The Influence of Father and Mother's Joint Decision Making on Children's Basic Immunization:Empirical Research on Indonesia's Demographic and Health Survey 2017

The 2017 diphtheria outbreaks in Indonesia shows the downside of inadequate immunization for certain group that could endanger public health. Despite years of government intervention on this vaccine-preventable disease, insofar mandating basic vaccination for children from an early age, ultimately, it is parents that will decide on having their children being immunized. Utilizing the 2017 Indonesia Demographic and Health Survey, this study aims to uncover the association between parents' decision-making processes and their demographic variables to their children's immunization completion status. Logistic regression suggests discussion between parents in household's major purchases, more likely to result in complete basic immunization for their children. Additionally, mothers' traits, which are education, frequency of access to mass media, and exposure to medical professionals, are positively associated with compliance with basic vaccines administration. Differences in compliance can also be observed in children's gender and order of birth.

Adolescent Dropout from Brief Digital Mental Health Interventions Within and Beyond Randomized Trials

Objective: Many adolescents struggle to access appropriate mental health care due to structural or psychological barriers. Among those who do access an intervention, retention is a pressing concern. As a result, adolescents are less likely to benefit from an intervention. Although traditional barriers to participation (e.g., location, cost) are hypothetically reduced or removed in internet interventions, low retention is still common, particularly in unguided programs (those not involving a clinician). It is therefore key to determine what factors are associated with dropout in digital mental health interventions with adolescents both within and beyond the context of research studies. Methods: We compare completion rates from two projects evaluating self-guided, online single-session mental health interventions (SSIs) for adolescents. One was a randomized controlled trial (RCT) in which participants were paid for participation. The other was a program evaluation project in which participants were not paid for participation. We additionally compare SSI completion rates across various demographic groups and across baseline hopelessness levels. Results: There was a statistically significant difference in SSI completion status between the RCT (84.75% full-completers) and the program evaluation (36.86% full-completers), X2 (2, N =2436) = 583.5, p < .05. There were no significant differences in the baseline hopelessness scores across completion statuses in either study. There were no significant differences in full-completion rates across demographic groups in either project. Conclusion: Adolescents may be more likely to complete a brief digital mental health intervention if they are paid for participation. Additionally, it is possible that the brevity of SSIs reduces demographic disparities related to retention by minimizing the time required to complete an intervention.

Incidence of exercise-associated hyponatremia during a high-altitude 161-km ultramarathon

[Purpose] Exercise-associated hyponatremia (EAH) is a well-known condition among endurance athletes at low altitudes. The incidence of EAH during ultramarathons at high altitudes warrants further investigation. This prospective observational study was conducted on the participants of the Leadville Trail 100 run, a 161- km race held at a high altitude (2,800 m-3,840 m).[Methods] Venous blood samples were collected before and immediately after the race. The participants completed an electronic survey after the race. Our main outcome measure was the post-race serum sodium ([Na+]) level.[Results] Of the 672 athletes who started the race, 351 (52%) successfully completed the event within the 30- hour cut-off. Post-race blood samples were collected from 84 runners (66 finishers). Both pre- and post-race blood samples were collected from 37 participants. Twenty percent of the post-race participants had EAH. Only one post-race participant had a [Na+] level of <130 mmol/L. All participants with EAH were asymptomatic. One participant had an abnormal pre-race [Na+] level (134 mmol/L). Female participants had a significantly higher rate of EAH than male participants (40% vs. 16%; p=0.039). Age, body mass index, weight changes, race completion status, nonsteroidal anti-inflammatory drug use, and urine specific gravity were not associated with the development of EAH. Lower postrace [Na+] levels were associated with higher serum creatine kinase values (R2=0.1, p<0.005).[Conclusion] High altitude (3,840 m peak) does not appear to enhance the incidence of EAH after an ultramarathon footrace. This suggests that ambient temperature (low temperatures reduce risk), sex (female predilection), endurance running, and overhydration are more prominent risk factors for EAH than high altitude.

Learners’ Performance in a MOOC on Programming

In every course, there are learners who successfully pass assessments and complete the course. However, there are also those who fail the course for various reasons. One of such reasons may be related to success in assessment. Although performance in assessments has been studied before, there is a lack of knowledge on the degree of variance between different types of learners in terms of scores and the number of resubmissions. In the paper, we analyse the performance in assessments demonstrated by non-completers and completers and by completers with different engagement levels and difficulty-resolving patterns. The data have been gathered from the Moodle statistics source based on the performance of 1065 participants, as regards their completion status, the number of attempts made per each programming task and quiz, and the score received per quiz. Quantitative analysis was performed with descriptive statistics and non-parametric tests. Non-completers and completers were similar in resubmissions per quiz, but the former, expectedly, made more resubmissions per programming task and received lower quiz scores. Completers made more attempts per task than per quiz. They could provide a correct solution with a few resubmissions and receive good scores already at a pragmatic engagement level. At the same time, the increased use of help sources in case of difficulties was also associated with a higher number of attempts and lower quiz scores received. The study may have implications in understanding the role of assessments in dropouts and how completers with different engagement and difficulty-resolving patterns cope with assessments.

P14: DISCONTINUATION AND NON-PUBLICATION OF SURGICAL RANDOMISED CONTROLLED TRIALS IN THE SETTING OF ILEUS: OBSERVATIONAL STUDY

Introduction Once regarded as an inevitable occurrence after surgery, ileus is now recognised as an unmet clinical need. Despite this, few studies have shown meaningful clinical benefit which may be due to the challenges associated with conducting trials in this setting. The aim of this study was to determine the rate of discontinuation and non-publication of randomised controlled trials (RCTs) in the setting of ileus. Method A systematic search of ClinicalTrials.gov was performed using the keyword “ileus”. RCTs registered between 2003-2019 involving abdominal surgery were eligible. Studies were divided according to completion status. Authors were contacted to seek information about the circumstances for discontinuation and non-publication. For completed studies, evidence of a published manuscript was sought. Result Of 262 trials identified, 81 were eligible for analysis. Amongst 27 discontinued trials, email addresses were identified for 24 (88.9%) and replies received from 6 (25.1%). The most common reasons for discontinuation were loss of clinical significance (n=2) and insufficient recruitment (n=2). Amongst 54 completed studies, manuscripts were identified for 34 (63.0%). Of these, email addresses were identified for 12 (60.0%) and replies received from 5 (41.7%). The most common reason for non-publication was a lack of time/resources/personnel (n=3). Conclusion One third of trials undertaken were discontinued and of those which did reach completion, less than two thirds reported results. A lack of resources and loss of clinical significance were predominant reasons. There is an urgent need to address methodological barriers in research relating to ileus to promote rigorous evaluation of new treatments. Take-home message One third of trials undertaken were discontinued and of those which did reach completion, less than two thirds reported results. A lack of resources and loss of clinical significance were predominant reasons. There is an urgent need to address methodological barriers in research relating to ileus to promote rigorous evaluation of new treatments.

A Longitudinal Analysis of SF-36 scores Within the Candrive Cohort: An Example of Survivor Bias

A bias inherent to prospective studies is focusing only on individuals who remain in the study; these individuals may differ from those who leave early. To examine this issue, we analyzed SF-36 scores by completion status for individuals enrolled in the seven-year Candrive cohort. The SF-36 provides a self-reported evaluation of health and well-being along two subscales, the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Of 928 participants in the cohort, 887 had at least two consecutive years of data starting at baseline (age=76.17, SD=4.81; 61.9% male). A total of 142 participants had 7 years of data. Study discontinuation (due to withdrawal, driving cessation, or death) happened least in early years, and peaked after 6 years (n=235). When analyzed according to completion status, patterns of change in SF-36 scores varied. For example, participants with 7 years of data had mean PCS scores ranging from 51.41 (SD=7.92) at baseline to 46.93 (SD=9.46) at year 7, a change of 0.75 points per year. For those with only two years of data, scores were lower and dropped from 45.82 (SD=9.98) to 43.59 (SD=10.90), a change of 2.23 points over a single year (p&lt;.001). Differences are also evident for other groups. While the results indicate relative stability of SF-36 scores among participants who remained in the study, participants who dropped out reported greater deterioration in scores. These results highlight important differences between participants based on completion status.