Reductions in convictions for violent crime during opioid maintenance treatment: a longitudinal national cohort study

Background

Although opioid maintenance treatment (OMT) has been found to reduce crime, less is known about its associations with violent crime. This study investigates changes in violent crime convictions prior to, during, and after OMT, and examines the relationship between violent crime convictions prior to OMT with the risk of violent and non-violent crime convictions during treatment.

Methods

The cohort comprised all who started OMT (n = 3221) in Norway between 1997 and 2003. Treatment data were cross linked with the national Crime Registry. Convictions for violent crime 3 years prior to, during, and after treatment were studied.

Results

Violent crime rates were significantly reduced during OMT compared with before treatment, for both men and women. The rate of convictions for violent crime during OMT was halved amongst those who remained in treatment. The reduction was less pronounced for those who left treatment: for this group, the rate of violent convictions after OMT was higher than before treatment. The risk of convictions for violent and non-violent crime during OMT was highest for those with violent convictions prior to treatment.

Conclusions

Violent crime is reduced during OMT. Screening for violent behaviour and violence risk assessment should be implemented in the treatment system.     

A comparative study of violence risk assessment tools: a systematic review and metaregression analysis of 68 studies involving 25,980 participants

There are a large number of structured instruments that assist in the assessment of antisocial, violent and sexual risk, and their use appears to be increasing in mental health and criminal justice settings. However, little is known about which commonly used instruments produce the highest rates of predictive validity, and whether overall rates of predictive validity differ by gender, ethnicity, outcome, and other study characteristics. We undertook a systematic review and meta-analysis of nine commonly used risk assessment instruments following PRISMA guidelines. We collected data from 68 studies based on 25,980 participants in 88 independent samples. For 54 of the samples, new tabular data was provided directly by authors. We used four outcome statistics to assess rates of predictive validity, and analyzed sources of heterogeneity using subgroup analysis and metaregression. A tool designed to detect violence risk in juveniles, the Structured Assessment of Violence Risk in Youth (SAVRY), produced the highest rates of predictive validity, while an instrument used to identify adults at risk for general offending, the Level of Service Inventory - Revised (LSI-R), and a personality scale commonly used for the purposes of risk assessment, the Psychopathy Checklist - Revised (PCL-R), produced the lowest. Instruments produced higher rates of predictive validity in older and in predominantly White samples. Risk assessment procedures and guidelines by mental health services and criminal justice systems may need review in light of these findings.     

Physical and Sexual Abuse among Homeless and Unstably Housed Adults Living with HIV: Prevalence and Associated Risks

We examined the prevalence and risks associated with interpersonal (physical and sexual) abuse among HIV-seropositive homeless or unstably housed adults. Data were obtained from the Housing and Health Study of participants living in Baltimore, Chicago, and Los Angeles (n = 644). We used logistic regression to identify risks associated with abuse. About 77% of men and 86% of women reported ever experiencing abuse. Women were at greater risk than men for intimate partner physical abuse, childhood sexual abuse (CSA), and adulthood sexual abuse. Men and women experiencing intimate partner physical abuse reported increased risk of unprotected sex. Other risks associated with abuse include sex exchange; lifetime alcohol abuse; and depressive symptoms. Abuse prevalence among sample exceeds those found in other samples of general USA, HIV-seropositive, and homeless populations. Identifying persons at risk of abuse is needed to reduce risk among homeless or unstably housed persons living with HIV.     

Assessing risk for imminent violence in the elderly: the Brøset Violence Checklist

OBJECTIVE: The Br?set Violence Checklist (BVC) assesses confusion, irritability, boisterousness, verbal threats, physical threats and attacks on objects as either present or absent. It is hypothesised that an individual displaying two or more of these behaviours is more likely to be violent in the next twenty-four hour period. This study aims to test the validity of the instrument in geriatric settings and to report on the predictive value of an easy-to-use risk assessment instrument. METHOD: Eight thousand eight hundred and thirty-five BVC observations were completed in two psychogeriatric wards (n = 42 patients) and two special care units for patients with dementia (n = 40 residents). To measure violent incidents the study group was monitored using the Staff Observation Aggression Scale-Revised (SOAS-R). RESULTS: This study disclosed that patients in geriatric wards and residents in nursing homes who are aggressive have higher BVC scores than the non-violent subjects indicating that the BVC does predict violent episodes in these settings. CONCLUSION: From a clinical perspective, it is most important that a prediction aid has good sensitivity, so that most cases are detected and have a high negative predictive value so that most non-cases on the measure are indeed non-cases. Our results indicate that the BVC was able to achieve this goal.     

护士工作场所暴力流行病学研究

目的探讨护士工作场所暴力的流行病学特征,为有效预防与控制工作场所暴力提供科学依据。方法整群与分层抽样相结合,调查广东省所属广州、揭阳、深圳和东莞4市医院在职护士工作场所暴力发生情况,采用频数分析和Logistic回归等统计方法对资料进行处理。结果被调查到的3319名护士在过去的一年中有2085人遭受过工作场所暴力,个别护士甚至因暴力伤害而致残或遭受强奸（含未遂）,暴力的年发生率为62．82％,其中心理暴力为62．07％,身体暴力为15．06％。暴力多发生在急诊科或住院部各科室,科室内部以病房和护士站最常见,近1／3的暴力事件发生在晚依班。男性护士比女性护士更容易遭受暴力伤害,小于40岁年龄段护士是工作场所暴力的高危人群。受访者认为传媒在暴力防治过程中起重要作用。结论护士工作场所暴力问题严重,正逐渐成为一种职业伤害。护士个人、医院、政府以及社会传媒应共同努力,消除暴力隐患,尽量减少和避免护士工作场所暴力发生。     

Street children and their relationship with the police

Background: This paper explores and analyses the experiences of school‐age street children. It specifically addresses the relationship of the street children who live on the streets of São Paulo (a large Brazilian metropolis), in relation to their experiences, with the policemen. Methods: The paper is a secondary analysis of date previously collected in 1999. The data were collected through individual semi‐structured interviews, with 14 school‐age children frequenting two city public refuges, with their legal guardians' consent. The text from transcribed interviews was organized according to the validity norms of ‘thematic analysis’, a technique of contents analysis method. The decomposing and reconstructing process of that analysis gave rise to thematic categories (among which ‘the police category’) that represented the reconstruction of the difficulties faced by the children in their development. Results and discussion: The children portrayed the police as an enemy, a fearful figure and one of the most agonizing street experiences. Rarely did the police have a positive image to them. According to the children, police violence occurs in three forms: through systematic police persecution in an effort to remove the children from the streets against their will; actions that had the deliberate intent to humiliate them with verbal or physical aggression; and through alleged sexual abuse, revealed by the children in a veiled manner. The authority that is supposedly intended to protect them is portrayed as one of the most feared social agents. Conclusion: The reported hostile behaviour of the policemen shows the state of vulnerability of those children living on the street. This situation must be focused like a health problem because it causes injury to development of children. Nurses can help them through organizing assistance to children in situation of personal and social risk in the school nursing and health institution.     

Intimate partner violence and reproductive health of women in Kenya

Background:  Reproductive age represents an augmented risk of intimate partner violence (IPV) despite its occurrence in women of all ages. IPV has been associated with various reproductive health outcomes (e.g. terminated pregnancies and infant mortality), although multi-country studies indicate that the findings may not be consistent across all cultures.
Study aim and method:  The current work describes the association between IPV and reproductive health of women in Kenya using the Demographic and Health Survey of 2003.
Results:  A significant association between physical/emotional/sexual abuse of women and negative reproductive health outcomes such as terminated pregnancies and infant mortality was identified. In addition, IPV exposure was associated with use of family planning methods and high fertility.
Conclusion and recommendations:  Practitioners in the healthcare sector should inquire about abuse. Provision of counselling services and information regarding IPV effects on reproductive outcomes as well as referring abused women to relevant institutions is recommended in secondary prevention of IPV and to improve the reproductive health status of abused women.     

住院精神病人暴力行为的特点及护理对策

目的 探讨精神病人暴力行为特点及护理对策.方法 对617例住院精神病人暴力行为的发生情况进行调查.结果 住院精神病患者暴力行为的发生率为4.54%,年龄小,有阳性精神病家族史者暴力行为发生率较高,而暴力行为的发生与性别、文化程度、住院次数、入院方式等无明显关系.精神分裂症患者暴力行为发生率高(50%).暴力行为多发生在新入院病情尚未控制的病人以及有意识障碍的病人,而且与工作人员的工作方式和态度有一定的关系.结论 针对暴力行为发生的特点,采取相应的护理干预对策,可以减少或避免住院精神病人暴力行为的发生.     

Methodological Structure for Aggression Research

Kendler’s seminal essay listed 8 major propositions outlining a philosophical framework for the entire field of psychiatry [Kendler (American Journal of Psychiatry 162:433–440, 2005)]. These propositions have grounded psychiatric research on a coherent conceptual basis. The field of aggression research needs a general conceptual framework that would help us to integrate the contributions of neurobiology, sociology, criminology, and other areas. All of Kendler’s propositions are generally relevant in this respect. The aim of the current article is to develop specific applications of four of Kendler’s propositions for aggression research. These four propositions are: “Psychiatry is irrevocably grounded in mental, first-person experiences”, “Psychiatric disorders are etiologically complex, and we can expect no more “spirochete-like” discoveries that will explain their origin in simple terms”, “Explanatory pluralism is preferable to monistic explanatory approaches, especially biological reductionism”, and “Acceptance of Patchy Reductionism”.