Development and Initial Validation of Measures of Proximal Stigmas and Experiences of Discrimination for Minor Attracted People.

Stigma-related stressors are central to understanding psychopathology, distress, and coping in stigmatized groups; individuals who experience attractions to children are a highly stigmatized group. Currently, few validated self-report measures exist to assess stigma-related stressors in minor attracted people (MAPs) and the current research describes the development and initial validation of two measures of internalized stigma and experiences of discrimination. A sample of MAPs (n = 289; mean age = 31.8 years, SD = 12.2) was recruited online and completed a set of self-report measures assessing stigma-related stress, negative mental health outcomes, substance use, and coping. Exploratory factor analyses of the two newly developed stigma-related stress measures were conducted and convergent associations with other constructs were examined for validity evidence. Exploratory factor analyses indicated a two-factor solution to both the measure of internalized stigma and experiences of discrimination. The total scale scores and factors scores generally demonstrated the anticipated patterns of correlations with mental health concerns, distress, coping, and substance use. Clinical intervention with MAPs may benefit from an exploration of stigma-related stressors in clients' lives to improve mental health outcomes. The relatively large sample that was recruited from multiple online forums is a strength of the current study. The use of a self-report measurement modality for all measures used in the study weakens that strength of the validation evidence presented here. These results provide initial validity evidence for the measures of stigma-related stress in MAPs and the promise of stigma processes in understanding negative outcomes in this population.

Secret-keeping in therapy by clients who are sexually attracted to children.

Objective This study investigated the reasons why pedohebephilic clients disclose their sexual attraction to children in therapy and the experiences associated with this decision among English-speaking samples. Method: The pre-registered online survey combined (1) quantitative correlational data of self-reported improvement, alliance, therapist reaction to disclosure, and the belief that mandatory reporting laws were in place, and (2) qualitative data about reasons for disclosure or no disclosure as well as perceived consequences. The sample consisted of pedohebephilic people who have been clients in therapy and have disclosed (n = 96) or not disclosed (n = 40). Results: While the disclosure and no disclosure groups did not differ in improvement or beliefs about mandatory reporting, those who had disclosed reported a stronger alliance. Clients who did not perceive the therapist's reaction as supportive reported less improvement than the no disclosure group. Thematic analysis of qualitative data identified three themes concerning motives for disclosing or not disclosing and a fourth regarding differential impacts of disclosure. Discussion: This study indicates that disclosing pedohebephilia does not in and of itself lead to improvement but is contingent on a therapist's reaction.

Examining the 4-D Model in Persons Enrolled in the Top DD Internet Intervention.

The 4-dimensional (4-D) model of trauma-related dissociation differentiates between dissociative experiences involving trauma-related altered states of consciousness and symptoms of distress that do not appear to involve alterations in normal waking consciousness across four phenomenological dimensions (i.e., our experience of time, thought, body, and emotions). The current study evaluated hypotheses associated with the 4-D model using analyses of variance and correlation analyses in individuals with a primary diagnosis of a trauma-related dissociative disorder who were participating in the TOP DD internet study involving a combination of in-person psychotherapy and an online psychoeducational program (n = 111). Intrusive memories of traumatic events were more frequently endorsed than flashbacks, but emotional numbing was more frequently endorsed than other forms of affect dysregulation. Negative thoughts and emotion dysregulation were more strongly intercorrelated than were voice hearing and emotional numbing. Distress symptoms were more strongly associated with PTSD symptoms and difficulties in emotion regulation, whereas experiences of depersonalization were more strongly associated with dissociative self-states. Greater reduction in distress symptoms was also seen in comparison with trauma-related altered states of consciousness over the course of the combined psychotherapy and internet-based psychoeducational intervention. Overall, results continue to suggest that measures of distress and dissociative experiences can be distinguished by measures of symptom frequency, co-occurrence, and convergence with other measures of distress vs. dissociation albeit that results varied across the four phenomenological dimensions that were surveyed.

Technical success and safety of peripherally inserted central catheters in the great saphenous and anterior accessory great saphenous veins.

BACKGROUND: Peripherally inserted central catheters (PICC) are occasionally placed in the great saphenous vein (GSV) and anterior accessory great saphenous vein (AAGSV) in patients with inadequate upper extremity veins or contraindications to upper extremity placement. Outcomes on the placement of PICCs in these veins are limited. OBJECTIVES: This study aimed to determine technical success and safety of GSV/AAGSV PICCs. MATERIALS AND METHODS: This is a retrospective study that reviewed all GSV/AAGSV PICC placements between January 2011 and December 2019. A total of 29 PICC placements procedures were identified. The electronic medical record was queried for demographic, procedural, and complication data. Technical success was defined by whether the vein could be accessed and a PICC could be placed. Catheter-associated infections, dislodgement or migration, malfunction, and PICC-associated thrombosis were recorded. RESULTS: Technical success of placement was 100%. Twenty-one (72%) catheters were placed in the GSV in the mid to upper thigh and eight (28%) were placed in the AAGSV. The median PICC dwell time was 13 days with a range of 3-155 days. PICC-associated complications occurred after 11 (37.9%) placements. Line associated infection was the most common complication (17.2%). CONCLUSION: Due to a high complication rate, GSV/AAGSV PICC placement should be considered only when upper extremity or cervical PICC placement is not feasible or contraindicated.

Evaluation of Changing Vena Cava Filter Use and Inpatient Hospital Mortality from 2016-2019: A Single-Institution Quality Improvement Project.

OBJECTIVE: To evaluate the changing trends of vena cava filter (VCF) insertion and determine whether changes in VCF use affected inpatient mortality. PATIENTS AND METHODS: A quality improvement project at Mayo Clinic, Rochester, Minnesota, tracks the type and reason for VCF insertions from January 1, 2016, through December 31, 2019, to facilitate appropriate retrieval. The rate of VCF insertions was compared with inpatient mortality rates, normalized for patient volumes using the number of hospital inpatient discharges. RESULTS: A total of 698 VCFs were placed in 695 patients: 2016 (n=243), 2017 (n=156), 2018 (n=156), and 2019 (n=120). The rate of VCF insertions (per 1000 inpatient discharges) was 4.02 in 2016, 2.91 in 2017, 2.54 in 2018, and 1.93 in 2019. Mean ± SD age at placement was 62±16.4 years and 59.2% (413/698) were men. Most VCFs were retrievable (85.1%; 594/698) and were placed for treatment (78.4%; 547/698) indications (acute venous thromboembolism within 3 months). The rate of VCF insertions was compared with the inpatient mortality rate (per 100 inpatient discharges) and remained stable (1.83 in 2016, 1.79 in 2017, 1.83 in 2018, and 1.76 in 2019) despite the significant decline in VCF use. CONCLUSION: Data from this quality improvement study demonstrate a reduction of more than 50% in the use of VCFs from 2016 through 2019 at a large academic hospital. These changes are difficult to attribute to any single change in clinical use and there was no appreciable increase in the inpatient hospital mortality rate associated with this decrease in VCF filter use.

A preliminary examination of sexual interest in children in a non-representative community sample of females.

There are few empirical studies examining sexological features of sexual interest in children among females. A non-representative sample of 20 females and 208 males who self-identified as having a sexual interest in children completed an anonymous survey. The primary purpose of the present study was to examine sexological features of sexual interest in children among females. Most females reported interest in prepubescent and pubescent children and rated their interest in different age categories similarly. Most females reported an interest in boys. Females first experienced sexual attractions during childhood, but awareness of sexual interest in children occurred later in their adolescence.

The Association between Maladaptive Coping and Treatment Motivation in Individuals who are Sexually Attracted to Children Living in the Community.

There is a need for community treatment programs for people who are sexually attracted to children, but individuals report difficulty accessing services. Individuals who are sexually attracted to children (n = 293) completed an online anonymous survey that revealed a significant positive association between maladaptive coping and two factors of the treatment motivation measure. The association between maladaptive coping and treatment motivation was attenuated at higher levels of ego dystonic distress/aversion. Results highlight the importance of targeting stigma toward those who are sexually attracted to children to increase treatment seeking behavior.

Global Psychotrauma Screen (GPS): psychometric properties in two Internet-based studies.

Background: Potentially traumatic stressors can lead to various transdiagnostic outcomes beyond PTSD alone but no brief screening tools exist for measuring posttraumatic responses in a transdiagnostic manner. Objective: Assess the psychometric characteristics of a new 22-item transdiagnostic screening measure, the Global Psychotrauma Screen (GPS). Method: An internet survey was administered with English speaking participants recruited passively via the website of the Global Collaboration on Traumatic Stress (GC-TS) (nGC-TS  = 1,268) and actively via Amazon's MTurk (nMTurk  = 1,378). Exploratory factor analysis, correlational analysis, sensitivity and specificity analysis, and comparisons in response between the two samples and between male and female respondents were conducted. Results: Exploratory factor analysis revealed a single factor underlying symptom endorsements in both samples, suggesting that such problems may form a unitary transdiagnostic, posttraumatic outcome. Convergent validity of the GPS symptom and risk factors was established with measures of PTSD and dissociative symptoms in the MTurk sample. Gender differences were seen primarily at the item level with women more often endorsing several symptoms and specific risk factors in the MTurk sample, and the GC-TS recruited sample endorsed more symptoms and risk factors than the MTurk sample, suggesting that the GPS may be sensitive to group differences. A GPS symptom cut-off score of 8 identified optimized sensitivity and specificity relative to probable PTSD based on PCL-5 scores. Conclusions: The current results provide preliminary support for the validity of the GPS as a screener for the concurrent measurement of several transdiagnostic outcomes of potentially traumatic stressors and the apparent unifactorial structure of such symptoms is suggestive of a single or unitary posttraumatic outcome. Future research is needed to evaluate whether similarly strong psychometric properties can be yielded in response to completion of the GPS in other languages.

Antecedentes: Los factores de estrés potencialmente traumáticos pueden conducir a varios resultados transdiagnósticos más allá del solo diagnóstico de TEPT, pero no existen herramientas de detección breves para medir las respuestas postraumáticas de una manera transdiagnóstica.Objetivo: Evaluar las características psicométricas de una nueva medida de cribado transdiagnóstico de 22 ítems, El Mapeo Global de Psicotrauma (Global Psychotrauma Screen o GPS en inglés).Método: Se administró una encuesta por Internet con participantes de habla inglesa reclutados pasivamente a través del sitio web de la Global Collaboration on Traumatic Stress (GC-TS) (nGC-TS = 1,268) y activamente a través de MTurk de Amazon (nMTurk = 1,378). Se realizaron análisis factoriales exploratorios, análisis correlacionales, análisis de sensibilidad y especificidad, y comparaciones en respuesta entre las dos muestras y entre encuestados masculinos y femeninos.Resultados: El análisis factorial exploratorio reveló un solo factor subyacente a la aprobación de los síntomas en ambas muestras, lo que sugiere que tales problemas pueden formar un resultado postraumático transdiagnóstico unitario. La validez convergente del síntoma GPS y los factores de riesgo se estableció con medidas de TEPT y síntomas disociativos en la muestra de MTurk. Las diferencias de género se observaron principalmente a nivel de ítem y las mujeres a menudo respaldaron varios síntomas y factores de riesgo específicos en la muestra de MTurk, y la muestra reclutada por GC-TS aprobó más síntomas y factores de riesgo que la muestra de MTurk, lo que sugiere que el GPS puede ser sensible a las diferencias de grupo. Una puntuación de corte de síntomas de GPS de 8 identificó una sensibilidad y especificidad optimizadas en relación con el probable TEPT según las puntuaciones de PCL-5.Conclusiones: Los resultados actuales proporcionan un apoyo preliminar para la validez del GPS como un filtro para la medición concurrente de varios resultados transdiagnósticos de factores estresantes potencialmente traumáticos y la aparente estructura unifactorial de tales síntomas sugiere un resultado postraumático único o unitario. Se necesitan investigaciones futuras para evaluar si se pueden producir propiedades psicométricas igualmente fuertes en respuesta al completar el GPS en otros idiomas.

Convergent and Predictive Associations of Three Measures of Pedophilic Interest.

Pedophilic interest is a central risk factor for sexual offending against children. Multiple measures exist to assess pedophilic interest, and the present study aims to provide validity evidence for three of these measures in a sample of men convicted of sexual offenses. The association between a phallometric test for pedophilic interest, the Screening Scale for Pedophilic Interest (SSPI), and the sexual deviance factor of the Violence Risk Scale-Sexual Offense (VRS-SO) version was examined in a sample of 261 men who participated in sexual violence reduction services. The association between these measures and sexual recidivism, both as sole predictors and while controlling for static risk, was also assessed. The second aim of the study was to examine the validity of different methods for modeling the distribution of pedophilic interests, using phallometric test scores, based on the findings in recent taxometric research. The measures generally showed a positive and moderate relationship with each other and predicted sexual recidivism. However, the SSPI did not significantly predict sexual recidivism, and when controlling for static risk, only the VRS-SO Sexual Deviance factor significantly predicted this outcome. Modeling phallometric test scores continuously and trichotomously produced significant associations with sexual recidivism; however, only a trichotomous model with two levels remained predictive after controlling for static risk. The results are broadly supportive of measures of pedophilic interest and underscore the importance of appropriately modeling the latent structure of pedophilic interest.

Construction and preliminary validation of the Cognitive and Emotional Congruence with Children (C-ECWC) Scale.

Emotional congruence with children is central in understanding why some adults pursue sexual contact with children. Although self-report scales have been developed to assess for emotional congruence with children, these scales have equivocal latent structure and less than desirable performance in validation research. Further, these scales were not developed to assess emotional congruence with children in individuals who commit Internet-facilitated offenses. In the current study, a sample of men with histories of Internet-facilitated sexual offenses, contact sexual offenses against children, and nonsexual offenses was used to examine factor structure, internal consistency, convergent and divergent validity, and known-group validity of the newly developed Cognitive and Emotional Congruence with Children (C-ECWC) scale. The scale had a three-factor latent structure, adequate internal consistency and adequately captured the nomological network of correlates and group differences anticipated for a measure of emotional congruence with children. Implications for scale validation and use in future research into emotional congruence with children are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Validity in Phallometric Testing for Sexual Interests in Children: A Meta-Analytic Review.

Valid assessment of pedohebephilic interests (i.e., sexual interest in children) is fundamental to forensic clinical practice. Phallometric testing-which measures changes in penile circumference or volume, while stimuli depicting different ages and sexual activities are presented-is widely used in clinical and research settings to detect such interests. This meta-analysis summarizes studies comparing sexual offenders against children and various types of controls on phallometric tests for pedohebephilic interests (37 samples; N = 6,785) and studies examining the relationship between phallometric test scores and sexual reoffending (16 samples; N = 2,709). The findings suggest that several phallometric testing procedures are valid indicators of pedohebephilic interest. Certain methodological features of phallometric tests were associated with greater validity, such as, slide or audio-plus-slide stimuli and z-score-based indices. In addition, phallometric tests for pedohebephilic, pedophilic, and hebephilic interests predicted sexual reoffending which provides further evidence that phallometric test scores are valid indicators of sexual interest in children. In general, the interpretation of phallometric test scores as indicators of pedohebephilic interests is supported.

Is Long-Term Anticoagulation Required after Stent Placement for Benign Superior Vena Cava Syndrome?

PURPOSE: To identify whether symptom relief and stent patency vary with use of long-term anticoagulation after stent placement for benign superior vena cava (SVC) syndrome. MATERIALS AND METHODS: Patients with benign SVC syndrome treated with stent placement between January 1999 and July 2017 were retrospectively identified (n = 58). Average age was 49 years (range, 24-80 y); 34 (58%) were women, and 24 (42%) were men. Average follow-up was 2.4 years (range, 0.1-11.1 y, SD 2.6). Of cases, 37 (64%) were due to a long-term line/pacemaker, and 21 (36%) were due to fibrosing mediastinitis. After stent placement, 36 (62%) patients were placed on long-term anticoagulation, and 22 (38%) were not placed on anticoagulation. Percent stenosis was evaluated on follow-up imaging by dividing smallest diameter of the stent by a normal nonstenotic segment of the stent and multiplying by 100. RESULTS: Technical success was achieved in all cases. There was no significant difference in number of patients who reported a return of symptoms characteristic of benign SVC syndrome between the anticoagulated (16 of 36; 44.4%) and nonanticoagulated (11 of 22; 50%) groups (P = .68). There was no significant difference in the mean percent stenosis between the anticoagulated (40.4% ± 34.7% [range, 0-100%]) and nonanticoagulated (32.1% ± 29.2% [range, 1.7%-100%]) groups (P = .36). No significant difference was found in the time (days) between date of procedure and date of return of symptoms (anticoagulated, 735.9 d ± 1,003.1 [range, 23-3,851 d]; nonanticoagulated, 478 d ± 826.6 [range, 28-2,922 d]) (P = .49). There was no difference in primary patency between groups (P = .59). Finally, 1 patient (2.8%) in the anticoagulated group required surgical intervention, whereas none in the nonanticoagulated group required surgical intervention. CONCLUSIONS: No significant difference was observed in clinical and treatment outcomes in patients who did and did not receive anticoagulation after stent placement for benign SVC syndrome. Management of benign SVC syndrome after stent placement may not require anticoagulation if confirmed by additional studies.

Emotional Congruence with Children: Are Implicit and Explicit Child-Like Self-Concept and Attitude Toward Children Associated with Sexual Offending Against Children?

Some men convicted of sexual offences against children express an exaggerated affiliation with childhood, ascribe child-like characteristics to themselves, experience strong non-sexual liking of children, and hold positive views of children and childhood. These features are generally called emotional congruence with children. The present study examined child-like self-concept, which is an association of self with children and child-like characteristics, attitude toward children, and general emotional congruence with children as correlates of sexual offending against children and pedophilia. Male participants (18 sexual offenders against unrelated children; 7 incest offenders; 22 non-sexual offenders; 54 students) completed newly developed implicit and explicit measures of child-like self-concept and attitude toward children, as well as more established self-report measures of emotional congruence with children. Assessments of pedophilic interest and sexual recidivism risk were obtained from official file information. Sexual offenders against unrelated children reported higher levels of implicit child-like self-concept and self-reported emotional congruence with children when compared to the other three groups. Implicit child-like self-concept showed a small correlation with emotional congruence measures, whereas implicit attitude toward children was moderately correlated with the emotional congruence measures. Implicit child-like self-concept, implicit attitude toward children, and the emotional congruence measures were associated with greater pedophilic interest and sexual recidivism risk. The present findings provide a nuanced understanding of the emotional congruence with children construct and have implications for theory, research, and treatment of sexual offenders against children.

Taxometric Analysis of the Latent Structure of Pedophilic Interest.

The present study examined the latent structure of pedophilic interest. Using data from phallometric tests for pedophilic interest across four samples of offenders (ns = 805, 632, 531, 261), taxometric analyses were conducted to identify whether pedophilic interest is best characterized as taxonic or dimensional. Across the samples, the majority of analyses supported taxonic latent structure in pedophilic interest. Visual inspection of taxometric curves indicated trichotomous latent structure (i.e., three-ordered classes) may characterize pedophilic interest in these samples. In a second step of taxometric analysis, the results supported trichotomous latent structure, indicating the presence of a complement taxon and two pedophilic taxa. In comparison with the complement taxon, the men in the first pedophilic taxon were non-exclusively pedophilic and had similar rates of sexual recidivism and sexual compulsivity. The men in the second pedophilic taxon were exclusively pedophilic, had more child victims and total victims, sexually re-offended at a higher rate, and were more sexually compulsive. The finding of trichotomous latent structure in pedophilic interest is both consistent and inconsistent with previous taxometric studies and has implications for research, assessment, and treatment of pedophilic interest.

Comparison of Covered Versus Uncovered Stents for Benign Superior Vena Cava (SVC) Obstruction.

PURPOSE: To identify whether long-term symptom relief and stent patency vary with the use of covered versus uncovered stents for the treatment of benign SVC obstruction. METHODS AND MATERIALS: We retrospectively identified all patients with benign SVC syndrome treated to stent placement between January 2003 and December 2015 (n = 59). Only cases with both clinical and imaging follow-up were included (n = 47). In 33 (70%) of the patients, the obstruction was due to a central line or pacemaker wires, and in 14 (30%), the cause was fibrosing mediastinitis. Covered stents were placed in 17 (36%) of the patients, and 30 (64%) patients had an uncovered stent. Clinical and treatment outcomes, complications, and the percent stenosis of each stent were evaluated. RESULTS: Technical success was achieved in all cases at first attempt. Average clinical and imaging follow-up in years was 2.7 (range 0.1-11.1) (covered) and 1.7 (range 0.2-10.5) (uncovered), respectively. There was a significant difference (p = 0.044) in the number of patients who reported a return of symptoms between the covered (5/17 or 29.4%) and uncovered (18/30 or 60%) groups. There was also a significant difference (p = < 0.001) in the mean percent stenosis after stent placement between the covered [17.9% (range 0-100) ± 26.2] and uncovered [48.3% (range 6.8-100) ± 33.5] groups. No significant difference (p = 0.227) was found in the time (days) between the date of the procedure and the date of clinical follow-up where a return of symptoms was reported [covered: 426.6 (range 28-1554) ± 633.9 and uncovered 778.1 (range 23-3851) ± 1066.8]. One patient in the uncovered group had non-endovascular surgical intervention (innominate to right atrial bypass), while none in the covered group required surgical intervention. One major complication (SIR grade C) occurred that consisted of a pericardial hemorrhagic effusion after angioplasty that required covered stent placement. There were no procedure-related deaths. CONCLUSION: Both covered and uncovered stents can be used for treating benign SVC syndrome. Covered stents, however, may be a more effective option at providing symptom relief and maintaining stent patency if validated by further studies.

Mediastinal seminoma presenting with superior vena cava syndrome.

We present a rare cause of superior vena cava syndrome (SVC) in a previously healthy male aged 31 years. Malignancy was suspected due to unintentional weight loss and childhood exposure to radioactive fallout from a nuclear facility accident. A very large anterior mediastinal mass was identified and demonstrated to be an extragonadal seminoma. Extragonadal germ cell tumours are rare tumours with a high potential for cardiovascular, pulmonary and vascular sequelae. Studies have documented an increased risk of developing seminoma in patients with radioactive exposure. Chemotherapy was initiated, during which the patient experienced progressive and new symptoms, found to be due to extensive thromboembolic disease, which responded well to anticoagulation. Seventy-two months after completing chemotherapy, without need for surgical management, he remains free of the disease.