Self-disclosure of HPV infection to sexual partners.

Disclosure decisions of persons with genital HPV infection were examined. The research questions focused on relationships among knowledge of transmission, beliefs about the obligation to disclose knowledge of HPV infection to sexual partners, factors that influence the disclosure decision, and evaluations of the decision. Participants were 92 persons diagnosed with HPV 6 months prior to data collection. Sixty-three women and 29 men whose average age was 23.1 years constituted the sample. A subset of 48 persons provided detailed information about their reasons for disclosing or not disclosing knowledge of HPV and subsequent evaluation of their behavior. Knowledge of HPV transmission was adequate; however, there was no relationship between transmission knowledge and disclosure beliefs. Participants tended to disclose the presence of HPV to partners at point of diagnosis, but not to new partners 6 months later. Both disclosers and non-+disclosers felt positively about their decision. Possible changes in clinical interventions for persons with HPV infection are discussed.

An instrument to measure the attentional demands of community-dwelling elders.

The capacity to direct attention (CDA) is a pivotal facet of cognitive functioning that allows people to focus on trains of thought, complex tasks, and the daily business of life. According to a theoretical framework of directed attentional fatigue (DAF) and restoration, excessive demand for attention depletes CDA, a condition called DAF. Attentional demands are factors such as feelings of loss and worries that require intense or prolonged use of CDA and thus can lead to DAF. The purposes of this study were to determine reliability and validity for an instrument to measure attentional demands, the Attentional Demands Survey (ADS). The ADS was administered to 197 (142 females, 50 males) community-dwelling elderly (ages 65-98 years, M = 77). A factor analysis revealed 4 factors/subscales consistent with theorized domains. Internal consistency for each subscale ranged from .87 to .90 and test-retest reliability was .91. The ADS can be used to explore the relationships among attentional demands, CDA, and interventions to support and restore attentional functioning for elders.

Falls in a psychiatric unit.

The purposes of this descriptive study were to document the prevalence of previously identified risk factors for falls in a group of acutely ill psychiatric patients, to determine if patients who fell differed from nonfallers with respect to risk factors, and to describe the circumstances surrounding falls that occurred on an inpatient unit. All patients admitted to an acute psychiatric unit during a 7-month period were entered into the study (N = 197). Twice a day, nurses who worked on the unit completed a fall-risk factors checklist for each patient. When a fall occurred, an additional instrument designed to measure circumstances associated with the fall was completed. The most frequently occurring risk factors were clinical diagnoses of depression and confusion or disorientation. Seventeen patients fell during their hospitalization. Compared with nonfallers, patients who fell were more likely to have a previous history of falls, generalized weakness, confusion or disorientation, difficulty with mobility or walking, elimination problems, and temperature elevation. Analysis of circumstances surrounding falls showed that the majority of falls occurred when patients were attempting to get out of bed, walk to the bathroom at night, or change from a sitting to a standing position. Findings from this research can be used to identify psychiatric patients who are at risk for falls during their hospitalization.

The development of sexual risk taking in adolescence.

This chapter reviews literature from 1985 to the present that is focused on the development of sexual behaviors in adolescents, decision making about sexual behavior, and sexual risk-taking behaviors. Results show that sexual behavior is part of most people's lives from childhood through adulthood, and that the majority of adolescents begin to engage in sexual behaviors in their teenage years. Synthesis of this large body of research reveals a lack of theoretical frameworks to guide research in sexual risk taking, resulting in an incomplete understanding of the predictors of sexual risk-taking behavior in adolescents. New and broader approaches in the study of sexual risk taking are needed that include consideration of the social and developmental context from which adolescents make decisions about sexual behavior.

Characterization of insulin-like growth factor-binding proteins in the uterus and conceptus during early conceptus elongation in cattle.

As a first step in determining the role that insulin-like growth factor (IGF)-binding proteins (BPs) may have in regulating initial stages of conceptus elongation in cattle, the type and relative abundance of IGFBPs in serum, uterine tissues, and uterine fluid from pregnant and noninseminated cows on Days 13 and 15 postestrus and in Day 15 conceptuses was evaluated. Uterine and serum samples contained IGFBPs 2, 3, 4, and 5 as determined by immunoprecipitation followed by Western ligand blots of precipitates. Compared with those in uterine and serum samples, IGFBPs in conceptuses and conceptus-conditioned culture media were only faintly detectable. The percentage of the total IGF-I binding activity attributed to IGFBP-3 was greater (p < 0.05) in myometrium, serum, and uterine fluid (> 50%) than in inter- (40%) and intracaruncular (37%) endometrium. Percentage of total binding attributed to IGFBP-2 was greater (p < 0.05) in endometrium and serum ( approximately 30%) than in myometrium (16%) and uterine fluid (9%). Binding activity of certain IGFBPs varied due to day of the estrous cycle or due to pregnancy status. Concentrations of IGF-I in serum were greater (p < 0.05) in nonpregnant (52 +/- 2 ng/ml) than in pregnant (40 +/- 4 ng/ml) cows. Concentration of IGF-I in uterine fluid did not differ due to pregnancy status or stage of cycle (4.4 pg IGF-I/ microg uterine protein). Northern blots revealed mRNAs for IGFBPs 1, 2, 3, 4, and 5 in uterine tissues but not in conceptuses. In situ hybridization indicated that IGFBP-1 mRNA was primarily localized in luminal epithelium of endometrium; IGFBP-2 mRNA was in luminal epithelium and dense stromal cells adjacent to endometrial epithelium; and IGFBP-3 mRNA was in vascular endothelial cells and was more prevalent in myometrium than in endometrium. Tissue specificity and changes in abundance of IGFBPs in the uterus during early conceptus elongation indicate the potential importance of IGFBP regulation of uterine IGFs during this time period.

Identifying the attentional demands perceived by elderly people.

The capacity to direct attention is an essential part of life. However, excessive demand for attention produces difficulty in managing everyday activities and stressful life events. This study identified attentional demands of elderly people. Thirty elderly adults were interviewed to ascertain their perceptions of demands on them in four theoretically derived domains. Physical environmental demands included the weather and living space. Informational demands included facing new situations because of a move or the loss of a spouse as well as vision and hearing difficulties. Behavioral demands mentioned were tasks such as exercising, cooking, being able to drive, dealing with finances, and a loss of stamina. Affective demands mentioned were loneliness and worries and sadness about health and the future. A content analysis of the interview data produced items for an instrument to be used during future interventions with elderly people aimed at decreasing the level of demands and restoring the attentional capacity necessary for functioning at an optimal level. This article also discusses the implications of assessing elderly patients.

Advice from affected persons about living with human papillomavirus infection.

PURPOSE: To describe the "advice or information" people who have had HPV for one year would give to the newly diagnosed. DESIGN: Descriptive. POPULATION, SAMPLE: The population was persons with HPV. A convenience sample of 61 women and 27 men, mean age 23.8 years, was recruited from 4 clinics in one midwestern U.S.A. city between 1990 and 1993. METHODS: Participants answered an open-ended question about the advice and information they would give to newly diagnosed persons. Content analysis was done. FINDINGS: Six major areas of advice were provided including keeping a balanced perspective, getting treatment, sexual behavior, knowledge, self-care, and other. A high percent of advice from women was to keep a balanced perspective on life. A high percent of the advice from men focused on sexual behavior. CONCLUSIONS: Advice covered a variety of topics touching on many aspects of daily life, not simply disease control and sexual behavior. CLINICAL IMPLICATIONS: Practitioners should carefully explore their clients' reactions to the diagnosis of HPV and address the sensitive emotional elements entailed.

Consequences of sexual decisions: the perceptions of rural adolescents.

The purpose of this study was to examine the content of adolescent thinking about the consequences of choosing abstinence, sexual intercourse with a condom, and unprotected intercourse. Consequences for the relationship and for each partner's thoughts and feelings were explored. Participants were 116 high school students living in a rural area of a midwestern state; their average age was 16 years. They completed a series of open-ended questions about possible outcomes to a scenario involving sexual decision making. Content analysis of responses revealed that about half of the participants associated abstinence with positive consequences; however, it was also associated with insecurity and the possibility of losing the relationship. Sexual intercourse with a condom was viewed as an indication of caring and responsibility and was associated with positive outcomes for the relationship. Identified consequences of unprotected intercourse were almost entirely negative. Some differences in perceived consequences were influenced by the gender of the partner. Integration of these findings into programs designed to prevent sexual risk-taking is discussed.

Adolescents' views of sexual decision-making.

The purpose of this study was to ascertain the reasons adolescents give for abstinence, safer sex, and unprotected sexual intercourse. Participants were 115 high school students living in a midwestern state; average age was 17.5 years. Students completed a two-part questionnaire about (a) their expectations for the outcome of a vignette in which two teenagers had the opportunity for intercourse and (b) their ideas about the reasons, thoughts, and feelings associated with three possible endings to the vignette-abstinence, intercourse with a condom, unprotected intercourse. Content analysis of responses indicated that four interconnected factors are significant contributors to sexual behavior: social norms, fear, gratification or pleasure, and availability of condoms.

Predictors of Taiwanese nurses' intention to care for patients who are HIV positive.

The purpose of this research was to explore the knowledge of, attitudes toward, and intention to care for HIV-positive patients among 223 Taiwanese nurses. They worked in many different settings and had a variety of levels of exposure to HIV-positive patients. The findings of this research revealed that most Taiwanese nurses lacked sufficient knowledge to prevent themselves from becoming infected in the workplace. Their attitude about giving care to HIV-positive patients was generally negative; most nurses stated that they did not intend to care for these patients. A regression analysis revealed that knowledge was not a significant predictor of intention. Attitudes about societal treatment of HIV-positive people and nursing care were significant predictors of intention. Implications for practice and education of Taiwanese nurses are discussed.

PIP: During June-July 1992 in Taiwan, 223 nurses on staff at four hospitals and at the only sexually transmitted disease clinic in the country completed a questionnaire so researchers could examine their knowledge of and attitudes toward HIV-infected people and to associate knowledge and attitudes with intention of caregiving. The researchers purposely selected nurses from units where HIV-positive patients were treated and from those where HIV-positive patients were not treated. 49% had provided care to HIV positive-patients. 76% had received no in-service training about AIDS. 91% did not personally know anyone with HIV infection. 7% knew that HIV transmission can occur due to prolonged skin-to-skin contact between nurse and patient. 50% knew that mouth-mouth resuscitation can transmit HIV. Only 38% realized that they need to discard needles without recapping to prevent HIV transmission. The mean number of items answered correctly was 43.12 (29-55). Almost everyone knew that HIV is a virus. The nurses expressed a slightly negative attitude (mean score, 2.5) towards nursing care of an HIV-infected person and a slightly positive attitude on social issues (3.5). For example, the nurses thought that HIV-positive patients should not completely be removed from society. They exhibited a low intention to care for HIV positive patients (2.8). For example, they would not volunteer to care for an HIV-positive patient, but they would provide emotional support for the partner or family members and collect specimens from them. 96% agreed that they needed to know the HIV status of their patients. Almost all agreed with items referring to nurses' psychosocial support needs (e.g., follow-up and treatment for nurses with needle-stick injuries). The regression analysis revealed that knowledge did not contribute to intention of caregiving. Significant predictors of intention were attitudes about social issues and nursing care. These findings show a need for strategies to improve knowledge and positive attitudes towards caring for HIV positive patients and to increase use of universal precautions.

Gender and knowledge about HIV, risky sexual behavior, and safer sex practices.

The purpose of this study was to examine gender differences in knowledge about HIV, the reported incidence of risky sexual behavior, and comfort with safer sexual practices among young adults. The conceptual framework was social role theory, which argues for the influence of gender roles on beliefs and social behaviors. Participants were 141 female and 131 male college students who responded to questions regarding their knowledge of HIV, risk-taking behaviors with respect to HIV, and comfort with safer sexual behaviors. Overall, respondents had accurate knowledge about HIV. However, men reported engaging in significantly more risky behaviors than women. More men reported that intercourse without a condom occurred in unplanned, spontaneous situations, while under the influence of alcohol or drugs, or with a person not well known. More women reported that intercourse without a condom occurred in long-term relationships. Women were significantly more comfortable abstaining from sexual intercourse and asking partners about their sexual history while men were significantly more comfortable buying condoms. Both men and women reported comfort using condoms. Gender roles help to explain why men are willing to take more risks, and in what situations risk taking is apt to occur.

Genital human papillomavirus infection: common but not trivial.

One of the most prevalent sexually transmitted diseases is genital human papillomavirus (HPV) infection. Because of its potentially serious consequences for women, HPV infection is receiving a significant amount of attention from researchers and clinicians. We summarize the research and clinical literature on HPV infection. The nature of the virus, the prevalence of HPV infection, and modes of transmission are discussed. Both the physiological and psychological consequences of the infection are explored. Perspectives on treatment are examined, and suggestions for psychoeducational interventions are offered.

Moral reasoning about sexually transmitted diseases.

The purpose of this research was to investigate moral reasoning related to sexual behavior that could lead to the transmission of sexually transmitted diseases (STDs). Using hypothetical dilemmas about situations in which STDs can be transmitted, respondents were asked to explain why they believed the characters should or should not engage in risky behaviors. 40 college freshmen (M = 18.3 years) and 32 college seniors (M = 22.3 years) participated. Using Kohlberg's moral stage theory and Gilligan's moral orientation model, the interviews were scored for moral stage and moral orientation. Results indicated that the older age group had a significantly higher stage of moral reasoning than the younger age group when responding to dilemmas about STDs. There was a significant difference in moral stage between dilemmas, reflecting the possible effect of dilemma content on moral reasoning. The overall pattern of results shows nonsignificant gender differences in stage of moral reasoning and moral orientation. Clinical and theoretical implications of these findings for understanding the role of moral reasoning in sexual risky behavior are discussed.

Measurement of symptoms of interstitial cystitis. A pilot study.

The existence of a reliable and valid measure of interstitial cystitis symptoms would assist with diagnosis and the evaluation of treatment effectiveness. The purpose of this article is to report development of a scale to measure symptoms of interstitial cystitis. Data concerning the evidence of content and construct validity, as well as reliability, is provided. The findings suggest that this scale accurately measures the symptoms of interstitial cystitis.

Mixed-function oxidase-specific activity in wild and caged speckled sanddabs Citharichthys stigmaeus in Elkhorn Slough, Moss Landing Harbor and nearshore Monterey Bay, California.

The goal of this study was to characterize the spatial, seasonal and annual hepatic activities of mixed-function oxidase (MFO) in the speckled sanddab Citharichthys stigmaeus, the most common fish in the Moss Landing area. In addition, techniques to monitor MFO activities in caged speckled sanddabs were developed and tested. Once the relationship between MFO activities in caged and wild fish populations is determined, caged fish could be used to monitor potential hydrocarbon impacts at Moss Landing, or other marine sites. During each of the spatial, seasonal and annual sediment samplings conducted in 1985-1987 as part of a separate hydrocarbon variability study at Moss Landing, 12 wild speckled sanddabs were collected from Moss Landing Harbor, Elkhorn Slough and nearshore Monterey Bay sites. In addition, four locations were chosen for a 14-day field caged fish experiment. The caged fish experiments successfully demonstrated the feasibility of using caged sanddabs as indicators of hydrocarbon exposure. The major source of variability in hepatic aryl hydrocarbon hydroxylase activity in wild speckled sanddabs from the Moss Landing area is due to seasonal rather than site differences. Significant relationships between caged fish MFO response and sediment hydrocarbon concentrations were found. It is possible that caged fish could be used in place of costly sediment sampling and analysis, and provide a more direct method to assess biological impacts. Many of the caging techniques demonstrated in this study can easily be transferred to other benthic flatfish, and other marine and freshwater environments.

Differential effects of estrogen and progesterone on levels of POMC mRNA levels in the arcuate nucleus: relationship to the timing of LH surge release.

Beta-endorphin is thought to be an important inhibitor of LHRH neuronal activity and also to play a role in conveying information about changes in steroid levels to LHRH neurons. We have previously shown that the mRNA encoding the precursor of beta-endorphin, proopiomelanocortin (POMC), fluctuates during the estrous cycle with the most dramatic changes occurring on proestrus. POMC mRNA levels decline before the onset of LH surge release but then dramatically rise and remain elevated during the surge. In the present studies we tested the hypothesis that the decline in POMC mRNA levels immediately before the proestrus LH surge is mediated by estrogen and the rise during the surge by progesterone. To test this hypothesis, we compared changes in POMC mRNA levels between ovariectomized (OVX) and OVX estrogen (E2)-treated rats and between OVX E2-treated rats with and without progesterone. Animals were examined at hourly intervals after the administration of progesterone, then at every 4 h during the LH surge. Using in situ hybridization histochemistry, we found that E2 decreased POMC mRNA levels in OVX rats before the onset of the LH surge and further suppressed levels during the surge. Compared to animals treated with E2 alone, progesterone advanced the time at which both the LH surge began and the time at which POMC mRNA levels declined. After a transient decline, POMC mRNA levels rose in these progesterone-treated animals and remained elevated throughout the period of the LH surge. These results support the hypothesis that progesterone times the LH surge and limits its appearance to one day be exerting a biphasic effect on the activity of beta-endorphinergic neurons of the arcuate nucleus.

Funding and socialization in the doctoral program at the University of Wisconsin-Madison.

This article describes the model of funding and socializing doctoral students that has been used by the School of Nursing at the University of Wisconsin-Madison. The goal of the Madison program is to educate persons who are capable of conducting research that will contribute to the scientific knowledge base of nursing. This goal is accomplished through immersing students in all aspects of the research process. Critical components of socialization are described. These include the mentor-student relationship, participation in a research group, and participation in informal discussions of faculty and students' research programs. The importance of establishing funding mechanisms and faculty work loads that support socialization is also emphasized.

Why don't young adults protect themselves against sexual transmission of HIV? Possible answers to a complex question.

Using theories of health behavior, this study aimed to advance the understanding of risk-taking regarding human immunodeficiency virus (HIV) infection among young adults by describing: (a) their representation (i.e., schema) about HIV infection, (b) their problems with use of condoms and comfort with safe-sex practices, and (c) situations associated with risky sexual behavior and reported reasons for risk-taking. Participants were 272 young adult college students whose average age was 19.3 years (SD = 2.4). They completed an extensive questionnaire developed for the study. The representation of HIV infection in this sample lacked the specific and detailed information necessary to guide sexual behavior. For example, participants were aware of the causes of sexual transmission of HIV, but many persons indicated uncertainty about the effectiveness of various preventive strategies (e.g., latex condoms, birth control devices). A number of specific problems with using condoms were identified or expected by participants. These included inadequate lubrication, poor fit, and breaks or leaks during intercourse. The majority of the sample (85.3%) reported at least one occurrence of unprotected sexual intercourse. For 60% of them, the stated reason for the risk-taking was that the intercourse was unplanned or spontaneous; 50% reported that they "just knew" the partner was safe and not infected with HIV. Implications for health education programs are discussed.

PIP: Although many HIV prevention programs have been targeted at adolescents and young adults, recent research demonstrates that high-risk sexual behavior has continued and possibly even increased among persons within the age group. This study uses theories of health behavior to try and advance the understanding of risk-taking regarding HIV infection among young adults by describing their representation about HIV infection, their problems with use of condoms and comfort with safe-sex practices, and situations associated with risky sexual behavior and reported reasons for risk-taking. Survey data were collected for the study from 272 young adult college students of average age 19.3 years at a large midwestern university. 192 were freshmen, 131 were male, 96% reported being heterosexual, 4% reported being bisexual, and 72% reported having had sexual intercourse. 62% of respondents reporting have had sexual intercourse had done so at least once without a condom. 60% of the students who had unprotected sex did so because intercourse was unplanned or spontaneous, while 50% reported feeling certain that the partner was safe and uninfected with HIV. 110 participants reported currently being in an ongoing sexual relationship, with 52% of them being in the relationship for more than one year. Of these persons in ongoing relationships, 26 (24%) reported having sexual intercourse with someone else during the relationship, with 19 (73.1%) of the 26 persons reporting that the intercourse occurred with using a condom. While respondents were aware of the causes of sexual transmission of HIV, many were uncertain about the effectiveness of various preventive strategies. A number of specific problems with using condoms were identified or expected by participants such as inadequate lubrication, poor fit, and breaks or leaks during intercourse. People who had not used condoms, however, anticipated many more problems than were actually encountered by people who had used them. Health education program implications are discussed.

Seasonal and annual distribution of organic contaminants in marine sediments from Elkhorn slough, moss landing harbor and nearshore Monterey Bay, California.

This 3-year study provides data on the spatial, seasonal and annual variability of hydrocarbons and total organic carbon present in marine sediments at three sites: Elkhorn Slough, Moss Landing Harbor and nearshore Monterey Bay in the vicinity of Moss Landing, California. The study provides baseline information that could be used to evaluate the potential impacts of future fuel oil releases occuring in the Moss Landing area. Groups of hydrocarbons were chosen to represent the hydrocarbon inputs into the Moss Landing area. These included the pesticide dichlorodiphenyltrichloroethane (DDT), polychlorinated biphenyl (PCB), phthalic acid ester (PAE), polycyclic aromatic hydrocarbon (PAH) and combustion PAHs (SigmaCOMBs). For SigmaDDTs, SigmaPCBs, SigmaPAEs, SigmaPAHs and SigmaCOMBs, the major sources of variability were between sites and random effects. Subsites within each site contributed little variability. No significant seasonal differences in any chemical contaminant group were found at any site. Significant seasonal differences in total organic carbon (TOC) and significant annual differences in SigmaPCBs, SigmaPAHs, SigmaCOMBs and SigmaPAEs were found at the nearshore Monterey Bay site. Significant annual differences in SigmaPAEs and TOC were found within Moss Landing Harbor, and significant annual differences in SigmaPAEs were found within the Elkhorn Slough site. Implications for future sampling designs in the Moss Landing area are that given the current baseline conditions (a stable, low rate of hydrocarbon input), a variability of 75-150 m(2) may not need to be heavily sampled. Spatial variability, not seasonal or annual variability, is the major source of hydrocarbon variability in Moss Landing sediments, although 3 years may not be long enough to establish long-term annual trends. Further research to determine the SigmaPAH spatial sampling scale for oil spills is needed.