Extremely Drug Resistant Tuberculosis XDR-TB

Extremely Drug Resistant Tuberculosis XDR-TB 

http://www.youtube.com/watch?v=INdBNgOc5ls

Effective Exercise for the Prevention of Falls: A Systematic Review

OBJECTIVES: To determine the effects of exercise on falls prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls.

DESIGN: Systematic review with meta-analysis. Randomized controlled trials that compared fall rates in older people who undertook exercise programs with fall rates in those who did not exercise were included.

SETTING: Older people.

PARTICIPANTS: General community and residential care.

MEASUREMENTS: Fall rates.

RESULTS: The pooled estimate of the effect of exercise was that it reduced the rate of falling by 17% (44 trials with 9,603 participants, rate ratio (RR)50.83, 95% confidence interval (CI)50.75–0.91, Po.001, I2562%). The greatest relative effects of exercise on fall rates (RR50.58, 95%

CI50.48–0.69, 68% of between-study variability explained) were seen in programs that included a combination of a higher total dose of exercise (450 hours over the trial period) and challenging balance exercises (exercises conducted while standing in which people aimed to stand

with their feet closer together or on one leg, minimize use of their hands to assist, and practice controlled movements of the center of mass) and did not include a walking program.

CONCLUSION: Exercise can prevent falls in older people. Greater relative effects are seen in programs that include exercises that challenge balance, use a higher dose of exercise, and do not include a walking program. Service providers can use these findings to design and implement

exercise programs for falls prevention. J Am Geriatr Soc 2008.

http://www3.interscience.wiley.com/cgi-bin/fulltext/121496774/PDFSTART

Inadequate prenatal care and its association with adverse pregnancy outcomes: A comparison of indices

Abstract

Background: The objectives of this study were to determine rates of prenatal care utilization in Winnipeg, Manitoba, Canada from 1991 to 2000; to compare two indices of prenatal care utilization in identifying the proportion of the population receiving inadequate prenatal care; to determine the association between inadequate prenatal care and adverse pregnancy outcomes

(preterm birth, low birth weight [LBW], and small-for-gestational age [SGA]), using each of the

indices; and, to assess whether or not, and to what extent, gestational age modifies this association.

Methods: We conducted a population-based study of women having a hospital-based singleton live birth from 1991 to 2000 (N = 80,989). Data sources consisted of a linked mother-baby database and a physician claims file maintained by Manitoba Health. Rates of inadequate prenatal care were calculated using two indices, the R-GINDEX and the APNCU. Logistic regression analysis was used to determine the association between inadequate prenatal care and adverse pregnancy outcomes. Stratified analysis was then used to determine whether the association between inadequate prenatal care and LBW or SGA differed by gestational age.

Results: Rates of inadequate/no prenatal care ranged from 8.3% using APNCU to 8.9% using RGINDEX. The association between inadequate prenatal care and preterm birth and LBW varied depending on the index used, with adjusted odds ratios (AOR) ranging from 1.0 to 1.3. In contrast, both indices revealed the same strength of association of inadequate prenatal care with SGA (AOR 1.4). Both indices demonstrated heterogeneity (non-uniformity) across gestational age strata, indicating the presence of effect modification by gestational age.

Conclusion: Selection of a prenatal care utilization index requires careful consideration of its methodological underpinnings and limitations. The two indices compared in this study revealed different patterns of utilization of prenatal care, and should not be used interchangeably. Use of these indices to study the association between utilization of prenatal care and pregnancy outcomes affected by the duration of pregnancy should be approached cautiously.

http://www.biomedcentral.com/1471-2393/8/15

AHA: JUPITER Results Point to Role of Statins for 'Apparently Healthy' Patients

"Introducción

Los niveles elevados de un marcador biologico de la inflamación , la proteina C reactiva altamente sensible, predice eventos cardiovasculares. Dado que las estatinas reducen los niveles de la proteina C altamente sesible asi como también el colesterol , nuestra hipotesis es que las personas con elevada proteina C altamente sensible pero sin hiperlipidemia podria beneficiarse del tratamiento con estatinas.

Metodologia.

Fueron asignados randomicamente 17,802 aparentemente saludables entre hombres y mujeres con bajos niveles de lipoproteina de baja densidad (LDL) menor a 130 mg  por decilitro (3.4 mmol per liter) y niveles de proteina C reactiva de alta sensibilidad de 2.0 mg per litro o mayor a una dosis de rosuvastatin, de 20 mg diaria, o placebo y fueron acompañados hasta la ocurrencia final sea , infarto de miocardio, ACV, revascularización arterial, hospitalización por angina inestable , o muerte por causas cardiovasculares.

Resultados

El trial fue interrumpido después de una media de seguimiento de 1.9 años(maximo, 5.0). La Rosuvastatin redujo los niveles del LDL colesterol en un 50% y de la Proteina C reactiva altamente sensible en un 37%. Las tasas del evento final fueron 0.77 y 1.36 por 100 personas-año de seguimiento en los grupos de rosuvastatin y placebo respectivamente (Razon de riesgo para rosuvastatin, fue de 0.56; al 95%, con un intervalo de confianza de [CI], 0.46 to 0.69; P<0.00001), p =" 0.0002)," p =" 0.002)," p =" 0.02).">

Conclusiones

En este trial aparentemente personas saludables sin hiperlipidemia pero con elevados niveles de Proteina C reactiva, redujeron significantemente la incidencia de eventos cardiovasculares mayores al utilizar rouvastatina. (ClinicalTrials.gov number, NCT00239681.)"

http://www.medpagetoday.com/upload/2008/11/9/NEJMoa0807646v1.pdf

http://www.medpagetoday.com/MeetingCoverage/AHA/11684