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1.
MMWR Morb Mortal Wkly Rep ; 68(47): 1096-1100, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31774740

RESUMO

During August 9-October 31, 2019, 96 patients were classified as having e-cigarette, or vaping, product use-associated lung injury (EVALI) by the Minnesota Department of Health (MDH); other patients are being investigated for case classification and exposures. Among 58 patients interviewed, 53 (91%) reported obtaining tetrahydrocannabinol (THC)-containing products from informal sources such as friends, family members, or in-person or online dealers. Using gas chromatography-mass spectrometry (GCMS), the MDH Public Health Laboratory (PHL) analyzed 46 THC-containing e-cigarette, or vaping, products obtained from 12 EVALI patients for various potential toxicants, including vitamin E acetate, which has recently been detected in some THC-containing products and in samples of lung fluid from EVALI patients (1-4). To explore whether vitamin E acetate is a recently added component in THC-containing products, MDH tested ten products seized by law enforcement in 2018, before the EVALI outbreak, and 20 products seized in 2019, during the outbreak. Twenty-four products obtained from 11 EVALI patients from 2019 contained vitamin E acetate. Among the seized products tested by MDH, none seized in 2018 contained vitamin E acetate, although all tested THC-containing products seized in 2019 tested positive for vitamin E acetate. These chemical analyses of products obtained from EVALI patients and of products intended for the illicit market both before and during the outbreak support a potential role for vitamin E acetate in the EVALI outbreak; however, the number of products tested was small, and further research is needed to establish a causal link between exposure to inhaled vitamin E acetate and EVALI. Collaboration between public health jurisdictions and law enforcement to characterize THC-containing products circulating before the recognition of the EVALI outbreak and during the outbreak might provide valuable information about a dynamic market. These Minnesota findings highlight concerns about e-cigarette, or vaping, products that contain THC acquired from informal sources. Because local supply chains and policy environments vary, CDC continues to recommend not using e-cigarette, or vaping, products that contain THC or any e-cigarette, or vaping, products obtained from informal sources. E-cigarette, or vaping, products should never be used by youths, young adults, or pregnant women.* Until the relationship between inhaled vitamin E acetate and lung health is better characterized, vitamin E acetate should not be added to e-cigarette, or vaping, products.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Legislação de Medicamentos , Lesão Pulmonar/epidemiologia , Vaping/efeitos adversos , Adolescente , Adulto , Idoso , Dronabinol/efeitos adversos , Dronabinol/análise , Feminino , Humanos , Aplicação da Lei , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Vitamina E/efeitos adversos , Vitamina E/análise , Adulto Jovem
2.
Georgian Med News ; (292-293): 129-134, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31560678

RESUMO

The aim of the study is to identify topical issues of the regulatory framework and the application of legal provisions related to acquisition (collection) of samples for examination in criminal proceedings. To achieve this objective, as well as justify the results, a set of general scientific and special methods is used. The comparative legal method enables to analyze the criminal procedure legislation of Ukraine and other countries, as well as the practice of the European Court of Human Rights. The system-structural method enables to reveal the procedure for sample acquisition for examination. The technical-logical method is the basis for forming the conceptual apparatus in the framework of the subject under study. The statistical method is used in the course of summarizing and processing of the data of investigative and judicial practice. The analysis of the procedure for acquisition (collection) of samples for examination in criminal proceedings is carried out in accordance with the Criminal Procedure Code of Ukraine and international acts. The study states that the CPC of Ukraine, first, does not reveal the concept of "samples for examination," "biological samples"; second, does not fix the list of sample objects that can be obtained for comparative examination; third, does not provide the list of persons authorized to conduct this procedural action and persons, from whom they can be collected. Taking into account the study conducted, the author suggests how to improve the procedure and organization of sample acquisition for examination, as well as recommends how to resolve problematic issues arising during their collection.


Assuntos
Criminosos , Aplicação da Lei , Criminosos/legislação & jurisprudência , Patologia Legal , Direitos Humanos , Humanos , Ucrânia
3.
Crim Behav Ment Health ; 29(4): 207-217, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31478274

RESUMO

BACKGROUND: Care pathway approaches were introduced into health care in the 1980s and have become standard international practice. They are now being introduced more specifically for health care in the criminal justice system. Care pathway delivery has the theoretical advantage of encouraging a whole-systems approach for health and social care within the criminal justice system, but how well is it supported by empirical evidence? AIMS: The aim of this study is to review the nature and extent of evidence streams supporting health care delivery within interagency pathway developments since 2000. METHOD: We used an exploratory narrative method to review the nature and extent of evidence streams supporting health care delivery within interagency pathway developments since 2000. The available literature was reviewed using a keyword search approach with three databases: PubMed, Medline, and Google Scholar. FINDINGS: Research in this field has covered police custody, courts, prisons, and the wider community, but there is little that follows the entire career through all these elements of offender placement. Main themes in the research to date, regardless of where the research was conducted, have been counting the disorder or the need, development and evaluation of screening tools, and evaluation of clinical intervention styles. Most evidence to date is simply observational, although the possibility of conducting randomised controlled trials of interventions within parts of the criminal justice system, especially prisons, is now well established. CONCLUSIONS: Access to health care while passing through the criminal justice system is essential because of the disproportionately high rates of mental disorder among offenders, and the concept of structured pathways to ensure this theoretically satisfying, but as yet empirically unsupported. Further, substantial cuts in services, generally following government economies, are largely unresearched. Considerable investment in new possibilities, driven by both pressure groups and government, tend to be informed by good will and theory rather than hard evidence and are often not evaluated even after introduction. This must change.


Assuntos
Direito Penal , Criminosos/psicologia , Assistência à Saúde/organização & administração , Acesso aos Serviços de Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Saúde Mental , Humanos , Aplicação da Lei , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Polícia/organização & administração , Prisioneiros/psicologia , Prisões
6.
BMC Health Serv Res ; 19(1): 536, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366363

RESUMO

BACKGROUND: Many low- and middle-income countries (LMIC) are moving towards enforcing prescription-only access to antibiotics. This systematic literature review aims to assess the interventions used to enforce existing legislation prohibiting over-the-counter (OTC) sales of antibiotics in LMICs, their impact and examine the methods chosen for impact measurement including their strengths and weaknesses. METHODS: Both PubMed and Embase were systematically searched for studies reporting on impact measurement in moving towards prescription only access to antibiotics in LMICs. The PRISMA methodological review framework was used to ensure systematic data collection and analysis of literature. Narrative data synthesis was used due to heterogeneity of study designs. RESULTS: In total, 15 studies were included that assessed policy impact in 10 different countries. Strategies employed to enforce regulations prohibiting OTC sales of systemic antibiotics included retention of prescriptions for antibiotics by pharmacies, government inspections, engaging pharmacists in the design of interventions, media campaigns for the general public and educational activities for health care workers. A variety of outcomes was used to assess the policy impact; changes in antimicrobial resistance rates, changes in levels of antibiotic use, changes in trends of antibiotic use, changes in OTC supply of antibiotics, and changes in reported practices and knowledge of pharmacists, medicine sellers and the general public. Differences in methodological approaches and outcome assessment made it difficult to compare the effectiveness of law enforcement activities. Most effective appeared to be multifaceted approaches that involved all stakeholders. Monitoring of the impact on total sales of antibiotics by means of an interrupted time series (ITS) analysis and analysis of pharmacies selling antibiotics OTC using mystery clients were the methodologically strongest designs used. CONCLUSIONS: The published literature describing activities to enforce prescription-only access to antibiotics in LMICs is sparse and offers limited guidance. Most likely to be effective are comprehensive multifaceted interventions targeting all stakeholders with regular reinforcement of messages. Policy evaluation should be planned as part of implementation to assess the impact and effectiveness of intervention strategies and to identify targets for further activities. Robust study designs such as ITS analyses and mystery client surveys should be used to monitor policy impact.


Assuntos
Antibacterianos , Comércio/legislação & jurisprudência , Aplicação da Lei , Legislação de Medicamentos , Medicamentos sem Prescrição , Comércio/estatística & dados numéricos , Países em Desenvolvimento , Humanos , Análise de Séries Temporais Interrompida
7.
Georgian Med News ; (290): 163-170, 2019 May.
Artigo em Russo | MEDLINE | ID: mdl-31322536

RESUMO

The objective of the article is to define the concept of iatrogenic crimes, the specifics of their forensic characteristics, the circumstances to be established and studied, and the development of tactics for the main investigative actions. To achieve this objective, the authors have used general scientific and special methods of cognition, chosen according to the objective of the paper. So, the circumstances to be established and studied during the investigation of cases involving iatrogenic crimes have been determined with the help of the method of legal analysis. The statistical method has been used to determine the tactics of the main investigative actions, to identify problem aspects faced by investigators or operative officers during the investigation of crimes on the commission of a negligent crime in the provision of medical assistance or improper performance of professional duties by medical employees or pharmacists. The carried out study made it possible to formulate a forensic characteristic of iatrogenic crimes, to determine and analyze the stages of the process of providing medical care to a patient, as a result of which the patient had or developed iatrogeny, to pay attention to specific features of the interrogation of victims, witnesses and suspects. The authors have highlighted some aspects of the problem of identifying and solving iatrogenic crimes faced by law enforcement agencies. For this purpose, the interviewing of certain groups of investigators and operative officers of the police and security service in Kharkiv region has been conducted. This made it possible to identify problematic issues faced by investigators or operative officers during the investigation of crimes on the commission of a careless crime while providing medical assistance or improper performance of professional duties by medical employees or pharmacists and to suggest the ways to solve them.


Assuntos
Crime , Assistência à Saúde , Medicina Legal , Doença Iatrogênica , Imperícia , Erros Médicos , Polícia , Humanos , Aplicação da Lei , Assistência ao Paciente
8.
Forensic Sci Rev ; 31(2): 161-184, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31270060

RESUMO

Reducing impaired driving requires a systematic, consistent, and multifaceted approach. There is strong evidence on the effectiveness of both direct and indirect measures. The strategy that has the most immediate and largest impact has been highly publicized, visible, and frequent impaired-driving enforcement, especially deploying sobriety checkpoints or random breath testing. Lowering legal blood alcohol concentration (BAC) limits for driving to 0.05 g/dL or lower has also had a world-wide impact. Raising the legal drinking age has been successful in the US and other countries in reducing young impaired-driver fatal crashes. Graduated drivers' licensing for youth has also been effective by restricting conditions under which youth can drive. Sanctions that reduce impaired-driving recidivism include special driving-under-the-influence (DUI)/driving-while-intoxicated (DWI) courts, mandatory alcohol ignition interlocks, and consistent alcohol-monitoring programs. Opportunities for further progress include better enforcement of the drinking age and refusing to serve obviously intoxicated patrons. Technology for detecting alcohol impairment and autonomous vehicles will also play an important role in future efforts to eliminate impaired driving.


Assuntos
Acidentes de Trânsito/prevenção & controle , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Condução de Veículo/legislação & jurisprudência , Dirigir sob a Influência/legislação & jurisprudência , Dirigir sob a Influência/prevenção & controle , Aplicação da Lei , Concentração Alcoólica no Sangue , Humanos
9.
J Forensic Leg Med ; 66: 117-119, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31299483

RESUMO

DNA can be useful corroborative evidence in establishing familial relationship in immigration cases. Presently, there is no specific law in the UK regulating the use of DNA in this domain. This has led to inconsistencies in policy guidance and the rejection of some immigrant applications solely or partly due to a lack of DNA evidence. This commentary draws on the DNA regulatory regime in law enforcement to make a case for a specific DNA immigration law to protect individual rights, assure fairness and trust in the treatment of applicants. In addition to a specific law, consistency in operations should be ensured by developing a central point of contact for guidance including a central IT system, and a custodian of the DNA application process. Further, a single code of practice and conduct is proposed to ensure that guidance products are in line with the law and practice. An independent multi-stakeholder board is also recommended to ensure that policies are representative of the views of applicants and their relatives; policy officers and operational staff; and policymakers and the public.


Assuntos
Impressões Digitais de DNA/legislação & jurisprudência , Emigrantes e Imigrantes/legislação & jurisprudência , Emigração e Imigração/legislação & jurisprudência , Humanos , Aplicação da Lei , Medidas de Segurança/legislação & jurisprudência , Reino Unido
10.
Forensic Sci Int ; 301: 107-117, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31153988

RESUMO

In the last year direct-to-consumer (DTC) genetic genealogy databases have been used to identify suspects and missing persons in over fifty cold cases, many of which have been unsolved for decades. Genealogists worked on these cases in collaboration with law enforcement agencies. Raw DNA data files were uploaded to the genealogy websites GEDmatch and FamilyTreeDNA, and identification was made by tracing the family trees of relatives who were predicted to be close genetic matches in the database. Such searches have far-reaching consequences because they affect not just those who have consented to upload their DNA results to these databases but also all of their relatives, regardless of whether or not they have taken a DNA test. This article provides an overview of the methods used, the potential privacy and security issues, and the wider implications for society. There is an urgent need for forensic scientists, bioethicists, law enforcement agencies, genetic genealogists and other interested parties to work together to produce international guidelines and policies to ensure that the techniques are used responsibly and effectively.


Assuntos
Crime , Impressões Digitais de DNA , Bases de Dados de Ácidos Nucleicos , Aplicação da Lei , Linhagem , Cromossomos Humanos Y , Privacidade Genética , Humanos , Consentimento Livre e Esclarecido , Repetições de Microssatélites , Sequenciamento Completo do Genoma
12.
Forensic Sci Int ; 299: 174-179, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31039545

RESUMO

Medical problems related to illicit drug use are frequently encountered at electronic dance music (EDM) events. In this prospective study, the medical problems and toxicological analyses on intoxicated persons and seized materials are described jointly. The aim of this study is to find out to what extent these efforts may assist in developing prevention strategies and organising on-site care at EDM events. The most frequently encountered clinical presentation in the 121 included patients was: agitation/aggression (26%), drunkenness (25%), depressed level of consciousness (24%) and hallucinations (9%). Only five patients were transported by ambulance to a hospital. In 100 of the 121 included patients (83%) an ethanolemia of at least 0.50 g/L was measured (with ethanol as the only drug found in 47 cases). 3,4-methylenedioxymethamphetamine (MDMA) was detected in 54% of the blood samples, cocaine in 11%, gamma-hydroxybutyric acid (GHB) in 11%, amphetamine in 7%, ketamine in 6% and a new psychoactive substance (NPS) in 4%. Except for 8 MDMA-users poly drug use was found in all these cases. The 178 seized samples most frequently contained MDMA (31%), cannabis (28%) or no active substance (15%). In 11 samples (6%) an NPS was detected. Of particular interest was a tablet containing 4-chloromethamphetamine (a previously unknown neurotoxic NPS), 4-chloroamphetamine, para-methoxyamphetamine, para-methoxymethamphetamine and ethylone. Our data show that at EDM events ethanol and MDMA are still the party drugs causing most health hazards and that NPS only play a minor role. Regarding the toxicological efforts, we recommend to analyse all seized materials from an EDM event, but only blood samples from the most severely intoxicated patients.


Assuntos
Intoxicação Alcoólica/epidemiologia , Concentração Alcoólica no Sangue , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Bélgica/epidemiologia , Serviços Médicos de Emergência , Humanos , Aplicação da Lei , Comportamento de Massa , Estudos Prospectivos , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/sangue
14.
J Emerg Manag ; 17(1): 45-52, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30933304

RESUMO

While the number of higher education programs in Emergency Management has increased significantly, many emergency management agencies continue to rely on emergency services organizations-including law enforcement agencies-as sources of experienced or trained emergency management practitioners. As the field of emergency management matures, however, becoming more complex, more technical, and significantly broader, law enforcement experience may no longer prepare an individual to succeed as a professional emergency manager. To ensure a successful transition, government officials seeking to fill emergency management leadership positions and law enforcement officers seeking to transition to emergency management must recognize the significant occupational, organizational, and cultural differences between law enforcement and emergency management, and they should develop strategies for mitigating those differences.


Assuntos
Serviços Médicos de Emergência/organização & administração , Aplicação da Lei , Polícia , Emergências , Humanos , Organizações
15.
Behav Sci Law ; 37(4): 372-387, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30941785

RESUMO

False confessors are stigmatized more than other exonerees. Traditional theories of stigma suggest that this difference may result from confessors being seen as more responsible for their own wrongful conviction. In the current study, we examined an important tangible consequence of stigma against false confessors-namely, that it might impede their ability to win financial restitution in post-exoneration civil lawsuits. Mock jurors (N = 129), recruited online, read a case summary in which an exoneree is seeking damages after being wrongly convicted due to a false confession or eyewitness misidentification, which either did or did not result from police misconduct. When the exoneree falsely confessed in the absence of police misconduct, mock jurors rated him as most responsible for his own conviction and expressed the most doubt over his actual innocence. Contrary to legal criteria, they also awarded him smaller compensatory and punitive damage awards. Notably, the false confessor was seen as more responsible than the misidentified exoneree even if his interrogation was highly coercive. In turn, false confessors who were seen as more responsible received smaller damage awards. Implications for trial procedure and exoneree compensation are discussed.


Assuntos
Coerção , Função Jurisdicional , Polícia , Humanos , Aplicação da Lei , Masculino
16.
Accid Anal Prev ; 128: 139-147, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31015183

RESUMO

The aim of this paper is to update the most recent published evidence on road safety estimates of recent red light camera (RLC) and speed/red light camera studies (SRLC). A literature search was carried out on RLC studies in the period 2013-2017 which, after screening, identified 18 recent studies on red light cameras (RLCs) and speed/red light cameras (SRLCs). The methodology and results of these studies were further examined and summary safety estimates were derived and compared to earlier meta-analysis summary estimates. The primary conclusion is that the new safety estimates from this paper show a 12% decrease of total crashes and confirm the general tendency of RLCs to reduce right angle crashes while at the same time increasing rear-end crashes. However, comparing the developments over time, the review reveals that safety estimates tend to increase with time (the safety effects of the most recent studies are the greatest). Also safety estimates suggest more positive effects with SRLCs than with RLCs. Most of recent studies indicate that spillover effects are present and can be quite substantial.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Fotografação/métodos , Acidentes de Trânsito/prevenção & controle , Condução de Veículo/legislação & jurisprudência , Humanos , Aplicação da Lei/métodos , Segurança
17.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30988023

RESUMO

The phenomenon of teen sexting emerged as a result of the proliferation of digital technology. More than 40 studies have established that teen sexting occurs relatively frequently and is a rising trend, commensurate with the ubiquity of smartphone ownership in teens. Studies have shown that sexting is associated with incidences of increased sexual behavior. US state laws on sexting vary widely, from decriminalization to misdemeanor charges or prosecution for child pornography with harsh sentences. Teen behavior and digital invention have outpaced the development of new laws, and this has the potential to have dire legal ramifications for teens. Separating consensual sexting from nonconsensual sexting and actual child pornography is a critical next step for law enforcement agencies and policy makers to catch up to technology. In this article, we argue that consensual teen-to-teen sexting does not warrant law enforcement involvement but rather is a health and education issue that is better addressed at home, in schools, and in primary care.


Assuntos
Comportamento do Adolescente , Literatura Erótica/legislação & jurisprudência , Aplicação da Lei , Comportamento Sexual , Mensagem de Texto/legislação & jurisprudência , Adolescente , Comportamento do Adolescente/psicologia , Literatura Erótica/psicologia , Humanos , Aplicação da Lei/métodos , Comportamento Sexual/psicologia
18.
Lancet ; 393(10179): 1412-1413, 2019 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-30967208
20.
Artigo em Inglês | MEDLINE | ID: mdl-30991657

RESUMO

Rural areas of New York State (NYS) have higher rates of alcohol-related motor vehicle (MV) crash injury than metropolitan areas. While alcohol-related injury has declined across the three geographic regions of NYS, disparities persist with rural areas having smaller declines. Our study aim was to examine factors associated with alcohol-related MV crashes in Upstate and Long Island using multi-sourced county-level data that included the Crash Outcome Data Evaluation System (CODES) with emergency department visits and hospitalizations, traffic citations, demographic, economic, transportation, alcohol outlets, and Rural-Urban Continuum Codes (RUCCS). A cross-sectional study design employed zero-truncated negative binominal regression models to assess relative risks (RR) with 95% confidence interval (CI). Counties (n = 57, 56,000 alcohol-related crashes over the 3 year study timeframe) were categorized by mean annual alcohol-related MV injuries per 100,000 population: low (24.7 ± 3.9), medium (33.9 ± 1.7) and high (46.1 ± 8.0) (p < 0.0001). In multivariable analyses, alcohol-related MV injury was elevated for non-adjacent, non-metropolitan counties (RR 2.5, 95% CI: 1.6-3.9) with higher citations for impaired driving showing a small, but significant protective effect. Less metropolitan areas had higher alcohol-related MV injury with inconsistent alcohol-related enforcement measures. In summary, higher alcohol-related MV injury rates in non-metropolitan counties demonstrated a dose-response relationship with proximity to a metropolitan area. These findings suggest areas where intervention efforts might be targeted to lower alcohol-related MV injury.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/epidemiologia , Intoxicação Alcoólica/epidemiologia , Aplicação da Lei , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Codificação Clínica , Estudos Transversais , Humanos , New York/epidemiologia
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