Abandono de la terapia antirretroviral entre adolescentes y jóvenes con VIH/SIDA durante el COVID-19: un estudio de casos y controles / Antiretroviral therapy abandonment among adolescents and young people with HIV/AIDS during COVID-19: A case-control study / Abandono da terapia antirretroviral entre adolescentes e jovens com HIV/aids durante a COVID-19: estudo caso-controle

Objetivo: identificar los factores asociados al abandono de la terapia antirretroviral entre adolescentes y jóvenes que vivían con VIH/sida durante la pandemia de COVID-19. Método: estudio de casos y controles realizado entre 2020 y 2021 en Maringá, Paraná. Los casos fueron: adolescentes y jóvenes (10 a 24 años) diagnosticados con VIH/sida y que abandonaron el tratamiento, mientras que el grupo de controles fue compuesto por personas con características sociodemográficas semejantes, diagnosticadas con VIH/sida, sin historia de abandono del tratamiento. El emparejamiento de casos y controles se hizo por conveniencia, con cuatro controles por cada caso. El instrumento de investigación presentó variables sociodemográficas y clínicas, entre otras y la asociación con el abandono del tratamiento se analizó por regresión logística. Resultados: se incluyeron 27 casos y 109 controles en el estudio (proporción 1/4). La variable asociada con mayor probabilidad de abandono fue la edad próxima a 22,8 años (ORaj:1,47; IC 95%:1,07-2,13; p=0,024). El uso esporádico del preservativo (ORaj:0,22; IC 95%:0,07-0,59; p=0,003) y padecer una infección oportunista (OR:0,31; IC 95%:0,10-0,90; p=0,030) fueron factores protectores. Conclusión: la edad próxima a los 23 años en la última visita se asoció al abandono de la terapia antirretroviral. La presencia de infección oportunista y el uso de preservativos son factores determinantes para la continuidad del tratamiento durante el COVID-19.

Objective: to identify the factors associated with antiretroviral therapy abandonment among adolescents and young people living with HIV/AIDS during the COVID-19 pandemic. Method: a case-control study carried out between 2020 and 2021 in Maringá, Paraná. The cases corresponded to the following: adolescents and young people (aged from 10 to 24 years old) diagnosed with HIV/AIDS and who abandoned treatment, while the Control Group consisted of people with similar sociodemographic characteristics, diagnosed with HIV/AIDS and with no history of treatment abandonment. Pairing of the cases and controls was by convenience, with four controls for each case. The research instrument presented sociodemographic variables, clinical characteristics and others, whose association with treatment abandonment was analyzed by means of logistic regression. Results: a total of 27 cases and 109 controls were included in the study (1/4 ratio). The variable associated with an increased chance of abandonment was age close to 22.8 years old (ORadj: 1.47; 95% CI: 1.07-2.13; p=0.024). Sporadic condom use (ORadj: 0.22; 95% CI: 0.07-0.59; p=0.003) and having an opportunistic infection (OR: 0.31; 95% CI: 0.10-0.90; p=0.030) were protective factors. Conclusion: age close to 23 years old at the last consultation was associated with antiretroviral therapy abandonment. The presence of opportunistic infections and condom use are determining factors for treatment continuity during COVID-19.

Objetivo: identificar os fatores associados ao abandono da terapia antirretroviral entre adolescentes e jovens vivendo com HIV/aids durante a pandemia de COVID-19. Método: estudo caso-controle realizado entre 2020 e 2021 em Maringá, Paraná. Os casos foram: adolescentes e jovens (10 a 24 anos) diagnosticados com HIV/aids e que abandonaram o tratamento, enquanto o grupo dos controles foi composto por pessoas com características sociodemográficas semelhantes, diagnosticadas com HIV/aids, sem histórico de abandono de tratamento. O pareamento dos casos e controles foi por meio de conveniência, sendo quatro controles para cada caso. O instrumento de pesquisa apresentou variáveis sociodemográficas, características clínicas e outras, cuja associação com o abandono do tratamento foi analisada por meio de regressão logística. Resultados: 27 casos e 109 controles foram incluídos no estudo (proporção 1/4). A variável associada à maior chance de abandono foi idade próxima de 22,8 anos (ORaj.:1,47; IC95%:1,07-2,13; p=0,024). O uso esporádico de preservativo (ORaj:0,22; IC95%:0,07-0,59; p=0,003) e ter infecção oportunista (OR:0,31; IC95%:0,10-0,90; p=0,030) foram fatores de proteção. Conclusão: idade próxima a 23 anos na última consulta foi associada ao abandono da terapia antirretroviral. A presença de infecção oportunista e o uso de preservativo são fatores determinantes para continuidade do tratamento durante a COVID-19.

The impact of a preanesthesia assessment clinic on scheduled elective case cancelations at a Thai university hospital.

Elective surgical case cancelations negatively impact healthcare systems and patient dissatisfaction. Preanesthesia assessment clinics (PACs) have been established in many countries to facilitate preoperative medical optimization. However, their benefits for elective procedure cancelations in Thailand have not been formally assessed. This study evaluated the impact of a PAC on scheduled elective surgical case cancelations at a Thai university hospital. A retrospective cross-sectional study was conducted for the period covering from May 2016 to April 2017. We included all scheduled elective surgical cases at Siriraj Hospital, Thailand, canceled on the day of surgery. The cancelation incidences of patients attending and not attending the PAC were compared. Cancellation reasons were categorized as "patient issue," "hospital-facility issue," "surgeon issue," "anesthesiologist issue," "medical condition," and "miscellaneous." The PAC patients' reasons were rigorously explored to determine their preventability. There were 30,351 scheduled elective procedures during the study period. The case-cancelation incidences were 0.9% (95% confidence interval [CI], 0.7-1.2%) for patients visiting the PAC and 5.9% (95% CI, 5.6-6.3%) for those who did not. Medical conditions were the most common reason for cancelation for non-PAC patients (27.3%), whereas hospital-facility issues were the most frequent for PAC patients (43.8%). The cancelation rate for patient issues was significantly lower in the PAC group (4.2% vs 20.7%; P < .05). Thirty-one (64.6%) of the PAC patients' cancelations were potentially preventable. Of the 15 PAC patient cancelations related to medical conditions, 12 were for patients with a history of acute illness and were determined to be nonpreventable. Visiting the PAC was significantly associated with a decreased elective-case cancelation rate. Cancellations were most frequently related to hospital-facility issues for patients visiting the PAC and medical conditions for those who did not. Some PAC patient cancelations for medical conditions involved unpreventable acute patient illnesses. Clinical Trials.gov (NCT02816281).

Closing the health gap in Central Australia: reduction in Indigenous Australian inpatient self-discharge rates following routine collaboration with Aboriginal Health Workers.

BACKGROUND: Indigenous Australians experience significant socioeconomic disadvantage and healthcare disparity compared to non-Indigenous Australians. A retrospective cohort study to describe the association between rates of self-discharge in Indigenous orthopaedic patients and the introduction of routine Aboriginal Liaison Officers (ALO) within the Orthopaedic multi-disciplinary team (MDT) was performed. METHODS: ALO were introduced within our routine Orthopaedic MDT on the 22nd of February 2021. Two patient cohorts were analysed, Group 1; patients admitted in the 9-months prior to inclusion of ALO, and Group 2; patients admitted within 9-months thereafter. The primary outcome of interest was the rate of self-discharge among Indigenous patients. Secondary outcomes of interest were the stage of treatment when patients self-discharged, recurrent self-discharge, risk factors for self-discharge and association between self-discharge and length of hospital stay. RESULTS: Introduction of ALO within routine Orthopaedic MDT was associated with a significant 37% reduced risk of self-discharge among Indigenous patients (p = 0·009), and significantly fewer self-discharges before their definitive surgical and medical treatment (p = 0·0024), or before completion of postoperative intravenous antibiotic treatment (p = 0·030). There was no significant change in the risk of recurrent self-discharge (p = 0·557). Risk factors for self-discharge were younger age; pensioners or unemployed; residents of Alice Springs Town-Camps or of communities within 51 to 100 km of Alice Springs; and those diagnosed with lacerations of the upper limb, but without tendon injury, wound and soft tissue infections or osteomyelitis. In Group 2, the odds of self-discharge decreased with increased length of hospital stay (p = 0·040). CONCLUSIONS: Routine inclusion of ALO within the Orthopaedic MDT reduced the risk of self-discharge in Indigenous patients. Those who self-discharged did so only after critical aspects of their care were met.

Evaluating the effect of electroconvulsive therapy (ECT) on post-traumatic stress disorder (PTSD): A systematic review and meta-analysis of five studies.

ECT has been proposed as a potential treatment for PTSD. There is a small number of clinical studies to date, but no quantitative review of the efficacy has been conducted. We performed a systematic review and meta-analysis to evaluate the effect of ECT in reducing PTSD symptoms. We followed the PICO and the PRISMA guidelines and searched PubMed, MEDLINE (Ovid), EMBASE (Ovid), Web of Science, and the Cochrane Central Register of Controlled Trials (PROSPERO No: CRD42022356780). A random effects model meta-analysis was conducted with the pooled standard mean difference, applying Hedge's adjustment for small sample sizes. Five within-subject studies met the inclusion criteria, containing 110 patients with PTSD symptoms receiving ECT (mean age 44.13 ± 15.35; 43.4% female). ECT had a small but significant pooled effect on reducing PTSD symptoms (Hedges' g = -0.374), reducing intrusion (Hedges' g = -0.330), avoidance (Hedges' g = -0.215) and hyperarousal (Hedges' g = -0.171) symptoms. Limitations include the small number of studies and subjects and the heterogeneity of study designs. These results provide preliminary quantitative support for the use of ECT in the treatment of PTSD.

Higher baseline emotion dysregulation predicts treatment dropout in outpatients with borderline personality disorder.

Treatment dropout is high among outpatients with borderline personality disorder (BPD) and is associated with myriad negative therapeutic and psychosocial outcomes. Identifying predictors of treatment dropout can inform treatment provision for this population. The present study investigated whether symptom profiles of static and dynamic factors could predict treatment dropout. Treatment-seeking outpatients with BPD (N = 102) completed pre-treatment measures of BPD symptom severity, emotion dysregulation, impulsivity, motivation, self-harm, and attachment style to determine their collective impact on dropout prior to 6 months of treatment. Discriminant function analysis was used to classify group membership (treatment dropout vs. nondropout) but did not produce a statistically significant function. Groups were distinguished by baseline levels of emotion dysregulation with higher dysregulation predicting premature treatment dropout. Clinicians working with outpatients with BPD might benefit from optimizing emotion regulation and distress tolerance strategies earlier in treatment to reduce premature dropout. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The association of baseline depressive symptoms and stress on withdrawal in a national longitudinal cohort: the REGARDS study.

PURPOSE: To measure the association of baseline psychological symptoms (depressive symptoms and perceived stress) with withdrawal from a cohort study. METHODS: Depressive symptoms and perceived stress were obtained using validated measures during the baseline computer-assisted telephonic interview for the REasons for Geographic and Racial Differences in Stroke study a national longitudinal cohort (≥45 years, 42% Black, 55% women) recruited between 2003 and 2007. Participants who completed follow-up after September 1, 2019, were considered active. Primary outcome was time to study withdrawal. The association of psychological symptoms and time-to-withdrawal was measured using Cox proportional hazard regression models with incremental adjustments by demographic and clinical factors. RESULTS: Out of 29,964 participants included in the analysis, 11,111 (37.1%) participants withdrew over the follow-up period (median: 11 years). Compared to participants with low depressive symptoms, those with moderate symptoms had 5% higher risk (aHR= 1.05; 95% CI= 1.00-1.10) and those with high level of depressive had 19% higher risk (aHR= 1.19; 95% CI= 1.11-1.27) of withdrawal in fully adjusted models. No significant association between perceived stress and withdrawal risk was observed. CONCLUSIONS: Depressive symptoms were significantly associated with withdrawal. Prevalence of depressive symptoms at baseline is an important indicator of participant retention in large prospective cohorts.

Absconding among admitted patients with bipolar affective disorder diagnosis in Uganda.

BACKGROUND: Hospitalization is often necessary for individuals with Bipolar affective Disorder (BAD) during severe manic or depressive episodes, as well as for stabilizing treatment regimens. However, a significant proportion of patients admitted for treatment of BAD abscond or leave the hospital without permission during their stay. In addition, patients managed for BAD may have unique characteristics that might force them into absconding. For example, the high prevalence of co-morbid substance use disorder - craving to use substances, suicidal behaviors - attempts to die by suicide, and cluster B personality disorders - characterized by impulsive acts. It is, therefore, essential to understand the factors contributing to absconding among patients with BAD, to facilitate designing strategies for preventing and managing this behavior. METHOD: This study was based on a retrospective chart review of the inpatients diagnosed with BAD at a tertiary psychiatry facility in Uganda from January 2018 to December 2021. RESULTS: Approximately 7.8% of those with BAD absconded from the hospital. The likelihood of absconding among those with BAD increased with the use of cannabis [adjusted odds ratio (aOR) = 4.00, 95% confidence interval (CI) = 1.22-13.09, p-value = 0.022] and having mood lability [aOR = 2.15, 95% CI = 1.10-4.21, p-value = 0.025]. However, receiving psychotherapy during the admission (aOR = 0.44, 95 CI = 0.26-0.74, p-value = 0.002) and treatment with haloperidol (aOR = 0.39, 95% CI = 0.18-0.83, p-value = 0.014) reduced the likelihood of absconding. CONCLUSION: Absconding among patients with BAD is common in Uganda. Those with symptoms of affective lability and those with comorbid cannabis use tend to abscond more, while those who receive haloperidol and psychotherapy are less likely to abscond.

Mediators of Ethnic Differences in Dropout Rates From a Randomized Controlled Treatment Trial Among Latinx and Non-Latinx White Primary Care Patients With Anxiety Disorders.

ABSTRACT: Disparities in treatment engagement and adherence based on ethnicity have been widely recognized but are inadequately understood. Few studies have examined treatment dropout among Latinx and non-Latinx White (NLW) individuals. Using Andersen's Behavioral Model of Health Service Use (A behavioral model of families' use of health services. 1968; J Health Soc Behav. 1995; 36:1-10) as a framework, we examine whether pretreatment variables (categorized as predisposing, enabling, and need factors) mediate the relationship between ethnicity and premature dropout in a sample of Latinx and NLW primary care patients with anxiety disorders who participated in a randomized controlled trial (RCT) of cognitive behavioral therapy. Data from a total of 353 primary care patients were examined; 96 Latinx and 257 NLW patients participated. Results indicated that Latinx patients dropped out of treatment more often than NLW patients, resulting in roughly 58% of Latinx patients failing to complete treatment compared with 42% of NLW, and approximately 29% of Latinx patients dropping out before engaging in modules related to cognitive restructuring or exposure, relative to 11% of NLW patients. Mediation analyses suggest that social support and somatization partially explained the relationship between ethnicity and treatment dropout, highlighting the importance of these variables in understanding treatment disparities.

The feasibility of daily monitoring in adolescents and young adults with mild intellectual disability or borderline intellectual functioning.

BACKGROUND: It is unclear whether the limitations of young persons with a mild intellectual disability or borderline intellectual functioning preclude feasibility of the daily diary method. METHOD: For 60 consecutive days, 50 participants (Mage = 21.4, 56% male) who receive care in an ambulatory, residential, or juvenile detention setting, self-rated both standardised and personalised diary questions through an app. Diary entries were used for feedback in treatment. Interviews were used to explore acceptability. RESULTS: Average compliance was 70.4%, while 26% of participants dropped out. Compliance was good in ambulatory (88.9%) and residential care (75.6%), but not in the juvenile detention setting (19.4%). The content of self-selected diary items varied widely. Participants deemed the method acceptable. CONCLUSIONS: Daily monitoring is feasible for individuals with a mild intellectual disability or borderline intellectual functioning receiving ambulatory or residential care, and can provide scientists and practitioners with important insights into day-to-day behavioural patterns.

Treatment Non-Adherence or Abandonment Among Adolescents and Young Individuals Living with HIV/AIDS: A Scoping Review / Não adesão ao tratamento ou abandono deste entre adolescentes e jovens vivendo com HIV/aids: scoping review / No adherencia o desistencia del tratamiento entre adolescentes y jóvenes viviendo con VIH/SIDA: scoping review

Objective: to identify and map the scientific literature on the reasons for treatment non-adherence or abandonment among adolescents and young individuals living with HIV/AIDS. Materials and method: a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) strategy for the presentation of data referring to the reasons for treatment non-adherence or abandonment among adolescents and young people living with HIV/AIDS. Seven information sources were used to search for the articles, namely: Medline via PubMed, Web of Science, LILACS, CINAHL, BDEnf, Scopus, and Embase, without a time frame and with the following search strategy: "patient dropouts" OR "abandonment" OR "lack of medication adherence" AND "adolescent" OR "young adult" AND "Acquired Immunodeficiency Syndrome" OR "HIV" AND "antiretroviral therapy highly active" OR "medication adherence." Results: eight articles were included in the study, contemplating the reasons for treatment non-adherence or abandonment, which were related to access to health services, sociodemographic, structural, psychosocial and behavioral conditions, and factors associated with the disease or the medication. Conclusions: the findings of this study evidenced how vulnerable adolescents and young people are to the issues inherent to HIV/AIDS treatment and that several reasons can influence its non-adherence or abandonment.

Objetivo: identificar e mapear a literatura científica da área acerca dos motivos da não adesão ao tratamento ou do abandono deste entre adolescentes e jovens que vivem com HIV/aids. Materiais e método: revisão de escopo com uso da estratégia Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) para a apresentação de dados referentes aos motivos da não adesão ao tratamento ou do abandono deste entre adolescentes e jovens que vivem com HIV/aids. Para a busca dos artigos, utilizaram-se de sete fontes de informação: Medline via PubMed, Web of Science, Lilacs, Cinahl, BDEnf, Scopus e Embase, sem recorte temporal, com a estratégia de busca "patient dropouts" OR "abandonment" OR "lack of adherence to medication" AND "adolescent" OR "young adult" AND "Acquired Immunodeficiency Syndrome" OR "HIV" AND "antiretroviral therapy highly active" OR "medication adherence". Resultados: foram incluídos oito artigos no estudo que contemplavam os motivos da não adesão ao tratamento ou do abandono deste, os quais estavam relacionados ao acesso ao serviço de saúde, às condições sociodemográficas, estruturais, psicossociais e comportamentais, e aos fatores associados à doença ou à medicação. Conclusões: os achados deste estudo evidenciaram o quanto os adolescentes e os jovens são vulneráveis às questões inerentes ao tratamento do HIV/aids e que vários motivos podem influenciar a não adesão a este ou seu abandono.

Objetivo: identificar y mapear la literatura científica del área acerca de los motivos para la no adherencia o desistencia del tratamiento entre adolescentes y jóvenes que viven con VIH/SIDA. Materiales y método: revisión de alcance con el empleo de la estrategia Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) para presentar datos referentes a los motivos de la no adherencia o desistencia del tratamiento entre adolescentes y jóvenes que viven con VIH/SIDA. Para la búsqueda de artículos, se utilizaron siete fuentes de información: Medline via PubMed, Web of Science, Lilacs, Cinahl, BDEnf, Scopus y Embase, sin limitación temporal, con la estrategia de búsqueda "patient dropouts" OR "abandonment" OR "lack of adherence to medication" AND "adolescent" OR "young adult" AND "Acquired Immunodeficiency Syndrome" OR "HIV" AND "antiretroviral therapy highly active" OR "medication adherence". Resultados: se incluyeron ocho artículos en el estudio que contemplaban los motivos para la no adherencia o desistencia del tratamiento, los que estaban relacionados al acceso al servicio de salud, a condiciones sociodemográficas, estructurales, psicosociales y comportamentales, y a los factores asociados con la enfermedad o medicamentos. Conclusiones: los hallazgos del estudio evidencian como son vulnerables los adolescentes y jóvenes a las cuestiones inherentes al tratamiento del VIH/SIDA y que varios son los motivos que pueden influir la no adherencia o desistencia del tratamiento.

A meta-analysis of the effects of role induction in psychotherapy.

Role induction is a pantheoretical method that can be used in the initial phase of psychotherapy to prepare patients for treatment. The purpose of this meta-analysis was to examine the effects of role induction on treatment dropout, and immediate, mid-, and posttreatment outcomes for adult individual psychotherapy patients. A total of 17 studies were identified that met all inclusion criteria. Data from these studies indicate that role induction has a positive impact on reducing premature termination (k = 15, OR = 1.64, p = .03, I² = 56.39) and improving immediate within-session outcomes (k = 8, d = 0.64, p < .01, I² = 88.80) and posttreatment outcomes (k = 8, d = 0.33, p < .01, I² = 39.89). However, role induction did not show a significant impact on midtreatment outcomes (k = 5, d = 0.26, p = .30, I² = 71.03). Results from moderator analyses are also presented. Training implications and therapeutic practices based on this research are also discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Boletim Tuberculose 2022 / Tuberculosis Bulletin 2022

A tuberculose (TB) é um grande desafio para as autoridades de saúde pública no mundo. O Brasil é um dos 30 países onde a doença ainda está presente e, portanto, fazendo parte da lista e das prioridades nas agendas internacionais para estratégias de controle do agravo (BRASIL, 2020; 2021b). O plano nacional pelo fim da TB como problema de saúde pública 2021-2025 renova as metas a serem atingidas para melhoria das condições da doença, com redução da incidência para 90% e da mortalidade para 95%. Estas metas tomaram como base o resultado do ano de 2015 no país (BRASIL, 2021; 2022). Com a emergência sanitária causada pelo advento da COVID 19 houve piora das condições da tuberculose com queda dos diagnósticos em 2020 e, consequentemente, do registro de notificações, e aumento dos óbitos, causando piora nos indicadores tanto epidemiológicos quanto operacionais (BRASIL, 2022). O estado do Rio de Janeiro dentro deste quadro da TB situa-se em posição de destaque negativo, sendo o 2º em taxa de incidência e o 1º em taxa de mortalidade, segundo dados do último boletim de 2022 do Ministério da Saúde (BRASIL, 2022). Para que a situação da doença seja acompanhada por gestores e programas de saúde, bem como por toda comunidade científica e social é através do cálculo de seus principais indicadores, por meio dos sistemas oficiais de vigilância padronizados nacionalmente. Sendo os indicadores de morbidade extraídos da alimentação do Sistema de Informação de Agravo de Notificação ­ SINAN, com preenchimento da ficha de notificação/investigação da tuberculose. E para os dados de mortalidade o Sistema sobre Mortalidade ­ SIM, por meio do registro da Declaração de Óbitos.

Monitoring adherence and abstinence of cannabis use disorder patients: Profile identification and relationship with long-term treatment outcomes.

BACKGROUND: Patients with cannabis use disorder (CUD) show heterogeneous sociodemographic and consumption patterns. Although previous studies, focused on identifying subgroups of CUD patients using input variables, have yielded useful results for planning individualized treatments, no published research has analyzed the profiles of CUD patients according to their therapeutic progress. This study therefore aims to identify subgroups of patients using adherence and abstinence indicators and to explore whether these profiles are associated with sociodemographic characteristics, consumption variables, and long-term therapeutic outcomes. METHODS: This was a retrospective observational study with a multisite sample of 2055 CUD outpatients who were beginning treatment. The study monitored patient data at two-year follow-up. We conducted latent profiles analysis on the appointment attendance ratio and percentage of negative cannabis tests. RESULTS: A three profile solution emerged: i) moderate abstinence/moderate adherence (n = 997); ii) high abstinence/moderate adherence (n = 613); and iii) high abstinence/high adherence (n = 445). The study found the most marked differences at the beginning of treatment for education level (chi2 (8) = 121.70, p < .001), source of referral (chi2 (12) = 203.55, p < .001), and frequency of cannabis use (chi2 (10) = 232.39, p < .001). Eighty percent of patients from the "high abstinence/high adherence" group were relapse-free at two year follow-up. This percentage decreased to 24.3 % in the "moderate abstinence/moderate adherence" group. CONCLUSIONS: Research has shown adherence and abstinence indicators to be useful for identifying subgroups of patients with different prognoses regarding long-term success. Recognizing the sociodemographic and consumption variables associated with these profiles at the beginning of treatment could help to inform the design of more individualized interventions.

Clinical insights: Preventing psychosis treatment disengagement.

Many patients with schizophrenia spectrum disorders disengage from treatment, with negative impacts on prognosis and recovery. This commentary provides an overview of common reasons underlying treatment dropout and strategies for overcoming obstacles and enhancing patient engagement. Basic clinical skills such as open-ended questions and reflective listening can be powerful tools in unmasking structural and attitudinal barriers to psychosis care.

Effects of a brief pre-admission telephone reminder on no-show and dropout rates in substance use disorder treatment: a quasi-experimental study.

BACKGROUND: Appointment no-show and early dropout from treatment represent major challenges in outpatient substance use disorder treatment, adversely affecting clinical outcomes and health care productivity. In this quasi-experimental study, we examined how a brief reminder intervention for new patients before their first appointment affected treatment participation and retention. No-shows (not attending any sessions) and dropouts (discontinuation of initiated treatment because of three consecutively missed appointments) were compared between a period with pre-admission telephone calls (intervention) and a period without such reminders (non-intervention). METHODS: Participants were all eligible patients (N = 262) admitted to a Norwegian specialist clinic for substance use disorder treatment. We used the Chi-square test for the no-show analysis. Of the eligible patients, 147 were included in a subsequent dropout analysis. We used the number of visits up to 10 appointments as a measure for time to event. Group differences were analyzed using a Kaplan-Meier plot and the log-rank test. To control for relevant sociodemographic variables, as well as substance use and mental distress severity, we used Cox regression. RESULTS: No-show rates did not differ between the two periods (12% for non-intervention vs. 14% for intervention; χ2 = 0.20, p = 0.653). Of those consenting to participate in the dropout analysis (n = 147), 28 (19%) discontinued treatment within the time frame of 10 appointments, with no differences between the two periods (log-rank test = 0.328, p = 0.567). Controlling for baseline characteristics did not alter this finding. In fact, of the registered covariates at baseline, only higher education level was associated with attrition, linked to a reduced risk for dropout (hazard ratio = 0.85, 95% CI = 0.74-0.98, p = 0.025). CONCLUSION: These findings do not provide support for the systematic use of a brief pre-admission telephone reminder in the current treatment setting. TRIAL REGISTRATION: The study was retrospectively registered 13 Jan 2021 at ClinicalTrials.gov, NCT04707599.

Outcomes of Interferon-free Treatment of Hepatitis C Virus Infection Seven Years after Approval and Problems with Drop out during and after Treatment: A Retrospective, Single-center Study.

Objective This retrospective, single-center study assessed the effects of interferon (IFN)-free treatment of hepatitis C virus (HCV) infection, which has been approved for seven years; calculated the incidence of hepatocellular carcinoma (HCC) after achieving a sustained virologic response (SVR); and elucidated problems with follow-up for surveillance of post-SVR HCC, particularly the impact of the coronavirus disease 2019 (COVID-19) pandemic. Methods We summarized the SVR achievement rate of 286 HCV-infected patients who received 301 IFN-free treatments and analyzed the cumulative incidence of initial HCC and the cumulative continuation rate of follow-up after SVR in the 253 patients who achieved SVR and did not have a history of HCC. Results Among 286 patients who received IFN-free treatments, 14 dropped out, and the 272 remaining patients achieved an SVR after receiving up to third-line treatment. Post-SVR HCC occurred in 18 (7.1%) of the 253 patients without a history of HCC, with a cumulative incidence at 3 and 5 years after SVR of 6.6% and 10.0%, respectively; the incidence of cirrhosis at those time points was 18.2% and 24.6%, respectively.Of the 253 patients analyzed, 58 (22.9%) discontinued follow-up after SVR. Patients who had no experience with IFN-based therapy tended to drop out after SVR. Notably, the number of dropouts per month has increased since the start of the pandemic. Conclusion Currently, IFN-free treatment is showing great efficacy. However, the incidence of HCC after SVR should continue to be monitored. In this study, the COVID-19 pandemic did not affect treatment outcomes, but it may affect surveillance for post-SVR HCC.

The acceptability of cognitive analytic therapy (CAT): Meta-analysis and benchmarking of treatment refusal and treatment dropout rates.

AIM: To estimate treatment refusal and treatment dropout rates for cognitive analytic therapy (CAT) and then benchmark these rates against other psychotherapies. METHOD: PROSPERO registration CRD4202017081. Systematic searches found CAT treatment studies reporting treatment refusal and dropout rates. Studies were narratively and quantitatively synthesised in a proportional random-effects meta-analysis and moderator analyses were performed. Secondary analyses compared refusal and dropout rates for CAT versus other psychotherapies via direct comparisons in the original studies and via benchmarking these rates against other acceptability meta-analyses for other psychotherapies. RESULTS: Thirty-four CAT studies were included in the review. The treatment refusal rate was 15.35% (k = 9, 95% CIs 8.78-23.21). The treatment dropout rate was 18.69% (k = 34, 95% CI's 15.02-22.62). CAT generated significantly lower dropout rates relative to treatment comparators in the original studies (OR = 0.67; 95% CI 0.48-0.93). Country and younger age were significant moderators of dropout rates. CAT had a comparable treatment refusal rate and was towards the lower end of the dropout range when benchmarked against other psychotherapies. CONCLUSIONS: CAT as a brief and integrative psychotherapy for individuals presenting with typically complex psychological disorders appears a relatively acceptable intervention to patients.

Programa de Controle do Tabaco: fatores associados ao risco de abandono do tratamento / obacco control program: factors associated with treatment dropout

No Brasil, a prevalência de tabagismo ainda é elevada em pessoas portadoras de Condições Crônicas não Transmissíveis (CCNT). A compreensão dos modelos de atenção ao tabagista é essencial para se reduzir o abandono do tratamento. Objetivos: identificar as características sociodemográficas e de saúde dos indivíduos que buscaram o Programa Nacional de Controle do Tabaco (PNCT) em duas Unidades Básicas de Saúde (UBS) do município de Campinas, estimar o percentual de abandono do tratamento e elencar os fatores associados a esse desfecho. Metodologia: coorte histórico cujos dados foram obtidos, entre 2016 e 2019, em grupos de tratamento do PNCT. Para a realização da análise exploratória, a pesquisa incluiu 276 participantes, dos quais foram registradas suas variáveis sociodemográficas, condições de saúde, formas de uso do tabaco e participação no programa. Foram estimados o índice de abandono do tratamento e as possíveis relações com as variáveis significativas através de regressão múltipla. Resultados: a média de idade foi de 50,7 anos, com 60% do sexo feminino, 57,7% brancos, 52,2% com companheiro, 84,7% com filhos, 52,5% com ensino fundamental, 64% com renda entre um e dois salários, 40,1% trabalhando em setor de serviços e 58% católicos. O percentual de abandono do tratamento foi de 31%. A hipertensão se relacionou com o abandono do tratamento (p=0,030), reduzindo-o. Conclusão: o perfil dos indivíduos foi semelhante ao encontrado em outras pesquisas; indivíduos não hipertensos apresentaram maioríndice de abandono. São necessários outros estudos que avaliem fatores associados ao abandono do tratamento

In Brazil, there is still a high prevalence of smoking among people with chronic diseases. The understanding of smoking treatments is essential to a reduction in treatment dropout. Objectives: to identify epidemiological and health aspects of smokers, estimate the dropout rates, and list the factorsassociated with treatment dropouts. Data from PNCT (National Program of Tobacco Control) treatment groups was obtained from a historical cohort between 2016 and 2019. The research included 276 participants with different sociodemographic realities, healthconditions, forms of tobacco use, and participation in the program to conduct an exploratory analysis. The treatment dropout rate and possible relations with significant variables were estimated through multiple regression. Results: The mean age was 50.7 years; 60% female; 57.7% white; 52.2% with a partner; 84.7% with children; 52.5% studied until elementary school; 64% received between one and two salaries; 40.1% worked in the service sector; 58% were Catholic. The percentage of treatment dropouts was 31%. Hypertension was related to treatment dropout (p = 0.030), reducing it. Conclusion: The profiles of individuals were similar to those in other surveys. Non-hypertensive individuals had a higher dropout rate. Further studies are needed to assess the factors associated with treatment dropout.

Motivational interviewing to enhance psychosocial treatment attendance in people with SMI.

BACKGROUND: While there is increasing support for the efficacy of psychosocial interventions for people with SMI, the real-world effectiveness of such treatments is diminished by lack of motivation for treatment, leading to poor treatment engagement/dropout. We sought to evaluate the efficacy of motivational interviewing (MI) in improving attendance in a full course of cognitive training, examine motivation level as a potential mechanism of action, and examine variables associated with initial engagement in the training. METHODS: One hundred fourteen participants with SMI were randomized to MI or sham control interview (CI), both of which were followed by a 4-month active phase during which participants could attend up to 50 unpaid cognitive training sessions. RESULTS: Fidelity to the MI intervention was high, and MI condition was associated with increases in perceived value of training tasks and, to a lesser extent, how enjoyable/interesting they were rated. Twenty-nine percent of the full sample did not attend any training sessions. In ITT analyses, there was no significant between-group impact of MI on treatment attendance, though one emerged when participants who did not attend any sessions were excluded. Treatment attendance was predicted by the level of motivation achieved after the MI/CI intervention. Those who attended at least one training session (regardless of randomization) were more likely to believe they had cognitive impairments, had higher IQ and had less severe general psychiatric symptoms. CONCLUSIONS: MI showed some promise and may be a worthwhile addition to more comprehensive, robust efforts to promote initial treatment engagement and subsequent adherence.

A systematic review and meta-analysis on dropout of infertility treatments and related reasons/factors.

Dropout of infertility treatments is a common phenomenon and many patients avoid continuing infertility treatments. Determining the total rate of treatment dropout, and related factors was the objective of the present systematic review and meta-analysis study. We performed an electronic literature search in Web of Science, Scopus, Embase, Cinhal, ProQuest and Medline databases and a manual search in Google scholar by using a set of Standard keywords. We included descriptive studies in English or Persian, from August 2000 to 2019. Finally, we extracted data of 25 papers for systematic review and 11 papers for meta-analysis. Data analysed by RevMan software. The results of the meta-analysis analysed by the random-effects model and studies heterogeneity analysed using the I2 calculation index. We tried to control high heterogeneity (because of the small amounts of p value and chi-square and large amount of I2) with statistical methods such as subgroup analysis and using random-effects model. The results showed that factors related to treatment, psychological and demographic/personal factors are the most common factors for dropout. It seems that educational and supportive programs on psychological, financial, therapeutic, demographic and personal factors can play an important role in reducing the incidence of infertility treatment's drop out before completing the course of treatment.