but can also trigger various mental health concerns. Schools should organize more activities aimed at reducing addiction to virtual platforms. Additionally, teachers and parents need to be vigilant regarding students' mental health and offer timely advice and appropriate interventions when issues arise.

Minimum intervention oral care: staging and grading dental carious lesions in clinical practice

Developmental staging of carious lesions is pivotal for appropriate ethical clinical decision-making in contemporary caries management. Accurate assessment of lesion extent/severity (staging) and activity (grading) allows practitioners to provide the most appropriate preventive advice and suitable interventions, enabling the implementation of evidence-based, person-focused, prevention-based, team-delivered and susceptibility-related phased minimum intervention oral care. Minimally invasive dentistry remains an important operative interventive option for cavitated lesions, but intervening at the right stage ensures patients are not started on an irreversible, destructive restorative cycle unnecessarily. This article provides an update on recommended practical methods for staging the extent/severity and grading the activity of dental carious lesions, especially for those clinical teams delivering primary care and needing to navigate remuneration systems.

AI in relationship counselling: Evaluating ChatGPT's therapeutic capabilities in providing relationship advice

Recent advancements in AI have led to chatbots, such as ChatGPT, capable of providing therapeutic responses. Early research evaluating chatbots' ability to provide relationship advice and single-session relationship interventions has showed that both laypeople and relationship therapists rate them high on attributed such as empathy and helpfulness. In the present study, 20 participants engaged in single-session relationship intervention with ChatGPT and were interviewed about their experiences. We evaluated the performance of ChatGPT comprising of technical outcomes such as error rate and linguistic accuracy and therapeutic quality such as empathy and therapeutic questioning. The interviews were analysed using reflexive thematic analysis which generated four themes: light at the end of the tunnel; clearing the fog; clinical skills; and therapeutic setting. The analyses of technical and feasibility outcomes, as coded by researchers and perceived by users, show ChatGPT provides realistic single-session intervention with it consistently rated highly on attributes such as therapeutic skills, human-likeness, exploration, and useability, and providing clarity and next steps for users’ relationship problem. Limitations include a poor assessment of risk and reaching collaborative solutions with the participant. This study extends on AI acceptance theories and highlights the potential capabilities of ChatGPT in providing relationship advice and support.

Online exercise added to ergonomic advice for reducing habitual upper body postures: A randomized trial

BackgroundOnline learning during the COVID-19 pandemic is associated with unfavorable habitual upper body postures. ObjectiveThis study explored whether adding a remedial exercise routine to an ergonomic advice intervention, delivered remotely, is helpful for reducing habitual postures of the neck, shoulders, and upper back. DesignPragmatic randomized controlled trial. Methods42 male adolescent students, initially selected with a forward head posture, were randomized to one of two intervention groups: ergonomic advice alone or exercise + ergonomic advice. Outcome measures were specific postural angles of, measured by a photogrammetric profile technique using a bespoke app before and after the 8-week intervention period. ResultsDuring online learning, most students used mobile phones (76%), while 35% used a table-chair-computer arrangement. At 8-week follow-up, a statistically significant reduction of forward head, shoulder protraction, and thoracic kyphosis angles was found in both groups (P < 0.001). However, the effect was significantly greater in the exercise + ergonomic advice group (P < 0.001): forward head, shoulder protraction, and thoracic kyphosis angles reduced by some 9, 6, and 5° respectively, compared with 4° for head and 2° for shoulder and thoracic angles for the ergonomic advice alone group. ConclusionThe results show that, a remedial online exercise routine is a beneficial addition to an ergonomic advice program for improving unfavorable habitual upper body postures. The impact of this intervention may extend beyond postural issues related just to online learning at home.

The positive impact of legal advice and services on the mental wellbeing of UK veterans

ABSTRACT Law has been recognised as a significant social determinant of health, however, micro-level legal advice interventions are underexplored. The dearth of research concerning the experience of British veterans highlights the need for uniquely tailored support services. This need is emphasised by the pervasiveness of mental health issues amongst this population. We investigate the feasibility of remotely delivered legal advice as a social intervention for supporting the mental wellbeing of UK veterans. This is based on the Warwick-Edinburgh Mental Wellbeing Scale results from 67 participants, who completed a pre and post legal intervention survey. Average WEMWBS results were higher post-intervention, particularly in participants with pre-identified mental health issues. The difference in overall scores pre and post intervention is statistically significant (p = 0.034). A correlation matrix identifies two variables, with one contributing to 59% variance (LV2). These are identified as “Affective” (LV2), and “Cognitive” (LV1). The difference between LV2 results pre and post intervention was significant (p = 0.016). Findings highlight the importance of individualised interventions for veterans. Free, remotely delivered, tailored legal advice and support shows feasibility as a social intervention due to its ability to encourage emotional disclosure, something which the veteran population can struggle with.

Treatment Effect Modifiers for Return-to-Work in Patients With Musculoskeletal Disorders

Investigating how individual characteristics modify treatment effects can improve understanding, interpretation, and translation of trial findings. The purpose of this secondary analysis was to identify treatment effect modifiers of the MI-NAV trial, a 3 arm, parallel randomized controlled trial which compared motivational interviewing and stratified vocational advice intervention in addition to usual case management (UC), to UC alone. This study included (n = 514) participants with musculoskeletal disorders on sick leave for at least 50% of their contracted work hours for at least 7 consecutive weeks with the Norwegian Labour and Welfare Administration. Sickness absence days was the primary outcome, measured from baseline assessment date until the 6-month follow-up. Potential treatment effect modifiers, identified a priori and informed by expert consultation and literature, were evaluated using linear regression models and statistical interaction tests. For motivational interviewing versus UC, age (mean difference [MD] −.7, 95% confidence interval [CI] −1.5 to .2; P = .13) and self-perceived health status (MD −.3, 95% CI −.7 to .1; P = .19) were identified as potential effect modifiers (P ≤ .2). For stratified vocational advice intervention versus UC, analgesic medication use (MD −26.2, 95% CI −45.7 to −6.7; P = .009) was identified as a treatment effect modifier (P ≤ .05). These findings may assist in more targeted treatment adaptation and translation as well as the planning of future clinical trials. PerspectiveThis secondary analysis of the MI-NAV trial found that analgesic medication use, age, and self-perceived health may modify the effect of 2 vocational interventions on reducing sickness absence in people with musculoskeletal disorders.

Methodological rigor and quality of reporting of clinical trials published with physical activity interventions: A report from the Strengthening the Evidence in Exercise Sciences Initiative (SEES Initiative).

This study addresses the need for improved transparency and reproducibility in randomized clinical trials (RCTs) within the field of physical activity (PA) interventions. Despite efforts to promote these practices, there is limited evidence on the adherence to established reporting and methodological standards in published RCTs. The research, part of the Strengthening the Evidence in Exercise Sciences Initiative (SEES Initiative) in 2020, assessed the methodological standards and reporting quality of RCTs focusing on PA interventions. RCTs of PA advice or exercise interventions published in 2020 were selected. Monthly searches were conducted on PubMed/MEDLINE targeting six top-tier exercise science journals. Assessments were conducted by two independent authors, based on 44 items originally from CONSORT and TIDieR reporting guidelines. These items were divided into seven domains: transparency, completeness, participants, intervention, rigor methodology, outcomes and critical analysis. Descriptive analysis was performed using absolute and relative frequencies, and exploratory analysis was done by comparing proportions using the χ2 test (α = 0.05). Out of 1,766 RCTs evaluated for eligibility, 53 were included. The median adherence to recommended items across the studies was 30 (18-44) items in individual assessments. Notably, items demonstrating full adherence were related to intervention description, justification, outcome measurement, effect sizes, and statistical analysis. Conversely, the least reported item pertained to mentioning unplanned modifications during trials, appearing in only 11.3% of studies. Among the 53 RCTs, 67.9% reported having a registration, and these registered studies showed higher adherence to assessed items compared to non-registered ones. In summary, while critical analysis aspects were more comprehensively described, aspects associated with transparency, such as protocol registrations/modifications and intervention descriptions, were reported suboptimally. The findings underscore the importance of promoting resources related to reporting quality and transparent research practices for investigators and editors in the exercise sciences discipline.

Weight maintenance after time-restricted eating vs. standard dietary advice interventions – A one-year follow-up

Weight maintenance after time-restricted eating vs. standard dietary advice interventions – A one-year follow-up

Six-month cost-effectiveness of adding motivational interviewing or a stratified vocational advice intervention to usual case management for workers with musculoskeletal disorders: the MI-NAV economic evaluation

ObjectivesThis study evaluates the six-month cost-effectiveness and cost-benefits of motivational interviewing (MI) or a stratified vocational advice intervention (SVAI) added to usual case management (UC) for workers on sick leave due to musculoskeletal disorders.MethodsThis study was conducted alongside a three-arm RCT including 514 employed workers on sick leave for at least 50% for ≥ 7 weeks. All participants received UC. The UC + MI group received two MI sessions, and the UC + SVAI group received 1–4 SVAI sessions. Sickness absence days, quality-adjusted life-years (QALYs), and societal costs were measured between baseline and six months.ResultsAdding MI to UC, resulted in incremental cost-reduction of -2580EUR (95%CI -5687;612), and a reduction in QALYs of -0.001 (95%CI -0.02;0.01). Secondly, adding MI to UC resulted in an incremental cost-reduction of -538EUR (95%CI -1358;352), and reduction of 5.08 (95%CI -3.3;13.5) sickness-absence days. Financial return estimates were positive, but not statistically significant. Adding SVAI to UC, resulted in an incremental cost-reduction of -2899 EUR (95% CI -5840;18), and a reduction in QALYs of 0.002 (95% CI -0.02;0.01). Secondly, adding SVAI to UC resulted in an statistically significant incremental cost-reduction of -695 EUR (95% CI -1459;-3), and a reduction of 7.9 (95% CI -0.04;15.9) sickness absence days. Financial return estimates were positive and statistically significant. The probabilities of cost-effectiveness for QALYs were high for adding MI or SVAI (ceiling ratio 0.90).ConclusionsIn comparison to UC only, adding MI to UC tends to be cost-effective. Adding SVAI to UC is cost-effective for workers on sick leave due to musculoskeletal disorders.Trial registrationClinicalTrials.gov (identifier: NCT03871712).

What are the current research results based on EBM recommendations and what they do not recommend in the treatment of chronic tinnitus?

Introduction: Chronic tinnitus is one of the most common symptoms accompanying hearing disorders. Epidemiological studies have shown that approximately 3% of the population of with symptoms require treatment. There is no available therapy to treat the cause. Current therapeutic strategies require rigorous scientific evaluation.Objective: The aim of the review is to present contemporary recommendations for treating chronic tinnitus based on the principles of EBM.Methods: The basis for those study is the current diagnostic and therapeutic guidelines of European, American and Japanese scientific societies and a literature review of the PubMed and Cochrane Library databases.Results: Tinnitus usually accompanies hearing loss, but the critical element is the distress resulting from chronic exposure to tinnitus. This results in constant level of psychosomatic overload of the body. In addition to counseling, the recommended course of action is psychotherapeutic intervention, particularly cognitive-behavioral therapy and hearing improvement methods.Conclusions: Based on contemporary research positively assessed according to EBM criteria and current global diagnostic and therapeutic guidelines, it should be concluded that a significant reduction in the annoyance of tinnitus and an improvement in the quality of life of patients is provided by cognitive-behavioral therapy preceded by properly conducted therapeutic advice (counseling) and appropriate hearing intervention.

Understanding the Impact of Team Cognitive Load and Advice Compliance in Urban Search and Rescue Task

This research concentrates on the impact of Artificial Social Intelligence (ASI)'s advice intervention text messages and the compliance of three human team members, who communicate via voice to carry out victim rescue operations, on the team's performance. This experiment takes place in a simulated Urban Search and Rescue (USAR) task environment built using Minecraft. The ASI agent, utilizing its analytical components designed around interactive real-time measurements, oversees the team's behavior in the USAR task environment. The agent discerns and forecasts the human team members' actions, offering interventions via text messages to foster and sustain team efficacy. The study examines (1) the influence of the team's cognitive load on message compliance from the advisor, and (2) how these elements collectively affect team performance. The results show a positive association between cognitive load, compliance, and enhanced task performance, despite the lack of a significant correlation between cognitive load and compliance.

Investment and Retirement Planning – A Conceptual Analysis

Purpose: The aim of this study is to examine the intricate interplay between investment strategies and retirement planning through a comprehensive conceptual analysis. This study aims to provide a holistic conceptual analysis that guides sound financial decision-making for a secure and fulfilling retirement by thoroughly examining the complex relationship between investment strategies and retirement planning and drawing conclusions from empirical investment and retirement theories.&#x0D; &#x0D; Theoretical framework: The research draws upon a multidisciplinary approach, integrating theories from finance, economics, and psychology to develop conceptual understanding that illuminates the complex dynamics influencing individuals' investment decisions within the context of retirement planning.&#x0D; &#x0D; Approach: Employing a qualitative research design, this study utilizes an extensive literature review and content analysis of scholarly articles, reports, and expert opinions to develop a nuanced understanding of the factors shaping investment behaviors and retirement preparedness.&#x0D; &#x0D; Findings: The results of this analysis highlight the critical role of risk tolerance, financial literacy, psychological biases, and socio-economic factors in shaping individuals' investment choices and retirement planning strategies. Moreover, the study underscores the significance of early and strategic investment decisions in ensuring a financially secure retirement.&#x0D; &#x0D; Research, practical &amp; social implications: Research, Practical &amp; Social implications: The study's insights offer a valuable resource for financial advisors, policymakers, and individuals seeking to optimize their investment and retirement strategies. By elucidating the underlying mechanisms driving investment behavior, the research informs the development of tailored advice, educational initiatives, and policy interventions that enhance retirement preparedness and overall financial well-being.&#x0D; &#x0D; Originality/Value: Furthermore, the study contributes to a broader societal understanding of the implications of investment choices on individuals' long-term financial security, thus fostering a more financially resilient aging population. Originality/value: The value of the study lies in its holistic approach to dissecting the intricacies of investment decisions within the realm of retirement planning. By synthesizing diverse theoretical perspectives, this research offers a comprehensive framework for comprehending the multifaceted factors that influence investment behaviors and retirement outcomes. The study's unique contribution lies in its ability to bridge the gap between academic research and practical application, providing actionable insights that have the potential to drive positive financial behaviors and reshape retirement planning paradigms.

Effect of low-glycemic index diet advice on pregnant outcomes in women with elevated risk of gestational diabetes mellitus: A meta-analysis of randomized controlled trails

The beneficial effect of low-glycemic index (GI) diet on gestational diabetes mellitus (GDM) has been suggested in many observational studies; however, results from intervention trials remain inconsistent. This study aims to estimate the effect of interventions with low-GI dietary advice on pregnant outcomes in women with elevated risk of GDM. PubMed, Web of Science, Embase, and Cochrane Library databases were searched for randomized clinical trials (RCTs) through March 2022. Studies reporting the effect of low-GI diet advice intervention on maternal and fetal outcomes in pregnant women with increased risks of GDM were included. Random or fixed effects model was used to calculate combined treatment effects. Publication bias was assessed via Begg's and Egger's tests and funnel plot inspection. Nine RCTs recruiting 3416 participants were included. Low-GI diet advice did not modulate the risk of GDM. Compared with control diets, low-GI diet advice significantly reduced gestational weight gain (GWG) (weighted mean differences, WMD=-0.93kg, 95% CI:-1.31,-0.55; p<0.001; n=7) and the risk of premature birth (RR=0.55, 95% CI: 0.35, 0.88; p=0.012; n=5). In subgroup analyses, the effect of low-GI diet interventions on premature birth was significant only in women with BMI higher than 30kg/m2 (RR=0.28, 95% CI: 0.10, 0.77, p=0.014; n=3); the significant effect on GWG was not altered by stratification of BMI and the type of GDM risk factors. No significant changes in other maternal and newborn outcomes were found. Low-GI diet advice interventions during pregnancy decreased GWG and the risk of premature birth in women with elevated GDM risk; however, the interventions did not significantly prevent GDM development in these women.

Standardized Stretching Postural postures to treat low-back pain in pregnancy: the GEMALODO randomized clinical trial

Two-thirds of pregnant women suffer from low-back pain during pregnancy, which leads to negative effects on quality of everyday life. According to the literature, an 8- to 12-week program of adapted physical activity during pregnancy has proven its efficacy in treatment of low-back pain and functional disability. Stretching Postural is a nondynamic technique using muscular contractions and stretches that act mainly on the back and that can be practiced alone. This study aimed to assess the effect of an 8-week program of standardized Stretching Postural postures in low-risk pregnant women suffering from low-back pain. This was an open-label, randomized, controlled trial in 1 French university hospital. Women with a singleton low-risk pregnancy between 15 and 32 weeks of gestation and with back, lumbar, or sacroiliac pain were randomly assigned (1:1) to either undergo an 8-week program of standardized Stretching Postural with basic advice (intervention group) or to receive basic advice only (control group). Both groups received ergonomic advice and encouragement to practice physical activity. The primary endpoint was the pain assessment at 8 weeks (defined by the mean pain level estimated by women in the previous week, scored on a numeric scale from 0 to 10). Secondary endpoints were pain after 4 weeks of follow-up, quality of life (12-item Short Form Survey), satisfaction (Patient Global Impression of Change), and delivery outcomes. The main analysis was intention-to-treat. From January 2019 to August 2020, 60 women were randomized: 30 were assigned to the intervention group and 30 to the control group. The mean level of pain at 8 weeks was significantly lower in the intervention group than in the control group (1.6±1.4 vs 4.1±2.2; P<.01). The mean 12-item Short Form Survey scores were significantly higher in the posture group than in the control group (Physical Component Score, 45.7±7.8 vs 37.4±8.5; P<.01; Mental Component Score, 54.3±5.8 vs 50.4±7.1; P=.04), and the Patient Global Impression of Change score was also significantly higher (6.1±1.5 vs 3.9±2.3; P<.01). No adverse effects were found. Stretching Postural appears to be a safe and efficient nondrug therapy to treat low-back pain during low-risk pregnancy.

Escherichia coli encoding Shiga toxin subtype Stx2f causing human infections in England, 2015-2022.

Introduction. Shiga toxin-producing Escherichia coli (STEC) belong to a diverse group of gastrointestinal pathogens defined by the presence of Shiga toxin genes (stx) of which there are at least ten subtypes (Stx1a-Stx1d and Stx2a-Stx2g).Gap Statement. Initially thought to be associated with mild symptoms, more recently STEC encoding stx2f have been isolated from cases of haemolytic uraemic syndrome (HUS) and the clinical significance and public health burden require further investigation.Aim. We analysed clinical outcomes and genome-sequencing data linked to patients infected with STEC encoding-stx2f in England to assess the risk to public health.Methodology. One hundred and twelve E. coli (n=58 isolates encoded stx2f; n=54 isolates E. coli belonging to CC122 or CC722 that had eae but were negative for stx) isolated from patients' faecal specimens between 2015 and 2022 were genome sequenced and linked to epidemiological and clinical outcome data. All isolates were investigated for the presence of virulence genes and a maximum-likelihood phylogeny of isolates belonging to CC122 and CC722 was constructed.Results. There were 52 cases infected with STEC harbouring stx2f between 2015 and 2022, with the majority identified in 2022. Most cases resided in the North of England (n=39/52, 75 %), were female (n=31, 59.6 %) and/or aged five and under (n=29, 55.8 %). Clinical outcome data were available for 40/52 cases (76.9 %) and 7/40(17.5 %) were diagnosed with STEC-HUS. In the two most common clonal complexes, CC122 and CC722, the presence of the stx2f-encoding prophage correlated with the presence of additional virulence genes, astA, bfpA and cdt, located on an 85kbp IncFIB plasmid.Conclusions. Certain serotypes of E. coli harbouring stx2f cause severe clinical outcomes, including STEC-HUS. Public health advice and possible interventions are limited, as little is known about the animal and environmental reservoirs and transmission routes. We recommend more comprehensive and standardized collection of microbiological and epidemiological data, and routine sharing of sequencing data between public health agencies worldwide.

Fidelity of a stratified vocational advice intervention for improving return to work for workers on sick leave due to musculoskeletal disorders

PURPOSE: To develop a fidelity score for the Stratified Vocational Advice Intervention (SVAI), and to evaluate associations between level of fidelity to the SVAI and number of sick leave days and work ability at six months follow-up in workers on sick leave due to musculoskeletal disorders (MSDs). METHODS: The SVAI was provided by physiotherapists (PTs) who documented delivery in individual participant logs. A fidelity score was developed based on the number of follow-up sessions held, core questions documented, and a written action plan. Data were extracted from the logs and fidelity to the SVAI was categorised as “fully delivered", “partially delivered, or “not delivered” based on predetermined criteria. The number of sick leave days was calculated from registry data, and work ability was assessed using a question from the Work Ability Index on current work ability compared with the lifetime best (0–10). RESULTS: 148 SVAI logs were available for fidelity evaluation (87%). The SVAI was fully delivered to 87 (56%) participants and partially delivered to 61 (39%) participants. There was no statistically significant association between level of fidelity and sick leave days (B = 5.8, 95% confidence interval (CI) –6.2, 17.7, p = 0.34) or work ability (B = –0.2, 95% CI –1.4, 1.1, p = 0.77). CONCLUSION: A three-category fidelity score was developed and the SVAI was generally delivered according to protocol. There were no statistically significant associations between level of fidelity and number of sick leave days or work ability in participants at six months follow-up.

Non-pharmacological Interventions for Tobacco Cessation in India: A Systematic Review and Network Meta-analysis.

Non-pharmacological management of tobacco cessation has been reported to yield a high level of abstinence from tobacco usage. However, it is unclear which type of non-pharmacological intervention to be adopted in national tobacco control program. Hence, we undertook this review to identify the best non-pharmacological tobacco cessation therapies for tobacco cessation. Systematic literature search was performed in EMBASE, SCOPUS, PubMed Central, CENTRAL, MEDLINE, Google Scholar, ScienceDirect, and Clinicaltrials.gov from 1964 until September 2022. Randomized controlled trials assessing the effectiveness of non-pharmacological intervention for tobacco cessation in India were eligible for inclusion. Comparative intervention effect estimates obtained from network meta-analyses were represented as pooled odds ratio (OR) with 95% confidence interval (CI). 21 studies were eligible for the analysis. More than half of the studies had high risk of bias. E-Health intervention had the highest OR (pooled OR = 9.90; 95% CI: 2.01 to 48.86) in terms of tobacco cessation rate followed by group counseling (pooled OR = 3.61; 95% CI: 1.48 to 8.78) and individual counseling (pooled OR = 3.43; 95% CI: 1.43 to 8.25). Brief advice or self-help intervention or comparison between each of these interventions against each other (both direct and indirect network) did not yield any significant results. E-Health intervention was the best intervention followed by group intervention and individual face-to-face counseling intervention for tobacco cessation in India. Nonetheless, more high-quality large-scale RCTs either individual or by combining the e-Health, individual, or group counseling interventions are required to provide conclusive evidence and subsequent adoption into the national health programs in India. This study would aid the policymakers, clinicians, and public health researchers in choosing the right tobacco cessation therapy to be offered across various levels of the healthcare delivery system, including major health facilities providing drug therapy (ie, concurrently with pharmacological treatment for tobacco cessation) in India. The study findings can be adopted by the national tobacco control program to decide the appropriate intervention package and identify the areas of focus to perform tobacco-related research in the country.

The influence of cognitive and affective components of the sentinel event on alcohol use following a brief intervention with trauma patients.

Alcohol-related injury is a sentinel event, an unanticipated medical event that may prompt a re-evaluation of health behaviors, such as alcohol use. Few studies have examined the psychological components of the sentinel event that motivate behavior change. In the present study, we examined the influence of cognitive and affective components of an alcohol-related injury on changes in alcohol use following a brief intervention. Injured patients (n = 411) who were drinking prior to their injury admission were recruited from three urban Level I trauma centers and randomized to receive brief advice or brief motivational intervention with or without a 1-month booster session. Assessments were completed at baseline and 3-, 6-, and 12-month follow-ups. Three groups were created based on endorsement (yes/no) of items assessing cognitive and affective components of the injury event: neither component, the cognitive component only, and both the cognitive and affective components. Mixed-effects models indicated that participants who endorsed both the cognitive and affective components had greater reductions in peak alcohol use from baseline to 3-month follow-up than those who did endorsed neither component. By contrast, participants who endorsed the cognitive component, but not the affective component, had greater increases in average drinks per week and percentage of days of heavy drinking from 3- to 12-month follow-ups than those who endorsed neither component. These results provide preliminary support for further consideration of an affective component of alcohol-related injuries that may motivate subsequent reductions in drinking following a sentinel event.

Constructing therapeutic support and negotiating competing agendas: A discourse analysis of vocational advice provided to individuals who are absent from work due to ill-health.

Work participation is known to benefit people's overall health and wellbeing, but accessing vocational support during periods of sickness absence to facilitate return-to-work can be challenging for many people. In this study, we explored how vocational advice was delivered by trained vocational support workers (VSWs) to people who had been signed-off from work by their General Practitioner (GP), as part of a feasibility study testing a vocational advice intervention. We investigated the discursive and interactional strategies employed by VSWs and people absent from work, to pursue their joint and respective goals. Theme-oriented discourse analysis was carried out on eight VSW consultations. These consultations were shown to be complex interactions, during which VSWs utilised a range of strategies to provide therapeutic support in discussions about work. These included; signalling empathy with the person's perspective; positively evaluating their personal qualities and prior actions; reflecting individuals' views back to them to show they had been heard and understood; fostering a collaborative approach to action-planning; and attempting to reassure individuals about their return-to-work concerns. Some individuals were reluctant to engage in return-to-work planning, resulting in back-and-forth interactional negotiations between theirs and the VSW's individual goals and agendas. This led to VSWs putting in considerable interactional 'work' to subtly shift the discussion towards return-to-work planning. The discursive strategies we have identified have implications for training health professionals to facilitate work-orientated conversations with their patients, and will also inform training provided to VSWs ahead of a randomised controlled trial.