The investigation of deaths in custody: a qualitative analysis of problems and prospects.

The right to be treated humanely when detained is universally recognized. Deficiencies in detention conditions and violence, however, subvert this right. When this occurs, proper medico-legal investigations are critical irrespective of the nature of death. Unfortunately, the very context of custody raises serious concerns over the effectiveness and fairness of medico-legal examinations. The aim of this manuscript is to identify and discuss the practical and ethical difficulties encountered in the medico-legal investigation following deaths in custody. Data for this manuscript come from a larger project on Death in Custody that examined the causes of deaths in custody and the conditions under which these deaths should be investigated and prevented. A total of 33 stakeholders from forensic medicine, law, prison administration or national human rights administration were interviewed. Data obtained were analyzed qualitatively. Forensic experts are an essential part of the criminal justice process as they offer evidence for subsequent indictment and eventual punishment of perpetrators. Their independence when investigating a death in custody was deemed critical and lack thereof, problematic. When experts were not independent, concerns arose in relation to conflicts of interest, biased perspectives, and low-quality forensic reports. The solutions to ensure independent forensic investigations of deaths in custody must be structural and simple: setting binding standards of practice rather than detailed procedures and relying on preexisting national practices as opposed to encouraging new practices that are unattainable for countries with limited resources.

A Delphi study on National PICU nursing research priorities in Australia and New Zealand.

BACKGROUND: There is a lack of evidence to direct and support nursing practice in the specialty of paediatric intensive care (PIC). The development of national PIC nursing research priorities may facilitate the process of undertaking clinical research and translating evidence into practice. PURPOSE: To (a) identify research priorities for the care of patients and their family as well as for the professional needs of PIC nurses, (b) foster nursing research collaboration, (c) develop a research agenda for PIC nurses. METHODS: Over 13 months in 2007-2008, a three-round questionnaire, using the Delphi technique, was sent to all specialist level registered nurses working in Australian and New Zealand PICUs. This method was used to identify and prioritise nursing research topics. Content analysis was used to analyse Round I data and descriptive statistics for Round II and III data. RESULTS: In Round I, 132 research topics were identified, with 77 research priorities (mdn>6, mean MAD(median) 0.68±0.01) identified in subsequent rounds. The top nine priorities (mean>6 and median>6) included patient issues related to neurological care (n=2), pain/sedation/comfort (n=3), best practice at the end of life (n=1), and ventilation strategies (n=1), as well as two priorities related to professional issues about nurses' stress/burnout and professional development needs. CONCLUSION: The research priorities identified reflect important issues related to critically ill patients and their family as well as to the nurses caring for them. These priorities can be used for the development of a research agenda for PIC nursing in Australia and New Zealand.

HACEK infective endocarditis: characteristics and outcomes from a large, multi-national cohort.

The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01) and younger age (OR 0.62; CI 0.49-0.90; p<0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p<0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences.

Education, disease prevalence and health service utilization in the Swiss National Health Survey "SOMIPOPS".

The relation among education, disease prevalence, and frequency of health service utilization was analyzed using data from the Swiss National Health Survey SOMIPOPS, conducted in 1981-1983 on a randomly selected sample of 4,255 individuals, representative of the entire Swiss population. The prevalence of several important cardiovascular, respiratory, digestive, osteoarticular, and psychiatric disorders was higher among less educated individuals; only allergic conditions were directly associated with indicators of social class. More educated individuals reported lower frequencies of general practitioner visits, but higher frequencies of specialized consultations. These findings confirm that education is an important determinant not only of mortality but also of morbidity and health-care utilization and require careful consideration in terms of the planning and evaluation of health services.

CRIMINAL JUSTICE, VICTIM SUPPORT CENTERS, AND THE EMOTIONAL WELLBEING OF CRIME VICTIMS

SUMMARY (Français au-dessous)After the Second World War, the role of the victim in criminal conflict became an objectof interest for academics. But it was only in the 1960s that the importance of providingprotection and assistance to crime victims was highlighted in particular by the victims'movement, which inaugurated a new era of criminal justice in systems throughout the world.Moving beyond just the role of controlling crime and punishing the offender, the criminaljustice system also began to contribute to the victims' rehabilitation and to help the victim tomove on from the event psychologically and emotionally.Although some criminological research has been conducted, to date the effect that thecriminal justice system and victim support services have on the well-being of crime victims isstill uncertain.The current study sought to understand better the healing process of victims of crime, thepotential consequences of their participation on the criminal justice system, and the supportof victim centers. Moreover, it aimed to find out whether the existence of a Victim SupportAct would change the treatment that the victim receives in the criminal justice system. Thusthis research was conducted based in two countries - Switzerland and Brazil - where theoutcome of the victims' movement on the criminal justice system was different, as was theparticipation of the victim in the criminal justice system and the government's provision ofsupport.In order to conduct this research we employed the qualitative method, which is the mostefficient to gather sensitive information. Interviews with crime victims were the main sourceof information. Hearing observation and document research were used as complementarysources.The results of this research show that victims who have contact with the criminal justicesystem and victim services are not more likely to recover than those who had no contact. Thisis to say, the support offered has no major effects; the influence of the criminal justice systemand the victim support services in the emotional well-being of crime victims is rather neutral.However, considering that the sample is not representative, findings are not expected to begeneralized. Instead, findings may give insight to practitioners or to future criminal justicepolicy makers, suggesting what may work to improve the emotional well-being of crimevictims, as well as suggesting further studies.________________________________________________________________________________RÉSUMÉAprès la deuxième guerre mondiale, le rôle de la victime est devenu un objet d'intérêtpour les académiciens. Par contre, c'est seulement dans les années 60 que l'importance defournir de la protection et de l'appui aux victimes d'infractions a été accentuée, en particulierpar un mouvement ― victims' mouvement ―, qui a inauguré un nouveau temps dans lajustice pénale des systèmes juridiques du monde entier. A part la fonction de contrôler lecrime et de punir le délinquant, le système de justice pénale joue également un rôle dans laréhabilitation des victimes.Malgré la réalisation de plusieurs recherches criminologiques sur ce sujet, les effets que lesystème de la justice pénale et les centres d'aides aux victimes ont sur le bien-être desvictimes d'infractions est encore incertain.Ainsi cette étude cherche à mieux comprendre le processus de réhabilitation des victimesd'infraction, les conséquences de leur participation dans le système de justice pénale ainsique la portée de l'appui des centres d'aide. De plus, l'étude vise à découvrir si l'existenced'une loi d'aide aux victimes, particulièrement la Loi d'Aide aux Victimes d'InfractionsLAVI, est susceptible de changer le traitement que la victime reçoit dans le système de lajustice pénale. Pour cela, elle a été conduite dans deux pays - la Suisse et le Brésil - où lesconséquences du mouvement des victimes sur le système de la justice pénale a eu undéveloppement différent; il en va de même pour la participation de la victime dans laprocédure pénale et pour l'appui offert par l'Etat.Cette étude utilise la méthode qualitative qui est la plus efficace pour le recueild'informations sensibles. La plus importante source des données sont les interviews avec lesvictimes. L'observation des audiences et l'analyse de documents ont été utilisés en tant quesources d'information complementáire.Les résultats de cette recherche montrent que les victimes qui ont porté plainte et qui ontreçu l'appui des centres d'aides ne sont pas mieux rétablies que celles qui n'ont rien fait. C'estainsi que nous avons conclu que les services offerts n'ont aucune influence dans ce processus.Cependant, considérant que notre échantillon n'est pas représentatif, il n'est pas possible degénéraliser nos résultats. Néanmoins, ceux-ci peuvent éclairer les praticiens ou les futursdécideurs politiques de la justice pénale, suggérant ce qui peut fonctionner pour lerétablissement des victimes d'infraction, aussi bien que suggérer d'autres études.

Workshop: Capacity building for national public health advocacy: case studies from national associations

The first statement of the EUPHA on the Future of Public Health in Europe refers to the need for going 'to policymakers, politicians and practitioners in all sectors of society and advise them on how to promote public health throughout society'. WHO-EURO Director General Marc Danzon, quoted in the second EUPHA statement on the responsibility of policy makers indicates that 'learning is not systematically applied in health policy development in our continent'. Statement 3 calls for the integration of public health into the political agenda in all sectors. The first EUPHA president, Louise Gunning-Schepers, quoted in Statement 10 called on EUPHA to become 'a powerful advocate of the public health community'. In addition to the above, the EU is now actively seeking ways to build capacity to implement its health strategy. Learning and building the capacity to achieve our aims The aims and objectives to promote the public's health as reflected in EUPHA's 10 statements are also mirrored in the national public health associations. However, many of EUPHA's national associations have little or limited experience in promoting public health policy at the national level. To assist in the learning of advocacy for public health policies, case studies presenting experiences of national public health organizations in lobbying for national public health policy will be presented and discussed. In addition to sharing experiences, the presentations will identify successful approaches to public health advocacy as well as lessons learned from unsuccessful attempts.

Record keeping by Swiss physiotherapists--a national survey of knowledge regarding legal requirements.

A national survey conducted in Switzerland aimed to evaluate the knowledge of physiotherapists regarding the legal requirements for record keeping and to collect their feedback about record keeping in general. Three physiotherapists from various professional practice groups and a lawyer specialised in health law developed a questionnaire that was sent to the 7,753 members of two existing national associations of physiotherapists. The questionnaire evaluated the participants' knowledge by calculating a score of legal knowledge, which had a maximum of 30 points. We included 825 questionnaires in the analysis. The large majority (83.4%) of participants confessed an ignorance of the legal requirements concerning record keeping prior to the survey. The average score of legal compatibility was 8 points. The younger age of the physiotherapists was a significant predictor of having knowledge of the legal requirements for record keeping (p <0.001). The participants had an appreciation of the value of records, but they did not have the relevant knowledge regarding the legal requirements for keeping records. The participants blamed a lack of time and remuneration for their failure to keep records according to known requirements. All practising allied health professionals should keep up-to-date and accurate records that conform to active legal requirements and existing international guidelines. In addition to the existing legal requirements, the emergence of e-health and the electronic era will trigger major changes in patient record management by physiotherapists.

Note sur les musaraignes (Soricidae, Mammalia) du Parc National du Souss-Massa Maroc

With 420 trap-nights we sampled shrews in different habitats of the Souss-Massa National Park. Crocidura viaria (n=11) was found in 5 habitats (cultivated land, wetland, beach dunes with Chenopodia, sand dunes with patchy vegetation and also in the Euphorbia association). No shrews were captured in Eucalyptus forest with undergrowth. Southward from Essaouira, C. viaria is obviously the most frequent species in dense or patchy lowland vegetation. Two other species (C. whitakeri and C. tarfayaensis) which occur in sympatry in the Agadir region were not captured. They live probably not in syntopy with C. viaria and their ecological requirements remain to be studied.