Impact of Educational Level on Study Attrition and Evaluation of Web-Based Computer-Tailored Interventions: Results From Seven Randomized Controlled Trials

BackgroundWeb-based computer-tailored interventions have shown to be effective in improving health behavior; however, high dropout attrition is a major issue in these interventions.ObjectiveThe aim of this study is to assess whether people with a lower educational level drop out from studies more frequently compared to people with a higher educational level and to what extent this depends on evaluation of these interventions.MethodsData from 7 randomized controlled trials of Web-based computer-tailored interventions were used to investigate dropout rates among participants with different educational levels. To be able to compare higher and lower educated participants, intervention evaluation was assessed by pooling data from these studies. Logistic regression analysis was used to assess whether intervention evaluation predicted dropout at follow-up measurements.ResultsIn 3 studies, we found a higher study dropout attrition rate among participants with a lower educational level, whereas in 2 studies we found that middle educated participants had a higher dropout attrition rate compared to highly educated participants. In 4 studies, no such significant difference was found. Three of 7 studies showed that participants with a lower or middle educational level evaluated the interventions significantly better than highly educated participants (“Alcohol-Everything within the Limit”: F_2,376=5.97, P=.003; “My Healthy Behavior”: F_2,359=5.52, P=.004; “Master Your Breath”: F_2,317=3.17, P=.04). One study found lower intervention evaluation by lower educated participants compared to participants with a middle educational level (“Weight in Balance”: F_2,37=3.17, P=.05). Low evaluation of the interventions was not a significant predictor of dropout at a later follow-up measurement in any of the studies.ConclusionsDropout attrition rates were higher among participants with a lower or middle educational level compared with highly educated participants. Although lower educated participants evaluated the interventions better in approximately half of the studies, evaluation did not predict dropout attrition. Further research is needed to find other explanations for high dropout rates among lower educated participants.     

Anti-C1q in chronic hepatitis C Virus genotype IV infection: association with autoimmune rheumatologic manifestations

A growing body of evidence suggests that anti-complement-1q (anti-C1q) antibodies are elevated in a variety of autoimmune disease. Therefore, we investigated their prevalence and clinical significance in plasma of patients with hepatitis C virus (HCV) genotype IV in the presence and absence of autoimmune extra hepatic manifestations in comparison to normal healthy individuals. Plasma Anti-C1q Abs levels were assessed by an Enzyme Linked Immunosorbant Assay in 91 chronic HCV-infected patients (51 with and 40 without autoimmune rheumatic manifestations) and 40 healthy volunteers matched for age and gender. Epidemiological, clinical, immunochemical and virological data were prospectively collected. Positive Anti-C1q antibodies were more frequent among HCV patients with extra-hepatic autoimmune involvement, than those without and healthy control subjects. No significant correlations were found between Anti-C1q levels with either the liver activity or the fibrosis scores. In HCV-patients with autoimmune involvements, plasma Anti-C1q levels were significantly higher in patients with positive cryoglobulin, and in those with lymphoma than in those without. These results were confirmed by multivariate analysis. Further large scale longitudinal studies are required to assess and clarify the significance and the pathogenic role of anti-C1q antibodies among HCV infected patients with positive cryoglobulinaemia and lymphoma.     

Phosphorylation levels of BCR-ABL, CrkL, AKT and STAT5 in imatinib-resistant chronic myeloid leukemia cells implicate alternative pathway usage as a survival strategy

Ex-vivo studies have suggested that imatinib-resistance in chronic myeloid leukemia (CML) patients occurs despite adequate suppression of BCR-ABL activity. Whether BCR-ABL phosphorylation levels differ between imatinib-sensitive and -resistant patients is not known. We compared the phosphorylation of BCR-ABL in 54 previously untreated CML patients and 62 imatinib-resistant CML patients with progressive disease. Resistant patients had significantly lower levels of BCR-ABL, CrkL and AKT phosphorylation than previously untreated patients, but STAT5 phosphorylation showed no difference. These observations suggest that imatinib- resistance is not necessarily dependent on higher activity in BCR-ABL-dependent pathways, but is likely due to the activation of other pathways.     

Prevalence and clinical significance of antiphospholipid antibodies among hospitalized COVID-19 patients

Objective: To describe the prevalence of antiphospholipid antibodies in coronavirus disease-19(COVID-19) and to find potential associations between antiphospholipid antibody positivity and clinical outcomes.Methods: From September to November 2020, clinical and laboratory data were collected from 50 COVID-19 patients hospitalized at Saiful Anwar General Hospital in Malang, Indonesia. Antiphospholipid antibodies were measured by finding Ig M anti-β2 glycoprotein, lupus anticoagulant, and Ig M/Ig G anticardiolipin. Clinical characteristics, thrombotic events, ICU admission, and mortality during hospitalization were recorded. Disease severity was defined by the Guidelines for the Prevention and Control of COVID-19, Indonesia.Results: Among 50 patients, 5 patients(10.0%) were positive for antiphospholipid antibodies: 4 patients(80.0%) had Ig M anti-β2 glycoprotein and 1 patient had Ig G anti-cardiolipin(20.0%) and Ig M anti-cardiolipin(20.0%), none of lupus anticoagulant was detected. Antiphospholipid antibodies were associated with anosmia(OR 8.1; 95% CI 1.1-57.9; P=0.018), nausea and vomiting(OR 12.4; 95% CI 1.2-122.6; P=0.010), diarrhea(OR 9.8; 95% CI 1.3-70.9; P=0.010), cardiovascular disease(OR 1.4; 95% CI 1.0-1.9; P=0.001), chronic kidney disease(OR 12.0; 95% CI 1.6-90.1; P=0.05), acute coronary syndrome(OR 29.3; 95% CI 2.0-423.7; P=0.001), moderate(OR 0.11; 95% CI 0.01-1.10; P=0.031) and severe(OR 18.5; 95% CI 1.8-188.4; P=0.002) disease severity, and in-hospital mortality(OR 8.1; 95% CI 1.1-57.9; P=0.018). However, there is no correlation between the presence of antiphospholipid antibody and ICU admission.Conclusions: In summary, the prevalence of antiphospholipid antibodies in COVID-19 patients is low, mainly against Ig M anticardiolipin, and is associated with an acute coronary syndrome, gastrointestinal manifestations, moderate and severe disease severity, and increased risk of mortality.