Assessment of the Capacity to Express Informed Consent for Organ Donation in Patients with Schizophrenia

Abstract: In Italy, the “silent‐consent” principle of donor’s willingness regulates organ donation for postmortem transplantation, but civil incompetence excludes it. We investigated decisional capacity for organ donation for transplantation of 30 controls and 30 nonincompetent patients with schizophrenia as related to clinical symptoms, cognition, and functioning. Assessments were carried out through the Competence for Donation Assessment Scale (CDAS), Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms, Life Skills Profile (LSP), Raven’s Colored Progressive Matrices (RCPM), Wisconsin Card Sorting Test, Rey RI, Rey RD, and Visual Search. Patients and controls differed on the CDAS Understanding and Choice Expression areas. Patients showed significant inverse bivariate correlations between CDAS Understanding and scores on total BPRS, LSP self‐care scale, and RCPM cognitive test. Our results show that decisional capacity for participating in research does not predict decisional capacity for postmortem organ donation in patients with schizophrenic or schizoaffective psychosis; hence, before judging consent for donation, patients must be provided with enhanced information to better understand this delicate issue.     

15 STR loci frequencies in the population from Santa Catarina, Southern Brazil

Allele frequencies for 15 short tandem repeats (STR) loci were determined with a sample of 3000 unrelated individuals from the population of Santa Catarina, Southern Brazil. The loci are most commonly used in forensic and paternity testing, being analyzed by the Powerplex 16 (Promega) commercial kit. The data shows that most polymorphic loci were Penta E and FGA. The distributions of the genotypes in the evaluated loci are in Hardy–Weinberg equilibrium. Comparative analyses between our population data and other Brazilian populations are presented. The calculated forensic parameters showed that the loci are useful for the solution of forensic problems in Brazilian Southern region.     

Death From Butane Inhalation Abuse in Teenagers: Two New Case Studies and Review of the Literature

The ready availability of butane makes butane abuse frequent. Fatalities are rare. This study presents two cases of death by butane overdose. The postmortem analyses were carried out using headspace gas chromatography–mass spectrometry. It revealed femoral blood butane concentrations of 18 and 22 mg/L, respectively, as well as specific combinations of adjuvants in each victim. In one of the victims, brain and fatty tissue also contained butane, pointing to chronic consumption. The originality of this study is to show that the identification of specific combinations of adjuvants can be helpful for identifying the brand of deodorant used. Also, sampling the skin and mucosa can help identify the method of drug delivery. The histological examination documented both the direct toxic effect of the gas on the respiratory mucosa and signs of chronic abuse. Volatile substance intoxications should be systematically considered in case of sudden death in a teenager.     

Morphometric Investigation of Death by Asphyxia

Abstract:  The aim of this study was to investigate the possibility of distinguishing deaths by asphyxia from those due to natural causes by comparing morphometric measurements in lungs. The study population comprised 27 subjects: 14 cases of death by asphyxia (hanging or drowning) and 13 cases of sudden natural death. Eighty parenchyma sections were used for each subject. Data were collected by computerized image analysis. Measurements aimed at quantifying, as percentages, pulmonary parenchyma (mean values of positive-fraction areas [PFA] and their standard deviations). Subjects who died of natural causes and of drowning showed a relative internal homogeneity compared to those who hanged. Results show significant discrimination between drowned subjects and those dying of natural causes (mean of PFA p  = 0.01) and between hanged and drowned subjects (SD of PFA p  = 0.04). Attention must be paid to the possible role played by senile emphysema. The method is proposed as a complementary tool in forensic cases.     

Co-occurring psychiatric and substance use disorders among male detainees in Italy

This paper presents data on the prevalence of co-occurring substance use and psychiatric disorders among newly imprisoned males in Italy. Interviewers conducted semi-structured clinical interviews with n = 302 male detainees seven days after their admission to the prison of Perugia from August 2005 through July 2006. Over half of male detainees (54.3%) had either a substance use disorder or another psychiatric disorder. One of every five detainees (20.9%) had comorbid substance use and psychiatric disorders. Compared to detainees with psychiatric disorder only, substance use disorder only, or no disorder, detainees with comorbid substance use and psychiatric disorders were significantly more likely to have severe impairment in the areas of employment, substance abuse, family and social functioning, and psychiatric symptoms. Findings underscore the need for careful diagnostic screening at intake, access to treatment during detention, and an effective transition to services at the time of release.     

Data envelopment analysis to investigate the Italian legal system and its reform

This work investigates the Italian judicial system and discusses the designing of a policy reform to boost the efficiency of courts, considering the human resources available as well as the expenditure generated by the process to deliver justice. The authors present the benchmarks and shed light on how policy makers embarking on such a process of reform may be misled by inappropriate model definition. In detail, the authors propose a comparative analysis of technical efficiency (TE) scores computed using data envelopment analysis, adopting the same output (number of settled cases) and two alternative sets of inputs (judicial expenditure and human resources). According to the results, without considering the information extracted from the two complementary benchmark analyses, policy makers might be misled in the reform process. Regarding the elements that affect the performance of courts, it may be possible to improve the efficiency of judicial districts by working on judicial procedures. Hence, these are the domains where interventions by policy makers may prove successful. As for policy implications, the models and benchmarks presented here could be used to devise a reform of the judicial system aimed at enhancing its TE, while also keeping public expenditure under control.     

Book reviews

Global Security: North American, European and Japanese Interdependence in the 1990s Eric Grove (Ed.). Brassey's (London) 1991.109 pp. £7.50, $13.50 (PBk) ISBN 0–0804–0988–1.

Revolution and Political Change in the Third World Edited by Barry M. Schutz and Robert O. Slater. Colorado: Lynne Rienner Publishers, Inc. 1991. 260 pp. £28.50 (HBk). ISBN 0–7449–0025–5.

British Security Policy; The Thatcher Years and the End of the Cold War Stuart Croft (Ed.). Harper Collins, 1991. 231 pp. £10.95 (PBk) ISBN 0–04–445819–3.

The Near East Since the First World War By M.E. Yapp. Longman: 1991. 526 pp. £24.95. ISBN 0582–09499–0.

Crimes of Obedience: Towards a Social Psychology of Authority and Responsibility By Herbert C. Kelman and V. Lee Hamilton. Yale 1990. 382 pp. £10.95 (PBk)

Palestinians Between Israel and Jordan By Raphael Israeli. Praeger. 1991. 206 pp. £35.95 (HBk) ISBN 0–275–93938–3.

Review of Edwina Mountbatten: A Life of her Own By Janet Morgan. Harper Collins. London. 1991. £20.

Politics and Government in the Middle East and North Africa By Tariq Y. Ismael and Jacqueline S. Ismael. Florida International University Press. Miami. 1991. 570 pp. £31.95 (HBk). ISBN 0–8130–1043–8.

Soviet Military Art in a Time of Change. Command and Control of the Future Battlefield By Robert Hall London: Brassey's. 1991. 203pp. £22.50 (HBk) ISBN 008–0413218.

Europe in Turmoil ‐ The Struggle for Pluralism. European Defence and Strategic Studies Annual 1990–91. Edited by Gerald Frost. Adamantine Press Ltd. 1991. 377pp. £32.50 (PBk) ISBN 0–7449–0029–8.     

The influence of site of collection on postmortem morphine concentrations in heroin overdose victims

When assaying for postmortem morphine concentration, significant site sampling variability exists between central and peripheral sampling sites and even within sampling regions of the body. To study the variation, 76 suspected heroin overdoses were identified. Each had femoral artery (FA) and vein (FV), left and right ventricle and pooled heart blood samples obtained at autopsy. Forty-four tested positive for morphine. Morphine concentrations were determined by gas chromatography/mass spectrometry, with sampling site differences reported as log-transformed ratios and compared by signed rank test.The mean FA to FV ratio for total morphine was 1.2 (range 0-4.5). The ratio for left heart to right heart total morphine was 1.1 (range 0.4-3.2). Left ventricular to FV total morphine ratio was 2.0 (range 0.6-6.9). In these opioid overdose deaths, FA and FV morphine concentrations are usually similar, although up to 4.5-fold differences were noted. Centrally obtained morphine concentrations are on average twice as high compared with peripheral morphine concentrations. Left and right ventricular morphine concentrations were usually similar, although up to 3.2-fold differences were noted (left side higher).