Clinical forensic examinations and prosecution in Danish child physical abuse cases.

A physician is crucial in the early recognition and reporting of suspected child abuse cases to avoid fatal outcomes. In 2021, the reported rate of suspected child abuse by healthcare providers in Korea was only 1.1%. It appeared that the low reported rate by physicians are mostly due to lack of confidence in diagnosis. Clinical forensic examination by trained physicians is essential on the first physical examination on suspected cases of child abuse, focusing on documentation of injuries and preservation of evidence for legal processing. While Germany, the United Kingdom, Australia, and the United States of America have their own education and training system of clinical forensic examination stressed on undergraduate medical students and physicians, the concept of clinical forensic medicine remains insufficiently known in Korea. To effectively implement the clinical forensic examination in the management of child abuse, it is essential to understand the current status of the curriculum for medical students and physicians. A more practical and integrated education program for medical students should be developed based on real cases incorporated by the experiences of forensic pathologists. Considering the overall shortage of forensic pathologists, pediatricians, and emergency medicine physicians concerned with child abuse, postgraduate training should be focused on securing a small number of clinicians and forensic pathologists specialized in clinical forensic examination to seize the referred cases of child abuse.

Examination of a person who has been a victim of a physical or sexual assault may be very important for upcoming legal proceedings. In the context of a clinical forensic examination, physical findings are recorded and biological trace material is gathered and secured. Ideally, all forensic findings are documented in a detailed report combined with photographic documentation, which employs a forensic scale to depict the size of the injuries. However, the integrity of such forensic findings depends particularly on two factors. First, the examination needs to be conducted professionally to ensure that the findings are properly admissible as court evidence. Second, the examination should take place as soon as possible because the opportunity to successfully secure biological samples declines rapidly with time. Access to low-threshold clinical forensic examinations is not evenly provided in all member states of the European Union (EU); in some states, they are not available at all. As part of the JUSTeU! (Juridical standards for clinical forensic examinations of victims of violence in Europe) project, the Ludwig Boltzmann Institute for Clinical Forensic Imaging in Graz, Austria created (in cooperation with its international partner consortium) a questionnaire: the purpose was to collect information about support for victims of physical and/or sexual assault in obtaining a low-threshold clinical forensic examination in various countries of the EU. Our paper provides a summary of the responses and an overview of the current situation concerning provided clinical forensic services.

Objectives: To determine the dental practitioner’s knowledge, attitude, and behavior towards child physical abuse in dental teaching hospitals of Peshawar.Methods and materials: An analytical cross-sectional study was executed in the two dental teaching hospitals of Peshawar using convenience sampling. The data was gathered by self-administered, structured questionnaire completed by 127 house offi cer, 147 trainees and 32 faculty members. Chi-square test was used to analyze association between categorical variables.Results: Out of 320 questionnaires, 306 were returned with complete evaluation yielding a response rate of 95.6%. In the present study, 69.6% of the respondents displayed suffi cient knowledge while 11.1% had poor knowledge on the topic of child physical abuse. Almost 83% of dental practitioners had positive attitude towards the importance of detecting and reporting cases of child physical abuse to legal authorities and 60.5% of dentists strongly agreed that training on child physical abuse should be provided in workplace. Only 11.1% of the respondents had suspected a cases of child physical abuse in their past professional life and only 3.2% of them had reported their suspicion to legal authorities.Conclusion: Dental practitioners have inadequate knowledge about the circumstances in which they should report suspected cases of physical abuse to legal authorities as well as to which legal authorities such cases should be reported. Majority of dentists stated that there is lack of training regarding this topic and showed positive attitude towards dental practitioners’ role in documenting, identifying, and reporting cases of child physical abuse.

To study the characteristics of the relationship between injury and disease in forensic identification cases of cervical trauma with cervical vertebra degeneration, and to explore the problems about how to identify the participation rates of injury and disease using the clinical information, forensic examination and imaging examination. Seventeen forensic identification cases of cervical trauma with cervical vertebra degeneration were collected. The age distributions, injury formations, injury severities and imaging findings of these cases were analyzed and the relationship between injury and disease was evaluated comprehensively. Middle-aged and elderly were common in 17 cases and every case was involved with intervertebral disc herniation. The main reasons of injuries were hyperextension. The degree of injury severity and vertebra degeneration were graded according to the imaging findings. The participation rates of injury and disease were also calculated comprehensively. The forensic identification cases of cervical trauma with cervical vertebra degeneration should be evaluated with clinical information, forensic examination and imaging finding.

Racial, Ethnic, and Gender Disparities in Substantiated Child Maltreatment: A State-Level Analysis of U.S. Incidence Rates.

In this paper certain explanations of health related aspects of human trafficking are discussed together with responsibilities of health care providers to the victims of trafficking. Clinical forensic medicine is outlined, and its role in obtaining of medical evidence has been discussed. Special remarks are made on the application of clinical forensic medicine skills in assessment of victims of human trafficking. Protocol for clinical forensic examination of the victims of human trafficking, which has been developed in the Institute of Forensic Medicine in Belgrade, has been discussed in details.

Non-fatal impalement of the brain: A case report

Brodifacoum exerts its antagonistic effect against the metabolism of vitamin K, an essential component in the synthesis of blood coagulation factors. This effect ultimately hinders the blood's capacity to clot effectively, rendering it a commonly employed rodenticide. Instances of lethal poisonings are exceedingly rare owing to expeditious medical intervention and treatment. Within this report, we present a case of brodifacoum-induced homicide, wherein the patient exhibited distinct clinical examinations and symptoms. Moreover, the patient's blood sample exhibited a noteworthy brodifacoum concentration of 0.681µg/mL even after a period of 43 days following the incident of poisoning. Although an autopsy was not conducted due to religious restrictions, we endeavor to reasonably deduce the cause of death and furnish corroborative evidence for clinical diagnosis, treatment, and forensic examination in instances involving brodifacoum poisoning.

Background: Child trafficking is a significant global concern that infringes upon the rights and welfare of children, subjecting them to exploitation, abuse, and neglect. Forensic medicine (FM) is distinctly equipped to aid in the identification, investigation, and prevention of child trafficking; yet, its practical applications in this domain necessitate enhanced emphasis and clarity. This study aims to (1) clearly define the role of forensic medicine in child trafficking cases, (2) detail specific forensic methods and their impact on victim identification and legal processes, and (3) highlight multidisciplinary strategies for prevention and intervention. Method: A comprehensive literature review was performed utilizing PubMed, Web of Science, and Google Scholar. The review concentrated on current advancements and case studies demonstrating the application of forensic medicine encompassing clinical forensic examination, forensic odontology, DNA profiling, and digital forensics in the identification and prevention of child trafficking. Results: Clinical Forensic Examination: Forensic medics meticulously record physical injuries, starvation, indicators of neglect, and psychological trauma, furnishing essential evidence for the identification of trafficking victims. Forensic Odontology: Dental age estimation and bite mark analysis aid in verifying the age and identity of minors, particularly in the absence of formal documentation. DNA Profiling: Rapid DNA analysis is crucial for reuniting trafficking children with their families, clarifying contested identities, and aiding criminal investigations. Digital Forensics: Analysis of digital devices and online communication facilitates the identification of trafficking networks and the monitoring of victim movements. Interdisciplinary Collaboration: An effective reaction necessitates collaboration among forensic specialists, law enforcement agencies, social services, and legal authorities. Conclusions: Forensic medicine is crucial for a strong, evidence-based approach to child trafficking. Forensic professionals utilize specific medical, dental, genetic, and digital skills to improve victim identification, assist legal proceedings, and aid in preventative measures. Continuous training, ethical conduct, and technical advancement are essential for optimizing the efficacy of forensic medicine in child protection.

Internationally, clinical forensic medicine (CFM) is diverse in content and conduct, and forensic medical methods are not always evidence based. The first step towards evidence-based practice is to achieve a thorough knowledge of international diversity, which necessitates that CFM practitioners provide information about their national practice. This paper’s aim is to describe the organisation of CFM in Denmark, exemplified by the set-up in Eastern Denmark, and the types of assessments performed. In Denmark, forensic medicine is a board-certified specialty under the health authorities, with mandatory qualifications. The Danish Accreditation Fund accredits the Departments of Forensic Medicine as inspection bodies, according to an international European standard that is approved by Danish Standards. Mainly at police request, forensic doctors perform examinations of both victims and suspected perpetrators of perilous crimes. The examinations’ purposes are documentation and assessment of the findings and collection of biological evidence. The clinical forensic examinations do not include any treatment or medical follow-up. Thus, the forensic doctors must be neutral, objective and impartial. The clinical forensic examinations provide documentation of findings and conclusions not otherwise available for the police investigation and legal aftermath. Moreover, the accredited, standardised protocols ensure that the Departments of Forensic Medicine meet their obligations as inspection bodies, thus ensuring public confidence in the departments’ services.

Children suffering physical abuse are at risk for abdominal trauma. When the abdominal trauma is not evident clinically and remains occult, the child's condition can rapidly deteriorate before the diagnosis is made, and delay may occur in the activation of child protective services. The use of markers for abdominal trauma in the evaluation of cases of child physical abuse was examined. Children younger than 12 years presenting to the Emergency Department at the Children's Hospital of Buffalo from August 1989 through April 1990 for the evaluation of suspected physical abuse were prospectively entered in the project. All patients had a complete history and physical examination performed. Those patients who did not show any signs of abdominal injury had the following laboratory tests done: (1) levels of liver transaminases, lactate dehydrogenase, and alkaline phosphatase; (2) amylase level; and (3) uranlysis. Of 49 patients without clinical signs of abdominal trauma, 4 children had elevated transaminase levels. Three of these 4 patients had liver lacerations documented by subsequent abdominal computed tomographic scans. A new finding of transaminase levels as markers of occult liver injury in children suffering physical abuse is reported.

Child abuse, including physical, sexual, or emotional violence or neglect, is a global problem with serious and long-term consequences for children. Even though child abuse is prohibited in Denmark, the estimated number of physically and sexually abused children is relatively high, whereas the annual number of forensically examined children is low. We present the Danish practice and legal foundation for the clinical forensic medical examination (hereinafter referred to as "forensic examination") in suspected child abuse cases. Forensically documented findings may contribute to the police investigation and legal assessment of child abuse cases, safeguarding the rule of law for both children and suspected perpetrators. The forensic examinations are accredited according to international and European standards, and the Department of Forensic Medicine is regularly assessed for the fulfillment of accreditation. Accreditation, delimitations from medical treatment and police employment, and the fact that the department refers to the University of Copenhagen ensure impartiality from the police and the judicial system. A cross-sectoral intervention project has significantly increased the annual number of forensically examined children at the Danish Children's Advocacy Center (CAC) in Copenhagen, which supports children's legal rights and holds research potential due to systematic and continuous data collection.

This prospective analysis is based on clinical forensic examinations and clinical case records of the victims who sustained burns and were admitted during a one-year period since 2017. Of the 90 patients (34 children and 56 adults), 54 % were male with ages ranging from 1 month to 80 years. Males below the age of 20 years (48 %) were highly vulnerable. Education status revealed that most of the patients have an education level below O/L representing 52 % (Ordinary Level/ O/L is similar to the General Certificate of Secondary Education/ GCSE in Cambridge Education System in United Kingdom) and the majority were married (52%). Scalds were seen in 52 %, while flame burns in 28 % cases. Most of the incidents had taken place at home (92%). Burn injuries were most frequently observed on upper extremities (47 %) and the majority were of first degree in nature. Furthermore, this study revealed that 57 % recovered without any complications, while 34 % resulted in scarring or disfigurement. It was highlighted that children are the most vulnerable to in sustaining burns, especially with hot water in domestic settings. The study recommends increasing awareness among parents/guardians regarding safe handling of hot water to minimize such incidents.

Introduction Road traffic trauma is a preventable cause of morbidity and mortality across the globe. A wide array of automotive safety measures have been implemented over several decades. They provide with active safety and passive safety. Seatbelts and supplementary restraint systems (SRS airbags) have undoubtedly been recognized as two important passive safety measures for vehicle occupants though they themselves may occasionally cause significant injuries in severe crashes. Injuries caused by inbuilt safety devices upon the occupants often come in atypical forms whose interpretation would be dubious unless carefully appreciated by forensic medical practitioner. This fact is elaborated with the following two case examples. Case reports The first case is regarding superficial burns on the face as a result of the deployment of airbags. The exact type, mechanism and the cause of the injuries were not recognized during the initial management. The second case is a diaphragmatic rupture which is extremely rare in healthy individuals with properly fastened seatbelts. Conclusions Injuries of both cases were properly interpreted at the clinical forensic examination. As correctly expected from a clinician he or she very justly pays more attention on the acute management, critical care and therapeutic aspects of such injuries rather than attempting to identify the exact type, mechanism of causation and other medico-legally significant issues. Yet, in the big picture outside the boundaries of providing critical care, including the implementation of preventive measures, precise identification and interpretation of such injuries become the vital obligation of the forensic medical expert.

Introduction: Clinical forensic medicine is a branch of medicine that applies medicine to uphold justice in the case of living victims. In accordance with this understanding, the handling of cases of living victims, especially victims of crime, must involve doctors in the field of forensics, in addition to doctors in other fields according to their competence. With so many cases of violent crime, a doctor must be able to provide a report on the results of the examination to the legal apparatus to assist in the judicial process.
 Case: A man, aged 44 years, found bruises on right eyelid, left eye, left cheek, left and right scalp; blisters on the left and right eye membranes; a cut wound on the right eye membrane and the left eyelid; bleeding under the thick membrane of the brain and swelling of the brain.
 Discussion: Injuries can occur as a result of violence perpetrated by criminal offenses, such as cases of theft by violence, murder, traffic accidents or ill-treatment. The doctor must be able to mention that the wound examined is caused by sharp violence, blunt force, electrical trauma, thermal trauma, chemical trauma, or other causes of trauma. Determination of the magnitude of the effect of injury to the victim, related to criminal sanctions that will be imposed on the perpetrators of criminal acts. The head is an organ that is often the target of violent blunt crimes. The brain and the surrounding layers are easily susceptible to trauma, resulting in death compared to other body parts. The wound is in accordance with Criminal Code article 90 concerning serious injuries, which results in injuries that do not give any hope of healing at all.