Positional Asphyxia in Opioid-Related Deaths: Is It Being Overlooked?

The contribution of positional asphyxia in opioid-related deaths is currently unknown. Diagnostic criteria for positional asphyxia include finding the decedent in a position that does not allow for adequate respiration and an inability to extricate themselves from the position due to various conditions. Our primary objective was to assess whether positional asphyxia and the resulting airway compromise were a contributing factor to death due to the toxic effects of opioids. We evaluated 225 deaths where the death scene investigation contained adequate information to evaluate for positional asphyxia and performed a Pearson chi-square test to determine if the proportion of deaths found in an airway compromising position was higher when opioid(s) caused the death. The proportion of decedents found in a potential airway compromising position was greater when the death was related to opioid use (p < 0.0001). Further, narrowing the dataset to decedents who were definitely in an airway compromising position [Yes (24.49%) vs. No (11.02%)] showed a statistically significant association between positional asphyxia and deaths related to opioid use (p = 0.0021). Carefully documenting the position in which the decedent was initially found may be a significant factor in accurate reporting and in harm reduction efforts to decrease the opioid mortality rate.     

Gendering the "Graying" of Society: A Discourse Analysis of the Care Gap

This article analyzes to what extent the “care‐gap”—that is, too few carers looking after increasing numbers of the elderly—has become part of the problem definition of the demographic shift in the Netherlands in reports of the major scientific policy advisor to the government. Do these reports still assume a gender order in which women are informal carers and men are breadwinners? What notions about gender are circulating, and is the gender order challenged by policy recommendations? With a framework for gender‐discourse analysis, the author shows that, despite increasing awareness of the care gap, the problem definition remains framed as the costs of collective provision of health care and pensions. Recommendations still assume that women will continue to provide informal care while they also enter the labor market to maintain collective provisions.     

INNOVATIVE APPROACHES IN CHILD CUSTODY EVALUATIONS

This article discusses the joint office interview as an innovative technique for evaluation of families, the feedback or "summary" sessions by evaluators, and the role of the mediator in the feedback process. A retrospective analysis of the procedures revealed that considerable material could be studied and presented. Summaries of these data are offered as a guide to those interested in the resolution of child custody disputes.