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  • 1.
    Ahlm, Kristin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Lindqvist, Per
    Division of Social and Forensic Psychiatry, Karolinska Institutet, Stockholm, Sweden; Dalarna University, Falun, Sweden.
    Saveman, Britt-inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Suicidal drowning deaths in northern Sweden 1992-2009: the role of mental disorder and intoxication2015In: Journal of Forensic and Legal Medicine, ISSN 1752-928X, E-ISSN 1878-7487, Vol. 34, p. 168-172Article in journal (Refereed)
    Abstract [en]

    Suicides by drowning have received limited attention by researchers. A recent finding that almost onethird of all drowning deaths in Sweden were classified as suicide instigated this study. We identified 129 cases of suicide by drowning in Northern Sweden and analyzed the circumstances and the psychiatric history prior to the suicide. Information was obtained from autopsy, police and medical records, as well as from the National Inpatient Register. One-third of the suicide victims had previously attempted suicide and half of the victims had been hospitalized due to mental health problems. One-third of these had left the hospital less than one week before the suicide. Alcohol and psychoactive drugs were present in 16% and 62% of the cases, respectively. A history of mental disorder and previous suicide attempt (s), especially by drowning, is an ominous combination necessitating efficient clinical identification, treatment and follow-up if a complete suicide is to be prevented.

  • 2. Colville-Ebeling, Bonnie
    et al.
    Freeman, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Banner, Jytte
    Lynnerup, Niels
    Autopsy practice in forensic pathology - Evidence-based or experience-based?: A review of autopsies performed on victims of traumatic asphyxia in a mass disaster2014In: Journal of Forensic and Legal Medicine, ISSN 1752-928X, E-ISSN 1878-7487, Vol. 22, p. 33-36Article in journal (Refereed)
    Abstract [en]

    Current autopsy practice in forensic pathology is to a large extent based on experience and individual customary practices as opposed to evidence and consensus based practices. As a result there is the potential for substantial variation in how knowledge is applied in each case. In the present case series, we describe the variation observed in autopsy reports by five different pathologists of eight victims who died simultaneously from traumatic asphyxia due to compression during a human stampede. We observed that there was no mention of the availability of medical charts in five of the reports, of potentially confounding resuscitation efforts in three reports, of cardinal signs in seven reports and of associated injuries to a various degree in all reports. Further, there was mention of supplemental histological examination in two reports and of pre-autopsy radiograph in six reports. We inferred that reliance on experience and individual customary practices led to disparities between the autopsy reports as well as omissions of important information such as cardinal signs, and conclude that such reliance increases the potential for error in autopsy practice. We suggest that pre-autopsy data-gathering and the use of check lists specific to certain injury causes are likely to result in less deviation from evidence-based practices in forensic pathology. Pre-autopsy data-gathering and check lists will help ensure a higher degree of standardization in autopsy reports thus enhancing the quality and accuracy of the report as a legal document as well as rendering it more useful for data-gathering efforts. (C) 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  • 3.
    Freeman, Michael
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Leith, Wendy
    Head and neck injury patterns in fatal falls: epidemiologic and biomechanical considerations2014In: Journal of Forensic and Legal Medicine, ISSN 1752-928X, E-ISSN 1878-7487, Vol. 21, p. 64-70Article in journal (Refereed)
    Abstract [en]

    Fatal falls often involve a head impact, which are in turn associated with a fracture of the skull or cervical spine. Prior authors have noted that the degree of inversion of the victim at the time of impact is an important predictor of the distribution of skull fractures, with skull base fractures more common than skull vault fractures in falls with a high degree of inversion. The majority of fatal fall publications have focused on skull fractures, and no research has described the association between fall circumstances and the distribution of fractures in the skull and neck. In the present study, we accessed data regarding head and neck fractures resulting from fatal falls from a Swedish autopsy database for the years 1992–2010, for the purposes of examining the relationships between skull and cervical spine fracture distribution and the circumstances of the fatal fall.

    Out of 102,310 medico-legal autopsies performed there were 1008 cases of falls associated with skull or cervical spine fractures. The circumstances of the falls were grouped in 3 statistically homogenous categories; falls occurring at ground level, falls from a height of <3 m or down stairs, and falls from ≥3 m. Only head and neck injuries and fractures that were associated with the fatal CNS injuries were included for study, and categorized as skull vault and skull base fractures, upper cervical injuries (C0–C1 dislocation, C1 and C2 fractures), and lower cervical fractures. Logistic regression modeling revealed increased odds of skull base and lower cervical fracture in the middle and upper fall severity groups, relative to ground level falls (lower cervical <3 m falls, OR = 2.55 [1.32, 4.92]; lower cervical ≥3 m falls, OR = 2.23 [0.98, 5.08]; skull base <3 m falls, OR = 1.82 [1.32, 2.50]; skull base ≥3 m falls, OR = 2.30 [1.55, 3.40]). C0–C1 dislocations were strongly related to fall height, with an OR of 8.3 for ≥3 m falls versus ground level. The findings of increased odds of skull base and lower cervical spine fracture in falls from a height are consistent with prior observations that the risk of such injuries is related to the degree of victim inversion at impact. The finding that C0–C1 dislocations are most common in falls from more than 3 m is unique, an indication that the injuries likely result from high energy shear forces rather than pure tension, as previously thought.

  • 4.
    Freeman, Michael
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Hand, ML
    Rossignol, AM
    Applied forensic epidemiology: a Bayesian evaluation of forensic evidence in a vehicular homicide investigation2009In: Journal of Forensic and Legal Medicine, ISSN 1752-928X, E-ISSN 1878-7487, Vol. 16, no 2, p. 83-92Article in journal (Refereed)
    Abstract [en]

    The comparative weighting of evidence in a criminal case can be a complicated task when the relevance or meaning of the evidence is disputed. An example of this complexity in seen in vehicular homicide investigations in which the identity of the driver (and thus the guilty party) is not clear. The discipline of Forensic Epidemiology, including the appropriate application of Bayes' Theorem (Bayes' Law) provides a systematic framework to bring clarity to the evaluation of such matters. Bayes' is a useful tool for the conditioning and quantification of probabilities associated with evidence in a vehicular homicide investigation. The authors present a case study in the application of Bayes' Theorem to the facts in a vehicular homicide investigation. An initial analysis of the crash dynamics in comparison with the injury pattern and ejection status of the surviving occupant versus that of the decedent suggested that the survivor was the driver. The results of the analysis were used as tests for guilt, with estimated true and false positive rates, which then formed the basis for a Bayesian calculation of the posterior probability of the survivor's guilt given the evidence. As a result of the Bayesian analysis described herein, it was determined that the survivor was 19 times more likely to have been the driver, in comparison with the decedent. This ratio far exceeded the suggested threshold of 10:1 for establishing the guilt of the survivor beyond a reasonable doubt. When used properly, Bayes' Theorem can offer definitive insight in the investigation and prosecution of vehicular homicide cases.

  • 5.
    Gustafsson, Torfinn
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Wingren, C. J.
    Multivariate linear regression modelling of lung weight in 24,056 Swedish medico-legal autopsy cases2017In: Journal of Forensic and Legal Medicine, ISSN 1752-928X, E-ISSN 1878-7487, Vol. 46, p. 20-22Article in journal (Refereed)
    Abstract [en]

    Heavy combined lung weight at autopsy is a non-specific autopsy finding associated with certain causes of death such as intoxication. There is however no clear definition of what constitutes "heavy" lung weight. Different reference values have been suggested but previous studies have been limited by small select populations and only univariate regression has been attempted. The aim of this study was to create a model to estimate lung weight from decedent parameters. We identified all cases >18 years age autopsied at the Swedish National Board of Forensic Medicine from 2000 through 2013, excluding cases with a post-mortem interval >5 days as well as cases with extreme values, totalling 24,056 cases. We analysed body weight, body height, sex, age, BMI, BSA as well as untransformed and transformed lung weight. The analysis was stratified for sex. We evaluated the fit of the models and that the model assumptions were not violated. We set out to apply the model with the highest residual sum of squares to derive limits for heavy lungs. In univariate regression BSA and height showed best performance. The final model included height, weight and age group. After excluding large standardized residuals (>3, <-3) the final model achieved R-2 of 0.132 and 0.106 for women and men respectively. While we managed to create a multivariate model its performance was poor, possibly a fact reflective of the physiological nature of the lungs and in turn its variability in fluid content. Linear regression is a poor model for estimating lung weight in an unselected population.

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