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Healthcare in general, and primary care specifically, is in a state of extreme disarray. There is an increasing role worldwide for family medicine to play in the health care system. The Middle-East is following the same trend. There is more support for family medicine within the medical profession; however we still have a long way to go to arrive with the specialty at its status. International comparisons of health care systems have shown a relationship at the macro level between a well-structured primary health care plan and lower total health care costs. Research on global characteristics of health care systems indicates that having a strong level of primary health care is cost-effective. We
can always learn from looking at the development of family medicine in different parts of the world.
In a paper from Iran, Kavari et al discussed the evaluation of physicians and paramedical doctor's viewpoints on the family physician as a lost link in the medical system of Iran. The authors investigated the perspectives and
beliefs of the physicians and paramedical doctors regarding family physicians' role as a lost link in the medical services of Iran. Using a questionnaire they showed that, family medicine could be an effective parameter to promote healthy attributes of people regardless of any cultural predicaments.
The importance of clinical research is stressed in this issue where we have four clinical research papers included. There are a number of problems that academic health professionals face in the Middle-east. Firstly, academic professionals in developing countries work in relative isolation. Barring a few examples and specialized centers most academic salaries are insufficient to support a white collar lifestyle, and thus private practice is the most common means of augmenting earnings. These economic issues are by far the major factor underlying the academic brain drain in developing countries. The capacity to conceive, undertake, and evaluate appropriate research is a cornerstone of academic medicine and scholarship anywhere in the world.
The decrease in the incidence of invasive cervical cancer has been credited to the widespread use of Papanicolaou (Pap) smear screening.
This issue of the journal has three papers on preventive aspects in women's health including cervical cancer and breast feeding. In the first paper by Dr Musmar from Palestine the authors studied the pattern and factors affecting
Pap smear testing in Nablus. The author analyzed the records of all patients who had pap smear done during the year 2002. The study revealed that about 12% of the study sample had abnormal (precursors of cervical cancer) results and the majority (88%) had normal and benign changes. No statistically significant relationship was found between the cervical cytology pap results and age, occupation, education, smoking, parity, contraceptive method or frequency of genital infections. The author concludes by saying that a screening program for cervical cancer is called for through collaboration between all Palestinian health providers.
The study by Dr Bakheit et al surveyed the knowledge, attitude, and practice of pap smear among local school teachers in
Sharjah district. This study showed that although the teachers have had a good knowledge about papanicolaou smear test they are not practicing it. Overall, the most frequently reported reasons for not having a recent pap smear were
belief that it might be painful, followed by embarrassment. The authors conclude that efforts to increase coverage in cervical screening programs need to be
directed toward medical practitioners as well as towards women.
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Breast milk is considered the optimum source of nutrition for
infants, the numerous infant benefits of breast-feeding include reducing allergic manifestations, sudden infant death syndrome, and infections, such as gastroenteritis, otitis media, respiratory tract infections, and others. The accompanying paper on breast feeding by Dr Al suwaidi et al
assesses the knowledge and attitude of female university students in Sharjah, about breast feeding. The study was carried out on a sample of 196 female students who were in Sharjah university hostel during the summer course 2002. A self administered questionnaire was answered by the students to assess their knowledge about important aspects of breast feeding and to know whether they are willing to breast feed in the future. The authors found statistically significant correlation between being breast fed as infant and
willingness to breast feed in the future ( p value of 0.004). The study showed that female university students in Sharjah were willing to breast feed in
the future. However their knowledge about breastfeeding needs to be increased
through future educational programs.
There are two case reports in this issue of the journal one by Cahfer GÜLOGLU et al on evaluation of anti thrombin-III in multiple traumatic patients where the authors discussed thirty cases and concluded that , AT-III levels decrease with severity of trauma. This may increase the risk of thrombo-emboli phenomena in multiple trauma patients.
In the second paper by Set et al the authors discussed the hyperventilation syndrome and they concluded that
if family physicians become alert to the diagnosis and have good knowledge for the treatment of hyperventilation syndrome, such clinical presentations can easily be handled with high patient satisfaction at the primary care level.
A review paper on erectile dysfunction from AFP is included that discusses the diagnostic aspects of the problem and highlights latest management strategies, in addition to the usual multimedia and other columns.
Some major differences in the content of general and family practice in the world will preclude completely common training programs.
WONCA the World Organisation of family Doctors is introducing the Wonca International
Diploma in Family Medicine (WIDFM) as an attempt at creating international recognition for the specialty,
and is a step forward toward standardization and further globalization of
the family medicine movement.
The Diploma is a three year course and initially supplied on multimedia
CD ROMs. Each candidate must complete five programs of choice, and one
compulsory program. Each successful candidate receives a diploma in
Family Medicine plus a Wonca pin.
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Dr Abdulrazak Abyad
Chief Editor |
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