Intra- & Extra-Familial Child Homicide in Sweden 1992-2012: A Population-Based Study

Previous studies have shown decreasing child homicide rates in many countries - in Sweden mainly due to a drop in filicide-suicides. This study examines the rate of child homicides during 21 years, with the hypothesis that a decline might be attributable to a decrease in the number of depressive filicide offenders (as defined by a proxy measure). 

In addition, numerous characteristics of child homicide are presented. All homicide incidents involving 0-14-year-old victims in Sweden during 1992-2012 (n = 90) were identified in an autopsy database. Data from multiple registries, forensic psychiatric evaluations, police reports, verdicts and other sources were collected. Utilizing Poisson regression, we found a 4% annual decrease in child homicides, in accordance with prior studies, but no marked decrease regarding the depressive-offender proxy. 

Diagnoses from forensic psychiatric evaluations (n = 50) included substance misuse (8%), affective disorders (10%), autism-spectrum disorders (18%), psychotic disorders (28%) and personality disorders (30%). Prior violent offences were more common among offenders in filicides than filicide-suicides (17.8% vs. 6.9%); and about 20% of offenders in each group had previously received psychiatric inpatient care. 

Aggressive methods of filicide predominated among fathers. Highly lethal methods of filicide (firearms, fire) were more commonly followed by same-method suicide than less lethal methods. Interestingly, a third of the extra-familial offenders had an autism-spectrum disorder. 

Based on several findings, e.g., the low rate of substance misuse, the study concludes that non-traditional risk factors for violence must be highlighted by healthcare providers. Also, the occurrence of autism-spectrum disorders in the present study is a novel finding that warrants further investigation.

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By:  Hedlund J1, Masterman T2, Sturup J3.

• 1National Board of Forensic Medicine, Department of Forensic Psychiatry, PO Box 4044, SE-141 04 Huddinge, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, SE-171 77 Stockholm, Sweden. Electronic address: jonatan.hedlund@ki.se.
• 2National Board of Forensic Medicine, Department of Forensic Psychiatry, PO Box 4044, SE-141 04 Huddinge, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, SE-171 77 Stockholm, Sweden.
• 3National Board of Forensic Medicine, Department of Forensic Psychiatry, PO Box 4044, SE-141 04 Huddinge, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, SE-171 77 Stockholm, Sweden; Stockholm University, Department of Criminology, Sweden.
• J Forensic Leg Med. 2016 Jan 25;39:91-99. doi: 10.1016/j.jflm.2016.01.011.  

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Critical Remarks on Strategies Aiming to Reduce Drug Related Harm: Substance Misuse & HIV/AIDS in a World in Turmoil

ABSTRACT

In the last decades, the initiatives implemented under the conceptual umbrella of Harm Reduction have gained momentum, with a vigor and scope (both from a geographic and social perspective) never seen before. A more balanced reevaluation could and should rather say such initiatives have resumed, to a large extent, ideas and actions launched much earlier, in the first decades of the 20th century. Notwithstanding, the dissemination of HIV/AIDS in recent years conferred an exceptional visibility and legitimacy to proposals formerly viewed as subsidiary or openly neglected. Nowadays, initiatives inspired by the Harm Reduction philosophy have faced an "identity crisis", not secondary (according to our perspective) to challenges faced by its concepts and operations, but rather as consequence of a world in a turmoil. Such fast-changing dynamics have reconfigured both drug scenes and the patterns and prospects of HIV/AIDS worldwide. This article briefly summarizes some of such recent, ongoing, changes, which have been deeply affecting both concepts and practices to the point of asking for a deep reformulation of most of the initiatives implemented so far.

...Drug scenes have been changing under a fast pace worldwide. The in-depth assessment of such new scenarios and trends has been addressed by recent reviews, some of them with a focus on the interface between the new drug scene and the prevention of HIV/AIDS⁹.

Both in Brazil and in the vast majority of other countries, worldwide, the habit of injecting illicit drugs has experiencing a fast and pronounced decline¹⁰. Exception made to some "hot spots", in which the injection of illicit substances remains a relatively frequent habit, such as some countries from Southern Asia and Eastern Europe, injection has been progressively replaced by alternative ways; people use classic substances, as cocaine, snorting, smoking and by other routes (e.g. ingesting, applying dermal patches, etc.), as well as by a growing number of modified/different (many times, brand new) non-injectable substances.

Even in some places where injection was especially prevalent and had been one of the key drivers of HIV and HCV spread, such as in Estonia, Eastern Europe, injection has becoming a less frequent habit in recent years¹¹.

However, the deep and fast transition of drug markets and scenes in recent years is much broader than the changes associated with new/renewed routes people may use substances. First of all, the very nature and composition of substances have been reconfigured and (re)designed. Some of these changes correspond to different presentations of a single or related group of substances, such as the increase of smoked crack cocaine in detriment of snorted powder cocaine in contemporary Brazil¹². From a different, maybe complementary perspective, markets and drug scenes have been flooded by brand new drugs, most of them undetectable by current toxicological analyses. Due to the illicit nature of such markets and the very fact such substances are specifically designed to evade detection, it is very difficult and many times impossible to track their dissemination and to better understand the profile, habits and risks faced by their consumers.

Anyway, sooner or later, substances initially regarded as local, sometimes idiosyncratic, have become global commodities, as happened to ecstasy over the last decade, a substance which is nowadays the "lubricant" of the disco party scenes all over the world.

To the best of our knowledge, exception made to compounds based on salvia divinorum, a plant which is native to many different Brazilian regions, there is no sound information on the putative misuse of such different substances, which may or may not be used in Brazil. These new substances may include: bath salts and other cathinones¹³, untraceable amphetamine-like substances¹⁴, new synthetic cannabinoids¹⁴ etc. Such vast and highly heterogeneous group of substances has been studied under the conceptual umbrella of "legal highs", i.e. substances with psychoactive effects which do not belong to the classic lists of substances under control, are virtually untraceable, and are not amenable to any modality of medical or legal surveillance¹⁵.

Despite the undeniable relevance of such substances in the American, Western European and Australian markets, as recently summarized by UNODC, in its 2012 Annual Report (http://www.unodc.org/documents/data-and-analysis/WDR2012/WDR_2012_web_small.pdf), there is no clear information about the putative association of their use and misuse with the acquisition and transmission of HIV and/or other sexually transmitted infections, either as mind-altering substances that might compromise the consistent use of condoms or substances that may be eventually injected, as have been seldom reported¹⁶.

One thing is pretty clear to experts and policy-makers: the markets and scenes of drug trafficking and use will be deeply impacted by such new substances, as well as by alternative modes of administration and habits, many of them navigating "under the radar" of surveillance systems worldwide...

Full article at:  http://goo.gl/fv4vrf

By:  Bastos FI1, Veloso Filho CL1.

• 1Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil. 

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Examination of the Community-Specific Prevalence Of & Factors Associated with Substance Use & Misuse among Rural & Urban Adolescents: A Cross-Sectional Analysis in Bosnia & Herzegovina

The community of residence (ie, urban vs rural) is one of the known factors of influence on substance use and misuse (SUM). The aim of this study was to explore the community-specific prevalence of SUM and the associations that exist between scholastic, familial, sports and sociodemographic factors with SUM in adolescents from Bosnia and Herzegovina.

In this cross-sectional study, which was completed between November and December 2014, the participants were 957 adolescents (aged 17 to 18 years) from Bosnia and Herzegovina (485; 50.6% females). The independent variables were sociodemographic, academic, sport and familial factors. The dependent variables consisted of questions on cigarette smoking and alcohol consumption. We have calculated differences between groups of participants (gender, community), while the logistic regressions were applied to define associations between the independent and dependent variables.

In the urban community, cigarette smoking is more prevalent in girls, while harmful drinking is more prevalent in boys. When data are weighted by gender and community, harmful drinking is more prevalent in urban boys, cigarette smoking is more frequent in rural boys, and urban girls misuse substances to a greater extent than rural girls. Academic failure is strongly associated with a higher likelihood of SUM. The associations between parental factors and SUM are more evident in urban youth. Sports factors are specifically correlated with SUM for urban girls.

Living in an urban environment should be considered as a higher risk factor for SUM in girls. Parental variables are more strongly associated with SUM among urban youth, most probably because of the higher parental involvement in children' personal lives in urban communities (ie, college plans, for example). Specific indicators should be monitored in the prevention of SUM.

Below:  Prevalence of harmful alcohol drinking with OR between and within genders. Percentage of reported frequency for boys and girls with n=472 and n=485, respectively, being 100%.

Below:  Prevalence of multiple substance use and misuse (simultaneous harmful drinking and cigarette smoking) with OR between and within genders. Percentage of reported frequency for boys and girls with n=472 and n=485, respectively, being 100%.

Full article at:  http://goo.gl/Xjzk74

By: Zenic N1, Ostojic L2, Sisic N1, Pojskic H3, Peric M1, Uljevic O1, Sekulic D4.

• 1Faculty of Kinesiology, University of Split, Split, Croatia.
• 2Faculty of Kinesiology, University of Split, Split, Croatia University of Mostar, Mostar, Bosnia and Herzegovina Academy of Medical Sciences of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina.
• 3Department for Health Sciences, Mid Sweden University, Östersund, Sweden.
• 4Faculty of Kinesiology, University of Split, Split, Croatia University Department of Health Care Studies, Split, Croatia. 

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Interrelationships among Parental Family History of Substance Misuse, Delay Discounting & Personal Substance Use

Despite consistent evidence of the familiality of substance misuse, the mechanisms by which family history (FH) increases the risk of addiction are not well understood. One behavioral trait that may mediate the risk for substance use and addiction is delay discounting (DD), which characterizes an individual's preferences for smaller immediate rewards compared to larger future rewards.

The aim of this study is to examine the interrelationships among FH, DD, and diverse aspects of personal substance use, and to test DD as a mediator of the relationship between FH and personal substance use.

The study used crowdsourcing to recruit a community sample of adults (N = 732). Family history was assessed using a brief assessment of perceived parental substance use problems, personal substance use was assessed using the Alcohol Use Disorders Identification Test and a measure of frequency of use, and delay discounting was assessed using a latent index of discounting preferences across six reward magnitudes.

Steeper discounting was significantly associated with personal alcohol, tobacco, and marijuana use, and level of substance experimentation. Steeper DD was also associated with a denser parental FH of alcohol, tobacco, and overall substance misuse. Parental FH density was significantly associated with several aspects of personal substance use, and these relationships were partially mediated by DD.

The current study suggests that impulsivity, as measured by DD, is one proximal mechanism by which parental FH increases substance use later in life. The causal role of DD in this relationship will need to be established in future longitudinal studies.

Via: http://ht.ly/SLsr2  Purchase full article at: http://goo.gl/Fw0KzK

By:  VanderBroek L1, Acker J1, Palmer AA2,3, de Wit H3, MacKillop J4,5.

• 1Department of Psychology, University of Georgia, Athens, GA, 30602-3013, USA.
• 2Department of Human Genetics, University of Chicago, Chicago, IL, 60637, USA.
• 3Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, 60637, USA.
• 4Department of Psychology, University of Georgia, Athens, GA, 30602-3013, USA
• 5Peter Boris Centre for Addictions Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, L8N 3K7, Canada 

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