Motivational interviewing in smoking cessation : effectiveness, active components, and acquisition of counsellor skills

Aim: The overall aims of the present thesis are to investigate the effectiveness and active components of Motivational Interviewing (MI) in telephone-based smoking cessation treatment, and to explore the acquisition of MI skills of smoking cessation counsellors. Method: The setting of all included studies was the Swedish National Tobacco Quitline (SNTQ). In evaluating the effectiveness of MI (Study I), clients calling the SNTQ between September 2005 and October 2006 were allocated to receive either treatment as usual (TAU) or TAU with added MI. The primary outcome measures were self-reported 7-day point prevalence abstinence and 6-month continuous abstinence at 12-month follow-up. To examine the predictive power of the hypothesised active MI components (Study II and III), 106 audio-recorded treatment sessions were analysed using the Motivational Interviewing Sequential Code for Observing Process Exchanges (MI-SCOPE) Coder's manual and the Motivational Interviewing Treatment Integrity (MITI) manual, version 3.1. The SNTQ counsellors’ acquisition and retention of MI skills (Study IV) were assessed using the MITI manual, version 3.0, over 11 assessment periods at fixed intervals over two and a half years (September 2004 to February 2007). Results: At 12-month follow-up, 19% of the clients allocated to MI-trained counsellors reported 6-month continuous abstinence, versus 14% of the TAU clients (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.00–2.19; p < .05). The counsellors’ relational skills (demonstrating MI spirit) were positively associated with smoking outcome among unmotivated SNTQ clients (i.e., clients not expressing Activation utterances favouring change). The counsellors’ technical MI skills (e.g., questions and reflections favouring change) were associated with in-session client language, while in-session client language was, in turn, found to predict smoking outcome. For each expressed Activation utterance favouring abstinence, clients were 73% more likely to stop smoking (OR 1.73, 95% CI 1.08-2.76, p < .05). Conversely, for each expressed Desire or Need utterance favouring continued smoking, clients were 80% less likely to stop smoking (OR 0.20, 95% CI 0.04; 0.97, p < .05). Mediation analysis also revealed that this client language mediated the relationship between counsellors’ reflections favouring continued smoking and smoking status at follow-up. In Study IV, we observed notable smoking cessation counsellor difficulties in acquiring MI skill as well as great variation in MI skill between counsellors and in counsellor performance over time. Conclusions: Integrating MI into a cognitive behavioural therapy-based smoking cessation protocol in an ordinary clinical setting increased clients’ 6-month continuous abstinence rates by 5%. Consistent with MI theory, the findings suggest that smoking cessation counsellors should cultivate client Activation utterances favouring abstinence and soften client utterances expressing Desire or perceived Need to smoke in order to contribute to higher rates of treatment success. However, MI implementation was only partly successful, despite an extensive MI training, including continual supervision and systematic feedback on counsellors’ clinical practice

Entré Uppsala

Ett första intryck är viktigt i alla sammanhang. Det är det första intrycket som påverkar ens kommande uppfattningar. Att ge människor ett bra välkomnande är viktigt, inte minst för en stad. Genom ett bra välkomnande kan man skapa goda förutsättningar till att folk får en god inställning för den plats man kommit till. I dagens samhälle är bilen ett av de vanligaste sätten att ta sig fram på och det är också med bilen som många anländer till nya platser. Många svenska städer har idag välkomstskyltar som möter trafikanter i utkanten av staden. En del städer har gått lite längre och har något slags monument eller symbol för platsen man kommit till. Gnista trafikplats i Uppsala är en plats där flera större vägar länkas samman och är den plats som många först anländer till när man kommer till Uppsala. I dag ser inte platsen särskilt välkomnande ut och ger inte det första intrycket som man vill ge besökare. Genom denna uppsats vill vi visa på hur Uppsala kan få en fin entré in till staden och välkomna sina besökare samtidigt som de får en fin passage ut ur staden. Eftersom den valda platsen är en cirkulationsplats fanns det många aspekter att tänka på i utformningen. För att kunna skapa en bra entré har kunskap inhämtats genom litteratur om cirkulationsplatser. Kunniga personer inom trafikmiljö, både ur funktionalitets- och ur designperspektiv har intervjuats. För att få en uppfattning om hur bilisten upplever området har vi färdats i bil genom cirkulationsplatsen och anlänt till platsen från olika riktningar. De största aspekterna att tänka på har varit säkerheten i trafikmiljö och den visuella upplevelsen i den hastighet som man färdas i. Den nya gestaltningen över Gnista trafikplats ger viss information om stadens historia och bidrar samtidigt till något nytt. Den blir en tydlig markör för staden och visar på in och utfart mellan stad och landsbygd. Genom denna gestaltning ger vi Uppsala den välkomnande entrén som vi tycker att staden ska ha.The first impression is important in every kind of context. It´s the first impression that influences the following perceptions. To give people a good welcome is important, not least for a city. Through a good welcoming you can create good condition for people to have a good approach for the place you have come to. In today’s society the car is one of the most common way to get around in and it’s also with the car that many arrives to new places. Many Swedish cities today have welcome signs that meet the visitors in the uptown. Some of the cities have taken it a step longer and have some kind of monument or symbol for the place you arrive to. Gnista interchange, Uppsala is a place where several bigger roads are linked together and are the first place you arrive to when you get to Uppsala. Today the place doesn’t look very welcoming and doesn’t really give the first impression that you want to give to visitors. In this essay we want to show how Uppsala can get a nice entrance to the city and welcome its visitors and at the same get a nice passage out of the city. Since the chosen place is a circular place there were a lot of aspects to take in consideration in the design. To create a good entrance, knowledge has been gathered through literature about circular places. Knowers within traffic, both in a functional- and a design perspective have been interviewed. To get a perception of how the passengers see the area we have traveled through the circular place and arrived to the place from different directions. The biggest aspects to take in consideration have been the traffic safety and the visual experience through movement.The new design of Gnista interchange gives information about the history of the city and at the same time contributes to something new. It´s going to be a clean portal for the city and shows to a way in and out between city and countryside. In this design we give Uppsala the welcoming entrance that we think the city shall have

Cdc25B cooperates with Cdc25A to induce mitosis but has a unique role in activating cyclin B1–Cdk1 at the centrosome

Cdc25 phosphatases are essential for the activation of mitotic cyclin–Cdks, but the precise roles of the three mammalian isoforms (A, B, and C) are unclear. Using RNA interference to reduce the expression of each Cdc25 isoform in HeLa and HEK293 cells, we observed that Cdc25A and -B are both needed for mitotic entry, whereas Cdc25C alone cannot induce mitosis. We found that the G2 delay caused by small interfering RNA to Cdc25A or -B was accompanied by reduced activities of both cyclin B1–Cdk1 and cyclin A–Cdk2 complexes and a delayed accumulation of cyclin B1 protein. Further, three-dimensional time-lapse microscopy and quantification of Cdk1 phosphorylation versus cyclin B1 levels in individual cells revealed that Cdc25A and -B exert specific functions in the initiation of mitosis: Cdc25A may play a role in chromatin condensation, whereas Cdc25B specifically activates cyclin B1–Cdk1 on centrosomes

Motivational Interviewing in an ordinary clinical setting: A controlled clinical trial at the Swedish National Tobacco Quitline

AbstractIntroductionThe present study aimed to assess the effect of adding Motivational Interviewing (MI) to the first session of an effective smoking cessation treatment protocol in an ordinary clinical setting: the Swedish National Tobacco Quitline (SNTQ).MethodThe study was designed as a controlled clinical trial. Between September 2005 and October 2006, 772 clients accepted the invitation to participate in the study and were semi-randomised to either standard treatment (ST) or MI. The primary outcome measures were self-reported 7-day point prevalence abstinence and 6-month continuous abstinence.ResultsAt 12-month follow-up, the 772 clients were included in an intention to treat analysis. Of the clients allocated to MI, 57/296 (19%) reported 6-month continuous abstinence compared to 66/476 (14%) of the clients allocated to ST (OR 1.48, 95% CI 1.00–2.19; P=.047).ConclusionsIntegrating MI into a cognitive behavioural therapy-based smoking cessation counselling in an ordinary clinical setting at a tobacco quitline increased client 6-month continuous abstinence rates by 5%

Self-Reported Physician Diagnosed Asthma with COPD is Associated with Higher Mortality than Self-Reported Asthma or COPD Alone – A Prospective 24-Year Study in the Population of Helsinki, Finland

Asthma and COPD are common chronic obstructive respiratory diseases. COPD is associated with increased mortality, but for asthma the results are varying. Their combination has been less investigated, and the results are contradictory. The aim of this prospective study was to observe the overall mortality in obstructive pulmonary diseases and how mortality was related to specific causes using postal questionnaire data. This study included data from 6,062 participants in the FinEsS Helsinki Study (1996) linked to mortality data during a 24-year follow-up. According to self-reported physician diagnosed asthma, COPD, or smoking status, the population was divided into five categories: combined asthma and COPD, COPD alone and asthma alone, ever-smokers without asthma or COPD and never-smokers without asthma or COPD (reference group). For the specific causes of death both the underlying and contributing causes of death were used. Participants with asthma and COPD had the highest hazard of mortality 2.4 (95% CI 1.7–3.5). Ever-smokers without asthma or COPD had a 9.5 (3.7–24.2) subhazard ratio (sHR) related to lower respiratory tract disease specific causes. For asthma, COPD and combined, the corresponding figures were 10.8 (3.4–34.1), 25.0 (8.1–77.4), and 56.1 (19.6–160), respectively. Ever-smokers without asthma or COPD sHR 1.7 (95% CI 1.3–2.5), and participants with combined asthma and COPD 3.5 (1.9–6.3) also featured mortality in association with coronary artery disease. Subjects with combined diseases had the highest hazard of overall mortality and combined diseases also showed the highest hazard of mortality associated with lower respiratory tract causes or coronary artery causes.Peer reviewe

Mortality associated with occupational exposure in Helsinki, Finland - a 24-year follow-up

Objectives: Our objective was to study mortality related to different obstructive lung diseases, occupational exposure, and their potential joint effect in a large, randomized population-based cohort. Methods: We divided the participants based on the answers to asthma and COPD diagnoses and occupational exposure and used a combined effects model and compared the results to no asthma or COPD with no occupational exposure. Results: High exposure had a hazard ratio (HR) 1.34 (1.11-1.62) and asthma and COPD coexistence 1.58 (1.10-2.27). The combined effects of intermediate exposure and coexistence had a HR 2.20 (1.18-4.09), high exposure with co-existence 1.94 (1.10-3.42) for overall mortality and sub-hazard ratio for respiratory related mortality sHR 3.21 (1.87-5.50). Conclusions: High occupational exposure increased overall, but not respiratory related mortality hazard while co-existing asthma and COPD overall and respiratory related hazard of mortalityPeer reviewe

Correspondence between practitioners’ self-assessment and independent motivational interviewing treatment integrity ratings

As evaluation of practitioners’ competence is largely based on self-report, accuracy in practitioners’ self-assessment is essential for ensuring high quality treatment-delivery. The aim of this study was to assess the relationship between independent observers’ ratings and practitioners’ self-reported treatment integrity ratings of Motivational interviewing (MI). Practitioners (N = 134) were randomized to two types of supervision [i.e., regular institutional group supervision, or individual telephone supervision based on the MI Treatment Integrity (MITI) code]. The mean age was 43.2 years (SD = 10.2), and 62.7 percent were females. All sessions were recorded and evaluated with the MITI, and the MI skills were self-assessed with a questionnaire over a period of 12 months. The associations between self-reported and objectively assessed MI skills were overall weak, but increased slightly from baseline to the 12-months assessment. However, the self-ratings from the group that received monthly objective feedback were not more accurate than those participating in regular group supervision. These results expand findings from previous studies and have important implications for assessment of practitioners’ treatment fidelity: Practitioners may learn to improve the accuracy of self-assessment of competence, but to ensure that patients receive intended care, adherence and competence should be assessed objectively

Age at asthma diagnosis is related to prevalence and characteristics of asthma symptoms

Background: Although asthma may begin at any age, knowledge about relationship between asthma age of onset and the prevalence and character of different symptoms is scarce. Objectives: The aim of this study was to investigate if adult-diagnosed asthma is associated with more symptoms and different symptom profiles than child-diagnosed asthma.Methods: A FinEsS postal survey was conducted in a random sample of 16 000 20-69-year-old Finnish adults in 2016. Those reporting physician-diagnosed asthma and age at asthma diagnosis were included. Age 18 years was chosen to delineate child-and adult-diagnosed asthma.Results: Of responders (N = 8199, 51.5%), 842 (10.3%) reported asthma diagnosis. Adult -diagnosed asthma was reported by 499 (59.3%) and child-diagnosed by 343 (40.7%). Of re-sponders with adult-diagnosed and child-diagnosed asthma, 81.8% versus 60.6% used asthma medication (p < 0.001), respectively. Current asthma was also more prevalent in adult-diagnosed asthma (89.2% versus 72.0%, p < 0.001). Risk factors of attacks of breathlessness during the last 12 months were adult-diagnosis (OR = 2.41, 95% CI 1.64-3.54, p < 0.001), female gender (OR = 1.49, 1.07-2.08, p = 0.018), family history of asthma (OR = 1.48, 1.07-2.04, p = 0.018) and allergic rhinitis (OR = 1.49, 1.07-2.09, p = 0.019). All the analysed asthma symptoms, except dyspnea in exercise, were more prevalent in adult-diagnosed asthma in age-and gender-adjusted analyses (p = 0.032-Peer reviewe

The combined effect of exposures to vapours, gases, dusts, fumes and tobacco smoke on current asthma

Smoking, exposure to environmental tobacco smoke (ETS) and occupational exposure to vapours, gases, dusts or fumes (VGDF) increase asthma symptoms. The impact of combined exposure is less well established. We aimed to evaluate the risk of combined exposure to smoking, ETS and VGDF on the prevalence of current asthma and asthma-related symptoms with a postal survey among a random population of 16,000 adults, aged 20-69 years (response rate 51.5%). The 836 responders with physician-diagnosed asthma were included in the analysis. Of them, 81.9% had current asthma defined as physician-diagnosed asthma with current asthma medication use or reported symptoms. There was a consistently increasing trend in the prevalence of current asthma by increased exposure. The highest prevalence of multiple symptoms was in smokers with VGDF exposure (92.1%) compared to the unexposed (73.9%, p = 0.001). In logistic regression analysis, combined exposure to several exposures increased the risk in all analysed symptoms (p = 0.002-0.007). In conclusion, smoking and exposure to ETS or VGDF increased the prevalence of current asthma and multiple symptoms. The combined exposure carried the highest risk. Preventive strategies are called for to mitigate exposure to tobacco smoke and VGDF.Peer reviewe

Asthma Remission by Age at Diagnosis and Gender in a Population-Based Study

BACKGROUND: Child-onset asthma is known to remit with high probability, but remission in adult-onset asthma is seem-ingly less frequent. Reports of the association between remission and asthma age of onset up to late adulthood are scarce. OBJECTIVE: To evaluate the association between asthma remission, age at diagnosis and gender, and assess risk factors of nonremission. METHODS: In 2016, a random sample of 16,000 subjects aged 20 to 69 years from Helsinki and Western Finland were sent a FinEsS questionnaire. Physician-diagnosed asthma was catego-rized by age at diagnosis to early-(0-11 years), intermediate-(12-39 years), and late-diagnosed (40-69 years) asthma. Asthma remission was defined by not having had asthma symptoms and not having used asthma medication in the past 12 months. RESULTS: Totally, 8199 (51.5%) responded, and 879 reported physician-diagnosed asthma. Remission was most common in early-diagnosed (30.2%), followed by intermediate-diagnosed (17.9%), and least common in late-diagnosed asthma (5.0%) (P < .001), and the median times from diagnosis were 27, 18.5, and 10 years, respectively. In males, the corresponding remission rates were 36.7%, 20.0%, and 3.4%, and in females, 20.4%, 16.6%, and 5.9% (gender difference P < .001). In multivariable binary logistic regression analysis, signifi-cant risk factors of asthma nonremission were intermediate (odds ratio [OR] = 2.15, 95% confidence interval: 1.373.36) and late diagnosis (OR = 11.06, 4.82-25.37) compared with early diagnosis, chronic obstructive pulmonary disease (COPD) (OR = 5.56, 1.26-24.49), allergic rhinitis (OR = 2.28, 1.50-3.46), and family history of asthma (OR = 1.86, 1.22-2.85). Results were similar after excluding COPD. CONCLUSION: Remission was rare in adults diagnosed with asthma after age 40 years in both genders. Late-diagnosed asthma was the most significant independent risk factor for nonremission. (C) 2020 American Academy of Allergy, Asthma & ImmunologyPeer reviewe