CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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A mandatory cardiopulmonary resuscitation (CPR) program that started as a pilot project in Ottawa-area high schools is expanding to other Canadian schools. Besides CPR techniques, Grade 9 students are being taught about healthy lifestyles and how to recognize cardiac arrest. Emergency physician Justin Maloney, the program's principal architect, believes that in a decade this mandatory training will translate into increased bystander-initiated CPR and improved chances of survival for victims of cardiac arrest.
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In the context of consent, "voluntariness" refers to a patient's right to make health care choices free of any undue influence. However, a patient's freedom to make choices can be compromised by internal factors such as pain and by external factors such as force, coercion and manipulation. In exceptional circumstances--for example, involuntary admission to hospital--patients may be denied their freedom of choice; in such circumstances the least restrictive means possible of managing the patient should always be preferred. Clinicians can minimize the impact of controlling factors on patients' decisions by promoting awareness of available choices, inviting questions and ensuring that decisions are based on an adequate, unbiased disclosure of the relevant information.
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There was much more to this summer's international AIDS conference in Vancouver than reports by researchers. Richard Cairney says the $15-million conference attracted a mix of activists, demonstrators, physicians and business representatives, and they coexisted somewhat uneasily.
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To recommend appropriate levels of calcium intake in light of the most recent studies. ⋯ Current recommended intakes of calcium are too low. Revised intake guidelines designed to reduce bone loss and protect against osteoporotic fractures are suggested. Canadians should attempt to meet their calcium requirements principally through food sources. Pharmaceutical calcium supplements and a dietician's advice should be considered where dietary preferences or lactase deficiency restrict consumption of dairy foods. Further research is necessary before recommending the general use of calcium supplements by adolescents. Calcium supplementation cannot substitute for hormone therapy in the prevention of postmenopausal bone loss and fractures. Adequate amounts of vitamin D are necessary for optimal calcium absorption and bone health. Elderly people and those who use heavy sun screens should have a dietary intake of 400 to 800 IU of vitamin D per day.