The Concept of Diminished Responsibility in Supranational Criminal Law (Psychiatric Approach)

The role of the community management order (CMO) in the management of mental illness has been associated with controversy. There is uncertainty as to the effectiveness of such involuntary treatment. Review of outcomes of involuntary community treatment has shown varied results, and in the remote areas of Australia the issue becomes more complex, and outcomes more difficult to measure. The Northern Territory's Mental Health Act 2000 has broadened criteria for detention. The decision to impose follow-up and case management on an individual (who may reside in a community several hundred kilometres from an in-patient facility) requires careful consideration of its ethical, professional and psychosocial implications. The trend toward increasing use of mental health legislation in the Northern Territory — particularly for Indigenous people — deserves close scrutiny in order that culturally appropriate and sensitive treatment plans are developed.     

A variety of methods for penile reconstruction

The authors have used microsurgical methods for one-stage phalloplasty in 63 penile reconstructions performed over the past 12 years. These operations account for about 10% of the free tissue microsurgical transfers performed in their clinic. Usually a one-stage microsurgical phalloplasty is performed using a combination of the techniques of Biemer, Trengove-Jones, and Gilbert together with the author's own way of sculpturing the glans. Several nontypical methods using multiple flap combinations were used in collaboration with Santi and Berrino in the Instituto Nazionale per la Ricerca sul Canro, Genoa (Italy) and Dominici and Pacifici at the University of Perugia (Italy). The authors were responsible for the idea of constructing a skin tunnel inside the penis using two microsurgical free flaps which allows insertion of a temporary inner stiffener. From the microsurgical point of view, this procedure should be considered a "flap within a flap."     

Hepatitis C virus infection in young, low-income women: the role of sexually transmitted infection as a potential cofactor for HCV infection

OBJECTIVES: We evaluated risk for hepatitis C virus (HCV) infection in women residing in low-income neighborhoods of northern California. METHODS: A population-based sample of 1707 women, aged 18 to 29, were surveyed and screened for sexually transmitted infections and HCV. RESULTS: Women infected with HCV (2.5%) were more likely to have a history of injection and noninjection drug use, to exchange sex for money or drugs, and to have sexually transmitted infections. HCV was independently associated with history of injection drug use, herpes simplex virus type 2 (HSV-2) infection, and heroin and cocaine use. CONCLUSIONS: Injection drug use is the highest risk exposure for HCV, but HSV-2 and noninjection drug use contribute significantly to increased risk. HCV prevention programs in impoverished areas should integrate drug treatment and sexually transmitted infection control.