首页 > 最新文献

Journal of forensic and legal medicine最新文献

英文 中文
Occurrence and circumstances of child sexual assault in Maputo, Mozambique 莫桑比克马普托儿童性侵犯的发生率和情况
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-15 DOI: 10.1016/j.jflm.2024.102778
Stela Ocuane Matsinhe , Shahnaaz Suffla , Tiffany Joy Hector

Background

Child Sexual Abuse (CSA) is a significant public health issue, with its health and social consequences well documented. While CSA has been extensively studied in high-income countries, its incidence and circumstances of occurrence in low-income countries, especially in Africa, remains under-represented in the scholarly literature.

Methods

This study aimed to investigate the occurrence and circumstances of CSA among victims assisted at the Forensic Service of the Hospital Central de Maputo in Mozambique. A cross-sectional, quantitative study was conducted using secondary data from 2015 to 2020, extracted from the medico-legal reports of all victims under 18 years old. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 28.0.

Results

2610 cases of CSA were reported for the period 2015 to 2020, of which 2588 were included for analysis. Of the cases analysed, the majority of victims were girls (93.7 %), predominantly aged 12–17 years (48.6 %). The reported types of penetration revealed that vaginal penetration was the most frequent (86 %), followed by anal (11 %) and oral (2 %). Most assaults occurred either at the victims' or perpetrators’ homes (54.8 %), primarily during the week (71.1 %), and typically in the afternoon (36.5 %) or evening (41.9 %). The assaults were predominantly perpetrated by a single individual (88.7 %), who was most often identified as an acquaintance (72.9 %). Additionally, 54.1 % of the children experienced concomitant physical violence, and approximately 74.9 % of the perpetrators did not use condoms during the assault.

Conclusions

The findings of this study underscore the urgent need to implement prevention measures specifically targeting adolescent girls and younger boys, aiming to promote early reporting and prevent mental, physical, and sexual and reproductive health complications. Raising awareness about all forms of child abuse, including sexual abuse, and enhancing reporting and diagnostic systems in Mozambique is crucial.
背景儿童性虐待(CSA)是一个重大的公共卫生问题,其对健康和社会造成的后果有据可查。虽然 CSA 在高收入国家得到了广泛研究,但其在低收入国家(尤其是非洲国家)的发生率和发生情况在学术文献中仍未得到充分反映。本研究采用 2015 年至 2020 年的二手数据,从所有 18 岁以下受害者的医疗法律报告中提取数据,进行了一项横断面定量研究。研究使用社会科学统计软件包(SPSS)28.0 版对数据进行了分析。结果 2015 年至 2020 年期间共报告了 2610 例 CSA,其中 2588 例被纳入分析范围。在分析的案例中,大多数受害者是女孩(93.7%),年龄主要集中在 12-17 岁(48.6%)。报告的插入类型显示,阴道插入最为常见(86%),其次是肛门插入(11%)和口交(2%)。大多数侵犯行为发生在受害者或施暴者家中(54.8%),主要发生在一周内(71.1%),一般在下午(36.5%)或晚上(41.9%)。施暴者主要是一个人(88.7%),最常见的是熟人(72.9%)。此外,54.1% 的儿童还伴随着身体暴力,约 74.9% 的施暴者在施暴过程中没有使用安全套。结论:本研究的结果突出表明,迫切需要实施专门针对少女和少男的预防措施,以促进及早报告并预防精神、身体、性健康和生殖健康并发症。在莫桑比克,提高对包括性虐待在内的各种形式的虐待儿童行为的认识以及加强报告和诊断系统至关重要。
{"title":"Occurrence and circumstances of child sexual assault in Maputo, Mozambique","authors":"Stela Ocuane Matsinhe ,&nbsp;Shahnaaz Suffla ,&nbsp;Tiffany Joy Hector","doi":"10.1016/j.jflm.2024.102778","DOIUrl":"10.1016/j.jflm.2024.102778","url":null,"abstract":"<div><h3>Background</h3><div>Child Sexual Abuse (CSA) is a significant public health issue, with its health and social consequences well documented. While CSA has been extensively studied in high-income countries, its incidence and circumstances of occurrence in low-income countries, especially in Africa, remains under-represented in the scholarly literature.</div></div><div><h3>Methods</h3><div>This study aimed to investigate the occurrence and circumstances of CSA among victims assisted at the Forensic Service of the Hospital Central de Maputo in Mozambique. A cross-sectional, quantitative study was conducted using secondary data from 2015 to 2020, extracted from the medico-legal reports of all victims under 18 years old. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 28.0.</div></div><div><h3>Results</h3><div>2610 cases of CSA were reported for the period 2015 to 2020, of which 2588 were included for analysis. Of the cases analysed, the majority of victims were girls (93.7 %), predominantly aged 12–17 years (48.6 %). The reported types of penetration revealed that vaginal penetration was the most frequent (86 %), followed by anal (11 %) and oral (2 %). Most assaults occurred either at the victims' or perpetrators’ homes (54.8 %), primarily during the week (71.1 %), and typically in the afternoon (36.5 %) or evening (41.9 %). The assaults were predominantly perpetrated by a single individual (88.7 %), who was most often identified as an acquaintance (72.9 %). Additionally, 54.1 % of the children experienced concomitant physical violence, and approximately 74.9 % of the perpetrators did not use condoms during the assault.</div></div><div><h3>Conclusions</h3><div>The findings of this study underscore the urgent need to implement prevention measures specifically targeting adolescent girls and younger boys, aiming to promote early reporting and prevent mental, physical, and sexual and reproductive health complications. Raising awareness about all forms of child abuse, including sexual abuse, and enhancing reporting and diagnostic systems in Mozambique is crucial.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102778"},"PeriodicalIF":1.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A retrospective study of the injury patterns seen in fatal falls downstairs 对致命坠楼事故中受伤模式的回顾性研究
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-09 DOI: 10.1016/j.jflm.2024.102767
Kate McGoldrick , SallyAnne Collis , Linda Mulligan

Introduction

Fatal falls involving stairs are often associated with advanced age, intoxication, acute natural pathology and less commonly – the involvement of a third-party. The injury patterns seen in these cases are often complex and from a medico-legal standpoint, determining third-party involvement based on pathology alone can prove a significant challenge. Classifying the manner of death in such cases, can become particularly complex when the injury pattern appears inconsistent with a simple fall downstairs, or there is an absence of eye-witness testimony.

Aim

To explore the circumstances and injury patterns seen in cases of fatal falls downstairs which were classified as accidental vs. undetermined by the coroners.

Study design

This retrospective study explored the injury patterns present in all cases of fatal falls downstairs referred to the Office of the State Pathologist (OSP) over a 10-year-period (2012–2022) (n = 51).

Results

Fatal falls downstairs which were classified as undetermined were found to have a greater number of craniofacial fractures, spinal fractures and intracranial injuries when compared to accidental falls. Undetermined staircase deaths also displayed more significant fracturing involving the facial skeleton.

Conclusion

Ultimately, where there is a question of third-party involvement, the Post-Mortem Examination (PME) findings alone cannot determine the manner of death. The pathologist's examination may identify injuries that are inconsistent with a simple fall downstairs, but it is the coroner who must conduct a thorough investigation into the circumstances of the fatal fall and ultimately determine the classification of the death.
导言涉及楼梯的致命跌倒通常与高龄、醉酒、急性自然病理学有关,较少见的是与第三方的参与有关。这些病例中的损伤模式通常很复杂,从医学法律角度来看,仅根据病理学来确定是否涉及第三方是一项重大挑战。研究目的探讨被验尸官归类为意外或未确定的致命坠楼案件中的情况和伤害模式。研究设计这项回顾性研究探讨了10年间(2012-2022年)所有转介至州立病理学家办公室(OSP)的致命坠楼病例(n = 51)的损伤模式。结果与意外坠楼相比,被归类为未确定的致命坠楼病例中颅面骨折、脊柱骨折和颅内损伤的数量更多。结论如果存在第三方参与的问题,仅凭尸检结果并不能确定死亡方式。病理学家的检查可能会发现与单纯坠楼不符的伤痕,但验尸官必须对致命坠楼的情况进行彻底调查,并最终确定死亡类别。
{"title":"A retrospective study of the injury patterns seen in fatal falls downstairs","authors":"Kate McGoldrick ,&nbsp;SallyAnne Collis ,&nbsp;Linda Mulligan","doi":"10.1016/j.jflm.2024.102767","DOIUrl":"10.1016/j.jflm.2024.102767","url":null,"abstract":"<div><h3>Introduction</h3><div>Fatal falls involving stairs are often associated with advanced age, intoxication, acute natural pathology and less commonly – the involvement of a third-party. The injury patterns seen in these cases are often complex and from a medico-legal standpoint, determining third-party involvement based on pathology alone can prove a significant challenge. Classifying the manner of death in such cases, can become particularly complex when the injury pattern appears inconsistent with a simple fall downstairs, or there is an absence of eye-witness testimony.</div></div><div><h3>Aim</h3><div>To explore the circumstances and injury patterns seen in cases of fatal falls downstairs which were classified as accidental vs. undetermined by the coroners.</div></div><div><h3>Study design</h3><div>This retrospective study explored the injury patterns present in all cases of fatal falls downstairs referred to the Office of the State Pathologist (OSP) over a 10-year-period (2012–2022) (n = 51).</div></div><div><h3>Results</h3><div>Fatal falls downstairs which were classified as undetermined were found to have a greater number of craniofacial fractures, spinal fractures and intracranial injuries when compared to accidental falls. Undetermined staircase deaths also displayed more significant fracturing involving the facial skeleton.</div></div><div><h3>Conclusion</h3><div>Ultimately, where there is a question of third-party involvement, the Post-Mortem Examination (PME) findings alone cannot determine the manner of death. The pathologist's examination may identify injuries that are inconsistent with a simple fall downstairs, but it is the coroner who must conduct a thorough investigation into the circumstances of the fatal fall and ultimately determine the classification of the death.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102767"},"PeriodicalIF":1.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Age estimation at death in individuals over 50 using CT images: An innovative anthropological approach 利用 CT 图像估算 50 岁以上人群的死亡年龄:一种创新的人类学方法。
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-03 DOI: 10.1016/j.jflm.2024.102766
Mohamed Kenani , Marwa Boussaid , Oumeima Brahim , Mohamed Amine Mesrati , Abir Aissaoui

Objectives

The aim of the present work is to develop a novel method for predicting age in individuals over 50 years old, utilizing regression models.

Methods

The conducted study is of an analytical cross-sectional nature, involving a sample of 44 young subjects and 107 elderly subjects. The necessary data for this research were extracted from "The New Mexico Decedent Image Database." Based on the phenomenon of height shrinkage with age, we created models for young subjects and applied them to elderly subjects, allowing us to extract the variables.

Results

We obtained highly encouraging results with an R2 of 0.73, a mean absolute error of 3.94, and stable cross-validation. We used a Student's t-test, which demonstrated no significant difference between predicted and actual values (p-value >0.05). We also conducted a learning curve analysis and examined residuals against predicted values. This suggests that the forecasts are accurate, with no significant bias in predictions.

Conclusion

This work has allowed us to conclude that it is possible to reliably estimate the age of subjects over 50, taking into account age-related physiological and pathological changes.
目的:本研究的目的是利用回归模型,开发预测 50 岁以上人群年龄的新方法:本研究旨在利用回归模型开发一种预测 50 岁以上人群年龄的新方法:本研究为横断面分析性质,涉及 44 名年轻受试者和 107 名老年受试者。研究的必要数据来自 "新墨西哥州死者图像数据库"。根据身高随年龄增长而缩小的现象,我们为年轻受试者创建了模型,并将其应用于老年受试者,从而提取出变量:我们获得了非常令人鼓舞的结果,R2 为 0.73,平均绝对误差为 3.94,交叉验证结果稳定。我们使用了学生 t 检验,结果表明预测值和实际值之间没有显著差异(p 值大于 0.05)。我们还进行了学习曲线分析,并对照预测值检查了残差。这表明预测是准确的,预测值没有明显偏差:这项工作使我们得出结论,考虑到与年龄有关的生理和病理变化,可靠地估计 50 岁以上受试者的年龄是可能的。
{"title":"Age estimation at death in individuals over 50 using CT images: An innovative anthropological approach","authors":"Mohamed Kenani ,&nbsp;Marwa Boussaid ,&nbsp;Oumeima Brahim ,&nbsp;Mohamed Amine Mesrati ,&nbsp;Abir Aissaoui","doi":"10.1016/j.jflm.2024.102766","DOIUrl":"10.1016/j.jflm.2024.102766","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of the present work is to develop a novel method for predicting age in individuals over 50 years old, utilizing regression models.</div></div><div><h3>Methods</h3><div>The conducted study is of an analytical cross-sectional nature, involving a sample of 44 young subjects and 107 elderly subjects. The necessary data for this research were extracted from \"The New Mexico Decedent Image Database.\" Based on the phenomenon of height shrinkage with age, we created models for young subjects and applied them to elderly subjects, allowing us to extract the variables.</div></div><div><h3>Results</h3><div>We obtained highly encouraging results with an R<sup>2</sup> of 0.73, a mean absolute error of 3.94, and stable cross-validation. We used a Student's t-test, which demonstrated no significant difference between predicted and actual values (p-value &gt;0.05). We also conducted a learning curve analysis and examined residuals against predicted values. This suggests that the forecasts are accurate, with no significant bias in predictions.</div></div><div><h3>Conclusion</h3><div>This work has allowed us to conclude that it is possible to reliably estimate the age of subjects over 50, taking into account age-related physiological and pathological changes.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"108 ","pages":"Article 102766"},"PeriodicalIF":1.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
“It changed my whole entire thinking”: Identifying narrative elements in medical affidavit writing for asylum seekers "它改变了我的整个思维":在为寻求庇护者撰写的医疗宣誓书中识别叙事要素。
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-01 DOI: 10.1016/j.jflm.2024.102759
Alexandria Yap , Radhika Sundararajan , Andrew Milewski , Mert Keceli , Mohammed Alkhafaji , Rachel Kowalsky
The medical affidavit is critically significant for asylum seekers. Studies have shown that asylum seekers applying with a medical affidavit (versus without a medical affidavit) have double the success rate. There are many training resources for clinician-evaluators on the interviewing process, but little instruction exists on the affidavit writing process. Our objective was to identify the most common narrative elements in medical affidavits of successful (versus unsuccessful) asylum seekers to provide further writing guidance for clinician-evaluators. We hypothesized that these elements, when thoughtfully employed, help clinician-evaluators best represent their clients in the US immigration system. We focused on the most vulnerable applicants: those applying after the one-year deadline. Using grounded theory, we coded 23 affidavits filed after the one-year deadline for narrative elements. We identified seven narrative elements more common in medical affidavits of asylum seekers who filed after the one-year deadline and were successful: (1) Recommending specific clinical interventions; (2) Quoting elevated diction by the client; (3) Using headlines; including anecdotes that describe (4) The client forming human connections, (5) Archetypal female characters, (6) Love stories, or (7) Moments of realization.
医疗宣誓书对寻求庇护者至关重要。研究表明,有医疗宣誓书(与没有医疗宣誓书相比)的申请成功率要高出一倍。针对临床评估人员的面谈流程培训资源很多,但关于宣誓书撰写流程的指导却很少。我们的目标是找出成功(与不成功)庇护申请者的医疗宣誓书中最常见的叙述要素,为临床评估人员提供进一步的写作指导。我们的假设是,这些要素如果得到深思熟虑的运用,将有助于临床评估人员在美国移民系统中最好地代表他们的客户。我们重点关注最弱势的申请人:那些在一年截止日期后申请的申请人。利用基础理论,我们对 23 份在一年期限后提交的宣誓书进行了叙事要素编码。我们发现,在一年期限后申请并获得成功的寻求庇护者的医疗宣誓书中,有七种叙事元素较为常见:(1)建议采取具体的临床干预措施;(2)引用客户的升华辞藻;(3)使用标题;包括描述以下内容的轶事:(4)客户形成的人际联系;(5)典型的女性角色;(6)爱情故事;或(7)感悟时刻。
{"title":"“It changed my whole entire thinking”: Identifying narrative elements in medical affidavit writing for asylum seekers","authors":"Alexandria Yap ,&nbsp;Radhika Sundararajan ,&nbsp;Andrew Milewski ,&nbsp;Mert Keceli ,&nbsp;Mohammed Alkhafaji ,&nbsp;Rachel Kowalsky","doi":"10.1016/j.jflm.2024.102759","DOIUrl":"10.1016/j.jflm.2024.102759","url":null,"abstract":"<div><div>The medical affidavit is critically significant for asylum seekers. Studies have shown that asylum seekers applying with a medical affidavit (versus without a medical affidavit) have double the success rate. There are many training resources for clinician-evaluators on the interviewing process, but little instruction exists on the affidavit writing process. Our objective was to identify the most common narrative elements in medical affidavits of successful (versus unsuccessful) asylum seekers to provide further writing guidance for clinician-evaluators. We hypothesized that these elements, when thoughtfully employed, help clinician-evaluators best represent their clients in the US immigration system. We focused on the most vulnerable applicants: those applying after the one-year deadline. Using grounded theory, we coded 23 affidavits filed after the one-year deadline for narrative elements. We identified seven narrative elements more common in medical affidavits of asylum seekers who filed after the one-year deadline and were successful: (1) Recommending specific clinical interventions; (2) Quoting elevated diction by the client; (3) Using headlines; including anecdotes that describe (4) The client forming human connections, (5) Archetypal female characters, (6) Love stories, or (7) Moments of realization.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102759"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fatality from Firework-Induced Trauma: A Case Report 火灾引发的创伤致死:病例报告。
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-01 DOI: 10.1016/j.jflm.2024.102761
Antun Ferenčić, Tomaž Zupanc, Martin Mervic
This case report presents the tragic death of a 56-year-old Slovenian woman who sustained fatal injuries from a stray firework during a New Year's Eve celebration in January 2024. The firework, launched by a relative, struck the woman in the right eye, causing extensive cranial and cerebral trauma. Despite immediate medical intervention, including attempted resuscitation, the woman was pronounced dead at the scene. The autopsy revealed severe damage, including fractures extending from the right orbital cavity to the occipital region and a penetrating brain injury affecting multiple regions of the brain. The case is complicated by the removal of the firework from the injury site before the arrival of emergency services, making the reconstruction of the exact sequence of events challenging. The findings emphasize the devastating consequences of fireworks-related injuries and the unique forensic challenges they present in determining the precise cause of death.
本病例报告介绍了一名 56 岁斯洛文尼亚妇女的死亡悲剧,她在 2024 年 1 月的除夕庆祝活动中被流散的烟花炸伤致死。烟花是由一名亲戚发射的,击中了这名妇女的右眼,造成了广泛的颅脑创伤。尽管立即进行了医疗干预,包括尝试进行人工呼吸,但该女子还是被当场宣布死亡。尸检显示,该女子受到严重损伤,包括从右眶延伸至枕部的骨折,以及影响大脑多个区域的穿透性脑损伤。由于在急救人员到达之前,烟花已被从受伤部位移走,这使得还原事件发生的确切顺序变得十分困难。调查结果强调了与烟花有关的伤害所造成的破坏性后果,以及在确定确切死因方面所面临的独特法医挑战。
{"title":"Fatality from Firework-Induced Trauma: A Case Report","authors":"Antun Ferenčić,&nbsp;Tomaž Zupanc,&nbsp;Martin Mervic","doi":"10.1016/j.jflm.2024.102761","DOIUrl":"10.1016/j.jflm.2024.102761","url":null,"abstract":"<div><div>This case report presents the tragic death of a 56-year-old Slovenian woman who sustained fatal injuries from a stray firework during a New Year's Eve celebration in January 2024. The firework, launched by a relative, struck the woman in the right eye, causing extensive cranial and cerebral trauma. Despite immediate medical intervention, including attempted resuscitation, the woman was pronounced dead at the scene. The autopsy revealed severe damage, including fractures extending from the right orbital cavity to the occipital region and a penetrating brain injury affecting multiple regions of the brain. The case is complicated by the removal of the firework from the injury site before the arrival of emergency services, making the reconstruction of the exact sequence of events challenging. The findings emphasize the devastating consequences of fireworks-related injuries and the unique forensic challenges they present in determining the precise cause of death.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102761"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Facial growth parameters in Down syndrome: Review of the literature and forensic application for missing persons age progression 唐氏综合征的面部发育参数:文献综述与失踪人员年龄进展的法医应用
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-01 DOI: 10.1016/j.jflm.2024.102756
Laura Donato , Douglas H. Ubelaker , Valentina Bugelli , Jessika Camatti , Michele Treglia , Luigi Tonino Marsella , Rossana Cecchi

Purpose

Individuals with Down syndrome (DS) show growth trajectories which deviate from standard ones due to variations in the growth of facial structures. Studying the effect of aging on the faces of DS individuals is necessary to obtain an accurate result through age progression, a technique based on the study of physiognomic features and used in cases of missing persons. Here we present scientific publications that delve into the rhythms of aging and morphological characteristics of facial features in DS individuals to enable appropriate age progression in cases of missing DS individuals.

Results

The scientific literature considered in this review studies the growth of soft tissue and bone substrate by comparing standard growth values with those measured through anthropometric measurements of individuals with DS. Growth trajectories are described by considering morphological trends both by comparing standard values with those found in individuals with DS and by observing individual physiognomic traits.

Conclusions

When a young individual with DS goes missing, the realization of an age progression requires knowledge of the aging dynamics peculiar to the DS face. Therefore, physical, cognitive, and clinical factors must be considered. Delayed physical development and early aging, such as the onset of puberty and weight gain, have an important impact on the realization of age progression. In fact, depending on the life period to be considered, the effects of aging must be calibrated based on the knowledge gathered from scientific research.
目的 唐氏综合症(DS)患者由于面部结构的生长变化,其生长轨迹与标准轨迹存在偏差。研究衰老对唐氏综合症患者面部的影响对于通过年龄进展获得准确结果是非常必要的,年龄进展是一种基于相貌特征研究的技术,被用于失踪人员案件中。结果本综述中的科学文献通过比较标准生长值和 DS 患者的人体测量值,研究了软组织和骨骼基质的生长。通过将标准值与 DS 患者的标准值进行比较,并通过观察个体的相貌特征,考虑形态学趋势,对生长轨迹进行了描述。因此,必须考虑身体、认知和临床因素。身体发育延迟和早期衰老,如青春期开始和体重增加,对实现年龄进展有重要影响。事实上,根据所考虑的生命周期,必须根据从科学研究中收集的知识来校准衰老的影响。
{"title":"Facial growth parameters in Down syndrome: Review of the literature and forensic application for missing persons age progression","authors":"Laura Donato ,&nbsp;Douglas H. Ubelaker ,&nbsp;Valentina Bugelli ,&nbsp;Jessika Camatti ,&nbsp;Michele Treglia ,&nbsp;Luigi Tonino Marsella ,&nbsp;Rossana Cecchi","doi":"10.1016/j.jflm.2024.102756","DOIUrl":"10.1016/j.jflm.2024.102756","url":null,"abstract":"<div><h3>Purpose</h3><div>Individuals with Down syndrome (DS) show growth trajectories which deviate from standard ones due to variations in the growth of facial structures. Studying the effect of aging on the faces of DS individuals is necessary to obtain an accurate result through age progression, a technique based on the study of physiognomic features and used in cases of missing persons. Here we present scientific publications that delve into the rhythms of aging and morphological characteristics of facial features in DS individuals to enable appropriate age progression in cases of missing DS individuals.</div></div><div><h3>Results</h3><div>The scientific literature considered in this review studies the growth of soft tissue and bone substrate by comparing standard growth values with those measured through anthropometric measurements of individuals with DS. Growth trajectories are described by considering morphological trends both by comparing standard values with those found in individuals with DS and by observing individual physiognomic traits.</div></div><div><h3>Conclusions</h3><div>When a young individual with DS goes missing, the realization of an age progression requires knowledge of the aging dynamics peculiar to the DS face. Therefore, physical, cognitive, and clinical factors must be considered. Delayed physical development and early aging, such as the onset of puberty and weight gain, have an important impact on the realization of age progression. In fact, depending on the life period to be considered, the effects of aging must be calibrated based on the knowledge gathered from scientific research.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102756"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A study to determine a practical method for weight estimation of deceased persons 研究确定估算死者体重的实用方法。
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-01 DOI: 10.1016/j.jflm.2024.102765
Tess M. Wemeijer , Inez Moorman , Tristan Krap , (H) Erik Stigter , Wilma L.J.M. Duijst

Background

Body weight is an important parameter for estimating the postmortem interval (PMI) at a crime scene. However, a challenge arises at crime scenes when a weight scale for measuring the total body weight is unavailable. Anthropometry-based models to estimate body weight have been developed in previous studies. This study aims to determine the accuracy of body weight estimations by practitioners, test the anthropometry-based models for applicability to deceased individuals, and examine a potential new method based on applying heel weight.

Methods

A prospective study was conducted at the Isala Hospital in the Netherlands. During the study period, deceased people that were admitted to the hospital mortuary were included consecutively. The body weight of deceased persons estimated by practitioners was compared to the actual body weight. Anthropometric measurements were taken and used to perform eight sex dependant anthropometry-based models, with accuracy for the actual body weight calculated using RMSE values. A Pearson's correlation test was used to determine the correlation between heel weight and total body weight.

Results

During the study period, a total of 100 cases, 56 males and 44 females, were included. Overall, only 33.3 % of practitioners' estimations were within 5 % of the actual measured weight. The model based on abdominal and thigh circumference performed best for weight estimation in males and the models based on mid-arm circumference, abdominal circumference, calf circumference and, in one model, subscapular skinfold performed best in females. A Pearson's correlation test revealed a weak positive correlation between weight of the heel and total body weight (Pearson's correlation coefficient: 0.214).

Discussion

Estimations of underweight or obese patients posed a challenge for weight estimation. Especially in these cases, study results showed that anthropometry-based models have potential for daily practice. However, additional research is required to assess the reliability of the best performing models before implementation in forensic casework. The correlation between the weight of the heel and body weight was low, therefore implementation of the current method is not recommended, and further research is required.
背景:体重是估算犯罪现场死后间隔(PMI)的一个重要参数。然而,在犯罪现场,如果没有测量全身重量的体重秤,就会遇到挑战。之前的研究已经开发了基于人体测量学的体重估算模型。本研究旨在确定从业人员估计体重的准确性,测试基于人体测量学的模型是否适用于死者,并研究一种基于脚跟重量的潜在新方法:荷兰伊萨拉医院开展了一项前瞻性研究。方法:在荷兰伊萨拉医院进行了一项前瞻性研究。在研究期间,连续纳入了医院太平间收治的死者。将医生估计的死者体重与实际体重进行比较。研究人员对死者进行了人体测量,并利用测量结果建立了八个基于性别的人体测量模型,利用均方根误差(RMSE)值计算实际体重的准确性。采用皮尔逊相关性检验来确定脚跟重量与总体重之间的相关性:在研究期间,共纳入了 100 例病例,其中男性 56 例,女性 44 例。总体而言,只有 33.3% 的从业人员的估计值与实际测量体重的误差在 5% 以内。基于腹围和大腿围的模型在男性体重估算中表现最佳,而基于中臂围、腹围、小腿围以及肩胛下皮褶的模型在女性体重估算中表现最佳。皮尔逊相关测试显示,脚跟重量与总体重之间存在微弱的正相关(皮尔逊相关系数:0.214):讨论:体重不足或肥胖患者的体重估计是一项挑战。特别是在这些情况下,研究结果表明,基于人体测量学的模型在日常实践中具有潜力。然而,在法医案件工作中实施之前,还需要进行更多的研究,以评估性能最佳模型的可靠性。脚跟重量与体重之间的相关性较低,因此不建议采用目前的方法,还需要进一步研究。
{"title":"A study to determine a practical method for weight estimation of deceased persons","authors":"Tess M. Wemeijer ,&nbsp;Inez Moorman ,&nbsp;Tristan Krap ,&nbsp;(H) Erik Stigter ,&nbsp;Wilma L.J.M. Duijst","doi":"10.1016/j.jflm.2024.102765","DOIUrl":"10.1016/j.jflm.2024.102765","url":null,"abstract":"<div><h3>Background</h3><div>Body weight is an important parameter for estimating the postmortem interval (PMI) at a crime scene. However, a challenge arises at crime scenes when a weight scale for measuring the total body weight is unavailable. Anthropometry-based models to estimate body weight have been developed in previous studies. This study aims to determine the accuracy of body weight estimations by practitioners, test the anthropometry-based models for applicability to deceased individuals, and examine a potential new method based on applying heel weight.</div></div><div><h3>Methods</h3><div>A prospective study was conducted at the Isala Hospital in the Netherlands. During the study period, deceased people that were admitted to the hospital mortuary were included consecutively. The body weight of deceased persons estimated by practitioners was compared to the actual body weight. Anthropometric measurements were taken and used to perform eight sex dependant anthropometry-based models, with accuracy for the actual body weight calculated using RMSE values. A Pearson's correlation test was used to determine the correlation between heel weight and total body weight.</div></div><div><h3>Results</h3><div>During the study period, a total of 100 cases, 56 males and 44 females, were included. Overall, only 33.3 % of practitioners' estimations were within 5 % of the actual measured weight. The model based on abdominal and thigh circumference performed best for weight estimation in males and the models based on mid-arm circumference, abdominal circumference, calf circumference and, in one model, subscapular skinfold performed best in females. A Pearson's correlation test revealed a weak positive correlation between weight of the heel and total body weight (Pearson's correlation coefficient: 0.214).</div></div><div><h3>Discussion</h3><div>Estimations of underweight or obese patients posed a challenge for weight estimation. Especially in these cases, study results showed that anthropometry-based models have potential for daily practice. However, additional research is required to assess the reliability of the best performing models before implementation in forensic casework. The correlation between the weight of the heel and body weight was low, therefore implementation of the current method is not recommended, and further research is required.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102765"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
In vitro β-hydroxybutyrate stability evaluation in femoral blood and vitreous humor for integration into forensic toxicology practices 用于法医毒理学实践的股血和玻璃体中β-羟丁酸体外稳定性评估
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-01 DOI: 10.1016/j.jflm.2024.102764
Aurélien Bauduin , Chadi Abbara , Antoine Baudriller , Laurent Leuger , Séverine Ferec , Stéphane Malbranque , Nathalie Jousset , Marie Briet , Guillaume Drevin
Thanatological biochemistry has gained prominence in determining causes of death, especially when suspected fatal pathologies do not exhibit clear postmortem macroscopic and/or microscopic features, such as in cases of ketoacidosis. Indeed, in these cases, the measurement of β-hydroxybutyrate (BHB) in femoral blood and/or vitreous humor is of particular importance. However, data on its in vitro stability remain scarce, especially in vitreous humor. In this context, the study reported here aims to assess the in vitro stability of BHB. BHB quantification was performed using a liquid chromatography coupled with tandem mass spectrometry method. To investigate BHB stability, two different postmortem matrices were considered: femoral blood and vitreous humor. These matrices were pooled, aliquoted and spiked with BHB at three different concentrations (50 mg/L, 100 mg/L, and 200 mg/L; n = 3). Initial BHB concentrations were established on day 1. Each sample was then divided into two aliquots for storage under two conditions: 20 °C and 4 °C. Analyses were performed on Day 3, 7, 14, and 28. The study revealed no significant degradation of BHB in femoral blood or vitreous humor over time (days 1–28), confirming the robustness and reliability of BHB measurement in these matrices as a postmortem biomarker of ketoacidosis under the tested temperature conditions (+4 °C or −20 °C). These results support a systematic integration of BHB measurement into the routine workflow of forensic toxicology laboratories.
在确定死亡原因方面,尤其是当疑似致命病症在死后的宏观和/或微观特征不明显时,如在酮症酸中毒病例中,解剖生化已变得越来越重要。事实上,在这些病例中,测量股静脉血和/或玻璃体中的β-羟丁酸(BHB)尤为重要。然而,有关其体外稳定性的数据仍然很少,尤其是在玻璃体液中。在这种情况下,本文报告的研究旨在评估 BHB 的体外稳定性。研究采用液相色谱-串联质谱法对 BHB 进行定量。为了研究 BHB 的稳定性,研究人员考虑了两种不同的尸检基质:股骨头血液和玻璃体。将这些基质汇集、等分并添加三种不同浓度(50 毫克/升、100 毫克/升和 200 毫克/升;n = 3)的 BHB。BHB 初始浓度在第 1 天确定。然后将每个样品分成两份等分样品,分别在 20 °C 和 4 °C 两种条件下储存:20 °C 和 4 °C。在第 3、7、14 和 28 天进行分析。研究结果表明,随着时间的推移(第 1-28 天),股静脉血或玻璃体液中的 BHB 没有明显降解,这证实了在测试温度条件(+4 °C或-20 °C)下,在这些基质中测量 BHB 作为酮症酸中毒死后生物标志物的稳健性和可靠性。这些结果支持将 BHB 测量系统地纳入法医毒理学实验室的常规工作流程。
{"title":"In vitro β-hydroxybutyrate stability evaluation in femoral blood and vitreous humor for integration into forensic toxicology practices","authors":"Aurélien Bauduin ,&nbsp;Chadi Abbara ,&nbsp;Antoine Baudriller ,&nbsp;Laurent Leuger ,&nbsp;Séverine Ferec ,&nbsp;Stéphane Malbranque ,&nbsp;Nathalie Jousset ,&nbsp;Marie Briet ,&nbsp;Guillaume Drevin","doi":"10.1016/j.jflm.2024.102764","DOIUrl":"10.1016/j.jflm.2024.102764","url":null,"abstract":"<div><div>Thanatological biochemistry has gained prominence in determining causes of death, especially when suspected fatal pathologies do not exhibit clear postmortem macroscopic and/or microscopic features, such as in cases of ketoacidosis. Indeed, in these cases, the measurement of β-hydroxybutyrate (BHB) in femoral blood and/or vitreous humor is of particular importance. However, data on its in vitro stability remain scarce, especially in vitreous humor. In this context, the study reported here aims to assess the in vitro stability of BHB. BHB quantification was performed using a liquid chromatography coupled with tandem mass spectrometry method. To investigate BHB stability, two different postmortem matrices were considered: femoral blood and vitreous humor. These matrices were pooled, aliquoted and spiked with BHB at three different concentrations (50 mg/L, 100 mg/L, and 200 mg/L; n = 3). Initial BHB concentrations were established on day 1. Each sample was then divided into two aliquots for storage under two conditions: 20 °C and 4 °C. Analyses were performed on Day 3, 7, 14, and 28. The study revealed no significant degradation of BHB in femoral blood or vitreous humor over time (days 1–28), confirming the robustness and reliability of BHB measurement in these matrices as a postmortem biomarker of ketoacidosis under the tested temperature conditions (+4 °C or −20 °C). These results support a systematic integration of BHB measurement into the routine workflow of forensic toxicology laboratories<strong>.</strong></div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102764"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Between blunt, sharp and hacking trauma: Observing the characteristics of pickaxe injuries 钝伤、锐伤和砍伤之间的区别:观察镐伤的特征
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-23 DOI: 10.1016/j.jflm.2024.102763
Alberto Amadasi , Lorenzo Franceschetti , Julia Babigian , Antonia Locatelli , Larissa Amadasi
Pickaxe injuries have never been thoroughly investigated in forensic science. This case, involving the fatal wounding of a 28-year-old individual by pickaxe blows to the head, abdomen, and hand, highlights the unique injury patterns associated with such an instrument. The injuries observed in the frontal skull exhibited characteristics akin to typical chop wounds, while those on the parietal skull bore similarities to blunt force trauma. The pickaxe penetrated the hands and the abdomen, with the depth of penetration directly correlating to the force applied. Consequently, pickaxe injuries can be considered a hybrid of different injury mechanisms, a fact that should be carefully considered in forensic analysis.
法医学从未对镐伤进行过彻底调查。这起案件涉及一名 28 岁的人头部、腹部和手部被镐头击打造成的致命伤,凸显了与这种工具相关的独特伤害模式。在前额颅骨上观察到的伤痕表现出类似典型砍伤的特征,而顶颅骨上的伤痕则与钝器击伤相似。镐头穿透了手部和腹部,穿透深度与施加的力量直接相关。因此,镐伤可被视为不同伤害机制的混合体,在法医分析中应仔细考虑这一事实。
{"title":"Between blunt, sharp and hacking trauma: Observing the characteristics of pickaxe injuries","authors":"Alberto Amadasi ,&nbsp;Lorenzo Franceschetti ,&nbsp;Julia Babigian ,&nbsp;Antonia Locatelli ,&nbsp;Larissa Amadasi","doi":"10.1016/j.jflm.2024.102763","DOIUrl":"10.1016/j.jflm.2024.102763","url":null,"abstract":"<div><div>Pickaxe injuries have never been thoroughly investigated in forensic science. This case, involving the fatal wounding of a 28-year-old individual by pickaxe blows to the head, abdomen, and hand, highlights the unique injury patterns associated with such an instrument. The injuries observed in the frontal skull exhibited characteristics akin to typical chop wounds, while those on the parietal skull bore similarities to blunt force trauma. The pickaxe penetrated the hands and the abdomen, with the depth of penetration directly correlating to the force applied. Consequently, pickaxe injuries can be considered a hybrid of different injury mechanisms, a fact that should be carefully considered in forensic analysis.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102763"},"PeriodicalIF":1.2,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Beyond the distance between juridic and scientific decision-making process: An evidence-based prediction algorithm for professional liability assessment in healthcare-associated infections 超越司法和科学决策过程之间的距离:基于证据的医疗相关感染职业责任评估预测算法
IF 1.2 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-23 DOI: 10.1016/j.jflm.2024.102762
Sara Sablone , Andrea Nicola Cardinale , Ettore Gorini , Lucia Diella , Alessandra Belati , Linda Bussini , Valeria Cento , Michele Bartoletti , Francesco Introna , Davide Fiore Bavaro
<div><h3>Background</h3><div>HAIs (Healthcare-Acquired-Infections) have been recently the subject of judgment n. 6386 pronounced on 3rd March 2023 by the Italian Supreme Court. This sentence provided three criteria to determine whether a health facility is responsible for the patient contracting a nosocomial infection, i.e. time criterion, topographical criterion and clinical criterion. Accordingly, the healthcare facility is obliged to prove the fulfillment of a series of preventive hygiene measures specifically detailed by the legislator. Herein, the positive predictive value of these criteria (“juridic criteria”) in the identification of professional liability for nosocomial infections was evaluated in comparison with clinical criteria reviewed by Infectious Disease specialists (“Infectious-Disease criteria”, i.e. presence of a Multidrug Resistant Organism (MDRO); development of surgical site infection; inadequate antibiotic therapy; inadequate disinfection).</div></div><div><h3>Methods</h3><div>Two retrospective cohorts were compared from the Portal of Telematic Services of the Ministry of Justice; 51 patients were extrapolated from Italian judgments concerning claims for Gram-negative nosocomial infections in the three-year period 2020–2022. On the other side, from the electronic database of University Hospital of Bari we extracted 349 patients affected by Gram-negative infections in the same timespan. Both “juridic” criteria and “Infectious-Disease” criteria were then applied to the full cohort after stratification for cohort of origin and after stratification for nosocomial or non-nosocomial infections. Predictive value of criteria was evaluated through receiver operating characteristic (ROC) curves and area under the curve (AUC).</div></div><div><h3>Results</h3><div>Overall, the incidence of definite nosocomial infections (according to final judgement or clinical records discharge letter) was 84 % in juridic cohort and 46 % in “real-world” series.</div><div>Data suggested that the presence of all three juridic criteria [ROC AUC = 0.944 (95%CI = 0.924–0.963)] or the four clinical criteria [ROC AUC = 0.948 (95%CI = 0.928–0.969)] predicted well a case of nosocomial infection with professional liability.</div><div>Moreover, by summarizing both criteria in a single classification system, the generated ROC curve (was the one with the highest AUC [0.9488 (95%CI = 0.928–0.969)].</div><div>Accordingly, further tests were performed, evaluating the predictive value of one juridic criterium plus at one of more Infectious-Disease criteria. Interestingly, the ROCs curves demonstrated that the presence of at least 1 juridic criteria plus at least 2 Infectious Disease criteria reached a predictive value comparable to 2 or 3 juridic criteria.</div></div><div><h3>Conclusions</h3><div>The results highlight the efficiency of new criteria laid down in the judgment of the Italian Supreme Court to attribute liability for nosocomial infection despite the dispute
背景最近,意大利最高法院于 2023 年 3 月 3 日宣布了第 6386 号判决,HAI(医源性感染)成为判决的主题。该判决提供了三项标准,即时间标准、地形标准和临床标准,以确定医疗机构是否对患者感染院内感染负有责任。因此,医疗机构有义务证明其履行了立法者具体规定的一系列预防性卫生措施。在此,将这些标准("司法标准")与传染病专家审查的临床标准("传染病标准",即方法比较了司法部远程服务门户网站的两个回顾性队列;从意大利 2020-2022 年三年期间有关革兰氏阴性菌医院内感染索赔的判决中推断出 51 名患者。另一方面,我们从巴里大学医院的电子数据库中提取了 349 名在同一时间段内受革兰氏阴性菌感染的患者。然后,将 "法学 "标准和 "传染病 "标准应用于整个队列,并对来源队列进行了分层,对医院内感染或非医院内感染进行了分层。通过接收器操作特征曲线(ROC)和曲线下面积(AUC)评估了标准的预测价值。结果总体而言,法医队列中明确的鼻腔感染(根据最终判断或临床记录出院信)发生率为 84%,"真实世界 "系列中为 46%。此外,通过将两个标准汇总到一个分类系统中,生成的 ROC 曲线是 AUC 最高的[0.9488(95%CI = 0.928-0.969)]。有趣的是,ROCs 曲线显示,至少有一个法学标准加上至少两个传染病标准,其预测价值可与 2 或 3 个法学标准相媲美。此外,结合 "司法 "和 "传染病 "标准的综合评分的使用为技术顾问提供了一个高质量的工具,可用于弥补临床文件的不足,通过对发生院内感染时的职业责任诉讼做出判断。这揭示了以科学严谨的态度面对全球司法调查的可能性。
{"title":"Beyond the distance between juridic and scientific decision-making process: An evidence-based prediction algorithm for professional liability assessment in healthcare-associated infections","authors":"Sara Sablone ,&nbsp;Andrea Nicola Cardinale ,&nbsp;Ettore Gorini ,&nbsp;Lucia Diella ,&nbsp;Alessandra Belati ,&nbsp;Linda Bussini ,&nbsp;Valeria Cento ,&nbsp;Michele Bartoletti ,&nbsp;Francesco Introna ,&nbsp;Davide Fiore Bavaro","doi":"10.1016/j.jflm.2024.102762","DOIUrl":"10.1016/j.jflm.2024.102762","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;HAIs (Healthcare-Acquired-Infections) have been recently the subject of judgment n. 6386 pronounced on 3rd March 2023 by the Italian Supreme Court. This sentence provided three criteria to determine whether a health facility is responsible for the patient contracting a nosocomial infection, i.e. time criterion, topographical criterion and clinical criterion. Accordingly, the healthcare facility is obliged to prove the fulfillment of a series of preventive hygiene measures specifically detailed by the legislator. Herein, the positive predictive value of these criteria (“juridic criteria”) in the identification of professional liability for nosocomial infections was evaluated in comparison with clinical criteria reviewed by Infectious Disease specialists (“Infectious-Disease criteria”, i.e. presence of a Multidrug Resistant Organism (MDRO); development of surgical site infection; inadequate antibiotic therapy; inadequate disinfection).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Two retrospective cohorts were compared from the Portal of Telematic Services of the Ministry of Justice; 51 patients were extrapolated from Italian judgments concerning claims for Gram-negative nosocomial infections in the three-year period 2020–2022. On the other side, from the electronic database of University Hospital of Bari we extracted 349 patients affected by Gram-negative infections in the same timespan. Both “juridic” criteria and “Infectious-Disease” criteria were then applied to the full cohort after stratification for cohort of origin and after stratification for nosocomial or non-nosocomial infections. Predictive value of criteria was evaluated through receiver operating characteristic (ROC) curves and area under the curve (AUC).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Overall, the incidence of definite nosocomial infections (according to final judgement or clinical records discharge letter) was 84 % in juridic cohort and 46 % in “real-world” series.&lt;/div&gt;&lt;div&gt;Data suggested that the presence of all three juridic criteria [ROC AUC = 0.944 (95%CI = 0.924–0.963)] or the four clinical criteria [ROC AUC = 0.948 (95%CI = 0.928–0.969)] predicted well a case of nosocomial infection with professional liability.&lt;/div&gt;&lt;div&gt;Moreover, by summarizing both criteria in a single classification system, the generated ROC curve (was the one with the highest AUC [0.9488 (95%CI = 0.928–0.969)].&lt;/div&gt;&lt;div&gt;Accordingly, further tests were performed, evaluating the predictive value of one juridic criterium plus at one of more Infectious-Disease criteria. Interestingly, the ROCs curves demonstrated that the presence of at least 1 juridic criteria plus at least 2 Infectious Disease criteria reached a predictive value comparable to 2 or 3 juridic criteria.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The results highlight the efficiency of new criteria laid down in the judgment of the Italian Supreme Court to attribute liability for nosocomial infection despite the dispute","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"107 ","pages":"Article 102762"},"PeriodicalIF":1.2,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of forensic and legal medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1