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PubMed2000

A transitional model for longitudinal binary data subject to nonignorable missing data.

Binary longitudinal data are often collected in clinical trials when interest is on assessing the effect of a treatment over time. Our application is a recent study of opiate addiction that examined the effect of a new treatment on repeated urine tests to assess opiate use over an extended follow-up. Drug addiction is episodic, and a new treatment may affect various features of the opiate-use process such as the proportion of positive urine tests over follow-up and the time to the first occurrence of a positive test. Complications in this trial were the large amounts of dropout and intermittent missing data and the large number of observations on each subject. We develop a transitional model for longitudinal binary data subject to nonignorable missing data and propose an EM algorithm for parameter estimation. We use the transitional model to derive summary measures of the opiate-use process that can be compared across treatment groups to assess treatment effect. Through analyses and simulations, we show the importance of properly accounting for the missing data mechanism when assessing the treatment effect in our example.

Algorithms↗
PubMed2002

Principal stratification in causal inference.

Many scientific problems require that treatment comparisons be adjusted for posttreatment variables, but the estimands underlying standard methods are not causal effects. To address this deficiency, we propose a general framework for comparing treatments adjusting for posttreatment variables that yields principal effects based on principal stratification. Principal stratification with respect to a posttreatment variable is a cross-classification of subjects defined by the joint potential values of that posttreatment variable tinder each of the treatments being compared. Principal effects are causal effects within a principal stratum. The key property of principal strata is that they are not affected by treatment assignment and therefore can be used just as any pretreatment covariate. such as age category. As a result, the central property of our principal effects is that they are always causal effects and do not suffer from the complications of standard posttreatment-adjusted estimands. We discuss briefly that such principal causal effects are the link between three recent applications with adjustment for posttreatment variables: (i) treatment noncompliance, (ii) missing outcomes (dropout) following treatment noncompliance. and (iii) censoring by death. We then attack the problem of surrogate or biomarker endpoints, where we show, using principal causal effects, that all current definitions of surrogacy, even when perfectly true, do not generally have the desired interpretation as causal effects of treatment on outcome. We go on to forrmulate estimands based on principal stratification and principal causal effects and show their superiority.

Child↗
PubMed1991

The failure of exposure treatment in agoraphobia: implications for the practice of nurse therapists and community psychiatric nurses.

There are no systematic studies of the failure of psychiatric nursing interventions and few very such studies in the psychological/psychiatric outcome literature. This study reports a controlled study of exposure treatment with agoraphobic clients who were treated by nurse therapists and psychologists. This includes an analysis of the four categories of treatment failure (i.e. treatment refusers, treatment dropouts, failures and relapsers). The analysis consisted of an examination of the outcome data of clients who met a priori criteria for the categories of failure and an examination of questionnaire responses. The results have implications for psychiatric nursing practice, particularly with regard to preparation for treatment. Additionally, the results indicate that much more research needs to be carried out on treatment methods and that exposure alone produces a significant but limited effect. Finally, the paper suggests that outcome research is a priority in psychiatric nursing.

Adult↗
PubMed1986

On latent school refusal in junior high school.

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.

Adolescent↗
PubMed2006

Attrition in longitudinal studies: who do you lose?

OBJECTIVE: To describe the risk factors for various types of attrition in three age cohorts of women in a longitudinal study and to discuss strategies to minimise attrition. METHODS: Analysis of survey data from the Australian Longitudinal Study on Women's Health, collected by mailed questionnaire. In 1996, the study recruited and surveyed a national random sample of 'younger' (18-23 years, n = 14,247), 'mid-age' (45-50 years, n = 13,716), and 'older' women (70-75 years, n = 12,432), and began a staggered cycle of mailed follow-up questionnaires: 1998 (mid-age), 1999 (older), 2000 (younger) and so on. Demographic, health and social risk factors for attrition were examined using multivariate analysis. RESULTS: Attrition at survey 2 was highest among younger women (32%), mainly because of participants not being contactable (21%), and lower among the older (16%) and mid-age women (10%). At survey 1, the survey 2 non-respondents were more likely to report having less education, being born in a non-English-speaking country and being a current smoker, in all cohorts, and had poorer health (mid-age and older cohort) and more difficulty managing on their income (younger and mid-age). CONCLUSION: Although the magnitude of different types of attrition was found to differ by age, there were several risk factors for attrition that remained consistent. These findings are important to inform future studies on ways to lessen or prevent systematic loss of participants. IMPLICATIONS: Recruitment and follow-up methods in longitudinal studies should be tailored to maximise retention of participants at higher risk of dropout.

Adolescent↗
PubMed2005

Buprenorphine retention in primary care.

BACKGROUND: This study assesses the rate and predictors of treatment retention for primary care patients with opioid dependence-prescribed buprenorphine, a long-acting partial opioid agonist. METHODS: Observational cohort study of patients prescribed buprenorphine/naloxone and followed for 6 months in the period after the adoption of buprenophine/naloxone by a primary care practice in Rhode Island. Practice policy precluded patient discharges due to continuing drug use. RESULTS: Patients (n=41) had a mean duration of opioid use of 15.7 years and most had a history of heroin use (63.4%). Thirty-nine percent of patients transferred from methadone maintenance. At 24 weeks, 59% remained in treatment. Nearly half of dropouts occurred in the first 30 days. Participants with opiate-positive toxicologies at week 1 were more likely to drop out of the program (P<.01) and had a significantly shorter retention time (P<.01) on average. Among other drug use and drug treatment variables, employment and addiction counseling during treatment were significantly associated with treatment retention (P=.03). CONCLUSION: Retention rates in a real world, primary care-based buprenorphine maintenance practice reflect those reported in clinical trials. Abstinence during the first week of treatment and receipt of counseling were critical to patient retention.

Adult↗
PubMed1991

Prevalence of dementia in the 'oldest old' of a Dutch community.

OBJECTIVE: To estimate the prevalence rate of dementia in subjects 85 years of age and over. DESIGN: A two-phase design with the Mini-Mental State Examination (MMSE) in the screening phase and the Geriatric Mental State Schedule (GMS) in the diagnostic phase. SETTING: Community survey including subjects in residential care. SUBJECTS: All (n = 1,259) inhabitants of Leiden, The Netherlands, aged 85 years and over on December 1, 1986. First phase participation rate was 71% (17% dropout due to death); second phase participation rate was 82%. MAIN OUTCOME MEASURE: DSM-III diagnosis of dementia without further specification of the etiology of the dementia. RESULTS: An overall prevalence rate of 23% (95% C.I.: 19%-26%) was found. This included 12% mild dementia, 7% moderate and 4% severe dementia. The prevalence rate was higher among women (24%) than among men (18%). It increased with age from 19% (95% C.I.: 16%-22%) in the group of 85-89 years to 32% (95% C.I.: 26%-39%) in the group of 90-94 years to 41% (95% C.I.: 25%-58%) in the 95+ group. CONCLUSION: A fifth of the 85+ and a third of the 90+ population suffer from dementia with an indication that half of the 95+ population is affected. With the expected steep rise in the number of the oldest old, dementia will stay a major health problem in the near future.

Aged↗
PubMed1993

Dropping out of marriage and family therapy: a critical review of research.

The lack of attention given to research on the premature termination by clients in marriage and family therapy is evident in research reviews of the dropout phenomenon in psychotherapy. This article is an attempt to fill that void. The research literature on dropping out of family therapy is reviewed and organized. Studies in this area tend to focus on four kinds of variables: client characteristics, therapist characteristics, therapy process variables, and interventions. Stable findings in each of these areas are pointed out. Both limitations and recommendations for future research are discussed.

Family Therapy↗
PubMed2004

Reliability and validity of the Dental Satisfaction Questionnaire in a population of 23-year-olds in Norway.

OBJECTIVE: The aim of this study was to explore the internal structure, reliability, and construct validity of the Dental Satisfaction Questionnaire (DSQ) in a population of young adults in Norway. METHODS: The DSQ scale was mailed to a representative sample of 968 subjects aged 23 years in two Norwegian counties. The reliability assessment of the instrument was based on internal consistency analysis (Cronbach's alpha). A factor analysis (principal component) was used to confirm the internal structure of the scale. The construct validity of the DSQ was indicated by: (i) its correlation with the patients' beliefs regarding the way dentists deliver care, indexed by the Dental Beliefs Survey (DBS); and (ii) differences in DSQ scores between subjects who had dropped out from dental care at the age of 23 years and regular attenders. RESULTS: The response rate was 69%. The alpha (Cronbach's) coefficient for the overall construct of DSQ was 0.81 (n = 655), and 0.65 or more for the subscales pain management, quality, and access. The correlation coefficient between the sum-scores of DSQ and DBS for the entire sample was r = -0.69. Subjects in the dropout group had significantly lower satisfaction with dental care than the rest of the group (P < 0.001). CONCLUSIONS: This study generally confirms the structure of the DSQ instrument and indicates that it is a reliable and valid instrument in cultures other than the one for which it was previously tested.

Adult↗
PubMed2004

Assessment and evaluation of individual prerequisites for dental education.

Since 2001 the School of Dentistry of Malmo University in Sweden has used an alternative admissions procedure based on results of an investigation supported by the Swedish Council for the Renewal of Undergraduate Education. The investigation concerned possibilities of predicting dental school performance on the basis of an interview, as well as tests of general intelligence, spatial ability, manual dexterity, empathy and social competence. Two groups of incoming students were followed from start to completion of their training. Significant relationships were found between (i) number of course examinations failed and poor results on interviews, as well as low scores on intelligence, spatial ability, and a test of spatial-manual ability, (ii) good results in a pre-clinical course in cavity preparation and high scores on spatial ability, (iii) assessments of high social competence during training and good results on interviews, as well as high scores on empathy and non-verbal intelligence. Dropout from the study programme could not be predicted, possibly due to the varying reasons for it.

Achievement↗
PubMed2006

Transarterial chemoembolization as a bridge to liver transplantation for hepatocellular carcinoma: an evidence-based analysis.

The aim of this review was to assess the impact of transarterial chemoembolization (TACE) as a neoadjuvant therapy prior to orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). An electronic search on the Medline database (1990-2005) was used to identify relevant articles. The studies were reviewed and ranked according to their quality of evidence using the grading system proposed by the Oxford Centre for Evidence-based Medicine. As a bridge to OLT, pretransplant TACE does not improve long-term survival (grade C). There is currently no convincing evidence that TACE allows to expand the current selection criteria for OLT, nor that TACE decreases dropout rates on the waiting list (grade C). However, TACE does not increase the risk for postoperative complications (grade C). There is insufficient evidence that TACE offers any benefit when used prior to OLT, neither for early nor for advanced HCC. Well-designed randomized controlled trials are needed to define the role of TACE in OLT patients.

Carcinoma, Hepatocellular↗
PubMed1979

Non-health professionals and the school-age child: early intervention for behavioral problems.

A methodology is described to utilize dormitory parents in direct care activities for the early intervention of behavioral problems of the school-age child. Specific information gathering, assessment, treatment, referral and follow-up tasks were defined and incorporated into a problem-solving protocol which served to guide the dormitory parents through the defined problem-solving process, to promote early identification of students with a behavioral problem, and to expedite referral to a professional for students with more severe problems. The methodology was pilot-tested in a large American Indian boarding school and demonstrated the feasibility and efficacy of dormitory parents in a therapeutic role as one component of a team approach to the management of behavioral problems. The pilot study resulted in a significant reduction in the rates of alcohol abuse and school dropouts and deserves application in a variety of settings.

Adolescent↗
PubMed1990

Swaziland: perspectives in school health.

Following major quantitative expansions of the educational system in Swaziland during the two decades since independence, the focus has shifted to improving efficiency. Efficiency of any educational system depends mainly on the characteristics of children entering school. Although Swaziland is not among the poorest countries, infant child mortality rates still reflect less than optimum living conditions and parental knowledge of child nutrition and disease prevention and management. Although access to primary schooling is universal, there is substantial waste during the early years of school through dropout and repetition, both associated with low socioeconomic status. School performance can be increased at little extra cost through increasing the nutrition and health status of students before school entry and through the early school years. In Swaziland, many activities are carried out to provide physical and mental health care to students. Coordinating these efforts and formulating clear policy on school health through cooperation among key ministries and nongovernmental organizations remains to be done.

Community Participation↗
PubMed1992

Comprehensive school-based services for pregnant and parenting adolescents in West Dallas, Texas.

A cohort of 339 Black (n = 210), Hispanic (n = 118), and other (n = 11) adolescent mothers in Dallas, Texas, were followed from the start of their pregnancy through the school year of the delivery to assess differences in numbers of prenatal care visits, postpartum care, repeat deliveries, and school continuation rates. Approximately one-half the teens received reproductive services at a comprehensive, school-based clinic and one-half at a categorical (Title XX) family planning and prenatal care clinic. Adolescents attending the school-based clinic were more likely to be in school at conception and averaged more prenatal visits than those served by the categorical provider. However, during the pregnancy and following the delivery, school dropout rates for the two sets of teens converged. School continuation rates were higher among a subset of adolescents attending the Dallas Independent School District school for pregnant teens than among other teens. Hispanic teens were two times more likely than their Black counterparts to drop out of school. No differences were found in repeat birth rates, by ethnicity, clinic site, or school attended.

Adolescent↗
PubMed1994

Discriminating suicide ideation among high-risk youth.

This study examined the hypothesis that among one group of high-risk youth--potential high school dropouts--key psychosocial factors would distinguish adolescents endorsing high suicide ideation from those who do not. Survey data compared high-risk youth with high suicide ideation (n = 43) with randomly selected samples of high-risk (n = 43) and "typical" youth (n = 42) without high suicide ideation. Repeat sampling of comparison groups verified results. Compared to high-risk and typical youth without suicide ideation, high-risk youth with high suicide ideation reported more psychosocial distress, problems with drug involvement, and disrupted family relations. They also described more unmet school goals and perceived a greater likelihood of dropping out of school. Discriminant analysis revealed that depression and low self-esteem were most effective in distinguishing between high-risk youth with and without high suicide ideation; family strain, anger, stress, and drug involvement also were differentiating factors. Implications for school-based screening and prevention programs are discussed within the context of the findings.

Adolescent↗
PubMed1979

Aspects of the patient intake process in a psychotherapy clinic.

Recent interest in psychotherapy services in the National Health Service has raised questions regarding the availability of existing psychotherapy facilities. In attempting to answer some of these questions, a study was made of aspects of the referral and assessment segments of the intake process of 180 patients referred in 1975 to the Paddington Centre for Psychotherapy Adult Out-patient Department. Of this group, 137 were referred for individual psychoanalytically oriented psychotherapy, 82 of whom were offered assessment interviews, 45 offered treatment and 40 actually began treatment during the study period. An additional seven patients originally assessed for group therapy were offered and began individual treatment. Some characteristics of the referral population, the referring agencies, the effects of a waiting list, and the phenomenon of dropouts are discussed and compared with findings from other Centres.

Hospitals, Psychiatric↗
PubMed1987

Premorbid prevalence of poor academic performance in severe head injury.

A study of 80 head injured patients revealed poor premorbid academic performance in up to 50% of the sample. Poor academic performance, as defined by diagnosis of learning disability, multiple failed academic subjects, or school dropout during secondary education, is not a previously cited risk factor for head injury. These findings have important implications in the identification of a high risk population and in the subsequent ability to reduce the incidence of head injury.

Achievement↗
PubMed2001

Multicenter randomized comparative double-blind controlled clinical trial of the safety and efficacy of zinc gluconate versus minocycline hydrochloride in the treatment of inflammatory acne vulgaris.

BACKGROUND: In addition to tetracyclines, zinc may constitute an alternative treatment in inflammatory lesions of acne. OBJECTIVE: To evaluate the place of zinc gluconate in relation to antibiotics in the treatment of acne vulgaris. METHODS: Zinc was compared to minocycline in a multicenter randomized double-blind trial. 332 patients received either 30 mg elemental zinc or 100 mg minocycline over 3 months. The primary endpoint was defined as the percentage of the clinical success rate on day 90 (i.e. more than 2/3 decrease in inflammatory lesions, i.e. papules and pustules). RESULTS: This clinical success rate was 31.2% for zinc and 63.4% for minocycline. Minocycline nevertheless showed a 9% superiority in action at 1 month and one of 17% at 3 months, with respect to the mean change in lesion count. Regarding safety, the majority of the adverse effects of zinc gluconate and of minocycline concerned the gastrointestinal system and were moderate (5 dropouts with zinc gluconate and 4 with minocycline). CONCLUSION: Minocycline and zinc gluconate are both effective in the treatment of inflammatory acne, but minocycline has a superior effect evaluated to be 17% in our study.

Abdominal Pain↗