From the Editor

This the fifth issue of the journal and the Middle-East journal of family medicine is growing in number of readers, breadth of content, number of papers submitted to the journal, and the countries contributing papers. This issue has a good mix of review papers, research, and news from the region.

Akturk Z et al. examined the associations between physical activity and some social factors in a sample of Turkish adolescents. They studied 883 middle and high school students. The study showed that 531 (60.1 %) students were practicing some kind of sport. The authors concluded that low physical activity was associated with some social factors in teenagers. Efforts should be sought to increase self-esteem and self-care of adolescents, and the possibility to participate in sportive activities with friends and parents.

There are two research papers on reproductive health. Musmar SG et al reports on the effect of intrauterine device on reproductive tract infection. They stated that intra uterine device (IUD) is one of the most popular methods of contraception among Palestinian women. Reproductive Tract Infection (RTI) is one of the main problems associated with IUD use. In their study a high number (87%) of women reported vaginitis or RTI symptoms. They concluded that: Vaginitis and RTI are common problems among women in Palestine, with a high association between IUD use and these types of infection.

Ayyad, I et al assessed the effectiveness of rectally used misoprostol in the prevention of postpartum hemorrhage compared with oxytocin. They concluded that Rectal misoprostol is as effective as intravenous oxytocin in preventing postpartum hemorrhage with the same incidence of side effects and is recommended to be used as a uterotonic agent for the routine management of third stage of labor.

Tobacco smoking is a major public health problem in the Middle-East. Dr Qidwai W presents a paper on barriers to smoking cessation among family practice patients. He carried a questionnaire-based survey, conducted at Family Practice Center, Aga Khan University Hospital, Karachi, Pakistan. Fifty two (52 percent) respondents wanted to give up smoking while fifty five (55 percent) had tried to do so in the past. Ninety one (91 percent) respondents give up smoking during the fasting month of Ramadan. Craving for smoking, fears of inability to cope with stress and an increase in irritability were reported by seventy four (30 percent), forty six (19 percent) and forty two (17 percent) respondents respectively.

In their review on measles epidemics in Turkey and developing countries Kara IH et stressed the global extent of measles outbreaks. They searched the reports of measles outbreaks that occurred between 1993 and 2002 in English published literature and data about measles morbidity and mortality rates of Turkey during 1970-2001. Thirty-five reports described outbreaks in a total of 19 middle or low income countries. In Turkey, 30509 measles cases and 18 associated deaths were reported in 2001. The authors stressed the importance of measures to control measles outbreaks.

The failure of healthcare delivery system was demonstrated in a case from clinical practice by Qidwai W from Karachi. In this case he noted how the specialist failed to recognize hypothyroidism post radiation therapy of the neck that was discovered by family physicians. There is a need to integrate medical care at the primary, secondary and tertiary levels. Failure to do so can result is serious adverse consequences for the patient
Güloglu C et al presented a case report on evaluation of acute cases of SO2 poisoning. They stressed that the effects of SO2 gases on human beings are depend on the intensity and the time of duration. The personnel worked in industrial and textile factories have to be informed about these kinds of chemical reactions. The prevention and first aid and the technical hardware have to be provided.

A landmark report on the future of family medicine appeared in the Annual of family medicine that raised questions for challenges in Family medicine. A number of these challenges apply to us in the Middle-East

In the Middle-East the specialty is entering its fourth decade yet the there are a lot of frustration, and concern. The major challenges in the area are:

1. Promoting a broader, more accurate understanding of the specialty among the public
2. Winning respect for the specialty in academic circles
3. Making family medicine a more attractive career option
4. Addressing the public's perception that family medicine is not solidly grounded in science and technology

Dr Abdulrazak Abyad  Chief Editor