A novel approach for estimating fertility rates in finite populations using count regression models

Demographic health surveys (DHS) contain in-depth information about the demographic characteristics and the factors affecting them. However, fertility rates which are the important indicators of population growth have been estimated by utilizing the design-based approaches. Model-based approach, on the other hand, facilitates efficient predictive estimates for these rates by utilizing the demographic and other family planning related characters. In this article, we first attempt to observe the effect of various socio-demographic and family planing related factors on births counts by fitting different regression models to Pakistan Demographic Health Survey 2017-2018 data under classical as well as Bayesian frameworks. The births occurred during the time periods of 1-year, 3-years and 5-years are taken as the responses and modeled using different non-linear models. The model-based approach is then used for estimation of the fertility measures including age-specific fertility rates, total fertility rate, general fertility rate, and gross reproduction rate for ever-married women in Pakistan. The performance of the model-based estimators is examined using a bootstrapped sampling algorithm. While the age-specific fertility rates are over-estimated for some age groups and under-estimated for others. The model-based fertility estimates are recommended for estimating the demographic indicators at national and sub-national levels when survey data contains incomplete or missing responses.

Physical health status of individuals convicted of sexual offences: Results from an Australian prisoner cohort

Although the poor health of prisoners poses a serious public health problem, very little is known about the health of specific offender groups. Three waves of an Australian Inmate Health Survey were used to describe the self-reported and objectively tested health of men incarcerated for sexual offences against children only (ISOC), adults only (ISOA), and against both (age-polymorphous; ISOP) compared to men incarcerated without sexual offences. ISOC and ISOP were found to have the poorest self-reported health of all groups, with higher rates of eyesight and cardiovascular problems; however, lower rates of Hepatitis B and Hepatitis C as objectively measured. There are important implications for the correctional and public health systems for addressing the health needs of specific offenders.

Who gets diverted into treatment? a study of defendants with psychosis

The current study aimed to advance our understanding of the factors that influence mental health diversion in Local Courts in New South Wales, Australia. Logistic regression was used to systematically identify the factors that are correlated with diversion in a cohort of individuals (N = 7283) diagnosed with psychosis. Those with a substance-induced psychotic disorder were less likely to be diverted than those with an affective psychosis or schizophrenia, after adjusting for age, gender, Indigenous status, offence seriousness, violence and criminal history. Unexpectedly, those with psychotic disorders committing violent or serious offences were more likely to be diverted than those committing non-violent, less serious offences. Legal representation should be provided to all individuals with serious mental illnesses facing criminal charges. The State-wide Community and Court Liaison Service should be expanded to more Local Courts. Further research is required into why Aboriginal defendants with a psychotic illness are less likely to be diverted.

Mental health service utilisation and reoffending in offenders with a diagnosis of psychosis receiving non-custodial sentences: A 14-year follow-up study

OBJECTIVE

While psychosis is considered a risk factor for offending, little is reported about mental health service utilisation in offenders with psychosis and its relationship with reoffending. We examined the association between contact with mental health services and reoffending in those diagnosed with psychosis.

METHODS

We linked health and offending records in New South Wales (Australia) and identified all individuals with a diagnosis of psychosis and a subsequent offence resulting in a non-custodial sentence between 2001 and 2012. We examined the incidence and risk factors for reoffending, and time to reoffending between 2001 and 2015 using Cox regression and Kaplan-Meier survival methods. We specifically examined the association between clinical contact with community mental health services following the index offence and reoffending.

RESULTS

Of the 7393 offenders with psychosis, 70% had clinical contact and 49% reoffended. There was a linear relationship between an increased number of clinical contacts and reduced risk of reoffending: those with no clinical contact had more than a fivefold risk of reoffending compared to those with the highest number of contacts (adjusted hazard ratio = 5.78, 95% confidence interval = [5.04, 6.62]). Offenders with substance-related psychosis and those convicted of non-violent offences had fewer clinical contacts and higher rates of reoffending when compared with controls (adjusted hazard ratio = 1.29, 95% confidence interval = [1.13, 1.47] and adjusted hazard ratio = 1.26, 95% confidence interval = [1.18, 1.35], respectively).

CONCLUSION

This study supports an association between more frequent mental health service use and reduced risk of reoffending. Efforts to enhance mental health service utilisation in those with psychosis who are at a higher risk of reoffending should be promoted.

Intracanal calcification following regenerative endodontic treatment: a systematic review and meta-analysis

OBJECTIVES

Calcification is a common finding in endodontic cases after regenerative endodontic therapy (RET). We aimed to identify the prevalence of intracanal calcification after RET and to compare intracanal calcification outcomes in RET using either calcium hydroxide [Ca(OH)₂] or antibiotics.

MATERIALS AND METHODS

We searched PubMed, Web of Science, ProQuest Dissertations & Theses, and Scopus databases for clinical, cross-sectional, case-control, and cohort RET studies published until May 2020 in the English language and reporting a calcified case after RET. The Cochrane risk-of-bias tool for randomized trials and Risk of Bias In Non-randomized Studies of Interventions were used for bias assessment. Meta-analyses were performed, overall and separately, for intracanal medicaments using a random-effects model with weighted inverse variance methods. Subgroup analysis was performed according to the calcification type.

RESULTS

Eight studies were included. The overall prevalence of intracanal calcification after RET was 30.7% (95% confidence interval [CI]: 0.15-0.45,[Formula: see text]=92.6%), 46.5% with Ca(OH)₂ vs. 25.8% with antibiotic-based intracanal medicaments. Subgroup analyses for complete calcification outcome showed a higher prevalence of complete calcification in the Ca(OH)₂ group (46.5%, 95% CI: 0.17-0.68,[Formula: see text]%) than in the antibiotic group (10%, 95% CI: - 0.04-0.43,[Formula: see text]%).

CONCLUSIONS

Based on the studies included, available evidence shows a statistically significant association between complete calcification and Ca(OH)₂ paste as an intracanal medicament. Other contributing factors, such as blood clot formation and follow-up time, might also play an essential role in forming intracanal calcification.

CLINICAL RELEVANCE

This study highlights the significant association between complete calcification and Ca(OH)₂ paste.

Mental health service contact following release from prison or hospital discharge in those with psychosis

BACKGROUND

An association exists between psychosis and criminal offending, which evidence suggests can be reduced by effective mental health care for this vulnerable population. However mental health services often lose contact with people after diagnosis. The association between the first episode of psychosis and criminal offending highlights the need for effective mental health care for this vulnerable population.

AIMS

To investigate the association between the first diagnosis of psychosis (FDP) in prison or hospital and subsequent mental health service contact following release from prison or discharge from hospital.

MATERIALS AND METHODS

Individuals with a FDP either in prison (n = 492) or hospital setting (n = 24,910) between July 2006 and December 2011 in NSW (Australia), were followed post-release or discharge until their first mental health service contact in the community, the occurrence of an offence, death, or completion of the study period at the end of December 2012. Cox regression models were used to examine the predictors for the mental health service contacts following release or discharge.

RESULTS

Over 70% of those with a FDP in prison or hospital had a psychosis-related or any community-based mental health service contact following release or discharge between July 2006 and December 2012. Those with a FDP in prison were more likely to have no contact with mental health services than those in hospital with no prior offence record (hazard ratio, HR = 3.14, 95% CI: 2.66-3.72 and adjusted hazard ratio, aHR = 3.05, 95% CI: 2.56-3.63) within a median follow-up time of 25 days for the prison group and 26 days for hospital group. Males, individuals of Aboriginal heritage and individuals diagnosed with substance-related psychoses compared to those with schizophrenia and related psychoses were less likely to have a mental health service contact following release or discharge in both the univariable and multivariable analysis.

CONCLUSION

This study suggests that prior offending or a previous prison episode represents a barrier to mental health service contact in the community for those with a FDP. Effective rehabilitation planning while exiting prison and discharge planning from hospital are essential to the successful reintegration of these individuals with a FDP.

Self-harm and suicidality among three subgroups of male sex offenders: results from an Australian prisoner cohort

OBJECTIVE

Prisoners complete suicide and self-harm more frequently than members of the community. Sex offenders have been found to be at greater risk of engaging in these behaviours. This study examines the characteristics, prevalence, and predictors of self-harm and suicide attempts among: sex offenders that only victimise children (ChildSOs); adults (AdultSOs); or both (age-crossover polymorphous; PolySOs).

METHODS

Data from three waves (1996, 2001, 2009) of the New South Wales (NSW) Inmate Health Survey was linked to the State's re-offending database to identify men with histories of sexual offending. The health surveys captured self-report data on self-harm and suicidality.

RESULTS

Non-sexual violent offenders (15%) and AdultSOs (14%) had the highest rate of self-harm, significantly more than ChildSOs (11%), non-sexual non-violent offenders (10%), and PolySOs (0%). Several factors significantly predicted self-harm at the bivariate level for both ChildSOs and AdultSOs, with unique predictors for each group. At the multivariate level, manic-depression trended towards significance for ChildSOs and any mental health condition remained a significant predictor for AdultSOs who self-harmed relative to AdultSOs who had not (aOR = 11.989, 95%CI [1.14, 126.66]). Approximately 23% of AdultSOs, 22% of PolySOs, and 19% of ChildSOs reported a suicide attempt throughout their lifetime, whereas only 15% of non-sexual non-violent offenders reported an attempt. At the bivariate level, few factors were significant for ChildSOs while several factors were significant for AdultSOs. At the multivariate level, a diagnosis of depression and treatment with psychiatric medication trended towards being significant predictors of suicide attempts for ChildSOs. In contrast, treatment with psychiatric medication (aOR = 25.732, 95%CI [1.91, 347.19])] remained a significant predictor for AdultSOs who attempted suicide relative to AdultSOs who had not, as well as historical psychiatric hospitalisation (aOR = 6.818, 95%CI [1.04, 44.82]) and self-harm (aOR = 5.825, 95%CI [1.31, 25.99]).

CONCLUSION

Sex offenders are at significantly higher risk of attempting and completing suicide relative to non-sexual non-violent offenders and warrant special attention. The prevalence rates and predictors of self-harm and suicidality suggest differences between sex offender subgroups may exist. These hold implications for the criminal justice and public health systems for addressing needs and identifying those most at risk of self-harm and suicide.

Clinical characteristics and predictors of mortality among COVID-19 patients in Saudi Arabia

BACKGROUND

The new coronavirus disease (COVID-19) has caused more than 1.8 million deaths, with a fatality rate of 2.5% in more than 200 countries as of January 4, 2021. Analysis of COVID-19 clinical features can help predict disease severity and risk of mortality, early identification of high-risk patients, and provide knowledge to inform clinical interventions.

OBJECTIVE

The purpose of this study is to investigate the clinical characteristics and possible predictors associated with mortality in patients with COVID-19 admitted to King Fahad (KFH), Ohood, and Miqat hospitals in Madina, Saudi Arabia.

METHODS

This retrospective observational study to investigate the clinical characteristic and possible predictors associated with mortality for those 119 mild, moderate, or critically ill patients confirmed by laboratory results to have COVID-19 who were admitted to three hospitals in Madina, Saudi Arabia, from March 25, 2020, to July 30, 2020. Data were collected from December 1, 2020, to December 14, 2020.

RESULTS

Of the 119 patients included in the study, the mean age was 54.2 (±15.7) years, with 78.2% survivors and 21.8% non-survivors. The demographic analysis indicated that the likelihood of mortality for patients in the older age group (i.e., ≥65 years) was five times higher than those in the younger age group (OR = 5.34, 95% CI 1.71-16.68, p = 0.004). The results also indicated those patients who admitted to the intensive care unit (ICU) was approximately seven times higher odds of mortality compare with those who were not admitted (OR = 6.48, 95% CI 2.52-16.63, p < 0.001). In addition, six laboratory parameters were positively associated with the odds of mortality: white blood cell count (OR = 1.11, 95% CI 1.02-1.21, p = 0.018), neutrophil (OR = 1.11, 95% CI 1.02-1.22, p = 0.020), creatine kinase myocardial band (OR = 1.02, 95% CI 1.00-1.03, p = 0.030), C-reactive protein (OR = 1.01, 95% CI 1.00-1.01, p = 0.002), urea (OR = 1.06, 95% CI 1.01-1.11, p = 0.026), and lactate dehydrogenase (OR = 1.00, 95% CI 1.00-1.01, p = 0.020).

CONCLUSIONS

In this cohort, COVID-19 patients within the older age group (≥65 years) admitted to the ICU with increased C-reactive protein levels in particular, were associated with increased odds of mortality. Further clinical observations are warranted to support these findings and enhance the mapping and control of this pandemic.

Disengagement from mental health treatment and re-offending in those with psychosis: a multi-state model of linked data

BACKGROUND AND AIMS

Individuals with psychosis are over-represented in the criminal justice system and, as a group, are at elevated risk of re-offending. Recent studies have observed an association between increased contacts with mental health services and reduced re-offending, as well as reduced risk of re-offending in those who are ordered to mental health treatment rather than punitive sanctions. In furthering this work, this study examines the effect of disengagement from mental health treatment on probability of re-offence in offenders with psychosis over time.

METHODS

Data linkage was conducted with judicial, health and mortality datasets from New South Wales, Australia (2001-2015). The study population included 4960 offenders with psychosis who received non-custodial sentences and engaged with community-based mental health treatment. Risk factors for leaving treatment and/or reconviction were examined using multivariate cox regression. Further, a multi-state model was used to observe the probabilities associated with individuals moving between three states: conviction, disengagement from mental health treatment and subsequent re-conviction.

RESULTS

A threefold increase was observed in the risk of re-offending for those who disengaged from treatment compared to those who did not (aHR = 2.76, 95% CI 1.65-4.62, p < 0.001). The median time until re-offence was 195 days, with the majority (67%) being convicted within one year of leaving treatment. A higher risk of leaving treatment was found for those born outside of Australia, with substance-related psychosis, and a history of violent offence.

CONCLUSIONS

The findings argue for an emphasis on continued engagement with mental health services following release for offenders with psychosis and identify subgroups within this population for whom concentrated efforts regarding treatment retention should be targeted.

Association Between Early Contact With Mental Health Services After an Offense and Reoffending in Individuals Diagnosed With Psychosis

IMPORTANCE

Psychosis is a known risk factor for offending behavior, but little is known about the association between clinical contact with mental health services after an offense and reoffending.

OBJECTIVE

To examine the association between early contact with mental health services and reoffending after an index offense in individuals with psychosis.

DESIGN, SETTING, AND PARTICIPANTS

In this cohort study, individuals diagnosed with psychosis before their index offense from July 1, 2001, to December 31, 2012, and who received a noncustodial sentence were identified by linking health and offending databases in New South Wales, Australia. The incidence of and risk factors for reoffending and time to reoffending within 2 years from the index offense were examined using Cox proportional hazards regression and Kaplan-Meier survival estimates. Specifically, the association between contact with mental health services within 30 days after an offense and reoffending was examined. Data were analyzed from July 1, 2019, to March 5, 2020.

EXPOSURES

Hospital admission, emergency department presentation, and contact with community mental health services associated with psychosis.

MAIN OUTCOMES AND MEASURES

Reoffending within 2 years of the index offense was compared in individuals with and without clinical contact with mental health services within 30 days after an offense, with adjustment for potential confounders.

RESULTS

Of the 7030 offenders with psychosis (4933 male [70.2%]; median age at the index offense, 34 [interquartile range, 26-42] years), 2605 (37.1%) had clinical contact with mental health services within 30 days after the index offense. The risk of reoffending was significantly lower in those with vs without clinical contact (adjusted hazard ratio [AHR], 0.83; 95% CI, 0.76-0.91). The risk of reoffending was 30% less in male offenders with 5 or more clinical contacts compared with male offenders with no clinical contact (AHR, 0.71; 95% CI, 0.59-0.84). Reoffending in both male and female offenders was associated with younger age (eg, AHR for male offenders aged <18 years, 3.31 [95% CI, 2.39-4.59]; AHR for female offenders aged <18 years, 2.60 [95% CI, 1.69-3.99]) and offending history (eg, AHR for male offenders with ≥4 prior offenses, 2.28 [95% CI, 1.98-2.64]; AHR for female offenders with ≥4 prior offenses, 2.22 [95% CI, 1.67-2.96]).

CONCLUSIONS AND RELEVANCE

In this cohort, early and frequent clinical contact with mental health services after an offense in individuals with psychosis was associated with reduced risk of reoffending in this group. More support may be needed for early treatment of those with serious mental illness who are at risk of reoffending.

First diagnosis of psychosis in the prison: results from a data-linkage study

BACKGROUND

Psychosis is more prevalent among people in prison compared with the community. Early detection is important to optimise health and justice outcomes; for some, this may be the first time they have been clinically assessed.

AIMS

Determine factors associated with a first diagnosis of psychosis in prison and describe time to diagnosis from entry into prison.

METHOD

This retrospective cohort study describes individuals identified for the first time with psychosis in New South Wales (NSW) prisons (2006-2012). Logistic regression was used to identify factors associated with a first diagnosis of psychosis. Cox regression was used to describe time to diagnosis from entry into prison.

RESULTS

Of the 38 489 diagnosed with psychosis for the first time, 1.7% (n = 659) occurred in prison. Factors associated with an increased likelihood of being diagnosed in prison (versus community) were: male gender (odds ratio (OR) = 2.27, 95% CI 1.79-2.89), Aboriginality (OR = 1.81, 95% CI 1.49-2.19), older age (OR = 1.70, 95% CI 1.37-2.11 for 25-34 years and OR = 1.63, 95% CI 1.29-2.06 for 35-44 years) and disadvantaged socioeconomic area (OR = 4.41, 95% CI 3.42-5.69). Eight out of ten were diagnosed within 3 months of reception.

CONCLUSIONS

Among those diagnosed with psychosis for the first time, only a small number were identified during incarceration with most identified in the first 3 months following imprisonment. This suggests good screening processes are in place in NSW prisons for detecting those with serious mental illness. It is important these individuals receive appropriate care in prison, have the opportunity to have matters reheard and possibly diverted into treatment, and are subsequently connected to community mental health services on release.

DECLARATION OF INTEREST

None.

Court diversion for those with psychosis and its impact on re-offending rates: results from a longitudinal data-linkage study

BACKGROUND

With significant numbers of individuals in the criminal justice system having mental health problems, court-based diversion programmes and liaison services have been established to address this problem.AimsTo examine the effectiveness of the New South Wales (Australia) court diversion programme in reducing re-offending among those diagnosed with psychosis by comparing the treatment order group with a comparison group who received a punitive sanction.

METHOD

Those with psychoses were identified from New South Wales Ministry of Health records between 2001 and 2012 and linked to offending records. Cox regression models were used to identify factors associated with re-offending.

RESULTS

A total of 7743 individuals were identified as diagnosed with a psychotic disorder prior to their court finalisation date for their first principal offence. Overall, 26% of the cohort received a treatment order and 74% received a punitive sanction. The re-offending rate in the treatment order group was 12% lower than the punitive sanction group. 'Acts intended to cause injury' was the most common type of the first principal offence for the treatment order group compared with the punitive sanction group (48% v. 27%). Drug-related offences were more likely to be punished with a punitive sanction than a treatment order (12% v. 2%).

CONCLUSIONS

Among those with a serious mental illness (i.e. psychosis), receiving a treatment order by the court rather than a punitive sanction was associated with reduced risk for subsequent offending. We further examined actual mental health treatment received and found that receiving no treatment following the first offence was associated with an increased risk of re-offending and, so, highlighting the importance of treatment for those with serious mental illness in the criminal justice system.