The mediating role of reflective functioning and general psychopathology in the relationship between childhood conduct disorder and adult aggression among offenders.

BACKGROUND: The nature of the pathway from conduct disorder (CD) in adolescence to antisocial behavior in adulthood has been debated and the role of certain mediators remains unclear. One perspective is that CD forms part of a general psychopathology dimension, playing a central role in the developmental trajectory. Impairment in reflective functioning (RF), i.e., the capacity to understand one's own and others' mental states, may relate to CD, psychopathology, and aggression. Here, we characterized the structure of psychopathology in adult male-offenders and its role, along with RF, in mediating the relationship between CD in their adolescence and current aggression. METHODS: A secondary analysis of pre-treatment data from 313 probation-supervised offenders was conducted, and measures of CD symptoms, general and specific psychopathology factors, RF, and aggression were evaluated through clinical interviews and questionnaires. RESULTS: Confirmatory factor analyses indicated that a bifactor model best fitted the sample's psychopathology structure, including a general psychopathology factor (p factor) and five specific factors: internalizing, disinhibition, detachment, antagonism, and psychoticism. The structure of RF was fitted to the data using a one-factor model. According to our mediation model, CD significantly predicted the p factor, which was positively linked to RF impairments, resulting in increased aggression. CONCLUSIONS: These findings highlight the critical role of a transdiagnostic approach provided by RF and general psychopathology in explaining the link between CD and aggression. Furthermore, they underscore the potential utility of treatments focusing on RF, such as mentalization-based treatment, in mitigating aggression in offenders with diverse psychopathologies.

An audit of tuberculosis health services in prisons and immigration removal centres.

Background: Tuberculosis (TB) is the second leading cause of death worldwide due to a single infectious agent. Rates of active TB in places of prescribed detention (PPD), which include Prisons, Young Offender Institutions and Immigration Removal Centres, are high compared with the general population. PPD therefore present an opportunity to develop targeted health programmes for TB control. This audit aims to assess current service provisions and identify barriers to achieving best practice standards in PPD across London. Methods: Twelve healthcare teams within PPD commissioned by NHS England (London Region) were included in the audit. Services were evaluated against the National Institute for Health and Care Excellence standards for TB best practice. Results: None of the health providers with a digital X-ray machine were conducting active case finding in new prisoners and no health providers routinely conduct Latent TB infection testing and preventative treatment. Barriers to implementing standards include the lack of staff skills and staff skills mix, structural and technical barriers, and demands of custodial and health services. Conclusions: This audit restates the importance of national public health TB strategies to consider healthcare provisions across PPD.

Do geodemographic typologies explain variations in uptake in colorectal cancer screening? An assessment using routine screening data in the south of England.

BACKGROUND: Uptake of colorectal cancer (CRC) screening in UK is less than 60%. Geodemographic typologies are useful in describing patterns of individual preventive health behaviour but little is known of their value in assessing uptake of CRC screening, or how this compares to traditional measures of area deprivation. METHODS: We used data on CRC screening uptake in the South Central, South-East Coast and South-West England National Health Service regions in multilevel logistic regression to describe the effects of individual composition and contextual factors (area deprivation and geodemographic segments) on non-response to screening invitation. The relative impact of geodemographic segmentation and the index of multiple deprivation (IMD) 2007 was compared. The potential population impact of a targeted increase in uptake in specific geodemographic segments was examined. RESULTS: About 88 891 eligible adults were invited to be screened from 2006 to 2008. Uptake rate was 57.3% (CI: 57.0-57.7) and was lower amongst younger persons, men, residents of more deprived areas and people in specific geodemographic segments. Age and gender were significant determinants of uptake and contextual factors explained an additional 3% of the variation. Geodemographic segmentation reduced this residual contextual variation in uptake more than the IMD 2007 (72% vs. 53% reduction). The three geodemographic types that best predicted non-response were characterized by both ethnic mix and a higher than average proportion of single pensioner households renting council properties. Achieving average uptake in the 2.3% of the study population in these geodemographic segments would only increase the total population uptake rate by 0.5% (57.3-57.8%). CONCLUSION: Variation in the CRC screening uptake in Southern England is principally explained by characteristics of individuals but contextual factors also have a small but significant effect. This effect is captured in greater detail by geodemographic segmentation than by IMD 2007. This information could be used to inform the design of interventions aiming to improve uptake.

Mentalization for Offending Adult Males (MOAM): study protocol for a randomized controlled trial to evaluate mentalization-based treatment for antisocial personality disorder in male offenders on community probation.

BACKGROUND: Antisocial personality disorder (ASPD), although associated with very significant health and social burden, is an under-researched mental disorder for which clinically effective and cost-effective treatment methods are urgently needed. No intervention has been established for prevention or as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment that has shown some promising preliminary results for reducing personality disorder symptomatology by specifically targeting the ability to recognize and understand the mental states of oneself and others, an ability that is compromised in people with ASPD. This paper describes the protocol of a multi-site RCT designed to test the effectiveness and cost-effectiveness of MBT for reducing aggression and alleviating the wider symptoms of ASPD in male offenders subject to probation supervision who fulfil diagnostic criteria for ASPD. METHODS: Three hundred and two participants recruited from a pool of offenders subject to statutory supervision by the National Probation Service at 13 sites across the UK will be randomized on a 1:1 basis to 12 months of probation plus MBT or standard probation as usual, with follow-up to 24 months post-randomization. The primary outcome is frequency of aggressive antisocial behaviour as assessed by the Overt Aggression Scale - Modified. Secondary outcomes include violence, offending rates, alcohol use, drug use, mental health status, quality of life, and total service use costs. Data will be gathered from police and criminal justice databases, NHS record linkage, and interviews and self-report measures administered to participants. Primary analysis will be on an intent-to-treat basis; per-protocol analysis will be undertaken as secondary analysis. The primary outcome will be analysed using hierarchical mixed-effects linear regression. Secondary outcomes will be analysed using mixed-effects linear regression, mixed-effects logistic regression, and mixed-effects Poisson models for secondary outcomes depending on whether the outcome is continuous, binary, or count data. A cost-effectiveness and cost-utility analysis will be undertaken. DISCUSSION: This definitive, national, multi-site trial is of sufficient size to evaluate MBT to inform policymakers, service commissioners, clinicians, and service users about its potential to treat offenders with ASPD and the likely impact on the population at risk. TRIAL REGISTRATION: ISRCTN 32309003 . Registered on 8 April 2016.

Vitamin D deficiency in multicultural primary care: a case series of 299 patients.

An increase in diagnoses of vitamin D deficiency prompted a review of cases from four general practices. Of the 299 cases identified, the predominant patient group comprised adult Somali females presenting with symptoms of chronic musculoskeletal pain. Women of childbearing age were particularly at risk. Known at-risk groups were not receiving supplementation. Significant clinical need appears not to be met in this population group and consideration of vitamin D deficiency during consultations is warranted.

Assessing feasibility and acceptability of a brief intervention for risky alcohol consumption in sexual health clinic attendees: a randomised controlled trial.

OBJECTIVES: To assess the feasibility and acceptability of screening attendees at a sexual health clinic (SHC) for alcohol misuse, and delivering a brief intervention (BI). To explore the effect of this BI on drinking and sexual behaviour. METHODS: A consecutive sample of consenting SHC attendees aged ≥16 years were screened using Alcohol Use Disorders Identification Test Consumption (AUDIT-C). Men scoring ≥5 and women scoring ≥4 were invited to complete the full AUDIT, alcohol diary and baseline questionnaire. INTERVENTIONS: Participants were randomised to receive BI by a trained sexual health professional or a standard alcohol leaflet (usual care, UC). All were followed up for changes in alcohol and sexual behaviour at 6 weeks and 6 months. A fidelity check and staff focus group were undertaken. RESULTS: Of 664 participants screened, 215 (32%) were eligible for randomisation and 207 were included in the final analysis: 103 (BI) and 104 (UC). Follow-up rates were 54% and 47% at 6 weeks and 6 months, respectively. Both groups reduced alcohol consumption though the degree of change did not differ between them. There was some evidence of positive changes in sexual health risk in both groups. BI was delivered as intended, adding 5 minutes to the consultation, and staff feedback was positive. CONCLUSIONS: Alcohol misuse was common in SHC attendees. Systematic assessment and BI for alcohol misuse was feasible and acceptable to staff and patients. Identification and provision of standard information alone appeared to influence drinking and sexual behaviour. TRIAL REGISTRATION NUMBER: ISRCTN19452424.

Clinical networks. Sum of the parts.

A simulation exercise intended to ease the development of clinical networks found that primary care trusts were eager to co-operate with one other. Acute trusts emerged as the most confident 'players'; they were perceived as a 'provider cabal' by PCTs. Participants felt the legacy of the internal market might have impeded joint-working across trusts. The regulator role of strategic health authorities was crucial.