Faculty Bibliography

Background. Traditionally a hospital-acquired pathogen, Clostridium difficile is increasingly recognized as an important cause of diarrhea in community settings. Health disparities in C. difficileinfection (CDI) have been reported, but little is known about the social determinants of health that influence community-associated (CA) CDI incidence. We sought to identify socioeconomic status (SES) factors associated with increased CA-CDI incidence. Methods. Population-based CDI surveillance is conducted in 35 U.S. counties through the Centers for Disease Control and Prevention's Emerging Infections Program. A CA-CDI case is defined as a positive C. difficile stool specimen collected as an outpatient or within three days of hospitalization in a person aged >= 1 year who did not have a positive test in the prior 8 weeks or an overnight stay in a healthcare facility in the prior 12 weeks. ArcGIS software was used to geocode 2014-2015 CA-CDI case addresses to a 2010 census tract (CT). Incidence rate was calculated using 2010 Census population denominators. CT-level SES factors were obtained from the 2011-2015 American Community Survey 5-year estimates and divided into deciles. To account for CT-level clustering effects, separate generalized linear mixed models with negative binomial distribution were used to evaluate the association between each SES factor and CA-CDI incidence, adjusted by age, sex and race. Results. Of 9686 CA-CDI cases, 9417 (97%) had addresses geocoded to a CT; of these, 62% were female, 82% were white, and 35% were aged >=65 years. Annual CA-CDI incidence was 42.9 per 100,000 persons. After adjusting for age, sex and race, CT-level SES factors significantly associated with increased CA-CDI incidence included living under the poverty level (rate ratio [RR] 1.12; 95% confidence interval [CI] 1.09-1.53), crowding in homes (RR 1.11; 95% CI 1.01-1.21), low education (RR 1.11; 95% CI 1.07-1.15), low income (RR 1.15; 95% CI 1.12-1.17), having public health insurance (RR 1.21; 95% CI 1.18-1.24), receiving public assistance income (RR 1.69; 95% CI 1.55-1.84), and unemployment (RR 1.14; 95% CI 1.07-1.22). Conclusion. Areas with lower SES have modestly increased CA-CDI incidence. Understanding the mechanisms by which SES factors impact CA-CDI incidence could help guide prevention efforts in these higher-risk areas

When courts look to mental health professionals to help inform legal decisions, psychiatrists are key members of the skilled clinicians qualified to respond. Child and adolescent psychiatrists are in a unique position to apply their diagnostic acumen and expertise in psychopharmacology to adjudicatory assessments. Key components of these evaluations include diagnostic assessment, risk assessment, treatment amenability, and specific recommendations for available treatment. This article culls guidelines for adjudicatory assessments from the existing peer-reviewed literature, including the use of structured professional judgment tools, the avoidance of dual agency, and the measured use of juvenile psychopathy assessment tools.

This paper aims to determine the prevalence, patterns, and demographic and diagnostic correlates of psychotropic medication use in a sample of youth in one state's post-adjudicatory secure facilities. The health records database of the facilities was the source of linked demographic, diagnostic and pharmacy information for the 1-year period ending June 30, 2008. Age, gender, race, offense, prior petitions and diagnoses were examined across groups, and concomitant psychotropic pharmacotherapy patterns were identified. Period prevalence was 10.2% for youth ranging in age from 12 through 22 years who had any psychotropic drug prescribed during the first 30 days after intake to the facility. Among medicated youths, almost half received concomitant therapy. Medicated youth were significantly less likely to be Hispanic and more likely to endorse one or more diagnoses. Antidepressants, antipsychotics and antihistamines were the most commonly dispensed agents. Our findings revealed that the rate of psychotropic medication use was low, concomitant medication use was common, and ethnic/race differences in psychopharmacologic treatment were present in this sample of youths in post-adjudicatory secure facilities.

Several factors influence a judge's decision to transfer youthful defendants to juvenile court from adult court, including the forensic evaluator's ultimate opinion, the defendant's amenability to treatment, and public safety risk. In this commentary, we examine the constructs that evaluators must assess, as established by Kent v. United States (1966). We begin by outlining the legal history that led to the large population of youths currently in the adult criminal justice system nationwide and the negative consequences of their incarceration in adult settings. We consider the unique role of forensic psychologists and psychiatrists as experts in development, with special regard to their ability to assess and inform the court about amenability to treatment and emotional maturity. The determination of amenability to treatment is further explored through a review of the current literature examining the influence of diagnostic labeling on judicial decisions and the treatment response of adolescent offenders who have psychopathy features. We conclude with an update on the recent proposal for juvenile justice reform in the authors' state of New York.