Cannabis use and age of admission to a psychiatric unit for first episode of psychosis

Background: Research has implicated that cannabis has an aetiological role in psychosis, and thus one can hypothesize that the onset of psychosis in patients who use cannabis occurs earlier in life than those who do not use cannabis Aim: The aim of this study is to assess the possible influence of cannabis on the age of onset of patients with first episode of psychotic illness admitted to a psychiatric unit in the Maltese Islands. Methods and sample: This study is a one year prospective study that includes all ICD-10 first episode psychosis patients admitted to a psychiatric hospital in the Maltese Islands. Age of admission to hospital was used as proxy for age of onset of psychosis. Use of cannabis prior to admission was ascertained by urine testing. Results: The mean age of admission to hospital for first onset psychosis for patients whose urine was positive to cannabis was 24.63 years old, and for patients whose urine was negative to cannabis was 44.63 years old. This difference was statistically significant, using the Mann Whitney-U test p=0.001. Conclusion: The results indicate that cannabis use can precipitate an earlier onset of psychotic illness. Considering the widespread use of cannabis, and that earlier age of onset of psychosis is associated with worse prognosis, this issue is of public health concern.peer-reviewe

Investigating incidence and prevalence of preeclampsia globally and within Aotearoa/New Zealand: An integrative review

Introduction: Preeclampsia is a complex hypertensive disorder diagnosed during pregnancy, ≥ 20 weeks’ gestation. Collectively, preeclampsia and eclampsia account for one-third of severe maternal morbidities and are responsible for 10–15% of maternal mortality rates, predominantly in low to middle-income countries. While the pathogenesis of preeclampsia remains unclear, multiple studies suggest aetiology may stem from a combination of several complex, multifactorial interactions, including genetic and environmental causes. Few studies report on the global incidence or prevalence of preeclampsia, nor examine specific risk factors within individual nations, including Aotearoa/New Zealand. Moreover, due to reliance on now outdated diagnostic criteria, under-reporting of rates of preeclampsia is likely. Aim: This research aims to 1) describe the incidence and prevalence of preeclampsia both globally and nationally, and 2) identify any environmental, geographical, cultural and socio-economic factors that may be associated with preeclampsia incidence and prevalence in Aotearoa/New Zealand. All primary research studies and other relevant published literature informing the topic between January 2010 and August 2020 will be critiqued and evaluated; in particular, those meeting with cross-sectional, cohort or systematic review criteria. Method: The quantitative method of an integrative review was selected as the most suitable for an extensive critique and analysis of international and national literature available over the past decade which commented on the mapping of the global incidence and prevalence of preeclampsia, while identifying emergent themes of interest. Key word searches will be undertaken within the Wintec ‘OneSearch’ library access of major data bases, including (but not limited to) CINAHL Complete, Clinical Trials, Directory of Open Access Journals, Gale Academic One File, PLOS/ONE and Science Direct. Articles not relating specifically to preeclampsia incidence and/or prevalence will be excluded along with any duplicates, articles not available in English, and those involving animal rather than human participants. By assessing many forms of research, the existing body of knowledge can be evaluated and future areas for interest and research potential ascertained.  Results: Following analysis of six multi-database keyword searches identifying 2833 potential articles for review, the search was limited to include academic journals only and studies undertaken between January 2015 and August 2020, in order to attempt to exclude those drawing on pre-2014 diagnostic criteria for preeclampsia requiring manifestation of proteinuria. Once duplicates were excluded, abstracts were then analysed for potential inclusion. Keyword search six was abandoned due to a significant number of identified duplicates. Those making no specific reference to incidence or prevalence of preeclampsia were also excluded. In total, 64 studies from around the globe were included in the final review analysis and examined in full-text PDF format. Many studies published beyond 2015 continued to apply outdated diagnostic criteria for preeclampsia or failed to report their countries overall incidence and/or prevalence of preeclampsia. Other studies that later re-evaluated their findings in line with the revised 2014 International Society for the Study of Hypertension in Pregnancy Guidelines noted higher incidence of preeclampsia once new criteria were applied. Many studies attributed the incidence of preeclampsia to poverty, delayed and/or inaccurate diagnosis, limited health resources, or inequitable access to those that were available; however, this aspect needs further and more in-depth exploration. There were no studies originating from Aotearoa/New Zealand that met with inclusion criteria, meaning scope for future research within this context is warranted. Conclusion: Globally and within Aotearoa/New Zealand, incidence and prevalence of preeclampsia cannot be determined in exact measures, due largely to limitations in reporting, and the potential for missed diagnosis due to use of conflicting diagnostic criteria. Additionally, further examination and assessment of factors such as environmental, geographical, cultural, and social considerations which may influence and/or impact on the incidence and prevalence of preeclampsia, both globally and within an Aotearoa/New Zealand framework, should be comprehensively explored and evaluated

Posttraumatic Growth In Inmates: An Exploration Of Cumulative Adverse Life Experiences And Its Relationship To Growth

Trauma is pervasive among incarcerated populations and revictimization is common. Trauma can ripple out, affecting other areas of life—for many inmates, trauma is related to mental health issues and substance abuse, both of which can contribute to increased likelihood of recidivism. This study evaluated cumulative trauma using the Adverse Childhood Experiences survey (ACEs) and the Trauma History Questionnaire (THQ) to find the effect of cumulative trauma on posttraumatic growth, the positive psychological change that may develop following a traumatic experience. Against the hypotheses and previous research, the results showed a negative relationship between cumulative trauma and posttraumatic growth, a negative relationship between both childhood and adulthood trauma and posttraumatic growth, and no difference in amount of growth experienced within any of the five facets of posttraumatic growth during incarceration. These results, while unexpected, may be due to a number of factors, including small sample size or an extraneous variable that was not taken into account in this study

Socioeconomic status and its impact on the prevalence of severe ADHD in the Maltese Islands

Attention deficit hyperactivity disorder (ADHD) is a common disorder associated with hyperactivity, impulsivity and reduced attention. If left untreated this may possibly lead to various impairments in other areas, such as lack of educational attainment, increased risk of accident-prone behaviour, substance misuse and antisocial behaviours. Although the exact aetiology is still not fully understood, various studies have demonstrated the presence of both a genetic and an environmental component. ADHD is highly hereditable, demonstrating a strong genetic component. Furthermore, increased rates of ADHD have been linked with a low socioeconomic status. The islands of Malta have traditionally been divided for statistical purposes into 6 districts, with certain districts more often being associated with low socioeconomic demographics. The main aim of this study was to assess whether higher prevalence rates of ADHD were present in the districts, which are classically associated with a low socioeconomic status. All persons aged 0 to 18 years attending the governmental clinics, having a documented diagnosis of severe ADHD and therefore being prescribed pharmacotherapy were identified and included in this study. 9 youngsters were living in institutional care and were therefore excluded from the study. A significant difference (p<0.0001) in the point prevalence of ADHD between the 6 Malta districts was found, with higher rates of ADHD occurring in the harbour districts. Though not statistically significant, a positive correlation was demonstrated between the ADHD prevalence and a number of socioeconomic variables, these included; the rate of smoking (p=0.111), number of people classified as at-risk-of-poverty per district (p=0.397), and number of people with no schooling per district (p=0.156). The overall point prevalence for ADHD in Malta obtained was 0.85, a value which is less than the average prevalence noted worldwide. The authors believe this value is an underestimation since the data collection in this study did not include ADHD cases off pharmacological treatment and any ADHD cases assessed and treated in the private sector.peer-reviewe

Structural Validity Evidence of the Wechsler Intelligence Scale for Children- Fifth Edition with African-American Students who have been Referred for Evaluation

The Wechsler Intelligence Scale for Children- Fifth Edition (WISC-V; Wechsler, 2014) is expected to be the most widely used measure of intelligence of school aged children in the United States for at least the next ten years. Results of this assessment are used to make decisions about students\u27 educational placements. Evidence of structural validity of previous versions of the Wechsler scales with subjects who have been referred for evaluation due to a suspected disability was rarely examined. Only six studies focused on evidence of structural validity of the Wechsler Intelligence Scale for Children- Fourth Edition with referred samples, during its reign as the leading measure of intelligence for over a decade. In five of those studies, researchers employed confirmatory factor analysis, while exploratory factor analysis was employed in one study. In this study, I investigated the factor structure and measurement invariance of the WISC-V with students who had been referred for evaluation because of academic and/or behavioral difficulties. Participants were African-American students in one urban school district in the southeastern United States who were administered the WISC-V during the 2015-2017 school years. Confirmatory factor analysis was conducted using Mplus version 7.4 to determine whether the referred sample’s data fit the 10 primary subtest structural model that is published in the WISC-V Technical and Interpretive Manual (Wechsler, 2014). Results indicated that the best fitting structural model was the four-factor hierarchical model, not the five-factor hierarchical model that the publishers endorse. Measurement invariance of the WISC-V between genders was also investigated using Mplus version 7.4. Invariance between genders was confirmed with the four-factor model. The five-factor model of the female sample’s data would not converge, which suggested measurement variance between genders or one of several other problems commonly associated with small sample sizes and large numbers of parameters to estimate. Interpretation of the WISC-V should be based on the Full Scale IQ only. Recommendations for future research were offered

Being given a diagnosis of dementia: the experiences of people with dementia and people who care for someone with dementia

This study explores the issues raised for people with dementia and their carers when they receive a diagnosis of dementia. Previous research suggests that more people with dementia than other serious illnesses such as cancer will not be told their diagnosis. The implications of this for the way that people with dementia adjust psychologically to their situation are reviewed. It is suggested that the complex illness concept and the particular nature of dementia as an illness influence communication about it The research had three groups of participants. Twenty-six people caring for a relative with dementia completed a short survey. Two people with dementia and seven people caring for someone with dementia were interviewed face-to-face to gather in-depth information about their experiences of receiving and coping with a diagnosis. Grounded theory was used to analyse the interviews and a descriptive summary of the survey was produced. The survey confirmed that many people with dementia do not get told their diagnosis. The interviews described the issues raised for people with dementia, such as the feelings raised for them by having dementia and highlighted their ways of coping with dementia. The interviews with carers suggested that if sharing was an issue, the carers tried to strike a balance between remaining honest and protecting the person from the implications of the knowledge. Maintaining a sense of hope for the person seemed to be very important. A critical discussion of the methodology is presented. The implications for future research and the clinical relevance of the research are also discussed

Intelligence-Sharing Agreements & International Data Protection: Avoiding a Global Surveillance State

International threats to national security have resulted in a coordinated response among states to protect their citizens, but in a post-Snowden world, are states also protecting the data integrity of its citizens? Intelligence-sharing agreements’ opacity undermine public trust given the revelations of unchecked government surveillance that emerged in 2013. The Five Eyes agreement, perhaps the most famous and fundamental promise amongst US allies, remains shrouded in mystery despite the public demand for less intrusive and more translucent government surveillance practices. This agreement and those which mirror it evade the few domestic safeguards that serve to ensure democratic surveillance. Taking a lesson from European courts’ skepticism of Five Eyes nations’ surveillance practices, this note urges American legislators and judges to favor democratic accountability over executive deference

Religious Organizations in Missouri Continue to Escape Liability in Negligence Actions Involving Abuse of Children Under the Guise of the First Amendment

“Church allowed abuse by priest for years” was the headline of the Boston Globe on Sunday, January 6, 2002. Reporters at the Boston Globe exposed the truth about the horrendous decades of child sexual abuse at the hands of Catholic priests in the Boston area. This story launched the Catholic Church’s secrets into public view and helped unravel the pattern of abuse perpetuated by its leaders for decades. The abuse, however, was not limited to the city of Boston—or even just the United States. Claims of sexual abuse spanned the globe. Thousands of priests have been accused, and the Catholic Church has paid almost $4 billion in lawsuits stemming from sexual abuse allegations. Church officials often swept these abuse allegations under the rug and effectively allowed priests to continue abusing children for decades. This represents a deeply-rooted systemic problem—church leaders protected priests and the image of the Catholic Church at the expense of children. When allegations came to light, rather than hold abusers accountable for their actions, church leaders would simply move the abusers to another diocese where they could continue harming children