Delivery Of Counseling Research Articles

Challenges in the delivery of public HIV testing and counselling (HTC) in Douala, Cameroon: providers perspectives and implications on quality of HTC services

BackgroundThe Cameroon government has made HIV testing and counselling (HTC) a priority in its HIV/AIDS strategic plan. However, there is a dearth of literature on the perspectives of providers on the quality of HTC services. The aim of this study was to explore challenges in the provision of HTC services and their implications on quality of HTC services in Douala’s district hospitals.MethodsTwo primary data collection methods supported by the Donabedian’s model of healthcare were used to explain the challenges in the provision of HTC services and their implications on quality of HTC services. This consisted of semi-structured individual interviews with 6 nurses and 16 lay counsellors and a non-participant observation of the physical environment for HTC by site. The study sites were the prevention and voluntary testing and counselling centre (PVTCC) of the six district hospitals of the city of Douala.ResultsThe study reveals concerns about confidentiality and privacy during the counselling sessions due to inadequate and limited space. An absence of consent, even verbal, was reported in one PVTCC. There is no specific accredited training curriculum that leads to a formal registration as a PVTCC staff, and some lay counsellors work without training. Lay counsellors carry the burden of HIV counselling, but the majority of them work for many years without remuneration and recognition. Another quality challenge is the high workload in the district hospitals’ lab, which leads to long waiting times for HIV test results, thus contributing to failure to return for results.ConclusionThe findings of this study highlighted some issues such as lack of adequate space and equipment for HIV testing and counselling that hinder the quality of HTC services and should challenge the health authorities of Cameroon on the need to reorganize HTC services and create a national HIV quality assurance program.

Implementing international sexual counselling guidelines in hospital cardiac rehabilitation: development of the CHARMS intervention using the Behaviour Change Wheel.

BackgroundDecreased sexual activity and sexual problems are common among people with cardiovascular disease, negatively impacting relationship satisfaction and quality of life. International guidelines recommend routine delivery of sexual counselling to cardiac patients. The Cardiac Health and Relationship Management and Sexuality (CHARMS) baseline study in Ireland found, similar to international findings, limited implementation of sexual counselling guidelines in practice. The aim of the current study was to develop the CHARMS multi-level intervention to increase delivery of sexual counselling by healthcare professionals. We describe the methods used to develop the CHARMS intervention following the three phases of the Behaviour Change Wheel approach: understand the behaviour, identify intervention options, and identify content and implementation options. Survey (n = 60) and focus group (n = 14) data from two previous studies exploring why sexual counselling is not currently being delivered were coded by two members of the research team to understand staff’s capability, opportunity, and motivation to engage in the behaviour. All potentially relevant intervention functions to change behaviour were identified and the APEASE (affordability, practicability, effectiveness, acceptability, side effects and equity) criteria were used to select the most appropriate. The APEASE criteria were then used to choose between all behaviour change techniques (BCTs) potentially relevant to the identified functions, and these BCTs were translated into intervention content. The Template for Intervention Description and Replication (TIDieR) checklist was used to specify details of the intervention including the who, what, how and where of proposed intervention delivery.ResultsProviding sexual counselling group sessions by cardiac rehabilitation staff to patients during phase III cardiac rehabilitation was identified as the target behaviour. Education, enablement, modelling, persuasion and training were selected as appropriate intervention functions. Twelve BCTs, linked to intervention functions, were identified for inclusion and translated into CHARMS intervention content.ConclusionsThis paper details the use of Behaviour Change Wheel approach to develop an implementation intervention in an under-researched area of healthcare provision. The systematic and transparent development of the CHARMS intervention will facilitate the evaluation of intervention effectiveness and future replication and contribute to the advancement of a cumulative science of implementation intervention design.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0493-4) contains supplementary material, which is available to authorized users.

INHALER COUNSELLING, THE REAL DEAL OR JUST FRESH AIR?

AimTo evaluate whether healthcare professionals within the local community are able to counsel paediatric patients on the essential steps required for drug delivery with multi-dose inhalers (MDI), MDIs with a...

Health-care Provider Screening and Advice for Smoking Cessation Among Smokers With and Without COPD: 2009-2010 National Adult Tobacco Survey.

Cigarette smoking is the predominant cause of COPD. Quitting can prevent development of and complications from COPD. The gold standard in clinician delivery of smoking cessation treatments is the 5As (ask, advise, assess, assist, arrange). This study assessed prevalence and correlates of self-reported receipt of the 5A strategies among adult smokers with and without COPD. Data were analyzed from 20,021 adult past-year cigarette smokers in the 2009-2010 National Adult Tobacco Survey, a nationally representative telephone survey of US adults 18 years of age and older. Past-year receipt of the 5As was self-reported by participants who saw a clinician in the past year. Logistic regression was used to estimate the likelihood of receipt of each of the 5As by COPD status, adjusted for sociodemographic and smoking characteristics. Among smokers, those with COPD were more likely than those without COPD to report being asked about tobacco use (95.4% vs 85.8%), advised to quit (87.5% vs 59.4%), assessed for readiness to quit (63.8% vs 37.9%), offered any assistance to quit (58.6% vs 34.0%), and offered follow-up (14.9% vs 5.2%). In adjusted logistic regression models, those with COPD were significantly more likely than those without COPD to receive each of the 5As. Health professionals should continue to prioritize tobacco cessation counseling and treatment to smokers with COPD. Increased system-level changes and insurance coverage for cessation treatments could be used to improve the delivery of brief tobacco cessation counseling to all smokers, regardless of COPD status.

Utilization and Outcomes of BRCA Genetic Testing and Counseling in a National Commercially Insured Population: The ABOUT Study.

BRCA genetic testing has substantial public health impact, yet little is known of the real-world experiences of the more than 100 000 Americans undergoing testing annually. To identify factors associated with use of BRCA testing, assess whether delivery of genetic counseling and testing services adheres to professional guidelines, and measure the impact on patient-reported outcomes. The American BRCA Outcomes and Utilization of Testing (ABOUT) Study analyzed data from a consecutive national series of 11 159 women whose clinicians ordered BRCA testing between December 2011 and December 2012. Aetna mailed recruitment information across the United States to commercial health plan members whose clinicians had ordered BRCA testing. A total of 3874 women (34.7%) completed questionnaires. Deidentified clinician-reported data from all respondents and a random sample of 2613 nonrespondents were also analyzed. The proportion of eligible participants who met testing criteria and respondents' report of receiving genetic counseling by a genetics clinician and its association with BRCA knowledge, understanding, and satisfaction were assessed. Among 3628 women respondents whose clinicians ordered comprehensive BRCA testing, most were white non-Hispanic (2502 [69.0%]), college educated (2953 [81.4%]), married (2751 [75.8%]), and had higher incomes (2011 [55.4%]). Approximately 16.4% (596) did not meet testing criteria. Mutations were identified in 161 (5.3%) of these women who received comprehensive testing. Only 1334 (36.8%) reported receiving genetic counseling from a genetics clinician prior to testing; the lowest rates (130 [12.3%]) were among patients of obstetrician/gynecologists. The most commonly reported reason for not receiving this clinical service was lack of clinician recommendation. Those who received it demonstrated greater knowledge about BRCA (mean score difference adjusted for demographics and clinician specialty, β = 0.99 [95% CI, 0.83-1.14]; P < .001) and expressed greater understanding (β = 0.47 [95% CI, 0.41-0.54]; P < .001) and satisfaction (β = 2.21 [95% CI, 1.60-2.81]; P < .001). Despite improved patient knowledge, understanding, and satisfaction among patients who receive genetic counseling provided by a genetics clinician, as well as multiple guidelines emphasizing the importance of genetic counseling, most US women undergoing BRCA genetic testing do not receive this clinical service. Lack of physician recommendation is the most commonly reported reason. These findings demonstrate important gaps in clinical genetics services. Recently mandated coverage of genetic counseling services as a preventive service without patient cost sharing should contribute to improving clinical genetics services and associated outcomes in the future.

Awareness, practices, and barriers regarding smoking cessation treatment among physicians in Saudi Arabia

ABSTRACTSmoking cessation counseling and therapy provided by physicians play an important role in helping smokers quit. Awareness and practices of the clinical practice guidelines for tobacco dependence (in particular the 5A's: Ask, Assist, Assess, Advise, and Arrange) among physicians and perceived barriers for their implementation is needed to improve care for individuals who smoke/use tobacco products in Saudi Arabia. A cross-sectional self-administered survey was conducted among 124 general and family practitioners in primary health care clinics belonging to 2 major medical centers in Riyadh city, Saudi Arabia. Descriptive statistics were reported for all survey variables. Logistic regression was used to examine the predictors of physicians' use of the 5A's for smoking cessation counseling and therapy. Among the 216 contacted physicians, 124 responded (57.4%). The majority (63.7%) were males, between the ages of 40 and 49 years (52.4%), practicing full-time (95.2%), and had not received smoking cessation training during medical school education or residency training (68.6%). Approximately 85.5% reported some experience with the guidelines (heard, read, or used). Asking (71.8%) and advising (87.9%) were the most implemented for smoking cessation, while assisting (15.3%) and arranging for follow-up (17.7%) were the least implemented. Most (96.0%) did not prescribe pharmacotherapy and 53.2% reported documenting the patient's smoking status. Reported barriers were mostly lack of time (72.6%) and lack of training (66.9%). Awareness of the guidelines, physician's smoking status, perceived competence in ability to provide smoking cessation counseling and therapy, reporting the ineffectiveness of smoking cessation therapy as a barrier, and the perceived benefit of reducing patient's physical symptoms were independently statistically significant predictors of the implementation of the 5A's for smoking cessation therapy. This preliminary study showed that smoking cessation delivery, according to the clinical practice guidelines recommendation, in Saudi Arabia is inadequate. Barriers were identified regarding the delivery of smoking cessation therapy and counseling for the first time. Physician training is likely to improve compliance with implementing smoking cessation counseling and therapy.

Sexually transmitted infection screening and reproductive health counseling in adolescent renal transplant recipients: Perceptions and practice patterns. A study from the Midwest Pediatric Nephrology Consortium.

We wanted to identify practice patterns and perceived barriers among pediatric nephrologists regarding STI screening and reproductive health counseling in adolescent renal transplant recipients. We created an online Likert-scaled survey. Response rate was 54%. The majority (83%) believed STI risk in their patients was similar to or higher than healthy teens. Interestingly, while 67% felt moderately or very confident in asking about sexual activity and counseling about safer sex, only 43% routinely or always inquired about sexual activity, and only 42% routinely or always counseled about safer sex. Fifty-four percent routinely or always discussed contraceptive options and implications of unintentional pregnancy. Fifty-one percent routinely or always referred patients to a gynecologist or adolescent provider for contraception prescription. The most common counseling mechanism was informal discussions in clinic (87%). Ten percent had no mechanism in place. Major barriers included time limitations, adolescents' fear regarding confidentiality, and lack of professional training. This is the first report of perceptions and practice patterns of pediatric nephrologists regarding STI screening and reproductive health counseling. Providers seem to recognize the importance of counseling; however, translation into practice remains low. Professional training in this area and increased encounter time could improve counseling delivery and thereby reduce risk in this population.

Animal-Assisted Therapy and Counseling Support for Women With Breast Cancer: An Exploration of Patient's Perceptions.

Animal-assisted therapy (AAT) interventions have been shown to assist in coping and improve patient responses to symptoms. Specifically, the presence of an animal has been found to lower anxiety and motivate participation in therapy. We aimed to explore the acceptability of and experience of AAT during individual breast cancer counseling sessions. Patients undertaking counseling with a therapy dog present were invited to participate in the study. Patients were individually interviewed and asked to reflect on their experiences of AAT. Data generation and analysis were concurrent. Transcripts were analyzed thematically using a process of constant comparison. Our sample included 8 female participants, 39 to 61 years old, at an average of 3 years post-breast cancer diagnosis. The majority of patients reported a positive experience with AAT. Themes that emerged around their counseling experience included benefits in the process of initiating counseling and benefits for greater engagement and personal disclosure. Incorporating AAT into the delivery of counseling for breast cancer patients appears to be feasible and acceptable at a patient level. From a clinical perspective, AAT promoted increased communication with health professionals. This is of clinical importance as a means to improve participation and engagement in therapy-important elements in therapeutic outcomes. However, further evaluation of the impact of AAT on specific patient outcomes and psychological morbidity is required.

Association of knowledge, preventive counseling and personal health behaviors on physical activity and consumption of fruits or vegetables in community health workers.

BackgroundThere is evidence that if a health professional is active and has a healthy diet, he/she is more likely to advise patients about the benefits of physical activity and healthy eating The aims of this study were to: (1) describe the personal physical activity, consumption of fruits and vegetables behaviors and nutritional status of community health workers; (2) evaluate the association between knowledge, delivery of preventive counseling and personal behaviors among community health workers.MethodsThis was a cross-sectional study conducted in a nationally sample of health professionals working in primary health care settings in Brazil in 2011. This survey was part of the second phase of the Guide for Useful Interventions for Activity in Brazil and Latin America project, and data were collected through telephone interviews of 269 community health workers from the Unified Health Care system of Brazil. We applied questionnaires about personal reported behaviors, knowledge and preventive counseling in physical activity and consumption of fruits and vegetables. We calculated the prevalence and associations between the variables with logistic regression.ResultsThe proportion of community health workers that practiced 150 minutes per week of physical activity in leisure time or transportation was high (64.9%). Half of community health workers were overweight and only 26.2% reported consuming five portions/day of fruits or vegetables. Most community health workers reported counseling about physical activity for more than six months (59.7%), and most were not knowledgeable of the fruits and vegetables and physical activity recommendations. Meeting the fruits and vegetables recommendations was associated with correct knowledge (OR = 4.5; CI95% 1.03;19.7), with reporting 150 minutes or more of physical activity per week (OR = 2.0; CI95% 1.03;3.7) and with reporting physical activity in leisure time (OR = 2.0; CI95% 1.05;3.6). Regular physical activity counseling was associated with reporting 10–149 minutes per week (OR = 3.8; CI95% 1.1;13.3) and with more than 150 minutes of physical activity per week (OR = 4.9; CI95% 1.5;16.5).ConclusionActions to promote physical activity and healthy eating and to improve knowledge among community health workers within the health care system of Brazil could have a potential positive influence on delivery of preventive counseling to patients on this topic.

University student counseling and mental health in the United States: Trends and challenges

This article reviews the status of the delivery of counseling and mental health services at colleges and universities in the United States. It provides an overview of historical and current trends of student mental health concerns and of the ways in which campus counseling services have responded to these challenges. Data from several sources are referenced to demonstrate both the increasing numbers of students seeking counseling services and the increasing severity of their concerns. Examples are provided for how these trends have influenced the delivery of counseling services and how they are changing college and university communities.

Frontline Worker (FLW) Knowledge and Motivation Influence Maternal Exposure to Complementary Feeding Counseling at Home

Home‐visit based counseling is a proven intervention to improve complementary feeding (CF) practices. In India, CF counseling is to be delivered by FLWs ‐ Anganwadi Workers (AWWs) and Accredited Social Health Activists (ASHAs) but program experience with CF counseling is limited. We surveyed 588 FLWs and 1183 households in Odisha state to assess the status and determinants of delivery of counseling and other nutrition interventions. Regression analysis was used to study FLW and maternal determinants of maternal exposure to CF counseling. Outcome variable: mother received CF advice at home visit; independent variables (FLW): FLW characteristics, knowledge, sources of motivation, training; independent variables (maternal): demographic characteristics and socio‐economic status. Although most mothers received home visits from FLWs (76% from AWWs and 88% from ASHAs), &lt;30% received CF advice in those visits. FLW motivation to help others (AWW: OR=2.9; CI: 1.61, 5.20; ASHA: OR = 2.2; CI: 1.19, 4.17) and CF knowledge (AWW: OR=2.3; CI: 1.28, 4.39; ASHA: OR = 3.6; CI: 2.12, 6.19) were associated with higher maternal exposure to CF advice. ASHAs' motivation to work for income lowered the odds of exposure to CF advice (OR=0.20; CI: 0.114, 0.371); ASHAs typically receive performance‐based incentives, which could limit their motivation to deliver non‐incentivized interventions. Our study highlights the role of FLW CF knowledge, intrinsic motivation to help others and extrinsic motivation from income as determinants of maternal exposure to CF counseling. Investments in building FLW knowledge and incentivizing or regularizing payment for counseling could improve CF counseling coverage. Funding: Bill &amp; Melinda Gates Foundation, through POSHAN, led by IFPRI

Comparative Effectiveness of Post-Discharge Strategies for Hospitalized Smokers: study protocol for the Helping HAND 2 randomized controlled trial.

BackgroundSmoking cessation interventions for hospitalized smokers are effective in promoting smoking cessation, but only if the tobacco dependence treatment continues after the patient leaves the hospital. Sustaining tobacco dependence treatment after hospital discharge is a challenge for health care systems. Our previous single-site randomized controlled trial demonstrated the effectiveness of an intervention that facilitated the delivery of comprehensive tobacco cessation treatment, including both medication and counseling, after hospital discharge. We subsequently streamlined the intervention model to increase its potential for dissemination. This new model is being tested in a larger multi-site trial with broader eligibility criteria in order to enroll a more representative sample of hospitalized smokers. This paper describes the trial design and contrasts it with the earlier study.Methods/DesignA 2-arm, 3-site randomized controlled trial is testing the hypothesis that a multi-component Sustained Care intervention is more effective than Standard Care in helping hospitalized cigarette smokers stop smoking after hospital discharge. The trial enrolls adult daily cigarette smokers who are admitted to 1 of 3 participating hospitals in Massachusetts or Pennsylvania. Participants receive the same smoking cessation intervention in the hospital. They are randomly assigned to receive either Standard Care or Sustained Care after hospital discharge. Participants in the Sustained Care arm receive a free 3-month supply of FDA-approved smoking cessation medication and 5 interactive voice response calls that provide tailored motivational messages, medication refills, and access to a live tobacco treatment counselor. Participants in the Standard Care arm receive a smoking cessation medication recommendation and information about community resources. Outcomes are assessed at 1, 3, and 6 months after discharge. The primary outcome is biochemically-validated tobacco abstinence for the past 7 days at 6-month follow-up. Other outcome measures include self-reported tobacco abstinence measures, use of medication and counseling after discharge, hospital readmissions, and program cost-effectiveness.DiscussionWe adapted a proven intervention for hospitalized smokers to enhance its potential for dissemination and are testing it in a multi-site trial. Study enrollment data suggests that the trial achieved the goal of recruiting a broader sample of hospitalized smokers.Trial registrationComparative Effectiveness of Post-Discharge Strategies for Hospitalized Smokers (Helping HAND2) NCT01714323. Registered October 22, 2012.

Program synergies and social relations: implications of integrating HIV testing and counselling into maternal health care on care seeking.

BackgroundWomen and children in sub-Saharan Africa bear a disproportionate burden of HIV/AIDS. Integration of HIV with maternal and child services aims to reduce the impact of HIV/AIDS. To assess the potential gains and risks of such integration, this paper considers pregnant women’s and providers’ perceptions about the effects of integrated HIV testing and counselling on care seeking by pregnant women during antenatal care in Tanzania.MethodsFrom a larger evaluation of an integrated maternal and newborn health care program in Morogoro, Tanzania, this analysis included a subset of information from 203 observations of antenatal care and interviews with 57 providers and 190 pregnant women from 18 public health centers in rural and peri-urban settings. Qualitative data were analyzed manually and with Atlas.ti using a framework approach, and quantitative data of respondents’ demographic information were analyzed with Stata 12.0.ResultsPerceptions of integrating HIV testing with routine antenatal care from women and health providers were generally positive. Respondents felt that integration increased coverage of HIV testing, particularly among difficult-to-reach populations, and improved convenience, efficiency, and confidentiality for women while reducing stigma. Pregnant women believed that early detection of HIV protected their own health and that of their children. Despite these positive views, challenges remained. Providers and women perceived opt out HIV testing and counselling during antenatal services to be compulsory. A sense of powerlessness and anxiety pervaded some women’s responses, reflecting the unequal relations, lack of supportive communications and breaches in confidentiality between women and providers. Lastly, stigma surrounding HIV was reported to lead some women to discontinue services or seek care through other access points in the health system.ConclusionWhile providers and pregnant women view program synergies from integrating HIV services into antenatal care positively, lack of supportive provider-patient relationships, lack of trust resulting from harsh treatment or breaches in confidentiality, and stigma still inhibit women’s care seeking. As countries continue rollout of Option B+, social relations between patients and providers must be understood and addressed to ensure that integrated delivery of HIV counselling and services encourages women’s care seeking in order to improve maternal and child health.

Pilot study of home-based delivery of HIV testing and counseling and contraceptive services to couples in Malawi.

BackgroundHIV counseling and testing for couples is an important component of HIV prevention strategies, particularly in Sub Saharan Africa. The purpose of this pilot study is to estimate the uptake of couple HIV counseling and testing (CHCT) and couple family planning (CFP) services in a single home visit in peri-urban Malawi and to assess related factors.MethodsThis study involved offering CHCT and CFP services to couples in their homes; 180 couples were sampled from households in a peri-urban area of Blantyre. Baseline data were collected from both partners and follow-up data were collected one week later. A pair of male and female counselors approached each partner separately about HIV testing and counseling and contraceptive services and then, if both consented, CHCT and CFP services (pills, condoms and referrals for other methods) were given. Bivariate and multivariate logistic regression analyses were done to examine the relationship between individual partner characteristics and acceptance of the services. Selected behaviors reported pre- and post-intervention, particularly couple reports on contraceptive use and condom use at last sex, were also tested for differences.Results89% of couples accepted at least one of the services (58% CHCT-only, 29% CHCT + CFP, 2% CFP-only). Among women, prior testing experience (p < 0.05), parity (p < 0.01), and emotional closeness to partner (p < 0.01) had significant bivariate associations with acceptance of at least one service. Reported condom use at last sex increased from 6% to 25% among couples receiving any intervention. First-ever HIV testing was delivered to 25 women and 69 men, resulting, respectively, in 4 and 11 newly detected infections.ConclusionsHome-based CHCT and CFP were very successful in this pilot study with high proportions of previously untested husbands and wives accepting CHCT and there were virtually no negative outcomes within one week. This study supports the need for further research and testing of home- and couple-based approaches to expand access to HCT and contraceptive services to prevent the undesired consequences of sexually transmitted infection and unintended pregnancy via unprotected sex.

The role of the regular teacher in a whole school approach to guidance counselling in Ireland

A whole school approach to guidance counselling has been promulgated by Irish policy-makers as a model of good practice in the delivery of guidance counselling in the post-primary sector since the 1998 Education Act (DES, 2005a, 2009, 2012). This approach to guidance counselling provision is viewed as a whole school responsibility where schools are expected to collaboratively develop a school guidance plan to support the needs of their students. The role of the regular teacher in a whole school approach to guidance counselling has received very little attention either in the Irish education system or in empirical research. This article will address this deficit through its discussion of a case study carried out in one school in 2012. It will position the findings from the study in the context of the re-allocation of post-primary guidance counselling provision in the national Budget 2012 that has witnessed the substantive erosion of the guidance counselling service in the last two years.

Improving the counselling skills of lay counsellors in antiretroviral adherence settings: a cluster randomised controlled trial in the Western Cape, South Africa.

Little research has investigated interventions to improve the delivery of counselling in health care settings. We determined the impact of training and supervision delivered as part of the Options: Western Cape project on lay antiretroviral adherence counsellors' practice. Four NGOs employing 39 adherence counsellors in the Western Cape were randomly allocated to receive 53 h of training and supervision in Options for Health, an intervention based on the approach of Motivational Interviewing. Five NGOs employing 52 adherence counsellors were randomly allocated to the standard care control condition. Counselling observations were analysed for 23 intervention and 32 control counsellors. Intervention counsellors' practice was more consistent with a client-centred approach than control counsellors', and significantly more intervention counsellors engaged in problem-solving barriers to adherence (91 vs. 41 %). The Options: Western Cape training and supervision package enabled lay counsellors to deliver counselling for behaviour change in a manner consistent with evidence-based approaches.

Receiving and adhering to lifestyle modification counseling for hypertension: disparities between smokers and nonsmokers.

Hypertensive patients who smoke are in particular need of lifestyle modification counseling because they are at increased risk for poorer outcomes. The authors examined whether hypertensive smokers were more or less likely than nonsmokers to report receiving recommendations for diet, salt intake, exercise, alcohol use, and medication and whether receipt of recommendations was differentially associated with lifestyle changes among smokers vs nonsmokers. In an analysis of data from the 2011 Behavioral Risk Factor Surveillance System on a representative sample of hypertensive adults from 9 US states (N=23,093), smokers were less likely than nonsmokers to report being told by a provider to exercise (odds ratio [OR], 0.66; P<.001) and change their diet (OR, 0.83; P<.05). Receiving dietary recommendations was more strongly associated with self-reported dietary improvements among smokers (OR, 7.08; P<.001) compared with nonsmokers (OR, 4.17; P<.001) P<.01. Delivery of counseling may vary by smoking status. When provided, lifestyle counseling may be equally or more effective for smokers compared with nonsmokers.

Effects of a Genetic Counseling Model on Mothers of Children with Down Syndrome: A Brazilian Pilot Study

Down syndrome occurs in approximately 1:600 live births. Genetic counseling is indicated for these families and may be beneficial for adaptation to the challenges that accompany by this diagnosis. Although the basic counseling goals are similar, there are many models of genetic counseling practiced around the world. The aim of this article is to report the results of a pilot study that evaluated the level of satisfaction with a model of service delivery of genetic counseling practiced in Brazil, the knowledge assimilated about Down syndrome and whether this process resulted in a feeling of well-being and psychological support. Thirty mothers of under 6-month-old children with Down syndrome were interviewed after having two sessions of genetic counseling in a public healthcare service within a period of 30days. A semi-structured questionnaire was developed by the researchers to collect identification, socioeconomic and demographic data and to assess the client's satisfaction with the model of genetic counseling. Data were collected using both open and closed questions. The reported level of satisfaction was high. The knowledge assimilated about Down syndrome after only two sessions was considered technically vague by raters in 44% of cases. Most mothers (96.7%) reported that genetic counseling was beneficial and provided psychological support. The model was considered satisfactory, but further research is needed to identify ways to improve knowledge retention by this population. These results highlight the utility of referring families for genetic counseling when there is a suspicion of a diagnosis of Down syndrome.

Practical considerations in the delivery of genetic counseling and testing services for inherited cancer predisposition

Practical considerations in the delivery of genetic counseling and testing services for inherited cancer predisposition

Conséquences familiales du diagnostic de FXTAS : le conseil génétique aux apparentés à risque

IntroductionFragile X associated Tremor/Ataxia Syndrome (FXTAS) is related to premutation expansions of the FMR1 gene, including 55 to 200CGG repeats, whereas full expansions, over 200 repeats, cause Fragile X mental retardation. FXTAS is observed in about one-third of men with premutation, generally in their 1950s and over, and less commonly in women. It is characterized by action tremor, ataxia, cognitive, parkinsonism, behavioral difficulties, autonomic dysfunction and peripheral neuropathy. Brain magnetic resonance imaging (MRI) often shows symmetric increases in T2-weighted signal intensity in the middle cerebellar peduncles. The diagnosis of FXTAS in a patient raises important family issues. Case reportA 47-year-old male patient complained of an abnormal hearing sensation and dizziness for several months. Neurological examination was normal. Brain MRI showed the common signal intensity in middle cerebellar peduncles and bilateral punctual increases in T2-weighted signal intensity in the cerebral white matter. Genetic analysis showed 87CGG repeats, in favor of a possible FXTAS. At the time of diagnosis, fragile X syndrome was subsequently suspected and confirmed in his 10-month-old grandson. DiscussionDue to X-linked inheritance and to the specific related mutational mechanism, the diagnosis of FXTAS in a patient raises major issues for relatives over several generations, including males and females, who should be considered as obligate or potential premutation carriers. Premutated females are not only at risk of transmitting a full mutation to their children but also of developing Fragile X related premature ovarian failure (FXPOI) that may influence their choices in family planning. ConclusionThe diagnosis of FXATS in a patient should induce delivery of extensive information and genetic counseling for potential carrier relatives.