[Risks and Opportunities of Reproducing with HIV]

The war in Ukraine is a major and long-lasting polytraumatic event which has deleterious psychological consequences on a very large number of people in the country (combatants, civilians of all ages), or outside the country. These psychological disorders can have a lasting effect on the lives of children, adolescents and adults who are direct or indirect victims.

Identifying risk factors for Jihadist terrorist offenders committing homicide: An explorative analysis using the European Database of Terrorist offenders

Although many studies have examined various aspects of terrorism, relatively little is known about risk indicators associated with specific types of terrorist offences. To partly fill this void, this study explores differences on risk indicators of the Violent Extremism Risk Assessment tool (VERA-2R) between 21 Jihadist offenders who were convicted for homicide and a comparison group of 30 Jihadist offenders convicted for other Jihadist terrorist offences. In doing so, we use judicial data from the European Database of Terrorist offenders (EDT). The results reveal that a number of risk and protective indicators differ between both groups. Both terrorist offender groups often expressed grievances about perceived injustice, but the homicide group more frequently expressed anger, moral outrage, or hatred in response to the perceived injustice than the comparison group. The homicide group also identified their attacks more often than the comparison group, and were more actively engaged in planning and preparation them. Additionally, the homicide group was less often motivated to commit their terrorist offences by group belonging compared with the non-homicide group. With respect to the protective indicators, persons in the comparison group more often reject violence as a means to achieve goals. Although further research is necessary, the results from this study indicate that a differentiated approach might be needed for risk assessment and risk management of the terrorist offender population.

Parental Perceptions of Their Children's Access to Household Firearms

OBJECTIVES

To provide a nationally representative estimate of the proportion of gun owners who report a child has independent access to one of their guns, and to describe characteristics of these gun owners relative to other gun-owning parents.

STUDY DESIGN

We conducted a cross-sectional analysis of online survey data collected in 2019 from a nationally representative sample of US adults in households with firearms (n = 4030, response 65%). The sample comprised gun-owning respondents living in homes with children (n = 689) who were asked questions about their firearms, including how they were stored, and about who other than themselves had access to their guns: "If you were not there, who in your household could get one of your guns (and load it if it is not loaded already) if they needed to?"

RESULTS

Twelve percent of US gun owners in homes with children report that a child has independent access to one of their guns (about one-fifth of those having children under age 12 years only). Gun owners who reported child access were more likely than those who reported no child access to store guns, unlocked and loaded, but still one-fifth of those reporting access, stored all guns locked and unloaded.

CONCLUSIONS

We find that more than 10% of gun owners with children report that a child can independently access one of their guns, including parents who store all guns locked and unloaded; suggesting that guidance to parents should focus on access in addition to firearm storage.

"Always Know Where the Gun Is": Service Providers Perceptions of Firearm Access, Violence, and Safety Planning During the COVID-19 Pandemic

Given the heightened risk for fatality and known non-fatal harm firearms pose in abusive situations, it is critical to consider the impact of the COVID-19 pandemic on firearm-related abuse and safety planning-particularly considering the surge in firearm sales in 2020. This study documented the impact of the pandemic on firearm access and violence, advice and safety planning surrounding firearms, and firearm-related abuse tactics through the perspective of victim service providers across the US participants included victim service professionals from both rural (n = 93) and urban/suburban (i.e., non-rural; n = 78) areas who worked with victims of gender-based violence (i.e., intimate partner abuse and dating violence, child abuse, elder abuse, sexual assault, stalking, or human trafficking victims). Results revealed that nearly half of participants reported that abusers threatening to shoot victims or others became more frequent since the start of the pandemic, while nearly 30% reported that homicide involving firearms became more frequent during the pandemic. Further, nearly 40% of participants indicated an increase in firearm sales during pandemic-with higher sales in non-rural versus rural areas. Common themes related to safety planning with firearms included advising the victim to contact the system for help, assessing the location of firearms and/or remove the firearms, and leaving the abuser. The results stress the importance for safety planning around firearms when victims are isolated with an abuser at home and potential impact of abuser firearm access on public safety.

Homicide associated with psychotic illness: What global temporal trends tell us about the association between mental illness and violence

Available evidence suggests that persons with serious forms of mental illness are 4-10 times more likely to commit homicide as compared to non-affected members of the general population. The relationship between homicide and psychotic illness has now been subject to longitudinal investigation in six different populations across eight studies covering time periods over the last six decades. With the exception of one study, these investigations demonstrate that homicide associated with psychotic illness appears relatively stable through time and, in most populations, is not related to factors that contribute to the rise and fall of total population homicide (TPH) rates. This suggests that illness and treatment factors are of most importance if we are to reduce the prevalence of this tragic illness complication.

Blunt force homicides in Denmark 1992-2016

Blunt force trauma is a common homicide method, inflicted in three different ways: bodily force, assault with blunt objects of various types and falls from height. The objective of this study is to provide thorough information on blunt force homicides with data on the victims, the offenders, the surrounding circumstances, the injury methods, the extent of injuries, and survival time, which will help inform the inexperienced as well as the seasoned forensic pathologist in their daily work with death investigation and as expert witnesses in court. We have analyzed autopsy reports and available case files of 311 blunt force homicides, making up 21.9% of all homicides in Denmark during 1992-2016. Most victims and offenders were male. Altercation in the setting of nightlife and intoxication was common in male victims, while most female victims were killed in a domestic setting. Bodily force was the most common primary homicide method, followed by assault with a blunt object and fall from height. The head was the region that most often had external injuries, with no noteworthy difference between cases with bodily force and blunt objects. Two out of three victims had one or more lacerations, most often located on the head and more often on the front. Brain injury was the primary cause of death in at least 72.0% victims. Compared to bodily force victims of blunt object assault were especially prone to skull and brain injuries, had a higher trauma score, and more died at the crime scene and had a shorter survival time.

[Units for difficult patients]

The ten French units for difficult patients are secure psychiatric services which receive people suffering from mental pathologies who could have committed or have committed dangerous acts. Among the mental health structures presented in this dossier, the units for difficult patients are those which admit prisoners with psychological disorders and problems of dangerousness for the longest period of time. As fully-fledged care facilities, they offer intensive and multi-professional care.

The Epidemiology of Violent Deaths in Chile between 2001 and 2018: Prevalence, Trends, and Correlates

BACKGROUND

Despite its enormous health and social burden, there are limited published studies describing the epidemiology of violent deaths in Chile. We described violent mortality rate trends in Chile between 2001 and 2018, its current spatial distribution and ecological level correlates.

METHODS

A population-based study using publicly accessible data. We calculated age-adjusted mortality rates per 100,000 persons for sex, age, intention, and mechanism of death. Next, we used linear regression to estimate time trends for sex and intention. We then employed hierarchical Poisson analyses to model the spatial distribution across 345 municipalities and the influence of six ecological level variables.

RESULTS

The average rate of violent death in Chile between 2001 and 2018 was 15.9 per 100,000 people, with the majority (70.3%) of these attributed to suicide. Suffocation was the most common mechanism of death for suicide (82.3%) and cut/pierce for homicide (43.1%), followed by firearm (33.2%). Violent deaths are trending downward in Chile across all categories except suicides by women, which have remained stable. Poverty rates and urban population were positively associated with violent mortality rates.

CONCLUSIONS

Although violence-related deaths seem to be decreasing, disparities across gender, age group, and geographic location may have continuing effects on mortality rates.

[The role of nurses in the prevention and post-traumatic management of domestic violence in South Africa]

The World Health Organization defines domestic violence as the deliberate use of force, power, threats, against a person or group of people, which may result in death or physical injury. As such, it usually results in physical, economic, psychological, sexual or emotional harm. This study assessed the prevalence and contributing factors of domestic violence among women and children in South Africa to better understand the factors surrounding domestic violence using the 2016 Demographic and Health Survey. Because domestic violence is a public health issue, nurses play a central role in prevention and post-trauma care, including within emergency and psychiatric services.

A Comparative Analysis of Knife and Firearm Homicides in the United States

In the United States of America firearms are the most common weapons used to commit homicide. This has led the public, academics, media, and policy makers to largely neglect other means of homicide. The second most common weapon used in the commission of a homicide in the USA are knives. On average more than 1,500 people are murdered with a knife each year in the USA. Little attention in the USA is focused on knife violence. However, the same is not true across the globe. After reviewing an international selection of literature, the current study aims to analyze both the victims and offenders of knife homicide in the USA by comparing them to the offenders and victims of firearm homicide. This was accomplished by analyzing data from the Supplementary Homicide Reports from 2014 to 2016. Comparisons between firearm and knife homicides included victim and offender demographics, as well as the relationship between the victim and offender. Bivariate and multivariate analysis are used to show that the victims and offenders of knife homicides are a significantly different group from the victims and offenders of firearm homicide. In the USA victims and offenders of knife violence are more likely to be female, less likely to be minorities, and are significantly older than firearm victims and offenders. The victim and offender in the case of a knife homicide are also significantly more likely to be closely related to one another. Unlike many other countries, in the USA the problem of knife violence appears much more similar to domestic violence than the typical street crime involving firearms. Because of this, knife homicides should not be approached with the same theoretical framework as firearm homicide. Additionally, the policies needed to effectively counter this problem will be different from those intended to deter firearm homicide.

Patterns of homicide in Sfax, Tunisia: A 9-year cohort study (2011-2019)

INTRODUCTION

In Tunisia, since the January 2011 revolution, there has been considerable media interest in violence, particularly homicides. A popular perspective is, aside from any politically motivated killings, of a rise in homicides from year to year. In the absence of Tunisian national homicide statistics, a more accurate picture may be obtainable from area pathologist records.

AIMS

To examine annual homicide rates from post-mortem data for the second largest administrative area of Tunisia, Sfax, with a mixed urban-rural population of about one million people.

METHODS

All victims of common law homicide for the region are taken to the forensic department of one hospital in Sfax. We conducted a retrospective and descriptive study of all such cases of homicide for the 9 year period from the date of the fall of the Tunisian government in 14 January 2011 to 31 December 2019 and linked these data to those from earlier studies in the same department.

RESULTS

One hundred and nine victims of unlawful homicide were identified during this nine year period, with an average of 12 cases per year and a peak of 17 cases in 2016, yielding a broadly consistent rate of 1.2 homicides per 100,000 inhabitants and no consistent pattern in fluctuations. Just over two-thirds of the victims were men. Mean age of victims was 34.85 years (range 8-90 years). Just under half were married (45%); largest employment groups were of low-paid casual workers (40%) or unemployed (28%). One third of the killings had taken place in a private residence, with interpersonal conflict given as the largest explanatory category; over one quarter were intra-familial and 14% between intimate partners. There was some seasonal variation, with nearly two-thirds of homicides occurring in the spring and summer months.

CONCLUSION

Contrary to press hype, we found no evidence of rising homicide rates in Southern Tunisia, although this does represent a different picture from that in the north of the country. The seasonal variation would merit further exploration as it raises questions around impact of fluctuations in mental health.

Police-involved Deaths and the Impact on Homicide Rates in the Post-Ferguson Era: A Study of 44 U.S. Cities

This study investigated whether homicides increased after protested police-involved deaths, focusing on the period after Michael Brown's death in Ferguson in August 2014. It also tests for effects of legal cynicism by comparing effects in homicide and aggravated assault on the assumption that reporting of the latter is discretionary and police abuses may make communities reluctant to notify police. Using FBI data from 44 U.S. cities, homicide and assault rates from 2011 to 2019 were analyzed using an interrupted time series design and combined in a meta-analysis to calculate pooled effects. A meta-regression tested effect moderators including external investigations and city/county sociodemographic characteristics. With a conservative threshold of p ≤ .01, 21 of the 44 cities experienced a significant increase and one had a significant decrease. The pooled effect was a 26.1% increase in the homicide (99% CI: 15.3% to 36.8%). Aggravated assaults increased above baseline, though the effect was 15.2 percentage points smaller (99% CI: -26.7 to -3.6) than the effect in homicides. When outcomes were measured as percent change, there were no significant effect moderators, but when measured as absolute change, homicides increased to a greater extent when the death was subject to external investigation and in cities with higher Black populations, poverty rates, and baseline homicide rates. The findings suggest that protested police-involved deaths led to an increase in homicides and other violence due to the distrust fomented within the very communities whom police are meant to protect.

Profiling Players Involved in Overkill: An Analysis of 71 Cases in Central Italy

"Overkill" is characterized by the finding of excessive wounds on the victim's body. Despite the large use of this term, it does not have a definition in the literature yet. Our study aimed to analyze the information related to the dynamics of overkill cases, collecting objective variables, and producing a profile of the players involved in this type of homicides. Data on 71 overkill cases from reports of the autopsies performed in the Section of Legal Medicine of the University of Rome Tor Vergata from 1 January 2000 to 31 December 2020 were collected. The victims and the perpetrators of overkill shared similar characteristics: they were usually male aged between 20 and 50 years, more likely in the 20-35 years range; victims however also showed another age peak in the range 50-55 years. The type of damage can be linked to the sole action of a cold weapon or the simultaneous use of multiple harmful tools with no significant differences. The most common motive proved to be a dispute for futile reasons; however, in the case of a single perpetrator of the crime, the economic and passionate motives are as frequent as the previous one. Implications of the findings and avenues for future research are discussed.

The Association of Federal and State-level Firearm Restriction Policies With Intimate Partner Homicide: A Re-analysis by Race of the Victim

Firearms present a significant risk of intimate partner homicide (IPH) among women in the United States, and Black women continue to be overrepresented among IPH fatalities. State-level firearm restrictions for individuals under domestic violence restraining orders (DVRO) and firearm restrictions for those convicted of violent misdemeanor crimes are associated with reductions in IPH. To receive these protections, individuals must engage with the civil or criminal justice system. While access to, and engagement with, these systems may differ between Black and White populations, research has yet to examine the impact of these firearm restriction laws on IPH by racial group.We conducted pooled, cross-sectional, time-series analyses to examine the association of selected firearm restriction laws on IPH by the race of the victims, from 1981 to 2013 for 45 states in the United States.State-level DVRO firearm restrictions were associated with reductions in IPH in the White population only. The inclusion of relinquishment provisions in state DVRO firearm laws is associated with an 11% reduction in IPH and a 16% reduction in firearm IPH for White, but not Black, victims. Similarly, laws prohibiting individuals convicted of violent misdemeanors from possessing firearms are associated with a 23% reduction in IPH and a 28% reduction in firearm IPH for White victims only. The federal DVRO firearm restriction law is associated with a 27% reduction in state-level IPH and a 28% reduction in firearm IPH for Black, but not White, victims.Firearm restriction laws may have a limited impact on IPH in Black populations. Future research should examine the factors behind the differential estimated impact of these laws by the race of the victims.

Receiving Notification of Unexpected and Violent Death: A Qualitative Study of Italian Survivors

(1) Background: The loss of a significant person can be especially traumatic when death comes without warning and is due to causes such as suicide, murder and accidents. The way an individual is informed about the loss can affect the way of adapting to the loss and the quality of life of survivors. Communication modalities of the notifier may deeply influence the bereavement process. Aim: The present investigation aimed to explore the experience of those who received communication of such a type of death by a professional figure. (2) Method: Snowball sampling was used to recruit the participants to this qualitative study. Social networks, word of mouth and researchers' acquaintances were used, including clients of the NGO De Leo Fund. A total of 52 Italian people (eight males and forty four females, mean age = 49.44; SD = 14.23) who received notification of the death of a loved one by police officers or by health professionals participated in the study. Deaths involved cases of suicide, murder, road accident and mountain accident. (3) Results: The following four key themes were identified: (a) how the communication took place; (b) reactions; (c) support; and (d) coping strategies. Only 22 participants reported having received clear information about the dynamics of what happened; the rest of the sample obtained only poor or ambiguous information. The majority of participants sought or received informal support from family and friends immediately after notification; however, some participants experienced a total lack of support. The opportunity to see the body of the loved one for the last farewell, when denied, caused discomfort in recipients of the news. (4) Conclusions: Even the impactful notification of a traumatic death such as suicide or road accident can be mitigated by the appropriate behaviour and attitude of notifiers, who should always avoid providing generic or ambiguous information about what happened. The notification process should not end with the simple transmission of the communication, but should also look at the following phases by including referral to supportive networks or bereavement services, aimed at assisting individuals in the immediate aftermath but also in the long term.

Criminal mutilation homicides in Japan: Corpse dismemberment and disposal pattern types, and offender characteristics

This study examined the offender characteristics of criminal mutilation homicides in Japan for offender profiling. The current sample (N = 108) showed that the most typical offender was a male, in his 30s (age that observed most often), one-person, and acquainted with the victim. This study highlighted that the cases of mutilation homicide differed in comparison with the regular homicide group in terms of the victim-offender (VO) relationship and the number of offenders. Furthermore, the multiple correspondence analysis classified mutilation homicides into four behavioral pattern types based on two dimensions (level of "efforts of corpse dismemberment" and "efforts of corpse disposal"). In the first type "high evidence destruction effort (n = 29)", having the greatest efforts to destroy evidence, all offenders were men. The rates of no VO relationship and serial murders were higher. In the second type "convenient disposal (n = 32)", likely to abandon victim body in home and trash, the rate of female offenders who assaulted family members was statistically significantly higher among the four types. In the third type "high geographic distance (n = 23)", traveling long distances for corpse disposal, the percentage of cases by co-offenders was likely to be higher than in the other types. Lastly, the offenders in "low evidence destruction effort (n = 24)" were likely to kill other acquaintances and have the least efforts for corpse dismemberment and disposal. From these results, the criminal profilers can estimate mutilation homicide offenders on the basis of efforts of corpse dismemberment and disposal.

Firearm-related Abuse and Protective Order Requests Among Intimate Partner Violence Victims

Firearms play a critical role in the murder of intimate partner violence (IPV) victims and there is evidence that laws prohibiting protective order (PO) respondents from possessing a firearm reduce IPV fatalities. However, little research has compared specific abuse tactics involving firearms among victims who have and have not sought a PO against an abuser. This study investigates IPV victims' experiences with a range of firearm-related abuse tactics across victim race/ethnicity, in addition to the relationship between firearm IPV and PO requests, above and beyond IPV not involving firearms. Questionnaires were administered to 215 female victims recruited from six domestic violence shelters in Texas. Over one-half of victims who sought a PO were threatened to be shot by their abuser and victims who experienced high levels of firearm abuse incurred a 302% increase in the odds of requesting a PO. There were no significant differences between White, Black, and Hispanic victims regarding firearm IPV tactics. The results shed light on the magnitude of risk IPV victims can experience when seeking a PO against an abusive partner.

A Qualitative Study: Emotional Damage to Police Victims in China

This article aims to analyze the emotional injury and behavioral consequences that police officers in China experience after they have been violently attacked (e.g., when police are victims of violent crimes). The analysis was based on self-narration from police officers who were victimized (from here "police victims"). First, the study explored the emotional trauma caused by violent and nonviolent attacks on police victims. Second, this study explored the impact of this violence on the police community. Finally, the study assessed the impact of violent attacks on police enforcement capabilities. Research shows that police in China have become victims of violent attacks that may have caused emotional damage. However, the extent and consequences of this emotional damage are not clear and deserve further discussion. Therefore, this research attempts to contribute to an in-depth discussion of this topic. The research used a focus group format to interview police victims (n = 40). The interviews included questions about emotional damage, occupational hazards, ensuing self-doubt, long-term behaviors, returning to work, and self-protection. The results show that police victims have suffered severe emotional damage, which may affect their ability to continue in law enforcement. It is particularly noteworthy that some police officers received unequal treatment, which led to the breakdown of family and social relationships. Chinese police victims face severe emotional damage. They have suffered great mental pressure and bad social evaluation. A reasonable recovery plan is required to help police victims return to normal life. The recovery plan should aim to improve the lives of police victims, especially by helping them relieve stress.

Males with low income and catastrophic illnesses are important risk factors for in-hospital homicide-related deaths in Taiwan from 1998 to 2015: A cross-sectional study

This study aimed to investigate not only the differences in in-hospital deaths between male and female homicides in Taiwan from 1998 to 2015, but also the epidemiological characteristics and long-term trend analysis. We collected data on 76,125 hospitalized patients injured in attempted homicides from January 1, 1998, to December 31, 2015, from the National Health Insurance Research Database (NHIRD), identifying 59,161 male and 16,694 female patients. Age, gender, and index date match. Multiple logistic regression was used to analyze the risks of gender differences in terms of homicide. The death risk of male patients was 1.673 times that of female patients and the mortality risk of low-income male patients was 3.447 times greater than that of non-low-income male patients. Moreover, the in-hospital death risk was 23.584 and 5.064 times higher for male and female patients with catastrophic illness, respectively, compared to patients with noncritical diseases. There is a higher trend of male than female patients hospitalized after an attempted homicide. Gender differences are significantly related to homicide, with males having a higher risk of death risk from homicide than females, especially in terms of low-income and catastrophic illness.

Voice of the Victims: Accounts of Secondary Victimization With the Court System Among Homicide Co-victims

The treatment homicide co-victims receive from the criminal justice system often leaves them aggrieved and feeling alienated. A neglected but important area of investigation is the courtroom workgroup's handling of murder cases. This exploratory study examines the nature and extent to which varying secondary victimization experiences are common among co-victims as the murder cases are processed through the court system. The sample consists of 27 co-victims connected to 24 separate cases where the murders occurred in a major metropolitan area in the southeastern United States. Drawing upon focus group data, Nvivo 10 was employed to identify themes that illustrate common secondary victimization experiences among co-victims along with positive and mixed reactions to court processes and personnel. The findings indicate that court requirements to provide notifications are infrequently met and attorney's practice to supply information about case progress and counseling to family members regarding plea-bargaining and sentencing decisions are greatly restrictive. When information is offered, it is often perceived as highly technical and when assistance is provided, it is frequently limited or intermittent. Despite the prevalence of negative experiences, there also were reports of positive interactions with the district attorney and victim advocates. The study concludes by identifying ways in which the courtroom workgroup can uphold the rights afforded to co-victims while at the same time meeting the duties and responsibilities of the workgroup.

Postmortem forensic toxicology cases: A retrospective review from Milan, Italy

We are presenting a study on 136 cases performed in a 2-year period (2018-2019) at the Bureau of Legal Medicine of the University of Milan for which toxicological analyses were requested and we are making a detailed interpretation of clinical records and discussing toxicological results from each case included in the study. Total number of autopsies was 1323 and in 10.3% of the cases, toxicological analyses were requested to obtain further information. Analyses were assessed with High-Performance Liquid Chromatography-Mass Spectrometry system and Gas Chromatography-Mass Spectrometry analyses. Additionally, Blood Alcohol Concentration and detection of volatile substances were obtained with Head Space-Gas Chromatography-Mass Spectrometry system. From these analyses, 101 cases out of 136 provided positive results (74.3%). Main substances detected were cocaine, diazepam, morphine, and ethanol. The most representative profiles of individuals that emerged from this study were: a Caucasian male, age 41-50, that died for cocaine acute intoxication or was killed; a Caucasian male or female with a range-of-age of 31-50 deceased for simple suicide caused by acute intoxication or by complex suicide caused by acute intoxication and suffocation; and finally, a Caucasian male with a range-of-age 21-40 that died in a car accident without any toxicological evidence. From the results, acute intoxication at the time of death was confirmed in 54 cases and in 57 cases the toxicological analyses helped in the determination of the cause and manner of death. From this study, the importance of toxicological data among forensic sciences is confirmed.

Forensic Examination of Six Homicide Injection Cases

OBJECTIVES

To retrospectively analyze homicide cases of death after injection and provide reference for forensic identification.

METHODS

Six homicide cases of death after injection which were investigated by the Criminal Investigation Team of Shanghai Public Security Bureau were collected and analyzed, including case situation, scene investigation, autopsy and other materials.

RESULTS

The 6 cases were premeditated crimes, 5 cases took place in private spaces, and 5 cases involved the victims approached by suspects' decoy. There were no obvious abnormalities at the scene of the 6 cases. In 6 cases, the victim's body surface injury was mild or no, lividity color was abnormal, and the needlestick injury showed different manifestations from conventional medical measures.

CONCLUSIONS

Death after injection is a highly concealed crime and easy to be ignored. For the suspected injection injury found in autopsy, it is necessary to carefully examine, identify and analyze, be alert to the situation of injecting poison (drug) and do a good job in evidence fixation and material extraction.

Serial killing in schizophrenia

Serial criminality, although rare, has always aroused the interest of researchers in criminology, psychiatry, psychology, and sociology. We report the case of a patient, suffering from a chronic psychotic disorder, having committed several murders over a period of 9 years, underpinned by a delirium of misidentification of Frigoli syndrome.

Accounting for Multiple Nonfatal Strangulation in Intimate Partner Violence Risk Assessment

Nonfatal strangulation is a prevalent, underreported, and dangerous form of intimate partner violence (IPV). It is particularly important to assess for strangulation among abused women as this form of violence may not leave visible injury. The most severe negative physical and mental health consequences of strangulation appear to be dose-related, with those strangled multiple times or to the point of altered consciousness at higher risk of negative sequelae. This research examines the relationship between multiple strangulation, loss of consciousness due to strangulation, and risk of future near-fatal violence to modify the Danger Assessment (DA) and the Danger Assessment for Immigrant women (DA-I), IPV risk assessments intended to predict near-fatal and fatal violence in intimate relationships. Data from one study (n = 619) were used to modify the DA to include an item on multiple strangulation or loss of consciousness due to strangulation. Data from an independent validation sample (n = 389) were then used to examine the predictive validity of the updated DA and DA-I. The updated version of the DA predicts near-fatal violence at 7-8 months follow-up significantly better than the original DA. Adding multiple strangulation or loss of consciousness to the DA-I increased the predictive validity slightly, but not significantly. The DA and DA-I are intended to be used as a collaboration between IPV survivors and advocates as tools for education and intervention. Whether or not an IPV survivor has been strangled, she should be educated about the dangerous nature of strangulation and the need for medical intervention should her partner use strangulation against her. This evidence-based adaptation of the DA and DA-I may assist practitioners to assess for and intervene in dangerous IPV cases.

[Management of patients with addictions in units for difficult patients]

The links between mental pathologies and violent acts, which can go as far as homicide, are a major concern for many mental health professionals. Addictive co-morbidities, which are increasingly frequent, are an additional risk factor for some of these patients to commit dangerous acts. Psychiatric and psychological care for pathological perpetrators of such violence can be provided under certain conditions in units for difficult patients, with addiction treatment if necessary.