Deaths associated with liposuction: case reports and review of the literature

Tumescent liposuction is a common cosmetic procedure that is performed as an outpatient service in physician's offices and is largely believed to be safe. The protuberant areas of the body containing the undesirable fat deposits are injected with normal saline containing lidocaine and epinephrine for pain control and hemostasis, and the waterlogged cells are suctioned out via cannula through a small incision. We recently encountered three cases in which deaths were attributed to this procedure. Two showed fat embolization in the lung and one died from fluid overload. The osmium tetroxide post-fixed lung sections showed fat emboli in the interstitial capillaries and arterioles. We reviewed the recent literature and found that pulmonary thromboemboli, fat embolization, fluid overload, and lidocaine and epinephrine intoxication are found at autopsy in many cases. Forensic pathologists responsible for determining the cause and manner of death should become familiar with the postmortem findings and risks of liposuction therapy and communicate them to their clinical colleagues and communities.     

A Prospective Study of Adolescents' Peer Support: Gender Differences and the Influence of Parental Relationships

This longitudinal study investigates parent and child predictors of adolescents' perceived social support from peers. Adolescents (285) and their parents filled out surveys when students were 11 and 15 years of age. Parent reports of their own social support and child reports of parental support to them, depression, and self-esteem were used as predictors of adolescents' peer social support. Path analyses revealed functional dissimilarity in the predictive model, for boys and girls. For boys and girls, the amount of spousal support parents' reported impacted the amount of parent to child support that children reported. For boys, this relationship impacted their perceptions of peer support indirectly through depression. However, for girls, parents' own supportive relationships directly impacted both their self-esteem and depression, above and beyond parent to child support, which then impacted girls' peer social support.     

Adolescent Self-Handicapping,Depressive Affect,and Maternal Parenting Styles

Most research on self-handicapping has focused on adults. Only a few studies have examined self-handicapping in adolescents or the particular characteristics of the family environment that are associated with self-handicapping. Adolescents (N = 141) and their mothers completed a series of questionnaires assessing adolescent self-handicapping, adolescent dysphoria, and parenting variables in mothers, including parenting styles (care and overprotection) and parenting stress due to situational variables, parent–child dysfunctional interactions, and behavioral characteristics of the child. Results showed (a) that self-handicapping was positively related to age in girls, but not in boys, (b) that there was a strong relation between self-handicapping and dysphoria in both boys and girls, (c) that mother-rated care negatively predicted self-handicapping in girls beyond the effects due to girls' dysphoria, and (d) that maternal care moderated the relationship between self-handicapping and dysphoria in boys. Maternal care and depressive affect in young persons are independently related to self-handicapping behaviors in adolescents. Results are discussed in terms of implications for the hypothesized etiology of self-handicapping.     

When Initial Interviews Are Delayed a Year: Effect on Children's 2-Year Recall

Three- to nine-year-old children were interviewed about a medical emergency (injury requiring hospital ER treatment) two years after it occurred. Half of the number of children had been interviewed shortly after injury as well as 6 and 12 months later, while the remaining children had had only one prior interview a year after injury. There was remarkably little long-term deterioration in memory by both groups. Having a delayed initial interview had two effects, and both were relevant only to the harder-to-remember hospital treatment event: (a) The late-interview group was less accurate, and (b) early-interview children had more extensive free recall, suggesting that multiple prior interviews teach children the “rules of the memory game' when they are asked open-ended questions. Forensic implications are discussed.     

The who, what, and why of risk adjustment: a technology on the cusp of adoption

Risk adjustment (RA) consists of a series of techniques that account for the health status of patients when predicting or explaining costs of health care for defined populations or for evaluating retrospectively the performance of providers who care for them. Although the federal government seems to have settled on an approach to RA for Medicare Advantage programs, adoption and implementation of RA techniques elsewhere have proceeded much more slowly than was anticipated. This article examines factors affecting the adoption and use of RA outside the Medicare program using case studies in six U.S. health care markets (Baltimore, Seattle, Denver, Cleveland, Phoenix, and Atlanta) as of 2001. We found that for purchasing decisions, RA was used exclusively by public agencies. In the private sector, use of risk adjustment was uncommon and scattered and assumed informal and unexpected forms. The most common private sector use of RA was by health plans, which occasionally employed RA in negotiations with purchasers or to allocate resources internally among providers. The article uses classic technology diffusion theory to explain the adoption and use of RA in these six markets and derives lessons for health policy generally and for the future of RA in particular. For health policy generally, the differing experiences of public and private actors with RA serve as markers of the divergent paths that public and private health care sectors are pursuing with respect to managed care and risk sharing. For the future of RA in particular, its history suggests the need for health service researchers to consider barriers to use adoption and new analytic technologies as they develop them.     

Post-traumatic stress disorder in maltreated youth: a study of diagnostic comorbidity and child factors

The study of post-traumatic stress disorder (PTSD) in maltreated youth has received increased attention, though extensive comparisons to maltreated youth without PTSD and administrations of anxiety-based structured diagnostic interviews remain needed. We examined maltreated youth with or without PTSD using structured diagnostic interviews and standardized child self-report measures. We hypothesized that maltreated youth with PTSD, compared to their peers without PTSD, would experience significantly greater duration of abuse, diagnostic comorbidity, PTSD symptomatology, dysfunctional family environment, and avoidant coping styles. Results indicated that the group with PTSD did indeed experience significantly greater duration of abuse, diagnostic comorbidity, and PTSD symptomatology, though less so dysfunctional family environment or avoidant coping styles. The presence of a mood or anxiety disorder was highly predictive of PTSD in this sample. Results are discussed within the context of evolving etiological and maintenance models of PTSD in maltreated youth.     

Intentional and unintentional injuries across health regions in Alberta, Canada: an implication for policy

The growing practice of including intentional injuries (suicide and interpersonal violence) under the injury control umbrella has produced some controversy. The present study was designed to determine whether or not there might be an empirical basis for this initiative from an ecological point of view by examining the associations among unintentional and intentional injuries across 17 geographically defined health regions. The study was set in the Province of Alberta, Canada, where health services were delivered to a population of 2.96 million persons in 1999 through 17 regional health authorities. The results of a principal components analysis showed that nearly all causes of injury-hospitalization loaded on a single factor. It was not possible to produce separate factors for intentional and unintentional injuries. The strong intercorrelation among all measures suggests that there is an empirical basis for the view that intentional and unintentional injuries belong under the same conceptual umbrella, at least at the ecological level.