Introduction US data reveal a Caesarean rate discrepancy between insured and uninsured patients, with the C-section rate highest among the privately insured. The data have prompted concern that financial incentives associated with insurance status might influence American physicians' decisions to perform Caesarean deliveries. Objective To determine whether differences in medical risk factors account for the apparent Caesarean rate discrepancy between Medicaid and privately insured patients in Michigan, USA. Method A retrospective review was performed of 617 269 live birth deliveries in (...) Michigan hospitals during 2004–8. All live birth records that were able to be linked to their mothers' hospital discharge records were utilised. Diagnosis-related group codes from the hospitalisation records were used to identify Caesarean deliveries. Regression models determined Caesarean probability for the time period under study, adjusted for insurance type, maternal age, race, maternal medical conditions, multiple births, prematurity and birth weight. Results From 2004 to 2008, Caesarean rates were 33% for privately insured patients and 29% for Medicaid patients. The probability of Caesarean delivery was significantly greater for privately insured than Medicaid patients on univariate analysis (OR 1.2, 95% CI 1.19 to 1.22) but not on multivariate analysis (adjusted OR 1.01, 95% CI 0.99 to 1.02). Conclusion No significant disparity was found in the odds of Caesarean delivery between privately insured and Medicaid patients in Michigan after adjusting for other Caesarean risk factors. A positive disparity would have provided de facto evidence that financial incentives play a role in physician decision-making regarding Caesarean delivery. (shrink)

This article relates two forms of political and cultural marginality and emancipation to a third one, which, in traditional patriarchal cultures, is the embodiment of marginality par excellence: that of the female self. It explores their similar positioning in the spatial and temporal economy of power relations in a detailed analysis of Irina Grigorescu Pana's novel Melbourne Sundays, a fictionallyrical account of the Romanian author's 11-year exile in Australia, read as a narrative counterpart of her critical approach to exile (...) in The Tomis Complex: Exile and Eros in Australian Literature. These two works describe an experience happening at the intersection between the author's national background – that of Romania – and the postcolonial one of her country of adoption – Australia – as they become relevant from her personal and professional experience as a woman writer. Exile is thus reflected in language, being spatially constructed by means of metaphors such as book, theatre, carnival, garden, which are also relevant for the process of identity formation. The argument mainly relies on Kristeva's theories, an approach motivated by Pana's own choice of the Kristevan discourse of love/hate in relation to the theme of exile in her fictional and critical works, since, as she remarks, exiles and lovers share a marginal, though at the same time essential, position in postcolonial cultures. (shrink)