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PubMed2005

Why do couples refuse or discontinue ART?

The first child born after in-vitro fertilisation, (IVF)-treatment, just passed its 26th birthday in July 2004. Since that birth-assisted reproduction techniques (ART) became a practicable technology, they had been used all over the world, and more than 2 million children were born after IVF-treatment. Despite all success in this field, ART is neither accepted nor used for all infertile couples, although this might be the only possibility of becoming pregnant. Two different kinds of ART refusal are distinguishable: the primary refusal being for financial, psychosocial, moral, ethical and medical reasons including the risk of severe ovarian hyperstimulation syndrome, the risk of multiple pregnancies and the risk of malformations. The secondary refusal includes dropouts after one or more unsuccessful IVF-treatments mainly influenced by the outcome of previous cycles (prognostic factors: oocyte and embryo count, embryo quality, females age) associated with psychological and emotional aspects. However, financial factors seem to be the most potent reasons for ART-refusal.

Adult↗
PubMed1998

Prevalence and incidence of hand dermatitis in hairdressing apprentices: results of the POSH study. Prevention of occupational skin disease in hairdressers.

OBJECTIVE: Occupational skin changes in hairdressers are very common. Morbidity, however, has not yet been quantified precisely. METHODS: A cohort of 2,352 hairdressing apprentices (of the 2,570 invited to participate, i.e., 91.5% response) was prospectively followed for the duration of their vocational training (3 years) by three examinations. Three waves (years) were recruited in 1992, 1993, and 1994 from 15 vocational training schools in northwestern Germany. RESULTS: The point prevalence of (mostly slight) irritant skin changes of the hands increased from 35.4% in the initial examination to 47.5% in the intermediate examination and to 55.1% in the final examination. Given a more conservative definition of a case of "hand dermatitis," these estimates were 12.9%, 23.5%, and 23.9%, respectively. Altogether, 34.3 and 15.2 cases of "skin changes (any degree)" and "hand dermatitis," respectively, in 100 person-years were observed during the study period. The incidence rate, i.e., the number of newly diseased study participants in relation to the person-time at risk contributed, decreased in the course of the study. The proportion of dropouts until final follow-up was 51.8%. CONCLUSION: The present results appear to lie in a range with those found in other, much smaller cohort studies. However, comparison of the results is hampered either by the lack of a clear definition or by a different definition of "person-time at risk" or "a case of hand dermatitis." As compared with an external control group of office apprentices, the incidence was several times higher in hairdressing apprentices, which points to the high risk for skin damage in this occupation.

Beauty Culture↗
PubMed2004

A randomized open-label comparative study of conventional therapy versus mizoribine onlay therapy in patients with steroid-resistant nephrotic syndrome (postmarketing survey).

BACKGROUND: A previous double-blind 24-week clinical trial of mizoribine (MZ) vs placebo in steroid-resistant primary nephrotic syndrome (SRPNS) showed that MZ was more effective than placebo in reducing the rate of deterioration of renal function. The present study was conducted to evaluate the efficacy and safety of MZ in patients with SRPNS after 2 years' treatment. METHODS: A multicenter randomized open-label controlled trial in patients with SRPNS was conducted as a 2-year prospective postmarketing study. RESULTS: There was a significant imbalance in the baseline serum albumin level (s-Alb) between the conventional therapy (CT) and MZ onlay therapy groups. Early dropouts were more frequent in the subset of patients in the CT group having a baseline s-Alb < or =3 g/dl. Therefore, the primary analysis (urinary protein level (UP)-improving effect) was performed using a mixed-effects model, with stratification according to the baseline s-Alb value. The analysis revealed that, in the subset of 34 patients with membranous nephropathy (MN) within the stratum of patients with baseline s-Alb < or =3 g/dl (n = 52), the rate of change (slope of change in the UP level/month), in terms of the log (UP+0.2), was -0.0577 in those allocated to the MZ group and -0.0227 in those allocated to the CT group (P = 0.058). In the stratum of patients with a baseline s-Alb >3 g/dl (n = 97), there were no significant differences in the UP between the two treatment groups. Hence, MZ onlay therapy was not considered to be efficacious in this group of patients. No serious adverse reactions to the drug were observed. CONCLUSIONS: The present study yielded significant results, in that it suggested the possibility that long-term MZ therapy may afford further reduction of the UP, in addition to that obtained following CT, in particular, in MN patients in a severe nephrotic state.

Adult↗
PubMed2004

[Psychosocial characteristics in persons who often change their psychotherapists].

This study was performed on a clinic group of patients (n = 1000, 83.9% responder) to test characteristics of persons who switched psychotherapists on three or more occasions (n = 74). Compared with the group of minor variation, these patients had higher rates of psychosomatic symptoms, lower systemic operativeness, a dissatisfying sexuality, tended towards alcohol and pharmaceutical abuse, and had significant higher exposure in infancy to violence and sexual abuse (all p < 0.01 after Bonferroni correction). Psychosocial factors including early experience in forming relationships in addition to current factors appear to play a decisive role in a person's dropout liability as well as the attitude to therapy.

Adolescent↗
PubMed2005

A longitudinal model for non-monotonic clinical assessment scale data.

Clinical assessment scales, where subitem ratings are added and summarized as a total score, are convenient tools for monitoring disease progression and often used to measure the effect of drug treatment in clinical trials. Statistical evaluation of any beneficial treatment effects tends to focus on single-valued summary measures, for example, the difference between the score at the end of treatment and the score at baseline. Such analyses ignore potentially important features of the data, e.g. early vs. late recoveries. It is therefore of interest to develop longitudinal models that make more efficient use of the information present in non-monotonic clinical assessment scale data. We propose a two-part modeling approach for the modeling of this type of data. Non-monotonicity is managed by regarding score changes as Markovian transition events. A set of probabilistic models are used to describe the occurrences of the transitions. Continuous models are used to describe the magnitude of the scale score change, given the observed transition. In this manner, a non-monotonic disease progression is handled more efficiently than if other available methods are used. We illustrate this approach using data from a recent phase II study of a drug used in the treatment of stroke, where stroke severity was measured on the Scandinavian Stroke Scale (SSS). This scale consists of nine subitems: consciousness, eye movements, hand/arm/leg motor performance, orientation, speech, facial palsy, and gait. The data were non-monotonic, since there was at any time a risk of a score decline, despite a general tendency towards healing. The two-part probabilistic/continuous model fit the data well and proved to be robust in model-checking procedures such as posterior predictive checks and bootstrapping. The models derived using this approach could potentially accommodate drug effects, not only in terms of score improvement at end of study, but also on the onset of recovery, on dropout and on the probability of unfavorable progression patterns. In addition, it is possible to use the resulting for simulation of the prospective outcome of future studies. We conclude that this approach has considerable potential for more efficient use of information in longitudinal modeling of non-monotonic clinical assessment scale data.

Algorithms↗
PubMed2006

Patterns of retention in a preventive intervention with ethnic minority families.

This study examined socio-demographic, child, and family-level correlates of retention patterns among parent participants of Familias Unidas/SEPI (Coatsworth, Pantin, & Szapocznik, 2002), a randomized, controlled trial of a family-focused preventive intervention. The current study's aim was to identify variables that could be used to classify ethnic minority (African American and Hispanic) caregivers (N = 143) into their known patterns of retention across 30 sessions of the intervention. Person-centered analyses identified three broad attendance pattern groups: (a) non-attenders; (b) variable-attenders; (c) consistent-high-attenders. Subgroups of the variable-attender group included: (a) dropouts; (b) variable-low-attenders; (c) variable-high-attenders. Four socio-demographic indicators were significant discriminators of the broad retention patterns. Three family-level factors were significant discriminators of the variable-attender subgroups. Additional significant mean/rate differences among retention pattern groups on correlates are reported. Implications for how retention is examined in preventive interventions and for developing intervention strategies for improving retention rates are discussed.

Adult↗
PubMed1991

Clinical experience with triphasic oral contraceptive (Triquilar) in 527 women in China.

From October 1987 to May 1989, a total number of 527 women completed a total of 6,291 treatment cycles in 6 centers in China for the study of a triphasic oral contraceptive - Triquilar. The mean age of subjects was 30.21 +/- 2.84 years. There were 7 pregnancies during the study period. Among them, five were patient failures because of missed pill or incorrect intake; one had taken barbiturates along with Triquilar. Only one woman became pregnant in the 11th treatment cycle without any reason being found. In most cases, menstrual flow decreased and dysmenorrhea improved as treatment continued. Of the total treatment cycles, the incidence of missed withdrawal bleeding was 0.25%, spotting 0.97%, and breakthrough bleeding 0.48%. Nausea and vomiting was the most common side effect and accounted for 6.4% of the total treatment cycles. This was followed by breast tenderness (3.7%), dizziness (2.4%) and headache (1.6%). Most of the side effects occurred during the first few cycles and were alleviated later. By the end of one year, the total dropout was 64 cases. The reasons for discontinuing treatment were: pregnancy 1.33 (per hundred women), menstrual disturbances 0.76, side effects 3.80, other medical reasons 2.09, and personal reasons 4.18. The results confirm that Triquilar is an effective oral contraceptive with good cycle control and low incidence of side effects. No serious reaction has been reported. It has been well accepted by the Chinese women. However, due to the low dosage of steroids, it is of utmost importance to avoid errors in its use.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

The treatment of mild to severe chronic idiopathic urticaria with astemizole: double-blind and open trials.

Astemizole is a new H1 histamine-receptor antagonist that has a long elimination half-life and high H1-receptor affinity. This double-blind study evaluated the safety and efficacy of astemizole in the treatment of chronic idiopathic urticaria (more than or equal to 3 months). Seventeen male and 34 female adult patients with chronic idiopathic urticaria entered the 2-month study. After a 48- to 72-hour washout, half the subjects were prerandomized to receive astemizole (10 mg), and the other half received placebo. Placebo-treated patients who were unable to complete the full 8 weeks because of uncontrolled chronic urticaria symptoms were entered into a 2-month open astemizole trial. Treatment with astemizole, as measured at the end point of each patient's treatment and compared to placebo, resulted in significant improvement of pruritus, erythema, number of wheals, frequency of urticarial attacks, and control of urticaria (p less than or equal to 0.03). The overall response to astemizole was significantly better than for placebo, according to both the investigator's and the patient's global evaluations (p less than 0.01) and as indicated by dropouts caused by treatment failure with placebo (p = 0.005). Six of 26 (24%) of the placebo-treated patients in the double-blind study had good to excellent results on the basis of global assessments. Thirteen of 16 patients with placebo-treatment failures who received astemizole in the open trial improved significantly from baseline symptoms of pruritus, erythema, and number of wheals (p less than or equal to 0.05). No significant side effects were reported except mild sedation in three astemizole-treated subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Patient attrition in a comparative outcome study of depression. A follow-up report.

Eighty-seven moderately to severely depressed psychiatric outpatients were randomly assigned to 12 weeks of cognitive therapy (n = 24), pharmacotherapy (n = 24), cognitive therapy plus pharmacotherapy (n = 22) or cognitive therapy plus active placebo (n = 17). Seventy patients completed the treatment protocol; 17 dropped out before the end of the treatment period. Completers and dropouts did not differ at pretreatment on demographic variables, measures of depression, cognitive functioning or social adjustment. Sixteen of the 17 patients who dropped out were followed up and interviewed to assess their clinical status and reasons for discontinuing treatment. Neither group remained depressed at follow-up. Practical matters and issues related to the type of treatment received seemed to contribute most to patients' decision to drop out. Patients assigned to the combination therapies were more likely to complete the research protocol than those assigned to single treatment modalities. These findings are discussed in terms of their implications for clinical practice and outcome research.

Adolescent↗
PubMed1991

Uncovering psychiatric test information with graphical techniques of Exploratory Data Analysis.

This article illustrates how Exploratory Data Analysis (EDA) can complement conventional statistical methods in evaluating psychiatric tests. Using one recent EDA computer program, we evaluated the ability of repeated psychiatric screening tests (the General Health Questionnaire [GHQ]) to predict medical and psychiatric service use in a Health Maintenance Organization (HMO), the Harvard Community Health Plan (HCHP). Using a stratified random sample of 244 new HCHP enrollees and viewing three-dimensional graphs of their data from multiple perspectives, we found two subpopulations: low GHQ scorers, for whom the tests did not predict service use; and high scorers, for whom they did. Surprisingly, improving scores forecast increased use and chronically high scores predicted diminished use. Using another stratified random sample of 213 new HCHP enrollees, and with scatterplot matrices from another interactive computer program, we found that high and unchanging GHQ scores forecast HMO dropout. We examine possible interpretations--for example, that chronically distressed patients may become immobilized, diminish service use, and ultimately leave the HMO. We also explain how EDA methods may help uncover elusive results in other data (e.g., mental health outcomes).

Adult↗
PubMed1981

A cooperative trial in the primary prevention of ischaemic heart disease using clofibrate: some statistical aspects.

Some results of the primary prevention trial using clofibrate not published in the original report are presented. After showing that the entry characteristics of the "dropouts" in the treated group and in the main control group were similar, the emphasis is on deaths from causes other than ischaemic heart diseases in the trial and within 1 year of leaving it. Such deaths occurred no earlier, in terms of time since entry to the trial, in the clofibrate-treated group than in the main control group; they were no less frequent in those men in the treated group who were shown in the earlier report to have the greatest reduction in nonfatal myocardial infarction than in the remainder; and they showed no clear relationship with cholesterol reduction during the trial. Death rates calculated by the indirect method of age-standardization are presented and are preferred to the published rates calculated by the direct method. All men in the trial were followed to the end of 1978 to ascertain survival or cause of death. This will provide much larger numbers on many of the issues discussed here.

Adult↗
PubMed1985

Enhancement of visit adherence in the national beta-blocker heart attack trial.

Efforts were made in the Beta Blocker Heart Trial (BHAT), a double-blind study of 3837 post-MI patients, to enhance visit adherence, a measure of compliance that is not subjective and can be easily monitored. Of the required visits, 93.9% were completed in the window, 3.9% of the patients were classified as dropouts and 12 persons were lost to follow-up. Methods used to enhance compliance varied with circumstances but included appointment reminders, assistance with transportation, minimal waiting times, newsletters, continuity of care, involvement of family members, and close contact with private physicians. Comparisons of the BHAT visit adherence rates to those from other clinical trials are difficult to make because there are few reports in the literature regarding follow-up in large multicenter clinical trials. However, data obtained through personal communications, as well as published reports, indicate that adherence in primary prevention trials was generally less than that of secondary prevention trials. Adherence rates in the BHAT tended to be slightly higher than those of comparable trials.

Adult↗
PubMed1996

Prediction of attrition from day hospital treatment in lower socioeconomic cocaine-dependent men.

This study attempted to identify predictors of completion of a 27 h/week 4-week day hospital program for cocaine dependence. The research subjects were 95 lower socioeconomic, primarily African American male veterans. Of a wide range of predictor variables available at baseline, including sociodemographic and historical information, Addiction Severity Index data, psychiatric diagnoses, SCL-90 measures, and measures of craving and familial alcoholism, only the cocaine urine toxicology result and self report of days of cocaine use in the past 30 days (log transformed) were significant predictors. The urine toxicology result was the more powerful predictor with 73 percent with a negative urine completing treatment, as contrasted with 36 percent with a positive urine. Three additional measures obtained at the end of treatment week 1 further increased ability to predict treatment completion/attrition. Two of these measures were based on counsellor ratings and one was based on the patient's report of psychiatric treatment services received during the first treatment week. Thus, patients at high risk for dropout can be identified fairly early. Whether treatments can be adapted to retain such patients is an important question for the field.

Black or African American↗
PubMedDate not supplied

The effect of anxiety and depression on completion/withdrawal status in patients admitted to substance abuse detoxification program.

A large proportion of patients entering substance abuse treatment carry psychiatric diagnoses, and some studies have found that those with psychopathology are more likely to withdraw before treatment is completed. We performed a prospective study of patients entering an inpatient substance abuse detoxification program to determine if the degree of anxiety and/or depression correlated with higher dropout rates. On entry to the unit, all patients were administered the Hamilton Rating Scales for Depression and Anxiety. Of the 148 patients studied, 97 (65.5%) completed treatment and 51 (34.5%) withdrew prematurely. There were no significant differences in Hamilton Depression and Anxiety Rating Scale scores between completers and withdrawers. This was true for the total study population, as well as for subgroups of patients based on primary drug abused (heroin or cocaine). Although anxiety and depression are common in substance abusers, we were unable to detect differences on validated anxiety and depression rating scales between those completing and those withdrawing from substance abuse detoxification.

Adult↗
PubMed2004

Smoking stage of change is associated with retention in a smoke-free residential drug treatment program for women.

Prochaska and DiClemente's Transtheoretical Model predicts dropout from substance-abuse treatment. However, it is not known whether readiness to quit smoking is associated with attrition from drug treatment programs with smoking restrictions. This study examined the relationship between smoking characteristics, smoking stage of change, and both length of stay (LOS) and discharge type among 75 perinatal substance abusers attending a smoke-free residential treatment program. URICA scores predicted LOS (P=.0004) and discharge type (P=.01). Women in action and maintenance remained in treatment longer and were more likely to complete treatment compared to those in precontemplation. Findings were not accounted for by addiction severity. Women with little interest in quitting smoking may have difficulty adhering to smoking restrictions during treatment for other drug problems, resulting in increased attrition. Alternatively, smoking stage of change may be a "proxy" for overall readiness to change in this population.

Adolescent↗
PubMed2004

The chronically ill elderly patients discharged from the hospital: interim report from a controlled study of home care attendance.

This controlled study evaluated various outcomes in a group of 127 chronically ill and frail elderly patients when discharged from a hospital ward, and cared at home, enrolled during 12 months starting from September 2001. The observation of patients is programmed to be of two years from enrollment, with a scheduled program of follow up at baseline,6, 12, and 24 months. Patients (of both sexes) were randomly assigned to one of two groups: (i) Control group (61 patients: mean age 85.2 years) having a usual home care program of assistance, guaranteed by the Social Health Care Service. (ii) Intervention group (66 patients: mean age 83.2 years), for whom the program of care mentioned above was integrated providing collaboration of a home care attendant. This was a lay-working person who has attended a specializing course about care of the elderly and of the very frail. The home attendance was provided for 4-10 hrs daily, according to a program established by a Geriatric Evaluation Unit. The team evaluated the patients at their home,deciding the amount of hours of attendance in the presence of the caregiver. The financial cost of the additional home care attendance was sponsored, totally or in part, according to the financial situation of the patient's family, by the "Fondazione del Monte di Bologna e di Ravenna". This report takes into consideration only few preliminary data, coming from the first 6 months of observation of all the patients included. The two groups were homogeneous when compared statistically at baseline. Data coming form laboratory and biological analysis will be available only at the end of the project as they are recorded in a blind methodology. A lower degree of mortality and of dropouts in the intervention group was observed,compared to the control group, already at 6 months. These outcomes can be considered favorable, and perhaps can be related to the various benefits gained by additional program of home attendance.

Aged↗
PubMed2005

A randomized controlled trial of an internet-based treatment for chronic headache.

Chronic headache is a significant public health problem in Western nations. Although controlled trials demonstrate the efficacy and cost-effectiveness of face-to-face behavioral therapy, most headache sufferers have limited access to these treatments. Delivery of behavioral interventions using Internet technology has the potential to reach a larger number of headache sufferers and reduce the burden of disease. This randomized controlled study evaluated an Internet-delivered behavioral regimen composed of progressive relaxation, limited biofeedback with autogenic training, and stress management versus a symptom monitoring waitlist control. Treatment led to a significantly greater decrease in headache activity than symptom monitoring alone. Thirty-nine percent of treated individuals showed clinically significant improvement on self-report measures of headache symptoms at post-treatment. At two-month follow-up, 47% of participants maintained improvement. Treatment had a significant impact on general headache symptoms and headache-related disability. There was a 35% within-group reduction of medication usage among the treated subjects. The Internet program was more time-efficient than traditional clinical treatment. Treatment and follow-up dropout rates, 38.1% and 64.8%, respectively, were typical of behavioral self-help studies. This approach to self-management of headache is promising; however, several methodological and ethical challenges need to be addressed.

Adult↗
PubMed2006

Influence of expressed emotion and perceived criticism on cognitive-behavioral therapy for social phobia.

This study examined significant others' expressed emotion (EE) and a closely related construct, perceived criticism, as predictors of cognitive-behavioral therapy outcome in a sample of 40 patients with social phobia (social anxiety disorder). Patients enrolled in group therapy for social phobia completed pre- and post-treatment questionnaire measures of perceived criticism and anxious and depressive symptoms. Designated significant others were assessed for the components of high EE (criticism, hostility and emotional overinvolvement) using the Camberwell Family Interview. It was hypothesized that these high-EE components and patients' perceived criticism would be associated with poorer treatment outcome, and results ran counter to these expectations. Controlling for initial social phobia severity, lower levels of perceived criticism predicted treatment dropout. There was also a nonsignificant trend for participants with a significant other rated as high in emotional overinvolvement to show less change on a composite symptom measure. Findings from this study suggest that close relationships impact the outcome of cognitive-behavioral interventions for social phobia.

Adolescent↗