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Australian women's needs and preferences for information about human papillomavirus in cervical screening.

OBJECTIVE: The role of human papillomavirus (HPV) in cervical cancer and developments in medical technology to prevent cervical cancer has changed information needs for women participating in cervical screening. DESIGN: Qualitative face-to-face interviews were conducted with 19 women diagnosed with HPV infection on their Pap smear following routine cervical screening. SETTING: Family planning clinics, general practice and specialist gynaecologist practices in Sydney and the surrounding area, Australia. MAIN OUTCOME MEASURES: Women's information needs, preferences and experiences of HPV diagnosis. RESULTS: Women wanted further information on different HPV viral types, transmission, implications for sexual partners, prevalence, latency and regression of HPV, their management options and the implications of infection for cancer risk and fertility. Uncertainty about the key aspects of HPV, the style in which the clinician communicated the result and the mode of delivering the result (letter, telephone or consultation) influenced women's psychological response to the diagnosis of HPV. The delivery of results by letter alone was linked to considerable anxiety among the women interviewed. Women's experience of searching the Internet for further information about HPV was reported as difficult, anxiety provoking and contributing to the stigma of the infection because information was often located in the context of other sexually transmitted infections, with multiple sexual partners highlighted as a risk factor for infection. CONCLUSION: Women participating in cervical screening need high-quality information about HPV and its role in cervical cancer prior to screening rather than afterwards, when they face an abnormal result. The clinician potentially plays an important role in moderating the effects of diagnosis through the manner and mode in which an HPV diagnosis is delivered. Revision of cervical screening policy and practice in light of the changes in the understanding of HPV is recommended.

Adult↗

On intersubjective engagement in autism: a controlled study of nonverbal aspects of conversation.

Does autism involve a deficit in intersubjective engagement with other persons? We studied nonverbal communication in children and adolescents with and without autism (n = 12 per group), group-matched for chronological age and verbal mental age, during 3 min of a videotaped interview. In keeping with previous studies, there were only subtle but potentially revealing group differences on behavioral ratings. Participants with autism made fewer head-shakes/nods (but not smiles) when the interviewer was talking, and the interviewer made fewer head-shakes/nods when participants were talking. Yet there were marked group differences on reliable 'subjective' ratings of (a) affective engagement and (b) the smoothness of reciprocal interaction. We interpret the findings in terms of a group difference in identification between conversational partners.

Adolescent↗

Facilitating inter-spousal communication for birth spacing--a feasibility study of Pakistani couples for policy implications.

OBJECTIVE: To test three practices introduced to couples for adaptation of a non-permanent modern method of family planning and the role that each partner played during the process. SETTING: Urban and sub-urban areas of Karachi, Lahore, and Quetta. METHODS: 'Behavioral trials' was conducted which is a formative research method in which researcher and participants negotiate behavior(s) that the participant agrees to try for a specific amount of time. Interviews were conducted on 72 married couples (144 men and women) living in urban and sub-urban areas of Karachi, Lahore and Quetta. Study participants were either non-users of modern methods of family panning, or using traditional methods. The three behaviors negotiated were: a) Discuss benefits of birth spacing with spouse; b) discuss specific methods of family planning and decide on the most appropriate one and c) initiate use of a modern temporary method of family planning. RESULTS: After the introduction of first practice, of 72 couples 38 reported failure to initiate the discussion with their spouse. Where women initiated the discussion the response from spouse was not as favorable as where men initiated the discussion. After introduction of second practice 28 couples were successful in discussing about selection of a family planning method. Twenty-four couples finally selected and used a method. Traditional users were more likely to adopt a modern method than non-users, especially those with 3-5 children. CONCLUSION: Strategies to cultivate a culture of inter-spousal communication on use of family planning methods should be developed as a component of family planning programs.

Adult↗

Conversation, co-ordination and convention: an empirical investigation of how groups establish linguistic conventions.

Two experiments are reported which demonstrate the development of co-ordinated description languages in two groups of communicators playing Garrod and Anderson's (1987) maze game. The experiments contrast language co-ordination between speakers who always interact with the same partner (isolated pairs) as compared with speakers who interact with different partners drawn from the same community. Whereas the isolated pairs show higher degrees of inter-speaker convergence than the community pairs at the start of the experiment, the situation reverses by the time they have all played six or more games. The results are discussed at two levels: (1) in terms of Lewis's formal theory of conventions, and (2) in relation to a language processing model which abides by the "output/input co-ordination" principle proposed in Garrod and Anderson (1987).

Group Processes↗

Positioning for partnerships. Assessing public health agency readiness.

BACKGROUND: Public health organizations are redefining their roles and aligning their structures with other components of the evolving American health system. Health departments must proactively and strategically plan how to position themselves for the coming years. Prior to implementing changes in functioning, structure, and/or future strategies, an organization should assess its internal readiness to commit to creating these substantial alterations. METHODS: Using a diagnostic tool developed by study investigators, employees of the Cobb and Douglas Counties Boards of Health were surveyed in order to assess their organizational readiness to enter into a strategic partnership with Promina Northwest, a not-for-profit hospital network in the Atlanta, Georgia area. Frequency distributions were conducted for each categorical variable and data were analyzed in aggregate and by job category. RESULTS: The 122 analyzed questionnaires revealed some significant trends. Respondents ranked the six factors having the greatest impact on an organization's ability to change in the following order: leadership, planning, teamwork, mission, information and operations. Interestingly, this rank ordering parallels the perceived strengths and weaknesses of the health departments as determined by the frequency of the most positive responses. CONCLUSION: Cobb and Douglas Counties Boards of Health have taken many key steps to prepare the organizations for significant proactive changes. Survey results emphasized the need for open channels of communication within the organizations and with the external environment so that effective planning can guide the strategic alignment of the health departments with community partners.

Community Health Planning↗

Injecting reason.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗

Direct monitoring of metal ion transfer between two trafficking proteins.

To avoid the toxic effects of both essential and nonessential metal ions, cells elaborate a variety of metal ion trafficking proteins that regulate metal ion mobility. While structures of several trafficking proteins have been determined, kinetic characterization of metal ion transfer between cognate protein partners and the factors controlling transfer has lagged behind, in part due to a limitation on methods to monitor the rapid transfer. In this Communication we report studies on the kinetics of Hg2+ transfer between separately expressed components of the flavoenzyme mercuric ion reductase (MerA) that take advantage of the sensitivity of the flavin fluorescence to the charge state of a cysteine thiol in the Hg2+ binding pathway. The thiolate form of C558 in the Tn501 MerA partially quenches the fluorescence of the oxidized enzyme. Protonation or binding of Hg2+ to the thiolate increases the fluorescence, providing a sensitive probe for kinetic analysis of the Hg2+ binding reaction. The kinetics of Hg2+ transfer in both directions between the cysteine pair of the separately expressed N-terminal domain and the C-terminal cysteines (C558, C559) of the catalytic core are presented, along with a model describing the overall process.

Kinetics↗

Evolutionary origins of stigmatization: the functions of social exclusion.

A reconceptualization of stigma is presented that changes the emphasis from the devaluation of an individual's identity to the process by which individuals who satisfy certain criteria come to be excluded from various kinds of social interactions. The authors propose that phenomena currently placed under the general rubric of stigma involve a set of distinct psychological systems designed by natural selection to solve specific problems associated with sociality. In particular, the authors suggest that human beings possess cognitive adaptations designed to cause them to avoid poor social exchange partners, join cooperative groups (for purposes of between-group competition and exploitation), and avoid contact with those who are differentially likely to carry communicable pathogens. The evolutionary view contributes to the current conceptualization of stigma by providing an account of the ultimate function of stigmatization and helping to explain its consensual nature.

Adaptation, Psychological↗

Using success stories to share knowledge and lessons learned in health promotion.

BACKGROUND: Compelling success stories, rich with details about real-life events and people, are a tool that health agencies can use to convey how their health promotion programs work, why they are successful, what lessons they have learned, and how others can launch similar programs. Success stories describe project accomplishments that are not easily captured by quantitative evaluation methods, such as surveys. METHODS: Although success stories have not been widely used in public health, the North Carolina Department of Health and Human Services developed a series of stories, the Community Change Chronicles, to highlight environmental and policy changes that promote cardiovascular health. In 2003, the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program used the Community Change Chronicles as a model to develop success stories about WISEWOMAN projects. RESULTS: WISEWOMAN Works: A Collection of Success Stories from Program Inception Through 2002 includes 12 stories and offers advice on how to create and use success stories in public health. This paper reviews the rationale for developing the stories, presents one success story as an example, and describes the process used to gather information, write the stories, and produce a resource for others interested in developing success stories. We also discuss how the WISEWOMAN success stories are being used to promote women's health and cardiovascular health. CONCLUSIONS: As the WISEWOMAN experience suggests, healthcare providers and organizations can use success stories to gain support for successful activities, inform the public about program benefits, complement other quantitative and qualitative evaluation methods, and publicly acknowledge the contributions of staff and organizational partners.

Alaska↗

Women's experiences after a third-degree obstetric anal sphincter tear: a qualitative study.

BACKGROUND: Little qualitative data are available that address the experiences of women who sustain a third-degree obstetric anal sphincter tear during childbirth. The objective of this study was to explore the views and experiences of women in the postpartum period after sustaining a third-degree obstetric anal sphincter tear. METHODS: A qualitative study was conducted using focus groups in a large maternity hospital in the United Kingdom. Two focus groups used a purposive sample of women who had suffered a third-degree tear. One group (n = 6) had a tear in the index pregnancy and the second group (n = 4) had a subsequent pregnancy after the tear. RESULTS: The main themes identified included apprehension about consequences of the injury in terms of continence; body image and sexual functioning; anxiety about and lack of involvement in planning for future pregnancies; poor information exchange and communication (including both content and timing of discussions); poor emotional support from professionals and family members; physical and emotional impact; and unresolved anxieties in partners. Similarities occurred across both groups. CONCLUSIONS: A third-degree tear causes a significant emotional and psychological impact on women's physical and emotional well-being. We recommend that all staff receive adequate training to deal with the issues that may be raised. The provision of a dedicated, multidisciplinary team involved at an early stage to coordinate the repair and follow-up is recommended to allow a sensitive, consistent, evidence-based approach, particularly in terms of decision-making for subsequent births. The experiences and needs of partners require further study.

Adult↗

A system of medical error disclosure.

External mandates for medical error disclosure are often justified by potential cost savings, the belief in individual moral obligations in health care, and the concept that patients have rights and providers have responsibilities. Such an approach does not recognise the systems nature of error and outcomes and the important quality role disclosure can play in a system of medical error disclosure. Systems concepts, the patient-provider partnership, and overall quality of care can be enhanced using a system of disclosure that provides for education about the systems nature of error, fulfills the delivery system philosophy of mutual respect, and integrates the patient and his/her family as a partner in the error reduction enterprise. Such a system can result using clear disclosure policies and procedures sensitive to patient and family needs, open communications with concerned, committed, and compassionate system representatives, and use of mediation methods that foster communication, allow for venting, and are flexible in their approach to resolving conflict, including using apology. Although a system may also result in conflict resolution costs, more importantly it may foster and solidify a team approach to reducing errors and promoting patient safety.

Humans↗

Increasing use of the female condom through video instruction.

The female condom is effective in preventing sexually transmitted diseases and when used properly reduces risk of HIV infection among women. This field experiment evaluated the effect of a video presentation on reported use of and satisfaction with the female condom. Participants were 100 women tested for HIV infection in a community agency. Ages ranged from 17 to 62 years, and one fifth of the sample were African American or Hispanic. The 23 women who viewed an instructional video were significantly more likely than 13 of the control group of 50 to try the condom and report to the researcher. Video viewing was unrelated to liking the product and future intent to use. Almost three quarters of those who used the condoms reported they liked and would use them.

Adolescent↗

[Effects of conversation act on conversation strategy and interpersonal cognition].

It is assumed that dyadic conversation proceed according to some of each participants' conversation strategies. The strategies are as follows; 1) Receptivity, 2) Emotional expressivity, 3) Cognitive expressivity, 4) Partner comprehension, 5) Contingent comprehension, 6) Self-assertivity. In this experiment, strategies and interpersonal cognition were manipulated by three factors, (1) partners' conversation acts, with high or low expressivity rule, and (2) high or low act of conversation performance rule, and (3) nature of topica. One hundred and twenty-eight undergraduates are asked to rate their level of intention to select a strategy, in a given conversation situation. The results are as follows: 1) Both cognition of conversational purpose for a given situation and partners' expressivity influenced on their conversation strategy, 2) correspondence of strategy prompt participants to active conversation, 3) partners' conversation acts influenced on interpersonal cognition in any situations, 4) social desirabililty in interpersonal cognition is influenced by both strategy and topic, 5) partners' strategy makes participants select different interaction in the subsequent conversation situation.

Adult↗

Defining a new term.

Organizations are using extranets to engage in electronic commerce with trading partners. But the definitions of what constitute an extranet vary widely.

Commerce↗

Partnering for employee health care.

Employee and retiree health care is no longer a fringe benefit. The issue of who pays what share of this growing expenditure is explosively divisive between employers and employees as well as payors and providers. And what appears to be lost in this debate--and the one point that employers, employees and providers will undoubtedly agree on--is that having one's health and a healthy work force is what really matters. If a partnership can be forged to achieve this basic outcome, the incentives for controlling the cost of health care can be put into place for the partners. HR professionals can help their companies by developing a partnering strategy to effectively address the issue of employee health.

Communication↗