AIDS, euthanasia and grief.
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Acquired Immunodeficiency Syndrome↗
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Psychological status before and after surgery for breast cancer.
A psychological study of 80 patients undergoing mastectomy showed that the preoperative period is more affected with anxiety, that the patients need communication to remove the anxious state, and that disclosure of the diagnosis should always be accompanied by an understanding interview that includes a clear and moderately optimistic evaluation of the consequences, plans for the future, involvement of the partner and other relatives. Physician and psychologist should share this task to inform the patient and help the patient's psychological reaction towards a constructive cooperation for treatment and rehabilitation.
Adult↗
Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women.
Developed by Robert Connell, the theory of gender and power is a social structural theory based on existing philosophical writings of sexual inequality and gender and power imbalance. According to the theory of gender and power, there are three major social structures that characterize the gendered relationships between men and women: the sexual division of labor, the sexual division of power, and the structure of cathexis. The aim of this article is to apply an extended version of the theory of gender and power to examine the exposures, social/behavioral risk factors, and biological properties that increase women's vulnerability for acquiring HIV. Subsequently, the authors review several public health level HIV interventions aimed at reducing women's HIV risk. Employing the theory of gender and power among women marshals new kinds of data, asks new and broader questions with regard to women and their risk of HIV, and, most important, creates new options for prevention.
Communicable Disease Control↗
Sex in the New World: an empowerment model for HIV prevention in Latina immigrant women.
In 1996, nearly 60% of U.S. AIDS cases among Latinas were attributed to unprotected sex with men. Economic disadvantage, language barriers, and strong cultural gender norms regarding sex exacerbate the risk for HIV infection among Latina immigrant women. Through a collaboration among scientists and providers, this study was designed to evaluate the impact of a multifaceted empowerment program for Latina immigrant women on HIV risk behaviors. Women (N = 74) were followed for the first 6 months of their participation and attended up to nine distinct types of activities (e.g., information meetings, friendship circles, and workshops). Although the program was not developed to specifically target HIV risk behaviors, women showed significant increases in sexual communication comfort, were less likely to maintain traditional sexual gender norms, and reported changes in decision-making power. Targeting broader sociocultural issues may increase the necessary skills for Latina women to prevent HIV infection from their sexual partners. Successful collaborations between scientists and providers are critical in developing effective, community-relevant interventions.
Adult↗
National and international veterinary reference laboratories for infectious diseases.
Reference laboratories play an increasingly important role in the harmonisation of laboratory diagnostic tests and the standardisation of veterinary vaccines. This is particularly important in building confidence between international trading partners. The authors review aspects of the organisation, designation and support of reference laboratories for infectious diseases of animals and discuss the principal activities which such laboratories would normally perform. These activities include advice and consultancy, publications and communication, training, research, disease surveillance, maintenance of culture collections, evaluation of reference methods, preparation of reference materials and organisation of inter-laboratory comparisons.
Animals↗
The superefficient company.
Most companies do a great job promoting efficiency within their own walls, streamlining internal processes wherever possible. But they have less success coordinating cross-company business interactions. When data pass between companies, inconsistencies, errors, and misunderstandings routinely arise, leading to wasted work--for instance, the same sales, order entry, and customer data may be entered repeatedly into different systems. Typically, scores of employees at each company manage these cumbersome interactions. The costs of such inefficiencies are very real and very large. In this article, Michael Hammer outlines the activities and goals used in streamlining cross-company processes. He breaks down the approach into four stages: scoping--identifying the business process for redesign and selecting a partner; organizing--establishing a joint committee to oversee the redesign and convening a design team to implement it; redesigning--taking apart and reassembling the process, with performance goals in mind; and implementing--rolling out the new process and communicating it across the collaborating companies. The author describes how several companies have streamlined their supply-chain and product development processes. Plastics compounder Geon integrated its forecasting and fulfillment processes with those of its main supplier after watching inventories, working capital, and shipping times creep up. General Mills coordinated the delivery of its yogurt with Land O'Lakes; butter and yogurt travel cost effectively in the same trucks to the same stores. Hammer says this new kind of collaboration promises to change the traditional vocabulary of corporate relationships. What if you and I sell different products to the same customer? We're not competitors, but what are we? In the past, we didn't care. Now, we should, the author says.
Commerce↗
Traditional Balinese youth groups as a venue for prevention of AIDS and other sexually transmitted diseases.
OBJECTIVES: Our aims were to assess the feasibility of conducting peer-led educational interventions against AIDS and other sexually transmitted diseases (STDs) through traditional Balinese youth groups and to gather information on sexual risk-taking and its correlates among Balinese youth. DESIGN: A cross-sectional survey was conducted, with follow-up questionnaires for pilot intervention participants. SUBJECTS AND METHODS: A self-administered questionnaire was given to 375 subjects (aged 16-25 years) from 12 youth groups representing four main resort areas in Bali. Post-intervention data were collected from 97 of these subjects who had taken part in pilot educational programs. Focus groups supplemented survey data in evaluating the intervention and understanding risk behaviors. RESULTS: In a cross-sectional survey, one-quarter of males and few females reported sexual activity; subsequent focus groups suggested under-reporting by females. While knowledge and worries about HIV/AIDS were high, only 10% of sexually active males and no females reported consistent condom use. The mean age of first sexual intercourse was highly correlated with first alcohol consumption (P = 0.0003). Peer educators from selected youth groups planned and implemented interventions for their own groups. Post-intervention data indicated significant increases in communication about sexual issues with friends and parents. Condom attitudes became less negative and efficacy increased. Participants reported this as a first experience with peer-led health education, preferred interactive activities to adult-led lectures and recommended follow-up educational sessions. CONCLUSIONS: Peer educators from traditional youth groups can plan and conduct prevention programs for HIV/STDs that are well-received by their group memberships. Using such venues may be an efficient way to reach a wide range of pre-sexual Balinese youth, as well as those already at risk for HIV/STD due to unprotected sex, alcohol consumption and multiple sexual partners.
Acquired Immunodeficiency Syndrome↗
Trachoma.
Trachoma is the most common infectious cause of blindness. It is caused by ocular serovars of Chlamydia trachomatis. Transmission is favoured in poor communities, where crowding is common and access to water and sanitation inadequate. Repeated reinfection over many years causes dense scarring of the upper eyelid. The resultant inversion of the lashes abrades the eyeball, and the abrasion leads to corneal opacification and visual impairment. The host immune response is probably at least partly the cause of this process. The "SAFE" strategy is used for the control of trachoma: surgery for in-turned lashes, antibiotics for active disease, facial cleanliness, and environmental improvement. The demonstration that a single oral dose of the antibiotic azithromycin is as effective as 6 weeks of topical tetracycline was an important advance in trachoma control. By means of the SAFE strategy, WHO and its partners aim to eliminate trachoma as a public-health problem by the year 2020.
Chlamydia trachomatis↗
Building Research Relationships With Managed Care Organizations: Issues and Strategies.
Managed care is now the dominant form of healthcare in the United States. The need for clinical research about the organization, delivery, and outcomes of primary care services in managed care models is high, yet access to managed care organizations as sites for clinical research may be problematic. The purpose of this article is to describe issues involved in obtaining access to managed care settings for clinical research and practical strategies for successful collaboration using literature review and case description. Three steps for developing collaborative relationships with managed care organizations (MCOs) are presented: 1) assessment of organizational structure, history, and culture; 2) finding common ground; and 3) project implementation. These steps are discussed within the context of MCO systems issues and a relationship-centered approach to communication between researchers and individuals from the MCO. Successful relationships with MCOs for clinical research are possible when careful attention is paid to inclusion of MCOs as collaborators in the development of the research questions and design, and as partners in the research implementation process.
Journal Article↗
Examining the direct costs and effectiveness of syphilis detection by selective screening and partner notification.
Selective screening and partner notification are two principal means of preventing and controlling syphilis in the United States, yet few studies have been undertaken to compare and evaluate the cost or effectiveness of detecting syphilis using either strategy. The objective of this paper is to assess from the perspective of a health department the cost-effectiveness of selective screening compared with the strategy of partner notification in the detection of early syphilis in Houston, Texas, in 1994 and 1995. The cost-effectiveness analysis was performed using the recurring direct costs associated with detecting syphilis by both strategies. The middle estimates for the total direct costs associated with selective screening and partner notification were $579,101 and $229,529, respectively, for the 1466 and the 567 cases of early syphilis detected. On a cost per case basis, selective screening was more cost-effective than partner notification in the detection of primary, secondary and maternal syphilis cases. However, when consideration was given to prophylactic treatment, partner notification was more cost-effective in the detection of all early stage disease. Our findings suggest that the relative benefit of partner notification over selective screening depends on prophylactic treatment and an increase in worker productivity.
Communicable Disease Control↗
The consumer's role in quality: partnering for quality outcomes.
Partnering with the patient in the planning and delivery of care to achieve high-quality outcomes is a goal shared by health care providers. The achievement of a full partnership with the patient often varies based on the communication skills of individual nurses. To provide more consistency, Patient Standards of Care (SOCs) were created that are written from the patients' viewpoint in lay terms and are condition-specific. The content includes commitments of the health care team, patient care issues and concerns, what the team will do, what the patient can do, and outcome expectations. The end result is to promote the patients' engagement in their own care through the sharing of accountabilities for desired outcomes.
Humans↗
HIV testing among Haitian women: lessons in the recognition of risk.
Haitian women in Miami, Florida, responded to recruitment for testing of HIV antibody serostatus in ways that demonstrated the value of ethnographic methods for studying reactions to this kind of test, especially pre- and posttest counseling sessions. A total of 155 women between 14 and 61 years old, recruited in Miami in 1992 and 1993, participated. Response to testing identified three primary obstacles to the women's understanding of content presented in pre- and posttest counseling sessions: (1) their confusion about the meaning of positive versus negative, (2) the investigators' difficulty in communicating the concept of antibody, and (3) vagueness of the concept of window period between exposure and presentation of antibody. Retesting of a subset of Haitian participants helped to define sexual risk among these women in terms of having partners who had other partners and perception of supernatural risk.
AIDS Serodiagnosis↗
The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997.
OBJECTIVES: This study developed national estimates of the burden of selected infectious diseases among correctional inmates and releases during 1997. METHODS: Data from surveys, surveillance, and other reports were synthesized to develop these estimates. RESULTS: During 1997, 20% to 26% of all people living with HIV in the United States, 29% to 43% of all those infected with the hepatitis C virus, and 40% of all those who had tuberculosis disease in that year passed through a correctional facility. CONCLUSIONS: Correctional facilities are critical settings for the efficient delivery of prevention and treatment interventions for infectious diseases. Such interventions stand to benefit not only inmates, their families, and partners, but also the public health of the communities to which inmates return.
Acquired Immunodeficiency Syndrome↗
[Sexual impotence: clinical and existential context].
A simple classification in global impotence and erective impotence appears closer to reality than more sophisticated but more arbitrary classification. In the majority of cases, impotence reflects a global psychological dysfunction. Psychogenic impotents are most of the time inferiorized subjects alledging organic or other non justified factors to their disorder. Generally, they are peaceful, obsessive, often hypothymic; they express disgust for the body, suffer various somatic dysfunctions due to the sexual stasis; they have difficulties in communicating with things and beings. As compared to erective impotents, it seems that the global impotents have a more rigid father, are among the younger sibblings and have more brothers and sisters. The author describes further some observations of partners and of couples, as well as etiological and prognostic factors.
Aggression↗
Potential role of male community-based distributors in a family-planning programme in western Uganda: results of a pilot study.
The aim of this pilot study was to determine the differences in family-planning knowledge and compliance with programme guidelines among male and female community-based distributors (CBDs) of contraceptives in Kabarole district, Uganda. A semi-structured questionnaire was used for interviewing 70 CBDs. Results of interviews showed that the knowledge and compliance scores were not significantly associated with gender and age. The female clients of male CBDs were more likely to discuss family planning with their partners, and the female CBDs included other health topics more in their family-planning counselling. Both male and female CBDs had equal knowledge about family planning and equally complied with the established programme protocols. The male CBDs enhanced communication about family planning between spouses. If this could be confirmed, gender should be considered in the recruitment of new CBDs. The results suggest that male CBDs may have a unique role in promoting family planning effectively and in enhancing communication between spouses about family planning.
Community Health Workers↗
The effectiveness of mass media in changing HIV/AIDS-related behaviour among young people in developing countries.
OBJECTIVES: To review the strength of the evidence for the effects of three types of mass media interventions (radio only, radio with supporting media, or radio and television with supporting media) on HIV/AIDS-related behaviour among young people in developing countries and to assess whether these interventions reach the threshold of evidence needed to recommend widespread implementation. METHODS: We conducted a systematic review of studies that evaluated mass media interventions and were published or released between 1990 and 2004. Studies were included if they evaluated a mass media campaign that had the main objective of providing information about HIV/AIDS or sexual health. To be eligible for inclusion studies had to use a pre-intervention versus post-intervention design or an intervention versus control design or analyse cross-sectional data comparing those who had been exposed to the campaign with those who had not been exposed. Studies also had to comprehensively report quantitative data for most outcomes. FINDINGS: Of the 15 programmes identified, 11 were from Africa, 2 from Latin America, 1 from Asia, and 1 from multiple countries. One programme used radio only, six used radio with supporting media, and eight others used television and radio with supporting media. The data support the effectiveness of mass media interventions to increase the knowledge of HIV transmission, to improve self-efficacy in condom use, to influence some social norms, to increase the amount of interpersonal communication, to increase condom use and to boost awareness of health providers. Fewer significant effects were found for improving self-efficacy in terms of abstinence, delaying the age of first sexual experience or decreasing the number of sexual partners. CONCLUSIONS: We found that mass media programmes can influence HIV-related outcomes among young people, although not on every variable or in every campaign. Campaigns that include television require the highest threshold of evidence, yet they also yield the strongest evidence of effects. This suggests that comprehensive mass media programmes are valuable.
Adolescent↗
Single Thai women's interpersonal communication and mass media reception on AIDS.
This research examines young unmarried women's ways of talking about AIDS, AIDS prevention, and its relationship to mass media AIDS messages in Thailand. Data were derived from a survey conducted in four districts of Kanchanaburi province. Three hundred ninety-seven unmarried women were extracted from the approximately 1,800 original subjects for this analysis. Respondents were asked about the subjects and extent of their conversations about AIDS, the choice of discussion partners, considerations of social appropriateness in talking about the disease, as well as their risk perception. Important findings were that (a) women tend to talk about AIDS primarily with friends and siblings, (b) their reception level of mass media messages is related to the number of topics discussed and frequency of talks by the subjects, and (c) socioeconomic status and age are related to the variety and frequency of talking about AIDS. Implications for AIDS education are discussed.
Acquired Immunodeficiency Syndrome↗
Approaches for improving patient safety through a safety clearinghouse.
Creating this type of a program is a challenge and takes the time and commitment of key players. Most healthcare facilities have had systems and processes in place for years to "ensure quality." Inherent in those systems has been some ability to detect errors and to identify opportunities for improving quality of care. The next evolution of ensuring quality requires healthcare organizations to become far more proactive with error detection and correction systems. How? Becoming more openly and honestly communicative internally is an important first step. That means creating a nonpunitive environment that encourages staff members to report known or suspected problems. To do this most successfully requires not only involving members of the hospital staff who become aware of concerns, but also engaging patients and families as partners in the process. Healthcare organizations can learn much from patients and families about things that actually or almost go wrong. In turn, healthcare organizations owe patients and their families honesty when they know something has gone wrong that could or should have been prevented. Many healthcare organizations throughout the country are struggling with these new expectations from accreditors and consumers about disclosing medical errors to patients (and/or their families). Some may still even be questioning the need and/or the value of doing so. The Lexington VA Medical Center has been disclosing errors for approximately 10 years. The center has also been piloting proactive approaches to identifying and eliminating threats to patient safety (i.e., error-prone systems and processes). VAMC's experiences have demonstrated that both are clearly worth the effort.
Communication↗