Intimate partner violence in prisoners: toward effective assessment and intervention

This paper reviews the significant challenges that are involved in the development of services for perpetrators of intimate partner violence who are in prison. It is suggested that difficulties in accurately identifying intimate partner violence, reliably assessing risk of re-offense, and in identifying offending behavior programs that meet the specific needs of prisoners have limited the development of services in this area. As a result it is argued that unique and complex victim related issues that arise during incarceration and post-release are not adequately recognized in current correctional assessment and case management systems. Four avenues for future research and service development in this area are identified, with a view to developing the role that correctional services have to play in preventing intimate partner violence.

Cardiovascular risk prediction model development and assessment

The aim of this article is to review the development and assessment of cardiovascular risk prediction models and to discuss the predictive value of a risk factor as well as to introduce new assessment methods to evaluate a risk prediction model. Many cardiovascular risk prediction models have been developed during the past three decades. However, there has not been consistent agreement regarding how to appropriately assess a risk prediction model, especially when new markers are added to an existing model. The area under the receiver operating characteristic (ROC) curve has traditionally been used to assess the discriminatory ability of a risk prediction model. However, recent studies suggest that this method has its limitations and cannot be the sole approach to evaluate the usefulness of a new marker. New assessment methods are being developed to appropriately assess a risk prediction model and they will be gradually used in clinical and epidemiological studies.

Extended supervision of sexual offenders in Australia and New Zealand : differences in implementation across jurisdictions

Australia and New Zealand have joined the movement of many Western societies in recent years to address a perceived gap in public safety by passing legislation allowing for extended supervision of sex offenders in the community after their release from prison. The Australian State of Victoria passed a law similar to that of New Zealand, and both laws have now been in effect for a similar period of time. Yet despite having comparable laws and approximately comparable base populations, there have been 145 extended supervision orders imposed in New Zealand and 20 such orders in Victoria. This article examines the differences in implementation and the underlying procedures used in the two jurisdictions to understand these very different outcomes. Implications for professional practice, ethics, public safety, and policy development are discussed.

Assessment and case conceptualization in sex offender treatment

The assessment of sexual offenders consists of the systematic collection of clinically relevant information in order to detect clinical phenomena or problems and to provide clear treatment targets. The result of this process is a conceptual model, or case formulation, representing the client’s various problems, the hypothesized underlying mechanisms, and their interrelationships. The focus of this article is on the importance of psychological assessment and case formulation in the rehabilitation and management of individuals convicted of sexual offences. First, we make a number of general points about the importance of evidence based assessment and clinical reasoning in case formulation. Second, we review key elements of contemporary sexual offender theory that highlights the heterogeneity evident among sex offenders and the implications for case formulation and treatment planning. Third, we discuss the role of case formulation for risk assessment and management. Finally, we illustrate our major points with a brief case study and conclude with a brief consideration of the value of case formulations.

Is jump risk in iTraxx Sector Indices diversifiable?

The article presents an analysis of jump risks in iTraxx Europe index in a multivariate structural time-series setting for the stochastic process, as well as in the credit default swap (CDS) market. It also examines the rapid development of the credit derivatives market, particularly the CDS market. This analysis found a significant Poisson-distributed jumps in the iTraxx Non-Financials index and its subindices. Based on a statistical analysis, nondiversifiable jump risk strongly exists in the CDS market.

Assessing the risk of suicide at triage

Mental health related presentations to Australian emergency departments are steadily increasing. There is a growing incidence of depression, substance abuse, and other mental illnesses in the Australian population. Mental health problems will contribute 15% of the total world disease burden by 2020. Triage nurses are pivotal to the early detection and management of mental health problems.

The rapid assessment of mental health presentations at triage requires skill, knowledge, experience and confidence. One of the more complex aspects of triage is suicide risk assessment.

An ABC approach to assessing the risk of violence at triage

There is evidence to suggest that the incidence of violent behaviour in the emergency department by patients toward staff is on the rise. As part of the process of determining urgency, triage nurses must assess the risk of violence at point of entry. The risk of violence, that is, behaviour that either involves a threat of physical or psychological harm to one's self or to others, is considered a critical predictor of urgency in mental health triage. A rapid violence risk assessment strategy will be described which can be utilised in emergency department triage.

An integrated theory of sexual offending

This paper represents a first attempt to provide an integrated framework to explain the onset, development, and maintenance of sexual offending. According to the Integrated Theory of Sexual Offending (ITSO), sexual abuse occurs as a consequence of a number of interacting causal variables. We examine the factors that affect brain development (evolution, genetic variations and neurobiology) and ecological factors (social and cultural environment, personal circumstances, physical environment) and discuss how they impact upon core neuropsychological functions underpinning human action. The ITSO then explains how clinical symptoms arise from the interaction between these neurological systems and ecological factors. The capacity of the ITSO to incorporate competing theories of sexual offending is considered, and we end the paper by critically evaluating its usefulness in stimulating research and further theory development.

Mental health-related risk factors for violence : using the evidence to guide mental health triage decision making

Mental health clinicians working in emergency crisis assessment teams or mental health triage roles are required to make rapid and accurate risk assessments. The assessment of violence risk at triage is particularly pertinent to the early identification and prevention of patient violence, and to enhancing the safety of clinical staff and the general public. To date, the evidence base for mental health triage violence risk assessment has been minimal. This study aimed to address this evidence gap by identifying best available evidence for mental health-related risk factors for patientinitiated violence.We conducted a systematic review based on the National Health and Medical Research Council of Australia’s methodology for systematic reviews. A total of 6847 studies were retrieved, of which 326 studies met the study inclusion criteria. Of these studies, 277 met inclusion criteria but failed the quality appraisal process, thus a total of 49 studies were included in the final review. The risk factors that achieved the highest evidence grading were predominantly related to dynamic clinical factors immediately observable in the patient’s general appearance, behaviour and speech. These factors included hostility/anger, agitation, thought disturbance, positive symptoms of schizophrenia, suspiciousness and irritability.

Understanding dynamic risk factors for violence

Recent years have seen a consensus emerge regarding the dynamic risk factors that are associated with future violence. These risk factors are now routinely assessed in structured violence risk assessment instruments. They provide a focus for treatment in structured group programmes. However, relatively little attention has been paid to risk-related theoretical issues, whether these dynamic risk factors are causally related or simply correlates of violent offending, or the extent to which they change as a consequence of treatment. More challenging is the lack of evidence to suggest that changes in these dynamic risk factors actually result in reductions in violent offending. In this paper we consider the meaning of the term dynamic risk, arguing that only those factors that, when changed, reduce the likelihood of violent recidivism, can be considered to be truly dynamic. We conclude that few of the violence risk factors commonly regarded as dynamic fulfil this requirement. There is a need to think more critically about assessment findings and treatment recommendations relating to dynamic risk, and conduct research that establishes, rather than assumes, that certain dynamic risk factors are directly related to violence. Some suggestions for advancing knowledge and practice are provided.

The management of adolescents at risk of suicide by Australian general practitioners: issues in practice and confidence

This study involved an anonymous survey of 41Victorian GPs regarding their diagnostic and treatment practices with adolescent patients with depression and/or suicide ideation. The results indicated that the majority of respondents correctly diagnosed the level of depression and the risk of suicide in a case scenario. Although they commonly asked some of the questions related to an assessment of suicide risk, they rarely conducted a comprehensive risk assessment and the level of referral to telephone and internet crisis services was poor. Most GPs indicated a lack of confidence in their ability to detect and manage depression and suicide in this population and strongly emphasized a need for more training.

Is the risk of illness through consuming vegetables irrigated with reclaimed wastewater different for different population groups?

The use of reclaimed wastewater for irrigation of horticultural crops is commonplace in many parts of the world and is likely to increase. Concerns about risks to human health arising from such practice, especially with respect to infection with microbial pathogens, are common. Several factors need to be considered when attempting to quantify the risk posed to a population, such as the concentration of pathogens in the source water, water treatment efficiency, the volume of water coming into contact with the crop, and the die-off rate of pathogens in the environment. Another factor, which has received relatively less attention, is the amount of food consumed. Plainly, higher consumption rates place one at greater risk of becoming infected. The amount of vegetables consumed is known to vary among ethic groups. We use Quantitative Microbial Risk Assessment Modelling (QMRA) to see if certain ethnic groups are exposed to higher risks by virtue of their consumption behaviour. The results suggest that despite the disparities in consumption rates by different ethnic groups they generally all faced comparable levels of risks. We conclude by suggesting that QMRA should be used to assess the relative levels of risk faced by groups based on divisions other than ethnicity, such as those with compromised immune systems.

Pressure injury: an exploration of the relationship between risk factors and interface pressure

Pressure injuries are a serious risk for patients admitted to hospital and are thought to result from a number of forces operating on skin tissue (pressure, shear and friction). Most research on interface pressure (IP) has taken place using healthy volunteers or mannequins. Little is currently known about the relationship between pressure injury risk and IP for hospital patients. This relationship was investigated with a sample of 121 adult hospital patients. Pressure injury risk was evaluated using the Waterlow Risk Assessment Tool (WRAT) and IP was measured at the sacrum using a Tekscan ClinSeatTM IP sensor mat. Other factors considered were body mass index (BMI), blood pressure, reason for hospital admission, comorbidities and admission route to hospital. Patients were classified according to WRAT categories (‘low risk’, ‘at risk’, ‘high risk’, ‘very high risk’) and then remained still on a standard hospital mattress for 10 minutes while IP was measured. Participants in the ‘low risk’ group were significantly younger than all other groups (p<0.001) and there were some group differences in BMI. IP readings were compared between the ‘low risk’ group and all of the participants at greater risk. The ‘low risk’ group had significantly lower IP at the sacrum on a standard hospital mattress than those at greater risk (p=0.002). Those at greater risk tended to have IP readings at the low end of the compromised IP range. This study is significant because it describes a new, clinically relevant methodology and presents findings that challenge clinician assumptions about the relationships between pressure injury risk assessment and IP.

Health impact assessment : environmental management vs healthy public policy perspective - exploring the nexus between the two

This paper will explore the links between the traditional role of HIA in an environmental management context and the new and emerging trend internationally to subject government policy to prospective HIA.  The goal of this new iteration of HIA is to develop healthy public policy across all sectors of government creating a more inclusive and evidence-based approach to public policy formation.  The risk-based, health protection approach is more widely understood, as it draws on existing health protection experience and is allied with risk assessment theory.  The new model is based on the health promotion perspective, and emphasizes social determinants of public health.  This latter approach draws on the foundations of the former.  It is vital that the links between the two are therefore considered especially from the perspective of transfer of knowledge between the two.  The paper will explore the similarities, the differences, the tensions and the lessons that can be learned.  It will report on the progress of a national study being conducted by Mary Mahoney and Gillian Durham that is looking at what is happening (or has happened) in other countires including Canada, New Zealand, Sweden, Netherlands, Germany and the United Kingdom

Risk items associated with patient falls in oncology and medical settings

The aim of this study was to determine whether items on a falls risk-assessment tool, made up of brief cognitive and physical measures that nurses use in practice, differentiated fallers and nonfallers in oncology and medical settings. A measure of leg muscle strength clearly distinguished between fallers and nonfallers, with the latter having stronger leg muscles. For nursing practice, the assessment of patients' muscle strength seems to be the most useful scale for identifying potential fallers.