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Attendance patterns of voluntary patients at an alcoholism clinic were compared with those of persons convicted of drunken driving who were required to attend the clinic as a condition of probation. The attendance rate of the coerced patients was much superior to that of the voluntary patients.
In-depth phone surveys were conducted with 32 consumer-run drop-in centers in Michigan. Results indicate that centers serve a diverse array of consumers at an average cost of about dollar 8 daily per person. Funding levels, salaries, and services are quite heterogeneous among centers. Those with higher funding levels, greater involvement with other human service agencies, and higher overall CMH county budgets differed significantly in total services and activities provided than those centers with less of each of these resources. Daily attendance was predicted by other-agency involvement, participation of volunteer personnel, and negative neighborhood context.
The outline organisation of a health survey of a secondary school is presented. The aims of the survey were primarilary to provide population data on rheumatic fever in a high incidence area, and to further knowledge of the distribution of risk factors for coronary heart disease in New Zealand adolescents. Ninety-six and a half percent coverage of the target group was achieved; non-responders were characterised from hospital and school records as being predominantly rural with greater early childhood hospital experience than respondents. The sample was considered to be representative of the adolescent population of the area.
BACKGROUND: Although prior research has examined predictors of treatment retention in public alcohol and drug treatment programs, little is known about factors that influence treatment retention in an insured outpatient population. Because there is growing evidence that the factors which influence treatment retention may differ by gender, we identify sex-specific predictors. METHODS: We recruited all eligible intakes to a health maintenance organization's outpatient alcohol and drug treatment program during a 2-year period and obtained a sample of 317 women and 599 men. The programs, day hospital and traditional outpatient modalities, were abstinence based. We separated our sample by sex and used least squares and logistic regression to identify independent predictors of length of stay and program completion, respectively. RESULTS: One general pattern of predictors of increased retention was shared by women and men in this alcohol and drug treatment program--fewer and less severe drug problems. However, most predictors were sex-specific. Among women, retention was predicted by having higher incomes, belonging to ethnic categories other than African American, being unemployed, being married, and having lower levels of psychiatric severity. Among men, predictors of higher retention included being older, receiving employer suggestions to enter treatment, and having abstinence goals. CONCLUSIONS: These findings highlight the importance of examining aspects of the course of treatment separately by sex. They also suggest treatment factors that may enhance retention among insured populations, including employer referrals, psychiatric services, and drug-related services.
Participant retention is a significant challenge for asthma field trials examining the effectiveness of prevention strategies in inner-city communities. Here, the authors evaluate factors associated with participant retention in an inner-city, pediatric, asthma intervention trial in Atlanta, Georgia, during 1998-2000. Demographic, clinical, residential, personnel, and logistical variables were analyzed by chi-square and Wilcoxon rank sum nonparametric tests to compare children who remained in the asthma study with those who were dropped. Of the 489 participants, 486 (99%) were African-American, 467 (96%) were non-Hispanic, 281 (57%) were male, and 142 (29%) remained in the study. Of the 347 dropouts, 149 (43%) were dropped because of missing study visits. Retention rates were significantly higher (P<.05) for participants enrolled in the second year of the study (2nd yr=43%, 1st yr=19%), for those who lived longer at the same residence (> or = 3 yrs=36%, 2-3 yrs=26%, 1-<2 yr=22%), and for those enrolled during a face-to-face follow-up home visit, rather than at the emergency department (ED) (follow-up=38%, ED=27%). Neither sex nor enrollment season were associated with retention. These findings underscore the importance of performing a comprehensive pilot study and considering a home residency period for participant enrollment eligibility, along with alternative study methods that take into account the challenges of retaining participants.
AIM: We examined changes in general psychopathology during psychotherapy of patients with eating disorders. We were also interested in distinguishing motivational characteristics of completers and dropouts with anorexia and bulimia nervosa. METHOD: All subjects completed two self-descriptive measures: Motivational Inventory and Hopkins Symptoms Checklist (HSCL-72). Questionnaires were completed three times: during the qualification visit, at admission and two weeks before discharge. RESULTS: It was observed that general psychopathology among patients with anorexia nervosa and bulimia nervosa decreased. Comparing to completers with bulimia nervosa completers with anorexia nervosa had a higher level of activity factor before the treatment. Dropouts with anorexia nervosa differed from completers in decreased level of threat factor and activity factor. Completers with bulimia contrasted markedly with statistically meaningful decrease of the Body Mass Index. CONCLUSIONS: The efficacy of cognitive-behavioural-social psychotherapy of patients with eating disorders seems to be confirmed by large decrease of general psychopathology. Dropouts with anorexia seem to have poorer insight concerned with lower need of health activity.
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A case control study among patients registered at the Addis Abeba Tuberculosis Centre was carried out from 1 September 1989 to 31 August 1990 to determine the rate of defaulting from treatment and to identify factors associated with it. The medical records of 1,206 new tuberculosis patients registered over the 12 month period were reviewed. A high rate of defaulting, 82%, was found. The rates of defaulting were higher in males, in the older age groups and in those living near to the TB centre. Most of the defaulting occurred in the third and fourth months of treatment. Social problems and feeling of improvement were the top two reasons for patients to default. A sample of the defaulters (cases) and the non-defaulters (controls) were then traced and interviewed. The two groups were compared by social, demographic and health variables. Inadequate knowledge, low educational level, nearer distance and negative attitude toward the TB Centre were found to be statistically significant predictors for defaulting p < 0.0001, p < 0.001, p < 0.001, and p < 0.05 respectively). These high rates of defaulting suggest important programme inadequacies and an urgent need for change. Therefore the introduction of an alternative national tuberculosis control programme with new strategies is recommended.
We compared the maternal and birth characteristics of 87 first-year dropouts with 103 active participants of a pediatric clinic which provides long-term follow-up care to offspring exposed in utero to substance abuse mothers. The age, ethnicity, and marital status of the mother; the type of drug used during pregnancy; and the length, gender, number, and type of addiction problems of the newborn were not significantly different between the two groups. However, the dropouts differed significantly from the active participants in many other aspects. More dropout mothers received no prenatal care and did not have children at home at the time of the present birth. More of them were smokers; had gonorrhea, heart, and kidney problems; and had infections complicating their pregnancy. The dropout newborns were found to have lower birthweight and shorter gestation. These clinical parameters defined a suboptimal group of mothers and children requiring more attention and care. The findings also alert investigators of long-term follow-up studies to be aware of basic differences between nonparticipants and participants.
A common problem in treating alcoholics is the high dropout rate. Many studies have identified individual factors associated with dropout, eg, poor motivation and previous dropout. We believe the present study reports the first major effort to use multivariate analyses to predict dropout in a large (792), one-year follow-up study of alcoholics, and examines the possibility that medical and nonmedical treatments lead to differential dropout rates. A multiple classification analysis technique showed that treatment variables as opposed to client characteristics were the best predictors of dropout. Patients remaining in treatment were more likely to have a variety of medical interventions, eg, medication and medical assessment, than those who dropped out. Results were similar to studies using other techniques and have interesting implications for the treatment of alcoholics, raising questions about current trends toward nonmedical treatment of alcoholism.
The present study examined whether exercise adherers and dropouts differ in their perceptions of success and, in turn, whether their social cognitions and behavior correspondingly differ. Using a prospective, observational design, exercise class participants were followed over 12 weeks of attendance. Social-cognitive measures were assessed at both early and late program while attendance was tracked for each half of the program. Multivariate analyses of variance (MANOVAs) using a 2 (Success/Failure) x 2 (Adherer/Dropout) factorial design revealed significant interactions for self-efficacy, affect, causal attributions, as well as rate of perceived exertion. Multiple main effects for perceived success and adherence were also found. The results suggest that "successful" dropouts possess social-cognitive characteristics that may enable them to resume their exercise participation at some later date. These findings provide evidence that the examination of perceived success allows for valuable insight into the differences among and between exercise adherers and dropouts, which may have implications regarding long-term exercise participation.
Homogeneity and other characteristics of rural community mental health center adult, outpatient dropouts were investigated with particular attention to length of stay. Analyses of 93 cases during a one year period revealed that qualities of the therapist discriminated short-term dropouts from long-term dropouts and long-term terminators. The client's chronicity discriminated short-term dropouts from short-term terminators. Dropouts were not found to be a homogeneous group. While therapist characteristics may be important in predicting termination status in long-term stays, the termination status of short-term clients may be determined primarily by the severity of the client's problems and whether or not they have received previous treatment.
This study investigated whether the degree of difficulty contacting participants at follow-up in a longitudinal study of adolescent psychiatric outpatients is associated with baseline and/or follow-up Axis I and II psychopathology and sociodemographic variables. At baseline, 101 participants 15 to 18 years old were assessed using standardized diagnostic instruments, and 97 were reinterviewed, face-to-face, at 2-year follow-up. A hierarchical tracking strategy and meticulous follow-up contact log were used. More than one quarter of the sample required multiple tracking efforts to be located and interviewed. The presence and number of Axis I and II disorders at 2-year follow-up was significantly associated with follow-up contact difficulty. Baseline psychopathology and sociodemographic variables were not associated with follow-up contact difficulty. The findings indicate that longitudinal studies of adolescent outpatients that compare dropouts with completers utilizing baseline characteristics are likely to underestimate the extent of psychopathology at follow-up.
School refusal is a grave social problem for adolescents, their families, schools and society in Japan today as well as other developed countries. We researched the mentality of junior high school pupils about their feelings or moods toward school attendance with a set of questionnaires in order to know how much they were oppressed by daily school attendance. From such a viewpoint, we tried the questionnaire program at seven public junior high schools in a small city in the suburbs that developed rapidly and located not far away from a big city. We selected our subjects at random from one class out of each grade of each junior high school. The number of the subject pupils was 838: 429 boys and 409 girls. We postulated that the latent school refusals were those who answered all "yes" to three items which was always the case by school refusals in our clinical experience. We found 117 latent school refusals out of the 838: 65 boys and 52 girls. We considered three factors--problems concerning school, family and other daily activities. From our research, we recognize that there are many pupils attending school with the possibility of them becoming dropouts (14.0%). Their mentality is characteristic of school refusal itself while they attend school almost everyday. We clinicians should be aware of the social structure and make every effort to secure the healthy development of adolescents.
Since our interim report of the intention-to-treat outcome of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC), we have performed a follow-up analysis of an expanded cohort of 70 patients to further assess whether the observed pattern and predictors of dropout are consistent with the rationale behind current HCC-adjusted Model for End Stage Liver Disease (MELD) organ allocation scheme. All except one patient had pretransplantation staging meeting our proposed expanded criteria-a single lesion < or =6.5 cm, or three or fewer lesions none >4.5 cm and total tumor diameter < or =8 cm. Thirty-eight patients received OLT. The cumulative probabilities of dropout at 6, 12, and 18 months were 7.2%, 37.8%, and 55.1%, respectively. The respective dropout probabilities would have been 11.0%, 57.4%, and 68.7% if the United Network for Organ Sharing (UNOS) criteria for exclusion (single lesion < or =5 cm or three or fewer lesions none >3 cm) were applied. Predictors of dropout with either criteria included three tumor nodules and a single lesion >3 cm at initial presentation, whereas preoperative chemoembolization or ablation therapies were associated with a lower risk for dropout only when applying the UNOS criteria for patient exclusion. In the subgroup with two or three lesions or a solitary tumor >3 cm, the cumulative probabilities of dropout were nine-fold higher than those with a single lesion < or =3 cm (P =.004). In conclusion, the low dropout rate in the first 6 months and the differing dropout risks based on tumor characteristics support further refinements in the HCC-adjusted MELD organ allocation scheme.
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CONTEXT: Atypical antipsychotic medications are widely used to treat delusions, aggression, and agitation in people with Alzheimer disease and other dementia; however, concerns have arisen about the increased risk for cerebrovascular adverse events, rapid cognitive decline, and mortality with their use. OBJECTIVE: To assess the evidence for increased mortality from atypical antipsychotic drug treatment for people with dementia. DATA SOURCES: MEDLINE (1966 to April 2005), the Cochrane Controlled Trials Register (2005, Issue 1), meetings presentations (1997-2004), and information from the sponsors were searched using the terms for atypical antipsychotic drugs (aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone), dementia, Alzheimer disease, and clinical trial. STUDY SELECTION: Published and unpublished randomized placebo-controlled, parallel-group clinical trials of atypical antipsychotic drugs marketed in the United States to treat patients with Alzheimer disease or dementia were selected by consensus of the authors. DATA EXTRACTION: Trials, baseline characteristics, outcomes, all-cause dropouts, and deaths were extracted by one reviewer; treatment exposure was obtained or estimated. Data were checked by a second reviewer. DATA SYNTHESIS: Fifteen trials (9 unpublished), generally 10 to 12 weeks in duration, including 16 contrasts of atypical antipsychotic drugs with placebo met criteria (aripiprazole [n = 3], olanzapine [n = 5], quetiapine [n = 3], risperidone [n = 5]). A total of 3353 patients were randomized to study drug and 1757 were randomized to placebo. Outcomes were assessed using standard methods (with random- or fixed-effects models) to calculate odds ratios (ORs) and risk differences based on patients randomized and relative risks based on total exposure to treatment. There were no differences in dropouts. Death occurred more often among patients randomized to drugs (118 [3.5%] vs 40 [2.3%]. The OR by meta-analysis was 1.54; 95% confidence interval [CI], 1.06-2.23; P = .02; and risk difference was 0.01; 95% CI, 0.004-0.02; P = .01). Sensitivity analyses did not show evidence for differential risks for individual drugs, severity, sample selection, or diagnosis. CONCLUSIONS: Atypical antipsychotic drugs may be associated with a small increased risk for death compared with placebo. This risk should be considered within the context of medical need for the drugs, efficacy evidence, medical comorbidity, and the efficacy and safety of alternatives. Individual patient analyses modeling survival and causes of death are needed.