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An analysis was made of South Auckland cases referred to the Auckland child health clinic in 1972 and 1973, and a survey of the views of the doctors and others who refer to the clinic was undertaken. The aim of the study was to establish whether the child assessment and treatment needs of the South Auckland area are being met, and the conclusion of the authors was that they are not. Recommendations are made.
This article describes a six-year evaluation of a comprehensive treatment program for abusive families in Spain. The evaluation involved practitioners' clinical judgments, standardized measures, and follow-up data about children's living situations. The results were similar to those obtained by similar programs from the United States and other developed countries. The analysis obtained the lowest rates of success for neglectful and abusive-neglectful families. Dropout and nondropout families differed in two paternal characteristics: alcohol problems and childhood experience of out-of-home care. Rehabilitated and nonrehabilitated families differed in several variables, including time elapsed between case detection and referral to the treatment program. Scores on measures showed significant changes during treatment.
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Using data from the Panel Study of Income Dynamics and the U.S. census, I examine the effect of four structural characteristics on individual poverty exists: (1) economic restructuring, (2) skills mismatches, (3) racial residential segregation, and (4) welfare benefit levels. Results show that these factors play a role in explaining African Americans' economic disadvantages, but they have a weaker and often contrary impact on whites' poverty exists. Overall, the differing impact of the contextual characteristics on African Americans and whites exacerbates social stratification and illustrates racial divisions that contribute to pervade the labor market.
The efficacy of an exercise cardiac rehabilitation programme depends on an adequate compliance of its participants. A 50% dropout rate after 12 months has been reported by most rehabilitation programmes. Compliance with attendance and the exercise prescription are monitored daily at the Johannesburg Cardiac Rehabilitation Centre. This study evaluated the attendance of 711 patients admitted to the programme between June 1986 and March 1990 and looked at possible differences in attendance and intensity rates of compliers and dropouts prior to dropout. Multiple regression analyses were performed on all patients using different measures of exercise compliance as dependent variables and patient characteristics on admission as explanatory variables in order to establish possible associations which could identify potential dropouts at an early stage. We found that 36% of patients dropped out by 12 months and that 50% managed to complete our 18 month programme. Dropouts complied less than compliers in terms of attendance and intensity before dropping out. Significant associations were found between the measures of compliance and patient characteristics. Age, smoking, peak oxygen uptake and a measure of hostility were identified as predictive factors. With the exception of the energy expended per session the variation in the other measures of compliance was poorly explained by the explanatory variables suggesting that other factors could be related to compliance at the Johannesburg Cardiac Rehabilitation Centre and need to be further evaluated.
The success of prevention trials of Alzheimer disease and other dementias (AD/dementia) hinges on their ability to recruit and retain at-risk study populations. Losing subjects is a threat to the power to detect a treatment effect and, potentially, to the validity of these studies. Observational cohort studies accumulate data around participant outcomes that can help to inform the design of future prevention trials. Our objectives were to investigate the rates of refusal and dropout within observational cohort studies and to evaluate their characteristics and impact. This study examined data from the Canadian Cohort Study of Cognitive Impairment and Related Dementias (ACCORD), a 2-year observational cohort study of patients newly referred to dementia clinics. The sample included 124 Not Cognitively Impaired (NCI) and 342 Cognitively Impaired Not Demented (CIND) subjects. Subjects who refused initial neuropsychological (NP) testing were compared to those who completed NP testing and subjects who dropped out to those who attended follow-up. Refusal was common, with 40% of subjects not completing neuropsychological testing at baseline. Dropout was also substantial, with 55% lost to the 2-year follow-up. Subjects who refused NP testing were significantly older and less educated. CIND refusers had lower cognitive and functional scores at entry and a 2-year progression rate to dementia twice as high as that of non-refusers. CIND dropouts also had lower baseline cognitive and functional scores. These observations suggest that dropouts and refusals in prevention trials include those subjects who are at high risk for progression to AD/dementia. Targeted strategies to retain these individuals within prevention studies will be needed to achieve sufficient study power and validity.
AIMS: To examine the methodological quality of the research literature examining treatment for alcohol use disorders. DESIGN: In total, 701 studies first reported between 1970 and 1998 were evaluated with a scoring system covering 19 areas of research quality. FINDINGS: Methodological quality improved from a score of 8.2 out of a possible 28.5 in the 1970s, to 10.6 in the 1990s. Strengths included reporting the initial number of participants and conducting follow-ups of 12 months or longer. Although the percentage of studies with adequate power also increased overall, the average statistical power of comparative studies to detect a medium-sized treatment effect was low (0.54). CONCLUSIONS: Areas with room for improvement include: ensuring that follow-up data are collected when respondents are not under the influence of alcohol, testing for differential dropout among treatment groups with respect to participant background characteristics, reporting the number of individuals being treated in the programs from which samples are drawn, noting the reliability and validity of measures used and conducting process analyses to examine potential mechanisms underlying treatment effects.
Based on 124 patients with squamous cell carcinoma of the vulva treated at the 1. Frauenklinik der Universität München from 1971 to 1980, the influence of pretreatment characteristics on survival was assessed. The patients underwent a simple vulvectomy with local and inguinal irradiation. All histologic specimens were worked up in the same manner, and all available specimens were reverified. Follow-up lasted from at least 2 up to 12 years post-treatment, with no dropouts. Using the Cox model of multivariate analysis, five pretreatment characteristics were found to most strongly influence survival: age, dissociated tumor growth, lymphatic spread, tumor thickness, and ulceration. These pretreatment characteristics were implemented in an algorithm for survival-oriented prognostic forecasting. Survival data as predicted from this algorithm correlated well with observed survival data. The validity of these prognostic factors needs to be examined in further studies using comparable patient populations and study designs.
A comprehensive battery of tests designed primarily to measure nonintellective characteristics was administered to 112 students entering five associate degree nursing programs. At the end of two years, analyses of the entrance data revealed significant differences between the 73 graduates (those who completed the program on schedule) and the 32 nongraduates (those who dropped our of the program for various reasons). Seven students who remained in the programs but who had not completed the requirements were not included in the analyses. The data indicated that at the time of entry into their programs, those students who later completed the program on schedule were more mature--older and married, more achievement oriented, responsible, and self-controlled than dropouts. Successful students also manifested more accepting and nonjudgmental attitudes toward other people.
This study compared respondents who completed an Internet sexuality questionnaire and those who dropped out before completion. The study was in Swedish and comprised 3,614 respondents over a 2-week period (53% males, 47% females). There were significant differences between males, of whom 51% dropped out before completion of the 175-item questionnaire, and females, of whom 43% dropped out. Dropout in both genders followed a curve of negative acceleration. The data suggest that dropout is likely to be significant and gender and demographically biased, and to occur significantly earlier for men than for women. Geography, education, sexual orientation, age, relationship status, living arrangements, and Internet connection speed were related to dropout for men, while only relationship status and living arrangements, which were in the opposite direction from men, were related to dropout in women.
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A study of 120 associate degree nursing (ADN) students at Illinois Central College during 1972-1973 tested the hypothesis that there will be no statistically significant difference in certain measured personality factors of the persister compared with the dropout. The Edwards Personal Preference Schedule (EPPS) was used to measure personality characteristics. The null hypothesis was rejected for four of the 15 variables measured by the EPPS. Significantly greater needs were achievement, deference, and heterosexuality for the persisters and abasement for the dropouts. Differences in needs may have resulted from two specific focuses of the ADN program: on the problem-solving process based on assessment of individual patient's needs and on team nursing which includes both the aspects of assuming responsibility for authority and accepting leadership. Through their greater need for abasement, the dropouts expressed a need for feelings of inferiority, guilt, blame, and inadequacy. Based on the academic prerequisites for admission to the ADN program, the dropouts should have succeeded. Therefore, it appeared the dropouts had a need to fail or withdraw from the program.
OBJECTIVE: To assess the validity of the perceptions that appetite-suppressant drugs are ineffective, potentially addictive, and fraught with side effects, we reviewed the effectiveness and safety of two such drugs with purported low abuse potential in the treatment of obesity: mazindol and fenfluramine hydrochloride. DATA SOURCES: Relevant studies in English published before September 1991 were identified using MEDLINE, accompanied by a cross-referenced manual search. STUDY SELECTION: All randomized clinical trials conducted with adults for at least 6 weeks' duration with weight change as an outcome. DATA EXTRACTION: Data extracted from each report included key study characteristics, clinical information, co-interventions, and outcomes, including dropouts due to either adverse drug effects or perceived lack of effect. DATA SYNTHESIS: Of 36 acceptable trials, 35 were double-blinded, 32 were placebo-controlled, and 13 were cross-over. Median duration of drug therapy was 12 weeks. In studies reporting such data, mean patient age was 41 years, and mean baseline weight was 84 kg (143% of ideal body weight). Among 1163 patients receiving drug therapy and 866 patients receiving placebo, mean weight loss across all trials was 5.2 and 1.9 kg, respectively (P < .001). Among 32 direct comparisons between drug and placebo, the mean weight loss by sample size was 3.0 kg greater in the treatment group (P < .001), and did not vary in subgroup analyses of trial type, drug, or dose. Similar proportions of treatment and placebo groups dropped out (20% vs 22%; P = .34); however, overall dropout rates were higher in parallel trials (25% vs 9% for crossover trials). Dropouts due to adverse drug effects were more common in the treatment group (7% vs 2%; P < .001), while those due to perceived lack of effect were more common in the placebo group (6% vs 2%; P < .001). Mazindol resulted in fewer dropouts due to adverse drug effects (4% vs 9%; P < .001) and a perceived lack of effect (1% v 3%; P = .04). No drug addiction or adverse drug effects requiring medical intervention were reported. CONCLUSION: The apparent short-term efficacy of these appetite-suppressant drugs and the lack of severe adverse drug effects or addiction suggest that they may be useful in the treatment of obesity. Further study of these agents with attention to long-term efficacy, safety, and health consequences is warranted.
BACKGROUND: Rheumatoid arthritis (RA) tends to remit during pregnancy, with more patients achieving remission in the third trimester, coinciding with an increase in levels of alpha-fetoprotein (AFP). In vitro and animal studies have shown that AFP has immunomodulatory properties. MM-093 is a non-glycosylated, recombinant version of human AFP. OBJECTIVE: To assess the safety, tolerability and clinical effects of MM-093 during a 12-week, randomised, double-blind, placebo-controlled study. METHODS: 12 patients with RA, who had active disease and were on stable doses of methotrexate, received weekly subcutaneous injections of placebo or 21 mg of MM-093. Assessments were carried out at baseline and weekly thereafter. RESULTS: Baseline characteristics were similar in both groups. There was one dropout in the placebo group, due to flare of disease. Treatment with MM-093 was well tolerated. No serious adverse event was observed. By day 85, MM-093 produced a significant mean improvement from baseline in Disease Activity Score 28 (DAS28; 0.913 vs 0.008, p = 0.033) and patient's global assessment (28.9% vs -36.3%, p = 0.02) compared with placebo. CONCLUSION: This is the first randomised, controlled trial of MM-093, a recombinant version of human AFP, in patients with RA. MM-093 was well tolerated. Evidence of efficacy was observed, suggesting that MM-093 may have therapeutic potential in RA.
While the current Tenckhoff catheter is generally successful, outflow failure due to omental obstruction, pericatheter hernias, pericatheter leaks, and exit infections remains a major cause for dropout from peritoneal dialysis therapy. Further, the irregular outflow characteristics of the catheter make highflow automated dialysis problematic. We have developed a catheter with a thin transabdominal tube connecting in a T-shape to a transverse cylinder resting against the parietal peritoneum, with flutes (grooves) as ports. The catheter can be inserted through the 3-mm diameter Quill guide of the Y-TEC peritoneoscopic system. Studies in normal dogs indicated that the T-fluted catheter allowed daily exchanges with 2 L of peritoneal dialysate without outflow obstruction, and peritoneoscopic inspection 2-4 weeks later showed no omental attachment to the grooved ports. By comparison, curled Tenckhoff catheters uniformly developed omental obstruction within 2-4 days, and all such catheters had firm omental attachment to the side holes. Five T-fluted catheters have been placed in continuous ambulatory peritoneal dialysis (CAPD) patients who had prior complications with Tenckhoff catheters (infections, leaks, and outflow failure). One patient with multiple intraperitoneal adhesions developed outflow failure of the T-fluted catheter, similar to a prior Tenckhoff catheter. All other T-fluted catheters had consistent outflow rates and no complications. In long-term use the T-fluted catheter should prevent omental attachment, deep cuff extrusion, pericatheter hernias, subcutaneous cuff erosion, and exit-site infection, although this is not yet proven.
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A total of 144 substance abusers entering consecutively a hierarchical therapeutic community, Phoenix House, Oslo, were followed prospectively 18 months through the entire program. Thirty percent completed the 1-year inpatient phase and 20% completed the total program. Using a structured interview and 3 self-report instruments, the Millon Clinical Multiaxial Inventory, Basic Character Inventory and Symptom Checklist-90, significant differences between dropouts and completers were found in 3 areas of pre-admission characteristics: gender, substance abuse and psychopathology. Completers were characterized by a greater percentage of females, a higher frequency of amphetamine use and a lower frequency of alcohol use and a higher frequency of histrionic and a lower frequency of schizotypal traits than dropouts. The study indicates the importance of paying closer attention to these factors during treatment.