Seasonal variation of seclusion incidents from violent and suicidal acts in forensic psychiatric patients

BackgroundA seasonal variation in violence and suicidal behaviour has been reported in several studies with partially congruent results. Most of forensic psychiatric patients have a history of severe violent behaviour that often continues in spite of regular treatment. In the forensic psychiatric hospital environment aggressive and suicidal acts are often sudden and unpredictable. For reasons of safety, rapid and intensive coercive measures, such as seclusion and restraint, are necessary in the treatment of such patients.ObjectiveTo examine whether these involuntary seclusions have a seasonal pattern, possibly similar than the reported seasonal variation in violence and suicidal behaviour. By investigating the possibility of a seasonal variation of seclusion incidents from violent and suicidal acts, it may become possible to improve the management of forensic psychiatric patients.MethodsThe hospital files of all secluded patients at Niuvanniemi Hospital from 1 January 1996 to 31 December 2002 were examined. In total, 385 patients (324 male and 61 female) were identified as being secluded at least once in 1930 different incidents (1476 from male and 454 from female patients). Seasonal decomposition and linear regression with dummy month variables were used to examine the possibility of annual variations for seclusions.ResultsThe seasonal variation of involuntary seclusion incidents was statistically significant. According to the linear regression model, most of the seclusion incidents, affecting many different patients, began in July and August, and were concentrated throughout the fall until November. The sum of all seclusion days was lowest in January and highest between July and November (difference + 31% to + 37%).ConclusionsThese findings are mainly in agreement with results from other studies on seasonal variation and violent behaviour. The allocation of staff for late summer and fall might enhance the management of forensic psychiatric patients, thus leading to possible decreases in seclusion incidents. The factors affecting violent, aggressive and suicidal behaviours are complex and more investigation is needed to understand, identify, intervene and effectively reduce such behaviours.     

Interpretation of neuropathological lesions: Its limitations in medico-legal experts’ reports

Aggressive or paradoxical behaviour may reflect an organic dementia. The most frequent is Alzheimer's disease, which results from an abnormal structural conformation of tubulin-associated protein (tau) and beta-amyloid protein that, respectively, aggregate in certain neurons as intracellular neurofibrillary tangles (NFTs) and in the extracellular environment as senile plaques.These lesions progress in the brain tissue according to the stages described by Braak and Braak. Staging of neurofibrillary pathology has proven anatomical and clinical correlation, which can be used in a medico-legal procedure. We report two cases demonstrating discrepancies between anatomical and clinical features, which should encourage medical expert to prudence when interpreting neuropathological reports.     

Is the Offense Serious Axis Free of Extralegal Influence?: Assessing the Predictors of a ‘Legally Relevant’ Guideline Criterion

Grid based sentencing guidelines, composed of offense seriousness and offender criminal history axis, have become a staple of US sentencing in recent decades. As such, extensive research explores whether they reduce extralegal sentence disparity. However, to date, no study has examined whether extralegal disparity is present in how either axis of guideline sentencing are constructed. Using federal sentencing commission data along with both single and multi-level analyses, this research explores the legal and extralegal factors that predict one of these key grid axes: the offense seriousness score. The results call into question not only some assumptions underlying guideline sentencing but also recent analytical strategies for assessing sentencing outcomes in guideline systems.     

“The big sleep: Elucidating the sequence of events in the first hours of death to determine the postmortem interval”

Recent developments on postmortem interval estimation (PMI) take an advantage of the autolysis process, pointing out to the analysis of the expression of apoptosis and autophagy genes towards this purpose. Oxidative stress plays a role in this signaling as a regulatory mechanism and/or as a consequence of cell death. Additionally, melatonin has been implicated on apoptosis and autophagy signaling, making melatonin a suitable target for PMI determination. The aim of this study was to investigate the early PMI through the analysis of the expression of autophagy genes as well as oxidative stress and melatonin receptor. Our results demonstrated a rapidly increased on the expression of autophagy genes according to the expected sequence of events, then a marked decrease in this expression, matched with the switch to the apoptosis signaling. These results revealed potential candidates to analyze the PMI in the first hours of death, helping to estimate the time-since-death.     

Social Networks and Social Control of Probationers with Co-Occurring Mental and Substance Abuse Problems

Probationers with co-occurring mental and substance abuse problems (PCPs) are both subject to considerable social control, and at high risk of probation failure. In this study, we screened 601 probationers for symptoms, interviewed 82 identified PCPs about their relationships, and then followed these PCPs for eight months to record treatment nonadherence and other probation violations. First, PCPs’ social networks were small, heavily comprised of professionals and opposing forces who engaged in risky behavior, and saturated with pressure to adhere to treatment. Second, the size and composition of PCPs’ social networks were more relevant to rule compliance than social support and undermining. Third, the quality of PCPs’ relationships was key: satisfying relationships with clinicians and, to a lesser extent, officers and the core network related to low perceived coercion, high treatment adherence, and low risk of future violations. In particular, having a likable clinician who engaged in participatory decision-making reduced the risk of violations. Implications for contextually sensitive risk reduction efforts are discussed.     

Finland's NATO membership: Continuous shelter-seeking strategy

This article offers a challenge, in the form of an illustrative case study, to the notion that Finland's NATO membership is a radical reversal in security policy. With the use of shelter theory, it examines how Finland (as a small state), beginning in the Cold War, has actively sought to achieve political, economic and societal shelter from Western organizations. However, due to geopolitical restraints, the country has at various times been unable to fully adopt preferred shelter arrangements, especially within the military security sphere. The analysis indicates that the institutionalisation of Finland's shelter strategy has often been a tedious, diplomatic quest to integrate with the West, contingent upon opportunistically taking advantage of external ‘critical junctures’ to solidify its own interests. The article posits that Finland's pursuit of Western economic and societal shelter during the Cold War transformed into further Western political shelter-seeking in its aftermath and, finally, membership of NATO in 2023. The case of Finland indicates that shelter theory captures the foreign policy strategy of a small neutral/nonaligned state. Nevertheless, our specific case also indicates that the theory ought to take a closer look at four features regarding relations between small and large states, that is how an agressive neighbour can restrict a small state's foreign policy choices, how economic and societal shelter relations may precede political shelter relations (or vice versa), the role of critical junctures within shelter theory, and, finally, how a history of cooperation may be transitioned into full-fledged shelter.     

Comparing regulatory processes in genome editing and autonomous vehicles: How institutional environments shape sociotechnical imaginaries

This study compares the regulation of two emerging technologies, the CRISPR genome-editing system and Connected and Autonomous Vehicles (CAV) in the United States. The study draws on 33 in-depth interviews with innovation and governance experts to study the relationship between their regulatory environments and developing beliefs about these technologies. Using sociotechnical imaginaries as a framework, we explore how social actors envision technologically driven futures and the social order that enables them. These imaginaries are essential to emerging technologies, where experts build a framework of potentialities for innovation still underway. While scholarship has documented how sociotechnical imaginaries arise among policymakers, groups of scientists, state and local stakeholders, and public actors in different countries, less has been said about how regulatory organizations and their actors shape expectations around technologies that are in the early and middle stages of development. This article finds that regulatory institutions shape emerging imaginaries along three related axes: the distribution of authority, technological novelty, and risk. Interviewees negotiate these three contingencies differently based on relevant extant regulatory structures and ideologies, resulting in distinct imaginaries around each technology. CRISPR actors envision genome editing as largely diminishing biomedical harm and eventually suitable for health markets, while CAV actors diverge on whether self-driving cars alleviate or exacerbate risk and how they may enter roads. That organizational structures and practices of regulation inform broadly held sociotechnical imaginaries bears significance for studies of innovation trajectories, suggesting regulators can take an active role in shaping how risks and benefits of emerging technology are defined.     

Presidential Approval and Public Security in Mexico's War on Crime

To fight criminal organizations effectively, governments require support from significant segments of society. Citizen support provides important leverage for executives, allowing them to continue their policies. Yet winning citizens' hearts and minds is not easy. Public security is a deeply complex issue. Responsibility is shared among different levels of government; information is highly mediated by mass media and individual acquaintances; and security has a strong effect on peoples' emotions, since it threatens to affect their most valuable assets—life and property. How do citizens translate their assessments of public security into presidential approval? To answer this question, this study develops explicit theoretical insights into the conditions under which different dimensions of public security affect presidential approval. The arguments are tested using Mexico as a case study.     

To Care and Protect: Care Workers Confronting Sweden Democrats in their Workplace

Austerity policies across European countries have encountered diverse forms of public protest and resistance. In Sweden, we have seen the emergence of a number of networks and organizations which take care workers’ professional identity as their point of departure. These networks and organizations stress the impossibility of being professional care workers in slimmed-down, neoliberal organizations. Parallel to this, and sometimes embedded into one another, female-dominated professions (e.g. social workers, nurses, doctors, and teachers) have been engaged in opposing restrictive refugee policies. This article analyses how care workers in an emergency room in Malmö mobilized against a visit by Jimmie Åkesson, leader of the right-wing, xenophobic Sweden Democrats. The article explores how workers used a gendered discourse of care and professionalism to argue that their actions were consistent with both organizational culture and their professional ethics. The article shows how, by defending their professional role of providing quality care to all in need, workers challenge both austerity and racist policies, which both impose restrictions on who has the right to care. Theoretically, the article explores how the politicization of care creates spaces of resistance, to critique both austerity policies and exclusionary understandings of national belonging. The study stresses the importance of identifying emerging forms of collective resistance among care workers at the intersection of the struggles against austerity and right-wing xenophobic parties.