Multidimensional assessment of criminal recidivism: Problems, pitfalls, and proposed solutions.

All states have statutes in place to civilly commit individuals at high risk for violence. The authors address difficulties in assessing such risk but use as an example the task of predicting sexual violence recidivism; the principles espoused here generalize to predicting all violence. As part of the commitment process, mental health professionals, who are often psychologists, evaluate an individual's risk of sexual recidivism. It is common for professionals conducting these risk assessments to use several actuarial risk prediction instruments (i.e., psychological tests). These tests rarely demonstrate close agreement in the risk figures they provide. Serious epistemological and psychometric problems in the multivariate assessment of recidivism risk are pointed out. Sound psychometric, or in some cases heuristic, solutions to these problems are proffered, in the hope of improving clinical practice. The authors focus on how to make these tests' outputs commensurable and discuss various ways to combine them in coherent, justifiable fashions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cancer mortality among atomic bomb survivors exposed in utero or as young children, October 1950-May 1992

Improvements in workplace health among silica exposed workers followed demonstrations of the severity of the risk of silicosis and means of controlling high dust levels on the job. Current ambient environmental analyses include either an adoption of air quality goals for reducing emissions of criteria pollutants or the conduct of risk assessments to determine if regulatory procedures are needed. Although silica has been regulated as a workplace hazard for most of the 20th century, only recently has it been considered for ambient control, and most of the thrust for this action has evolved from environmental regulatory work in California, where both state initiative (Proposition 65) and legislative law (Air Toxics Hot Spots Information and Assessment Act; Assembly Bill number 2588) have required risk assessments for silica dust emissions as carcinogens.     

Review of Assessing and managing violence risk in juveniles.

Reviews the book, Assessing and managing violence risk in juveniles by Randy Borum and David Verhaagen (see record 2006-12484-000). This book is a compilation of research findings designed to accomplish the goal of equipping the reader to "conduct risk assessments that are thorough, fair, helpful, and developmentally and empirically sound." New school psychologists will find an excellent framework for learning how to approach the daunting task of assessing risk of violence in children and adolescents. Experienced practitioners will find new research results integrated throughout the book to improve the precision of their risk assessments as well. This book is written for mental health professionals in schools, therapy settings, and juvenile justice systems. Although these three contexts are presented as very different from each other (differences in treatment plans are noted), the basic principles of assessment are applicable to all. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief psychotherapy and psychological assessments: Entering a relationship, establishing a focus, and providing feedback.

Brief psychotherapy is aimed at facilitating change within a circumscribed time frame. To do this, therapists in this specialty actively engage clients, establish a focus to the treatment, and provide ongoing feedback throughout treatment. The authors show how using these features of brief psychotherapy in the assessment process can enhance the clinical usefulness of an assessment. By also incorporating an emphasis on respect for the client, in line with existential/client-centered principles, psychological assessments can be made more personally relevant and meaningful for the client. The approach outlined has been useful within a hospital-based, adult inpatient and outpatient mental health service in which assessments are conducted before starting psychotherapy or as clinical activities in themselves (e.g., psychodiagnosis). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Breast-feeding exposure of infants to cadmium, lead, and mercury: a public health viewpoint

The purpose of this report is to provide an overview of the public health implications of exposure via breast milk to cadmium, lead, and mercury for nursing infants and to provide health-based guidance. Daily intakes were calculated and compared with guidance values used for public health assessments at hazardous waste sites. Cadmium, lead, and mercury under normal conditions are found in breast milk at concentration ranges of < 1 microgram/L, 2-5 micrograms/L, and 1.4-1.7 micrograms/L, respectively. Women exposed environmentally or occupationally can have higher levels in their breast milk. Concentrations of about 5 micrograms/L (cadmium), 20 micrograms/L (lead), and 3.5 micrograms/L (mercury) appear to be adequate screening levels. Many factors affect both the distribution of cadmium, lead, and mercury in breast milk and the health consequences to an infant. It is not clear what additional impact low-level exposure via breast milk may have on an infant born with a body burden to one of these metals. There is sufficient evidence to make the case that contaminated breast milk is a source of potential risk to infants in certain populations. Prevention strategies that include behavior modification and proper nutrition should be communicated to women at risk. Identification and elimination of exposure pathways and a critical analysis of the benefits of breast feeding versus heavy metal exposure are needed on a site-specific or individual basis. Research is required to better understand the impact of low-level exposure to heavy metals via breast milk. Breastfeeding should be encouraged under most circumstances.     

Associative tolerance to nicotine analgesia in the rat: Tail-flick and hot-plate tests.

Previous assessments of associative nicotine tolerance may have confounded associative effects with novelty-induced stress effects, instrumental learning effects, or both. That is, subjects were tested in novel environments, allowed to practice the test response, or both during the tolerance development phase. In the first study, 32 male Sprague-Dawley rats were injected with various doses of nicotine and tested for nociception in the tail-flick and hot-plate tests to assess nicotine's analgesic effects. In the second study, 35 rats received nicotine explicitly paired or unpaired with a distinctive test context. All animals were equally preexposed to the test environment, and none had the opportunity to practice the test response. Paired rats developed greater nicotine tolerance than unpaired rats. This context-dependent (associative) tolerance effect was found with both tail-flick and hot-plate tests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of behavioral experience in judging risks.

This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10–30; N?=?577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dose-response relationships for polyhalogenated dioxins and dibenzofurans following subchronic treatment in mice. I. CYP1A1 and CYP1A2 enzyme activity in liver, lung, and skin

The dose-response relationships for induction of liver, lung, and skin ethoxyresorufin-O-deethylase (EROD) activity and liver acetanilide-4-hydroxylase (ACOH) activity following subchronic exposure to either 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), 1,2,3,7,8-pentachlorodibenzo-p-dioxin, 2,3,7,8-tetrabromodibenzo-p-dioxin, 2,3,7,8-tetrachlorodibenzofuran (TCDF), 1,2,3,7,8-pentachlorodibenzofuran (1-PeCDF), 2,3,4,7,8-pentachlorodibenzofuran (4-PeCDF), or octachlorodibenzofuran (OCDF) were determined in female B6C3F1 mice in order to estimate the relative enzyme inducing potency of these chemicals in three different tissues. The relative potencies were calculated based on tissue concentrations as well as administered dose. A dose-dependent induction of EROD activity in liver, lung, and skin and of ACOH activity in liver was found for all seven chemicals. When based on administered dose, the relative potencies for specific congeners did not vary substantially among tissues. The relative potencies for TCDF and 1-PeCDF, congeners which have much shorter half-lives than TCDD, increased for all enzymes when estimated from tissue concentrations. The relative potency of OCDF, which is poorly absorbed, was greater when estimated from tissue concentrations than when estimated from administered dose. 4-PeCDF is highly sequestered in hepatic tissue and when the relative potency was estimated based on tissue concentration, its potency for skin enzyme induction increased. These data indicate that the relative potency of these chemicals is influenced not only by the relative binding affinity to the Ah receptor, but also by differences in pharmacokinetic properties of these chemicals. In addition, it may be useful to derive two sets of toxic equivalency factor values, one used for estimating intake equivalents and the other for estimating tissue equivalents.     

Latex allergens: review of current knowledge

Both health care workers and spina bifida patients are at risk to develop type I latex allergy since allergenic proteins of natural rubber latex are present in a variety of latex products. Natural latex contains more than 250 polypeptides and approximately 60 of them show IgE-binding characteristics. A multitude of these latex allergens has been identified, and their sensitization potency for both risk groups has been determined. While hevein (Hev b 6.02) is the major allergen in latex-allergic health care workers, 80% of latex sensitized-spina bifida children have IgE antibodies to the "rubber elongation factor" (Hev b 1). Almost all relevant latex allergens have been identified in natural latex products: however, no data on the allergen profiles of individual latex products exist. The knowledge of the major latex allergens enables improved diagnosis and to monitor the success of prevention strategies for decreasing the high prevalence of latex allergies.     

Decompression comparison of helium and hydrogen in rats

The hypothesis that there are differences in decompression risk between He and H2 was examined in 1,607 unanesthetized male albino rats subjected to dives on 2% O2-balance He or 2% O2-balance H2 (depths < or = 50 ATA, bottom times < or = 60 min). The animals were decompressed to 10.8 ATA with profiles varying from rapid to slow, with up to four decompression stops of up to 60 min each. Maximum likelihood analysis was used to estimate the relative decompression risk on a per unit pressure basis (termed "potency") and the rate of gas uptake and elimination, both factors affecting the decompression sickness risk, from a specific dive profile. H2 potency for causing decompression sickness was found to be up to 35% greater than that for He. Uptake rates were unresolvable between the two gases with the time constant (TC) estimated at approximately 2-3 min, leading to saturation in both cases in < 15 min. Washout of both gases was significantly slower than uptake, with He washout (TC approximately 1.5-3 h) substantially slower than H2 washout (TC approximately 0.5 h). It is unknown whether the decompression advantage of the faster washout of H2 or the disadvantage of its increased potency, observed in the rat, would be important for human diving.     

Ethical and competent care of suicidal patients: Contemporary challenges, new developments, and considerations for clinical practice.

Clinical work with suicidal patients has become increasingly challenging in recent years. It is argued that contemporary issues related to working with suicidal patients have come to pose a number of considerable professional and even ethical hazards for psychologists. Among various concerns, these challenges include providing sufficient informed consent, performing competent assessments of suicidal risk, using empirically supported treatments/interventions, and using suitable risk management techniques. In summary, there are many complicated clinical issues related to suicide (e.g., improvements in the standard of care, resistance to changing practices, alterations to models of health care delivery, the role of research, and issues of diversity). Three experts comment on these considerations, emphasizing acute versus chronic suicide risk, the integration of empirical findings, effective documentation, graduate training, maintaining professional competence, perceptions of medical versus mental health care, fears of dealing with suicide risk, suicide myths, and stigma/blame related to suicide. The authors' intention is to raise awareness about various suicide-related ethical concerns. By increasing this awareness, they hope to compel psychologists to improve their clinical practices with suicidal patients, thereby helping to save lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risks and prevention of contamination of dairy products

Consumers and regulatory officials are becoming increasingly aware of the human health risk of the presence of micro-organisms or chemicals in the agricultural environment. Providing 'on-farm food safety' programmes which address the daily management of the production unit with regard to animal health and well-being, public health and environmental health must be a top priority for agriculturalists and veterinarians. Developing critical control point management (CCPM) procedures for animal and human health concerns is a viable approach to aid in alleviating public concerns about dairy products and the food supply in general. Such CCPM programmes may be created for individual production units based upon risk analysis, total quality management and hazard analysis and critical control point principles. Implementation of these programmes will be essential both in addressing food safety concerns for the resident population of a nation and in developing or maintaining international markets for the export of animal products.     

Cognitive and emotional factors predicting decisional conflict among high-risk breast cancer survivors who receive uninformative BRCA1/2 results.

Objective: To investigate high-risk breast cancer survivors' risk reduction decision making and decisional conflict after an uninformative BRCA1/2 test. Design: Prospective, longitudinal study of 182 probands undergoing BRCA1/2 testing, with assessments 1-, 6-, and 12-months postdisclosure. Measures: Primary predictors were health beliefs and emotional responses to testing assessed 1-month postdisclosure. Main outcomes included women's perception of whether they had made a final risk management decision (decision status) and decisional conflict related to this issue. Results: There were four patterns of decision making, depending on how long it took women to make a final decision and the stability of their decision status across assessments. Late decision makers and nondecision makers reported the highest decisional conflict; however, substantial numbers of women—even early and intermediate decision makers—reported elevated decisional conflict. Analyses predicting decisional conflict 1- and 12-months postdisclosure found that, after accounting for control variables and decision status, health beliefs and emotional factors predicted decisional conflict at different timepoints, with health beliefs more important 1 month after test disclosure and emotional factors more important 1 year later. Conclusion: Many of these women may benefit from decision making assistance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An introduction to the use of physiologically based pharmacokinetic models in risk assessment

Many extrapolation issues surface in quantitative risk assessments. The extrapolation from high-dose animal studies to low-dose human exposures is of particular concern. Physiologically based pharmacokinetic (PBPK) models are often proposed as tools to mitigate the problems of extrapolation. These models provide a representation of the disposition, metabolism, and excretion of xenobiotics that are believed to possess the potential of inducing adverse human health responses. Given a model of xenobiotic disposition that is applicable for multiple species and appropriate for nonlinearity of the xenobiotic biotransformation process, better extrapolation may be possible. Unfortunately, the true structure of these models (e.g. number of compartments, type of metabolism, etc.) is seldom known, and attributes of these models (tissue volumes, partition coefficients, etc.) are often experimentally determined and often only central measures of these quantities are reported. We describe the use of PBPK models in risk assessment, the structural and parameter uncertainty in these models, and provide a simple illustration of how these characteristics can be incorporated in a statistical analysis of PBPK models. Additional complexity in the analysis of variability in the models is also outlined. This discussion is illustrated using data from methylene chloride.     

Practical and ethical assessment issues in rural, impoverished, and managed care settings.

The rising costs of new psychological tests, increased frequency of test revisions, and difficulty receiving authorization and reimbursement from managed care companies make it increasingly difficult for practitioners to provide the best standard of care to clients when conducting psychological and neuropsychological assessments. Practitioners, especially those in low-income and rural areas, may struggle with handling these practical realities while maintaining ethical standards in conducting psychological assessment. Suggestions for how to manage practical challenges faced by practitioners who provide psychological assessments, such as selecting tests when authorization or reimbursement by a third-party payer is restricted or denied, purchasing psychological tests on a budget, and providing assessments with a limited number of qualified staff are discussed. The authors also provide recommendations for the future prevention of these challenges through work with test developers, test publishing corporations, third-party payers, political action groups, and the psychology profession itself. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current challenges to the principles of medical law and their new interpretation

The traditional function of the principles of medical law has been to protect the person of the patient against the use of power in health care. These principles have not generally been seen as factors which would also protect the patient economically. An analysis of the significance of the use of power in health care and a review of the field of damage sustained through erroneous procedures in the care relationship, make it possible to observe that the patient's need for legal protection is particularly great not only as regards factors related to the person, but also as regards the finances of the patient. On the other hand, evaluation of the relevant contents of the principles shows beyond doubt that they are to be conceived of generally as norms safeguarding the patient's rights. In Western countries in particular, where some years ago an economic recession set in, serious note should be taken of the wider interpretation of the principles of medical law as one potential means of furthering the well-being of the patient. In the application of legal rules affecting the legal position of the patient the principles of medical law may--like legal principles in general--be utilized both to guide the choice of a solution norm and to complement/ specify the solution norm. In both these roles the principles yield criteria for application of the law which lead to the taking into consideration of aspects relating to the patient's financial interests and assessments.     

Monitoring challenges: A closer look at parental monitoring, maternal psychopathology, and adolescent sexual risk.

The present study sought to examine associations between maternal psychopathology, parental monitoring, and adolescent sexual activity among adolescents in mental health treatment. Seven hundred ninety mother-adolescent dyads recruited from adolescent mental health treatment settings completed audio computer-assisted structured interview assessments examining parent psychiatric symptoms, parental monitoring, and adolescent sexual risk behavior. Path analysis was used to examine the associations between variables of interest. Maternal caregivers who reported more mental health symptoms were more likely to have adolescents who reported recent sex and this relationship was mediated by less parental monitoring. These findings suggest that maternal caregivers with mental health symptoms may need specific interventions that provide assistance and support in monitoring their teens in order to reduce sexual risk taking among adolescents in mental health treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Scope and significance of eating disorders.

Anorexia nervosa and bulimia are major health concerns in many industrialized societies. Both disorders appear to be increasing in prevalence, and both (particularly anorexia nervosa) are associated with significant morbidity and mortality. Genetic studies have suggested that there may be a genetic risk for the development of anorexia nervosa. Various treatment strategies have been advocated for these conditions. Both pharmacotherapy and psychotherapy, particularly psychotherapy that incorporates cognitive-behavioral principles, appear to be useful. Recent biological studies on appetite and weight regulation are beginning to yield findings of clinical significance in the treatment of these disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric disorders and sexual risk among adolescents in mental health treatment.

Objective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited. Method: Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI). Results: Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder. Conclusions: The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

International bank for foot-and-mouth disease vaccine: assessment of Montanide ISA 25 and ISA 206, two commercially available oil adjuvants

The International Vaccine Bank at Pirbright has recently installed large-scale vaccine formulation equipment for the preparation of oil-adjuvanted vaccines. Such vaccines are claimed to offer a number of advantages over Al(OH)3, particularly their ability to raise better immunity in pigs. This paper reports on the potency in pigs, cattle and guinea-pigs of foot-and-mouth disease vaccines prepared with two novel oil adjuvants, Montanide ISA 25 and 206 (Seppic, Paris). The results indicate that vaccines adjuvanted with these oils retain potency for a longer period than our conventional aqueous formulation, following storage at +4 degrees C, and elicit good antibody responses in both pigs and cattle regardless of injection route. In addition they gave no evidence of toxicity or prolonged pyrexia following their administration. Local reactions at the site of inoculation were not observed in cattle vaccinated intramuscularly, even following a booster dose. Pigs vaccinated intramuscularly only showed local reactions if the volume administered exceeded the 2.0 ml dose or the animals received a second vaccination. These observations on the efficacy of such oil formulated vaccines suggest that they have potential as an alternative to the current aqueous formulation.