Forensic analysis of carbohydrate-deficient transferrin (CDT) by HPLC--statistics and extreme CDT values

Background

Carbohydrate-deficient transferrin (CDT) is the most specific serum marker of chronic alcohol abuse so far. There is little knowledge about extreme CDT values of >20% and the more >30% CDT.

Methods

Serum CDT/transferrin ratios from 19,236 serum samples sent to our laboratory for routine CDT analysis were determined by HPLC. About 75% of these serum samples were from traffic or employment medicine investigations. A CDT value frequency histogram was computed and extreme CDT values were clinically validated.

Results

Fourteen thousand four hundred and sixty-one CDT results were normal (≤1.7%) and 4775 increased (1.8–36.9% CDT). Most frequent normal and increased results were 0.9% CDT (n = 1964) and 1.8% CDT (n = 356). CA. 70% of the pathological results were between 1.8% and 5.0% CDT, ca. 88% between 1.8% and 10.0% CDT, and 98% between 1.8% and 20.0%. CDT values >20.0% appeared in 79 cases and results >30.0% in two cases (33.8% and 36.9%). In each case of CDT values >20%, chronic alcohol abuse was the underlying cause as confirmed by anamnestic exploration.

Conclusions

CDT/transferrin ratios are usually <20%. Higher values can appear in rare cases. CDT results >30% can be due to alcohol abuse but should be considered as remarkable single observations. Visualization of the transferrin isoform patterns by HPLC allows the detection of pathological transferrin isoform patterns and of genetic transferrin variants. This is essential for a reliable interpretation of (extreme) CDT values. CDT analysis by immunoassays without physico-chemical confirmatory analysis is no longer acceptable.     

Interactional Aspects of Intimate Partner Violence Result in Different Help-Seeking Behaviors in a Representative Sample of Women

This article reports a study of the possible impact of sociodemographic and interactional aspects of intimate partner violence (IPV) on help-seeking behavior. Do different sociodemographic groups of IPV survivors use different professional supports and treatments? Do different professional support and treatment agencies come predominantly in contact with women who have been subjected to different characteristics of IPV? Do different interactional IPV variables predict whether IPV victims contact the police, a family doctor, or a psychologist or psychiatrist? A representative sample of 157 women recruited from family counseling, the police, and shelters in Norway was interviewed. Three of seven sociodemographic variables showed statistically significant differences among the recruitment groups. No significant differences in characteristics of IPV were found among the recruitment groups. However, there were significant differences between the main categories (physical, psychological, and sexual) of IPV and interactional IPV factors concerning help-seeking. Our findings indicate that the help-seeking of IPV survivors is differentiated and interaction-specific and that they respond adequately to the different interactional consequences of IPV.     

First report from the Swedish National Forensic Psychiatric Register (SNFPR)

To the best of our knowledge, the present register is the only nationwide forensic psychiatric patient register in the world. The aim of this article is to describe the content of the Swedish National Forensic Psychiatric Register (SNFPR) for Swedish forensic patients for the year 2010. The subjects are individuals who, in connection with prosecution due to criminal acts, have been sentenced to compulsory forensic psychiatric treatment in Sweden. The results show that in 2010, 1476 Swedish forensic patients were assessed in the SNFPR; 1251 (85%) were males and 225 (15%) were females. Almost 60% of the patients had a diagnosis of schizophrenia, with a significantly higher frequency among males than females. As many as 70% of the patients had a previous history of outpatient psychiatric treatment before becoming a forensic psychiatric patient, with a mean age at first contact with psychiatric care of about 20 years old for both sexes. More than 63% of the patients had a history of addiction, with a higher proportion of males than females. Furthermore, as many as 38% of all patients committed crimes while under the influence of alcohol and/or illicit drugs. This was more often the case for men than for women. Both male and female patients were primarily sentenced for crimes related to life and death (e.g., murder, assault). However, there were more females than males in treatment for general dangerous crimes (e.g., arson), whereas men were more often prosecuted for crimes related to sex. In 2010, as many as 70% of all forensic patients in Sweden had a prior sentence for a criminal act, and males were prosecuted significantly more often than females. The most commonly prescribed pharmaceuticals for both genders were antipsychotics, although more women than men were prescribed other pharmaceuticals, such as antidepressants, antiepileptics, and anxiolytics. The result from the present study might give clinicians an opportunity to reflect upon and challenge their traditional treatment methods.     

Modelling appellate courts’ responses in motor injury disputes

Motor third-liability insurance is compulsory in the European Union. We examine the behaviour of Spanish appellate courts in the context of motor liability insurance and pay particular attention to four characterising features. Specifically, we investigate (1) how the appellate court interprets the rules for updating the financial compensation when the courts’ ruling is made in a different year to that in which the motor accident occurred; (2) the response of the appellate court when its legal medical evaluation differs from the court’s decision; (3) whether the appellate court modifies the criteria when the insurance company was not charged with interest for delaying payment in the first instance; (4) whether the fault allocated by trial courts is revised by the appellate court. We apply a multi-categorical selection mechanism to deal with samples that are potentially non-random. This allows us to separately consider the characteristics of victim’s and the insurer’s decisions to appeal. The results indicate that disputing agents have significantly different appeal functions, where insurers show a more effective and consistent behaviour than victims.     

Intimate partner violence against older women in Germany: prevalence and associated factors

Violence against women is a recognized human rights and public health issue, with significant impacts on women's life and health. Until now, several studies, most of them relying on small scale samples, have explored the prevalence and health effects of intimate partner violence against older women, whereas few have examined what actually puts older women at risk of intimate partner violence. This study is based on a secondary analysis of the first national survey on violence against women in Germany, looking at the prevalence and associated factors for physical and for sexual violence by the current partners of women aged 50 to 65 and women aged 66 to 86 years. The prevalence of violence in women's current relationships was 12% and 5%, respectively. In both age groups, women who had experienced violence during childhood and nonpartner physical or sexual violence after the age of 16 had higher odds of experiencing current partner violence. Current partner violence was associated only with women and their partner's level of education and women's vocational training among women aged 66 to 86 years. Relationships where one or both partners drank heavily in recent months were associated with higher odds of violence among women aged 50 to 65. Future studies on intimate partner violence need to recognize that women above reproductive risk are also at risk of current partner violence.     

Mentally challenged patients in a forensic hospital: a feasibility study concerning the executive functions of forensic patients with organic brain disorder, learning disability, or mental retardation

The past years have seen an increasing number of patients of lower intelligence or with organic brain disorder being committed into our forensic psychiatry. Our clinic has an ongoing scientific project to investigate the possibilities of reducing costs while at the same time guaranteeing adequate treatment and enforcement practice in forensic hospitals. This current project did not take these kinds of patients into consideration initially. This feasibility study is intended to examine if and to what extent these patients can be part of the scientific project. All patients of forensic psychiatry in Rostock (Mecklenburg-Western-Pomerania) with an IQ<80 (learning disorder) or a primary or secondary organic brain dysfunction that have been committed to the clinic since 2009 are included. These patients went through an extensive battery of neuropsychological tests. Furthermore, the treating psychotherapists had to rate the prognoses for criminal re-offending at discharge. Patients affected by lower intelligence or an organic brain dysfunction achieve lower results in neuropsychological testing than other patients participating in the main project. Nevertheless, participation in neuropsychological testing does not appear to overtax them. Future examination of the patients will be conducted to investigate to what extent certain therapeutic methods have been of noticeable benefit to this problematic group.     

Literatur

Ohne Zusammenfassung     

Der Feinstaubschleier lichtet sich – rechtlich II – zugleich Anmerkung zum Urteil des Bundesverwaltungsgerichts vom 27.9.2007 – 7 C 36.07

Zusammenfassung Nur selten schafft es eine verwaltungsgerichtliche Entscheidung an die erste Stelle der ARD-Tagesschau um 20 Uhr. Dem Urteil des BVerwG vom 27.9.2007 ist das gelungen. Es liefert die Antwort auf eine Frage, die sich mancher TV-Zuschauer und Zeitungsleser seit der ersten H?lfte des Jahres 2005 gestellt haben mag. Einer aufgeregten Medienberichterstattung war damals zu entnehmen, dass der gerade verbindlich gewordene Feinstaubgrenzwert vielerorts überschritten werde und davon Betroffene Erkrankungen des Herz-Kreislauf-Systems und der Atemwege, ja sogar eine Verkürzung ihrer Lebenserwartung zu befürchten h?tten. Die Frage die sich stellte: Was kann ein Betroffener dagegen unternehmen?