Effectiveness of bilateral tubotubal anastomosis in a large outpatient population

Is bilateral tubotubal anastomosis a successful treatment in an outpatient patient population

Medical Care Costs Associated with Postmenopausal Estrogen Plus Progestogen Therapy

OBJECTIVE: To investigate the medical management costs of estrogen plus progestogen hormone therapy (HT) among postmenopausal women taking HT primarily as a preventive treatment for osteoporosis. DESIGN: Retrospective longitudinal comparative analysis of HT users and demographically matched nonusers using administrative databases on physician services, hospital stays and prescription medications. SETTING: Saskatchewan, Canada. PATIENTS: a total of 5762 women aged 55 years or more who took HT sometime between 1990 and 1997 and 5762 demographically matched controls who did not take HT from 1990 to 1997. MAIN OUTCOME MEASURES: total medical care expenditures and apparent costs of managing adverse events associated with HT. RESULTS: Excluding drug acquisition costs for HT and costs of care for osteoporosis, women in their first year of postmenopausal HT had total medical care costs about $400 greater than women who had never used HT (1997 Canadian dollars). This total medical care cost differential falls to about$90 to $120 per annum after the first year of therapy. If osteoporosis-related medical care costs are not excluded, the cost differential is about$390 during the first year of therapy and $80 to$110 per annum after the first year of therapy. These excess costs primarily are the result of excess rates of resource utilization for uterine- and breast-related diagnostic and treatment procedures. CONCLUSION: Medical management costs for HT may be substantial during the first year of therapy, and some medical management costs may persist over several years. These short-term management costs, combined with recent data about the long-term safety of HT as a preventive therapy, reinforce the importance of considering therapeutic alternatives to HT

Diagnosis of bacterial vaginosis from self-obtained vaginal swabs.

OBJECTIVE: To determine the concordance between vaginal fluid Gram stains and pH obtained at speculum exam with similar stains and pH prepared from self-obtained vaginal swabs. METHODS: Using vaginal fluid Gram stain, 129 pregnant women were screened for bacterial vaginosis at 24 to 29 weeks' gestation. Two smears were collected from each woman during the same prenatal visit: the first was prepared from a self-obtained vaginal swab and the second from a physician-obtained speculum examination. Vaginal pH was recorded for each swab. Kappa coefficient was used to quantify agreement between the two sets of results. RESULTS: When compared with the physician-obtained smear, the ability of the self-obtained Gram stain to diagnose bacterial vaginosis had a sensitivity of 77%, specificity of 97%, positive predictive value of 71% and negative predictive value of 97%. There was substantial agreement (weighted kappa=0.82) between the two techniques in the ability to determine the grade of vaginal flora. CONCLUSION: When compared with physician-obtained vaginal smears, self-obtained smears have substantial agreement in the diagnosis of bacterial vaginosis

Vitamin D in pregnancy: current concepts

Vitamin D (VD) is part of a complex steroid hormone system long known to be involved in bone metabolism. Recently, VD has been implicated physiologic processes as diverse as vascular health, immune function, metabolism and placental function. This review summarizes the current evidence for the role of VD in perinatal health

A Bayesian Latent Variable Mixture Model for Longitudinal Fetal Growth

Fetal growth restriction is a leading cause of perinatal morbidity and mortality that could be reduced if high risk infants are identified early in pregnancy. We propose a Bayesian model for aggregating 18 longitudinal ultrasound measurements of fetal size and blood flow into three underlying, continuous latent factors. Our procedure is more flexible than typical latent variable methods in that we relax the normality assumptions by allowing the latent factors to follow finite mixture distributions. Using mixture distributions also permits us to cluster individuals with similar observed characteristics and identify latent classes of subjects who are more likely to be growth or blood flow restricted during pregnancy. We also use our latent variable mixture distribution model to identify a clinically-meaningful latent class of subjects with low birth weight and early gestational age. We then examine the association of latent classes of intrauterine growth restriction with latent classes of birth outcomes as well as observed maternal covariates including fetal gender and maternal race, parity, body mass index (BMI), and height. Our methods identified a latent class of subjects who have increased blood flow restriction and below average intrauterine size during pregnancy who were more likely to be growth restricted at birth than a class of individuals with typical size and blood flow

Characterizing the Cool KOIs. VI. H- and K-band Spectra of Kepler M Dwarf Planet-Candidate Hosts

We present H- and K-band spectra for late-type Kepler Objects of Interest (the "Cool KOIs"): low-mass stars with transiting-planet candidates discovered by NASA's Kepler Mission that are listed on the NASA Exoplanet Archive. We acquired spectra of 103 Cool KOIs and used the indices and calibrations of Rojas-Ayala et al. to determine their spectral types, stellar effective temperatures and metallicities, significantly augmenting previously published values. We interpolate our measured effective temperatures and metallicities onto evolutionary isochrones to determine stellar masses, radii, luminosities and distances, assuming the stars have settled onto the main-sequence. As a choice of isochrones, we use a new suite of Dartmouth predictions that reliably include mid-to-late M dwarf stars. We identify five M4V stars: KOI-961 (confirmed as Kepler 42), KOI-2704, KOI-2842, KOI-4290, and the secondary component to visual binary KOI-1725, which we call KOI-1725 B. We also identify a peculiar star, KOI-3497, which has a Na and Ca lines consistent with a dwarf star but CO lines consistent with a giant. Visible-wavelength adaptive optics imaging reveals two objects within a 1 arc second diameter; however, the objects' colors are peculiar. The spectra and properties presented in this paper serve as a resource for prioritizing follow-up observations and planet validation efforts for the Cool KOIs, and are all available for download online using the "data behind the figure" feature.Comment: Accepted for publication in the Astrophysical Journal Supplement Series (ApJS). Data and table are available in the sourc