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The social constructions of sexuality: marital infidelity and sexually transmitted disease-HIV risk in a Mexican migrant community.

OBJECTIVES: This article explores the social context of the migration-related HIV epidemic in western Mexico. METHODS: Data collection involved life histories and participant observation with migrant women in Atlanta and their sisters or sisters-in-law in Mexico. RESULTS: Both younger and older women acknowledged that migrant men's sexual behavior may expose them to HIV and other sexually transmitted diseases.Younger Mexican women in both communities expressed a marital ideal characterized by mutual intimacy, communication, joint decisionmaking, and sexual pleasure, but not by willingness to use condoms as an HIV prevention strategy. CONCLUSIONS: Migrant Mexican women's commitment to an illusion of fidelity will hinder HIV prevention initiatives targeted toward them. Furthermore, the changing meanings of marital sex may make it harder to convince young couples to use condoms as an HIV prevention strategy. If the chain of heterosexual marital HIV transmission is to be interrupted in this community, prevention programs must target men.

Communication↗

Developing a European Internet and kiosk-based health information system.

A consortium of partner organisations (universities, health care organisations and information technology companies) from Northern Ireland, Germany, Portugal and Italy have collaborated to develop a multi-lingual, multi-media Internet and kiosk-based health information system in cardiology and skin cancer. The project, CATCH II (Citizens Advisory System based on Telematics for Communication and Health), has been funded by the European Commission under the Fourth Framework Research and Development TELEMATICS Applications Program (TAP), Health Care Sector. In this paper we provide an overview of the system and the methodological approach adopted. Key characteristics with respect to the technical architecture and flexible customisation of different web and kiosk-based versions will be presented. In particular, the development of dedicated software for the procurement, structuring and management of the information knowledge-base is illustrated. Some of the most interesting findings from a cross-national study of health information needs on the internet are presented along with information on the validation of the system by the general public, content providers and health care authorities.

European Union↗

The regulatory challenge.

The concepts of drug regulation should ideally be derived from an appropriately defined and broadly agreed national drug and health policy, according to health needs, relevant criteria and the local circumstances. The major long term challenge emerging from these concepts is how to establish a sufficiently comprehensive and functional drug and therapeutic audit as a basis for regulatory and other decisions within the health chain that strike a balance between sociomedical and economic requirements. Such an audit involves three sequential phases: collection and compilation of all relevant facts and premises; data organisation and analyses by competent auditors and decision, implementation, and re-evaluation with subsequent adjustments. Despite extensive international and national efforts during recent years, only fragmentary solutions exist, and only in a few countries. Thus, another major challenge still remains: how to weight and integrate the sometimes quite conflicting interests and scopes of politicians, administrators, the teaching institutions, the health professions, the pharmaceutical manufacturers--and the consumers. All the partners involved have to emphasise that the problems behind the present miseries of global drug use are basically of political and economic nature, although there are considerable limitations imposed by widely varying attitudes and deficient knowledge and criteria. Thus there is a need for joint action and a strengthening of collaboration and communication combined with the best possible elements of professional skills and common sense.

Drug-Related Side Effects and Adverse Reactions↗

Physical, sexual and emotional violence against women: a general practice-based prevalence study.

OBJECTIVE: To determine the prevalence of domestic violence, childhood abuse and sexual assault experienced by women attending general practitioners. DESIGN: A cross-sectional, questionnaire-based prevalence survey. SETTING: 15 general practices in metropolitan Melbourne between November 1993 and February 1994. SUBJECTS: 3026 women over the age of 18 attending for a consultation. RESULTS: The response rate was 72%. Over a quarter of women in relationships had been victims of physical or emotional partner abuse in the previous year, one in 10 having experienced severe physical violence. Thirteen percent of women had experienced rape or attempted rape, 10% had been severely beaten during childhood and 28% had experienced childhood sexual abuse involving physical contact. The abuse had been disclosed to the woman's doctor by only 27% of those who had experienced partner or childhood physical abuse (mostly because the doctor had never asked) and 9% of those who had experienced sexual abuse (mostly because the woman did not see it as relevant to the consultation). CONCLUSION: There is a high prevalence of physical, sexual and emotional violence against women as well as poor communication about this violence to their general practitioners. RECOMMENDATION: Medical practitioners should be more proactive in questioning women about violence.

Adult↗

Effects of intoxication on alcoholics' marital communication and problem solving.

The effects of intoxication on the marital interactions of treatment-motivated alcoholics and their nonalcoholic spouses were studied in eight couples (two of which had an alcoholic wife). In half of the sessions, the alcoholics were given enough alcohol to reach a blood level of 10 mg/dl. Couples engaged in three 10-min conflict-resolution discussions of varying intensity counterbalanced for alcohol and no-alcohol sessions. Couples expressed significantly more positive verbalizations in the alcohol sessions than in the no-alcohol sessions. This was true especially for the nonalcoholic spouses, who doubled their rate of positive verbal behavior when interacting with an intoxicated partner. Alcoholics spoke more and tended to make more problem-describing statements while intoxicated than while sober. The alcoholics made a greater number of problem-solving statements than did their spouses. Alcoholics were significantly more negative and less positive in nonverbal behaviors than were their spouses, but neither self-report of marital satisfaction nor observations of verbal behavior reflected this. The models of both social-learning theory and systems theory for the relationship of marital factors to the etiology and maintenance of alcoholism are supported.

Adult↗

Tonkean macaques ( Macaca tonkeana) find food sources from cues conveyed by group-mates.

It is possible that non-specialised cues transmitted by conspecifics guide animals' food search provided they have the cognitive abilities needed to read these cues. Macaques often check the mouth of their group-mates by olfactory and/or visual inspection. We investigated whether Tonkean macaques ( Macaca tonkeana) can find the location of distant food on the basis of cues conveyed by group-mates. The subjects of the study were two 6-year-old males, who belonged to a social group of Tonkean macaques raised in semi-free-ranging conditions. In a first experiment, we tested whether the subject can choose between two sites after having sniffed a partner who has just eaten food corresponding to one of the sites. We found that both subjects were able to choose the matching site significantly above the chance level. This demonstrated that Tonkean macaques are capable of delayed olfactory matching. They could associate a food location with an odour conveyed by a partner. In a second experiment, the same subjects were allowed to see their partner through a Plexiglas window. Both subjects were still able to choose the matching site, demonstrating they could rely on visual cues alone. Passive recruitment of partners appears possible in macaques. They can improve their foraging performances by finding the location of environmental resources from olfactory or visual cues conveyed by group-mates.

Animal Communication↗

Spatial perspective-taking in conversation.

Speakers can describe the locations of objects from their own perspective ("on my left" or "on the left"), their addressee's ("on your right" or "on the right"), or some perspective that avoids choosing one or the other person ("closer to both of us"). This study shows that speakers set spatial perspectives differently with actual conversational partners than with the usually studied imaginary addressees. Speakers with partners tended to use more egocentric perspectives than solo speakers. Pairs varied idiosyncratically in the perspective-setting strategies they picked, but all engaged in the same collaborative process: talking until both were sure they had understood each other. When conversational roles switched, the new speakers allocated spatial perspectives with remarkable precision, taking their partners' perspectives just as often as the partner had taken theirs. Speakers were more explicit about whose perspective they were taking when they held the floor for only one description than when they gave many descriptions in a row.

Communication↗

Reproductive health needs and the reproductive health behaviour of the youth in Mangaung in the Free State province: a feasibility study.

From the community profiles conducted by nursing students in Mangaung, the following observation was prevalent: an increase in the prevalence of teenage pregnancy together with a high prevalence of HIV infection was demonstrated. The relationship between young people's reproductive behaviour and the prevalence of HIV is well documented. To address this problem, a community -based education programme is required. Developing a successful community-based educational programme that addresses the needs of youth requires that such a programme be based on the needs of such a group. The research question is applicable: How do youth in Mangaung in the Free State province in South Africa perceive their reproductive health needs and their reproductive health behaviour? The aim of this article is to explore and describe the reproductive health needs and the reproductive health behaviour of the youth in Mangaung. A quantitative research design that is descriptive and explorative in nature was conducted. The reproductive health needs and the reproductive health behaviour of the youth were collected by means of a structured questionnaire with open-ended and closed questions. A purposive non - probability sampling method was utilized and (n=250) drawn from the youth. The justification of the sample was further enhanced by collecting data from youth aged 13-25 at three high schools in Mangaung and at the health centre of MUCPP. Qualitative data obtained from open-ended questionnaires was coded and analyzed by using Tech's (1990) content analysis approach. A descriptive statistical analysis was performed on the quantitative data from closed questions. A descriptive analysis of the participant's ages and their perceived reproductive health needs and reproductive health behaviour was done. The mean age of the participants was 18.6, which could be because all the respondents were of school- going age. The results indicated that the youth received insufficient reproductive health information to be able to prevent pregnancy and HIV/AIDS. The special needs of youth were indicated by 92% who requested that the clinic should accommodate both boys and girls and 96% of the respondents requested sessions for discussions facilitated by a professional person. A total of 95% of the youth requested that a special programme of activities be conducted during school holidays. The risk behaviours practised by the youth were: having sex with a stranger, many partners, drinking alcohol, and using drugs and dagga. The researcher recommends that such a programme be supported by different university departments and rolled out to different

Adolescent↗

The burden of care: the impact of HIV-associated dementia on caregivers.

It has been suggested that up to 15% of patients with AIDS may develop HIV-associated dementia. The syndrome may be either abrupt or insidious and is characterized by poor prognosis. Increasing cognitive impairment will necessitate the patient receiving a substantial amount of care and support in the community in addition to medical treatment and periods of hospitalization. The impact of caregiver burden is reasonably well documented in Alzheimer's disease, but there is a dearth of literature relating to caregiving and HIV-associated dementia. The current investigation is an observational study based on a small group of individuals which evaluates the experiences of these particular individuals as they care for their partner, friend, or son with HIV-associated dementia. The caregivers experience the stresses described in the non-HIV dementia literature; however, the nature of HIV disease means that there are issues involved in caring for this patient group that distinguish it from other types of dementia care; these include difficulties relating to specific HIV medical problems and problems with service shortfalls. The caregiver is more likely to be a parent or partner than a child of the patient due to the early age onset seen in this disease compared with Alzheimer's disease. Caregivers express their need for information about dealing with the everyday physical, behavioral, and emotional challenges and about services and benefits available. The interviewees expressed concerns over a perceived lack of communication and information from professionals involved in the patient's care and in the provision of services. The study offers an insight into the relevant issues affecting such caregivers and suggests areas of unmet needs that might be addressed in future service provisions.

AIDS Dementia Complex↗

Quality of care in sexually transmitted diseases in Zambia: patients' perspective.

The aims of this study were to describe Zambian STD patients response to treatment, compliance with partner notification, and further to measure patients' satisfaction with the health care received. The majority of 179 STD patients (92 men, 87 women) interviewed twice at an urban health centre were not satisfied with the care received. Their response to treatment and compliance with partner notification were not satisfactory. Thirteen patients had not been able to buy medicines, since they had no money. One hundred and twenty-five patients had asked 134 sexual partners to come for treatment but only 60 percent of them had received treatment. To get free medicines, to have privacy, to get injections instead of tablets, to be examined before treatment, and to be informed about the diagnosis were judged most important for good quality STD care. Health workers must improve their communication and counselling skills to understand the needs of their patients, who are the ultimate evaluators of the quality of care.

Adolescent↗

Developmental epidemiology: the perfect partner for clinical practice.

Outlines the complimentary and, at times, the seemingly contradictory relation between developmental epidemiology and the practice of clinical child psychology from the perspective of a clinical child psychologist. I argue that, although there has been a perception of tension between clinical practice and epidemiological research, the two are, in fact, closely related. Epidemiology can contribute to clinical practice by advancing psychology as a primary care profession, informing case conceptualization, and facilitating psychologists' communication with the public. Clinicians, in turn, can help advance the field of epidemiology by using clinical observations to inform the design of epidemiological studies and providing solid theoretical modeling for epidemiological research.

Adolescent↗

Talking Wellness: a description of a community-academic partnered project to engage an African-American community around depression through the use of poetry, film, and photography.

The design, implementation, and preliminary evaluation of an enhanced community-engagement program that uses poetry, film, and photography at a film festival in south Los Angeles is described. This project is one of several Talking Wellness projects designed to develop social capital and enhance community engagement in projects designed to improve the community's capacity to communicate effectively about depression, to decrease the associated stigma, and to participate in the design and evaluation of research interventions. The high degree of collaboration in the development and evaluation of this community participatory research model is illustrated by describing the selection and design of the intervention and the development of the survey questionnaires used for data collection. The project is described from the perspective of community members involved in the process.

Adult↗

National plan for reliable tuberculosis laboratory services using a systems approach. Recommendations from CDC and the Association of Public Health Laboratories Task Force on Tuberculosis Laboratory Services.

Since the mid-1990s, public health laboratories have improved tuberculosis (TB) test performance, which has contributed to the resumption of the decline in TB incidence in the United States. However, to eliminate TB in the United States, further improvements are needed in laboratory services to support TB treatment, prevention, and control. A critical step is the development of an integrated system that ensures prompt and reliable laboratory testing and flow of information among laboratorians, clinicians, and TB-control officials. Challenges to developing such a system include 1) establishing lines of communication among laboratorians, clinicians, and TB-control officials; 2) expediting reporting of laboratory results, which can avoid delayed or inappropriate treatment and missed opportunities to prevent transmission; 3) developing evidence-based recommendations for use of new laboratory technologies; 4) maintaining staff proficiency in light of declining numbers of specimens to test, workforce shortages, and loss of laboratory expertise; and 5) upgrading laboratory information systems and connecting all partners. The report of the Association of Public Health Laboratories Task Force presents a framework to improve the future of TB laboratory services and describes the role of the laboratory in TB treatment and control, Task Force processes, general principles and benchmarks, and steps for the dissemination of the Task Force recommendations. This MMWR expands on the Task Force report by describing specific actions and performance measures to guide development and implementation of an integrated system for providing TB laboratory services. CDC and the Association of Public Health Laboratories have developed these guidelines so that laboratorians, clinicians, public health officials, administrators, and funding entities can work together to ensure that health-care providers and TB-control officials have the information needed to treat TB patients, prevent TB transmission, and ultimately eliminate TB in the United States.

Clinical Laboratory Information Systems↗

Knowledge about condoms among low-income pregnant Latina adolescents in relation to explicit maternal discussion of contraceptives.

PURPOSE: To examine pregnant adolescents' conceptual knowledge about condom use and its relation to maternal implicit and explicit communication about contraceptives. METHODS: Forty-five pregnant Latina adolescents (aged 14 to 18 years) were interviewed regarding their knowledge about how condoms prevent pregnancy. In addition, the adolescents were videotaped having a conversation with their mothers (23 English-speaking, 22 Spanish-speaking) about dating and sexuality, which was coded for maternal explicit and implicit messages about contraception. RESULTS: A more detailed, accurate understanding of how condoms work, and the ability to explicitly describe that knowledge, was associated with adolescents reporting higher levels of confidence about using condoms, and increased comfort talking to partners about condoms. Mothers' explicit mention of contraception was related to their adolescents having detailed, accurate information about condoms. Among Spanish-speaking dyads only, maternal explicit messages were associated with adolescents using more explicit terminology in describing their knowledge. CONCLUSIONS: Study results have implications for intervention with a high-risk population of Latina mothers and adolescents. The study also highlights the importance of examining specific aspects of knowledge, namely conceptual, biological knowledge.

Adolescent↗

Co-financing as a means to improve collaboration between primary health care, social insurance and social service in Sweden. A qualitative study of collaboration experiences among rehabilitation partners.

Collaboration between services has often been suggested as a means to increase effectiveness and reduce costs especially in the care and rehabilitation of long-term illness. In Sweden, a special legislation named SOCSAM was introduced in 1994, enabling financial collaboration between governmental and municipal authorities. In this paper we report on a qualitative study on collaboration around patients with musculoskeletal diseases. The aim of the study was to assess differences in goal formulation, collaboration and communication between staff in intervention health centres that have implemented co-financing projects and health centres working under conventional conditions. Focus group interviews were performed with staff at intervention and control health care centres. We found that the interdisciplinary collaboration had improved in the intervention health care centres compared to the controls. Our findings suggest that co-financing can enhance development of better forms of interdisciplinary and interorganisational collaboration through legitimising formulation of common long-term goals, while emphasising mutual benefits.

Cooperative Behavior↗

Synaptic connections of neurones identified by Golgi impregnation: characterization by immunocytochemical, enzyme histochemical, and degeneration methods.

For more than a century the Golgi method has been providing structural information about the organization of neuronal networks. Recent developments allow the extension of the method to the electron microscopic analysis of the afferent and efferent synaptic connections of identified, Golgi-impregnated neurones. The introduction of degeneration, autoradiographic, enzyme histochemical, and immunocytochemical methods for the characterization of Golgi-impregnated neurones and their pre- and postsynaptic partners makes it possible to establish the origin and also the chemical composition of pre- and postsynaptic elements. Furthermore, for a direct correlation of structure and function the synaptic interconnections between physiologically characterized, intracellularly HRP-filled neurones and Golgi-impregnated cells can be studied. It is thought that most of the neuronal communication takes place at the synaptic junction. In the enterprise of unravelling the circuits underlying the synaptic interactions, the Golgi technique continues to be a powerful tool of analysis.

Animals↗