Publications by authors named "Rachel Campbell"

45 Publications

A Low-carbohydrate, Ketogenic Diet Enhances Hippocampal Mitochondrial Bioenergetics and Efficiency.

FASEB J 2022 May;36 Suppl 1

Cell Biology and Physiology, Brigham Young University, Provo, UT.

Mitochondrial dysfunction and cognitive impairment are common symptoms in many neurologic and psychiatric disorders, as well as in nonpathological aging. Ketones have been suggested as therapeutic for their relevance in epilepsy as well as other neurodegenerative diseases such as Alzheimer's and Parkinson's disease. Here we explored whether a low-carbohydrate, ketogenic diet (KD) alters recognition memory, hippocampal mitochondrial bioenergetics, and expression of proteins involved in mitochondrial dynamics. Mature-to-middle-aged adult male and female mice were placed on a lard-based KD supplemented with an exogenous ketone ester for eight weeks. Changes in behavioral recognition memory were measured in a two-object novel object recognition test. Hippocampal mitochondrial physiology was assessed using high-resolution respirometry to measure changes in oxygen flux, biochemical assays to quantify ATP production, and western blot to measure changes in Drp1 expression. Here we demonstrate that the KD reduces hippocampal oxygen consumption (p=0.013), but does not alter ATP production (p=0.42) or Drp1 expression (p=0.51). These results indicate an enhancement of mitochondrial coupling and efficiency independent of mitochondrial dynamics, as changes in oxygen flux occurred without changes in Drp1 expression. Together, these findings add to growing support for the use of ketones and KDs in pathological brain states in which mitochondrial function is compromised, especially within the hippocampus.
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http://dx.doi.org/10.1096/fasebj.2022.36.S1.R5607DOI Listing
May 2022

Improving the patient-reported outcome sections of clinical trial protocols: a mixed methods evaluation of educational workshops.

Qual Life Res 2022 May 12. Epub 2022 May 12.

NHMRC Clinical Trial Centre, University of Sydney, Sydney, Australia.

Introduction: Failure to incorporate key patient-reported outcome (PRO) content in trial protocols affects the quality and interpretability of the collected data, contributing to research waste. Our group developed evidence-based training specifically addressing PRO components of protocols. We aimed to assess whether 2-day educational workshops improved the PRO completeness of protocols against consensus-based minimum standards provided in the SPIRIT-PRO Extension in 2018.

Method: Annual workshops were conducted 2011-2017. Participants were investigators/trialists from cancer clinical trials groups. Although developed before 2018, workshops covered 15/16 SPIRIT-PRO items. Participant feedback immediately post-workshop and, retrospectively, in November 2017 was summarised descriptively. Protocols were evaluated against SPIRIT-PRO by two independent raters for workshop protocols (developed post-workshop by participants) and control protocols (contemporaneous non-workshop protocols). SPIRIT-PRO items were assessed for completeness (0 = not addressed, 10 = fully addressed). Mann-Whitney U tests assessed whether workshop protocols scored higher than controls by item and overall.

Results: Participants (n = 107) evaluated the workshop positively. In 2017, 16/41 survey responders (39%) reported never applying in practice; barriers included role restrictions (14/41, 34%) and lack of time (5/41, 12%). SPIRIT-PRO overall scores did not differ between workshop (n = 13, median = 3.81/10, interquartile range = 3.24) and control protocols (n = 9, 3.51/10 (2.14)), (p = 0.35). Workshop protocols scored higher than controls on two items: 'specify PRO concepts/domains' (p = 0.05); 'methods for handling missing data' (p = 0.044).

Conclusion: Although participants were highly satisfied with these workshops, the completeness of PRO protocol content generally did not improve. Additional knowledge translation efforts are needed to assist protocol writers address SPIRIT-PRO guidance and avoid research waste that may eventuate from sub-optimal PRO protocol content.
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http://dx.doi.org/10.1007/s11136-022-03127-wDOI Listing
May 2022

Evaluating patient-reported symptoms and late adverse effects following completion of first-line chemotherapy for ovarian cancer using the MOST (Measure of Ovarian Symptoms and Treatment concerns).

Gynecol Oncol 2022 02 24;164(2):437-445. Epub 2021 Dec 24.

Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia.

Objectives: Knowledge on the course of symptoms patients with ovarian cancer experience is limited. We documented the prevalence and trajectories of symptoms after first-line chemotherapy using the Measure of Ovarian Symptoms and Treatment concerns (MOST).

Methods: A total of 726 patients who received platinum-based chemotherapy for ovarian cancer were asked to complete the MOST every 3 months, beginning 6 months post-diagnosis and continuing for up to 4 years. We used descriptive statistics to examine temporal changes in MOST-S26 index scores for disease or treatment-related (MOST-DorT), neurotoxicity (MOST-NTx), abdominal (MOST-Abdo), and psychological (MOST-Psych) symptoms, and wellbeing (MOST-Wellbeing) and selected individual symptoms. We used group-based trajectory models to identify groups with persistently poor symptoms.

Results: The median MOST-Abdo, MOST-DorT and MOST-Wellbeing score were worst at chemotherapy-end but improved and stabilised by 1, 3 and 12 months after treatment, respectively. The median MOST-NTx score peaked at 1 month after treatment before improving, while the median MOST-Psych score did not change substantially over time. Long-term moderate-to-severe fatigue (32%), trouble sleeping (31%), sore hands and feet (21%), pins and needles (20%) and anxiety (18%) were common. Trajectory models revealed groups of patients with persistent symptoms had MOST-DorT scores above 30 and MOST-NTx scores above 40 at treatment-end.

Conclusions: Although many patients report improvements in symptoms by 3 months after first-line chemotherapy for ovarian cancer, patients who score > 30/100 on MOST-S26-DorT or > 40/100 on MOST-S26-NTx at the end of chemotherapy are likely to have persistent symptoms. The MOST could triage this at-risk subset for early intervention.
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http://dx.doi.org/10.1016/j.ygyno.2021.12.006DOI Listing
February 2022

A Quality-of-Life Evaluation Study Assessing Health-Related Quality of Life in Patients Receiving Medicinal Cannabis (the QUEST Initiative): Protocol for a Longitudinal Observational Study.

JMIR Res Protoc 2021 Nov 24;10(11):e32327. Epub 2021 Nov 24.

School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia.

Background: Evidence supports several countries introducing legislation to allow cannabis-based medicine as an adjunctive treatment for the symptomatic relief of chronic pain, chemotherapy-induced nausea, spasticity in multiple sclerosis (MS), epileptic seizures, depression, and anxiety. However, clinical trial participants do not represent the entire spectrum of disease and health status seen in patients currently accessing medicinal cannabis in practice.

Objective: This study aims to collect real-world data to evaluate health-related quality of life in patients prescribed medicinal cannabis oil and describe any differences over time, from before starting therapy to after 3 and 12 months of therapy.

Methods: Adult patients newly prescribed medicinal cannabis oil by authorized prescribers and under the Special Access Schemes across Australia will be screened for eligibility and invited to participate. A sample size of 2142 is required, with a 3-month follow-up. All participants will complete the EuroQol 5-Dimension; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30; Depression, Anxiety, and Stress Scale-21; Patients' Global Impression of Change; Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form (SF) version 1.0: Sleep Disturbance 8b; and PROMIS SF Fatigue 13a questionnaires. Patients with chronic pain conditions will also complete the PROMIS SF version 1.0: Pain Intensity 3a and PROMIS SF version 1.0: Pain Interference 8a. Patients with movement disorders will also complete Quality of Life in Neurological Disorders (Neuro-QoL) SF version 1.0: Upper Extremity Function (Fine Motor and Activities of Daily Living) and if chorea is indicated, the Neuro-QoL SF version 2.0: Huntington's Disease health-related Quality of LIFE-Chorea 6a. All questionnaires will be administered at baseline, 2 weeks (titration), monthly up to 3 months, and then every 2 months up to 1 year.

Results: Recruitment commenced in November 2020. By June 2021, 1095 patients were screened for the study by 69 physicians in centers across 6 Australian states: Australian Capital Territory, New South Wales, Queensland, South Australia, Victoria, and Western Australia. Of the patients screened, 833 (39% of the target sample size) provided consent and completed baseline questionnaires. Results are expected to be published in 2022. Results of this study will show whether patient-reported outcomes improve in patients accessing prescribed medicinal cannabis from baseline to 3 months and whether any changes are maintained over a 12-month period. This study will also identify differences in improvements in patient-reported outcomes among patients with different chronic conditions (eg, chronic pain, MS, epilepsy, Parkinson disease, or cancer).

Conclusions: This protocol contains detailed methods that will be used across multiple sites in Australia. The findings from this study have the potential to be integral to treatment assessment and recommendations for patients with chronic pain and other health indicators for accessing medicinal cannabis.

Trial Registration: Australian New Zealand Clinical Trials Registry: ANZCTRN12621000063819; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380807&isReview=true.

International Registered Report Identifier (irrid): DERR1-10.2196/32327.
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http://dx.doi.org/10.2196/32327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8663597PMC
November 2021

Perceived benefits and limitations of using patient-reported outcome measures in clinical practice with individual patients: a systematic review of qualitative studies.

Qual Life Res 2022 Jun 27;31(6):1597-1620. Epub 2021 Sep 27.

The University of Sydney, Faculty of Science, School of Psychology, Sydney Quality of Life Office, Sydney, Australia.

Purpose: Patient-reported outcome measures (PROMs) are increasingly used in clinical settings to inform individual patient care. In-depth understanding of end-users' experiences may help identify factors that promote or hinder their use in clinical decision-making. We aimed to examine stakeholder perceptions of the utility of using PROMs in clinical practice based on real-life experience.

Methods: Systematic review searching Medline, Embase and PsychINFO from inception to May 2021. Qualitative studies examining patients' and/or clinicians' experiences of using PROMs in clinical settings were included. Study screening and data extraction were performed by two independent reviewers. Qualitative data from included studies was analysed thematically.

Results: Of 2388 abstracts retrieved, 52 articles reporting 50 studies met eligibility. Five key benefits were identified: (1) promotes active patient involvement (enables goal setting and discussion of sensitive topics); (2) enhances the focus of consultations (prioritizes patient needs); (3) improves quality of care (enables tailored, holistic care and prompts action); (4) enables standardized monitoring of patient outcomes; and (5) enhances the patient-clinician relationship (provides reassurance). Perceived limitations included the capacity of PROMs to shift the focus of consultations; inaccurately estimate problems; raise unrealistic expectations for care; inhibit patient-clinician interaction; lack clinically meaningful information; and not be suitable for all patients.

Conclusion: Both patients and clinicians reported benefits of using PROMs across diverse health conditions and clinical settings, but also highlighted several limitations. These limitations shed some light on why PROM use may not always improve patient outcomes and provide considerations for the design and implementation of future PROM initiatives.
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http://dx.doi.org/10.1007/s11136-021-03003-zDOI Listing
June 2022

Getting the MOST out of follow-up: a randomized controlled trial comparing 3 monthly nurse led follow-up via telehealth, including monitoring CA125 and patient reported outcomes using the MOST (Measure of Ovarian Symptoms and Treatment concerns) with routine clinic based or telehealth follow-up, after completion of first line chemotherapy in patients with epithelial ovarian cancer.

Int J Gynecol Cancer 2022 Apr 4;32(4):560-565. Epub 2022 Apr 4.

Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia.

Background: Physical symptoms, anxiety, depression, fear of recurrence, sexual dysfunction, and social withdrawal are common in women after treatment for ovarian cancer. Most patients would like and need help dealing with these symptoms. The traditional model of follow-up care is unstructured and largely focused on diagnosing recurrent disease, and most oncologists lack skills to identify and manage psychosocial issues. No high quality prospective clinical trials have been conducted to determine the optimal follow-up regimen or the cost effectiveness of ovarian cancer surveillance strategies.

Primary Objectives: To assess emotional wellbeing, acceptability, safety, and cost effectiveness of nurse led follow-up via telehealth for women with ovarian cancer following completion of primary treatment.

Study Hypothesis: We hypothesize that compared with routine clinic based follow-up, nurse led follow-up via telehealth, including serum CA125 monitoring and completion of a patient reported outcome instrument, the Measure of Ovarian Symptoms and Treatment concerns-Surveillance (MOST-S26), will improve emotional wellbeing in women with ovarian cancer; be feasible, safe, acceptable, and not delay the time to diagnosis of recurrent disease; will result in greater patient satisfaction; will identify more patients with psychological distress, lead to better care, and improved psychological outcomes; and be cost-effective.

Trial Design: Phase II multicenter randomized trial comparing 3 monthly nurse led telehealth consultations that include serum CA125 monitoring and completion of the MOST-S26, with routine clinic based follow-up. The allocation ratio will be 1:1.

Major Inclusion/exclusion Criteria: Eligible patients will be women with high grade epithelial ovarian cancer who have normalized serum CA125 (to <35 kU/L) at completion of first line chemotherapy.

Primary Endpoints: Emotional wellbeing at 12 months.

Sample Size: 150 patients.

Estimated Dates For Completing Accrual And Presenting Results: July 2023. Results expected in 2025, 24 months after the last participant is enrolled.

Trial Registration: ACTRN12620000332921.
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http://dx.doi.org/10.1136/ijgc-2021-002999DOI Listing
April 2022

Using a community-based participatory research approach to meaningfully engage those with lived experience of diabetes and homelessness.

BMJ Open Diabetes Res Care 2021 09;9(1)

Department of Medicine, Unity Health Toronto, Toronto, Ontario, Canada.

Introduction: Participatory research is a study method that engages patients in research programs, ideally from study design through to dissemination. It is not commonly used in diabetes health services research. Our objectives were to describe the process and challenges of conducting a participatory research project and to highlight the experiences of both patient co-researchers and academic researchers.

Research Design And Methods: We recruited people with lived experience of homelessness (PWLEH) and diabetes in Toronto, Canada to become patient co-researchers. They were asked to commit to attending biweekly meetings. We undertook two major research projects: concept mapping to choose a research focus; and photovoice to explore accessing healthy food while homeless. We used a convergent mixed-methods design to evaluate their experience.

Results: A diverse group of eight PWLEH had an average attendance of 82% over 21 meetings-despite this success, we encountered a number of challenges of conducting this research: funding, ethics approval and recruitment were particularly difficult. Group members reported that participation improved their ability to self-advocate in their diabetes care and provided them with tangible skills and social benefits. Group members stated that they valued being involved in all aspects of the research, in particular knowledge translation activities, including advocating for nutritious food at shelters; presenting to stakeholders; and meeting with policymakers.

Conclusions: The use of participatory research methods enables academic researchers to support community members in pursuing research that is pertinent to them and which has a positive impact. In our study, co-researchers contributed in meaningful ways and also valued the experience.
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http://dx.doi.org/10.1136/bmjdrc-2021-002154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424863PMC
September 2021

Use of Erector Spinae Fascial Plane Blocks in Enhanced Recovery for Open Abdominal Surgery.

J Surg Res 2021 12 3;268:673-680. Epub 2021 Sep 3.

University of New Mexico Health Sciences Center, Department of Surgery, Albuquerque, New Mexico. Electronic address:

Background: Bilateral erector spinae fascial plane blocks (ESPB) offers a novel, alternative method of regional post-operative pain control to thoracic epidural analgesia (TEA). The aim of this study was to compare rates of postoperative hypotension, and other standard enhanced recovery after surgery (ERAS) endpoints, in patients receiving ESPB versus TEA for open hepatopancreaticobiliary (HPB) surgery.

Materials And Methods: This retrospective analysis compared historical controls of ERAS patients undergoing open HPB surgery with TEA versus ESPB. The incidence of postoperative hypotension and clinical outcomes, including opioid requirements, were compared.

Results: Forty patients receiving TEA were compared to 27 ESPB patients. Return of bowel function and length of stay (mean 7.2 versus7.4 days; P = 0.83) were similar. ESPB patients received less intraoperative colloid (142cc versus 340cc; P = 0.01) and had less postoperative hypotension versus TEA (22% versus 55%; P = 0.03). No ESPB patient required patient-controlled analgesia (versus 32.5% TEA; P< 0.001). ESPB MME requirements decreased over time, while TEA MME requirements increased over 72 hours (P = 0.019).

Conclusions: ESPB is a novel method that shows promising outcomes in improving enhanced recovery parameters and minimizing opioid administration in open HPB surgery.
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http://dx.doi.org/10.1016/j.jss.2021.08.008DOI Listing
December 2021

Development and validation of the measure of ovarian symptoms and treatment concerns for surveillance (MOST-S26): An instrument to complement the clinical follow-up of women with ovarian cancer after completion of first-line treatment.

Gynecol Oncol 2021 11 1;163(2):398-407. Epub 2021 Sep 1.

Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia.

Objective: The Measure of Ovarian Symptoms and Treatment (MOST-T35) is a patient-reported symptom index, developed and validated in the context of palliative chemotherapy for recurrent ovarian cancer (OC). We aimed to develop and validate a version suitable for surveillance of symptoms following first-line treatment for OC to support clinical follow-up.

Methods: In a prospective study of women following completion of first-line chemotherapy for OC, patients completed MOST-T35 every 3 months for up to 3.5 years and other patient-reported outcome measures. Construct validity (Spearman's correlations), discriminative validity (t-tests/ANOVAs assessing differences between clinically distinct groups), ability to detect clinically important symptoms (receiver operating characteristic analysis), and responsiveness (t-tests examining change) were assessed.

Results: Data from 726 women who received ≥3 cycles of chemotherapy, did not progress within 3 months, and completed ≥one MOST-T35 were analysed. The revised version, MOST-S26, has 26 items and 5 multi-item indexes: peripheral neuropathy (MOST-NTx), disease or treatment-related (MOST-DorT), abdominal (MOST-Abdo), and psychological symptoms (MOST-Psych), and MOST-Wellbeing, plus 9 individual items. Construct validity was confirmed (r range = 0.43-0.88). Discriminative validity confirmed expected differences between groups. MOST-NTx and MOST-Psych detected improvements in peripheral neuropathy and psychological symptoms respectively, whereas MOST-Abdo detected worsening of abdominal symptoms pre-recurrence.

Conclusions: This study developed and validated the MOST-S26, for surveillance of women in follow-up after first-line chemotherapy for OC. MOST-S26 reliably detected improvement in symptoms of peripheral neuropathy, psychological distress and may detect symptoms of relapse. Administration of MOST-S26 in follow-up consultations could identify concerning symptoms and facilitate timely and appropriate intervention.
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http://dx.doi.org/10.1016/j.ygyno.2021.08.022DOI Listing
November 2021

Daily ups and downs in adolescents' depressive symptoms: The role of daily self-criticism, dependency and basic psychological needs.

J Adolesc 2021 08 4;91:97-109. Epub 2021 Aug 4.

Department of Developmental, Social, and Personality Psychology, Ghent University, Ghent, Belgium.

Introduction: Although associations between Blatt's personality dimensions of self-criticism and dependency and adolescents' depressive symptoms are well-established, only few studies have examined associations between these variables at the level of daily, within-person fluctuations. Moreover, our understanding of the mechanisms underlying this personality vulnerability to depressive symptoms is limited. Therefore, we studied (a) daily fluctuations in both personality and depressive symptoms over a 7-day period and (b) the possible interplay between daily variations in personality vulnerability, need-based experiences (as conceptualized in Self-Determination Theory), and depressive symptoms. This interplay was examined in terms of both a mediational and a moderating role of the need-based experiences.

Methods: Participants were 121 Belgian adolescents (M = 15.81; SD = 1.50; 52 % male) who completed questionnaires tapping into daily self-criticism, dependency, need-based experiences, and depressive symptoms every evening during seven consecutive days.

Results & Conclusions: Multilevel analysis revealed that self-criticism and dependency fluctuated substantially on a daily basis. These daily fluctuations in personality were related to daily fluctuations in depressive symptoms, with daily variation in need-based experiences mediating these associations. We found no evidence for interactions between personality and the need-based experiences. The findings underscore the importance of considering daily fluctuations in individuals' personality vulnerability and point to the explanatory role of need-based experiences in the relation between personality and depressive symptoms on a daily basis.
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http://dx.doi.org/10.1016/j.adolescence.2021.07.005DOI Listing
August 2021

Les défis de la gestion du diabète chez les personnes itinérantes : étude qualitative avec la méthode photovoix.

CMAJ 2021 08;193(30):E1184-E1192

Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.

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http://dx.doi.org/10.1503/cmaj.202537-fDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354642PMC
August 2021

Using concept mapping to prioritize barriers to diabetes care and self-management for those who experience homelessness.

Int J Equity Health 2021 07 9;20(1):158. Epub 2021 Jul 9.

Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.

Background: Diabetes is a chronic medical condition which demands that patients engage in self-management to achieve optimal glycemic control and avoid severe complications. Individuals who have diabetes and are experiencing homelessness are more likely to have chronic hyperglycemia and adverse outcomes. Our objective was to collaborate with individuals experiencing homelessness and care providers to understand the barriers they face in managing diabetes, as a first step in identifying solutions for enhancing diabetes management in this population.

Methods: We recruited individuals with lived experience of homelessness and diabetes (i.e. clients; n = 32) from Toronto and health and social care providers working in the areas of diabetes and/or homelessness (i.e. providers; n = 96) from across Canada. We used concept mapping, a participatory research method, to engage participants in brainstorming barriers to diabetes management, which were subsequently categorized into clusters, using the Concept Systems Global MAX software, and rated based on their perceived impact on diabetes management. The ratings were standardized for each participant group, and the average cluster ratings for the clients and providers were compared using t-tests.

Results: The brainstorming identified 43 unique barriers to diabetes management. The clients' map featured 9 clusters of barriers: Challenges to getting healthy food, Inadequate income, Navigating services, Not having a place of your own, Relationships with professionals, Diabetes education, Emotional wellbeing, Competing priorities, and Weather-related issues. The providers' map had 7 clusters: Access to healthy food, Dietary choices in the context of homelessness, Limited finances, Lack of stable, private housing, Navigating the health and social sectors, Emotional distress and competing priorities, and Mental health and addictions. The highest-rated clusters were Challenges to getting healthy food (clients) and Mental health and addictions (providers). Challenges to getting healthy food was rated significantly higher by clients (p = 0.01) and Competing priorities was rated significantly higher by providers (p = 0.03).

Conclusions: Experiencing homelessness poses numerous barriers to managing diabetes, the greatest of which according to clients, is challenges to getting healthy food. This study showed that the way clients and providers perceive these barriers differs considerably, which highlights the importance of including clients' insights when assessing needs and designing effective solutions.
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http://dx.doi.org/10.1186/s12939-021-01494-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8272311PMC
July 2021

Toward a Better Understanding of the Reciprocal Relations Between Adolescent Psychological Need Experiences and Sleep.

Pers Soc Psychol Bull 2021 03 19;47(3):377-394. Epub 2020 Jun 19.

Bilkent University, Ankara, Turkey.

In two diary studies, we examined the reciprocal daily association between the satisfaction and frustration of adolescents' basic psychological needs and sleep, and the role of stress and fatigue in these associations. In Study 1 ( = 211; 52% female; age = 15.86 years, = 1.18 years), daily need experiences were unrelated to daily fluctuations in subjective sleep outcomes. However, shorter daily sleep quantity was related to higher daily fatigue, which in turn related to more daily need frustration and less need satisfaction. Study 2 ( = 51; 49% female; age = 15.88 years, = 2.88 years) extended these findings by demonstrating that daily need frustration related to shorter objective sleep quantity and longer wake after sleep onset, indirectly through higher symptoms of stress. Poor sleep quality also related to worse need experiences via higher daily fatigue. These findings underscore the dynamic interplay between daily need experiences and adolescent sleep.
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http://dx.doi.org/10.1177/0146167220923456DOI Listing
March 2021

Predictive validity of the HCR-20 in a sample of Australian forensic psychiatric patients.

Psychiatr Psychol Law 2021 16;28(3):325-342. Epub 2020 Jun 16.

Translational Social Research Division, National Council of Social Service, Singapore.

The Historical Clinical Risk Management-20 Version 3 is the latest iteration in the HCR-20 series, adopting novel changes such as the addition of Relevance ratings and non-requirement to include the Psychopathy Checklist-Revised. This study aimed to examine these changes and compare the predictive validity of the HCR-20 to the HCR-20. The sample comprised of 100 forensic psychiatric patients, retrospectively followed up for a maximum period of approximately 13 years post-discharge from the Thomas Embling Hospital. Recidivism data were sourced from official police records. Results indicated good to excellent inter-rater reliability. The HCR-20 significantly predicted violent recidivism (area under the curve = .70 to .77), levels of accuracy that were not significantly different from the HCR-20. HCR-20 Relevance ratings failed to add incremental validity above Presence ratings; however, the PCL-R improved upon the HCR-20's validity. The study represented one of the first evaluations of the HCR-20 in Australia.
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http://dx.doi.org/10.1080/13218719.2020.1775152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9068010PMC
June 2020

Innovations in Providing Diabetes Care for Individuals Experiencing Homelessness: An Environmental Scan.

Can J Diabetes 2020 Oct 14;44(7):643-650. Epub 2020 Feb 14.

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Objectives: For a variety of reasons, homelessness creates major challenges for the management of diabetes, resulting in excess morbidity and mortality in this population. The objective of this study was to document innovations in providing diabetes care for individuals experiencing homelessness.

Methods: Using directed snowball sampling, we recruited a sample of service providers (family physicians, nurses, social workers, endocrinologists, diabetes educators, shelter workers) in 5 Canadian cities (Vancouver, Calgary, Edmonton, Toronto, Ottawa). Data were collected using detailed, open-ended interviews. Transcripts and field notes were analyzed using thematic analysis.

Results: We interviewed 96 program managers and providers representing 38 organizations. Although many of the same challenges were faced by care providers in different jurisdictions, there was little communication or sharing of experiences across providers and organizations. However, we identified 5 unique and innovative approaches to providing diabetes care to individuals experiencing homelessness. These include: 1) provision of in-shelter care, 2) peer outreach/support workers, 3) diabetes specialty outreach clinics, 4) diabetes group care specific for this population and 5) community-based pharmacy interventions.

Conclusions: Providers and organizations in different cities face similar challenges in providing diabetes care to individuals who are experiencing homelessness, yet they tend to address these difficulties in isolation. Despite this, numerous organizations have created innovative solutions to improve diabetes care. Sharing experiences across organizations and jurisdictions can facilitate development and implementation of successful program models.
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http://dx.doi.org/10.1016/j.jcjd.2020.01.011DOI Listing
October 2020

Patient-reported outcomes as predictors of survival in patients with bowel cancer: a systematic review.

Qual Life Res 2019 Nov 30;28(11):2871-2887. Epub 2019 Jul 30.

Faculty of Science, School of Psychology, Quality of Life Office, The University of Sydney, Sydney, NSW, Australia.

Introduction: The prognostic value of patient-reported outcomes (PROs) has been determined in some cancers, but a focussed review in colorectal cancer (CRC) has not yet been conducted. We systematically reviewed PRO predictors of CRC patient survival.

Methods: We searched four electronic databases (from inception to May 2018), reference lists and professional organisations to identify studies reporting pre-treatment PRO predictors of overall survival (OS) or progression-free survival (PFS) in CRC identified through univariate or multivariate models. Two reviewers independently applied inclusion criteria and extracted data on study characteristics, median and 1-year survival rates, PROs assessed and model results.

Results: In 25 of 27 studies (n = 12,544), at least one PRO was significantly associated with survival. Physical functioning, fatigue, pain and appetite loss predicted OS more often than other PROs in metastatic disease (19/27 studies). One study explored PRO predictors in early-stage CRC, finding emotional well-being and mood predicted OS. In mixed-stage samples (7/27 studies), physical functioning predicted OS more often than other PROs. Few studies modelled PFS, for which few PROs had predictive value.

Conclusions: Physical and psychological functioning, pain, fatigue and appetite loss had prognostic significance above and beyond clinical predictors in CRC. Routine monitoring of these PROs may allow earlier detection and amelioration of problems, which may improve quality of life and perhaps extend survival. More research is needed to determine prognostic value of PROs in early-stage CRC, and prognostic significance of changes in PRO scores.
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http://dx.doi.org/10.1007/s11136-019-02255-0DOI Listing
November 2019

A pilot peer interview preparation scheme for foundation doctors.

Future Healthc J 2019 Mar;6(Suppl 1):168

Northern Ireland Medical and Dental Training Agency (NIMDTA), Belfast, UK.

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http://dx.doi.org/10.7861/futurehosp.6-1-s168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616748PMC
March 2019

Interventions for improved diabetes control and self-management among those experiencing homelessness: protocol for a mixed methods scoping review.

Syst Rev 2019 04 22;8(1):100. Epub 2019 Apr 22.

Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.

Background: Diabetes is a chronic medical condition that requires patients to be actively engaged in intensive self-management to achieve optimal clinical outcomes. Unfortunately, individuals who are experiencing homelessness often struggle to manage diabetes and consequently suffer numerous and severe complications-both acute and chronic. There are many barriers to optimal diabetes self-management among this population, and this may be exacerbated by the lack of tailoring and customization of care to this unique population. Given this disconnect, it is likely that many organizations have attempted to provide specialized innovations for this population-which may or may not be reported in the formal literature. Our objective is to perform a scoping review to summarize and synthesize the experiences of those who have attempted to provide tailored interventions.

Methods: We propose a mixed methods scoping review that will include both a formal search of the published literature (MEDLINE, CINAHL, EMBASE, Web of Science, Scopus) and a thorough search of the grey literature. Eligible articles and documents are those that report on an intervention or guideline for the management of diabetes among those experiencing homelessness. All titles and abstracts will undergo duplicate review, as will the full article/document. We will include any report that either includes a description of an intervention or provides recommendations for the treatment of individuals who are homeless with diabetes. We will extract both qualitative and quantitative data for analysis and interpretation. Meta-analysis will not be performed.

Discussion: Those experiencing homelessness who also have diabetes often struggle to manage their chronic condition. When care is tailored to suit their needs, it is feasible that outcomes may be improved. By collating and synthesizing information from diverse organizations and jurisdictions, we hope to facilitate the sharing of knowledge with others who wish to provide this type of care.
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http://dx.doi.org/10.1186/s13643-019-1020-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477731PMC
April 2019

Comparison of generic and disease-specific measures in their ability to detect differences in pressure ulcer clinical groups.

Wound Repair Regen 2019 07 30;27(4):396-405. Epub 2019 Mar 30.

Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom.

Patient-reported outcomes can be included as end points in pressure ulcer (PU) intervention trials to provide information to inform decision-making and improve the lives of patients. However, the challenge for researchers and clinicians is identifying and choosing an appropriate instrument for each particular application that suits their research questions and clinical context. To provide researchers and clinicians with the information needed to inform choice of patient-reported outcome measures, we compared a generic and disease-specific measures' ability to discriminate between clinical groups known to differ, and determined their responsiveness to change. We performed analyses on a subset of patients recruited to the PRESSURE 2 trial that completed the pressure ulcer quality of life instrument-prevention version (PU-QOL-P) and Short Form 12 Questionnaire (SF12) measures at baseline and 30-day posttreatment. Known-group validity and responsiveness-to-change analyses were conducted. The analysis sample consisted of 617 patients that completed both measures at baseline. Known-group validity revealed that some PU-QOL-P symptoms and function scales differentiated between people with category 2 PUs and those without PUs. A less meaningful pattern of results was observed for the SF12 scales, suggesting that the PU-QOL-P is more sensitive to differences between PU and non-PU populations. Responsiveness analysis revealed that the PU-QOL-P was more responsive in detecting disease severity than the SF12. The PU-QOL-P provides a standardized method for assessing PU-specific symptoms and functioning outcomes and is suitable for quantifying the benefits of PU interventions from the patient's perspective. Generic measures are useful for group comparisons of global quality of life domains. Choice of measure for each particular application should be determined by the purpose of the measurement and the information required.
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http://dx.doi.org/10.1111/wrr.12716DOI Listing
July 2019

Reciprocal associations between daily need-based experiences, energy, and sleep in chronic fatigue syndrome.

Health Psychol 2018 Dec 15;37(12):1168-1178. Epub 2018 Oct 15.

Department of Psychology, TED University.

Objective: Previous findings indicate that patients with chronic fatigue syndrome (CFS) report significant day-to-day fluctuations in subjective energy and sleep. Herein, we examined whether daily variation in the satisfaction and frustration of the basic psychological needs for autonomy, competence, and relatedness would contribute to daily variation in subjective energy and quality and quantity of sleep. In addition, we examined whether daily variation in sleep would contribute to daily need-based experiences through (i.e., mediated by) daily fluctuations in subjective energy.

Method: CFS patients (N = 120; 92% female; M = 42.10 years, SD = 10.46) completed a diary for 14 days which assessed their need-based experiences and subjective energy every evening and sleep every morning.

Results: Results indicated that subjective energy, sleep, and need experiences fluctuated significantly from day to day. Daily need satisfaction related to less daily fatigue and more daily vitality, while the opposite pattern was observed for daily need frustration. Daily need frustration was also uniquely related to poorer daily sleep quality. Lastly, better daily sleep quality was also uniquely related to more daily need satisfaction and less daily need frustration via (i.e., mediated by) daily variation in subjective energy. These reciprocal within-day associations remained significant after controlling for the previous day's level of each outcome, with the exception of the relation between need frustration and sleep quality.

Conclusion: The present findings underscore the reciprocal day-to-day association between need-based experiences and subjective energy in CFS. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000621DOI Listing
December 2018

Clinician-reported changes in octreotide prescribing for malignant bowel obstruction as a result of an adequately powered phase III study: A transnational, online survey.

Palliat Med 2018 09 1;32(8):1363-1368. Epub 2018 Jun 1.

4 Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.

Background: Translating research evidence into clinical practice often has a long lag time.

Aim: To determine the impact of a phase III randomised controlled trial on palliative care clinicians' self-reported practice change.

Design: Online survey about use of octreotide in managing inoperable malignant bowel obstruction due to cancer or its treatments distributed in November 2016, 2 years after the first publication of the study in a peer-reviewed journal. Demographic, self-reported practice and the reasons underpinning this were collected. Responses were aggregated to 'practice modified' or 'practice not modified'. A multinomial regression model explored predictors of practice change.

Setting: Members of the Australian New Zealand Society of Palliative Medicine.

Results: Response rate was 20.8% (106/509): 55.6% were aged >50 years, 56.5% were female and 77% had previously prescribed octreotide for this clinical indication. Out of 106 respondents, 52 (49.1%) indicated modified practice (60.9% of those who had previously prescribed octreotide in this setting). In those who reported practice change, most frequently octreotide was now used when other therapies failed; for not changing practice, 'more confirmatory evidence was needed' was most often cited. In the regression model, older age (clinician age = 50-59 years; relative risk = 0.147; 95% confidence interval = 0.024-0.918; p = 0.04) and having practices with lower proportions of people treated with octreotide (0%-20%; relative risk = 0.039; 95% confidence interval = 0.002-0.768; p = 0.033) predicted greater self-reported practice change.

Conclusion: Clinician-reported change in practice in the survey is seen in the majority of respondents. This suggests that there is a cohort of 'early adopters' within palliative care practice as new evidence becomes available.
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http://dx.doi.org/10.1177/0269216318778460DOI Listing
September 2018

Psychological need frustration as a transdiagnostic process in associations of self-critical perfectionism with depressive symptoms and eating pathology.

J Clin Psychol 2018 10 30;74(10):1775-1790. Epub 2018 Apr 30.

Ghent University.

Objective: The identification of transdiagnostic risk factors and processes that explain the comorbidity between depressive symptoms and eating disorder symptoms is critical. We examined the mediating role of the frustration of adolescents' psychological needs for autonomy, competence, and relatedness in the association between self-critical perfectionism, depressive symptoms and eating disorder symptoms.

Method: A cross-sectional study (N = 248; 58% female, mean age = 14 years) and a two-wave longitudinal study (N = 608; 59% female; mean age = 16 years) were conducted.

Results: At the level of inter-individual differences and intra-individual change, self-critical perfectionism was a robust predictor of both symptoms. After introducing need frustration as an underlying mechanism, the relation between self-critical perfectionism and the two types of symptoms, as well as the relation between the symptoms themselves, decreased.

Conclusions: Need frustration represents a transdiagnostic vulnerability process that helps to explain why self-critical perfectionism relates to depressive symptoms and eating disorder symptoms.
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http://dx.doi.org/10.1002/jclp.22628DOI Listing
October 2018

Linking psychological need experiences to daily and recurring dreams.

Motiv Emot 2018 30;42(1):50-63. Epub 2017 Nov 30.

2Ghent University, Ghent, Belgium.

The satisfaction of individuals' psychological needs for autonomy, competence, and relatedness, as conceived from a self-determination theory perspective, is said to be conducive to personal growth and well-being. What has been unexamined is whether psychological need-based experiences, either their satisfaction or frustration, manifests in people's self-reported dream themes as well as their emotional interpretation of their dreams. A cross-sectional study ( = 200; age = 21.09) focusing on individuals' recurrent dreams and a three-day diary study ( = 110; age = 25.09) focusing on daily dreams indicated that individuals experiencing psychological need frustration, either more enduringly or on a day-to-day basis, reported more negative dream themes and interpreted their dreams more negatively. The contribution of psychological need satisfaction was more modest, although it related to more positive interpretation of dreams. The discussion focuses on the role of dreams in the processing and integration of psychological need-frustrating experiences.
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http://dx.doi.org/10.1007/s11031-017-9656-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775982PMC
November 2017

Relations between problem behaviors, perceived symptom severity and parenting in adolescents and emerging adults with ASD: The mediating role of parental psychological need frustration.

Res Dev Disabil 2018 Feb 12;73:21-30. Epub 2017 Dec 12.

Erasmus University Rotterdam, Faculty of Social Sciences, Department of Psychology, Education & Child Studies, Burg. Oudlaan 50, 3000 DR Rotterdam, The Netherlands.

Research in parents of youngsters with Autism Spectrum Disorder (ASD) increasingly documents associations between children's problem behaviors and symptom severity and more dysfunctional and less adaptive parenting behaviors. However, the mechanisms underlying these associations have not been examined thoroughly. This study examines the mediating role of parental need frustration in the relation between child maladjustment (i.e., problem behavior and autism severity) and parenting behavior (i.e., controlling and autonomy-supportive parenting). The sample included 95 parents of adolescents/emerging adults with ASD (M=18.8years, SD=2.3). Parents completed questionnaires assessing their parenting strategies and psychological need frustration as well as the internalizing and externalizing problem behaviors and autism severity of their child. Results indicate that the association between externalizing problems and controlling parenting was partially mediated by need frustration. This suggests that externalizing problems go together with lower feelings of parent-child closeness, lower parental competence, and a decreased sense of volitional functioning, feelings that, in turn, relate to more controlling strategies. Symptom severity has a direct negative association with autonomy support, suggesting that parents lower their autonomy support when their child has high levels of autism symptoms, without experiencing these symptoms as a threat to their own psychological needs.
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http://dx.doi.org/10.1016/j.ridd.2017.12.012DOI Listing
February 2018

The Utility of the HCR-20 in an Australian Sample of Forensic Psychiatric Patients.

Psychiatr Psychol Law 2018 30;25(2):273-282. Epub 2017 Aug 30.

Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, VIC, Australia.

The Historical Clinical Risk Management-20 (HCR-20) is utilised internationally to assess an individual's risk for violence. Despite being widely administered in Australian correctional and forensic populations, the predictive validity of the HCR-20 instrument has never been explored in Australian settings. This retrospective study investigated the predictive validity of the HCR-20 for an Australian cohort of 136 forensic psychiatric patients. Findings support the relationship between the HCR-20 and violent offending post hospital discharge. The HCR-20 Total, Historical, and Risk Management scales shared moderate to large positive correlations with several reconviction categories.
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http://dx.doi.org/10.1080/13218719.2017.1364676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818267PMC
August 2017

Association between urinary biomarkers of total sugars intake and measures of obesity in a cross-sectional study.

PLoS One 2017 19;12(7):e0179508. Epub 2017 Jul 19.

Department of Food & Nutritional Sciences, University of Reading, Reading, United Kingdom.

Obesity is an important modifiable risk factor for chronic diseases. While there is increasing focus on the role of dietary sugars, there remains a paucity of data establishing the association between sugar intake and obesity in the general public. The objective of this study was to investigate associations of estimated sugar intake with odds for obesity in a representative sample of English adults. We used data from 434 participants of the 2005 Health Survey of England. Biomarkers for total sugar intake were measured in 24 h urine samples and used to estimate intake. Linear and logistic regression analyses were used to investigate associations between biomarker-based estimated intake and measures of obesity (body mass intake (BMI), waist circumference and waist-to-hip ratio) and obesity risk, respectively. Estimated sugar intake was significantly associated with BMI, waist circumference and waist-to-hip ratio; these associations remained significant after adjustment for estimated protein intake as a marker of non-sugar energy intake. Estimated sugar intake was also associated with increased odds for obesity based on BMI (OR 1.02; 95%CI 1.00-1.04 per 10g), waist-circumference (1.03; 1.01-1.05) and waist-to-hip ratio (1.04; 1.02-1.06); all OR estimates remained significant after adjusting for estimated protein intake. Our results strongly support positive associations between total sugar intake, measures of obesity and likelihood of being obese. It is the first time that such an association has been shown in a nationally-representative sample of the general population using a validated biomarker. This biomarker could be used to monitor the efficacy of public health interventions to reduce sugar intake.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0179508PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5517003PMC
September 2017

Basic psychological need experiences, fatigue, and sleep in individuals with unexplained chronic fatigue.

Stress Health 2017 Dec 3;33(5):645-655. Epub 2017 Apr 3.

Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium.

Grounded in self-determination theory, this study tested the hypothesis that the satisfaction and frustration of the psychological needs for autonomy, competence, and relatedness would relate to fatigue and subjective and objective sleep parameters, with stress and negative sleep cognitions playing an explanatory role in these associations. During a stay at a sleep laboratory in Belgium, individuals with unexplained chronic fatigue (N = 160; 78% female) underwent polysomnography and completed a questionnaire at 3 different points in time (i.e., after arrival in the sleep lab, before bedtime, and the following morning) that assessed their need-based experiences and stress during the previous week, fatigue during the preceding day, and sleep-related cognitions and sleep during the previous night. Results indicated that need frustration related to higher stress, which in turn, related to higher evening fatigue. Need frustration also related to poorer subjective sleep quality and shorter sleep duration, as indicated by both subjective and objective shorter total sleep time and subjective (but not objective) longer sleep latency. These associations were accounted for by stress and negative sleep cognitions. These findings suggest that health care professionals working with individuals with unexplained chronic fatigue may consider focusing on basic psychological needs within their therapeutic approach.
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http://dx.doi.org/10.1002/smi.2751DOI Listing
December 2017

The role of basic psychological need satisfaction, sleep, and mindfulness in the health-related quality of life of people living with HIV.

J Health Psychol 2019 03 24;24(4):535-545. Epub 2016 Nov 24.

2 Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium.

Research has not yet examined the relationship between psychological need satisfaction, sleep, mindfulness, and health-related quality of life in people living with HIV. This cross-sectional study ( N = 101; 84% male; mean age = 45.48, SD = 12.75) found need satisfaction to relate positively to physical and mental health. Sleep quality fully mediated the association with physical health and partially mediated the association with mental health. Furthermore, mindfulness related to higher sleep quality through higher need satisfaction. Findings underscore the role of need satisfaction in determining health-related quality of life and sleep quality in people living with HIV and suggest that mindfulness may facilitate need satisfaction.
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http://dx.doi.org/10.1177/1359105316678305DOI Listing
March 2019

Psychopathy, Antisocial Personality Disorder, and Reconviction in an Australian Sample of Forensic Patients.

Int J Offender Ther Comp Criminol 2018 02 9;62(3):609-628. Epub 2016 Jun 9.

1 Swinburne University of Technology, Clifton Hill, Victoria, Australia.

This study identified the presence of psychopathy (as measured by the PCL-R/PCL:SV instruments) and antisocial personality disorder (APD) and their relationship with future reconviction in an Australian forensic sample ( N = 136) of patients with a mental disorder. Patients were tracked for over 4 years postrelease to determine associations between a diagnosis of APD/psychopathy and reoffense. Patients with higher psychopathy scores were found to have an increased likelihood of reincarceration, a higher rate of reconviction, and were reconvicted earlier compared with patients with lower psychopathy scores. Patients with APD were more likely to be reconvicted and reincarcerated during the follow-up period than patients without an APD diagnosis. Despite demonstrating associations with general reconviction, the PCL instruments did not exhibit statistically significant relationships with violence. Implications for the clinical identification of personality disordered patients in forensic settings are discussed.
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http://dx.doi.org/10.1177/0306624X16653193DOI Listing
February 2018
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