Early Dropout Research Articles

L’enseignement bilingue à l’école primaire au Sénégal.

In Senegal, where education takes up about 35% of the national budget, where the increasing number of pupils in urban contexts is such that classes have had to be doubled up, where there is much school loss due to early drop-outs or repeats, and where qualitative and quantitative disparities between public and private teaching are constantly growing, it seems necessary and urgent to change the policies governing formal education.

The effect of COPD severity and study duration on exacerbation outcome in randomized controlled trials.

BackgroundWhen discontinuation in COPD randomized controlled trials (RCTs) is unevenly distributed between treatments (differential dropout), the capacity to demonstrate treatment effects may be reduced. We investigated the impact of the time of differential dropout on exacerbation outcomes in RCTs, in relation to study duration and COPD severity.MethodsA post hoc analysis of 2,345 patients from three RCTs of 6- and 12-month duration was performed to compare budesonide/formoterol and formoterol in moderate, severe, and very severe COPD. Outcomes were exacerbation rate, time-to-first exacerbation, or discontinuation; patients were stratified by disease severity. Outcomes were studied by censoring data monthly from 1 to 12 months.ResultsIn patients treated with budesonide/formoterol, annualized exacerbation rates (AERs) were comparable for each study duration (rate ratio [RR] =0.6). With formoterol, the AER decreased with study duration (RR =1.20 at 1 month to RR =0.86 at 12 months). There was a treatment-related difference in exacerbation rates of 45%–48% for shorter study durations (≤4 months) and 27% for 12-month duration. This treatment-related difference in exacerbation rates was comparable for the three disease severities in studies ≤4 months (range: 39%–51%), but this difference decreased with longer study durations, especially in more severe groups (22% and 29% at 12 months). There were fewer discontinuations with budesonide/formoterol; the treatment-related difference in time-to-first discontinuation decreased by study duration (35%, 30%, 26%, and 22% at 3, 6, 9, and 12 months, respectively). Numbers of differential dropouts increased with increasing disease severity, being greatest during second, third, and fourth months.ConclusionsCOPD severity and study duration impact exacerbation as an outcome in double-blind RCTs. This effect is most obvious in patients with severe/very severe COPD and in studies that are longer than 4 months. Early differential dropout particularly impacts study outcome, producing a “healthy survivor effect,” which reduces estimations of treatment impact on exacerbations.

Resistance Training Versus General Exercise In Multidisciplinary Rehabilitation Of Low Back Pain

PURPOSE: Chronic low back pain (CLBP) is commonly managed through multidisciplinary rehabilitation (MDR). We aimed to assess if the effectiveness of MDR could be improved by replacing general exercise (GE) with progressive resistance training (PRT) with high intensity using elastic bands. METHODS: Consenting adults (n=99) with moderate to severe non-specific CLBP were randomized to an intervention (PRT) or a comparative group (GE). Both groups received 3-weeks MDR with either GE or PRT (squats, stiff-legged deadlifts, flies, unilateral rows, reversed flies, lateral shoulder raises and lateral pulldown performed 3 times per week with resistance varying from 15-20 to 8-10 repetitions). Both groups were instructed to continue their respective exercise program for 9 weeks after completing the MDR, in which time participants were offered up to three supervised booster sessions. Researchers were blinded during data collection and analyses. The difference in change between groups at 12-weeks in pain-related disability (Oswestry disability index; ODI: 0-100) was the primary outcome. Secondary outcomes were pain (numerical pain rating scale), limitations in important activities (patient-specific functioning scale; PSFS: 0-10), health related quality of life, work ability, global perceived change, fear-avoidance beliefs and back-extension strength were secondary outcomes. RESULTS: Baseline data were missing for 25 patients due to early dropouts. Thus, data from 74 participants (mean age: 45 years, 57% women, mean ODI: 30.4) were obtained at baseline and included in the analyses. Forty-six persons participated at the 12-week follow-up test. There were no difference in change in ODI score between groups at 12 weeks (mean difference 1.6, 95% CI: -3.9-7.0, p=0.570, in favor of GE). The improvement in PSFS was larger in the GE group than in the PRT group (mean difference 1.4, 95% CI: 0.1-2.7, p=0.033). No significant differences between the groups were observed for the other secondary outcomes (p≥0.11). CONCLUSIONS: This study provided no evidence in support of replacing GE with PRT in MDR for CLBP. In fact, GE might be slightly more beneficial than PRT in reducing limitations in important activities.

Prevalence and pattern of morbidities among children at a private school in rural area of Koppal, Karnataka

Introduction: Children are the most valued resources and their health is the biggest investment for any country in the world. Morbidity rates among school children in our country are among the highest in the world and are the common causes of low school enrolment, high absenteeism, early dropout and poor classroom performance. Frequent and regular health check-ups are considered as an ideal platform for earlier detection and prompt treatment of the health problems among them. Objective: To study the prevalence and pattern of morbidities among Primary school children in the study setting. Methods: A cross sectional study was conducted among school children at a Private Primary school situated in the Katharki village, a rural area of Koppal. A pretested and semi structured questionnaire was used for data collection and analyzed using Epiinfo software version 3.5.4. Results: The prevalence of morbidity was found to be among 79 (44.63%) of children and the most common morbidities were Dental Fluorosis and Dental caries followed by Upper respiratory tract infections. Morbidity was marginally higher among male children and was found to be directly proportional to the age group of the children in our study. Conclusion: There is a need to focus on the regular health check-up of school children to improve their health status so that they can attain their full potential and become productive citizens of the country.

Thinness among the Rural Primary School Children of Bali Gram Panchayat, Arambag, Hooghly District, West Bengal, India

Background: Primary school age is a dynamic period of physical growth and mental development of the child. Research indicates that nutritional deficiencies and poor health in primary school age children are among the causes of low school enrolment, high absenteeism, early dropout and poor classroom performance. Chronic undernutrition is linked to slower cognitive development and serious health impairments later in life that reduce the quality of life. The thinness (low BMI for age) may be one of the tool to measure the level of undernutrition. Objective: The objective of the present study was to assess the different grades of thinness by using age and sex specific cut off values based on body mass index (BMI). Materials and Methods: The present cross-sectional study was conducted at Bali-Gram Panchayat, Arambagh, West Bengal, India. The data were collected from 618 rural Bengalee primary school children comprising of both boys (304) and girls (314) within the age group 5-11 years. The measurements (height in cm. and weight in kg) were taken following standard methods Thinness was evaluated using the age and sex specific cut-off points of BMI. Results: The overall (age combined) prevalence of thinness among the boys was slightly higher (83.2%) in comparison to the prevalence of thinness among the girls (81.5%). The prevalence of thinness was higher in case of lower age group children among both boys and girls and it gradually decreases with the increase of age. The rate of grade III thinness (30.5%) was greater among the girls than others while among the boys it was higher in grade I (32.9%) category. It indicates the severity of thinness was much more among the girls than the boys. Although there was no significant sex difference between the two sexes. Conclusion: The prevalence of undernutrition as measured by thinness was significantly higher than the national level scenario. In spite of the Mid Day Meal scheme which is running for more than 20 years, the result is dissatisfactory. The competent authority should look into the matter seriously for better nutritional and health condition of the children.

Friends, foes, and self-defence: students with EBD navigating social conflicts and bullying

ABSTRACTStudents with emotional and behavioural difficulties (EBD) are more likely to struggle than their peers, which can lead to disengagement and early dropout. Although there are alternate programmes for these students, they are rarely consulted about their struggles, or about their perceived needs. The purpose of this study was to explore the lived experiences of students with EBD from their entry in mainstream classrooms to their placement in an alternate programme. During a semi-structured interview and visual mapping activity, six participants described their schooling experiences and their depictions were analysed using an interpretative phenomenological analysis. Participants described the social process of school and emphasised the importance of relationships with peers and teachers, and the challenges they experienced in these relationships, which included relational, psychological, and physical aggression. Findings highlight the need to consider the reciprocal nature of bullying for students with EBD, and its influence on their schooling.

Treatment Duration With Long-Acting Injectable Antipsychotics After In-hospital Initiation: A Retrospective Cohort Study.

Long-acting injectable (LAI) antipsychotics are recommended especially for patients with multiple admissions and poor adherence. The empirical basis of this strategy is a matter of debate. In a retrospective cohort study extending over 6 years, all patients admitted for inpatient treatment with a diagnosis of psychotic disorders according to International Statistical Classification of Diseases and Related Health Problems, 10th Revision (F2) were screened for treatment episodes with a new start of an LAI. Indication for LAI treatment was based primarily on previous medication default. All-cause discontinuation was used as a measure of treatment efficiency. Patients with early dropout (termination of LAI treatment within 6 months) were compared with patients with longer treatment (treatment >6 months) for sociodemographic and treatment variables using bivariate and multivariate analyses. A total of 194 treatment episodes with new start of LAIs were identified. Almost one half dropped out within 6 months (early dropout: n = 95 [49%]; mean duration, 2.2 months). Termination of treatment was mainly due to patients' refusal to continue. However, almost a third of patients (61; 31.4%) had a treatment duration of more than 2 years. In a multivariate Cox regression model, longer treatment duration was associated with older age (P = 0.05), not being single (P = 0.04), fewer admissions during the year preceding the index episode (P = 0.02), and better ratings for adherence at the index episode (P = 0.03). There are both more patients than expected leaving the treatment early and more patients than expected staying for long periods, even among patients with a history of poor adherence.

Attendance Trajectory Classes Among Divorced and Separated Mothers and Fathers in the New Beginnings Program.

We examined attendance trajectories among mothers and fathers in the effectiveness trial of the New Beginnings Program, a parenting-focused prevention program for divorced and separated parents. We also investigated attendance trajectory class differences on two sets of pretest covariates: one set previously linked to participation in programs not specifically targeting divorced parents (i.e., sociodemographics, perceived parenting skills, child problem behaviors, parent psychological distress) and another that might be particularly salient to participation in the context of divorce (i.e., interparental conflict, level of parent-child contact, previous marital status to the ex-spouse). For mothers and fathers, results supported four attendance trajectory classes: (1) non-attenders (NA), (2) early dropouts (ED), (3) declining attenders (DA), and (4) sustained attenders (SA). In the final model testing multiple covariates simultaneously, mothers who were EDs and DAs were more likely to be Latina than SAs, and EDs reported more interparental conflict than SAs. Mother trajectory groups did not differ on parenting skills, child problem behavior, or mother-child contact in the final or preliminary models. In the final model for fathers, EDs rated their children higher on externalizing than DAs, had less contact with their children than DAs and NAs, and reported less distress than SAs. Father trajectory groups did not differ on fathers' age, ethnicity, income, perceived parenting skills, or interparental conflict in the final or preliminary models. Results highlight qualitatively distinct latent classes of mothers and fathers who disengage from a parenting intervention at various points. We discuss implications for intervention engagement strategies and translational science.

Development and Validation of the Treatment Attrition-Retention Scale for Personality Disorders.

This study is an investigation of the psychometric properties of the Treatment Attrition-Retention Scale for Personality Disorders (TARS-PD), an instrument developed to identify patients with personality disorder (PD) at risk of early dropout from psychotherapy. In a first study, assessment files from 320 patients referred for PD evaluation at an outpatient clinic were examined to assess the instrument's inter-rater reliability, construct validity, and discriminant validity. Results showed that the global scale could be scored with excellent reliability. Exploratory factor analysis identified five factors: Narcissism, Psychopathy, Secondary gains, Low motivation, and Cluster A features. A second study focused on the scale's predictive validity. The TARS-PD showed high specificity (94%) in identifying dropouts, using a cut-off of ≥ 10. Both global and factor scores from the TARS-PD were significant predictors of treatment status (dropout vs. continuation) at 6 months. The scale should be considered promising for PD evaluation and treatment planning.

Diagnosis of Transferable Competences of Young People in the Dual Vocational Education—A German Perspective

In Germany the dual vocational education system plays a central role in preparing young people for work. In order to succeed on the labour-market they need competences that go way beyond knowledge and cognitive skills. A quarter of trainees however dropout of vocational education raising questions about their professional action competence. This paper discusses the issue as to what extent subjective ideas of trainees from different occupational fields about their competences compiled using a questionnaire for Social, Methodical, and Personal Competences (SMP-C) are reliable and valid regarding the social, methodical, and personal competence classes. This entails an examination as to whether the SMP-C competence assessment questionnaire features satisfactory psychometric characteristics, on how the formed ability concepts behave towards each other and other constructs, and which competence values can be diagnosed. In order to examine these questions 937 trainees were asked about their competences and tendencies to dropout of vocational training. The analysis attests the assessment procedure overall satisfactory to good reliability, which speaks in favour of surveying social, methodical, and personal ability concepts using the subjective ideas of trainees regarding the application of competences. Furthermore, it seems that a stronger manifestation of specific social, methodical, and personal competences reduces the tendency to dropout of vocational training. Hence it might be possible to prevent early dropout from vocational training through specific strengthening of these competences.

Initial treatment dropout in patients with substance use disorders attending a tertiary care de-addiction centre in north India.

Background & objectives:Dropout from substance use disorders treatment is associated with poor outcomes. Although many factors have been associated with an early dropout of patients, the reasons for dropping out of treatment prematurely remain poorly understood particularly in the Indian context. This study was aimed to study socio-demographic and clinical variables predicting initial dropout of patients attending a tertiary care de-addiction treatment centre in north India.Methods:Information was extracted from the records of consecutive newly registered patients from January 2011 to December 2014. The patients who did not come for follow up within 30 days of the first contact were defined as initial dropouts.Results:Data of 7991 patients could be retrieved. Majority of the sample consisted of male, married and employed individuals. Of them, 4907 patients (61.3%) were considered initial dropouts. Multivariate analysis revealed that after controlling for other factors, greater age, being employed, lower educational status, lesser duration of substance use, use of alcohol, opiate, tobacco, cannabis or sedative-hypnotic use but the absence of multi-substance use predicted initial drop out.Interpretation & conclusions:This study identified some socio-demographic and clinical variables which might predict treatment attrition in substance use disorders. Clinician's awareness towards these factors and tailor-made intervention might improve initial treatment retention. Future research could be directed to find the validity of this assumption.

Grade Repetition and Primary School Dropout in Uganda

Research on education in low-income countries rarely focuses on grade repetition. When addressed, repetition is typically presented along with early school dropout as the “wasting” of educational resources. Simplifying grade repetition in this way often fails to recognize significant methodological concerns and also overlooks the unique insight that can be gained by focusing on repetition. In this article, Sarah Kabay uses mixed methods research to investigate repetition and its association with later school dropout in Ugandan primary schools. In a representative sample of pupils from 136 schools, Kabay finds that in spite of a policy of automatic promotion meant to limit repetition, 88 percent of pupils had repeated a grade and 11 percent had repeated three or more times. Kabay identifies age as a confounding variable for the association between repetition and dropout, and argues that attention should be drawn to the age of entry into schooling and language policy.

Treatment dropout in web-based cognitive behavioral therapy for patients with eating disorders.

Treatment dropout is an important concern in eating disorder treatments as it has negative implications for patients' outcome, clinicians' motivation, and research studies. Our main objective was to conduct an exploratory study on treatment dropout in a two-part web-based cognitive behavioral therapy with asynchronous therapeutic support. The analysis included 205 female patients with eating disorders. Reasons for dropout, treatment experiences, and predictors of dropout were analyzed. Overall treatment dropout was 37.6%, with 18.5% early dropout (before or during treatment part 1) and 19.0% late dropout (after part 1 or during part 2). Almost half of the participants identified personal circumstances as reason for dropout. The other participants mostly reported reasons related to the online delivery or treatment protocol. Predictors of early dropout included reporting less vigor and smoking at baseline and a longer average duration per completed treatment module of part 1. Late dropout was predicted by reporting less vigor at baseline and uncertainty about recommendation of the treatment to others after completion of treatment part 1. Generally, the web-based treatment and online therapeutic support were evaluated positively, although dropouts rated the treatment as significantly less helpful and effective than completers did.

Outpatient psychodynamic group psychotherapy - outcomes related to personality disorder, severity, age and gender.

Outpatient group psychotherapy is frequent within specialist services, recruits a mixed population, but effects are poorly documented. This study investigates long-term outcomes for patients with personality disorder (PD) treated in outpatient, psychodynamic groups within secondary mental health service. A naturalistic study (N = 103) with repeated assessments of process and clinical outcomes. Longitudinal statistics are linear mixed models. The main PDs were avoidant, borderline and NOS PD, mean number of PDs 1.4(SD0.7), 60% females and mean initial age 38(SD10) years. Mean treatment duration was 1.5(SD 0.9) years. Therapist alliance and experienced group climate was satisfactory and stable. Improvements were significant (symptom distress, interpersonal problems, occupational functioning and additional mental health services), irrespective of general PD-severity, but not of PD-type, age or gender. The study demonstrates PD NOS benefits across all outcomes, occupational improvements for avoidant PD, despite prevailing symptoms, but generally poorer outcomes for males and age >38 years. For borderline PD, experienced conflict was stronger, treatment duration shorter and outcomes poor for early drop-outs (28%). Psychodynamic group psychotherapy is a recommendable treatment for moderate PDs, which may address avoidant strategies, but may not meet clinical challenges of borderline PD. The outcome differences related to gender and age are noteworthy. Copyright © 2016 John Wiley & Sons, Ltd.

What Drives the Relationship Between Early Criminal Involvement and School Dropout?

ObjectiveWe examine the relationship between early criminal involvement and school dropout, and analyze which factors underlie this relationship, making use of administrative data from the Netherlands.MethodsWe start by determining the unconditional correlation between early criminal involvement and school dropout, using a basic ordinary least squares model. As this association is likely to be driven by different factors, we proceed by including an extensive set of observable family and individual characteristics into the estimation model. We further proceed to models that account for the influence of unobservable heterogeneity by estimating school, class, sibling and twin fixed effects.ResultsCriminal involvement is associated with an 11 percentage point higher probability of school dropout. The magnitude of this relationship decreases gradually when we account for larger shares of observed and unobserved heterogeneity. The coefficient in the same-gender twin fixed effects model indicates a 3 percentage point higher probability of school dropout, which is statistically significant at a 10 % level. We also find that the association between criminal involvement and school dropout is stronger if juveniles are involved in severe criminal activities.ConclusionsWe conclude that the observable and unobservable factors for which we account explain around 73 % of the unconditional correlation between criminal involvement and school dropout. The remaining variation likely reflects individual-specific characteristics that are different between same-gender twins. A true treatment effect, if existing, is likely to be relatively small. At the same time, serious criminal behavior appears to causally affect school dropout.

Baseline Motivation Type as a Predictor of Dropout in a Healthy Eating Text Messaging Program.

BackgroundGrowing evidence suggests that text messaging programs are effective in facilitating health behavior change. However, high dropout rates limit the potential effectiveness of these programs.ObjectiveThis paper describes patterns of early dropout in the HealthyYou text (HYTxt) program, with a focus on the impact of baseline motivation quality on dropout, as characterized by Self-Determination Theory (SDT).MethodsThis analysis included 193 users of HYTxt, a diet and physical activity text messaging intervention developed by the US National Cancer Institute. Descriptive statistics were computed, and logistic regression models were run to examine the association between baseline motivation type and early program dropout.ResultsOverall, 43.0% (83/193) of users dropped out of the program; of these, 65.1% (54/83; 28.0% of all users) did so within the first 2 weeks. Users with higher autonomous motivation had significantly lower odds of dropping out within the first 2 weeks. A one unit increase in autonomous motivation was associated with lower odds (odds ratio 0.44, 95% CI 0.24–0.81) of early dropout, which persisted after adjusting for level of controlled motivation.ConclusionsApplying SDT-based strategies to enhance autonomous motivation might reduce early dropout rates, which can improve program exposure and effectiveness.

„Die Veränderung beginnt im Therapeuten“ (Herberth/Maurer): Die Überwindung einer destruktiven Dynamik in einer Therapiegruppe

Summary “Changes Begin Within the Psychotherapist” (Herberth/Maurer): How Destructive Psychodynamics Could be Overcome in a Psychoanalytic Group Setting Based on the course of an ambulant, slow-open psychoanalytic group over two years it will be demonstrated how destructive group dynamics seized the group and how it could finally be overcome. Initially, several new participants could not successfully integrate themselves in the group, several “early dropouts” being the result. Thereafter, even a longtime member of the group terminated treatment; the group faced discontinuation. Intuitively I assumed a connection to the psychodynamics of a patient who had suffered the Sudden Infant Death of her daughter prior to treatment. But this did not yet enable me to stop the destructive group dynamics. With the help of supervision I came to recognize my involvement with thepatient. As a result, my inner position towards the patient changed. This marked a turning point within the group – from now on it was again possible for new participants to arrive in the group. Retrospectively I was able to make the interpretation for the patient that she had unconsciously made me feel like losing a child. Thereafter, faced with a new co-patient intending to terminate group therapy, it was her who struggled constructively to hold her in the group, trying to build her a bridge to help her stay.

Time of Dropout From the Liver Transplant List in Patients With Hepatocellular Carcinoma: Clinical Behavior According to Tumor Characteristics and Severity of Liver Disease.

Prolonged time on the waiting list affects post-transplant survival of patients with hepatocellular carcinoma (HCC). However, it is not yet known which patients will be at higher risk for early dropout from the list. We investigate specific risk factors for early waiting list dropout in patients with HCC. This was a single-center, intention-to-treat analysis of adults with HCC, within the Milan criteria, from July 2006 through September 2013. Patients were divided into groups according to waiting list time. The main end point was dropout from the list. The dropout rates of the study cohort at 3, 6, and 12-months were 6.4%, 12.4%, and 17.7%, respectively. Patients who dropped out from the list tended to be older, with blood types A and O, and with higher Child-Pugh and Model for End-Stage Liver Disease (MELD) scores. They also had larger nodules, responded poorly to trans-arterial chemo-embolization (TACE), and had a higher alpha-fetoprotein. Those with blood types B and AB appeared to be protected for dropout (odds ratio [OR]= 0.21, P= .02). Patients who responded to TACE were also protected (OR= 0.22, P< .001). When we looked into time to dropout, the only baseline characteristic that stood out was a higher MELD score (13 for those dropping out up to 90 days vs 10 for those dropping out after 180 days, P= .0025). We conclude that patients who drop out early from the list are primarily driven by the severity of liver disease. Patients who had progressive HCC had a high tumor load and poor response to loco-regional therapies, dropping out from the list after 180 days of inclusion.

An ounce of prevention: A pre-randomization protocol to improve retention in substance use disorder clinical trials

BackgroundMissing data in substance use disorder (SUD) research pose a significant threat to internal validity. Participants terminate involvement or become less likely to attend intervention and research visits for many reasons, which should be addressed prior to becoming problematic. During a 9-month study targeting stimulant abuse, early dropouts and participant reported attendance barriers led to implementing a structured, pre-randomization protocol with participants about retention and solution-focused strategies (the “Fireside Chat”). Our aim is to outline this approach and present data on intervention participation and research visit attendance after implementation. Methods/designSTimulant Reduction using Dosed Exercise (STRIDE) was a two-arm, multisite randomized clinical trial testing treatment-as-usual for stimulant abuse/dependence augmented by Exercise or Health Education. For both groups, study intervention visits at the site were scheduled 3/week for 12weeks followed by 1/week for 24weeks. During The Chat, research staff thoroughly reviewed participants' expectations, and barriers and solutions to retention. Fifteen participants were randomized (to Exercise or Health Education) prior to and fourteen were randomized after Chat implementation. Intervention and monthly follow-up attendance (before and after implementation) were compared at the site (N=29) that developed and rigorously implemented The Chat. ResultsIndividuals who participated in The Chat (n=14) attended significantly more intervention visits during weeks 1–12 (p<0.001) and weeks 13–36 (p<0.05) and attended more research visits (p<0.001). DiscussionProactive discussion of expectations and barriers prior to randomization was associated with greater study attendance. SUD researchers should consider tailoring this approach to suit their needs. Further investigation is warranted.

Investigating health factors as predictor of early drop-out of first year accounting students at the University of the Free State, South Africa

&#x0D; &#x0D; &#x0D; Introduction: The future of the South African workforce looks bleak given the challenges posed, not only by health factors, including HIV and AIDS, but also the success and throughput rate of rst year university students.&#x0D; Methodology: The research in this study was conducted in 2013 using a post-positivist approach and applying an interpretive stance using a mixed method approach, which included a quantita- tive non-experimental predictive multivariate design as well as focus group interviews to triangu- late the ndings.&#x0D; Results: We present ndings that psychosocial background factors, physical health and emotion- al health in uence success and non-completion rates among rst year students at the University of the Free State, South Africa.&#x0D; Conclusion: We argue that early identi cation of poor psychosocial background, including health factors, can assist in empowering youths helping them to make healthy decisions and deal with stressful situations in a way that will not compromise their academic success. &#x0D; &#x0D; &#x0D;