Organised Assistance to Suicide in England?

Guidelines provided by the Director of Public Prosecutions suggest that anyone assisting another to commit suicide in England and Wales, or elsewhere, will not be prosecuted provided there are no self-seeking motives and no active encouragement. This reflects the position in Switzerland. There, however, no difference is made between assistance and inducement. In addition, the Swiss approach makes it possible to establish organisations to assist the suicides of both their citizens and foreign visitors. It should not be assumed that this approach is without controversy in Switzerland. Proposals for reform continue to be debated there, not least because of the concern about some of the actual practices of certain end-of-life organisations. It is likely that a few English citizens will continue to avail themselves of these services in Switzerland if they cannot find the help they require here. This paper explores the legitimacy of the current restrictive position adopted towards assisted suicide in England. It argues that the provisions within the guidelines prohibiting organisations that assist suicides, leaves some without the help they need. While legislative decriminalisation of assisted suicide and the establishment of state-sponsored suicide centres would represent the most permissive regime, this paper proposes that this would be a step too far. The preference here is for decriminalisation but adopting a ‘middle way’ between the two extremes: the more permissive approach provided by the ‘Swiss model’ is one that could be employed here, albeit within a more robust regulatory regime.     

The Urban Built Environment and Associations with Women’s Psychosocial Health

The determinants that underlie a healthy or unhealthy pregnancy are complex and not well understood. We assess the relationship between the built environment and maternal psychosocial status using directly observed residential neighborhood characteristics (housing damage, property disorder, tenure status, vacancy, security measures, violent crime, and nuisances) and a wide range of psychosocial attributes (interpersonal support evaluation list, self-efficacy, John Henryism active coping, negative partner support, Perceived Stress Scale, perceived racism, Center for Epidemiologic Studies—Depression) on a pregnant cohort of women living in the urban core of Durham, NC, USA. We found some associations between built environment characteristic and psychosocial health varied by exposure categorization approach, while others (residence in environments with more rental property is associated with higher reported active coping and negative partner support) were consistent across exposure categorizations. This study outlines specific neighborhood characteristics that are modifiable risk markers and therefore important targets for increased research and public health intervention.     

Hypnotic Age Regression and the Importance of Assessing Interpersonally Relevant Affect

The present study was undertaken to replicate an earlier experiment and to clarify which factors in this previous experiment (Nash, Johnson, & Tipton, 1979) were responsible for the obtained child-like behaviors of hypnotically regressed Ss. As in the previous study, 3 characteristics of the transitional object relationship (spontaneity, specificity, and intensity) were used as the primary criteria to investigate the effects of hypnotic age regression when Ss were regressed to age 3 and placed in 3 home situations. While in the previous study E suggested separation anxiety and isolation during the 3 home situations (mother-absent condition), the present study deleted all references to anxiety and isolation, and replaced them with suggestions of security and maternal proximity (mother-present condition). As expected, the mother-present versus mother-absent conditions led to similar hypnotized-simulating differences. In further accord with predictions, hypnotized Ss and simulating Ss requested a transitional object infrequently in the presence of mother. The importance of using dependent measures which index affective processes germane to interpersonal affect-laden experience is discussed.     

P REHOSPITAL U SE OF A NALGESIA FOR S USPECTED E XTREMITY F RACTURES

Introduction. Pain and its control have been studied extensively in the emergency department. Numerous studies indicate that inadequate treatment of pain is common, despite the availability of myriad analgesics. It has been suggested that oligoanesthesia is also a common practice in the prehospital setting. Objective. To assess the use of prehospital analgesia in patients with suspected extremity fracture. Methods. Emergency medical services (EMS) call reports were reviewed for all patients with suspected extremity fractures treated from June 1997 to July 1998 in a midwestern community with a population base of 223,000. Data collected included demographic information, mechanism of injury, medications given, and field treatment. Standing orders for administration of analgesia were available and permitted paramedics to give either morphine sulfate or nitrous oxide per protocol. Results. The EMS call reports were analyzed for 1,073 patients with suspected extremity fractures. The mean patient age was 47 years. Accidental injuries comprised 86.5% of those reviewed. Suspected leg fractures were most common (20%), followed by hips (18%), arms (11%), knees (10%), ankles (9%), shoulders (7.2%), hands (5.5%), and wrists (5.3%). Multiple trauma and assorted broken digits accounted for the remaining 14%. The most common mechanisms of injury were: fall (43%), motor vehicle collision (21%), and human assault (10%). Intravenous lines were placed in 9.4% of patients; 17% received ice packs; 16% received bandage/dressings; 25% received air splints; and 19% were fully immobilized. Analgesia was administered to 18 patients (1.8%): 16 patients received nitrous oxide and two received morphine. Conclusion. Administration of analgesics to prehospital patients with suspected fractures was rare. Prehospital identification and treatment of pain for patients with musculoskeletal trauma could be improved.     

Pay for Performance Improves Rural EMS Quality: Investment in Prehospital Care

Objective. To evaluate the effect of a system of financial reward for emergency medical technicians (EMTs) who meet selected quality marker goals. Methods. This project was reviewed by an institutional review board (IRB) andwas found to be exempt from IRB review. Two operational andfour clinical markers were targeted for improvement. Baseline performance measurements were retrospectively measured for the preceding year, andchallenging but achievable goals for improvement were established. Operational markers included completing run reports within three hours after completion of the run andcall-to-en route (“out-of-chute”) times of less than 90 seconds for emergency calls on our first-line ambulance. Clinical markers included the use of aspirin in adults with nontraumatic chest pain, electrocardiogram (ECG) performance in adults with nontraumatic chest pain, documentation of pain assessment andintervention in patients with traumatic hip pain, anddocumentation of the time of onset of symptoms in stroke calls. Each full-time EMT could earn up to $1,000 in addition to baseline pay, with part-time EMTs eligible for prorated amounts. Results. Postincentive run reports were completed within three hours 99.7% of the time, with 21 of 24 providers meeting the goal 100% of the time. Before the incentive, reports were completed within three hours 64% of the time, with only two of 23 providers meeting the goal 100% of the time. The out-of-chute goal of less than 90 seconds was met 98.7% of the time, compared with 90.1% before the incentive. Aspirin use in adult nontraumatic chest pain improved from 68% to 96.3%, andECG performance in this group improved from 43% to 87.8%. Documentation of the time of onset of symptoms in stroke patients improved from 97% to 100%, andthe assessment of andintervention for pain in traumatic hip pain patients improved from 56% to 100%. Conclusion. Financial motivation improved targeted quality measures in this rural emergency medical service. It appears to be a useful adjuvant to traditional quality improvement mechanisms.     

Disaster Response After Hurricane Katrina: A Model for an Academic–Community Partnership in Mississippi

Team Reach Out Biloxi is a nursing student-initiated service-learning project with the goal of providing ongoing assistance to the victims of Hurricane Katrina. On 6 different occasions from 2005 to 2008, Purdue nursing students integrated their leadership skills with application of public health knowledge, compassion, and concern as they worked in partnership with the Gulfport region Coastal Family Health Clinics (CFHC). This article reviews the service-learning framework, course planning, and implementation of a 3-year posthurricane disaster project.     

Pediatric Power Wheelchairs: Evaluation of Function in the Home and School Environments

The purpose of this study was to compare the performance of four power wheelchairs when used by children to perform a variety of indoor activities. Eight boys and eight girls performed a series of 11 functional tasks when positioned in each of four different power wheelchairs reflecting different design classes. There were no significant differences for many of the dependent variables. However, the Everaid Turbo was significantly better for functional positioning at a standard kitchen table and at school desks and for accessing objects at different heights. By contrast the Invacare Jaguar was better for straight-line driving speed. Other findings include children's subjective impressions of the four power wheelchairs.     

Promoting Sexual Health With SMS Texting Technology

Most cell phone owners use the short message service (SMS), also known as “texting.” Most teens and young adults use text messages; they were the first users to embrace this technology and are still the most frequent users. Text messaging has the potential to provide them with information about preventing sexually transmitted infections. Several innovative programs that use text messaging to promote sexual health are described here.     

IgG4-related tubulointerstitial nephritis

Tubulointerstitial nephritis (TIN) is a disease pattern with heterogeneous causes. Recently a specific subtype of autoimmune TIN, IgG4-related TIN, has been identified that is part of systemic IgG4-related disease/ autoimmune pancreatitis. On biopsy, this TIN shows an IgG4+ plasma cell-rich infiltrate, akin to the pancreatic tissue findings in autoimmune pancreatitis, and may show tubulointerstitial immune complex deposits. Notably, some cases may be mass-forming. Recognition of this specific type of TIN can guide appropriate patient therapy.