Patterns of Risk and Trajectories of Preschool Problem Behaviors: a Person-Oriented Analysis of Attachment in Context

A small proportion of children exhibit extreme and persistent conduct problems through childhood. The present study employed the multiple-domain model of Greenberg and colleagues as the framework for person-oriented analyses examining whether parents\u27 child attachment combines with parenting, family ecology, and child characteristics in particular configurations of risk that are linked to this problematic developmental pathway. Using prospective data from a community sample of adolescent mothers and their children, latent variable growth mixture modeling identified a normative trajectory with declining problem behaviors during the preschool period. Consistent with research on early-starter pathways, a distinct group of children featured a higher intercept and a positive slope, indicating an escalation in disruptive behaviors. Attachment security played a role in defining specific risk profiles associated with the probability of exhibiting this problem trajectory. Given particular patterns of risk exposure, secure attachment served a protective function. Avoidant, but not disorganized, attachment was associated with significantly higher likelihood of the disruptive problem trajectory. The results also indicated the general accumulation of risk was detrimental, but the particular configuration of risk made a difference. Overall, the findings suggest early attachment operates in conjunction with personal and contextual risk to distinguish the development of later problem behaviors

Rapid progression of atherosclerotic coronary artery disease in patients with human immunodeficiency virus infection

We describe the case of a 39-year-old human immunodeficiency virus (HIV)-infected man with angiographically documented rapid progression of coronary artery disease. Over a time course of only 2 months, he developed high-grade stenosis of the left anterior descending coronary artery. The risk of myocardial infarction is increased in patients with HIV infection receiving antiretroviral therapy. However, the absolute risk is small and the marked overall benefits of antiretroviral therapy are evident. Patients receiving HIV protease inhibitors should be screened for hyperlipidemia, hyperglycemia, and hypertension. They may be candidates for lipid-lowering therapies depending on their long-term prognosis and individual risk of cardiovascular disease. Care is need because of possible drug interactions between lipid-lowering drugs and antiretroviral therapy. Invasive treatment of acute myocardial infarction does not differ from that in patients not infected with HIV. The rate of progression of coronary artery disease and the restenosis rate, however, are often unexpectedly high in these patient

Cardiac arrest in a soccer player: a unique case of anomalous coronary origin detected by 16-row multislice computed tomography coronary angiography

Anomalous origin of the coronary arteries may be present in otherwise normal subjects without clinical significance, but can also be the cause of myocardial ischemia and sudden death in both adults and teenagers. In particular, the origin of the left main coronary artery or left anterior descending artery from the right sinus of Valsalva or right coronary artery may result in compression of the vessel during or immediately after exercise. We present a unique case of coronary anomaly with four separate coronary ostia originating from the right coronary sinus in a soccer player with sudden cardiac arrest. Multislice contrast-enhanced computed tomography has emerged as a valid noninvasive method for the diagnosis of coronary artery anomal

Understanding Difference-in-differences methods to evaluate policy effects with staggered adoption: an application to Medicaid and HIV

While a randomized control trial is considered the gold standard for estimating causal treatment effects, there are many research settings in which randomization is infeasible or unethical. In such cases, researchers rely on analytical methods for observational data to explore causal relationships. Difference-in-differences (DID) is one such method that, most commonly, estimates a difference in some mean outcome in a group before and after the implementation of an intervention or policy and compares this with a control group followed over the same time (i.e., a group that did not implement the intervention or policy). Although DID modeling approaches have been gaining popularity in public health research, the majority of these approaches and their extensions are developed and shared within the economics literature. While extensions of DID modeling approaches may be straightforward to apply to observational data in any field, the complexities and assumptions involved in newer approaches are often misunderstood. In this paper, we focus on recent extensions of the DID method and their relationships to linear models in the setting of staggered treatment adoption over multiple years. We detail the identification and estimation of the average treatment effect among the treated using potential outcomes notation, highlighting the assumptions necessary to produce valid estimates. These concepts are described within the context of Medicaid expansion and retention in care among people living with HIV (PWH) in the United States. While each DID approach is potentially valid, understanding their different assumptions and choosing an appropriate method can have important implications for policy-makers, funders, and public health as a whole

Of autoregressive continuous time model parameters estimation

This article revisits a sequential approach to the estimation of the parameter in a first-order autoregressive model (AR(1)) with continuous time. There is provided a numerical study to get a results of sequential estimations of the parameter in first-order autoregressive model with continuous time and is computed a stopping rule and the optimal time of observations. Also there is provided a comparing analysis of estimation results with using the sequential approach both the optimal time of observations