Differential pharmacological treatment of paraphilias and sex offenders

This article gives an overview of current pharmacological treatment of paraphilias and sex offenders focusing on the situation in Germany. Information about selective serotonin reuptake inhibitors (SSRI) is followed by data about established antihormonal substances (cyproterone acetate/CPA, and medroxyprogesterone acetate/MPA), as well as a more detailed account on luteinizing hormone-releasing hormone agonists (LHRH agonists). The results of open, uncontrolled clinical studies with SSRIs (n = 16) and LHRH agonists (n = 11) in paraphilic outpatients confirm the positive effects of these substances. A survey about the use of CPA and LHRH agonists in forensic hospitals in Germany shows that half of the patients treated with any kind of (anti-) hormonal agents received an LHRH agonist. The authors present a protocol on side effects, contraindications, and monitoring of CPA and LHRH agonists and develop an algorithm for differential pharmacotherapy of paraphilias.     

Petechial Hemorrhages and Ethanol in Deaths from Intoxication

Petechiae in conjunctivae and in the palpebrae/skin of the eyelids are of particular interest for the forensic pathologist, because of their association with pressure on the neck. They have been described in the eyelids of intoxicated persons both in case reports and in text books of forensic pathology. We studied 590 deaths caused by intoxication, and 75 had petechiae either in the conjunctivae, the eyelids, or in both locations. We examined the influence of drugs and ethanol on the location of the petechial hemorrhages in these deaths. Deaths with ethanol in blood and in urine/vitreous humor more often had petechiae in both locations than those without. This association was statistically significant, independent of body position and livor mortis. No association between the location of petechiae, medicinal drugs, or narcotics was found. These results suggest that ethanol may contribute to the development of petechial hemorrhages in deaths from intoxication.     

Criminal recidivism in sexual homicide perpetrators

Forensic psychiatric reports on 166 sexual homicide perpetrators in Germany were retrospectively analyzed for criminal risk factors. Follow-up information about release and reconvictions from federal criminal records was available for 139 offenders; 90 (64.7%) had been released. The estimated recidivism rate (Kaplan-Meier analyses) for 20 years at risk was 23.1% for sexual and 18.3% for nonsexual violent reoffences. Three men (3.3%) were reconvicted for attempted or completed homicide. Only young age at the time of sexual homicide resulted in higher sexual recidivism, whereas increased nonsexual violent recidivism was related to previous sexual and nonsexual delinquency, psychopathic symptoms, and higher scores in risk assessment instruments. Increased recidivism with any violent reoffence was associated with age-related factors: young age at first sexual offence, at homicide, and at release and duration of detention. The impacts of the results for risk assessment, relapse prevention, and supervision are discussed.     

The PMMA epidemic in Norway: comparison of fatal and non-fatal intoxications

During a 6 month period (July 2010-January 2011) we observed 12 fatal intoxications and 22 non-fatal cases related to the drug paramethoxymethamphetamine (PMMA) in Norway (4.8 mill inhabitants). This toxic designer drug, also known as "Death", is occasionally found in street drugs offered as "ecstasy" or "amphetamine". The present study aimed to evaluate the cause of death, and to compare the PMMA blood concentrations in fatal and non-fatal cases. Methods for identification and quantification of PMMA are presented. The median age of fatalities was 30 years (range 15-50) with 67% males; in non-fatal cases 27 years (20-47) with 86% males. In the 12 fatalities, the median PMMA blood concentration was 1.92 mg/L (range 0.17-3.30), which is in the reported lethal range of 0.6-3.1 mg/L in peripheral blood and 1.2-15.8 mg/L in heart blood. In the 22 non-fatal cases, the median PMMA concentration was 0.07 mg/L (range 0.01-0.65). Poly-drug use was frequent both in fatal and non-fatal cases. The PMA concentrations ranging from 0.00 to 0.26 mg/L in both groups likely represented a PMMA metabolite. Three fatalities were attributed to PMMA only, six to PMMA and other psychostimulant drugs, and three to PMMA and CNS depressant drugs, with median PMMA concentrations of 3.05 mg/L (range 1.58-3.30), 2.56 (1.52-3.23) and 0.52 mg/L (0.17-1.24), respectively. Eight victims were found dead, while death was witnessed in four cases, with symptoms of acute respiratory distress, hyperthermia, cardiac arrest, convulsions, sudden collapse and/or multiple organ failure. In summary, all fatalities attributed to PMMA had high PMMA blood concentrations compared to non-fatal cases. Our sample size was too small to evaluate a possible impact of poly-drug use. A public warning is warranted against use and overdose with illegal "ecstasy" or "speed" drugs.     

Ethnic Diversity and Social Capital in Europe: Tests of Putnam's Thesis in European Countries

This article focuses on the core theory recently proposed by Putnam on the relationship between ethnic diversity and dimensions of social capital. Hypotheses are derived from this theory, but also from other theories that propose competing hypotheses on relationships between national characteristics and dimensions of social capital. Essentially, the authors propose more rigorous empirical tests of Putnam's hypotheses by including these competing hypotheses: tests of these hypotheses provide possibilities to evaluate Putnam's and these other theories in terms of general (i.e. cross‐national) tenability for the European continent. The general question is: To what extent do national‐level characteristics like ethnic diversity, next to other national characteristics, actually affect dimensions of social capital of individual citizens in European countries? The authors set out to answer this question by testing hypotheses on cross‐national data from 28 European countries. These data contain valid measurements of a number of dimensions of social capital. The individual‐level data are enriched with contextual‐ (i.e. national‐) level characteristics to be included in more advanced multilevel analyses. The main finding is that Putnam's hypothesis on ethnic diversity must be refuted in European societies. Instead, it is found that economic inequality and the national history of continuous democracy in European societies turn out to be more important for explaining cross‐national differences in social capital in Europe.     

Water as a political good: implications for investments

There is an urgent need for investments in the water sector. Still about a billion people lack access to drinking water services, and the double amount lacks proper sanitation services. To reach the Millennium Development Goals (MDGs) substantial additional funding needs to be accessed. In view of the low priority given to the water sector by all prospective investors, the perspective of failure to reach the MDGs is eminent. The main argument made in this paper is that a formidable obstacle in accessing and using funds in the water sector is the omission to include explicitly the political nature of water in investment decisions. Due to its multifaceted and internally conflicting character, politics are a fact of life in the water sector. The menu of (suitable) investment options for a given locality is very much dependent on the political environment in which these water services are to be provided. While the impact of the political realm on water services is often acknowledged (most frequently in negative terms as it is seen as one of the main causes of poor performance of public utilities), few professionals really take the political environment explicitly into account when taking decisions relating to the provision of water services. In this paper it is propagated that the political dimension of water should be made explicit in an attempt to increase access and sustainability of investments in the water sector. Sound and sustainable investment in water services can only be achieved by taking into account the existing political environment in which those water services are to be delivered.     

Comparing Sexuality,Aggressiveness, and Antisocial Behavior of Alleged Juvenile Sexual and Violent Offenders,

Sexual delinquency in juveniles is insufficiently explored in regard to the specificity of offender characteristics. The aim is to investigate relevant areas for juvenile sexual offending in a precourt, pretreatment group. Thirty‐two alleged juvenile sexual offenders (ASO) referred to by police were compared with 32 juvenile nonsexual violent offenders (VNO) on standardized measures of aggressiveness and psychopathology, antisocial behavior, substance use problems, and sexuality. Less externalizing disorders and antisocial behavior were found among the ASOs than among the VNOs. The ASO group was sexually less experienced, had less trust in their relationship abilities, fewer victimization experiences, and reported more sexual deviance, while pornography use and obscene calls were reported less often. Few juvenile sexual offenders had severe problems in the investigated areas. Including groups of offenders before court, treatment or incarceration in research appears crucial to understand the full spectrum of sexual deviance in youth and avoid misguidance due to selection factors.     

Combining work and family in the Netherlands: Blessing or burden for one's mental health?

In this article we study which characteristics of combining work and family put people at risk for mental illness. Two alternative perspectives on the impact of multiple social roles on mental health are tested: the role accumulation perspective and the role strain perspective. Both perspectives are studied with data from a cross-sectional national survey held among a large, representative sample of Dutch people (N=1008). Multivariate analyses provided support for both perspectives. Having more social roles was related to better mental health. We also found a positive mental health effect of having a full-time job in combination with having children. However, having a partner who contributes less to household duties or having a job with low decision latitude or lower skill discretion was related to mental illness. So, certain aspects of social roles may also threaten people's mental health. Overall, our findings do not support the idea that combining work and family is necessarily a burden and harmful for people's mental health. Whether multiple social roles are a blessing or burden for people's mental health seems to depend on the characteristics of the social roles.     

Spaces and Places: A Systems Theory Approach to Regulatory Competition in European Company Law

Abstract:  This article takes issue with the longstanding oppositional themes of harmonisation versus regulatory competition in European company law. Instead of embracing one approach over the other in exclusivity, the article draws attention to the persisting mixture of approaches to an emerging European-wide law regulating the business corporation. Against the background of an ongoing struggle over identifying the goals and taboos of the European legislator's mandate in regulating the company, the argument put forward here is that this very struggle is reflective of the nature of the evolution of company law in an 'integrating Europe and a globalising world'. European attempts of developing European company law as part of a larger initiative of improving the Union's potential for innovation and competition are thus likely to meet with the challenges that contemporary Nation States are facing when adapting their modes of regulation and representation to the demands of an increasingly complex and decentralised fields of market activities. Situating the law of the business corporation within the larger theme of European integration on the one hand, and of issues of market regulation, domestic, transnational, and international, on the other, suggests the adoption of a systems theory-based approach to understanding the boundaries of law in this multilevel and multipolar process.