Finnish Homicides and Mental Disorders: An investigation of offense and offender characteristics

Although the majority of people with mental illness are not violent, scientific studies over the last decades show that certain psychiatric disorders increase the risk of violent behavior, including homicide. This thesis examined crime scene behaviors and offender background characteristics among mentally ill Finnish homicide offenders. Previously, homicide crime scene behaviors have been investigated in relation to offender demographic characteristics, whereas this study compares the behaviors of offenders with various mental illnesses. The study design was a retrospective chart review of the forensic psychiatric statements of Finnish homicide offenders. The work consists of four substudies. The aims of the study were as follows: To describe differences in the childhood and family backgrounds as well as in the adolescent and adult adjustment of Finnish homicide offenders belonging to different diagnostic categories (schizophrenia, personality disorder, alcoholism, drug addiction or no diagnosis). Further, the study examined associations between the crime scene behaviors and mental status of these offenders. Also, the distinguishing characteristics between two groups of offenders with schizophrenia were examined: early starters, who present antisocial behavior before the onset of schizophrenia, and late starters, who first offend after the onset of mental disorder. Finally, it was investigated how the use of excessive violence is associated with clinical and circumstantial variables as well as offender background characteristics among homicide offenders with schizophrenia. The main findings of the study can be summarized as follows. First, offenders with personality disorder or drug addiction had experienced multiple difficulties in their early environments: both family and individual problems were typical. Offenders with schizophrenia were relatively well-adjusted in childhood compared to the other groups. However, in adolescence and adulthood, social isolation, withdrawal and other difficulties attributable to these offenders illness became evident. In several aspects, offenders with alcohol dependency resembled offenders with no diagnosis in that these offenders had less problematic backgrounds compared to other groups. Second, the results showed that crime scene behaviors, victim gender and the victim-offender relationship differ between the groups. In particular, offenders with a diagnosis of schizophrenia or drug addiction have some unique features in their crime scene behaviors and choice of victims. Offenders with schizophrenia were more likely to kill a blood relative, to use a sharp weapon and to injure the victim s face. Drug addiction was associated with stealing from the victim and trying to cover up the body. Third, the results suggest that the offense characteristics of early- and late-start offenders with schizophrenia differ only modestly. However, several significant differences between the groups were found in characteristics of offenders: early starters had experienced a multitude of problems in their childhood surroundings and also later in life. Fourth, violent acts where the offender did not commit the offense alone or had previous homicidal history were predictive of excessive violence among offenders with schizophrenia. Positive psychotic symptoms did not predict the use of excessive violence. Nearly one third of the cases in the sample involved multiple and severe violence, including features such as sadism, mutilation, sexual components or extreme stabbing. In sum, mentally disordered homicide offenders are heterogeneous in their offense characteristics as well as their background characteristics. Empirically based information on how the offender s mental state is associated with specific crime scene behaviors can be utilized within the police force in developing methods of prioritizing suspects in unsolved homicide cases. Also, these results emphasise the importance of early interventions for problem families and children at risk of antisocial behavior. They may also contribute to the development of effective treatment for violent offenders.

The Europeanisation of occupational health services: A study of the impact of EU policies

This study concerns Framework Directive 89/391/EEC on health and safety at work, which encouraged improvements in occupational health services (OHS) for workers in EU member states. Framework Directive 89/391/EEC originally aimed at bringing the same level of occupational health and safety to employees in both the public and private sectors in EU member states. However, the implementation of the framework directive and OHS varies widely among EU member states. Occupational health services have generally been considered an important work-related welfare benefit in EU member states. The purpose of this study was to analyse OHS within the EU context and then analyse the impact of EU policies on OHS implementation as part of the welfare state benefit. The focus is on social, health, and industrial policies within welfare state regimes as well as EU policy-making processes affecting these policies in EU member states. The research tasks were divided into four groups related to the policy, functions, targets,and actors of OHS. The questions related to policy tried to discover the role of OHS in other policies, such as health, social, and labour market policies within the EU. The questions about functions sought to describe the changes, as well as the path dependence, of OHS in EU member states after the framework directive. The questions about targets were based on the general aims of WHO and the ILO in relation to equity, solidarity, universality, and access to OHS. The questions on actors were designed to understand the variety of stakeholders interested in OHS. The actors were supranational (EU, ILO, and WHO), national (ministries, institutes, and professional organisations), and social partners (trade unions and employers organisations). The study data were collected by interviewing 92 people in 15 EU member states, including representatives of ministries, institutions, research,trade unions, employers organisations, and occupational health organisations. Other documents were collected from the Internet,databases, libraries, and conference materials for a systematic review of the policies, strategies, organisation, financing, and monitoring of OHS in EU member states. Different analytical methods were used in the data analysis. The main findings of the study can be summarised as follows. First, occupational health services is a context-dependent phenomenon, which therefore varies according to the development of the welfare state in general, and depends on each country s culture, history, economy, and politics. The views of different stakeholders in EU member states concerning the impact and possibilities of OHS to improve health vary from evidence-based opinions to the sporadic impact of OHS on occupational health. OHS as a concept is vaguely defined by the EU, whereas the ILO defines OHS content. The tasks of OHS began as preventive and protective services for workers. However, they have moved towards multidisciplinary and organisational development as well as the workplace health promotion sphere.Since 1989 OHS has developed differently in different EU member states depending on the starting position of those states, but planning and implementation are crucial phases in the process toward better OHS coverage, equity, and access. Nevertheless, the data used for the planning and legitimisation of OHS activities are mainly based on occupational health data rather than on OHS data. This makes decisions on political or policy grounds inaccurate. OHS is still an evolving concept and benefit for workers, but the Europeanisation of OHS reflects contextual changes, such as the impact of the internal market, competition, and commercialisation on OHS. Stronger cooperation and integration with health, social, and employment services would be an asset for workers, because of new epidemics, an epidemiological shift towards new risks, an ageing labour market, and changes in the labour market. Different methods and approaches are needed in order to study the results of integrated services. In the future, more detailed information will be needed about the actual impact of EU policies on OHS and decision-making processes in order to get OHS into different policies in the EU and its member states. Further results and effects of OHS processes on occupational health need to be analysed more carefully. The adoption of a variety of research strategies and a multidisciplinary approach to understand the influence of different policies on OHS in the EU and its member states would highlight the options and opportunities to improve workers occupational health. Key subject headings: Occupational health services, EU policy, policymaking,framework directive 89/391/EEC

Applying the principles of interpretive field research: An example of an IS case study on shared services

All sound research commence with the selection of a research paradigm. The chosen research paradigm is significant in shaping the researcher’s perspectives of the world and it is a vital step in any study’s’ research design. There are different paradigms that IS researchers can choose from; amongst which the interpretive paradigm is growing in acceptance.. Though interpretive research has emerged as an important strand in Information Systems (IS), guidelines on how to conduct interpretive research and how to evaluate them have been scarce. Klein and Myers presented seven principles with examples for each from three case examples. While these principles are much valued, there is a lack of support for novice researchers on how to embed these principles in an overall research design, which could help with the aid of a detailed example that has done so. Thus, this paper aims to address this gap, and presents how Klein and Myers’s principles were applied within an example study that investigated shared services in the Malaysian Higher Education context. The example study adopted the interpretive paradigm as the most suited approach that fitted their research questions and goals. More details about the selection and adoption of the Klein and Myers’s guidelines in the context of the shared services research case study are presented in the paper.

Reduced visual function and its association with physical functioning in the Finnish adult population : Prevalence, causes, and need for eye care services

The purpose of this study was to estimate the prevalence and distribution of reduced visual acuity, major chronic eye diseases, and subsequent need for eye care services in the Finnish adult population comprising persons aged 30 years and older. In addition, we analyzed the effect of decreased vision on functioning and need for assistance using the World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (ICF) as a framework. The study was based on the Health 2000 health examination survey, a nationally representative population-based comprehensive survey of health and functional capacity carried out in 2000 to 2001 in Finland. The study sample representing the Finnish population aged 30 years and older was drawn by a two-stage stratified cluster sampling. The Health 2000 survey included a home interview and a comprehensive health examination conducted at a nearby screening center. If the invited participants did not attend, an abridged examination was conducted at home or in an institution. Based on our finding in participants, the great majority (96%) of Finnish adults had at least moderate visual acuity (VA ≥ 0.5) with current refraction correction, if any. However, in the age group 75–84 years the prevalence decreased to 81%, and after 85 years to 46%. In the population aged 30 years and older, the prevalence of habitual visual impairment (VA ≤ 0.25) was 1.6%, and 0.5% were blind (VA < 0.1). The prevalence of visual impairment increased significantly with age (p < 0.001), and after the age of 65 years the increase was sharp. Visual impairment was equally common for both sexes (OR 1.20, 95% CI 0.82 – 1.74). Based on self-reported and/or register-based data, the estimated total prevalences of cataract, glaucoma, age-related maculopathy (ARM), and diabetic retinopathy (DR) in the study population were 10%, 5%, 4%, and 1%, respectively. The prevalence of all of these chronic eye diseases increased with age (p < 0.001). Cataract and glaucoma were more common in women than in men (OR 1.55, 95% CI 1.26 – 1.91 and OR 1.57, 95% CI 1.24 – 1.98, respectively). The most prevalent eye diseases in people with visual impairment (VA ≤ 0.25) were ARM (37%), unoperated cataract (27%), glaucoma (22%), and DR (7%). One-half (58%) of visually impaired people had had a vision examination during the past five years, and 79% had received some vision rehabilitation services, mainly in the form of spectacles (70%). Only one-third (31%) had received formal low vision rehabilitation (i.e., fitting of low vision aids, receiving patient education, training for orientation and mobility, training for activities of daily living (ADL), or consultation with a social worker). People with low vision (VA 0.1 – 0.25) were less likely to have received formal low vision rehabilitation, magnifying glasses, or other low vision aids than blind people (VA < 0.1). Furthermore, low cognitive capacity and living in an institution were associated with limited use of vision rehabilitation services. Of the visually impaired living in the community, 71% reported a need for assistance and 24% had an unmet need for assistance in everyday activities. Prevalence of ADL, instrumental activities of daily living (IADL), and mobility increased with decreasing VA (p < 0.001). Visually impaired persons (VA ≤ 0.25) were four times more likely to have ADL disabilities than those with good VA (VA ≥ 0.8) after adjustment for sociodemographic and behavioral factors and chronic conditions (OR 4.36, 95% CI 2.44 – 7.78). Limitations in IADL and measured mobility were five times as likely (OR 4.82, 95% CI 2.38 – 9.76 and OR 5.37, 95% CI 2.44 – 7.78, respectively) and self-reported mobility limitations were three times as likely (OR 3.07, 95% CI 1.67 – 9.63) as in persons with good VA. The high prevalence of age-related eye diseases and subsequent visual impairment in the fastest growing segment of the population will result in a substantial increase in the demand for eye care services in the future. Many of the visually impaired, especially older persons with decreased cognitive capacity or living in an institution, have not had a recent vision examination and lack adequate low vision rehabilitation. This highlights the need for regular evaluation of visual function in the elderly and an active dissemination of information about rehabilitation services. Decreased VA is strongly associated with functional limitations, and even a slight decrease in VA was found to be associated with limited functioning. Thus, continuous efforts are needed to identify and treat eye diseases to maintain patients’ quality of life and to alleviate the social and economic burden of serious eye diseases.

Major Events and the European Code of Police Ethics

Examines the symbolic significance of major events and their security provision in the historical and contemporary context of the European Code of Police Ethics. Stresses the potential of major events to set new practical policing and security standards of technology and in doing so necessitiate the maintenance of professional ethical standards for policing in Europe.

The impacts of leadership in the quality of municipal public services: case study of a portuguese municipal council

[EN]The present research work, based on some of the components of the Common Assessment Framework, sets to analyse the influence held by leadership in specific factors that constitute the organisational climate, and also the impact that these factors have on the quality of municipal public services. For the purposes of this study, we propose Likert’s exploitative autocratic and participative leadership styles to explain the genesis, structure and workflow. As far as the organisational climate is concerned, the variables used are motivation, satisfaction, empowerment, conflict and stress. The main conclusions that arose was that a participative leader confers higher relevance to the quality of service, through motivation, satisfaction, empowerment and human resources positive results, than an exploitative autocratic leader. Performed contributions are based on the empiric research hereby presented, and new research guidelines are proposed. The research methodology used was qualitative, based on the case study.

Reform of Spain's profesional services market: Implementation of the EU Services Directive

The implementation of the European Commission Services Directive initiated the modernization process of services markets within the European Union. The objective was to guarantee the creation of a single market by ensuring the freedom of establishment and circulation. The transposition of the Directive in Spain triggered an initial wave of reforms in the Spanish legal system. A second package of reforms is currently underway, following recommendations by the EC, IMF and OECD, which highlight the relative lack of competition in Spain’s services as one of the major imbalances in its economy, alongside the public deficit and unemployment. Both the implemented and planned reforms represent a major step forward. Nevertheless, the government has recently announced modifications to the draft bill of the Professional Services and Associations Law, which is expected to soon be submitted for parliamentary debate and approval. Taking into consideration modifications already introduced, together with anticipated further changes, it will be important to maintain the main points of the draft bill and to introduce a deeper review of the legal framework for professional services, of the professional associations themselves, and for the activities that are subject to compulsory membership within a professional association. Spain’s territorial map of professional associations must too be redrawn.

Política de atenção ao indivíduo em sofrimento mental em um município do oeste do Paraná

A assistência psiquiátrica a indivíduos com sofrimento psíquico, em seu campo político, passou por um longo processo de discussão e formulação de estratégias a fim de garantir condição de humanidade aos indivíduos assistidos. A Reforma Psiquiátrica brasileira, como ficou conhecida, ocorreu concomitante ao processo de Reforma Sanitária e formulou leis para a garantia da integralidade e do acesso universal à saúde em território nacional sob a responsabilidade das esferas governamentais. No município de Cascavel PR, o processo de formulação das políticas assistenciais para o indivíduo com transtorno mental se inicia na década de 90, porém só é efetivamente estruturado a partir de 2003 com o fechamento do Hospital Psiquiátrico São Marcos, que forçou o município a agilizar o processo de implantação da rede assistencial e de serviços complementares com moldes psicossociais. Com isso o município estrutura a assistência ao portador de transtorno mental através da implantação de ambulatório especializado, serviço de urgência e centros de atenção psicossocial para adultos, crianças e usuários de álcool e outras drogas, todos estruturados com suporte assistencial realizado pela Unidade Básica de Saúde (UBS). Em cada UBS foi nomeado um profissional de referência para o acompanhamento desses usuários e de seus familiares com o intuito de fortalecer o vínculo e manter a relação entre os serviços complementares e atenção primária. O presente estudo é centrado na pesquisa bibliográfica e de campo, com caráter qualitativo, cujo ponto de partida é a coleta de dados por meio de aplicação de questionário semi-estruturado com a finalidade de conhecer o processo de formulação das políticas municipais de atenção ao doente mental através do questionamento sobre as práticas assistenciais desenvolvidas pela atenção primária à saúde. A população é composta por 10 (dez) profissionais das UBS, referências em saúde mental, e 10 (dez) familiares de usuários com sofrimento mental, assistidos pela atenção básica, mas inseridos em algum dos serviços ofertados da rede assistencial de saúde mental. A análise dos dados se deu por meio de análise de conteúdo, com estruturação de dois grandes focos de análise para melhor compreensão dos conteúdos (Análise de Conteúdo de Bardin). O resultado apontou dados positivos em relação à política de saúde mental municipal uma vez que, embora com apontamentos divergentes entre profissionais e usuários, percebe-se a intenção em assegurar aos indivíduos em sofrimento psíquico uma gama de procedimentos que são, inclusive, orientados por portarias ministeriais. Em relação à assistência prestada pela atenção básica de saúde, há convergência em relação às ações desenvolvidas pelos profissionais da UBS, embora os profissionais afirmem o desenvolvimento de atividades que não são confirmadas pelos usuários. Em relação às dificuldades encontradas para efetivação do tratamento, tanto profissionais quanto usuários apontam que há muito a avançar no campo da saúde mental para que efetivamente seja prestada assistência de forma equânime e integral.

An integrated representation of the services provided by global water resources

Water is essential not only to maintain the livelihoods of human beings but also to sustain ecosystems. Over the last few decades several global assessments have reviewed current and future uses of water, and have offered potential solutions to a possible water crisis. However, these have tended to focus on water supply rather than on the range of demands for all water services (including those of ecosystems). In this paper, a holistic global view of water resources and the services they provide is presented, using Sankey diagrams as a visualisation tool. These diagrams provide a valuable addition to the spatial maps of other global assessments, as they track the sources, uses, services and sinks of water resources. They facilitate comparison of different water services, and highlight trade-offs amongst them. For example, they reveal how increasing the supply of water resources to one service (crop production) can generate a reduction in provision of other water services (e.g., to ecosystem maintenance). The potential impacts of efficiency improvements in the use of water are also highlighted; for example, reduction in soil evaporation from crop production through better farming practices, or the results of improved treatment and re-use of return flows leading to reduction of delivery to final sinks. This paper also outlines the measures needed to ensure sustainable water resource use and supply for multiple competing services in the future, and emphasises that integrated management of land and water resources is essential to achieve this goal. © 2013 Elsevier Ltd.

The management of health library outreach services: evaluation and reflection on lessons learned on the VIVOS project

Yeoman, A. J., Cooper, J. M., Urquhart, C. J. & Tyler, A. (2003). The management of health library outreach services: evaluation and reflection on lessons learned on the VIVOS project. Journal of the Medical Library Association, 91(4), 426-433. Sponsorship: Resource

Police accountability in Ireland: an analysis of the problems posed by the legal, constitutional and political dimensions and how they might be addressed

The concept of police accountability is not susceptible to a universal or concise definition. In the context of this thesis it is treated as embracing two fundamental components. First, it entails an arrangement whereby an individual, a minority and the whole community have the opportunity to participate meaningfully in the formulation of the principles and policies governing police operations. Second, it presupposes that those who have suffered as victims of unacceptable police behaviour should have an effective remedy. These ingredients, however, cannot operate in a vacuum. They must find an accommodation with the equally vital requirement that the burden of accountability should not be so demanding that the delivery of an effective police service is fatally impaired. While much of the current debate on police accountability in Britain and the USA revolves around the issue of where the balance should be struck in this accommodation, Ireland lacks the very foundation for such a debate as it suffers from a serious deficit in research and writing on police generally. This thesis aims to fill that gap by laying the foundations for an informed debate on police accountability and related aspects of police in Ireland. Broadly speaking the thesis contains three major interrelated components. The first is concerned with the concept of police in Ireland and the legal, constitutional and political context in which it operates. This reveals that although the Garda Siochana is established as a national force the legal prescriptions concerning its role and governance are very vague. Although a similar legislative format in Britain, and elsewhere, have been interpreted as conferring operational autonomy on the police it has not stopped successive Irish governments from exercising close control over the police. The second component analyses the structure and operation of the traditional police accountability mechanisms in Ireland; namely the law and the democratic process. It concludes that some basic aspects of the peculiar legal, constitutional and political structures of policing seriously undermine their capacity to deliver effective police accountability. In the case of the law, for example, the status of, and the broad discretion vested in, each individual member of the force ensure that the traditional legal actions cannot always provide redress where individuals or collective groups feel victimised. In the case of the democratic process the integration of the police into the excessively centralised system of executive government, coupled with the refusal of the Minister for Justice to accept responsibility for operational matters, project a barrier between the police and their accountability to the public. The third component details proposals on how the current structures of police accountability in Ireland can be strengthened without interfering with the fundamentals of the law, the democratic process or the legal and constitutional status of the police. The key elements in these proposals are the establishment of an independent administrative procedure for handling citizen complaints against the police and the establishment of a network of local police-community liaison councils throughout the country coupled with a centralised parliamentary committee on the police. While these proposals are analysed from the perspective of maximising the degree of police accountability to the public they also take into account the need to ensure that the police capacity to deliver an effective police service is not unduly impaired as a result.

The utility of survey and administrative data to generate information for research and outcomes-based oral health services development

The aim of this research, which focused on the Irish adult population, was to generate information for policymakers by applying statistical analyses and current technologies to oral health administrative and survey databases. Objectives included identifying socio-demographic influences on oral health and utilisation of dental services, comparing epidemiologically-estimated dental treatment need with treatment provided, and investigating the potential of a dental administrative database to provide information on utilisation of services and the volume and types of treatment provided over time. Information was extracted from the claims databases for the Dental Treatment Benefit Scheme (DTBS) for employed adults and the Dental Treatment Services Scheme (DTSS) for less-well-off adults, the National Surveys of Adult Oral Health, and the 2007 Survey of Lifestyle Attitudes and Nutrition in Ireland. Factors associated with utilisation and retention of natural teeth were analysed using count data models and logistic regression. The chi-square test and the student’s t-test were used to compare epidemiologically-estimated need in a representative sample of adults with treatment provided. Differences were found in dental care utilisation and tooth retention by Socio-Economic Status. An analysis of the five-year utilisation behaviour of a 2003 cohort of DTBS dental attendees revealed that age and being female were positively associated with visiting annually and number of treatments. Number of adults using the DTBS increased, and mean number of treatments per patient decreased, between 1997 and 2008. As a percentage of overall treatments, restorations, dentures, and extractions decreased, while prophylaxis increased. Differences were found between epidemiologically-estimated treatment need and treatment provided for those using the DTBS and DTSS. This research confirms the utility of survey and administrative data to generate knowledge for policymakers. Public administrative databases have not been designed for research purposes, but they have the potential to provide a wealth of knowledge on treatments provided and utilisation patterns.

The increasing impact of human immunodeficiency virus infections, sexually transmitted diseases, and viral hepatitis in Durham County, North Carolina: a call for coordinated and integrated services.

BACKGROUND: Durham County, North Carolina, faces high rates of human immunodeficiency virus (HIV) infection (with or without progression to AIDS) and sexually transmitted diseases (STDs). We explored the use of health care services and the prevalence of coinfections, among HIV-infected residents, and we recorded community perspectives on HIV-related issues. METHODS: We evaluated data on diagnostic codes, outpatient visits, and hospitalizations for individuals with HIV infection, STDs, and/or hepatitis B or C who visited Duke University Hospital System (DUHS). Viral loads for HIV-infected patients receiving care were estimated for 2009. We conducted geospatial mapping to determine disease trends and used focus groups and key informant interviews to identify barriers and solutions to improving testing and care. RESULTS: We identified substantial increases in HIV/STDs in the southern regions of the county. During the 5-year period, 1,291 adults with HIV infection, 4,245 with STDs, and 2,182 with hepatitis B or C were evaluated at DUHS. Among HIV-infected persons, 13.9% and 21.8% were coinfected with an STD or hepatitis B or C, respectively. In 2009, 65.7% of HIV-infected persons receiving care had undetectable viral loads. Barriers to testing included stigma, fear, and denial of risk, while treatment barriers included costs, transportation, and low medical literacy. LIMITATIONS: Data for health care utilization and HIV load were available from different periods. Focus groups were conducted among a convenience sample, but they represented a diverse population. CONCLUSIONS: Durham County has experienced an increase in the number of HIV-infected persons in the county, and coinfections with STDs and hepatitis B or C are common. Multiple barriers to testing/treatment exist in the community. Coordinated care models are needed to improve access to HIV care and to reduce testing and treatment barriers.

Developing “middle leaders” in the public services? The realities of management and leadership development for public managers

Purpose – This paper aims to assess the actual contribution to organisational change of management and leadership development (MLD) activity for middle managers (MMs) in public service organisations (PSOs). Design/methodology/approach – Using the case study approach, the paper compares the content and outcomes of management and leadership training interventions for MMs in two large PSOs. The organisations, a fire brigade and a train operating company, are leaders in their sectors with respect to management development and “modernisation” of their services. Findings – The paper demonstrates how, in one case, MM development was largely an exercise in regulatory compliance, with little effect on individual MMs' performance or organisational outcomes. The second case demonstrates how MMs were effectively trained to enforce specific human resource policies which contributed to the successful implementation of top-down strategy yet paid little attention to the potential leadership role of MMs. Research limitations/implications – The paper highlights the need for further contextualised research at organisational level into the outcomes of MLD, especially in terms of different public service contexts. Practical implications – The paper demonstrates the dangers of designing and implementing development programmes without sufficient regard to professional practice and the realities of managerial discretion in PSOs. Originality/value – The paper provides an in-depth and contextualised insight into the conditions for success and failure in management development interventions in PSOs.

The role of joint training in practitioner development for learning disability services

The presentation explores and evaluates an innovation in education and training in which two different professional trainings (nursing and social work) are integrated to produce jointly qualified specialist practitioners.