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After several years of control effort using multidrug therapy, there is a glimmer of light at the end of the tunnel. There remain, however, many obstacles preventing the Programme from achieving a better health status for sufferers. The Togo Government, in cooperation with its partners, is preparing a National Leprosy and Tuberculosis Action Plan.
This article highlights that there is a need for an inventory of all the health system research and studies which have been conducted by the Moroccan Ministry of Health and its partners, and that this knowledge base should be made available to the decision-makers, the researchers and even the public. This could be done using the new information and communication technology which is available at the Ministry. This will gradually lead to establishing a single-window service for access to health knowledge and know-how in the near future.
Communication training and positive exchange training are the two methods for improving marital relations that research has established as being the most effective. However, even after conducting therapy involving both partners based on these methods, too few couples (35%) succeed in reaching the same level of satisfaction as couples who are already satisfied with their relationship. The efforts that have been undertaken to increase this rate have focused mainly on developing new therapeutic techniques that include cognitive, emotional and systemic approaches. However, the results of experimental studies to date do not prove the superiority of these new approaches. Given this situation, it is time to pay more attention to particular characteristics of the therapeutic relation in marital therapy and to the means of obtaining the collaboration of the two spouses. As is the opinion of certain authors, the most difficult clinical task does not consist of finding what the clients must do to solve their problems, but rather to determine how to motivate them and help them achieve their goal. An analysis of this task, based on clinical observations and results of recent research in this area, has allowed the authors to present a number of hypotheses about ways to reinforce the therapeutic alliance and eventually reduce the failure rate of marital therapy.
Snails recover function following a variety of neural injuries. They grow new tentacles with associated tentacle ganglia, selectively reinnervate peripheral targets, repair central connections and may even replace lost neurons and ganglia. The plasticity revealed in their responses to neural injury is an extreme expression of the adaptability observed in studies of learning and age-related changes in the nervous system. Recent information on neurogenesis in gastropods is providing a basis for comparing developmental events with neural regeneration. Studies of neural regeneration in gastropods have capitalized on our ability to identify many gastropod neurons individually and characterize the cellular properties and network properties that generate output patterns that underlie behaviors. The robustness of the model systems formed by cultured gastropod neurons is apparent in the similarity of the activity patterns in circuits formed in vitro and in vivo. Cell membrane repair, activation of an altered pattern of protein synthesis, and observation of the searching action of the growth cones can be studied under defined conditions that promote or inhibit the processes. Basic properties of growth cones, the molecular binding and second messenger systems underlying adhesion, sprouting and pathfinding, and events in synaptogenesis are accessible to analysis. Rules that govern selection of synaptic partners are being evaluated on the basis of cellular characteristics such as transmitter and receptor expression and ganglion of origin. The conservation of the molecular language that governs growth and communication between cells suggest that information gained in such studies may some day be applied to promote neural regeneration in mammals.
The carcinoembryonic antigen (CEA) domain specificities of a library of monoclonal anti-CEA antibodies were determined to investigate the mechanisms of homophilic binding involved in CEA-mediated intercellular adhesion. Using an indirect immunofluorescence cell surface staining technique, the reactivities of these antibodies were tested systematically on Chinese hamster ovary cells stably transfected with constructs of CEA gene family members CEA, nonspecific cross-reacting antigen, CGM6, and biliary glycoprotein, as well as on stable Chinese hamster ovary transfectants expressing truncated CEA and CEA/nerve cell adhesion molecule chimeric proteins. Epitopes for these antibodies were thus localized on the CEA molecule as follows: monoclonal antibody groups 1, 2, and 6 react with epitopes in the N-terminal domain of CEA, whereas groups 3, 5a, 5b, and 9 react with determinants found in the internal repeating domains located in the C-terminal part of the CEA molecule. Groups 4 and 8 appear to react with a repeating epitope in the internal domains of CEA and in all CEA subfamily members. Fab fragments of monoclonal antibody group 1 block aggregation of CEA transfectant cells, indicating that a region in the N domain is involved in CEA homophilic interaction. Fab fragments of monoclonal antibody group 9 recognize an epitope dependent on the B2 and A3 domains and stimulate aggregation. These results support the recently reported CEA-CEA homophilic reciprocal binding model in which anti-parallel molecules are bound by 2 bonds between the N domain of one molecule and the A3B3 domain of the interacting partner.
Being able to collaborate effectively is important for teachers who work together to serve students with learning disabilities in general education classrooms. Effective collaboration requires that teachers have knowledge and skills in how to effectively communicate and share their technical expertise for the purpose of solving classroom problems and providing continuity across instructional settings. Although both special education and general education preparation programs provide preservice teachers with the technical expertise for their respective areas of certification, few programs provide both special education and general education majors with instruction in interpersonal communication skills and collaboration strategies. The purpose of this article is to suggest guidelines and strategies to help teacher preparation programs move toward collaboration instruction for all educators. Suggestions for what to teach and how to teach it are offered, as well as an overview of factors that influence the implementation of collaboration instruction for all educators.
Electronic communication can enhance long-distance networking and scholarly activity and make long-distance collaboration through technology a reality. Technology presents a new world of opportunity for improving writing skills, nurturing collegiality, and maximizing efficiency in the successful completion of collaborative projects. The concept of "seamless technology" introduced by the authors provides a guide to assist partners involved in collaborative projects to manage technology for a successful, rewarding experience. Basic questions regarding technology that need to be answered on the front end of a long-distance project are suggested in this article. In addition, the steps taken by the authors to co-author and co-edit a nursing textbook and accompanying instructor's manual by using electronic communication and other sources of technology are outlined. The authors address ways that long-distance collaboration required them to maximize their communication and planning skills, thereby increasing productivity and reducing costs. The challenges and rewards of working together exclusively through technology are discussed, and finally, implications for professional nursing are addressed.
Mouse ascites tumor cells (MAT-cells) were co-cultured with mesothelial cells of the mouse. During early stages of coexistence (30-60 min) the mesothelial cells show fingerlike protrusions formed mostly at their flanks pointing towards MAT-cells in the neighbourhood. Obviously there is a directional response of the mesothelial cells to the existence of MAT-cells. The mesothelial cells are the most active partner at the beginning of coexistence. Later on MAT-cells also develop fingerlike protrusions which grow towards the mesothelial cells. A network of fingerlike protrusions is formed in the region between MAT-cells and mesothelial cells when they come near to each other. The advantages of the system serving as a model for investigations on intercellular communication are discussed.
Experiences of men who have internet sex with men were studied to determine the level of misrepresentation in real life and on the Internet of physical, relationship, sexual interests, and HIV status. An internet-based questionnaire in English and Spanish ($20 compensation) recruited 1,026 Latino MISM over 3 weeks. Four 'fib' scales were created to measure misrepresentation by the respondent and to the respondent on the Internet and IRL. Overall, respondents rated being misrepresented to on the Internet significantly highest, followed by being misrepresented to IRL and misrepresenting themselves to others on the Internet, and misrepresenting themselves to others IRL lowest. For HIV status there were no differences between Internet and IRL misrepresentation by others and Internet and IRL misrepresentation by self, but a significant difference between HIV status misrepresentation by self and others. Misrepresenters were more likely to have had cybersex before meeting their last partner and to prefer cybersex, to be more sexually compulsive, and to speak and think more in Spanish. Social desirability considerations account for the higher misrepresentation on physical characteristics and sexual interests by others, and higher misrepresentation on the Internet. However, misrepresentation of HIV status was the lowest category and while it was misrepresented more often by others than self, there were no internet/IRL differences. Data suggest that HIV misrepresentation occurred for 20% of men and was lower than other forms of misrepresentation. Implications for HIV prevention are discussed, along with the concept of levels of accuracy in internet communications.
The aim of this small-scale, qualitative study was to explore partners' experiences of breast reconstruction after mastectomy. Interviews with 6 men, analysed using thematic analysis identified key themes of Involvement in the Decision-Making Process, Giving and Seeking Support, Opportunity to Talk, and Adapting Behaviour. Whilst most participants wanted to be involved in the decision-making process, they reported having experienced barriers to this, including difficulty in talking to others and expressing their true feelings about the surgery. Participants described difficulties with intimate contact after their partner had undergone surgery due to reactions to the appearance and feel of the reconstructed breast and a fear of hurting their partner and of reopening scars. This study highlights the need to recognise the role of the partner's involvement and of their own experiences during this time. The findings are of value to healthcare professionals, in particular specialist nurses, who work with women undergoing breast reconstruction and indicate areas where further research is needed.
The European Union is supporting research into medical informatics via its Advanced Informatics in Medicine (AIM) program. One of the current AIM projects is the Good European Healthcare Record (GEHR) project. Its objective is to devise an architecture for electronic healthcare records that will enable them to be comprehensive, communicative, and portable to different systems. The work was funded from January 1992 to December 1994. The project team consisted of over 50 personnel representing clinicians, computer scientists, and computer programmers in eight European countries. The partner organizations are Health Data Management Partners (Belgium), Croix Rouge Francaise (France), France Telecom, Association des Medecins et Medicins Dentistes (Luxembourg), Instituto Clinica Geral Zona Norte (Portugal), Medical College of St Bartholomew's Hospital (UK), and SmithKline Beecham (UK). The work of the project has been carried out by three subgroups covering clinical, architecture, and systems aspects. One of the strengths of the project has been that most of the work has been done as collaborations between members of different groups. This has meant that there has been very close contact between clinicians and computer experts. The GEHR project is providing important input into the standardization process in Europe via, for example, PT011 of Working Group 1 of CEN TC/251 (the developing standards for the architecture of healthcare records).
The purpose of this study was to investigate the relation between social status and discourse skills in preschool children. Using peer nominations, 48 acquainted preschool children were classified as liked, disliked, or low impact. Children were videotaped in freeplay interactions in which one child entered the play of a pair of same-sex peers. Social status differences were found primarily in skills contributing to coherent discourse. Specifically, liked children were more inclined to direct their initiations clearly, to speak to both interaction partners rather than just one, to respond contingently to others, to acknowledge others, and to reinitiate when rejecting. Liked children were also better able to adapt to the differing social demands of entry versus nonentry contexts in that they were more likely to give information and less likely to express their feelings when entering a group. Deficits in communication skill were greater for disliked children than for low-impact children. Results indicate that communication skills that contribute to coherent discourse are fundamental to social interaction and may influence young children's peer acceptance.
In sexology the existing questionnaires do not sufficiently consider the experiencing of sexuality and the extent of sexual satisfaction. That is why a questionnaire was developed which includes, besides the frequency and duration of sexual activities, the satisfaction with frequency and duration of these activities and the desired sexual behaviour. A first study with this questionnaire was carried out on 112 women with heterosexual behaviour, aged 20 to 48 years. The frequent desire with regard to coital orgasm as one result of our investigation confirms the centering of orgasm in other studies. But half of the women do not describe orgasm as the favoured feeling during sexual intercourse. For 37% of the women the emotional and physical closeness to the partner is explicitly more important than experiencing an orgasm. According to the comparison of extreme groups sexual satisfaction particularly correlates with self-determination realized in partnership and with satisfaction of communicational desires and need for tenderness within the partnership.
The objective of our study was to test whether attendance for breast cancer screening and satisfaction with the service could be predicted from a knowledge of the woman's social and psychological characteristics. In a prospective design, demographic characteristics, self-reported health status and behaviour, expectations and attitudes were examined through postal questionnaires sent out shortly before the invitation to screening, and the measures were used to predict subsequent attendance and satisfaction. The sample was taken from three areas in the South-East Thames Regional Health Authority providing a Forrest service--one rural, one provincial and one inner city--and consisted of 3160 women aged 50-64 invited routinely for screening. The main predictors of attendance were the woman's attitude to being screened and her belief that 'salient others' wanted her to attend. The main predictors of satisfaction with the service were the behaviour of the staff and the facilities at the centre. Three implications of the findings are discussed: (a) health education should include partners, relatives and friends of the target women, as their views had as much effect on attendance as did the women's attitudes; (b) staff training and development should focus on communication with the patient; (c) further research should examine the precursors of reported discomfort and pain.
PURPOSE: This paper seeks to address how and why trust relations in the NHS may be changing and presents a theoretical framework for exploring them in future empirical research. DESIGN/METHODOLOGY/APPROACH: This paper provides a conceptual analysis. It proposes that public and patient trust in health care in the U.K. appears to be shaped by a variety of factors. From a macro perspective, any changes in levels of public trust in health care institutions appear to derive partly from top-down policy initiatives that have altered the way in which health services are organised and partly from broader social and cultural processes. A variety of policy initiatives, including the introduction of clinical governance and the resulting use of performance management to scrutinise and change clinical activity, increasing patient choice and involvement in decision-making regarding their care, are examined for how they have changed the context for trust relations within the NHS. FINDINGS: It is argued that these policy initiatives have produced a new context for trust relations within the NHS, shifting the inter-dependence and distribution of power between patients, clinicians, and mangers and changing their vulnerability to each other and to health care institutions. The paper presents a theoretical framework based on current policy discourses which illustrates how new forms of trust relations may be emerging in this new context of health care delivery, reflecting a change in motivations for trust from affect based to cognition based trust as patients, clinicians and managers become more active partners in trust relations. The framework suggests that trust relations in all three types of relationship in the "new" modernised NHS might, in general, be particularly characterised by an emphasis on communication, providing information and the use of "evidence" to support decisions in a reciprocal, negotiated alliance. ORIGINALITY/VALUE: The paper examines the drivers for change in trust in health care relations in the U.K. and develops a theoretical framework for the emergence of new trust relations that can be subsequently explored through empirical research.
Procoagulant microparticles (MP) constitute valuable hallmarks of vascular cell damage at the crossroad of atherothrombosis processes. Detectable at low concentrations in the blood flow of healthy individuals, elevated levels of procoagulant microparticles are characteristic features of most cardiovascular risk factors. Circulating MP support cellular cross-talk leading to vascular inflammation, endothelial dysfunction, leukocyte adhesion and recruitment possibly contributing to plaque growth with consecutive development of local thrombosis and altered vasomotion. Within the plaque, MP shed by apoptotic monocytes and smooth muscle cells are major determinant of plaque thrombogenicity mainly through the presence of tissue factor (TF) activity. Besides this procoagulant potential, trapped MP could contribute to plaque vulnerability through multiple pathways including angiogenesis, extracellular matrix proteolysis, recruitment of inflammatory cells, smooth muscle cell and endothelial apoptosis. Having long been considered sufficient to initiate coagulation following plaque disruption, the role assigned to plaque-bound TF does not appear physically realistic at a macroscopic scale, the swift growth of the thrombus probably involving blood-borne TF conveyed by circulating MP. As participants in crucial steps of atherosclerotic disease, MP can now be viewed as "partners in crime" in acute ischemic syndromes.
Information systems compatibility can directly affect the benefits an organization receives from a merger or acquisition. At the macro level, the degree of compatibility determines whether consolidating systems is feasible and cost effective. At the micro level, information systems compatibility is closely tied to every benefit a merger or acquisition brings. Potential merger partners can assess whether their systems will mesh with an information systems compatibility index.
Next-generation remote-monitoring devices may achieve the dual goals of boosting the effectiveness of the healthcare sector as a whole and empowering users to take control of their health status. One technology centre, operating an open innovation partnership model, is looking for partners to be involved in developing a generic smart technology platform that will make this goal a reality.