BackgroundMicronutrient deficiency is a common public health problem in developing countries, especially for infants and children in the first two years of life. As this is an important time window for child development, micronutrient fortified complementary feeding after 6 months of age, for example with milk or cereals products, in combination with continued breastfeeding, is recommended. The overall effect of this approach is unclear.MethodsWe performed a Systematic Review and Meta-analysis to assess the impact of micronutrient fortified milk and cereal food on the health of infants and little children (aged 6 months to 5 years) compared to non-fortified food. We reviewed randomized controlled trials using electronic databases (MEDLINE and Cochrane library searches through FEB 2011), reference list screening and hand searches. Three reviewers assessed 1153 studies for eligibility and extracted data. One reviewer assessed risk of bias using predefined forms.ResultsWe included 18 trials in our analysis (n = 5’468 children; range of mean hemoglobin values: 9.0 to 12.6 g/dl). Iron plus multi micronutrient fortification is more effective than single iron fortification for hematologic outcomes. Compared to non-fortified food, iron multi micronutrient fortification increases hemoglobin levels by 0.87 g/dl (95%-CI: 0.57 to 1.16; 8 studies) and reduces risk of anemia by 57% (relative risk 0.43; 95%-CI 0.26 to 0.71; absolute risk reduction 22%; number needed to treat 5 [95%-CI: 4 to 6]; 6 Studies). Compared to non-fortified food, fortification increases serum levels of vitamin A but not of zinc. Information about functional health outcomes (e.g. weight gain) and morbidity was scarce and evidence is inconclusive. Risk of bias is unclear due to underreporting, but high quality studies lead to similar results in a sensitivity analysis.ConclusionsMulti micronutrient fortified milk and cereal products can be an effective option to reduce anemia of children up to three years of age in developing countries. On the basis of our data the evidence for functional health outcomes is still inconclusive.

ACS causes considerable costs in terms of direct medical expenditures, lost production, suffering and premature death, even without taking into account costs for its chronic consequences such as congestive heart failure.

demographic characteristics, total health care utilization and cost burden were higher for patients who suffered a TIA after an NVAF diagnosis, relative to patients who did not. OBJECTIVES:To compare clinical outcomes and cost burden of patients who suffered a stroke during the 180 days after diagnosis of non-valvular atrial fibrillation (NVAF) with patients who did not. METHODS: Based on 2005-2007 US Medical insurance claim files, patients aged 65 years and older who have had two or more primary diagnoses of NVAF, occurring within 30 days of one another, were selected. The 180-day follow-up mortality rate, health care facility use and costs for patients with and without incidences of stroke were compared. Risk adjustment was performed using the propensity score matching (PSM) method with the ProbChoice™ algorithm. RESULTS: Out of patients who were identified with and without NVAF pre-stroke (nϭ18,195), 541 (2.97%) suffered a stroke during the 180 days after the NVAF diagnosis. After PSM risk-adjustment for pre-specified covariates, mortality (7.39% vs. 1.07% pϽ0.0001), outpatient emergency room (ER) visits (80.59% vs. 48.11% pϽ0.0001), readmission rates (1.85% vs. 0.40%, pϽ0.0001), transient ischemic attacks (44 vs. 8 /100 person years), and intracranial hemorrhage rates (71 vs. 7/100 person years) were all higher for patients who suffered a stroke compared to those who did not. Although risk-adjusted outpatient ER costs and office visit costs did not differ significantly between the two groups, patients who suffered a stroke had significantly higher inpatient ($24,231 vs. $15,137, pϽ0.0001) and total ($33,439 vs. $13,782, pϽ0.0001) expenditures. CONCLUSIONS: Most of the adverse events analyzed were higher for patients who suffered a stroke after an NVAF diagnosis relative to patients who did not. Total health care utilizations and health care costs were also significantly increased. OBJECTIVES:The objective of this study was to quantify, for the first time in a Spanish population, the time and cost burden of informal care for pts with heart failure. METHODS: A descriptive analysis of a multicenter, prospective observa-A373

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sus those with 80% adherence. Total expenditures considered expenditures from inpatient admissions, ER visits, and medications. Potential savings was defined as reduction in total expenditures due to increasing adherence. RESULTS: Nonadherence resulted in increased all-cause total expenditures in diabetes, cholesterol, and heart by $240 million (M), $150M, and $47M, respectively. Increasing adherence by 2% reduced increases in all-cause expenditure by 11% to 21%. Nonadherence resulted in increased disease-specific hospitalization and ER visit expenditure for depression ($6M), diabetes ($44M), and cholesterol ($5M). However, increases in the disease-specific hospitalization and ER expenditures were offset by lower medication expenditure, thus resulting in overall lower disease-specific expenditure among the nonadherent patients. Overall, increases in medication adherence resulted in savings in all-cause expenditure but not in disease-specific expenditure. CONCLUSIONS: Medication nonadherence can be costly to payers. Increasing adherence even by small amounts may result in significant savings. OBJECTIVES:The aim of this study was to estimate prevalence and preventability of drug-related morbidity in Sweden based on pharmacists' expert opinion. Furthermore, the aim was to estimate the cost-of-illness (COI) of drug-related morbidity. METHODS: Probabilities of therapeutic outcomes of medication therapy were estimated by an expert panel of pharmacists (Nϭ29) using a two-round delphi-methodology and a conceptual model of drug-related morbidity based on a decision tree. We used an American conceptual model adjusted to the Swedish context. In the model, drug-related morbidity included new medical problems (adverse drug reactions, drug dependence and intoxications by overdose) and therapeutic failures (insufficient effects of medicines and morbidity due to untreated indication). The cost-of-illness analysis included all direct costs applying a health care perspective, using national statistics on costs. RESULTS: The expert panel estimated that 61Ϯ14% (mean Ϯ SD) of all patients visiting health care suffered from drug-related morbidity, of which 29Ϯ8% suffered from new medical problems, 17Ϯ6% from therapeutic failures, and 14Ϯ7% from a combination of both types. Of patients with drug-related morbidity, 44Ϯ18% suffered from preventable drug-related morbidity. Participants estimated that 7-39% of patients with drugrelated morbidity do not require further attention, but a majority requires health care resources due to the drug-related morbidity. The direct costs were calculated to EUR 575 (2009 value) per patient, which corresponds to an annual cost of EUR 4 billion to the Swedish health care system. The largest component in the COI of drug-related morbidity was hospitalizations, with 50% of the total cost. Advanced specialist care represented 20%, and prolonged hospital stay 11% of the resulting costs. CONCLUSIONS: Drug-related morbidity is perceived frequent and often preventable. The estimated health care costs for this mor...