Evaluation of the severity of harm to health by gastrointestinal injury caused by blunt trauma

A total of 226 forensic medical conclusions in traumas of the gastrointestinal tract with blunt objects, 111 of these with lethal outcomes, are analyzed. The types of injuries, clinical course, medical care, complications, flaws in medical care and their consequences, and pathomorphology of the injury were analyzed. Criteria of harm inflicted to health are determined and a table of qualifying signs is suggested for cases with blunt injuries of the gastrointestinal system, with consideration for the type of injury.     

Forensic medical evaluation of harm severity inflicted to one's health by slight craniocerebral injuries in the remote period

A pressing problem is discussed: forensic medical evaluation of harm inflicted to health by slight craniocerebral injuries. Analysis of 2150 expert forensic medical and medico-social conclusions revealed serious organization and methodological errors in evaluation of harm inflicted to health by slight craniocerebral injuries. Approaches to improving the quality of such forensic medical expert evaluations are outlined.     

Peculiar approaches to the estimation of the severity of harm to health in children with non-fatal injuries

The medico-legal estimation of non-fatal injuries in the children and adolescents is presented. The data obtained have been used to develop and substantiate the algorithm of forensic medical expertise of such injuries. Scientifically sound criteria have been proposed to be used for the purpose of expert estimation of the severity of harm to health associated with non-fatal injuries taking into consideration their clinical manifestations. The procedures of forensic medical expertise for the estimation of the harm to health have been analysed with special reference to non-fatal injuries in children and adolescents. Main attention was given to the accompanying strategic, organizational, and methodological errors. The approaches to their prevention and correction are described.     

Forensic medical evaluation of the severity of harm to the health in the cases of a fracture of the zygomaticoorbital complex complicated by ophthalmological disorders

Expert reports of the cases of a fracture of the zygomaticoorbital complex are presented along with their comprehensive assessment based on the available investigative, clinical, and anamnestic data. The analysis included 71 patients, materials of forensic medical examination and other medical documentation, civil, criminal, and administrative proceedings. It was shown that forensic medical evaluation of the severity of harm to the health in the cases of a fracture of the zygomaticoorbital complex including those complicated by ophthalmological disorders is possible both in terms of the total duration of health impairment and in terms of the persistent loss of ability to work (on a percentage base). It is concluded that the degree of harm to the health in the cases of a fracture of the zygomaticoorbital complex complicated by ophthalmological disorders can be categorized as mild, moderate, and severe depending on the total duration of health impairment and percentage loss of ability to work. In case of irreparable facial disfigurement, the moderate harm to the health can be re-evaluated by the court as a severe one.     

Assessment of harm to the health in proximal hip fractures

The analysis of expert certification on isolated hip fractures has shown that some experts make errors of underestimation of harm to the health basing on the criterion "duration of health impairment". How to prevent such errors and to improve quality of forensic medical certification is proposed. Such measures will raise social value of medical forensic expertise.     

A case of aortic dissection caused by blunt chest trauma

A 74-year-old woman was struck by a car travelling at about 50 km/h. On arrival at hospital, a CT scan showed dissection of the ascending and descending aorta. She collapsed and died suddenly 8h later. At autopsy, there was massive bleeding into the left pleural cavity, ruptures of the pericardium and right ventricle, and a type A thoracic aortic dissection. The cause of death was haemorrhagic shock due to rupture of the pericardium and delayed rupture of the right ventricle following trauma to the chest. The thoracic aortic dissection was not the direct cause of death although histological examination did reveal that it occurred in the accident. Traumatic aortic dissection is rare although traumatic aortic rupture is a major cause of death after blunt chest trauma. This paper discusses the mechanisms, and factors involved in aortic dissection caused by blunt trauma.     

Natural helpers: a community approach to harm reduction

This paper, by Jennifer Taylor and Theresa Jasperson, looks at a successful harm-reduction initiative developed by Streetworks, a needle exchange program in Edmonton, Alberta. The Natural Helpers initiative provides and enhances the skills, knowledge, resources, and support that people who use injection drugs need in order to take care of others in their community. The evolution of the project, from its inception to the present situation, is described.     

Penal harm medicine: state tort remedies for delaying and denying health care to prisoners

In prison and jail subcultures, custodial personnel are committed to the penal harm movement, which seeks to inflict pain on prisoners. Conversely, correctional medical personnel are sworn to the Hippocratic Oath and are committed to alleviating prisoners' suffering. The Hippocratic Oath is violated when correctional medical workers adopt penal harm mandates and inflict pain on prisoners. By analyzing lawsuits filed by prisoners under state tort law, this article shows how the penal harm movement co-opts some correctional medical employees into abandoning their treatment and healing mission, thus causing denial or delay of medical treatment to prisoners. This revised version was published online in July 2006 with corrections to the Cover Date.     

Analysis of mortality caused by ischemic heart disease in Astrakhan from 1983 to 1997

Mortality caused by coronary disease is analyzed for Astrakhan for the period of 1983-1997 (total, non-hospital and hospital mortality). The distribution of mortality by the years and months of the year, sex, age, and cause of death structure is analyzed as exemplified by 6505 deaths.     

Expert criteria of the degree of severity of the chemical trauma in acute poisonings by organophosphate insecticides

The article deals with quantitative assessment of severity of chemical trauma (according to life-threatening characteristics) in case of acute peroral poisoning with OPI (carbophos and chlorophos). Standard diagrams were plotted which help to assess the life threatening values of the given compounds depending on the initial blood poison level or recorded decrease in enzyme cholinesterase activity. Basic opportunity to assess severity of body lesions in case of poisoning with OPI according to character of specific clinical signs was evidenced.     

The application of the medical criteria for the harm to health: expert and law-enforcement practice

This paper is devoted to the practical application of the medical criteria (MC) for the harm to health (HH) put into force on September 16, 2008. The authors undertook the analysis of procedures of forensic medical expertises for the estimation of the harm to health during the periods before and after putting MC into action (between 2007 and 2010). The results of this analysis were compared with the number of documented criminal actions that caused harm to health and the number of subjects convicted of such crimes. It is shown that the frequency of crimes leading to the serious harm to health has increased (by 22%) in parallel to the roughly similar decrease in the frequency of crimes responsible for the moderate harm. These trends are unrelated to the changes in the number of subjects convicted of such crimes. The frequency of intentional infliction of the serious harm to health decreased by 12% and the number of subjects convicted of the crimes that caused serious (Criminal Code of the Russian Federation, parts 1-3, article 111) and moderate (Criminal Code, article 112) harm to health decreased in 2010 by 5% compared with 2007. The rise in the frequency of the crimes responsible for the serious harm to health (Medical Criteria, pp. 6.11.1-6.11.11) revealed during forensic medical expertises is unrelated to the number of documented crimes and subjects convicted of them under parts 1,2, article 264 of the Criminal Code. The number of documented crimes and subjects convicted of them after the new medical criteria had been put into force (2009 and 2010) decreased by 23% and 15% respectively. It is concluded that putting into effect the new regulations and medical criteria did not result in a substantial change in the relative frequency of the serious and moderate harm to health. Nor did the law enforcement practice gives evidence of any change in the relationship between cases of moderate and serious harm to health and in the number of grave crimes causing the harm to health. The new medical criteria allowed to put in order and present in a structured fashion the data on the harm to health depending on the degree of its severity.     

Sudden death caused by coronary artery aneurysms: a late complication of Kawasaki disease

The authors describe three cases (two blacks and one Latin American) of sudden death caused by late complications of Kawasaki disease (mucocutaneous lymph node syndrome). At autopsy each heart contained multiple coronary artery aneurysms with luminal stenosis caused by intimal hyperplasia and thrombi. Although virtually all fatal cases of Kawasaki disease occur within six months of the onset of symptoms, there have been other reported deaths up to 14 years after the acute illness. The coronary artery aneurysms of Kawasaki disease may persist and cause death years after the acute illness.     

Justification, perception of severity and harm, and criminalization of wife abuse in the Palestinian society

The purpose of this study was to examine the perceptions of Palestinian adults toward different dimensions of wife abuse. A cross-sectional survey, using a combination of self-administered questionnaires and interviews, was conducted among a systematic random sample of 624 adult Palestinian men and women from the West Bank and Gaza Strip (18 years or older). Study results indicated a strong tendency to justify wife beating in different situations, such as when the wife is perceived as having an affair with another man or as physically attacking her husband. Participants considered the following acts of husband's violence against wife as most severe: using a weapon (86%), having sex with the wife against her will (67%), and hitting her with his fist (57%). The majority of participants thought that wife beating should be considered a crime (82.3%). Traditional marital role expectations was the main significant predictor for all of the study criterion variables. Gender, place of residence, age, and marital status were significant predictors of some of the criterion variables.     

交通肇事眼损伤鉴定及其VEP检查特征分析

对 30例交通肇事眼损伤鉴定及其VEP检查结果进行回顾性分析 ,旨在探讨交通肇事眼损伤鉴定的特征 ;结果表明 :与普通伤害案件相比 ,(1)交通肇事眼损伤鉴定时合并颅脑损伤 (83% )及多颅神经损伤 (53% )的比例较高 ;导致复视及眼球运动受限 (30 % )的情况较多 ;视神经损伤 (2 0 % )及眶壁骨折 (2 0 % )的发生率较高 ;鉴定时应注重这些方面的检查。 (2 )交通肇事眼损伤鉴定当事人主诉双眼视力下降 (53% )的比例较高 ,雾视法进行伪盲试验受到限制 ,VEP检查显得更为主要。VEP检查是确证视神经损伤的良好方法 ,不同程度的视功能障碍其VEP表现为波形熄灭、波形离散、波幅降低、潜伏期延长不等。另一方面 ,交通肇事后弥漫性脑组织损伤也在眼底及VEP上有一定表现。     

Not by accident: An analytical approach to traffic crash harm reduction

Purpose

This study examines whether a problem-oriented approach used by police in Cincinnati, Ohio called the Crash Analysis Reduction Strategy (CARS) corresponded with a change in the number of traffic crashes that resulted in injuries after implementation onset. Under the CARS model, police developed tactics that focused on targeting high-risk driving behaviors, impaired drivers, and crash hotspot locations within the city.

Methods

Using a two-phase strategy we first assess local impact by examining injury-related traffic crash patterns at targeted locations. Second, we examine whether traffic crashes that resulted in injuries in Cincinnati significantly diverged relative to similar outcomes across a number of comparison sites.

Results

Difference-in-difference negative binomial regression analyses indicates that traffic crashes were significantly lower in Cincinnati - down roughly 5.7% to 10.3% in the post-intervention period - when contrasted with comparison sites.

Conclusions

Our findings suggest that comprehensive problem solving approaches can significantly reduce the risk of life changing events such as automobile crashes that result in injuries beyond traditional policing efforts that explicitly focus on crime and violence.     

Contacts with public services, with special reference to mental health care, preceding a serious crime: a retrospective study of 268 subjects of forensic psychiatric investigations

Between July 1995 and June 1996, 533 subjects underwent forensic psychiatric investigation I Sweden. Odd case numbers (n = 268) were included in the study. Of these 268 people, 50% had been in contact with psychiatric services during the six-month period preceding the crime leading to forensic psychiatric assessment. Contacts with psychiatric services during the six-month period preceding the crime were significantly more common in three categories of individuals than others. These were: women, individuals who were diagnosed as having a psychotic disorder during the forensic psychiatric investigation, and individuals found to suffer from a serious mental disorder as defined in the legislation. Subjects who were found not to suffer from a serious mental disorder and were thus not eligible for special sanctions on medicolegal grounds had significantly less psychiatric contacts before the crime, as did subjects under 20 years of age. However, these two groups still had considerably more psychiatric contacts than the general population. The present results suggest that the patient category studied requires special monitoring and case management in general psychiatry in Sweden. To this end, we call for closer studies of high-risk individuals, particularly of previously violent offenders and potentially violent offenders, and closer studies of their psychiatric contacts. This will provide a basis for the development of adequate programs and guidelines for effective care and treatment within the psychiatric sector.     

当前人身伤害赔偿鉴定的几个问题

在审判实践中,涉及刑事、民事人身伤害赔偿案件不断增多.法医鉴定在案件审理中的重要地位已匆庸置疑,审判人员对法医鉴定的要求也越来越高,越来越细.从笔者本地区赔偿案件鉴定情况看,近几年除要求对伤者进行伤情程度鉴定外,还要求对伤残程度、医疗时限、医疗费用等进行鉴定.实践中,法医技术人员与审判人员在对上述问题的认识还不尽一致,有些问题上认识差距较大,确需不断探讨、研究,逐步统一认识,以使案件得以合理公正地解决.