Short-term Health Outcomes Research Articles

The Speed of Increasing milk Feeds: a randomised controlled trial

BackgroundIn the UK, 1–2% of infants are born very preterm (<32 weeks of gestation) or have very low birth weight (<1500 g). Very preterm infants are initially unable to be fed nutritional volumes of milk and therefore require intravenous nutrition. Milk feeding strategies influence several long and short term health outcomes including growth, survival, infection (associated with intravenous nutrition) and necrotising enterocolitis (NEC); with both infection and NEC being key predictive factors of long term disability. Currently there is no consistent strategy for feeding preterm infants across the UK. The SIFT trial will test two speeds of increasing milk feeds with the primary aim of determining effects on survival without moderate or severe neurodevelopmental disability at 24 months of age, corrected for prematurity. The trial will also examine many secondary outcomes including infection, NEC, time taken to reach full feeds and growth.Methods/designTwo thousand eight hundred very preterm or very low birth weight infants will be recruited from approximately 30 hospitals across the UK to a randomised controlled trial. Infants with severe congenital anomaly or no realistic chance of survival will be excluded. Infants will be randomly allocated to either a faster (30 ml/kg/day) or slower (18 ml/kg/day) rate of increase in milk feeds. Data will be collected during the neonatal hospital stay on weight, infection rates, episodes of NEC, length of stay and time to reach full milk feeds. Long term health outcomes comprising vision, hearing, motor and cognitive impairment will be assessed at 24 months of age (corrected for prematurity) using a parent report questionnaire.DiscussionExtensive searches have found no active or proposed studies investigating the rate of increasing milk feeds. The results of this trial will have importance for optimising incremental milk feeding for very preterm and/or very low birth weight infants. No additional resources will be required to implement an optimal feeding strategy, and therefore if successful, the trial results could rapidly be adopted across the NHS at low cost.Trial registrationISRCTN Registry; ISRCTN76463425 on 5 March, 2013.

Self-Assessed Health into Late Adulthood

Abstract. Self-assessed health (SAH) is the personal assessment of one’s own health ( Idler &amp; Benyamini, 1997 ; Jylhä, 2009 ). It is often measured using a single item asking whether adults rate their health as excellent, very good, good, fair, or poor. When measured at a single point in time, SAH relates to a variety of short-term and long-term health outcomes and behaviors, including morbidity, healthcare utilization, and mortality ( Benyamini, 2008 ; Mossey &amp; Shapiro, 1982 ; Westerhof &amp; Wurm, 2015 ). Recently, attention has shifted away from examining SAH at a single point in time toward understanding whether SAH trajectories can better predict health outcomes ( Ayyagari et al., 2012 ; Schmitz et al., 2013 ). Therefore, it is critical to understand the factors contributing to the SAH process. This article provides a multidisciplinary overview of SAH and SAH change while illustrating the benefits of adopting a lifespan approach in future research. The current SAH literature, including cross-sectional and longitudinal studies, is used to examine what is known about the SAH process into late adulthood. From the literature, it is clear SAH is a multidimensional construct, susceptible to age-related change and sociohistorical contexts. Understanding the developmental mechanisms and multiple influences underlying change, however, may help further the use of SAH as a life-long health-promotion tool. Lifespan concepts are applied to expand discussion and recommendations are made concerning the application of alternative variables and methodologies. Future studies of SAH should consider these personal perceptions of health not only as predictors of health outcomes in later life, but also as tools for effective health promotion in everyday life.

PIH4 - Prevalence of Low Birthweight and its Correlates from 2008 to 2014 in Xindu County of Chengdu, China

Low birthweight is associated with adverse short-term and long-term health outcomes. We aimed to examine the trend in the prevalence of low birthweight and factors that were associated with low birthweight from 2008 to 2014 in Xindu County of Chengdu, China. Birth data for 2008-2014 were retrieved from the Chengdu Municipal Maternal and Child Health Management System. A total of 51,580 singleton live births were included for analysis. We defined low birthweight as an infant weighting < 2,500 g, and small for gestational age (SGA) as sex-specific fetal growth below the 10th percentile at each completed week of gestation. We performed logistic regression to examine the secular trends in the prevalence of low birthweight and SGA, and univariable and multivariable logistic regression to assess potential factors that were associated with the prevalence of low birthweight. The prevalence of low birthweight and SGA was 3.5% [95% confidence intervals (CI): 3.3-3.7%] and 8.6% (95% CI: 8.4-8.9%), respectively, during the period of 2008-2014. Statistically significant increase was noted in regards to the prevalence of low birthweight (2008-2014, p<0.001). Regression analysis indicated that increased odds of low birthweight were associated with higher level of hospital [odds ratio (OR): 2.33; 95% CI: 1.99-2.70], specialist maternal and child hospital (OR: 1.20; 95% CI: 1.05-1.37), maternal age < 20 (OR: 1.52; 95 % CI: 1.10-2.13), high-risk pregnancy (OR: 1.63; 95% CI: 1.45-1.84), and preterm labor (OR: 65.45; 95 % CI: 43.48-71.43) after controlling for year of birth. The prevalence of low birthweight shows an increasing trend in Xindu. The identified correlates for low birthweight may be useful for tackling the health challenge in this region.

Association of Age, Systolic Blood Pressure, and Heart Rate with Adult Morbidity and Mortality after Urgent Care Visits.

IntroductionLittle data exists to help urgent care (UC) clinicians predict morbidity and mortality risk. Age, systolic blood pressure (SBP), and heart rate (HR) are easily obtainable and have been used in other settings to predict short-term risk of deterioration. We hypothesized that there is a relationship between advancing age, SBP, HR, and short-term health outcomes in the UC setting.MethodsWe collected retrospective data from 28 UC clinics and 22 hospitals in the Intermountain Healthcare system between years 2008–2013. Adult patients (≥18 years) were included if they had a unique UC visit and HR or SBP data. Three endpoints following UC visit were assessed: emergency department (ED) visit within three days, hospitalization within three days, and death within seven days. We analyzed associations between age, SBP, HR and endpoints using local regression with a binomial likelihood. Five age groups were chosen from previously published national surveys. Vital sign (VS) distributions were determined for each age group, and the central tendency was compared against previously published norms (90–120mmHg for SBP and 60–100bpm for HR.)ResultsA total of 1,720,207 encounters (714,339 unique patients) met the inclusion criteria; 51,446 encounters (2.99%) had ED visit within three days; 12,397 (0.72%) experienced hospitalization within three days; 302 (0.02%) died within seven days of UC visit. Heart rate and SBP combined with advanced age predicted the probability of ED visit (p<0.0001) and hospitalization (p<0.0001) following UC visit. Significant associations between advancing age and death (p<0.0001), and VS and death (p<0.0001) were observed. Odds ratios of risk were highest for elderly patients with lower SBP or higher HR. Observed distributions of SBP were higher than published normal ranges for all age groups.ConclusionAmong adults seeking care in the UC, associations between HR and SBP and likelihood of ED visits and hospitalization were more pronounced with advancing age. Death following UC visit had a more limited association with advancing age or the VS evaluated. Rapidly increasing risk below SBP of 100–110 mmHg in older patients suggests that accepted normal ranges for SBP may need to be redefined for patients treated in the UC clinic.

ASCIA‐P65: HAEMATOPOIETIC STEM CELL TRANSPLANTATION FOR PRIMARY IMMUNODEFICIENCY SYNDROMES, A FIVE YEAR SINGLE CENTRE EXPERIENCE

Haematopoietic stem cell transplantation is a central therapy in the treatment of several primary immunodeficiency syndromes. More recently reduced intensity conditioning regimens have been used in an attempt to reduce adverse outcomes while maintaining adequate immune reconstitution. This study is an audit of children with primary immunodeficiency who have received haematopoietic stem cell transplantation at the Sydney Children's Hospital, Randwick, in the last 5 years during which time, reduced intensity conditioning has been used. The primary objective is to audit the short and longer term health outcomes of these patients and compare these to outcomes from other transplant units locally in Australia and globally. This will also be compared to previously used higher intensity conditioning regimens. Data will be collected retrospectively from clinical records and pathology results. Information will be gathered regarding the haematopoietic stem cell transplantation protocol, short term outcomes during transplant, post transplant immune reconstitution and general health. 22 patients were identified who received haematopoietic stem cell transplantation for primary immunodeficiency at the Sydney Children's Hospital Randwick in the last 5 years. Post transplant complications included autoimmune haemolytic anaemia, hypogammaglobulinaemia, graft failure, graft vs host disease, renal impairment, veno-occlusive disease and disseminated viral infection. There were 2 deaths. One patient required ongoing immunological support, with the remainder demonstrating adequate immune reconstitution. The use of reduced intensity conditioning for haematopoietic stem cell transplantation in primary immunodeficiency syndromes at Sydney Children's Hospital has resulted outcomes comparable to that of other transplant units, both locally and globally, and results are favourable compared to previous higher intensity conditioning regimens.

Strong, healthy, energized: Striving for a healthy weight in an older lesbian population

ABSTRACTThe Office on Women’s Health funded five pilot healthy weight intervention studies for lesbian and bisexual (LB) women, which included a program called Strong. Healthy. Energized (SHE). SHE was a 12-session program, targeted toward LB women age 60 and older, which focused on exercise, including a pedometer to track steps; nutrition; stress management; and group discussions. The program enrolled 39 participants. Waist circumference decreased by 3.7% across the group (p < .01). Participants with the lowest one-third baseline step count saw a marked step increase. This intervention was effective in improving health behaviors and short-term health outcomes for older LB women.

Risk factors for gestational diabetes: is prevention possible?

Gestational diabetes mellitus (GDM), a common pregnancy complication, continues to be a significant public health and clinical problem. It carries significant short-term and long-term adverse health outcomes for both mother and offspring, which reinforces the significance of understanding risk factors, in particular modifiable factors, for GDM and of preventing the condition. Research in the past decade from observational studies has identified a few diet and lifestyle factors that are associated with GDM risk and demonstrated that time frames both before and during pregnancy may be relevant to the development of GDM. Findings from intervention studies on the effect of diet and lifestyle on the prevention of GDM have been largely controversial and inconsistent. Variations in study population, types of intervention, timing and duration of intervention and diagnostic criteria for GDM may all at least partly account for the large heterogeneity in the findings from these intervention studies. This review provides an overview of emerging diet, lifestyle, and other factors that may help to prevent GDM, and the challenges associated with prevention. It also discusses major methodological concerns about the available epidemiological studies on GDM risk factors. Findings from both observational and intervention studies are discussed. This review summarises a presentation given at the 'Gestational diabetes: what's up?' symposium at the 2015 annual meeting of the EASD. It is accompanied by two other reviews on topics from this symposium (by Peter Damm and Colleagues, DOI: 10.1007/s00125-016-3985-5 , and by Marja Vääräsmäki, DOI: 10.1007/s00125-016-3976-6 ) and an overview by the Session Chair, Kerstin Berntorp (DOI: 10.1007/s00125-016-3975-7 ).

Different intensities of glycaemic control for women with gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) has major short- and long-term implications for both the mother and her baby. GDM is defined as a carbohydrate intolerance resulting in hyperglycaemia or any degree of glucose intolerance with onset or first recognition during pregnancy from 24 weeks' gestation onwards and which resolves following the birth of the baby. Rates for GDM can be as high as 25% depending on the population and diagnostic criteria used and rates are increasing globally. Risk factors associated with GDM include advanced maternal age, obesity, ethnicity, family history of diabetes, and a previous history of GDM, macrosomia or unexplained stillbirth. There is wide variation internationally in glycaemic treatment target recommendations for women with GDM that are based on consensus rather than high-quality trials. To assess the effect of different intensities of glycaemic control in pregnant women with GDM on maternal and infant health outcomes. We searched the Cochrane Pregancy and Childbirth Group's Trials Register (31 January 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (1 February 2016) and reference lists of the retrieved studies. We included one randomised controlled trial. Cluster-randomised and quasi-randomised controlled trials were eligible for inclusion. We used the methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. Two review authors independently assessed trial eligibility for inclusion, evaluated methodological quality and extracted data for the one included study. We sought additional information from one trial author but had no response. We assessed the quality of evidence for selected outcomes using the GRADE approach. We included one Canadian trial of 180 women, recruited between 20 to 32 weeks' gestation, who had been diagnosed with GDM. Data from 171 of the 180 women were published as a conference abstract and no full report has been identified. The overall risk of bias of the single included study was judged to be unclear.The included trial did not report on any of this review's primary outcomes. For the mother, these were hypertension disorders of pregnancy or subsequent development of type 2 diabetes. For the infant, our primary outcomes were (perinatal (fetal and neonatal) mortality; large-for-gestational age; composite of death or severe morbidity or later childhood neurosensory disability).The trial did report data relating to some of this review's secondary outcomes. There was no clear difference in caesarean section rates for women assigned to using strict glycaemic targets (pre-prandial 5.0 mmol/L (90 mg/L) and at one-hour postprandial 6.7 mmol/L (120 mg/dL)) (28/85, 33%) when compared with women assigned to using liberal glycaemic targets (pre-prandial 5.8 mmol/L (103 mg/dL) and at one-hour postprandial 7.8 mmol/L (140 mg/dL)) (21/86, 24%) (risk ratio (RR) 1.35, 95% confidence interval (CI) 0.83 to 2.18, one trial, 171 women; very low quality). Using the GRADE approach, we found the quality of the evidence to bevery low for caesarean section due to poor reporting of risk of bias, imprecision and publication bias. Strict glycaemic targets were associated with an increase in the use of pharmacological therapy (identified as the use of insulin in this study) (33/85; 39%) compared with liberal glycaemic targets (18/86; 21%) (RR 1.85, 95% CI 1.14 to 3.03; one trial, 171 women). CIs are wide suggesting imprecision and caution is required when interpreting the data. No other secondary maternal outcome data relevant to this review were reported. For the infant, there were no clear differences between the groups of women receiving strict and liberal glycaemic targets for macrosomia (birthweight greater than 4000 g) (RR 1.35, 95% CI 0.31 to 5.85, one trial, 171 babies); small-for-gestational age (RR 1.12, 95% CI 0.48 to 2.63, one trial, 171 babies); birthweight (mean difference (MD) -92.00 g, 95% CI -241.97 to 57.97, one trial, 171 babies) or gestational age (MD -0.30 weeks, 95% CI -0.73 to 0.13, one trial, 171 babies). Adverse effects data were not reported. No other secondary neonatal outcomes relevant to this review were reported. This review is based on a single study (involving 180 women) with an unclear risk of bias. The trial (which was only reported in a conference abstract) did not provide data for any of this review's primary outcomes but did provide data for a limited number of our secondary outcomes. There is insufficient evidence to guide clinical practice for targets for glycaemic control for women with GDM to minimise adverse effects on maternal and fetal health. Glycaemic target recommendations from international professional organisations for maternal glycaemic control vary widely and are reliant on consensus given the lack of high-quality evidence.Further high-quality trials are needed, and these should compare different glycaemic targets for guiding treatment of women with GDM, assess both short-term and long-term health outcomes for women and their babies, include women's experiences and assess health services costs. Four studies are ongoing.

Cluster randomised controlled trial of a financial incentive for mothers to improve breast feeding in areas with low breastfeeding rates: the NOSH study protocol

IntroductionBreast feeding can promote positive long-term and short-term health outcomes in infant and mother. The UK has one of the lowest breastfeeding rates (duration and exclusivity) in the world, resulting...

Who Cares about the Health of Health Care Professionals? An 18-Year Longitudinal Study of Working Time, Health, and Occupational Turnover

Health care workers are employed in a complex, stressful, and sometimes hazardous work environment. Studies of the health of health care workers tend to focus on estimating the effects of short-term health outcomes on employee attitudes and performance, which are easier to observe than long-term health outcomes. Research has paid only scant attention to work characteristics that are controlled by the employer and its employees, and their relationship to employees’ long-term physical health and organizational outcomes. The authors use data from the National Longitudinal Survey of Youth (NLSY) from 1992 to 2010 to estimate the relationships among working time, long-term physical health, job satisfaction, and turnover among health care employees. Using a between- and within-person design, they estimate how within-person changes in work characteristics affect the within-person growth trajectory of body mass index (BMI) over time and the relationship between working-time changes and physical health, and occupational turnover. The study finds that health care employees who work more hours suffer from a higher level of BMI and are more likely to leave their occupation.

Health impact of catch-up growth in low-birth weight infants: systematic review, evidence appraisal, and meta-analysis.

This study aimed to systematically review and appraise evidence on the short-term (e.g. morbidity, mortality) and long-term (obesity and non-communicable diseases, NCDs) health consequences of catch-up growth (vs. no catch-up growth) in individuals with a history of low birth weight (LBW).We searched MEDLINE, EMBASE, Global Health, CINAHL plus, Cochrane Library, ProQuest Dissertations and Thesis and reference lists. Study quality was assessed using the risk of bias assessment tool from the Agency for Health Care Research and Quality, and the evidence base was assessed using the GRADE tool. Eight studies in seven cohorts (two from high-income countries, five from low-middle-income countries) met the inclusion criteria for short-term (mean age: 13.4 months) and/or longer-term (mean age: 11.1 years) health outcomes of catch-up growth, which had occurred by 24 or 59 months. Of five studies on short-term health outcomes, three found positive associations between weight catch-up growth and body mass and/or glucose metabolism; one suggested reduced risk of hospitalisation and mortality with catch-up growth. Three studies on longer-term health outcomes found catch-up growth were associated with higher body mass, BMI or cholesterol. GRADE assessment suggested that evidence quantity and quality were low. Catch-up growth following LBW may have benefits for the individual with LBW in the short term, and may have adverse population health impacts in the long-term, but the evidence is limited. Future cohort studies could address the question of the consequences of catch-up growth following LBW more convincingly, with a view to informing future prevention of obesity and NCDs. © 2016 John Wiley & Sons Ltd.

Study on Physical Activity as a Determinant of Gestational Diabetes Mellitus in Antenatal Women attending a Tertiary Care Hospital

ABSTRACT Gestational diabetes mellitus (GDM), defined as glucose intolerance with first recognition in pregnancy, has become a growing health concern. Gestational diabetes mellitus has been related to significant short-term and long-term adverse health outcomes for both mothers and offspring. Physical activity in all stages of life has a great role in maintaining cardiorespiratory fitness. Regular physical activity during pregnancy improves and maintains physical fitness. In this study, 301 antenatal women aged between 19 and 45 years attending the outpatient department (OPD) of Obstetrics and Gynecology were studied for the association of physical activity and GDM. No significant association was observed between age and GDM (p = 0.0968) and between physical activity and GDM (p = 0.5880). Therefore, the present study recommends antenatal women to perform physical activity for recommended duration with all precautions and also do the activity that has minimal risk, such as brisk walk and balanced aerobic exercises. How to cite this article Srivastava S, Joshi HS, Singh A, Katyal R, Agarwal K. Study on Physical Activity as a Determinant of Gestational Diabetes Mellitus in Antenatal Women attending a Tertiary Care Hospital. Int J Adv Integ Med Sci 2016;1(3):98-100.

Oral appliance (OA) vs. CPAP in the treatment of mild obstructive sleep apnea (OSA): Are they equally effective in short term health outcomes?

Oral appliance (OA) vs. CPAP in the treatment of mild obstructive sleep apnea (OSA): Are they equally effective in short term health outcomes?

Patient cost sharing and medical expenditures for the Elderly

Despite the rapidly aging population, relatively little is known about how cost sharing affects the elderly's medical spending. Exploiting longitudinal claims data and the drastic reduction of coinsurance from 30% to 10% at age 70 in Japan, we find that the elderly's demand responses are heterogeneous in ways that have not been previously reported. Outpatient services by orthopedic and eye specialties, which will continue to increase in an aging society, are particularly price responsive and account for a large share of the spending increase. Lower cost sharing increases demand for brand-name drugs but not for generics. These high price elasticities may call for different cost-sharing rules for these services. Patient health status also matters: receiving medical services appears more discretionary for the healthy than the sick in the outpatient setting. Finally, we found no evidence that additional medical spending improved short-term health outcomes.

Two-stage model for time varying effects of zero-inflated count longitudinal covariates with applications in health behaviour research.

This study proposes a two-stage approach to characterize individual developmental trajectories of health risk behaviors and delineate their time-varying effects on short-term or long-term health outcomes. Our model can accommodate longitudinal covariates with zero-inflated counts and discrete outcomes. The longitudinal data of a well-known study of youth at high risk for substance abuse are presented as a motivating example to demonstrate the effectiveness of the model in delineating critical developmental periods of prevention and intervention. Our simulation study shows that the performance of the proposed model improves as the sample size or number of time points increases. When there are excess zeros in the data, the regular Poisson model cannot estimate either the longitudinal covariate process or its time-varying effect well. This result, therefore, emphasizes the important role that the proposed model plays in handling zero-inflation in the data.

Public versus Private Investment in Determining Child Health Outcomes in India: A Quantile Regressions Approach

This paper examines the relationship between access to drinking water, sanitation facilities, and health outcomes for children in India. We use the NFHS 2005-2006 household-level survey data to construct the conditional nutritional distribution for two anthropometric health measures for children between ages six months to two years that capture both short term and longer term health outcomes: the weight-for-height (wasting - short term) and height-forage (stunting - long term) z-scores. Using a quantile regressions approach, we find that public goods such as piped water and access to healthcare facilities are not associated with improving child health outcomes. On the other hand, private investments within the home such as pit latrines and flush toilets do have a strong influence on health outcomes, with the magnitude of the effects being the largest in the middle of the respective conditional nutritional distributions. Further, rural children at the lower end of the nutritional distribution benefit much more than their urban counterparts. We also find that the educational attainment of the mother has a strong association with better health outcomes, both in the short run as well as the long run. Finally, access to well water and boiling drinking water also matter, though their effects depend on whether the underlying health measure is a short term or long term one, and the child's relative position in the conditional nutritional distribution. Over all, our results provide evidence against one size fits all policies, and point towards incentives for private investments in sanitation and mother's education, especially in rural areas and for children in the middle of the conditional nutritional distribution.

Implementation of Computerized Physician Order Entry Is Associated With Increased Thrombolytic Administration for Emergency Department Patients With Acute Ischemic Stroke

Electronic health record systems with computerized physician order entry and condition-specific order sets are intended to standardize patient management and minimize errors of omission. However, the effect of these systems on disease-specific process measures and patient outcomes is not well established. We seek to evaluate the effect of computerized physician order entry electronic health record implementation on process measures and short-term health outcomes for patients hospitalized with acute ischemic stroke. We conducted a quasi-experimental cohort study of patients hospitalized for acute ischemic stroke with concurrent controls that took advantage of the staggered implementation of a comprehensive computerized physician order entry electronic health record across 16 medical centers within an integrated health care delivery system from 2007 to 2012. The study population included all patients admitted to the hospital from the emergency department (ED) for acute ischemic stroke, with an initial neuroimaging study within 2.5 hours of ED arrival. We evaluated the association between the availability of acomputerized physician order entry electronic health record and the rates of ED intravenous tissue plasminogen activator administration, hospital-acquired pneumonia, and inhospital and 90-day mortality, using doubly robust estimation models to adjust for demographics, comorbidities, secular trends, and concurrent primary stroke center certification status at each center. Of 10,081 eligible patients, 6,686 (66.3%) were treated in centers after the computerized physician order entry electronic health record had been implemented. Computerized physician order entry was associated with significantly higher rates of intravenous tissue plasminogen activator administration (rate difference 3.4%; 95% confidence interval 0.8% to 6.0%) but not with significant rate differences in pneumonia or mortality. For patients hospitalized for acute ischemic stroke, computerized physician order entry use was associated with increased use of intravenous tissue plasminogen activator.

Physical health of singleton children born after frozen embryo transfer using slow freezing: a 3-year follow-up study.

Are there differences in the physical health of singleton children born after frozen embryo transfer (FET) compared with children born after fresh embryo transfer (fresh ET)? Register-based health indicators were similar among FET and fresh ET singletons during a 3-year follow-up. Large cohort studies have shown that perinatal outcomes are similar or even better in FET than fresh ET children. The early childhood morbidity among FET and fresh ET children has been shown to be quite similar, but so far these studies have been small. The short-term health outcomes of assisted reproductive technology (ART) children have been shown to be slightly worse compared with spontaneously conceived children. This register-based study includes women who had undergone ART treatments leading to singleton live births (n = 4758 children) in 1995-2006. A 10% random sample of women with spontaneous pregnancies from the Finnish Medical Birth Register (FMBR) served as the reference group (n = 31 137 children). The children were identified through the FMBR by using the mother's personal identification (ID) number. Children's ID numbers were linked with two nationwide registries; the Finnish Hospital Discharge Register and the Cause-of-Death Register at Statistics Finland. Information on all visits was received until 2009 using ICD-10 codes. The study includes 1825 children born after FET, 2933 children born after fresh ET and 31 137 children born after spontaneous pregnancies. The risk estimates for diseases were adjusted for the child's year of birth and maternal age, parity, socio-economic status and prematurity. The study focused on the differences between FET and fresh ET children. Most health indicators were similar among FET and fresh ET children during the 3-year follow-up. The most common discharge diagnoses, including gastroenteritis and colitis, otitis, upper and lower respiratory diseases, asthma and allergies were similar between the ART groups. A large proportion of FET children (70.1%) and fresh ET children (69.9%) had visited a hospital at least once (P = 0.877). The risk of hospital admission did not differ between the two groups after adjusting for premature births [adjusted odds ratio (aOR) 1.01; 0.88-1.17]. Comparing with children born after spontaneously conceived pregnancies, the risk of hospital admission was slightly increased in the ART group, even after adjusting for premature births (aOR 1.10; 1.02-1.19). Due to the study design, we were not able to control for some parental background factors, such as the cause and length of infertility. Furthermore, the health registries do not include data on the growth of the children. Our findings are generalizable only to the slow-freezing method. Our study provides further evidence of the safety of embryo cryopreservation. The early physical health of FET children is similar to that of children born after fresh ET. This study was funded by the University Hospital of Oulu and Helsinki, Finland. The National Institute for Health and Welfare (THL) covered the data linkages and the work of Mika Gissler. There are no competing interests to be reported.

Implementation and Operational Research: Effect of Integration of HIV Care and Treatment Into Antenatal Care Clinics on Mother-to-Child HIV Transmission and Maternal Outcomes in Nyanza, Kenya: Results From the SHAIP Cluster Randomized Controlled Trial.

Many HIV-infected pregnant women identified during antenatal care (ANC) do not enroll in long-term HIV care, resulting in deterioration of maternal health and continued risk of HIV transmission to infants. We performed a cluster randomized trial to evaluate the effect of integrating HIV care into ANC clinics in rural Kenya. Twelve facilities were randomized to provide either integrated services (ANC, prevention of mother-to-child transmission, and HIV care delivered in the ANC clinic; n = 6 intervention facilities) or standard ANC services (including prevention of mother-to-child transmission and referral to a separate clinic for HIV care; n = 6 control facilities). There were high patient attrition rates over the course of this study. Among study participants who enrolled in HIV care, there was 12-month follow-up data for 256 of 611 (41.8%) women and postpartum data for only 325 of 1172 (28%) women. By 9 months of age, 382 of 568 (67.3%) infants at intervention sites and 338 of 594 (57.0%) at control sites had tested for HIV [odds ratio (OR) 1.45, 95% confidence interval (CI): 0.71 to 2.82]; 7.3% of infants tested HIV positive at intervention sites compared with 8.0% of infants at control sites (OR 0.89, 95% CI: 0.56 to 1.43). The composite clinical/immunologic progression into AIDS was similar in both arms (4.9% vs. 5.1%, OR 0.83, 95% CI: 0.41 to 1.68). Despite the provision of integrated services, patient attrition was substantial in both arms, suggesting barriers beyond lack of service integration. Integration of HIV services into the ANC clinic was not associated with a reduced risk of HIV transmission to infants and did not appear to affect short-term maternal health outcomes.

Returns to Treatment in the Formal Health Care Sector: Evidence from Tanzania.

Improving access to the formal health care sector is a primary public health goal in many low-income countries. But the returns to this access are unclear, given that the quality of care at public health facilities is often considered inadequate. We exploit temporal and geographic variation in the cost of traveling to formal sector health facilities to show that treatment at these facilities improves short-term health outcomes for acutely ill children in Tanzania. Our results suggest that these improvements are driven in part by more timely receipt of and better adherence to antimalarial treatment.