Counseling Intervention Research Articles

Prevalence Estimate for Adjustment Disorders in the South African Navy.

Adjustment Disorder is among the most commonly diagnosed mental disorders in the armed forces, with a mean prevalence estimated at 7.4% across military populations. The prevalence in South African military populations is not known. This study aimed to estimate the prevalence of Adjustment Disorders in the South African Navy and to explore potential risk factors. In this cross-sectional study, a representative sample of 714 sailors completed the International Adjustment Disorder Questionnaire, and also provided information from their biennial occupational health assessment mental health screening, which included other clinical screeners of mental health and adjustment history. The estimated prevalence of Adjustment Disorders in the South African Navy was 6.9%, and was proportionally distributed across gender and age categories. Depression and PTSD were the main comorbid conditions. Risk factors included a) history of adjustment difficulties during military deployment or family adjustment difficulties, b) domestic discord (difficulties in relationship with spouse/partner or immediate family), and c) the experience of stress overload (i.e., that the demands of life are overwhelming available resources). The estimated prevalence was similar to the expectation of military personnel generally, although the self-report data needs to be interpreted cautiously. The contributing risk factors offer possible direction for targeted intervention, e.g., skills training and relationship counselling to enhance coping with military service and family challenges, and cognitive behaviour therapy generally to address sailors' experience of stress overload.

Strengthening contraceptive counselling services to empower clients and meet their needs: protocol for a two-stage, multiphase complex intervention in Pakistan and Nigeria

BackgroundHigh-quality contraceptive counselling can accelerate global efforts to reduce the unmet need for and suboptimal use of modern contraceptives. This study aims to identify a package of interventions designed to...

The Importance of Counseling Interventions for Early Childhood in Improving Emotional and Social Well-Being: A Literature Review

This study looks at how important counseling is for improving the emotional and social health of young children. We evaluated previous research in this area through a review of the literature, highlighting the benefits of counseling in the child's early developmental stages. This study found that timely and targeted counseling interventions in early childhood can improve emotional well-being, social development, and academic achievement. The focus of such interventions is often a counseling approach that is play-based, involves the family, and supports the child's independence. Counseling has also been shown to help young children avoid more serious behavioral or emotional problems in the future. The practical implications of these findings highlight the importance of a holistic approach to supporting early childhood development and highlight the need for investment in mentoring resources at the early childhood education level.

Optimizing Blood Pressure Management in Type 2 Diabetes: A Comparative Investigation of One-Time Versus Periodic Lifestyle Modification Counseling.

Background Type 2 diabetes mellitus (T2DM) often coexists with hypertension, significantly increasing cardiovascular risks. Lifestyle modification counseling has shown promise in managing T2DM and its comorbidities. However, the optimal frequency and structure of counseling for blood pressure control remain uncertain. Our study examines the best approach for managing blood pressure in T2DM patients by comparing the outcomes of two counseling strategies: a single session and periodic counseling over time. Methodology A total of 110 diabetic patients were enrolled, with 52 patients in each group after loss to follow-up.A randomized controlled trial compared one-time counseling (control) to six months of periodic counseling (intervention) on lifestyle modification. A weighing machine, stadiometer, 24-hour dietary recall, food frequency questionnaire, biochemical blood sugar level analysis, and telephonic follow-up were the essential tools used. The data were analyzed using SPSS version 24.0 (IBM Corp., Armonk, NY, USA), employing descriptive statistics, including frequencies, percentages, graphs, mean, and standard deviation. Statistical significance at the 5% level was tested using probability (p) calculations. The Kolmogorov-Smirnov test confirmed normal distribution (p > 0.05). Parametric tests, specifically independent t-tests, were used for between-group comparisons of continuous variables, while categorical variables were analyzed using the chi-square test or Fisher's exact test. Intragroup comparisons over time employed repeated-measures analysis of variance for continuous variables. Changes within groups after six months were assessed using paired t-tests. All statistical analyses adhered to a significance level of p < 0.05. Results The gender distribution at baseline was similar between the control (55.8% male, 44.2% female) and intervention (46.2% male, 53.8% female) groups, with no significant differences (p = 0.327).The mean weight was 66.67 ± 11.51 kg in the control group and 67.14 ± 11.19 kg in the intervention group (p = 0.835), and the body mass index was 25.61 ± 4.09 kg/m² and 26.29 ± 6.01 kg/m², respectively (p = 0.503).Clinical parameters such as fasting blood sugar, postprandial blood sugar, glycosylated hemoglobin, and blood pressure showed no significant differences between the control and intervention groups at baseline (p > 0.05).After six months, the intervention group exhibited a trend toward lower blood pressure compared to the control group, but the differences were not statistically significant. The mean systolic blood pressure was 132.15 ± 14.867 mmHg in the control group and 129.15 ± 9.123 mmHg in the intervention group (p = 0.218). Changes in blood pressure over the six-month period showed significant decreases within the intervention group, while changes in the control group did not reach statistical significance. The mean difference in systolic blood pressure in the intervention group was 5.54 ± 9.77 mmHg (p = 0.0001), indicating a notable reduction, while the control group had a smaller and statistically insignificant increase of 2.308 ± 9.388 mmHg (p = 0.082). Conclusions This study addresses a significant gap in the literature by comparing the efficacy of one-time vs. periodic counseling in T2DM management. While periodic counseling shows promise in improving diastolic blood pressure, further research is needed to understand its nuanced effects and optimize lifestyle interventions for T2DM patients.

Sexual Self-Identification Offsets and Self-Stigma Moderates: Expanding the Rejection-Identification Model to Examine Stigma’s Effects on Well-Being Among Gay and Bisexual Men

ABSTRACT Gender and sexual minorities still face stigma-related stress from all areas of society. The rejection-identification model (RIM) proposes that some stigmatized individuals may respond to the negative effects of stigma on well-being by enhancing their self-identification. However, this does not apply to all gender and sexual minorities. Grounded in minority stress theory and the RIM, this study examined how stigma-related stressors (i.e. perceived stigma and self-stigma) and their associated mechanisms impact sexual self-identification and subjective well-being. A total of 366 Chinese gay and bisexual men were included in the study. The results showed that sexual self-identification, as a protective factor, mediated the association between perceived stigma and subjective well-being. Furthermore, the indirect effect of the mediation model was moderated by self-stigma, such that the indirect effect of perceived stigma on subjective well-being through sexual self-identification was the highest among Chinese gay and bisexual men with low self-stigma. Given that research into the mental health and well-being of Chinese gay and bisexual men is still in its infancy, our findings are important and may help in developing and improving socially and psychologically sensitive counseling services or intervention strategies for these populations.

Maternal and child health intervention to promote behaviour change: a population-level cluster-randomised controlled trial in Honduras

ObjectivesTo assess the efficacy of a sustained educational intervention to affect diverse outcomes across the pregnancy and infancy timeline.SettingA multi-arm cluster-randomised controlled trial in 99 villages in Honduras’ Copán region,...

Communicating cardiovascular health information and improving coordination with primary care: A Childhood Cancer Survivor Study randomized trial.

10011 Background: Childhood cancer survivors are at risk of early cardiovascular disease (CVD). We conducted a survivorship care plan (SCP)-based counseling intervention to improve CVD risk factor control in adult-aged survivors. Methods: Randomized (1:1) trial of survivors at high CVD risk based on history of anthracycline or chest radiotherapy exposures with undertreated hypertension (≥130/80 mmHg), dyslipidemia (LDL ≥160 mg/dL or triglyceride ≥200 mg/dL), and/or glucose intolerance (threshold varied if history of pre-diabetes or diabetes) based on in-home testing. Approximating a survivorship clinic visit, the intervention consisted of a remotely delivered session with an advanced practice provider to review results, a SCP with personalized CVD risk information, and an action plan to help manage CVD risk factors. A remote booster session was provided 4 months later with the action plan updated. Control participants only received a copy of their in-home results with abnormalities noted and written encouragement to follow-up with their primary care provider (PCP). Blood pressure, lipid profile, and glucose tolerance were retested after 1y. For both groups, all participant materials were sent to PCPs throughout the study, and PCP medical records were abstracted at study completion. Logistic regression assessed the odds ratio (OR) for undertreatment at 1y associated with the intervention, adjusting for pre-specified variables (sex, current age, time since cancer, insurance status, recent history of survivorship clinic visit, and undertreated CVD risk factor). Results: Among 644 survivors who completed in-home testing, 347 met inclusion criteria and were randomized (175 intervention; overall 52% male, mean age 40y, 31y since cancer diagnosis); 264 with 1y follow-up (126 intervention). At baseline, rates of hypertension, dyslipidemia, and glucose intolerance were 53%, 52%, and 49%, respectively; 43% had &gt; 1 undertreated condition. Although the intervention achieved &gt; 95% satisfaction, it was not associated with reduced undertreatment vs control (OR 0.9, 95% CI 0.7-1.3). Notably, 48% of intervention and 44% of control participants had less undertreatment after 1y. In secondary analysis, greater internal locus of control was associated with less undertreatment at 1y (OR 0.7, 95% CI 0.6-0.9). The intervention group was more likely than controls to have CVD risk (+10 vs -1%), SCP (+17 vs -2%), and some late effects surveillance plan (+8 vs +2%) documented within PCP records at 1y vs baseline (p &lt; 0.05 for all). Conclusions: While a remotely delivered counseling intervention did not reduce CVD risk factor undertreatment compared with provision of test results alone, both study arms had &gt; 40% reduction in undertreatment. These results suggest that simply providing a formal CVD risk assessment to high-risk cancer survivors and their PCPs may be effective. Clinical trial information: NCT03104543 .

The Influence of Natural Environment on the Effectiveness of Guidance and Counseling at Planet Nufo Nature School Rembang

This study examines the impact of the natural environment on the effectiveness of guidance and counseling at Nufo Planet School, Rembang. The natural environment surrounding educational institutions is increasingly recognized for its potential influence on student well-being and academic achievement. Employing a qualitative approach, the research utilizes interviews and observations to explore how the natural surroundings at Nufo Planet School contribute to guidance and counseling. The findings indicate that the natural environment plays a significant role in enhancing the effectiveness of counseling sessions, creating a supportive atmosphere for emotional expression and psychological support among students. The implications of these findings underscore the importance of integrating natural elements into educational settings to enhance the effectiveness of counseling interventions.

Implementation and evaluation of a fertility preservation telehealth counseling intervention for males with cystic fibrosis

BackgroundMost males with cystic fibrosis (MwCF) have congenital bilateral absence of the vas deferens and require assisted reproductive technology to conceive, yet many have limited knowledge about how CF affects sexual and reproductive health (SRH). This study evaluates the feasibility, acceptability, and potential effectiveness of telehealth fertility preservation (FP) counseling for MwCF. MethodsPre-lung transplant MwCF ≥18 years, recruited from U.S. CF centers, social media, and via snowball sampling, received individualized telehealth counseling. Participants completed intervention feasibility/acceptability one week post-counseling and FP knowledge, care satisfaction, and self-efficacy assessments at baseline and two months post-counseling. We completed acceptability interviews one-week post-counseling and audio-recorded, transcribed, and thematically analyzed results. We descriptively analyzed survey results and conducted pre/post comparisons using paired t-tests. ResultsThirty MwCF (ages 22–49 years) completed counseling. Most were in a relationship (70 %) and White (86.7 %). Telehealth FP counseling was acceptable (M = 4.38/5 ± 0.60), appropriate (M = 4.37/5 ± 0.60), and feasible (M = 4.60/5 ± 0.45) to MwCF. FP knowledge (9.53 vs. 10.40/12; p = .010), care satisfaction (20.23 vs 26.67/32; p<.001), and self-efficacy (22.87 vs 25.20/30; p = .016) improved at two months post-counseling. Despite desiring provider-initiated SRH, wanting children (81 %), and perceiving the CF team as their primary care provider (97 %), 44 % report not receiving information about infertility by the CF team. ConclusionsIntegrating FP counseling into CF care is feasible and acceptable to MwCF and can improve FP knowledge, self-efficacy, and care satisfaction. MwCF desire early and regular provider-initiated SRH education.

Depression Related to COVID-19, Coping, and Hopelessness in Sports Students.

This study aimed to explore the impact of the first two waves of the COVID-19 pandemic on the mental and physical states of sports students from Romania and also to compare the differences according to gender and the type of sport. Initially, in order to collect demographic data and health reports, a cross-sectional survey was developed to evaluate the emotional needs of sports students during the pandemic. After the second wave, the coping strategies used by the participants to fight negative emotions were assessed using the CERQ questionnaire. The results indicate that depression symptoms are the most reported psychological issues among the participants and that there are differences according to gender concerning the cognitive schemas they use in order to reduce the symptoms. Also, it was found that there are differences, corresponding to the type of sport, in choosing adaptive coping mechanisms. Ultimately, it was confirmed that higher levels of hopelessness among sports students are associated with increased vulnerability to substance use, with the correlation between those two indicators being strong. Delving deeper into this relationship can help identify critical points for intervention to prevent substance abuse. At the same time, the dichotomic analysis of the results found as moderators-the gender and the type of sport in decreasing the severity of depression could be an important aspect of the next counseling interventions.

The Effect of Psychosocial Interventions on Gambling Disorder: A Systematic Review

Gambling is an unlawful act that has negative consequences for the life, health, and welfare of individuals, families, and communities. One of the efforts made to reduce the health impacts of gambling is by providing psychosocial interventions. This systematic review aims to examine the effect of various types of psychosocial interventions on gambling disorders. The systematic review was conducted on Clinical Key, Clinical Key for Nursing, Science Direct, ProQuest, Scopus, Sage Journal and Springer Link, Ebsco databases with searches conducted between October - December 2023. Screening articles according to inclusion criteria in the form of full-text articles, English, and published between 2012 and 2023. The initial search results obtained 4,194 articles. Then the initial screening was carried out through reading the title and abstract so that 215 articles were left to be processed to the next stage. In the next stage, the author checked the duplication of the article, so that 51 articles were obtained. In the fourth stage, the author read the full text and obtained a total of 10 articles. The results of the 10 articles reviewed found that CBT, motivational intervention, telephone counseling, and brief intervention are various types of psychotherapy that can help overcome gambling disorders. It is not clear which therapy is better among these therapies, but all therapies have their advantages and disadvantages, which are adjusted to the client's condition. Providing psychosocial interventions such as a combination of Motivational Interview Therapy, Cognitive Behavior Therapy, telephone counseling, and Brief Telephone Intervention can provide an effective solution to help individuals overcome gambling disorders and begin the journey of recovery. The use of Motivational Interviewing therapy, Cognitive Behavior Therapy, telephone counseling, and Brief Therapy can be used in clinical and community settings to treat gambling disorder problems.

Psycho-educational group leaders through the homeroom approach: A systematic literature review

Guidance and counseling services can be done through the form of individual or group. A group shall be led by a counselor who has been previously trained in guidance and counseling. A leader must choose a leadership style with priority given to the achievement of goals within the group such as achieving cohesion within the group. The homeroom approach is how a counselor is able to create a group atmosphere of intervention, like a family atmosphere or a home atmosphere. The study aimed to review the reseach of homeroom intervention in guidance and counseling. The literature review is carried out in five stages: formulation of research questions, search for literature, processing of data, and assessment of the quality of filtering received and not received. A total of 100 articles were identified and subjected to PRISMA analysis, resulting in the selection of 12 articles for further in-depth examination. The criteria for articles included discussions on group leadership, counseling groups, strategies in group leadership, targeting students and guidance and counseling teachers in 2013-2023. The results showed that the homeroom approach can be considered as one of the group leader's qualifications. A group leader must have the ability to listen actively, receive, pay attention, create a warm and welcoming atmosphere, connect among members. A homeroom approach can facilitate the group leader to create an atmosphere of warm, welcoming, safe and comfortable within the group dynamics.

Influence of Social Skills on Behavioural Adjustments among University Students in Uasin Gishu County, Kenya

The study aimed to investigate the influence of social skills on behavioural adjustments among university students in Uasin Gishu County. The study was anchored on Albert Bandura's Social Learning Theory (Bandura, 1977). A mixed-methods approach and a phenomenological design were employed in the research. The target population comprised of 85,000students and 10 counselors drawn from six universities in Uasin Gishu County. Simple random sampling was used to draw a sample of 323 students while purposive sampling was used to select four counselors and three universities. This study used questionnaires and in-depth interviews guide to collect data. Qualitative data were transcribed and analyzed through themes derived from the research questions. Quantitative data was analyzed using SPSS version 26.0 and presented into frequencies, percentages, mean and standard deviations. To test the hypotheses, the researcher used ANOVA to determine whether there is a relationship that exists between the variables. From the findings it was social skills (F (25,173) =5.573, p=0.00) significantly influenced behavioural adjustments of students. The findings of the study may be useful to the community, institutions of higher learning and the society. The study recommended that there was need for dedicated efforts aimed at assessing the types of psychological counseling interventions available, their accessibility, and the level of awareness among students in Uasin Gishu County universities.

Changes in HIV Internalized and Experienced Stigmas and Social Support After an Urban Gardens and Peer Nutritional Counseling Intervention Among People With HIV and Food Insecurity in the Dominican Republic.

Food insecurity and HIV-related stigma negatively affect HIV outcomes. Few studies have examined how food security interventions affect HIV-related stigma and social support. Two HIV clinics in the Dominican Republic. A pilot cluster randomized controlled trial of an urban gardens and peer nutritional counseling intervention was conducted to examine outcomes of HIV-related stigmas and social support. Adult patients (≥18 years of age) with moderate or severe household food insecurity and evidence of suboptimal ART adherence and/or a detectable viral load were enrolled; standard measures of internalized and experienced stigmas and social support were collected at baseline and at 6 and 12 months. Intervention clinic participants received training and materials from agronomists for a home garden, 3-4 sessions of nutritional counseling from the clinic's peer counselor, and a garden produce cooking workshop facilitated by professional nutritionists. Of 109 study participants (46 intervention and 63 control), 103 (94%) completed 12-month follow-up. Difference-in-differences multivariate longitudinal linear regressions adjusting for sociodemographic factors found that intervention participants had reduced internalized stigma by 3.04 points (scale 0-32) at 12 months (P = 0.002); reduced probability of experiencing HIV-related stigma or discrimination in the past 6 months (20 percentage points at 6 months, P = 0.05 and 25 percentage points at 12 months, P = 0.02); and modestly improved social support at 12 months (1.85 points on 30-pt scale, P = 0.093). A fully powered, larger trial is needed to establish the efficacy of the intervention and assess pathways by which the intervention may improve HIV stigma and social support.

Effect of sustained decreases in sedentary time and increases in physical activity on liver enzymes and indices in type 2 diabetes.

Current guidelines for nonalcoholic fatty liver disease (NAFLD) recommend high volumes and/or intensities of physical activity (PA), the achievement of which generally requires participation in supervised exercise training programs that however are difficult to implement in routine clinical practice. Conversely, counselling interventions may be more suitable, but result in only modest increases in moderate-to-vigorous-intensity PA (MVPA). This study assessed whether a counseling intervention for increasing PA and decreasing sedentary time (SED-time) is effective in improving NAFLD markers in people with type 2 diabetes. Three-hundred physically inactive and sedentary patients were randomized 1:1 to receive one-month theoretical and practical counseling once-a-year (intervention group) or standard care (control group) for 3 years. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ-glutamyltranspeptidase (γGT) levels were measured and fatty liver index (FLI), hepatic steatosis index (HSI), and visceral adiposity index (VAI) were calculated. Total PA volume, light-intensity PA (LPA), moderate-to-vigorous-intensity PA (MVPA), and SED-time were objectively measured by an accelerometer. Throughout the 3-year period, NAFLD markers did not change in the control group, whereas ALT, γGT, FLI, and HSI decreased in the intervention group, with significant between-group differences, despite modest MVPA increases, which however were associated with larger decrements in SED-time and reciprocal increments in LPA. Mean changes in NAFLD markers varied according to quartiles of (and correlated with) changes in MVPA (all markers) and SED-time, LPA, and PA volume (ALT, γGT, and HSI). Mean changes in MVPA or PA volume were independent predictors of changes in NAFLD markers. When included in the models, change in cardiorespiratory fitness and lower body muscle strength were independently associated with some NAFLD markers. A behavior change involving all domains of PA lifestyle, even if insufficient to achieve the recommended MVPA target, may provide beneficial effects on NAFLD markers in people with type 2 diabetes.

Predictors of HIV Viral Load Suppression After Enhanced Adherence Counseling, Nekemte, Ethiopia

BackgroundEnhanced adherence counseling refers to the counseling intervention for Human Immunodeficiency Virus (HIV) patients with an elevated viral load result, a viral load of > 1000 copies/ml, on a routine or need-based viral load test. The Federal Ministry of Health, Ethiopia, has launched routine viral load testing and enhanced adherence counseling since 2016 for high-viral load people living with HIV, which is applicable throughout the country for all health facilities providing HIV care and treatment. Our study aimed to assess viral load suppression after enhanced adherence counseling and its predictors among high viral load people living with HIV who were on antiretroviral therapy.MethodWe conducted a health facility-based retrospective follow-up study among 352 HIV-infected high-viral load people enrolled in enhanced adherence counseling from July 2018 to June 2021 in Nekemte town public health facilities. Cox proportional hazard analysis was used to identify independent predictors.ResultsThe overall 65.1% of 352 persons on antiretroviral treatment achieved HIV viral load suppression after enhanced adherence counseling, (15.01 per 100 person months (95% CI13.02-16.99)). The median time to viral load suppression was 5 months. Age ≥ 15 years (AHR = 1.99, 95% CI: 1.11–3.57), no history of opportunistic infection (AHR = 2.01, 95% CI: 1.18–3.41), and not using substances (AHR = 2.48, 95% CI: 1.19–5.14) were more likely to have viral load suppressed, while having an initial viral load count greater than 50,000 RNA copies/ml (AHR = 0.56, 95% CI: 0.37–0.85) were less likely to have viral load suppressed after enhanced adherence counseling.ConclusionAge, history of opportunistic infections, substance use, and an initial viral load count > 50,000 RNA copies/mL were significant predictors of viral load suppression. Enrolling all high-viral-load patients in enhanced adherence counseling is recommended for viral load suppression.

Risk–return preferences, gender inequalities and the moderating role of a counselling intervention on choice of major: evidence from a field and survey experiment

Risk–return preferences, gender inequalities and the moderating role of a counselling intervention on choice of major: evidence from a field and survey experiment

How did the use of the social marketing approach in Egyptian communities succeed in improving breastfeeding practices and infants’ growth?

IntroductionImproving breastfeeding practices does not always link to interventions relying only on improving nutrition awareness and education but needs cultural and behavioral insights. AimThis study aimed to evaluate the changes in core breastfeeding indicators as a result of the use of social marketing (SM) approach for improving breastfeeding practices of Egyptian women and the physical growth of infants aged 6 to 12 months. The core breastfeeding indicators were: Early initiation of breastfeeding within one hour of birth, Predominant and exclusive breastfeeding to 6 months (EBF), Bottle feeding with formula, continued breastfeeding to 1 and 2 years, and responsiveness to cues of hunger and satiety.MethodsA quasi-experimental longitudinal study with a posttest-only control design was done over 3 years in three phases; the first was in-depth interviews and formative research followed by health education and counseling interventions and ended by measuring the outcome. Motivating mothers’ voluntary behaviors toward breastfeeding promotion “feeding your baby like a baby” was done using SM principles: product, price, place, and promotion. The interventions targeted 646 pregnant women in their last trimester and delivered mothers and 1454 women in their childbearing period. The statistical analysis was done by using SPSS program, version 26.ResultsMost mothers showed significantly increased awareness about the benefits of breastfeeding and became interested in breastfeeding their children outside the house using the breastfeeding cover (Gawn) (p < 0.05). Breastfeeding initiation, exclusive breastfeeding under 6 months, frequency of breastfeeding per day, and percentage of children who continued breastfeeding till 2 years, were significantly increased (from 30%, 23%, 56%, and 32% to 62%, 47.3%, 69%, and 43.5% respectively). The girls who recorded underweight results over boys during the first year of life were significantly improved (p < 0.01) after the intervention (from 52.1% to 18.8% respectively). At the same time, girls found to be obese before the intervention (15.6%) became no longer obese.ConclusionsImprovement for the majority of the key breastfeeding indicators and physical growth of infants indicates that raising a healthy generation should start by promoting breastfeeding practices that are respectable to societal norms.

Provocative Findings From a Transdiagnostic Counseling Intervention to Improve Psychiatric Comorbidity and HIV Care Engagement Among People With HIV: A Pilot Randomized Clinical Trial.

Depression, anxiety, post-traumatic stress, and alcohol/substance use disorders are prevalent among people with HIV (PWH), commonly co-occur, and predict worse HIV care outcomes. Transdiagnostic counseling approaches simultaneously address multiple co-occurring mental health disorders. We conducted a pilot individually randomized trial of the Common Elements Treatment Approach adapted for people with HIV (CETA-PWH), a transdiagnostic counseling intervention, compared with usual care at a large academic medical center in the southern United States. Participants were adults with HIV; at risk for HIV care disengagement; and with elevated symptoms of depression, anxiety, post-traumatic stress, and/or alcohol/substance use. Mental health and HIV care engagement were assessed at 4 and 9 months. Among participants (n = 60), follow-up was high at 4 (92%) and 9 (85%) months. Intervention engagement was challenging: 93% attended ≥1 session, 43% attended ≥6 sessions in 3 months ("moderate dose"), and 30% completed treatment. Although not powered for effectiveness, mental health outcomes and HIV appointment attendance improved in CETA-PWH relative to usual care in intent-to-treat analyses; those receiving a moderate dose and completers showed progressively greater improvement. Viral load showed small differences between arms. The dose-response pattern was not explained by differences between those who did and did not complete treatment. This pilot trial provides preliminary evidence for the potential of CETA-PWH to simultaneously address co-occurring mental health comorbidities and support HIV appointment attendance among PWH. Additional strategies may be an important part of ensuring that clients can engage in the full course of treatment and realize its full benefits.

How Can We Improve the Appetite of Older Patients on Dialysis in Japan?

It is necessary to ensure adequate energy and protein intake in dialysis patients. However, in addition to the decline in dietary intake in older dialysis patients due to aging, the rate of anorexia is high in dialysis patients, which increases the risk of protein–energy wasting (PEW), sarcopenia, and frailty. There are many causes of anorexia in dialysis patients, including older dialysis patients, and approaches to improve the appetite of such patients have been reported; however, there has been no established approach to improve appetite adequately. Therefore, a key practical goal is to identify anorexia early and implement timely interventions before weight loss occurs. Appetite assessment tools and weight loss assessments are helpful for the screening and early identification of anorectic signs. Nutritional interventions include reducing dietary restrictions, using oral nutritional supplements, and intradialytic parenteral nutrition, as well as replenishing energy, protein, and zinc to prevent the development of nutritional disorders among older dialysis patients. Appetite assessments, early intervention, and dietary and nutritional counseling are key to improving appetite in these patients. The aging rate of dialysis patients in Japan is unprecedented globally, and I believe that this is a situation that will eventually occur in other countries as well. I discuss the factors that contribute to anorexia, especially in older dialysis patients, and Japan’s efforts to address this problem, such as the relaxation of dietary restrictions and the use of oral nutritional supplements.