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PubMedDate not supplied

Important aspects of health care for women with gynecologic cancer.

PURPOSE/OBJECTIVES: To describe what women diagnosed with primary gynecologic cancer reported to be important during their interaction with the healthcare system. DESIGN: Qualitative. SETTING: A specialized gynecologic cancer care unit in central Sweden. SAMPLE: 14 women diagnosed with primary gynecologic cancer were recruited. The women had been referred to the specialized care unit for radiation or cytostatic therapy. METHODS: Tape-recorded interviews were transcribed, coded, categorized, and analyzed. MAIN RESEARCH VARIABLES: Primary diagnosed women with cancer and their experience with quality of care during diagnosis and treatment. FINDINGS: Three partly overlapping categories (i.e., optimal care, good communication, and self-image and sexuality) were found to be of central importance in quality of health care. Participants stated that health care should be based on their own perceptions of the need for information and dialogue and how the disease and treatment would affect their health, self-image, and sexuality. Everyday conversations also were very important. CONCLUSIONS: Central importance in health care for the women included both rational and human aspects. The primary need of participants was to achieve a rapid cure, which necessitated health care that was available, competent, and coordinated. IMPLICATIONS FOR NURSING: Women with gynecologic cancer should be given individualized information and care to satisfy their individual needs and reinforce their self-image. Nurses have an important role in strengthening women's feelings of hope and supporting them in maintaining as positive a self-image as possible. Information and everyday conversation are of great significance. Sexuality should be an integral part of holistic care; to this end, inclusion of each woman's sexual partner may be helpful when discussions concerning sexuality occur.

Adult↗
PubMed2000

Modeling intervention efficacy for high-risk women. The WINGS Project.

This study evaluates the effectiveness of two strategies--communication and condom skills training--for increasing condom-protected sex in a sample of 510 high-risk women ages 17 to 61. Baseline and 3- and 6-month postintervention interview data were gathered in three cities participating in a randomized trial of a six-session, group skill-building intervention. This analysis was conducted for the entire sample and for six subgroups categorized by age, single or multiple partners, and history of childhood sexual abuse. The dependent variable was the odds ratio of protected sex acts at each follow-up. Structural equation modeling was used to estimate effects for two intervention pathways. The pathway through condom skills increased the odds of protected sex for the intervention group (chi 2 difference = 35, df = 2, p < .05) as well as for all subgroups. The pathways through communication were significant for the intervention group (chi 2 difference = 23, df = 3, p < .05) but fully effective only for participants under 30 and participants who reported childhood sexual abuse. The effectiveness of both pathways diminished at 6 months. WINGS demonstrates that condom skills training can increase protected sex for a heterogeneous group of women. Further research needs to examine how such skill training translates into use of condoms by male partners. To increase the duration of intervention effects, booster sessions may need to be incorporated.

Adolescent↗
PubMedDate not supplied

Contact tracing for human immunodeficiency virus (HIV) infection.

Contact tracing--or partner notification--is a generally accepted method for the control of sexually transmitted diseases (STDs), but its use as an epidemiological tool against the spread of acquired immunodeficiency syndrome (AIDS) has been questioned. The authors find contact tracing for infection with human immunodeficiency virus (HIV) quite feasible; it makes it possible for health care providers to reach people at high risk for infection in order to offer them counseling and testing. Contact tracing must be performed by someone directly engaged in caring for the HIV infected patient, as well as in giving support and aiding the patient through possible crisis reactions. Through this approach the authors were able to identify 188 contacts to 91 index patients. Thirty-eight of the contacts were seropositive for HIV infection, and 21 of these were previously unaware of their infection.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Developing a culturally appropriate video to promote dual-method use by urban teens: rationale and methodology.

This article describes the development and production of a video targeted to urban adolescent women who use hormonal contraception. Research has shown that this population is at high risk for nonuse of condoms. Extensive preliminary qualitative and quantitative studies were done to understand the situations in which young women do and do not ask their partners to use a condom. Combining constructs from the health belief model, social cognitive learning theory and the theory of reasoned action with insights gleaned from the preliminary studies, the researchers developed a video that features two young HIV-positive women and two young HIV-negative men. Focus groups with young women helped the researchers edit the video to its current length of 21 minutes. Responses from the focus groups suggest that the video has a strong impact on young women. The video is currently part of a randomized controlled trial of two HIV prevention interventions.

Adolescent↗
PubMed2006

Surveying acute care providers in the U.S. to explore the impact of HIT on the role of nurses and interdisciplinary communication in acute care settings.

In 2005, the Healthcare Information and Management Systems Society's Nursing Informatics Task Force surveyed acute care providers across the United States to explore the impact of health information technology on the role of nurses and interdisciplinary communication in acute care settings. More than 1,700 healthcare professionals responded to the online survey and provided numerous insights into the impact that clinical information systems have in their daily communication and workflow patterns. This paper provides an overview of survey results from four large healthcare delivery systems with a focus on how the results will be employed to support an evidence-based approach to improving acute care IT systems across the following healthcare delivery systems: Partners and Lifespan Health Systems in the Northeast, Baptist Health South Florida in the Southeast, and Providence HealthSystem in the Northwest.A case study approach is employed to describe survey findings at the healthcare system level and then provide a set of recommendations to leverage findings to capitalize on the strengths of existing IT applications and tools, and work towards overcoming barriers to interdisciplinary communication or acute care workflows.

Acute Disease↗
PubMed1996

Specific muscle contacts induce increased transmitter release and neuritic arborization in motoneuronal cultures.

Identified buccal motoneuron 19 (B19), isolated from the nervous system of Helisoma and plated into cell culture, is selective in synapse formation and requires contact with appropriate muscle targets before acquiring secretory competence. Action potential-regulated transmitter release was elevated specifically at neuritic arbors in contact with appropriate muscle fibers. In contrast, contact between B19 and inappropriate muscle targets failed to induce changes in presynaptic secretory properties. Spontaneous transmitter release rate was elevated globally across neuritic arbors of B19 in appropriate muscle cocultures, including arbors without direct muscle contact. In addition, dual contacts formed between B19 and two different muscle targets resulted in significant elevations in excitation-secretion coupling only at neuritic sites of appropriate muscle contact and not at sites of contact with mismatched targets. Image analyses of presynaptic neuronal architecture revealed that appropriate, but not novel, muscle targets elicited increased arborization of neurites at sites of neuron-muscle contact. In contrast to results with neuron B19, secretory properties of buccal neuron 5 (B5), a neuron capable of forming inappropriate chemical synapses with a number of novel targets in culture, were not enhanced by inappropriate muscle contact. We conclude that muscle targets vary in their ability to induce presynaptic modifications (e.g., excitation-secretion coupling, spontaneous transmitter release, and neuritic arborization) in identified motoneurons of Helisoma. These results imply that separate molecular pathways exist which control each of these events during synaptic differentiation. The differential potency of muscle targets for induction of presynaptic changes indicates the existence of a cellular mechanism of target recognition. We hypothesize that such a mechanism underlies the ability of neuron B19 to discriminate between potential postsynaptic partners in cell culture.

Analysis of Variance↗
PubMed1994

Vasopressin and serotonin interactions in the control of agonistic behavior.

In hamsters, dominant/subordinate relationships are initially determined by overt aggression, but subsequently communicated by flank marking, an arginine vasopressin (AVP)-dependent behavior. Once a relationship is established, dominant males will flank mark at a higher frequency than their subordinate partners. Flank marking displayed during social encounters can be turned "on or off" by microinjection of AVP or AVP-receptor antagonist within the anterior hypothalamus (AH). For instance, microinjecting dominant hamsters with AVP-receptor antagonist blocks their flank marking and provokes an immediate induction of flank marking by subordinate animals. The central effects of AVP have been extended to include a role in offensive aggression. Microinjection of AVP-receptor antagonist into the AH inhibits the aggression of a resident hamster toward an intruder and diminishes aggression between hamsters placed into a neutral arena. Microinjection of AVP into the ventrolateral hypothalamus (VLH) facilitates offensive aggression of a resident toward an intruder. As AVP receptors in the VLH are testosterone-dependent, it is possible that the reduction of aggression observed in castrated hamsters is due to a loss of AVP responsiveness in the VLH. Recent work has focused on the notion that serotonin (5-HT) antagonizes AVP activity in the CNS. The AH and VLH have a high density of 5-HT terminals and binding sites. Indeed, there appear to be 5-HT synapses on AVP neurons in the AH. Microinjection of 5-HT into the AH inhibits AVP-induced flank marking while IP injection of fluoxetine a serotonin reuptake inhibitor inhibits AVP-induced offensive aggression in the VLH. It is possible that serotonin interacts with AVP to modulate offensive aggression.

Aggression↗
PubMedDate not supplied

Effects of different social partners on the discriminated requesting of a young child with autism and severe language delays.

We examined the effects of two adult social partners on the requesting repertoire of a young child with autism and severe language delays. We used a multiple-schedule design (Kazdin, 1982) to evaluate the request topography that the participant emitted relative to each social partner's contingent differential reinforcement for specific requesting forms. The contingencies associated with each adult were reversed after the participant reached a preestablished criterion of discriminated responding. The participant learned to request in a discriminated manner in the presence of each social partner. Implications of these results are discussed.

Autistic Disorder↗
PubMed1992

Self-fulfilling effects of stigmatizing information on children's social interactions.

The stigmatizing effects of negative expectancies were examined in observations of interactions between children with and without a behavior problem. Ss were 68 pairs of unacquainted boys in Grades 3-6. In each dyad, a normal boy was either told that his partner had a behavior problem or given no expectancy; this expectancy manipulation was crossed with the partner's actual diagnostic status with respect to hyperactivity. The perceivers' expectancy that their partner had a behavior problem as well as the actual diagnostic status of the target adversely affected the boys' interactions. Behavioral data suggest how the expectancies were communicated to the target. The processes underlying interpersonal expectancy effects and the ways in which a childhood stigma can act as a self-fulfilling prophecy are discussed.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

The ability of children with specific language impairment to access and participate in an ongoing interaction.

This study investigated the ability of 6 children with specific language impairment (SLI), ages 8;10 to 12;5 (years; months), to enter and participate in an ongoing dyadic interaction. Performance was compared to that of 6 chronological age-matched (CA) peers and 6 language-similar (LS) peers. All children in the LS and CA groups successfully accessed the interaction, and most did so quickly. Two children from the SLI group did not access, and the 4 remaining subjects required varying amounts of time to access. Following successful access, the triadic interactions of subjects were examined. The accessing children with SLI talked significantly less, were addressed significantly less, and collaborated less than either of the partners within their triads. Few significant differences were observed between LS or CA children and their partners.

Child↗
PubMed1991

Negative modes of relating, marital quality and depression.

Young married couples, with or without a depressed wife, were divided into three groups according to marital quality. Negative modes of relating were assessed by self-rating and partner-rating questionnaires. The intercorrelation of scores for different modes of relating was higher on partner-rating than on self-rating scales. There was a significant gradient of mean negative-relating scores across the three levels of marital quality. The partner-ratings of depressives and their husbands were higher on all negative-relating scales than those of non-depressed women and their husbands. The self-ratings of the depressives corresponded with these negative ratings while those of their husbands did not. The partner-rating scores differentiated between the depressives with poor marriages and those with better marriages.

Adult↗
PubMed2006

Analysis of complex physiological systems by information flow: a time scale-specific complexity assessment.

In the last two decades conventional linear methods for biosignal analysis have been substantially extended by non-stationary, non-linear, and complexity approaches. So far, complexity is usually assessed with regard to one single time scale, disregarding complex physiology organised on different time scales. This shortcoming was overcome and medically evaluated by information flow functions developed in our research group in collaboration with several theoretical, experimental, and clinical partners. In the present work, the information flow is introduced and typical information flow characteristics are demonstrated. The prognostic value of autonomic information flow (AIF), which reflects communication in the cardiovascular system, was shown in patients with multiple organ dysfunction syndrome and in patients with heart failure. Gait information flow (GIF), which reflects communication in the motor control system during walking, was introduced to discriminate between controls and elderly patients suffering from low back pain. The applications presented for the theoretically based approach of information flow confirm its value for the identification of complex physiological systems. The medical relevance has to be confirmed by comprehensive clinical studies. These information flow measures substantially extend the established linear and complexity measures in biosignal analysis.

Adult↗
PubMed1998

The gamesmanship of sex: a model based on African American adolescent accounts.

This article examines adolescent understanding of the social context of sexual behavior. Using grounded theory to interpret interviews with 39 African American male and female adolescents, the article builds a model of sex-related behavior as a set of interrelated games. A courtship game involves communication of sexual or romantic interest and, over time, formation of a romantic relationship. A duplicity game draws on conventions of a courtship game to trick a partner into having sex. A disclosure game spreads stories about one's own and other's sex-related activities to peers in a gossip network. Finally, a prestige game builds social reputation in the eyes of peers, typically based on gender-specific standards. The article concludes by examining the meanings that sex-related behavior may have for adolescents and the potential use of social knowledge for facilitating adolescent health.

Adolescent↗
PubMedDate not supplied

Suggestions for improving AIDS treatment in hospitals.

On July 26, 1994, John William George Swaffer died of AIDS in an Ottawa hospital. His partner shares his experience while caring for John at the hospital. While the hospital did many things well, it seemed that requests for palliative care were poorly communicated among the various physicians involved with John's care. Coordination between hospital doctors and those from a local HIV clinic also seemed poor. The author recommends eight changes to better serve patients with AIDS and other terminal illnesses.

AIDS-Related Opportunistic Infections↗
PubMed2002

[Study of the motivation of physicians participating in public health research].

In order to explore practitioners' motivations to participate in epidemiological research, a study was conducted among doctors who had been requested to provide clinical information on their patients included in the group study DESIR in the Inde and Loire regions of France. Six semi-structured individual interviews were carried out by two sociologists, and were then followed-up by 216 questionnaires, 80 of which were completed and analysed. Finally, 18 telephone interviews were conducted to complete the data collected. Reasons given for participating in epidemiological studies are mainly the perceived scientific interest, relevance for public health and the feeling of being a partner in the research. The obstacles seem to be the vague image of the promoter, ignorance of the DESIR study's objectives, lack of direct contact for communicating information, and the mixture and confusion between filling out the study's questionnaire and handling administrative constraints in general. Therefore, better communication, centred on the concept of partnership between research and practical medicine, informing on the usefulness of knowledge from epidemiological studies for the practice of medicine, and clarifying the promoter's role, could improve the level of participation from general practitioners.

Communication↗
PubMedDate not supplied

The Internet's role in patient/physician interaction: bringing our understanding in line with online reality.

The Internet has changed the way medical practitioners communicate and educate themselves and their patients. The Internet has provided enormous opportunity, but it has also led to complexity and uncertainty. We hope patients are intelligent partners in the management of their health, and we invite them to engage in the process of this management. Managed care has forced us to limit the length, depth, and frequency of patient encounters. Hopefully, patients will become more literate concerning their own conditions and their own bodies. They may lack medical knowledge and language. As a result, they may be drawn to online resources. Physicians often get angry or irritated when patients seek and retrieve information on their own. Our attempts to mediate patients' online activities can stress the patient/physician relationship. This could lead to misunderstandings, miscommunications, and fray an already fragile trust. There are many issues that accompany this cultural shift. We need to acknowledge the problem in order to achieve a resolution that is mutually satisfactory.

Health Knowledge, Attitudes, Practice↗
PubMed1978

Husband-wife agreement about reproductive goals.

Data from Malaysia on the reproductive goals of husbands and wives are analyzed to determine level of agreement, using new scale measures on preferences for number and sex of children as well as the conventional measure of desired number of children. The level of agreement between husband and wife varies considerably depending on the focus of analysis and the measure of agreement used. Overall aggregate agreement of men and women is high but lower for subgroups of the population, particularly among various ethnic groups. For marital partners, the agreement is much lower, especially on sex preferences. The level observed depends on whether the measure is identity of responses or an index of homogeneity which allows for couple concordance based on chance or common socialization factors. The views about the reproductive goals of one marital partner cannot with confidence be assumed to represent the views of the other.

Age Factors↗
PubMed1976

[Twin studies with a differentiated diagnosis of endogenic psychoses - psychosocial influences in certain forms of schizophrenia].

The examination started from the premise that "systematic schizophrenias", which constitute the majority of chronic schizophrenias in "differentiated diagnostics", only very rarely have a family history of psychosis. We set out to obtain an explanation of this observation by means of investigation in twins. Surprisingly, these types were not present in identical twins. It seems, therefore, that the severe schizophrenias, which we consider to be similar in character to systemic diseases, are prevented by the influence of an identical twin partner. As, however, the illness did occur in two-egg twins, the favourable influence must be effective during a period of life, when mutual understanding between the twins is already decisive, i.e. during later childhood, probably during puberty. An interaction between individual and environment is probably necessary for normal mental development and also for the maturing of brain systems essential in the adult psyche. In autistic patients there is no interaction, thus schizophrenia may develop. With an identical twin, however, contact is always present: because of similarity in character it is impossible that the partners minds are not mutually accessible. Thus, a satisfactory mental interrelationship is maintained, by which systematic schizophrenia is prevented. For refernces see the end of the following communication.

Autistic Disorder↗