[Association Between Medication Compliance and Various Risky Behaviors in Patients With Schizophrenia]

Objective

To investigate the status of medication adherence and various types of risky behaviors of schizophrenia patients in a certain area of western China and to explore accordingly the correlation between the two.

Methods

A total of 292 667 patients with schizophrenia were enrolled in a follow-up survey between 2006 and 2018. In addition, based on the outcome-wide analysis strategy, a multivariate Cox proportional risk regression model was used to estimate and compare the impact of medication adherence on different types of risky behaviors in schizophrenia patients.

Results

In this 13-year prospective cohort, 65 175 patients (31.4%) showed good medication adherence, while 142 394 patients (68.6%) showed poor medication adherence. The incidence rates of various risky behaviors during the follow-up period were as follows, minor nuisances, 12.25%, violation of the Law of the People's Republic of China on Penalties for Administration of Public Security (APS law), 3.82%, violation of criminal law, 0.94%, suicide completed, 0.28%, self-harm, 1.42%, and attempted suicide, 0.82%. Schizophrenia patients who had poor medication adherence had higher risks of committing violence against others and self-inflicted injury compared to patients with good medication adherence did, with the associated effects being minor nuisances (hazard ratio [HR]=1.31, 95% confidence interval [CI]: 1.27-1.35), violation of APS law (HR=1.47, 95% CI: 1.38-1.56), violation of criminal law (HR=1.17, 95% CI: 1.05-1.31), and self-harm (HR=1.43, 95% CI: 1.32-1.56), respectively, while the risk of suicide completed is lower in schizophrenia patients with poor medication adherence than that in patients with good medication adherence (HR=0.56, 95% CI: 0.47-0.66). There was no statistically significant association between attempted suicide and medication adherence.

Conclusion

There are variations in the direction and strength of the association between medication adherence and different types of risky behaviors and further research is needed to elucidate the mechanisms of the association.

[Development and validation of nomogram for predicting prognosis of patients with laryngeal squamous cell carcinoma after surgery]

Objective:To explore the relationship between preoperative blood indexes, clinicopathological characteristics and prognosis of patients with laryngeal squamous cell carcinoma（LSCC）, and to establish a nomogram for predicting survival and recurrence time of LSCC patients. Methods:The clinical data of 530 patients with LSCC who received primary surgical treatment were analyzed retrospectively. The patients were randomly divided into training group and testing group according to the ratio of 7∶3. The nomograms of overall survival（OS） and recurrence-free survival（RFS） were constructed based on Cox regression model, and the nomograms were verified and compared with TNM stage. Results:The results of multivariate analysis showed that age, operation mode, tumor diameter, TNM stage, cervical lymph node metastasis, fibrinogen level and systemic immune inflammation index were significantly correlated with OS, while operation mode, tumor diameter, TNM stage, cervical lymph node metastasis, international normalized ratio, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio were significantly correlated with RFS. The nomograms were constructed based on the above factors. The C-indexes of the nomograms of OS and RFS in the training group were 0.755 and 0.687, respectively, which were higher than those of TNM stage（0.657 and 0.582）. In the testing group, the C-indexes of OS and RFS nomograms were 0.717 and 0.646, respectively, which were higher than those of TNM stage（0.599 and 0.528）. The area under the receiver operating characteristic curves of these nomograms were also higher than TNM stage. The calibration curves showed that the models had good consistency. Decision curve analysis（DCA） showed that these nomograms had higher clinical benefit than TNM stage. Conclusion:Based on the independent prognostic factors, the predictive nomograms of OS and RFS at 1, 3 and 5 years after LSCC were constructed, which have certain clinical significance in guiding the individualized diagnosis and treatment of LSCC.