Cause of death and drug use pattern in deceased drug addicts in Sweden, 2002-2003

Compared with their contemporaries, individuals abusing illicit drugs suffer a higher risk of premature death. In Sweden, a simple protocol for registration of fatalities among abusers of alcohol, pharmaceuticals, illicit drugs, or other substances, has been used by the forensic pathologists since 2001. This routine was introduced to allow for an evaluation of the cause and manner of death, and patterns of abuse among different groups of abusers. We explored the data on drug abusers (i.e. abusers of illicit drugs) subjected to a forensic autopsy 2002-2003. The Swedish forensic pathologists examined 10,273 dead victims during the study period and 7% (743/10,273) of the cases were classified as drug abusers. Toxicological analyses were carried out in 99% (736/743) and illicit drugs were detected in 70% (514/736) of these. On average, 3.8 substances (legal or illegal) were found per case. The most common substances were ethanol and morphine, detected in 43 and 35% of the cases, respectively. When exploring the importance of the different substances for the cause of death, we found that the detection of some substances, such as fentanyl and morphine, strongly indicated a poisoning, whereas certain other substances, such as benzodiazepines more often were incidental findings. In total, 50% (372/743) died of poisoning, whereas only 22% (161/743) died of natural causes. Death was considered to be directly or indirectly due to drug abuse in 47% (346/743), whereas evidence of drug abuse was an incidental finding in 21% (153/743) or based on case history alone in 33% (244/743). We believe that this strategy to prospectively categorize deaths among drug addicts constitutes a simple means of standardizing the surveillance of the death toll among drug addicts that could allow for comparisons over time and between countries.     

Palliative sedation in the Netherlands: starting-points and contents of a national guideline

In December 2005 the first national guideline for palliative sedation in the Netherlands was published. This guideline was developed by a committee of the Royal Dutch Medical Association, at the request of the Dutch government. The guideline defines palliative sedation as 'the intentional lowering of consciousness of a patient in the last phase of his or her life'. According to the guideline the objective of palliative sedation is to relieve suffering, and lowering consciousness is a means to achieve this. It is very important that palliative sedation is given for the right indication, proportionally, and adequately. It is the degree of symptom control, not the level to which consciousness is lowered, which determines the dose and combinations of the sedatives used and duration of treatment. The assessment and decision-making processes must focus on adequate relief of the patient's suffering, so that a peaceful and acceptable situation is created. Palliative sedation is given in the last phase of life, in the imminently dying patient. Palliative sedation raises several legal questions. In this article we describe the structure and contents of the guideline, with special attention for the main legal issues involved, like the distinction between palliative sedation and euthanasia and the process of informed consent.     

Anabolic androgenic steroids in police cases in Sweden 1999-2009

Anabolic Androgenic Steroids (AAS) are considered drugs of abuse and are controlled substances in Sweden since 1999. Traditionally AAS have been used by elite athletes to enhance performance, but in recent years it has become an increasing problem outside elite sport among athletes, bodybuilders and criminals. Use of AAS is associated with psychiatric side effects such as aggression, depression and violent behavior. Supraphysiological doses and long term use can cause serious physical harm such as cardiovascular toxicity and even premature death. We investigated and evaluated the drug analytical findings in forensic cases from suspected perpetrators in cases from the police where a screening for AAS was requested to get information about the prevalence of AAS use and the occurrence of poly-drug abuse. The study was based on samples submitted from the police authorities to the Department of Forensic Toxicology in Sweden during the period 1999-2009. Urines were analyzed by methods based on GC-MS and LC-MS-MS. We also analyzed the prevalence of AAS use at the prison and probation services. A total number of 12,141 urine samples (6362 police cases and 5779 inmates) were analyzed and 33.5% of the cases from the police and 11.5% of the inmates were tested positive for AAS. The users of AAS were mainly in 99.2% men with a mean age of 26.2±6.2 years whereas the women were 29.5±6.5 years old. The most frequently used AAS was nandrolone followed by testosterone and methandienone. Other illicit and licit drugs were detected in 60% of the cases from the police, strongly indicating a frequent poly-drug abuse among users of AAS.     

The State as Investment Market: A Framework for Interpreting the Post‐Soviet State in Eurasia

What type of state has emerged in post‐Soviet Eurasia, and what kind of theoretical framework can help us understand its behavior and performance? This article argues that we can usefully understand the logic of political and administrative organization in terms of a kind of “investment market.” Access to the state is frequently determined by actual financial payment. Would‐be officials invest in offices to obtain access to a stream of income associated with an office. This framework represents a novel perspective on the post‐Soviet state, which has hitherto either been premised on modernization theory or emphasized a robustly personalistic logic of political organization.     

The technocratic tendencies of economists in government bureaucracy

Economists are by many accounts the most influential group of experts in contemporary political decision-making. While the literature on the power of economists mostly focuses on the policy ideas of economic experts, some recent studies suggest that economists also hold particular technocratic ideas about the policy process. The article systematically tests this argument. Focusing on economists within government bureaucracy, the study is based on a quantitative analysis of a large-scale survey of Norwegian ministerial civil servants. It finds that economists are more likely to hold technocratic role perceptions than officials with other educational backgrounds only if they work in the finance ministry or in higher administrative grades. The findings contribute to scholarship on the political sway of economists and to debates about technocracy and the technocratic views of civil servants.     

Offender’s Personal Circumstances and Punishment: Toward a More Refined Model for the Explanation of Sentencing Disparities

Prior research suggests that offender sex, age, and race are often influential determinants of sentencing outcomes. According to focal concerns theory, they affect sentencing because—due to limited time and information—judges rely on stereotypical behavioral expectations when assessing offender blameworthiness and dangerousness. As such, extralegal offender characteristics may serve as proxies for more specific risk indicators. Whether more complete information on additional risk factors helps account for the effects of extralegal characteristics, however, remains an untested assumption. Therefore, this study analyzes the Dutch data on standardized pre-sentencing reports to examine the influence of personal circumstances of the offender, such as employment, family, and drug use factors, on the likelihood and length of incarceration. The results suggest that personal circumstances exert inconsistent influence over sentencing outcomes and that they fail to significantly mitigate the direct effects of sex and age, but do mitigate the effects of national origin.     

Toxicology and circumstances of death of homicide victims in New South Wales, Australia 1996-2005.

To determine the prevalence and circumstances of psychoactive substances amongst homicide victims, 485 consecutive cases autopsied at the NSW Department of Forensic Medicine (1/1/1996-12/31/2005) were analyzed. Substances were detected in 62.6% of cases, and illicit drugs in 32.8%. Alcohol, cannabis, opioids, and psychostimulants were most commonly detected. Alcohol and cannabis were both more prevalent amongst males. Mean ages were significantly younger for decedents who tested positive for a substance and for an illicit drug. Cases where death resulted from a physical altercation were more likely to have had alcohol and cannabis present. Illicit drugs were prominent amongst firearms deaths. The proportion of alcohol positive cases increased from 25.0% on Monday to 49.4% for Saturdays/Sundays. Alcohol was more common in incidents in the 0001-0600 h and 1800-2400 h periods. Psychoactive substances appear to substantially increase the risk of homicide, although there are important differences between drug classes in the circumstances of such incidents.     

Can Renal Acute Tubular Necrosis Be Differentiated from Autolysis at Autopsy?*

Abstract: We investigate the morphological characteristics that may differentiate between ischemic acute tubular necrosis (ATN) and autolysis in postmortem samples. Renal tissue from 57 postmortem cases with an antemortem diagnosis of ATN and 57 age-/sex-matched control cases were examined for 10 morphological characteristics: epithelial proliferation (Ki-67 immunoperoxidase positivity), fibrin thrombi, tubular epithelial whorls, mitoses, casts, autolysis, tubulorrhexis, epithelial flattening, interstitial inflammation, and interstitial expansion. Tubular epithelial whorls were found in 16 ATN cases and were absent in controls. These findings suggest that specific morphological criteria may distinguish ischemic ATN from autolysis. Diagnoses of ATN may be confirmed using these combined criteria as contributing to cause of death and/or to ascertain previously undiagnosed cases of ATN postmortem.     

Ideologie,kultuur en hegemonie: Toerusting vir media-ontleding

SUMMARY

This paper has four aims. The first is to present the major tenets of an emergent paradigm in cultural studies by critically outlining the three main concepts of that paradigm, viz., ideology, culture and hegemony; secondly, to relate this paradigm to concerns in communication and media studies; thirdly, to establish some connections between this paradigm and some recent work done in this area in SA; and finally to indicate some of the new directions this paradigm is taking in current social theorizing.     

Security, Equality, and the Clash of Ideas: Sweden's Evolving Anti-Trafficking Policy

Seeking to explain the emergence of anti-trafficking initiatives, scholars have explored two sets of ideas??national security and gender equality??thought to shape policy. In this study, we examine whether such ideational influence accounts for Sweden's evolving anti-trafficking policy over the past decade. As powerful domestic ideas about gender inequality informed the adoption of an abolitionist prostitution policy in the 1990s, one would expect similar ideas to influence domestic responses to the related issue of cross-border trafficking. However, our case study shows that the policy area of trafficking has largely followed a different ideational path. Gendered ideas, periodically nested in a human rights discourse, have been salient in the public debate on trafficking in human beings, especially during the campaign to boycott the 2006 FIFA World Cup. However, they have exerted substantially less influence on Swedish legislative initiatives to combat trafficking, with security concerns still holding sway.