BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7160.758 (Published 12 September 1998) Cite this as: BMJ 1998;317:758

Recent high profile pregnancies have focused attention on postmenopausal women who have children, an act that many people consider an “unnatural” indulgence. One commentator argues, however, that infertility in middle age is an evolutionary legacy that we should be happy to lose (Fertility and Sterility 1999;70:204-6). Female mammals become infertile to protect them from the dangers of late pregnancy and their offspring from the reproductive disadvantage of being an orphan, he says. Technology has greatly reduced the risks of pregnancy and childbirth, so the evolutionary advantage of declining infertility has disappeared.

A randomised controlled trial finds that non-invasive ventilation by face mask can be as effective as ventilation via an endotracheal tube in patients with respiratory failure and hypoxaemia (New England Journal of Medicine 1998;339:429-35). Gas exchange improved in both groups, but complications, including pneumonia and sinusitis, were less common in patients ventilated with a tightly fitting mask. Death rates in both groups were high, as expected, but survivors in the non-invasive group were discharged earlier from the intensive care unit.

Patients with severe inflammatory bowel disease have a poor quality of life, which can substantially improve after surgery (Archives of Surgery 1998;133:826-32). A consecutive series of 63 patients completed the health status questionnaire before …

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