Injuries due to deliberate violence in areas of Denmark. III. Lesions. The Copenhagen Study Group

As part of a transcultural investigation of violent behavior in Denmark and South America, the lesions from accidents involving deliberate violence registered in three Danish emergency wards during a 1-year period were studied. A quantity of 2211 lesions were diagnosed in 1316 patients (953 male and 363 female patients). Sixty-five percent of the lesions were in the head/neck region, 13% in truncus, 18% in the upper extremities and 5% in the lower extremities. The most frequent diagnosis was an open wound in the head/neck region. Adding contusions and fractures in the same region this amounted to more than half of the total number of lesions. In the upper extremities 62% of the lesions were contusions or open wounds. Serious lesions of internal arteries were few, however always caused by sharp instruments (knives). Serious lesions due to firearms were not recorded/reported. Strangulation had been used against 1.1% of the victims, the male/female ratio being 1:6. The main part of the lesions were of minor severity when assessed on the basis of the scores in the Abbreviated Injury Scale (AIS). The lesions were, however, more serious compared to other recent studies, and it appeared that the female victims had fewer but more serious lesions than the male victims. The need for treatment and hospitalization was in the range of other recent studies.     

Injuries due to deliberate violence in Chile

An analysis was made over a period of 6 months of the incidents involving deliberate violence as registered in 'Vicaria', the clinic for out-patients within the Cathedral of Santiago de Chile. A total of 236 victims of deliberate violence were observed. Men aged 15-24 years were found to be victims of deliberate violence most frequently. 'Under education' was the most frequently registered occupation for both sexes, and a large group of male victims were 'Unemployed'. 82% of the victims were men and 14% women, 1.5% were boys and 1.5% girls less than or equal to 14 years of age. None of the victims were alcohol intoxicated when arriving in the clinic. The incidents took place in streets for 81% of the male victims and 79% of the female victims, and in the majority of the cases the aggressor(s) was one (or several) police officer(s). Six percent of the female victims had been injured at home. There was no reporting of the aggressor being a relative or acquaintance. The most frequent type of violence was blunt violence from baton(s) (44%), while blunt violence without the use of instruments was reported less frequently (33%). The use of firearms was registered in 18% of the cases, and of sharp instruments, combustion, electro-shock and chain in 1.4%, 1.4%, 1.1% and 0.4% of the cases respectively. A total of 517 primary and secondary diagnoses were applied to the patients. Most of the victims (99%) had moderate or less serious lesions according to the Abbreviated Injury Scale (AIS) (score less than or equal to 2). Twenty-four percent of the victims had more than 4 lesions, and 7% more than 10 lesions. The head/neck region and the trunk were affected with equal frequency, the frequency of injuries of the head/neck region being comparable with that observed among torture victims and in contrast to the pronounced predominance of injuries of the head/neck region observed in a Danish emergency ward study of deliberate violence.     

Injuries due to deliberate violence in areas of Argentina. I. The extent of violence. Copenhagen Study Group

As part of a transcultural investigation of violent behaviour in Argentina and Denmark an analysis was made of the incidents involving deliberate violence as registered in the emergency wards of Hospital Fernandez and Hospital Pinero in Capital Federal Buenos Aires over a period of 13 and 17 months, respectively. In the two emergency wards a total of 281 victims of deliberate violence were observed corresponding to a rate of approximately 0.2/1000 per year in a mainly middle income area of the metropolis Buenos Aires, the catchment region of Hospital Fernandez, and 0.6/1000 per year in a mainly low income area of Buenos Aires, the catchment region of Hospital Pinero. Men aged 20-24 years and 40-49 years were found to be the most frequent victims of deliberate violence, 13% and 11%, respectively. Elderly women greater than or equal to 60 years of age were rarely found to be victims of deliberate violence (2%). Skilled and unskilled male workers were over-represented as victims of violence. Sixty-four percent of the victims were men and 29% women, 6% were boys and 0.7% girls less than or equal to 14 years of age. Twenty-one percent of the male victims and 5% of the female victims were alcohol intoxicated when arriving in the emergency ward. The incidents took place in restaurants or in the vicinity of restaurants for only 7% of the male victims, while 55% of male victims and 34% of female victims had been injured in the street, most often by non-acquainted men. Fifty-eight percent of the female victims had been subject to deliberate violence at home, in the majority of the cases beaten by their spouse. Twelve percent of the male victims and 8% of the female victims were estimated to be under the influence of drugs. The incidence of deliberate violence seems to be lower in Argentina than in Denmark. However, serious lesions appear to be considerably more frequent in male Argentinian victims compared to male Danish victims, maybe because the practice of seeking medical assistance is different in the two countries. The pattern of deliberate violence appears to be associated with socio-economic and cultural factors. Influence of alcohol does not appear to play a role that is comparable to the situation observed in Denmark. A considerably larger percentage of victims in Argentina than in Denmark had been injured in the street.     

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.     

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.     

Injuries due to deliberate violence in areas of Denmark. IV. Alcohol intoxication in victims of violence. The Copenhagen Study Group

A material of 1316 victims of deliberate violence was collected prospectively during a one year period in three Danish emergency wards covering a provincial/rural area and two metropolitan areas. The frequency of alcohol intoxication was determined. Forty-one percent of the patients were intoxicated. The highest frequency was found in male victims, in the provincial/rural area, in restaurants or their vicinity, in the age group 35-49, during evenings and nights and in May. It is difficult to indicate specific preventive measures. However, a more restrictive attitude is suggested with regard to serving alcohol to intoxicated persons in restaurants.     

Homicide by firearms in two Scandinavian capitals

In the Oslo and Copenhagen areas, 83 homicides by firearms were registered in the 10-year period 1985 to 1994, accounting for 19.3% of all homicides in that period. The majority of the victims were between 20 and 50 years old, and 58% were male, 42% female. The yearly number of firearm homicides varied between 4 and 15, with neither an increase nor decrease throughout the period. Most of the victims had no detectable blood alcohol at autopsy. Female victims were typically shot in their own domicile with a shotgun by their spouse, mostly because of jealousy or in a family argument, whereas male victims were shot on different locations, predominantly with a handgun, for many different reasons. Most victims were shot in the head, and few had entrance wounds in more than one anatomic region.     

Suicide by firearms: a 15-year experience.

A retrospective review of 1704 cases of suicide involving firearms investigated by the Bexar County Medical Examiner's office between 1984 and 1998 was performed. The age distribution was similar in male and female victims, and the type of weapon was not associated with age. Approximately 78% of the victims used a handgun (87% of female and 76% of male victims). In 4.0% of head wound cases, the site of the entrance wound was the back of the head. Thus, this report refutes the common belief that all gunshot wounds to the back of the head represent homicides. In 1.9% of the cases, the wounds were inflicted at intermediate range. With handguns, the right temple was the most common site, but with rifles and shotguns, the most common site was the mouth.     

Fatal head injuries from firearms. An autopsy study of 270 cases

Autopsy findings in 270 fatal head injuries from firearms are reported, including 243 suicides and 27 homicides. The most frequent weapon used for both groups were shot guns which are easily available in Norway. For suicides the most favored sites were right tempoparietal, frontal, and mouth. Twenty-six percent of the victims from homicides had multiple wounds in their head. Suicide by firearms showed marked male predominance, whereas the sex ratio for homicide was rather equal between the two sexes.     

Pedicide revisited. The slaughter continues

Pedicide, a reliable indicator of interpersonal violence and severe child abuse, has risen in Cuyahoga County (Metropolitan Cleveland), Ohio, U.S.A., over the past quarter of a century, paralleling or exceeding the increase in adult homicide. However, neonaticides have decreased, a phenomenon mirroring a marked fall in fatal maternal criminal abortions. As previously noted, modalities of lethal violence in pedicide are significantly determined by victim age. An increasing proportion of pedicide victims, like their adult counterparts, have been killed by firearms. Pedicide victims are much apt to be killed by close relatives than are adult homicide victims. Similarly, perpetrators of pedicide are much more likely to commit suicide than are their adult-slaying counterparts. Fatally "battered" children, the victims of multiple, metasynchronous traumata, represent a significant fraction (22%) of the overall pedicide population and constitute a segment of the victims with a potential for being saved by intervention. Overall, pedicide remains a challenge to our profession and a threat to society as a whole.     

Firearm fatalities in Edirne, 1984–1997

During the 14-year period from 1984 to 1997 there were 85 firearm fatalities investigated by the Department of Forensic Medicine and the Department of Pathology in Edirne, Turkey. We determined the characteristics of these 85 firearm deaths which comprised 17.03% of all medicolegal autopsies. The overall incidence was 1.58 per 100 000 population. The median age was 35.5 years. Fifty-four percent of the victims were aged between 20 and 40 years. Males constituted 82% of the victims. The most frequent manner of death was homicide (68.3%). Handguns accounted for 62.4% of the weapons used. The most common sites for the firearm entrance wounds were both head–neck–nape (32.8%) and chest (32%). In conclusion, our study shows that, in spite of legal restrictions, illegal access to firearms is easy and deaths by firearms are still increasing.     

Homicide by gunshot. An evaluation of 50 homicides with reference to gunshot wound site]

In this paper the homicides committed in the region of Ulm with firearms over a period of 17 years were studied. These included 50 deaths caused by gunshot wounds, 33 males and 17 females. Homicides by firearms accounted for 44 percent, which was slightly higher than in other German regions. Homicide victims were found in all age groups with a markedly higher number up to the 20th year and in the fourth decade of life. In most cases small arms were used, and in many cases multiple shots were fired primarily hitting the head and the left side of the trunk: but injuries in the region of the extremities were also seen.     

Injuries due to deliberate violence in areas of Denmark. II. Victims of homicide in the Copenhagen area

As part of a transcultural investigation of injuries due to deliberate violence in Denmark and South America, homicides in the Copenhagen area were studied for a 1-year period. Forty-five cases corresponding to a rate of approximately 2/10(5) per year were recorded. The rate seems to be increasing and the pattern changing with a higher frequency of stabbing and with an increasing frequency of high blood-alcohol concentrations in the victims. The highest number were killed at home. In the majority of cases the aggressor and the victim knew each other. A reduction in alcohol consumption is indicated as a possible preventive measure.     

Homicide-suicide (dyadic death), homicide, and firearms use in England and Wales

Homicide-suicide forms a distinct form of homicide. An analysis of cases in the Yorkshire and Humberside region of England between 1991 and 2005 revealed 37 episodes with 42 victims. Previous studies have shown a high rate of use of firearms. Over the last 2 decades firearms legislation has become more restrictive. In this study all assailants were male, mean age 46.8 years. The commonest method of homicide was strangulation (36%) with 16% killed by firearms. This is a reduction compared with a previous study in the same region. All killers who shot their victims killed themselves with firearms. There were no multiple killings with firearms in this study and no stranger killings. Hanging was the commonest method of suicide. During the same period the use of firearms as a method of homicide increased in England and Wales with handguns, the most common weapon. Nationally, suicide after homicide has remained at a similar rate over the half century and is an uncommon phenomenon. Firearms use remains low in both homicide and homicide-suicide episodes in England, and further analysis is required to determine changes in patterns of killing.     

Living victims of strangulation: a 10-year review of cases in a metropolitan community

The prevalence of reported domestic violence or intimate partner violence has greatly increased, with approximately 1.5 million women violently assaulted annually in the United States by an intimate partner. Strangulation is often seen in violence against women, including domestic violence cases. Strangulation is defined as "a form of asphyxia characterized by closure of the blood vessels or air passages of the neck as a result of external pressure on the neck." This is a 10-year case review of 102 living victims of strangulation who underwent medicolegal evaluation at the Clinical Forensic Medicine Program at a State Medical Examiner's Office serving Southern Indiana and all of Kentucky. The majority of victims (79%) were strangled by an intimate partner, and manual strangulation was the most common method (83%). A total of 38 victims (38%) described a history of domestic violence, and the same number lost consciousness while being strangled. Nine (9%) women were pregnant at the time of the attack, while 13 (13%) had a history of being sexually abused in addition to being strangled. A paucity of cases involved only strangulation, as most of the victims were subjected to myriad forms of blunt force trauma which included not only the head and neck but also other bodily regions. This is a unique presentation of strangulation of living persons as most evidence of strangulation in the forensic literature has been derived from postmortem examinations of the victims. This comprehensive study discussing the examination of a living strangulation victim offers valuable insight into the mechanism and the physical findings involved in the strangulation process.     

Intimate Partner Violence: The Role of Suspect Gender in Prosecutorial Decision‐Making

Utilizing a sample of 8,461 cases involving heterosexual intimate partner violence, this paper examines the role of suspect gender in prosecutorial decision‐making. Four decision points are assessed: the decision to file charges (versus rejection for insufficient evidence); to file as a felony (versus a misdemeanor or probation violation); to dismiss for insufficient evidence (versus full prosecution); and to reduce felony charges to a misdemeanor or violation of probation. Suspect gender was found to be statistically significant in relation to all four outcomes in favoring female over male suspects. Numerous interaction effects were observed between gender and measures of prior arrest and offense severity in particular, suggesting that prosecutors distinguish between male and female suspects across these variables. We suggest that these data provide some support for recent qualitative research suggesting that court personnel are responsive to the gendered asymmetry of intimate partner violence, and may view female intimate violence perpetrators more as victims than offenders.     

Non-fatal injuries due to interpersonal violence in Johannesburg-Soweto: incidence, determinants and consequences.

A prospective, hospital based sampling procedure conducted between June 8th, 1989 and August 24th, 1990 identified 1592 victims of interpersonal violence in six state and five private hospitals serving the Johannesburg magisterial district (which includes Soweto). For the 1282 victims resident in the area, this corresponded to crude annualised incidence rates per 100,000 population of 3821 for coloureds, 1527 for blacks, 467 for whites, 433 for asians and 1380 for all residents. Males, most of whom were aged 20-24 years, constituted 83.9% of all victims and were most often attacked on the streets. The majority of females were attacked at home by a spouse or lover, and most incidents occurred between dusk and midnight on weekends. Sharp violence was the most frequent type, involving 52.2% of the male and 51.4% of the female victims. Analysis by racial classification of the overall findings for mechanism of injury and relationship to aggressor showed dramatic differences. Limitations of the findings are discussed. After comparison with similar data for two United States cities and Copenhagen, Denmark, it is hypothesised that the racial differences in the present findings reflect the interplay of universal structural determinants and a specific colonial factor rooted in the sociology and psychology of oppression. Some implications of these findings and hypothesised determinants for violence prevention initiatives are mentioned.     

The Role of Place and Sociodemographic Characteristics on the Issuance of Temporary Civil Protection Orders

Civil protection orders are one of the most widely used legal interventions for intimate partner violence. Every American state has legislation that allows victims to seek legal remedies through protection orders such as preventing abusers from contacting them, requiring perpetrators to stay away from specific locations, and ordering removal of firearms. However, judges do not grant every petition for a protection order. This study analyzed over 1000 civil protection order cases from Nebraska to identify how factors not prescribed in the legal statute contribute to a determination of whether victims receive protection. The results suggest that victims' gender and the counties in which they file influence victims' chances of obtaining a protection order. Male victims, victims with children with their abuser, and married victims are significantly less likely to receive protection orders, even after controlling for the severity, recency, and type of abuse. Both male and female victims who file their cases in metropolitan counties are more likely to receive protection orders than their nonmetropolitan counterparts.     

Mental disorders and charges of violent offences. A study of male adolescent remand prisoners

This study describes associations between mental disorders and charges of violence among remanded adolescents. 100 15-17 year old boys from East Denmark, consecutively remanded during one year, were interviewed with SCAN, K-SADS and SCID-II to obtain past year ICD-10 diagnoses. There was no statistically significant association between the occurrence of a violent charge and mental disorders in general (OR=1.02, 95% confidence interval (CI) [0.24; 4.38]). An association was found between violent charge and non-Danish ethnicity (OR=7.58, [1.60; 35.92]). Previously reported association between violence and mental disorder among adults were not replicated in this male adolescent remand population. A developmental hypothesis is proposed.     

Body Transportation after Homicides: Offender and Offense Characteristics

Body transportation is defined as moving the body of the victim from the scene of a homicide to another location. We analyzed data on 513 South Korean homicide cases with convictions to compare 104 homicides involving the transportation of victims’ bodies with 409 homicides that did not. Offenders who transported their victims’ bodies were significantly younger and more likely to be related to the victims and were less likely to use sharp instruments and more likely to use blunt instruments or strangle the victims than offenders who did not. Victims of homicide involving body transportation were more likely to suffer injuries to the neck and head and less likely to suffer injuries to the torso. Finally, offenders who transported victims’ bodies were more likely to have planned the offense and destroyed evidence. The present findings have practical implications for police investigations.