Establishment and validation of a nomogram for dropout intention in Chinese early year medical undergraduates.

BACKGROUND: The attrition rate of Chinese medical students is high. This study utilizes a nomogram technique to develop a predictive model for dropout intention among Chinese medical undergraduates based on 19 individual and work-related characteristics. METHOD: A repeated cross-sectional study was conducted, enrolling 3536 medical undergraduates in T1 (August 2020-April 2021) and 969 participants in T2 (October 2022) through snowball sampling. Demographics (age, sex, study phase, income, relationship status, history of mental illness) and mental health factors (including depression, anxiety, stress, burnout, alcohol use disorder, sleepiness, quality of life, fatigue, history of suicidal attempts (SA), and somatic symptoms), as well as work-related variables (career choice regret and reasons, workplace violence experience, and overall satisfaction with the Chinese healthcare environment), were gathered via questionnaires. Data from T1 was split into a training cohort and an internal validation cohort, while T2 data served as an external validation cohort. The nomogram's performance was evaluated for discrimination, calibration, clinical applicability, and generalization using receiver operating characteristic curves (ROC), area under the curve (AUC), calibration curves, and decision curve analysis (DCA). RESULT: From 19 individual and work-related factors, five were identified as significant predictors for the construction of the nomogram: history of SA, career choice regret, experience of workplace violence, depressive symptoms, and burnout. The AUC values for the training, internal validation, and external validation cohorts were 0.762, 0.761, and 0.817, respectively. The nomogram demonstrated reliable prediction and discrimination, with adequate calibration and generalization across both the training and validation cohorts. CONCLUSION: This nomogram exhibits reasonable accuracy in foreseeing dropout intentions among Chinese medical undergraduates. It could guide colleges, hospitals, and policymakers in pinpointing students at risk, thus informing targeted interventions. Addressing underlying factors such as depressive symptoms, burnout, career choice regret, and workplace violence may help reduce the attrition of medical undergraduates. TRIAL REGISTRATION: This is an observational study. There is no Clinical Trial Number associated with this manuscript.

Who stays? Who goes? Motivation and tendency to drop out in music schools.

Based on self-determination theory, this study examined the extent to which the satisfaction of the basic psychological needs for autonomy, competence, and social relatedness in instrumental lessons explain the quality and quantity of motivation, which are responsible for persistence and dropout in music schools. This study also investigated whether parental involvement contributes to dropout. A total of 140 music students from Austria (37.16% male, 62.1% female, 0.8% diverse) were surveyed using a quantitative questionnaire. The central variables are the tendency to dropout (dependent variable) and, as predictors, the motivational regulation styles, the satisfaction of basic psychological needs in the classroom and parental involvement. The results of a structural equation model indicated that satisfaction of basic needs in class and parental involvement, mediated by motivation, predicted dropout tendencies. Autonomous motivation in lessons is negatively associated and controlled motivation is positively associated with the tendency to drop out of music schools. Satisfaction of basic psychological needs during lessons and parental involvement predicts autonomous motivation. However, basic psychological needs cannot predict controlled motivation but parental involvement can predict controlled motivation to a limited extent. Finally, this study emphasizes the practical importance of need satisfaction and parental involvement in motivation and continuing to play a musical instrument.

Navigating the transition: a multidisciplinary approach to inflammatory bowel disease in children.

PURPOSE: A multidisciplinary approach to Inflammatory Bowel Disease (IBD) has recently demonstrated a positive impact in pediatric patients, reducing dropout rates and facilitating the transition to adult care. Our study aims to evaluate how this approach influences disease activity, dropout rates, and transition. METHODS: We conducted a longitudinal observational study including all patients diagnosed with IBD during pediatric-adolescent age, with a minimum follow-up period of 12 months. For each patient, endpoints included therapeutic approach, need for surgery and transition features. RESULTS: We included 19 patients: 13 with Ulcerative Colitis (UC) and 6 with Crohn's disease (CD). Most patients required multiple lines of therapy, with over 50% in both groups receiving biological drugs. Compliance was good, with a single dropout in each group (10, 5%). The need for surgery was significantly higher in the CD group compared to the UC group (16% vs. 7.7%, p < 0.01). Mean age at transition was significantly higher in the UC group compared to the CD group (19.2 ± 0.7 years SD vs. 18.3 ± 0.6 years SD, p < 0.05). CONCLUSIONS: In our experience, the multidisciplinary approach to IBD in transition-age patients appears effective in achieving clinical remission, offering the potential to reduce therapeutic dropouts.

Correlates of burnout and dropout intentions in medical students: A cross-sectional study.

BACKGROUND: Burnout is a pervasive issue among medical students, exhibiting a high prevalence that jeopardizes their academic success and may also predispose them to more severe affective disorders such as depression. This study aims to explore the complex relationships between psychological capital (PsyCap), general social support, educational satisfaction, and burnout, and how these factors collectively influence dropout intentions. METHODS: A non-probabilistic convenience sample was collected through an online survey from first- and second-year medical students at a Faculty of Medicine in Portugal. The survey employed psychometric instruments to measure burnout (BAT-12), social support (F-SozU K-6), PsyCap (CPC-12R), satisfaction with education, and dropout intentions (Screening Instrument for Students At-Risk of Dropping Out). Structural equation modeling was applied to analyze the data from 351 participants. RESULTS: The model demonstrated a significant positive association between burnout and dropout intentions (ß̂ = 0.37; p < 0.001), underscoring burnout as a direct correlate of dropout intentions alongside educational satisfaction (ß̂ = -0.25; p = 0.003) and PsyCap (ß̂ = -0.22; p = 0.005). Higher social support is associated with reduced burnout (ß̂ = -0.28; p < 0.001) and increased educational satisfaction (ß̂ = 0.22; p = 0.002). LIMITATIONS: The non-probabilistic sampling method prevents the generalization of the findings. The cross-sectional data do not permit the inference of temporal relationships between the studied variables. CONCLUSIONS: These findings emphasize the importance that burnout may have on dropout intentions, and contribute to the understanding of affective syndromes such as burnout in educational settings.

Determining factors of sports dropout of young scholars: a cross-sectional analysis in the 8-13 year age group.

This article investigates the phenomenon of sports abandonment among young scholars aged between 8 and 13 years. Regardless of the growing awareness of the importance of sport and physical activity during childhood and adolescence, this theme must be adequately explored in the scientific literature. Our study addresses this gap through a cross-sectional research design, tracking and analyzing data from a cohort of young athletes over one year. The main objective of our study is to identify the determinants leading to sports dropout in this specific age group. We looked at several possible causes through a multivariate analysis, including social pressures, parental expectations, time conflicts, physical and psychological stress, and lack of enjoyment. The results show a significant attrition rate, with psychosocial factors emerging as the most influential in determining whether a young person will continue or stop their participation in sport. Furthermore, our study highlights the importance of targeted interventions and preventive strategies that promote a positive, inclusive, and balanced sports environment for adolescents. These interventions can be particularly effective when implemented by coaches, parents and others involved in youth sports education. Finally, this paper discusses the implications of the findings for sports professionals, physical educators, and public policy makers. It highlights the need for more effective support policies and innovative pedagogical approaches to promote sporting persistence during adolescence. Our findings can serve as a starting point for further research in this field, helping to build a future where young people can enjoy the many benefits of sport and physical activity.

The associations between organized sport participation and physical fitness and weight status development during adolescence.

OBJECTIVES: We are yet to understand how continuous participation in organized sports, dropout from organized sports, or complete non-participation affect adolescents' trajectories of physical fitness and body mass index (BMI). Thus, the aim was to examine longitudinal changes in cardiorespiratory and muscular fitness, and BMI between adolescents 1) who continued or started organized sport participation, 2) who dropped out, and 3) who never participated in organized sport or dropped out before adolescence. DESIGN: Longitudinal observational study. METHODS: Over four years (2017-2021), sport participation, cardiorespiratory and muscular fitness, and BMI data were collected annually from 963 participants (Mage = 11.25 ±â€¯0.31). Latent growth curve models were utilized to examine levels (baseline) and slopes (rate of change) of BMI, cardiorespiratory, and muscular fitness in each sport participation group. RESULTS: Fitness levels significantly varied among groups. Continuing sport participants exhibited the highest levels, non-participants the lowest. Both groups showed significant improvements in cardiorespiratory and muscular fitness over time. Dropouts had higher baseline fitness than non-participants but demonstrated no change in cardiorespiratory fitness over time and a significantly smaller increase in muscular fitness than the two other groups. BMI increased similarly in all groups, with non-participants starting at higher baseline levels. CONCLUSIONS: Individuals who continually participated in sports maintained higher levels of fitness than individuals who did not participate in organized sports across adolescence. However, individuals who dropped out of organized sports, showed plateau in their fitness improvements, suggesting that the physical activity previously obtained through organized sports may not be replaced elsewhere.

Modelling a self-defined CNN for effectual classification of PCOS from ultrasound images.

BACKGROUND: Polycystic Ovary Syndrome (PCOS) is a medical condition that causes hormonal disorders in women in their childbearing years. The hormonal imbalance leads to a delayed or even absent menstrual cycle. Women with PCOS mainly suffer from extreme weight gain, facial hair growth, acne, hair loss, skin darkening, and irregular periods, leading to infertility in rare cases. Doctors usually examine ultrasound images and conclude the affected ovary but are incapable of deciding whether it is a normal cyst, PCOS, or cancer cyst manually. OBJECTIVE: To have access to the high-risk crucial PCOS and to detect the condition and the treatment aimed at mitigating health hazards such as endometrial hyperplasia/cancer, infertility, pregnancy complications, and the long-term burden of chronic diseases such as cardiometabolic disorders linked with PCOS. METHODS: The proposed Self-Defined Convolution Neural Network method (SD_CNN) is used to extract the features and machine learning models such as SVM, Random Forest, and Logistic Regression are used to classify PCOS images. The parameter tuning is done with lesser parameters in order to overcome over-fitting issues. The self-defined model predicts the occurrence of the cyst based on the analyzed features and classifies the class labels effectively. RESULTS: The Random Forest Classifier was found to be the most reliable and accurate among Support Vector Machine (SVM) and Logistic Regression (LR), with accuracy being 96.43%. CONCLUSION: The proposed model establishes better trade-off compared to various other approaches and works effectually for PCOS prediction.

Using preimplantation genetic testing for monogenic disease for preventing citrullinemia type 1 transmission.

Aim: The aim of this study is to investigate if Preimplantation Genetic Testing (PGT) can effectively identify unreported variants according to American College of Medical Genetics and Genomics (ACMG)to prevent citrullinemia type 1 affection. Design: This study involves a detailed case analysis of a family with history of citrullinemia type 1, focusing on the use of PGT for monogenic diseases (PGT-M). The genetic variants were identified using ACMG guidelines, and PGT was employed to prevent the inheritance of these variants. The study included haplotype analysis and Sanger sequencing to confirm the results. Results: The study identified previously unreported variations in the ASS1 gene causing citrullinemia type 1. PGT successfully prevented the transmission of these variants, resulting in the birth of a healthy fetus. However, challenges such as allele dropout (ADO) and gene recombination were encountered during haplotype analysis, which could potentially defeat the diagnosis. The study demonstrated that combining haplotype analysis with Sanger sequencing can enhance the accuracy of PGT. Conclusion: Preimplantation Genetic Testing (PGT) targeting likely pathogenic and pathogenic variants in the ASS1 gene, as rated by ACMG, allows the birth of healthy infants free from citrullinemia type 1. Additionally, the establishment of single haplotypes and Sanger sequencing can reduce the misdiagnosis rate caused by allele dropout (ADO) and genetic recombination.

Framework Development for Reducing Attrition in Digital Dietary Interventions: Systematic Review and Thematic Synthesis.

BACKGROUND: Dietary behaviors significantly influence health outcomes across populations. Unhealthy diets are linked to serious diseases and substantial economic burdens, contributing to approximately 11 million deaths and significant disability-adjusted life years annually. Digital dietary interventions offer accessible solutions to improve dietary behaviors. However, attrition, defined as participant dropout before intervention completion, is a major challenge, with rates as high as 75%-99%. High attrition compromises intervention validity and reliability and exacerbates health disparities, highlighting the need to understand and address its causes. OBJECTIVE: This study systematically reviews the literature on attrition in digital dietary interventions to identify the underlying causes, propose potential solutions, and integrate these findings with behavior theory concepts to develop a comprehensive theoretical framework. This framework aims to elucidate the behavioral mechanisms behind attrition and guide the design and implementation of more effective digital dietary interventions, ultimately reducing attrition rates and mitigating health inequalities. METHODS: We conducted a systematic review, meta-analysis, and thematic synthesis. A comprehensive search across 7 electronic databases (PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus, and Academic Search Complete) was performed for studies published between 2013 and 2023. Eligibility criteria included original research exploring attrition in digital dietary interventions. Data extraction focused on study characteristics, sample demographics, attrition rates, reasons for attrition, and potential solutions. We followed ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used RStudio (Posit) for meta-analysis and NVivo for thematic synthesis. RESULTS: Out of the 442 identified studies, 21 met the inclusion criteria. The meta-analysis showed mean attrition rates of 35% for control groups, 38% for intervention groups, and 40% for observational studies, with high heterogeneity (I²=94%-99%) indicating diverse influencing factors. Thematic synthesis identified 15 interconnected themes that align with behavior theory concepts. Based on these themes, the force-resource model was developed to explore the underlying causes of attrition and guide the design and implementation of future interventions from a behavior theory perspective. CONCLUSIONS: High attrition rates are a significant issue in digital dietary interventions. The developed framework conceptualizes attrition through the interaction between the driving force system and the supporting resource system, providing a nuanced understanding of participant attrition, summarized as insufficient motivation and inadequate or poorly matched resources. It underscores the critical necessity for digital dietary interventions to balance motivational components with available resources dynamically. Key recommendations include user-friendly design, behavior-factor activation, literacy training, force-resource matching, social support, personalized adaptation, and dynamic follow-up. Expanding these strategies to a population level can enhance digital health equity. Further empirical validation of the framework is necessary, alongside the development of behavior theory-guided guidelines for digital dietary interventions. TRIAL REGISTRATION: PROSPERO CRD42024512902; https://tinyurl.com/3rjt2df9.

Rethinking treatment failures. Research on a group of Italian psychotherapists.

Introduction: Psychotherapeutic failures involve situational, relational, and personal factors. Dropout refers to a patient's unilateral termination of treatment without the therapist's knowledge or approval. Premature termination occurs when therapy is discontinued before achieving a sufficient reduction in initial problems. Objective: This study explores the role of therapist's emotional response (countertransference), gender, psychotherapeutic orientation, and patient diagnosis in the context of psychotherapeutic failures. Method: A mixed-method approach was used. Fifty-nine Italian psychotherapists, practicing mostly privately with at least 5 years of experience, were recruited through Italian professional internet websites. The Therapist Response Questionnaire and the Impasse Interview were administered to each psychotherapist. Each therapist was asked to reflect on their last dropout patient. Quantitative (MANOVA) and qualitative analyses (textual content analysis) were conducted with SPSS and T-LAB, respectively. Results: The quantitative analyses revealed that the most frequent countertransference response was Helpless/Inadequate, with female therapists experiencing this more frequently than male therapists. The qualitative analyses identified two main factors explaining most of the variance in countertransference responses: Parental/Protective versus Hostile/Angry, and Positive/Satisfying versus Helpless/Inadequate, with Helpless/Inadequate central. Additionally, the qualitative analysis of treatment interruption methods revealed two factors explaining over 50% of the variance. Lack of communication was linked to negative themes, while mediated and direct communication were associated with positive terms. Direct communication was characterized as useful, while mediated communication was linked to dropout and attachment figures. Conclusion: Under pressure, psychotherapists' anxiety levels increase, often managed ambivalently or avoidantly. These results suggest that awareness of psychotherapist emotional responses is important to limit psychotherapeutic failures. These findings offer valuable insights for clinical practice.

Effect of University Social Capital on Working Students' Dropout Intentions: Insights from Estonia.

This study investigates the role of social capital within the university context in retaining working students. It specifically examines the effects of university social capital factors-such as teacher-student relationships, peer networks, and support services-on the dropout intentions of working students, emphasizing the mediating role of employability trust. Using a sample of 1902 working students from the Eurostudent VII survey, this study employed factor analysis techniques and structural equation modeling to derive its findings. The results indicated that university social capital significantly reduces dropout intentions among working students. Strong teacher-student relationships, satisfaction with support services, robust peer networks, and high employability trust positively influence this social capital. There is a statistically significant negative association between teacher-student relationships, peer networks, employability trust, and dropout intentions. Furthermore, the findings reveal that without enhancing students' employability trust, the effectiveness of support services might be limited. These findings not only contribute to the discourse on student retention and the development of university social capital but also provide practical insights for higher education strategies aimed at supporting working students.

Drop-out rates in animal-assisted psychotherapy - Results of a quantitative meta-analysis.

INTRODUCTION: Animal-assisted psychotherapy is an emerging field with great potential and growing popularity. However, empirical research on its effectiveness is insufficient, and consistent evidence about patients' commitment is missing. The present meta-analysis addresses this gap by systematically comparing drop-out rates in animal-assisted psychotherapy and by relating the resulting across study drop-out rate to across study drop-out rates reported in meta-analyses on conventional psychotherapy. METHOD: Fifty-seven studies published until August 2022 were identified as eligible for meta-analytic comparison, that is, they conducted animal-assisted psychotherapy on at least one group of psychiatric patients and reported drop-out rates. Potential moderating influences of the type of animal and patients' disorder were considered, as well as multiple other demographic and study design variables. RESULTS: The across study drop-out rate in animal-assisted psychotherapy was 11.2%. This was significantly lower than the across meta-analyses drop-out rate of conventional psychotherapy (d = -.45, p = .0005). Although effects of moderator variables could not be evaluated statistically due to too small and heterogeneous data sets, descriptive results suggest influences of the type of animal and patient disorder. However, study quality ratings identified serious shortcomings regarding proper research design, most critically concerning the report of effect size measures, the use of standardized intervention plans and Open Science practices. CONCLUSION: Drop-out constitutes a major problem of psychotherapeutic research and practice. By proposing that the inclusion of an animal in the psychotherapeutic setting can enhance patients' commitment and by outlining challenges and opportunity of animal-assisted psychotherapy, this meta-analysis offers a starting point for future research in this evolving field.

Visual predictive check of longitudinal models and dropout.

Visual predictive checks (VPC) are commonly used to evaluate pharmacometrics models. However their performance may be hampered if patients with worse outcomes drop out earlier, as often occurs in clinical trials, especially in oncology. While methods accounting for dropouts have appeared in literature, they vary in assumptions, flexibility, and performance, and the differences between them are not widely understood. This manuscript aims to elucidate which methods can be used to handle VPC with dropout and when, along with a more informative VPC approach using confidence intervals. Additionally, we propose constructing the confidence interval based on the observed data instead of the simulated data. The theoretical framework for incorporating dropout in VPCs is developed and applied to propose two approaches: full and conditional. The full approach is implemented using a parametric time-to-event model, while the conditional approach is implemented using both parametric and Cox proportional-hazard (CPH) models. The practical performances of these approaches are illustrated with an application to the tumor growth dynamics (TGD) modeling of data from two cancer clinical trials of nivolumab and docetaxel, where patients were followed until disease progression. The dataset consisted of 3504 tumor size measurements from 855 subjects, which were described by a TGD model. The dropout of subjects was described by a Weibull or CPH model. Simulated datasets were also used to further illustrate the properties of the VPC methods. The results showed that the more familiar full approach might not provide meaningful improvement for TGD model evaluation over the naive approach of not adjusting for dropout, and could be outperformed by the conditional approach using either the Weibull model or the Cox proportional hazard model. Overall, including confidence intervals in VPC should improve interpretation, the conditional approach was shown to be more generally applicable when dropout occurs, and the nonparametric approach could provide additional robustness.

Beyond the mind: Understanding the influence of mental health on youth NEET status in Europe-A systematic literature review.

INTRODUCTION: In the fields of labor market and education research, there is a vast interest in mental health factors affecting unsuccessful school-to-work transitions, dropout from school and labor market disconnections for young people. Young people who are not in employment, education or training are conceived of as NEET. AIM: To get an overview we conducted a systematic review of the present literature on the influence of mental health on the likelihood of becoming NEET in Europe. METHOD: A Systematic literature search was conducted in four databases on February 21, 2023, with an update on January 15, 2024. RESULTS: 33,314 articles were screened whereas 41 studies involving 8,914,123 individuals were included. Poor mental health such as attention deficit hyperactive disorder, autism, depression, borderline, and psychosis during childhood and adolescence is strongly associated with becoming NEET. CONCLUSION: Mental health issues, whether mild or severe, heighten significant the risk of adverse education and employment outcomes in early adulthood, extending to young individuals with personality disorders, borderline personality disorder, and psychoses. These observations inform early intervention strategies for children and young people grappling with mental health challenges. Timely treatment is essential. Future research should focus on the gap in research like specific disorders such as eating disorders and anxiety.

Determinants of pneumococcal vaccination dropout among children aged 12-23 months in Ethiopia: a secondary analysis from the 2019 mini demographic and health survey.

Background: Vaccination is a cost-effective public health program that helps reduce significant morbidity and mortality in children under the age of five. Worldwide, the number of vaccine-preventable causes of child death has significantly decreased since the Expanded Program of Immunization (EPI) was introduced. However, for a variety of reasons, 23 million children did not have adequate access to vaccines in 2020. Therefore, this study aimed to evaluate the determinants of pneumonia conjugate vaccine (PCV) dropout among children aged 12-23 months in Ethiopia. Methods: The study analyzed cross-sectional data obtained from the 2019 mini Ethiopian demographic and health survey. Multilevel binary logistic regression analysis was utilized, and the best fit model was chosen using the Akaike Information Criteria. The study comprised a weighted sample of 989 children aged 12 to 23 months. The study presented the Adjusted Odds Ratio (AOR) along with a 95% Confidence Interval (CI) to identify the significant factors influencing PCV dropout. Results: The PCV dropout rate was reported at 20.2% in this study. In the multilevel analysis, possession of a health card (AOR = 0.076, 95% CI: 0.019, 0.04), vaccination for PCV 2 (AOR =0.002, 95% CI: 0.023, 0.263), and region 7 (AOR = 6.98, 95% CI: 10.1, 48.31) were significantly associated with children's PCV dropout. Conclusion: Having a health card, having received the PCV 2 vaccinations, and region were significant predictors of PCV dropout. Consequently, health education on immunization for all mothers and region-specific, customized public health interventions are needed to reduce the vaccination dropout rate.

School Dropout, Absenteeism and Coverage of Sexual and Reproductive Health Services in South Africa: Are Those Most at Risk Reached?

School attendance or completion is important for adolescents' development. Adolescents who drop out or are regularly absent from school are at higher risk of adverse sexual and reproductive health (SRH) outcomes. However, there is little evidence evaluating SRH service coverage among adolescents in and out of school. In the context of a large-scale combination HIV and pregnancy prevention intervention funded by the Global Fund, we compared the SRH intervention coverage and SRH risks among adolescent girls who dropped out of school with those who were still in school or who had completed grade 12 in South Africa. Among those still in school, we compared the SRH intervention coverage and SRH risk profiles of those with high versus low or no absenteeism. In 2017 to 2018, we conducted a household survey of adolescent girls aged 15 to 19 years in six of the ten combination intervention districts. Of 2515 participants, 7.6% had dropped out of school. Among the 1864 participants still in school, 10.8% had high absenteeism. Ever having had sex, and condomless sex were more prevalent among dropouts compared with non-dropouts. Dropouts were more likely to access SRH services such as condoms and contraceptives, except the combination prevention intervention services which were more likely to reach those who had not dropped out and were equally likely to reach those in school with high versus low/no absenteeism. Combination SRH prevention programmes can improve the accessibility of SRH services for adolescents in school/who complete school.

Medical care for transgender individuals at a hospital in southern Brazil: why do they drop out from our service?

Objective: The objective of the study was to investigate dropout rates and discern potential factors contributing to the discontinuation of treatment provided to transgender individuals by the Transdisciplinary Gender Identity Program at the Hospital de Clínicas de Porto Alegre (PROTIG). Methodology: This study employs a descriptive, cross-sectional, retrospective design to analyze socio-demographic and clinical data obtained from medical records of patients treated at PROTIG between 2000 and 2018. A structured form, devised by PROTIG's professional team, was utilized to extract and evaluate several variables including: age, gender, education level, diagnosis of F64 according to the International Classification of Diseases (ICD-10: Version: 2010), clinical comorbidities (coded by ICD-10), laboratory diagnosis of sexually transmitted infections, distance between patients' residence and the hospital, and year of entry into PROTIG. The patient cohort was stratified into two categories based on their duration of attendance: dropout (defined as attendance for up to 365 days) and non-dropout (attendance exceeding 365 days). Categorical variables between dropout and non-dropout groups were compared using Pearson's chi-square test. Additionally, Poisson regression analysis was utilized, employing a 95% confidence interval (CI) and setting the significance level at 0.05. Results: The study included a total of 888 patients accessing PROTIG, with 275 (31%) classified in the dropout group. Of the patient population, 65.5% (n = 582) self-identified as transgender women, while 34.5% (n = 306) identified as transgender men. Significant differences were noted between the dropout and non-dropout groups. Specifically, differences were noted among transgender women (p < 0.001), individuals with lower levels of education (p < 0.001), those with fewer diagnoses classified under ICD-10 as F64 (p < 0.001), individuals exhibiting fewer clinical comorbidities recorded in ICD-10 (p < 0.001), and those who commenced inclusion in PROTIG after 2010 (p < 0.001). Conclusion: There exists a notable rate of treatment discontinuation among individuals receiving care at PROTIG, with statistically significant variances observed between groups. We posit potential rationales for this discontinuation, informed by care experiences and feedback from group attendees: Increased accessibility to outpatient services in our jurisdiction for Transgender Care, along with heightened societal awareness of gender identity fostering diverse gender expression avenues devoid of reliance on gender-affirming surgical interventions.

Optimisation of Remote Monitoring Programmes in Heart Failure: Evaluation of Patient Drop-Out Behaviour and Healthcare Professionals' Perspectives.

Heart failure (HF) is a growing epidemic, affecting millions of people worldwide, and is a major cause of mortality, morbidity, and impaired quality of life. Traditional cardiac rehabilitation is a valuable approach to the physical and quality-of-life recovery of patients with cardiovascular disease. The innovative approach of remote monitoring through telemedicine offers a solution based on modern technologies, enabling continuous collection of health data outside the hospital environment. Remote monitoring devices present challenges that could adversely affect patient adherence, resulting in the risk of dropout. By applying a cognitive-behavioral model, we aim to identify the antecedents of dropout behavior among patients adhering to traditional cardiac rehabilitation programs and remote monitoring in order to improve the latter. Our study was conducted from October 2023 to January 2024. In the first stage, we used data from literature consultation. Subsequently, data were collected from the direct experience of 49 health workers related to both remote monitoring and traditional treatment, recruited from the authors' workplace. Results indicate that patients with cardiovascular disease tend to abandon remote monitoring programs more frequently than traditional cardiac rehabilitation therapies. It is critical to design approaches that take these barriers into account to improve adherence and patient satisfaction. This analysis identified specific antecedents to address, helping to improve current monitoring models. This is crucial to promote care continuity and to achieve self-management by patients in the future.

The safety of orthokeratology contact lens wear in slowing the axial elongation of the eye in children.

PURPOSE: To evaluate the safety of orthokeratology contact lens wear in slowing the axial elongation of the eye in myopic children. METHODS: Safety data from three prospective studies, which evaluated the use of orthokeratology for slowing myopia progression in children in comparison to a parallel control group of single-vision spectacle lens wearers over a 2-year period, were pooled together for analysis. The primary and secondary safety endpoints are the comparisons of adverse events and slit-lamp findings grades ≥ 2 between orthokeratology and control groups, respectively. RESULTS: Collectively, data from 125 orthokeratology and 118 control subjects were analyzed in this study. Of these, 101 (81 %) and 88 (75 %) orthokeratology and control subjects completed the 2-year follow-up period, respectively. Nineteen orthokeratology subjects experienced 28 adverse events, of which 6 were significant, whereas just one adverse event was found in the control group; this difference was statistically significant (p < 0.001). Most adverse events found in the orthokeratology group were corneal in nature, primarily corneal abrasion/staining, accounting for around 40 % of all adverse events. Of the 28 adverse events, only 18 (3 significant) are likely to be contact lens-related, leading to incidence rates of total and device-related adverse events per 100 patient years of lens wear (95 % confidence intervals) of 13.1 (9.2-18.2) and 8.4 (5.4-10.7), respectively. No significant differences were found between groups in the total number of silt-lamps findings with grades ≥ 2 (p > 0.05). CONCLUSION: Around 13% of eyes wearing overnight orthokeratology contact lenses are likely to experience an adverse event over one year of lens wear, with this figure being lower when considering device-related adverse events alone. No serious adverse events were found, with most being non-significant. These results inform eye care practitioners on the safety of orthokeratology lenses when prescribed for slowing myopia progression to myopic children.

Socioeconomic differences in the long-term effects of teacher absence on student outcomes.

School teachers' sickness absence has been shown to affect student achievement in the short run. However, we know little about whether socioeconomic backgrounds may compensate for reductions in instructional quality and to what extent teacher absence effects persist over time. This paper examines the socioeconomic differences in the short- and long-term effects of teacher absence. We use population-wide Norwegian register data to study the effects of certified teacher absence during lower secondary school (grades 8-10) on non-completion of upper secondary education by age 21 (i.e. school dropout) as well as academic achievement in 10th grade. In a school fixed effects model, we find that an increase in teacher absence of 5 percentage points reduces students' examination grades by 2.3% of a standard deviation and increases the dropout probability by 0.6 percentage points. However, the teacher absence effects vary considerably by family background, with large effects for low-SES students driving the overall effects. Overall, our findings indicate that reductions in instructional quality increase social inequality in long-term educational outcomes. This result highlights that studying heterogeneous impacts of contextual exposures is needed to understand the role of schools in shaping inequality.