A comparison of pharmacoepidemiological study designs in medication use and traffic safety research

In order to explore how the choice of different study designs could influence the risk estimates, a case–crossover and case–time–control study were carried out and their outcomes were compared with those of a traditional case–control study design that evaluated the association between the exposure to psychotropic medications and the risk of having a motor vehicle accident (MVA). A record-linkage database availing data for 3,786 cases and 18,089 controls during the period 2000–2007 was used. The study designs (i.e., case–crossover and case–time–control) were derived from published literature, and the following psychotropic medicines were examined: antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants, stratified in the two groups selective serotonin reuptake inhibitors (SSRIs) and other antidepressants. Moreover, in order to further investigate the effects of frequency of psychoactive medication exposure on the outcomes of the case–crossover analysis, the data were also stratified by the number of defined daily doses (DDDs) and days of medication use in the 12 months before the motor vehicle accident. Three-thousand seven-hundred fifty-two cases were included in this second part of the case–crossover analysis. The case–crossover design did not show any statistically significant association between psychotropic medication exposure and MVA risk [e.g., SSRIs—Adj. OR = 1.00 (95 % CI: 0.69–1.46); Anxiolytics—Adj. OR = 0.95 (95 % CI: 0.68–1.31)]. The case–time–control design only showed a borderline statistically significant increased traffic accident risk in SSRI users [Adj. OR = 1.16 (95 % CI: 1.01–1.34)]. With respect to the stratifications by the number of DDDs and days of medication use, the analyses showed no increased traffic accident risk associated with the exposure to the selected medication groups [e.g., SSRIs, <20 DDDs—Adj. OR = 0.65 (95 % CI: 0.11–3.87); SSRIs, 16–150 days—Adj. OR = 0.55 (95 % CI: 0.24–1.24)]. In contrast to the above-mentioned results, our recent case–control study found a statistically significant association between traffic accident risk and exposure to anxiolytics [Adj. OR = 1.54 (95 % CI: 1.11–2.15)], and SSRIs [Adj. OR = 2.03 (95 % CI: 1.31–3.14)]. Case–crossover and case–time–control analyses produced different results than those of our recent case–control study (i.e., case–crossover and case–time–control analyses did not show any statistically significant association whereas the case–control analysis showed an increased traffic accident risk in anxiolytic and SSRI users). These divergent results can probably be explained by the differences in the study designs. Given that the case–crossover design is only appropriate for short-term exposures and the case–time–control design is an elaboration of this latter, it can be concluded that, probably, these two approaches are not the most suitable ones to investigate the relation between MVA risk and psychotropic medications, which, on the contrary, are often use chronically

Use of a Prescribed Ephedrine/Caffeine Combination and the Risk of Serious Cardiovascular Events: A Registry-based Case-Crossover Study

Ephedrine and herbal ephedra preparations have been shown to induce a small-to-moderate weight loss. Owing to reports on serious cardiovascular events, they were banned from the US market in 2004. There have been no large controlled studies on the possible association between prescribed ephedrine/caffeine and cardiovascular events in general. The authors linked data from four different sources within Statistics Denmark, using data on 257,364 users of prescribed ephedrine/caffeine for the period 1995–2002. The data were analyzed using a case-crossover technique with a composite endpoint: death outside of a hospital, myocardial infarction, or stroke. To account for effects of chronic exposure and effects in naïve users, the authors performed a secondary case-control study nested within the cohort of ephedrine/caffeine ever users. Among 2,316 case subjects, 282 (12.2%) were current users of ephedrine/caffeine. The case-crossover analysis yielded an odds ratio of 0.84 (95% confidence interval: 0.71, 1.00); after adjustment for trends in ephedrine/caffeine use, it was 0.95 (95% confidence interval: 0.79, 1.16). Subgroup analyses revealed no strata with significantly elevated risk. In the case-control substudy, there was no increased risk among naïve users or users with large cumulative doses. Prescribed ephedrine/caffeine was not associated with a substantially increased risk of adverse cardiovascular outcomes in this study

When veiled silences speak: reflexivity, trouble and repair as methodological tools for interpreting the unspoken in discourse-based data

Researchers who have attempted to make sense of silence in data have generally considered literal silences or such things as laughter. We consider the analysis of veiled silences where participants speak, but their speaking serves as ‘noise’ that ‘veils’, or masks, their inability or unwillingness to talk about a (potentially sensitive) topic. Extending Lisa Mazzei’s ‘problematic of silence’ by using our performativity-performance analytical method, we propose the purposeful use of ‘unusual conversational moves’, the deployment of researcher reflexivity, and the analysis of trouble and repair as methods to expose taken-for-granted normative frameworks in veiled silences. We illustrate the potential of these research practices through reference to our study on men’s involvement in reproductive decision-making, in which participants demonstrated an inability to engage with the topic. The veiled silence that this produced, together with what was said, pointed to the operation of procreative heteronormativity

Scottish adherence to antihypertensive medication in the elderly: promoting evidence-based community pharmacy services.

Background and Objective: Detection and treatment of hypertension continues to be a major public health challenge affecting between 30 and 45% of the general population, increasing steeply with age. Many studies have shown the benefit of antihypertensive agents in improving clinical outcomes. However, their effectiveness is dependent on persistent adherence to prescribed medication. Objectives (1) to assess adherence to antihypertensive medication; (2) to examine patient-specific factors associated with antihypertensive medication adherence among Scottish adults aged 65 years plus. Design: Pre-registration pharmacy trainees (pre-regs) undertaking postgraduate placement-in-practice based in community pharmacies across Scotland were invited to take part. Each pre-reg invited and consented up to 15 patients (aged 65 plus; at least one prescribed medication) presenting with a prescription which indicated treatment for hypertension, to take part in a telephone interview. Pre-regs added pharmacy dispensing data to a paper-based structured data collection tool for later online data entry. The structured interview focused on patient's beliefs about medicines and medication adherence. The study had NHS ethical approval. Results: Of the 130 pre-regs working in community pharmacy in Scotland 92% (n=119) took part with a patient-participant response rate of 75% (n=1332). 94% of respondents always-or-often strive to follow doctor's instructions and have a strict routine for use of their regular medicines. 87% rarely-or-never get confused about their medicines. 78% of respondents believed their medication prevented them becoming ill; unpleasant side effects were reported by 8%. 93% said taking medication did not disrupt their life. Respondents had visited a medical practice twice in previous 6 months. 69% reported normal blood pressure. 49% of respondents had previously smoked daily; 13% currently smoke. Conclusion: The SAAME study provides strong evidence of patients adhering to antihypertensive medication, also a model for promoting evidenced-based community pharmacy services: public health data year-on-year; raise the profile of clinical research in community pharmacy services. Feedback suggests pharmacies have concerns about telephone interviews preventing calls coming in so would prefer the option of face-to-face interviews; also direct online entry of data, and; online consent forms for the pre-regs. Future research is planned around evaluating pre-reg engagement, training needs, impact on community pharmacy based tutors and staff

Estimation of transient increases in bleeding risk associated with physical activity in children with haemophilia

BACKGROUND: Although it is widely appreciated that vigorous physical activity can increase the risk of bleeding episodes in children with haemophilia, the magnitude of the increase in risk is not known. Accurate risk estimates could inform decisions made by children with haemophilia and their parents about participation in physical activity and aid the development of optimal prophylactic schedules. The aim of this study is to provide an accurate estimate of the risks of bleeding associated with vigorous physical activity in children with haemophilia. METHODS/DESIGN: The study will be a case-crossover study nested within a prospective cohort study. Children with moderate or severe haemophilia A or B, recruited from two paediatric haematology departments in Australia, will participate in the study. The child, or the child's parent or guardian, will report bleeding episodes experienced over a 12-month period. Following a bleeding episode, the participant will be interviewed by telephone about exposures to physical activity in the case period (8 hours before the bleed) and 2 control periods (an 8 hour period at the same time on the day preceding the bleed and an 8 hour period two days preceding the bleed). Conditional logistic regression will be used to estimate the risk of participating in vigorous physical activity from measures of exposure to physical activity in the case and control periods. DISCUSSION: This case-control study will provide estimates of the risk of participation in vigorous physical activity in children with haemophilia

Troubling "understanding mathematics-in-depth": Its role in the identity work of student-teachers in England

Copyright @ The Author(s) 2013. This article is published with open access at Springerlink.comThis article has been made available through the Brunel Open Access Publishing Fund.In this paper, we focus on an initiative in England devised to prepare non-mathematics graduates to train as secondary mathematics teachers through a 6-month Mathematics Enhancement Course (MEC) to boost their subject knowledge. The course documentation focuses on the need to develop “understanding mathematics in-depth” in students in order for them to become successful mathematics teachers. We take a poststructural approach, so we are not interested in asking what such an understanding is, about the value of this approach or about the effectiveness of the MECs in developing this understanding in their participants. Instead we explore what positions this discourse of “understanding mathematics in-depth” makes available to MEC students. We do this by looking in detail at the “identity work” of two students, analysing how they use and are used by this discourse to position themselves as future mathematics teachers. In doing so, we show how even benign-looking social practices such as “understanding mathematics in-depth” are implicated in practices of inclusion and exclusion. We show this through detailed readings of interviews with two participants, one of whom fits with the dominant discourses in the MEC and the other who, despite passing the MEC, experiences tensions between her national identity work and MEC discourses. We argue that it is vital to explore “identity work” within teacher education contexts to ensure that becoming a successful mathematics teacher is equally available to all.King’s College Londo

Epistemic roles of materiality within a collaborative invention project at a secondary school

In this study, we examined maker‐centred learning from an epistemic perspective, highlighting the agentic role of material engagement and artefacts in learning and creativity. The use of physical materials plays a crucial role in maker activities where the socio‐epistemic aspects of knowledge creation entangle with the designing and making of physical artefacts. By taking a case study perspective, we analysed video data from nine design sessions involving a team of students (aged 13 to 14) developing an invention. First, we analysed knowledge that was built during the process. Our analysis revealed how design ideas evolved from preliminary to final stages and, together with the expressed design problems and conversations preceding the ideas, formed an epistemic object pursued by the team. Next, we included non‐human agencies into the analysis to understand the role of materials in the process. Features of materials and human design intentions both constrained and enabled idea improvement and knowledge creation, intermixing meanings and materials. Material making invited the students to not only rely on human rationalisation, but also to think together with the materials.In this study, we examined maker-centred learning from an epistemic perspective, highlighting the agentic role of material engagement and artefacts in learning and creativity. The use of physical materials plays a crucial role in maker activities where the socio-epistemic aspects of knowledge creation entangle with the designing and making of physical artefacts. By taking a case study perspective, we analysed video data from nine design sessions involving a team of students (aged 13 to 14) developing an invention. First, we analysed knowledge that was built during the process. Our analysis revealed how design ideas evolved from preliminary to final stages and, together with the expressed design problems and conversations preceding the ideas, formed an epistemic object pursued by the team. Next, we included non-human agencies into the analysis to understand the role of materials in the process. Features of materials and human design intentions both constrained and enabled idea improvement and knowledge creation, intermixing meanings and materials. Material making invited the students to not only rely on human rationalisation, but also to think together with the materials.Peer reviewe

'You were quiet - I did all the marching': Research processes involved in hearing the voices of South Asian girls

This article is available open access through the publisher’s website at the link below. Copyright @ 2011 A B Academic Publishers.This article provides insights into the outcomes of reflection following two interview approaches used to explore narratives of the lived, individual experiences of South-Asian girls living in West London. In attempting to illuminate and re-present the cultural experiences as told by these girls, the choice of interview approach became critical in allowing the voices to be effectively heard (Rogers, 2005). This article therefore considers how a semi-structured interview approach offered valuable insights into the girls' experiences but became constraining for both researcher and participant in unveiling the complexity and depth of their lives. These constraints emerged through reflection by both participants and researcher. As a result of reflexivity during the research process, the researcher moved towards the use of research conversations during the second phase of the study. Ultimately the study revealed how the girls felt empowered by the opportunity to narrate their individual experiences and tell of their lives. In narrating their reflections on being part of the research, there was a clear recognition that the process facilitated the articulation of new voices and ‘multi-voicedness’ (Moen, 2006

‘I had to pop a wheelie and pay extra attention in order not to fall:’ embodied experiences of two wheelchair tennis athletes transgressing ableist and gendered norms in disability sport and university spaces

When bodies move in certain contexts, it can mean very different things for different people. In our society, some bodies are more valued than others, and detrimentally, this can mean that certain types of bodies are ostracised and segregated to the outskirts of production economies and society. Dis/ability sport spaces, able-bodied sports spaces and able-bodied university spaces have been an under-researched area when considering how the body moves throughout these spaces for elite wheelchair athletes taking part in university courses. To learn more, this paper drew on feminist poststructuralism and new materialist perspectives and shared an insight into how two athletes with dis/abilities transgressed abled and gendered norms in different spaces and how they positioned themselves as athletic bodies and disabled bodies in these spaces. Employing a post-critical ethnographic design, we found that dependent on the space a dis/abled body is in constant flux as to when it feels marginalised and different (typically able-bodied spaces) and when it feels included, valued, and strong (typically dis/abled spaces). Significantly, the materiality of the institutional structures of universities, founded upon historic aesthetics of beauty dictated the physical spaces the athletes entered and created spaces of exclusion based on capitalist and ableist ideologies