Forced Marriage and Birth Outcomes.

We study the impact of marriages resulting from bride kidnapping on infant birth weight. Bride kidnapping-a form of forced marriage-implies that women are abducted by men and have little choice other than to marry their kidnappers. Given this lack of choice over the spouse, we expect adverse consequences for women in such marriages. Remarkable survey data from the Central Asian nation of Kyrgyzstan enable exploration of differential birth outcomes for women in kidnap-based and other types of marriage using both OLS and IV estimation. We find that children born to mothers in kidnap-based marriages have lower birth weight compared with children born to other mothers. The largest difference is between kidnap-based and arranged marriages: the magnitude of the birth weight loss is in the range of 2 % to 6 % of average birth weight. Our finding is one of the first statistically sound estimates of the impact of forced marriage and implies not only adverse consequences for the women involved but potentially also for their children.

The relationship between violence in Northern Mexico and potentially avoidable hospitalizations in the USA-Mexico border region.

BACKGROUND: Substantial proportions of US residents in the USA-Mexico border region cross into Mexico for health care; increases in violence in northern Mexico may have affected this access. We quantified associations between violence in Mexico and decreases in access to care for border county residents. We also examined associations between border county residence and access. METHODS: We used hospital inpatient data for Arizona, California and Texas (2005-10) to estimate associations between homicide rates and the probability of hospitalization for ambulatory care sensitive (ACS) conditions. Hospitalizations for ACS conditions were compared with homicide rates in Mexican municipalities matched by patient residence. RESULTS: A 1 SD increase in the homicide rate of the nearest Mexican municipality was associated with a 2.2 percentage point increase in the probability of being hospitalized for an ACS condition for border county patients. Residence in a border county was associated with a 1.3 percentage point decrease in the probability of being hospitalized for an ACS condition. CONCLUSIONS: Increased homicide rates in Mexico were associated with increased hospitalizations for ACS conditions in the USA, although residence in a border county was associated with decreased probability of being hospitalized for an ACS condition. Expanding access in the border region may mitigate these effects by providing alternative sources of care.

Key concepts in postmortem drug redistribution.

Postmortem redistribution (PMR) refers to the changes that occur in drug concentrations after death. It involves the redistribution of drugs into blood from solid organs such as the lungs, liver, and myocardium. Drug properties such as volume of distribution, lipophilicity, and pKa are important factors. Basic, highly lipophilic drugs with a volume of distribution greater than 3 l/kg are most likely to undergo PMR. Examples include the tricyclic antidepressants, digoxin, and the amphetamines. The anatomical location of blood sampling can influence the drug concentration. The ideal site is a ligated or clamped femoral vein. Medical toxicologists participating in forensic cases involving drugs likely to undergo PMR must be aware of its potential contribution to the postmortem drug concentration. Correlation with laboratory data and any available antemortem or perimortem clinical information is necessary to render an appropriate opinion on the cause of death.

Mortality recovery and stabilization in Kazakhstan, 1995-2001.

This paper documents both the extraordinary rise in mortality that accompanied economic deterioration in the former Soviet Republic of Kazakhstan, as well as the far more tentative recovery. Kazakhstan's multi-ethnic population also makes it possible to identify a large mortality disadvantage for those--especially working-age males--who are not of Kazakh ethnicity. There are also stark regional differences--mortality decline is underway in many areas with substantial economic recovery, while elsewhere there has been no discernable improvement.

Exploring the Association of Homicides in Northern Mexico and Healthcare Access for US Residents.

Many legal residents in the United States (US)-Mexico border region cross from the US into Mexico for medical treatment and pharmaceuticals. We analyzed whether recent increases in homicides in Mexico are associated with reduced healthcare access for US border residents. We used data on healthcare access, legal entries to the US from Mexico, and Mexican homicide rates (2002-2010). Poisson regression models estimated associations between homicide rates and total legal US entries. Multivariate difference-in-difference linear probability models evaluated associations between Mexican homicide rates and self-reported measures of healthcare access for US residents. Increased homicide rates were associated with decreased legal entries to the US from Mexico. Contrary to expectations, homicides did not have significant associations with healthcare access measures for legal residents in US border counties. Despite a decrease in border crossings, increased violence in Mexico did not appear to negatively affect healthcare access for US border residents.

Disability incidence and official health status transitions in Russia.

This paper examines determinants of being disabled in Russia, along with the probability of moving from one disability status to another, using data from 1994 through 2005 from the Russian Longitudinal Monitoring Survey. Results from multinomial probit regressions indicate that disability risk rises sharply with age, declines with income and self-reported good health, and is lower for women. Neither smoking nor drinking alcohol increases either the risk of being or becoming disabled. Recovery--health status improvement--improves with household size. Misclassification or measurement error is important: a surprisingly large proportion of "incurably" disabled Russians do in fact recover. This study has been funded in part by National Institute of Aging grant #2P30 AG17248-02 through the Population Aging Center at the University of Colorado at Boulder. We are grateful to Aleksandr Andreev for outstanding research assistance. Jeanine Braithwaite, John Komlos, Cem Mete, Mieke Meurs, Daniel Mont, Frank Sloan, and five anonymous referees contributed valuable comments. We acknowledge our appreciation without implicating them in remaining errors and misinterpretations.

The clinical significance of variations in ethanol toxicokinetics.

INTRODUCTION: Many variables affect the interpretation of an isolated ethanol level in an acutely intoxicated patient. This review demonstrates the significant variability in metabolism and elimination of ethanol, how it can differ between individuals, and the clinical importance of these variables. DISCUSSION: Isolated ethanol values in a clinical scenario are only a snapshot of a dynamic process. The individual pharmacokinetic differences of people make it extremely difficult to estimate ethanol elimination rates or calculate previous ethanol concentrations at the time of an accident because of medical-legal reasons. Not only are the techniques used in measuring ethanol concentrations in bodily fluids (blood, serum, breath, and urine) not equivalent, but also the units used to report ethanol concentrations are often misinterpreted. Acute and chronic tolerance and social adaptive changes make interpreting this isolated ethanol level extremely difficult. The purpose of this review is to enable the clinician to appropriately interpret ethanol concentrations. CONCLUSION: The clinical evaluation of a patient's inebriation is always more reliable than an isolated ethanol level for determining disposition. Only an estimation of a current serum ethanol level can be made if the blood draw was performed hours earlier. This review is clinically important because it shows the clinically significant variability in metabolism and elimination of ethanol and how it can differ between individuals. It will also describe different ways to measure ethanol concentrations and how to compare them. Finally, the interpretation of isolated ethanol levels will be discussed.

Motional-narrowing-type dephasing of electron and hole spins of itinerant excitons in magnetically doped II-VI bulk semiconductors.

Time-resolved optical spin-quantum-beat measurements performed on magnetically doped II-VI bulk semiconductors reveal an increase of the electron spin dephasing time with rising temperature typical for motional narrowing. With the dephasing being notably faster than in undoped II-VI semiconductors, the magnetic dopants must play a key role, modifying the known dephasing mechanisms and introducing new ones. Focusing on the latter, we theoretically explore the spin dephasing channel arising from magnetization fluctuations sampled by the itinerant excitons. This mechanism suffices to explain quantitatively the results of our time-resolved Faraday-rotation experiments on optically excited Cd(1-x)Mn(x)Te which we present here as a function of magnetic field, temperature and manganese dopant density. In addition to electron spin-quantum beats, some of our experiments reveal hole spin beats as well.

Unexpected "gas" casualties in Moscow: a medical toxicology perspective.

In October 2002, the Russian military used a mysterious "gas" to incapacitate Chechen rebels at a Moscow theater. Despite increased interest in the potential use of lethal chemical weapons in recent years, the medical community has paid little attention to the development of incapacitating, calmative, and "less than lethal" technologies. In this analysis, we review the events surrounding the use of a calmative "gas" during the Russian military action and discuss what is currently known about fentanyl derivatives, their aerosolization, and the rationale for their use as incapacitating agents. Collectively, the available evidence strongly suggests that a combination of a potent aerosolized fentanyl derivative, such as carfentanil, and an inhalational anesthetic, such as halothane, was used. The paper also assesses potential errors leading to the loss of a substantial number of hostages. Several lessons can be learned from this surprising and novel use of an incapacitating gas.