Regimen-related Mortality Risk in Patients Undergoing Peritoneal Dialysis Using Hypertonic Glucose Solution: A Retrospective Cohort Study / 예방의학회지

OBJECTIVES: The main purpose of this study was to quantify the risk of mortality linked to various regimens of hypertonic peritoneal dialysis (PD) solution. METHODS: A retrospective cohort study of patients using home-based PD was carried out. The prescribed regimen of glucose-based PD solution for all patients, determined on the basis of their individual conditions, was extracted from their medical chart records. The primary outcome was death. The treatment regimens were categorized into 3 groups according to the type of PD solution used: original PD (1.5% glucose), shuffle PD (1.5 and 2.5% glucose), and serialized PD (2.5 and 4.5% glucose). Multivariate analysis (using the Weibull model) was applied to comprehensively examine survival probabilities related to the explanatory variable, while adjusting for other potential confounders. RESULTS: Of 300 consecutive patients, 38% died over a median follow-up time of 30 months (interquartile range: 15-46 months). Multivariate analysis showed that a treatment regimen with continued higher-strength PD solution (serialized PD) resulted in a lower survival rate than when the conventional strength solution was used (adjusted hazard ratio, 2.6; 95% confidence interval, 1.6 to 4.6, p < 0.01). Five interrelated risk factors (age, length of time on PD, hemoglobin levels, albumin levels, and oliguria) were significant predictors contributing to the outcome. CONCLUSIONS: Frequent exposure to high levels of glucose PD solution significantly contributed to a 2-fold higher rate of death, especially when hypertonic glucose was prescribed continuously.

Meditation for Preterm Birth Prevention: A Randomized Controlled Trial in Udonthani, Thailand

Preterm birth represents a major obstetric complication. This study aimed to assess the efficacy of a meditation programme in the prevention of preterm birth. This study was a randomized controlled trial without blinding. The study was performed at Udonthani Hospital in Northeast Thailand. A total of 199 eligible participants were randomly assigned to a five-step mindfulness meditation programme (n=84) or a control group (n=115). The control group received routine prenatal care. The meditation and control group subjects did not differ on a wide variety of sociodemographic characteristics, or in terms obstetric history and prior meditation experience. The data were analyzed on an intention-to-treat basis after delivery, using less than 37 weeks as the criterion for a preterm birth. Other outcome variables included a subjective measure of symptoms of stress. The preterm birth rate for the meditation group was significantly less than that for the control group (6.0% vs. 15.7%, p=0. 037). The stress scores reported by the meditation group markedly decreased over time (p<0.001), while the control group scores showed no change (p=0.375). The results confirm and strengthen the findings of past research indicating that participation in a meditation programme can reduce symptoms of stress. Meditation appears to be a promising technique for reducing the incidence of preterm birth. Recommendations are made for future research in this area.