Psychosocial problems after stroke

Each year in the UK 80,000 people survive their first stroke. Many of these people will suffer psychosocial difficulties including depression, anxiety and social maladjustment. Such problems are often not identified or treated effectively. It would therefore be useful to establish their nature and frequency, to identify those patients at particular risk and to develop therapeutic interventions.We attempted to address these issues in the context of a randomised controlled trial of a Stroke Family Care Worker (SFCW), an intervention we hoped would reduce psychosocial difficulties.We assessed a consecutive series of stroke patients who were referred to a teaching hospital within one month of stroke. Having collected detailed baseline data, patients were then randomised either to receive care from, or avoid contact with. the SFCW. Six months after onset we assessed, blind to treatment allocation, patients' psychosocial and physical outcomes using standardised measures. These included, the Oxford Handicap Scale, the Barthel Index. the Frenchav Activities Index, the General Health Questionnaire -30 item, the Social Adjustment Scale. the Recovery Locus of Control Scale, the Medical Coping Modes Questionnaire. the Mental Adjustment to Stroke Scale, the Hospital Anxiety and Depression Scale, the Patient Satisfaction Scale, and a service and equipment use questionnaire.In this thesis I describe the psychosocial outcome of 417 patients six months after stroke, and address some of the issues involved in measuring these aspects of outcome. I go on to examine independent factors which may be related to poor outcomes to increase our understanding of their aetiology and to identify those at greatest risk. Finally I compare the outcomes of patients treated by our SFCW and those who were not to establish the effectiveness of this intervention in alleviating psychosocial problems

Assessing the cognitive contributors to violence:A pilot and feasibility study protocol

In recent years there has been considerable progress in the development, validation and use of violence risk assessments (VRA). Their predictive ability however remains modest and, due to the repetitive use of certain risk factors, collectively, they appear to have hit an allegorical ‘glass ceiling’. Further limiting VRA is the use of self-report, collateral information, and file reviews to assess clinical and risk-related factors, rather than validated performance measures. Correspondingly, converging findings from neuropsychology and neurobiology have underlined brain regions associated with violent behaviour and subsequent research has further demonstrated this through observational studies. Thus, it is hypothesised that VRA may benefit from the integration of behaviourally measured neuropsychological risk factors. The current study is a feasibility and pilot study with a prospective, observational approach and a retrospective component. It aims to investigate the feasibility of using a neuropsychological battery to aid in the identification of violence risk in an inpatient and community setting, and to pilot a neuropsychological battery of measures examining risk factors for violence identified through a meta-analysis and an international Delphi study. The primary outcomes of interest are violent incidents or offences recorded during the 6-month follow-up periods

Technical behaviours of child sexual exploitation material offenders

An exploration of the technological behaviours of previously convicted child sexual exploitation material (CSEM) offenders provides a foundation for future applied research into deterrence, investigation, and treatment efforts. This study evaluates the technology choices and transitions of individuals previously convicted of CSEM offenses. Based on their inclusion in two sex offender registries, anonymous survey results (n=78) were collected from English-speaking adults within the United States. CSEM offenders chose technologies based on both utility and perceived risk; peer-to-peer and web-browsers were the most common gateway technologies and showed substantial sustained usage; a substantial minority of users never stored CSEM and only viewed it; most respondents used more than one technology to view CSEM; CSEM offenders used more countermeasures than the public but did not use encryption at higher rates; almost all CSEM consumers started viewing adult SEM first; and countermeasures were used primarily to reduce psychological strain (anxiety)