Time estimates in prognostic discussions: A conversation analytic study of hospice multidisciplinary team meetings.

BACKGROUND: Recommendations state that multidisciplinary team expertise should be utilised for more accurate survival predictions. How the multidisciplinary team discusses prognoses during meetings and how they reference time, is yet to be explored. AIM: To explore how temporality is conveyed in relation to patients' prognoses during hospice multidisciplinary team meetings. DESIGN: Video-recordings of 24 hospice multidisciplinary team meetings were transcribed and analysed using Conversation Analysis. SETTING/PARTICIPANTS: A total of 65 staff participating in multidisciplinary team meetings in a UK hospice from May to December 2021. RESULTS: Team members conveyed temporality in three different ways. (i) Staff stated that a patient was dying as part of the patient's current health status. These formulations did not include a time reference per se but described the patient's current situation (as dying) instead. (ii) Staff used specific time period references where another specific reference had been provided previously that somehow constrained the timeframe. In these cases, the prognosis would conflict with other proposed care plans. (iii) Staff members used unspecific time period references where the reference appeared vague and there was greater uncertainty about when the patient was expected to die. CONCLUSIONS: Unspecific time period references are sufficient for achieving meaningful prognostic talk in multidisciplinary teams. In-depth discussion and accurate prediction of patient prognoses are not deemed a priority nor a necessity of these meetings. Providing precise predictions may be too difficult due to uncertainty and accountability. The lack of staff pursuing more specific time references implies shared knowledge between staff and a context-specific use of prognostic estimates.

The effectiveness of prenatal and postnatal home visits by paramedical professionals and women's group meetings in improving maternal and child health outcomes in low and middle-income countries: a systematic review and meta-analysis.

OBJECTIVE: To assess the effectiveness of prenatal and postnatal home visits (HVs) and women group meetings (WGMs) by paramedical professionals to improve maternal and child health outcomes in low- and middle-income countries (LMICs). STUDY DESIGN: Systematic review and meta-analysis. METHODS: We conducted a systematic review of trials published till December 2020, as per registered protocol in The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42018091968). Outcomes were neonatal mortality rate (NMR), maternal mortality ratio (MMR), the incidence of low birth weight, and still birth rate (SBR). The Cochrane Pregnancy and Childbirth Group's Trials Register, Cochrane Central Register of Controlled Trials, PubMed, and Excerpta Medica Database (EMBASE) were searched. Pooled results were estimated using random-effects meta-analysis in RevMan version 5.2. RESULTS: Twenty-five trials met the inclusion criteria. HVs were the key intervention in 12, WGMs in 11, and both interventions in 2 trials. The pooled estimates have shown that NMR was significantly reduced by HVs (OR 0.77, confidence interval [CI]: 0.67-0.90, P = 0.0007, I2 = 77%) and WGMs (OR 0.76, CI: 0.65-0.90, P = 0.001, I2 = 71%). SBR was significantly reduced by HVs (OR 0.77, CI: 0.70-0.85; P < 0.001, I2 = 0%). Subgroup analysis of studies in which more than 10% of pregnant women participated in the WGMs showed significant reduction in NMR (OR 0.67, CI 0.58-0.77, P = 0.00001, I2 = 31%) and MMR (OR 0.55, CI 0.36-0.84, P = 0.005, I2 = 27%). Two studies reported improvement in birth weight by HVs. CONCLUSIONS: HVs and WGMs (with >10% pregnant women) by paramedical professionals are effective strategies in reducing the NMR and MMR in LMICs. HVs were also effective in reducing SBR.

The Family Support Movement and Schizophrenia in India.

PURPOSE OF REVIEW: To review the evolution of family support movement for schizophrenia in India and to report perspectives of family caregivers who are running family support groups across the country in the backdrop of recent legislations in India. RECENT FINDINGS: Family support movement started in the 1990s, mostly by family caregivers independently in multiple cities across the country. Apart from periodic support meetings, they have successfully influenced recent legislations to address the felt needs of families. Mental health professionals need to gain skills to work collaboratively with assertive family caregivers to develop services to support those diagnosed with mental illness. Though there is a need for such movement, funding is poor and very few caregivers of persons with schizophrenia are forthcoming to participate. The formation of national federation with government and non-government partnership could help give the required impetus to the family support movement for persons with schizophrenia in India.

'I want every minute to be worthwhile now': The views and experiences of people living with dementia and their care partners about returning to in-person group meetings after COVID-19 lockdown restrictions.

COVID-19 and the resulting limitations on freedom of movement has been difficult for many, including individuals living with dementia and those who provide support and care. In the summer of 2021, England's national lockdown measures eased, and regulations were amended to allow indoor social gatherings. With this enabling a return to in-person meetings, this study explored the experiences of people living with dementia and current and former care partners who had previously attended groups at Salford Institute for Dementia (UK). Two phases of research were conducted. In the first phase, during the summer of 2020, telephone interviews were utilised to ask participants (n = 13) about their views of re-engagement and how the in-person groups might be best reintroduced. Phase two began in the summer of 2021, where mood questionnaires (n = 10) were administered and observations conducted to explore how participants experienced the return to in-person meetings. Thematic analysis resulted in the construction of three overarching themes: planning for and the reality of transitioning; safety versus autonomy; and tensions and complexities of life in the 'new normal'. Despite initial concerns about their reintegration into the community, participants all enjoyed resuming in-person meetings. An inclusive and consultative approach to re-engagement allowed all participants to feel valued, safe, and informed about their return to campus. However, individuals living with dementia and care partners experienced the transition to re-engagement in different ways and their perceptions shifted over time. We therefore highlight the complexities of responding to different perceptions of risk and safety, while also promoting engagement and inclusivity after a period of social isolation. In this paper, we consider implications for the re-integration of individuals with dementia and their care partners into in-person social groups and propose further avenues for research.

Characteristics of the COVID-19 Outbreak in Korea From the Mass Infection Perspective.

On December 31, 2019, the Chinese government officially announced that the country had some cases of pneumonia with an unknown cause. By February 8, 2020, there were 24 confirmed cases in Korea, and the number of cases has steadily increased since then. On March 9, 2020, the cumulative number of confirmed cases in Korea was 7382, with 51 deaths. This study examines the characteristics of the coronavirus disease 2019 (COVID-19) outbreak from the perspective of the large-scale number of confirmed COVID-19 cases and deaths. This study is significant in that it emphasizes the precautionary principle in preventing and managing infectious diseases, and makes suggestions for urgently needed public health policies.

Key Factors to Consider in Team Meetings when Dealing with Multimorbidity in Primary Care: Results from a Delphi Panel.

BACKGROUND: Multimorbidity brings several difficulties and challenges to the daily work of primary care teams. Team meetings are opportunities to discuss approaches and solutions on how to best manage multimorbid patients. OBJECTIVE: This qualitative study aimed to collect a consensus, from general practitioners that deal with multimorbid patients, about their perspectives regarding multimorbidity team meetings in primary care. METHODS: The study followed a modified Delphi method with 15 Portuguese general practitioners. After every round of responses, results were analyzed, and justifications for non-consensual items were aggregated by the investigators, and then a new Delphi round with the revised questionnaire was again initiated. This process was repeated until consensus has been reached. RESULTS: Overall, a list of 10 key themes associated with the ideal meeting was agreed: (a) definition; (b) setting; (c) duration; (d) frequency; (e) number of participants; (f) attendance; (g) requirement of patient's presence; (h) number of patients/clinical cases; (i) structure of the meeting; and (j) sharing meeting results. The consensus was achieved after two Delphi rounds with a mean score between 7.9 and 8.7 (maximum score of 9.0 per key theme). CONCLUSION: The complexity of multimorbidity affects meetings' periodicity, duration, and participants. Ideally, it should be an interprofessional primary care team meeting. Further research exploring meeting outcomes (organizational effectiveness and healthcare quality) of the proposed factors is needed before they can be recommended for general use.

Group meetings after critical illness-Giving and receiving strength.

INTRODUCTION: An increasing number of intensive care patients are surviving critical illness, but many develop mental, cognitive and physical impairments after discharge. Adapting to a new life situation, often with major challenges, implies the need of support. Therefore, it is important to develop interventions aimed at promoting recovery. OBJECTIVE: The aim was to describe former intensive care patients' feelings of sharing their experience of critical illness with other former patients. METHOD: Former intensive care patients (n = 17) participated in group meetings and wrote about their thoughts in a notebook after each group meeting. To deepen the understanding of the former patients' experience 11 of the former patients were interviewed. The notes in the notebooks and the interviews were analysed using qualitative content analysis. FINDINGS: Meeting others revealed to the former patients new dimensions of being critically ill, and they both gave and received strength from each other. The meetings were meaningful as they gained insight into other patients' lives, and realised what it meant to survive intensive care. CONCLUSIONS: The group meetings meant sharing experiences and understanding the process of survival after critical illness. Giving and receiving strength from others helped the participants to go further.

Traditional Balinese youth groups as a venue for prevention of AIDS and other sexually transmitted diseases.

OBJECTIVES: Our aims were to assess the feasibility of conducting peer-led educational interventions against AIDS and other sexually transmitted diseases (STDs) through traditional Balinese youth groups and to gather information on sexual risk-taking and its correlates among Balinese youth. DESIGN: A cross-sectional survey was conducted, with follow-up questionnaires for pilot intervention participants. SUBJECTS AND METHODS: A self-administered questionnaire was given to 375 subjects (aged 16-25 years) from 12 youth groups representing four main resort areas in Bali. Post-intervention data were collected from 97 of these subjects who had taken part in pilot educational programs. Focus groups supplemented survey data in evaluating the intervention and understanding risk behaviors. RESULTS: In a cross-sectional survey, one-quarter of males and few females reported sexual activity; subsequent focus groups suggested under-reporting by females. While knowledge and worries about HIV/AIDS were high, only 10% of sexually active males and no females reported consistent condom use. The mean age of first sexual intercourse was highly correlated with first alcohol consumption (P = 0.0003). Peer educators from selected youth groups planned and implemented interventions for their own groups. Post-intervention data indicated significant increases in communication about sexual issues with friends and parents. Condom attitudes became less negative and efficacy increased. Participants reported this as a first experience with peer-led health education, preferred interactive activities to adult-led lectures and recommended follow-up educational sessions. CONCLUSIONS: Peer educators from traditional youth groups can plan and conduct prevention programs for HIV/STDs that are well-received by their group memberships. Using such venues may be an efficient way to reach a wide range of pre-sexual Balinese youth, as well as those already at risk for HIV/STD due to unprotected sex, alcohol consumption and multiple sexual partners.

PIP: In a 1995 survey of Balinese youth, 75% expressed a desire to discuss sexual issues and AIDS/sexually transmitted diseases (STDs) with their peers. A cross-sectional survey of 375 young people 16-25 years of age assessed the feasibility of using traditional Balinese youth groups as a vehicle for peer-led AIDS education. In Bali virtually all youth, regardless of educational level or socioeconomic status, join the youth group in their neighborhood at puberty and remain members until they marry. The average age at first intercourse reported in the baseline survey was 18.8 years for males and 20.0 years for females. For 46% of sexually active males, intercourse was accompanied by alcohol consumption. Although youth had adequate knowledge of AIDS before the intervention, only 10% of sexually active males reported consistent condom use. Follow-up interviews with 97 young people from 3 resort areas of Bali who were exposed to the peer-led intervention revealed significant increases in communication about sexual matters with friends and family, more positive attitudes toward condoms, and increased condom use. Exposed youth who participated in focus group discussions expressed a preference for peer-led interactive activities over lectures and indicated they felt more comfortable asking their peers questions about sex. Use of peer educators from Balinese youth groups appears to represent an efficient way to reach young people before the initiation of sexual activity as well as those at high risk of AIDS and other STDs as a result of unprotected sex, alcohol consumption, and multiple sexual partners.

Use of ethnographic research for instrument development in a case-control study of immunization use in Haiti.

A rapid ethnographic assessment of barriers to health service utilization was conducted to identify maternal factors predicting use of child immunizations in Haiti. Methods included four focus group interviews, four natural group interviews, individual interviews with 14 health care providers and participant observation at vaccination posts. Analysis of qualitative data identified five categories of maternal factors associated with immunization use: competing priorities, low motivation, socioeconomic constraints, perceived accessibility of services, fears about health or social consequences and knowledge and folk beliefs related to vaccines. Selected variables among these factors were incorporated into a survey instrument designed to compare mothers of completely vaccinated children (cases) with mothers of incompletely vaccinated children (controls). The questionnaire was administered to 299 randomly selected mothers (217 cases, 82 controls). Bivariate and multivariate analyses found that of the factors identified through ethnographic research, only vaccine-related knowledge was significantly associated with immunization status. The utility and constraints of using ethnographic research for instrument development in epidemiological studies are discussed.

PIP: A rapid ethnographic assessment consisting of 4 focus groups, 4 natural group interviews, 14 provider interviews and participant observation rally posts was combined into a questionnaire which was tested by chi square for use in predicting which Haitian mothers utilize immunization services. The study population were mothers of 1800 children 12-23 months old in the Mirebalais Area Community Health program in the central highlands of Haiti. The program uses the rally post system, with teams visiting villages at 6-week intervals. Audio tapes and written notes were reduced to lists of all possible barriers to maternal utilization, and then regrouped into 16 categories, under 5 topics: competing priorities, lack of motivation, socioeconomic constraints, perceived accessibility of posts, fears of health consequences and knowledge of folk beliefs about vaccines. 22 questionnaire items were then developed, which were edited by the overall project director without input from the ethnographer. The questions were administered to 299 mothers, 82 with incompletely immunized, and 217 with completely immunized children. The questions which significantly predicted complete vaccination by bivariate analysis were knowledge of the name of 1 or more vaccines or illnesses, the recommended number of doses, and the correct age to begin vaccinations. It was likely that time demands from subsistence farming and income generating activities also affected service utilization, but the women probably interpreted the question on employment incorrectly.

Changes in knowledge, attitudes, and behavior as a result of a community-based AIDS prevention program.

The study evaluates the outcome of a California-based AIDS prevention program, "Stop AIDS." Community discussion groups focusing on information, attitudes, and behavior associated with HIV infection and transmission were conducted in one-time, 3 1/2-hour sessions. Participants completed different versions of the AIDS Prevention Test before and after the discussion group. Significant positive shifts in information, attitudes, and behavior were observed as a function of the discussion group participation. Whereas pretest knowledge correlated with pretest behavior and posttest knowledge, only pretest behavior correlated with the crucial variable of posttest intended behavior. When changes from pretest to posttest were analyzed, both information and attitude change correlated to changes in behavior. The intervention and evaluation procedures are proposed as a replicable national model for community-based AIDS prevention programs.

PIP: To evaluate the impact of an acquired immunodeficiency syndrome (AIDS) prevention program on knowledge, attitudes, and intended behavior, a test instrument for use with gay and bisexual men was developed and administered to participants in the California-based Stop AIDS Project. The intervention is comprised of a 3 1/2 hour group discussion facilitated by a specially trained peer leader and held in private homes. Its ultimate objective is to persuade gay and bisexual men top make a personal commitment to safe sex practices and to stopping the transmission of human immunodeficiency virus (hIV). Topics included in the discussion were; how the AIDS epidemic had personally affected group members, safe sex guidelines, possible negative feelings about life- style changes required by the threat of AIDS, the proper use of condoms, the pros and cons of HIV antibody testing, and ways that participants could become involved in ending the AIDS epidemic. 148 participants from 16 discussion groups held in Orange County, California, were administered the test instrument before and after the intervention. Significant (p 0.001) increases from pretest to posttest were recorded for all 3 test components: from a mean of 78.5% to 84.7% correct on the knowledge section, from 30.02 to 31.31 out of a possible 35 on attitude, and from 17.21 to 18.84 out of a possible 21 on intended behavioral changes. Notable was a lack of correlation between information, attitudes, and a commitment to change behavior. Only pretest behavior correlated with the crucial variable of posttest intended behavior. On the other hand, there were significant correlations between both knowledge and attitude change and commitment to behavior change, demonstrating the effectiveness of this relatively simple intervention. Useful would be a follow-up study to determine how much of the commitment to behavior changes expressed after these group discussions is actualized.

Family planning programs during last one decade in Korea.

PIP: The public and private family planning programs in Korea are described and their progress in population control during the 1960's is discussed. A goal of a natural increase rate of 2% per year by 1971 was set in 1961 when the rate was 3%. It was estimated that 45% of the married couples of childbearing age would have to actively practice family planning to meet that goal, and 2370 family planning workers are participating now in the program throughout the country. The family planning program operates as part of the already existing national health service network. All fmaily planning services are provided free or with only a nominal charge at most. Intrauterine devices, oral contraceptives, condoms and vasectomies are the most common contraceptive methods chosen, in that order. A 1968 survey on abortion which is illegal in Korea showed 30% of urban women and 15% of rural women had had at least 1 induced abortion. In 1970 it was estimated that 1.8 million IUD insertions and 146 thousand vasectomies had been performed, 276,000 women had been started on oral contraceptives, and 163,000 condoms had been distributed. Numerous problems have been encountered by the Korean family planning program including inadequate financing and political power, association with a generally poor maternal health service, lack of follow-up and statistical evaluating, and unnecessary bureaucratic procedures. Professionally, trained family planning workers have a high attrition rate. Ever-greater numbers of young Korean women are now entering their childbearing period which increases the challenge to the family planning program, along with the problems of an increasingly heterogeneous urban society. Reducing family size to only 2 children conflicts with deep-seated cultural traditions, and even if the motivation exists, present contraceptive technology remains inadequate. In partial response to these problems, increasing emphasis is being placed on paramedical personnel and a mass media educational campaign. Improved organization, a greater supply of well-trained workers, and well-controlled field and clinical studies are needed to improve Korea's family planning program.^ieng

Culturally sensitive prenatal care for Southeast Asians.

OBJECTIVE: To evaluate the success of the Southeast Asian Health Project in terms of client satisfaction with the prenatal care and other services. To obtain additional data about Southeast Asian women's health practices regarding childbearing. DESIGN: Survey through questionnaires administered as interviews. SETTING: In clients' homes or via telephone. PARTICIPANTS: 119 women from SEAHP's case files of recently delivered clients. MEASUREMENTS AND MAIN RESULTS: Interviews were conducted by four community workers fluent in Cambodian or Lao. The majority of women were satisfied with SEAHP, particularly the interpretation and education in native languages. Women were also satisfied with SEAHP, encouraging others to seek care. CONCLUSIONS: SEAHP appears to meet prenatal care needs of Southeast Asian women in Long Beach, California. More objective outcome data await analyses, but the program's approach may ensure access to and use of health services.

PIP: The outreach program for Southeast Asian immigrants, chiefly Cambodians who arrived after 1980, begun by St. Mary Medical CEnter of Long Beach California, called the Southeast Asian Health Project (SEAHP) was evaluated by structured interviews of 199 women. The obstacles to full participation by these Asian immigrants in health care are described at length. They range from illiteracy and abuse in refugee camps to the immense cultural barrier involving philosophy of health to language barriers. The SEAHP Outreach services began with door-to-door canvassing, ads in refugee papers, and meetings in temples. Special educational resource materials were printed covering prenatal care, nutrition, child development, and feeding. Oral classes were held in CAmbodian and Lao with Vietnamese translators, as well as babysitters, transportation, and snacks. Class topics were nutrition, parenting skills, labor and delivery, child development, hygiene, and breast feeding. Training was also given to professional staff. 600 clients in prenatal clinics since 1987, 119 were interviewed by 4 workers fluent in Cambodian and Lao. The women were typical of refugees, only 1/2 were literate in native languages. 49% had delivered babies at home in Asia; 39% had delivered in refugee camp clinics. Women cited several different behaviors as a result of SEAHP classes: intake of milk products, use of food substitutes, food preparation, attendance at regular medical care, child care, and bathing. They said that they felt more comfortable at the clinic, and would recommend that friends go to the clinic for prenatal care. The concept of culture broker, and the role of nurses as culture brokers are discussed.

Primary care in the village. An approach to village self-help health programmes.

PIP: The health clinic run in Kalirandu, Indonesia, by Foster Parents Plan, a private philanthropic welfare organization is described. In 1974 the Plan was serving 3000 families through 4 clinics, providing general curative services, pre- and postnatal services, family planning, dental care, and referral to the local urban hospital where needed. Each clinic treated about 100 patients per day at a cost of $1 per client family per month. However, few inocculations were given and few preventive health checks were requested. When the number of Plan families grew to 9500 while the population of the served communities grew to 400,000 with no increase in clinic budget, a different approach was tried. Instead of serving only the families helped direactly by the Plan, a total community service was developed. Plan personnel began to encourage use of the government health clinics. A rural health insurance system was developed which entitles the families to preventive health services. Plan medical staff and the local health center trained volunteers from Kalirandu in the use of a few simple medicines. The volunteers were selected by the village headmen and generally have elementary school education and a position of responsibility. This health "kader" works without payment and has 10-15 families living near him for whom he is responsible. At the time of writing there were over 500 kaders trained. Inservice courses are conducted to keep them up-to-date. An acceptors club was formed to motivate use of family planning. Seeking a more active role in village life, the acceptors club then took on child nutrition as a project, weighing children and reminding mothers of inoculations. The self-help momentum is spreading to housing and better farming practices, which is providing more vegetable gardens and better sources of Vitamin A. It is emphasized that this type of group responsibility cannot be imposed from outside. It is community leaders within that provide the motivation for self-help projects.^ieng

The impact of support for black adolescent mothers.

PIP: This exploratory study focuses on the association between social support and adolescents' responses to early motherhood. Subjects are 64 Black adolescent mothers in three groups: high school attenders, participants in the Baltimore City Public Schools Infant Parent Program and dropouts from school. Structured interviews are used to assess the young mothers' emotional stress as well as the amounts, sources, and kinds of support available. Self esteem and sense of control were assessed via standardized instruments. Respondents averaged 16.27 years of age when their children were born; at the time of the interview, ages of the mothers ranged form 14 to 19 years. 50.7% had completed school or were enrolled; 66% were working, typically in part time, work study type programs. Of the heads of their households, 40.3% were employed or receiving Social Services payments, 7.7% held technical jobs with the majority in the skilled or unskilled blue collar category. The children ranged in age from 2 months to 2 years. A major finding was that support from individuals is related to a decrease in stress and an increase in self esteem. The results are discussed in relation to the growing body of research documenting the impact of such support on maternal role performance.^ieng

[Female circumcision opposed in Haninge]. / Kvinnlig könsstympning motarbetas i Haninge.

PIP: Less radical forms of female circumcision are called infibulation and Pharaonic circumcision. It is estimated that 113 million women in the world are exposed to female circumcision of one form or another. In Sweden about 16,000 women originate from countries where female circumcision is practiced. 60% of them are from Somalia or Ethiopia, and 11,000 of these women are of reproductive age. About 5000 girls are under 18 years of age and are at risk of female circumcision if it has not already taken place. Sweden has ratified a UN convention on the right of children, and since 1982 there has been a law in force that prohibits female circumcision. A great number of African refugees have been settling in Jordbro, in the county of Haninge, south of Stockholm, since 1992. 35 central African families live there, one-third of them from Somalia. The mother and child health care agency has confronted several problems related to female circumcision: infibulated women do not get traditional gynecological examinations, families demand that women get infibulated after delivery, and some families have asked for circumcision of their newborn daughters. The agency organized African family group sessions, held for a month during evenings, in which all families were invited to discuss topics related to the improvement of women's and children's health and the fight against female circumcision. At each family group meeting 10-15 adults participated. Several sessions dealt with children's diseases, reproductive physiology, and the role of female circumcision in religion and tradition. Most women were illiterate and this was their first encounter with the Swedish health system whereby they were informed about the functioning of the human body. African traditions are deeply rooted. In Gambia female circumcision is practiced by 50-60% of people, although in milder forms. Since 1993, when the group discussions started, not a single case of circumcision was reported in pre-school-age girls.^ieng

Communicating population issues in sub-Saharan Africa: a development policy for Nigeria.

PIP: The author proposes a strategy for the development of a communication policy that would slow population growth, with particular reference to the situation in Nigeria and other African countries. The focus is on the involvement of individuals at the local level in discussion groups to create the atmosphere for developing small family norms.^ieng

[A problem-posing educational methodology for the prevention of HIV / AIDS]. / Una pedagogia de concientizacion para la prevencion del VIH / SIDA.

PIP: The problem-posing methodology of Brazilian educator Paulo Freire, using the reading circle approach previously deployed in successful literacy campaigns in developing countries, is introduced for application in AIDS information programs. The basis of this educational process is the dialogue where those to be educated resolve their problems by evaluating information critically, capturing concepts by codification and decodification, and transmitting information by creating relevant educational materials. Health circles are organized with women as educators to impart knowledge about AIDS and HIV: definitions, epidemiological components (sex, age, and risk behavior), means of transmission, stages of the progression of AIDS, prevention of HIV infection, and tests for detecting HIV antibodies. The dialogue explores knowledge and feelings about AIDS and how it affects life in the community reveals personal experiences and accounts of knowing someone who was HIV-positive, and develops action plans to minimize AIDS cases in the community. The Latin population of California, mainly of Mexican origin, with low levels of education, income, and acculturation and a high incidence of AIDS, is an appropriate target of such intervention. In 1980, there were 12.3 million people of Hispanic origin in the US. In August 1990, there were 143,280 persons diagnoses with AIDS according to the Centers for Disease Control. 78,878 of these (55%) were Anglos, and 21,752 (15%) were Hispanics. Among the Anglos, the incidence was 300/million inhabitants, while among Hispanics, it was 1059/million, a 3-field higher rate.^ieng

Nobody asked the mother: women and maternity on Simbo, western Solomon Islands.

PIP: This article's focus is on the role of mothers in Simbo, one of the New Georgia islands in the western Solomon Islands. Mother's role is examined from the standpoint of the actual experiences of motherhood and mother's perceptions and reactions to child rearing, child care, burdensome tasks, and social participation. Anthropological studies emphasize non-Western notions of maternity or romanticize the primitive. Obscured in the process is who these women really are. Western feminist accounts of Third World women emphasize the oppression and uniformity of the "natural" mother. This characterization of Simbo women is presented as a single non-Western view and is unrelated to a global vision. Simbo women as mothers feel oppressed and are envious of Western notions of parenting, yet at the same time feel that Western child rearing deprives the child. Maternity is a state of ambivalence, where women feel both love for and oppression by children, spouses, and other women. The tasks and responsibilities of childbearing are more difficult because of increased fertility and changes in social practices. Women without children are viewed with sympathy and mild condescension. Changes in social practices are in part due to the presence of missionaries after 1903 and the over 200 year involvement of the islands in world trading. The most significant impact on women post-Christianity is the change from the emphasis on female-child relationships to male-female relationships. Pre-Christianity, marriage ceremonies stressed equality of spouses and their kin groups. New customs emphasize brideprice and the husband's authority over women's bodies. The change in power affects fertility levels, child care, women's work, and contraception. Men today do less labor relative to women and, when husbands are absent due to temporary labor migration, women may not have any help. The nuclear family is responsible for all labor. Women specifically tend the gardens and house, care for children, and care for ill members of the family. The concept of maternity changes with the stage in the life cycle. The first child is the easiest because grandmothers help with infant care. Children are both indulged and then resented when the demands interfere with activities or the children are too difficult.^ieng

Family support group in psychosocial rehabilitation.

BACKGROUND: Support groups for families of persons with mental illness are emerging as significant components in psychosocial rehabilitation programmes. AIM: To ascertain the expectations of family members who attend family support group meetings and to find out the efficacy of such programmes. METHODS: The data were collected from support group members using a semi-structured interview schedule. The study sample (n=20) was drawn from family members who attended the support group meetings regularly for a minimum period of 6 months. Data analysis was done using percentile. RESULTS: Analysis of the data revealed that members attending the support group meetings expected to get more information about the illness, develop skills to cope with problems at home and learn skills to deal with the ill person. An important finding of the study was that the members developed a 'feeling of togetherness' as a result of being a member of a group with common aims. CONCLUSION: Participation in a support group meeting positively affects key variables in the participant's adaptation to mental illness in a relative.