Positive and Negative Parenting in Conduct Disorder with High versus Low Levels of Callous-Unemotional Traits

Less is known about the relationship between conduct disorder (CD), callous-unemotional (CU) traits, and positive and negative parenting in youth compared to early childhood. We combined traditional univariate analyses with a novel machine learning classifier (Angle-based Generalized Matrix Learning Vector Quantization) to classify youth (N = 756; 9-18 years) into typically developing (TD) or CD groups with or without elevated CU traits (CD/HCU, CD/LCU, respectively) using youth- A nd parent-reports of parenting behavior. At the group level, both CD/HCU and CD/LCU were associated with high negative and low positive parenting relative to TD. However, only positive parenting differed between the CD/HCU and CD/LCU groups. In classification analyses, performance was best when distinguishing CD/HCU from TD groups and poorest when distinguishing CD/HCU from CD/LCU groups. Positive and negative parenting were both relevant when distinguishing CD/HCU from TD, negative parenting was most relevant when distinguishing between CD/LCU and TD, and positive parenting was most relevant when distinguishing CD/HCU from CD/LCU groups. These findings suggest that while positive parenting distinguishes between CD/HCU and CD/LCU, negative parenting is associated with both CD subtypes. These results highlight the importance of considering multiple parenting behaviors in CD with varying levels of CU traits in late childhood/adolescence

Η αντίληψη της εικόνας εαυτού - κόσμου - μέλλοντος σε εφήβους με παραβατική συμπεριφορά

Σκοπός Η νεανική ή ανήλικη παραβατικότητα είναι ένα σύνθετο ατομικό και κοινωνικό φαινόμενο, που αναπτύσσεται ραγδαία. Οι έφηβοι που εμφανίζουν παραβατική συμπεριφορά φαίνεται να έχουν δυσλειτουργικές πεποιθήσεις και να εμφανίζουν γνωσιακές διαστρεβλώσεις για τον εαυτό, τον κόσμο και το μέλλον. Η παρούσα εργασία πραγματοποιήθηκε προκειμένου να μελετηθούν τα δημογραφικά χαρακτηριστικά των εφήβων που εμφανίζουν παραβατική συμπεριφορά και πώς αυτά συσχετίζονται με τις δυσλειτουργικές αντιλήψεις για τον «εαυτό», τον «κόσμο» και το «μέλλον», καθώς και με την πρόσφατη ψυχική νοσηρότητα που αυτοί εμφανίζουν. Μεθοδολογία Το δείγμα της μελέτης αποτελείται από 60 έφηβους – νεαρούς με παραβατική συμπεριφορά, ηλικίας 16-21 ετών. Η συλλογή των δεδομένων πραγματοποιήθηκε στο πλαίσιο του Δικαστηρίου Ανηλίκων Αθηνών. Η συλλογή των δεδομένων έγινε με τρία ανώνυμα αυτό- συμπληρούμενα ερωτηματολόγια. Δόθηκε το Ερωτηματολόγιο Γενικής Υγείας (General Health Questionnaire-28), το Dysfunctional Preconceptions Questionnaire (DPQ) για την αποτύπωση των δυσλειτουργικών αξιολογήσεων και ένα ερωτηματολόγιο καταγραφής δημογραφικών χαρακτηριστικών, που δομήθηκε για την εργασία αυτή. Αποτελέσματα Το 95,0% των εφήβων ήταν άντρες και το 75,0% ήταν Έλληνες. Το 56,7% των συμμετεχόντων ήταν απόφοιτοι λυκείου/επαγγελματικού λυκείου. Το 41,7% των συμμετεχόντων είχε επισκεφτεί ψυχίατρο ή ψυχολόγο και το 56,0% αυτών που πήγαν σε ψυχίατρο ή ψυχολόγο διαγνώστηκε με διαταραχές συμπεριφοράς. Επίσης, το 58,3% των συμμετεχόντων είχαν ιστορικό κατάχρησης/εξάρτησης από ουσίες. Στο 18,3% των περιπτώσεων, η τέλεση της παραβατικής πράξης ήταν σχετιζόμενη με ψυχοτρόπες ουσίες. Περισσότεροι από τους μισούς συμμετέχοντες είχαν βιώσει κάποιο στρεσσογόνο γεγονός ζωής τους τελευταίους 24 μήνες πριν από την παραβατική πράξη με το ποσοστό να είναι 63,3%, ενώ το 18,3% είχε ιστορικό αυτό- ή ετεροκαταστροφικής συμπεριφοράς. Όσον αφορά το οικογενειακό ιστορικό, το 23,3% των συμμετεχόντων είχε ιστορικό ψυχιατρικής νόσου, το 23,3% ιστορικό κατάχρησης/εξάρτησης από ουσίες και το 26,7% ιστορικό εγκληματικής/παραβατικής συμπεριφοράς, ενώ το 51,7% των συμμετεχόντων είχαν κάνει συμμετοχική παραβατική πράξη. Οι ποινικές παραβάσεις που σημειώθηκαν κυρίως ήταν η κλοπή ή ληστεία και η κατοχή και χρήση ναρκωτικών ουσιών με τα ποσοστά να είναι 45,0% και 21,7% αντίστοιχα. Το μορφωτικό επίπεδο των συμμετεχόντων και η ύπαρξη στρεσσογόνων γεγονότων ζωής τους τελευταίους 12 μήνες βρέθηκαν να σχετίζονται με τη διάσταση «Εαυτός» και με τη διάσταση «Κόσμος», καθώς επίσης η διακοπή σχολείου λόγω απουσιών και η εθνικότητα των συμμετεχόντων βρέθηκαν να σχετίζονται με τη διάσταση «Μέλλον». Η ύπαρξη ατομικού ιστορικού αυτό- ή ετεροκαταστροφικής συμπεριφοράς φαίνεται να σχετίζεται με τη διάσταση «Εαυτός» και με τη διάσταση «Κόσμος», όπως επίσης και με τη συνολική βαθμολογία (νιώθω) των συμμετεχόντων. Μόνο η διακοπή σχολείου λόγω απουσιών βρέθηκε να σχετίζεται με τη διάσταση «Μέλλον». Οι διαστάσεις «Άγχος/ Αϋπνία», «Κοινωνική δυσλειτουργία» και η συνολική βαθμολογία GHQ-28 σχετίζονταν θετικά σημαντικά με όλες τις υποκλίμακες του συναισθηματικού σκέλους (νιώθω) του DPQ. Η διακοπή σχολείου λόγω απουσιών και η ύπαρξη στρεσσογόνων γεγονότων ζωής τους τελευταίους 12 μήνες βρέθηκαν να σχετίζονται με τη διάσταση «Σωματικά συμπτώματα» και με τη διάσταση «Άγχος/ Αϋπνία», όπως και η ύπαρξη ατομικού ιστορικού αυτό- ή ετεροκαταστροφικής συμπεριφοράς. Οι υψηλότερες τιμές στη συνολική βαθμολογία «νιώθω» του DPQ σχετίζονται με περισσότερα συμπτώματα κοινωνικής δυσλειτουργίας, ενώ υψηλότερες τιμές στη συνολική βαθμολογία «πιστεύω» σχετίζονται με περισσότερα συμπτώματα κατάθλιψης. Συζήτηση Το χαμηλό μορφωτικό επίπεδο, η ύπαρξη στρεσσογόνων γεγονότων, η διακοπή του σχολείου και η ύπαρξη ατομικού ιστορικού κατάχρησης/εξάρτησης από ουσίες σχετίζονται με αρνητική θεώρηση τόσο του εαυτού, όσο και του κόσμου, ενώ οι έφηβοι που είχαν διακόψει το σχολείο λόγω απουσιών, καθώς και ο παράγοντας της εθνικότητας, σχετίζονται με αρνητική θεώρηση του μέλλοντος. Αυτό συνεπάγεται αδυναμία να αξιοποιήσουν δημιουργικά τις ικανότητές τους, ώστε να διαχειριστούν τις αρνητικές καταστάσεις και την καταστροφικότητά τους. Εν συνεχεία, η αρνητική θεώρηση εαυτού, κόσμου, μέλλοντος συνεπάγεται αυξημένο άγχος και αϋπνία, αυξημένη κοινωνική δυσλειτουργία και γενικά χειρότερη ποιότητα ζωής. Οι έφηβοι που είχαν διακόψει το σχολείο λόγω απουσιών και αυτοί που είχαν βιώσει κάποιο στρεσσογόνο συμβάν τους τελευταίους 12 μήνες πριν την παραβατική πράξη, καθώς και αυτοί που είχαν ατομικό ιστορικό αυτό- ή ετεροκαταστροφικής συμπεριφοράς, ανέφεραν αυξημένα σωματικά συμπτώματα, αυξημένο άγχος και αϋπνία. Τέλος, από τα αποτελέσματα της συσχέτισης της κλίμακας δυσλειτουργικών αξιολογήσεων (DPQ) και του Eρωτηματολογίου Γενικής Υγείας (GHQ-28) φαίνεται ότι οι αυξημένες τιμές στη συνολική βαθμολογία των συναισθηματικών προ-αξιολογήσεων σχετίζεται με αυξημένα συμπτώματα κοινωνικής δυσλειτουργίας. Ενώ, όσο περισσότερες νοητικές προ-αξιολογήσεις έκαναν οι συμμετέχοντες εμφάνιζαν περισσότερα συμπτώματα κατάθλιψης.Aim The juvenile delinquency is a complex individual and social phenomenon, which is growing rapidly. Adolescents who deliver delinquent behaviour seem to have dysfunctional beliefs and to demonstrate cognitive distortions as regards the self, the world and the future. This study was carried out in order to study the demographic characteristics of adolescents who deliver delinquent behaviour and how these characteristics are related to dysfunctional perceptions of the "self", the "world" and the "future" and to the recent psychological morbidity. Methodology The study sample consisted of 60 adolescents - young offenders aged 16 to 21 years. The data collection held under the Juvenile Court of Athens. The data collection was done by three anonymous self-supplemented questionnaires. The data collection was done by three anonymous self-supplemented questionnaires. The General Health Questionnaire (General Health Questionnaire-28), the Dysfunctional Preconceptions Questionnaire (DPQ) in order to capture dysfunctional assessments and a questionnaire about the demographic characteristics, which was constructed for this study. Results 95.0% of adolescents were male and 75.0% were Greek. 56.7% of participants were high school graduates. 41.7% of respondents had visited a psychiatrist or psychologist and 56.0% of those who went to a psychiatrist or psychologist have been diagnosed with behavioral disorders. Also, 58.3% of participants had a history of abuse / drug dependence. In 18.3% of cases, the delinquent act was related to psychoactive substances. More than half of the participants had experienced a stressful life event the last 24 months prior to the delinquent act with the rate being 63.3%, while 18.3% had a history of self or aggressive behaviour against others. As for the family history, 23.3% of participants had a history of psychiatric illness, 23.3% historical abuse / drug dependence and 26.7% historical criminal / delinquent behavior, while 51.7% of participants who done a delinquent act participate as members in groups. Criminal offenses that occurred mainly were theft or robbery and the possession and use of drugs with the percentages being 45.0% and 21.7% respectively. The educational level of the participants and the existence of stressful life events in the last 12 months were found to be associated with the dimension "Self" and the dimension "World" as well as school drop-out and the nationality of the participants were found to be associated with the dimension "Future". The existence of individual background of self-harm or aggressiveness against others seems to be related to the dimension "Self" and the dimension "World" and the total score (feel) of the participants. Only school drop out found to be associated with the dimension "Future". The dimensions "Anxiety / Insomnia", "Social Dysfunction" and the total score of GHQ-28 seem to be correlated positive significantly with all the subscales of emotional part (feel) of the DPQ. School drop out and the existence of stressful life events were found to be associated with the dimension "Somatic Symptoms" and dimension "Anxiety / Insomnia", as the existence of individual background of self –harm or aggressiveness against others. Higher scores in the overall rating "feel" of the DPQ associated with more social dysfunction symptoms, while higher scores in the overall rating "beliefs" associated with more depressive symptoms. Discussion Lower educational level, stressful events, school drop out and the existence of personal history of abuse / substance dependence associated with a negative view of both the self and the world, while adolescents who had stopped school and the factor of ethnicity, associated with a negative view of the future. This implies an inability to use creatively their abilities in order to manage negative situations and their destructiveness. Thereafter, the negative view of the self, the world and the future entails increased anxiety and insomnia, increased social dysfunction and generally lower quality of life. Adolescents who had interrupted school and those who had experienced a stressful event in the last 12 months before the delinquent act and those who have a personal history of self-harm behavior or history of aggressive behavior against others, reported increased physical symptoms, increased anxiety and insomnia. Finally, the results of the correlation of the Dysfunctional Preconceptions Questionnaire (DPQ) and the General Health Questionnaire (GHQ-28) reveal increased prices in total score of emotional pre-assessments associated with increased social dysfunction symptoms. While more cognitive pre-evaluations depict more depressive symptoms

Modern bioethical issues: Euthanasia, physician assisted suicide and abortion. Comparative study of attitudes between physicians and law professionals.

We aimed to examine and compare the attitudes of physicians and law professionals on modern bioethical issues. Euthanasia, physician assisted suicide and abortion were selected for this study, as they underline the conflict between human life as a fundamental value, and the individual's right to self-determination. The demand of euthanasia and physician assisted suicide services reflects each person's right to decide on the way their life will end, while the legalization of abortion determines the individual's right to self-determination. These are complex issues with moral, religious and social implications, and as such tend to divide public opinion. In order to investigate their attitudes, physicians of all specialties, as well as law professionals from all over Greece, were invited to participate in the study. In total, 220 professionals responded to the call and participated in the survey. The professionals involved showed fairly high rates of agreement in all the issues studied, but a significant difference in results was found when the occupation of participants was set as a criterion, with physicians being more negative to euthanasia, physician assisted suicide and abortion than lawyers. Religiousness, age and male sex were negatively correlated with "positive" attitudes towards euthanasia, physician assisted suicide and abortion. Moreover, participants' attitudes towards euthanasia and physician assisted suicide were found to predict their attitudes towards abortion, indicating a single ideological direction of agreement or disagreement, accordingly. Individuals' attitudes and opinions are complicated issues, not easy to be categorized. However, it is of scientific interest to shape a legislative framework that is close to the social consensus, ideological evolution and moral needs. This study tried to pave the way for a modern approach to the issues of euthanasia, physician assisted suicide and abortion

Positive and negative parenting in conduct disorder with high versus low levels of callous–unemotional traits

Less is known about the relationship between conduct disorder (CD), callous-unemotional (CU) traits, and positive and negative parenting in youth compared to early childhood. We combined traditional univariate analyses with a novel machine learning classifier (Angle-based Generalized Matrix Learning Vector Quantization) to classify youth (N = 756; 9-18 years) into typically developing (TD) or CD groups with or without elevated CU traits (CD/HCU, CD/LCU, respectively) using youth- A nd parent-reports of parenting behavior. At the group level, both CD/HCU and CD/LCU were associated with high negative and low positive parenting relative to TD. However, only positive parenting differed between the CD/HCU and CD/LCU groups. In classification analyses, performance was best when distinguishing CD/HCU from TD groups and poorest when distinguishing CD/HCU from CD/LCU groups. Positive and negative parenting were both relevant when distinguishing CD/HCU from TD, negative parenting was most relevant when distinguishing between CD/LCU and TD, and positive parenting was most relevant when distinguishing CD/HCU from CD/LCU groups. These findings suggest that while positive parenting distinguishes between CD/HCU and CD/LCU, negative parenting is associated with both CD subtypes. These results highlight the importance of considering multiple parenting behaviors in CD with varying levels of CU traits in late childhood/adolescence.</p

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine