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PURPOSE: To support a community effort to establish a health service in a Nova Scotia high school, adolescents' sexual behaviours and use of physicians for sexual health services were assessed. METHODS: A self-completion survey asked students about sexual behaviours, use of physician services and barriers to use of those services. RESULTS: Only 8.7% of male and 37.9% of female students with family physicians had discussed with the physician whether they were sexually experienced (p < 0.0001). More females had discussed sexual activity when the physician was female than when the physician was male (43.7% vs. 35.1%; p < 0.05). More sexually experienced females who had not discussed this behaviour with their physicians identified specific issues as barriers to discussion. CONCLUSIONS: Female physicians discuss sexual activity more with their adolescent female patients than do male physicians. The results support the need to provide health services in addition to those of physicians to meet the sexual health needs of adolescents.

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SETTING: Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. OBJECTIVES: (1) To assess the attitudes of full-time clinical faculty members towards medical communication using the newly developed Attitudes Towards Medical Communication Scale; (2) to determine faculty members' perceptions of communications training for students and residents. METHODS: An anonymous self-completion survey was sent to 233 full-time clinical faculty members. The questionnaire asked about faculty attitudes towards medical communication, and assessed faculty members' views of student and resident training in communication. RESULTS: Faculty scored highly in the Attitudes Towards Medical Communication Scale, with a mean score of 51.5 (SD 4.1) out of a possible 60. In univariate analysis, rating of personal enjoyment of teaching, rating of the importance of teaching, and having attended at least one faculty communications workshop in the previous 5 years were significantly associated with higher scale scores. When these factors were assessed using linear regression, only having attended a workshop and higher rating of the importance of teaching remained significant. Faculty assessed student training in communications skills poorly overall. When assessing seven specific communications areas, more than 20% rated this training as poor for six of the areas for third- and fourth-year students and for five of the areas for residents. CONCLUSIONS: Clinical faculty at Dalhousie have very positive attitudes towards medical communication, and more highly positive attitudes are found in those who have attended a communications workshop. Despite this evidence that faculty appreciate the importance of medical communication skills, many assessed students' training in this curriculum area as poor.

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PURPOSE: This study was performed in the context of a sexual health promotion project in a Nova Scotia community. Community members wanted information about adolescent females' knowledge and use of emergency contraception (EC). The study was done to meet this need. METHODS: Female high school students aged 14 to 19 were administered a self-completion survey asking about their knowledge of EC, the time frame for its use, its effectiveness, their personal use of EC, unsuccessful attempts to obtain EC, and sources of knowledge of EC. RESULTS: Eighty-five percent of 411 female students participated. Eighty percent knew about EC, though few (8%) knew the time frame for EC use. Most (42%) heard of EC at school. Eighteen percent used no contraception at last intercourse. Only 2% ever had used EC. CONCLUSIONS: Adolescent women know about EC but use it infrequently, even though they frequently lack contraception. These findings raise questions about alternative methods for providing EC to young women.

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BACKGROUND: By 2016, the proportion of Canadians older than 65 years of age will increase to 16%, and there will be an increase in the absolute number of cases of cardiovascular disease in older Canadians. The Canadian Heart Health Surveys database provides information about this population upon which health policy related to cardiovascular disease can be based. This paper presents for the first time population-based data on the risk factors for cardiovascular disease in older Canadians. METHODS: Canadians from all 10 provinces participated in surveys of cardiovascular risk factors; health insurance registries were used as sampling frames. In each province, probability samples of 2200 adults 18 to 74 years old not living in institutions, on reserves or in military camps were asked to participate in interviews and to undergo testing at clinics for major risk factors for cardiovascular disease. RESULTS: A total of 2739 men (response rate 70%) and 2617 women (response rate 66%) aged 55 to 74 years participated in the survey and also provided follow-up clinical measurements at the clinic. Overall, 52% of participants were hypertensive, 26% had isolated systolic hypertension, and 30% had a total blood cholesterol level of 6.2 mmol/L or greater. Rates of current smoking were lower in women than men (17% v. 22%). Overall, 87% of men and 78% of women who were current smokers smoked at least 10 cigarettes per day. Only slightly more than half of participants exercised at least once a week for at least 15 minutes, and almost half had a body mass index of 27 or greater. In only 4% was no major risk factor for cardiovascular disease detected. INTERPRETATION: Significant numbers of older Canadians have one or more major risk factors for cardiovascular disease. Many of these risk factors are amenable to modification.

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BACKGROUND: Cardiovascular disease is the leading cause of death and disability in older people, who account for an increasing proportion of Canada's population. Knowledge and awareness of risk factors is essential for changes in behaviour, yet little is known about these issues in older people. The Canadian Heart Health Surveys database provides a unique resource to examine knowledge and awareness of cardiovascular risk factors in older Canadians. METHODS: This descriptive cross-sectional study used data from the Canadian provinces' Heart Health Surveys, for the years 1986 to 1992. Sampling within each province consisted of stratified, 2-stage, replicated probability samples; 4976 people 55 to 74 years of age were included in the present analysis. Knowledge and awareness of cardiovascular risk factors was determined from the survey question "Can you tell me what are the major causes of heart disease or heart problems?" Blood pressure was measured during a home visit; anthropometric and blood measurements were obtained during a clinic visit. Cardiovascular health status was determined by self-reporting. RESULTS: Smoking and stress or worry were mentioned as major causes of heart disease by the greatest proportion of participants (41% and 44% respectively); hypertension was mentioned by only 16%. Men and women did not differ in their awareness of high blood cholesterol (cited by 23% of participants), smoking (41%), excess weight (30%) or lack of exercise (28%) as causes of heart disease. A greater proportion of women than men were aware of hypertension (19% v. 12%) and heredity (31% v. 17%) as major causes of heart disease. Awareness of risk factors was consistently lower in the older age group (65-74 v. 55-64 years). Among women, there was greater awareness of the respective risk factors as causes of heart disease among those who were smokers (60% v. 35% of nonsmokers), those who had a body mass index (BMI) of 25 or greater (38% v. 24% of those with a BMI less than 25) and those who were hypertensive (22% v. 17% of those without hypertension). Those who had experienced a heart attack had greater awareness of the major causes of heart disease than those who had not; this pattern was stronger among women than among men. Of those in whom elevated cholesterol level was identified during the course of the study, 62% of men and 67% of women were unaware of their cholesterol status. Of those in whom high blood pressure was diagnosed, 43% of men and 33% of women were unaware of their hypertensive status. INTERPRETATION: Awareness of the major causes of cardiovascular disease is low among older Canadians, especially among men and in those 65 to 74 years of age.

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OBJECTIVE: To provide and evaluate telemedicine services for rural physicians and patients in Nova Scotia. MATERIALS AND METHODS: As a pilot project, three telemedicine services (videoconference continuing medical education [CME], teledermatology, and teleradiology) were provided to four hospitals in Nova Scotia communities. All four sites received CME (a total of 269 physicians, 53 other health care professionals); three sites received teledermatology (66 consultations), and two sites received teleradiology (808 radiologic examinations). At the consulting site, 12 faculty members presented 24 one-hour videoconferences, and there was one consulting radiologist and dermatologist. Each service was evaluated independently. Methods included participant questionnaires; focus groups; numbers and categories of participants or examinations; comparison of operational costs, capitol costs (teledermatology and teleradiology), and travel costs (CME); technical assessments of hardware, software, and telecommunications; assessment of clinical diagnostic procedures (teledermatology); and comparative study of original and digitized films (teleradiology). RESULTS: Despite growing pains, the technologies effectively provided the three services: the services were acceptable to referring and consulting physicians and patients. Improvements in patient care and outcomes comparable to those of traditional methods were demonstrated in teleradiology and teledermatology, especially for emergencies. Physician access to CME and patient access to dermatology consultation services were improved. Financial savings were demonstrated for CME, but further investigation is required to determine the savings attributable to teleradiology and teledermatology. CONCLUSIONS: The telemedicine services supported rural physicians, their patients, and their communities. Although telemedicine is not a panacea for all concerns of rural physicians, the pilot project provided a strong foundation for further development and study.

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PURPOSE: In the context of a community development project related to adolescent sexual health, this study was carried out at Amherst Regional High School (ARHS) in Amherst, Nova Scotia, to assess students' sexual health knowledge, gender differences in knowledge, and associations between knowledge and sexual behaviours. METHODS: A 29-item scale assessed knowledge in five areas of sexual health. Gender differences in correct responses to questions were compared. Overall knowledge scores were compared by gender, grade, and sexual activity, and tested for association with sexual behaviours. RESULTS: Of 796 students, 80% participated. Sexual health knowledge scores were highest for sexually active females. Higher score was associated with oral contraceptive use and later sexual debut. Knowledge was highest for HIV/AIDS. Students were insufficiently aware of their right to patient confidentiality. CONCLUSIONS: ARHS students lack knowledge in some sexual health areas. School programs should consider these findings, and work to improve school-based sexual health education.

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The purpose of the study was to compare the impact of continuing medical education for primary care physicians in Halifax, Nova Scotia, Canada, delivered through a problem-based learning (PBL) format with that of a lecture-based format, in the clinical area of headache diagnosis and management. From January to June 1995, 38 physicians participated in three problem-based learning sessions, and 49 in a lecture-based session in the clinical area of headache. Pre- and posttest assessments of knowledge were made of each group before and immediately after the educational sessions. A second evaluation using Key Features Problems (KFP) to measure clinical reasoning was administered to both groups 3 months later. Analysis of covariance between groups on the post-test, using the pre-test result as covariate, showed significantly greater knowledge in the PBL group. Mean post-test KFP scores also were significantly higher for the PBL group. The PBL group's satisfaction with several programme dimensions was significantly higher than that of the lecture group. These results must be viewed in the context of differing amounts of exposure for the two groups. Problem-based learning in continuing medical education in the area of headache management was associated with greater knowledge acquisition and with greater improvement in clinical reasoning skills than in a lecture-based approach. Problem-based learning also was preferred by family physicians. However, the cost-benefit of this approach was questioned, since the PBL group had more exposure. Several factors limit the generalizability of this study, e.g. the impossibility of randomly composing the two experimental groups. Further research is required to determine if the results are generalizable and whether a PBL approach results in change in practice behaviour.

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OBJECTIVE: To determine family physicians' approaches to detecting, managing, and preventing genital Chlamydia trachomatis infection and their perceptions of barriers to prevention. To determine whether sex of physician is associated with differences in clinical approach to chlamydia, with levels of effort aimed at its prevention, and with perceived barriers to preventive efforts. DESIGN: Questionnaires were sent to a random sample of family physicians. SETTING: All health regions in Nova Scotia. PARTICIPANTS: Two hundred fifty-seven Nova Scotia family physicians. MAIN OUTCOME MEASURES: Responses to survey questions analyzed for association of practice behaviours with sex of physician. RESULTS: Response rate was 60%. Most physicians performed diagnostic tests for chlamydia on all patients. Responses indicated that 17% would test for C trachomatis during an annual Papanicolaou test in a low-risk 30-year-old, 61% would test a high-risk 21-year-old man, and 89% would test a pregnant 17-year-old. Therapies physicians might use were judged appropriate in 96% of responses. Only 51% indicated they would ever discuss false-positive test results with patients. Men physicians were less likely than women to ask 75% or more of their adolescent patients about sexual activity or to educate them about prevention of sexually transmitted diseases. Women physicians saw time and the fee schedule as less serious barriers to prevention than men did. CONCLUSIONS: Some physicians are not managing C trachomatis well. We should explore situations where gaps in performance are associated with sex of physician.

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INTRODUCTION: This study was carried out to determine the predisposing, enabling, and reinforcing factors related to practice behaviors in the prevention of adolescent pregnancy and sexually transmitted diseases (STDs), and to assess physicians' "ideal" history taking and service provision versus their actual practice in this clinical area. METHODS: Twenty-six of 37 physicians in a single county in Nova Scotia took part in a face-to-face interview. RESULTS: Analysis of predisposing factors found that, for seven of 10 areas related to knowledge of the epidemiology of adolescent pregnancy and STDs, fewer than 50% of male physicians were able to give correct responses. All physicians believed this to be an important area for prevention, and 89% that prevention is possible, but only 62% believed that their own prevention efforts are effective. Respondents were about equally likely to view schools and physicians as having responsibility for prevention of adolescent pregnancy and STDs. Significant enabling factors included high levels of perceived personal comfort and skill, but time factors and opportunities to interact with adolescents sufficiently frequently to carry out prevention were seen as barriers. Most physicians (68%) agreed that the physician fee schedule was a negative reinforcing factor. Male physicians and those in rural practice were significantly more likely to have larger gaps between those preventive practices they saw as desirable and those they actually performed.

PIP: In 1992, the reported Nova Scotia provincial rate for Chlamydia trachomatis genital infection was 15/1000 for girls and 2/1000 for boys, whereas rates for County A were 12/1000 for girls and 1/1000 for boys. The predisposing, enabling, and enforcing factors related to practice behaviors in the prevention of adolescent pregnancy and sexually transmitted diseases (STDs) were determined in face-to-face interviews to assess 26 physicians' ideal history taking and service provision versus their actual practice. Beliefs, attitudes, and enabling and reinforcing factors were assessed using a 5-point Likert scale. Interviews were completed between July 7 and August 31, 1994, with 26 doctors, of whom 20 were men (median age, 39 years) and 6 were women (median age, 35 years). The number of years in practice was 12. Fewer than 50% of male physicians were able to answer 7 of the 10 questions in relation to predisposing factors in prevention of adolescent pregnancy and STDs. 89% of the physicians believed that adolescent pregnancy and STDs are preventable, only 62% believed their own efforts to be effective in prevention. 85% of the physicians believed that schools had a responsibility to provide sex education, while 81% considered the role of parents in avoiding pregnancy and STDs crucial. 85% agreed that they were comfortable about talking with adolescents about sexuality, but only 36% felt that their medical school education had provided adequate preparation and 46% cited lack of time. While two-thirds agreed that female adolescents often made appointments for pregnancy prevention, only 23% said that girls did the same for STD prevention and 12% said that boys did. 68% of the physicians claimed that the current Medical Services Insurance fee schedule discouraged them from talking to adolescents about prevention. The lowest rate of agreement was with questions about sexual orientation (69%) and sexual practices (62%). The median score difference between believing that questions should be asked in the history and actually asking those questions was 0.0 for women and 2.0 for men (p = 0.04).

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OBJECTIVE: To determine the prevalence of initial and booster positive responses to tuberculin skin testing among staff of an acute care hospital, and among staff and residents of two chronic care facilities on Prince Edward Island (PEI). PATIENTS AND METHODS: Two hundred and eighty-six staff from the hospital and the facilities, and 164 residents from the facilities were given tuberculin testing using 5 tuberculin units (TU) of purified protein derivative (PPD) of tuberculin. A two-step booster test was performed on 125 of 173 staff (73%) aged 35 years or older who initially tested negative, and on 138 of 141 residents (97.9%) at the chronic care homes. RESULTS: The overall rate of initial tuberculin positivity among staff at the facilities was 15.7%. Among residents, the rate of positivity was 14.0%. Histories given by institutional staff of having previously received Bacille bilié de Calmette-Guérin vaccine (BCG) were associated with tuberculosis (TB) test reactivity, but not with mean reaction size. Staff with a history of BCG who tested positive did not differ in age from those testing negative. Institutional staff whose work involved patient contact were more likely to have a positive test than those whose work did not involve such contact. Booster positivity among those older than 35 years of age ranged from 2.0 to 5.2%. CONCLUSIONS: These results suggest that, for health care institutions in PEI, tuberculin testing should be performed on all new or current hospital staff at risk of TB exposure, all new or current staff of chronic care facilities, and all new or current residents of chronic care facilities unless contraindicated. Booster testing should also be performed on all institutional staff and residents 35 years of age or older if their initial tuberculin test is negative.

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High school students ina county in Nova Scotia were asked about sexual activity, including high risk practices. Fifty-five per cent had had intercourse, including 82% of those 18 and 19 years of age. Being sexually active was associated with poorer school performance, having parents with less than a university education, being female, and living with other than both parents. Forty per cent of sexually active students had more than one partner in the year before the survey. Thirty-five per cent always used condoms for vaginal intercourse. Students having regular intercourse used condoms less, but less frequent condom use was not associated with having fewer sexually partners. Twenty per cent of sexually active students engaged in anal intercourse; 18% of females and 35% of males reporting this practice used condoms for all sexual encounters. Students in this high school population are highly sexually active, and report high risk sexual activities at levels which should be of concern to both public health practitioners and educators.

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OBJECTIVE: To examine the demographic characteristics of patients who underwent testing for Chlamydia trachomatis and to determine the clinical and behavioural characteristics and the types of treatment for those who had positive test results. DESIGN: Case series. SETTING: Rural county in Nova Scotia. PATIENTS: All residents of the county for whom testing for C. trachomatis was ordered at the regional hospital from Sept. 1, 1990, to Mar. 31, 1991. MAIN OUTCOME MEASURES: Rates of testing and of positive test results by age and sex. Comparison of patient and physician characteristics in relation to testing rates. RESULTS: Of the 1116 patients tested 58 (5.2%) had positive test results. Females accounted for 82.8% of those with positive results whose sex could be determined. Among the females the mean age of those with a positive result was 22.3 years, as compared with 27.5 years for those with a negative result (p < 0.0001). Females 15 to 19 years of age were less likely to have a test performed than women 20 to 29 years and were more likely to have a positive test result than the women in the older groups. Almost 9% of the testing among the females was in those over 39 years of age, although no infection was seen in this age group. The number of tests ordered per general or family practitioner varied from 1 to 154; the physicians' sex, practice location and length of time in practice did not predict the rates of positive test results. Treatment was most often in keeping with that recommended by national guidelines. Four (8.5%) of the 47 patients with positive results who were interviewed were not aware of their diagnosis, either because they had not returned for follow-up or had not being notified by the physician's office. CONCLUSIONS: The frequency of testing for C. trachomatis infection may be less than is desirable among young patients, who, if tested, are more likely than older patients to have positive results. More understanding of the diagnostic approach taken by physicians is needed.

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In 1990, Cobequid Health Unit was approached by Polymer International, a plastics manufacturer, and planning began for a worksite cardiovascular risk factor screening and follow-up program. In 1991, 302 Polymer employees (89.1%) participated in a screening. Follow-up included smoking cessation programs, fitness opportunities, dietary counselling, and physician referral for further investigation of blood pressure and cholesterol levels. Policy and environmental changes include heart healthy foods at the cafeteria, development of non-smoking policy, and coverage under the corporate group insurance plan for dietary counselling. This process demonstrates the potential for public health and private industry to collaborate in preventive efforts and the principles required for success.

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To evaluate the possible public health consequences of diabetic retinopathy in Nova Scotia, we investigated the number and frequency of ophthalmologic examinations in patients with diabetes mellitus. A total of 36,683 people (4.2%) were identified from the administrative database of the provincial health department as having a diagnostic code of diabetes during the period March 1987 to February 1990. All billings by ophthalmologists for these patients during the same period were then identified. Of the 36,129 patients aged 10 years or more, 17,518 (48.5%) had seen an ophthalmologist at least once during the study period, and 5218 (14.4%) had seen an ophthalmologist approximately annually. Increased age and being female were associated in univariate logistic regression analysis with higher use of ophthalmologic services. The medical insurance system is free of direct costs to patients, and there are enough ophthalmologists to meet patient needs (4.35 per 100,000 population). The findings indicate that most diabetic patients in Nova Scotia are not seen at least once a year, as recommended by the Expert Committee of the Canadian Diabetes Advisory Board, despite ready availability of ophthalmologic care.

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From September 1990 to March 1991, 47 of 52 patients with genital C. trachomatis infections in a rural health unit in Nova Scotia were interviewed about preventive education by physicians partner notification, past history, and treatment. Seventy-six percent of those with partners of the previous month were instructed by physicians to notify these partners. Twenty-five of 37 partners were notified. Of those not notified, 83% could have been reached. Reasons for cases not notifying partners included not being informed of test results, embarrassment, and not considering notification important. Fifty-two percent of cases were advised to practise safer sex; this was generally limited to advice to use condoms. Twenty-three percent had had a previous sexually transmitted disease. Treatment was appropriate in all cases where it could be determined. More preventive education by physicians and public health involvement in partner notification for such patients are required.

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