Is There a Relationship Between Bladder Outlet Obstruction due to Benign Prostatic Hyperplasia and Pulmonary Thromboembolism?

Benign prostatic hyperplasia with chronic bladder outlet obstruction has been associated with deep venous thrombosis (DVT) and fatal pulmonary thromboembolism (PTE). To evaluate this further, 60 autopsy cases of men with PTE were compared with 60 age-matched controls. The criteria for outlet obstruction were macroscopic prostatic enlargement with bladder trabeculation and benign prostatic hyperplasia on microscopy. Ten of the 60 men (16.7%) with fatal PTE had evidence of bladder outlet obstruction (age 57-78 years; mean 71.4 years). Of the 60 controls, 12 had evidence of bladder outlet obstruction (20%) (age 67-86 years; mean 75.5 years). No significant relationship could be demonstrated between bladder outlet obstruction and fatal PTE cases (p = 0.8). Given reports of this association, however, it is possible that bladder distension with venous compression may act as a risk modifier in certain individuals in association with other significant comorbidities, but this risk appears low.     

Community Development Block Grant Spending Revisited: Patterns of Benefit and Program Institutionalization

This article analyzes Community Development Block Grant (CDBG)spending by local governments between 1988–1992. We addressfour issues examining actual expenditure patterns in a smallcentral city and five satellite cities in Michigan: changesin CDBG expenditure patterns; levels of social targeting; theextent of institutionalization of expenditure patterns; andthe level of privatization of CDBG spending. We conclude thatwhile spending for housing and public works is related to thefiscal health of cities, expenditures for economic developmentand social services are related to political characteristics.Further, local governments exceed federal social targeting guidelines.Finally, while there is little privatization, the communitiesstudied evidence modest levels of program innovation in thelater years of the CDBG program.     

Object relations in criminal psychopaths

Although many empirical studies have documented the range and severity of problems caused by psychopaths, considerably less attention has focused on understanding its origins. Efforts to treat this potentially dangerous population have been equally frustrating, as psychotherapeutic approaches have almost always proven ineffectual. Because of the limited understanding of the psychological and interpersonal dynamics underlying psychopathy, the authors sought to assess the extent to which object relations theory could inform our understanding of psychopathy. In addition to eliciting background information, 74 men sentenced to probation following a criminal conviction were assessed using the Psychopathy Checklist: Screening Version, a clinician-rated measure of psychopathy, and were administered the BORI, a self-report measure of object relations. Results showed significant correlations between object relations dimensions, psychopathy scores, and childhood environment data. Furthermore, object relations scores added to the prediction of psychopathy even after demographic and behavioral variables were considered, suggesting that object relations deficits comprise a significant component of psychopathy. Results suggest that psychopaths harbor profound underlying psychosocial damage including intense anxiety, anger, bitterness, and resentment. Implications for interventions and future research are discussed.     

Validation of an Abbreviated Version of the Structured Interview of Reported Symptoms in Outpatient Psychiatric and Community Settings

This study examined the effectiveness of an abbreviated version of the Structured Interview of Reported Symptoms (SIRS-A) in identifying malingered mental illness. The SIRS-A is comprised of 69 items drawn from the SIRS (R. Rogers et al. 1992, SIRS: Structured Interview of Reported Symptoms: Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc.), substantially reducing the administration time. A simulation design was used with three samples; 87 psychiatric outpatients who responded honestly were compared to 29 community-dwelling adults and 24 psychiatric patients instructed to malinger psychopathology. The SIRS-A generated sensitivity comparable to or exceeding that of the SIRS normative data, but specificity was poorer; many genuinely impaired patients were misclassified as malingering. Although these findings suggest the SIRS-A may be an effective means to assess malingering in psychiatric populations, further research assessing the reasons for the elevated false positive rates is necessary.     

Forensic Mental Health Clinical Evaluation: An Analysis of Interstate and Intersystemic Differences

Forensic mental health evaluation systems have undergone major changes during the past two decades, and the variability of service delivery systems across states is significant. We compared assessments of competence to stand trial and criminal responsibility in three states with different systems for forensic mental health evaluations: Michigan, Ohio, and Virginia. Although all three states use comparable legal criteria to judge competence and criminal responsibility, we found large, statistically significant differences among the states in the proportion of defendants referred for evaluation who were assessed as incompetent or not criminally responsible. In addition, significant differences were found in the diagnostic and offense categories of defendants referred for evaluation. Our findings suggest that the structure of a system for providing forensic evaluation services may significantly affect both the group of individuals referred for evaluation as well as evaluation outcome.     

Facilitating Violence: A Comparison of Gang-Motivated, Gang-Affiliated, and Nongang Youth Homicides

It is well established that gangs facilitate violent offending by members,but the mechanisms by which that facilitation occurs remain unclear. Gangsmay promote violence indirectly by facilitating members' access to riskysituations such as drug markets or directly through gang functions such asturf defense. We explore alternative modes of facilitation in a comparisonof gang-affiliated homicides (which involve gang members but do not resultfrom gang activity), gang-motivated homicides (which result from gangactivity), and nongang youth homicides in St. Louis. We find importantdifferences as well as similarities in the time trends and eventcharacteristic of the two types of gang homicide; in key respects thegang-affiliated homicides more closely resemble the nongang events. Thegang-motivated events exhibit a somewhat distinctive spatial patterning,as might be expected from their connection to turf conflicts. However, allthree homicide types are highly concentrated in racially isolated,disadvantaged neighborhoods, which remain the fundamental socialfacilitators of both gang and nongang violence.     

Connecting the dots: Crime rates and criminal justice evaluation research

The National Research Council’s report on evaluating anticrime programs contains sensible suggestions for improving evaluation research in criminal justice but neglects the important role of substantive theory in linking evaluations of anticrime initiatives to variation in crime rates across time and place. A working knowledge of crime rates is essential for designing and evaluating anticrime programs. This essay calls for the development of a policy evaluation infrastructure that would support the continuous monitoring of crime rates, generate knowledge of crime-producing conditions, and link evaluation research findings to one another and to expected policy outcomes, notably crime reduction.