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PubMed2006

Retention of survivors of acute lymphoblastic leukemia in a longitudinal study of bone mineral density.

Attrition in longitudinal studies of survivors of childhood cancer reduces these studies' statistical power, introduces bias and threatens internal and external validity. This study investigated the variables associated with dropout of survivors of acute lymphoblastic leukemia in a trial investigating the effect of vitamin D and calcium supplementation and nutritional counseling on bone mineral density (BMD). Twenty-five participants withdrew from the study. Common reasons given for withdrawing were intolerance of the study drug, family hardship and schedule conflicts. Few statistically and clinically significant differences identified participants who completed the study. Nurses need to be aware of the reasons that participants withdraw from clinical trials, as they are in a strategic position to encourage patients to participate in health promotion studies.

Adaptation, Psychological↗
PubMed2005

Are alcoholism treatments effective? The Project MATCH data.

BACKGROUND: Project MATCH was the largest and most expensive alcoholism treatment trial ever conducted. The results were disappointing. There were essentially no patient-treatment matches, and three very different treatments produced nearly identical outcomes. These results were interpreted post hoc as evidence that all three treatments were quite effective. We re-analyzed the data in order to estimate effectiveness in relation to quantity of treatment. METHODS: This was a secondary analysis of data from a multisite clinical trial of alcohol dependent volunteers (N = 1726) who received outpatient psychosocial therapy. Analyses were confined to the primary outcome variables, percent days abstinent (PDA) and drinks per drinking day (DDD). Overall tests between treatment outcome and treatment quantity were conducted. Next, three specific groups were highlighted. One group consisted of those who dropped out immediately; the second were those who dropped out after receiving only one therapy session, and the third were those who attended 12 therapy sessions. RESULTS: Overall, a median of only 3% of the drinking outcome at follow-up could be attributed to treatment. However this effect appeared to be present at week one before most of the treatment had been delivered. The zero treatment dropout group showed great improvement, achieving a mean of 72 percent days abstinent at follow-up. Effect size estimates showed that two-thirds to three-fourths of the improvement in the full treatment group was duplicated in the zero treatment group. Outcomes for the one session treatment group were worse than for the zero treatment group, suggesting a patient self selection effect. Nearly all the improvement in all groups had occurred by week one. The full treatment group had improved in PDA by 62% at week one, and the additional 11 therapy sessions added only another 4% improvement. CONCLUSION: The results suggest that current psychosocial treatments for alcoholism are not particularly effective. Untreated alcoholics in clinical trials show significant improvement. Most of the improvement which is interpreted as treatment effect is not due to treatment. Part of the remainder appears to be due to selection effects.

Alcoholics Anonymous↗
PubMed2005

Direct likelihood analysis versus simple forms of imputation for missing data in randomized clinical trials.

BACKGROUND: In many clinical trials, data are collected longitudinally over time. In such studies, missingness, in particular dropout, is an often encountered phenomenon. METHODS: We discuss commonly used but often problematic methods such as complete case analysis and last observation carried forward and contrast them with broadly valid and easy to implement direct-likelihood methods. We comment on alternatives such as multiple imputation and the expectation-maximization algorithm. RESULTS: We apply these methods in particular to data from a study with continuous outcomes. The outcomes are modelled using a general linear mixed-effects model. The bias with CC and LOCF is established in the case study and the advantages of the direct-likelihood approach shown. CONCLUSIONS: We have established formal but easy to understand arguments for a shift towards a direct-likelihood paradigm when analysing incomplete data from longitudinal clinical trials, necessitating neither imputation nor deletion.

Data Collection↗
PubMed1983

Are there anticompulsive or antiphobic drugs? Review of the evidence.

Review of 19 uncontrolled studies of antidepressants in phobic and in obsessive-compulsive disorders suggests that such drugs do not act reliably in the absence of symptoms of anxiety-depression (dysphoria). In dysphoric patients the drugs have a broad-spectrum effect, not only reducing phobias and rituals but also anxiety-depression, panic, anger, and hostility, all of which are highly intercorrelated, but none yet demonstrated to be the core disturbance. Phobics, but not obsessive-compulsives, have an unusually high dropout rate from treatment when drugs or placebo are given. When antidepressants are stopped, even after 6-8 months, relapse is likely. The drugs do not reduce the liability of many phobics and obsessive-compulsives to have dysphoric episodes over the years. Exposure treatments are not lastingly effective for phobias and for rituals, but do not reduce the liability to later dysphoric episodes.

Adult↗
PubMed1985

Anorexia nervosa, parental 'expressed emotion' and dropping out of treatment.

The number of dropouts from a long-term treatment study of patients with anorexia nervosa (AN) and bulimia nervosa (BN) was substantial. A variety of social, clinical, parental, and treatment factors were examined for their association with early termination of treatment by the patient or the family. Parents' expressed emotion' (EE) (particularly critical comments), BN, and the type of therapy offered (family or individual) were found to interact in some manner to result in dropping out. Some other aspects of parents' EE were also examined, including a comparison of scores in parental pairs; EE was found to be influenced by social class, and there were significant associations with the patient's symptomatology and social adjustment. There was a strong relationship between mothers' and fathers' scores in parental pairs.

Adult↗
PubMed2004

Therapist verbal behavior early in treatment: relation to successful completion of parent-child interaction therapy.

We examined the role of specific therapist verbal behaviors in predicting successful completion of Parent-Child Interaction Therapy (PCIT) in 22 families, including 11 families that successfully completed treatment and 11 that discontinued treatment prematurely. The children were 3 to 6 years old and diagnosed with oppositional defiant disorder (ODD). Chamberlain et al.'s (1986) Therapy Process Code (TPC) was used to measure therapist verbalizations during therapist-parent interactions during the initial clinical interview and the second treatment session. Results indicated that therapists' use of the categories Question, Facilitate, and Support during these sessions accurately predicted treatment dropout versus completion for 73% of families. Findings suggest that the early therapist-parent relationship in PCIT may be critical to successful treatment completion.

Adult↗
PubMed1994

Comparative cocaine abuse treatment strategies: enhancing client retention and treatment exposure.

The current investigation explores the clinical utility in providing a series of enhanced clinical services to a sample of 303 cocaine-abusing clients (primarily crack smokers) relative to a standard group therapy treatment program. In addition to examining the comparative impact of six varying psychosocial treatment approaches for cocaine abuse on client retention and treatment exposure rates, an additional emphasis has been to examine the ability of fixed and dynamic client variables in predicting client outcome in this regard. No fixed (e.g., sex, income, marital status, income level, or employment status) or dynamic (e.g., recent alcohol use, antisocial personality disorder diagnoses, or motivational variables) client characteristics were useful in predicting client retention or treatment exposure rates. Program characteristics, however, or the frequency, intensity, and/or type of treatment services offered, were related to client retention and treatment exposure. Treatment exposure and retention were significantly enhanced by providing clients with more frequent and intensive group therapy, or by adding individual treatment services to a standard group therapy treatment regimen. With a population such as cocaine abusers, who typically have an extremely high treatment dropout rate, an obvious strategy is to focus efforts on engaging and retaining clients in treatment, and maximizing levels of treatment exposure. The current findings suggest that one successful approach towards enhancing psychosocial treatments for cocaine abuse is to increase the frequency, intensity, and/or types of treatment services offered.

Adult↗
PubMed2006

Making it in America: high school completion by immigrant and native youth.

Using data from the National Longitudinal Study of Adolescent Health (Add Health), we find that first-generation youth of Hispanic, Asian, and African heritage obtain more education than their parents, but the second generation and third or higher generations lose ground. Differences in dropout rates by race-ethnicity and immigrant generation are driven by differences in human, cultural, and social capital. Low levels of family human capital, school social capital, and community social capital place the children of immigrants at risk of dropping out. However, cultural capital and immigrant optimism buffer first-generation Hispanic youth and the children of Asian immigrants from the risk of dropping out of high school. While human and social capital resources improve with immigrant generation, cultural capital diminishes.

Acculturation↗
PubMed1993

Some factors that influence dropping out from outpatient alcoholism treatment facilities.

Even though clients treated in an outpatient setting have been documented to have very high dropout rates, evidences of the factors that influence dropping out are fragmentary and are based on small-scale studies. In our attempt to distinguish such factors, outpatient and intensive outpatient alcoholism admissions for the State of New Jersey were analyzed. Our findings indicated that females, the young and the unskilled are at a higher risk of dropping out. We also documented that drinking status of patients, occupational status, health insurance coverage, educational status, living arrangement, duration of stay in treatment and the number of sessions of service were important factors that influenced the likelihood of dropping out. Controlling for the number of sessions revealed that the relationship between the odds of dropping out and duration in treatment was mixed. Primary drug abusers in our cohort had the highest likelihood of dropping out followed by the dually addicted. It is argued that dropping out is likely to be complicated by the inability of alcoholism treatment facilities to cope with multiple addiction problems.

Adolescent↗
PubMed2006

Alcohol abuse and dependence in college and noncollege samples: A ten-year prospective follow-up in a national survey.

OBJECTIVE: This prospective study examines the association of educational status in 1984 and the risk for past-year Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), alcohol-use disorders (AUDs) in 1994, 10 years later. METHOD: A sample of 8,661 respondents was drawn from the National Longitudinal Survey of Labor Market Experience in Youth. Measures included baseline heavy episodic drinking, alcohol-dependence symptoms, early problem behaviors (antisocial behaviors, illicit substance use, family history of alcoholism, and age at onset of alcohol use), demographic characteristics (gender, race/ethnicity, age, marital status), and 1994 assessment for past-year DSM-IV AUDs. RESULTS: Findings from this 10-year prospective study indicate that education beyond high school had a protective effect for alcohol dependence, and dropping out of high school resulted in an elevated long-term risk for alcohol dependence. These associations remained significant when other early behavioral problems were included in the models. CONCLUSIONS: The risk of alcohol dependence and, consequently, the need for appropriately tailored prevention efforts is greater among high school dropouts and college nonattenders than among college students, although much of the current literature has focused on the latter.

Adult↗
PubMed1992

Preventing low birth weight, child abuse, and school failure: the need for comprehensive, community-wide approaches.

Based on numerous examples from this country and abroad, we now have a reasonable idea of how we can reduce substantially the incidence of low-weight births, child abuse, adolescent pregnancy, school failure, and school dropout. The most effective long-term strategy appears to be the development of a comprehensive, coordinated, community-wide approach focused on preventing low- and medium-risk families from becoming high-risk as well as providing intensive services to those who already have reached a high-risk status. The best results can be obtained when all levels of government and the private sector work together. In this partnership, the best outcomes appear to result when the state and federal governments, private corporations, or both provide technical assistance, additional funding as needed, and help in setting program standards, and when the community maintains local control over establishing priorities and implementation strategies. However, to reach these goals and to maintain program support over the long time periods needed to show positive results (4 to 8 years), it is necessary to become skilled in social marketing techniques to turn program need into demand and to develop a strong local and statewide advocacy group to facilitate passage of needed legislation and prevent funding cutbacks. Pediatricians can modify their practices to make them more supportive to families and can work with other community leaders to bring about the changes in attitudes and about the changes in attitudes and funding priorities at the state and community levels that will be necessary to develop more effective preventive programs.

Adolescent↗
PubMed2006

School trajectory and teenage pregnancy in three Brazilian state capitals.

This paper describes the relationship between school trajectory and incidence of teenage pregnancy. A cross-sectional residence-based questionnaire was applied, interviewing 4,634 youth ages 18 to 24 years, selected through a stratified three-stage sample. For the present study, young people ages 20 to 24 years (65.6%) were chosen, with teenage pregnancy rates of 29.5% for females and 21.4% for males (in relation to their partners). Sexual debut was reported by 87% of women and 95.3% of men. The majority of young people reported irregular school trajectory, with 39% enrolled in school at the time of the study. Nearly half of those who had interrupted their studies at least once reported a teenage pregnancy. The main reasons for interrupting their studies were pregnancy and children for women and work for men. School dropout due to teenage pregnancy was mentioned by 40.1% of women for whom the outcome of pregnancy was a child. However, 20.5% had already dropped out of school before becoming pregnant.

Adolescent↗
PubMed2007

[Teenage pregnancy: Behavioral and socio-demographic profile of an urban Brazilian population].

To identify the socio-demographic behavioral profile of low-income pregnant teenagers, 1,000 adolescents admitted to a Brazilian public maternity hospital from July 24, 2001, to November 27, 2002, were interviewed. Socio-demographic and behavioral variables were assessed through a questionnaire. Over the 492 days of the study, 24.3% of admissions were adolescents (930 for childbirth and 70 for miscarriage). Mean maternal age was 17 years. Most teenagers (72.9%) lived near the hospital. 930 (93%) belonged to socioeconomic classes C, D, and E. School dropout was identified in 67.3% of the total. 80.1% of the subjects were giving birth for the first time. 81.2% had not planned the pregnancy, and 23.8% had been using some contraceptive method. 67.4% had vaginal deliveries. Some 13.3% of the newborns were premature and 15.9% had low birth weight. 17.3% of these adolescent mothers reported smoking during pregnancy, with 2.8% reporting alcohol and 1.7% illicit drugs. Teenage pregnancy is a complex phenomenon associated with various economic, educational, and behavioral factors. The study provides importance references for public policies to prevent teenage pregnancy.

Adolescent↗
PubMed1998

Retention, HIV risk, and illicit drug use during treatment: methadone dose and visit frequency.

OBJECTIVES: This study examined two major methadone treatment factors, visit frequency and methadone dose, posited to be important in reducing intravenous drug use and human immunodeficiency virus (HIV) transmission. METHODS: One hundred fifty opiate-dependent subjects randomly assigned to four groups received 50 or 80 mg of methadone and attended a clinic 2 or 5 days per week. RESULTS: Survival analysis indicated higher dropout rates for groups having five vs two visits per week (Chi2[1]=7.76). Higher proportions of opiate-positive results on urine screens were associated with lower methadone doses (F[1,91]=4.74). CONCLUSIONS: Receiving take-home doses early in treatment enhanced treatment retention. The 50-mg dose combined with five visits per week produced the worst outcome. Fewer visits enhanced retention at 50 mg, but opiate use rates were higher at this dose than they were for either 80-mg group. The HIV infection rate at entry was 9%. No subjects seroconverted during the study. Risk behaviors for acquired immunodeficiency syndrome declined over time regardless of group/dose assignment. These results have important implications for modification of regulatory and clinic policy changes.

Adult↗
PubMed2000

Early predictors of adolescent violence.

OBJECTIVES: This study sought to identify early predictors of adolescent violence and to assess whether they vary by sex and across different types and levels of violence. METHODS: Data from a 5-year longitudinal self-report survey of more than 4300 high school seniors and dropouts from California and Oregon were used to regress measures of relational, predatory, and overall violence on predictors measured 5 years earlier. RESULTS: Deviant behavior in grade 7, poor grades, and weak bonds with middle school predicted violent behavior 5 years later. Attending a middle school with comparatively high levels of cigarette and marijuana use was also linked with subsequent violence. Early drug use and peer drug use predicted increased levels of predatory violence but not its simple occurrence. Girls with low self-esteem during early adolescence were more likely to hit others later on; boys who attended multiple elementary schools were also more likely to engage in relational violence. CONCLUSIONS: Violence prevention programs for younger adolescents should include efforts to prevent or reduce troublesome behavior in school and poor academic performance. Adolescent girls may also profit from efforts to raise self-esteem; adolescent boys may need extra training in resisting influences that encourage deviant behavior. Programs aimed at preventing drug use may yield an added violence-reduction bonus.

Adolescent↗
PubMed1995

Cost analysis of paroxetine versus imipramine in major depression.

A simulation decision analytical model was used to compare the annual direct medical costs of treating patients with major depression using the selective serotonin reuptake inhibitor (SSRI) paroxetine or the tricyclic antidepressant (TCA) imipramine. Medical treatment patterns were determined from focus groups of general and family practitioners and psychiatrists in Boston, Dallas and Chicago, US. Direct medical costs included the wholesale drug acquisition costs (based on a 6-month course of drug therapy), psychiatrist and/or general practitioner visits, hospital outpatient visits, hospitalisation and electroconvulsive therapy. Acute phase treatment failure rates were derived from an intention-to-treat analysis of a previously published trial of paroxetine, imipramine and placebo in patients with major depression. Maintenance phase relapse rates were obtained from a 12-month trial of paroxetine, supplemented from the medical literature. The relapse rates for the final 6 months of the year were obtained from medical literature and expert opinion. Direct medical costs were estimated from a health insurance claims database. The estimated total direct medical cost per patient was slightly lower using paroxetine ($US2348) than generic imipramine ($US2448) as first-line therapy. This result was sensitive to short term dropout rates but robust to changes in other major parameters, including hospitalisation costs and relapse rates. The financial benefit of paroxetine, despite its 15-fold higher acquisition cost compared with imipramine, is attributable to a higher rate of completion of the initial course of therapy and consequent reduced hospitalisation rates.

Antidepressive Agents, Second-Generation↗
PubMed2000

Outcomes associated with service involvement among disengaged youth.

This pilot study examined outcomes of a school-based effort to promote bonding to the conventional mainstream by integrating socially disengaged youth with conventional peers in a service activity. A sample of forty-two ninth-graders in four schools achieved significant improvements in attendance, achievement, ratings of social-academic competence and conventionality, and in positive peer associations, which protect against risk for problems such as dropout, delinquency, and substance abuse. Comparisons of improvements in school performance with changes in performance exhibited by a group of similar peers indicate that effects were probably not due to the effects of maturation over the ninth-grade year. Findings lend tentative support to the notion that social bonding is enhanced through opportunities for service, and justify efforts to develop and study methods for incorporating service components in school programs. Recommendations for further experimental study addressing design limitations of this pilot study are discussed.

Adolescent↗