Less health care for new refugees
People who arrive in Canada claiming refugee status will now be denied all health coverage, including coverage for emergencies. New federal government legislation also limits access to health insurance for preventive services, medications, emergency dental and vision care, and translation services for most refugees. According to Arya and colleagues, these changes shift health care costs to vulnerable refugees and provincial health plans. See Commentary, page 1875
Collaborative maternity care
Women attending a program of collaborative, interdisciplinary maternity care were more likely to have a physiologic birth than women receiving standard care. This retrospective study measured several outcomes among 1238 women attending an innovative birth program in Vancouver and observed favourable effects on rates of cesarean delivery, length of hospital stay and exclusive breast feeding at discharge. These results should encourage the implementation and evaluation of similar approaches elsewhere, say the authors. See Research, page 1885
Sleep in adolescents
Sleep disturbance is common among adolescents and was seen to be associated with an increased prevalence of cardiovascular risk factors, including higher levels of blood pressure, cholesterol and BMIs. However, duration of sleep did not show the same associations. This cross-sectional study used data from a prospective population-based study of 4104 high school students in Ontario, Canada. The findings call for intervention studies to evaluate the benefits of optimizing sleep in adolescents on cardiovascular risk, say the authors. See Research, page E913
The “mother’s kiss” technique
A foreign body stuck in a child’s nostril may be safely removed by a trusted adult applying positive pressure through a short puff, using a technique similar to mouth-to-mouth resuscitation. This review of 8 case series and case reports describes a high success rate for the technique. If promoted as a first-line approach, it could reduce the need for medical intervention and anesthesia in some cases, say the authors. See Research, page E904
Bike helmets may save lives
Cyclists in a collision or accident who did not wear a helmet had 3.1 times the odds of dying compared with those who did wear a helmet. This case–control study included 129 fatalities and gathered information provided in coroners’, police and accident reconstruction reports. The authors suggest that policies and campaigns that promote helmet use may decrease cycling mortality. See Research, page E921
Managing borderline personality disorder
Psychotherapy is the most important component in the treatment of borderline personality disorder, leading to large reductions in symptoms that persist over time, say Biskin and Paris. However, availability of these specialized psychotherapy techniques is limited. Pharmacotherapy may be beneficial as an adjunct to psychotherapy to reduce symptoms sufficiently for patients to stay in treatment. See Review, page 1897
The case for greening operating rooms
Canada’s health care sector generates about 1.5% of our national greenhouse gas emissions and is a source of about 1% of solid waste. The operating room is one of the worst offenders. Kagoma and colleagues present strategies and technologies to make operating rooms more ecologically sound without compromising patient care. These range from proper sorting of hazardous and nonhazardous materials, to innovative closed collection systems for fluid waste. See Analysis, page 1905
Melatonin
Although the use of melatonin for insomnia is controversial, melatonin has been shown to be effective against jet lag, particularly for people flying eastward and crossing many time zones. Short-term use appears safe, but Carter and Juurlink remind readers that melatonin is a synthetic hormone, not an herbal supplement. See Practice, page 1923