Treatment and Intervention for Opiate Dependence in the United Kingdom: Lessons from Triumph and Failure

The history of opiate treatment in the United Kingdom (UK) since the early 1980s is a rich source of learning about the benefits and pitfalls of drug treatment policy. We present five possible lessons to be learnt about how factors outside the clinic, including government, charities and researchers can influence treatment and outcomes. First, do not let a crisis go to waste. The philosophical shift from abstinence to harm reduction in the 1980s, in response to an HIV outbreak in injecting users, facilitated expansion in addiction services and made a harm reduction approach more acceptable. Second, studies of drug-related deaths can lead to advances in care. By elucidating the pattern of mortality, and designing interventions to address the causes, researchers have improved patient safety in certain contexts, though significant investment in Scotland has not arrested rising mortality. Third, collection of longitudinal data and its use to inform clinical guidelines, as pursued from the mid-1990s, can form an enduring evidence base and shape policy, sometimes in unintended ways. Fourth, beware of the presentation of harm reduction and recovery as in conflict. At the least, this reduces patient choice, and at worst, it has caused some services to be redesigned in a manner that jeopardises patient safety. Fifth, the relationship between the third and state sectors must be carefully nurtured. In the UK, early collaboration has been replaced by competition, driven by changes in funding, to the detriment of service provision.     

The Irish Republic – A 'Showpiece of Globalisation'?

Once the 'sick man of Europe', the Irish Republic is now hailed as the 'Celtic Tiger'. Commentators and politicians, both within and outside Ireland, point to the Republic's supposedly dazzling economic success as evidence of how nations can flourish in a globalised world. I question this notion, suggesting that Ireland's improved economic performance is best explained by a combination of factors, which cannot simply be lumped under the term 'globalisation'. Indeed, they seem directly to contradict many of the arguments made in the name of globalisation. However, I also contend that ideas about globalisation may play an increasingly important role in Irish economic developments.     

Pulmonary embolization by chorionic villi causing maternal death after a car crash

Throughout the last century, there has been a marked decline in obstetric maternal deaths, resulting in an increase in the proportion of nonobstetric deaths among pregnant women. Trauma, in particular, has become a leading cause of maternal death. We report the case of a 20-year-old primigravid woman who was involved in a motor vehicle crash at 36 weeks gestation. The woman developed abruptio placentae, followed by disseminated intravascular coagulation, adult respiratory distress syndrome, and shock, and died the day after the crash. Widespread pulmonary embolization by chorionic villi was identified at autopsy. This report discusses traumatic maternal deaths, with emphasis on the differences in injury pattern observed in pregnant trauma victims in comparison with other adults. It is important that the pathologist be aware of these problems so that an accurate cause of death can be identified in cases of maternal death after trauma. Also discussed is the relationship between trauma and placental abruption and the mechanism of death in the patient. To the authors' knowledge, this is the first reported case of extensive embolism of chorionic villi to the lungs after trauma.     

Urban commons and freedom of movement The housing struggles of recently arrived migrants in Rome

ABSTRACT

The arrival of migrants on Italian coasts following the so-called Arab Spring in 2011 has led to a multiplication of housing struggles. These struggles are widespread across the country and focus on the occupation of abandoned buildings and their transformation into collective housing spaces to provide an alternative to the formal reception system. This article will focus on the housing struggles in Rome, as the place with the highest number of occupations and the longest tradition of campaigns for the right to housing of migrants in the country. These struggles are the outcome of the encounter of recently arrived migrants with local solidarity movements and build on existing occupation movements and housing struggles. The article explores how the mobilizations over the right to housing intersect with issues such as the social appropriation of urban commons, the regeneration from below of unused areas, freedom of movement, and the contestation of Italian government policies on the relocation of migrants and refugees. The paper argues that housing struggles not only appropriate and regenerate urban commons, but also challenge the reception governance of migration and the policies of border control.     

Long-Term Effects of Homophobic Stigmatization During Adolescence on Problem Behavior in Emerging Adult Offspring of Lesbian Parents

Journal of Youth and Adolescence - The long-term impact of homophobic stigmatization on adolescents with lesbian parents has not been explored. This longitudinal study investigated the effects of...     

The effect of feeding enrichment upon reported working ability and behavior of kenneled working dogs

It is widely recommended that kenneled dogs are provided with environmental enrichment such as toys or feeding devices. However, the adoption of enrichment for military working dogs is impeded by a widespread belief that it reduces their motivation to work. Handlers of 22 working German Shepherd dogs were asked to rate their dogs on 11 attributes pertaining to working ability, related behavioral traits, and health. Eight of the dogs were then provided with daily feeding enrichment for 4 months, while the remainder were given equivalent human attention. The same 11 traits were scored again following the enrichment period: 10 changed little over the period while handlers' reports of their dogs' Ability to learn from being rewarded increased significantly. Changes for all attributes were virtually identical in enriched and control dogs. We conclude that if correctly managed, feeding enrichment can be introduced to kenneled working dogs without any reported detrimental effects upon working ability, health, or behavior.     

Off-label Paediatric Drug Use for Juvenile Depression and the Clinical Trial Regulations 2004: The Impact of Available Protective Mechanisms

Across Europe, around one in four adults experience a mental health problem in any 1 year. It is estimated that 2–6% of children and adolescents suffer from depression and suicide is now the third leading cause of death in 10–19 year olds. Despite traditional Freudian teachings that children rarely suffer from clinically diagnosed depression, treatment figures for juvenile depression have soared in recent years. For adults, the current treatment trend, as advocated by the National Institute for Health and Clinical Excellence (NICE), is the use of Selective Serotonin Reuptake Inhibitors (SSRIs), such as Prozac. For children, efficacy of such treatment remains difficult to judge as all SSRI use in paediatric care remains ‘off-label’ or unlicensed. Notwithstanding this, in 2006 the European Medicines Agency (EMEA) advocated the use of Prozac within the EU for children from the age of eight, a position that reinforced the stance adopted by NICE in 2005. These recommendations have been made despite growing concern that many SSRIs have some serious side effects. In new legislation for paediatric medicines, that came into effect on 26th January 2007, the European Union (EU) has attempted to address several unresolved issues relating to children’s needs for medicines in Europe. This paper considers the position of off-label drug-therapy for juvenile depression, and assesses the effectiveness of available legal mechanisms that can protect juveniles from harm when involved in clinical drug trials, most notably the Clinical Trial Regulations 2004. It further reviews the new EU legislation and evaluates its likely impact.

Psychopathy among prisoners in England and Wales

Most research into psychopathy among prisoners is based on selected samples. It remains unclear whether prevalences are lower among European populations. This study aimed to measure the prevalence of psychopathy, and the distribution and correlates of psychopathic traits in a representative national sample of prisoners. Psychopathy was measured using the revised Psychopathy Checklist (PCL-R) in a second stage, cross-sectional survey of prisoners in England and Wales in 1997 (n = 496). Poisson regression analysis was carried out to examine independent associations between correlates and PCL-R total and factor scores. The prevalence of categorically diagnosed psychopathy at a cut off of 30 was 7.7% (95%CI 5.2–10.9) in men and 1.9% (95%CI 0.2–6.9) in women. Psychopathic traits were less prevalent among women. They were correlated with younger age, repeated imprisonment, detention in higher security, disciplinary infractions, antisocial, narcissistic, histrionic, and schizoid personality disorders, and substance misuse, but not neurotic disorders or schizophrenia. The study concluded that psychopathy and psychopathic traits are prevalent among male prisoners in England and Wales but lower than in most previous studies using selected samples. However, most correlates with psychopathic traits were similar to other studies. Psychopathy identifies the extreme of a spectrum of social and behavioral problems among prisoners.     

The Red Swamp Crayfish Procambarus Clarkii (the Louisiana Crayfish) as a Particular Scavenger on a Human Corpse

An 85-year-old man was found deceased floating in an irrigation ditch 18 days after his disappearance. During crime scene investigation, specimens of the red swamp crayfish Procambarus clarkii were found in proximity of the body. The feeding activity of these nonendemic crayfishes contributed to the formation of specific injuries on the body and in the production of a large substance defects inside the corpse. The aim of this paper was to illustrate the scavenging activity of P. clarkii on a human body and highlight the potential postmortem artefacts caused by this species. This is the first report on a real case of postmortem injuries produced by P. clarkii crayfishes on a submerged human body. So far, crustaceans are not considered useful for the estimation of the minimum postmortem interval. However, the important modifications on the corpses deriving from the activity of these animals should be kept in consideration.