Assessing the Effectiveness of a Specialized, Field-Based Treatment Program for Youth Who Have Committed Sexual Offenses in an Australian Jurisdiction

This study provides an evaluation of recidivism outcomes for a specialized, field-based treatment program for youth who perpetrate sexual offenses in an Australian jurisdiction. Using survival analyses, recidivism outcomes for the treatment group (n = 200), who were followed for an average of 5.07 years (SD = 3.13), were contrasted with a sample of sexually offending youth who were either referred but not accepted or not referred to the program (n = 295). Rates of sexual recidivism were low and not significantly different between the groups (9.5% for treated and 10.8% for untreated). Unadjusted Cox regression results indicated that the treated group were less likely to violently recidivate compared to the untreated group (HR = 1.41, 95% CI [1.01, 1.96]), but this effect became nonsignificant when controlling for offense history covariates (HR = 1.22, 95% CI [0.87, 1.72]). Both groups exhibited high rates of nonsexual offending during the follow-up period, and treatment factors including clinician-rated success, were found to be associated with a lower frequency of reoffending after treatment. Findings highlight important considerations for both practice and research. First, findings suggest the need for specialized programs to ensure factors associated with general recidivism are also addressed in treatment; second, findings reinforce potential utility for clinician-rated and structured assessments to inform treatment planning and outcomes. Finally, the findings raise the importance of appropriate comparison groups when designing evaluation studies, to accurately inform policy and practice.

Psychiatric illness and the risk of reoffending: recurrent event analysis for an Australian birth cohort

BACKGROUND

Psychiatric illness is a well-established risk factor for criminal justice system involvement, but less is known about the relationships between specific psychiatric illnesses and reoffending. Research typically examines reoffending as a single discrete event. We examined the relationship between different psychiatric disorders and types of reoffending while accounting for multiple reoffending events over time.

METHODS

Data were drawn from a population cohort of 83,039 individuals born in Queensland, Australia, in 1983 and 1984 and followed to age 29-31 years. Psychiatric diagnoses were drawn from inpatient health records and offending information was drawn from court records. Descriptive and recurrent event survival analyses were conducted to examine the association between psychiatric disorders and reoffending.

RESULTS

The cohort included 26,651 individuals with at least one proven offence, with 3,580 (13.4%) of these individuals also having a psychiatric disorder. Individuals with any psychiatric disorder were more likely to reoffend compared to those without a disorder (73.1% vs. 56.0%). Associations between psychiatric disorders and reoffending varied across age. Individuals with a psychiatric disorder only started to accumulate more reoffending events from ~ 27 years, which accelerated up to age 31 years. There were both specificity and common effects in the associations between different psychiatric disorders and types of reoffending.

CONCLUSIONS

Findings demonstrate the complexity and temporal dependency of the relationship between psychiatric illness and reoffending. These results reveal the heterogeneity present among individuals who experience psychiatric illness and contact with the justice system, with implications for intervention delivery, particularly for those with substance use disorders.

Psychiatric disorders and offending in an Australian birth cohort: Overrepresentation in the health and criminal justice systems for Indigenous Australians

OBJECTIVE

Most studies that examine psychiatric illness in people who offend have focused on incarcerated samples, with little known about the larger population of individuals with criminal justice system contact. We examine the overlap between proven offences and psychiatric diagnoses with an emphasis on experiences for Indigenous Australians.

METHODS

In a population-based birth cohort of 45,141 individuals born in Queensland, Australia, in 1990 (6.3% Indigenous), psychiatric diagnoses were identified from hospital admissions between ages 4/5 and 23/24 years and proven offences were identified from court records (spanning ages 10-24 years). Prevalence rates for offending, psychiatric diagnoses and their overlap were examined for Indigenous and non-Indigenous individuals. Associations between specific psychiatric diagnoses and types of offending were examined using logistic regressions.

RESULTS

There were 11,134 (24.7%) individuals with a finalised court appearance, 2937 (6.5%) with a diagnosed psychiatric disorder and 1556 (3.4%) with a proven offence and diagnosed psychiatric disorder, with Indigenous Australians significantly overrepresented across all outcomes. Compared with non-Indigenous Australians, Indigenous Australians were younger at their first court finalisation (Cohen's d = -0.62, 95% confidence interval = [-0.67, -0.57]), experienced a higher number of finalisations (d = 0.94, 95% confidence interval = [0.89, 1.00]) and offences (d = 0.64, 95% confidence interval = [0.59, 0.69]) and were more likely to receive custodial (d = 0.41, 95% confidence interval = [0.36, 0.46]) or supervised (d = 0.55, 95% confidence interval = [0.50, 0.60]) sentences. The overlap between offending and psychiatric illness was more pronounced for Indigenous Australians compared with non-Indigenous Australians (14.8% vs 2.7%). Substance use disorders were the most prevalent psychiatric diagnosis among individuals with a court finalisation (9.2%).

CONCLUSIONS

Indigenous Australians were significantly overrepresented in court finalisations and psychiatric diagnoses. Indigenous Australians with a psychiatric diagnosis were at highest risk of experiencing a court appearance, emphasising the importance of culturally appropriate mental health responses being embedded into the criminal justice system.

Examining the health and criminal justice characteristics for young people on compulsory community treatment orders: An Australian birth cohort and data linkage study

BACKGROUND

Most studies on the predictors and effectiveness of community treatment orders (CTOs) are restricted to health-related variables and do not consider forensic contacts as established by criminal justice databases or predictors from birth. We used linked administrative health and criminal justice data for a birth cohort in Queensland, Australia to investigate the characteristics and outcomes of people placed on CTOs.

METHODS

CTOs were identified from administrative data for hospital admissions and community mental health service contacts for a population cohort of 45,141 individuals born in Queensland in 1990. These data were linked with administrative court records, with individuals followed up to age 23/24 years. Logistic regression analyses were used to examine characteristics associated with CTO placement and Tobit regression analyses to examine factors predicting health and criminal justice outcomes in the following year.

RESULTS

There were 211 CTO cases by age 23/24 years, for whom it was possible to identify 413 controls on voluntary treatment. Non-affective psychoses [F20-F29] were the strongest predictors of CTO placement (OR_adj = 4.07, 2.77-5.99) followed by a court appearance (OR_adj = 1.99, 1.28-3.09). CTOs were associated with greater, not lower, subsequent psychiatric hospital admissions, inpatient bed-days and community mental health service contacts, although on sensitivity analyses psychiatric hospital admissions were the same as voluntary controls. CTOs were not associated with more subsequent court appearances despite higher rates of offending before CTO placement.

CONCLUSIONS

Both clinical and forensic variables can determine CTO placement and, on adjustment for these covariates, CTOs were not associated with reductions in psychiatric hospital admission, time spent as an inpatient, or subsequent court appearances. The latter finding might mean that CTOs reduce the risk of offending to that of voluntary controls.

Prospective Memory Training in Older Adults: A Systematic Review and Meta-Analysis

Prospective memory (PM), which enables one to remember to carry out delayed intentions, is crucial for everyday functioning. PM commonly deteriorates upon cognitive decline in older adults, but several studies have shown that PM in older adults can be improved by training. The current study aimed to summarise this evidence by conducting a qualitative systematic analysis and quantitative meta-analysis of the effects of PM training in older adults, for which systematic searches were conducted across seven databases (Cochrane Library, Embase, PubMed, PsycInfo, Web of Science, CINAHL and Scopus). Forty-eight studies were included in the qualitative analysis, and 43% of the assessed PM training interventions showed positive gains in enhancing PM. However, the methodological quality varied across the studies, with 41% of the non-randomised control trials (non-RCTs) rated as having either serious or critical risk of bias. Therefore, only 29 RCTs were included in the subsequent quantitative meta-analysis. We found a significant and moderate immediate efficacy (Hedges' g = 0.54) of PM training in enhancing PM performance in older adults, but no significant long-term efficacy (Hedges' g = 0.21). Two subgroup analyses also revealed a robust training efficacy across the study population (i.e., healthy and clinical population) and the number of training sessions (i.e., single session and programme-based). Overall, this study provided positive evidence to support PM training in older adults. Further studies are warranted to explore the mechanisms by which PM training exerts its effects, and better-quality RCTs are needed to provide more robust evidence supporting our findings.

Measuring Engagement in Antisocial Behavior During Late Adolescence and Early Adulthood for Typically Developing Youth

Research examining the nature and extent of participation in antisocial behavior (ASB) in typically developing individuals during late adolescence and early adulthood remains rare. A self-report instrument for measuring participation in ASB was developed and administered to an Australian sample of 404 youth (64.9% females) aged 17 to 22-years using item-response theory methods. All participants reported involvement in multiple forms of ASB, although this involvement was skewed toward less serious behaviors, suggesting that engagement in these behaviors were common for typically developing youth. Unlike previous research, few sex differences were detected, with females' self-reported involvement in ASB similar to that of males. A need for ongoing longitudinal research in typically developing samples was highlighted, particularly on the transition to adulthood.

Executive Functions in Late Adolescence and Early Adulthood and Their Relationship with Risk-Taking Behavior

Executive functions (EF) continue developing throughout adolescence, with immaturity in EF theorized to underlie risk-taking. 129 older adolescents and young adults (aged 17 to 22 years) were assessed using a battery of cool and hot EF tasks, and a behavioral measure of risk-taking propensity. Minimal age-related differences in EF performance were evident, confirming they were largely functionally mature by mid-adolescence. Inconsistent with the predictions of imbalance models of adolescent development, weaker EF was not associated with greater risk-taking propensity. The findings suggest that during later adolescence and early adulthood, not all forms of risk-taking are associated with EF.

A meta-analysis of cognitive impairment and decline associated with adjuvant chemotherapy in women with breast cancer

A meta-analysis was performed to quantify the magnitude and nature of the association between adjuvant chemotherapy and performance on a range of cognitive domains among breast cancer patients. A total of 27 studies (14 cross-sectional, 8 both cross-sectional and prospective, and 5 prospective) were included in the analyses, involving 1562 breast cancer patients who had undergone adjuvant chemotherapy and 2799 controls that included breast cancer patients who did not receive adjuvant chemotherapy. A total of 737 effect sizes (Cohen's d) were calculated for cross-sectional and prospective longitudinal studies separately and classified into eight cognitive domains. The mean effect sizes varied across cross-sectional and prospective longitudinal studies (ranging from -1.12 to 0.62 and -0.29 to 1.12, respectively). Each cognitive domain produced small effect sizes for cross-sectional and prospective longitudinal studies (ranging from -0.25 to 0.41). Results from cross-sectional studies indicated a significant association between adjuvant chemotherapy and cognitive impairment that held across studies with varied methodological approaches. For prospective studies, results generally indicated that cognitive functioning improved over time after receiving adjuvant chemotherapy. Greater cognitive impairment was reported in cross-sectional studies comparing chemotherapy groups with healthy control groups. Results suggested that cognitive impairment is present among breast cancer patients irrespective of a history of chemotherapy. Prospective longitudinal research is warranted to examine the degree and persisting nature of cognitive impairment present both before and after chemotherapy, with comparisons made to participants' cognitive function prior to diagnosis. Accurate understanding of the effects of chemotherapy is essential to enable informed decisions regarding treatment and to improve quality of life among breast cancer patients.

Growth factors in combination, but not individually, rescue rd mouse photoreceptors in organ culture

The rd mouse retina is an animal model for human retinal dystrophy in which the rod photoreceptors undergo apoptosis during the first 4 weeks in vivo or in organ culture. We have examined the effect of different families of trophic factors on the survival of rd mouse photoreceptors in organ culture. Retinas were harvested from rd mice at postnatal day 2 and grown in organ culture for 27 days in vitro (DIV) in DMEM with 10% fetal calf serum. Ciliary neurotrophic factor (CNTF), brain-derived neurotrophic factor (BDNF), fibroblast growth factor-2 (FGF2), glial cell line-derived neurotrophic factor (GDNF), neurturin, and persephon were added individually or in combination to the medium at a dose of 50 ng/ml or less. CNTF + BDNF in combination resulted in photoreceptor survival comparable to wild-type retinas after 27 DIV. CNTF + FGF2 or CNTF + GDNF produced a partial prevention of photoreceptor death. Photoreceptor degeneration was not blocked by any of the trophic factors added individually. A significant increase in photoreceptor survival was seen with forskolin added to CNTF, but not to BDNF, FGF2, or GDNF. These results demonstrate that trophic factors promote photoreceptor survival through a synergistic interaction. Increased understanding of receptor interactions and signaling pathways may lead to a potential therapeutic role for combinatorial trophic factors in treatment of photoreceptor dystrophies.

A reliable method for organ culture of neonatal mouse retina with long-term survival

Organ culture systems of the central nervous system have proven to be useful tools for the study of development, differentiation, and degeneration. Some studies have been limited by the inability to maintain the cultures over an extended period. Here we describe an organ culture technique for the mouse retina. This method uses commercially available supplies and reproducible procedures to maintain healthy retinas with normal architecture for 4 weeks in vitro. The system is amenable to quantitative analysis. It can be used with both normal and retinal degeneration (rd) retinas to study of the role of various factors in photoreceptor degeneration in retinal cell fate determination and development.

Photoreceptor transplants increase host cone survival in the retinal degeneration (rd) mouse

Retinal transplants offer a potentially interesting approach to treating human retinal degenerations, but so far little quantitative data are available on possible beneficial effects. We isolated photoreceptor layers from normal-sighted mice and grafted them into the subretinal space of retinal degeneration (rd) mice lacking rod photoreceptors. At 2 weeks after surgery, the numbers of residual host cone photoreceptors outside the graft zone were quantified following specific labelling. Examination of operated retinas revealed highly significantly greater numbers of surviving cones (mean of 38% more at 2 weeks) within the central field compared to sham-operated paired control retinas (p < 0.01). These are the first quantified data indicating a trophic effect of transplanted photoreceptors upon host cone cells. As cone cells are responsible for high acuity and colour vision, such data could have important implications not only for eventual therapeutic approaches to human retinal degenerations but also to understanding underlying interactions between retinal photoreceptors.

Progression of cochlear and retinal degeneration in the tubby (rd5) mouse

Mice homozygous for a defect of the tub (rd5) gene exhibit cochlear and retinal degeneration combined with obesity, and resemble certain human autosomal recessive sensory deficit syndromes. To establish the progressive nature of sensory cell loss associated with the tub gene, and to differentiate tub-related losses from those associated with the C57 background on which tub arose, we evaluated cochleas and retinas from tub/tub, tub/+, and +/+ mice, aged 2 weeks to 1 year by light and electron microscopy. Cochleas from mice of all three genotypes show progressive inner (IHC) and outer hair cell (OHC) loss. Relative to tub/+ and +/+ animals, however, tub homozygotes show accelerated OHC loss, affecting the extreme cochlear base (hook region) by 1 month, and the apex by 6 months. IHC loss in tub/tub animals is accelerated in the basal half of the cochlea, affecting the hook region by 6 months. Spiral ganglion cell losses were observed only in tub/tub mice, and only in the cochlear base. Retinas of tub/tub mice are abnormal at maturity, exhibiting shortened photoreceptor outer segments by 2 weeks, and progressive photoreceptor loss thereafter. Because the tub mutation causes degeneration of sensory cells in the ear and eye but has no other neurological effects, tubby mice hold unique promise for the study of human syndromic sensory loss.

Age-related distribution of cones and ON-bipolar cells in the rd mouse retina

PURPOSE

Retinal dystrophic (rd) mice lose most of their rod photoreceptors within the first three weeks after birth. We determined the age-related distribution of peanut agglutinin lectin (PNA)-labeled cones during the first 12 months of age. We also investigated whether the density of ON-bipolar cells expressing L7 protein was affected by their loss of photoreceptor inputs.

METHODS

rd mice were selected from a transgenic strain which expresses an L7-beta-galactosidase fusion gene localized to ON-bipolar cells. Cones were stained with PNA and ON-bipolar cells with bluo-gal (halogenated indolyl-beta-D-galactoside). Retinas were flat-mounted and observed at 1, 2, 3, 6 and 12 months of age.

RESULTS

PNA-labeled cones are distributed unevenly across the retina at 1 month postnatal. Their concentration decreases first in the central and far peripheral retina, leaving a ring of labeled cells in the midperipheral region. At 3 months, a larger patch of cones remains in the supero-temporal midperipheral region and a smaller patch in the infero-nasal retina. By 6 months, few cones remain in the infero-nasal retina; by 1 year approximately 100 cones remain in the entire retina, localized to the superior midperipheral region. ON-bipolar cells appear evenly distributed at 1 month. By 2-3 months, relatively more bluo-gal staining is seen in the midperipheral regions underlying dense cone populations. At 6-12 months, bluo-gal label is distributed in a spotty pattern with little or no staining seen in areas of apparent neovascularization.

CONCLUSIONS

(1) PNA-labeling of cones in the rd retina deteriorates in a distinct spatial pattern with the longest cone survival in the midperipheral superior retina. (2) ON-bipolar cells are more densely labeled in regions of high cone density during the early months of cone degeneration and, in later stages, show relative decreases in regions of apparent neovascularization.