Car surfing in Indiana--an unusual form of motor vehicle fatality.

A new form of joyride known as "car surfing" with fatal results is documented. The possible role of this activity in extra-vehicular motor vehicle deaths involving teenage or youthful drivers is described. Potential scene and autopsy findings are discussed.     

Medicaid and access to child health care in Chicago.

In this article we examine how increasing the reimbursement of physicians and expanding Medicaid eligibility affect access to care for children in Cook County, Illinois, which overlies Chicago. Using Medicaid claims and other data at the zip-code level, we compare the places where Medicaid children live with the places where all the physicians who treat children and those who accept Medicaid patients have their practices. Our findings suggest that the recent changes in legislation are unlikely to benefit extremely poor children, who are more likely to live in depressed inner-city areas, where there are few physicians. "Near-poor" children whose homes are dispersed throughout the county, who are now eligible for Medicaid as a result of the recent changes, are likely to see improvements in their access to care. Further changes in policy, aimed at enhancing the capacity of institutions providing care, could improve access for the children of the inner city.     

Policy failure and public support: The Iran-Contra affair and public assessment of President Reagan

The Iran-Contra affair is an example of the type of event that is expected to give rise to a rally of public opinion behind the president. However, the public's response to this event, uncharacteristically, was a sharp decrease in support for President Reagan. This case study constitutes an attempt to explore the sources of the public opinion response to foreign policy events. Statements of political elites, news coverage and commentary, and public opinion assessments are examined to test the patriotism, priming, and opinion leadership explanations of the rally phenomenon. The actions of opinion leaders appears to provide the best explanation of the differential public response to the Iran-Contra affair.     

Suicide by jumping from buildings

A study of 82 suicides during 1982-1986 that were committed by jumping from buildings was performed using the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, U.S.A. The analysis involved the age, race, and sex of the victim along with the results of toxicologic studies and the cause of death. Additionally, the decedent's place of residence, location of the suicide, height of the building, and the reason for the suicide were investigated. Whether or not a note was left by the decedent was also ascertained. The suicidal "jumper" most commonly was a white man who was greater than 60 years of age who died from the resultant multiple injuries. The victim commonly was sober and drug free at the time of the incident. In approximately two-thirds of the cases, the location of the suicide was the victim's residence, which frequently was an apartment or condominium-type dwelling that was seven floors or higher from the ground. The victim often had experienced depression prior to the incident and did not usually leave a suicide note. This article compares the Dade County cases with others that have been studied and discusses the reasons why jumping from a building may have been chosen as the suicidal mechanism.     

Identification of a red "fiber": chironomid larvae

During preliminary examination of the body of a homicide victim, a peculiar red "fiber" was noticed and recovered. Initially believing this to be a carpet fiber, the item was subjected to fiber analysis. It was found to be a short coiled particle not like any known natural or synthetic fabric fiber. Subsequent examinations determined this "fiber" to be the larva of a common freshwater midge (Diptera; Chironomidae). Chironomid larvae have been observed on other bodies recovered from freshwater environments. Entomological studies of this organism have led to the conclusion that the presence of chironomid larvae indicates submersion of the body.     

Forensic psychiatry: a subspecialty. The presidential address at the nineteenth annual meeting of the American Academy of Psychiatry and the Law

The implications of the definition of forensic psychiatry are explored, with particular reference to the field as a subspecialty of general psychiatry. The allegation of undue moral uncertainty in forensic psychiatry is denied and the moral issues are revealed to be related to the status of the underlying philosophical disputes. An outline for the organization of the forensic psychiatric assessment is presented. The charge that forensic psychiatry is not as "hard" a science as the other forensic sciences is denied. The administrative and political organizational problems facing the subspecialty are explored. The practitioners in the field are encouraged to recognize that forensic psychiatry is a subspecialty and to work for official subspecialty status. Cautious predictions about the future of the field are provided.     

Complications following cell therapy

So far, the law in the Federal Republic of Germany still allows the injection of fresh-cell preparations from animals as a roborant to increase the vitality of the organism and to strengthen the body's immune defense system. The use of "sicca-cell" preparations was provisionally forbidden in 1987 by the Federal Health Organization (Bundesgesundheitsamt; BGA). Prohibition of fresh-cell injections would have exceeded the authority of this office, although the same serious reservations also applied in the case of this treatment method. Several publications that have appeared since 1955 have reported serious complications of this therapy, some life-threatening and some even lethal. Two further cases are now added: (1) A woman aged 69 had been receiving treatment with cell injections for 9 years. Immediately after an injection of sicca cells she collapsed and was hospitalized; 7 days thereafter she developed an ascending paralysis with increasing inability to swallow or breathe. She died 25 days after the injection as a consequence of central and peripheral respiratory failure. Autopsy revealed the alterations typical for acute Landry-Guillain-Barré-Strohl syndrome. (2) A 76-year-old healthy woman had been receiving treatment with fresh-cell preparations for several years. After an injection of cell suspensions a painful local swelling was observed. The symptoms were interpreted as the consequence of an iatrogenic local hematoma, and repeated punctures were performed to obtain blood. The patient was transferred to a surgical department for further therapy. Two days after the injection she suddenly died with signs of acute cardiovascular failure. Autopsy revealed the signs of a fulminating clostridial infection and also the characteristic signs of Landry-Guillain-Barré syndrome with involvement of the autonomic nervous system. In both cases the development of an inflammatory process in the peripheral nervous system could be interpreted as an immune-mediated allergic disease, related to the repeated injection of heterologous antigenic material containing nervous tissues. This hypothesis would also explain the two other cases already published and would be consistent with the observed perivenous leukoencephalopathy of the central nervous system. The human disease pictures correspond to the well-established animal models of EAEM (experimental allergic encephalomyelitis) and EAN (experimental allergic neuritis). The pathogenesis is discussed; the major role of the central and peripheral nervous system is stressed, with special reference to the risk of acute autonomic failure. The need for specific autopsy techniques for the investigation of the entire nervous system, including spinal cord, roots, spinal ganglia and peripheral nerves with sympathetic chains, is raised.