AUTHOR A. Abyad, MD, MPH, MBA, AGSF, AFCHSE Chief Editor

In this issue we commence our Focus on Quality Care (FOQC) initiative. There are two papers, one from Australia on Family Practice - a global perspective, and a second paper from Iraq on establishing a Centre of Disease Control in the Middle East.

The first paper in our Focus on Quality Care initiative provides an overview of the challenges global family doctors now face and those they will begin to face as our world becomes even more challenging on every front. This paper and indeed the initiative itself, sets out to highlight some of these challenges, but also to provide where possible, some insights and solutions. It also recognizes the vital role of the primary care physician who is at the forefront of these many challenges, be they environmental, epidemiological, social, psychological or medical.

The author stressed that this century provides a new set of problems, and problems of a more residual nature. Social unrest, climate change, less availability of clean water, polluted air in the main population centres, and increased levels of stress and depression are becoming mainstream health issues even in high income nations. Perhaps if we can look at these issues as challenges, itemise and quantify the problems and set up programs to overcome them, then the problems are already half solved. Another important challenge I feel will have a great effect on the health care systems in the developing world is poverty which is hindering the progress of health especially in African countries where people are surviving on less than a dollar a day and where AIDS is predominant and war and famine have contributed to the systemic destruction of whatever health care systems existed.

The second paper on FOQC discusses The status of health and medicine in the Middle East - disease control. The author conveys a pessimistic view about the Middle East where he propounds that it is the most neglected health arena in the world today. Although to a certain extent this is true in some of the countries in the Middle East, other countries have an excellent health care system compared to the less privileged and poor countries of the World. In the Middle East there is good infrastructure and large number of physicians, which does not exist in Africa for example. Even the health care sector in Iraq, although it has suffered tremendously through the war, is still functioning and still havs excellent health professionals. The author stresses that the media ignores that much of the credit for early medical discoveries is owed to physicians from the Middle East in the first millennium. The author calls for the establishment of of a Center of Disease Control in the Middle East. The center should handle diseases grouped into the following three categories: diseases which cause high levels of mortality; diseases which place on populations heavy burdens of disability; and diseases which owing to the rapid and unexpected nature of their spread can have serious global repercussions. Among the tasks envisioned for the center are harmonisation of surveillance methodologies across the middle east, providing scientific opinions and technical assistance.

Dr Al Mustafa BA discussed the Development of Encounter Forms for Cardiovascular Disease Risk Management. He stressed that during the last decade many guidelines have been published for detection, evaluation and treatment of different cardiovascular disease (CVD) risk factors (RF).

Nevertheless, guidelines were not sufficient to change either the outcome or the behavior of the caregiver. The author describes 4 pages of evidence-based encounter forms (EF) that have been developed by the author, to facilitate office assessment, follow-up and audit of services delivered to patients with chronic CVD risk factors.

A study from Iran investigated medical staff awareness of patients' rights in Fasa Hospitals and Medical Centers. The authors stressed that Medical staff should gain, learn and use the medical principle of morality along with experimental, applied and theoretical sciences. In the second paper the authors looked at the effective factors on patients' satisfaction, who are referred to medical centers in regard to family planning services in Fasa in 2005.

A study from Department of Microbiology, University of Nigeria, Nsukka, Nigeria, reports on In Vitro Susceptibility Testing of 71 species of Dermatophytes isolated from pediatric cases in Nigeria against five antifungal agents. This appears to be the first documented data on the susceptibility of isolates of dermatophytes, from Nigeria.

A paper from Dubai reports on the use of special software for Safer Drug Therapy in the Middle East. The authors stress that medical errors rank as the eighth leading cause of death, killing more Americans than motor vehicle accidents, breast cancer, or AIDS. A large percentage of Medical Errors are related to the mistakes made by a doctor during the Drug Therapy. The authors stressed that the product will help doctors to reduce medication errors.

A study from Eygpt looked at the relationship between severity of inflammatory reaction in gastritis and intensity of Helicobacter pylori in the antrum. This study revealed that many factors play a role in the relationship between severity of inflammatory reaction and intensity of helicobacter in antral chronic gastritis, and these factors include host immunity, virulence of the microorganism, genetic factors, and diet rich in antioxidants that neutralize the mediators.

A retrospective survey from the Royal Medical Services and the Ministry of Health in Jordan reports on the effect of Clomiphene citrate on the incidence of Hypospadias. In their study period between 1999 and 2003 they found a total of 104 cases of hypospdias in all hospitals. There was no association between clomiphene citrate and external genital malformation, specifically Hypospadias.

A cross sectional hospital based study from Basrah/Iraq studied patients with sickling disorder who presented for screening. The total number of patients was 647. In most of the patients (69.3%), the HbS range is 31-40 %. Only 5.7% of patients had HbS >40%. This study represents the first reported level of HbS among both sexes in Basrah.

A paper from Pakistan discusses the epidemiological survey of maternal mortality rate . Two hundred houses were included in the study. From those houses 400 women in their reproductive ages were selected. The authors concluded that socioeconomic, marital and obstetric factors are still major causes of maternal deaths. Another study from Iran studied the Parent-Adolescent Relationships in the City of Amol. The aim of this research is to identify the value order in two generations (fathers and their children), and to specify the value gap and the reasons related to it.