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Highlights of this issue
Anterior knee pain
Abuse and low birth weight
Low birth weight (< 2500 g) affected 5.8% of Canadian newborns in 1995 and is responsible for most neonatal deaths and substantial childhood morbidity in developed countries. Abuse during pregnancy is a potentially modifiable risk factor for low birth weight. Claire Murphy and coauthors examined the association in a systematic review of the literature and a meta-analysis of the results of 8 selected papers. Using a fixed-effects model, they found that women who reported physical, sexual or emotional abuse during pregnancy were more likely than nonabused women to give birth to a baby with low birth weight (odds ratio 1.4, 95% confidence interval 1.11.8). "So when do we start to act?" asks Jacquelyn Campbell in her commentary.
Assisted reproductive technologies (ARTs) currently encompass noncoital insemination with partner or donor sperm, hormonal ovarian stimulation and in-vitro fertilization. Laura Shanner and Jeffrey Nisker consider the ethical issues surounding ARTs, including family relationships, informed choice, gender issues, embryo status and the commercialization of reproduction, as well as legal and policy issues. They summarize Canadian information on success rates and complications and advise how to approach ARTs in practice.
The Oregon Health Plan is regarded as having pioneered explicit, systematic and open rationing of health care by denying services. According to Jonathan Oberlander and colleagues, the reality is somewhat different: Oregon has neither achieved the universal coverage the plan was intended to allow, nor has widespread rationing been instigated. The number of services excluded has been small, physicians still provide uncovered services, savings have not been significant, and the original mathematical scoring system has been subverted by political concessions. Oregon's experience, from which Canada and others might learn, is that the explicit removal of items from the list of insured services is unlikely to save much in costs.
Copyright 2001 Canadian Medical Association or its licensors |