Journal de médecine légale

Introduction: The aim of this study is to present an overview of socio-economic inequalities in suicide mortality among neighbourhoods in Barcelona according to territorial distribution of family income and population density during the period ranging from 2012 to 2014.

Material and methods: 278 accomplished suicides were related to territorial distribution of family income and population density during the period ranging from 2012 to 2014. The rate of the territorial distribution of family income was less than 100 in the poorest neighbourhoods and more than 100 in wealthier neighbourhoods and the population average was 22.417 inhabitants according to our Council data.

Results: In the poorest neighbourhoods 169 suicides occurred (60.79%) and in the richest neighbourhoods 109 (39.21%) (p<0.03). According to neighbourhoods with lower than average population density, the number of suicides were 65, (23.38 %) higher than the average population density 213, (76.61%) (p<0.001). The coefficient correlation was 0.16 (highly correlated).

Conclusion: According to previous research, resources for suicide prevention should be targeted to high poverty/ deprivation areas, incorporating socio-economic disadvantage in prevention policy.

Rising costs of health care has been a cause of concern in recent years. According to the latest estimates we spend $2.9 trillion dollars every year, around 18% of the GDP, and about $9,255 per person each year in health care costs. But it is highly debatable if this high expenditure translates into improved patient care and healthcare outcomes. The healthcare is presently considered an industry or a business venture. The corporatization of medicine leading to the rising administrative costs and growing cost of prescription drugs and devices is also a cause of concern and are major contributing factors to the rising health care costs. The practice of defensive medicine is, in part, contributing to the present situation. We believe that the present-fee-for-service reimbursement model needs to be changed to value-based-care which can help in improvement of patient care outcomes without increase in the health care costs. Major health care reforms are long overdue, but who will ring the cat?

The assessment of criminal responsibility is complex and challenging. In the article “Reliability of repeated forensic evaluations of legal sanity” [1] we found that criminal responsibility was changed at least once in subsequent assessment in 32(27.3%) out of 117 cases. One possible explanation is, that the assessments issued by psychiatrists not employed by courts, were placed on an equal footing with opinions issued by forensic experts. These assessments, given by clinical psychiatrists, were often contrary to forensic opinions and led to the uncertainty of the court. Furthermore, due to academic and professional position of these psychiatrists, these opinions were frequently difficult to challenge by forensic experts. It resulted in prolonged proceedings, increases in costs, and especially created a possibility of legal sanity change.

Clinical psychiatrist should be conscious, that every psychiatric certificate can be used for insanity defense in criminal proceeding. Every psychiatrist examining a defendant may potentially influence the final diagnosis and hence the evaluation of the defendant’ legal sanity, even if the psychiatrist does not directly participate in court proceeding.

Human body fluids are of great interest in forensics, due to the possibility to extract their genetic information. At the moment, there is the need to develop a non-destructive, rapid and user-friendly method for the detection and identification of the body fluids usually found at crime scenes: blood, semen, vaginal fluid, saliva, sweat and urine. In this review, the spectroscopic techniques used or being researched on this topic are discussed, taking into account their advantages, limitations and advances. Although, UV-Vis light sources are used worldwide in forensic laboratories for the location of body fluids, they are not selective enough to be confirmatory. HSI, FTIR and Raman spectroscopy seem to be suitable for the identification and discrimination of body fluids, though comprehensive research about some unsolved aspects must be performed first.