Insertion dans les soins après une première hospitalisation dans un secteur pour psychose [Linkage to care after first hospitalisation for psychosis]

BACKGROUND: First hospitalisation for a psychotic episode causes intense distress to patients and families, but offers an opportunity to make a diagnosis and start treatment. However, linkage to outpatient psychiatric care remains a notoriously difficult step for young psychotic patients, who frequently interrupt treatment after hospitalisation. Persistence of symptoms, and untreated psychosis may therefore remain a problem despite hospitalisation and proper diagnosis. With persisting psychotic symptoms, numerous complications may arise: breakdown in relationships, loss of family and social support, loss of employment or study interruption, denial of disease, depression, suicide, substance abuse and violence. Understanding mechanisms that might promote linkage to outpatient psychiatric care is therefore a critical issue, especially in early intervention in psychotic disorders. OBJECTIVE: To study which factors hinder or promote linkage of young psychotic patients to outpatient psychiatric care after a first hospitalisation, in the absence of a vertically integrated program for early psychosis. Method. File audit study of all patients aged 18 to 30 who were admitted for the first time to the psychiatric University Hospital of Lausanne in the year 2000. For statistical analysis, chi2 tests were used for categorical variables and t-test for dimensional variables; p<0.05 was considered as statistically significant. RESULTS: 230 patients aged 18 to 30 were admitted to the Lausanne University psychiatric hospital for the first time during the year 2000, 52 of them with a diagnosis of psychosis (23%). Patients with psychosis were mostly male (83%) when compared with non-psychosis patients (49%). Furthermore, they had (1) 10 days longer mean duration of stay (24 vs 14 days), (2) a higher rate of compulsory admissions (53% vs 22%) and (3) were more often hospitalised by a psychiatrist rather than by a general practitioner (83% vs 53%). Other socio-demographic and clinical features at admission were similar in the two groups. Among the 52 psychotic patients, 10 did not stay in the catchment area for subsequent treatment. Among the 42 psychotic patients who remained in the catchment area after discharge, 20 (48%) did not attend the scheduled or rescheduled outpatient appointment. None of the socio demographic characteristics were associated with attendance to outpatient appointments. On the other hand, voluntary admission and suicidal ideation before admission were significantly related to attending the initial appointment. Moreover, some elements of treatment seemed to be associated with higher likelihood to attend outpatient treatment: (1) provision of information to the patient regarding diagnosis, (2) discussion about the treatment plan between in- and outpatient staff, (3) involvement of outpatient team during hospitalisation, and (4) elaboration of concrete strategies to face basic needs, organise daily activities or education and reach for help in case of need. CONCLUSION: As in other studies, half of the patients admitted for a first psychotic episode failed to link to outpatient psychiatric care. Our study suggests that treatment rather than patient's characteristics play a critical role in this phenomenon. Development of a partnership and involvement of patients in the decision process, provision of good information regarding the illness, clear definition of the treatment plan, development of concrete strategies to cope with the illness and its potential complications, and involvement of the outpatient treating team already during hospitalisation, all came out as critical strategies to facilitate adherence to outpatient care. While the current rate of disengagement after admission is highly concerning, our finding are encouraging since they constitute strategies that can easily be implemented. An open approach to psychosis, the development of partnership with patients and a better coordination between inpatient and outpatient teams should therefore be among the targets of early intervention programs. These observations might help setting up priorities when conceptualising new programs and facilitate the implementation of services that facilitate engagement of patients in treatment during the critical initial phase of psychotic disorders.

Coronary heart disease and cerebrovascular disease mortality in young adults: recent trends in Europe.

Background: Over the last two decades, mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) declined by about 30% in the European Union (EU). Design: We analyzed trends in CHD (X ICD codes: I20-I25) and CVD (X ICD codes: I60-I69) mortality in young adults (age 35-44 years) in the EU as a whole and in 12 selected European countries, over the period 1980-2007. Methods: Data were derived from the World Health Organization mortality database. With joinpoint regression analysis, we identified significant changes in trends and estimated average annual percent changes (AAPC). Results: CHD mortality rates at ages 35-44 years have decreased in both sexes since the 1980s for most countries, except for Russia (130/100,000 men and 24/100,000 women, in 2005-7). The lowest rates (around 9/100,000 men, 2/100,000 women) were in France, Italy and Sweden. In men, the steepest declines in mortality were in the Czech Republic (AAPC = -6.1%), the Netherlands (-5.2%), Poland (-4.5%), and England and Wales (-4.5%). Patterns were similar in women, though with appreciably lower rates. The AAPC in the EU was -3.3% for men (rate = 16.6/100,000 in 2005-7) and -2.1% for women (rate = 3.5/100,000). For CVD, Russian rates in 2005-7 were 40/100,000 men and 16/100,000 women, 5 to 10-fold higher than in most western European countries. The steepest declines were in the Czech Republic and Italy for men, in Sweden and the Czech Republic for women. The AAPC in the EU was -2.5% in both sexes, with steeper declines after the mid-late 1990s (rates = 6.4/100,000 men and 4.3/100,000 women in 2005-7). Conclusions: CHD and CVD mortality steadily declined in Europe, except in Russia, whose rates were 10 to 15-fold higher than those of France, Italy or Sweden. Hungary and Poland, and also Scotland, where CHD trends were less favourable than in other western European countries, also emerge as priorities for preventive interventions.

Diabetes care in Switzerland: good, but perfectible: a population-based cross-sectional survey.

BACKGROUND: While Switzerland invests a lot of money in its healthcare system, little is known about the quality of care delivered. The objective of this study was to assess the quality of care provided to patients with diabetes in the Canton of Vaud, Switzerland. METHODS: Cross-sectional study of 406 non-institutionalized adults with type 1 or 2 diabetes. Patients' characteristics, diabetes and process of care indicators were collected using a self-administered questionnaire. Process indicators (past 12 months) included HbA1C check among HbA1C-aware patients, eye assessment by ophtalmologist, microalbuminuria check, feet examination, lipid test, blood pressure and weight measurement, influenza immunization, physical activity recommendations, and dietary recommendations. Item-by-item (each process of care indicator: percentage of patients having received it), composite (mean percentage of recommended care: sum of received processes of care / sum of possible recommended care), and all-or-none (percentage of patients receiving all specified recommended care) measures were computed. RESULTS: Mean age was 64.4 years; 59% were men. Type 1 and type 2 diabetes were reported by 18.2% and 68.5% of patients, respectively, but diabetes type remained undetermined for almost 20% of patients. Patients were treated with oral anti-diabetic drugs (50%), insulin (23%) or both (27%). Of 219 HbA1C-aware patients, 98% reported ≥ one HbA1C check during the last year. Also, ≥94% reported ≥ one blood pressure measurement, ≥ one weight measurement or lipid test, and 68%, 64% and 56% had feet examination, microalbuminuria check and eye assessment, respectively. Influenza immunization was reported by 62% of the patients.The percentage of patients receiving all processes of care ranged between 14.2%-16.9%, and 46.6%-50.7%, when considering ten and four indicators, respectively. Ambulatory care utilization showed little use of multidisciplinary care, and low levels of participation in diabetes-education classes. CONCLUSIONS: While routine processes-of-care were performed annually in most patients, diabetes-specific risk screenings, influenza immunization, physical activity and dietary recommendations were less often reported; this was also the case for multidisciplinary care and participation in education classes. There is room for diabetes care improvement in Switzerland. These results should help define priorities and further develop country-specific chronic disease management initiatives for diabetes.

Public health assessment : Railroad Avenue groundwater contamination, West Des Moines, Polk County, Iowa EPA facility ID: IA0001610963 (2004)

The Railroad Avenue groundwater contamination site (the site) is in West Des Moines, Polk County, Iowa. Located on approximately 120 acres. The site comprises mixed residential, industrial and commercial properties. Underneath the site, chlorinated volatile organic compounds (VOCs) have contaminatcd the shallow (i.e., 30-50 feet deep) groundwater. These compounds have compromised several shallow wells within the West Des Moines water works system. A contamination source, however, has not yet been identified. In 1993, routine water analysis by the City of West Des Moines identified 1, 2 cis-dichlorocthylcne (1, 2 cis-DCE) at a concentration of 1.2 μg/L (micrograms) per liter of water) in the water supply. Subsequently. several shallow municipal wells were found to be contaminated by VOCs, including 1. 2 cis-DCE, trichloroethylene (TCE), tetrachloroethylene (PCE) and benzene. Five of these wells have been taken out of service. Because of the impact on the West Des Moines water supply, the U.S. Environmental Protection Agency (USEPA) has assigned the site to the National Priorities List. Surface water und sediment at the site have not been impacted by the VOCs. Testing for VOCs in surface soils has not revealed any significant VOC contamination. Subsurface soils -- generally 8 feet or greater in depth -- are contaminated with VOCs, but at levels which should not present a health hazard. The past, present, and future health hazard category chosen for this site is no apparent public health hazard. This category is used when exposure to toxins might be occurring or might have occurrcd in the past, but at levels below any known health hazard. Analysis of available environmental data has not revealed that residental or commercial water customers are or have been exposed to VOCs at concentrations that might cause any adverse health effects.

Les composantes du risque : une entrée par les acteurs et le conflit lors de la mise en place des solutions : le cas de Los Chorros, Guatemala

Ce travail présente une étude de cas post-catastrophe à San Cristobal, Guatemala, où un important glissement de terrain du nom «Los Chorros» (8-10 millions de m3 de roche) affecte depuis 2009 diverses communautés et une des routes principales du pays. Les gestionnaires des risques, sur la base de leur propre évaluation, ont décidé de répondre d'une manière qui ne correspond pas aux intérêts de la population affectée. Les communautés locales ont évalué le risque de catastrophe et ont établi une autre solution suivant une conception du risque différente. Les conflits sociaux et la concurrence entre les différents acteurs du territoire, pour la définition des priorités et des solutions, révèlent les aspects sous-jacents de la société, utiles pour identifier et comprendre ce qui constitue le risque de catastrophe dans un contexte donné. Ce conflit montre que le risque de catastrophe n'est pas univoque mais un concept complexe, constitué par un grand nombre de composants. En termes de gouvernance, il met également en évidence la confrontation des savoirs et la tension qui peut exister entre les différentes approches du risque. Depuis une approche où le risque de catastrophe est considéré comme une construction sociale (les vulnérabilités étant historiquement générées par des processus sociaux, politiques, économiques et culturels), ce travail évalue d'autres modes d'interprétation, de traitement et d'intervention qui peuvent aider à améliorer les méthodes d'évaluation et de gestion des risques. Enfin, la proposition de gestion qui découle de l'exemple guatémaltèque invite à une autre manière de concevoir la gestion des risques en intégrant les différentes conceptions du risque et en visant une coordination stratégique entre les acteurs des politiques publiques, les échelles d'intervention, les experts en charge des différents aléas et la société civile, afin d'obtenir une solution acceptable pour tous les acteurs impliqués dans un territoire. -- This work analyses a post-disaster case study from San Cristobal, Guatemala where a large landslide named "Los Chorros (8 millions cubic meters of rock) affects several communities and one of the country's main west-east access highways. Risk managers, starting from their own assessment, decided to respond in a way that does not correspond to the interests of the afected population. Local communities assessed the risk disaster situation and establised another solution from a different conception of risk. These social conflict and competition for priorities and solutions for risk management reveal that disaster risk is not unequivocal but a complex and holistic concept, constituted by a large set of components. From a social constructivism approach, where disaster risk is considered as the results of social, political, economic and historic process, this thesis evaluates other modes of interpreting, shaping and managing risk that can help improve methods of risk assessment and management. Studying the logic of action of actors, who mobilize to establish a solution, enables to identify as to what constitutes a disaster. For this reason, the study focus, in particular, on the analysis of practices (practical science) implemented by all actors in San Cristobal Altaverapaz. Finally, it puts into perspective the risk management in terms of an integrative approach for policy experts that find compromise between different conceptions of risk in order to obtain a solution acceptable to all those involved.

Exploring multiracial/cultural identities through mothers' voices /

This study explored the experiences of mothers of multiracial/cultural children within the context of family, school, and community. Three categories of mothers of multiracial/cultural children were interviewed privately and then invited to meet as a group to explore some of their reflections and experiences. The categories consisted of 4 mothers with multiracial/cultural children presently attending elementary school, 2 mothers of multiracial/cultural children who are now adults and 3 mothers from my own multiracial/cultural family. The study explored the researcher's personal quest for a multiracial/cultural identity and combined interviews with her daughter, her sister, and her mother to reveal the multiracial/cultural experience from a personal perspective. Content analysis of the narratives revealed that multiracial/cultural children produce their own culture and establish new and personally relevant priorities as they develop their self-identities. Findings further indicated that present-day, mainstream mothers from the dominant majority group of Canadians, tell a different story than similar mothers of previous cohorts, and that although sociopolitical and economic changes have influenced the experiences ofthese women, their stories remain remarkably similar across racial and cultural lines. The findings from this study may promote the development of multicultural programs in Canada as they offer both prospects and challenges to multiracial/cultural children and multicultural educators. It is hoped that this study will provide a better understanding of multiculturalism and encourage educators to heighten their racial and cultural awareness as they strive to critically examine their own cultural stories and realign their praxis within the evolving Canadian mosaic.

Public service reform and the role of the Auditor General /

The objective of this thesis is to study the involvement of the Auditor General in the proposal, implementation and review of major public service reform initiatives during a period spanning nearly forty years, from the early 1960s to 2001 . This period began with the Glassco Commission and concludes at the end of the term in office of Auditor General Denis Desautels in 2001. It has been demonstrated throughout this work that the role of the OAG has varied, from proponent to critic, from instigator to reviewer. In the past forty years the OAG's mandate has changed to meet the requirements of critical analysis of government operations and this has been aptly demonstrated in the office's relationship to the issue of public service reform. It has been argued that many of the problems facing the public service are cultural in nature. Reform initiatives have taken on a number of various forms with each addressing a different set of priorities. However, there has been a great deal of consistency in the cultural values that these initiatives articulate. Throughout this thesis attention has been paid to values. Values define a culture and cultural change is required within the Canadian federal public service. How and when this cultural change will occur is but one question to be answered. During the period under consideration in this thesis the government undertook several significant public service reform initiatives. Those examined in this thesis include: The Royal Commission on Government Organization, The Special Committee on the Review of Personnel Management and the Merit Principle, The Royal Commission on Financial Management and Accountability, Increased Ministerial Authority and Accountability, Public Service 2000, Program Review and finally La Releve. The involvement, or interest, of the Auditor General's Office on the subject of public service reform is generally articulated through the means of its annual reports to Parliament although there have been supplementary undertakings on this issue. Such material relevant to this study include: Towards Better Governance: Public Service Reform in New Zealand (1984-94) and its Relevance to Canada and Reform in the Australian Public Service. Annual reports to Parliament include: "Values, Service and Performance," (1990), "Canada's Public Service Reform and Lessons Learned from Selected Jurisdictions," (1993), "Maintaining a Competent and Efficient Public Service," (1997), and "Expenditure and Work Force Reduction in Selected Departments,"

Introducing e-learning in a large multisite academic health sciences centre: a case study of e-curriculum planning and educator support /

This qualitative study investigated how a team of 7 hospital educators collaborated to develop e-curriculum units to pilot for a newly acquired learning -r management system at a large, multisite academic health sciences centre. A case study approach was used to examine how the e-Curriculum Team was structured, how the educators worked together to develop strategies to better utilize e-leaming in their ovwi practice, what e-curriculum they chose to develop, and how they determined their priorities for e-curriculum development. It also inquired into how they planned to involve other educators in using e-leaming. One set of semistructured interviews with the 6 hospital educators involved in the project, as well as minutes of team meetings and the researcher's journal, were analyzed (the researcher was also a hospital educator on the team). Project management structure, educator support, and organizational pressures on the implementation project feature prominently in the case study. This study suggests that implementation of e-leaming will be more successful if (a) educators involved in the development of e-leaming curriculum are supported in their role as change agents, (b) the pain of vmleaming current educational practice is considered, (c) the limitations of the software being implemented are recognized, (d) time is spent leaming about best practice, and (e) the project is protected as much as possible from organizational pressures and distractions.

Marketing Brock University in the 1980's: assessing freshman student feedback in strategic planning approach

Universities have entered a period of rapid change and upheaval due to an external environment beyond their control which includes shifting demographic patterns, accelerating technology, funding shortages, and keener competition for students. Strategic planning, a comprehensive vision which challenges universities to take bold and creative measures to meet the threats and opportunities of the future, is an institutional imperative in the 1980's. This paper examines freshman student feedback in an effort to incorporate this important element into a strategic plan for Brock University, a small, predominantly liberal arts university in St. Catharines, Ontario. The study was designed to provide information on the characteristics of the 1985-86 pool of freshman registrants: their attitudes towards Brock's recruitment measures, their general university priorities, and their influences in regard to university selection (along with other demographical and attitudinal data). A survey involving fixed-alternative questions of a subjective and objective nature was administered in two large freshman classes at Brock in which a broad cross-section of academic programs was anticipated. Computer analysis of the data for the 357 respondents included total raw frequencies and rounded percentages, as well as subgroup cross-tabulation by geographic home area of respondent, academic major, and high school graduating average. The four directional hypotheses put forward were all substantiatied by the survey data, indicating that 1) the university's current recruitment program had been a positive influence during their university search 2) parents were the most influential group in the students' decisions related to university 3) respondents viewed institutional reputation as less of a priority than an enjoyable university lifestyle in a personal learning atmosphere 4) students had a decided preference for co-operative study and internship programs. Strategic planning recommendations included a reduction in the faculty/student ratio through faculty hirings to restore the close rapport between professors and students, increased recruitment presentations in Ontario high schools to enlarge the applicant pool, creation of an Office of Co-operative Study and Internship Programs, institutional emphasis on a "customer orientation", and an extension of research into student demographics and attitudinal data.

Sinister creativity: a phenomenological exploration of some of the experiences and perceptions of six lefthanded visual artists

Six lefthanded artist-educators were interviewed to attempt to discover any patterns t6 their perceptions and experiences. Artists have their own culture and priorities. According to the literature, lefthanded people appear more likely to suffer from dyslexia, allergies, asthma and other auto-immune diseases as well as machinery and equipment injuries. Patterns emerging suggested that lefthanded people indeed suffer more from dyslexia. More startling was the distinct possibility that many artists have traumatic childhood histories. This would commonly include negative school experiences, and for a significant number sexual assault, perceived or actual abandonment by parents, and/or consistently low selfesteem. The researcher discovered possible reasons why creative people frequently have problems at school, why they tend to be rebellious and anti-establishment oriented, how many of them perceive societal rules, and why they are more likely to be lefthanded. These characteristics all have significant implications for art school administrators.

The status of drama in education in an Ontario school board

Drama in education has been describea- as a valuable pedagogical medium and methodology, enriching child development in the cognitive, skill, affective, and aesthetic domains, and spanning all areas of curriculum ~ oontent. However, despite its considerable versatility and cost-effectiveness, drama appears to maintain low status within the education system of ontario. This thesis investigated teacher perceptions of both the value and status of drama in education in one ontario school board. Data were gathered in the form of an attitude questionnaire, which was devised for the purpose of this research and administered to a stratified cluster sample of 126 teachers employed in the board's elementary schools. These data were then used to examine teacher perceptions based on their knowledge, attitudes, and self-reported behaviour in the classroom. Teacher characteristics of gender, teaching assignment, years experience, and courses taken in drama were also analyzed as potential determinants of teacher attitudes towards drama in education. Results of the study confirmed apparent discrepancy between teacher perceptions of the value of drama and its current educational status. It was indicated that what teachers value most about drama is its capacity to enhance creativity, social skills, empathy, personal growth, and problem-solving ability among students. Teachers attribute its low status both to school and board priorities of time and resources, and to deficiencies in their knowledge and confidence in the planning, implementation, and evaluation of drama in the classroom. Teacher subgroup analysis revealed no significant differences in attitudes towards the status of drama in education; it did, however, suggest that both teachers who have studied drama and teachers with between ten and twenty years experience are most likely to value drama more highly than their colleagues. Recommendations proposed by the study include the provision of increased - time and resource allotment for drama within the elementary curriculum as well as increased teacher training at both faculty of education and board inservice levels.

Who expects what from whom? : a gender based study on expectations and secondary school administration

This study is about expectations and aspirations of secondary school teachers. It is an investigation of why some teachers aspire to become administrators and why some teachers do not. My research compares expectations and existing attltudes regarding aspirations toward administration which are held by three distinct groups within the secondary school system: 1) principals/vice-principals, 2) aspiring teachers, and 3) non-aspiring teachers. This study questions why, in the late 60's, secondary school administration is still predominated by men. The conclusions and recommendations were based on interviews with thirty men and women in the Hamilton Secondary School System. In addltion, Mr. Keith Rielly, Superintendent of Operations, made valuable contributions to my work. The interviews revealed experiences and percept ions of men and women in di scourse about f amil y re lat i onshi ps, educational choices and perceived internal and external barriers which inhiblted or enhanced their decision to aspire to secondary school administration. Candidates spoke about their personal and professional Hves wlth respect to encouragement, perceived images of an administrator, netWOrking and the effect of marriage and children on their careers. Historically, women have not accepted the challenge of administration and It would appear as if this is still the case today. My research suggests that women are under-represented in secondary school administration because of internal and external barriers which discourage many women from aspiring. I conclude that many of women's internal barrlers are reinforced by external roadblocks which prevent women from aspiring to secondory school administration. Thus. many women who do not envision a future in educational administration establish priorities outside the general realm of education. I recommend that males and females recognize that women make valuable contributions to educational theory and design based on their experiences which may be "differene from mole experiences. but just as significant. Mole and female representation in secondary school administration represents a balance between attitudes and behaviours which can not be accomplished when an administrative offlce is dominated by on all ma1e or all female staff.

How Ontario elementary school principals negotiate their varied work roles

This qualitative study>addresses the question of how Ontario elementary school principals negotiate their varied work roles, through interviews with and observations of 6 principals. Using inductive data analysis, principals' negotiations were divided into 5 categories: negotiating priorities, negotiating the process, negotiating constraints, negotiating the roles of others, and negotiating the self. These principals worked within these categories simultaneously, emphasizing some more than others, dependent on the circumstances. For these principals, the time they spent with people in the school and the resulting relationships that enabled them to build were a first priority, and a large part of how each principal chose to negotiate the demands of their role arose from their personality and their personal values.

Scales, networks and uncertainty : an examination of environmental policy-making in Ontario

Through a case-study analysis of Ontario's ethanol policy, this thesis addresses a number of themes that are consequential to policy and policy-making: spatiality, democracy and uncertainty. First, I address the 'spatial debate' in Geography pertaining to the relevance and affordances of a 'scalar' versus a 'flat' ontoepistemology. I argue that policy is guided by prior arrangements, but is by no means inevitable or predetermined. As such, scale and network are pragmatic geographical concepts that can effectively address the issue of the spatiality of policy and policy-making. Second, I discuss the democratic nature of policy-making in Ontario through an examination of the spaces of engagement that facilitate deliberative democracy. I analyze to what extent these spaces fit into Ontario's environmental policy-making process, and to what extent they were used by various stakeholders. Last, I take seriously the fact that uncertainty and unavoidable injustice are central to policy, and examine the ways in which this uncertainty shaped the specifics of Ontario's ethanol policy. Ultimately, this thesis is an exercise in understanding sub-national environmental policy-making in Canada, with an emphasis on how policy-makers tackle the issues they are faced with in the context of environmental change, political-economic integration, local priorities, individual goals, and irreducible uncertainty.

Utilizing a Phenomenological Approach to Examine the Experience of Sexuality for Women Concerned about Urinary Incontinence following Spinal Cord Injury

Sexuality after spinal cord injury (SCI) is a complex issue that is influenced by a number of social, psychological and physiological factors, one of which is urinary incontinence (UI). Using a phenomenological approach, seven mixed methods interviews combining both the interview guide and standardized open-ended approaches were conducted to examine the experience of sexuality for women who are concerned about UI following SCI. Sexual function was one of the top priorities for the women after SCI, and UI was one of the main concerns the women had regarding sexuality. The findings of this study demonstrate that various dimensions of intimacy and the sexual experience as a whole were affected by UI, and the women discussed both physical and psychological concerns. The main issues regarding sexuality included concerns related to relationships, frustrations with limited sexual activities and the difficulty of being sexually satisfied, the number of unanswered questions and concerns, and a fear of being hurt or injured while participating in sexual activities. The main concerns regarding UI were embarrassment, the work and inconvenience involved with the clean-up of UI, bladder infections, the lack of accessible washrooms, and the negative effects of UI medications. When examining sexuality and UI together, the major issues were the constant comparison to the way things were before SCI, as well as the new concerns that the women did not have to worry about previously, worrying about how their partner would react if UI were to occur during sexual activity, and the impact of their own feelings toward UI on sexuality, a connection between pleasurable sexual sensations and UI as well as difficulty differentiating between the sensation of UI with the sensation of UI, dealing with infected urine during sexual activity, having to discuss UI with a new potential sexual partner, and a fear of rejection. Other identified issues included those related to body image, a lack of resources, Doctors who were inadequately educated regarding SCI, and issues related to both having and raising children. There is a significant shortage of information available for women with SCI to use as a resource regarding sexual function in general, and sexual function as it relates to UI. It is necessary that future work focus on creating resources to assist in this area, and that the dissemination of those resources becomes both appropriate and effective. Addressing sexual function and UI which are among the top concerns for this population has the opportunity to greatly improve quality of life (QOL) for these individuals.