Forensic-medical assessment of terroristic chemical attacks

By potential damage, chemical terroristic attacks are much more dangerous than terroristic bombing. To fight chemical terrorism it is necessary to create the system of medical-environmental defense of the population. In line with emergency medicine, forensic medical service is a very important element of the antiterroristic defense. The activity of forensic-medical experts in the field of terroristic chemical attack is analysed.     

Assessment of unfavorable outcomes of dental care provoked by the patient

Some causes of ineffective dental care because of the patient's negligence were analyzed. In 16 cases the patients ignored recommendations of the dentist and missed visits to the doctor. As a result, the patients developed complications leading to esthetic dissatisfaction, prolonged treatment, repeated prosthetic management.     

Family Representative Payeeship and Violence Risk in Severe Mental Illness

Although representative payeeship is prevalent among people with mental illness and shows promise to positively influence clinically relevant outcomes, research also suggests this legal mechanism could be implemented in ways that are problematic. The current study examined whether family representative payeeship was associated with elevated risk of family violence perpetrated by persons with severe mental illness (SMI). Data were collected every 4 months for 1 year in structured interviews with N = 245 persons with SMI who received disability benefits. Multivariate analyses showed that substance abuse, history of violence, frequency of family contact, and family representative payeeship were associated with elevated odds of family violence. Analyses also showed family contact and family representative payeeship had a cumulative effect on increasing the predicted probability of family violence (controlling for covariates such as violence history and substance abuse). The data shed light on the potential for family representative payeeship to be associated with increased risk of interpersonal conflict and violence in SMI.     

The Decline and Decay of European Refugee Policy

This article challenges the view, implicit in much current researchon EU migration and asylum policy, that supranationalizationis a self-evident antidote to the exclusionary and securitizedmigration policy that has been enacted through inter-governmentalcooperation. It does so by treating supranationalization asan open question in need of empirical scrutiny. To develop thisthesis, it undertakes not only a critique of the current developmentstowards supranational policies, but also of the inter-governmentalpolicy-making system, pursuing a broad brush historical assessmentup to and beyond Amsterdam, with the aim of bringing fresh andfurther insights into the future development of EU asylum policy.It concludes that the current aims are less to do with the establishmentof a common European asylum system and more to do with reducingimmigration pressure and compensating for the perceived lossesof internal security in the wake of full freedom of movementinside the Union. Communitarization will not necessarily occursimply because the European Union is intent upon institutingever stricter immigration controls. Communitarization is doggedby the legacy of intensive trans-governmentalism. In particular,the British, Danish and Irish governments have only been preparedto support communitarization so long as they could have separateprotocols that legitimized their non-participation. The UK andIreland have opted into all proposals on asylum, illegal migrationand civil law but have opted out of practically all proposalsconcerning visas, borders, and legal migration. The securitarianframe still predominates and trans-governmentalism refuses todie. In January 2005, following the agreement on The Hague programme,there was change in decision-making rules from unanimous votingto Qualified Majority Vote (QMV) in the European Council andco-decision with the European Parliament. Yet, there is no guaranteethis will bring about more liberal asylum rules, as is clearfrom the ‘Schengen Borders Code’ which was agreedin June 2005. This is because European migration policy hasalways been fraught with internal contradictions, which haveyet to be resolved. Accordingly, the emergence of a rights-respectingmodel of asylum law based on the Geneva Convention 1951 remainsa distant dream.     

Federal employees health benefits program; revision of contract cost principles and procedures, and miscellaneous changes. Final rule

The U.S. Office of Personnel Management (OPM) is issuing a final regulation amending the Federal Employees Health Benefits (FEHB) Acquisition Regulation (FEHBAR). This regulation provides additional contract cost principles and procedures for FEHB Program experience-rated contracts and is intended to clarify our requirements and enhance our oversight of FEHB carriers.     

Reduced punishment in Israel in the case of murder: bridging the medico-legal gap

The psychiatrist's assessment of criminal responsibility of an accused in court for an act of crime has always been a matter of great difficulty. In 1997, clause 300a was incorporated into the Penal Code of Israel, thereby permitting a more lenient punishment for murder than mandatory life imprisonment. The clause includes the definition of what is meant by "severe mental disorder" and "significantly restricted capacity" by the defendant to understand the criminal nature of his or her act and to refrain from committing it. Usage of the concepts "disorder" and "significantly restricted capacity" in addressing the issue of diminished responsibility of the mentally ill is new to the Israeli legal code. The emergence and evolvement of the above concepts are presented through a historical review of the Israeli encoded law concerning mental illness, analyzed from a psychiatric perspective.     

State autonomy, policy paralysis: paradoxes of institutions and culture in the French health care system

In this article, we assess the recent performance of the French state at containing costs in health care using political science concepts such as path dependency and incentives, which are central to an economic approach. The article focuses on institutional capacities and cultural immobilism and attempts to lay bare the tensions at play in seizing (or not) opportunities for structural change. In particular, we attempt to delineate what constitutes real change in this policy arena (big reforms versus the accumulation of many small policy movements) and to understand the variables at play in the coming together of conjunctures that provide for the big, as well as the underlying structures that allow the accumulation of the small. Except in cases of favorable conjuncture, the analysis bodes very ill for nonincremental reform and, indeed, for significant change over the long term.     

The who, what, and why of risk adjustment: a technology on the cusp of adoption

Risk adjustment (RA) consists of a series of techniques that account for the health status of patients when predicting or explaining costs of health care for defined populations or for evaluating retrospectively the performance of providers who care for them. Although the federal government seems to have settled on an approach to RA for Medicare Advantage programs, adoption and implementation of RA techniques elsewhere have proceeded much more slowly than was anticipated. This article examines factors affecting the adoption and use of RA outside the Medicare program using case studies in six U.S. health care markets (Baltimore, Seattle, Denver, Cleveland, Phoenix, and Atlanta) as of 2001. We found that for purchasing decisions, RA was used exclusively by public agencies. In the private sector, use of risk adjustment was uncommon and scattered and assumed informal and unexpected forms. The most common private sector use of RA was by health plans, which occasionally employed RA in negotiations with purchasers or to allocate resources internally among providers. The article uses classic technology diffusion theory to explain the adoption and use of RA in these six markets and derives lessons for health policy generally and for the future of RA in particular. For health policy generally, the differing experiences of public and private actors with RA serve as markers of the divergent paths that public and private health care sectors are pursuing with respect to managed care and risk sharing. For the future of RA in particular, its history suggests the need for health service researchers to consider barriers to use adoption and new analytic technologies as they develop them.     

Carbon monoxide-related deaths in a metropolitan county in the USA: an 11-year study

Carbon monoxide (CO) poisoning as a cause of death is well documented in industrialized countries. The objective of this study was to compare demographic data in deaths due to accidents (in fires) and suicides in the same population between 1988 and 1998. Furthermore, the potential effect of a community wide education effort regarding safety in the home was assessed. Postmortem reports were reviewed for all deaths examined at the Office of the Cuyahoga County Coroner in Cleveland, OH, USA. During the study period, there were 209 accidental deaths due to fires in the home (6.5% of all accidents in the home) and 182 CO deaths by suicide (9.8% of all suicides). Demographic characteristics of the two groups differed: while males represented the majority of cases in both groups (55% of accidents, 70% suicides), race specific death rates were higher for whites than blacks (18/100,000 white, 3/100,000 black) in suicides compared with 29/100,000 deaths for blacks and 11/100,000 for whites in accidental cases. Fire deaths were prevalent in the young (0-9 years) and old (>60) whereas in the suicide group the age specific death rate was highest for those over 70 years. The majority of fire deaths occurred in the city of Cleveland but suicides were prevalent in the suburbs. More fire deaths occurred in December than any other month whereas more suicides occurred in April. In 1992, there was a community wide effort to provide free smoke detectors to residents in Cleveland. In 1992, there were 4.2/100,000 fire deaths in the city. This decreased to 0.6/100,000 in 1996, increased to 1.2/100,000 in 1997 followed by a decrease to 0.8/100,000 in 1998. This suggested that the program may have aided in decreasing these types of deaths. Deaths due to fires in the suburbs were <1/100,000 throughout the study period.