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| In this issue | About the MEJFM | Welcome to the Middle-East Journal of Family Medicine
Family medicine is strongly influenced by the country in which it is practiced. There are lessons to be learned from examining other health care systems as well as the experiences of family physicians in different countries. A changing trend in the delivery of medical care around the world and the acceptance of the principle “health for all by year 2000” has resulted in a shift of health care delivery from hospitals and allied facilities to community health centers (1-3). At the same time, family medicine has been recognized as a speciality in its own right. Because this specialty is the cornerstone for developing a community-based health care system, training family physicians is more important than ever (3, 4).
During the past two decades most Middle Eastern countries have placed increasing emphasis on improved health care. Delivery of health care in the region interrelates strongly with other factors, such as food and nutrition, sanitation, water supply, literacy, and income distribution. In general, the government is the main provider of health care, and social insurance is viewed as a public responsibility. Health problems in this region are similar to those of industrialized and developing countries. The health care system is mainly oriented toward therapeutic and episodic care, with occasional attention to disease prevention, health promotion, and primary care (4).
The aim of the different family medicine programs in the region is to train family physicians to provide a comprehensive, patient-centered approach within primary care. The model of training follows either the American Model, the British model, or a combination. The American Model was pioneered by the American University of Beirut, whereas the British Model was applied in Kuwait by the Royal college of General Practitioner (RCGP) in the United Kingdom (4).
Family medicine in the region has not yet developed its full potential. It is a specialty that was recently introduced to the region and is still in need of nurturing and attention. Family practice is formally and publicly recognized as a medical specialty in this area of the world. Yet, in some countries, family physicians have been denied hospital admission privileges; in addition, the public continues to resist the idea of family physicians being their guide to the health care system of their country. In year 2000 the population of the Arabic countries and Israel approached 300 million, and 29,000 family physicians will be needed to provide health care, but there are only 12 residency programs in the Arabic countries graduating 100 residents each year at most, with an additional 80 residents graduating annually in Israel (4).
The income, standard of living, and professional respect of Middle Eastern
family physicians are inferior in general to those of USA family physicians,
for they enjoy little of the political and social strength accorded to
family practice in the USA and Europe. In most medical schools in the
region, integration of family practice education is lacking for medical
students, residents, and practicing physicians. Nevertheless, despite
the current problems, there is great enthusiasm in all countries at both
academic and governmental levels for furthering the cause of general practice
and improving training (4). |
| IN THIS ISSUE In her stimulating editorial Dr Al-baho (5) discussed the importance of Evidence Based Medicine: She stressed that the concept of EBM is not new but its development has accelerated over the past decade. She discussed briefly the development of EBM, its definition and importance. The conscientious, explicit, and judicious use of current and best evidence in making decisions about the care of individual patients is important for the speciality as it is seen as a method of promoting life-long learning. She pointed to two study on the importance of EBM, one in Oregon USA and the second one in Saudia Arabia The two research papers dealt with cancer. The first paper by Zoorob and Colleagues (6) from Louisiana discussed the issue of cancer screening. In this fine paper the authors (6) surveyed all current family practice residents in Louisiana in order to assess their knowledge, skills and attitudes about screening for breast, cervical, prostate and colorectal cancers. They concluded that although Louisiana family practice residents report better knowledge and feel more positively about performing cervical and breast cancer screening, family practice residency directors and educators should direct attention toward more training in prostate and colorectal cancer screening. In the second epidemiological study, Alkaff et al (7) discussed rarity of carcinoma of the prostate in Yemeni patients. In their review of 360 cases. the most striking epidemiological observation regarding prostate cancer is the very large differences in incidence rate among racial/ethnic groupings despite the current belief that the prevalence of microscopic (latent) prostatic tumors in most populations is similar. They concluded that the large disparity in the incidence between Western and Asian men is striking (about 40 fold); this observation remains one of the most intriguing etiologic clues for prostate cancer Medical education in Turkey was highlighted in two papers. Fusun in the first paper (8) discussed the restructuring of medical education in Turkey. In this paper the authors discussed the transition of medical education from the classical model of education to more modern. She noted that out of the 47 medical schools only three of them implemented the problem-based learning curriculum in 2002. She elaborated on the importance of faculty development in improving medical education and movement toward problem-based education. She added that the restructuring effort is concentrating on educating the family physicians to be the gate-keepers of primary health care. The second paper from Turkey by Erosy & Unluoglu (9) reflected on the development of family practice. They stated that the speciality started in Turkey in 1984 in three big cities. This was followed by Family practice departments which were established in universities. The Turkish Association of Specialists on Family Practice (TAHUD) was established in 1990.There is an attempt to reform the system with family physicians taking the leading role in primary health care services. However the number of family physicians availableright now is around 1300 while the number of family physicians needed for this project would be around 2000. The state of the art review paper on Aging mechanisms by Michel et al (10) illustrated the complexity of aging through examples retrieved from the literature at different levels from genes to individuals. The authors stressed the fact that the ultimate goal of gerontologists would be to slow down aging indefinitely and in parallel to enhance the human well being.The authors concluded that it is still difficult to identify the causes of the time-related-changes in human beings that we call aging. In his review papers on Cardiac Rehabilitation the author (11) discussed the importance of coronary artery disease as a major health problem .He alluded therefore that cardiac rehabilitation is a comprehensive exercise, and that education, and behavioral modification programs should be designed to improve the physical and emotional condition of patients with heart disease. He stressed the fact that the team for cardiac rehabilitation among others typically includes the family physician. He stressed that the comprehensive risk evaluation specifically focuses on blood pressure control, blood lipid management, weight management, and smoking cessation I would like to thank all authors who have contributed to the first issue.The journal is indebted as well to the editorial board , the production team , and the Royal College of General Practitioners - Australia for their help and support. We look forward for a successful journal that will promote family medicine profession and subsequently help people in the region | Top | |
| About the MEJFM Today’s world is, in many ways, unimaginably different from that of even 50 years ago. The dominant driver for such change is a new knowledge, and its translation into new ways of doing things. The first online journal of family medicine for the Middle East has started despite all obstacles, as the idea behind the journal is unique, and futuristic. From its beginning, the specialty of family practice has also distinguished itself as unique. Family practice even earned itself the designation of a "counterculture" specialty, not surprising given the individualism and rebelliousness of those who entered family practice in the early years of the specialty. The Middle East Journal of Family Medicine (MEJFM) is a new peer-reviewed journal to meet the needs of scientists, practitioners, policymakers, and the patients and communities they serve in the Middle-East. It is born out of the growing need for the exchange of ideas and research results in the region. It will foster a knowledge base for caring for individuals, families, societies and communities. The Mission of the Journal will be to promote family medicine in the Middle East. The journal will publish original clinical and educational research of interest to primary care specialties, practicing clinicians, residents and others involved in primary care and community medicine education. Faculty development and clinical research and methods will be also featured in the journal. It will include state of the art review articles based on evidence based medicine and teaching case reports. Reflections from editorial members, clinicians and policy makers will be included as well. Environmental health and control of environmental hazards will receive attention, in addition to the effect of war on health. The aim of the journal will be to provide academically sound, clinically practical information for family and general physicians, in addition to the promotion of the specialty of family medicine in the Middle East Region. The Journal will be published twice in the first year. The frequency will be once every three months in the second year, followed by once every two months from the third year onward. The Middle East Journal of Family Medicine web site (http://www.mejfm.com) provides access to the online journal and the daily news for family doctors, the notice board, and the MEJFM browser. The full-text online journal is available free to all. This encourages sharing new knowledge about primary care and health systems in the Middle East. The journal represents an unparalleled collaborative effort by two departments of family medicine in the region, community centers, Australian Family Physician (Royal Australian College of General Practitioners) and medi+World International. The editorial and peer-review processes of the journal have full editorial autonomy from both organizational and commercial pressures. A prominent regional and international Editorial Board facilitates to direct the journal to achieve its mission and foster regional, and international participation. | Top | This issue | |