Alcoholic cirrhosis remains the second most common indication for liver transplantation.A comprehensive medical and psychosocial evaluation is needed when making a decision to place such patients on the transplant lis...Alcoholic cirrhosis remains the second most common indication for liver transplantation.A comprehensive medical and psychosocial evaluation is needed when making a decision to place such patients on the transplant list.Most transplant centers worldwide need a minimum of 6 mo of alcohol abstinence for listing these patients.Patients with alcohol dependence are at high risk for relapse to alcohol use after transplantation(recidivism).These patients need to be identified and require alcohol rehabilitation treatment before transplantation.Recidivism to the level of harmful drinking is reported in about 15%-20%cases.Although,recurrent cirrhosis and graft loss from recidivism is rare,occurring in less than 5%of all alcoholic cirrhosis-related transplants,harmful drinking in the post-transplant pe-riod does impact the long-term outcome.The development of metabolic syndrome with cardiovascular events and de novo malignancy are important contributors to non liver-related mortality amongst transplants for alcoholic liver disease.Surveillance protocols for earlier detection of de novo malignancy are needed to improve the long-term outcome.The need for a minimum of 6 mo of abstinence before listing makes transplant a nonviable option for patients with severe alcoholic hepatitis who do not respond to corticosteroids.Emerging data from retrospective and prospective studies has challenged the 6 mo rule,and beneficial effects of liver transplantation have been reported in select patients with a first episode of severe alcoholic hepatitis who are unresponsive to steroids.展开更多
Currently,alcoholic cirrhosis is the second leading indication for liver transplantation in the United States and Europe.The quality of life and survival after a liver transplantation(LT)in patients with alcoholic liv...Currently,alcoholic cirrhosis is the second leading indication for liver transplantation in the United States and Europe.The quality of life and survival after a liver transplantation(LT)in patients with alcoholic liver disease(ALD)are similar to those in patients with other cirrhosis etiologies.The alcoholic relapse rate after a LT varies from 10%-50%,and these relapse patients are the ones who present a reduced long-term survival,mainly due to cardiovascular diseases and the onset of de novo neoplasms,including lung and upper aerodigestive tract.Nearly 40%of ALD recipients resume smoking and resume it early post-LT.Therefore,our pre-and post-LT follow-up efforts regarding ALD should be focused not only on alcoholic relapse but also on treating and avoiding other modifiable risk factors such as tobacco.The psychiatric and psychosocial pre-LT evaluation and the post-LT follow-up with physicians,psychiatrists and addiction specialists are important for reversing these problems because these professionals help to identify patients at risk for relapse as well as those patients who have relapsed,thus enabling responsive actions.展开更多
Acute alcoholic hepatitis (AH) is a distinct clinical entity amongst patients with chronic alcohol abuse.Patients with severe AH are at risk of dying in about 20%-25% cases despite specific treatment with corticostero...Acute alcoholic hepatitis (AH) is a distinct clinical entity amongst patients with chronic alcohol abuse.Patients with severe AH are at risk of dying in about 20%-25% cases despite specific treatment with corticosteroids and/or pentoxifylline.Clearly,a need for an additional more effective treatment option is unmet currently.Liver transplantation (LT),a definitive treatment option for alcoholic cirrhosis requires 6 mo abstinence.However,this rule cannot be applied to patients with AH as these patients are actively drinking prior to their presentation.Shortage of donors,ethical issues,and fear of recidivism after transplantation with less than 6 mo pretransplant abstinence are some of the reasons behind this rule of 6 mo of abstinence and hesitancy of transplanting patients with AH.These issues are debated at length in this manuscript.Further,retrospective studies have shown that patients undergoing transplantation for alcoholic cirrhosis and having histological changes of AH have been shown to fare as well when compared to patients without these histological changes.Recently,French workers have reported a case matched prospective study showing encouraging data on the usefulness of LT for patients who are non-responders to cortico-steroid and/or pentoxifylline therapy.Future studies are needed to identify patients with severe AH who are going to benefit most with LT.In the light of emerging data on the efficacy of LT in improving survival of patients with severe acute AH who do not respond to corticosteroids,the time is ripe to re-evaluate our policy of LT in patients with AH.展开更多
BACKGROUND Liver transplantation is the accepted standard of care for end-stage liver disease due to a variety of etiologies including decompensated cirrhosis, fulminant hepatic failure, and primary hepatic malignancy...BACKGROUND Liver transplantation is the accepted standard of care for end-stage liver disease due to a variety of etiologies including decompensated cirrhosis, fulminant hepatic failure, and primary hepatic malignancy. There are currently over 13000 candidates on the liver transplant waiting list emphasizing the importance of rigorous patient selection. There are few studies regarding the impact of additional psychosocial barriers to liver transplant including financial hardship, lack of caregiver support, polysubstance abuse, and issues with medical noncompliance. We hypothesized that patients with certain psychosocial comorbidities experienced worse outcomes after liver transplantation. AIM To assess the impact of certain pre-transplant psychosocial comorbidities on outcomes after liver transplantation. METHODS A retrospective analysis was performed on all adult patients from 2012-2016. Psychosocial comorbidities including documented medical non-compliance, polysubstance abuse, financial issues, and lack of caregiver support were collected. The primary outcome assessed post-transplantation was survival. Secondary outcomes measured included graft failure, episodes of acute rejection, psychiatric decompensation, number of readmissions, presence of infection, recidivism for alcohol and other substances, and documented caregiver support failure.RESULTS For the primary outcome, there were no differences in survival. Patients with a history of psychiatric disease had a higher incidence of psychiatric decompensation after liver transplantation (19% vs 10%, P = 0.013). Treatment of psychiatric disorders resulted in a reduction of the incidence of psychiatric decompensation (21% vs 11%, P = 0.022). Patients with a history of polysubstance abuse in the transplant evaluation had a higher incidence of substance abuse after transplantation (5.8% vs 1.2%, P = 0.05). In this cohort, 15 patients (3.8%) were found to have medical compliance issues in the transplant evaluation. Of these specific patients, 13.3% were found to have substance abuse after transplantation as opposed to 1.3% in patients without documented compliance issues (P = 0.03). CONCLUSION Patients with certain psychosocial comorbidities had worse outcomes following liver transplantation. Further prospective and multi-center studies are warranted to properly determine guidelines for liver transplantation regarding this highrisk population.展开更多
Alcoholic liver disease(ALD) is the second most common indication for liver transplantation(LT) in the United States and Europe. Unlike other indications for LT, transplantation for ALD may be controversial due to the...Alcoholic liver disease(ALD) is the second most common indication for liver transplantation(LT) in the United States and Europe. Unlike other indications for LT, transplantation for ALD may be controversial due to the concern for alcohol relapse and non-compliance after LT. However, the overall survival in patients transplanted for ALD is comparable or higher than in patients transplanted for other etiologies of liver disease. While the rate of alcohol use after liver transplantation does not differ among various etiologies of liver disease, alcohol relapse after transplantation for ALD has been associated with complications such as graft rejection, graft loss, recurrent alcoholic cirrhosis and reduced long-term patient survival. Given these potential complications, our review aimed to discuss risk factors associated with alcohol relapse and the efficacy of various interventions attempted to reduce the risk of alcohol relapse. We also describe the impact of alcohol relapse on post-transplant outcomes including graft and patient survival. Overall, alcohol liver disease remains an appropriate indication for liver transplantation, and long-term mortality in this group of patients is primarily attributed to cardiovascular disease or de novo malignancies rather than alcohol related hepatic complications, among those who relapse.展开更多
Substance abuse is related to re-offending, and substance abuse treatment may be effective in reducing criminal recidivism. Psychopathy, however, another factor that strongly correlates with re-offending, may be negat...Substance abuse is related to re-offending, and substance abuse treatment may be effective in reducing criminal recidivism. Psychopathy, however, another factor that strongly correlates with re-offending, may be negatively associated with treatment utilization. This qualitative study explored perceptions of substance abuse treatment among offenders with mental health problems, problematic substance use, and various degrees of psychopathic personality traits. An Interpretative Phenomenological Analysis (IPA) revealed that some treatment perceptions may vary with degree of psychopathic traits. For instance, participants with low and high degrees of psychopathic personality traits had different views on treatment requirements imposed upon them. Many treatment perceptions were also similar between the two participant groups. Thus, treatment perceptions may not be explained by degree of psychopathic personality traits alone, but the presence of some particular psychopathic traits may be relevant in explaining certain treatment perceptions. The results highlight the complex relationship between the individual and the treatment system, and may give input to future studies on rehabilitation of offenders with multiple treatment needs.展开更多
<strong>Background:</strong> The objective of cholesteatoma surgery is not only to eradicate disease, but also reduce the risk of recurrence. While the use of the endoscope has been shown to reduce the rat...<strong>Background:</strong> The objective of cholesteatoma surgery is not only to eradicate disease, but also reduce the risk of recurrence. While the use of the endoscope has been shown to reduce the rate of residual disease, there is currently insufficient data on recidivism and hearing outcomes following exclusive endoscopic use in cholesteatoma ear surgery. <strong>Objectives:</strong> Auditing outcomes of exclusive endoscopic surgery (EES) for the surgical management of cholesteatoma, with a secondary aim of comparing recidivism and hearing outcomes of 4 different surgical techniques, namely, EES, microscopic canal wall down (CWD), microscopic canal wall up (CWU) and combined endoscopic-microscopic techniques (CEM). <strong>Methods:</strong> A retrospective chart review was conducted at two tertiary academic hospitals in Cape Town, namely, Red Cross War Memorial Children’s Hospital (RCWMH) for patients below13 years and Groote Schuur Hospital (GSH) for patients above 13 years, over a 5 year period, between January 2012 and December 2016. <strong>Results:</strong> 128 cholesteatoma surgeries overall;110 patients were from GSH and 18 from RCWMH. Eight RCWMH patients underwent EES, 7 had CWU, 2 had CWD and 1 underwent CEM. Overall recidivism in the RCWMH population was 33% (6/18), 2 underwent EES, 2 underwent a microscopic CWU, 1 had a CWD and 1 underwent CEM. The mean postoperative hearing in this group was 40 dB from 50.3 decibels (dB) preoperatively. In the GSH group, 23 underwent an EES, 42 had a CWU, 40 underwent CWD and 5 underwent CEM. Overall recidivism for the GSH group was 17% (19/110). Of those, 7 underwent EES, 8 underwent microscopic CWU, 1 underwent CWD and 3 underwent CEM. Mean postoperative hearing was 47.4 dB from 48.4 dB preoperatively. <strong>Conclusions:</strong> The CWD technique demonstrated superior outcomes. In the GSH group, the EES approach had the same recurrence rate as CWU. Much higher recidivism was observed in the RCWMH group. Management of cholesteatoma requires a highly individualized approach to determine the most appropriate surgical treatment paradigm.展开更多
Intimate partner violence(IPV)is simultaneously assumed as a serious crime and a major public health issue,having recurrences as one of its main characteristics and,consequently,re-entries of some alleged offenders in...Intimate partner violence(IPV)is simultaneously assumed as a serious crime and a major public health issue,having recurrences as one of its main characteristics and,consequently,re-entries of some alleged offenders in the criminal justice system(CJS).The main goal of this study is to assess if in cases of female victims of IPV,violence decreases after the first entry of the alleged offender in the CJS.A retrospective study was performed based on the analysis of police reports of alleged cases of IPV during a 4-year period.The final sample(n=1488)was divided into two groups according to the number of entries in the CJS(single or multiple)followed by a comparative approach.Results suggest that violence decreases after the first entry of alleged offenders in the CJS.Re-entries were found in only 15.5%of the cases but they were accountable for 3.3 times more crimes on average.Besides,victims of recidivism presented more injuries and required more medical care.Thus,a small group of alleged offenders seems to be more violent and accountable for most of the IPV crimes registered in the CJS suggesting that regardless of legal sanctions aiming to deter violence,these measures may not be enough for a certain group of offenders.This study sustains the need for a predictive model to quantify the risk of repeated IPV cases within the Portuguese population.展开更多
The Historical-Clinical-Risk Management Scale 20(HCR-20)is a structured tool to assess the risk of violence and assist in its management.French professionals are reluctant to use it because only a few studies have sho...The Historical-Clinical-Risk Management Scale 20(HCR-20)is a structured tool to assess the risk of violence and assist in its management.French professionals are reluctant to use it because only a few studies have shown its psychometric qualities with French samples.The objective of this study is to test the psychometric qualities of the HCR-20 with samples of violent detainees in France.The HCR-20 and Level of Service/Case Management Inventory(LS/CMI)were administered to 128 violent offenders with an average age of(44.16±12.30)years.We evaluated the reliability,internal consistency and validity of the HCR-20 and conducted an exploratory factor analysis.The results show that the HCR-20 has good psychometric qualities with a sample of French prisoners.Only the Risk domain presents weak results due to the data collection locations and the participants’age.Correlations were observed between certain factors.The exploratory factor analysis shows four factors explaining 44%of the variance.The continuation of this work will enable French professionals to use sound tools to assess the risk of recidivism.展开更多
Background:Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma,known as trauma recidivism.The epidemiology of burn recidivism,spec...Background:Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma,known as trauma recidivism.The epidemiology of burn recidivism,specifically,has not been described.This study aimed to characterize cases of burn recidivism at a large US tertiary care burn center and compare burn recidivists(RCs)with non-recidivists(NRCs).Methods:A 10-year retrospective descriptive cohort study of adult burn patients admitted to the North Carolina Jaycee Burn Center was conducted using data from an electronic burn registry and the medical record.Continuous variables were reported using medians and interquartile ranges(IQR).Chi-square and Wilcoxon-Mann-Whitney tests were used to compare demographic,burn,and hospitalization characteristics between NRCs and RCs.Results:A total of 7134 burn patients were admitted,among which 51(0.7%)were RCs and accounted for 129(1.8%)admissions.Of the 51 RCs,37 had two burn injuries each,totaling 74 admissions as a group,while the remaining 14 RCs had between three and eight burn injuries each,totaling 55 admissions as a group.Compared to NRCs,RCs were younger(median age 36 years vs.42 years,p=0.02)and more likely to be white(75%vs.60%,p=0.03),uninsured(45%vs.30%,p=0.02),have chemical burns(16%vs.5%,p<0.0001),and have burns that were≤10%total body surface area(89%vs.76%,p=0.001).The mortality rate for RCs vs.NRCs did not differ(0%vs.1.2%,p=0.41).Psychiatric and substance use disorders were approximately five times greater among RCs compared to NRCs(75%vs.15%,p<0.001).Median total hospital charges per patient were nearly three times higher for RCs vs.NRCs($85,736 vs.$32,023,p<0.0001).Conclusions:Distinct from trauma recidivism,burn recidivism is not associated with more severe injury or increased mortality.Similar to trauma recidivists,but to a greater extent,burn RCs have high rates of comorbid psychiatric and medical conditions that contribute to increased health care utilization and costs.Studies involving larger samples from multiple centers can further clarify whether these findings are generalizable to national burn and trauma populations.展开更多
文摘Alcoholic cirrhosis remains the second most common indication for liver transplantation.A comprehensive medical and psychosocial evaluation is needed when making a decision to place such patients on the transplant list.Most transplant centers worldwide need a minimum of 6 mo of alcohol abstinence for listing these patients.Patients with alcohol dependence are at high risk for relapse to alcohol use after transplantation(recidivism).These patients need to be identified and require alcohol rehabilitation treatment before transplantation.Recidivism to the level of harmful drinking is reported in about 15%-20%cases.Although,recurrent cirrhosis and graft loss from recidivism is rare,occurring in less than 5%of all alcoholic cirrhosis-related transplants,harmful drinking in the post-transplant pe-riod does impact the long-term outcome.The development of metabolic syndrome with cardiovascular events and de novo malignancy are important contributors to non liver-related mortality amongst transplants for alcoholic liver disease.Surveillance protocols for earlier detection of de novo malignancy are needed to improve the long-term outcome.The need for a minimum of 6 mo of abstinence before listing makes transplant a nonviable option for patients with severe alcoholic hepatitis who do not respond to corticosteroids.Emerging data from retrospective and prospective studies has challenged the 6 mo rule,and beneficial effects of liver transplantation have been reported in select patients with a first episode of severe alcoholic hepatitis who are unresponsive to steroids.
文摘Currently,alcoholic cirrhosis is the second leading indication for liver transplantation in the United States and Europe.The quality of life and survival after a liver transplantation(LT)in patients with alcoholic liver disease(ALD)are similar to those in patients with other cirrhosis etiologies.The alcoholic relapse rate after a LT varies from 10%-50%,and these relapse patients are the ones who present a reduced long-term survival,mainly due to cardiovascular diseases and the onset of de novo neoplasms,including lung and upper aerodigestive tract.Nearly 40%of ALD recipients resume smoking and resume it early post-LT.Therefore,our pre-and post-LT follow-up efforts regarding ALD should be focused not only on alcoholic relapse but also on treating and avoiding other modifiable risk factors such as tobacco.The psychiatric and psychosocial pre-LT evaluation and the post-LT follow-up with physicians,psychiatrists and addiction specialists are important for reversing these problems because these professionals help to identify patients at risk for relapse as well as those patients who have relapsed,thus enabling responsive actions.
文摘Acute alcoholic hepatitis (AH) is a distinct clinical entity amongst patients with chronic alcohol abuse.Patients with severe AH are at risk of dying in about 20%-25% cases despite specific treatment with corticosteroids and/or pentoxifylline.Clearly,a need for an additional more effective treatment option is unmet currently.Liver transplantation (LT),a definitive treatment option for alcoholic cirrhosis requires 6 mo abstinence.However,this rule cannot be applied to patients with AH as these patients are actively drinking prior to their presentation.Shortage of donors,ethical issues,and fear of recidivism after transplantation with less than 6 mo pretransplant abstinence are some of the reasons behind this rule of 6 mo of abstinence and hesitancy of transplanting patients with AH.These issues are debated at length in this manuscript.Further,retrospective studies have shown that patients undergoing transplantation for alcoholic cirrhosis and having histological changes of AH have been shown to fare as well when compared to patients without these histological changes.Recently,French workers have reported a case matched prospective study showing encouraging data on the usefulness of LT for patients who are non-responders to cortico-steroid and/or pentoxifylline therapy.Future studies are needed to identify patients with severe AH who are going to benefit most with LT.In the light of emerging data on the efficacy of LT in improving survival of patients with severe acute AH who do not respond to corticosteroids,the time is ripe to re-evaluate our policy of LT in patients with AH.
文摘BACKGROUND Liver transplantation is the accepted standard of care for end-stage liver disease due to a variety of etiologies including decompensated cirrhosis, fulminant hepatic failure, and primary hepatic malignancy. There are currently over 13000 candidates on the liver transplant waiting list emphasizing the importance of rigorous patient selection. There are few studies regarding the impact of additional psychosocial barriers to liver transplant including financial hardship, lack of caregiver support, polysubstance abuse, and issues with medical noncompliance. We hypothesized that patients with certain psychosocial comorbidities experienced worse outcomes after liver transplantation. AIM To assess the impact of certain pre-transplant psychosocial comorbidities on outcomes after liver transplantation. METHODS A retrospective analysis was performed on all adult patients from 2012-2016. Psychosocial comorbidities including documented medical non-compliance, polysubstance abuse, financial issues, and lack of caregiver support were collected. The primary outcome assessed post-transplantation was survival. Secondary outcomes measured included graft failure, episodes of acute rejection, psychiatric decompensation, number of readmissions, presence of infection, recidivism for alcohol and other substances, and documented caregiver support failure.RESULTS For the primary outcome, there were no differences in survival. Patients with a history of psychiatric disease had a higher incidence of psychiatric decompensation after liver transplantation (19% vs 10%, P = 0.013). Treatment of psychiatric disorders resulted in a reduction of the incidence of psychiatric decompensation (21% vs 11%, P = 0.022). Patients with a history of polysubstance abuse in the transplant evaluation had a higher incidence of substance abuse after transplantation (5.8% vs 1.2%, P = 0.05). In this cohort, 15 patients (3.8%) were found to have medical compliance issues in the transplant evaluation. Of these specific patients, 13.3% were found to have substance abuse after transplantation as opposed to 1.3% in patients without documented compliance issues (P = 0.03). CONCLUSION Patients with certain psychosocial comorbidities had worse outcomes following liver transplantation. Further prospective and multi-center studies are warranted to properly determine guidelines for liver transplantation regarding this highrisk population.
文摘Alcoholic liver disease(ALD) is the second most common indication for liver transplantation(LT) in the United States and Europe. Unlike other indications for LT, transplantation for ALD may be controversial due to the concern for alcohol relapse and non-compliance after LT. However, the overall survival in patients transplanted for ALD is comparable or higher than in patients transplanted for other etiologies of liver disease. While the rate of alcohol use after liver transplantation does not differ among various etiologies of liver disease, alcohol relapse after transplantation for ALD has been associated with complications such as graft rejection, graft loss, recurrent alcoholic cirrhosis and reduced long-term patient survival. Given these potential complications, our review aimed to discuss risk factors associated with alcohol relapse and the efficacy of various interventions attempted to reduce the risk of alcohol relapse. We also describe the impact of alcohol relapse on post-transplant outcomes including graft and patient survival. Overall, alcohol liver disease remains an appropriate indication for liver transplantation, and long-term mortality in this group of patients is primarily attributed to cardiovascular disease or de novo malignancies rather than alcohol related hepatic complications, among those who relapse.
文摘Substance abuse is related to re-offending, and substance abuse treatment may be effective in reducing criminal recidivism. Psychopathy, however, another factor that strongly correlates with re-offending, may be negatively associated with treatment utilization. This qualitative study explored perceptions of substance abuse treatment among offenders with mental health problems, problematic substance use, and various degrees of psychopathic personality traits. An Interpretative Phenomenological Analysis (IPA) revealed that some treatment perceptions may vary with degree of psychopathic traits. For instance, participants with low and high degrees of psychopathic personality traits had different views on treatment requirements imposed upon them. Many treatment perceptions were also similar between the two participant groups. Thus, treatment perceptions may not be explained by degree of psychopathic personality traits alone, but the presence of some particular psychopathic traits may be relevant in explaining certain treatment perceptions. The results highlight the complex relationship between the individual and the treatment system, and may give input to future studies on rehabilitation of offenders with multiple treatment needs.
文摘<strong>Background:</strong> The objective of cholesteatoma surgery is not only to eradicate disease, but also reduce the risk of recurrence. While the use of the endoscope has been shown to reduce the rate of residual disease, there is currently insufficient data on recidivism and hearing outcomes following exclusive endoscopic use in cholesteatoma ear surgery. <strong>Objectives:</strong> Auditing outcomes of exclusive endoscopic surgery (EES) for the surgical management of cholesteatoma, with a secondary aim of comparing recidivism and hearing outcomes of 4 different surgical techniques, namely, EES, microscopic canal wall down (CWD), microscopic canal wall up (CWU) and combined endoscopic-microscopic techniques (CEM). <strong>Methods:</strong> A retrospective chart review was conducted at two tertiary academic hospitals in Cape Town, namely, Red Cross War Memorial Children’s Hospital (RCWMH) for patients below13 years and Groote Schuur Hospital (GSH) for patients above 13 years, over a 5 year period, between January 2012 and December 2016. <strong>Results:</strong> 128 cholesteatoma surgeries overall;110 patients were from GSH and 18 from RCWMH. Eight RCWMH patients underwent EES, 7 had CWU, 2 had CWD and 1 underwent CEM. Overall recidivism in the RCWMH population was 33% (6/18), 2 underwent EES, 2 underwent a microscopic CWU, 1 had a CWD and 1 underwent CEM. The mean postoperative hearing in this group was 40 dB from 50.3 decibels (dB) preoperatively. In the GSH group, 23 underwent an EES, 42 had a CWU, 40 underwent CWD and 5 underwent CEM. Overall recidivism for the GSH group was 17% (19/110). Of those, 7 underwent EES, 8 underwent microscopic CWU, 1 underwent CWD and 3 underwent CEM. Mean postoperative hearing was 47.4 dB from 48.4 dB preoperatively. <strong>Conclusions:</strong> The CWD technique demonstrated superior outcomes. In the GSH group, the EES approach had the same recurrence rate as CWU. Much higher recidivism was observed in the RCWMH group. Management of cholesteatoma requires a highly individualized approach to determine the most appropriate surgical treatment paradigm.
基金Partially supported by[Xunta de Galicia.Proxectos Plan Galego IDT ED431C 2021/35].
文摘Intimate partner violence(IPV)is simultaneously assumed as a serious crime and a major public health issue,having recurrences as one of its main characteristics and,consequently,re-entries of some alleged offenders in the criminal justice system(CJS).The main goal of this study is to assess if in cases of female victims of IPV,violence decreases after the first entry of the alleged offender in the CJS.A retrospective study was performed based on the analysis of police reports of alleged cases of IPV during a 4-year period.The final sample(n=1488)was divided into two groups according to the number of entries in the CJS(single or multiple)followed by a comparative approach.Results suggest that violence decreases after the first entry of alleged offenders in the CJS.Re-entries were found in only 15.5%of the cases but they were accountable for 3.3 times more crimes on average.Besides,victims of recidivism presented more injuries and required more medical care.Thus,a small group of alleged offenders seems to be more violent and accountable for most of the IPV crimes registered in the CJS suggesting that regardless of legal sanctions aiming to deter violence,these measures may not be enough for a certain group of offenders.This study sustains the need for a predictive model to quantify the risk of repeated IPV cases within the Portuguese population.
文摘The Historical-Clinical-Risk Management Scale 20(HCR-20)is a structured tool to assess the risk of violence and assist in its management.French professionals are reluctant to use it because only a few studies have shown its psychometric qualities with French samples.The objective of this study is to test the psychometric qualities of the HCR-20 with samples of violent detainees in France.The HCR-20 and Level of Service/Case Management Inventory(LS/CMI)were administered to 128 violent offenders with an average age of(44.16±12.30)years.We evaluated the reliability,internal consistency and validity of the HCR-20 and conducted an exploratory factor analysis.The results show that the HCR-20 has good psychometric qualities with a sample of French prisoners.Only the Risk domain presents weak results due to the data collection locations and the participants’age.Correlations were observed between certain factors.The exploratory factor analysis shows four factors explaining 44%of the variance.The continuation of this work will enable French professionals to use sound tools to assess the risk of recidivism.
基金supported by the University of North Carolina at Chapel Hill Junior Faculty Development Award.
文摘Background:Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma,known as trauma recidivism.The epidemiology of burn recidivism,specifically,has not been described.This study aimed to characterize cases of burn recidivism at a large US tertiary care burn center and compare burn recidivists(RCs)with non-recidivists(NRCs).Methods:A 10-year retrospective descriptive cohort study of adult burn patients admitted to the North Carolina Jaycee Burn Center was conducted using data from an electronic burn registry and the medical record.Continuous variables were reported using medians and interquartile ranges(IQR).Chi-square and Wilcoxon-Mann-Whitney tests were used to compare demographic,burn,and hospitalization characteristics between NRCs and RCs.Results:A total of 7134 burn patients were admitted,among which 51(0.7%)were RCs and accounted for 129(1.8%)admissions.Of the 51 RCs,37 had two burn injuries each,totaling 74 admissions as a group,while the remaining 14 RCs had between three and eight burn injuries each,totaling 55 admissions as a group.Compared to NRCs,RCs were younger(median age 36 years vs.42 years,p=0.02)and more likely to be white(75%vs.60%,p=0.03),uninsured(45%vs.30%,p=0.02),have chemical burns(16%vs.5%,p<0.0001),and have burns that were≤10%total body surface area(89%vs.76%,p=0.001).The mortality rate for RCs vs.NRCs did not differ(0%vs.1.2%,p=0.41).Psychiatric and substance use disorders were approximately five times greater among RCs compared to NRCs(75%vs.15%,p<0.001).Median total hospital charges per patient were nearly three times higher for RCs vs.NRCs($85,736 vs.$32,023,p<0.0001).Conclusions:Distinct from trauma recidivism,burn recidivism is not associated with more severe injury or increased mortality.Similar to trauma recidivists,but to a greater extent,burn RCs have high rates of comorbid psychiatric and medical conditions that contribute to increased health care utilization and costs.Studies involving larger samples from multiple centers can further clarify whether these findings are generalizable to national burn and trauma populations.
