Assessment and Modification of General Criminal Attitudes Among Men Who Have Sexually Offended

General criminal attitudes have been well established as a dynamic risk factor for the origin, maintenance, and continuation of criminal behavior. Guided by the risk–need–responsivity (RNR) framework, this study examined self-reported change on a measure of general criminal attitudes in a sample of incarcerated men who participated in a sexual offense treatment program. Participants were administered the original version of the Criminal Sentiments Scale (CSS) and other measures at pretreatment and posttreatment and followed up in the community an average 14 years post-release. The results demonstrated that CSS total and subscale scores predicted general and violent recidivism, showed convergence with actuarial measures of criminogenic need, and had clinically meaningful associations with responsivity considerations. Pre–post changes on the CSS were associated with decreased general and violent recidivism controlling for pretreatment score and baseline risk. Implications for forensic assessment and correctional intervention are discussed.

Clinical Outcomes of Hernia Nucleous Pulposus after Microendodiscectomy

There are several options of surgical treatment of Hernia Nucleous Pulposus (HNP) such as discectomy and micro-endodiscectomy (MED). The fundamental differences between these procedures are the size of the incision, the discectomy procedure and the volume of disc taken. However, until now, there has not been any class 1 evidences explaining the efficacy of these procedures, and there is only a few studies about its safety and factors influencing its efficacy in treating HNP, especially in Indonesia. This study is aimed to assess clinical outcomes and safety of MED in HNP patients who underwent this procedure. Patient with HNP who underwent MED were followed prospectively in a period of January 2015 until December 2016. Clinical outcomes were evaluated by using Visual Analog Score (VAS) for assessing back pain and leg, and Oswestry Disability Index (ODI). The mean of pre-treatment score was compared with the mean of post-surgical treatment score by using paired t-test. Sampel were 78 HNP patients treated surgery. The average surgery duration (± SD) was 60 ± 17.1 minutes. The pretreatment score mean on VAS and ODI were 4.88 ± 1.10 and 35.21 ± 8.24. After surgical treatment, the VAS and ODI score obtained were significantly reduced to 1.53 ± 1.14 and 5.16 ± 5.52, respectively (p<0,001). A type of complication was observed, which was 5 (6.4%) cases of dural tear; no deficit in ankle dorsiflexion nor foot paresis were found. MED has been shown to be able to treat HNP with clinical outcomes similar to conventional open discectomy but with better levels of safety and effectiveness. However, this procedure still requires high quality randomized controlled trials studying about its efficacy and cost effectiveness in HNP treatment.

Obstructive Sleep Apnea Syndrome and the Quality of Life

Background and aims. Obstructive sleep apnea syndrome (OSA) affects the quality of life (QOL) due to the effects on the patient’s physical and mental function. QOL in sleep apnea may improve under continuous airway positive pressure (CPAP) therapy. The purpose of this study was to assess the OSA patients QOL before and after 3 months of CPAP therapy using Calgary Sleep Apnea Quality of Life Index (SAQLI).Methods. We conducted a study in 79 sleep apnea subjects diagnosed using cardiorespiratory portable monitoring, under CPAP therapy, monitored in our Sleep Laboratory from January 2011 to December 2014. This is a cross-sectional study, achieved through quantitative research (SAQLI questionnaire application) about the perception of quality of life in patients with sleep apnea in the moment of diagnosis and 3 months after CPAP therapy. Results. Of the 79 subjects, 59 (74.7%) were men and 20 (26.3%) women; mean age was 54.13 years (SD±10.87), the mean apnea-hypopnea index (AHI) was 52.46±20.83 events/h. In all 4 domains of SAQLI: daily functioning with mean pretreatment score 4.13±0.58 versus mean post treatment score 5.43±0.52; social interactions with mean pretreatment score 3.68±0.55 versus post treatment mean score 5.36±0.57; emotional functioning with mean pretreatment score 3.83±0.53 versus mean post treatment mean 5.38±0.56 and symptoms with mean pretreatment score 0.81±0.12 versus mean post treatment score 1.15±0.14, quality of life was improved after 3 months of therapy, with significantly statistical correlation (p=0.00). Also, an improvement was seen in mean total score of SAQLI after therapy as compared to baseline 3.11±0.32 versus 4.24±0.39 (p<0.01). Conclusion. The quality of life in sleep apnea was better after CPAP therapy than from baseline, according Calgary Sleep Apnea Quality of Life Index. The SAQLI is a useful toll to evaluate quality of life in sleep apnea, especially to highlight the benefits of CPAP therapy, even with short time monitoring.

Do Obstructive Sleep Apnea Syndrome Patients Underestimate Their Daytime Symptoms before Continuous Positive Airway Pressure Treatment?

BACKGROUND: Daytime somnolence is an important feature of the obstructive sleep apnea (OSA) hypopnea syndrome and is usually subjectively assessed using the Epworth Sleepiness Scale (ESS).OBJECTIVE: To compare the scores of the ESS and different domains of the Quebec Sleep Questionnaire (QSQ) assessed before and after the first months of continuous positive airway pressure (CPAP) treatment, as well as retrospectively without treatment.METHODS: The ESS score and domain scores of the QSQ were obtained before and after a three-month period of CPAP treatment using a retrospective assessment of the pretreatment scores in 76 untreated OSA patients.RESULTS: Fifty-two patients completed the study. The ESS and QSQ scores significantly improved following CPAP therapy. Retrospective evaluation of the ESS score was significantly worse than pre- and post-treatment values (mean [± SD] pretreatment score 11.0±4.8; retrospective pretreatment score 13.5±5.1). Such differences were not observed in any domain of the QSQ, including the domain assessing hypersomnolence.CONCLUSION: OSA patients underestimated their sleepiness according to the most widely used instrument to assess hypersomnolence. This finding may not be observed with other methods used to assess OSA-related symptoms such as quality of life questionnaires.

Endoscopic Laryngeal Findings in Japanese Patients with Laryngopharyngeal Reflux Symptoms

Objective. To know the characteristics of endoscopic laryngeal and pharyngeal abnormalities in Japanese patients with laryngopharyngeal reflux symptoms (LPRS).Methods. A total of 146 endoscopic images of the larynx and pharynx (60 pairs for the rabeprazole group and 13 pairs for the control group) were presented to 15 otolaryngologists blinded to patient information and were scored according to several variables potentially associated with laryngopharyngeal reflux. The median value of the 15 scores for each item from each image was obtained. The mean pretreatment scores of each item and total score were assessed in both rabeprazole and control groups. In the rabeprazole group, the endoscopic findings before and after the 4-week treatment with rabeprazole were compared. Changes between corresponding duration in the control group were also evaluated.Results. The median and mean pretreatment total score was 3 and 3.02, respectively, from the 73 patients with LPRS. No significant differences were observed before and after treatment in either the rabeprazole or control groups for any item or total score. In 24 patients with a high pretreatment score (total score ≥ 4) from the rabeprazole group, significant decreases in scores for “thick endolaryngeal mucous” (0.54 to 0.17,P=0.017) and total (4.77 to 3.58,P=0.0003) were observed after the 4-week treatment.

Long-term (up to 22 years), open-label, compassionate-use study of glatiramer acetate in relapsing—remitting multiple sclerosis

To evaluate the safety and efficacy of long-term glatiramer acetate (GA) therapy, 46 patients with relapsing—remitting multiple sclerosis (RRMS) were treated for up to 22 years in an ongoing, open-label study. Kurtzke expanded disability status scale (EDSS) was measured every six months, relapses were reported at occurrence and patients self-reported adverse events (AEs). At GA initiation, disease durations ranged from 0—20 years (median 6.0 years) and at data cut-off (October 2004), GA therapy duration ranged from 1—22 years (median 12.0 years). Mean EDSS score increased 0.9 ± 1.9 from the pretreatment score (3.0 ± 1.8; P = 0.076). Only 10/28 (36%) patients with baseline EDSS <4.0 had a last observed value ≥ 4.0 and 8/34 (24%) with entry EDSS < 6.0 reached EDSS ≥ 6.0. A majority (57%) maintained improved or unchanged EDSS scores. Annualized relapse rate decreased to 0.1 ± 0.2 from 2.9 ± 1.4 prestudy ( P < 0.0001). Of the 18 remaining patients in October 2004 (average disease duration 23 years), 17% with baseline EDSS scores < 4.0 reached EDSS ≥ 4.0 and 28% with baseline scores < 6.0 reached EDSS ≥ 6.0. Adverse events were similar to those reported in short-term clinical trials. This study shows a low rate of relapses and EDSS progression in RRMS patients on GA for up to 22 years. Multiple Sclerosis 2008; 14: 494—499. http://msj.sagepub.com

Preservation of erectile function after permanent radioactive seed implantation for treatment of prostate cancer

15596 Purpose: Assess erectile function before and after prostate brachytherapy. Materials and Methods: A total 241 patients were treated with permanent I-125 prostate brachytherapy for T1 and T2 adenocarcinoma of the prostate. A retrospective chart review was undertaken to assess erectile function before and after treatment using the scoring system of, 1- complete inability to have erections, 2 - can sometimes have erections sufficient for intercourse with or without medication, and 3 - has normal erectile function. Pretreatment testosterone levels were reviewed for correlation with pretreatment erectile function. Results: The median age was 68. At presentation, the median age of patients with erectile scores of 1, 2 and 3 was 70, 67 and 67 respectively. The median time of follow-up was 48 months. Pretreatment erectile function assessment revealed scores of 1 in 28%, 2 in 27% and 3 in 45% of patients. Median pretreatment testosterone levels were 296 ng/dl in the patients with pretreatment score of 1 compared to 360 ng/dl in patients with a score of 2 and 370 ng/dl in patients with a score of 3. The normal testosterone range for this age group is 165 ng/dl to 830 ng/dl. After 12 months erectile function assessment revealed scores of 1 in 29%, 2 in 42% and 3 in 29% of patients. After 24 months erectile function assessment revealed scores of 1 in 30%, 2 in 41% and 3 in 29% of patients. After 36 months erectile function assessment revealed scores of 1 in 32%, 2 in 45% and 3 in 23% of patients. After 48 months erectile function assessment revealed scores of 1 in 39%, 2 in 36% and 3 in 25% of patients. After 48 months, the median age of patients with erectile scores of 1, 2 and 3 was 75, 69 and 66 respectively. After 60 months erectile function assessment revealed scores of 1 in 32%, 2 in 47% and 3 in 21% of patients. After 72 months erectile function assessment revealed scores of 1 in 24%, 2 in 52% and 3 in 24% of patients. 49% of patients were given sildenafil, vardenafil, or tadalafil to improve erectile function. Conclusion: The rate of potency preservation in this cohort declined in an expected manner after permanent brachytherapy for prostate cancer. No significant financial relationships to disclose.

School Performance and Theophylline

To the Editor.— My interest in the article by Rachelefsky et al (Pediatrics 1986;78:1133-1138) stems in part from the heightened media coverage it received. I must admit as a professional biostatistician that I have some difficulties with regard to its conclusions. The authors report a P value equal to .004 for the intergroup comparison of change scores for the teacher's behavioral assessment. However, the statistically significant change (P = .04), a reduction for placebo and an increase for theophylline, in the posttreatment score when compared to the pretreatment score is completely ignored.