Conduct problems among children in low-income, urban neighborhoods: A developmental psychopathology- and RDoC-informed approach

Abstract Conduct problems are associated with numerous negative long-term psychosocial sequelae and are among the most frequent referrals for children's mental health services. Youth residing in low-income, urban communities are at increased risk for conduct problems, but not all youth in these environments develop conduct problems, suggesting heterogeneity in risk and resilience processes and developmental pathways. The present study used a developmental psychopathology- and Research Domain Criteria (RDoC)-informed approach for conceptualizing risk and resilience for conduct problems among children from low-income, urban neighborhoods. Participants were 104 children (M = 9.93 ± 1.22 years; 50% male; 96% African American, 4% Latinx). We assessed four constructs reflecting cognitive and neurobiological processes associated with conduct problems using multiple levels of analysis and informants: autonomic nervous system reactivity, limbic system/orbitofrontal cortical functioning, dorsolateral prefrontal cortical functioning, and conduct problems. Latent profile analysis identified four profiles: typically developing (TD, n = 34); teacher-reported conduct problems (TCP, n = 14); emotion processing (EP, n = 27); and emotion expression recognition (EER, n = 29). External validation analyses demonstrated that profiles differed on various indices of conduct problems in expected ways. The EP profile exhibited lower levels of emotional lability and callous–unemotional behaviors, and higher levels of prosocial behavior. The TD profile demonstrated elevated emotional lability. Implications for etiological and intervention models are presented.

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A Population-Level Approach to Promoting Healthy Child Development and School Success in Low-Income, Urban Neighborhoods: Impact on Parenting and Child Conduct Problems

Prevention Science ◽

10.1007/s11121-014-0473-3 ◽

2014 ◽

Vol 16 (2) ◽

pp. 279-290 ◽

Cited By ~ 26

Author(s):

Spring Dawson-McClure ◽

Esther Calzada ◽

Keng-Yen Huang ◽

Dimitra Kamboukos ◽

Dana Rhule ◽

...

Keyword(s):

Child Development ◽

Conduct Problems ◽

Low Income ◽

Healthy Child ◽

School Success ◽

Population Level ◽

Urban Neighborhoods ◽

Child Conduct Problems ◽

Child Conduct

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Predictors of Chronic Opioid Use: A Population-level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djab082 ◽

2021 ◽

Author(s):

Devon K Check ◽

Christopher D Bagett ◽

KyungSu Kim ◽

Andrew W Roberts ◽

Megan C Roberts ◽

...

Keyword(s):

North Carolina ◽

Substance Use ◽

Cancer Survivors ◽

Low Income ◽

Opioid Therapy ◽

Adjusted Relative Risk ◽

Opioid Use ◽

Chronic Opioid Therapy ◽

Increased Risk ◽

Chronic Opioid Use

Abstract Background No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. Methods We conducted a retrospective cohort study using North Carolina (NC) cancer registry data linked with claims from public and private insurance (2006–2016). We included adults with non-metastatic cancer who had no prior chronic opioid use (N = 38,366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (>90-day continuous supply of opioids in the 13–24 months following diagnosis) associated with patient characteristics. Results Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR], 50–59 vs 60–69 = 1.23, 95% confidence interval [CI] = 1.05–1.43), baseline depression (aRR = 1.22, 95% CI = 1.06–1.41) or substance use (aRR = 1.43, 95% CI = 1.15–1.78) and Medicaid (aRR vs Private = 1.93, 95% CI = 1.56–2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in early survivorship (aRR = 2.62, 95% CI = 2.28–3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95 CI = 14.30–19.40). Conclusions Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.

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When one size does not fit all: A latent profile analysis of low-income preschoolers’ math skills

Journal of Experimental Child Psychology ◽

10.1016/j.jecp.2021.105156 ◽

2021 ◽

Vol 209 ◽

pp. 105156

Author(s):

Nicole R. Scalise ◽

Emily N. Daubert ◽

Geetha B. Ramani

Keyword(s):

Low Income ◽

Latent Profile Analysis ◽

Profile Analysis ◽

Math Skills ◽

Latent Profile

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A nomogram prediction model for lymph node metastasis in endometrial cancer patients

BMC Cancer ◽

10.1186/s12885-021-08466-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhiling Wang ◽

Shuo Zhang ◽

Yifei Ma ◽

Wenhui Li ◽

Jiguang Tian ◽

...

Keyword(s):

Logistic Regression ◽

Endometrial Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

External Validation ◽

Clinicopathological Parameters ◽

Bootstrap Sample ◽

Multivariate Logistic Regression ◽

Node Metastasis ◽

Increased Risk

Abstract Background This study aimed to explore the risk factors for lymph node metastasis (LNM) in patients with endometrial cancer (EC) and develop a clinically useful nomogram based on clinicopathological parameters to predict it. Methods Clinical information of patients who underwent staging surgery for EC was abstracted from Qilu Hospital of Shandong University from January 1st, 2005 to June 31st, 2019. Parameters including patient-related, tumor-related, and preoperative hematologic examination-related were analyzed by univariate and multivariate logistic regression to determine the correlation with LNM. A nomogram based on the multivariate results was constructed and underwent internal and external validation to predict the probability of LNM. Results The overall data from the 1517 patients who met the inclusion criteria were analyzed. 105(6.29%) patients had LNM. According the univariate analysis and multivariate logistic regression analysis, LVSI is the most predictive factor for LNM, patients with positive LVSI had 13.156-fold increased risk for LNM (95%CI:6.834–25.324; P < 0.001). The nomogram was constructed and incorporated valuable parameters including histological type, histological grade, depth of myometrial invasion, LVSI, cervical involvement, parametrial involvement, and HGB levels from training set. The nomogram was cross-validated internally by the 1000 bootstrap sample and showed good discrimination accuracy. The c-index for internal and external validation of the nomogram are 0.916(95%CI:0.849–0.982) and 0.873(95%CI:0.776–0.970), respectively. Conclusions We developed and validated a 7-variable nomogram with a high concordance probability to predict the risk of LNM in patients with EC.

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662 PAP Therapy: A Review of Resources for the Uninsured during COVID-19

SLEEP ◽

10.1093/sleep/zsab072.660 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A259-A259

Author(s):

Melissa Malinky ◽

Abigail Oberla ◽

Meena Khan ◽

M Melanie Lyons

Keyword(s):

Low Income ◽

Web Search ◽

Low Cost ◽

Wait Time ◽

The United States ◽

Fixed Cost ◽

United States Census ◽

Lower Socioeconomic ◽

Increased Risk ◽

Available Resources

Abstract Introduction In 2019, the United States Census estimated 8% (26.1 million) people were without health insurance. Further, an estimated 3.5 million people became/remained uninsured from COVID-19-related job losses. Patients with OSA that belong to a lower socioeconomic status (SES) are less likely to have access to healthcare and may be under or uninsured. Untreated OSA can lead to increased risk of symptoms and associated co-morbidities. Resources to help the uninsured to obtain PAP therapy were available pre-COVID, including two main sources, American Sleep Apnea Association (ASAA) and our local branch serving central Ohio, The Breathing Association. However, the COVID pandemic limited access or closed these programs. Our Sleep Medicine clinics saw 148 uninsured OSA patients between March-December, 2020. Given these difficulties, we re-evaluated available resources for the uninsured. Methods We conducted a search for current low cost ($100 or less) PAP therapy options for the uninsured, March 15, 2020-December 3, 2020, by: (1) contacting pre-COVID-19 resources, including Durable Medical Equipment (DME) providers, (2) consulting social work, and (3) completing a librarian assisted web-search not limited to PubMed, Embase, CINAHL for academic related articles and electronic searches using a combination of English complete word and common keywords: OSA, PAP, uninsured, no insurance, cheap, medically uninsured, resources, self-pay, low-income, financial assistance, US. Resources such as private sellers were not investigated. Results During COVID-19, assistance for PAP machines/supplies have closed or required a protracted wait-time. Options including refurbished items range from low, one-time fixed cost or income-based discounts from: one local charity (Joint Organization for Inner-City Needs) and DME (Dasco), and four national entities (ASAA, Second Wind CPAP, Reggie White Foundation, CPAP Liquidators). An Electronic Health Record-based tool was developed and distributed to increase provider awareness of pandemic available resources. Conclusion Untreated OSA is associated with increased risk of cardiovascular co-morbidities. Access and cost may limit treatment in OSA patients from a lower SES. The COVID-19 pandemic has shuttered programs providing discount PAP and supplies, leaving fewer resources for these patients, thus further widening this health care disparity. Alternatives are needed and current resources are not easily accessible for providers and patients. Support (if any):

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756 The Moderating Influence of Depression on Insomnia and Suicidal Ideation in a Military Sample

SLEEP ◽

10.1093/sleep/zsab072.753 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A294-A295

Author(s):

Emma Palermo ◽

Jennifer Goldschmied ◽

Elaine Boland ◽

Elizabeth A Klingaman ◽

Philip Gehrman ◽

...

Keyword(s):

Depressive Symptoms ◽

Suicidal Ideation ◽

Research University ◽

Negative Binomial ◽

Suicide Attempts ◽

Risk And Resilience ◽

Depression Severity ◽

Significant Interaction Effect ◽

Increased Risk ◽

The Impact

Abstract Introduction Military personnel are at an increased risk for suicide compared to the general population, making it important to develop a deeper understanding of which factors contribute to this elevated risk. Given that suicidal ideation (SI) is one of the strongest predictors of suicide attempts, understanding factors that underlie SI may improve prevention efforts. Insomnia and depression both serve as independent risk factors for SI, and therefore the aim of this study was to examine the extent to which depressive symptoms moderate the association between insomnia and SI. Methods Data were obtained from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS). Soldiers (n=21,450) completed questions related to suicidal ideation (5 items), depressive symptoms (9 items), and insomnia (5 items) based on symptom presence in the past 30 days. Items in each domain were summed to create a total severity score. GEE models using a negative binomial linking function were conducted to examine the impact of depression, insomnia, and their interaction on SI. Results Both depression (χ2 =117.56, p<0.001) and insomnia (χ2=11.79, p=0.0006) were found to have significant main effects on SI, and there was a significant interaction effect (χ2=4.52, p=0.0335). Follow up simple effects revealed that insomnia was no longer significantly associated with SI when depression severity was low, but was associated with SI in the presence of greater depression severity (χ2=2.91, p=0.0882). Conclusion In a large sample of Army soldiers, depression significantly moderated the association between SI and insomnia, such that insomnia seems to amplify the effects of depression on SI. These findings highlight the importance of addressing insomnia severity as a mean of reducing SI in those with depression, potentially allowing for intervention prior to a suicide attempt. Support (if any) Perlis: K24AG055602 & R01AG041783. This publication is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan- http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981.

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P82 NUn score validation at a district general hospital

BJS Open ◽

10.1093/bjsopen/zrab032.081 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Jacob Rapier ◽

Steven Hornby ◽

Jacob Rapier

Keyword(s):

Positive Predictive Value ◽

Anastomotic Leak ◽

Confidence Intervals ◽

Predictive Value ◽

External Validation ◽

District General Hospital ◽

Anastomotic Leaks ◽

Upper Gi ◽

Increased Risk ◽

Operative Complications

Abstract Introduction The NUn score was created to try and predict the risk of anastomotic leak or major complications (using the Clavien- Dindo classification) from upper GI resections with an oesophageal anastomosis. A score of > 10 was used to predict an increased risk. In this study we attempt validation. Methods A database of 101 patients was studied, who underwent an Oesophagectomy for cancer between March 2017 and 2020. 72 patients had complete Post-operative day 4 bloods, needed to calculate the score. These patients were then studied for post-operative complications. Results A total of 12 patients had a NUn score of > 10 (16.67%). There was 1 death (1.37%) and 11 anastomotic leaks (15.28%). Of these the NUn score did not predict the death and predicted 8 of the 11 anastomotic leaks. From our data Conclusion From our analysis the NUNs score cannot be shown to be sensitive, specific or have useful positive predictive value. The average Nun score was not reliable, with confidence intervals crossing 10. There may be some merit in using the test for its negative predictive value, but further analysis into this is needed. The results of this audit are consistent with previous efforts at external validation.

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Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-043837 ◽

2021 ◽

Vol 11 (2) ◽

pp. e043837

Author(s):

Usha Dutta ◽

Anurag Sachan ◽

Madhumita Premkumar ◽

Tulika Gupta ◽

Swapnajeet Sahoo ◽

...

Keyword(s):

High Risk ◽

Low Income ◽

Tertiary Care ◽

Low Risk ◽

Transmission Risk ◽

Healthcare Personnel ◽

Risk Zone ◽

Increased Risk ◽

Medium Risk ◽

Risk Zones

ObjectivesHealthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty.SettingOur tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless.ParticipantsWe recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone.ResultsBetween 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment.ConclusionA multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.

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Multiple developmental pathways underlying conduct problems: A multitrajectory framework

Development and Psychopathology ◽

10.1017/s0954579420001650 ◽

2020 ◽

pp. 1-10

Author(s):

Jules R. Dugré ◽

Stéphane Potvin

Keyword(s):

Conduct Disorder ◽

Conduct Problems ◽

Latent Class ◽

Population Based ◽

Anxiety Symptoms ◽

Behavioral Approach ◽

Parameter Estimates ◽

Childhood And Adolescence ◽

Increased Risk ◽

Psychological Features

Abstract In the past decades, there has been an overemphasis of a descriptive/behavioral approach to study conduct disorder. In an equifinal perspective, we aimed to examine the developmental multitrajectory groups of psychological features (irritability, interpersonal callousness, hyperactivity/impulsivity, and depressive–anxiety symptoms) and their associations with conduct problems. In a population-based cohort (n = 1,309 participants followed from 5 months to 17 years old), latent-class growth analysis was performed for each psychological feature to identify a two-trajectory model (from ages 6 to 12 years). Based on parameter estimates of the two-trajectory models for each of the four psychological features, a parallel process growth mixture model identified eight significant developmental patterns that were subsequently compared with typically developing children. Furthermore, we observed that while interpersonal callousness conferred an increased risk for childhood and adolescence conduct problems, its co-occurrence with hyperactivity/impulsivity, irritability, and/or depressive–anxiety symptoms heightened the general risk, but also predicted distinct subtypes of conduct problems (i.e., aggressive and rule-breaking behaviors). Thus, by studying complex developmental combinations of psychological features, we observed qualitatively distinct pathways towards conduct problems. A multitrajectory framework of psychological features should be considered as a significant step towards unveiling the multiple etiological pathways leading to conduct disorder and its substantial clinical heterogeneity.

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