Surveillance of human immunodeficiency virus (HIV) antibodies in medicolegal autopsies in Finland--monitoring early changes in HIV-seropositivity among risk groups and average population.

In order to cooperate with voluntary screening programs aimed at the surveillance of the HIV epidemic in Finland, we have studied medicolegal autopsies for HIV antibodies since 1986 using an enzyme immunoassay on postmortem sera. The investigation covered 47.4% and 39.2%, respectively, of all deaths under the age of 65 years in the metropolitan areas of Helsinki and Turku--two cities on the densely populated southern coast of Finland from which most HIV infections have thus far been detected. Nine HIV-positive cases (0.12%) were detected among the 7305 medicolegal autopsies tested in 1986 to 1990. This figure is higher than the prevalence of 0.01 to 0.03% in voluntary screening programs for the general population would suggest. Seven of our cases had previously tested positive, and two were previously unknown cases, indicating that people at high risk are clustered in the medicolegal autopsy series. Of the six cases in an early stage of infection, three committed suicide suggesting the importance of HIV-screening in suicide cases in tracing symptomless HIV carriers. Five of the cases were detected in 1990, a year when the number of new HIV infections had more than doubled compared to the previous two years. This suggests that testing of medicolegal autopsies as surrogate tests for the population gives useful information even in low-prevalence areas like Finland. Such testing has none of the ethical problems of many other back-up surveys, and may be particularly sensitive to early changes in epidemiology.     

Dissecting intramural haematoma of the coronary artery with intimal tears.

A dissecting intramural haematoma of the coronary artery is an infrequent cause of sudden and unexpected death. Most cases are women and in a significant number of these women, the haematoma occurred at term to 80 days postpartum. Because the intimal rupture and communication with the lumen were not found in most of the cases, the site of rupture has been considered to be a vasa vasorum. The authors report on a case of one woman who was at a later postpartum period (106 days). The microscopic finding of the dissected coronary artery revealed two intimal tears in a section. The case showed that the dissecting intramural haematoma of the coronary artery is caused not only by the rupture of the vasa vasorum but also by the rupture of the intima.     

Identification based on medical findings

1. The indications such as the place of finding, the identification of clothes or other personal items, represent only the first step towards the identification of a corpse. 2. An identification based on medical data, other than dental, is often possible, more often than it is believed. 3. The forensic pathologist plays a double role in the case of such an identification: a) in the phase of the inquiry, he must contact the investigators and the families to explain his wishes and the different possibilities of identification. b) he must use the gathered information in the appropriate way. 4. It would be desirable to compose some statistical tables of the various medical elements useful for the identification (mutilations, surgical operations, etc...). We present six cases of identification in our practice.     

Inmates: Who occupies our jails?

The purpose of this investigation was to identify inmate personal and demographic data that may be used to further define or profile persons with a greater likelihood of being at risk for serving a jail sentence. This study was explorative. The survey administration was similar in format to that conducted by the U.S. Department of Justice. Chaplains were used as survey proctors. Pilot studies were conducted to determine the suitability of survey content. Surveys consisted of 172 items. Subjects included four hundred inmates: males comprised 88.75 percent of the sample, Caucasians 58.25 percent, Blacks 37 percent, Hispanics 3.25 percent and other 1.5 percent of the sample. Respondents ranged in age from 15 to 64 years with an average age of 30.3 years. Less than two percent of the contacted inmates refused participation in the survey. Results are presented for demographic data, select legal/criminal data, select drug and alcohol use data, employment data, health, parent/family data, education data, social data, and “other”.     

Relationships between psychosocial development and personality disorder symptomatology in late adolescents

The present study investigated the extent to which psychosocial development through the first five stages of Erik Erikson's theory of personality development is associated with Diagnostic and Statistical Manual (third edition, revised; DSM-III-R) Axis II personality disorder symptomatology in a late adolescent sample of undergraduate students. The Inventory of Psychosocial Development (IPD) and the Personality Diagnostic Questionnaire—Revised (PDQ-R) were administered to a mixed-sex sample of 106 undergraduate students. The results of this research were that IPD scores assessing negative resolutions of the first five Eriksonian developmental stages consistently predicted scores on the PDQ-R composite scale and the PDQ-R impairment/distress index—both measures of overall personality disorder symptomatology. The IPD subscales varied substantially in the extent to which they predicted scores on the 13 PDQ-R subscales that assess symptoms of specific DSM-III-R personality disorders—ranging from the trust vs. mistrust subscale, which predicted scores on 12 of the 13 PDQ-R subscales, to the initiative vs. guilt subscale, which predicted scores on only 6 of the 13 PDQ-R subscales. Implications of these findings for our understanding of the relationship between psychosocial development and psychopathology are discussed in the context of previous research in this area, and suggestions for future research are offered.Received Ph.D. from Temple University. Research interests include personality disorders, depression, and life events.     

CONTRACTORS' EXPERIENCE OF COMPULSORY COMPETITIVE TENDERING: A CASE STUDY OF CONTRACT CLEANERS IN THE NHS

Compulsory competitive tendering (CCT) has been an important instrument of Conservative government economic policy since 1979. Its effectiveness in generating cost-effective services depends on competition to supply the service in question.
The NHS domestic market is large and, prior to the introduction of CCT, promised to be profitable for contractors. Many contract cleaners with office cleaning experience entered. In the event the costs of entry were heavy, and the profit margins of established firms were reduced. When contracts have been awarded to firms, they tended to be to those with a track record. Many firms therefore withdrew; and the few that remained have profit margins in the NHS little different from those found elsewhere. Of more than by firms with a serious interest in entry, probably no more than a handful can have come out of the experience in net profit in the first seven years.
The experience of CCT in the market for NHS domestic services has shown that a degree of competition in the market can be achieved, arguably because of the presence of direct service organizations. Competition for this market, on the other hand, can be limited by the high costs of entry.     

Children in the environment: Forest day-care centers: Modern day care with historical antecedents

Some features of early child care are more prominent in Norway than in other countries, such as emphasis on the outdoor environment. Of general relevance and interest is the form of day care provided by forest day-care centers. Three ideas form the development of these centers placed in wild areas. First, throughout history, Norwegians have had a close attachment to nature and some parents want to provide their children with outdoor experiences at an early age. Second, urging children to play outdoors characterizes the image many parents have of a happy, healthy childhood. Third, provision of day care for children has always been restricted in western countries, forcing parents to invent types of service that can become part of an ecological system that promotes healthy development.The forest day-care centers developed recently represent a supplement to the wide typology of child care in the 21st century. The article outlines the connections between these ideas in general European and western history and Norwegian history and presents debate and decisions about a question dating from the last half of the 1980s. It concludes that the forest day-care centers are perhaps only a modern form of the original kindergarten concept, which started in Europe and America as gardens for children not gardens of children.