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PubMed2002

Meta-analyses of ethnic match as a predictor of dropout, utilization, and level of functioning.

Meta-analyses were performed on 7 studies of ethnic match and psychotherapy. From 13 comparisons of ethnic match and dropout, a small overall effect size was found (r = .03). From 16 comparisons of ethnic match and number of sessions attended, a small overall effect size was found (r = .04). Effect sizes for dropout and utilization were heterogeneous, with ethnic minority groups having larger effect sizes than Caucasian Americans. From 9 comparisons of ethnic match and termination Global Assessment Score, a negligible overall effect size was found (r = .01). The small dropout and utilization effect sizes indicate that ethnic match is not a significant clinical predictor of decreasing dropout after the first session or increasing number of sessions attended.

Adult↗
PubMed2004

Factors affecting the probability of first year medical student dropout in the UK: a logistic analysis for the intake cohorts of 1980-92.

BACKGROUND: In the context of the 1997 Report of the Medical Workforce Standing Advisory Committee, it is important that we develop an understanding of the factors influencing medical school retention rates. AIMS: To analyse the determinants of the probability that an individual medical student will drop out of medical school during their first year of study. METHOD: Binomial and multinomial logistic regression analysis of individual-level administrative data on 51 810 students in 21 medical schools in the UK for the intake cohorts of 1980-92 was performed. RESULTS: The overall average first year dropout rate over the period 1980-92 was calculated to be 3.8%. We found that the probability that a student would drop out of medical school during their first year of study was influenced significantly by both the subjects studied at A-level and by the scores achieved. For example, achieving 1 grade higher in biology, chemistry or physics reduced the dropout probability by 0.38% points, equivalent to a fall of 10%. We also found that males were about 8% more likely to drop out than females. The medical school attended also had a significant effect on the estimated dropout probability. Indicators of both the social class and the previous school background of the student were largely insignificant. CONCLUSIONS: Policies aimed at increasing the size of the medical student intake in the UK and of widening access to students from non-traditional backgrounds should be informed by evidence that student dropout probabilities are sensitive to measures of A-level attainment, such as subject studied and scores achieved. If traditional entry requirements or standards are relaxed, then this is likely to have detrimental effects on medical schools' retention rates unless accompanied by appropriate measures such as focussed student support.

Adult↗
PubMed2003

Characteristics of men and women who complete or exit from an on-line internet sexuality questionnaire: a study of instrument dropout biases.

This study compared respondents who completed an Internet sexuality questionnaire and those who dropped out before completion. The study was in Swedish and comprised 3,614 respondents over a 2-week period (53% males, 47% females). There were significant differences between males, of whom 51% dropped out before completion of the 175-item questionnaire, and females, of whom 43% dropped out. Dropout in both genders followed a curve of negative acceleration. The data suggest that dropout is likely to be significant and gender and demographically biased, and to occur significantly earlier for men than for women. Geography, education, sexual orientation, age, relationship status, living arrangements, and Internet connection speed were related to dropout for men, while only relationship status and living arrangements, which were in the opposite direction from men, were related to dropout in women.

Adult↗
PubMed2005

Neglect of dropout underestimates effects of death in longitudinal studies.

Investigations of terminal declines in mental abilities have assessed cognitive performance at a single time point and retrospectively compared survivors and decedents at a single later census date. Neglect of outcomes other than death, such as dropout, causes a loss of information on the relative frailty of survivors and deceased persons before the census date and on incidence of mortality and frailty among survivors after the census date. This discards information on differences in health status between younger and older survivors. The Heim AH4-1 intelligence test was given to 4,228 people between the ages of 42 and 92 years, and both deaths and dropouts were logged during three successive census periods during the subsequent 11 years. Within and across census periods, effects of impending death and dropout did not differ, decreasing with time from initial assessment. Thus the effects of terminal decline, or indeed of any other variable affecting cognitive performance, are miscalculated if dropout is ignored.

Adult↗
PubMed2002

Impact of missing data due to selective dropouts in cohort studies and clinical trials.

BACKGROUND: Many cohort studies and clinical trials use repeated measurements of laboratory markers to track disease progression and to evaluate new therapies. A major problem in the analysis of such studies is that marker data are censored in some patients owing to withdrawal, loss to follow-up, or death. The objective of this paper is to evaluate the impact of selective dropouts attributable to death or disease progression on the estimates of marker change among different groups. METHODS: Data on CD4 cell count in human immunodeficiency virus 1-infected individuals from a clinical trial and a cohort study are used to illustrate this problem and a possible solution. Simulation studies are also presented. RESULTS: When the rate of dropout is greater in subjects whose marker status is declining rapidly, commonly used methods, like random effects models, that ignore informative dropouts lead to overoptimistic statements about the marker trends in all compared groups, because subjects with steeper marker drops tend to have shorter follow-up times and hence are weighted less in the estimation of the group rate of the average marker decline. CONCLUSIONS: The potential biases attributable to incomplete data require greater recognition in longitudinal studies. Sensitivity analyses to assess the effect of dropouts are important.

Adolescent↗
PubMed2000

Factors associated with early dropout from adolescent psychiatric outpatient treatment.

OBJECTIVE: To examine background factors, psychopathology, and psychosocial impairment among adolescents complying with or dropping out early from outpatient psychiatric treatment. METHOD: Family background, psychiatric history, and other data were collected prospectively on 143 male and 154 female outpatients aged 12 to 22 years. DSM-II-R psychiatric diagnoses were assessed at the end of treatment. RESULTS: Fifty-three adolescents (17.8%) attended 1 or 2 treatment appointments, and 33 of them (11.1% of 297) then dropped out; 50.5% of the total attended 3 to 13, and 31.6% attended 14 or more appointments. Low parental socioeconomic status was more common among the early dropouts than the other patient groups (88%, 69%, 63%, respectively). The early dropouts had had more problems with the law than the adolescents attending 14 or more appointments (18%, 6%), but less suicidal behavior (24%, 56%, respectively). Among the early dropouts, mood disorders were less common (21%, 49%), especially major depression (0%, 20%), and substance abuse was more common (9%, 0%) than among patients attending 14 or more appointments. CONCLUSIONS: Low parental socioeconomic status, not having mood disorder, not having psychotropic medication, and having substance abuse were associated with early dropout of adolescents from outpatient psychiatric treatment.

Adolescent↗
PubMed1996

Impact of missing data due to dropouts on estimates of the treatment effect in a randomized trial of antiretroviral therapy for HIV-infected individuals. Canadian HIV Trials Network A002 Study Group.

PURPOSE: To evaluate the impact of missing data due to nonrandom dropout on estimates of the effect of treatment on the CD4 count in a clinical trial of antiretroviral therapy for HIV infected individuals. METHODS: The effect of treatment on CD4 counts in a recent study of continued ZDV versus ddI in HIV-infected individuals was estimated from the observed data and after imputing missing CD4 counts for patients who dropped out of the study. Imputation methods studied were (a) carrying forward the last observed CD4 count, (b) predicting missing CD4 counts from regression models, and (c) assuming that CD4 counts of patients who dropped out declined at a rate of 100 cells per year. RESULTS: Of the 245 patients enrolled in the study, 52% completed the planned 48 weeks of follow-up. Patients with lower CD4 counts were more likely to drop out of the study (RR = 1.77; p = 0.0001). Patients receiving ZDV had a greater tendency to drop out than patients receiving ddI (p = 0.07). Mean CD4 counts calculated after imputing missing data were lower than those obtained from the observed data at all follow-up times for both treatment groups. Imputing CD4 counts with regression models yielded higher estimates of the effect of treatment than were obtained using the observed data. CONCLUSION: Missing outcome data due to dropouts can result in an underestimation of the treatment effect and overly optimistic statements about the outcome of participants on both treatment arms due to the selective dropout of participants with lower or decreasing CD4 counts. When there are significant dropout rates in randomized trials, imputation is a useful technique to assess the range of plausible values of the treatment effect.

Antiviral Agents↗
PubMed1990

Effect of time-limited psychotherapy on patient dropout rates.

The authors conducted an archival study of 149 new clinic patients at a large community mental health center. The dropout rate for patients in brief psychotherapy in which the length of therapy was specified at the outset of treatment (time-limited psychotherapy) (32%) was about one-half the dropout rate for patients in brief (67%) and long-term (61%) individual psychotherapy. The difference in dropout rates could not be explained by patient demographic or diagnostic variables or by therapist characteristics measured in the study. The results suggest that setting a specific time limit on individual psychotherapy at the outset of treatment can reduce the patient dropout rate in a public mental health clinic.

Ambulatory Care↗
PubMed1999

Do male dropouts benefit from obtaining a GED, postsecondary education, and training?

The authors use longitudinal data from the National Longitudinal Survey of Youth to investigate whether the wage trajectories of male high school dropouts are affected by the acquisition of the General Educational Development (GED) credential, by postsecondary education, and by training. The authors show that acquisition of the GED results in wage increases for dropouts who left school with weak skills, but not for dropouts who left high school with stronger skills. College and training provided by employers are associated with higher wages for male dropouts.

Adolescent↗
PubMed2001

School dropout and conduct disorder in Brazilian elementary school students.

OBJECTIVES: To evaluate the association between DSM-IV conduct disorder (CD) and school dropout in a sample of students from the third and fourth elementary grades at state schools in the capital of the southernmost state of Brazil. METHODS: In this case-control study, students that dropped out of schools (n = 44) and a control group who continued attending schools (n = 44) were assessed for CD and other prevalent mental disorders, using the Schedule for Affective Disorders and Schizophrenia for School Age Children, Epidemiological Version (K-SADS-E). RESULTS: The prevalence of DSM-IV CD was significantly higher in the school-dropout group than in control subjects (P < 0.001), both in the entire sample and in a subsample including only subjects under age 12 years (P = 0.001). Also, the odds ratio (OR) for school dropout was significantly higher in the presence of DSM-IV CD, even after controlling for potential confounding factors (age, estimated IQ, school repetition, family structure, and income) (P < 0.01). CONCLUSION: Our results extend to children and young adolescents previous findings from studies of older adolescents, suggesting an association between school dropout and CD.

Adolescent↗
PubMed2006

Dropouts and refusals in observational studies: lessons for prevention trials.

The success of prevention trials of Alzheimer disease and other dementias (AD/dementia) hinges on their ability to recruit and retain at-risk study populations. Losing subjects is a threat to the power to detect a treatment effect and, potentially, to the validity of these studies. Observational cohort studies accumulate data around participant outcomes that can help to inform the design of future prevention trials. Our objectives were to investigate the rates of refusal and dropout within observational cohort studies and to evaluate their characteristics and impact. This study examined data from the Canadian Cohort Study of Cognitive Impairment and Related Dementias (ACCORD), a 2-year observational cohort study of patients newly referred to dementia clinics. The sample included 124 Not Cognitively Impaired (NCI) and 342 Cognitively Impaired Not Demented (CIND) subjects. Subjects who refused initial neuropsychological (NP) testing were compared to those who completed NP testing and subjects who dropped out to those who attended follow-up. Refusal was common, with 40% of subjects not completing neuropsychological testing at baseline. Dropout was also substantial, with 55% lost to the 2-year follow-up. Subjects who refused NP testing were significantly older and less educated. CIND refusers had lower cognitive and functional scores at entry and a 2-year progression rate to dementia twice as high as that of non-refusers. CIND dropouts also had lower baseline cognitive and functional scores. These observations suggest that dropouts and refusals in prevention trials include those subjects who are at high risk for progression to AD/dementia. Targeted strategies to retain these individuals within prevention studies will be needed to achieve sufficient study power and validity.

Aged↗
PubMed2006

Protecting low-income children's access to care: are physician visits associated with reduced patient dropout from Medicaid and the Children's Health Insurance Program?

OBJECTIVE: Dropout among patients who are enrolled in Medicaid and the Children's Health Insurance Program contributes to a lack of health care access among millions of Americans. The purpose of this study was to determine which, if any, types of clinical contact with physicians are associated with reduced dropout among children who are enrolled in Medicaid and the Children's Health Insurance Program. METHODS: The data are from the nationally representative Medical Expenditure Panel Survey, 1998-2002. The sample is composed of all children (n = 3043) who were reported to have Medicaid or Children's Health Insurance Program coverage throughout their first year in the survey and who did not acquire other insurance during the study period. The outcome measure is whether an individual remained enrolled in Medicaid or the Children's Health Insurance Program by the end of the following year. Exposure variables were clinical contact during an individual's first year in the survey: numbers of office visits, hospital outpatient department visits, emergency department visits, inpatient hospital stays, and dental visits. The analysis uses multivariate logistic regression to control for patient and family characteristics-most important, health status, functional status, and overall health care expenditures. RESULTS: Eight percent of the children in the sample had left Medicaid/the Children's Health Insurance Program by the end of the second year in the survey. More frequent contact with clinicians in an office setting was associated with a significantly lower risk for dropping out of Medicaid/the Children's Health Insurance Program among children, even controlling for demographics, health and functional status, and overall health care expenditures. After multivariate adjustment, more frequent contact in hospital outpatient departments also was associated with reduced dropout, with a borderline statistically significant odds ratio. Notably, emergency visits and inpatient stays were not associated with any significant change in the risk of Medicaid/Children's Health Insurance Program dropout. CONCLUSIONS: These results suggest that some but not all types of clinician visits are serving an important function in maintaining Medicaid and the Children's Health Insurance Program coverage among low-income patients. Two possible approaches to improve access to care among low-income children therefore would be (1) increased awareness among clinicians, especially in hospitals and emergency departments, regarding Medicaid/Children's Health Insurance Program retention as an issue in the ongoing care of their patients and (2) Medicaid/Children's Health Insurance Program reimbursement of clinicians and their staff for assisting patients with the public insurance renewal process.

Aid to Families with Dependent Children↗
PubMed1996

Trends in drug use among American Indian students and dropouts, 1975 to 1994.

OBJECTIVES: This 20-year surveillance project tracks the trends in substance abuse among American Indian students and examines the observed patterns to discover implications for prevention and treatment. The current phase of this work includes data on drug use among Indian school dropouts. METHODS: Anonymous drug use surveys are administered annually to a nationally representative sample of 7th- to 12th-grade Indian youths residing on or near reservations. An adjustment for dropouts is made to provide estimates for the entire age cohort. RESULTS: Indian youth continue to show very high rates of drug use compared with their non-Indian peers. The trends in rates during the last 20 years parallel those of non-Indian youth. While overall drug use may be decreasing, about 20% of Indian adolescents continue to be heavily involved with drugs, a proportion that has not changed since 1980. Adjustment for school dropouts increases the estimate for the entire age cohort. CONCLUSIONS: Indian youth, particularly school dropouts, remain at high risk for drug use. The similarity to trends for non-Indians indicates that prevention strategies effective with other youth can be effective with this population.

Adolescent↗
PubMed1992

Dropout and relapse during diabetes care.

OBJECTIVE: To determine factors associated with dropout and relapse during chronic diabetes care. RESEARCH DESIGN AND METHODS: Private practice outpatient treatment-education program for adult diabetes was surveyed. Retrospective analysis was done, involving 422 patients for up to 3 yr. RESULTS: Of the patients in the study, 12% dropped out after the initial visit, and 33% of the residual cohort dropped out during each subsequent 6-mo period. Factors associated with dropout included distance from home to clinic > 100 miles, lack of insulin treatment, and cigarette smoking. In patients who remained in follow-up, a significant decrease in HbA1C occurred during the first 6 mo, but 40% of the patients relapsed between 6 and 12 mo. Frequency of relapse declined as time passed. Relapse was more frequent in women. CONCLUSIONS: Dropout from treatment and relapse after temporary improvement account for a substantial amount of uncontrolled diabetes, and overcoming the obstacles of dropout and relapse has potential for significant improvement in diabetes care.

Adolescent↗
PubMed1986

Differences between dropouts and active participants in a pediatric clinic for substance abuse mothers.

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.

Adolescent↗
PubMed1995

Comparison of stayers, dropouts, and newcomers in a longitudinal population study of asthma and bronchial hyperresponsiveness: introduction of bias?

A random sample of children and adolescents from the general population in Copenhagen, Denmark, has been examined twice (6 years apart) with respect to asthma, allergy, and nonspecific bronchial hyperresponsiveness. To investigate potential bias resulting from loss of baseline subjects at follow-up (dropout bias) and bias resulting from subjects entering the study at the follow-up stage (newcomer bias), stayers (subjects who participated in both examinations) were compared to dropouts and newcomers, respectively. The sample consisted of 983 subjects (aged 7-17 years at the time of the baseline study), of whom 408 (199 boys) participated in both examinations (stayers), 119 (62 boys) in the baseline study only (dropouts), and 257 (124 boys in the follow-up study only (newcomers). Thus, a total of 784 subjects (80% of the sample) were examined either once or twice. At baseline dropouts did not differ from stayers with respect to anthropometric data, smoking habits, pulmonary function, or prevalence of positive skin prick tests, bronchial hyperresponsiveness, asthma, and allergic diseases. Likewise, these variables for newcomers were not different from those of the stayers apart from a significantly higher smoking rate in newcomers (45% vs. 32%, p = 0.003). Based on these findings and the high overall response rate, it seems reasonable to assume that the group of stayers is representative of the whole sample, apart from an underestimation of the number of smokers and, therefore, an underestimation of the risks associated with smoking.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

AIDS-related knowledge, attitudes, and behavior: a comparison of Dutch students and dropouts.

School dropouts are considered an important target group for AIDS prevention. They are expected to be less knowledgeable about AIDS and to show a higher degree of risky behavior as compared with their school-attending peers. Several small-scale studies among specific groups of dropouts seem to confirm such expectations. However, due to differences in methodology, it is often difficult to compare the results of such studies with findings for youths who have not dropped out of school. The present study sought to remedy this by examining AIDS-related knowledge, attitudes, and behavior among comparable samples of Dutch secondary school students and dropouts (excluding homeless and drug-addicted adolescents). The two groups were compared with regard to knowledge about AIDS prevention, attitude toward condom use, intention to use condoms, sexual history, and condom use. Contrary to expectations, few differences were found. It was concluded that, in most respects, dropouts are similar to those who have remained in school.

Acquired Immunodeficiency Syndrome↗
PubMed2000

[Characteristics of dropouts and participants in a twelve-year longitudinal research of Japanese elderly].

PURPOSES: The attrition of respondents in panel studies of the elderly can create bias in data analysis. The purposes of this study are two fold; 1) to examine characteristics of dropouts, from a particular panel lost except due to natural attrition (by death) by comparison with continuing participants in that wave, and 2) to assess representativeness of those actually continuing in a particular panel by comparison with those eligible for inclusion in that wave. Only those who died were excluded from the group of respondents at the baseline survey because they constituted natural attrition in this longitudinal survey. METHOD: At baseline (1987), 2,200 individuals age 60+ from 3,288 national representative sample were interviewed. Non-response status to three contacts (1990, 1993, 1996) with the panel was examined in relation to variables included in the baseline interview. A number of characteristics of demographic background, health, life-style, and social relations obtained in the baseline survey (1987) were compared between those re-interviewed in a particular panel and subjects lost through unnatural attrition until that wave. To study the influence of unnatural attrition on variable distributions and each related factors of two health indicators (self-rated health and depressive symptoms), baseline responses were compared between those re-interviewed in a particular panel and all who were eligible to respond in that wave. RESULTS: 1) Dropouts lost to each wave were significantly older and had a lower level of social participation than persons remaining in that wave. Significant differences in health and life-style variables appeared between dropouts lost and continuing participants until third or later waves. 2) Continuing participants in a particular panel were likely to be younger, to be more physically, mentally, or socially healthy than those eligible to respond in the wave. Each related factors of two health indicators were almost same between those re-interviewed in a particular panel and those eligible to respond in that wave. CONCLUSION: Dropouts in longitudinal research were found to appear nonrandomly. While distributions of age and health indicators in those re-interviewed were influenced by respondent attrition, related factors of health indicators may be free of bias that can be created by it.

Age Factors↗