Exploring the causal nature of neighborhood influences on violent criminality, substance misuse and psychiatric morbidity

Individuals who live in socioeconomically deprived neighborhoods, particularly in urban settings, experience elevated risk of being convicted of violent criminality, to engage in substance misuse and to be diagnosed with psychiatric disorders. The causal nature of these associations is questioned in the literature because previous studies have insufficiently accounted for genetic and environmental risks shared within families. The aim of the dissertation was therefore to explore the etiological relevance of neighborhoods in these traits by combining quasi-experimental, family-based research designs with nationwide Swedish registry data. In Studies I and II, we investigated the associations between residence in deprived neighborhoods and family income during childhood on subsequent risks of being convicted of violent offences and to engage in substance misuse. We found that biological full-siblings who had been differentially exposed to deprived neighborhoods, due to residential relocations between their birthdays, or to family income, due to the parents’ career trajectories, did not differ from one another in terms of their risks for being convicted or to engage in substance misuse. In Study III, we studied the associations between neighborhood deprivation and population density on later risks of being diagnosed with schizophrenia. Biological full-siblings who had been differentially exposed to the different neighborhood conditions did not differ from one another in terms of their risks of schizophrenia. In Study IV, we used quantitative genetic models that compared biological full and half-siblings to understand the etiology of social drift in schizophrenia. We found that the heritability of living in deprived neighborhoods was 60 percent. Schizophrenia patients were more likely to live in deprived neighborhoods but this was due to common genetic influences. In conclusion, we found that familial risks simultaneously explained parental selection into high-risk neighborhoods as well as their offspring’s increased risks of adverse outcomes. Methodologically, these studies emphasize the importance of accounting for unobserved familial confounders in epidemiological studies of socioeconomic status and later behavioral and psychiatric outcomes. Substantively, the findings indicate that efficient prevention efforts to decrease the rates of the examined outcomes must consider a broader range of familial and individual risks than merely socioeconomic and demographic measures, at least in the Swedish context

A ruthenium-based catalytic system with switchable selectivity between cyclotrimerization and enyne metathesis/Diels–Alder reactions of terminal alkynes

AbstractIn this study, we report a practical catalytic system, [RuCl2(p-cymene)]2/IPr (IPr: 1,3-bis(2,6 diisopropylphenyl)imidazol-2-ylidene), that can switch between cyclotrimerization and cross enyne metathesis. The cyclotrimerization reaction of phenylacetylene catalyzed by [RuCl2(p-cymene)]2 can be switched to enyne metathesis by the introduction of a sterically hindered N-heterocyclic carbene. The 1,3-diene formed during this reaction reacts with dienophiles to form the Diels–Alder adduct. A practical one-pot synthesis method, utilizing enyne metathesis/Diels–Alder reactions, was used to construct cyclic compounds in an efficient manner

Risk of Subjection to Violence and Perpetration of Violence in Persons With Psychiatric Disorders in Sweden

Importance Key outcomes for persons with psychiatric disorders include subjection to violence and perpetration of violence. The occurrence of these outcomes and their associations with psychiatric disorders need to be clarified. Objective To estimate the associations of a wide range of psychiatric disorders with the risks of subjection to violence and perpetration of violence. Design, Setting, and Participants A total of 250 419 individuals born between January 1, 1973, and December 31, 1993, were identified to have psychiatric disorders using Swedish nationwide registers. Premorbid subjection to violence was measured since birth. The patients were matched by age and sex to individuals in the general population (n = 2504 190) and to their full biological siblings without psychiatric disorders (n = 194 788). The start date for the patients and control groups was defined as the discharge date of the first psychiatric episode. The participants were censored either when they migrated, died, experienced the outcome of interest, or reached the end of the study period on December 31, 2013. Data were analyzed from January 15 to September 14, 2019. Exposures Patients with common psychiatric disorders (eg, schizophrenia, bipolar disorder, depression, and anxiety) were differentiated using a hierarchical approach. Patients with personality disorders and substance use disorders were also included. Main Outcomes and Measures Subjection to violence was defined as an outpatient visit (excluding a primary care visit), inpatient episode, or death associated with any diagnosis of an injury that was purposefully inflicted by other persons. Perpetration of violence was defined as a violent crime conviction. Stratified Cox regression models were fitted to account for the time at risk, a range of sociodemographic factors, a history of violence, and unmeasured familial confounders (via sibling comparisons). Results Among 250 419 patients (55.4% women), the median (interquartile range) age at first diagnosis ranged from 20.0 (17.4-24.0) years for alcohol use disorder to 23.7 (19.9-28.8) years for anxiety disorder. Compared with 2504 190 matched individuals without psychiatric disorders from the general population, patients with psychiatric disorders were more likely to be subjected to violence (7.1 [95% CI, 6.9-7.2] vs 1.0 [95% CI, 0.9-1.0] per 1000 person-years) and to perpetrate violence (7.5 [95% CI, 7.4-7.6] vs 0.7 [95% CI, 0.7-0.7] per 1000 person-years). In the fully adjusted models, patients with psychiatric disorders were 3 to 4 times more likely than their siblings without psychiatric disorders to be either subjected to violence (adjusted hazard ratio [aHR], 3.4 [95% CI, 3.2-3.6]) or to perpetrate violence (aHR, 4.2 [95% CI, 3.9-4.4]). Diagnosis with any of the specific disorders was associated with higher rates of violent outcomes, with the sole exception of schizophrenia, which was not associated with the risk of subjection to violence. Conclusions and Relevance In this study, persons with psychiatric disorders were 3 to 4 times more likely than their siblings without psychiatric disorders to have been subjected to violence or to have perpetrated violence after the onset of their conditions. The risks of both outcomes varied by specific psychiatric diagnosis, history of violence, and familial risks. Clinical interventions may benefit from targeted approaches for the assessment and management of risk of violence in people with psychiatric disorders.Peer reviewe

Childhood family income, adolescent violent criminality and substance misuse : a quasi-experimental total population study

Background: Low socioeconomic status in childhood is a well-known predictor of subsequent criminal and substance misuse behaviors but the causal mechanisms are questioned. Aims: To investigate if the associations between childhood family income and subsequent adolescent criminality and substance misuse are explained by unobserved familial risk factors. Method: Swedish population-based quasi-experimental, family-based study following cohorts born 1989-1993 (ntotal=529,428; ncousins=262,816; nsiblings=217,035) from their 15th birthday up until the end of 2009. Results: Children of parents in the lowest income quintile experienced a seven-fold increased hazard rate of being convicted of violent criminality compared to peers in the highest quintile (HR=6.84, 95% CI: 6.28-7.44). This association was entirely accounted for by unobserved familial risk factors (HR=0.99; 95% CI: 0.46-2.13). Similar pattern of effects was found for substance misuse. Conclusions: There are no associations between childhood family income and subsequent violent criminality and substance misuse once unobserved familial risk factors are adjusted for.The Swedish Council for Working Life and Social ResearchThe Swedish Research CouncilThe National Institute of Child Health and Human DevelopmentAccepte

Associations between individual antipsychotics and the risk of arrests and convictions of violent and other crime : a nationwide within-individual study of 74925 persons

Background Individuals diagnosed with psychiatric disorders who are prescribed antipsycho-tics have lower rates of violence and crime but the differential effects of specific antipsychotics are not known. We investigated associations between 10 specific antipsychotic medications and subsequent risks for a range of criminal outcomes. Method We identified 74 925 individuals who were ever prescribed antipsychotics between 2006 and 2013 using nationwide Swedish registries. We tested for five specific first-generation antipsychotics (levomepromazine, perphenazine, haloperidol, flupentixol, and zuclo-penthixol) and five second-generation antipsychotics (clozapine, olanzapine, quetiapine, ris-peridone, and aripiprazole). The outcomes included violent, drug-related, and any criminal arrests and convictions. We conducted within-individual analyses using fixed-effects Poisson regression models that compared rates of outcomes between periods when each individual was either on or off medication to account for time-stable unmeasured confounders. All models were adjusted for age and concurrent mood stabilizer medications. Results The relative risks of all crime outcomes were substantially reduced [range of adjusted rate ratios (aRRs): 0.50-0.67] during periods when the patients were prescribed antipsychotics v. periods when they were not. We found that clozapine (aRRs: 0.28-0.44), olanzapine (aRRs: 0.46-0.72), and risperidone (aRRs: 0.53-0.64) were associated with lower arrest and conviction risks than other antipsychotics, including quetiapine (aRRs: 0.68-0.84) and haloperidol (aRRs: 0.67-0.77). Long-acting injectables as a combined medication class were associated with lower risks of the outcomes but only risperidone was associated with lower risks of all six outcomes (aRRs: 0.33-0.69). Conclusions There is heterogeneity in the associations between specific antipsychotics and subsequent arrests and convictions for any drug-related and violent crimes.Peer reviewe

CANER IŞIK, ALEVÎ ERENLER GELENEĞİ

In the study, Caner Işık's work titled "Alevi Erenler Tradition" was introduced. In the work, the data of both oral and written sources have been analyzed by considering the origins and mystical characteristics of dervishes, who have an important place in the tradition. The tradition of Alevi saints has been examined by classifying the saints and dervishes and explaining their functions. In addition, the concepts of poet, minstrel, saz poet, dervish minstrel, folk poet are discussed and their changes and transformations in the historical process are explained. The work is a guide in understanding Alevism in the example of Derviş Ruhan

Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes

BACKGROUND: Traumatic brain injury (TBI) is the leading cause of disability and mortality in children and young adults worldwide. It remains unclear, however, how TBI in childhood and adolescence is associated with adult mortality, psychiatric morbidity, and social outcomes. METHODS AND FINDINGS: In a Swedish birth cohort between 1973 and 1985 of 1,143,470 individuals, we identified all those who had sustained at least one TBI (n = 104,290 or 9.1%) up to age 25 y and their unaffected siblings (n = 68,268) using patient registers. We subsequently assessed these individuals for the following outcomes using multiple national registries: disability pension, specialist diagnoses of psychiatric disorders and psychiatric inpatient hospitalisation, premature mortality (before age 41 y), low educational attainment (not having achieved secondary school qualifications), and receiving means-tested welfare benefits. We used logistic and Cox regression models to quantify the association between TBI and specified adverse outcomes on the individual level. We further estimated population attributable fractions (PAF) for each outcome measure. We also compared differentially exposed siblings to account for unobserved genetic and environmental confounding. In addition to relative risk estimates, we examined absolute risks by calculating prevalence and Kaplan-Meier estimates. In complementary analyses, we tested whether the findings were moderated by injury severity, recurrence, and age at first injury (ages 0-4, 5-9, 6-10, 15-19, and 20-24 y). TBI exposure was associated with elevated risks of impaired adult functioning across all outcome measures. After a median follow-up period of 8 y from age 26 y, we found that TBI contributed to absolute risks of over 10% for specialist diagnoses of psychiatric disorders and low educational attainment, approximately 5% for disability pension, and 2% for premature mortality. The highest relative risks, adjusted for sex, birth year, and birth order, were found for psychiatric inpatient hospitalisation (adjusted relative risk [aRR] = 2.0; 95% CI: 1.9-2.0; 6,632 versus 37,095 events), disability pension (aRR = 1.8; 95% CI: 1.7-1.8; 4,691 versus 29,778 events), and premature mortality (aRR = 1.7; 95% CI: 1.6-1.9; 799 versus 4,695 events). These risks were only marginally attenuated when the comparisons were made with their unaffected siblings, which implies that the effects of TBI were consistent with a causal inference. A dose-response relationship was observed with injury severity. Injury recurrence was also associated with higher risks-in particular, for disability pension we found that recurrent TBI was associated with a 3-fold risk increase (aRR = 2.6; 95% CI: 2.4-2.8) compared to a single-episode TBI. Higher risks for all outcomes were observed for those who had sustained their first injury at an older age (ages 20-24 y) with more than 25% increase in relative risk across all outcomes compared to the youngest age group (ages 0-4 y). On the population level, TBI explained between 2%-6% of the variance in the examined outcomes. Using hospital data underestimates milder forms of TBI, but such misclassification bias suggests that the reported estimates are likely conservative. The sibling-comparison design accounts for unmeasured familial confounders shared by siblings, including half of their genes. Thus, residual genetic confounding remains a possibility but will unlikely alter our main findings, as associations were only marginally attenuated within families. CONCLUSIONS: Given our findings, which indicate potentially causal effects between TBI exposure in childhood and later impairments across a range of health and social outcomes, age-sensitive clinical guidelines should be considered and preventive strategies should be targeted at children and adolescents