Epidemiology and Health

Volume 33; 2011

Original Articles

Evaluation of Acute Flaccid Paralysis in Hamadan, Iran from 2002 to 2009: Jalal Poorolajal, Shadi Ghasemi, Leila Nezamabadi Farahani, Atefeh Sadat Hosseini, Seyyed Jalal Bathaei, Ali Zahiri; Epidemiol Health. 2011;33:e2011011. Published online November 16, 2011; DOI: https://doi.org/10.4178/epih/e2011011

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Abstract

<sec><title>OBJECTIVES</title>To achieve a polio-free certification in Iran, a nationwide active surveillance program for acute flaccid paralysis (AFP) was set up following World Health Organization guidelines. This article describes the results of an eight-year surveillance of AFP in Hamadan, in the west of Iran.</sec><sec><title>METHODS</title>A standard set of minimum core variables were collected. All cases of non-polio AFP in children aged <15 years old were reported. Two stool specimens were collected within 14 days of the onset of paralysis.</sec><sec><title>RESULTS</title>During the eight-year survey, 88 AFP cases aged <15 years old were reported. About 40% (35/88) of cases were aged ≤5 years, 56% (49/88) were boys, 19 (21.6%) had fever at the onset of paralysis, 74 (84.0%) had complete paralysis within four days of onset, and 22 (24.7%) had asymmetric paralysis. More than one AFP case was detected per 100,000 children aged <15 years old in all years. The risk of AFP in patients aged <5 years old was almost double that of older patients. Guillain-Barré Syndrome was the major leading cause of AFP (66/88). Adequate stool specimens were collected from 85% of AFP patients. All stool specimens were tested virologically, but no wild polioviruses were detected.</sec><sec><title>CONCLUSION</title>The active surveillance of non-polio AFP was efficient over the last eight years and exceeded 1.0 case per 100,000 children aged <15 years old. Nonetheless, there was a decreasing trend in the detection of AFP cases during the last two years and should be the focus of the policymakers' special attention, although AFP cases were still above the target level.</sec>

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The Polio Vaccination Status of Non-polio Acute Flaccid Paralysis Cases in the Far North Region of Cameroon: A Five-Year Retrospective Study From 2015 to 2019
Blaise Wakam Nkontchou, Etienne Guenou, Collins Buh Nkum, Celine Mairousgou Tchida, Alphonse Marie Nono, Jerome Ateudjieu
Cureus.2024;[Epub] CrossRef
Assessment of Met and Unmet Care Needs in Older Adults without Mental Disorders Using the Camberwell Assessment of Need for the Elderly: A Systematic Review and Meta-analysis
Parvin Cheraghi, Ahmad Delbari, Zahra Cheraghi, Akram Karimi-Shahanjarini, Nasibeh Zanjari
Journal of Research in Health Sciences.2021; 21(4): e00530. CrossRef
The Acute Flaccid Paralysis (AFP) Surveillance System in Yemen, 2010-2015: Descriptive Study Based on Secondary Data Analysis
Khaled Abdullah Almoayed, Ali Bin Break, Mutahar Al-Qassimi, Ali Assabri, Yousef Khader
JMIR Public Health and Surveillance.2019; 5(4): e14413. CrossRef
Surveillance of poliomyelitis in Northern Italy: Results of acute flaccid paralysis surveillance and environmental surveillance, 2012–2015
Laura Pellegrinelli, Laura Bubba, Valeria Primache, Elena Pariani, Andrea Battistone, Roberto Delogu, Stefano Fiore, Sandro Binda
Human Vaccines & Immunotherapeutics.2017; 13(2): 332. CrossRef
Eradication of Polio in the World; Iran is at Risk for Reemerging of Polio: A Review of the Literature
Seyed Mansour Razavi, Masoud Mardani, Payman Salamati
Archives of Clinical Infectious Diseases.2016;[Epub] CrossRef
An epidemiological analysis of acute flaccid paralysis in Khuzestan Province, southwest Iran, from 2006 to 2010
Ali Akbar Momen, Abdolhussein Shakurnia
Epidemiology and Health.2016; 38: e2016030. CrossRef
Surveillance of acute flaccid paralysis (AFP) in Lombardy, Northern Italy, from 1997 to 2011 in the context of the national AFP surveillance system
Laura Pellegrinelli, Valeria Primache, Lucia Fiore, Concetta Amato, Stefano Fiore, Laura Bubba, Elena Pariani, Antonella Amendola, Maria Barbi, Sandro Binda
Human Vaccines & Immunotherapeutics.2015; 11(1): 277. CrossRef
Clinical and enterovirus findings associated with acute flaccid paralysis in the republic of Korea during the recent decade
HyeJin Kim, Byounghak Kang, Seoyeon Hwang, Sang Won Lee, Doo-Sung Cheon, Kisang Kim, Yong-Seok Jeong, Ji-Yeon Hyeon
Journal of Medical Virology.2014; 86(9): 1584. CrossRef
Characteristics of Acute Flaccid Paralysis Reported by the Surveillance System and Verified by WHO Officer in Akwa Ibom State-Nigeria, 2006-2012
Bassey Enya Bassey, Vaz Gama Rui, Alex Ntale Gasasira, Mkanda Pascal, Goitom Weldegbriel, Ticha Johnson Mulum, Sylvester T. Maleghemi, Emem Abasi Bassey
Health.2014; 06(19): 2602. CrossRef

Risk Factors for Group B Streptococcus Colonization Among Pregnant Women in Korea: Eun Ju Kim, Kwan Young Oh, Moon Young Kim, Yong Soo Seo, Jung-Hwan Shin, Young Rae Song, Jae-Hyug Yang, Betsy Foxman, Moran Ki; Epidemiol Health. 2011;33:e2011010. Published online November 11, 2011; DOI: https://doi.org/10.4178/epih/e2011010

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Abstract

<sec><title>OBJECTIVES</title>To identify obstetric and maternal factors related to Group B Streptococcus (GBS) colonization in pregnant women in Korea.</sec><sec><title>METHODS</title>The study was conducted between the years 2006-2008 in four hospitals, Cheil and Eulji hospital in Seoul, and Motae and Eulji hospital in Daejeon. We recruited 2,644 pregnant women between 35 to 37 weeks of gestation who had visited for antenatal care. Participants completed a questionnaire, and urine, vaginal and rectal specimens were obtained and cultured using selective broth media. After delivery, medical records were reviewed.</sec><sec><title>RESULTS</title>GBS colonization was significantly associated with hospital, age group, education, frequency of pregnancy, and premature rupture of membranes (PROM, more than 18 hours). After adjustment for other variables, Cheil hospital (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.20-3.52), and the first pregnancy (OR, 2.32; 95% CI, 1.12-4.81) remained significant. History of vaginitis showed marginal significance (OR, 1.50; 95% CI, 0.98-2.29).</sec><sec><title>CONCLUSION</title>To prevent GBS infection of neonates, clinicians should be alert to the potentially higher risk of GBS colonization in pregnant women in their first pregnancy, and women with premature rupture of membranes (PROM) (18 hours+) or who have a history of vaginitis.</sec>

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Vertical Transmission, Risk Factors, and Antimicrobial Resistance Patterns of Group B Streptococcus among Mothers and Their Neonates in Southern Ethiopia
Belayneh Regasa Dadi, Mulatu Sime, Mohamed Seid, Dagimawie Tadesse, Munira Siraj, Dagninet Alelign, Zerihun Solomon, Sanket Kaushik
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Group BStreptococcuscolonisation and their antimicrobial susceptibility among pregnant women attending antenatal clinics in tertiary care hospitals in the Western Province of Sri Lanka
G. N. Dilrukshi, J. Kottahachchi, D. M. B. T. Dissanayake, R. P. Pathiraja, J. Karunasingha, M. K. A. Sampath, U. A. Vidanage, S. S. N. Fernando
Journal of Obstetrics and Gynaecology.2021; 41(1): 1. CrossRef
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Leonard Fonkeng Sama, Michel Noubom, Christelle Kenne, Thibau Flaurant Tchouangueu, Omer Bebe Ngouateu, Albert Donatien Atsamo, Ousenu Karimo, Christopher Bonglavnyuy Tume
International Journal of Clinical Practice.2021;[Epub] CrossRef
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Mohammad Qadi, Adham AbuTaha, Ro’ya Al-Shehab, Salsabil Sulaiman, Abdallah Hamayel, Amjad Hussein, Shatha AbuTaha, Ayman Dawoud, Faizeh Hussein, Tingtao Chen
Canadian Journal of Infectious Diseases and Medical Microbiology.2021; 2021: 1. CrossRef
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Myo-Jing Kim
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Neeraj Goel, Chand Wattal, Kanwal Gujral, Nehal Dhaduk, Chandra Mansukhani, Pankaj Garg
Indian Journal of Medical Microbiology.2020; 38(3-4): 357. CrossRef
Maternal Microbiome and Infections in Pregnancy
Mohammed Amir, Julia A. Brown, Stephanie L. Rager, Katherine Z. Sanidad, Aparna Ananthanarayanan, Melody Y. Zeng
Microorganisms.2020; 8(12): 1996. CrossRef
Group B streptococcus colonisation and associated risk factors among pregnant women: A hospital‐based study and implications for primary care
Zhiyao Chen, Guoming Wen, Xuelian Cao, Shunming Li, Xiaolin Wang, Zhenjiang Yao, Chuan'an Wu, Xiaohua Ye
International Journal of Clinical Practice.2019; 73(5): e13276. CrossRef
Prevalence of rectovaginal colonization by group B Streptococcus in pregnant women seen at prenatal care program of a health organization
Nilson Abrão Szylit, Fernanda Lima Malburg, Carla de Azevedo Piccinato, Lais Assenheimer de Paula Ferreira, Sérgio Podgaec, Eduardo Zlotnik
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Xiaolin Wang, Xuelian Cao, Shunming Li, Qianting Ou, Dongxin Lin, Zhenjiang Yao, Sidong Chen, Chuan'an Wu, Guoming Wen, Xiaohua Ye
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Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses
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Clinical Infectious Diseases.2017; 65(suppl_2): S133. CrossRef
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Modern Care Journal.2017;[Epub] CrossRef

Factors Associated with Insulin Resistance in a Middle-Aged Non-Obese Rural Population: The Chungju Metabolic Disease Cohort (CMC) Study: Sun Young Lim, Hee Sung Ha, Hyuk-Sang Kwon, Jin-Hee Lee, Hyeon Woo Yim, Kun-Ho Yoon, Won-Chul Lee, Ho-Young Son, Yong-Moon Park; Epidemiol Health. 2011;33:e2011009. Published online September 26, 2011; DOI: https://doi.org/10.4178/epih/e2011009

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Abstract

<sec><title>OBJECTIVES</title>We aimed to determine the characteristics affecting insulin resistance in non-obese middle-aged adults in a rural community.</sec><sec><title>METHODS</title>A total of 1,270 non-diabetic adults aged between 40 and 64 years old with body mass index (BMI) less than 25 kg/m2 were analyzed. Subjects with insulin resistance were defined as those who had the highest quartile value of the homeostasis model assessment of insulin resistance (HOMA-IR) in a non-diabetic population.</sec><sec><title>RESULTS</title>A total of 217 subjects (20.6%) had insulin resistance. Prevalence of metabolic syndrome was significantly higher in insulin-resistant subjects in both men (29.3% vs. 10.3%) and women (34.1% vs. 15.6%). Among metabolic syndrome components, elevated waist circumference and elevated triglyceride were higher in insulin-resistant subjects in both genders. After being controlled for socioeconomic status and lifestyle related covariates, the association between insulin resistance and BMI was statistically significant in the category of 23.0-24.9 kg/m2 in men (adjusted OR, 4.63; 95% confidence interval [95% CI], 1.77-12.15) using the category of 18.5-20.9 kg/m2 as a reference. In addition, the association between insulin resistance and abdominal obesity was statistically significant only for men (adjusted OR, 2.57; 95% CI, 1.29-5.11).</sec><sec><title>CONCLUSION</title>Insulin resistance appears to be highly associated with high BMI and abdominal obesity, even in non-obese, non-diabetic middle-aged men.</sec>

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Relapsing-remitting multiple sclerosis patients display an altered lipoprotein profile with dysfunctional HDL
Winde Jorissen, Elien Wouters, Jeroen F. Bogie, Tim Vanmierlo, Jean-Paul Noben, Denis Sviridov, Niels Hellings, Veerle Somers, Roland Valcke, Bart Vanwijmeersch, Piet Stinissen, Monique T. Mulder, Alan T. Remaley, Jerome J. A. Hendriks
Scientific Reports.2017;[Epub] CrossRef
Insulin Resistance of Normal Weight Central Obese Adolescents in Korea Stratified by Waist to Height Ratio: Results from the Korea National Health and Nutrition Examination Surveys 2008–2010
Won Kyoung Cho, Hyojin Kim, Hyun Young Lee, Kyung Do Han, Yeon Jin Jeon, In Ah Jung, Shin Hee Kim, Kyoung Soon Cho, So Hyun Park, Min Ho Jung, Byung-Kyu Suh
International Journal of Endocrinology.2015; 2015: 1. CrossRef
Impact of ENPP1 K121Q on Change of Insulin Resistance after Web-Based Intervention in Korean Men with Diabetes and Impaired Fasting Glucose
Ji Yeon Kang, Sook Hee Sung, Yeon Ju Lee, Tae In Choi, Seung Jin Choi
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Using Formative Research to Design an Epidemiologic Survey: The North Carolina Study of Home Care and Hospice Nurses: Jack K. Leiss, Jennifer T. Lyden, Cynthia Klein; Epidemiol Health. 2011;33:e2011008. Published online September 7, 2011; DOI: https://doi.org/10.4178/epih/e2011008

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<sec><title>OBJECTIVES</title>Formative research can serve as a means of obtaining important information for designing an epidemiologic study, but descriptions of this approach in the epidemiologic literature are lacking. The objective of this paper is to describe the use of three formative research techniques in designing a survey of home care and hospice nurses.</sec><sec><title>METHODS</title>We conducted two focus groups, seven key informant interviews, and approximately fifteen hours of direct observation among home care and hospice nurses recruited by word of mouth in North Carolina in 2006.</sec><sec><title>RESULTS</title>We used information obtained from the formative research to decide which survey design would likely be most successful with this population (mail survey, as opposed to Internet survey or in-person interviews), which measure to use for the denominator of the blood exposure incidence rates (number of visits, as opposed to patient-time), and which items and response options to include in the questionnaire, as well as to identify specific survey techniques that would likely increase the response rate (emphasizing the regional focus of the study; sending the questionnaire to the home address).</sec><sec><title>CONCLUSION</title>When particular information for planning a study is unavailable from the literature or the investigator's experience, formative research can be an effective means of obtaining that information.</sec>

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Nutrition and dietetic students’ knowledge and attitudes regarding food science and technology
Alex E. Mohr, Selicia T. Mayra, Lindsay Gnant, Anthony J. Basile, Karen L. Sweazea
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Adiponectin is Associated with Impaired Fasting Glucose in the Non-Diabetic Population: Sang Yeun Kim, Sun Ju Lee, Hyoun Kyoung Park, Ji Eun Yun, Myoungsook Lee, Jidong Sung, Sun Ha Jee; Epidemiol Health. 2011;33:e2011007. Published online August 20, 2011; DOI: https://doi.org/10.4178/epih/e2011007

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Abstract

<sec><title>OBJECTIVES</title>Adiponectin is strongly associated with diabetes in the Western population. However, whether adiponectin is independently associated with impaired fasting glucose (IFG) in the non-obese population is unknown.</sec><sec><title>METHODS</title>The serum adiponectin, insulin resistance (IR), and waist circumference (WC) of 27,549 healthy Koreans were measured. Individuals were then classified into tertile groups by gender. IFG was defined as a fasting serum glucose of 100-125 mg/dL without diabetes. IR was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR). The association of adiponectin and IFG was determined using logistic regression analysis.</sec><sec><title>RESULTS</title>WC and adiponectin were associated with IFG in both men and women. However, the association of WC with IFG was attenuated in both men and women after adjustment for the HOMA-IR. Adiponectin was still associated with IFG after adjustment for and stratification by HOMA-IR in men and women. Strong combined associations of IR and adiponectin with IFG were observed in men and women. Multivariate adjusted odds ratios (ORs) (95% confidence interval [CI]) among those in the highest tertile of IR and the lowest tertile of adiponectin were 9.8 (7.96 to 12.07) for men and 24.1 (13.86 to 41.94) for women.</sec><sec><title>CONCLUSION</title>These results suggest that adiponectin is strongly associated with IFG, and point to adiponectin as an additional diagnostic biomarker of IFG in the non-diabetic population.</sec>

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Supanee Thanakun, Hisashi Watanabe, Sroisiri Thaweboon, Yuichi Izumi
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Using Bayesian Networks to Model Hierarchical Relationships in Epidemiological Studies: Georges Nguefack-Tsague; Epidemiol Health. 2011;33:e2011006. Published online June 17, 2011; DOI: https://doi.org/10.4178/epih/e2011006

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<sec><title>OBJECTIVES</title>To propose an alternative procedure, based on a Bayesian network (BN), for estimation and prediction, and to discuss its usefulness for taking into account the hierarchical relationships among covariates.</sec><sec><title>METHODS</title>The procedure is illustrated by modeling the risk of diarrhea infection for 2,740 children aged 0 to 59 months in Cameroon. We compare the procedure with a standard logistic regression and with a model based on multi-level logistic regression.</sec><sec><title>RESULTS</title>The standard logistic regression approach is inadequate, or at least incomplete, in that it does not attempt to account for potentially causal relationships between risk factors. The multi-level logistic regression does model the hierarchical structure, but does so in a piecewise manner; the resulting estimates and interpretations differ from those of the BN approach proposed here. An advantage of the BN approach is that it enables one to determine the probability that a risk factor (and/or the outcome) is in any specific state, given the states of the others. The currently available approaches can only predict the outcome (disease), given the states of the covariates.</sec><sec><title>CONCLUSION</title>A major advantage of BNs is that they can deal with more complex interrelationships between variables whereas competing approaches deal at best only with hierarchical ones. We propose that BN be considered as well as a worthwhile method for summarizing the data in epidemiological studies whose aim is understanding the determinants of diseases and quantifying their effects.</sec>

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Brief Communication

Quality of Cohort Studies Reporting Post the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Jalal Poorolajal, Zahra Cheraghi, Amin Doosti Irani, Shahab Rezaeian; Epidemiol Health. 2011;33:e2011005. Published online June 7, 2011; DOI: https://doi.org/10.4178/epih/e2011005

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The quality of reporting of cohort studies published in the most prestigious scientific medical journals was investigated to indicate to what extent the items in the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist are addressed. Six top scientific medical journals with high impact factor were selected including New England Journal of Medicine, Journal of the American Medical Association, Lancet, British Medical Journal, Archive of Internal Medicine, and Canadian Medical Association Journal. Ten cohort studies published in 2010 were selected randomly from each journal. The percentage of items in the STROBE checklist that were addressed in each study was investigated. The total percentage of items addressed by these studies was 69.3 (95% confidence interval: 59.6 to 79.0). We concluded that reporting of <italic>cohort</italic> studies published in the most prestigious scientific medical journals is not clear enough yet. The reporting of other types of observational studies such as case-control and cross-sectional studies particularly those being published in less prestigious journals expected to be much more imprecise.

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Original Articles

Reliability of Quadruplicated Serological Parameters in the Korean Genome and Epidemiology Study: Jae Jeong Yang, Ji Hyun Yang, Jimin Kim, Lisa Y. Cho, Boyoung Park, Seung Hyun Ma, Sang Hoon Song, Won-Ki Min, Sung Soo Kim, Man Suck Park, Sue K. Park; Epidemiol Health. 2011;33:e2011004. Published online May 19, 2011; DOI: https://doi.org/10.4178/epih/e2011004

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Abstract

<sec><title>OBJECTIVES</title>The aim of this study was to evaluate whether clinical test values from different laboratories in the Korean Genome and Epidemiology Study (KoGES) can be integrated through a statistical adjustment algorithm with appropriate intra- and inter-laboratory reliability.</sec><sec><title>METHODS</title>External quality control data were obtained from the Korean Society for Laboratory Medicine and quadruplicated standardized serological samples (N=3,200) were manufactured in order to check the intra- and inter-laboratory reliability for aspartic acid transaminase (AST), alanine transaminase (ALT), gamma-glutamyl transpeptidase (γ-GTP), blood urea nitrogen (BUN), creatinine, uric acid (UA), fasting blood sugar (FBS), cholesterol, and triglyceride (TG). As an index of inter- and intra-rater reliability, Pearson's correlation coefficient, intraclass correlation coefficients and kappa statistics were estimated. In addition, to detect the potential for data integration, we constructed statistical compensation models using linear regression analysis with residual analysis, and presented the R-square values.</sec><sec><title>RESULTS</title>All correlation coefficient values indicated good intra- and inter-laboratory reliability, which ranged from 0.842 to 1.000. Kappa coefficients were greater than 0.75 (0.75-1.00). All of the regression models based on the trial results had strong R-square values and zero sums of residuals. These results were consistent in the regression models using external quality control data.</sec><sec><title>CONCLUSION</title>The two laboratories in the KoGES have good intra- and inter-laboratory reliability for ten chemical test values, and data can be integrated through algorithmic statistical adjustment using regression equations.</sec>

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ADIPOQ Gene Variants Associated with Susceptibility to Obesity and Low Serum Adiponectin Levels in Healthy Koreans: Ji Wan Park, Jungyong Park, Sun Ha Jee; Epidemiol Health. 2011;33:e2011003. Published online April 25, 2011; DOI: https://doi.org/10.4178/epih/e2011003

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Abstract

<sec><title>OBJECTIVES</title>This study aimed to measure the association between the adiponectin, C1Q and collagen domain-containing (<italic>ADIPOQ</italic>) gene variants and obesity in Koreans.</sec><sec><title>METHODS</title>Three single nucleotide polymorphisms located in the <italic>ADIPOQ</italic> gene were genotyped in a population-based cross-sectional study of 986 healthy Koreans. Three different case-control groups (i.e. G1, G2, and G3) were defined according to body mass index (BMI) and serum adiponectin levels. Allelic and genotypic associations of this gene with obesity were measured using multivariate logistic regression analyses in each group.</sec><sec><title>RESULTS</title>The G allele of -11377C>G, a polymorphism located in the promoter region of the <italic>ADIPOQ</italic> gene (odds ratio (OR), 1.48; 95% confidence interval, 1.13-1.94) and most haplotypes including this allele significantly increased the risk for obesity. However, the OR decreased from 3.98 (G1 group) to 2.90 (G2 group) and 2.30 (G3 group) when a less strict definition of obesity was used. Most haplotypes, including this allele, significantly increased the risk of obesity. The statistical evidence from the GG genotype of -11377C>G (OR, 3.98) and the GT/GT diplotype composed of -11377G>C and +45T>G (OR, 5.20) confirmed the contribution of the G allele toward a predisposition for obesity.</sec><sec><title>CONCLUSION</title>These results suggest the contribution of the <italic>ADIPOQ</italic> gene toward susceptibility to obesity in healthy Koreans. The high-risk genotypes and haplotypes identified here may provide more information for identifying individuals who are at risk of obesity.</sec>

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Editorial

Comments on Jo and Colleagues' Paper (2010) "Association of Subway Driver's Depressive Symptoms and Experience of Work-Related Problems": Jae-Min Kim; Epidemiol Health. 2011;33:e2011002. Published online April 25, 2011; DOI: https://doi.org/10.4178/epih/e2011002

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Original Article

Effect of Medicine Adherence on the Occurrence of Cerebrovascular Disorders in Diabetes Mellitus Patients: Il-Su Park, Hae-Sook Sohn; Epidemiol Health. 2011;33:e2011001. Published online January 28, 2011; DOI: https://doi.org/10.4178/epih/e2011001

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Abstract

<sec><title>OBJECTIVES</title>To assess the association between the occurrence of cerebrovascular disorders and a medication adherence in diabetes mellitus patients.</sec><sec><title>METHODS</title>Medical records from 1,114 new patients with diabetes mellitus were collected and the occurrence of cerebrovascular disorders was observed. Data was gathered from the health examination records of diabetes mellitus patients registered at the Korean Metabolic Syndrome Research from 1996 to 2005, medication records from the National Health Insurance Corporation and death data from the National Statistics Office from 1997 to 2007. Hazard ratios were analyzed using the Cox proportional hazard model to test the association between the occurrence of cerebrovascular disorders and the level of medication adherence. Medication adherence was calculated using Continuous measure of Medication Acquisition (CMA).</sec><sec><title>RESULTS</title>Of 1,114 diabetes mellitus patients, cerebrovascular disorders occurred in 67 cases (6.1%). The mean duration for the development of a cerebrovascular disorder was 3.82 yr. Medication adherence (≥0.8 vs. <0.5: HR, 3.26; 95% CI, 1.47-7.21, ≥0.8 vs. 0.5-0.7 HR, 0.99; 95% CI, 0.33-2.95) was an independent factor associated with the occurrence of cerebrovascular disorders in diabetes mellitus.</sec><sec><title>CONCLUSION</title>Increased medication adherence is necessary to prevent the occurrence of cerebrovascular disorders in diabetes mellitus patients. Furthermore we propose that CMA be considered as a method for monitoring medication adherence in clinics.</sec>

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