Decreased fertility rates in 9639 women diagnosed with inflammatory bowel disease: a United Kingdom population-based cohort study

Background: Clinical studies have reported reduced fertility in women with inflammatory bowel disease (IBD). Aim: To compare fertility rates in women with IBD to those in women without IBD and assess whether the relative fertility differed following IBD diagnosis, flares and surgery. Methods: Women aged 15-44 years in 1990-2010 were identified from a UK primary care database. We estimated overall and age-specific fertility rates by 5-year age bands for women with and without IBD. We used Poisson regression to calculate adjusted fertility rate ratios (AFRR), adjusted for age, smoking and socioeconomic deprivation. Results: There were 46.2 live births per 1000 person-years [95% confidence interval (95% CI); 44.6-47.9] in 9639 women with IBD and 49.3 (95% CI 49.2-49.5) in 2 131 864 without (AFRR: 0.93; 95% CI: 0.89-0.96). Excluding periods of contraception use, the AFRR was 0.99 (95% CI: 0.95-1.03). Before diagnosis, the AFRR for women with ulcerative colitis (UC) was 1.07 (95% CI: 0.99-1.16) and was 0.88 (95% CI: 0.81-0.97) for women with CD. After diagnosis, AFRRs were 0.87 (95% CI: 0.82-0.94) for CD and 0.92 (95% CI: 0.86-1.00) for UC. The fertility rate was lower following flares (AFRR: 0.70; 95% CI: 0.59-0.82) or surgery (AFRR: 0.84; 95% CI: 0.77-0.92). Women with pouch and non-pouch surgery had similar overall fertility though the reduction after surgery was greater for pouches (AFRR: 0.48; 95% CI: 0.23-0.99). Conclusions: Women with Crohn's disease have marginally lower fertility rates. These rates decreased following flares and surgical interventions. Fertility rates returned almost to normal when women were not prescribed contraception but the reduction following surgical intervention remained. As the lifetime effect of pouch vs. nonpouch surgery on fertility is small, the reduction post-pouch surgery should be interpreted with caution

Systematic review with network meta‐analysis: the efficacy of anti‐ TNF agents for the treatment of Crohn's disease

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107372/1/apt12749.pd

Letter: biological drugs for inducing remission in ulcerative colitis – authors' reply

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106897/1/apt12724.pd

Letter: comparative efficacy of biological therapy in patients with ulcerative colitis – authors’ reply

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107370/1/apt12773.pd

Advances in the healing of flexor tendon injuries

The intrasynovial flexor tendons of the hand are critical for normal hand function. Injury to these tendons can result in absent finger flexion, and a subsequent loss of overall hand function. The surgical techniques used to repair these tendons have improved in the past few decades, as have the postoperative rehabilitation protocols. In spite of these advances, intrasynovial flexor tendon repairs continue to be plagued by postoperative scar formation, which limits tendon gliding and prevents a full functional recovery. This paper describes the current challenges of flexor tendon repair, and evaluates the most recent advances and strategies for achieving an excellent functional outcome.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106844/1/wrr12161.pd

Editorial: visceral fat as a predictor of post‐operative recurrence of Crohn’s disease

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137608/1/apt14069.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137608/2/apt14069_am.pd

The meaning of educational change in post-Soviet Tajikistan : educational encounters in Badakhshan : how educators in an in-service institution in rural Badakhshan understand and respond to educational change

Abstract\ud This thesis examines educational change in the province of Badakhshan,\ud Tajikistan, where the processes of change are framed in the post -Soviet\ud transition from communism to incipient forms of democracy and from a command\ud to market economy. It focuses on the encounter of an international development\ud agency, the Aga Khan Foundation (AKF), and a government, in-service, teacher\ud training institution, the Institute of Professional Development (IPD). That\ud interaction is also contextualised in a very particular relationship: the head of\ud AKF, the Aga Khan, is also the spiritual leader of the Badakhshani community.\ud Hence, development and faith perspectives intersect in this change process (es).\ud Using a qualitative approach and a case study design the research makes visible\ud educational change as it impacts structures, institutions and individual educators\ud in post-Soviet Badakhshan. It draws on the work of Birzea (1994), Venda 1991;\ud 1999), Foucault (1972; 1980) and Gramsci (1971) to understand how institutional\ud transformation processes are mediated and contested as the IPD changes from a\ud government body to a 'public-private' one.\ud The research finds that notwithstanding the faith connection, institutional\ud transformation involves ideological, epistemological and hegemonic contestations\ud as well as new learning. Responses include ambivalence, resistance,\ud adaptation, appropriation and reclamation of educational and institutional change\ud through a recasting of social and professional relationships and a mastery of\ud international aid discourses. The study reveals that there is not 'a change\ud process' but, instead, change(s) processes that are multiple, interlinked, iterative,\ud simultaneous and sometimes chaotic. It argues that the change contexts, the\ud macro and micro narratives that attend it and the processes of educational\ud transformation are better understood through a re-conceptualisation of familiar\ud notions of educational change(s), tradition and development. It concludes that\ud the role of faith is central to how development is defined, responded to and\ud appropriated in this little-studied context and contributes to the knowledge of\ud international development across cultures

Semi‐supervised joint learning for longitudinal clinical events classification using neural network models

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163377/2/sta4305.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163377/1/sta4305_am.pd

Spironolactone and colitis: Increased mortality in rodents and in humans

Background: Crohn's disease causes intestinal inflammation leading to intestinal fibrosis. Spironolactone is an antifibrotic medication commonly used in heart failure to reduce mortality. We examined whether spironolactone is antifibrotic in the context of intestinal inflammation. Methods: In vitro, spironolactone repressed fibrogenesis in transforming growth factor beta (TGF‐β)‐stimulated human colonic myofibroblasts. However, spironolactone therapy significantly increased mortality in two rodent models of inflammation‐induced intestinal fibrosis, suggesting spironolactone could be harmful during intestinal inflammation. Since inflammatory bowel disease (IBD) patients rarely receive spironolactone therapy, we examined whether spironolactone use was associated with mortality in a common cause of inflammatory colitis, Clostridium difficile infection (CDI). Results: Spironolactone use during CDI infection was associated with increased mortality in a retrospective cohort of 4008 inpatients (15.9% vs. 9.1%, n = 390 deaths, P < 0.0001). In patients without liver disease, the adjusted odds ratio (OR) for inpatient mortality associated with 80 mg spironolactone was 1.99 (95% confidence interval [CI]: 1.51–2.63) In contrast to the main effect of spironolactone mortality, multivariate modeling revealed a protective interaction between liver disease and spironolactone dose. The adjusted OR for mortality after CDI was 1.96 (95% CI: 1.50–2.55) for patients without liver disease on spironolactone vs. 1.28 (95% CI: 0.82–2.00) for patients with liver disease on spironolactone when compared to a reference group without liver disease or spironolactone use. Conclusions: We propose that discontinuation of spironolactone in patients without liver disease during CDI could reduce hospital mortality by 2‐fold, potentially reducing mortality from CDI by 35,000 patients annually across Europe and the U.S. (Inflamm Bowel Dis 2011;)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92045/1/21929_ftp.pd