The 'family' context of HIV: a need for comprehensive health and social policies.

This paper reports on the findings from a multi-site psychosocial study of Canadian families with HIV-positive mothers. A total of 110 adults, representing 91 families across Canada participated in interviews. Qualitative analysis revealed a number of themes including: a complex web of personal, health and family concerns; the needs of children; family finances; disclosure dilemmas; and social experiences and challenges. These themes reflect an intricate and dynamic picture of parental and family life for adults and children living with HIV infection. Nowhere in the literature do we see HIV framed as a 'family infection'. Surveillance reporting reflects information on infected adults and children but not family groupings. Yet with HIV several family members and multiple generations as well as single or both parents may be infected, highlighting the importance of 'family HIV' as a framework for health policy and programme development. At issue is the problem that medical and other institutions view issues of surveillance, treatment and care through the lens of the infected individual, rather than being family focused. Often it is only in the context of identifying support, or barriers to support, for the medically diagnosed individual that biological or socially created families become a focus of concern. The failure to situate both chronic and life-threatening illnesses within the family setting has serious quality of life and planning consequences for parents and children living with HIV infection as well as other illnesses.

The role of physicians in mammography referral for older Caribbean women in Canada.

BACKGROUND: Despite the fact that the proportion of immigrant and minority women who consult a general practitioner about their health is similar to that of their Canadian-born counterparts, studies suggest that they are less likely to be screened for breast cancer. This study examines physician characteristics associated with mammography referral and perceived barriers to mammography among family physicians serving the Caribbean community of Toronto. METHODS: The study consisted of a mail-back family physician survey. RESULTS: Among the 64 physicians who responded to the survey, over half reported that they were "very likely" to refer women for mammography during a regular preventive check-up. Among physician variables, only the amount of time spent on patient education was significantly associated with the likelihood of referral. Regarding perceived barriers, for male physicians, patient refusal and intervention causing patient discomfort were significantly associated with referral. For female physicians, only forgetting to provide service was identified as a significant barrier to referral. INTERPRETATION: An increased emphasis on patient education may help to increase screening referral among all physicians. Gender differences in perceived barriers to referral suggest that the gender of the physician is of major importance to the Caribbean community.

Challenges of parenting for families living with HIV/AIDS.

Given the continual rise of HIV infection in our communities and the improved life span for many who are HIV-positive, social workers in all fields of practice have clients whose lives have been touched by HIV/AIDS. This article reviews relevant literature and reports on the parenting needs that emerged in a Canadian study that examined the experiences of 105 mothers and fathers living with HIV/AIDS. The majority of the children in the study were not HIV-positive. Some themes related to parenting in the literature, and evident in this study, were chronic sorrow, stress and burden, normalization, stigma, secrecy, and disclosure. In the study parenting was found to be a source of joy and an additional challenge in an already complicated life. Important new themes were family life as precious time, focused parenting, the different effects of HIV/AIDS, the parenting preparation needs of fathers, and the efforts to parent affected and infected children differently. Parenting when living with HIV/AIDS requires attention from clinicians and researchers in a range of settings.

Social planning in Canada for families with HIV infection.

Parents living with HIV and their children face complex medical and social problems. Whether the children are infected or not, they are all affected by the presence of HIV in a parent. The purpose of this article is to describe the problems of families with HIV and to propose social planning measures to respond to their psychosocial needs. It is based on a multicentre study that included in-depth interviews with 110 parents representing 91 Canadian families living with HIV. The study's findings and recommendations were reviewed by parents with HIV, social workers specializing in helping affected families, and a multidisciplinary consensus conference. This process identified six areas needing attention: stigma and disclosure; promoting and supporting family health; planning and transitions for the care of children; economic issues; cultural and immigrant issues; and education, advocacy, policy development, and research. Recommendations for action were made in each area.

Rethinking knowledge and pedagogy in dental education.

Dentistry as a profession has often been considered both art and science. Traditional dental education has attempted to address both; however, in many places only the science of dentistry is emphasized. The move toward competency-based curricula in dental education requires an expansion of what constitutes meaningful knowledge in the curriculum and what pedagogies best support that curriculum. The scientific and technical knowledge considered foundational to clinical practice is not sufficient to teach competencies associated with the art of dentistry. Habermas, a social scientist, offers a way of looking beyond technical knowledge to consider two other forms of knowledge: practical and emancipatory. Pedagogy that supports development of practical and emancipatory knowledge includes problem-based learning and case methods, heuristics, reflective practica, journals, storytelling, and performance-based assessment methods. These important teaching strategies are being integrated into various dental curricula including a new competency-based dental curriculum at Marquette University's School of Dentistry. It will be critical for dental educators to continue developing these methods to provide efficient and effective education for future practitioners in both the art and science of dentistry.

Acute ethanol toxicity from ingesting mouthwash in children younger than 6-years of age.

The purpose of our study was to analyze reports of the American Association of Poison Control Centers (AAPCC) of suspected overingestion of ethanol from mouthrinses by children younger than 6 years of age between 1989 and 1994. Annual incidence rates of reported ethanol exposures attributed to mouthrinses were calculated. Lethal and toxic amounts of several mouthrinses were calculated using peak blood ethanol concentrations of 500 and 50 mg per 100 mL, respectively. In 1994, there were 2937 calls reported by poison control centers related to ethanol-containing mouthrinses, an estimated incidence of 168 reported exposures per 100,000 children younger than 6 years of age. A 15-kg child who ingests 212 mL (7.2 oz.) of Listerine (26.9% ethanol) ingests 57 mL (1.9 oz.) of ethanol, which is potentially lethal. Approximately one-tenth that amount of ethanol can produce a toxic reaction. Physicians, dentists, and other health care providers should inform parents of the dangers associated with accidental ingestion of mouthrinse and encourage them to keep mouthrinse out of the reach of children. The Food and Drug Administration (FDA) should require readily visible warning labels and child-resistant caps for containers with potentially toxic volumes of ethanol. The American Dental Association (ADA) should re-evaluate its acceptance criteria for advertising cosmetic mouthrinses in its publications and consider including child-resistant caps and warning labeling.

Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age.

OBJECTIVE: This paper analyzes reports to the American Association of Poison Control Centers (AAPCC) of suspected overingestion of fluoride by children younger than 6 years of age between 1989 and 1994, and estimates the probably toxic amounts of various home-use fluoride products in children younger than 6 years of age. METHODS: Annual incidence rates of reported fluoride exposures attributed to dietary supplements, toothpaste, and rinses were calculated. Probably toxic amounts of each product were calculated using the frequently cited dose of 5 mg/kg. RESULTS: Children younger than 6 years of age accounted for more than 80 percent of reports of suspected overingestion. While the outcomes were generally not serious, several hundred children were treated at health care facilities each year. A 10 kg child who ingests 50 mg fluoride (10.1 g 1.1% NaF gel; 32.7 g 0.63% SnF2 gel; 33.3 g 1,500 ppm F toothpaste; 50 g 1,000 ppm F toothpaste; and 221 mL 0.05% NaF rinse) will have ingested a probably toxic dose. CONCLUSIONS: Overingestion of fluoride products in the home is preventable. Dentists and other health care providers should educate parents and child care providers about the importance of keeping fluoride products out of reach of children. Manufacturers should be encouraged by the ADA and the FDA to use child-resistant packaging for all fluoride products intended for use in the home.

Provision of free and discounted dental services to selected populations: a survey of attitudes and practices of dentists attending the 1996 Dallas Midwinter Meeting.

An attitudes and practices survey of dentists attending the Dallas Midwinter Meeting in January 1996 in Dallas was conducted as a collaborative effort between the Dallas County Dental Society and the Baylor College of Dentistry. The survey was developed to help determine participating dentists' attitudes and practices in the area of provision of dental services on a discounted or free basis to disadvantaged patient groups. A total of 225 dentists responded to the survey. Of these surveyed dentists, 213 (94.6%) were in private practice and 199 (88.4%) described themselves as general dentists. A considerable amount of charitable dental services, discounted and free, was reported to be provided by the group of respondent dentists. A total of 152 (67.6%) of the dentists surveyed reported providing discounted or free care to elderly patients with low income, 125 (55.6%) provided such care to low-income patients without age restriction, and 137 (60.9%) cared for patients of record with temporary financial hardship. In other patient categories, 79 (35.1%) of the dentists provided free/discounted services to handicapped persons and 47 (20.9%) provided care to homebound patients. These findings concerning charitable practices by dentists were similar to those found in a comparable survey conducted by the American Dental Association in 1994. Dentists were fairly evenly split as to their preference where to volunteer services. Of the total respondents, 84 (40.6%) preferred providing services in their own office and 91 (44.0%) preferred to do so at a community health clinic that hosted volunteers.

Developing, implementing, and evaluating a handbook for parents of pediatric hematology/oncology patients.

This article details the development of a parent handbook for pediatric hematology and oncology patients. The planning and content development are discussed. Adult learning principles were incorporated throughout the handbook. Use of the handbook in a pediatric cancer center is described. Both subjective and objective methods were used to evaluate the handbook. Results from the evaluation verify the value of the handbook to parents and give direction for future revisions of the handbook.

Enhancing rehabilitation through mutual aid: outreach to people with recent amputations.

Social workers in a rehabilitation hospital established an outreach service through which volunteers with previous amputations visited patients with recent amputations, acting as role models and offering emotional support and information. Volunteers received in-depth training and continued with their own system of support. Patients who were visited had strong positive responses to the program. Critical components of the program were developing a collaborative partnership between volunteers and social workers; demonstrating credibility to health care professionals; linking emotional support, information, and affirmation; providing benefits to both patient and volunteer; and strengthening linkages among patient, community, and institution.

The effects of group therapy on bereaved extended family of children with cancer.

The impact of the death of a child from cancer and subsequent grief on the extended family members has not been documented. Additionally, the effect of a support group for these individuals has not been explored. Therefore, this one group pretest/post-test study sought to determine the effects of participation in a support group for bereaved extended family members whose child died from cancer. Extended family members completed the Emotions Profile Index before and after the group sessions. Descriptive data were collected from the cotherapists' process log and the participants' evaluation. No significant differences were found between pretest and post-test scores for any emotional state. However, the group process log showed significant clinical data related to the intensity of the grief experienced and ways of coping with the loss. The Bereaved Extended Family Group Evaluation demonstrated the usefulness of the group experience. Tentative conclusions support the value of such a group in providing a forum for the bereaved extended family to ventilate feelings of anger and sadness and find ways to cope with the future.

"Lasting Impressions: adolescents with cancer share how to cope"--a videotape program.

This article discusses the production of a videotape program for newly diagnosed adolescent cancer patients and their parents. The video was developed as a goal of the members of Lasting Impressions, a support program for adolescent cancer patients and their parents. The patients wanted to help other patients realistically understand the stresses they would encounter and learn ways to cope with them. The project is unique in that the patients developed the content, wrote the script, and starred in the production. This article details the various components of the project and describes the therapeutic goals achieved.

Responsiveness and accountability in long-term care: strategies for policy development and empowerment.

This paper presents a model for engaging planners, service providers and consumers in a collaborative process of improving quality of life in long-term care facilities, discussing the implications of this approach for standards of care and policy development. This empowerment model was refined and tested in a large system of skilled-nursing-care facilities using a matched-pair comparison group design. The rationale, theory base and the relationship of the empowerment model to current concepts of health promotion are shown. Subsequent follow-up indicated examples of the impact of the model on broader aspects of public policy.

Lasting impressions. A psychosocial support program for adolescents with cancer and their parents.

Adolescents with cancer undergo numerous stresses due to their disease, its treatment, and its potential late effects. These patients may experience delayed mastery of developmental tasks, intimacy, and independence and may have long-term psychological sequelae. Parents of adolescents with cancer also encounter many stresses related to coping with their child's illness. Lasting Impressions, a support program for adolescent cancer patients and their parents, was developed to help overcome these problems. The purpose of the program is to promote positive mental health and adaptation in participants. This article describes the program's goals and methods for accomplishing them, including components and therapeutic activities. The activities include a scrapbook, a newsletter, peer visitation, and a speakers' bureau. The most recent project is a video that is shown to newly diagnosed cancer patients. This program could be easily replicated by other oncology nurses who work with adolescents or young adults with cancer.

Strategies for organizing and maintaining successful support groups.

Nurses often become involved in organizing and leading support groups either through needs in their institutions or at the request of consumers interested in forming self-help groups. Nurses without formal training in group therapy may find it difficult to organize and maintain support groups. Successful strategies, based on group therapy techniques and project management skills, can assist group leaders in organizing a group "from scratch" or in revitalizing existing groups.

Effects of group therapy on parents of children with cancer.

Group therapy for parents of children with cancer has been suggested as a means of relieving stress. This quasi-experimental study sought to determine the effect of participation in a support group for parents of children aged 10 to 14 years with cancer. Parents completed the Wallston Health Locus of Control (HLOC) Scale and the Social Adjustment Scale-Self Report (SAS-SR) both before and following seven group sessions. Descriptive data were collected from the cotherapists' process log and the participants' evaluation. A significant t test score (P = .017) was obtained for the HLOC Scale questionnaire. The group process log showed recurrent themes of helplessness and powerlessness. The Parent Support Group Evaluation (PSGE) developed by the researchers, demonstrated satisfaction and revealed that school and community activities were considered the most helpful. Tentative conclusions support the value of such a group in providing a forum for the parents to discuss concerns and decrease their sense of isolation. However, more study is needed with a larger sample before definitive conclusions can be reached.