Notre système de santé subit des pressions constantes pour réduire et rationnaliser ses dépenses. Dans un tel contexte, modifier durablement les comportements individuels constitue un enjeu de taille. Plus que jamais, l’individu est invité à devenir acteur de sa santé en s’autorégulant tout au long de sa vie. Pour autant, c’est dans un monde complexe où les univers de référence s’effritent, qu’il doit désormais être en capacité d’agir. Ces dernières années, Internet a investi le champ de la santé, modifiant le rapport au savoir médical. Le médecin n’est plus perçu comme le seul détenteur de savoir et de pouvoir. Chacun souhaite dorénavant prendre une part active dans la gestion de sa santé, brouillant ainsi les lignes de partage entre savoir profane et savoir expert.Notre travail de recherche interroge la capacité des individus à exercer un contrôle sur leur santé. Notre objectif est de comprendre comment ce pouvoir d’agir sur soi se construit au fil du temps puis se déploie au gré des évènements biographiques. Notre démarche vise donc la compréhension du phénomène de l’autorégulation de la santé, dont il s’agit de rendre intelligible le fonctionnement. De ce fait, ce sont des entretiens biographiques qui ont été menés auprès de vingt-quatre individus au mitan de leur vie. Cette enquête a permis de mettre en lumière un modèle d’analyse et de compréhension des comportements de santé et surtout de poser des hypothèses de recherche que nous avons pu éprouver sur une population plus importante dans le cadre d’une deuxième enquête quantitative portant sur 451 individus. Grâce à cette double approche méthodologique nous sommes en mesure de constater que les comportements de santé peuvent s’analyser en considérant conjointement trois facteurs que sont le rapport de l’individu au savoir, son rapport au médecin et son rapport à la fatalité. / Our healthcare system is under constant pressure to reduce spending. In such a context, more than ever, bringing about lasting change to individuals' behavior is a key issue. In this regard, all individuals are urged to become lifelong, self-regulated contributors to their own health maintenance. However, the context in which people are encouraged to take on this role is extremely complex. Internet has become part of the healthcare scene and changed the way people think about healthcare and gain access to medical knowledge. Doctors are no longer believed to be the only people who possess knowledge and power in the field. Everyone now wants to have an active hand in managing their own health, which blurs the boundaries between lay and expert knowledge. Our research explores people's ability to exercise control over their own health. Our objective is to understand how this self-determining power develops over time and is exercised in accordance with life events. Our approach thus aims to understand the self-regulation of health as an intelligible phenomenon. Biographical interviews were conducted with twenty-four middle-aged individuals. This survey not only provides a model of analysis and understanding of health-related behavior, but also puts forward hypotheses that were tested on a larger population as part of a second quantitative study involving 451 participants. Given this two-pronged methodological approach, we observe that people's healthcare-related behavior can indeed be analyzed in light of three joint factors, namely the individual's relationship to knowledge, doctors, and fatality.

RUSSO, Maurício Bastos. Violência no trânsito "À Moda Brasileira": Insegurança, Letalidade e Impunidade. 2012. 226f. – Tese (Doutorado) – Universidade Federal do Ceará, Programa de Pós-graduação em Sociologia, Fortaleza (CE), 2012. / Submitted by Márcia Araújo (marcia_m_bezerra@yahoo.com.br) on 2013-10-22T11:57:43Z No. of bitstreams: 1 2012-TESE-MBRUSSO.pdf: 4517841 bytes, checksum: afdf394b86e051afb2174f40fb5696ed (MD5) / Approved for entry into archive by Márcia Araújo(marcia_m_bezerra@yahoo.com.br) on 2013-10-22T13:30:21Z (GMT) No. of bitstreams: 1 2012-TESE-MBRUSSO.pdf: 4517841 bytes, checksum: afdf394b86e051afb2174f40fb5696ed (MD5) / Made available in DSpace on 2013-10-22T13:30:21Z (GMT). No. of bitstreams: 1 2012-TESE-MBRUSSO.pdf: 4517841 bytes, checksum: afdf394b86e051afb2174f40fb5696ed (MD5) Previous issue date: 2012 / The Brazilian car fleet almost doubled its size in the last decade. At the same time, the number of victims from car accidents rises every year. This thesis aims at understanding how economic and cultural conditions contribute to violence caused by cars. In spite of the fact that this is a common issue in every country nowadays, in some cases, such as it happens in Brazil, the problem is not the total number of car accidents but their lethal percentage. In Brazil, contrary to what is seen in developed countries, most automobiles, a kind of vehicle most frequently involved in accidents with victims, do not offer basic safety equipment, such as airbags and anti-lock braking system (ABS) which are major deterrent of fatalities. One should add to this the state’s inability to regulate properly the social environment created for vehicles. Exemption from punishment for violators, ranging from light infractions, such as parking at unauthorized places, to more serious ones, such as homicides fired by car accidents foments illegal practices. Problems involving training of new drivers and issuing of a driver’s license release thousands of unauthorized drivers to take Brazilian streets and roads. The country’s economic development did not create an equal process of transformation that allowed drivers to changing into individuals capable of respecting alterity involving other users of the transit system. Transit is still a privileged space for some who do not respect the existing social hierarchy and who defy those who consider driving a car an exercise of democracy. / Na última década a frota brasileira de veículos quase dobrou de tamanho. Ao mesmo tempo, a cada ano, aumenta o número de vítimas decorrentes de acidentes de trânsito no Brasil. O objetivo desta tese é compreender como as condições socioeconômicas e culturais contribuem com a violência no trânsito. Embora este seja um problema comum a todos os países na modernidade, em alguns casos, como no Brasil, o maior problema não é o número total de acidentes, mas o percentual letal destes. Ao contrário dos países desenvolvidos, no Brasil, a maior parte dos automóveis de passeio, tipo de veículo que mais se envolve em acidente de trânsito com vítimas, não dispõem de equipamentos de segurança básicos, como airbags e freios ABS, essências para evitar que o acidente se torne fatal. Soma-se a isto a incapacidade do Estado em regular adequadamente o ambiente social do trânsito. A falta de punição dos infratores, desde infrações leves, como o estacionamento em local proibido, a casos mais graves como o homicídio no trânsito, incentiva as práticas ilegais. Problemas no aprendizado dos condutores e na obtenção da Carteira Nacional de Habilitação (CHN) permitem que milhares de motoristas não qualificados circulem nas ruas e estradas brasileiras. Nosso crescimento econômico não foi acompanhado por um processo que transformasse os condutores em indivíduos capazes de respeitar a alteridade dos demais participantes do sistema de trânsito. O trânsito ainda é para alguns um espaço privilegiado, que deveria respeitar a hierarquia social existente, que entra em conflito com aqueles que consideram este um espaço democrático

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Na Ãltima dÃcada a frota brasileira de veÃculos quase dobrou de tamanho. Ao mesmo tempo, a cada ano, aumenta o nÃmero de vÃtimas decorrentes de acidentes de trÃnsito no Brasil. O objetivo desta tese à compreender como as condiÃÃes socioeconÃmicas e culturais contribuem com a violÃncia no trÃnsito. Embora este seja um problema comum a todos os paÃses na modernidade, em alguns casos, como no Brasil, o maior problema nÃo à o nÃmero total de acidentes, mas o percentual letal destes. Ao contrÃrio dos paÃses desenvolvidos, no Brasil, a maior parte dos automÃveis de passeio, tipo de veÃculo que mais se envolve em acidente de trÃnsito com vÃtimas, nÃo dispÃem de equipamentos de seguranÃa bÃsicos, como airbags e freios ABS, essÃncias para evitar que o acidente se torne fatal. Soma-se a isto a incapacidade do Estado em regular adequadamente o ambiente social do trÃnsito. A falta de puniÃÃo dos infratores, desde infraÃÃes leves, como o estacionamento em local proibido, a casos mais graves como o homicÃdio no trÃnsito, incentiva as prÃticas ilegais. Problemas no aprendizado dos condutores e na obtenÃÃo da Carteira Nacional de HabilitaÃÃo (CHN) permitem que milhares de motoristas nÃo qualificados circulem nas ruas e estradas brasileiras. Nosso crescimento econÃmico nÃo foi acompanhado por um processo que transformasse os condutores em indivÃduos capazes de respeitar a alteridade dos demais participantes do sistema de trÃnsito. O trÃnsito ainda à para alguns um espaÃo privilegiado, que deveria respeitar a hierarquia social existente, que entra em conflito com aqueles que consideram este um espaÃo democrÃtico / The Brazilian car fleet almost doubled its size in the last decade. At the same time, the number of victims from car accidents rises every year. This thesis aims at understanding how economic and cultural conditions contribute to violence caused by cars. In spite of the fact that this is a common issue in every country nowadays, in some cases, such as it happens in Brazil, the problem is not the total number of car accidents but their lethal percentage. In Brazil, contrary to what is seen in developed countries, most automobiles, a kind of vehicle most frequently involved in accidents with victims, do not offer basic safety equipment, such as airbags and anti-lock braking system (ABS) which are major deterrent of fatalities. One should add to this the stateâs inability to regulate properly the social environment created for vehicles. Exemption from punishment for violators, ranging from light infractions, such as parking at unauthorized places, to more serious ones, such as homicides fired by car accidents foments illegal practices. Problems involving training of new drivers and issuing of a driverâs license release thousands of unauthorized drivers to take Brazilian streets and roads. The countryâs economic development did not create an equal process of transformation that allowed drivers to changing into individuals capable of respecting alterity involving other users of the transit system. Transit is still a privileged space for some who do not respect the existing social hierarchy and who defy those who consider driving a car an exercise of democracy.

La nouvelle étant un récit bref, elle est à même de représenter le tragique de l'existence : elle attrape sur le vif tous les événements de la vie et les présente dans une économie restreinte. Theodor Storm et Guy de Maupassant ne manquent pas à cette règle et proposent des récits marqués par l'empire de la fatalité. Celle-ci est la manifestation du destin et/ ou du hasard qui transparaissent à travers la description de paysages réalistes et à travers la mise en avant d'objets clé qui entraînent avec eux la décrépitude des personnages. La technique narrative est également au service de la mise en scène de ce déterminisme, ainsi, l'un et l'autre auteur se permettent d'enchâsser les histoires, de revenir en arrière dans la narration pour mieux faire peser le poids du destin et/ ou du hasard afin de souligner que chacun fonctionne comme un mécanisme à ressort se déroulant tragiquement. Pourtant, même si tout laisse supposer le contraire, ces nouvelles ne sont pas qu'imprégnées de pessimisme. En effet, de cette fatalité empreinte de destin et/ ou de hasard se dégage un élan vital caractéristique de la pensée philosophique et sociale du XIXe siècle. Le destin et/ ou le hasard est en fait l'expression aveugle d'une volonté qui détermine le choix des personnages. Aussi ces nouvelles mettent-elles l'accent sur l'illusion du libre arbitre des personnages qui pensent pouvoir se déterminer eux-mêmes. De là, l'élan créatif issu de l'écriture permet une suspension de ce déterminisme. Ainsi, ce sont ces mécanismes de la fatalité qui sont démontés dans ce travail afin de repérer cet élan vital, salvateur et libérateur propre à la conception philosophique et littéraire du XIXe siècle. / A short story is a brief narrative and therefore can represent the tragic of existence : it catches on the spot all the events of life and presents them in a restricted economy. Theodor Storm and Guy de Maupassant obey the rule and offer narratives marked by fatality, which is the demonstration of fate and/ or chance shown through the description of realistic landscapes and through the emphasis of key objects which pull with them the decline of the characters. The narrative technique also serves the fabrication of this determinism. So, both authors allow themselves to intersperse stories, to go back into the narration, so that the weigh of fate and/ or chance is heavier and works as a spring mechanism taking place tragically. Nevertheless, even if everything suggests the opposite, these short stories are not so pessimistic. Indeed, a life force typical of the philosophical and social thinking of the 19th century arises from this fatality marked with fate and/ or chance. Fate and/ or chance is in fact the blind expression of a will which determines the choice of characters. So these short stories emphasize the illusion of characters' free will who think they can decide of their life. From there, the creative impulse stemming from the writing allows a interruption of this determinism. So, it is those mechanisms of fate that are defused in this work to observe this saving and liberatoring life force, inherent to the philosophic and literary concept of the XIXth century.

Background Malaria remains a serious epidemic threat in the Lowveld region of Mpumalanga Province. In order to appropriately target interventions to achieve substantial reductions in malaria morbidity and mortality, there is a need to assess the impact of current control interventions such as indoor residual spraying (IRS) for vector control. This study aimed to assess long-term changes in the burden of malaria in Mpumalanga Province during the past eight years (2001-2009) and whether IRS and climate variability had an effect on these changes. Methods All malaria cases and deaths notified to the Malaria Control Programme, Department of Health was reviewed for the period 2001 to 2009. Data were retrieved from the provincial Integrated Malaria Information System (IMIS) database. Climate and population data were obtained from the South Africa Weather Service and Statistics South Africa, respectively. Descriptive statistics were computed to determine any temporal changes in malaria morbidity and mortality. Autoregressive integrated moving average (ARIMA) models were developed to assess the effect of climatic factors on malaria. Results Within the eight-year period of the study, a total of 35,191 cases and 164 deaths-attributed to malaria were notified in Mpumalanga Province. There was a significant decrease in the incidence of malaria in Mpumalanga Province from 385 in 2001/02 to 50 cases per 100,000 population in 2008/09 (P < 0.005). The overall incidence and case fatality rates were 134 cases per 100,000 and 0.54%, respectively. Malaria incidence and case fatality rate by gender showed significant differences, higher in males than in L.M. Ngomane University of Pretoria, 2012 iv females (166.9 versus 106.4; P < 0.001; CFR 0.41% versus 0.55%). The incidence of malaria increased from age 5-14 years (70), reaching a peak at age 25-34 years (190), declining thereafter (50 in those >65 years). Mortality due to malaria was higher in those >65 years, the mean CFR reaching a 2.1% peak. Almost half (47.8%) of the notified cases originated from Mozambique and Mpumalanga Province itself constituted 50.1%. The distribution of malaria varied across the districts, highest in Ehlanzeni district (96.5%), lowest in Nkangala (<1%) and Gert Sibande (<1%). A notable decline in malaria case notification was observed following the increased IRS coverage from 2006/07 to 2008/09 malaria seasons. A distinct seasonal transmission pattern was found to be significantly related to changes in rainfall patterns (P = 0.007). Conclusion Decades of continuous IRS with insecticides have proved to be successful in reducing the burden of malaria morbidity and mortality in Mpumalanga Province between 2001 and 2009. A decline of above 50% in malaria morbidity and mortality was observed following expanded IRS coverage. These results highlight the need to continue with IRS together with other control strategies until interruption in local malaria transmission is completely achieved and alternative vector control strategies implemented. Efforts need to be directed towards the control of imported cases, interruption of local transmission and focus on research into sustainable and cost-effective combination of control interventions. / Dissertation (MSc)--University of Pretoria, 2012. / School of Health Systems and Public Health (SHSPH) / Unrestricted

京都大学 / 0048 / 新制・課程博士 / 博士(地球環境学) / 甲第21241号 / 地環博第177号 / 新制||地環||35(附属図書館) / 京都大学大学院地球環境学舎地球環境学専攻 / (主査)教授 清野 純史, 准教授 小林 広英, 准教授 古川 愛子 / 学位規則第4条第1項該当 / Doctor of Global Environmental Studies / Kyoto University / DFAM

Objetivos: Descrever o comportamento da Doença Meningocócica (DM) focalizando aspectos clínicos e seus desfechos, analisar o possível impacto da descentralização da assistência hospitalar, investigando também fatores associados à sua gravidade no município de São Paulo (SP), de 1986 a 2004. Metodologia: Trata-se de um estudo de corte transversal com componente descritivo e analítico, abrangendo o período de 1986 a 2004. A população de estudo abrange pacientes de DM, residentes no município de SP, notificados à vigilância. Os dados foram obtidos junto à vigilância passiva da DM e ao Instituto Adolfo Lutz de São Paulo. A descrição da doença foi efetuada segundo aspectos relativos ao tempo, espaço e pessoa. Para a investigação dos fatores associados à gravidade da DM tomou-se como variável dependente o óbito por DM e como variável independente, as exposições de interesse. Elas foram investigadas por meio das estimativas das odds ratio não ajustadas e ajustadas pela regressão logística não condicional, com os respectivos intervalos de confiança de 95 por cento. Resultados: Foram confirmados 10.087 casos de DM no município de São Paulo, durante o período de interesse. No pico epidêmico de 1995, a taxa de incidência média da DM foi de 8,1 casos/100.000 habitantes (hab), a mortalidade de 1,8 casos/hab/ano e letalidade média de 22 por cento. Crianças menores de quatro anos foram as mais atingidas, constituindo 54 por cento dos casos, principalmente entre os menores de um ano, com taxa de incidência média de 60,1/100000 casos/hab. Em 1986, o Hospital Especializado atendia 83 por cento dos casos e os Assistenciais apenas 12 por cento. No final do período estudado (2004), com a descentralização do serviço, o Hospital Especializado passou a atendeu 22 por cento dos casos e 71 por cento dos casos os Assistenciais. O Hospital Especializado manteve a letalidade anual dos casos de DM constante durante todo período, em torno de 11 por cento. A letalidade 15 dos Hospitais Assistenciais foi diminuindo gradativamente ao longo do período, inicialmente com 60 por cento e terminando com 16 por cento. Conclusão: A identificação de fatores associados à gravidade da DM e a repercussão da assistência hospital podem contribuir na melhoria das condutas clínicas, e subsidiar políticas públicas e intervenções de saúde pública / Objectives: To describe the behavior of meningococcal disease (MD) focusing on clinical features and outcomes, analyze the potential impacts of decentralization of hospital care, also investigating factors associated with the severity of MD in São Paulo (SP) city, from 1986 to 2004. Methods: This is a cross-sectional study with descriptive and analytical component covering the period 1986 to 2004. The population of the study was inhabitants in SP city, registered in the surveillance system. The data were obtained from the surveillance system of the DM MD and the Adolfo Lutz Institute of São Paulo. The descriptive analysis was presented by aspects of the time, space and person. The investigation of factors associated with the severity of the MD, it was considered as dependent variable death, and as independent variable, the exposure of interest. They were investigated by unadjusted and adjusted odds ratios by unconditional logistic regression, with their confidence intervals of 95 per cent. Results: There were 10,087 confirmed cases of MD in SP city, from 1986 to 2004. In epidemic peak (1995), the average rate of incidence of MD was 8.1 cases/100000 inhabitants (inhabit), the mortality rate was 1.8 cases/inhab/year and average case fatality rate (CFR) was of 22 per cent. Children under four years were the highest risk, representing 54 per cent of cases, especially among children under one year with average incidence rate of 60.1/100000 cases/inhab. In 1986, the specialized hospital cared 83 per cent of cases and non-specialized hospital only 12 per cent. At the end of the period studied (2004), with the decentralization of service, the specialized hospital has attended 22 per cent and 71 per cent of cases by the non-specialized. The referential hospital represented an annual CFR of MD constant in over time, around 11 per cent. The CFR of non-specialized hospital has been decreasing gradually 17 over the period, initially with 60 per cent and ending with 16 per cent. Conclusion: The identification of factors associated with the severity of DM and the impact of decentralization of the hospitals care can help in improving the clinical procedures, and support public policies and public health interventions

Objetivos: Descrever o comportamento da Doença Meningocócica (DM) focalizando aspectos clínicos e seus desfechos, analisar o possível impacto da descentralização da assistência hospitalar, investigando também fatores associados à sua gravidade no município de São Paulo (SP), de 1986 a 2004. Metodologia: Trata-se de um estudo de corte transversal com componente descritivo e analítico, abrangendo o período de 1986 a 2004. A população de estudo abrange pacientes de DM, residentes no município de SP, notificados à vigilância. Os dados foram obtidos junto à vigilância passiva da DM e ao Instituto Adolfo Lutz de São Paulo. A descrição da doença foi efetuada segundo aspectos relativos ao tempo, espaço e pessoa. Para a investigação dos fatores associados à gravidade da DM tomou-se como variável dependente o óbito por DM e como variável independente, as exposições de interesse. Elas foram investigadas por meio das estimativas das odds ratio não ajustadas e ajustadas pela regressão logística não condicional, com os respectivos intervalos de confiança de 95 por cento. Resultados: Foram confirmados 10.087 casos de DM no município de São Paulo, durante o período de interesse. No pico epidêmico de 1995, a taxa de incidência média da DM foi de 8,1 casos/100.000 habitantes (hab), a mortalidade de 1,8 casos/hab/ano e letalidade média de 22 por cento. Crianças menores de quatro anos foram as mais atingidas, constituindo 54 por cento dos casos, principalmente entre os menores de um ano, com taxa de incidência média de 60,1/100000 casos/hab. Em 1986, o Hospital Especializado atendia 83 por cento dos casos e os Assistenciais apenas 12 por cento. No final do período estudado (2004), com a descentralização do serviço, o Hospital Especializado passou a atendeu 22 por cento dos casos e 71 por cento dos casos os Assistenciais. O Hospital Especializado manteve a letalidade anual dos casos de DM constante durante todo período, em torno de 11 por cento. A letalidade 15 dos Hospitais Assistenciais foi diminuindo gradativamente ao longo do período, inicialmente com 60 por cento e terminando com 16 por cento. Conclusão: A identificação de fatores associados à gravidade da DM e a repercussão da assistência hospital podem contribuir na melhoria das condutas clínicas, e subsidiar políticas públicas e intervenções de saúde pública / Objectives: To describe the behavior of meningococcal disease (MD) focusing on clinical features and outcomes, analyze the potential impacts of decentralization of hospital care, also investigating factors associated with the severity of MD in São Paulo (SP) city, from 1986 to 2004. Methods: This is a cross-sectional study with descriptive and analytical component covering the period 1986 to 2004. The population of the study was inhabitants in SP city, registered in the surveillance system. The data were obtained from the surveillance system of the DM MD and the Adolfo Lutz Institute of São Paulo. The descriptive analysis was presented by aspects of the time, space and person. The investigation of factors associated with the severity of the MD, it was considered as dependent variable death, and as independent variable, the exposure of interest. They were investigated by unadjusted and adjusted odds ratios by unconditional logistic regression, with their confidence intervals of 95 per cent. Results: There were 10,087 confirmed cases of MD in SP city, from 1986 to 2004. In epidemic peak (1995), the average rate of incidence of MD was 8.1 cases/100000 inhabitants (inhabit), the mortality rate was 1.8 cases/inhab/year and average case fatality rate (CFR) was of 22 per cent. Children under four years were the highest risk, representing 54 per cent of cases, especially among children under one year with average incidence rate of 60.1/100000 cases/inhab. In 1986, the specialized hospital cared 83 per cent of cases and non-specialized hospital only 12 per cent. At the end of the period studied (2004), with the decentralization of service, the specialized hospital has attended 22 per cent and 71 per cent of cases by the non-specialized. The referential hospital represented an annual CFR of MD constant in over time, around 11 per cent. The CFR of non-specialized hospital has been decreasing gradually 17 over the period, initially with 60 per cent and ending with 16 per cent. Conclusion: The identification of factors associated with the severity of DM and the impact of decentralization of the hospitals care can help in improving the clinical procedures, and support public policies and public health interventions

To achieve the goal of universal coverage of health insurance for the Americans, in March 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law. The ACA targets at providing help to improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. One of the precedent mandates, implemented in September 2010, is to expand coverage on young adults of age 19 to 26, who may lose insurance coverage due to the remove from their parents’ plan after age 18 and lacking of productivity to bargain with employers in the labor market. This dissertation looks into the impact of the ACA health insurance coverage expansion for young adults on the subsequent health outcomes, health care utilization, and further social impact on traffic fatalities. Difference-in-differences models are used with different treatment groups and corresponding control groups. Chapter I uses survey data (BRFSS) to evaluate health care access, health behavior and self-assessed health status. The results suggest an improvement in health care access and self-assessed health but more risky behavior. Chapter II uses hospital discharge data (NIS) to estimate avoidable hospitalization in order to assess primary care utilization. The result shows that less primary care was consumed, which leads to more avoidable hospitalization but health may have been improved by using more hospital care. The results from both chapters imply potential ex ante moral hazard among young adults in the policy targeting age group. Thus, chapter III uses accident records data (FARS) to examine the impact of the health insurance expansion on traffic fatality for young adults, to see whether young drivers perform ex ante moral hazard through risky behavior like drunk and/or reckless driving after they get covered by the health insurance expansion policy. Primary result shows that there is an increase in traffic accidents and fatalities for those younger adults as a result of the ACA dependent coverage expansion.

In this thesis, red flags for dangerousness/lethality established from domestic violence and homicide research provided the social framework for an examination of legal responses to violence in intimate heterosexual relationships. The research investigated these gendered, structural patterns of violence and the effectiveness of criminal justice interventions in keeping victims safe. Agency interactions with offenders and victims prior to women's deaths were reviewed in selected cases. Criminal law constructions of violence in intimate relationships were evaluated for their recognition and understanding of primary risk factors for dangerousness/lethality. The research found major red flags remain invisible in criminal law stereotypes of violence between intimates. The significance of these risk factors for dangerousness/lethality is therefore overlooked, misunderstood and even misrepresented in defence of violent offenders. Although the aim of the Domestic Violence Act 1995 is to ensure effective protection for victims, the study found a significant number of women (and sometimes other family members and children) experience further sub-lethal and lethal violence following legal interventions with perpetrators. Lacking a principled policy foundation, central focus on victim safety and clear framework for interventions, legal responses are internally incoherent and inconsistent with New Zealand Family Violence Prevention Strategy. The New Zealand government has committed to principled domestic violence intervention and consistency in law and policy. This will require: a) legislative reform; b) public and professional education on the dynamics of violent relationships, including the interrelationship between sublethal and lethal assaults; and c) monitoring of criminal justice interventions to improve accountability. Until this is accomplished, stories of abused women and their children, including informal attempts to seek help and contact with state and community agencies will continue to be dishonoured by a legal system which silences their voices and fails to learn lessons from their injuries and deaths.