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Situational factors and thought processes associated with unprotected intercourse in young gay men.

OBJECTIVES: To investigate (1) the types of justifications, if any, that young gay men give themselves at the time they make the decision to have unprotected anal intercourse and (2) the types of occasion on which they are most at risk of having unprotected intercourse. DESIGN AND METHODS: In structured interviews, gay men aged 15-21 years were asked to recall two sexual encounters from the preceding 6 months: one in which they had had unprotected anal intercourse ('unsafe' encounter) and one in which they had resisted a strong temptation to have unprotected intercourse ('safe' encounter). We studied both types of encounter to enable identification of situational variables distinguishing between them. RESULTS: The first two factors that emerged from a Factor Analysis of the self-justification data ('unsafe' encounter, n = 219) involved, respectively, high-risk behaviour in response to a negative mood state and inferring from perceptible characteristics that the partner was unlikely to be infected. The most commonly reported self-justification was of this latter type. In respondents recalling both encounters (n = 115), sexual desires, mood, communication, and use of 'dirty talk' distinguished between the encounters. In contrast, type of partner, consumption of alcohol or drugs, desire for excitement, and use of pornography did not. CONCLUSIONS: Results are discussed in relation to those obtained in our earlier study of older gay men. Young gay men appear to be more single-minded about what they want to do sexually, and more likely to infer from perceptible characteristics that their partner is unlikely to be infected. In young gay men, a negative mood state is associated with unsafe sex, an opposite finding to that obtained with older gay men. The results also suggest the possible importance of failure to communicate about desires concerning safe sex and the use of 'dirty talk'; these may help to facilitate the occurrence of unsafe sex.

Adolescent↗

Partner notification for sexually transmitted diseases in Peru: knowledge, attitudes, and practices in a high-risk community.

OBJECTIVES: Notification and treatment of sex partners after diagnosis of a sexually transmitted disease (STD) is essential to reduce reinfection and further transmission. GOAL: The goal of this study was to determine the prevalence of partner notification and subsequent health-seeking behavior in a high-risk population in Lima, Peru. STUDY DESIGN: STD-infected participants of an HIV/STD prevention trial completed a questionnaire concerning partner notification. RESULTS: Of the 502 STD-positive subjects, 287 completed the survey. Among survey participants, 65% informed their primary partner and 10.5% informed casual or anonymous partners. Reasons for failure to notify varied by partner type and included not understanding the importance of partner notification, embarrassment, fear of rejection, and inability to locate the partner. When notified, approximately one third of all partners sought medical attention. CONCLUSIONS: Partner notification in Peru is limited by relationship dynamics, social stigma, and limited contact information. Interventions could emphasize the importance of notification, improvement of communication skills, and introduce contact tracing programs (including Internet-based systems) and expedited partner therapy.

Adolescent↗

Adolescent and family predictors of physical aggression, communication, and satisfaction in young adult couples: a prospective analysis.

This study tested a model wherein the family conflict, depression, and antisocial behavior of 254 adolescents (mean age = 17 years; 63% female) are prospectively related to functioning within a marital (51%) or dating relationship in young adulthood (mean age = 23 years). Family aversive communication in adolescence and adolescent antisocial behavior predicted couple physical aggression. Family aversive communication predicted dyadic satisfaction and aversive couple communication for married women and dating men. Among those with partners who reported little antisocial behavior, adolescent antisocial behavior inversely predicted couple satisfaction and facilitative behavior. Partner antisocial behavior did not mediate the relation between adolescent characteristics and couple functioning. Findings emphasize the importance of the early family environment and psychopathology of the adolescent in the development of adaptive couple relationships.

Adolescent↗

Developing and adapting a family-based diabetes program at the U.S.-Mexico border.

CONTEXT: The prevalence of diabetes among Hispanics is more than twice that of non-Hispanic whites in communities along the U.S.-Mexico border. The University of Arizona and two community health agencies on the Arizona border, Campesinos Sin Fronteras and Mariposa Community Health Center, collaborated to design, pilot and assess the feasibility of a lay health-outreach worker- (promotora-) delivered diabetes education program for families. La Diabetes y La Unión Familiar was developed to build family support for patients with diabetes and to teach primary prevention behaviors to family members. METHOD: Community and university partners designed a culturally appropriate program addressing family food choices and physical activity, behavior change, communication, and support behaviors. The program offers educational content and activities that can be presented in home visits or multifamily group sessions. Community partners led the implementation, and university partners guided the evaluation. CONSEQUENCES: Seventy-two families (249 total participants) including children and grandchildren participated. Preintervention and postintervention questionnaires completed by adults (n = 116) indicate a significant increase in knowledge of eight diabetes risk factors (P values for eight factors range from < 001 to .006) and a significant increase in family efficacy to change food (P < .001) and activity behaviors (P < .001). Interviews with participants highlight the program's positive psychosocial impact. INTERPRETATION: Community and university collaboration involved building upon the promotoras' expertise in engaging the community and the university's expertise in program design and evaluation. A promotora-delivered family-based diabetes prevention program that emphasizes family support, communication, and health behaviors is feasible and can yield change in family knowledge, attitude, and behavior relative to diabetes risk factors.

Adolescent↗

Determinants of shift-work adjustment for nursing staff: the critical experience of partners.

Levels of congruence between shift workers and their partners on experiences of shift work are rarely addressed. Partners, however, might be a potential source for validation of shift-work issues in terms of their understanding of these issues and might have an impact on the shift workers' experience of support or personal disruption. Participants consisted of 59 hospital shift-working nurses (55 women, 4 men) and their 59 partners. Two parallel versions of a previous questionnaire (Smith & Folkard, 1993a, 1993b) were used to obtain subjective data from workers and their partners on perceptions of the workers' experience of sleep flexibility and chronotype and lifestyle factors (sleep/fatigue, health/stress, and social/family) relating to tolerance across three shift types: day, evening, and night. All participants provided information on ideal shift choice and ratings of their own personal disruption and family, communication, and relationship issues. Results indicate that shift workers and their partners are congruent in their perceptions of the impact of shift work on the worker in all three lifestyle factors relating to tolerance across the three shift types. Shift workers experience more health/stress and social/family problems on the evening shift; this is related to their partners' increased sense of personal disruption. Similarly, when partners report the perceived impact of shift work on these same dimensions, it is associated with shift workers' heightened sense of personal disruption. Fewer sleep/fatigue and health/stress problems on the night shift are related to greater sleep flexibility, and evening types experience increased sleep/fatigue problems on the day shift. Social measures (particularly the personal disruption of the partner) rather than biological measures are the greatest predictors of shift workers' personal disruption. Findings are supported by qualitative data. It appears that the partner's understanding and own sense of disruption is critical to the experience of the shift worker regarding coping and predictability of tolerance.

Adaptation, Psychological↗

Managing HIV among serodiscordant heterosexual couples: serostatus, stigma and sex.

A qualitative study was conducted with 28 men and women in HIV-serodiscordant couples to explore the management of HIV in their relationship. Content analysis of the interviews revealed the role of serostatus and stigma in shaping partners' experience of HIV, sex and risk. Partners' differing serostatus often created feelings of alienation within the relationship. Compounding this interpersonal dynamic, the HIV service community was experienced as segregating because they were not funded or prepared to work with seronegative partners. Thus many, particularly seronegative women, felt invisible both within and outside of the relationship. Yet, the uninfected partners shared the burden of a stigmatizing illness because of the serodiscordant relationship. Stigma hindered communication about HIV and sex, disclosure to others and access to services. Many experienced HIV as a loss of their sexuality. Seronegative partners spoke about 'keeping sex alive' and often had to push to continue having sex. Couples used multiple strategies to manage HIV, including developing strict behavioural guidelines, connecting with other couples, accessing scientific information and becoming educators and activists. These altruistic activities, which also included participation in research, helped to transcend external and internalized stigma. Implications for developing interventions for HIV-serodiscordant couples are discussed.

Adult↗

[Peculiarities of crisis intervention with marital partners in the 2d half of life].

Marital therapeutic procedures can be reduced to two fundamental psychotherapeutic orientations: Communication and behavior therapy. From these, we selected four strategies of treatment. They concerned training in goal-orientated, conflict-orientated, feedback-orientated and goal-plus feedback-orientated dialogue of the partners. There is no knowledge about the possible effects with regard to spouses of the second half of life. So we analyzed these strategies empirically with eight groups of different variables for a sample of 20 dyads. Their disturbances and disharmonies existed many years. A goal-oriented treatment is the most effective of all the strategies. A combination of communication-therapeutic and behavior-therapeutic elements proves itself to be an overstrain for couples of the studied group of age.

Aged↗

Responsiveness of male adolescents with mental retardation to input from nondisabled peers: the summoning power of comments, questions, and directive prompts.

The expressive communication of individuals with cognitive impairments may be directly influenced by a partner's input, because such individuals often have limited conversational skills. Sequential analyses of dyadic interactions examined the effects of input by 32 normally developing adolescents on responses by male subjects with mental retardation whose communication modes included augmented communication. Results suggested that (a) verbal prompts in the form of questions were significantly more likely to receive responses from subjects with mental retardation than directive prompts, (b) comments were significantly more likely to receive responses from subjects with retardation than were directive prompts, when the nondisabled peer was male, and (c) male subjects with mental retardation were more likely to respond to input from male peers than from females. These data suggest that questions facilitate naturally occurring conversations but underscore the importance of evaluating gender-related effects on interaction involving persons with severe cognitive and communication impairments.

Adolescent↗

Smelling renal dysfunction via electronic nose.

The human body odor plays an important role in social communication in various situations, like the olfactory identification of partners and relatives as well as in parents-child interactions. In patients with renal dysfunction the compound of sweat and volatile gases is changed because of the limited ability for removing metabolic products from the blood. The regulation of electrolyte composition and acid-base balance are also altered so that the body odor of these patients may be significantly influenced by these disorders. We show the ability of an electronic nose to detect changes in the human body odor in consequence of renal dysfunction by reducing multivariate sensor signals with principal component analysis to its first and second principal odor component (POC). All healthy subjects could clearly be distinguished from patients with renal failure using quadratic discriminant analysis, whereas a correct classification of 95.2% (98.4% using 1st-3rd POC) of patients between end stage renal failure and chronic renal failure was found. This methodology of analyzing human body odor may also provide new approaches for investigating symptoms of renal failure and for diagnosing other diseases of internal or cutaneous origin.

Biomarkers↗

Urban black adolescents who obtain contraceptive services before or after their first pregnancy. Psychosocial factors and contraceptive use.

This paper compares three groups of urban black teenagers at their enrollment in a contraceptive program and at a one-year follow-up. The groups comprise 263 never-pregnant, postabortion, and postpartum teens ages less than or equal to 17 years at their initial family planning visit. Self-report questionnaires examined attitudes and information about pregnancy and contraceptive use, sources of contraceptive information, sexual and contraceptive experience, family and partner support for contraceptive use, and demographic background factors. Emotional, personality, and psychosocial factors were assessed with standard measures. Age, partner relationships, and items relating to the mother's communication about contraception and pregnancy were significant variables in the outcome of never-pregnant and delivery of pregnancy. Self-esteem was highest in the never-pregnant group. Personality factors, emotional distress, and social adjustment scores were in the normal ranges and did not differ between the groups. Contraceptive use at follow-up was most consistent in the never-pregnant group. These data suggest the need for earlier family involvement in educating and guiding teens together with access to contraceptive services in preventing unwanted adolescent pregnancies.

Abortion, Induced↗

Biomedical research councils. Their role and function in transferring information.

Biomedical research plays a great part in promoting not only advances in scientific knowledge but also in the continuous flow of technological innovations in health care. One of the first conditions for the successful transformation of research into an innovation is overcoming the divisions between science and technology, between the researchers and their partners in the innovation process. Biomedical Research Councils (BMRCs) have an important role in the transfer of information. To improve the chances of successful developments and transfers of scientific breakthroughs, the BMRCs must adopt new, comprehensive strategies for such transfer. They must learn to recognize as early as possible which new opportunities hold promise, at which stage of development information should be transferred to other areas of expertise, and which target groups in which fields should be made partners in the research.

Communication↗

The potential contribution of sexuality and gender awareness.

To make well-informed decisions about reproductive health, individuals need information about their body, gender and sexuality as well as the communication skills to convey their choices to their family, partners and health care providers. Gender and sexuality are at the core of each individual's identity; understanding and acceptance of these aspects of ourselves is basic to our ability to have healthy relations with self, family and sexual partners. Throughout an individual's life cycle information is needed about gender and sexuality changes according to needs of their age group. A holistic approach to reproductive health is needed, based in the community where people live, in the schools where young people study and in the community health care centers where they receive services.

Awareness↗

Astrocyte and oligodendrocyte connexins of the glial syncytium in relation to astrocyte anatomical domains and spatial buffering.

Astroctyes express a set of three connexins (Cx26, Cx30, and Cx43) that are contained in astrocyte-to-astrocyte (A/A) gap junctions; oligodendrocytes express a different set of three connexins (Cx29, Cx32, and Cx47) that are contained in the oligodendrocyte side of necessarily heterotypic astrocyte-to-oligodendrocyte (A/O) gap junctions, and there is little ultrastructural evidence for gap junction formation between individual oligodendrocytes. In addition, primarily Cx29 and Cx32 are contained deeper in myelin sheaths, where they form autologous gap junctions at sites of uncompacted myelin. The presence of six connexins in macroglial cell populations has revealed unprecedented complexity of potential connexin coupling partners, and with restricted deployment of gap junctional intercellular communication (GJIC) within the "pan-glial" syncytium. New implications for the organization and regulation of spatial buffering mediated by glial GJIC are derived from recent observations of the existence of separate astrocyte anatomical domains, with only narrow regions of overlap between astrocyte processes at domain borders. Thus, widespread spatial buffering in the CNS may occur not successively through a multitude of processes arising from different astrocytes, but rather in a more orderly fashion from one astrocyte domain to another via intercellular coupling that occurs only at restricted regions of overlap between astrocyte domains, augmented by autocellular coupling that occurs within each domain.

Animals↗

Bioterrorism preparedness: planning for the future.

The release of nerve gas in a Tokyo subway and attempted releases of biological agents by the Aum Shinrikyo cult have demonstrated the willingness and ability of modern-day terrorists to use unconventional weapons. Unlike explosive weapons, the use of biologic weapons may only become apparent once people become ill. The detection and response to these man-made outbreaks will occur initially at the medical and public health levels. Therefore, the Centers for Disease Control and Prevention and its partners are strengthening their response, disease detection, diagnostic, and communication capabilities to better protect the nation's citizens against biological or chemical terrorism.

Biological Warfare↗

Providers' gender and moral reasoning: a proposed agenda for research on providers and patients.

Women constitute 35% of providers in genetics, at the doctoral level. A survey of 682 geneticists in 19 nations showed that gender was the single most important determinant of ethical decision making. Women were less directive and more observant of patient autonomy than men. The future influx of women into medicine calls for research on provider gender and decisions. Research is also needed on women's and men's perceptions of abortion for genetic reasons, on extended families' views, on agreement between partners and on overall effectiveness of genetic counseling, including communication, elements of provider satisfaction, interpretation of risk and uncertainty after counseling.

Abortion, Eugenic↗

Conversational engagement of children with learning disabilities.

This study was designed to characterize the conversational engagement techniques employed by children with and without learning disabilities while in a dyadic interaction. Engagement was defined and measured in terms of the degree to which utterances provided information and evidenced responsiveness to one's conversational partner. Sixty (30 with learning disabilities and 30 nondisabled) 9- to 13-year-old subjects participated. Analyses indicated that the subjects with learning disabilities (LD) could and did employ engagement-related techniques similar in levels of sophistication to those of their nondisabled peers, although they did so less consistently and frequently. Further, the relationship between affective measures and the engagement-related techniques used by the subjects with LD differed markedly from those of the nondisabled subjects. The results are interpreted from a motivational standpoint and suggest that future research should focus on the knowledge and application of engagement-related techniques of the children with LD, across settings and conversational partners.

Adolescent↗

Applying new thinking from the linked and emerging fields of digital identity and privacy to information governance in health informatics.

Recent work in the emerging field of network or digital identity suggests a new approach to the design of informatics systems, in which the individual becomes the guardian of their own personal data, and is assisted in controlling access to it by an infrastructure that is aware of roles, such as 'doctor', and relationships, such as 'doctor-patient'.For these purposes, an 'identity' is defined as the history of a relationship between two entities, and thus encompasses not only name and address but also data that would usually be regarded as part of an electronic patient or health record. This paper presents a description of how such a true person-centric architecture might work, and shows how it can be seen as an evolution of current plans in the NHS for a national patient data spine. One application, the electronic transmission of prescriptions, is described in detail. Other applications, both within and without the healthcare field, are described in outline. The implementation of such a person-centric system requires a modest degree of technical innovation, but significant change in organisational and business models. It is suggested that there is a need for one or more not-for-profit trusts, each with a remit to act as host for an individual's digital identity, and as the individual's true agent. Service providers - such as healthcare organisations - will pay the trust for provision of authentication, and for the storage and transmission of a patient's data; the trust in turn will pay implementation partners, such as smart card issuers and providers of communication channels, acting on behalf of the individual.

Access to Information↗

Community mental health professionals' theoretical assumptions about families: responses to a practice simulation vignette.

Seventy-three community mental health professionals read a practice simulation vignette about a man with increased schizophrenia symptoms who appears at a community mental health agency accompanied by his parents. Professionals reported their levels of agreement that the parent/s may play a role in the man's schizophrenia symptoms and/or mental health treatment, i.e., serving as treatment resources; expecting consultation from professionals; serving as partners and allies; expressing negative emotions; expressing double bind communication; engaging in hostile behavior per the schizophrenogenic mother; having marriage conflicts; and also having a psychiatric disability. Professionals reported their level of agreement that the parents may be experiencing responses to their son's schizophrenia such as coping; grieving; adjusting to a biological illness; dealing with caregiving responsibilities/burdens; and remaining strong, resilient people. Findings revealed that this sample of mental health professionals most strongly agreed that families are coping, grieving, and positive treatment resources.

Adaptation, Psychological↗