Repetition of Suicide Attempts Data from Emergency Care Settings in Five Culturally Different Low- and Middle-Income Countries Participating in the WHO SUPRE-MISS Study

Background: Attempted suicide is a strong risk factor for subsequent suicidal behaviors. Innovative strategies to deal with people who have attempted suicide are needed, particularly in resource-poor settings. Aims: To evaluate a brief educational intervention and periodic follow-up contacts (BIC) for suicide attempters in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, People's Republic of China) as part of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS). Methods: Among the 1,867 suicide attempters enrolled in the emergency departments of the participating sites, 922 (49.4%) were randomly assigned to a brief intervention and contact (BIC) group and 945 (50.6%) to a treatment as usual (TAU) group. Repeated suicide attempts over the 18 months following the index attempt - the secondary outcome measure presented in this paper - were identified by follow-up calls or visits. Subsequent completed suicide - the primary outcome measure has been reported in a previous paper. Results: Overall, the proportion of subjects with repeated suicide attempts was similar in the BIC and TAU groups (7.6% vs. 7.5%, chi(2) = 0.013; p = .909), but there were differences in rates across the five sites. Conclusions: This study from five low-and middle-income countries does not confirm the effectiveness of brief educational intervention and follow-up contacts for suicide attempters in reducing subsequent repetition of suicide attempts up to 18 months after discharge from emergency departments.

As implicações do curso de formação continuada sobre consumo de álcool: uma proposta de intervenção breve aplicada por professores

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comportamentos de risco para acidentes em playgrounds: identificação e opiniões de profissionais de educação infantil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Adolescentes em semiliberdade: consumo de álcool e outras drogas e atendimento em uma unidade do interior do estado de São Paulo

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A avaliação da efetividade de um modelo de intervenção breve (método BASICS) para o uso de risco de álcool em estudantes do ensino médio

Pós-graduação em Saúde Coletiva - FMB

Efetividade da fonoterapia e proposta de intervenção breve em respiradores orais

OBJETIVOS: verificar o efeito da intervenção fonoaudiológica em um grupo de respiradores orais e propor terapia fonoaudiológica mínima no tratamento da respiração oral. MÉTODO: estudo prospectivo longitudinal, casuística de 40 sujeitos respiradores orais tratados no Hospital das Clínicas - setor de Reabilitação Orofacial do Ambulatório de Respirador Oral da Disciplina de Otorrinolaringologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas - UNICAMP. Realizada documentação fotográfica, avaliação clínica, aplicação de protocolo para categorizar modo respiratório, postura (lábios e bochechas); força e praxias (lábios, bochechas e língua) nas semanas 0, 12 e 24. A proposta terapêutica constou de treino e conscientização da respiração nasal; manobras para aquecimento e vascularização da musculatura orofacial; aplicação de pontos e zonas motoras na face; manobras passivas; uso do impulso distal; exercícios miofuncionais e registro da percepção dos pacientes sobre suas condições olfativas e obstruções nasais.Teste estatístico: não paramétrico de Igualdade de Duas Proporções, p < 0,05. RESULTADOS: houve adequação da função respiração nasal. Aumento da força de lábios, língua e bochechas. Melhora nas praxias: bico direita, bico esquerda, estalo e vibração de lábios. Vibração e estalo de língua. Inflar simultaneamente as bochechas, inflar bochecha direita e esquerda. O tempo com maior ganho terapêutico foi de 12 semanas. A partir deste dado foi esquematizado protocolo com 12 sessões estruturadas abordando estratégias utilizadas nesta pesquisa. CONCLUSÃO: a pesquisa demonstrou que o uso da reabilitação miofuncional para pacientes respiradores orais foi eficiente com maior evolução terapêutica observada na semana 12.

La conduite avec facultés affaiblies : les contrevenants et les services offerts dans les établissements de détention du Québec

Rapport de stage présenté à la Faculté des études supérieures en vue de l’obtention du grade de Maître ès science (M. Sc.) en criminologie Option stage en analyse criminologique

La conduite avec facultés affaiblies : les contrevenants et les services offerts dans les établissements de détention du Québec

Rapport de stage présenté à la Faculté des études supérieures en vue de l’obtention du grade de Maître ès science (M. Sc.) en criminologie Option stage en analyse criminologique

Attitudes and management of alcohol problems in general practice: Descriptive analysis based on findings of a world health organization international collaborative survey

Aims: To determine if general practitioners' (GPs) experience of education on alcohol, support in their working environment for intervening with alcohol problems, and their attitudes have an impact on the number of patients they manage with alcohol problems. Methods: 1300 GPs from nine countries were surveyed with a postal questionnaire as part of a World Health Organization (WHO) collaborative study. Results: GPs who received more education on alcohol (OR = 1.5; 95% CI, 1.3-1.7), who perceived that they were working in a supportive environment (OR = 1.6; 95% CI, 1.4-1.9), who expressed higher role security in working with alcohol problems (OR = 2.0; 95% CI, 1.5-2.5) and who reported greater therapeutic commitment to working with alcohol problems (OR = 1.4: 95% CI, 1.1-1.7) were more likely to manage patients with alcohol-related harm. Conclusion: Both education and support in the working environment need to be provided to enhance the involvement of GPs in the management of alcohol problems.

The role of alcohol expectancy and drinking refusal self-efficacy beliefs in university student drinking

Aims: University student alcohol misuse is a considerable problem. Alcohol expectancy research has contributed significantly to our understanding of problem drinking in young adults. Most of this research has investigated positive expectancy alone. The current study utilized two measures of alcohol expectancy, the alcohol expectancy questionnaire (AEQ) and the drinking expectancy profile [consisting of the drinking expectancy questionnaire (DEQ) and the drinking refusal self-efficacy questionnaire] to predict severity of alcohol dependence, frequency of drinking, and the quantity of alcohol consumed per occasion. Methods: Measures of drinking behaviour and alcohol expectancy were completed by 174 undergraduate university students. Results: Positive alcohol expectancy factors accounted for significant variance in all three drinking indices, with the DEQ adding additional variance to AEQ scores on frequency and severity of alcohol dependence indices. Negative expectancy did not add incremental variance to the prediction of drinking behaviour in this sample. Drinking refusal self-efficacy and dependence beliefs added additional variance over positive and negative expectancies in the prediction of all three drinking parameters. Conclusions: Positive expectancy and drinking refusal self-efficacy were strongly related to university student drinking. The incorporation of expectancy as a means of informing prevention approaches in tertiary education shows promise.

Statistical dialog management for health interventions

Research endeavors on spoken dialogue systems in the 1990s and 2000s have led to the deployment of commercial spoken dialogue systems (SDS) in microdomains such as customer service automation, reservation/booking and question answering systems. Recent research in SDS has been focused on the development of applications in different domains (e.g. virtual counseling, personal coaches, social companions) which requires more sophistication than the previous generation of commercial SDS. The focus of this research project is the delivery of behavior change interventions based on the brief intervention counseling style via spoken dialogue systems. ^ Brief interventions (BI) are evidence-based, short, well structured, one-on-one counseling sessions. Many challenges are involved in delivering BIs to people in need, such as finding the time to administer them in busy doctors' offices, obtaining the extra training that helps staff become comfortable providing these interventions, and managing the cost of delivering the interventions. Fortunately, recent developments in spoken dialogue systems make the development of systems that can deliver brief interventions possible. ^ The overall objective of this research is to develop a data-driven, adaptable dialogue system for brief interventions for problematic drinking behavior, based on reinforcement learning methods. The implications of this research project includes, but are not limited to, assessing the feasibility of delivering structured brief health interventions with a data-driven spoken dialogue system. Furthermore, while the experimental system focuses on harmful alcohol drinking as a target behavior in this project, the produced knowledge and experience may also lead to implementation of similarly structured health interventions and assessments other than the alcohol domain (e.g. obesity, drug use, lack of exercise), using statistical machine learning approaches. ^ In addition to designing a dialog system, the semantic and emotional meanings of user utterances have high impact on interaction. To perform domain specific reasoning and recognize concepts in user utterances, a named-entity recognizer and an ontology are designed and evaluated. To understand affective information conveyed through text, lexicons and sentiment analysis module are developed and tested.^

Electronic health records: essential tools in integrating substance abuse treatment with primary care.

While substance use problems are considered to be common in medical settings, they are not systematically assessed and diagnosed for treatment management. Research data suggest that the majority of individuals with a substance use disorder either do not use treatment or delay treatment-seeking for over a decade. The separation of substance abuse services from mainstream medical care and a lack of preventive services for substance abuse in primary care can contribute to under-detection of substance use problems. When fully enacted in 2014, the Patient Protection and Affordable Care Act 2010 will address these barriers by supporting preventive services for substance abuse (screening, counseling) and integration of substance abuse care with primary care. One key factor that can help to achieve this goal is to incorporate the standardized screeners or common data elements for substance use and related disorders into the electronic health records (EHR) system in the health care setting. Incentives for care providers to adopt an EHR system for meaningful use are part of the Health Information Technology for Economic and Clinical Health Act 2009. This commentary focuses on recent evidence about routine screening and intervention for alcohol/drug use and related disorders in primary care. Federal efforts in developing common data elements for use as screeners for substance use and related disorders are described. A pressing need for empirical data on screening, brief intervention, and referral to treatment (SBIRT) for drug-related disorders to inform SBIRT and related EHR efforts is highlighted.

Group problem-solving skills training for self-harm: randomised controlled trial

Background: Rates of self-harm are high and have recently increased. This trend and the repetitive nature of self-harm pose a significant challenge to mental health services. Aims: To determine the efficacy of a structured group problem-solving skills training (PST) programme as an intervention approach for self-harm in addition to treatment as usual (TAU) as offered by mental health services. Method: A total of 433 participants (aged 18-64 years) were randomly assigned to TAU plus PST or TAU alone. Assessments were carried out at baseline and at 6-week and 6-month follow-up and repeated hospital-treated self-harm was ascertained at 12-month follow-up. Results: The treatment groups did not differ in rates of repeated self-harm at 6-week, 6-month and 12-month follow-up. Both treatment groups showed significant improvements in psychological and social functioning at follow-up. Only one measure (needing and receiving practical help from those closest to them) showed a positive treatment effect at 6-week (P = 0.004) and 6-month (P = 0.01) follow-up. Repetition was not associated with waiting time in the PST group. Conclusions: This brief intervention for self-harm is no more effective than treatment as usual. Further work is required to establish whether a modified, more intensive programme delivered sooner after the index episode would be effective.

Statistical Dialog Management for Health Interventions

Research endeavors on spoken dialogue systems in the 1990s and 2000s have led to the deployment of commercial spoken dialogue systems (SDS) in microdomains such as customer service automation, reservation/booking and question answering systems. Recent research in SDS has been focused on the development of applications in different domains (e.g. virtual counseling, personal coaches, social companions) which requires more sophistication than the previous generation of commercial SDS. The focus of this research project is the delivery of behavior change interventions based on the brief intervention counseling style via spoken dialogue systems. Brief interventions (BI) are evidence-based, short, well structured, one-on-one counseling sessions. Many challenges are involved in delivering BIs to people in need, such as finding the time to administer them in busy doctors' offices, obtaining the extra training that helps staff become comfortable providing these interventions, and managing the cost of delivering the interventions. Fortunately, recent developments in spoken dialogue systems make the development of systems that can deliver brief interventions possible. The overall objective of this research is to develop a data-driven, adaptable dialogue system for brief interventions for problematic drinking behavior, based on reinforcement learning methods. The implications of this research project includes, but are not limited to, assessing the feasibility of delivering structured brief health interventions with a data-driven spoken dialogue system. Furthermore, while the experimental system focuses on harmful alcohol drinking as a target behavior in this project, the produced knowledge and experience may also lead to implementation of similarly structured health interventions and assessments other than the alcohol domain (e.g. obesity, drug use, lack of exercise), using statistical machine learning approaches. In addition to designing a dialog system, the semantic and emotional meanings of user utterances have high impact on interaction. To perform domain specific reasoning and recognize concepts in user utterances, a named-entity recognizer and an ontology are designed and evaluated. To understand affective information conveyed through text, lexicons and sentiment analysis module are developed and tested.

The use of motivational interviews by nurses to promote health behaviors in adolescents: A scoping review protocol

Abstract The developmental changes during adolescence may affect subsequent risk for diseases and health-related behaviors. Motivational Interview (MI) may be taken as an essential tool in the provision of nursing care to adolescents, being itself a workspace with possible therapeutic effects. At this context, it is important to examine and map the use of MI by nurses in their clinical practice with adolescents to promote health behaviors. Objetives A scoping review has been currently undertaking to find out what is the current extent of the use of nurse-led MI; which adolescent populations were included; in which contexts nurses use MI; which MI techniques/strategies have been used and what outcomes on health behaviors promotion have been reported. The first task was to develop a search strategy to identify relevant studies for this review. It is described here the experience in constructing a search strategy for this review. Methodology This scoping review will be informed by JBI methodology. An initial search of MEDLINE and CINAHL was undertaken. An analysis of the text words contained in the title and abstract, and of the index terms used to describe the searched articles were retrieved and these were then used to construct a search strategy for use in Medline and Cinahl. Results Analysis of the text words and the index terms generated 19 keywords: It was identified 5 synonyms for "Adolescents", 12 for "MI" and 2 for "nurse". A new research formula was designed using the text words identified. Adolescen*[Title/Abstract]) OR Younger*[Title/Abstract]) OR Youth*[Title/Abstract]) OR Teen*[Title/Abstract]) OR Adolescent[MeSH Terms])) AND (((((((((((("Motivational interview"[Title/Abstract]) OR "Motivational intervention"[Title/Abstract]) OR "Motivational interviews"[Title/Abstract]) OR "Motivational interventions"[Title/Abstract]) OR "motivational interviewing"[Title/Abstract]) OR "motivational counseling"[Title/Abstract]) OR "motivational support"[Title/Abstract]) OR "Motivational enhancement"[Title/Abstract]) OR "Brief intervention"[Title/Abstract]) OR "Brief interventions"[Title/Abstract]) OR Motivational Interviewing[MeSH Terms]) OR Directive Counseling[MeSH Terms])) AND ((nurs*[Text Word]) OR Nurses[MeSH Terms]). Limiters - Language: English, Portuguese, Spanish. In MEDLINE this research formula generated 125 results. Other 16 databases referenced at the protocol will be searched to identify additional studies. Articles identified from the final search will be assessed for relevance to the review, based on information provided in the title and abstract. The full article will be retrieved for all studies that meet the inclusion criteria of the review. Conclusions It was presented here the initial results of this search. Next steps of this study will be to develop and refine the search strategy for use in other databases. It is expected that findings from this Scoping Review provide needed information to nurses related to the use of MI to promote health behaviors in adolescents and inform opportunities for future development in nursing practice.