Significant Predictor Of Negative Outcomes Research Articles

Utility of Multiple Specifiers for Subtyping Oppositional Defiant Problems: Investigating Multiple Psychopathy Dimensions as Specifiers.

Past research has speculated that using grandiose-manipulative (GM) and daring-impulsive (DI) traits, rather than solely callous-unemotional (CU) traits, could better inform subtyping youths with behavioral problems. However, this approach remains largely untested. To further enhance our understanding of this matter, the current study utilized self-report (n = 2,381) and parent-report (n = 1,846) data to examine the utility of three psychopathic dimensions as specifiers for oppositional defiant problems (ODP). Findings showed that ODP was a significant predictor of negative outcomes, while the GM, CU, and DI traits emerged as significant predictors of theoretically and clinically relevant external variables (e.g., conduct problems and proactive aggression), independent of ODP (and age, gender, and socioeconomic status), forming the potential foundation for the development of specifiers for ODP. Furthermore, children presenting ODP alongside heightened levels of the three psychopathic traits demonstrated notably higher scores in important external variables compared to other groups, including but not confined to the subgroup of children with ODP and high CU trait levels. Findings provide preliminary support for employing GM and DI traits as specifiers for ODP. However, more comprehensive evaluations of these specifiers' utility would help inform ongoing discussions before definitively concluding they should be included in diagnostic manuals.

Drawing techniques as tools for the evaluation of scholastic integration and emotional components in primary and secondary school: A cross-sectional study.

In the last decades, many studies have emphasized emotion's role in psycho-educational processes during childhood, such as scholastic integration. Emotional variables in childhood can be assessed through projective graphic techniques, as they allow children to use kinetic components of the draws to communicate emotions. 1.757 couple of draws were collected, from primary school children (N = 1.270; F = 643 [50.6%]; Age = 8.6; SD = 1.31) and secondary school children (N = 487; F = 220 [45.2%]; Age = 11.72; SD = 0.70) and from eight schools in Sicily and over 60 different classrooms. The Drawn Stories Technique and the Classroom Draw were used to assess children's current emotional state and scholastic integration. Pearson's correlation showed significant relationships between the Drawn Stories Technique and both sex and age. In contrast, Classroom Drawing total score showed a significant relationship with the female sex but no significant relationship with age. Linear regression analysis, including sex and age as independent variables, showed that sex is a significant predictor of Negative Outcomes of the Drawn Stories Technique, while no effect of age was detected. These findings showed that adequate attention is needed to the learners' emotional-affective world that influences their relationships and their vision within the class group. Although the drawing techniques alone seem to be not as such sufficient to explain children's individual differences in the classroom on the whole, they could be helpful for the teacher to facilitate dialogues with children, modulate didactical materials, and detect and prevent some problems in group class functioning.

Clinical and genetic risk factors define two risk groups of extracranial malignant rhabdoid tumours (eMRT/RTK).

Extracranial rhabdoid tumours are rare, highly aggressive malignancies primarily affecting young children. The EU-RHAB registry was initiated in 2009 to prospectively collect data of rhabdoid tumour patients treated according to the EU-RHAB therapeutic framework. We evaluated 100 patients recruited within EU-RHAB (2009-2018). Tumours and matching blood samples were examined for SMARCB1 mutations by sequencing and cytogenetics. A total of 70 patients presented with extracranial, extrarenal tumours (eMRT) and 30 with renal rhabdoid tumours (RTK). Nine patients demonstrated synchronous tumours. Distant metastases at diagnosis (M+) were present in 35% (35/100), localised disease (M0) with(LN+) and without (LN-) loco-regional lymph node involvement in 65% (65/100). SMARCB1 germline mutations (GLM) were detected in 21% (17/81 evaluable) of patients. The 5-year overallsurvival (OS) and event-free survival (EFS) rates were 45.8±5.4% and 35.2±5.1%, respectively. On univariate analyses, age at diagnosis (≥12 months), M0-stage, absence of synchronous tumours, absence of a GLM, gross total resection (GTR), radiotherapy and achieving a CR were significantly associated with favourable outcomes. In an adjusted multivariate model presence of a GLM, M+ and lack of a GTR were the strongest significant negative predictors of outcome. We suggest to stratify patients with localised disease (M0), GTR+ and without proof of a GLM (5-year OS 72.2±9.9%) as 'standard risk'. Patients presenting with one of the features M+ and/or GTR- and/or GLM+ belong to a high risk group (5-year, OS 32.5±6.2%). These patients need novel therapeutic strategies such as combinations of targeted agents with conventional chemotherapy or novel experimental approaches ideally within international phase I/II trials.

Treatment of selective mutism: a 5-year follow-up study

Selective mutism (SM) has been defined as an anxiety disorder in the diagnostic and statistical manual of mental disorders (DSM-5). Cognitive behavioral therapy (CBT) is the recommended approach for SM, but prospective long-term outcome studies are lacking. Reports from the children themselves, and the use of more global quality of life measures, are also missing in the literature. We have developed a school-based CBT intervention previously found to increase speech in a pilot efficacy study and a randomized controlled treatment study. Continued progress was found in our 1-year follow-up studies, where older age and more severe SM had a significant negative effect upon outcome. In the present study, we provide 5-year outcome data for 30 of these 32 children with SM who completed the same CBT for mean 21 weeks (sd 5, range 8–24) at mean age 6 years (10 boys). Mean age at the 5-year follow-up was 11 years (range 8–14). Outcome measures were diagnostic status, the teacher- and parent-rated selective mutism questionnaires, and child rated quality of life and speaking behavior. At the 5-year follow-up, 21 children were in full remission, five were in partial remission and four fulfilled diagnostic criteria for SM. Seven children (23%) fulfilled criteria for social phobia, and separation anxiety disorder, specific phobia and/or enuresis nocturna were found in a total of five children (17%). Older age and severity at baseline and familial SM were significant negative predictors of outcome. Treatment gains were maintained on the teacher- and parent questionnaires. The children rated their overall quality of life as good. Although most of them talked outside of home, 50% still experienced it as somewhat challenging. These results point to the long-term effectiveness of CBT for SM, but also highlight the need to develop more effective interventions for the subset of children with persistent symptoms.Clinical trials registration NCT01002196

Thrombocytopenia and hepatectomy for hepatocellular cancer

In this article by Venkat et al., the authors evaluated whether thrombocytopenia in patients with well-compensated cirrhosis impacts outcome in following liver resection for hepatocellular cancer (HCC). Their key finding was that isolated thrombocytopenia is a significant predictor of perioperative morbidity and mortality even when other indicators of liver function were normal and Model for End Stage Liver Disease (MELD) score was low. The methodology of this article and the high numbers of patients evaluated lend credence to concept that isolated thrombocytopenia is a significant predictor of negative outcomes after hepatectomy in cirrhotic patients [ [1] Venkat R. Hannallah J.R. Krouse R.S. Maegawa F.B. Preoperative thrombocytopenia and outcomes of hepatectomy for hepatocellular carcinoma. J Surg Res. 2016; 201: 498 Abstract Full Text Full Text PDF Scopus (13) Google Scholar ]. This article and its findings, therefore, provide valuable insights to hepatobiliary surgeons who not infrequently encounter relatively healthy cirrhotic patients with low platelet count and resectable HCC lesions. Preoperative thrombocytopenia and outcomes of hepatectomy for hepatocellular carcinomaJournal of Surgical ResearchVol. 201Issue 2PreviewPlatelet count is known to be an indirect indicator of portal hypertension but is not a part of the model for end-stage liver disease (MELD) score or the Child–Pugh score for risk stratification in hepatobiliary surgery. Full-Text PDF

Associations between duration of untreated psychosis and domains of positive and negative symptoms.

The duration of untreated psychosis (DUP) has been established as an independent and significant predictor of negative outcomes in first-episode psychosis samples. Whereas literature has supported the association between DUP and severity of positive and negative symptoms, surprisingly little research to date has explored specifically what types of positive and negative symptoms are most associated with DUP. DUP, Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) data were collected in 247 first-episode psychosis participants (mean age: 23.9 ± 4.8) between August 2008 and June 2013. DUP was significantly but modestly associated with the severity of hallucinations (ρ = 0.222; P = 0.001), delusions (r = 0.202; P = 0.003) and formal thought disorder (ρ = 0.138; P = 0.043) but was not associated with bizarre behaviour. DUP was significantly but modestly associated with SANS avolition-apathy (ρ = 0.164; P = 0.016) and anhedonia-asociality (r = 0.321; P < 0.001) subscales but was not associated with affective flattening or blunting, alogia or attention. DUP is a complex and multifaceted phenomenon that is associated with early-course illness development. In efforts to improve early intervention services, prognoses and outcomes, it is vital to understand both the factors that contribute to lengthy untreated psychosis as well as the illness characteristics that are impacted by untreated psychosis.

The “Tip of the Spear” Revisited: Evidence from Recent Deployments of U.S. National Guard Troops to Iraq and Afghanistan

The unconventional wars in Iraq and Afghanistan alter the link between military occupational specialties and proximity to the “tip of the spear,” in other words, military actions on the leading edge of combat. We examine the psychological and behavioral consequences of deployment and combat stressors for a sample of U.S. Army National Guard (ARNG) soldiers. The analyses confirm that combat service and support personnel are more likely than those in the combat arms to experience tip-of-the-spear stressors. However, regardless of specialty, exposure to death carries through the analyses as a significant predictor of negative outcomes. An appreciation of these nuances may help mental health professionals provide assistance more effectively for their ARNG clients.

Outcomes for unruptured ophthalmic segment aneurysm surgery

Ophthalmic segment aneurysms present unique technical challenges because of their proximity to the optic nerve and the anterior clinoid process. The current study was performed to examine whether surgery for unruptured ophthalmic segment aneurysms is an effective treatment modality with acceptable complication rates. A consecutive case series (prospectively collected data) was retrospective reviewed for the period between April 1992 and August 2012. Clinical results, operative complications, angiographic outcomes and prognostic factors associated with surgery are presented. Of the 169 patients with 182 unruptured ophthalmic segment aneurysms that were surgically repaired, 11 (6.4%) experienced new permanent neurological deficits, including six instances of complete visual loss. There was one postoperative death (0.6%) related to a middle cerebral artery infarction. Transient morbidity occurred in 18 patients (10.4%), including cerebrospinal fluid rhinorhea (10 patients), oculomotor nerve palsy (four patients) and transient dysphasia (four patients). A total of 142 aneurysms (78.0%) had documented postoperative angiography. Surgical treatment resulted in 135 (95.1%) complete obliterations and seven (4.9%) neck remnants. Retreatment was performed in three patients (1.7%). Logistic regression analysis of risk factors revealed that age (p<0.02), aneurysm size (p<0.01) and the use of temporary clipping (p<0.01) were significant negative predictors of outcome. The risk associated with surgical repairs for unruptured ophthalmic segment aneurysms is no greater than aneurysms in other locations (6.4% morbidity; 0.6% mortality) and no more hazardous than outcomes achieved by alternative therapies. The robustness of aneurysm repair achieved by open microsurgery is an important consideration.

Microneurosurgical Management of Ophthalmic Segment of the Internal Carotid Artery Aneurysms: Single-Surgeon Operative Experience From Louisiana State University, Shreveport

Surgical clipping of ophthalmic segment aneurysms is more technically challenging than other anterior circulation aneurysms. To analyze whether surgical clipping is an effective treatment for ophthalmic segment aneurysms with good clinical outcomes and acceptable complication rates. From 1994 to 2009, a total of 86 aneurysms of the ophthalmic segment of the internal carotid artery were surgically clipped in 80 patients. We retrospectively reviewed the records of these patients to analyze the clinical outcome. Of the 86 aneurysms, 68 (79%) were large or giant. Cranial base modification was required in 28 operations. Drilling of the anterior clinoid process was performed in 49 operations. The mean follow-up was 27.38 months. Of the 80 patients, 76 were assessable for clinical outcome. At the last follow-up, 5 patients had a Glasgow Outcome Scale (GOS) score of 1, 4 had a GOS score of 3, 10 had a GOS score of 4, and 57 had a GOS score of 5. Thus, the clinical outcome was good (GOS scores of 5 and 4) in the majority (88%) of patients. Of the 15 patients who presented with visual problems before surgery, 77% showed improvement after surgical clipping. The overall visual morbidity rate was 2.5%. Outcome assessment indicated that infarcts (P = .000), hydrocephalus (P = .001), and poor grade (P = .000) were significant negative predictors of outcome. Surgical clipping is an effective treatment for ophthalmic segment of the internal carotid artery aneurysms with excellent or good clinical outcome. Infarcts, hydrocephalus, and poor grade were significant negative predictors of outcome. Surgical clipping may facilitate improvement in vision by decompression of the visual apparatus.

Children who return home from foster care: a 6-year prospective study of behavioral health outcomes in adolescence.

Returning children to their biological families after placement in foster care (ie, reunification) has been prioritized with legislation. Comprehensive studies of child behavioral health functioning after reunification, however, have not been conducted. This study examined outcomes for youth who were reunified after placement in foster care as compared with youth who did not reunify. Prospective cohort. Children who entered foster care in San Diego, California, and who remained in foster care for at least 5 months. Participants. A cohort of 149 ethnically diverse youth, 7 to 12 years old, who entered foster care between May 1990, and October 1991. Seventy-five percent of those interviewed at Time 1 were interviewed at Time 2 (6 years later). 1) Risk behaviors: delinquent, sexual, self-destructive, substance use, and total risk behaviors; 2) Life-course outcomes: pregnancy, tickets/arrests, suspensions, dropping out of school, and grades; 3) Current symptomatology: externalizing, internalizing, total behavior problems, and total competence. Compared with youth who were not reunified, reunified youth showed more self-destructive behavior (0.15 vs -0.11), substance use (0.16 vs -0.11), and total risk behavior problem standardized scores (0.12 vs -0.09). Reunified youth were more likely to have received a ticket or have been arrested (49.2% vs 30.2%), to have dropped out of school (20.6% vs 9.4%), and to have received lower grades (6.5 vs 7.4). Reunified youth reported more current problems in internalizing behaviors (56.6 vs 53.0), and total behavior problems (59.5 vs 55.7), and lower total competence (41.1 vs 45.0). There were no statistically significant differences between the groups on delinquency, sexual behaviors, pregnancy, suspensions, or externalizing behaviors. Reunification status was a significant predictor of negative outcomes in 8 of the 9 regression equations after controlling for Time 1 behavior problems, age, and gender. These findings suggest that youth who reunify with their biological families after placement in foster care have more negative outcomes than youth who do not reunify. The implications of these findings for policy and practice are discussed.