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PubMed1996

Modulation of intercellular communication between smooth muscle cells by growth factors and cytokines.

We recently reported that tumor necrosis factor alpha is able to cause a dose-dependent and persistent reduction in gap junctional intercellular communication between primary human smooth muscle cells. In order to study whether this observed persistent reduction in gap junctional intercellular communication is a unique feature for tumor necrosis factor alpha, the present study focuses on the effects of other growth factors and cytokines on gap junctional intercellular communication. Platelet-derived growth factor AA and BB (PDGF-AA, PDGF-BB), basic fibroblast growth factor (bFGF), interleukin-6 and interferon-gamma were able to modulate gap junctional intercellular communication between primary human smooth muscle cells in vitro. However, our results demonstrate that the magnitude and nature of the observed effects are growth factor- and cytokine-specific. PDGF-AA, PDGF-BB and interleukin-6 caused a transient reduction in gap junctional intercellular communication, while bFGF induced a transient increase in gap junctional intercellular communication. Interferon-gamma was shown to be capable of causing a persistent reduction in gap junctional intercellular communication. In addition, PDGF-AA, PDGF-BB, bFGF, interleukin-6, interferon-gamma and tumor necrosis factor alpha all stimulated smooth muscle cell proliferation. These observations suggest a more complex relationship between modulation of gap junctional intercellular communication and cell proliferation than current hypotheses imply. The implications of the observed effects of growth factors and cytokines on gap junctional intercellular communication between smooth muscle cells in relation to the process of atherosclerosis is discussed.

Arteriosclerosis↗
PubMed1990

Inhibition of intercellular communication in smooth muscle cells of humans and rats by low density lipoprotein, cigarette smoke condensate and TPA.

Inhibition by tumor promoting chemicals of intercellular communication via gap junctions may be important in carcinogenesis. In order to investigate the possible role of gap junctional intercellular communication in atherogenesis, we examined the effect of known inhibitors of intercellular communication, 12-O-tetradecanoylphorbol-13-acetate (TPA) and cigarette smoke condensate (CSC), and low density lipoproteins (LDL) and high density lipoproteins (HDL) on cellular communication in smooth muscle cells of human and rat by the microinjection-dye transfer technique. When lucifer yellow CH solution is injected into a cell, the average numbers of human and rat smooth muscle cells that become fluorescent is about 22 and 6, respectively. The tumor promoter (TPA) almost completely blocked gapjunctional communication between smooth muscle cells at 100 ng/ml after 4 h exposure. LDL and CSC were able to inhibit intercellular communication in human and rat cells in a dose-dependent manner up to 60%. LDL-pretreatment of human smooth muscle cells did not affect inhibition of intercellular communication, which suggests that this effect is mainly non-receptor mediated. HDL did not influence junctional communication. The results indicate that inhibition of intercellular communication may also contribute to the pathogenesis of atherosclerotic lesions, such as plaques.

Animals↗
PubMed1992

Effects of cholesterol and oxysterols on gap junctional communication between human smooth muscle cells.

Intercellular communication is considered to play an essential role in maintaining and controlling cell growth, cell differentiation and homeostasis. Cell-cell communication can be regulated by factors that influence gap junctional function. In this study it was demonstrated that cholesterol and oxidized cholesterol have the potential to modulate gap junctional communication between human smooth muscle cells in an opposite way. Cholesterol supplementation to human smooth muscle cells resulted in an increase of gap junctional communication up to 130% with regard to the control values. However, autooxidized cholesterol inhibited gap junctional communication more than 40%. Testing of several pure cholesterol oxidation derivates on gap junctional communication demonstrated that all of them were capable to inhibit intercellular communication in the order 25-hydroxycholesterol greater than cholestan-3 beta,5 alpha,6 beta-triol greater than 7-ketocholesterol greater than cholesterol 5,6 alpha-epoxide. The cell-cell communication-inhibiting potency of these oxysterols is in accordance with their atherogenic potency. This implies that cholesterol oxidation products, instead of pure cholesterol, can be promoting factors in the atherogenesis by influencing gap junctional communication between arterial smooth muscle cells, the target cells of atherosclerotic lesions.

Cell Communication↗
PubMed2006

[Management of communication in patients after severe traumatic brain injury. Pilot study].

OBJECTIVE: In the long term, people with traumatic brain injury (TBI) present with communication disorders impairing their professional and social integration. The aim of this study was to evaluate the feasibility of group therapy on communication disorders of people with TBI in the post-hospital period. MATERIALS AND METHOD: Four patients were followed in the medico-social department "Auprès-TC" and took part in various day programs. Two speech therapists participated for a 7-month period using group therapy to take into account communication disorders. The patients and families were evaluated at the beginning and end of care, by use of the Lille Communication Test, the Bordeaux Scale of Verbal Communication, the Revised Neurobehavioural Rating Scale, and part of the European document EBIS. RESULTS: Despite the delay since TBI, patients showed quantitative and qualitative evolution of communicative abilities. DISCUSSION-CONCLUSION: The influence of group therapy on the improvement of communication in patients with TBI should be reconsidered, because in this study, familial and institutional environment influenced the communication. Group therapy allows for communication care from an ecological point of view, by enhancing interactions.

Adult↗
PubMed2006

A randomised trial of the effects of an additional communication strategy on recruitment into a large-scale, multi-centre trial.

Timely participant recruitment remains a significant challenge for most clinical trials. We evaluated the effects on participant recruitment of communication between the central trial coordinators and the clinical sites in the setting of a large international multi-centre clinical trial. The effects of communication were determined in a single-blind randomised controlled trial involving 167 clinical sites in 19 countries. Clinical sites were randomised to either additional or usual communication strategies - the additional communication group received a communication package based on additional, individually-tailored feedback about recruitment, in addition to the usual correspondence from the central trial coordinators that was provided to the control group. The two study outcomes were the median time to half randomisation target and the median total number of participants randomised per clinical site. Eighty-five clinical centres were randomised to receive additional communication and 82 to receive usual communication. At the conclusion of recruitment, there was no significant difference in the median number of participants randomised per centre between the additional and usual groups (37.5 vs. 37.0, p=0.68). The median time to half randomisation target was lower in the additional communication group compared to the usual group, however this difference did not achieve conventional levels of statistical significance (4.4 months vs. 5.8 months, p=0.08). The findings suggest that the additional communication strategy may be of some incremental benefit in helping sites achieve recruitment targets sooner.

Communication↗
PubMed2005

The impact of SCHIP enrollment on adolescent-provider communication.

PURPOSE: Effective communication between physicians and adolescents is critical to convey health information, provide counseling and identify emerging health problems. This article addressed two questions: (a) After an adolescent enrolls in a State Children's Health Insurance Program (SCHIP), is there a change reported in communication between the adolescent and his/her health care provider; and (b) Is there a relationship between respondent's characteristics and change observed within specific content areas? METHODS: Adolescent preventive care guidelines developed by national organizations provided the study framework. Surveys were mailed to 3472 12-19-year-olds in a SCHIP; 1689 responded (response rate = 49%). Frequencies described the study population, chi-square analysis explored differences in adolescent-provider communication before and after enrollment, and multiple linear regressions were used to determine relationships between respondents' characteristics and provider communication topics. RESULTS: There were substantial increases after enrollment in SCHIP in the general area of communication between adolescents and their health care providers. Specifically, the presence of a special health care need had a significant influence on most communication areas. Further, females were more likely than males to talk about sexual health (p = .049) and diet and exercise (p < or = .001); older more likely than younger to discuss sexual health (p = .026) and mental health feelings (p = .023); and white more likely than nonwhite to have better overall communication with the provider after enrollment (p = .029) but Whites also were more likely to experience more negative mental health feelings after enrollment in SCHIP (p = .029). CONCLUSIONS: Practice guidelines define the content of preventive services; but, it appears that many adolescents do not receive adequate guidance from their physicians. For the group of adolescents in this study who had recently enrolled in SCHIP, there was a reported increase in their communication with their health care provider. The positive changes in communication suggest that encouraging providers and adolescents to discuss risky behaviors is a feasible, achievable goal.

Adolescent↗
PubMed2006

Sexual communication and contraceptive use in adolescent dating couples.

PURPOSE: This study had two aims: first, to examine the relationship between general sexual communication and contraceptive use in sexually active adolescent romantic couples, and second, to explore predictors of open communication from characteristics of adolescent couples and individual adolescents. METHODS: Data were drawn from 209 couples dating a minimum of four weeks who participated in the Study of Tennessee Adolescent Romantic Relationships. Seventy-three adolescent dating couples (ages 14-21 years) that engaged in sexual intercourse and completed a sexual communication questionnaire were included in current analyses. RESULTS: Nearly 30% of couples failed to use contraception at first intercourse and almost half of couples did not use contraception every time they had sex. More open communication about sex from both male and female partners was associated with increased contraceptive use. Additionally, adolescents who were more satisfied in their relationships reported more open communication about sex, and adolescent females who self-silenced reported less open communication about sex. Finally, mediation analyses revealed that boys' and girls' relationship satisfaction and girls' self-silencing indirectly predicted contraceptive use through their effects on general sexual communication. CONCLUSIONS: This is the first known study to address individual and dyadic components of sexual communication using reports from both members of established adolescent dating couples. Findings suggest that open sexual communication between intimate partners is important to sexual decision-making. The clinical implications of these findings are discussed.

Adolescent↗
PubMed2005

The impact of an intervention in intercultural communication on doctor-patient interaction in The Netherlands.

OBJECTIVE: Findings of scarcely available studies indicate that there are substantial gaps in intercultural doctor-patient communication. In order to improve intercultural communication in medical practice in The Netherlands, an educational intervention was developed. The aim of the present study was to examine the effects of this intervention on doctor-patient communication. METHODS: Participants (general practitioners: n=38; patients: n=124) were assigned at random to an intervention or a control group. GPs in the intervention group received 2.5 days training on intercultural communication. Patients in the intervention group were exposed to a videotaped instruction in the waiting room, right before the consultation. Data were collected through videotapes of visits of ethnic minority patients to their GP and home interviews with the patients after their medical visit. Communication behaviour was assessed using the Roter interaction analysis system (RIAS). Interview length was assessed as well. RESULTS: The length of the medical encounter increased significantly after having received the intervention. Total number of GP utterances increased significantly too. When comparing relative frequencies on affective and instrumental verbal behaviour of both patients and doctors, no significant changes could be detected. CONCLUSION: It is concluded that there seems to be some change in doctor-patient interaction, but RIAS may not be suitable to detect subtle changes in the medical communication process. It is recommended to use other analysis methods to assess cultural differences in medical communication. PRACTICE IMPLICATIONS: Knowledge about possible antecedents of gaps in intercultural medical communication should be increased in order to be able to design effective interventions for intercultural doctor-patient communication.

Communication↗
PubMed2006

Making communication research matter: what do patients notice, what do patients want, and what do patients need?

OBJECTIVE: To explore limitations of current communication theory by considering different perspectives of researchers, clinicians, patients and teachers of communication. METHOD: Theory development based on limitations of the current communication research literature due to inconsistencies between patient reports and observed communication behavior. RESULTS: While researchers focus on the mechanics and techniques of communication, patients seek relationships in which they experience trust, the right amount of autonomy, caring, and expertise. Patients', physicians', and communication experts' perspectives do not always define the same problems and often point to different solutions. CONCLUSIONS: In addition to studying clinician behaviors and patient perceptions of care, communication research should focus on five additional factors: what patients notice, want and need, and how their perspectives differ from those of physicians and researchers; the context, including illness severity and type and family influences; how complex health systems facilitate and impede communication; patients' influences on physician communication behavior; and habits of mind that promote attentive care.

Assertiveness↗
PubMed2006

Cancer communication patterns and the influence of patient characteristics: disparities in information-giving and affective behaviors.

OBJECTIVE: To examine whether patient characteristics are associated with communication patterns between oncologists and breast cancer patients. METHODS: The study was conducted at 14 practices with 58 oncologists with 405 newly diagnosed patients with no prior history of breast cancer. The initial consultation between oncologist and patient was audiotaped and a detailed communication analysis performed. Interviews were conducted with patients and physicians immediately before and after consultations. RESULTS: Disparities were found across all patient demographics. Younger patients asked more questions as did those who were white had more than a high school education and when they reported an income that was high or medium income, compared to low (p<0.01). Patient proactive behavior, such as volunteering information to the physician unasked, was similarly related with all demographic predictors as was physician tendency to ask patients questions. Despite the inherently emotional nature of this encounter, there was surprisingly little overt discussion about how the patient felt about her diagnosis and how she was coping. Both patients and physicians spent time trying to establish an interpersonal relationship with each other, although patients spent more time. Patients differed in the number of relationship building utterances by age, education and income and physicians spent more time engaged in relationship building with white than non-white patients (p<0.01) and more educated and affluent patients (p<0.05). CONCLUSION: This study indicates that patient demographic factors, such as race, income level, education and age seem to influence the amount of time physicians spend in almost all communication categories with patients. One recurring difference across most communication categories was race. Racial differences occurred in almost every one of the communication categories examined. White patients had many more utterances in almost every communication category than their non-white counterparts. These differences may mean a less adequate decision-making process for patients who are members of racial or ethnic minorities, patients who are less affluent, older, and have less education. PRACTICE IMPLICATIONS: This study found that providers communicate differently with patients by age, race, education and income. These differences in communication may lead to disparities in patient outcomes. Communication skills training should explicitly train clinicians to recognize these tendencies. Patients with different demographics characteristics may also required education that is tailored to them.

Affect↗
PubMed2006

Conceptualizing and measuring pharmacist-patient communication: a review of published studies.

BACKGROUND: Pharmacist-patient communication in community pharmacies has been studied for over 25 years with little effort to evaluate this research comprehensively. OBJECTIVE: The main objective of this review is to examine and summarize how researchers have conceptualized, defined, and measured pharmacist-patient communication across studies and identify gaps in the literature. METHODS: Articles were compiled from a search of (1) Medline, IPA, CINAHL, and PubMed databases using the keywords, "counseling", "patient communication", "patient counseling", "patient education", "patient consult( *)", and/or "pharmacists", (2) bibliographies of selected articles. The search generated 56 studies on community pharmacy, of which 39 studies met the inclusion criteria. RESULTS: Most studies (72%) have used the term patient counseling, although pharmacist-patient communication and patient education were also used. The definition of patient counseling varies across studies. Almost half of the studies (49%) conceptualized pharmacist-patient communication solely as a pharmacist information provision activity. A total of 16 studies (41%) also focused on pharmacists' interpersonal behavior in addition to the information provision activity of the pharmacist. In contrast, patient communication behavior and the exchange process between both parties has been understudied. A total of 16 studies (41%) used a retrospective design. All studies used a cross-sectional design, with varying modes of data collection such as mail surveys, telephone interviews, nonparticipant observation, and shopper studies. Taped encounters are rare. SUMMARY/IMPLICATIONS: This review revealed that most studies have focused on a one way communication of pharmacists to patients. A need for examining the patient-pharmacist dyad is apparent. Future research could explore a greater use of taped encounters to analyze the interactive communication process, affective components of communication such as collaborative problem solving, interpersonal relationship development, and the expertise that patients bring into the encounter.

Communication↗
PubMed2004

Gendered communication among young people in Mexico: implications for sexual health interventions.

Effective communication between partners is crucial for good sexual health, but is often difficult to achieve. This qualitative study shows how gendered communication can act as an important barrier to successful dialogue between men and women. Both content and manner of speaking are often gendered: not only can topics of conversation be socially defined as more or less appropriate for a speaker according to his or her sex, but men and women can also differ systematically in terms of the phrases and words they use. This may lead to a lack of the common forms of expression that are needed for effective communication. The study examines communication about sexuality among young men and women in low-income areas of Mexico City. The relationship between gender stereotypes of sexual behaviour and the gendered nature of communication strategies is explored. The negative consequences of gendered communication for effective dialogue between men and women are illustrated. Interventions that can enhance communication between men and women would be expected to have a positive impact on sexual health. This paper argues that research and interventions intended to improve sexual health may instead inadvertently reinforce communication barriers not only by failing to address the social pressures that exacerbate gendered communication, but also more insidiously, by using language that actively contributes to these pressures. An example of an intervention that avoids this problem is the Mexican programme "Gente Joven" ("Young People").

Adolescent↗
PubMed2004

Physician-elderly patient-companion communication and roles of companions in Japanese geriatric encounters.

Although the triadic encounter of physician, patient, and an accompanying family member is a common phenomenon in geriatrics, previous research on the communication in medical encounters has primarily focused on dyadic interactions between physician and patient. This study aimed to explore the triadic communication and communication roles of patient companions in Japanese geriatric encounters. Among elderly patients aged 65 or over who were under continuous care of nine attending physicians at a university affiliated geriatric clinic in Tokyo, 63 accompanied patients and 82 unaccompanied patients were included for this study. The consultation was audiotape recorded and analyzed using the Roter Interaction Analysis System (RIAS) with additional categories developed to code aspects of companion communication. In dyadic encounters, the average proportions of physician's talk and patient's talk were 54% and 46%, respectively, while in triadic encounters the average talk proportions of physician, patient, and companion were 49%, 29%, and 22%. Companions made a significant contribution to the communication during the visit by providing information and asking the physician questions, as well as facilitating patient's talk. The companion's communication may influence not only the patient's but also the physician's communication. The patient's expectation of the companion's role during the visit and the companion's intention regarding their role were generally related to one another, and had positive associations with the companion's actual behavior during the visit. Nevertheless, companions often anticipated playing a more direct communication role during the visit, including the provision of information and asking of questions, than patients expected of them. Further investigation is needed to explore the communication dynamics in triads and dyads, and its relation to patient outcomes.

Adult↗
PubMed2006

Parent communication and child pain and distress during painful pediatric cancer treatments.

Children with cancer often consider treatment procedures to be more traumatic and painful than cancer itself. Previous research indicates that parents' behavior before and during painful medical procedures influences children's distress level. Understanding parents' naturally occurring communication patterns is essential to identifying families in need of an intervention to enhance coping and emotional well-being. Using the concept of definition of the situation from a symbolic interactionism theoretical framework, this study developed a typology of parent communication patterns and tested relationships between those patterns and children's responses to potentially painful treatment procedures. Analyses are based on video-recorded observations of 31 children and their primary parents (individuals functioning in a parenting role and serving as the primary familial caregivers during the observed procedure) in the USA during clinic visits for potentially painful pediatric oncology treatments. Four communication patterns emerged: normalizing, invalidating, supportive, and distancing. The most common communication patterns differed by clinic visit phase: normalizing during pre-procedure, supportive during procedure, and both distancing and supportive during post-procedure. Parents' communication also varied by procedure type. Supportive communication was most common during lumbar punctures; normalizing and distancing communication were most common during port starts. Six children (19.4%) experienced invalidation during at least one clinic visit phase. Analyses indicated that invalidated children experienced significantly more pain and distress than children whose parents used other communication patterns. This typology provides a theoretical approach to understanding previous research and offers a framework for the continuing investigation of the influence of parents' communication during potentially painful pediatric oncology procedures.

Adult↗
PubMed2001

Primary care physician attitudes regarding communication with hospitalists.

Hospitalist systems create discontinuity of care. Enhanced communication between the hospitalist and primary care physician (PCP) could mitigate the harms of discontinuity. We conducted a mailed survey of 4,155 physician members of the California Academy of Family Physicians to determine their preferences for and satisfaction with communication with hospitalists. We received 1,030 completed surveys (26%). PCPs overwhelmingly stated that they "very much prefer" to communicate with hospitalists by telephone (77%), at admission (73%), and discharge (78%). Only discharge medications (94%) and discharge diagnosis (90%) were deemed "very important" by >90% of PCPs. Of the 556 respondents (54%) who had ever used a hospitalist, 56% were very or somewhat satisfied with communication with hospitalists, and 68% agreed that hospitalists are a good idea. Regarding communication at discharge, only 33% of PCPs reported that discharge summaries always or usually arrive before the patient is seen for follow-up. Only 56% of PCPs in our survey were satisfied with communication with hospitalists. Hospitalists should communicate with PCPs in a timely manner by telephone, at least at admission and discharge, and provide the specific pieces of information deemed important by the vast majority of PCPs. Hospitalists should also ensure that discharge information arrives in time to assist the PCP in reassuming care of their patients. It may be possible to tailor communication to individual PCPs. Further research could assess the impact of such communication on patient satisfaction and outcomes.

Adult↗
PubMed2002

Primary care physician attitudes regarding communication with hospitalists.

Hospitalist systems create discontinuity of care. Enhanced communication between the hospitalist and primary care physician (PCP) could mitigate the harms of discontinuity. We conducted a mailed survey of 4,155 physician members of the California Academy of Family Physicians to determine their preferences for and satisfaction with communication with hospitalists. We received 1,030 completed surveys (26%). PCPs overwhelmingly stated that they "very much prefer" to communicate with hospitalists by telephone (77%), at admission (73%), and discharge (78%). Only discharge medications (94%) and discharge diagnosis (90%) were deemed "very important" by >90% of PCPs. Of the 556 respondents (54%) who had ever used a hospitalist, 56% were very or somewhat satisfied with communication with hospitalists, and 68% agreed that hospitalists are a good idea. Regarding communication at discharge, only 33% of PCPs reported that discharge summaries always or usually arrive before the patient is seen for follow-up. Only 56% of PCPs in our survey were satisfied with communication with hospitalists. Hospitalists should communicate with PCPs in a timely manner by telephone, at least at admission and discharge, and provide the specific pieces of information deemed important by the vast majority of PCPs. Hospitalists should also ensure that discharge information arrives in time to assist the PCP in reassuming care of their patients. It may be possible to tailor communication to individual PCPs. Further research could assess the impact of such communication on patient satisfaction and outcomes.

Attitude of Health Personnel↗
PubMed1997

Canine communication.

Communication occurs when one individual, the sender, produces a signal that alters the behavior of another individual, the receiver. The signal can provide broadcast information about species and individual identity or transmitted information, in which the sender effects a change in the receiver's behavior. To reduce ambiguity, signals have evolved to be conspicuous, redundant, and stereotypic. These features allow communication signals to be produced by senders and perceived and acted upon appropriately by receivers, both conspecific and heterospecific. The modality of the communication signal can be visual, olfactory, or acoustic. Visual signals can be adjusted rapidly for response during interactions between individuals at close or medium range. Examples include displays of relative dominance or submission. Olfactory signals can be used for individual, sex, or group identity at close range during greetings and assessments of individuals. Excretory products can be used for olfactory communication over long distances and for long periods of time. Acoustic signals can be adjusted rapidly for close- and far-range communication. They do not persist in the environment. For dogs, communication is fundamental to maintaining affiliations, reducing competition, and identifying individuals. These factors are critical to the highly developed social behavior of dogs. In an ultimate sense, dogs have been selectively bred for positive interactions with humans; in a proximate sense, many dogs spend their lives in close social association with humans. For these reasons, many of the signals used by dogs in dog-dog communication are also used in dog-human communication. Veterinarians act as receivers for communication signals when greeting dogs as patients. The information obtained is used to assess the state of arousal and probability of future behavior of the dog so that handling of the animal can be facilitated. The goals are to minimize stress and injury, to successfully complete the treatment program, and to promote the health of the animal.

Animal Communication↗
PubMed2002

Do gender-dyads have different communication patterns? A comparative study in Western-European general practices.

From the viewpoint of quality of care, doctor-patient communication has become more and more important. Gender is an important factor in communication. Besides, cultural norms and values are likely to influence doctor-patient communication as well. This study examined (1). whether or not communication patterns of gender-dyads in general practice consultations differ across and between Western-European countries, and (2). if so, whether these differences continue to exist when controlling for patient, GP and consultation characteristics. Doctor-patient communication was assessed in six Western-European countries by coding video taped consultations of 190 GPs and 2812 patients. Cluster analysis revealed three communication patterns: a biomedical, a biopsychosocial and a psychosocial pattern. Across countries, communication patterns of the female/female dyad differed from that of the other gender-dyads. Differences in communication patterns between countries could especially be explained by differences in consultations of male doctors, irrespective of the patients' gender. It is important to take into consideration differences between gender-dyads and between countries when studying gender effects on communication across countries or when comparing studies performed in different countries.

Attitude of Health Personnel↗