Fatal Falls from Height in Taiwan

This study conducts an investigation of fatal falls from height, examines gender differences, and compares our findings with those of Western countries. We review deaths in Taiwan caused by falls from height that underwent forensic autopsy from 1994 to 2010. Among the examined cases, 182 were suicide, 156 were accidents, and 18 were homicides. Men who fell from greater heights had a lower probability of fatal head trauma (p = 0.045), and women exhibited a lower fatal head trauma rate when falling from heights of between 10 and 25 m in accident group (p = 0.003). There was no significant difference between cases of falling from greater and lower heights within the suicide group (p = 0.834). Psychiatric illness was only reported in 20.3% and 28.8% cases in suicide and accident groups. Only in male cases was the use of psychotropic substances higher in the suicide groups than in the accident groups (p = 0.047).     

The Relationship between Meteorological Conditions and Homicide,Suicide, Rage,and Psychiatric Hospitalization

This study focuses on the relationship between the incidence of homicide, rage, suicide, and psychiatric hospitalization as violent behaviors with temperature, humidity, and air pressure as specific meteorological variables in the city of Mashhad, in the northeast of Iran. The data were obtained from Iran Meteorological Organization, official registry of Legal Medicine Organization and the local psychiatric hospital, March 2009 to Feb 2010 daily and were analyzed with SPSS‐14 using Pearson correlation coefficient, ANOVA, and post hoc analysis tests. The rates of rage and psychiatric admission had a significant relationship with the daily mean air temperature, minimum relative humidity, maximum relative humidity, minimum daily pressure, and maximum daily air pressure (p < 0.0001). There was no significant correlation between homicide and suicide rates with any meteorological variables (p > 0.05). We concluded that, the possibility of nonfatal violence and psychiatric hospitalization would increase in hot and arid weather with low air pressure.     

Increasing Methamphetamine Detection in Cases of Early Childhood Fatalities

Age and organ maturity can influence drug toxicity in children; however, most clinical data and literature are based on drug concentrations in adults. Therefore, the interpretation of drugs detected in children is often difficult or not possible. Retrospective reviewing of pathology and toxicology information from postmortem cases may assist in future interpretations or identify drug trends. A search of the Forensic Science SA case files was undertaken over 15 years from January 2002 to December 2016 for all children (<13 years). Of the 412 pediatric coronial cases, toxicological information was available on 373. At least one drug was detected in 94 cases with paracetamol, ibuprofen, codeine and hospital-administrated lignocaine and morphine among the most commonly detected agents. Methamphetamine, one of the most commonly abused illicit drugs in Australia, was found in seven cases. In the methamphetamine cases, deaths were associated with shared sleeping in three, pneumonia in one, and stillbirth in one. Methamphetamine was considered potentially contributory to death in two cases. The causes of death in the remaining two cases were undetermined. As six of the seven positive cases occurred in the 2012–2016 (n = 106) timeframe, an increase has occurred over recent years in the number of infants and young children presenting to forensic autopsy in South Australia who have detectable concentrations of methamphetamine. If this is an indication of a more generalized increased childhood exposure in the community there may be significant long-term physical and psychological effects.     

Self-immolation Suicide in Greece: A Forensic Psychiatric Autopsy Study between 2011 and 2019

Self-immolation is a rare suicide method in the developed countries of the western world (0.06–1%); however, it has relatively higher prevalence rates in the developing countries of Asia and Africa (6–57%). The present study aims to examine self-immolation suicides within the Greek mainland (Attiki, Thrace, and Peloponnese) over a period of 9 years (2011–2019) in order to investigate the phenomenon in the Greek population forensically, identify the characteristics and motivations of suicide victims, explore its associations to socio-cultural or psychiatric factors, and describe a fatal case of suicide by self-immolation that was partially recorded on camera. The medical files (autopsy reports) of cases performed at the Departments of Forensic Medicine of the National and Kapodistrian University of Athens, Democritus University of Thrace, and the Forensic Service of Messinia—Peloponnese were retrospectively examined yielding 19 cases of suicides by self-immolation. A 3.7% prevalence of suicide by self-immolation among suicide fatalities within the Greek population was estimated. A distinctive feature of the Greek population regarding self-immolation was disclosed that it is being practiced predominantly by the elderly (mean age 2–3.5 decades higher than other countries). The phenomenon correlated strongly with poorly controlled mental disorders (mostly affective and adjustment disorders). Unlike other countries, there was no significant association with domestic or sexual violence, social or political protest, or religious issues. Therefore, the suicide victims preferred secluded or private outdoor locations (not public). Findings deriving from the examined variables localize Greek population culturally between the Western European and Asian African countries, but with its own idiosyncrasies.     

Temporal Trends in Rainwater Tank Suicides in Rijeka,Croatia—A 30‐year Study

Although drowning in rainwater tanks is a generally rare phenomenon, this method for suicide has been observed in parts of Croatia. Review of autopsy records at the University of Rijeka, Croatia, was undertaken from 1987 to 2016 to examine this phenomenon. Of 469 drowning deaths, there were 35 suicides in rainwater tanks (7.5%). Overall drowning deaths showed no temporal trends. In contrast, suicidal drownings in rain water tanks showed a marked decline over the years, with 15 cases in 1987–1991, seven in 1992–1996, six in 1997–2001, six in 2002–2006, one in 2007–2011, and none in 2012–2016. Thus, suicidal drowning cases as a percentage of overall drownings dropped from 18% to zero (p<0.001). This study reports a very unusual method of suicide that may have occurred because of the ready availability of large water reservoirs in homes. The recent fall in numbers may relate to less reliance on domestic reservoirs of water.     

Child Suicide in the North of Portugal

Suicide in children is a rare finding and is probably motivated by acts of impulsiveness. This study aims to contribute to the characterization of child suicide in a forensic perspective in the Portuguese population. Data of forensic autopsies from 2004 to 2012 related to suicide victims under 18 years were reviewed. A total of 17 cases, with a male predominance (64.7%) and a mean age of 15.24 ± 1.348 for both genders, were registered. The leading suicide method was hanging (35.3%), and a suicide note was found in 41.2%. Psychological autopsy proved to be useful in promoting a better understanding of these incidents and their antecedents. This study also offers useful information, namely the implied risk factors, for future programs of suicide research and prevention.     

Suicide and Psychiatrist's Liability in Italian Law Cases

The aim of the study is to analyze the factors that are most frequently associated with a verdict of guilty delivered to the psychiatrist in cases of a patient's suicide in Italian law. Twenty‐six sentences (1975–2009) were analyzed according to the claim of malpractice, patient characteristics, circumstances of the suicide, and reasons for the court's judgment. The court held the psychiatrist guilty in 12 cases, considering that the act of suicide was predictable and could have been avoided. Predictability was mainly related to errors in surveillance (7 cases), therapy (1 case), or both (2 cases). An error in diagnosis was considered to be related to the patient's death in two cases. Analysis of medical behavior considered to be erroneous and associated with a verdict of guilty provides an opportunity to discuss the topics relevant not only to practicing psychiatrists but also to experts assessing medical liability in cases of patient suicide.     

Schizophrenia and suicide: a 10-year review of Kentucky medical examiner cases

The risk of suicide is significantly increased in schizophrenics; it is estimated that 10-13% of individuals suffering from schizophrenia commit suicide. Schizophrenia is marked by psychotic exacerbations and remissions, with persistent deterioration in baseline functioning with each relapse. We present a 10-year (1993-2002) retrospective review of Medical Examiners' cases of suicide of schizophrenic victims. Twenty-nine cases were between the ages of 20 and 75 (mean age of 41.6 years). The majority of victims were male (62.1%) and Caucasian (86.2%). The leading method of suicide for both males and females was firearm injury (48.3%) mostly of the head, followed by overdose (20.7%), and hanging (13.8%). A comprehensive investigation of the biopsychosocial factors is warranted in cases of schizophrenics who commit suicide. This study offers an insightful analysis pertaining to the determination of intent in formulating the manner of death in this unique population.     

Effect of Sex Offenders Treatment Program on Cognitive and Emotional Characteristics of Mentally Ill Sex Offenders

This study assessed the effect of a 10‐week cognitive behavior treatment program in 30 mentally ill sex offenders. The effect of the program was evaluated using the Interpersonal Responsiveness Index (IRI), UCLA Loneliness Scale (UCLALS), Coping Using Sex Inventory (CUSI), and Rape Myth Acceptance Scale (RMAS). Data were analyzed using the paired t‐test. The ability of sex offenders to cope with sexual acts when they faced stressful situations and to accept the rape myth was significantly improved on CUSI (t = 2.09, p = 0.04) and RMAS (t = 5.45, p < 0.001). Feelings of isolation and the ability to empathize based on IRI (t = 0.62, p = 0.54) and UCLALS (t = 0.88, p = 0.38) were not significantly improved. To prevent recidivism, treatment for mentally ill sex offenders should focus on changes in their cognitive and emotional characteristics in addition to their main psychiatric illness.     

Suicide Pacts: Six Cases and Literature Review

A suicide pact is the decision of two or more people to die together. This event is rare. The majority of suicide pacts victims are married, socially isolated, with a serious physical illness in one or both partners. We performed a retrospective study of all cases of suicide pacts leading to death between January 1, 2003 and December 31, 2010 referred to the Forensic Medicine Department of Tours (France). Six cases were recorded as suicide pacts. Firearms were the preferred means of death. Five suicide notes were discovered. For some cases, it was difficult to establish whether death was the result of a suicide pact or of a homicide–suicide without the consent of the victim. An objective element, such as a suicide note and motive, is required to prove that a suicide pact is involved. The prevalence of mental disorders is hard to assess. In France, psychological autopsies are not performed in such cases, as the investigation is usually very sparse after the death of both individuals.     

Incidence of Low Body Mass Index in the Elderly in Forensic Cases—A Possible Marker for Frailty Syndrome?

Diagnosing frailty syndrome at autopsy may be difficult if no adequate clinical history is provided. As low body mass index (BMI) may be associated with frailty in the elderly, the following study was undertaken to determine the percentage of medicolegal cases with BMIs < 18.5 in decedents aged over 75 years. Review was undertaken over three time periods: January to December 1986, January to December 2006, and January to December 2012. In 1986, 16% (15 of 93) of individuals aged ≥75 years had BMIs < 18.5, in 2006, 15% (50 of 336), and in 2012, 13% (35 of 274). In no case was frailty syndrome mentioned. This study demonstrates that frailty syndrome appears to be an underappreciated diagnosis in forensic practice despite a significant percentage of elderly decedents (13–16% over a 27‐year period) having low BMIs. Prospective assessment of this group is required to determine the incidence and contribution to mortality of frailty syndrome in a forensic context.     

Sudden or Unnatural Deaths Involving Anabolic‐androgenic Steroids

Anabolic‐androgenic steroids (AASs) are frequently misused. To determine causes of death, characteristics, toxicology, and pathology of AAS positive cases, all cases (n = 24) presenting to the New South Wales Department of Forensic Medicine (1995–2012) were retrieved. All were male, and the mean age was 31.7 years. Deaths were mainly due to accidental drug toxicity (62.5%), then suicide (16.7%) and homicide (12.5%). Abnormal testosterone/epitestosterone ratios were reported in 62.5%, followed by metabolites of nandrolone (58.3%), stanozolol (33.3%), and methandienone (20.8%). In 23 of 24 cases, substances other than steroids were detected, most commonly psychostimulants (66.7%). In nearly half, testicular atrophy was noted, as was testicular fibrosis and arrested spermatogenesis. Left ventricular hypertrophy was noted in 30.4%, and moderate to severe narrowing of the coronary arteries in 26.1%. To summarize, the typical case was a male polydrug user aged in their thirties, with death due to drug toxicity. Extensive cardiovascular disease was particularly notable.     

Criminological and Medico-legal Aspects in Homicidal and Suicidal Sharp Force Fatalities

The interpretation of sharp force fatality dynamics may be difficult in some cases, but a contribution to analysis of the phenomenon may be provided by case studies. Therefore, the purpose of our study is focused on identifying, in observed sharp force fatalities, reliable parameters that can differentiate a homicidal and suicidal manner of death, with particular reference to criminological parameters. Data derived from sharp force fatality cases in Padua and Venice from 1997 to 2019, anonymized and collected in Excel, included personal, circumstantial, clinical, and psychopathological–criminological data, as well as crime scene investigation, necroscopic, and toxicological data. Statistical analyses were performed using chi-square and Wilcoxon rank-sum tests. Possible predictors of homicide were analyzed by logistic regression. Six parameters (bloodstains distant from the body, clothing lacerations, hesitation/defense wounds, number of injuries, and potential motives) were significantly different in the two groups (p < 0.05). An independent statistical association between potential motives explaining the crime (p < 0.001; OR 27.533) and homicide on multiple logistic regression analysis was highlighted. The absence of clothing lacerations was inversely related to homicide (p = 0.002, OR 0.092). To the best of our knowledge, this is one of very few Italian studies concerning the differential diagnosis between homicidal and suicidal sharp force fatalities. The dynamics of the event is established in most cases by the integrated evaluation of data from crime scene investigation and the autopsy. Nevertheless, in an atypical scenario, a psychopathological–criminological analysis may provide essential elements, and particular attention should be given to the identification of potential explanatory motives.     

DNA in the Criminal Justice System: The DNA Success Story in Perspective,

Current figures on the efficiency of DNA as an investigative tool in criminal investigations only tell part of the story. To get the DNA success story in the right perspective, we examined all forensic reports from serious (N = 116) and high‐volume crime cases (N = 2791) over the year 2011 from one police region in the Netherlands. These data show that 38% of analyzed serious crime traces (N = 384) and 17% of analyzed high‐volume crime traces (N = 386) did not result in a DNA profile. Turnaround times (from crime scene to DNA report) were 66 days for traces from serious crimes and 44 days for traces from high‐volume crimes. Suspects were truly identified through a match with the Offender DNA database of the Netherlands in 3% of the serious crime cases and in 1% of the high‐volume crime cases. These data are important for both the forensic laboratory and the professionals in the criminal justice system to further optimize forensic DNA testing as an investigative tool.     

Volatile Organic Compound Profiling from Postmortem Microbes using Gas Chromatography–Mass Spectrometry

Volatile organic compounds (VOCs) are by-products of cadaveric decomposition and are responsible for the odor associated with decomposing remains. The direct link between VOC production and individual postmortem microbes has not been well characterized experimentally. The purpose of this study was to profile VOCs released from three postmortem bacterial isolates (Bacillus subtilis, Ignatzschineria indica, I. ureiclastica) using solid-phase microextraction arrow (SPME Arrow) and gas chromatography–mass spectrometry (GC-MS). Species were inoculated in headspace vials on Standard Nutrient Agar and monitored over 5 days at 24°C. Each species exhibited a different VOC profile that included common decomposition VOCs. VOCs exhibited upward or downward temporal trends over time. Ignatzschineria indica produced a large amount of dimethyldisulfide. Other compounds of interest included alcohols, aldehydes, aromatics, and ketones. This provides foundational data to link decomposition odor with specific postmortem microbes to improve understanding of underlying mechanisms for decomposition VOC production.     

Determination of Nitrite in Whole Blood by High‐Performance Liquid Chromatography with Electrochemical Detection and a Case of Nitrite Poisoning

Although nitrite is widely used in meat processing, it is a major toxicity hazard to children and is responsible for the blue‐baby syndrome. A simple and effective method to determine nitrite in whole blood has been devised using ion chromatography with suppressed conductivity detection. The blood sample was deproteinized by adding acetonitrile and purified with mini‐cartridges to remove hydrophobic compounds, chloride ions, and metal ions. An aliquot of the filtrate was injected onto the ion chromatography. The retention time for nitrite was 13.8 min and the detection limit of nitrite in whole blood was 0.4 μmol/L. The calibration curve was linear (r² = 0.9999) over the concentration working range. The blood nitrite concentration of a victim who attempted suicide by ingesting sodium nitrite powder was determined using the present method. The basal levels for nitrite in human blood was determined with 7.1 ± 0.9 μmol/L (n = 12).     

How Should Forensic Anthropologists Correct National Weather Service Temperature Data for Use in Estimating the Postmortem Interval?

This study examines the correlation between site‐specific and retrospectively collected temperature data from the National Weather Service (NWS) over an extended time period. Using iButtonLink thermochrons (model DS1921G), hourly temperature readings were collected at 15 sites (1 validation; 14 experimental) from December 2010 to January 2012. Comparison between the site‐specific temperature data and data retrieved from an official reporter of NWS temperature data shows statistically significant differences between the two in 71.4% (10/14) of cases. The difference ranged between 0.04 and 2.81°C. Examination of both regression and simple adjustment of the mean difference over extended periods (1, 2, 3, 4, 5, 6, & 9 months) suggests that on the timescale typical in forensic anthropology cases neither method of correction is consistent or reliable and that forensic anthropologists would be better suited using uncorrected NWS temperature data when the postmortem interval is extended.     

A Forensic and Medical Evaluation of Dog Bites in a Province of Western Turkey

The aim was to evaluate the demographic data of dog‐bite cases organized from criminal and forensic reports. This study evaluated 328 cases admitted to the Director of Forensic Medicine, Eskisehir, as a result of dog bites between January 1, 2006 and December 31, 2010. It was found that those in the age‐group of 0–18 were most frequently exposed to dog bites (48.5%). Injuries to the lower extremity, upper extremity, and chest/abdomen/back were more frequent in men (72.6%, 76.4%, and 66.1%, respectively), while injuries to the head/neck/face were more frequent in women (52.3%) (p < 0.01). While most of those wounded in the upper extremity, the head/neck/face, and the chest/abdomen/back were in the child age‐group, most of those wounded in the lower extremity were in the adult age‐group (p < 0.001). Teaching children, in particular, how to behave around dogs would be useful in reducing the incidence of bite.     

Evaluation of Postmortem Cerebrospinal Fluid S100B Protein and Serotonin Levels: Comparison of Suicidal Versus Nonsuicidal Deaths in Konya,Turkey

Although suicide is a preventable public health problem, objective assays for suicide risk are limited. In this study, it was aimed to determine levels of S100B protein and serotonin as a marker for risk of suicide. S100B protein and serotonin levels were investigated with ELISA method in the cerebrospinal fluid (CSF) in medicolegal autopsy cases, including those of suicide cases (n = 32) and nonsuicide cases (n = 56). The CSF S100B levels were higher (9.3 ± 2.9 ng/mL vs. 5.4 ± 2.0 ng/mL), and serotonin levels were lower (10.4 ± 4.9 ng/mL vs. 19.0 ± 5.7 ng/mL) in suicide group than nonsuicide group (p < 0.05). There was no correlation between S100B protein and serotonin levels with gender, age groups, postmortem interval, and cause of death. It is concluded that both S100B protein and serotonin in CSF may be useful for determination of suicide risk.