Economic implications of assisted reproductive techniques: a systematic review.

BACKGROUND: Approximately one in six couples experiences problems with their fertility at some point in their reproductive lives. The economic implications of the use of assisted reproductive techniques require consideration. Herein, the health economics research in this area are critically appraised. METHODS: Multiple strategies were used to identify relevant studies. Each title and abstract was independently reviewed by two members of the study team and categorized according to perceived relevance. The selected papers were then assessed for quality and data were extracted, converted to UK pounds sterling at 1999/2000 prices, tabulated and critically appraised. RESULTS: A total of 2547 papers was identified through the searches; this resulted in 30 economic evaluations, 22 cost studies and five economic benefit studies that met the selection criteria. The quality of these studies was mixed; many failed to disaggregate costs, discount future costs or conduct sensitivity analyses. Consistent findings included the following: initiating treatment with intrauterine insemination appeared to be more cost-effective than IVF; vasectomy reversal appeared to be more cost-effective than ICSI; factors associated with poor prognosis decreased the cost-effectiveness of interventions. CONCLUSIONS: The cost-effectiveness of different interventions should be considered when making decisions about treatment. Future economic appraisals of assisted reproductive techniques would benefit from more robust methodology than is evident in much of the published literature to date.

[Consumers' perspective of mental health service in front line, second and third stages clinics.]. / Perspective d'usagers suivis en clinique externe d'établissements de première, deuxième et troisième lignes.

This study is based on results of four major surveys on the satisfaction of the clientele regarding external consultation of mental health services in Montréal. It covers milieux offering primary care, specialized and ultra-specialized services. Conducted with 856 patients through personal interviews, this study has allowed to document consumers' perspectives. The major tendencies observed indicate that patient are generally highly satisfied with the work of mental health professionals and the therapeutic alliance they establish with them. Organization as well as functioning of services however, generate less satisfaction. These results appear to reflect the impact of recent transformation of the mental health system.

Population-based primary health care for women. An overview for midwives.

This home study program has as its focus population-based care for women. Although clearly significant, concentrating effort solely on the individual does not ensure that the population as a whole is healthier. Experts are encouraging health care providers to consider the population as their "patient" and to begin documenting the incidence and prevalence of its disease. This article addresses the following issues: the definition of population-based health care; the relationship between primary care, women's health care, and population-based health care; the importance of a population-based approach or perspective for midwives; the use of population-based care in the provision of prenatal care; the definition of the populations to whom midwives have historically provided care and the documentation of how those populations are changing; and the research and policy issues for midwives related to population-based health care.

Production of a specific polyclonal antibody against the rat beta thyroid receptor, using synthetic peptide as antigen.

We have developed a polyclonal antibody to a synthetic peptide corresponding to the deduced amino acid residues 67-80 of the amino terminal sequence of the rat thyroid receptor beta cDNA. Immunopositive sera were identified by radioimmunoassay and purified by affinity chromatography. The antibody specifically immunoprecipitated the labelled thyroid receptor beta synthetized in vitro but not the rat thyroid receptor alpha. Furthermore, 38% of the L-T3 binding capacity of the rat liver nuclear receptor were immunoabsorbed by this antibody. By immunocytochemistry, this antibody stained specifically the nuclei of hepatocytes while no staining was observed in the rat testis. This study presents a specific polyclonal antibody against the thyroid receptor beta. This antibody will be of a great help in determining the role of the beta receptors in the mechanism of action of thyroid hormone.