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A transdisciplinary-translation matrix is posited as a new direction reflected by the work presented in this and the two previous special issues. In fact, the demands inherent in this matrix suggest that a revolution in health research is in the works. Potential barriers and future directions of the matrix are suggested.
Health communications campaigns are a major strategy used by governments to promote health. This article discusses key issues in the ethics of health communications campaigns, including the compatibility of health campaigns with the principle of respect for autonomy and how conflicts with this principle can be justified. Five potential justifications for state-sponsored health communications campaigns are reviewed: the public's health as an independent value; collective efficiency and majoritarian preferences; third party or state's interests; harm to the health of others; and countering the short-term contingencies of a market.
In order to increase communication channels for child survival and development, the government and UNICEF Ghana undertook a "social mobilization analysis." This analysis included three studies that aimed to identify individuals and existing organizations with the potential to serve as health communicators and to determine the type of assistance that they needed to maximize their effectiveness in this role. The first study surveyed governmental institutions, trade unions, revolutionary organizations, traditional leaders, and others and found a largely untapped reservoir of capacities to promote child health, with varying levels of current involvement. The primary need identified was for information and training materials. The second study focused on the mass media and revealed a low coverage of maternal and child health topics and the need for better cooperation between journalists and health professionals. The third study assessed sources of health information for parents and found several sources, such as religious organizations, women's groups, and school teachers that could be mobilized to promote child health. Recommendations are made for the use of the findings.
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Children between the ages of 9 and 15 are a high-risk group for tobacco use. The Centers for Disease Control estimates that first use of cigarettes among adolescents has risen 30% over the past decade, and that more than 1.2 million people age < 18 became daily smokers in 1996 alone. Moreover, research indicating that awareness and liking of cigarette advertisements is higher among adolescents than adults underscores the need to devote more effort to understanding reactions to tobacco-related messages. Adding to this problem is the fact that the early gains of some successful anti-tobacco interventions disappear as adolescents age. Drawing on the theory of psychological reactance, a number of hypotheses were tested that addressed the impact of pro- and anti-smoking messages on a variety of outcomes, including participants' intended behaviors, evaluation of message sources, and seeking of disconfirming information. All the messages were created and delivered to 4th-, 7th-, and 10th-grade students via personal computers. The pattern of results supports the theoretically derived hypotheses, indicating that grade level and message type had a significant impact on the processing of tobacco-related messages. Implications and suggestions for future tobacco prevention campaigns are discussed.
Automatic muscle relaxation control may reduce anesthesiologists' workload freeing them for other patient care requirements. In this report we describe a muscle relaxation controller designed for routine clinical application using rocuronium and the train-of-four count. A muscle relaxation monitor (TOF Watch SX) was connected to a laptop computer running a controller algorithm program that communicates with a syringe pump to form a closed-loop muscle relaxation system. The control algorithm uses proportional-integral and lookup table components and is designed to avoid the usability restrictions of existing controllers. The controller is optimized using an objective method to avoid the uncertainties of ''hand-crafted'' controller algorithms. Controller target was train-of-four count 1 or 2 and controller performance was evaluated in 15 patients. During 39 hours of closed-loop control, 96.1% of all twitches recorded were in the target range. Average rocuronium infusion rate was 0.36 mg.kg(-1).h(-1) (sd 0.18 mg.kg(-1).h(-1)). We show that the controller remains useful even in the presence of disturbances that can arise in routine clinical conditions. The muscle relaxation controller maintained the target train-of-four count values and may serve as a basis for the design of hardware and user interfaces for closed-loop muscle relaxation control in clinical conditions.
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The research literature reports numerous negative consequences of adolescent pregnancy. Unfortunately, contemporary approaches to preventing teenage pregnancies have been largely unsuccessful. Recent evidence, however, suggests that interpersonal communication skill training may represent an important step in helping adolescents deal with their sexual and contraceptive behavior. This describes a pilot study of an interpersonal skill training model for sexually active inner-city teenagers. Results show that this training model is a feasible and attractive approach to modifying the youths' communication patterns. Findings indicate that such training is a fruitful direction for future pregnancy prevention research with the adolescent target population.
This article focused on nonfinancial barriers to prenatal care and pointed out that these barriers cannot be ignored if access to care is to be improved. The strategies suggested by the Consensus Conferences for reducing these barriers provide abundant opportunities for all professionals, and the implications for health policy formulated by the Conferences provide direction for eventually eliminating the barriers. It will take a combination of professional, political and public will to make this happen.
Interventions in health care must be sensitive to the part that culture plays in treatment, recovery and healing of the American Indian patient. Cultural factors play an important part in how the family participates and copes with the intervention program. Interpreting communication and behavior from the perspective of the family's culture contributes to positive family-professional interaction. This paper addresses the most important cultural factors impinging on positive health care for American Indian families and addresses a process for assessment of cultural conflicts which may prevent positive outcomes in the delivery of health care to this population. In addition, this paper offers strategies throughout that can be used by health care professionals to assure culturally sensitive service delivery to American Indians.
Results are presented from the 1978 multi-method national summative evaluation of the goal-directed television program, Over Easy. Targeted to persons 55 years of age and older, and setting informational, attitudinal and behavioral objectives, the Over Easy program successfully communicated prevention information, conveyed a positive philosophy of aging, and encouraged target group utilization of existing social services. Three design features of the Over Easy intervention are recommended for future social interventions attempted through television.
The role of a prevention advisory committee in maintaining Michigan's prevention effort is examined. Accomplishments in the areas of program development, communication, policy formulation, and advocacy are described and structural aspects contributing to the success of the committee are discussed.
We evaluated the influence of child location on the occurrence of self-injurious behavior (SIB) during functional analyses conducted in home settings. An initial functional analysis conducted with 2 children who had developmental disabilities showed undifferentiated patterns of SIB. Analyses of behavior during free play suggested that the child's location was an active variable for self-injury. Both children showed a decrease in self-injury when they were placed next to their parent versus being placed in a wheelchair or on the floor. A second functional analysis was conducted with child and parent on a couch. Results showed low percentages of self-injury during free play, but high percentages during other test conditions. Functional communication training programs for each child resulted in decreases in self-injury.
A four year study examined the effects of a sign communication intervention program designed to enhance teachers' ability to consistently code English into sign. The secondary goal of the project was to help teachers use American Sign Language as an intervention tool for enhancing students' comprehension of instructions. Starting with an initial sign to speech ratio of 59.8% and 66.2%, two teachers were able to improve their ratio to 98.9% and 89.7% respectively. The basic components of the intervention program are presented along with their rationale. A breakdown of the sign to speech ratio is provided in an examination of how effectively the teachers coded articles, pronouns, sign markers, and the verb "to be."
Normal cellular behavior depends on functional integration of extracellular stimuli with intracellular signal transduction pathways. Coupling cell surface message reception to nuclear gene expression is no longer a linear model constructed with molecular components acting merely as conduits to relay signals that cascade toward the nucleus. What has emerged instead is a highly integrated circuit comprised of numerous molecular components harmoniously programmed to communicate a multitude of internal signals that controls cellular response. Despite increasing understanding of cell signaling, mutinous elements embedded in these pathways have defied complete resolution. Research indicates that propagation of signals emanating from the extracellular environment to the cell nucleus follows a complex internal circuit equipped with sophisticated molecular components that provide rigid control over a variety of cellular responses. Although increasing understanding of genetic aberrations and signaling pathway transgressions can lead to novel strategies for targeting cancer cells, the disappointing results from clinical trials suggest that the occult processes responsible for neoplastic transformation remain largely unexplained.
This study was designed to determine whether signs would prompt bar patrons to avail themselves of free condoms. The intervention at three "gay bars" involved placing a large sign directly above a container of free condoms; the sign gave statistics for the number of people who have died from AIDS in the state and pointed out that condoms can reduce the spread of AIDS. Additional signs placed in the restrooms gave information about safe sex practices and reminded patrons that free condoms could be obtained at a given location in the bar. An ABAB design was used, with a 2-week baseline, 2-week treatment with signs present, 2-week reversal with no signs, and 2-week reinstatement of treatment with signs present. For all three bars combined, 748 condoms were taken with signs present and 510 condoms were taken with signs absent. Overall, when signs were present, the number of condoms taken increased by 47%.
The pandemic of HIV/AIDS continues to pose a serious threat to the population of sub-Saharan Africa, despite ongoing public health efforts to control the spread of infection. Given the important role of oral tradition in indigenous settings throughout rural Africa, we are beginning an innovative approach to HIV/AIDS prevention based on the use of folk media. This commentary explains the types of folk media used in the traditional Ghanaian setting and explores their consistency with well-known theories. Folk media will be integrated with broadcast radio for interventions under the HIV/AIDS Behavior Change Communication Project being undertaken as part of the CARE-CDC Health Initiative (CCHI) in 2 districts in Ghana.