Child Abuse: il ruolo del medico legale nell'assistenza, nella prevenzione e nella preparazione di linee guida

Con questo mio lavoro di tesi ho voluto esplorare il fenomeno del maltrattamento e dell’abuso sui minori delineandone, sulla base della letteratura scientifica nazionale ed internazionale, gli aspetti clinici, epidemiologici ed i fattori di rischio. Un breve excursus giuridico illustrerà, poi, gli articoli di legge relativi alla tutela dei minori; in particolare, ci si soffermerà ad illustrare quegli articoli che normano i doveri dei sanitari nei confronti dell’autorità giudiziaria nel caso si sospetti un abuso su minori. La conoscenza della semeiotica dell’abuso, il suo riconoscimento all’interno di una diagnostica differenziale clinico-forense, la corretta repertazione e la consapevolezza che, un approccio autenticamente tutelante verso la vittima, deve sempre realizzarsi all’interno di una cornice giuridica fanno si che, il ruolo della medicina legale, competente in tutti questi ambiti, diventi senza ombra di dubbio “primum inter pares” all’interno dei team multidisciplinari ed interistituzionali che si occupano di minori vitti. Il gruppo scientifico in cui sono stata inserita e con cui si è proceduto alla redazione del manuale è il Gruppo di lavoro per l’abuso e il maltrattamento dell’infanzia coordinato dalla dott.ssa Maria Rosa Giolito ed ha coinvolto professionisti italiani afferenti a tre differenti aree sanitarie: quella ginecologica, quella medico-legale e quella pediatrica. Il testo elaborato è stato immaginato come un aiuto ai professionisti medici che si trovano a valutare un soggetto prepubere con sospetto di abuso sessuale. Non costituisce una linea-guida per la diagnosi di abuso sessuale, ma definisce alcuni requisiti essenziali e diffonde alcune conoscenze per evitare errori che possano ripercuotersi negativamente sulla valutazione clinica e sull’eventuale conseguente iter giudiziario.

Fire victim identification by post-mortem dental CT: Radiologic evaluation of restorative materials after exposure to high temperatures

The aim of this study was to evaluate the use of high resolution CT to radiologically define teeth filling material properties in terms of Hounsfield units after high temperature exposure.

IORs in development assistance: USAID's agricultural project in Bosnia

We employ the case of USAID's Linking Agricultural Markets with Producers (LAMP) project to address opportunities and obstacles to development assistance. Framed within LAMP's identification of constraints to growth within Bosnia's agricultural market, we explore the complex interorganizational linkages required for success. We identify three distinct linkage types inherent to development situations. Relationships exist (1) within the international community, (2) within the local Bosnian community and (3) between international and local organizations.

The Economics and Nutritional Impacts of Food Assistance Policies and Programs

Recent evidence on malnutrition and poverty raise important questions on the role of food assistance policies and programs. In this review article, we examine evidence on the economic and nutritional impacts of international food assistance programs (FAPs) and policies. The returns on investments in FAPs are, on average, high but depend considerably on the targeting and cost structures as well as on food quality and role of complementary activities. We disaggregate findings into four classes of recipients. Returns to FAPs are highest for children under two. But, FAPs oriented towards early childhood interventions are less well funded than are interventions aimed at school-age children or at the broader, largely adult population even though available evidence indicates that these latter classes of interventions offer considerably lower average returns in economic, health, and nutrition terms. Nonetheless, FAP effectiveness in achieving any of several objectives varies with a range of key factors, including targeting, additionality, seasonality, timeliness, incentive effects, social acceptability and political economy considerations. (C) 2013 Elsevier Ltd. All rights reserved.

On The Choice and Impacts of Innovative International Food Assistance Instruments

The rise of new food assistance instruments, including local and regional procurement, cash, and vouchers, has surpassed increase in understanding of the tradeoffs among and impacts of these options relative to traditional food aid. Response choices rarely appear to result from systematic response analyses. Further, impacts along multiple dimensions-timeliness, cost-effectiveness, local market effects, recipient satisfaction, food quality, impact on smallholder suppliers, etc.-may be competing or synergistic. No single food assistance tool is always and everywhere preferable. A growing body of evidence, including the papers in this special section, nonetheless demonstrates the clear value-added of new food assistance instruments. (C) 2013 Elsevier Ltd. All rights reserved.

Use of a State-Level Pharmaceutical Assistance Program Among Urban and Rural Elders

A number of state-level pharmaceutical assistance programs have been established as a result of the growing recognition of the role of pharmaceuticals in the long-term care of the elderly. However, existing research does not provide a coherent expectation for patterns of use by rural and urban elderly. The data for this analysis are drawn from a larger study of the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE). PACE provides prescription medicines for elderly who meet income requirements. The research project was designed to assess the characteristics of PACE program participants and non-participants on a wide range of issues. Chi-square analysis and regression models were used to assess the association between rural and urban residence and access to the PACE Program. The results indicate that rural/urban status of the elderly is not a significant predictor of the use of PACE. Other traditional variables (e.g., health self-rating and physician visits) did predict difference in the pattern of use.

State-Level Pharmaceutical Assistance Programs for the Elderly: A national survey.

In order to put Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) Program in a national context, a nationwide mail survey and telephone follow-up to each of the 58 State Unit Directors on Aging in the United States and its territories identified 10 programs. The results reported in this article are specific to the seven state-level pharmaceutical assistance programs which were in operation during the fiscal year 1984-85. In general, the programs varied on select program characteristics and on their efforts to address major policy issues. Data from the non-program states indicated support, legislative efforts, and a high interest in fiscal concerns. The findings reflect a lack of program uniformity and have implications for program development and implementation. Suggestions on how to identify the "optimum" or best combination of program and policy options are discussed.

How Many Elders Receive Assistance?: A Cross-National Comparison

To examine models of informal support received by elders in the United States and Sweden and to test whether differences in informal support appear to stem from demographic differences between the nations alone or whether cultural and historical differences must also be considered.

Exploring Assistance in Sweden and the United States

Few international comparisons of health services are performed using microlevel data. Using such data, this paper compares the need for and receipt of assistance with activities of daily living (ADLs) in comparable samples in the United States and Sweden, a country with a universal system of community-based services.Design and Methods: Data from national surveys of community residents completed at approximately the same time in each nation are used to create comparable measures of need and assistance. Descriptive and logistic regression analyses compare need and assistance patterns across the nations and identify individual factors that explain receipt of assistance and unmet needs.Results:Our results indicate that a simple story of greater use of paid formal services in Sweden and more unpaid informal use in the United States masks a more complex relationship. Assistance with ADLs seems to be more targeted in Sweden; narrow differences in assistance widen considerably when the analysis is limited to those reporting need. Implications:Although these two different health systems result in similar levels of overall ADL assistance, a detailed microlevel comparison reveals key distinctions. Further microlevel comparisons of access, cost, and quality in cross-national data can further aid our understanding of the consequences of health policy.

Use of multislice computed tomography in disaster victim identification--advantages and limitations

After a mass fatality incident (MFI), all victims have to be rapidly and accurately identified for juridical reasons as well as for the relatives' sake. Since MFIs are often international in scope, Interpol has proposed standard disaster victim identification (DVI) procedures, which have been widely adopted by authorities and forensic experts. This study investigates how postmortem multislice computed tomography (MSCT) can contribute to the DVI process as proposed by Interpol. The Interpol postmortem (PM) form has been analyzed, and a number of items in sections D and E thereof have been postulated to be suitable for documentation by CT data. CT scans have then been performed on forensic cases. Interpretation of the reconstructed images showed that indeed much of the postmortem information required for identification can be gathered from CT data. Further advantages of the proposed approach concern the observer independent documentation, the possibility to reconstruct a variety of images a long time after the event, the possibility to distribute the work by transmitting CT data digitally, and the reduction of time and specialists needed at the disaster site. We conclude that MSCT may be used as a valuable screening tool in DVI in the future.