Highlights of this issue
Physical abuse in pregnancy
See also:
- Evidence: Physical abuse during pregnancy: prevalence and risk factors
- Editorial: Physical abuse during pregnancy: a significant threat to maternal and child health
Muhajarine and D'Arcy interviewed 543 women receiving prenatal services through the Saskatoon District public health system between 1993 and 1994. In all, 31 (5.7%) of the women reported having experienced physical abuse during pregnancy, and 46 (8.5%) reported having been abused within the 12 months before the third trimester. Of the 31 women, 20 (63.3%) identified the perpetrator as their husband, boyfriend or ex-husband. Women whose partner had a drinking problem, aboriginal women and those who felt they were under stress, had less social support and had experienced more negative life events in the preceding year were more likely to have been abused. In an accompanying editorial, MacMillan points out that these prevalence rates are likely underestimates and that several of the risk factors identified should be interpreted with caution because the statistical significance is borderline.
Which doctors prescribe more antibiotics?
See also:
- Evidence: Method of physician remuneratin and rates of antibiotic prescription
- Editorial: Can the health care system buy better antibiotic prescribing behaviour?
Hutchinson and Foley have calculated prescription rates for all 153 047 antibiotic prescriptions generated by 476 Newfoundland general practitioners and paid for by the Newfoundland Drug Plan between 1995 and 1996. Fee-for-service payment (rather than salary) and greater patient volume were strongly associated with higher antibiotic prescription rates. In an accompanying editorial, Levine emphasizes the need for studies using patient records to determine whether factors other than method of physician remuneration underlie these differences.
A salute to Nunavut
See also:
- The Left Atrium: Metamorphoses
On Apr. 1 the map of Canada changed for the first time since Newfoundland joined Confederation in 1949. What will self-government mean for the new territory of Nunavut, whose population of 25 000, spread over an area 5 times the size of Alberta, is not only the youngest in Canada but has some of the highest rates of infant mortality, teenage suicide and chronic disease?
Autologous blood donation
See also:
- Evidence: Autologous versus allogeneic transfusion: patients' perceptions and experiences
- Evidence: Transfusion practices among patients who did and did not predonate autologous blood before electivrdiac surgery
In their retrospective study comparing transfusion practices among 176 cardiac surgery patients who predonated autologous blood and 176 matched cardiac surgery patients who did not predonate, Dupuis and colleagues found that exposure to allogeneic transfusion was more likely among the nondonors than among the autologous donors (odds ratio [OR] 14.0, 95% confidence interval [CI] 5.833.8). This finding was still true after exclusion of transfusions not meeting selected transfusion criteria (OR 19.3, 95% CI 6.755.7), which suggests that physicians did not withhold allogeneic transfusions from autologous donors. The autologous donors were more likely than the nondonors to receive any transfusion (OR 10.8, 95% CI 5.720.3), but this association was much less important after exclusion of transfusions not meeting the transfusion criteria (OR 1.9, 95% CI 1.13.2), which suggests that physicians used liberal criteria for transfusion of autologous blood.
Graham and colleagues found similar results among 153 patients undergoing elective cardiac or orthopedic surgery in a Canadian teaching hospital during a 10-month period: autologous donors were less likely to receive allogeneic transfusions but more likely to receive any transfusion than were nondonors. However, the 78 autologous donors overestimated their chances of receiving allogeneic blood transfusions had they not predonated (median response 80%) and underestimated their chances with predonation (median response 0%).
