Health status of juvenile offenders. A survey of young offenders appearing before the juvenile courts

This paper reports on the health needs of a sample of juvenile offenders appearing before a Manchester Court during the month of August 1992. Of the 192 subjects interviewed (74% of those listed), 19% had significant medical problems, 42% a history of substance abuse and 7% psychiatric problems requiring further treatment. Substantial numbers (26%) engaged in a variety of dangerous behaviours. Custodial remands were common (21%), particularly in those with multiple psychosocial difficulties.     

Therapeutic Agents of Assertive Community Treatment

The goal of this study was to learn how assertive community treatment (ACT) contributes to the improvement of those with serious mental illness in order to contribute to the growing clinical literature regarding the therapeutic agents of ACT teams. Methods included reviewing the case records of three ACT clients who have improved significantly, as well as interviewing the clients themselves and their clinicians. The results indicated that there was significant agreement among the case records, the clients, and their clinicians in identifying the most useful aspects of assertive community treatment. Primary among these factors were the persistence demonstrated by ACT clinicians in engaging their clients, the trust that clients developed in their clinicians, and as a result, the process by which their clinicians became guides to the world of psychiatric and social services that further facilitated their clients' community adjustment. In closing, we consider implications from these findings both for staff development for ACT team members, and for suggestions toward the development of a model of recovery from serious mental illness.     

Avoiding malpractice in private practice and the hospital setting

An overview of very real considerations for the practicing plastic surgeon with regards to potential areas of risk and liability have been presented. As one can see, the hospital environment presents many potential sources of liability that can involve the attending or consulting plastic surgeon.     

Search for a gene x environment interaction: G x E hunt

We developed a method to identify gene x environment interactions (G x Es). To test this method in the simulated data (Problem 2, GAW11), we first identified an environmental factor (E1) that was associated with the simulated disorder. We stratified affected sibling pairs (ASPs) into two groups, those concordant for the presence of E1 and those concordant for the absence of E1. We then localized genes on chromosomes 3 and 5 using identity-by-descent (IBD) sharing rates among ASPs. Because the stratified IBD sharing rates are independent of the environmental factor if there is no G x E, we inferred the existence of a G x E near loci 3G44 and 3G45 by testing whether the proportion of ASPs sharing no alleles IBD differed among the two groups.     

A comparison between propranolol and hypothermia in preventing ischemic contracture of the left ventricle (stone heart).

Ischemic contracture of the left ventricle ("stone heart") was studied utilizing a previously described stone heart model. Our studies suggest that beta-adrenergic blockade is not quantitatively as important as hypothermia in protecting ischemic myocardium. On the basis of reduced fibrillatory activity and a slight protective effect shown by electron microscopy, it would appear that combining propranolol with hypothermia may be superior to either used singly.     

Section II: General orthopaedics. Anterior cervical fusion for trauma.

Anterior bone grafts of 24 injured cervical spines were reviewed with respect to early postoperative instability and eventual malunion. Spinal redislocation or graft extrusion occurred in 21% representing failure to attain early stability. In 38%, the late complication of kyphotic malunion occurred, averaging 21%. The Yale instability criteria were fulfilled in 15 cases and mechanical complications developed in 87% of these. When posterior instability was present, the mechanical complication rate rose to 92%. Early stabilization of most neck injuries is not achieved by the anterior bone graft and its use as a means of "stabilization" is unsubstantiated by clinical experience.