Left Atrial Strain Predicts Stroke Recurrence and Death in Patients With Cryptogenic Stroke

Left atrial strain (LAS) has been widely studied as a predictor of atrial fibrillation (AF) after cryptogenic stroke (CS). However, the evidence about its prognostic role in terms of stroke recurrence and death in this setting remains scarce. A total of 92 consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale ≥4 of unknown etiology were prospectively recruited. Echocardiography, including LAS was performed during admission. The primary outcome measure was the composite of stroke recurrence or death. The mean age was 77.5 ± 7.7, and 58% of patients were female. After a median follow up of 28 months, the primary outcome measure occurred in 15 patients (16%). The primary outcome was more frequent in patients with diabetes (53% vs 21%, p = 0.02), chronic kidney disease (33% vs 10%, p = 0.034), and a history of heart failure (13% vs 0%, p = 0.025). LAS reservoir (LASr) and LAS conduit (LAScd) were lower in patients developing the primary outcome (21% ± 7% vs 28.8% ± 11%, p = 0.017 and 7.7% ± 3.9% vs 13.7% ± 7%, p = 0.007, respectively). On multivariate analysis, LASr (hazard ratio 0.9, 95% confidence interval 0.85 to 0.99, p = 0.048) and diabetes (hazard ratio 3.3, 95% confidence interval 1.03 to 10.4, p = 0.045) were associated with stroke recurrence or all-cause death after CS. On the log-rank test (using the discriminatory cut-off value of LASr <23%), LASr (p = 0.009) was associated with higher risk of the primary outcome. In conclusion, lower values of the LAS reservoir were associated with a higher risk of stroke recurrence or death after CS. LAS may identify patients at higher risk of thromboembolism and stress conditions.

Prevalence and Quantification of the Effects of Sexual Harassment Victimization of School-Aged Adolescents

BACKGROUND/AIM

Sexual harassment has become a serious social and public health problem in adolescents, causing adverse effects on mental health. Nevertheless, some behaviours arise that, due to their characteristics, might be misinterpreted as sexual harassment. A field study using a survey with non-probabilistic accidental sampling was designed in order to estimate the prevalence of sexual harassment victimization in the Spanish adolescent population as well as to quantify the harms.

METHOD

A total of 1028 Spanish adolescents, 54.3% females and 45.7% males aged 13-17 years (M = 15.21, SD = 1.03), responded to a diagnostic measure of sexual harassment victimization and an inventory measure of internalizing and externalizing mental health problems (MHPs).

RESULTS

The results showed a significant prevalence of diagnosed sexual harassment victimization of school-aged adolescents, 24.1%, 95% CI [0.215, 0.267], with adverse effects on internalizing and externalizing MHPs. As for the internalizing MHPs, the results exhibited moderate adverse effects on depression, anxiety, somatic burns, posttraumatic symptoms, and obsessive-compulsive symptoms, as well as mild adverse effects on social anxiety. Regarding externalizing MHPs, the results revealed moderate adverse effects on hyperactivity-impulsivity, anger control, and antisocial behaviour, as well as mild adverse effects on attention problems, aggression, and defiant behaviour. In addition, it was confirmed that sexual harassment victimization affects adolescent females to a greater extent, with the effect being significantly greater in internalizing than in externalizing MHPs.

CONCLUSIONS

The results obtained are discussed and future lines of research and intervention are proposed to promote the implementation of prevention and intervention programs that address this phenomenon and, in turn, improve the physical, psychological, and social well-being of adolescents.

Risk of recurrent stroke and mortality after cryptogenic stroke in diabetic patients

BACKGROUND

Diabetes mellitus is a highly prevalent and growing chronic disease that is associated with increased risk of recurrence among several stroke subtypes. However, evidence on the prognostic role of diabetes in the setting of cryptogenic stroke (CS) remains scarce.

METHODS

From April 2019 to November 2021, we recruited prospectively 78 consecutive patients with CS. Patients were classified according to the presence of diabetes. Main outcome was the composite of stroke recurrence and death. Secondary outcome was stroke recurrence.

RESULTS

Mean age of the cohort was 78 ± 7.7 years and 18 patients (23%) had diabetes. After a median clinical follow-up of 23 months the incidence of stroke recurrence and mortality [HR 5.8 (95% CI 1.9-19), p = 0.002] and the incidence of stroke recurrence [HR 16.6 (95% CI 1.8-149), p = 0.012], were higher in patients with diabetes. After adjusting for potential confounders diabetes was identified as an independent predictor of stroke recurrence and death in patients with CS [HR 33.8 (95% CI 2.1-551), p = 0.013]. Other independent predictors of stroke recurrence and mortality were hypertension [HR 31.4 (95% CI 1.8-550), p = 0.018], NTproBNP [HR 1.002 (95% CI 1.001-1.004), p = 0.013] and chronic kidney disease (CKD) [HR 27.4 (95% CI 1.4-549) p = 0.03]. Furthermore, diabetes was an independent predictor of stroke recurrence [HR 103 (95% CI 1.3-8261), p = 0.038].

CONCLUSION

Diabetic patients with CS are at higher risk of stroke recurrence and death. Hypertension CKD and NTproBNP are also independent predictors of stroke recurrence and death after CS.

Estimating the Psychological Harm Consequence of Bullying Victimization: A Meta-Analytic Review for Forensic Evaluation

The prevalence of traditional bullying victimization has been estimated at around 36%, while that of cyberbullying has been estimated at 15%. The victimization of bullying brings with it harm to mental health that must be compensated for, after a forensic evaluation, by the aggressor or legal guardian. Thus, a meta-analytic review was undertaken with the aim of knowing the effect of bullying victimization on psychological harm, as well as quantifying the magnitude of the harm and estimating the probability that no harm associated with bullying victimization is generated.

METHOD

A random-effects correlational meta-analysis correcting effect size by sampling error and criterion and predictor unreliability was performed.

RESULTS

The results exhibited a positive (i.e., more victimization and more psychological harm) and significant mean true effect size, implying an average psychological harm associated to bullying victimization of 29.7%. Nevertheless, 26.7% of students victimized by bullying did not develop psychological harm.

CONCLUSIONS

Bullying victimization causes psychological harm, with an average increase in psychological harm associated with bullying victimization of 29.7%.

Study of informal reasoning in judicial agents in sexual aggression cases

Background/Objective

Judicial decisions must rest on formal reasoning. Nevertheless, informal reasoning sources (cognitive and motivational biases) were observed in judicial judgment making. Literature has identified sexual aggression cases as the most favorable for informal reasoning. Thus, a field study was designed with the aim of assessing the incidence and effects of cognitive and motivational biases in judicial agents in a case to rape to a woman.

Methods

As for this, Chilean judicial agents (N = 217) assessed an allegation (weak evidence) of sexual assault in a case where the perpetrator was known or unknown to the victim. The judicial agents answered to a measure of the myths about sexual aggression, the attribution of responsibility to complainant, the attribution of responsibility to accused, the attribution of credibility to the complainant testimony, the attribution of a nature of a rape to the alleged facts and an estimation of the probability of false/unfounded accusations.

Results

The results revealed an estimation of false/unfounded accusations of sexual aggression significantly higher than the mean of the best estimates, but into the upper limit of the best estimates; that the studied population did not share, in general, the myths about sexual aggression; and that the sources of attributional biases were driven in favor and against the complainant. Nevertheless, the case study showed that a large number of judicial agents participated of an overestimation of the probabilities of false or unfounded allegations, and of the myths about sexual aggressions and of attributional biases against the complainant.

Conclusion

In conclusion, informal reasoning sources were observed in judicial agents when only formal reasoning should prevail. Thus, judicial agents should be trained to control these sources of bias substituting them by formal reasoning (evidence).