The onward walk

Since their foundation in the 17th century the purpose of medical journals has been the registration and dissemination of scientific findings based on a quality assurance through peer review, and to provide a means for using and citing the work of others. In an international journal like AOGSs we await the new impact factor released by the international science citation index in June. It may again rise, as in recent years, because our submission rates have nearly doubled which allows the editors to increase the quality of what is accepted for publication. Increasing submissions are also seen at other established sister journals and in addition the new open access journals have their rising share of articles. In the last few months there has been much debate about the merits of open access compared to traditional subscription publishing (1,2,3). In one the reader pays, in the other the author. Publishing houses and professional societies like NFOG benefit in varying ways from both. Someone must pay. The debate has centered on costs and profits and on universal accessibility of data. There are many studies, not least in the clinical sector which AOGS largely serves, which would not be so easily published if the authors had to pay to publish. The middle “green road” may be the way forward, where open publishing in institutional repositories (storage sites for electronic data in university institutions and similar databanks) would be available for preliminary or near finished research reports, followed by publication of the final product in a medical journal which would have to be accessed on a subscription basis at least for some initial time (called “embargo time”). This has to be in tandem with reasonable open access fees at the traditional journals. At AOGS we follow what is happening in order to stay near the center of current developments. Like the woman on our July cover we are going forward, based on our good old track-record, and holding hands with the future. The issue starts with a commentary on targeted genetic/immunological prenatal testing which is coupled to a case report further back, both from the same group in Aarhus, Denmark, lead by Hans Ingerslev (pp. 765–768 and 876–878). This is futuristic technology in assisted reproduction being put to the test. When they provide new understanding of either etiology or management, as here, case reports have a certain clinical interest. More often they just reiterate what has already been shown several times before. Sometimes they serve to alert clinicians to a serious situation, as done by Kristina Renault and her colleagues in Copenhagen, Denmark (pp. 874–875) writing on a maternal death after gastric bypass surgery. Morbid obesity is a situation seen increasingly in connection with pregnancy and gynecologic conditions, also when such operative treatment has been done. While by-pass surgery usually improves health and quality of life, there are dangers involved which must not be ignored. This is followed by a new overview of the evidence for a relation between venous thromboembolism and hormonal contraception, from Øjvind Lidegaard in Copenhagen, Denmark, and three Nordic colleagues of whom this writer is one (pp. 769–778). The subject has generated considerable debate, with different views of the same evidence having lead to conflicting statements (4,5). It is for the individual reader to weigh the evidence. Potentially thromboembolism may affect many, but in reality only a very small minority are affected to a degree that leads to a medical problem. Adequate contraception is a cornerstone of modern society and rocking the boat is not lightly undertaken. While newer third generation oral contraceptives have advantages and are used by a majority of young women in Denmark (and elsewhere) as demonstrated by the first author’s group on pp. 810–815, there may be a small but notable health cost involved. Marketing of newer contraceptives is profitable and has been effective. That is part of the picture as well. Ioannis Mavromatis and co-workers in Athens, Greece, then present a readable systematic review of how well intraoperative eye-balling of myometrial invasion in endometrial cancer may work (pp. 779–793). Every day we are in numerous ways reminded about the serious obesity epidemic, which most high-income and many middleand low income countries grapple with and have no good solutions for. One way to change the life habits that create this adverse situation could involve the same as done with smoking, namely to make obesity socially unattractive, not least to the impressionable young. The consequence of