A prospective study of conduct disorder (CD) was conducted using 4 annual structured diagnostic interviews of 171 clinic-referred boys, their parents, and their teachers. Only about half of the 65 boys who met criteria for CD in Year 1 met criteria again during the next year, but 88% met criteria for CD again at least once during the next 3 years. For most boys with CD, the number of symptoms fluctuated above and below the diagnostic threshold from year to year but remained relatively high. Lower socioeconomic status, parental antisocial personality disorder (APD), and attention-deficit hyperactivity disorder were significant correlates of CD in Year 1, but the interaction of parental APD and the boy's verbal intelligence predicted the persistence of CD symptoms over time (i.e., only boys without a parent with APD and with above-average verbal intelligence clearly improved).
Rationale: Estimating the annual incidence and prevalence of nontuberculous mycobacterial (NTM) lung disease may assist in improving understanding of the public health and economic impacts of this disease and its treatment. Objective: To estimate the yearly incidence and prevalence of administrative claims–based NTM lung disease between 2008 and 2015 in a U.S. managed care claims database. Methods: We used a national managed care claims database (Optum Clinformatics Data Mart) representing a geographically diverse population of approximately 27 million members annually. All medical claims from January 1, 2007, to June 30, 2016, were scanned for diagnosis codes for NTM lung disease ( International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 031.0 or ICD-10-CM code A31.0). We defined a case of NTM lung disease as having at least two medical claims with a code of 031.0 or A31.0 that were dated at least 30 days apart. Annual incidence and prevalence were estimated for each calendar year from 2008 to 2015. Results: From 2008 to 2015, the annual incidence of NTM lung disease increased from 3.13 (95% confidence interval [CI], 2.88–3.40) to 4.73 (95% CI, 4.43–5.05) per 100,000 person-years, and the annual prevalence increased from 6.78 (95% CI, 6.45–7.14) to 11.70 (95% CI, 11.26–12.16) per 100,000 persons. The average annual changes in incidence and prevalence were +5.2% (95% CI, 4.0–6.4%; P < 0.01) and +7.5% (95% CI, 6.7–8.2%; P < 0.01), respectively. For women, the annual incidence increased from 4.16 (95% CI, 3.76–4.60) to 6.69 (95% CI, 6.19–7.22) per 100,000 person-years, and the annual prevalence increased from 9.63 (95% CI, 9.08–10.22) to 16.78 (95% CI, 16.04–17.55) per 100,000 persons. For individuals aged 65 years or older, the annual incidence increased from 12.70 (95% CI, 11.46–14.07) to 18.37 (95% CI, 16.98–19.87) per 100,000 person-years, and the annual prevalence increased from 30.27 (95% CI, 28.41–32.24) to 47.48 (95% CI, 45.37–49.67) per 100,000 persons. The incidence and prevalence of NTM lung disease increased in most U.S. states and overall at the national level. Conclusions: The incidence and prevalence of NTM lung disease appears to be increasing in the United States, particularly among women and older age groups.
The concurrent and predictive influence of deviant peers on boys' disruptive and delinquent behavior was examined in a community sample of fourth- and seventh-grade boys, who were followed-up over six data waves. Analyses were conducted separately for three different types of behavior problems: authority conflict, covert, and overt disruptive behavior. Consistent with the existing literature, concurrent relations between peers' and boys' disruptive behavior were expected to be significant. A more informative test, however, was whether exposure to deviant peers resulted in boys' subsequent initiation of disruptive behavior. Although peer influences were expected in the predictive analyses, the relations were hypothesized to differ by type of behavior. The potential moderating effects of hyperactivity and poor parenting practices were also examined to test the hypothesis that boys who are already at risk for behavior problems will be more susceptible to deviant peer influence. Results supported the significant concurrent and predictive relation between exposure to deviant peers and boys' engagement in disruptive and delinquent behavior. There were no significant moderating effects of attention-deficit hyperactivity disorder (ADHD) or parenting practices on peer influence.
Protective and risk factors were examined in three samples, each of about 500 boys. Cross-sectional analyses examined a large number of independent variables for their potential protective and risk effects on different levels of seriousness of boys' delinquency. The results showed that protective and risk effects often co-occurred in the same variables, that few variables had risk effects only, and none had protective effects oniy. Protective effects were as likely to promote nondelinquency as to suppress serious delinquency, whereas risk effects were as likely to suppress nondelinquency as to promote serious delinquency. Certain variables were mostly associated with distinctions between nondelinquency and minor delinquency, other variables were related to the distinction between minor delinquency and serious delinquency, and a third group of variables was associated with both distinctions. Developmental analyses indicated that the magnitude of protective and risk effects increased with age. Implications of the findings for research and clinical practice are discussed.
Alzheimer's disease (AD) is prevalent throughout the world and is the leading cause of dementia in older individuals (aged C 65 years). To gain a deeper understanding of the recent literature on the epidemiology of AD and its progression, we conducted a review of the PubMed-indexed literature (2014)(2015)(2016)(2017)(2018)(2019)(2020)(2021) in North America, Europe, and Asia. The worldwide toll of AD is evidenced by rising prevalence, incidence, and mortality due to ADestimates which are low because of underdiagnosis of AD. Mild cognitive impairment (MCI) due to AD can ultimately progress to AD dementia; estimates of AD dementia etiology among patients with MCI range from 40% to 75% depending on the populations studied and whether the MCI diagnosis was made clinically or in combination with biomarkers. The risk of AD dementia increases with progression from normal cognition with no amyloid-beta (Ab) accumulation to early neurodegeneration and subsequently to MCI. For patients with Ab accumulation and neurodegeneration, lifetime risk of AD dementia has been estimated to be 41.9% among women and 33.6% among men. Data on progression from preclinical AD to MCI are sparse, but an analysis of progression across the three preclinical National Institute on Aging and Alzheimer's Association (NIA-AA) stages suggests that NIA-AA stage 3 (subtle cognitive decline with AD biomarker positivity) could be useful in combination with other tools for treatment decision-making. Factors shown to increase risk include lower Mini-Mental State Examination (MMSE) score, higher Alzheimer's Disease Assessment Scale (ADAS-cog) score, positive APOE4 status, white matter hyperintensities volume, entorhinal cortex atrophy, cerebrospinal fluid (CSF) total tau, CSF neurogranin levels, dependency in instrumental activities of daily living (IADL), and being female. Results suggest that use of biomarkers alongside neurocognitive tests will become an important part of clinical practice as new disease-modifying therapies are introduced.
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