Adolescent Risk for Intimate Partner Violence Perpetration.

The prevention of intimate partner violence is a desirable individual and public health goal for society. The purpose of this study is to provide a comprehensive assessment of adolescent risk factors for partner violence in order to inform the development of evidence-based prevention strategies. We utilize data from the Rochester Youth Development Study, a two decade long prospective study of a representative community sample of 1000 participants that has extensive measures of adolescent characteristics, contexts, and behaviors that are potential precursors of partner violence. Using a developmental psychopathology framework, we assess self-reported partner violence perpetration in emerging adulthood (ages 20-22) and in adulthood (ages 29-30) utilizing the Conflict Tactics Scale. Our results indicate that risk factors for intimate partner violence span several developmental domains and are substantially similar for both genders. Internalizing and externalizing problem behaviors as well as early intimate relationships are especially salient for both genders. Additionally, cumulative risk across a number of developmental domains places adolescents at particularly high risk of perpetrating partner violence. Implications for prevention include extending existing prevention programs that focus on high risk groups with multiple risks for developmental disruption, as well as focusing on preventing or mitigating identified risk factors across both genders.

Mixed Pneumocystis and Cryptococcus cutaneous infection histologically mimicking xanthoma.

Cutaneous Pneumocystis jirovecii infection is rare. It is thought that the disease emerges from a latent infection delivered via hematogenous and/or lymphatic dissemination from a primary lung infection in immunocompromised individuals. A 32-year-old human immunodeficiency virus-positive male was admitted for headache and vomiting. He was diagnosed with meningitis due to Cryptococcus neoformans and sputum tested positive for Pneumocystis. Six months later, he presented with a slightly crusted yellowish brown plaque and 2 similar but smaller papules with telangiectasia near the right angle of the mouth. Biopsy of the area featured histiocytes expanded by foamy cytoplasm as in a xanthoma except that the vacuoles were coarser. Special stains ultimately demonstrated the characteristic disks of Pneumocystis accompanied by a minor component of budding yeasts (Cryptococcus) in the same fields. This case illustrates the utility of adequate special stains in recognizing a mixed cutaneous infection, particularly in human immunodeficiency virus-positive patients, when microscopy presents an odd xanthoma-like lesion.

Living in partner-violent families: developmental links to antisocial behavior and relationship violence.

Links between living in a partner-violent home and subsequent aggressive and antisocial behavior are suggested by the "cycle of violence" hypothesis derived from social learning theory. Although there is some empirical support, to date, findings have been generally limited to cross-sectional studies predominantly of young children, or retrospective studies of adults. We address this issue with prospective data from the Rochester Youth Development Study (RYDS), an ongoing longitudinal investigation of the development of antisocial behavior in a community sample of 1,000 urban youth followed from age 14 to adulthood. The original panel included 68% African American, 17% Hispanic, and 15% White participants, and was 72.9% male, and 27.1% female. Measures come from a combination of sources including interviews with parents, interviews with youth, and official records. We test the general hypothesis that there is a relationship between living in partner-violent homes during adolescence, and later antisocial behavior and relationship violence. Employing logistic regression and controlling for related covariates, including child physical abuse, we find a significant relationship between exposure to parental violence and adolescent conduct problems. The relationship between exposure to parental violence and measures of antisocial behavior and relationship aggression dissipates in early adulthood, however, exposure to severe parental violence is significantly related to early adulthood violent crime, and intimate partner violence. Our results suggest that exposure to severe parental violence during adolescence is indeed consequential for violent interactions in adulthood.

Childhood maltreatment and antisocial behavior: comparison of self-reported and substantiated maltreatment.

Although accurate assessment of maltreatment is critical to understanding and interrupting its impact on the life course, comparison of different measurement approaches is rare. The goal of this study is to compare maltreatment reports from official Child Protective Services (CPS) records with retrospectively self-reported measures. Research questions address the prevalence and concordance of each type of measure, their relationship to social disadvantage, and their prediction to four antisocial outcomes in adolescence and early adulthood including arrest, self-reported violence, general offending, and illegal drug use. Data to address this comparison come from the Rochester Youth Development Study (RYDS), a longitudinal panel study of 1,000 adolescents. Findings indicate that self-reported retrospective maltreatment is somewhat more prevalent (29%) than official substantiated maltreatment (21%). Among those with official reports, in young adulthood about half self-reported maltreatment, whereas 37% of those self-reporting have an official report. In general, both sources suggest that maltreatment is associated with a higher prevalence of antisocial behavior. It is not clear that combining sources of information improves prediction.

Adolescent maltreatment and its impact on young adult antisocial behavior.

STATEMENT OF PROBLEM: Childhood maltreatment is known to be a risk factor for a range of later problems, but much less is known about adolescent maltreatment. The present study aims to investigate the impact of adolescent maltreatment on antisocial behavior, while controlling for prior levels of problem behavior as well as sociodemographic characteristics. METHODS: Data are from the Rochester Youth Development Study, a cohort study of the development of problem behaviors in a sample of 1,000 urban youth followed from age 13 into adulthood. Subjects include 68% African American, 17% Hispanic, and 15% White youth. This analysis includes a maximum of 884 subjects, of whom 9.3% had substantiated maltreatment reports in adolescence. Among the maltreated adolescents, 14 experienced sex abuse, 36 experienced physical abuse, and 32 were neglected or emotionally abused. Outcomes explored in late adolescence (ages 16-18) and young adulthood (ages 20-22) include arrest, self-reported general and violent offending, and illicit drug use. Control variables include prior levels of these outcomes as well as sociodemographic characteristics like poverty, parent education, and caregiver changes. RESULTS: Logistic regression analysis determined that experiencing any substantiated maltreatment during adolescence increases the odds of arrest, general and violent offending, and illicit drug use in young adulthood, even controlling for sociodemographic characteristics and prior levels of problem behavior. Different types of adolescent maltreatment, including neglect, appear to produce similar adverse behavioral consequences. CONCLUSIONS: Adolescent maltreatment necessitates increased attention in view of its enduring and potentially wide-ranging impact on the life span.

Linked lives: the intergenerational transmission of antisocial behavior.

There is a strong assumption of intergenerational continuity in behavior patterns, including antisocial behavior. Using a 3-generation, prospective study design, we examine the level of behavioral continuity between Generation 2 (G2) and Generation 3 (G3), and the role of economic disadvantage and parenting behaviors as mediating links. We estimate separate models for G2 fathers and G2 mothers. Data are drawn from the Rochester Youth Development Study, a longitudinal study begun in 1988 during G2's early adolescence (n = 1,000), which has collected prospective data on G2, their parents (G1), and now their G3 children. Results show that intergenerational continuity in antisocial behavior is evident, albeit somewhat modest. Parenting styles and financial stress do play a mediating role, although their effects vary by G2's gender. In general, adolescent delinquency plays a larger role in linking the generations for G2 fathers, whereas parenting behaviors and financial stress play a larger role for G2 mothers.

Adolescent risk factors for child maltreatment.

We investigate adolescent risk factors, measured at both early and late adolescence, for involvement in child maltreatment during adulthood. Comprehensive assessments of risk factors for maltreatment that use representative samples with longitudinal data are scarce and can inform multilevel prevention. We use data from the Rochester Youth Development Study, a longitudinal study begun in 1988 with a sample of 1,000 seventh and eighth graders. Participants have been interviewed 14 times and, at the last assessment (age 31), 80% were retained. Risk factors represent 10 developmental domains: area characteristics, family background/structure, parent stressors, exposure to family violence, parent-child relationships, education, peer relationships, adolescent stressors, antisocial behaviors, and precocious transitions to adulthood. Maltreatment is measured by substantiated reports from Child Protective Services records. Many individual risk factors (20 at early adolescence and 14 at later adolescence) are significantly, albeit moderately, predictive of maltreatment. Several developmental domains stand out, including family background/structure, education, antisocial behaviors, and precocious transitions. In addition, there is a pronounced impact of cumulative risk on the likelihood of maltreatment. For example, only 3% of the youth with no risk domains in their background at early adolescence were involved in later maltreatment, but for those with risk in 9 developmental domains the rate was 45%. Prevention programs targeting youth at high risk for engaging in maltreatment should begin during early adolescence when risk factors are already at play. These programs need to be comprehensive, capable of addressing the multiple and interwoven nature of risk that is associated with maltreatment.

Long-term outcomes of young adults exposed to maltreatment: the role of educational experiences in promoting resilience to crime and violence in early adulthood.

This study investigates whether positive educational experiences in midadolescence mitigate the impact of exposure to substantiated maltreatment and reduces young adult antisocial behavior. While there is theoretical and empirical support for the mediating or moderating role of educational experiences on maltreatment and antisocial outcomes, few prospective studies exist. In this exploratory study, data are from the Rochester Youth Development Study (RYDS), a longitudinal panel study of 1,000 adolescents. The original sample included 73% males, and 85% African American or Hispanic youth of whom about 20% were maltreated. Measures in this study are from a combination of interview data and official records collected through age 23. Outcomes include self-reported crime and violence, arrest, and partner violence perpetration. Educational variables include midadolescent self-report of high school graduation, educational aspiration, college expectation, school commitment, teacher attachment, self-reported grades, school GPA, attendance, and an additive index of all school assets. Multivariate path analysis controlled for gender, race/ethnicity, poverty, and early antisocial behavior. Path analysis examined whether educational experiences mediated the impact of maltreatment on antisocial outcomes. Although maltreatment was significantly predictive of criminal and violent behaviors, it only was weakly associated with educational experiences. The impact of maltreatment on arrest was weakly mediated (reduced) by educational GPA and by high school graduation. The additive index also mediated the impact of maltreatment on crime and violence. Maltreatment's impact on partner violence was also weakly mediated by school GPA. Interaction terms were used to test for moderation: only one significant effect was found: school GPA protects maltreated youth from perpetration of partner violence as young adults. Although there are few significant effects in a number of models, the research is consistent with a focus on promoting school achievement and completion among urban youth in general, in conjunction with addressing earlier antisocial behavior problems.

Breaking the cycle of maltreatment: the role of safe, stable, and nurturing relationships.

PURPOSE: We examine two research questions. First, does a history of child maltreatment victimization significantly increase the likelihood of maltreatment perpetration during adulthood? Second, do safe, stable, and nurturing relationships (SSNRs) during early adulthood serve as direct protective factors, buffering protective factors, or both to interrupt intergenerational continuity in maltreating behaviors? METHODS: Data come from the Rochester Youth Development Study that followed a community sample from age 14 to 31 with 14 assessments. Maltreatment victimization records covering birth through age 17 were collected from Child Protective Services records as were maltreatment perpetration records from age 21 to 30. Data on five SSNRs were measured during three interviews from ages 21 to 23. RESULTS: There is a significant relationship between maltreatment victimization and maltreatment perpetration (odds ratio = 2.57; 95% confidence interval = 1.47-4.50). Three of the five SSNRs investigated-relationship satisfaction, parental satisfaction, and attachment to child-served as direct protective factors, significantly reducing risk for those who had been maltreated. However, none of the interaction terms--between maltreatment victimization and the SSNR--was statistically significant, indicating that the SSNRs did not serve as buffering protective factors CONCLUSIONS: Although a history of maltreatment significantly increases the risk of subsequent perpetration of maltreatment, enhancing SSNRs with intimate partners and with children during early adulthood can decrease the odds that a victim of maltreatment will become a perpetrator. Mandated reporters and service providers should be aware of the risk posed by earlier maltreatment and be prepared to ameliorate that risk, in part by strengthening supportive social relationships.

Successful implementation of a referral-based academic pediatric hospitalist service.

OBJECTIVE: St Louis Children's Hospital (SLCH) developed Service for Hospital Admissions by Referring Physicians (SHARP) in January 2008 as an inpatient referral service for pediatricians who previously admitted their own patients. We hypothesized that use of SHARP would make hospitalization more efficient and cost-effective compared with the general pediatric medicine (GM) service. METHODS: Admission volumes, diagnoses, length of stay (LOS), costs, and physician billing data were abstracted from SLCH information systems and the Pediatric Health Information System database. We compared admissions for SHARP and GM from January 2008 through June 2010. RESULTS: SHARP had lower LOS and costs versus GM, with no change in 7-day readmission rate. Median LOS was 2 days for SHARP and 3 days for GM (P<.001). Median hospital cost per patient was $2719 for SHARP and $3062 for GM (P<.001). Over the study period, the admission rate increased 37% and daily patient encounters increased 39%. Physician billing revenue increased 25% in the first 6 months, then continued to increase steadily. Total physicians and geographic referral area using SHARP increased, and referring physician satisfaction was high. CONCLUSIONS: SHARP approaches financial independence and provides a cost savings to SLCH. LOS decreased by a statistically significant amount compared with GM with no change in readmission rate. Referring physician satisfaction was high, likely allowing for growth in referrals to SLCH. SHARP hospitalists' collaboration with referring physicians, ensuring excellent follow-up, provides decreased duration of hospitalization and resource utilization. Our availability throughout the day to reassess patients increases efficiency. We project that we must average 12.6 daily encounters to be financially independent.

Intergenerational continuities and discontinuities in intimate partner violence: a two-generational prospective study.

This study focuses on intergenerational continuity in violent partner relationships. We investigate whether exposure to caregiver intimate partner violence (IPV) during adolescence leads to increased involvement in IPV during early adulthood (age 21-23) and adulthood (age 29-31). We also investigate whether this relationship differs by gender. Although there is theoretical and empirical support for intergenerational continuity of relationship violence, there are few prospective studies of this issue. We use data from the Rochester Youth Development Study (RYDS), a longitudinal study of the development of antisocial behavior in a community sample of 1,000 urban youth followed from age 14 to adulthood. The original sample includes 73% men and 85% African American or Hispanic youth. Measures come from a combination of interviews and official records. The Conflict Tactics Scale (CTS) is used to assess IPV and severe IPV in the youth and parent generations. Analyses controlled for child physical abuse, race/ethnicity as well as parent education, family stability, and poverty. In multivariate models, adolescent exposure to caregiver severe IPV resulted in significantly increased risk of relationship violence in early adulthood (age 21-23). Furthermore, there is an indirect effect of adolescent exposure to severe IPV on later adult involvement in IPV (age 29-31), mediated by involvement in a violent relationship in early adulthood. These results were largely invariant by gender. However, we observed a direct pathway between IPV exposure and adult IPV for women (marginally significant) suggesting that adolescent exposure to caregiver IPV may set in motion women-specific processes.

The causal impact of childhood-limited maltreatment and adolescent maltreatment on early adult adjustment.

PURPOSE: We use full-matching propensity score models to test whether developmentally specific measures of maltreatment, in particular childhood-limited maltreatment versus adolescent maltreatment, are causally related to involvement in crime, substance use, health-risking sex behaviors, and internalizing problems during early adulthood. METHODS: Our design includes 907 participants (72% male) in the Rochester Youth Development Study, a community sample followed from age 14 to age 31 with 14 assessments, including complete maltreatment histories from Child Protective Services records. RESULTS: After balancing the data sets, childhood-limited maltreatment is significantly related to drug use, problem drug use, depressive symptoms, and suicidal thoughts. Maltreatment during adolescence has a significant effect on a broader range of outcomes: official arrest or incarceration, self-reported criminal offending, violent crime, alcohol use, problem alcohol use, drug use, problem drug use, risky sex behaviors, self-reported sexually transmitted disease diagnosis, and suicidal thoughts. CONCLUSIONS: The causal effect of childhood-limited maltreatment is focused on internalizing problems, whereas adolescent maltreatment has a stronger and more pervasive effect on later adjustment. Increased vigilance by mandated reporters, especially for adolescent victims of maltreatment, along with provision of appropriate services, may prevent a wide range of subsequent adjustment problems.

Impact of adolescent exposure to intimate partner violence on substance use in early adulthood.

OBJECTIVE: Youth exposure to intimate partner violence has been theorized to increase the risk of adverse outcomes in adulthood including substance-use problems. However, the limited research on the association between early exposure to intimate partner violence and later alcohol- or drug-use problems is inconclusive. Using a prospective design, this study investigates whether adolescent exposure to intimate partner violence increases the risk for problem substance use in early adulthood and whether this relationship differs by gender. METHOD: The study uses a subsample (n = 508) of participants from the Rochester Youth Development Study, a longitudinal study of urban, largely minority adolescents that oversampled youth at high risk for antisocial behavior and drug use. Logistic regression analyses were conducted to assess whether adolescent exposure to intimate partner violence predicted increased odds of four indicators of problem substance use in early adulthood, controlling for parental substance use, adolescent maltreatment, and sociodemographic risk factors. RESULTS: Exposure to severe intimate partner violence as an adolescent significantly increased the odds of alcohol-use problems in early adulthood for young women (odds ratio = 5.63, p < .05) but not for young men. Exposure to intimate partner violence did not increase the odds of other substance-use indicators for either gender. CONCLUSIONS: Girls exposed to intimate partner violence may be at increased risk for problems with alcohol use in adulthood and should be a target for prevention and intervention efforts. Overall, however, the association between exposure to intimate partner violence and later substance-use problems is less than anticipated in this high-risk community sample.

Continuities in antisocial behavior and parenting across three generations.

BACKGROUND: Accumulating evidence indicates that there are intergenerational continuities in antisocial behavior, and that parenting patterns play a role in these continuities. Very few studies, however, enable assessment across two generations of children at comparable ages, employing independent reporters and comparable measurements. The present study addresses the extent to which antisocial behavior in parents predicts antisocial behavior in children in two successive generations; the degree to which a man's childhood antisocial behavior predicts antisocial behavior in his own children; the extent to which parenting problems are related to child antisocial behavior similarly in two successive generations; and the extent to which intergenerational continuities in antisocial behavior are mediated by parenting variables. METHODS: Questions are addressed with prospective longitudinal data from the Cambridge Study in Delinquent Development (CSDD). The CSDD includes data on 411 Inner London males (Generation 2, or G2), their female partners, their parents (G1) and their children (G3). At time 1, when G2 were aged 8-10, data on G2 child conduct problems and G1 parenting and convictions were available. At time 2 when G2 males were aged 32, data were available on the parenting of 178 G2 fathers with G3 children aged 3-15, and on their G3 children's behavior. Time 1 data come predominantly from G1 mothers, whereas time 2 data come predominantly from G2 fathers. RESULTS: Between generations, antisocial G1 mothers and fathers predicted conduct problems in G2 and G3 children, but G2 child conduct problems did not predict G3 child conduct problems. Within generations, G2 child conduct problems predicted G2 adult antisocial behavior and antisocial partnerships, which in turn predicted G3 conduct problems. Parental conflict and authoritarian parenting were similarly related to early childhood conduct problems in two successive generations. There was relatively little continuity between G1 and G2 parenting except that G2 males who were poorly supervised by their parents were themselves poor supervisors as fathers. Both G1 and G2 generations displayed assortative mating, with antisocial males tending to partner antisocial female peers. CONCLUSIONS: There are between-generation and within-generation continuities in antisocial behavior, although assessment of such continuities is complicated by inevitable design and measurement limitations. Parenting partly mediated the impact of parental antisocial behavior on child antisocial behavior in two successive generations, but the relation between antisocial parents and antisocial children is not fully mediated by parenting variables.

Primary hyperoxaluria in a 27-year-old woman.

Primary hyperoxaluria is a rare autosomal recessive disorder resulting in precipitation of insoluble oxalate crystals in the joints, kidneys, heart, eyes, and skin. Two thirds of patients have calcium oxalate nephrolithiasis by age 5 years and 80% die of renal failure by age 20 years. Rarely, the disease will present in adulthood, with the onset of symptoms occurring as late as the sixth decade. We present a 27-year-old woman with end-stage renal disease who presented to the dermatology department for the evaluation of a reticular rash shortly after beginning peritoneal dialysis. Associated symptoms included arthralgias and episodic acral cyanosis. Previous kidney and skin biopsy specimens revealed crystalline deposition, however, the diagnosis of primary hyperoxaluria was not entertained until an atrial mass was found to have the same crystalline material. This report reviews primary hyperoxaluria and underscores the importance of recognizing the disease as a cause of renal failure in a patient with livedo reticularis and skin lesions resembling calciphylaxis. Early recognition of the disease is important because combined liver-kidney transplantation may achieve long-term survival.