Forensic Medical Reports Research Articles

A review of the diversity in taxonomy, definitions, scope, and roles in forensic medicine: implications for evidence-based practice

The scope, roles, and tasks of forensic medicine and forensic medical experts currently vary widely between countries and legal systems, which has resulted in barriers to organization, standard setting, and quality assurance for practice in forensic medicine, including for reporting. The legal fact finder is thus confronted with variability in the quality, structure, and content of forensic medical reports. We sought to define and categorize the scope, methods, and practices that fall under the description of forensic medicine, the various issues encountered in current forensic medical practice, and the potential role of evidence-based practice in forensic medicine. We searched electronic databases and reviewed relevant articles, as well as conducting personal correspondences with forensic medical practitioners around the world, to obtain a description of current forensic medical practice. The terms forensic medicine, legal medicine, medical jurisprudence, medico-legal services, forensic pathology, and clinical forensic medicine are used with mixed interpretations in different countries. The systems and services rendered are not uniform either. The methods used by forensic medical practitioners are not always evidence-based, or based on standardized methods, and vary greatly between experts and centers. There are also no universally accepted guidelines to prepare a standard and admissible report. The lack of a uniform system in forensic medicine creates difficulties in assessing the development and performance of forensic medicine as a distinct discipline. To prepare evidence-based forensic medical reports, generally accepted guidelines are necessary.

Czy występowanie okrzemek w organach wewnętrznych zawsze świadczy o utonięciu?

Diatoms (Bacillariophyta) are unicellular algae inhabiting in aquatic ecosystems and marsh habitats on the entire Earth. This group of algae, variable in terms of species, comprises both cosmopolitan ones but also those whose occurrence is limited to specific environmental conditions, i.e. stenotopic species. Diatoms are distinguished by unique cell walls making so-called, frustules, whose structures constitute the bases for differentiation between species. Frustules are resistant to the majority of environmental conditions that destroy other algae. Due to the above characteristics diatoms have been incorporated in forensic investigations and they can be the conclusive component of the proceedings by indicating drowning as the cause of death. In those cases, it is important to answer the question whether finding diatoms in internal organs of corpses found in water always proves drowning. The publication uses reports from forensic medical examinations of corpses and reports from detecting presence of diatoms in internal organs performed in years 2013-2017 in the Institute of Forensic Medicine of Warsaw Medical University, which is presently the only centre in Poland that routinely performs the diatom test. It has been demonstrated that a positive result of the diatom test generally coincides with the conclusive indications of the cause of death in the forensic medical autopsy reports. Only in few individual well-explainable cases the results of the diatom tests did not confirm conclusions from the forensic autopsies, which excluded drowning as the cause of death.

La violencia de género en el teatro español de denuncia: Acercamiento al problema en cuatro textos contemporáneos

Current Spanish Theater clearly shows its ethical commitment to the society in which it is born, and it does so by critically reflecting contemporary society in a way that helps to set new paradigms regarding the controversial issues, and that we are most concerned about. In this line of testimonial viewing and complaint, violence is one of the recurring arguments, and the various manifestations of gender-based violence have a remarkable place. The stages bear witness to gender violence since always, as examples of the treatment of the theme of honor in the baroque theater of the seventeenth century. The social impact that this topic of honor risen to the baroque stages still have in our society is of great importance, because for centuries has not only reflected the conception of absolute submission of women to the patriarchal figure and the prevalence of the man over her, but has also helped it to take root. Faced with this vision, other texts have served to begin to raise awareness of the problem. From the mid-twentieth century until today, an interesting list of titles serves as a sample of the attention given by our playwrights to gender abuse and everything that surrounds them: legislation, forensic medical forensic reports, care of socio-health care professionals And psychological, pedagogical actions with minors, etc.

The Influence of Forensic Medical Reports of Forensic Nurses on Prosecution Outcomes of Child and Adolescent Sexual Crime

The Influence of Forensic Medical Reports of Forensic Nurses on Prosecution Outcomes of Child and Adolescent Sexual Crime

Fatal Intoxications in the North of Portugal: 12 Years of Retrospective Analysis.

Fatal intoxications are a topic of great relevance in today's society. They typically occur by accidental or voluntary ingestion, but its characterization by a forensic perspective was not fully explored. This study retrospectively reviews fatal intoxication cases autopsied at the northern forensic medicine services of Portugal, between 2001 and 2013. For this purpose, we analyzed postmortem forensic medical reports with positive qualitative analysis for xenobiotics. A total of 27,778 autopsy reports were analyzed, of which 1,269 cases fulfilled the selection criteria, representing 4.6% of total number of individuals autopsied during the period under analysis. Men were involved in most of the cases (73.8%) and most individuals were adults with ages between 36 and 65 years old (57.0%). The highest incidences were medicines (22.9%) and alcohol (15.8%), followed by their association. Cases of fatal intoxications involving opioids come on fifth place (5.8%) namely due to accidental overdoses. Moreover, intoxications appeared as the leading cause of death in reports concerning accidental etiology, with drugs and alcohol associations having a great expression. Due to morbidity and relevant number of fatal cases, risk prevention measures, such as public health policies should be implemented to reduce the number of intoxications.

Forensic evaluations of drug endangered children: “My house caught on fire; my cat jumped out the window”

Although there is a sizeable body of empirical literature examining the health consequences of exposure to drug use and manufacture in childhood, little is known about how drug endangered children themselves perceive their environment and situation. This study examines the types of information obtained from forensic medical evaluations that include the collection of verbal accounts from children about their situations. Forensic medical examination reports of 173 children removed from residences where methamphetamine manufacturing was suspected of occurring were analyzed. The children's verbal accounts highlight themes of hazards and toxins in the home, criminal and delinquent activity among children and caregivers, knowledge of drug-related activity, poor health and well-being, and traumatic law enforcement encounters. Drug endangered children represent a shadow population often overlooked in responses to the drug problem. Drug-related research and responses should prioritize children and their long-term well-being. Further research on the short- and long-term impacts of exposure as well as the social and physical development of these children is needed.

Victims of Intimate Partner Violence. The Physician’s Intervention in the Portuguese National Health Service

This study intends to characterize the current situation in Portugal regarding intimate partner violence (IPV) disclosure by the victims and its detection and report by the National Health Service (NHS) professionals, in order to promote the health and protection of the former. We interviewed 101 adult victims of IPV who sought care in the NHS. The results reveal that a relevant number of victims did not disclose the abuse to NHS physicians (18.8 %). According to the victims, in 57.9 % of the cases, physicians did not suspect IPV. In cases where there actually was suspicion (based on specific evidence and markers) or where there was no concealment of such type of violence, 52.3 % of the physicians did not inform the victims about the risks this situation posed to them, 89.8 % did not mention their obligation to denounce the case (as it is foreseen by the Portuguese law), and the number of injuries they described was lower than the one described in the forensic medical reports.

Head and maxillofacial injuries in child and adolescent victims of automotive accidents.

Background. Victims of motor vehicle accidents may suffer multiple lesions, including maxillofacial injuries. The aim of this study was to evaluate the prevalence and factors associated with head, facial, and maxillofacial injuries in child and adolescent victims of automobile accidents. A cross-sectional study was carried out with analysis of forensic medical reports from the Legal Medical Institute of Campina Grande, Brazil, between January 2008 and December 2011. Descriptive and inferential statistical analysis was conducted using the chi-square test (α = 0.05). From 1613 medical reports analyzed, the sample is composed 232 (14.4%) reports referring to child and adolescent victims of automobile accidents aged 0–19 years of both sexes. Victims were mostly adolescents aged from 15 to 19 years (64.2%), males (73.7%), and motorcyclists (51.3%). More than half of the victims had single lesions (54.3%) located in the head (20.7%) and face (21.6%). Head injuries occurred more frequently in children aged 0–4 years (53.8%, PR = 5.065, 95% CI = 1.617–5.870) and pedestrians (30.4%, PR = 2.039, 95% CI = 1.024–4.061), while facial and maxillofacial injuries occurred in higher proportion among females (31.1%, PR = 0.489, 95% CI = 0.251–0.954). Our findings suggest that accidents involving motorcyclists are the most prevalent, affecting male adolescents aged from 15 to 19 years, resulting in a high frequency of injuries in the head and face regions.

1203 – Cognition and civil capacity in diogenes syndrome: analysis of psychiatric reports from the public attorney district of rio de janeiro

Introduction Diogenes Syndrome (DS) refers to a collection of features found mainly in older persons which includes social isolation, self-neglect, poor insight, domestic squalor and hoarding behavior. Underlying psychiatric disorders might be identified in most of those elders. Issues of law have been embedded in DS cases, since individuals commonly expose themselves and their neighborhood to preventable health risks, due to extreme self-neglect and poor sanitation. Objective This cross-section aims to assess health-care, cognitive and civil capacity status of patients with DS, based on data from forensic-medical reports. Methods Psychiatric-forensic reports concerning to elders living alone, recorded between January 2009 to December 2010 in the archives of the Public Attorney District of the State of Rio de Janeiro, Brazil, were analyzed. Results Reports from 40 living alone elders (mean age=79.63 ± 7.84 years; mean schooling= 5.68 ± 5.43 years; 75% female) were eligible for the study. 20 individuals (50%) fulfilled diagnostic criteria for DS. DS individuals presented significantly lower mean scores in MMSE than non-DS persons (p= 0.019). More individuals with dementia were found among DS group. Fewer recent medical consultations (p= 0.038) and higher rates of civil incapacity (p= 0.001) were identified in DS elders. Negative moderate correlation was found between MMSE scores and diagnostic of DS (rho=-0.403; p= 0.016). Medical support (phi= 0.388; p= 0.016) and civil incapacity (phi= 0.554; p Conclusion DS might be related to poor cognitive status, health care neglect and impaired discernment, which may be of interest to both health and law practitioners.

Why did the patient die? The relationship between ambulance accidents and death of patients: Forensic medical issues

This article's aim is investigating traumatic consequences of ambulance accident on patients and discussing difficulties to give a decision about the relation between death and accident at these cases. The cases were selected among the forensic medical reports concluded between 1996 and 2005 years. They were documented for age, sex, causes of urgent call, localization and extent of traumatic lesion, properties of events and board decisions. A total of 21 cases were found. 15 cases died on the day of the accident. Skin injuries at head (8 cases) and legs (6 cases) were most common traumatic lesions. Totally 6 deaths were found related with ambulance accident. Death of patient after ambulance accidents may not be associated easily to the accident. Delay due to accident or concomitant contributing medical conditions may also facilitate the death in this type of cases. Reliable medical records were needed for accurate medicolegal evaluation.

Occurrence of traumatic dental injury in cases of domestic violence

The purpose of this study was to investigate the prevalence and types of traumatic dental injuries in situations of domestic violence. A coross-sectional study was conducted and data were collected from the police occurrence records to domestic physical aggression between 2001 and 2005. Of the 1,844 subjects who underwent medical evaluation, 15 had information pertaining to traumatic dental injuries. From the medical records, the forensic medical reports completed by the forensic medical experts who examined the victims after the aggression were reviewed and data of individuals with dental injuries (e.g., fractures, luxation and avulsion) were collected. In the selected sample, there was a predominance of individuals with injuries to the head and neck region (38.7%), and the frequency of traumatic dental injuries among all injuries to the head and neck region was 2.0%. The most frequently injured teeth were the maxillary incisors (31.8%), followed by the mandibular incisors (27.3%) and the maxillary canines (9.1%). In 31.8% of the injured teeth, the forensic experts did not specify the nomenclature. Of the dental trauma cases, 59.1% were fractures, 27.2% were luxations and 13.7% were avulsions. In conclusion, domestic violence was an important etiologic factor of traumatic dental injury. The aggression in all cases occurred in the form of punches and slaps. Fracture was the most common type of traumatic dental injury, and the most frequently injured teeth were the incisors.

Prevalence and characteristics of injuries to the head and orofacial region in physically abused children and adolescents – a retrospective study in a city of the Northeast of Brazil

The aim of this study was to evaluate the prevalence and characteristics of injuries to the head and orofacial region in physically abused children and adolescents from a city of the Northeast of Brazil, based on the review of forensic medical reports. This retrospective study was undertaken by the analysis of expert medical reports derived from medical forensic exams performed at the Department of Forensic Medicine of the city of Campina Grande, PB, Brazil, between January 2003 and December 2006. From a universe of 11 624 reports issued in this time span, the study sample consisted of 1070 reports referring to children and adolescents aged 0-17 years that were confirmedly victims of physical abuse. Male children (52.8%) in the 13- to 17-year-old range (72.4%) were the most frequent victims, with an association between gender and age group (P = 0.039). Most children (58.2%) presented a single type of injury, with a statistically significant association between number of injuries and gender (P = 0.040), but no significant association between number of injuries and age (P = 0.163). The percentage of victims injured in the head and face corresponded to 56.3%, with a statistically significant association between the presence of injury in the head and face and gender (P = 0.046). As much as 12.4% of the children and adolescents presented intraoral injuries, with no significant difference between genders (P = 0.543). However, a statistically significant association was observed between the number of existing injuries and the presence of oral injuries (P = 0.005). The maxilla was predominantly affected (55.6%), most injuries (94.8%) being soft-tissue lacerations located mainly in the upper lip (46.4%). The findings of this survey revealed a high prevalence of injuries to the head and orofacial region of physically abused children and adolescents.

Women Who Kill Their Children

The killing of a newborn on the day of its birth is known as neonaticide. A child aged 1 through 16 has a different role in the family, and their murder is perceived differently. We would expect mothers charged with filicide to be drawn from a slightly different population than other child-killing mothers. Our study was carried out at the Institute of Forensic Medicine in Angers over a 10-year period. All the victims were autopsied at the Institute of Forensic Medicine in Angers. Information concerning the mothers was collected from forensic medical files, police reports, and legal files. Interviews and forensic psychiatric examinations were available for consultation. Our study concerns 17 observations of child-killing mothers and 19 child autopsies. In 2 cases, the issue was in fact a double murder, with the mother killing all the siblings. The mean age was 3.5 years for victims and 29.5 years for the women. The majority of the mothers were married or lived with their partners. They often had an occupation. Generally the economic status was average. Head trauma, strangulation, suffocation, and drowning were the most frequent means of filicide. However, some mothers used more active methods such as striking and shooting. Disturbed or disturbing behavior was documented in 15 perpetrators. Seven women tried to commit suicide. It was often possible to identify apparent motivation for the offense. In our study, we can distinguish 2 types of killer mothers. We distinguished a first group made up of 5 mothers. These 5 women killed their children in a general context of abused children and present similarities with the neonaticide mothers (young, immature). The other group of filicide mothers is different. They are generally older, married, and employed. The crime is usually premeditated, committed with the direct use of hands and sometimes very violent. To understand the motives or the source of the impulse to kill, we can use a classification such as Resnick's classification: mothers from the first group fall within the framework of accidental filicides: the risk and prevention factors are those of infanticide and ill treatment. For the other mothers, we can distinguish altruistic filicides (8 cases) and spouse revenge filicides (2 cases). Few of the mothers suffered from real psychiatric problems; however, most of them presented troubles which could have been taken into account. A lot of women showed signs of suicidal tendencies prior to the event, displaying aggressive and angry behavior. In general, suicide attempts tend to prevail. These offenders act out of an acute sensitivity to social regulation. A variety of psychosocial stresses appears to have been a major factor. These stresses include lack of social or marital support, economic difficulties, family stress, and unrealistic expectations of motherhood. The precipitating stress may have been a dispute. Prevention begins with the identification of potential perpetrators. Therefore, medical doctors have a significant role in relation to the prevention of child murder.

Da der anfängliche Schmerz in Liebeshitze übergehen kann

On the bases of 18th-century forensic medical reports, the authoress reconstructs the changing medical perspective on rape, juxtaposing it to the perception of the victims in order to trace how different perceptions of sexual violence became engraved in the male and female mind. Medical interpretations of the offence transmitted stereotypes of male and female sexual behaviour in the seemingly objective manner of the natural sciences, and thus turned them into unquestionable facts of nature. The physicians' normative dichotomous image of women as either virgins or harlots predetermined the physicians' reports even before the onset of the physical examination. Attention to the victim's statements was highly selective, and it was mainly the woman's reputation which decided the outcome of her examination. Towards the end of the 18th century a gynaecological legitimation of this social and legal trivialisation of rape becomes discernible. Thus by nature the female body had become ,inscribed' with the sole responsibility for the sexual violence against it.

Changes in external respiratory function in severe combined cranial and thoracic trauma

We analyzed case histories and forensic medical examination reports of 247 deceased patients with combined cranial and chest trauma, which allowed us to identify the following difficulties in the differential diagnosis of respiratory disorders.