Recent treatment outcomes studies address not only the effectiveness, but also the efficacy of different treatment approaches. Results of two meta-analysis studies showed that nonpharmacological treatments have a larger overall effect size than pharmacological treatments; however, owing to the diversity in study designs, it is unclear whether nonpharmacological treatments are more effective than pharmacological treatments at this point.
Objectives
Get Healthy in Pregnancy (GHiP) is a telephone based lifestyle coaching service for pregnant women, in New South Wales, Australia. GHiP had two service options; a telephone-based health coaching program consisting of up to 10 calls and information only (including one call). This study sought to compare the outcomes of the two GHiP options, to determine the characteristics of women likely to use the service and to explore the feedback from women and health professionals.
Methods
A pragmatic stratified clustered randomised controlled trial was conducted. Two metro and three rural hospitals were randomised into health coaching or information only arms. Self-reported measures of height and weight and health behaviours (dietary and physical activity) were collected at baseline and 36 weeks gestation. Process evaluation included descriptive analysis of routine program data, and semi-structured interviews with participants and health professionals.
Results
Of 3736 women screened, 1589 (42.5%) were eligible to participate, and of those eligible, 923 (58.1%) were recruited. More women in the health coaching arm gained weight within the target range for their BMI at 36 weeks gestation (42.9%) compared with information only (31.9%). Women found GHiP to be useful and supportive and midwives and doctors said that it facilitated conversations about weight with pregnant women.
Conclusions for Practice
Telephone-based lifestyle programs integrated with routine clinical care show promise in helping pregnant women achieve healthy gestational weight gain, but in this case was not significantly different from one information telephone call. Strong positive feedback suggests that scaled-up service delivery would be well received.
Trial Registration
ACTRN12615000397516 (retrospectively registered).
Aims-This study evaluated the prevalence and reliability of DSM-IV adopted criteria for 3,4-methylenedioxymethamphetamine (MDMA) abuse and dependence with a purpose to determine whether it is best conceptualized within the category of hallucinogens, amphetamines, or its own category.
Design-Test-retest study.Participants-MDMA users (lifetime use >5 times) were recruited in St. Louis, Miami, and Sydney (n=593). The median lifetime MDMA consumption was 50 pills at the baseline.Measurements-The computerized Substance Abuse Module for Club Drug (CD-SAM) was used to assess MDMA abuse and dependence. The Discrepancy Interview Protocol (DIP) was used to determine the reasons for the discrepant responses between the two interviews. Reliability of diagnoses, individual diagnostic criteria, and withdrawal symptoms was examined using the kappa coefficient (κ).Findings-For baseline data, 15% and 59% meeting MDMA abuse and dependence respectively. Substantial test-retest reliability of the diagnoses was consistently observed across cities (κ=0.69). Continued use despite knowledge of physical/psychological problems' (87%) and `Withdrawal' (68%) were the two most prevalent dependence criteria. `Physically hazardous use' was the most prevalent abuse criterion. Six dependence criteria and all abuse criteria were reliably reported across cities (κ: 0.53 to 0.77). Seventeen out of 19 withdrawal symptoms showed consistency in the reliability across cities. The most commonly reported reason for discrepant responses was Interpretation of question changed'. Only a small proportion of the total discrepancies were attributed to lying or social desirability.Conclusion-The adopted DSM-IV diagnostic classification for MDMA abuse and dependence was moderately reliable across cities. Findings on MDMA withdrawal support the argument that MDMA should be separated from other hallucinogens in DSM.
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