BACKGROUND: Most studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants.PURPOSE: To examine the prevalence, longitudinal patterns and predictors of individual and multiple health risk behaviors among adolescents.METHODS: Eight health risk behaviors (no regular consumption of fruit, vegetables or breakfast, overweight or obesity, physical inactivity, smoking, alcohol use and cannabis use) were assessed in a prospective population study (second and third wave). Participants were assessed in three waves between ages 10 and 17 (2001-2008; n=2230). Multiple linear regression was used to assess the influence of gender, self-control, parental health risk behaviors, parental monitoring and socioeconomic factors on the number of health risk behaviors adjusted for preceding multiple health risk behaviors (analysis: 2013-2014).RESULTS: Rates of >5 health risk behaviors were high: 3.6% at age 13.5 and 10.2% at age 16. Smoking at age 13.5 was frequently associated with health risk behaviors at age 16. No regular consumption of fruit, vegetables and breakfast, overweight or obesity, physical inactivity and smoking predicted the co-occurrence of health risk behaviors at follow-up. Significant predictors of the development of multiple health risk behaviors were adolescents' levels of self-control, socioeconomic status and maternal smoking.CONCLUSIONS: Multiple health risk behaviors are common among adolescents. Individual and social factors predict changes in multiple health risk behaviors, showing that prevention targeting multiple risk behaviors is needed. Special attention should be paid to adolescents with low self-control and families with low socioeconomic status or a mother who smokes.
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We examined trajectories of multiple health risk behavior (MHRB) patterns throughout adolescence, and changes in mental health from childhood to young adulthood. Further, we assessed how continuity or onset of MHRBs overall were associated with subsequent changes in mental health, and whether this varied by type of MHRBs. We used six waves of the prospective Dutch TRAILS study (2001–2016; n =2229), covering ages 11 until 23. We measured MHRBs (substance use: alcohol misuse, cannabis use, smoking; and obesity-related: overweight, physical inactivity, irregular breakfast intake) at three time points during adolescence. We assessed mental health as Youth/Adult Self-report total problems at ages 11 and 23. Latent class growth analyses and ANOVA were used to examine longitudinal trajectories and associations. We identified six developmental trajectories for the total of MHRBs and mental health. Trajectories varied regarding likelihood of MHRBs throughout adolescence, mental health at baseline, and changes in mental health problems in young adulthood. We found no associations for the continuity of overall MHRBs throughout adolescence, and neither for early, mid- or late onset, with changes in mental health problems in young adult-hood. However, continuity of MHRBs in the obesity-related subgroup was significantly associated with an in-crease in mental health problems. Adolescents with the same MHRB patterns may, when reaching adulthood, have different levels of mental health problems, with mental health at age 11 being an important predictor. Further, involvement with obesity- related MHRBs continuously throughout adolescence is associated with increased mental health problems in young adulthood.
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International Week workshop in Madrid over Sustainable Risk Leadership
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What does this paper add to existing knowledge? • This study provides insight into the severity of the problem. It demonstrates the differences in risk factors and OHRQoL between patients diagnosed with a psychotic disorder (first-episode) and the general population. • A negative impact on OHRQoL is more prevalent in patients diagnosed with a psychotic disorder (first-episode) (14.8%) compared to the general population (1.8%). • Patients diagnosed with a psychotic disorder (first-episode) have a considerable increase in odds for low OHRQoL compared to the general population, as demonstrated by the odds ratio of 9.45, which supports the importance of preventive oral health interventions in this group. What are the implications for practice? • The findings highlight the need for oral health interventions in patients diagnosed with a psychotic disorder (first-episode). Mental health nurses, as one of the main health professionals supporting the health of patients diagnosed with a mental health disorder, can support oral health (e.g. assess oral health in somatic screening, motivate patients, provide oral health education to increase awareness of risk factors, integration of oral healthcare services) all in order to improve the OHRQoL.
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Patients with cardiovascular risk factors can reduce their risk of cardiovascular disease by increasing their physical activity and their physical fitness. According to the guidelines for cardiovascular risk management, health professionals should encourage their patients to engage in physical activity. In this paper, we provide insight regarding the systematic development of a Web-based intervention for both health professionals and patients with cardiovascular risk factors using the development method Intervention Mapping. The different steps of Intervention Mapping are described to open up the “black box” of Web-based intervention development and to support future Web-based intervention development.
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Risk assessment plays an important role in forensic mental health care. The way the conclusions of those risk assessments are communicated varies considerably across instruments. In an effort to make them more comparable, Hanson, R. K., Bourgon, G., McGrath, R., Kroner, D. D., Amora, D. A., Thomas, S. S., & Tavarez, L. P. [2017. A five-level risk and needs system: Maximizing assessment results in corrections through the development of a common language. The Council of State Governments Justice Center. https:// csgjusticecenter.org/wp-content/uploads/2017/01/A-Five-Level-Risk-and-Needs-system_Report.pdf] developed the Five-Level Risk and Needs System, placing the conclusions of different instruments along five theoretically meaningful levels. The current study explores a Five-Level Risk and Needs system for violent recidivism to which the numerical codings of the HCR-20 Version 2 and its successor, the HCR-20V3 are calibrated, using a combined sample from six previous studies for the HCR-20 Version 2 (n = 411 males with a violent index offence) and a pilot sample for the HCR-20V3 (n = 66 males with a violent index offence). Baselines for the five levels were defined by a combination of theoretical (e.g. expert meetings) and empirical (e.g. literature review) considerations. The calibration of the HCR-20 Version 2 was able to detect four levels, from a combined level I/II to an adjusted level V. The provisional calibration of the HCR-20V3 showed a substantial overlap with the HCR-20 Version 2, with each level boundary having a 2-point difference. Implications for practice and future research are discussed.
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The Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) is a risk assessment instrument for adolescents that estimates the risk of multiple adverse outcomes. Prior research into its predictive validity is limited to a handful of studies conducted with the START:AV pilot version and often by the instrument’s developers. The present study examines the START:AV’s field validity in a secure youth care sample in the Netherlands. Using a prospective design, we investigated whether the total scores, lifetime history, and the final risk judgments of 106 START:AVs predicted inpatient incidents during a 4-month follow-up. Final risk judgments and lifetime history predicted multiple adverse outcomes, including physical aggression, institutional violations, substance use, self-injury, and victimization. The predictive validity of the total scores was significant only for physical aggression and institutional violations. Hence, the short-term predictive validity of the START:AV for inpatient incidents in a residential youth care setting was partially demonstrated and the START:AV final risk judgments can be used to guide treatment planning and decision-making regarding furlough or discharge in this setting.
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Background: Changes in reimbursement have been compelling for Dutch primary care practices to apply a disease management approach for patients with chronic obstructive pulmonary disease (COPD). This approach includes individual patient consultations with a practice nurse, who coaches patients in COPD management. The aim of this study was to gauge the feasibility of adding a web-based patient self-management support application, by assessing patients’ self-management, patients’ health status, the impact on the organization of care, and the level of application use and appreciation. Methods: The study employed a mixed methods design. Six practice nurses recruited COPD patients during a consultation. The e-Health application included a questionnaire that captured information on demographics, self-management related behaviors (smoking cessation, physical activity and medication adherence) and their determinants, and nurse recommendations. The application provided tailored feedback messages to patients and provided the nurse with reports. Data were collected through questionnaires and medical record abstractions at baseline and one year later. Semi-structured interviews with patients and nurses were conducted. Descriptive statistics were calculated for quantitative data and content analysis was used to analyze the qualitative data. Results: Eleven patients, recruited by three nurses, used the application 1 to 7 times (median 4). Most patients thought that the application supported self-management, but their interest diminished after multiple uses. Impact on patients’ health could not be determined due to the small sample size. Nurses reported benefits for the organization of care and made suggestions to optimize the use of the reports. Conclusion: Results suggest that it is possible to integrate a web-based COPD self-management application into the current primary care disease management process. The pilot study also revealed opportunities to improve the application and reports, in order to increase technology use and appreciation.
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Within recent years, Financial Credit Risk Assessment (FCRA) has become an increasingly important issue within the financial industry. Therefore, the search for features that can predict the credit risk of an organization has increased. Using multiple statistical techniques, a variance of features has been proposed. Applying a structured literature review, 258 papers have been selected. From the selected papers, 835 features have been identified. The features have been analyzed with respect to the type of feature, the information sources needed and the type of organization that applies the features. Based on the results of the analysis, the features have been plotted in the FCRA Model. The results show that most features focus on hard information from a transactional source, based on official information with a high latency. In this paper, we readdress and -present our earlier work [1]. We extended the previous research with more detailed descriptions of the related literature, findings, and results, which provides a grounded basis from which further research on FCRA can be conducted.
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The HCR-20V3 is a violence risk assessment tool that is widely used in forensic clinical practice for risk management planning. The predictive value of the tool, when used in court for legal decisionmaking, is not yet intensively been studied and questions about legal admissibility may arise. This article aims to provide legal and mental health practitioners with an overview of the strengths and weaknesses of the HCR-20V3 when applied in legal settings. The HCR-20V3 is described and discussed with respect to its psychometric properties for different groups and settings. Issues involving legal admissibility and potential biases when conducting violence risk assessments with the HCR-20V3 are outlined. To explore legal admissibility challenges with respect to the HCR-20V3, we searched case law databases since 2013 from Australia, Canada, Ireland, the Netherlands, New Zealand, the UK, and the USA. In total, we found 546 cases referring to the HCR-20/HCR-20V3. In these cases, the tool was rarely challenged (4.03%), and when challenged, it never resulted in a court decision that the risk assessment was inadmissible. Finally, we provide recommendations for legal practitioners for the cross-examination of risk assessments and recommendations for mental health professionals who conduct risk assessments and report to the court. We conclude with suggestions for future research with the HCR-20V3 to strengthen the evidence base for use of the instrument in legal contexts.
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