Using Food Timing as an Intervention to Improve Medication Compliance

2021 ◽  
Vol 10 (3) ◽  
pp. 16-31
Author(s):  
Saibal Kumar Saha ◽  
Anindita Adhikary ◽  
Ajeya Jha ◽  
Vijay K. Mehta
Keyword(s):  
Chronic Disease ◽  
Relative Risk ◽  
Confidence Interval ◽  
Medication Compliance ◽  
Risk Difference ◽  
Referral Hospital ◽  
Lower Odds ◽  
Probability Estimates ◽  
Medication Dose ◽  
Scheduled Time

Medication non-compliance is common among patients suffering from chronic disease. The research aims to find the effectiveness of food timing as a form of intervention to improve medication compliance. 509 patients were interviewed who were under the medication and had their treatment from Central Referral Hospital, Sikkim. The technique of probability estimates, risk difference, relative risk, and odds ratios were used to do the analysis and predictions of medication compliance when food timing was used as a form of reminder. Analysis of confidence interval at 95% ensured that the results obtained were due to the use of reminder and not by chance. The study reveals that with the help of food timing as a form of reminder, a patient has 50.2% lower odds of deferring from the scheduled time of medicine. There are 129.2% greater odds of completing the course of medication, 41.4% lower odds of missing the medication consciously, and there are 56.6% lower odds of missing the medication dose. The probability numbers indicate the effectiveness of usage of this form of reminder.

scholarly journals Formulas, Algorithms and Examples for Binomial Distributed Data Confidence Interval Calculation: Excess Risk, Relative Risk and Odds Ratio

Mathematics ◽  
2021 ◽  
Vol 9 (19) ◽  
pp. 2506
Author(s):  
Lorentz Jäntschi
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Risk Difference ◽  
Excess Risk ◽  
Distributed Data ◽  
Medical Studies ◽  
Measures Of Association ◽  
Discrete Population ◽  
Current Guidelines

Medical studies often involve a comparison between two outcomes, each collected from a sample. The probability associated with, and confidence in the result of the study is of most importance, since one may argue that having been wrong with a percent could be what killed a patient. Sampling is usually done from a finite and discrete population and it follows a Bernoulli trial, leading to a contingency of two binomially distributed samples (better known as 2×2 contingency table). Current guidelines recommend reporting relative measures of association (such as the relative risk and odds ratio) in conjunction with absolute measures of association (which include risk difference or excess risk). Because the distribution is discrete, the evaluation of the exact confidence interval for either of those measures of association is a mathematical challenge. Some alternate scenarios were analyzed (continuous vs. discrete; hypergeometric vs. binomial), and in the main case—bivariate binomial experiment—a strategy for providing exact p-values and confidence intervals is proposed. Algorithms implementing the strategy are given.

scholarly journals Association between use of macrolides in pregnancy and risk of major birth defects: nationwide, register based cohort study

BMJ ◽  
2021 ◽  
pp. n107 ◽  
Author(s):  
Niklas Worm Andersson ◽  
Rasmus Huan Olsen ◽  
Jon Trærup Andersen
Keyword(s):  
Cohort Study ◽  
Relative Risk ◽  
Confidence Interval ◽  
Birth Defects ◽  
Absolute Risk ◽  
Risk Difference ◽  
Relative Risk Ratio ◽  
Macrolide Antibiotics ◽  
Increased Risk ◽  
In Pregnancy

Abstract Objective To examine the association between the use of macrolide antibiotics in pregnancy and the risk of major birth defects. Design Nationwide, register based cohort study. Setting Denmark, 1997-2016. Participants Of 1 192 539 live birth pregnancies, pregnancies during which macrolides had been used (13 019) were compared with those during which penicillin (that is, phenoxymethylpenicillin) had been used (matched in a 1:1 ratio on propensity scores). Other comparative groups were pregnancies when macrolides had been used recently but before pregnancy (matched 1:1) and pregnancies where no antibiotics had been used (matched 1:4). Main outcome measures Association with an outcome of any major birth defect and specific subgroups of birth defects were assessed by relative risk ratios and absolute risk differences. Results In matched comparisons, 457 infants were born with major birth defects to women who had used macrolides during pregnancy (35.1 per 1000 pregnancies) compared with 481 infants (37.0 per 1000 pregnancies) to women who had used penicillin (relative risk ratio 0.95; 95% confidence interval 0.84 to 1.08), corresponding to an absolute risk difference of −1.8 (95% confidence interval −6.4 to 2.7) per 1000 pregnancies. The risk of major birth defects was not significantly increased for women who had used macrolides during pregnancy compared with those who had used macrolides recently but before becoming pregnant (relative risk ratio 1.00 (95% confidence interval 0.88 to 1.14); absolute risk difference −0.1 (95% confidence interval −4.8 to 4.7) per 1000 pregnancies) or compared with women who did not use any antibiotics (1.05 (0.95 to 1.17); 1.8 (−1.7 to 5.3) per 1000 pregnancies). For all three comparative group analyses and in the analyses of use of individual macrolides, no significant increased risk of specific subgroups of birth defects associated with the use of macrolides was found. Conclusions In this nationwide cohort study, the use of macrolide antibiotics in pregnancy was not associated with an increased risk of major birth defects. Analyses of the associated risk of 12 specific subgroups of birth defects with the use of macrolides in pregnancy were not significant.

scholarly journals Descriptive Epidemiology of Rescue-Related Fatal Drowning in Turkey

2021 ◽  
Vol 18 (12) ◽  
pp. 6613
Author(s):  
Ali Işın ◽  
Adnan Turgut ◽  
Amy E. Peden
Keyword(s):  
Public Health ◽  
Retrospective Study ◽  
Relative Risk ◽  
Confidence Interval ◽  
Descriptive Epidemiology ◽  
Death Registry ◽  
Public Health Threat ◽  
Reduction Strategies ◽  
Media Reports ◽  
Risk Reduction Strategies

Drowning is a public-health threat and a leading cause of injury-related death. In Turkey, drowning results in 900 fatalities annually, and the rate is rising. As data on rescue-related drowning are scarce, this retrospective study explores the epidemiology of fatal drowning among rescuers in Turkey. As there are no routinely collected death registry data on drowning in Turkey, data were sourced from media reports of incidents between 2015 and 2019. Rescuer fatalities were analysed by age, sex, activity prior to rescue, location, incident day of week and season, and place of death. Statistical analyses comprised X2 tests of significance (p < 0.05) and calculation of relative risk (95% confidence interval) using fatality rates. In total, 237 bystander rescuers drowned (90% male; 35% 15–24 years). In 33% of cases, the primary drowning victim (PDV) was successfully rescued, while in 46% of cases the rescue resulted in multiple drowning fatalities (mean = 2.29; range 1–5 rescuers). Rescues were more likely to be successful in saving the PDV if undertaken at the beach/sea (X2 = 29.147; p < 0.001), while swimming (X2 = 12.504; p = 0.001), or during summer (X2 = 8.223; p = 0.029). Risk of bystander rescue-related fatal drowning was twice as high on weekdays compared to on weekends (RR = 2.04; 95%CI: 1.56–2.67). While bystanders play an important role in reducing drowning, undertaking a rescue is not without risk and can lead to multiple drowning incidents. Training in rescue and resuscitation skills (especially the prioritization of non-contact rescues) coupled with increasing awareness of drowning risk, are risk-reduction strategies which should be explored in Turkey.

Combined Associations of Muscle-Strengthening Activities and Accelerometer-Assessed Physical Activity on Multimorbidity: Findings From NHANES

2016 ◽  
Vol 31 (4) ◽  
pp. 274-277 ◽  
Author(s):  
Scott J. Dankel ◽  
Jeremy P. Loenneke ◽  
Paul D. Loprinzi
Keyword(s):  
Physical Activity ◽  
Logistic Regression ◽  
Chronic Disease ◽  
Confidence Interval ◽  
National Health ◽  
Cost Effective ◽  
Muscle Strengthening ◽  
Recommended Guidelines ◽  
Nutritional Examination Survey

Purpose. Physical activity (PA) has previously been demonstrated to be inversely related with multimorbidity (having more than one chronic disease); however, it is unknown whether dual participation in both PA and muscle-strengthening activities (MSA) may further reduce the odds of being multimorbid. Therefore, the purpose of our study was to determine the association between multimorbidity and individuals meeting recommended guidelines for both PA and MSA. Design. Nonexperimental. Setting. The 2003–2006 National Health and Nutritional Examination Survey. Subjects. Four thousand five hundred eighty-seven adults aged ≥20 years. Measures. Accelerometry-measured PA, self-reported MSA, and multimorbidity. Analysis. Data were analyzed using multivariable linear and logistic regression. Results. The odds (95% confidence interval) of being multimorbid for those only meeting MSA guidelines, only meeting PA guidelines, and meeting both PA and MSA guidelines (vs. not meeting either), respectively, were .69 (.48, .98; p = .04), .55 (.44, .70; p < .01), and .38 (.27, .53; p < .01). Conclusion. Our findings demonstrate that individuals meeting recommended guidelines for both MSA and PA were less likely to be multimorbid than individuals participating in one or none of these exercise modalities. Determining effective ways to initiate and maintain concurrent adoption of MSA and PA is needed to provide a cost-effective behavioral alternative for reducing the prevalence of multimorbidity.

Risky Business: Making Sense of Estimates of Risk

1998 ◽  
Vol 43 (4) ◽  
pp. 411-415 ◽  
Author(s):  
David L Streiner
Keyword(s):  
Relative Risk ◽  
Odds Ratio ◽  
Risk Difference ◽  
Attributable Risk ◽  
Absolute Difference ◽  
Number Needed To Treat ◽  
Making Sense ◽  
Specific Outcome ◽  
Relative Differences ◽  
Risky Business

This article describes various indices of risk, which is the probability that a person will develop a specific outcome. The risk difference is the absolute difference in risks between 2 groups and can be used either to compare the outcome of 2 groups, one of which was exposed to some genetic or environmental factor, or to see how much of an effect a treatment may have. The reciprocal of the risk difference, the number needed to treat, expresses how many patients must receive the intervention in order for 1 person to derive some benefit. Attributable risk reflects the proportion of cases due to some putative cause and indicates the number of cases that can be averted if the cause were removed. Finally, the relative risk and odds ratio reflect the relative differences between groups in achieving some outcome, either good (a cure) or bad (development of a disorder).

Association between Diabetes Mellitus and the Risk of Herpes Zoster: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Chun-Ta Huang ◽  
Chi-Yu Lee ◽  
Heng-You Sung ◽  
Shu-Jung Liu ◽  
Po-Chih Liang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Herpes Zoster ◽  
Relative Risk ◽  
General Population ◽  
Confidence Interval ◽  
Varicella Vaccination ◽  
Cochrane Central Register ◽  
Case Control Studies ◽  
Increased Risk

Abstract Context Individuals with diabetes mellitus (DM) are susceptible to various infections. Objective We estimated the risk of herpes zoster (HZ) among individuals with DM compared to individuals in the general population. Data Sources We searched the PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trails, Cumulative Index to Nursing and Allied Health Literature and PerioPath databases from their inception to January 30, 2021 for studies on the risk of HZ in individuals with DM. Study Selection Two authors independently screened all articles identified. Data Extraction The same two authors independently extracted the data. Four case-control studies and 12 cohort studies were included. Data Synthesis Meta-analyses were performed using fixed and mixed-effects models. In the pooled analysis, individuals with DM had a higher risk of developing HZ (pooled relative risk: 1.38, 95% confidence interval: 1.21–1.57) than individuals in the general population. The results were consistent in subgroup analyses stratified by type of diabetes, age, and study design. In individuals with DM, cardiovascular disease had an additive effect on increasing the risk of HZ (pooled relative risk: 1.19, 95% confidence interval: 1.11–1.28). There was a linear dose-response association between age and the risk of HZ in individuals with DM. Conclusion Individuals with DM have an increased risk of HZ compared to the general population. Varicella vaccination should be provided to individuals with DM regardless of their age, prioritizing older adults and those with cardiovascular disease. Varicella vaccination policies for individuals with DM should be updated based on the evidence.

Mental disorders and their impact on school performance and high school completion by gender in Australia: A matched population-based cohort study

2021 ◽  
pp. 000486742110616
Author(s):  
Rebecca J Mitchell ◽  
Anne McMaugh ◽  
Carolyn Schniering ◽  
Cate M Cameron ◽  
Reidar P Lystad ◽  
...  
Keyword(s):  
High School ◽  
Relative Risk ◽  
Young People ◽  
Confidence Interval ◽  
Mental Disorder ◽  
School Performance ◽  
Adjusted Relative Risk ◽  
Minimum Standard ◽  
Young Males ◽  
Increased Risk

Background: Young people with a mental disorder often perform poorly at school and can fail to complete high school. This study aims to compare scholastic performance and high school completion of young people hospitalised with a mental disorder compared to young people not hospitalised for a mental disorder health condition by gender. Method: A population-based matched case-comparison cohort study of young people aged ⩽18 years hospitalised for a mental disorder during 2005–2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalised linear mixed modelling examined risk of school performance below the national minimum standard and generalised linear regression examined risk of not completing high school for young people with a mental disorder compared to matched peers. Results: Young males with a mental disorder had over a 1.7 times higher risk of not achieving the national minimum standard for numeracy (adjusted relative risk: 1.71; 95% confidence interval: [1.35, 2.15]) and reading (adjusted relative risk: 1.99; 95% confidence interval: [1.80, 2.20]) compared to matched peers. Young females with a mental disorder had around 1.5 times higher risk of not achieving the national minimum standard for numeracy (adjusted relative risk: 1.50; 95% confidence interval: [1.14, 1.96]) compared to matched peers. Both young males and females with a disorder had around a three times higher risk of not completing high school compared to peers. Young males with multiple disorders had up to a sixfold increased risk and young females with multiple disorders had up to an eightfold increased risk of not completing high school compared to peers. Conclusion: Early recognition and support could improve school performance and educational outcomes for young people who were hospitalised with a mental disorder. This support should be provided in conjunction with access to mental health services and school involvement and assistance.

scholarly journals Pregnancy Outcome Following Gestational Exposure to Fluoroquinolones: a Multicenter Prospective Controlled Study

1998 ◽  
Vol 42 (6) ◽  
pp. 1336-1339 ◽  
Author(s):  
Ronen Loebstein ◽  
Antonio Addis ◽  
Elaine Ho ◽  
Roseann Andreou ◽  
Suzanne Sage ◽  
...  
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Pregnancy Outcome ◽  
Bacterial Resistance ◽  
Antimicrobial Agents ◽  
In Utero ◽  
Controlled Study ◽  
Control Group ◽  
Increased Risk ◽  
Clinically Significant

ABSTRACT Concerns regarding the teratogenicity of fluoroquinolones have resulted in their restricted use during gestation. This is despite an increasing need for their use due to emerging bacterial resistance. The objectives of the present investigation were to evaluate pregnancy and fetal outcomes following maternal exposure to fluoroquinolones and to examine whether in utero exposure to quinolones is associated with clinically significant musculoskeletal dysfunctions. We prospectively enrolled and followed up 200 women exposed to fluoroquinolones (norfloxacin, ciprofloxacin, ofloxacin) during gestation. Pregnancy outcome was compared with that for 200 controls matched for age and for smoking and alcohol consumption habits. Controls were exposed to nonteratogenic, nonembryotoxic antimicrobial agents matched by indication, duration of therapy (±3 days), and trimester of exposure. Rates of major congenital malformations did not differ between the group exposed to quinolones in the first trimester (2.2%) and the control group (2.6%) (relative risk, 0.85; 95% confidence interval, 0.21 to 3.49). Women treated with quinolones had a tendency for an increased rate of therapeutic abortions compared with the rate among women exposed to nonteratogens (relative risk, 4.50; 95% confidence interval, 0.98 to 20.57), resulting in lower live-birth rates (86 versus 94%; P = 0.02). The rates of spontaneous abortions, fetal distress, and prematurity and the birth weight did not differ between the groups. Gross motor developmental milestone achievements did not differ between the children of the mothers in the two groups. We concluded that the use of fluoroquinolones during embryogenesis is not associated with an increased risk of major malformations. There were no clinically significant musculoskeletal dysfunctions in children exposed to fluoroquinolones in utero. The higher rate of therapeutic abortions observed in quinolone-exposed women compared to that for their controls may be secondary to the misperception of a major risk related to quinolone use during pregnancy.

Anxiety and depression in parents 4–9 years after the loss of a child owing to a malignancy: a population-based follow-up

2004 ◽  
Vol 34 (8) ◽  
pp. 1431-1441 ◽  
Author(s):  
ULRIKA KREICBERGS ◽  
UNNUR VALDIMARSDÓTTIR ◽  
ERIK ONELÖV ◽  
JAN-INGE HENTER ◽  
GUNNAR STEINECK
Keyword(s):  
Psychological Distress ◽  
Relative Risk ◽  
Confidence Interval ◽  
Stressful Life Event ◽  
Population Based ◽  
Anxiety And Depression ◽  
Control Group ◽  
Bereaved Parents ◽  
Increased Risk ◽  
Loss Of A Child

Background. Some consider the loss of a child as the most stressful life event. When the death is caused by a malignancy, the parents are commonly exposed not only to their own loss, but also to the protracted physical and emotional suffering of the child. We investigated parental risk of anxiety and depression 4–9 years after the loss of a child owing to a malignancy.Method. In 2001, we attempted to contact all parents in Sweden who had lost a child due to a malignancy during 1992–1997. We used an anonymous postal questionnaire and utilized a control group of non-bereaved parents with a living child.Results. Participation among bereaved parents was 449/561 (80%); among non-bereaved 457/659 (69%). We found an increased risk of anxiety (relative risk 1·5, 95% confidence interval 1·1–1·9) and depression (relative risk 1·4, 95% confidence interval 1·1–1·7) among bereaved parents compared with non-bereaved. The risk of anxiety and depression was higher in the period 4–6 years after bereavement than in the 7–9 years period, during which the average excess risks approached zero. Psychological distress was overall higher among bereaved mothers and loss of a child aged 9 years or older implied an increased risk, particularly for fathers.Conclusions. Psychological morbidity in bereaved parents decreases to levels similar to those among non-bereaved parents 7–9 years after the loss. Bereaved mothers and parents who lose a child 9 years or older have on average an excess risk for long-term psychological distress.

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