Episodic homelessness and health care utilization in a prospective cohort of HIV-infected persons with alcohol problems

BACKGROUND: Because individuals with HIV/AIDS often have complex medical and social needs, the impact of housing status on medical service utilization is difficult to isolate from the impact of conditions that may worsen during periods of homelessness such as depression and substance abuse. We examine whether episodes of homelessness are independently associated with suboptimal medical utilization even when accounting for concurrent addiction severity and depression. METHODS: We used data from a 30-month cohort of patients with HIV/AIDS and alcohol problems. Housing status, utilization (ambulatory visits, emergency department (ED) visits, and hospitalizations) and other features were assessed with standardized research interviews at 6-month intervals. Multivariable longitudinal regression models calculated incidence rate ratios (IRR) comparing utilization rates during 6-month intervals (homeless versus housed). Additional models assessed whether addiction severity and depressive symptoms could account for utilization differences. RESULTS: Of the 349 subjects, 139 (39%) reported homelessness at least once during the study period; among these subjects, the median number of nights homeless per 6-month interview period was 30. Homelessness was associated with higher ED utilization (IRR = 2.17; 95% CI = 1.72–2.74) and hospitalizations (IRR = 2.30; 1.70–3.12), despite no difference in ambulatory care utilization (IRR = 1.09; 0.89–1.33). These associations were attenuated but remained significant when adjusting for addiction severity and depressive symptoms. CONCLUSION: In patients with HIV/AIDS and alcohol problems, efforts to improve housing stability may help to mitigate intensive medical utilization patterns

Anticipated Shaming and Criminal Offending

Criminological research suggests that informal sanctions like shaming may have a stronger influence on crime than do formal sanctions, but research has yet to examine whether anticipated shaming may mediate the relationship between crime and variables derived from dominant micro-level theories. The present paper argues that variables derived from learning, control, strain, and deterrence theories influence criminal offending via their effect on anticipated shaming. Using data collected from a sample of young adults, results from both tobit and path analyses suggest that the prospect of shaming among friends and family bears a stronger direct relation to criminal intent than do more commonly examined variables and that the effect of such variables on criminal intent is largely indirect, mediated by anticipated shaming. We therefore suggest that crime control efforts might benefit from incorporating a greater role for Braithwaite\u27s conception of reintegrative shaming

Anticipated shaming and criminal offending

Criminological research suggests that informal sanctions like shaming may have a stronger influence on crime than do formal sanctions, but research has yet to examine whether anticipated shaming may mediate the relationship between crime and variables derived from dominant micro-level theories. The present paper argues that variables derived from learning, control, strain, and deterrence theories influence criminal offending via their effect on anticipated shaming. Using data collected from a sample of young adults, results from both tobit and path analyses suggest that the prospect of shaming among friends and family bears a stronger direct relation to criminal intent than do more commonly examined variables and that the effect of such variables on criminal intent is largely indirect, mediated by anticipated shaming. We therefore suggest that crime control efforts might benefit from incorporating a greater role for Braithwaite's conception of reintegrative shaming.

Gender Differences in Criminal Intent: Examining the Mediating Influence of Anticipated Shaming

Research finds males to have a higher likelihood of offending than females. Dominant explanations of the gender/crime relationship tend to invoke strain, learning, and control theories, but we propose that part of the relationship is attributable to differences in anticipated shaming. We test this argument using data collected from a sample of 439 young adults. Results of both Tobit regressions and path analyses support our hypothesis, suggesting that anticipated shaming may actually mediate more of the gender/crime relationship than do variables derived from alternative perspectives. Implications for understanding and controlling crime are discussed

Gender Differences in Criminal Intent: Examining the Mediating Influence of Anticipated Shaming

Research finds males to have a higher likelihood of offending than females. Dominant explanations of the gender/crime relationship tend to invoke strain, learning, and control theories, but we propose that part of the relationship is attributable to differences in anticipated shaming. We test this argument using data collected from a sample of 439 young adults. Results of both Tobit regressions and path analyses support our hypothesis, suggesting that anticipated shaming may actually mediate more of the gender/crime relationship than do variables derived from alternative perspectives. Implications for understanding and controlling crime are discussed

Evaluation of common genetic variants in 82 candidate genes as risk factors for neural tube defects

<p>Abstract</p> <p>Background</p> <p>Neural tube defects (NTDs) are common birth defects (~1 in 1000 pregnancies in the US and Europe) that have complex origins, including environmental and genetic factors. A low level of maternal folate is one well-established risk factor, with maternal periconceptional folic acid supplementation reducing the occurrence of NTD pregnancies by 50-70%. Gene variants in the folate metabolic pathway (e.g., <it>MTHFR</it> rs1801133 (677 C > T) and <it>MTHFD1</it> rs2236225 (R653Q)) have been found to increase NTD risk. We hypothesized that variants in additional folate/B12 pathway genes contribute to NTD risk.</p> <p>Methods</p> <p>A tagSNP approach was used to screen common variation in 82 candidate genes selected from the folate/B12 pathway and NTD mouse models. We initially genotyped polymorphisms in 320 Irish triads (NTD cases and their parents), including 301 cases and 341 Irish controls to perform case–control and family based association tests. Significantly associated polymorphisms were genotyped in a secondary set of 250 families that included 229 cases and 658 controls. The combined results for 1441 SNPs were used in a joint analysis to test for case and maternal effects.</p> <p>Results</p> <p>Nearly 70 SNPs in 30 genes were found to be associated with NTDs at the p < 0.01 level. The ten strongest association signals (p-value range: 0.0003–0.0023) were found in nine genes (<it>MFTC, CDKN2A, ADA, PEMT, CUBN, GART, DNMT3A, MTHFD1</it> and <it>T (Brachyury)</it>) and included the known NTD risk factor <it>MTHFD1</it> R653Q (rs2236225). The single strongest signal was observed in a new candidate, <it>MFTC</it> rs17803441 (OR = 1.61 [1.23-2.08], p = 0.0003 for the minor allele). Though nominally significant, these associations did not remain significant after correction for multiple hypothesis testing.</p> <p>Conclusions</p> <p>To our knowledge, with respect to sample size and scope of evaluation of candidate polymorphisms, this is the largest NTD genetic association study reported to date. The scale of the study and the stringency of correction are likely to have contributed to real associations failing to survive correction. We have produced a ranked list of variants with the strongest association signals. Variants in the highest rank of associations are likely to include true associations and should be high priority candidates for further study of NTD risk.</p