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Introduction/aims In this study, researchers evaluated the effects of lung volume recruitment treatment (LVR) - a low-tech, low-cost, manual 'breath stacking' technique used to help people cough with enough force to clear their airways, thereby reducing the risk of aspiration and choking - on five volitional airway clearance and protection behaviors used by people living with amyotrophic lateral sclerosis (PwALS). Methods Using a repeated-measures cross-over design, 29 PwALS performed five volitional airway clearance and protection behaviors in LVR treatment and in no-treatment, control conditions. Peak cough flow (PCF) was used to measure maximum expiratory rate during forced expiration, throat clearing, hawking, post-swallow coughing and the supraglottic swallowing maneuver. Comparisons were made as a function of condition (treatment or control) and three time-points (pre-treatment, and 15- and 30-minutes post-treatment). Results LVR treatment had a significant positive effect on maximum expiratory rates during all tested airway clearance and protection behaviors. Increased PCF values lasted for up to 30 minutes post-LVR for all tested behaviors in the treatment condition. Discussion Findings demonstrate that LVR treatment can increase control over airway clearance in PwALS, as well as provide improved airway protection for up to 30 minutes, the duration of a typical meal. This study has implications for patient care. These include offering patients control over some of the most feared symptoms of ALS, particularly choking during activities of daily living, and enhanced ALS respiratory care in low-resource settings. Findings may have implications for other neurodegenerative disorders in which dysphagia occurs with retained sensory function. This article is protected by copyright. All rights reserved.

Background:Amyotrophic lateral sclerosis (ALS) presents many transitions for persons/people with ALS (PwALS) and their caregivers. Transitions are passages from one life phase, condition, or status to another. We used qualitative methods to understand how PwALS and caregivers experience transitions throughout their ALS journey.Methods:PwALS and their caregivers were recruited from a multidisciplinary ALS clinic in Edmonton, Canada. We recruited patients at the stage of ALS that home mechanical ventilation, a feeding tube, and/or assistive communication technology had been offered. Semi-structured interviews were audio-recorded, transcribed, and analyzed using qualitative thematic analysis.Results:We interviewed 14 PwALS and 15 caregivers and identified 5 recurring themes. The importance of community was identified by many PwALS and caregivers who expressed feelings of loneliness and isolation. Most caregivers were spouses and couples navigated a change in their relationship roles as one spouse transitioned to becoming a caregiver while the other transitioned to dependency. The caregiver spouses reported a sense of “total responsibility” that encompassed continual vigilance for the PwALS’s well-being, managing their household and finances. PwALS and caregivers reported transitioning to reliance on life-sustaining medical devices; early adoption and information on these devices increased their quality of life. Participants also wanted more and earlier information on advanced care planning. PwALS and caregivers identified adapting to new forms of communication as a necessity.Conclusion:ALS presents many transitions for PwALS and caregivers. Understanding these transitions is important for ALS healthcare professionals who seek to implement best care practices.

Background People with amyotrophic lateral sclerosis (ALS) are at high risk for severe outcomes from Covid-19 infection. Researchers exploring ALS and Covid-19 have focused primarily on system response and adaptation. Using Protection Motivation Theory, we investigated how people with ALS and family caregivers appraised and responded to Covid-19 threat, the ‘costs’ associated with pandemic response, and how health professionals and systems can better support people affected by ALS who are facing public health emergencies. Methods Data were drawn from the ‘ALS Talk Project,’ an asynchronous, moderated focus group study. Participants were recruited from regions across Canada. Seven groups met online over 14 weeks between January and July 2020. Fifty-three participants contributed to Covid-19 discussions. Data were qualitatively analyzed using directed content analysis and the constant-comparative approach. Results Participants learned about the Covid-19 pandemic from the media. They rapidly assessed their vulnerability and responded to Covid-19 threat by following recommendations from health authorities, information monitoring, and preparing for worst-case scenarios. Adopting protective behaviors had substantial response costs, including adaptations for medical care and home support workers, threatened access to advance care, and increased caregiver burden. Participants expressed need for ALS-specific, pandemic information from trusted health professionals and/or ALS health charities. Telemedicine introduced both conveniences and costs. Prior experience with ALS provided tools for coping with Covid-19. Threat and coping appraisal was a dynamic process involving ongoing vigilance and adaptation. Findings draw attention to the lack of emergency preparedness among participants and within health systems. Conclusions Clinicians should engage ALS patients and families in ongoing discussions about pandemic coping, strategies to mitigate response costs, care pathways in the event of Covid-19 infection, and changing information about Covid-19 variants and vaccines. Healthcare systems should incorporate flexible approaches for medical care, leveraging the benefits of telemedicine and facilitating in-person interaction as needed and where possible. Research is needed to identify strategies to mitigate response costs and to further explore the interaction between prior experience and coping. Further study is also needed to determine how communication about emergency preparedness might be effectively incorporated into clinical care for those with ALS and other medically vulnerable populations.

We explore how principles predicting the success of a medical information commons (MIC) advantaged or disadvantaged three MIC initiatives in three Canadian provinces. Our MIC case examples demonstrate that practices and policies to promote access to and use of health information can help improve individual healthcare and inform a learning health system. MICs were constrained by heterogenous health information protection laws across jurisdictions and risk-averse institutional cultures. A networked approach to MICs would unlock even more potential for national and international data collaborations to improve health and healthcare.

This investigation examines perceptions of normality emerging from two distinct studies of information behavior associated with life disrupting health symptoms and theorizes the search for normality in the context of sense making theory. Study I explored the experiences of women striving to make sense of symptoms associated with menopause; Study II examined posts from two online discussion groups for people with symptoms of obsessive compulsive disorder. Joint data analysis demonstrates that normality was initially perceived as the absence of illness. A breakdown in perceived normality because of disruptive symptoms created gaps and discontinuities in understanding. As participants interacted with information about the experiences of health-challenged peers, socially constructed notions of normality emerged. This was internalized as a "new normal." Findings demonstrate normality as an element of sense making that changes and develops over time, and experiential information and social contexts as central to health-related sense making. Re-establishing perceptions of normality, as experienced by health-challenged peers, was an important element of sense making. This investigation provides nuanced insight into notions of normality, extends understanding of social processes involved in sense making, and represents the first theorizing of and model development for normality within the information science and sense making literature.

Commonly used as flame retardants, polybrominated diphenyl ethers (PBDEs) are routinely detected in the environment, animals, and humans. Although these persistent organic pollutants are increasingly recognized as having serious health implications, particularly for children, this is the first study, to our knowledge, to investigate an intervention for human elimination of bioaccumulated PBDEs. Objectives. To determine the efficacy of blood, urine, and perspiration as PBDE biomonitoring mediums; assess excretion of five common PBDE congeners (28, 47, 99, 100, and 153) in urine and perspiration; and explore the potential of induced sweating for decreasing bioaccumulated PBDEs. Results. PBDE congeners were not found in urine samples; findings focus on blood and perspiration. 80% of participants tested positive in one or more body fluids for PBDE 28, 100% for PBDE 47, 95% for PBDE 99, and 90% for PBDE 100 and PBDE 153. Induced perspiration facilitated excretion of the five congeners, with different rates of excretion for different congeners. Conclusion. Blood testing provides only a partial understanding of human PBDE bioaccumulation; testing of both blood and perspiration provides a better understanding. This study provides important baseline evidence for regular induced perspiration as a potential means for therapeutic PBDE elimination. Fetotoxic and reproductive effects of PBDE exposure highlight the importance of further detoxification research.

We examine the role of Canadian non-profit and nongovernmentalenvironmental groups in publicdiscourse about environmental health risk.Organization representatives were interviewed;implications for risk communication areconsidered. Findings suggest: organizationscontribute to the information worlds of citizens;benefit may be realized from fostering dialogue andpartnership with these organizations.environnementaux sans but lucratif et les organismesnon gouvernementaux du Canada dans le discourspublic sur les risques de santé dus à l’environnement.Des représentants des organisations ont étéinterrogés; les implications pour la communicationdes risques ont été prises en compte. Les résultatsindiquent que ces organisations contribuent auxmondes informationnels des citoyens, et qu’il y aavantage à favoriser le dialogue et les partenariatsavec ces organisations.

In this article I use Social Positioning Theory to explore the experiences of women as they interact with and make sense of evolving health information mediated by formal and informal sources. I investigate how women position themselves within their accounts of information seeking, and the influence of positioning on interactions with health professionals (HPs). Interviewed women gathered and valued information from a range of sources, and were likely to position themselves as autonomous, rather than collaborative or dependent. Faced with evolving health information, women felt responsible not only for information seeking, but also for making sense of gathered and encountered information. Participants did, however, value information provided by HPs and were likely to view decision making as collaborative when HPs fostered information exchange, appeared to appreciate different types of knowledge and cognitive authority, and supported women in their quests for information. Implications for shared decision making are discussed.

A Canadian national survey of 788 library staff doing instructional work revealed that most participants expected to be doing some teaching in their workplaces, and the largest proportion of participants have been teaching for more than 10 years. Most instruction continues to take the form of short presentations to groups of learners. On the whole, preparatory experiences are informal—on-the-job experience, reading professional literature, and attending workshops. The majority of respondents identify instructional work as integral to their professional identity, but nearly one-third see this work as a duty or expectation, and a small proportion view it as an imposition. The study results have implications for design of programs that prepare library staff for the workplace, and for library managers who need to support effective instructional practice.

PurposeLibrary staff are experiencing increased work role complexity as they move from being service providers towards greater instructional roles, providing bibliographic instruction, user education, and information literacy instruction. The purpose of this paper is to explore how library staff relate to their instructional roles and the implications of those self‐understandings for instructional outcomes.Design/methodology/approachData collected from qualitative interviews with library staff in Canadian academic and public libraries and diary entries written over a three‐month period were analyzed using NVivo software and an open‐coding, grounded‐theory approach. The study took a phenomenological perspective and was influenced by constructivist sociological role theory.FindingsData analysis revealed the central place of affect in the experiences of librarians engaged in instructional work, and brought focus to the relational aspects of this work and the affective impact of visibility/invisibility of instructional outcomes. A prominent theme was the expression of “emotional labour”; participants used a variety of methods to manage this occupational stressor as they experienced it within the context of instructional work.Practical implicationsIndividuals and organizations will benefit from considering the influence of affect on library staff. Those who educate librarians should seek to improve understanding of affect and its impact on instruction; organizations will benefit from addressing the emotional labour performed as a part of the teaching role.Originality/valueThe study draws attention to the affective experiences of library staff. This is the first research article in the LIS literature to explore emotional labour as it relates to librarians.

Objective . To examine the contribution of student co-researchers to a community-based participatory Photovoice investigation of Indigenous children’s food-related lived experience. We examine co-researchers’ contributions to the research process, their role in knowledge co-generation and dissemination, and factors that fostered research partnership with the teenage co-researchers. Methods . High school students attending a First Nation community school in Canada were trained as research partners. They contributed to aspects of research design, conducted interviews with grades 3 and 4 Photovoice participants, and participated in data analysis and the development of a culturally relevant photobook. The study was initiated by the community’s research committee. It is informed by critical consciousness theory and the positive youth development framework. Results . Student co-researchers incorporated culturally appropriate strategies as they interviewed participants. Co-researchers adopted conversational approaches, built rapport by articulating personal and cultural connections, and engaged in mentoring and health promotion as they interviewed participants. They made critical contributions to dissemination by developing photobook content that promoted the importance of traditional foods and the vital role of family and community in healthy eating practices. Relationships and “dialogic” space were important to building partnership with and promoting capacity development among youth co-researchers. Conclusions . Partnership between university researchers and Indigenous student co-researchers holds great promise for health promotion in communities. Co-researchers developed research and leadership skills, gained understanding of health challenges facing their community, and initiated health and cultural promotion through the project’s Photobook. This investigation supports the powerful potential of student co-researchers to meaningfully contribute to research processes and to build knowledge that is relevant and credible both within and outside of their communities. Findings have implications for youth, communities and researchers. Keywords: adolescent; Canada; community-based participatory research; community researchers; First Nations; health promotion; Indians; North American; qualitative research; research; collaborative (Published: 27 July 2015) Citation: Int J Circumpolar Health 2015, 74: 27838 - http://dx.doi.org/10.3402/ijch.v74.27838

Contemporary clinical practice increasingly functions within a disease management paradigm aimed at finding and implementing therapeutic interventions that demonstrate efficacy in clinical trials. Disease prevention, elucidation of illness aetiology and proactive health promotion have taken a back seat. Current clinical care often includes a 'fast-food' type of medical encounter, which frequently neglects disease causality. The medical community is presently challenged by unique administrative and professional adversities as well as undue commercial influence; these factors contribute to a lethargic response to escalating rates of chronic illness and to mainstream medicine's relative inattention to emerging research about disease aetiology. Individual medical practitioners and the medical establishment must strategically seek to advance patient health and maintain professional relevancy by a renewed emphasis on the following principles: patient-based clinical care, aetiology-centred medicine, and proactive health promotion.

This paper investigates the translation of medical information into clinical practice and the role of thoughtful dissent by exploring the influence of sociological factors on change, the impact of evidence-based medicine (EBM), and the role of industry. Changing practice related to hormone therapy for menopausal and post-menopausal women provides context for this discussion. Medical change involves diffusion of ideas to potential users and ongoing reconciliation of new information with old ideas; this process is influenced by sociological factors including values and experiences, interpersonal relationships and local context. While EBM has alerted doctors to the importance of high quality research and theoretically provides a tool for translating research into practice, there are important problems with its application: (1) it has resulted in a reductionist approach to research and illness; (2) there is a considerable gap between research findings and the complex environment of clinical practice; and (3) EBM has been appropriated by experts, thus corporately developed 'standard-of-care' documents have become instruments of external regulation, and EBM has ceased to be a tool in the hand of individual clinicians. In addition, industry impacts the translation of knowledge by significantly influencing academia, researchers, medical publications, consensus conferences, and practising doctors. While questioning doctrinaire practices or directives is a daunting prospect for individual clinicians, the translation of knowledge into practice and evolution of medical thought is dependent on the progressive role of thoughtful dissent.

Human exposure assessment and the results of implementing 'precautionary avoidance' suggested a relationship between a hairdresser's neuropsychiatric symptoms and occupational exposure to potentially hazardous chemicals. A variety of investigations in response to patient complaints of depression, emotional instability and various physical symptoms revealed no objective abnormality; the CH2OPD2 mnemonic (community, home, hobbies, occupation, personal habits, diet and drugs) recommended by the Ontario College of Family Physicians was used as a first-line screening tool to assess potential environmental exposure to toxins. After occupational leave of absence, the patient reported cessation of symptoms. Environmental causes for familiar medical problems are frequently undiagnosed; it is recommended that, where appropriate, a screening tool for evaluation of environmental exposure to toxics be incorporated into primary care assessment and management of patients.

Background The related issues of food security and obesity among North American Indigenous children are serious public health concerns. This community-based participatory study sought to gain deeper understanding of young First Nation children's lived experience with food and to learn, from their perspective, about food security issues in their community. Methods In this Photovoice investigation 26 young children attending a rural reserve school in Canada were asked to take photographs of the food they ate. Nine high school students from the same school were trained as co-researchers: they interviewed the younger students, helped identify emerging themes and contributed to knowledge translation. Data analysis incorporated conventional content analysis, grounded theory's constant-comparative method, and examination of photos and texts. Results Five primary findings emerged from photographs and interviews: (1) children had a dualistic understanding of healthy vs. unhealthy foods; (2) packaged, quick-preparation foods played a dominant role in children's everyday food experiences; (3) families were critical to children's food-related experiences; (4) although traditional foods are viewed as central to Aboriginal health, few were depicted in the photographs; and (5) photos do not tell the whole story – despite the smaller numbers of fruits and vegetables in photos, children like to eat these foods when they are available at home. Conclusions The study improved understanding of children's everyday food-related experiences, provided insight into community food security, and demonstrated the contribution of children and youth as experts on their lives and matters affecting them. A photobook representing findings provided a rich, visual tool for communicating the food-related experiences of children and messages about healthy eating within the school and to community members and leaders. Intervention efforts can build on participants' understanding of healthy versus unhealthy foods and on the critical role of family for healthy eating.

Using Participatory Video, this community-based study explored the efficacy of a health promotion program that engaged Indigenous youth in developing culturally relevant smoking prevention/cessation messages in the form of YouTube videos. This facilitated sharing of youth stories and perceptions, critical consideration of health information communication, and development of leadership skills.À l'aide de la vidéo participative, cette etude communautaire explore l'efficacité d'un programme de promotion de la santé qui incitait les jeunes autochtones à développer des messages culturellement adaptés pour la prévention ou l'arrêt du tabagisme sous forme de vidéos YouTube. Ce programme a favorisé le partage des histoires des jeunes, la perception des messages, les considérations critiques des messages d'information sur la santé et le développement d'habiletés de leadership.

Objective: to evaluate the well-being of post-menopausal women and to determine whether certain factors may have a positive, negative or neutral influence on well-being in this sector of the population. Design: a survey of public attitude. Setting: the general post-menopausal population of Canada. Participants: twenty-eight physicians and two nurse directors of health clinics in various parts of Canada agreed to give the questionnaire to interested post-menopausal patients. A total of 2,000 stamped, self-addressed surveys were sent to these physicians and nurses with the request to distribute the questionnaires, between July 1994 and March 1995. Four hundred and thirty-four individuals subsequently returned a completed questionnaire. Main outcome measures: the subjective well-being (SWB) of post-menopausal women was assessed. Family history, medical history, therapeutic interventions economic status, social factors and philosophical perspectives were explored and analysed and related to well-being. Comments and demographic data were also solicited. Results: most post-menopausal women reported a high level of subjective well-being with 61.7 percent stating that they are happy and satisfied. Forty-six percent stated that their lives were close to their ideal and just over half (52%) reported feeling as happy as they were at a younger age. Various social economic, philosophical and medical factors appeared to influence SWB in this population, with logistic regression analysis indicating that the three most important factors were the degree of loneliness, the amount of stress and any difficult financial circumstances. Of the 47.7 Percent of respondents who had used or were using hormone replacement therapy (HRT), 84.3 Percent reported some or marked improvement in SWB following therapy. While the preferred source of information on menopausal issues was health care workers 49.7 Percent of respondents were not satisfied with the teaching on this topic received from their personal physicians. Conclusions: although most Canadian women report being content in the post-menopausal stage of life well-being appears to be associated with both medical and social events, with demographic factors and philosophical outlook. Social and familial factors are of at least as much importance to overall well-being as is actual physical health. Given the lack of satisfaction with the scope of teaching on menopausal issues, it is important that health care delivery to this population moves beyond symptomatology to addressing questions related to physical and social well-being.

This qualitative paper explores how health information mediated by the internet and media is used and made valuable within the life of consumers managing non-crisis health challenges, and how informal information seeking and gathering influences self-positioning within patient-clinician relationships. Findings have implications for health information literacy and collaborative, patient-centred care.Cette étude qualitative explore comment l’information sur la santé relayée par Internet et les médias est utilisée et rendue utile dans le contexte de consommateurs gérant des problèmes médicaux non urgents, et comment la recherche et la collecte d’information informelles influencent l’auto-positionnement dans la relation patient clinicien. Les résultats ont des applications dans la maîtrise de l’information médicale et les soins collaboratifs centrés sur le patient.

This paper reports results from a national online survey exploring librarians’ experiences of their teaching roles. Triangulated with interview and diary data from earlier phases of this research, the paper highlights the joys and challenges experienced by library staff as they negotiate new expectations in a rapidly changing work environment.Cet article présente les résultats d’un sondage national en ligne portant sur les expériences des bibliothécaires en matière d’enseignement. Fondé sur des entrevues et des entrées de journaux provenant des phases antérieures de la recherche, cet article illustre les joies et les défis du personnel des bibliothèques face aux nouvelles attentes qui caractérisent un monde du travail en constante évolution.

An analytic lens focused on “affect” was used to examine the experience of librarians doing instructional work in Canadian libraries. As part of larger project, 14 librarians agreed to participate in a process of self-reflection about their instructional experiences, recorded as diary entries over a period of several months.Une étude axée sur l’analyse de « l’état affectif » a été réalisée afin d’examiner l’expérience des bibliothécaires accomplissant le travail d’enseignement dans les bibliothèques canadiennes. Dans le cadre d’un projet plus vaste, 14 bibliothécaires ont accepté de participer à un processus d’autoréflexion portant sur leurs expériences d’enseignement et rapportées quotidiennement dans des journaux de bord sur une période de plusieurs mois.

This qualitative study explored individuals’ everyday life experiences as they interacted with and integrated uncertain health information mediated by formal and informal sources. Findings demonstrate that knowledge translation is a multifaceted, ongoing process of social construction. The study has implications for health literacy and shared decision-making.Cette étude qualitative explore les expériences individuelles quotidiennes dans une option d’interaction et d’intégration de renseignements médicaux incertains provenant de sources formelles et informelles. Les résultats démontrent que le transfert de connaissances est un processus de construction sociale continu à multiple facettes. L’étude a des répercussions sur la littératie en santé et la décision par consensus.

Using content analysis, this study provides theoretical means for reconciling social network theory focusing on human influence in information use and behavior change, and current emphasis in medical fields on the principle role of published literature in guiding and changing clinical practice. Trust enhancing features within published articles are explored.En utilisant l’analyse de contenu, cette étude présente les moyens théoriques pour relier la théorie du réseau social en convergeant sur l’influence humaine de l’utilisation de l’information et sur le changement de comportement, de même que sur l’impact courant des domaines médicaux sur le rôle principal de la littérature publiée pour guider et modifier les pratiques cliniques. Les caractéristiques facilitant la confiance à propos des articles publiés sont explorées.

The rapid expansion of assisted reproductive technologies and related research offers great hope for those experiencing the problem of infertility. Concern has been expressed, however, that practical, legal, and ethical evaluations of new technologies have not kept pace with the introduction of these services into clinical practice. Even common reproductive services, such as gamete donation, need to be examined on an ongoing basis as new research becomes available and as long term implications are revealed. Despite the increasing public familiarity with gamete donation, many issues related to this medical procedure require careful consideration. Canadian public attitudes toward gamete donation will be highligthted as the following areas are explored: the acquisition of donor gametes and embryos; the disclosure or non-disclosure of biological origins and the ’best interest’ of the child; and the potential long term implications for donors and recipients. The dilemmas raised by the relatively routine practice of gamete donation clearly illustrate the need for ongoing examination of the many complexities arising from assisted reproductive technologies, and the need for careful guidelines and accountability in the area of reproductive medicine.

Through the presentation of three clinical case reports and subsequent discussion, it is demonstrated that physicians must begin to familiarize themselves with the health-related implications of online communication, and must proactively address Internet use as it relates to health and well-being. Included case presentations highlight the following: the established association between those seeking sexual partners through the Internet and an increased risk for sexually transmitted disease; the implications of cyber-communication for young people and concerns related to unsafe online behaviors including sharing identifying information with strangers; the potential use of strategically constructed virtual identities to facilitate sexual exploitation; the impact of accelerated intimacy and disinhibition evident in online communication; and the invasive nature of Internet sexual harassment or bullying. Although it is recognized that most online activities do not negatively affect health, doctors must be prepared to ask patients about Internet use and become involved in educating children, teenagers, and parents about safe online relationships to promote optimal physical, mental, and social health.

The serious implications of the sexually transmitted disease (STD) pandemic that currently challenges educators, medical practitioners and governments suggest that prevention strategies, which primarily focus on barrier protection and the management of infection, must be reevaluated and that initiatives focusing on primary prevention of behaviors predisposing individuals to STD risk must be adopted. Human immunodeficiency virus/acquired immunodeficiency syndrome, human papillomavirus, genital herpes, and Chlamydia are used to illustrate the pervasive presence of STDs and their serious consequences for individuals and national infrastructures. Long-term sequelae are discussed, including the emerging link between various sexually transmitted infections and cancer, and the psychosexual and psychosocial factors which impact infected individuals. Although risk reduction and treatment of existing infection is critical, the promotion of optimal life-long health can be achieved most effectively through delayed sexual debut, partner reduction, and the avoidance of risky sexual behaviors.

Using content analysis, this study explores information context as expressed in medical and consumer articles, and the role of the literature in influencing the innovation-decision process. Changing practices related to hormone therapy for menopausal and postmenopausal women, and the expression of biomedical and normal life transition models within published literature provided context for the study; 'diffusion of innovations' theory provided the theoretical framework that informed the investigation. Findings suggest that both medical and consumer health literature is dominated by the biomedical model; that context may influence the presentation of information, thus impacting innovation decision-making; and that published literature not only provides information and reinforces knowledge, but, through information context, it also produces and shapes meaning, and creates belief. Librarians and information professionals are encouraged to recognize the influence of context within published literature; to facilitate access by both professionals and consumers to the diversity of information that informs human knowledge; and to enhance appreciation for the contribution of diverse theoretical perspectives and research methods.

The worldwide epidemic of sexually transmitted diseases (STDs) presents a major public health challenge to medical practitioners and educators as they seek to implement preventive educational strategies in the adolescent population. The serious consequences of many STDs and the insufficient impact of condom promotion in this high-risk group have led to increasing recognition that sexual intercourse is medically unwise for young adolescents. As a result of this recognition, some educators have proposed that adolescent sexuality education focus on the explicit teaching of noncoital sexual activities, sometimes called outercourse. This paper explores the emergence of this educational strategy, the assertion that noncoital sexual activities will positively impact the rising incidence of STDs and unplanned pregnancy in teenagers, and the hypothetical benefits of adolescent noncoital sex.

“It is now the standard of care that every postmenopausal woman be given replacement hormones for the rest of her life unless there is a medical reason not to; to practise otherwise may be considered malpractice.” These words, passionately spoken at a 2001 medical education conference by a foremost authority on women's health, left some listeners feeling uneasy. Unable to find randomised controlled trials that validated the presumed benefits of long term hormone replacement therapy (HRT), we concluded that HRT for disease prevention represented an experiment on women. Today, two years after the release of the results of the women's health initiative study showing that HRT has more potential for harm than for good in healthy postmenopausal women taking a combination of oestrogen and progestogen to prevent chronic disease, the questions of 2001 remain relevant. Do individual doctors have the freedom to critically …

Early sexual intercourse is commonly associated with a higher number of lifetime sexual partners1 and, consequently, a higher risk of contracting sexually transmitted infections. From the perspective of sexually transmitted infection, sexual encounters include not only present partners but also past partners and all of their partners' partners. Thus voluntarily delaying sexual debut is of key importance in the prevention of sexually transmitted infections and the promotion of long term health. The ABC approach to changing sexual behaviour described by Shelton and colleagues can be used as a primary strategy for tackling all sexually transmitted infections. Since the World Health Organization estimates that two thirds of sexually transmitted …