Specific Counseling Research Articles

Homozygous GRN mutations: new phenotypes and new insights into pathological and molecular mechanisms.

Homozygous mutations in the progranulin gene (GRN) are associated with neuronal ceroid lipofuscinosis 11 (CLN11), a rare lysosomal-storage disorder characterized by cerebellar ataxia, seizures, retinitis pigmentosa, and cognitive disorders, usually beginning between 13 and 25 years of age. This is a rare condition, previously reported in only four families. In contrast, heterozygous GRN mutations are a major cause of frontotemporal dementia associated with neuronal cytoplasmic TDP-43 inclusions. We identified homozygous GRN mutations in six new patients. The phenotypic spectrum is much broader than previously reported, with two remarkably distinct presentations, depending on the age of onset. A childhood/juvenile form is characterized by classical CLN11 symptoms at an early age at onset. Unexpectedly, other homozygous patients presented a distinct delayed phenotype of frontotemporal dementia and parkinsonism after 50 years; none had epilepsy or cerebellar ataxia. Another major finding of this study is that all GRN mutations may not have the same impact on progranulin protein synthesis. A hypomorphic effect of some mutations is supported by the presence of residual levels of plasma progranulin and low levels of normal transcript detected in one case with a homozygous splice-site mutation and late onset frontotemporal dementia. This is a new critical finding that must be considered in therapeutic trials based on replacement strategies. The first neuropathological study in a homozygous carrier provides new insights into the pathological mechanisms of the disease. Hallmarks of neuronal ceroid lipofuscinosis were present. The absence of TDP-43 cytoplasmic inclusions markedly differs from observations of heterozygous mutations, suggesting a pathological shift between lysosomal and TDP-43 pathologies depending on the mono or bi-allelic status. An intriguing observation was the loss of normal TDP-43 staining in the nucleus of some neurons, which could be the first stage of the TDP-43 pathological process preceding the formation of typical cytoplasmic inclusions. Finally, this study has important implications for genetic counselling and molecular diagnosis. Semi-dominant inheritance of GRN mutations implies that specific genetic counselling should be delivered to children and parents of CLN11 patients, as they are heterozygous carriers with a high risk of developing dementia. More broadly, this study illustrates the fact that genetic variants can lead to different phenotypes according to their mono- or bi-allelic state, which is a challenge for genetic diagnosis.

Does self-esteem lead to high achievement of the science college's students? A study from the six health science colleges.

Background and objectiveSelf-esteem refers to a degree to which a person esteem himself or herself, the summation in light of cognizant self-evaluative considerations and feeling or in short as global emotional placement of self. This study investigates the relationship between self-esteem, social factors, and academic achievement in the form of grade point average (GPA) standing for academic achievement in the health science colleges.MethodsThis study is a quantitative cross-sectional design. The study was conducted at Princess Nourah bint Abdulrahman University (PNU), and the participants were health Science Colleges' undergraduate students. The questionnaire is composed of 24 questions in 4 main sections. The self-esteem was evaluated by using a validated Rosenberg Self-Esteem 7-questions Scale used only.ResultsA total of 551 questionnaires were distributed to the students, and 507 of them responded. Out of 507 responded, 7 were excluded due to a lack of the information. 47 (9.4%) were Foundation year students, 109 (21.8%) Medical students, 44 (8.8%) Dental students, 97 (19.4%) Pharmacy students, 101 (20.2%) Nursing students and 102 (20.4%) from Applied science. The students’ overall responses demonstrated that most of the health science students agreed in a positive way of self-esteem (1.68 ± 0.31).ConclusionThe findings from the current study contribute to the resources to better oversee projects to upgrade health sciences students' self-esteem, some short term courses (i.e. English, personality development and motivation) are requested to boost the academic career and confidence by lifting self-esteem; it indirectly helps to better academic performance. Students also need special counseling for how to deal with stress, anxiety and depression.

The Law: “Witch Hunts” and the Rule of Law: Trump, the Special Counsel, and the Department of Justice

AbstractThis article summarizes the previous behavior of presidents subjected to independent counsel investigations, and compares President Donald Trump's behavior to theirs. It concludes that while Trump's behavior is part of a larger pattern of presidential use of various executive prerogatives to try to counteract independent counsels, it departs from that pattern in several distinct ways. I conclude that several developments in the broader political environment over the last several decades have contributed to his distinctive behavior, including the highly fragmented media market, the degree of partisan polarization in the electorate, the conservative populist distrust of federal law enforcement, and the mainstreaming of the unitary executive theory in the courts and executive branch.

EXPANDING THE PROFESSIONAL PEDAGOGICAL PROFILE OF TEACHER FROM PROFESSIONAL (VOCATIONAL) EDUCATION SCHOOL UNDER THE CONDITIONS OF INCLUSION

Relevance: persons with special educational needs require professional qualifications. This leads to theactualization of the issue of expanding the professional and pedagogical profile of the teacher of the P (V) Eschool and the inclusive competence acquisition.Aim: to analyze the legal documents on the provision of inclusive education in the system of vocationaleducation and training and study the needs of teachers of P(V)E school in the formation of inclusive competence.Methods: theoretical (analysis, synthesis, generalization); empirical (interviewing methods, conversation).Results: it has been found out that the problem of expanding the professional and pedagogical profile of theteacher of the professional (vocational) education school in the direction of his inclusive competence development needs to be addressed. It has been established that the creation of the barrier-free educational environment and the architectural accessibility of facilities in educational institutions for education applicants with special educational needs is necessary. The vast majority of teachers require the specially organized training on issues of inclusion introduction. It has been defined that teachers identify such forms of increasing the inclusive competence as training, specialist counseling and full-time targeted courses. The experience of forming the inclusive competence of teachers through the introduction of formal, non-formal and informal education has been presented. It has been stated that it is important to establish cooperation between educational institutions and regional inclusive resource centers. It has been proved that teachers need assistance in developing an individual curriculum for the education applicants with special educational needs and evaluation of its implementation.Conclusions: the introduction of inclusive education in the system of vocational education and training willgive the opportunity to obtain the working

376P - Adoption of molecular testing in breast cancer in a tertiary care center in a developing country

BackgroundThe clinical application of rapidly developing new molecular tests in breast cancer is debatable and often not affordable for most of the patients from developing countries. We assessed the adoption of molecular testing and their utility in breast cancer patients in the setting of a developing Nation. MethodsWe analysed the results of next-generation sequencing (NGS) based BRCA1 and 2 and multi-gene testing, immunohistochemistry based (IHC) based mismatch repair genes (MMR), Programmed cell death ligand 1(PDL1) and Androgen receptor (AR) testing done in breast cancer patients diagnosed from 2015 to 2018. ResultsThere was an overall increase in the number of molecular tests offered to breast cancer patients in subsequent years. 141 patients opted for BRCA testing out of which 56 (40%) were triple negative (TNBC). 27(19%) out of 141 patients were BRCA mutated and 8(6%) had variants of unknown significance (VUS). Among 15 metastatic breast cancer patients tested for mutations on Multi-gene NGS, 3 had Her2neu amplification. Out of 8 TNBC cases, 5 had TP53 mutation, 1 had exon 14 skipping mutation of MET gene and 1 showed EGFR amplification. None of the five and six breast cancer patients with TNBC tested for MMR and PD-L1 were MMR deficient or positive respectively. Of the 7 TNBC patients tested, 4 were found to have Androgen receptor expression. ConclusionsThere is a significant rise in the use of modern molecular techniques in developing nations like India. However, Country Specific guidelines guided by International guidelines and awareness in patients with specific counseling on advantages and disadvantages of these tests may help in the usage of these techniques by most needy patients, breast cancer in particular. Legal entity responsible for the studyRajiv Gandhi Cancer Institute and Research Centre, New Delhi. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Update on KMT2B-Related Dystonia.

To summarize the molecular and clinical findings of KMT2B-related dystonia (DYT-KMT2B), a newly identified genetic dystonia syndrome. Since first described in 2016, 66 different KMT2B-affecting variants, encompassing a set of frameshift, nonsense, splice-site, missense, and deletion mutations, have been reported in 76 patients. Most mutations are de novo and expected to mediate epigenetic dysregulation by inducing KMT2B haploinsufficiency. DYT-KMT2B is characterized phenotypically by limb-onset childhood dystonia that tends to spread progressively, resulting in generalized dystonia with cranio-cervical involvement. Co-occuring signs such as intellectual disability are frequently observed. Sustained response to deep brain stimulation (DBS), including restoration of independent ambulation, is seen in 93% (27/29) of patients. DYT-KMT2B is emerging as a prevalent monogenic dystonia. Childhood-onset dystonia presentations should prompt a search for KMT2B mutations, preferentially via next-generation-sequencing and genomic-array technologies, to enable specific counseling and treatment. Prospective multicenter studies are desirable to establish KMT2B mutational status as a DBS outcome predictor.

Counselors in training identifying and responding to suicidal clients: a matched-control study

ABSTRACTUsing a matched-control experimental design, this study explored the use of Applied Suicide Intervention Skills Training (ASIST) with fifty-four counselors in training (CIT). Over the course of 10 weeks CIT self-reported interactions with suicidal clients and their use of counseling skills. Trainees who completed ASIST were significantly more likely to report they had identified and used specific intervention strategies and counseling skills with suicidal clients during sessions. Implications for future training and research are provided.

Genomics and breast cancer screening.

Many women fear the risk of developing breast cancer, and some women have increased fear because of their family history. Thankfully, the study of genetics has brought forth tools to better identify women at risk. An understanding of genetics and cancer has led to genetic testing protocols which enable at-risk women to take preventative action through medication, surgery, and intensive screenings. These protocols not only have the potential to prevent cancer but also lead to early detection. Appropriate screening for women at risk for genetic breast cancer is essential for patient care. These screenings include specific risk assessment tests, genetic counseling, and genetic testing. To provide the best possible care for patients, providers must have a basic understanding of cancer, genetics, screening tests, genetic testing, and available prevention measures.

International Perspectives: IUDs and Adolescents.

Unplanned or unwanted pregnancy among adolescents is a worldwide public health issue. In many countries unmarried young women are denied contraceptive services. Long-acting reversible contraceptive methods such as the intrauterine devices (IUDs) have been shown to be more effective than short-acting such as the pill, and safe also for adolescents. The popularity has varied a lot with time and between populations. Health care providers, health system, and user factors all influence IUD use. A good sexuality education through school provides a foundation, and health care providers give specific individual counseling. International and country-specific guidelines have been published during the past decade indicating the advantage of IUDs. New smaller size devices make placement easier for nulliparous adolescents. Still the uptake has remained rather low in most regions, cost being one barrier. Several municipalities have started to provide long-acting reversible contraceptive methods for adolescents free of charge, and this has led to a significant increase in IUD use, accompanied by a reduction in abortion rates. Adolescent-friendly services should offer low-cost or free contraception, including male and female condoms, emergency contraception, and a full range of modern methods, including long-acting reversible methods, according to adolescents' preferences and needs.

Pain on the first postoperative day after tonsillectomy in adults: A comparison of metamizole versus etoricoxib as baseline analgesic

ObjectiveTo compare the effect of metamizole versus etoricoxib as baseline analgesic for treating postoperative pain after tonsillectomy.DesignSingle centre prospective cohort study.SettingTwo consecutive cohorts of tonsillectomy patients.Participants124 patients (n = 55 treated with etoricoxib, n = 69 with metamizole); median age 30.5 years; 50% women.Main outcome measuresPatients rated their pain on first postoperative day using the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including numeric rating scales (NRS, 0–10) for pain determination. The influence of preoperative and postoperative parameters on patients' pain was estimated by univariate and multivariate statistical analysis.ResultsThe demographic parameters showed no differences between the patients in the metamizole group and the etoricoxib group (all p>0.05) with one exception: Patients in the metamizole group had significantly more preoperative pain than patients in the etoricoxib group (p = 0.001). The metamizole group had a mean postoperative pain in activity of 4.4 ± 2.1 and the etoricoxib group of 4.5 ± 2.2. Maximal pain for the metamizole group and the etoricoxib group were 5.6 ± 2.2 and 6.1 ± 1.9, respectively. Pain in activity, maximal pain and minimal pain were not different between both groups (p = 0.652, p = 0.113, p = 0.276, respectively). Patients of the etoricoxib group received more frequently piritramide in recovery room as demand medication (p = 0.046). In the whole cohort, patients with peritonsillar abscess had more preoperative pain in comparison to chronic tonsillitis (p<0.001). Patients under 30.5 years reported higher maximal pain than older patients (p = 0.049). On the other hand, a significant influence of patients’ age on the pain in activity and minimal pain could not be demonstrated (p = 0.368, p = 0.508, respectively). Men reported lower minimal pain than women (p = 0.041). Also, patients with ASA status I had lower minimal pain than patients with higher ASA status (p = 0.019). The multivariate analysis did not show an association between postoperative pain in activity and preoperative counseling on postoperative pain management (p = 0.588, p = 0.174, respectively). Special preoperative counseling on postoperative pain management resulted in lower levels of maximal pain (p = 0.024). Linear regression demonstrated an independent association of higher pain in activity with higher mobility impairment (p = 0.034) and respiratory impairment (p = 0.002). The linear regression of minimal pain identified female gender (p = 0.005) as an independent influencing factor with higher pain levels. In terms of satisfaction, no preoperative pain therapy (p = 0.016) could be found as an independently significant influencing factor with higher satisfaction.ConclusionEtoricoxib does not have an advantage as baseline analgesic for post tonsillectomy pain in comparison to metamizole.

Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

Background and objectives: Differences in patient anatomy and physiology exist between young and older patients undergoing breast reconstruction after mastectomy. Breast cancer has been described as being more aggressive, more likely to receive radiation, contralateral mastectomy, as well as bilateral reconstruction in young patients. Our purpose is to report long-term experience on two-staged implant-based breast reconstruction (IBR) in young females, with complication sub-analysis based on obesity and adjuvant radiation. Materials and Methods: Retrospective chart review of all consecutive young patients who underwent two-staged IBR at our institution, between 2000 and 2016, was performed. Patients between 15 and 40 years old with least 1-year follow-up were included. Univariate logistic regression models and receiver operating characteristic (ROC) curves were created. Results: Overall 594 breasts met our inclusion criteria. The mean age was 34 years, and the median follow-up was 29.6 months. Final IBR was achieved in 98% of breasts. Overall, 12% of breasts had complications, leading to explantations of 5% of the devices. Adjuvant radiation was followed by higher rates of total device explantations (p = 0.003), while obese patients had higher rates of total complications (p < 0.001). For each point increase in BMI, the odds of developing complications increased 8.1% (p < 0.001); the cutoff BMI to predict higher complications was 24.81 kg/m2. Conclusions: This population demonstrates high successful IBR completion and low explantation rates. These data suggest that obese women and those with planned adjuvant radiation deserve special counseling about their higher risk of complications.

Implementation of Inclusion Education Program in the Junior High School 4 at Praya

This study aims to determine the management model and identify obstacles in the implementation of inclusive education programs at Junior High School 4 in Praya. This study uses a descriptive qualitative approach with a case study method (casy study). Data collection techniques are carried out using in-depth interviews, participatory observation, and document studies. Sources of research data are principals, deputy principals, special escort teachers and counseling teachers. Furthermore, data analysis is carried out through the steps of data reduction, data presentation, and conclusion drawing. The results of the research found in Junior High School 4 at Praya relating to the management of inclusive education there were 18 special needs students who had various abnormalities and obstacles, namely; 13 students were slow to learn, 1 low vision person, 1 mentally retarded person, 1 hearing impaired and 1 person had communication disorders. These problems often experience obstacles in the management of curriculum modification, between the curriculum of regular students with special needs students (PDBK), there is only 1 special assistant teacher who serves special needs students, lack of facilities and infrastructure that support the implementation of inclusive education programs in Junior High School 4 at Praya. The model of inclusive education applied in Junior High School 4 at Praya is a regular class model with full out, namely students with special needs learning with other children (normal) in the regular class and developing their talents and interests by special tutors so that students can develop optimally according to skills possessed.

Social determinants associated to chronic pain after total knee arthroplasty.

Analyze the association between social health determinants (SHD) and chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA). A cross-sectional study was performed in 58 TKA patients. The subjects were classified in two groups: with (n = 22) or without (n = 36) CPSP. SHD considered were gender, age, educational level, economic income, and labour conditions. Significant differences were found concerning educational level when comparing subjects with or without CPSP, with a low educational level of 22.4% and 19%, respectively. 15.5% of patients with persistent pain had a high educational level compared with 43.1% of the patients without persistent pain (p = 0.032). No significant differences were found for the other categories (p > 0.05). The odds ratio (95% confidence interval) was 3.28 (1.09-9.93) for lower educational level compared with high educational level. CPSP must be considered a severe health problem. In addition to SDH, there are multiple factors associated with chronic pain after TKA that must be considered for an effective treatment. Patients with lower educational level showed a three-time higher association to develop CPSP. Considering SHD could be of relevance when elaborating new interventions or health strategies and more specialized counseling for patients with persistent pain after TKA.

Do health care providers give sufficient information and good counseling during ante-natal care in Lao PDR?: an observational study

BackgroundIt is increasingly recognized that improving the quality of maternal health care delivery is of utmost importance in many countries. In Laos, the quality of antenatal care (ANC) service remains inadequate, but it has never been assessed thoroughly. This study aims to determine the ANC quality at the urban and rural public health facilities in Laos and provides suggestions to improve health education and counseling in addition to other routine care in public ANC services.MethodsThis health-facility based, cross-sectional observation study included both health providers (n = 77) and pregnant women (n = 421) from purposively selected health facilities (n = 16). Information on the mothers’ current pregnancies, previous visits and their last children was collected. The time spent for each ANC session as well as ANC services provided were recorded. Descriptive and inferential statistics were applied to analyze the data.ResultsOverall performance of ANC services by health care providers was poor in both urban and rural areas. Insufficient provision of information on danger signs during pregnancy, nutrition, breast feeding and iron supplements was revealed. Generally the communication skills, behavior and attitude of health providers were very poor. Less than a quarter of pregnant women were treated with kindness and respect. Only 4% of the observed ANC session took privacy into consideration. Less than 10% of available information materials were used during each ANC session. None of the health providers in both rural and urban areas performed specific counseling. Overall mean (SD) time-spent for each ANC session was 16.21 (4.28) minutes. A positive correlation was identified between the length of working experience of health providers and their physical performance scores (adjusted R square = 0.017).ConclusionsThe overall performance of ANC services by health care providers was inadequate in both urban and rural areas. Insufficient provision of health education and poor communication skills of health care providers were revealed. Existing IEC materials were scarcely used. Taking action to improve the quality of ANC services by training and providing specific guidelines, creating dedicated rooms, and providing sufficient and effective materials for counseling are all greatly needed in public health facilities in Laos.

MON-311 The Psychosocial Implications for Patients and their Families of Introducing Genomic Testing into Mainstream Paediatric Nephrology

Approximately 20% of children with chronic kidney disease carry a genetic mutation1. Following advances in sequencing technologies, genomic testing is increasingly being offered and accessed in renal clinics across Australia. The introduction of this service signals a series of challenges for health care professionals as well as the patients and families. Yet, there is a lack of literature exploring the impact of genomic testing in the renal clinic. The aim of this study was to use qualitative analysis to understand the psychosocial impact of genomic testing on individual patients and their families and in addition to better understand their information/service needs during the process. We recruited i) primary carers of children who have undergone genomic testing for a suspected genetic kidney disease within the last 4 years; ii) adolescents who have a proven genetic kidney disease, from The Sydney Children’s Hospital Network. Semi-structured interviews were used to investigate individual experiences of testing (including pre and post-test experiences), perceived benefits/challenges associated with genomic testing, and participant information and support needs. Interviews were transcribed, de-identified, coded and analysed for salient themes. Content and iterative thematic analysis was conducted to explain experiences. Thirteen participants (20% male, mean age = 35years) agreed to participate in a semi-structured interview. Key themes emerged; participants discussed the utility of current genomic testing, their genomic information and support needs, and concern for their child’s future. Communicated benefits of testing included the provision of an explanation for symptoms and a clarification of cause for disease, access to medications, empowerment associated with being informed and family planning provisions. Hope for future research including entry into clinical trials, and the development of targeted treatments was reported by the majority of participants. Challenges associated with genomic testing included difficulty comprehending genomic information during consultations, trouble explaining diagnosis to friends and family and dissatisfaction with length of time taken to receive test results. The need for genomic information to be simplified, specific and understandable was emphasised across all interviews. Families also expressed a desire for the provision of supplementary written and visual information and support resources to complement the information received during consultations. Participants identified the importance of developing rapport with healthcare providers, having a support network when undergoing testing and the need to provide assistance to navigate the health system. The study is ongoing but preliminary findings indicate that parents and families are likely to benefit from condition specific information resources and genetic counselling services beyond the renal clinic in order to optimise psycho-social adjustment during and after receiving genomic testing for kidney disease.

Responses of German-speaking voice assistants to questions about health issues

In Germany, there is widespread use of smartphones that can be operated via voice assistants (VAs). Due to their increasing distribution, they hold the potential to influence health behavior at apopulation level. This study examines the response behavior of German-speaking VAs to questions on mental and physical health as well as interpersonal violence. Common VAs received nine standardized health questions. Responses were evaluated in terms of the categories "Recognizing the question," "Respectful responsiveness," and "Referring to support services." Fifty-one VAs were tested on 44devices. Mental health issues were mostly recognized and answered with respect. Regarding expressed suicidal thoughts, only one VA did not refer to aspecific crisis line. With respect to "interpersonal violence," only one VA recognized the expressed problems. In terms of physical health, only one VA showed respectful responses in all three tested healthcare areas, leading help seekers to additional healthcare services (e.g., hospitals, pharmacies). For some complaints, the VAs gave behavioral advice. VAs are able to recognize health issues, to respond respectably, and to guide those in need of care to specific healthcare and counselling services. However, responsiveness is insufficient and inconsistent. Future research should investigate how the responsiveness of VAs can be improved to provide the best possible support to people in crisis.

Special Counsel Investigations and Legal Ethics: The Role of Secret Taping

In July 2016, Michael Cohen, then presidential candidate Donald Trump’s lawyer, secretly recorded Trump discussing how they would use the publisher for the National Enquirer to purchase former Playboy model Karen McDougal’s story about an alleged affair with Trump in order to stop it from becoming public before the 2016 presidential election. The National Enquirer’s publisher purchased McDougal’s story in August 2016. In a similar move to quash another alleged affair from going public in October 2016, Cohen set up a corporation to purchase adult film star Stormy Daniels’s story of her affair with Trump. Trump was elected President in November 2016. Cohen’s secret recording contradicted Trump’s claims that he knew nothing about payments to McDougal, and it raises issues concerning the lengths to which Trump has gone to keep his private life a secret. The taped conversation between Cohen and Trump later became public when Cohen’s lawyer released a copy of the tape in July 2018, which was after the Federal Bureau of Investigation (FBI) raided and seized audio tapes from Cohen’s office, home, and hotel room. It was also reported that Cohen was cooperating with Special Counsel Robert Mueller’s investigation into Russia’s interference in the 2016 presidential election and possible coordination between the Russian government and individuals associated with Trump’s presidential campaign. Reacting to the release of the tape, Trump tweeted: “Even more inconceivable that a lawyer would tape a client–totally unheard of & perhaps illegal.” Trump also tweeted: “What kind of a lawyer would tape a client? So sad! Is this a first, never heard of it before? . . . I hear there are other clients and many reporters that are taped–can this be so? Too bad!” Contrary to Trump’s Twitter rant, this incident is not the first time a lawyer has secretly taped a conversation with a client or others. Even secret tapings involving Presidents and special counsel investigations have happened previously. Indeed, evidence that special counsels obtained through secret tapes was partially responsible for one former U.S. President to resign and another to be impeached. Secret taping, though, raises a number of questions, including the following: Is secret taping legal? Is secret taping by a lawyer ethical? Lastly, if legal and ethical, what are the pros and cons of a lawyer secretly taping conversations? This essay sets out to answer those questions.

Systemische Kinderwunschberatung

Summary Systemic counselling for involuntary childlessness – Effective support in a distressed phase of life The unfulfilled wish to have a child causes a profound disruption in everyday life. In this distressed phase of life, women and men can find valuable support in psychosocial counselling for involuntary childlessness. After a definition of unwanted childlessness, this article provides an overview of current approaches in psychosocial counselling and visualizes possible systemic interventions in a tableau. The specific possibilities of a systemic counselling approach are elaborated and illustrated via practical examples. Family planning is a biographic topic. The crisis of involuntary childlessness is placed in present adulthood, but must be considered between childhood origins, the aspired founding of an own family and the succession of generations in the future. This trans generational perspective is considered in specific systemic counselling. Appreciating the desired child as a member of the system allows for a change of perspective. Especially when considering the donation of gametes, thus family planning with the help of third parties, the inclusion of the interests of the desired child represents an important asset. Considering today‘s options of reproductive medicine, but also ethical aspects and legal requirements, unintentional childlessness also unfolds a political dimension. In a systemic counselling for involuntary childlessness, the manifold implications are reflected in responsibility for the future child and family system.

Use of Situational Vignettes Helps Assess the Competence of Frontline Workers (FLW) in Nutrition Counseling Programs (OR13-07-19)

ObjectivesBehavior change communication (BCC) effectiveness depends on the knowledge of frontline workers (FLWs) who counsel clients. Most studies assess content-based knowledge of FLWs but do not examine their ability to apply this content. We tested the use of situational vignettes to assess ‘application knowledge’ and examined gaps between content and application knowledge, and the association between both types of FLW knowledge and that of clients (mothers). MethodsData are from a survey of 100 FLWs and 409 mothers with children <2y in Madhya Pradesh, India. Content knowledge was assessed using questions on nutrition. Application knowledge to assess FLW knowledge of topics to cover in specific counselling contacts was measured using situation-based vignettes and follow-up questions. Gap was defined as FLW demonstrating content knowledge without application knowledge. Regression models were used to assess determinants of knowledge, gaps in types of knowledge and associations with mothers’ knowledge. ResultsMany FLWs had reasonable content knowledge of family planning (94%), iron-folic acid during pregnancy (68%) and exclusive breastfeeding (93%). However, vignette-based application knowledge was lower than content knowledge. FLW education was associated with higher content knowledge (β = 0.69; P < 0.05) and higher application knowledge (β = 1.08; P < 0.01) of FLWs. FLWs’ age and caste were associated with gaps between content and application knowledge (β = 0.03 and β = 0.51, P < 0.10). The magnitude of association of FLWs’ application knowledge with maternal knowledge (β = 0.07; P < 0.10) was nearly twice the association of FLWs’ content knowledge with maternal knowledge (β = 0.04; P < 0.10), adjusted for maternal characteristics. ConclusionsAssessing application-based knowledge using situational vignettes was feasible and helped understand FLW competence more than content-based knowledge tests only. Counseling programs must strengthen both content and application knowledge. Funding SourcesBill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute.

Evaluating the Utility of a Diet Quality Screener in Clinical Practice to Improve Quality of Preventive Care (P07-002-19)

ObjectivesTo assess the impact of an office based dietary screener aimed to improve dietary counseling for the cost effective improvement of patient health. MethodsWe evaluated the utility of incorporating a 10-item diet quality measure (self-rated diet quality question used in the National Health and Nutrition Examination Survey and a 9-item Mediterranean diet screener recommended by the American Heart Association) prior to the cardiology visit in improving efficiency of dietary assessment, guidance of referrals, and in improving diet quality and health indicators over a 6-month period. To assess provider uptake of the dietary screener, we reviewed a random sample of charts (n = 190) to determine the proportion of notes that referenced the dietary screener and documented specific counseling based on the screener. ResultsBetween December 2017 and August 2018, 865 patients completed the diet screener. Mean age was 59 (SD 16) years, 54% were male, and mean BMI was 27.4 (SD 6.0) kg/m2. 18.5% of participants rated their diet as fair or poor, and mean score on the screener (range 0–9) was 5.6 (SD 1.8). Overall, the diet screener appeared in the chart in 87%, the physician gave specific counseling based on the screener in 11% of the visits. ConclusionsFindings from this work demonstrate a dietary screener can facilitate identification of patients who might benefit from specific interventions such as the Diabetes Prevention Program. Since cardiovascular disease is just one diet-influenced disease state, this screener could be implemented in other aspects of the health system to guide referrals to RDs for patients with other diet-related disease states. Funding SourcesThis work was funded by the Center for Healthcare Innovation and Delivery Sciences at NYU Langone Health. Supporting Tables, Images and/or Graphs▪▪▪