Resource allocation of in vitro fertilization: a nationwide register-based cohort study

<p>Abstract</p> <p>Background</p> <p>Infertility is common and in vitro fertilization (IVF) is a widely used treatment. In IVF the need increases and the effectiveness and appropriateness decrease by age. The purpose of this study was to describe allocation of resources for IVF by women's age, socioeconomic position, area of residence and treatment sector (public vs. private) and to discuss how fairly the IVF resources are allocated in Finland.</p> <p>Methods</p> <p>Women who received IVF between 1996 and 1998 (N = 9175) were identified from the reimbursement records of the Social Insurance Institution (SII). Information on IVF women's background characteristics came from the Central Population Register and the SII, on treatment costs from IVF clinics and the SII, and on births from the Medical Birth Register. The main outcome measures were success of IVF by number of cycles and treated women, expenditures per IVF cycles, per women, per live-birth, and per treatment sector, and private and public expenditures. Expenditures were estimated from health care visits and costs.</p> <p>Results</p> <p>During a mean period of 1.5 years, older women (women aged 40 or older) received 1.4 times more IVF treatment cycles than younger women (women aged below 30). The success rate decreased by age: from 22 live births per 100 cycles among younger women to 6 per 100 among older women. The mean cost of a live birth increased by age: compared to younger women, costs per born live birth of older women were 3-fold. Calculated by population, public expenditure was allocated most to young women and women from the highest socioeconomic position. Regional differences were not remarkable.</p> <p>Conclusion</p> <p>Children of older infertile women involve more expense due to the lower success rates of IVF. Socioeconomic differences suggest unfair resource allocation in Finland.</p

Recovery of Sleep or Recovery of Self? A Grounded Theory Study of Residents’ Decision Making Regarding How to Spend Their Nonclinical Postcall Time

Purpose As resident work hours policies evolve, residents' off-duty time remains poorly understood. Despite assumptions about how residents should be using their postcall, off-duty time, there is little research on how residents actually use this time and the reasoning underpinning their activities. This study sought to understand residents' nonclinical postcall activities when they leave the hospital, their decision-making processes, and their perspectives on the relationship between these activities and their well-being or recovery. Method The study took place at a Liaison Committee on Medical Education-accredited Canadian medical school from 2012 to 2014. The authors recruited a purposive and convenience sample of postgraduate year 1-5 residents from six surgical and nonsurgical specialties at three hospitals affiliated with the medical school. Using a constructivist grounded theory approach, semistructured interviews were conducted, audio-taped, transcribed, anonymized, and combined with field notes. The authors analyzed interview transcripts using constant comparative analysis and performed post hoc member checking. Results Twenty-four residents participated. Residents characterized their predominant approach to postcall decision making as one of making trade-offs between multiple, competing, seemingly incompatible, but equally valuable, activities. Participants exhibited two different trade-off orientations: being oriented toward maintaining a normal life or toward mitigating fatigue. Conclusions The authors' findings on residents' trade-off orientations suggest a dual recovery model with postcall trade-offs motivated by the recovery of sleep or of self. This model challenges the dominant viewpoint in the current duty hours literature and suggests that the duty hours discussion must be broadened to include other recovery processes

Efficacy of a 3-hour Aboriginal Health Teaching in the Medical Curriculum: Are We Changing Student Knowledge and Attitudes?

There is national recognition of the need to incorporate Aboriginal health issues within the medical school curricula. This study aims to evaluate changes in medical students’ knowledge and attitudes about Aboriginal health, and their preparedness to work in Aboriginal communities after attending a 3-hour Aboriginal health seminar. A cross-sectional survey was administered before and after the seminar for Year 1 and 2 medical students at the University of Western Ontario. The survey included four true or false questions and 24 questions using a seven-point Likert scale (1 – strongly disagree, 7 – strongly agree). Eighty two of 130 (64 per cent) Year 1 students and 55 of 86 (63 per cent) Year 2 students completed both questionnaires. Knowledge-based questions were answered correctly by most students before the seminar, with an increasing number of correct responses noted after the seminar (p \u3c 0.05). Students’ perceptions about sociocultural and economic factors affecting health showed uncertainty before the seminar, but changed towards greater agreement regarding its impact on health after the seminar (p \u3c 0.05). Students initially felt unprepared to care for Aboriginal patients before the seminar, but felt more prepared after the seminar (p \u3c 0.05). A 3-hour seminar using both didactic and non-traditional teaching methods appears to be effective in the short term in improving knowledge, changing attitudes and reversing some of the uncertainties medical students have about practicing in Aboriginal communities