Antisocial behaviour over the life course among females and males treated for substance misuse

Aims: (1) To compare the prevalence of adverse outcomes in adulthood between a clinic cohort and a matched sample from the general population; (2) To examine the associations between adolescent antisocial behaviour and adverse outcomes in adulthood; (3) To identify subgroups of male and female offenders with distinct features of offending, and to examine the long-term continuity of offending in the subgroups, and; (4) To identify long-term offending trajectories and examine the relationship between these offending trajectories and concurrent problems in other areas. Method: Participants were part of a longitudinal study of adolescents who were treated at a substance misuse clinic during two periods: 1968-1971 (Cohort 1; 1992 participants), and 1980-1984 (Cohort 2; 1576 participants). The same number of individuals were randomly selected from the general population and matched to the clinic cohorts. Baseline data was extracted from archival data, and participants were followed to 2002 through multiple national registers. Results: Individuals from cohort 1 were at increased risk of several adverse outcomes in adult life when compared to the matched sample. Additionally, adolescent antisocial behaviour increased the risk of adversity in multiple domains up to age 50 in cohort 1. Several subgroups of offenders could be identified in adolescence and again in adulthood in cohort 1, and considerable continuity in offending was shown among several subgroups. Individuals with high levels of violent and non-violent offending in adulthood also demonstrated high levels of substance-related crimes. Multiple longterm offending trajectories were identified in cohort 2 and in the matched sample. Cohort 2 showed less desistance in offending than the matched sample, and trajectories with the highest offending rates displayed the highest rates of concurrent problems. Both sex differences and similarities were demonstrated in all studies; larger differences in outcomes were found between women in cohort 1 and women in the matched sample, than between their male counterparts. In cohort 1, males demonstrated higher offending levels and more offending diversity, and specific subgroups and trajectories were identified among the males that were not replicated among the females. Conversely, adolescent antisocial behaviour was associated with adult adversity equally in females and males in cohort 1, and no sex differences were found in the continuity of offending, or in the relationship between substance-related crimes and other crimes in the same cohort. Both genders also demonstrated similarities in the associations between concurrent problems and offending trajectories in cohort 2. Conclusions: An increased risk of both homotypic and heterotypic continuity of problems through 30 years of adult life was demonstrated among individuals treated for substance misuse as adolescents. This highlights the importance of assessing and treating the multiplicity of problems to prevent continuation of current problems, and the emergence of new ones. Treatment should also acknowledge heterogeneity and aim to target specific needs, instead of accommodating a wide range of problems with the same intervention strategy. The findings further suggest that intervention is equally needed among girls who present antisocial behaviour in adolescence, as this is predictive of adult adversity. Altogether, the findings point to the importance of early and effective interventions to prevent further antisocial behaviour, and the problems associated with it

Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS)

Background Assessment of suicide risk in individuals who have self-harmed is common in emergency departments, but is often based on tools developed for other purposes. Objective We developed and validated a predictive model for suicide following self-harm. Methods We used data from Swedish population-based registers. A cohort of 53 172 individuals aged 10+ years, with healthcare episodes of self-harm, was split into development (37 523 individuals, of whom 391 died from suicide within 12 months) and validation (15 649 individuals, 178 suicides within 12 months) samples. We fitted a multivariable accelerated failure time model for the association between risk factors and time to suicide. The final model contains 11 factors: age, sex, and variables related to substance misuse, mental health and treatment, and history of self-harm. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis guidelines were followed for the design and reporting of this work. Findings An 11-item risk model to predict suicide was developed using sociodemographic and clinical risk factors, and showed good discrimination (c-index 0.77, 95% CI 0.75 to 0.78) and calibration in external validation. For risk of suicide within 12 months, using a 1% cut-off, sensitivity was 82% (75% to 87%) and specificity was 54% (53% to 55%). A web-based risk calculator is available (Oxford Suicide Assessment Tool for Self-harm or OxSATS). Conclusions OxSATS accurately predicts 12-month risk of suicide. Further validations and linkage to effective interventions are required to examine clinical utility. Clinical implications Using a clinical prediction score may assist clinical decision-making and resource allocation

Comparative effect of metformin versus sulfonylureas with dementia and Parkinson's disease risk in US patients over 50 with type 2 diabetes mellitus

This work was supported by Janssen Pharmaceuticals. LJL is supported by the National Institute on Aging Intramural Research Program, USA. Additional funds were provided by Rosetrees Trust (M937) and John Black Charitable Fund (ID A2926). AJN-H has received funding from Janssen Pharmaceuticals, GlaxoSmithKline and Ono Pharma. QSL is an employee of Janssen Research & Development, Johnson & Johnson, and may hold equity in Johnson & Johnson.Introduction Type 2 diabetes is a risk factor for dementia and Parkinson's disease (PD). Drug treatments for diabetes, such as metformin, could be used as novel treatments for these neurological conditions. Using electronic health records from the USA (OPTUM EHR) we aimed to assess the association of metformin with all-cause dementia, dementia subtypes and PD compared with sulfonylureas. Research design and methods A new user comparator study design was conducted in patients ≥50 years old with diabetes who were new users of metformin or sulfonylureas between 2006 and 2018. Primary outcomes were all-cause dementia and PD. Secondary outcomes were Alzheimer's disease (AD), vascular dementia (VD) and mild cognitive impairment (MCI). Cox proportional hazards models with inverse probability of treatment weighting (IPTW) were used to estimate the HRs. Subanalyses included stratification by age, race, renal function, and glycemic control. Results We identified 96 140 and 16 451 new users of metformin and sulfonylureas, respectively. Mean age was 66.4±8.2 years (48% male, 83% Caucasian). Over the 5-year follow-up, 3207 patients developed all-cause dementia (2256 (2.3%) metformin, 951 (5.8%) sulfonylurea users) and 760 patients developed PD (625 (0.7%) metformin, 135 (0.8%) sulfonylurea users). After IPTW, HRs for all-cause dementia and PD were 0.80 (95% CI 0.73 to 0.88) and 1.00 (95% CI 0.79 to 1.28). HRs for AD, VD and MCI were 0.81 (0.70-0.94), 0.79 (0.63-1.00) and 0.91 (0.79-1.04). Stronger associations were observed in patients who were younger (<75 years old), Caucasian, and with moderate renal function. Conclusions Metformin users compared with sulfonylurea users were associated with a lower risk of all-cause dementia, AD and VD but not with PD or MCI. Age and renal function modified risk reduction. Our findings support the hypothesis that metformin provides more neuroprotection for dementia than sulfonylureas but not for PD, but further work is required to assess causality.Peer reviewe

Illicit Drug Use Among Gym-Goers: a Cross-sectional Study of Gym-Goers in Sweden

Abstract Background The use of anabolic-androgenic steroids has increased among gym-goers, and it has been proposed that this may be part of a polysubstance use pattern that includes the use of illicit drugs. Still, epidemiological data on illicit drug use among gym-goers of both genders are meager. The aim of the present study was thus to examine the use of illicit drugs and its correlates in a large sample of men and women who engaged in weight training at gyms across Sweden. Methods In this cross-sectional study, a total of 1969 gym-goers who engaged in weight training in 54 gyms across Sweden were invited to fill in a questionnaire. The questionnaire included 25 items on background variables, weight training frequency, use of illicit drugs and doping substances, and non-medical use of benzodiazepines. Results Of the gym-goers, 19.6% reported having ever used illicit drugs, 6.5% reported use during the past 12 months, and 2.1% during the past 30 days. The most commonly used drug was cannabis, followed by cocaine, amphetamine, and ecstasy. Almost 40% of those who reported drug use had used more than one drug. Male participants and participants between 20 and 39 years of age made up the majority of users. Furthermore, 5.1% of the reported drug users had ever used a doping substance. There was an almost threefold higher odds (OR = 2.99, 95% CI = 1.16–7.66, p < 0.023) of doping use among people who had reported drug use as compared to non-users. Conclusions Training at gyms is typically considered a health-promoting behavior. However, our results revealed a slightly higher prevalence of illicit drug use among gym attendees as compared to the general population. Our findings may have captured an underrecognized group of young adult males who engage in weightlifting and use illicit drugs recreationally and/or as training aids. Developing knowledge is imperative in orientating preventive efforts among at-risk gym-goers. Trial Registration ISRCTN1165504

Treatment of exceptions (outliers) in the use of data analytics in audit

[ES] Nos encontramos en un momento marcado por la digitalización y las nuevas tecnologías. Este contexto está incidiendo profundamente en la profesión de auditoría, a fin de obtener una mayor calidad y eficiencia a la hora de desempeñar los encargos de auditoría. En este sentido, la analítica de datos de auditoría (ADA), a través de las diferentes herramientas, permite analizar grandes cantidades de datos, permitiendo, entre otros aspectos, obtener una mayor evidencia de auditoría. Sin embargo, la posibilidad de analizar mayores volúmenes de datos, gracias a esta tecnología creciente, ha llevado a un problema común en los auditores: cómo abordar el gran volumen de valores atípicos que se obtiene tras el uso de la ADA. Así pues, el presente artículo muestra diferentes guías que abordan el tratamiento de estos valores atípicos, concretamente, en las pruebas sustantivas de detalle. Con todo ello, se pretende que los auditores tengan la capacidad de identificar y priorizar los mismos, con el objeto de focalizarse en aquellas partidas que, efectivamente, tengan mayor probabilidad de contener incorrecciones o errores.[EN] Nowadays digitalisation and new technologies are present on our reality. Consequently, these events have had an impact on the auditing profession, in order to obtain a higher quality when carrying out audit assignments. Hence, audit data analytics (ADA), with the use of different tools, allows the analysis of large amounts of data, allowing, among other features, to obtain greater audit evidence. However, the ability to analyze larger volumes of data, due to new technologies, has led to a common problem for auditors and audit firms: how to address the large volume of outliers in the use of Audit Data Analytics. Thus, this article shows different guides that address the treatment of these outliers, specifically, in substantive tests of detail. In conclusion, it is intended that auditors and audit firms can identify and prioritize them, in order to focus on those items that, indeed, are more likely to contain misstatements or errors.Polo-Garrido, F.; Yasmina Maalem Soler; Molero Prieto, R. (2022). Tratamiento de las excepciones (atípicos) en el uso de la analítica de datos en auditoría. Observatorio contable. (13):16-23. http://hdl.handle.net/10251/20039216231

Additional file 1: of Effectiveness and implementation of a community-based prevention programme targeting anabolic androgenic steroid use in gyms: study protocol of a quasi-experimental control group study

The Standard Protocol Items: Recommendations for Intervention Trials SPIRIT 2013 Checklist. (DOC 123 kb

Associations between prisons and recidivism: A nationwide longitudinal study.

ObjectivesTo examine differences in recidivism rates between different prisons using two designs-between-individual and within-individual-to account for confounding factors.MethodsWe examined recidivism rates among 37,891 individuals released from 44 Swedish prisons in three security levels, and who were followed from 2006 to 2013. We used longitudinal data from nationwide registers, including all convictions from district courts. First, we applied a between-individual design (Cox proportional hazards regression), comparing reconviction rates between individuals released from prisons within the same security level, while adjusting for a range of individual-level covariates. Second, we applied a within-individual design (stratified Cox proportional hazards regression), comparing rates of reconviction within the same individuals, i.e., we compared rates after release from one prison to the rates in the same individual after release from another prison, thus adjusting for all time-invariant confounders within each individual (e.g. genetics and early environment). We also adjusted for a range of time-varying individual-level covariates.ResultsResults showed differences in the hazard of recidivism between different prisons in between-individual analyses, with hazards ranging from 1.22 (1.05-1.43) to 4.99 (2.44-10.21). Results from within-individual analyses, which further adjusted for all time-invariant confounders, showed minimal differences between prisons, with hazards ranging from 0.95 (0.87-1.05) to 1.05 (0.95-1.16). Only small differences were found when violent and non-violent crimes were analyzed separately.ConclusionsThe study highlights the importance of research designs that more fully adjust for individual-level confounding factors to avoid over-interpretation of the variability in comparisons across prisons

Selective Serotonin Reuptake Inhibitors and Violent Crime: A Cohort Study

<div><p>Background</p><p>Although selective serotonin reuptake inhibitors (SSRIs) are widely prescribed, associations with violence are uncertain.</p><p>Methods and Findings</p><p>From Swedish national registers we extracted information on 856,493 individuals who were prescribed SSRIs, and subsequent violent crimes during 2006 through 2009. We used stratified Cox regression analyses to compare the rate of violent crime while individuals were prescribed these medications with the rate in the same individuals while not receiving medication. Adjustments were made for other psychotropic medications. Information on all medications was extracted from the Swedish Prescribed Drug Register, with complete national data on all dispensed medications. Information on violent crime convictions was extracted from the Swedish national crime register. Using within-individual models, there was an overall association between SSRIs and violent crime convictions (hazard ratio [HR] = 1.19, 95% CI 1.08–1.32, <i>p <</i> 0.001, absolute risk = 1.0%). With age stratification, there was a significant association between SSRIs and violent crime convictions for individuals aged 15 to 24 y (HR = 1.43, 95% CI 1.19–1.73, <i>p <</i> 0.001, absolute risk = 3.0%). However, there were no significant associations in those aged 25–34 y (HR = 1.20, 95% CI 0.95–1.52, <i>p =</i> 0.125, absolute risk = 1.6%), in those aged 35–44 y (HR = 1.06, 95% CI 0.83–1.35, <i>p =</i> 0.666, absolute risk = 1.2%), or in those aged 45 y or older (HR = 1.07, 95% CI 0.84–1.35, <i>p =</i> 0.594, absolute risk = 0.3%). Associations in those aged 15 to 24 y were also found for violent crime arrests with preliminary investigations (HR = 1.28, 95% CI 1.16–1.41, <i>p <</i> 0.001), non-violent crime convictions (HR = 1.22, 95% CI 1.10–1.34, <i>p <</i> 0.001), non-violent crime arrests (HR = 1.13, 95% CI 1.07–1.20, <i>p <</i> 0.001), non-fatal injuries from accidents (HR = 1.29, 95% CI 1.22–1.36, <i>p <</i> 0.001), and emergency inpatient or outpatient treatment for alcohol intoxication or misuse (HR = 1.98, 95% CI 1.76–2.21, <i>p <</i> 0.001). With age and sex stratification, there was a significant association between SSRIs and violent crime convictions for males aged 15 to 24 y (HR = 1.40, 95% CI 1.13–1.73, <i>p =</i> 0.002) and females aged 15 to 24 y (HR = 1.75, 95% CI 1.08–2.84, <i>p =</i> 0.023). However, there were no significant associations in those aged 25 y or older. One important limitation is that we were unable to fully account for time-varying factors.</p><p>Conclusions</p><p>The association between SSRIs and violent crime convictions and violent crime arrests varied by age group. The increased risk we found in young people needs validation in other studies.</p></div

Violent crime convictions in 2006–2009 in individuals treated with SSRI medication as compared to non-medicated individuals, and comparing treatment to non-treatment periods within the same person.

<p>^<b>ǂ</b>Including all individuals with dispensed SSRI prescriptions.</p><p>Violent crime convictions in 2006–2009 in individuals treated with SSRI medication as compared to non-medicated individuals, and comparing treatment to non-treatment periods within the same person.</p