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PubMed1997

Communication of HIV serostatus between potential sex partners in personal ads.

We studied reference to HIV in personal ads from 1986 to 1993 to assess knowledge of HIV serostatus as a criterion for selecting sex partners. Personals increased exponentially during 1986 to 1993. Men seeking men (MSM) were more likely (8%) to mention HIV than persons seeking other situations (0% to 1.6%). The proportion of personals mentioning HIV increased from 0.5% to 2.9% globally and from 1.9% to 12.2% for MSM (chi-square tests for trend; p < .001). Younger MSM mentioned HIV less often than MSM older than 35 years (odds ratio = .46; 95% confidence interval: 31 to .70). The increasing proportion of personals mentioning HIV suggests that serostatus is increasingly used as a criterion for partner selection, although most (84%) such ads concerned MSM. We discussed the implications of these findings for preventing sexual transmission of HIV.

Adult↗
PubMed1988

Nonverbal communication as a compensative strategy for severely nonfluent aphasics? A quantitative approach.

Seven severely nonfluent aphasics and one relative or close friend were investigated in an interview situation. The conversation was videotaped and analyzed for the use of nonverbal communication between aphasic and partner. The results indicate that the group of aphasics used significantly more frequently and for a significantly longer period of time nonverbal channels of communication than their healthy partners. The aphasic patients also used significantly fewer speech-focused movements and significantly more codified gestures. Nonverbal elements were more frequently used as speech substitutes by the group of aphasics.

Adult↗
PubMed2002

Synergism of frail rural elderly couples: influencing interdependent independence.

In this phenomenological study, a purposive sample of 19 frail rural elderly couples were interviewed as dyads to identify programs, services, and relationships perceived by the couples as beneficial to their ability to continue to live independently in the community. Communication between the partners, and roles and relationships were observed and discussed. Findings showed that mutually supportive dyads generated a synergism or energy that acted as a vital resource to couples. Research results led to the development of a continuum of spousal relationships and a trajectory of couple communication. Support to the couple as a unit, to the couple relationship, and to address the couple's needs may be strategic foci for nurses in their delivery of care and their involvement in planning programs and developing policy.

Activities of Daily Living↗
PubMed2004

Myocardial infarction: narrations by afflicted women and their partners of lived experiences in daily life following an acute myocardial infarction.

BACKGROUND: The review of the literature showed that many people and their family members share feelings of distress after an acute myocardial infarction. Therefore, it is important to show how the illness affects the relationship in the couple's daily life when the closest relatives involved are men. AIM: The aim was to illuminate the meaning of lived experiences in daily life after an acute myocardial infarction, as narrated by afflicted women and their partners. METHODS: Nine women and their partners narrated their experiences three and 12 months after an infarction. The interview texts were then interpreted, using a phenomenological hermeneutic method, inspired by the philosophy of Ricoeur. The text was divided into meaning units that were condensed and abstracted. Two themes and eight sub-themes were then extracted from the text. RESULTS: The first theme was 'living in a changed life situation' with the sub-themes: 'showing consideration', 'taking responsibility', 'living side by side' and 'desiring what to do'. The second theme was 'looking to the future' with the sub-themes: 'feeling uncertain', 'feeling powerless', 'feeling limited' and 'feeling hope'. CONCLUSIONS: The results revealed that couples lived in a changed life situation, somewhat in 'discordance', and showed consideration to each other in order to protect the partner. There seemed to be a lack of verbal communication, but both women and their partners revealed that they sensed how their partners felt without verbal communication. In this 'discordance', couples may experience loneliness, in that they may not share feelings about the event and the situation it causes. RELEVANCE TO CLINICAL PRACTICE: Women and their partner have specific needs in daily living following an acute myocardial infarction. Therefore, nurses should acknowledge the specific needs for the female patient and the partner more clearly.

Activities of Daily Living↗
PubMedDate not supplied

[What are the sexual discomforts of the institutionalized elderly and what do nurses know about the problem?].

The aims of this study were to identify the sexual problems of elderly people institutionalised in 2 nursing-homes and to find out how much the caregivers employed at these homes know about the sexuality-related problems affecting the elderly people they care for. Two questionnaires were issued: one to the residents of the home, the other to the caregivers. Results showed that the caregivers had very little awareness of sexuality in elderly people and of the particular problems and discomfort of those living in institutions. Discomfort was mainly due to loneliness, difficulty in communicating with caregivers about sentimental and sexual needs, finding new partners and lack of communication between the elderly person and his relatives regarding sexuality-related problems.

Aged↗
PubMed1999

Facilitators and barriers to use of the female condom: qualitative interviews with women of diverse ethnicity.

Women in the United States, particularly African-Americans and Hispanics, are at increased risk for HIV. The female condom now offers women a potentially important option for HIV prevention, yet few efforts have been made to increase its use. To elucidate strategies to promote the use of the female condom, we conducted in-depth interviews with 62 women recruited from the four major racial/ethnic groups of the U.S. (African-American, Asian-American, Hispanic, and white). Subject recruitment took place at a family planning clinic in San Francisco during 1996-97. We identified four major types of facilitators and barriers to use of the female condom: mechanical, psychosexual, interpersonal, and situational. Specifically, the mechanical facilitators and barriers included positive and negative aspects of the device, and difficulty with insertion. The psychosexual factors were female empowerment, more options for contraception and disease prevention, discomfort with vaginal insertion, and condom use norms. The interpersonal factors included: enhanced communication, relationship status, partner preferences, and partner objections. Finally, the situations that made women disinclined to use the device were: no access to the female condom when having sex and using other forms of contraceptives. The implications of these findings for HIV prevention and future research are discussed.

Adolescent↗
PubMed2006

Ethnic Korean women's perceptions about birth control.

CONTEXT: We see many Korean women in our clinics and we have found them to have negative attitudes to hormonal contraception. We need to understand their perceptions and experiences with contraception in order to improve the effectiveness of our contraceptive counseling. METHODS: This was a qualitative descriptive study, conducted in an urban family practice office. The participants were a convenience sample of 40 ethnic Korean women. Data were collected in semistructured interviews by one interviewer who is fluent in English and Korean. Transcribed interviews were analyzed to identify salient themes. RESULTS: There was a deep distrust of hormonal methods of contraception and belief that hormones caused permanent harm. Unlike the findings in our other studies of Asian women, these women were satisfied with their usual methods of combining condoms, rhythm and withdrawal. They described good communication with their partners (which is necessary for the effective use of their chosen approaches). CONCLUSION: When counseling Korean women about contraception, it is important to discuss the cultural bias against hormonal contraception involving beliefs that hormones cause permanent harm. It is also important to recognize the very successful use of condoms, rhythm and withdrawal by these couples.

Adolescent↗
PubMed2005

Connecting health departments and providers: syndromic surveillance's last mile.

INTRODUCTION: A critical need exists for mechanisms to identify and report acute illness clusters to health departments. The Massachusetts Department of Public Health (MDPH) works with partner organizations to conduct syndromic surveillance. This effort is based on CDC's Health Alert Network program and includes automated generation and notification of signals and a mechanism to obtain detailed clinical information when needed. METHODS: Syndromic surveillance partners collect emergency department and ambulatory care data. The principal communications platform between syndromic surveillance partners and MDPH is the Massachusetts Homeland and Health Alert Network (HHAN). This Internet-based application serves as a portal for communication and collaboration and alerts predefined groups of users involved in emergency response. Syndromic surveillance partners' systems report to HHAN by using Public Health Information Network Messaging System events that meet thresholds selected by MDPH. Cluster summaries are automatically posted into a document library. HHAN notifies users by electronic mail, alphanumeric pager, facsimile, or voice communications; users decide how they want to be notified for each level of alert. Discussion threads permit real-time communication among all parties. RESULTS: This automated alert system became operational in July 2004. During July-December 2004, HHAN facilitated communication and streamlined investigation of 15 alerts. CONCLUSION: The system allows rapid, efficient alerting and bidirectional communication among public health and private-sector partners and might be applicable to other public health agencies.

Disaster Planning↗
PubMed1997

[Intercultural communication in general practice].

What is the reason for possible communication problems between physicians and immigrants from the third world? How is the interaction between the two groups regulated? To answer such questions, 15 doctors and 10 immigrants were interviewed about their experience of the doctor-patient interaction in unstructured open-ended interviews. Culturally based verbal and non-verbal expressions were particularly difficult to interpret, being based on different thought models and language. Owing to the world wide generalisation of the doctor-patient roles the gap between the two "partners" in the communication has been to some extent bridged. Largely independent of the doctors' will, the immigrants assigned considerable authority to the doctors. Thus the power of the doctor is based on the institutionalisation of the more universal doctor-patient role.

Communication↗
PubMed1995

Experiences of the male partner in cervical and endometrial cancer--a prospective interview study.

This article focuses on social, psychological and sexual experiences of 47 men before their partner was treated for cervical or endometrial cancer and 1 year later. As a complement to the interviews the men completed a symptom check-list. Before initiation of treatment, a great majority of the men were in psychological crisis. The number of psychological symptoms decreased from the first to the last interview. Symptoms with psychosomatic character increased, however, considerably. In the endometrial group, several had intrapsychic problems, while interpersonal problems were more common in the cervical group. Both groups found it difficult to know how to behave and how to communicate with their partner, friends and acquaintances. A majority had nobody to whom they could speak honestly, and most did not obtain basic information about their partner's disease. The experiences of intercourse were much more negative after completed treatment and a majority described impaired sexual desire. Provided that the woman herself desires it, the coping and rehabilitation of the woman, the man and the couple would improve if the male were integrated in the care program from the moment the diagnosis of cancer is made.

Adaptation, Psychological↗
PubMed2006

The clinical context and patient participation in post-diagnostic consultations.

OBJECTIVE: Although patient participation is an important feature of patient-centered health care, few studies have examined how the clinical context affects patient involvement in medical encounters. This investigation examined the way patients communicate with physicians in two diverse post-diagnostic settings, post-angiogram consultations and initial lung cancer visits. METHODS: From transcripts and audiorecordings of post-angiogram consultations (n=88) and initial lung cancer visits (n=62) within a VA hospital in the United States, three measures of patient participation were coded--number of active participation behaviors (questions, acts of assertiveness, and expressions of concern), proportion of patients' utterances in the form of active participation, and conversational involvement (ratio of patient utterances to physician plus patient utterances). Mixed linear regression procedures assessed the independent effects of the clinical setting, physicians' facilitative communication (partnership-building and supportive talk), and patients' age, education, and ethnicity on patient participation. RESULTS: Not only was their less talk in the post-angiogram consultations compared with the lung cancer visits, heart patients also were less conversationally involved (accounted for 25% of the talk) than were lung cancer patients (45% of the talk) and their doctors used proportionally less facilitative talk than did the lung cancer physicians. In both settings, patients were more conversationally engaged when proportionally more of the physicians' talk was facilitative. CONCLUSIONS: The clinical context has a profound effect on patient participation. However, within individual settings, physicians can increase patient involvement by using partnering and supportive communication. PRACTICE IMPLICATIONS: Clinicians and administrators should assess clinical practices that restrict patient involvement in ways that could affect quality of decision-making.

Adult↗
PubMed1997

Unique requirements for retinoid-dependent transcriptional activation by the orphan receptor LXR.

LXR is an orphan nuclear receptor that confers retinoid responsiveness to the retinoid X receptor (RXR) by its interaction on a specific response element called an LXRE. To understand the mechanism of this response, three characteristics were identified that are crucial to activation of the RXR-LXR complex. First, the orientation of the RXR-LXR heterodimer on DNA indicates that as the ligand-binding partner, RXR occupies the 5' half-site of the response element. Next, the sequence specificity of the LXRE was determined in order to identify residues required for retinoid activation of the heterodimer. Remarkably, subtle changes in the nucleotide sequence of the LXRE half-sites that do not substantially alter DNA binding of the RXR-LXR heterodimer have a significant effect on the ability of the complex to be activated by ligand. Finally, we characterized the contributions of the activation domains of each receptor to the trans-activation potential of the RXR-LXR heterodimer. Surprisingly, our results show that only the activation domain of LXR is required for retinoid activation. Taken together, these results demonstrate the existence of a unique form of communication between heterodimer partners in which the activation potential of one receptor (LXR) is enabled by ligand binding to its partner (RXR). Furthermore, we conclude that RXR ligand activation potential is not dictated solely by its position on DNA, but is influenced by other factors such as the receptor partner and sequence of the response element.

Alitretinoin↗
PubMed2004

Creating cross-racial primary care relationships in a nurse-managed center.

Culturally incompetent communication patterns with providers influence the health disparities of African Americans. Limited knowledge exists on cross-racial nurse practitioner nurse-patient relationships (NP-NPRs). The purpose of this paper is to describe how NPs and patients in cross-racial relationships developed primary care relationships in one nurse managed center (NMC). A qualitative design incorporated a social constructivist paradigm and the methodology of Interpretive Interactionism. Twenty cross-racial NP-patient dyads (White NPs and Black patients) participated in individual 1 to 3-hour audiotaped interviews regarding their ongoing relationships and the impact of the NMC. The analysis uncovered a rich description of the relationship processes from the initial meeting to its current state. Multiple themes for each phase, as well as, four typologies of primary care cross-racial NP-NPRs are described. Significant relationship work was needed by both partners to overcome communication misunderstandings, contextual aspects of cross-racial interactions and other overt and covert perceptions.

Adaptation, Psychological↗
PubMedDate not supplied

Interaction between children with cerebral palsy and their mothers: the effects of speech intelligibility.

Children with cerebral palsy and severe speech disorders have been described as passive communicators, whose conversation partners control and dominate interaction. This paper studies the effects of speech intelligibility on interaction between mothers and their children with cerebral palsy to examine if similar patterns of child passivity and adult domination are also observed in dyads in which children are physically dependent but naturally intelligible to their parents. Two groups, each of 20 children who had four-limb cerebral palsy and who differed in their speech intelligibility, participated in the study. Children in Group 1 (whose interaction has been previously reported) were unintelligible to their parents out of context. Children in Group 2 had speech that was understood without situational cues. Children and their mothers were videotaped playing with a set of toys that had been shown to elicit from non-disabled children a full range of the conversational moves and speech acts targeted in the study. Videotaped interaction was transcribed and coded at three levels to show conversation structure, the pragmatic functions expressed and the method of communication used. Percentage distribution of coding categories was compared across groups using coda. Results showed that verbally intelligible children initiated more conversations and used their communication for a wider range of functions than did non-speaking children, for whom more restricted patterns of conversation were noted. Unexpectedly, few differences were observed between the two groups of mothers, who initiated and closed most exchanges. Implications for intervention are discussed.

Cerebral Palsy↗
PubMed2006

Comparison of individuals opting for BRCA1/2 or HNPCC genetic susceptibility testing with regard to coping, illness perceptions, illness experiences, family system characteristics and hereditary cancer distress.

OBJECTIVE: To study differences between individuals opting for genetic cancer susceptibility testing of a known familial BRCA1/2 and HNPCC related germline mutation. METHODS: Coping, illness perceptions, experiences with cancer in relatives and family system characteristics were assessed in 271 applicants for genetic testing before test result disclosure. Hereditary cancer distress, worry and cancer risk perception were assessed before, 1 week after, and 6 months after disclosure. RESULTS: Individuals from BRCA1/2 and HNPCC mutation families did not differ with regard to the number of experiences with cancer in relatives, grief symptoms, the course of cancer distress, worry and risk perception through time and most illness perceptions, coping responses and family characteristics. Individuals from BRCA1/2 families perceived hereditary cancer as more serious. They reported more frequently a passive coping style, cancer worry and a less open communication with their partner and children. CONCLUSION: Besides subtle differences, psychological mechanisms may be mainly identical in individuals opting for BRCA1/2 and HNPCC susceptibility testing. PRACTICE IMPLICATIONS: Based on our findings, using a similar counseling approach for individuals opting for BRCA1/2 or HNPCC genetic susceptibility testing is justified. In this approach, attention should be directed more to individual aspects than to the type of disorder.

Adaptation, Psychological↗
PubMedDate not supplied

Developing national epidemiologic capacity to meet the challenges of emerging infections in Germany.

In January 1996, the Robert Koch Institute, Germany's national public health institute, began strengthening its epidemiologic capacity to respond to emerging and other infectious diseases. Six integrated strategies were initiated: developing employee training, outbreak investigation, and epidemiologic research programs; strengthening surveillance systems; improving communications to program partners and constituents; and building international collaborations. By December 1999, five employees had completed a 2-year applied epidemiology training program, 186 health department personnel had completed a 2-week training course, 27 outbreak investigations had been completed, eight short-term research projects had been initiated, major surveillance and epidemiologic research efforts for foodborne and nosocomial infections had begun, and 16 scientific manuscripts had been published or were in press. The German experience indicates that, with a concerted effort, considerable progress in building a national applied infectious disease program can be achieved in a short time frame.

Communicable Disease Control↗
PubMed2001

Gendered construction of sexual risks: implications for safer sex among young people in Kenya and Sweden.

This study compared perceptions of sexual risk and sexual practices among youth in Kenya and Sweden. Self-generated questions on the body, perceptions of sexual risk and sexual practices were collected in Kenya while focus group discussions and individual interviews on these same issues were used in Sweden. The most striking differences between the two countries were in the level of knowledge on matters of sexuality and the ability to talk with ease on these matters. The refusal in Kenya to provide adolescents with information and services has left the 'safe period' as their only protective option and pregnancy as the overriding concern. Communication at the partner level and lack of condom use are problematic in both countries and even where access to information and preventive services exist, these may not be used optimally. In both countries, boys had more sexual freedom, while girls were controlled through labelling and rumours, and girls were assigned responsibility for safer sex. We conclude that sexual education should be based more broadly on an understanding of the social norms defining sexual behaviour. It is at the level of sexual relations that the tensions between culturally-defined sexual and gender norms and public health assumptions should be addressed, a level at which health policy and education are silent in both countries.

Adolescent↗
PubMed1991

Development of a rehabilitation program for people affected with occupational hearing loss. 2. Results from group intervention with 48 workers and their spouses.

A group intervention program was designed to initiate an active search for solutions to listening and communication problems among hearing-impaired workers. Six groups of 8 workers were recruited from different areas of the Province of Québec. The workers were males; they had hearing threshold levels equal to or higher than 30 dB averaged over 0.5, 1, 2 and 4 kHz in at least one ear. The recruitment was conducted by occupational health nurses of local community health centers. The workers were invited to a group meeting with their spouses by means of a home interview. Three groups met during 2-hour weekly evening sessions, and three groups during a 1.5-day weekend session. A follow-up was conducted over a period of 3 months ending with an evaluation meeting. Results based on responses to a handicap questionnaire showed that the workers judged their hearing problem as being significantly less severe after their participation in the session. Group interviews showed that, although they were more conscious of their hearing difficulties, they agreed on being much more confident in dealing with them. Different steps were taken towards improving their situation, including disclosure of their hearing impairment to others, making requests to conversational partners to facilitate communication, and acquiring instrumental aids.

Communication Methods, Total↗