Clinical forensic examination findings in assault cases among adolescents

Child and youth criminality has risen markedly over the past 25 years and causes increasing concern to the general public. The clinical forensic examination cases of youth violence victims examined at the Institute of Legal Medicine of the Hanover Medical School and its Oldenburg Branch between 1999 and 2008 were retrospectively analyzed. In all, 55 adolescents (37 females, 18 males; median age 15.5 years) were examined. In most cases the suspect was a close (40.0%) or passing (23.6%) acquaintance. 16 assaults were committed by two or more adolescents jointly. Most of the juveniles were victims of sexual assaults (56.4%). In 15 victims of sexual offences (51.7%) diagnostic findings were obtained on the basis of anogenital injuries and/or the presence of sperm. In summary, the analysis shows that adolescents frequently become victims of sexual assault. In addition, youth violence is often committed in a group.     

Clinical forensic examination findings and legal outcome in cases of suspected physical child abuse

Clinical forensic examinations performed at the Institute of Legal Medicine of the Hanover Medical School between 1999 and 2008 in cases of suspected physical abuse of children were analyzed retrospectively with special emphasis on the legal consequences. Altogether, 192 children (85 girls, 107 boys) with a median age of 4.4 years were examined. In 47 cases (24.5 %), the clinical forensic examination findings were interpreted as accidental injuries, birth traumas or unspecific findings. 29 victims (20.0 %) had suffered a shaken baby syndrome. Only part of the presented cases ended with conviction, which was more likely if the victims were aged between 7 and 11 years. Prison terms of 2 years and more were imposed only if the child suffered potentially or acute life-threatening injuries or if additional anogenital lesions were diagnosed indicating sexual child abuse.     

Functions of Social Representations in Honour Violence: The “Other East” as Responsible

Although extensive research has been carried out in the field of social justice in terms of femicide in defence of family honour around the globe, intersecting aspect of identity as an underlying psychological mechanism to justify the social sources of these killing has not been addressed in much detail. The present study, therefore, examined the role of (a) diverse social representations in femicide, (b) geography and ethnicity in social representations of honour violence, and (c) the functions of these diverse social representations in maintaining social injustice towards women through the promotion of occidentalism in line with the boundaries for a hegemonic notion of western modernisation. Two studies were conducted. The first study includes a content analysis investigating data from 73 respondents living in the western part of Turkey. The present findings showed that there are different social representations of honour killings, such as töre killings and namus killings. These diverse representations were found to reflect the fact that individuals delegitimise töre killings as eastern, outrageous, tribalistic, and related to family honour while legitimising namus killings as personal, valuable, self-aware, and vulnerable, in the context of “westernised” Turkey. The second study comprises an experimental design in which participants were randomly assigned to one of three conditions: namus killing, töre killing, and control. The results showed that diverse social representations of femicide have psychological functions such that a namus representation gives more legitimacy to femicide than does a töre representation. The consideration of diverse representations in honour killings and their functions has the potential to inform research as well as to build effective prevention policies targeting the reduction in femicides. A focus on the concept of namus and an emphasis on moving the focus of social representations away from responsible backwards, “the other East” and towards namus as one of the leading sources of domestic violence may switch the problem from the perception of victimised eastern women and to a general injustice problem.

     

Examination results and autopsy findings in assaults on elderly people

As the percentage of elderly people in the population grows, violence against persons of advanced age constitutes an increasing social problem. The findings of the clinical forensic examinations (CE group) and autopsies performed on elderly violence victims (> or = 60 years) between 1999 and 2008 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analysed. In all, the study material comprised 55 victims of the CE group (35 females and 20 males, median age 73.5 years) and 55 autopsies (33 females and 22 males, median age 72.7 years). In most of the autopsy cases, the suspect was a family member or partner. In contrast, the alleged perpetrator was a stranger in most cases of the CE group. Blunt force injuries were most often found in the CE group victims (63.6%). Altogether, 38.2% (CE group) and 20.0% (autopsy cases) of the violent assaults were associated with robbery. In the majority of the CE cases, the victims suffered potentially or acute life-threatening injuries. In summary, the analysis shows that elderly people frequently become victims of robbery and blunt force injury. In most homicides of old people, the perpetrator is familiar to the victim. In surviving elderly violence victims, the assault is more likely to be reported to the police if the suspect is a stranger.     

Clinical forensic examination findings and legal outcome in cases of suspected sexual child abuse

The clinical forensic examinations conducted at the Institute of Legal Medicine of the Hanover Medical School between 1999 and 2008 in cases of suspected sexual abuse of children were evaluated retrospectively and analysed with regard to their legal outcome. In total, the study included 223 children (172 girls, 51 boys) with a median age of 8.6 years. In 34 children (15.2%), forensically relevant diagnostic findings due to anogenital injury and/or detection of semen were recorded. Perpetrators were convicted more often when they were not a member of the victim's family. In cases with victims aged seven years or older, conviction was more common. The study shows that medical findings can best be preserved by an immediate clinical forensic examination. Suspected sexual child abuse can often not be proved by medical examination results, but in some cases diagnostic findings are not mandatory for conviction.     

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 1 998年 4月～ 1 999年 1 2月间来诊的 1 59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% ) ,其次为虐老 ( 7 5% )和虐儿 ( 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4 0 %的受害人投诉前未去医院就诊 ;损伤程度多为轻微伤 ,达轻伤标准占 1 0 %。结论　家庭暴力损伤具有隐藏性和复杂性 ,准确及时地进行法医学鉴定可为受害人主张权利提供有力的证据和帮助 ,对揭露家庭犯罪有着重要意义     

Injuries due to deliberate violence in areas of Denmark. V. Violence against women and children. Copenhagen Study Group

As part of an European-South American study of deliberate violence cases of violence against women greater than or equal to 15 years of age and violence against and among children under the age of 15 years were registered at 3 Danish emergency wards and at the Institute of Forensic Medicine in Copenhagen. 352 cases of violence against women and 46 cases of violence against children were registered in the three emergency wards corresponding to rates of about 1.6/1000 per year for women, 0.6/1000 per year for boys and 0.7/1000 per year for girls in a provincial/rural district, the catchment region of Holbaek County Hospital, 3.4/1000 per year for women, 2.8/1000 per year for boys and 0.6/1000 per year for girls in a mainly middle income area of the metropolis Copenhagen, the catchment region of Frederiksberg Hospital, and 4.0/1000 per year for women, 4.0/1000 per year for boys and 0.9/1000 per year for girls in a mainly low income area of Copenhagen, the catchment region of the Rigshospital. Nineteen live adult female victims and 17 dead adult female victims of violence were registered in the Institute of Forensic Medicine in Copenhagen, where also one was registered as a victim of homicide. Nearly half of the adult live female victims of violence had been injured at home while this was the case for approximately three fourth of the dead victims. In 35% of the live cases the husband was the aggressor and in 12% a former cohabitant. In 71% of the homicide cases the husband was the aggressor. The live women appeared to have fewer but more serious lesions than men. The pattern of deliberate violence against women appears to be associated with socio-economic and cultural factors. In cases with a preceding quarrel there is statistically a link to alcohol intoxication. In half of the cases of violence against children the aggressor was known to the victim, in 15% the aggressor was one of the parents, while 42% of the cases were violence among children. The pattern of violence according to sex, and the distribution and severity of lesions for 10-14 years old children showed resemblance to the situation for adults. The lesions were more serious in young infant victims, especially boys, than in adult victims.     

Customary Homicides in Diyarbakir Province

This study presents an analysis of the causes of so‐called honor killings in the context of “customary homicide” and a discussion of preventive measures. Finalized case files of customary homicide between January 1, 2007 and December 31, 2012 were retrospectively examined in Diyarbakir Province, Turkey. Of a total of 28 case victims, 17 (60.7%) were females and 11 (39.3%) were males. All perpetrators were male. There was a significant difference between male and female victims in terms of economic independence (p = 0.000). A direct blood relationship or relationship by marriage (such as brother‐in‐law) was found to have a significant association with the gender of the victim (p < 0.001). Multilevel educational activities targeting a transformation of the perception of women by society, replacement of patriarchal models with more modern attitudes, and encouragement of individuality may represent effective strategies that may help reduce the number of customary homicide, which represents a multifaceted problem.     

Female versus male perpetrated femicide: an exploratory analysis of whether offender gender matters

Femicide, the murder of females (most often at the hands of males), is an understudied area in homicide research. Furthermore, femicide perpetrated by females has been all but ignored. One reason this may be is because of the rarity of homicide victimization perpetrated by females. Rather, most homicide incidents consist of a male offender and a male victim. When a homicide does involve a female, either as a victim or as an offender, the other party implicated is generally a male. The primary goal of the proposed study is to provide an in-depth, albeit exploratory, examination of female-perpetrated femicide. Using homicide data taken from the Dallas Homicide Unit, 403 cases of femicide will be analyzed, with special attention devoted to comparing female-perpetrated femicide incidents (n = 39) against male-perpetrated femicide incidents (n = 364). Specifically, the current study will explore the similarities and differences in sociodemographic characteristics of victims and suspects, offense characteristics, and offense circumstances. Contrary to what was expected, results, at first glance, seem to suggest an overwhelming similarity between femicide suspects and victims, irrespective of gender. However, when the relationship between victim and suspect is considered, distinct differences appear. Implications from these findings as well as limitations and suggestions for further research are discussed.     

Death from thermal effects and burns

One hundred and fifteen unselected autopsy cases of death from thermal effects and/or fire between 1990 and 1999 were analyzed with regard to time of death, signs of vitality at the scene of the fire, the manner and cause of death, and the extent of soft tissue loss. The cases represented approximately 6% of all autopsy cases at the Institute of Legal Medicine responsible for a catchment area with approximately 700,000 inhabitants. In 23 victims suffering burn injuries, death occurred during initial medical care or clinical treatment. The causes of death were primary respiratory arrest due to smoke poisoning or delayed shock caused by thermal injuries to the skin. Death occurred at the scene of the fatal event in 85 cases: eight cases exhibited no thermal effects; the cause of death in one of these cases was polytrauma incurred in a leap from a height; in seven cases there was poisoning due to smoke inhalation. The remaining 77 cases were characterized by signs of intensive thermal and/or fire effects. Clear signs of vitality (carboxyhemoglobin (COHb) in blood, inhalation and/or swallowing of soot) were found in 84.7% of the victims dying at the site of the fatal event. Of the 13 victims showing no signs of vitality at the scene, a cause of death could be determined in only seven cases; death in the other six cases remains unexplained. Quantification of the soft tissue loss revealed a possible correlation with the temperature and time course of heat exposure.     

Examination reports on survived strangulation cases

Clinical-forensic examination of strangulation victims is an increasing part of the routine of many forensic pathology institutes. The cases examined between 2004 and 2008 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analysed. In total, the study material comprised 218 victims (175 females and 43 males). In 80.7 %, the clinical-forensic examination was performed within 24 hours after the incident. In the overwhelming number of cases, the alleged perpetrator was no stranger. 128 victims (58.7 %) had strangulation marks, 32 victims (14.7 %) ligature marks and 65 victims (29.8 %) nail marks. Four victims showed injuries of the laryngeal and pharyngeal structures (reddening, hematomas, swelling and in one case a fracture of the cricoid cartilage on both sides). Extensive petechiae were predominantly seen in the conjunctivae, the buccal mucosa and the skin of the face in cases where the victims suffered a loss of consciousness. 87 cases (39.9% were classified as potentially life-threatening and 30 cases (13.8 %) as acute life-threatening events. This classification is of legal relevance for the penalty. In addition, 60 victims experienced sexual violence. These results suggest that early clinical-forensic examination is crucial for documenting forensic evidence in support of police investigations and may deliver significant details relevant in court.     

Suicide in children, youths and young adults

Suicides among children and youths are tragic events. The suicide cases of children, youths and young adults examined between 1995 and 2009 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analyzed. Altogether, 54 suicides among children, youths and young adults (37 males, 17 females; median age 17.5 years) were evaluated. The suicide victims were predominantly male (68.5%). The vast majority used "hard" methods such as hanging, jumping from a height or being run over by a train. In seven cases (13.0%) psychiatric disorders were known. Seven victims (13.0%) left a suicide note. Suicide was most frequently (40.7%) committed in the open air (40.7%). In addition, the evaluation shows that at the time of committing suicide more than 40% of the youths and adolescents, in whom a chemical toxicological examination was performed, were under the influence of alcohol, medical and/or illegal drugs.     

Aquatic fatalities--a systematic retrospective analysis

In a retrospective analysis of the autopsy material (n = 5,767) of the Institute of Legal Medicine of the Hanover Medical School covering the period of 1998-2007, all aquatic fatalities were evaluated, categorized and systematically compared under epidemiological and forensic criteria. The total of 156 cases of death by drowning (2.7 % of all autopsies) included 38 bathtub drownings and 28 deaths in the water for which no pathological anatomical cause of death could be reliably demonstrated. A control group (n = 221) was investigated for the presence of aqueous liquid in the sphenoid sinuses and compared with the findings of the drowning cases without signs of putrefaction. About 16 % of the control cases had fluid in the sphenoid sinuses compared with 57.6 % in the drowning group. Most of the drowning victims were men (60.9 %), whereas in the group of bathtub drownings the majority were women. More than half of the drowning cases (n = 89) could be classified as accidents. The individual groups showed a different incidence of findings associated with drowning.     

Sharp Force Homicide in Denmark 1992–2016

Sharp force trauma is a common homicide method. The weapon is typically a knife, which is easily accessible and does not require special skills. We have analyzed all 471 sharp force homicides in Denmark during 1992–2016 with special focus on aspects that are relevant to forensic pathologists, including the distribution of wounds and organ injuries. Most homicides were committed inside with a kitchen knife. The front left thorax was the most common area to be affected by sharp force trauma. In 18.9% of the victims, there was only one sharp injury, the majority on the thorax. The most common trajectory for stab wounds was directly posterior with no deviation to the sides or up/down followed by directly anterior. The heart (including pericardium) and lungs (including hemo- and pneumothorax) had injuries in more than 75% of the victims. 67% of victims were males. Female victims had more sharp force injuries and defense wounds than male victims. Most females were killed in domestic homicides (73.7%), most commonly in partner killings (56.4%). In contrast, many male victims were killed in a setting of nightlife/intoxication (34.0%) most by a friend/acquaintance delivering a few stab wounds. The results clearly show strong sex differences in both victims and offenders. This could be useful for shaping policies and public opinion, and as a route for understanding the developments in interpersonal violence. In the narrow setting of death investigation, our results will provide an evidence-based approach to understanding the injury patterns in sharp force homicide.     

Applying NIBRS Data to the Study of Intimate Partner Violence: Massachusetts as a Case Study

Using data from Massachusetts, we illustrate three ways in which National Incident-BasedReporting System (NIBRS) data can improve the collection of importantinformation on intimate partner violence. First, because NIBRS usesincident-based reporting, data are collected on all crimes associated witheach incident. In our sample of women victimized by an intimate partner, 10%had experienced more than one crime during the incident. Second, NIBRSinvolves expanded data collection on the offender–victim relationship, aswell as reporting about additional offenses. For female victims, partnerswere more likely than nonpartners to commit the crimes of simple assault,intimidation, and aggravated assault. For crimes involving male victims, anaquaintance was most likely to be the offender. Third, NIBRS data allow usto connect information about the incident, the offender(s), and thevictim(s). Our data indicted that several victim- offender-, and incident-relatedvariables were risk factors for injury, including victims ethnicity,offenders relationship to the victim, offender's use of a weapon, whether or not thecase was cleared, type of crime committed, and whether or not drugs and/or alcoholwere involved in the incident. Although there are several limitations to NIBRSdata, its potential usefulness to the study of intimate partner violence deserves furtherattention.     

How many DNA analyses are performed on adult sexual assault victims in Milan (Italy): A ten-year review

The aim of this study is to evaluate the actual use of serological/DNA analyses in the investigations carried out on adult sexual violence victims in Italy during the years 2006–2015.The victims were assisted in the largest Italian rape center, in Milan (Soccorso Violenza Sessuale e Domestica – SVSeD - Service for Sexual and Domestic Violence).The total number of sexual violence victims examined during the years 2006–2015 (adults and minors) was 3521, in 1697 of cases, biological evidence had been collected, while the number of adult victims (>18 y.o.) examined was 2300, in 1211 of cases biological evidence had been collected.Biological evidence was collected from the victims’ bodies using two swabs in five anogenital areas (labia maiora, labia minora, perineum, perianal and anal/rectum regions) and two swabs in all other skin areas suggested by the victims as areas of possible contact (double swab technique). Clothes were also collected on a case by case basis for the search of biological stains. Despite the proper collection, handling and chain of custody for all the swabs/items collected, serological/DNA analyses were requested in 86 cases out of 1211 only (710%). This percentage dropped to 190% when considering adolescent victims (13–19 y.o.).The reason why Italian Magistrates make little use of the powerful tool of DNA analyses in sexual assault cases, still remains unclear. Legal and procedural aspects are therefore also discussed.     

Injuries due to deliberate violence in areas of Denmark. I. The extent of violence

As part of a transcultural investigation of violent behavior in Denmark and South America an analysis was made during a one year period of the incidents involving deliberate violence as registered at 3 Danish emergency wards, and at the Institute of Forensic Medicine in Copenhagen. In the three emergency wards a total of 1316 victims of deliberate violence were observed corresponding to a rate of about 3.3/1000 per year in a provincial/rural district, the catchment region of Holbaek County Hospital, 5.5/1000 per year in a mainly middle income area of the metropolis Copenhagen, the catchment region of Frederiksberg Hospital, and 7.6/1000 per year in a mainly low income area of Copenhagen, the catchment region of the Rigshospital. The highest risk, 28/1000 per year, was found for young men between 15 and 19 years of age living in the low income area of Copenhagen. The risk was low for people greater than or equal to 60 years of age in all three areas investigated, ranging from 0 (men) to 1.3/1000 per year (women). Skilled and unskilled workers were greatly over represented as victims of violence, considering their share of the background population. Seventy percent of the victims were men. At least 44% of the men and 32% of the women were alcohol intoxicated when arriving in the emergency ward. The incidents took place in restaurants or in the vicinity of restaurants for 30% of the male and 11% of female victims respectively, while 45% of the women had been subject to deliberate violence at home. The rate of fatal cases of deliberate violence in the Eastern part of Denmark, the catchment area for the Institute of Forensic Medicine in Copenhagen, was found to be 0.02/1000 per year. The risk of becoming a victim of deliberate violence has not increased during the last 4 years comparing with similar investigations from other parts of Denmark. However, the rate of homicide seems to have increased, and so has the severity of the injuries caused by deliberate violence. The pattern of deliberate violence appears to be associated with socio-economic and cultural factors, and to be closely linked with alcohol intoxication.     

Examination of live victims of violent crimes at the Institutes of Legal Medicine of Hanover, Cologne and Leipzig

During the last few years the importance of clinical forensic medicine has increased within the field itself, but also in interdisciplinary cooperation. Although examinations of live victims play a substantial role in the every-day work of most German forensic scientists, the number of data published on their frequency and the type of offence for which they were performed is small. For this reason a comparison of the data from the Institutes of Legal Medicine in Hanover, Cologne and Leipzig was carried out. Most of the examinations performed by all the three institutes were ordered by courts, the prosecution or the police. Only in a few cases did private persons or hospitals ask for a forensic expert opinion on injuries. During the study period the total number of examined violence victims per annum increased noticeably from 252 in 1999 to 507 in 2003. The total number of examinations during the five-year study period amounted to 1181 in Hanover, 393 in Leipzig and 198 in Cologne, which all have a similar number of inhabitants in the respective catchment area of the institutes. Most of the examinations were carried out in victims of bodily harm, sexual assault and child abuse, but also in traffic offences, for age determination, in self-inflicted injuries and in suspects of homicide. On the one hand the remarkable rise of the number of physical examinations shows that the importance of forensic expert opinions is increasingly recognized. On the other hand the considerable regional differences demonstrate that the competence offered by the Institutes of Legal Medicine in the documentation and interpretation of violence is by far not yet sufficiently used.     

Incidence of xenobiotics among drivers killed in single-vehicle crashes.

The authors have performed a study of single-vehicle crashes (SVCs) in order to verify a correlation between the loss of vehicle control and the presence of drugs in the body. Overall, 129 cases were recorded and occurred in the catchment area of the Institute of Legal Medicine in Milan between 1986 to 1996. Among the 129 cases under study, respectively 121 men and eight women, 101 were car-drivers and 28 motor-cyclists. The median age was equal to 29 years, while the average age to 32.0 years (range 15-65 years). Fifty eight cases (45.0%) were "positive" for the presence of ethanol > or = 0.8 g/l or other drugs. The sample of "positive cases" was studied according to sex, age, day, hour and type of vehicle. Considering the cases with presence of ethanol, although under the legal limit (20 cases), the total amount of cases (78) becomes even more consistent. The amount of ethanol was found to be respectively 0.34 g/l in daily drivers and 0.87 g/l in nightly drivers (p < 0.01). Our considerations confirm the importance of toxicological analyses in the forensic investigation of traffic deaths being the sample under study recorded following criteria which minimised other possible factors effecting road accidents.