Sj?gren''s syndrome with acute renal failure

STUDY OBJECTIVE: "Suicide by cop" is a term used by law enforcement officers to describe an incident in which a suicidal individual intentionally engages in life-threatening and criminal behavior with a lethal weapon or what appears to be a lethal weapon toward law enforcement officers or civilians to specifically provoke officers to shoot the suicidal individual in self-defense or to protect civilians. The objective of this study was to investigate the phenomenon that some individuals attempt or commit suicide by intentionally provoking law enforcement officers to shoot them. METHODS: We reviewed all files of officer-involved shootings investigated by the Los Angeles County Sheriff's Department from 1987 to 1997. Cases met the following criteria: (1) evidence of the individual's suicidal intent, (2) evidence they specifically wanted officers to shoot them, (3) evidence they possessed a lethal weapon or what appeared to be a lethal weapon, and (4) evidence they intentionally escalated the encounter and provoked officers to shoot them. RESULTS: Suicide by cop accounted for 11% (n=46) of all officer-involved shootings and 13% of all officer-involved justifiable homicides. Ages of suicidal individuals ranged from 18 to 54 years; 98% were male. Forty-eight percent of weapons possessed by suicidal individuals were firearms, 17% replica firearms. The median time from arrival of officers at the scene to the time of the shooting was 15 minutes with 70% of shootings occurring within 30 minutes of arrival of officers. Thirty-nine percent of cases involved domestic violence. Fifty-four percent of suicidal individuals sustained fatal gunshot wounds. All deaths were classified by the coroner as homicides, as opposed to suicides. CONCLUSION: Suicide by cop is an actual form of suicide. The most appropriate term for this phenomenon is law enforcement-forced-assisted suicide. Law enforcement agencies may be able to develop strategies for early recognition and handling of law enforcement-forced-assisted suicide (suicide by cop). Health care providers involved in the evaluation of potentially suicidal individuals and in the resuscitation of officer-involved shootings should be aware of law enforcement-forced-assisted suicide as a form of suicide.     

The possibility for treating certain forms of endometrial and ovarian carcinomas with GnRH agonists]

The purpose of this study was to quantify the proportion of men and women seen in a university emergency department (ED) for treatment of injuries resulting from intimate partner violence (IPV) that require reports to law enforcement authorities. A total of 1,516 adult ED patients were asked to complete a written survey instrument; 1,003 patients (66.2%) completed the survey. Two percent of patients reported they presented to the ED for treatment of injuries resulting from IPV. Three percent reported IPV within the last year, and 10% reported that they had ever been physically abused by a partner. Six percent of respondents reported that they had ever been threatened with a gun or knife by a partner, 2% within the past year. Only the lifetime prevalence of IPV was significantly greater among female patients, 15% versus 6% (P < .001). Approximately 2% of our ED patients require law enforcement intervention for IPV.     

Gender differences in patterns of relationship violence in Alberta.

Gender differences in patterns of relationship violence were investigated in a sample of 356 men and 351 women. Respondents reported on their receipt and perpetration of violent acts in the year prior to the survey. Men and women, respectively, reported similar 1-yr prevalence rates of husband-to-wife violence and wife-to-husband violence. However, differential gender patterns of reporting were identified. On average, men reported that they and their female partners were equally likely to engage in violent acts and to initiate violent conflicts. In contrast, women reported lower levels of victimization than perpetration of violence, and they reported less male-only and male-initiated violence than did men. The majority of respondents in violent relationships reported a pattern of violence that was bidirectional, minor, infrequent, and not physically injurious. The discussion focuses upon the meaning of gender differences in reports of relationship violence, and the existence of distinct patterns of violence within intimate relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of exposure to violence on young children.

Violence has been characterized as a "public health epidemic" in the United States. At the same time, children's witnessing of violence is frequently overlooked by law enforcement officers, families, and others at the time of a violent incident. Although mothers describe the panic and fear in their children and themselves when violence occurs, little research or clinical attention has focused on the potential impact on children of living under conditions of chronic community violence. The purpose of this article is to present an overview of available research and clinical understanding of the effects of exposure to violence on school-age and younger children. Suggestions for future research and public policy initiatives are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental illness and violence: an epidemiological appraisal of the evidence

OBJECTIVE: To conduct a critical review of the literature on the matter of mental illness and violence, to examine whether there is enough evidence to establish a causal link, and to provide epidemiological background to measure the risk to the population. METHOD: Based on a computerized search of the literature on mental illness and violence previously conducted for Health Canada, studies in the area were critically reviewed and divided into 3 main categories: 1) studies of criminal and violent behaviour among psychiatric patients, 2) studies of psychiatric illness among offenders (prevalence studies in institutions, analytical studies, and community follow-up of offenders), and 3) epidemiological community-based studies on the issue of mental illness and violence (police-citizen encounters, representative samples, and other epidemiological studies). Causality rules and measures of risk were then applied to the evidence elicited. RESULTS: The review of the literature suggests that only a small minority of hospitalized patients, typically those suffering from acute psychotic symptoms, are involved in violent incidents. Formerly hospitalized patients are at a higher risk of committing violence if they are not properly treated and are experiencing threat/control-override psychotic symptoms. Substance abuse disorders significantly raise the risk for violence. Family members are the most at risk of being victimized. CONCLUSION: An association exists between mental illness and violence, but the many covariations that naturally affect the equation between them introduce uncertainties in establishing causality.     

Perceptions of the validity and utility of criminal profiling among forensic psychologists and psychiatrists.

Criminal profiling is the process of using crime scene evidence to make inferences about potential suspects, including personality characteristics and psychopathology. An exploratory Internet survey of forensic psychologists and psychiatrists was conducted to examine their experiences with and opinions about profiling and to determine whether referring to profiling as "criminal investigative analysis" had any impact on these opinions. About 10% of the 161 survey respondents had profiling experience, although more than 25% considered themselves knowledgeable about profiling. Fewer than 25% believed that profiling was scientifically reliable or valid, and approximately 40% felt that criminal investigative analysis was scientifically reliable or valid. Although the scientific aspects of profiling lacked support, respondents viewed profiling as useful for law enforcement and supported profiling research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intravesical bacillus Calmette-Guérin treatment for Stage T1 grade 3 transitional cell carcinoma of the bladder

OBJECTIVE: To ascertain the current knowledge base and screening practices of obstetrician-gynecologists in the area of domestic violence. METHODS: We mailed a survey to 189 ACOG Fellows who are members of the Collaborative Ambulatory Research Network. Questionnaires were also mailed to a random sample of 1250 nonmember Fellows. RESULTS: Obstetrician-gynecologists are aware of the nature of domestic violence and are familiar with common symptomatology that may be associated with domestic violence. For pregnant patients, 39% of respondents routinely screen at the first prenatal visit; 27% of respondents routinely screen nonpregnant patients at the initial visit. Screening is most likely to occur when the obstetrician-gynecologist suspects a patient is being abused, both during pregnancy (68%) and when the patient is not pregnant (72%). Only 30% of obstetrician-gynecologists received training on domestic violence during medical school; 37% received such instruction during residency training. The majority (67%) have received continuing education on the subject. Years since training and personal experiences with intimate-partner violence were associated with increased screening practices. CONCLUSION: Routine screening of all women for domestic violence has been recommended by ACOG for more than a decade. The majority of obstetrician-gynecologists screen both pregnant and nonpregnant patients when they suspect abuse. However, with universal screening, more female victims of violence can be identified and can receive needed services.     

Endoscopic CO2 laser excision of large or recurrent laryngeal saccular cysts in adults

BACKGROUND: Most paediatric cardiac arrest studies have been conducted in the USA, where paramedics provide prehospital emergency care. We wanted to study the outcome of paediatric cardiac arrest patients in an emergency medical system which is based on physician staffed emergency care units. METHODS: We analysed retrospectively the files of 100 prehospital cardiac arrest patients from Southern Finland during a 10-year study period. The patients were less than 16 years of age. RESULTS: Fifty patients were declared dead on the scene (DOS) without attempted resuscitation, and cardiopulmonary resuscitation (CPR) was initiated in 50 patients. The sudden infant death syndrome was the most common cause of arrest in the DOS patients (68%) as well as in those receiving CPR (36%). Asystole was the initial cardiac rhythm in 70% of the patients in whom CPR was attempted. Resuscitation was successful in 13 patients, 8 of whom were ultimately discharged. Six of the patients survived with mild or no disability and 4 of them had near-drowning aetiology. In multivariate analysis, the short duration of CPR (< or = 15 min) was the only factor significantly associated with better survival. CONCLUSIONS: Although prehospital care was provided by physicians, the overall rate of survival was found to be equally poor as reported from systems with paramedics. The only major difference between physician- and paramedic-staffed emergency care units is the ability of physicians to refrain from resuscitation already on the scene when prognosis is poor.     

Primary malignant lymphoma of the bladder: a case report

CONTEXT: Pharmaceutical samples are commonly used in ambulatory care settings. There is limited research on their use or impact on health care providers and patients. OBJECTIVE: To determine the extent of personal use of drug samples over a 1-year period by physicians and medical office staff. DESIGN, SUBJECTS, AND SETTING: An anonymous cross-sectional survey of all physicians, resident physicians, nursing staff, and office staff in a family practice residency. MAIN OUTCOME MEASURE: Quantity of drug samples taken for personal or family use. RESULTS: Of 55 surveys issued, 53 (96%) were returned. A total of 230 separate drug samples were reported taken in amounts ranging from 1 dose to greater than 1 month's supply. Two respondents reported no use of drug samples, while 4 respondents reported taking more than 10 different samples. CONCLUSION: Drug samples are commonly taken by physicians and office staff for personal and family use. The ethical implications of this practice warrant further discussion.     

Responses to unsolicited patient e-mail requests for medical advice on the World Wide Web

CONTEXT: The Internet is increasingly used by consumers to seek health and medical information, but online medical advice has not been explored systematically. OBJECTIVE: To explore the attitude of physicians and other providers of medical information on the Internet toward unsolicited e-mail from patients and their reaction to a fictitious acute medical problem described in such an e-mail. DESIGN: E-mail in December 1997 and January 1998 to Web sites from a fictitious patient describing an acute dermatological problem. Follow-up questionnaire survey to the same sites. SETTING: World Wide Web. SUBJECTS: Fifty-eight physicians and Web masters. MAIN OUTCOME MEASURES: Response rate and types of responses. RESULTS: Twenty-nine (50%) responded to the fictitious patient request; 9 respondents (31%) refused to give advice without having seen the lesion, 27 (93%) recommended that the patient see a physician, and 17 (59%) explicitly mentioned the correct "diagnosis" in their reply. In response to the questionnaire, 8 (28%) of the 29 respondents said that they tended not to answer any patient e-mail, 7 (24%) said they usually reply with a standard e-mail message, and 7 (24%) said they answer each request individually. CONCLUSIONS: Responses of physicians and Web masters to e-mail requests for medical advice vary as do approaches to handling unsolicited e-mail. Standards for physician response to unsolicited patient e-mail are needed.     

Professional psychologists' conceptualizations of intimate partner violence.

Psychologists' conceptualizations of intimate partner violence were studied by surveying practicing psychologists on their causal attributions and expectations for violence depicted in a written scenario. The perpetrator of violence was held by respondents to be most responsible for the violence, especially in severely violent cases. Although the victim was seen as less responsible for the violence, greater responsibility was attributed to her, especially to her character, in scenarios in which she had a previous history of being abused by a partner than when she had not. Violence severity had inconsistent effects on psychologists' expectations, in that respondents expected worse outcomes for the victim of more severe violence, but did not expect therapeutic interventions to be any less effective in ameliorating these outcomes. These conceptualizations point to dilemmas in treatment of intimate partner violence, such as empowerment without blame and the tension between hope and realistic assessment of risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Workplace violence: Prevention, response, and recovery.

Describes a model of collaboration between business leaders and mental health clinicians in developing programs and strategies to prevent violence, handle acute crises, and cope with recovery and rebuilding in the aftermath of a workplace violence incident. Sections address the following: (1) demographics, costs, and risk factors and warning signs of workplace violence; (2) workplace violence prevention policies, including hiring, discipline, and termination practices; (3) responses to emergencies, such as potentially dangerous situations, violent episodes, and guns or weapons in the workplace; and (4) strategies for recovery following workplace violence that involve mental health and law enforcement mobilization, dealing with the media, assisting employees and families, legal issues, identification and treatment of posttraumatic stress disorder (PTSD), and follow-up procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heroin related overdose problems

During the first ten months of 1992 the Oslo Ambulance Department registered 716 incidences of assumed drug-related intoxications. 80% happened in down town Oslo. 19 cases of asystoly were recorded, 13 of the patients recovered after treatment, without sequelae. Five of these patients left the location after emergency help and they refused hospitalization. 432 of the patients were unconscious when the ambulance personal arrived, 472 were treated with naloxone both by the intramuscular and the intravenous route. Most of the persons refused further observation. A team of specially trained out reach workers offers help after acute medical treatment by means of "streetwork". The intervention is directed at addicts who have experienced an overdose.     

Violence and aggression in psychiatric units

OBJECTIVE: To help predict aggressive and violent behaviors, the frequency and types of these behaviors in acute psychiatric inpatient settings were examined, and potential interactions between staffing and patient mix and rates of the behaviors were explored. METHODS: Data on violent incidents were gathered prospectively in three adult acute psychiatric units in a general hospital and two units in a primary psychiatric hospital in Sydney, Australia. Staff recorded violent and aggressive incidents, which were ranked on an 8-level scale. They also completed weekly reports of staffing levels and patient mix. Poisson regression analysis was used to calculate relative rates, 95 percent confidence intervals, and p values. RESULTS: A total of 1,289 violent incidents were recorded over a seven-month period. Based on the scale, 58 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more nonnursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness. In total these factors accounted for 62 percent of the variance in violence. CONCLUSIONS: Violent incidents in psychiatric settings are a frequent and serious problem. Incidents appear to be underreported, and the seriousness of an incident does not guarantee it will be reported.     

Stress and burnout in Israeli border police.

Despite great interest in police stress, very little research attention focused on border police. The study aimed to map the stressors that effect Israeli border police (MAGAV), assess the outcomes resulting from these stressors and suggest ways to reduce stress and burnout. A representative sample of MAGAV officers (N=497) responded to a questionnaire at the height of the Palestinian violent uprising and a time of unusually high stress; 18% were interviewed. At the top of the list of stressors reported by the officers were: low salary, lack of resources and overload. This is significant in light of the finding that 74% reported a traumatic experience (such as a terrorist attack), 52% reported high or very high levels of stress (as compared to 32% reported by blue police officers) their burnout level was high (4.15 as compared to the national burnout level of 2.8 and 3.05 found during the same period of time among blue police officers). Despite the high stress of their work, the officers evaluation of their work was high and they expressed satisfaction from their work. These findings can be explained by the officers' feeling that their work is important. Coping strategies offered by MAGAV officers are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Violence and psychiatric disorders: results from an epidemiological study of young adults in Israel

This paper investigates the association between various psychiatric disorders and violent behavior using data from a community-based epidemiological study of young adults in Israel (N = 2678). Self-reports of recent fighting and weapon use were elevated among respondents diagnosed with psychotic or bipolar disorders but not among those diagnosed with non-psychotic depression, generalized anxiety disorder or phobias compared to respondents without these disorders. Violence was measured using the Psychiatric Epidemiology Research Interview; psychiatric disorders were diagnosed using a modified version of the Schedule for Affective Disorders and Schizophrenia. The analyses controlled for lifetime substance abuse, antisocial personality disorder and demographic characteristics, thereby extending support for a causal connection between some types of psychiatric disorders and violence. The association between disorder and violence was stronger among respondents with less education, indicating the potentially important role of social and cultural contexts in moderating the association between mental illness and violence.     

Interaction between birth complications and early maternal rejection in predisposing individuals to adult violence: specificity to serious, early-onset violence

OBJECTIVE: The authors previously reported that birth complications interact with early maternal rejection in predisposing individuals to violence at age 18 years. This study extended the follow-up period for violent offending from 18 years to 34 years, thus increasing the sample of violent offenders threefold and allowing more detailed analyses on onset and type of violence, the form of maternal rejection, and the effect of maternal mental illness. METHOD: Complications in the births of 4,269 males in Denmark, maternal rejection of these individuals before the age of 1 year, and their histories of criminal offenses at age 34 years were assessed. RESULTS: The biosocial interaction previously observed held for violent but not nonviolent crime, was specific to more serious forms of violence and not threats of violence, held for early-onset but not late-onset violence, and was not accounted for by psychiatric illness in the mothers. Being reared in a public care institution in the first year of life and the mother's attempt to abort the fetus were the key aspects of maternal rejection that interacted with birth complications in predisposing a subject to violence. CONCLUSIONS: These findings 1) indicate that the mechanisms underlying early-onset, serious violence differ from those for less serious, late-onset violence, 2) implicate very early factors in the development of violence, 3) highlight the potential importance of integrating psychosocial with biological factors in understanding and preventing violence, and 4) suggest that interventions to reduce birth complications and maternal rejection may help reduce violence.     

Relation of low-severity violence to women's health

OBJECTIVE: To determine if women who experience low-severity violence differ in numbers of physical symptoms, psychological distress, or substance abuse from women who have never been abused and from women who experience high-severity violence. DESIGN: Cross-sectional, self-administered, anonymous survey. SETTING: Four community-based, primary care, internal medicine practices. PATIENTS: Survey respondents were 1,931 women aged 18 years or older. SURVEY DESIGN: Survey included questions on violence; a checklist of 22 physical symptoms; the Symptom Checklist-22 (SCL-22) to measure depression, anxiety, somatization, and self-esteem; CAGE questions for alcohol use; and questions about past medical history. Low-severity violence patients had been "pushed or grabbed" or had someone "threaten to hurt them or someone they love" in the year prior to presentation. High-severity violence patients had been hit, slapped, kicked, burned, choked, or threatened or hurt with a weapon. MAIN RESULTS: Of the 1,931 women, 47 met criteria for current low-severity violence without prior abuse, and 79 met criteria for current high-severity violence without prior abuse, and 1,257 had never experienced violence. The remaining patients reported either childhood violence or past adult abuse. When adjusted for socioeconomic characteristics, the number of physical symptoms increased with increasing severity of violence (4.3 for no violence, 5.3 for low-severity violence, 6.4 for high-severity violence, p < .0001). Psychological distress also increased with increasing severity of violence (mean total SCL22 scores 32.6 for no violence, 35.7 for low-severity violence, 39.5 for high-severity violence, p < .0001). Women with any current violence were more likely to have a history of substance abuse (prevalence ratio [PR] 1.8 for low-severity, 1.9 for high-severity violence) and to have a substance-abusing partner (PR 2.4 for both violence groups). CONCLUSIONS: In this study, even low-severity violence was associated with physical and psychological health problems in women. The data suggest a dose-response relation between the severity of violence and the degree of physical and psychological distress.     

Prevalence of adult domestic violence among women seeking routine care in a Native American health care facility

OBJECTIVES: The purpose of this study was to determine the prevalence of, and sociodemographic factors associated with, adult domestic violence within a Native American community. METHODS: Adult women in the community were surveyed. RESULTS: Of 371 eligible women, 341 (92%) were surveyed. Among respondents, 179 reported a history of at least 1 episode of domestic violence. Fifty-six (16.4%) reported violence within the previous 12 months. Age under 40 years and living in a household receiving governmental financial assistance were independently associated with 1-year prevalence of adult domestic violence. CONCLUSIONS: Adult domestic violence is prevalent within this Native American community. Additional research is required to characterize further the relationship between domestic violence and socioeconomic status.