Long-Term Cardiovascular Risk in Women Prescribed Fertility Therapy

ObjectivesThe purpose of the study was to investigate whether fertility therapy might contribute to subsequent cardiovascular disease.BackgroundFertility medications are used for 1% of births yet may also lead to endothelial injury with long-term adverse consequences for the mother.MethodsA population-based cohort analysis was performed of women who gave birth in Ontario, Canada, between July 1, 1993, and March 31, 2010, distinguishing those who did and did not receive fertility therapy in the 2 years before delivery. Cox proportional models were derived to estimate hazard ratios with and without adjustment for baseline characteristics. The primary outcome was a composite cardiovascular endpoint of death, nonfatal coronary ischemia, stroke, transient ischemic attack, thromboembolism, or heart failure.ResultsAmong 1,186,753 women who delivered during the study period, 6,979 gave birth after fertility therapy. After 9.7 years of median follow-up, women who delivered after fertility therapy had fewer cardiovascular events than controls (103 vs. 117 events per 100,000 person-years), equivalent to an unadjusted hazard ratio of 0.96 (95% confidence interval: 0.72 to 1.29, p = 0.79) and an adjusted hazard ratio of 0.55 (95% confidence interval: 0.41 to 0.74, p < 0.0001). An apparent relative lower risk was observed across all age and income groups. Women who received fertility therapy also had lower risk-adjusted all-cause mortality, thromboembolic events, subsequent depression, alcoholism, and self-harm (p < 0.01 for each).ConclusionsSuccessful fertility therapy was not associated with an increased risk of cardiovascular disease later in life

The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis

The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis.BackgroundHome nocturnal hemodialysis is an intensive form of hemodialysis, where patients perform their treatments at home for about 7hours approximately 6 nights a week. Compared with in-center conventional hemodialysis, home nocturnal hemodialysis has been shown to improve physiologic parameters and reduce health care costs; however, the effects on quality of life and cost utility are less clear. We hypothesized that individuals performing home nocturnal hemodialysis would have a higher quality of life and superior cost utility than in-center hemodialysis patients.MethodsHome nocturnal hemodialysis patients and a demographically similar group of in-center hemodialysis patients from a hospital without a home hemodialysis program underwent computer-assisted interviews to assess their utility score for current health by the standard gamble method.ResultsNineteen in-center hemodialysis and 24 home nocturnal hemodialysis patients were interviewed. Mean annual costs for home nocturnal hemodialysis were about $10,000 lower for home nocturnal hemodialysis ($55,139 ±$7651 for home nocturnal hemodialysis vs.$66,367 ±$17,502 for in-center hemodialysis, P = 0.03). Home nocturnal hemodialysis was associated with a higher utility score than in-center hemodialysis (0.77 ± 0.23 vs. 0.53 ± 0.35, P = 0.03). The cost utility for home nocturnal hemodialysis was$71,443/quality-adjusted life-year (QALY), while for in-center hemodialysis it was $125,845/QALY. Home nocturnal hemodialysis was the dominant strategy, with an incremental cost-effectiveness ratio (ICER) of -$45,932. The 95% CI for the ICER, and 2500 bootstrap iterations of the ICER all fell below the cost-effectiveness ceiling of $50,000. The net monetary benefit of home nocturnal hemodialysis ranged from$11,227 to $35,669.ConclusionHome nocturnal hemodialysis is associated with a higher quality of life and a superior cost utility when compared to in-center hemodialysis

Influenza Morbidity and Mortality in Elderly Patients Receiving Statins: A Cohort Study

BACKGROUND: Statins possess immunomodulatory properties and have been proposed for reducing morbidity during an influenza pandemic. We sought to evaluate the effect of statins on hospitalizations and deaths related to seasonal influenza outbreaks. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a population-based cohort study over 10 influenza seasons (1996 to 2006) using linked administrative databases in Ontario, Canada. We identified all adults older than 65 years who had received an influenza vaccination prior to the start of influenza season and distinguished those also prescribed statins (23%) from those not also prescribed statins (77%). Propensity-based matching, which accounted for each individual's likelihood of receiving a statin, yielded a final cohort of 2,240,638 patients, exactly half of whom received statins. Statins were associated with small protective effects against pneumonia hospitalization (odds ratio [OR] 0.92; 95% CI 0.89-0.95), 30-day pneumonia mortality (0.84; 95% CI 0.77-0.91), and all-cause mortality (0.87; 95% CI 0.84-0.89). These protective effects attenuated substantially after multivariate adjustment and when we excluded multiple observations for each individual, declined over time, differed across propensity score quintiles and risk groups, and were unchanged during post-influenza season periods. The main limitations of this study were the observational study design, the non-specific outcomes, and the lack of information on medications while hospitalized. CONCLUSIONS/SIGNIFICANCE: Statin use is associated with a statistically significant but minimal protective effect against influenza morbidity that can easily be attributed to residual confounding. Public health officials and clinicians should focus on other measures to reduce morbidity and mortality from the next influenza pandemic

Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis

Abstract Introduction Intensive care unit (ICU) admission for bone marrow transplant recipients immediately following transplantation is an ominous event, yet the survival of these patients with subsequent ICU admissions is unknown. Our objective was to determine the long-term outcome of bone marrow transplant recipients admitted to an ICU during subsequent hospitalizations. Methods We conducted a population-based cohort analysis of all adult bone marrow transplant recipients who received subsequent ICU care in Ontario, Canada from 1 January 1992 to 31 March 2002. The primary endpoint was mortality at 1 year. Results A total of 2,653 patients received bone marrow transplantation; 504 of which received ICU care during a subsequent hospitalization. Patients receiving any major procedure during their ICU stay had higher 1-year mortality than those patients who received no ICU procedure (87% versus 44%, P < 0.0001). Death rates at 1 year were highest for those receiving mechanical ventilation (87%), pulmonary artery catheterization (91%), or hemodialysis (94%). In combination, the strongest independent predictors of death at 1 year were mechanical ventilation (odds ratio, 7.4; 95% confidence interval, 4.8 to 11.4) and hemodialysis (odds ratio, 8.7; 95% confidence interval, 2.1 to 36.7), yet no combination of procedures uniformly predicted 100% mortality. Conclusion The prognosis of bone marrow transplant recipients receiving ICU care during subsequent hospitalizations is very poor but should not be considered futile

Angiotensin-converting enzyme inhibitors and aortic rupture: a population-based case-control study

Summary Background Angiotensin-converting enzyme (ACE) inhibitors prevent the expansion and rupture of aortic aneurysms in animals. We investigated the association between ACE inhibitors and rupture in patients with abdominal aortic aneurysms

Analisis dan Perancangan Sistem Akuntansi dengan Model Driven Development (MDD) Pada Konveksi Anemarie

Informasi Akuntansi merupakan salah satu alat untuk mengambil keputusan dalam perusahaan.Sistem Informasi Akuntansi dapat memberikan kemudahan dalam menghasilkan informasi yang akurat, tepat waktu dapat dipahami dan teruji.Selain itu, sistem informasi akuntansi dapat memudahkan siklus operasional perusahaan baik dari pembelian, produksi, sampai penjualan.Maka dari uraian itu, peneliti ingin menganalisis dan merancang sistem informasi akuntansi pada usaha yang tidak memiliki sistem informasi akuntansi dan masih melakukan pencatatan secara manual. Peneliti menggunakan data sistem akuntansi Konveksi Anemarie periode April 2017 dan Model Driven Development untuk merancang Sistem Informasi Akuntansi konveksi Anemarie. Hasil pengembangan Sistem Informasi Akuntansi dengan Model Driven Development ini ialah Desain Model Data dengan Entity Relathionship diagram baik secara keseluruhan maupun per subsistem, Desain model Proses dengan Data Flow Diagram, dan desain model output dengan pembuatan interface dari form yang dibutuhka

Motor Vehicle Crashes in Diabetic Patients with Tight Glycemic Control: A Population-based Case Control Analysis

Using a population-based case control analysis, Donald Redelmeier and colleagues found that tighter glycemic control, as measured by the HbA1c, is associated with an increased risk of a motor vehicle crash

Alcohol Sales and Risk of Serious Assault

In a population-based case-crossover analysis, Joel Ray and colleagues find that the risk of being a victim of serious assault increases with retail alcohol sales, especially among young urban men