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  • 1.
    Ahlm, Kristin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Traffic and drowning incidents with emphasis on the presence of alcohol and drugs2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Worldwide, fatal traffic injuries and drowning deaths are important problems. The aim of this thesis was to investigate the cirumstances of fatal and non-fatal traffic injuries and drowning deaths in Sweden including analysis of the presence of alcohol and drugs, which are considered to be major risk factors for these events. Data where obtained from the database of National Board of Forensic Medicine.

    In the first study, we investigated 420 passenger deaths from 372 crashes during 1993-1996. There were 594 drivers involved. In total, 21% of the drivers at fault were alcohol positive compared to 2% of drivers not at fault (p<0.001) (Paper I). During 2004-2007, crashes involving 56 fatally and 144 non-fatally injured drivers were investigated in a prospective study from Northern Sweden (Paper II). The drivers were alcohol positive in 38% and 21%, respectively. Psychoactive drugs were found in 7% and 13%, respectively. Benzodiazepines, opiates and antidepressants were the most frequent drugs found in drivers. Illict drugs were found 9% and 4% respectively, with tetrahydrocannabinol being the most frequent of these drugs (Paper II).

    We investigated 5,125 drowning deaths in Sweden during 1992-2009 (Paper III). The incidence decreased on average by about 2% each year (p<0.001). Unintentional drowning was most common (50%). Alcohol was found in 44% of unintentional, 24% of intentional, and 45% of undetermined drowning deaths. Psychoactive substances were detected in 40% and benzodiazepines were the most common substance. Illicit drugs were detected in 10%. Of all drowning deaths, a significantly higher proportion females commited suicide compared with males (55% vs. 21%, p<0.001). Suicidal drowning deaths (n=129) in Northern Sweden were studied further in detail (Paper IV). of these, 53% had been hospitalized due to a psychiatric diagnosis within five years prior to the suicide. Affective and psychotic disorders were the most common psychiatric diagnoses. Almost one third had performed a previous suicide attempt. One fourth had committed suicide after less than one week of discharge from hospital. Alochol was found in 16% and psychoactive drugs in 62% of these cases, respectively. 

    In conclusion, alcohol and psychoactive drugs are commonly detected among injured drivers and drowning victims, and probably play a role in these events. Most of the individuals that tested positive for alcohol and high blood concentrations, indicating alochol dependence or abuse. This association warrants futher attention when planning future prevention. 

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    Traffic and drowning incidents with emphasis on the presence of alcohol and drugs
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  • 2.
    Ahlm, Kristin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Öström, Mats
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Alcohol and drugs in fatally and non-fatally injured motor vehicle drivers in northern Sweden2009In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 41, no 1, p. 129-136Article in journal (Refereed)
    Abstract [en]

    Alcohol and drugs are important risk factors for traffic injuries, a major health problem worldwide. This prospective study investigated the epidemiology and the presence of alcohol and drugs in fatally and hospitalized non-fatally injured drivers of motor vehicles in northern Sweden. During a 2-year study period, blood from fatally and hospitalized non-fatally injured drivers was tested for alcohol and drugs. The study subjects were recruited from well-defined geographical areas with known demographics. Autopsy reports, medical journals, police reports, and toxicological analyses were evaluated. Of the fatally injured, 38% tested positive for alcohol and of the non-fatally 21% tested positive; 7% and 13%, respectively, tested positive for pharmaceuticals with a warning for impaired driving; 9% and 4%, respectively, tested positive for illicit drugs. The most frequently detected pharmaceuticals were benzodiazepines, opiates, and antidepressants. Tetrahydrocannabinol was the most frequently detected illicit substance. No fatally injured women had illegal blood alcohol concentration. The relative proportion of positively tested drivers has increased and was higher than in a similar study 14 years earlier. This finding indicates that alcohol and drugs merit more attention in future traffic safety work.

  • 3.
    Ahlm, Kristin
    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.
    Blood loss in exsanguination deaths2011In: Indian Journal of Forensic Medicine & Toxicology, ISSN 0973-9122, Vol. 5, no 2, p. 5-8Article in journal (Refereed)
    Abstract [en]

    Deaths by exsanguination among various underlying causes of death were analyzed in order to expand the knowledge on the relation of extravasated blood volume to other documented parameters.

    A consecutive series of 193 cases of ruptured thoracic aortic aneurysm (n=13), gunshot wounds (n=63), stab wounds (n=28), rib fractures (n=5), and blunt injury to thoracic aorta (n=84) were investigated.

    The amount of internal bleeding into pleural cavities only varied greatly (200-3,400 ml) with a mean value of 1,174 ml, slightly higher among males. Age, body weight, cause and manner of death, external bleeding, alcohol inebriation, multiplicity of injuries, and degree of coronary heart disease did not significantly affect the amount of internal (pleural) bleeding. Also, post-mortem delay to autopsy did not correlated to the amount of extravasated blood, indicating that post-mortem bleeding is of no importance in these days.

     

  • 4.
    Ahlm, Kristin
    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.
    Driver's alcohol and passenger's death in motor vehicle crashes2006In: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 7, no 3, p. 219-223Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Previous studies on alcohol involvement associated with fatal injury in traffic crashes have focused on the drivers, but the passenger's view is not well known. This study (1) analyzes the relationship between passenger's death and alcohol inebriation of the driver and (2) estimates the role of alcohol as the cause of a crash by examining who was at fault, sober, or inebriated.

    METHOD: The study includes all motor vehicle passengers (n = 420) who died in crashes in Sweden 1993 through 1996 and were medicolegally autopsied. Autopsy reports from the Departments of Forensic Medicine, including toxicological analyses, and police reports were studied. Presence of alcohol among drivers was based on blood and breath tests.

    RESULTS: One-fifth of the fatally injured passengers and one-fifth of the tested drivers were under the influence of alcohol. The youngest drivers had the highest prevalence of drunken driving. Drivers at fault were alcohol positive in 21% of these crashes and drivers were not at fault in 2% of these crashes. In 53% of the crashes where both the passenger and driver were alcohol positive, the passenger had a lower alcohol concentration than the driver. Children (<16 years) comprised 15% of the killed passengers. Notably, the children were riding with a driver who was under influence of alcohol in 13% of these crashes. Alcohol involvement was not tested in half of the surviving drivers.

    CONCLUSIONS: The data show that 20% of both passengers and drivers were under the influence of alcohol. Increased testing of surviving drivers regarding alcohol and other drugs is recommended.

  • 5.
    Ahlm, Kristin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Hassler, Sven
    Sjölander, Per
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Unnatural deaths in reindeer-herding Sami families in Sweden, 1961-20012010In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 69, no 2, p. 129-137Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Unnatural deaths among Indigenous populations, including the Swedish Sami, occur more often than among the general population. To find prevention strategies, we explored the circumstances of the unnatural deaths of members of reindeer-herding Sami families.

    STUDY DESIGN: The number of deaths from among a cohort of 7,482 members of reindeer-herding Sami families were retrieved from the National Board of Health and Welfare for the years 1961- 2001.

    METHODS: An evaluation of the information from autopsy records at the National Board of Forensic Medicine, police reports, and available medical records identified 158 unnatural deaths. These were then analysed in detail.

    RESULTS: Transport-related deaths and suicides were the most common unnatural deaths among Swedish reindeer-herding Sami family members. Suicides contributed to 23% of all deaths, road traffic accidents to 16%, and snowmobile fatalities to 11%. The accidents generally reflected an "outdoor lifestyle" and the working conditions were characterized by the use of off-road vehicles such as snowmobiles. Half of the number of victims tested positive for alcohol and alcohol abuse was documented in 15% of all victims.

    CONCLUSIONS: The results indicate that alcohol is an important factor in preventing unnatural deaths among reindeer-herding Sami, together with increased safety of both on-road and off-road transportation.

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  • 6.
    Ahlm, Kristin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Saveman, Britt-inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Suicidal drowning deaths in Northern Sweden 1992-2009Manuscript (preprint) (Other academic)
  • 7.
    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.

  • 8.
    Ahlm, Kristin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    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.
    Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs: a retrospective study, 1992-20092013In: BMC Public Health, E-ISSN 1471-2458, Vol. 13, p. 216-Article in journal (Refereed)
    Abstract [en]

    Background: Drowning deaths constitute a significant proportion of unnatural deaths globally. In Sweden and other high-income countries, drowning deaths have decreased. This study investigates the epidemiology and current trends of unintentional, intentional, and undetermined drowning deaths with emphasis on the presence of alcohol and other drugs.

    Methods: During an 18-years period, 5,125 drowning deaths were autopsied in Sweden. Data on cases including toxicological analysis on alcohol, pharmaceutical drugs, and illicit drugs were obtained from the National Board of Forensic Medicine.

    Results: During the study period, the annual incidence of drowning deaths in Sweden was 3.1/100,000 inhabitants and decreased on average by about 2% each year (p<0.001). The highest incidence was found among males and in middle/older age groups. The incidence increased 3% for each year of age. Children/adolescents (<= 18 years) constituted 5% of all drowning deaths. Of all drowned females in the study, 55% (847/1,547) committed suicide, which was a significantly higher proportion compared with males (21%, 763/3,578) (p<0.001). In total, 38% (1,656/4,377) of tested drowned persons had alcohol in their blood and the mean concentration was 1.8 g/l. In the unintentional drowning group, intentional drowning group, and the undetermined group, the proportion of alcohol positive was 44%, 24%, and 45%, respectively. One or several psychoactive drugs were present in the blood in 40% (1,688/4,181) of all tested persons and in 69% (965/1,394) of tested persons who died from suicidal drowning. The most common drug was benzodiazepines (21%, 891/4,181). Illicit drugs were detected in 10% (82/854) of tested persons.

    Conclusion: Presence of alcohol and drugs were frequent and may have contributed to the drowning deaths. The incidence of drowning deaths significantly decreased during the study period. Males and the middle/older age groups had a higher incidence compared to females and children. Suicidal drowning was common especially among women. Alcohol and drugs are significant contributors in drowning deaths in Sweden and should be considered as part of a comprehensive prevention program.

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  • 9.
    Alm, Fredrik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Barn som dödar barn2012Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    Två svenska pojkar, Texas Linderot och Kevin Hjalmarsson, var båda fyra år gamla med en tydlig sak gemensam. Båda är döda. När det är ett barn som blivit dödat/mördat vill vi inte tro att det är sant.  

     

    I de båda fallen med pojkarna var det inte en vuxen person eller en pedofil som var gärningsmännen, det var barn. Kevin Hjalmarssons mördare var två syskon som var fem respektive sju år gamla. Texas Linderoths mördare var en pojke som var tio år gammal.

    Vad är det som har hänt de båda mördade pojkarna är frågor som vi ställer oss.

    Var det lekar som gått snett?

     

    Nu i efterhand vet vi svaren på frågorna och vi vet med säkerhet att det inte var en lek som gick snett. Det var barn som med avsikt mördade andra barn. I båda fallen var det rättsläkarna på Rättsmedicinalverket som kunde konstatera att dödsorsaken var strypning och dödsättet inte skett genom en olycka  utan troligt orsakats av någon utomstående.

    När massmedia berättade den hemska sanningen bakom dessa två mord var vi många som inte trodde det var sant. Vi vill nog tro att barn är goda och inte benägna att utföra hemska våldshandlingar.

  • 10.
    Atmarsson, Kamilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    När är en människa död?: En studie av den juridiska definitionen av döden2012Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    Fram till den 1 januari 1988 saknade Sverige rättsregler som angav när en människa skulle anses vara död. Innan år 1984 hade inte heller frågan om dödsbegreppet lyfts till analys. I medicinsk przis hade emellertid döden sedan länge ansetts träda in vid det tillfälle då en människas hjärt- och andningsverksamhet varaktigt upphört. Under intensivsvårdens växande framsteg på sextio-, sjuttio- och åttiotalen utvecklades dock ett behov av att både ändra den allmänt vedertagna definitionen av dödens inträdande och av att införa en juridiskt bindande definition om när döden ansågs ha inträffat. Efter en omfattande utredning beslutades till sist att lagstadga dödsbegreppet och döden definierades ha inträffat när hjärnans samtliga funktioner totalt och oåterkalleligt fallit bort. Frågan som ställs i denna uppsats är hur dagens definition av döden lyder. Uppsatsen undersöker därav skälen som föranlett den nuvarande definitionen och hur den rent praktiskt går till när döden ska fastställas.

  • 11.
    Balciunaite, Elona
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Vad säger skadorna om gärningsmannen?: beydelse i brottsutredningen Gärningsmannaprofilering2010Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    Vissa typer av brott kräver stora insatser och kunskap för att hitta en gärningsman. Sådana situationer uppstår när ett offer är död och/eller när man har ett seriemord eller till och med när ett offer har svåra skador med är medvetslöst. I vissa fall kan det vara att offret inte vet vem gärningsman är. Man bör inte heller glömma ett levande offer som skadat sig själv.

       Just skadorna som återfinns hos ett offer indikerar en hel del om en gärningsman. Till skillnad från det juridiska begreppet – en skada, som används i brottsrubriceringssyfte[1], så används skadorna som finns på ett offer i utredningsarbetet för att hitta en gärningsman och återskapa ett händelseförlopp. Med andra ord försöker man svara på frågor: vem har begått ett brott, hur och när brottet har begåtts och varför det har begåtts.[2] Själva utredningsarbetet som omfattar gärningsmannaidentifiering kan i vissa komplicerade, allvarliga fall även inkludera en gärningsmannaprofilering. Syftet är att hitta en gärningsman, dvs. även verifiera om det är just den person som begått visst brott – bevissyfte.

       Skadorna bedöms utifrån art, ålder, grad och antal, t.ex. vilken karaktär en skada har, hur den kunde uppkomma osv. Man försöker bedöma utifrån skadornas art eller andra förhållanden om det kan tyda på ett bestämt motiv, planering av brott eller om det handlar om en impulshandling.[3]

    [1] Thomsen, s. 85.

    [2] Ainsworth, s. 17.

    [3] Thomsen, s. 148-153.

  • 12.
    Beer, Torfinn
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    An epidemiological perspective on heart and lung weight in cardiac and intoxication deaths2022Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The main purpose of a medico-legal autopsy is to determine the cause and manner of death. A forensic pathologist makes assessments of this using several sources of information, one of which is the discrepancy between measured organ weight and reference values. Of particular interest is the heart weight in heart disease and the weight of the lungs in fatal intoxications. 

    In this thesis, a linear model of lung weight was created, but the model could at best explain only 13% of the variation in combined lung weight (Paper I). Unsurprisingly, this meant that the model was a poor definition of “normal” lung weight and could not be used to identify intoxication cases (Paper II). A ratio of lung weight to heart weight (LWHW ratio) also failed to differentiate intoxication cases from controls. The poor performance of these methods could plausibly have been due to fatal intoxications with only some substances being associated with increased lung weight, but an analysis showed that many common intoxicants were associated with heavier lungs than hanging deaths (Paper III). 

    To establish heart weight references more applicable in a medico-legal autopsy population, a model of heart weight accounting for undiagnosed cardiac hypertrophy was created (Paper IV). The model showed that for a decedent of average the evidence that a was hypertrophic reached, substantial support at around 470 g.

    In conclusion, a definition of “heavy lungs” remains elusive. However, it seems to be a finding compatible with fatal intoxications with many substances and the low predictive value found may be due to study design. The heart weight model presented allows pathologists to assess the evidence of cardiac hypertrophy more easily than previously published models.

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  • 13.
    Beer, 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, Carl Johan
    Forensic Medicine Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Cardiac enlargement in a medicolegal autopsy setting2023In: American Journal of Forensic Medicine and Pathology, ISSN 0195-7910, E-ISSN 1533-404X, Vol. 44, no 4, p. 267-272Article in journal (Refereed)
    Abstract [en]

    A key element for diagnosing cardiac enlargement in an autopsy setting is relevant heart weight references. However, most available references are to a large extent not representative of a medicolegal autopsy population, implying that reference weights are likely lower than those in the relevant population.To establish more applicable heart weight references in a medicolegal autopsy population, we designed a heart weight model that accounts for undiagnosed cardiac enlargement using data from 11,897 nontraumatic Swedish medicolegal autopsy cases autopsied between 2010 and 2019. The model was validated in 296 nonobese young adult suicidal hanging cases.For a decedent of average height (174 cm), the evidence that a heart weight was enlarged reached weak support at approximately 430 g, substantial support at approximately 480 g, and strong support at 520 g. The modeled prevalence of cardiac enlargement was very high among elderly and obese decedents.We believe that our model is more applicable in a medicolegal setting than those previously published. The presented quantification of the degree of uncertainty regarding diagnosis can help the pathologist in diagnosing cardiac enlargement. To facilitate the use of this model, we also made it available through a simple online tool (https://formedum.shinyapps.io/HeartWeightCalc/).

  • 14.
    Beer, 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, Carl Johan
    Lunds universtitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Rättsmedicin.
    Diagnosing cardiac hypertrophy as a potential cause of death in a medico-legal autopsy populationManuscript (preprint) (Other academic)
  • 15.
    Beer, 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, Carl Johan
    Unit for Forensic Medicine, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Increased lung weight in fatal intoxications is not unique to opioid drugs2023In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 68, no 2, p. 518-523Article in journal (Refereed)
    Abstract [en]

    Fatal intoxications with opioids are known to be associated with an increased lung weight, as well as with brain and pulmonary edema and urinary retention. However, there is evidence to suggest that fatal intoxications with non-opioid substances are also associated with increased lung weight; however, the latter aspect has not been comprehensively analyzed. To determine to what extent opioid and non-opioid substances are associated with increased lung and brain weight, we studied these organs in cases where the cause of death was attributed to intoxication with a single agent. Using data from cases autopsied at the National Board of Forensic Medicine (NBFM) in Sweden from 2009 through 2019 where the cause of death was attributed to a single substance, we created models of combined lung weight and brain weight. The models used age and sex as predictors as well as nested varying effects for the specific intoxicant and category of intoxicant. Suicidal hanging with negative toxicology cases served as controls. The population majority was male among both intoxications (68%) and controls (83%). The most common single substance group was opioids. All tested substances were associated with heavier lungs than controls, with the largest effect in the opioid group. Our findings show that several substances are associated with increased lung weight and that among intoxication deaths there is no difference in expected brain weight between substances. Hence, heavy lungs, without a reasonable explanation, should prompt a broad toxicological screening.

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  • 16.
    Beer, 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, Carl Johan
    Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Rättsmedicin.
    Increased lung weight is not unique to fatal opioid intoxicationsManuscript (preprint) (Other academic)
  • 17.
    Bergqvist, Caroline
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Dödförklaring: Förändringari teorin och praktiken efter Estoniakatastrofen och tsunamin i Sydostasien2012Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    En händelse likt Estoniakatastrofen den 28 september 1994 eller tsunamin i Sydostasien den 26 december 2004 är förödande, inte bara för inblandade och dess familj utan för hela världen. Hur kan en sådan händelse inträffa? Varför inträffade det? Hade det kunna förebyggas? Tänk om just jag hade varit med, eller känt någon som var med, hur hade jag reagerat då? Flertalet frågor bland världens befolkning uppstår. Något som kanske inte väcker särskilt mycket uppmärksamhet eller frågor är vad som händer efter att de stora tidningarna slutat skriva om katastrofen, antalet offer är fastställt och allt går tillbaka till det vanliga i övriga världen. Men sökandet, och kanske framför allt lidandet, för de inblandade och närstående har bara börjat. I de båda ovan nämnda katastroferna har många svenskar varit inblandade och i båda katastroferna slutade arbetet med att söka offer långt innan alla var hittade. Personer, som med största sannolikhet avlidit, måste alltså dödförklaras utan att deras kroppar hittats.

    Den 1 april 2005 fick vi en ny lag, lag (2005:130) om dödförklaring (lagen om dödförklaring), med regler om hur och när dödförklaring ska ske. Lagen om dödförklaring ersatte kap. 25 i ärvdabalken (ÄB) som tidigare gällde. Reglerna i den nya lagen överensstämmer till viss del med den äldre regleringen men på en, för händelser likt Estoniakatastrofen och tsunamin i Sydostasien, viktig punkt skiljer de sig. Det är detta denna uppsats kommer behandla, vilken betydelse har ändringen – i teorin och i praktiken.

  • 18.
    Björkén, Elin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Medicinsk gräns mellan grov misshandel och synnerligen grov misshandel: En studie av svensk rättspraxis2014Student paper other, 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Den 1 juli 2010 infördes, genom SFS 2010:370, nya straffbestämmelser i brottsbalken (1962:700) (BrB). Dessa innebar en uppdelning av den grova formen av misshandel som reglerades i 3 kap. 6 § BrB, den kvalificerade formen av misshandel delades upp till grov misshandel och synnerligen grov misshandel. De grövsta brotten skulle omfattas av den strängare brottsrubriceringen som innebar en strängare straffskala på fyra till tio års fängelse, medan grov misshandel skulle ge fängelse om lägst ett år och högst sex år. Det främsta syftet med reformen var att de grövsta brotten skulle stå i proportion till brottets allvar då man tidigare gjort bedömningen att de grövsta brotten endast dömdes ut i den nedre delen av straffskalan.

     

    Olika rekvisit tas hänsyn till när domstolarna ska bedöma en misshandel som grov eller synnerligen grov men det jag främst vill undersöka i denna promemoria är om det finns någon medicinsk gräns som man kan utläsa för att skilja på grov misshandel samt synnerligen grov misshandel. Jag kommer främst försöka finna detta genom hänvisning till de rättsintyg som eventuellt finns med i domskälen till de rättsfall jag valt att studera. Ett rättsintyg är ett dokument som har arbetats fram av en läkare innehållande bedömning och beskrivning av olika medicinska fynd. Dessa dokument ska framläggas inför domstol eller användas vid utredning av brott. Ett rättsintyg är ingen patientjournal utan har ett juridiskt ändamål. I ett rättsintyg presenteras samtliga undersökningsfynd, både förekomst och frånvaro av skador.

  • 19.
    Björnstig, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Björnstig, Johanna
    The Emergency and Disaster Medical Center, University Hospital, SE-901 85 Umeå, Sweden.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine. Rättsmedicin.
    Passenger car collision fatalities - with special emphasis on collisions with heavy vehicles2008In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 40, no 1, p. 158-166Article in journal (Refereed)
    Abstract [en]

    Between 1995 and 2004, 293 passenger car occupants died in collisions with other vehicles in northern Sweden (annual incidence: 3.3 per 100,000 inhabitants, 6.9 per 100,000 cars, or 4.8 per 109 km driven); half of these deaths involved heavy vehicles. The annual number of passenger car occupant death per 100,000 cars in var-truck/bus collisions has remained unchanged since the 1980s, , but in car-car collisions it has decreased to one third of its former level. As crash objects, trucks and buses killed five times as many car occupants per truck/bus kilometer driven as did cars.

    The collisions were characterized by crashes in the oncoming vehicle´s lane, under icy, snowy, or wet conditions; crashes into heavy vehicles generally occurred in daylight, on workdays, in winter, and on 90 and 70 km/h two-lane roads. Head and chest injuries accouted for most of the fatal injuries. multiple fatal injuries and critical and deadly head injuries characterized the deaths in collisions with heavy vehicles.

    An indication of suicide was present in 4% of the deaths; for thos who crashed into trucks, this percentage was doubled. Among the driver victims, 4% had blood alcohol levels above the legal limit of 0.2 g/L.

    Frontal collision risks might be reduced by a mid-barrier, by building less injurious fronts on trucks and buses, by efficient skid prevention, and by use of flexible speed limits varying with road and light conditions.

  • 20.
    Blom, Josefina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Bevisning i våldtäktsmål: Hur starkt bevisvärde har rättsintyg?2012Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    Överfallsvåldtäkter är sällsynta och av naturliga skäl saknas oftast vittnen till händelsen, den huvudsakliga bevisningen består vanligtvis av målsägandens och den åtalades utsagor. I NJA 2009 s. 447 I och II menade Högsta domstolen att det inte räckte att målsägandens utsaga var mer trovärdig än den tilltalades. Det krävede dessutom att målsägandens utsaga, till den del det var möjligt, kunde kontrolleras. De två åtalade männen, som av lägre instanser dömdes för våldtäkt, friades av Högsta domstolen. Deras nekande och avsaknaden av stödbevis medförde att det inte kunde anses vara ställt utom rimligt tvivel att de gjort sig skyldiga till de påstådda brotten.

    I våldtäktsmål ska alltså målsägandens utsaga kontrolleras för att kunna värderas högre än den åtalades. Det gäller, i enlighet med NJA 2009 s. 447 I och II, även om den målsägandens utsaga anses vara mer trovärdig än den åtalades. Med andra ord är det särskilt viktigt med stödbevisning, till exemple i form av rättsintyg, i våldtäksmål om en fällande dom ska kunna komma på tal. Med anledning av ovanståden finner jag det intressant att undersöka i vilken omfattning rättsintyg har åberopats och vilket bevisvärde rättsintygen tillmäts i våldtäktsmål.

  • 21. Boman, Helena
    et al.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Forensic Medicine.
    Små barn lever farligt i traktorers närhet. Håll barn borta från traktorer; gör traktorer säkrare!1999In: Läkartidningen, ISSN 0023-7205, Vol. 96, no 18, p. 2222-4Article in journal (Other academic)
    Abstract [sv]

    Under åren 1992-1997 inträffade i Sverige 14 traktorrelaterade dödsfall bland barn. Elva var pojkar och medelåldern 5 år. I nära hälften av fallen var barnets far förare av traktorn. För att förebygga dessa händelser bör barn inte tillåtas vara i närheten av traktorer i arbete eller färdas som passagerare. Med hänsyn till hur svåråtkomlig "den mänsliga faktorn" är, torde också utvecklande av skadeförebyggande åtgärder i traktorn vara av betydelse.

  • 22.
    Boman, Helena
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
    Hedelin, Annika
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Forensic Medicine.
    "Avoidable" deaths in two areas of sweden - Analysis of deaths in hospital after injury1999In: The European journal of surgery = Acta chirurgica, ISSN 1102-4151, Vol. 165, no 9, p. 828-33Article in journal (Other academic)
    Abstract [en]

    OBJECTIVE: To describe causes of death and other characteristics of "avoidable" deaths in patients admitted to hospital after trauma, and estimate and analyse changes in the avoidable death rate during the years studied. DESIGN: Retrospective analysis of medico legal autopsy material. SETTING: One northern and one western area in Sweden 1988-1996. SUBJECTS: 335 cases who died in hospital after trauma. MAIN OUTCOME MEASURES: Avoidable death, defined as an Injury Severity Score (ISS) of 35 or less and Abbreviated Injury Scale (AIS) head of 4 or less and cause of death. RESULTS: We found 70 avoidable deaths (21%). Among these, 15 (21%) died of head injuries, 17 (24%) of thoracic, abdominal, or pelvic injuries, and 38 (54%) of medical complications. The number of deaths after trauma decreased considerably from 1988-90 to 1994-96, but the proportion who died in hospital remained almost constant. The proportion of avoidable deaths decreased from 22% to 17%, mainly because the proportion of deaths from medical complications was halved. CONCLUSION: The standard of Swedish in-hospital trauma care has improved, particularly with a reduction in post-traumatic complications. However, there is still room for improvement in the treatment of complications among elderly people.

  • 23.
    Brook, Chris
    et al.
    Universidad de La Laguna, Av. Del Astrofísico Francisco Sánchez, Tenerife, La Laguna, Spain.
    Lynøe, Niels
    Centre for Healthcare Ethics, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Balding, David
    School of BioSciences and School of Mathematics & Statistics, University of Melbourne, VIC, Australia.
    Retraction of a peer reviewed article suggests ongoing problems with Australian forensic science2021In: Forensic Science International: Synergy, E-ISSN 2589-871X, Vol. 3, article id 100208Article in journal (Other academic)
    Abstract [en]

    We describe events arising from the case of Joby Rowe, convicted of the homicide of his three month old daughter, and explore what they illustrate about systemic problems in the forensic science community in Australia. A peer reviewed journal article that scrutinized the forensic evidence presented in the Rowe case was retracted by a forensic science journal for reasons unrelated to quality or accuracy, under pressure from forensic medical experts criticized in the article. Details of the retraction obtained through freedom of information mechanisms reveal improper pressure and subversion of publishing processes in order to avoid scrutiny. The retraction was supported by the editorial board and two Australian forensic science societies, which is indicative of serious deficiencies in the leadership of forensic science in Australia. We propose paths forward including blind peer review, publication of expert reports, and a criminal cases review authority, that would help stimulate a culture that encourages scrutiny, and relies on evidence-based rather than eminence-based knowledge.

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  • 24.
    Brändström, Helge
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Giesbrecht, Gordon
    University of Manitoba, Winnipeg, Canada. Dep of Anesthesia.
    Ängquist, Karl-Axel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Haney, Michael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Fatal hypothermia: an analysis from a sub-arctic region2012In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 71, no 0, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Objectives. To determine the incidence as well as contributing factors to fatal hypothermia.

    Study design. Retrospective, registry-based analysis.

    Methods. Cases of fatal hypothermia were identified in the database of the National Board of Forensic Medicine for the 4 northernmost counties of Sweden and for the study period 1992-2008. Police reports, medical records and autopsy protocols were studied.

    Results. A total of 207 cases of fatal hypothermia were noted during the study period, giving an annual incidence of 1.35 per 100,000 inhabitants. Seventy-two percent occurred in rural areas, and 93% outdoors. Many (40%) were found within approximately 100 meters of a building. The majority (75%) occurred during the colder season (October to March). Some degree of paradoxical undressing was documented in 30%. Ethanol was detected in femoral vein blood in 43% of the victims. Contributing co-morbidity was common and included heart disease, earlier stroke, dementia, psychiatric disease, alcoholism, and recent trauma.

    Conclusions. With the identification of groups at high risk for fatal hypothermia, it should be possible to reduce risk through thoughtful interventions, particularly related to the highest risk subjects (rural, living alone, alcohol-imbibing, and psychiatric diagnosis-carrying) citizens.

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  • 25.
    Bäckstrom, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine. Department of Forensic Medicine, National Board of Forensic Medicine, PO Box 7616, SE-907 12 Umeå, Sweden..
    Hedlund, Jonatan
    Masterman, Thomas
    Sturup, Joakim
    Injury-Related Healthcare Use and Risk of Filicide Victimization: A Population-Based Case-Control Study2019In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 64, no 1, p. 166-170Article in journal (Refereed)
    Abstract [en]

    Research on child‐related risk factors for filicide is scant. We investigated whether prior healthcare use for injury (including poisoning) influences filicide risk. Victims (0–14 years; n = 71) were identified in a national autopsy database for the years 1994–2012 and compared to matched, general population controls (n = 355). Healthcare use data were retrieved from a national patient registry. Risks were estimated using odds ratios (ORs) and 95% confidence intervals (CIs). For females, prior inpatient care for injury conferred a statistically significant sevenfold risk (OR = 6.67 [95% CI: 1.49–29.79]), and any prior injury‐related healthcare use conferred a statistically significant fourfold risk (OR = 3.57 [95% CI: 1.13–11.25]), of filicide victimization. No statistically significant risks were found for males. Healthcare personnel should be aware that children treated for injuries, especially females, may be at an elevated risk of filicide victimization. Nevertheless, the filicide base rate remains low, and parents may be stigmatized by unfounded alerts; thus, prudent reflection should precede reports to the authorities.

  • 26.
    Bäckstrom, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine. Department of Forensic Medicine, National Board of Forensic Medicine, PO Box 7616, SE-907 12, Umeå.
    Johansson, Bengt
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Death from Nitrous Oxide2015In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 60, no 6, p. 1662-1665Article in journal (Refereed)
    Abstract [en]

    Nitrous oxide is an inflammable gas that gives no smell or taste. It has a history of abuse as long as its clinical use, and deaths, although rare, have been reported. We describe two cases of accidental deaths related to voluntary inhalation of nitrous oxide, both found dead with a gas mask covering the face. In an attempt to find an explanation to why the victims did not react properly to oncoming hypoxia, we performed experiments where a test person was allowed to breath in a closed system, with or without nitrous oxide added. Vital signs and gas concentrations as well as subjective symptoms were recorded. The experiments indicated that the explanation to the fact that neither of the descendents had reacted to oncoming hypoxia and hypercapnia was due to the inhalation of nitrous oxide. This study raises the question whether nitrous oxide really should be easily, commercially available.

  • 27.
    Bäckström, Björn
    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.
    Accidental death by voluntary nitrous oxide inhalation: effects on subjective dyspnea by nitrous oxide2015In: Scandinavian Journal of Forensic Science, ISSN 1503-9552, Vol. 21, no 1, p. 78-78Article in journal (Other academic)
  • 28.
    Bäckström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Sprogoe-Jakobsen, Susan
    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.
    Homicid among the young2012In: Scandinavian Journal of Forensic Science, ISSN 1503-9552, Vol. 18, p. 82-83Article in journal (Other academic)
  • 29.
    Bäckström, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Utfärdande av rättsintyg: Den åtalades möjligheter2010Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    ”Det bör ånyo framhållas att det inte är unikt för detta fall att sakkunniga har olika uppfattning om vilka slutsatser som kan dras av vid obduktioner och kompletterande undersökningar gjorda fynd.”[1]

     

    Ovanstående utlåtande gav Justitiekanslern i samband med hans granskning av de rättsmedicinska undersökningarna av Osmo Vallo efter att denne avlidit i samband med ett polisingripande den 30 maj 1995. Kroppen genomgick tre oberoende rättsmedicinska undersökningar vilka resulterade i olika slutsatser. Någon dödsorsak kunde dock inte fastställas.

     

    Till skillnad från obduktionsutlåtanden innehåller rättsintyg medicinska utlåtanden över skador på levande människor. Problemet med att fastställa orsak och verkan över skador och tillstånd är dock detsamma. Liksom i Osmo Vallos fall kan det vid utfärdande av rättsintyg vara mycket svårt att fastställa exakt hur en viss skada har uppkommit. Ett rättsintyg kan många gånger ha avgörande betydelse i brottmålsrättegång. Bland annat för att skapa en enhetlighet i verksamheten och en bättre kvalité på det rättsmedicinska arbetet i Sverige bildades 1991 Rättmedicinalverket. Detta är en statlig förvaltningsmyndighet som tillhandahåller expertis inom områdena rättspsykiatri, rättsmedicin, rättskemi och rättsgenetik. Verket är en mycket viktig del i det svenska rättssamhället genom att utfärda medicinska utlåtanden, däribland rättsintyg, till rättsväsendet. Men verket nekar idag andra parter än polis, åklagare och domstol att få rättsintyg utfärdade. Advokatsamfundet påpekade genom en skrivelse till Justitiedepartementet i september 2002 att detta inte är en acceptabel ordning och att det avsevärt kan undergräva den tilltalades möjlighet att effektivt bereda sitt försvar. [2]

    [1] Justitiekanslern i JK Dnr 2684, s. 7.

    [2] Advokatsamfundets skrivelse till justitiedepartementet den 16 september 2002.  (Bilaga 1).

  • 30.
    Carlborg, Emil
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    En fyrkantig definition av narkotika?: Uppfyller dagens narkotikareglering sitt syfte mot bakgrund av den snabba utvecklingen av nya narkotiska preparat?2012Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    Hösten 2010 kom ett larm från rättsmedicinska enheten i Umeå om den nya drogen krypton som vid det årsskiftet 2010/2011 tagit 9 personers liv.[1] Trots detta fanns ingen möjlighet för polisen och tullen att stoppa användandet av substansen, vilken såldes helt öppet på internet då denna inte ännu hunnit narkotikaklassas och således fortfarande var fullt laglig att såväl sälja som inneha och använda i Sverige.

     

    I narkotikastrafflagen (1968:64) (NSL) 8 § definieras narkotika som ”läkemedel eller hälsofarliga varor med beroendeframkallande egenskaper eller euforiserande effekter”, och substanser som med lätthet kan omvandlas till sådana varor. I paragrafen stadgas även att det krävs att substansen är föremål för kontroll enligt en internationell överenskommelse som Sverige biträtt eller att substansen har förklarats vara att anse som narkotika av regeringen att för att en substans ska vara förbjuden att inneha.

     

    Den svenska lagstiftningen medför förvisso en mycket hög grad av rättssäkerhet då man utan problem kan få fullständig klarhet i huruvida ett preparat är förbjudet eller inte. Problemet med lagstiftningen är emellertid att innan en ny substans kan narkotikaklassas måste preparatet genomgå en utredning hos Statens folkhälsoinstitut.[2] Denna tidsödande process innebär att substanser med i praktiken samma effekter som narkotikaklassade substanser kan säljas och användas fritt under långa perioder innan de kan förbjudas.

    [1]  Bäckström, Jörn G, Classon, Gisela, Löwenhielm, Peter, Thelander, Gunilla. 2010. Krypton – ny, dödlig Internetdrog, Läkartidningen. Nr. 50 vol. 107: 3196-3197.

    [2] 3§ 2p. Förordning (2009:267) med instruktion för Statens folkhälsoinstitut

  • 31. Carlsson, P
    et al.
    Thamsen, F
    Thiblin, I
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Death during apprehension2014Conference paper (Other academic)
  • 32.
    Centeno, Christopher J.
    et al.
    Centeno Schultz Clinic, Broomfield, CO, United States.
    Freeman, Michael D.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine. Department of Public Health and Preventive Medicine, Oregon Health and Science University School of Medicine, Portland, OR, United States; Department of Forensic Medicine, Aarhus University, Aarhus, Denmark.
    Percutaneous injection of autologous, culture-expanded mesenchymal stem cells into carpometacarpal hand joints: a case series with an untreated comparison group2014In: Wiener Medizinische Wochenschrift, ISSN 0043-5341, E-ISSN 1563-258X, Vol. 164, no 5-6, p. 83-87Article in journal (Refereed)
    Abstract [en]

    In the present study, we describe six patients who received autologous mesenchymal stem cell (MSC) therapy for symptomatic carpometacarpal (CMC) joint and hand osteoarthritis (OA). Six patients who received injections of adult autologous culture expanded MSCs in their thumb CMC joints were followed for 1 year posttreatment, and matched with four procedure candidates who remained untreated. We observed positive outcomes in the treatment group for both symptoms and function related to the OA, compared with a reported worsening among the untreated controls. While these results should be interpreted with caution because of the small number of treated subjects and lack of placebo control and randomization, we find sufficient evidence for further investigation of MSC therapy as an alternative to more invasive surgery in patients with OA of the hand. © 2013 Springer-Verlag.

  • 33.
    Clara, Alfsdotter
    et al.
    Bohusläns museum, Department of Archaeology, 451 50, Uddevalla, Sweden.
    Anja, Petaros
    National Board of Forensic Medicine, Division of Forensic Medicine, 587 58, Linköping, Sweden.
    Ankin, Güvencel
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine. National Board of Forensic Medicine, Division of Forensic Medicine, 751 40, Uppsala, Sweden.
    Petra, Molnar
    Swedish Police Authority, Forensic Section Stockholm, 106 75, Stockholm, Sweden.
    Rebecka, Teglind
    Department of Oncology-Pathology, Karolinska Institute, 171 77 Stockholm, Sweden; National Board of Forensic Medicine, Division of Forensic Medicine, 751 40, Stockholm, 171 65, Sweden.
    Kanar, Alkass
    Department of Oncology-Pathology, Karolinska Institute, 171 77 Stockholm, Sweden.
    Development and implementation of forensic anthropology in Swedish forensic practice2022In: Scandinavian Journal of Forensic Science, ISSN 2353-0707, Vol. 28, no Supplement 1, p. 10-19Article in journal (Refereed)
    Abstract [en]

    This paper presents the ongoing development of forensic anthropology in Sweden. We discuss the background of the discipline, its application, as well as its current and potential development in Swedish forensic practice. Collaboration with osteoarchaeologists in skeletal forensic cases has a long tradition in Sweden. Analyses of skeletal remains are performed ad-hoc, in contrast to analyses of fleshed human remains. While several law enforcement employees are educated in forensic anthropology and /or osteoarchaeology , they are not employed in these fields, and regional variations are evident. Internationally, forensic anthropology has become an autonomous forensic discipline over the past decades, requiring skills beyond mere skeletal analysis. To keep on a par with international standards, it may be time to revisit the concept of forensic anthropology in Sweden. Despite the limited presence of supporting organisational structures and systems, forensic anthropological and hard-tissue-reliant physico-chemical analyses have proven valuable in Swedish forensic practice, especially in cases of personal identification, trauma analysis and search efforts. We argue that Sweden could benefit from making qualified forensic anthropology expertise available in all law enforcement regions, starting to implement and promote forensic anthropology in routine forensic casework and formalising the role of forensic anthropology practitioners.

  • 34. 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.

  • 35.
    Connolly-Andersson, Anne-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Ahlm, Kristin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Ahlm, Clas
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Klingström, Jonas
    Puumala virus infections associated with cardiovascular causes of death2013In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 19, no 1, p. 126-128Article in journal (Refereed)
    Abstract [en]

    We studied the causes of death of patients in Sweden with diagnoses of hemorrhagic fever with renal syndrome (HFRS) during 1997–2009. Cardiovascular disorders were a common cause of death during acute-phase HFRS and were the cause of death for >50% of those who died during the first year after HFRS.

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  • 36.
    Crona, Alexander
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Dödförklaring: När anses en försvunnen person vara avliden?2014Student paper other, 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Att förlora en nära anhörig är en tragedi som många varit med om. Att förlora en anhörig utan att kunna veta och utan att kunna få bekräftat att personen är död är dock inte lika vanligt. För de fall det inte går att undersöka kroppen och på så vis bekräfta att en person avlidit används regelverket som finns kring dödförklaring av personer. Det är dessvärre inte alltför ovanligt att personer försvinner utan i snitt är det runt 6000 – 7000 personer som försvinner i Sverige varje år. Av dessa återfinns de allra flesta men cirka 30 stycken av dessa personer försvinner spårlöst utan att hittas igen.[1] Är det så att en person försvinner utan att hittas ska reglerna i lag (2005:130) om dödförklaring användas för att kunna fastställa att en försvunnen person är död. Alla fall av försvinnanden behandlas dock inte likadant av lagstiftningen. Vilket sätt en person försvinner på och från var personen försvinner är sådana omständigheter som får betydelse för hur lång tid det måste passera från försvinnandet tills dess att dödförklaringen kan ske. Har en person försvunnit från hemmet är det inte säker att det finns något som pekar på att personen har avlidit. Är det däremot bekräftat att personen försvunnit från ett fartyg som är långt ute på öppet hav finns det mycket som talar för att personen måste ha avlidit och personen kan då dödförklaras tidigare än om personen försvunnit från sitt hem. Lagstiftaren har medvetet gjort skillnad på olika typer av försvinnanden och det är exempelvis skillnad på om att försvinnande sker när en person befunnit sig ensam på en båt än om personen försvinner under en större olycka. Trots att omständigheterna inte skiljer så mycket åt mellan fallen anser lagstiftaren att en person som försvunnit vid en större olycka ska dödförklaras direkt medan det i andra fallet måste gå minst ett år innan dödförklaring kan ske. Det är av stor vikt att en dödförklaring kan ske snabbt. Det finns känslomässiga, ekonomiska och juridiska skäl för detta.[2] Frågan är då varför lagstiftaren gör skillnad på försvinnanden som sker i ett större sammanhang och försvinnanden som sker i samband med en mindre olycka?

  • 37.
    Davies Forsman, Lina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Öström, Mats
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Svanström, Mikael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Fatal bupivacaine overdose through intrathecally positioned epidural catheter2013In: Scandinavian Journal of Forensic Science, ISSN 1503-9552, Vol. 19, no 1, p. 10-12Article in journal (Refereed)
    Abstract [en]

    We describe a fatality due to an intrathecally positioned epidural catheter and an infusion rate of bupivacaine set 10 times higher than planned. The undetected misplacement, despite safety routines, is discussed along with the toxicological findings and new information on the intrathecal distribution of bupivacaine. From a clinical point of view, the human factor, in combination with an indistinct decimal point on the pump, was considered as the reason for the unfortunate overdose. In continuous epidural infusion of local anesthetics, the importance of guidelines and informed staff in managing complications of epidural lumbar infusion as well as careful monitoring of the vital functions is essential. Guidelines are also vital during the procedure of insertion of epidural catheters. When using combined spinal and epidural anaesthesia, we believe that an epidural catheter should be inserted, and its position tested, prior to spinal anesthesia. The case also illustrates the need of innovative investigation techniques to confirm the suspicion of unusual manifestations of inadvertent drug effects. Segmental analysis, together with analyses in a control case, enabled us to elucidate the high and varying tissue concentrations in the central nervous system.

  • 38. Dobbertin, Konrad M.
    et al.
    Freeman, Michael D.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Lambert, William E.
    Lasarev, Michael R.
    Kohles, Sean S.
    The relationship between vehicle roof crush and head, neck and spine injury in rollover crashes2013In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 58, p. 46-52Article in journal (Refereed)
    Abstract [en]

    Background: It is well established that rollover crashes are associated with a higher risk of serious injury and death than other types of crashes. Some of the most serious injuries that can result from a rollover crash are those to the head, neck and spine. The mechanism of injury to these body parts in a rollover is a matter of dispute in the literature. Some authors have concluded that the magnitude of vehicle roof deformation or vertical roof crush resulting from a rollover crash is not causally associated with head and neck injury severity, while others offer support for a causal association between roof crush and the degree of injury. A better understanding of the cause of serious injuries resulting from rollover crashes is important for improving injury prevention. Methods: This study utilized data from the National Automotive Sampling System - Crashworthiness Data System (NASS-CDS) for the years 1997 through 2007. Both cross-sectional and matched case-control designs along with a new composite injury metric termed the Head, Neck and Spine New Injury Severity Score (HNS-NISS) were used to analyze these data. Results: The cross-sectional analysis demonstrated a 64% (95% CI: 26-114%) increase in the odds of a life-threatening injury as estimated by the HNS-NISS with every 10 cm of increased roof crush. The results of the matched case-control analysis demonstrated a 44% (95% CI: 8-91%) increase in the odds of sustaining any injury to the head, neck or spine with every 10 cm increase in roof crush. Conclusion:These results lend statistical support to a causal association between roof crush and head, neck and spine injury severity. Though they do not constitute definitive proof, they do contradict previously published theories suggesting that roof deformation is unrelated to such injuries. 

  • 39.
    Ekman, Jonn
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Death in Custody in Sweden. Demographics and preventive measures.2015Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 40.
    Ekman, Jonn
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Deaths in custody in Sweden2012In: Scandinavian Journal of Forensic Science, ISSN 1503-9552, Vol. 18, p. 89-90Article in journal (Refereed)
  • 41.
    Elala, Sara
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Kvinnlig könsstympning och manlig "omskärelse": En utredande uppsats om skyddet av människokroppen2011Student paper other, 5 credits / 7,5 HE creditsStudent thesis
    Abstract [sv]

    Nedan vill jag för läsaren berätta om ett tillfälle, som en ung flicka antagligen aldrig glömmer. Hon blev placerad i sin säng, hennes pappa och en annan för henne okänd person hade fattat tag om varsitt ben medan en tredje person skar med ett rakblad i hennes underliv. Flickan var då mellan elva och tolv år gammal och befann sig i sin pappas hemland Somalia. Hon var uppvuxen i Sverige och kände inte till företeelsen med könsstympning. I pappans hemland var hon helt utlämnad, då pappan hade ensam vård om henne.1

    Mellan 100 och 140 miljoner flickor och kvinnor världen över har blivit utsatta för könsstympning. Var och en har en egen berättelse likt eller olikt den ovan. 2 miljoner flickor och kvinnor utsätts årligen för ingreppet och i Sverige finns det 28 000 kvinnor som kommer från länder som har denna tradition som kulturell norm. Av dessa är 5000 flickor under sju år.2 Lag (1982:316) med förbud mot kvinnlig könsstympning (nedan förkortad LFK) medförde att det blev olagligt att utföra kvinnlig könsstympning, vilket gäller oavsett om samtycke föreligger eller inte från flickan eller kvinnans sida.3 Och det gäller oavsett om ingreppet utförs av privatperson eller läkare.4 Genom denna lag har lagstiftaren visat ett tydligt avståndstagande från företeelsen, åtminstone avseende flickor och kvinnor. Men vad har lagstiftaren intagit för ställning gentemot de pojkar som blir utsatta för omskärelse?

    Låt mig berätta ytterligare en berättelse från verkligheten, den här gången om en pojke. Som en av sex pojkar som skulle omskäras väntade han tillsammans med sina föräldrar på sin tur med ett skynke runt kroppen. En pojke i taget blev placerad på rygg med benen vinklade upp och fötterna mot bordsskivan uppe på ett bord. Pappan eller någon annan vuxen höll fast pojkens ben bakifrån, varpå ingreppet utfördes utan smärtlindring. Penisens förhud drogs fram över ollonet och skars av, sen kom smärtan och man satte ett bandage runt pojkens penis.5 I Sverige är omskärelse av pojkar lagligt, om föräldrarna samtycker och det sker inom vissa ramar – såsom inom hälso-och sjukvården eller av någon som genom Socialstyrelsen erhållit ett tillstånd, detta enligt lag (2001:499) om omskärelse av pojkar (nedan förkortad LOP). Är det riktigt att ett ingrepp på den kroppsliga integriteten kan vara laglig eller olaglig endast beroende på vilket kön man tillhör?

  • 42. Elinder, Göran
    et al.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine. The National Board of Forensic Medicine, Sweden.
    Hallberg, Boubou
    Lynøe, Niels
    Sundgren, Pia Maly
    Rosén, Måns
    Engström, Ingemar
    Erlandsson, Björn-Erik
    Traumatic shaking: the role of the triad in medical investigations of suspected traumatic shaking2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, p. 3-23Article, review/survey (Refereed)
    Abstract [en]

    The Swedish Agency for Health Technology Assessment and Assesment of Social Services (SBU) is an independent national authority, tasked by the government with assessing methods used in health, medical and dental services and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects. The language in SBU's reports are adjusted to a wide audience. SBU's Board of Directors has approved the conclusions in this report. The systematic review showed the following graded results:

    • There is limited scientific evidence that the triad (Three components of a whole. The triad associated with SBS usually comprises subdural haematoma, retinal haemorrhages and encephalopathy.) and therefore, its components can be associated with traumatic shaking (low-quality evidence).
    • There is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low-quality evidence).

    Limited scientific evidence (low-quality evidence) represents a combined assessment of studies of high or moderate quality which disclose factors that markedly weaken the evidence. It is important to note that limited scientific evidence for the reliability of a method or an effect does not imply complete lack of scientific support. Insufficient scientific evidence (very low-quality evidence) represents either a lack of studies or situations when available studies are of low quality or show contradictory results. Evaluation of the evidence was not based on formal grading of the evidence according to GRADE but on an evaluation of the total scientific basis.

  • 43.
    Ericsson, Mica
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Läkares sekretess: Mäns våld mot kvinnor i nära relationer2014Student paper other, 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    I detta PM kommer läkares sekretess angående mäns våld mot kvinnor i nära relationer att behandlas. Inledningsvis kommer en kort bakgrund till ämnet ”Mäns våld mot kvinnor i nära relationer” att ges. Sedan kommer en förklaring göras av vad en läkares sekretess generellt innebär, undantagen därifrån och när läkare har rätt att bryta sekretessen. PM:et avslutas med en diskussion och en slutsats där jag kommer se ämnet ur ett kvinnorättsperspektiv, ge en förklaring till vad perspektivet innebär och vad det skulle kunna innebära att använda det valda perspektivet på ämnet i fråga.

     

    Lagrum om sekretess som kommer att behandlas i detta PM gäller alla sjukvårdspersonal men då jag har lagt fokus på läkare som personalgrupp inom sjukvården är det endast läkares sekretess jag kommer att behandla och förklara. Ha i bakhuvudet när du läser vidare att det jag skriver om läkare också kan tillämpas på annan sjukvårdspersonal.

     

  • 44.
    Eriksson, Alice
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Det prediktiva värdet av obduktionsfynd vid misstänkt förgiftning2022Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 45.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Asfyksi - kvaelning2004In: Nordisk Laerebog i Retsmedicin / [ed] Jørgen L. Thomsen, Copenhagen: FADL , 2004, 1, p. 125-144Chapter in book (Other (popular science, discussion, etc.))
  • 46.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Asfyksi - kvaelning2013In: Retsmedicin / [ed] Thomsen JL, FADL's Forlag a/s, 2013, 3, p. 120-135Chapter in book (Refereed)
  • 47.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Asfyksi - kvaelning2008In: Retsmedicin: nordisk laerebog / [ed] Jørgen Lange Thomsen, Köbenhavn: Foreningen af Danske Laegestuderendes Forlag Aktieselskab , 2008, 2, p. 131-147Chapter in book (Other (popular science, discussion, etc.))
  • 48.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Forensic Medicine.
    Asfyxi - kvävning2006In: Rättsmedicin / [ed] Thomsen J, Liber , 2006, p. 121-139Chapter in book (Other academic)
  • 49.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Forensic Medicine.
    Den svenska identifieringsverksamheten - ett exempel från Thailand 20052006In: Rättsmedicin / [ed] Thomsen Jørgen, Liber , 2006, p. 65-67Chapter in book (Other (popular science, discussion, etc.))
  • 50.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Forensic pathology2016In: Forensic epidemiology: principles and practice / [ed] Michael D. Freeman; Maurice P. Zeegers, Academic Press, 2016, p. 151-177Chapter in book (Refereed)
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