Profiles

The Canadian Medical Association (CMA) recognizes that there is justification for abortion on medical and nonmedical socioeconomic grounds and that such an elective surgical procedure should be decided upon by the patient and the physician(s) concerned. Ideally, the service should be available to all women on an equitable basis across Canada. CMA has recommended the removal of all references to hospital therapeutic abortion committees as outlined in the Criminal Code of Canada. The Criminal Code would then apply only to the performance of abortion by persons other than qualified physicians or in facilities other than approved or accredited hospitals. The Canadian Medical Association is opposed to abortion on demand or its use as a birth control method, emphasizing the importance of counselling services, family planning facilities and services, and access to contraceptive information.     

Contraceptives,counselling, and pregnancy in women with sickle cell disease.

Sickle cell disease is listed in the manufacturers'' data sheets in the United Kingdom as a contraindication to the use of most combined contraceptive pills; the result is confused advice on family planning to a group of women who are at substantial risk from both planned and unplanned pregnancy. A study in north London on the use of contraceptives by women with sickle cell disease indicates that the use of combined oral contraceptives is common. Although medical staff usually advised against pregnancy, such advice was almost always ignored. Over half of the women surveyed had some knowledge about antenatal diagnosis. Family planning advice should be an integral part of the care of women with sickle cell disease. In the absence of specific data to the contrary all methods of contraception may be considered, although with appropriate caution.     

国家公园研学旅行适宜性评价指标体系构建与实证研究

国家公园兼具自然生态系统保护与教育、游憩等社会文化功能,是自然性、体验性和课程性研学旅行的潜在活动场所之一。研学旅行为国家公园的教育、游憩价值实现提供路径参考。基于"内在价值-外在条件"分析框架,根据独立性、全面性、科学性及可操作原则,选择教育价值、游憩价值、环境条件、相关设施及服务等4个因子构建国家公园研学旅行适宜性评价指标体系,并以钱江源国家公园为例进行实证分析。结果表明,国家公园的研学旅行利用应首先考虑教育价值,在完善教育、游憩等相关设施及服务的同时兼顾环境承载力及利益相关者态度等环境条件,最后考虑游憩价值;钱江源国家公园的研学旅行利用具有良好的教育及游憩价值基础,中小学生的研学旅行需求与利益相关者的支持态度等提供了外在环境条件保障,但在教育、交通及安全等方面的设施及服务有待改善。研究结果可为国家公园及其他场地的研学旅行利用规划与管理提供参考。     

The psychological and social effects of myocardial infarction on wives.

Eighty-two wives of men suffering a first myocardial infarction were interviewed while their husbands were in hospital, and again two months and a year after they went home. The wives had substantial and persistent psychological symptoms, and the husbands'' illness had continuing effects on their work, leisure and social activities, and family life and marriage, their psychosocial disability being comparable to that of the patients. Measures of psychosocial adjustment before the illness and the quality of the marriage and of family life were good predictors of outcome for the wives. The women had a major role in the patients'' readjustment during convalescence, and their attitudes and behaviour as well as the general quality of family life were important determinants of the rate and extent of the patients'' recovery. The wives of patients with myocardial infarction should have more practical help and advice during the hospital period, and the whole family should be given advice and help throughout the convalescence.     

Child spacing and two child policy in practice in rural Vietnam: cross sectional survey.

OBJECTIVE: To explore the reproductive pattern of women in rural Vietnam in relation to the existing family planning policies and laws. DESIGN: Cross sectional survey with question-naires on reproductive history. SETTING: Tien Hai, a district in Red River Delta area, where the population density is one of the highest in Vietnam. SUBJECTS: 1132 women who had at least one child under 5 years of age in April 1992. MAIN OUTCOME MEASURES: Birth spacing and probability of having a third child. RESULTS: The mean age at first birth was 22.2 years. The average spacing between the first and the second child was 2.6 years. Mothers with a lower educational level, farmers, and women belonging to the Catholic religion had shorter spacing between the first and second child and also a higher probability of having a third child. In addition, women who had no sons or who had lost a previous child were more likely to have a third child. CONCLUSION: Most families do not adhere to the official family planning policy, which was introduced in 1988, stipulating that each couple should have a maximum of two children with 3-5 years'' spacing in between. More consideration should be given to family planning needs and perceptions of the population, supporting the woman to be in control of her fertility. This may imply improved contraceptive services and better consideration of sex issues and cultural differences as well as improved social support for elderly people.     

Making family planning accessible in resource-poor settings

It is imperative to make family planning more accessible in low resource settings. The poorest couples have the highest fertility, the lowest contraceptive use and the highest unmet need for contraception. It is also in the low resource settings where maternal and child mortality is the highest. Family planning can contribute to improvements in maternal and child health, especially in low resource settings where overall access to health services is limited. Four critical steps should be taken to increase access to family planning in resource-poor settings: (i) increase knowledge about the safety of family planning methods; (ii) ensure contraception is genuinely affordable to the poorest families; (iii) ensure supply of contraceptives by making family planning a permanent line item in healthcare system''s budgets and (iv) take immediate action to remove barriers hindering access to family planning methods. In Africa, there are more women with an unmet need for family planning than women currently using modern methods. Making family planning accessible in low resource settings will help decrease the existing inequities in achieving desired fertility at individual and country level. In addition, it could help slow population growth within a human rights framework. The United Nations Population Division projections for the year 2050 vary between a high of 10.6 and a low of 7.4 billion. Given that most of the growth is expected to come from today''s resource-poor settings, easy access to family planning could make a difference of billions in the world in 2050.     

Some experience in an area health authority child health clinic.

Three years'' experience as a doctor taking two clinics a week in an area health authority child health clinic was reviewed. A wide range of clinical conditions was seen, including: problems associated with feeding in breast- and bottle-fed infants; minor developmental abnormalities (mental, behavioural, and physical); surgical and orthopaedic conditions requiring treatment; medical conditions, mainly respiratory and alimentary infections, skin conditions, and problems of over-treatment for minor ailments; and minor genetic abnormalities. Mothers asked for advice on a wide range of topics, risks and benefits of immunisation being the most common. The clinic doctor needs a wide experience in paediatrics to deal with such problems. It is suggested that all lecturers in child health and paediatric and senior registrars should take one clinic a week for six months, and all medical students should attend some clinics as part of their paediatric training. Health visitors have an important role in helping the clinic doctor, but their training should be more realistic and appropriate facilities should be provided to keep them up to date in their work.     

Anesthesia training for family practitioners

The 1988 CMA report on anesthesia training for general practitioners/family physicians outlined recommendations about the provision of anesthesia services, the educational process for the family practitioner anesthetist, including educational objectives, as well as comments on continuing medical education and maintenance of competence.     

Medical Care of the Alcoholic Patient

Alcoholism is an illness that constitutes a major health problem at all levels of society. The physician should accept his responsibility to prevent it and to care for the alcoholic. If he knows that one of his patients is drinking immoderately, he should warn him of the outlook. A patient''s acquired dependence on alcohol may be overt, or revealed only on examination for organic disease or emotional disturbance. The diagnosis may be accepted reluctantly, or denied despite positive evidence, but the patient should be persuaded to give up drinking. He may require psychiatric help or advice from a social worker. He may be so ill as to require treatment in hospital, and hospitals must recognize the urgency of such admissions. Discharge from hospital does not end treatment, for alcoholism is a chronic disease, requiring long-term planning, persistent follow-up and enduring sympathy by the physician, who must always be as available to his alcoholic patient as he is to his patient with diabetes, epilepsy or cardiac disease.     

Drinking and Driving

Alcohol misuse generates many health and social problems at a cost that society is increasingly unwilling to sustain. One of the most tragic consequences of alcohol misuse is the result of drinking and driving. Each week, impaired drivers kill 40 Canadian men, women and children and injure 1250 others. The Canadian Medical Association (CMA), in its campaign against drinking and driving, has recommended that a condition of obtaining or renewing a driver''s licence include the individual''s written consent to allow the taking of blood samples by qualified medical personnel when deemed necessary by law enforcement agencies. CMA has recommended to the provinces that the legal age for the purchase and public possession of alcohol be raised to 21. CMA also supports the ban of all alcohol advertising in the electronic media and emphasizes that since alcohol is a drug, all containers should be visibly labelled “Misuse of this Product can be Injurious to Health”. CMA continues to support and encourage the federal and provincial governments in their battle to prevent alcohol-related deaths and injuries through education, control of advertising, use of breathalyzer devices, mandatory blood alcohol testing and legislation enacting stiffer penalties for drinking and driving.     

Council Highlights: Minutes of the 549th and 550th Meetings of the Council

This summary is published so that CMA membership may be advised in brief of the actions of the Association''s Council. It covers only major actions and is not intended as a detailed report. Full minutes of these meeings are available upon any member''s request to the CMA office.     

Council Highlights: Minutes of the 557th and 558th Meetings of the Council

This summary is published so that CMA membership may be advised in brief of the actions of the Association''s Council. It covers only major actions and is not intended as a detailed report. Full minutes of these meetings are available upon any member''s request to the CMA office.     

Guidelines for physicians reviewing proposed legislation on health care occupations

The premise of the CMA guidelines is that legislation on health care occupations should protect the public and therefore should be based on the needs of the patient rather than on the wishes of the health care worker. Health care should be provided by personnel with appropriate training; thus, the scope of practice of any group must be based on relevant educational preparation. In a review of legislation the procedure for amending both the statutes and the regulations should be examined.     

Council Highlights: Minutes of the 547th and 548th Meetings of the Council

This summary is published so that CMA membership may be advised in brief of the actions of the Association''s Council. It covers only major actions and is not intended as a detailed report. Full minutes of these meetings are available upon any member''s request to the CMA office.     

The scientific board.

This summary is published so that CMA membership may be advised in brief of the actions of the Association''s Council. It covers only major actions and is not intended as a detailed report. Full minutes of these meetings are available upon any member''s request to the CMA office.     

Council Highlights: Minutes of the 551st and 552nd Meetings of the Council

This summary is published so that CMA membership may be advised in brief of the action of the Association''s Council. It covers only major actions and is not intended as a detailed report. Full minutes of these meetings are available upon any member''s request to the CMA office.     

Council Highlights: Minutes of the 560th Meeting of the Council

This summary is published so that CMA membership may be advised in brief of the actions of the Association''s Council. It covers only major actions and is not intended as a detailed report. Full minutes of these meetings are available upon any member''s request to the CMA office.     

Kay Elected Chairman of the CMA Council

This summary is published so that CMA membership may be advised in brief of the actions of the Association''s Council. It covers only major actions and is not intended as a detailed report. Full minutes of these meetings are available upon any member''s request to the CMA office.     

Council Highlights: Minutes of the 541st, 542nd and 543rd Meetings of the Council

This summary is published so that CMA membership may be advised in brief of the actions of the Association''s Council. It covers only major actions and is not intended as a detailed report. Full minutes of these meetings are available upon any member''s request to the CMA office.