(in press). 4. McCormack WM: Sexually transmitted diseases: Women as victims. JAMA 1982; ... 'Reg d Trade Mark. CAN. FAM. PHYSICIAN Vol. 29: APRIL 1983.
Prodiem Indications: The relief of acute and obstinate constipation, the early stages of more severe simple constipation and constipation of the elderly caused by loss of muscle tone and neuromusculature reflex. For use in patients being weaned off harsh laxatives or where a straight bulk forming preparation has failed to provide regular bowel evacuation. Contraindications: The presence of nausea, vomiting, abdominal pain or symptoms of an acute abdomen or fecal impaction. Marc Steben Jean Yelle Precautions: For patients with a history of esophageal disorders. If mild cramping occurs, dosage should be reduced. Dosage: Adults -1 to 2 level teaspoonfuls (5 g to 10 g) should be placed in the mouth and swallowed unchewed with at least 240 ml of any Dr. Steben practices family cool beverage including juice, milk or water. medicine at the Clinique Medicale This dose may be taken before breakfast and/or in the evening depending on the con- Hickson, and the Centre dition being treated, its severity and indivi- Hospitalier de Verdun. Dr. Yelle dual responsiveness. practices family medicine at the Children - Forchildren aged 6to12 years, the Centre local des services dosage is half the adult dose. communautaires, St-Henri, Supplied: Petite-Bourgogne. Reprint requests Each 5g (1 level teaspoonful) of dark brown to: Dr. Marc Steben, Clinique minty-tasting granules contains 2.71 g of psyllium hydrophilic mucilloid and .62g of Medicale Hickson, 3805 ave senna pod, 1.5 mg of sodium, 30 mg of potas- Verdun, Verdun, PQ. H4G 1K8. sium and furnishes 3.5 calories. Available in lOOg and 250g canisters.
Sexually Transmitted Diseases And the Family Physician
Prodiem Plain Indications: The relief of simple, chronic and spastic constipation and for constipation associated with pregnancy, convalescence and advanced age. For use in special diets lacking in residue fibre and in the management of constipation associated with irritable bowel syndrome, diverticulitis, hemorrhoids and anal fissures. Contraindications: The presence of nausea, vomiting, abdominal pain or symptoms of an acute abdomen or fecal impaction. Precautions: For patients with a history of esophageal disorders. Dosage: Adults -1 to 2 level teaspoonfuls (5 g to 10 g) should be placed in the mouth and swallowed unchewed with at least 240 ml of any cool beverage including juice, milk or water. This dose may be taken before breakfast and/or in the evening, depending on the condition being treated, its severity and individual responsiveness. Children - For children aged 6 to 12 years, the dosage is half the adult dose.
HE MEMBERS OF the Sexually I Transmitted Disease (STD) Division of the Canadian Public Health Association (CPHA) met for their first national conference last November in Toronto. The subject was "sexually transmitted diseases: issues and priorities". Although 150 people attended, and despite major publicity directed to Canadian family doctors, fewer than ten family physicians were present.
The Role of the Family Doctor
Why should family physicians be interested in STD? Family doctors are still the main entrance to care in our health system. With their global approach to health care problems, they are ideally placed to treat STD, which infects one out of 20 Canadians each year. Already 25 different STD have Supplied: been identified, including hepatitis B Each 5g (1 level teaspoonful) of light brown and the recently discovered acquired minty-tasting granules contains 3.25g of psyllium hydrophilic mucilloid, 1.5 mg of so- immune deficiency syndrome (AIDS). dium, 30 mg of potassium and furnishes 3.5 Every human organ can be affected, calories. directly or indirectly, by STD. Available in 100g and 250g canisters. The current benchmark for STD in Canada is gonorrhea, a notifiable dis|PAAB ease. Yet the dimensions of that benchmark are incomplete. It has Rorer Canada Inc. Bramalea, Ontario L1T 1C3
been reported' that 80% of all STD are treated by private practitioners, who report to public health authorities only 30-35% of notifiable cases seen.3 If we use 1981 data2 for gonorrhea (56,000 cases) this means that the actual caseload is probably closer to 120,000. Since non-gonococcal urethritis (NGU) occurs three times more frequently than gonorrhea, the national STD caseload increases by a further 360,000 cases.3 Public clinics report a ratio of gonorrhea to herpes of approximately five to one. This estimate is probably low if we accept that the majority of cases are not seen in public clinics, but it means that the national caseload is increased by at least 24,000 cases. Jessamine3 suggests that private practitioners see genital warts as frequently as they see gonorrhea. If we categorize these as STD, we have another 125,000 cases annually. Everyone worries about syphilis, but with fewer than 3,000 cases annually, it is not the public health problem that we face with the other STD. Only five of the 25 STD are reportable; therefore, the real magnitude of the STD problem is unknown. The cost is most likely staggering.
The Real Victims Women are the real victims of
STD,46 because they bear an inordinate share of the complications, as do their offspring. In a recent seven year period in Canada, 20,000 ectopic pregnancies occurred.7 Pelvic inflammatory disease (PID) is a major cause of ectopic pregnancy, and STD is a major cause of PID. 10 Studies8 and mathematical models9 CAN. FAM. PHYSICIAN Vol. 29: APRIL 1983
gAtivan* (lorazspam)
A compatible benzodiazepine
indicate that women exposed to infected partners are four times more likely than men to acquire an STD. The majority of women will remain asymptomatic and therefore unknowingly contribute to the spread of STD. The situation is unlikely to change without innovative control and prevention programs.
Where Are We Going Now? Next month a major public information campaign on STD begins in Quebec. This campaign will emphasize the current epidemic of STD, their contagious nature and the need to warn the sexual partner(s) who are asymptomatic but contagious. In June 1983, in St. John's, Newfoundland, the CPHA will hold a half day session on STD. In the fall of 1984, the second world congress of the International Union against Venereal Diseases and Treponematosis (IUVDT) will be held, at the same time as the second national conference of the STD Division of the CPHA, in Montreal. These local efforts should all be focused and coordinated, in order to raise the general level of awareness.
Conclusions Since it is estimated that they see 80% of STD, family physicians should take a leading role in the control of STD. To do this, our scientific knowledge must be continually updated, our access to diagnostic equipment must be adequate and our index of suspicion for STD must be high. Contact tracing is important because the majority of patients are asymptomatic but contagious. When faced with a possible case of STD, CAN. FAM. PHYSICIAN Vol. 29: APRIL 1983
the physician should treat even before laboratory results are available, if necessary, and should encourage the patient to inform his or her contacts. Reporting all cases should be considered part of treatment. More material and human resources should be provided for diagnosis and treatment of STD, contact tracing and fundamental research in STD. Programs for control and prevention require the cooperation and the collaboration of private and public health sectors, no matter how poorly they consider each other's efforts to be today. The amplitude of the problem is far too great for one sector to solve it by itself.
References 1. Catterall RD: Sexually transmitted diseases in Ontario. Br J Vener Dis 1979; 55:300-303. 2. Notifiable Diseases Summary. Can Dis Weekly Rep 1983 Feb 5; p 22. 3. Jessamine G: An epidemiological overview of sexually transmitted diseases in Canada. Can Public Health Assoc J 1983 (in press). 4. McCormack WM: Sexually transmitted diseases: Women as victims. JAMA 1982; 248:177-179. 5. Curran JW: Economic consequences of pelvic inflammatory disease in the United States, Part 2. Am J Obstet Gynecol 1980; 138:848-851. 6. Kendall PR: Pelvic inflammatory disease. BC Med J 1980; 22:417-419. 7. Hospital Morbidity Annual Reports 1972-1978. Ottawa, Statistics Canada. 8. Holmes KK, Johnson DW, Throstle HI: An estimate of the risk of acquiring gonorrhea by sexual contact with infected females. Am J Epidemiol 1970; 91:170. 9. Willcox RR: Society and high risk groups, in Catterall RD, Nicol CS (eds): Sexually Transmitted Diseases. New York, Academic Press, Inc., 1975, pp 31-50. 10. Sweet R: Chlamydial Salpingitis and associated ectopic pregnancy.
COMPOSITION: Ativan 1 mg.-Each white, oblong, scored tablet contains: Lorazepam 1 mg. (DIN 348325) Ativan 2 mg.-Each white, ovoid, scored tablet contains: Lorazepam 2 mg. (DIN 348333) INDICATIONS: Ativan is useful for the short-term relief of manifestations of excessive anxiety in patients with anxiety neurosis. CONTRAINDICATIONS: Ativan is contraindicated in patients with known hypersensitivity to benzodiazepines and in patients with myasthenia gravis or acute narrow angle glaucoma. DOSAGE: The dosage of ATIVAN must be individualized and carefully titrated in order to avoid excessive sedation or mental and motor impairment. As with other anxiolytic sedatives, it is not recommended to prescribe or administer ATIVAN for periods in excess of six weeks, without followup and establishing the need for more prolonged administration in individual patients. Usual Adult Dosage: The recommended initial adult daily dosage is 2 mg in divided doses of 0.5 mg, 0.5 mg and 1.0 mg, or of 1 mg and 1 mg. The daily dosage should be carefully increased or decreased by 0.5 mg dependirng upon tolerance and response. The usual daily dosage is 2 to 3 mg. However, the optimal dosage may range from 1 to 4 mg daily in individual patients. Usually, a daily dosage of 6 mg should not be exceeded. Elderly and Debilitated Patients: The initial daily dose in these patients should not exceed 0.5 mg and should be very carefully and gradually adjusted, depending upon tolerance and response. PRECAUTIONS: Use in the Elderly: Elderly and debilitated patients, or those with organic brain syndrome, have been found to be prone to CNS depression after even low doses of benzodiazepines. Therefore, medication should be initiated in these patients with very low initial doses, and increments should be made gradually, depending on the response of the patient, in order to avoid oversedation or neurological impairment. Dependence Liability: Ativan should not be administered to individuals prone to drug abuse. Caution should be observed in patients who are considered to have potential for psychological dependence. It is suggested that the drug should be withdrawn gradually if it has been used in high dosage. Use in Mental and Emotional Disorders: Ativan is not recommended for the treatment of psychotic or depressed patients. Since excitement and other paradoxical reactions can result from the use of these drugs in psychotic patients, they should not be used in ambulatory patients suspected of having psychotic tendencies. ADVERSE EFFECTS: The side effect most frequently reported was drowsiness. Other reported side effects were dizziness, weakness, fatigue and
lethargy, disorientation, ataxia, anterograde amnesia, nausea, change in appetite, change in weight, depression, blurred vision and diplopia, psychomotor agitation, sleep disturbance, vomiting, sexual disturbance, headache, skin rashes, gastrointestinal, ear, nose and throat, musculoskeletal and respiratory disturbances. Full product information available on request.
Wyeth M
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Wyeth Ltd., Downsview, Ontario M3M 3A8
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'Reg d Trade Mark
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