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PubMed1994

Changing Social Security benefits to reflect child-care years: a policy proposal whose time has passed?

This article estimates the effects of proposals to increase the retirement benefits of women who reduce their earnings to care for young children. Using the 1990 Survey of Income and Program Participation file--exactly matched to the Social Security Administration's record of lifetime earnings--the authors present the distribution of child-care dropout years by retirement cohort and other demographic characteristics, and estimate the dollar impact of adjustments for caregiving years. The policies examined do increase the retirement benefits of some women, but the increases on average are small, are lowered with each successive retirement cohort, and benefit women from the more privileged socioeconomic groups. Thus, because the policy effects are small and will diminish in the future, the time of efficacy for the proposals has passed. Subsidizing child-care dropout years does not seem to be a well-targeted policy.

Adult↗
PubMed1998

Using geographic information systems to assess spatial patterns of drug use, selection bias and attrition among a sample of injection drug users.

This study sought to assess whether frequency and type of drug use are geographically located within the city of Baltimore independent of neighborhood characteristics. The second goal was to assess geographic factors associated with sample selection and attrition. The sample consisted of 597 inner-city injection drug users who were enrolled in a HIV prevention study. The residential locations were plotted using Geographic Information Systems (GIS) software. Three patterns of drug use in the prior 6 months were examined: daily use of injection heroin, daily use of injection cocaine and any use of crack cocaine. Daily use of cocaine and any use of crack were found to be statistically associated with residing in the western portion of the city and distance from the western district sexually transmitted disease clinic. After adjusting for individual level characteristics and neighborhood level variables, as measured by 1990 census tract data, daily use of cocaine was found to be associated with residing in a more southern area of the city and distance from the western district sexually transmitted disease clinic, and any crack use was found to be associated with residing in a more western area of the city and distance from the western district sexually transmitted disease clinic. Men and younger participants were more likely to reside further away from the study clinic as were individuals who dropped out of the intervention condition. The results of this study suggest that type and frequency of drug use is associated with specific geographic areas, independent of neighborhood characteristics. These results have implications for the location of drug prevention, needle exchange and other HIV prevention activities.

Adult↗
PubMed1994

Factors associated with dropout from group psychotherapy with depressed adolescents.

Attempts to determine the characteristics of those individuals who drop out from psychotherapy have yielded few consistent findings. Clinically depressed adolescents who completed a course of brief group therapy were compared with those who failed to complete treatment. Although no differences were found on a number of clinical and demographic variables, those who dropped out were more likely to be one grade behind in school and to have a history of alcohol and/or drug abuse. The implications of these findings for research and practice are discussed.

Adolescent↗
PubMed2001

Addressing an idiosyncrasy in estimating survival curves using double sampling in the presence of self-selected right censoring.

We investigate the use of follow-up samples of individuals to estimate survival curves from studies that are subject to right censoring from two sources: (i) early termination of the study, namely, administrative censoring, or (ii) censoring due to lost data prior to administrative censoring, so-called dropout. We assume that, for the full cohort of individuals, administrative censoring times are independent of the subjects' inherent characteristics, including survival time. To address the loss to censoring due to dropout, which we allow to be possibly selective, we consider an intensive second phase of the study where a representative sample of the originally lost subjects is subsequently followed and their data recorded. As with double-sampling designs in survey methodology, the objective is to provide data on a representative subset of the dropouts. Despite assumed full response from the follow-up sample, we show that, in general in our setting, administrative censoring times are not independent of survival times within the two subgroups, nondropouts and sampled dropouts. As a result, the stratified Kaplan-Meier estimator is not appropriate for the cohort survival curve. Moreover, using the concept of potential outcomes, as opposed to observed outcomes, and thereby explicitly formulating the problem as a missing data problem, reveals and addresses these complications. We present an estimation method based on the likelihood of an easily observed subset of the data and study its properties analytically for large samples. We evaluate our method in a realistic situation by simulating data that match published margins on survival and dropout from an actual hip-replacement study. Limitations and extensions of our design and analytic method are discussed.

Arthroplasty, Replacement, Hip↗
PubMed1997

Academic success among students at risk for school failure.

A sample of 1,803 minority students from low-income homes was classified into 3 groups on the basis of grades, test scores, and persistence from grade 8 through Grade 12; the classifications were academically successfully school completers ("resilient" students), school completers with poorer academic performance (nonresilient completers), and noncompleters (dropouts). Groups were compared in terms of psychological characteristics and measures of "school engagement." Large, significant differences were found among groups on engagement behaviors, even after background and psychological characteristics were controlled statistically. The findings support the hypothesis that student engagement is an important component of academic resilience. Furthermore, they provide information for designing interventions to improve the educational prognoses of students at risk.

Achievement↗
PubMed2003

Retention of court-referred youths in residential treatment programs: client characteristics and treatment process effects.

The juvenile justice system relies heavily on residential treatment services for adolescents. Because treatment dropout limits the likely effectiveness of these services, in this study we examine the client and program characteristics associated with program retention among a sample of adolescent probationers referred to residential rehabilitation by the Juvenile Court in Los Angeles. Participants in the present study (n = 291) are a subset of those in the Adolescent Outcomes Project, conducted within RAND's Drug Policy Research Center, to examine the outcomes of youths entering treatment at seven residential treatment programs. Three months after a preadmission interview, youths were asked about their perceptions of counselors at the program, other residents, and their feelings of safety in the program. In addition, they were asked whether they needed and had received various services (e.g., job training, legal advice, family counseling). Results of a multivariate survival analysis revealed that pretreatment characteristics including motivation and substance use severity, as well as treatment program factors including safety, and perceived over- and underprovision of services, contribute significantly to the prediction of retention. Pretreatment environmental risk factors and ratings of program counselor and resident support were marginally significant. These results imply that changes in adolescent residential program delivery may serve to increase retention rates, thus improving long-term outcomes.

Adolescent↗
PubMed1991

Meibomian gland dysfunction in chronic blepharitis.

We examined 57 patients with symptoms of chronic blepharitis using meibomian gland expression, meibography, tear osmolarity, and the Schirmer's test. We also performed meibography on 20 normal patients free of chronic blepharitis. We found that 42 blepharitis patients (74%) had evidence of meibomian gland loss, whereas only four of 20 normal patients (20%) had any gland dropout. We performed cluster analysis on the data from the patients with blepharitis and found that these patients tended to fall into distinct groups with clinically relevant characteristics. We also found that tear osmolarity correlated positively with gland dropout (+0.413) and negatively with excreta volume (-0.499). This study demonstrates that an objective analysis of meibomian gland function may be used to assess chronic blepharitis and define subsets of blepharitis with measurable differences. It also supports the significance of meibomian gland dysfunction on tear osmolarity and the evaporative state of the eye.

Adult↗
PubMed1979

Cultural factors and attrition in drug abuse treatment.

The present study examined how race related to attrition in drug abuse treatment. 165 male voluntary admissions to an inpatient Substance Abuse Unit were tested at admission on functioning, motivation, attitudes, symptoms, and mood-using reliable and valid scales. One week later they completed a 12-factor scale measuring perception of the treatment milieu. Data were analyzed in a 2 x 2 factorial design of analysis of variance. There were 106 White subjects and 59 Blacks. The dropout rate for Blacks and Whites was 63%. Two factors measured at intake, motivation and social functioning, showed statistically significant interactions between race and attrition. Four ward perception factors showed a differential effect related to race and attrition. The White dropout and completer did not differ in how they perceived the ward. Blacks, however, who perceived the environment as being more insightful, spontaneous, autonomous, and practical remained. Although Blacks and Whites differed on many variables, only six showed race-related differences in attrition. Having higher motivation and poorer adjustment influenced Whites to stay. Factors in the environment, however, influenced Blacks. What might be considered a more "therapeutic" milieu was effective in helping Blacks remain in treatment. Knowledge of these cultural differences could help in designing treatment programs.

Black or African American↗
PubMed2006

Treatment of alcohol withdrawal syndrome with a combination of tiapride/carbamazepine: results of a pooled analysis in 540 patients.

This was a retrospective study to examine the efficacy, practicability and medical safety of a combination of tiapride and unretarded (fast acting formula) carbamazepine in the treatment of alcohol withdrawal syndrome. In five hospitals using this combination for treatment of alcohol withdrawal, 540 patients who had been treated with this combination were identified. An intensive evaluation of patients files and charts was performed. Details of alcohol history and comorbid disorders were extracted from patient files. Severity of alcohol withdrawal had been assessed using the CIWA-A-Score. Gender differences and differences between patients in their first and at least second withdrawal were computed by means of variance analyses (GLM). At baseline (day 1) mean dosage given was 796 for tiapride and 543 mg for carbamazepine. A pooled analysis of the results showed that, in general, medication was well tolerated. Withdrawal symptomatology as indicated by CIWA-A scores clearly decreased over time. Although a significant number of patients had a history of alcohol withdrawal delirium (103) and epileptic seizures (151), few patients suffered from them during treatment (8 and 5, respectively). Only 24 (4.4%) patients dropped out because of lack of efficacy or change of medication, 15 (2.8%) because of side effects. No case of malignant neuroleptic syndrome was recorded. Data analysis showed gender differences and differences between patients in their first and at least second withdrawal for side effects, complications, and in some CIWA-A-scores. In general, severe complications of withdrawal syndrome were more frequent in men compared to women and in patients with repeated inpatient treatment. In line with previous research, the results from this study give further evidence that a combination of the anticonvulsant carbamazepine and tiapride is an effective and safe treatment for alcohol withdrawal treatment.

Adult↗
PubMedDate not supplied

Predictors of attrition from an outpatient marijuana-dependence counseling program.

We sought to characterize attrition-related characteristics of three subgroups of adults (i.e. early dropouts, late dropouts, treatment completers) who had participated in a marijuana-dependence treatment outcome study involving two alternative forms of outpatient group counseling. Early dropouts were younger, earned less income, were more likely to rent rather than own their domiciles, were less able to pay bills, and had a higher level of psychological distress than was the case with treatment completers. Late dropouts and completers were quite similar on a number of measures (e.g., age, income, home ownership, ability to pay bills, psychological stress level, confidence in being abstinent in the future), yet the lower rates of abstinence in the late dropouts largely resembled the treatment outcomes of early dropouts. The findings suggest that attrition prevention in the early phase of counseling ought to focus on motivational ambivalence as well as assisting the client in dealing with schedule conflicts or financial impediments to continued involvement. In the later stage of counseling, attrition reduction is more likely to be accomplished through efforts to better understand and address the client's dissatisfaction with treatment components delivered at that stage.

Adolescent↗
PubMed2005

Predictors of attrition from day treatment of adolescents with substance-related disorders.

The study assessed the predictor variables of attrition from a day treatment for adolescents with substance-related disorders. The adolescents who were living in housing services and had more delinquent behaviors presented more difficulties to adhere, to attend regularly, and to maintain a link with the day program. The presence of cocaine among the substance-related disorders predicted an irregular attendance. Conversely, the adolescents with more self-reported symptoms of anxious and depression revealed a better initial adherence, a more regular attendance, and a longer length of the treatment.

Adolescent↗
PubMed2002

Motor unit number estimates in idiopathic Parkinson's disease.

We previously reported changes in motor unit morphology in patients with Parkinson's disease (PD) using subjective and computerized quantitative electromyography. Now, we present data on motor unit number estimates (MUNE) to address the hypothesis of motor neuron dropout in PD. Twenty patients with PD and 20 age-matched control subjects were screened by clinical criteria and nerve conduction studies to exclude those with neuropathy. Motor unit number estimates in the extensor digitorum brevis and hypothenar group were assessed by three different MUNE techniques. The MUNE technique types included (1) the statistical method developed by Daube, (2) a threshold method, and (3) an F-wave method. The overall multivariate comparison for the six MUNE measurements was significantly lower for the patients than the controls (P=0.02). The only significant difference in the individual measures was found in the threshold MUNE method of the hypothenar group (P<0.05). These results are consistent with those of our previous work, and both support the hypothesis that mild motor neuron dropout occurs in idiopathic PD. However, MUNE methods characteristically have large standard deviations which make it difficult to detect small changes. Progress in decreasing the variance of MUNEs will facilitate their use in detecting small motor unit number changes in neurodegenerative disease.

Aged↗
PubMed1999

Effects on body weight of strict or liberal adherence to an initial period of VLCD treatment. A randomised, one-year clinical trial of obese subjects.

OBJECTIVES: To examine the impact on early and late weight loss of three different, initial very low calorie diet (VLCD) approaches in a one-year obesity treatment program. DESIGN: Randomised clinical trial. SUBJECTS: 121 obese subjects, aged 21-60y, BMI > or = 30.0kg/m2. INTERVENTIONS: The VLCD-strict group was prescribed a strict outpatient VLCD for 16 weeks, followed by a 36-week hypocaloric diet. The VLCD-mw group received the same treatment, but were hospitalised in a metabolic ward for the initial week. The VLCD-plus group was allowed two small meals weekly, but received otherwise the same recommendations as the VLCD-strict group. RESULTS: After 16 weeks, there was no difference in weight loss between the treatment groups in the intent-to-treat population, while among completers, the weight loss was about 7 kg larger in the VLCD-strict group compared to the VLCD-plus group (P < 0.05). At one year, these groups differed by approximately 4 kg, both according to intention-to-treat and among completers (P < 0.05, both differences). These differences were more prominent among females. The weight reduction in the VLCD-mw group was generally not superior to the VLCD-strict group. CONCLUSIONS: In the short-term, strict VLCD only reduced weight better than a liberal VLCD approach among completers. However, after one year, a strict VLCD regimen seemed beneficial compared to a liberal VLCD for all patients. There was no extra weight loss if the VLCD period was initiated on a metabolic ward.

Adult↗
PubMed2000

Statistical analysis of the long-term effects of recombinant human deoxyribonuclease on pulmonary function in cystic fibrosis patients.

The problem of evaluating the long-term effects of recombinant human deoxyribonuclease (rhDNase) on forced expiratory volume in one second (FEV1) in cystic fibrosis (CF) patients was considered. A two-stage mixed effects model, incorporating relevant predictive variables, captured the diverse patterns of decline of FEV1 for patients with different demographic characteristics. Based on the results of modeling the dropout process, it is clear that the probability of early dropout was closely related to patient's responsiveness to rhDNase treatment. Failure to consider the existence of informative censoring severely biased the estimates of the rate of decline and affected the interpretation of the results.

Adolescent↗
PubMed2003

A position paper: based on observational data indicating an increased rate of altered blood chemistry requiring withdrawal from the Alzheimer's Disease Cholesterol-Lowering Treatment Trial (ADCLT).

Recruitment for the inaugural double-blind placebo-controlled trial investigating a cholesterol-lowering treatment for benefit in Alzheimer's disease (AD) (ADCLT) ended after obtaining 98 informed consents. Suspension of recruitment of the ADCLT occurred in concert with initiation of two separate multicenter trials testing similar hypotheses. Although occurring at very low rates (<2%), altered-chemistry adverse events requiring discontinuation of therapy (withdrawal AEs) are not unexpected with use of cholesterol-lowering statins. We suggest that exceptionally close monitoring for altered chemistry among individuals with AD should be undertaken in future statin treatment trials, as limited data from the ADCLT indicate that chemically based withdrawal AEs could be more prevalent among female AD patients. There was no apparent correlation between the occurrence of withdrawal-AE incidence and lower body mass among the female AD trial subjects and, therefore, probably was not a dose-related resultant. This might indicate that cognitively intact elderly women at risk for heart disease and those with clinically documented AD should not be presumed to be pharmocodynamically equivalent. Lipid profiles obtained at screening in the ADCLT are consistent with a possible difference between patients with current AD and those at risk for heart disease. Elevated cholesterol, increased cholesterol/high-density lipid (HDL) ratios, and elevated triglycerides are routinely observed among those at risk for heart disease; however, among ADCLT study participants, only cholesterol levels were increased while cholesterol/HDL ratio and triglyceride levels remained within normal limits.

Alzheimer Disease↗