Dropout Group Research Articles

Skilled Nursing Facility Participation in a Voluntary Medicare Bundled Payment Program: Association With Facility Financial Performance.

Model 3 of the Bundled Payments for Care Improvement (BPCI) is an alternative payment model in which an entity takes accountability for the episode costs. It is unclear how BPCI affected the overall skilled nursing facility (SNF) financial performance and the differences between facilities with differing racial/ethnic and socioeconomic status (SES) composition of the residents. The objective of this study was to determine associations between BPCI participation and SNF finances and across-facility differences in SNF financial performance. A longitudinal study spanning 2010-2017, based on difference-in-differences analyses for 575 persistent-participation SNFs, 496 dropout SNFs, and 13,630 eligible nonparticipating SNFs. Inflation-adjusted operating expenses, revenues, profit, and profit margin. BPCI was associated with reductions of $0.63 million in operating expenses and $0.57 million in operating revenues for the persistent-participation group but had no impact on the dropout group compared with nonparticipating SNFs. Among persistent-participation SNFs, the BPCI-related declines were $0.74 million in operating expenses and $0.52 million in operating revenues for majority-serving SNFs; and $1.33 and $0.82 million in operating expenses and revenues, respectively, for non-Medicaid-dependent SNFs. The between-facility SES gaps in operating expenses were reduced (differential difference-in-differences estimate=$1.09 million). Among dropout SNFs, BPCI showed mixed effects on across-facility SES and racial/ethnic differences in operating expenses and revenues. The BPCI program showed no effect on operating profit measures. BPCI led to reduced operating expenses and revenues for SNFs that participated and remained in the program but had no effect on operating profit indicators and mixed effects on SES and racial/ethnic differences across SNFs.

Factors associated with dropout from physical function assessment programs among participants receiving maintenance hemodialysis: A retrospective observational cohort study.

We aimed to investigate the factors associated with dropout from a physical function assessment program among participants receiving outpatient hemodialysis (HD). The participants were divided into continuation and dropout groups and followed up for 3 years after the initial physical function assessment. Multivariate logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the dropout group to determine the factors associated with dropout from the physical function assessment program. The continuation and dropout groups included 43 and 58 participants, respectively. The continuation group had a significantly higher self-efficacy (SE) and age than the dropout group (p=0.001, p=0.047). Multivariate logistic regression analysis indicated that only SE (OR: 1.202, 95% CI: 1.082-1.334) remained a significant predictor after adjustment (p < 0.05). There is a need to evaluate SE to prevent dropout from physical functioning assessment programs.

Proteomic and metabolic profiling of chronic patients with schizophrenia induced by a physical activity program: Pilot study

IntroductionSchizophrenia is a chronic illness often accompanied by metabolic disorders, diabetes, obesity and cardiovascular problems often associated with unhealthy lifestyles, as well as neuroendocrine problems caused by the disease itself. Lifestyle changes, such as regular physical exercise, have a positive effect on metabolic disorders and mental health, although the molecular changes that occur in this type of patient and how they explain the changes in their response are unknown. This study wants to analyze in a novel way the proteins and molecular pathways involved in critical plasmatic proteins in plasma to reveal the pathways involved in the implementation of physical exercise and the changes that occur among patients who participate in such programs with those who leave. MethodsTwenty-one patients with chronic schizophrenia underwent a daily, 6-month aerobic training program. We divided them into a group that completed the program (12 patients) and a second group that left the training program (9 patients). The biochemical and clinical data of each patient were analyzed and the proteomic profile of the plasma was studied using ESI-LC–MS/MS. ResultsProteomic analysis recognizes 21.165 proteins and peptides in each patient, of which we identified 1.812 proteins that varied between both groups linked to the metabolic and biological regulation pathways. After clinical analysis of each patient we found significant differences in weight, BMI, abdominal perimeter, diastolic blood pressure, and HDL cholesterol levels. The main change that vertebrates both groups is the Self-Assessment Anhedonia Scale, where we detected higher levels in the dropout group (no physical activity) compared to the active group. ConclusionThe benefits of physical exercise are clear in chronic patients with schizophrenia, as it substantially improves their BMI, as well as their clinical and biochemical parameters. However, our study reveals the biological and molecular pathways that affect physical exercise in schizophrenia, such as important metabolic proteins such as ApoE and ApoC, proteins involved in neuronal regulation such as tenascin and neurotrophins, neuroinflammatory regulatory pathways such as lipocalin-2 and protein 14-3-3, as well as cytoskeleton proteins of cells such as spectrins and annexines. Understanding these molecular mechanisms opens the door to future therapies in the chronicity of schizophrenia.

MO1053FACTORS INFLUENCING DROPOUT FROM PHYSICAL FUNCTION ASSESSMENT PROGRAMS AMONG PATIENTS RECEIVING MAINTENANCE HEMODIALYSIS

Abstract Background and Aims Continuing participation in physical function assessment programs is a critical component of treatment for patients undergoing hemodialysis (HD). Maintaining physical function through participation in a physical function assessment program is important to prevent adverse events in the clinical field of nephrology. Several clinical practice guidelines recommend regular assessment of physical activity and physical function as part of routine care for patients receiving hemodialysis (HD). However, the factors related to patients’ continuation of a physical function assessment program while undergoing HD remain unknown. We aimed to investigate the predictors associated with dropout from a physical function assessment program among patients receiving outpatient HD. Method In 2016, Seirei Sakura Citizen Hospital initiated a physical function assessment program for patients receiving outpatient HD. This retrospective cohort study included 230 patients receiving HD who participated in the first physical function assessment program in 2016. Following the initial visit, all patients were invited to complete a physical function assessment once a year. We assessed self-efficacy (SE), short physical performance battery (SPPB), exercise habits, and hand grip and provided patients with appropriate feedback. These measures were performed before the hemodialysis session. Laboratory Data and dialysis status were also collected. Participants were tracked for three years after their first physical function assessment to determine their attendance rate. Patients were provided with four opportunities for participation, including the initial assessment. The program's participation rate was defined as the number of program sessions in which the patient actually participated and the percentage (%) of the four physical functioning assessment visits attended. Patients were then divided into a continuation group (&amp;gt; 50% participation, including the initial assessment) and a dropout group (≤ 50% participation, including the initial assessment). Multivariate logistic regression analyses were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the continuation group to determine the predictors of dropout from the physical function assessment program. Ethical approval was provided by Seirei Sakura Citizen Hospital,and written informed consent. Results A total of 230 patients receiving outpatient HD were invited to participate in the study. Among these, 78 patients refused to participate, 45 participants died or changed clinic within three years of obtaining baseline measurements, and six patients had missing data. Therefore, the final analysis included 101 patients undergoing HD. The continuation and dropout groups included 43 and 58 patients, respectively. SE (continuation: 13.0 ± 4.3 points; dropout: 9.8 ± 4.8 points) and age (continuation: 65.7 ± 10.4 years; dropout: 61.2 ± 12.2 years) were significantly higher in the continuation group than in the dropout group (p = 0.001, p = 0.047, respectively). Multivariate logistic regression analyses indicated that only SE (OR: 1.192, 95% CI: 1.088–1.319) remained a significant predictor after adjustment (p &amp;lt; 0.05). Conclusion Our data demonstrate that exercise-related SE and age significantly influenced dropout from the physical function assessment program; in particular, SE was a strong predictor of dropout, possibly because the patients with high SE may have had positive feelings about exercise based on previous experience. The older patients may have had a smaller social circle and more time to spare and been more aware of their health and desires. There is a need to evaluate SE to prevent dropout from physical functioning assessment programs. Interventions designed to enhance exercise-related SE may improve program retention among patients with HD.

Youth Sports Participation Is More Important among Females than Males for Predicting Physical Activity in Early Adulthood: Iowa Bone Development Study.

A gender difference in youth sports and physical activity participation is well documented. However, research is limited to understand potential gender difference in the long-term effects of youth sports participation. The study aim was to compare the likelihood of meeting the aerobic Physical Activity Guidelines (PAG) in early adulthood by youth sports participation patterns among females and males. The study sample included 582 Iowa Bone Development Study participants (Iowa, USA). Participation in organized sports was assessed using a physical activity questionnaire 19 times on average between age 6 and 17 years. Accelerometer and dual-energy X-ray absorptiometry assessments were conducted at an average age of 23 years. Group-based trajectory analysis was conducted to identify youth sports participation trajectory patterns. Multivariable logistic regression analysis was conducted to examine the association between youth sports participation patterns and meeting the PAG in adulthood. We identified three youth sports participation patterns: “continuous participation,” “drop-out,” and “no participation.” Females in the continuous participation group were more likely to meet the aerobic PAG at age 23 years, compared to females in the no-participation group (OR = 2.63; 95% CI = 1.05, 6.55) or the drop-out group (OR = 2.55; 95% CI = 1.38, 4.69). However, among males, youth sports participation patterns were not significantly associated with meeting the aerobic PAG at age 23 years. In conclusion, this study suggests that youth sports participation could be more important among females than males for predicting physical activity in early adulthood.

Buprenorphine Medication for Opioid Use Disorder: A Study of Factors Associated With Postpartum Treatment Retention.

The factors associated with medication for opioid use disorder (MOUD) treatment retention among pregnant women with opioid use disorder (OUD) are largely unknown. This study sought to characterize factors associated with postpartum treatment retention. A retrospective chart review from 2014 to 2017 was conducted among women with OUD in pregnancy treated with buprenorphine. Women were assigned to the treatment retention group if they attended an appointment within 10 to 14 weeks postpartum. Others were assigned to the dropout group. The groups were compared using bivariate analysis for sociodemographic variables, obstetrical and neonatal outcomes, clinical and subjective opioid withdrawal symptoms, buprenorphine dosage, urine drug toxicology (UDT) results, and other factors. A total of 64 pregnancies received treatment until delivery, and 47 (73.1%) were retained in treatment by 12 weeks postpartum. The treatment dropout group had lower buprenorphine doses at delivery, a higher percentage of benzodiazepine positive UDT, and number of UDT positive for benzodiazepine in the third trimester. Breastfeeding rates were higher in the treatment retention group. Future research of variables related to postpartum treatment retention is needed to provide guidelines regarding MOUD during the perinatal period and to optimize maternal and fetal well-being. This study supports previous recommendations that aggressive treatment of withdrawal symptoms in pregnant women with OUD is needed to maximize treatment retention. This is the first study to find that breastfeeding was associated with postpartum treatment retention; while, increased use of benzodiazepines during pregnancy was associated with postpartum treatment dropout. (Am J Addict 2021;30:43-48).

Predictors of dropout from cohort study due to deterioration in health status, with focus on sarcopenia, locomotive syndrome, and frailty: From the Shiraniwa Elderly Cohort (Shiraniwa) study

BackgroundConditions of the elderly like sarcopenia, locomotive syndrome, and frailty have been attracting attention recently. However, the relationship of these 3 conditions and the difference in the magnitude of influence each has on deterioration in health status remain unclear. The purpose of this study was to investigate the prevalence and relationship of sarcopenia, locomotive syndrome, and frailty, and to clarify their influence on the dropout from cohort study due to deterioration in health status. MethodsThe 1st survey of the Shiraniwa Elderly Cohort (Shiraniwa) study was conducted in 2016. We examined 409 participants (aged ≥ 65 years; 164 males, 245 females) and assessed sarcopenia, locomotive syndrome, and frailty. Those who could not attend the 2nd survey (2017) due to deterioration in health status were defined as the Dropout group. We investigated the predictors of Dropout using multiple logistic regression analysis. ResultsThe prevalence of sarcopenia, locomotive syndrome stage 2, and frailty were 4.4%, 40.1%, and 14.2%, respectively; 89.7% of participants with frailty were also diagnosed with locomotive syndrome stage 2. From the results of the 2nd survey, 46 people were classified into the Dropout group. Independent predictors of the Dropout were locomotive syndrome stage 2 (adjusted odds ratio [OR]: 2.42, 95% confidence interval [CI]: 1.11–5.31) and frailty (adjusted OR: 3.37, 95%CI: 1.56–7.30). ConclusionsLocomotive syndrome stage 2 was the most common condition in the elderly, and most people with frailty also had locomotive syndrome stage 2. Locomotive syndrome stage 2 and frailty independently influenced the dropout from cohort study due to deterioration in health status. These results suggest that screening for locomotive syndrome is useful for early detection of the elderly with a risk of deterioration in health status, and screening for frailty may contribute to detecting the elderly with higher risk of deterioration in health status.

Sarcopenic Obesity Predicts Early Attrition in Treatment-Seeking Patients with Obesity: A Longitudinal Pilot Study.

Attrition is a major cause of failure in obesity treatment, which is still not fully understood. The identification of factors related to this outcome is of clinical relevance. We aimed to assess the relationship between sarcopenic obesity (SO) and early attrition. Early attrition was assessed at six months, and two groups of patients were selected from a large cohort of participants with overweight or obesity enrolled at the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Body composition was measured using a bioimpedance analyser (Tanita BC-418) and participants at baseline were categorized as having or not having SO. The “dropout group” included 72 participants (cases) compared to 31 participants (controls) in the “completer group”, with the former displaying a higher prevalence of SO than the latter (51.0% vs. 25.8%; p = 0.016). In the same direction, Poisson regression analysis showed that SO increased the relative risk of dropout by nearly 150% (RR = 1.45; 95% CI = 1.10–1.89; p = 0.007) after adjustment for age, gender, body mass index (BMI), age at first dieting, sedentary habits and weight-loss expectation. In conclusion, in a “real-world” outpatient clinical setting, the presence of SO at baseline increases the risk of dropout at six months. New directions of future research should be focused on identifying new strategies to reduce the attrition rate in this population.

Predictive Factors of Graduation Delay in a Medical Program: a Retrospective Cohort Study in Brazil, 2010-2016

Abstract: Introduction: Medical training is a long and expensive process. Admission processes are highly competitive all over the world but being accepted is no guarantee of academic success. Medical school is demanding and stressful, and some students are not able to cope with this new scenario successfully. It is estimated that 10-15% of medical students experience difficulties in adapting to the course, which can lead to academic failure. The identification of predictive factors of failure supports the creation of mechanisms and strategies to avoid course dropout or graduation delay. To identify predictive factors of academic failure in a Brazilian medical program. Methods: A retrospective observational study was carried out with all medical students admitted to a private Brazilian medical school in 2010 and 2011. The main outcome was academic success. Academic failure was defined as graduation delay or course dropout (Group 1), and academic success was defined as graduating within 6 years (Group 2). Sociodemographic and academic data were collected, including grades obtained at the admission process and the first-semester courses. Freshman students and students with passing grades in the first semester (passed students) were analyzed separately. Descriptive and comparative analyses, logistic regression and ROC curve analysis were performed. The level of significance was 0.05. Results: A total of 312 students were admitted during the study period, but 10 were excluded due to lack of information. Of the 302 students included in the study, 105 were included in Group 1 and 197 were included in Group 2. Thirty-two students failed the first semester. The 270 students with passing grades in the first semester were divided into Group 1 (n=73) and Group 2 (n=197). Among the freshman students, lower admission grades were associated with a higher chance of failure (padjusted=0.012). Of the 270 students with passing grades, low academic performance (courses’ mean grades) was associated with graduation delay (padjusted&lt;0.001). Conclusions: Low grades at the admission process (freshman students) and low academic performance in the first semester (students with passing grades) were predictive factors of academic failure.

Work-related, personal, and diabetes-related factors relevant to dropout from outpatient diabetes treatment visits among Japanese male employees with diabetes.

In recent years, support for coexisting diabetes treatment and work (Ryoritsu Shien) has become increasingly important for employees with diabetes. It is important to identify factors associated with dropout from outpatient visits for diabetes treatment among employees with diabetes to determine appropriate support to prevent dropout. Therefore, we explored work-related, personal, and diabetes-related factors relevant for dropout from outpatient diabetes treatment visits among Japanese employees with diabetes. This cross-sectional study was conducted in 2018. Participants were 140 full-time employees with type 2 diabetes aged over 40years. Participants were classified into two groups: a dropout group and a continuation group. Work-related, personal, and diabetes-related factors were evaluated using a self-administered questionnaire and specific health checkup data. Of the 140 employees with diabetes, 12 (8.6%) were classified in the dropout group. Multivariable logistic regression analysis revealed three factors associated with a lower risk for dropout from diabetes treatment outpatient visits. These were: high supervisor support, as measured by the Job Content Questionnaire (multivariable-adjusted odds ratio [OR] 0.71, 95% confidence interval [CI] 0.52-0.97, per 1 score); older age (multivariable-adjusted OR 0.79, 95% CI: 0.66-0.95, per 1year); and presence of metabolic syndrome (multivariable-adjusted OR 0.04, 95% CI 0.01-0.28, presence vs. absence). Our findings suggest that supervisor support, age, and metabolic syndrome are important factors related to dropout from outpatient diabetes treatment visits among Japanese male employees with diabetes.

Analysis of factors associated with dropping-out from HIV antiretroviral therapy in Kunming City, China

BackgroundThe implementation of national antiretroviral therapy (ART) and expanded ART policies results in that more and more HIV-infected patients receive ART in Kunming, Yunnan province, China. At the same time, however, the number of patients, who drop-out from ART, are also increasing. In this study, we explored the factors that may account for drop-out.MethodsFour hundred and thirty-nine HIV-infected patients, who received or used to receive ART, were recruited in this study. Their age is among 18 and 75. All patients were divided into two group: ART group (187 patients) and drop-out group (252 patients). Appropriate bio-statistics analysis, including univariate analysis and Multivariate analysis, were used to identify factors associated with drop-out.ResultsData from all patients were analyzed. Univariate analysis suggested that the factors associated with drop-out may include age, residential area, educational level, occupation, monthly income, the access to minimum living allowance, HIV transmission route, and living status. On the other hand, factors including area, monthly income, the access to minimum living allowance, and referral methods of follow-up institutions account for drop-out in multivariate analysis.ConclusionsThis study identified a number of factors associated with drop out from ART. Based on our findings,appropriate interventions should be introduced decrease drop-out.

Preimplantation Genetic Testing for Aneuploidy Improves Clinical, Gestational, and Neonatal Outcomes in Advanced Maternal Age Patients Without Compromising Cumulative Live-Birth Rate.

To report the effects of blastocyst stage aneuploidy testing on clinical, gestational, and neonatal outcomes for patients of advanced maternal age undergoing IVF. This is a single-center observational-cohort study with 2 years follow-up. The study includes a total of 2538 couples undergoing 2905 egg collections (control group), 308 (PGT-A), and 106 (drop-out group, consenting for PGT-A but withdrawing due to poor embryological outcome) RESULTS: Compared with control group, PGT-A showed improved clinical outcomes (live-birth rate per transferred embryo, LBR 40.3% vs 11.0%) and reduced multiple pregnancy rate (MPR, 0% vs 11.1%) and pregnancy loss (PL, 3.6% vs 22.6%). Drop-out group showed the worst clinical outcomes suggesting that abandoning PGT-A due to poor response to ovarian stimulation is not a favorable option. Cytogenetic analysis of product of conceptions and CVS/amniocentesis showed higher aneuploid pregnancy rates for control group regardless of embryo transfer strategy (0%, 17.9%, and 19.9%, for PGT-A, control day 5 and day 3, respectively). Multivariate analysis showed no negative impact of PGT-A-related interventions on cumulative delivery rate (26.3%, 95% CI 21.5-31.6 vs 24.0%, 95% CI 22.5-25.6 for PGT-A and control, respectively) and on neonatal outcomes. PGT-A improves clinical outcomes, particularly by reducing pregnancy loss and chromosomally abnormal pregnancy for patients of advanced maternal age, with no major impact on cumulative live-birth rate (CLBR) per egg retrieval.

Relationship between Type D personality and dropout from dental treatment in middle-aged adults.

Type D personality-the tendency toward combined negative affectivity and social inhibition-is a risk factor for coronary heart disease. Although Type D personality has been linked to low adherence to diabetic care, it is unclear whether it is related to adherence to dental therapy. Thus, study examined the relationship between Type D personality and withdrawal from dental therapy. A web-based questionnaire was used to compare a treatment dropout group (n = 225) and maintenance group(n = 236). The questionnaire was designed to assess Type D personality traits, reasons for dropout, and respondent sociodemographic characteristics and attitudes. There were no significant differences in the sociodemographic characteristics of the two groups. However, the proportion of respondents with a Type D personality was significantly larger in the dropout group than in the maintenance group (P = 0.04). The most common reasons for dental therapy dropout were "improvement of symptoms" (46.2%) and "busy with business or study" (30.7%). The most frequent attitude reported in the dropout group was negative feelings toward dental practice. In conclusion, Type D personality might be related to dropout from dental therapy.

Pain catastrophizing predicts dropout of patients from an interdisciplinary chronic pain management programme: A prospective cohort study.

To explore predictors of dropout of patients with chronic musculoskeletal pain from an interdisciplinary chronic pain management programme, and to develop and validate a multivariable prediction model, based on the Extended Common-Sense Model of Self-Regulation (E-CSM). In this prospective cohort study consecutive patients with chronic pain were recruited and followed up (July 2013 to May 2015). Possible associations between predictors and dropout were explored by univariate logistic regression analyses. Subsequently, multiple logistic regression analyses were executed to determine the model that best predicted dropout. Of 188 patients who initiated treatment, 35 (19%) were classified as dropouts. The mean age of the dropout group was 47.9 years (standard devition 9.9). Based on the univariate logistic regression analyses 7 predictors of the 18 potential predictors for dropout were eligible for entry into the multiple logistic regression analyses. Finally, only pain catastrophizing was identified as a significant predictor. Patients with chronic pain who catastrophize were more prone to dropout from this -chronic pain management programme. However, due to the exploratory nature of this study no firm conclusions can be drawn about the predictive value of the E-CSM of Self-Regulation for dropout.

Analysis of the drop-out rate in patients receiving mepolizumab for severe asthma in real life

Mepolizumab (anti IL-5, monoclonal antibody) is commercially available in Italy since more than one year for the treatment of severe hypereosinophilic asthma. Its efficacy and safety were evaluated in several regulatory trials. The characteristics of this drug in real life began to be assessed only recently. We describe herein the drop-out rate observed with mepolizumab in real life, because this datum can indirectly reflect the safety and tolerability aspects. The demographic and clinical data of patients receiving mepolizumab for severe asthma were collected, and the number and reasons for discontinuation of the treatment were analyzed. The database involves 143 patients (67 male, age range 19–80 year) who received at least one dose of mepolizumab. The observed discontinuation rate was 6/143 (4.2%). Five out of 6 discontinuations were due to lack of response, and one was an adverse event (urticaria) probably related to the treatment. There was no clinical difference between the drop-out group and the patients still ongoing. As compared to the clinical trials published the discontinuation rate was lower in our population, especially for adverse events (7% vs 23.7%). Thus, the tolerability of mepolizumab, as derived from discontinuations, seems to be better in real-life than in clinical trials.

Perinatal probiotic intervention prevented allergic disease in a Caesarean-delivered subgroup at 13-year follow-up.

The long-term effects of probiotic intervention for primary prevention of allergic diseases are not well known. We previously reported less eczema until 10years in our probiotic intervention trial. To investigate the effect of early probiotic intervention on the prevalence of allergic diseases up to 13years of age. Pregnant women (n=1223) carrying a child at a high risk of allergy (at least one parent with allergic disease) were randomized to receive a mixture of probiotics (Lactobacillus rhamnosusGG and LC705, Bifidobacterium breve Bb99 and Propionibacterium freudenreichii) or placebo in a double-blind manner from 36weeks of gestation until birth. Their infants received the same product for the first six months (registration number NCT00298337). At 13-year follow-up, the participants were requested to return a questionnaire and to provide a blood sample. A questionnaire was returned by 642 participants (63.1% of intention-to-treat infants), and 459 provided a blood sample. In the whole cohort, there were no statistically significant differences in doctor-diagnosed allergic disease (55.2% and 59.0%, probiotic and placebo group, respectively) or allergic disease (47.9% and 51.6%) based on the ISAAC questionnaire data. Inhalant-specific IgE sensitization (>0.7 kU/L) was 59.3% in the probiotic group and 49.8% in the placebo group (P=0.040). In a post hoc analysis made in Caesarean-delivered subgroup, allergy was reported in 41.5% of the probiotic group and 67.9% of the placebo group (P=0.006), and eczema in 18.9% and 37.5%, respectively (P=0.031). In the whole cohort, 8.5% of the probiotic group had suffered from wheezing attacks during the previous 12months vs 14.7% in the placebo group (P=0.013). There were no statistically significant differences discovered between the characteristics of the participating group and the dropout group. Probiotic intervention protected Caesarean-delivered subgroup from allergic disease and eczema, but not the total cohort.

Natural history after discharge from a hospital psychosomatic treatment - Results of a one-year follow-up

The effectiveness of the inpatient psychosomatic treatment has been documented in various settings. The question of the sustainability of the improvement achieved as well as the prognostic factors is of interest for public health.Primary outcome variables reflect the stability or change in the clinical status of patients one year after the discharge from the inpatient psychosomatic treatment. Secondary outcome variables reflect differences in utilization of medical services between the year before and after admission.One-year naturalistic follow-up of a sample consisting of patients treated in a psychosomatic hospital service by means of 9 clinical and 3 variables for measurement of utilization of medical services. Four measuring points were considered: agreeing at admission (N = 262), discharge (N = 249), 6 months (N = 148) and 12 months (N = 114) after discharge. Differences and associations were assessed by means of t tests and multivariate linear as well as logistic regressions.The subsample with adherence to the study is representative for the whole sample since hardly any differences to the drop-out group were found. A year after discharge, all clinical variables showed significant differences (p < 0.001) compared with clinical status at admission and no significant differences compared with status at discharge (p > 0.05). Three quarters of sample reported a subjective improvement one year after discharge, contrary to results of clinical scales. Medical aftercare was ensured principally by psychotherapists (78 %), followed by general practitioners (63 %), and psychiatrists (44 %). Relevant associations were found between psychotherapy appointments and clinical variables in follow-up.The clinical improvement attained through the psychosomatic hospitalization remain on average stable a year after discharge. Subjective global assessment of health status shows an improvement for the majority of the sample, contrary to results of clinical scales; that is the reason why both assessment approaches have to be considered. Psychotherapy in aftercare could play a prominent role for health preservation.

Discontinuation of Orthodontic Treatment: what are the early predictive factors?

Discontinuation of orthodontic treatment has iatrogenic, psychological, ergonomic and financial consequences. The objective of this study was to investigate early risk factors (prior to installation) of discontinuation of orthodontic treatment. We performed a case-control study between a group of patients who dropped their orthodontic treatment ("A") and a randomly selected group of patients who had completed their orthodontic treatment ("NA"). The two groups were compared, with descriptive, uni and multivariate analyzes. The risk factors assessed were age, gender, socioeconomic status, type of treatment, dysmorphism, malocclusion, need for treatment, compliance. In the dropout group 55 patients were included ("A") and 100 in the non-abandoned ("NA") group randomly selected. The subject at risk of abandonment was a girl of less than 11 years of age with a low socio-economic level with antero-posterior and vertical skeletal dysmorphisms, a molar class II, a teeth crowding, a small aesthetic prejudice or, on the contrary, very important, complex treatment (with extractions or with surgery) and having delays or missed appointments before the installation of the orthodontic appliance. Patients' motivation needs to be strengthened for both extremes: treatments that appear simple and conversely for complex cases requiring strong cooperation.

Comparable rates of simulator sickness in Huntington’s disease and healthy individuals

ObjectiveInvestigating driving competence with a simulator provides a controlled setting and has a high reproducibility. In addition, there is less risk of physical harm compared to on-road tests. A disadvantage of using simulators is the occurrence of simulator sickness, which is comparable to symptoms of motion sickness.The aim of this study was to examine whether patients with Huntington’s disease (HD) are more susceptible to develop simulator sickness compared to healthy individuals. Further, we investigated if the clinical symptoms of HD, such as motor disabilities and cognitive deterioration, might increase the occurrence of simulator sickness. MethodsEighty-three participants (54 HD, 29 controls) drove in a driving simulator that included urban and motorway scenarios. All participants were still active drivers. Motor, cognitive, and oculomotor assessments were administered. Participants completed a questionnaire after the driving session to report possible symptoms of simulator sickness. ResultsFifty-eight (70%) participants completed the driving session, while 25 (30%) participants dropped out due to simulator sickness. The most reported symptoms of simulator sickness by dropouts were difficulties concentrating, dizziness, nausea, sweating, and vomiting. Dropouts were significantly older and more often female compared to completers. Decreased smooth ocular pursuit was predictive of dropout due to simulator sickness. The number of HD participants and controls in the dropout group was comparable. There was no significant difference in cognitive performance and motor functioning between completers and dropouts. ConclusionsHD participants did not have a higher chance of developing simulator sickness while driving in a simulator compared to controls. Female gender, older age, and smooth ocular pursuit were associated with increased simulator sickness, whereas cognitive and motor functioning were unrelated to dropout due to simulator sickness.

Identification of dropout predictors to a community-based physical activity programme that uses motivational interviewing.

Participant dropout reduces intervention effectiveness. Predicting dropout has been investigated for Exercise Referral Schemes, but not physical activity (PA) interventions with Motivational Interviewing (MI). Data from attendees (n = 619) to a community-based PA programme utilizing MI techniques were analysed using a chi-squared test to determine dropout and attendance group differences. Binary logistic regression investigated the likelihood of dropout before 12 weeks. A total of 44.7% of participants dropped out, with statistical (P < 0.05) differences between groups for age, PA and disability. Regression for each variable showed participants aged 61-70 years (OR = 0.28, CI = 0.09-0.79; P = 0.018), >70 years (OR = 0.30, CI = 0.09-0.90; P = 0.036), and high PA (OR = 0.40, CI = 0.20-0.75; P = 0.006) reduced dropout likelihood. Endocrine system disorders (OR = 4.24, CI = 1.19-19.43; P = 0.036) and musculoskeletal disorders (OR = 3.14, CI = 1.84-5.45; P < 0.001) increased dropout likelihood. Significant variables were combined in a single regression model. Dropout significantly reduced for 61-70 years old (OR = 0.31, CI = 0.10-0.90; P = 0.035), and high PA (OR = 0.39, CI = 0.19-0.76; P = 0.008). Musculoskeletal disorders increased dropout (OR = 2.67, CI = 1.53-4.75; P < 0.001). Age, PA and disability type significantly influence dropout at 12 weeks. These are the first results specific to MI based programmes indicating the inclusion of MI and highlighting the need for further research.