Nonparametric Tests Of Association Research Articles

Circulating tumor tissue modified viral (TTMV)-HPV DNA in Recurrent, metastatic HPV-driven oropharyngeal cancer

BackgroundHuman papillomavirus (HPV) is causally linked to oropharyngeal squamous cell carcinoma (OPSCC). Testing for plasma tumor tissue modified viral (TTMV)-HPV DNA has emerged as a biomarker strategy for post-treatment surveillance to identify recurrent disease. We aimed to understand the prognostic and predictive potential of TTMV-HPV DNA when monitoring patients who had developed recurrent or metastatic (R/M) HPV+OPSCC. MethodsThis retrospective observational cohort study included 80 patients from 4 academic centers with R/M HPV+OPSCC if they had ≥ 1 plasma TTMV-HPV DNA test obtained at any point during their R/M disease course. Physician-reported clinical data and treatment history were captured in a centralized database, along with investigator-assessed response to therapy and survival. Descriptive statistics and non-parametric tests of association were employed along with survival analyses (Kaplan-Meier method). ResultsSixteen (20 %) patients had ≥ 5 test results over time. Consecutive TTMV-HPV DNA tests were performed a median of 73 days apart. Median TTMV-HPV DNA scores were higher with an increasing per-patient number of metastatic sites (<2 vs. 2+; p < 0.01). Score changes over time were influenced by R/M treatment modality and became undetectable in 67 % (12/18) of patients who achieved a complete response to R/M therapy. Patients with detectable scores at last follow-up had significantly worse survival compared with those who were undetectable (log-rank test, p < 0.01). ConclusionsTTMV-HPV DNA appears useful as a prognostic tool for monitoring response to therapy in the R/M setting. In the future, TTMV-HPV DNA could be explored as an exploratory clinical trial endpoint in the metastatic setting.

Cross-sectional survey of staff and family perspectives on the use of CCTV in Australian residential aged care.

To describe staff and family members' opinions about closed-circuit television (CCTV) in communal and private areas of residential aged care facilities (RACF), and to investigate how this relates to perceptions of care quality. A cross-sectional survey was developed to capture perceptions of CCTV's influence on care quality, and acceptable locations for CCTV placement. Data were recorded as ordinal-scale and open responses. Non-parametric tests of association were conducted. The survey was completed by 81 staff and 74 family members. Both staff and family were satisfied with care quality and safety, irrespective of CCTV use. More family members were in favour of CCTV in both public and private areas, compared to staff who favoured public areas. Staff and family assumed there was real-time monitoring, leading to a belief that CCTV monitoring would improve safety and prevent falls and abuse. Concerns were raised that CCTV could be used instead of improving staff-to-resident ratios and interaction. Overall, participants supported the use of CCTV more in public than in private areas and believed it reveals and prevents poor care. There was no association between CCTV use and satisfaction with care. Closed-circuit television can have positive impacts if all stakeholders are involved in implementation.

Why Do Music Students Attend Counseling? A Longitudinal Study of Reasons in One UK Conservatoire

Music students in tertiary education struggle with a range of health-related problems. We investigated students’ self-referrals for counseling at a UK conservatoire to explore trends in students’ attendance at counseling sessions over time and identify their reasons for seeking and continuing to attend counseling. We conducted a secondary analysis of data collected from 645 students by two in-house counselors at the conservatoire between 2000 and 2016. We obtained analogous data on all students registered during the same period for comparison and conducted nonparametric tests of association between the groups. A total of 645 students attended a mean of eight ( Mdn = 4) counseling sessions over the 16-year period: 63% were female, 79% were from the UK, and 72.5% were undergraduate students. The percentages of students attending counseling increased from 2 (1%) in 2000–2001 to 71 (13%) in 2015–2016. The presenting concerns of almost one in 10 students who sought counseling were related to self-esteem, self-confidence, ego strength, and coping ability. Their main reasons for continuing to attend counseling were also to do with self and identity, relationships, academic concerns, loss, abuse, and anxiety. Female students, postgraduate students, and those studying singing were most likely to attend counseling sessions.

Pancreatic ductal adenocarcinoma: Prognostic indicators of advanced disease

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy associated with high metastatic risk. Prognosis remains poor even after resection. Previously our group identified biomarkers that improved diagnostic accuracy in PDAC beyond the established diagnostic tumour marker, CA19-9. Risk factors, symptoms and circulating biomarkers associated with a PDAC diagnosis may differ from those that alter disease progression and metastasis. This study aimed at assessing the risk factors, presenting symptoms and potential prognostic biomarkers in PDAC and determine their relationship with PDAC stage and/or metastatic status. Seventy-two PDAC patients with imaging available for TNM staging at presentation were enrolled following informed consent. Demographic and clinical data were captured. Blood was collected and 38 cytokines/angiogenic factors measured. Nonparametric association tests, univariate and multivariate logistic regression were performed using STATA version 14.2. A p-value≤0.05 was considered significant and odds ratios reported for effect size. Most risk factors and symptoms did not differ across the stages of cancer. Although male gender and smoking are risk factors for PDAC, the majority of study patients with metastatic PDAC were non-smoking females. In addition to CA19-9, the platelet count (p<0.01), IL-15 (p = 0.02) and GM-CSF (p<0.01) were significant, independent negative predictors of metastatic PDAC. Moreover, using specific cut-off values in a combined panel, the odds in a patient with all three biomarker levels below the cut-offs is 21 times more likely to have metastatic PDAC (p<0.0001). Platelet count, IL-15 and GM-CSF are potential prognostic indicators of metastatic disease in PDAC patients from our local South African population.

Platelets In Metastatic Pancreatic Ductal Adenocarcinoma

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy associated with high metastatic risk. Survival of circulating tumour cells (CTCs) is a crucial step for metastasis. Platelets protect CTCs by encasing them in a thrombus. Elevated pretreatment platelet count associates with poor prognosis in many cancer types, however the relationship remains controversial in PDAC. We aimed to evaluate the prognostic value of platelet counts in predicting metastatic PDAC. Methods: Seventy-two PDAC patients with imaging available for staging at presentation were enrolled following informed consent. Demographic and clinical data were captured. Pretreatment bloods were collected for routine biochemistry measurements. The Youdin-Index was applied to determine the optimal cut-off value. Nonparametric association tests and univariate logistic regression were performed using STATA 14.2. A p-value≤0.05 was considered significant and odds ratio (OR) reported for effect size. Results: The mean (±SD) age was 60.3 (±11.1) years, 57% were male and 25% had metastatic PDAC. Platelet count was a significant, independent negative predictor of metastatic PDAC (p=0.006). The optimal cut-off value for platelet count was 290 109/L; 72% of metastatic PDAC patients had values below this cut-off, compared to 30% in non-metastatic disease. The OR of a patient with a platelet count below this cut-off is 6 (95% CI: 1.62–24.6) times more likely to have metastatic PDAC (p=0.002). Conclusions: Platelet count is an independent, negative prognosticator of metastatic PDAC in our local South African population. Larger validation studies are required that should take the different phases of platelet activation into account.

Long-term dupilumab treatment for chronic refractory generalized prurigo nodularis: A retrospective cohort study

Long-term dupilumab treatment for chronic refractory generalized prurigo nodularis: A retrospective cohort study

So Similar and Yet So Different: Reasons for Online Purchasing, a Comparative Research in Colombia and Mexico Using Nonparametric Association Tests

&lt;p&gt;The reasons for buying online have occupied the literature of consumer behavior on the Internet for quite some time. Different theories seek to understand the relationships between different variables of purchasing behavior using this channel. However, the literature has not been sufficiently focused on making comparative analysis between countries, especially between emerging and Latin American countries. For this reason, a comparative study that seeks to understand differences between the reasons to purchase online by country. In 2017, we did survey 552 students, professors and administrative staff in two universities: one in Bogotá, Colombia, and one in Puebla, México using a convenience sampling. We designed a semi-structured questionnaire of 7 items, mostly categorical. Using nonparametric association tests, we discovered that in five of the six questions that are carried out there are significant statistical differences for the two countries such as why they buy in internet, payment methods, shipment, and why they would not buy in the internet . The implications for marketing for those companies interested in penetrating or improving their participation in these markets, is that they should be aware of their differences and use, depending on the country, adapted strategies.&lt;/p&gt;

Moral Distress Assessment in the Nursing Team of a Hematology-Oncology Sector.

To identify the frequency and intensity of Moral Distress, and to analyze the associations between Moral Distress and sociodemographic and labor characteristics of the nursing team of a Hematology-Oncology. A cross-sectional study was carried out with 46 nursing professionals from a Hematology-Oncology sector of a hospital institution in Rio Grande do Sul State, Brazil, through the application of the Moral Distress Scale - Brazilian version. In the data analysis, descriptive statistics and nonparametric association tests were used. Mortal Distress intensity of 3.27 (SD= 1.79) and frequency of 1.72 (SD= 1.02) were found in this team. The Moral Distress of greater intensity and frequency were related to the denial of the role of Nursing as a patient's advocate and the disrespect to the patient's autonomy, respectively. It is suggested a greater space for discussion among professionals, multiprofessional team and managers, so that adequate conditions of action and communication are provided.

Leading the field: Fortune favors the bold in Thurstonian choice models

Schools with the highest average student performance are often the smallest schools; localities with the highest rates of some cancers are frequently small; and the effects observed in clinical trials are likely to be largest for the smallest numbers of subjects. Informal explanations of this “small-schools phenomenon” point to the fact that the sample means of smaller samples have higher variances. But this cannot be a complete explanation: If we draw two samples from a diffuse distribution that is symmetric about some point, then the chance that the smaller sample has larger mean is 50%. A particular consequence of results proved below is that if one draws three or more samples of different sizes from the same normal distribution, then the sample mean of the smallest sample is most likely to be highest, the sample mean of the second smallest sample is second most likely to be highest, and so on; this is true even though for any pair of samples, each one of the pair is equally likely to have the larger sample mean. The same effect explains why heteroscedasticity can result in misleadingly small nominal $p$-values in nonparametric tests of association. Our conclusions are relevant to certain stochastic choice models, including the following generalization of Thurstone’s Law of Comparative Judgment. There are $n$ items. Item $i$ is preferred to item $j$ if $Z_{i}<Z_{j}$, where $Z$ is a random $n$-vector of preference scores. Suppose $\mathbb{P}\{Z_{i}=Z_{j}\}=0$ for $i\ne j$, so there are no ties. Item $k$ is the favorite if $Z_{k}<\min_{i\ne k}Z_{i}$. Let $p_{i}$ denote the chance that item $i$ is the favorite. We characterize a large class of distributions for $Z$ for which $p_{1}>p_{2}>\cdots>p_{n}$. Our results are most surprising when $\mathbb{P}\{Z_{i}<Z_{j}\}=\mathbb{P}\{Z_{i}>Z_{j}\}=\frac{1}{2}$ for $i\ne j$, so neither of any two items is likely to be preferred over the other in a pairwise comparison. Then, under suitable assumptions, $p_{1}>p_{2}>\cdots>p_{n}$ when the variability of $Z_{i}$ decreases with $i$ in an appropriate sense. Our conclusions echo the proverb “Fortune favors the bold.”

Clerkship Curriculum Design and USMLE Step 2 Performance: Exploring the Impact of Self-Regulated Exam Preparation.

This study examined medical students' stress and certification exam preparation practices in a reformed clerkship curriculum that excluded high-stakes knowledge testing from end-of-rotation performance evaluation. Stress and exam preparation practices were assessed via a survey comprising locally developed questions, three subscales of the Motivated Strategies for Learning Questionnaire, and two subscales of the Medical Student Stressor Questionnaire. The association between stress, learning self-regulation, and certification exam scores was evaluated retrospectively using non-parametric tests of association (Spearman's rho). Forty students responded to the survey and consented to use of academic performance data (57% participation rate). Mean certification exam scores were indistinguishable from historical controls. Exam preparation practices resembled those of pre-clinical students: exam-related worrying and time devoted to studying were high, increasing as the exam drew near; preferred study resources were directly analogous to exam questions; and study involved relatively few generative strategies (e.g., concept mapping). Sustaining effort and creating time and space to study were associated with better exam performance, as was participation in this study. On the surface, the absence of regularly spaced, high-stakes testing from clerkship performance evaluation appears to "do no harm" to students' certification exam scores. Students already performing better academically may excel due in part to effective learning self-regulation strategies. However, a clerkship curriculum that does not scaffold self-regulation via cumulative knowledge assessment could further disadvantage students already earning lower scores. Evaluating the impact of curriculum reforms should continuously examine changes to learners' experience in context.

Measuring the patient experience in community mental health services for older people: A study of the Net Promoter Score using the Friends and Family Test in England.

The research aimed to explore the value of the Net Promoter Score as a service improvement tool and an outcome measure. The study objectives were to (1) explore associations between the Net Promoter Score with patient and service-receipt characteristics; (2) evaluate the strength of association between the Net Promoter Score and a satisfaction score; and (3) evaluate its test-retest reliability. A postal survey was sent to service users on caseloads of community mental health teams for older people in four localities of England. The survey collected the Net Promoter Score, a single satisfaction question, and data on socio-demographics, clinical profile, and service receipt. Analysis used non-parametric tests of association and exploratory least squares regression. A second survey was administered for test-retest reliability analysis. Fieldwork concluded in April 2016. For 352 respondents, the Net Promoter Score was negatively related to age and was lowest for those still within 6months of their initial referral. Receiving support from a psychiatrist and/or support worker was linked to higher scores. A strong but imperfect correlation coefficient with the satisfaction score indicates they evaluate related but distinct constructs. It had a reasonable test-retest reliability, with a weighted kappa of 0.706. Despite doubts over its validity in community mental health services, the Net Promoter Score may produce results of value to researchers, clinicians, service commissioners, and managers, if part of wider data collection. However, multi-item measures would provide greater breadth and improved reliability.

Common Risk Factors for Urinary House Soiling (Periuria) in Cats and Its Differentiation: The Sensitivity and Specificity of Common Diagnostic Signs.

Urinary house soiling (periuria) in the home is a common but serious behaviour problem in cats. Although many specific risk factors and triggers have been postulated, their importance is largely unknown. This study assessed: (1) the significance of purported risk factors for periuria as well as specifically marking and latrine behaviour in the home; (2) the specificity and sensitivity of signs commonly used to differentiate latrine and marking behaviour. Owner responses to an internet survey (n = 245) were classified into three groups: control, marking and latrine behaviour, along with 41 potential risk factors and 15 predictors used to diagnose marking and latrine problems. Univariate statistical analyses and non-parametric tests of association were used to determine simple associations. In addition the sensitivity and specificity of four cardinal signs (posture to urinate, attempt to cover soiled area, surface chosen and volume of urine deposited) were calculated. Significant potential risk factors were: age (marking cats were older than the other two groups); multi-cat household (increased risk of marking and latrine behaviours); free outside access and cat flaps in the house (higher frequency of marking); outside access in general (lower prevalence of latrine behaviour); defecation outside the litter box (higher frequency of latrine behaviour); a heavy dependence by the cat on its owner (lower frequency of latrine behaviour) and a relaxed personality (lower risk of marking behaviour). Litterbox attributes and disease related factors were not significant. Individual cardinal signs were generally not good predictors of diagnosis. This study challenges the poor quality of evidence that has underpinned some of the hypotheses concerning the causes of periuria in cats. The results, in particular, highlight the general importance of the social environment, with the presence of other cats in the household, the cat-owner bond and personality related factors, alongside factors like the use of a cat flap which might also alter the social environment, all implicated as significant risk factors. While the physical environment may be important in specific cases, it seems this is less important as a general risk factor. The findings quantify the risk of misdiagnosis if a single sign is considered sufficient for diagnosis.

Motor programme activating therapy influences adaptive brain functions in multiple sclerosis: clinical and MRI study.

There is still little scientific evidence for the efficacy of neurofacilitation approaches and their possible influence on brain plasticity and adaptability. In this study, the outcome of a new kind of neurofacilitation approach, motor programme activating therapy (MPAT), was evaluated on the basis of a set of clinical functions and with MRI. Eighteen patients were examined four times with standardized clinical tests and diffusion tensor imaging to monitor changes without therapy, immediately after therapy and 1 month after therapy. Moreover, the strength of effective connectivity was analysed before and after therapy. Patients underwent a 1-h session of MPAT twice a week for 2 months. The data were analysed by nonparametric tests of association and were subsequently statistically evaluated. The therapy led to significant improvement in clinical functions, significant increment of fractional anisotropy and significant decrement of mean diffusivity, and decrement of effective connectivity at supplementary motor areas was observed immediately after the therapy. Changes in clinical functions and diffusion tensor images persisted 1 month after completing the programme. No statistically significant changes in clinical functions and no differences in MRI-diffusion tensor images were observed without physiotherapy. Positive immediate and long-term effects of MPAT on clinical and brain functions, as well as brain microstructure, were confirmed.

Pain measurement as part of primary healthcare of adult patients with sickle cell disease

ObjectiveThe aim of this exploratory, cross-sectional study was to evaluate pain in sickle cell disease patients and aspects related to primary healthcare. MethodsData were obtained through home interviews. The assessment instruments (body diagram, Numerical Pain Scale, McGill Pain Questionnaire) collected information on the underlying disease and on pain. Data were analyzed using the Statistical Package for Social Sciences program for Windows. Associations between the subgroups of sickle cell disease patients (hemoglobin SS, hemoglobin SC, sickle β-thalassemia and others) and pain were analyzed using contingency tables and non-parametric tests of association (classic chi-square, Fisher's and Kruskal-Wallis) with a level of 5% (p-value < 0.05) being set for the rejection of the null hypothesis. ResultsForty-seven over 18-year-old patients with sickle cell disease were evaluated. Most were black (78.7%) and female (59.6%) and the mean age was 30.1 years. The average number of bouts of pain annually was 7.02; pain was predominantly reported by individuals with sickle cell anemia (hemoglobin SS). The intensity of pain (Numeric Pain Scale) was 5.5 and the quantitative index (McGill) was 35.9. This study also shows that patients presented a high frequency of moderately painful crises in their own homes. ConclusionAccording to these facts, it is essential that pain related to sickle cell disease is properly identified, quantified, characterized and treated at the three levels of healthcare. In primary healthcare, accurate measurement of pain combined with better care may decrease acute painful episodes and consequently minimize tissue damage, thus improving the patient's overall health.

Nonparametric Covariate-Adjusted Association Tests Based on the Generalized Kendall's Tau

Identifying the risk factors for comorbidity is important in psychiatric research. Empirically, studies have shown that testing multiple correlated traits simultaneously is more powerful than testing a single trait at a time in association analysis. Furthermore, for complex diseases, especially mental illnesses and behavioral disorders, the traits are often recorded in different scales, such as dichotomous, ordinal, and quantitative. In the absence of covariates, nonparametric association tests have been developed for multiple complex traits to study comorbidity. However, genetic studies generally contain measurements of some covariates that may affect the relationship between the risk factors of major interest (such as genes) and the outcomes. While it is relatively easy to adjust for these covariates in a parametric model for quantitative traits, it is challenging to adjust for covariates when there are multiple complex traits with possibly different scales. In this article, we propose a nonparametric test for multiple complex traits that can adjust for covariate effects. The test aims to achieve an optimal scheme of adjustment by using a maximum statistic calculated from multiple adjusted test statistics. We derive the asymptotic null distribution of the maximum test statistic and also propose a resampling approach, both of which can be used to assess the significance of our test. Simulations are conducted to compare the Type I error and power of the nonparametric adjusted test to the unadjusted test and other existing adjusted tests. The empirical results suggest that our proposed test increases the power through adjustment for covariates when there exist environmental effects and is more robust to model misspecifications than some existing parametric adjusted tests. We further demonstrate the advantage of our test by analyzing a dataset on genetics of alcoholism.

Linear and non-linear dependencies between copy number aberrations and mRNA expression reveal distinct molecular pathways in breast cancer

BackgroundElucidating the exact relationship between gene copy number and expression would enable identification of regulatory mechanisms of abnormal gene expression and biological pathways of regulation. Most current approaches either depend on linear correlation or on nonparametric tests of association that are insensitive to the exact shape of the relationship. Based on knowledge of enzyme kinetics and gene regulation, we would expect the functional shape of the relationship to be gene dependent and to be related to the gene regulatory mechanisms involved. Here, we propose a statistical approach to investigate and distinguish between linear and nonlinear dependences between DNA copy number alteration and mRNA expression.ResultsWe applied the proposed method to DNA copy numbers derived from Illumina 109 K SNP-CGH arrays (using the log R values) and expression data from Agilent 44 K mRNA arrays, focusing on commonly aberrated genomic loci in a collection of 102 breast tumors. Regression analysis was used to identify the type of relationship (linear or nonlinear), and subsequent pathway analysis revealed that genes displaying a linear relationship were overall associated with substantially different biological processes than genes displaying a nonlinear relationship. In the group of genes with a linear relationship, we found significant association to canonical pathways, including purine and pyrimidine metabolism (for both deletions and amplifications) as well as estrogen metabolism (linear amplification) and BRCA-related response to damage (linear deletion). In the group of genes displaying a nonlinear relationship, the top canonical pathways were specific pathways like PTEN and PI13K/AKT (nonlinear amplification) and Wnt(B) and IL-2 signalling (nonlinear deletion). Both amplifications and deletions pointed to the same affected pathways and identified cancer as the top significant disease and cell cycle, cell signaling and cellular development as significant networks.ConclusionsThis paper presents a novel approach to assessing the validity of the dependence of expression data on copy number data, and this approach may help in identifying the drivers of carcinogenesis.

Propensity score‐based nonparametric test revealing genetic variants underlying bipolar disorder

Association analysis has led to the identification of many genetic variants for complex diseases. While assessing the association between genes and a disease, other factors can play an important role. The consequence of not considering covariates (such as population stratification and environmental factors) is well-documented in genetic studies. We introduce a nonparametric test of association that adjusts for covariate effects. Specifically, the adjustment is realized through weights that are constructed from genomic propensity scores that summarize the contribution of all covariates. The benefit of our test is demonstrated through an important data set on bipolar disorder (BD) collected by the Wellcome Trust Case Control Consortium. When compared to other tests, our test identified an unreported region with three single nucleotide polymorphisms (SNPs) on chromosome 16 that show strong evidence of association (P-value <5 × 10(-7)). This region is near the RPGRIP1L gene known to be associated with BD. A haplotype block including these three SNPs was further discovered to be strongly associated with BD. It is also interesting to note that our nonparametric test did not reveal strong signals at two SNPs that were detected by a covariate-adjusted parametric test. This suggests that different methods of covariate adjustment can complement each other. Thus, we recommend using both parametric and nonparametric testing. Additionally, we performed simulation studies to compare our proposed test with the unadjusted test and an adjusted parametric test. Our finding underscores the importance of accommodating and controlling for covariate effects in discovering genetic variants associated with complex disorders.

Comorbidities and depression in older adults with HIV

To investigate whether the high rates of depression found in older adults living with HIV are associated with the number and types of comorbidities. The Research on Older Adults with HIV (ROAH) study collected self-reported health data on ~1000 New York City HIV-positive men and women aged 50 years and older. Participants provided data on health problems experienced in the past year and depressive symptomatology (Center for Epidemiological Studies Depression Scale (CES-D)). Data were analysed using a non-parametric test of association and multiple regression analysis. The correlation between CES-D scores and number of comorbidities was significant (r=0.24). In multivariate analyses, depression remained a significant covariate of the number of comorbid conditions, in addition to female gender, inadequate income, history of drug and alcohol use, AIDS diagnosis and self-rated health. Correlations of depression with specific comorbidities varied. Significant correlations with sensory loss and dermatological problems were observed. Significant correlations existed with heart and respiratory conditions as well as fractures, but the directionality of these cross-sectional relationships is uncertain. The findings suggest the need for further longitudinal research to understand how high rates of depressive symptoms are related to comorbidities. Focussed clinical care that strives to prevent the collapse of the immune system must evolve into an effective treatment strategy for multimorbidities, where HIV is but one of many other chronic illnesses. If the management of depression continues to be a low priority, the older person with HIV may experience an avoidable reduction in life expectancy.

Cultural variations in attitudes towards family risk of diabetes

Aims To examine differences in attitudes and behaviours towards familial risk of type 2 diabetes in populations in Ireland and Bahrain. Methods Cross-sectional ecological study. Questionnaires were developed and administered to patients with diabetes and their first degree relatives in both Bahrain and Ireland. Data was analysed using non-parametric tests of association. Results Responses were compared between 297 patients with diabetes from Ireland and 201 from Bahrain and between 364 relatives of patients with diabetes in Ireland and 244 from Bahrain. Relatives in Bahrain had more knowledge of risk factors for diabetes and an increased perception of the seriousness of diabetes but a more external, chance locus of control and perceived more barriers to changing lifestyles than those in Ireland. There was no difference in perception of personal risk of diabetes. Conclusions Knowledge of risk factors and seriousness of diabetes are higher in Bahrain than in Ireland but perception of personal risk of diabetes and intention to adopt risk reducing behaviours are no different. There is a need to develop models of behavioural change that are more relevant to the needs of the Bahraini population in reducing their risk of diabetes.

The use of complementary and alternative medicine by patients with diabetes mellitus in Bahrain: a cross-sectional study

BackgroundCAM use is widespread, especially among patients with diabetes. The Gulf States have a high prevalence of diabetes, alongside a long tradition of CAM use. The aim of this study is to establish the prevalence of CAM use among patients with diabetes mellitus in Bahrain and to examine the characteristics of the CAM users.MethodsA questionnaire was developed and administered to a convenience sample of patients with diabetes (n = 402) above the age of 20 attending two hospital diabetes clinics. Data were analysed using descriptive statistics and non-parametric tests of association.Results63% of responders utilized CAM within the previous 12 months. CAM users were more likely to be female, to have had diabetes for longer and to have complications of their diabetes. 64% of CAM users stated that they had used CAM for managing their diabetic condition, with 46% of these having used it solely for their diabetes. Respondents using CAM to manage their diabetes were more likely to be male, to be using CAM on a daily basis and to have informed their physician of their CAM use.ConclusionsThere is a high rate of CAM use in patients with diabetes attending two hospital diabetes clinics in Bahrain. There is also a high rate of non-disclosure of CAM use to physicians. There is a continuing need for health professionals to be more aware and better trained in order to inform their decision making and communication related to CAM use.