Schizophrenia in a high-security hospital: long-term forensic,clinical, administrative & social outcomes

Objective: To determine forensic, clinical, social and administrative outcomes of high-security patients. Method: Prospective year follow-up study of 169 patients with schizophrenia, 1992–1993. Results: By the end of the study, 46 (27.2%) patients were in high security, 43 (25.5%) in medium- or low-secure units, 35 (20.7%) in an open ward, 3 (1.8%) in prison and 40 (23.7%) in the community. Violence occurred in 75% of patients over the 10-year follow-up period, and this was serious in 25%. Continuous positive symptoms of psychosis were present in over one-third. One-third had self-harmed during this period but there was only one known suicide and 11 (6.5%) deaths in total. At the end of the study, there was only one person in voluntary employment, 18 (12.7%) living independently and 10 (7.1%) in a relationship. Models were developed to determine factors relevant to these major outcomes. Conclusions: This is the first study providing comprehensive outcome data over a 10-year period. Forensic services appear good at managing the risk to the community but poor at promoting better social outcomes. The levels of violence within inpatient units are high.     

Comparative evaluation of postmortem serum concentrations of neopterin and C-reactive protein

The cellular immune response is accompanied by the release of neopterin. The level of neopterin in serum is increased in patients suffering from viral infections, autoimmune diseases, systemic inflammation, allograft rejection and malignant diseases, while that of C-reactive protein (CRP) is known to rise during inflammatory diseases and traumas. To investigate postmortem neopterin and CRP concentrations with regard to the cause of death, we examined cardiac and peripheral blood samples in 474 autopsy cases without advanced decomposition (0-96 years of age, 343 males and 131 females), 2.8 h to 3 days (median, 18.0 h) after death. Survival time was 0.1 h to 5 months (median, 3.0 h) for traumatic death, and 0.1-1, 440 h (median, 2.5 h) for natural death. In autopsied subjects, neopterin concentrations were higher than the clinical reference, independent of the time after death, and depended on the survival time. In cases of acute and subacute death due to trauma, the neopterin level in right heart blood was mildly to moderately elevated (about 50-200 nmol/l) except for sharp instrument injury, whereas the CRP concentration usually remained low (<1 mg/dl). However, a moderate rise in the CRP level (around 1-10 mg/dl) was observed in fatal cases of hypothermia (cold exposure). Markedly elevated serum CRP and neopterin levels (>10 mg/dl and >500 nmol/l, respectively) were detected in cases of delayed death due to trauma involving systemic inflammatory response syndrome (SIRS) and of fatal bacterial infections. For sepsis, the serum CRP level was markedly elevated but the neopterin level was low in some cases. Fatal viral infections usually resulted in a marked elevation in the serum neopterin level (>500 nmol/l) with a mild to moderate rise in the CRP level. Combined analyses of neopterin and CRP may be useful to investigate viral infections and delayed traumatic death involving SIRS to support pathological findings.     

Injuries to law enforcement officers: the backface signature injury

In today's law enforcement community, one of the most vital tools an officer can possess is personal body armor. However, a recent Department of Justice investigation has raised important questions regarding the protection actually afforded officers through the use of personal body armor, and the current test methods used to assess the armor. Test results show that most Zylon-containing vests showed deformations in excess of the 0101.04 Standard's 44 mm backface signature limit. Such increased deformation can lead to serious injuries, including backface signature injuries, which have occurred in the field. Although the vest is successful in containing the round, it is not effectively dissipating the energy enough to prevent large amounts of vest deformation at the area of impact. Therefore, open, penetrating wounds occur even though the bullet did not penetrate the vest. The objective of the current study was to further define the backface signature injury through the use of case studies and laboratory experiments. Following the case study investigation, backface signature testing was conducted using a clay medium based on the NIJ 0101.04 Standard. The final component of this research involved the use of post-mortem human specimens (PMHS) for further investigation of the backface signature injury. Although the underlying cause of backface signature injuries is unknown, energy density is likely to play a role in the mechanism. Energy density (E/a) is defined as the energy per unit area and has been previously used in less lethal skin penetration research. Further research into the underlying causes of backface signature injuries is necessary. In addition to armor testing, the study of law enforcement personnel who have been shot while wearing soft body armor is also a valuable tool for determining the effectiveness of certification standards. Finally, it is important for medical personnel to recognize the backface signature injury and document this as a type of injury separate from blunt trauma or penetrating trauma behind armor injuries. Detailed knowledge of the injury, including the depth of the wound, would be beneficial to the scientific community.     

Postmortem Detection of Hepatitis B,C, and Human Immunodeficiency Virus Genomes in Blood Samples from Drug‐Related Deaths in Denmark*

Abstract: Blood‐borne viral infections are widespread among injecting drug users; however, it is difficult to include these patients in serological surveys. Therefore, we developed a national surveillance program based on postmortem testing of persons whose deaths were drug related. Blood collected at autopsy was tested for anti‐HBc, anti‐HBs, anti‐hepatits C virus (HCV), or anti‐human immunodeficiency virus (HIV) antibodies using commercial kits. Subsets of seropositive samples were screened for viral genomes using sensitive in‐house and commercial polymerase chain reaction (PCR) assays. Hepatitis B virus (HBV) DNA was detected in 20% (3/15) of anti‐HBc‐positive/anti‐HBs‐negative samples, HCV RNA was found in 64% (16/25) of anti‐HCV‐positive samples, and HIV RNA was detected in 40% (6/15) of anti‐HIV‐positive samples. The postmortem and antemortem prevalences of HBV DNA and HCV RNA were similar. Postmortem HIV RNA testing was less sensitive than antemortem testing. Thus, postmortem PCR analysis for HBV and HBC infection is feasible and relevant for demonstrating ongoing infections at death or for transmission analysis during outbreaks.     

Evaluation of diagnostic tools applied in the examination of sudden unexpected deaths in infancy and early childhood

During the period between 1984 and 1999, 309 cases of sudden unexpected death in infancy and early childhood (0-3 years) were investigated at the Institute of Forensic Medicine in Oslo. In 73 cases, an explainable cause of death was found. In this non-sudden infant death syndrome (SIDS) group, 42 cases were due to disease, 14 to accidents, 7 to neglect/abuse and 10 cases were due to homicide. In 43 cases, there were pathological findings at the autopsy or suspect features in the history and/or circumstances, which were, however, insufficient to explain death ("borderline" SIDS). In the remaining 193 cases, nothing of significance was detected ("pure" SIDS).The purpose of the present study was to evaluate the importance of the different diagnostic tools used in diagnosing non-SIDS and borderline SIDS cases. The definition of SIDS requires a negative history as well as a negative autopsy result. Thus, the following variables were analysed: circumstances, medical history and autopsy, which included a gross pathological investigation, histology, neuropathology, microbiology, radiology and toxicology. In diagnosing deaths due to disease, histology, neuropathology and microbiology were the most important diagnostic tools. In contrast, information about the circumstances of death and the gross pathological findings at autopsy most often revealed the cause of death in accidents and cases of neglect/abuse and homicide.Following the drop in SIDS rate in Norway after 1989, the share of pure SIDS in proportion to the total population of sudden unexpected deaths in infancy and early childhood has decreased. The increasing proportion of non-SIDS and borderline SIDS cases presents a challenge to improve the quality of the investigation in cases of sudden death in infancy and early childhood.     

Women in the Czech Republic: Feminism, Czech Style

Many years after the Velvet Revolution, feminism remains close to a dirty word in the Czech Republic, even among women who share the views of Western feminists. Surprisingly, this may in part hark back to the negative views of bourgeois feminism propounded by the Communists. Equally surprising is the very high proportion of women who are employed, almost all of them full-time, although they continue to do the lion's share of homemaking. This strategy enables Czech women to have a high sense of personal efficacy and independence. This paper emphasizes the historical roots of women's position in Czech society, and the importance of the cultural and social context for the emergence of what we term Feminism, Czech Style.