Pickering area may be attributable to radiation from the reactor. This effect cannot be detected by epidemiologic techniques. While it may be reasonable to suggest that no member of the general public should be disturbed by the health risks of a normally operating nuclear reactor, it would be unwise to ignore the fact that people are more disturbed by the possible consequences of an accident in such a reactor. During the 20 years that have elapsed since the first nuclear power reactor in the world became operational in the United Kingdom, there has been no accident in a power reactor that has resulted in the loss of appreciable quantities of radioactivity to the environment. In Canada, during more than 30 years of nuclear research, development and operations, there has not been one radiation injury that has resulted in the loss of a day's work. This is the experience and it has been quantified by sophisticated mathematical models that suggest serious accidents will happen less than once in 1000 reactor-years. Whether or not one accepts the validity of these models, the experience remains a demonstrable fact indicating that although reactor accidents are possible they are improbable. The risk, by reasonable analysis, is sufficiently small that it should not be considered a contraindication to the development of nuclear power in Canada. The nuclear power plant is but one part of the nuclear fuel cycle. For any estimate of total biologic effect to be derived the whole cycle must be considered, from the mining of uranium, through reactor operations to the handling of wastes generated at different stages of the cycle. This type of exercise is equally necessary for hydroelectric power and for electric power generated from other energy sources, such as coal, oil and natural gas. The chief radiation hazard in uranium mining is the release to the working environment of radon, a radioactive gas that is formed during the decay of radium. This gas, together with its radioactive decay products, can be in-

haled in biologically significant quantities if mine ventilation is inadequate. There is a clear relation between the level of radioactivity in mine air and the frequency of lung cancer in uranium miners. A cohort of miners heavily exposed to radiation during the early years of uranium mining is now moving through the population. In this cohort one may expect to find an incidence of lung cancer accounting for approximately 15 deaths per 10 000 manyears of mining.6 This situation has been discussed at length in the report of the Ontario Royal Commission on the Health and Safety of Workers in Mines7 and a number of recommendations have been made. It is apparent, however, that measures taken prior to the publication of the royal commission report have achieved substantial reductions in the levels of radioactivity in the working areas of uranium mines. While there can be no complacency about this problem, it should be recognized that, in terms of electricity produced, the death rate for persons working in coal mining is estimated to be roughly 18 times greater than that for persons working in uranium mining.8 The milling and processing of uranium ores, together with the fabrication of nuclear fuel, are other areas that must be considered. There is no indication that occupational health costs specific to these activities must be met. From the viewpoint of community health, proper provision for the management of wastes arising from these operations is mandatory. This in turn raises the question of how radioactive wastes should be managed. It is one that has aroused considerable public interest because some of these wastes remain radioactive for many thousands of years. The problem is not technically difficult to solve. The technology is available and it is necessary only to ensure that it is operational by the mid-1980s, when it will be required in Canada. Provided that this is done the dose commitment to the public that results from waste management will be so low as to be unmeasurable.

Consideration of the biologic effects of the increased use of nuclear power cannot be separated from the wider question of the extent to which an increase in electric generating capacity is needed. If the community, in its collective wisdom, decides that such a need exists, then in 1977 the options available are limited. It appears unlikely that wind, solar or biomass energies can contribute any substantial segment of power within the next 25 to 30 years, though research should be done to determine the biologic and fiscal economics of these resources. This leaves coal and uranium as the available energy options, and in all probability the needs of the next 25 years will be met by a combination of these two resources. Of the two options, coal has the familiarity associated with long usage, but a great deal more is known about the potential hazards of nuclear energy, and the evidence does not suggest that these hazards are any greater than those that are an accepted part of everyday life. It remains to ensure that the standards of safety already achieved are maintained into the distant future. J.L. WEEKS, MD, IMH Director Health and safety division Atomic Energy of Canada Limited Pinawa, Man.

References 1. HiGoiNsoN J: Present Trends in Cancer Epidemiology, Oxford, Pergamon, 1968, pp 40-75 2. Royal Commission on Environmental Pollution: Sixth Report - Nuclear Power and the Environment, Cmd 6618, London, HMSO, 1976 3. International Commission on Radiological Protection: The Evaluation of Risks from Radiation, pubi no 8, Oxford, Pergamon, 1966, p 15 4. Biological Effects of Ionizing Radiation Report: The Effects on Populations of Exposure to Low Levels of Ionizing Radiation, Washington, National Academy of SciencesNational Research Council, division of medical sciences, 1972 5. United Nations Scientific Committee on the Effects of Atomic Radiation Report: Ionizing Radiation: Levels and Effects, New York, United Nations, 1972 6. PocHIN EE: Estimated Population Exposure from Nuclear Power Production and Other Radiation Sources, Paris, OECD, 1976, p 24 7. Report of the Royal Commission on the Health and Safety of Workers in Mines, Toronto, Ministry of the Attorney General, Province of Ontario, 1976, recommendations 31-53 8. LAva LB, Fasasuso LC: Health effects of electricity generation from coal, oil and nu-

clear fuel. Nucl Saf 14: 409, 1973

The mentally retarded and sexuality The National Institute on Mental Retardation, York University, Toronto, has stated that 3% of Canadians are mentally retarded. Recently there has been an increased effort to assimilate mentally retarded persons into society - to keep them at

home, in school and in jobs - so that they can live to their fullest individual potential. Therefore, personal and social factors that until recently were thought to be beyond the comprehension of mentally retarded people must now be considered. Among these fac-

tors are sexuality and sex education. Daily those who work closely with retarded people seek help, information and material on human sexuality. Physicians, parents and volunteers who work with and teach the mentally retarded have identified and articulated

CMA JOURNAL/SEPTEMBER 17, 1977/VOL. 117 567

numerous problems pertaining to sex their particular needs and to the social education for these individuals. For context in which they live. example: The sex drive in retarded people 1. How does one help the retarded varies in intensity just as it does in person establish realistic and sound other individuals, and, like others, attitudes about sexual relations? mentally retarded boys and girls are 2. How does one help him or her introduced and exposed to sex in a channel natural drives into socially ac- variety of ways. They come from wideceptable behaviour? ly different cultural backgrounds, so 3. How does one provide the men- they will develop different attitudes tally retarded person, when necessary, towards sex and will be given different with some form of lifetime supervision information about it. over relationships of a sexual nature? A complete examination of human Sex education and sex instruction sexuality and the retarded, which is are not identical. Sex education begins helpful to the physician, can be found with concepts and attitudes towards in a book edited by de la Cruz and masculinity and femininity that are de- La Veck.3 I have selected the followveloped subtly from early infancy and ing nine guidelines from a resource are affected by every aspect of life.1 guide4 in order to make a plea not to Like other children, the mentally re- shut out mentally retarded persons from tarded child has sexual feelings and is the area of human sexuality. exposed to sexual messages and experi1. All retarded children and young ences. Since, by definition, mentally people have sexual feelings and drives, retarded children are less capable of which are unrelated to mental ability. comprehension and understanding than Some with low intelligence quotients "normal" children, special guidance and have little interest in sex and have a education are needed to help them un- weak sex drive, while others in the derstand sex and their own sexuality.' same group demonstrate a great deal Even among these children some have of curiosity about sex and have a strong greater limitations than others, and sex drive. Parents and other adults their sex education must be related to must take care not to stereotype retarded persons regarding sex; some have little or limited sexual development, while others, even those with underdeveloped bodies, have normal sexual desires and interests. 2. Sexuality for the mentally retarded This list is an acknowledgement of books received. It does not preclude is, as it is for most people, part physical or physiologic and part emotional. How review at a later date. an individual responds to a wide variety of stimuli will depend upon his exATLAS OF STRABISMUS SURGERY. 2nd ed. Eugene M. Helveston. 262 pp. ilIust. The CV. Mosby perience, his learned patterns of beCompany, Saint Louis, 1977. $37.30. ISBN 0-80162138-0 haviour and the guidance he has received. AU.DELA DES MASSACRES: LA VIE. Marcel. Charles Roy. 219 pp. Dlagr. Las Editions Lemeac 3. Human sexuality is a normal part Inc., Ottawa, 1977. Prix non mentionn6, broch6. ISBN 0-7761-9459-3 of everyone's life, including that of the CANCER MANAGEMENT. Walter Lawrence, Jr. retarded person, and calls for underand Jose J. Terz. 566 pp. Illust. Grune & Stratton, standing in terms of the age and conInc., New York; Longman Canada Limited, Don Mills, 1977. $44.25. ISBN 0-8089-0985-1 dition in life of each individual. There must be a realistic approach to the CLINICAL ENDOCRINOLOGY: A SURVEY OF CUR. RENT PRACTICE. Edited by Calvin Ezrln, John 0. needs and drives of each person. Godden and Paul G. Walfish. 334 pp. Illust. Ap. leton-Century-Crofts, New York, 1977. $18.50. 4. An interest in sexual topics is IS N 0-8385-1137.6 normal for both the retarded and the CRITICAL EVALUATION OF CARDIAC REHABIL. general populace. This should be acITATION. Proceedings of the Scientific Meeting of Critical Evaluation of Cardiac Rehabilitation, cepted as a fact and not as reflecting Tel Aviv, November 30 to December 3, 1975. "bad" tendencies. Parents and other Edited by Jan J. Dellermann and Henry Denolin. 188 pp. Charts. S. Karger AG, Basal, 1976. $24, adults should channel this interest into paperbound. ISBN 3-8055-2373-4 open discussion rather than avoid the CURRENT TRENDS IN THE MANAGEMENT OF BREAST CANCER. Edited by R. Robinson Baker. topic, thus driving it underground. 159 pp. illust. The Johns Hopkins University Press, 5. Retarded people learn more from Baltimore; Burns & MacEachern Limited, Don Mills, 1977. $15.50. ISBN 0-8018-1858.3 example than from words. Attitudes DIET MANUAL. Ontario Dietetic Association and of adults toward sexual growth and Ontario Hospital Association. Approved by the development are reflected more by Ontario Medical AssociatIon. 4th ad. Complied by A Special Committee of the Ontario Dietetic their tone of voice and manner of reAssocIation. 139 pp. CharL. The Ontario Hospital sponding than by their choice of words Association, Don MIlls, 1977. Price not stated. FLUIDS AND ELECTROLYTES IN THE SURGICAL and the concepts they express. The PATIENT. Carlos Pastana. 154 pp. Charts. The WiI. llama & Wilkins Company, Baltimore; Bums & adult should answer questions in a MacEacharn Limited, Don Mills, 1977. $11.40, straightforward, matter-of-fact manner, paperbound. ISBN 0-683-06859-8 expressing or showing no shock at any continued on page S92 question.

BOOKS

568 CMA JOURNAL/SEPTEMBER 17, 1977/VOL 117

6. Retarded children, like their normal siblings, want and need healthy peer acceptance. Ordinary social and physical contact with members of the same and of the opposite sex is healthy and normal for retarded children just as it is for other young people. 7. Not all that looks or sounds like sex is sexual in meaning. For example, the playful holding of hands by mongoloid children is probably not in the same category of sociosexual conduct that it might be for other retarded youngsters. 8. Parents and substitute parents should recognize the need for assistance in dealing with retarded children with respect to sex. They should not expect to have all the answers themselves, nor should they believe that they can handle all possible problems themselves. They should, on occasion, seek the help and advice of physicians, nurses and other specialists. 9. Retarded children at all mental levels can learn responsible and acceptable behaviour in all areas of sexuality if parents and adults who work with them provide careful instruction, good models and thoughtful support. As professionals we cannot ignore. the following statement by Winifred Kempton: Sex education for the retarded is an acute need, too long ignored. Many parents of the retarded, staff members of institutions, and those who are helping the retarded in the community have begun to realize that until we have faced the fact that the retarded are sexual and have developed programs to help them understand and enjoy appropriately their own sexuality, we have not truly progressed in our efforts to help them, nor indeed in our acceptance of their rights.5 Canada's physicians who work with retarded people can help in clarifying the sexual needs of our retarded population. With understanding they can help the families of mentally retarded children see sexuality as part of the child's growth process. BENJAMIN SCHLESINGER, PH n Professor Faculty of social work Universi.pr of Toronto oronto, Ont.

References I. KaMPTON W: Guidelines br Planning a Training-Course on Human Sexuality and the Retarded, Philadelphia, Planned Parenthood Assoc of Southeastern Pennsylvania, 1973 2. Sex Information and Education Council of the United States: A Resource Guide in Sex Education for the Mentally Retarded, New York, 1971 3. GESHARD PH: Sexual behavior of the mentally retarded, in Hujnan Sexuality and the Mentally Retarded, na LA Cauz FF, LA VECK GD (eds), New York, Brunner-Mazel, 1973, pp 29-50 4. Sex Information and Education Council of the United States: A Resource Guide l,t Sex Education for the Mentally Retarded, op cit. pp 10, 11 5. KEMPTON W: Guidelines for Planning a Training-Course on Human Sexuality and the Retarded, op cii, p 7

The mentally retarded and sexuality.

Pickering area may be attributable to radiation from the reactor. This effect cannot be detected by epidemiologic techniques. While it may be reasonab...
515KB Sizes 0 Downloads 0 Views