INTRODUÇÃO: As Estratégias de Diagnóstico e Intervenções Breves (EDIB) propostas pela Organização Mundial de Saúde são consideradas efetivas para o diagnóstico e prevenção dos agravos decorrentes do uso do álcool. Atitudes, crenças e expectativas dos profissionais de saúde em relação ao uso de álcool influenciam o efeito destas novas propostas. OBJETIVO: Este trabalho propõe a avaliação do efeito do treinamento em EDIB sobre as crenças e expectativas a respeito do uso de álcool. MÉTODOS: O estudo é do tipo observacional, transversal, comparativo, sobre uma amostra de 88 profissionais da atenção primária à saúde, provenientes de Ribeirão Preto e região, que concordaram em participar da pesquisa conforme os procedimentos éticos recomendados, treinados pelo Programa de Ações Integradas para Prevenção e Atenção ao Uso de Álcool e Drogas na Comunidade (PAIPAD) no período de 2003 a 2006. Os dados foram coletados através de questionários individuais aplicados antes do treinamento e no período de 4 a 6 meses depois. Os questionários incluíram um formulário sócio-demográfico, o Teste de Conhecimento sobre álcool e Intervenções Breves (IB), o Inventário de Expectativas e Crenças Pessoais acerca do Álcool (IECPA) e um formulário de estimativas sobre o uso do AUDIT (Alcohol Use Disorder Identification Test) e das IB. A amostra foi caracterizada quanto à prática e preparação profissional na atenção primária, papel, atitudes e crenças dos profissionais em relação aos problemas relacionados ao uso de álcool ou outras drogas pelos seus pacientes. RESULTADOS: No Teste de Conhecimento sobre álcool e Intervenções Breves, a pontuação média foi maior após o treinamento, passando de 4,1 para 5,57(Wilcoxon Test: z= -4,936; p 0,001). Os resultados médios do IECPA passaram de 93,45 pontos na fase pré para 78,74 pontos na fase pós-treinamento (Wilcoxon, z=-4,138; p 0,001). Através do teste de Spearman observou-se tendência à correlação positiva entre a aquisição de conhecimento e as variações no IECPA (p=0,095); o nível de conhecimento pré-treinamento e as estimativas de realização de EDIB(p=0,082); as estimativas de aplicação de AUDITS e o intervalo de tempo(p=0,009). As variações do IECPA se correlacionaram positivamente com as expectativas de aplicação de EDIB (Nonparametric Chi-Square: p=0,053). No Teste de Conhecimento, o nível médio (incompleto e completo) apresentou menor nível de aproveitamento que os outros níveis de escolaridade. As maiores variações no IECPA foram observadas entre os profissionais de nível de escolaridade superior (incompleto e completo). Os profissionais com ocupações de nível superior apresentaram maiores variações positivas quanto ao conhecimento que os de nível técnico, e maior redução na pontuação do IECPA. CONCLUSÕES: A estratégia de formação oferecida pelo PAIPAD foi efetiva, promovendo mudanças nas crenças e expectativas da equipe sobre uso de álcool, interferindo positivamente na conduta preventiva dos profissionais treinados junto aos pacientes. / BACKGROUND: The Strategies of Screening, Brief Intervention and Referral to Treatment (SBIRT) proposed by World Health Organization (WHO) are considered effective to perform the diagnosis and the prevention of damage caused by alcohol. Attitudes, beliefs and expectations of health professionals in relation to alcohol use have influence over the effect of these new proposals. OBJECTIVE: This study aimed at evaluating the effect of training in SBIRTs on the beliefs and expectations of professionals about the alcohol use. METHODS: The study is observational, cross-sectional and comparative, with a sample of 88 professionals of primary care, from Ribeirão Preto and region, who agreed to participate following ethical procedures, trained by Program of Integrated Action for Prevention and Attention to Alcohol and Drug Use in the Community (PAIPAD), in period from 2003 to 2006. Data were collected through individual questionnaires applied before the training and in the period from 4 to 6 months later. The questionnaires included a socio-demographic inventory, the Test of Knowledge about alcohol and brief interventions (IB), the Inventory of Positive Expectations and Beliefs about Alcohol (IECPA) and an inventory of estimates on the use of the AUDIT (Alcohol Use Disorder Identification Test) and brief interventions. The sample was characterized in relation to the practice and professional preparation in primary care, the professional role in primary care and attitudes and beliefs of professionals about problems related to alcohol or other drugs for their patients. RESULTS: In the Test of Knowledge about alcohol and brief interventions, the average score was higher after the training, increasing from 4.1 to 5.57 (Wilcoxon test: z =- 4.936, p0001). The IECPA average changed from 93.45 points to 78.74 points after intervention, in the post-training (Wilcoxon, z =- 4.138, p0001). A trend toward positive correlation between the acquisition of knowledge and changes in IECPA (p = 0,095) was found (Spearman test), as well the level of pre-training knowledge and estimates of conducting SBIRTs (p = 0,082), estimates of implementing AUDIT and the time (p = 0,009). In the Test of Knowledge, the intermediate level of schooling (complete and incomplete) showed lower score than the others. Variations of IECPA correlated positively with the expectations of applying SBIRTs (Nonparametric Chi-Square: p = 0,053). The highest changes in IECPA were seen among higher level professionals (complete and incomplete). The professionals of higher-level occupations showed bigger positive changes in knowledge than workers of technical level and higher reduction in scores of IECPA. CONCLUSIONS: The strategy of training offered by PAIPAD was effective, promoting changes in beliefs and expectations of the team about alcohol use, interfering positively in the preventive attitudes of trained professionals with the patients.

The purpose of this study was to examine the utility of a brief assessment for the selection of an effective instruction to increase fluency performance on computation math problems. Participants were four general education third-grade students who performed below the median score on a classwide administered multiple math skills probe. Students first participated in a brief assessment within a mini-withdrawal design to compare the relative effects of a contingent reward (CR) condition to a baseline condition on math fluency performance using a multiple skills probe. All four students increased performance when given an opportunity to earn an incentive for meeting a performance goal. Increased performance indicated a performance deficit to explain low math performance and that the students would positively respond to a contingent reward intervention on single math skills. To validate this hypothesis, the effects of baseline, CR, and instruction plus CR on fluency performance over time was assessed using a multiple baseline design across three single target skills for each student. Of the 12 skills assessed, results from the extended analysis demonstrated that the CR was effective on one skill, instruction plus CR was effective on five skills, and performance improved during baseline on six skills. Post results showed improved performance on the multiple probe for all students but performance was retained over 2 to 4 weeks on 5 of the 12 skills mastered during the study. Discussion focuses on considerations of the utility of a brief assessment approach in the application decision making and for future research

Background The European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers. Methods/design In a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals’ role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling. Discussion Effective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers. / <p>Funding Agencies|European Communitys Seventh Framework Program|259268|The Netherlands Organisation for Health Research and Development (ZonMW)|200310017|FP7 EC Grant||</p>

Loss to follow-up (LTF) is an important issue that can affect the validity of longitudinal studies. Further, LTF among adolescent study participants may be predicted by variables such as substance use, educational attainment, and demographic information. The purpose of this study was to determine if alcohol or marijuana use, high school completion, or demographic information was correlated with LTF among adolescent participants in the Real Talk Study. The Real Talk study is a randomized control trial that employs a brief motivational interview intervention in a clinical setting to reduce perpetration of teen dating violence (TDV) in Boston. Current participants of the Real Talk study who were eligible for follow up comprised the study sample (N=127). Baseline characteristics on age, gender, race/ethnicity, high school completion, alcohol use, and marijuana use were analyzed using Pearson’s Chi Square, and the level of significance set to p < 0.10. A post-hoc analysis was conducted on frequency of alcohol use using Pearson’s Chi Square. Of the total sample, 13% were LTF (n=17). The results of the analyses indicated that there was a statistically significant difference between those LTF and those retained for gender and drinking 6 or more drinks of alcohol per occasion. Females were more likely to be LTF than males (p<0.10), and those participants who responded “never” or “less than monthly” to the question, “how many times do you drink 6 or more drinks per occasion?” were more likely to be retained, or less likely to be LTF (p<0.10) than those who responded differently. While some of the results were consistent with the literature, it is also possible that the follow-up procedure for Real Talk ensured that there were minimal differences in LTF.

Alcohol consumption during pregnancy remains a common occurrence and is associated with a multitude of adverse birth and long-term outcomes. Binge drinking in particular is shown to be particularly harmful to the developing fetus. Effects include full fetal alcohol syndrome, with characteristic facial dysmorphology, growth restriction, and developmental to delays. Exposed children may also have partial fetal alcohol syndrome, alcohol-related birth defects, and alcohol-related neurodevelopmental disorders. These effects are preventable, and efforts must begin with accurate identification of women who consume alcohol during pregnancy. Several screening tools have been developed and validated for use in prenatal care settings, and the most recently proposed brief and easy to use T-ACER3 has demonstrated high sensitivity and specificity in both identifying risk drinking during pregnancy and predicting long-term neurobehavioral outcomes in exposed children. Once identified, effective interventions are available for use with pregnant women consuming alcohol. Brief interventions, which can be delivered by a health professional and involve motivational interviewing, have been demonstrated to significantly reduce alcohol consumption during pregnancy. These approaches, recommended by American College of Obstetricians and Gynecologist (ACOG), help move patients toward increased readiness to positively change their drinking behavior. Ultimately, all prenatal care providers should routinely screen all patients for alcohol use using validated tools, and where appropriate, should offer intervention.

Alcohol consumption during pregnancy remains a common occurrence and is associated with a multitude of adverse birth and long-term outcomes. Binge drinking in particular is shown to be particularly harmful to the developing fetus. Effects include full fetal alcohol syndrome, with characteristic facial dysmorphology, growth restriction, and developmental to delays. Exposed children may also have partial fetal alcohol syndrome, alcohol-related birth defects, and alcohol-related neurodevelopmental disorders. These effects are preventable, and efforts must begin with accurate identification of women who consume alcohol during pregnancy. Several screening tools have been developed and validated for use in prenatal care settings, and the most recently proposed brief and easy to use T-ACER3 has demonstrated high sensitivity and specificity in both identifying risk drinking during pregnancy and predicting long-term neurobehavioral outcomes in exposed children. Once identified, effective interventions are available for use with pregnant women consuming alcohol. Brief interventions, which can be delivered by a health professional and involve motivational interviewing, have been demonstrated to significantly reduce alcohol consumption during pregnancy. These approaches, recommended by American College of Obstetricians and Gynecologist (ACOG), help move patients toward increased readiness to positively change their drinking behavior. Ultimately, all prenatal care providers should routinely screen all patients for alcohol use using validated tools, and where appropriate, should offer intervention.

Over the years, many interventions have been used to ameliorate couple distress and increase relationship satisfaction. These interventions have been getting shorter in duration. The purpose of this pilot study was to test the feasibility and impact of a brief intervention using a solution-focused approach (SFBT) for couples. The brief intervention included two two-hour consultations. Data were collected from 30 couples and were analyzed using a repeated measures design. The analyses yielded mixed results. There were statistically significant improvements in the areas of individual well-being and relationship knowledge. There were no significant differences in terms of marital satisfaction, communication skills, and readiness to change, although positive trends were observed in this pilot phase. Implications for future research and development are discussed.

This study examined the utility of a pilot "call-in service" coordinated with two rural pediatric primary care clinics. This service provided practical, empirically supported recommendations to parents with concerns about their children's development, behavior, or emotional well-being. Over 70 weeks, 81 calls were received. Five specific concerns including daytime wetting, conduct problems, anxiety, sleep, and repetitive behavior comprised 75% of all calls. In addition to describing the service overall, the current article examined the top concerns in terms of their process and outcomes in this brief intervention format. Overall, calls averaged 21 min, and parents reported high satisfaction and positive outcomes at follow-up. This format appeared to be most useful for calls regarding daytime wetting and repetitive behaviors/habits. The utility of a call-in service has not been recently explored. Moreover, specific pediatric problems amenable to brief intervention in primary care have rarely been researched. This study provides direction for the future use of call-in services or brief interventions in primary care. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Syftet för föreliggande studie var att undersöka olika sätt att organisera primärvårdens om- händertagande av patienter med psykisk ohälsa och hur det påverkar patienters nöjdhet med vården. Studiens frågeställningar syftade att undersöka 1) skillnader i nöjdhet mellan patienter som erbjuds sedvanlig Integrerad Beteendehälsa (IBH) med Brief Interventions (BI) och de som får utökad bedömning med vägledd självhjälp 2) om patienters vardagliga funktion förbättras och om förbättringen har ett samband med deras upplevelse av nöjdhet 3) hur vanligt negativa upplevelser är inom behandlingsmetoderna. Av 41 randomiserade primärvårdspatienter kunde 30 analyseras utifrån deras upplevda nöjdhet inom vården. Båda grupperna var i genomsnitt nöjda med vården och skattade besöken som hjälpsamma. Patienter som efter utökad bedömning fick vägledd självhjälp skattade tidigt i behandlingen högre grad av nöjdhet och den skillnaden kvarstod. Det fanns en signifikant förändring av vardaglig funktion till det bättre för patientgruppen som helhet, men förändringen korrelerade inte signifikant med nöjdhet. Det fanns en tydlig skillnad i antal rapporterade negativa upplevelser. 14 negativa upplevelser rapporterades av patienter som fått Brief Interventions, medan en negativ upplevelse rapporterades av patienterna som fått vägledd självhjälp. Slutsatser från föreliggande studie bekräftar tidigare forskning kring att nöjdhet går att uppfylla med kortare behandlingsinterventioner samt strukturerade behandlingar. / The purpose of the present study was to examine different ways of organizing primary care for patients with general mental disorders, and how the treatment affects the patient’s satisfaction with the care. The study aimed to examine 1) if there is a difference in patient satisfaction between patients offered brief interventions within the primary care behavior health model, and patients offered an extended assessment with guided self help 2) if the patients everyday function improves and correlates with their experience of satisfaction 3) how common adverse events are within the two treatment methods. Out of 41randomized primary care patients, 30 could be analyzed based on their perceived satisfaction in health care. The result showed that both treatment groups were overall satisfied with the care and estimated the care visits as helpful. Patients who received guided self-help estimated a higher degree of satisfaction earlier in the treatment, and the level of satisfaction remained high throughout the treatment. Regarding the patient group as a whole, there was a significant change in everyday function; the patients improved their everyday function although it did not correlate with satisfaction. There was a significant difference in the number of adverse events between the two treatment groups. 14 adverse events were reported from patients who received Brief Interventions and 1 adverse event was reported from a patient who received guided self-help. Conclusions from the present study confirm findings from previous research that it is possible to achieve patient satisfaction with brief treatment interventions and structured treatment plans.

The research described in this thesis reviewed previous uses of Interactive Voice Response (IVR), developed appropriate software, and employed IVR to obtain self-report of sensitive issues in surveys and conduct brief public health interventions. Chapter 1 introduces IVR and describes a systematic critical review of the use of IVR. IVR is a telephone interviewing technique where the human speaker is replaced by a high quality recorded interactive script to which the respondent provides answers by pressing the keys of a touch-telephone (touchphone). IVR has numerous advantages, including: economy, autonomy, confidentiality, access to certain population groups, improved data quality, standardised interviewing, multi-lingual interfaces, and detailed longitudinal assessments. Despite this, there have been few survey applications of IVR compared to alternative methods such as Computer-Assisted Telephone Interview (CATI). There has not been any evaluation of the use of IVR for asking sensitive questions in surveys or as a tool for health promotion at the community level. A literature review, described in Chapter 2, was conducted to identify other methods of asking sensitive questions. The literature review identified 19 different methods. Those methods that were most successful were those that provided the greatest degree of anonymity to the respondent. It was suggested that IVR may be a suitable method for community surveys. As described in Chapter 3, a custom software called Generalized Electronic Interviewing System (GEIS) was developed. This provided both CATI and IVR interviewing modes. As described in Chapter 4, it was found that the response rate obtained using IVR was unacceptably low, and an alternative interviewing method, the Hybrid method was developed. In the Hybrid method the interview was initiated by the interviewer but completed using IVR with GEIS. As described in Chapter 5, the IVR, CATI and Hybrid methods were used to investigate self-reported rates of alcohol and drug consumption within a telephone household survey of 2880 households. The self-report rates were compared to the National Drug Strategy Household Survey (NDSHS). Response rates did not differ significantly between the CATI and Hybrid methods, however the response rate for IVR was significantly less than the other methods. The Hybrid and IVR methods obtained significantly higher self-report consumption rates for alcohol and marijuana, and significantly higher hazardous drinking scores using Alcohol Use Disorders Identification Test (AUDIT). In Chapter 6 a pilot of an IVR cervical screening brief advice interface is described. A total of 5000 households were contacted by the IVR system. The system randomly selected an eligible woman aged 18-69 per household and determined her cervical screening status. A total of 661 women listened to the IVR message. The IVR call was shown to be acceptable and inexpensive compared to a mail pamphlet intervention. In Chapter 7 a randomized controlled trial of an IVR cervical screening brief advice involving 17,008 households is described. Cervical screening rate data were obtained from the Health Insurance Commission (HIC) for a period spanning six months before and following the intervention. The cervical screening rate was increased in the intervention postcodes by 0.43% compared to the control postcodes, and the increase was greater for older women at 1.34%. This was a desirable outcome since this group is considered to be an at-risk group. The overall conclusion was that IVR technology could be feasibly used to contact women to deliver brief interventions aimed at increasing cervical screening rates, but the cost per screen was likely to be high. It is suggested that an IVR system could be linked to cervical screening registers to more directly and economically contact women, and provide an efficacious complementary approach to the existing letter reminder system. / PhD Doctorate