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At least 811 records · Page 45Linked to original sources
PubMed1996

Ten-year evaluation of removable partial dentures: survival rates based on retreatment, not wearing and replacement.

From a group of 1480 patients, 1036 were treated with metal frame removable partial dentures (RPDs) at least 5 years before this analysis. Of those, 748 patients who wore 886 RPDs were followed up between 5 and 10 years; 288 patients dropped out. The 748 patients in the study groups were wearing 703 conventionally designed metal frame RPDs and 183 RPDs with attachments. When dropout patients and patients who remained in the study were compared, no differences were shown in the variables analyzed, which indicated that the dropouts did not bias the results. Survival rates of the RPDs were calculated by different failure criteria. Taking abutment retreatment as failure criterion, 40% of the conventional RPDs survived 5 years and more than 20% survived 10 years. In RPDs with attachments crowning abutments seemed to retard abutment retreatment. Fracture of the metal frame was found in 10% to 20% of the RPDs after 5 years and in 27% to 44% after 10 years. Extension base RPDs needed more adjustments of the denture base than did tooth-supported base RPDs. Taking replacement or not wearing the RPD as failure criteria, the survival rate was 75% after 5 years and 50% after 10 years (half-life time). The treatment approach in this study was characterized by a simple design of the RPD and regular surveillance of the patient in a recall system.

Adult↗
PubMed2002

Intention-to-treat meets missing data: implications of alternate strategies for analyzing clinical trials data.

True intention-to-treat analyses are rare in reports of randomized clinical trials. To highlight the complex issues that arise in conducting and interpreting data from intention-to-treat analyses in studies with substantial levels of protocol violation (e.g. attrition, noncompliance, or withdrawal of participants), data from a clinical trial of treatment for cocaine dependence were analyzed using three strategies to manage missing data: Strategy 1 addressed the effectiveness of treatments based on data collected from participants up to the point of dropout. Strategy 2 addressed the effectiveness of treatments based on data from the full intended duration of the protocol including data collected after participant dropout. The third strategy used a more novel approach, which used an intention-to-treat strategy for the full duration of the trial and the full sample, but also evaluated the effect of treatment retention outcomes by including an independent variable to reflect active treatment retention as a time-varying covariate. Conclusions about the relative efficacy of the study treatments varied to some extent depending on the analytic strategy used. These findings suggest that investigators should make every effort to conduct intent-to-treat analyses, but also to make use of multiple analytic strategies to fully understand the effects of the treatments studied. Moreover, regardless of the strategy used, investigators should clearly describe their handling of data from participants who violate the protocol.

Data Interpretation, Statistical↗
PubMed2003

Cognitive impairment, retention and abstinence among cocaine abusers in cognitive-behavioral treatment.

Cognitive-behavioral therapy (CBT) depends on adequate cognitive functioning in patients, but prolonged cocaine use may impair cognitive functioning. Therefore, cognitive impairment may impede the ability of cocaine abusers to benefit from CBT. To begin to address this issue, we investigated the relationship between cognitive impairment and two treatment outcomes, therapy completion and abstention. Eighteen carefully screened non-depressed cocaine-dependent patients in a psychopharmacological clinical trial were administered the MicroCog computerized battery to assess cognitive performance at treatment entry. T-tests were used to compare cognitive functioning between completers (patients remaining in treatment at least 12 weeks) and dropouts. The results indicated that treatment completers had demonstrated significantly better cognitive performance at baseline than patients who dropped out of treatment. Cognitive domains that significantly distinguished between treatment completers and dropouts were attention, mental reasoning and spatial processing. This study provides preliminary evidence that cognitive impairments may decrease treatment retention and abstinence in CBT of cocaine dependence.

Adult↗
PubMed1999

Nicodermal patch adherence and its correlates.

The patch adherence behavior of 101 smokers receiving 8 weeks of the nicodermal patch was examined while undergoing one of three levels of adjunctive psychosocial treatment. Additionally, regression analyses were undertaken to: (1) identify subject variables predictive of patch adherence and (2) to determine the predictive validity of patch treatment dropout, smoking and patch adherence during patch treatment to smoking 9 and 26 weeks post-treatment entry. Fifty-five percent of the patients wore the patch as prescribed for at least 50 of 56 treatment days. A multiple regression model including the Fagerström severity of dependence score, psychosocial treatment group, and the URICA commitment score predicted 18% of the variance in days of patch use. All treatment dropouts were found to be smoking at followup. Although both smoking and low patch compliance during treatment were significant predictors subjects of week 9 and 26 smoking for the remaining subjects, at the individual variable level of analysis, only smoking during treatment predicted week 9 and 26 outcomes in a two-variable predictor model.

Administration, Cutaneous↗
PubMed1999

Level of education and injecting drug use among African Americans.

Drawing upon a nationally representative survey sample of African American (AA) drug injectors and non-injectors, this study tests for a suspected causal association between dropping out of school and the occurrence of injecting drug use (IDU), which remains a major cause of human immunodeficiency virus (HIV) transmission in this population. The data are from public use files of the National Household Surveys on Drug Abuse (NHSDA) conducted between 1991 and 1995. From within the NHSDA's nationally representative sample of adult household residents, a total of 389 AA adults with a history of IDU were matched on neighborhood of residence with 2253 AA adults with no history of IDU. The conditional form of multiple logistic regression was used to estimate the relative risk of having injected a drug for school dropouts relative to a reference category of AA who received the high school diploma but did not go to college. AAs who dropped out of high school were an estimated two times more likely to have injected drugs. With statistical adjustment for age, sex, and Hispanic background, the estimated association was 1.9 (95% confidence interval (C.I.) = 1.3-2.6, P<0.001). Contrary to our advance hypothesis, earning the graduate equivalency certificate (GED) did not seem to affect the magnitude of excess risk for having started IDU (adjusted odds ratio (aOR) = 2.3, 95% C.I. = 1.4-3.8, P<0.001). Hence, school dropout prevention might reduce the risk of IDU per se, in addition to the many other general benefits of educational attainment. The issue of GED-associated reduced risk of IDU remains open for future study.

Adolescent↗
PubMed2002

Predicting treatment-outcome in cocaine dependence from admission urine drug screen and peripheral serotonergic measures.

We investigated whether urine drug screens (UDS) at admission and platelet paroxetine binding, a measure of serotonin transporter sites, were related to outcome measures for cocaine patients in treatment. Tritiated paroxetine binding sites on platelets were assayed and UDS were obtained for 105 African American cocaine-dependent outpatients. Outcome measures included number of negative urines, days in treatment, dropouts, and number of treatment sessions attended. A significant association was found between cocaine-positive UDS at admission and negative urines, treatment retention, dropouts, and treatment sessions; while Bmax values of paroxetine binding (density of serotonin transporter sites) were significantly associated with treatment retention and negative urines. Moreover, UDS and paroxetine binding combined to enhance prediction of retention and abstinence. Although both admission UDS and paroxetine binding seem to contribute individually in predicting outcome of cocaine patients, a combination of the two variables seems to have a stronger effect in terms of predicting treatment-outcome.

Adult↗
PubMed2002

Gender differences in detoxification: predictors of completion and re-admission.

This study examined the medical records of 2595 consecutive admissions over a 3-year period to an inpatient mixed-gender, hospital-based alcohol and drug detoxification unit. Women reported a significantly different pattern of primary drug use, a younger age, a different pattern of referral sources, and higher rates of parenting status and unemployment. In addition, females were administered prescription medication and medical evaluation tests at a significantly higher rate than males. Multiple regression analyses demonstrated that an opiate as a primary drug of choice was a significant risk factor for dropout. Risk factors for re-admission to inpatient detoxification included: alcohol as a primary drug of choice, residential instability, multiple drug use, single marital status, unemployment, an older age (> 37 years), and treatment dropout at Time 1 in the study. For both the final prediction models, gender was not a significant factor. The treatment implications of these findings are discussed.

Adult↗
PubMedDate not supplied

Perinatal substance abusers: factors influencing treatment retention.

This study investigated the association between two demographic and two psychological variables and treatment retention for 65 perinatal substance abusers. Subjects who lived in the community while attending day treatment were 6.125 times more likely to drp out than subjects who lived in a program-operated shelter (p < .0001). An interaction was found for pregnancy status and antisocial personality disorder (p < .0478). Subjects who were both pregnant and antisocial were 4.876 times more likely to remain in treatment than those who were neither pregnant nor antisocial. Degree of "treatment resistance," measured by the MMPI Negative Treatment Indicators (TRT) Scale, did not predict dropout. These findings indicate that supportive housing can play an important role in preventing dropout for perinatal substance abusers. Additionally, pregnancy may present a "window" of opportunity for treating a hard to reach population, drug abusing women with comorbid ASP.

Adult↗
PubMed2003

Health-related quality of life predicts survival, cytomegalovirus disease, and study retention in clinical trial participants with advanced HIV disease.

We tested whether health related quality of life (HRQOL) predicts mortality, development of active cytomegalovirus (CMV) disease, and study retention. We studied 957 patients with CD4 counts <100 cells/mm(3) in AIDS Clinical Trials Group Protocol 204, a randomized, double-blind trial comparing three prophylactic regimens against CMV end-organ disease. The MOS-HIV, a brief HRQOL questionnaire, generated physical health summary (PHS) and mental health summary (MHS) scores. We used Cox proportional hazards to predict events by baseline HRQOL, adjusted for treatment, demographics, and CD4. Each point increase in baseline PHS decreased the risk of death by 4%, CMV by 2%, and dropout by 2%. Each point increase in baseline MHS decreased the risk of death by 4% and study dropout by 1%. In conclusion, self-rated physical and mental health demonstrated predictive validity for survival, CMV end-organ disease, and retention in advanced HIV patients. The results show the clinical importance of HRQOL and may facilitate interpretation by clinicians.

Acute Disease↗
PubMed1999

The Zelen design may be the best choice for a heroin-provision experiment.

Recently, the Dutch Parliament agreed upon the conduct of a randomized clinical trial on the effects on heroin provision on general health and psychosocial and criminal behavior in long-term addicts. Previous studies failed to establish the effects beyond reasonable doubt. The main reasons why previous trials failed are massive dropout or noncompliance in the control group. Designing a new heroin-provision trial, we concluded that the Zelen design provides the best guarantee for obtaining valid study results. Compared with the traditional design, the Zelen design probably reduces noncompliance and dropout considerably, thus increasing validity. Depending on the study population, the Zelen design may reduce study precision. However, in a trial aimed at badly integrated addicts, the Zelen design can be conducted without loss of precision because baseline measurements will only weakly correlate with effect measurements. The arguments favoring the Zelen design may be generalized to trials in which the experimental treatment is highly attractive to the study participants. However, the use of the Zelen design precludes blinding of participants who receive the experimental treatment. We argue that the conduct of studies that predictably tend to produce invalid results is ethically dubious. The ethical problem of studying participants without their consent can be solved by a slight modification of the Zelen design in which the sampling of a control group is postponed. Both the traditional and the Zelen design can imply ethical problems. Both designs can be ethically justifiable and should not be rejected on a priori grounds.

Analgesics, Opioid↗
PubMed2001

Attrition from after school programs: characteristics of students who drop out.

A goal of many after-school programs is to provide supervision to youths who might potentially engage in delinquent activities during the afternoon hours. By comparing students who remained in a sample of Maryland after-school programs to students who withdrew prior to the end of the school year, this study provides evidence that after-school programs are serving a lower-risk population than intended. Findings indicate that prior to dropping out of the programs, dropouts scored in the more at-risk direction on 11 out of 12 indicators examined in this study and had significantly more peer drug models and days absent from school than students who stayed in the programs. Census data indicate that dropouts came from neighborhoods characterized by higher levels of social disorganization than students who stayed in the programs. Program attendance is also related to several of the risk-factors examined. The results suggest the need for improved communication with parents and further creativity in program planning as a means of retaining high-risk students.

Adolescent↗
PubMed2002

The effect of compliance-improving interventions on the cognitive-behavioural treatment of pathological gambling.

This exploratory study investigated the effect of interventions designed to improve compliance and reduce dropout rates during the outpatient treatment of pathological gambling at a University-based gambling treatment clinic. Forty subjects (29 males, 11 females, mean age = 37.6) meeting DSM-IV criteria (APA, 1994) for pathological gambling were randomly assigned to either a cognitive-behavioural treatment or a cognitive-behavioural treatment combined with interventions designed to improve treatment compliance. Compliance was indicated by the completion of all treatment sessions. Outcome measures were DSM-IV criteria assessed by structured clinical interview, South Oaks Gambling Screen scores, and percentage of income gambled. Logistic regression analyses identified pretreatment characteristics predicting compliance and outcome. Compliance-improving interventions significantly reduced dropout rates, resulting in superior outcomes at posttreatment compared to the cognitive behavioural treatment alone. At 9-month follow-up, there was no difference in outcome between treatments, although both produced clinically significant change. Comorbid problem drinking, drug use, and problem gambling duration predicted poor compliance. Poor outcome was predicted by comorbid problem drinking. The clinical implications of these results are discussed in light of the exploratory nature of the study and the need for future research to address compliance, outcome, and comorbidity issues.

Adult↗
PubMed1998

"Seeking safety": outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence.

Women with current posttraumatic stress disorder (PTSD) comprise 30-59% of substance abuse treatment samples and experience a more severe course than women with either disorder alone. As yet, no effective treatment for this population has been identified. This paper reports outcome results on 17 women who completed a new manual-based 24-session cognitive behavioral group therapy protocol treatment, based on assessments at pretreatment, during treatment, posttreatment, and at 3-month follow-up. Results showed significant improvements in substance use, trauma-related symptoms, suicide risk, suicidal thoughts, social adjustment, family functioning, problem solving, depression, cognitions about substance use, and didactic knowledge related to the treatment. Patients' treatment attendance, alliance, and satisfaction were also very strong. Treatment completers were more impaired than dropouts, yet more engaged in the treatment. Overall, our data suggest that women with PTSD and substance abuse can be helped when provided with a treatment designed for them. All results are clearly tentative, however, due to the lack of a control group, multiple comparisons, and absence of assessment of dropouts.

Adult↗
PubMed2004

Exploring risk in early adolescent African American youth.

Two studies were conducted to explore the degree to which single- and multiple-risk profiles were evident in samples of African American early adolescents in low-income inner-city, rural, and suburban schools. Study 1 examined early adolescent risk status (i.e., single, multiple) in relation to later adjustment in a representative sample (70% European American, 30% African American). Youth who experienced a single risk in early adolescence had moderately increased levels of school dropout and criminal arrests, whereas youth with multiple risks (i.e., combination of 2 or more risks) had significantly increased levels of school dropout, criminal arrests, and teen parenthood. Study 2 examined the extent to which single- and multiple-risk profiles were evident in cross-sectional samples of African American youth from low-income inner-city and rural areas. About one fourth of both the inner-city and rural samples of African American youth were composed of youth in the single-risk category. A significantly greater proportion of boys in the inner-city sample (20%) than boys in the rural sample (13%) experienced multiple risks. Girls across the rural and inner-city samples did not differ in terms of risk. Overall, more than 60% of African American youth in these two low-income samples did not evidence risk for later adjustment problems. Implications for research and intervention are discussed.

Adolescent↗
PubMed1997

Attrition in the treatment of childhood anxiety disorders.

The present study explored the differences between completers and terminators (including both refusers and dropouts) of an individual cognitive-behavioral treatment for childhood anxiety. Participants were 190 children with anxiety disorders and their parents: 146 completed treatment and 44 terminated. Terminators were more likely to live in a single-parent household, be ethnic minorities, and self-report less anxious symptomatology. Follow-up interviews indicated that identifiable child factors were influential in terminators' decisions to discontinue treatment. Among terminators, differences between refusers and dropouts were also investigated.

Adolescent↗
PubMed2006

Correlates of change in student reported parent involvement in schooling: a new look at the National Education Longitudinal Study of 1988.

Using a subsample (2174 students, 174 schools) from the National Education Longitudinal Study of 1988 (NELS), this study drew on Eccles and Harold's (1996) framework of parent involvement in schooling to estimate the relative influence of key child, family, and school characteristics on change in three types of student-reported parent involvement in schooling between eighth and tenth grades: home communication about school, monitoring, and direct interactions with schools. It also examines relationships between changes in involvement, change in grade point average (GPA), and dropout. Overall, measured school effects accounted for a small proportion of the variation in changes in home communication and direct parent interactions with schools. Sustained home communication related to higher grades and lower likelihood of dropout, although the size of effects was small.

Adolescent↗
PubMed2003

Staying in treatment: how much difference is there from prison to prison?

This is the 1st study to examine the effects of individual- and program-level characteristics on treatment attrition within a prison-based setting. The sample of 1,446 men and women were from 19 programs. Differences were found in both individual- and program-level predictors of disciplinary discharges and dropouts. Dropouts were more likely to be women and enter treatment with lower levels of motivation. Individuals who were disciplinary discharges from treatment were more likely to be young, have a history of violence, and have a diagnosis of antisocial personality. Only 1 program factor--an emphasis on disciplinary discharge for violation of program rules--was associated with disciplinary discharge. The clinical implications of these findings are discussed.

Adult↗