Suicide in children and adolescents: a 10-year retrospective review

Suicide is second only to accidents as the most common cause of death for children and adolescents age 10 to 19 in Canada. All of the pediatric cases that were referred to the Hamilton Regional Forensic Pathology Unit from 1993 to 2002 were reviewed. For the purpose of this study, pediatric deaths were defined as deaths in the age group of 1 day up to and including 19 years of age. Specific criteria for suicide were applied to each case, independent of the manner of death issued by the coroner. The criteria were 3-fold. First, homicide had to be ruled out by the police investigation and autopsy findings. Second, the method had to be consistent with self-infliction. Finally, there had to be some evidence of suicidal intent. Questionable cases were discussed among the authors, and if reasonable intent could not be established, then the case was excluded. The autopsy and police reports were examined in detail regarding age, sex, location and method of suicide, presence of suicide notes, and any contributing psychologic factors or stressors. Of the 501 pediatric autopsies performed during the 10-year period, 31 (6%) met the criteria of suicide. The majority of cases (87%) were in older adolescents (age 15 to 19), and the male to female ratio was 2.4:1. Psychologic factors were identified in some of the cases, including depressed mood (77%), suicidal ideation (45%), previous suicide attempts (23%), and drug or alcohol problems (19%). Most of the suicides (61%) occurred in the victim's home, and 12 (39%) cases left a suicide note. In 9 cases (29%), alcohol or street drugs were detected postmortem, though in 8 cases toxicology was not performed. Hanging (48%) was the most common method of suicide, followed by firearms (13%), poisoning (10%), drowning (10%), and blunt force vehicular trauma (10%). Almost 60% of the male suicides were by hanging. No specific trend was identified in the 9 female suicides. These results were compared with similar studies within Canada and other countries. Overall, the method of suicide is dictated by what is convenient and readily available, though the acceptance of various suicide methods can change over time. Suicide prevention efforts should be tailored to address local trends.     

Autoerotic accident by inhalation of propane-butane gas mixture

We present a case of an accidental autoerotic death involving the inhalation of a propane-butane gas mixture, also known as LPG (liquefied petroleum gas). A 19-year-old male was found dead in supine position in his bed in a residential accommodation one day after he was last seen alive. On a personal computer at the end of the bed, a pornographic movie was still running. On his left shoulder, an empty rubber balloon and on the bedside 2 empty "Kisag-Gas" cartridges were found. Toxicologic investigations revealed an intoxication with propane and butane, together with a recent consumption of cannabis. This case report compares the toxicologic findings with other recently published cases, and the theories of the toxic effects are discussed.     

A coffee can, factor analysis, and prediction of antisocial behavior: the structure of criminal risk

The predictive accuracy of the Psychopathy Checklist-Revised, Level of Service Inventory-Revised, Violence Risk Appraisal Guide, and the General Statistical Information on Recidivism were compared to four instruments randomly generated from the total pool of original items. None of the four original instruments better predicted post-release failure than the four randomly generated instruments. These results suggest two conclusions: (a) the instruments are only measuring criminal risk, and (b) no single instrument has captured sufficient risk assessment theory to result in better prediction than randomly derived instruments measuring criminal risk. A two-stage factor analysis was completed on 1614 cases. This analysis of the risk items indicated a 4-factor solution and all 4 factors were equal to the original instruments in predicting post-release failure. Thus, the original instruments did not improve prediction over randomly structured scales, nor did the restructuring of items improve risk assessment, suggesting substantial deficiencies in the conceptualization of risk assessment and instrumentation. We argue that developing a risk-based construct, which involves hypothesis testing and an explanation of behavior, is the optimal method to advance risk assessment within the criminal justice and mental health systems. Such an approach would provide targeted areas for clinical intervention that are salient to risk.     

Cognitive processes in criminal profile construction: a preliminary study

This study undertook an empirically based examination of the cognitive processes associated with the accurate construction of a criminal psychological profile. This was accomplished by comparing the abilities of profilers and nonprofilers in two simulated profiling exercises that measured both profile accuracy and an individual's performance on various tests of memory and comprehension related to the case materials presented in each exercise. The results of these experiments suggest that an incremental relationship exists between comprehension of the case materials and accuracy of the profiles generated. In addition, the findings provide some tentative indications that the comprehension of case material in a narrative (i.e., written) format is an integral cognitive function to proficient profiling.     

Protecting elders: regulating intergenerationally transmitted debt in Australia

Australia, like other western nations, is facing the prospect that in the decades ahead the overall population will age dramatically. This article considers legal issues associated with the aged and intergenerationally transmitted debt. It will be argued that the present legal regulation of guarantees is a complex amalgam of case law, statute and finance industry self-regulatory codes which does not necessarily or adequately take into account the particular vulnerabilities of the aged and the very old or the intergenerational pressures which they may confront. It may be necessary to take significant steps to protect vulnerable elders while still recognizing their rights to exercise personal autonomy. Some proposals for reform are made.     

The changing process and politics of health policy in Korea

Korea recently introduced three major health care reforms: in financing (1999), pharmaceuticals (2000), and provider payment (2001). In these three reforms, new government policies merged more than 350 health insurance societies into a single payer, separated drug prescribing by physicians from dispensing by pharmacists, and attempted to introduce a new prospective payment system. This essay compares the three reforms in Korea and draws important lessons about the country's changing process and politics of health care policy. The change of government, the president's keen interest in health policy, and democratization in the public policy process toward a more pluralist context opened a policy window for reform. Civic groups played an active role in the policy process by shaping the proposals for reform-a major change from the previous policy process that was dominated by government bureaucrats. The three reforms also showed important differences in the role of interest groups. Strong support by the rural population and labor unions contributed to the financing reform. In the pharmaceutical reform, which was a big threat to physician income, the president and civic groups succeeded in quickly setting the reform agenda; the medical profession was unable to block the adoption of the reform but their strikes influenced the content of the reform during implementation. Physician strikes also helped block the implementation of the payment reform. Future reform efforts in Korea will need to consider the political management of vested interest groups and the design of strategies for both scope and sequencing of policy reforms.     

Driving under the influence of drugs -- evaluation of analytical data of drugs in oral fluid, serum and urine, and correlation with impairment symptoms

A study was performed to acquire urine, serum and oral fluid samples in cases of suspected driving under the influence of drugs of abuse. Oral fluid was collected using a novel sampling/testing device (Dr?ger DrugTest System). The aim of the study was to evaluate oral fluid and urine as a predictor of blood samples positive for drugs and impairment symptoms. Analysis for cannabinoids, amphetamine and its derivatives, opiates and cocaine was performed in urine using the Mahsan Kombi/DOA4-test, in serum using immunoassay and gas chromatography-mass spectrometry (GC-MS) confirmation and in oral fluid by GC-MS. Police and medical officer observations of impairment symptoms were rated and evaluated using a threshold value for the classification of driving inability. Accuracy in correlating drug detection in oral fluid and serum were >90% for all substances and also >90% in urine and serum except for THC (71.0%). Of the cases with oral fluid positive for any drug 97.1% of corresponding serum samples were also positive for at least one drug; of drug-positive urine samples this were only 82.4%. In 119 of 146 cases, impairment symptoms above threshold were observed (81.5%). Of the cases with drugs detected in serum, 19.1% appeared not impaired which were the same with drug-positive oral fluid while more persons with drug-positive urine samples appeared uninfluenced (32.7%). The data demonstrate that oral fluid is superior to urine in correlating with serum analytical data and impairment symptoms of drivers under the influence of drugs of abuse.     

Social isolation and delayed discovery of bodies in houses: the value of forensic pathology, anthropology, odontology and entomology in the medico-legal investigation

The bodies of socially isolated people may remain undiscovered in their own houses for prolonged periods. Occasionally the body is in situ for sufficient time to become skeletonised, or partially so. Medico-legal investigation of these cases is complicated by degradation and contamination of evidence. Thus, a multidisciplinary forensic investigation is recommended. The potential contributions of forensic pathology, anthropology, odontology and entomology are outlined here with reference to two cases that occurred in Victoria, Australia, in 2003. Forensic pathologists are often unable to determine the cause of death in skeletonised bodies, however, they may find evidence to support either a natural or unnatural mode of death, and they may describe skeletal pathology or trauma, and identify skeletal features to support radiological identification of the deceased. Anthropologists can provide supplementary evidence of skeletal trauma. Additionally, they can assess age, sex, stature and racial affiliation from skeletal remains. Odontologists can identify individuals through comparison with ante-mortem dental records; however, potential difficulties exist in identifying the treating dentist of a socially isolated person. Odontologists may also examine the teeth and oro-facial skeleton for trauma. Entomologists may estimate minimum death time and/or season of death. Entomological examination of insect remains may also confirm that a body has lain in situ for a considerable period.