Poor Parental Supervision Associated With Traumatic Brain Injury and Reactive Aggression in Young Offenders.

OBJECTIVE: To establish whether poor parental supervision is associated with head injury and self-reported reactive aggression (ie, aggression in response to perceived provocation or threat) in adolescents in a Young Offender's Institute, by examining correlations between these variables. Understanding this population is important, as they are at a key pivotal age for intervention to prevent lifelong reoffending. METHODS: Ninety-six male participants aged 16 to 18 years were recruited from a UK Young Offender's Institute. Self-report measures of remembered parenting, reactive aggression, and head injury history were administered during individual interviews. RESULTS: Seventy-four percent of participants reported having experienced a lifetime traumatic brain injury (TBI), and 46% of participants reported experiencing at least 1 TBI leading to a loss of consciousness (LOC). We found that poor parental supervision, length of LOC following TBI, and self-reported reactive aggression were all positively correlated. CONCLUSIONS: Findings show that there are correlational relationships between poor parental supervision, length of LOC following lifetime TBI, and higher levels of self-reported reactive aggression. This suggests there may be pathways resulting from poor parental supervision leading to both TBI with LOC, and reactive aggression. We advocate for future research with longitudinal designs and larger samples to examine the nature of these interactions, and to establish whether poor parental supervision is a prospective risk factor for more TBIs leading to LOC, and reactive aggression. This is key to understanding whether parenting interventions could help to reduce the disabling effects of TBI in adolescents, and help to prevent contact with the law.

Adjusting to living with multiple sclerosis: The role of social groups.

Multiple sclerosis (MS) is typically associated with life-long adjustment to wide-ranging, changeable symptoms and psychosocial disruption as all relationships are changed or lost. Despite accumulating evidence, the therapeutic impact of harnessing social group factors in MS management and rehabilitation remains largely unexplored. We investigated their role specific to adjusting to MS. A qualitative approach was used with thematic analysis to induce a rich and developing account of the impact of social groups on adjustment for 15 individuals with MS. An adjustment questionnaire was used to provide a framework for its organisation and discussion. The analysis revealed three themes associated with loss, change and social processes that influenced adjustment. These features distinguished between those who were more or less able to adjust, and resonated well with processes previously identified as central to identity loss and change. Social factors enhanced adjustment through easing transition between pre- and post-MS diagnosis lives. Notably, maintenance of pre-existing social roles and relationships was critical in providing a meaningful basis for integrating the old with new senses of self. The capacity to join new social groups was as key in adjustment as was awareness of having access to multiple social groups to avoid being solely defined by MS. These concepts provided a more stable grounding upon which to nurture value systems and employ collective support to counter the negative consequences of living with MS.

Association between three different cognitive behavioral alcohol treatment programs and recidivism rates among male offenders: findings from the United Kingdom.

BACKGROUND: Cognitive behavioral therapy-based alcohol treatment programs have been widely used to break the link between alcohol and crime. While evidence exists on the connection between alcohol and crime, there is little data that demonstrate the effectiveness of different alcohol treatment programs in reducing criminal behavior. We tested whether male offenders who participate in alcohol treatment programs show lower rates of recidivism than a matched offender group who did not participate in an alcohol prevention program. METHODS: This is an observational matched case-control study. Participants were 564 male offenders with an alcohol problem related to offending. Participants were assigned by the courts to 1 of 3 alcohol treatment programs (141 offenders per treatment): Low Intensity Alcohol Program (LIAP), Alcohol Specified Activity Requirement, and Addressing Substance-Related Offending. A fourth matched group (n = 141) was not assigned to a program and served as a control group. Survival analysis was used to calculate participants' charged and reconviction rates over 4 time periods (0 to 3, 4 to 6, 7 to 9, and 10 to 12 months after completion of program or order). RESULTS: Offenders who did not participate in a program were more than twice as likely to be charged compared to offenders who participated in a program. Furthermore, offenders who did not participate in a program were over 2.5 times more likely to be reconvicted. Among the 3 alcohol treatment programs evaluated, the LIAP was the most cost-effective. CONCLUSIONS: Offenders enrolled in an alcohol treatment program showed a significant reduction in being charged with or reconvicted of a crime. With costs of keeping offenders in prison per year reaching close to £40,000 per offender per year (Mulheirn et al., 2010, www.smf.co.uk), assigning offenders to alcohol preventive programs-such as LIAP-are a promising way to reduce recidivism and reduce cost.

Does the doctor or the patient control sick leave certification? A qualitative study interpreting patients' interview dialogue.

BACKGROUND: Sickness certification poses challenges and problems for the GP. Patient factors may influence the sick leave period. OBJECTIVE: To explore how sickness certification occurred based on patients' reports of medical consultations for a new episode of low back pain. METHODS: A qualitative study using semi-structured interviews with 16 employees who were currently or had recently been off work with an episode of low back pain. RESULTS: We present a preliminary typology of sickness certification responses by medical practitioners comprising four response types: 'process', 'cued', 'consultative' and 'laissez-faire'. All but the process response allows the patient some influence in the sickness certification decision. It is possible that certain types of response may occur at specific stages of recovery. CONCLUSIONS: Doctors may allow patients input into the sickness certification process for a number of reasons. As yet, we do not know if this helps or hinders the return to work process.

Traumatic brain injury in a prison population: prevalence and risk for re-offending.

BACKGROUND: TBI can lead to cognitive, behavioural and emotional difficulties. Previous studies suggest that TBI is relatively elevated in offender populations. In this study the aims were to establish the rate of TBI of various severities in a representative sample of adult offenders and patterns of custody associated with TBI. METHODS: A self-report survey of adult, male offenders within a prison. Of 453 offenders, 196 (43%) responded. RESULTS: Over 60% reported 'Head Injuries'. Reports consistent with TBI of various severities were given by 65%. Of the overall sample, 16% had experienced moderate-to-severe TBI and 48% mild TBI. Adults with TBI were younger at entry into custodial systems and reported higher rates of repeat offending. They also reported greater time, in the past 5 years, spent in prison. CONCLUSIONS: These findings indicate that there is a need to account for TBI in the assessment and management of offenders.

Self-reported traumatic brain injury in male young offenders: a risk factor for re-offending, poor mental health and violence?

Adolescence is a risk period for offending and for traumatic brain injury (TBI) and TBI is a risk factor for poor mental health and for offending. TBI has been largely neglected from guidance on managing the mental health needs of young offenders. We sought to determine the rate of self-reported TBI, of various severities, in a male, adolescent youth offending population. We also aimed to explore whether TBI was associated with number of convictions, violent offending, mental health problems and drug misuse. Young male offenders aged 11 to 19 years were recruited from a Young Offender Institute, a Youth Offending Team and a special needs school. A total of 197 participants were approached and 186 (94.4%) completed the study. They completed self-reports on TBI, crime history, mental health and drug use. TBI with loss of consciousness (LOC) was reported by 46% of the sample. LOC consistent with mild TBI was reported by 29.6%, and 16.6% reported LOC consistent with moderate to severe TBI. Possible TBI was reported by a further 19.1%. Repeat injury was common - with 32% reporting more than one LOC. Frequency of self-reported TBI was associated with more convictions. Three or more self-reported TBIs were associated with greater violence in offences. Those with self-reported TBI were also at risk of greater mental health problems and of misuse of cannabis. TBI may be associated with offending behaviour and worse mental health outcomes. Addressing TBI within adolescent offenders with neurorehabilitative input may be important for improving well-being and reducing re-offending.

The consequences of traumatic brain injury from the classroom to the courtroom: understanding pathways through structural equation modelling.

Purpose: Paediatric traumatic brain injury (TBI) can have resultant ongoing significant impairments which can impact life outcomes. The primary aim of this research was to explore whether TBI contributes to the relationship between poor educational outcomes and offending trajectories.Materials and methods: Through analysis of a dataset consisting of self-reported health, educational, and offending histories of 70 incarcerated young males, structural equation modelling was used to explore the mediation of educational outcomes and patterns in offending behaviour by chronic symptoms following TBI.Results: Symptoms related to TBI significantly mediated the relationship between decreased educational attainment and more frequent convictions. It did not mediate any relationships involving age at first conviction.Conclusions: Traumatic brain injury appears to have more influence over frequency of offending patterns than age at first conviction. However, TBI remains a pervasive factor in both higher rates of offending and poorer educational attainment. In order to tackle this effect on adverse social outcomes, greater attention to the impact of TBI is required in education and criminal justice systems.IMPLICATIONS FOR REHABILITATIONHighlights traumatic brain injury as a contributory factor in some education to offending pathways, suggesting that greater focus on rehabilitation within the education and criminal justice systems is required.Reinforces that greater understanding of educational pathways post-injury is needed to better facilitate rehabilitation within the school system.

Evaluating internet interviews with gay men.

In this article we describe the use of the Internet to conduct online synchronous interviews on gay men's experiences of Internet sex-seeking and barebacking, using interpretative phenomenological analysis (IPA). We then present the results of a separate IPA of the issues we encountered during the research. The analysis is focused around four superordinate themes: positive experience, technological issues, boundaries, and requests/expectations. We argue that online qualitative research is valuable in its own right, and that the advantages considerably outweigh the difficulties. This is particularly true in accessing individuals who might not participate in other types of research settings to discuss experiences that would otherwise be too difficult to talk about. Several issues that are problematic in more conventional research still apply, albeit in a different guise, but these must be situated in the context of who or what is being researched, and why, and can be largely overcome with more creative methodologies and considered preparation.

Informing the development of online weight management interventions: a qualitative investigation of primary care patient perceptions.

BACKGROUND: The internet is a potentially promising medium for delivering weight loss interventions. The current study sought to explore factors that might influence primary care patients' initial uptake and continued use (up to four-weeks) of such programmes to help inform the development of novel, or refinement of existing, weight management interventions. METHODS: Semi-structured interviews were conducted with 20 patients purposively sampled based on age, gender and BMI from a single rural general practice. The interviews were conducted 4 weeks after recruitment at the general practice and focused on experiences with using one of three freely available weight loss websites. Thematic Analysis was used to analyse the data. RESULTS: Findings suggested that patients were initially motivated to engage with internet-based weight loss programmes by their accessibility and novelty. However, continued use was influenced by substantial facilitators and barriers, such as time and effort involved, reaction to prompts/reminders, and usefulness of information. Facilitation by face-to-face consultations with the GP was reported to be helpful in supporting change. CONCLUSIONS: Although primary care patients may not be ready yet to solely depend on online interventions for weight loss, their willingness to use them shows potential for use alongside face-to-face weight management advice or intervention. Recommendations to minimise barriers to engagement are provided.

Supervisors' responses to sickness certification for an episode of low back pain: employees' personal experiences.

PURPOSE: To understand how work supervisors respond to sickness certification for an episode of low back pain based on employees' reports of employer-employee interactions. METHOD: Thematic analysis of semi-structured in-depth interviews with 16 employees who were currently or had recently been off work with an episode of low back pain. RESULTS: Two types of initial supervisor response were identified: See you later and take your time and get it right. Both of these relied on the employee returning to work once they were able to do their normal work tasks. Three types of subsequent response were identified: proactive, apathetic and negative. Only the proactive response included actions to encourage and assist the employee to return to the workplace. CONCLUSIONS: The interactions described by participants suggest that employers and their representatives often postpone actioning to return to work interventions which potentially delays the rehabilitation of the employee.

Associations between authoritative parenting and the sun exposure and sun protective behaviours of adolescents and their friends.

Associations between the sun exposure and sun protective behaviours of adolescents and their friends were examined along with the role played by authoritative parenting and other family and peer socialisation factors. Four hundred and two adolescents (198 males, 204 females) participated in the research. It was found that these adolescents and their friends shared similar sun exposure and sun protective behaviours and had similar parenting backgrounds. Parental authoritativeness was positively associated with the use of sun protection, even after the effects of other familial and peer variables were controlled, but not with the time spent sunbathing which was associated with friends' behaviours. The theoretical and practical implications of these findings are discussed.