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This study aims to analyze the pattern of deaths in detention in Northern Tunisia as well as the causes of death.

The authors conducted a cross-sectional retrospective study including all the casualties of death in detention examined in the legal medicine Department in the main teaching hospital from 2005 to 2019. The department covers 10 out of the 11 governorates of Northern Tunisia and 13 prisons.

Of a total of 197 casualties, only 2 were females. The mean age was 45.39 ± 14.43 years. A known medical history was reported in 63.5%, mainly cardiovascular disease, mental health disorders and diabetes. Half of the deaths occurred at the hospital. A total of 53 victims spent less than one year in custody before their death. Most deaths occurred due to disease-related causes (78.7%; n = 155); among these, 69 victims died from cardiovascular disease. Suicide accounted for 3.6% of the casualties and homicides for four cases.

Several missing data regarding the details of the detention circumstances as well as the absence in some cases of the toxicological and histopathology analysis results, which could bias the study findings.

Death in detention in Northern Tunisia involved mainly males between their 30s and their 50s who died mainly from cardiovascular or pulmonary disease. These results underscore the importance of empowering the penitentiary health system.

To the best of the authors’ knowledge, this study is one of largest studies with regard to the number of decedents and the number of prisons from the Arab countries allowing to draw a pattern of casualties of death in prison.

The dual epidemic of non-communicable diseases (NCDs) and human immuno-deficiency virus (HIV) in Sub-Saharan Africa has increased substantially in recent years, with cardiovascular disease representing a significant contributor to the regional burden of disease. Very little is known about the cardiovascular health of people deprived of their liberty in the region. The purpose of this study was to collate extant literature on the topic.

A scoping review mapped and described what is known about cardiovascular disease in prison populations in Sub-Saharan Africa. A systematic search of empirical literature with no date limitation was conducted in English. Sixteen studies representing six Sub-Saharan African countries (Cameroon, Nigeria, Guinea, Burkina Faso, Ghana and Ethiopia) were charted, categorised and thematically analysed.

Seven key themes were identified: custodial deaths and autopsy; cardiorespiratory fitness and exercise; cardiovascular disease and elderly people in prison; cardiovascular disease and women in prison; dietary deficiencies; influence of sleep patterns on cardiovascular disease; and other associated risk factors. Most natural deaths at autopsy of custodial deaths were due to cardiovascular disease. Cardiorespiratory fitness was low in prisons, and poor sleep patterns and dietary deficiencies are likely contributors to the burden of cardiovascular disease in prisons. The needs of elderly and female prison populations are ill-considered.

To the best of the authors’ knowledge, this is the first known attempt to scope extant literature on cardiovascular disease in Sub-Saharan African prisons. A strategic focus on the cardiovascular health of people in prison is warranted. Routine monitoring and expansion of existing prison health-care services and integration of NCD services with infectious disease (HIV and tuberculosis) programmes in prisons are required.

This chapter contributes to a better knowledge of the role played by the collective entrepreneurship of networks of scientists and doctors in the transfer and adaptation of ideas on hospital organization and management for modern hospitals with new technology, from Western Europe and above all the United States. Literature about new medical technology has demonstrated how medical innovations required changes in human capital and organization in hospitals, to benefit patients in the private and the public hospitals after World War II. The chapter provides an analysis about the origins of the modern North American ideas about professionalization and hospital accreditation, in the consolidation of a modern hospital management and organization. In particular, the focus is in demonstrating how networks of scientists’ entrepreneurs were fundamental drivers in the process of knowledge transfer and the dissemination of these ideas to the large Western European hospitals. More specifically, the chapter studies the diffusion of the new ideas about the large hospital organization and management from the United States to the Western Europe, applied to the Spanish context. Informal networks of doctors applied new ideas developed in the United States to new clinics and hospitals in Spain. Some of them occupied official positions in the key public health administrations and were crucial to introducing the hospital accreditation systems and the US ideas in Spain.

High rates of suicide and self-harm are reported in prisons in Western countries, while fewer studies exist from a non-Western context. This study aims to identify rates of suicide, non-fatal suicide attempts and self-harm in Moroccan prisons and to better understand the context, methods, tools, predictors and profile of persons engaged in the acts.

The authors report findings from a mixed-methods study carried out before an intervention project. The study consists of a systematic literature review, an analysis of suicide case files, a quantitative survey on suicide attempts and self-harm, as well as interviews and focus group discussions. The authors calculate suicide, suicide attempt and self-harm rates and present descriptive data on the incidents. The authors use regression models to explore the association between the number of incidents per individual and selected predictors, adjusting for clustering by institution.

Over a four-year period, 29 detained persons in Morocco died by suicide (average annual suicide rate 8.7 per 100,000). Most were men under the age of 30. Hanging accounted for all but one case. In one year, 230 suicide attempts were reported. Over a three-months period, 110 self-harm cases were reported from 18 institutions, cutting being the most common method. Self-harm was significantly more prevalent among persons with a life sentence or repeated incarcerations.

To make the study manageable as part of an intervention project, the authors collected data on suicides and suicide attempts from all prisons, while data on self-harm were collected from fewer prisons and over a shorter time period. The authors did not collect comparable information from detained persons who did not die by suicide, attempt suicide or self-harm. This prevented comparative analyses. Further, it is possible that self-harm cases were not reported if they did not result in serious physical injury. Data were collected by prison staff; thus, the voice of incarcerated persons is absent.

This study provided a solid basis for designing an intervention project including the development of a national prison policy and guidelines on suicides, suicide attempts and self-harm and a country-wide training program for prison staff. It also led to a better surveillance system, allowing for trend analysis and better-informed policymaking. The qualitative results helped create an understanding of how staff may trivialize self-harm. This was integrated into the training package for staff, resulting in the creation of prison staff trainers who became the strongest advocates against the notion that self-harm was best ignored.

To the best of the authors’ knowledge, this is the first published data on suicide and self-harm in Moroccan prisons. It underscores the necessity for the intervention project and gives valuable insights into suicide and self-harm in a non-Western prison context. Further research is needed to assess whether the findings are typical of the region.

This chapter seeks to shed light on the many factors that contribute to people becoming school shooters. These factors are divided into four domains: biological, psychological, social, and cultural. At the biological level, this chapter explores the potential influence of genetics, pre- and post-natal development, and body-related issues that may affect the perpetrators' sense of self. A psychological typology is presented, consisting of psychopathic, psychotic, and traumatized school shooters. Socially, school shooters often have multiple setbacks, failures, and rejections that contribute to their distress. Finally, the cultural domain includes such factors as media violence, role models for killing, and ideologies of hatred and supremacy. Rather than attributing school shootings to a simplistic cause such as bullying, this chapter discusses a wide range of potential influences that combine to cause mass attacks at schools.

This chapter critically examines the dialectical relationship between colonial capitalism, racism, state terrorism, and racial/ethnonational domination from the sixteenth to the twenty-first century. It demonstrates the deficiencies of theories of global studies. In reformulating and improving critical international studies, this study advances the idea that excluding indigenous wisdom and knowledge from this area has allowed the hegemonic Euro-American-centric scholarship and ideology to limit our understanding of the racist sickness and its continuous evolution in the modern world system. Since this sickness has been hidden under the rhetoric of democracy, human rights, and social justice, even progressive intellectuals have failed to thoroughly comprehend the devastating consequences of racism and terrorism in global studies.

First, the chapter critically establishes the dialectical relationship between colonial capitalism, racial terrorism, and the continuous destruction of indigenous peoples in the Americas, Africa, Asia, and Australia. It explains how the dominant racial/ethnonational groups have continued to maintain their privileges at the cost of marginalized societies. Second, using indigenous wisdom and knowledge, the piece exposes the intellectual deficiencies of Euro-American scholarship and ideology from the right and left in global studies. Third, the chapter demonstrates that the claims of democracy, human rights, and social justice do not adequately apply to the conditions of the indigenous peoples in the world. Fourth, it proposes ways of developing a comprehensive critical global studies by critically including the wisdom and knowledge of indigenous peoples.