Sterilization. Low-income women have special counseling needs.
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A CDC-funded community project is teaching young men who have sex with men how to discuss and negotiate safer sex. The issue of communicating with partners about sex is an important part of an intervention strategy because some preliminary findings indicate that young MSM do not consistently include safer-sex negotiations and behavior in their 'sexual script'.
Many studies have suggested that merely warning people about the dangers of sexually transmitted diseases (STDs) and urging the use of condoms as protection will not result in widespread use of condoms. Regular condom use appears to be grounded in knowledge of its effectiveness, perception of STD risk, and belief in a partner's acceptance. But these are not the only barriers to condom use. Negotiating condom use often comes at a sensitive stage in intimate relationships, when individuals prefer to avoid such discussions and simply to trust the powerful and compelling feelings of mutual attraction. This review will consider (1) the effectiveness of condoms in preventing STD transmission, (2) barriers to the use of condoms, and (3) recommended strategies to promote acceptance and use of condoms by heterosexual women.
LifeBridge Health, Baltimore, created a directory of its physicians, which developed into a 100-page consumer magazine titled Md.MD A Directory of the Region's Finest Physicians. Written and designed in-house, the premier edition paid for itself, thanks to publishing partner, Alter Communications. The premier edition was mailed to 50,000 Baltimore area homes last September.
If the efforts now underway to limit access to abortion services in the United States are successful, their greatest impact will be on women who lack the funds to obtain abortions elsewhere. There is little published information, however, about the experience of medically indigent women who sought abortions under the old, restrictive state laws. This article details the psychiatric evaluation of 199 women requesting a therapeutic abortion at a large municipal hospital in New York City under a restrictive abortion law. Thirty-nine percent had tried to abort the pregnancy. Fifty-seven percent had concrete evidence of serious psychiatric disorder. Forty-eight percent had been traumatized by severe family disruption, gross emotional deprivation or abuse during childhood. Seventy-nine percent lacked emotional support from the man responsible for the pregnancy, and the majority were experiencing overwhelming stress from the interplay of multiple problems exacerbated by their unwanted pregnancy.
Until the sixties, it was usual for a MD to make some lab tests in a room close to his medical office. During the next decades, the number of lab tests has exploded, and the performance of the test became dissociated from the MD ordering the tests. All Belgian clinical laboratories are involved in the management of a quality system, and within it, the general practitioner is essential as partner. Good communication with him/her may put in evidence inadequacies in some processes such as the performance of the tests or the transmission of the reports to the ordering MD. The requirement for a good contact between the ordering MD and the clinical pathologist is described in some cases of everyday work in laboratory medicine: screening for thyroid dysfunction; indications of total PSA and free PSA; screening for hemochromatosis; prothrombin time and INR; serology tests for infectious mononucleosis or syphilis.
Face movements of infants 2 months of age when they are interacting with their mothers give evidence both for innate representation of the mother as a partner in communication and for an emotional system that evaluates her expressions and regulates their interpersonal contact. Although the facial neuro-motor system is immature in infancy, it can generate many expressions that compare closely with those by which adults transmit emotions and control engagements and relationships. It also expresses rudiments of special motivation for speaking. Even newborns show clear evidence of organized facial expressions defining distinct communicative states that respond to maternal care. Emotional communication is multimodal; as infants gain in perceptuo-motor and cognitive powers, they both express and respond to simultaneous signals of affect in multiple channels of voice, gesture and postural change. Face expressions form but part of a stream of motor evidence of central affective state and its changes. Mothers present to infants a form of expressive activity (baby talk) that has clearly marked synchronous visible and audible features. The precocious expressive capacities and sensitivities of infants and maternal fostering of them would appear to be a human adaptation to facilitate development of observational learning and language. Developments in the first year expand the scope of communication and play without changing the fundamental emotional code by which infant and familiar caretakers construct and defend their special relationships.
This study examined the ability of 2 1/2-4 1/2-years-olds to recognize comprehension difficulties and to implement strategies for resolving them. In the course of a play interaction, an adult female experimenter made a series of requests, some of which were designed to be difficult for the child to understand or to execute. Children's responses to these requests were compared with their responses to control requests that were easy to comprehend and comply with 3-year-olds exhibited appropriate and selective monitoring responses for some kinds of problems but not others, while 4-year-olds displayed discriminative monitoring for all types of problems presented. In contrast to previous experimental findings, these results indicate that young children are capable of detecting a variety of comprehension problems and possess appropriate strategies for resolving these difficulties with a partner in communication.
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BACKGROUND: Many pregnant women in the United States do not obtain adequate prenatal care. While it is essential to provide women with access to prenatal care, access alone is insufficient to guarantee that all women will receive adequate prenatal care. Previous research has identified a number of personal and cultural barriers to prenatal care. We have integrated these barriers into an explanatory model called the Social Pregnancy Interaction Model, the centerpiece of which is the concept of a "social pregnancy identity," as distinct from the physiologic reality of pregnancy. The purpose of this study was to validate the dimensions of this model. METHODS: Based on previous qualitative work, a questionnaire was developed. It was administered by interview to a convenience sample of 287 pregnant women receiving prenatal care in 11 practices in central Missouri. Item analysis and factor analysis were used to define scales and validate the relationships predicted by the model. RESULTS: With some modifications, the following dimensions of the model were confirmed as distinct and significant: awareness of pregnancy, acceptance of pregnancy, self-care, communication with family, communication with partner, social attitudes toward prenatal care, and attitudes toward the health care provider. CONCLUSIONS: The model has potential for predicting the utilization of prenatal care. The results also suggest that a woman's relationship with her prenatal care provider is important to obtaining adequate prenatal care.
This article utilizes constructs of the AIDS Risk Reduction Model (ARRM) to examine condom use in a sample of 215 HIV-infected women in New Jersey. We find evidence that processes affecting condom use in HIV-infected individuals are similar to those found in HIV-negative individuals. Results suggest that partner-related factors are important to consistent condom use in HIV-infected women. Women are more likely to use condoms consistently if they have high perceived power to influence their partner's condom use, have partners who are HIV seronegative, and have partners who do not want more children. Conflicts with the partner decrease the probability of consistent condom use. Also negatively associated with condom use are the woman's use of drugs and/or alcohol and her belief that condoms reduce sexual enjoyment. Implications of these findings for designing interventions for HIV-infected women are considered.
Although strategies for decreasing injection drug use have met with moderate success, efforts to decrease high-risk sexual behaviors have been less successful. Because condom use reduces HIV transmission, it is critically important to identify the attitudinal, emotional, and behavioral factors associated with using condoms. This study evaluated the relationship between condom use and various psychological and behavioral variables among heterosexual, African-American, cocaine-dependent men within the context of the AIDS Risk Reduction Model (ARRM). Subjects who used condoms (n = 52) reported significantly higher levels of self-efficacy, condom use skills, and sexual communication with partners than non-users (n = 84). However, the groups did not differ in perceived susceptibility, anxiety concerning HIV transmission, response efficacy, or knowledge regarding HIV. These findings suggest that future interventions focus on enhancing self-efficacy and condom use skills, as well as eroticizing condom use.
Data from an urban obstetrics clinic on 291 unmarried women with a current unplanned pregnancy show that women with only one partner in the past year are older and are more likely to use the most effective contraceptive methods than are women who have more than one partner. Women with only one partner are also more likely to be solely responsible for decision-making about the choice of contraceptive methods, and are not as likely to use drugs in conjunction with sex. However, women with one partner are also less likely than others to use condoms or to protect in some other way against sexually transmitted diseases or the human immunodeficiency virus.
A comparison of five in-school educational and service approaches offered at seven sites in Arizona to 789 pregnant and parenting teenagers shows that except for those who enroll in a program in their third trimester, pregnant and parenting teenagers who attend a comprehensive, school-based, community-linked program are significantly more likely to continue in school than are those who have no access to a special program. The comprehensive program's impact is greatest among Hispanic students, younger students, those in grades 9-10, those who are living with their partner and those who enter the program in the first trimester. Two of the program components--strong outreach efforts and case management-are believed to have an especially favorable impact on continuation in school.
Condoms are an important method of reducing the risk of sexually transmitted disease among sexually active adolescents. This study used a developmental approach to examine the negotiation of condom use. The Interpersonal Negotiation Strategy Interview was administered to adolescents using two vignettes that were focused on the negotiation of "safer sex" behaviors. The sample consisted of 196 girls and 92 boys recruited from their primary care clinic or Job Corps. The mean scores for each problem-solving step were at the subjective, unilateral stage, which indicates that problems are resolved through one-way methods. Current educational strategies and the lack of mutuality in adolescents' sexual relationships influence the level of negotiation skills. Interventions need to be at the appropriate developmental level but also need to encourage progress toward collaborative relationships.