Attitudes and beliefs of palliative care physicians regarding communication with terminally ill cancer patients.

The subject of communication between palliative care physicians and their patients regarding their diagnosis and prognosis has not been extensively researched. The purpose of this survey was to compare the attitudes and beliefs of palliative care specialists regarding communication with the terminally ill in Europe, South America, and Canada. A sample of palliative care physicians from South America (Argentina and Brazil), French-speaking Europe, and Canada were identified, and posted a questionnaire. Physicians who stated that they practised palliative care at least 30% of their time were considered evaluable as palliative care specialists. Of a total of 272 questionnaires, 228 were returned (84%); and 182/228 (81%) respondents were considered to be palliative care specialists. Palliative care physicians in all three regions believed that cancer patients should be informed of their diagnosis and the terminal nature of their illness. Physicians reported that at least 60% of their patients knew their diagnosis and the terminal stage of their illness in 52% and 24% of cases in South America, and 69% and 38% of cases in Europe, respectively. All physicians agreed that 'do not resuscitate' orders should be present, and should be discussed with the patient in all cases. While 93% of Canadian physicians stated that at least 60% of their patients wanted to know about the terminal stage of their illness, only 18% of South American, and 26% of European physicians said this (P < 0.001). Similar results were found when the physicians were asked the percentage of families who want patients to know the terminal stage of their illness. However, almost all of the physicians agreed that if they had terminal cancer they would like to know. There was a significant association between patient based decision-making and female sex (P = 0.007), older age (P = 0.04), and physicians from Canada and South America (P < 0.001). Finally, in their daily decision making, South American physicians were significantly more likely to support beneficence and justice as compared with autonomy. Canadian physicians were more likely to support autonomy as compared with beneficence. In summary, our findings suggest that there are major regional differences in the attitudes and beliefs of physicians regarding communication at the end of life. More research is badly needed on the attitudes and beliefs of patients, families, and health care professionals in different regions of the world.

Maahanmuuttajaoppilaat erityiskouluissa

Immigrant Pupils in Special Education Schools The study focused on the opinions of immigrant pupils in the 1st–9th grades of basic education in four special education schools of the City of Turku and in need of special support about the following: 1. Their difficulties in going to school in general education before the transfer to a special education school. 2. Their opinions about the transfer process to special education and the changes in their school practice after being transferred to a special education school. 3. Their experiences about their school and coping in special education school. The study strengthened the idea that immigrant pupils need positive special treatment, linguistic support, individual guidance, small teaching groups and operating models that promote well-being on their integration and education path. The central educational idea of inclusive education is based on deconstructing the power structures concerning gender, ethnicity and “race” and approval of differences in the pupils. Shifting the emphasis from the pupil to working on the learning environment has resulted in special education no longer being primarily separate special education tied to a certain place, but directing the teaching more towards individuality. The central dimension of intercultural competence of a teacher working in a multicultural class seems to be the attitudes and approaches to a different pupil; the teacher must be interculturally sensitive when facing children and young people from a foreign culture. Education and teaching affect every sector of the pupil’s well-being. Learning and learning results have a connection with teaching, education and well-being. Every sector is important for the going to school and integration of an immigrant pupil in need of special support. The basis of the study is the equality of opportunities and the humanistic idea of the human being in the Finnish education policy. The immigrant pupils selected for the study represented the following language groups: Arabian, Albanian, Somali, Russian and Vietnamese. In the four special education schools, the number of immigrant pupils belonging to these language groups (2004) totalled 104. A total of 89 pupils i.e. 86% answered the questionnaire, which is sufficient considering the generalisation of the study. Although this is basically a quantitative study, the interviewing method was used in part of the study, because the questionnaires were in Finnish and consequently, it was difficult for some immigrant pupils to understand them. Understanding the questions was also affected by the fact that the age distribution in the study was very wide (7–18). According to the results of the study, the immigrants felt that the biggest drawbacks in general education were their inability to speak Finnish and lack of concentration. The actual process of being transferred to a special education class remained unclear for immigrant pupils, and they could do very little about the transfer themselves. The results show that immigrant pupils coped well in special education school; they felt that their learning ability and concentration improved in the small groups of the special education school. They considered the individual support given in the special education schools to be useful. The lower-grade immigrant pupils had a more positive attitude towards special education school than the upper-grade immigrant pupils. In all the special education schools the immigrant pupils experienced that they were in a good position in the class; girls felt this even a little more strongly than boys. The teacher-pupil-relationship was felt to be good. School bullying being so common was a negative feature experienced by immigrant pupils, who were often targets or bullies themselves. Immigrant pupils believed in their success at school and in the opportunities offered by special education schools. Generally they were of the opinion that pupils are not labelled by special school; however, upper-grade immigrant pupils were more hesitant than lower-grade immigrant pupils. This study aimed at bringing out the immigrant pupils’ own opinions. Teaching immigrant pupils in special education schools has not been very much studied in Finland, which made the topic new and even more challenging.

Coping with an HIV infection. A multicenter qualitative survey on HIV positive adolescents' perceptions of their disease, therapeutic adherence and treatment.

HIV-positive adolescents face a number of challenges in dealing with their disease and its treatment. In this qualitative study, twenty-nine HIV-positive adolescents aged 13 to 20 years (22 girls), who live in Switzerland, were asked, in a semi-structured interview (duration of 40-110 minutes), to describe their perceptions and experiences with the disease itself and with therapeutic adherence. While younger adolescents most often thought of their disease as fate, older adolescents usually knew that they had received it through vertical transmission, although the topic appeared to be particularly difficult to discuss for those living with their HIV-positive mothers. Based on their attending physician's assessment, 18 subjects were judged highly adherent, 4 fairly and 7 poorly adherent. High adherence appeared linked with adequate psychological adjustment and effective coping mechanisms, as well as with the discussion and adoption of explicit medication-taking strategies. The setting and organisation of health care teams should allow for ongoing discussions with HIV-positive adolescents that focus on their perceptions of their disease, how they cope with it and with the treatment, and how they could improve their adherence.

La contraception d'urgence chez les adolescents en Suisse: une étude sur la sexualité des 16-20 ans

Objectifs: Faire le point sur les connaissances concernant la contraception post-coïtale (CPC) et son utilisation par les adolescentes, et réunir les recommandations utiles aux médecins prescripteurs. Matériel et méthodes: La revue de littérature concernant la CPC et les résultats d'une enquête concernant les comportements sexuels des adolescents de 16-20 ans en Suisse sont utilisés. Résultats: Plusieurs méthodes peuvent être utilisées incluant les oestroprogestatifs et les progestatifs seuls. C'est surtout à l'occasion de rupture de préservatif, d'oubli de pilule ou d'absence de contraception que la CPC peut être utile. Les adolescents sexuellement actifs semblent connaître l'existence de la CPC et 20% des jeunes filles y ont eu recours en Suisse. Mais les obstacles qui limitent l'accès à la CPC sont nombreux au niveau de l'information et de la qualité des services dans cette situation d'urgence. Discussion et conclusion: La sensibilisation des adolescents et des jeunes aux conditions d'utilisation de la CPC est nécessaire, et doit être associée à un effort de formation des professionnels et de qualité des services pour faciliter l'accès à la CPC. Mots-clefs: contraception d?urgence, contraception post-coïtale, pilule du lendemain, adolescents.<br/><br/>Purpose: To describe and analyze emergency contraception (EC) awareness and use among sexually active Swiss teenagers. Methods: Anonymous computerized questionnaires were distributed to a national representative sample of 4283 in-school adolescents (aged 16 to 20 years) in high schools and professional centers. Young people who were sexually active (51.5% of the sample: 1058 girls and 1073 boys) responded to questions on EC awareness and use and on sexual perception, attitude and behaviors. Univariate analyses and multiple regression analyses were used to describe EC awareness and use and their correlates. Results: Most of the sexually active girls (89.3%) and boys (75.2%) knew of the existence of EC. Of girls, 20% reported having used EC, and the majority of them used it only once (64.1%) or twice (18.5%). EC awareness was positively associated with the father's level of education (girls: odds ratio:5.18), and the scholastic curriculum of the respondent. Gender differences in the correlates of EC awareness demonstrate that girls who had a confidant, or a group of friends or boys of Swiss nationality and those who have had the opportunity to discuss the issue of contraception declare greater awareness of EC. EC use was higher among girls who lived in urban areas (odds ratio: 1.91) and occasionally had unprotected intercourse. We did not find any significant difference in the profile of multiple vs. one-time users. Conclusion: EC awareness and use should be improved through better information and accessibility, especially among teenagers who place themselves in at-risk situations. Keywords: Adolescents, Emergency contraception, Gender differences, Teenage pregnancy prevention, Switzerland.

Lasten luvaton tuli – perusasteen oppilaat sytyttelijöinä

Tutkimus lasten ja nuorten luvattomasta tulen käsittelystä perustuu näkemykseen siitä, että ilmiöön voidaan puuttua tehokkaasti interventioin, jos toiminta havaitaan ajoissa. Ilmiötä sävyttää teon salailu ja neutralisaatio eli vähättely. Tulella tehtyjen tuhotöiden lisääntymistä ja muuttumista aggressiivisemmaksi voidaan ennalta ehkäistä ongelman tunnistamisella ja reagoimalla lasten häiriökäytökseen. Lasten ja nuorten luvatonta tulen käyttöä ei ole tutkittu Suomessa aiemmin. Työn ensimmäisessä osiossa tarkastellaan luvattomaan tulen käsittelyyn liittyviä teorioita (esim. Fineman 1980, 1995), kansainvälisiä näkökohtia, teonpiirteitä ja yksilön sisäisiä prosesseja. Lisäksi tarkastellaan perheen, koulun ja ystäväpiirin osuutta ilmiöön, niin sanotun Oregonin mallin mukaisesti (Oregon Treatment Strategies Task Force 1996, 16 – 47). Työn empiirisessä osiossa ilmiötä ja sen ilmenemistä lasten ja nuorten keskuudessa kuvataan oppilaiden, vanhempien ja opettajien näkökulmasta. Tutkimukseen osallistui 661 oppilasta perusasteen toiselta, viidenneltä ja kahdeksannelta luokalta, 341 vanhempaa ja 22 koulun työntekijää. Oppilaiden ja vanhempien aineisto kerättiin survey-tutkimuksella ja opettajat tutkittiin haastattelumenetelmällä. Lasten luvaton tulen käyttö on yleisempää kuin aiemmin on luultu. Vielä viidenteen luokkaan mennessä luvaton tulen käsittely oli yleisempää pojille kuin tytöille, mutta murrosikään tultaessa sukupuolierot vähenivät. Pojista 37 % ja tytöistä 25 % raportoi käsitelleensä tulta luvattomasti. Kaikkiaan kolmasosa oppilaista raportoi leikkineensä tulella. Yleisin tulen sytyttelypaikka oli oma koti tai kodin lähiympäristö, josta tulentekovälineet yleisimmin hankittiin pyytämällä tai ottamalla. Luvattomasti tulta käsitelleet oppilaat olivat häirinneet oppitunteja. Tilastollisesti merkitsevimmin runsasta luvatonta tulen käsittelyä ennusti omien tulentekovälineiden omistaminen ja häiriökäyttäytyminen koulussa. Vanhemmat eivät pitäneet lastensa tulen käyttöä merkittävänä vaarana. Aikuisten suhtautumista lasten luvattomaan tulen käyttöön sävytti tekojen vähättely eli neutralisaatio; vähättelyilmiö oli yhteinen sekä lapsille itselleen, vanhemmille että viranomaisille. Kasvattajilla ei ollut käytössään tehokkaita interventiomenetelmiä ongelman ratkaisemiseen. Viranomaisyhteistyöstä raportoitiin vain vähän. Pelastusviranomaisia ei juurikaan käytetty lasten luvattoman tulen käsittelyn interventiossa. Interventiota sävytti aikuisten käsitysten mukaan tapauskohtaisuus ja sattumanvaraisuus.