In-depth Counseling Research Articles

Women's experiences of, and preferences for, postpartum contraception counselling.

The lack of access to and uptake of postpartum contraception is a key contributor to an estimated 121million unintended pregnancies worldwide. Research on counselling and women's preferences for postpartum contraception is scarce in Australia. We therefore aimed to explore Australian women's experiences of, and preferences for, accessing postpartum contraceptive counselling. In this qualitative study, English-speaking women of reproductive age (18-40years) with at least one child under the age of 5years were recruited via social media to participate in a semi-structured telephone interview. Interviews focussed on women's experiences of, and preferences for, postpartum contraception. The interviews were audio-recorded, transcribed, coded and thematically analysed. Twenty women participated. Most did not receive in-depth contraceptive counselling antenatally or postnatally, though had brief discussions with their GPs or obstetricians at the 6-week postnatal check. Participants felt some counselling throughout their antenatal and postnatal care would have been useful, particularly those who experienced medical complications perinatally. Most participants expressed a general preference for their GP or a midwife to provide such counselling, rather than an obstetrician or nurse, and they noted characteristics such as compassion, trust and care as being particularly important. The provision of postpartum contraceptive counselling could be enhanced in Australia. Contraceptive uptake in the postpartum period may be promoted by ensuring consistent and routine provision of contraceptive counselling for women antenatally and postnatally by their maternity carers.

Design and Implementation of Mental Health Consultation System for Primary and Secondary School Students Based on Credibility Matching Model.

Primary and secondary schools have the enormous responsibility of developing talent over a hundred years, and they should not only be concerned with the moral, ideological, and cultural development of teenagers but also with their mental well-being. We need to start by making the external environment better, provide in-depth psychological counseling, and support students as they work to continually increase their psychological adaptability in order to promote the healthy development of their personalities. As the epidemic situation in China has now stabilized into a normal state of prevention and control, it is imperative to provide primary and secondary school students with mental health education. In light of this context, this paper develops a browser-server network architecture-based consultation system for the mental health of students in primary and secondary schools. It eliminates the conventional booking mode and substitutes credibility as the characteristic programming parameter. The performance of the original system is improved by the reliability model the most when the parameter is set to 0.2, and the recovery rate rises by 1.32 percent. Compared to the original reliability model, which improved the system's F value performance by 0.83 percent, the accuracy rate only declines by 0.68 percent while F rises by 0.37 percent. This research is crucial for creating an information campus and raising the standard of psychological counseling.

Developing a WhatsApp hotline for female entertainment workers in Cambodia: a qualitative study.

Female entertainment workers (FEWs) in Cambodia experience high levels of stress due to economic hardship, exposure to violence, and harassment by law enforcement due to their employment. This study aims to gather qualitative data on stressors, coping strategies, and preferences for chatline functions to inform the development of a WhatsApp hotline (chatline) for FEWs in Cambodia. This qualitative study includes data from 5 focus groups and 10 in-depth interviews (IDIs), at which point data collectors felt we approached saturation. Participants were asked to respond to open-ended questions, a comic strip showing how the hotline might work and an audio recording of a hypothetical hotline conversation. Primary structural coding was used to identify the preferred functions and type of support participants want to receive from hotline staff. As more secondary themes arose during codebook development, an inductive thematic analytical approach was selected to categorize these data. Participants identified several stressors associated with female entertainment work, including concerns about physical and mental health, fear related to experiences with the police or threat of arrest, and exposure to violence. Passive/avoidance and active coping strategies were also identified. Participants preferred a 24 h chatline that provides emotional support from a kind and comforting female staff person. The types of support participants were looking for were advice about personal problems, encouragement to achieve their goals and address depression, and immediate help for violence. Most participants felt that the hotline could bring them a sense of relief and safety and improve their mood. Some stated that the hotline alone would not alleviate the stressors they were exposed to, particularly related to violence and called for more transformational change. This study offers textured evidence to inform the WhatsApp hotline development and staff training tailored to meet the needs of this specific population. Linking this hotline with crisis response, legal support, and longer-term in-depth counseling and using information gathered from this project to inform more extensive structural and policy-level changes should also be part a foundational part of this project.

Missed opportunities in contraceptive counselling: findings from a European survey-based study with simulated patient consultation

Purpose Available evidence highlights unmet needs in contraceptive counselling practices. This study aimed to understand current practises and clinician behaviour across Europe. Methods A novel, online approach was used to simulate contraceptive counselling discussions based on three, predefined patient types with a hidden need: poor compliance (patient X), headaches (Y) or desire for a hormone-free option (Z). Clinicians were asked to provide guidance about a contraceptive method for their randomly assigned patient at two time points: (1) after a simulated discussion, (2) after seeing a full patient profile. Descriptive statistical analyses included evaluation of the clinicians’ counselling approach and a change in contraceptive recommendation thereof. Results Out of 661 clinicians from 10 participating European countries, including obstetricians/gynaecologists, midwives and general practitioners, most failed to uncover patient X and Y’s hidden needs (78.8% and 70.5%, respectively), whereas, 63.4% of clinicians uncovered patient Z’s hidden need. Clinicians who uncovered their patients’ hidden needs asked significantly more questions than those who did not (range of mean, 5.1–7.8 vs 1.5–2.2 respectively). Clinicians were more likely to recommend a change of prescription after seeing the full patient profile than after the simulated discussion (increase in prescription change, range: 12.3–30.2%), indicating that clinicians rely on patients speaking up proactively about any concerns. Conclusions Insufficient existing counselling practices result in missed opportunities for shared decision-making and discussion. Clinicians and contraceptive counselling services should empower women by introducing more in-depth contraceptive counselling, incorporating clear, open-ended questions, to improve patient adherence and enhance reproductive planning.

Relationship between Family Income and Support for Health Workers on Exclusive Breastfeeding in Indragiri Hulu District

Exclusive breastfeeding (ASI) is the practice of breastfeeding without giving the baby any other food or drink other than breast milk. Exclusive breastfeeding is the basis for the continuity of the child's life and health because breast milk is irreplaceable for its nutrition for the growth and development of children. A country is said to be developed if the infant mortality rate is low and the health status is good. Breastfeeding is important because the amount of breast milk is needed by babies until the age of 6 months, by breastfeeding can reduce infant mortality. This study aims to determine the relationship between family income and support for health workers on exclusive breastfeeding in Indragiri Hulu District. The type of research used is observational quantitative using a cross sectional research design. The number of samples was 173 mothers who had babies aged 6-8 months. Research analysis was conducted using bivariate test. The results showed that there was a relationship between family income (p=0.005) and exclusive breastfeeding. There was no relationship between the support of health workers on exclusive breastfeeding (p=0.410). It is recommended for health workers to conduct more in-depth counseling, especially counseling about what the true meaning of exclusive breastfeeding for babies is when pregnant women are born until their babies are born and can increase the coverage of exclusive breastfeeding in Indragiri Hulu District. Keywords: Family Income, Support for Health Workers, Exclusive Breastfeeding.

Effectiveness of a Multicomponent Strategy for Implementing Guidelines for Treating Tobacco Use in Vietnam Commune Health Centers.

Strategies are needed to increase implementation of evidence-based tobacco dependence treatment (TDT) in health care systems in low-and middle-income countries (LMICs). We conducted a two-arm cluster randomized controlled trial to compare the effectiveness of two strategies for implementing TDT guidelines in community health centers (n = 26) in Vietnam. Arm 1 included training and a tool kit (eg, reminder system) to promote and support delivery of the 4As (Ask about tobacco use, Advise to quit, Assess readiness, Assist with brief counseling) (Arm 1). Arm 2 included Arm 1 components plus a system to refer smokers to a community health worker (CHW) for more intensive counseling (4As + R). Provider surveys were conducted at baseline, 6 months, and 12 months to assess the hypothesized effect of the strategies on provider and organizational-level factors. The primary outcome was provider adoption of the 4As. Adoption of the 4As increased significantly across both study arms (all p < .001). Perceived organizational priority for TDT, compatibility with current workflow, and provider attitudes, norms, and self-efficacy related to TDT also improved significantly across both arms. In Arm 2 sites, 41% of smokers were referred to a CHW for additional counseling. The study demonstrated the effectiveness of a multicomponent and multilevel strategy (ie, provider and system) for implementing evidence-based TDT in the Vietnam public health system. Combining provider-delivered brief counseling with opportunities for more in-depth counseling offered by a trained CHW may optimize outcomes and offers a potentially scalable model for increasing access to TDT in health care systems like Vietnam. Improving implementation of evidence-based TDT guidelines is a necessary step toward reducing the growing burden of noncommunicable diseases and premature death in LMICs. The findings provide new evidence on the effectiveness of multilevel strategies for adapting and implementing TDT into routine care in Vietnam and offer a potentially scalable model for meeting Framework Convention on Tobacco Control Article 14 goals in other LMICs with comparable public health systems. The study also demonstrates that combining provider-delivered brief counseling with referral to a CHW for more in-depth counseling and support can optimize access to evidence-based treatment for tobacco use.Clinical trials number: NCT01967654.

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.

This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation. The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for making recommendations. The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI); an increase in lowest oxygen saturation (LSAT) and sleep quality; and an improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI and an increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, and ODI and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggested that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. Kent D, Stanley J, Aurora RN, etal. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(12):2507-2531.

Importance of pharmacist-patient relationship in people living with HIV and concomitant opioid use disorder

BackgroundPLWHA commonly suffer from chronic pain that is often treated with opioids, leading to subsequent opiate use disorders. As the majority of Americans live in close proximity to a pharmacy, community pharmacists are well equipped to interact with PLWHA. Few data quantify the needs of PLWHA with OUD, or how they utilize community pharmacists. ObjectivesTo characterize the perceptions of Persons Living with HIV/AIDS (PLWHA) and using opioid medications on the interaction with pharmacists. MethodsFor this study, a qualitative approach was used. A key purpose of interviews is to encourage and inspire the subject to share a significant event of his/her life with the interviewer. Recruitment for face-to-face interviews with PLWHA continued until saturation was achieved. The Theory of Planned Behavior was used to assess the findings from this study. Sixteen interviews were transcribed verbatim and content analysis was performed by two researchers using Dedoose®, a qualitative software. Codes were grouped based on similarities into categories that facilitated the emergence of themes. ResultsContent analysis revealed two major themes. The first theme presents the subjects' beliefs and opinions about pharmacists' interactions when picking up their opioid prescriptions. Several subjects described encounters with the pharmacists that facilitated a trustful relationship. In the second theme, the analysis showed that the relationship with community pharmacists could be improved by having a more in-depth counseling about opioid medication and abuse. ConclusionsThese data highlight how PLWHA would like to interact with pharmacists when picking up opioid prescriptions. These results depicted how some subjects are using the pharmacists as a vital resource for medication information. These findings also demonstrated how for some subjects a more detailed counseling session when they receive opioid medications could be crucial in changing their behavior. Thus, community pharmacists are well positioned to reduce the usage of opioid medications and change PLWHA behavior and attitudes toward opioid prescriptions.

Client and Provider Experiences in Uganda Suggest Demand for and Highlight the Importance of Addressing HIV Stigma and Gender Norms Within Safer Conception Care.

Safer conception counseling supports HIV-serodifferent couples to meet reproductive goals while minimizing HIV transmission risk, but has not been integrated into routine HIV care. We piloted a novel safer conception program in an established public-sector HIV clinic in Uganda to inform future implementation. In-depth interviews and counseling observations explored experiences of program clients and healthcare providers to assess program acceptability, appropriateness, and feasibility. Fifteen index clients (8 women, 7 men), 10 pregnancy partners, and 10 providers completed interviews; 15 participants were living with HIV. Ten observations were conducted. We identified four emergent themes: (1) High demand for safer conception services integrated within routine HIV care, (2) Evolving messages of antiretroviral treatment as prevention contribute to confusion about HIV prevention options, (3) Gender and sexual relationship power inequities shape safer conception care, and (4) HIV-related stigma impacts safer conception care uptake. These findings confirm the need for safer conception care and suggest important implementation considerations.

Physical activity counseling to cancer patients: How are patients addressed and who benefits most?

ObjectiveThis study examined cancer patients’ reporting on physicians’ physical activity (PA) counseling, its associations with patients’ PA, and comparisons of patients’ and physicians’ reports of the type(s) of PA counseling provided. MethodsPatients with breast, colorectal, or prostate cancer (n = 1206) participated in a nationwide cross-sectional study. Cancer patients’ sociodemographic and treatment-related characteristics as well as self-reported PA levels (pre- and post-diagnosis) were assessed. PA counseling was queried according to the counseling steps of the 5As framework (Assess/Advise/Agree/Assist/Arrange). For a subsample (n = 135), matched patient-physician data were available. ResultsPatient-reported PA counseling was categorized into “no counseling” (indicated by 20.8% of participants), “basic counseling” (Assess and/or Advise; 58.8%), and “in-depth counseling” (Agree, Assist, and/or Arrange; 20.4%). “In-depth counseling” was associated with an increase in PA levels pre- to post-diagnosis. This relationship was enhanced for patients with metastases. There were low agreements between patients’ and physicians’ reporting of PA counseling steps. ConclusionIn-depth PA counseling is rarely provided to cancer patients but seems to be required to affect PA levels. Patients often report receiving less intensive PA counseling than reported by their physician. Practice implicationsPhysicians should be enabled to provide routine in-depth PA counseling to all patients with cancer.

Applying genomic and transcriptomic advances to mitochondrial medicine.

Next-generation sequencing (NGS) has increased our understanding of the molecular basis of many primary mitochondrial diseases (PMDs). Despite this progress, many patients with suspected PMD remain without a genetic diagnosis, which restricts their access to in-depth genetic counselling, reproductive options and clinical trials, in addition to hampering efforts to understand the underlying disease mechanisms. Although they represent a considerable improvement over their predecessors, current methods for sequencing the mitochondrial and nuclear genomes have important limitations, and molecular diagnostic techniques are often manual and time consuming. However, recent advances in genomics and transcriptomics offer realistic solutions to these challenges. In this Review, we discuss the current genetic testing approach for PMDs and the opportunities that exist for increased use of whole-genome NGS of nuclear and mitochondrial DNA (mtDNA) in the clinical environment. We consider the possible role for long-read approaches in sequencing of mtDNA and in the identification of novel nuclear genomic causes of PMDs. We examine the expanding applications of RNA sequencing, including the detection of cryptic variants that affect splicing and gene expression and the interpretation of rare and novel mitochondrial transfer RNA variants.

Effect of Counseling Packages on The Diet of Pregnant Women With Chronic Energy Deficiency

Pregnancy is the most important of nutrition of each woman's lifetime. Proper nutrient intake during this period has an important role in fetal development. This type of research is a quasy experiment that researchers measure variables before a counseling package. The design of this study is Observational Analytics. The sample in this study used non probability sampling te type namely 30 pregnant women who experienced chronic energy deficiency. Data collection using cheklis food recal. The data analysis technique to be used with T-Test. The results of the studya value of p=0.001 (&lt;0.05) can be concluded that Ho was rejected and Ha accepted which means there is a very significant difference between the diet of respondents before and after the provision of counseling packages. It is expected for midwives to provide more in-depth counseling and continuous monitoring to pregnant women who are chronically deficient.&#x0D; Keywords : pregnancy, chronic energy deficiency, counseling

Preferences of healthcare professionals regarding hexavalent pediatric vaccines in Italy: a survey of attitudes and expectations.

SummaryIntroductionIn Italy, three hexavalent pediatric vaccines are available: two are ready-to-use (RTU) as pre-filled syringes, while the third must be reconstituted (need-for-reconstitution [NFR]). The formulation is related to the vaccination timing, safety of preparation and administration, and possible errors in immunization. We surveyed Italian healthcare professionals (HCPs) experienced with RTU and NFR vaccines in order to investigate their opinions on key aspects of the vaccines.MethodsIn Q1 2018, a qualitative study, ethnographic observations and in-depth interviews were performed in public vaccination settings of three Italian Regions. Data on how the vaccination process was managed and perceptions about the value of the RTU formulation were collected. In Q2 2018, face-to-face interviews were carried out to explore the attitude and preferences of Italian HCPs from nine Regions, assessing advantages and disadvantages of the two formulations from a quantitative point of view. In Q3-Q4 data analysis was carried out, using both qualitative and quantitative methodologies.ResultsThe first phase demonstrated the following advantages of the RTU versus the NFR formulation: time-saving, lower probability of needle contamination and needle stick incidents, better handling, simpler procedure, easier disposal of waste. For the survey, 149 HCPs were interviewed; 80% and 40%, respectively, were very satisfied with the RTU and NFR vaccine.ConclusionsOur study demonstrated that HCPs prefer the RTU formulation, as it simplifies vaccinations, reduces preparation time and minimizes the risk of errors. This formulation also saves time that can be spent on more in-depth counseling.

The Effects Of An Antenatal Lifestyle Intervention On Pregnancy Outcomes In Overweight And Obese Pregnant Women

Three reviews of antenatal behavioral lifestyle interventions did not find significant intervention effects on maternal complications and adverse neonatal outcomes, perhaps due to the inclusion of low to medium quality studies. PURPOSE: To evaluate the effect of a lifestyle intervention program on pregnancy outcomes in overweight and obese pregnant women. METHODS: This study was a randomized controlled trial. Overweight and obese pregnant women were recruited from Columbia, South Carolina and were randomized to a behavioral intervention group (n=110) or to a standard care group (n=104). The antenatal intervention was designed to target weight self-monitoring, increasing physical activity, and increasing healthy dietary behavioral practices. Intervention contents were delivered through one in-depth counseling session, followed by phone counseling, behavioral podcasts, and social media support. Standard care women received monthly mailings and a match number of podcasts on non-weight related topics. RESULTS: Our study population was racially diverse (56% white, 44% African American) with a mean prepregnancy BMI of 32.2±5.9 and was 12.7±2.4 wks gestation at baseline. Compared to standard care women, women in intervention group had lower percentages of gestational hypertension (9.1 vs. 21.2%, p=0.01) and delivering a low birth weight baby (<2500g) (1.9 vs. 10.6%, p=0.009). These women also had lower percentages of gestational diabetes (7.3 vs. 12.5%) and delivering a preterm baby (<37 wks of gestation)(2.8 vs. 7.7%), although these differences were not significant at the 0.05 level. No group differences were found in other outcomes (i.e., cesarean deliveries, macrosomia births (birthweight ≥4000g), and Apgar scores). CONCLUSIONS: An antenatal behavioral lifestyle intervention designed to reduce gestational weight gain was beneficial in improving pregnancy outcomes in overweight and obese pregnant women. Future analyses will examine mechanisms for this effect.

Pendampingan Remaja di Kabupaten Kuningan Jawa Barat dalam Penggunaan Media Sosial Instagram sebagai Pelestarian Budaya

Masuknya era 4.0 sekarang ini atau dikenal sebagai era disrupsi yang mengharuskan beragam aspek untuk maju dan dapat mengikuti perkembangan kemajuan teknologi. Dibutuhkan inovasi, problem solving, dan kreatif untuk menghadapi era disrupsi ini. Salah satu aspeknya adalah promosi kebudayaan Indonesia sebagai identitas diri bangsa yang masih terbatas menggunakan beragam media konvensional, dimana harus segera dirubah. Media jejaring sosial merupakan sarana yang efektif untuk mempromosikan beragam budaya nusantara, pengguna muda mendominasi pengguna internet di Indonesia, terutama media jejaring sosial. Pada program pengabdian masyarakat kali ini, memberikan pemahaman berupa penyuluhan secara mendalam mengenai identitas dan pelestarian nilai budaya lokal, dilanjutkan dengan pelatihan penggunaan media sosial, khususnya Instagram untuk meningkatkan kesadaran remaja milenial dan Gen Z akan pelestarian budaya lokal yang mereka miliki. Adanya pelatihan dan penyuluhan penggunaan media sosial sebagai pelestarian budaya lokal yakni Kuningan, Jawa Barat melalui promosi budaya lokal dengan Instagram sebagai medianya, diharapkan setelah mengikuti pelatihan mereka mampu mengimplementasikan Instagram sebagai sarana promosi budaya lokal Kuningan.

Studying the impact of a medication use evaluation by the community pharmacist (Simenon): Drug-related problems and associated variables.

A medication use review (MUR) aims to optimize medication use, patient knowledge and can improve health outcomes. This pharmaceutical care service is not yet available in Belgium. To describe drug-related problems (DRPs) detected during a MUR, subsequent interventions proposed by pharmacists and evolution of DRPs until follow-up and to identify patient-related variables associated with the number of reported DRPs. Belgian community pharmacists provided a MUR to older polymedicated ambulatory patients and registered DRPs, interventions and resolution at follow-up using the PharmDISC classification. The relationship between 14 patient-related variables and the number of reported DRPs was investigated with univariate analysis. A prediction model was developed with significant variables using negative binomial regression analysis. Across 56 pharmacies, 453 patients received a MUR and 1196 DRPs were registered (median 3DRPs/patient, range 0-10). Only for 11.7% of patients no problems were identified. The top-3 causes were interaction (15.2%), inappropriate timing or frequency (13.5%) and adverse effect (11.9%). The top-3 recommended interventions by pharmacists were transmission of information (25.1%), in-depth patient counselling (15.0%) and therapy stop (8.2%). After six weeks, 42.6% of DRPs were resolved; data was missing for 33.3%. A higher number of chronic drugs, female gender and living alone were associated with more DRPs. The prediction model found that per additional chronic drug, the number of problems increases by 4.3% (95% CI: 2.0-6.6%). Male gender decreases DRPs by 22.1% (95% CI: 10.4-32.0%). Living alone provided no additional predictive value in the prediction model. Confounding process- and pharmacist-related variables also influenced the number of reported DRPs. A MUR appears an effective strategy to detect and resolve DRPs. The number of chronic medications and female gender predict a higher number of DRPs. These findings are a starting point for evidence-based eligibility criteria for a MUR service in Belgium.

Psychosocial Effects of Multigene Panel Testing in the Context of Cancer Genomics.

In recent years, with both the development of next-generation sequencing approaches and the Supreme Court decision invalidating gene patents, declining costs have contributed to the emergence of a new model of hereditary cancer genetic testing. Multigene panel testing (or multiplex testing) involves using next-generation sequencing technology to determine the sequence of multiple cancer-susceptibility genes. In addition to high-penetrance cancer-susceptibility genes, multigene panels frequently include genes that are less robustly associated with cancer predisposition. Scientific understanding about associations between many specific moderate-penetrance gene variants and cancer risks is incomplete. The emergence of multigene panel tests has created unique challenges that may have meaningful psychosocial implications. Contrasted with the serial testing process, wherein patients consider the personal and clinical implications of each evaluated gene, with multigene panel testing, patients provide broad consent to whichever genes are included in a particular panel and then, after the test, receive in-depth genetic counseling to clarify the distinct implications of their specific results. Consequently, patients undergoing multigene panel testing may have a less nuanced understanding of the test and its implications, and they may have fewer opportunities to self-select against the receipt of particular types of genetic-risk information. Evidence is conflicting regarding the emotional effects of this testing.

Improved unhealthy lifestyle habits in patients with high cardiovascular risk: results from a structured lifestyle programme in primary care

Background. Physical activity, healthful dietary habits, and not smoking are associated with reduced cardiovascular morbidity and mortality. However, few studies have examined how counselling to improve poor lifestyle habits might be carried out in clinical practice. In Swedish primary care, structured lifestyle counselling is still not integrated into everyday clinical practice. The aim of the present study was two-fold: (1) to describe a novel lifestyle intervention programme in primary care; and (2) to evaluate change in unhealthy lifestyle habits over 1 year in men and women with high cardiovascular risk who participated in the lifestyle intervention programme.Method. A single-group study with a 1-year follow-up was carried out. A total of 417 people was enrolled, median age 62 years (54% women), with either hypertension (69%), type 2 diabetes mellitus, or impaired glucose tolerance. The 1-year intervention included five counselling sessions that focused on lifestyle habits, delivered by a district nurse with postgraduate credits in diabetes care and the metabolic syndrome. All patients were offered in-depth counselling for one or more lifestyle habits when needed. Lifestyle habits were assessed by a questionnaire at baseline and 1-year follow-up. Total change was assessed using a nine-factor unhealthy lifestyle habit index.Results. Favourable, significant changes were observed for physical activity, dietary habits, smoking, and stress over 1 year. Similar improvements were seen for both sexes and type of diagnosis.Conclusions. The results support the utility of a multifactorial, structured approach to change unhealthy lifestyle habits for cardiovascular risk prevention in a primary care setting.

A clinic-based tablet application to support safer conception among HIV serodiscordant couples in Kenya: feasibility and acceptability study.

HIV serodiscordant couples are at heightened risk of HIV transmission when attempting to conceive, yet reproductive goals can outweigh concerns about HIV exposure. Safer conception strategies support fertility desires while minimizing HIV transmission risk and novel mHealth tools can optimize their use. The objective of this analysis is to examine the feasibility and usability of short message service (SMS) messages and a mobile application to support safer conception for HIV serodiscordant couples. We enrolled 74 heterosexual HIV serodiscordant couples with immediate pregnancy desires into a pilot safer conception intervention study in Thika, Kenya. Prior to pregnancy, women received daily 6-item SMS surveys to capture fertility indicators (e.g., menses, basal body temperature) and sexual behavior. The intervention also provided daily oral pre-exposure prophylaxis (PrEP) for the HIV-negative partner and in-depth counseling to accompany publicly-provided antiretroviral therapy (ART) for the HIV-infected partner. Couples attended monthly visits until pregnancy occurred. We measured PrEP use with medication event monitoring system (MEMS) caps and ART use via quarterly viral load quantification. We imported SMS, MEMS, and viral load data into an Android tablet application designed specifically for this setting for couples to view during clinic visits and included predictions of peak fertility days using SMS data. We used descriptive statistics to summarize SMS response data and developed a Google Analytics platform to monitor tablet application usage during follow-up. We also conducted semi-structured interviews with a purposive sample of 5 healthcare providers and 19 couples. Qualitative data were analyzed using a modified constant comparative approach to identify themes related to mHealth intervention feasibility and acceptability. In our sample, 34 (45.9%) couples had an HIV-infected female partner. The median age of the female partner was 30 years [interquartile range (IQR), 27-35 years], education was 10 years (IQR, 8-12 years), and partnership duration was 3 years (IQR, 2-7 years). Couples were followed for a median of 218 days (IQR, 116-348 days) prior to pregnancy. Participants completed 13,181 of 16,905 (78.0%) SMS surveys surveys sent with a median of 167 completed surveys (IQR, 74-299) per participant. Most participants completed at least 75% of the total SMS messages received (N=58; 77.3%). The tablet application was opened by counselors 1,806 times during the study period (March 2016 through April 2018). In qualitative interviews, the SMS messages were reportedly easy to respond to and "part of the daily routine". Few participants had concerns about message confidentiality. mHealth tools were also found to be acceptable for tracking fertility indicators and enhancing provider-patient communication. mHealth strategies are feasible to use and acceptable to support the delivery of safer conception intervention services among HIV serodiscordant couples in Kenya.

Mothers' Experiences with Neonatal Care for Low Birth Weight Infants at Home; A Qualitative Study in the Hohoe Municipality, Ghana

PurposeTo explore knowledge and beliefs of mothers on low birth weight (LBW), examine care provision at home and societal perceptions of LBW infants. Design and methodsThis qualitative study was conducted using hermeneutic phenomenological approach. Data of mothers who delivered LBW infants within 2 years preceding the study were purposively extracted from the medical records of the Hohoe Municipality Hospital in Ghana. Twenty semi-structured interviews and three focus group discussions were conducted. A thematic analysis approach was performed using Atlas.ti. ResultsMothers identified and described LBW babies based on frailty, size and activity levels. LBW recognition was easier for multiparous mothers by comparing with previous deliveries. LBW was linked to poor maternal diet, diseases during pregnancy and heavy workload. Although most mothers perceived their LBW babies as healthy irrespective of the size a few home-care practises differed. Smaller LBW infants were less likely to be socially accepted. In the first few weeks after birth the care of LBW infants is the core responsibility of grandmothers. Primiparous mothers and those whose infants were smaller (<2 kg) quested for more information and support on LBW newborn care at home. ConclusionThere is a need to increase knowledge on risk factors and tackle lapses in the recognition and care of LBW infants. Counselling on recommended neonatal care should begin during antenatal care and reiterated during postnatal care. Practical implicationTailored in-depth and culturally-adapted counselling, discharge instructions and home-based postnatal visits targeted at LBW infants and their primary caregivers could improve care.