CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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The author comments on the report by Dr. Benjamin Chan and associates on spirometry utilization rates in Ontario (see pages 169 to 176 of this issue). ⋯ The author argues, however, that to a large extent the wrong type of spirometry is being done. Although the wider use of flow studies should be promoted, the utility of flow-volume loops rather than simple spirograms as an office procedure is highly questionable.
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To assess the effect of the tobacco tax cuts made in 1994 on the smoking habits of Canadians. ⋯ Although smoking rates are declining in Canada, tobacco tax cuts appear to have slowed the rate of decline by inducing more nonsmokers to take up smoking and leading fewer smokers to quit.
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Editorial Comment
A surgical subculture. The use of mastectomy to treat breast cancer.
The results of the study by Dr. Vivek Goel and associates (see page 25 of this issue) are similar to those of studies conducted in the United States that have found that the use of breast-conserving surgery to treat breast cancer is inconsistent. ⋯ However, the goal of consistency may not be served by guidelines that present only a summary of scientific findings. Guidelines must present clear recommendations, and the diffusion of these recommendations into general medical practice must involve regional medical groups and their opinion leaders.
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In this issue (see pages 37 to 41) Dr. Bruce B. Allan and associates report a small but statistically significant decrease--of about 0.2%--in the proportion of male live births in Canada over the period 1970-90. ⋯ Data from the Nova Scotia Atlee Perinatal Database are discussed with a view to explaining the trend observed in Atlantic Canada, but no obvious explanation emerges. The authors argue that when the period of observation is extended no overall change in the sex ratio is apparent. This would suggest a tendency toward stabilization rather than decline.