The assessment of risk of general recidivism in offenders with an intellectual disability

Despite growth in research regarding people with an Intellectual Disability who offend, there has yet to have been a tool that accurately predicts reoffending amongst this population across the broad range of offence types over the short term. This thesis addressed this gap by examining the reliability, ecological validity and predictive validity of the Assessment of Risk and Manageability of Individuals with Developmental and Intellectual Limitations who Offend – Generally (ARMIDILO-G). The ARMIDILO-G, along with the Historical Clinical Risk – 20 (HCR-20), Level of Service Inventory – Revised (LSI-R), Current Risk of Violence (CuRV), Group Risk Assessment Model (GRAM) and Psychopathy Checklist Revised (PCL-R) were administered to 139 people with an Intellectual Disability who have a history of offending and were being supported by a NSW community based forensic disability service. Whilst found reliable, the factor structure of the ARMIDILO-G raised question as to the separation of risk and protective items. Predictive validity of instruments was measured prospectively at three and six months based on official criminal charges, convictions and custodial episodes. Little difference was found in the predictive validity of tools when used in an actuarial manner. The GRAM performed best out of all actuarial measures and reliably predicted reoffending across general, theft and violent offences. The ARMIDILO-G using a structured professional judgment (SPJ) approach demonstrated good predictive validity for general, violent, public order and theft offences. Methodological limitations made it unclear whether the ARMIDILO-G’s performance was owing to the qualities of the tool or assessor. No conclusion could be made as to whether SPJ or actuarial approaches, or static or dynamic variables, are more effective in predicting short term risk of reoffending for those with an Intellectual Disability

Transgender Healthcare Teaching in the Undergraduate Medical School Curriculum

With increasing recognition of the diverse and specific needs of transgender individuals in a health care setting, lack of knowledge, poor attitudes and prejudice towards transgender patients can result in this population being afraid to access medical care. Educating medical students early in their career in a sensitive and inclusive manner could help change these attitudes. It has been shown that medical undergraduates and post-graduates often feel unprepared or uncomfortable in caring for transgender patients due to lack of training and experience2-4. The aim of this study was to address this through introduction of basic transgender healthcare education into the University of Glasgow undergraduate medical curriculum, with the goal of implementing further interactive and fully inclusive teaching

Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection: mortality, retention in care, and viral suppression

OBJECTIVE: Adolescence is the only age group globally where HIV associated mortality is rising, with poorer outcomes at all stages of the care cascade compared to adults. We examined post-transition outcomes for young adults living with perinatal HIV (YAPaHIV). DESIGN: Retrospective cohort analysis. SETTING: A tertiary Youth Friendly Service (YFS) London, UK. PARTICIPANTS: 180 YAPaHIV registered between 01.01.06 and 31.12.17 contributed 921 person-years of follow up post-transition to adult services. INTERVENTION: YFS with multidisciplinary care and walk-in access. MAIN OUTCOME MEASURES: mortality, morbidity, retention in care, antiretroviral (ART) uptake and HIV-viral load (HIV-VL) suppression. Crude incidence rates (CIR) are reported per 1000 person-years. RESULTS: Of 180 youth registered; 4 (2.2%) died, 14 (7.8%) transferred care and 4 (2.2%) were lost to follow up. For the 158 retained in care the median age was 22.9 years (IQR 20.3-25.4), 56% were female, 85% Black African, with a median length of follow up in adult care of 5.5 years (IQR 2.9-7.3). 157 (99.4%) ever received an ART prescription, 127/157 (81%) with a latest HIV-VL < 200 copies RNA/ml, median CD4 count of 626 cells/ul (IQR 441-820). The all-cause mortality was 4.3/1000 person-years (95% CI 1.2 - 11.1), ten fold the aged-matched UK HIV-negative population (0.43/1000 person-years (95% CI 0.41 - 0.44). Post-transition, 17/180 (9.4%) developed a new AIDS diagnosis; CIR 18.5/1000 person-years (95% CI 10.8 - 29.6). CONCLUSION: Whilst this youth-friendly multi-disciplinary service achieved high engagement and coverage of suppressive ART, mortality remains markedly increased compared to the general UK population

Prevention of acute malnutrition: distribution of special nutritious foods and cash, and addressing underlying causes--what to recommend when, where, for whom, and how

Acute malnutrition is associated with increased morbidity and mortality risk. When episodes are prolonged or frequent, acute malnutrition is also associated with poor growth and development, which contributes to stunting Nutrition-specific and nutrition-sensitive strategies to prevent undernutrition during the first 1,000 days from conception to 24 months of age can reduce the risks of wasting, stunting, and micronutrient deficiencies. Under circumstances that exacerbate the underlying causes of undernutrition and increase the incidence of wasting, such as food insecurity related to lean seasons or emergencies, or increased incidence of illness, such as diarrhea or measles, additional efforts are required to prevent and treat wasting. Special nutritious foods directly meet the increased nutrient requirements of children at risk for wasting; assistance to vulnerable households, in the form of cash or food, enables households to better meet the food, health, and other needs of household members and may increase resilience; water, sanitation, and hygiene (WASH) and health interventions help prevent and address illness and hence reduce wasting risk. The contributions of specific interventions to reducing the incidence of wasting are difficult to assess under emergency conditions, due to ethical constraints and to the fact that multiple strategies are implemented at the same time. However, pragmatic studies under real-life circumstances, using different designs, e.g., including a group receiving "best possible" treatment, can provide evidence about what works, to what extent, at what cost, and under which circumstances. Programs should address the most important causes in given contexts, be feasible to implement at scale, and assess implementation, coverage, and outcomes

Inequalities in diet and physical activity in Europe

The contribution of food, nutrition and physical activity to inequalities in health across Europe is largely unexplored. This paper summarizes cross sectional survey data on food patterns and nutrient intakes, and briefer data on physical activity, by various indicators of socio-economic status for countries across Europe. Factors are examined which underlie the outcome data seen. These include structural and material conditions and circumstances which contribute to excluding sociodemographic groups from participating in mainstream patterns of living. Trends in social and economic conditions, and their implications for nutritional and physical wellbeing are briefly outlined

Quantitative assessment of pain-related thermal dysfunction through clinical digital infrared thermal imaging

BACKGROUND: The skin temperature distribution of a healthy human body exhibits a contralateral symmetry. Some nociceptive and most neuropathic pain pathologies are associated with an alteration of the thermal distribution of the human body. Since the dissipation of heat through the skin occurs for the most part in the form of infrared radiation, infrared thermography is the method of choice to study the physiology of thermoregulation and the thermal dysfunction associated with pain. Assessing thermograms is a complex and subjective task that can be greatly facilitated by computerised techniques. METHODS: This paper presents techniques for automated computerised assessment of thermal images of pain, in order to facilitate the physician's decision making. First, the thermal images are pre-processed to reduce the noise introduced during the initial acquisition and to extract the irrelevant background. Then, potential regions of interest are identified using fixed dermatomal subdivisions of the body, isothermal analysis and segmentation techniques. Finally, we assess the degree of asymmetry between contralateral regions of interest using statistical computations and distance measures between comparable regions. RESULTS: The wavelet domain-based Poisson noise removal techniques compared favourably against Wiener and other wavelet-based denoising methods, when qualitative criteria were used. It was shown to improve slightly the subsequent analysis. The automated background removal technique based on thresholding and morphological operations was successful for both noisy and denoised images with a correct removal rate of 85% of the images in the database. The automation of the regions of interest (ROIs) delimitation process was achieved successfully for images with a good contralateral symmetry. Isothermal division complemented well the fixed ROIs division based on dermatomes, giving a more accurate map of potentially abnormal regions. The measure of distance between histograms of comparable ROIs allowed us to increase the sensitivity and specificity rate for the classification of 24 images of pain patients when compared to common statistical comparisons. CONCLUSIONS: We developed a complete set of automated techniques for the computerised assessment of thermal images to assess pain-related thermal dysfunction

Cultural Adaption, Translation, Preliminary Reliability and Validity of Key Psychological and Behavioural Measures for 18 to 25 Year-Olds Living with HIV in Uganda: A Multi-Stage Approach.

HIV remains a significant public health issue among young adults living in Uganda. There is a need for reliable and valid measures of key psychological and behavioural constructs that are related to important outcomes for this population. We translated, adapted and tested the psychometric properties of questionnaires measuring HIV stigma, HIV disclosure cognitions and affect, antiretroviral therapy (ART) adherence, social support, personal values, and hope, using a multi-step process. This included: translation, back-translation, expert review, cognitive interviewing, readability and assessments of internal consistency with 93 young adults (18-25 years) living with perinatally acquired HIV in Uganda. Preliminary criterion validity was assessed by examining relationships between the adapted measures and wellbeing, HIV disclosure behaviour, HIV disclosure intention and viral load suppression. The measures all showed acceptable reliability and every questionnaire apart from the Agentic and Communal Value Scale was easy to read. Those scales measuring HIV disclosure affect and cognitions, social support, HIV stigma and hope showed relationships with other constructs suggestive of validity. There is preliminary evidence to support the use of these measures in research and clinical contexts for young adults living with perinatally acquired HIV in Uganda