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PubMed1991

Aminoguanidine treatment inhibits the development of experimental diabetic retinopathy.

Retinal capillary closure induced by hyperglycemia is the principal pathophysiologic abnormality underlying diabetic retinopathy, but the mechanisms by which this induction occurs are not clear. Treatment of diabetic rats for 26 weeks with aminoguanidine, an inhibitor of advanced glycosylation product formation, prevented a 2.6-fold accumulation of these products at branching sites of precapillary arterioles where abnormal periodic acid/Schiff reagent-positive deposits also occurred. Aminoguanidine treatment completely prevented abnormal endothelial cell proliferation and significantly diminished pericyte dropout. After 75 weeks, untreated diabetic animals developed an 18.6-fold increase in the number of acellular capillaries and formed capillary microaneurysms, characteristic pathologic features of background diabetic retinopathy. In contrast, aminoguanidine-treated diabetic animals had only a 3.6-fold increase in acellular capillaries and no microaneurysms. These findings indicate that advanced glycosylation product accumulation contributes to the development of diabetic retinopathy and suggest that aminoguanidine may have future therapeutic use in this disorder.

Animals↗
PubMed1976

Psychosocial aspects of sickle cell disease.

The study described in this article deals with sickle cell patients in Jamaica whose illness is accompanied by leg ulceration, a common complication of sickle cell disease. After exploring the disease's psychological, social, and economic effects, the authors suggest various ways for social workers to help sickle cell patients.

Adaptation, Psychological↗
PubMed1976

Variables related to length of stay in day programs for drug abusers.

In a study of client variables related to length of stay in two types of drug-free day treatment programs, results varied according to program structure and sex of the clients. In the more loosely structured Youth Centers, in which the programs differed from center to center and the populations were heterogenous, there were no clear-cut results. However, within the more tightly structured Ambulatory Treatment Units, the programs and the populations were more homogeneous, and the results showed a significant pattern related to length of stay, but for males only.

Age Factors↗
PubMed2001

The prevalence and correlates of untreated serious mental illness.

OBJECTIVE: To identify the number of people in the United States with untreated serious mental illness (SMI) and the reasons for their lack of treatment. DATA SOURCE/STUDY DESIGN: The National Comorbidity Survey; cross-sectional, nationally representative household survey. DATA COLLECTION: An operationalization of the SMI definition set forth in the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act identified individuals with SMI in the 12 months prior to the interview. The presence of SMI then was related to the use of mental health services in the past 12 months. PRINCIPAL FINDINGS: Of the 6.2 percent of respondents who had SMI in the year prior to interview, fewer than 40 percent received stable treatment. Young adults and those living in nonrural areas were more likely to have unmet needs for treatment. The majority of those who received no treatment felt that they did not have an emotional problem requiring treatment. Among those who did recognize this need, 52 percent reported situational barriers, 46 percent reported financial barriers, and 45 percent reported perceived lack of effectiveness as reasons for not seeking treatment. The most commonly reported reason both for failing to seek treatment (72 percent) and for treatment dropout (58 percent) was wanting to solve the problem on their own. CONCLUSIONS: Although changes in the financing of services are important, they are unlikely by themselves to eradicate unmet need for treatment of SMI. Efforts to increase both self-recognition of need for treatment and the patient centeredness of care also are needed.

Adolescent↗
PubMed1990

Effect of worksite health promotion programs on employee absenteeism. A comparative analysis.

Employee absenteeism is an important economic variable that needs to be examined by occupational health nurses when evaluating worksite health promotion programs. Two of the three Blue Cross and Blue Shield Plan studies suggested that their programs acted to contain absenteeism among program participants. The worksite programs that met with success tended to be comprehensive and to have strong management support. Strengths of the three studies included the use of comparison groups and pretest measures of absenteeism in the analyses. Limitations included selection bias, subject dropout over time, limited monitoring of the program process, and the use of an analysis method that did not consider the statistical characteristics of the absenteeism variable.

Absenteeism↗
PubMed1986

Program characteristics for successful treatment of adolescent drug abuse.

The relationship to treatment outcome, as measured by reduction in drug use, of specific characteristics and elements of 30 drug-free outpatient programs for adolescents is reported. Admission and discharge data were obtained from National Institute on Drug Abuse-Client Oriented Data Acquisition Process on 5789 adolescents in the 30 programs. A partial cross-validation study was conducted by analyzing separately for two annual client subsamples. The program, not the individual clients, was the unit of analysis. While controlling for differences between programs on their client populations, multiple regression analysis indicated that the following characteristics of programs were found to predict the outcome criterion variable, to a statistically significant degree: treat a large number of adolescent clients; have a special school for school dropouts; have a relatively large budget; employ counselors or therapists who have at least 2 years' experience in working with adolescent drug abusers; provide special services such as vocational counseling, recreational services, and birth control services; use such therapy methods as crisis intervention, gestalt therapy, music/art therapy, and group confrontation; and be perceived by the clients as allowing and encouraging free expression and spontaneous action by clients. There was a high degree of replication of these findings across the two annual subsamples of clients; and the amount of variance in the treatment outcome criterion variable accounted for by the above-listed program characteristics was quite impressive.

Adolescent↗
PubMed2005

Diabetes education on Turkish immigrant diabetics: predictors of compliance.

A controlled experiment on the effect of ethnic specific diabetes education in Turkish type 2 diabetics revealed substantial problems with compliance. The cost effectiveness of such a programme would improve if patients most likely to dropout or overuse the education facility could be identified. The 45 patients of the intervention group were categorized into three groups: non-compliers, compliers and over-compliers, and we assessed the association between patient characteristics and these three groups. Compared to the compliers, non-compliers had a longer history of diabetes and poorer knowledge of diabetes. Over-compliers were more often younger, female, scored low on attitude or self-efficacy, and experienced more stress. Turkish patients having diabetes for a longer period or with poor knowledge of diabetes are at risk to dropout from the programme, while younger Turkish females scoring low on attitude or self-efficacy as well as those with more stress, are more likely to over-use the education facility.

Adult↗
PubMed1984

Factors associated with patient dropout from an outpatient alcoholism treatment service.

Treatment dropout was studied in 172 patients (40 women) of an outpatient alcoholism treatment program. The best predictors of dropout were the length of delay between appointments, and variables related to symptom levels such as the number of prior alcohol-related arrests, the use of illicit drugs and scores on the Michigan Alcoholism Screening Test. Of lesser importance, but in line with previous findings, were sociodemographic variables such as age, the level of social stability and the presence of dependents at home. No personality variables were found to be relevant. It is suggested that treatment programs can improve attendance by reducing the delay with which services are offered and by changing certain characteristics of treatment personnel.

Adolescent↗
PubMed1998

Therapist/patient race and sex matching: treatment retention and 9-month follow-up outcome.

AIMS: The current study was conducted to (a) replicate previous findings regarding the effect of patient/therapist race and sex-matching as this relates to the early dropout rate of substance abusers, and (b) to extend previous work by examining the impact of such matching on treatment retention and 9-month outcome. DESIGN: Patient and therapist characteristics were crossed in a 2 x 2 factorial design. Matching effects were then tested using retrospective data. PARTICIPANTS: Participants were 967 African-American cocaine-dependent people. SETTING: The study site was a university sponsored outpatient treatment facility located in an economically depressed section of a large Northeastern US city. MEASUREMENTS: Follow-up data were drawn from the Addiction Severity Index, the Risk for AIDS Behavior Inventory, and a questionnaire measuring post-discharge need for treatment, employment and education. Retention was defined as the number of days inclusive between the last date of service and the date of admission. FINDINGS: No significant differences in early dropout rates were found after initial contact with 10 different therapists. Matching therapist and patients with respect to gender and race did not decrease the premature dropout rate, but partial support for gender matching was noted. CONCLUSION: Matching therapist and substance abusing patients on gender and race may not be essential to improving retention and outcome.

Adult↗
PubMed1992

Ineffectiveness of colchicine for the prevention of restenosis after coronary angioplasty.

Colchicine, an antimitogenic agent, has shown promise in preventing restenosis after coronary angioplasty in experimental animal models. A prospective trial was conducted involving 197 patients randomized in a 2:1 fashion to treatment with oral colchicine, 0.6 mg twice daily (130 patients), or placebo (67 patients) for 6 months after elective coronary angioplasty. Treatment in all patients began between 12 h before angioplasty and 24 h after angioplasty. Compliance monitoring revealed that 96% of all prescribed pills were ingested. Demographic characteristics were similar in colchicine- and placebo-treated groups. A mean of 2.7 lesions/patient were dilated. Side effects resulted in a 6.9% dropout rate in the colchicine-treated patients. Complete quantitative angiographic follow-up was obtained in 145 patients (74%) with 393 dilated lesions. Quantitative angiographic measurements were obtained in two orthogonal views at baseline before angioplasty and immediately and at 6 months after angioplasty. The quantitative mean lumen diameter stenosis before angioplasty was 67% both in the 152 lesions in the placebo-treated group and in the 241 lesions in the colchicine-treated group; this value was reduced to 24% immediately after angioplasty in the lesions in both treatment groups. At the 6-month angiogram, lesions had restenosed to 47% lumen diameter narrowing in the placebo-treated group compared with 46% in the colchicine-treated group (p = NS). Forty-one percent of colchicine-treated patients developed restenosis in at least one lesion compared with 45% of the placebo-treated group (p = NS). In conclusion, colchicine was ineffective for preventing restenosis after coronary angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1991

Liver involvement in Alpers disease.

Alpers disease consists of diffuse cerebral degeneration manifested as developmental delay, seizures, vomiting, and progressive neuromuscular deterioration, with liver disease and death. We report the clinical course of the liver disease, histologic progression of the hepatic lesions, and etiologic investigations in five patients (four girls, three kinships). All had grown and developed normally until seen at 6 to 36 months of age (mean 20 months), with vomiting (n = 5), progressive hypotonia (n = 3), or seizures (n = 2). All had been given anticonvulsants, including valproic acid in three. Liver disease was noted at a mean age of 35 months (range 9 to 67 months), with hepatomegaly (two patients), abnormal hepatic synthetic function (three) or transaminase values (three), and cirrhosis in one. Patients survived for a mean of 4.6 weeks (range 1 to 8 weeks) after the identification of liver disease; all died of hepatic failure. Results of evaluation for infectious and metabolic causes of liver disease and causes of degenerative neuromuscular disease were negative in all patients. Premortem liver biopsy specimens (n = 3) demonstrated an early lesion consisting of lobular disarray, microvesicular steatosis, periportal acute and chronic inflammation, and individual hepatocyte necrosis. Autopsy findings (n = 5) consisted of macrovesicular steatosis, massive hepatocyte dropout, and proliferation of bile ductular elements, with almost complete replacement of hepatocytes by proliferating bile ductular elements in two patients. Brain showed characteristic neuronal degeneration. We conclude that Alpers disease can be a cause of rapidly progressive liver failure in early childhood. Although the cause of this autosomal recessive disease is not known, it does not appear to be related to peroxisomal dysfunction.

Biopsy↗
PubMed2004

Life satisfaction following spinal cord injury: long-term follow-up.

OBJECTIVE: To determine the course of self-reported life satisfaction in a spinal cord injury (SCI) cohort. DESIGN: Prospective study using longitudinal data from the Injury Control Research Center. PARTICIPANTS: Adult persons with traumatic-onset SCI (n = 207) evaluated at 1, 2, 4, and 5 years postinjury using the Life Satisfaction Index-A. RESULTS: A nonsignificant (P > 0.05) main effect of time was found using a repeated-measures analysis controlling for education and employment status. Several methods were used that provided a range of liberal to conservative estimates for missing data (ie, 38% retention rate at year 5). Subsequent missing data analyses tended to corroborate the finding of a nonsignificant effect of time, although the most conservative methods showed a significant decrease in life satisfaction between year 1 and year 5 postinjury (P < 0.05). Examination of numerous demographic, injury, and treatment-related characteristics at each follow-up time point suggested that the main findings of the study were not merely the result of differential dropout rates. CONCLUSION: Life satisfaction after the first year of injury remains largely the same over the next 4 years. Methodologic and analytic recommendations are discussed.

Adolescent↗
PubMed2005

Women in cardiac rehabilitation: outcomes and identifying risk for dropout.

BACKGROUND: Women are underrepresented in cardiac rehabilitation (CR). Few reports describe outcomes and explore factors that may be barriers to CR participation among women. The purposes of this study were to (1) compare baseline characteristics between women who completed and did not complete CR, (2) identify factors associated with women completing CR, and (3) describe outcomes among completers. METHODS: Study sample included women (n = 228) with coronary heart disease enrolled in CR at an academic medical center's program (January 1996-August 2003). Baseline differences between completers and noncompleters were compared; multivariate regression analyses identified factors associated with completers. Outcome measures included lipid levels, 6-minute walk distances, body mass index, Beck Depression Inventory II (BDI-II), self-reports of diet, physical activity, smoking, and perceived health status. RESULTS: Mean age was 62 +/- 11 years, 44% were nonwhite, and 42% were stratified as high risk. Dyslipidemia was the most common risk factor (85%) followed by hypertension (81%), low physical activity (74%), obesity (53%), diabetes (39%), and smoking (18%). BDI-II scores were elevated (> or = 14) in 31% of women. In the adjusted multivariate regression model, completers were less likely to be obese (adjusted odds ratio [AOR] 0.28, CI 0.10-0.76, P = .01) or have elevated BDI-II scores (AOR 0.87, CI 0.81-0.95 P = .001) than noncompleters. Completers achieved significant improvements in all outcome measures (all P < .05) except for high-density lipoprotein. CONCLUSION: Women enrolled in CR had a high risk factor burden and those completing achieved significant benefits. Women not completing CR were more likely to be obese or have depressive symptoms which may serve as barriers to completing CR.

Coronary Disease↗
PubMed1993

Dropping out of marriage and family therapy: a critical review of research.

The lack of attention given to research on the premature termination by clients in marriage and family therapy is evident in research reviews of the dropout phenomenon in psychotherapy. This article is an attempt to fill that void. The research literature on dropping out of family therapy is reviewed and organized. Studies in this area tend to focus on four kinds of variables: client characteristics, therapist characteristics, therapy process variables, and interventions. Stable findings in each of these areas are pointed out. Both limitations and recommendations for future research are discussed.

Family Therapy↗
PubMed1983

Predictors of dropout from cardiac exercise rehabilitation. Ontario Exercise-Heart Collaborative Study.

The Ontario Exercise-Heart Collaborative Study was a multicenter randomized clinical trial of high intensity exercise for the prevention of recurrent myocardial infarction in 733 men. Of the 678 subjects who could have participated for at least 3 years, 315 (46.5%) dropped out. Stepwise multiple linear logistic regression analysis was carried out to examine the relation between subject characteristics and the probability of dropping out during the study. Analysis was performed on the entry group as a whole by considering those subjects who had reinfarction while complying with the program and also by excluding all subjects with reinfarctions. The consistent and statistically significant predictors of dropout in both analyses were smoking and a blue collar occupation. Angina was significantly associated with dropout only when reinfarctions were excluded. It may be important to consider these factors when investigating the potential for compliance-improving strategies in reducing dropout from exercise rehabilitation programs.

Adult↗
PubMed1997

Contraceptive continuation and its determinants in Benin.

To understand better the rates of continuation of different contraceptive methods, a study in 12 family planning centers in Cotonou and Porto Novo, the two largest cities in Benin, was conducted. From January 1 to December 31, 1993, 944 questionnaires completed by new women acceptors of one of three methods of contraception (oral contraceptive, injection, or IUD) were analyzed. For all methods of contraception, the average length of follow-up was 9.5 months. From the start of the analysis, 44.4% (n = 419) of the women were regularly followed, 49.5% (n = 467) were not regularly followed, and 6.1% (n = 58) reported discontinuation of the method. One year after beginning the use of contraception, the cumulative proportion of women at risk of becoming pregnant, for all the methods together, was 42.0% (38.6-45.4%). Age was associated with the probability of abandoning oral contraception (p = 0.01). Three months after the start, the cumulative proportion of drop-out women having chosen oral contraceptive was 37.2% (22.8-51.6%) of the less than 20-year-olds, 19.0% (14.3-23.7%) of the 20- to 30-year-olds, and 23.4% (15.6-31.2%) of the over 30-year-olds. In contrast, drop-out was not associated with age for women using injection (p = 0.96) or the IUD (p = 0.47). Our results indicate a relatively high and rapid rate of discontinuation for modern contraceptive methods, particularly for young women having chosen oral contraceptive. This finding should incite the family planning educators to give more emphasis to the counseling programs, especially during the first three months.

Adolescent↗