Normative Class Research Articles

The Severe 5%: A Latent Class Analysis of the Externalizing Behavior Spectrum in the United States

Objective Criminological research consistently demonstrates that approximately 5% of study populations are comprised of pathological offenders who account for a preponderance of antisocial behavior and violent crime. Unfortunately, there have been no nationally representative epidemiological studies characterizing the severe 5% group. Materials and Methods Data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 43,093 non-institutionalized U.S. residents aged 18 years and older were analyzed using latent class analysis to assess sociodemographic, psychiatric, and behavioral characteristics. Results Four-classes of respondents were identified vis-à-vis lifetime externalizing behaviors. A normative class (66.1% of respondents) demonstrated little involvement in antisocial conduct. A low substance use/high antisocial behavior class (20.7% of respondents) and high substance use/moderate antisocial behavior (8.0% of respondents) class evinced diverse externalizing and psychiatric symptoms. Finally, a severe class (5.3% of respondents) was characterized by pathological involvement in more varied and intensive forms of antisocial and externalizing behaviors and extensive psychiatric disturbance. Conclusions The current study is the first nationally representative epidemiological study of criminal careers/externalizing behavior spectrum in the United States and validates the existence of the 5% pathological group demonstrated by prior research.

Neuropsychiatric Symptom Patterns in Hospice-Eligible Nursing Home Residents with Advanced Dementia

The purpose of this study was to determine whether specific neuropsychiatric symptom patterns could be identified in a cohort of hospice-eligible nursing home residents with advanced dementia. Surrogate decision makers gave informed consent to enroll 123 residents from 3 nursing homes. All participating residents met criteria for hospice eligibility and were determined by direct examination at the time of study enrollment to have advanced dementia. Retrospective medical record review was used to collect data on residents' demographics, diagnoses, and the presence of any neuropsychiatric symptoms during the 6 months prior to study enrollment. Latent class analysis (LCA) was used to classify residents based on neuropsychiatric symptom patterns. Overall, 85% of residents exhibited one or more neuropsychiatric symptoms. LCA revealed that these individuals could be classified into 3 groups: one with low symptom frequencies (36%) considered to be the normative class, one characterized by psychosis and agitation or aggression (23%), and a third characterized by withdrawal or lethargy (41%). These results add to the growing understanding of neuropsychiatric symptom patterns in advanced dementia and have implications for more dimensional classification and treatment approaches.

Family intervention effects on co-occurring early childhood behavioral and emotional problems: a latent transition analysis approach.

This study used latent transition analysis (LTA) to examine changes in early emotional and behavioral problems in children age 2 to 4 years resulting from participation in a family-centered intervention. A sample of 731 economically disadvantaged families was recruited from among participants in a national food supplement and nutrition program. Families with toddlers between age 2 and 3 were randomized either to the Family Check-Up (FCU) or to a nonintervention control group. The FCU's linked interventions were tailored to each family's needs. Assessments occurred at age 2, 3, and 4. The FCU followed age 2 and age 3 assessments. Latent class analyses were conducted on mother reports of behavior and emotional problems from age 2 to 4 to study transitions among the following four groups: (a) externalizing only, (b) internalizing only, (c) comorbid internalizing and externalizing, and (d) normative. LTA results revealed that participation in the FCU increased the likelihood of transitioning from either the comorbid or the internalizing class into the normative class by age 4. These results suggest family interventions in early childhood can potentially disrupt the early emergence of both emotional and behavioral problems.

Does feedback matter? Practice-based learning for medical students after a multi-institutional clinical performance examination

Achieving competence in 'practice-based learning' implies that doctors can accurately self- assess their clinical skills to identify behaviours that need improvement. This study examines the impact of receiving feedback via performance benchmarks on medical students' self-assessment after a clinical performance examination (CPX). The authors developed a practice-based learning exercise at 3 institutions following a required 8-station CPX for medical students at the end of Year 3. Standardised patients (SPs) scored students after each station using checklists developed by experts. Students assessed their own performance immediately after the CPX (Phase 1). One month later, students watched their videotaped performance and reassessed (Phase 2). Some students received performance benchmarks (their scores, plus normative class data) before the video review. Pearson's correlations between self-ratings and SP ratings were calculated for overall performance and specific skill areas (history taking, physical examination, doctor-patient communication) for Phase 1 and Phase 2. The 2 correlations were then compared for each student group (i.e. those who received and those who did not receive feedback). A total of 280 students completed both study phases. Mean CPX scores ranged from 51% to 71% of items correct overall and for each skill area. Phase 1 self-assessment correlated weakly with SP ratings of student performance (r = 0.01-0.16). Without feedback, Phase 2 correlations remained weak (r = 0.13-0.18; n = 109). With feedback, Phase 2 correlations improved significantly (r = 0.26-0.47; n = 171). Low-performing students showed the greatest improvement after receiving feedback. The accuracy of student self-assessment was poor after a CPX, but improved significantly with performance feedback (scores and benchmarks). Videotape review alone (without feedback) did not improve self-assessment accuracy. Practice-based learning exercises that incorporate feedback to medical students hold promise to improve self-assessment skills.

A latent class analysis of positive psychosis symptoms based on the British Psychiatric Morbidity Survey

This study aimed to describe the distribution of positive psychosis symptoms in a large scale, population-based sample. Data from the British Psychiatric Morbidity Survey was used to examine homogeneous sub-types of participants based on their responses to the five probe items of the Psychosis Screening Questionnaire. Latent class analysis was used to identify the underlying class structure of psychosis. Four classes of psychosis were identified. Associations between the latent classes and the demographic risk factors, clinical variables and reports of traumatic experiences showed significantly higher risks for the psychosis class, the paranoid class, and the intermediate class compared to the normative class. Four classes that appeared to represent an underlying continuum could best explain psychosis symptom expression at the population level.

The distribution of positive psychosis-like symptoms in the population: A latent class analysis of the National Comorbidity Survey

Objective Previous research has suggested that psychosis is better described as a continuum rather than a dichotomous entity. This study aimed to describe the distribution of positive psychosis-like symptoms in the general population by means of latent class analysis. Method Latent class analysis was used to identify homogeneous sub-types of psychosis-like experiences. Multinomial logistic regression models were used to interpret the nature of the latent classes, or groups, by estimating the associations with demographic factors, clinical variables, and experiences of traumatic events. Results The best fitting latent class model was a four-class solution: a psychosis class, a hallucinatory class, an intermediate class, and a normative class. The associations between the latent classes and the demographic risk factors, clinical variables, and experiences of traumatic events showed significantly higher risks for the psychosis class, the hallucinatory class, and the intermediate class compared to the normative class. Furthermore there appeared to be a grading in the magnitude of the odds ratios: the odds ratios for the psychosis group were generally higher than those for the hallucinatory class, and the odds ratios for the hallucinatory class were generally higher than those for the intermediate class. Conclusions The latent class analysis showed that psychosis-like symptoms at the population level could be best explained by four groups that appeared to represent an underlying continuum.

Subversive Laughter: The Sayings of Courtesans in Book 13 of Athenaeus' Deipnosophistae

Although the witticisms of courtesans recorded by Athenaeus in Book 13 of the Deipnosophistae (577d-85f) comprise an important source, if not of the actual words of hetaeras, at least of the genres and verbal conventions identified with them, they have received scant attention from classical scholars. The content and context of these remarks reveal a complex verbal dynamic in which obscene punning challenges normative class and gender categories and represents the hetaera as in discursive control. By ventriloquizing these witticisms, Athenaeus' interlocutors appropriate yet another aspect of Athenian literary heritage to articulate their own self-presentation as they vie for discursive status.

Policing boundaries: race, class, and gender in Cartagena, Colombia

Analysis of everyday discourse among the poor of Cartagena, Colombia, reveals the mutual construction of race, class, and gender identities. Discourse on class and gender encodes racially discriminatory concepts, identifying blackness with acts that contradict normative class and gender identities. This article shows how the interlocking meanings of race, class, and gender enforce the status quo of men's, nonblacks', and elders' authority within the popular class. [race, class, gender, symbolic analysis of difference and inequality, Afro‐Spanish America]