The epidemiology of new persistent hypnotic/sedative use after surgical procedures: a retrospective cohort study.

The use of hypnotic and sedative medication for sleep improvement is common and long-term use has been associated with an increased risk of adverse events and mortality. A proportion of patients might develop long-term use after initiating new persistent use following surgery. This retrospective cohort study aimed to determine the incidence of new persistent hypnotic/sedative use after surgical procedures and associated patient and procedural factors. Data on prescriptions for hypnotic and sedative medications used for sleep improvement were retrieved from the National Prescription Medicine Registry. Medication naivety was defined as not filling a prescription for hypnotics/sedatives from 365 days through 31 days preceding surgery, new use was defined as medication naivety followed by filling a prescription for hypnotic/sedative medication from 30 days before surgery through 14 days after surgery. New persistent hypnotic/sedative use was defined as new use followed by filling another hypnotic/sedative prescription from 15 days through 365 days after surgery. Of 55,414 patients included in the study, 43,297 were naive to hypnotic/sedative medications. Of those naive patients, 4.6% met the criteria for new peri-operative use, of whom 51.6% developed new persistent hypnotic/sedative use. Patient and procedural factors associated with increased risk of new persistent use were older age; female sex; the presence of malignant neoplasm; ischaemic heart disease; and having undergone either cardiac or thoracic surgery. The hazard of long-term mortality was higher for patients with new persistent use (1.39, 95%CI 1.22-1.59) compared with patients who remained naive. While a small ratio of surgical patients initiates the use of hypnotics/sedatives in the peri-operative period, a substantial proportion of these develop persistent use, which is associated with adverse outcomes. Over time, the proportion of patients using hypnotics/sedatives has declined, but the risk of persistent use within this group has remained stable.

Needs of an uninsured equity-deserving minority patient cohort with physical disabilities during the first wave of the COVID-19 pandemic.

Background: Patients with disabilities and those from diverse equity-deserving backgrounds have been disproportionately affected by the SARS COV-2 ("COVID-19") pandemic. Objective: To describe the significant needs and social determinants of health that affected a group of uninsured patients (from equity-deserving groups) with rehabilitation diagnoses during the early months of the COVID-19 pandemic. Design: Retrospective cohort study utilizing a telephone-based needs assessment from April to October, 2020. Setting: Free interdisciplinary rehabilitation clinic serving patients with physical disabilities from equity-deserving minority backgrounds. Participants: 51 uninsured, diverse patients with spinal cord injuries, brain injuries, amputations, strokes, and other diagnoses requiring interdisciplinary rehabilitation care. Methods: Using a non-structured approach, telephone-based needs assessments were collected monthly. Reported needs were summarized into themes and the frequencies of each theme were recorded. Results: From the total number of concerns, medical issues were reported with the highest frequency (46%), followed by equipment needs (30%) and mental health concerns (30%). Other frequently mentioned needs centered around themes of rent, employment, and supplies. Rent and employment were more frequently cited in earlier months, and equipment problems were more frequently cited in later months. A minority of patients reported they had no needs, some of whom had acquired insurance. Conclusions: Our objective was to describe the needs of a racially and ethnically diverse set of uninsured individuals with physical disabilities seen at a specialized interdisciplinary rehabilitation pro bono clinic during the early months of COVID-19. Medical issues, equipment needs, and mental health concerns were the top three needs. To optimally serve them, care providers must be aware of current and future needs for their underserved patients, especially if future lockdowns occur.

European League Against Rheumatism recommendations for the inclusion of patient representatives in scientific projects.

OBJECTIVE: To develop recommendations to enable successful inclusion of the patient perspective in European League Against Rheumatism (EULAR)-funded scientific research projects. METHODS: The EULAR standardised operational procedures for guideline development were followed. A systematic literature review was presented during a first task force meeting, including 3 rheumatologists, 1 rheumatologist/epidemiologist, 2 allied health professionals, 2 representatives of arthritis research organisations and 7 patient representatives, resulting in 38 statements. A Delphi method was carried out to reduce and refine the statements and agree on a set of eight. Next, a survey among a wider group of experts, professionals and patient representatives (n=42), was completed. Feedback from this wider group was discussed at the second meeting and integrated in the final wording of the recommendations. Subsequently, the level of agreement of the group of experts (n=81) was re-evaluated. RESULTS: The project resulted in a definition of patient research partner and agreement on a set of eight recommendations for their involvement in research projects. These recommendations provide practical guidance for organising patient participation, capturing (1) the role of patient research partners, (2) phase of involvement, (3) the recommended number, (4) recruitment, (5) selection, (6) support, (7) training and (8) acknowledgement. CONCLUSION: Collaboration between patients and professionals in research is relatively new. Trials or effectiveness studies are not yet available. Nevertheless, it is possible to define recommendations for the inclusion of patients in research following a solid expert opinion based consensus process.

The role of early aggressive behavior in the frequency, seriousness, and types of later crime.

This study reports on the relation between aggressive behavior at early school age and later delinquent activities of 1,027 subjects (517 boys and 510 girls) prospectively followed from late childhood to adulthood. The research group was a fairly unbiased age sample of children, covering most of the range of social and psychological upbringing conditions for 10-year-old children in a Swedish community. Aggressiveness was measured by teacher ratings at ages 10 and 13 years. Delinquency, defined as registered lawbreaking, was covered through age 26. There was a strong connection between both the aggressiveness ratings at ages 10 and 13 and adult delinquency for boys, with the majority of delinquents and recidivists being recruited from the early-aggressive boys. High ratings of aggressiveness were characteristic of boys who later committed violent crimes and damage to public property and generally of subjects with a diversified offense pattern. Aggressiveness was not predictive of later crime for girls until they reached the age of 13. For both sexes the relation between aggressiveness and crime was to a large extent independent of intelligence and family education. The possibility of making individual prognoses and the role of aggressiveness for the sexes are discussed.

Perceptions of and reactions to stressful situations.

Two approaches to the study of the psychological significance of situations were compared, one using data for individuals' perceptions of situations and the other using data for individuals' reactions to situations. Perception and reaction data for 40 subjects were used for multidimensional classification of 12 situations, which were selected so as to cover four different types of stressful situations. For three of the a priori groupings of situations the congruence in outcomes between the two methods was high. The implications of the congruence and the discrepancies in outcomes for the two approaches are discussed. The main conclusion is that one should distinguish clearly between situation perception factors and situation reaction factors in further research on the psychological significance of situations.

Drinking habits and alcohol abuse among young men: a prospective longitudinal study.

The relationship between self-reported frequency of drunkenness at 14-16 years of age and registered alcohol abuse at age 15-25 was studied in a large and representative group of Swedish men. The results showed that the proportion of boys who had experienced drunkenness more than 10 times increased rapidly between ages 14-16. Before the age of 25, 17% of the boys were registered in governmental records (police, social authorities or psychiatric services) because of alcohol abuse. A high frequency of self-reported drunkenness at age 14-16 was found to be significantly related to registered alcohol abuse at age 18-24. At the same time, however, it was found that 70-80% of the adolescent boys with the greatest frequency of drunkenness were not registered for alcohol abuse in early adult years. Using self-reported frequency of drunkenness at age 14-16 as a basis for predicting registered alcohol abuse at age 18-24 allowed correct classification of only 6% more boys than would have been expected by using a random procedure. The present study indicated that initial drinking habits per se are of limited importance in the development of alcohol abuse in early adulthood. However, the results showed that the combination of high self-reported frequency of drunkenness and appearance in government registers as early as age 15-17 constitutes a serious indication of continuing alcohol abuse.

Cooperative teaching project: a model for students at risk.

This article describes an innovative teaching model designed to impact students at risk with the cooperative efforts of regular and special education in Grades K-3. Evaluation outcomes are presented that show the model has a positive effect on individual student performance, total building progress as measured by curriculum based measurement, special education referrals, and attitudes of participating teachers.

Co-frequency ratings of anxiety reactions.

The method of direct co-frequency rating was explored for the study of relationships among individuals' self-reported anxiety reactions. The subjects were 40 adolescents who gave co-frequency ratings (how often the reactions co-occurred) for all pairs of 10 preselected reactions to anxiety. The mean co-frequency matrix was subjected to multidimensional scaling and cluster analysis. The same subjects also rated the intensity of the same reactions in an anxiety inventory of the "S-R" type. The correlations among reactions were computed and compared with corresponding co-frequency estimates. The relationship between these two types of data was relatively high. Factor analysis of the correlations gave a "Psychic" and a "Somatic" reaction factor, whereas the main dimension obtained from co-frequency ratings reflected a general reaction factor. This outcome was supported by the cluster analyses, which yielded two and one clusters, respectively, interpretable in accordance with the dimension analyses.

Integration of information in a clinical judgment task, an empirical comparison of six models.

Six models were compared for their effectiveness in reproducing six clinical psychologists' judgments of 38 patients on intelligence, ability to establish contact, and control of affect and impulses. In two of the models, subjective weights were used in the prediction of a judge's ratings. The judges based their judgments solely on verbal protocols from the Rorschach, a sentence completion test, and the Thematic Apperception test. The stability of the linear aspect of the judgment process was very high but decreased as the depth of interpretation of the rating variable increased. The nonlinear aspect of the judgment process had considerably low stability. In general, a model based on subjective weights was most effective in reproducing the judges' ratings.

Coping behaviors in relation to frequency and intensity of anxiety-provoking situations.

The relationships between coping strategies (constructive, passive, and escape), on the one hand, and anxiety reactions and individuals' frequency of experiences of anxiety, and situations' rate of recurrence, and general anxiety-inducing effect on the other, were explored. The investigated factors and their associations were studied both as individual characteristics and situational properties. Data for boys and girls were treated separately. The results for individuals showed that both trait-anxiety and frequency of stressful experience were related positively to escape strategies and negatively to constructive solutions. For situations, general situational effect correlated positively with escape solutions and negatively with constructivity. Rate of recurrence was correlated positively with constructive strategies and negatively with escape solutions. No significant sex differences were found.

Behavior at 10 and 13 years of age for children with low birth weight.

This study was based on data from a longitudinal research program. The cohort consisted of 874 normal children in an entire school grade in a Swedish community. The aim of the study was to investigate the relation between birth weight and behavior at school, for all children and for each sex separately. The results identified specific aspects of behaviour disorder significantly related to low birth weight (LBW) for children at the age of 10 but not at the age of 13. When the sexes were separated, there were no relations between birth weight and deviant behaviour for boys of low birth weight as compared to boys of normal birth weight, while girls of low birth weight showed specific behavioural disorders at age 10 as compared to girls of normal birth weight. For girls reared in families of low parental socioeconomic status, aggressiveness and motor restlessness at age 10 but not at age 13 was also present. Further analyses showed that girls born small-for-gestational age showed lack of school motivation and concentration difficulties both at age 10 and age 13.

Biological maturation in adolescence and the development of drinking habits and alcohol abuse among young males: A prospective longitudinal study.

In the present study, the relationship between biological maturation (skeletal growth) in adolescence and the development of drinking habits and alcohol abuse were studied for a representative group of Swedish males. The results showed that early maturers and late maturers had more advanced drinking habits at age 14 as compared to their normally maturing same-aged peers (p<.05).This difference was not significant 1 1/2 years later. In young adulthood more than one third (36%) of the late maturers were registered for alcohol abuse as compared to 14% of the normal maturers and 8% of the early maturers (p=.12).The relevance of psychosocial factors as mediating the relationship between biology and actual behavior was discussed. It was emphasized that differences in biological and psychosocial maturity should be taken into consideration when studying adolescent behavior, both in cross-sectional and in longitudinal perspectives.

PREDICTIVE EFFICIENCY AS A FUNCTION OF AMOUNT OF INFORMATION.

The effect of changing the amount of information on judges' predictive efficiency in a clinical prediction task was studied. Thirty judges predicted 30 students' average achievement scores on the basis of different amount of test data. One group of judges had information about the intercorrelations among the tests and the ecologkal validity of the tests. Another group of judges had only informahion about which tests were used. The predictive efficiency was not a monotonically increasing function of amount of test data. The most marked result was that the relative predictive efficiency decreased from four to six tests in both groups.