Multiple Counselling Sessions Research Articles

The Perception of Telemedicine as a Consultation Method by Antenatal Women in a Covid 19 Pandemic

BACKGROUND
 Covid 19 is a pandemic which created anxiety especially among the antenatal women regarding their health and the fetus in the womb. During the lockdown period this apprehension doubled and we had to use telemedicine as a tool for clearing their queries. We wanted to assess the perception of telemedicine as a consultation method by antenatal women in a covid 19 pandemic.
 METHODS
 It was a cross sectional study involving 100 antenatal women conducted in 2019 for over three months. The telephonic consultation was done and counseled them regarding nutrition, covid prevention, warning signs and high risk factors where she has to report to the hospital immediately. Feedback on their perception was obtained by Likert scale and analysed.
 RESULTS
 A majority of antenatal women (92%) opined that telemedicine was useful for clearing their queries. They felt that it should be integrated on regular basis and done continuosly. All 100 women were asked the same questions. Teleconsultation was satisfactory for 84%, for 12% it was just satisfactory: They were from urban area & educated, on the other extreme 4% women were highly satisfied: They were from rural area & illiterate. Irrespective of socioeconomic status we got calls. Patients’ views on telemedicine were - Asset for gaining confidence (72%), Useful for themselves & family members (10%), excellent for clearing apprehension and anxiety (8%), wanted multiple counselling sessions through out pregnancy (6%) and could avoid issues related to high risk pregnancy (4%). On the whole, majority ( 94%) of them expressed that examination part was missing and they were still worried about baby.
 CONCLUSIONS
 Though the traditional approach was missing, telemedicine was good for antenatal women on the whole for better communication with the doctors in the lockdown period due to covid 19 pandemic.

An Automatically Adaptive Digital Health Intervention to Decrease Opioid-Related Risk While Conserving Counselor Time: Quantitative Analysis of Treatment Decisions Based on Artificial Intelligence and Patient-Reported Risk Measures.

Some patients prescribed opioid analgesic (OA) medications for pain experience serious side effects, including dependence, sedation, and overdose. As most patients are at low risk for OA-related harms, risk reduction interventions requiring multiple counseling sessions are impractical on a large scale. This study evaluates whether an intervention based on reinforcement learning (RL), a field of artificial intelligence, learned through experience to personalize interactions with patients with pain discharged from the emergency department (ED) and decreased self-reported OA misuse behaviors while conserving counselors' time. We used data representing 2439 weekly interactions between a digital health intervention ("Prescription Opioid Wellness and Engagement Research in the ED" [PowerED]) and 228 patients with pain discharged from 2 EDs who reported recent opioid misuse. During each patient's 12 weeks of intervention, PowerED used RL to select from 3 treatment options: a brief motivational message delivered via an interactive voice response (IVR) call, a longer motivational IVR call, or a live call from a counselor. The algorithm selected session types for each patient each week, with the goal of minimizing OA risk, defined in terms of a dynamic score reflecting patient reports during IVR monitoring calls. When a live counseling call was predicted to have a similar impact on future risk as an IVR message, the algorithm favored IVR to conserve counselor time. We used logit models to estimate changes in the relative frequency of each session type as PowerED gained experience. Poisson regression was used to examine the changes in self-reported OA risk scores over calendar time, controlling for the ordinal session number (1st to 12th). Participants on average were 40 (SD 12.7) years of age; 66.7% (152/228) were women and 51.3% (117/228) were unemployed. Most participants (175/228, 76.8%) reported chronic pain, and 46.2% (104/225) had moderate to severe depressive symptoms. As PowerED gained experience through interactions over a period of 142 weeks, it delivered fewer live counseling sessions than brief IVR sessions (P=.006) and extended IVR sessions (P<.001). Live counseling sessions were selected 33.5% of the time in the first 5 weeks of interactions (95% CI 27.4%-39.7%) but only for 16.4% of sessions (95% CI 12.7%-20%) after 125 weeks. Controlling for each patient's changes during the course of treatment, this adaptation of treatment-type allocation led to progressively greater improvements in self-reported OA risk scores (P<.001) over calendar time, as measured by the number of weeks since enrollment began. Improvement in risk behaviors over time was especially pronounced among patients with the highest risk at baseline (P=.02). The RL-supported program learned which treatment modalities worked best to improve self-reported OA risk behaviors while conserving counselors' time. RL-supported interventions represent a scalable solution for patients with pain receiving OA prescriptions. Clinicaltrials.gov NCT02990377; https://classic.clinicaltrials.gov/ct2/show/NCT02990377.

Treatment chain charged with fraud

The Department of Justice this month charged the operators of a chain of treatment centers for not providing (but still billing for) counseling, billing for multiple counseling sessions that didn't take place, concealing tax crimes convictions, causing identity theft and money laundering, filling fraudulent prescriptions using doctors’ names without their permission, and causing millions of dollars in fraudulent billing to Medicare and other health insurers.

'We don't see because we don't ask': Qualitative exploration of service users' and health professionals' views regarding a psychosocial intervention targeting pregnant women experiencing domestic and family violence.

Given the relative recency of Domestic and Family Violence (DFV) management as a field of endeavour, it is not surprising that interventions for addressing DFV is still in its infancy in developing countries. In order to maximise the success of an intervention, it is important to know which aspects of the intervention are considered important and helpful by service providers and service users. This study, therefore, examined the acceptability of an antenatal-based psychosocial intervention targeting DFV in Nepal and explored suggestions for improving the program in future. Intervention participants and health care providers (HCPs) were interviewed using semi-structured interviews. Data were audio-recorded and thematic analysis was used to analyse the data. Final codes and themes were identified using an iterative review process among the research team. Themes emerging from the data were grouped into domains including perceptions towards DFV, impact of the intervention on women's lives and recommendations for improving the program. DFV was recognised as a significant problem requiring urgent attention for its prevention and control. Intervention participants expressed that they felt safe to share their feelings during the counselling session and got opportunity to learn new skills to cope with DFV. The majority of the participants recommended multiple counselling sessions and a continued provision of the service ensuring the intervention's accessibility by a large number of women. This is the first study to document the perspectives of women and HCPs regarding an antenatal-based intervention targeting psychosocial consequences of DFV in Nepal. There was a clear consensus around the need to engage, support and empower victims of DFV and the intervention was well received by the participants. Ensuring good mental health and wellbeing among victims of DFV requires work across individual, organisational and community levels.

The Impact of Breast Cancer on the Patient and the Family in Indian Perspective.

Purpose:To understand the role played by the immediate family in treatment decision and support in patients diagnosed with breast cancer, the influence of demographic factors on psychosocial roles of women within the family.Methods:A mixed method design used for data collection on family support, financial arrangement and psychosocial impact of cancer from 378 women with breast cancer recruited at first diagnosis between 2008 and 2012, during multiple counseling sessions. The median follow-up is 7 years with only 2% lost to follow-up.Results:Most patients (99%) had support from family members. 57% of patients met the costs of treatment through personal savings and health insurance. The rest (43%) had difficulty and had to resort to desperate measures such as selling their property or taking on high-interest personal loans. Patients with higher education and urban settings had better financial management. A male member of the family (husband or son) was the main decision maker in half of the cases. Concerns over women's responsibilities within the family varied by the age of the patient. The vast majority of women (90%) experienced social embarrassment in dealing with the disease and its aftermath.Conclusion:In India, it is the family that provides crucial support to a woman with breast cancer during her ordeal with the disease and its treatment. This study has implications on the psychosocial support beyond the cancer patients alone, to include the immediate family and consider aspects of finance and social adjustments as critical in addition to the routine medical aspects of the disease.

Factors influencing the likelihood of acceptance of postpartum intrauterine devices across four countries: India, Nepal, Sri Lanka, and Tanzania.

To examine the factors that positively influenced the likelihood of accepting provision of postpartum intrauterine devices (PPIUDs) across four countries: Sri Lanka, Nepal, Tanzania, and India. Healthcare providers were trained across 24 facilities in counselling and insertion of PPIUDs as part of a large multicountry study. Women delivered were asked to take part in a 15-minute face-to-face structured interview conducted by in-country data collection officers prior to discharge. Univariate analysis was performed to investigate factors associated with acceptance. From January 2016 to November 2017, 6477 health providers were trained, 239033 deliveries occurred, and 219242 interviews were conducted. Of those interviewed, 68% were counselled on family planning and 56% on PPIUD, with 20% consenting to PPIUD. Multiple counselling sessions was the only factor resulting in higher consent rates (OR 1.30-1.39) across all countries. Odds ratios for women's age, parity, and cadre of provider counselling varied between countries. Consent for contraception, specifically PPIUD, is such a culturally specific topic and generalization across countries is not possible. When planning contraceptive policy changes, it is important to have an understanding of the sociocultural factors atplay.

Moderators of Establishing a Smoke-Free Home: Pooled Data from Three Randomized Controlled Trials of a Brief Intervention.

Interventions to create smoke-free homes typically focus on parents, involve multiple counseling sessions and blend cessation and smoke-free home messages. Smoke-Free Homes: Some Things are Better Outside is a minimal intervention focused on smokers and nonsmokers who allow smoking in the home, and emphasizes creation of a smoke-free home over cessation. The purpose of this study is to conduct moderator analyses using pooled data from three randomized controlled trials of the intervention conducted in collaboration with 2-1-1 contact centers in Atlanta, North Carolina and Houston. 2-1-1 is a strategic partner for tobacco control as it connects over 15million clients, largely socio-economically disadvantaged, to social and health resources each year. A total of 1506 2-1-1 callers participated across the three intervention trials. Outcomes from 6months intent-to-treat analyses were used to examine whether sociodemographic variables and smoking-related characteristics moderated effectiveness of the intervention in establishing full home smoking bans. Intervention effectiveness was not moderated by race/ethnicity, education, income, children in the home or number of smokers in the home. Smoking status of the participant, however, did moderate program effectiveness, as did time to first cigarette. Number of cigarettes per day and daily versus nondaily smoking did not moderate intervention effectiveness. Overall, the intervention was effective across socio-demographic groups and was effective without respect to daily versus nondaily smoking or number of cigarettes smoked per day, although smoking status and level of nicotine dependence did influence effectiveness.

Writing a Self-introduction and Feedback

이 연구에서는 자기소개서의 기본 항목의 질문 분석을 통해 자기소개서 작성 방안을 살펴보고 실제 자소서 첨삭 지도 사례를 살펴보고자 한다. 또한 이를 통해 자기소개서 작성과 첨삭 지도에서의 유의점을 제시하고자 한다. 취업을 위한 자기소개서는 자기 표현의 성격을 가진 논증적 글쓰기로 의도성, 정보성, 상황성, 통일성, 일관성의 특징을 가진다. 이중 자소서의 질문 의도를 파악하는 상황성은 자신을 표현하고 채용담당자를 설득시키기 위해 무엇보다 중요하다. 따라서 성장과정, 성격의 장단점, 지원동기, 입사 후 포부에 대한 질문 의도를 잘 이해해야 한다. 질문 분석으로 작성된 자소서의 첨삭 지도는 학습자 주도로 이루어져야 한다. 또한 여러 번의 첨삭을 통해 학생들이 글을 쓰는 능력이 내면화될 수 있도록 해야 한다. 이때 첨삭은 내용 첨삭과 형식 첨삭이 균형을 이루어야 하며, 명시적 첨삭과 암시적 첨삭도 마찬가지이다. 이외에도 구체성을 확보하지 못한 부정적 첨삭은 미숙한 수준의 학습자에게 글쓰기에 대한 부정적 인식을 강화시킬 수 있다는 점을 명심해야 한다.In this study, I will examine how to write a self-introduction letter through question analysis of basic items of self-introduction letter. And I look at the case of the actual bookmarking. And I would like to point out the implications of writing and introducing self-introduction. It also has intrinsic, informative, situational, coherent, and consistent characteristics. Contextuality, which grasps the intentions of the question of the self-master, is of utmost importance to express oneself and to persuade recruiters. Therefore, it is important to understand the growth process, the strengths and weaknesses of personality, motivation for support, and intention to ask about ambition after joining. The counseling guidance of the self-written by the question analysis should be led by the learner. It is also important to ensure that students are able to internalize their ability to write through multiple counseling sessions. At this time, the counseling has to balance the contents addition and the format addition. Explicit and implicit additions must be balanced. Negative additions that are not concreteness can reinforce the negative perception of writing to an inexperienced level of learners.

Outcome Evaluation of the You Can Do It Initiative to Promote Exclusive Breastfeeding Among Women Enrolled in the New York State WIC Program by Race/Ethnicity

ObjectiveTo evaluate the effectiveness of You Can Do It at improving exclusive breastfeeding (BF) among New York State women enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DesignQuasi-experimental study, September, 2013 through February, 2016. SettingMulticomponent intervention paired with a yearlong learning community in 12 clinics. ParticipantsWomen who were enrolled in WIC during the first trimester, intended to breastfeed or were undecided, and continued in WIC after delivery, comprised 1 baseline cohort (n = 688) and 2 intervention cohorts: Breastfeeding Attrition Prediction Tool (BAPT) (consented, n = 362) and non-BAPT (declined, n = 408). InterventionThe BAPT was offered to all eligible women in the intervention enrollment period. Consenting women received multiple counseling sessions tailored to individual BAPT results throughout pregnancy and were contacted promptly after delivery. Main Outcome Measure(s)Prevalence of exclusive BF at 7, 30, and 60 days. AnalysisMultivariate logistic regression, stratified by race/ethnicity. Statistical significance set at P < .05. ResultsPrevalence of exclusive BF at 7 and 30 days was significantly higher among BAPT women compared with non-BAPT or baseline cohorts. Non-Hispanic black and Hispanic women in the BAPT cohort achieved significantly higher exclusive BF rates at 30 and 60 days compared with those in non-BAPT and baseline cohorts. Conclusions and ImplicationThe initiative seems to be effective at increasing exclusive BF, particularly among non-Hispanic black and Hispanic women in the New York State WIC program.

Telephone counselling for smoking cessation

Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. To evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. We searched the Cochrane Tobacco Addiction Group Specialised Register for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2013. randomized or quasi-randomised controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. One author identified and data extracted trials, and a second author checked them. The main outcome measure was the risk ratio for abstinence from smoking after at least six months follow-up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow-up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I² statistic. We considered trials recruiting callers to quitlines separately from studies recruiting in other settings. Where appropriate, we pooled studies using a fixed-effect model. We used a meta-regression to investigate the effect of differences in planned number of calls, selection for motivation, and the nature of the control condition (self help only, minimal intervention, pharmacotherapy) in the group of studies recruiting in non-quitline settings. Seventy-seven trials met the inclusion criteria. Some trials were judged to be at risk of bias in some domains but overall we did not judge the results to be at high risk of bias. Among smokers who contacted helplines, quit rates were higher for groups randomized to receive multiple sessions of proactive counselling (nine studies, > 24,000 participants, risk ratio (RR) for cessation at longest follow-up 1.37, 95% confidence interval (CI) 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Three studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that tested the provision of access to a hotline two detected a significant benefit and one did not.Telephone counselling not initiated by calls to helplines also increased quitting (51 studies, > 30,000 participants, RR 1.27; 95% CI 1.20 to 1.36). In a meta-regression controlling for other factors the effect was estimated to be slightly larger if more calls were offered, and in trials that specifically recruited smokers motivated to try to quit. The relative extra benefit of counselling was smaller when it was provided in addition to pharmacotherapy (usually nicotine replacement therapy) than when the control group only received self-help material or a brief intervention.A further eight studies were too diverse to contribute to meta-analyses and are discussed separately. Two compared different intensities of counselling, both of which detected a dose response; one of these detected a benefit of multiple counselling sessions over a single call for people prescribed bupropion. The others tested a variety of interventions largely involving offering telephone counselling as part of a referral or systems change and none detected evidence of effect. Proactive telephone counselling aids smokers who seek help from quitlines. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness. There is limited evidence about the optimal number of calls. Proactive telephone counselling also helps people who receive it in other settings. There is some evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self-help materials, or brief advice, or compared to pharmacotherapy alone.

HIV-positive Women Living in the Metropolitan Toronto Area: Their Experiences and Perceptions Related to HIV Testing

Forty HIV-positive women from diverse socioeconomic backgrounds were interviewed. Most (90%) did not perceive themselves to be at risk of HIV infection prior to knowing their HIV-positive status. The majority (61%) were tested because they developed symptoms, or because someone with whom they were intimate, or their child, tested positive for HIV or became ill. The majority (93%) of the women interviewed indicated that they did not receive both pre- and post-test counselling. The findings from this study suggest that encouraging individuals to be tested if they have engaged in "at risk" activities will not be appropriate for individuals who have no perception of risk, and other strategies to encourage appropriate testing may be needed. This research also suggests that continued emphasis needs to be placed on the counselling process, and that consideration may need to be given to multiple counselling sessions to ensure individuals clearly understand the information provided.

Efficacy of prenatal nutrition counseling: Weight gain, infant birth weight, and cost-effectiveness

A retrospective study on the effect of intensive nutrition counseling on weight gain of pregnant women and birth weight of their infants was conducted at an outpatient clinic by comparing one group of 86 women who attended only a nutrition class with another group of 114 women who attended the class plus multiple counseling sessions on appropriate weight gain and nutrient intake. The women receiving the counseling on an average gained 2.5 kg more weight, had fewer low-birth-weight infants (4% vs. 13%), and had infants weighing 100 gm more at birth. That indicates that intensive nutrition counseling results in a superior outcome of pregnancy. When the cost of intensive neonatal care for six infants was compared with the cost of nutrition counseling, a benefit-to-cost ratio of 1:5 was found.