Statement on access to relevant medical and other health records and relevant legal records for forensic medical evaluations of alleged torture and other cruel, inhuman or degrading treatment or punishment

In some jurisdictions attempts have been made to limit or deny access to medical records for victims of torture seeking remedy or reparations or for individuals who have been accused of crimes based on confessions allegedly extracted under torture. The following article describes the importance of full disclosure of all medical and other health records, as well as legal documents, in any case in which an individual alleges that they have been subjected to torture or other forms of cruel, inhuman or degrading treatment of punishment. A broad definition of what must be included in the terms medical and health records is put forward, and an overview of why their full disclosure is an integral part of international standards for the investigation and documentation of torture (the Istanbul Protocol). The fact that medical records may reveal the complicity or direct participation of healthcare professionals in acts of torture and other ill-treatment is discussed. A summary of international law and medical ethics surrounding the right of access to personal information, especially health information in connection with allegations of torture is also given.

Socioeconomic health inequalities among a nationally representative sample of Danish adolescents: the role of different types of social relations

STUDY OBJECTIVE

To investigate the role of different types of social relations in adolescent health inequalities.

DESIGN

Cross sectional study. Measures included family social class, indices of social relations to parents, friends, teachers, and school.

SETTING

Random sample of 55 schools in Denmark.

PARTICIPANTS

Nationally representative sample of 5205 students from grades 5, 7, and 9.

MAIN OUTCOME MEASURES

Self reported physical and psychological symptoms.

RESULTS

Adolescents from families of lower socioeconomic position reported more physical and psychological symptoms. This ranged from 40% increased odds for multiple physical symptoms among less advantaged girls, to 90% increased odds of multiple psychological symptoms for less advantaged boys. Relationships with friends or teachers showed small social class differences, while strong and consistent social class differences were found in the ways adolescents reported their own and their parents relations to school. For example, girls from families of lower socioeconomic position were more than four times as likely to report their parents unwilling to attend school meetings (odds ratio=4.54, 95% confidence intervals: 2.68 to 7.69). Poorer relations with parents, peers, teachers, and school were all associated with worse health. Patterns of parent-child relations with the school were the greatest contributors to socioeconomic differences in physical and psychological symptoms.

CONCLUSIONS

The school is one of the first important social institutions directly experienced by children and socioeconomic differences in how adolescents and their parents relate to the school may be part of the cascade of early life influences that can lead to later social and health disadvantage.

Stability and change in structural social relations as predictor of mortality among elderly women and men

In a follow-up study of 70-95 years old women and men (n = 911) we studied the association between change and stability in three structural aspects of social relations (contact frequency, contact diversity, cohabitation status) from 1986-1990 and mortality after the next four years in 1994. Women aged 70-74 years who developed low contact frequency or developed small contact diversity showed significantly higher mortality, adjusted ORfreq: 3.78 (1.08-13.20), adjusted ORdiv: 3.79 (1.24-11.58). Women aged 70-74 years with continuously low contact frequency showed an increased mortality compared to women constantly experiencing high contact frequency, adjusted OR: 2.75 (1.04-7.26). A tendency in the same direction for sustained small contact diversity was found, adjusted OR: 1.98 (0.70-5.61). Among women aged 75+ years no impact of frequency and diversity was demonstrated, whereas continuously living alone was a significant predictor of mortality, when compared to women continuously living with somebody, adjusted OR: 2.57 (1.29-5.09). In men, we found a significantly increased mortality among those who developed high contact frequency and developed large contact diversity ORfreq: 3.91 (1.02-14.94) and ORdiv: 6.04 (1.30-28.03). In summary, we found rather larger age differences in the strength of the association between change in structural social relations and mortality. Furthermore, the associations seemed stronger among women than men, which may however mainly be explained by the small number of men in our cohort.

Risk of low birthweight in social districts of Copenhagen

The purpose of this survey was to investigate the small-area variations in low birthweight within social services districts in Copenhagen and the relation of such variations to the socioeconomic characteristics of the district. The study was based on register data and included all live-born single on births to women living in the city of Copenhagen from 1987-90. We found a statistically significant association between district and risk of newborns being small-for-gestational age (SGA). This association was independent of adjustment for maternal age and parity. Only part of the association was explained, though this was still significant, using an index summarizing the socioeconomic living conditions in the district. Splitting up the index into its four constituent components, however, showed that the association between SGA and district was primarily due to housing conditions in the districts. Mapping the districts demonstrated a clear tendency of clustering of the high-risk areas with poor socioeconomic conditions.

Social relations: network, support and relational strain

We introduce a conceptual framework with social relations as the main concept and the structure and the function of social relations as subconcepts. The structure of social relations covers aspects of formal relations and social network. The function of social relations covers social support, social anchorage and relational strain. We use this conceptual framework to describe social relations in the Danish population, with questionnaire data from the Danish Longitudinal Health Behaviour Study including a random sample of each of the age groups 25-, 50-, 60-and 70-year olds, N = 2,011. The postal questionnaires were answered by a random sample in each of the age groups. The results show marked age and gender differences in both the structure and the function of social relations. The social network, measured as weekly contacts, weakens with age and so does instrumental support. Emotional support is unrelated to this decline in contact frequency and appears to be at the same level for younger and older individuals. Relational strain, measured as conflicts, declines with age for all kinds of social relations. The weakening of the social network with age does not seem to affect the level of emotional support and in turn seems to be partly compensated for by a simultaneous decline in relational strain.

The Danish SF-36 Health Survey: translation and preliminary validity studies

This article reports on the Danish translation of SF-36 and discusses the procedures used for translation improvement, translation evaluation, and scale evaluation. We followed the standard procedures of the International Quality of Life Assessment (IQOLA) Project including forward and backward translation, independent assessment of translation quality, assessment of response-choice weighting through visual analogue scale (VAS) investigations, and psychometric testing of the translated questionnaire. We found that backward translation, independent quality assessment, and VAS studies provided useful information for translation improvement. The Danish SF-36 received a favorable translation evaluation by independent rating; however, interrater agreement was low. Preliminary validity studies generally supported the internal consistency and homogeneity of the Danish SF-36, and the questionnaire performed satisfactorily in distinguishing depressive patients from nonpatients. On the basis of this and other studies, we recommend use of the Danish SF-36 in research.

The lethal paraphiliac syndrome. Accidental autoerotic deaths in Denmark 1933-1990

A new definition of accidental autoerotic death (AAD) is proposed. A death is an AAD if it is solitary, accidental, and caused by a lethal paraphilia. On the basis of a series of 46 AADs, all occurring among men in the period 1933-1990 in Denmark, the definition cannot be rejected. A paraphilia is regarded as lethal if it is inherently life-threatening. The results of this study have been related to previous reports of similar autoerotic deaths in the literature. It is suggested that the present distinction between asphyxial AAD as typical and nonasphyxial ADD as atypical be replaced with lethal paraphilia with accompanying nonlethal paraphilia or props as typical AAD and lethal paraphilia with no accompanying nonlethal paraphilia or props as atypical AAD.

Estimation of the spontaneous abortion risk in the presence of induced abortions

We propose a method of estimating the miscarriage risk in a setting where counts of births, miscarriages and induced abortions are available, and also the gestational week of each induced abortion. Unlike previously proposed methods, ours takes into account the fraction of the miscarriage risk to which each interrupted pregnancy has been exposed. For this purpose, we draw on an extraneous standard foetal survival curve and stipulate that the survival curve of the study population is a scaled version thereof. Three such scaling models are discussed, and it is shown that the choice is largely a matter of computational convenience. Separate attention is given to a competing-risk model of miscarriages and interruptions, and examples are given of reasons why the crucial assumption that these two sources of termination operate independently is unlikely to be met. Finally, it is argued that pregnancy wishes, especially those of habitual aborters, shape the miscarriage rate to the extent that it becomes as much a cultural parameter as a marker of biological hazards.

Measurement of total risk of spontaneous abortion: the virtue of conditional risk estimation

The concepts, methods, and problems of measuring spontaneous abortion risk are reviewed. The problems touched on include the process of pregnancy verification, the changes in risk by gestational age and maternal age, and the presence of induced abortions. Methods used in studies of spontaneous abortion risk include biochemical assays as well as life table technique, although the latter appears in two different forms. The consequences of using either of these are discussed. It is concluded that no study design so far is appropriate for measuring the total risk of spontaneous abortion from early conception to the end of the 27th week. It is proposed that pregnancy may be considered to consist of two or three specific periods and that different study designs should concentrate on measuring the conditional risk within each period. A careful estimate using this principle leads to an estimate of total risk of spontaneous abortion of 0.33.