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PubMed2003

Recommendations for incorporating human immunodeficiency virus (HIV) prevention into the medical care of persons living with HIV.

The estimated number of annual new human immunodeficiency virus (HIV) infections in the United States has remained at 40,000 for >10 years. Reducing the rate of transmission will require new strategies, including emphasis on prevention of transmission by HIV-infected persons. Medical care providers can affect HIV transmission by screening HIV-infected patients for risk behaviors, communicating prevention messages, discussing sexual and drug-use behaviors, reinforcing changes to safer behavior, referring patients for services such as substance abuse treatment, facilitating partner counseling and referral, and identifying and treating other sexually transmitted diseases. The Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) have recently collaborated to develop evidence-based recommendations for incorporating HIV prevention into the medical care of persons living with HIV. This article summarizes key aspects of the recommendations.

Behavior Therapy↗
PubMed1975

Errors in decoding tone of voice during dyadic interaction.

Predictions derived from evidence on projection, behavioural assimilation and attribution theory suggest differing ways in which one individual may perceive another's tone of voice in dyadic interaction. Pairs of male subjects undertook a competitive or cooperative counting task. One member of each pair was instructed that he could best influence the dyad's performance by the use of an angry or pleased tone of voice. The results indicate that while subjects in the cooperative condition tended to attribute their own tone of voice to their (neutral) partner, competitive subjects attributed a discrepant or neutral tone. The findings are interpreted in terms of attribution theory. Implications for studies of non-verbal communication are discussed.

Adult↗
PubMed2005

Diagnoses of HIV-1 and HIV-2 in England, Wales, and Northern Ireland associated with west Africa.

OBJECTIVES: To describe HIV diagnoses, including those of HIV-2 infection, made in England, Wales, and Northern Ireland (E,W&NI) among those probably infected in west Africa, and to consider whether there is evidence for ongoing heterosexual transmission within the United Kingdom. METHODS: Reports of new HIV diagnoses received at the Communicable Disease Surveillance Centre were analysed. Individuals probably infected in west Africa and those infected through heterosexual intercourse within the United Kingdom by a heterosexual partner infected in west Africa were included. RESULTS: Between 1985 and 2003 inclusive, 1324 individuals diagnosed and reported with HIV had probably been infected in west Africa, with 222 diagnoses made in 2003. 917 (69%) were HIV-1 infected and 52 (6%) HIV-2 or HIV-1/HIV-2 co-infected. For 355 (27%) the HIV type was not reported. The proportion of HIV-2 and HIV-1/HIV-2 infections varied by country of infection (p<0.001): ranging from the Gambia (11.7%-15.2%) to Nigeria (0.7%-1.0%). A further 130 individuals were probably infected through heterosexual intercourse within the United Kingdom by a heterosexual partner infected in west Africa. 89 (68%) were HIV-1 infected and three (2%) HIV-2 infected or HIV-1/HIV-2 co-infected. For 38 (29%) HIV type was not reported. CONCLUSION: The number of people infected with HIV in west Africa and diagnosed in E,W&NI has increased in recent years, and there is evidence of heterosexual transmission within the United Kingdom from people infected in west Africa. While numbers of HIV-2 diagnoses remain relatively low, an appreciable proportion of people infected in some west African countries and diagnosed in the United Kingdom may be HIV-2 positive, with implications for prognosis and treatment.

Adolescent↗
PubMed2005

Conceptual modeling for adaptive environmental assessment and management in the Barycz Valley, lower Silesia, Poland.

The complexity of interactions in socio-ecological systems makes it very difficult to plan and implement policies successfully. Traditional environmental management and assessment techniques produce unsatisfactory results because they often ignore facets of system structure that underlie complexity: delays, feedbacks, and non-linearities. Assuming that causes are linked in a linear chain, they concentrate on technological developments ("hard path") as the only solutions to environmental problems. Adaptive Management is recognized as a promising alternative approach directly addressing links between social and ecological systems and involving stakeholders in the analysis and decision process. This "soft path" requires special tools to facilitate collaboration between "experts" and stakeholders in analyzing complex situations and prioritizing policies and actions. We have applied conceptual modeling to increase communication, understanding and commitment in the project of seven NGOs "Sustainable Regional Development in the Odra Catchment". The main goal was to help our NGO partners to facilitate their efforts related to developing sustainable policies and practices to respond to large-scale challenges (EU accession, global changes in climate and economy) to their natural, economic and socio-cultural heritages. Among the variety of sustainability issues explored by these NGOs, two (extensive agricultural practices and "green" local products) were examined by using Adaptive Management (AM) as a framework that would link analysis, discussion, research, actions and monitoring. Within the AM framework the project coordinators used tools of systems analysis (Mental Model Mapping) to facilitate discussions in which NGO professionals and local stakeholders could graphically diagram and study their understanding of what factors interacted and how they affect the region's sustainability. These discussions produced larger-scale Regional Sustainability Models as well as more detailed sub-models of particular factors, processes, and feedback loops that appear critical to a sustainable future. The Regional Sustainability Model was used to identify a subset of key interacting factors (variables). For each variable, several sustainability indicators were suggested. The growing understanding and acceptance of the AM framework and systems analysis created a momentum both locally and within the region, which makes continued successful use of these indicators quite likely. In contrast to expert-driven projects that inject outside knowledge into a local context, this project established a broad basis for stakeholder-driven discussion that is articulated into goals, objectives, conceptual models, and indicators. The ability to learn and adapt in the AM framework increases the capacity to innovate and find policies and practices that enhance resilience and sustainability in a world in transition.

Agriculture↗
PubMed2001

Contraceptive risk-taking in women and men facing legal abortion.

OBJECTIVE: The aim of the study was to gain knowledge about contraceptive use, reproductive risk-taking and sexuality in Swedish women seeking abortion and their partners. METHODS: Two hundred and eleven women and 75 men answered a questionnaire before the abortion. The data have been divided into six subgroups: women with and without previous experience of abortion, single women and women with a partner relationship, and women whose partner participated in the study and the male partners. RESULTS: The main findings showed that there are more similarities than differences between the subgroups. Overall, there were no differences regarding use of contraceptives, sexual life and psychosocial characteristics. However, women with previous abortion experience were found to be older, had longer partner relationships and more often had children. Some gender differences were also found, i.e. women favored coitus-dependent contraceptives to a larger extent and took more responsibility for preventing unwanted pregnancies. At the time of conception, half the participants had not used any contraceptive methods and one-fifth had relied on 'natural family planning'. The most common reasons for not using contraceptives were related to risk-taking and/or to strong sexual desire. Twelve per cent of the women had felt pressure/threat from their partner in connection with the conception. CONCLUSION: In efforts to prevent undesired pregnancies, this study highlights the need to incorporate a gender perspective both in communication about risk-taking and in counselling about contraceptives.

Abortion, Legal↗
PubMed2003

Internet use and early syphilis infection among men who have sex with men--San Francisco, California, 1999-2003.

During the summer of 1999, an outbreak of early syphilis among men who have sex with men (MSM) who met their sex partners on the Internet presaged a rapidly expanding syphilis epidemic in San Francisco. By 2002, San Francisco had the highest rates of primary and secondary syphilis of any metropolitan area in the United States. During 1998-2002, the number of early syphilis cases increased, from 41 cases in 1998 to 495 cases in 2002. Concomitant with the increase in early syphilis was an increase in the proportion of cases among MSM, from 22% in 1998 to 88% in 2002. To assess the association between early syphilis infection and use of the Internet by MSM to meet sex partners, the San Francisco Department of Public Health (SFDPH) analyzed surveillance data and case reports. This report summarizes the results of that analysis, which suggest that public health officials might find the Internet to be an important tool for 1) promoting disease awareness, prevention, and control and 2) accessing sex partners of syphilis patients to conduct appropriate partner notification, evaluation, and management. The findings underscore the need for public health officials to understand the role of the Internet in facilitating the spread of sexually transmitted diseases (STDs), including the human immunodeficiency virus (HIV). With the assistance of community partners, other jurisdictions can examine the online social/sexual networks that are used commonly in their gay and bisexual communities and develop an effective means of communicating prevention and control messages online.

Adult↗
PubMed1992

Transactions in the family of the schizophrenic.

According to a large exemplification derived by the clinical practice, the relation between the schizophrenic's parents shows a concealed symmetry, that never escalates, but implies an endless excitement, that reassures the couple of their mutual consensus. As result, inhibition and inconclusiveness cause a loss of spontaneity and a reciprocal stereotyped characterization, connivingly accepted by both partners. Either a substitution without proxy or a swindle of one spouse by the other occurs in vital areas of their relation. The spouse's communication shows a continuous reciprocal attempt not to define their own relation, by the use of a wide wordiness, that includes different subjects and meanings in a confusive and spiral-shaped sequence. Such a kind of relation is assumed as originated by a massy influence of at least one spouse's family, that stops the couple at early stages of their relation.

Adult↗
PubMed1983

[Authority between discourse and consultation].

Since the turn of the century the practice of general upbringing has been shaken by a number of authority crises. In this field a new way is currently being paved in the comprehension of education in which the authoritative powers are limited to two directions: on one hand to discussion (discourse) between equal partners and on the other hand in counselling that neither binds nor obliges. Authority lies between discussion and counselling: it must materialize as a social, communicative and identity-promoting competent form of action.

Authoritarianism↗
PubMed2006

Since 911, where has the urgency gone? Are we really prepared?

From Are We Really Prepared?--Part I in CARING's last issue, it was determined that all agencies have updated their emergency preparedness plans. However, Universal ID Cards for home health care workers do not exist at this time. The study also revealed that most agencies have not increased inter-agency cooperation. In Part II of this study, we learned that some agencies have improved their communication capabilities whereas others remain limited in their attempts to upgrade to this recommendation. Transportation issues during an emergency/disaster situation continue to be a major area of concern for all homecare providers. The agencies that appeared to be best prepared for an emergency were the larger home care providers with the most resources, both technical and financial. While the larger agencies still remain vulnerable in an emergency situation, the smaller, less technically and financially equipped agencies would benefit from partnering with the larger home care companies. Critical to any emergency preparedness and response endeavor is the capacity to maintain or re-establish a "command operations center", and to insure the ability of essential employees to communicate with each other in an attempt to direct or redirect caregivers to their highest priority patients. Engaging the assistance of patients' families, significant others, and emergency contacts is crucial in our endeavor to be prepared for all emergency and catastrophic events. In addition, because the transportation infrastructure, power grid and communication network all continue to be susceptible to failure, insuring that critical personnel (especially direct care workers) have a personal family emergency back-up plan in place increases the likelihood of successfully responding to an emergency or disaster, and fulfilling the central mission of the home care provider--maintaining continuity of services to all patients. Considering governmental failures in responding to the hurricanes in Florida and the Gulf Coast, it becomes paramount for every individual to develop contingency plans for any and all emergency/disaster events.

Disaster Planning↗
PubMedDate not supplied

Control of epidemic early syphilis: the results of an intervention campaign using social networks.

BACKGROUND: During an epidemic of early syphilis, social networks were used for an intervention campaign. GOAL OF THIS STUDY: To characterize the epidemic and describe the yield of new cases from index-case interviews. METHODS: Analyses of morbidity data collected by the Montgomery County, Alabama, sexually transmitted disease program determined the course of the epidemic and characterized the new case yields from social networks identified via index-case interviews (partner notification investigations) and interviews with sex partners and their associates (cluster investigations). Results and costs were compared to a noncampaign period. RESULTS: The number of reported syphilis cases nearly doubled from 1990 to 1991 (201 to 348 per 100,000 residents). During the 21-week campaign, 373 case-patients had partner notification/cluster investigations; 113 (11%) of 984 sex partners and 41 (3%) of 1,146 high-risk associates (persons identified during cluster investigations) had syphilis. No subgroup of case-patients for which the partner notification/cluster investigation yielded more infected persons than other subgroups was identified. The cost per case detected was more than twice that during a noncampaign period ($1,627 vs. $771). CONCLUSION: Partner notification investigations yielded more infected persons than cluster investigations. Further evaluation is needed to determine the role of intense partner notification/cluster investigators' efforts in the control of epidemic syphilis.

Adolescent↗
PubMed1998

Adolescent males' combined use of condoms with partners' use of female contraceptive methods.

OBJECTIVE: Protection from both sexually transmitted diseases and pregnancy is best obtained by the combined use of male condoms and effective female contraceptive methods. This research examines dual contraceptive method use among teenage men. METHOD: Analyzed data from the 1995 National Survey of Adolescent Males, a nationally representative survey of 15 to 19-year-old males. Used bivariate analyses and logistic regression to examine the correlates of combined use of condoms and female methods. RESULTS: At last intercourse, 17% of sexually active males reported use of a condom and a female method of contraception. Condom use, alone and in combination with a female method, was positively associated with talking with the partner about contraception and condoms, believing that males have a responsibility for contraception, and being in an earlier stage of a relationship. Only high levels of worry about sexually transmitted diseases differentially influenced dual method use, increasing the likelihood of using a condom with a female method, but not using condoms alone. CONCLUSIONS: The results suggest that efforts to increase condom use in general should also influence young men's use of condoms when their partner is using a female method. Providing information to young males about the high prevalence and serious consequences of sexually transmitted diseases may increase dual method use among adolescents.

Adolescent↗
PubMedDate not supplied

Adhesion-mediated gap junctional communication between lung-metastatatic cancer cells and endothelium.

Adhesion to vascular endothelium is a primary step in the colonization of select target organs by blood-borne cancer cells. Previous studies in our laboratory have shown that adhesion is followed by the establishment of fully functional gap junctional channels between the arrested tumor cell and the endothelium and that gap junctional communication might play an important role in extravasation. Here we report on a critical interdependence between endothelial cell adhesion and communication of lung-metastatic cancer cells. Gap junctions are assembled at focal adhesion contacts between tumor cells and endothelial cells where they mediate metabolic coupling between the junction-forming cell pair. The level of coupling depends on sufficient amounts of connexin43 (cx43) protein expression by both cell partners and, in a rate-limiting fashion, on the expression level of the receptor/ligand pair that mediates adhesion between tumor cells and the endothelium. This conclusion is based on our findings that (a) tumor cells with equal cx43 message, yet different adhesion potential for endothelial cells, differ significantly in their level of communication with the endothelium (e.g., R230AC-MET vs. R3230AC-LR), and (b) gap junctional communication between B16-F10 melanoma cells and lung-matrix-modulated endothelium can be effectively blocked by antiadhesive, anti-Lu-ECAM-1 monoclonal antibody 6D3 and by soluble Lu-ECAM-1. Significantly increased adhesion and communication levels in highly lung-metastatic carcinoma cells imply a role of gap junctional coupling in cancer metastasis, presumably by facilitating extravasation.

Animals↗
PubMed1975

Sexual counseling with spinal cord-injured clients.

Spinal cord-injured clients have many fears and misapprehension about their sexual functioning. Common beliefs include: (a) disabled men cannot sexually satisfy able-bodied women; and (b) cord-injured persons cannot have sexual intercourse. Such misapprehensions can be helped by the counselor's willingness to discuss sexual issues openly. Clients need a clear and accurate picture of the facts, as well as encouragement and support to help them rediscover their sexuality. Spinal cord injury does not mean sexual incapacity. Given a knowing and patient partner, most clients can enjoy a satisfying sex life.

Attitude of Health Personnel↗
PubMed2006

Sexual risk reduction interventions do not inadvertently increase the overall frequency of sexual behavior: a meta-analysis of 174 studies with 116,735 participants.

A meta-analytic review of the influence of HIV risk reduction interventions on sexual occasions, number of partners, and abstinence was conducted to assess whether condom-related interventions inadvertently undermine sexual risk reduction efforts by increasing the frequency of sexual behavior. Included studies examined sexual risk reduction strategies and used a controlled design. Data from 174 studies (206 interventions, N = 116,735 participants) were included. In general, HIV risk reduction interventions neither increased nor decreased sexual occasions or number of partners reported. Participants in intervention conditions were less likely to be sexually active than those in control conditions. When samples included more black participants, interventions reduced the number of sexual occasions; interventions were more successful at reducing the number of partners in samples that included more men who have sex with men (MSM) or individuals engaged in sex trading. Samples that included more MSM were more likely to adopt abstinence as a risk reduction strategy. Interventions that included more information, motivational enhancement, and skills training also led to greater risk reduction. HIV risk reduction interventions do not increase the overall frequency of sexual activity. To the contrary, for some subgroups, interventions that include components recommended by behavioral science theory reduce the frequency of sexual events and partners.

Adult↗
PubMed1999

Prevention of sexually transmitted diseases. A model for overcoming barriers between managed care and public health. The IOM Workshop on the Role of Health Plans in STD Prevention.

CONTEXT: The growth of managed care has spurred re-evaluation of the roles and responsibilities of public health agencies and private health plans for providing public health services. Although rates of curable sexually transmitted diseases (STDs) in the United States are the highest in the developed world, many clinicians and managed care organizations are not systematically providing high-quality, comprehensive STD-related services to their patients and the community. OBJECTIVE: To examine issues around managed care and STD prevention as a model for overcoming barriers that impede managed care organizations from providing comprehensive public health services and collaborating with health agencies. SETTING: Two-day invitational workshop. PARTICIPANTS: Representatives from 18 health plans, 10 public health agencies, 6 academic institutions, 1 purchasing coalition, and 5 other health organizations. RESULTS: Major obstacles include: turnover and heterogeneity in the health care system; deficiencies in clinical knowledge and skills; differences in organizational culture and language; low priority of STDs; inadequate public health surveillance data and performance measures; confidentiality concerns; and lack of coverage for sex partners. CONCLUSIONS: Potential approaches for addressing these barriers include: requiring that STD-related services be covered by Medicaid managed care programs; implementing performance measures; requiring collaborative activities; promoting education of and outreach to stakeholders; funding of pilot projects; and researching the cost-benefit and cost-effectiveness of STD-related services for various populations.

Communication↗