Factors associated with condom use among brothel-based female sex workers in Thailand.

This study sought to determine the actual levels of condom use by female sex workers (FSW) in Thailand brothels. Specifically, it examined the influence that the country of origin of the FSW patrons exerted on usage of a condom, and it assessed the relevancy of constructs from the Health Belief Model in predicting FSW requesting condom usage by their clients. A survey was administered to a cross-sectional non-randomized convenience sample of 150 FSW in four geographic locations in Thailand, which included: Bangkok, Chang Mai, Mae Hong Son and Other (comprised mainly of brothels in small villages). Statistical interpretation of the data indicated that Thai FSW requested condom use in 63% of the cases, while the overall mean of condom use was only 51%. Condom use by patrons' country of origin was as follows: westerners 76%, foreign Asians 52% and native Thai men 27%. These results fall considerably short of the Ministry of Health's goal of 100% condom use in Thai brothels. Furthermore, public health education initiatives need to effectively target the native Thai FSW patrons since they represent the clients least likely to use a condom (27%).

A comparative study of hospice services in the United States.

In order to document the implementation of the hospice concept in the United States, 24 hospices, in operation at least one year and serving at least 100 patients, were selected from the National Hospice Organization roster to participate in a survey of organization, staffing, funding, services and population served. All of the hospices offered both home care and bereavement programs but only 41.7 per cent provided an inpatient program. Ten of the hospices were institutionally based, usually in a hospital. Inpatient services were associated with institutional affliations. The average profile of patients admitted to hospice was a 60-year-old White (89 per cent), female (54.3 per cent) cancer patient (94.5 per cent) whose spouse was primary care giver (63.8 per cent). Hospices provided a wide variety of both medical and social services provided by volunteers as well as paid staff. It appears that two divergent types of hospices are developing: 1) independent, heavily volunteer hospices with a variety of professional staff delivering a wide array of social/psychological services with unstable funding; and 2) institutionally based hospices providing both inpatient and home care, greater variety of medical/nursing services, less variety of social/psychological services, using fewer types of volunteers and paid staff, and not experiencing funding problems.

Hospice and health policy.

This article gives a review of the hospice concept of care. The importance of caring for the patient and family as one unit for the purpose of addressing needs of each, and the specific needs of the dying patient and of his/her family are discussed. The alleviation of symptoms and control of pain are of primary importance in terminal cases. Throughout the dying process the patient should be treated as a unique individual and his fear of isolation and abandonment must be overcome by the availability of personal attention. Although the patient receives a great deal of attention it is of vital importance to him/her that he/she is just as involved in giving as receiving. The family is both an agency and a recipient of care. It is the task of hospice care to allow the family to go on living. Feelings of anticipatory grief--of which a definition is given--have to be reduced; the most difficult time for the family is however when the patient is very close to death. It is stressed that real exchange of feelings between family and the dying person is of utmost importance for both, and should be encouraged by hospice care. The hospice staff should maintain contact with the family and close friends after the death of their loved one, to allow them ventilation of their feelings.

Living with the dying: use of the technique of participant observation.

Through participant observation, questions concerning optimal care of dying patients and needs of their families were answered. A general surgical ward and a palliative care unit were the sites of observation. The observations support the belief that a palliative care unit, specifically designed to meet the known needs of dying patients and their families, is preferable to a general surgical ward. The main findings, of less concern in the palliative care unit than on the surgical ward, were the following: the importance of patient-to-patient support; the discomfort of sick-role behaviour; the impersonal and sometimes intimidating nature of patient care; the limitation of the patient's need (as a person) to give as well as to receive; and the value of families, student nurses and volunteers in total care. These findings emphasize the importance of personal interest in relieving the distress suffered by many terminally ill patients.