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Research is just one part of an academic physician's activities, which also include teaching, patient care, and administration. Research productivity, however, is still expected for academic advancement and to enhance family medicine as an academic discipline. The five units of Laval University's Department of Family Medicine were surveyed to determine the effect of family physicians trained in research on the number and type of publications produced by all of their teachers between 1982 and 1987. A total of 55 articles were published. Forty-eight per cent of the teachers had participated in the generation of at least one publication during the study period. The presence of family physicians trained in research proved to be the most significant factor influencing the number and type of articles published in each unit.

The author describes a simple eight-item personal care index of activities of daily living (ADL) to aid in assessing the needs of patients requiring placement in a long-term care institution. Using the index, an analysis of patients in a nursing home was undertaken, comparing regular care patients with patients designated as heavy care. The results of the survey, including the ADL index and demographic and diagnostic data, are described.

Many family physicians in North America have been trained to use forceps when instrumental deliveries are needed; few have been trained to use the vacuum extractor. Vacuum extraction was introduced to family physicians in a geographically isolated hospital. A retrospective chart audit of all instrumental deliveries was done, comparing the four years before the vacuum extractor was introduced with the subsequent four years. Vacuum extraction quickly became the most common form of instrumental delivery and was associated with a lower maternal complication rate than the use of forceps. Fetal complications were infrequent in both groups. A questionnaire was administered to all family physicians practising obstetrics at the hospital after the introduction of the vacuum extractor. Those exposed to the vacuum extractor were enthusiastic about it.

Case examples of hysterical coma and paralysis in two Ojibway patients are used to introduce a discussion of conversion symptoms. Somatoform disorders are described using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition; these are then applied to hysteria in the Native American patient. The authors discuss the cultural context of conversion symptoms in this population and describe guidelines for the provision of culturally sensitive therapy by the family physician.

A questionnaire was mailed to 564 rural Alberta physicians to determine the demographic profile of practising rural physicians, to identify factors that attracted and retained physicians in rural practice, and to identify the skills that newly trained general practitioners require for rural practice. Rural-based physicians were relatively young (50% below the age of 38 years) and predominantly male (86%). Approximately 73% were general practitioners without certification by the College of Family Physicians of Canada, and 19% were family physicians with certification. Compared with the Canadian-trained physicians (56%), foreign-trained rural physicians (44%) tended to be older, to have been longer than 10 years in rural practice, and to have had more than four years of postgraduate training. The major reasons for contemplating leaving rural practice were retirement, career advancement or limited challenge, and heavy work-load.

The authors examined charts for evidence of the use of intravenous fluids in all patients who died from malignant disease occurring in a tertiary care teaching hospital during a one-year period. Of 106 patients who were identified, 86 received intravenous fluids within their last 30 days of life, and 73 died with an intravenous line running.Intravenous fluid use appeared to be independent of age, sex, language, presence of family members, primary tumour site, presence of metastases, duration of illness, and presence of a "no cardiopulmonary resuscitation" order. Total lengths of stay and survival time after obtaining "do not resuscitate" orders were longer in those who died without intravenous fluids. More than two-thirds of patients with cancer who died in hospital did so with an intravenous line.

A 21-item check-list is presented that evaluates the quality of the medical interview, focusing on politeness, respect, and communication. Twenty-eight interviews conducted by family medicine residents were videotaped. Using the check-list, four teachers as well as the resident evaluated each interview. Reliability and content validity were demonstrated. This list is easy to use and may enhance the learning of interviewing skills by giving objective feedback to the resident.

Most clinical drug trials relating to acute otitis media have evaluated medications in terms of treatment. In this randomized double-blind, cross-over study, the effectiveness of an antihistamine decongestant in the prevention of AOM was investigated, rather than the treatment. The medication/placebo was started at the onset of a cold and continued throughout its duration. No treatment effect was evident in the results obtained with 308 children who completed the eight-month study. However, the results indicated a strong relationship between colds and AOM, and a trend toward higher occurrence of AOM in children under four years of age.

Various authors have suggested the possibility of a link between biological age and sexual activity. Zelnick (1981) described the relationship between sexual activity and age at menarche. To determine the relationship between biological age and age at first sexual intercourse, we presented a questionnaire to 450 students attending a comprehensive secondary school in Montreal. Age at menarche and age at first conscious ejaculation were used to measure biological age. A partial correlation was made between biological age and age at first sexual intercourse by controlling for chronological age. The results were r = 0.24 (p

Following a computer-generated, randomized, chart review at the Sunnybrook Medical Centre Family Practice Unit, an attempt was made to delineate the factors that would determine the likelihood of influenza vaccination in the elderly population during 1985 and/or 1986. Although current recommendations call for vaccination of all patients over the age of 65, particularly those with chronic underlying disease, only the presence of chronic obstructive lung disease (p = 0.003) and the total number of visits (p = 0.0001) were found to be significant among 15 variables examined in 451 patients. A subsequent questionnaire relating to vaccination was distributed to the participating family practitioners to determine the degree to which physicians' ideas about indications for influenza vaccination concur with the actual determinants of patients being immunized in their practices. The overall Sunnybrook vaccination rate was compatible with that obtained in national surveys, indicating that compliance rates are remarkably low (20%).

The authors studied 46 eldest or only children under school age and their parents to determine the relationship between parents' recollections of their own childhoods and the way they use their family physician for care of their children. The parents completed a questionnaire that measured the caring and overprotection dimensions of the parenting they themselves remember. Positive correlations were found between perceptions of maternal overprotection and the frequency of children's visits. Negative correlations were found between perceptions of parental affection and children's visits and non-routine diagnoses. Neuroticism was found to be a confounding variable that slightly weakened the relationship between maternal caring and children's visits.

Since the Memoria, Voz, y Patrimonio (MVP) Conference (2003), the archival literature continues to grapple with issues pertinent to Latina/o archives. Extending the work of the MVP Conference, drawing on the archival and cultural studies literature, and grounded in our experiences with under-represented communities, this epilogue offers our meditations on the future of Latina/o archival and memory practice, research and education. The archives and archivists as social structures and agents, respectively, are viewed through the lens of Pierre Bourdieu’s symbolic power whereby they need to be liberated from the symbolic domination legitimized and reproduced in the classic archives.

Este artigo apresenta a experiência da aplicação de um método qualitativo de pesquisa que, além da compreensão das práticas de educação em saúde desenvolvidas por uma equipe de saúde de um ambulatório-escola, proporcionou um processo educativo com base na reflexão crítica dos resultados do estudo, com os próprios sujeitos da pesquisa. Essa experiência foi desenvolvida com dezenove profissionais de saúde do Serviço de Assistência Integrada à Saúde de Tubarão, Santa Catarina. O processo de pesquisa ocorreu em quatro momentos. Momento 1: caracterizado como momento inicial de interação com os sujeitos do estudo - escuta e diálogo - para a primeira fase de levantamento dos dados. Momento 2: momento particular reflexivo-criativo do pesquisador, representando a primeira fase do processo de análise-reflexão-síntese dos dados. Momento 3: momento coletivo de interação e diálogo reflexivo com a equipe de saúde para discussão da realidade encontrada e descoberta de temas emergentes. Momento 4: momento particular do pesquisador para análise-reflexão-síntese da totalidade dos dados. Dessa prática educativa com a equipe de saúde emergiu o tema "A necessidade e a vontade de transcender para o contexto do cliente e as (im)possibilidades de romper com os atuais padrões das práticas em saúde", cuja síntese final gerou estratégias de mudanças naquele Serviço. This paper presents the experience of applying a qualitative survey method that offers an understanding of the educational healthcare practices developed by a healthcare group working at a teaching out-patient clinic. This method also led the survey subjects through an educational process based on critical thinking about the findings of the survey. This experiment was conducted with nineteen healthcare practitioners at the Tubarão Integrated HealthCare Unit in Santa Catarina State. The survey was carried out in four phases. Phase 1: initial interaction with the participants in the study (listening and dialog) for the first data collection phase. Phase 2: private time for the researcher to think creatively as a first step in the process of analyzing, considering, and summarizing the data. Phase 3: collective interaction and reflective dialog with the healthcare group, discussing the situations encountered and exploring emerging topics. Phase 4: private time for the researcher to analyze, consider and summarize all data. This educational practice with the healthcare group resulted in the appearance of the topic: "The need and the will to transcend to the client's context and the (im)possibilities of breaking away from current patterns of healthcare practices", prompting suggestions for strategic changes in the Unit.

2005

Teaching about the family has become an important part of the family medicine curriculum. The family orientation index, a 39-item questionnaire, was designed to evaluate the family orientation of services and care provided as well as the teaching and research. The questionnaire was distributed to 55 program directors at 16 Canadian universities. The response rate was 84%. The results indicate that the family orientation of services is less than optimal.

The relative frequency with which family medicine residents managed several sports-related problems, their level of comfort with each of the conditions, and the sources of information they planned to use to improve their knowledge or skills were studied. Pearson correlation analysis revealed that residents reported greater comfort with conditions they saw most often. Reading was the preferred information source regardless of the clinical problem. The choice of information source did not differ by the frequency with which the condition was seen by the resident.

Self-administered questionnaires about diaper choices and the reasons for such choices were completed by 600 parents of children younger than two years of age attending a hospital walk-in clinic or the private office of one of four pediatricians. Only 2.7% of the parents used cloth alone; another 15% used both cloth and disposable diapers; a further 18% reported having used cloth at some time. Convenience and rash prevention were reasons for choosing disposable diapers. Those who used only cloth washed at home cited cost and rash prevention. Those who used cloth diapers from a service cited convenience and rash prevention. Only 10% of parents received advice about diapers from their physicians, but 70% said they would follow such advice. Primary care providers can point out to parents that disposable diapers are more costly and present environmental concerns.

A patient's personal experience of an illness is as important as the illness itself. A patient-centred approach focuses on the patient's views and feelings concerning his health problem or illness, i.e., his beliefs, fears, his expectations, and the impact that the problem or illness is having on his life. A review of the literature by a group of researchers at the University of Western Ontario suggests that this approach results in improved patient satisfaction, observance and results. This approach can be used on a daily basis in almost all clinical situations. The results of a study on strategies used by clinicians with experience in family medicine to detect the "functional" patient are also presented.

In January and February of 1988, a questionnaire was sent to family physicians affiliated with family practice teaching departments in Toronto to determine whether there was any consensus among family physicians as to which patients they counselled about AIDS and to whom they recommended antibody testing for HIV. Ninety-seven out of 126 questionnaires were answered, for a response rate of 77.0%. More than 90% of the physicians reported discussing AIDS and its prevention with patients in high-risk groups, sexual partners of such patients, and those with multiple sexual contacts. More than 90% recommended HIV antibody testing for patients in high-risk groups who requested it. For discussing AIDS with all sexually active patients, however, there was much less consensus in the reported physician practices.

A chart audit of 106 women after delivery was undertaken consecutively to discover the extent and type of problems they encountered during the first six months after childbirth. In 34% of the charts, no complaints were noted. The most common problems were non-obstetrical infections, fatigue, and back pain, while hemorrhoids, dyspareunia, and depression were noted less often.

If one strives to provide care for the mother as a person adjusting to a major life change, then one needs to know more about the particular concerns of mothers of newborns. Open-ended interviews with mothers of newborns provided a list of basic concerns, which was then used to create a self-administered check-list. Eighty-four mothers of newborns revealed that their top three concerns were "feeling exhausted," "amount of time as a couple," and "body weight." These concerns were similar for many subgroups of mothers except when the babies were older than 10 weeks of age. Paradoxically, physicians and nurses providing post-partum care are not seen as sources of help for any of the 10 most frequent concerns reported by the mothers.

From 376 randomly selected nulliparous women who delivered at the Grace Hospital in 1986, we selected 133 low-risk women and performed a retrospective chart review to ascertain the episiotomy rate for physicians by sex, years since graduation, and specialty status. There was a statistically significant difference between the rate for specialists (65%) and general practitioners (38%). A non-significant difference was found between male physicians (41%) and female physicians (56%) and between physicians who had graduated within 15 years (42%) and those who graduated more than 15 years ago (52%). Subgroup analysis of the general practitioner data revealed different patterns for male and female physicians according to their graduation cohort.

The author reports on six months' experience of obtaining advance directives from patients for care in a family practice. Patients were questioned about their preferences for comfort or prolonging life and then were asked to delegate a substitute decision maker. Of 20 patients, all who responded chose comfort over prolonging life. Delegated substitute decision makers included spouses, children, and professionals or friends. In this population, patients overwhelmingly favoured comfort over prolonging life in the event that they might be irreversibly disabled, and they tended to choose spouses or other first-degree relatives as substitute decision makers.

A sample of 323 physicians from Edmonton, Alberta, was surveyed to evaluate their attitudes and knowledge level concerning heart disease and lipids. Of the sample, 117 physicians returned the questionnaire. When asked to choose significant risk factors of cardiovascular disease, 69% of the physicians indicated hypertension; 85% indicated smoking; and 87% indicated elevated serum cholesterol. Concerning the minimal low-density lipoprotein level that warrants treatment, 82% of the general practitioners and 50% of the specialists indicated that 4.2 mmol/L was the minimal level. This is in contrast to the level of 3.4 mmol/L for low-density lipoprotein recommended by the Canadian Consensus Conference on Cholesterol as the level at which treatment should be initiated.

Breast rejection is a common cause of breast-feeding failure. We describe 51 mother-infant pairs who visited the Hospital for Sick Children breast-feeding clinic because the baby refused to take the breast. Management was successful in 21 (40%), partially successful in 11 cases (22%), and unsuccessful in 16 (31%). (Three mothers were lost to follow up.) We believe that the early introduction of bottles results in the baby's developing an ineffective suckle, which then causes frustration when the baby tries to breast-feed. Good management of breast-feeding in the newborn period involves avoiding bottles and teaching the mother proper positioning and latching, as well as signs that indicate whether her baby is getting adequate milk. A method of giving supplemental fluids without direct bottle-feeding is described.

To determine family physicians' preferences for time, location, instructional format, and topics, the Division of Continuing Medical Education at the University of British Columbia conducted a survey, in which 1200 questionnaires were mailed to a stratified, proportional random sample of the 3270 general practitioners in the province, the stratifications being urban or rural and decade of graduation. A return rate of 61% yielded 648 usable questionnaires, which exceeds the sample required for analysis with no stratifications. Most popular days for involvement in continuing medical education were Fridays and Saturdays in the months of February, March, October, and November. Common skin disorders and hypertension headed the list of most relevant topics for the whole group and for the urban stratification. Hypertension was superseded by eye emergencies in the rural stratification.

Discute a necessidade de introduzir uma nova concepção de ensinar e aprender na universidade, pautada pela articulação entre ensino e pesquisa. Considera que essa concepção pode ser viabilizada no âmbito do ensino de Biblioteconomia e Ciência da Informação. Para tanto, apresenta uma nova proposta deformação para o profissional da informação. The paper presents perspectives to integrate research practices in Information Science undergraduate education.

We have developed some education support systems using Web，and made some trials of the systems in our college. This paper reports one of the above systems，the Web-based examination system. There are many advantages in learning and examination using PC，compared to the conventional methods via books and paper texts. However，some problems such as authoring load and diversification of the test form and test security were pointed out. Here，by solving these problems，we present Web-based examination system that has advantages for both teachers and students .I n this system，security environment of the client PC was drastically improved further than the Web browser by the adoption of the secure exclusive client operation screen.

In the recent developments of the high-speed network technology，it is expected that high-speed communication infrastructure will improve environments of research and education in university. We have tried to develop Web-based systems which support educations for these several years. These systems are classified into two categories: one is“the lecture supporting systems" and the other is“the learning and examination systems". In a series of papers，w e are going to report these systems. The present paper gives an outline of the former，which consists of three parts: ① VLSI design education system， ② the system of telemetering experiments，and ③ the system of virtual experiments in physics. Some of them have already used for some classes in Hiroshima Institute of Technology.

A family-practice residency program has been involved in providing direct patient care to a number of Native communities in a remote area of Manitoba. The residents and preceptors have provided care on site in the communities, as well as being the primary referral services in the tertiary-care setting. During the 12 years of the program's evolution much experience was gained in dealing with a generally high-risk obstetric population whose care was complicated by such factors as language barriers, distance, and economic and social circumstances. The author of this article reviews the nature of the program and the issues, medical and other, that it deals with, making some reference to experience of similar populations elsewhere.

The authors surveyed 16 Canadian Family Medicine Departments to ascertain the availability and content of faculty development activities. The majority of Departments sponsored some faculty development; they were limited, however, by financial constraints, a lack of available manpower, and time restrictions. Few departments had a specified plan for faculty development. No comprehensive orientation activities were available for new faculty, and little attention was paid to established part-time faculty. Although teaching workshops were the most popular faculty-development activity, most programs were planned on an ad hoc basis. A number of effective local programs were not shared nationally. The authors discuss the implications of these results and the need for greater national and regional co-ordination.

Since their creation in the early 1970s, the residency programs in family medicine have attracted an increasing number of medical graduates. In Quebec, over 1000 general practitioners have received their primary-care training in these programs. In order to assess the potential impact of these new training programs, we surveyed the medical practice characteristics of a representative sample of general practitioners, 294 trained in family medicine and 442 trained in the traditional programs. Results showed that trainees in family medicine were more likely to join group practice, to work in rural areas, to deliver hospital care, to work on a salary basis in local community health centres, and to be involved in teaching and research. There were, however, no differences between the two groups of general practitioners in their interventions with patients, particularly with regard to health promotion, patient education, and humanization of care. Implications of these results are discussed.

A good deal of controversy surrounds the issue of optimal treatment approaches for persons with an addictive disorder. The field is rampant with questions pertaining to goals of abstinence as distinct from moderation, in-patient rather than out-patient care, and short-term rather than long-term treatment. In recent years it has become increasingly evident to clinicians and researchers that there simply is no single, best, treatment approach for all patients suffering the effects of substance abuse. These effects constitute a multi-faceted disorder that involves biological and medical aspects, social and psychological dimensions, psychiatric and policy perspectives. A "systems" approach to the treatment of alcoholism is emerging with the identification of various alcoholic syndromes, each demanding a different management strategy. Such an approach requires new methods of patient assessment, and this paper identifies psychological factors that may influence not only the diagnosis and treatment of alcoholic syndromes, but also other health-related behaviour disorders. (The opinions expressed in this article are those of the authors and do not necessarily reflect the views or policies of the Addiction Research Foundation.).

A retrospective report of the experience of nine years of simplified office screening for infantile urinary tract infection (UTI) is compared with the more invasive and stringent methodology widely considered necessary. Urine samples were obtained from 1313 infants of two years or less. In 27 of these infants UTI was diagnosed and the data analysed from 24 cases. Nine infants were completely asymptomatic, while the rest had non-specific symptoms. Radiological investigations were carried out in all the infants with UTI. Urine samples were obtained without any specific precleansing of the perineum, and the criteria for diagnosing UTI were two consecutive positive cultures. The results were statistically similar to studies in which there was pre-cleansing, and in which the criteria were three consecutive positive cultures.

Walk-in clinics have proliferated rapidly in many areas of Canada and the United States. Patients who attend these clinics have illnesses that are similar to those seen in family physicians' offices, yet walk-in patients perceive their symptoms to be more urgent and present at a much earlier stage of their illness than patients who attend their family doctor. Research has not yet proven that the opening of walk-in facilities lowers the demand for traditional primary care services; therefore the cost-effectiveness of walk-in clinics needs further evaluation.

The performance of a 10-minute immunoassay, TestPack Strep A, was compared with culture for the detection of Group A β-hemolytic streptococci (GABHS) from 298 throat swabs. When cultured, 17.4% of the samples grew GABHS. The values calculated for the test were sensitivity, 67.3%; specificity, 99.2%; positive predictive value, 94.6%; negative predictive value, 93.5%; positive likelihood ratio, 82.79; and negative likelihood ratio, 0.33. The sensitivity decreased with decreasing growth of GABHS in the culture. If cultures with only light GABHS growth were eliminated from the analysis, the sensitivity was increased to 74.4%. The test has the advantages of immediate results, available while the patient is still in the office; simplicity; easy-to-interpret end-points, high positive likelihood ratio; high specificity; and high predictive values, which make it a rather attractive supplement to sore throat management in a busy family practice. The cost of the kit, however, may diminish its attractiveness.

The prevalence of chlamydia trachomatis was investigated over a two-year period in a population of women university students attending a student health clinic for routine pelvic examination or for a gynecologic complaint. Direct immunofluorescence slide test was used to determine the presence of C. trachomatis. The overall prevalence rates for the two-years periods studied were 8.2% and 7.1%. When women who had symptoms of a urogenital infection were compared to women who were asymptomatic, it was found that symptomatic women were more likely to have C. trachomatis in the cervix. To determine whether women with positive cases showed differences in appearance of the cervix, method of contraception, or other organisms colonizing the vagina, the cases were matched with two controls, and a retrospective chart review was performed. The cases were more likely to have cervicitis and to be culture positive with gardnerella vaginalis, and they were less likely to have used condoms for contraception. In the two periods studied, the carriage rates for asymptomatic cases were 6% and 5%. Fifty-eight per cent of all positive cases were asymptomatic. If this organism is to be eradicated from college-women populations, all women attending for a urogenital infection should be screened, and women attending for routine annual examinations should be screened if there is a clinical indication.

The health of Canada's Native people has improved considerably over the last 50 years. Nonetheless, standard rates of health measurement, including mortality and morbidity, remain remarkably elevated. There now exists a coincident burden of infectious and degenerative or chronic illness. Most significant, there is considerable mortality related to injuries, violence, and suicide, and these occurrences are related, to a large extent, to the abuse of alcohol. Many of the ensuing deaths are therefore preventable. The concepts of health promotion and of transfer of control overlap considerably. Both evidently increase the potential of improved health through individual and community empowerment.

The authors compare the ideal composition of medical practice, as seen by graduating family medicine residents, with the characteristics of practice these residents were about to enter. This exploration of practice ideals finds somewhat anemic interest in several of the more technical aspects of practice. A substantially higher percentage of graduates was expecting to do obstetrics on graduation then would do so by choice, suggesting the possibility of a further decline in obstetrical activity should opportunity occur. A similar pattern emerges for family counselling, nursing-home activity and house calls, producing a composite picture of potential evolution toward more exclusive office practice. Substantial variations are shown to exist, however, among the five programs studied, both in relation to the ideals expressed by the graduates and also in relation to their first-practice profiles. Possible implications for residency programs and the profession are discussed.

Pap testing is one of the few effective preventive health practices available to primary care physicians. Yet we know little about how well this procedure is being done. Using data from the province of Manitoba's universal health insurance plan for the years 1976, 1978 and 1982, we determined the proportion of all Pap tests of women over 25 years of age performed by the various physician specialties; the percentage of physicians in each specialty who performed tests; and the mean number of tests per specialty group. We also determined the mean number of tests by age and training of the physician. The number of physicians performing Pap tests increased from 749 in 1976 to 780 in 1982. About 2% of Pap tests performed in the province were done by internists, 5% by general surgeons, about 33% by obstetrician/gynecologists, 40% by urban general practitioners, and 22% by rural general practitioners. Other physicians accounted for less than 0.2% of all tests. The mean number of Pap tests performed increased with increasing physician age up to age 60 and declined thereafter. Manitoba-trained physicians performed the highest rate of Pap testing, and this pattern was maintained over time. In 1982, only 22% of internists, 29% of general surgeons, and 78% of family physicians/general practitioners were performing tests. These results raise the question of why a significant number of physicians are not carrying out this effective preventive health practice.

Patient satisfaction has been considered important for many years. This article provides a review of various methods that have been developed to measure patient satisfaction and describes the use of the Smith-Falvo scale in determining patient satisfaction with the medical services provided by residents in the Verdun Family Practice Program. In view of the limited range of scores provided by the use of this scale, the authors recommend that further research be done to develop a method of assessment of patient satisfaction that will take into account the duration of patient-physician interviews.

The authors assessed the influence of residency training in family medicine on physicians' attitudes toward comprehensive care by surveying a representative sample of Quebec family physicians. The sample consisted of 290 physicians trained in family medicine and 267 physicians trained in internship programs. Multivariate regression analysis was performed to measure the influence of training on physicians' attitudes independently of physicians' sociodemographic and practice characteristics. Graduates of family medicine had more positive attitudes than other generalists toward three aspects of comprehensive care, even after controlling for sociodemographic and practice characteristics.

The rate of non-compliance with the post-vasectomy semen examination procedure at the Centre Hospitalier de l'Université Laval (CHUL) between October 1, 1985 and March 31, 1987 was 21%, one of the highest in the literature. The purpose of our study was to determine the causes of this situation. The socio-demographic profile obtained from the computerized files of 50 patients who did not comply with the procedure was comparable to that of the 183 patients who did comply. A telephone survey of 43 non-compliant patients was carried out. In 70% of the responses to an open question on the reasons for non-compliance, the subject cited on his own negligence. In response to the closed questions, the constraints involved in the semen examination procedure were cited most often (49%). In the responses to both open and closed questions, a lack of information was cited least often. There is not a distinctive profile among vasectomy patients at the CHUL that would make it possible to predict compliance. Despite the fact that it would be difficult to improve the factors associated with patient negligence, it might be possible to increase compliance by following up more closely and lessening the constraints.

The couvade syndrome describes the various physical symptoms found in expectant fathers. In this descriptive study, we have attempted 1) to determine the extent to which this syndrome occurs among expectant fathers in Quebec, 2) to identify certain risk factors, and 3) to observe the repercussions of pregnancy on the social and family behaviour of the expectant father as well as on the use of health care services. Within four days of delivery, a group of thirty-one fathers completed a multiple-choice questionnaire during an individual interview. Sixty-one per cent reported at least one of twenty-eight physical symptoms listed. It would also appear that the men's relationship with their own father before the age of 12 had an impact on the development of the syndrome.

WOMEN MEDICAL GRADUATES OF MCMASTER UNIVERSITY WERE DIVIDED INTO TWO GROUPS: those in the fields traditionally chosen by women (primary care, general internal medicine, pediatrics, psychiatry, and anesthesia), and those in nontraditional fields (surgery, subspecialties of medicine, and academic medicine). The careers of the two groups of women were then compared with matched groups of men physicians. More women choosing traditional careers worked in another field, frequently health-related, before deciding to enter medicine than women entering nontraditional careers. Fewer of the former had a university education in the natural sciences, and more of them were married at the start of post-graduate training. Both groups of women worked shorter hours than the comparison groups of men. More women in traditional careers had selected group practice than had the corresponding men. Influences on career choices showed more sex similarities than career-type similarities, with women influenced more by factors related to family responsibilities. Few in any group reported that their choices are not their preferences. The results suggest that complete convergence of the medical careers of men and women in the near future is unlikely.

The author of this paper examines physicians' regard for the confidentiality of medical information in the light of their perception of their own role. Five case studies of increasing complexity of medical management and ethical issues, derived from practice and accompanied by questions relating to confidentiality and medical management, were submitted to randomly selected family physicians in Alberta. Analysis of the replies to determine attitudes to confidentiality and how the respondents perceived patients' best interests, and statements of how they would act in certain situations, disclosed that a substantial minority of the physicians were still prepared to breach confidentiality and exercise Hippocratic professional judgement in certain situations. The bases of confidentiality of medical information are reviewed, together with changing modes of medical ethics and the increasing trend to rights derived from patients, autonomy, and the ways in which these factors may affect the physician-patient relationship.

Hospital-based audits of family physicians are of uncertain utility, since most family physicians conduct community-based practices. We evaluated the feasibility of using a skill-based audit procedure. Blood-pressure measurement is a common and important skill which is often performed poorly by physicians because of a combination of poorly maintained equipment and poor technique. Physicians attending a family-medicine rounds were invited to participate in an evaluation of their skills in taking blood pressure. The usual sphygmomanometer used by the physician was calibrated, and he/she then measured the blood pressure of 10 volunteers, using his/her usual technique. We found that most of the physicians obtained reasonable blood-pressure readings, although there was a significant tendency to produce diastolic readings which were lower than the gold standard (1.6 mmHg.). Eight of the 19 physicians examined demonstrated significant end-digit bias. Two of 16 sphygmomanometers were very badly out of calibration. These results indicate that family physicians can produce accurate blood-pressure readings, but that their technique and equipment would benefit from adjustment.