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A new approach to gonorrhea control. The asymptomatic man and incidence reduction.

Reduction of gonorrhea incidence in the United States continues to resist public health intervention. Control strategies currently in use are associated with containment of the disease; about 1 million cases have been reported annually since 1975. Control efforts emphasize treatment of symptomatic men and the detection of asymptomatic women. Asymptomatic gonorrhea in men is well known clinically, but its epidemiologic significance has not been detailed. More than 60% of the infected partners of certain selected women are asymptomatic. By focusing control resources on these women and removing their asymptomatic partners from the disease reservoir, a substantial reduction in gonorrhea incidence can be expected.

Colorado↗

Predictors of women's decision to ask new partners to use condoms to avoid HIV/AIDS in South Africa.

OBJECTIVES: (i) to identify the key determinants of women's decision to ask a new partner to use condoms during sexual intercourse in order to reduce the probability of HIV infection. (ii) to estimate the impact of social, economic and educational factors identified above on the likelihood of a positive decision and; (iii) to explore the policy implications of the analysis. DESIGN: Cross-sectional national household sample survey. SETTING: South African Health Inequalities Survey, 1994. SUBJECTS OR PARTICIPANTS: Three thousand three hundred and thirty three South African women aged between 16 and 64 years. INTERVENTIONS: Descriptive/inferential non-intervention study. MAIN OUTCOME MEASURES: Respondent's decision to ask one's new partner to use a condom during sexual intercourse. RESULTS: The study revealed that condoms have a contraceptive benefit; AIDS epidemic is spreading rapidly across South Africa; people in ones own community are using condoms to avoid getting AIDS; and AIDS can be transmitted by having sexual intercourse with someone without using a condom were positive and statistically significant at p < or = 0.05. CONCLUSION: Equipping women with above mentioned forms of knowledge would go a long way in empowering them to exercise their rights to uncoerced choice to have safe sexual relationships.

Adolescent↗

Teaching pathophysiology to diverse students using an online discussion board.

Communication on the internet offers teachers a unique method for promoting learning among students who are challenged by numerous factors such as linguistic and cultural considerations. This article describes the use of out-of-class online discussions to promote active student learning among a diverse group of baccalaureate nursing students enrolled in a large lecture class. Student-to-student and teacher-to-student asynchronous threaded discussions occurred out of class. Students earned class points by posting and responding to classroom topics. By the end of the 15-week semester, there were approximately 790 messages on the bulletin board. Eighty-five percent of the 64 students participated in this assignment. Of the 64 students, approximately 50% were moderate to high users of the activity and 14% did not participate at all. There were no statistical differences between native English-speaking and non-native English-speaking students and their preference for study partners, interest, or experience with the internet. These initial results suggest that this assignment, based on electronic discussions, promoted greater participation and feedback among this diverse nursing student population. Despite the potential isolation of internet and e-mail-based communications, this computer-based technology may, ironically, facilitate an important shift from teacher-orchestrated to student-centered learning.

California↗

Knowledge, attitudes and practices concerning AIDS in Ugandans.

A survey of the knowledge, attitudes and practices of 3928 Ugandans concerning AIDS was done in two semi-rural communities in August 1987. Eighty-eight per cent of the respondents knew that AIDS could be acquired from other people and that having multiple sexual partners was high-risk behaviour. There were, however, many incorrect beliefs about HIV transmission, including belief in transmission by insect bites (37%), witchcraft (22%) and casual contact with ill people (21%). AIDS was believed to be curable by 15% of the respondents. As part of the survey, blood was obtained from 3907 (99%) participants; 421 (10.8%) had antibody to HIV-1 by enzyme-linked immunosorbent assay (ELISA) and females were more likely to be infected than males (12.5 versus 8.8%, relative risk 1.42). Factors significantly associated with HIV infection on univariate analysis include multiple sexual partners, sexually transmitted diseases (STDs), injections, and being female. Stratified analysis of a history of STDs in people who were monogamous still showed an association with HIV infection. Information about the AIDS epidemic is reaching the Ugandan population; however, changes in behaviour are slower to follow.

Acquired Immunodeficiency Syndrome↗

Prevention of Lyme disease in Dutch children: analysis of determinants of tick inspection by parents.

BACKGROUND: This study examined factors that discriminate between parents who regularly inspect their children for ticks and those who do not do so. METHODS: Knowledge, cognitive and emotional attitudes, social influences, and self-efficacy expectations were assessed in 230 parents living in high endemic regions. RESULTS: Regression analysis showed that moral norms, emotional attitude, anticipated regret, role models, and stress self-efficacy were positively associated with inspection behavior. CONCLUSIONS: Health education programs not only need to stimulate parental knowledge and discuss the health effects of tick bite prevention, they also need to stress the emotional benefits of tick bite prevention for children and parents and induce positive norms toward inspecting others. Furthermore, they need to stimulate openness about inspection behaviors, since the modeling examples of partners, relatives, and grandparents and the behavior of friends discriminate between inspecting and noninspecting parents. Finally, education programs should clearly indicate how tick inspection works, how the need for it should be communicated to the children, and how to take enough time to do it.

Adult↗

Sustaining passion: eroticism and safe-sex talk.

It is axiomatic that communicating effectively is important for good sexual relations. In light of the AIDS epidemic and the necessity for safe-sex practices, the topic of caution and prevention is an emerging and critical discourse for the sexual encounter. Yet if this discourse is not to defy passion but rather complement it, then the study of sexual linguistics must be grounded within the realm of erotic reality. Three themes of eroticism and their implications for sexual interaction are explored in this paper: identity, context, and danger. Linguistic and relational constraints for enacting such a discourse are identified, accompanied by a critique of the treatment of erotic discourse in educational programs and the media.

Affect↗

Healthy reciprocity in sexual interaction.

The purpose of the article is to discuss reciprocity in sexual interaction within a couple relationship in which heterosexual orientation is assumed and satisfaction considered. Reciprocity is modelled as an exchange of services which at its best functions as an unwritten contract, a mutual understanding regarding fairness of returned services, and a desire to comply with this principle together with a loved one/lover. An equal treatment of and balanced attitudes towards one another are present together with a just distribution of benefits and concessions or compromises. Reciprocity involves a relative term although healthy reciprocity can be defined for discussion and assessed as a degree of mutual satisfaction. Sexual interaction issues, skills to obtain satisfaction, and sexual and emotional compatibility are important elements in reciprocity. Understandable communication is an essential contributor in the implementation of reciprocity. Conflict-making dialogue should generally be avoided and connotive meanings of words taken into account. Erotophilia-erotophobia dimensions influence both the learning about and attitudes towards sexuality and contribute to personal and professional abilities to assess sexual problems and to attend to them. Erotic touch is a minimum requirement of love making. Sexual orientation, sexual desire, and intimacy influence sexual compatibility. Equity and exchange models are discussed, and a reciprocity model is proposed.

Attitude↗

Internally displaced persons.

There were estimated to be over 20 million internally displaced persons (IDPs) at the end of 1999, a number that surpasses global estimates of refugees. Displacement exposes IDPs to new hazards and accrued vulnerability. These dynamics result in greater risk for the development of illness and death. Often, access of IDPs to health care and humanitarian assistance is excluded deliberately by conflicting parties. Furthermore, the arrival of IDPs into another community or region strains local health systems, and the host population ends up sharing the sufferings of the internally displaced. Health outcomes are dismaying. From a health perspective, the best option is to avoid human displacement. WHO contributes to the prevention of displacement by working for sustainable development. Placing health high on the political agenda helps maintain stability, and thereby, reduce the likelihood for displacement. Primary responsibility for assisting IDPs, irrespective of the cause, rests with the national government. However, where the government is unwilling or unable to provide the necessary aid, the international humanitarian community must step in, with WHO playing a major role in the health sector. There is consensus among the partners of the World Health Organization (WHO) that, in emergencies, the WHO must: 1) take the lead in rapid health assessment, epidemiological and nutritional surveillance, epidemic preparedness, essential drugs management, control of communicable diseases, and physical and psychosocial rehabilitation; and 2) provide guidelines and advice on nutritional requirements and rehabilitation, immunisation, medical relief items, and reproductive health. If the vital health needs of IDPs--security, food, water, shelter, sanitation and household items--are not satisfied, the provision of health services alone cannot save lives. Community participation is essential, and community participation implies bolstering the assets and capacities of the beneficiaries.

Adult↗

What it will take to create new Internet initiatives in health care.

Today's Internet cannot fulfill the anticipated future needs of health care organizations. To address growing administrative, clinical, and research communication networking requirements and to serve as a test bed for future technology, two separate initiatives, the Next Generation Internet (NGI--federally funded by the NIH/NLM) and Internet2 (a consortium of academic partners), are establishing project partnerships that will create new and improved opportunities for health care applications and interactions such as telemedicine, medical imaging, virtual medicine, home health care, public health, consumer medicine, medical education, and medical research, among other uses. In addition to creating and improving large-scale health care networking, it is also expected that much of the technology developed and tested for NGI/Internet2 will filter down to improve the mainstream Internet.

Delivery of Health Care↗

The helping process in couples during recovery from heart attack: a single case study.

This single case study aimed to illustrate help-intended communication in couples, in particular how a husband and wife attempted to help each other with adjusting to the husband's recent myocardial infarction. The study employed a semi-structured communication task to gather samples of the couple's helping interactions: the couple had two conversations in which they alternated helper and discloser roles. Quantitative and qualitative data were obtained from the couple and from expert raters (observers) about their perspectives of the conversations. The observers' ratings and verbal response mode patterns indicated that the conversations were characterized by low levels of empathy and exploration of feelings and relatively high levels of helper disclosure and advice; overall, the observers found the conversations to be somewhat unhelpful. In contrast, the couple rated the conversations more positively; the 'helpful events' they identified consisted of their partner disclosing a new piece of information and giving advice. The results were discussed in terms of the unique features of helping in close relationships.

Communication↗

Sexual partner networks in the transmission of sexually transmitted diseases. An analysis of gonorrhea cases in Sheffield, UK.

BACKGROUND AND OBJECTIVES: Routine contact tracing data on patients with gonorrhea are used to identify sexual partner networks. These are combined with gonococcal typing data to study patterns of transmission. The role of persons in transmission is discussed. STUDY DESIGN: Contact tracing data on patients with gonorrhea attending the Royal Hallamshire Hospital in Sheffield in 1988 and 1989 are analyzed. Gonococcal strains identified by auxotype/serovar (A/S) class are combined with these data to identify transmission paths. RESULTS: The network contained 1,272 persons, 724 (77%) of whom had gonorrhea during the study period. Four hundred two clusters of linked cases were identified. The largest cluster, containing 35 persons connected over 16 months, is discussed in greater detail to illustrate how these data may help identify patterns of transmission and the role of persons. CONCLUSION: Contact tracing data can be used to identify sexual partner networks and to study transmission patterns. Microbiologic data can aid interpretation. An person's risk of acquiring infection depends on indirect links as well as direct links. To understand patterns of transmission it may be important to distinguish between those involved in transmission and those only acquiring infection. Networks established through gonococcal transmission are also relevant to the transmission of other sexually transmitted diseases.

Adolescent↗

Audience drives male songbird response to partner's voice.

According to the social intelligence hypothesis, social context represents an important force driving the selection of animal cognitive abilities such as the capacity to estimate the nature of the social relationships between other individuals. Despite this importance, the influence of this force has been assessed only in primates and never in other animals showing social interactions. In this way, avian communication generally takes place in a network of signallers and receivers, which represents an audience altering individual signalling behaviours. Indeed, vocal amplitude and repertoire are known to be socially regulated and the attitude towards the opposite sex may change depending on the audience. This 'audience effect' provides support for the reality of social awareness in some bird species. However no evidence has yet been found to suggest that birds are able to estimate the characteristics of the social relationships between group-mates. Here we show that the male of a gregarious songbird species--the zebra finch (Taeniopygia guttata)--pays attention to the mating status of conspecific pairs, and uses this information to control its behaviour towards its female partner.

Acoustic Stimulation↗

[Study of relational collusion in infertile couples with a possible psychogenic background].

The authors have investigated the psychodynamic background of possible psychogenic infertility in twenty couples. Four levels were studied: 1. Functioning of the relationship was measured with the Consensus Rorschach Test, following communication patterns in the couples. 2. Individual psychological functioning was investigated with the Individual Rorschach Test, positive and negative choices were asked, and titles were given to the figures. 3. Positive and negative reactions to particular image stimuli were also recorded, thus the joint psychological functioning of the couple was analysed. 4. Content analysis of Rorschach responses was also performed, and associations of the infertile couples were compared with associations of twenty couples expecting a child (matched by education level, SES and age). Results have provided evidence for the "phallic collusion" originally conceptualised by Jürg Willi. Starting from Willi's model, we can identify fixation at the Oedipal stage of development (3-6 years) in these partners living in a dysfunctional relationship. They have the same Achilles heel, a common grievance, a common "history pattern". Their common life is built on the hope that by living together, they could solve the problems originating from the childhood trauma. Generally, they have common fears of authority, and fears of adopting mature gender roles. According to maturity of communication content, their personality is in a transitional stage between childhood and adulthood. At a manifest level however, they hope to achieve fulfillment (birth of a child). The interactions are very ambivalent, strong mutual confirmation is present as well as criticism, devaluation and ignoration of the partner. Results of the study provide various new possibilities for promoting personality development through therapy in infertile couples with a possible psychogenic background.

Adult↗

Building a partnership to evaluate school-linked health services: the Cincinnati School Health Demonstration Project.

The Cincinnati School Health Demonstration Project was a 3-year collaboration that evaluated school-linked health services in 6 urban elementary (kindergarten to eighth grade) schools. Partners from the Cincinnati Health Department, Cincinnati Public Schools, Cincinnati Children's Hospital Medical Center, and The Health Foundation of Greater Cincinnati wanted to determine if levels of school-linked care made a difference in student quality of life, school connectedness, attendance, emergency department use, and volume of referrals to health care specialists. School nurses, principals and school staff, parents and students, upper-level managers, and health service researchers worked together over a 2.5-year period to learn about and use new technology to collect information on student health, well-being, and outcome measures. Varying levels of school health care intervention models were instituted and evaluated. A standard model of care was compared with 2 models of enhanced care and service. The information collected from students, parents, nurses, and the school system provided a rich database on the health of urban children. School facilities, staffing, and computer technology, relationship building among stakeholders, extensive communication, and high student mobility were factors that influenced success and findings of the project. Funding for district-wide computerization and addition of school health staff was not secured by the end of the demonstration project; however, relationships among the partners endured and paved the way for future collaborations designed to better serve urban school children in Cincinnati.

Cooperative Behavior↗

Dyadic coorientation: reexamination of a method for studying interpersonal communication.

The coorientation method is used rarely to study communication in sexual dyads or other relationships due to uncertainty regarding the optimal way to calculate key variables (i.e., understanding, agreement, and perceived agreement). We examined this matter empirically, assessing sexual coorientation among 76 cohabiting couples; 152 adults completed measures of their own and their partners' sexual preferences as well as sexual satisfaction. Three sets of sexual preference coorientation variables were calculated using correlational, difference score, and combined approaches. These variables were then correlated with the sexual adjustment measures to determine which coorientation approach had greater explanatory power across several hypothesized relationships. Results clearly favored the correlational method. We identify several potential applications of the coorientation method and provide guidelines for its application to research on dyadic relationships.

Adult↗

Social perception deficits after traumatic brain injury: interaction between emotion recognition, mentalizing ability, and social communication.

Thirty-four adults with severe traumatic brain injuries (TBI) and 34 matched control participants were asked to interpret videotaped conversational exchanges. Study participants were asked to judge the speakers' emotions, the speakers' beliefs (first-order theory of mind), what the speakers intended their conversational partners to believe (second-order theory of mind), and what they meant by remarks that were sincere or literally untrue (i.e., a lie or sarcastic retort). The TBI group had marked difficulty judging most facets of social information. They could recognize speaker beliefs only when this information was explicitly provided. In general, emotion recognition and first-order theory of mind judgments were not related to the ability to understand social (conversational) inference, whereas second-order theory of mind judgments were related to that ability.

Activities of Daily Living↗

Phosphodiesterase type 5 inhibitors' extended duration of response as a variable in the treatment of erectile dysfunction.

The phosphodiesterase type 5 (PDE5) inhibitors, sildenafil, tadalafil and vardenafil, are a class of medications that are safe and effective in treating erectile dysfunction (ED). Yet, resuming sexual activity following a period of abstinence in response to ED may be anxiety-provoking for the man, his partner and their relationship, causing the sexual encounter to become a stressful event. The differences between PDE5 inhibitors in terms of duration of action can be successfully utilized by healthcare professionals to mitigate some of the psychosocial barriers that interfere with treating ED. PDE5 inhibitors with a longer duration of responsiveness provide some men with ED and their partners, a treatment option that may offer greater flexibility and potentially less anxiety surrounding the resumption of sexual activity. Shorter-acting PDE5s may be preferred by men/couples with predictable sexual scripts, excellent communication strategies and concerns regarding the duration of side effects.

3',5'-Cyclic-GMP Phosphodiesterases↗

Hemolytic disease of the newborn following maternal self-injection of blood.

A teenage primigravida with no prior history of transfusion presented with anti-D, anti-C, and anti-E in her serum and subsequently developed anti-Fya. The infant had hemolytic disease of the newborn. The antibodies were provoked by the girl's self-injection of her partner's blood for emotional gratification. Clinicians and transfusion services should be aware that hemolytic disease of the newborn in a first pregnancy can be caused by self-inflicted maternal immunization. Close communication between clinicians and transfusion service is emphasized.

Adolescent↗