Qualitative assessment of medication adherence at an urban leprosy outpatient clinic in Hyderabad, India.

OBJECTIVES: The objective of this study was to measure medication adherence amongst outpatients attending an urban leprosy clinic in Hyderabad, India. DESIGN: In this study of observational design, the urine spot test and Morisky Scale questionnaire were concurrently used as qualitative measures of medication adherence. RESULTS: Fifty two patients met the inclusion criteria for this study; 13 patients (25%) were non-adherent according to the Morisky scale questionnaire and 17 patients (33%) according to the urine spot test. 48% of patients were non-adherent on the basis of the urine spot test and/or the Morisky scale questionnaire. CONCLUSION: The results suggest that poor medication adherence remains an ongoing issue in the management of outpatients with leprosy.

A viagem científica de Neiva e Penna: roteiro para os estudos das doenças do sertão / The scientific journey taken by Neiva and Penna: a blueprint for studies of diseases from the Brazilian hinterland

Analisa o relatório de Arthur Neiva e Belisario Penna , focalizando a contribuição dos autores ao estudo de uma das doenças endêmicas por eles encontrada ao longo de todo o trajeto percorrido, de longa data conhecida popularmente por 'mal de engasgo'. Observaram e descreveram com minúcia os sintomas apresentados pelos doentes e a associação frequente do mal de engasgo com outro mal endêmico conhecido por 'vexame' ou 'vexame do coração', que consistia em crises de palpitações. Os estudos epidemiológicos e clínicos de Neiva e Penna sobre o mal de engasgo muito contribuíram para o conhecimento dessa afecção e representaram um incentivo para todos os pesquisadores que se dedicaram ao seu estudo, especialmente quanto a sua relação com a doença de Chagas.

Analyze the report by Neiva and Penna, focusing on the contribution these authors made to the study of one of the endemic diseases encountered throughout their journey, which had been long known under the popular name of mal de engasgo (choking disease). They recorded their observations and detailed descriptions of the patients' symptoms and the association frequently encountered between mal de engasgo and another endemic disease, known as vexame or vexame do coração, characterized by bouts of palpitations. Neiva and Penna's epidemiological and clinical observations of mal de engasgo were crucial for all the researchers interested in the disease, especially its relationship with Chagas disease.

A note on testing for intervention effects on binary responses.

OBJECTIVES: In some circumstances controlled trials are not feasible and treatments can only be evaluated using clinical databases. Here we consider the situation where treatment is introduced at a particular calendar time and can only be evaluated by comparison with historical controls. In these circumstances Heuer and Abel recommended using change-point methods to search for change in characteristics over the whole study period rather than simply comparing treated and untreated patients. Their recommendation is to only conclude that the intervention had an effect if a change-point could be demonstrated close in time to the introduction of the new treatment. This reduces the risk of false positives caused by confounding changes in population characteristics or changes in patient management. For binary data we develop a method that follows their philosophy and apply it to an observational study in the treatment of pin sites after orthopaedic surgery. METHODS: Tests for change in binomial probabilities based on Brownian bridge and Hansen's approximation for maximally selected chi(2) statistics are compared to an exact test by Worsley. The approximate method is generalized to logistic regression models allowing for covariates. RESULTS: The agreement of the exact and approximate method is good for sample sizes of 100 or more. The actual test size of the Hansen approximate test allowing for covariates is close to the nominal level, whereas the Brownian bridge approximation is slightly conservative. The change in pin site treatment significantly reduces the risk of infection for both adults and children. CONCLUSIONS: We consider the Hansen approximation to provide a very good and very simple method for obtaining the p-value when testing for a change in binary data event probabilities, with or without covariates.