Teaching post-mortem external examination in undergraduate medical education--the formal and the informal curriculum

In undergraduate medical education, the training of post-mortem external examination on dead bodies might evoke strong emotional reactions in medical students that could counteract the intended learning goals. We evaluated student perception of a forensic medicine course, their perceived learning outcome (via self-assessment) and possible tutor-dependent influences on the overall evaluation of the course by a questionnaire-based survey among 150 medical students in Hamburg, Germany. The majority of students identified post-mortem external examination as an important learning objective in undergraduate medical education and did not feel that the dignity of the deceased was offended by the course procedures. After the course, more than 70% of the students felt able to perform an external examination and to fill in a death certificate. Respectful behavior of course tutors towards the deceased entailed better overall course ratings by students (p<0.001). Our findings highlight the importance of factors such as clearly defined learning goals and course standardization (formal curriculum) as well as tutor behavior (informal curriculum) in undergraduate education in forensic medicine. Furthermore, we suggest embedding teaching in forensic medicine in longitudinal curricula on death and dying and on the health consequences of interpersonal violence.     

Examining the Influence of Family Environments on Youth Violence: A Comparison of Mexican,Puerto Rican,Cuban, Non-Latino Black,and Non-Latino White Adolescents

Existing research rarely considers important ethnic subgroup variations in violent behaviors among Latino youth. Thus, their risk for severe violent behaviors is not well understood in light of the immense ethnic and generational diversity of the Latino population in the United States. Grounded in social control theory and cultural analyses of familism, we examine differences in the risk for severe youth violence, as well its associations with family cohesion, parental engagement, adolescent autonomy, household composition, and immigrant generation among Mexican (n = 1,594), Puerto Rican (n = 586), Cuban (n = 488), and non-Latino Black (n = 4,053), and White (n = 9,921) adolescents with data from the National Longitudinal Study of Adolescent Health. Results indicate a gradient of risk; White youth had the lowest risk for severe violence and Puerto Rican youth had the highest risk compared to all other racial/ethnic subgroups. Within-group analysis indicates that family factors are not universally protective or risk-inducing. While family cohesion decreased the risk of severe violence among all groups, parental engagement was associated with increased risk among Blacks and Whites, and adolescent autonomy was associated with increased risk among Puerto Ricans and Cubans. In addition, Cuban and White adolescents who lived in single parent households or who did not live with their parents, had higher risk for severe violent behaviors than their counterparts who lived in two parent households. Among Latinos, the association of immigrant generation was in opposite directions among Mexicans and Cubans. We conclude that family and immigration factors differentially influence risk for violence among Latino subgroups and highlight the significance of examining subgroup differences and developing intervention strategies that are tailored to the needs of each ethnic subgroup.     

The impact of organisational attributes on political participation: results of a multi‐level survey from Switzerland

Abstract: The notion of civil society associations as schools of democracy has resulted in models of political participation that place an emphasis on membership in civic associations as a means of developing personal skills that are conducive to political participation. These suppositions seem well established. It is still contested, however, to what extent the particular characteristics of the associations that offer such membership have an impact on civic engagement. Expanding recent research that mainly builds on group characteristics aggregated from the characteristics of the associations’ members, we apply the Swiss part of a unique multi‐level data set, the CID‐data, which provides information about approx. 1000 activists from about 400 associations. This data allows us to measure group characteristics, such as the function of an association and its connection to the local elite, directly and thus provides us with a special opportunity for a multi‐level analysis of activists nested in organisations.     

Small and smart: the role of Switzerland in the Cartagena and Nagoya protocols negotiations

This paper looks at Switzerland to examine the role of a small state during the negotiations of the Cartagena and the Nagoya Protocols to the Convention on Biological Diversity. The influence of this small country was substantial at some point in the negotiation processes and on important features of the protocols. The main explanatory factors for this influence are identified as the competence and the tactical skills of the Swiss delegations as well as the flexible and timely mandates they received. This was reinforced by the way the position formation process was organized at the domestic level, namely a lead ministry strongly committed to the process and an efficient coordination between domestic actors, including the delegations. The Swiss delegations were thus able to support the progress of the negotiations, and in parallel to secure some of their interest, by assuming entrepreneurial and intellectual leadership strategies in function of the evolution of domestic and international constraints and opportunities.     

Delayed pericardial tamponade following a stab wound to a branch of the right coronary artery

A 45-year-old man was attacked with a knife and suffered multiple stab wounds to the chest and abdomen. After surgical treatment and hospitalization for 9 days he was discharged in a stable condition. The following day he was found dead in his apartment. The autopsy revealed a pericardial tamponade caused by acute bleeding from an injured branch of the right coronary artery. This case shows that life-threatening late complications in patients with penetrating cardiac wounds may occur despite an initially uneventful course.     

Premature detachment of the placenta due to kicks to the lower abdomen

An 18-year-old woman in an advanced stage of pregnancy was admitted to hospital for gynaecological emergency treatment with pain after kicks to the lower abdomen. Premature detachment of the placenta was diagnosed and an immediate Caesarian section was performed. Although the newborn was resuscitated at once by the medical team, it died two days later in the paediatric hospital from multiorgan failure. The autopsy results together with the pathological findings of the palcenta proved the causal context between the kicks, the premature detachment of the placenta and the hypoxia requiring postnatal resuscitation, so that the perpetrator was found guilty.