Thursday, October 30, 2008

The Vocational and Rehabilitation Research Institute (VRRI) in Alberta is an excellent source of information for people with disabilities and people who work with them. Plain language booklets are available from the website on a range of health and life skills. Also available are short, practical publications for service providers to facilitate respectful and successful communication and support. The following recent item caught my eye:

Speaking Plain Language: How disability support workers can use plain language with clients who may have limited literacy or language comprehension skills by Aiofe Freeman. (FastFacts Vol 1, no. 2 March 2008)

While resources on plain language writing are happily fairly plentiful these days, information about how to communicate verbally in accessible language is more unusual. This brief guide with a reference list offers practical tips for conversing with people who have difficulty understanding because of literacy or language challenges. While these tips sound like common sense, consistently putting them into practice can be tricky.

Suggestions include:

  • Think about your audience
  • Be aware of your tone
  • Reduce the amount of information you provide at one time
  • Use short and everyday words
  • Find out if you are being understood--but recognize that your listener may be uncomfortable admitting that they don't know what you're talking about!

How to be a "pleasantly assertive" patient

Researchers at University of North Carolina at Chapel Hill offer five ways to get more from your doctor.

These days, going to the doctor may seem more like speed dating than care giving. Patients get a few minutes with the clinician, and he or she does most of the talking. How can a person get the information they need and the outcome they desire in a 15-minute office visit? What if the treatment options don’t feel right? Is it too much for a patient to feel they are considered a partner in their own well-being?

Often, people leave their doctor’s office with more questions than answers, according to researchers at the University of North Carolina at Chapel Hill School of Medicine who are looking at how patients can get more of what they need from the health-care system. They have found that patients (or their advocates) who talk to physicians about their beliefs, values, lifestyle and
concerns can get better results from their health-care experience.

“Research shows if you ask doctors what they think is important to patients, and then ask patients what’s important to them, there’s not a great match,” said Dr. Michael Pignone, chief of the UNC division of general internal medicine.

But, as smart as doctors are, they aren’t mind readers, Pignone and his colleagues note. “A common problem is patients thinking that their physician will know how they – the patient – feels about specific decisions” said Dr. Carmen Lewis, assistant professor of medicine of general internal medicine and clinical epidemiology. “Doctors don’t – you need to tell them. People feel the doctor is the expert, but the individual is the expert about his or her lifestyle and how he or she values options and outcomes.”

Pignone offered some tips for becoming what he calls a “pleasantly assertive” patient, so that patients’ health-care providers can better help them.

  1. Prepare for your visit. “It might seem silly, but it’s really helpful to write down your symptoms, complaint or problem, then summarize it into a couple of sentences,” Pignone said. “Bring your list and your summary with you to the visit. This allows the doctor to quickly review your condition and ask specific questions, instead of spending time focused on general issues. This one step can make visits 25 percent to 50 percent more effective.”
  2. Have an agenda. “Before your appointment, decide what you want from the visit,” Pignone recommends. “For instance, if you’re suffering back pain, you might want to know what is causing the pain as well as a treatment plan for getting better. Make sure you share that with your doctor at the very beginning of your visit. It might feel funny at first, but your doctor will appreciate it. Sharing this information will help you all make better decisions about treatment, make the visit more efficient, and improve the chance that your health-care needs will be met effectively.”
  3. Know your medical history and medications. “To help you get the treatment you need, doctors need to know what tests you’ve had – and when – as well as what medications you’re taking,” Pignone said. “Without that information, they might mistakenly re-order tests or prescribe medication that has a bad interaction with something you’re already taking. That can have adverse effects for your health and your wallet.”
  4. Tell your provider about your values or lifestyle preferences that could affect your treatment. “It doesn’t make sense to agree to a treatment plan you know you won’t follow – it won’t result in your feeling better,” Pignone cautioned. “For example, if a Wednesday night smoking cessation class conflicts with your book club, it’s not going to be an effective intervention for you. On a more serious level, if you don’t want to deal with the uncertainty of a possible recurrence of cancer, you might prefer a mastectomy to a lumpectomy. Similarly, if you can’t afford medication or to take off work for recurring visits, tell your provider even if you’re embarrassed. There are often ways to work around the challenges if your care team knows about them.”
  5. Clarify the decision to be made. “Sometimes you’re offered several options, so be sure you understand the alternatives and if you don’t, ask for clarification,” Pignone said. “Your doctor should be able to give you important details about each option either during the visit, or on a follow-up call. In addition to the details, ask them how good the medical information is.”
Pignone and Lewis acknowledged that this approach results in a very different doctor-patient relationship, but evidence shows that proactive patients tend to get more effective and efficient care.

“The sicker you are, the more this matters,” Pignone said. “But it’s harder to do. If you’re not comfortable interacting this way, involve other people who support you in your life to come with you and play this role.”

Wednesday, October 29, 2008

FDA education program for over-the-counter medications

The US Food and Drug Administration's (FDA) Center for Drug Evaluation and Research (CDER), in cooperation with the National Council on Patient Information and Education (NCPIE) and Maryland's Montgomery County Public Schools, has launched "Medicines in My Home," an interactive educational program about the safe and effective use of over-the-counter medicines, located at The website includes a "Teachers Room," featuring a PowerPoint presentation, pre- and post test, in class lesson materials, and materials and activities for use in the home with family members. Key concepts students will learn from the program are:

  1. The Drug Facts label tells you what a medicine treats, if it is right for you and your problem, and how to use the medicine;
  2. Read the label and follow the directions carefully and correctly;
  3. Two medicines with the same active ingredient shouldn't be used at the same time; and,
  4. Measure medicines correctly with measuring tools made for medicines.
The program emphasizes that medicines should be used only with permission from an adult and that if there are questions about medicine use, ask a pharmacist or doctor. Materials are provided to encourage students to share what they learn with their families so that all family members can learn to use over-the-counter medicines more safely.

Research: Neutral HIV presentations more likely to be considered inviting

A recent study by University of Illinois professor of psychology Dolores Albarracín and her colleagues at the University of Florida and the Alachua County Health Department in Florida found a method to increase enrollment among high-risk individuals in HIV prevention programs.

The study, which appeared in the September 2008 issue of Health Psychology, found that by offering an experimental introduction to a counseling session, public health institutions could increase enrollment by a significant amount.

Previous research by Albarracín found that those most likely to engage in behaviour that puts them at a high risk for HIV are also the least likely to enroll and stay in HIV intervention programs.

Therefore the researchers studied the effects of delivering different messages to participants screened for high-risk behavior as an invitation to a counseling program delivered at the Alachua County Health Department in Gainesville, Fla. They found one message that increased enrollment among participants.

All the messages informed participants who had signed up for a generic health study that they could speak to an HIV-prevention counselor. In the experimental condition, they were also told that the counseling session was not intended to change their behaviour, only to provide them with the most current information. Compared with a message that indicated that the counseling increased condom use, recipients of the experimental message enrolled at a rate higher by 15 percent. This effect was particularly strong when participants had no intention of using condoms at the beginning of the study.

“Public health experts around the world are regularly in search of the most effective methods for curbing preventable health problems,” Albarracín said. “HIV is a disease caused by a number of risky behaviors like unsafe sex and unsafe needle sharing, but health information is often disseminated without complete knowledge of how it will be received by audiences,” she said.

“The research indicates that people will be more receptive to information when they don't believe they are trying to be influenced,” she said. “This approach will be helpful in giving public health professionals effective ways to introduce the public to information without repulsing those they are trying to help most.”

Other researchers involved in the study were Marta R. Durantini, Allison Earl, and Josh Leeper, of the University of Florida, and Joann B. Gunnoe of the Alachua County Health Department.


Beyond the most willing audiences: A meta-intervention to increase exposure to HIV-prevention programs by vulnerable populations.
Albarracín, Dolores; Durantini, Marta R.; Earl, Allison; Gunnoe, Joanne B.; Leeper, Josh
Health Psychology. Vol 27(5), Sep 2008, 638-644.

Read the abstract at

US health education in barbershops and beauty salons

As part of its mission to train the next generation of physicians and scientists, the Mayo Clinic Center for Translational Science Activities (CTSA) offers the Health Disparities Field Experience, a unique course through Mayo Graduate School. For this year's fieldwork, course scholars and faculty are joining with the Center for Minority Health (CMH) at the University of Pittsburgh's Graduate School of Public Health in its innovative program called 'Take a Health Professional to the People Day' on Sept. 18, 2008. This event has been recognized nationally with a feature on the Web site of the National Center on Minority Health and Health Disparities (NCMHD), National Institutes of Health (NIH).

Health disparities — the gaps in health care access and outcomes among different populations — lead to higher rates of chronic illness, disability and death from preventable causes for minorities. Now in its seventh year, Take a Health Professional to the People Day deploys teams of physicians, nurses, pharmacists, dentists and public health educators to 10 barbershops and beauty salons in inner-city Pittsburgh to deliver health information and health screenings to customers. In 2007, 150 health professionals screened more than 556 African-Americans in these neighborhood settings.

Why take health education efforts to barbershops and beauty salons?

These settings are effective because they are familiar community assets and trusted institutions in African-American neighborhoods where people gather to connect and exchange information. "Far too many African-Americans have no 'medical home' to access health care services, so government programs that promote 'taking a loved one to the doctor' are not as effective for this community," explains Stephen B. Thomas, Ph.D., director of CMH and the Philip Hallen Professor of Community Health and Social Justice. "Therefore, CMH created Take a Health Professional to the People Day. By focusing our efforts on a single day, we believe we can help generate a greater understanding of the importance of regular health screenings while at the same time reaching people who tend to have the least access to health care." In addition, the program serves as an excellent training opportunity for health professionals, who benefit from engaging minority populations outside of the clinical environment.

For more information about Take A Health Professional to the People Day, the NIH-NCMHD Research Center for Excellence in Minority Health Disparities, and other activities of the University of Pittsburgh Center for Minority Health, visit the University of Pittsburg Center for Minority Health Web site.

Radio stories of living with HIV reduces stigma in Ethiopia

Betengna, a radio program in Ethiopia that showcases the diaries of ordinary people living with HIV, may contribute to reducing HIV-related stigma, according to the results of a research study disseminated September 24, 2008 in Addis Ababa. Results of the research indicate that listeners of Betengna were found to have lower stigma toward people living with HIV and had greater knowledge about HIV transmission, prevention and management.

The program has aired on Ethiopian radio stations over the past two years, and it boasts an exposure of 29% in Addis Ababa and SNNPR, according to the study. It is also available for downloading on the National AIDS Resource Center’s website (

The radio diaries narrate the everyday experiences and challenges of living with HIV in Ethiopia and are broadcast weekly on five radio stations in Amharic, Tigrigna, and Oromoiffa languages. Betengna aims to decrease the stigma and discrimination that HIV positive people face in Ethiopia by exposing the human face of living with the disease and providing a platform for creating discussion on these issues among the general public. Over time, diarists cover a broad range of their everyday life experiences such as teen pregnancy, relationships with partners, family, friends and their communities, health issues, emotional and physical stress and living positively.

The research findings come from a household study conducted in November 2007 in four regions – Amhara, Tigray, Addis Ababa and SNNPR - in order to determine exposure to Betengna and the extent to which changes could be linked with exposure to the broadcast. Data was collected by a local research organization, Addis Continental Institute of Public Health.

Study results indicated that listening to Betengna was associated with increased empathy and affinity for the diarists and a better understanding of the challenges of leading an HIV positive life. Other indicators of decreased stigma were a greater perceived identification with people living with HIV and a stronger belief that HIV positive persons should be treated with respect. Caller feedback from listeners supports that Betengna is increasing empathy and reaching listeners on a more emotional level than just promoting rational thinking.

“Many people go to test after they become very sick. Sirak’s story motivated me to get tested and I found out that I’m HIV+,” indicated a male listener. “I live in South Africa, Cape Town. I always listen to Hiwot Mamo’s program and it really amazes me; she really is a wonderful woman. I just wanna tell her be strong and to always look after her self. Stay blessed,” commented a web listener.

The Radio Diaries are produced by the National AIDS Resource Center (ARC) and Johns Hopkins Bloomberg School of Public Health/Center or Communication Programs (CCP). The program's design is based on and builds on similar projects run by CCP in Nigeria and Malawi. Betengna is produced in collaboration with the National HIV/AIDS Prevention and Control Office (HAPCO) with technical assistance from Internews Network-Ethiopia. Funding is provided by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC).

Vulnerable Populations & Global Public Health Presentation Oct 31/08

Time sensitive

Vulnerable populations and global public health

UBC-School of Population and Public Health (SPPH) Grand Rounds
Presentation for Friday, October 31, 2008

Presented by: Katia Mohindra, Post Doctoral Fellow, Global Health Research Program, SPPH, UBC

Topic: Vulnerable populations and global public health: perspectives from some 'egalitarian' societies***

Date: Friday October 31, 2008
Time: 9:00 AM TO 10:00 AM
James Mather Building
Room: #253 - 5804 Fairview Avenue
Vancouver, BC

Please join us for the Grand Rounds. If you are unable to attend in person, please join us remotely through our website and simultaneously via conference call.

Dial in: 1-866-596-5278
Conference ID: 7347312#

If you do join us via conference call, it is very much appreciated if you put your phone on mute to enhance the listening ability of all remote listeners.

**Presentations are the property of the presenter(s) and permission must be obtained before copying or distribution of presentation occurs. Presentations for rounds from the website are for viewing purposes only.**

Should you have any questions, please contact Sylvia at or 604-822-7646

[Posted on: Women-Health eNews - an electronic mailing list for activists, researchers, and policy makers, both nationally and internationally, who are working to improve women's health. The list was created and is managed by the BC Centre of Excellence for Women's Health ]

Community Health Discusssions

CHNET-Works! a project from Community Health Research Unit, University of Ottawa is hosting a series of Fireside Chats (FREE pan-Canadian discussions for community health professionals - via telephone/internet conferences). October, November and December 'chats' are focusing on: Climate Change and Health, Healthy Aging and Food Insecurity. Discussions need to include perspectives re: social ceterminants of health.

Info and registration: and click on Fireside Chats

[posted on the Social Determinants of Health (SDOH) listserv October 29, 2008 by Dot Bonnenfant, CHNET-Works! Animateur]

Upcoming topics:
Climate Change and Health: shedding light November 20/08

Canadian Falls Prevention Curriculum - an UPdate February 5/09

Climate Change and Health: newHealth Canada Report November 13/08

Children Vulnerable to Environmental Contaminants December 10/08

Health Care: Preparation for Age of Scarce Oil October 30/08

Climate Change and Health: A Breath of Fresh Air November 7/08

Healthy Aging: Housing, Support Service and Health November 26/08

Food Insecurity: The Cost of Living - a tool December 5/08

Info Tech and Health Promotion.... December 4/08

Healthy Aging #2 - Aging with Dignity February 12/09

Skateboarding and Youth: What's working? December 3/08

Friday, October 24, 2008

Scientific Cafe: Is menopause a disease? [Vancouver]

Time sensitive

Is menopause a disease?
We will discuss different perspectives from around the world on gendered aging with input by women doctors from Eastern Europe and India. How does the emergence and popularity of menopause-specific products, pills, and supplements reflect how we view menopause as a society? Hormone Therapy controversies - do women's hormones need replacing? "Bioidentical" vs. "synthetic" hormones: Is one better then the other, and what are the risks of ovarian hormone therapy? Hot flashes and night sweats - is estrogen the only option? Is osteoporosis inevitable?

Expert Panel:
Dr. Jerilynn Prior, UBC Professor of Endocrinology, Scientific Director of CeMCOR
Ms. Karen Coulson, Executive Director with Osteoporosis Canada (BC Division)
Dr. Sheela Mistry, foreign trained OB/GYN and Research Coordinator
Dr. Vesna Stajic, foreign trained MD and Research Coordinator

Date: Tuesday Oct 28th, 2008
Time: 7:00-9:00pm, doors at 6:30pm
Venue: Little Nest (,
1716 Charles St, Vancouver (Commercial Drive)

Cost: Admission is free but space is limited - be sure to arrive on time! For more information see: