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PubMed2003

Talking dirty: how to save a million lives.

Infectious diseases are still the number one threat to public health in developing countries. Diarrhoeal diseases alone are responsible for the deaths of at least 2 million children yearly - hygiene is paramount to resolving this problem. The function of hygienic behaviour is to prevent the transmission of the agents of infection. The most effective way of stopping infection is to stop faecal material getting into the child's environment by safe disposal of faeces and washing hands with soap once faecal material has contaminated them in the home. A review of the literature on handwashing puts it top in a list of possible interventions to prevent diarrhoea. Handwashing with soap has been calculated to save a million lives. However, few people do wash their hands with soap at these critical times. Obtaining a massive increase in handwashing worldwide requires a sea-change in thinking. Initial results from a new programme led by the World Bank, with many partner organisations, suggest that health is low on people's list of motives, rather, hands are washed to remove dirt, to rinse food off after eating, to make hands look and smell good, and as an act of motherly caring. Professional consumer and market research agencies are being used to work with the soap industry to design professional communications programmes to reach whole populations in Ghana and India. Tools and techniques for marketing handwashing and for measuring the actual impact on behaviour will be applied in new public-private handwashing programmes, which are to start up soon in Nepal, China, Peru and Senegal.

Adult↗
PubMed1991

Boundaries as distance regulators in personal relationships.

Received wisdom suggests that boundaries are, or should be, important in intimate relationships. In this essay, we focus primarily upon the beliefs and phenomenology relating to a variety of boundaries, and provide a discussion of some conceptual issues, in order to understand better the development, facilitation, and maintenance of, as well as restraints upon, intimacy. Although we attend mainly to dyadic relationships, we believe that our observations and suggestions have application to larger groups.

Communication Barriers↗
PubMed2006

Efficacy of an HIV prevention program among female adolescents experiencing gender-based violence.

OBJECTIVES: We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. METHODS: In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. RESULTS: Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. CONCLUSIONS: Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence.

Adolescent↗
PubMedDate not supplied

Case study: improving efficiency in a large hospital laboratory.

Saint Francis Health System (SFHS) consists of three hospitals and one clinic: Saint Francis Hospital (SFH); Broken Arrow Medical Center; Laureate Psychiatric Hospital; and Warren Clinic. SFHS has 670 physicians on staff and serves medical (oncology, orthopedic, neurology, and renal), surgical, cardiac, women and infant, pediatric, transplant, and trauma patients in Tulsa County, Oklahoma, which has a population of 660,000. SFH incorporates 706 staffed beds, including 126 pediatric beds and 119 critical care beds. Each year, the health system averages 38,000 admissions, 70,000 emergency department visits, 25,000 surgeries, and 3,500 births. Saint Francis Laboratory is located within the main hospital facility (SFH) and functions as a core lab for the health system. The lab also coordinates lab services with Saint Francis Heart Hospital, a physician-system joint venture. The Optimal Equipment Configuration (OEC) Project was designed by the Clinical Laboratory Services division of Premier, a group purchasing organization, with the goal of determining whether laboratories could improve efficiency and decrease unit cost by using a single-source vendor. Participants included seven business partners (Abbott, Bayer, Beckman/Coulter, Dade/Behring, J&J/ Ortho, Olympus, and Roche) and 21 laboratory sites (a small, mid-sized, and large site for each vendor). SFH laboratory staff embraced Premier's concept and viewed the OEC project as an opportunity to "energize" laboratory operations. SFH partnered with Abbott, their primary equipment vendor, for the project. Using resources and tools made available through the project, the laboratory was re-engineered to simplify workflow, increase productivity, and decrease costs by adding automation and changing to centralized specimen processing. Abbott and SFH shared a common vision for the project and enhanced their partnership through increased communication and problem solving. Abbott's area representatives provided for third-party design expertise and quarterly metric reporting through Argent Consulting. Abbott incorporated lessons learned from the SFH OEC project with organizational changes to improve the way they work with customers. Following is a step-by-step description of the OEC project to allow others to benefit from the experience (Figure 1).

Efficiency, Organizational↗
PubMedDate not supplied

AIDES to improving medication adherence in older adults.

Medication regimens for older adults are often complex and costly. Designing, implementing, and maintaining an appropriate treatment regimen is challenging. The AIDES method is built on the principles of completing a comprehensive medication Assessment; partnering with patients to ensure Individualization of the regimen; choosing appropriate Documentation; providing accurate and ongoing Education tailored to the age group and needs of the individual; and continuing Supervision after initiation.

Aged↗
PubMed2000

Affect and behavioral involvement in spousal complaints and compliments.

The authors explored affect and behavioral involvement (gaze, talk time, and speaking turns) in spousal complaints and compliments, relating these constructs to current and longitudinal relational well-being. Participants were 65 married couples. Concurrent relational well-being was higher when partners negotiated (a) complaints with less negative affect, more gaze, less wife talk time, and more husband talk time and (b) compliments with less negative affect and more husband gaze. Husbands' satisfaction decreased over time when they experienced more negative affect while complimenting. Both spouses' satisfaction decreased over time when either partner, especially wives, took more speaking turns complaining. Partial support for the sentiment-override effect is discussed, but findings went beyond the effect to demonstrate contingent affect when responding to spousal behaviors.

Adult↗
PubMed2001

Patterns of elderly spousal caregiving in dementia care: an observational study.

AIM: The aim of this study was to describe which caring activities eight spouses performed when caring for a partner with dementia, and in what way these activities were carried out. BACKGROUND: Family caregivers are recognized as being the primary source of care for the community's older people. The largest group is comprised of spouses, with wives as the predominant caregivers. This informal care seems to be more or less invisible and performed in silence within the family. Despite the wealth of studies, the essence of family caregiving is not well understood. METHODS: Data collection was conducted by observing the dyads in their homes. A qualitative approach inspired by grounded theory was chosen to discover qualities and describe patterns of spousal caregiving in dementia care. RESULTS: The analysis yielded four broad themes, which included nine categories. Findings from the study shed some light on the invisible aspects besides the traditional hands-on caregiving. CONCLUSION: The elderly carers were engaged in demanding and time-consuming care ranging from supervision to heavy physical responsibility. They were caring for as well as about their partners. The study also showed that spouses were successful in managing their situation in different ways. The results reported in this article are unique as they come from direct observations in family home settings where a spouse cared for a partner with dementia. Knowledge about family caregiving is valuable for nurses as there is an emphasis on collaboration between family caregivers and professionals.

Activities of Daily Living↗
PubMed2005

Community-academic research on hard-to-reach populations: benefits and challenges.

In this article, the authors examine some of the benefits and challenges associated with conducting research on hard-to-reach/hidden populations: in this instance, sex workers. The population studied was female and male sex workers working in different sectors of the sex industry in a medium-size Canadian metropolitan area. The authors describe the need for close community-academic cooperation, given the hidden and highly stigmatized nature of the target population that was investigated and the local context in which the research project was embedded. The authors discuss the main benefits and challenges of the research collaboration for the various parties involved, including the community partner organization, indigenous research assistants, and academic research team. They conclude with a discussion of strategies to help overcome the main challenges faced during the research endeavor.

Adult↗
PubMedDate not supplied

Partners' perspective of erectile dysfunction: literature review.

Erectile dysfunction is a problem which men may or may not share with their partners for a variety of reasons. This literature review of 26 articles revealed the partners' perspective of men with erectile dysfunction. Partners fell into four groups: supportive partner/acceptable to patient (the optimum category); supportive partner/unacceptable to patient; non-supportive partner/acceptable to patient; and non-supportive partner/unacceptable to patient. With comprehensive education and counselling by urology nurses, the couples could move into the optimal category. There is increasing recognition that the partner should be involved in the assessment, diagnosis, patient education, counselling and choice of treatment for long-term treatment to be successful, unless the informed patient is unwilling.

Adaptation, Psychological↗
PubMed1990

Using condoms in the age of AIDS: a phenomenological study with marketing implications.

The authors examine respondents' potential reactions to the suggestion of condom usage by and to their sex partner. Results indicate that when a sex partner suggests condom use, individuals may react with a feeling of shared responsibility and/or look favorably upon the suggesting partner. In contrast, persons who suggest condom usage may be questioning their partner's past and envisioning a short-term relationship. The effects of individual-difference variables on feelings about condom usage are described and implications for marketing are delineated.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Promoting AIDS risk reduction via behavioral training.

The present study employed behavioral techniques to teach assertive strategies designed to reduce the risk of contracting AIDS and to promote "safer-sex" behaviors. A total of 79 university students (38 male and 41 female) were included in the final data analysis. Subjects participated in three one-hour training sessions which included live modeling of assertive interactions, role-playing, behavior shaping, corrective feedback, verbal reinforcement, assertiveness training, and an AIDS educational lecture. Dependent measures included ratings of the key components of assertive behavior from videotaped role-plays at pre- and posttests. Behavioral training had a positive effect on participants' assertive behavior. On the role-play ratings, experimental subjects were rated higher on overall assertiveness than the controls. Even brief behaviorally based educational interventions can produce increases in assertive behaviors known to be related to AIDS prevention, for example, insisting on condom use and requesting information about a prospective partner's sexual and drug use histories. Behavior changes extended to in vivo situations, of course, remain less assured.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Neuroendocrine and immune system interactions in stress and depression.

Based on the extensive characterization of communication pathways between the nervous system and the immune system, there has been increasing interest in the impact of the nervous system on the development and expression of disorders involving the immune system and the contribution of the immune system to psychiatric disease. A vast literature has documented the impact of various stressors on a wide array of immune partners, and the specific neuroendocrine pathways involved have been elucidated. The impact of cytokines on neuroendocrine function and behavior has also been determined, and the relevance of cytokines to the pathophysiology of depression has become an exciting new research frontier. This article provides a foundation for integrating neuroendocrine-immune interactions into the formulation of neuropsychiatric and immunologic disease.

Depression↗
PubMed2003

Alexithymia is inversely associated with women's frequency of vaginal intercourse.

The study examined the relation between frequency of penile-vaginal intercourse (FSI; contrasted with other sexual behavior) and alexithymia (difficulty recognizing, identifying, and communicating emotions, reduced fantasy capacity, and an externally oriented cognitive style). To minimize response bias, persons scoring above the 86th percentile on the Eysenck Personality Inventory Lie scale were excluded. Participants (54 female and 39 male healthy young adults) completed the German version of the Toronto Alexithymia Scale (TAS-20), and provided both recall and diary measures of FSI, partner sex without vaginal intercourse, and masturbation. For women, TAS-20 scores were inversely associated with both recall and diary measures of FSI but not other sexual behavior. For men, TAS-20 scores were unrelated to all sexual behavior measures. Thus, for normal women but not men, alexithymia was specifically associated with lower FSI. Results are discussed in terms of the unique nature of penile-vaginal intercourse, emotional integration and sexuality, and both less alexithymia and greater FSI being associated with indices of better physical and psychological health.

Adult↗
PubMed2005

Lipid rafts and regulation of the cytoskeleton during T cell activation.

The ability of polarized cells to initiate and sustain directional responses to extracellular signals is critically dependent on direct communication between spatially organized signalling modules in the membrane and the underlying cytoskeleton. Pioneering work in T cells has shown that the assembly of signalling modules critically depends on the functional compartmentalization of membrane lipids into ordered microdomains or lipid rafts. The significance of rafts in T cell activation lies not only in their ability to recruit the signalling partners that eventually assemble into a mature immunological synapse but also in their ability to regulate actin dynamics and recruit cytoskeletal associated proteins, thereby achieving the structural polarization underlying stability of the synapse-a critical prerequisite for activation to be sustained. Lipid rafts vary quite considerably in size and visualizing the smallest of them in vivo has been challenging. Nonetheless it is now been shown quite convincingly that a surprisingly large proportion-in the order of 50%-of external membrane lipids (chiefly cholesterol and glycosphingolipids) can be dynamically localized in these liquid ordered rafts. Complementary inner leaflet rafts are less well characterized, but contain phosphoinositides as an important functional component that is crucial for regulating the behaviour of the actin cytoskeleton. This paper provides an overview of the interdependency between signalling and cytoskeletal polarization, and in particular considers how regulation of the cytoskeleton plays a crucial role in the consolidation of rafts and their stabilization into the immunological synapse.

Actins↗
PubMed2002

Reconciling messages: the process of sexual talk for Latinas.

Young Latinas' experiences and meanings of sexuality were explored through 31 interviews, with grounded theory used to provide theoretical understanding of sexual talk. The women's level of comfort with sexual talk and their explicitness influenced the kind of sexual talk they engaged in with partners. The analysis of being in a romantic relationship revealed similar descriptions of processes within the accounts that led to the discovery of the core variable reconciling messages. This describes the Latinas' process of accepting messages that fit their value system, rejecting messages that theyfeel misrepresent their beliefs, and altering messages to accept their own sexuality. The findings expand Communication Boundary Management theory and have implications for interventions aimed at assisting women with safer sex topics.

Adult↗
PubMed2005

Aromatase inhibition abolishes courtship behaviours in the ring dove (Streptopelia risoria) and reduces androgen and progesterone receptors in the hypothalamus and anterior pituitary gland.

The aim of this study was to determine in the ring dove, the effects of aromatase inhibition on the expression of aggressive courtship and nest-soliciting behaviours in relation to the distribution of cells containing immunoreactive androgen (AR) and progesterone (PR) receptor in the hypothalamus and pituitary gland. Isolated sexually experienced ring doves were transferred in opposite sex pairs to individual breeding cages, and then injected with the aromatase inhibitor, fadrozole (four males and four females), or saline vehicle (four males and four females) for 3 days at 12 hourly intervals. Saline-injected control males displayed aggressive courtship behaviours (bow-cooing and hop-charging) and nest-soliciting throughout the study, and control females displayed nest-soliciting. By day 3, fadrozole treatment resulted in the disappearance of all these behaviours and in a decrease or disappearance of AR and PR in the anterior pituitary gland, and in the nucleus preopticus paraventricularis magnocellularis (PPM), nucleus preopticus medialis (POM), nucleus hypothalami lateralis posterioris (PLH), and ventral, lateral and dorsal nucleus tuberalis in the hypothalamus (VTu, LTu, DTu). In the nucleus preopticus anterior (POA), fadrozole treatment decreased AR in both sexes and decreased PR in females but not in males. Cells containing co-localized nuclear AR and PR were found in all hypothalamic areas examined, and in the anterior pituitary gland. Fadrozole is suggested to reduce the local availability of estrogen required indirectly for the induction of AR, and except in cells containing PR in the male POA, for the direct induction of PR. It is suggested that aggressive courtship behaviour is terminated by "cross talk" between aromatase-independent PR and aromatase-dependent AR co-localized in neurons in the POA. Aromatase-independent PR may increase in the male POA in response to visual cues provided by a partner. Aromatase-dependent PR in the POM, and basal hypothalamus may play a role in the facilitatory effect of progesterone on estrogen-induced nest-orientated behaviours.

Animal Communication↗
PubMed2005

Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda.

UNLABELLED: The article summarises the baseline assessments of emergency obstetric care (EmOC) carried out in Uganda, Kenya, Southern Sudan, and Rwanda in 2003 and 2004. OBJECTIVES: Our objectives were to: (1) set up program baselines on the availability and utilization of EmOC services in these countries; (2) identify gaps and obstacles in providing EmOC services; and (3) make recommendations to governments based on evidence generated. METHODS: Data were collected from clinical record reviews, provider and client interviews, observations, and focus group discussions. Either random or universal sampling was applied in the selection of health facilities assessed. Local nurses and midwives participated in the data collection and, to some extent, data processing and analysis. RESULTS: The coverage of basic EmOC services ranged 0-1.1/500,000 population compared to the UN-recommended level of 4/500,000. The coverage of comprehensive EmOC services ranged 0.5-4.3/500,000 compared to the recommended level of 1/500,000. Between 0.6% and 8.8% of all births took place in EmOC facilities, and 2.1% and 18.5% of all expected direct obstetric complications were treated. Cesarean section as a proportion of all births was between 0.1% and 1%. Shortage of trained staff especially mid-level providers, poor basic infrastructure such as lack of electricity and water supplies, inadequate supply of drugs and essential equipment, poor working conditions and staff morale, lack of communication and referral facilities, cost of treatment, and lack of accountability and proper management were identified as the main obstacles in providing 24-h quality EmOC services especially in remote and rural areas. CONCLUSIONS: Lack of basic EmOC services limits women's access to life-saving services during obstetric complications. To reduce maternal mortality ratio the states and development partners need to focus their effort to improve the coverage, quality, and utilization of EmOC services through supportive national policy, effective program strategies, increased budget allocation to maternal health program, rural infrastructure development, and regular monitoring, and evaluation of progress.

Attitude to Health↗
PubMedDate not supplied

The measurement of HIV risk level in African American women who dwell in the Southeastern United States.

African American women are the group most heavily afflicted with heterosexually transmitted HIV. The southeastern United States suffers a disproportionate degree of this burden. The purpose of this study was to present the psychometric testing of the HIV Risk Behavior Questionnaire, which was designed and tested for use in this population. The instrument, initially comprised of 32 items, was screened for face validity by experts in the field. This resulted in a revised 28-item instrument. Internal consistency was tested in 74 subjects and yielded Cronbach's a of 0.74. High interitem correlations coupled with similarity between the items resulted in the elimination of three additional items. The final 25-item instrument was then administered to 304 subjects, with Cronbach's a of 0.82. Factor analysis yielded a four-factor solution: barrier/fluid avoidance modalities, survival sex, sexual communications, and factors that increase sexual risk. This indicated the complex multidimensional variables that affect sexual risk. Construct validity was then established through correlation with existing instruments of assertiveness and personal control, using an additional sample of 131 subjects.

Adult↗