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PubMed2004

The concordance of self-report with other measures of medication adherence: a summary of the literature.

OBJECTIVE: The objective of this study was to evaluate the concordance of self-report measures of medication adherence (interview, diary, or questionnaire) with nonself-report measures of adherence (administrative claims, pill count or canister weight, plasma drug concentration, electronic monitors, or clinical opinion). METHODS: A literature search was conducted to identify published reports in which self-report and nonself-report measures of adherence were used within the same study. The concordance of measures within each study was categorized as high, moderate, or low based on a comparison of the adherence estimates. RESULTS: Eight-six comparisons of self-report to nonself-report measures of adherence were identified. Thirty-seven of the 86 comparisons (43%) were categorized as highly concordant. However, concordance varied substantially by type of self-report measure and nonself-report measure. Self-report measures, in general, were highly concordant with electronic measures in only 17% of comparisons, whereas they were highly concordant with other types of nonself-report measures in 58% of comparisons (chi-square = 14.30, P <0.01). When comparing self-report measures, interviews had significantly lower concordance with nonself-report measures as compared with questionnaires or diaries (chi-square = 8.47, P = 0.01). In 15 comparisons of interviews with electronic measures, none of the comparisons were highly concordant, whereas questionnaires and diaries had moderate-to-high concordance with electronic measures in 12 of 16 comparisons (75%). CONCLUSIONS: The concordance of self-report and other measures of medication adherence varies widely based on the type of measures used. Questionnaires and diaries tend to have moderate-to-high concordance with other measures of medication adherence. However, interview-based self-reports are not concordant with electronic measures. Questionnaire and diary methods could be preferable to interviews for self-reported medication adherence.

Data Collection↗
PubMed2006

The promise and limits of racial/ethnic concordance in physician-patient interaction.

Although some scholars suggest that racial/ethnic concordance between physicians and patients will do much to eliminate disparities in medical care, the evidence for concordance effects is mixed. Using nationally representative data with an oversample of blacks and Latinos, this study examines a variety of topics, including beliefs about and preferences for concordance, the effects of concordance on patient experiences, and interactions between expectations and experiences. The results point to the limited effects of concordance in general but illuminate for whom concordance matters most. The results encourage more nuanced and contingent theories. They suggest that racial/ethnic concordance holds little salience in the minds of most black and Latino patients and that discordance has little effect. Nevertheless, there is some evidence that concordance has a positive effect among those who prefer concordance-thus the apparent effects of concordance might reflect the effects of patient choice more than concordance per se. The conclusion sketches policy implications, including the merits of promoting concordance among targeted groups of patients, even in the absence of overall effects on disparities.

Adult↗
PubMedDate not supplied

Mean arterial pressure in extremely low birth weight concordant and discordant twins during the first day of life.

OBJECTIVE: To determine mean arterial pressure (MAP) values during the first 24 hours for stable concordant and discordant extremely low birth weight (ELBW) twins and to ascertain its association with perinatal factors. BACKGROUND: In ELBW infants, whether singletons or concordant or discordant twins, hypotension is diagnosed by nonspecific clinical signs together with reference arterial pressure values extrapolated from regression models or from scarce actual observations. DESIGN: Retrospective cohort study. METHODS: We studied 26 sets of concordant and 29 sets of discordant twins, one of whom in each set weighed < or = 800 g at birth. Infants with umbilical cord hemoglobin > or = 14 g/dl and who, although mechanically ventilated, had normal acid-base balance, no patent ductus arteriosus, had not received indomethacin, steroids, muscle relaxants, narcotics, were never treated for hypotension, and survived at least 7 days were considered stable. Arterial pressures were determined by oscillometry (OBP) and direct transducer readings using an umbilical line (MAP). All admission and 10 % of the subsequent readings were measured by OBP; the remaining were measured by MAP. RESULTS: Concordant and discordant twins were similar in demographics, history of chorioamnionitis, preeclampsia, antepartum steroids, cesarean delivery, and neonatal morbidity, but were different in mean birth weight (700 and 789 g), and gestational age (GA) (25 and 27 weeks). Forty-four (82%) of all concordant and 14 (26%) of 58 discordant twins were treated empirically for hypotension. Head ultrasounds were normal or showed Grade I/II in 74% concordant, 81% discordant, and 80% discordant infants with twin-to-twin transfusion syndrome (TTTX). Neonatal mortality was 46%, 45%, and 47%, respectively. There were 14 stable concordant and 22 stable discordant. Their MAPs were different at 1 hour (29 and 34 Torr), 3 hours (29 and 35 Torr), 6 hours (30 and 37 Torr), 12 hours (31 and 36 Torr), 18 hours (33 and 35 Torr), and 24 hours (34 and 36 Torr), respectively. Twenty-six small and 26 large concordant infants had similar MAP from the 1st (27 and 28 Torr) to the 24th hour of life (43 and 43 Torr). Concordant males (often not stable) had lower MAP than concordant females. Seventeen small discordant twins had lower MAP from 1 to 24 hours (28 and 33 Torr) than 17 large discordant twins without TTTX (32 and 38 Torr). Small discordant twins with (donors) and without TTTX had similar trends and MAP values. Large discordant twins with TTTX (recipient) had the highest MAP from birth to 24 hours than any other subgroup of infants and, unlike the others, the MAP trend decreased over time. MAP correlated with GA but not with very low birth weight (< or = 750 g), although with the same GA, those with higher birth weights had higher MAP, and at the same birth weight younger GA twins had lower MAP values. CONCLUSION: MAP increases from birth to 24 hours in all concordant and discordant twins regardless of condition (stable or unstable), birth weight (large or small) or GA. Recipient TTTX twins had higher MAP throughout but, unlike the other twins, it declined over 24 hours. Small discordant and donor TTTX infants should be considered intrauterine growth restricted and are expected to have MAP commensurable to their GA and not to their birth weight.

Apgar Score↗
PubMed2006

Axial rotation of the lumbar spinal motion segments correlated with concordant pain on discography: a preliminary study.

OBJECTIVE: One possible cause of back pain in patients with intervertebral disk degeneration is decreased stability of the motion segment. Axial rotations between lumbar spinal vertebrae can be measured noninvasively with CT. We tested the hypothesis that larger axial rotations are found in motion segments with disks that test positive for concordant pain, which is considered by some investigators to be a reasonable, accurate predictor of spinal instability. SUBJECTS AND METHODS: Between October 2002 and March 2004, all patients undergoing discography were evaluated for inclusion in the study, with the approval of the institutional review board. All patients in whom concordant pain was detected at discography were enrolled in the study. The patients were placed supine in the CT scanner on a table that rotated the pelvis 8 degrees clockwise and then counterclockwise with respect to the thorax. CT images were obtained with the patient in the two positions of rotation. An automated program calculated the amount of rotation between each lumbar vertebra as a result of the table rotations. Rotations were stratified by disk level and by disk classification (concordant pain, nonconcordant pain, no significant pain). RESULTS: We recorded the axial rotations of 94 disks in 16 consecutive patients (10 women, six men; age range, 26-53 years) after two disks were excluded because of a previous fusion. There were 68 normal disks by MRI and discography, six disks with nonconcordant pain, and 20 disks with concordant pain. Rotation averaged 0.6 degrees for the normal disks, 1.4 degrees for disks with nonconcordant pain, and 1.8 degrees for disks with concordant pain. The differences were significant (analysis of variance, p < 0.001). Disks at L3-L4 with concordant pain rotated on average 1.2 degrees , whereas disks classified as normal or nonconcordant pain rotated on average 0.7 degrees (significant at p = 0.005). Disks at L4-L5 with concordant pain rotated on average 1.9 degrees , and those without concordant pain rotated on average 1.4 degrees (significant at p = 0.05). Disks with concordant pain at L5-S1 had an average rotation of 2.2 degrees , whereas disks without concordant pain had an average rotation of 1.5 degrees (marginally significant difference at p = 0.07). CONCLUSION: Concordant pain at discography predicts increased axial rotation at a lumbar disk level.

Adult↗
PubMed1999

Likelihood-based approach to estimating twin concordance for dichotomous traits.

Genetic epidemiologists are well aware that the casewise and pairwise twin concordances are two different measures. In determining appropriate estimators for each of these measures, the method of ascertainment must be considered. Here, we derive expressions for the concordance estimators and their asymptotic variances appropriate to different twin ascertainment schemes using a likelihood framework, and apply these formulas to existing data. We emphasize the distinction between concordance measures (i.e., the parameters of interest) and the concordance estimators based on the number of pairs observed. Under random or complete ascertainment the casewise estimator is asymptotically unbiased for the casewise concordance, and the pairwise estimator is asymptotically unbiased for the pairwise concordance. Under incomplete ascertainment, the casewise estimator is biased for the casewise concordance, the pairwise estimator is biased for the pairwise concordance, but the probandwise estimator is asymptotically unbiased for the casewise concordance. One can extend the likelihood equations presented here to allow the concordance parameter of interest to depend on zygosity and, if measured, other factors such as cohabitation status and similarity for genetic markers, while concurrently allowing the disease prevalence to depend on measured covariates.

Humans↗
PubMed2005

The relationship of guideline-concordant depression treatment and patient adherence to oral diabetes medications.

BACKGROUND: Many patients with diabetes experience depression, yet it is unclear if the treatment of depression in diabetic patients is concordant with national guidelines, and whether appropriate antidepressant use is associated with better diabetes self-care behaviors. OBJECTIVES: The purpose of this study was to (1) determine whether antidepressant medication use for managed care enrollees with type 2 diabetes was concordant with The Agency for Healthcare Research and Quality depression treatment guidelines; and (2) examine the relationship between guideline concordance and oral diabetes medication adherence. METHODS: Retrospective analyses were conducted using medical/pharmacy claims for 2001 from a managed care organization in the midwestern United States. Subjects were adults with type 2 diabetes treated with oral medications only. The subjects were divided into 3 groups: (1) guideline-concordant users of antidepressants; (2) those who received antidepressants not in concordance with the guidelines; and (3) nonusers of antidepressants. Antidepressant users were determined to be in concordance with the acute phase treatment guidelines if they filled at least 90 days supply of antidepressant drugs within 118 days of the first fill. Adherence to diabetes medications was measured by the medication possession ratio. A 1-way analysis of variance with Scheffe's test was used to compare the antihyperglycemic medication possession ratio across the three groups. RESULTS: One hundred eighty-two (12.5%) of the 1454 subjects initiated treatment with antidepressants. Eighty-nine (48.9%) of the 182 antidepressant users were in concordance with the acute phase treatment guidelines. Subjects with subconcordant antidepressant use had a lower mean diabetes medication possession ratio than those with either guideline-concordant use or no use (F=14.3, P<.01). CONCLUSION: Over half of the diabetic patients initiating treatment for depression did not receive therapy in concordance with the Agency for Healthcare Research and Quality guidelines. Patients whose antidepressant use was not concordant with the guidelines were also less adherent to diabetes medications.

Antidepressive Agents↗
PubMed2003

Mean arterial pressure in very low birth weight (801 to 1500 g) concordant and discordant twins during the first day of life.

OBJECTIVE: To determine retrospectively mean arterial pressure (MAP) for stable and unstable concordant and discordant very low birth weight (VLBW: 801 to 1500 g) twins during the first 24 hours of life. BACKGROUND: Morbidity and mortality are much higher for extremely low birth weight (ELBW < or =800 g) than for VLBW twins. Recently, we reported MAP trends and reference values in concordant and discordant ELBW twins. No comparable information is available for VLBW infants. DESIGN: Retrospective cohort study. METHODS: We studied 48 sets of concordant and 40 sets of discordant (birth weight difference > or =20%) consecutively born VLBW twins. Stable patients were defined as having umbilical cord hemoglobin > or =14 g/dl, nonacidotic blood gases, never treated for hypotension and survived at least 7 days. MAPs (Torr) were measured by oscillometry in 3163 and by transducer via umbilical artery in 2028 instances. RESULTS: Concordant and discordant twins were similar in demographics, history of twin-twin transfusion (TTTX), antenatal steroids, chorioamnionitis, pre-eclampsia, cesarean delivery, cord hemoglobin, normal head ultrasounds or I to II intracranial hemorrhage (97 and 99%) and neonatal mortality (4 and 5%), but were different in incidence of preterm labor (83 and 58%), birth weight (1227 and 1509 g) and gestational age (GA) (30 and 32 weeks). In all, 66 (69%) concordant twins and 61 (76%) discordant twins were stable. Stable concordant twins, whether small or large, had comparable MAP on admission that increased to 24 hours. Twins of < or =32 weeks GA had lower MAP throughout than those of > or =33 weeks GA. Although their mean birth weights were similar (1262 and 1274 g), 23 stable concordant males had significantly higher MAP than 43 concordant females. Stable discordant twins were divided into 31 small (1241 g) and 30 large (1845 g); their MAPs were different (p<0.05): 35 and 39 (admission), 35 and 39 (1 hour), 36 and 46 (6 hours), 38 and 41 (12 hours), 40 and 41 (18 hours) and 42 and 42 (24 hours) Torr. In all, 88% of small discordant twins were IUGR and 91% of large discordant twins had normal growth. TTTX syndrome occurred in 12 monochorionic sets. Nine of 12 donors were IUGR while 10 of 12 recipients had normal growth. Four of 12 donors had grades III to IV intracranial hemorrhage, eight donors and all 12 recipients had normal ultrasounds. Although their cord hemoglobin levels were similar, donor and recipient MAPs were higher than in any other group and, opposite to concordant and discordant twins, their values decreased from birth to 24 hours. CONCLUSION: In stable concordant, stable discordant, and small and large discordant twins, MAP correlates with birth weight, GA and postnatal age, and increases during the first 24 hours. In recipient and donor twin-twin transfusion infants, MAP is higher throughout and declines over time.

Birth Weight↗
PubMed1996

Concordance for childhood cancer in twins.

The causes of most childhood cancer remain elusive; some children clearly have a genetic predisposition, but in the majority the relative contributions of environmental and host factors are not established. One approach to this question is through twin concordance studies, but only the most common malignancy, acute leukemia, has been studied to date, owing to the rarity of other forms of childhood cancer. The aim of the study was to determine the concordance rates for childhood cancer in twins, in order to clarify the importance of constitutional predisposition for a range of tumor types. Twins with cancer were ascertained through three cooperative clinical trials groups, a cancer-twin registry, and a large pediatric hospital. Subjects were sent a postal questionnaire requesting information on cancer concordance and zygosity. Data were obtained on 556 twins with cancer. Three twin pairs, out of 197 twin pairs (76 monozygous, MZ, twin pairs), were concordant for leukemia, giving an MZ case-wise concordance rate (5%) that is substantially lower than previously reported. The case-wise concordance for non-retinoblastoma solid tumors was 2.2%: Two twin pairs were concordant for CNS tumors, one was concordant for neuroblastoma, and two twin pairs were concordant for cancer but not for the type of cancer. The results of the present study, together with previous data from population studies of siblings and offspring, suggest that there is not in general a strong constitutional genetic component for childhood cancers other than retinoblastoma.

Adolescent↗
PubMed1996

Concordance between rats and mice in bioassays for carcinogenesis.

According to current policy, chemicals are evaluated for possible cancer risk to humans at low dose by testing in bioassays in which high doses of the chemical are given to rodents. Thus, risk is extrapolated from high dose in rodents to low dose in humans. The accuracy of these extrapolations is generally unverifiable because data on humans are limited. However, it is feasible to examine the accuracy of extrapolations from mice to rats. If mice and rats are similar with respect to carcinogenesis, this provides some evidence in favor of interspecies extrapolations; conversely, if mice and rats are different, this casts doubt on the validity of extrapolations from mice to humans. One measure of interspecies agreement is concordance, the percentage of chemicals that are classified the same way as to carcinogenicity in mice and rats. Observed concordance in National Cancer Institute/National Toxicology Program bioassays is about 75%, which may seem on the low side because mice and rats are closely related species tested under the same experimental conditions. However, observed concordance could underestimate true concordance due to measurement error in the bioassays-a possibility demonstrated by Piegorsch et al. (Risk Anal. 12, 115-121, 1992). Expanding on this work, we show that the bias in observed concordance can be either positive or negative: an observed concordance of 75% can arise if the true concordance is anything between 20 and 100%. In particular, observed concordance can seriously overestimate true concordance.

Animals↗
PubMed2004

Care concordant with guidelines predicts decreased long-term mortality in patients with unstable angina pectoris and non-ST-elevation myocardial infarction.

Data are sparse regarding the long-term benefit of care concordant with clinical practice guidelines in patients presenting with unstable angina pectoris and non-ST-segment elevation myocardial infarction (UAP/NSTEMI), particularly in the general care setting. We extended follow-up in a preexisting cohort of 275 patients hospitalized with primary UAP/NSTEMI. Using Cox models, we compared long-term mortality between patients who received care concordant with > or =80% of 8 important guideline recommendations during the index hospitalization and patients who did not. Among all study patients, 68% received guideline-concordant care. During follow-up (median 9.4 years) 49% of patients died. Patients with UAP/NSTEMI who received guideline-concordant care had significantly decreased long-term mortality compared with those who received guideline-discordant care (hazards ratio [HR] 0.45, 95% confidence interval [CI] 0.32 to 0.64). Guideline-concordant care remained associated with decreased mortality after adjusting for other predictors of long-term mortality (HR 0.57, 95% CI 0.39 to 0.84) and after adjustment for the propensity to receive guideline-concordant care (HR 0.61, 95% CI 0.43 to 0.88). The benefit of guideline-concordant care relative to discordant care was preserved in high-risk populations shown to be less likely to receive guideline-concordant care, including patients with advanced age, congestive heart failure, elevated serum creatinine, and prior myocardial infarction. Care concordant with UAP/NSTEMI clinical practice guidelines is associated with substantially improved long-term survival. Our findings endorse the approach adopted by authors of clinical practice guidelines in generalizing evidence-based medicine to usual clinical care. In firmly establishing the benefit of consensus guidelines, the foundation is set for efforts to improve practitioner compliance with these standards.

Aged↗
PubMed2002

Non-concordance in amblyopia treatment: the effective use of 'smileys'.

PURPOSE: The success of any specific occlusion regimen is limited by the level of concordance, which is difficult to measure accurately in patching treatment. The aim of this study was to investigate prospectively the concordance rate of a group of children with strabismic and/or anisometropic amblyopia using a schematic diary based on completing 'smiley' images, filled in by the child under parental supervision, and to assess the effect of correlates such as initial visual acuity, age, and total and daily occlusion time on concordance. METHODS: We recruited 51 amblyopic children aged 13 months to 12 years (mean 6.57 +/- 2.82). The median duration of treatment was 16 weeks. Non-concordance was defined as occluding less than 75% of the prescribed time and was analyzed using a concordance index calculated from occlusion time recorded in the diary/prescribed occlusion time. RESULTS: Of the 51 patients followed prospectively, 12 (23.5%) failed to return their diaries (Group 1); 27 (52.9%) complied with occlusion (Group 2); and 12 (23.5%) failed to comply with occlusion completely (Group 3). The total proportion of non-concordance was 47.1% (Group 1 + Group 3). Concordance was not significantly related to initial visual acuity (r = -0.22, p = 0.19), patient age (F = 1.0787, p = 0.349) or total occlusion time (X2 = 2.779, p = 0.249), but the number of daily occlusion hours showed significant difference in Group 1 (X2 = 15.894, p = 0.000). When the three groups were compared for change in visual acuity, a significant difference was found between group 1 and group 2 (X2 = 6.125, p = 0.047). CONCLUSION: The substantial proportion of non-concordance in our study suggests that, although useful for recording purposes, parental diaries may not be stimulating enough to increase the overall level of concordance. Therefore, other forms of monitoring need to be explored.

Amblyopia↗
PubMed2000

Concordance of inflammatory bowel disease among Danish twins. Results of a nationwide study.

BACKGROUND: Previous studies have shown an increased risk of inflammatory bowel disease (IBD) among relatives of patients with Crohn disease and ulcerative colitis. In the present study the probandwise concordance rates for ulcerative colitis and Crohn disease among mono- and dizygotic twins were estimated. Further we aimed to evaluate whether smoking habits might influence the concordance, and to look for clinical characteristics of concordant versus discordant twin pairs. METHODS: Among the 38,507 identified twins born in Denmark from 1953 to 1982, a questionnaire was sent to the 34,076 who previously had accepted to participate in studies. For twins reporting IBD, the diagnosis was verified by applying standard criteria to records requested from hospitals or practitioners. RESULTS: Among the 29,421 (86.3%) twins answering the questionnaire, 103 pairs had at least one twin who suffered from IBD. In the Crohn disease group five of 10 monozygotic pairs, but none of 27 dizygotic pairs were concordant. In the ulcerative colitis group three of 21 monozygotic, and two of 44 dizygotic pairs were concordant. The probandwise concordance rate among monozygotic pairs was 58.3% for Crohn disease and 18.2% for ulcerative colitis; among the dizygotic pairs the rates were 0 and 4.5%, respectively. The frequency of smokers was higher among twins with Crohn disease and lower among twins with ulcerative colitis compared to the frequency in the twin register. Furthermore, smoking habits were found to be of significance for discordance for disease. Regarding the clinical characteristics no homogenous pattern was observed within the concordant pairs and the differences between concordant and discordant pairs were not significant. CONCLUSION: The observation of a significantly higher concordance rate among monozygotic than among dizygotic twin pairs strongly points to a genetic influence on occurrence of IBD, which seems to be more pronounced with regard to Crohn disease than to ulcerative colitis. Differences in smoking habits among the members of the discordant twin pairs may influence the discordance.

Colitis, Ulcerative↗
PubMed2005

The parent-provider relationship: does race/ethnicity concordance or discordance influence parent reports of the receipt of high quality basic pediatric preventive services?

Recent research among adults suggests that having a provider of the same race/ethnicity may enhance the quality of health care above and beyond just having any regular source of care. It is not known whether such relationships exist in pediatric care. The purpose of this study is to identify the distribution and methods by which families have a race/ethnicity concordant provider of well-child care and examine whether differences exist in the receipt of basic preventive services (BPS) and family-centered care (FCC) among those with concordant, discordant, and no regular providers. Analyses are stratified by geography to assess whether urban versus nonurban setting moderates these differences. This study uses publicly available data from the 2000 National Survey of Early Childhood Health (NSECH), a nationally representative, cross-sectional telephone survey of parents of children ages 4-35 months (n = 1,996). African Americans and Latinos were more likely than whites to lack a regular provider of well-child care (60.9% and 65.7% vs. 50.6%) and less likely to have a concordant provider (9.8% and 5.7% vs. 38.5%) (P < .001). African Americans with a regular provider were about three times more likely to establish a concordant relationship in urban versus nonurban settings (32.4% vs. 12.5%, P < .01). No statistically significant differences in BPS or FCC were found by concordance versus discordance for any group, a finding that held regardless of geographic setting. White children with no regular provider received better BPS than those with a discordant provider (e.g., excellent BPS of 37.2% vs. 27.1%, P < .05), but children with no regular provider were more likely than those with either concordant or discordant providers to have lower FCC in one (Latinos, whites) or three domains (African Americans). Despite racial/ethnic differences in the likelihood of having a concordant regular provider of well-child care, no disparities were found in BPS or FCC associated with discordance, even after stratification by urban/nonurban setting. Lacking a regular provider was associated with lower FCC versus having either a concordant or discordant provider, suggesting that efforts to improve these aspects of well-child care might focus less on linking children with a race/ethnicity concordant provider and more on social, cultural, and linguistic factors that impact having any regular provider.

Child, Preschool↗
PubMed1982

Spouse concordance for fasting plasma glucose in non-diabetics.

Spouse concordance for fasting plasma glucose was determined in 1710 currently married spouse pairs from a retired community in Southern California who had married durations of from 1 year to more than 40 years. A highly significant concordance was found in marriages of all durations, with the highest concordance in marriages of short duration. Concordance for fasting plasma glucose was not explained by concordance for education, obesity, cigarette smoking, ingestion of whole milk or eggs, the use of antihypertensive medications or a family history of heart disease. Nor was the observed spouse concordance due to selective mortality of discordant spouse pairs. Although there was significant seasonal variation in fasting plasma glucose levels, spouse concordance was not entirely a function of seasonality of sampling. The data suggest that concordance for other environmental attributes--possibly specific nutrients--is responsible for fasting plasma glucose concordance.

Adult↗
PubMed2006

Individual characteristics, area social participation, and primary non-concordance with medication: a multilevel analysis.

BACKGROUND: Non-concordance with medication remains a major public health problem that imposes a considerable financial burden on the health care system, and there is still a need for studies on correlates of non-concordance. Our first aim is to analyse whether any of the individual characteristics age, educational level, financial strain, self-rated health, social participation, and trust in the health care system are associated with primary non-concordance with medication. Our second aim is to investigate whether people living in the same area have similar probability of primary non-concordance with medication, that relates to area social participation. METHODS: We analysed cross sectional data from 9,070 women and 6,795 men aged 18 to 79 years, living in 78 areas in central Sweden, who participated in the Life & Health year 2000 survey, with multilevel logistic regression (individuals at the first level and areas at the second level). RESULTS: Younger age, financial strain, low self-rated health, and low trust in the health care system were associated with primary non-concordance with medication. However, area social participation was not related to primary non-concordance, and the variation in primary non-concordance between the areas was small. CONCLUSION: Our results indicate that people in central Sweden with younger age, financial difficulties, low self-rated health, and low trust in the health care system may have a higher probability of primary non-concordance with medication. However, the area of residence--as defined by administrative boundaries--seems to play a minor role for primary non-concordance.

Adolescent↗
PubMed1991

Objective assessment of concordance of secretory events in two endocrine time series.

A new objective method is presented for investigating the presence of a temporal relationship between episodic release of two hormones. The two time series of hormone concentrations are first analysed by an objective method for peak detection. Both data series are then transformed into "quantized" or discretized series by recording the occurrence of a hormone pulse as an "event", characterized by the onset, the maximum, or another unique feature. The two quantized series are then matched, and the number of concordant events and discordant events are counted. Each point in series A is compared with a "time-window" of a selected number of points in series B, to accommodate small degree of mismatch between events in the two series. An index of concordance is computed, compensating for any spurious random coincidence: the "Specific Concordance", to evaluate the frequency of concordant events in excess of those expected on the basis of chance alone. This calculation is systematically repeated, interposing a range of time-lags between the two series. A graph of Specific Concordance versus time-lag indicates the time-lag corresponding to a maximal concordance. Simulations of random series of events are performed, and their degree of concordance is evaluated in a similar fashion, thus generating frequency distributions of Specific Concordance values under the null hypothesis of no temporal relationship. This permits the selection of criteria for statistical significance at any desired p-level, for one or many lag times, and for one or multiple subjects. Various degrees of concurdance can also be stimulated to evaluate the performance (sensitivity, statistical power) of this approach. These methods have been implemented as a collection of short microcomputer programmes, and applied to the study of the temporal relationship between beta-endorphin and cortisol in normal subjects sampled every 10 min for 24 h. This analysis demonstrated concordance between events in the two series, with synchronous occurrence of beta-endorphin and cortisol release events significantly more frequently than expected on the basis of random association (p less than 0.01).

Adult↗
PubMed2002

The probability of topological concordance of gene trees and species trees.

The concordance of gene trees and species trees is reconsidered in detail, allowing for samples of arbitrary size to be taken from the species. A sense of concordance for gene tree and species tree topologies is clarified, such that if the "collapsed gene tree" produced by a gene tree has the same topology as the species tree, the gene tree is said to be topologically concordant with the species tree. The term speciodendric is introduced to refer to genes whose trees are topologically concordant with species trees. For a given three-species topology, probabilities of each of the three possible collapsed gene tree topologies are given, as are probabilities of monophyletic concordance and concordance in the sense of N. Takahata (1989), Genetics 122, 957-966. Increasing the sample size is found to increase the probability of topological concordance, but a limit exists on how much the topological concordance probability can be increased. Suggested sample sizes beyond which this probability can be increased only minimally are given. The results are discussed in terms of implications for molecular studies of phylogenetics and speciation.

Biological Evolution↗
PubMed2005

Perceptions and practice of concordance in nurses' prescribing consultations: findings from a national questionnaire survey and case studies of practice in England.

BACKGROUND: The number of nurses able to independently prescribe medicines in England is increasing. Patient adherence to prescribed medicines remains a significant problem [Department of Health, 2000. Pharmacy in the Future: Implementing the NHS Plan. A Programme for Pharmacy in the NHS. Stationary Office, London]. Concordance-a partnership approach to medicine consultations-is advocated as an effective solution [Medicines Partnership, 2003. Project Evaluation Toolkit. Medicines Partnership, London]. OBJECTIVES: To investigate whether nurses were practising the principles of concordance within their prescribing interactions. DESIGN: Phase (i) postal questionnaire survey. Phase (ii): case studies of practice. SETTINGS: Phase (i) primary and secondary care trusts throughout England in which nurse prescribers were practicing. Phase (ii) six general practice settings; one community midwifery service; one specialist community palliative care service; one secondary care ophthalmology unit; one NHS walk-in centre. PARTICIPANTS: Phase (i) a random sample of 246 nurses registered as independent nurse prescribers with the Nursing and Midwifery Council in 2002/2003. Phase (ii) purposively selected sample of 14 nurse prescribers who participated in Phase (i) of the study; a total of 208 purposively selected patients completed self-administered questionnaires. METHODS: Phase (i) postal questionnaires. Phase (ii) structured non-participant observation of 118 nurse prescribing consultations; 115 post-consultation patient questionnaires; 93-patient postal questionnaires. RESULTS: 99% of the nurses in the national survey stated they were practising the principles of concordance. The majority of patients surveyed also reported experiencing concordance in practice. Observation of practice revealed that although some principles of concordance were regularly integrated into nurses' practice, other principles were less often in evidence. Some evidence from both observation of practice and patient questionnaires suggested that a professionally determined 'compliance' agenda may still be partially operating in practice. CONCLUSIONS: Most nurses believe they are practicing concordance in their prescribing consultations. The majority of patients also reported that they had experienced some of the principles of concordance in practice. Observation of practice highlighted that the shift from a professionally determined compliance agenda to the integration of concordance into nurses' prescribing consultations had not yet taken place.

Attitude of Health Personnel↗