Social Support, Risk-Level and Safety Actions Following Acute Assessment of Suicidal Youth

The purpose of the pilot study was to examine the interrelationship between social support, risk-level, and safety actions for 2 groups of suicidal adolescents (50 attempters and 50 ideators), who had presented for an acute assessment at an outpatient mental health service. A social support model was proposed in which it was thought that information related to patients' social support would impact upon the types of risk-level and safety actions made by clinicians. Data was collected from a total of 100 patient files, utilizing the acute assessment reports (e.g., reports assessing risk of self-harm). Findings show that groups differed significantly on indices of negative support severity, positive support, and risk-level. Limited support was found for the proposed social support model. Limitations and implications for future research are discussed.     

The Cost of Discrimination in Latin America

Indigenous and linguistic minorities are in an inferior economic and social position. The ethnic concentration of inequality is increasingly being recognized in the literature. In this review, studies from six Latin American countries that estimate the costs to an individual of being an economic minority are reviewed. The studies decompose the overall earnings gap into two components. One is the portion attributable to differences in the endowments of income-generating characteristics (“explained” differences) and the other is attributable to differences in the returns that majority and minority workers receive for the same endowment of income-generating characteristics (“unexplained”). This latter component is often taken as reflecting the “upper bound” of wage discrimination. In two studies for Bolivia, one using a 1966 survey and the other a 1989 survey, decomposition of the differential between indigenous and nonindigenous earnings leads to the conclusion that most of the overall differential is due to productivity. In Guatemala, Mexico and Peru, only one-half of the earnings differential can be attributed to differences in productivity-enhancing characteristics. In Paraguay, decomposition of the overall earnings differential between monolingual Spanish speakers and Guaraní speakers shows that most of the differential is explained by human capital differences. In Brazil, however, there is a significant cost to “being non-white.” Harry Anthony Patrinos is a Senior Education Economist at the World Bank. He leads the Economics of Education Thematic Group and manages EdInvest (www.worldbank.org/edinvest), the Education Investment Information Facility. He is co-author ofDecentralization of Education: Demand-Side Financing (1997). His latest co-edited book isPolicy Analysis of Child Labor: A Comparative Study (St. Martin's Press, 1999).Indigenous People and Poverty in Latin America: An Empirical Analysis (edited with George Psacharopoulos), was one of the first studies of the socioeconomic situation of indigenous peoples in Latin America.     

Arterial-esophageal fistulae in patients requiring nasogastric esophageal intubation

A rare and potentially fatal cause of hematemesis is fistula formation between the esophagus and the vascular system. A case report of a 39-year-old woman with congenital aortic arch anomalies hospitalized for treatment of head injuries demonstrates the potential for iatrogenic esophageal trauma to initiate fistula formation between the esophagus and an anomalous arterial system. A literature review revealed 6 other cases of vascular-esophageal fistulae caused by nasogastric esophageal intubation. It is concluded that aortic arch anomalies increase the risk of esophageal injury and subsequent fistula formation from nasogastric esophageal intubation. In addition, the clinical features and pathologic findings of vascular-esophageal fistulae are reviewed.     

Unexpected childhood death due to hemolytic uremic syndrome

Two cases of unexpected childhood death due to hemolytic uremic syndrome are reported. A 21-month-old girl who was discovered dead in bed following a short illness was found at autopsy to have overwhelming sepsis resulting from transmural colitis. Escherichia coli serotype 0157A was isolated from the intestine, and renal changes of hemolytic uremic syndrome were found. A 4-year-old girl died suddenly in hospital from intracranial hemorrhage while being treated for hemolytic uremic syndrome-related renal failure. Culture of urine and feces grew verocytotoxin producing E. coli. These cases demonstrate that hemolytic uremic syndrome may be a rare cause of unexpected childhood death and that the diagnosis may not be established prior to autopsy. Postmortem culture of tissues and fluids in cases of suspected sepsis in children may be essential in establishing this diagnosis, because histologic evaluation may be compromised by profound sepsis and tissue putrefaction. Accuracy in diagnosis may have significant public health and medicolegal consequences.     

Stereolithography: a potential new tool in forensic medicine

Stereolithography is a computer-mediated method that can be used to quickly create anatomically correct three-dimensional epoxy and acrylic resin models from various types of medical data. Multiple imaging modalities can be exploited, including computed tomography and magnetic resonance imaging. The technology was first developed and used in 1986 to overcome limitations in previous computer-aided manufacturing/milling techniques. Stereolithography is presently used to accurately reproduce both the external and internal anatomy of body structures. Current medical uses of stereolithography include preoperative planning of orthopedic and maxillofacial surgeries, the fabrication of custom prosthetic devices; and the assessment of the degree of bony and soft-tissue injury caused by trauma. We propose that there is a useful, as yet untapped, potential for this technology in forensic medicine.