archy. No mention is made of the anthropologic research on the foremost matriarchal society, the. Iroquois-Mohawk, and itspen- chant for violent empire-building.
archy. No mention is made of the anthropologic research on the foremost matriarchal society, the Iroquois-Mohawk, and its penchant for violent empire-building and torture. Because in my practice I ask about violence in a non-sex-discriminatory manner I now commonly hear about the difficulties women have with their physical aggressiveness. Atomistic approaches to the interconnected problem of family and societal violence -perpetuate rather than reduce the problem. Any scientific discussion of wife abuse deserves better than "standalone mention." It's as silly as suggesting that we study the Middle East problem from the point of view of "Arab abuse." William Hay, MD, FRCPC Vancouver, BC
Reference 1. McNeely RL, Robinson-Simpson G: The truth about domestic violence: a falsely framed issue. Soc Work 1987; Nov-Dec: 485-490
Chlamydial infection in Canada W r hile browsing through x the informative report by Dr. Paul R. Gully and Ms. Daphne K. Rwetsiba (Can Med Assoc J 1992; 147: 893896) on genital chlamydial infections during 1989 and 1990, the astute reader may have been struck by a lack of data from the nation's third most populous province. Although the collection of laboratory results positive for Chlamydia trachomatis was considered largely complete only from 1991 onward in British Columbia, some information is available for 1990 that certainly adds to the picture painted by Gully and Rwetsiba. DECEMBER 15,1992
The number of positive laboratory reports was 149.3 per 100 000 population in British Columbia during 1990. Reporting was estimated to be 60% complete for that year, and thus the real incidence of chlamydial infection would have been about 250 per 100 000 population. Age distribution could be examined for approximately half the reports. As with the national data the bulk (86.6%) of cases occurred in patients between the ages of 15 and 30 years. Most reports (81.6%) were of tests performed on women. Gully and Rwetsiba rightly question why the apparent rate of chlamydial infection is higher in women than in men. The prevalence may be greater, but the data from our provincial laboratory show that the higher rates in women are also, in part, an artifact of the volume of testing performed in that sex. The laboratory tested 20 521 specimens for chlamydial infection in 1990 and found an overall positivity rate of 5.9%; 70.4% of the tests were performed in women. When the tests performed at the Vancouver STD Clinic were excluded, so that the data were more representative of those in general practice in the province, 88% of 13 857 tests were performed in women. In this sample of reports the positivity rates were 10.6% for men and 5.1% for women. The logical conclusion is that the threshold for testing is higher in men than in women. Preliminary data from a sentinel physicians network in British Columbia support the hypothesis that more tests in women than in men are performed for screening purposes. Detailed demographic and clinical information is collected on all patients found to be seropositive for chlamydial infection in a number of general practices. Of the 60 women for whom the reason for testing was recorded 65% had been tested as part of
routine or prenatal screening. The remaining women and all of the men were tested because of symptoms or a diagnosed sexually transmitted disease in a partner. A higher rate of screening in women may be appropriate, because women less often experience symptoms and, together with their offspring, are more likely to have serious complications of chlamydial infection. Starting in 1991 more complete data on laboratory reports of chlamydial infection have been available from British Columbia. Because of inconsistencies in patterns of testing between the sexes such reports, though helpful, cannot provide the complete story on the activity of this provocative pathogen. David M. Patrick, MD, FRCPC Associate director Division of STD Control BC Centre for Disease Control Ministry of Health and Ministry Responsible for Seniors Province of British Columbia Vancouver, BC
Physicians and the environment I n 1990 CMAJ published our letter (143: 176), which expressed our anxieties about the state of the global environment and our intention to form a group, tentatively called Physicians for Global Healing. We invited other interested physicians to contact us. About 40 physicians expressed interest, and as a result we prepared a short newsletter for circulation to all respondents. The response to the newsletter, however, was marginal: only three or four of our original correspondents offered support. Whatever the reason for nonresponse the proposition of a physicians' group to address environCAN MED ASSOC J 1992; 147 (12)
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