Childhood Abusive and Supportive Experiences, Inter-Parental Violence, and Parental Alcohol Use: Prediction of Young Adult Depressive Symptoms and Aggression

Issues in both the children of alcoholics and child abuse literatures were addressed in an attempt to disentangle the effects on young adults of growing up in alcoholic homes versus abusive homes. Using multiple regression, retrospective reports of parental abuse (emotional, physical, and sexual) and parental support (love/support, independence, and fairness), witnessing violence between parents, and parental alcohol use were used as predictor variables for outcomes noted by both literatures. When the effects of all other predictors were statistically controlled, parental alcohol use was not significantly related to depressive symptoms or aggression. Different abusive and supportive behaviors, depending on sex of parent and sex of participant, were significant predictors of both depression and aggression. Results underscore the importance of including and controlling for inter-parental violence and for different types of child abuse (especially emotional abuse) and parental supportive behaviors in investigations of outcomes related to abusive and alcoholic families. Implications for treatment of individuals from these families are discussed.     

Predictors of Early Engagement in Home Visitation

Predictors of engagement in mothers receiving home visitation in the first year of service was examined. Early engagement was studied in three ways: (1) length of time active in the program during the first year of service (duration), (2) number of visits received (quantity), and (3) gaps in service between visits (consistency). Examined visits received in 515 first-time mothers in a Healthy Families America (HFA) program. Parameters of engagement were investigated, and predictors of engagement were identified using demographics and the Kempe Family Stress Inventory. Inclusive of the Assessment Visit, 31.8% of mothers disengaged prior to the first month of service. Remaining active in the program was associated with being Caucasian, and increased parenting risk (mental health/substance abuse history, low social support, increased stress). Most mothers had fewer home visits than prescribed. Gaps in prescribed service were common, with 89.4% of mothers experiencing gaps between visits of 1 month, and dropping to 16.4% having gaps of 2 months. In contrast to findings from clinic-based interventions, early engagement in home visitation is associated with lower levels of functioning and acute needs. These findings add to a growing body of literature suggesting that increased adversity promotes engagement in prevention programs in general, and home visitation programs in particular. To the extent that mothers who are actively engaged in home visitation are likely to have increased psychosocial needs, curricula may require modification and augmentation to address these needs and optimize program effectiveness.     

The Problem of Self-Representation at International Criminal Tribunals: Striking a Balance between Fairness and Effectiveness

The principle that the right to self-representation is not absolute,as established by international criminal tribunals, raises difficultquestions of application that are still being worked out inthe jurisprudence. There has been a recent shift in focus, fromestablishing the modalities for the exercise of the right inthe early stages of the Miloevi trial to establishing the circumstancesin which the right may be qualified. This article examines recentdevelopments and considers where the threshold for revokingor qualifying the right to self-representation lies, how thevarious modes of court imposed representation may be synthesizedand what the standard is for counsel who is representing anuncooperative accused.     

Protection and Dignity in Johannesburg: Shortcomings of South Africa's Urban Refugee Policy

Since the end of apartheid, South African cities have becomedestinations for refugees and asylum seekers from across Africa.In line with its constitutional commitments to human rightsand dignity, South Africa has enacted a refugee policy intendedto maximize freedom and protection by promoting refugees' temporaryintegration into local communities. In doing so, the law guaranteesfreedom of movement, access to many social services, and rightsto compete in labour and housing markets. This article arguesthat because refugees and asylum seekers are effectively unableto convert these legal entitlements into effective protection,South Africa has failed to meet its domestic and internationalobligations. This argument draws particular attention to institutionalfailures in determining refugee status and issuing recognizableidentity documents; denial of essential social services; andabuse at the hands of law enforcement agents. It concludes bysuggesting a positive obligation for the state to counter thefull range of obstacles that prevent asylum seekers and refugeesfrom securing effective protection.     

Celebrity stalking, homicide, and suicide: a psychological autopsy

Despite the high-profile nature of many celebrity stalking cases, little is known about the offenders and even less is known about those who kill their celebrity victims. The case of an obsessed fan who attempted to kill a rock star and then committed suicide is presented. By analyzing his detailed diary, both insight into the motivational dynamics of this type of stalker and delineation of several warning signs, which help differentiate an enthusiastic fan from one who harbors a potentially dangerous obsession, is gained.     

Fatty degeneration of myocardial cells as a sign of death due to hypothermia versus degenerative deposition of lipofuscin

Lipid-deposits in internal organs, e.g. nephrons, are discussed as reliable marker to determine hypothermia as cause of death. While investigations concerning lipid vacuoles in the epithelium of the renal tubules are already published, there is no systematic information available about hypothermia and lipid deposits in cardiomyocytes. Therefore, this retrospective study presents the first results of lipid-stainings of myocardial samples taken by autopsies in hypothermia-cases in comparison to samples from a control group. It was the aim of the study to clarify the conceivable causal relationship between death due to hypothermia and lipid-deposits apart from lipofuscin and fatty degeneration, respectively, in cardiomyocytes.     

Accurately assessing elderly fall deaths using hospital discharge and vital statistics data

Historically, fatal injury monitoring and surveillance have relied on mortality data derived from death certificates (DC). However, problems associated with utilizing DC have been well documented. Recently, access to and utilization of hospital discharge data (HDD) have offered a new and important secondary source of data regarding in-hospital deaths. However, studies have shown that discrepancies between the HDD and the corresponding DC often exist. This discrepancy was especially evident when comparing HDD to the vital statistics data (VSD) for deaths by falls among those aged 65 and over in 19 states.This was a retrospective forensic review of elderly (age 65 and over) fall-associated fatalities (E880-E888) identified from HDD and VSD in Allegheny County, Pennsylvania, between 1997 and 1998. Seventy-seven cases were identified, with the original manner of death listed as natural (34), suicide (1), and accidental (42) on the DC. Following a forensic review of the cases, the manner of the death on the DC should have been changed from natural to accidental in 28% (n = 12) of the cases, representing an undercount in the VSD. Undercounts were due to a failure of clinicians to account for the significance of a fall event that contributed to subsequent pathology and death. In addition, in that 22% (n = 17) of the HDD fall-associated deaths, the fall did not contribute directly or sequentially to the underlying cause of death, thereby representing an overcount in the HDD.Based on these findings we recommend (1) elderly fall surveillance systems should only count HDD E-coded falls that demonstrate a serious traumatic injury which directly or subsequently results in death, (2) all in-hospital fall-associated deaths should be reported to and reviewed by coroner/Medical Examiner offices for determination of the cause and manner of death, and (3) physicians should be better educated in properly completing death certificates.