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PubMed2006

[Standard of integration management at company level and its auditing].

SITUATION: Responsibility at company level for the employment of workers with health-related problems or disabilities has increased, inter alia because of integration management at company level according to section 84 (2) of the German Social Code Book IX. Although several recommendations exist, no standard is available for auditing and certification. Such a standard could be a basis for granting premiums according to section 84 (3) of Book IX of the German Social Code. AUDIT AND CERTIFICATION: One product of the international "disability management" movement is the "Consensus Based Disability Management Audit" (CBDMA). The Audit is a systematic and independent measurement of the effectiveness of integration management at company level. CBDMA goals are to give evidence of the quality of the integration management implemented, to identify opportunities for improvement and recommend appropriate corrective and preventive action. In May 2006, the integration management of Ford-Werke GmbH Germany with about 23 900 employees was audited and certified as the first company in Europe. STANDARD OF INTEGRATION MANAGEMENT AT COMPANY LEVEL: In dialogue with corporate practitioners, the international standard of CBDMA has been adapted, completed and verified concerning its practicability. Process orientation is the key approach, and the structure is similar to DIN EN ISO 9001:2000. Its structure is as follows: (1) management-labour responsibility (goals and objectives, program planning, management-labour review), (2) management of resources (disability manager and DM team, employees' participation, cooperation with external partners, infrastructure), (3) communication (internal and external public relations), (4) case management (identifying cases, contact, situation analysis, planning actions, implementing actions and monitoring, process and outcome evaluation), (5) analysis and improvement (analysis and program evaluation), (6) documentation (manual, records).

Disability Evaluation↗
PubMed1998

[Cochlear implant for non-deaf patients?].

BACKGROUND: Cochlear implants have proven to be the method of choice for postlingually deafened adults. The great success of this application requires discussion of the degree in which the indication for cochlear implantation should be expanded to include patients with residual hearing. METHOD AND PATIENTS: Following an initial discussion of the term deafness, we present the preoperative and postoperative results in five patients with residual hearing. These patients achieve a certain degree of speech recognition with their well fitted hearing aids. However, their aided speech intelligibility did not exceed 30% with the standardized Freiburg monosyllabic word test at 70 dB. In each case the worse hearing ear was treated with a cochlear implant. Speech discrimination in silence and noise are compared with the results of a group of postlingually deafened cochlear implant patients. RESULTS: The five patients are very satisfied with the cochlear implant and use the telephone to communicate with unknown partners. They score 100% in the standardized four-syllable number test above 55 dB and they document a loss of speech discrimination between 0 and 25% within the open-set monosyllabic word test. The mean increase of best monosyllable intelligibility by the cochlear implant over the hearing aids is 65%. Using the innsbruck sentence test the patients score 100% at 70 dB; with the Göttingen sentence test, the mean result is 75%. Their mean results in noise are also very good, 76% at 10 dBS/N and 57% at 5 dBS/N respectively. None of these patients use the hearing aid on the untreated, better hearing ear. CONCLUSION: A multichannel cochlear implant lead to a significant improvement of speech comprehension in these patients with residual hearing. We can successfully implant patients with minimal benefit of their well fitted hearing aids. Our group is too small to be able to define general selection criteria. For the time being we use as an audiological indication a open-set monosyllabic word intelligibility of not more than 30% at 70 dB with well fitted hearing aids.

Adolescent↗
PubMed2000

Symbiosis-specific expression of Rhizobium etli casA encoding a secreted calmodulin-related protein.

Symbiosis between Rhizobium and its leguminous host requires elaborate communication between the partners throughout the interaction process. A calmodulin-like protein, termed calsymin, was identified in Rhizobium etli; a calmodulin-related protein in a Gram-negative bacterium had not been described previously. Calsymin possesses three repeated homologous domains. Each domain contains two predicted EF-hand Ca(2+)-binding motifs. Ca(2+)-binding activity of calsymin was demonstrated on purified protein. R. etli efficiently secretes calsymin without N-terminal cleavage of the protein. The gene encoding calsymin, casA, is exclusively expressed during colonization and infection of R. etli with the host. Expression of casA is controlled by a repressor protein, termed CasR, belonging to the TetR family of regulatory proteins. Mutation of the casA gene affects the development of bacteroids during symbiosis and symbiotic nitrogen fixation.

Amino Acid Sequence↗
PubMed1983

Preorgasmic group treatment: assertiveness, marital adjustment and sexual function in women.

Five measures were used in this study to assess preorgasmic group treatment: Gambill-Richey Assertiveness Scale, Dyadic Adjustment Scale, Sexual Arousal Inventory, Survey of Sexual Activity, and General Information Questionnaire. The total sample (N = 70) was made up of two groups: a control group of 32 women and a treatment group of 38 women who had completed preorgasmic group treatment. Analysis of the data showed that the treatment group women were having orgasms more frequently, had developed significantly more positive feelings about themselves, and established better communication with their partners. In assertiveness, the treatment group was somewhat higher, while no significant differences were found on the Dyadic Adjustment Scale. Of most significance for future research was the finding of increased sexual arousal for treatment group women.

Adaptation, Psychological↗
PubMedDate not supplied

Safer sexual decision making in adolescent women: perspectives from the conflict theory of decision-making.

Adolescent women are at risk for unintended pregnancies and sexually transmitted diseases, including human immune deficiency virus (HIV)/acquired immunodeficiency deficiency syndrome (AIDS), if they do not engage in safer sexual practices. Adolescent women are biologically, behaviorally, and socially more at risk for sexually transmitted diseases (STDs) and HIV than adolescent men. Although abstinence is the safest sexual health practice for adolescent women, once sexual activity begins, safer sexual practices involve condom and contraceptive use, and communicating with sexual partners to negotiate condom use. A number of implicit and explicit decisions are involved in these activities. A number of researchers have examined safer sexual decisions of adolescent women, some of whom have used theory models such as the Transtheoretical Model of Change. Although these findings have contributed to the knowledge base about safer sexual decision making, many questions remain unanswered about how adolescent women make safer sexual decisions. The Conflict Model of Decision Making is presented and discussed as a framework for enhanced understanding of safer sexual decision making by adolescent women.

Adolescent↗
PubMed2003

Characteristics of HIV antiretroviral treatments, access and adherence in an ethnically diverse sample of men who have sex with men.

Data regarding HIV antiretroviral treatment regimens, access to treatment and medical care, and adherence to medications were collected as part of the Seropositive Urban Men's Study, a formative study of HIV-positive men who have sex with men. Participants (N = 456) were recruited from AIDS service organizations, mainstream gay venues and public/commercial sex environments. The sample was 94% gay or bisexually-identified; 29% were African American, 24% Latino and 30% white. The majority (71%) indicated being on antiretroviral treatment, and most were taking a protease inhibitor/nucleoside reverse transcriptase inhibitor combination. African American men in New York City were less likely to be on treatment. Among those on treatment (n = 322), 51% reported at least one day in which they had missed a dose of their medication and the mean number of days in which a dose was missed (in the past 30 days) was 1.72. Multivariate analyses indicated that avoidant coping, frequency of drinking alcohol and difficulty in communicating with sex partners about HIV were related to days of missed doses, suggesting the need or desire to escape from the reality of life with HIV as a potential explanation for poor adherence.

Adult↗
PubMedDate not supplied

Enhancing communication in jargon aphasia: a small group study of writing therapy.

People with jargon aphasia have severely disordered and incomprehensible speech that may be resistant to therapeutic intervention. In this study, we treated written output and examined whether it assisted communication for these clients. In stage one of the study, anagram sorting, delayed copying and lexical decision tasks were used to investigate the residual knowledge of written words in a group of ten people with jargon aphasia. Evidence of the presence of orthographic knowledge was taken as an indication that writing might be a useful focus for therapy. This hypothesis was explored in stage two with six clients. A personally useful vocabulary was selected for each, and copying, word completion and written picture-naming tasks were used in therapy to improve written production of these words. The clients made progress in written naming. However, they showed little change on a 'message' assessment that tested their ability to use the written words to convey messages. Stage three targeted communicative writing. Here, three of the clients received 'message therapy', which encouraged them to relate treated words to functional messages and to communicate them to a partner. The clients improved on the message assessment and observation of their communication and reports from relatives suggested that they made functional use of writing in a range of communication settings.

Aged↗
PubMed2005

Condom use among female sex workers in China: role of gatekeepers.

OBJECTIVE: The objective of this study was to assess the potential role of gatekeepers of establishments in promoting condom use among female sex workers (FSWs) in China. GOALS: The goals of this study were to explore FSWs' perceptions of gatekeeper attitudes and support for condom use, and to assess their association with FSWs' practice, communication, intention, proper use, knowledge of correct use, and perceptions related to condom use. STUDY: The authors conducted a cross-sectional study among 454 establishment-based FSWs in one Chinese county. RESULTS: Perceived gatekeeper support for condom use was low among FSWs. Perceived support was positively associated with condom use communication with sexual partners, condom use frequency and intention, but not associated with proper condom use among FSWs. Perceived support was significantly associated with most condom use-related perceptions (e.g., self-efficacy of condom use, barriers to condom use, and perceived peer condom use) among FSWs. CONCLUSIONS: Healthcare professionals should work with gatekeepers to create a supportive local environment for condom use in sex work establishments. Gatekeepers need to clearly articulate their support for condom use to the FSWs. Training and skill acquisition regarding correct use of condoms among FSWs will be necessary.

Adult↗
PubMed1992

Job share a consultant post.

Job sharing offers advantages to both employer and employee but it is still uncommon in medicine. Based on the experiences of two psychiatrists sharing a consultant post this article describes some of the problems in obtaining a job share. The most difficult part can be getting an interview, and once a post has been obtained the terms and conditions of service may have to be modified to suit job sharing. Getting on well with your job sharing partner and good communication will not only help overcome the obstacles but ensure that the sharing is successful.

Employment↗
PubMed2005

Self-esteem and theoretical mediators of safer sex among African American female adolescents: implications for sexual risk reduction interventions.

Theories of health behavior posit that change is accomplished by modifying factors deemed as mediators. A set of mediators from several theoretical models used in sexual risk reduction programs was assessed among a sample of 522 African American female adolescents. The goal was to determine whether self-esteem was associated with sexually transmitted disease (STD), pregnancy, and the set of theoretical mediators controlling for covariates. Bivariate analyses showed no relationship between self-esteem and STD or pregnancy; multivariate regression analysis revealed a significant relation between self-esteem and the set of mediators. Girls higher in self-esteem were more likely to hold positive condom attitudes, felt more efficacious in negotiating condom use, had more frequent communication with sex partners and parents, perceived fewer barriers to using condoms, and were less fearful of negotiating condom use. Self-esteem should be considered when designing and evaluating sexual risk reduction programs for this population.

Adolescent↗
PubMed1993

Characteristics of women at risk for psychosocial distress in the year after breast cancer.

PURPOSE: To provide a detailed description of rehabilitation problems of women, considered to be low risk and at risk for psychosocial morbidity, diagnosed with stage I and II breast cancer 1 month and 1 year after primary treatment. PATIENTS AND METHODS: A sample of 227 newly diagnosed breast cancer patients were systematically interviewed by a clinical social worker and classified for risk of psychosocial distress in the year after diagnosis. They completed a battery of standardized instruments to assess quality of life (QL), rehabilitation needs, and psychologic distress. The primary QL instrument, the Cancer Rehabilitation Evaluation System (CARES), provides a detailed listing of rehabilitation needs. Descriptive CARES data are presented with comparisons between the two groups. RESULTS: The at-risk women had significantly more problems with greater severity than the low-risk women in all areas (physical, psychosocial, medical interaction, sexual, and marital). While both groups showed improvement over the year following diagnosis, the at-risk group had significantly more problems 1 year later. Many physical problems subside, but problems at the local surgical site, psychologic distress, communication with marital partners, and negative body image are more persistent in the at-risk group 1 year later, while half of both groups continue to have sexual dysfunction. CONCLUSION: The detailed listing of problems provided by the CARES may be helpful to clinicians in their interactions with patients. The need for preventive and early intervention for the at-risk patients is underscored.

Anxiety↗
PubMed2002

Speech events, language development and the clinical situation.

Psychoanalysis brings about psychic change by the mediation of speech. This paper reflects upon the significance of the structure and developmental organisation of the speech event as a verbal and non-verbal unit composed of semantically and prosodically encoded messages, interactions and emotional contact between partners. Spoken words communicate semantic meanings and the affects of a given speech event. Words carry personal emotional meanings which are inseparable from their referential significance. Such emotional meanings are very hard to articulate in words. They are conveyed by the ineffable but essential feelings present in their sound and pronunciation. Speech is an intentionally object-related and emotionally engaging social activity resulting from a child having been spoken to early in life by an adult wanting to establish affective verbal contact. The early organisation and later transformation of the structure of the speech event carries private meanings for each person's listening and speaking stance. A refined understanding of the structural and emotional complexities of verbal communicative exchanges during analysis may enhance the analyst's ability to understand the patient's manner of participation in the analytic process.

Adult↗
PubMedDate not supplied

Differences and similarities in sexual and contraceptive knowledge, attitudes, and behavior among Latino male adolescent students in California, United States and Lima, Peru.

To identify the differences and similarities in sexual and contraceptive knowledge, attitudes, and behavior among Latino male adolescent students living in California and Lima. Self-administered, anonymous surveys were completed by Latino male students aged 12-19 participating in California, and by male adolescent students in four high schools in Lima. Both surveys contained similar questions allowing for comparisons regarding sexual activity and contraceptive behavior. The mean age of male students were 16 and 15 years, respectively. More California males reported having engaged in sexual intercourse (69% vs 43%. The sexual debut was 13 years in both samples. More students in California were aware of their risk of pregnancy at first sexual intercourse than in Lima (82% vs 50%). One-third of the California males reported communicating with their partner about sex and contraception to be "easy" as compared to 53% of males in Lima. More students in California reported knowing a place to obtain contraceptives if they need them (85% vs 63%), having ever gotten someone pregnant (29% vs 7%), and having fathered a child (67% vs 16%).

Adolescent↗
PubMed2000

[Prenatal care in the border city of Tijuana, Mexico].

This study was intended to explore the conditions under which prenatal care is delivered in the border city of Tijuana, Baja California, Mexico, and to assess the possible associations between that care and neonatal results in terms of birthweight, health of the neonate, and prematurity. Seven hospitals serving persons from different socioeconomic strata were chosen, and between December 1993 and March 1994 interviews were conducted with 279 women who were in the first 24 to 48 hours of puerperium. During the interviews data were collected on socioeconomic level; the mothers' knowledge, attitudes, and practices concerning obstetric health; the mothers' perceptions of access to prenatal care; the quality of prenatal care visits (evaluated in terms of having blood and urine tested and weight and blood pressure measured); and the gynecological and obstetric and health history of the mother. A database was created using the SPSS statistics software package. Possible associations were explored, with prenatal care as the independent variable and various dependent variables, by means of contingency tables and a two-tailed Fisher's exact test. None of the neonates was premature, ill, or had a birthweight of < or = 2,500 g. For this reason it was decided to divide the variable corresponding to birthweight into two groupings, < or = 3,000 g and > 3,000 g. A significant (P < 0.00038) relationship was found between a lack of prenatal care and low birthweight. In addition, a lack of prenatal care was associated with: low family income; the mother's financial dependence on the father; the mother being in an unmarried relationship; little communication with the partner; having no medical insurance; an unwanted pregnancy; and giving delivery at the General Hospital. Out of the total sample of 279 women, 15 (5.4%) had received no prenatal care. None of these 15 women reported they had encountered difficulties that prevented them from obtaining prenatal care, but only 7 of those women answered that question. The prenatal care was of good quality in 190 of the cases (68%). Both the number and the timing of the prenatal visits were adequate in 142 of the cases (50%). The mother's having worked during pregnancy or before had a positive predictive value in terms of utilization of prenatal care services. Additional studies are needed to evaluate the possible relationship between domestic violence and the lack of prenatal care or a delay in seeking such care.

Apgar Score↗
PubMed1991

Reduction of high-risk sexual behavior among heterosexuals undergoing HIV antibody testing: a randomized clinical trial.

BACKGROUND: We evaluated the effect of HIV antibody testing on sexual behavior and communication with sexual partners about AIDS risk among heterosexual adults at a clinic for sexually transmitted diseases. METHODS: We randomized 186 subjects to receive either AIDS education alone (the control group) or AIDS education, an HIV antibody test, and the test results (the intervention group). These subjects were then followed up 8 weeks later. RESULTS: At follow-up, mean number of sexual partners decreased, but not differently between groups. However, compared with controls, HIV antibody test intervention subjects, all of whom tested negative, questioned their most recent sexual partner more about HIV antibody status (P less than 0.01), worried more about getting AIDS (P less than 0.03), and tended to use a condom more often with their last sexual partner (P = 0.05): 40% of intervention subjects vs 20% of controls used condoms, avoided genital intercourse, or knew their last partner had a negative HIV antibody test (P less than 0.005). CONCLUSION: HIV antibody testing combined with AIDS education increases concern about HIV and, at least in the short term, may promote safer sexual behaviors. Additional strategies will be necessary if behaviors risky for HIV transmission are to be further reduced.

AIDS Serodiagnosis↗
PubMed1995

Quality of condom use as reported by female clients of a family planning clinic.

OBJECTIVES: This study analyzed the prevalence and determinants of the quality of condom use after a woman's first visit to a family planning clinic. METHODS: This report presents data from 360 female family planning clients who reported using condoms as their primary method of contraception for at least 1 sexually active month during the study's follow-up period after their first clinic visit. RESULTS: Only 1% always engaged in all five use behaviors studied: using a condom for each sexual intercourse, putting the condom on before first entry, withdrawal after intercourse while there is still an erection, holding on to the condom's rim during withdrawal, and using foam. Multiple linear regression indicated that more effective condom use was reported by women who had not had an induced abortion, were not using condoms just because they were starting oral contraceptive pill regimens, had more knowledge about birth control in general, had received a nursing intervention, and had more communication with their partner. CONCLUSIONS: Increasing attention needs to be devoted to understanding determinants of the specific actions that differentiate between more and less effective contraceptive use.

Adolescent↗
PubMed1997

Connected information networks take the paper burden off your shoulders.

Electronic transfer of data within health systems and between offsite facilities, including payers, is becoming a cost-effective strategy for members of the Brookfield-based Wisconsin Health Information Network. The intranet technology is particularly well-suited for managed care because it generates even greater efficiencies and allows electronic communication between newly integrated health system partners.

Community Networks↗
PubMed2001

[Marital therapy at the day care hospital department for alcoholism and other drug addictions at the Sarajevo Canton].

Therapy of married couples in one segment of the therapeutical programs applied in Zavod za alkoholizam i druge toksikomanije in Sarajevo with the goal of protection of mental health of addicts and treatment of addictive tendencies of alcoholics. Therapeutic program is focused on marital relations. The improvement of communication between marital partners positively reflects on entire family, and better quality relations are created in the entire family environment.

Adult↗