Canadian Pregnancy Outcomes in Rheumatoid Arthritis and Systemic Lupus Erythematosus

Objective. To describe obstetrical and neonatal outcomes in Canadian women with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). Methods. An administrative database of hospitalizations for neonatal delivery (1998–2009) from Calgary, Alberta was searched to identify women with RA (38 pregnancies) or SLE (95 pregnancies), and women from the general population matched on maternal age and year of delivery (150 and 375 pregnancies, resp.). Conditional logistic regression was used to calculate odds ratios (OR) for maternal and neonatal outcomes, adjusting for parity. Results. Women with SLE had increased odds for preeclampsia or eclampsia (SLE OR 2.16 (95% CI 1.10–4.21; P = 0.024); RA OR 2.33 (95% CI 0.76–7.14; P = 0.138)). Women with SLE had increased odds for cesarean section after adjustment for dysfunctional labour, instrumentation and previous cesarean section (OR 3.47 (95% CI 1.67–7.22; P < 0.001)). Neonates born to women with SLE had increased odds of prematurity (SLE OR 6.17 (95% CI 3.28–11.58; P < 0.001); RA OR 2.66 (95% CI 0.90–7.84; P = 0.076)) and of SGA (SLE OR 2.54 (95% CI 1.42–4.55; P = 0.002); RA OR 2.18 (95% CI 0.84–5.66; P = 0.108)) after adjusting for maternal hypertension. There was no excess risk of congenital defects in neonates. Conclusions. There is increased obstetrical and neonatal morbidity in Canadian women with RA or SLE

Mercado y solidaridad

A free society should reconcile market and solidarity. This is getting difficult to achieve in a global economy, by the means of Welfare State. But this could be achieved by liberal means, if we had a more adequate concept of capital, including moral capital (with within it solidarity and peace), and a more adequate concept of responsibility (including the duty of reproducing the capital adequately conceived). The practical mean of reaching this goal is the working together of free enterprises and free associations, so that social and moral efficiency of the market could become as good as its economic efficiency. Such a market is called a subtle market

Ethnic differences in the use of prescription drugs: a cross-sectional analysis of linked survey and administrative data

Background Evidence from the United States and Europe suggests that the use of prescription drugs may vary by ethnicity. In Canada, ethnic disparities in prescription drug use have not been as well documented as disparities in the use of medical and hospital care. We conducted a cross-sectional analysis of survey and administrative data to examine needs-adjusted rates of prescription drug use by people of different ethnic groups. Methods For 19 370 non-Aboriginal people living in urban areas of British Columbia, we linked data on self-identified ethnicity from the Canadian Community Health Survey with administrative data describing all filled prescriptions and use of medical services in 2005. We used sex-stratified multivariable logistic regression analysis to measure differences in the likelihood of filling prescriptions by drug class (antihypertensives, oral antibiotics, antidepressants, statins, respiratory drugs and nonsteroidal anti-inflammatory drugs [NSAIDs]). Models were adjusted for age, general health status, treatment-specific health status, socio-economic factors and recent immigration (within 10 years). Results We found evidence of significant needs-adjusted variation in prescription drug use by ethnicity. Compared with women and men who identified themselves as white, those who were South Asian or of mixed ethnicity were almost as likely to fill prescriptions for most types of medicines studied; moreover, South Asian men were more likely than white men to fill prescriptions for antibiotics and NSAIDs. The clearest pattern of use emerged among Chinese participants: Chinese women were significantly less likely to fill prescriptions for antihypertensives, antibiotics, antidepressants and respiratory drugs, and Chinese men for antidepressant drugs and statins. Interpretation We found some disparities in prescription drug use in the study population according to ethnic group. The nature of some of these variations suggest that ethnic differences in beliefs about pharmaceuticals may generate differences in prescription drug use; other variations suggest that there may be clinically important disparities in treatment use

Penelusuran Kualitas dan Kuantitas Sanad Qiraah Sab’ah: Kajian Takhrij Sanad Qiraah Sab’ah

Qiraah sab‟ah telah disepakati ke-mutawatir-annya oleh jumhur ulama. Namun ada ulama yang berpendapat bahwa sanad qiraah sab‟ah dari para imam qiraah sab‟ah kepada Rasulullah Saw, tidak mencapai derajat mutawatir, melainkan hanya masyhur, yang berkualifikasi sahih dan maqbul. Artikel ini ini bertujuan untuk mengetahui kualitas dan kuantitas sanad qiraah sab‟ah berdasarkan kajian takhrij hadis. Pendekatannya menggunakan pendekatan kualitatif dengan metode library research. Analisis datanya menggunakan teori takhrij hadis. Hasilnya menunjukkan bahwa dalam perspektif Ilmu Hadis, sanad qiraah sab‟ah dari para Imam qiraah sab‟ah kepada Rasulullah Saw tidaklah mutawatir secara kuantitas, dan dinilai hanya sampai pada derajat masyhur jika ditinjau dari sisi sanad masing-masing individu Imam qiraah sab‟ah. Sementara itu, jika ditinjau dari keseluruhan jalur qiraah sab‟ah kepada Rasulullah, maka sanad-nya bisa dianggap mutawatir, karena memenuhi kriteria umum ke-mutawatir-an. Namun jika ditinjau dari perspektif ilmu qiraah, bahwa qiraah sab‟ah dari para imam keapda Rasulullah Saw, sebagaimana dinyatakan jumhur ulama adalah mutawatir. Dengan alasan, sekalipun dalam sanad qiraahnya ada yang menyendiri (sedikit) dan tidak memiliki keseimbangan pada setiap thabaqah-nya, namun hakikatnya tidak sendiri. Pada saat yang sama terdapat keluarga perawi qiraah, juga penduduk di negeri tersebut yang ikut meriwayatkannya sekalipun tidak dicantumkan dalam rangkaian sanad qiraah. Selain itu, ditemukan pula bahwa masing-masing sanad qiraah sab‟ah diyakini berkualifikasi mutawatir pula jika tinjauan sanad qiraah-nya, dari perawi zaman modern sampai kepada pengarang kitab sumber qiraah. Dan dari para pengarang kitab qiraah standar kepada para Imam qiraah. Sebab diriwayatkan oleh para ahli qiraah yang jumlahnya sangat banyak

Lack of patient involvement in care decisions and not receiving written discharge instructions are associated with unplanned readmissions up to one year

This retrospective, cross-sectional study examined the relationship between aspects of inpatient communication and discharge instructions and unplanned, all-cause readmissions using individual-level data up to one-year post-discharge. Patients completed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) telephone survey within 6 weeks of hospital discharge in Alberta, Canada. Survey data were linked to corresponding inpatient records. Independent variables included selected demographic characteristics, clinical variables, and five survey questions: a) patient involvement in care decisions, b) receiving written information at discharge, c) understanding the purpose of taking medications, d) understanding responsibility for one’s health, and e) discussing help needed when returning home. From April 2011 to March 2014, 24,869 patients with a mean age of 52.8±19.8 years (range=18-100) were included. 18.6% of patients (n=4,821) experienced an unplanned hospital readmission within 43 to 365 days post-discharge. In adjusted, logistic regression models, patients who felt they were not involved in care decisions were more likely to be readmitted (OR=1.34; 95%CI: 1.17-1.53), as were patients who reported not receiving written information about signs and symptoms to watch out for post-discharge (OR=1.24; 95%CI: 1.15-1.35). Odds of readmission did not differ according to understanding of medications, understanding responsibility for one’s health, or discussion of help needed when returning home. This study provides objective data, showing that specific hospital actions are associated with unplanned readmissions. It is an example of how patient-reported measures may be linked to administrative data to drive quality improvement initiatives

Authors' opinions on publication in relation to annual performance assessment

<p>Abstract</p> <p>Background</p> <p>In the past 50 years there has been a substantial increase in the volume of published research and in the number of authors per scientific publication. There is also significant pressure exerted on researchers to produce publications. Thus, the purpose of this study was to survey corresponding authors in published medical journals to determine their opinion on publication impact in relation to performance review and promotion.</p> <p>Methods</p> <p>Cross-sectional survey of corresponding authors of original research articles published in June 2007 among 72 medical journals. Measurement outcomes included the number of publications, number of authors, authorship order and journal impact factor in relation to performance review and promotion.</p> <p>Results</p> <p>Of 687 surveys, 478 were analyzed (response rate 69.6%). Corresponding authors self-reported that number of publications (78.7%), journal impact factor (67.8%) and being the first author (75.9%) were most influential for their annual performance review and assessment. Only 17.6% of authors reported that the number of authors on a manuscript was important criteria for performance review and assessment. A higher percentage of Asian authors reported that the number of authors was key to performance review and promotion (41.4% versus 7.8 to 22.2%). compared to authors from other countries.</p> <p>Conclusions</p> <p>The number of publications, authorship order and journal impact factor were important factors for performance reviews and promotion at academic and non-academic institutes. The number of authors was not identified as important criteria. These factors may be contributing to the increase in the number of authors per publication.</p