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[Names-Lab : a model for the standardization of biology message exchanges].

The growing requirements of communication between health partners urges to standardize the language used in laboratories data management systems. Names-Lab is the only semantic reference system allowing to describe synchronously the body of prescription and result messages. Its hierarchical structure allows a simple coding, easily accessible to all biologists without imposing or even requiring a language. Other internationally proposed systems as Loinc and Euclides are similar to Names-Lab in their purposes but are completely different by their content and structure. This prompts the medical and biologic community for a comparison of these tools before setting the choice of an international referencing system.

Clinical Laboratory Information Systems↗

Hospitalists and family physicians: understanding opportunities and risks.

BACKGROUND: Emergence of the hospitalist as a specialist in inpatient medicine provides an opportunity to examine a new provider type and its relation to family physicians. OBJECTIVES: To review the hospitalist literature to understand the hospitalist role, identify benefits and risks of the hospitalist model to family physicians, and discuss future opportunities to study and work with hospitalists. METHODS: An integrative review of published literature about the hospitalist model focused on the influence of hospitalists on family practice. RESULTS: Three main themes were identified as interest areas for family physicians: descriptions of the hospitalist role and responsibilities; hypothesized benefits and risks of the hospitalist model; and reported research results evaluating the effect of the hospitalist model. Two major opportunities related to hospitalists and family physicians were also uncovered: opportunities to conduct future research to study the influence of hospitalists on family physicians; and opportunities to create workable relationships with these new practitioners. CONCLUSIONS: Despite some opposition to hospitalist programs, the economic climate and increasing productivity standards suggest that these programs are here for the foreseeable future, and it is in family physicians' best interests to understand the opportunities and risks of the hospitalist model. Family physicians can work proactively with this new patient care model by participating in the development of standardized and efficient ways to communicate and to partner with hospitalists. Meanwhile, future research studies can help inform the debate by investigating the specific influence of hospitalist models on family practice.

Family Practice↗

Benefits and weaknesses of health cards used in health information systems.

The acceptance-based success of modern health information systems and health networks highly depends on the respective involvement of all relevant partners into the communication and co-operation processes characterising the medical and administrative workflow. Personal information stored in a networking environment guarantee for fast access fulfilling advanced shared care requirements whereas security token like smart cards stand for identification purposes, data protection, privacy protection, access rights, and limited person-based information storage, e.g., for emergency procedures. Linking these means of information provision allows for making use of the benefits of the different technologies without ignoring their existing weaknesses. The presented paper intends to summarise the respective categories of benefits and weaknesses allowing the reader to implement cards in health information systems as well as with the related aspects of awareness, confidence, and acceptance. Concluding this analysis, the preferred way to deal with the challenges of modern healthcare and welfare requirements shall be a well-balanced combination of cards and networks.

Diffusion of Innovation↗

[A study of morphopathological changes in the ovary caused by parabiotic union in rats].

Male and female Wistar rats from the same brood were joined parabiotically and histopathological changes in the ovary of the reactor were observed from the 8th to the 41st week. Only one tumor, a granulosa cell tumor appearing in the 28th week, was seen to form. Histogenetically, it appeared to have arisen from the follicular granulosa cells. In many cases, stromal luteinization progressed until the entire ovary appeared to consist of luteinized tissue, but in no case were tumor features noted. Changes followed the same process as in autotransplantation of the ovary into the spleen or as in irradiation; eventual tumor formation was judged likely from the observations in some cases. The cause of the extremely low rate of tumor formation in this experiment is thought to be inhibition of gonadotropin production by estrogen transferred from reactor to partner via capillary communicating branches.

Animals↗

Cognitive-behavioral group intervention to assist substance-dependent adolescents in lowering HIV infection risk.

Substance dependent adolescents (N = 19), court referred into a residential drug treatment facility received a five-session HIV risk-reduction intervention that provided risk education, social competency skills (sexual assertion, partner negotiation, and communication skills), technical skills (condom use), and problem-solving training. Before and after the intervention, subjects completed measures of AIDS risk knowledge, health locus of control, social support, attitudes toward HIV prevention, attitudes toward condoms, self-efficacy, and perceptions of risk in addition to role-play assessments of behavioral skill resisting high-risk coercions. Postintervention, subjects exhibited increased knowledge about HIV/AIDS, more favorable attitudes toward prevention, greater internal and lower external locus of control scores, more favorable attitudes toward condom use, increased self-efficacy, and greater recognition of HIV vulnerability. Following intervention, the percentage of participants reporting sexual activity in high-risk contexts decreased, substantiating the intervention's effectiveness. Self-report data were corroborated by sexually transmitted disease treatment records. This uncontrolled demonstration effort suggests that skills training based on cognitive-behavioral principles may be a promising intervention strategy to lower vulnerable adolescents' risk of HIV infection.

Adolescent↗

[Nosocomial infections: new agents, incidence, prevention].

Nosocomial infection is one of the major health problems confronting clinicians in intensive care units. Incidence has been estimated to vary from 5 to 10%, leading to death in one of every 5000 persons hospitalized. This situation is not however static since hospital epidemics and nosocomial infections evolve as a consequence of advances in antibiotic drug therapy and surgical and intensive care techniques. Microbial investigations themselves are of major importance as the collection of epidemiological data and its communication to hospital partners affects their approach to patient management. Nosocomial pneumonia, particularly in ventilated patients, urinary infection in those with indwelling catheters and wound colonization after surgery are still major problems and explain part of the variations between wards and hospitals. The main changes concern the bacteria involved. Classical agents with new mechanisms of resistance (Klebsiella pneumoniae, extended spectrum beta-lactamase producers) have been joined by other "new" agents emerging as pathogens (Xanthomonas maltophilia, Acinetobacter baumannii). The incidence of resistance in Staphylococcus and Enterococcus strains as well as new Gram positive species including Corynebacterium jeikeium and Rhodococcus equi, now recognized as opportunistic agents, has also increased. The multiresistance of these pathogens is often responsible for failure of antibiotic therapy and emphasizes the need both for rigorous prevention through active cooperation between bacteriologists, ward clinicians and intensive care units, and further research in the fields of microbial resistance mechanisms and antibiotics. Preventive measures have become a priority creating an international challenge to health care policy makers.

Cross Infection↗

Women's socioeconomic position and contraceptive behavior in Togo.

Few studies have examined empirically the influence of women's position on contraceptive behavior in sub-Saharan Africa. Using data from the 1988 Togo Demographic and Health Survey, this article explores the linkages between various indicators of women's position and spousal communication about family planning and contraceptive use. The results highlight the importance to their contraceptive behavior of women's economic power and individual control over choice of partner. The likelihood of spousal communication about family planning and modern contraceptive use is significantly higher among women who exercised complete control over selection of partner than among those with arranged marriages. Women who work for cash are significantly more likely than those who do not to communicate with their spouses about family planning, particularly if they participate in rotating credit or savings schemes. Such participation also increases significantly the likelihood of ever using traditional and modern methods of contraception.

Adolescent↗

Reported affectionate communication and satisfaction in marital and dating relationships.

This study analyzed affectionate communication and satisfaction in marital and dating relationships. 100 married and dating partners completed the Relationship Satisfaction Scale, the Interpersonal Communication Satisfaction Inventory, and the Affectionate Communication Index. Analysis indicated both married and dating partners were satisfied with their relationships; however, individuals in dating relationships reported higher Nonverbal and Verbal Affectionate Communication than individuals in married relationships. Moreover, there was a significant difference between married and dating partners on Supportive Affectionate Communication. Married partners were more likely to express supportiveness than dating partners.

Adult↗

Patient-led partner referral in a district hospital based STD clinic.

CONTEXT: Sexual communication and appropriate treatment of sexual partners is critical to the success of STD and HIV/AIDS prevention and control. AIMS: To understand factors influencing intention of STD patients to inform their regular sexual partners and identify predictors influencing actual return of the partners. SETTINGS AND DESIGN: A non-randomised survey of patients attending STD clinic in a district hospital between May and November 2000. METHODS AND MATERIAL: 182 patients were administered structured questionnaires to understand their intention to notify their regular sexual partners and encouraged to refer their regular sexual partners to the clinic for management. Factors related to intent to notify partners and actual partner referral were analysed. STATISTICAL ANALYSIS USED: Chi square test and forward stepwise logistic regression. RESULTS: Of the 182 STD patients 77.47% expressed their positive intention to notify their regular sexual partners. However, overall partner return rate was 40.65%. Patients from a better economic class (p=0.014), those who had sex since having the disease (p=0.001), those who felt it was easy to tell their partners (p=0.047) and perceived the necessity of investigating their partners (p<0.001) were more likely to have an intention to notify their partners. Independent predictors of actual return of sexual partners were patients' perception of partners' susceptibility (p=0.044), positive intention to notify partners (p=0.001), partners already informed before clinic visit (p=0.030) and presence of genital ulcerative diseases (p=0.033). CONCLUSIONS: STD clinic counselling and education should focus on risk reduction, partner susceptibility, role of STDs in HIV transmission and improving spousal communication.

Adolescent↗

Risk factors for domestic violence: findings from a South African cross-sectional study.

In 1998 a cross-sectional study of violence against women was undertaken in three provinces of South Africa. The objectives were to measure the prevalence of physical, sexual and emotional abuse of women, to identify risk factors and associated health problems and health service use. A multi-stage sampling design was used with clusters sampled with probability proportional to number of households and households were randomly selected from within clusters. One randomly selected woman aged 18-49 years was interviewed in each selected home. Interviews were held with a total 1306 women, the response rate was 90.3% of eligible women. For the risk factor analysis, multiple logistic regression models were fitted from a large pool of candidate explanatory variables, while allowing for sampling design and interviewer effects. The lifetime prevalence of experiencing physical violence from a current or ex-husband or boyfriend was 24.6%, and 9.5% had been assaulted in the previous year. Domestic violence was significantly positively associated with violence in her childhood, her having no further education, liberal ideas on women's roles, drinking alcohol, having another partner in the year, having a confidant(e), his boy child preference, conflict over his drinking, either partner financially supporting the home, frequent conflict generally, and living outside the Northern Province. No significant associations were found with partners' ages, employment, migrant status, financial disparity, cohabitation, household possessions, urbanisation, marital status, crowding, communication, his having other partners, his education, her attitudes towards violence or her perceptions of cultural norms on women's role. The findings suggest that domestic violence is most strongly related to the status of women in a society and to the normative use of violence in conflict situations or as part of the exercise of power. We conclude by discussing implications for developing theory on causal factors in domestic violence.

Adolescent↗

Schizophrenics show a failure in the decoding of violations of conversational implicatures.

OBJECTIVES: Recent approaches to the 'theory of mind' and pragmatics support that, if we did not have any idea about what other people know, we could hardly use language effectively. Successful communication (the pragmatic aspect of language) depends on inferring the beliefs and intentions of the partner in the conversation. Such successful communication is linguistically realized in part by cohesion and in part by abiding by the maxims derived from the cooperative principle. However, the violations of the Gricean implicatures are generally used in everyday language, mainly to point at a hidden, most commonly negative opinion on others. We hypothesize that schizophrenics have difficulties in the decoding of these violations, as the core deficit in this disorder is around social cognition, theory of mind and pragmatic language use. MATERIAL AND METHOD: We have examined 26 paranoid schizophrenic patients and 26 normal control subjects by using 4 'question and answer' vignettes, where the Gricean maxim of relevance was violated to express a hidden, negative opinion by one partner during the communicative act. The subjects were asked to judge these opinions and were evaluated by the investigators on a score from 0 to 2 points. In a pilot study, interrater reliability was judged to be satisfactory. The data were analysed statistically by parametric and non-parametric tests. RESULTS: Statistical analyses of our data have shown that schizophrenics made significantly more mistakes during the decoding of the violated maxim as compared with controls (p < 0.0001), reflecting on the difficulties during the correct exploration of the social context, i.e. recognition of the speaker's hidden opinion. CONCLUSION: We conclude that patients with schizophrenia fail to decode intentional violations of conversational implicatures. These results point at a dysfunctional pragmatic language use among schizophrenic patients.

Adult↗

Leadership, management and technical lessons learnt from a successful public-private partnership for TB control in Nepal.

BACKGROUND: There is considerable interest in involving private practitioners (PPs) in tuberculosis (TB) control, but little experience. OBJECTIVE: To describe and discuss leadership, management and technical lessons learnt from the successful implementation of a public-private partnership (PPP) for TB control in Nepal. METHODS: Description and discussion of implementation of the PPP is based on feedback from the working group charged with developing the PPP, PPs involved in diagnosis and referral, NGOs providing direct observation of treatment and tracing of late patients, and members of the Nepal National TB Programme. FINDINGS: The process of building the partnership was slow and demoralising, yet with perseverance partners gradually increased their involvement and commitment to the PPP. Leadership was needed to foster communication and openness between partners. It was not necessary to involve all PPs: many patients bypassed PPs and went directly to the free DOTS centres. CONCLUSION: An understanding of issues that arose during development of the Lalitpur PPP may assist assessment of the feasibility of PPPs in other settings, and increase the likelihood of successful implementation. The wider literature on partnerships may be useful to further inform the development of PPPs for health in developing countries.

Antitubercular Agents↗

Serostatus disclosure, sexual communication and safer sex in HIV-positive men.

This study assessed HIV-positive men's sexual behaviours with partners at risk for infection, and examined the extent to which safer sex was associated with interpersonal communication variables, namely, (1). disclosure of one's seropositive status and (2). specific communication with partners about safer-sex practices. A total of 105 HIV-positive men (43% homosexual, 38% bisexual, 19% heterosexual), randomly sampled at an HIV outpatient clinic in Los Angeles, completed a behavioural questionnaire assessing events in their most recent sexual encounter with an HIV-negative or unknown serostatus partner. Results indicated that men who disclosed their seropositive status and explicitly discussed the topic of safer sex with their at-risk partners had a significantly higher prevalence of protected anal or vaginal intercourse than did men who disclosed only. The findings suggest that post-test counselling regarding the importance of disclosing one's seropositive status to sex partners should be augmented by behavioural interventions that enhance seropositive persons' skills in communicating explicitly with partners about safer sex to help reduce transmission of HIV.

Adult↗

Sexual practices and AIDS knowledge among women partners of HIV-infected hemophiliacs.

About 12 percent of the women sex partners of hemophilic men who are seropositive for the human immunodeficiency virus (HIV) have themselves become seropositive. Questionnaires were completed in January 1988 by 15 women who were in long-term, monogamous relationships with HIV-positive hemophiliacs; 11 of the women were not HIV seropositive and 4 were. None of the couples was abstaining from sexual intercourse, and during the 4 weeks prior to responding, the couples had intercourse a mean of 6.2 times. Sixty percent always used condoms, 13 percent did so most of the time, and the remaining 27 percent did sometimes. Condom use was not significantly related to either frequency of intercourse, the women's knowledge of acquired immunodeficiency syndrome (AIDS) and AIDS-risk reduction, the actual HIV status of both partners and the women's perceived status of both, the extent of the women's worry about contracting AIDS, their reported degree of negative impact from AIDS, or to their mood, age, or education. All women who reported not always using condoms had been informed of their own and their partner's HIV status; were counseled repeatedly regarding risk reduction; acknowledged the possibility of heterosexual HIV transmission; said they knew of recommendations for the use of condoms; recognized their risk of HIV infection; claimed some degree of worry about acquiring HIV through sexual activity; had children at home; and were not, with one exception, trying to become pregnant. There were several possible factors influencing the decision by women at high risk for acquiring HIV not to use condoms. Among them were complaints that the women found condoms unpleasant or an unwanted reminder of AIDS, a sense of obligation or a drive to continue unaltered sexual relations, the false reassurance of HIV-negative test results for some of the women who did not always use condoms, a willingness to sacrifice and to share their partner's fate, a desire to avoid communicating rejection and adding to their partner's burdens, and difficulty changing long-standing behavior patterns despite logical understanding of the risks involved.

Acquired Immunodeficiency Syndrome↗

Predicting patterns of interaction between children with cerebral palsy and their mothers.

Children with cerebral palsy (CP) have often been described as passive communicators. Their familiar conversation partners tend to direct and control interaction. Such conversation patterns may have various precursors: children's motor impairment, their intelligibility difficulties, and/or their level of cognitive development. To test the comparative influence of these factors, measures of motor function, speech, communication, cognitive and language skills were applied in 40 children (18 males, 22 females) with CP who were aged from 2 years 8 months to 10 years. These variables were correlated with measures relating to interaction patterns to investigate whether individual features predicted communication style. In this group, poor speech intelligibility was the main predictor of restrictive communication patterns, such as fewer child-initiated conversation exchanges, more simple child communicative acts such as yes/no answers and acknowledgements of the other partner's messages. Results support the provision of therapy to increase children's intelligibility, whether spoken or augmented, such as the introduction of communication aids and training programmes for parents.

Adult↗

Communication and associated relationship issues in female anorgasmia.

Communication problems are among the most common complaints brought to couples' counseling and are believed to play a central role in the development and maintenance of many sexual dysfunctions. The present study examined self-reported communication patterns within heterosexual couples where the wife is experiencing anorgasmia and within two groups of control couples. As hypothesized, couples with an anorgasmic female partner reported more problematic communication regarding issues of sexuality than did control couples. In particular, the anorgasmic women and their male partners reported significantly more discomfort than did controls in discussing sexual activities associated with direct clitoral stimulation. The etiologic and treatment implications of these differences are discussed.

Adult↗

The negotiating strategies determining coitus in stable heterosexual relationships.

Heterosexual behaviour is a complex subject and one which is aggravated by confounding variables. Few studies have investigated the way in which one variable, namely coitus, is initiated and negotiated in stable marital relationships. As the HIV/AIDS pandemic spreads in sub-Saharan Africa, the subject of marital coitus becomes of increasing concern. This study tests a methodology of semi-structured interviews and diary-keeping techniques to investigate how the activity is initiated and negotiated. A research team monitored the study and evaluated the research techniques. The study concluded that the HIV/AIDS pandemic is affecting the initiation and negotiation of coitus between marital partners and that the partners wish to renegotiate the relationship, but the mechanisms for renegotiation are not at present available.

Adult↗

Hiding classical data in multipartite quantum states.

We present a general technique for hiding a classical bit in multipartite quantum states. The hidden bit, encoded in the choice of one of two possible density operators, cannot be recovered by local operations and classical communication without quantum communication. The scheme remains secure if quantum communication is allowed between certain partners, and can be designed for any choice of quantum communication patterns to be secure, but to allow near perfect recovery for all other patterns. No entanglement is needed since the hiding states can be chosen to be separable. A single ebit of prior entanglement is not sufficient to break the scheme.

Journal Article↗