Behavioural Advice Research Articles

Different types of dietary advice for women with gestational diabetes mellitus.

Different types of dietary advice for women with gestational diabetes mellitus.

Psychological Therapy for People with Tinnitus: A Scoping Review of Treatment Components.

Tinnitus is associated with depression and anxiety disorders, severely and adversely affecting the quality of life and functional health status for some people. With the dearth of clinical psychologists embedded in audiology services and the cessation of training for hearing therapists in the UK, it is left to audiologists to meet the psychological needs of many patients with tinnitus. However, there is no universally standardized training or manualized intervention specifically for audiologists across the whole UK public healthcare system and similar systems elsewhere across the world. The primary aim of this scoping review was to catalog the components of psychological therapies for people with tinnitus, which have been used or tested by psychologists, so that they might inform the development of a standardized audiologist-delivered psychological intervention. Secondary aims of this article were to identify the types of psychological therapy for people with tinnitus, who were reported but not tested in any clinical trial, as well as the job roles of clinicians who delivered psychological therapy for people with tinnitus in the literature. The authors searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; LILACS; KoreaMed; IndMed; PakMediNet; CAB Abstracts; Web of Science; BIOSIS Previews; ISRCTN; ClinicalTrials.gov; IC-TRP; and Google Scholar. In addition, the authors searched the gray literature including conference abstracts, dissertations, and editorials. No records were excluded on the basis of controls used, outcomes reached, timing, setting, or study design (except for reviews-of the search results. Records were included in which a psychological therapy intervention was reported to address adults (≤18 years) tinnitus-related distress. No restrictive criteria were placed upon the term tinnitus. Records were excluded in which the intervention included biofeedback, habituation, hypnosis, or relaxation as necessary parts of the treatment. A total of 5043 records were retrieved of which 64 were retained. Twenty-five themes of components that have been included within a psychological therapy were identified, including tinnitus education, psychoeducation, evaluation treatment rationale, treatment planning, problem-solving behavioral intervention, thought identification, thought challenging, worry time, emotions, social comparison, interpersonal skills, self-concept, lifestyle advice, acceptance and defusion, mindfulness, attention, relaxation, sleep, sound enrichment, comorbidity, treatment reflection, relapse prevention, and common therapeutic skills. The most frequently reported psychological therapies were cognitive behavioral therapy, tinnitus education, and internet-delivered cognitive behavioral therapy. No records reported that an audiologist delivered any of these psychological therapies in the context of an empirical trial in which their role was clearly delineated from that of other clinicians. Scoping review methodology does not attempt to appraise the quality of evidence or synthesize the included records. Further research should therefore determine the relative importance of these different components of psychological therapies from the perspective of the patient and the clinician.

The Well-Being Measure - dementia: Avalidation study

The Well-Being Measure - dementia is adigital observation instrument that assesses the well-being of persons with dementia on four domains of quality of life: Mental well-being, Physical well-being, Participation, and Living arrangements. Its goal is to assess the well-being of persons with dementia in an easy and positive way. Besides illness-related symptoms and problems, the instrument also assesses positive aspects of functioning. It visualizes the results and provides specific behavioural advice to the caregivers. The goal of the present article is to conduct afirst psychometric analysis: factor structure, reliability (Cronbach's alpha), concurrent, and convergent validity.Observations were carried out among 168persons with dementia in eleven different small-scale psychogeriatric wards. Five existing instruments were used among 63persons to validate the Well-Being Measure-dementia: quality of life, neuropsychiatric symptoms, care dependency, depression, and agitation.The expected factor structure was found in each of the four domains. Coefficients were high on the expected factor and low on the other factor(s). The scale means were on the positive side, but showed an adequate range and variability. Reliability was satisfactory to good. The relation with existing scales was moderate to strong. The pattern of relations was consistent with the measurement intentions of the different existing instruments.The Well-Being Measure - dementia appears to be avalid and reliable scale. Further studies should assess its test-retest reliability, sensitivity to change and relation with the course of dementia. Current experience shows that the instrument is also useful in everyday practice.

Interventions to reduce harm from continued tobacco use.

Interventions to reduce harm from continued tobacco use.

P002 Is enquiry regarding alcohol consumption and alcohol reduction advice acceptable to sexual health service users? A cross-sectional study of clinic attendees

Background/introduction Problem alcohol consumption is a major health problem in the UK. Alcohol assessment and behavioural advice or “brief interventions” are effective in decreasing alcohol intake in primary and secondary care but not in sexual health clinics. Aim(s)/objectives We assessed sexual health service user views towards alcohol screening using a prospective cross-sectional survey to identify any themes, which limit acceptability of these methods. Methods Age, gender, alcohol consumption measured by AUDIT-C score, and opinion towards 10 statements on alcohol screening within a sexual health clinic were assessed. Results 462 surveys were returned. Respondents were 64% female, 36% male. Most, 53.7%, were aged ≥25 years, the highest number of responses was received from those aged 20–24 (32.2%), median age category was 25–29 years. The majority of respondents, 61.6% had hazardous alcohol consumption. Males had more positive AUDIT-C scores (indicating hazardous alcohol consumption) compared to females (75% vs 54%, p Discussion/conclusion Different strategies need to be explored within sexual health for alcohol consumption reduction interventions as clinic users are younger, have higher rates of hazardous alcohol consumption and are potentially more resistant to standard brief interventions.

Outcomes of different protocols of pelvic floor physical therapy and anti-cholinergics in women with wet over-active bladder: A 4-year follow-up.

We investigated the 4-year outcomes of three protocols of pelvic floor physical therapy and anticholinergic drug in women with wet over-active bladder (OAB). One hundred and sixty-four women were randomly allocated to one of four interventions: drug therapy (DT), bladder training (BT), pelvic floor muscle training (PFMT), or combined pelvic floor rehabilitation (CPFR) that includes BT, PFMT, and behavioral advice. The active treatment in each group lasted 3 months. Of the 132 women who completed a 1-year follow-up, 120 women (90%) responded to our questionnaires and therefore were included in this study. Outcome measures were the number of voids per day, number of urgency urinary incontinence (UUI) episodes per week, completely dry rate and Incontinence Quality of Life questionnaire (I-QOL) at 4 years. After 4 years of follow-up, the outcome measures improved significantly and equally in all four groups. The median number of UUI episodes/week dropped by 3, 1, 2, and 2 in the DT, BT, PFMT, and CPFR groups, respectively (P = ns). The dry rates were 25%, 31%, 44%, 34% in the DT, BT, PFMT, and CPFR groups, respectively (P = ns). I-QOL scores improved significantly in all four groups. Women who suffer from wet-OAB may experience the same degree of long-term improvement following various pelvic floor physical therapy protocols as they would from drug therapy. Neurourol. Urodynam. 36:755-758, 2017. © 2016 Wiley Periodicals, Inc.

Efficacy of written behavioral advice for separation-related behavior problems in dogs newly adopted from a rehoming center

Abstract Separation anxiety/separation-related behavior problems (SA/SRB) are a significant cause of abandonment and failure of rehoming in dogs. The aim of this study was to investigate the effect of providing written advice to adopters of dogs, aimed at reducing the risk of SA/SRB occurring in the new home. An opportunity sample of 176 dogs was taken from animals rehomed over a 13-month period. Adopters of dogs were allocated alternately to 2 groups, experimental (treatment) and no treatment (control). Adopters in the control group were given advice about healthcare. Adopters in the treatment group received behavioral advice, designed to prevent SA/SRB. Efficacy of the advice was measured 12 weeks after rehoming, when owners were asked to complete a postal questionnaire detailing their dog's behavior when alone, as well as other factors previously suggested to influence the occurrence of SA/SRB. Overall, 53 (30%) of the dogs were reported to show SA/SRB (38% of the control group and 22% of the treatment group). Younger dogs were more likely to show SA/SRB and neutered females showed lower levels of SA/SRB. Although compliance with the advice was generally poor and varied between recommendations, dogs in the control group were more likely to show signs of SA/SRB than those in the treatment group, and hence the provision of written advice to adopters appears to be effective in reducing the development of SA/SRB after rehoming.

An exploration of female offenders’ memorable messages from probation and parole officers on the self-assessment of behavior from a control theory perspective

ABSTRACTGuided by control theory, this study examines memorable messages that women on probation and parole receive from their probation and parole agents. Women interviewed for the study were asked to report a memorable message they received from an agent, and to describe situations if/when the message came to mind in three contexts likely to emerge from a control theory perspective: when they did something of which they were proud, when they stopped themselves from doing something they would later regret, and when they did something of which they were not proud. The types of memorable messages and the reactions to these messages within the three contexts were coded, and differences between women on probation versus parole were examined. Overall, a greater proportion of women on parole recalled memorable messages, and the most frequently reported type of memorable message was behavioral advice. Women reported that the message helped them do things of which they were proud, such as engaging in routine activities and fulfilling goals; helped them to not give into urges that could lead to further negative sanctions or feelings of regret; and came to mind when they relapsed. Practical implications of the findings for training are presented.

Efficacy of Mediterranean diet in a peculiar case of non-alcoholic steatohepatitis and hypobetalipoproteinemia

s / Digestive and Liver Disease 47S (2015) e226–e235 e233 therapy strategies, such as vitamin E or insulin-sensitizers, lead to controversial clinical outcomes. The aim of this studywas to evaluate the efficacy of a fixed combination of berberine, tocotrienols and chlorogenic acid (Trixy®, Nathura s.r.l.), in combination with diet and moderate aerobic physical activity, on the biochemical parameters of steatosis. In this study we examined 19 patients consistent with ultrasounddiagnosedNAFLD, elevatedaminotransferase levels, BMI>25kg/m2 and<30kg/m2 and/or altered lipid and/or glucose levels. After three months of an appropriate diet andmoderate aerobic physical activity, we compared those who only followed the behavioural advice (n=10),with thosewhoalso took thenutraceutical (n=9), assessing any additional efficacy. In both groups we observed a marked improvement in most parameters. However, the percentages of reduction in plasma glucose, insulin and HOMA-IR were significantly different, e.g. themeanpercentages of reductionofHOMA-IR were−60.03%±9.328and−12.62%±12.11 in thenutraceutical and in the control group respectively (P<0.01). Even the HSI and the NAFLD fibrosis score diminished but they did not reach statistical significance probably for the short period of treatment. The use of the nutraceutical combination might reduce insulin resistance, which is likely the first hit of NAFLD. http://dx.doi.org/10.1016/j.dld.2015.07.039

Behavioural changes in dogs treated with corticosteroids

In human medicine, psychiatric side effects among patients on corticosteroid therapy are widely reported, but this appears to have been largely overlooked in the animal literature despite glucocorticoids being widely used in veterinary medicine. Therefore the aim of the current study was to identify possible psycho-behavioural changes in dogs treated with corticosteroids. Two different methodologies were used. Firstly, dog owners were asked to fill a 12 item questionnaire aimed at further validating the initial results of a previous survey relating to changes seen when their dog was receiving corticosteroid treatment. In a second study, a population of dogs undertook behavioural tests aimed at objectively identifying changes when receiving corticosteroid therapy.In the first study, a sample of owners whose dogs were receiving treatment for dermatological, orthopaedic or other conditions evaluated their dogs' behaviour on and off therapy, using a seven point scale. The survey was completed by 44 dog owners with dogs receiving treatment with a range of corticosteroid preparations (mainly prednisolone and methylprednisolone) and 54 dog owners with dogs receiving treatment with other drugs, mainly antibiotics and non-steroidal anti-inflammatory drugs. Dogs under corticosteroid treatment were reported to be significantly less playful, more nervous/restless, more fearful/less confident, more aggressive in the presence of food, more prone to barking, more prone to startle, more prone to reacting aggressively when disturbed, and more prone to avoiding people or unusual situations.In the second study, eleven “treatment” dogs were tested both before and during corticosteroid treatment with either methyl-prednisolone or prednisolone to assess their sensitivity to a potentially aversive sound stimulus. Eleven control dogs were also tested at the same time intervals in the same environment. Dogs were exposed to a brief dog growl while they explored bowls containing food and their behaviour was video recorded. Treatment dogs were found to investigate the area in the vicinity of the bowls for significantly less time and to eat significantly fewer pieces of food when on corticosteroids, compared to control dogs, after hearing the growl.These results provide the first empirical evidence of possible adverse psycho-behavioural side effects in a veterinary clinical setting following the use of corticosteroids, and suggest the need for concomitant behavioural advice when these drugs are used in general veterinary practise to avoid the risks associated with these changes.

Cognitive dysfunction in older dogs and cats: the role of the veterinary nurse in screening

Cognitive dysfunction is a progressive neurodegenerative disorder. It affects 14.2% of older dogs over 8 years of age. In cats, 28% aged 11 to 14 years develop one geriatric-onset behaviour problem. This increases to over 50% in cats 15 years of age and older. Detection of cognitive dysfunction in cats and dogs is by observation of clinical behavioural signs, often thought to be a normal part of ageing. Early recognition is crucial. Signs detected early are treatable or temporarily reversible. This literature review focused on areas the veterinary nurse could influence in practice such as detection of behavioural signs and advice on diet, behaviour management and enrichment. Results showed dietary and nutritional supplements as well as behavioural and environmental enrichment alongside medication can slow progression of cognitive dysfunction predominately in dogs. Regular screening of older pets and education of owners by veterinary nurses can help with early detection and referral to a veterinary surgeon. Future research should focus on further development of standardised, validated screening tools and management protocols.

Dissemination of Evidence-Based Behavioral Advice via Video in Pediatric Primary Care: An Acceptance and Utilization Study.

Research suggests that multimedia-based interventions possess advantages for disseminating safe and effective methods of behavior management to parents in pediatric primary care; however, little is known about their utilization in real-life settings. In order to maximize the impact of multimedia resources, more knowledge regarding dissemination and implementation is needed. To examine provider and parental perception and utilization of videos designed to communicate evidence-based parenting strategies for disruptive behavior. Videos were available in clinic and online. Both provider and parent perceptions of the videos were largely positive. However, of 240 parents surveyed, only 33% were aware of the availability of videos subsequent to a well-child visit. Parents were unlikely to view the videos if they did not do so as part of their child's health care visit. Multimedia interventions for behavior management are likely to be well received, but systematic methods of implementation are needed. Further study of dissemination of multimedia interventions is merited.

Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease

Objective To test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions.Design Cluster randomised controlled trial.Setting 36 general practices in the north...

Risk Behavior in Patients Operated for Spontaneous Pneumothorax

Objectives: Spontaneous pneumothorax (PTX) is a common disease frequently operated at specialized thoracic surgery units. It may arise in adolescents with healthy lung tissue (primary PTX) or in elder patients with preexisting lung disease (secondary PTX). Videothoracoscopic surgery (VATS) has become the surgical standard for treatment and recurrence prevention. While there is broad consensus regarding indications and techniques of PTX surgery, potential postoperative risks and consecutive patient behavioral advice have not been sufficiently elucidated to date. Methods: Single-center cohort analysis of 646 patients operated for primary PTX by VATS over a time period of 10 years. Putatively recurrence prone lifestyle activities (smoking status, flying habits, scuba diving) and actual occurrence of recurrences were correlated. Results: Follow up rate was 43% (279/646 patients). Mean time interval between primary operation and follow up was 61 (range 5–177) months. In 10 patients (3.6%), a PTX recurrence was observed. Regarding postoperative risk behavior reported at follow-up, 28% of patients were active smokers (in average 15 ± 7 cigarettes/day), 59% travelled by plane repeatedly, and only 2 patients did scuba diving (0.7%). Neither smoking nor flying or scuba diving could not be identified as statistically significant risk factors for PTX recurrence. Conclusions: In our study, none of the supposed “classic” lifestyle-associated risk factors for PTX recurrence after VATS proved to be a significant threat. Thus, postoperative patient behavior might not necessarily be constrained by overcautious medical advice.

How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study

In sub Saharan Africa (SSA), access to affordable hypertension care through health insurance is increasing. But due to poor adherence, hypertension treatment outcomes often remain poor. Patient-centered educational interventions may reverse this trend. Using a pre-test/post-test design, in this study we investigated the effects of a structured cardiovascular health education program (CHEP) on treatment adherence, blood pressure (BP) control and body mass index (BMI) among Nigerian hypertensive patients who received guideline-based care in a rural primary care facility, in the context of a community based health insurance program. Study participants included 149 insured patients with uncontrolled BP and/or poor self-reported medication adherence after 12 months of guideline-based care. All patients received three group-based educational sessions and usual primary care over 6 months. We evaluated changes in self-reported adherence to prescribed medications and behavioral advice (primary outcomes); systolic BP (SBP) and/or diastolic BP (DBP) and BMI (secondary outcomes); and beliefs about hypertension and medications (explora- tory outcomes). Outcomes were analyzed with descriptive statistics and regression analysis. 140 patients completed the study (94%). At 6 months, more participants reported high adherence to medications and behavioral advice than at baseline: respectively, 101 (72%) versus 70 (50%), (p < 0.001) and 126 (90%) versus 106 (76%), (p < 0.001). Participants with controlled BP doubled from 34 (24%) to 65 (46%), (p = 0.001). The median SBP and DBP decreased from 129.0 to 122.0 mmHg, (p = 0.002) and from 80.0 to 73.5 mmHg, (p < 0.001), respectively. BMI did not change (p = 0.444). Improved medication adherence was associated with a decrease in medication concerns (p = 0.045) and improved medication self-efficacy (p < 0.001). By positively influencing patient perceptions of medications, CHEP strengthened medication adherence and, consequently, BP reduction among insured hypertensive Nigerians. This educational approach can support cardiovascular disease prevention programs for Africa’s growing hypertensive population.

The effect of dentists’ body-weight size on student social judgments of dental skill and patients’ behavioural intentions: A vignette study

ObjectivesWhere previous work has suggested that over-weight individuals may be subject to negative social judgments, a finding also seen in judgments applied to healthcare professionals (HCPs), this study investigated whether these findings extend to judgments made about dental practitioners. MethodsA photo of a normal weight male and one of a normal weight female dentist were digitally modified to reliably show them as overweight, giving a total of 4 conditions. In a single-blind quasi-randomised controlled study of 302 undergraduate and postgraduate student participants used a 5 point Likert scale to appraise a single, gender-matched colour photograph as to whether they thought the dentist depicted was competent, professional, caring, had patients’ best interests at heart, and was a good dentist. They further rated their future intentions to follow behavioural advice (reduce snacking and take-up flossing) given by the depicted dentist. ResultsThe data were analysed using independent sample t-tests. There were no differences in outcomes as a function of the weight status of the depicted dentist in any of the variables explored with the exception of the normal-weight images being rated as more caring than the overweight ones (p<.04). ConclusionsImages of overweight dentists do not receive lower social judgement ratings than images of normal-weight dentists. Previous research in medicine reporting adverse social judgments made of over-weight HCPs does not apply to dental practitioners. Future research should focus on factors that may explain these findings. Clinical significanceDentists appear to be protected from the adverse effect of overweight on social judgments of their personal characteristics and on their health-promoting advice.

Development of a Dietary Management Care Map for Metabolic Syndrome.

Metabolic syndrome (MetS) refers to a particular cluster of metabolic abnormalities (hypertension, dyslipidemia, type 2 diabetes, and visceral fat deposition) that can lead to a 1.5- to 2-fold increased relative risk of cardiovascular disease. Various combinations of healthier eating patterns and increased physical activity have been shown to improve metabolic abnormalities and reduce MetS prevalence. Dietitians who counsel MetS patients are challenged to integrate guidance from various medical management guidelines and research studies with effective behavioural change strategies and specific advice on what food and eating pattern changes will be most effective, feasible, and acceptable to clients. As part of a demonstration project that is currently underway, we developed a care map (decision aid) that represents the key decision processes involved in diet counselling for MetS. The care map is based on evidence from both clinical and health behaviour change studies and expert consensus and has undergone limited dietitian review. It is being used to help project dietitians clearly articulate their specific food intake change goals. Additional studies to directly compare counselling strategies could inform future development of the map. In the meantime, dietitians may find this care map helpful in clarifying counselling goals and strategies in this client group.

Institutionalisation of knowledge transfer on sexual behaviour in the times of AIDS: a case study from a village community in north-central Namibia

This paper concentrates on the changes in knowledge transfer in northern Namibia with respect to sexual norms, behavioural advice and sexual health information. The research was conducted in a small village community in Ohangwena region, where over 100 semi-structured and structured interviews were held with a sample of 67 community members and 50 professionals dealing with HIV/AIDS issues. The results of the research indicate the change in social roles in family and community dynamics, especially between generations, and thus a change in trust, respect and responsibility attached to information sharing. This further exerts pressure on the classification, choice, adaptation and transmission of information at both the individual and family level. Secondly, and partly as a consequence of this, the levels of indigenous, community level information from elders to youth and the level of institutionalised information sharing leave space for variations in behavioural norms. The research contributes to the discussion on problems in information sharing, knowledge transfer and adaptation of behavioural advice in HIV/ AIDS work.

HIV/AIDS status disclosure increases support, behavioural change and, HIV prevention in the long term: a case for an Urban Clinic, Kampala, Uganda

BackgroundDisclosure of HIV status supports risk reduction and facilitates access to prevention and care services, but can be inhibited by the fear of negative repercussions. We explored the short and long-term outcomes of disclosure among clients attending an urban HIV clinic in Uganda.MethodsQualitative semi-structured interviews were administered to a purposeful sample of 40 adult HIV clients that was stratified by gender. The information elicited included their lived experiences and outcomes of disclosure in the short and long term. A text data management software (ATLAS.ti) was used for data analysis. Codes were exported to MS Excel and pivot tables, and code counts made to generate statistical data.ResultsOf the 134 short-term responses elicited during the interview regarding disclosure events, most responses were supportive including encouragement, advice and support regarding HIV care and treatment. The results show on-disclosing to spouse, there was more trust, and use of condoms for HIV prevention. Only one third were negative responses, like emotional shock and feeling of distress. The negative reactions to the spouses included rejection, shock and distress in the short term. Even then, none of these events led to drastic change such as divorce. Other responses reflected HIV prevention and call for behavioural change and advice to change sexual behaviour, recipient seeking HIV testing or care. Women reported more responses of encouragement compared to men. Men reported more preventive behaviour compared to women. Of the 137 long-term outcomes elicited during disclosure, three quarters were positive followed by behavioral change and prevention, and then negative responses. Men reported increased care and support when they disclosed to fellow men compared to when women disclosed to women. There was better or not change in relationship when women disclosed to women than when women disclosed to men.ConclusionsThere is overwhelming support to individuals that disclose their HIV status, especially in the long term. Besides, gender appears to influence responses to HIV disclosure, highlighting the need for gender specific disclosure support strategies.

Base rates and Bayes’ Theorem for decision support

Purpose – The purpose of this paper is to discuss and demonstrate “best practices” for creating quantitative behavioural investigative advice (i.e. statements to assist police with psychological and behavioural aspects of investigations) where complex statistical modelling is not available. Design/methodology/approach – Using a sample of 361 serial stranger sexual offenses and a cross-validation approach, the paper demonstrates prediction of offender characteristics using base rates and using Bayes’ Theorem. The paper predicts four dichotomous offender characteristic variables, first using simple base rates, then using Bayes’ Theorem with 16 categorical crime scene variable predictors. Findings – Both methods consistently predict better than chance. By incorporating more information, analyses based on Bayes’ Theorem (74.6 per cent accurate) predict with 11.1 per cent more accuracy overall than analyses based on base rates (63.5 per cent accurate), and provide improved advising estimates in line with best practices. Originality/value – The study demonstrates how useful predictions of offender characteristics can be acquired from crime information without large (i.e. &gt;500 cases) data sets or “trained” statistical models. Advising statements are constructed for discussion, and results are discussed in terms of the pragmatic usefulness of the methods for police investigations.