A Quasi-Experimental Evaluation of High-Intensity Inpatient Sex Offender Treatment in the Netherlands

The current study quasi-experimentally assessed the outcome of high-intensity inpatient sex offender treatment in the Netherlands in terms of sexual and violent (including sexual) recidivism. It was hypothesized that treated sex offenders would show lower recidivism rates than untreated sex offenders of the same risk level. In line with the risk principle of the Risk, Need, Responsivity (RNR) model, we predicted that this would especially hold true for offenders of higher risk levels. The study sample consisted of 25% of all convicted Dutch sex offenders not referred to any form of treatment and discharged from prison between 1996 and 2002, and all convicted Dutch sex offenders referred to inpatient treatment who were discharged between 1996 and 2002. Static- 99R risk levels of these 266 offenders were retrospectively assessed and survival curves regarding sexual and violent (including sexual) recidivism were compared between treated and untreated offenders, controlling for level of risk. Mean follow-up was 148.0 months (SD = 29.6) and the base rate of sexual recidivism was 15.0% and 38.4% for violent (including sexual) recidivism. Cox regression survival analyses showed marginally significant lower failure rates regarding sexual recidivism for treated high-risk offenders only, and significantly lower failure rates regarding violent (including sexual recidivism) for treated sex offenders of moderate-high and high-risk levels. No treatment effects for low and low-moderate risk offenders were found. Results underscore the risk principle of the RNR model: Treatment is more effective when its dosage is attuned to risk level

Clinical Appraisals of Individual Differences in Treatment Responsivity Among Patients With Psychopathy: A Consensual Qualitative Research Study

This study addressed which factors expert clinicians consider crucial in successful completion versus dropout in the mandatory forensic psychiatric treatment of psychopathic patients in the Netherlands. Eleven clinicians were interviewed about patient characteristics, treatment (provider) characteristics, and other factors they deemed associated with failure (transfer to another facility) or completion. The interviews were coded using the guidelines of Consensual Qualitative Research (CQR). Overall, extremely high scores on Psychopathy Checklist–Revised (PCL-R) Facets 1 (Deceitful Interpersonal Style) and 2 (Defective Affective Experience) were thought to impede treatment retention, particularly by its negative impact on motivation and therapeutic relationship. Older patients, those with a prosocial network, and/or patients with comorbid borderline traits appeared to fare better. Treatment success was deemed more likely when treatment goals and expectations are stipulated in a concrete fashion, when an extended and gradual resocialization trajectory is offered, and the treatment team is expert, cohesive, and stable.</p

Using MMPI–2–RF Correlates to Elucidate the PCL–R and Its Four Facets in a Sample of Male Forensic Psychiatric Patients

This study documents the associations between the MMPI-2-RF (Ben-Porath & Tellegen, 2008 ) scale scores and the Psychopathy Checklist Revised (PCL-R; Hare, 2003 ) facet scores in a forensic psychiatric sample. Objectives were to determine how the MMPI-2-RF scales might enhance substantive understanding of the nature of the 4 PCL-R facets and to discern possible implications for the treatment of psychopathic patients. A sample of 127 male forensic psychiatric offenders admitted to a Dutch forensic psychiatric hospital completed the PCL-R and the MMPI-2. Exploratory stepwise regression analyses assessed the prediction of the PCL-R total and its facet scores from MMPI-2-RF scales at its 3 hierarchical levels. Conceptually meaningful results emerged at each level of the MMPI-2-RF hierarchy, including several consistent differences between predictor sets across the facets. Interestingly, ideas of persecution (RC6) was a specific predictor of PCL-R Facet 2, a facet noted for its association with treatment failure. Results are compared and contrasted to the extant body of empirical work to date, and some tentative clinical implications are offered

Treatment responsiveness of replicated psychopathy profiles.

Theory and accumulating data suggest systematic heterogeneity among offenders with psychopathic traits. Several empirical investigations converge on the nature of subtypes, but little is known about differences in treatment responsivity. We have used the 4-facet model of the Psychopathy Checklist-Revised (PCL-R) to provide a framework for detecting subtypes. The present study used the full range of PCL-R scores in a sample of male violent offenders (N = 190) to replicate subtypes found in a partly overlapping sample by Neumann, Vitacco, and Mokros (2016), using Latent Profile Analysis (LPA), and subsequently to examine potential differences in treatment responsivity. Four subtypes emerged. Within the prototypical psychopathic group, the distinction between intent-to-treat and completers was crucial. Prototypical psychopathic offenders were significantly more likely to drop out, but completers appeared to proceed through the different phases of treatment in much the same way as the other groups. Clearly, more research is needed to elucidate treatment interfering mechanisms and their associated patient characteristics, particularly for the prototypical psychopathic group. Developing therapeutic strategies to improve treatment compliance is a necessary step in the development of specialized treatment programs for these difficult patients

Do We Hold Males and Females to the Same Standard? A Measurement Invariance Study on the Psychopathy Checklist-Revised

ABSTRACT Psychopathy in females has been understudied. Extant data on gender comparisons using the predominant measure of assessment in clinical practice, the Psychopathy Checklist Revised (PCL-R), points to a potential lack of measurement invariance (MI). If indeed the instrument does not perform equally (well) in both genders, straightforward comparison of psychopathy scores in males and females is unwarranted. Using a sample of female and male forensic patients (N ¼ 110 and N ¼ 147 respectively), we formally tested for MI in a structural equation modeling framework. We found that the PCL-R in its current form does not attain full MI. Four items showed threshold biases and particularly Factor 2 (the Social Deviance Factor) is gender biased. Based on our findings, it seems reasonable to expect that specific scoring adjustments might go a long way in bringing about more equivalent assessment of psychopathic features in men and women. Only then can we begin to meaningfully compare the genders on the prevalence, structure, and external correlates of psychopath

Maternal race and intergenerational preterm birth recurrence

Background Preterm birth is a complex disorder with a heritable genetic component. Studies of primarily White women born preterm show that they have an increased risk of subsequently delivering preterm. This risk of intergenerational preterm birth is poorly defined among Black women. Objective Our objective was to evaluate and compare intergenerational preterm birth risk among non-Hispanic Black and non-Hispanic White mothers. Study Design This was a population-based retrospective cohort study, using the Virginia Intergenerational Linked Birth File. All non-Hispanic Black and non-Hispanic White mothers born in Virginia 1960 through 1996 who delivered their first live-born, nonanomalous, singleton infant ≥20 weeks from 2005 through 2009 were included. We assessed the overall gestational age distribution between non-Hispanic Black and White mothers born term and preterm (<37 weeks) and their infants born term and preterm (<37 weeks) using Cox regression and Kaplan-Meier survivor functions. Mothers were grouped by maternal gestational age at delivery (term, ≥37 completed weeks; late preterm birth, 34-36 weeks; and early preterm birth, <34 weeks). The primary outcomes were: (1) preterm birth among all eligible births; and (2) suspected spontaneous preterm birth among births to women with medical complications (eg, diabetes, hypertension, preeclampsia and thus higher risk for a medically indicated preterm birth). Multivariable logistic regression was used to estimate odds of preterm birth and spontaneous preterm birth by maternal race and maternal gestational age after adjusting for confounders including maternal education, maternal age, smoking, drug/alcohol use, and infant gender. Results Of 173,822 deliveries captured in the intergenerational birth cohort, 71,676 (41.2%) women met inclusion criteria for this study. Of the entire cohort, 30.0% (n = 21,467) were non-Hispanic Black and 70.0% were non-Hispanic White mothers. Compared to non-Hispanic White mothers, non-Hispanic Black mothers were more likely to have been born late preterm (6.8% vs 3.7%) or early preterm (2.8 vs 1.0%), P <.001. Non-Hispanic White mothers who were born (early or late) preterm were not at an increased risk of early or late preterm delivery compared to non-Hispanic White mothers born term. The risk of early preterm birth was most pronounced for Black mothers who were born early preterm (adjusted odds ratio, 3.26; 95% confidence interval, 1.77–6.02) compared to non-Hispanic White mothers. Conclusion We found an intergenerational effect of preterm birth among non-Hispanic Black mothers but not non-Hispanic White mothers. Black mothers born <34 weeks carry the highest risk of delivering their first child very preterm. Future studies should elucidate the underlying pathways leading to this racial disparity

Practicalities of using non-local or non-recent multilocus sequence typing data for source attribution in space and time of human campylobacteriosis

In this study, 1208 Campylobacter jejuni and C. coli isolates from humans and 400 isolates from chicken, collected in two separate periods over 12 years in The Netherlands, were typed using multilocus sequence typing (MLST). Statistical evidence was found for a shift of ST frequencies in human isolates over time. The human MLST data were also compared to published data from other countries to determine geographical variation. Because only MLST typed data from chicken, taken from the same time point and spatial location, were available in addition to the human data, MLST datasets for other Campylobacter reservoirs from selected countries were used. The selection was based on the degree of similarity of the human isolates between countries. The main aim of this study was to better understand the consequences of using non-local or non-recent MLST data for attributing domestically acquired human Campylobacter infections to specific sources of origin when applying the asymmetric island model for source attribution. In addition, a power-analysis was done to find the minimum number of source isolates needed to perform source attribution using an asymmetric island model. This study showed that using source data from other countries can have a significant biasing effect on the attribution results so it is important to carefully select data if the available local data lack in quality and/or quantity. Methods aimed at reducing this bias were proposed

Risk Factors for Campylobacteriosis of Chicken, Ruminant, and Environmental Origin: A Combined Case-Control and Source Attribution Analysis

Background: Campylobacteriosis contributes strongly to the disease burden of food-borne pathogens. Case-control studies are limited in attributing human infections to the different reservoirs because they can only trace back to the points of exposure, which may not point to the original reservoirs because of cross-contamination. Human Campylobacter infections can be attributed to specific reservoirs by estimating the extent of subtype sharing between strains from humans and reservoirs using multilocus sequence typing (MLST). Methodology/Principal Findings: We investigated risk factors for human campylobacteriosis caused by Campylobacter strains attributed to different reservoirs. Sequence types (STs) were determined for 696 C. jejuni and 41 C. coli strains from endemic human cases included in a case-control study. The asymmetric island model, a population genetics approach for modeling Campylobacter evolution and transmission, attributed these cases to four putative animal reservoirs (chicken, cattle, sheep, pig) and to the environment (water, sand, wild birds) considered as a proxy for other unidentified reservoirs. Most cases were attributed to chicken (66%) and cattle (21%), identified as the main reservoirs in The Netherlands. Consuming chicken was a risk factor for campylobacteriosis caused by chicken-associated STs, whereas consuming beef and pork were protective. Risk factors for campylobacteriosis caused by ruminant-associated STs were contact with animals, barbecuing in non-urban areas, consumption of tripe, and never/seldom chicken consumption. Consuming game and swimming in a domestic swimming pool during springtime were risk factors for campylobacteriosis caused by environment-associated STs. Infections with chicken-and ruminant-associated STs were only partially explained by food-borne transmission; direct contact and environmental pathways were also important. Conclusion/Significance: This is the first case-control study in which risk factors for campylobacteriosis are investigated in relation to the attributed reservoirs based on MLST profiles. Combining epidemiological and source attribution data improved campylobacteriosis risk factor identification and characterization, generated hypotheses, and showed that genotype-based source attribution is epidemiologically sensible

Confirmation of a metastasis-specific microRNA signature in primary colon cancer

The identification of patients with high-risk stage II colon cancer who may benefit from adjuvant therapy may allow the clinical approach to be tailored for these patients based on an understanding of tumour biology. MicroRNAs have been proposed as markers of the prognosis or treatment response in colorectal cancer. Recently, a 2-microRNA signature (l et-7i and miR-10b) was proposed to identify colorectal cancer patients at risk of developing distant metastasis. We assessed the prognostic value of this signature and additional candidate microRNAs in an independent, clinically well-defined, prospectively collected cohort of primary colon cancer patients including stage I-II colon cancer without and stage III colon cancer with adjuvant treatment. The 2-microRNA signature specifically predicted hepatic recurrence in the stage I-II group, but not the overall ability to develop distant metastasis. The addition of miR-30b to the 2-microRNA signature allowed the prediction of both distant metastasis and hepatic recurrence in patients with stage I-II colon cancer who did not receive adjuvant chemotherapy. Available gene expression data allowed us to associate m iR-30b expression with axon guidance and l et-7i expression with cell adhesion, migration, and motility