Externalizing disorders, as described by DSM-V (2013), are an empirically supported group of mental health conditions characterized by impulsiveness, antisocial behaviors, and disruptive conduct. These include Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), Attention-Deficit/Hyperactivity Disorder (ADHD), and Impulse Control Disorders (ICDs). Symptoms often emerge during childhood or adolescence, when brain development is still ongoing. A prematurely-developed prefrontal cortex, paired with reward-seeking and emotional responses in youth, can contribute to impulsive behaviors and limited ability to predict the consequences of one’s actions (Casey, Jones, & Hare, 2008). Compared to females, males tend to be diagnosed with higher rates of externalizing disorders (Kerr, Reinke, & Eddy, 2013), which may place them at higher risk for engaging in risky and/or harmful behaviors. Research indicates that youth with externalizing disorders engage in a number of risky/harmful behaviors that could have negative consequences. A meta-analysis by Allely (2014) suggests that certain externalizing disorders, such as ADHD, may be a risk factor for self-harm behaviors in child, adolescent, and adult populations. Further, those with externalizing disorders in late childhood tend to have co-morbid depression and are more prone to suicidal ideation and suicide attempts during late adolescence and early adulthood (Kerr, Reinke, & Eddy, 2013). Others have also found a strong connection between externalizing disorders and suicidal behaviors among youth (Beautrais, 2000; Goldston et al., 1998; Hills, Cox, McWilliams, & Sareen, 2005; Verona & colleagues, 2000; 2001; 2004). Moreover, externalizing disorders, such as ADHD or CD, are correlated with sexual offending behaviors, which may be a result of sexual disinhibition (Kafka, 2012). While diverse, persons who have engaged in sexually abusive behavior often evidence antisocial behaviors and diagnoses of ADHD and CD (Prendergast, 2004; Shields, 1995). Grant et al. (2009) additionally indicated that the presence of trauma may also contribute to behavioral problems that resemble externalizing disorders. The current study aims to investigate male adolescents with and without externalizing disorders (i.e., ADHD, ODD, CD, and ICDs) by investigating a sample of youth in a residential treatment facility for sexually abusive behaviors (N = 295). Data related to adolescents’ self-harm behaviors, suicidal ideation and/or attempts, sexual offending behaviors, arrest histories, and diagnostic mental health histories were gathered from archival records. Within the sample, 234 participants were diagnosed with at least one externalizing disorder, including ADHD (n = 209), ODD (n = 91), CD (n = 102), and ICDs (n = 50). Chi-square analyses and one-way ANOVAs will be conducted to explore relationships among externalizing disorders, presence and frequency of self-harm behaviors and/or suicide attempts, frequency and types of sexual offenses committed, and frequency and types of arrest. Presence of PTSD diagnoses and Adverse Childhood Experiences (ACE) will also be taken into consideration, as previous literature suggests that early sexual, physical, and emotional trauma may also contribute to behavioral problems and sexual offending behaviors in adolescents (Grant et al., 2009). The goal of the current study is to fill gaps within the literature by identifying areas of concern among adolescents with externalizing disorders. The findings from the current study will be discussed in terms of clinical implications regarding risk reduction, prevention, and treatment.

Objective A systematic review and meta-analysis was conducted to assess the efficacy of low-sodium salt substitutes (LSSS) as a potential intervention to reduce cardiovascular (CV) diseases. Methods Five engines and ClinicalTrials.gov were searched from inception to May 2018. Randomised controlled trials (RCTs) enrolling adult hypertensive or general populations that compared detected hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), overall mortality, stroke and other CV risk factors in those receiving LSSS versus regular salt were included. Effects were expressed as risk ratios or mean differences (MD) and their 95% CIs. Quality of evidence assessment followed GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Results 21 RCTs (15 in hypertensive (n=2016), 2 in normotensive (n=163) and 4 in mixed populations (n=5224)) were evaluated. LSSS formulations were heterogeneous. Effects were similar across hypertensive, normotensive and mixed populations. LSSS decreased SBP (MD-7.81 mm Hg, 95% CI-9.47 to-6.15, p<0.00001) and DBP (MD-3.96 mm Hg, 95% CI-5.17 to-2.74, p<0.00001) compared with control. Significant increases in urinary potassium (MD 11.46 mmol/day, 95% CI 8.36 to 14.55, p<0.00001) and calcium excretion (MD 2.39 mmol/day, 95% CI 0.52 to 4.26, p=0.01) and decreases in urinary sodium excretion (MD-35.82 mmol/day, 95% CI-57.35 to-14.29, p=0.001) were observed. Differences in detected hypertension, overall mortality, total cholesterol, triglycerides, glucose or BMI were not significant. Quality of evidence was low to very low for most of outcomes. Conclusions LSSS significantly decreased SBP and DBP. There was no effect for detected hypertension, overall mortality and intermediate outcomes. Large, long-term RCTs are necessary to clarify salt substitute effects on clinical outcomes. / Wellcome Trust / Revisión por pares

OBJECTIVE: Patellofemoral Pain Syndrome (PFPS) is the most common diagnosis in patients presenting knee pain (~25%), and one of the most common diagnosis in sports medicine centers. Here we examine believed risk factors in Patellofemoral Pain Syndrome (PFPS) and assess their relationship to PFPS. METHODS: The study was a retrospective study completed at Johns Hopkins Department of Orthopaedic Surgery. All patients, who were referred to physical therapy at Johns Hopkins Rehabilitation Therapy Services Clinic, were diagnosed with PFPS for the first time and were mostly recreational runners. Body mass indexes (BMI) were calculated from weight and height. Pain scores were taken using the visual analog scale. Strength measurements were taken from the left and right leg for the following measurements: hip abduction external rotation, hip abduction, knee extension, and hip extension. Balance measurements were also taken on the left and right sides measuring the postural sway with eyes open and eyes closed. Statistical analysis were accomplished using excel. RESULTS: A total of 23 patients were included in the present study, 9 females and 14 males. BMI's (lb/in^2) for the population was 25.1 (±4.2), males were 26.4 (±3.6) and females were 23.2 (±4.2). Pain scores were 6 (±1.9) out of 10 for the total population, males, and females. The total population had composite hip scores 35.0% and 22.9% for the right and left sides, while the knee extension was 50.7% and 51.7%. All hip scores were below 40 except for right hip ABD/ER in females and lower than knee extension scores in males, females, and total population. The ratio for right eyes closed to open was 34.2 (±62.7) and left eye closed to open was 24.7 (±44.3) for the total population CONCLUSION: This study demonstrated that age and BMI may have an effect on the development of PFPS but no statistical significance was confirmed. Results suggest that hip strength is a better indicator than knee strength in risk associated with PFPS. Balance appears to be more of an indicator of poor hip strength than as a measurement or potential risk factor for PFPS.

Background: Globally, studies have established that 40-50% of psychiatric patients with SMDs are readmitted within one year of discharge from the acute hospital admission. Lowand middle-income countries (LMICs) such as Malawi have also reported high rates of psychiatric readmissions. This poses challenges when providing psychiatric care to patients. Most of Malawi`s health institutions, including Saint John of God Psychiatric Hospital (SJOG), rely primarily on donor funding. In order to maximise the available donor funding, there is a need to reduce readmissions resulting from modifiable or controlled factors. There are no studies in Malawi which have investigated these risk factors. The study aimed to establish the frequency of readmissions and the associated factors among patients at SJOG Psychiatric Hospital in Mzuzu, Malawi. The specific areas examined were sociodemographic and clinical-related factors associated with readmission. Methods: This was a retrospective cohort case record review study. Two hundred and seventy five clinical files of patients admitted for the first time at SJOG Psychiatric Hospital Mzuzu, Malawi between 1 January, 2014 and 31 December, 2015 were extracted. Data on socio-demographics and clinical information were collected using an extraction sheet at 3, 6 and 12 months post-discharge from the acute (first) hospital admission. Logistic regression models were developed to investigate the associations between socio-demographics, clinicalrelated factors and readmissions. Ethical approval for this study was granted by the Faculty of Health Sciences Human Research Ethics Committee at the University of Cape Town. Approval to conduct this research in Malawi was obtained from the National Health Sciences Research Ethics Committee. Results: Readmission rates of 1.5%, 4.4%, and 11.3% were found within the 3, 6 and 12 months of discharge from the acute hospital admission respectively. None of the independent variables predicted readmission within the 3 month of discharge from the acute hospital admission. In the unadjusted logistic regression model, having children (OR=0.26, 95% C.I 0.07-0.96) protected against readmissions within the 6 month of follow-up period. In the unadjusted logistic regression model, having children (OR= 0.40, 95% C.I 0.18-0.88), staying outside the hospital catchment area (OR=0.44, 95% C.I 0.20-0.96), and having insight (OR=0.22, 95% C.I 0.10-0.49) into their illness were protective factors to readmission, while taking SGAs (OR=4.67, 95% C.I 1.33-16.39) predicted readmission within the 12 month follow-up period. After adjusting for age and gender in the multivariable analysis, staying outside catchment area (OR=0.33, 95% C.I 0.14-0.79) and having insight (OR=0.19, 95% C.I 0.08-0.46) to their illness were protective factors, while taking SGAs (OR=5.29, 95% C.I 1.43-19.51) remained a predictor of readmission within 12 months of discharge from the acute admission. Conclusion: The findings of this study demonstrated that readmissions are associated with socio-demographic and clinical factors such as catchment area, patient insight into their condition and type of antipsychotics. The study identifies the need to develop interventions targeting the groups at risk of being readmitted.

An estimated 50% of older hospitalized patients experience delirium. This has created significant complications costing an estimated $164 billion or more per year worldwide. The ability to identify patients developing delirium would allow the implementation of specific interventions to decrease or eliminate the adverse effects of delirium. The purpose of this quality improvement project was to provide high quality delirium education to determine if medical unit nursing staff could successful implement the Confusion Assessment Method (CAM) screening tool to identify patients experiencing delirium as the first phase of an overall plan. Implementation of the project followed Roger's diffusion of innovations theory. Patients were additionally screened for 5 potential risk factors of delirium from the multifactorial model of delirium to determine if delirium could be identified in the local population admitted to a single hospital. With a high quality education intervention, the staff nurses on the medical unit successfully implemented the CAM into their nursing practice and accurately identified delirium. Nurses identified delirium and subsyndromal delirium in 25% of the 208 patients in the study population. Consistent with the literature, patients who had a urinary catheter and experienced an iatrogenic event were predictors of delirium. An additional predictor of delirium, not included in the multifactorial model of delirium, included patients receiving benzodiazepines. This quality improvement project suggests that quality delirium education combined with the use of an accurate delirium detection tool could predict delirium accurately in the medical floor population. This has the potential to reduce the impact of delirium on patients, hospital staff, and reduce hospital expenditures.

Conducting an Assessment for Hypertension in African American College Students by Frances E. Montague MS, Hampton University, 1985 BS, Hampton University, 1979 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2017 Abstract Hypertension (HTN) in African American (AA) young adults is diagnosed, treated, and controlled at a lower rate than it is among older AA adults and Caucasians. Untreated high blood pressure (BP) can progress to pre-HTN, HTN, and cardiovascular disease (CVD), which is the leading cause of death in the United States. Guided by Pender's health promotion model, this project sought to identify modifiable and nonmodifiable risk factors for pre-HTN and HTN in AA students at a historically black university. In this quantitative study, 115 students completed a questionnaire regarding personal and family medical history and health behaviors, and had their height, weight, BP and heart rate measured by a nurse. The data were summarized descriptively using frequencies and percentages and revealed that, while 81% of the students presumed that their BP was normal, 45% had a BP reading that indicated pre-HTN and 5% had a BP reading that indicated HTN. Some students had nonmodifiable risk factors: 62% reported a family history of HTN and 5% reported a personal history of HTN. Ten percent of students smoked, 44% were not physically active daily, and 62% were overweight/obese. These are modifiable behaviors and risk factors that can be altered with lifestyle changes. The rate of behavioral risks, whether personal or familial, could predispose the AA college student to HTN later in life. This project has the potential to produce positive social change by providing a guide to nurses working in student health services departments in developing educational programs designed to promote general health and prevent HTN. These programs can help reduce AA students' rates of mortality and morbidity in later life.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Firefighters are exposed to carcinogens, toxic agents, and other risks for cancer and cardiovascular disease. Research shows that aero-digestive and genitourinary cancers are in excess among firefighters compared to the general population. Studies examining excess cardiovascular mortality are inconsistent. Limited data exist on chronic disease mortality, risk factor profiles, and barriers to a healthy lifestyle among firefighters at the local level. Purpose: This project examines the relationship between firefighting and chronic disease mortality, determines trajectories of cardiovascular risk factors in a cohort of new firefighters, and studies the relationship between barriers to weight management and firefighter health characteristics. Methods: This study used death certificate data from the Indiana State Department of Health and clinical data from a large occupational medical practice serving firefighters. Regression techniques were used to examine excess mortality among firefighters compared to non-firefighters, evaluate changes in cardiovascular disease risk factors among new firefighters over time, and explore correlates of risk factors and barriers to weight management among overweight and obese firefighters. Results: The odds of death due to malignant cancers were significantly higher among firefighters than non-firefighters (OR, 1.19; 95% CI, 1.08-1.30). Body mass index, total cholesterol, LDL cholesterol, and triglyceride levels increased significantly (p<0.001) while HDL cholesterol levels decreased (p<0.001) from baseline during the first 10 years of the firefighter’s career. Overweight firefighters who were “ready to begin a weight management program” were more likely to identify ‘‘lack of knowledge about weight management,’’ ‘‘lack of access to exercise opportunities,’’ and ‘‘eating helps me cope with stress’’ as barriers, and report a greater number of barriers to weight management. Older firefighters were less likely to identify or report one or more barriers to weight management. Conclusion: These studies suggest the importance of early-career and targeted cardiometabolic health and cancer prevention strategies to reduce chronic disease morbidity and mortality among firefighters. / 2021-06-28

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第17859号 / 医博第3828号 / 新制||医||1000(附属図書館) / 30679 / 京都大学大学院医学研究科医学専攻 / (主査)教授 松田 秀一, 教授 佐藤 俊哉, 教授 戸口田 淳也 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

付記する学位プログラム名: グローバル生存学大学院連携プログラム / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20266号 / 医博第4225号 / 新制||医||1021(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 小泉 昭夫, 教授 中山 健夫, 教授 髙折 晃史 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

付記する学位プログラム名: グローバル生存学大学院連携プログラム / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21670号 / 医博第4476号 / 新制||医||1035(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 今中 雄一, 教授 佐藤 俊哉, 教授 川村 孝 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM