Asphyxial homicide in two Scandinavian capitals

In the Oslo and Copenhagen capital areas, 94 asphyxial homicides were committed in the 10-year period 1985-1994, accounting for 22% of all homicides in that period. Sixty-nine (73%) of the asphyxia victims were female. The most common method of asphyxiation was manual strangulation. Seventeen (18%) of the victims were below the age of 10, accounting for 59% of all homicides in that age group. Whereas 38% of the female victims were killed by their spouse, this was the case for only one male victim. The motive was not known in a great proportion of cases. Fifty-seven percent of the victims had been subjected to additional violence, and in this respect there was no difference between the sexes. In 12 of the cases the offender was female; in 9 such cases the victim was her offspring. More than half of the victims had no blood alcohol. When disregarding the victims less than 10 years of age, 33% of the male and 49% of the female victims had no blood alcohol. The crime scene was the victim's domicile among 72% of female and 52% of male victims. Forty-two percent of the female and 11% of the male victims above the age of 10 years were married or cohabitant.     

Asphyxial deaths and petechiae: a review

Conjunctival and facial petechiae, although nonspecific findings, are considered hallmarks of asphyxial deaths. Consensus in the literature suggests that their pathogenesis is related to the combined effects of increased cephalic venous pressure and hypoxic damage to endothelial cells. Despite the common knowledge that they are neither predictable findings in all asphyxial deaths nor rare in natural, nonasphyxial deaths, the belief persists that petechiae are corroborative evidence of asphyxia. We suggest that a clear, physiologically based understanding of the pathogenesis of petechiae of the head is critical for their appropriate interpretation. We present a review of the literature and the basis of our conclusion that conjunctival and facial petechiae are the product of purely mechanical vascular phenomena, unrelated to asphyxia or hypoxia.     

窒息死亡的法医病理学分析

目的探讨窒息死亡的法医病理学特点。方法对四川大学华西法医学鉴定中心1982年10月1日～2006年9月30日所作160例窒息死亡尸体剖验病理材料进行统计分析。结果窒息死亡案例占整个法医学检案的9.9%,年龄:30～39岁的死者占整个研究对象的29.4%,平均年龄为31.25岁。性别:男性103例,女性57例。男女比例1.81∶1。死亡方式:意外死亡最多(63.1%),其次为自杀(24.4%)和他杀(12.5%)。死亡原因:缢死最多(21.9%),其次为CO中毒(17.5%)、溺死(16.25%)等。医疗纠纷共计39例,均为新生儿窒息,主要发生在乡镇医院和县级医院(76.92%)。结论加强法制教育,提高安全隐患意识等是减少窒息死亡的重要手段。提高城乡医疗水平,加强窒息急诊抢救的临床技能是防止窒息引起医疗纠纷的关键。     

Age estimation from teeth in children and adolescents

The aim of this cross-sectional study was to evaluate the dental formulas according to age because of possible changes during the last decades. From these dental formulas, the median age of emergence for the permanent teeth was deduced. The study population corresponded to the 1 to 15 year-old children who had consulted either a pediatric dentist or orthodontist in the city of Nice (France). Data were collected from the 5,848 patients' charts that included an orthopantomography. This permitted the observation of emerged teeth and agenesis. Bar charts were used to indicate the dental formula according to age. There was no significant difference in the emergence pattern of both controlateral maxillary and mandibular teeth. Only the anterior tooth emergence significantly differed according to the maxillary. The lower central incisor was the lone tooth with a median age earlier than others; the remaining teeth had an age equivalent to those of previously estimates.     

窒息死亡的法医病理学分析

目的探讨窒息死亡的法医病理学特点。方法对四川大学华西法医学鉴定中心1982年10月1日-2006年9月30日所作160例窒息死亡尸体剖验病理材料进行统计分析。结果窒息死亡案例占整个法医学检案的9．9％，年龄：30-39岁的死者占整个研究对象的29．4％，平均年龄为31．25岁。性别：男性103例，女性57例。男女比例1．81：1。死亡方式：意外死亡最多（63．1％），其次为自杀（24．4％）和他杀（12．5％）。死亡原因：缢死最多（21．9％），其次为CO中毒（17．5％）、溺死（16．25％）等。医疗纠纷共计39例，均为新生儿窒息，主要发生在乡镇医院和县级医院（76．92％）。结论加强法制教育，提高安全隐患意识等是减少窒息死亡的重要手段。提高城乡医疗水平，加强窒息急诊抢救的临床技能是防止窒息引起医疗纠纷的关键。     

Asphyxial suicide with helium and a plastic bag

Suicide by helium inhalation inside a plastic bag has recently been publicized by right-to-die proponents in "how to" print and videotape materials. This article reports a suicide performed according to this new and highly lethal technique, which is also a potentially undetectable cause of death. Toxicology information could not determine helium inhalation, and drug screening did not reveal data of significance. The cause of death could be determined only by the physical evidence at the scene of death. Helium inhalation can easily be concealed when interested parties remove or alter evidence. To ensure that their deaths are not documented as suicide, some individuals considering assisted suicide may choose helium methods and assistance from helpers. Recent challenges to Oregon's physician-assisted suicide law may increase interest in helium instead of barbiturates for assisted suicide.     

Gunshot fatalities in children and adolescents in New York City

We reviewed the case records of all fatalities due to gunshot wounds in children and adolescents under 19 years of age in New York City from 1996 to 2000. The epidemiological profile, circumstances, toxicology results, location, and injuries were examined. There were 263 deaths: 242 homicides, 17 suicides, and 4 accidents. Among the homicides, 96% involved Black or Hispanic and 68% involved 17 and 18-year-old decedents. There were 11 times as many male as female homicides. The detection of ethanol and/or illicit drugs was 56% in the homicide and 53% in the suicide groups. Suicide notes were found in 18% of suicides, and an additional 35% verbally expressed a plan to commit suicide. Most suicides (77%) were in the home and half of the homicides occurred on the street.     

Suicide in children and adolescents at a province in Turkey

Despite the well-documented increases in the rate of completed suicide among children, accurate knowledge of the characteristics of these suicides is limited. We examined all suicides by children and adolescents in Diyarbakir during 1999 and 2001. All of the cases were analyzed regarding the age, sex, method and location of suicide, time of year, and predictive factors. There were 56 children aged 11 through 19 years. Adolescents between 15 and 19 years of age constituted the overwhelming number (87%) of all the childhood suicides. Female children and adolescents predominated among the suicide victims (71%). The most frequent means of suicide were firearms (43%), hanging (28%), and jumping (16%), respectively. The majority of suicides occurred at the decedent's home (88%). Reasons identified were mainly psychiatric disorders, followed by troubles within the family. A prior suicide attempt or a note that was left by the decedent and elucidated the reason for the suicide was rare. There was no seasonal difference in rates of suicides.     

Peculiarities of combined blunt head injuries in children and adolescents

The objective of the present study was to evaluate the frequency and peculiar features of combined head injuries in children and adolescents who suffered the fatal blunt trauma. A total of 101 corpses and 188 archive records were available for the analysis. The control data group was comprised of 227 original observations of adult corpses. It was shown that head injuries prevail over injuries to other parts of the body in children with combined blunt traumas. The craniocerebral injuries are more frequent in children and adolescents than in adult subjects but their extent is smaller. Fractures of the facial bone skeleton in adults occur twice as frequently as in children. A peculiar feature of craniocerebral injuries in children and adolescents is incomplete splintered fractures and folded deformation of the bone plate. Subarachnoidal hemorrhage occurs equally frequently in children and adults with craniocerebral injuries. Other intracranial manifestations of the injury, such as ruptured brain tunics, epidural and subdural hemorrhage, cerebral contusion and ventricular hemorrhage in children occur less frequently than in adults.     

Suicide in children and adolescents: a 10-year retrospective review

Suicide is second only to accidents as the most common cause of death for children and adolescents age 10 to 19 in Canada. All of the pediatric cases that were referred to the Hamilton Regional Forensic Pathology Unit from 1993 to 2002 were reviewed. For the purpose of this study, pediatric deaths were defined as deaths in the age group of 1 day up to and including 19 years of age. Specific criteria for suicide were applied to each case, independent of the manner of death issued by the coroner. The criteria were 3-fold. First, homicide had to be ruled out by the police investigation and autopsy findings. Second, the method had to be consistent with self-infliction. Finally, there had to be some evidence of suicidal intent. Questionable cases were discussed among the authors, and if reasonable intent could not be established, then the case was excluded. The autopsy and police reports were examined in detail regarding age, sex, location and method of suicide, presence of suicide notes, and any contributing psychologic factors or stressors. Of the 501 pediatric autopsies performed during the 10-year period, 31 (6%) met the criteria of suicide. The majority of cases (87%) were in older adolescents (age 15 to 19), and the male to female ratio was 2.4:1. Psychologic factors were identified in some of the cases, including depressed mood (77%), suicidal ideation (45%), previous suicide attempts (23%), and drug or alcohol problems (19%). Most of the suicides (61%) occurred in the victim's home, and 12 (39%) cases left a suicide note. In 9 cases (29%), alcohol or street drugs were detected postmortem, though in 8 cases toxicology was not performed. Hanging (48%) was the most common method of suicide, followed by firearms (13%), poisoning (10%), drowning (10%), and blunt force vehicular trauma (10%). Almost 60% of the male suicides were by hanging. No specific trend was identified in the 9 female suicides. These results were compared with similar studies within Canada and other countries. Overall, the method of suicide is dictated by what is convenient and readily available, though the acceptance of various suicide methods can change over time. Suicide prevention efforts should be tailored to address local trends.     

Asphyxial deaths: a retrospective study and review of the literature

An increasing death rate as a result of violence constitutes a large group in medicolegal autopsies. Specially, deaths due to asphyxia are one of the most important causes in violence deaths.During the 21-year period from January 1984 to October 2004, there were 134 asphyxial deaths autopsied by the Department of Forensic Medicine, Trakya University, Edirne, Turkey. Asphyxial deaths comprise 15.7% of all forensic autopsies; 20.8% of the cases are aged between 30 and 39 years, and the average age was 41.9 years. Males constitute 79.8% of all the cases.The most frequent method of asphyxiation death is hanging (56 cases, 41.8%), followed by drowning (30.5%) and carbon monoxide poisoning (8.2%). More violent methods, such as ligature or manual strangulations, constitute 2.9% and 2.3% of all asphyxial deaths, respectively. Although it was varying according to the methods of asphyxiation, suicide was found to be the manner of death in the majority of the cases.     

Asphyxial suicide by inhalation of helium inside a plastic bag

Asphyxial suicide by placing a plastic bag over the head, especially in combination with inhalation of gases, is a rarely described method of committing suicide. This article reports a case of suicidal asphyxiation by inhaling the inert gas helium inside a plastic bag. A 64-year-old man probably followed the instructions described in an article about committing suicide written by a medical practitioner from Zürich. This form of suicide is recommended by right-to-die groups and in the internet as a certain, fast, and painless suicide method. Additionally, it leaves only seldom externally visible marks or pathomorphological findings on the body. If the plastic bag and other auxiliary means are removed by another person, the forensic death investigation of cause and manner of death may be very difficult. Therefore, the death scene investigation and the inquiry ordered in the environment of the deceased are very important.     

Asphyxial deaths from the recreational use of nitrous oxide.

The recreational use of nitrous oxide is widespread. Nitrous oxide for recreational use is usually obtained from anesthesia tanks or whipped-cream machine chargers or cans. Twenty previously described deaths associated with recreational nitrous-oxide use describe anesthesia tanks and whipped-cream machine dispensors as a source. Five deaths associated with nitrous oxide use are presented; two involving whipped-cream cannisters as the source, two involving anesthesia tanks, and one involving a racing fuel tank as a source of nitrous oxide. Autopsy findings in our cases were subtle or negative, but usually suggestive of asphyxia. Through a laboratory simulation, we have confirmed that nitrous oxide displaces oxygen in a closed space, which probably leads to asphyxia. A review of the literature, neuropharmacology, and pathophysiology of nitrous oxide use is also presented.     

Asphyxial death during prone restraint revisited: a report of 21 cases

Determining the cause of death when a restrained person suddenly dies is a problem for death investigators. Twenty-one cases of death during prone restraint are reported as examples of the common elements and range of variation in these apparently asphyxial events. A reasonable diagnosis of restraint asphyxia can usually be made after ruling out other causes and collecting supportive participant and witness statements in a timely fashion. Common elements in this syndrome include prone restraint with pressure on the upper torso; handcuffing, leg restraint, or hogtying; acute psychosis and agitation, often stimulant drug induced; physical exertion and struggle; and obesity. Establishing a temporal association between the restraint and the sudden loss of consciousness/death is critical to making a correct determination of cause of death.     

Eruption times of permanent teeth in children and adolescents of Paderborn, Westphalia, Germany

The eruption times of permanent teeth and the sequence of tooth eruption were investigated in 1535 individuals aged 3 to 24 years. Wisdom teeth were excluded from the evaluation. All individuals were inhabitants of Paderborn, Westphalia, Germany. The results were compared to results of other German studies on tooth eruption of the 20th century. The teeth emerged symmetrically in each jaw. However, teeth erupted earlier in the mandible than in the maxilla. Teeth erupted earlier in females than in males. The sequence of emerging teeth in the maxilla is identical in both sexes: first molar, central incisor, lateral incisor, first premolar, and canine, second premolar, second molar. The sequence of tooth eruption of the mandible is identical in both sexes but differs from the maxillary sequence: first molar, central incisor, lateral incisor, canine, first premolar, second premolar, second molar. Since the fifties of the last century the acceleration of teeth emergence has not increased in German studies on this subject.     

Eruption times of permanent teeth in male children and adolescents of Tehran (Iran)

The eruption times of permanent teeth and the sequence of tooth eruption were investigated in 952 individuals aged 4 to 24 years. Wisdom teeth were excluded from the evaluation. All individuals were inhabitants of Tehran, Iran. The results were compared to results of international studies on tooth eruption of the 20th century and studies published in recent years. The teeth emerged symmetrically in each jaw. However, teeth erupted earlier in the mandible than in the maxilla, excluding the earlier eruption of maxillary premolars. The sequence of emerging teeth in the maxilla is: first molar, central incisor, lateral incisor, first premolar, second premolar, canine, and second molar. The sequence of tooth eruption of the mandible differs from the maxillary sequence: first molar, central incisor, lateral incisor, canine, first premolar, second premolar, second molar. The sequence of all teeth is: lower first molar, lower central incisor, upper first molar, upper central incisor, lower lateral incisor, upper lateral incisor, upper first premolar, lower canine, lower first premolar, upper second premolar, upper canine, lower second premolar, lower second molar, and upper second molar. The results support current theories that the differences in tooth eruption times between humans of different ethnic origin are small.     

Children rearing children: A study of reportedly maltreating younger adolescents

This ex post facto study of officially reported child abuse and neglect incidents examined the demographic and dynamic variables associated with reportedly maltreating adolescent mothers of differing ages. A sample of one half of all the incidents reported within Maricopa County, Arizona, was drawn for the period January 1, 1976, through December 31, 1978 (N =5,098). Adolescent mothers were compared on the basis of their age at the time of the incident, and were categorized as younger adolescents (less than 16 years of age) and older adolescents (16 to 19 years of age). It was found that this total sample of adolescents was faced with pressures such as those found within the general, non-age-specific maltreating population. However, the younger adolescent was faced with the greatest financial stress, yet was less likely to be receiving any income supplement. Additionally, the younger adolescent was more likely to be a minority group member, was less likely to be married, and the maltreating situation involved neglect of children. In sum, the reported situation was likely to have been a direct result of the financial, educational, employment, and life experience limitations found in the adolescent's environment. Discussion of the findings reported that the younger adolescent parent's problems were rooted in basic survival and environmental stabilization needs. Implications and suggestions for further research are also presented.     

Coase theorem and exchangeable rights in non-cooperative games

In this paper we consider the Coase theorem in a non cooperative game framework. In particular, we explore the Coase theorem with respect to the final distribution of alienable property rights which constitutes, as far as we know, a less cultivated field of research. In our framework, in order to reach efficiency, agents have to stipulate binding contracts (temporary or permanent). We show under our payoff conditions the role of binding contracts (permanent and temporary) in the final attribution of individual rights.     

Relationship between type of trauma exposure and posttraumatic stress disorder among urban children and adolescents

This study examines the association between trauma exposure and posttraumatic stress disorder (PTSD) among 157 help-seeking children (aged 8-17). Structured clinical interviews are carried out, and linear and logistic regression analyses are conducted to examine the relationship between PTSD and type of trauma exposure controlling for age, gender, and ethnicity. Confrontation with traumatic news, witnessing domestic violence, physical abuse, and sexual abuse are each significantly associated with PTSD. Witnessing a crime, being the victim of a crime, and exposure to accidents, fire, or disaster are not associated with PTSD. These findings underscore the association between interpersonal violence and childhood PTSD.