Persisting disability after head injury in juvenile prisoners and Clinical research portfolio

Background: The prevalence of head injury (HI) in juvenile offenders is estimated to be 30%, however no studies report disability after HI in prisoners. Furthermore, a recent Doctoral thesis found that adult offenders with a history of moderate-severe HI were more likely to experience disability, cognitive impairment, and anxiety than those with a mild HI history. Aims: To explore disability, health-related outcomes and offence characteristics associated with HI in juvenile prisoners in Scotland. Methods: HI, mental health, trauma, substance use, cognitive function and offending history were assessed in 78 male juvenile prisoners in HMYOI Polmont. Results: Compared with No/Mild HI, Multiple HI (as defined by the Ohio State University Traumatic Brain Injury Identification Method) was associated with greater substance use, poorer mental health, slower information processing, more violent convictions and prison incidents. Disability and self-report of dysexecutive functioning were associated with Multiple HI in univariate analysis. Regression indicated that a PTSD screening score and not HI group, ADHD, problematic alcohol/drug use, adverse childhood experiences, age or education predicted outcomes. Conclusions: Multiple HI was highly prevalent in juvenile prisoners and had associations with disability, dysexecutive difficulties and offence characteristics. A PTSD screening score was the only significant predictor of disability and dysexecutive difficulties. Those who score above the cut-off on the PTSD screening tool may not be referring to PTSD symptoms alone; clinical interview would be required for PTSD diagnosis. Staff working with juvenile prisoners should be aware of the impact of HI and trauma on their health and offending risk

Associations between significant head injury in male juveniles in prison in Scotland UK and cognitive function, disability and crime: a cross sectional study

Background: Although the prevalence of head injury is estimated to be high in juveniles in prison, the extent of persisting disability is unknown and relationships with offending uncertain. This limited understanding makes it difficult to develop effective management strategies and interventions to improve health or reduce recidivism. This study investigates effects of significant head injury (SHI) on cognitive function, disability and offending in juvenile prisoners, and considers relationships with common comorbidities. Methods: This cross-sectional study recruited male juvenile prisoners in Scotland from Her Majesty’s Young Offenders Institute (HMYOI) Polmont (detaining approximately 305 of 310 male juveniles in prison in Scotland). To be included juveniles had to be 16 years or older, fluent in English, able to participate in assessment, provide informed consent and not have a severe acute disorder of cognition or communication. Head injury, cognition, disability, history of abuse, mental health and problematic substance use were assessed by interview and questionnaire. Results: We recruited 103 (34%) of 305 juvenile males in HMYOI Polmont. The sample was demographically representative of juvenile males in prisons for young offenders in Scotland. SHI was found in 82/103 (80%) and head injury repeated over long periods of time in 69/82 (85%). Disability was associated with SHI in 11/82 (13%) and was significantly associated with mental health problems, particularly anxiety. Group differences on cognitive tests were not found. However the SHI group reported poorer behavioural control on the Dysexecutive Questionnaire and were more often reported for incidents in prison than those without SHI. Characteristics of offending, including violence, did not differ between groups. Conclusions: Although SHI is highly prevalent in juvenile prisoners, associated disability was relatively uncommon. There was no evidence for differences in cognitive test performance or offending in juveniles with and without SHI. However, signs of poorer behavioural control and greater psychological distress in juveniles with SHI suggest that they may be at greater risk of recidivism and of potentially becoming lifelong offenders. This implies a need for remedial programmes for juvenile prisoners to take account of persisting effects of SHI on mental health and self-control and education and to improve their understanding of the effects of SHI reduce the likelihood of cumulative effects from further SHI

Breastfeeding in infancy is not associated with inflammatory status in healthy adolescents

It has been suggested that breast-feeding (BF) may be associated with a decreased risk of cardiovascular disease in adulthood. A low-grade inflammation is associated with an increased risk of cardiovascular disease, even in apparently healthy children. The objective of this study was to assess the potential modulating effect of BF on the inflammatory status of healthy adolescents. Information on BE (duration) was obtained from parental records in 484 of 1040 healthy European urban adolescents (56.4% females) that had a blood sample obtained as part of the Healthy Lifestyle in Europe by Nutrition and Adolescence study. Blood serum inflammatory markers were measured, including high sensitivity C-reactive protein, complement factors 3 and 4, ceruloplasmin, adhesion molecules (L-selectin and soluble endothelial selectin, soluble vascular cell adhesion molecule 1, and intercellular adhesion molecule 1), cytokines, TGF beta 1, and white blood cells. After univariate analysis, a propensity score, including the potential confounding factors, was computed and used to assess the association between BF and selected inflammatory markers. BE was not significantly associated with any of the selected inflammatory markers after adjustment for gender and propensity score. In our study, BE was not associated with low-grade inflammatory status in healthy adolescents, suggesting that the potential cardiovascular benefits of BF are related to other mechanisms than modulation of inflammation or might become relevant at a later age. Groups at high risk for cardiovascular disease should be a target for further research concerning the effects of BF