Survey of Condom-Related Beliefs, Behaviors, and Perceived Social Norms in Mexican Migrant Laborers

This study reports findings from a survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers that live and work in the United States for extended periods of time. Snowball sampling was used to recruit 501 Mexican migrants from five sending towns in Jalisco, Mexico, with historically high rates of out-migration to the United States. Results showed that subjects reported few negative beliefs about condom use and high efficacy to use condoms in challenging sexual situations but social norms sanctioning condoms were limited. Results also revealed mixed knowledge of HIV transmission, poor knowledge of condom use, and higher condom use with occasional versus regular sex partners. Forty-four percent of male migrants reported sex with prostitutes while in the U.S., with married men reporting less condoms use with prostitutes than single men. It was concluded that condom promotion efforts with Mexican migrants should concentrate on men to encourage consistent use with occasional sex partners, including prostitutes. AIDS prevention education should be provided with sensitivity to the language needs, limited education, and extreme social and geographic marginality of this highly underresearched Latino population.     

Cognitions and sexual expression in the aging

This study investigated the relation of cognitions to sexual expression in aging couples where the male had undergone transurethral prostatectomy. Cognitive factors explored were sexual efficacy expectations, value of sex, sexual attitudes, and sexual knowledge. Sexual expression was defined in terms of the following three dimensions: couple sexual frequency, desired sexual frequency, and quality of sexual functioning. Subjects consisted of 32 married couples whose ages ranged from 50 to 77 years. In this sample of sexually active couples, the cognitive variables most highly correlated with all the dimensions of sexual expression were efficacy expectations for the male's sexual performance and individual sexual drive. High sexual efficacy expectations predicted high couple sexual frequency and good male and female sexual functioning. High individual sexual drive predicted high actual and desired couple sexual interaction. In general, it was the male partner's sexual confidence and drive that was highly related to couple sexual expression.     

Relationship Quality and Depressed Affect Among a Diverse Sample of Relationally Unstable Relationship Education Participants

The association between depression and marital satisfaction has been clearly documented. Theoretical approaches describe the direction of effects as depression leading to marital dissatisfaction (stress generation model) and, alternately, marital dissatisfaction leading to depression (marital discord model). Clinical research indicates that treating the relationship of unstable couples can result in improvements in relationship satisfaction and depression. However, many unstable couples may not attend therapy and choose rather to attend Couple and Relationship Education (CRE). Using 250 ethnically diverse couples in community CRE classes, the authors found that relationally unstable participants of CRE report improvements in depressed affect and relationship quality after program participation. Additionally, decreased depressed affect predicted increased relationship quality, not vice versa, and there were no differences by sex. The authors note the potential value of CRE for unstable couples and recommend that interventionists utilize an inclusive approach, devoting attention to the couple relationship as well as individual distress variables.     

Exploring relationships among communication, sexual satisfaction, and marital satisfaction

This study examined relationships among couple communication, sexual satisfaction, and marital satisfaction in 387 married couples. Regression analyses demonstrated that communication and sexual satisfaction independently predict marital satisfaction. However, there is a significant interaction between communication and sexual satisfaction; if couples are successful at communicating constructively, sexual satisfaction fails to contribute to marital satisfaction. Alternatively, if couples have difficulty communicating but are sexually satisfied, they will experience greater marital satisfaction than if they have a less satisfying sexual relationship. Thus, sexual satisfaction may partially compensate for the negative effects of poor communication on marital satisfaction.     

Predictors of quality of life and psychological health in infertile couples: the moderating role of duration of infertility

Purpose

To investigate the influence of individual characteristics (age, gender, educational level, coping strategies), perceived couple’s Dyadic Adjustment, type of diagnosis and duration of infertility on self-reported quality of life (QoL) and psychological health in infertile couples, examining the potential moderating role of duration of infertility.

Methods

A questionnaire composed by socio-demographics, Coping Orientations to Problem Experienced, Dyadic Adjustment Scale, FertiQoL, State-Trait Anxiety Inventory and Edinburgh Depression Scale was submitted to 206 couples undergoing infertility treatments.

Results

Female patients perceived significantly lower levels of QoL and higher levels of Anxiety and Depression. High Educational level and Social Support Coping strategy were associated with higher QoL and psychological health only in female patients. Problem Solving Coping strategy was associated with higher QoL and psychological health only in male patients. Positive Attitude and Avoidance/Distancing Coping strategies and perceived couple’s Dyadic Adjustment were associated with higher QoL and psychological health in both male and female patients. Duration of infertility?>?3 years was associated with a reduction of protective effects of all coping strategies but did not affect protective effects of Educational level and couple’s Dyadic Adjustment.

Conclusions

Both positive/active and avoiding/distancing coping strategies are effective to promote QoL and psychological health in infertile couples, but they are all compromised by a long duration of infertility. Conversely, positive effects of educational level and couple’s Dyadic Adjustment persist and should be emphasised in the definition of interventions to promote well-being in couples undergoing long-term treatments.

     

Copper/Metal Ratios in the Gills of Rainbow Trout (Oncorhynchus mykiss) Provide Evidence of Copper Exposure Under Conditions of Mixed-Metal Exposure

Previous work has suggested that the ratio of copper residues to zinc in the gills of rainbow trout may indicate short-term exposure to increased levels of waterborne copper. However, the effect of exposure to a combination of increased copper and zinc concentrates in the water column was unknown. We exposed rainbow trout to 8 ± 2 g L^–1, 40 ± 2 g L^–1 and 90 ± 9 g L^–1 of waterborne copper and 21 ± 3 g L^–1, 129 ± 40 g L^–1, and 202 ± 40 g L^–1 of waterborne zinc in a 2-factor experiments and gill copper and zinc residues were examined. Other gill parameters analyzed included the concentrations of calcium, magnesium, sodium, and potassium, liver copper and zinc concentrations and plasma copper, calcium, sodium, and potassium are also reported here. Copper residues in the gill filaments were significantly higher in the highest level of copper exposure (high Cu, 4.06 g g^–1; low Cu 2.41 g g^–1; 0 Cu 2.01 g g^–1; P = 0.001), whereas no differences were seen in zinc concentrations at any treatment level. Gill sodium and plasma calcium concentrations were also decreased at the highest waterborne copper concentrations. Although copper–zinc ratios in the gills were significantly different between the highest and lowest copper treatments (P = 0.002, F = 6.59), copper–sodium and copper–magnesium ratios were more sensitive to waterborne copper exposure (P = 0.001, F = 17.91 and P = 0.002, F = 15.45, respectively). These copper–metal ratios may be better indicators of copper loading in the water column.     

Responses to reading erotic stories: Male-female differences

In individual sessions, 120 female and 120 male students read one of two stories in which the sexual experience of a young couple was described. The stories differed in the degree to which affection was expressed. The results were as follows: (1) On the average, the stories were rated as moderately sexually arousing. (2) The emotional reactions during and to a lesser degree in the 24 hr after the experiment may be described as general activation, an increase of emotional instability, and avoidance reactions. (3) Most of the subjects registered sexual-physiological reactions in the genital region during the experiment. (4) In the 24 hr period following the experiment, there was a slight to moderate activation of sexual behavior, sexual fantasy, and sexual drive. (5) With reference to all measured responses, only slight sex differences were found. Compared to men, women displayed significantly less emotional activation and significantly greater emotional instability and avoidance. Coital activity and sexual drive were significantly more increased among women than among men during the 24 hr following the experiment. (6) The type of story has only a very slight influence on the measured responses. This is true for both men and women.This paper was translated by Mr. David Harris, Berlin.     

Premarital sexual behavior and postmarital adjustment

Data from a large sample survey of sexual attitudes and behavior were examined for correlations between various premarital sexual experiences and postmarital sexual behavior. Hypotheses concerning the effects of intervening and extraneous variables on the relationships between premarital chastity and postmarital adjustment did not receive support. In general, a relationship between pre- and postmarital sexual activity exists in these data despite the fact that extraneous variables such as liberalism and romanticism were held constant. Moreover, value-behavior discrepancy when viewed as an intervening variable did not account for the premarital-postmarital correlations. The implications of these correlations are discussed in terms of developing norms for new types of marital sex ethics.An earlier version of this paper was read at the National Institute for Child Health and Human Development Conference on Sex and the Mentally Retarded, Hot Springs, Arkansas, November 7–10, 1971.Requests for reprints may be directed to Robert Athanasiou, Ph.D., Albany Medical College, Albany, New York.     

Bromacil and diuron herbicides: Toxicity,uptake, and elimination in freshwater fish

Fathead minnows, 30 days old, were exposed to technical grade bromacil and diuron in flow-through tests to determine acute toxicity. LC₅₀ values for bromacil were 185, 183, 182 and 167 mg/L at 24, 48, 96, and 168 hr, respectively; and for diuron, 23.3, 19.9, 14.2, and 7.7 mg/L at 24, 48, 96, and 192 hr, respectively. Eggs, newly hatched fry, and juvenile fish were continuously exposed to lower concentrations of the herbicides for 64 days. Growth was significantly reduced (p 0.01) at the lowest bromacil exposure of 1.0 mg/L. Therefore, it was not possible to determine a no effect concentration. The no effect concentration for diuron was 33.4 g/L, while the lowest concentration which resulted in adverse effects was 78.0 g/L. Adverse effects at 78.0 g/L were an increased incidence of abnormal or dead fry immediately after hatch (p 0.01) and decreased survival throughout the exposure period (p 0.05). Neither herbicide accumulated significantly in fish tissue, as bioconcentration factors were <3.2 and 2.0 for bromacil and diuron, respectively. Rainbow trout (Salmo gairdneri) injected with radiolabeled bromacil or diuron eliminated over 90% of the radioactivity within 24 hr. Parent compound and metabolites were detected in the aquarium water in both cases. Metabolites of diuron recovered from the water included 3,4-dichloroaniline and several demethylated products.     

Short-term exposure of zooplankton to the synthetic pyrethroid,fenvalerate, and its effects on rates of filtration and assimilation of the alga,Chlamydomonas reinhardii

In acute tests of toxicity, two cladocerans,Daphnia galeata mendotae andCeriodaphnia lacustris, and the calanoid,Diaptomus oregonensis, were more sensitive to fenvalerate thanDaphnia magna, the organism used in standard laboratory bioassays. The 48-hr EC₅₀s for each species/stage in order of increasing sensitivity were adultD. magna — 2.52 g/L;D. magna (48-hr old) — 0.83 g/L; adultD. galeata mendotae — 0.29 g/L; adultC. lacustris — 0.21 g/L;D. galeata mendotae (48-hr old) — 0.16 g/L; adultDiaptomus oregonensis — –0.12 g/L. No toxicity was observed when these organisms were exposed to a range of concentrations of the emulsifiable concentrate without fenvalerate (the EC blank).Rates of filtration of the¹⁴C-labelled alga,Chlamydomonas reinhardii byD. galeata mendotae, C. lacustris andD. oregonensis were decreased significantly at sublethal concentrations of fenvalerate after only 24-hr exposure.Ceriodaphnia lacustris showed the greatest sensitivity with rates of filtration significantly decreased at 0.01 g fenvalerate/ L. Concentrations of fenvalerate 0.05 g/L resulted in decreased rates of filtration byD. galeata mendotae. A concentration of 0.10 g fenvalerate/ L caused rates of filtration to increase inD. oregonensis. whereas 0.05 and 0.5 g/L resulted in a decrease in these rates.Rates of assimilation of algae byD. galeata mendotae, C. lacustris andD. oregonensis exposed to similar concentrations of fenvalerate were decreased at concentrations 0.05 g fenvalerate/L. Changes in rates of assimilation were not as sensitive a parameter of toxicity as changes in rates of filtration. The EC blank had no significant effects on rates of filtration or assimilation for all three species.     

Marital Quality and Health of Chinese Couples: A Longitudinal Study

The linkage between marital quality (marital adjustment and marital satisfaction) and mental health (midlife crisis symptoms and life satisfaction) as well as perceived health status in 378 Chinese married couples over 2 years was examined. Results showed that marital adjustment and marital satisfaction were concurrently related to midlife crisis symptoms, life satisfaction, and perceived health at Time 1 and Time 2. Longitudinal and prospective analyses (Time 1 predictors predicting Time 2 criterion variables) suggest that the relationships between marital quality and health measures are bidirectional in nature. While marital quality predicted changes in midlife crisis symptoms in husbands, but not in wives, marital quality predicted changes in perceived health status in wives, but not in husbands. Results also showed that mental health influenced the marital adjustment of the wives, but not the husbands, over time.     

Crack,crack house sex,and HIV risk

Limited attention has been focused on HIV risk behaviors of crack smokers and their sex partners, yet there is evidence that the crack house and the crack-using life-style may be playing significant roles in the transmission of HIV and other sexually transmitted diseases. The purposes of this research were to study the attributes and patterns of sex for crack exchanges, particularly those that occurred in crack houses, and to assess their potential impact on the spread of HIV. Structured interviews were conducted with 17 men and 35 women in Miami, Florida, who were regular users of crack and who had exchanged sex for crack (or for money to buy crack) during the past 30 days. In addition, participant observation was conducted in 8 Miami crack houses. Interview and observational data suggest that individuals who exchange sex for crack do so with considerable frequency, and through a variety of sexual activities. Systematic data indicated that almost a third of the men and 89% of the women had had 100 or more sex partners during the 30-day period prior to study recruitment. Not only were sexual activities anonymous, extremely frequent, varied, uninhibited (often undertaken in public areas of crack houses), and with multiple partners but, in addition, condoms were not used during the majority of contacts. Of the 37 subjects who were tested for HIV and received their test results 31% of the men and 21% of the women were HIV seropositive.     

Long-term effects of dinoseb and paraquat,both individually and combined,on embryonic development and hatching success ofFasciola hepatica miracidia

Toxic effects of the herbicides dinoseb and paraquat, both individually and combined, on embryonic development and hatching ofFasciola hepatica miracidia were assessed by exposing the eggs to varying concentrations (0–20 g/ml) of each of the herbicides. The results showed that dinoseb has an LC₅₀ value of 4.3 g/ml, paraquat has an LC₅₀ of 4.9 g/ml and the mixture of both dinoseb and paraquat has an LC₅₀ of 7.1 g/ml. Based on the LC₅₀ values, dinoseb is slightly more toxic than paraquat on the tested organisms. The results also showed that the mixture of dinoseb and paraquat is significantly less toxic than the individual pesticides.Eggs ofF. hepatica cultured in either dinoseb or paraquat both individually and combined showed a delay of embryonic development and hatching of the miracidia. Eggs cultured in 0–2 g/ml of dinoseb, paraquat and their mixture, fully embryonated and hatched within 14–16 days, while eggs cultured in 4–6 g/ml of the same herbicides showed a delay of four days for embryonic development and hatching of their miracidia.     

The role of body image in sexually avoidant behavior

Spectatoring refers to a cognitive self-absorption, wherein individuals fixate on and carefully monitor personal body parts and/or the adequacy of personal sexual functioning. To examine this process within a university population, undergraduate and graduate students (108 male and 140 female) filled out questionnaires that assessed body image, sexual knowledge, global sexual attitudes (i.e., liberal—conservative), general psychological adjustment, and frequency of sexual behaviors. Multiple regression analyses were used to determine if spectatoring, operationalized by measures of body image, would significantly predict sexually avoidant behavior. Results indicated that body image scores significantly predicted frequency of sexual behaviors for both genders, while general sexual knowledge and psychological adjustment did not predict sexual behavior. Overall, sexual attitude scores were the best predictors of sexual approach/avoidance behaviors for both genders. Implications are drawn for future research using the assessment of more global sex attitudes in the study of spectatoring.     

Clinical and prognostic characteristics associated with age and gender in acute myocardial infarction: A multihospital perspective in the Murcia region of Spain

Age and female gender have been associated with poor prognosis in acute myocardial infarction (AMI). Data currently available about the prognostic significance of gender in AMI might well have led to inappropriate/incomplete conclusions. A multicenter, prospective study on 1239 patients with AMI was conducted. Clinical characteristics, complications during the acute phase and one-year follow-up were monitored. Women constituted 24.1% of all patients. Female patients were older with more prevalence of diabetes, hypertension, and previous congestive heart failure. Compared with men, the following complications were more frequently found in women: heart failure, 43% vs. 22% (p<0.001); reinfarction, 5% vs. 2% (p<0.05); use of pacemaker, 7% vs. 4% (p<0.05). Women had higher mortality: early, during the first 24 hours post-admission, 10.7 vs. 3.1%; in-hospital, 23% vs. 8.1%; and 1-year, 33.7% vs. 16% (p<0.001 for all the 3 cases of mortality). In the age-groups considered (<65, 65–74, and 75 years), 1-year mortality increased exponentially with ageing in men: 7.8%, 21.3%, and 38.9%, whereas in women the figures were: 15.3%, 41.5%, and 38.8%. Multivariate analysis showed that, among other variables, age and female gender had independent prognostic value for in-hospital mortality whereas gender lost its prognostic significancy for 1-year mortality. Multivariate analysis restricted to those patients aged over 75 years showed that age but not gender had independent prognostic value. In conclusion, age and female sex have independent prognostic value for predicting mortality in patients with AMI. Mortality increases exponentially with ageing in men whereas it stabilises in the case of women over 65 years. Female gender loses its independent value for predicting mortality in patients over 75 years.     

Salient factors influencing resident advisor turnover: An exploratory study

Child care workers have been in the forefront of using their expertise in planning and staffing Community Living Arrangements (e.g., small group homes and apartments) for mentally retarded children and adults. Unfortunately, many child care workers who entered the field of Resident Advisorship (e.g., houseparents) with enthusiasm have voluntarily left after a short period of time. This study examines the results of several open-ended interviews with Resident Advisors working in apartment-based Community Living Arrangements for the mildly and moderately retarded. These interviews were conducted to identify those factors they perceived as sources of job satisfaction and dissatisfaction, contributing to employment longevity. Herzberg's formulations regarding the attractiveness of employment are presented as a logical way of interpreting the data.     

Der Einfluß von Alter,Geschlecht und Gewicht auf die HÄufigkeit unspezifischer Atemwegserkrankungen

Zusammenfassung Die Untersuchungsergebnisse bestÄtigen den Befund zahlreicher klinischer und epidemiologischer Untersuchungen, in denen eine Zunahme von Husten, Auswurf und Atemnot mit zunehmendem Lebensalter beschrieben wurde. Dabei weisen die Frauen im allgemeinen weniger Klagen über bronchitische Symptome auf. Nur Atemnot bei Anstrengungen wird von ihnen hÄufiger angegeben als von den MÄnnern.Ebenso wie die subjektiven Bronchitissymptome zeigen auch die objektiven Mewerte eine vom Alter und Geschlecht abhÄngige VerÄnderung. Differenzen in der HÄufigkeit obstruktiver Atemwegserkrankungen lassen sich jedoch zwischen MÄnnern und Frauen nicht feststellen. Obstruktive Ventilationsstörungen mit erhöhtem intrabronchialem Strömungswiderstand und auffallenden Erniedrigungen des arteriellen Sauerstoffdruckes sind bei MÄnnern und Frauen fast gleichhÄufig vertreten.Im übrigen zeigt die Untersuchung, da die im Zusammenhang mit der extremen Fettsucht von vielen Autoren beschriebenen cardiopulmonalen Störungen in abgemilderter Form auch bei dem mÄigen übergewicht nachzuweisen sind. Der arterielle Sauerstoffdruck fÄllt mit zunehmendem relativen Körpergewicht ab. Der intrabronchiale Strömungswiderstand zeigt dagegen in AbhÄngigkeit vom Körpergewicht einen Anstieg. Besonders ausgeprÄgt sind die VerÄnderungen am intrathorakalen Gasvolumen. Hier ergibt sich eine Abnahme mit zunehmendem Körpergewicht, die wesentlich gröer ist als die mit dem Alter und der Körpergröe korrelierte Zunahme. Die HÄufigkeiten von Husten und Auswurf sind dagegen vom Körpergewicht unabhÄngig. Der mit zunehmendem Körpergewicht steigende bronchiale Strömungswiderstand scheint weniger durch einen intrabronchialen Entzündungsprozess als durch mit der Fettsucht zusammenhÄngende extrapulmonale Faktoren bedingt zu sein.

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Influence of age, sex and weight on the incidence of non specific respiratory diseasesII. Communication

Summary These findings confirmed many clinical and epidemiological investigations which described an increase of coughing, sputum production and dyspnoea with advancing age. Although women complained less about bronchitic symptoms, the incidence of dyspnoea with effort was higher than in men.Together with the subjective bronchitic symptoms the objective measured values showed an age and sex related change. The difference in the incidence of obstructive airways diseases in men and women was not significant.Both men and women having bronchitis and obstructive ventilation showed similar tendencies to high intrabronchial resistance and lowering of arterial oxygen tension. In general the investigation has shown, as has been shown by many authors, the close relationship between obesity and cardio-pulmonary disturbances. These changes were also observed in a milder form in slightly obese subjects.The arterial oxygen tension fell with increasing bodyweight; conversely intrabronchial resistance increased. The intrathoracic gas volume showed a marked bodyweight related change, diminishing with increasing weight. This reduction was greater than expected even when the normal increase related to age and weight was allowed for. The incidence of caughing and sputum production in contrast, was not related to bodyweight. The bronchial resistance which rose with bodyweight appeared to be less related to an intrabronchial process but more to extrapulmonary related factors.

     

Cross-cultural analysis of students' sexual standards

Our purpose was to investigate, cross-culturally, university students' premarital sexual standards. A number of predictions were derived from the work of Christensen, Reiss, and Burr. Data were collected via self-administered questionnaires from over 1100 English-speaking respondents in five cultures (four countries). These cultural contexts had a strong effect on the attitudes and behavior of individual respondents. As predicted, the difference in the standards held by males and females was small in highly permissive societies. Negative consequences of premarital intercourse (i.e., guilt) were reported by the highest proportion of sexually experienced respondents in the most restrictive society. An unsuccessful effort was made to predict how the correlation between permissiveness and such variables as religiosity would change in different cultures. Across all five cultures, greater courtship participation, less religiosity, greater physical attractiveness, and spending less time with one's family were associated with greater permissiveness. Finally, students from high-status backgrounds were generally more permissive.This research was supported by a Canada Council Grant (574–0557) and Leave Fellowship to the senior author.     

In vitro susceptibility of mycelial and yeast forms of Penicillium marneffei to amphotericin B,fluconazole, 5-fluorocytosine and itraconazole

The mycelial (25°C) and yeast-like (37°C) forms of Penicillium marneffei clinical and type strains were investigated for their in vitro susceptibility to amphotericin B (AmB), 5-fluorocytosine (5-FC), fluconazole (FLU) and itraconazole (ITZ), using Bacto antibiotic medium 3, yeast-nitrogen, Sabouraud's dextrose (pH 5.7) and high resolution (pH 7.1) broth media (1ml/tube), respectively. Results indicated that the minimal inhibitory and minimal fungicidal concentrations (MICs and MFCs) for the mycelial cultures of P. marneffei to AmB were in the range 0.78–1.56 and 0.78–3.125 g/ml, respectively, as against 3.125–25 g (MICs) for the yeast form cultures. The MFCs to AmB for the yeast form were one dilution higher. The MICs to FLU were generally lower for the yeast form (6.25–25 g) than the mycelial form (25–50 g/ml), whereas MFCs for the mycelial cultures were > 100 g as compared to 6.25–100 g for their yeast form. The MICs for the mycelial form to 5-FC ranged from < 0.195–0.39 g. Higher MICs (6.25 g) were recorded for their yeast form. The MFCs to 5-FC for the yeast form were 25–100 g/ml. The MICs for the mycelial form to ITZ ranged from < 0.195 to 3.125 g/ml. Higher values (< 0.195–50 g) were recorded for their yeast-like form. The MFCs to ITZ for mycelial and yeast forms ranged from < 0.195–0.39 and 25–100 g/ml, respectively. Results indicate that P. marnefei's yeast form is more sensitive to FLU and ITZ (8 of 10 strains) while the mycelial form displayed greater susceptibility to AmB and 5-FC. The MICs for ITZ remained steady in SD medium, pH 5.7 to 7.1. However, some strains gave higher MIC values (0.39–1.56 g/ml) when tested in the HR.     

The voluntary community health movement in India: A strengths,weaknesses, opportunities,and threats (SWOT) analysis

There has been a prolific growth of voluntary organizations in India since independence in 1947. One of the major areas of this growth has been in the field of community health. The purpose of this article is to historically trace the voluntary movement in community health in India, analyze the current status, and predict future trends of voluntary efforts. A review of the literature in the form of a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was the method of this study. Some of the key trends which emerged as the priority areas for progress and for strengthening voluntary organizations in the future were enhancing linkages between health and development; building upon collective force; greater utilization of participatory training; establishing egalitarian and effectual linkages for decision making at the international level; developing self-reliant community-based models; and the need for attaining holistic empowerment at individual, organizational, and community levels through duty consciousness as opposed to merely asking for rights.The authors would like to express gratitude to Voluntary Health Association of India for sharing the necessary documents and to Dr. Rick Petosa for valuable editorial comments.