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At least 865 records · Page 48Linked to original sources
PubMed1997

Assertive community treatment versus usual care in engaging and retaining clients with severe mental illness.

OBJECTIVE: Two assertive community treatment teams were compared with a usual-care control condition based on their ability to engage and retain clients with serious and persistent mental illness in community-based mental health services. METHODS: Clients were randomly assigned to one of two assertive community treatment teams (N = 116) or to usual care (N = 58). Survival analysis was used to compare clients' length of engagement and retention in service in the two treatment conditions and in usual care. Cox regression analyses were conducted to determine whether demographic, program, or client variables were significantly associated with length of retention in treatment. Data on these baseline variables were collected after clients made initial contact with their community mental health provider. Clients were observed for up to 870 days. RESULTS: By the end of the observation period, the assertive community treatment teams retained 68 percent of their clients, compared with 43 percent in usual care. In both types of treatment, clients were at greatest risk of dropping out of services during the first nine months. The risk of dropout was associated with the type of treatment. Usual-care clients were more than twice as likely as assertive community treatment clients to drop out for reasons related to dissatisfaction with treatment. Each additional night homeless during the six months before enrollment in the study resulted in a 14 percent increase in the probability of dropout. CONCLUSIONS: Assertive community treatment clearly demonstrated a greater ability than usual care services to engage and retain clients in community mental health care.

Adult↗
PubMed1997

Outcomes of patients in a VA ambulatory detoxification program.

OBJECTIVE: The study examined outcomes of patients enrolled in a Veterans Affairs ambulatory detoxification program. METHODS: Descriptive statistical data were collected by routine clerical processes at a VA medical center. Patients' outcomes were operationally defined to include completion of the detoxification program, dropout or discharge, or re-enrollment in the program; admission to inpatient detoxification; and referral to, entry into, and completion of substance abuse rehabilitation after detoxification. Outcomes were determined for 517 of the 577 patients consecutively referred to the program during nine months in 1995. Patients met established criteria for mild to moderate alcohol withdrawal syndrome. RESULTS: Of the 517 patients, 453 successfully completed outpatient detoxification. Twenty patients dropped out, 19 were discharged, 37 re-enrolled, and 25 were admitted for inpatient detoxification. Of the 453 patients who completed outpatient detoxification, 434 were referred for further treatment; 415 entered and 322 completed the next treatment phase. CONCLUSIONS: The completion rate for patients in the outpatient detoxification program and rates for continuing and completing further treatment were higher than in previous studies. Measures of poor short-term outcome (dropout, re-enrollment, and admission to inpatient detoxification) also compared favorably with previous studies. Unique factors contributing to outcomes included systematic screening, medical protocols for detoxification, psychosocial therapies, program-supported housing, and attention to patient satisfaction.

Adult↗
PubMed2004

A drop-out prevention program for high-risk inner-city youth.

Inner-city youth are at high risk for dropping out of high school. Within this article, risk factors associated with dropout and strategies for effective prevention and intervention are reviewed. An example of a school-based drop-out prevention program is highlighted. The FUTURES Program is a school-based drop-out prevention program designed to address the needs of high-risk youth through smaller classes, character development, career preparation, case management/mentoring, positive incentives, and access to mental health services. Components of the program are described in detail and data evaluating the effectiveness of the program are presented. Directions for the future development of programs and conducting research to prevent dropout by inner-city youth are discussed.

Adolescent↗
PubMedDate not supplied

Impact of community-based diabetes education on program attenders and nonattenders.

This study reports on the differential impact of a moderately intensive diabetes education program on program attenders and dropouts. Sixty-one individuals with diabetes mellitus participated in a diabetes education program to increase knowledge, self-care, and metabolic control. Program attenders demonstrated a significant increase in diabetes knowledge and foot care irrespective of whether they attended the control or education groups. A discriminant analysis suggested that the nonattenders were more poorly educated, had less income, were younger, had had diabetes twice as long, reported more barriers to self-care, and were in poorer health than attenders. These results suggest that patients who attend interventions may be able to benefit from even minimal levels of intervention, while program dropouts may need special assistance to overcome obstacles to program participation.

Adult↗
PubMed2001

The placebo response in social phobia.

The placebo response forms a growing problem in randomized, placebo-controlled clinical trials in psychiatry. Research into the placebo response is on the increase, but remains very limited in relation to social phobia. Together with the dropout rate, the placebo effect is an important factor limiting the discriminative properties of any study. In this study, we reviewed 15 placebo-controlled studies in social phobia, focussing on patients and study characteristics. In social phobia, the placebo effect has turned out to be moderately large and has shown no increase over the past decade. Placebo response was highest in large, multicentred trials and was independent of study duration. No validation for a placebo run-in was found. Taking into account both response to placebo and active drug, as well as dropout rate, the most discriminative results are probably to be expected in a sample of patients who are moderately to severely impaired. More research in the field of the placebo response is needed.

Double-Blind Method↗
PubMed2006

An investigation of whether factors associated with short-term attrition change or persist over ten years: data from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS).

BACKGROUND: Factors associated with the loss of participants in long-term longitudinal studies of ageing, due to refusal or moves, have been discussed less than those with short term follow-up. METHODS: In a population-based study of cognition and ageing (the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS)), factors associated with dropout due to refusal and moving in the first follow-up period (over two years) are compared with factors associated with dropout over ten years. Participants at 10-year follow-up are compared with their age-standardised baseline contemporaries. RESULTS: Some consistent trends are found over the longer term. Refusers tended to have poorer cognition, less years of education, not have a family history of dementia and be women. Characteristics of people who moved differed between waves, but the oldest and people in worse health moved more. When surviving and responding individuals at ten years are compared with those of the same age at baseline many differences are found. Individuals of lower social class, education, cognitive ability, in residential care, with sight/hearing problems and poor/fair self-reported health are less likely to be seen after 10 years of follow-up. Individuals report more health problems when they participate in multiple interviews. CONCLUSION: The characteristics of refusers in the longer term are similar to those refusing to participate over the shorter term. Long-term follow-up studies will under represent the disadvantaged and disabled but represent full health status of participating individuals better. There are advantages and disadvantages to both short-term and long-term follow-up.

Aged↗
PubMed2005

Methodological issues in clinical trials of opioids for chronic pain.

Clinical trials of opioid analgesics for chronic pain are recognized to frequently fail to distinguish the analgesic effect from placebo, despite known efficacy of the drug. This paper reviews the methodologic features of such trials that may be associated with risk of failure. A literature search yielded 23 randomized placebo-controlled studies of opioids with at least one week of continuous treatment; contacting pharmaceutical companies yielded six additional studies. A classification system and standard terminology were developed for describing the methodologic features of these trials. The methodologic features that appeared to augur well for success of the trials were slow titration of medications, flexible dosing, minimizing concomitant and rescue analgesics, homogeneous samples, particularly in terms of opioid use upon entry, fewer study sites (for the same sample size), and including as much data as possible in statistical analyses. Study designs that lead to high dropout rates lack internal validity, unless dropout is the intended endpoint of the trial. Opioid analgesics should be studied in a manner that is clinically relevant, and that supports internal validity. More systematic attention is needed to clinical research methodology.

Analgesics, Opioid↗
PubMed1996

Impact of tobacco-free policy on recruitment and retention of adolescents in residential substance abuse treatment.

As residential treatment programs consider adopting smoke-free policies, treatment providers question whether such policies interfere with patient recruitment and retention. This study assesses the effect of a smoke-free policy on retention using a sample of 155 low-income, mainly minority youth, randomly assigned to two long-term adolescent residential programs at the New Jersey Substance Abuse Treatment Campus. One of these programs has a smoke-free policy, the other does not. Smoking rates are high for the sample. Eighty-five percent of those adolescents smoke, on average half a pack daily, and 39% smoke a pack or more daily. Differential dropout rates between programs for key time periods related to tobacco withdrawal were analyzed to assess the potential effect of smoking policy on retention. Differential dropout rates at the point of program assignment, in the first two days of residency (p = .43), and for the first two weeks of residency (p = .37) show no differences between programs. While analyses showed heavy smokers are more likely than others to leave treatment early, they were likely to leave from either program regardless of smoking policy. As well, verbal expressions of dissatisfaction with smoking policy did not result in drop outs. These results indicate that smoke-free policies have no detrimental effect on program retention.

Adolescent↗
PubMed2005

Duloxetine and venlafaxine-XR in the treatment of major depressive disorder: a meta-analysis of randomized clinical trials.

BACKGROUND: Duloxetine has joined venlafaxine on the antidepressant market as a second serotonin-norepinephrine reuptake inhibitor. No previous studies have directly compared these drugs. OBJECTIVE: To compare indirectly the efficacy and safety of extended-release (XR) venlafaxine and duloxetine, the 2 currently available serotonin-norepinephrine reuptake inhibitors (SNRIs) in treating major depressive disorder. METHODS: Outcomes from published, randomized, placebo-controlled trials reporting on moderately to severely depressed patients (Hamilton Rating Scale for Depression [HAM-D] > or =15 or Montgomery-Asberg Depression Rating Scale [MADRS] > or =18). A systematic literature search of Cochrane, EMBASE, and MEDLINE (1996-January 2005) was performed. Two independent reviewers judged the trials for acceptance, and last observation carried forward data were extracted. Differences in remission (8-week HAM-D score < or =7 or MADRS < or =10), response (50% decrease on either scale), and dropout rates from lack of efficacy and adverse events were meta-analyzed using a random effects model. Each rate was contrasted with placebo. Sensitivity analyses were performed to examine the robustness of the results. RESULTS: Data were obtained from 8 trials evaluating 1754 patients for efficacy and 1791 patients for discontinuation/safety. Venlafaxine-XR rates were 17.8% (95% CI 9.0 to 26.5) and 24.4% (95% CI 15.0 to 37.7) greater than those with placebo for remission and response compared with 14.2% (95% CI 8.9 to 26.5) and 18.6% (95% CI 13.0 to 24.2) for duloxetine. Although numerically higher for venlafaxine-XR, no statistically significant differences were found between the drugs; however, both demonstrated overall remission and response rates significantly higher than the rates achieved with placebo (p < 0.001). Reported adverse events were comparable between drugs. CONCLUSIONS: Venlafaxine-XR tends to have a favorable trend in remission and response rates compared with duloxetine. However, dropout rates and adverse events did not differ. A direct comparison is warranted to confirm this tendency.

Adult↗
PubMed1987

Predictors of attrition from an outpatient alcoholism treatment program for couples.

Applicants (N = 105, 22 women) to an outpatient alcoholism treatment research program for married couples were categorized into three classifications: (1) treatment refusers (N = 37), (2) treatment dropouts (N = 23) and (3) treated subjects (N = 45). Discriminant analyses were performed to determine the best predictors of eventual category from baseline data. Compared with those who consented to treatment, refusers were found to be younger, have shorter drinking histories and were less likely to have personally initiated contact with the treatment program. Dropouts were less likely than treated subjects to have made their own initial contact with the program, more likely to have depressive symptoms not associated with alcohol use and were not employed full time. Remaining in treatment was most strongly associated with marital factors--assignment of the couple to a marital therapy condition versus a treatment in which the spouse was not fully involved and the spouse's initial satisfaction with the marriage. Results are discussed in terms of the treatment implications for spouse involvement in treatment.

Adult↗
PubMed1997

Substance use in the US college-age population: differences according to educational status and living arrangement.

OBJECTIVES: Substance use in the college-age population is an important public health and educational concern. This study compared rates of use among college students and nonstudents, including high school dropouts, from a single data source representative of the nation. METHODS: Rates of use were estimated from the combined National Household Surveys on Drug Abuse from 1991 to 1993. Logistic regression models were used to test the effects of educational status and living arrangement. RESULTS: Educational status and living arrangement were found to be significant predictors of substance use. Rates of illicit drug and cigarette use were highest among high school dropouts, while current and heavy alcohol use were highest among college students who did not live with their parents. CONCLUSIONS: Substantial variation in substance use patterns within the college-age population suggests that overall rates of use for young adults should not be used to characterize specific subgroups of young adults. These data from a single source will thus help planners more clearly distinguish the service needs of the diverse subgroups within this population.

Adolescent↗
PubMed1999

Differences in program implementation between nurses and paraprofessionals providing home visits during pregnancy and infancy: a randomized trial.

OBJECTIVES: This study examined differences between nurses and paraprofessionals in implementation of a home visiting program for low-income, first-time parents during pregnancy and the first 2 years of the child's life. METHODS: Mothers were randomly assigned to either a nurse-visited (n = 236) or a paraprofessional-visited (n = 244) condition. Nurse- and paraprofessional-visited families were compared on number and length of visits, topics covered, number of program dropouts, and relationship with home visitor. RESULTS: On average, nurses completed more visits than paraprofessionals (28 vs 23; P < .001) and spent a greater proportion of time on physical health issues during pregnancy (38% vs 27%; P < .001) and on parenting issues during infancy (46% vs 32%; P < .001). Paraprofessionals conducted visits that lasted longer and spent a greater proportion of time on environmental health and safety issues (15% vs 7% pregnancy; 15% vs 8% infancy; P < .001). While home visitors were viewed equally positively by mothers, nurses had fewer dropouts than did paraprofessionals (38% vs 48%; P = .04). More paraprofessional-visited families than nurse-visited families experienced staff turnover. CONCLUSIONS: Nurses and paraprofessionals, even when using the same model, provide home visiting services in different ways.

Adult↗
PubMed1997

Effect of a bicultural community health worker on completion of diabetes education in a Hispanic population.

OBJECTIVE: To determine the effect of a bicultural community health worker (CHW) on completion of diabetes education in an inner-city Hispanic patient population and to evaluate the impact of completion of the education program on patient knowledge, self-care behaviors, and glycemic control. RESEARCH DESIGN AND METHODS: Patients were randomized into CHW intervention and non-CHW intervention groups. All patients received individualized, comprehensive diabetes education from a certified diabetes nurse educator after baseline demographic information, diabetes knowledge, diabetes self-care practices, and glycohemoglobin levels were assessed. Rates of education program completion were determined. Diabetes knowledge, self-care practices, and glycohemoglobin levels were reassessed at program completion and at a later postprogram follow-up medical appointment and compared to baseline. Logistic regression analysis and the Mantel-Haenszel chi 2 statistic were used to determine the effect of the CHW assignment on program completion. Analyses of covariance were performed with end-of-treatment behavior scores, knowledge scores, and glycohemoglobin levels as outcome variables, controlling for baseline values and testing for the effect of CHW assignment. RESULTS: Of 64 patients enrolled in the study, 40 (63%) completed and 24 (37%) dropped out before completing the diabetes education program. Of the patients having CHW intervention, 80% completed the education program, compared with 47% of patients without CHW intervention (P = 0.01). "Dropouts" were younger (age 47.5 +/- 12.5 years [mean +/- SD]) compared with patients who completed the program (55.9 +/- 9.9 years) (P = 0.004). Dropout status showed no significant relationship to educational level achieved or literacy level. For the program "completers," knowledge levels and selected self-care practices significantly improved, and glycohemoglobin levels improved from a baseline level of 11.7% to 9.9% at program completion (P = 0.004) and 9.5% at the postprogram follow-up (P < 0.001). The effect of the CHW assignment on program completion, controlling for financial status and language spoken, was extremely robust (P = 0.007). The effect of the CHW on knowledge, self-care behavior, or glycohemoglobin outcome variables was not statistically significant. CONCLUSIONS: These findings suggest that intervention with a bicultural CHW improved rates of completion of a diabetes education program in an inner-city Hispanic patient population irrespective of literacy or educational levels attained. Our data further suggests that completion of individualized diabetes educational strategies leads to improved patient knowledge, self-care behaviors, and glycemic control.

Adult↗
PubMed2004

Re-examining the role of interscholastic sport participation in education.

The purpose of the present study was to examine the relationships of interscholastic sports participation with locus of control, self-concept, cognitive test scores, and school dropout in adolescents via a secondary analysis of National Educational Longitudinal Study 1988 (NELS:88). Subjects were 1,883 students who completed all measurements in 8th grade (1988), at Follow-up 1 (10th, 1990), and Follow-up 2 (12th, 1992). Scales utilized to measure locus of control, self-concept, and cognitive ability were developed by the National Center for Educational Statistics. Dropout was assessed through school records and contact with participants. At baseline and Follow-up 1, students self-reporting sport participation displayed higher self-concept and locus of control; however, these differences were no longer observed at Follow-up 2. Drop-out rate for boys at Follow-up 2 was significantly lower for students reporting interscholastic sport participation at baseline or at Follow-up 1. Similarly, drop-out rate for girls at Follow-up 2 was significantly lower for students reporting interscholastic sport participation at baseline or at Follow-up 1. These findings support the presumed positive role of sport participation for adolescents in American schools.

Adolescent↗
PubMed1987

Admission level and students' performance at a Norwegian dental school.

Data on students' performance at the Oslo Dental Faculty for 1977-86 were divided in two 5-year periods and analyzed in accordance with admission levels, largely on the basis of academic performance in junior college. During these years admission level decreased considerably, whereas the frequency of 'not passed', 'dropouts', and candidates using prolonged student time increased. The dental school grade average and the distribution of high- and low-performance candidates varied with the admission level. This trend was visible most clearly in the first 5-year period, when the admission point range included a considerable number of high admission level students. However, the admission level was not a good predictor of students' performance in the large middle or low admission level groups prominent in the second 5-year period. Poor preclinical results were not compensated for by clinical skills. All comparison of students' performance gave results in favor of the female students, but no sex-related differences were statistically significant. Most dropouts left dental school during the 1st year without visible examination difficulties. Students with several 'not passed' tended to repeat examinations, dropping out at a later stage or graduating after prolonged student time with poor results. With low interest in odontology, selection of students on the basis of minute differences in academic performance in the lower admission point scale is of limited value as a predictor of students' performance.

Achievement↗
PubMed1980

Effective and inexpensive procedures for decreasing client attrition in an outpatient alcohol treatment program.

Dropout rates in alcohol treatment programs are typically quite high. Three studies with outpatient alcohol abusers investigated several different follow-through procedures designed to increase the return rate of clients who prematurely drop out of treatment. Subjects were also asked why they had abruptly left treatment. Inexpensive letter and telephone follow-through procedures were found to be effective at reducing early client attrition and at providing valuable information about the fate of dropouts.

Alcoholism↗
PubMed1984

Strategies to improve compliance with narcotic antagonists.

The pharmacologic promise of naltrexone has not been matched by therapeutic usefulness. Plagued by difficulties in the induction period and very high dropout, the drug remains limited to a very small segment of the opiate-addited population. Some programs have managed, however, to substantially improve on these problems and such strategies will be discussed. The paper will look at the different problems raised during the high dropout periods of induction, the first month of stabilization, and the later stages of maintenance. It will then focus on methods to deal with these problems. Strategies examined will include among others individual and group counseling, family and couples' therapy, and contingency contracting. Strengths and weaknesses of each of these both from our own 7 years of experience and in the literature will be examined.

Combined Modality Therapy↗