Little is known about whether the accuracy of tools for assessment of sexual offender recidivism risk holds across ethnic minority offenders. I investigated the predictive validity across ethnicity for the RRASOR and the Static-99 actuarial risk assessment procedures in a national cohort of all adult male sex offenders released from prison in Sweden 1993-1997. Subjects ordered out of Sweden upon release from prison were excluded and remaining subjects (N = 1303) divided into three subgroups based on citizenship. Eighty-three percent of the subjects were of Nordic ethnicity, and non-Nordic citizens were either of non-Nordic European (n = 49, hereafter called European) or African Asian descent (n = 128). The two tools were equally accurate among Nordic and European sexual offenders for the prediction of any sexual and any violent nonsexual recidivism. In contrast, neither measure could differentiate African Asian sexual or violent recidivists from nonrecidivists. Compared to European offenders, AfricanAsian offenders had more often sexually victimized a nonrelative or stranger, had higher Static-99 scores, were younger, more often single, and more often homeless. The results require replication, but suggest that the promising predictive validity seen with some risk assessment tools may not generalize across offender ethnicity or migration status. More speculatively, different risk factors or causal chains might be involved in the development or persistence of offending among minority or immigrant sexual abusers.
The aims of this study were to determine the magnitude of the increase in fracture risk after hospitalization for stroke, and in particular to determine the time course of this risk.
The records of the Swedish register of patients admitted during 1987-1996 were examined to identify all patients who were admitted to the hospital for stroke. Patients were followed for subsequent hospitalizations for hip and all fractures combined. We analyzed 16.3 million hospitalizations, from which 273 288 individuals with stroke were identified. A Poisson model was used to determine the absolute risk of subsequent fractures and the risk compared with that of the general population.
After hospitalization for stroke, there was a >7-fold increase in fracture risk, including that for hip fracture within the first year after hospitalization for stroke. Thereafter, fracture risk declined toward, but did not attain, the baseline risk except in men and women aged >/=80 years.
The high incidence of new fractures within the first year of hospitalization for stroke suggests that such patients should be preferentially targeted for treatment. It is possible that short courses of treatment at the time of stroke would provide important therapeutic dividends.
An increased risk for diabetes mellitus (DM) adds significantly to the burden of late complications in childhood cancer survivors. Complications of DM may be prevented by using appropriate screening. It is, therefore, important to better characterise the reported increased risk for DM in a large population-based setting.
From the national cancer registries of the five Nordic countries, a cohort of 32,903 1-year survivors of cancer diagnosed before the age of 20 between start of cancer registration in the 1940s and 1950s through 2008 was identified; 212,393 comparison subjects of the same age, gender and country were selected from national population registers. Study subjects were linked to the national hospital registers. Absolute excess risks (AERs) and standardised hospitalisation rate ratios (SHRRs) were calculated.
DM was diagnosed in 496 childhood cancer survivors, yielding an overall SHRR of 1.6 (95% confidence interval (CI), 1.5-1.8) and an AER of 43 per 100,000 person-years, increasing from approximately 20 extra cases of DM in ages 0-19 to more than 100 extra cases per 100,000 person-years in ages > or =50. The relative risks for DM were significantly increased after Wilms' tumour (SHRR, 2.9), leukaemia (2.0), CNS neoplasms (1.8), germ-cell neoplasms (1.7), malignant bone tumours (1.7) and Hodgkin's lymphoma (1.6). The risk for DM type 2 was slightly higher than that for type 1.
Childhood cancer survivors are at increased risk for DM, with absolute risks increasing throughout life. These findings underscore the need for preventive interventions and prolonged follow-up of childhood cancer survivors.
In this study we examine the effect of several alcohol-related measures on self-reported collision involvement within the previous 12 months while controlling for demographic and driving exposure factors based on a large representative sample of adults in Ontario. Data are based on the 2002-2006 Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older (n=8542). Three logistic regressions of self-reported collision involvement in the past 12 months were implemented, each consisting of 3 steps: (1) demographic factors and driving exposure entered, (2) driving after drinking within the last 12 months entered, and (3) one of three alcohol-related measures (AUDIT subscales of alcohol consumption, dependence and problems) entered. In each step, measures from the preceding step were included in order to control for those variables. In Step 1, age (OR=0.989), region overall, Central East region (OR=0.71), West region (OR=0.67), and North region (OR=0.67), income overall and those who did not state income (OR=0.64), marital status overall and those married or living common law (OR=0.60), and number of kilometers driven in a typical week (OR=1.00) were found to be significant predictors of collision involvement. The analyses revealed that driving after drinking was a significant predictor of collision involvement in Step 2 (OR=1.51) and each of the Step 3 models (ORs=1.52, 1.37, 1.34). The AUDIT Consumption subscale was not a significant factor in collision risk. Both the AUDIT Dependence and AUDIT Problems subscales were significantly related to collision risk (ORs=1.13 and 1.10, respectively). These findings suggest that alcohol, in addition to its effects on collision risk through its acute impairment of driving skills, may also affect collision risk through processes involved when individuals develop alcohol problems or alcohol dependence.
When competing risks are present, two types of analysis can be performed: modelling the cause specific hazard and modelling the hazard of the subdistribution. This paper contrasts these two methods and presents the benefits of each. The interpretation is specific to the analysis performed. When modelling the cause specific hazard, one performs the analysis under the assumption that the competing risks do not exist. This could be beneficial when, for example, the main interest is whether the treatment works in general. In modelling the hazard of the subdistribution, one incorporates the competing risks in the analysis. This analysis compares the observed incidence of the event of interest between groups. The latter analysis is specific to the structure of the observed data and it can be generalized only to another population with similar competing risks.
Comment In: Stat Med. 2007 Aug 15;26(18):3521-3; author reply 352317476646
Comment In: Stat Med. 2007 Aug 30;26(19):3676-9; author reply 3679-8017299738
Stroke is amenable to the entire spectrum of health services, ranging from prevention of its risk factors, to the treatment of acute stroke and rehabilitation and palliation of stroke. The aim of this study was to determine the number of persons with the capacity to benefit from evidence-based effective stroke services. Population-based survey and registry data along with published, evidence-based recommendations for services were used to determine the number of persons in Eastern Ontario with stroke (including risk factors, acute stroke and chronic stroke) and their related need for services (including prevention programs, diagnostic services, treatment of acute stroke and rehabilitation). These estimates were then compared to the actual provision of these services. Estimates of the need for effective services exceeded the provision of all services with the exception of pharmacologic treatment for diabetes mellitus and carotid endarterectomy for acute stroke. The approach was able to identify both the under-provision and over-provision of evidence-based effective services for stroke. This study has shown that an epidemiologically-based needs assessment could be a useful basis for the planning of health services.
The current study investigates the geographic and social differences in injury risks across living areas in a small semi-urban Swedish municipality. The study population consisted of all people living in the municipality during the years 1992-1996 (31,820, December 1996). Area comparisons were made based on data related to the municipality's 15 census districts and grouped according to the geographic location and three different social characteristics (proportion of unemployed, of low educated, or of people born outside Sweden). Injury data was gathered for the period 1992-1996 from two data sources: Sweden's National Hospital Discharge Register, and the local outpatient register. Three diagnosis groups were used: all injuries aggregated, traffic injuries and other unintentional injuries. Odds-ratios were calculated for males and females separately. There were no remarkable differences in injury risks between areas, whether compared on the basis of their geographic location or some of their socio-economic characteristics. These findings could be attributed to either a lack of sensitivity of the measures employed or the existence of a well-functioning safety promotion program in the municipality that impacts on injury risk distribution between areas. This, in turn, does not imply that members of underprivileged social groups are not in need of special support regardless of the area to which they belong.
Low participation in population-based follow-up studies addressing psychosocial risk factors may cause biased estimation of health risk but the issue has seldom been examined. We compared risk estimates for selected health outcomes among respondents and the entire source population.
In a Danish cohort study of associations between psychosocial characteristics of the work environment and mental health, the source population of public service workers comprised 10,036 employees in 502 work units of which 4,489 participated (participation rate 45%). Data on the psychosocial work environment were obtained for each work unit by calculating the average of the employee self-reports. The average values were assigned all employees and non-respondent at the work unit. Outcome data on sick leave and prescription of antidepressant medication during the follow-up period (1.4.2007-31.12.2008) was obtained by linkage to national registries.
Respondents differed at baseline from non-respondents by gender, age, employment status, sick leave and hospitalization for affective disorders. However, risk estimates for sick leave and prescription of antidepressant medication, during follow-up, based on the subset of participants, did only differ marginally from risk estimates based upon the entire population.
We found no indications that low participation at baseline distorts the estimates of associations between the work unit level of psychosocial work environment and mental health outcomes during follow-up. These results may not be valid for other exposures or outcomes.
Cites: Int J Epidemiol. 1999 Dec;28(6):1134-4010661659
Cites: Am J Epidemiol. 2011 Jan 1;173(1):94-10221071605
The reliability of a statistical mortality rate due to pulmonary tuberculosis was analyzed in 10 Russian Federation's subjects having the least rates. It was shown that its reliability might be objectively assessed by a method for complex analysis of the rates reflecting the population coverage of prophylactic examinations, the proportion of tuberculosis patients identified at their visits to health care facilities, and the pattern of patients with new-onset pulmonary tuberculosis. The reliability of this rate is mainly influ-enced by the prophylactic examination coverage of the population at increased risk for tuberculosis. Underidentification of patients with pulmonary tuberculosis leads to a discrepancy in the actual and statistical deaths from pulmonary tuberculosis with its underestimated values.
Ranking a group of candidate sites and selecting from it the high-risk locations or hotspots for detailed engineering study and countermeasure evaluation is the first step in a transport safety improvement program. Past studies have however mainly focused on the task of applying appropriate methods for ranking locations, with few focusing on the issue of how to define selection methods or threshold rules for hotspot identification. The primary goal of this paper is to introduce a multiple testing-based approach to the problem of selecting hotspots. Following the recent developments in the literature, two testing procedures are studied under a Bayesian framework: Bayesian test with weights (BTW) and a Bayesian test controlling for the posterior false discovery rate (FDR) or false negative rate (FNR). The hypotheses tests are implemented on the basis of two random effect or Bayesian models, namely, the hierarchical Poisson/Gamma or Negative Binomial model and the hierarchical Poisson/Lognormal model. A dataset of highway-railway grade crossings is used as an application example to illustrate the proposed procedures incorporating both the posterior distribution of accident frequency and the posterior distribution of ranks. Results on the effects of various decision parameters used in hotspot identification procedures are discussed.