Strengthening policies and structures to combat illicit tobacco trade in the Philippines.

The Philippines has been seeing an increase in illicit tobacco trade in recent years, undermining the impacts of legal measures such as tobacco products' taxation and regulation due to circumvention of established avenues and costing the government its revenue. Currently, the country has twelve policies related to the prevention of illicit tobacco trade with gaps identified in its lack of licensing systems for tobacco retailers and policies on law enforcement cooperation, which manifests in the country being fully compliant to only 5 of the 16 articles under the World Health Organization's Illicit Tobacco Trade Protocol. It is recommended that the country establish a national agency or framework specifically for illicit tobacco trade to address its gaps under Tracking and Tracing, Due Diligence, and Unlawful Conduct.

Does heroin-assisted treatment reduce crime? A review of randomized-controlled trials.

BACKGROUND AND AIMS: Several randomized controlled trials (RCTs) conclude that heroin-assisted-treatment (HAT) has a larger benefit-cost ratio than oral methadone because HAT more reliably and substantially reduces participants' criminal activity. This review: (1) summarizes results from RCTs concerning the comparative effectiveness of HAT for reducing criminal activity and (2) examines the role of different mechanisms for explaining changes in crime. DESIGN: Systematic search of five databases for RCTs evaluating comparative effectiveness of HAT on participant crime outcomes and potential mediators of crime. Narrative synthesis with tabular comparisons of outcomes extracted across RCTs. SETTING: Europe and Canada. PARTICIPANTS: Twenty studies, spanning 10 RCTs with 2427 participants, met inclusion criteria. INTERVENTIONS: HAT compared to other treatments for opioid use disorder, primarily oral methadone. MEASUREMENTS: The primary outcome was criminal activity. Mediator outcomes included illicit heroin use, drug expenditures, employment and earnings and social functioning. FINDINGS: All trials found significantly reduced criminal activity among HAT participants, and four found significantly larger reductions for HAT compared to control condition [median odds ratios (ORs) = 0.45]. Reductions in crime are concentrated in drug-related and property offenses (ORs range from 0.14 to 0.90 and from 0.12 to 1.89, respectively). Comparative efficacy of HAT for reducing illicit heroin use probably explains reductions in drug possession offenses, but does not show consistent correlation with drug dealing or property offenses. While three trials showed reductions in drug expenditures as possibly driving crime reductions, others did not report expenditures. There is little evidence that treatment effects on economic and social functioning outcomes explain within-trial changes in criminal activity. CONCLUSIONS: Existing literature suggests that heroin-assisted treatment reduces criminal activity, but trials varied in whether these effects exceeded those from oral methadone treatment. Inconsistency in outcome measures across trials complicates understanding drivers of heterogeneity. More detailed information on legal and illegal income, drug expenditures and social interactions could improve our understanding of the causal mechanisms underlying the effect of heroin-assisted-treatment on crime.

Envolvimento com o crime: principais fatores de risco e modelos teórico-explicativos / Involvement in crime: principal risk factors and some theoretical and explanatory models / Implicación con el crimen: principales factores de riesgo y algunos modelos teórico-explicativos

A criminalidade figura entre as maiores preocupações da sociedade contemporânea, que tem ficado cada vez mais apreensiva com a crescente insegurança que a circunda. Em sintonia com essa inquietação social, pesquisadores de diferentes áreas do conhecimento têm diligenciado no sentido de lançar luz sobre as causas da delinquência. O presente trabalho teórico elucida e discute alguns dos principais fenômenos que têm sido apontados pela literatura como fatores de risco para o envolvimento de indivíduos com o crime, nas esferas microssocial, macrossocial e psíquica, bem como alguns dentre os mais aceitos modelos teórico-explicativos desse fenômeno. O artigo conclui sinalizando para a multideterminação do envolvimento criminal, subjacente ao qual há uma constelação de fatores que atuam em rede e interagem dinamicamente entre si, arranjando-se de forma personalizada e singular em cada trajetória infracional. A compreensão desses fatores insinua-se como um importante passo na direção do planejamento e da implementação de estratégias sociais mais eficazes de prevenção e enfrentamento à criminalidade.(AU)

Criminality is one of the main concerns of contemporary society, which has become increasingly apprehensive about the growing climate of insecurity arising from it. In line with this social anxiety, researchers from different knowledge areas have endeavored to shed light on the causes of delinquency. This theoretical work elucidates and discusses some of the principal phenomena described in the literature as risk factors for an individual's involvement in crime, in the micro-social, macro-social and psychological spheres, as well as some from the most accepted theoretical and explanatory models for this phenomenon. The paper concludes by pointing out the multi-determinants of criminal involvement, underlying which is a constellation of factors that operate and interact dynamically in conjunction with one another, forming a personalized and singular pathway for each offender trajectory. Understanding these factors is an important step towards planning and implementing more effective social strategies for preventing and combating crime.(AU)

La criminalidad figura entre las mayores preocupaciones de la sociedad contemporánea, que ha quedado cada vez más preocupada por el creciente clima de inseguridad que la rodea. En sintonía con esa inquietud social, investigadores de distintas áreas del conocimiento se han esforzado, en el sentido de lanzar luces sobre las causas de la delincuencia. El presente trabajo teórico elucida y discute algunos de los principales fenómenos que han sido apuntados por la literatura como factores de riesgo para la implicación de individuos con el crimen, en las esferas micro-social, macro-social y psíquica, así como algunos de los más aceptados modelos teórico-explicativos de ese fenómeno. El artículo concluye señalando la multi-determinación de la implicación criminal, subyacente al cual hay una constelación de factores que actúan en red e interactúan dinámicamente entre sí, disponiéndose de forma personalizada y singular en cada trayectoria infraccional. La comprensión de estos factores implica un paso importante hacia la planificación y aplicación de estrategias sociales más eficaces de prevención y enfrentamiento a la criminalidad.(AU)

Species identification from seized animal oil: a case study of suspected Gangetic dolphin (Platanista gangetica).

Poaching of South Asian river dolphins is considered one of the main reasons for the rapid decline of their natural populations. To curb the escalated rate of poaching, high numbers of oil and meat seizures are recovered with subsequent convictions by the law enforcement agencies. In this connection, we report a case where suspected animal oil was confiscated by the forest official of West Bengal. We extracted DNA and successfully amplified partial fragments of Cytb and 16S rRNA mitochondrial genes. The generated sequences identified that the seized oil belonged to the Ganges river dolphin (Platanista gangetica) which is protected as Schedule I under the Wildlife (Protection) Act, 1972 of India and listed as "Endangered" under IUCN and APPENDIX I in CITES. In routine case work analysis, oil samples are not preferred for forensic DNA investigation due to low DNA yield and presence of inhibitors or contaminants leading to high failure rate. However, the present study generates hope for identifying species from seized animal oil and supports law enforcement in successful prosecution of the case.

Fatores determinantes do controle da criminalidade em gestão de políticas de segurança pública / Determinantes del control de la criminalidad en la gestión de políticas de seguridad pública / Determinants of crime control in public security policy management

Resumo É alvo central de discussões a temática relacionada à segurança pública no país, especialmente, no tocante aos índices de criminalidade. Este estudo aborda a temática a partir da Teoria Econômica da Escolha Racional e de teorias de base sociológica que buscam explicar as causas do crime. O objetivo do estudo foi identificar fatores determinantes para o controle dos índices de criminalidade a partir de dados do estado do Espírito Santo. Trata-se de um estudo de abordagem quantitativa. Foram utilizados dados secundários, tendo como referência o modelo teórico proposto. Adotou-se, ainda, como método de teste de hipóteses, o modelo de regressão linear, com o auxílio do software SPSS Statistics, versão 25. Os resultados da pesquisa demonstram que o elemento relativo à empregabilidade da população influencia direta e significativamente o controle dos índices de crimes de homicídios dolosos e de crimes contra o patrimônio. Ademais, conjugado ao emprego (atividades laborais formais), os fatores renda e educação da população demonstraram influenciar positivamente no controle dos crimes contra o patrimônio.

Resumen La temática relacionada con la seguridad pública en el país es objeto central de discusión, especialmente con respecto a los índices de criminalidad. Este estudio aborda el tema a partir de la teoría económica de la elección racional y las teorías sociológicas que buscan explicar las causas del delito. El objetivo del estudio fue identificar los factores determinantes para el control de los índices de criminalidad con base en datos del estado de Espírito Santo. Este es un estudio con un enfoque cuantitativo. Se utilizaron datos secundarios, basados en el modelo teórico propuesto. El modelo de regresión lineal también se adoptó como método de prueba de hipótesis, con la ayuda del software SPSS Statistics versión 25. Los resultados de la investigación muestran que el elemento relacionado con la empleabilidad de la población influye directa y significativamente en el control de los índices de homicidios dolosos y delitos contra la propiedad. Además, combinado con el empleo (actividades laborales formales), los factores ingresos y educación de la población han demostrado tener una influencia positiva en el control de los delitos contra la propiedad.

Abstract The topic related to public security in Brazil is central in discussions regarding crime rates. This study approaches the theme from the economic theory of rational choice and sociological theories that seek to explain the causes of crime. The study's objective was to identify determining factors for controlling crime rates based on data from the state of Espírito Santo. This is a study with a quantitative approach. Secondary data were used, based on the proposed theoretical model. The linear regression model was also adopted as a hypothesis testing method, with the aid of the SPSS Statistics software version 25. The results show that the element related to the population's employability directly and significantly influences the control of crime rates, intentional homicides, and crimes against property. Furthermore, combined with employment (formal labor activities), the population's income and education positively influence the control of crimes against property.

Helping individuals with firearm injuries: A cluster randomized trial.

BACKGROUND: Patients with firearm injuries are at high risk of subsequent arrest and injury following hospital discharge. We sought to evaluate the effect of a 6-month joint hospital- and community-based low-intensity intervention on risk of arrest and injury among patients with firearm injuries. METHODS: We conducted a cluster randomized controlled trial, enrolling patients with firearm injuries who received treatment at Harborview Medical Center, the level 1 trauma center in Seattle, Washington, were 18 years or older at the time of injury, spoke English, were able to provide consent and a method of contact, and lived in one of the five study counties. The intervention consisted of hospital-based motivational interviewing, followed by a 6-month community-based intervention, and multiagency support. The primary outcome was the risk of subsequent arrest. The main secondary outcome was the risk of death or subsequent injury requiring treatment in the emergency department or hospitalization. RESULTS: Neither assignment to or engagement with the intervention, defined as having at least 1 contact point with the support specialist, was associated with risk of arrest at 2 years post-hospital discharge (relative risk for intervention assignment, 1.15; 95% confidence interval, 0.90-1.48; relative risk for intervention engagement, 1.07; 95% confidence interval, 0.74-2.19). There was similarly no association observed for subsequent injury. CONCLUSIONS: This study represents one of the first randomized controlled trials of a joint hospital- and community-based intervention delivered exclusively among patients with firearm injuries. The intervention was not associated with changes in risk of arrest or injury, a finding most likely due to the low intensity of the program. LEVEL OF EVIDENCE: Care management, level II.

Real-time Concealed Object Detection from Passive Millimeter Wave Images Based on the YOLOv3 Algorithm.

The detection of objects concealed under people's clothing is a very challenging task, which has crucial applications for security. When testing the human body for metal contraband, the concealed targets are usually small in size and are required to be detected within a few seconds. Focusing on weapon detection, this paper proposes using a real-time detection method for detecting concealed metallic weapons on the human body applied to passive millimeter wave (PMMW) imagery based on the You Only Look Once (YOLO) algorithm, YOLOv3, and a small sample dataset. The experimental results from YOLOv3-13, YOLOv3-53, and Single Shot MultiBox Detector (SSD) algorithm, SSD-VGG16, are compared ultimately, using the same PMMW dataset. For the perspective of detection accuracy, detection speed, and computation resource, it shows that the YOLOv3-53 model had a detection speed of 36 frames per second (FPS) and a mean average precision (mAP) of 95% on a GPU-1080Ti computer, more effective and feasible for the real-time detection of weapon contraband on human body for PMMW images, even with small sample data.

Memoranda of understanding: a tobacco industry strategy to undermine illicit tobacco trade policies.

OBJECTIVE: Analyse the transnational tobacco companies' (TTCs) memoranda of understanding (MoUs) on illicit trade and how they could undermine the WHO Framework Convention on Tobacco Control (FCTC) and the Protocol to Eliminate Illicit Trade in Tobacco Products (Protocol). METHODS: Review of tobacco industry documents and websites, reports, news and media items using standard snowball search methods. RESULTS: Facing increasing pressure from governments and the FCTC to address illicit tobacco trade during the late 1990s, TTCs entered into voluntary partnerships embodied in MoUs with governments' law enforcement and customs agencies. One of the earliest known MoUs was between Philip Morris International and Italy in 1999. TTCs agreed among themselves to establish MoUs individually but use the Italian MoU as a basis to establish similar connections with other governments to pre-empt more stringent regulation of illicit trade. TTCs report to have signed over 100 MoUs since 1999, and promote them on their websites, in Corporate Social Responsibility reports and in the media as important partnerships to combat illicit tobacco trade. There is no evidence to support TTCs' claims that these MoUs reduce illicit trade. The terms of these MoUs are rarely made public. MoUs are non-transparent partnerships between government agencies and TTCs, violating FCTC Article 5.3 and the Protocol. MoUs are not legally binding so do not create an accountability system or penalties for non-compliance, rendering them ineffective at controlling illicit trade. CONCLUSION: Governments should reject TTC partnerships through MoUs and instead ratify and implement the FCTC and the Protocol to effectively address illicit trade in tobacco products.

Not an 'iron pipeline', but many capillaries: regulating passive transactions in Los Angeles' secondary, illegal gun market.

OBJECTIVES: California has strict firearm-related laws and is exceptional in its regulation of firearms retailers. Though evidence suggests that these laws can reduce illegal access to guns, high levels of gun violence persist in Los Angeles (LA), California. This research seeks to describe the sources of guns accessed by active offenders in LA, California and reports offenders' motivations for obtaining guns. SETTING: Los Angeles County Jail (LACJ) system (four facilities). METHODS: Random sampling from a screened pool of eligible participants was used to conduct qualitative semistructured interviews with 140 incarcerated gun offenders in one of four (LACJ) facilities. Researchers collected data on firearm acquisition, experiences related to gun violence, and other topics, using a validated survey instrument. Grounded theory guided the collection and analysis of data. RESULTS: Respondents reported possession of 77 specific guns (79.2% handguns) collectively. Social networks facilitate access to illegal guns; the majority of interviewees acquired their illegal guns through a social connection (85.7%) versus an outside broker/unregulated retailer (8.5%). Most guns were obtained through illegal purchase (n=51) or gift (n=15). A quarter of gun purchasers report engaging in a passive transaction, or one initiated by another party. Passive gun buyers were motivated by concerns for personal safety and/or economic opportunity. CONCLUSIONS: In LA's illegal gun market, where existing social relationships facilitate access to guns across a diffuse network, individuals, influenced by both fear and economic opportunity, have frequent opportunities to illegally possess firearms through passive transactions. Gun policies should better target and minimise these transactions.

Radioisotopes produced by neutron irradiation of food.

The use of neutrons for cargo interrogation has the potential to drastically improve threat detection. Previous research has focussed on the production of (24)Na, based on the isotopes produced in pharmaceuticals and medical devices. For both the total activity and the ingestion dose we show that a variety of isotopes contribute and that (24)Na is only dominant under certain conditions. The composition of the foods has a strong influence on the resulting activity and ingestion dose suggesting that the pharmaceuticals and medical devices considered initially are not a viable analogue for foodstuffs. There is an energy dependence to the isotopes produced due to the cross-sections of different reactions varying with neutron energy. We show that this results in different isotopes dominating the ingestion dose at different energies, which has not been considered in the previous literature.

The Development and Validation of an Actuarial Risk Assessment Tool for the Prediction of First-Time Offending.

For prevention purposes, it is important that police officers can estimate the risk for delinquency among juveniles who were involved in a criminal offense, but not in the role of a suspect. In the present study, the Youth Actuarial Risk Assessment Tool for First-Time Offending (Y-ARAT-FO) was developed based solely on police records with the aim to enable Dutch police officers to predict the risk for first-time offending. For the construction of this initial screening instrument, an Exhaustive Chi-squared Automatic Interaction Detector (Exhaustive CHAID) analysis was performed on a data set that was retrieved from the Dutch police system. The Y-ARAT-FO was developed on a sample of 1,368 juveniles and validated on a different sample of 886 juveniles showing moderate predictive accuracy in the validation sample (area under the receiver operating characteristic curve [AUC] = .728). The predictive accuracy of the Y-ARAT-FO was considered sufficient to justify its use as an initial screening instrument by the Dutch police.

Corruption in health-care systems and its effect on cancer care in Africa.

At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients.

Comparing the Functioning of Youth and Adult Partnerships for Health Promotion.

Youth partnerships are a promising but understudied strategy for prevention and health promotion. Specifically, little is known about how the functioning of youth partnerships differs from that of adult partnerships. Accordingly, this study compared the functioning of youth partnerships with that of adult partnerships. Several aspects of partnership functioning, including leadership, task focus, cohesion, participation costs and benefits, and community support, were examined. Standardized partnership functioning surveys were administered to participants in three smoke-free youth coalitions (n = 44; 45 % female; 43 % non-Hispanic white; mean age = 13) and in 53 Communities That Care adult coalitions (n = 673; 69 % female; 88 % non-Hispanic white; mean age = 49). Multilevel regression analyses showed that most aspects of partnership functioning did not differ significantly between youth and adult partnerships. These findings are encouraging given the success of the adult partnerships in reducing community-level rates of substance use and delinquency. Although youth partnership functioning appears to be strong enough to support effective prevention strategies, youth partnerships faced substantially more participation difficulties than adult partnerships. Strategies that youth partnerships can use to manage these challenges, such as creative scheduling and increasing opportunities for youth to help others directly, are discussed.

Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years.

BACKGROUND: A seven-year follow-up of heroin dependent patients treated in a buprenorphine-maintenance program combining contracted work/education and low tolerance for non-prescribed drug use. Gender-specific differences in outcome were analysed. METHODS: A consecutively admitted cohort of 135 men and 35 women, with eight years of heroin abuse/dependence on average was admitted to enhanced buprenorphine maintenance treatment. Standardized interviews, diagnostic assessments of psychiatric disorders and psychosocial conditions were conducted at admission and at follow-ups. Outcome associated with gender was reported for abstinence, retention, psychiatric symptoms, employment and criminal convictions. RESULTS: 148 patients started treatment. After seven years, 94/148 patients (64%) were retained in the program, employed and abstinent from drugs and alcohol. Women had more continuous abstinence, retention and employment than men (76% versus 60%). After one year patients with a high-risk consumption of alcohol were no longer heavy consumers of alcohol and remained so throughout the study (p < .001). All women regained custody of their children. At admission, more women than men had been admitted for psychiatric disorders (70%/44%) and to compulsory care for substance abuse (30%/18%). Initial gender differences of psychiatric co-morbidity decreased and were no longer significant after one year. More men than women had been imprisoned (62% versus 27%) or in non-institutional care (80% versus 49%). Criminal convictions were reduced from 1751 convictions at admission to 742 (58%) after seven years. Eight patients in the entire cohort died over the 7 years (0.7% per year). One patient died in the completers group while still in the program (0.1% per year). CONCLUSIONS: After seven years, two thirds of the patients in the program were abstinent and employed. Convictions ceased in the completers group. One patient died in the completers group. Women had superior long-term outcome compared to men: more continuous abstinence, employment and fewer convictions. Women also lived with their children to a higher extent than men. The positive outcome highlights the importance of maintaining high structure in combining pharmacological treatment with a focus on employment and psychological treatment and low tolerance for non-prescribed drug use.

As vítimas da voolência: entre discursos científicos e biopolíticas do contemporâneo / Víctimas dela viiolencia: mientre discursos científicos y las biopolíticas contemporáneas / Vitims of violennce: between scienific discourses and biopoliticss of contemporary

Este artigo apresenta reflexões em torno do papel social da vítima da violência na produção do medo e da insegurança, e sua influência no aumento dos mecanismos repressivos do estado penal brasileiro. Foi realizada uma pesquisa bibliográfica não sistemática buscando proposições acerca da criação de uma psicopatologia relacionada à vitimização, nesse caso o Transtorno de Estresse Pós-Traumático (TEPT). Indo além de uma proposta de caracterização do transtorno em si, o presente trabalho teve como objetivo entender as práticas que o engendram, quais contingências históricas o fizeram emergir em um determinado momento e quais efeitos têm produzido na medicalização da vida e nas atuais políticas públicas de segurança de nossa sociedade...

Este artículo presenta una reflexión sobre el papel social de las víctimas de la violencia en la génesis del miedo y la sensación de inseguridad, así como su influencia en el aumento de los mecanismos represivos del Estado penal brasileño. Se realizó una búsqueda no sistemática en la literatura sobre las propuestas de la creación de una psicopatología relacionada con la victimización, en este caso el Trastorno de Estrés Postraumático (TEPT). Más allá de una propuesta de caracterización del trastorno en sí, el objetivo de este estudio fue comprender las prácticas que lo causan, así como las contingencias históricas que lo hicieron surgir en un momento determinado y los efectos que han producido en la medicalización de la población y en las políticas públicas de seguridad de nuestra sociedad...

This article presents some reflections about the social role of the victims of violence in production of fear and insurance, and its influences in the repressive mechanisms in the state criminal justice. We performed a systematic literature search seeking proposals about the creation of a psychopathology related with the victimhood, the Posttraumatic Stress Disorder (PTSD). More than a simple characterization of the disorder, our aim was to investigate what practices create it, what effects produces in the medicalization of life and the actual public security policies in our society...

Os olhares sociais acerca da prática do ato infracional: reflexões éticas para o tempo presente / The social looks on practice of the infractional act: ethical reflections for the present time

O atual cenário de violência instalado na sociedade e o envolvimento de crianças e adolescentes chamam a atenção para uma questão importante: o debate acerca do ato infracional. As discussões que o norteia partem do pressuposto de que o adolescente deve ser punido igualmente ao adulto; que o Estatuto da Criança e do Adolescente (ECA) fortaleceu a proteção ao jovem "bandido", levando-o à impunidade e acentuando os índices da criminalidade juvenil. Percebe-se uma crise ética quando se discute adolescência, pobreza, violência e ato infracional, nos levando a essa reflexão que se mostra oportuna e desafiadora no tempo presente.

The current scenario of violence installed in the society and the involvement of children and adolescents in the settlement of this draws the attention to an important issue: the debate about the infraction act. The discussions that guides this question assumes that teenagers should be punished equally to adults; the Child and Adolescent Statute (ECA) strengthened the protection of the young "criminal", which leads him/her to impunity and increasing the rates of juvenile crimes. We perceived an ethical crisis when adolescence, poverty, violence and infractional acts are discussed, leading us to this reflection, which shows itself convenient and challenging nowadays.

Operation CeaseFire-New Orleans: an infectious disease model for addressing community recidivism from penetrating trauma.

BACKGROUND: CeaseFire, using an infectious disease approach, addresses violence by partnering hospital resources with the community by providing violence interruption and community-based services for an area roughly composed of a single city zip code (70113). Community-based violence interrupters start in the trauma center from the moment penetrating trauma occurs, through hospital stay, and in the community after release. This study interprets statistics from this pilot program, begun May 2012. We hypothesize a decrease in penetrating trauma rates in the target area compared with others after program implementation. METHODS: This was a 3-year prospective data collection of trauma registry from May 2010 to May 2013. All intentional, target area, penetrating trauma treated at our Level I trauma center received immediate activation of CeaseFire personnel. Incidences of violent trauma and rates of change, by zip code, were compared with the same period for 2 years before implementation. RESULTS: During this period, the yearly incidence of penetrating trauma in Orleans Parish increased. Four of the highest rates were found in adjacent zip codes: 70112, 70113, 70119, and 70125. Average rates per 100,000 were 722.7, 523.6, 286.4, and 248, respectively. These areas represent four of the six zip codes citywide that saw year-to-year increases in violent trauma during this period. Zip 70113 saw a lower rate of rise in trauma compared with 70112 and a higher but comparable rise compared with that of 70119 and 70125. CONCLUSION: Hospital-based intervention programs that partner with culturally appropriate personnel and resources outside the institution walls have potential to have meaningful impact over the long term. While few conclusions of the effect of such a program can be drawn in a 12-month period, we anticipate long-term changes in the numbers of penetrating injuries in the target area and in the rest of the city as this program expands. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Accounting for individual differences and timing of events: estimating the effect of treatment on criminal convictions in heroin users.

BACKGROUND: The reduction of crime is an important outcome of opioid maintenance treatment (OMT). Criminal intensity and treatment regimes vary among OMT patients, but this is rarely adjusted for in statistical analyses, which tend to focus on cohort incidence rates and rate ratios. The purpose of this work was to estimate the relationship between treatment and criminal convictions among OMT patients, adjusting for individual covariate information and timing of events, fitting time-to-event regression models of increasing complexity. METHODS: National criminal records were cross linked with treatment data on 3221 patients starting OMT in Norway 1997-2003. In addition to calculating cohort incidence rates, criminal convictions was modelled as a recurrent event dependent variable, and treatment a time-dependent covariate, in Cox proportional hazards, Aalen's additive hazards, and semi-parametric additive hazards regression models. Both fixed and dynamic covariates were included. RESULTS: During OMT, the number of days with criminal convictions for the cohort as a whole was 61% lower than when not in treatment. OMT was associated with reduced number of days with criminal convictions in all time-to-event regression models, but the hazard ratio (95% CI) was strongly attenuated when adjusting for covariates; from 0.40 (0.35, 0.45) in a univariate model to 0.79 (0.72, 0.87) in a fully adjusted model. The hazard was lower for females and decreasing with older age, while increasing with high numbers of criminal convictions prior to application to OMT (all p < 0.001). The strongest predictors were level of criminal activity prior to entering into OMT, and having a recent criminal conviction (both p < 0.001). The effect of several predictors was significantly time-varying with their effects diminishing over time. CONCLUSIONS: Analyzing complex observational data regarding to fixed factors only overlooks important temporal information, and naïve cohort level incidence rates might result in biased estimates of the effect of interventions. Applying time-to-event regression models, properly adjusting for individual covariate information and timing of various events, allows for more precise and reliable effect estimates, as well as painting a more nuanced picture that can aid health care professionals and policy makers.