counseling

Pharmacologic Treatment of Perinatal Depression

Megan George — Fri, 21 Nov 2025 19:44:10 +0000

Date Added:

November 21, 2025

Journal/Publication:

JAMA Insights

Publication Date:

November 19, 2025

URL:

Pharmacologic Treatment of Perinatal Depression

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.17250

Keywords

Pharmacology

Perinatal Depression

Major Depressive Disorder

abuse

depression

PMID (1):

41259042

A review of the treatment of patients with perinatal depression with an emphasis on pharmalogic therapy. James W. Mold, MD, MPH

View

Approximately 1 in 7 individuals are affected by perinatal depression, defined as a depressive episode occurring during pregnancy or within 12 months after delivery. Although the diagnostic criteria are similar to those of major depressive disorder, perinatal depression may also include symptoms such as difficulty forming an emotional attachment with the fetus or infant, persistent doubts about parenting abilities, and intrusive thoughts of harm to self or infant.1 Mental health conditions are leading contributors to maternal mortality in the US; among reporting states, the rate of death from perinatal suicide ranges from 4.2 to 21.4 per 100 000 pregnancies.2 Untreated or undertreated perinatal depression increases other maternal risks, including limited engagement in care, impaired relationships, substance use, preeclampsia, and suicide, as well as fetal or neonatal risks, including preterm birth, low birth weight, and disrupted attachment with long-term developmental consequences.3 Individuals from marginalized communities, such as those who are non–English speaking, uninsured, or geographically isolated, experience a higher prevalence of perinatal depression and are at increased risk of underdiagnosis and undertreatment.3

Risk factors for perinatal depression include a personal or family history of depression, abuse, stressful life events, low socioeconomic status, adolescent or single parenthood, and pregnancy complications, such as preterm birth or pregnancy loss. Each factor individually confers only a small increase in risk, making accurate prediction based on clinical factors challenging.4 Therefore, to facilitate early identification and treatment, universal screening during and after pregnancy is recommended. The American College of Obstetricians and Gynecologists (ACOG) recently issued 2 Clinical Practice Guidelines on perinatal mental health, 1 on screening and diagnosis5 and 1 on treatment and management,3 highlighting opportunities for obstetricians to address existing health gaps.

Author/s:

Emily S. Miller, S. Karlene Cunningham, Lauren M. Osborne

Prenatal Cannabis Use and Neonatal Outcomes A Systematic Review and Meta-Analysis

Hope Smashey — Tue, 08 Jul 2025 16:15:44 +0000

Date Added:

July 8, 2025

Journal/Publication:

JAMA Pediatrics

Publication Date:

May 5, 2025

Issue:

179

Volume:

URL:

Prenatal Cannabis Use and Neonatal Outcomes A Systematic Review and Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamapediatrics.2025.0689

Keywords

PMID (1):

40323610

MeSH

Evidence-Based Medicine

Maternal marijuana use during pregnancy is bad for babies. James W. Mold, MD, MPH.

Commercial full text (fees may apply)

View

Importance: Prenatal cannabis use continues to increase, and cannabis remains the most commonly used illegal substance in pregnancy. Accumulating evidence suggests potential adverse effects on fetal and neonatal outcomes following cannabis use in pregnancy.

Objective: To update a living systematic review and meta-analysis to provide a timely understanding regarding cannabis use in pregnancy and fetal and neonatal outcomes.

Data sources: The previous review was updated by searching bibliographic databases MEDLINE, CINAHL, PsycInfo, Global Health, and Evidence-Based Medicine Reviews Cochrane Database of Systematic Reviews from November 1, 2021, through April 4, 2024.

Study selection: Cohort or case-control studies comparing pregnancies with and without prenatal cannabis use on prespecified fetal or neonatal outcomes with adjustment for confounders, such as co-use of tobacco products, were included. Two independent reviewers screened studies, with disagreements resolved through discussion.

Data extraction and synthesis: Included studies were extracted by 1 reviewer and confirmed by a second. Risk of bias was assessed with the Newcastle-Ottawa Scale. Random-effects meta-analyses of unadjusted and adjusted odds ratios (ORs) were performed for all primary outcomes. Results were synthesized using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Main outcomes and measures: Primary outcomes were preterm birth (PTB; <37 weeks of gestation), small for gestational age (SGA), low birth weight (LBW; <2500 g), and perinatal mortality.

Results: For this update, 8 new studies with 1 709 998 participants were added, for a total of 51 studies synthesized (N = 21 146 938). From meta-analyses of adjusted effect sizes, moderate-certainty evidence indicated that cannabis use in pregnancy was associated with increased odds of LBW (20 studies; OR, 1.75; 95% CI, 1.41-2.18), PTB (20 studies; OR, 1.52; 95% CI, 1.26-1.83), and SGA (12 studies; OR, 1.57; 95% CI, 1.36-1.81), and low-certainty evidence indicated that it was associated with greater odds of perinatal mortality (6 studies; OR, 1.29; 95% CI, 1.07-1.55). Previously, the evidence was rated as very low or low certainty.

Conclusions and relevance: Cannabis use in pregnancy was associated with greater odds of PTB, SGA, and LBW even after adjusting for co-use of tobacco products, and confidence in these findings increased from low in the prior review to moderate in the current meta-analysis. The findings of this study may help inform patient counseling and future public health policies.

Author/s:

Jamie O Lo, Chelsea K Ayers, Snehapriya Yeddala, Beth Shaw, Shannon Robalino, Rachel Ward, Devan Kansagara

Clinical Approaches to the Prevention of Firearm-Related Injury

Erin Blanchette — Mon, 16 Sep 2024 13:17:52 +0000

Date Added:

September 16, 2024

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

September 12, 2024

Issue:

Volume:

391

Pages:

926-940

URL:

Clinical Approaches to the Prevention of Firearm-Related Injury

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMra2306867

Keywords

PMID (1):

39259896

MeSH

Firearm-related injuries are the second leading cause of death in children. If one our goals as PCPs is to prevent premature deaths, we need to make this issue a focus of attention during WCCs. James W. Mold, MD, MPH

Free full text

View

Firearm-related injuries are an urgent health crisis in the United States, with firearm-related deaths surpassing deaths from motor vehicle crashes in 2017.1 In contrast to other conditions for which clinicians have evidence-based solutions to reduce harm, the 25-year gap in federal research funding2,3 halted substantial advances in the science of firearm-related injury prevention. Yet renewed funding and emerging science continue to highlight the critical role clinicians have in prevention efforts.2,3 Similar to other complex health issues, firearm-related injury is heterogeneous, with multiple causes (Figure 1). Each of these causes has entry points within clinical encounters that represent opportunities to interact, interrupt, and prevent negative outcomes.

The lack of research has resulted in a generation of clinicians currently lacking the training necessary to implement the solutions generated by recent science. As a result, despite clinicians recognizing the need for prevention and agreeing that prevention of firearm-related injury is within their scope of practice,13 few deliver evidence-based interventions even though their patients find such measures acceptable within the context of clinical care.14 This lack of training is compounded by a shortage of adequate health care infrastructure necessary to support the integration of useful approaches into practice. Clinicians note multiple barriers, including a lack of knowledge, guidelines, time, clinical support, and reimbursement, as well as a fear of offending patients or encountering legal trouble.15-17

Clinicians routinely provide harm-reduction measures and anticipatory guidance for a range of complex health issues (e.g., substance use and vaccination), capitalizing on available evidence, their relationships with patients, and their community standing to promote health and safety. Although gaps exist, there remain opportunities to improve the current standard of care for the prevention of firearm-related injury. In this article, we review clinical approaches to prevention, ranging from ones implemented within individual clinical encounters to ones advanced by health care leaders within the systems and communities they serve.

Author/s:

Patrick M Carter, Rebecca M Cunningham

Nonpharmacologic Treatments for Maternal Mental Health Conditions

Alex Haga — Tue, 20 Aug 2024 19:53:30 +0000

Date Added:

August 20, 2024

Journal/Publication:

Agency for Healthcare Research and Quality

Publication Date:

July 31, 2024

URL:

Nonpharmacologic Treatments for Maternal Mental Health Conditions

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

Cognitive Behavioral Therapy

counseling

Postpartum period

An evidence-based review of non-pharmocologic treatments for maternal mental health conditions. James W. Mold, MD, MPH

Free full text

View

Objectives. This systematic review evaluates nonpharmacologic treatments for mental health conditions during the perinatal period (pregnancy and up to 12 months postpartum). We evaluated nonpharmacologic treatments for perinatal individuals with depressive disorders, anxiety disorders, bipolar disorder, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD).

Data sources and review methods. We searched MEDLINE®, PsycINFO®, Embase®, CINAHL®, the Cochrane Register of Clinical Trials, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov from January 1, 2000, to January 17, 2024, to identify relevant randomized controlled trials (RCTs). Nonpharmacologic interventions of interest included, among others, cognitive behavioral therapy (CBT), interpersonal therapy (IPT), exercise, non-directive counseling, behavioral activation, bright light therapy, eye movement desensitization and reprocessing (EMDR), and acupuncture. Outcomes of interest were improvement in scores on psychological assessment tools, cure or resolution of symptoms, suicide-related outcomes, and adherence to treatment. PROSPERO registration number: CRD42023440650.

Results. We identified 103 RCTs. Nonpharmacologic treatments were compared to control or each other in 101 RCTs and to pharmacologic treatments in 2 RCTs. The risk of bias was moderate for the majority of included studies, mostly related to lack of blinding. For perinatal individuals with depressive disorders, CBT was more effective than treatment as usual (TAU) to reduce depressive and anxiety symptoms (both moderate strength of evidence [SoE]); IPT was more effective than TAU to treat depressive symptoms (moderate SoE) and anxiety symptoms (low SoE); and both behavioral activation (a CBT technique, with low SoE) and exercise interventions (moderate SoE) were more effective than TAU to reduce depressive symptoms. Remission rates for depressive symptoms were higher with CBT and IPT compared to TAU (both low SoE) and higher with specific acupuncture than nonspecific or sham acupuncture (low SoE). There were no differences between CBT and non-directive counseling (an active patient-led intervention), between counseling and TAU, and between bright light and placebo light therapy (all low SoE). CBT was more effective than TAU to reduce anxiety and depressive symptoms for individuals with combined depressive and anxiety disorders (low SoE). Few (or no) eligible studies evaluated individuals with anxiety disorder, PTSD, OCD, or bipolar disorders, precluding conclusions for these conditions. There was also insufficient evidence for suicide-related outcomes, potential harms of treatment, and adherence to treatment, and for comparisons of nonpharmacologic with pharmacologic treatments.

Conclusion. Several nonpharmacologic treatments are more effective than TAU for perinatal mental health conditions, with the strongest evidence for CBT and IPT to reduce depressive symptoms among perinatal individuals with depressive disorders or combined depressive and anxiety disorders. Future research is needed to evaluate the comparative effectiveness of lesser studied nonpharmacologic interventions and lesser studied perinatal mental health conditions.

Sexually Transmitted Infections: Behavioral Counseling

Brian Desmarais — Thu, 20 Aug 2020 14:37:26 +0000

Date Added:

August 20, 2020

Publisher:

U.S. Preventive Services Task Force

Publication Date:

August 18, 2020

URL:

Sexually Transmitted Infections: Behavioral Counseling

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

MeSH

sexually transmitted diseases

counseling

adolescent

The USPSTF now recommends behavioral counseling regarding prevention of STIs for all sexually active adolescents and adults at risk for STIs (a category B recommendation). James W. Mold, MD, MPH

Free full text

View

Not available.

Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis

Brian Desmarais — Mon, 22 Jun 2020 15:22:14 +0000

Date Added:

June 22, 2020

Journal/Publication:

JAMA Network Open

Publisher:

American Medical Association

Publication Date:

June 1, 2020

Issue:

Volume:

URL:

Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2020.8279

Keywords

substance abuse

treatment

MeSH

motivational interviewing

Cognitive Behavioral Therapy

behavior therapy

counseling

The most effective treatment of substance abuse disorders includes the combination of medications and cognitive behavioral therapy. James W. Mold, MD, MPH

Free full text

View

Abstract

Importance: Substance use disorders (SUDs) represent a pressing public health concern. Combined behavioral and pharmacological interventions are considered best practices for addiction. Cognitive behavioral therapy (CBT) is a first-line intervention, yet the superiority of CBT compared with other behavioral treatments when combined with pharmacotherapy remains unclear. An understanding of the effects of combined CBT and pharmacotherapy will inform best-practice guidelines for treatment of SUD.

Objective: To conduct a meta-analysis of the published literature on combined CBT and pharmacotherapy for adult alcohol use disorder (AUD) or other SUDs.

Data sources: PubMed, Cochrane Register, MEDLINE, PsychINFO, and Embase databases from January 1, 1990, through July 31, 2019, were searched. Keywords were specified in 3 categories: treatment type, outcome type, and study design. Collected data were analyzed through September 30, 2019.

Study selection: Two independent raters reviewed abstracts and full-text articles. English language articles describing randomized clinical trials examining CBT in combination with pharmacotherapy for AUD and SUD were included.

Data extraction and synthesis: Inverse-variance weighted, random-effects estimates of effect size were pooled into 3 clinically informative subgroups: (1) CBT plus pharmacotherapy compared with usual care plus pharmacotherapy, (2) CBT plus pharmacotherapy compared with another specific therapy plus pharmacotherapy, and (3) CBT added to usual care and pharmacotherapy compared with usual care and pharmacotherapy alone. Sensitivity analyses included assessment of study quality, pooled effect size heterogeneity, publication bias, and primary substance moderator effects.

Main outcomes and measures: Substance use frequency and quantity outcomes after treatment and during follow-up were examined.

Results: The sample included 62 effect sizes from 30 unique randomized clinical trials that examined CBT in combination with some form of pharmacotherapy for AUD and SUD. The primary substances targeted in the clinical trial sample were alcohol (15 [50%]), followed by cocaine (7 [23%]) and opioids (6 [20%]). The mean (SD) age of the patient sample was 39 (6) years, with a mean (SD) of 28% (12%) female participants per study. The following pharmacotherapies were used: naltrexone hydrochloride and/or acamprosate calcium (26 of 62 effect sizes [42%]), methadone hydrochloride or combined buprenorphine hydrochloride and naltrexone (11 of 62 [18%]), disulfiram (5 of 62 [8%]), and another pharmacotherapy or mixture of pharmacotherapies (20 of 62 [32%]). Random-effects pooled estimates showed a benefit associated with combined CBT and pharmacotherapy over usual care (g range, 0.18-0.28; k = 9). However, CBT did not perform better than another specific therapy, and evidence for the addition of CBT as an add-on to combined usual care and pharmacotherapy was mixed. Moderator analysis showed variability in effect direction and magnitude by primary drug target.

Conclusions and relevance: The present study supports the efficacy of combined CBT and pharmacotherapy compared with usual care and pharmacotherapy. Cognitive behavioral therapy did not perform better than another evidence-based modality (eg, motivational enhancement therapy, contingency management) in this context or as an add-on to combined usual care and pharmacotherapy. These findings suggest that best practices in addiction treatment should include pharmacotherapy plus CBT or another evidence-based therapy, rather than usual clinical management or nonspecific counseling services.

Author/s:

Ray, L.A., Meredith, L.R., Kiluk, B.D., Walthers, J., Carroll, K.M., Magill, M.

Screening for Alcohol Use and Brief Counseling of Adults — 13 States and the District of Columbia, 2017

John Bayhi — Sat, 14 Mar 2020 20:31:53 +0000

Date Added:

March 14, 2020

Journal/Publication:

MMWR Morbidity and Mortality Weekly Report

Publisher:

Centers for Disease Control and Prevention

Publication Date:

March 13, 2020

Issue:

Volume:

Pages:

265-270

URL:

Screening for Alcohol Use and Brief Counseling of Adults — 13 States and the District of Columbia, 2017

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.15585/mmwr.mm6910a3

Keywords

alcohol use

screening and brief intervention

alcohol SBI

binge drinking

PMID (1):

32163383

MeSH

Behavioral Risk Factor Surveillance System

Fetal Alcohol Spectrum Disorders

Public Health Practice

health personnel

Evidence-Based Medicine

insurance coverage

Telephone

Centers for Disease Control and Prevention

U.S.

Longitudinal Studies

The CDC recommends screening all adults for binge drinking with a single question and recommending reduction to those who screen positive. James W. Mold, MD, MPH

Free full text

View

What is already known about this topic?

Binge drinking increases the risk for adverse health conditions and death. Alcohol screening and brief intervention (SBI), recommended by the U.S. Preventive Services Task Force (USPSTF) for all adults in primary care, is effective in reducing binge drinking.

What is added by this report?

In 2017, 81% of survey respondents were asked by their health care provider about alcohol consumption and 38% about binge drinking at a checkup in the past 2 years. Among those asked about alcohol use and who reported current binge drinking, 80% received no advice to reduce their drinking.

What are the implications for public health practice?

Implementation of alcohol SBI as recommended by USPSTF, coupled with population-level evidence-based interventions, can reduce binge drinking among U.S. adults.

Author/s:

McKnight-Eily, LR, Okoro, CA, Turay, K, Acero, C, Hungerford, D

What Parents Know Matters: Parental Knowledge at Birth Predicts Caregiving Behaviors at 9 Months

Brian Desmarais — Sat, 25 Jan 2020 22:22:10 +0000

Date Added:

January 25, 2020

Journal/Publication:

The Journal of Pediatrics

Publication Date:

January 1, 2020

URL:

What Parents Know Matters: Parental Knowledge at Birth Predicts Caregiving Behaviors at 9 Months

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.jpeds.2019.12.021 showArticle

Keywords

cognitive development

MeSH

A reminder to assess parental knowledge of infant growth and development at the first well child check and to provide education as needed. The first year of life is arguably the most critical period of human psychological and cognitive development. James W. Mold, MD, MPH

Free full text

View

Objective

To examine the mediating role of socioeconomically disadvantaged parents' knowledge of early cognitive and language development at the first postpartum visit in the relation between education and caregiving behaviors at 9 months.

Study design

Parental knowledge was assessed at the 1-week newborn visit (n = 468); anticipatory guidance received and desired at 1-month (n = 212) and 6-month (n = 191) visits were reported; and caregiving behaviors toward infants during a teaching task were observed at 9-month visit (n = 173).

Results

We found substantial variation in knowledge and caregiving behaviors. Parents who had more knowledge of infant development at 1 week were more likely to respond to cues (r = 0.18; P < .05) and foster social-emotional (r = 0.17; P < .05) and cognitive growth (r = 0.20; P < .05) at 9 months. Importantly, the indirect effect of education on cognitive growth fostering at 9 months through knowledge at 1 week was significant, controlling for primary language and number of other children in the home (infancy: β = 0.06; B = 0.07; SE = 0.04; 95% CI, 0.007-0.165; early childhood: β = 0.04; B = 0.06; SE = 0.03; 95% CI, 0.008-0.152). Open-ended responses indicated that anticipatory guidance in the first 6 months focused on infant physical growth; however, parents did not request additional anticipatory guidance from their pediatricians.

Conclusions

This study sheds light on the importance of promoting parental knowledge about cognitive and language development to foster parental cognitive stimulations and language inputs during the first year of life. This study highlights the important role of anticipatory guidance on cognitive and language development during the earliest well-child visits and the need to better understand parental baseline knowledge to tailor anticipatory guidance to the family strengths and needs.

Author/s:

Leung, C.Y., Suskind, D.L.

What Parents Know Matters: Parental Knowledge at Birth Predicts Caregiving Behaviors at 9 Months

Brian Desmarais — Sat, 25 Jan 2020 22:21:26 +0000

Date Added:

January 25, 2020

Journal/Publication:

The Journal of Pediatrics

Publication Date:

January 1, 2020

URL:

What Parents Know Matters: Parental Knowledge at Birth Predicts Caregiving Behaviors at 9 Months

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.jpeds.2019.12.021 showArticle

Keywords

cognitive development

MeSH

Free full text

View

Objective

Study design

Results

Conclusions

Author/s:

Leung, C.Y., Suskind, D.L.

Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation Statement.

Brian Desmarais — Wed, 21 Aug 2019 19:42:45 +0000

Date Added:

August 21, 2019

Journal/Publication:

Journal of the American Medical Association

Publication Date:

August 20, 2019

URL:

Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation Statement.

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2019.10987

Keywords

MeSH

early detection of cancer

Genetic Counseling

I suspect you are already doing this, but since it is making a splash on the TV news programs, I thought you ought to see it. James W. Mold, MD, MPH

Commercial full text (fees may apply)

View

IMPORTANCE:

Potentially harmful mutations of the breast cancer susceptibility 1 and 2 genes (BRCA1/2) are associated with increased riskfor breast, ovarian, fallopian tube, and peritoneal cancer. For women in the United States, breast cancer is the most common cancer after nonmelanoma skin cancer and the second leading cause of cancer death. In the general population, BRCA1/2 mutations occur in an estimated 1 in 300 to 500 women and account for 5% to 10% of breast cancer cases and 15% of ovarian cancer cases.

OBJECTIVE:

To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer.

EVIDENCE REVIEW:

The USPSTF reviewed the evidence on risk assessment, genetic counseling, and genetic testing for potentially harmful BRCA1/2 mutations in asymptomatic women who have never been diagnosed with BRCA-related cancer, as well as those with a previous diagnosis of breast, ovarian, tubal, or peritoneal cancer who have completed treatment and are considered cancer free. In addition, the USPSTF reviewed interventions to reduce the risk for breast, ovarian, tubal, or peritoneal cancer in women with potentially harmful BRCA1/2 mutations, including intensive cancer screening, medications, and risk-reducing surgery.

FINDINGS:

For women whose family or personal history is associated with an increased risk for harmful mutations in the BRCA1/2 genes, or who have an ancestry associated with BRCA1/2 gene mutations, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are moderate. For women whose personal or family history or ancestry is not associated with an increased risk for harmful mutations in the BRCA1/2 genes, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are small to none. Regardless of family or personal history, the USPSTF found adequate evidence that the overall harms of risk assessment, genetic counseling, genetic testing, and interventions are small to moderate.

CONCLUSIONS AND RECOMMENDATION:

The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. (B recommendation) The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations. (D recommendation).

Author/s:

US Preventive Services Task Force

Preventing Firearm-Related Death and Injury

Brian Desmarais — Wed, 05 Jun 2019 19:32:12 +0000

Date Added:

June 5, 2019

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

June 4, 2019

Issue:

Volume:

170

URL:

Preventing Firearm-Related Death and Injury

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/AITC201906040

Keywords

MeSH

A comprehensive summary of what we know about firearm-associated injuries and firearm safety to support physician-initiated patient education. James W. Mold, MD, MPH

Free full text

View

Deaths and injuries from firearms are significant public health problems, and clinicians are in a unique position to identify risk among their patients and discuss the importance of safe firearm practices. Although clinicians may be ill-prepared to engage in such discussions, an adequate body of evidence is available for support, and patients are generally receptive to this type of discussion with their physician. Here, we provide an overview of existing research and recommended strategies for counseling and intervention to reduce firearm-related death and injury.

Author/s:

Pallin, R., Spitzer, S.A., Ranney, M.L., Betz, M.E., Wintemute, G.J.

Obesity Treatment, Beyond the Guidelines: Practical Suggestions for Clinical Practice

Tracy Ashby — Fri, 22 Mar 2019 05:00:00 +0000

Date Added:

March 26, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 21, 2019

URL:

Obesity Treatment, Beyond the Guidelines: Practical Suggestions for Clinical Practice

Type:

Clinical Decision Aids

Format:

Article

DOI (1):

10.1001/jama.2019.2352

Keywords

PMID (1):

30896727

MeSH

This provides some practical clinical advice for primary care clinicians trying to help their patients lose weight and keep it off. James W. Mold, MD, MPH

Free full text

No abstract available.

Author/s:

Kahan, Scott, Manson, JoAnn E.

Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices

Jeffrey Wilson — Wed, 02 Jan 2019 14:31:45 +0000

Date Added:

January 2, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

April 1, 1997

Issue:

Volume:

277

Pages:

1039-1045

URL:

Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.1997.03540370029032

Keywords

PMID (1):

9091691

MeSH

In this RCT conducted in primary care settings, two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information was sufficient to reduce 7-day alcohol use from 19.1 to 11.5 at 12 months in the experimental group vs 18.9 at baseline to 15.5 at 12 months in controls (P<.001); episodes of binge drinking from 5.7 at baseline to 3.1 at 12 months in the experimental group vs 5.3 at baseline to 4.2 at 12 months in controls (P<.001), and percentage drinking excessively in previous 7 days from 47.5% at baseline to 17.8% at 12 months in the experimental group vs 48.1% at baseline to 32.5% at 12 months in controls (P<.001) at one year.

Commercial full text (fees may apply)

View

OBJECTIVE:

Project TrEAT (Trial for Early Alcohol Treatment) was designed to test the efficacy of brief physician advice in reducing alcohol use and health care utilization in problem drinkers.

DESIGN:

Randomized controlled clinical trial with 12-month follow-up.

SETTING:

A total of 17 community-based primary care practices (64 physicians) located in 10 Wisconsin counties.

PARTICIPANTS:

Of the 17695 patients screened for problem drinking, 482 men and 292 women met inclusion criteria and were randomized into a control (n=382) or an experimental (n=392) group. A total of 723 subjects (93%) participated in the 12-month follow-up procedures.

INTERVENTION:

The intervention consisted of two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information.

MAIN OUTCOME MEASURES:

Alcohol use measures, emergency department visits, and hospital days.

RESULTS:

There were no significant differences between groups at baseline on alcohol use, age, socioeconomic status, smoking status, rates of depression or anxiety, frequency of conduct disorders, lifetime drug use, or health care utilization. At the time of the 12-month follow-up, there were significant reductions in 7-day alcohol use (mean number of drinks in previous 7 days decreased from 19.1 at baseline to 11.5 at 12 months for the experimental group vs 18.9 at baseline to 15.5 at 12 months for controls; t=4.33; P<.001), episodes of binge drinking (mean number of binge drinking episodes during previous 30 days decreased from 5.7 at baseline to 3.1 at 12 months for the experimental group vs 5.3 at baseline to 4.2 at 12 months for controls; t=2.81; P<.001), and frequency of excessive drinking (percentage drinking excessively in previous 7 days decreased from 47.5% at baseline to 17.8% at 12 months for the experimental group vs 48.1% at baseline to 32.5% at 12 months for controls; t=4.53; P<.001). The chi2 test of independence revealed a significant relationship between group status and length of hospitalization over the study period for men (P<.01).

CONCLUSIONS:

This study provides the first direct evidence that physician intervention with problem drinkers decreases alcohol use and health resource utilization in the US health care system.

Author/s:

Fleming, Michael F., Barry, Kristen L., Manwell, Linda B., Johnson, Kristen, London, Richard

Brief physician and nurse practitioner-delivered counseling for high-risk drinking. Results at 12-month follow-up

Jeffrey Wilson — Wed, 02 Jan 2019 14:26:10 +0000

Date Added:

January 2, 2019

Journal/Publication:

Journal of General Internal Medicine

Publisher:

Society of General Internal Medicine

Publication Date:

January 1, 2005

Issue:

Volume:

Pages:

7-13

URL:

Brief physician and nurse practitioner-delivered counseling for high-risk drinking. Results at 12-month follow-up

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1111/j.1525-1497.2005.21240.x

Keywords

alcohol

alcoholism

PMID (1):

15693921

MeSH

In this RCT conducted in academic primary care practices, brief (5–10 minute) patient-centered counseling plus an office system that cued providers to intervene and provided patient educational materials was sufficient to reduce weekly alcohol intake in patients with unhealthy alcohol intake one year post-intervention.

Free full text

BACKGROUND:

The objective of this study was to determine the effects of a brief primary care provider-delivered counseling intervention on the reduction of alcohol consumption by high-risk drinkers. The intervention was implemented as part of routine primary care medical practice.

METHODS:

We performed a controlled clinical trial with 6- and 12-month follow-up. Three primary care practices affiliated with an academic medical center were randomly assigned to special intervention (SI) or usual care (UC). A total of 9,772 primary care patients were screened for high-risk drinking. A fourth site was added later. From the group that was screened, 530 high-risk drinkers entered into the study, with 447 providing follow-up at 12 months. The intervention consisted of brief (5-10 minute) patient-centered counseling plus an office system that cued providers to intervene and provided patient educational materials.

RESULTS:

At 12-month follow-up, after controlling for baseline differences in alcohol consumption, SI participants had significantly larger changes (P=.03) in weekly alcohol intake compared to UC (SI=-5.7 drinks per week; UC=-3.1 drinks per week), and of those who changed to safe drinking at 6 months more SI participants maintained that change at 12 months than UC.

CONCLUSIONS:

Project Health provides evidence that screening and very brief (5-10 minute) advice and counseling delivered by a patient's personal physician or nurse practitioner as a routine part of a primary care visit can reduce alcohol consumption by high-risk drinkers.

Author/s:

Reiff-Hekking, Sarah, Ockene, Judith K., Hurley, Thomas G.

Motivational Techniques and Skills for Health and Mental Health Coaching/Counseling

Jeffrey Wilson — Mon, 17 Dec 2018 15:32:06 +0000

Date Added:

December 17, 2018

Publisher:

Nova Southeastern University

Publication Date:

January 1, 2013

URL:

Guided Self-Change

Type:

Clinical Decision Aids

Format:

Article

Keywords

MeSH

This is a concise summary with examples of common motivational interviewing strategies.

Free full text

Guided Self-Change Healthy Lifestyles Program. The Guided Self-Change (GSC) Healthy Lifestyles outpatient program at Nova Southeastern University's (NSU) College of Psychology offers a unique short-term, evidence-based, non-12 step alternative treatment not available elsewhere in Florida. The GSC program has been recognized in the Surgeon General's report Facing Addiction in America (November 2016) as an appropriate treatment for individuals who have mild alcohol or drug problems. It also is included on the American Psychological Association's (APA) Division 12 (Society of Clinical Psychology) website listing of Empirically Supported Treatments.

Author/s:

Sobell, Mark B., Sobell, Linda, C.