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PubMed2002

In the shadow of risk. How men cope with a partner's gynaecological cancer.

This paper discusses a qualitative, grounded theory study of partners' perspectives on gynaecological cancer that compared their experience of illness with that of the cancer patient. The study investigated, through unstructured interviews, gender differences in attitude to, and communication about, serious illness, with particular reference to coping and risk management. The results illuminate issues surrounding the sharing of a cancer diagnosis, offering an insight into the care processes that enhance or impede partner involvement. The paper discusses issues beyond immediate treatment, and explores the recovery process as both patient and partner experience it. The implications of the findings and the development of clinical practice are subsequently highlighted.

Adaptation, Psychological↗
PubMed2005

Pilot intervention to enhance sexual rehabilitation for couples after treatment for localized prostate carcinoma.

BACKGROUND: The majority of prostate carcinoma survivors experience enduring sexual difficulties and associated distress in the years after definitive treatment. A counseling intervention aimed at improving levels of sexual satisfaction and increasing successful utilization of medical treatment for erectile dysfunction (ED) was developed and pilot-tested for both the survivor of prostate carcinoma and his partner. METHODS: All male participants were 3-month to 5-year survivors of localized prostate carcinoma who had been treated with radical prostatectomy or radiation therapy, and were married or in a committed relationship. Couples were randomized to attend four sessions of counseling together or to have the man attend alone. In both groups, partners completed behavioral homework. The sessions included education on prostate carcinoma and sexual function and options to treat ED as well as sexual communication and stimulation skills. Standardized questionnaires at baseline, posttreatment, and at 3-month and 6-month follow-up assessed sexual function, marital adjustment, psychologic distress, and utilization of treatments for ED. RESULTS: Fifty-one of 84 couples randomized to treatment completed the intervention (61%). Attendance by the partner did not affect outcomes. Participants completing the intervention demonstrated improvement in male overall distress (P < 0.01), male global sexual function (P < 0.0001), and female global sexual function (P < 0.05) at 3-month follow-up, but regression toward baseline was noted at 6-month follow-up. However, utilization of ED treatments increased from 31% at the time of study entry to 49% at the 6-month follow-up (P = 0.003). CONCLUSIONS: The results of this brief pilot counseling intervention demonstrated significant gains in sexual function and satisfaction and increased utilization of treatments for ED. However, modifications are needed in future randomized trials to reduce the rate of premature termination and to improve long-term maintenance of gains.

Aged↗
PubMed1999

Public/private partners. Key factors in creating a strategic alliance for community health.

BACKGROUND: The rapidly evolving American health system creates economic and societal incentives for public and private health organizations to collaborate. Despite the apparent benefits of collaboration, there is a paucity of information available to help local agencies develop partnerships. This study, itself a collaboration between a school of public health (SPH) and a Georgia health district, was undertaken to identify critical factors necessary to successfully initiate and sustain a public/private community health collaboration. METHODS: Professional staff at the SPH conducted 26 standardized interviews involving participants from Cobb and Douglas counties Boards of Health; Promina Northwest (now known as Wellstar), a not-for-profit health system; and community stakeholders. Content analysis of each interview question was performed and comparisons were made both within each group and across groups. RESULTS: Trends were identified in the following key areas: vision of health care for Cobb and Douglas counties, forces driving collaboration, strengths of each organization, critical negotiating issues, and potential community gain resulting from the partnership. CONCLUSION: A shared vision between potential collaborators facilitates communication regarding strategies to achieve common goals. A previous history of working together in limited capacities allowed the partners to develop trust and respect for one another prior to entering negotiations. These factors, when taken in conjunction with each organization's strong leadership and knowledge of the community, build a strong foundation for a successful partnership.

Community Health Centers↗
PubMedDate not supplied

Interventions to prevent HIV/AIDS among adolescents in less developed countries: are they effective?

The objective of this study was to summarize and critically assess the effects of interventions to prevent HIV/AIDS among adolescents in less developed countries. Reports of studies that evaluated interventions for preventing HIV/AIDS/STDs among persons aged 11-25 years were obtained from online computer databases, by searching conference proceedings and relevant journals, and by following up references cited in published reports. Studies were included if they investigated any educational, behavioral, psychosocial or other intervention that aimed to prevent or reduce HIV/AIDS/STD among persons aged 11-25 years in a less developed country. Only studies that included a control group, and which involved pre- and post-intervention assessments were included. Outcome measures included: (i) changes in safe sex practices (abstinence, condom use, limitation of sexual partners, avoidance of casual sex), (ii) knowledge about HIV/AIDS transmission and prevention methods, (iii) perception of HIV/AIDS/STD risks, (iv) self-efficacy with regard to condom negotiation and refusal of sex, (v) uptake of voluntary counseling and testing (VCT), and (vi) reduction in incidence of HIV/AIDS/STDs. Studies were assessed in terms of intervention format (e.g., education, role-play, video), duration, and setting (school or community). Reported improvements in outcome measures in intervention versus control groups were assessed. Sixteen studies met the inclusion criteria. Thirteen of these were conducted in Africa and three in Latin America. Twelve of the sixteen studies were school-based, and four were community-based. The interventions reviewed were not resoundingly successful in achieving their goals of increasing knowledge of HIV/AIDS, altering attitudes, improving negotiation and communication skills, or in influencing positive behavior evidenced through consistent condom use, abstinence, or reducing the number of partners. Considering the importance of HIV/AIDS prevention among adolescents, design of evaluation studies of programs in less developed countries need to be improved. The use of randomized controlled trials or other rigorous approaches for evaluating population-based behavioral interventions (e.g., Solomon Four design) is recommended.

Acquired Immunodeficiency Syndrome↗
PubMed1997

New tools for laboratory design and management.

The clinical laboratory is changing from a place of activity based on sample analysis to an in vitro diagnostic network. To convince our team, partners, and administrators, we need new comprehensive tools to define a strategy with limited risk of failure or conflicts. Specific quality goals should be established before choosing automated tools for sample handling, analytical systems, laboratory information systems, communication systems, or advanced technologies. A system approach maps and simplifies the process, based more on a functional study than on classical disciplines. A customer-supplier approach establishes the requirements between partners either inside or outside the laboratory. The quality system must be a management tool, linking samples, tasks, information, and documents. Quantitative simulation modeling explores different automation alternatives and their impact on laboratory workflow. Finally, integration of results in interactive semirealistic simulation tools for laboratory design or reengineering can be used as communications tools to involve laboratory professionals in the change of their practice.

Chemistry, Clinical↗
PubMed1997

Health online and the empowered medical consumer.

BACKGROUND: Lay health care consumers' emergence as active participants in online health care networks is a powerful new technological pattern that promises to take the American health care system through all stages of cultural adaptation--substitution, innovation, and transformation. Soon everyone will recognize the fundamental changes online health has produced in the way we think and act about health care. A NEW ACADEMIC SUBSPECIALTY: A new subspecialty--consumer health informatics (CHI)--is covering two domains: (1) community CHI resources--the online networks, forums, databases, and World Wide Web sites that anyone with a home computer can access, and (2) clinical CHI resources--programs or systems developed by clinicians, system developers, or health maintenance organizations and provided to selected membership groups or patients. EXHIBITS: Sample communications among online self-helpers within their chat groups, e-mail exchanges, bulletin boards, and USENET newsgroups for chosen health topics show what is on their mind, how they get information, how they use it, and how they correct it. Sometimes, clinicians have observed, lay care offers higher quality than professional care. Lay self-helpers, such as the originator of the Brain Tumor Mailing List, have observed several potential benefits in linking online self-helpers and providers and at a very modest cost. FUTURE DIRECTIONS: In a coming six-level system of information-age health care, patient-consumers may seek what they need in the following order: individual self-care, family and friends, informal self-help networks, the professional as coach, the professional as partner, and the professional as authority.

Adult↗
PubMed2001

Carrying their own medical records: the perspective of pregnant women.

Freedom of information, access to and ownership of medical records are current and controversial issues in Australia. Relating to pregnancy and birth the debate provokes emotional responses and raises important questions about access to information, decision-making, responsibility, power and control. The aim of this qualitative study was to explore the impact on pregnant women of carrying their medical records throughout pregnancy Twenty-one women participated in face-to-face individual interviews, which were coded for thematic analysis. The study found the reaction of women toward carrying their own records to be overwhelmingly positive. Maternal record holding had the potential to improve the level of communication between the health care worker and the pregnant woman and provided a greater sense of sharing and communication within the family The study also established that maternal record holding was of benefit to the woman's partner who was better informed and more involved in the pregnancy All but one of the women who participated favoured carrying their records in subsequent pregnancies. A concern about the potential for losing or misplacing records was not seen in this study, as no women lost their records. A sense of ownership would argue against this possible drawback.

Access to Information↗
PubMed2001

Training in communication skills for informal carers of people suffering from dementia: a cluster randomized clinical trial comparing a therapist led workshop and a booklet.

The objective of the study was to evaluate whether a short training workshop in communication techniques is more effective than an information booklet for improving communication skills in informal carers of people suffering from dementia. 30 informal carers were allocated to the workshop sessions and 15 to the booklet. Outcome measures included awareness of communication strategies; perceived frequency of communication breakdown at home, and the associated level of distress; general stress; and consumer satisfaction. At six week follow-up, the workshop group demonstrated a significantly greater awareness of communication strategies than the booklet-only group. Both groups reported some reduction in the frequency of communication problems at home, and a reduction in the associated level of distress. The frequency of other problem behaviours remained stable. Satisfaction with the workshop indicated that training was helpful but depended on the stage of illness of the partner.

Activities of Daily Living↗
PubMed1997

Dynamics of families during the third trimester of pregnancy in southwest Finland.

Transition to a changed family structure during pregnancy brings into focus the family's dynamics. To describe these dynamics during the third trimester of a healthy pregnancy, the Family Dynamics Measure was administered to 136 mothers and 131 fathers in southwest Finland. Mothers and fathers reported differences in 4 of the 6 dimensions of family dynamics. Clearer communication was perceived by mothers of higher social status. Second-time parents perceived greater isolation and role conflict than first-time parents. Findings contribute cues for specific family guidance by nurses during the transition to parenthood regarding partner differences, parity and social status.

Adolescent↗
PubMed2006

Abnormal social behaviors in young and adult rats neonatally infected with Borna disease virus.

Autism spectrum disorders (ASD) have been the focus of a great deal of research and clinical speculation. This intense interest relates to both the perplexing pathogenesis and devastating consequences of these disorders. One of the obstacles to understanding the pathogenesis of autism and to developing efficient treatment has been the paucity of animal models that could be used for hypotheses-driven mechanistic studies of abnormal brain and behavior development and for the pre-clinical testing novel pharmacological treatments. In this report, we briefly review our animal model of ASD based on neonatal Borna disease virus (BDV) infection and present new data about abnormal social interaction in adult BDV-infected rats. We found that neonatal BDV infection profoundly affected social behaviors in adult rats. Compared to the control rats, both 90- and 180-day-old infected rats spent less time in active social interaction and more time in following their partners. In the intruder-resident test, the BDV-infected resident rats exhibited less aggression towards the intruders and showed more the following-the-intruder behavior. The following-the-partner behavior may be an example of "stereotypic" activity due to BDV-induced abnormal social communication between rats. The previously published results and present findings indicate that neonatal BDV infection significantly altered the normal pattern of social interaction in rats. Co-localization of activated microglia and dying Purkinje cells in BDV-infected rats suggests that the BDV model could be used to study a pathogenic link of Purkinje cell dropout and neuroinflammation to abnormal social behaviors.

Age Factors↗
PubMedDate not supplied

Minimizing disincentives for collaborative research.

While collaborative research partnerships offer a number of advantages, the disincentives to collaboration which are present in the academic environment can be daunting and can result in failure unless they are explicitly and proactively addressed. Based on successful models of collaboration and a review of the literature, four disincentives to collaboration-increased requirements for time and communication, lack of clarity regarding leadership, need to share resources and revenue, and the problem of partners who do not fulfill their commitments-are discussed and strategies to minimize these disincentives are presented.

Cooperative Behavior↗
PubMed2005

A longitudinal assessment of inter-sectoral participation in a community-based diabetes prevention programme.

To understand the development of inter-sectoral participation in the three intervention municipalities of Stockholm Diabetes Prevention Programme (SDPP) case studies with a longitudinal assessment were conducted using the spidergram method, document analysis and group discussions. At three time points, the members of the local steering committees assessed the extent of participation from narrow to wide inter-sectoral participation in five key areas: planning, resources, leadership, network and implementation. Wide participation of various interest groups was recognised in planning and implementing activities whereas local resources, the representation of the leadership and the extent of the network were perceived as more restricted. Expert involvement varied during the programme period but was not regarded as exerting control over the local programmes. Participation within the local steering committees decreased, with a stronger focus on the project co-ordinator and other local partners in latter years. The extent of partner engagement increased due to focusing on activities approaching multi-sector collaboration and institutionalisation. Overall, communication and shared responsibility appeared critical in influencing both the development and perception of participation. In conclusion, to understand the dynamic process of participation at different times, areas and levels, the development and use of evaluation designs combining different methods and information sources throughout the lifespan of a project are recommended.

Communication↗
PubMed2002

Gender, relationship stage, and sexual behavior: the importance of partner emotional investment within specific situations.

This study examined the relationship of type of sexually instigating situation (partner behavior conveying emotional investment or not), relationship stage, and gender to self-reported likelihood of engaging in sexual behavior. Participants (200 female and 122 male college students) read scenarios describing partner behavior in eight hypothetical sexual situations. Five of the sexual situations were proposed to explicitly communicate a sense of emotional investment in the relationship, and three other scenarios were conceived as not explicitly conveying emotional investment. Emotional investment situations were hypothesized to influence likelihood ratings as a function of imagined relationship stage (dating or in a serious relationship), manipulated across participants. Situations not conveying investment were hypothesized to influence ratings as a function of both relationship stage and gender. In large part, hypotheses were confirmed. The few exceptions were consistent with other gender-role considerations related to trust and power.

Adult↗
PubMed1999

Rearranged marriages: marital relationships after head injury.

An in depth study of 18 heterosexual couples investigated the quality of the marital and sexual relationships 1-7 years after the male partner had suffered a severe head injury. Both quantitative and qualitative methods were employed and the focus was on the perspective of the uninjured female partner. The female partners reported both marital and sexual satisfaction as lower following injury. They rated their current marital satisfaction as significantly less than their brain injured partners. The quantitative part of the study revealed major role changes experienced by the women, with many comparing their new role to that of a parent with total decision making responsibility. The incompatibility of this role with that of sexual partner was mentioned by many. A tendency for the males to express gratitude but not to communicate their feelings was described by many women. Most women were resigned to the expectation that there would be little change in the future and, for most, the only positive aspect of the relationship was a sense of commitment and continuing companionship. The implications of the findings for rehabilitation and couple therapy are discussed.

Adaptation, Psychological↗
PubMed1990

Differences in knowledge of and risk factors for AIDS between Hispanic and non-Hispanic women attending an urban family planning clinic.

Risk factors for AIDS, contraceptive use, seroprevalence of HIV, and level of knowledge before and after an AIDS education session were assessed for 657 clients attending a family planning clinic in Los Angeles, USA. History of a partner who was bisexual, an intravenous drug user, or a blood transfusion recipient were the most common risk factors. Spanish speakers reported fewer traditional risk factors than English speakers. They were also less likely to report a history of drug or alcohol use or sexually transmitted diseases, and to have had fewer sexual partners. Less than one-third of the women identified as being at risk of exposure were using condoms. None of 351 consecutive patients tested for HIV antibodies was positive. English speakers scored higher on both pre- and post-tests of knowledge about AIDS. Cultural factors may lower the personal risk of HIV exposure for Spanish-speaking women, but lack of knowledge about AIDS and partner behavior may increase risk.

Acquired Immunodeficiency Syndrome↗
PubMed2005

The emergence of social cognition in three young chimpanzees.

We report a series of 10 studies on the social-cognitive abilities of three young chimpanzees. The studies were all ones previously conducted with human infants. The chimpanzees were 1-5 years of age, had been raised mostly by humans, and were tested mostly directly by a familiar human experimenter. First, in a longitudinal investigation with repeated measurements from a social-cognitive test battery, the three young chimpanzees were similar in many ways to human infants; the major difference was a total lack of attempts to share attention with others either in joint attentional interactions or through declarative gestures. Second, in imitation-based tests of the understanding of intentional action, the chimpanzees, like human infants, showed an understanding of failed attempts and accidents; but they did not pay attention to the behavioral style of the actor or the actor's reasons for choosing a particular behavioral means. Third, in tests of their understanding of visual perception, the chimpanzees followed the gaze direction of a human to an out-of-sight location behind a barrier and gestured more to a human who could see them than to one who could not; but they showed no understanding that perceivers can focus their attention on one thing, or one aspect of a thing, within their perceptual fields for a reason. Finally, in tests of joint intentions and joint attention, the chimpanzees showed no ability to either reverse roles with a partner in a collaborative interaction or to set up a joint attentional framework for understanding the communicative intentions behind a pointing gesture. Taken together, these findings support the idea that the early ontogeny of human social cognition comprises two distinct trajectories, each with its own evolutionary history: one for understanding the basics of goal-directed action and perception, common to all apes, and another for sharing psychological states with others in collaborative acts involving joint intentions and attention, unique to the human species.

Affect↗
PubMed2003

A patient-centred approach to sexuality in the face of life-limiting illness.

Sexuality is intrinsic to a person's sense of self and can be an intimate form of communication that helps relieve suffering and lessens the threat to personhood in the face of life-limiting illness. Health professionals struggle to accept that people with life-limiting illness, especially older people, continue to be sexual beings. People facing life-limiting illness may appreciate the opportunity to discuss issues of sexuality and intimacy with a trusted health professional. Practical strategies to assist health professionals to communicate effectively about sexuality and intimacy include creating a conducive atmosphere, initiating the topic, using open-ended questions and a non-judgmental approach, and avoiding medical jargon.

Aged↗
PubMed2002

Surveillance for waterborne-disease outbreaks--United States, 1999-2000.

PROBLEM/CONDITION: Since 1971, CDC, the U.S. Environmental Protection Agency (EPA), and the Council of State and Territorial Epidemiologists (CSTE) have maintained a collaborative surveillance system for the occurrences and causes of waterborne-disease outbreaks (WBDOs).This surveillance system is the primary source of data concerning the scope and effects of waterborne diseases on persons in the United States. REPORTING PERIOD COVERED: This summary includes data regarding outbreaks occurring during January 1999-December 2000 and previously unreported outbreaks occurring in 1995 and 1997. DESCRIPTION OF THE SYSTEM: The surveillance system includes data for outbreaks associated with drinking water and recreational water. State, territorial, and local public health departments are primarily responsible for detecting and investigating WBDOs and voluntarily reporting them to CDC on a standard form. The unit of analysis for the WBDO surveillance system is an outbreak, not an individual case of a waterborne disease. Two criteria must be met for an event to be defined as a WBDO. First, > or = 2 persons must have experienced a similar illness after either ingestion of drinking water or exposure to water encountered in recreational or occupational settings. This criterion is waived for single cases of laboratory-confirmed primary amebic meningoencephalitis and for single cases of chemical poisoning if water-quality data indicate contamination by the chemical. Second, epidemiologic evidence must implicate water as the probable source of the illness. RESULTS: During 1999-2000, a total of 39 outbreaks associated with drinking water was reported by 25 states. Included among these 39 outbreaks was one outbreak that spanned 10 states. These 39 outbreaks caused illness among an estimated 2,068 persons and were linked to two deaths. The microbe or chemical that caused the outbreak was identified for 22 (56.4%) of the 39 outbreaks; 20 of the 22 identified outbreaks were associated with pathogens, and two were associated with chemical poisoning. Of the 17 outbreaks involving acute gastroenteritis of unknown etiology, one was a suspected chemical poisoning, and the remaining 16 were suspected as having an infectious cause. Twenty-eight (71.8%) of 39 outbreaks were linked to groundwater sources; 18 (64.3%) of these 28 groundwater outbreaks were associated with private or noncommunity wells that were not regulated by EPA. Fifty-nine outbreaks from 23 states were attributed to recreational water exposure and affected an estimated 2,093 persons. Thirty-six (61.0%) of the 59 were outbreaks involving gastroenteritis. The etiologic agent was identified in 30 (83.3%) of 36 outbreaks involving gastroenteritis. Twenty-two (61.1%) of 36 gastroenteritis-related outbreaks were associated with pools or interactive fountains. Four (6.8%) of the 59 recreational water outbreaks were attributed to single cases of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri. All four cases were fatal. Fifteen (25.4%) of the 59 outbreaks were associated with dermatitis; 12 (80.0%) of 15 were associated with hot tubs or pools. In addition, recreational water outbreaks of leptospirosis, Pontiac fever, and chemical keratitis, as well as two outbreaks of leptospirosis and Pontiac fever associated with occupational exposure were also reported to CDC. INTERPRETATION: The proportion of drinking water outbreaks associated with surface water increased from 11.8% during 1997-1998 to 17.9% in 1999-2000. The proportion of outbreaks (28) associated with groundwater sources increased 87% from the previous reporting period (15 outbreaks), and these outbreaks were primarily associated (60.7%) with consumption of untreated groundwater. Recreational water outbreaks involving gastroenteritis doubled (36 outbreaks) from the number of outbreaks reported in the previous reporting period (18 outbreaks). These outbreaks were most frequently associated with Cryptosporidium parvum (68.2%) in treated water venues (e.g., swimming pools or interactive fountains) and by Escherichia coli O157:H7 (21.4%) in freshwater venues. The increase in the number of outbreaks probably reflects improved surveillance and reporting at the local and state level as well as a true increase in the number of WBDOs. PUBLIC HEALTH ACTION: CDC and others have used surveillance data to identify the types of water systems, their deficiencies, and the etiologic agents associated with outbreaks and evaluated current technologies for providing safe drinking water and safe recreational water. Surveillance data are used also to establish research priorities, which can lead to improved water-quality regulations. Only the groundwater systems under the influence of surface water are required to disinfect their water supplies, but EPA is developing a groundwater rule that specifies when corrective action (including disinfection) is required. CDC and EPA are conducting epidemiologic studies to assess the level of waterborne illness attributable to municipal drinking water in nonoutbreak conditions. Rules under development by EPA--the Ground Water Rule (GWR), the Long Term 2 Enhanced Surface Water Treatment Rule (LT2ESWTR), and Stage 2 Disinfection Byproduct Rules (DBPR)--are expected to further protect the public from contaminants and disinfection byproducts in drinking water. Efforts by EPA under the Beaches Environmental Assessment, Closure, and Health (BEACH) program are aimed at reducing the risks for infection attributed to ambient recreational water by strengthening beach standards and testing; providing faster laboratory test methods; predicting pollution; investing in health and methods research; and improving public access to information regarding both the quality of the water at beaches and information concerning health risks associated with swimming in polluted water. EPA's Beach Watch (available at http://www.epa.gov/waterscience/beaches) provides online information regarding water quality at U.S. beaches, local protection programs, and other beach-related programs. CDC partnered with a consortium of local and national pool associations to develop a series of health communication materials for the general public who attend treated recreational water venues and to staff who work at those venues. CDC has also developed a recreational water outbreak investigation toolkit that can be used by public health professionals. All of the CDC materials are accessible at the CDC Healthy Swimming website (http://www.cdc.gov/healthyswimming).

Communicable Diseases↗