A qualitative study of the transition to adulthood for youth with physical disabilities.

The purpose of this qualitative study was to explore the experiences, perceptions, and needs of youth with physical disabilities in transition from adolescence to adulthood. Purposeful sampling strategies were used to select 34 study participants who lived in three regions of south-central Ontario, Canada. Data collection methods were individual and focus group interviews, and were guided by a set of open-ended questions. An editing style of analysis sorted the text into codes for description and interpretation. Themes emerged about context, the transition process, needs, and services. Participants identified a poor fit between young persons with disabilities and the adult world they were entering. They recommended that services be focused on environmental supports to enable them to "build their own bridges" to the adult world. Community-based transition services need to be planned in collaboration with youth with disabilities and their parents. Concepts of person-environment fit and health promotion can be incorporated into services to enable young persons with disabilities to experience a smooth transition from adolescence to adulthood.

Canadian ethnocultural communities facing AIDS: overview and summary of survey results from phase 111

This paper describes the survey results reporting demographic profiles, behaviours, opinions beliefs, attitudes and intentions related to condom use for three Canadian ethnocultural communities (Latin American, English-speaking Caribbean and South Asian) participating in the Ethnocultural Communities facing AIDS Study. Specific recommendations are presented for HIV-prevention programming based on the research results (AU).

Understanding use of condoms among Canadian ethnocultural communities: methods and main findings of the survey

The aim of this study was to understand the intention to use a condom for each instance of sexual intercourse with a new partner in three of Canada's non-dominant ethnocultural communities: Latin American (N=346), English-speaking Caribbean (N=358), and South Asian (N=355). All respondents were recruited from multiple ethnocultural venues using predetermined sampling frames and quotas for each community. Anonymous questionnaire assessing culturally specific theoretical constructs were completed. This paper presents the methodology and the main findings. The high quality of the results of this study demonstrate the advantage of establishing strong partnerships with members of communities being studied (AU)

Many voices: sociocultural results of the ethnocultural communities facing AIDS study in Canada

This paper presents the results of Phase 11 of the Ethnocultural Communities facing AIDS Study, the sociocultural investigation of factors contributing to risk behaviour associated wih HIV/AIDS in six ethnocultural communities in Canada in three urban sites. In Vancouver, the South Asian and Chinese communities were studied, the Horn of Africa and English-speaking Caribbean communities in Toronto and the Latin American and Arab-speaking communities in Montreal. Results demonstrated that there are common elements across these ethnocultural communities that increase the risk for HIV transmission. HIV/AIDS awareness and prevention in ethnocultural communities must address sociocultural differences, particularly sex role differences between men and women in terms of power within relationships to negotiate for safer sexual practices (AU).

HIV/AIDS in the context of culture: selection of ethnocultural communities for study in Canada.

This article reports on the methodology used to select six ethnocultural communities invited to participate in subsequent phases of the project on HIV/AIDS in the context of culture in Canada. Selection was based on quantitative data on demography, qualitative assessment of ethnocultural cohesion; and quantitative data and qualitative data of exposure to risk for sexually transmitted disease. A principle of partnership insured that the final selection was completed by interaction between the investigators and the National Advisory Committee representing ethnocultural communities in Canada. The six communities asked to participate in Phase II of the study were: in Montreal, the Latin American and the Arabic-speaking communities; in Toronto, the English-speaking Caribbean communities and communities from the Horn of Africa; in Vancouver, the Chinese and the South Asian communities. The results are significant for the future both of research on ethnicity in Canada and of control of HIV and AIDS.

Many voices--sociocultural results of the ethnocultural communities facing AIDS study in Canada.

This paper presents the results of Phase II of the Ethnocultural Communities Facing AIDS Study, the sociocultural investigation of factors contributing to risk behaviour associated with HIV/AIDS in six ethnocultural communities in Canada in three urban sites. In Vancouver, the South Asian and Chinese communities were studied, the Horn of Africa and English-speaking Caribbean communities in Toronto and the Latin American and Arabic-speaking communities in Montreal. Results demonstrated that there are common elements across these ethnocultural communities that increase the risk for HIV transmission. HIV/AIDS awareness and prevention in ethnocultural communities must address sociocultural differences, particularly sex role differences between men and women in terms of power within relationships to negotiate for safer sexual practices.

Aqueous beclomethasone dipropionate nasal spray in the treatment of seasonal (ragweed) rhinitis.

OBJECTIVES: To determine whether the provision of appropriate medication and comprehensive information before the ragweed pollen season enables patients to manage their hay fever successfully, achieving satisfactory symptom control and quality of life, to examine patient characteristics that may predict successful symptom management and to learn which factors patients consider when making treatment choices. DESIGN: Single-group prospective cohort management study. SUBJECTS: Ninety adults sensitive to ragweed pollen recruited from those who had participated in previous clinical studies and from those who responded to advertisements in the local media. INTERVENTION: Aqueous beclomethasone dipropionate nasal spray and comprehensive information about optimal therapy (starting before the ragweed pollen season and continued throughout at a dose of 400 micrograms/d) and how it may be used less intensively with an as-required regimen. MAIN OUTCOME MEASURES: Symptom control, patient satisfaction, quality of life and medication use. RESULTS: More than 80% of the patients reported very good symptom control and were very satisfied. In all, 62% chose to use less than the optimal daily dose. Patients who had less than optimal symptom control used significantly less of the nasal spray than those with very good control either because they wanted to keep medication use to a minimum or because they were unable to remember to take their medication. The only significant predictor of inadequate control was an acknowledged inability to remember to take medication. Symptoms and trust in the practitioner were the primary factors perceived by the patients to determine their treatment choices. CONCLUSION: When provided with aqueous beclomethasone dipropionate nasal spray and comprehensive information on the drug and dosing, most patients are successful in managing their hay fever.

A lament by women for "the people, the land" [Nishnawbi-Aski Nation]: an experience of loss.

In response to a hunger fast by five members of the Sandy Lake Band at the Sioux Lookout Zone Hospital in Northern Ontario (Canada)--a cultural protest of the status of health care services in the Zone--the Federal Minister of Health agreed to establish a Panel to review the region's health care system. The year-long study involved hearings in each of the 28 remote communities of the Zone, and interviews with elders and chiefs, women, and health care providers. A consultation team from McMaster University (Faculty of Health Sciences) assisted the Panel with epidemiological survey research, literature reviews, and the interpretation of the data collected in the proceedings. This paper offers our interpretation of data collected from the qualitative study component. Specifically, it provides an interpretation of the discourse of the native women of the Nishnawbi-Aski Nation on their experience of health and health care. An "idiom of loss" captures, we feel, the depth of their concerns, dilemmas and frustrations.

A family physician smoking cessation program: an evaluation of the role of follow-up visits.

Our purpose in this randomized clinical trial was to compare a two-visit smoking cessation intervention by family physicians with the same intervention supplemented by additional follow-ups. Forty-one southern Ontario family physicians volunteered for the study and subsequently participated in a four-hour training program on smoking cessation techniques. Physicians advised patients who smoked and indicated an interest in attempting to quit with the help of their physician to stop smoking at the end of a regularly scheduled visit. Physicians instructed patients to make a specific appointment for an evaluation of their smoking habits. Six hundred forty-seven patients returned for that assessment and were than randomized into either the two-visit intervention group (with risk assessment, support, the setting of a cessation date, self-help literature, and a prescription for nicotine gum, where appropriate) or into the other intervention group (with the same maneuvers as well as the offer of four more supportive follow-up visits). We found no statistically significant difference in one-year, biochemically validated, sustained cessation rates between the group offered the long-term follow-up visits (12.5%) and the group given the brief intervention (10.2%). The 95% confidence interval on the difference between the groups was 2.8% in favor of the brief intervention group to 7.3% in favor of the group offered follow-up. The results do not support the value of long-term follow-up visits for smokers.

Patients' perspectives of a physician-delivered smoking cessation intervention.

Forty-three patients--recipients of a highly structured, physician-delivered smoking cessation intervention--were interviewed using ethnographic (anthropological) research methods. We conducted interviews with patients after visits with the physician, then audiotaped and transcribed them. Discourse analysis of interview texts identified features and components of the physician maneuver most effective from the patients' point of view. Patients discussed two general areas of physicians' preventive activities: an interventionistic component (in which professional, diagnostic, and authoritative features were emphasized) and a personalistic component (in which physicians were experienced as equals, supportive, caring, empowering, and challenging). From the perspective of patients, the personalistic component of the physician-delivered smoking cessation maneuver appeared most effective. We conclude that, in clinical preventive medicine generally, patients (1) evaluate the kind of support they receive from their physician (e.g., degree of empathy, encouragement, and sincerity), (2) respond favorably to positive imagery in the challenge to alter their lifestyle, (3) look for a balance in the relationship established with their physician (negotiation, respect, mutual understanding, and rapport), and (4) remember the consistency and regularity of their physician's health promotion messages.

A new stage, a new life: individual success in quitting smoking.

This paper posits an anthropological perspective on smoking cessation that considers both the social context for cigarette use and disuse, and the construction of meanings for the quitting process. With reference to the dialectic of person and individual propounded by Burridge (1979), four case studies of cigarette smokers are presented to elucidate the quitting process in the context of achieving a 'new stage, a new life'. At certain times, events-that-happen may cause persons to act as individuals; by seizing the moment in this way, they achieve a moment of individuality in which roles, desires, and objectives for living are recreated and transformed.

Smoking cessation in primary care. A randomized controlled trial of nicotine-bearing chewing gum.

The results are reported from a multicentered, randomized clinical trial of a physician-delivered smoking cessation intervention package. All physicians attended a four-hour training session during which the rationales for the different aspects of the intervention were discussed, including a detailed description of the proper use of nicotine-bearing chewing gum. Patients were randomized to receive an offer of a prescription of 2 mg of nicotine chewing gum in addition to the basic intervention (n = 111) or the basic intervention alone (n = 112). The basic intervention included advice, setting a date for quitting, self-help materials, and the offer of supportive follow-up visits. Receptionists were instructed to recruit the first two smokers attending the practice each day. One-year smoking cessation was validated by cotinine saliva analysis. The validated three-month sustained abstinence rates at one year were 8.1 percent and 9.8 percent in the gum and no-gum groups, respectively. The 95 percent confidence interval about this difference was -9.3 percent to 6.4 percent. There is no evidence from this study that the offer of 2 mg of nicotine-bearing gum enhances smoking cessation rates when added to a comprehensive intervention offered to all smokers in primary care. Until larger trials are completed, however, the possibility that this dose of nicotine gum may produce small beneficial effects cannot be excluded.

A randomized trial of physician training for smoking cessation.

Abstract This randomized controlled trial investigated the effects of a smoking cessation workshop on physician practices and on patients' smoking behavior. Eighty-three community family physicians were randomly allocated by practice to either 1) a Usual Care condition, 2) a group in which physicians were not trained but were asked to address smoking cessation with specific patients, or 3) a condition which included physician training as well as printed resources and in which specific patients were identified as smokers. The intervention taught to the physicians through a four hour training workshop included providing advice about stopping smoking, the setting of a date for stopping, the offer of nicotine gum, take-home materials, and the offer of follow-up visits. The intervention was described, demonstrated, and the physicians practiced with simulated patients. The outcome of the intervention was assessed in terms of physician behavior and patient smoking behavior. Exit interviews with patients demonstrated that patients of trained physicians did not differ from patients of untrained physicians on how willing they were to try to stop smoking nor on their receptiveness to nicotine gum. However, there was a small but statistically significant difference favoring the patients from the trained physician group who successfully stopped smoking.

A randomized trial of a family physician intervention for smoking cessation.

We assessed the impact of three conditions on one-year smoking cessation rates. Physicians in 70 community general practices were randomly allocated by practice to one of three groups: In the usual care group, smoking patients were to receive the care they normally would receive. In the gum only group, physicians were asked to speak to patients about smoking cessation and offer nicotine gum. In the gum plus group, physicians were trained in the experimental intervention. This intervention involved advice to stop smoking, the setting of a quit date, the offer of nicotine gum, and four follow-up visits. Smoking cessation was measured by self-report after one year and validated using saliva cotinine measures. Using a criterion of at least three months of abstinence, 8.8% of the patients of the trained physicians had stopped smoking at the one-year follow-up compared with 4.4% and 6.1% of the patients in the usual care and gum only groups, respectively.

A smoking cessation intervention program for family physicians.

Family physicians are able to approach many patients who smoke but are often hesitant to help them quit. Lack of knowledge about effective interventions is a major reason for this hesitancy. The important components that have been tested in physician-initiated smoking cessation interventions are advice to quit, information about the risks of smoking and techniques for quitting, nicotine gum, setting a date for quitting and offers of supportive follow-up visits. We describe a cessation program developed for family physicians that incorporates these factors into three types of visits over a 2-month period: the challenge visit, which occurs during a regular office visit and focuses on advice and setting a date to quit; the quit-date visit, which involves instructing patients on the proper use of nicotine gum, if applicable, and confirming their desire to quit; and four supportive follow-up visits, which provide continuing encouragement for 2 months and allow physicians to monitor withdrawal symptoms, relapses and other problems. Such a program can be effectively incorporated into a general practice.

"""We are Dying and Getting Finished; Who Will We Leave These Ones For?"" Women's Concerns about Childbearing in Rural Rakai; SW Uganda."

Objectives: To a) Establish the parameters of reproductive choice amongst women who are at high risk for HIV infection. b) Discuss the impact ofthese parameters on issues concerning perinatal transmission. Methods: Research wasdone in amixed ethinicity trading centre in AIDS affected SW Uganda. This ethnographic study used both in-depth; open ended interviews and focus groups with women who believe they are infected or have been tested HIV positive. Results: Regardless of' marriage form' birth control including condom use is perceived to be non negotiable. 'They only use them with those women from out' 'Men want to be associated with many numbers of children... want to leave someone behind' 'Did you come here just to eat?' Women do exercise reproductive choice; either in refusal or without husbands' knowledge (pills; injections; traditional methods). The consquences of refusal to either have sex or produce children are very restrictive; they lead to separation(leaving women economically vulnerable) or the men will go out and find another woman. Little change occurs in relationships where positive sero-status of one or both partners is a real possibility. Evidence suggests that certainty of sero-status gives the impetus to make hard decisions;reproductively. Uncertainty leads to both confusion and fatalism. REgardless of access to cash; sick babies are neglected(immunization; breast feeding; treatment) by both parents. ''This one is slimming anyway''. Mothers experience both the stigma and associated burdens of caring for the sick child. In addition they often decide not to treat themselves. Birth of healthy babies indicate that parents are negative. Conclusion: The voices of women are a testimony to the constraints they expirience sexually and reproductively. They do have a 'choice'. However ;the repercussions of this choice; particularly in high risk environments become restrictive and burdensome