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PubMed2007

Women's use of physical and nonphysical self-defense strategies during incidents of partner violence.

Two incidents of partner violence are investigated using qualitative methodology to discover strategies women use to protect themselves and examine women's use of violence. Data were collected from 447 women (age 18 or older) from 7 domestic violence programs and 5 substance use disorder treatment programs in a midwestern state. Women were found to have developed numerous self-protection strategies, some using nonphysical means only, others using physical means only, and others combining nonphysical and physical means. Women often used a variety of strategies in the same incident. Few women initiated violence against partners. Implications for theory and research are discussed.

Adaptation, Psychological↗
PubMed1999

The secret: study of a perverse transference.

This clinical communication describes the analysis of a perverse transference in an overtly bisexual man. An intricate interplay between heterosexual and homosexual relations enabled him to maintain some heterosexual functioning and to counteract or evacuate intolerable affects and vengeful impulses--originating from early traumas--through perverse acting out with sexual partners. Building on the notion that patients with sexual perversions recreate aspects of their perversion in the transference/countertransference relationship, where it must be analysed, the author illustrates through detailed clinical material how she was drawn into the fabric of her patient's perversion and how this was worked through. She offers an object-relational understanding of his perversion as a complex erotised defensive/reparative/vengeful manoeuvre permitting the disavowal and magical reversal into triumph and sexual pleasure of perceived threats to his personal or sexual identity. Engaging or changing in analysis evoked fears of losing his identity by surrendering to the analyst, rooted in the patient's early experience of serving as his mother's fetish-object. The author suggests that the patient needed to turn the analyst into a perverse partner (disavowing her other-ness) in order to reverse and triumph over this core trauma. She attributes the good treatment outcome to the detection and working through of the perverse transference and monitoring of her countertransference.

Adult↗
PubMed2005

Risk taking behavior and Sexually Transmitted Diseases: a study among men.

Sexually Transmitted Diseases (STDs) among men not only jeopardize their own health but also increase sexual morbidities among their spouses. STDs are primarily attributed to high-risk sexual behavior. The study was carried out among male patients attending the OPD of a Government dispensary. Risk taking behavior was assessed using a structured, pre-tested questionnaire and STDs were diagnosed using syndromic approach supported by laboratory investigations. Three hundred two men were selected by systemic random sampling for inclusion in the study. 39% had pre-marital sexual relationship, 20% had sex with Commercial Sex Workers. 12% of the married men had extramarital sex mostly with CSWs. 27% had more than one sex partner ever. Only 3.6% used condoms consistently. Thirteen per cent respondents had history of symptoms suggestive of STDs. Prevalence of syphilis, gonorrhea and other STDs among study subjects were 3.6%, 0.7% and 0.7% respectively. High risk sexual behavior is widely prevalent and STDs are also common. Behavior change communication and early diagnosis and prompt treatment of STDs will reduce the burden significantly.

Adolescent↗
PubMed1995

Future strategy for telepathology in Sweden: higher resolution, real time transmission in a multipurpose work station for diagnostic pathology.

The general reaction among Swedish pathologists to the nationwide experimentation static teletransmission of microscopic images can be briefly summarized as follows: "interesting, but technically imperfect: we need more friendly interface, faster transmission, preferably in real time, better resolution, and the possibility for slide operation by the receiver". In Sweden all Pathology laboratories are presently changing administrative routines to PC-platformed networks, which means that each pathologist has a microscope and a PC as obligatory tools to perform diagnostic work. Therefore, we plan to incorporate Telepathology, including picture archiving, along with administrative software and improved software for static DNA-measurements and morphometry. The latter is including a novel system for quantification of color images e.g. immunohistochemistry into a standard work-station for diagnostic pathology. The features of this technique are presented as well as the general outline of the work-station. Steps have been taken to build up and test such a work-station in the broad band (ATM) laboratories of the Ericsson Company and a cooperation with several Scandinavian partners in computer and teletechnology. Hopefully, similar competitive actions are taken elsewhere to help bring down the prices and facilitate adoption among diagnostic pathologists world-wide.

Computer Communication Networks↗
PubMedDate not supplied

Context trees: representing co-operative healthcare activities in IREP.

The IREP Project is based on the concept of 'rehabilitation programme' (LLP--Life Long Programme). It consists in a global vision of the patient's therapeutic-rehabilitative path, that is realised by the description, selection, adaptation and evaluation of generalised protocols. This paper discusses the issues arising in the definition of multidisciplinary rehabilitation programmes involving the co-operation of independent teams. A methodology to formalise and collect descriptions of programmes is presented. A programme is considered as a set of interconnected activities, represented as a graph of Activity Modules, organised in Context Trees; the resulting structured representation is the framework to implement timely and effective communication services in a global information system on rehabilitation. Based on this experience, a set of possible requirements for software tools to formalise and manage programmes have been suggested; it was the basis for the realisation of a first prototype under field test in a rehabilitation environment by other partners of the IREP Project.

Decision Support Techniques↗
PubMed1997

Human immunodeficiency virus risk behavior among white and Asian/Pacific Islander high school students in the United States: does culture make a difference?

PURPOSE: This article analyzes sexual behavior among white and Asian/Pacific Islander (API) adolescents, to determine the risk for human immunodeficiency virus (HIV) transmission from a multicultural point of view. METHODS: A total of 5,385 white and 408 API high school students were included. The national school-based Youth Risk Behavior Survey (YRBS 1991) was used. RESULTS: After controlling for academic performance, white students were 2.3 times more likely to communicate about acquired immunodeficiency syndrome (AIDS)/HIV, 2.7 times more likely to be sexually experienced, and 2.5 times more likely to use alcohol or other drugs before sex than APIs. There were no significant differences between these two groups in the age of initiating sex, the number of lifetime partners, the proportion of being currently sexually active (having had sex during the past 3 months), and condom use behavior. Although APIs had a low rate of AIDS/HIV, they have behaviors at as high a risk as white students once they became sexually experienced, and they have an even greater number of recent partners if they are currently sexually active. Use of alcohol or other drugs before sex and condom use is significantly related. CONCLUSIONS: Given the importance of attention to risks among API adolescents, this study underscores the need for more research to explore how culture values play a role among all API students, those who are sexually experienced, and those who are currently sexually active API students, to develop culturally sensitive AIDS/HIV prevention programs.

Adolescent↗
PubMed2001

E-health: transforming the physician/patient relationship.

Healthcare delivery is being transformed by advances in e-health and by the empowered, computer-literate public. Ready to become partners in their own health and to take advantage of online processes, health portals, and physician web pages and e-mail, this new breed of consumer is slowly redefining the physician/patient relationship. Such changes can effect positive results like improved clinical decision-making, increased efficiency, and strengthened communication between physicians and patients. First, however, physicians and the organizations that support them must fully understand their role in the e-health revolution. Both must advance their awareness of the new consumers and their needs and define specific action items that will help them realize the benefits of e-health. Through a combination of timely research and advice, this article will aid them in fulfilling both tasks.

Decision Making↗
PubMed2002

Bioelectrocatalysis by redox enzymes at modified electrodes.

Self-assembled monolayers of thiolated compounds are used as promoters for protein-electrode reactions. They provide an anchor group based on thiol chemisorptions and also a functional group for effective interaction with the protein. These interactions are often governed by electrostatic attraction. For example, for positively charged proteins, such as cytochrome c and the selenoprotein glutathione peroxidase, mercaptoalkanoic acids have been used. Clay modification of the electrode surface has been found to facilitate the heterogeneous electron transfer process for heme proteins, e.g. cytochrome c, cytochrome P450 and myoglobin. Interestingly, nucleic acids at carbon electrodes and thiol-modified double stranded oligonucleotides act as promoters of the redox communication to proteins, whereas the mechanism is still subject to controversy interpretations. By interacting the protein immobilised at the electrode with species in solution, signal chains have been constructed. The interaction can result in a simple co-ordination or redox reaction, depending on the nature of the reaction partners. For analytical purposes, e.g. biosensors, the electrochemical redox conversion of the immobilised protein is evaluated.

Biotechnology↗
PubMed2006

The biotin regulatory system: kinetic control of a transcriptional switch.

An organism's response to environmental and metabolic cues requires communication between transcription regulatory processes and "other" cellular events. In a number of biological control circuits, the communication is carried out by a single multifunctional protein that participates directly in transcription initiation and in at least one other cellular process. Structural studies suggest that the function of these proteins is dictated by the formation of mutually exclusive protein-protein interactions. However, the rules that govern partner, and thus functional switching, are not known. In the Escherichia coli Biotin Regulatory System, the bifunctional protein, BirA, catalyzes post-translational biotin addition to a biotin-dependent carboxylase and binds sequence-specifically to DNA to repress transcription initiation at the biotin biosynthetic operon. Previous structural and modeling studies suggest that BirA function is determined by formation of alternative homo- and heterodimeric protein-protein interactions. In this work, the BirA functional switch is investigated using DNaseI footprinting and MALDI-TOF mass spectrometry. Results of these measurements indicate that BirA can be selectively targeted toward its enzymatic function simply by increasing the kinetic probability of heterodimerization relative to that of homodimerization. Subsequent shifting to the DNA binding function occurs as the pool of heterodimer partner is depleted and homodimerization dominates. The data support a switching mechanism in which BirA's function is dictated by its probability of encountering a particular protein partner.

Acetyl-CoA Carboxylase↗
PubMed2006

[First-trimester-test--support-tool for the individual decision or screening-tool for public health planning?].

International studies about women's knowledge of the first-trimester-test show that they are quite often not sufficiently informed for their personal decision-making: The information needed is not given in an understandable way; they are not informed that the test is only a risk assessment and not a diagnosis; and they often don't understand the concept of false positive and false negative results. Other studies show, that this sophisticated and complex information about the first-trimester-test can be given in an understandable way. But even with adequate information most women are unable to make an informed choice as long as the test is presented as a routine for screening. However, for an informed and free choice, an individual decision-making-process has to take place. For this reason a counseling concept has been developed in Switzerland. It introduces the first-trimester-test not as a screening-tool for the public health planning but as a support-tool for the individual decision. It consists of an information brochure for the pregnant woman and her partner, a counseling framework for the physicians and a two days training program. The counseling concept has been evaluated by a research project of the Swiss National Science Foundation and has been adopted as an official counseling standard by the Swiss Society of Obstetrics and Gynaecology. Recommendations for the communication skills together with a short time training program were added, such that the concept can serve as an integrative tool for decision-making support concerning first-trimester tests.

Choice Behavior↗
PubMed1996

Integrating public health information and surveillance systems.

The Centers for Disease Control and Prevention (CDC) recognizes sound public health information is the essential ingredient of all of its work and the key to effective public health decision making. A CDC/ATSDR committee reached a consensus that CDC needed to streamline and consolidate its public health surveillance and information systems into an integrated system. With integrated systems, a wide range of diverse individual information systems will continue to exist but these systems must be coordinated, interconnected, comparable, and easy to use. The "glue" that holds these systems together consists of (1) uniform data standards, (2) communications networks, and (3) policy-level agreements regarding data access, sharing, and reduction of data collection burdens. By putting the appropriate policy-making apparatus and resources in place, CDC believes the end result will be a streamlined process that meets the information needs of CDC and its partners with less confusion and frustration.

Humans↗
PubMed2005

Initiation and continuation of breastfeeding: theory of planned behaviour.

AIMS: This paper reports a study investigating new mothers' subjective norms in relation to both breast- and bottle-feeding. The influence of norms on women's infant feeding decisions and the relative influence of social referents at varying degrees of social distance were assessed. BACKGROUND: Increasing breastfeeding initiation and continuation rates is a key challenge for health educators. The perceived influence of other people's views (subjective norms), including the views of women's partners and health care professionals, is an important predictor of infant feeding behaviour. METHODS: Semi-structured questionnaires were administered to 203 new mothers in central and northern Scotland and followed-up by postal questionnaire at 6 weeks. Infant feeding intentions, feeding behaviour at birth and follow-up, behavioural beliefs and subjective norms for both breastfeeding and bottle-feeding were assessed. The data were collected in 1998-1999. RESULTS: Subjective norms were important determinants of initiation and continuation of breastfeeding for breast- and bottlefeeders. Breastfeeders rated close social referents as more in favour of bottle-feeding and more against breastfeeding at follow-up, whereas bottlefeeders' ratings did not change. Partner's and nurses'/midwives' views were an important influence at baseline and follow-up. Breastfeeding 'continuers' perceived their partners as more pro-breastfeeding at 6 weeks. Discontinuers perceived more overall social pressure to bottle-feed. However, sampling limitations may have led to over-representation of the views of breastfeeders at baseline and follow-up. CONCLUSIONS: Nurses and midwives have a crucial role in communicating positive views on breastfeeding to new mothers at different time points. Future interventions to promote breastfeeding could adopt a broad social approach, encouraging positive norms for existing and potential mothers and fathers, families and people in general.

Adult↗
PubMed2002

Participation in screening for colorectal cancer based on a faecal occult blood test is improved by endorsement by the primary care practitioner.

OBJECTIVES: To investigate the influence of general practitioner (GP) endorsement on participation in screening for colorectal cancer based on a faecal occult blood test (FOBT). SETTING: South Australian residents (n=2400), in 1999, aged >50 years. METHODS: Random selection of three groups (GP1, GP2, GP3) from two general practices and of one group (ER) from the federal electoral roll; n=600 per group. Without previous communication or publicity, subjects were posted an offer of screening by immunochemical FOBT. The GP1 and ER groups were invited without indication that their GP was involved; GP2 received an invitation indicating support from the practice; and GP3 received an invitation on practice letterhead and signed by a practice partner. A reminder was posted at 6 weeks. Participation was defined as return of correctly completed FOBT sample cards within 12 weeks. RESULTS: Participation rates were: GP1 192/600 (32.0%), GP2 228/600 (38.0%), and GP3 244/600 (40.7%); chi(2)=10.2, p=0.006. Both GP2 and GP3 differed significantly from GP1 (odds ratio (OR) 0.77, 95% confidence interval (95% CI) 0.60 to 0.98 and relative risk (RR)=0.69, 95% CI 0.54 to 0.87 respectively). ER (193/600 (32.2%)) and GP1 were not significantly different. Age but not sex was significantly associated with participation. Overall test positivity rate was 4.6%; five malignancies were found in the 918 who performed FOBT. CONCLUSIONS: Association of a GP of recent contact with a screening offer in the form of a personalised letter of invitation achieves better participation than does the same letter from a centralised screening unit that does not mention the GP. Thus, GP enhanced participation is achievable without their actual involvement. Additional strategies are needed to further improve participation.

Age Factors↗
PubMed2003

Reproductive health risk and protective factors among unmarried youth in Ghana.

CONTEXT: In Ghana, as in many other Sub-Saharan African countries, the behaviors of the current cohort of adolescents will strongly influence the course of the HIV/AIDS epidemic. This study sought to identify factors associated with elevated risks of pregnancy and sexually transmitted infection among unmarried Ghanaian youth. METHODS: A nationally representative sample of 3,739 unmarried 12-24-year-olds were surveyed. Various regression techniques were used to assess the effects of individual and contextual factors on sexual behavior and condom use. RESULTS: Forty-one percent of female and 36% of male youth reported being sexually experienced. On average, sexually experienced youth had had fewer than two partners; only 4% of these females and 11% of males had had more than one sexual partner in the three months before the survey. Although Ghanaian youth are knowledgeable about condoms, only 24% of sexually experienced males and 20% of females reported consistent condom use with their current or most recent partner. A sizable number of contextual factors and attributes of youth themselves were associated with sexual behaviors, while individual characteristics were stronger predictors of condom use. CONCLUSIONS: The findings provide further justification for interventions targeting key contextual factors that influence youth behaviors in addition to providing youth with necessary communication, negotiation and other life skills.

Adolescent↗
PubMed1992

Does the codependent encourage substance-dependent behavior? Paradoxical injunctions in the codependent relationship.

It is argued that the paradoxical nature of the power structure within the codependent relationship places limits on the types of control strategies that codependents can utilize in their attempts to extinguish their partner's substance-dependent behavior. From a social exchange and learning theory perspective, it is argued that the types of control strategies that codependents utilize are not only ineffective, but they actually operate to strengthen the likelihood that substance misuse will be repeated in the future. Types of communication behaviors that codependents utilize in order to control are considered, along with ensuing implications for intervention.

Codependency, Psychological↗
PubMed2026

Teach-Back in Clinical Communication: A Systematic Review and Meta-analysis.

BACKGROUND: Teach-back has been identified as a high-quality clinical communication strategy. Our aim was to synthesize current literature on teach-back effectiveness. METHODS: We searched MEDLINE, Embase, and CINAHL Complete databases to identify relevant studies published between 2018 and 2026. We also included pre-2018 studies identified in prior systematic reviews. Studies were eligible for inclusion if they involved adult patients and/or care partners, delivered teach-back in a single encounter, had a comparator group, and reported proximal/intermediate patient outcomes (as defined in our conceptual model). Two independent investigators screened each citation at the title/abstract and full-text levels and assessed risk of bias. Study characteristics and results were extracted. When meta-analysis was performed, we used standardized mean differences (SMD) to estimate summary effects. We assessed certainty of evidence (COE) using Grading of Recommendations Assessment, Development and Evaluation (GRADE) domains. RESULTS: Our systematic review included 18 randomized controlled trials (RCTs) involving 1985 participants. Across 9 RCTs assessing knowledge acquisition, conceptual inconsistencies precluded meta-analysis. Overall, there was no clear pattern of the effect of teach-back on knowledge (very low COE). In a meta-analysis of 5 RCTs assessing self-efficacy (416 participants), we found that teach-back interventions led to a large increase in self-efficacy relative to usual care (SMD = 2.40; 95%CI 0.37-4.44) (very low COE). In a meta-analysis of 7 RCTs assessing adherence to health behaviors (571 participants), teach-back interventions led to a large increase in adherence (SMD = 1.04; 95%CI 0.45-1.64) (low COE). Meta-analyses for both self-efficacy and adherence had large confidence intervals that ranged from small to large effect sizes and had substantial heterogeneity. DISCUSSION: In this systematic review and meta-analysis, we did not identify a clear benefit of teach-back on knowledge acquisition but did find evidence that teach-back improves self-efficacy and self-reported, short-term adherence to health behaviors.

clinical communication↗
PubMed1993

STDs and the overseas traveller.

Although most HIV and STD patients acquire their infections in Australia there is an increase in the numbers diagnosed with these infections after international travel. Risks to the sexual health of the travellers and their subsequent partners are discussed and suggestions made for minimising risks.

Asia↗
PubMed2007

Men who have sex with men: perceptions about sexual risk, HIV and sexually transmitted disease testing, and provider communication.

OBJECTIVES: This study was designed to gain a deeper understanding of the barriers and facilitators related to sexually transmitted diseases (STDs) and HIV screening among at-risk Boston men who have sex with men (MSM). STUDY DESIGN: The cohort was recruited by a modified respondent-driven sampling technique and used one-on-one semistructured interviews and a quantitative survey to examine participants' understanding of STDs and HIV, perceptions of risk for disease, reasons for getting (or not getting) tested, and experiences with testing. RESULTS: The study found that although most of the MSM knew the signs and symptoms of HIV, they were less familiar with STDs. MSM were most likely to be screened if they had symptoms or were told by a partner of a recent exposure. However, many barriers to STD/HIV screening among MSM still exist, including lack of awareness of symptoms, misperceptions about the ways STDs are transmitted, and perceived impediments from the healthcare system, including misgivings about provider sensitivity. CONCLUSIONS: To decrease current increases in HIV/STDs among MSM, new strategies that include community and provider education are needed.

Adult↗