Intentional child and adolescent homicides in Milan (Italy): A 30-year interdisciplinary study.

This study aims to discuss the forensic and criminological implications of child homicides in the territory of Milan, Italy. The authors present a retrospective study on all the cases of child and adolescent homicides, that were observed at the Institute of Legal Medicine of Milan (Italy) in the last 30 years (from January 1991 to December 2020). A total of 46 child homicides were collected, focusing on the sociological features, by highlighting peculiar cases, risk factors, potential changing social trends, and comparing our cases with the current literature. The analysis revealed a statistically significant relationship (p < 0.05) for male adolescents and indicated that adolescent homicides were more frequently perpetrated in extrafamilial contexts. In contrast, neonaticides and infanticides were mainly committed at home. Furthermore, the Fisher's Exact test revealed that child murders were mainly committed by immigrants in the Milan district after 2005 (p < 0.05). The two main causes of death were due to sharp and firearm injuries. While the relationship between homicide clusters and homicides committed by sharp objects was not significant, adolescent homicides were mainly committed using firearms (p < 0.05). The present study may help to identify risk factors for homicides against child and adolescent. Consequently, policies that identify, prevent, and minimize this extreme violence should be designed to interrupt the vicious circle of such dreadful murderous events. Child and adolescent homicides deserve additional focus and better education for healthcare professionals and further research should be carried out to develop therapeutic and caring strategies.

Portfolio frontier analysis: Applying mean-variance analysis to health technology assessment for health systems under pressure.

The COVID-19 pandemic is challenging how healthcare technologies are evaluated, as new, more dynamic methods are required to test the cost effectiveness of alternative interventions during use rather than before initial adoption. Currently, health technology assessment (HTA) tends to be static and a priori: alternatives are compared before launch, and little evaluation occurs after implementation. We suggest a method that builds upon the current pre-launch HTA procedures by conceptualizing a mean-variance approach to the continuous evaluation of attainable portfolios of interventions in health systems. Our framework uses frontier analysis to identify the desirability of available health interventions so decision makers can choose diverse portfolios based upon information about expected returns and risks. This approach facilitates the extension of existing methods and assessments beyond the traditional concern with pre-adoption data, a much-needed innovation given the challenges posed by COVID-19.