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Previous research illustrated that the laws regulating involuntary placement and treatment of people with mental-health problems are diverse across countries. International studies comparing satisfaction levels between countries are rare. We compared the opinions of professionals and family members about the operation of the national mental-health law regulating forcibly admission and treatment of psychiatric patients in 11 countries: Ireland, Iceland, England and Wales, Romania, Slovenia, Denmark, Germany, Sweden, Norway and India. An online survey design was adopted using a Mental Health Legislation Attitudes Scale (MHLAS). This brief nine-item questionnaire was distributed via email to psychiatrists, general practitioners, acute and community mental-health nurses, tribunal members, police officers and family members in each collaborating country. The levels of agreement/disagreement were measured on a Likert scale. Data were analysed both per question and with regard to a total MHLAS 'approval' score computed as a sum of the nine questions. We found that respondents in England and Wales and Denmark expressed the highest approval for their national legislation (76% and 74%, respectively), with those in India and Ireland expressing the lowest approval (65% and 64%, respectively). Almost all countries had a more positive attitude in comparison to Ireland on the admission criteria for involuntary placement and the way people are transferred to psychiatric hospitals. There are significant variations across Europe and beyond in terms of approval for how the national mental-health law framework operates in each country.

Abstract Background There is evidence that low back pain (LBP) during young adulthood and military service predicts LBP later in life. The purpose of this study was to investigate the incidence and trends of LBP hospitalisation among Finnish military conscripts. Methods All male conscripts performing their compulsory military service during 1990–2002 were included in the study population. Altogether 387,070 military conscripts were followed throughout their six-to-twelve-month service period. Data on LBP hospitalisations were obtained from the National Hospital Discharge Register. Results Altogether 7,240 LBP hospitalisations were identified among 5,061 (1.3%) male conscripts during the study period. The event-based incidence of LBP hospitalisation was 27.0 (95% confidence interval (CI): 25.7–28.2). In most cases, the diagnosis was unspecified LBP ( n = 5,141, 71%) followed by lumbar disc disorders ( n = 2,069, 29%). Hospitalisation incidence due to unspecified LBP was 19.1 per 1,000 person-years (95% CI: 18.3 to 20.4), and 7.8 per 1,000 person-years (95% CI: 6.7 to 8.3) due to lumbar disc disorders. The incidence of unspecified LBP remained unaltered, while hospitalisation due to lumbar disc disorders declined from 1993 onwards. Conclusion Although conscripts accepted into military training pass physician-performed examinations as healthy, young adults, LBP hospitalisation causes significant morbidity during military service.

The role of Nearest Relative is intended as a safeguard in the Mental Health Act 1983 (as amended in 2007) to curb the excesses of professional discretion and protect patients from unwarranted compulsory hospitalisation. It is unique to the mental health compulsory detention process in England and Wales. There are, however, evident tensions in the role and a lack of clarity surrounding the precise functions of the nearest relative. There is also some uncertainty and confusion among practitioners about the scope of the nearest relative involvement. Despite longstanding concerns about the role, there is remarkably little published research available to date on its use and effectiveness, in so far as evaluating the extent to which it provides an adequate safeguard for patients, as intended by the legislation. This article will briefly explore the background to the role, highlight some of the difficulties and tensions within it and conclude with some observations about where further research and reform may be needed to provide greater protection and clarity for patients, relatives and health and social care practitioners.

Установив в части 4 статьи 15 Конституции РФ принцип непосредственной применимости Конвенции о защите прав человека и основных свобод (далее Конвенция) в национальных судах, нужно еще научиться работать с Конвенцией и видеть в ней те гарантии, которых нет в российском законодательстве и, что самое главное, в практике. В первой части данной работы мы рассмотрим существующий законодательных мезанизм применения Конвенции в судах России. Во второй части пример гарантий Конвенции в делах о принудительной госпитализации. ; Having established in Part 4 of Article 15 of the Constitution of the Russian Federation a principle of direct applicability of the Convention on protection of human rights and the basic freedom (further the Convention) in national courts, it is still necessary learn to work with the Convention and see those guarantees which are not present in the Russian legislation and that the most important thing, in practice. In the first part of the given work we will consider established legislative mechanism Convention applications in courts of Russia. In the second part an example of guaranteee of the Convention in affairs about compulsory hospitalisation.

The role of nearest relative (NR) is intended as a safeguard in the Mental Health Act 1983 (as amended in 2007) to curb the excesses of professional discretion and protect patients from unwarranted compulsory hospitalisation. It is unique to the mental health compulsory detention process in England and Wales. There are, however, evident tensions in the role and a lack of clarity surrounding the precise functions of the NR. There is also some uncertainty and confusion among practitioners about the scope of the NR involvement, and government plans announced recently to review mental health legislation will include a focus on the role of family and carers in the care of detained patients. Despite long-standing concerns about the role, there is remarkably little published research available to date on its use and effectiveness, in so far as evaluating the extent to which it provides an adequate safeguard for patients, as intended by the legislation. This article will briefly explore the background to the role, highlight some of the difficulties and tensions within it and conclude with some observations about where further research and reform may be needed to provide greater protection and clarity for patients, relatives and health and social care practitioners.

Reforms to the mental health law framework for England and Wales, which were introduced by the Mental Health Act 2007, are now having a practical effect on day-to-day mental health decision-making. The 2007 Act amends the Mental Health Act 1983, which governs the compulsory hospitalisation and treatment of people with mental disorder; and represents the culmination of a protracted and controversial reform process which has spanned much of the last 15 years. One of the key foci in the 2007 Act is the question of the risk posed by the patient, primarily to others; a result of both the social and political impetus behind the reform process and mounting public anxiety at the management of the mentally disordered. The new Act seeks, as with past legislation, to find the elusive balance between protecting and facilitating the individual's autonomy while also providing an effective framework for the wider public right to protection. The 2007 Act solidifies the dominance of risk by providing a legitimating framework in which risk can be assessed, monitored, and managed. This attitudinal change is demonstrated by the gradual and almost insidious adoption of risk terminology within the practical decision-making setting and the increasing use of risk assessment and management tools. This article is informed by an empirical study which examined individual professional and institutional responses to the mental health legislation in relation to risk. It examines whether the amended legislative framework amplifies risk as an increasingly dominant concern within decision-making. The paper then goes on to consider how decision-makers use risk to assist with their daily roles. Extrapolated from data obtained through the study, several models of risk determination are then discussed. Finally, some thought is given to whether the extension of the risk concept has the potential to become more fundamental within the organisation and legitimisation of mental health care. © The Author [2011]. Published by Oxford University Press; all rights reserved.

AbstractThe purpose of the present study was to investigate the effects of parental health problems on the probability of youths leaving upper secondary education before completion in Sweden, and to investigate potential gender differences in these effects. Medical and social microdata from Swedish administrative registers were used. The study population consisted of individuals born between 1987 and 1990 (N = 398,748) who were still alive and residing in Sweden in 2010. We employed a quasi-experimental pre-test post-test study design. Logistic regression was used to analyse the relationships between indicators of parental illness and young people's early school leaving in relation to health and sociodemographic confounders. Having had a mother or father with psychiatric, but not somatic, illness that necessitated hospitalisation after completing compulsory schooling was significantly associated with an increased probability of leaving upper secondary education. We found no significant gender-specific interaction effects. The existence of these effects in Sweden, a country with an extensive institutional welfare system, suggests that similar but more pronounced effects may exist in regions lacking such systems.

Purpose
– Previously, diversion from the criminal justice system for people with learning disability (LD) and serious forensic needs in Scotland meant hospitalisation. More recently new legislation has meant that community-based rehabilitation is possible for this group. The purpose of this paper is to qualitatively explore the views of people with LD subject to these legal orders. This is both a chance to work in partnership to improve services and also to make the voices of this potentially vulnerable group heard.


Design/methodology/approach
– Semi-structured interviews were conducted with ten participants subject to a community-based order. All participants were male. Ages, index behaviour, and time spent on order varied. The data was transcribed and analysed using interpretative phenomenological analysis.


Findings
– The main themes which emerged from the data were a taste of freedom, not being in control, getting control back, loneliness, and feeling like a service user. Participants described positives about community-based rehabilitation but also a number of negatives.


Practical implications
– Participant accounts suggest that the current community rehabilitation model has some shortcomings which need to be addressed. Suggestions are made for improvements to the current model relating to: achieving clarity over the role of support staff and pathways out of the system; increasing opportunities for service users to voice concerns; empowering staff teams via extensive training and supervision; and directly addressing internalised stigma to promote community integration.


Originality/value
– This is the first piece of work evaluating compulsory community forensic care for people with LD from the perspective of service users. It highlights difficulties with the system which could lead to helpful ways to evolve this model.

BACKGROUND Widespread vaccination uptake has been shown to be crucial in controlling the COVID-19 pandemic and its consequences on healthcare infrastructures. Infection numbers, hospitalisation rates and mortality can be mitigated if large parts of the population are being vaccinated. However, one year after the introduction of COVID-19 vaccines, a substantial share of the Swiss population still refrains from being vaccinated. OBJECTIVES We analysed COVID-19 vaccination uptake during the first 12 months of vaccine availability. We compared vaccination rates of different socioeconomic subgroups (e.g., education, income, migration background) and regions (urban vs rural, language region) and investigated associations between uptake and individual traits such as health literacy, adherence to COVID-19 prevention measures and trust in government or science. METHODS Our analysis was based on self-reported vaccination uptake of a longitudinal online panel of Swiss adults aged 18 to 79 (the "COVID-19 Social Monitor", analysis sample n = 2448). The panel is representative for Switzerland with regard to age, gender, and language regions. Participants have been periodically surveyed about various public health issues from 30 March 2020, to 16 December 2021. We report uptake rates and age-stratified hazard ratios (HRs) by population subgroups without and with additional covariate adjustment using Cox regression survival analysis. RESULTS Higher uptake rates were found for individuals with more than just compulsory schooling (secondary: unadjusted HR 1.39, 95% confidence interval [CI] 1.10-1.76; tertiary: HR 1.94, 95% CI 1.52-2.47), household income above CHF 4999 (5000-9999: unadj. HR 1.42, 95% CI 1.25-1.61; ≥10,000 HR 1.99, 95% CI 1.72-2.30), those suffering from a chronic condition (unadj. HR 1.38, 95% CI 1.25-1.53), and for individuals with a sufficient or excellent level of health literacy (sufficient: unadj. HR 1.13, 95% CI 0.98-1.29; excellent: HR 1.21, 95% CI 1.10-1.34). We found lower rates for residents of rural regions (unadj. HR 0.79, 95% CI 0.70-0.88), those showing less adherence to COVID-19 prevention measures, and those with less trust in government or science. CONCLUSIONS Vaccination uptake is multifactorial and influenced by sociodemographic status, health literacy, trust in institutions and expected risk of severe COVID-19 illness. Fears of unwanted vaccine effects and doubts regarding vaccine effectiveness appear to drive uptake hesitancy and demand special attention in future vaccination campaigns.

Ylipaino altistaa nuoren miehen polvivammalle Väitöskirjatutkimus selvittää polvivammojen yleisyyttä, riskitekijöitä ja diagnostiikkaa Polvivammat ovat yleisiä erityisesti alle 30-vuotiailla miehillä, mutta sairaalahoitoa vaativien polvivammojen ilmaantuvuudesta ja riskitekijöistä ei ole esitetty tarkkaa tietoa. Väitöskirjatutkimus selvitti aihetta suomalaisilla 18 30-vuotiailla miehillä varusmiespalveluksen aikana (n=128 584). Tulokset osoittivat, että sairaalahoitoon johtaneiden polvivammojen ilmaantuvuus oli 11 potilasta 1000 henkilövuotta kohden [95 % luottamusväli (CI): 10,4 11,7] tarkoittaen sitä, että joka vuosi noin yksi sadasta varusmiehestä joutuu sairaalahoitoon polvivamman vuoksi. Merkittävimmät riskitekijät polvivammoille olivat korkeampi ikä, jonka ristitulosuhde oli 1,7-kertainen yli 20-vuotiailla, sekä ylipaino, jonka ristitulosuhde oli 1,6-kertainen verrattuna niihin, joilla ylipainoa ei ollut. Kirurginen toimenpide tehtiin kahdelle kolmasosalle kaikista sairaalassa hoidetuista potilaista ja pidempiaikainen haitta (palveluskelpoisuusluokan muutos) jäi yhdelle kolmasosalle potilaista. Tiedot sairaalahoitoon johtaneista polvivammoista ja kirurgisista toimenpiteistä saatiin selvitettyä kansallisen hoitoilmoitusrekisterin avulla. Tiedot palveluskelpoisuusluokan muutoksista ja mahdollisesti polvivammoihin yhteydessä olevista riskitekijöistä saatiin puolustusvoimien Vartti- ja palveluskelpoisuusluokanmuutosrekistereistä. Palveluskelpoisuusluokan muutosta käytettiin tutkimuksessa kuvaamaan pidempiaikaista haittaa. Polvivammojen riskitekijöitä analysoitiin logistisella regressiolla. Väitöskirjatutkimus paneutui myös polvivammojen ja polven etuosan kiputilan magneettikuvauspainotteiseen diagnostiikkaan suomalaisilla varusmiehillä. Magneettikuvausta pidetään yleisesti herkkänä ja tarkkana polvivammojen tutkimisvälineenä, mutta polven etuosan kiputilassa, tuoreissa rustovaurioissa ja vanhoissa nivelkierukkarepeämissä sen merkitys on epäselvempi. Tutkimustulokset osoittivat, että lähes puolet syvistä, tuoreista polven rustovaurioista jäi diagnosoimatta normaalin kliinisen työn yhteydessä suoritetussa 1.0 Teslan magneettikuvauksessa. Huolimatta normaalista magneettikuvauslöydöksestä saattaa polvinivelen tähystystutkimus paljastaa korjaustoimenpiteisiin soveltuvia syviä rustovaurioita. Magneettitutkimuksen diagnostisessa validiteetissa nivelkierukkarepeämän diagnostiikassa ei todettu eroa akuutissa polvivammassa ja kroonisissa, yli 6 kk kestäneissä polvioireissa. Polven etuosan kipua käsittelevässä aineistossa yleisimmät löydökset olivat polvilumpion rustovaurio (45 % polvista) ja nivelkalvon poimu (45 %). Oireiden, löydösten ja polvilumpion rustovaurion asteen välillä ei todettu selkeää yhteyttä (p = 0,83). Tulokset tukevat aiempia havaintoja siitä, että polvilumpion rustovaurioita ei voida luotettavasti diagnosoida polven etuosan kiputilaan liittyvien oireiden ja statuslöydösten perusteella. Tässä aineistossa 1.0 Teslan magneettikuvauksessa käytettiin erityisesti polvilumpion ruston arvioimiseen sopivaa kuvausleikettä (aksiaalinen 3D T1 FS SPGR). Herkkyys oli alhainen pinnallisille polvilumpion rustovaurioille (13 %), mutta selkeästi parempi syvemmille rustovaurioille (83 %). Magneettikuvausta tällä menetelmällä voidaankin käyttää diagnostisena apuvälineenä polvilumpion syvempien, mahdollisesti operatiivista hoitoa tarvitsevien rustovaurioiden diagnostiikassa. Tuoreita rustovaurioita käsittelevässä retrospektiivisessa aineistossa oli 32 potilasta, joilla oli todettu artroskopiassa tuore traumaattinen rustovaurio. Tuoreiden ja vanhojen nivelkierukkarepeämien magneettikuvausdiagnostiikkaa vertailevien aineistojen mukaanottokriteerit täytti 82 potilaista, joilla oli tuore polvivamma, ja 40 potilasta, joilla oli pidempikestoinen polviongelma. Pitkäaikaiseen polven etuosan kiputilaan liittyvien oireiden ja löydösten yhteyttä tähystystutkimuksen tuloksiin tutkittiin prospektiivisesti 56 potilaan aineistossa. Kaikissa diagnostiikkaa käsittelevissä osatutkimuksissa magneettikuvauksen tuloksia verrattiin polvinivelen tähystystutkimuksen tuloksiin. Tutkimukset suoritettiin keskussotilassairaalassa Helsingissä. Tutkimuspotilaat olivat varusmiehiä, joiden ikä oli tutkimushetkellä 18 25-vuotta. ; Knee injuries and anterior knee pain are frequently encountered and treated by orthopaedic surgeons and general practitioners in daily clinical practice. Knee injuries are most common in those under 30 years of age and especially in males. Accurate incidence rates of knee injuries requiring hospitalisation (i.e. inpatient care admission) in this high-risk subgroup, however, are not known. Also unclear are the roles of intrinsic modifiable factors, such as body mass index (BMI), weight, aerobic fitness, and muscular strength, as risk factors for knee injuries. The epidemiologic section of this dissertation is based on population-based data among Finnish young adult male conscripts. Our aim was to determine the incidence and possible risk factors for knee injuries requiring inpatient care. Moreover, knee injuries were analysed by specified diagnosis (cruciate and collateral ligament tears, meniscal tears, traumatic chondral lesions, and patellar dislocations). The total number of Finnish male conscripts performing their compulsory military service during the study period was 128,584 and total exposure time was 97,503 person-years. Risk factor analyses were performed by logistic regression. The person-based incidence of inpatient care admissions for knee injury in general was 11 cases per 1000 person-years (95% confidence interval [CI]: 10.4 11.7). The most important risk factors were higher age (odds ratio [OR] 1.7; 95% CI: 1.3 2.2) and obesity (OR 1.6; 95% CI: 1.03 2.5). Two-thirds of all subjects admitted to inpatient care for knee injuries had surgery, and one-third had long-term notable disability. The diagnostic section of this dissertation addresses three diagnostic challenges: fresh traumatic chondral lesions, fresh meniscal tears, and anterior knee pain (AKP). Study populations were based on conscripts treated at the Central Military Hospital in Helsinki, Finland. Arthroscopic results served as the gold standard for calculating the sensitivity, specificity, and accuracy of magnetic resonance imaging (MRI) findings. The validity of MRI for fresh traumatic chondral lesions and for fresh vs. old meniscal tears was studied retrospectively. Study populations comprised young adult conscripts in whom both knee MRI and arthroscopy were performed at the Central Military Hospital. In the first sample, 32 patients, ranging in age from 19 to 21 years (median, 19 years), with arthroscopically proven fresh traumatic chondral lesions of the knee met the inclusion criteria. In the samples used for comparing MRI validity in fresh traumatic and old meniscal tears, 82 patients, ranging in age from 18 to 25 (median, 20 years) met the inclusion criteria with acute knee trauma (MRI within 30 days from trauma) and 40 patients with chronic knee symptoms (symptoms lasting over 6 months before MRI). Diagnostic studies revealed that routine clinical use of 1.0 Tesla (T) MRI has poor sensitivity (36%) for detecting fresh traumatic articular cartilage lesions. Sensitivity was associated with the lesion grade and was only 17% for superficial lesions and moderately better, 57%, for full-thickness lesions. Thus, almost half of the full-thickness cartilage lesions remained undiagnosed following preoperative MRI. Despite negative MRI findings, arthroscopy may reveal lesions amenable to cartilage repair procedures.The diagnostic validity of MRI for meniscal tears in acute knee trauma and in knee symptoms lasting over 6 months in young adults was similar. This study also suggests that effusion and haemarthrosis are not associated with the diagnostic validity of MRI for meniscal tears. The association between the clinical symptoms and arthroscopic findings, and the role of MRI in AKP were studied prospectively. Fifty-six young adult conscripts (median age, 19.5 years) with AKP were prospectively selected for the study and MRI of the knee followed by arthroscopy was performed at the Central Military Hospital in Finland. Arthroscopy con?rmed the presence of patellar chondral lesions in 25 (45%) of 56 knees of patients with AKP. Synovial plicae were as common a finding as patellar chondral lesions and was present in 25 knees. Normal anatomy was observed in only six knees. The presence of retropatellar crepitus or pain on manipulation of the patella was not associated with a higher proportion of patellar chondral lesions in patients with typical clinical AKP symptoms. The severity of patellar chondral lesions observed at arthroscopy was not associated with clinical symptoms of AKP syndrome (p = 0.83). This data supports earlier reports that patellar chondral lesions cannot be distinguished from other causes of AKP based on clinical symptoms and physical examination signs. The routine MRI protocol used for patients with AKP showed a sensitivity of only 13% for superficial patellar chondral lesions. For more severe lesions, the sensitivity was substantially higher, 83%, and 1.0T MRI may be considered a sensitive diagnostic tool in these cases.