Pub Date : 2024-09-16DOI: 10.1097/paf.0000000000000984
Deland Weyrauch,Jacqueline Nunez,Christopher C Borck,Jonathan Gates,Monika Nelson,Tyler J Jones,Lisa Henneberry,James R Gill
As a powerful tool for discovering and documenting injury, the forensic autopsy has been incorporated into trauma care quality improvement. Autopsy findings are used to determine the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) to assess a patient's trauma severity. Clinical trauma services use autopsy reports to educate, improve patient care, and strengthen the information used in epidemiological and injury prevention studies. However, there is sometimes a disconnect between the forensic pathologist's injury descriptions and the information needed by the trauma service and for AIS/ISS coding.We formed a collaboration between forensic pathologists and trauma teams to improve this communication. Accordingly, we describe injuries that are commonly overlooked or poorly described in autopsy reports, useful injury terminology, opportunities for trauma care improvement revealed by autopsies, and which medical examiner/coroner cases will most benefit from attention to specific injury details. We demonstrate how differences in injury description impact AIS/ISS results, and distill the detailed AIS manual into a pragmatic, concise, "quick reference" autopsy-directed guide for the forensic pathologist. Collaborations between trauma teams and forensic pathologists benefit each other and help communicate autopsy findings in a more clinically useful way to stakeholders to further benefit the living.
{"title":"Forensic Pathologists and Clinical Trauma Reviews: Performance Improvement, Public Health, and a Concise Autopsy Documentation Guide.","authors":"Deland Weyrauch,Jacqueline Nunez,Christopher C Borck,Jonathan Gates,Monika Nelson,Tyler J Jones,Lisa Henneberry,James R Gill","doi":"10.1097/paf.0000000000000984","DOIUrl":"https://doi.org/10.1097/paf.0000000000000984","url":null,"abstract":"As a powerful tool for discovering and documenting injury, the forensic autopsy has been incorporated into trauma care quality improvement. Autopsy findings are used to determine the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) to assess a patient's trauma severity. Clinical trauma services use autopsy reports to educate, improve patient care, and strengthen the information used in epidemiological and injury prevention studies. However, there is sometimes a disconnect between the forensic pathologist's injury descriptions and the information needed by the trauma service and for AIS/ISS coding.We formed a collaboration between forensic pathologists and trauma teams to improve this communication. Accordingly, we describe injuries that are commonly overlooked or poorly described in autopsy reports, useful injury terminology, opportunities for trauma care improvement revealed by autopsies, and which medical examiner/coroner cases will most benefit from attention to specific injury details. We demonstrate how differences in injury description impact AIS/ISS results, and distill the detailed AIS manual into a pragmatic, concise, \"quick reference\" autopsy-directed guide for the forensic pathologist. Collaborations between trauma teams and forensic pathologists benefit each other and help communicate autopsy findings in a more clinically useful way to stakeholders to further benefit the living.","PeriodicalId":501647,"journal":{"name":"The American Journal of Forensic Medicine and Pathology","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.1097/PAF.0000000000000941
{"title":"Updated AJFMP 2023 Reviewer Thank You.","authors":"","doi":"10.1097/PAF.0000000000000941","DOIUrl":"https://doi.org/10.1097/PAF.0000000000000941","url":null,"abstract":"","PeriodicalId":501647,"journal":{"name":"The American Journal of Forensic Medicine and Pathology","volume":"21 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140672391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1097/paf.0000000000000880
Addie Hancock, Mark Giffen
As the fifth leading cause of death in individuals aged 1 to 64 years in the United States, forensic pathologists frequently encounter firearm-related deaths and are trained to approach these cases by utilizing information from the investigation, radiographs, and autopsy findings to discern the logical sequence of events that lead to death. We also emphasize the importance and utility of various factors such as bullet wound characteristics, type of ammunition used, and type of tissues involved in a forensic pathologist's determination of events and in medicolegal investigations. However, the unusual presentations of firearm-related deaths can cause confusion and even frustration when there are contradicting circumstances or findings at work. We present the case of a 61-year-old woman with an atypical pattern of 2 distinct irregular entrance gunshot wounds determined to be caused by a single projectile.
{"title":"Two Bullet Wounds, One Bullet: The Atypical Fragmentation of a .223 Caliber Ammunition.","authors":"Addie Hancock, Mark Giffen","doi":"10.1097/paf.0000000000000880","DOIUrl":"https://doi.org/10.1097/paf.0000000000000880","url":null,"abstract":"As the fifth leading cause of death in individuals aged 1 to 64 years in the United States, forensic pathologists frequently encounter firearm-related deaths and are trained to approach these cases by utilizing information from the investigation, radiographs, and autopsy findings to discern the logical sequence of events that lead to death. We also emphasize the importance and utility of various factors such as bullet wound characteristics, type of ammunition used, and type of tissues involved in a forensic pathologist's determination of events and in medicolegal investigations. However, the unusual presentations of firearm-related deaths can cause confusion and even frustration when there are contradicting circumstances or findings at work. We present the case of a 61-year-old woman with an atypical pattern of 2 distinct irregular entrance gunshot wounds determined to be caused by a single projectile.","PeriodicalId":501647,"journal":{"name":"The American Journal of Forensic Medicine and Pathology","volume":"301 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139669519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1097/paf.0000000000000912
Cameron Fink, Clare H Bryce, Laura D Knight
Chiropractic cervical spinal manipulations have several complications and can result in vascular injury, including traumatic dissection of the vertebral arteries. A 43-year-old woman was admitted to the emergency department after performing a self-chiropractic spinal manipulation. She experienced headache and vomiting and was unresponsive with severe hypertension at the time of hospital admission. Clinical computerized tomography angiography showed narrowing of the right vertebral artery but was inconclusive for dissection or thrombosis. At autopsy, subacute dissection of the right vertebral artery was identified along with cerebral edema and herniation. A small peripheral pulmonary thromboembolism in the right lung was also seen. Neuropathology consultation confirmed the presence of diffuse cerebral edema and acute hypoxic-ischemic changes, with multifocal acute subarachnoid and intraparenchymal hemorrhage of the brain and spinal cord. This case presents a unique circumstance of a fatal vertebral artery dissection after self-chiropractic manipulation that, to the best of our knowledge, has not been previously described in the medical literature.
{"title":"Self-Chiropractic Cervical Spinal Manipulation Resulting in Fatal Vertebral Artery Dissection: A Case Report and Review of the Literature.","authors":"Cameron Fink, Clare H Bryce, Laura D Knight","doi":"10.1097/paf.0000000000000912","DOIUrl":"https://doi.org/10.1097/paf.0000000000000912","url":null,"abstract":"Chiropractic cervical spinal manipulations have several complications and can result in vascular injury, including traumatic dissection of the vertebral arteries. A 43-year-old woman was admitted to the emergency department after performing a self-chiropractic spinal manipulation. She experienced headache and vomiting and was unresponsive with severe hypertension at the time of hospital admission. Clinical computerized tomography angiography showed narrowing of the right vertebral artery but was inconclusive for dissection or thrombosis. At autopsy, subacute dissection of the right vertebral artery was identified along with cerebral edema and herniation. A small peripheral pulmonary thromboembolism in the right lung was also seen. Neuropathology consultation confirmed the presence of diffuse cerebral edema and acute hypoxic-ischemic changes, with multifocal acute subarachnoid and intraparenchymal hemorrhage of the brain and spinal cord. This case presents a unique circumstance of a fatal vertebral artery dissection after self-chiropractic manipulation that, to the best of our knowledge, has not been previously described in the medical literature.","PeriodicalId":501647,"journal":{"name":"The American Journal of Forensic Medicine and Pathology","volume":"173 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139669644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1097/paf.0000000000000917
Kaylan Peterson, Wayne Lord, Ross Miller, Mark McCoy, Timothy Dwyer, Amber Fortney, Sean Laverty
This study examined 71 cases, where 45 cases were equine-related and 26 were bovine-related. Data for this study were collected by examining cases between 2000 and 2022 from the Oklahoma Office of the Chief Medical Examiner database.A majority of the equine-related fatality cases involved males aged 0 to 18 and 60 to 69 years, with sustained injuries of the head, neck, and thoracic regions while being mounted. These injuries were most often inflicted by being kicked or resulted from blunt force of impact. A majority of the bovine-related fatality cases involved males aged 60 to 79 years, with sustained injuries of the head, neck, and thoracic regions while being unmounted. These injuries were most often inflicted by being butted, trampled, or resulted from blunt force of impact. Of the total cases, approximately 42% of the causes of death were blunt force trauma of the head/neck and nearly 34% were multiple blunt force injuries. Only 3 mechanisms of death were discussed.There are distinct similarities in the most prominent gender, cause of sustained injury, and location of injury between equine- and bovine-related fatalities in Oklahoma. This study lends significant support to the need for increased awareness of safe handling practices and safety precaution education for both equine and bovine activities.
{"title":"A Comparative Investigation of Equine-Related and Bovine-Related Human Fatalities in Oklahoma.","authors":"Kaylan Peterson, Wayne Lord, Ross Miller, Mark McCoy, Timothy Dwyer, Amber Fortney, Sean Laverty","doi":"10.1097/paf.0000000000000917","DOIUrl":"https://doi.org/10.1097/paf.0000000000000917","url":null,"abstract":"This study examined 71 cases, where 45 cases were equine-related and 26 were bovine-related. Data for this study were collected by examining cases between 2000 and 2022 from the Oklahoma Office of the Chief Medical Examiner database.A majority of the equine-related fatality cases involved males aged 0 to 18 and 60 to 69 years, with sustained injuries of the head, neck, and thoracic regions while being mounted. These injuries were most often inflicted by being kicked or resulted from blunt force of impact. A majority of the bovine-related fatality cases involved males aged 60 to 79 years, with sustained injuries of the head, neck, and thoracic regions while being unmounted. These injuries were most often inflicted by being butted, trampled, or resulted from blunt force of impact. Of the total cases, approximately 42% of the causes of death were blunt force trauma of the head/neck and nearly 34% were multiple blunt force injuries. Only 3 mechanisms of death were discussed.There are distinct similarities in the most prominent gender, cause of sustained injury, and location of injury between equine- and bovine-related fatalities in Oklahoma. This study lends significant support to the need for increased awareness of safe handling practices and safety precaution education for both equine and bovine activities.","PeriodicalId":501647,"journal":{"name":"The American Journal of Forensic Medicine and Pathology","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139669408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-13DOI: 10.1097/paf.0000000000000906
Antonietta Porzio, Alessandro Feola, Francesco La Sala, Bruno Della Pietra, Carlo Pietro Campobasso
Honor killing is a murder carried out to protect the family's reputation by actions that are perceived as shameful. Usually, honor killing occurs to preserve family's honor, which has been violated by adulteries, premarital pregnancies, or inappropriate relationships. In Southern Italy, the culture of honor is quite strong especially among the local criminal organizations. Honor crimes by Italian Mafia are intended to have an admonitory significance, and they can be carried out following a macabre ritual of "incaprettamento." The aim is to humiliate the victim treating him like an animal, a bonded young goat where the victim is secured by a rope passing behind the back from the upper to lower extremities. In this case study, the honor homicide was perpetrated against the lover of a butcher's wife by sharp weapon, followed by a postmortem atypical incaprettamento of the corpse. The wrists and ankles were tied together by ropes, and the extremities were fixed to the abdomen with a string. The body was also wrapped in a plastic tape after penile amputation. According to killer's confession, the mutilation and the incaprettamento were expressions of revenge and contempt for the victim to restore the honor lost.
{"title":"Atypical Postmortem \"Incaprettamento\" After an Honor Homicide.","authors":"Antonietta Porzio, Alessandro Feola, Francesco La Sala, Bruno Della Pietra, Carlo Pietro Campobasso","doi":"10.1097/paf.0000000000000906","DOIUrl":"https://doi.org/10.1097/paf.0000000000000906","url":null,"abstract":"Honor killing is a murder carried out to protect the family's reputation by actions that are perceived as shameful. Usually, honor killing occurs to preserve family's honor, which has been violated by adulteries, premarital pregnancies, or inappropriate relationships. In Southern Italy, the culture of honor is quite strong especially among the local criminal organizations. Honor crimes by Italian Mafia are intended to have an admonitory significance, and they can be carried out following a macabre ritual of \"incaprettamento.\" The aim is to humiliate the victim treating him like an animal, a bonded young goat where the victim is secured by a rope passing behind the back from the upper to lower extremities. In this case study, the honor homicide was perpetrated against the lover of a butcher's wife by sharp weapon, followed by a postmortem atypical incaprettamento of the corpse. The wrists and ankles were tied together by ropes, and the extremities were fixed to the abdomen with a string. The body was also wrapped in a plastic tape after penile amputation. According to killer's confession, the mutilation and the incaprettamento were expressions of revenge and contempt for the victim to restore the honor lost.","PeriodicalId":501647,"journal":{"name":"The American Journal of Forensic Medicine and Pathology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138689415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-08DOI: 10.1097/paf.0000000000000907
Rand A Miyashiro, Willi McFarland
The Health Officer of the City and County of San Francisco, California, issued the order that all decedents were required to have a documented COVID-19 test effective from June 2020 to June 2021. The justification for the requirement was that complete data on COVID-19 status at the time of death were needed to help protect first responders and funeral home workers, identify missed cases, and characterize the places of death for otherwise unknown COVID-19 cases. To fill the gap in COVID-19 testing for all decedents, particularly among persons dying outside of hospitals, a specialized Decedent Testing Unit was created along with an increased capacity of the Office of the Chief Medical Examiner. From July 1, 2020, to June 30, 2021, the Decedent Testing Unit and Office of the Chief Medical Examiner provided postmortem testing results for 2776 decedents. Of these, 80 tested positive for COVID-19 for a positivity rate of 2.97%. The largest number of COVID-19-positive specimens were collected from persons who died at home (n = 37, 46.3%), followed by those who died in hospice (n = 20, 25.0%), other places outside of homes or facilities (n = 8, 10.0%), and in skilled nursing or long-term care facilities (n = 7, 8.8%). Follow-up of California death records found that 17 of these 80 cases (21.3%) had COVID-19 listed as one of the causes of death, 22 (27.5%) mentioned COVID-19 under "other conditions," and 41 (51.3%) made no mention of COVID-19. In the context of providing the COVID-19 status of decedents not otherwise known to have infection, our data help gauge the likelihood of missing deaths due to or with COVID-19 and inform future public health decisions on whether to require universal postmortem testing with COVID-19 resurgences or with new deadly epidemics.
{"title":"A Year of Deaths Due to or With COVID-19 Under Universal Postmortem Testing in San Francisco.","authors":"Rand A Miyashiro, Willi McFarland","doi":"10.1097/paf.0000000000000907","DOIUrl":"https://doi.org/10.1097/paf.0000000000000907","url":null,"abstract":"The Health Officer of the City and County of San Francisco, California, issued the order that all decedents were required to have a documented COVID-19 test effective from June 2020 to June 2021. The justification for the requirement was that complete data on COVID-19 status at the time of death were needed to help protect first responders and funeral home workers, identify missed cases, and characterize the places of death for otherwise unknown COVID-19 cases. To fill the gap in COVID-19 testing for all decedents, particularly among persons dying outside of hospitals, a specialized Decedent Testing Unit was created along with an increased capacity of the Office of the Chief Medical Examiner. From July 1, 2020, to June 30, 2021, the Decedent Testing Unit and Office of the Chief Medical Examiner provided postmortem testing results for 2776 decedents. Of these, 80 tested positive for COVID-19 for a positivity rate of 2.97%. The largest number of COVID-19-positive specimens were collected from persons who died at home (n = 37, 46.3%), followed by those who died in hospice (n = 20, 25.0%), other places outside of homes or facilities (n = 8, 10.0%), and in skilled nursing or long-term care facilities (n = 7, 8.8%). Follow-up of California death records found that 17 of these 80 cases (21.3%) had COVID-19 listed as one of the causes of death, 22 (27.5%) mentioned COVID-19 under \"other conditions,\" and 41 (51.3%) made no mention of COVID-19. In the context of providing the COVID-19 status of decedents not otherwise known to have infection, our data help gauge the likelihood of missing deaths due to or with COVID-19 and inform future public health decisions on whether to require universal postmortem testing with COVID-19 resurgences or with new deadly epidemics.","PeriodicalId":501647,"journal":{"name":"The American Journal of Forensic Medicine and Pathology","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138564211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-08DOI: 10.1097/paf.0000000000000896
Kari M Midthun
Umbilical cord tissue (UCT) traditionally has been used as an antemortem matrix for identifying and monitoring fetal exposure to drugs suspected to have been used during pregnancy. The specimen offers several advantages as a testable tissue, including accessibility and ease of collection, ample sample volume, a long window of detection, and ability to detect for a wide range of drugs. Despite these advantages, little to no research exists on the use of UCT as a postmortem forensic toxicology specimen. This article aims to provide insights into UCT toxicological testing and infer potential applications for postmortem use, such as investigations into stillbirths and infant abandonment. Umbilical cord tissue offers several benefits as a postmortem toxicological specimen. Importantly, it can be collected with or without an autopsy being performed and may help explain factors that contribute to the underdevelopment and death of the neonate. With the limited sample volumes present in infant investigations, toxicological analysis of UCT could become a valuable tool for neonatal medicolegal death investigations.
{"title":"Umbilical Cord Tissue: From Antemortem Monitoring to Postmortem Possibilities.","authors":"Kari M Midthun","doi":"10.1097/paf.0000000000000896","DOIUrl":"https://doi.org/10.1097/paf.0000000000000896","url":null,"abstract":"Umbilical cord tissue (UCT) traditionally has been used as an antemortem matrix for identifying and monitoring fetal exposure to drugs suspected to have been used during pregnancy. The specimen offers several advantages as a testable tissue, including accessibility and ease of collection, ample sample volume, a long window of detection, and ability to detect for a wide range of drugs. Despite these advantages, little to no research exists on the use of UCT as a postmortem forensic toxicology specimen. This article aims to provide insights into UCT toxicological testing and infer potential applications for postmortem use, such as investigations into stillbirths and infant abandonment. Umbilical cord tissue offers several benefits as a postmortem toxicological specimen. Importantly, it can be collected with or without an autopsy being performed and may help explain factors that contribute to the underdevelopment and death of the neonate. With the limited sample volumes present in infant investigations, toxicological analysis of UCT could become a valuable tool for neonatal medicolegal death investigations.","PeriodicalId":501647,"journal":{"name":"The American Journal of Forensic Medicine and Pathology","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138564213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-04DOI: 10.1097/paf.0000000000000902
Francesco Lupariello, Barbara Lauria, Federica Mirri, Sonia Aguzzi, Emanuele Castagno, Claudia Bondone, Giancarlo Di Vella
In the scientific literature, few authors deal with child sexual abuse (CSA) in boys. In addition, these authors debate this phenomenon in most available articles without statistically evaluating the occurrence of different or similar distributions of variables under sex. In light of the above, the authors compared multiple variables between female and male samples. The aim was to explore the characteristics of boys' CSA, identifying the main differences existing compared with the same phenomenon occurring in girls. The authors selected 2 samples for sex: group A, females; group B, males. The authors statistically compared the main variables between the 2 groups. The study yielded the following main results: the population was characterized by 607 children (476 were females-group A; 131 were males-group B); the variables' source of the referral and the type of anogenital findings were statistically significant. These data gave new insights into the CSA phenomenon. Because this study pointed out that sexual abuse does not have the same characteristics in boys and girls, researchers and safeguarding agencies should consider the abovementioned differences when planning preventive strategies against CSA.
{"title":"Child Sexual Abuse: Comparison of Male and Female Victims.","authors":"Francesco Lupariello, Barbara Lauria, Federica Mirri, Sonia Aguzzi, Emanuele Castagno, Claudia Bondone, Giancarlo Di Vella","doi":"10.1097/paf.0000000000000902","DOIUrl":"https://doi.org/10.1097/paf.0000000000000902","url":null,"abstract":"In the scientific literature, few authors deal with child sexual abuse (CSA) in boys. In addition, these authors debate this phenomenon in most available articles without statistically evaluating the occurrence of different or similar distributions of variables under sex. In light of the above, the authors compared multiple variables between female and male samples. The aim was to explore the characteristics of boys' CSA, identifying the main differences existing compared with the same phenomenon occurring in girls. The authors selected 2 samples for sex: group A, females; group B, males. The authors statistically compared the main variables between the 2 groups. The study yielded the following main results: the population was characterized by 607 children (476 were females-group A; 131 were males-group B); the variables' source of the referral and the type of anogenital findings were statistically significant. These data gave new insights into the CSA phenomenon. Because this study pointed out that sexual abuse does not have the same characteristics in boys and girls, researchers and safeguarding agencies should consider the abovementioned differences when planning preventive strategies against CSA.","PeriodicalId":501647,"journal":{"name":"The American Journal of Forensic Medicine and Pathology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138564214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-04DOI: 10.1097/paf.0000000000000897
Lilli Stephenson, Corinna Van Den Heuvel, Melissa Humphries, Roger W Byard
Methadone is one of the most common medications currently prescribed for the treatment of opioid use disorders (OUDs). While methadone maintenance programs (MMPs) have been highly successful in the management and treatment of OUDs resulting in a reduced number of fatalities, the risk of overdose/toxicity remains. The current study was undertaken to analyze trends in overdoses attributed to prescribed and diverted methadone in South Australia (SA) between 2000 and 2019. Over the 20-year period, 344 methadone-related deaths occurred in SA with a significant increase in deaths over the study period (P = 0.03). The mean age of decedents was 42.5 years with a male to female ratio of 1.8:1, with approximately 20% of decedents enrolled in a MMP at the time of death. Overall, only 5.2% of cases demonstrated methadone diversion, which was associated with methadone prescribed for chronic pain and was most likely to be diverted from a friend/housemate or a partner. However, the source of methadone in more than half of cases was unknown, so this is likely a significant underestimate of actual MMP methadone diversion and total methadone diversion.
{"title":"Prescribed and Diverted Methadone Toxicity in South Australia: An Update.","authors":"Lilli Stephenson, Corinna Van Den Heuvel, Melissa Humphries, Roger W Byard","doi":"10.1097/paf.0000000000000897","DOIUrl":"https://doi.org/10.1097/paf.0000000000000897","url":null,"abstract":"Methadone is one of the most common medications currently prescribed for the treatment of opioid use disorders (OUDs). While methadone maintenance programs (MMPs) have been highly successful in the management and treatment of OUDs resulting in a reduced number of fatalities, the risk of overdose/toxicity remains. The current study was undertaken to analyze trends in overdoses attributed to prescribed and diverted methadone in South Australia (SA) between 2000 and 2019. Over the 20-year period, 344 methadone-related deaths occurred in SA with a significant increase in deaths over the study period (P = 0.03). The mean age of decedents was 42.5 years with a male to female ratio of 1.8:1, with approximately 20% of decedents enrolled in a MMP at the time of death. Overall, only 5.2% of cases demonstrated methadone diversion, which was associated with methadone prescribed for chronic pain and was most likely to be diverted from a friend/housemate or a partner. However, the source of methadone in more than half of cases was unknown, so this is likely a significant underestimate of actual MMP methadone diversion and total methadone diversion.","PeriodicalId":501647,"journal":{"name":"The American Journal of Forensic Medicine and Pathology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138564208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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