Reducing LDL cholesterol (LDL-C) with statin-based therapy reduces the risk of major atherosclerotic events among patients with CKD, including dialysis patients, but the effect of lowering LDL-C on ...vascular access patency is unclear.
The Study of Heart and Renal Protection (SHARP) randomized patients with CKD to 20 mg simvastatin plus 10 mg ezetimibe daily versus matching placebo. This study aimed to explore the effects of treatment on vascular access occlusive events, defined as any access revision procedure, access thrombosis, removal of an old dialysis access, or formation of new permanent dialysis access.
Among 2353 SHARP participants who had functioning vascular access at randomization, allocation to simvastatin plus ezetimibe resulted in a 13% proportional reduction in vascular access occlusive events (355 29.7% for simvastatin/ezetimibe versus 388 33.5% for placebo; risk ratio RR, 0.87; 95% confidence interval 95% CI, 0.75 to 1.00; P=0.05). There was no evidence that the effects of treatment differed for any of the separate components of this outcome. To test the hypothesis raised by SHARP, comparable analyses were performed using the AURORA (A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events) trial cohort. AURORA did not provide independent confirmation (vascular access occlusive events: 352 28.9% for rosuvastatin versus 337 27.6% for placebo; RR, 1.06, 95% CI, 0.91 to 1.23; P=0.44). After combining the two trials, the overall effect of reducing LDL-C with a statin-based regimen on vascular access occlusive events was not statistically significant (707 29.3% with any LDL-C-lowering therapy versus 725 30.5% with placebo; RR, 0.95, 95% CI, 0.85 to 1.05; P=0.29).
Exploratory analyses from SHARP suggest that lowering LDL-C with statin-based therapy may improve vascular access patency, but there was no evidence of benefit in AURORA. Taken together, the available evidence suggests that any benefits of lowering LDL-C on vascular access patency are likely to be modest.
Background. Homicide of women (femicide) by intimate partners is the most serious form of violence against women. The purpose of this analysis of a larger multisite study was to describe health care ...use in the year prior to murder of women by their intimate partner in order to identify opportunities for intervention to prevent femicide.
Methods. A sample of femicide cases was identified from police or medical examiner records. Participants (n = 311) were proxy informants (most often female family members) of victims of intimate partner femicide from 11 U.S. cities. Information about prior domestic abuse and use of health care and other helping agencies for victims and perpetrators was obtained during structured telephone interviews.
Results. Most victims had been abused by their partners (66%) and had used health care agencies for either injury or physical or mental health problems (41%). Among women who had been pregnant during the relationship, 23% were beaten by partners during pregnancy. Among perpetrators with fair or poor physical health, 53% had contact with physicians and 15% with fair or poor mental health had seen a doctor about their mental health problem. Among perpetrators with substance problems, 5.4% had used alcohol treatment programs and 5.7% had used drug treatment programs.
Conclusions. Frequent contacts with helping agencies by victims and perpetrators represent opportunities for the prevention of femicide by health care providers.
Many college students experience difficulties in basic academic skills. Recent research suggests that much of this difficulty may lie in heuristic competency-the ability to use and successfully ...manage general cognitive strategies. In the present study, the authors evaluated this possibility. They compared participants' performance on a practice California Basic Educational Skills Test and on a series of questions in the natural sciences with heuristic and algorithmic performance on a series of mathematics and reading comprehension exercises. Heuristic competency in mathematics was associated with better scores in science and mathematics. Verbal and algorithmic skills were associated with better reading comprehension. These results indicate the importance of including heuristic training in educational contexts and highlight the importance of a relatively domain-specific approach to questions of cognition in higher education.
PDF
