Client predictors of therapy dropout in a primary care setting

Bakgrunn: Frafall fra terapi representerer en betydelig utfordring. Derfor har det blitt grundig studert hva som kan predikere frafall fra terapi. Dette har hittil ikke blitt undersøkt i primærhelsetjenesten i Norge. Formålet med denne studien var å undersøke hvilke karakteristikker ved klienter som kan predikere frafall fra tjenesten Rask Psykisk Helsehjelp (RPH). Metode: Vi gjennomførte en sekundær analyse av en randomisert kontrollert studie (RCT). Utvalget besto av 526 voksne deltakere som mottok behandling fra Rask Psykisk Helsehjelp i kommunene Sandnes og Kristiansand fra november 2015 til august 2017. Ved bruk av logistisk regresjon undersøkte vi sammenhengen mellom ni klientkarakteristikker og frafall. Resultater: Frafallsraten i studien var 25.3%. Eldre klienter hadde lavere odds ratio (OR) for å falle fra sammenlignet med yngre klienter (OR = 0.44, [95% CI = .27, .71]). Klienter med høyere utdanning hadde lavere odds ratio for å falle fra sammenlignet med klienter med lavere grad av utdanning (OR = .57, 95% CI [.35, .92]). Klienter med dårlig sosial støtte hadde høyere odds ratio for å falle fra sammenlignet med klienter med god sosial støtte (OR = 1.90, [95% CI = 1.20, 2.99]). Karakteristikkene kjønn, innvandrerbakgrunn, arbeidsstatus, funksjonsnivå, symptomtrykk og problemvarighet predikerte ikke frafall. Diskusjon: De predikerende karakteristikkene vi fant i denne prospektive studien kan hjelpe RPH-terapeuter å identifisere klienter i risiko for frafall. Strategier for å forebygge frafall diskuteres.Hovedoppgave psykologprogrammetPROPSY317PRPSY

Client predictors of therapy dropout in a primary care setting: a prospective cohort study

Background Therapy dropout poses a major challenge. Considerable research has been conducted on predictors of dropout, however none in the context of primary mental health services in Norway. The purpose of this study was to investigate which client characteristics can predict dropout from the service Prompt Mental Health Care (PMHC). Methods We performed a secondary analysis of a Randomized Controlled Trial (RCT). Our sample consisted of 526 adult participants receiving PMHC-treatment in the municipalities of Sandnes and Kristiansand, between November 2015 to August 2017. Using logistic regression, we investigated the association between nine client characteristics and dropout. Results The dropout rate was 25.3%. The adjusted analysis indicated that older clients had a lower odds ratio (OR) of dropping out compared to younger clients (OR = 0.43, [95% CI = 0.26, 0.71]). Moreover, clients with higher education had a lower odds ratio of dropping out compared to clients with lower levels of education (OR = 00.55, 95% CI [0.34, 0.88]), while clients who were unemployed were more likely to drop-out as compared the regularly employed (OR = 2.30, [95% CI = 1.18, 4.48]). Finally, clients experiencing poor social support had a higher odds ratio of dropping out compared to clients who reported good social support (OR = 1.81, [95% CI = 1.14, 2.87]). Sex, immigrant background, daily functioning, symptom severity and duration of problems did not predict dropout. Conclusion The predictors found in this prospective study might help PMHC-therapists identify clients at risk of dropout. Strategies for preventing dropout are discussed.publishedVersio

Faecal calprotectin concentrations in apparently healthy children aged 0-12 years in urban Kampala, Uganda: a community-based survey

<p>Abstract</p> <p>Background</p> <p>Calprotectin is a calcium and zinc binding protein, abundant in neutrophils and is extremely stable in faeces. Faecal calprotectin is used as a non-specific marker for gastrointestinal inflammation. It has a good diagnostic precision to distinguish between irritable bowel syndrome and inflammatory bowel disease. Studies have established normal concentrations in healthy children; all these studies have been performed in high-income countries. The objective of this study was to determine the concentration of faecal calprotectin in apparently healthy children aged 0-12 years in urban Kampala, Uganda.</p> <p>Method</p> <p>We tested 302 apparently healthy children aged, age 0-12 years (162 female, 140 male) in urban Kampala, Uganda. The children were recruited consecutively by door-to-door visits. Faecal calprotectin was analyzed using a quantitative enzyme-linked immunosorbent assay. Faeces were also tested for <it>Helicobacter pylori (H. pylori) </it>antigen, for growth of enteropathogens and microscopy was performed to assess protozoa and helminths. A short standardized interview with socio-demographic information and medical history was obtained to assess health status of the children.</p> <p>Results</p> <p>In the different age groups the median faecal calprotectin concentrations were 249 mg/kg in 0 < 1 year (n = 54), 75 mg/kg in 1 < 4 years (n = 89) and 28 mg/kg in 4 < 12 years (n = 159). There was no significant difference in faecal calprotectin concentrations and education of female caretaker, wealth index, gender, habits of using mosquito nets, being colonized with <it>H. pylori </it>or having other pathogens in the stool.</p> <p>Conclusion</p> <p>Concentrations of faecal calprotectin among healthy children, living in urban Ugandan, a low-income country, are comparable to those in healthy children living in high-income countries. In children older than 4 years, the faecal calprotectin concentration is low. In healthy infants faecal calprotectin is high. The suggested cut-off concentrations in the literature can be used in apparently healthy Ugandan children. This finding also shows that healthy children living under poor circumstances do not have a constant inflammation in the gut. We see an opportunity to use this relatively inexpensive test for further understanding and investigations of gut inflammation in children living in low-income countries.</p

Client predictors of therapy dropout in a primary care setting

Bakgrunn: Frafall fra terapi representerer en betydelig utfordring. Derfor har det blitt grundig studert hva som kan predikere frafall fra terapi. Dette har hittil ikke blitt undersøkt i primærhelsetjenesten i Norge. Formålet med denne studien var å undersøke hvilke karakteristikker ved klienter som kan predikere frafall fra tjenesten Rask Psykisk Helsehjelp (RPH). Metode: Vi gjennomførte en sekundær analyse av en randomisert kontrollert studie (RCT). Utvalget besto av 526 voksne deltakere som mottok behandling fra Rask Psykisk Helsehjelp i kommunene Sandnes og Kristiansand fra november 2015 til august 2017. Ved bruk av logistisk regresjon undersøkte vi sammenhengen mellom ni klientkarakteristikker og frafall. Resultater: Frafallsraten i studien var 25.3%. Eldre klienter hadde lavere odds ratio (OR) for å falle fra sammenlignet med yngre klienter (OR = 0.44, [95% CI = .27, .71]). Klienter med høyere utdanning hadde lavere odds ratio for å falle fra sammenlignet med klienter med lavere grad av utdanning (OR = .57, 95% CI [.35, .92]). Klienter med dårlig sosial støtte hadde høyere odds ratio for å falle fra sammenlignet med klienter med god sosial støtte (OR = 1.90, [95% CI = 1.20, 2.99]). Karakteristikkene kjønn, innvandrerbakgrunn, arbeidsstatus, funksjonsnivå, symptomtrykk og problemvarighet predikerte ikke frafall. Diskusjon: De predikerende karakteristikkene vi fant i denne prospektive studien kan hjelpe RPH-terapeuter å identifisere klienter i risiko for frafall. Strategier for å forebygge frafall diskuteres

Body Mass Index Is Associated with Impaired Semen Characteristics and Reduced Levels of Anti-Müllerian Hormone across a Wide Weight Range

There is still controversy as to how body mass index (BMI) affects male reproduction. We investigated how BMI is associated with semen quality and reproductive hormones in 166 men, including 38 severely obese men. Standard semen analysis and sperm DNA integrity analysis were performed, and blood samples were analysed for reproductive hormones. Adjusted for age and time of abstinence, BMI was negatively associated with sperm concentration (B = -0.088, P = 0.009), total sperm count (B = -0.223, P = 0.001), progressive sperm motility (B = -0.675, P = 0.007), normal sperm morphology (B = -0.078, P = 0.001), and percentage of vital spermatozoa (B = -0.006, P = 0.027). A negative relationship was observed between BMI and total testosterone (B = -0.378, P < 0.001), sex hormone binding globulin (B = -0.572, P < 0.001), inhibin B (B = -3.120, P < 0.001) and anti-Müllerian hormone (AMH) (B = -0.009, P < 0.001). Our findings suggest that high BMI is negatively associated with semen characteristics and serum levels of AMH

Characteristics of reproductive hormones according to BMI group, and associations between BMI and serum hormone levels by multiple linear regression.

<p>T, testosterone; FAI, free androgen index; SHBG, sex hormone binding globulin; FSH, follicle stimulating hormone; LH, luteinizing hormone; AMH, anti-Müllerian hormone; B, regression coefficient; CI, confidence interval.</p><p>Associations tested by multiple linear regression were adjusted for age. All variables in the regression analyses were continuous variables.</p><p>^a, log transformed data.</p><p>Characteristics of reproductive hormones according to BMI group, and associations between BMI and serum hormone levels by multiple linear regression.</p

Characteristics of the participants according to BMI groups.

<p>BMI, body mass index.</p><p>Characteristics of the participants according to BMI groups.</p

Proportions of normal weight and severely obese men with semen parameters below the WHO lower reference limits [38].

<p>χ², Chi-square value; df, degrees of freedom.</p><p>n (%), number (percentage) of participants with sperm characteristics below WHO lower reference limit/ group total.</p><p>Associations were tested by Chi-square test with Yates’ correction for continuity.</p><p>Proportions of normal weight and severely obese men with semen parameters below the WHO lower reference limits [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0130210#pone.0130210.ref038" target="_blank">38</a>].</p

Characteristics of semen parameters according to BMI groups, comparison between group 1 and group 4, and associations between BMI and semen parameters by multiple linear regression.

<p>BMI, body mass index; DFI, DNA fragmentation index; B, regression coefficient; CI, confidence interval.</p><p>P-values for differences between group 1 and group 4 were calculated by Mann-Whitney U test. Associations tested by multiple linear regression were adjusted for age and time of abstinence. All variables in the regression analyses were continuous.</p><p>^a, log transformed data</p><p>^b, square root transformed data</p><p>Characteristics of semen parameters according to BMI groups, comparison between group 1 and group 4, and associations between BMI and semen parameters by multiple linear regression.</p

Characteristics of reproductive hormones according to BMI group, and associations between BMI and serum hormone levels by multiple linear regression.

<p>T, testosterone; FAI, free androgen index; SHBG, sex hormone binding globulin; FSH, follicle stimulating hormone; LH, luteinizing hormone; AMH, anti-Müllerian hormone; B, regression coefficient; CI, confidence interval.</p><p>Associations tested by multiple linear regression were adjusted for age. All variables in the regression analyses were continuous variables.</p><p>^a, log transformed data.</p><p>Characteristics of reproductive hormones according to BMI group, and associations between BMI and serum hormone levels by multiple linear regression.</p