BACKGROUND: One hundred twenty women alcoholics recruited to a treatment program called EWA (Early Treatment for Women With Alcohol Addiction) were studied. The selected women were not previously treated for alcohol abuse. METHODS: The women were followed up by use of a structured personal interview, biomarkers sensitive for alcohol abuse (i.e., glutamyl transpeptidase), and questionnaires, by using defined criteria for abstinence, social drinking, satisfactory drinking outcome, and unsatisfactory drinking outcome. RESULTS: Drinking outcome was good (i.e., total abstinence, social drinking, or satisfactory drinking outcome) for 67% of the women during the total follow-up time, by use of strict criteria for relapse. The results were corroborated by the biomarkers. Similar results were reported from two previously studied groups of women from the same department. However, the frequency of abstinence was higher and social drinking was significantly lower among this sample of women. Daily drinking, the use of sedatives, and a long duration of pretreatment alcohol abuse predicted an unfavorable outcome. However, a long duration of outpatient treatment predicted a good outcome, whereas treatment dropout was related to an unsatisfactory drinking outcome. A majority of the women (96%) rated the treatment experience and the treatment program favorably. The overall good results might reflect the selection of the subjects studied. CONCLUSIONS: Improving treatment program adherence would probably improve outcome for the women with an unsatisfactory drinking outcome.
To investigate attrition of subjects in a longitudinal study of caries.
A radiographic study of caries and caries-associated factors was carried out in subjects, initially aged 14 years, and followed-up for six years. Attrition of subjects occurred at the last stage of the study.
A nationwide survey of subjects living in fishing, rural farming, and urban communities in Iceland.
A sub-sample of the nationwide random sample comprising 150 subjects was investigated using bitewing radiographs and a structured questionnaire to determine caries-risk factors. Subjects were re-examined at 16 years and 20 years using the same methods.
Mean caries increment from 14-16 years was 3.0 lesions (1.5 lesions/subject/year) but reduced to 2.6 lesions (0.7 lesions/subject/ year) by 20y. The proportion of subjects found to be caries-free at 14 years, 16 years and 20 years, was 29%, 17% and 10%, respectively. "Dropouts" from this study occurred mostly after 16 years. Analysis of subjects dropping out showed that they were least likely to be from the rural farming community but most likely from the fishing community. Those dropping out attended their dentist less frequently, had a higher consumption of carbonated drinks and a higher prevalence and incidence of caries by 16 years.
Subjects with high-risk behaviours, or residents in a fishing community were more likely to drop out of the study. Recognised advantages of conducting longitudinal studies of caries may, therefore, be lost.
The Cardiovascular Risk in Young Finns Study is an on-going multicentre study of atherosclerosis precursors in Finnish children and young adults. We have collected risk factor data in the 21-year follow-up performed in 2001. The aims of this analysis were to examine the levels, secular trends and east-west difference in risk factors amongst young adults.
Population based follow-up study.
A total of 2283 participants aged 24-39 years in 2001 (63.5% of the original cohort).
Levels of serum lipids, apolipoproteins, blood pressure and smoking.
The mean serum total cholesterol, low density lipoprotein cholesterol, high density lipoprotein (HDL) cholesterol and triglyceride concentrations in 24-39-year-old adults were 5.16, 3.27, 1.29 and 1.34 mmol L(-1), respectively. Total cholesterol (5.21 vs. 5.12 mmol L(-1), P = 0.046), HDL cholesterol (1.31 vs. 1.28 mmol L(-1), P = 0.027), systolic blood pressure (118 vs. 115 mmHg, P
This paper is a report of a study conducted to evaluate change in health-related quality of life for people with constipation receiving abdominal massage and to estimate the cost-effectiveness of two alternative scenarios developed from the original trial.
Constipation is a common problem and is associated with decrease in quality of life. Abdominal massage appears to decrease the severity of gastrointestinal symptoms, but its impact on health-related quality of life has not been assessed.
A randomized controlled trial including 60 participants was conducted in Sweden between 2005 and 2007. The control group continued using laxatives as before and the intervention group received additional abdominal massage. Health-related quality of life was assessed using the EQ-5D and analyzed with linear regression. Two scenarios were outlined to conduct a cost utility analysis. In the self-massage scenario patients learned to give self-massage, and in the professional massage scenario patients in hospital received abdominal massage from an Enrolled Nurse.
Linear regression analysis showed that health-related quality of life was statistically significantly increased after 8 weeks of abdominal massage. About 40% were estimated to receive good effect. For 'self-massage', the cost per quality adjusted life year was euro75,000 for the first 16 weeks. For every additional week of abdominal massage, the average dropped and eventually approached euro8300. For 'professional massage', the cost per quality adjusted life year was euro60,000 and eventually dropped to euro28,000.
Abdominal massage may be cost-effective in the long-term and it is relevant to consider it when managing constipation. A crucial aspect will be to identify those who will benefit.
Trials in which intact communities are the units of randomization are increasingly being used to evaluate interventions which are more naturally administered at the community level, or when there is a substantial risk of treatment contamination. In this article we focus on the planning of community intervention trials in which k communities (for example, medical practices, worksites, or villages) are to be randomly allocated to each of an intervention and a control group, and fixed cohorts of m individuals enrolled in each community prior to randomization. Formulas to determine k or m may be obtained by adjusting standard sample size formulas to account for the intracluster correlation coefficient rho. In the presence of individual-level attrition however, observed cohort sizes are likely to vary. We show that conventional approaches of accounting for potential attrition, such as dividing standard sample size formulas by the anticipated follow-up rate pi or using the average anticipated cohort size m pi, may, respectively, overestimate or underestimate the required sample size when cluster follow-up rates are highly variable, and m or rho are large. We present new sample size estimation formulas for the comparison of two means or two proportions, which appropriately account for variation among cluster follow-up rates. These formulas are derived by specifying a model for the binary missingness indicators under the population-averaged approach, assuming an exchangeable intracluster correlation coefficient, denoted by tau. To aid in the planning of future trials, we recommend that estimates for tau be reported in published community intervention trials.
Both psychosocial and biologic interventions may delay or prevent Alzheimer disease. Staying mentally active may help older people maintain their cognitive abilities. In the Alzheimer Disease Cooperative Study Prevention Instrument Project a book club was introduced as a recruitment and retention device. A 3-arm study was designed and included: a nonrandomized, self-selected group (n=211) who chose not to participate in the book club, and 2 groups randomly assigned to receive 2 books per year in individual self-improvement (n=210) or community involvement (n=207) categories. Participants reported their reactions to the selections and other reading behaviors. Results from the first 2 years revealed that most book club participants agreed with Likert-type statements indicating the readings were enjoyable (P
The purpose of the present study was to investigate the prevalence of adolescents with high periodontal risk and to identify factors with influence on the decision to refer a patient to a specialist clinic of Periodontology, on compliance rate and on treatment outcome. The investigation was conducted as a retrospective study on adolescents at age 13-17. In total, clinical examinations and risk evaluations according to caries- and periodontal risk were performed on 50347 adolescents in general dentistry at ages 13, 15 and 17 in 2007. Individuals with a high periodontal risk were included in the present investigation. A high periodontal risk was defined as presence of sites with periodontal pocket depths >6mm and loss of periodontal tissue support. Multiple logistic regression analyses were adopted to calculate the influence of the potential predictors on the investigated dependent variables. In total, 0.5% of the adolescents were found to have high periodontal risk. The diagnosis local periodontitis and the number of periodontal pockets with probing depths >6 mm were positively and significantly correlated to referral to a periodontist. Eighteen percent dropped out before the treatment was completed. Smokers had a significantly lower compliance than non-smokers. The success rate was significantly lower for individuals with many periodontal pockets and for those with the diagnosis local periodontitis. The prevalence of adolescents classified as having high periodontal risk was low. A large frequency of subjects dropped out before the periodontal treatment was completed, especially at the specialist clinics.
Utilization of dental services by 30 diabetic and 30 nondiabetic subjects was assessed by longitudinal monitoring over a period of 3 years. All subjects were examined clinically three times, and their treatment consisted mainly of cariologic and periodontal treatment. The treatment was delivered by a dentist and an expanded-duty dental hygienist. The study groups were similar with regard to the total number of dental visits needed. However, the treatment of diabetic subjects was more demanding in that more dentist's workload was needed for the diabetic group. They also missed more appointments without cancellation and therefore more office time had to be reserved for them.
Our objective was to examine the influence of adult and childhood socioeconomic status (SES) on attained adult food intake patterns. We used data from a 20- to 22-y follow-up study of 1904 Danish teenagers. The baseline survey was conducted partly in 1983 and partly in 1985 and the follow-up survey was conducted in 2005. Dietary data were collected at follow-up using a 195-item FFQ. Food patterns were derived from principal component analysis. Two food patterns labeled "traditional-western food pattern" and "green food pattern" were identified. In men, adult SES was inversely associated with adherence to the traditional-western food pattern. High adherence to the green food pattern was positively related to high adult SES in both sexes. Among women, those with high SES in childhood had higher green food pattern factor scores than those with low childhood SES, regardless of adult SES. Among men, those with high adult SES had higher green food pattern factor scores than those with low adult SES, regardless of childhood SES. In conclusion, socioeconomic position is important for the development of adult food intake patterns. However, childhood SES seems more important for adult female food intake patterns, whereas adult SES seems more important for adult male food intake patterns.
Studies on patient mobility have focused on patients who become lost-to-follow-up (LTFU). Much less is known about patients who move with a planned transfer of care from one HIV center to another. We assess disease progression in patients who moved and then returned to our care compared with patients remaining or were LTFU.
We identified which patients left our HIV care program between January 01,2000, to January 01,2008, defined how they left (either moved or LTFU), and then determined the health status of returning patients. We examined the impact of the move on their health by comparing clinical measurements (eg, CD4, new AIDS) at their departure and on return.
Forty-four percent of all patients left care; 38% of these returned. In contrast to those remaining in local care whose CD4 counts climbed, "moved" patients exhibited deterioration in both CD4 counts and incident AIDS comparable to LFTU patients. Only 1 in 3 patients who moved had our medical records requested by a new HIV center.
We suspect that despite forward planning, a move may result in potential serious interruptions and/or disengagements of care. The potential harmful health effects can in some be equivalent becoming LTFU. Recognizing and addressing the potential disruption in care from a planned move may be of value in improving outcomes.