The Importance of Establishing Reliability and Validity of Assessment Instruments for Mental Health Problems: an Example from Somali Children and Adolescents Living in Three Refugee Camps in Ethiopia

Assessing mental health problems cross-culturally for children exposed to war and violence presents a number of unique challenges. One of the most important issues is the lack of validated symptom measures to assess these problems. The present study sought to evaluate the psychometric properties of two measures to assess mental health problems: the Achenbach Youth Self-Report and the Child Posttraumatic Stress Disorder Symptom Scale. We conducted a validity study in three refugee camps in Eastern Ethiopia in the outskirts of Jijiga, the capital of the Somali region. A total of 147 child and caregiver pairs were assessed, and scores obtained were submitted to rigorous psychometric evaluation. Excellent internal consistency reliability was obtained for symptom measures for children and their caregivers. Validation of study instruments based on local case definitions was obtained for the caregivers but not consistently for the children. Sensitivity and specificity of study measures were generally low, indicating that these scales would not perform adequately as screening instruments. Combined test–retest and inter-rater reliability was low for all scales. This study illustrates the need for validation and testing of existing measures cross-culturally. Methodological implications for future cross-cultural research studies in low- and middle-income countries are discussed.     

Are they different? A comparison of risk in Dangerous and Severe Personality Disordered and Personality Disordered hospitalized populations

Abstract

There has been considerable interest internationally in the assessment and treatment of individuals who have a severe personality disorder and who might pose a high risk of future recidivism. In the UK, the Dangerous and Severe Personality Disorder (DSPD) programme was initiated to deal with just this group. It is unclear, yet, whether those admitted to these services are different from those admitted to conventional personality disorder (PD) services. In the present study, 60 patients admitted to DSPD services, under DSPD criteria, were compared with 44 patients admitted to personality disordered (non-DSPD) services within the same high secure psychiatric hospital, on risk measures, including (1) an index of predicted future violence, (2) previous offending behaviour and (3) ‘pre-treatment’ levels of institutional risk-related behaviour. Results indicated that DSPD patients do pose a greater clinical and management risk, have a higher number of ‘pre-treatment’ risk-related behaviour, and have a greater number of convictions and imprisonments after age 18, relative to PD patients. The implications and limitations of these results are discussed.     

Capture Theory and the Public Interest: Balancing Competing Values to Ensure Regulatory Effectiveness

Problems arise when a regulatory agency acts in the interests of the industry it is charged with regulating, rather than in the public interest. When a governmental agency established to regulate an industry for the benefit of society acts instead for the interests of the industry it is regulating, it has been “captured” by the industry. This article examines the level of input received from the regulated community and the tendency of regulatory agency capture. Here, the proposed zone of effectiveness suggests a balance between the two scopes by incorporating a stronger focus on public interest.     

The EU in the South Caucasus and the Impact of the Russia-Ukraine War

Despite hopes that it would act as a transformative tool in the South Caucasus to strengthen democracy, stability, security and regional cooperation, the Eastern Partnership (EaP) has produced limited results, with the region more fragmented today than it was five years ago. Russia’s war against Ukraine has further exacerbated the situation, raising concerns over the extent to which South Caucasus countries can genuinely rely on the West. Today, Georgia, Armenia and Azerbaijan have different geostrategic trajectories. While Georgia has stuck to the Euro-Atlantic track, Armenia joined the Russian-led Eurasian Union in January 2015. Meanwhile Azerbaijan has the luxury of choosing not to choose. Developments in the region have demonstrated that a ‘one size fits all’ approach does not work and a more differentiated policy is required.     

Health and social care staff responses to working with people with a learning disability who display sexual offending type behaviours

Abstract

This study found that 59% of social care staff were currently supporting a client with a learning disability who had offended or displayed an offending type behaviour. The range of behaviours was similar to that displayed by clients in a secure health facility and included rape, sexual assault and exposure. Only 22.9% of social care staff had received training in this area, while none of the health staff had. Both groups expressed low levels of confidence in supporting this client group. The areas of difficulty were common to both groups and included personal attitudes and attitudes of others to the behaviour, and concerns over risk, responsibility and safety. In respect of attitudes, social care staff were found to be significantly more likely to hold negative attitudes towards the person's behaviour, while health staff were significantly more likely to feel negatively towards the person. Health staff were significantly more likely to identify training as a means of further support, while social care staff identified professional input. Both groups identified the need for theoretical training about working with this client group. Despite this no significant differences were found between those who had and had not received training and confidence, attitudes and the need for further support.     

The prevalence of drugs in carbon monoxide-related deaths: a retrospective study, 2000-2003

The objective of this study was to review demographic characteristics and drugs detected in carbon monoxide (CO)-related deaths from cases received by the Office of the Cuyahoga County Coroner in Cleveland, Ohio, from 2000-2003. Postmortem reports were reviewed, and decedents for which CO was listed as the cause of death were included. The data were compiled into 3 groups according to the official coroner's verdict as to the manner of death: accident, suicide, and homicide. Included in this study were 122 cases: 84 (69%) accidental, 31 (25%) suicide, and 7 (6%) homicide. Accident decedents were typically white males, aged 40-59 years, residing in Cleveland. Suicide decedents were also middle-aged, white males but residing in the suburbs. Homicide decedents under the age of 6 were characteristically black (N=2), while decedents over the age of 39 were predominately white (N=3). Carboxyhemoglobin (COHb) levels in suicide cases were higher than concentrations measured in accidental deaths. The highest percentage of suicide decedents (36%) had a COHb level>70% saturation, accident decedents (36%) between 50% and 69% saturation, and homicide decedents (71%) below 50% saturation. Ethanol (N=34) was detected in 28% of deaths, and therapeutic and/or abused drugs (N=50) were detected in 41% of deaths. Illicit drugs were detected in 11% of cases (cocaine/metabolites; THC/metabolites), other drug positives were therapeutic medications. The most common drugs detected were antidepressants and antihistamines in suicides and pain medications and antihistamines in accidents.     

LoComatioN: a software tool for the analysis of low copy number DNA profiles

Previously, the interpretation of low copy number (LCN) STR profiles has been carried out using the biological or 'consensus' method-essentially, alleles are not reported, unless duplicated in separate PCR analyses [P. Gill, J. Whitaker, C. Flaxman, N. Brown, J. Buckleton, An investigation of the rigor of interpretation rules for STRs derived from less than 100 pg of DNA, Forens. Sci. Int. 112 (2000) 17-40]. The method is now widely used throughout Europe. Although a probabilistic theory was simultaneously introduced, its time-consuming complexity meant that it could not be easily applied in practice. The 'consensus' method is not as efficient as the probabilistic approach, as the former wastes information in DNA profiles. However, the theory was subsequently extended to allow for DNA mixtures and population substructure in a programmed solution by Curran et al. [J.M. Curran, P. Gill, M.R. Bill, Interpretation of repeat measurement DNA evidence allowing for multiple contributors and population substructure, Forens. Sci. Int. 148 (2005) 47-53]. In this paper, we describe an expert interpretation system (LoComatioN) which removes this computational burden, and enables application of the full probabilistic method. This is the first expert system that can be used to rapidly evaluate numerous alternative explanations in a likelihood ratio approach, greatly facilitating court evaluation of the evidence. This would not be possible with manual calculation. Finally, the Gill et al. and Curran et al. papers both rely on the ability of the user to specify two quantities: the probability of allelic drop-out, and the probability of allelic contamination ("drop-in"). In this paper, we offer some guidelines on how these quantities may be specified.     

Enhancing accurate data collection in mass fatality kinship identifications: Lessons learned from Hurricane Katrina

A mass fatality DNA identification effort is a complex process in which direct matching and kinship analysis is used for identifying human remains. Kinship DNA identification is an important tool in the identification process in which victim's DNA profiles are compared to the profiles of “known” biologically related reference samples. Experience from the 9/11 World Trade Center DNA identification efforts showed that forms used to record biological relationships are important and that inaccurately documented information may hamper the kinship analysis and DNA identification process. In the identification efforts following Hurricane Katrina, a Family and/or Donor Reference Collection (FDRC) form was used as a means to document the reported relationship between the reference DNA donor and the purported missing individual. This FDRC form was developed based upon lessons learned from 9/11 and the Tsunami identification efforts. This paper analyses the effectiveness of the FDRC form used in the Hurricane Katrina kinship DNA identification efforts and proposes an improved sample collection form for kinship and other donor reference samples. The data presented can be used to enhance the accuracy of the data collection process through an improved sample collection form, streamlining the DNA kinship identification process and decreasing the burden on valuable resources.