Human trafficking and drug distribution in Sweden from a market perspective—similarities and differences

Based on several studies, the aim of the article is to compare trafficking in women for the purpose of sexual exploitation to trafficking in drugs. Women are recruited and drugs are bought in other countries and transported to Sweden. What are the similarities and differences between the recruitment phase (women) and the purchases (drugs)? Both sexual services and drugs are sold in local markets. This requires marketing, contacts and access to customers. Women need accommodation and often a place to sell the services, drugs must be stored somewhere and prepared for sale. Procurement, trafficking and the purchase of sexual services are illegal and in the case of drugs even consumption and possession for personal use is illegal and prosecuted. Facilitators often play an important role in connecting customers and providers. This article will further describe what kind of organizational structure is needed to arrange these logistics and some different strategies used by organizers and distributors.     

Esophageal injury in fatal rear-impact collisions

Neck injuries resulting from motor vehicle collisions (MVC), often referred to as whiplash trauma and injury, often demonstrate little or no evidence of significant tissue damage. In rare instances, however, serious injury to the anterior neck organ injuries can result from such trauma. The present study describes esophageal injury associated with rear-impact collisions, based on a unique case report, review of the scientific literature and a query in the National Automotive Sampling System (NASS) database of the US National Highway Traffic Safety Administration. The Medline search and present case study totaled five cases of rear-impact collision-related serious esophageal injury (laceration or rupture). In the four published cases all patients survived, whereas in the presented case study, the patient died due to mediastinitis and sepsis. The NASS query revealed an additional three cases out of a total of 55,926 investigated crashes. All three cases were associated with fatalities. Although no anatomical or bioengineering studies have presented data on the behavior of the esophagus during rear-impact whiplash loading, sudden tensile and/or compressive forces is the likely explanation of injury, often in combination with a local fracture of a vertebral body. In these 8 cases significant esophageal injury carried a substantial (50%) risk of mortality. Clinicians should be aware of the potential for significant complications in the whiplash trauma-exposed patient who complains of chest pain, mid-thoracic pain, discomfort in the neck and throat, respiratory distress, or hoarseness. For those forensic specialists involved in whiplash cases these study results highlight the need to consider esophageal injuries as a rare but potential consequence of whiplash trauma.     

Whole body postmortem magnetic resonance angiography

Computed tomography (CT) and magnetic resonance (MR) imaging have become important elements of forensic radiology. Whereas the feasibility and potential of CT angiography have long been explored, postmortem MR angiography (PMMRA) has so far been neglected. We tested the feasibility of PMMRA on four adult human cadavers. Technical quality of PMMRA was assessed relative to postmortem CT angiography (PMCTA), separately for each body region. Intra-aortic contrast volumes were calculated on PMCTA and PMMRA with segmentation software. The results showed that technical quality of PMMRA images was equal to PMCTA in 4/4 cases for the head, the heart, and the chest, and in 3/4 cases for the abdomen, and the pelvis. There was a mean decrease in intra-aortic contrast volume from PMCTA to PMMRA of 46%. PMMRA is technically feasible and allows combining the soft tissue detail provided by MR and the information afforded by angiography.     

Investigation of morphine and morphine glucuronide levels and cytochrome P450 isoenzyme 2D6 genotype in codeine-related deaths

Compared to morphine and morphine-6-glucuronide (M6G), codeine and its other major metabolites codeine-6-glucuronide and norcodeine have weak affinity to opioid μ-receptors. Analgesic effects of codeine are thus largely dependent on metabolic conversion to morphine by the polymorphic cytochrome P450 isoenzyme 2D6 (CYP2D6). How this relates to toxicity and post-mortem whole blood levels is not known. This paper presents a case series of codeine-related deaths where concentrations of morphine, M6G and morphine-3-glucuronide (M3G), as well as CYP2D6 genotype, are taken into account. Post-mortem toxicological specimens from a total of 1444 consecutive forensic autopsy cases in Central Norway were analyzed. Among these, 111 cases with detectable amounts of codeine in femoral blood were identified, of which 34 had femoral blood concentrations exceeding the TIAFT toxicity threshold of 0.3mg/L. Autopsy records of these 34 cases were retrieved and reviewed. In the 34 reviewed cases, there was a large variability in individual morphine to codeine concentration ratios (M/C ratios), and morphine levels could not be predicted from codeine concentrations, even when CYP2D6 genotype was known. 13 cases had codeine concentrations exceeding the TIAFT threshold for possibly lethal serum concentrations (1.6 mg/L). Among these, 8 individuals had morphine concentrations below the toxic threshold according to TIAFT (0.15 mg/L). In one case, morphine as well as M6G and M3G concentrations were below the limit of detection. A comprehensive investigation of codeine-related fatalities should, in addition to a detailed case history, include quantification of morphine and morphine metabolites. CYP2D6 genotyping may be of interest in cases with unexpectedly high or low M/C ratios.     

Criminality,thinking patterns and treatment effects – evaluation of the Swedish cognitive intervention programme ‘new challenges’ targeting adult men with a criminal lifestyle

The cognitive intervention programme ‘New Challenges’ targeting adult men with a criminal lifestyle was evaluated in a pilot study. The participants were divided into a cognitive treatment group (n = 32) and a control group (n = 11). In the control group, six participants had no treatment and five participated in 12-step treatment. The participants were measured pre and post using the Psychological Inventory of Criminal Thinking Styles (PICTS), the abridged version of sense of coherence (SOC), Positive and Negative Affect Scale, and Bergström’s quality of programme delivery (QPD). The results of the treatment group showed that criminal thinking patterns dropped significantly from high values to close to normal level. SOC and positive affect increased significantly in the treatment group. Both SOC and positive affect showed positive correlation with QPD. Regarding the possible influence of the 12-step treatment, there was no difference in the control group between participants receiving 12-step treatment and those not receiving treatment. The main conclusion is that the cognitive treatment programme ‘New Challenges’ can contribute to reduced criminal thinking and increased SOC and positive affect, which may prove to be important precursors of reduced criminality.     

A systematic review of suicide rating scales in schizophrenia

In spite of a substantial number of suicides in patients with schizophrenia, this area of research has until very recently been the Cinderella of schizophrenia research. Both clinical and research practices have been hampered by a lack of assessment tolls specifically designed to measure suicidality in patients with schizophrenia. This has partly been because of uncertainty about what constitutes reliable risk factors for suicide in schizophrenia. A literature search following evidence-based guidelines was carried out. A number of relevant articles were found, which were then critically reviewed. The majority of rating scales used for patients with schizophrenia were actually based--at least partly--on patients with other diagnoses than schizophrenia (affective conditions, schizoaffective disorder). This procedure could result in misleading conclusions as a result of the heterogeneity of the different mental illnesses. We conclude that, at present, only one rating scale measuring suicidality specifically designed for patients with schizophrenia (the InterSePT-scale) is based on both sound methodology and has clinical relevance. Suicide in patients with schizophrenia remains a pressing problem in the treatment of this high-risk group.