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Introduction Methods Results Conclusions Research has largely conceptualized suicidal ambivalence as the difference between one's wish to live and wish to die without fully considering other suicide ideation (SI) experiences included on measures like the Beck Scale for Suicide Ideation (BSS). We utilized BSS items to identify SI latent classes and examined relevant correlates and outcomes.We collected self‐report data from two samples of US adults who: (1) self‐identified as LGBTQ+ (N = 349; cross‐sectional) and (2) self‐reported past‐week SI (BSS score ≥ 11; N = 133; 3 timepoints).Latent class analyses supported three‐class (Sample 1) and four‐class solutions (Sample 2), which included ambivalent classes. In Sample 1, sexual orientation, gender, depression, anxiety, SI, and suicide‐specific rumination were concurrently associated with class membership. In Sample 2, depression, SI, suicide‐specific rumination, and physical/psychological distance from suicide methods were concurrently associated with class membership. In Sample 2, at both follow‐ups, suicide plans/preparations and Acute Suicidal Affective Disturbance symptom frequencies were provided by class membership, and suicidal intent significantly differed by class membership.SI classes differed by sample and evidenced nuances in SI and suicidal ambivalence. Risk factors and suicide‐related outcomes also differed by class membership. Implications and limitations are discussed. [ABSTRACT FROM AUTHOR]

This study aimed to determine a typical profile of elite breath-hold divers (BHDs), in relation to loss of consciousness (LOC) and episodic memory. Forty-four BHDs were evaluated during a world championship with anthropometric and physiological measurements, psychosociological factors and memory assessment. Seventy-five percent of the BHDs had at least one LOC with the predominance being men (p < 0.05). Thirty six percent of BHDs presented a low-risk profile and 64% a high-risk profile with no particular psychological pattern. Stepwise multiple linear regression showed that body fat, years of BH practice, age and forced vital capacity explained a significant amount of the variance of LOC for all BHDs (F(4,39) = 16.03, p < 0.001, R2 = 0.622, R2Adjusted = 0.583). No correlation was found between resting physiological parameters and their training or depth performances. In conclusion, anthropometric data, pulmonary factors and breath-holding experience were predictive of LOC in elite BHDs, with men taking more risks. BHDs episodic memory was not impaired. [ABSTRACT FROM AUTHOR]

Research indicates that there is a strong association between childhood adversity and youth suicide and self-harm. However, there is currently a lack of understanding about the patterns of adversity most frequently experienced by youth across social settings, and whether these typologies differently predict youth engagement in suicide and self-harm. This study examines the dominant patterns of adversity experienced by adolescents across home, peer, and school contexts, and explores the relationship between youth's adversity profiles and their suicide and self-harm outcomes, across a two year period (2020–2022). Secondary analyses were performed on data collected from 10,281 (50 % male) adolescents who participated in the Irish Planet Youth questionnaire in 2020 (n = 5004) or 2022 (n = 5277). Findings from clustered latent class analyses indicated that there are four dominant profiles of adversity experienced by adolescents. Class 1 (Multiple Adversity) was characterised by a high probability of experiencing adversity across multiple social settings. Class 2 (Parent Adversity) had a strong likelihood of experiencing adversity with parents. Class 3 (Peer Adversity) were likely to experience adversity within the peer/friend domain. Class 4 was characterised by a low probability of experiencing adversity. Findings from logistic regression models with BCH training weights indicated that there were significant differences in self-harm and suicidality across the adversity classes. In comparison to the low adversity group, adolescents in the multiple adversity group were more likely to self-harm and attempt suicide. These findings are based on cross-sectional data and rely on the use of single-item measurements, which may limit the generalisability of findings. Results indicate that youth who experience adversity across home, peer and school contexts are at the greatest risk of engaging in suicide and self-harm. These findings have important implications for policy and practice, and suggest that youth experiencing adversity across multiple settings should be priority targets for intervention. • Youth who experience adversity are at greater risk of suicide and self-harm. • Youth who experience adversity across multiple settings are most at risk. • Greater consideration of the context in which adversity is experienced is needed. [ABSTRACT FROM AUTHOR]

Background: Heavy alcohol use is a growing risk factor for chronic disease, yet little is known about its co‐occurrence with other risk factors and health problems. This study aimed to identify risk profiles of adults with heavy alcohol use and examined potential disparities by race and ethnicity. Methods: This cross‐sectional study included 211,333 adults with heavy alcohol use (in excess of daily or weekly limits recommended by National Institute on Alcohol Abuse and Alcoholism) between June 1, 2013 and December 31, 2014 in Kaiser Permanente Northern California. Latent class analysis was used to examine how heavy drinking patterns clustered with other behavioral and metabolic risk factors and health problems to form risk profiles. Multinomial logistic regression models were fit to examine associations between race, ethnicity, and risk profiles. Results: A 5‐class model was selected as best fitting the data and representing clinically meaningful risk profiles: (1) "heavy daily drinking and lower health risks" (DAILY, 44.3%); (2) "substance use disorder and mental health disorder" (SUD/MH, 2.3%); (3) "heavy weekly drinking and lower health risks" (WEEKLY, 19.6%); (4) "heavy daily drinking and more health risks" (DAILY‐R, 18.5%); (5) "heavy weekly drinking and more health risks" (WEEKLY‐R, 15.3%). American Indian or Alaska Native (AIAN) and Black patients had higher odds than White patients of being in the SUD/MH, DAILY‐R, and WEEKLY‐R profiles than the DAILY profile. AIAN, Black, and Latino/Hispanic patients had higher odds than White patients of being in the SUD/MH, DAILY‐R, and WEEKLY‐R profiles rather than the WEEKLY profile. Conclusions: AIAN, Black, and Latino/Hispanic patients with self‐reported heavy drinking were more likely to be in risk profiles with greater alcohol consumption, more health risks, and higher morbidity. Targeted, culturally appropriate interventions for heavy alcohol use that may address other modifiable risk factors are needed to work towards health equity. [ABSTRACT FROM AUTHOR]

Annemarie Voss,1 Bianca Kollhorst,2 Katharina Platzbecker,1 Ute Amann,1 Ulrike Haug1,3 1Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 2Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 3Faculty of Human and Health Sciences, University of Bremen, Bremen, GermanyCorrespondence: Ulrike Haug, Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany, Tel +49 421 218 56862, Email haug@leibniz-bips.dePurpose: Over the last decade, the use of direct oral anticoagulants (DOACs) has strongly increased. We aimed to describe and compare risk profiles including potential changes over time among persons with non-valvular atrial fibrillation initiating treatment with different DOACs or phenprocoumon (vitamin K antagonist) between 2011 and 2019 in Germany.Patients and Methods: Using the German Pharmacoepidemiological Research Database (GePaRD; claims data of ~20% of the German population), we identified persons with a first dispensing of phenprocoumon or a DOAC and a diagnosis of non-valvular atrial fibrillation between August 2011 and December 2019. We described the morbidity of included patients prior to treatment initiation, stratified by year of treatment initiation.Results: Overall, we included 448,028 new users (phenprocoumon: N = 118,117, rivaroxaban: N = 130,997, apixaban: N = 130,300, edoxaban: N = 38,128, dabigatran: N = 30,486). Comparing new DOAC users in 2019, the proportion with prior ischemic stroke was highest for dabigatran (17%) and lowest for rivaroxaban (8%). The proportion with prior major bleeding was also highest for dabigatran (25%) and lowest for edoxaban (20%). New users of apixaban were oldest and, eg, showed the highest prevalence of congestive heart failure. Changes over time were most pronounced for phenprocoumon. For example, among persons initiating phenprocoumon in 2012 vs 2019, the proportion with prior major bleeding increased from 18% to 35%; the proportion with renal disease increased from 20% to 36% and the proportion with liver disease from 18% to 24%.Conclusion: This study demonstrated differences in risk profiles between new users of different oral anticoagulants and substantial changes over time among new phenprocoumon users. These differences have to be considered in head-to-head comparisons of these drugs based on observational data, especially regarding potential unmeasured confounding.Keywords: atrial fibrillation, oral anticoagulants, direct oral anticoagulants, DOACs, risk profiles

Abstract Background Cardiovascular diseases (CVD) are a precursor for disabilities and death worldwide. Being overweight or obese in combination with physical inactivity and smoking habits may increase the risk for CVD and other health problems such as lower limb osteoarthritis, diabetes, stroke, and various cancer types among children and adolescents. The literature emphasizes the need to follow such groups and evaluate the risk of individuals developing CVD diseases. Therefore, the current study explores the variety of cardiovascular risks in children and adolescents’ profiles clusters with and without disabilities. Methods Data from 42 countries including Israel, was collected with the support of the world health organization (WHO, Europe) through a questionnaire from 11–19 years old school-aged. Results The study finding shows that children and adolescents with disabilities demonstrated a higher prevalence of overweight than those who completed the HBSC youth behavior survey. Moreover, the prevalence of tobacco smoking and alcohol use was statisticaly significantly higher among the disabled group than the non-disabled group. In addition, socioeconomic status of responders who presented a very high CVD risk was found as significantly lower than those from the first and second low risk groups. Conclusion This led to the conclusion that children and adolescents with disability were at a higher risk of developing CVDs than their non-disabled peers. In addition, intervention programs tailored to the needs of adolescents with disability should consider lifestyle habit change and promoting healthy living thus improving their quality of life as well as reducing their risk of being exposed to severe CVD diseases.

This paper discusses how Carnegie Mellon University launched a cyclical enterprise risk management framework that incorporates both emergency preparedness and response and business continuity into its purview, to deliver greater organisational resiliency. The paper goes on to describe the governance structure that defines roles and responsibilities throughout the organisation, before discussing how faculty, staff and students are engaged and educated to sense risks, and to collaborate with leadership at all levels in prioritising risks for deep-dive assessments and employing feedback loops to support continuous process improvement. As the paper will show, these cyclical practices support organisational resiliency and a greater sense of risk consciousness. [ABSTRACT FROM AUTHOR]

Identifying factors that predict higher levels of children's subjective well-being (SWB) is imperative for practice and policy implications. The current study explored latent subgroups of risks characterized by various dimensions of child well-being and investigated whether the latent risk groups were associated with children's SWB across 16 nations. The moderating role of subjective child rights as a protective factor in the relationship between latent risk profiles and children's SWB was also examined. Data of children aged 12 years from the second wave of the International Survey of Children's Well-Being (N = 19,212) was analyzed. Latent profile analysis was used to identify risk profiles based on children's different risk experiences, and subsequently, multilevel regression analysis was used to identify whether group membership predicted SWB. Five latent profiles were identified: low, moderate, dual, material, and victimization risk groups. Findings revealed the concurrent nature of risks in children's lives, as they are often exposed to deficiencies across multiple domains, rather than just one. Multilevel regression analysis results signified that membership in any risk profile is linked with lower SWB of children when compared to the low risk group and highlighted the significant conditioning role of subjective child rights in the relationship between the risk profiles and SWB. Policymakers should be aware of the co-experience of multiple risk factors and devise policies that meet the needs of various groups of children at risk and advocate children as rights holders to further help children with co-occurring risks attain a higher level of SWB. [ABSTRACT FROM AUTHOR]

Research suggests that exposure to adversity can lead to an increased risk of experiencing suicidal and self-injurious thoughts or behaviours, but few studies have examined whether different patterns of adversity are differentially associated with youth suicide/self-harm. The current study aims to explore the relationship between exposure to adversity across various social domains and youth self-harm and suicidality, using a person centred approach, and examines whether access to social support and a sense of safety across home, peer or school settings buffer the relationship between adversity and self-harm/suicidality. Secondary data analyses were carried out on cross-sectional self-report data collected from 4848 (Mage=15.78, SD = 0.59; 50% female) adolescents who participated in the Irish Planet Youth survey. Latent Class Analyses identified four distinct profiles of adversity; low-adversity (n = 2043, 42%); peer-adversity (n = 972, 20%); parental-adversity (n = 1189, 25%); and multiple-adversity (n = 644, 13%). Findings from logistic moderated regressions indicated that there were significant differences in self-harm and suicidality across the adversity classes. Although parental support and perceived safety at school were negatively associated with suicidality and self-harm outcomes, no significant moderation effects were observed. These findings suggest that youth who experience adversity across multiple social domains are more likely to report suicidal and self-harm thoughts and behaviours, and should be key targets for intervention/prevention efforts. While parental support and school safety may act as significant compensatory factors, further work is needed to identify the social resources that can offset the risk imposed by youth's adverse experiences. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVD) are a precursor for disabilities and death worldwide. Being overweight or obese in combination with physical inactivity and smoking habits may increase the risk for CVD and other health problems such as lower limb osteoarthritis, diabetes, stroke, and various cancer types among children and adolescents. The literature emphasizes the need to follow such groups and evaluate the risk of individuals developing CVD diseases. Therefore, the current study explores the variety of cardiovascular risks in children and adolescents' profiles clusters with and without disabilities. Methods: Data from 42 countries including Israel, was collected with the support of the world health organization (WHO, Europe) through a questionnaire from 11–19 years old school-aged. Results: The study finding shows that children and adolescents with disabilities demonstrated a higher prevalence of overweight than those who completed the HBSC youth behavior survey. Moreover, the prevalence of tobacco smoking and alcohol use was statisticaly significantly higher among the disabled group than the non-disabled group. In addition, socioeconomic status of responders who presented a very high CVD risk was found as significantly lower than those from the first and second low risk groups. Conclusion: This led to the conclusion that children and adolescents with disability were at a higher risk of developing CVDs than their non-disabled peers. In addition, intervention programs tailored to the needs of adolescents with disability should consider lifestyle habit change and promoting healthy living thus improving their quality of life as well as reducing their risk of being exposed to severe CVD diseases. [ABSTRACT FROM AUTHOR]

Gender has been identified as an important social determinant for health. This study investigates gender-specific characteristics for alcohol use (AU) among community-dwelling older adults. This is a retrospective cross-sectional study in 1,406 community-dwelling older adults. We used standardized questionnaires to collect self-reported data on alcohol use behavior, mental health, drinking motives and resilience by using, respectively, the Alcohol Use Identification Test (AUDIT), the Brief Symptom Inventory (BSI), the Drinking Motives Questionnaire (DMQ), and the Connor-Davidson Resilience Scale (CD-RISC). Multiple linear regression was used to identify the joint contribution of those factors on AU. Hierarchical regression was used to investigate the influence of the interaction between gender and those factors on AU. Linear regression analyses showed different associations with AU in men and women. Hierarchical regression analyses showed that gender presented a two-way interaction effect with enhancement and anxiety variables related to AU. Different characteristics were found as predictors for AU among older men and women. Clinicians and health-care providers should be aware of these differences in order to provide tailored screening and intervention programs to reduce AU in older adults. [ABSTRACT FROM AUTHOR]

Abstract Background Adolescents with externalising problems in secure residential care differ in age of onset of disruptive behaviour and in cumulative risks in several domains. In order to reduce negative consequences of externalising behaviour for society and the adolescents themselves, it is important to gain more insight into the complexity and heterogeneity of disruptive behaviour in these adolescents. To look beyond the influence of single risk factors, the aim of this study is to investigate the moderator effect of co-occurring risk factors in multiple domains on the relation between age of onset of disruptive behaviour and two types of externalising problems in adolescence. Methods Retrospectively collected data of 225 adolescents admitted to secure residential care were analysed. The four risk profiles were based on co-occurring pre-admission risk factors in four domains, which were identified in a previous study by latent class analysis. Multiple regression models were used to test whether the independent variable age of onset and dummy-coded moderator variable risk profiles had statistically significant associations with aggressive behaviour and rule-breaking behaviour of the adolescents, as reported by professional caregivers in the first months of admission. Results Risk profiles moderated the relation between age of onset of disruptive behaviour and rule-breaking behaviour. Adolescents with childhood-onset disruptive behaviour within the risk profile with mainly family risks showed more rule-breaking behaviour in the first months of their admission to secure residential care than adolescents with an onset in adolescence within the same risk profile. Risk profiles, however, did not moderate the relation between age of onset of disruptive behaviour and aggressive behaviour. Conclusion Heterogeneity of aggressive and rule-breaking behaviour was established in this study by finding differences on these two types of externalising behaviour between the childhood- and adolescence-onset groups and between the four risk profiles. Furthermore, risk profiles moderated the effect between age of onset of disruptive behaviour and rule-breaking behaviour—not aggressive behaviour—in adolescents admitted to secure residential care. While respecting the limitations, adolescents’ childhood-onset disruptive behaviour within a profile with mainly family risk factors appear to be distinctive from adolescents with adolescence-onset disruptive behaviour within the same risk profile.

Introduction: Although prior studies have supported the effectiveness of Multi-Tiered Systems of Support (MTSS) on addressing social, emotional, behavioral, and academic challenges faced by youth at-risk, educators using MTSS often do not consider contextual factors which may also influence youth at-risk and the interventions targeting them. This study thus aimed to identify youth at-risk who should be referred to targeted instructions within MTSS by examining the risk profiles of Korean adolescents. Based on the identified risk profiles, we also tried to investigate the effect of contextual factors on deciding youth at-risk and confirm whether and/or what contextual factors should be considered when implementing targeted interventions for them. Method: To accomplish the research goal, a latent profile analysis on risk factors of Korean adolescents was performed, using the first year data of "Korean Children and Youth Panel Study (KCYPS) 2018." Results: Four risk profiles were identified, using low academic motivation, low academic behavior, attention deficit, aggression, social withdrawal, and depression as indicators: the high risk, M-SEB (Moderate-social, emotional, & behavioral) risk, M-ACA (Moderate-academic) risk, and low risk group. The covariates of this study, home and school environmental variables, worked as predictors of adolescents included in the high group. Conclusion: The results of this study suggest students in the high risk group (16.8%) should be given targeted instructions combining academic and SEB support within MTSS so as to prevent negative outcomes in the future among all adolescents. Those instructions need to be planned with consideration of contextual factors accompanied by teacher's careful understanding of social dynamics surrounding each student. [ABSTRACT FROM AUTHOR]

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IntroductionAlthough prior studies have supported the effectiveness of Multi-Tiered Systems of Support (MTSS) on addressing social, emotional, behavioral, and academic challenges faced by youth at-risk, educators using MTSS often do not consider contextual factors which may also influence youth at-risk and the interventions targeting them. This study thus aimed to identify youth at-risk who should be referred to targeted instructions within MTSS by examining the risk profiles of Korean adolescents. Based on the identified risk profiles, we also tried to investigate the effect of contextual factors on deciding youth at-risk and confirm whether and/or what contextual factors should be considered when implementing targeted interventions for them.MethodTo accomplish the research goal, a latent profile analysis on risk factors of Korean adolescents was performed, using the first year data of “Korean Children and Youth Panel Study (KCYPS) 2018.”ResultsFour risk profiles were identified, using low academic motivation, low academic behavior, attention deficit, aggression, social withdrawal, and depression as indicators: the high risk, M-SEB (Moderate-social, emotional, & behavioral) risk, M-ACA (Moderate-academic) risk, and low risk group. The covariates of this study, home and school environmental variables, worked as predictors of adolescents included in the high group.ConclusionThe results of this study suggest students in the high risk group (16.8%) should be given targeted instructions combining academic and SEB support within MTSS so as to prevent negative outcomes in the future among all adolescents. Those instructions need to be planned with consideration of contextual factors accompanied by teacher's careful understanding of social dynamics surrounding each student.

The US DOE-funded National Risk Assessment Partnership (NRAP) has developed an integrated assessment model (NRAP-IAM-CS) that can be used to simulate carbon dioxide (CO2) injection, migration, and associated impacts at a geologic carbon storage site. The model, NRAP-IAM-CS, incorporates a system-modeling-based approach while taking into account the full subsurface system from the storage reservoir to groundwater aquifers and the atmosphere. The approach utilizes reduced order models (ROMs) that allow fast computations of entire system performance even for periods of hundreds to thousands of years. The ROMs are run in Monte Carlo mode allowing estimation of uncertainties of the entire system without requiring long computational times. The NRAP-IAM-CS incorporates ROMs that realistically represent several key processes and properties of storage reservoirs, wells, seals, and groundwater aquifers. Results from the NRAP-IAM-CS model are used to quantify risk profiles for selected parameter distributions of reservoir properties, seal properties, numbers of wells, well properties, thief zones, and groundwater aquifer properties. A series of examples is used to illustrate how the risk under different storage conditions evolves over time, both during injection, in the near-term post injection period, and over the long term. It is also shown how results from NRAP-IAM-CS can be used to investigate the importance of different parameters on risk of leakage and risk of groundwater contamination under different storage conditions.

The US DOE-funded National Risk Assessment Partnership (NRAP) has developed an integrated assessment model (NRAP-IAM-CS) that can be used to simulate carbon dioxide (CO2) injection, migration, and associated impacts at a geologic carbon storage site. The model, NRAP-IAM-CS, incorporates a system-modeling-based approach while taking into account the full subsurface system from the storage reservoir to groundwater aquifers and the atmosphere. The approach utilizes reduced order models (ROMs) that allow fast computations of entire system performance even for periods of hundreds to thousands of years. The ROMs are run in Monte Carlo mode allowing estimation of uncertainties of the entire system without requiring long computational times. The NRAP-IAM-CS incorporates ROMs that realistically represent several key processes and properties of storage reservoirs, wells, seals, and groundwater aquifers. Results from the NRAP-IAM-CS model are used to quantify risk profiles for selected parameter distributions of reservoir properties, seal properties, numbers of wells, well properties, thief zones, and groundwater aquifer properties. A series of examples is used to illustrate how the risk under different storage conditions evolves over time, both during injection, in the near-term post injection period, and over the long term. It is also shown how results from NRAP-IAM-CS can be used to investigate the importance of different parameters on risk of leakage and risk of groundwater contamination under different storage conditions.

Abstract Background Evidence has pointed towards differences in the burden of arteriosclerosis according to its location and sex. Yet there is a scarcity of population-based data on aggregated sex-specific cardiovascular risk profiles, instead of single risk factors, and mortality risk according to the location of arteriosclerosis. We assessed sex-specific cardiovascular risk profiles and mortality risk associated with arteriosclerosis. Methods From the population-based Rotterdam Study, 2357 participants (mean age 69 years, 53% women) underwent non-contrast computed tomography to quantify calcification, as a proxy for arteriosclerosis, in the coronary arteries (CAC), aortic arch (AAC), extracranial (ECAC) and intracranial carotid arteries (ICAC), vertebrobasilar arteries (VBAC), and aortic valve (AVC). Principal component analysis (PCA) of eight distinct cardiovascular risk factors was performed, separately for women and men, to derive risk profiles based on the shared variance between factors. We used sex-stratified multivariable logistic regression to examine the associations between PCA-derived risk profiles and severe calcification at different locations. We investigated the associations of severe calcification with mortality risk using sex-stratified multivariable Cox regression. Results PCA identified three cardiovascular risk profiles in both sexes: (1) anthropometry, glucose, and HDL cholesterol; (2) blood pressure; and (3) smoking and total cholesterol. In women, the strongest associations were found for profile 2 with severe ECAC and ICAC (adjusted OR [95% CI] 1.32 [1.14–1.53]) and for profile 3 with severe at all locations, except AVC. In men, the strongest associations were found for profile 2 with VBAC (1.31 [1.12–1.52]) and profile 3 with severe AAC (1.28 [1.09–1.51]). ECAC and AVC in women and CAC in men showed the strongest, independent associations with cardiovascular mortality (HR [95% CI] 2.11 [1.22–3.66], 2.05 [1.21–3.49], 2.24 [1.21–3.78], respectively). Conclusions Our findings further underline the existence of sex- and location-specific differences in the etiology and consequences of arteriosclerosis. Future research should unravel which distinct pathological processes underlie differences in risk profiles for arteriosclerosis.

Abstract Background Adolescents in residential care are a vulnerable population with many problems in several life areas. For most of these adolescents, these problems persist after discharge and into adulthood. Since an accumulation of risk factors in multiple domains increases the likelihood of future adverse outcomes, it would be valuable to investigate whether there are differences in life after residential care between subgroups based on multiple co-occurring risk factors. Aims and hypothesis The aim of this exploratory follow-up study is to explore differences between young adults—classified in four risk profiles—in relation to life after discharge from a secure residential care setting. It is hypothesised that young adults with a profile with many risks in multiple domains will experience more problems after discharge, such as (persistent) delinquency, compared to young adults with a profile with lower risks. Methods Follow-up data were collected from 46 former patients of a hospital for youth forensic psychiatry and orthopsychiatry in the Netherlands. In order to illustrate these young adults’ life after discharge, self-reported outcome measures divided into five domains (i.e., quality of life, daily life, social life, problems, and delinquency) were used. Differences between four classes based on pre-admission risk factors, which were identified in a previous study by latent class analysis, were explored by three (non-)parametric statistical tests. Results Life after discharge for most young adults was characterised by close friends and a high quality of life, but also by substance abuse, professional support, debts, and delinquency. Only a few significant differences between the classes were found, primarily between young adults with risk factors in the individual, family, school, and peer domains and young adults in the other three classes. Conclusions Young adults experience a high quality of life after discharge from secure residential care, despite the presence of persistent problems. Some indications have been found that young adults with risk factors in four domains are at greatest risk for persistent problems in young adulthood. Because of the high amount of persistent problems, residential treatment and aftercare should focus more on patients’ long-term needs.

Epidemiological studies show an increasing number of patients worldwide suffering from chronic kidney diseases (CKD), which are associated with a risk for progression to end-stage kidney disease (ESKD). CKD patients stage 2–5, patients with regular chronic dialysis treatment (hr peritoneal dialysis), and patients suffering from kidney allograft dysfunction are at high risk to develop infections, e.g. urinary tract infections (UTI) and/or sepsis (urosepsis). These groups show metabolic disturbance, chronic inflammation, and impaired immunocompetence. is still the most common pathogen in UTI. A wide variety of other pathogens may be involved in UTI. Urological interventions, catheterization, as well as repeated courses of antibiotics contribute to an increased challenge of antimicrobial resistance. The diagnosis of UTI in CKD is based on standard clinical and laboratory criteria. Pyuria (≥10 leucocytes/µl) is more often observed in patients with oligoanuria and low bacterial colony counts. The treatment strategies for this population are based on the same principles as in patients with normal renal function. However, drugs cleared by the kidney or by dialysis membranes need dose adjustment. Antimicrobials with potential systemic toxicity and nephrotoxicity should be administered with caution.

Abstract Background Understanding sexual activity is necessary to prevent sexually transmitted infections. Evidence from Sub-Saharan Africa suggests that 10–20% of youth aged 15–24 are sexually active before reaching 15 years, yet estimating sexual activity remains challenging. This study explored the use of multiple sexual health outcomes to identify sexually-active young women in rural KwaZulu-Natal, South Africa. Methods Using a multi-component sexual activity profile (MSAP), we aimed to identify sexually active students. Based on data from 2675 grade 9 and 10 students attending 14 high schools) in rural KwaZulu-Natal, we constructed a descriptive diagram identifying students who were sexually active by self-report vs MSAP profile. T-tests for two independent samples was performed to compare by sex and ecological variables that characterise students newly-identified as sexually active. Results Using self-report only, 40.3% self-reported as sexually active, whilst the MSAP identified 48.7% (223 additional students). More females were identified than males. Younger adolescents were more likely to underreport sexual activity but were identified using MSAP. Newly-identified as sexually active were more likely to be female (p =

Background: Adolescents with externalising problems in secure residential care differ in age of onset of disruptive behaviour and in cumulative risks in several domains. In order to reduce negative consequences of externalising behaviour for society and the adolescents themselves, it is important to gain more insight into the complexity and heterogeneity of disruptive behaviour in these adolescents. To look beyond the influence of single risk factors, the aim of this study is to investigate the moderator effect of co-occurring risk factors in multiple domains on the relation between age of onset of disruptive behaviour and two types of externalising problems in adolescence. Methods: Retrospectively collected data of 225 adolescents admitted to secure residential care were analysed. The four risk profiles were based on co-occurring pre-admission risk factors in four domains, which were identified in a previous study by latent class analysis. Multiple regression models were used to test whether the independent variable age of onset and dummy-coded moderator variable risk profiles had statistically significant associations with aggressive behaviour and rule-breaking behaviour of the adolescents, as reported by professional caregivers in the first months of admission. Results: Risk profiles moderated the relation between age of onset of disruptive behaviour and rule-breaking behaviour. Adolescents with childhood-onset disruptive behaviour within the risk profile with mainly family risks showed more rule-breaking behaviour in the first months of their admission to secure residential care than adolescents with an onset in adolescence within the same risk profile. Risk profiles, however, did not moderate the relation between age of onset of disruptive behaviour and aggressive behaviour. Conclusion: Heterogeneity of aggressive and rule-breaking behaviour was established in this study by finding differences on these two types of externalising behaviour between the childhood- and adolescence-onset groups and between the four risk profiles. Furthermore, risk profiles moderated the effect between age of onset of disruptive behaviour and rule-breaking behaviour—not aggressive behaviour—in adolescents admitted to secure residential care. While respecting the limitations, adolescents' childhood-onset disruptive behaviour within a profile with mainly family risk factors appear to be distinctive from adolescents with adolescence-onset disruptive behaviour within the same risk profile. [ABSTRACT FROM AUTHOR]

Background: Few studies to date have analyzed the epidemiology of acute kidney injury (AKI) in children with cancer in developing countries. The aim of this study was to assess the incidence, risk profile and outcomes of AKI in Chinese children hospitalized with cancer. Methods: This multi-center study analyzed Chinese children hospitalized with cancer in 2013–2015. Electronic hospital and laboratory databases were screened to select pediatric patients with malignancy who had at least two Scr results within any 7-day window during their first 30 days of hospitalization. AKI events were identified and staged according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The incidence of and risk factors for AKI were analyzed, as were mortality rate, incidence of kidney recovery, and length of hospital stay. Results: Of the 9828 children with cancer, 1657 (16.9%) experienced AKI events, including 549 (5.6%) community-acquired (CA-AKI) and 1108 (11.3%) hospital-acquired AKI (HA-AKI) events. The three types of cancer with the highest incidence of AKI were urinary system cancer (25.8%), hepatic cancer (19.4%), and retroperitoneal malignancies (19.1%). The risk factor profiles of CA-AKI and HA-AKI events differed, with many HA-AKI events due to treatment with nephrotoxic agents. In-hospital death rates were 5.4% (90 of 1657) in children with and 0.9% (74 of 8171) in children without AKI events. AKI events were also associated with longer hospitalization and higher daily costs. Conclusions: AKI events are common among Chinese children hospitalized for cancer and are associated with adverse in-hospital outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Anticoagulation therapy is a standard treatment for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) that have risk factors for stroke. However, anticoagulant increases the risk of bleeding, especially in Asians. We aimed to investigate the risk profiles and pattern of antithrombotic use in patients with NVAF in Thailand, and to study the reasons for not using warfarin in this patient population. Methods A nationwide multicenter registry of patients with NVAF was created that included data from 24 hospitals located across Thailand. Demographic data, atrial fibrillation-related data, comorbid conditions, use of antithrombotic drugs, and reasons for not using warfarin were collected. Data were recorded in a case record form and then transferred into a web-based system. Results A total of 3218 patients were included. Average age was 67.3 ± 11.3 years, and 58.2% were male. Average CHADS2, CHA2DS2-VASc, and HAS-BLED score was 1.8 ± 1.3, 3.0 ± 1.7, and 1.5 ± 1.0, respectively. Antiplatelet was used in 26.5% of patients, whereas anticoagulant was used in 75.3%. The main reasons for not using warfarin in those with CHA2DS2-VASc ≥2 included already taking antiplatelet (26.6%), patient preference (23.1%), and using non-vitamin K antagonist oral anticoagulants (NOACs) (22.7%). Anticoagulant was used in 32.3% of CHA2DS2-VASc 0, 56.8% of CHA2DS2-VASc 1, and 81.6% of CHA2DS2-VASc ≥2. The use of NOACs increased from 1.9% in 2014 to 25.6% in 2017. Conclusions Anticoagulation therapy was prescribed in 75.3% of patients with NVAF. Among those receiving anticoagulant, 90.9% used warfarin and 9.1% used NOACs. The use of NOACs increased over time.

Background: Youth psychosocial and school adjustment results from complex developmental transactions between their individual characteristics and diverse environmental influences, which appear as risk or protective factors throughout one's development. Objective: From an ecosystemic and developmental perspective, this study aims to: (1) identify risk profiles among 13-year-old adolescents, and (2) associate these specific profiles with school dropout risk and substance abuse at age 15 years. Method: Data comes from a large Canadian study, the Quebec Longitudinal Study of Development through which adolescents (n = 1312) answered questionnaires at 13 and 15 years old. Results: First, through latent profile analyses, five profiles were identified based on individual, family, social, and school-based risk factors. Some profiles present higher levels of risk factors, while others comprise risk factors that are under the sample average level. Higher-risk profiles show stronger longitudinal associations with later adjustment difficulties. Conclusions: The findings help provide a deeper understanding of how the co-occurrence of various risk factors in adolescence is associated with later adjustment. The combination of the developmental psychopathology and ecosystemic frameworks, as well as the person-centered approach allowed by the latent profile analyses, helps shed new light on individual and developmental risk. [ABSTRACT FROM AUTHOR]

Women who use opiates and are involved in the criminal justice system in Appalachia may be prone to adverse health outcomes. In this study, we performed a latent class analysis of risk and protective factors on 400 drug-using women recruited from rural, Appalachian jails. A two-profile solution best fit the data. Both profiles evinced low levels of condom use, reproductive and physical health screens, and STD history. However, the primary substantive difference between the profiles was partner risk behavior: the higher risk class had main male partners with histories of injection drug use and incarceration. Results suggest that interventions need to be tailored to unique profiles of risk and protective factors, which should include taking partner risk into consideration. [ABSTRACT FROM AUTHOR]

Introduction: In the Netherlands, skin cancer is the most common type of cancer (KWF, 2016). More than 51.000 new cases of skin cancer are diagnosed every year and over 900 fatalities are reported (RIVM, 2017). Skin cancer incidence rates increase dramatically: since 1990 the number of new patients with skin cancer quadrupled (RIVM, 2017). This increase is much higher than in other types of cancer (IKNL, 2016). It is expected that incidence rates of skin cancer will increase even further, probably with a factor 2 to 5 (RIVM, 2017). Direct costs for medical treatment of skin cancer are estimated at 325 million each year (250-400 million) (RIVM, 2017). On top of that, sick leave and premature mortality are also important indirect costs in melanoma (Brochez et al., 1999). Increasing use of more costly treatment, such as Mohs surgery and photodynamic therapy, is contributing to rising treatment costs (Hollestein et al, 2017). In addition to the costs, this growing group of patients with skin cancer will represent an important burden on the limited specialized dermatological care in the Netherlands. Subsequent early assessment of skin cancer risk is necessary for timely preventive measures in the general population. Methods: 1- A systematic review of the literature on patient characteristics with a prognostic predictive value for future basal cell carcinoma, squamous cell carcinoma or melanoma (such as age, gender, presages, signs and risk behaviour). 2- A Current practice analysis on care concerning risk behaviour, presages and signs of skin cancer. 3- Prognostic modelling using existing data of over 5000 cases from the Netherlands Comprehensive Cancer Organisation (IKNL). 4- Developing risk profiles and implement these through internet and social media. Results: It will provide insight in early risk behaviours in the general population. It also provide knowledge of serious presages or signs enabling these patients to be seen by their GP timely. Conclusion: Basal cell carcinoma (BCC, approx. 70%), squamous cell carcinoma (SCC, approx. 20%) and melanoma (approx. 10%) are the three most common types of skin cancer. Melanoma is the most lethal type, accounting for 90% of all skin cancer fatalities. The incidence of melanoma in the Netherlands is among the highest in Europe (RIVM, 2017). Despite the fact that most non-melanoma skin cancers (BCC and SCC) can be cured, the treated lesions can be disfiguring or even lethal if not treated timely. Lessons learned: Risk profiles will enable healthcare professionals and citizens both with knowledge which persons are at high risk and should be screened and insight in risk behaviour. Limitations: Risk screening is costly, time consuming and it is to be expected that the adherence will be moderate. Suggestions for future research: Behaviour change intervention target groups in the society as implementation research

One of the main purposes of juvenile risk assessment is to distinguish different risk profiles, which may lead to referring youths into specific intervention programs tailored to their specific needs. This study is devoted to identifying main typologies of risk in a sample of 286 Spanish young offenders aged 14 to 22 (M = 17.36; SD = 1.61) years. Participants were classified into different profiles, representing different levels of risk in terms of individual and psychosocial dynamic variables. A three-class (low-, middle-, and high-risk profiles) and a four-class (low-, middle-, high-risk family problems/callous-unemotional (CU) traits, and high-risk impulsive/undercontrolled) solutions were identified. These profiles showed their distinctiveness and meaningfulness in a set of comparisons on antisocial behavior and prior offenses measures. These findings highlight the presence of diverse patterns of risk and suggest that a limited number of specialized interventions may respond to the main needs of most institutionalized youths. [ABSTRACT FROM AUTHOR]

Adolescents who are placed in Residential Care (RC) show an increased risk of antisocial behavior. From a restorative perspective, it has been proposed that interventions carried out in RC might significantly reduce the probability of negative consequences in adolescents, provided that they are adapted to the specific needs of this population. Therefore, the aim of the current study is to identify different subgroups of adolescents placed in RC on the basis of different dynamic factors and analyze their relation with antisocial behavior and family violence. For that purpose, the sample was composed of 145 adolescents aged 11 to 19 (M = 14.80; SD = 1.80), 59.3% males, from 19 out-of home centers in Galicia (NW Spain). Information was collected through the Juvenile Offender's Risk Assessment (VRAI) protocol. Results show three specific risk profiles that were identified on the basis of different dynamic factors: a low-risk, a middle-risk, and a high-risk profile. The high-risk group revealed the highest scores on different types of antisocial behavior whereas the low-risk group evidenced the opposite pattern of risk, with relationships with antisocial behavior being the weakest. These findings have theoretical and practical implications for the Child Welfare System and contribute to the development of specific intervention strategies in RC. • Three profiles of adolescents in RC were identified on the basis of dynamic factors. • The high-risk subgroup evidenced the strongest relation with antisocial behavior. • No significant differences between subgroups were found on family violence. • These results contribute to the development of specific intervention strategies. [ABSTRACT FROM AUTHOR]

Objective: We examined associations between developmental vulnerability profiles determined at the age of 5 years and subsequent childhood mental illness between ages 6 and 13 years in an Australian population cohort. Methods: Intergenerational records from New South Wales (NSW) Government Departments of Health and Child Protection spanning pre-birth to 13 years of age were linked with the 2009 Australian Early Development Census records for 86,668 children. Mental illness indices for children were extracted from health records between 2009 and 2016 (child's age of 6–13 years). Associations between mental disorder diagnoses and membership of early childhood risk groups, including those with established 'special needs' (3777, 4.3%) at school entry, or putative risk classes delineated via latent class analysis of Australian Early Development Census subdomains – referred to as 'pervasive risk' (N = 3479; 4.0%), 'misconduct risk' (N = 5773; 6.7%) or 'mild generalised risk' (N = 9542; 11%) – were estimated using multinomial logistic regression, relative to children showing 'no risk' (N = 64,097; 74%). Poisson regression models estimated the relative risk of a greater number of days recorded with mental health service contacts among children in each Australian Early Development Census risk group. Adjusted models included child's sex, socioeconomic disadvantage, child protection contacts and parental mental illness as covariates. Results: The crude odds of any mental disorder among children aged 6–13 years was increased approximately threefold in children showing pervasive risk or misconduct risk profiles at the age of 5 years, and approximately sevenfold in children with special needs, relative to children showing no risk; patterns of association largely remained after adjusting for covariates. Children with special needs and the misconduct risk class used mental health services over a greater number of days than the no risk class. Conclusion: Patterns of early childhood developmental vulnerability are associated with subsequent onset of mental disorders and have the potential to inform interventions to mitigate the risk for mental disorders in later childhood and adolescence. [ABSTRACT FROM AUTHOR]

While smoking prevalence in the U.S. and other industrialized countries has decreased substantially, this change has been unevenly distributed, with dramatic decreases in certain subpopulations but little change or even increases in others. Accordingly, considerable attention has been fruitfully devoted to identifying important risk factors for smoking (e.g., mental illness, other substance use disorders). However, there has been little research on the intersection of these risk factors. As risk factors rarely occur in isolation, it is important to examine risk-factor profiles as is commonly done in studying other chronic conditions (e.g., cardiovascular disease). The purpose of this Commentary is to encourage greater interest in the intersection of multiple risk factors using cigarette smoking as an exemplar. We focus on the intersection of eight well-established risk factors for smoking (age, gender, race/ethnicity, educational attainment, poverty, drug abuse/dependence, alcohol abuse/dependence, mental illness). Studying the intersection of risk factors is likely to require use of innovative data-analytic methods. We illustrate, using years 2011-2016 of the US National Household Survey on Drug Use and Health, how Classification and Regression Tree (CART) analysis can be an effective tool for identifying risk profiles for smoking. Examination of the intersection of these risk factors elucidates a series of risk profiles with associated, orderly gradations in vulnerability to current smoking, including the striking and reliable strength of a college education as a stand-alone profile predicting low risk for current smoking, and illustrating the potentially increasing importance of drug abuse/dependence as a risk factor. [ABSTRACT FROM AUTHOR]

Background: Anticoagulation therapy is a standard treatment for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) that have risk factors for stroke. However, anticoagulant increases the risk of bleeding, especially in Asians. We aimed to investigate the risk profiles and pattern of antithrombotic use in patients with NVAF in Thailand, and to study the reasons for not using warfarin in this patient population.Methods: A nationwide multicenter registry of patients with NVAF was created that included data from 24 hospitals located across Thailand. Demographic data, atrial fibrillation-related data, comorbid conditions, use of antithrombotic drugs, and reasons for not using warfarin were collected. Data were recorded in a case record form and then transferred into a web-based system.Results: A total of 3218 patients were included. Average age was 67.3 ± 11.3 years, and 58.2% were male. Average CHADS2, CHA2DS2-VASc, and HAS-BLED score was 1.8 ± 1.3, 3.0 ± 1.7, and 1.5 ± 1.0, respectively. Antiplatelet was used in 26.5% of patients, whereas anticoagulant was used in 75.3%. The main reasons for not using warfarin in those with CHA2DS2-VASc ≥2 included already taking antiplatelet (26.6%), patient preference (23.1%), and using non-vitamin K antagonist oral anticoagulants (NOACs) (22.7%). Anticoagulant was used in 32.3% of CHA2DS2-VASc 0, 56.8% of CHA2DS2-VASc 1, and 81.6% of CHA2DS2-VASc ≥2. The use of NOACs increased from 1.9% in 2014 to 25.6% in 2017.Conclusions: Anticoagulation therapy was prescribed in 75.3% of patients with NVAF. Among those receiving anticoagulant, 90.9% used warfarin and 9.1% used NOACs. The use of NOACs increased over time. [ABSTRACT FROM AUTHOR]

Objective: Detecting the early emergence of childhood risk for adult mental disorders may lead to interventions for reducing subsequent burden of these disorders. We set out to determine classes of children who may be at risk for later mental disorder on the basis of early patterns of development in a population cohort, and associated exposures gleaned from linked administrative records obtained within the New South Wales Child Development Study. Methods: Intergenerational records from government departments of health, education, justice and child protection were linked with the Australian Early Development Census for a state population cohort of 67,353 children approximately 5 years of age. We used binary data from 16 subdomains of the Australian Early Development Census to determine classes of children with shared patterns of Australian Early Development Census-defined vulnerability using latent class analysis. Covariates, which included demographic features (sex, socioeconomic status) and exposure to child maltreatment, parental mental illness, parental criminal offending and perinatal adversities (i.e. birth complications, smoking during pregnancy, low birth weight), were examined hierarchically within latent class analysis models. Results: Four classes were identified, reflecting putative risk states for mental disorders: (1) disrespectful and aggressive/hyperactive behaviour, labelled 'misconduct risk' (N = 4368; 6.5%); (2) 'pervasive risk' (N = 2668; 4.0%); (3) 'mild generalised risk' (N = 7822; 11.6%); and (4) 'no risk' (N = 52,495; 77.9%). The odds of membership in putative risk groups (relative to the no risk group) were greater among children from backgrounds of child maltreatment, parental history of mental illness, parental history of criminal offending, socioeconomic disadvantage and perinatal adversities, with distinguishable patterns of association for some covariates. Conclusion: Patterns of early childhood developmental vulnerabilities may provide useful indicators for particular mental disorder outcomes in later life, although their predictive utility in this respect remains to be established in longitudinal follow-up of the cohort. [ABSTRACT FROM AUTHOR]

Purpose Although previous research has made progress in identifying individuals predicted to face an elevated risk of being shot, it is not clear how that risk varies within individuals based on the contexts they encounter as they navigate daily life. The current study examines how the convergence of individual risk activity and neighborhood disadvantage and disorder triggers the risk of being shot. Methods Using a novel geographic information system application, 123 male gunshot assault victims between 10 and 24 years old in Philadelphia, Pennsylvania, described their minute-by-minute movements over the course of the day of the gunshot assault. Through latent class analysis, the primary exposure was real-life circumstance where nine theoretically informed risk factors converged, compared with two other circumstances. Case-crossover analyses of subjects' 10-minute segments of full-day activities compared gunshot assault victims at the time of assault with themselves earlier in the day. Results Compared to when individuals were exposed to minimal situational risk or were mainly exposed to neighborhood disadvantage and disorder, the concurrence of risk activity and neighborhood disadvantage and disorder was associated with a 9.90 (95% CI: 2.72–36.14) and 6.06 (95% CI: 2.78–13.22) times higher risk of being shot. Importantly, the likelihood of being in the high-risk circumstance increased systematically over the course of the day leading up to the time when young individuals were shot. Conclusions After controlled individual's propensity to be shot (e.g., inherent traits), the concurrence of situational risks emerged as significant triggers of gunshot assault. The findings suggest potential for community-based gunshot violence interventions. [ABSTRACT FROM AUTHOR]

Recent theoretical advances in the welfare state literature have outlined the differences between labour market- and life course-related schemes as centre-right parties have difficulties in enacting retrenchment on life course-related schemes because these concern every voter. In contrast, the textbook risk profile of centre-right parties' electorates allows them to cutback on labour market-related schemes as these parties get negligible support from workers and low-income voters. Conducting a comparative case study of recent Danish and Swedish centre-right governments, this article analyses the stylized assumptions on the party level by comparing two similar centre-right governments, which differed in their voter coalitions' risk profile. I first argue that centre-right governments are generally constrained by the popular entrenchment of the universal welfare state when it comes to life course-related welfare schemes. Second, I argue that the leeway on labour market-related schemes is contingent on the actual risk profile of the centre-right's electorate, and thereby move beyond the stylized assumptions from recent literature. In this respect, the Danish centre-right did, in contrast to its Swedish counterpart, gain power with an unusual high support among workingclass voters which constrained its latitude on labour market-related schemes. I find that the Danish centre-right governments after 2001 acted with bound hands thanks to its high working-class backing, and refrained from outright cutbacks on both labour market- and life course-related schemes until 2010 except for labour market outsiders. In contrast, the Swedish centre-right had a much lower working-class backing and therefore engaged in some outright cutbacks of labour market-related schemes such as unemployment benefits directly after taking office 2006. The centre-right's actual voter coalition's risk profile is thus an important determinant for its public policies and its leeway for policy-seeking. [ABSTRACT FROM AUTHOR]