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PubMed1995

An audit study of defaulters of regular psychiatric outpatient appointments in Hong Kong.

This paper describes an audit study of general psychiatric outpatient defaulters in Hong Kong. Defaulters were increased among those who were married, unemployed, housewives, seen within one year, receiving medications and previously admitted to hospital. Clinical diagnoses (ICD-10 Axis-1) of the F1, F2, F3 and F7 groups were also associated with increased defaulting behaviour. However, fewer defaulters were found among those who were aged below 19, single, employed, students, and had diagnostic groups of F4 and F9. These results added new information on the non-attendance behavioral pattern of Chinese patients.

Adolescent↗
PubMed2003

Retaining school children and families in community research: lessons from the Study of Children's Activity and Nutrition (SCAN).

Retaining school-aged study participants poses a major challenge in any longitudinal research study. Dropouts produce bias in the remaining sample and this loss may affect study findings and their interpretation. Dominant factors that influence retention in pediatric research studies include family versus individual participation, patient management strategies of study personnel, knowledge about the condition or therapy, age and gender factors, credibility within the community, monetary incentives, and altruism. Eleven years after baseline assessment, Studies of Children's Activity and Nutrition boasts a 53% retention of the original biethnic cohort in San Diego. Retention occurred partly due to a trained measurement team which completed sequential observations primarily in family homes and implemented continuous participant follow-up procedures. Approaches for increasing student retention based on carefully designed studies and adherence indicators can assist researchers seeking maximum retention of school-aged participants.

Adolescent↗
PubMed2000

Six-month treatment of obesity with sibutramine 15 mg; a double-blind, placebo-controlled monocenter clinical trial in a Hispanic population.

OBJECTIVE: To evaluate the safety and efficacy of sibutramine 15 mg by mouth once per day in obese patients over a period of 6 months. RESEARCH METHODS AND PROCEDURES: A monocenter, double-blind, placebo controlled, parallel, prospective clinical trial was carried out. Sixty-nine male and female obese patients (body mass index [BMI] > 30 kg/m2) aged 16 to 65 years entered the trial. RESULTS: 22 of 35 patients in the sibutramine group and 9 of 34 patients in the placebo group completed the trial. The high dropout rate in the sibutramine group was due to adverse events in 3 cases, lack of efficacy (as judged by patients) in 7, loss to follow-up in 2, and an orthopedic device being worn in 1; in the placebo group the dropouts were ascribed to lack of efficacy (as judged by patients) in 17 cases and to loss to follow-up in 8 cases. Using the method of last observation carried forward, the weight loss in the sibutramine group was 10.27 kg (95% confidence intervals [95% CI] 7.66; 13.07) and 1.26 kg (95% CI 0.3; 2.23) in the placebo group. The BMI loss was 4.17 kg/m2 (95% CI 3.11; 5.22) in the sibutramine group and 0.53 kg/m2 (95% CI 0.13; 0.92) in the placebo group. The waist circumference reduction was 12.51 cm (95% CI 9.25; 15.77) in the sibutramine group and 3.26 cm (95% CI 1.38; 5.14) in the control group (p<0.05 by paired Student's t test for all the intragroup comparisons). Twenty-three sibutramine patients had 34 adverse events, the most frequent adverse events in the sibutramine group were upper respiratory tract infections (n = 6) and constipation (n = 6); 16 placebo patients had 21 adverse events. Three sibutramine patients withdrew their informed consent when they had adverse events. DISCUSSION: The results show that sibutramine induces significant loss of body weight and waist circumference. Cardiovascular function was not significantly affected by sibutramine. Sibutramine was well tolerated by most of the patients.

Adolescent↗
PubMed2002

Development and immediate impact of a self-instruction curriculum for an adolescent indicated drug abuse prevention trial.

This article describes the development and immediate impact of a self-instruction indicated drug abuse prevention program, Project Towards No Drug Abuse (TND). Self-instruction programming often is used to help youth that are at high risk for dropout and drug abuse to complete their high school education, and is a method of choice among educators at alternative high schools. This article describes the justification for the self-instruction program, keys to good programmed self-learning, and how a 12-session health educator delivered program was converted to a self-instruction format. In addition, the immediate impact of a 3-group experimental trial is presented. Health educator led, self-instruction, and standard care control conditions are compared on knowledge change, and the two program conditions are compared on process ratings. Self-instruction programming can be successfully adapted from a health educator-led format, though the lack of student group interaction in this modality may limit its receptivity among students.

Adolescent↗
PubMed1996

A prospective outcome study of patients missing regular psychiatric outpatient appointments.

This paper describes a prospective follow-up study of defaulters of regular psychiatric outpatient appointments in Hong Kong. To establish outcome, 258 patients were traced 6 months after their non-attendance at a follow-up clinic. Results showed that 50% returned while the rest dropped out of treatment. The clinical and demographic variables, including employment, marriage, being seen by faculty rather than resident staff, a past history of default and shorter length of contact at the clinic studied (within a year), were all significant in predicting drop-out. There was a trend for those who reattended to have received a telephone reminder, to be a student and to be single. Out of the 129 drop-out patients, 84 were traced, 23 were admitted to hospital and 5 died. There were no deaths and only 5 patients required hospitalisation among the attenders. We concluded that active reengagement of psychiatric outpatient defaulters is required.

Adult↗
PubMedDate not supplied

Measuring cocaine effect expectancies among therapeutic community inpatients.

Evidence has accumulated that beliefs about alcohol contribute to the etiology and maintenance of different patterns of drinking and drinking-related behavior. This research focus has been expanded from alcohol to include marijuana and cocaine. The present study was designed to improve upon earlier efforts to measure the domain of cocaine effect expectancies, which were based on samples of college students. Confirmatory factor analyses of the 24-item Cocaine Effect Expectancy Questionnaire (CEEQ) were conducted using a sample of 231 therapeutic community inpatients in the northeastern United States. The suggested factor structure was not confirmed. Empirical support was found for a 4-item Positive Effects scale. This scale did not have a significant effect on treatment participation.

Adult↗
PubMed2006

Resident selection: a key to the future of orthopaedics.

Recognizing the challenges presented in the process of resident selection, in 1981 the American Orthopaedic Association formed a Steering Committee on Resident Selection. This Committee was charged with studying the processes involved in the selection of orthopaedic residents and developing guidelines and making suggestions to program directors. The activities of the Committee focused on five areas: (1) the mechanics of resident selection; (2) the assessment of cognitive skills; (3) the assessment of motor ability; (4) the assessment of noncognitive factors (the affective domain); (5) the assessment of "dropouts." The Committee made the following recommendations to help program directors in the selection of residents: (1) use of a standardized application form; (2) full disclosure to applicants; (3) careful selection of candidates to be interviewed; (4) careful planning and implementation of the interview and visit; (5) broad faculty representation and discussion at time of selection; (6) due diligence when necessary. We still believe these criteria important in resident selection.

Aptitude↗
PubMed2000

Analysis of CYP21 coding polymorphisms in three ethnic populations: further evidence of nonamplifying CYP21 alleles among whites.

BACKGROUND: Adrenal steroid 21-hydroxylase is essential for the synthesis of both mineralocorticoids and glucocorticoids. The gene for this enzyme, CYP21, contains several frequent coding polymorphisms. Because of its essential function in steroid synthesis, polymorphisms in this enzyme might influence a variety of disease processes. However, before disease-association studies are performed, it is important to understand the frequency of these polymorphisms among normal individuals. METHODS: Using polymerase chain reaction (PCR) with restriction enzyme digestion or size length polymorphism analysis, we measured the frequencies of the +Leu(10), Arg102Lys, and Ser268Thr polymorphisms in CYP21 in healthy whites, blacks, and Indian Americans. The subjects were all young female college students participating in a study of relative risks for cardiovascular disease in these populations. RESULTS: The frequency of each polymorphism among whites, blacks, and Indian Americans were as follows: +Leu(10), 0.55, 0.96, 0.75; Arg102, 0.63, 0.97, 0.82; and Ser268, 0.92, 0.68, 0.79, respectively. With the exception of the frequencies of the Ser268Thr polymorphism among blacks and Indian Americans, there were significantly different frequencies of each polymorphism among all groups (P<.05). Among whites, the distribution of genotypes for the +Leu(10) and Arg102Lys polymorphisms deviated significantly from expected Hardy-Weinberg values because of an excess of homozygotes. CONCLUSIONS: Among the ethnic groups, there are statistically significant differences in the frequencies of these common coding polymorphisms in CYP21 that need to be considered in disease-association studies. Deviation from Hardy-Weinberg distributions might be explained by allelic dropout during PCR, a phenomenon previously reported at this locus.

Adolescent↗
PubMed1987

The self-fulfilling prophecy in dental prophylaxis.

This report deals with the influence of the self-fulfilling prophecy on dental prophylaxis. The aim was to test if this phenomenon had any influence on the treatment of patients, they and their therapeutist's perception of each other and the result of the prophylactic work. Sixty patients and 34 students were involved. The patients were randomly classified as "good" or "bad". Twenty-seven students had a patient from each group. Dental plaque and gingival inflammation were recorded before and after the treatment. No difference in improvement between the two groups could be shown. Both patients and students were interviewed about their experiences and feelings during the treatment. All patients were satisfied with their therapeutist. The students generally accepted the classification although they were made aware of the self-fulfilling prophecy. This was confirmed by a significantly higher frequency of patient drop-outs, broken appointments and critical notes about the patients in the "bad" group compared to the "good". The conclusions are that the self-fulfilling prophecy can be initiated by even minor notes in patient files, and that this affects the treatment of patients.

Appointments and Schedules↗
PubMed2002

Reasons for therapy termination in a university psychology clinic.

This study examined the reasons for therapy termination documented by graduate student therapists. The closed case files of individual adult clients who had terminated their therapy experience at a university-based psychology clinic were reviewed. Results indicated that the most frequent reasons for termination documented by graduate student therapists were that clients stopped attending therapy sessions without providing their therapists with notice or reason and that clients reached a satisfactory termination point in their therapy experience. A substantial number of clients terminated therapy because of difficulties unrelated to therapy, seeking services elsewhere, or dissatisfaction with therapy services. Level of depressive symptomatology and the number of sessions attended differed across clients who had different reasons for termination. By addressing such client concerns early in the therapy experience, premature termination may be prevented.

Adolescent↗
PubMedDate not supplied

Applying theory of planned behavior to fruit and vegetable consumption of young adolescents.

PURPOSE: The purpose of this research was to investigate how well Theory of Planned Behavior (TPB) predicted frequency of consumption of fruits and vegetables among seventh graders and to investigate whether gender or socioeconomic status (SES) had moderating effects on the relationships between the constructs in the model. DESIGN: Two identical self-administered paper and pencil surveys were distributed 6 months apart. Path analyses of the TPB models by gender and SES were performed with AMOS software. SETTING: The study occurred in eight middle schools from school districts in the Minneapolis--St. Paul metropolitan area, where a minimum of 20% of the students qualified for free or reduced-price meals. SUBJECTS: Of the invited seventh graders, 1406 (74%) completed data for the model constructs at baseline and for behavior at interim data collection. MEASURES: We assessed frequency of consumption of fruits and vegetables and attitudes, subjective norms, barriers, and intentions related to this behavior. Three levels of SES were created based on questions about free lunch, parents' education, and work. RESULTS: No significant direct effects of attitudes and subjective norms on behavior were found, but for barriers, both indirect effects through intentions and direct effects on behavior were significant. Seven percent of the variation in the frequency of fruit and vegetable consumption and 31% of the variation in intention to eat more fruits and vegetables were explained by the model. Gender appeared to have moderating effects on the relationships between attitudes and intention and between intentions and behavior in the model. There were no moderator effects of SES, but the larger dropout rates from the low-SES group could have caused the groups to become more homogeneous. CONCLUSION: The data fit the model well; still, large proportions of the variance in the frequency of consumption of fruits and vegetables were unexplained. This may be related to the operationalization of the model constructs or to missing important factors in the model. Furthermore, there appeared to be strong relationships between subjective norms or barriers and intentions as well as gender differences in the strengths of the relationships in the model that may have implications for intervention methods or messages.

Adolescent↗
PubMed1982

Discharge against medical advice (AMA) from an acute care private psychiatric hospital.

Discharge from psychiatric hospitals against medical advice (AMA) is noncompliance with a physician's treatment regimen. Forty-one patients (26 male, 15 female) discharged AMA from a 32-bed proprietary acute care psychiatric hospital were matched by sex to 41 regularly discharged patients. Data that pertained to account status, marital status, race, month of admission, day of week of admission, time of admission, day of week of discharge, time of discharge, length of stay, religion, diagnosis, employment status, presence of prior psychiatric treatment, attending physician, hospital census, and adolescent census at time of admission were analyzed by Student's t-test, Chi-square, and Pearson correlation coefficients. Significant differences were found for length of stay (p less than .01), time of discharge (p less than .002), presence of prior psychiatric treatment (p less than .0005), and attending physician (p less than .02). Age and length of stay for the regularly discharged group were correlated (r = .47; p less than .001). The failure of this study to support much prior research may be related to differences in hospital setting, client population, and therapist variables.

Adult↗
PubMed2006

Educational achievement and early school behavior as predictors of alcohol-use disorders: 35-year follow-up of the Woodlawn Study.

OBJECTIVE: Using prospectively gathered data across a 35-year follow-up interval, we assessed the association of educational achievement and school behaviors with risk for the development of an alcohol-use disorder in adulthood. METHOD: The baseline population consisted of 1242 first-grade students in 1966-1967 residing in the Woodlawn community of Chicago, Illinois. Follow-up interviews were completed for adolescents and their mothers (1975-1976), during young adulthood (1992-1993), and midlife (2002-2003). A total of 1052 individuals completed the young adult and/or midlife interviews and provided information to assess the presence of a lifetime alcohol-use disorder. Logistic regression with multiple imputation to account for missing information was used to assess the relationships between early-educational and school-behavior characteristics with onset of a DSM-III-R/DSM-IV alcohol-use disorder (defined using the Composite International Diagnostic Interview). RESULTS: Relatively few of the hypothesized educational predictors were associated with risk for alcohol-use disorders in adulthood. The measures found to be predictive of a subsequent alcohol-use disorder included the following: (1) math achievement among first-grade boys, (2) mothers' report of skipping school among adolescent males, (3) self-report of skipping school among adolescent girls, and (4) school dropout. Early shyness among first-grade boys was protective for later alcohol-use disorders. CONCLUSIONS: The current report supplies data on the association of educational characteristics and school behaviors with the development of an alcohol-use disorder in a population-based sample with an extended interval of follow-up. Gender-specific differences are discussed.

Achievement↗
PubMed2005

Psychometric properties of the Toronto Alexithymia Scale (TAS-20) for substance users.

OBJECTIVE: To determine the psychometric properties of the Toronto Alexithymia Scale (TAS-20), an established self-report measure of alexithymia, for a substance user sample participating in a clinical trial of outpatient cognitive-behavioral therapies (N=230). METHODS: Confirmatory and exploratory factor analyses were used to determine the number and nature of the factors underlying the TAS-20 in a sample of substance users. Structural equation modeling was used to determine the predictive validity of the TAS-20. RESULTS: A factor structure comparable, but not identical, with TAS-20 psychometric results with other populations was found; alpha coefficients were .88 for the feelings factor, .62 for the external thinking factor, and .87 for the total score. Although, on average, the substance users did not appear to have elevated alexithymia scores compared with the undergraduate students, alexithymia predicted less treatment engagement, i.e., fewer sessions attended and weaker helping alliance. Alexithymia also predicted alcohol use outcomes but not drug use outcomes. The relation between alexithymia and drinking outcome was conditional on whether the patient was using solely alcohol at baseline. CONCLUSION: The TAS-20 has reasonably good psychometric properties in this sample, which might be improved by dropping several marginal questionnaire items. Alexithymia appears to attenuate substance abuse treatment engagement. More clinical and research experience with this construct and specific instrument in substance user samples is needed.

Adult↗
PubMed2002

[Efficacy of efavirenz in a mixed population of patients. Identification of drop-out causes].

AIM: To determine drop-out causes and EFV efficacy in ARVT. MATERIALS: We examined a case-study of 106 patients (74% males, 26% females) followed for up to 23 months. 14% of the patients were naive for ARVT, 21% had already been treated with other drugs (non effective therapy), 28% were administered EFV as a supporting drug, 37% were administered EFV as a replacement drug (side-effects). The parameters used to assess efficacy are: CD4+ lymphocyte count and HIV viral load. The statistical tests used are: Student t, Fischer F, Kruskal Wallis H. RESULTS: 33 (31.1%) patients are D.O. because of: non efficacy (11%), rash (5%), psychological disorders (8%), impotence (1%), psychosis (2%), acute hepatitis (1%), abdominal pain (2%), self-suspended ARVT (2%). After the EFV introduction, in few months it has been observed a sudden fall of the viral load while the CD4+ course increases up to the 18 month of follow up, and later on it has been observed a small decrease. CONCLUSION: This study proves the efficacy of EFV in ARVT. The D.O. patients because of side-effects are only a small number.

Adult↗
PubMed1996

Family, peer, and neighborhood influences on academic achievement among African-American adolescents: one-year prospective effects.

Using a 1-year prospective design, this study examined the influence of family status variables (family income, parental education, family structure), parenting variables (maternal support and restrictive control), peer support, and neighborhood risk on the school performance of 120 African American junior high school students. In addition to main effects of these variables, neighborhood risk was examined as a moderator of the effects of parenting and peer support. Family status variables were not predictive of adolescent school performance as indexed by self-reported grade point average. Maternal support at Time 1 was prospectively related to adolescent grades at Time 2. Neighborhood risk was related to lower grades, while peer support predicted better grades in the prospective analyses. Neighborhood risk also moderated the effects of maternal restrictive control and peer support on adolescent grades in prospective analyses. These findings highlight the importance of an ecological approach to the problem of academic underachievement within the African American Community.

Achievement↗
PubMed1978

Evaluation of an Emergency Department Patient Advocacy Program.

In the Patient Advocacy Program at the Adult Emergency Department of The Johns Hopkins Hospital, first year medical and health associate students provide patient teaching, crisis intervention, emotional support, assistance in patient-provider-family communication, resource referrals, information and assistance in maintaining patients' rights. The advocacy program was evaluated through a three-month trial of a Control Group, Patient Advocacy Group, Halo Group and Placebo Group, including 412 study subjects in all. It was hypothesized that patients' satisfaction, behavior and knowledge would improve significantly as a result of the advocate's intervention in this order: Patient Advocacy, Halo, Placebo and Control. Patient interviews and medical reports were used to assess the impact of patient advocacy. Results did not support the hypotheses of either improvement or the ranked order. Competition with traditional roles, identification of advocates with providers rather than patients, and placing the needs of the institution over patients were suggested as explanations for the advocacy program's failure.

Emergency Service, Hospital↗
PubMed1998

An investigation of male attitudes toward marketing communications from dental service providers.

OBJECTIVE: To identify the process by which males aged 25-34 who do not display regular attendance behaviour are exposed to, attend, comprehend and are persuaded by communications by general dental practitioners. DESIGN: Focus groups (of 1 hour duration) comprising 6-7 members, conducted over a period of 18 months, discussing five open-ended questions or statements. SETTING: The Manchester Metropolitan University, Crewe+Alsager Faculty, Cheshire, UK during 1995-96. SUBJECTS: 116 non-attending males (aged between 25-34 years) taken from professional lecturers (17%), full-time (50%) and part-time students (33%) with varying income and education levels. INTERVENTIONS: A theoretical linear-sequential model related to patients behaviour was considered in relation to the timing of communications but this was not tested. MAIN OUTCOME MEASURES: Views of group members concerning their attitudes, perceptions and experience of communications from GDPs. RESULTS: Informative oral communications were considered as important during treatment. Most written communications were cited as impersonal, health posters were perceived as negative being targeted at children only, general media articles on dentistry were not very evident or interesting, however, a practice brochure was viewed as a handy communication tool. CONCLUSIONS: General dental practitioners should look carefully at all of their own methods of communication with patients (from oral to written) and consider the value of their marketing and all areas of communications, especially when considering non-attenders and males (aged 25-34).

Adult↗