Reasons For Dropout Research Articles

Integrated low-intensity biofeedback therapy in fecal incontinence: evidence that "good" in-home anal sphincter exercise practice makes perfect.

Biofeedback therapy (BFT) is an established treatment for fecal incontinence (FI), with access often being restricted to tertiary centers due to resources and the perceived requirement for high-intensity regimes. However, the optimal regime remains unknown. We evaluated outcomes from our low-intensity integrated BFT program in a secondary care center. Outcomes of our BFT service for FI were evaluated retrospectively. Response was defined by ≥50% improvement in FI frequency from baseline or complete continence. Responders were compared to non-responders for factors including symptoms, manometry data, sphincter exercise technique and duration of practice, and the number and frequency of sessions. Where patients dropped out, outcomes and the reason for dropout were obtained retrospectively. Fecal incontinence patients (n=205, median 62years, 72% female) attended a median (IQR) 3 (2) BFT sessions with 55 (36) days between visits. Overall, 146/205 (71%) responded with 97/205 (47%) achieving continence. Fecal incontinence frequency improved dramatically in completed cases (P=0.000). While non-response was associated with males (P=0.03) and dropout (P=0.000), "good" anal sphincter exercise technique (P=0.008) and longer in-home practice (P=0.007) and more sessions (P=0.04) were associated with response. Dropout rate was 80/205 (39%), with the reason for dropout being obtained in 80%. Despite low-intensity BFT, comparable outcomes to data from tertiary centers were achieved. Our data emphasize the importance of technique and in-home practice of anal sphincter exercises. Customizing BFT intensity based on predictive factors and encouraging in-home practice may optimize outcomes, reduce dropout rates, and rationalize resources.

Deserción y rezago académico en el programa de medicina de la Universidad del Rosario, Bogotá, Colombia

Introduction: Dropout and graduation delay in higher education programs are a major problemworldwide, therefore also in Colombia, where it affects about 50 % of the students, a fact thatproduces a high personal, social and economic impact. Objective: To describe the characteristics of the dropout and graduation delay of Medical School students at the El Rosario University, and its associated variables. Materials and methods: A retrospective, descriptive study of the two cohorts admitted in 2003 and of the academic information of students enrolled during the years 2003 through 2008 was performed. Data were analyzed from longitudinal and transversal perspectives. Results: Longitudinal analysis showed that both cohorts admitted in 2003 had a dropout rate of 47 % and 36 %, graduation delay of 29 % and 36 %;and 22 % and 19 % of the students, respectively, obtained their degree in the expected time. The mean dropout per academic period between 2003 and 2008 was 7.1 %. The main reason for dropout was academic failure. Discussion: The dropout and graduation delay rates in the traditional curriculum of the Medical School between 2003 and 2008 were high, similar to those found in higher education in Colombia. Among the complexity that characterizes this phenomenon, teaching strategies and academic and curricular aspects seem to play a major role. This historical cohort and the associated dropout indicators will serve as a basis for comparison for the new curriculum of the Medical School program recently established.

Evaluation of a Public Awareness Campaign to Prevent High School Dropout.

Many advocacy organizations devote time and resources to increasing community awareness and educating the public in an effort to gain support for their issue. One such effort, the Dropout Prevention Campaign by America's Promise Alliance, aimed to increase the visibility of the high school dropout problem and mobilize the community to take action. The objective of this paper is to evaluate the framing of the Dropout Prevention Campaign in television news media. To evaluate this campaign, television news coverage about high school dropout in 12 U.S. communities (N=982) was examined. A content analysis of news transcripts was conducted and coded to determine the definition of the problem, the reasons for dropout and the possible solutions. Findings indicated that the high school dropout problem was most often framed (30% of news segments) in terms of the economic and societal implications for the community. Individual student factors as well as broader societal influences were frequently discussed as possible reasons for dropout. The most commonly mentioned solutions were school-based interventions. News segments that mentioned America's Promise Alliance were more likely to frame the issue as a crisis and to use statistics to illustrate that point. Solutions that were more likely to appear in America's Promise segments promoted community and cross-sector involvement, consistent with the messages promoted by the Dropout Prevention Campaign. The findings suggest that a media content analysis can be an effective framework for analyzing a prevention campaign.

Study Habits in Relation to Socio-Economic Status and Gender among Muslim Adolescents

ABSTRACT: Students’ educational outcome is greatly influenced by number of factors. Study habits of students and their parental socio-economic status are two such correlates of academic achievement, which have been studied repeatedly during the past five decades. According to D.P. Smith (1961) study, habits included student’s habits of concentration, note taking, time budgeting, and study method. Research studies indicate that academic achievement of Muslim adolescents in India at secondary level is far behind than their Non-Muslim counter parts and poor academic performance is one of the reasons of school dropouts. The present research is a humble attempt to examine the study habits of Muslim adolescents belonging to different socio-economic strata of the society. The study is descriptive and statistical in nature. Standardized scales have been used to collect the data from a sample of 208 Muslim students. The data was subjected to statistical analysis by applying Mean (M), Standard Deviation (SD), product moment correlation (r), and t-test. Findings of the study indicate that significant difference exists in the study habits of Muslim adolescents in relation to gender, significant and positive relationship exists between study habits and socio-economic status. High SES (Socio-Economic Status) and Low SES Muslim adolescents and similarly Middle SES and Low SES Muslim adolescents differed significantly with regard to their study habits where in both the cases going in favour of the upper SES groups. KEY WORDS: Study habits, socio-economic status, Muslim, adolescents, gender, academic achievement, secondary level, and significant difference exist. About the Authors: Dr. Nabi Ahmad and B. Razia are Professor and Research Scholar at the Department of Education AMU (Aligarh Muslim University) in Aligarh, Uttar Pradesh, India. For academic purposes, the authors can be contacted via e-mails at: nabiahmad@rediffmail.com and razianaushad.amu@gmail.com How to cite this article? Ahmad, Nabi & B. Razia. (2015). “Study Habits in Relation to Socio-Economic Status and Gender among Muslim Adolescents” in EDUCARE: International Journal for Educational Studies , Vol.8(1) August, pp.73-80. Bandung, Indonesia: Minda Masagi Press and UMP Purwokerto, ISSN 1979-7877. Chronicle of the article: Accepted (July 6, 2015); Revised (August 6, 2015); and Published (August 25, 2015).

Early rheumatoid arthritis treated with tocilizumab, methotrexate, or their combination (U-Act-Early): a multicentre, randomised, double-blind, double-dummy, strategy trial

For patients with newly diagnosed rheumatoid arthritis, treatment aim is early, rapid, and sustained remission. We compared the efficacy and safety of strategies initiating the interleukin-6 receptor-blocking monoclonal antibody tocilizumab with or without methotrexate (a conventional synthetic disease-modifying antirheumatic drug [DMARD]), versus initiation of methotrexate monotherapy in line with international guidelines. We did a 2-year, multicentre, randomised, double-blind, double-dummy, strategy study at 21 rheumatology outpatient departments in the Netherlands. We included patients who had been diagnosed with rheumatoid arthritis within 1 year before inclusion, were DMARD-naive, aged 18 years or older, met current rheumatoid arthritis classification criteria, and had a disease activity score assessing 28 joints (DAS28) of at least 2·6. We randomly assigned patients (1:1:1) to start tocilizumab plus methotrexate (the tocilizumab plus methotrexate arm), or tocilizumab plus placebo-methotrexate (the tocilizumab arm), or methotrexate plus placebo-tocilizumab (the methotrexate arm). Tocilizumab was given at 8 mg/kg intravenously every 4 weeks with a maximum of 800 mg per dose. Methotrexate was started at 10 mg per week orally and increased stepwise every 4 weeks by 5 mg to a maximum of 30 mg per week, until remission or dose-limiting toxicity. We did the randomisation using an interactive web response system. Masking was achieved with placebos that were similar in appearance to the active drug; the study physicians, pharmacists, monitors, and patients remained masked during the study, and all assessments were done by masked assessors. Patients not achieving remission on their initial regimen switched from placebo to active treatments; patients in the tocilizumab plus methotrexate arm switched to standard of care therapy (typically methotrexate combined with a tumour necrosis factor inhibitor). When sustained remission was achieved, methotrexate (and placebo-methotrexate) was tapered and stopped, then tocilizumab (and placebo-tocilizumab) was also tapered and stopped. The primary endpoint was the proportion of patients achieving sustained remission (defined as DAS28 <2·6 with a swollen joint count ≤four, persisting for at least 24 weeks) on the initial regimen and during the entire study duration, compared between groups with a two-sided Cochran-Mantel-Haenszel test. Analysis was based on an intention-to-treat method. This trial was registered at ClinicalTrials.gov, number NCT01034137. Between Jan 13, 2010, and July 30, 2012, we recruited and assigned 317 eligible patients to treatment (106 to the tocilizumab plus methotrexate arm, 103 to the tocilizumab arm, and 108 to the methotrexate arm). The study was completed by a similar proportion of patients in the three groups (range 72-78%). The most frequent reasons for dropout were adverse events or intercurrent illness: 27 (34%) of dropouts, and insufficient response: 26 (33%) of dropouts. 91 (86%) of 106 patients in the tocilizumab plus methotrexate arm achieved sustained remission on the initial regimen, compared with 86 (84%) of 103 in the tocilizumab arm, and 48 (44%) of 108 in the methotrexate arm (relative risk [RR] 2·00, 95% CI 1·59-2·51 for tocilizumab plus methotrexate vs methotrexate, and 1·86, 1·48-2·32 for tocilizumab vs methotrexate, p<0·0001 for both comparisons). For the entire study, 91 (86%) of 106 patients in the tocilizumab plus methotrexate arm, 91 (88%) of 103 in the tocilizumab arm, and 83 (77%) of 108 in the methotrexate arm achieved sustained remission (RR 1·13, 95% CI 1·00-1·29, p=0·06 for tocilizumab plus methotrexate vs methotrexate, 1·14, 1·01-1·29, p=0·0356 for tocilizumab vs methotrexate, and p=0·59 for tocilizumab plus methotrexate vs tocilizumab). Nasopharyngitis was the most common adverse event in all three treatment groups, occurring in 38 (36%) of 106 patients in the tocilizumab plus methotrexate arm, 40 (39%) of 103 in the tocilizumab arm, and 37 (34%) of 108 in the methotrexate arm. The occurrence of serious adverse events did not differ between the treatment groups (17 [16%] of 106 patients in the tocilizumab plus methotrexate arm vs 19 [18%] of 103 in the tocilizumab arm and 13 [12%] of 108 in the methotrexate arm), and no deaths occurred during the study. For patients with newly diagnosed rheumatoid arthritis, strategies aimed at sustained remission by immediate initiation of tocilizumab with or without methotrexate are more effective, and with a similar safety profile, compared with initiation of methotrexate in line with current standards. Roche Nederland BV.

Evaluation of immunization status and factors responsible for drop outs in primary immunization in children between 1-2 years – a hospital based study

Introduction: Immunization programme has been a major cost-effective public health intervention for child survival. Despite implementation of immunization programme since 1978 by Govt of India (GOI), the coverage of immunization is not satisfactory due to various socio economic factors influencing vaccination coverage. Aim: To determine the coverage and to identify the various factors influencing primary immunization in children. Methods: Hospital based cross sectional study was conducted from January 2012 to September 2013 by interviewing parents of 2000 children of 1-2 yr age attending OPD and Children`s ward in Govt General Hospital, Kakinada, AP. Socio demographic factors and details of immunization status of the children and the reasons for dropouts were noted. The child who received all primary doses of BCG, DPT, Hepatitis B, OPV and Measles mentioned in National immunization schedule is considered fully immunised. Child who missed even a single dose and who did not receive even a single dose of any vaccine is considered partially immunised and un-immunised respectively. Percentages and Chi square test were used for statistical analysis. Results: Overall, 1810 were fully immunised (90.5%), 186 were partially immunised (9.3%) and 4 were unimmunised. Type of family and education of parents had a significant role in the immunization coverage of children whereas gender, religion and residence of children were not found to have significant impact on immunization status. Unwell child, lack of knowledge and migration to other places were found to be major contributing factors for poor immunization. Conclusion: Regular health education of all sections of the community especially the mothers to increase awareness of childhood immunization and addressing the issues of dropouts and poor accessibility is urgently required for better and equitable coverage of across all regions of the country.

Modelling variable dropout in randomised controlled trials with longitudinal outcomes: application to the MAGNETIC study.

BackgroundClinical trials with longitudinally measured outcomes are often plagued by missing data due to patients withdrawing or dropping out from the trial before completing the measurement schedule. The reasons for dropout are sometimes clearly known and recorded during the trial, but in many instances these reasons are unknown or unclear. Often such reasons for dropout are non-ignorable. However, the standard methods for analysing longitudinal outcome data assume that missingness is non-informative and ignore the reasons for dropout, which could result in a biased comparison between the treatment groups.MethodsIn this article, as a post hoc analysis, we explore the impact of informative dropout due to competing reasons on the evaluation of treatment effect in the MAGNETIC trial, the largest randomised placebo-controlled study to date comparing the addition of nebulised magnesium sulphate to standard treatment in acute severe asthma in children. We jointly model longitudinal outcome and informative dropout process to incorporate the information regarding the reasons for dropout by treatment group.ResultsThe effect of nebulised magnesium sulphate compared with standard treatment is evaluated more accurately using a joint longitudinal-competing risk model by taking account of such complexities. The corresponding estimates indicate that the rate of dropout due to good prognosis is about twice as high in the magnesium group compared with standard treatment.ConclusionsWe emphasise the importance of identifying reasons for dropout and undertaking an appropriate statistical analysis accounting for such dropout. The joint modelling approach accounting for competing reasons for dropout is proposed as a general approach for evaluating the sensitivity of conclusions to assumptions regarding missing data in clinical trials with longitudinal outcomes.Trial registrationEudraCT number 2007-006227-12. Registration date 18 Mar 2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1342-0) contains supplementary material, which is available to authorized users.

Impact of physical activity domains on subsequent physical activity in youth: a 5-year longitudinal study

ABSTRACTThis study evaluates how domains of physical activity (PA) in youth predict later PA and assesses factors influencing changes in sports participation. Young people from the Children’s Sport Participation and Physical Activity study (n = 873; baseline age 10–18 years; 30.4% male) completed self-report surveys in 2009 and 2014. In a multiple linear regression analysis, participation frequency in club sport (β = 0.18) and extracurricular sport (β = 0.13) significantly predicted PA 5 years later, adjusted for age, sex and urban/rural classification (P < 0.01). Overall, rates of regular (at least once per week) youth sports participation were high (males 79.3–85.5%; females 74.8–83.2%). Uptake and dropout of specific sports varied widely. Despite high levels of migration into and out of Gaelic games, they remained popular at follow-up. Weight training was the only sport that increased in both sexes (P < 0.05). Fitness, friends and enjoyment were top motivations for taking up a new sport. Other commitments, a lack of interest and time were important factors leading to sports dropout. PA promotion strategies should include youth sport, take into consideration what sports are attractive to young people and address reasons for uptake and dropout.

A randomized controlled trial of two simple mind-body programs, Kirtan Kriya meditation and music listening, for adults with subjective cognitive decline: Feasibility and acceptability

Purpose of the studyIn this randomized controlled trial (RCT), we assessed the feasibility and acceptability of two simple home-based relaxation programs in adults experiencing subjective cognitive decline, a strong predictor of Alzheimer's disease. Design and methodsSixty participants were randomized to a beginner Kirtan Kriya meditation (KK) program or a music listening (ML) program. Participants were asked to practice 12min daily for the first 12 weeks, then as often as they liked for the following 3 months. Participants underwent assessments at baseline, 12 weeks, and 6 months to evaluate changes in key outcomes. Feasibility and acceptability were evaluated by measuring recruitment and retention rates, assessment visit attendance, practice adherence, and treatment expectancy; exit questionnaires completed at 12 weeks and 6 months provided additional data regarding participant experience with the study, perceived barriers to and facilitators of practice, reasons for drop-out, and views regarding the assigned intervention. ResultsFifty-three participants (88%) completed the 6 month study. Adherence in both groups was excellent, with participants completing 93% (91% KK, 94% ML) of sessions on average in the first 12 weeks, and 71% (68% KK, 74% ML) during the 3 month, practice-optional, follow-up period. At week 12, over 80% of participants indicated they were likely to continue practicing following study completion. Responses to both structured and open-ended exit questionnaire items also suggested high satisfaction with both programs. ConclusionsFindings of this RCT of a beginner meditation practice and a simple ML program suggest that both programs were well accepted and the practices are feasible in adults with early memory loss.

Chronic disease risks and use of a smartphone application during a physical activity and dietary intervention in Australian truck drivers

ObjectiveThis study examined chronic disease risks and the use of a smartphone activity tracking application during an intervention in Australian truck drivers (April‐October 2014). MethodsForty‐four men (mean age=47.5 [SD 9.8] years) completed baseline health measures, and were subsequently offered access to a free wrist‐worn activity tracker and smartphone application (Jawbone UP) to monitor step counts and dietary choices during a 20‐week intervention. Chronic disease risks were evaluated against guidelines; weekly step count and dietary logs registered by drivers in the application were analysed to evaluate use of the Jawbone UP. ResultsChronic disease risks were high (e.g. 97% high waist circumference [≥94 cm]). Eighteen drivers (41%) did not start the intervention; smartphone technical barriers were the main reason for drop out. Across 20‐weeks, drivers who used the Jawbone UP logged step counts for an average of 6 [SD 1] days/week; mean step counts remained consistent across the intervention (weeks 1–4=8,743[SD 2,867] steps/day; weeks 17–20=8,994[SD 3,478] steps/day). The median number of dietary logs significantly decreased from start (17 [IQR 38] logs/weeks) to end of the intervention (0 [IQR 23] logs/week; p<0.01); the median proportion of healthy diet choices relative to total diet choices logged increased across the intervention (weeks 1–4=38[IQR 21]%; weeks 17–20=58[IQR 18]%). ConclusionsStep counts were more successfully monitored than dietary choices in those drivers who used the Jawbone UP. ImplicationsSmartphone technology facilitated active living and healthy dietary choices, but also prohibited intervention engagement in a number of these high‐risk Australian truck drivers.

Predictors of Safety and Efficacy of 2-Stage Hepatectomy for Bilateral Colorectal Liver Metastases

In patients with bilateral colorectal liver metastases (CLM) not resectable in 1 operation, 2-stage hepatectomy is the standard surgical approach. The objective of this study was to determine factors associated with safety and efficacy of 2-stage hepatectomy. The study included all 109 patients for whom 2-stage hepatectomy for CLM was planned during 2003 to 2014. The RAS mutation status and other clinicopathologic factors were evaluated for association with major complications and survival using multivariate analysis. Two-stage hepatectomy was completed in 89 of 109 patients (82%). Reasons for dropout after the first stage were disease progression (n= 12), insufficient liver growth (n= 5), and complications after first stage or portal vein embolization (n= 3). More than 6 cycles of preoperative chemotherapy were associated with failure to proceed to the second stage (p= 0.009). Rates of major complications (26% vs 6%; p < 0.001) and 90-day mortality (7% vs 0%; p= 0.006) were higher after the second stage. The cumulative rate of major complications was 15% (n= 29). Factors independently associated with major complications were rectal primary tumor, metachronous CLM, and more than 1 lesion resected at first stage. At median follow-up of 29.5 months, 3-year (68% vs 6%; p < 0.001) and 5-year overall survival rates (49% vs 0%; p < 0.001) were better after 2-stage hepatectomy completion than noncompletion. Factors independently associated with poor overall survival were rectal primary tumor (p= 0.044), more than 5 CLMs (p= 0.043), need for chemotherapy after first stage (p= 0.046), and RAS mutation (p < 0.001). The RAS mutation independently predicts the oncologic efficacy of 2-stage hepatectomy and may help guide patient selection for this aggressive surgical strategy.

A Guided Online and Mobile Self-Help Program for Individuals With Eating Disorders: An Iterative Engagement and Usability Study.

BackgroundNumerous digital health interventions have been developed for mental health promotion and intervention, including eating disorders. Efficacy of many interventions has been evaluated, yet knowledge about reasons for dropout and poor adherence is scarce. Most digital health intervention studies lack appropriate research design and methods to investigate individual engagement issues. User engagement and program usability are inextricably linked, making usability studies vital in understanding and improving engagement.ObjectiveThe aim of this study was to explore engagement and corresponding usability issues of the Healthy Body Image Program—a guided online intervention for individuals with body image concerns or eating disorders. The secondary aim was to demonstrate the value of usability research in order to investigate engagement.MethodsWe conducted an iterative usability study based on a mixed-methods approach, combining cognitive and semistructured interviews as well as questionnaires, prior to program launch. Two separate rounds of usability studies were completed, testing a total of 9 potential users. Thematic analysis and descriptive statistics were used to analyze the think-aloud tasks, interviews, and questionnaires.ResultsParticipants were satisfied with the overall usability of the program. The average usability score was 77.5/100 for the first test round and improved to 83.1/100 after applying modifications for the second iteration. The analysis of the qualitative data revealed five central themes: layout, navigation, content, support, and engagement conditions. The first three themes highlight usability aspects of the program, while the latter two highlight engagement issues. An easy-to-use format, clear wording, the nature of guidance, and opportunity for interactivity were important issues related to usability. The coach support, time investment, and severity of users’ symptoms, the program’s features and effectiveness, trust, anonymity, and affordability were relevant to engagement.ConclusionsThis study identified salient usability and engagement features associated with participant motivation to use the Healthy Body Image Program and ultimately helped improve the program prior to its implementation. This research demonstrates that improvements in usability and engagement can be achieved by testing and adjusting intervention design and content prior to program launch. The results are consistent with related research and reinforce the need for further research to identify usage patterns and effective means for reducing dropout. Digital health research should include usability studies prior to efficacy trials to help create more user-friendly programs that have a higher likelihood of “real-world” adoption.

A non-response analysis of 2-year data in the Swedish Knee Ligament Register.

To analyse the non-response group in the Swedish Knee Ligament Register (SKLR). All 3588 patients in the SKLR who had undergone anterior cruciate ligament surgery in 2010 were included. Respondents (n=1865) and non-respondents (n=1723) at the 2-year follow-up survey were assessed for potential differences in demographics and baseline data. KOOS/EQ5D questionnaires were sent to non-respondents together with a non-response survey asking questions about reasons for dropout. Respondents had a significantly higher mean age (27.8years, range 9-64) than non-respondents (25.9years, range 12-65) (p<0.001). Women had a higher rate of response 927 (62.8%) than men 938 (44.4%) even after correction for age (p<0.001). Alpine/telemark skiing was the only activity at time of injury that showed higher rate of respondents 280 (62.5%) compared to non-respondents 168 (37.5%) (p<0.001). No differences in EQ5D at 2-year follow-up were found between the groups. The change in KOOS from 0 to 2years showed difference in the subscale pain with 9.4 in the response group compared to 6.3 in the late-response group (p<0.05) and the subscale quality of life with a difference of 26.1 and 22.6, respectively (p<0.05). The non-response questionnaire showed shortcomings in patient information regarding the importance of the SKLR. The register is valid concerning baseline surgical data, but higher age, female gender and perhaps higher socioeconomic status improve the response rates. KOOS showed small differences of questionable clinical significance. The SKLR patient information could be improved. Retrospective comparative study, Level III.

A follow-up study of patients with Dhat syndrome: Treatment pattern, outcome, and reasons for dropout from treatment.

Aim:The aim of this study was to evaluate the treatment pattern and satisfaction with treatment provided to patients with Dhat syndrome. It was also aimed to study the follow-up rates and reasons for dropping out of treatment in patients with Dhat syndrome.Materials and Methods:Sixty-four subjects diagnosed with Dhat syndrome were prospectively contacted to evaluate treatment satisfaction and reason for dropout after 6 months of baseline evaluation. Sociodemographic, clinical details were recorded at initial intake and Sex Knowledge and Attitude Questionnaire was applied. After 6 months, information on treatment received, number of follow-up visits to the clinic and the outcome were extracted from the treatment records. Treatment satisfaction using Patient Satisfaction Questionnaire and reasons for dropping out from treatment were assessed by a telephonic interview.Results:Twenty-three patients were categorized as treatment completers, 14 as early drop-outs and 27 as late drop-out. The mean (standard deviation) number of visits over the period of 6 months was 3.81 (3.06). The outcome at 6 months was no change in 45.3%, improved in 32.8% and recovered in 21.9%. Higher proportion of treatment completers (52.2%) sought psychiatric help on their own compared to those who dropped out early from the treatment (7.1%). Treatment completers had better knowledge, and more positive attitude toward sex compared to late drop-out group. 34.4%of the subjects were fully satisfied with the various components of treatment. Level of satisfaction was highest for treatment completers. The most common reasons given by those who dropped out early were “not able to spare time for consultation” (21.4%) and “not prescribed medications” (21.4%). The most common reason given by those belonging to “late drop-out” group was ‘no improvement with treatment in symptoms of Dhat syndrome (40.7%).Conclusions:Patients with Dhat syndrome frequently drop-out of the treatment network. There is a need to reorganize the services for these patients and understand their expectations from the treatment so as to provide better care.

A Health Clinic for the Severely Mentally Ill at a Community Mental Health Centre: A Danish Pilot Study

Aim: In this study it was aimed to pilot testing a Danish health clinic in a community mental health centre where patients with severe mental illness (SMI) and increased risk of developing fatal coronary heart disease are offered screening and prevention by a primary care physician and nurse. Methods: 19 patients (16 with schizophrenia and 3 with affective illnesses) out of a total of 22 fulfilled the inclusion criteria. In all, 15(79%) patients were included in the project, which encompassed four consultations over a 12-week period. At each of the four consultations, lifestyle interventions were performed. A total of 12(63%) patients completed all four consultations. Reasons for dropout were investigated. At the first and last consultation, data were collected in order to assess the risk of developing fatal cardiovascular disease. Results: All patients attending the health clinic were screened. Among the 12 patients who completed, several known risk factors for the development of fatal cardiovascular disease were reduced, including a reduction in smoking. Other effects were increased physical activity and a healthier diet. Two patients received medical treatment for hypertension and hypercholesterolemia, respectively. Conclusions: On-site, integrated primary care in a community mental health clinic was associated with improved quality of medical care for SMI patients. It was possible to recruit and retain the patients in a health clinic. There was a positive effect on risk factors for the development of cardiovascular disease, but the results must be interpreted with caution as it is a pilot study.

Perceptions of Barriers to and Facilitators of Participation in Health Research Among Transgender People.

Purpose: Although transgender people may be at increased risk for a range of health problems, they have been the subject of relatively little health research. An important step toward expanding the evidence base is to understand and address the reasons for nonparticipation and dropout. The aim of this study was to explore the perceptions of barriers to and facilitators of participation in health research among a sample of transgender people in San Francisco, CA, and Atlanta, GA.Methods: Twelve in-person focus groups (FGs) were conducted; six (three with transwomen, three with transmen) were conducted in San Francisco and six FGs were conducted in Atlanta (three with transwomen and three with transmen). FGs were audiorecorded, transcribed, and uploaded to MaxQDA software for analysis. A codebook was used to code transcripts; new codes were added iteratively as they arose. All transcripts were coded by at least 2 of the 4 researchers and, after each transcript was coded, the researchers met to discuss any discrepancies, which were resolved by consensus.Results: Among 67 FG participants, 37 (55%) identified as transmen and 30 (45%) identified as transwomen. The average age of participants was ∼41 years (range 18–67) and the majority (61%) were non-Hispanic Whites. Several barriers that can hinder participation in health research were identified, including logistical concerns, issues related to mistrust, a lack of awareness about participation opportunities, and psychosocial/emotional concerns related to being “outed.” A broad range of facilitators were also identified, including the opportunity to gain knowledge, access medical services, and contribute to the transgender community.Conclusion: These findings provide insights about the perceived barriers to and facilitators of research participation and offer some guidance for researchers in our ongoing effort to engage the transgender community in health research.

Study of University Dropout Reason Based on Survival Model

In this paper, we introduce the survival modelling methodology in order to identify some factors which may be influencing the university dropout. By using the data base provided by the Fundación Universidad Autónoma de Colombia and the semi parametric proportional hazard Cox model, we have been able to identify these risk factors.

Dropping Out of Rural China's Secondary Schools: A Mixed-methods Analysis

AbstractStudents in rural China are dropping out of secondary school at troubling rates. While there is considerable quantitative research on this issue, no systematic effort has been made to assess the deeper reasons behind student decision making through a mixed-methods approach. This article seeks to explore the prevalence, correlates and potential reasons for rural dropout throughout the secondary education process. It brings together results from eight large-scale survey studies covering 24,931 rural secondary students across four provinces, as well as analysis of extensive interviews with 52 students from these same study sites. The results show that the cumulative dropout rate across all windows of secondary education may be as high as 63 per cent. Dropping out is significantly correlated with low academic performance, high opportunity cost, low socio-economic status and poor mental health. A model is developed to suggest that rural dropout is primarily driven by two mechanisms: rational cost-benefit analysis or impulsive, stress-induced decision making.

Light therapy for preventing seasonal affective disorder.

Light therapy for preventing seasonal affective disorder.

Sensitivity analyses for partially observed recurrent event data.

Recurrent events involve the occurrences of the same type of event repeatedly over time and are commonly encountered in longitudinal studies. Examples include seizures in epileptic studies or occurrence of cancer tumors. In such studies, interest lies in the number of events that occur over a fixed period of time. One considerable challenge in analyzing such data arises when a large proportion of patients discontinues before the end of the study, for example, because of adverse events, leading to partially observed data. In this situation, data are often modeled using a negative binomial distribution with time-in-study as offset. Such an analysis assumes that data are missing at random (MAR). As we cannot test the adequacy of MAR, sensitivity analyses that assess the robustness of conclusions across a range of different assumptions need to be performed. Sophisticated sensitivity analyses for continuous data are being frequently performed. However, this is less the case for recurrent event or count data. We will present a flexible approach to perform clinically interpretable sensitivity analyses for recurrent event data. Our approach fits into the framework of reference-based imputations, where information from reference arms can be borrowed to impute post-discontinuation data. Different assumptions about the future behavior of dropouts dependent on reasons for dropout and received treatment can be made. The imputation model is based on a flexible model that allows for time-varying baseline intensities. We assess the performance in a simulation study and provide an illustration with a clinical trial in patients who suffer from bladder cancer.