Lower Dropout Rates Research Articles

Dropout rate and cumulative birth outcomes in couples undergoing in vitro fertilization within a funded and actively managed system of care in New Zealand

To determine the dropout rate between the first and second invitro fertilization (IVF) cycles in a controlled population derived from a funded and actively managed system of care in New Zealand, including the reason for dropout and associated cumulative live birth rate. Retrospective cohort. Multicenter IVF practice. Couples qualifying for publicly funded IVF treatment under New Zealand's Clinical Priority Assessment Criteria. Couples (n = 974) started treatment between July 2011 and June 2013, used their own gametes, and were eligible for up to 2 IVF packages of funded care (including the transfer of surplus embryos). None. IVF dropout rate, reason for dropout, and cumulative live birth rate. A low IVF dropout rate between the first and second IVF cycle was reported within this controlled IVF population, with 10% of couples discontinuing treatment for reasons related to stress. The cumulative live birth rate in this "low dropout" population was 59% at the end of treatment, ranging from 72% (≤30 years) to 42% (38-39 years) according to female age. Most patients who discontinued for stress had a good prognosis, and a third of patients still had embryos in cryostorage. Only 30% of those who discontinued used the funded counseling services. A low dropout rate (10%) can be achieved within an actively managed IVF population. This was lower than previously reported, suggesting that prognosis, cost, and treatment management are the significant causes of dropout within the general IVF population. Couples with many embryos also require psychological support because of treatment fatigue or repeated transfers.

Are Highly Motivated Learners More Likely to Complete a Computer Programming MOOC?

Computer programming MOOCs attract people who have different motivations. Previous studies have hypothesized that the motivation declared before starting the course can be an important predictor of distinctive dropout rates. The aim of this study was to outline the main motivation clusters of participants in a computer programming MOOC, and to compare how these clusters differed in terms of intention to complete and actual completion rate. The sample consisted of 1,181 respondents to the pre-course questionnaire in the Introduction to Programming MOOC. A validated motivation scale, based on expectancy-value theory and k-means cluster analysis, was used to form the groups. The four identified clusters were named as Opportunity motivated (27.7%), Over-motivated (28.6%), Success motivated (19.6%) and Interest motivated (24.0%). Comparison tests and chi-square test were used to describe the differences among the clusters. There were statistically significant differences among clusters in self-evaluated probability of completion. Also, significant differences emerged among three clusters in terms of percentages of respondents who completed the MOOC. Interestingly, the completion rate was the lowest in the Over-motivated cluster. A statistically significant higher ratio of completers to non-completers was found in the Opportunity motivated, Success motivated, and Interest motivated clusters. Our findings can be useful for MOOC instructors, as a better vision of participants’ motivational profiles at the beginning of the MOOC might help to inform the MOOC design to better support different needs, potentially resulting in lower dropout rates.

Exploring Blended Curriculum to Enhance Adult High School Learning

At the study site school for this research, the online curriculum in the current blended learning program was not promoting the desired student achievement outcomes. It was unknown if and how research-based best practices associated with blended learning were being implemented. This qualitative case study explored which elements of blended learning best practices were currently implemented in the online blended curriculum at one school to understand the factors enhancing or constraining student learning outcomes. A communities of inquiry framework was used to explore which blended learning best practices were currently implemented and which of those elements enhanced and constrained learning based on teacher and student perspectives. Data were collected using a whole population questionnaire, individual student/teacher interviews, and classroom observations. Three students and five teachers participated in the interviews and five classrooms were observed. Data were analyzed using a combination of open coding and a priori codes. Findings indicated that while teacher presence was evident in the blended learning curriculum, the focus on self-paced assignments limited the social and cognitive presence needed in blended learning best practices. Results were used to design a blended learning professional development course to help prepare teachers to implement missing elements of blended learning best practices. This research study can create social change by increasing teachers’ understanding of blended learning and providing student learning data to help educational leaders close the achievement gap at the local site. Increasing student success could lead to lower dropout rates and enhance students’ abilities to become more successful members of society.

Effects of a gratitude intervention program on work engagement among Japanese workers: a protocol for a cluster randomized controlled trial

BackgroundWork engagement is one of the most important outcomes for both employees and employers. Although the findings to date, integrated 40 intervention studies aiming to improve work engagement, consistent results have not yet been produced, suggesting the importance of further intervention studies. This study aims to investigate the effects of gratitude intervention programs focused on two important work engagement factors among Japanese workers: personal and job resources.MethodsThis study will be a two-arm, parallel-group cluster (organization) randomized control trial. Japanese organizations and nested employees will be recruited through the first author’s acquaintances using snowball sampling. Organizations that meet the inclusion criteria will be randomly allocated to intervention or control groups in a 1:1 ratio within the company unit. The intervention groups will be provided with a 1-month long gratitude intervention program, which aims to promote reciprocal gratitude exchanges within the same organization. The program consists of psychoeducation, gratitude lists, and behavioral gratitude expression. The control groups will not receive any intervention. The primary outcome will be work engagement measured by the Japanese version of the Utrecht Work Engagement Scale at baseline and after 1 (immediate post-survey), 3, and 6 months. Multilevel latent growth modeling will be conducted to examine the effectiveness of the intervention program.DiscussionThis study will be the first cluster randomized controlled trial applied to the investigation of gratitude intervention aimed at improving work engagement among Japanese workers; to promote reciprocal gratitude exchanges within a given organization; and to include both gratitude lists and behavioral gratitude expression. Gratitude interventions have several strengths in terms of implementation: the objectives of the exercises are easy to understand and implement; it does not require much time or expense; they tend to have lower dropout rates; and they do not require experts in psychology. Although implementation difficulties have been common in previous interventions targeting work engagement, gratitude intervention may be suitable even for workers who have limited time to devote to the tasks.Trial registration: This study was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR, ID=UMIN000042546): https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000048566 on November 25, 2020.

Healthy Lifestyle Management of Pediatric Obesity with a Hybrid System of Customized Mobile Technology: The PediaFit Pilot Project.

Pediatric obesity management strategies suffer from a high rate of dropout and persistence of weight excess, despite the use of new tools, such as automated mobile technology (MT). We aimed to compare the efficacy of two 6-month personalized MT protocols in terms of better engagement, adherence to follow-up visits and improved anthropometric and lifestyle parameters. MT contacts consisted of three personalized/not automated What’s App® self-monitoring or challenge messages per week. Messages, sent by a dedicated coach were inserted between three-monthly in-presence regular visits with (PediaFit 1.2) or without (PediaFit 1.1) monthly free-of charge short recall visits carried out by a specialized pediatric team. The sample included 103 children (mean age 10 years, range 6–14) recruited in the Pediatric Obesity Clinic between January 2017 and February 2019, randomized into Intervention group (IG) (n = 24 PediaFit 1.1; n = 30 PediaFit 1.2) and Control group (CG) (total n = 49). Controls received standard treatment only (indications for healthy nutrition and physical activity, and three months in presence regular visits). Overall, both IGs achieved significantly better results than the CGs for all considered parameters. Comparison of the two IGs at the sixth month in particular showed an IG 1.2 statistically significantly lower drop-out rate (10% vs. 62%, p = 0.00009), along with significantly improved BMI (p = 0.003), Screen Time (p = 0.04) and fruit and vegetables consumption (p = 0.02). The study suggests that the hybrid association of messaging through personalized/not automated MT plus monthly free-of charge recall visits may improve the prefixed outcomes of MT weight loss intervention programs.

Problematic internet use: The effect of comorbid psychopathology on treatment outcomes

Problematic Internet use (PIU) behaviours involve one's maladaptive Internet use and have been often described as secondary manifestations of pre-existing psychopathology. Furthermore, different profiles of PIU sufferers have been proposed. However, little is known of the impact these may be having on treatment responses. Thus, this study aims to investigate the psychopathological profiles of those who seek treatment for PIU within a specialised public outpatient unit and whether these influence treatment outcomes. This research utilised 203 treatment seekers of the Specialized Department of Problematic Internet Use (SD-PIU) of the Psychiatric Hospital of Attica, in Greece (mean age = 26.02; SD = 7.9). To assess psychopathology, the Symptom Checklist-90 Revised (SCL-90-R) was used. Treatment responses were reported either as completed, continued, or drop out. A Latent Class/Profiling-Analysis (LCA) was performed, guided by variations across the SCL-90-R psychopathologies. It indicated two naturally occurring profiles of comorbid psychological symptoms; 66% were classified as the “High Comorbidity” (HC) and 34% as the “Low Comorbidity” (LC) profile. Regarding treatment outcomes, LC patients presented with significantly lower dropout rates and higher levels of completion. The present study poses imperative clinical implications regarding the necessity of specialized treatment planning based on the different PIU treatment seekers psychopathological comorbidities.

Let's talk virtual! Online focus group facilitation for the modern researcher.

Focus group discussions typically involve face-to-face facilitation. There is growing interest in utilising digital technologies to facilitate aspects of focus group research. To date, no study in the pharmacy profession has comprehensively described and evaluated a fully virtual process to focus group research, from recruitment to reimbursement. This study aims to describe an entirely online approach to: recruiting for and facilitating virtual focus group discussions, and reimbursement of participants within the pharmacy profession. Specifically, our objectives were to identify 1) the dropout rate, 2) the geographic diversity of focus group participants, and 3) the occurrence of technological issues. Traditional face-to-face focus group recruitment and facilitation methods were adapted, pre-tested, and conducted using online platforms for advertising, participant expressions of interest, participant consent, focus group facilitation, and participant reimbursement. Populations of interest included community pharmacists, specialty practice pharmacists, hospital pharmacists, and pharmacy assistants and technicians across Australia. Of the 153 potential participants who either completed an expression of interest to participate (135/153) or agreed to participate after direct contact (18/153), 59 confirmed that they would attend the focus group discussion (39%); 49 of the 59 (dropout rate: 17%) participated in one of eight focus groups. Collectively, there was representation from all States and Territories in Australia, as well as representation in each of the populations of interest. Three of 49 participants (6%) experienced minor technological issues during the process; no participant encountered major technological issues that precluded successful participation. Our study demonstrates that an entirely online approach to focus group methodology is possible, has the potential to recruit demographically and geographically-diverse participants with low dropout rates, and can be successfully conducted with minimal technological issues. Despite the recent COVID-19 pandemic making physical focus group facilitation untenable, this fully-online approach enables research to be completed uninterrupted.

Natural Language Generation Using Deep Learning to Support MOOC Learners

Among all the learning resources within MOOCs such as video lectures and homework, the discussion forum stood out as a valuable platform for students’ learning through knowledge exchange. However, peer interactions on MOOC discussion forums are scarce. The lack of interactions among MOOC learners can yield negative effects on students’ learning, causing low participation and high dropout rate. This research aims to examine the extent to which the deep-learning-based natural language generation (NLG) models can offer responses similar to human-generated responses to the learners in MOOC forums. Specifically, under the framework of social support theory, this study has examined the use of state-of-the-art deep learning models recurrent neural network (RNN) and generative pretrained transformer 2 (GPT-2) to provide students with informational, emotional, and community support with NLG on discussion forums. We first trained an RNN and GPT-2 model with 13,850 entries of post-reply pairs. Quantitative evaluation on model performance was then conducted with word perplexity, readability, and coherence. The results showed that GPT-2 outperformed RNN on all measures. We then qualitatively compared the dimensions of support provided by humans and GPT-2, and the results suggested that the GPT-2 model can comparably provide emotional and community support to human learners with contextual replies. We further surveyed participants to find out if the collected data would align with our findings. The results showed GPT-2 model could provide supportive and contextual replies to a similar extent compared to humans.

Care partner-assisted intervention to improve oral health for older adults with cognitive impairment: A feasibility study.

Older adults with cognitive impairment often experience poor oral health outcomes due to inadequate oral hygiene practices. This pilot study aimed to evaluate the feasibility of a care partner-assisted intervention to improve the oral hygiene of community-dwelling older adults with cognitive impairment. The 6-month intervention included 25 older adults with mild dementia or mild cognitive impairment, who were randomly assigned to Treatment Group 1 or Treatment Group 2. Treatment Group 1 (n=7) received an educational booklet. Treatment Group 2 (n=18) received a booklet, a tailored care plan for the participants with cognitive impairment and the care partner received four coaching sessions to learn to facilitate good oral hygiene. Both groups received electric toothbrushes. The study consisted of a 3-month active intervention and 3-month maintenance phase. The outcomes of gingival index, plaque index and overall oral health status based on the Oral Health Assessment Tool were measured at baseline, 3months (end of active intervention) and 6months of the study. This study had very low dropout rate. Participants' oral hygiene improved in this study. In comparison to Treatment Group 1, participants in Treatment Group 2 had a greater reduction in plaque level and gingival inflammation, and greater improvement in overall oral health status. This study demonstrates the feasibility of this intervention designed to improve the oral health of persons with cognitive impairment and it lays the foundation for using this protocol in a future large randomised clinical trial.

A new treatment approach for PTSD: High-Intensive Narrative Exposure Therapy (HI-NET)

Current international guidelines recommend Trauma-Focused Therapies (TFT) to treat Post-Traumatic Stress Disorder (PTSD). However, non-response and dropout rates have shown to be substantial. TFT, delivered in a highly intensive dose may lead to a more efficacious symptom reduction and lower dropout rates. This article describes an inpatient treatment program with Narrative Exposure Therapy (NET), called High-Intensive NET (HI-NET). The program consists of sixteen NET sessions during two weeks, combined with art therapy and yoga. After describing the treatment program, we present two case reports of patients who received HI-NET. We measured amongst others symptoms of PTSD and depression, sleep quality and general psychopathology at pre-treatment, post-treatment and at four months' follow-up. The two patients showed that applying HI-NET is a promising approach to append to the existing way of conducting NET. One patient reported a slight increase in symptoms at post-treatment, but was fully recovered of PTSD at follow-up. The other patient recovered gradually, with full recovery at follow-up. The other measures also showed important improvements at the end of treatment and at follow-up. Concluding: NET in a high intensive form is applicable and feasible. Our two cases showed an important improvement in PTSD symptoms and in general psychopathology. More research is needed with larger patient groups to determine efficacy and efficiency more properly.

Students’ beliefs about physical education and the impact of lesson frequency

This study aims to highlight students’ beliefs about physical education (PE). The specific objectives are a) to describe students’ behavioural, normative, and control beliefs; b) to establish patterns between the three belief domains; and c) to analyse the impact of the PE lesson frequency on beliefs. A nationwide random stratified sample of 1,736 ninth-grade students in Sweden completed the study’s questionnaire, while the high response rate and the low internal dropout rate support the generalizability of the findings. The data analysis focused on three student groups based on lesson frequency of one, two, and three or more times weekly. On average, students’ answers indicated overwhelmingly positive beliefs. A second-order model with very close fit indexes showed similarities among the three groups. However, testing for the equivalence of the latent mean structures indicated a group non-invariant solution. The study demonstrates interrelation patterns among behavioural, normative, and control beliefs and significant associations between lesson frequency and beliefs.

Immigration and the Short- and Long-Term Impact of Improved Prenatal Conditions

This paper investigates the effects of immigration from a developing country to a developed country during pregnancy on offspring's outcomes. We focus on intermediate and long-term outcomes, using quasi-experimental variation created by the immigration of Ethiopian Jews to Israel in May 1991. Individuals conceived before immigration experienced dramatic changes in their environmental conditions at different stages of prenatal development depending on their gestational age at migration. We find that females whose mothers immigrated at an earlier gestational age have lower grade repetition and dropout rates in high school. They also show better cognitive performance during primary and middle school and in the high school matriculation study program. As adults, they have higher post-secondary schooling, employment rates, and earnings than those whose mothers migrated at a later stage of pregnancy.

Effectiveness and Acceptability of Noninvasive Brain and Nerve Stimulation Techniques for Migraine Prophylaxis: A Network Meta-Analysis of Randomized Controlled Trials

Background: Current pharmacologic prophylactic strategies for migraine have exhibited limited efficacy, with response rates as low as 40%–50%. In addition to the limited efficacy, the acceptability of those pharmacologic prophylactic strategies were unacceptable. Although noninvasive brain/nerve stimulation strategies may be effective, the evidence has been inconsistent. The aim of this network meta-analysis (NMA) was to compare strategies of noninvasive brain/nerve stimulation for migraine prophylaxis with respect to their effectiveness and acceptability. Methods: The PubMed, Embase, ScienceDirect, ProQuest, ClinicalTrials.gov, ClinicalKey, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs). Patients with diagnosis of migraine, either episodic migraine or chronic migraine, were included. The primary outcome was the changes in monthly migraine days and response rate, and the acceptability was defined as the drop-out rate. All NMA procedures were conducted under the frequentist model. Findings: Nineteen randomized controlled trials were included (N=1493; mean age=38.2 years; 82.0% women). We determined that the high frequency repetitive transcranial magnetic stimulation (rTMS) over C3 yielded the most decreased monthly migraine days among all the interventions [mean difference=-8.70 days, 95% confidence intervals (95%CIs): -14.45 to -2.95 compared to sham/control groups]. In addition, high-frequency (100 Hz) transcutaneous occipital nerve stimulation (tONS) over the Oz provided the highest response rate in migraine prophylaxis [rate ratio (RR)=9.00, 95%CIs: 1.24 to 65.16 compared to sham/control groups]. Only alternative frequency (2/100 Hz) tONS over the Oz (RR=0.36, 95%CIs: 0.16 to 0.82) yielded a significantly lower drop-out rate than the sham/control groups did. Interpretation: The current study provided a new direction for the design of more methodologically robust and larger RCTs based on the findings of the potentially beneficial effect on migraine prophylaxis in participants with migraine by different noninvasive brain/nerve stimulation, especially the application of rTMS and tONS. Funding Information: None. Declaration of Interests: The authors report no financial interests or potential conflicts of interest.

Development of the distance education course Principles and Practice of Clinical Research: 9 years of experience in the Dominican Republic

Introduction: Critical thinking is an ideal tool for evaluating information as a guiding action. With the conjunct use of the internet and applied pedagogy, PPCR looks to develop its alumni’s superior cognitive skills. We aim to characterize alumni and their experiences in the Dominican Republic for over nine years. Method: This descriptive, cross-sectional study used a survey instrument formatted with closed and semi-closed questions, which was sent to each participant’s email. The survey had two segments, the first with twelve questions related to the participant’s personal information and characteristics related to their background education and profession. The second section evaluated satisfaction during their participation in the PPCR course. Results: Out of a total of 62 graduates from 2012 to 2019, data was collected from 52 participants, of which 92% are medical doctors. The mean age was 36 years, with a predominance of the female gender (56%). The vast majority of participants are Dominican (90%), with a postgraduate program (61.2%). More than half carry out university teaching activities (54%), and a part of them continued to be affiliated in the program as Teaching Assistants, performing pedagogical assistance tasks (38%). The global satisfaction rate was high (92%), with a low dropout rate (2%). Conclusions: Based on our study’s characteristics, this course is estimated to be a novel element capable of promoting scientific production and promoting clinical research activities in developing countries. It creates connections and exploits virtuality to improve knowledge through the critical analysis of information. This experience plays a prominent role in the enrichment of many teachers by providing them with methodological tools, developing the excellent training of educators.

Preliminary Real-World Evaluation of an Intervention for Parents of Adolescents: The Open Door Approach to Parenting Teenagers (APT)

Most parenting interventions report high dropout rates for parents who exhibit clinically high levels of stress and/or are parents of adolescents with severe emotional and/or behavioral difficulties. The objective of this preliminary study was to evaluate the feasibility and real-world effectiveness of the Open Door Approach to Parenting Teenagers (APT), a six-session individually delivered face-to-face intervention for typically hard to engage parents of 11 to 21-year-olds. A one-group, pre-post evaluation design was adopted due to the naturalistic clinic-based setting of the study. Participants were 279 parents reporting clinical levels of stress relating to parenting an adolescent. Parents receiving the APT intervention demonstrated lower dropout rates than other parenting programs and reported high scores across several items relating to service satisfaction. The APT intervention was associated with significant reductions in parental stress and improvements in parent-adolescent relationships immediately post-intervention. Findings suggest that parents found the APT intervention acceptable and beneficial, and further suggest that the intervention is feasible and effective in retaining hard to engage parents. Moreover, preliminary findings suggest that the APT intervention is a promising intervention that may support parents who fail to engage in group programs. However, further research is required to establish the efficacy of the intervention.

Using Hybrid Telepractice for Supporting Parents of Children with ASD during the COVID-19 Lockdown: A Feasibility Study in Iran.

During the three-month closure of clinics and day centers in Iran due to the coronavirus disease 2019 (COVID-19) lockdown, parents of children with Autism Spectrum Disorder (ASD) became solely responsible for their care and education. Although centers maintained telephone contact, it quickly became evident that parents needed more detailed advice and guidance. Staff from 30 daycare centers volunteered to take part in a two-month online support and training course for 336 caregivers of children with ASD of different ages. In addition to the provision of visual and written information, synchronous video sessions were used to coach parents on the learning goals devised for the children. Both qualitative and quantitative data were collected to understand the acceptability of using telepractice and the outcomes achieved. A low dropout rate and positive feedback from parents indicated that they perceived telepractice sessions to be useful. The factors contributing to parents’ satisfaction were identified. Although the use of telepractice would be a good alternative for caregivers in any future lockdowns, it could also be used in conjunction with daycare center services to encourage greater parental participation, or with families living in areas with no day centers. Further studies are needed to compare telepractice to usual daycare face-to-face interventions, and to document its impact and cost-effectiveness for parents and children.

A One-Session Treatment of PTSD After Single Sexual Assault Trauma. A Pilot Study of the WONSA MLI Project: A Randomized Controlled Trial.

Sexual abuse is a crime with devastating health consequences. Accessible, acceptable and affordable treatment of PTSD after sexual abuse is important. In this pilot study, a one-session PTSD treatment and a modified perspective to PTSD treatment is introduced. The aim of the study was to test the efficacy of one session of Modified Lifespan Integration (MLI) on reduction of symptoms of PTSD in individuals with PTSD after one sexual assault. This was a single-center, individually randomized waitlist-controlled treatment study with 1:1 allocation, with the intervention of one 90 - 140 minutes session of MLI and with post-treatment follow-up at 3 weeks (time point two). All participants were females, mean age 24, with PTSD symptoms after one sexual assault during the past 5 years. Exclusion criteria were poor understanding of Swedish, multiple traumas, active substance abuse, active psychosis, ADHD, or autism spectrum disorder. Of 135 interested participants, 38 were finally included, 36 completed baseline measures and were included in the intent to treat analyses and 33 were analyzed per protocol. The primary outcome was the difference between the two trial arms in mean PTSD symptoms as measured by the Impact of Event Scale Revised (IES-R) at time point two. In the intervention arm, 72% no longer scored PTSD in per-protocol analysis, compared to 6% in the waiting list arm. IES-R scores were on average halved in the intervention arm (F=21.37, P<0.001), but were essentially unchanged in the waiting list arm. No adverse effects or drop-outs were seen. One session of Modified Lifespan Integration was an effective treatment with a low drop-out rate for females aged 15-65 with PTSD after one sexual assault. Provided that this result can be replicated, MLI should be offered to these patients in clinical settings. Registration number NCT03141047 was given 03/25/2016 at ClinicalTrials.gov (https://register.clinicaltrials.gov/).

Adherence to Low-Fat, Vegan Diets in Individuals With Type 2 Diabetes: A Review.

Low-fat, vegan diets seem to be particularly effective for glycemic control and may significantly lower hemoglobin A1c levels in individuals with type 2 diabetes. However, health care providers report low levels of practice and argue that this diet is hard to follow. This controversy on the acceptability of low-fat vegan diets appears to be a significant barrier to its broader clinical implementation. This review investigated dropout and adherence rates in intervention studies using a low-fat vegan diet in individuals with type 2 diabetes. In contrast to the common belief that this diet is poorly accepted, this review suggests different findings. Dietary adherence appears to be good with approximately 50% of individuals meeting the criteria for high adherence in most studies. Adherence to a low-fat vegan diet was higher than adherence to conventional diets in several studies. Group support and regular supervision improve adherence. Moreover, relatively low dropout rates were found-indirectly indicating good acceptance and high patient interest in this particular dietary modification. Although this review has several important limitations, it appears inappropriate to associate low-fat, vegan diets with poor adherence in individuals with type 2 diabetes. With good and regular support, adherence rates are more than solid and physicians should advocate for this diet more frequently.

Factors associated with dropout in a lifestyle modification program for weight management in children and adolescents

BackgroundSignificant dropout rates remain a serious concern in pediatric weight control program, but few studies have identified predictors of dropout. AimsThe objective of the study is to identify factors associated with dropout from a pediatric lifestyle modification weight control program at different phases. MethodsData on overweight and obese participants (n = 242) aged 11–18 years in the Intervention for Childhood and Adolescent Obesity via Activity and Nutrition (ICAAN) study were collected at baseline, 6-months, and 24-months through self-report and a laboratory test. Logistic regression analysis was performed for those who dropped out during the first 6-months, and multivariate generalized estimating equation analysis identified longitudinal factors associated with those who dropped out after 24 months. ResultsLower family functioning (OR = 2.30, 95% CI [1.18−4.46]), exercise group (OR = 0.36, 95% CI [0.15−0.86]), lower initial attendance rate (OR = 6.09, 95% CI [2.94−12.6]), and non-self -referral pathways (OR = 2.35, 95% CI [1.05−5.27]) were significantly associated with 6-month dropouts. For late dropout, lower family functioning (OR = 1.71, 95% CI [1.06−2.77]) and lower initial attendance rates (OR = 2.06, 95% CI [1.12−3.81]) remained significant. ConclusionFamily function and initial attendance rate were associated with lower dropout rates. Developing a supportive family environment and focusing on the early-stage factors at the intervention’s outset may reduce overall dropout rates in obesity prevention intervention.

Imagery rescripting and eye movement desensitisation and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: randomised clinical trial.

Investigation of treatments that effectively treat adults with post-traumatic stress disorder from childhood experiences (Ch-PTSD) and are well tolerated by patients is needed to improve outcomes for this population. The purpose of this study was to compare the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR), for treating Ch-PTSD. We conducted an international, multicentre, randomised clinical trial, recruiting adults with Ch-PTSD from childhood trauma before 16 years of age. Participants were randomised to treatment condition and assessed by blind raters at multiple time points. Participants received up to 12 90-min sessions of either ImRs or EMDR, biweekly. A total of 155 participants were included in the final intent-to-treat analysis. Drop-out rates were low, at 7.7%. A generalised linear mixed model of repeated measures showed that observer-rated post-traumatic stress disorder (PTSD) symptoms significantly decreased for both ImRs (d = 1.72) and EMDR (d = 1.73) at the 8-week post-treatment assessment. Similar results were seen with secondary outcome measures and self-reported PTSD symptoms. There were no significant differences between the two treatments on any standardised measure at post-treatment and follow-up. ImRs and EMDR treatments were found to be effective in treating PTSD symptoms arising from childhood trauma, and in reducing other symptoms such as depression, dissociation and trauma-related cognitions. The low drop-out rates suggest that the treatments were well tolerated by participants. The results from this study provide evidence for the use of trauma-focused treatments for Ch-PTSD.