Accuracy of Arabic versions of three asthma symptoms questionnaires against the clinical diagnosis of asthma.

Validation studies of asthma symptom questionnaires against provocation tests of bronchial hyperresponsiveness have shown comparable performances of written and video taped questionnaires. This study aimed to determine the test characteristics of Arabic versions of two written and one video taped questionnaires when compared to the clinical diagnosis of asthma made by two respiratory physicians. The written International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire had higher sensitivities and greater accuracy than the other two questionnaires. Comparisons between corresponding questions and scenes in the ISAAC questionnaires in general revealed no significant differences in performance. The ISAAC written questionnaire had test characteristics consistent with its potential use as a screening instrument for asthma in this population of children.

Urinary free deoxypyridinoline excretion in lactating and non-lactating Arabic women of the United Arab Emirates.

BACKGROUND: This study aimed to measure urinary free deoxypyridinoline (Dpd) excretion in non-lactating and lactating Arabic women of the United Arab Emirates. METHODS: Morning urine specimens were obtained from 679 non-pregnant, non-lactating women and 268 lactating women. Commercial enzyme-linked immunoassay kits were used for urinary free Dpd determinations. RESULTS: For the non-lactating women, the mean urinary free Dpd excretion was 9.20 nmol/mmol creatinine (95% confidence interval: 8.82-9.59). This result was significantly higher than those reported elsewhere. There was a trend towards lower Dpd excretion with increasing age (ANOVA test of linearity P<0.05). Urinary free Dpd in lactating women was 9.92 (9.33-10.5); this was not significantly different from that of non-lactating women (P=0.052). Dpd excretion was higher in the first month post-partum, with a significant trend towards diminishing levels thereafter, returning to non-lactating levels by 9 months post-partum (ANOVA test for linearity P<0.005). CONCLUSION: Dpd excretion in UAE Arabic women aged 20-44 years was higher than in other groups. This could be due to ethnicity or vitamin D status.

The glycaemic index of dates and date/yoghurt mixed meals. Are dates 'the candy that grows on trees'?

OBJECTIVE: To determine the glycaemic index of one variety of date, alone and in mixed meals with plain full-milk yoghurt. DESIGN: An experimental study involving the measurement of the glycaemic responses of participants to the ingestion of dates, alone and with yoghurt. SETTING: Within the Department of Family Medicine, Faculty of Medicine and Health Sciences, UAE University. SUBJECTS: Healthy male and female volunteers aged 32-67 y. INTERVENTION: Glycaemic responses to date and date/yoghurt meal ingestion were plotted for each subject. Glycaemic indexes were calculated as the ratios of the incremental areas under these response curves to those for glucose ingestion. Results are presented using means and standard deviations. Glycaemic indexes were compared using paired t-tests. RESULTS: Mean glycaemic indexes of the dates were 47.2, 45.3, 35.5, 37.3, 28.9 for rutab, traditionally stored, commercial, rutab/yoghurt and commercial tamer/yoghurt preparations, respectively. There was a significant difference between the results for rutab vs commercial tamer dates (P<0.05), but other comparisons failed to reach statistical significance. CONCLUSIONS: Khalas dates, when eaten alone or in mixed meals with plain yoghurt have low glycaemic indexes. The consumption of dates may be of benefit in glycaemic and lipid control of diabetic patients. The consumption of dates in mixed meals with yoghurt appears to have, at most, a minimal effect on the glycaemic index.

Quantitative ultrasound of the calcaneus in Arabian women: relation to anthropometric and lifestyle factors.

OBJECTIVES: To determine factors influencing quantitative ultrasound (QUS) parameters of the calcaneus in a population-based sample of United Arab Emirates (UAE) women, and to compare QUS parameters of the calcaneus for healthy young UAE women with the manufacturer's reference ranges for other populations. METHODS: All subjects completed a questionnaire on reproductive and life style factors. Height and weight were measured, and body composition was determined by bioelectric impedence. Estimated bone mineral density (BMD), Speed of sound (SOS), broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) of the right calcaneus were determined by Sahara ultrasound. RESULTS: In premenopausal women (n=330), age, weight, body mass index (BMI), lean weight, fat weight, education, age at menarche, and number of pregnancies, correlated significantly with QUS parameters. Multiple regression analysis showed that age at menarche, number of pregnancies, and BMI, were the best predictors of QUS parameters although these factors explained only small amounts of the variance (R(2)=0.05). In postmenopausal women (n=81), age, BMI and physical activity were the best predictors of BUA (R(2)=0.35), SOS (R(2)=0.39), and QUI (R(2)=0.43). Mean estimated BMD, QUI and SOS for healthy young UAE women were significantly lower than the manufacturer's reference ranges for U.S. Caucasian, European Caucasian, and Chinese Asian healthy young women of the same age range (P<0.001 for all comparisons). Mean BUA was not significantly different, however. CONCLUSIONS: Menopausal status, age, BMI and physical activity are strong predictors of QUS parameters of the calcaneus in Arabian women. Healthy young Arabian women have lower estimated calcaneal BMD compared with the manufacturer's reference ranges for other populations.

The introduction of a ten-week general practice clerkship in the United Arab Emirates.

Clerkships in general practice have become established in medical curricula around the world. The reorganization of the clinical course at the United Arab Emirates University Faculty of Medicine and Health Sciences was an opportunity to design and introduce a new 10-week clerkship in general practice. This article reports the aims, structure and educational processes of the clerkship including the student assessment methods adopted. Early student feedback on the clerkship is positive.

The use of an objective structured clinical examination (OSCE) for formative and summative assessment in a general practice clinical attachment and its relationship to final medical school examination performance.

OBJECTIVES: To report the use of OSCEs for both formative and summative purposes within a general practice undergraduate clinical attachment and to compare student performance in the departmental OSCEs with that of their final medical school examinations. METHODS: Twenty-eight students rotated through the attachment and undertook pre- and post-attachment OSCEs of similar format but different content. Results were analysed to determine relationships between mean scores in the two OSCEs and student performance in their final medical school MBBS examinations. RESULTS: There was a marked improvement in all OSCE station scores. Pre-attachment scores for those stations measuring physical examination and problem-solving skills were unrelated to prior clinical experience. Post-attachment OSCE mean scores were significantly correlated with final examination OSCE and total mean scores. CONCLUSION: The general practice attachment appears to upgrade those clinical skills measured by the pre- and post-attachment OSCE, however, there was no control group of students. Problem-solving and focused physical examination skills need to be targeted by all undergraduate clinical departments. The department's post-attachment OSCE and total assessment results are predictors of final examination OSCE and total results. The use of pre- and post-attachment OSCEs facilitates both students' formative learning processes and the department's evaluation of its educational programme.

Asthma diagnosis and management in adults: is the risk of underdiagnosis and undertreatment related to patients' education levels?

To determine the relationship between patient education and the risk of underdiagnosis and undertreatment of asthma, a cross-sectional study of 500 (250 males and 250 females) adult attendees between 16 and 44 years of age was undertaken at five primary health care (PHC) centers in Al-Ain, United Arab Emirates. We used an Arabic translation of the European Community Respiratory Health Survey Screening Questionnaire. Asthmatics with higher levels of education had a significantly higher risk of underdiagnosis and undertreatment than asthmatics with less education. Doctors at PHC centers railed to diagnose 34.6% of the asthmatics with lower levels of education and 77.6% of the patients with higher levels of education. Eighty-five percent of the asthmatics with lower levels of education and 46.6% of the asthmatics with higher levels of education recognized that they had asthma. Thirty-eight percent of the asthmatics with lower levels of education and 83% of the asthmatics with higher levels of education were undertreated. It was found that 19% of the asthmatics with lower levels of education and 3% of the asthmatics with higher level of education were on prophylactic medication for asthma. We concluded that education level was related to underdiagnosis and undertreatment of asthma among adults between 16 and 44 years of age. People with higher levels of education have a higher risk of underdiagnosis and undertreatment than do those with lower levels of education. The factors that might be associated with these findings need to be explored in further studies.

A clinical trial of chronic care diabetic clinics in general practice in the United Arab Emirates: a preliminary analysis.

Control of diabetes mellitus is a high priority for primary health care systems. One innovative method of diabetes care delivery is the use of structured diabetes care in primary care. This includes the use of chronic care diabetes clinics or mini-clinics operated by general practitioners in primary care. There is limited experience with this model in non-Western settings. This study sought to evaluate a multi-component structured approach to diabetes care in primary care including chronic care diabetes clinics in a newly developed country in the Arabian Gulf. The study design used was a controlled before-after methodology. Three primary health centers were chosen for the intervention with six of the remaining clinics in a Health District being used as controls. A multifaceted intervention was initiated in the intervention clinics composed of chronic care diabetes clinics, a diabetic flow chart, and educational programs for clinic nurses and doctors and patients. The study intervention took place over a period of 18 months with three diabetic outcomes (fasting blood glucose, blood pressure and cholesterol) and adherence to seven diabetes guidelines being compared for the year prior to the intervention and during the last 12 months of the intervention period. Knowledge and satisfaction questionnaires were also administered to intervention and control subjects at the end of the study. In this study, 219 subjects were enrolled (130 males and 89 females). They had a mean age of 51.6 years and a mean of 3.1 years of formal education. Of these 109 were enrolled in one of three clinics that had a chronic care diabetes clinic and 110 were enrolled in one of the six control clinics. Subjects had diabetes for a mean of 7.8 +/- 4.8 years and the majority was treated with pharmacological therapy. Baseline characteristics in the intervention and the control clinics were similar with the exception of younger age (p = 0.01) and a trend for more males (p = 0.06) in the intervention clinics. There was a statistically insignificant change noted with the intervention in the three clinical outcomes studied (fasting blood glucose, blood pressure and cholesterol) both in comparison to the control group before and after and within the intervention group. However most changes noted were in the expected direction of improvement; six of the seven guidelines were statistically improved in the intervention group when compared with the control group. Within the intervention group, adherence with five of seven guidelines was also statistically significantly increased with the remaining guidelines showing a trend in favor of improvement (fasting blood glucose measurements (p = 0.07) and urine determinations for protein (p = 0.07)). Knowledge questionnaire scores were similar between the intervention and control groups on completion of the study but 2 of 4 items on a satisfaction scale were statistically significantly higher in the intervention group. The intervention described in this setting was successful in improving adherence to diabetes guidelines and increased some aspects of satisfaction with diabetes care. The intervention did not result in a statistically significant improvement in clinical outcomes but changes noted were in the expected direction of improvement. The significant improvement in adherence to diabetes guidelines suggests that this intervention is a promising model for diabetes care for newly developed countries.

Knowledge, attitudes, and practices related to breast cancer screening: a survey of Arabic women.

BACKGROUND: Incorporating breast cancer screening into day-to-day clinical care leads to early diagnosis and decreases mortality. Patients' participation in screening depends on their knowledge and attitudes, other barriers, and physician behavior. METHODS: A cross-sectional questionnaire survey was conducted to evaluate knowledge, attitudes, barriers, and practices related to breast cancer screening among Arabic women. A convenience sample was selected from 1,750 women aged 40-65 years who, for any reason, attended primary health care (PHC) clinics in Al-Ain, United Arab Emirates (UAE). RESULTS: Of the 1,750 invited women, 1,445 agreed to participate; 78 were excluded from analysis because of histories of breast cancer. Breast self-examination (BSE) was practiced by 12.7% of the study population, clinical breast examination (CBE) by 13.8%, and mammography by 10.3%. Knowledge about breast cancer screening was low in the study population. Women were infrequently instructed about or offered screening for breast cancer by health professionals. Being employed was an independent predictor for participation in the three screening examinations. CONCLUSIONS: Health workers infrequently offered screening examinations and women lacked adequate knowledge about breast cancer screening. Acquired information about barriers to screening may help in the design of effective screening programs for Arabic women.

Migraine associated with road traffic accidents in United Arab Emirates.

OBJECTIVE: To study migraine associated with road traffic accidents in the United Arab Emirates. METHODS: A cross-sectional hospital based study was conducted at Al-Ain Medical Health District, Al-Ain and Tawam Hospitals, United Arab Emirates. A total 1985 vehicle drivers aged 18 years and above were seen at Al-Ain and Tawam Hospitals for accidents and trauma for the period of 1994. During this period a total of 1715 vehicle drivers responded for the study. RESULTS: Of the 1715 vehicle drivers, 80 drivers had migraine condition in association with road traffic accidents. Migraine related vehicle accidents comprised about 4.7% of road traffic accidents; a higher proportion being relevant for motorways. The majority of victims (72.5%) were males and most (53.4%) were young and under the age of 35 years; 63% were married; 82.5 % had some formal education, 40% had a full license to drive a commercial taxi-cab; 63.7% had more than 2 years driving experience and 46.3% used safety seat belts occasionally. 61.3% admitted driving at excessive speeds; 35% smoke while driving; 33.8% use phones during driving and 38.8% drove with their child in the front seat. Overall, the prevalence rate of migraine at the present sample of adult drivers was 4.7% (80/1715). Of those studied 80 (4.7%) which were 72% migraine without aura and 28% migraine with aura, respectively. The comparison of licensed drivers with migraine and all other licensed drivers without migraine was made. Significantly higher risk was observed for careless driving [RR=1.54; 95% CI=1.21-1.94, p<0.002] and property damage [RR=1.88; 95% CI=1.02-3.44; p<0.05] among drivers having migraine. However, excessive speed violations, traffic violations, alcohol and drug use did not show significant association with RTA. Finally, there were very strong correlation between severity and frequency of migraine with the risk of careless driving (r=0.76, p<0.001) and property damage (r=0.61, p<0.001). CONCLUSION: More public awareness needs to be drawn to the dangers of driving while having difficulty with migraine conditions.

Measurement-specific quality-of-life satisfaction during the menopause in an Arabian Gulf country.

OBJECTIVE: The aim of this study was to use an instrument, the menopause-specific quality-of-life satisfaction questionnaire for the postmenopausal period, in the United Arab Emirates (UAE). DESIGN: A cross-sectional descriptive study was used to generate menopause symptoms experienced by Arabian Gulf women. Measurement-specific quality-of-life satisfaction questionnaires were used and face-to-face interviews were performed. SETTING: The study was based in primary health-care clinics in Al Ain City, Sharjah and Dubai Emirates, UAE. SUBJECTS: A multistage sampling design was used, and a representative sample of 450 UAE females aged 45 years and above were included during January-April 1999. RESULTS: Of the 450 women living in both urban and rural areas, 390 women agreed to participate (86.7%) and responded to the study. The mean age and standard deviation (SD) of the subjects was 56.5 +/- 6.6 years, and the median age of natural menopause in the present study was 48 years (mean +/- SD 48.4 +/- 3.8). The rate of consanguinous marriages in the sample was found to be 47.2%. The most common disease was found to be diabetes mellitus (10.3%), followed by osteoarthritis (7.7%), hypertension (7.2%) and asthma (6.2%), but the majority of subjects (68.7%) had no specific disease. Out of 29 possible symptoms, the mean number of symptoms was 7.57 (range 0-24). The most frequent symptom was 'aches in the back of the neck or head' at 46.4% followed by 'aches in the muscles/joints' at 34.6%. The least reported symptom was 'facial hair' at 15.9%. Increasing education resulted in more symptoms reported, and increasing parity resulted in fewer symptoms reported. In the present study, it was found that employed women experienced more symptoms and disorders. Of the total sample, 28.5% of the subjects reported no symptoms. In the four domains, 69% reported physical symptoms, 58.7% reported psychosocial symptoms, 40% reported vasomotor symptoms and 37.9% reported sexual symptoms. Spearman's rank correlation coefficient indicated that there is highly statistically significant concordance between the four domains (p < 0.01). CONCLUSION: The present study showed that menopause-related symptoms in UAE women are fewer and of less severity than in Western women. The postmenopausal women, despite a continued decline in estrogen levels, reported few symptoms as part of a normal life stage, suggesting that they were able to cope with stress.

Evaluating the effectiveness of 2 educational interventions in family practice.

BACKGROUND: Structured feedback of information can produce change in physician behaviour. The objective of this study was to assess the effectiveness of 2 educational interventions for improving the quality of care provided by family physicians in Ontario: the Practice Assessment Report (PAR) and the Continuing Medical Education Plan (CMEP) with a follow-up visit by a mentor. METHODS: The study was a randomized controlled trial. Physicians in the control group received only the PAR, whereas those in the experimental group received the PAR, CMEP and mentor interventions. The participants were 56 family physicians and general practitioners (27 in the PAR group and 29 in the CMEP group) in southern Ontario who agreed to participate in the interventions and provide data. A total of 2395 patients randomly sampled from the practices returned questionnaires and consented to have their medical records abstracted. The outcome measures were global scores in 4 areas--quality of care, charting, prevention and overall use of medications--and patient ratings of satisfaction with care and preventive practices. The measures were applied at the beginning (phase 1) and end (phase 2) of the study. RESULTS: The mean global scores at the end of the study for the PAR group were 70.1% for quality of care, 84.7% for prevention, 77.7% for charting and 82.2% for overall use of medications. The corresponding scores for the CMEP group were 68.3%, 82.1%, 76.4% and 83.2%. In the patient satisfaction component, the personal care scores at phase 2 were 93.6% for the PAR group and 94.6% for the CMEP group. Examples of the scores for prevention for the PAR group were 98.3% for children's current immunization, 96.6% for blood pressure measured within the previous 5 years, 79.4% for referral of women of the appropriate age for mammography within the previous 2 years, and 58.4% for discussion about alcohol use. The corresponding scores for the CMEP group were 95.8%, 97.6%, 77.6% and 64.6%. The changes in mean scores between phase 1 and phase 2 ranged from -1.9 to 2.3 points. There were no significant differences between the 2 groups in phase 1 or phase 2 scores or in change in scores. A total of 64.3% of the physicians rated the PAR as useful, 26.5% found the CMEP to be useful, and 41.0% considered the mentor strategy to be a useful form of continuing medical education. Although changes in practice related to the PAR, CMEP or mentor were reported by some physicians, they were not related to chart audit or patient scores. INTERPRETATION: Educational interventions based on quality-of-care assessments and directed to global improvements in quality of care did not result in improvements in the outcome measures. Educational interventions may have to be targeted to specific areas of the practice, with physicians being monitored and receiving ongoing feedback on their performance.

Clinical factors affecting physicians' management decisions in cases of female partner abuse.

BACKGROUND AND OBJECTIVES: This study determined which clinical factors influence Canadian primary care physicians' management decisions in cases of female partner abuse. METHODS: We used a cross-sectional survey design and randomly sampled (n = 2,014) English-speaking Canadian physicians with a primary interest in family or general practice who were practicing in any of the 12 provinces and territories in Canada and who were active in private practice and registered to prescribe. Respondents completed a questionnaire that required them to score management decision plans in response to case scenarios illustrating typical office-based situations that might involve domestic violence. RESULTS: The response rate was 50.7% (n = 1,022). Using forward stepwise regression analysis, the strongest predictor of whether a physician endorsed a management plan in response to violence was whether the woman acknowledged or revealed the abuse. Male physicians were more likely than females to endorse talking with the suspected abuser if he was known to them, regardless of the quality of this patient-physician relationship with the abuser. CONCLUSIONS: Decisions about whether to deal with the abuse or the selection of a management plan are not dependent on the severity of the physical abuse and the emotional consequences. Whether a woman acknowledges or reveals the abuse, as well as whether both the male and female patients are in the physician's practice, are predictive of whether a physician's response to a case scenario involves dealing with spousal abuse and how he/she will address it.

Long-term follow-up in the Peer Assessment Program for nonspecialist physicians in Ontario, Canada.

BACKGROUND: The College of Physicians and Surgeons of Ontario has assessed randomly selected physician office practices since 1972. Each assessment consists of a tour of the premises and a review of a random selection of 20 to 30 medical records to evaluate the system of record keeping and the content of the records and to thereby indicate the quality of the physician's examinations, history taking, diagnosis and management plan. About 12% of nonspecialist physicians who need help to improve their records and/or the care they provide are identified annually, and following an interview with peers and simple educational interventions, more than 75% are successful in improving. METHODS: A follow-up was conducted to assess physician practices an average of six years after the first intervention. The reviewers were blinded as to whether the physician being reviewed had been reviewed previously. Each revisited physician was matched to three others undergoing their initial assessments in the same year. The matching variables were age, sex, school of graduation (Canadian versus other), rural versus urban practice location, and affiliation status with the College of Family Physicians of Canada. The assessed performance of the two groups was compared. RESULTS: The performance of the revisit group was significantly better than that of the matched group (p = 0.05). CONCLUSIONS: The assessment, interview, and educational interventions undertaken by the licensing authority produced an improvement in practice in the short term in the bottom 10%-15% of all physicians reviewed, which was sustained for more than six years.

What factors affect quality of care? Using the Peer Assessment Program in Ontario family practices.

OBJECTIVE: To describe the relationship between the quality of care provided by family and general practitioners in Ontario and the demographics of the practitioners. DESIGN: Descriptive study using univariate and multivariate analysis to relate physician demographics to quality of care. SETTING: Ambulatory family and general practices in Ontario. PARTICIPANTS: Each year from 1990 to 1994, all non-specialist physicians in Ontario reaching 70 years of age and a random sample of physicians younger than 70 who had been in practice more than 5 years were selected for assessment. After exclusion criteria were applied, the sample size was 922 physicians. MAIN OUTCOME MEASURES: Grades assigned by the College of Physicians and Surgeons of Ontario's Peer Assessment Committee. RESULTS: Practices were assessed and graded by the Peer Assessment Committee. Grades were related to many variables, but many variables were correlated. Four variables remained significant at the P < .05 level. Younger physicians, female physicians, certificates of the College of Family Physicians of Canada, and urban physicians had, on average, higher grades. CONCLUSION: Grades reflecting quality of care and record keeping were significantly associated with age, sex, certification status, and practice location. These findings should be examined and, for the benefit of patients, methods for improving care should be developed and explored.

Guidelines for managing domestic abuse when male and female partners are patients of the same physician. The Delphi Panel and the Consulting Group.

OBJECTIVE: To provide clinical guidelines for primary care physicians who are dealing with domestic abuse and who have both the abused woman and her partner as patients. PARTICIPANTS: A 15-member expert panel with members having experience in family practice, gynecology, emergency medicine, medical ethics, nursing, psychology, law, and social work; an 11-member consulting group with members representing medicine, consumers, police, psychology, social work, and nursing; and participants from focus groups including 48 previously abused women and 10 previously abusive men. Members of the expert panel and the consulting group were recruited by the research team. Focus group members were recruited through the agencies from which they were receiving services. EVIDENCE: Available research information, and opinions of the expert panel, the consulting group, and the focus group participants. CONSENSUS PROCESS: Scoring of 144 clinical scenarios was performed by the expert panel using a modified Delphi technique involving 4 iterations. Scenarios were rated in terms of best practice for primary care physicians dealing with suspected and confirmed cases of physical abuse. Consulting group members and focus group participants then commented on the panel's results. Final guidelines were approved by the panel and the consulting group, with comments reserved in the guidelines for information from focus group participants. CONCLUSIONS: It is not a conflict of interest for the physician to deal with abuse of the female partner when both partners are patients. Both patients have a right to autonomy, confidentiality, honesty, and quality care. Patients should be dealt with independently, thereby facilitating assessment of the magnitude and severity of the victim's injuries. Physicians should not discuss the possibility of domestic abuse with the male partner without the prior consent of the abused female partner. Joint counseling is generally inadvisable and should be attempted only when the violence has ended, provided both partners give independent consent and the physician has adequate training and skills to deal with the situation without escalating the violence. If the physician feels unable to deal effectively with either patient because of the dual relationship, referral to another qualified physician is preferred.

A comparison of the effects of oral conjugated equine estrogen and transdermal estradiol-17 beta combined with an oral progestin on quality of life in postmenopausal women.

OBJECTIVE: To compare the effect of transdermal estradiol-17 beta and oral conjugated equine estrogen when combined with an oral progestin on quality of life in post-menopausal women. DESIGN: Randomized controlled double-blind trial. A randomization error lead to the exclusion of six subjects but the soundness of the remaining randomization was confirmed. SETTING: Large urban community. PATIENTS: Women 2-7 years after menopause with a uterus and ovaries, and not currently using hormone replacement therapy. Seventy-four women completed the trial. INTERVENTIONS: After baseline measures of quality of life, subjects were randomly assigned to either continuous oral conjugated equine estrogen 0.625 mg daily or continuous transdermal estradiol-17 beta 50 mcg twice weekly, for four 4-week cycles. Medroxyprogesterone acetate 10 mg oral tablets was administered to both groups for the last 12 days of each cycle. OUTCOMES MEASURED: Quality of life was determined using the Menopause-Specific Quality of Life Questionnaire. Tolerability was determined by a specifically designed list of adverse effects. Both measures were recorded at base-line and in mid-cycle during the second, third and fourth cycles of treatment. RESULTS: There were no statistically significant differences in any of the domains at baseline between the oral and transdermal treatment groups. In the vasomotor domain-scores for the oral and transdermal groups improved from baseline levels of 3.14 and 3.09, respectively, to 1.32 and 1.23; physical domain scores improved from 2.45 and 2.73 to 2.04 and 1.78; psychosocial domain scores improved from 2.72 and 3.04 to 2.21 and 1.94; sexual domain scores improved from 2.32 and 2.16 to 1.64 and 1.30. There were no statistically significant group differences or time/group interactions. Both forms of therapy were equally well tolerated. CONCLUSIONS: Improvement in all domains, measured by the Menopause-Specific Quality of Life Questionnaire, was observed in both the oral and transdermal groups. In the absence of a placebo control group, the improvements observed cannot be attributed solely to the therapy. Neither form of therapy offered an advantage over the other in respect to improvement in quality of life.

Fetal tissue transplantation and abortion decisions: a survey of urban women.

OBJECTIVE: To describe women's attitudes and predicted behaviour regarding the potential for fetal tissue transplantation (FTT) to influence abortion decisions. DESIGNS: Self-administered questionnaire survey by mail. SETTING: Academic family practice in Toronto. PARTICIPANTS: Random sample of 475 women 18 to 40 years of age selected from the family practice registry of an urban teaching hospital. Family physicians were blind to their patients' participation, and investigators were blind to the subjects' identity. Forty questionnaires were undeliverable. Of the remaining 435, 272 (62.5%) were completed. Six of the women were over 40 years of age or did not indicate their age and were excluded, which left 266 (61.1%) questionnaires for analysis. OUTCOME MEASURES: Number of women who would (a) be more likely to have an abortion if they could donate tissue for FTT and (b) feel better or worse about choosing abortion if FTT were an option, and open-ended comments about the potential for FTT to influence abortion decisions. RESULTS: Of the 266 respondents 32 (12.0%) reported that they would be more likely to have an abortion if they could donate tissue for FTT, 178 (66.9%) stated that they would not be more likely to do so, and 56 (21.1%) were uncertain. Of the 122 who indicated that they would consider an abortion if they were pregnant, 21 (17.2%) stated that they would be more likely to have an abortion if they could donate tissue for FTT, 77 (63.1%) replied that they would not be more likely to do so, and 24 (19.7%) were uncertain. The women 25 to 33 years of age were more likely to be influenced by FTT than the younger or older women, and the women 18 to 24 years were more uncertain about the influence of FTT on abortion decisions than the older women. In written responses some of the women felt that FTT might make abortion decisions easier; many were troubled that FTT might be used to justify a morally problematic abortion decision and felt that FTT should not be used to justify abortion. CONCLUSION: The data, the first of their kind gathered from from women, suggest that some women's abortion decisions may be influenced by the option to donate tissue for FTT. Further research is necessary to explore the mechanism of influence.

Family practice in Ontario. How physician demographics affect practice patterns.

As the demographics of practising physicians change, especially as the number of women doctors in an area increases, it is important that those planning for the provision of medical care in the future understand the relationships between the demographics and changes in practice patterns.

Advance directives: the views of health care professionals.

OBJECTIVES: This study examined the views and experiences of 20 physicians and 20 nurses at a major Canadian teaching hospital regarding the use of advance directives in clinical care. DESIGN: The participants were purposively drawn from four clinical specialties: family and community medicine, oncology, intensive care and geriatrics. Detailed interviews were conducted in person. Content analysis was used to code the data, which were further analysed with both quantitative and qualitative techniques. MAIN RESULTS: Thirty-nine of the 40 participants favoured the use of advance directives in clinical care; physicians had somewhat less positive attitudes than nurses toward such directives. Advance directives were thought by participants to be helpful in resolving disagreements between patients and their families about treatment options; in making patients more comfortable, both physically and psychologically, during the process of dying; and in opening up communication and trust among patients, their families and health care professionals. Concerns about the use of advance directives focused on the lack of clarity in some patients' instructions, the absence of legal status for directives, the possible interference with a practitioner's clinical judgement, the adequacy and appropriateness of patients' information about their circumstances, and the type of intervention (passive or active) requested by patients. CONCLUSIONS: New regulations and legislation are making the use of advance directives more widespread. Health care professionals should participate in the development and implementation of these directives. Continuing professional education is essential in this regard.