Chewing Ability and the Quality of Life: A Cross-Sectional Study to Assess the Relationship Between Tooth Wear and Oral Health

INTRODUCTION

It is important to understand how a very common prevalent condition of tooth wear (TW) impacts a person's day-to-day oral health. An emerging concept of measuring the parameter of oral health-related quality of life (OHRQoL), which evidently impacts the daily living of a person, makes it practical to examine the correlation between TW and OHRQoL. For measuring the OHRQoL, we can apply various methods, and the most effective is the use of the Oral Health Impact Profile (OHIP) questionnaire. Accordingly, the aim of this study was to assess the correlation between TW and the OHRQoL among adult patients attending a dental college and hospital.

METHODS

A cross-sectional research was performed on patients who visited the outpatient department of Teerthanker Mahaveer Dental College and Research Centre, Moradabad, India. Initially, the sociodemographic details of patients, including their oral hygiene and dietary habits, were recorded. This step was followed by the assessment of TW using the Smith and Knight TW index. Then, the translated and validated version of the OHIP questionnaire was filled up, in which the patients were asked to rate each question on a Likert scale, with five points ranging from 0 to 4, where 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, and 4 = very often.

RESULTS

Based on a clinical examination on 630 subjects and the OHIP questionnaire responses from the participants, a significantly remarkable association (p ≤ 0.05) was found using a chi-square test between TW and the OHRQoL. In particular, TW was linked to other sociodemographic data and various lifestyle, dietary, and drinking habits. Along with the OHRQoL, TW also showed a positive correlation with gender. Using the chi-square test, a statistically significant association between age and TW was observed, with p-value = 0.004. Meanwhile, the place of residence did not show any association with TW. Educational qualifications of patients, visits to dental clinics, and reasons for dental visits showed very significant association with TW. Oral hygiene aids, materials used, frequency of brushing, and brushing technique did not have any association with TW as per the results obtained. A highly significant association was found between consumption of fruit drinks, citric drinks, and beverages and TW in the adult patients. Among all the domains of the OHIP questionnaire, the physical pain domain was the most affected, followed by the physical disability domain.

CONCLUSION

We conclude that TW has a direct association and positive correlation with the OHRQoL. As TW was increasing, so were the OHIP values, which indicated a lesser OHRQoL. The study also presents information on how to maintain a regular and healthy dietary lifestyle and oral hygiene to combat the impacts of TW.

Incidence and predictors of attrition among adults receiving first line anti-retroviral therapy at public health facility in Adea Berga district, Oromia, Ethiopia

Background

According to current estimates, there are 665,723 people in Ethiopia who have human immunodeficiency syndrome. As Ethiopia inches closer to attaining the 95/95/95 targets for treatment coverage and reaching epidemic control, however, attrition from anti-retroviral treatment is still one of the key programmatic challenges.

Objective

To assess the incidence of attrition rate and its predictors among adult HIV patients receiving anti retro viral treatment at Public Health Facility in Adea Berga/Enchini District.

Method

A 6-year (June 28, 2015 to June 27, 2021) institution-based retrospective cohort study was used to recruit 540 study participants by using simple random sampling. Data were obtained from chart review, coded, entered into Epi Data, and exported to Stata 14.2 software for analysis. At least 1 month missed appointment is considered as attrition and the predictors of attrition were identified using bivariable and multivariable Cox proportional hazard models and an adjusted hazard ratio (AHR). Bivariate and multivariate analyses were conducted to find predictors of attrition, p-value < 0.05 was considered statistically significant.

Results

From the total 540 study participant, 158 (29.26%) patients were discontinuing from follow up making the incidence rate of attrition 9.50 per 100 person years .Being WHO clinical stage III or IV (AHR = 1.96,), non-practice of Appointment spacing model (AHR = 3.98), poor or fair ART adherence level (AHR = 6.47), age groups (15-24) years (AHR = 1.73) and Others ART linkage points[index case testing, tuberculosis clinic and referral from private/public health institutions] (AHR = 1.76) were significantly associated.

Conclusions

The study showed that the incidence of attrition among adults receiving antiretroviral therapy was high. Patient sociodemographic, clinical, and treatment-related factors were significantly associated with patients on ART.

Attrition and withdrawal in multiple myeloma randomized controlled trials: A systematic review

OBJECTIVES

Patients with multiple myeloma (MM) enrolled in randomized control trials (RCTs) discontinue treatment for various reasons; however, no prior study has analyzed reasons for discontinuation. We performed a systematic review of MM RCTs to investigate reasons for treatment discontinuation, imbalances between trial cohorts, and reporting practices.

METHODS

A comprehensive search for RCTs in MM from 2015 to 2021 identified 45 studies meeting inclusion criteria.

RESULTS

Of 21 236 randomized patients, 10 161 (47.8%) discontinued therapy by primary endpoint ascertainment. Causes of discontinuation included progression (n = 4790; 22.6% of randomized patients); toxicity (n = 2569; 12.1%); patient/physician withdrawal (n = 1200; 5.7%) and death (n = 495; 2.3%). Of randomized patients, 20 914 (98.5%) were included in the RCT analysis. Imbalances of attrition, defined as trials with greater than 5% absolute difference in discontinuation rate for reasons other than death, progression, and toxicity between intervention and control arms, were found in 11 (24.4%) studies.

CONCLUSIONS

Although progression is the most common reason for RCT treatment discontinuation in patients with MM, over 10% discontinued due to toxicity. Furthermore, 24.4% of trials showed substantial imbalances between trial cohorts; raising concern for informative censoring and emphasizes the importance of detailed characterization of withdrawal in MM RCTs.

Usage and Daily Attrition of a Smartphone-Based Health Behavior Intervention: Randomized Controlled Trial

BACKGROUND

Although most adolescents have access to smartphones, few of them use mobile health (mHealth) apps for health improvement, highlighting the apparent lack of interest in mHealth apps among adolescents. Adolescent mHealth interventions have been burdened with high attrition rates. Research on these interventions among adolescents has frequently lacked detailed time-related attrition data alongside analysis of attrition reasons through usage.

OBJECTIVE

The objective was to obtain daily attrition rates among adolescents in an mHealth intervention to gain a deeper understanding of attrition patterns, including the role of motivational support, such as altruistic rewards, through analysis of app usage data.

METHODS

A randomized controlled trial was conducted with 304 adolescent participants (152 boys and 152 girls) aged 13-15 years. Based on 3 participating schools, participants were randomly assigned to control, treatment as usual (TAU), and intervention groups. Measures were obtained at baseline, continuously throughout the 42-day trial period (research groups), and at the trial end. The mHealth app is called SidekickHealth and is a social health game with the following 3 main categories: nutrition, mental health, and physical health. Primary measures were attrition based on time from launch, and the type, frequency, and time of health behavior exercise usage. Outcome differences were obtained through comparison tests, while regression models and survival analyses were used for attrition measures.

RESULTS

Attrition differed significantly between the intervention and TAU groups (44.4% vs 94.3%; χ²₁=61.220; P<.001). The mean usage duration was 6.286 days in the TAU group and 24.975 days in the intervention group. In the intervention group, male participants were active significantly longer than female participants (29.155 vs 20.433 days; χ²₁=6.574; P<.001). Participants in the intervention group completed a larger number of health exercises in all trial weeks, and a significant decrease in usage was observed from the first to second week in the TAU group (t₁₀₅=9.208; P<.001) but not in the intervention group. There was a significant increase in health exercises in the intervention group from the fifth to sixth week (t₁₀₅=3.446; P<.001). Such a significant increase in usage was not evident in the TAU group. The research group was significantly related to attrition time (hazard ratio 0.308, 95% CI 0.222-0.420), as well as the numbers of mental health exercises (P<.001) and nutrition exercises (P<.001).

CONCLUSIONS

Differences in attrition rates and usage between groups of adolescents were identified. Motivational support is a significant factor for lowering attrition in adolescent mHealth interventions. The results point to sensitivity periods in the completion of diverse health tasks, and emphasis on time-specific attrition, along with the type, frequency, and time of health behavior exercise usage, is likely a fruitful avenue for further research on mHealth interventions for adolescent populations, in which attrition rates remain excessive.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05912439; https://clinicaltrials.gov/study/NCT05912439.

Comparisons of statistical methods for handling attrition in a follow-up visit with complex survey sampling

Design-based analysis, which accounts for the design features of the study, is commonly used to conduct data analysis in studies with complex survey sampling, such as the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). In this type of longitudinal study, attrition has often been a problem. Although there have been various statistical approaches proposed to handle attrition, such as inverse probability weighting (IPW), non-response cell weighting (NRCW), multiple imputation (MI), and full information maximum likelihood (FIML) approach, there has not been a systematic assessment of these methods to compare their performance in design-based analyses. In this article, we perform extensive simulation studies and compare the performance of different missing data methods in linear and generalized linear population models, and under different missing data mechanism. We find that the design-based analysis is able to produce valid estimation and statistical inference when the missing data are handled appropriately using IPW, NRCW, MI, or FIML approach under missing-completely-at-random or missing-at-random missing mechanism and when the missingness model is correctly specified or over-specified. We also illustrate the use of these methods using data from HCHS/SOL.

Student Dropout as a Never-Ending Evergreen Phenomenon of Online Distance Education

The research on student dropout demonstrates that there is no consensus on its definition and scope. Although there is an expanding collection of research on the topic, student dropout remains a significant issue, characterized by numerous uncertainties and ambiguous aspects. The primary aim of this investigation is to assess the research trends of student dropout within the distance education literature by employing data mining and analytic approaches. To identify these patterns, a total of 164 publications were examined by applying text mining and social network analysis. The study revealed some intriguing facts, such as the misinterpretation of the term "dropout" in different settings and the inadequacy of nonhuman analytics to explain the phenomenon, and promising implications on how to lessen dropout rates in open and distance learning environments. Based on the findings of the study, this article proposes possible directions for future research, including the need to provide a precise definition of the term "dropout" in the context of distance learning, to develop ethical principles, policies, and frameworks for the use of algorithmic approaches to predict student dropout, and finally, to adopt a human-centered approach aimed at fostering learners' motivation, satisfaction, and independence to reduce the rate of dropout in distance education.

Attrition in the Gothenburg H70 birth cohort studies, an 18-year follow-up of the 1930 cohort

Background

Longitudinal studies are essential to understand the ageing process, and risk factors and consequences for disorders, but attrition may cause selection bias and impact generalizability. We describe the 1930 cohort of the Gothenburg H70 Birth Cohort Studies, followed from age 70 to 88, and compare baseline characteristics for those who continue participation with those who die, refuse, and drop out for any reason during follow-up.

Methods

A population-based sample born 1930 was examined with comprehensive assessments at age 70 (N = 524). The sample was followed up and extended to increase sample size at age 75 (N = 767). Subsequent follow-ups were conducted at ages 79, 85, and 88. Logistic regression was used to analyze baseline characteristics in relation to participation status at follow-up.

Results

Refusal to participate in subsequent examinations was related to lower educational level, higher blood pressure, and lower scores on cognitive tests. Both attrition due to death and total attrition were associated with male sex, lower educational level, smoking, ADL dependency, several diseases, poorer lung function, slower gait speed, lower scores on cognitive tests, depressive symptoms, and a larger number of medications. Attrition due to death was also associated with not having a partner.

Conclusions

It is important to consider different types of attrition when interpreting results from longitudinal studies, as representativeness and results may be differently affected by different types of attrition. Besides reducing barriers to participation, methods such as imputation and weighted analyses can be used to handle selection bias.

The impact of treatment preferences: A narrative review

Attending to treatment preferences is an element of person-centred care, reported as beneficial in improving treatment adherence, satisfaction, and outcome, in practice. The results of preference trials were inconsistent in supporting these benefits in intervention evaluation research. Informed by the conceptualisation of treatment preferences positing their indirect impact on outcomes, this narrative review aimed to summarise the evidence on the effects of preferences on enrolment; withdrawal or attrition; engagement, enactment, and satisfaction with treatment; and outcomes. The search yielded 72 studies (57 primary trials and 15 reviews). The results of vote counting indicated that (1) offering participants the opportunity to choose treatment enhances enrolment (reported in 87.5% of studies), and (2) providing treatments that match participants' preferences reduces attrition (48%); enhances engagement (67%), enactment (50%) and satisfaction with (43%) treatment; and improves outcomes (35%). The results are attributed to conceptual and methodological issues including less-than-optimal assessment of treatment preferences, which contributes to ill-identified preferences, accounting for withdrawal, low enactment, and limited satisfaction with treatment. These treatment processes, in turn, mediate the impact of treatment preferences on outcomes. It is important to refine and standardise the methods for assessing preferences and to examine their indirect impact (mediated by treatment processes) on outcomes in future preference trials to validly identify their benefits.

Paramedic educational program attrition accounts for significant loss of potential EMS workforce

Objective

Recent concerns for the strength and stability of the emergency medical services (EMS) workforce have fueled interest in enhancing the entry of EMS clinicians into the workforce. However, the educational challenges associated with workforce entry remain unclear. Our objective was to evaluate the educational pathway of entry into the EMS workforce and to identify factors that lead to the loss of potential EMS clinicians.

Methods

This is a cross-sectional evaluation of all US paramedic educational programs, with enrolled students, in the 2019 Committee on Accreditation of Educational Programs for the EMS Professions annual report survey. This data set includes detailed program characteristics and metrics including program attrition rate (leaving before completion), and certifying exam pass rates. Descriptive statistics were calculated, and multivariable logistic regression analysis was conducted to evaluate the association between high program attrition rates (>30%) and program specific characteristics.

Results

In 2019, 640 accredited programs met inclusion with 17,457 students enrolled in paramedic educational programs. Of these, 13,884 students successfully graduated (lost to attrition, 3,573/17,457 [21%]) and 12,002 passed the certifying exam on the third attempt (lost to unable to certify, 1,882/17,457 [11%]). High program attrition rates were associated with longer programs (>12 months), small class sizes (<12 students), and regional locations.

Conclusions

Nearly 1 in 3 paramedic students were lost from the potentially available workforce either owing to attrition during the educational program or failure to certify after course completion. Attrition represented the largest loss, providing an avenue for future targeted research and interventions to improve EMS workforce stability.

Keeping children and youth in trauma treatment: Examination of an alliance building dropout management program

Evidence-based treatments exist to address traumatic stress related symptoms for children, however dropout from trauma-focused treatment remains a concern. This study examined use of an alliance building dropout management program for a group of children ages 3-17 who received an evidence-based trauma-focused treatment. Logistic regression analysis was conducted to examine the relationships between child gender, race, ethnicity, age, guardianship, externalizing behaviors, participation in a dropout management program and the dose of treatment received. The final model was significant and participation in the dropout management program as well as a child's placement in foster care were significant individual correlates with full completion of treatment. Use of an Alliance Building Dropout Management program may help decrease overall dropout over and above the contribution of other variables known to impact treatment completion.

Retention in care for type 2 diabetes management in Sub-Saharan Africa: A systematic review

OBJECTIVE

Diabetes prevalence has risen rapidly in Sub-Saharan Africa, but rates of retention in diabetes care are poorly understood. We conducted a systematic review and meta-analysis to determine rates of retention in care of persons with type 2 diabetes.

METHODS

We searched MEDLINE, Global Health and CINAHL online databases for cohort studies and randomised control trials (RCTs) published up to 12 October 2021, that reported retention in or attrition from care for patients with type 2 diabetes in Sub-Saharan Africa. Retention was defined as persons diagnosed with diabetes who were alive and in care or with a known outcome, while attrition was defined as loss from care.

RESULTS

From 6559 articles identified, after title and abstract screening, 209 articles underwent full text review. Forty six papers met the inclusion criteria, comprising 22,610 participants. Twenty one articles were of RCTs of which 8 trials had 1 year or more of follow-up and 25 articles were of non-randomised studies of which 19 had 12 months or more of follow-up. A total of 11 studies (5 RCTs and 6 non-randomised) were assessed to be of good quality. Sixteen RCTs were done in secondary or tertiary care settings. Their pooled retention rate (95% CI) was 80% (77%, 84%) in the control arm. Four RCTs had been done in primary care settings and their pooled retention rate (95% CI) was 53% (45%, 62%) in the control arm. The setting of one trial was unclear. For non-randomised studies, retention rates (95% CI) were 68% (62%, 75%) among 19 studies done in secondary and tertiary care settings, and 40% (33%, 49%) among the 6 studies done in primary care settings.

CONCLUSION

Rates of retention in care of people living with diabetes are poor in primary care research settings.

Rehabilitating an attrited language in a bilingual person with aphasia

Language difficulties can arise from reduced exposure to any given language (e.g. attrition) or after brain damage (e.g. aphasia). The manifestations of attrition and aphasia are often similar so differentiating between their effects on language loss and recovery is challenging. We investigated treatment effects for an English-Hebrew bilingual person with stroke-induced aphasia who had minimal contact with his Hebrew for over 14 years. We asked whether his attrited language could be rehabilitated, how effects of attrition and aphasia can be dissociated, and how such dissociation aids our understanding of the mechanisms involved in language recovery in aphasia. We administered a verb-based semantic treatment in Hebrew three times a week for six weeks (totalling 29 hours of therapy) and assessed changes in both Hebrew and English comprehension and production abilities across a variety of language tasks. Quantitative analyses demonstrated improvement in Hebrew production across language tasks, including those involving lexical retrieval processes that were trained during treatment. Improvement to English occurred in these same lexical retrieval tasks only. We interpret these results as indicating that the participant's attrited language (Hebrew) could be rehabilitated with both specific treatment and general exposure to Hebrew contributing to improvement. Furthermore, treatment effects transferred to the untreated English. Qualitative analyses indicated that an interaction among aphasia, incomplete mastery of Hebrew pre-stroke, and attrition contributed to the participant's language difficulties post-stroke. We conclude that partially shared underlying mechanisms of attrition and aphasia drive language processing and changes to it with treatment.

Perceived barriers in family-based behavioural treatment of paediatric obesity - Results from the FABO study

BACKGROUND

To date, few studies have investigated perceived barriers among those who participate in and drop out of family-based behavioural treatment (FBT) for paediatric obesity. Examining experienced barriers during treatment, and their role in participation and completion of treatment has important implications for clinical practice.

OBJECTIVES

To compare perceived barriers to participating in a family-based behavioural social facilitation treatment (FBSFT) for obesity among families who completed and did not complete treatment.

METHODS

Data were analysed from 90 families of children and adolescents (mean (M) age = 12.8 years, standard deviation (SD) = 3.05) with severe obesity enrolled in a 17-session FBSFT program. After completing 12 sessions or at the time of dropout, parents and therapists completed the Barriers to Treatment Participation Scale (BTPS), a 5-point Likert scale (1 = never a problem, 5 = very often a problem) which includes four subscales: 1. Stressors and obstacles that compete with treatment, 2. Treatment demands and issues, 3. Perceived relevance of treatment, 4. Relationship with the therapist.

RESULTS

Families who did not complete treatment scored significantly higher on the BTPS subscales stressors and obstacles that compete with treatment (M = 2.03, SD = 0.53 vs. M = 1.70, SD = 0.42), p = 0.010 and perceived relevance of treatment (M = 2.27, SD = 0.48 vs. M = 1.80, SD = 0.50), p < 0.001 than families who completed treatment. No other significant differences between groups were observed.

CONCLUSION

Families are more likely to drop out of FBSFT when experiencing a high burden from life stressors or when treatment is not meeting the expectations and perceived needs of the family.

Gene Expression Profile as a Predictor of Seizure Liability

Analysis platforms to predict drug-induced seizure liability at an early phase of drug development would improve safety and reduce attrition and the high cost of drug development. We hypothesized that a drug-induced in vitro transcriptomics signature predicts its ictogenicity. We exposed rat cortical neuronal cultures to non-toxic concentrations of 34 compounds for 24 h; 11 were known to be ictogenic (tool compounds), 13 were associated with a high number of seizure-related adverse event reports in the clinical FDA Adverse Event Reporting System (FAERS) database and systematic literature search (FAERS-positive compounds), and 10 were known to be non-ictogenic (FAERS-negative compounds). The drug-induced gene expression profile was assessed from RNA-sequencing data. Transcriptomics profiles induced by the tool, FAERS-positive and FAERS-negative compounds, were compared using bioinformatics and machine learning. Of the 13 FAERS-positive compounds, 11 induced significant differential gene expression; 10 of the 11 showed an overall high similarity to the profile of at least one tool compound, correctly predicting the ictogenicity. Alikeness-% based on the number of the same differentially expressed genes correctly categorized 85%, the Gene Set Enrichment Analysis score correctly categorized 73%, and the machine-learning approach correctly categorized 91% of the FAERS-positive compounds with reported seizure liability currently in clinical use. Our data suggest that the drug-induced gene expression profile could be used as a predictive biomarker for seizure liability.

Refusal of Retreatment With Topical 5-Fluorouracil Among Patients With Actinic Keratosis: Qualitative Analysis

BACKGROUND

Actinic keratosis (AK) is a common premalignant skin lesion, and topical 5-fluorouracil (5-FU) is commonly used in field-directed therapy. However, 5-FU is associated with frequent local skin reactions.

OBJECTIVE

This study aimed to qualitatively assess experiences among patients with AK who refuse retreatment with 5-FU.

METHODS

Semistructured interviews were conducted with 10 adult participants who had received treatment with 5-FU for AK between January 1, 2017, and January 1, 2020, and refused future treatment with 5-FU. Results were analyzed using qualitative research methods.

RESULTS

Although most participants had low concern upon having received a diagnosis of AK, most felt that treatment is very important. When initiating treatment with 5-FU, most cited recommendation by their health care professionals as the primary motivator and initially had low concern regarding treatment. The side effects associated with treatment were physically and psychosocially burdensome for most participants and led to temporary lifestyle adjustments. After treatment, most did not believe that their health care provider prepared them for treatment or were unsure. While half of the participants felt that 5-FU helped treat AKs, half were either unsure, due to premature discontinuation, or did not think that 5-FU treated their AKs.

CONCLUSIONS

5-FU is one of the most commonly prescribed treatments for AKs, yet most patients experienced both a physical and psychosocial burden with the treatment. Inability to assess efficacy due to premature discontinuation secondary to 5-FU-related reactions is common, and shared decision-making, navigating treatment options, and taking into account patient preferences may be critical to help assure better adherence and outcomes. Although our study was limited by input from participants who refused future treatment with 5-FU, most stated that they would still continue to seek treatment for AKs in the future and would consider other topical treatments, especially if associated with a milder tolerability profile.

Self-withdrawal from scheduled bariatric surgery: Qualitative study exploring patient and healthcare provider perspectives

The objective of the study was to explore the experience of patients who self-withdrew from their scheduled bariatric surgery (BS) after completing the lengthy multidisciplinary assessment and optimization process, and to examine how these withdrawals affect healthcare providers (HCPs) in a Bariatric Centre of Excellence (BCoE). Interviews were conducted with patients who self-withdrew, within 1 month, from scheduled BS. Additionally, a focus group with HCPs from the same BCoE was completed. The data were analysed using an inductive, emergent thematic approach with open coding in NVivo 12, with comparative analysis to identify common themes between groups. Eleven patients and 14 HCPs participated. HCPs identified several behavioural and logistical red flags among patients who self-withdrew from scheduled BS. Patients and HCPs felt the decision was appropriate, owing to a patient's lack of mental preparedness for change, social supports, or fears of postoperative complications. HCPs reported frustration and described negative impacts on clinic efficiency. Additional mental health resources for patients contemplating self-withdrawal, such as peer support, were suggested. In conclusion, a patient's decision to self-withdraw from a scheduled BS is often sudden, definite, and associated with anxiety, fear of surgical risks and post-operative complications. Additional mental health resources at a BCoE may be beneficial to support patients at risk of self-withdrawal from scheduled BS.

The biasing effects of selection and attrition on estimating the mean

Organizational and validation researchers often work with data that has been subjected to selection on the predictor and attrition on the criterion. These researchers often use the data observed under these conditions to estimate either the predictor or criterion's restricted population means. We show that the restricted means due to direct or indirect selection are a function of the population means plus the selection ratios. Thus, any difference between selected mean groups reflects the population difference plus the selection ratio difference. When there is also attrition on the criterion, the estimation of group differences becomes even more complicated. The effect of selection and attrition induces measurement bias when estimating the restricted population mean of either the predictor or criterion. A sample mean observed under selection and attrition does not estimate either the population mean or the restricted population mean. We propose several procedures under normality that yield unbiased estimates of the mean. The procedures focus on correcting the effects of selection and attrition. Each procedure was evaluated with a Monte Carlo simulation to ascertain its strengths and weaknesses. Given appropriate sample size and conditions, we show that these procedures yield unbiased estimators of the restricted and unrestricted population means for both predictor and criterion. We also show how our findings have implications for replicating selected group differences.

Diagnosis and Treatment Pathway of MDR/RR-TB in Taizhou, Zhejiang Province, China

This study aims to understand MDR/RR-TB patients' experience from seeking TB-related health care to diagnosis and treatment completion, as well as the social determinants with the waiting time for DST and treatment, pre-treatment attrition, and treatment outcome based on a retrospective cohort study. Univariate and multi-variate logistic regressions were used to analyze the associated factors. The median time of waiting time for DST and treatment was 24.00 and 30.00 days, respectively. Non-residential patients (aOR: 2.89, 95% CI: 1.14-7.70), registered before 2018 (aOR: 19.93, 95% CI: 8.99-48.51), first visited a county-level hospital (aOR: 4.65, 95% CI: 1.08-21.67), sputum smear-negative (aOR: 3.54, 95% CI: 1.28-10.16), and comorbid with pneumoconiosis (aOR: 7.10, 95% CI: 1.23-47.98) had a longer DST delay. The pre-treatment attrition was 26.9% (82/305). Elderly, non-residential patients and patients registered before 2018 were more likely to refuse MDR/RR treatment. However, in housekeeping/unemployment and farmer/fisherman, recurrent patients tended to take therapeutic measures actively. The successful treatment rate was 62.1% (105/169). Elderly, comorbidity with diabetes and sputum smear conversion time >1 month may lead to poorer outcomes. Immediate interventions should be taken to smooth diagnosis and treatment pathways and improve the social protections further so as to encourage patients to cooperate with the treatment actively.

Can a Single Variable Predict Early Dropout From Digital Health Interventions? Comparison of Predictive Models From Two Large Randomized Trials

BACKGROUND

A single generalizable metric that accurately predicts early dropout from digital health interventions has the potential to readily inform intervention targets and treatment augmentations that could boost retention and intervention outcomes. We recently identified a type of early dropout from digital health interventions for smoking cessation, specifically, users who logged in during the first week of the intervention and had little to no activity thereafter. These users also had a substantially lower smoking cessation rate with our iCanQuit smoking cessation app compared with users who used the app for longer periods.

OBJECTIVE

This study aimed to explore whether log-in count data, using standard statistical methods, can precisely predict whether an individual will become an iCanQuit early dropout while validating the approach using other statistical methods and randomized trial data from 3 other digital interventions for smoking cessation (combined randomized N=4529).

METHODS

Standard logistic regression models were used to predict early dropouts for individuals receiving the iCanQuit smoking cessation intervention app, the National Cancer Institute QuitGuide smoking cessation intervention app, the WebQuit.org smoking cessation intervention website, and the Smokefree.gov smoking cessation intervention website. The main predictors were the number of times a participant logged in per day during the first 7 days following randomization. The area under the curve (AUC) assessed the performance of the logistic regression models, which were compared with decision trees, support vector machine, and neural network models. We also examined whether 13 baseline variables that included a variety of demographics (eg, race and ethnicity, gender, and age) and smoking characteristics (eg, use of e-cigarettes and confidence in being smoke free) might improve this prediction.

RESULTS

The AUC for each logistic regression model using only the first 7 days of log-in count variables was 0.94 (95% CI 0.90-0.97) for iCanQuit, 0.88 (95% CI 0.83-0.93) for QuitGuide, 0.85 (95% CI 0.80-0.88) for WebQuit.org, and 0.60 (95% CI 0.54-0.66) for Smokefree.gov. Replacing logistic regression models with more complex decision trees, support vector machines, or neural network models did not significantly increase the AUC, nor did including additional baseline variables as predictors. The sensitivity and specificity were generally good, and they were excellent for iCanQuit (ie, 0.91 and 0.85, respectively, at the 0.5 classification threshold).

CONCLUSIONS

Logistic regression models using only the first 7 days of log-in count data were generally good at predicting early dropouts. These models performed well when using simple, automated, and readily available log-in count data, whereas including self-reported baseline variables did not improve the prediction. The results will inform the early identification of people at risk of early dropout from digital health interventions with the goal of intervening further by providing them with augmented treatments to increase their retention and, ultimately, their intervention outcomes.

Who Sticks with Meditation? Rates and Predictors of Persistence in a Population-based Sample in the USA

Objectives

Despite the well-documented psychological benefits of meditation practice, limited research has examined factors associated with meditation practice persistence. Like other health behaviors (e.g., exercise), non-persistence may undermine the effectiveness of meditation.

Methods

We examined rates and correlates of meditation persistence using a population-based sample (n = 953) in the United States. Persistence was operationalized in two ways: number of lifetime practice sessions (i.e., lifetime persistence) and current practice frequency (i.e., current persistence). Consistent with the National Health Interview Survey, we defined meditation as mindfulness meditation, mantra meditation, and spiritual meditation. We examined factors related to the Reasoned Action Approach (RAA), a theory that has been used to explain adherence to health behaviors.

Results

Almost half of the sample (49.3%) indicated lifetime exposure to meditation and a third (35.0%) indicated practice in the past year. Factors positively associated with persistence (lifetime and/or current) included having spoken with a meditation teacher, higher perceived effectiveness of meditation, higher meditation-positive subjective norms, lower perceived barriers, higher conscientiousness, higher wellbeing growth mindset, and retreat experience. Factors negatively associated with persistence included first exposure through various forms of technology and having a mental health motivation for practice. First exposure through a smartphone app and first exposure through friends and family were not associated with lifetime or current persistence. Findings were unchanged after controlling for demographics and applying a false discovery rate p-value adjustment.

Conclusions

These findings provide insights into factors that may promote persistence with meditation which can guide the delivery of meditation training.

Preregistration

This study was preregistered at the Open Science Framework (https://osf.io/4h86s).

Mental health in the veterinary profession: an individual or organisational focus?

The veterinary profession is experiencing a shortage of veterinarians, with attrition recognised as a substantial contributor. Research has also indicated increased levels of mental ill health and alarming suicide rates in practitioners. The primary aim of this study was to investigate the impact of eleven modifiable workplace factors on mental health outcomes, job appreciation and intention to leave the veterinary profession. The second aim was to ascertain whether workplace factors influence mental health outcomes after controlling for individual resilience. An online survey was completed by 73 practising Australian veterinarians. Unfavourable workplace factors correlated with adverse outcomes including depression, stress, reduced job appreciation and increased likelihood of leaving both the role and the profession. Workplace factors remained linked with the outcomes of job appreciation, depression and stress whilst controlling for practitioner resilience. Job appreciation was a significant predictor of intention to leave both the current role and the profession. Via multiple linear regression, two categories were identified as associated with improved psychological outcomes and job appreciation. These were workplace factors that represent breaks from workload and control or decision latitude in the workplace. Whilst resilience represents a key area for intervention, workplace factors potentially represent an easier-to-modify area for intervention.

Parent-led stepped care for traumatised children: parental factors that predict treatment completion and response

Background: Stepped care cognitive behavioural therapy for children after trauma (SC-CBT-CT; aged 7-12 years) can help to increase access to evidence-based trauma treatments for children. SC-CBT-CT consists of a parent-led therapist-assisted component (Step One) with an option to step up to standard therapist-led treatment (Step Two). Studies have shown that SC-CBT-CT is effective; however, less is known about what parent variables are associated with outcome of Step One.Objective: To examine parent factors and their relationship with completion and response among children receiving Step One.Method: Children (n = 82) aged 7-12 (M = 9.91) received Step One delivered by their parents (n = 82) under the guidance of SC-CBT-CT therapists. Logistic regression analyses were used to investigate whether the following factors were associated with non-completion or non-response: the parents' sociodemographic variables, anxiety and depression, stressful life experiences and post-traumatic symptoms, negative emotional reactions to their children's trauma, parenting stress, lower perceived social support, and practical barriers to treatment at baseline.Results: Lower level of educational achievement among parents was related to non-completion. Higher levels of emotional reactions to their child's trauma and greater perceived social support were related to non-response.Conclusions: The children seemed to profit from the parent-led Step One despite their parents` mental health challenges, stress, and practical barriers. The association between greater perceived social support and non-response was unexpected and warrants further investigation. To further increase treatment completion and response rates among children, parents with lower education may need more assistance on how to perform the interventions, while parents who are very upset about their child's trauma may need more emotional support and assurance from the therapist.Trial registration: ClinicalTrials.gov NCT04073862; https://clinicaltrials.gov/ct2/show/NCT04073862. Retrospectively registered 03 June 2019 (first patient recruited May 2019).

Compassionate Off-Ramps: The Availability of Terminal Master's Degrees in US Medical Schools

Medical students who underperform or find they are not a "good fit" for medicine have limited options. A terminal master's degree represents an exit alternative that recognizes students' completed coursework and acknowledges their commitment to the medical sciences. Although medical educators have called for the creation of such programs, termed "compassionate off-ramps," the prevalence of degree offerings in US programs is unknown. In the fall of 2020, a survey was sent to Student Affairs Deans at 141 LCME-accredited MD programs; 73 institutions responded (52%). Terminal master's degrees were offered by 19% of respondent institutions (n = 13). While 85% of those without a terminal master's (n = 48) endorsed degree benefits, only 36% (n = 21) had plans to create the degree. This study demonstrates that few US medical schools offer a terminal master's degree, leaving students who exit medicine with high levels of debt without an avenue for a degree to support employment or future academic pursuits. The authors identify implications for students, particularly those who are at a higher risk of failing Step 1, such as students who are underrepresented in medicine, socioeconomically disadvantaged, or who have a disability and are unaccommodated. Potential barriers to terminal master's program creation are identified and mitigating strategies are recommended.

Dropout Rate in Digital Health Interventions for the Prevention of Skin Cancer: Systematic Review, Meta-analysis, and Metaregression

BACKGROUND

Digital strategies are innovative approaches to the prevention of skin cancer, but the attrition following this kind of intervention needs to be analyzed.

OBJECTIVE

The aim of this paper is to assess the dropouts from studies focused on digital strategies for the prevention of skin cancer.

METHODS

We conducted this systematic review with meta-analyses and metaregression according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statements. Search terms for skin cancer, digital strategies, and prevention were combined to search PubMed, Scopus, Web of Science, CINAHL, and Cochrane Library from inception until July 2022. Randomized clinical trials that reported dropouts of participants and compared digital strategies with other interventions to prevent skin cancer in healthy or disease-free participants were included. Two independent reviewers extracted data for analysis. The Revised Cochrane Collaboration Bias tool was employed. We calculated the pooled dropout rate of participants through a meta-analysis of proportions and examined whether dropout was more or less frequent in digital interventions against comparators via an odds ratio (OR) meta-analysis. Data were pooled using a random-effects model. Subgroup meta-analyses were conducted in a meta-analysis of proportions and OR meta-analysis to assess the dropout events when data were sorted by digital interventions or control comparator. A univariate metaregression based on a random-effects model assessed possible moderators of dropout. Participants' dropout rates as pooled proportions were calculated for all groups combined, and the digital and comparator groups separately. OR>1 indicated higher dropouts for digital-based interventions. Metaregressions were performed for age, sex, length of intervention, and sample size.

RESULTS

A total of 17 studies were included. The overall pooled dropout rate was 9.5% (95% CI 5.0-17.5). The subgroup meta-analysis of proportions revealed a dropout rate of 11.6% for digital strategies (95% CI 6.8-19.0) and 10.0% for comparators (95% CI 5.5-17.7). A trend of higher dropout rates for digital strategies was observed in the overall (OR 1.16, 95% CI 0.98-1.36) and subgroup OR meta-analysis, but no significant differences were found between the groups. None of the covariates moderated the effect size in the univariate metaregression.

CONCLUSIONS

Digital strategies had a higher dropout rate compared to other prevention interventions, but the difference was not significant. Standardization is needed regarding reporting the number of and reasons for dropouts.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) CRD42022329669; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=329669.

Factors Predicting Adherence to Artistic-Singing Groups for Older Adults and their Role as Moderators of the Intervention Outcomes

OBJECTIVES

Group singing (GS), as an art-based intervention, has demonstrated a wide range of biopsychosocial benefits in older adult participants. However, the factors that predict the adherence of older adults to these programs and that moderate the intervention outcomes were not yet studied, which is the aim of this study.

METHODS

A randomized controlled trial was developed to test the efficacy of a GS intervention, from which pre-post intervention data was collected and analyzed. Participants: 149 retired older adults (M = 76.66, SD = 8,79 years old) users of a social care institution.

RESULTS

Principal component analysis of responses to a pre-intervention assessment yielded 10 factors. General well-being (GWB), negative mood and loneliness, blood pressure, and the participants' years of formal education predicted the number of sessions attended by the participants. GWB moderated the intervention's outcomes on life satisfaction, social identification, and systemic inflammation.

CONCLUSIONS

Years of education, well-being, negative mood and loneliness, and blood pressure at baseline predicted participants' adherence to a singing group artistic intervention.

CLINICAL IMPLICATIONS

For future artistic interventions with older adults, screening for participants' characteristics such as formal education, health and well-being before the intervention is important as it allows predicting adherence and tailoring more adjusted and cost-effective interventions.