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.

Device-Related Skin Reactions Increase Emotional Burden in Youths With Type 1 Diabetes and Their Parents.

BACKGROUND: Skin reactions due to technological devices pose a significant concern in the management of type 1 diabetes (T1D). This multicentric, comparative cross-sectional study aimed to assess the psychological impact of device-related skin issues on youths with T1D and their parents. METHODS: Participants with skin reactions were matched in a 1:1 ratio with a control group. Diabetes-related emotional distress was evaluated using the Problem Areas in Diabetes-Teen version (PAID-T) for participants aged 11 to 19 years and the Problem Areas in Diabetes-Parent Revised version (PAID-PR) completed by parents. In addition, glucose control was assessed through glycated hemoglobin (HbA1c) values and continuous glucose monitoring (CGM) metrics. RESULTS: A total of 102 children and adolescents were consecutively recruited. Adolescents with skin issues had higher PAID-T scores compared to those without (79.6 ± 21.1 vs 62 ± 16.8; P = .004). Parents of youths with skin reactions also reported higher PAID-PR scores than the control group (34.0 ± 11.0 vs 26.9 ± 12.3; P = .015). No differences were observed in HbA1c levels (6.9 ± 0.8% vs 6.8 ± 0.8%, P = .555) or CGM glucose metrics between the two groups. Remarkably, 25.5% were forced to discontinue insulin pumps and/or glucose sensors (21.5% and 5.9%, respectively). CONCLUSIONS: Our study highlighted the increased emotional burden experienced by youths with T1D and their parents due to device-related skin reactions, emphasizing the need for further research and interventions in this crucial aspect of diabetes management.

Efficacy of physical activity shared between parents and children to improve sports initiation in the M.A.M.I.deporte® program.

Objective: To determine if the active methodology for improving sports initiation (M.A.M.I.deporte®) shared between children and parents successfully promotes children in sports activities, maintains their activity and improves long-term adherence. Participants: The study involved 118 participants aged between 2 and 11 years (6.3 ± 2.3). In the first season, 34 participated (16 girls; 18 boys); in the second season, 46 participated (22 girls; 24 boys) and in the third season, 38 participated (19 girls; 19 boys). Methodology: It was carried out from October to June over three academic years for two hours a week. Every 4 sessions a different sporting activity was carried out, planned so that parents and children could practise them, simultaneously. Analysis: At the beginning and end of each period, a survey was carried out on the sports activities in which the participants had started. If participants remained in the activity, the survey was face-to-face and if participants no longer attended the activity, they were contacted by telephone. Descriptive values were obtained for the variables in absolute and percentage form and a repeated measures anova was performed. Results: Vigorous physical activity performed was 3.82 ± 1.16 h/week in the first year, 3.38 ± 1.59 in the second year and 2.99 ± 1.46 in the third year with no significant differences between any of the years. 32.20% joined other sporting activities and only 6.78% gave up vigorous physical activity. Conclusion: Joint activity of parents and children contributed to maintaining vigorous physical activity at the recommended levels in the child population with only 6.78% (n = 8) of the participants dropping out.

Why Do New Parents Stop Practising Sport? A Retrospective Study towards the Determinants of Dropping Out after Becoming a Parent.

Despite the known health benefits of sport, recent studies showed that parenthood is related to decreased sport participation. Changes in sport behaviour after becoming a parent have been explained by gender or with the rational resource perspective of limited time and energy. However, the latter is mostly theoretical, since empirical insights on resource mechanisms are scarce. We want to improve and go beyond these explanations by investigating them empirically and by examining sport socialisation during the formative years as an alternative explanation. Consequently, our main objective is to explain changes in sport participation after becoming a parent with gender, limited resources and socialisation with sport. To this end, we employ representative Dutch survey data of new parents (n = 594), containing detailed information on sport careers and sport socialisation, as well as babysitter availability, partner support and physical discomfort after childbirth. The results of the logistic regression analyses show that, besides gender and resource mechanisms, sport socialisation and social support seem to have a great impact on sport behaviour when people become parents. That is, men are more likely to continue sport participation, as well as people with more resources (physical, temporal and social) and more socialisation with sport during the formative years. So including sport socialisation and social support seems necessary to better explain and prevent sport dropout during major life transitions, like becoming a parent.

School-based physical activity interventions: which intervention characteristics are associated with participation and retention? A meta-analysis.

OBJECTIVE: Many school-based intervention studies are conducted to increase students' physical activity (PA). Recruitment and retention problems potentially impact the robustness of RCT findings. We conducted a meta-analysis to summarize recruitment and retention rates in long-term secondary school-based PA intervention studies and examined associated participant and intervention characteristics. METHODS: Web of Science, Pubmed, Medline, and PsychInfo were searched until March 20th 2023. We included studies on secondary school-based PA interventions ≥12 weeks, aimed at typically developing adolescents. We abstracted number of schools and students invited, randomized, and participating at follow-up to calculate pooled recruitment and retention rates; participant and intervention characteristics were abstracted to execute subgroup or meta-regression analyses. RESULTS: Recruitment rates were 51% for invited schools and 80% for invited students, the retention for schools was almost 100% and for students 91%. Interventions with fixed and flexible components, executed in Asia and South America, and from later publication years had higher student recruitment rates. Students' retention rates were lower for interventions which had flexible components, were theory/model-based, used an accelerometer, had a longer intervention duration, and included more females. CONCLUSION: Recruitment and retention rates in school-based PA interventions are high. Some participant and intervention characteristics influence these rates: flexibility of the intervention, theory/model-based intervention, accelerometer use, intervention duration, continent, and number of females. Researchers should consider these characteristics in intervention development to achieve optimal balance between intervention effectiveness, recruitment, and retention.

An exploratory view into allelic drop-out of sequenced autosomal STRs.

As massively parallel sequencing is implemented in forensic genetics, an understanding of sequence data must accompany these advancements, that is, accurate modeling of data for proper statistical analysis. Allelic drop-out, a common stochastic effect seen in genetic data, is often modeled in statistical analysis of STR results. This proof-of-concept study sequenced several serial dilutions of a standard sample ranging from 4 ng to 7.82 pg to evaluate allelic drop-out trends on a select panel of autosomal STRs using the ForenSeq™ DNA Signature Prep Kit, Primer Set A on the Illumina MiSeq FGx. Parameters assessed included locus, profile, and run specific information. A majority of the allelic drop-out occurred in DNA concentrations less than 31.25 pg. Statistical results indicated a need for locus-specific modeling based on STR descriptors, like simple versus compound repeat patterns. No correlation was seen between average read count of scored alleles and allelic drop-out at a locus. A statistical correlation was observed between the amount of allelic drop-out and the starting amount of DNA in a sample, average read count of a sample, and total read count generated on a flow cell. This study supports using common allelic drop-out factors used in fragment length analysis on sequenced STRs while including additional locus, sample, and run specific information. Results demonstrate multiple factors that can be considered when developing probability of allelic drop-out models for sequenced autosomal STRs including locus-specific analysis, total read count of a profile, and total read count sequenced on a flow cell.

Risk and protective factors for early dropout from telephone monitoring for individuals with drug convictions in community mental health centers in Japan.

INTRODUCTION: Individuals involved with the criminal justice system face challenges in receiving and maintaining substance use disorder (SUD) treatment and support. Although telephone monitoring (TM) could reduce these barriers, data on TM for community-dwelling individuals involved with the criminal justice system and research on individuals who drop out of TM are scarce. We examined the factors associated with dropping out early from the Voice Bridges Project, which provides TM for individuals on probation for drug-related convictions through community mental health centers in Japan. METHODS: Participants (n = 546) were individuals aged ≥20 years with methamphetamine-related convictions who were on probation. Univariate analyses examine the associations between one-year follow-up status and baseline variables, and multivariate Cox proportional hazards regression analyses identify the risk and protective factors associated with dropping out. Stratified analyses report results based on sex and halfway-house residency. RESULTS: The one-year dropout rate was 43.6 % (n = 238). Multivariate analysis identified two risk factors for dropping out-halfway-house residency and suicide attempts in the past year, and two protective factors-higher education and the current use of SUD services. Sex-stratified analyses showed that halfway-house residency was a risk factor for both men and women. Attempted suicide was a risk factor for women. Conversely, higher education and current use of SUD services were protective factors for men. CONCLUSIONS: Our results identify unique risk factors for women, such as a recent history of suicide attempts, and distinctive protective factors for men, including higher education and current use of SUD services, emphasizing the importance of sex-specific approaches. Furthermore, the study reveals that irrespective of sex, vulnerable individuals, such as halfway-house residents, are at a higher risk of dropping out from TM.

Navigating Adherence: Unraveling Factors Shaping Opioid Substitution Therapy Compliance.

Background and objective In drug-deaddiction programs, dropout is a major problem in any drug de-addiction program, as dependence is a chronic illness known to relapse frequently. Understanding factors that predict dropout can help design targeted interventions to promote follow-up. This study aimed to assess the various sociodemographic characteristics of opioid-dependent subjects on buprenorphine maintenance treatment and dropping out at or before the three-month follow-up period. Method In this study, the sociodemographic characteristics and quality of life (QOL) of 34 opioid-dependent subjects (males, 32, 94%; females, 2, 6%) on the day of their enrolment in an opioid substitution therapy (OST) center were assessed, and a comparison of sociodemographic and drug use pattern was made between those who followed up and those who dropped out by the end of three months. Results Statistical analysis of the various sociodemographic characteristics using appropriate tests yielded that predictors of good follow-up are younger age (F = 4.57907, P = 0.04008), better education (F = 5.07221, P = 0.031305), and being part of a nuclear family. Longer follow-up was associated with shorter opioid intake duration (F = 8.58908, P = 0.006195). Better social relationships, as evidenced by the social relationship domain score of QOL, predicted longer follow-up (F = 8.58908, P = 0.006195). Other characteristics analyzed did not yield significant associations. Conclusions The study unveils the complexity of opioid addiction recovery, revealing the interplay of age, education, family, addiction duration, and support, shaping one's resilience in recovery.

Perceptions of nursing staff and students regarding attrition: a qualitative study.

OBJECTIVES: This research aims to explore the perceptions of nursing students and directors of bachelor of nursing degree courses regarding reasons for attrition amongst nursing students. METHODS: A qualitative descriptive study was conducted using inductive thematic analysis. The study included a purposeful sample of 12 students and 4 directors of bachelor of nursing degree courses. RESULTS: As reasons for attrition, the directors highlighted a lack of preparation for nursing studies and students' limited awareness of possibilities for support and learning. The students emphasized insufficient support from academic staff and poor course organization. Economic and family issues and a misunderstanding of the professional role of a nurse were cited as reasons by both directors and students. CONCLUSIONS: The findings provide important insight into attrition in the nursing programme. Further research is warranted, particularly in other contexts. Addressing student attrition requires a comprehensive approach that includes the provision of adequate support systems, mentorship, and resources for students.

Efficacy and Acceptance of Cognitive Behavioral Therapy in Adults with Chronic Fatigue Syndrome: A Meta-analysis.

BACKGROUND: The systematic aggregation of research on cognitive behavioral therapy (CBT) in chronic fatigue syndrome (CFS) needs an update. Although meta-analyses evaluating interventions typically focus on symptom reduction, they should also consider indicators of treatment acceptability, e.g., drop-out rates. METHODS: Randomized controlled trials (RCTs) investigating CBT in adults with CFS compared to inactive and non-specific control groups were included. First, efficacy was examined, considering fatigue, depression, anxiety, and perceived health. Secondly, drop-out rates through different trial stages were analyzed: Non-completion of all mandatory sessions, drop-out (primary study definition), treatment refusal (non-starters), and average of sessions completed. RESULT: We included 15 RCTs with 2015 participants. CBT was more effective than controls in fatigue (g = -0.52, 95%CI -0.69 to -0.35), perceived health, depression, and anxiety at post-treatment. At long-term follow-up the effects were maintained for fatigue and anxiety. Rates of non-completion (22%, 95%CI 3-71), drop-out (15%, 95%CI 9-25), and treatment refusal (7%, 95%CI 3-15) were relatively low, with a high average proportion of sessions completed. Total time of therapy moderated the effect on fatigue, while the number of sessions moderated the effect on perceived health. Fatigue severity influenced adherence. CONCLUSION: The results indicate that CBT for CFS is effective in reducing fatigue, fatigue related impairment, and severity of depression and anxiety. Conclusions on efficacy at follow-ups are still limited. However, adherence is high in CBT. The results may help to inform clinical practice. Future research should focus on examining the maintenance of effects, while also emphasizing the importance of treatment acceptance.

Is there a prospective association between psychological distress as measured by the CORE-OM and treatment attendance and treatment duration? A follow-up study at a Norwegian Community Mental Health Centre.

BACKGROUND: Feasible and reliable methods for identifying factors associated with treatment duration and treatment attendance in mental health services are needed. This study examined to what degree the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the start of treatment is associated with treatment attendance and treatment duration. METHODS: Outpatients (N = 124) at a community mental health centre in Norway completed the 34-item CORE-OM questionnaire addressing the domains of subjective well-being, problems and symptoms, functioning and risk at the start of treatment. The CORE-OM subscales and the 'all' items total scale were used as predictor variables in regression models, with treatment duration, number of consultations attended, treatment attendance (number of therapy sessions attended divided by number of sessions offered) and termination of treatment (planned versus unplanned) as outcome variables. RESULTS: Higher CORE-OM subscale scores and the 'all' scale were associated with longer treatment duration. No association was found between CORE-OM scales and number of therapy sessions, treatment attendance (sessions attended/offered) or whether the patients unexpectedly ended treatment. CONCLUSION: Higher patient-reported psychological distress as measured by the CORE-OM at the start of treatment was prospectively associated with treatment duration but not with treatment attendance or drop-out of treatment. The findings imply that patients with higher initial psychological distress need longer treatment but that treatment attendance may be related to factors other than the severity of distress.

Youth Sport Participation Trends Across Europe: Implications for Policy and Practice.

Purpose: Despite the known health and wellbeing benefits of taking part in sport for children and adolescents, it is reported that sports participation declines during adolescence. The purpose of this study was to explore current organized youth sport participation rates across Europe for both males and females and update current understanding. Method: Sport participation registration data was collected for 18 sports from 27 countries. In total, participation data was collected from over 5 million young people from Under 8s (U8s) to Under 18s (U18s). Differences in the participation rates between age categories were investigated using a generalized linear mixed effects model. Results: Overall, males were four times more likely to participate in organised youth sport than females' participants, with this trend apparent across all age categories and across most sports. There was a significant decrease across sports in participation rates for males during adolescence from U14-U16 and U16-U18. There was a significant decrease in participation rates for females from U14-U16 for most sports except but an increase in participation rates from U16-U18 for 12 out of 18 sports. Soccer (1262%), wrestling (391%) and boxing (209%) were the sports that had greater male sport participation rates. In contrast, dance sports (86%) and volleyball (63%) had more female participants than males. This research shows male sports participation is significantly greater than female in youth sport across Europe. Conclusion: Furthermore, findings showed that for both male and female participants, participation rates increased from U8-U14 for the majority of sports followed by reduced participation rates during adolescence. Findings of this research can be used by national governing bodies and sporting organizations to inform youth sport participation initiatives.

Factors of oncological failure in two stage hepatectomy for colorectal liver metastases.

BACKGROUND: Two-stage hepatectomy (TSH) has increased the chance of surgical resections for bilobar colorectal liver metastases (CRLM). Nevertheless, drop-out between stages and early recurrence rates raise the question of surgical futility in some situations. This study aimed to identify factors of TSH oncological failure. METHODS: Patients with bilobar CRLM eligible for TSH in three tertiary centers between 2010 and 2021 were included, and divided in Failure and Success groups. Oncological failure was defined as failure of the second stage hepatectomy for tumor progression or recurrence within 6 months after resection. RESULTS: Among 95 patients, 18 (18.9%) had hepatic progression between the two stages, and 7 (7.4%) failed to complete the second stage hepatectomy. After TSH, 31 (32.6%) patients experienced early recurrence. Overall, 38 (40.0%) patients experienced oncological failure (Failure group). The Failure group had lower median DFS (3 vs. 32 months, p < 0.001) and median OS (29 vs. 70 months, p = 0.045) than the Success group. On multivariable analysis, progression between the two stages in the future liver remnant (OR = 15.0 (3.22-113.0), p = 0.002), and maximal tumor size ≥40 mm in the future liver remnant (OR = 13.1 (2.12-117.0), p = 0.009) were independent factors of oncological failure. CONCLUSION: Recurrence between the two stages and maximal tumor size ≥40 mm in the future liver remnant were associated with TSH failure for patients with bilobar CRLM.

Embryo drop-out rates in preimplantation genetic testing for aneuploidy (PGT-A): a retrospective data analysis from the DoLoRes study.

PURPOSE: To evaluate the decline in transferable embryos in preimplantation genetic testing for aneuploidy (PGT-A) cycles due to (a) non-biopsable blastocyst quality, (b) failure of genetic analysis, (c) diagnosis of uniform numerical or structural chromosomal aberrations, and/or (d) chromosomal aberrations in mosaic constitution. METHODS: This retrospective multicenter study comprised outcomes of 1562 blastocysts originating from 363 controlled ovarian stimulation cycles, respectively, 226 IVF couples in the period between January 2016 and December 2018. Inclusion criteria were PGT-A cycles with trophectoderm biopsy (TB) and next generation sequencing (NGS). RESULTS: Out of 1562 blastocysts, 25.8% were lost due to non-biopsable and/or non-freezable embryo quality. In 10.3% of all biopsied blastocysts, genetic analysis failed. After exclusion of embryos with uniform or chromosomal aberrations in mosaic, only 18.1% of those originally yielded remained as diagnosed euploid embryos suitable for transfer. This translates into 50.4% of patients and 57.6% of stimulated cycles with no euploid embryo left for transfer. The risk that no transfer can take place rose significantly with a lower number of oocytes and with increasing maternal age. The chance for at least one euploid blastocyst/cycle in advanced maternal age (AMA)-patients was 33.3% compared to 52.1% in recurrent miscarriage (RM), 59.8% in recurrent implantation failure (RIF), and 60.0% in severe male factor (SMF). CONCLUSIONS: The present study demonstrates that PGT-A is accompanied by high embryo drop-out rates. IVF-practitioners should be aware that their patients run a high risk of ending up without any embryo suitable for transfer after (several) stimulation cycles, especially in AMA patients. Patients should be informed in detail about the frequency of inconclusive or mosaic results, with the associated risk of not having an euploid embryo available for transfer after PGT-A, as well as the high cost involved in this type of testing.

The neglected emotional drawbacks of the prioritization of embryos to transfer.

In recent years, increasing efforts have been made to develop advanced techniques that could predict the potential of implantation of each single embryo and prioritize the transfer of those at higher chance. The most promising include non-invasive preimplantation genetic testing for aneuploidy and artificial intelligence-based algorithms using time lapse images. The psychological effect of these add-ons is neglected. One could speculate that embarking on another transfer after one or more failures with the prospect of receiving an embryo of lower potential may be distressing for the couple. In addition, the symbolic and mental representation of an embryo with 'lower capacity to implant' is currently unknown but could affect couples' choices and wellbeing. These emotional responses may also undermine adherence to the programme and, ultimately, its real effectiveness. Future trials aimed at evaluating the validity of prioritization procedures must also consider the emotional burden on the couples.

Gene regulatory network analysis predicts cooperating transcription factor regulons required for FLT3-ITD+ AML growth.

Acute myeloid leukemia (AML) is a heterogeneous disease caused by different mutations. Previously, we showed that each mutational subtype develops its specific gene regulatory network (GRN) with transcription factors interacting within multiple gene modules, many of which are transcription factor genes themselves. Here, we hypothesize that highly connected nodes within such networks comprise crucial regulators of AML maintenance. We test this hypothesis using FLT3-ITD-mutated AML as a model and conduct an shRNA drop-out screen informed by this analysis. We show that AML-specific GRNs predict crucial regulatory modules required for AML growth. Furthermore, our work shows that all modules are highly connected and regulate each other. The careful multi-omic analysis of the role of one (RUNX1) module by shRNA and chemical inhibition shows that this transcription factor and its target genes stabilize the GRN of FLT3-ITD+ AML and that its removal leads to GRN collapse and cell death.

Bayesian second-order sensitivity of longitudinal inferences to non-ignorability: an application to antidepressant clinical trial data.

Incomplete data is a prevalent complication in longitudinal studies due to individuals' drop-out before intended completion time. Currently available methods via commercial software for analyzing incomplete longitudinal data at best rely on the ignorability of the drop-outs. If the underlying missing mechanism was non-ignorable, potential bias arises in the statistical inferences. To remove the bias when the drop-out is non-ignorable, joint complete-data and drop-out models have been proposed which involve computational difficulties and untestable assumptions. Since the critical ignorability assumption is unverifiable based on the observed part of the sample, some local sensitivity indices have been proposed in the literature. Specifically, Eftekhari Mahabadi (Second-order local sensitivity to non-ignorability in Bayesian inferences. Stat Med 2018;59:55-95) proposed a second-order local sensitivity tool for Bayesian analysis of cross-sectional studies and show its better performance for handling bias compared with the first-order ones. In this paper, we aim to extend this index for the Bayesian sensitivity analysis of normal longitudinal studies with drop-outs. The index is driven based on a selection model for the drop-out mechanism and a Bayesian linear mixed-effect complete-data model. The presented formulas are calculated using the posterior estimation and draws from the simpler ignorable model. The method is illustrated via some simulation studies and sensitivity analysis of a real antidepressant clinical trial data. Overall, the numerical analysis showed that when repeated outcomes are subject to missingness, regression coefficient estimates are nearly approximated well by a linear function in the neighbourhood of MAR model, but there are a considerable amount of second-order sensitivity for the error term and random effect variances in Bayesian linear mixed-effect model framework.

Premature termination of inpatient eating disorder treatment: Does timing matter?

BACKGROUND: Premature termination of treatment is a serious problem in the treatment of eating disorders. Prior research attempting to differentiate patients who are able to complete treatment from those who terminate early has yielded mixed results. One proposed explanation for this is a failure to examine the time course of treatment termination. This study was designed to explore associations between baseline patient characteristics and timing of treatment termination. METHODS: Participants were 124 eating disorder patients admitted voluntarily to the inpatient program at Toronto General Hospital between 2009 and 2015. At admission, all patients completed measures of eating disorder symptoms, eating disorder cognitions, depressive symptoms and emotional dysregulation. Body weight was measured weekly. Data analyses were completed using one-way ANOVAs and Chi Square tests. RESULTS: Results showed significant associations between timing of treatment termination and eating disorder diagnosis, severity of eating disorder cognitions and severity of depressive symptoms. Post-hoc analyses revealed that patients who left treatment early had more severe depressive symptoms, eating disorder cognitions related to eating and difficulties engaging in goal directed behaviors when emotionally dysregulated. CONCLUSIONS: Patients who terminated inpatient treatment early in their admissions differ from patients who terminated later and those who completed treatment. These differences have potential clinical implications for the clinical management of patients with severe eating disorders requiring inpatient admission. Trial registration This paper is not associated with a clinical trial.

Patients being unable to complete inpatient treatment is serious problem in the treatment of eating disorders. Prior research attempting to identify differences between patients who can complete treatment and those who cannot has had mixed results. This study was designed to explore whether patients who leave treatment at different times differ from each other. To do this we compared eating disorder symptoms, eating disorder thoughts, depressive symptoms and emotional regulation symptoms of patients who left treatment early (0­4 weeks), later (after 4 weeks but before completion) and those who completed treatment. Results showed that patients who left treatment early reported the most severe eating disorder beliefs and depressive symptoms. They also had the most difficulties engaging in goal directed behaviours when experiencing intense emotions. They were not found to have differences in body weights or rates of eating disorder behaviors (i.e. self-induced vomiting). These results suggest that patients who leave treatment early are the most unwell and may benefit from learning emotional regulation skills prior to, or early in, treatment.

Outpatient care for adolescents' and young adults' mental health: promoting self- and others' understanding through a metacognitive interpersonal therapy-informed psychological intervention.

Introduction: Psychological distress may result in impairment and difficulty understanding oneself and others. Thus, addressing metacognitive issues in psychotherapy may improve psychopathology in adolescents and young adults (AYAs). We aimed to compare metacognitive interpersonal therapy (MIT)-informed psychotherapy with other treatment-as-usual (TAU) therapies. Methods: We administered the Global Assessment of Functioning (GAF) scale, the Clinical Global Impressions-Severity (CGI-S) scale, and the Brief Psychiatric Rating Scale (BPRS) at baseline (BL) and at treatment termination (the endpoint was at 6 months and any last results obtained before that term were carried forward in analyzes). Patients received concomitant psychiatric and psychological treatment. Results: Sixty AYAs were involved in the study. There was a significant reduction in symptomatology after the intervention. Twelve patients (17%) dropped out; treatment adherence was 83%. In the MIT group, 2 patients dropped out (11%), and in the TAU group, 9 patients dropped out (19%). All scales showed a significant reduction in symptoms between baseline (BL) and the 6-month endpoint: GAF (χ2 = 6.61, p < 0.001), BPRS (χ2 = 6.77, p < 0.001), and CGI (χ2 = 7.20, p < 0.001). There was a greater efficacy for the MIT group in terms of symptom reduction on the BPRS (t = 2.31; p < 0.05). Conclusion: The study confirmed the efficacy of early and integrated care in adolescence and suggested greater symptom reduction for a psychotherapeutic intervention focused on stimulating mentalization skills. The study indicates the usefulness of this type of approach in the treatment of adolescent psychopathology. Due to the small sample size, the results need replication.