丈夫施暴致伤妇女101例鉴定分析──兼论家庭暴力的法医学鉴定

本文对101例因丈夫施暴致妻子损伤法医学鉴定的资料进行整理分析。资料显示，暴力类型以拳打脚踢为主（49．50％），持械与否在所致损伤程度上没有差异（P＞0．05）。家庭暴力对受伤害妇女造成多种类型的躯体和心理方面的损害，常见损伤类型为软组织伤（47．52％）、鼓膜穿孔（9．90％）和骨折（23．76％）。头部（30．03％）及四肢（36．50％）是常见损伤部位，反复伤（5．94％）、复合伤（30．69％）以及虐待伤是家庭暴力的特征性损伤。本文阐述了法医学鉴定与家庭暴力的关系，认为法医能够在发现、认证家庭暴力及支持诉讼等方面为受伤害人提供帮助。     

儿童及青少年组损伤特点分析

儿童及青少年遭受意外事件和暴力事伤害的现象日益突出，本文对１５６例２～１７岁涉及诉讼的未成年人法医学鉴定案例进行回顾性研究，结果表明：３月、４月、８月、１２月四个月发案率偏高，每天下午４点前后最易发生伤害案件；损伤部位以头面部最多见，损伤类型以软组织损伤最多；案发地点于儿童组以住家及其周围场所、学校或幼儿园居多，于青少年则以公共场所居多；加害人多为熟人，包括同学、邻居，青少年受陌生人攻击明显增多，儿童遭受意外事件多，受故意伤害的少，青少年组则刚好相反。同时，作者讨论时还指出，我国目前存在虐待儿童和忽视儿童的现象，以后者更为普遍，这种消极不作为的侵害未成年人权益的现象在司法实践中应引起重视。     

虐待儿童致皮肤损伤及骨折的法医学意义

近年来,我国虐待儿童致伤、致死的案件时有发生,未被发现的虐待儿童案件可能更多。而许多儿科医生和法医都缺乏虐待儿童方面的专业知识及正规培训,导致许多虐待儿童案件被漏诊、误诊及错误鉴定的发生。本文复习了国内外相关文献,结合实际工作经验及我国国情,初步总结出关于虐待儿童案件的临床诊断及法医学鉴定要点,以期为虐待儿童案件的早期发现、准确鉴定及受虐儿童得到及时有效的治疗保护提供一些帮助。     

66例听力障碍的法医学鉴定分析

本文统计了６６例外伤性听力障碍的法医学鉴定案例，通过对致伤凶器、方式、部位，听力传导环节受损部位及鉴定结果分析，发现钝器损伤占９６．７％，质量较重砍器占３．３％，因此提出外伤性听力障碍的法医学成因可归属钝器损伤范围。受伤部位以颞耳面部、鼓膜损伤最常见，听骨链、内耳损伤次之，听神经、听中枢最少。颞骨骨折在听力传导各环节受损中起直接因果关系，伴颞骨骨折的听力损伤程度均在轻伤起点之上。伤情中以轻伤最多，重伤中无一例外地伴内耳至听中枢某一环节受损。根据鉴定结果对听力损伤的鉴定提出了几点修改意见，供参考。     

活体鉴定400例放射学特点分析──兼论法医临床学与放射学的关系

为探讨法医临床学鉴定与放射学的关系，本文对４００例活体鉴定就放射学检查的有关问题进行回顾性研究。结果表明：２６６例进行了放射学检查（占６６．５％），其中Ｘ线１７６例（６６．２％），ＣＴ４３例（１６．１％），两者均有的４７例（１７．７％）。放射学检查部位中，Ｘ线以四肢为多，ＣＴ以颅脑为多。误诊率为９．０２％，放射学检查与致伤原因之间有一定关系，轻微伤中不必要的ＣＴ检查多见。并就放射学误诊的法律后果及不必要的放射学检查问题进行了讨论。本文从法医临床学的角度对放射学进行了评价，指出在活体鉴定中可以应用放射学知识协助证明损伤、推断损伤形成机制、个人识别及研究损伤时间。因此法医学鉴定人必须有放射学理论和技术方面的知识。作者还试图提出法医临床放射学。     

老年人损伤特点及法医学鉴定(附63例分析)

老年人受到伤害的法医学鉴定并不少见，有关损伤及其法医学鉴定的特点，国内法医学界尚无报道。本文结合63例老年人伤害案例进行分析，发现老年人受伤害的高发年龄段为60～69岁（85．71％），并具有轻微外力可导致较严重损伤、伤残率高等特点，其案发原因及地点也具有一定的特点。上述特点对法医学鉴定均具有一定的影响，本文就老年人损伤程度鉴定及损害赔偿方面进行了讨论。     

159例家庭暴力损伤的法医学鉴定分析

目的 探讨家庭暴力损伤的特点及其有关的法医学鉴定问题。方法 对１９９８年４月～１９９９年１２月间来诊的１５９例家庭暴力损伤鉴定案件进行回顾研究。结果 家庭暴力的受害者绝大多数为妇女（占９３．１％），主要发生在配偶间（８５．５％），其次为虐儿（５％）。家庭暴力一般发生在家中，以晚上为发生高峰。致伤方式以拳脚为主，其次为随手可得的钝器或锐器。损伤多为软组织损伤；有４０％的受害人投诉前未去医院就诊；损伤     

旅客列车爆炸案之法医学问题分析

近年来，因旅客非法携带爆炸物乘车而导致的旅客列车爆炸案件时有发生，由于铁路运输行业的特殊性，因而涉案的法医学问题也便有着自身的特点。本文拟对四起旅客列车爆炸案件所引发的法医学问题作相应的分析，以供探讨。一、案例简介（一）基本情况（二）伤亡结果（三）个体存在的损伤类型（四）损伤分布部位（五）死亡原因二、旅客列车爆炸案件的法医学损伤特点根据前述统计分析，旅客列车爆炸案件的法医学损伤有着明显的特点。现从以下三个方面予以讨论：１．关于损伤部位。表（四）的统计分析表明，在总计１５６名伤亡人员中，９６．１％…     

167例眼损伤的法医学鉴定分析

统计了 167例外眼损伤的法医学鉴定资料。在该组案例中 ,男性 140例 ,女性 27例 ,年龄分布在 2～ 72岁 ,其中 15～ 40岁年龄段最多 ;致伤物以拳脚多见 ,占 39.5％ ;左眼受伤的占 51.5％ ;重伤 71例 ,轻伤 44例 ,轻微伤 49例 ;伤残鉴定以 7级到 8级多见。对致伤物与眼别、致伤物与眼损伤部位、啤酒瓶炸伤等眼损伤鉴定的增多、损伤程度与鉴定时限的把握等问题进行了分析 ,旨在探讨眼损伤在法医学鉴定中的规律及特点。     

50例指骨骨折的法医学鉴定

目的研究指骨骨折的法医学鉴定特点,探讨如何综合运用临床病历、影像学及法医检查资料对指骨骨折进行法医学鉴定。方法收集2009—2011年进行法医学鉴定的50例指骨骨折,对伤者一般情况、骨折部位分布、骨折形态、致伤物及鉴定结果等进行回顾性分析。结果指骨骨折以男性中青年居多,骨折部位以食指和远节指骨为多见,左、右手指骨骨折数无差异。致伤物以刀械类、棍棒类为多见,其次为砖石类。结论致伤物及致伤方式与骨折形态、部位分布及损伤程度均有一定关系,综合分析对指骨骨折的法医学鉴定有一定的帮助。     

Social Support Choices for Help with Abusive Relationships: Perceptions of African American Women

A recent national telephone study of the African American community found that over 90% of respondents would feel comfortable talking to a family member or friend who was being abused about the abuse, with the majority advising she get help from a domestic violence program. The purpose of this study was to understand how comfortable abused women would feel talking to members of her support system about the abuse and how comfortable women who have not experienced partner abuse would feel if they were abused. Over 70% of women who have experienced abuse reported at least some comfort getting assistance for abuse from a friend, clergy/spiritual leader, Black community member, family member their age, or physician. Women who reported never experiencing physical or sexual partner violence were less likely to perceive feeling comfortable getting assistance from their social support systems (both formal and informal) if they were abused. Implications of these findings are discussed.     

The Effect of Childhood Sexual Abuse on Psychosexual Functioning During Adulthood

The study examined whether and how characteristics of childhood sexual abuse and disclosure influenced three dimensions of psychosexual functioning—emotional, behavioral and evaluative—during adulthood. The sample included 165 adults who were sexually abused as children. The General Estimating Equation was used to test the relationship among the predictors, moderators and five binary outcomes: fear of sex and guilt during sex (emotional dimension), problems with touch and problems with sexual arousal (behavioral), and sexual satisfaction (evaluative). Respondents who were older when they were first abused, injured, had more than one abuser, said the abuse was incest, and told someone about the abuse were more likely to experience problems in at least one area of psychosexual functioning. Older children who told were more likely than younger children who told to fear sex and have problems with touch during adulthood. Researchers and practitioners should consider examining multiple dimensions of psychosexual functioning and potential moderators, such as response to disclosure.     

Battered mothers who physically abuse their children

The purpose of this study is to understand why some battered mothers physically abuse their children. Mothers who were battered and physically abused their children (the co-occurrence group) were compared with mothers who were neither battered nor physically abused, who were only battered, and who only abused (N = 184). The mothers in the co-occurrence group were more likely than the mothers who did not physically abuse their children to have been severely assaulted by their own mothers as children, have had poorer quality relationships with and receive less support from their mothers, have more stressors, and have known their partners for less time. These differences were not found between the mothers in the co-occurrence and abuse-only groups. In the multivariate analysis, having been assaulted by one's own mother as a child--not being battered by one's partner--was the most potent predictor for whether a mother physically abused her child.     

Do parents blame or doubt their child more when sexually abused by adolescents versus adults?

Although the importance of parental support for child sexual abuse victims is well documented, the nature of parental support for victims sexually abused by adolescents is less understood. In this exploratory study, we examine whether parents differ in their levels of blame or doubt for their child when sexually abused by adolescents versus adults. Data included 161 reports of child sexual abuse. Parental blame toward their child was higher when sexually abused by an adolescent versus an adult suspect. In the bivariate and multivariate analysis, parental blame was significantly higher as victim age increased, for Black, non-Hispanic children, and when there was an adolescent suspect. Practitioners need to recognize that high levels of blame and doubt could exist for adolescent victims of sexual abuse and when children are sexually abused by adolescents.     

African American Women’s Readiness to Change Abusive Relationships

This study explores 178 low-income, abused African American women’s readiness to change abusive relationships and achieve safety. We explore stages of change using Prochaska and DiClemente’s transtheoretical model (TM; Precontemplation, Contemplation, Action, Preparation, and Maintenance). Results reveal that: for abused women, the stages fall along a continuum (versus discreet and linear stages); abused women are primarily in the Contemplation stage; and multiple factors (perception of current abuse, number of children in her home, symptoms of general anxiety and posttraumatic stress disorder [PTSD], substance use, spiritual well-being, self-esteem, and social support) affect women’s total readiness to change intimate partner violence (IPV). Current IPV, anxiety, PTSD, substance abuse, and spirituality were positively correlated with readiness to change, and children in the home and self-esteem were negatively correlated with readiness to change. Multiple regression analysis revealed that PTSD and spiritual well-being are positive predictors of readiness to change. Findings contribute to the growing body of literature supporting the TM as applied to IPV. Results are discussed in terms of applicability to interventionists, policy makers, and community leaders as they consider the plight of abused women and their efforts towards violence-free relationships.     

Psychiatric aspects of sexual abuse

Sexual abuse of children and adolescents has become an increasingly publicized phenomenon. Psychiatrists and other mental health professionals are often called upon to evaluate and treat children and adolescents who may have been sexually abused, to provide counseling or treatment to the families of such children, and to provide reports and testimony for proceedings about such cases in the child protection system, the criminal justice system, and in custody disputes. Clarity regarding the medical, psychiatric, and legal aspects of sexual abuse is essential in carrying out such professional activities and in evaluating and formulating research on sexual abuse. In this paper current knowledge regarding these aspects of sexual abuse is summarized, and the role of psychiatrists in clinical and forensic work involving allegations of sexual abuse is discussed.     

Effects of Past Abuse Experiences on Children's Eyewitness Memory

Relations between child maltreatment and children's eyewitness memory were examined. A matched sample of abused and nonabused 3- to 10-year-old children (n = 70) participated in a play session with an unfamiliar adult and were interviewed about the interaction 2 weeks later. Consistent with results from previous research, older compared to younger children's reports were more complete and accurate. Abused and nonabused children performed similarly with several exceptions: Nonabused children were more accurate in answering specific questions, made fewer errors in identifying the unfamiliar adult in a photo identification task, and (at least for younger boys) freely recalled more information. Most effects remained when group differences in IQ and behavioral symptomology were statistically controlled. Importantly, abused and nonabused children did not differ in their accuracy or suggestibility in response to questions that were relevant to abusive actions. Among abused children, however, those who suffered more severe sexual abuse made more omission errors to specific abuse-relevant questions. Contributions to psychological theory and legal implications for understanding children's eyewitness memory and testimony are discussed.     

Fatal child abuse-maltreatment syndrome. A retrospective study in Ontario,Canada, 1990-1995

Child death due to repeated episodes of physical assault or neglect has been termed the child abuse-maltreatment syndrome (CAMS). We characterized the injuries in a series of fatally abused or maltreated child to delineate objective diagnostic criteria for the CAMS for use by clinicians and pathologists. All deaths (age <17 years) investigated by the Office of the Chief Coroner for Ontario, Canada during the time period 1990-1995 were reviewed. Cases of CAMS were defined as death due to lethal recent injury or malnutrition in the presence of significant old (healing or healed) injuries indicative of repeated episode of inflicted trauma. The nature and frequency of the various injuries was determined. The frequency of the shaken baby syndrome, and the types and frequency of ano-genital injuries were also studied. Twenty-one cases of fatal CAMS were found in the study period. Most cases had significant recent head injury with intra-cranial hemorrhage (71%). Other significant recent injuries commonly observed included blunt injuries of the skin and soft tissues (67%), blunt abdominal trauma with visceral injuries (14%), and fractures (18%). Eight cases (38%) fulfilled accepted criteria for the shaken baby syndrome. Many children with fatal head injuries had evidence of older head trauma (38% of all cases). A significant minority of cases had evidence of malnutrition due to neglect (10%) or ongoing ano-genital injuries (10%). Most cases of child homicides due to repeated episodes of abuse or maltreatment involve head trauma including shaken baby syndrome. Fractures of long bone and ribs, the classical markers of child abuse, were relatively infrequent compared with head injury. A proportion of cases had ano-genital injuries due to repeated sexual abuse or punitive maltreatment. All clinicians and pathologists must recognize the wide spectrum of injuries in child abuse to ultimate protect the victim or other children in an at-risk situation.     

Anal findings in sexual abuse of children (a descriptive study)

The aim of this study was to assess anal physical findings in children whose abuse was admitted by the perpetrator. Fifty children were studied in whom medical assessment took place remote in time from anal abuse which was admitted by the perpetrator. Medical assessment included examination to detect the presence of anal physical signs. Most frequent signs were anal scars and tags (either single or multiple) present, respectively, in 84 and 32% of cases. In some cases scars extended to the perianal region. Other signs included reflex anal dilatation (RAD) and venous congestion (VC) found, separately or associated with other signs, in over 33% of the cases. In 6% of the cases there were no abnormal anal findings. The results confirm earlier reports that physical signs, including scars, tags, RAD, funneled anus and extensive venous congestion, are often present in abused children, singly or in combination, and that anal examination should be undertaken even months after a known or suspected sexual assault. In the legal setting these physical signs are seen in association with anal abuse and support the child's statement. They do not per se provide proof of abuse.