Medically Examined Research Articles

Medical examination of detainees in Catalonia, Spain, carried out in the presence of police officers.

On 14th October 2019, the Supreme Court of Spain issued a court judgment convicting social and political leaders in Catalonia, of crimes of embezzlement, sedition and disobedience. Following this, wide- spread protests in Catalonia began. During these protests, there were also numerous clashes between protesters and members of different Catalan and Spanish police forces, which ended with more than 600 people suffering injuries to varying degrees. Semi-structured interviews in prison (n=22) with people injured and detained during demonstrations. No detainees were informed of their right to a medical examination. 50% of detainees reported access to medical examinations in police custody. In all cases this was carried out in primary healthcare centres in the presence of police in the examination room. In all cases the report was given to the police instead of the detainee.The whereabouts of this documentation is unknown despite attempts from the detainees and their lawyers to obtain them. 31% of detainees reported being medically examined in the courthouse, with police presence at all examinations. Finally, all detainees reported routine medical examinations at the entrance to prison for pre-trial detention, none of which were carried out in the presence of police forces. Detainees reported good treatment once in the prison. The results show a serious breach of regional, national and international, regulations and in particular the Istanbul Protocol principles relating to the medical examination of detainees.

Child sexual abuse — Initial suspicion and legal outcome

ObjectivesTo evaluate the association of primary reason to suspect child sexual abuse with the legal end-point in medically examined, police reported cases. Study designObservational post hoc analysis of retrospective review of records of 155 medically examined, police reported alleged child sexual abuse (CSA) cases during 2001–2009. Primary referral indications for medical examinations or criminal investigations were analyzed with an end-point in the legal process. The data consists of official investigation documents from University Hospital records, police, crime laboratories, state prosecutor, and courts of Law. ResultsThe median age of the children was 7.1 years (range 11 months–17.5 years) at the time when suspicion of sexual abuse was reported to police. Conviction of the alleged perpetrator was significantly more likely in cases where the child’s disclosure was the reason for the initial suspicion of CSA, compared to cases with referrals for “suspicious circumstances” (39/92, 42.4% vs. 7/37, 19%, p<0.001). In 92 (59.5%) cases the initial suspicion of CSA arose from child’s disclosure. The forensic interviewer’s report supported more likely CSA allegations where the suspicion of CSA arose by child’s clear, detailed and credible disclosure of what had happened, compared to the other initial reasons of suspicion (35/61, 57.4% vs. 13/42, 31.0%, p=0.001). In child’s age category of 4–9 years conviction was significantly more likely where the initial suspicion of CSA arose with child’s disclosure, compared to other reasons of suspicion (21.45, 46.7% vs. 5/27, 16.7%, p=0.001). No association was found regarding to whom the initial suspicion of CSA arose and legal outcome. Forensic interviewer’s report supported the allegation of CSA more often if the suspicion was arose first to a neutral person (p=0.019). Legal outcome of conviction was associated with child’s disclosure of perpetrator’s physical contact regardless of how the suspicion arose (45/99, 45.5% vs. 10/46, 21.7%, p<0.001). ConclusionThe reason which initially arise a suspicion of child sexual abuse plays an important role in the criminal investigation. Initial suspicion of CSA by child’s disclosure, an eyewitness or objective material may lead to higher conviction rates. If a concerning physical symptom or finding arise the suspicion of CSA, referral to expert consultation is recommended to prevent unnecessary allegations and investigations. Other possible differential diagnostic medical conditions need to be evaluated. Furthermore, when child’s disclosure arise a suspicion of CSA, it needs to be thoroughly investigated, regardless to whom the child discloses to.

Multiple brief interventions in police custody: The MuBIC randomized controlled study for primary prevention in police custody. Protocol and preliminary results of a feasibility study in the Paris metropolitan area, France

BackgroundThe 15- to 35-year-old population has little contact with the health care system and is exposed to risk factors. Several studies demonstrated the feasibility of brief interventions (BIs) in different settings, e.g., in addiction medicine during police custody, where arrestees are entitled to a medical examination. Approximately 700,000 individuals are detained in police custody in France annually, and custody is an opportunity for young people to be medically examined. The characteristics of the detainees and previous experience with BIs suggest that custody is an opportunity to contribute to primary prevention. We propose to investigate the feasibility of such a contribution. ObjectivesThe aim of this article is to present a study protocol and some preliminary results. The primary research objective is to assess the feasibility of performing brief interventions without a specific topic in police custody settings in arrestees aged 15–35 years. The secondary research objectives include i) testing four strategies for engaging in BIs that maximize the chances of success of the BI; ii) identifying the determinants that can orient the practitioner's choice to use a specific strategy over another one; and iii) analysing the differences between individuals who engage in BIs and those who do not and, in those who do engage, the determinants of success of the intervention. MethodsA two-step randomized and prospective study: i) randomization of eligible patients into 4 groups of 500 patients each; analysis of the response rates for each strategy; performance of the BI; and analyses of the associated factors and ii) a real-life, full-scale phase study evaluating the effectiveness of BIs performance of the BI; and analyses of the interventions. Analyses of the determinants of a positive response to BI, of success and of the topic of intervention will be conducted. Expected resultsThe rates of BI performed, rates of success, and characteristics associated with response and with success are the main expected results. Additionally, the development and assessment of filter questions and an improved BI dedicated to primary prevention for police custody settings will be attained.

OCCUPATIONAL HEALTH-RELATED MORBIDITIES AMONG STREET SWEEPERS AND WASTE COLLECTORS AT BENI-SUEF, EGYPT

Introduction: Street sweepers play an important role in maintaining the health and hygiene in the communities. However, their job exposes them to various hazards while, little or no attention is paid to their health status. Aim of the work: To study the possible work-related morbidities among street sweepers and waste collectors emphasizing on the occupational risks they are exposed to and the preventive measures they take to avoid their job-related hazardous exposures. Materials and Methods: A total of 138 street sweepers and waste collectors and a matching control group of randomly selected 127 university workers and clerks were interviewed, answered the study questionnaire, and had medical examination, then they offered blood and stool samples for laboratory investigations. Results: Compared to the control group, street sweepers and waste collectors had significantly higher rates of HCV seropositivity, parasitic infestations, skin irritation, respiratory complaints and work-related injuries; but with significantly lower mean hemoglobin levels, (p<0.05).However, no significant difference was detected for HBV infection, eye complaints, joint or lower back pains. Most of street sweepers had never been medically examined, vaccinated, trained for safety practices or even health educated regarding their occupation-related health hazards. Conclusion: Street sweeping and waste collection is a hazardous job that exposes its workers to infections especially with the little, in any, protective measures they apply. Guidelines for safety measures and controlling infections should be emphasized and employed for those workers, while offering periodic medical examinations and supplying them with personal protective equipments.

The Medically Examined Applicant for Private Insurance and his/her Right to Informed Consent: A Comparative Analysis

Within the context of health and insurance law, an important question that arises is "to what extent is an applicant for private insurance truly capable of giving his/her 'free' and informed consent for a medical examination?". It should be borne in mind that it is the private insurer who requires a medical examination in order to gather medical information, and, moreover, that the insurer will not be inclined to conclude or carry out an insurance contract without this medical information. A distinction has to be made between not being free by legal coercion and not being (completely) free by factual circumstances. Exercising the right to informed consent involves exactly weighing up the consequences of the decision. Hence the applicant must be put in a position of being able to weigh up the consequences and take them into consideration.

Sexual assault centers: Attendance rates, and differences between early and late presenting cases

Sexual assault centers (SACs) aim at assisting victims and to provide forensic medical examination (FME). This study explores the gap between assaults actually occurring and those seen at SAC; and the characteristics of cases presented in time/too late for FME (early and late cohorts). Retrograde descriptive study. A two-year series from a self-referral SAC; characteristics of victims, assaults, use of services. Chi-quadrate, uni- and multivariate logistic regression analyses. Number of female victims seen/female at-risk population (attendance rates). Case and service profiles in the two cohorts. Adjusted odds for late presentation. Attendance rates for females were 0.12% (14-55 years); an estimated 4-7% of sexually assaulted females in the catchment area. Two hundred and seventy eight victims arrived in time for FME, 76 later; 6% males. Assaults in the early cohort were more often performed by strangers. Two hundred and thirty-eight victims underwent FME, 55% complied with follow-up, 55% reported to the police. The late cohort contained more adolescent victims, more acquainted/partner perpetrators, more verbal coercion; 45% medically examined, 80% follow-up compliance; 34% reported to police. Further referrals occurred equally often in both cohorts; 12% to somatic and 39% to psychiatric services. Among victims seen, 5% died within 7 years of consultation. Cases seen at SAC are strongly selected. The late cohort seems more representative of the commonly occurring assaults; young victims, known assailants. Even late presenters are in need of a multidisciplinary approach.

Immunological Aspects and Affections of Rubbish Collectors Caused by Bioaerosols

Immunological Aspects and Affections of Rubbish Collectors Caused by Bioaerosols: Stephan Becher, et al. Rheinischer Gemeindeunfallversicherungsverband—From the point of view of industrial medicine, the maintenance of industrial health and safety standards to minimize health hazards for staff is the most important item in dealing with biological materials at work. With regard to the rubbish industry, it is therefore mandatory to recognize every possible health hazard in order to supplement preventive measures and to increase industrial medical prevention. In a cross‐sectional study of industrial medicine, 83 trash collectors were medically examined, their case history having been taken by means of a standardized questionnaire. The immunobiological examination consisted of the measurement of specific IgE and IgG antibodies to Aspergillus fumigatus. An immunoblot was used to supplement the investigation and to illustrate individual epitopes of allergens of Aspergillus fumigatus. In 16 trash collectors (19%) there was a specific sensitization against Aspergillus fumigatus Type I and Type III simultaneously, as proven by the standards of Coombs and Gell. Specific antibodies to Aspergillus fumigatus were discovered in 27 employees. Neither the information given by the dust collectors nor medical examination results allowed the deduction of the presence of an allergy in the sense of typical health disturbances. Based on the results of this study, however, the immunological parameters may indicate a possible sensitization of the employees in the rubbish industry.

The care and health needs of children in residential care in the Maltese Islands1

To survey the health needs of children in residential care in the Mediterranean Islands of Malta and Gozo. Thirteen children's Residential Homes in the Maltese Islands. Cross-sectional interview survey. Carers at the Residential Homes were interviewed using a semistructured questionnaire between June and November 1996. Data related to all the children resident in the homes at the time of the interview were collected including socio-demographic factors, reasons for admission to care, medical needs and medical services received. In all, 309 children, aged birth-16 years-equivalent to 4.2/1000 Maltese children-were in residential care at the time of the study. Fifty-three per cent were boys and 52% were < 8 years of age. The most common reasons for admission into residential care were single parenthood (25%), separated parents and parents unable to offer adequate care (19% each). Admission 'medicals' rarely included a developmental assessment or use of growth charts. Medical and developmental examinations were not carried out on a regular basis and children were medically examined only when required. Dental check-ups were performed more regularly; 30% of the children had a dental check-up every 6 months. Behavioural problems were common affecting 20.7% of all children, followed by chronic bronchial asthma which was present in 7.4%. Developmental delay (global or specific) was reported in 23.3% of children under the age of 4. Residential care is the predominant form of substitute care for disadvantaged children in Malta and Gozo. The demography of the child population in Residential Homes in these Islands is different from that in other countries, in that 52% of children in residential care are < 8 years of age compared to proportionately more adolescents in other countries. Medical supervision is minimal. A standardised medical and developmental assessment should be established as an essential part of this form of substitute care.

Mortality of Dutch coal miners in relation to pneumoconiosis, chronic obstructive pulmonary disease, and lung function.

OBJECTIVES: To analyse the mortality patterns of former Dutch coal miners, focusing on coal workers' pneumoconiosis (CWP) and chronic obstructive pulmonary diseases (COPD) in relation to pre-existing impairment of lung...

The Outcome of a Medical Examination for Applicants to Leicestershire Homes for Older People

Medical screening of applicants to residential homes for older people has been shown to redirect inappropriate applications, although other outcomes have not been reported. This study assessed 117 applicants, of whom 63% were medically examined and offered medically directed interventions if indicated. All applicants were then reassessed at 6 and 12 weeks. No significant differences in survival, or changes in cognitive score, disability, incontinence or self-reported health were found between intervention and control groups. Intervention did redirect some applicants to more appropriate care and resulted in significantly greater improvements in morale. These results raised the question of whether it is appropriate for medical assessment to be used primarily to enforce admission criteria in the absence of other significant health benefits. However, the greater improvements in morale of the intervention group did indicate some benefit from the medical examination.

CO-VARIATION BETWEEN BIOLOGICAL MARKERS AND SELF-REPORTED ALCOHOL CONSUMPTION A TWO-YEAR STUDY OF THE RELATIONSHIP BETWEEN CHANGES IN CONSUMPTION AND CHANGES IN THE BIOLOGICAL MARKERS GAMMA-GLUTAMYL TRANSPEPTIDASE (GGT) AND AVERAGE VOLUME PER ERYTHROCYTE (MCV) AMONG PROBLEM DRINKERS

Co-variations between self-reported alcohol consumption and the biological markers MCV (average volume per erythrocyte) and GGT (gamma-glutamyl transpeptidase) over a 2-year period were studied in a group of 84 men and 53 women recruited to out-patient treatment by advertisements in the press. Upon admission, the drinking pattern of the participants during the preceding year was registered in detail. The participants were also medically examined, and blood samples taken. All the participants were followed up by new personal interviews, medical examinations and new blood sampling after 3, 9, 25 and 21 months. For the group as a whole, alcohol consumption was significantly lower at the end of the observation period than at admission. GGT was also decreased, but not MCV. Both self-reported consumption and the values for the biological markers showed large inter-individual and intra-individual variations during the observation period. The biological markers seemed to co-vary to a limited degree with changes in reported consumption. Both GGT and MCV seemed to have a low sensitivity but a high specificity to changes in consumption. Both markers also seemed to be somewhat more useful in identifying decreases than increases in consumption. The markers GGT and MCV should be used with caution in connection with therapeutic counselling to individuals.

OCCUPATIONAL EXPOSURE OF FOREST WORKERS TO GLYPHOSATE DURING BRUSH SAW SPRAYING WORK

The purpose of this study was to measure forest workers' exposure to the herbicide glyphosate during silvicultural clearing work done with brush saws equipped with pressurized herbicide sprayers. Both the exposed (study) group and the nonexposed (control) group contained five persons who were medically examined before and after their 1-week working period (including laboratory tests) for possible health effects. In addition, exposure to glyphosate was measured in the study group from samples taken from the workers' breathing zone and from urine samples collected during the afternoons of the workweek. The laboratory tests and urinary glyphosate analyses were repeated for the exposed group 3 weeks later, when the men had entirely stopped their work with the herbicide. Exposure to glyphosate through the workers' breathing zone was low. The highest value found was 15.7 micrograms/m3. In this study, a biological monitoring method was also developed to monitor the workers' exposure to glyphosate. Urine concentrations were under the gas chromatographic detection level of less than 0.1 ng/microL (less than 1.0 mumol/L). No major differences were noted, either in medical examinations or in the laboratory tests performed, between the exposed and control groups before and after the work period.

Rheumatic disorders in a health survey: how valid and reliable are the reports?

The validity and reliability of interview reports on rheumatic disorders in a Swedish nationwide health survey were studied. Two samples, including altogether 157 individuals, who had reported rheumatic disorders, were medically examined 6 to 24 months after the original interview. The reproducibility of the original interview was studied by the means of two re-interviews. The proportional distribution of rheumatic disorders according to diagnostic group was similar to that in the original interview, in the two re-interviews and at the medical examination. In a subject-to-subject comparison the overall agreement between the medical examination and the lay re-interview was 84% (kappa 0.35) regarding presence of rheumatic disorders, and 57% (kappa 0.41) regarding matching of rheumatic diagnostic groups. In the original interview and the lay re-interview the same individual rheumatic disorder was reported by 38% of the subjects; 58% agreed regarding rheumatic diagnostic groups. The interview reports on rheumatic disorders in the health survey can therefore be considered to have acceptable validity and reliability only with regard to the proportional distribution of groups of rheumatic disorders, based on aggregated data.

A longitudinal study of psychosomatic symptoms in healthy 11–18 year old girls and boys

In a longitudinal developmental study, 90 boys and girls participated in a psychological investigation and were medically examined when they were 11, 13, 15 and 18 years old. Habitual somatic discomfort was assessed by means of a questionnaire. Frequency of reported symptoms reached a peak at age-level 13. Females reported more symptoms than males at age 15 and 18, and the constancy over age of the symptoms was greater in the female group. Frequency of discomfort symptoms was unrelated to the variables of the medical examinations, but positively related to measures of anxiety, and negatively related to satisfaction with the situation at home and (at some age levels) to self-esteem and to experienced attractiveness and body-image satisfaction. At age-level 18, frequency of symptoms was (a) negatively related in the male and positively in the female group to overachievement in school, and (b) negatively related, in both sexes, to neuroendocrinological reactivity to examination stress in subjects taking the matriculation examinations.

Disability rates of bus drivers.

<b>Raffle, P. A. B. (1974).</b><i>British Journal of Industrial Medicine,</i><b>31,</b> 152-158. <b>Disability rates of bus drivers.</b> The proposal that ordinary driving licences should be valid up to the age of 70 has stimulated much discussion on the place of medical surveillance in the prevention of road crashes. London Transport bus drivers are medically examined on entry to the service, after absence from work attributed to sickness or accident for more than 21 days (and in certain other circumstances), and at age 50 and routinely thereafter. Average annual rates of deaths in the service and recommendations for retiral on medical grounds and for transfers to alternative work for these drivers are presented. These disability rates are low even at the older ages. Most of those drivers who recommended for work other than bus driving were considered to be fit to drive a car. Between ages 50 and 64, 85% of the recommendations for discontinuance of bus driving resulted from post-sickness medical examinations and only 15% from routine age examinations. It is concluded that the available evidence supports the legislative proposals for ordinary driving licensing. However, licence holders will need considerable help from their doctors in discharging their legal obligation to notify their licensing authority of medical conditions likely to affect their ability to drive safely.